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

Reposted from Imaging Technology News (ITN) with permission.

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.

Radiology’s Role in Medicine’s Mobile Revolution

Patient Portal

“Radiology’s primary job in this kind of mobile imaging environment will be to deliver images (and reports) that clinicians can easily use at the point-of-care.” – Jim Knaub, editor, Radiology Today

My dermatologist walked into the exam room, peering through his half-glasses at the smallish tablet computer in his left hand. He promptly looked up, greeted me, and shook my hand with his right.

“Last time you were here, we froze a couple spots on your scalp, one on your left hand and one your right lower leg,” he said, while dragging his finger across the touch screen and showing me the figure that represents me and my various lesions. “Have you noticed anything else you want me to have a look at?”

With that, he then slipped the tablet, which had one of those heavy-duty protective cases on it, into the flat pocket of his lab coat and started with my quarterly skin check. (That’s what happens when you’re a 54-year-old, sun-baked ginger.)

My adventures in aggressive skin cancer defense are not the point of this blog entry, but my dermatologist provides a good example of mobile medical imaging making its way into a clinician’s routine practice. Not long ago, that skin check visit would have started with the same greeting, followed by my doctor making his way to the laptop computer an assistant had placed on the counter next to the exam table. He would review my medical record on his EHR and then start the examination. The portability and ease of use of the tablet has upped his patient engagement game. I have seen doctors express concern about how working with a laptop EMR interferes with paying attention to the patient, but using a tablet, my dermatologist has worked it out.

Imaging did not come into play on my most recent visit because my dermatologist does not photograph the suspected precancerous lesions he freezes with his cryo-blister gun (not the technical term).  He has photographs of the melanoma he’s cut off me, the basal cell carcinoma he burned off, and the squamous cell he froze. Dermatology does not provide a good example of how radiology images are used by clinicians because the only modality is a digital camera that costs a few hundred bucks and almost all of a dermatology practice’s images are generated in house. The doctor takes the pictures and hands the camera to the assistant who then uploads the images to the EHR.

That said, my dermatologist’s use of his tablet beautifully illustrates how clinicians want their images available to them when treating their patients. And for specialties that you routinely provide images for, I believe radiology’s primary job in this kind of mobile imaging environment will be to deliver images (and reports) that clinicians can easily use at the point-of-care. As clinicians figure out how they will integrate tablets, images, and EHRs into efficient day-to-day care, they will increasingly expect their imaging providers to deliver patient images to their EMR, or at least in a way that the referrer can easily upload them to the EMR so they can be readily used in a clinical setting.

Radiologists will always do most of their reads at their workstations, with a small percentage of off-hour or emergency cases read on a laptop, tablet, or phone in various outlier situations. The greater mobile revolution will be among your referral customers—which any forward-thinking organization wants to serve better—and imagers will be asked to enable that by being able to deliver images readily usable at the point of care, or at least easily uploaded to where the referrer can easily make that happen.

JimKnaub_headshotJim Knaub is the editor of Radiology Today.



Radiología portátil, Accesible Para Todos en el Futuro

Carestream DRX-1 System

The English version of this post can be read here.

Sabemos que la tecnología hace milagros, pero ¿qué importa todo eso cuando esta solo al alcance de unos pocos?, Seguramente  Roentgen  no podría  ni imaginar  que  al descubrir los   “rayos x”  estaba contribuyendo al  nacimiento de una de las ramas más importantes de la medicina.


Hoy en día a los estudiantes de medicina de todo el mundo se les enseña que habrá que someter a la mayoría de sus futuros pacientes a exámenes radiológicos, porque se ha convertido en algo crucial  en el diagnostico y tratamiento de  enfermedades.  Pero  la triste  realidad es que cuando ejerzan  a menudo tendrán que hacerlo en medios rurales, lejos de hospitales donde pueden recibir los exámenes radiológicos.

Por ello es importante el desarrollo  y la envergadura de losequipos de diagnostico portátiles digitales  para asegurar la accesibilidad de los habitantes que viven en zonas rurales, desprovistas o aisladas por cuestiones geográficas.


La OMS calcula  que más de 2/3 de la población mundial no tiene acceso a pruebas radiológicas.Hoy, Uno de los objetivos principales de la OMS es asegurar  la accesibilidad, ya que cualquier patología aguda requiere un estudio radiológico de urgencias.

Por ello es necesario salir del ámbito hospitalario y llevar la radiología allí donde se encuentran los paciente., por ejemplo, detectores digitales portátiles , aparte de ser móvil, tener un bajo consumo, y estar provisto de larga autonomía.Al ser digital, cuenta con la ventaja  de poder enviar la imagen para que sea vista por otros médicos y que puedan dar un segundo diagnóstico, supone entrar de lleno en el concepto de la telerradiología llevando la sanidad  donde sea necesario.


Un aparato portátil con un detector de rayos X permite llevar la tecnología médica a lugares inimaginables y con ello poder llevar la salud a zonas impenetrables del mundo para utilizarlo en diferentes misiones humanitarias.La cuestión del tiempo es importante en el diagnóstico por la imagen, y un diagnostico precoz marca la diferencia en  fracturas o en la  detección de  cuerpos extraños metálicos provocado por traumatismos externos. La radiología es el acceso a la información  de la manera más rápida y proporciona la velocidad que a veces no se dispone.

Esta tendencia necesaria y vital  no solo ha llegado a uso militar, o a misiones humanitarias , también a expediciones. En la expedición atraves del Antártico, el equipo de Ranulph Fiennes llevó un escáner portátily esta tecnología se usa en el  deporte de elite, diagnosticando las lesiones de los jugadores rápidamente.

Los equipos portátiles  se han expandido  en hospitales públicos dotados de sala de rayos, ya que  a veces son necesarios equipos portátiles cuando un paciente no se puede trasportar de forma segura a la sala, debido a una enfermedad, por posibles contagios o porque este se encuentra en cuarentena.

La tecnología, como se utiliza más frecuentemente, está demostrando ser todo un éxito en el campo de la radiología. Los radiólogos creen en la eficacia de la tecnología, y en la mejora eficiente sin comprometer la calidad de imagen, los profesionales del diagnostico por la imagen pueden asegurarse de que están proporcionando el mejor cuidado a los pacientes.

FernandezRafael Fernández Navarro es el especialista de Iberia de rayos X Soluciones de Business Manager Iberia y Servicio de Ventas de Carestream


RSNA 2013: Medical Imaging Used to Capture Diseases in India

Dr. Harsh Mahajan, director of radiology, Mahajan Imaging, took a few minutes to speak with us at RSNA. In our conversation, Dr. Mahajan talked about the populations that his organization currently serves. Within these regions, infections, disease and cancer are primary focus points for his imaging initiatives, particularly since there are diseases that catch on fast among the populations. Capturing these diseases is accomplished via cath labs, and CT scanners, PET-CT, and MR, with X-ray usually serving as the starting point for many of these diagnoses.

Dr. Mahajan also talks about his organization’s use of the Carestream CS 9300 CBCT technology and the benefits that he has seen. One of the key benefits that he has enjoyed involve the company’s ability to expand across the whole imaging spectrum, as opposed to only having a focus on dental imaging capabilities.


AHRA 2013: Patient Satisfaction vs. Quality in Bedside Imaging

Todd Minnigh, Vice President of Digital X-ray, Americas, Carestream

Todd Minnigh, Vice President of Digital X-ray, Americas, Carestream

In the 1980s my spelling was marginal. Readers would need to look past it, focusing on the main point of my letters and papers.  Sometimes it would lead to a mistake in understanding, but usually things were okay.  One day the world changed.  Spell checkers.

How often do we sacrifice quality for speed and convenience?    When we take an X-ray the patient’s time, safety and comfort are along for the ride.  Avoiding clinical errors and improving quality are critically important. Technology may be about to make things easier.

I’ll be giving a presentation a couple of weeks from now in Minneapolis, MN, at AHRA 2013 on the importance of bedside imaging and how we can get to the level of quality imaging that we should expect. When the patient is so compromised they cannot  come to the X-ray room, we really need to take the x-ray room to them.  Several technology advancements are getting us closer to just that. . These result in improvements and ensure that radiologists are equipped with the best capabilities available to provide the best care possible.

  • In my CE presentation on Sunday afternoon I’ll be covering the challenges associated with bedside imaging.  These could be driven by exposure, grid cut off, lost identification, positioning or other reasons.  Most mistakes involve a return trip to the room, disturbing the patient or heaven forbid the OR again, and repeating the image.  To  manage these challenges, most folks focus on a few areas:  : proper identification, infection control, and retained foreign body search  in the OR to name a few.Mobile Xray
  • Patient identification is vital  to preventing medical errors. DR allows verification of the image and patient at bedside, scanning wristbands to ID images can take this one step further.  Mixing up paper requisitions between exposing and processing CR cassettes is eliminated. . Infection control and patient satisfaction don’t always go hand in hand. What is sterile is sometimes a bit cold and unfriendly. But a plastic bag and rubber gloves is preferred to a staph infection.  I’ll have a few suggestions from other Radiographers for how to boost comfort.
  • It is important to  use  a grid often for improving the image quality so that radiologists won’t need to rely on repeat images. The capability exists from multiple sources to make grid alignment easier. Along with grid alignment, it’s important that  departments track exposure to prevent “dose creep”. To realize the improvements productivity, thoughtful implementation and the organized tracking of metrics are needed so operational improvements can be made.   Patients can recognize discomfort when it comes to capturing another image, but what they can’t tell is if they have been overexposed.  This must be managed to follow through on our mission to achieving both optimal patient care and patient satisfaction.

If you’re interested in attending this presentation to learn more, I will be speaking on Sunday, July 28, from 4:30-5:30 p.m. at the Minneapolis Convention Center in Minneapolis, Minn. Looking forward to seeing you there and to another great year at AHRA.

RSNA Hot Topics: Portable Imaging and Radiology’s Transformation

Todd Kranpitz, Executive Director of Radiology at Iowa Health, Des Moines, visited our social media broadcast center at RSNA to offer his thoughts on the transformation underway in radiology.  Kranpitz feels its important that the radiology professionals become educators and reach out to other specialties to ensure they understand ALL that diagnostic imaging can bring to the table throughout the care continuum.

Also, Kranpitz recently acquired a CARESTREAM DRX-Revolution Mobile X-Ray System and shares his feedback on the impact of the portable unit on technologist productivity. He also discusses how surgeons want the technology and he sees the potential to replace c-arm systems in the operating room with a DRX unit.

Business Intelligence & Mobile Imaging To Take Center Stage At AHRA

Doug Spotts

Doug Spotts, General Manager, United States and Canada Medical Sales, Carestream

When the exhibit floor at AHRA opens tomorrow radiology administrators will be looking for innovative new technologies.  I’ll be in Carestream’s booth (#609) as we unveil capabilities that can impact radiology administrators, technologists, radiologists and ultimately patients:

  • A real-time view of departmental workflow that can help administrators improve staff productivity and profitability
  • New mobile imaging tools that display current and prior images side-by-side on an iPad; and
  • Features for the DRX-Evolution that can help limit patient exposure and optimize chest and pediatric imaging.

Our new Vue Beyond for Radiology can produce shorter patient wait times and enhanced profitability by providing a single real-time view into metrics like study volumes and turnaround times, modality usage, patient type and critical results notification to help administrators detect and understand any bottlenecks that exist in the departmental workflow.

Radiology administrators can take the DRX-Revolution for a test drive and see a demo of the Vue Motion imaging viewer that delivers two important features: side-by-side display of current and prior images on an iPad—a much-requested feature—and the ability for clinicians to input order notes to an exam.

With dose reduction sure to be on the mind of every professional at the meeting, our staff will describe a host of new capabilities for the DRX-Evolution including: image processing techniques optimized for pediatric views; linear tomography (not commercially available in the U.S.) that aids in viewing anatomy obscured by overlying organs and tissues; asymmetric collimation to help limit patient exposure during an exam, and Pneumothorax Visualization Software that creates a companion image (from the original exposure) to accentuate the appearance of free air in the chest cavity and aid in visualization of a collapsed lung.

This meeting offers the perfect blend of knowledge sharing and hands on access to new products that will redefine image capture and management. Hope to see you there.

What new technologies are you most interested in seeing at AHRA? 

Bedside Imaging at San Antonio’s University Hospital

Andy Mendoza

Andy Mendoza, Medical Sales, Carestream

Living in Helotes, Texas – a suburb of San Antonio – I, like many residents, have sense of pride about the hospitals in our area.  U.S. News & World Report’s ranking of “best hospitals” for 52 U.S. metropolitan areas, featured five San Antonio hospitals, placing University Hospital  at #1 and ranked nationally. We can feel good about the care available to us in this area.

On Friday, San Antonio’s local news station, KENS 5, took a look at new bedside imaging technology at University Hospital that is speeding the radiology process and allowing radiologists and physicians to make faster diagnosis. [ Click the Image Below to View]

Click to ViewI worked closely with the hospital on their decision to invest in this Carestream DRX-Revolution Mobile X-Ray System.  As KENS 5 reported, with 12 floors to tackle on rounds, 140 patient x-rays per day and more than 4,000 images a month, the hospital needed a portable unit that was easy to transport and could transmit images in seconds for real-time decisions.

It was nice to see medical imaging getting some mainstream attention. University Hospital’s director of radiology Rick Pena said it best: “When you have good image quality, you feel good about the diagnostics that you provide.”

As a member of the local community, I also hope stories like these make us feel good about the caliber of care available to us in San Antonio.

What role does bedside imaging play in your department’s approach to patient care? 

Attending AHRA 2012 in August? Schedule a DRX-Revolution test drive.

Spire Healthcare Gives Clinicians On-Demand Access to Imaging Data

Robert Ashby, Carestream

Robert Ashby, European Communications Manager, Carestream Health

The IT director and Imaging Manager at the UK’s second largest private healthcare provider, Spire Healthcare, had an interesting challenge. How do you use technology to provide better service for both patients and referring physicians, who have a choice of where to go for care, when your 37 hospitals are on different PACS platforms?

To differentiate their services, Spire sought a secure, PACS and archive-agnostic image viewer that would be accessible from almost any device—predominantly iPads and other tablets—running a Web browser with no local installation or download.

Since January, Spire has been using Carestream’s Vue Motion viewer to allow radiologists and referring physicians to see PACS images from all 37 sites in the Spire network—on the way to the operating room, at the patient bedside or even from home.

I recently had the opportunity to sit down with Stephen Hayward, IT Director, Andrew Milne, Imaging Manager, and Dr. Qaiser Malik, Consultant Radiologist, to talk about their experience with Carestream Vue Motion:

Three professionals with different views on the value of freeing images from the PACS workstation.

IT Director, Stephen Hayward

“There is certainly a huge future in mobile health. Having access to care records and reports on a mobile device at the clinician’s finger tips will be a great boom going forward.”

Imaging Manager, Andrew Milne

“Our consultants can access the system remotely, download, and print without any interaction with my staff. This reduces the traffic into the imaging department and makes our service much more efficient. Staff is free to deal with other matters directly involving patient care.”

Consulting Radiologist, Dr. Qaiser Malik

“The clinician may come across a report and he may want to discuss it with me when I may not actually be there.  I can log in to the system wherever I am.  He can log in from the hospital and we can both look at the same images at the same time.”

At UKRC this week? Come see Vue Motion in stand 99. 

Hamilton General Hospital Takes the DRX-Revolution for a Test Drive

Glen Nicholson

Glen Nicholson, Medical Sales, Carestream Canada

At the beginning of the year I posed an interesting question to Cheryl Malcolmson, RT (R), Manager, Diagnostic Imaging, Hamilton General Hospital, Hamilton, Canada:

“Can I interest you in a test drive?”

No, I wasn’t selling her a Volvo. But I was offering her facility the opportunity to be a  trade trial site for the CARESTREAM DRX-Revolution Mobile X-Ray System.

Bedside diagnostic imaging has several frustrating challenges ranging from maneuverability to positioning and alignment. Carestream engineering teams developed the first mobile DR system designed “from the ground up” with technologist workflow in mind.  Now we needed to see if we got it right and that required a system test drive.

Hamilton General Hospital is a leading healthcare provider, not only for the downtown community of Hamilton, but for the entire South Central Ontario region. It is recognized as a regional centre of excellence in cardiovascular care, neurosciences, trauma and burn treatment, making it an ideal site for our trade trial – a provider where mobile x-ray systems are an essential tool in treating what are often the sickest of patients – those confined to bed and in need of urgent care.  Cheryl agreed to be a test site for the DRX-Revolution and the trade trial is now complete.

Has the DRX-Revolution redefined mobile x-ray? I’ll let Cheryl and her team share their experience with you:

I’ve been anxiously waiting for this system to hit hospital hallways because I know what a difference it will make in technologist productivity and satisfaction. Hearing a Hamilton technologist comment:

“Really nice images on a system that is easy to drive — just like a lawn mower…”

Means a true x-ray room on wheels is now a reality.

Thanks so much to Cheryl and her team at Hamilton Hospital for putting the DRX-Revolution through the paces in the trial.

Have you taken a test drive of our DRX-Revolution at RSNA or another event? What did you think?