Diagnostic Reading #37: Five “Must Read” Articles on HIT & Radiology from the Past Week

Headlines include weight-bearing imaging for knee injuries; and telemedicine saving lives


Articles include: weight-bearing X-rays for knee pain could replace MRI as first choice for 40+ patients with knee pain; machine learning might threaten radiology; Americans use their smart phones to send photos of medical issues; telemedicine saves lives in Syria; and QA databases can benefit radiology departments.

MRIs getting ordered for knee pain when weight-bearing X-rays would do just fine – Health Imaging

Physicians treating possibly osteoarthritic patients 40 and older for knee pain can save these patients time, trouble and quite a lot of money—while sacrificing little to nothing on diagnostic accuracy—by sending them for weight-bearing X-ray exams rather than MRI scans.xrays good for knee diagnosis

Does machine learning threaten radiology’s future?– Radiology Business

Radiology is one of the cornerstones of modern healthcare, but according to a new analysis published by the Journal of the American College of Radiology, machine learning could potentially end the specialty as we know it within the next decade. For example, the machines allow data “to speak for themselves,” which can lead to trends being uncovered that could have gone unnoticed otherwise. Also the pixel-by-pixel focus of machines can pick up key predictors. Computers can also quickly digest complex data sets and while even the most trained radiologists will have cognitive limitations, no such issues exist with machine learning. Continue reading

Research: Impact of Weight-bearing Images in Orthopaedic Imaging

Study favors weight-bearing images for orthopaedic patellofemoral diagnosis and surgery

In clinical orthopedics advanced imaging like computed axial tomography (CT) scanning, has become invaluable to the evaluation and management of patients with musculoskeletal disease. Bone detail is much better visualized with 2D and 3D CT renderings of patients with problems like glenoid fracture, failed shoulder instability surgery, and meniscal root avulsions.

Conventional CT technology requires subject in supine position

High-quality images provide multiplanar 2D and 3D visualization for practitioners who think and work in three dimensions. However, a significant limitation of CT technology has been that it forces image acquisition with the subject in a supine, relaxed position. When imaging an injured knee, for example, the leg is in full extension and the muscles relaxed.

The conventional measures of patellofemoral alignment include the congruence angle, patellar tilt angle, and tibial tubercletrochlear groove offset distance. There are clearly defined limits of normal use for each of these measures, and they are used by surgeons to plan corrective operations on the patellofemoral joint. The degree of knee flexion and activity of the quadriceps are known to influence patellar tracking on the trochlea, but these factors are removed when images are taken with the patient supine.

Some have tried to simulate weight bearing in a CT scanner by custom designing a rig to apply longitudinal  load  through  the  patient  for  imaging  of  the  spine or  lower  extremity. These  methods  are  at worst,  a  poor depiction  of  functional  anatomy;  and  at  best , a cumbersome  and a less-than-accurate simulation of function.

Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo undertake study

Myself and other researchers from the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo are currently performing research on a new  cone  beam CT scanner,  the  CARESTREAM OnSight  3D  Extremity  System,  developed by Carestream Health. The system is designed to offer high-quality, portable,  low-dose  3D  point-of­ care imaging by orthopaedic and sports medicine practices, hospitals, imaging centers, urgent care facilities, and other healthcare providers.

We have been performing institutional IRB-approved clinical trials and basic sciences studies with the prototype model. These studies are being carried out at the Erie County Medical Center, Buffalo’s regional orthopedic tertiary care facility. Based on early data, we are convinced that many imaging studies should be acquired with subjects in positions that represent true human function, such as weight bearing on the lower extremities.

Comparing Carestream OnSight 3D Extremity System to predicate devices

We compared the 2D imaging performance of the CARESTREAM OnSight 3D  Extremity System to the predicate CARESTREAM DRX-1 Detector used with the CARESTREAM DRX-Evolution System. We compared the 3D volumetric imaging performance of the OnSight system to a multiple detector computed  tomography (MDCT) scanner  (“predicate device”). The purpose of the study was to demonstrate equivalent diagnostic  image quality between the investigational and predicate devices, using a Radlex subjective quality rating scale.

The evaluation was performed on equal numbers of knees, ankles, feet, elbows, and hands from 33 cadaveric human specimens and 13 living human subjects. Four independent, board-certified radiologists of varying general reading experience performed evaluations of the images/exams captured using both the investigational and predicate devices.

Results: OnSight 3D Extremity System produced 2D images with equivalent diagnostic image quality to predicate system

In summary, the CBCT system produced 2D images with equivalent diagnostic image quality to the predicate system for a range of exams, and 3D images were rated equal or better when compared to the predicate device for a range of exams on cadaveric specimens and human subjects.

  • More than 80% of all the 2D images were rated diagnostic or exemplary, whereas approximately 98% of all 3D images were rated diagnostic or exemplary.
  • More than 75% of all Radlex rating responses counted for all 2D images were rated equivalent or favored the investigational device.
  • Approximately 85% of the Radlex rating responses counted for the 3D images were rated equivalent or favored the investigational device.

Examples of representative scans are seen below.

2D and 3D orthopaedic renderings generated by the CBCT scanner

Figure 5: 2D and 3D renderings generated by the CBCT scanner

Our conclusion from this study is that for cases of patella instability, it may be desirable to obtain images while the patient is weight bearing on a flexed knee with their quadriceps muscles active. Improvement in objective measures of patella alignment should lead to improved clinical and surgical care of patients with this condition.

New study: comparing measures of ankle stability

A second clinical study is currently under way to take advantage of the unit’s ability to obtain images in weight bearing. The research will compare measures of ankle stability from the investigational weight-bearing cone beam computed tomography scanner to the same measures on gravity stress X-ray in patients who have supination-external rotation ankle fractures.

These and future studies may validate the value of the OnSight 3D Extremity System. Potential benefits include better quality images with a lower radiation dose than conventional computed tomography. The unit is proposed for use in orthopedic offices, but it might have applications to the operating room or at athletic competition sites. The unit is less expensive than a traditional in-hospital or radiology center CT scanner, and can be used with existing electrical systems (220V). Most important however, is the potential to acquire images while bearing weight and in more functionally relevant positions.

Editor’s note: The CARESTREAM OnSight 3D Extremity System received FDA 510(k) clearance in September 2016 and is available for order in the United States.

Dr. John Marzo, UBMD

Dr. John Marzo is a physician with UBMD Orthopaedics & Sports Medicine, Associate Professor of Clinical Orthopaedics, Jacobs School  of  Medicine  and  Biomedical  Sciences,  University at Buffalo and  former  Medical  Director,  Buffalo Bills.

Diagnostic Reading #36: Five “Must Read” Articles on HIT and Radiology from the Past Week

Learn about MRI scans for Zika virus and apps designed by and for radiologists

Articles include: research suggests smartphone use – including apps for radiologists – can lead to better brain function; a new methodology predicts future ER demand; a radiologist developed a smartphone app to help doctors respond to in-flight emergencies; more workloads are headed to the cloud using SaaS technology; and Zika’s rapid spread seen on MRI scans shock cancer researchers.

How Smartphones Can Make Radiologists Even Smarter – Imaging Technology News

Research suggests that smartphone use might warm up the cortex, which leads to better brain function and plasticity. And many smartphone applications have been created specifically for radiologists, including Carestream’s Vue Motion.

Intelligent smart phone

Analytics approach aims to cut overcrowded ERs – Health Data Management

Using data analytics to understand hospital emergency department overcrowding and wait times, two researchers have developed a methodology to predict future ER demand. Hospitals could use the results to reduce wait times for patients by as much as 15 percent, the researchers contend. The methodology uses machine learning technology to assess data on known patterns of ER activity.

Radiologist develops app for helping doctors respond to in-flight emergencies – Radiology Business

A non-profit organization has developed a new smartphone app that helps health professionals deal with in-flight medical emergencies. According to the Chicago Tribune, the app helps doctors treat 23 common emergencies such as chest pain and seizures. The app is available for Apple and Android smartphones and can be used while the phone is in airplane mode. Continue reading

White Paper: Interoperability of Health Information Systems

The challenges and pathways to creating a unified framework for capturing, distributing and accessing clinical information

What is interoperability in healthcare? Interoperability can be described as a well-functioning central nervous system, coordinating the enterprise’s many roles and tasks toward a common end: the well-being of each patient.

illustration depicting connection

But when communications are slow, incomplete, or missing between any two entities — patients and providers, primary-care physicians and specialists, central and remote locations, and so on — the timeliness and quality of patient care can suffer. Many other parts of the total healthcare ecosystem can be affected as well: costs can rise, resources can be allocated inefficiently, and opportunities for constructive collaboration can be lost.

Information generated by different systems, on different networks and for different purposes becomes far more useful when a unified framework is in place for capturing, distributing and using the information. Ideally, with the appropriate security credentials, any individual user or collaborative team should be able to interact with the information they need, in the format they prefer, on their choice of device.

Why is interoperability important to healthcare?

Every stakeholder in the healthcare delivery process stands to benefit from interoperable systems built on interoperability standards that deliver collaborative transparency and efficiency. These stakeholders include patients who want to take more active responsibility for their own health; primary care physicians and specialists who are seeking meaningful collaboration, without information gaps, delays, or redundancies that could compromise quality; and providers in remote and rural areas who need the ability to share clinical images and data with centrally located specialists. Continue reading

Diagnostic Reading #35: Five “Must Read” Articles on HIT and Radiology

Patient portals, teleradiology and healthIT security gaps are in the news

Articles include: use of virtual reality technology to alleviate pain; what patients want in a patient portal; many mobile devices pose security gap; the job outlook for radiologists is bright; and teleradiology is gaining acceptance as demand increases due to better technology and higher ER imaging volumes.

Hospitals Try Giving Patients a Dose of Virtual Reality – Health Data Management

It’s still a new and experimental approach, but proponents of virtual reality say that it can be an effective treatment for everything from intense pain to Alzheimer’s disease to arachnophobia to depression. The idea is that the worst pain can be alleviated by manipulating the way the human mind works: the more you focus on pain, the worse it feels. Swamp the brain with an overload of sensory inputs and a person’s consciousness of pain, anxiety or depression can be reduced. Virtual Healthcare

What keeps patients from adopting patient portals, health IT? – Health Management Technology
Despite the fact that patient portals often receive industry praise, the technology suffers from a number of user frustrations and critiques. Understanding the differences in patient portal interfaces and using pilot groups to determine which seem most navigable might help healthcare organizations avoid patient complaints about portal usability. Continue reading

Guess the X-ray: September’s Image Challenge

Happy September!!

It is the beginning of the month so it’s time for a new “Guess the X-ray Challenge”! We welcome radiologists, technicians, RAs, MDs, PAs – or anyone who thinks they’re up to the challenge – to guess the subject in this X-ray. Please leave your answer in the comment section below or on our Facebook page. The challenge will stop at the end of the month.

Congratulations to those who correctly guessed the August image challenge!  The correct answer was — a wire stripper!

Happy guessing and good luck!

September Image Challenge Image






Sorry… Carestream employees and their agencies are prohibited from answering.

Heathcare IT, Your Cloud has Arrived Courtesy of Intel (and Carestream)

Preparing for the next-generation of medical imaging data and analytics

Today, the cloud is a grownup with a seat at the IT table. The major issues around the cloud (security, access and speed) have been satisfactorily resolved by industries outside of healthcare: technology, software, financial services, Cloud_imageand retail have been using the cloud for years.

Of course, healthcare does have its own unique issues of privacy, security and access that make it slow to adopt any new technology, and the cloud has been no exception. But progress has been made. In a recent annual study of 125 large and small cloud users, for the first time in 2016, security was not the first concern mentioned. Technology has jumped ahead to meet the challenges of healthcare’s journey to value.

The cloud is an essential part of the healthcare industry’s IT structure/restructure to reduce costs, increase clinical collaboration and speed up clinicians’ access to information. As larger study files boost storage requirements, Intel and Carestream have partnered in Intel’s Storage Builder Program. The purpose of the collaboration is to blend Carestream’s expertise in healthcare information systems with Intel’s technological prowess to increase the performance of Carestream’s PACS and RIS systems and to make them more useful to clinicians.  For example, Carestream recently deployed the new Intel® Solid-State Drive (SSD) Data Center (DC) Family for PCle® P3700 featuring Non-Volatile Memory Express™ (NVMe™) and observed a threefold increase in throughput in that portion of the Carestream Vue workflow.

Continue reading

Diagnostic Reading #33: Five “Must Read” Articles on HIT and Radiology

The role of imaging in stress tests and MTBI; and the cost of health IT are in the news

Articles include: zero-gravity treadmills beneficial for stress tests; plans that don’t require pre-authorization for radiology imaging are a worst-case scenario; a type of MRI might be effective in assessing mild traumatic brain injury (MTBI); healthcare IT systems and technology cost physicians anRunning on treadmill average of $32,000 a year; and seniors are not embracing digital technology for healthcare management.

Study uses NASA technology for heart health tests – Health Imaging

A new study could give physicians a better understanding of patients’ cardiac health. To combat the burden that traditional treadmill exercise places on patients, physicians are using zero-gravity treadmills in stress tests. The treadmills can reduce patients’ weight by 25 to 50 percent, making it much more comfortable for them to walk for the amount of time necessary to reach a stress test-level heart rate. Then doctors can use normal imaging techniques to take pictures of the heart and its blood supply to determine the patient’s condition.

How to improve patient care and get paid for it too – Health Imaging

It’s a paradox. Procedures listed by payers as “no pre-authorization required” are among the most commonly denied for payment after they’ve been completed. Part of the problem is the general unwillingness of payers to authorize procedures they’ve listed this way. The radiology stakeholders on the short end of this stick include referring physicians along with patients and radiology services providers.

Imaging Predicts Long-Term Effects in Veterans With Brain Injury – Radiology Today

A type of MRI – diffusion tensor imaging (DTI) – might be able to predict post-deployment outcomes for veterans who sustained mild traumatic brain injury (MTBI) or a concussion during combat, according to a study. Current assessment of MTBI remains challenging due to the difficulties in separating the effects of MTBI from other conditions like post-traumatic stress disorder. DTI uses measurements of water movement in the brain to detect abnormalities, particularly in white matter. Previous studies have linked DTI metrics to neurocognitive function and short-term functional outcomes in groups of patients

Health IT now costs $32,000 per doctor, annually – DotMed Healthcare Business News

A new survey reveals that the move to digitization costs more than $32,000 per doctor per year. Physician-owned multispecialty practices spent more than $32,500 per full-time physician on information technology equipment, staff, maintenance and other related expenses in 2015. That’s a whopping 40 percent bump up for IT costs for doctors since 2009 – the last year before new regulations ushered healthcare into the digital era.

Digital health technology not popular among seniors – Health Data Management

Seniors might be the sickest, most expensive and fastest growing segment of the U.S. healthcare population, but they are not embracing digital technology for healthcare management. A new study of Medicare beneficiaries over age 65 is underway to gather data about how seniors are using digital health.

#HIT #Radres

Diagnostic Reading #32: Five “Must Read” Articles on HIT and Radiology from the Past Week

In the news: medical devices might pose HIT risk; increase in radiology jobs

Articles include: medical devices offer risks for authorized access; ACR projects 16% job growth for radiologists in 2016; Stanford’s radiology department uses patient input to improve processes; FDA issued updated requirements Image of Healthcare Network Access

regarding 510(k) submissions for medical devices and software changes; and RSNA teams with The Sequoia Project to support the electronic exchange of medical images and related diagnostic reports.

Medical devices offer new risks for network access – Health Data Management

Hospitals typically have hundreds of medical devices, which represent an easy gateway for hackers. Newer medical devices might be more robust in the types and amounts of data they collect, and they might connect not only to the core network but also through Wi-Fi networks. A security consulting firm recommends healthcare facilities use “network segmentation,” so that devices are linked to a separate network.

ACR projects 16% job growth for radiologists in 2016 – Auntminnie

The number of new jobs available for radiologists in 2016 will be 16% higher than those available in 2015, according to the fifth annual workforce survey by the Commission on Human Resources at the American College of Radiology (ACR). The study was published online August 3 in the Journal of the American College of Radiology. Continue reading

Columbus Regional Health Gets Creative When 3 RAD Rooms are Eliminated

Reliability, redundancy and mobility help provider keep pace with imaging needs

Many radiology departments are feeling the pressure of “doing more with less”. For Columbus Regional Health in Indiana, the pressure was literal: the medical provider had to eliminate three RAD rooms yet maintain the same Bill-Algee-Columbus-Regional-Healththroughput. The hospital is meeting the challenge by transitioning to DR and adding mobility to the modality mix.

The provider started by converting its CR mobile X-ray equipment to DR with Carestream’s mobile retrofit kit. That retrofit was followed by the purchase of a Carestream mobile DRX-Revolution.

“Mobility is essential to bringing imaging to where we need it,” said Bill Algee, Radiology Manager at Columbus Regional Health. “Our staff drove it around for a little bit and fell in love with the product.”

Next, the hospital outfitted its imaging room in the emergency department with a DRX-Evolution Plus. The product’s high level of reliability is critical to meeting the needs of the busy ED, which was relocated a considerable distance away from the imaging department.

“It absolutely has to be reliable because it’s the only imaging solution in that area of the hospital,” said Algee. “The reliability factor was really important to us.”

Also, the product’s extended tube column and wall stand provide make it flexible enough to meet the varying imaging needs of patients coming in to the ED.

The hospital has an added level of support from Carestream’s DR Detectors. The wireless DR detector can be used with imaging systems throughout the facility.

“Having uniform detectors gives us an added layer of redundancy. If a cassette goes down in emergency, we can replace it with one from diagnostics,” explained Algee. “And the software is always the same no matter what room we go in to. The technologist doesn’t have to take the time to figure out what to do in different rooms.”

The combination of retrofitting existing equipment and purchasing new products helped Columbus Regional Health transition from CR to DR to meet the U.S. Consolidated Appropriations Act at their own pace.

“We kind of took it in baby steps and that worked well for us. Our staff didn’t feel overwhelmed,” said Algee. “Carestream was the right partner to help us through it; they had the right methodology.”

Watch the video interview with Bill Algee to learn more about Columbus Regional Health’s transition to DR. #radiology #AHRA2016

Erica Carnevale


Erica Carnevale is a marketing manager at Carestream Health in the United States and Canada Region.