X-rays and Mom — Case Study into the State of Imaging Technology

Reposted from Imaging Technology News (ITN) with permission.

Dave Fornell, ITN

While I write a lot about medical imaging technology and how new technology can and should work, it is not often that I get to experience how things actually work in the real world. This past Thanksgiving I received a call from a paramedic explaining that my mom had fractured her leg and I should stop working on the turkey and fixings and rush to the emergency department (ED) at Edward Hospital in Naperville, Ill. She had been walking her dog on wet grass and leaves in a park when her dog took off after another dog and pulled her down. She was whipped around and the change in weight caused her to dislocate her ankle (the bottom of her shoe was facing her when she looked at her feet) and caused a spiral fracture to her fibula.

ImagingTechnologyNews December-2015 X-ray_Fractured_fibula_with_permission_of_patient_MF

A bedside screen shot of a Carestream DRX mobile X-ray in the ED of the fractured fibula.

When I got there my mom was already heavily sedated due to the pain and because the ED staff had already put her ankle back in place. The ED doctor ordered a digital radiograph (DR) of her leg to see the extent of damage. They wheeled in a new Carestream DRX mobile X-ray system and I had a live demonstration of how fast these types of systems can snap the pictures. It called up the images immediately on the machine’s screen. The image of the Pott’s fracture with fragments was really interesting as someone who covers radiology, but I also realized from a non-clinical standpoint she was really messed up and in pain. Additionally, she would need reconstructive surgery to put her Humpty Dumpty leg back together again. She was way up the creek without a paddle with it being Thanksgiving and there were no orthopedic surgeons in staff due to the holiday. The day after Thanksgiving was not much better, as we found, since most physicians were out through the following Monday. So the ER splinted the leg, wrapped it in ace bandages and sent her home with heavy pain killers.

Compounding her mobility issues was the fact that she has bilateral knee replacements. Due to the trauma, broken bone and knowing she had these implants that further limited her ability to move around, she was prescribed a prophylactic anticoagulant.

Knowing we would need the images for a surgeon to review, I had the ED burn a CD. However, I was happy to find

ITN NEWS Orthopedic_Surgery_repair_of_Broken_fibula_with_permission_of_patient_MF_0

The post-surgical X-ray showing the bone repair, which was accessed and copied by the patient using a patient portal.

Edward is among the growing number of hospitals to grant patients access to their health records via a DR Systems Internet image/results distribution system. This technology pulls images and reports from the hospitals’ Epic EMR (electronic medical record) system and makes them available for remote viewing by clinicians outside of the hospital’s picture archiving and communication system (PACS). She also was given login instructions at discharge for a patient portal so she could access her records and images herself on a home computer or smartphone.

We managed to find one orthopedic surgeon in their office on the Friday after Thanksgiving. They thought it was great that we had a CD, but before attempting to open it, they asked which hospital she had been at. Edward was already in a health information exchange, so outlying offices such as this one from a different medical group could access her records remotely in less than a minute. They were able to call up her images and see what meds she was prescribed, which made the office visit go much faster.

She had surgery on Dec. 1, the Tuesday of RSNA 2015. The orthopedic surgeon practiced at Elmhurst Hospital in Elmhurst, Ill., across the county from Naperville. But, thanks to the remote image viewing system, they could get the ED images for reference and planning. The surgeon’s post-surgery DR image showing the reconstruction of the fibula also was available via my mom’s patient portal.

She did what most patients today do with this type of access and posted her X-rays on Facebook. Leveraging the Facebook form of patient engagement, the result was lots of sympathy, flowers and friends volunteering to help her with things around the house and groceries since she cannot walk or drive for at least two months.

While an unfortunate incident and a horrible thing to have happen to my mom, from a professional standpoint, I was happy to see the technology I cover working in the real world as it was intended. The speed in workflow efficiency, speed and ease of access to her imaging at the point of care and remotely, and access to a patient portal are all examples of how the healthcare system should work. In this case, the technology and imaging integration was flawless.

David_FDave Fornell, ITN Editor

Dave Fornell is the editor of Diagnostic & Interventional Cardiology magazine and assistant editor for Imaging Technology News magazine.

 


Imaging Case Study: Carestream Mobile DRX-Revolution

 

To learn more about the CARESTREAM DRX-Revolution, click here.

A Medical Imaging Revolution at Okinawa Churaumi Aquarium

By Tomoki Oka, Manager, X-ray Systems Business, Japan, Carestream

日本語版はここで読むことができます。

The DRX-Revolution has been visiting and capturing images of some new patients in Japan at Ocean Expo Park, Okinawa Churaumi Aquarium.

Ocean Expo Park houses the aquarium and is a national government park located on the site of the Okinawa International  Ocean Exposition held in 1975. The aquarium, located within the park, is one of the most popular tourist spots in Okinawa. It is home to approximately 740 different species and 21,000 marine life that inhabit the sea around Okinawa.

Animal Management Team Sub-Leader Keiichi Ueda, is one of two veterinarians at the aquarium, and is responsible for the health and physical status of the animals. In an interview,  Vet Ueda explains the differences of human care in a hospital versus animal care in the aquarium—particularly that they have to take the animals out of the water for an extended period of time, and in the case of x-rays, the exposure dose is different and time must also be considered.

With some animals being quite large, the facility required x-ray equipment that would be able to capture high-quality images of the animals, capture multiple images without using different cassettes, and also provide enough radiation dose so image quality would not be compromised.

In the interview, Fish Team Chief Technician Makio Yanagisawa, says, “Because the Revolution can be used to expose continuous radiographic images of dolphins without having to place and change the cassettes under them each time, it is much easier to use when compared with the previous types of analog film that had to be developed after each exposure.”

Additionally, their work environment is much different than that of a hospital. There are no hallways, several small hills, and rougher terrain that can make pushing and pulling equipment more difficult.  Vet Yanagisawa found the ease of use with the DRX-Revolution to be valuable in helping to move and maneuver around the facility.

The video below shows the DRX-Revolution in action at Okinawa Churaumi Aquarium, and includes in-depth interviews with the aquarium’s medical staff.

沖縄美ら海水族館にてRevolution稼働開始

大場拓也/岡知樹

An English version of this post can be read here.

DRX-Revolutionが海洋博公園沖縄美ら海水族館に導入され、イルカなど海洋動物たちの撮影に貢献しています。

ここ海洋博公園は1975年に開催された沖縄国際海洋博覧会跡地に設置された国営公園で、沖縄の観光スポットのひとつとして人気のある沖縄美ら海水族館もこの公園の中にあります。約740種21000点ほどの沖縄近海に生息する生物を飼育しています。

動物管理チームサブリーダーの植田啓一氏は常駐する医師の一人で、動物の健康管理・体調管理を担当しています。インタビューで植田氏は、特に動物を水から出して固定及び拘束時間を考慮しなければならない点や種別に応じて撮影線量を変えなければならない点など、人と動物の撮影方法の違いを述べています。

動物の種別によっては非常に大型になるので、高線量で高画質な画像が確実に取得できること、カセッテを都度交換することなく何枚も撮影できることなどが求められます。

魚類チーム 主任技師の柳澤牧央氏は「Revolutionは、イルカの下に入れたカセッテを一回づつ入れ替えずにそのまま撮り続けることができるのが、今まで現像しないといけなかったものに比べると利点だと思います。」と述べています。

水族館は病院と違って廊下が整備されていなかったり、本体を押したり引いたりすることが困難な場合が多いのですが、DRX-Revolutionは軽い力で簡単に動かすことができ小回りが利くので非常に便利であると述べています。

インタビュービデオではDRX-Revolutionでの撮影の様子やスタッフのインタビュー内容をご覧いただけます。

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.

[Video] Replacing Analog to Allow for DRX-1 Detector Sharing

Karen Swanson, R.T. (R) (M), Director of Medical Imaging, at Platte Valley Medical Center in Brighton, CO, shares her feedback about wireless detector sharing at her facility and the CARESTREAM DRX-Revolution.

The medical center replaced three analog portables with two DRX-Revolution Mobile X-Ray Systems. They share the DRX-1 detector between the portables and the RF room – making the best use of the most expensive piece of the system at peak times.

Dream Job: Applications Engineer, Digital Medical Solutions

Marty Pesce, Applications Engineer, CarestreamAfter receiving his X-ray certification, Marty Pesce worked in a hospital for 10+ years as a chief technologist and was cross-trained in different modalities. He became an applications consultant in 2000 and transitioned to Carestream in 2007. When an opportunity arose to be an applications engineer, Marty moved his office base from Philadelphia to Rochester, NY, and shifted his focus from U.S. to Worldwide Operations.

Q: What made you decide to become a Radiologic Technologist?

To answer with a short response: my mom. When I was in college, I changed my major a lot. I went from art, to art history and then to physics and was still unsure about my decision. One summer I was home from college and my mom, an ER nurse at the local hospital, got me a job doing CAT scans. My hometown was in rural Pennsylvania so at that time the CAT scan would come in on a truck to the hospital. Pennsylvania was one of five states that had no requirements for licensure. I did this job for 6 months until the law changed which required technologists working for a private company to be registered, though technologists in the hospital still did not need to be.  So, I went to get my X-ray Certification at Bradford Hospital School of Radiologic Technology. I had to go to school to keep my job rather than go to school to get a job.   After my first year, I also worked a Baylor position as a technologist on the weekends at another hospital so I worked 16 hours a day, 7 days a week.

Q: What is your favorite part about your job?

A: Getting to travel all over the world to work with customers. I have been to 17 countries across Europe, Asia, and Central America. I haven’t gotten to see South America or Africa yet. My favorite trip has to be to Salt Lake City, Utah for the 2002 Winter Olympic Games. I arrived two weeks before the games to train the staff in the Olympic Village and had the opportunity to see the opening ceremonies, and different events.  As a former college athlete, it was a thrill to be so close to the games, the participants, and dignitaries that came through the facility.  It was a once in a lifetime experience.

Applications Engineer Marty Pesce using the Carestream DRX-Evolution.

Applications Engineer Marty Pesce using the Carestream DRX-Evolution.

Q: Outside of work, how have you been involved in the profession?

A: I’ve been involved in State & National X-ray societies. I served two terms on the Board of Directors for the Pennsylvania Society of Radiologic Technologists (PSRT). I recently attended the American Society of Radiologic Technologists (ASRT) House of Delegates meeting in Florida as the PA Delegate. On behalf of the ASRT, I lobbied for the CARE (Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy) Bill which sought to protect patients by way of better education. In April I did a presentation to the Pennsylvania State Society about the history of radiology and how the things we did 100 years ago still influence what we do today. I dedicated the presentation to John (“Jack”) Cullinan.  Jack was a former PSRT president, an author, and my predecessor.  He was known as “Mr. X-ray” and made a big impact on the field of radiology as well as me personally. Jack passed away about a year and a half ago but his book still remains on my desk and I refer to it often.

Q: Tell us some stories relating to the history of X-ray imaging

A: When X-ray technology was new, people feared that X-rays could see through their clothing. As a result, there were companies that manufactured and sold lead lined underwear. An Assemblyman in New Jersey went so far as to enter legislation to make X-ray opera glasses illegal. The funny thing is that concerns over privacy haven’t changed. Just last year the TSA pulled out backscatter scanners from airports because they were too intrusive.

Another story, that pre-dates X-ray regulation, is a documented case about a man from Rochester, NY, that made his own X-ray machine.  His wife was experiencing hip problems so he wrote to a prominent doctor in NYC. After 10 hours of trying to take a good X-ray image, he finally got one and sent that image to the doctor along with an inquiry on how to treat his wife’s burns.

Q: What last question…I heard that you like to dance?

A: Well, only when I am demoing products. One year at RSNA, before I did a product demo with our portable X-ray unit, our CEO said, “Marty, make this thing dance!” It took off from there and I made a full routine!

Uncompromised Quality: Bone Suppression and Chest X-Ray Images

No one would claim that any part of a radiologist’s job is easy, but there are some aspects of their work that pose greater challenges than others. The interpretation of chest X-rays, the most common way to screen and diagnose lung diseases, is one of those tasks that can often frustrate a radiologist.

The average radiologist has probably viewed thousands of chest X-rays over the course of a career, and is well acquainted with the challenges they pose.  A traditional 2-D image of the chest will include all of the different bones surrounding the patient’s chest cavity, often obscuring the lungs. There are ways to see around the bones, but these systems often require the use of large imagining equipment that make it difficult to get an image of an immobile patient.

Carestream Bone Suppression Software

The bone suppression software can potentially improve the detection of both lung nodules and pneumothorax.

The recent FDA-approved Carestream Bone Suppression Software, now gives radiologists a better solution for chest X-rays—a clear image of the lungs without the expense of difficulties of a full 3-D image. Employing machine learning and pattern recognition technologies, the software accurately detects a patient’s ribs and clavicle structure and suppress these structures on the X-ray image, giving the radiologist an unobstructed view of the lung tissue. By focusing on the ribs and clavicle—the two most distracting bone structures—the software provides a high-quality, clear image that stays as close as possible to the quality of the original image. Five board certified radiologists put the bone suppression software to the test.  They were asked to interpret a series of chest x-rays with and without the bone suppression software, and to rate any change they may have noticed. In studies measuring both lung nodule detection and pneumothorax detection the radiologists recorded a statistically significant increase in detection sensitivity, with no significant increase in false positives when using Carestream’s bone suppression software.

On average, the radiologists who participated in the study reported being 58% more confident in their ability to accurately diagnose patients when presented with the images generated by Carestream’s software.

In addition to the advantages of image interpretation, the bone suppression software works in tandem with traditional 2-D x-rays.  Therefore, there is no need to subject a patient to any additional radiation.   Further, thanks to the portability of 2-D x-ray systems, such as Carestream’s DRX-Revolution, ICU patients no longer need to be physically brought to imaging equipment in order to get a reliable chest x-ray; a reliable chest x-ray can be taken right in the patient’s room.  Radiologists should not be forced to compromise between image quality and practicality when it comes to the health of their patients. Applications such as the bone suppression software are designed to help alleviate the need for compromise by providing a high-quality, low-dose image in a manner that is efficient and practical for both radiologists and patients.

Additional details about Carestream’s bone suppression software can also be found in the white paper, Bone Suppression for Chest Radiographic Images.

Zhimin Huo, Carestream

Zhimin Huo, Ph.D., is a lead scientist at Carestream. She participated in and co-authored the study, Bone Suppression Technique for Chest RadiographsShe also presented a paper at RSNA on this topic, as well as the paper, Computer-Aided Detection of Malpositioned Endotracheal Tubes in Portable Chest Radiographs for ICU Patients.

Seven Reasons Why the DRX-Revolution is a Rad Tech’s Dream Machine

Don Thompson, Digital Capture Solutions, Marketing Manager, Carestream U.S. & Canada

Don Thompson, Digital Capture Solutions, Marketing Manager, Carestream U.S. & Canada

The social media phenomenon of sharing motivational quotes has infiltrated our professional lives. Yesterday on LinkedIn a connection posted an image with this statement:

“The most dangerous phrase in the language is

‘We’ve always done it this way.'”

— Grace Hopper, American computer scientist and United States Navy rear admiral.

A simple and poignant point about challenging yourself and your organization to break from tradition and create better ways to work.

One aspect of a radiology department that, until recently, suffered from stagnation was portable imaging. People did things in mobile imaging for so long that they believed there was no other way to do it.

When we developed the CARESTREAM DRX-Revolution we wanted to do something that had never been done before. We really wanted to design the DRX-Revolution from the ground up to be a digital portable x-ray system that was more efficient for radiologic technologists.

To do this we not only went to more than 50 healthcare sites, but we also observed rad techs conducting exams. We even returned to the sites to show them design sketches and get their input.

With the DRX-Revolution portable rounds are now different. Finally technologists have an easy mobile DR system that was designed for the way they want to work, not the way they’ve always done things.

So in the spirit of motivational quote sharing, here are seven reasons – told in quotes from DRX-Revolution users – why a portable imaging system that challenged norms is now most likely to be the machine in a rad tech’s dreams:

  1. “Technologists stand in line waiting for the DRX-Revolution to come back from a portable because they want to use the Revolution. The collapsible column allows the technologist to see over the portable machine so we are certainly able to see anyone coming down the hallway.” – Mike Foley, Director of Radiology, Physical & Occupational Therapy, Tufts Medical Center

    The moveable, collapseable column is one of the many benefits rad techs love about the DRX-Revolution.

    The moveable, collapseable column is one of the many benefits rad techs love about the DRX-Revolution.

  2. “An image recall feature allows technologists to pull up the last three exams for each patient and copy the techniques that were used to help ensure consistency.       Two technologists conduct 20-25 inpatient exams each morning in just 45 minutes. It used to take four technologists 1.5 hours with CR-based portable systems.” – Chief Technologist Chris Vineyard, University Health System, San Antonio
  3. “With wireless technology, they no longer have to watch out for the various cords that once tethered detectors to the X-ray machine. Wireless, digital X-ray technology makes our jobs a lot more efficient and a lot easier. There’s less running between patients rooms, and if we get a bad image, we can retake it immediately.” – Susan Moody, Radiologic Technologist and Clinical Manager of Portable and OR imaging, University of Rochester Medical Center
  4. “Thanks to its powerful 32kW generator and DRX detector, we have lowered exposures—and the tube and grid alignment system simultaneously enhances image quality by facilitating grid use.” – Chris Schneider, Director of Radiology Imaging Services, Brookhaven Memorial Hospital
  5. “DRX-Revolution systems contain an automatic radio frequency identification (RFID) reader that signs in technologists using RFID chips in their badges. This automatic process ensures that we have an accurate record of which technologist is using the machine for each exam. It’s also much more convenient for the techs. By the time they touch the machine, they are already logged in for use.” – Todd Stanley, Administrative Director of Radiology, IU Health Methodist Hospital
  6. “DR technology made it easier to keep the images attached to the correct patient, even when they came into the hospital without identification. While everyone was double-checking patient IDs on exam orders, the portable digital systems also allowed the techs to edit the exam information, if it needed to be corrected, before sending the images to radiologists. There wasn’t a lot of handoff of paperwork and handoff of cassettes. Because it was digital, it really cut down on errors.” – Elisabeth Grady, General Diagnostic Manager of the Radiology Department, Beth Israel Deaconess Medical Center
  7. “Having two review screens comes in handy when the technologists are working by themselves. If they are on the far side they can select what they need to right on the tubehead without leaving the patient’s bedside.” – Kathy Morreale, Charge Technologist, Hamilton General Hospital

Are you ready to get the DRX-Revolution out of your dreams and into your department? Learn more and contact us.

Four Radiology Department Improvements Unlocked by the DRX-Revolution

Don Thompson, Digital Capture Solutions, Marketing Manager, Carestream U.S. & Canada

Don Thompson, Marketing Manager, Carestream U.S. & Canada

Patient experience. Cost containment. Clinical Quality. Physician alignment.

A recent Advisory Board blog post about the CXO perspective of imaging success reported that the C-Suite places more importance on these factors than volume growth.

It’s no surprise that provider priorities are changing. In response to this change imaging leaders are seizing the opportunity to adopt the broader system’s objectives and success measures.

This service line realignment becomes even more important during purchasing decisions. Radiology administrators must be able to demonstrate the impact of a new technology
investment on the right institutional objective.

Consider how the CARESTREAM DRX-Revolution helped these four DRX_Revolution_Image_09_Upright_Column
radiology departments:

  1. Clinical quality – “The DRX-Revolution helps our neonatologists improve care by delivering exceptional image quality and has also helped enable our staff to reduce dose by more than half. The ability to lower dose is especially important for pediatric patients due to the harmful effects of radiation on children and also because these very ill babies often require frequent X-ray exams. The DRX-Revolution automatically displays the previous technique so that we can ensure imaging consistency, which is especially important to help physicians detect changes in these very small patients. Physicians also report that being able to view images at the tubehead when they are inserting PICC lines and other devices is especially helpful because they no longer have to leave the bedside to verify correct placement. This speeds the process and reduces discomfort for these very fragile patients.” – Brad Hellwig, Director of Radiology, and Beth Wilson, Manager of Radiology, Crouse Hospital
  2. Cost containment – “We have reduced our fleet of portable imaging systems by one-third. Carestream’s DRX detectors can also be moved to another mobile imaging system. So if one of our existing portable systems goes down, we can move the detector to another unit,– Juanita Reader, RT(R), Manager of Diagnostic Radiology In-Patient and Informatics, OSF Saint Francis Medical Center
  3. Patient experience – “With the DRX detector, images are available over a wireless network in about five seconds, which can expedite diagnosis and treatment. This also eliminates the time-consuming process of transporting cassettes to a CR system for processing. The detector is light and it’s much easier for technologists to position correctly because the detector offers a full field of view. Detectors that are larger than the size of the image they capture are more difficult to work with.”  –  Tina Harvey, RT (R), Radiology Manager, Baylor University Medical Center
  4. Physician Alignment – “The DRX-Revolution also delivers process improvements for everyone involved in the imaging workflow—from technologists to physicians, radiologists and specialists. Since images from the portable systems are available in about five seconds, physicians can make rapid decisions that can improve patient care. The hospital’s technologists worked with radiologists to create new techniques for portable exams that lowered the dose while optimizing image quality. When Carestream’s consultant came to the site for training, she displayed four views of the same exposure so radiologists could select their preferred display preference. We didn’t even know it was possible to do this but it made our radiologists extremely happy.” – Chief Technologist Chris Vineyard, University Health System, San Antonio

Have you explored how a change in portable imaging strategy could contribute to your organizational goals?

Learn how one of American’s top hospitals – Indiana University Methodist Hospital –  converted from portable CR systems to DRX technology to improve physician satisfaction and boost staff morale here.

Why DR is Important for Facilities in India

The benefits of DR have been discussed at great length, but there are regions around the world that have not been able to implement the technology as fast as others.

Dr. Anirudh Kohli, Head of Radiology, Breach Candy Hospital, Mumbai says that the turn-around time and ergonomics of using DR have resulted in several benefits including better care and a better patient experience. He mentions that a medical imaging process that used to take 10-15 minutes now takes under 3-4 minutes thanks to DR.

In the video below, Dr. Kohli explains this and more about Breach Candy Hospital’s uses of DR, as well as why more facilities in India should be using DR technologies.