Training, Technology & Professionalism: Life as an Athletic Trainer in the NFL

Bills logo

The author of this article, Bud Carpenter, was the Head Certified Athletic Trainer of the Buffalo Bills. In June 2016, he was promoted to Director of Athletic Training Operations.

My non-traditional 29-year career journey—including a SUNY education in Elementary Education and History followed by a stint in the U.S. Air Force as a Russian linguist, to time in training and coaching roles in women’s volleyball, NBA basketball and the legendary Boston Bruins hockey team—has in some crazy way prepared me for the job of a lifetime as Head Certified Athletic Trainer for the Buffalo Bills.

We have a small, tightly knit team of top-notch athletic trainers—all of whom are professionally certified as required by the National Football League. Over the years I have had the privilege to train and mentor about 150 assistants, many of whom now have successful careers in physical therapy, training and sports medicine.

Our job is to provide extensive and highly disciplined care to a large group of elite athletes that present a broad spectrum of needs, challenges and injuries. Our work takes place in a high-intensity world where excellent care is paramount—both to ensure the health of our players and to contribute to the success of the team—and where time is accelerated in ways that are unimaginable to many people. Speed is the key in everything we do and the world of the NFL gives us only 60 minutes per game to get it all right.

The range of injuries we see knows no limit: sprains, cuts, contusions, concussions and fractures…just for starters. Technology—especially modern medical imaging systems—is helping us make better and faster decisions in determining whether a player can safely return to the game. And while speed is critically important to us, it never trumps a player’s health.

Like many areas in life, we’ve moved from technologies we all knew and loved (yes, think X-ray film) to advanced digital diagnostic imaging systems that deliver excellent images in seconds that are easy to access and share. Our training staff serves as the triage point for player injuries and this often leads us to capture X-ray images for evaluation by our team physicians to determine how quickly we need to get a player to a hospital, or whether he can return to the game. Imaging technology helps identify a “degree of injury acuteness” that assists us in making treatment decisions quickly, while also setting a course for longer term tracking and treatment.

Because imaging technology is critically important to us, we are working with Carestream to share information on the specifics of injuries when they occur for use in developing new systems. Carestream has been developing a new CBCT (Cone Beam CT) system for capturing weight-bearing images of extremities (legs, feet, arms and hands) that would be very valuable in the field of sports medicine. Having a compact CBCT imaging system that could be located in the stadium or locker room could further enhance our ability in making treatment decisions.

Having highly trained medical professionals on site with immediate access to the best available technology allows us to provide the best possible medical coverage for our players.  The combination of physicians, athletic trainers and technology is certainly the right formula to treat and safely return our athletes to the playing field.  Facilitating the safe return to play following a serious injury always give athletic trainers a great sense of pride and we are grateful to all who help us achieve that goal.

Carestream OnSight 3D Extremity System received FDA 510(k) clearance in September 2016.

Carpenter_BudBud Carpenter was the Head Certified Athletic Trainer of the Buffalo Bills when he authored this blog. In June 2016, he was promoted to Director of Athletic Training Operations, and Shone Gipson was promoted to Head Athletic Trainer.



Gwinnett Medical Center & the DRX-Revolution

Gwinnett Medical Center in Georgia shoots over 100 portable X-rays each day. With this volume, they not only needed one reliable mobile X-ray system, but multiple. Since the installation of the DRX-Revolutions in their facilities, the results have been positive.

Karen Kubik, Imaging Director at Gwinnett Medical Center shares their story.

Improving Image Access and Transfer with Online Applications

The efficiency and effectiveness of viewing and sharing diagnostic images are vital when you handle the imaging process for 24,000 exams on annual basis, with 18,000 of those also including reporting.

Our facility, Cobalt Health, has had the hardware and software in place to properly handle the massive volume of images we collect throughout a given year, but new needs have arrived where what we had was no longer enough. These needs stemmed from two major issues:

  1. Referrers may not have had access to our PACS: This resulted in a staggered, inefficient process in providing them with access to needed images and reports.
  2. Images were transferred via CD/DVD: This resulted in issues related to information governance (privacy), losing image quality in transfer to CD/DVD, and high costs related to purchasing CDs, postage, etc.
Vue Motion

Cobalt Health received positive feedback from referrers who used Vue Motion to access medical images.

We solved both of these issues through the implementation of Vue Motion and MyVue. With the Vue Motion image viewer, we needed to address the issue of providing referrers with easy and access to images and exam results. The solution needed to be intuitive to view images from anywhere, at any time. We targeted MSKCAT (MusculoSKeletal Clinical Assessment and Treatment) referrers and received feedback that the image viewer was easy to use, provided access to previous imaging exams and reports, was easy to navigate, and was seen as a clear preference over using CDs.

With MyVue, the patient portal, we saw a positive result from patients who used it. From the 31 patients who responded back to us about its use, 85% said that the portal worked well. The use of the portal was able to streamline the image access and sharing processes, and thanks to its security, provided a vast improvement in information governance.

By providing this type of ubiquitous image access via web browsers—be it on desktop PCs, or on mobile devices such as an iPad—we were able to remove our worries about referrers not being able to see the images, while the patient access eliminated the need to use CD or DVDs.

What are your thoughts on improving image access and transfer capabilities? Have you been moving toward online/mobile applications instead of hard copy or CD/DVD? If so, what success and issues have you experienced?


Peter Sharpe, CEO, Cobalt HealthRoisin Dobbin-Stacey, Cobalt HealthPeter Sharpe (left) is the CEO of Cobalt Health, and Roisin Dobbin-Stacey (right) is the PET/CT operation manager and PACS manager at Cobalt Health. Together, they presented on their use of Vue Motion and MyVue at UKRC 2014.


Implementing Effective Ways to Reduce and Track Radiation Dose for X-ray Exams

DRX-Revolution Mobile X-ray Unit

El Camino uses two DRX-Revolutions as part of its conversion to DR technology.

El Camino Hospital has made dramatic decreases in patient dose in recent years. We use Bayer Radimetrics dose management software to track dose for all CT exams and we are now starting to collect dose for our room and portable X-ray exams and for fluoroscopy and interventional radiography procedures. We are especially proud of our accomplishments in the area of portable imaging, where we have made a significant reduction in dose.

We have lowered dose by replacing CR with DR technology—and by implementing software that enhances visualization and reduces the need for repeat exams.

We installed three new wireless DR portable systems that are used for imaging of critical care patients in our neonatal ICU, ER and OR as well as bedside exams for our main Mountain View campus. We have two Carestream DRX-Revolution portables and have retrofitted two existing mobile imaging systems with DR detectors to perform ER, OR and bedside exams at our Los Gatos campus.

Since critical care patients require more images than other patients, they benefit most from dose reduction as well as the enhanced image quality we are now able to provide to our physicians. We use grids for 90 percent of adult exams and our new imaging software lines up the grid with the tube head. This makes it much easier for technologists to achieve an excellent quality image and reduces the need for repeat exams. The grid improves details in the chest and abdomen as well as thicker body parts and provides better diagnostic data for physicians.

We now use a cesium iodide DR detector that fits into the incubator tray to image fragile neonatal ICU patients. This enables us to produce excellent quality images at a very low dose. Our imaging software includes pediatric settings that help technologists use the correct technique for each patient.

Both adult and pediatric critical care patients benefit from imaging software that helps enhance visualization of pneumothorax as well as tubes and lines by producing an image that is optimized to display the chest and tubes/lines from the original image. This also eliminates repeat exams and reduces dose.

Patient care is also improved by the higher power generators offered by modern portable X-ray systems. These generators enable us to image heavy or obese patients at a lower dose and provide better quality images at a lower dose for all our patients.

Have you converted all your X-ray imaging systems from CR to DR? As part of this transition, are you retrofitting existing systems, purchasing new DR systems or both?

Howard Sanford, El Camino Hospital


Howard Sanford, R (MR), is the imaging operations manager at El Camino Hospital.

The Future of Mobile Technology in Healthcare

Andy Lim,HCIS Business Manager ASEAN, Carestream Health Singapore

Andy Lim, HCIS Business Manager ASEAN,
Carestream Health Singapore

Technology is constantly evolving. It seems like every day there is a better, smaller device that replaces the new one you bought yesterday and still don’t know how to use yet. In the past (present for some hospitals), image sharing was done solely via film distribution and multiple copies needed to be printed for multiple physicians to view the study.

As technology advances, hospitals begin looking to store their digital images in a centralized archive for distribution within and outside the hospital. This enhances the workflow of the hospital and brings clinical benefits not only to radiologists and clinicians, but also to patients.

While different technology may support certain mobile devices, your archive is the source where data is fed to your device. Your archive is also the foundation of data sharing.

Having a Vendor Neutral Archive (VNA) in place today ensures all clinical data belonging to the patient is securely stored and ready to be connected to a validated mobile technology/device. The other advantage of VNA is that data is stored in a non-proprietary format with the ability to ingest and store DICOM and NON-DICOM files so it gives the clinical users a complete patient portfolio, hence enhancing better patient care.

This mobile technology is extremely beneficial to three key groups of mobile users in the radiology space:

  1. Radiologists want access to view emergency cases and provide preliminary reports without traveling back to the hospital when they’re on call.
  2. Clinicians want access to images and reports in the clinic without complex installation or the need for a high end workstation.
  3. Patients want access to images and medical reports without the need to carry film or DVDs, and to be able to share their studies with other doctors for second opinions.

At Carestream, we’ve come a long way in the design of our software for use with mobile technologies and platforms to ensure they evolve in accordance with the needs of our customers and are easily integrated with the wide array of healthcare technologies. We realize that nothing lasts forever but rather than just accepting the fact, we responded by creating affordable solutions for our customers to stay one step ahead of technology.

Health IT Timeline

We recognize that not every IT solution can provide enterprise distribution – and yet that is what you need. For this reason we developed Vue Motion, a lightweight, vendor neutral viewer that can enables radiologists and clinicians to access patient data regardless of whether it is embedded in an EMR or it is serving as a standalone imaging viewer.  It has an intuitive interface, so it requires no dedicated resources or training. Yet it can handle virtually any task from calling up basic patient information to accessing full studies, as well as distributing reports and images.

Patients are becoming more involved than ever in their healthcare. As image distribution in radiology evolves, hospitals are constantly looking at innovative and cost effective methods to distribute images and results to the patient. Spire Healthcare, the UK’s second largest provider of private healthcare, has implemented Carestream’s Vue Motion zero-footprint viewer to enable its clinicians to view patient images on Apple, Android and other validated devices.

As this independent viewer is PACS-agnostic, clinicians across Spire can securely view PACS images from all of Spire’s 37 locations, where 27 sites have CARESTREAM Vue RIS/PACS and 10 sites use other systems. This ability to access images across multiple platforms is bringing increased flexibility to Spire consultants and timely results to patients.

“Vue Motion has made a vast difference to my image reporting,” said Dr Qaiser Malik, Consultant Radiologist at Spire Healthcare. “I no longer have to physically go to the hospital to log in at one of the workstations to view images and previous reports. I can log in at weekends wherever I am which is of great advantage. It is an absolutely fabulous tool and advances patient care by providing clinicians with timely reports and a head-start on treatment options.”

Read the full case study on Spire Healthcare and see what more Vue Motion provided the facility with here:


What is the biggest obstacle for your facility to overcome when trying to keep up with the variety of healthcare technologies?

Not a Typical Day at the Office: Application Engineers Taking Steps to Improve Customer Experience

Laurie Cesar, Application Engineer, DMS, Carestream Health

Laurie Cesar, Application Engineer, DMS, Carestream Health

Jenn Thwaits, Application Engineer, DMS, Carestream Health

Jenn Thwaits, Application Engineer, DMS, Carestream Health

Customers have never had more access to information than they do today. Everything they need is at their fingertips- product reviews, testimonials, competitor information. It’s a key factor driving companies to deliver stronger incentives to their customers because if they can’t provide them with what they want, someone else can and will.

Staying at the forefront of technology in this day and age is almost impossible as it seems to change daily, but keeping your customers happy is a lot simpler. How? By just listening to them. Communication barriers no longer exist between consumers and big companies making it easier than ever to connect with each other.

As application engineers, we’re involved in the design and implementation of products, training, troubleshooting, and product enhancement. Much of our product enhancements come straight from our customers. We gather their feedback and information about their needs and work with our team to develop and enhance our products with our customers in mind.

It’s not every day that we get to be on the sidelines at an NFL game or X-ray an African Guinea Pig, but we’ve had some pretty interesting days outside of our four walls and it was all to better our customers experience with our products. Here are some of our most memorable moments:

*JT (Jenn Thwaits) & LC (Laurie Cesar)

  • (JT & LC) Buffalo Bills: We announced our partnership with the Bills back in August 2013 and installed the DRX-Ascend System and DIRECTVIEW CR System at Ralph Wilson Stadium. They’re not using our equipment every day like facilities are; they’re using them every Sunday. We were present on the sidelines for the first three games of the season to ensure their radiologist tech, Gary Celotto, knew how to work the equipment in order to properly treat a player because if someone gets injured, Celottoneeds to get to them so that the trainers can immediately assess their injuries. During the pre-season game against the Lions, We ended up X-raying about five players (ribs, knees, feet, etc…) but luckily none were seriously injured.
  • (JT & LC) Spurwink Farms We partnered with Idexx to develop image processing for veterinary DR (digital radiography). We worked on equine image processing at Spurwink Farms in Maine and were able to acquire all imaging needed by X-raying three horses. When you get image data off a CR/DR plate there are so many shades of grey that the human eye cannot distinguish the details in an image. Image processing enhances the darkness, contrast, sharpness and noise to optimize the image so that the eye can differentiate the bone structure and soft tissue, etc. Image processing is an intense task that requires lots of images to do well, which is why it took us multiple horses in order to get the correct images for our software.
  • (LC) Animal Kingdom: While I was working in the field as an Applications Consultant I had the opportunity to go behind the scenes at Disney’s Animal Kingdom. We were developing an early version of our vet product. I was tasked to optimize the existing human image processing that was in the current product to make it work for animals – large, small & exotic animals. The novelty of being in an unusual environment made the trip very interesting. It also provided an opportunity to see how medical care is provided in an environment different than the one I’d worked in for all those years.
  • (JT & LC) URMC MorgueIn order to receive FDA clearance for a new product you must demonstrate substantial equivalence to a legally marketed product to ensure it’s as safe and effective (or more so) as one that is already in clinical use. This is often established by taking images acquired from both the previous and new product. Since it’s not a good idea for people to have two x-rays when one is sufficient for their diagnosis, cadavers [those who agreed to donate their bodies to science] are often used. When the 2530C detector first came out, we wanted to ensure both specifications were met. We contacted one of our research partners access their morgue where we were able to acquire pairs of anatomical images using two receptor types. Once we confirmed the intended improvements of the new detector we were able to file the appropriate paperwork with the FDA and received clearance for the detector.

Upgrading Your Portable X-ray Fleet?

Juanita Reader, RT(R), Manager of Diagnostic Radiology In-Patient and Informatics, OSF Saint Francis Medical Center

Juanita Reader, RT(R), Manager of Diagnostic Radiology In-Patient and Informatics,
OSF Saint Francis Medical Center

The radiology department of our 616-bed hospital conducts 125,000 imaging procedures a year. We have an extensive investment in portable and room-based imaging systems—so finding an affordable way to upgrade to DR was a challenge. We are still in the process of conversion, but we have found that combining new portable systems with retrofitted portable units has enabled us to deliver higher image quality and faster image access while lowering dose.

Initially we were skeptical: Would the image quality of the retrofitted units be acceptable? To find out, we conducted a week of on-site patient imaging with the DRX-Revolution Mobile X-ray System and an existing mobile imaging system updated with a CARESTREAM DRX-Mobile Retrofit Kit that includes wireless communication capabilities and a high-resolution detector. When our radiologists reviewed images from both trials, they reported excellent image quality and consistency across both types of systems.

We purchased one DRX-Revolution for general use in the ED and bedside portable exams throughout the hospital and two retrofit kits – one is dedicated to the OR which has 22 suites and the other retrofitted system performs bedside exams. Use of the Carestream DRX-1C detectors on all three systems has reduced patient dose by 20-30 percent for many exams, and up to 50 percent for some exams.

Our OR surgeons are extremely pleased with the performance of their retrofitted portable system. It not only delivers access to high-quality images immediately, but it also offers advanced features offered by Carestream’s specialized imaging software – including enhanced visualization of tube and line placements. The high-resolution images produced by these systems are also important for hardware placements and deliver the detailed imaging required during orthopaedic and spinal surgeries.

Another important feature is that DRX detectors can be moved from one imaging system to another. So if one of our portable systems goes down, we can move the detector to another unit and continue imaging patients.

If your radiology department is evaluating upgrading its portable systems, combining new wireless DR portables with wireless DR retrofits for existing systems is an excellent solution that helps enhance patient care while meeting budget requirements.

Studies Have Proved the Benefits of Digital Breast Tomosynthesis: Now How Do We Change Referral Habits?

Dr. Harmindar Gill, Medical Director, Premier Women’s Radiology (Bonita Springs, Fla.)

Dr. Harmindar Gill, Medical Director, Premier Women’s Radiology (Bonita Springs, Fla.)

As a female radiologist, I have created a practice dedicated to women’s imaging that includes digital breast tomosynthesis (DBT), breast and body ultrasound, whole body bone density screening and other services. I also read breast MR images that are captured at another facility.

According to the American Cancer Society, 1 in 8 women will develop breast cancer during her lifetime—just over a decade ago the rate was 1 in 11 women. Genetics cannot account for this increase since 85 percent of breast cancer victims have no family history of the disease. There are a variety of factors that may be contributing to increased risk, including estrogen in our foods, post-menopausal hormone therapy and childbearing later in life. The good news is that the ACS reports death rates from breast cancer in the U.S. have dropped 34% since 1990.

I am an avid proponent of DBT because I believe it can assist in the effort to further reduce deaths from breast cancer. In my personal experience, I have found small lesions that I did not detect on other breast imaging exams and it also decreased the need to recall patients for additional testing. The ability for DBT to increase cancer detection rates and decrease recall rates has now been well documented through studies conducted across the country. In 2013 breast tomosynthesis captured attention and acceptance throughout the radiology community, as illustrated by the dozens of scientific presentations and poster sessions focused on DBT at RSNA 2013.

One RSNA 2013 presentation reported results from a study in which every patient since October 2011 was screened for breast cancer using DBT at Hospital of the University of Pennsylvania (HUP) in Philadelphia. The study’s lead author was Emily F. Conant, M.D., chief of breast imaging at HUP. Dr. Conant and five colleagues compared imaging results from 15,633 women who underwent DBT at HUP beginning in 2011 to those of 10,753 patients imaged with digital mammography the prior year. Six radiologists trained in DBT interpretation reviewed the images. The researchers found that compared to digital mammography:

  • Average recall rate using DBT decreased from 10.40 percent to 8.78 percent
  • Overall cancer detection rate increased from 3.51 to 5.25 (per 1,000 patients)
  • Overall positive predictive value for the group—the proportion of positive screening mammograms from which cancer was diagnosed—increased from 4.1 percent to 6.0 percent with DBT.

A prominent earlier study published in the June 2013 issue of the American Journal of Roentgenology documented the benefits of DBT by Dr. Stephen L. Rose and his colleagues at TOPS Comprehensive Breast Center of Houston, Texas. This study compared recall rates, biopsy rates, and cancer detection rates for six radiologists who interpreted 13,856 screening mammography studies without tomosynthesis and 9,499 studies with tomosynthesis.

For the group as a whole, the use of tomosynthesis resulted in:

  • Increase in invasive cancer detection rate from 2.8 to 4.3 per 1,000 screening examinations
  • Increased cancer detection rates from 4.0 to 5.4 per 1,000 screenings
  • A reduction in recall rates from 8.7% to 5.5%
  • Reduction in biopsy rates from 15.2 to 13.5 per 1,000 screenings.

As a result of my personal experience and the scientific studies now available, I advocate use of DBT for all screening mammograms—especially for patients with dense breasts, patients with BRCA gene mutation and those who have been previously diagnosed with breast cancer—because its three-dimensional imaging offers significantly enhanced visualization of breast tissue.

Now that we recognize the advantages offered by DBT, the challenge is to make tomosynthesis a mainstream screening protocol. It’s not enough for radiologists to recognize the value of tomosynthesis—physicians and gynecologists need to be educated about the benefits of this technology since these doctors account for a majority of the referrals for annual screenings and follow up exams.

Hear more about Dr. Gill’s practice and the importance of DBT below from RSNA 2013.

Wireless DR Rooms: Careful Evaluation Will Allow Your Facility to Maximize Productivity and Flexibility

By Fred Hastings, R.T., C.R.A., Director of Operations, Harbin Clinic

Our company is a large multi-specialty physician clinic with 23 separate locations in Northwest Georgia. We recently decided to install fully automated wireless DR rooms at our two busiest locations for routine radiology procedures—our orthopaedic clinic and our main clinic. Even though we had DR systems in these facilities, we chose to upgrade because the latest generation of wireless DR technology offered substantial gains in both image quality and productivity. Automated hardware features and advanced software functionality were also important benefits.

Achieving a streamlined process is extremely important because the orthopaedic site requires that patients first meet with their physician, have an imaging study if needed, and then go back for a consultation. At the main clinic, patients may be imaged and sent on their way or the patient may be required to return to the referring office with the results DRX-Evolutionof their exam. Rapid delivery of high-quality imaging studies is essential to keeping physicians on schedule and reducing patient wait times. A smooth workflow greatly impacts both physician and patient satisfaction.

After conducting an evaluation of several wireless DR systems, Harbin clinic managers and technologists unanimously selected a new DR room that is configured with a motorized overhead tube, motorized wall stand and an automated table for convenient, efficient patient positioning. The system’s software can automatically capture and stitch long-length images in the upright and supine position—which is a key benefit for orthopaedic studies.

For healthcare providers who are evaluating new DR rooms, I would make several suggestions based on our experience:

  • Wireless DR technology should offer both wireless transmission and removable detectors. Some DR systems we initially considered used a wireless network but the detector was wired into the wall Bucky. We wanted the flexibility of using the same detector for wall stand, Bucky and tabletop exams.
  • A detector that can move between multiple DR systems further boosts productivity and helps lower costs, while also offering redundancy.
  • An easy-to-use operator interface can maximize productivity. As technologists rotate between different sites, having the same type of DR equipment with a highly intuitive interface at all sites significantly enhances technologist efficiency.

Digital radiography has been around awhile, but the newest generation of wireless DR systems delivers significant advantages that make it worth evaluating for a variety of imaging environments.

Patient Portals Enable Immediate, Secure Access to Medical Images

Cobalt Imaging Center is a medical charity that provides state of the art imaging for a large population in Southwest England. The facility recently adopted Carestream’s MyVue patient portal to enable patients’ immediate, secure access to their medical images via the web. Peter Sharp and Roisin Dobbins-Stacey of Cobalt Imaging spoke with us at RSNA and emphasized the need for a patient portal over CDs–their current means of sharing patient images—which are costly and timely.

Patients want access to their images now and a patient portal allows them instant access at their fingertips to share with whoever they want whether it’s the referring physician, or friends and family. The facility will slowly roll out MyVue and get patients adapted to a timely, functional, and secure way of sharing medical images.

Hear more about the benefits a patient portal brings to patients and imaging facilities in the video below.