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.

Five Ideas the Medical Imaging World Will Be Implementing in 2014

Carestream CMO

Norman Yung, Chief Marketing Officer, Carestream

A new year means it is time to turn a new leaf. However, in the medical imaging world, this leaf may not be as new as we think. In 2013, many trends, topics, and ideas became part of the industry’s vernacular: multidisciplinary teams, big data, tomosynthesis, etc. While these trends gained traction through highly publicized research, 2014 will be the year of implementation.

Last year marked the time when certain trends were shown to have benefits, and this year will be the time when these ideas are put into practice among a larger portion of the industry. The following five trends are what we expect to see implemented widely throughout 2014, and we will be looking forward to measured results, analyses, successes throughout the year and into 2015.

Multidisciplinary Teams: This has proven to be a major benefit for healthcare organizations across the world, and a necessity for those working in radiology who want to emerge from the darkness. In a post from 2013, Dr. Marc Zins, Department of Radiology, Hôpital Saint-Joseph, explained the numerous benefits his multidisciplinary team provided: The quality of the communication throughout the department improved immensely, the department became better organized and have implemented new processes and protocols that have improved efficiency, it has become easier to sustain quality time, and better communicate metrics to members across the team. If radiologists want a more prominent role within their organizations, then forming and joining multidisciplinary teams is a must.

Tomosynthesis: This was a popular topic at RSNA 2013. There was a great deal of research presented that demonstrated the benefits of tomosynthesis and how it can improve diagnoses. We conducted a study in collaboration with the University of North Carolina School of Medicine that showed the feasibility of a stationary chest tomosynthesis system, and how it had the ability to improve image quality and enhance detection of small lung nodules and other chest pathology. Additional research presented at RSNA 2013 showed that the degree of visibility vastly improved using tomosythnesis, a higher percentage of the cancers were more definitively characterized as masses compared to asymmetries when using tomosynthesis for diagnosis, and when compared to conventional radiology, tomosynthesis allowed for increased cancer detectability upon screening. This was because of its improved visibility and the precise morphology of cancers allow for a better lesion diagnostics in initial imaging. It’s being proven over and over how beneficial 3D imaging can be, and look for more healthcare facilities to put this technology in place in 2014.

Reporting/Data: The idea about providing better reporting and data collection for radiologists is that it leads to better decision making and improves the patient’s understanding of their images. The implementation of better reporting tools would influence much of the decision making being done by radiology departments today. Data is becoming more and more valuable, and when it is brought into the decision-making process, it results in clearer, more appropriate actions being made that benefit the patient, department, and healthcare organization as a whole. Reporting software has the ability to reduce errors, improve productivity with automatic inclusion of data from modalities, embed clinically rich insight such as key images and multi-media content, quantitative analysis, or lesion management graphs into the final report. With these capabilities, the radiologist has access to a wealth of vital information that can be used for improved diagnoses.

Article courtesy of The Wall Street Journal: http://on.wsj.com/1gAT5oy

Article courtesy of The Wall Street Journal: http://on.wsj.com/1gAT5oy

Image Storage & Access: According to Frost & Sullivan, the amount of storage volume needed to house medical images has more than tripled since 2005, and it is projected to double in the next five years. A statistic like this is quite daunting. Data is everywhere. It is being created and consumed at exponential rates, and it is the job of healthcare facilities to properly store the images, and simultaneously ensure that they are accessible for the appropriate people. Security of these images is a necessity because of HIPPA regulations.  The ease of access is becoming even more of a necessity as not only medical professionals need these images and data, but more often patients are demanding access to their images too.

Patient Engagement: This topic has been a hot item for the past couple of years due to the prominence of EHRs, but now radiology is becoming invested in this arena. Medical images are becoming a more important component of the EHR, and the portals are serving as the access point for patients to view and share these images. In a study we conducted with IDR Medical in 2013,we found that 79% of patients would be more likely to return to a facility that offers online image portal and 76% indicated they would recommend the facility to others. In the end, 83% of those surveyed said that they would use a patient portal to access and share their medical images—a sign that this is a need that healthcare organizations should be providing.

These are not the only trends that will be popular in 2014, but are certainly among the most prominent. This year is going to be a year of action. We have passed the testing phase and now must move into implementation if the benefits of newer technologies are to be realized. It is going to be another exciting year for healthcare and medical imaging.

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.

Vue PACS Enables Image Sharing Among 11 UK Trusts

The Cheshire and Merseyside NHS Consortium covers 11 trusts in the UK and chose Carestream to be their new PACS supplier after their existing contracts for PACS and RIS systems, delivered through the National Program for Information Technology (NPfIT), expired. When selecting a new provider, the consortium was aiming to get the most cost effective and feature-rich system to meet their needs. One feature that came equipped with their chosen system was the advanced features of CT reconstruction. Taking steps to be cost effective has allowed Cheshire and Merseyside to pay 40 percent less than their previous national contract.

Cheshire and Merseyside is unusual in that there are multiple trusts in a small geographic area with a number of specialist hospitals. Royal Liverpool University Hospital is one hospital in the trust and for them it has been a challenge between patients moving around to hospitals and keeping images with the patient. The PACS system makes it easy for images to be acquired at one site and reported at another, a high priority for the trusts. When reporting, radiologists have access to previous studies where they can report right then and there, which is a big advantage. Roughly 1.5 to 2 million exams are conducted each year across the consortium and the more studies that are done, the faster the amount of data being transferred increases. Royal Liverpool has greatly decreased their amount of data transfers from about 250 studies per week to around 180 and is looking forward to that number dropping even further than 100 studies per week. This provides lead image transfer teams with more resources to do other things instead of importing such a large amount of studies.

Digital Breast Tomosynthesis Brings Benefits to Patient Exams

Digital Breast Tomosynthesis (DBT) provides higher quality mammography images and is becoming more vital to breast exams. At RSNA we spoke with Dr. Harmindar Gill, Medical Director of Premiere Women’s Radiology in Bonita Springs, Florida, about the benefits of DBT and what patients get out of having it as part of their exam. Being the first office in Southwest Florida to offer DBT as part of breast exams, Dr. Gill noticed a decrease in patients’ recall rates and found that it’s easier to spot small lesions that go unnoticed by traditional mammography exams.  The video below provides more insight on Dr. Gill’s practice and DBT discussion at RSNA.

What does the Power of Partnership really mean?

The theme of RSNA 2013 was “The Power of Partnership,” and it didn’t take long to discover that theme throughout the halls among vendors, and in the educational sessions. Greg Freiherr of Imaging Technology News took some time to speak with us at RSNA and provided some insight on what partnership means in the medical imaging space, and the trends he saw at RSNA, as well as what he expects to see heading into 2014. Cultural development in the healthcare environment and the mission to bring the radiologist further into the medical process is what Freiherr saw as being the ultimate goal behind the theme. The video below provides the complete interview that expands on the RSNA theme, and how it was put on display and practiced throughout the week.

[youtube=http://www.youtube.com/watch?v=92iAV_xg2vU&w=560&h=315]

RSNA 2013: Preparing for the Annual Feast

Cheryl Proval, Vice President, Publishing, imagingBiz, and Editor of Radiology Business Journal.

Cheryl Proval, Vice President, Publishing, imagingBiz, and Editor of Radiology Business Journal.

When viewed over time, the themes that have marked the annual meeting of the Radiological Society of North America might be seen as signposts indicating the way forward for radiology. From Personalized Medicine in 2010, to Celebrate the Image in 2011, and Patients First in 2012, we can witness radiology moving from an internal focus to a more outward-facing stance.  In 2013, the RSNA signals an even greater transition ahead with its Power of Partnership theme.

Expect the theme to recur throughout the meeting, with several keynotes exploring the potential of clinical partnerships both within and outside the specialty, to improve, optimize, and perhaps even revolutionize patient care.

As medicine grapples with the transition to new payment models on the business side, I see partnership (and its corollary, collaboration) as one of the most potentially transformative concepts working in medicine today.

The trend is evident in the consolidation occurring across the health-care landscape, as former rivals become partners in community health. Not all of these partnerships involve the integration of assets; some simply entail shared mission and IT resources, proving that there are multiple ways to partner.  How well diverse organizations work togethRSNA2013_RGB_Logo_Dateser to deliver health care more effectively and efficiently has great bearing on the future viability of our hospitals.

The same principles likely are at work in the vendor community, which is subject to many of the same forces that are reshaping health care providers: regulatory change, diminishing reimbursement, the need for economies of scale and better access to capital, and the emergence of new, disruptive business models.

Aside from the above pressures, radiology practices are experiencing the additional threat of commoditization.  Everyone who works in radiology understands that there is tremendous variation and complexity involved in the practice of radiology, hardly a ripe environment for commoditization—one would think. Nonetheless, the perception is real, and there are limited clinical quality metrics to counter that belief.

How practices employ the “power of partnership” to combat this perception and to weave themselves into the fabric of care at every level will determine whether the specialty continues to prosper. I see inspirational examples of radiology practices working with other specialties to develop clinical care pathways and standardize imaging protocols. I hear encouraging stories about how practices are working in partnership to develop external as well as internal peer evaluation and other methods of cross-practice quality collaboration. I think that radiology has a great deal to offer its partners in care.

While I often sit on the sidelines and make observations on subjects that others must grapple with, the issue of partnership is one that I will actively live and explore in 2014. The company I work for, imagingBiz, publisher of Radiology Business Journal and a portfolio of digital journals, has merged with TriMed Media, publisher of Health Imaging, and other publications. I have a head start, as I have grown to respect my new partners over the years: We have worked together beneath one banner in the past and competed for business under separate banners more recently.

If radiology does not exactly resemble the Peaceable Kingdom, that is nonetheless a lovely image to take into the Thanksgiving holiday and on to Chicago, as we all investigate partnership and collaboration as a means to succeed, prosper, and meet health care’s new challenges in the year, and years, ahead.

RSNA 2013: Understanding the Importance of Dose Evaluation and Reporting

Sam Richard, PhD, Senior Research Scientist, Carestream

Sam Richard, PhD, Senior Research Scientist, Carestream

Radiologists wish to keep the amount of radiation during a medical imaging exam “As Low As Reasonably Achievable” – known as the ALARA principle – but just how much radiation are we receiving? First we need to be able to quantify it. Radiation dose is measured in units of Gray (Gy) which is proportional to the amount of absorbed energy per unit mass. In turn, the absorbed energy is proportional to the physical damage on the cell’s chemical bonds- such as DNA double strand breaks. Radiologists determine how changes in techniques impact radiation dose and image quality, which helps your physician determine whether the benefits from the diagnostic information outweigh the exposure risks of the exam. It should be noted that in most exams the benefits far outweigh any measurable risks. Reporting and monitoring of dose also enables hospitals to track dose and ensure that patients are receiving acceptable levels of radiation based on established guidelines.

Effective dose is an another measure of dose which quantifies the risk associated with an exposure and is reported in Sieverts (Sv). The Sievert allows comparison of the risk estimates associated with partial or whole-body radiation exposures. This quantity first requires the measurement of organ dose (in Grays) and incorporates the different radiation sensitivities of the various organs in the body. This evaluation tool is useful for comparing exposure levels across different x-ray imaging system and from different sources – man made or natural. The chart below compares imaging procedures with natural background radiation, that is, how long it would take to receive the same amount of radiation (effective dose) from the natural background in a normal environment.

CSH_Comparison_Chart

Source: www.radiologyinfo.org

For further information on Dose Evaluation and Reporting, please refer to the presentation below:

A Systematic Approach to Pediatric Low Dose

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

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

For years radiology has worked on this problem—how to minimize X-Ray dose for children, who are vulnerable not only because of their sensitivity but because of the cumulative effect of radiation that stays with the patients their entire lives.

Carestream supports the “Image Gently” campaign of the Alliance for Radiation Safety in Pediatric Imaging at www.pedrad.org. The remainder of the post outlines guidelines that we and the alliance believe are important.

One size does not fit all…image gently

There’s no question:  X-rays are important tools in pediatric care.  But when we image, radiation matters.  Children are more sensitive to radiation.  What we do now lasts their lifetimes.  So, when we image, let’s image gently.

More is often not better–when X-ray is the right thing to do:

  • Measure patient thickness for “child-size” technique
  • Avoid using grids for body parts less than 10–12 cm thick
  • X-ray only the indicated area with proper collimation and shielding
  • Check exposure indicators and image quality

We have developed a Carestream white paper “Maximizing Dose Efficiency for Pediatric Patient Imaging,” available at http://bit.ly/15yCe0k. In this paper we discuss dose reduction in image acquisition as well as efficiencies in image processing, image display, and in quality control. Our DRX-Revolution Mobile X-ray System is now doing rounds in many children’s wards and hospitals, with the result that we hear repeated often:2530C DRX_small

“We started noticing that we could drop our doses down, so we went down a little more. We found that with our DRX portable, we were cutting our dose in half,” said Casey Dye, Diagnostic Coordinator, Intermountain Primary Children’s Hospital

New low-dose, small-format DR detector.

In addition, with the introduction of our new small-format DRX 2530C wireless DR detector, we can provide clinicians yet another opportunity to reduce dose: our smaller detector is designed to fit into pediatric incubator trays and offer higher DQE (detective quantum efficiency) with its Cesium scintillator, which can lead to lower dose requirements than CR cassettes or gadolinium scintillator detectors. The DRX 2530C is compatible with both our DRX Revolution Mobile X-ray System as well as with other portables upgraded with our DRX-Mobile Retrofit Kit.

Technique based on the patient’s size and age, new DRX portables, and our new Cesium detector (the DRX 2530C) help to keep dose to a minimum. In addition, image processing optimized for the size and age of the patient can also be employed to emphasize appropriate details in the image after acquisition, sometimes providing an acceptable image in a situation that might otherwise require a repeat. Finally, new analytic reporting software allows the clinician to evaluate performance over time and to identify areas for possible improvement.

To make the imaging experience more comfortable for our young patients, Carestream has developed a coloring book for children about X-rays, titled “I can see your bones,” available by visiting this link.

Combating the Challenges of Portable Imaging

Rafael Fernandez, DMS Product Specialist, Spain, Carestream

Rafael Fernandez, DMS Product Specialist, Spain, Carestream

The Spanish translation of this post can be found after the English version.

For a period of time, portable imaging had been mostly forgotten, the least evolved of medical imaging trends. A few years ago, it was common seeing radiographers pushing a contraption that looked like a wheelchair through the corridors completely loaded while another technician would push a piece of analog equipment that tended to be at least 10-years-old. Interestingly, these devices were used with the most critical patients (ICU, Pediatrics), who needed a better diagnostic quality due to injury or critical life situations

Portable imaging continues to face three key challenges: mobility, image quality and productivity. To address these challenges, Carestream designed the DRX-Revolution System:

  1. Mobility: ICUs are filled with appliances, tubes, cables, etc. that leave little space available in the room that tripping over any cables can disconnect some vital equipment. For this, the DRX-Revolution system has the first column and retractable (up to 135 cm), allowing technicians to see any obstacle in front of them and can capture a quality image with limited patient mobilization. This along with a volume of only 0.89 m3, this makes the DRX-Revolution an ideal team member for their work in the ICU
  2. Image quality: the great power of the generator (32 kW), the use of wireless sensor DRX-1/DRX-1 C/DRX 25x30C with cesium iodide scintillator result in improved image quality and in reduced dose. In addition to being wireless, we can use sterile bags in clean environment without causing contamination. The ability to retrieve patients’ previous images was done via the hospital’s PACS and copy radiographic technique with which it became the latest study. The images are made with quality unknown to date and under the same boundary conditions, which makes tracking the evolution of a disease such as pneumothorax easily.
  3. Productivity: instead of bringing the patient to the X-ray, the X-ray room can now be taken to the patient. The DRX-Revolution design gives the ability to maximize a radiology department’s investment, as it is the first mobile X-ray system with two screens (19 “screen and a secondary 8″ tube). User identification via QR code cards have been designed by and for diagnostic imaging technicians. In the end, this serves as an ideal system in the portable imaging revolution.

I enjoyed giving a speech on October 4, 2013, at the Congress of the Association of South Radiologists in Cadiz, sharing and explaining scientific advances in the field. This is a time when Carestream is embracing the opportunity to lead through the challenges and changes in the portable radiology sector.

SPANISH TRANSLATION

Los Retos de la Imagen Portátil

Históricamente, la imagen portátil ha sido la gran olvidada, la que menos ha evolucionado en el tiempo. Hace unos años, era muy común ver por los pasillos a técnicos de radiodiagnóstico empujando una silla de ruedas (o algún artilugio similar) cargado  de chasis junto con otro técnico que empujada un equipo analógico con una edad media de más de 10 años. Curiosamente, los pacientes en los que se usaban estos equipos eran los enfermos más críticos (UCI, Pediatría) y los que necesitaría una mejor calidad diagnóstica debido a lesiones o situaciones vitales críticas.

La imagen portátil se sigue enfrentando a tres retos fundamentales: movilidad, calidad de imagen y productividad. Para  hacer frente a estos retos Carestream Health ha diseñado el sistema DRX-Revolution que cambia radicalmente la imagen portátil y soluciona totalmente dichos retos.

  1. Movilidad, las unidades de cuidados intensivos (UCI) se encuentran llenas de aparatos, tubos, cables, etc. que hacen que se disponga de muy poco espacio útil y que cualquier tropiezo con un cable pueda desconectar algún aparato vital (respiradores, etc.…), para ello, el sistema DRX- Revolution tiene la primera columna retráctil del mercado y la que mayor alcance tiene (hasta 135 cm), lo que hace que el técnico pueda ver siempre el obstáculo que tiene delante y puede alcanzar mejor al paciente sin necesidad de su movilización. Esto junto con un volumen de sólo 0,89 m3 hace del DRX-Revolution un equipo ideal para su trabajo en UCI, incubadoras, etc.…
  2. Calidad de imagen, la gran potencia del generador (32 Kw), el uso del detector wireless DRX-1/DRX-1 C/DRX 25x30C con centelleador y yoduro de cesio, hace que la calidad de imagen y la reducción de dosis deje de ser una quimera. Además al ser wireless, podemos usar bolsas estériles sin dejar cables no esterilizados en entornos limpios y sin que se produzcan enganchones. La posibilidad de recuperar las imágenes previas que el paciente tenía en el PACS del hospital y copiar la técnica radiográfica con la que se hizo el último estudio, hace que las imágenes se realicen con un calidad desconocida hasta la fecha y en las mismas condiciones de contorno, lo que hace que ver la evolución de una patología como el Neumotórax, sea muy fácil.
  3. Productividad, en vez de llevar el paciente a la sala de R-X, llevamos la sala de R-X al paciente. El diseño del DRX-Revolution hace que maximicemos nuestra inversión, ya que es el primer equipo con dos pantallas (19” de pantalla principal y una secundaria de 8” en el tubo), identificación del usuario mediante tarjetas con códigos BIDI y diseñado por y para técnicos en diagnóstico por imagen, hace que sea el sistema idóneo y revolucionario para la imagen portátil.

Me encantó dar el discurso el pasado 4 de octubre de 2013, en el congreso de la Asociación de Radiólogos del Sur en Cádiz, para compartir los avances científicos en esta reunión  España y poder explicar como Carestream quiere liderar el los retos en la radiología portátil.