How Can You Measure Innovation in Diagnostic Imaging?

Patents and industry recognition are two ways to quantify it

Innovation in diagnostic imaging and healthIT is continually evolving, improving their potential to help provide better patient care and at less cost.

But how can you measure innovation? Patents and industry recognition are two ways. Please indulge us while we share some of our accomplishments from 2016. And if you’d like a preview of our plans to advance imaging capture this year, read the recent blog by our president of Digital Medical Solutions, Jianqing Bennett.

Let’s start with patents. In 2016, we were awarded 43 new patents from the U.S. Patent and Trademark Office for innovation in radiographycone beam CT imaginghealthcare IT, and other areas. We also received 52 additional patents in European and Asian countries.

The patents earned by Carestream’s smart scientists and engineers include:

  • New medical image capture technologies related to the development of cone beam computed tomography (CT) systems designed for orthopaedic extremity imaging
  • Enhancements to our portfolio of healthcare IT systems that manage, store, and share patient data and medical imaging exams
  • Continued technology advances in our growing portfolio of radiology systems that can enhance diagnostic image quality for a wide range of healthcare providers
  • Continued advancements in laser imagers that provide affordable output of digital X-ray exams onto medical film and paper Continue reading

Guess the X-ray: December’s Image Challenge

Can you guess the image in the X-ray?

Happy December! It is time to put your thinking caps on for December’s “Guess the X-ray” Image Challenge! No one correctly guessed the November image: it was … Batman! More specifically, a Batman action figure with flexed elbow!

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. We’ll share the answer at the end of the month.

December Image Challenge

Have fun and happy guessing!

How the Affordable Care Act Affects Diagnostic Medical Sonographers

Six years yield five significant changes in the field of sonography

Over the last six years, healthcare in the U.S. has undergone a rapid series of changes and reforms. From the way Americans pay for care to how care is provided, the post Affordable Care ActIllustration of Affordable Care Act era of healthcare is unlike anything we have ever experienced. Diagnostic medical sonographers, also known as ultrasound technologists or ultrasound technicians, have begun to feel the effects of the Affordable Care Act on almost every aspect of their daily job duties.

More healthcare consumers

More Americans are consuming healthcare services than ever before. It is estimated that more than 20 million previously uninsured Americans gained access to health insurance through the Affordable Care Act from federal and state exchange programs, employer mandates, and/ or Medicaid expansion. Hospital and healthcare facilities are seeing more patients than ever before, which means more diagnostic tests, like ultrasounds, are being ordered. However, this sharp increase in healthcare consumption was not matched with an equal increase in human or capital healthcare resources.

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. He is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends.

Diagnostic Reading #27: Five “Must Read” Articles on HealthIT and Radiology from the Past Week

Top news includes clinical decision making, EHRs and personalized recommendations in healthcare

 

This week’s articles include: radiologists playing a more active role in clinical decision making; use of EHR and CPOE systems create added clerical work for doctors; new systems can deliver a doctor’s personalized recommendations to patients to enhance compliance; a color-coded, user-friendly dashboard that tracks ER exams allows medical staff to better monitor patients; and companies are experimenting with ways to reach lower-income patients through apps, text messaging and video conferencing.

Radiologists Take On Bigger Role in Diagnosis – Wall Street Journal

At one of the top radiology departments in the country radiologists are now playing an active role in helping clinicians make medical decisions for their patients. Radiologists at NYU Langone Medical Center provide their analysis of imaging studies (via computer screen) as medical staff make their rounds in pediatrApplications in healthcare photoic intensive care units, where frail patients are imaged daily to monitor their progress. The initiative to involve radiologists in making treatment decisions is led by Michael Recht, chairman of the radiology department, who oversees more than 200 physicians
and researchers.

EHRs are making things harder for physicians – DotMed Healthcare Business News

Physicians who used an EHR and CPOE were 30 percent less likely to be satisfied with clerical burden, according to a Mayo Clinic physician who was the lead author of a study. Doctors spend hours placing orders for patient procedures such as imaging exams and lab tests and are also spending more than 10 hours a week using the EHR on nights and weekends, according to the study. Continue reading

Radiology Insights #55: Five Must-Read Articles From the Past Week

This week’s articles focus on the move to personalized medicine, increased imaging use in the ED, an IDC reportCarestream, Radiology that predicts increased cyberattacks on patients’ healthcare data, the value of data stored in RIS and PACS systems for effective decision support, and a study that compared radiology findings with diagnoses provided by other clinical data sources.

Top 5 trends from RSNA 2015 in Chicago – AuntMinnie

This year, RSNA cast its gaze forward, looking at the trends that will shape medical imaging in the years to come. The move toward personalized medicine and data analytics will enable radiologists to find circumstances where imaging can be used most efficiently and economically. There is no doubt that the future of healthcare will be technology-driven, and it’s hard to find a medical specialty more grounded in technology than radiology.

Overall imaging use has slowed — but ED rates still high – AuntMinnie

Despite an overall slowdown in the rate of noninvasive diagnostic imaging in other settings, imaging use rates have continued to increase in the emergency department (ED), according to a study presented at the RSNA 2015 meeting by researchers from Thomas Jefferson University in Philadelphia. Why do imaging use rates in the ED keep climbing? It could be because emergency departments are a significant source of medical care in the U.S. In fact, nationwide ED visits increased from 95 million per year in 1997 to nearly 140 million in recent years, which translates into higher imaging use rates, Patel said. Other factors include defensive medicine, dependence on technology, and the difficulty of evaluating complex patients under tight time constraints, she said.

Cyberattacks will compromise 1-in-3 healthcare records next year – ComputerWorld

Consumers will see an increase in successful cyberattacks against their online health records next year. A new report from IDC’s Health Insights group claims that because of a legacy of lackluster electronic security in healthcare and an increase in the amount of online patient data, one in three consumers will have their healthcare records compromised by cyberattacks in 2016. “Frankly, healthcare data is really valuable from a cyber criminal standpoint. It could be 5, 10 or even 50 times more valuable than other forms of data,” said Lynne Dunbrack, research vice president for IDC’s Health Insights.

Too much Big Data may not be enough – Health Management Technology

The quest to mine and analyze meaningful, reliable, and useful data from the burgeoning plethora of electronic and online sources, healthcare organizations can allow the big picture to overshadow many underlying and valuable components contributing to patient care improvement. The clinical data and diagnostic images in radiology information systems (RIS) and picture archiving and communication systems (PACS) remain two examples. For clinical imaging and radiology executives, these visual clues and cues are necessary for effective, efficient decision support. Certainly a growing number of manufacturers and information technology companies recognize this. As a result, they’re offering providers a light at the end of the tunnel.

System compares radiology results with downstream clinical information – Health Imaging

A system comparing radiology findings with diagnoses provided by other clinical data sources was recently put to the test in a study published online in the Journal of the American Medical Informatics Association.  Early indications are that it passed. Lead researcher William Hsu, PhD, of Medical Imaging Informatics Group in Los Angeles, and colleagues evaluated their system, which pulls data from electronic health records and examines clinical reports for imaging studies relevant to the diagnosis. They said the goal of their system was “to establish a method for measuring the accuracy of a health system at multiple levels of granularity, from individual radiologists to subspecialty sections, modalities, and entire departments.”

RSNA 2015: Important Presentations and Studies from Day 2

RSNA 2015One of the best parts of RSNA is that there are so many sessions and posters that cover topics vital to the advancement of medical imaging. One of the worst parts of RSNA is that there are so many sessions and posters that cover topics vital to the advancement of medical imaging to the point that it is impossible to learn about them all.

Each morning on this blog, we will share what we see as some of the most important presentations and studies being talked about at the annual meeting.

Digital Breast Tomosynthesis May Improve Detection, Outcomes – RSNA Daily Bulletin

According to a study presented by researchers from the University of Pennsylvania, digital breast tomosynthesis (DBT) used with digital mammography may over time detect more cancers, and more clinically significant cancers, than digital mammography (DM) alone, the current standard of care. The study built on previous studies showing that DBT/DM screening leads to decreased recalls and increased cancer detection. The study found that DBT screening resulted in increased cancer detection and positive predictive value over time. It also showed a decrease in interval cancer rate within one year of screening, suggesting that DBT detects more clinically significant cancers earlier.

Radiology Workload Outpacing Reimbursement, Study Shows – RSNA Daily Bulletin

Manisha Patel, M.D., of Thomas Jefferson University in Pennsylvania, presented on how radiologists can implement strategies. such as advocacy and adding value, to combat a reimbursement imbalance. The presentation discussed how while radiologists’ workloads increased by 43 percent between 2001-2013, their Medicare reimbursements have only increased by 24 percent.

Future of Imaging Interoperability Key to Improved Patient Care – RSNA Daily Bulletin

David Mendelson, M.D., representative of the RSNA Integrating the Healthcare Enterprise (IHE) Board and member of the IHE USA Board, addressing attendees during the program “IHE Clinical Solutions for Interoperability: Imaging and Beyond, IHE or HIE, Does the Order Matter?” According to Dr. Mendelson, image sharing is essential to give physicians the benefit of historical exams, counteract the growing cost of healthcare, reduce radiation exposure, and expedite clinical care.

Concussion Effects Vary Among Former Football Players – AuntMinnie

According to a comparison of diffusion-tensor MR images (DTI-MRI) presented, repetitive hits to the head and a history of concussions can affect different areas of the brain in former collegiate and professional football players, based on the player’s position. Researchers found lower fractional anisotropy values — an indication of abnormal movement of water molecules in brain tissue — in frontal white-matter tracts of nonspeed players, such as offensive and defensive linemen, compared with speed positions, such as quarterbacks, running backs, wide receivers, linebackers, and defensive backs.

MRI Confirms, Weight Loss Good for Knees – Diagnostic Imaging

Researchers from the University of California in San Francisco investigated the association of weight loss and the progression of knee cartilage degeneration in patients who are overweight or obese. The results demonstrated that overall cartilage Whole-Organ Magnetic Resonance Imaging Score (WORMS) showed significantly less progression in both weight loss groups compared to the stable weight group over the 48 months. The researchers plan to perform an eight-year follow-up to assess the effects weight gain may have on the knee joint.

Imaging Portals Drive Patient Engagement and Satisfaction

A survey of 1,000 U.S.-based patients revealed that 83% believed that there is value in being able to access their medical images via a secure portal.

This may not come as a huge surprise as patient portal adoption continues to grow in the U.S. and throughout the world, but medical images are often left out of the portal mix. The benefits to providing this access to patients are numerous, with the most obvious being that patients are rightfully provided with the ability to engage with their healthcare providers, effectively empowering them with control over their own care.

In the white paper embedded below that was originally hosted on Healthcare IT News, the study referenced above is explained in further detail. In addition to the 83% of patients who said they would use a patient portal to access images, 76.5% said they would recommend such a portal to their family and friends, and 79.3% said said that they would return for future imaging exams to facilities that offered such a portal.

These types of findings not only give providers an idea of how their patients want information delivered to them, but also gives an idea of how bringing medical images into the patient portal mix can provide value to the overall business with a high number of returning patients, as well as recommending such facilities that provide this offering.

To learn more about the study, you can read the embedded version below, or download Imaging Portals: Driving Patient Engagement, Improving Patient Experience and Satisfaction via the link.

University College Hospital & Diagnostic Imaging Needs of Nigeria

We spoke with Dr. Biodun Adeyinka, consultant radiologist at University College Hospital in Ibadan, Nigeria at RSNA 2014 about what brought him and his colleagues to the meeting. He explained that while Nigeria is a wealthy country, he and his colleagues need to make a strong case for purchasing equipment. They came to RSNA to learn about the latest and greatest pieces of equipment and plan to bring this information back home to help with purchasing decisions.

DI Europe Asks Carestream, “Why Ultrasound? Why Now?”

Alan Barclay, Ph.D., editor, Diagnostic Imaging (DI) Europe, interviews Carestream’s Helen Titus, about the launch of the CARESTREAM Touch Ultrasound System. The interview looks at the $6 billion ultrasound market, why Carestream made the decision to enter the market, and what sets the Touch system apart from other technologies in the space.