The U.S. Consolidated Appropriations Act: Moving from CR to DR

Rental, retrofit and trade-in are financial options for moving to digital radiographyimage of DR systems and cassettes

The benefits of moving from CR to DR are widely recognized by the medical imaging community. Radiology Today summarizes them as, “the technology is more efficient, quicker, and, most importantly, requires less dose to the patient.”

They also include  a more productive radiology workflow than computed radiography (CR). In fact, WellStar North Fulton Hospital told 24×7 magazine that DR reduces their processing time by 90 to 95%. With fast and efficient DR technology, they can see more patients and gain higher utilization of their assets.

The advantages of DR – along with upcoming reimbursement cuts for film and CR exams as a result of the U.S. Consolidated Appropriations Act (also known as HR 2029) – make a strong case for facilities to transition to digital x-ray. Yet at least 8,000 CR systems are still in use today, according to IMV Medical Information Division’s “2015 X-ray Market Report”.  Why the delay?

Some medical xray facilities are reluctant to make the transition because their CR systems are working reliably. For others, the biggest hurdle is finding a cost-effective path to upgrade their existing technology. Facilities also need to weigh whether they should make the move from CR to DR one room at a time or in one swoop.

Carestream Health recommends that radiology managers consider the age of each existing X-ray system, its current operating condition, and whether it provides all the necessary imaging capabilities. In some cases, the X-ray imaging system might need to be updated to deliver advanced features or enhanced productivity. In other cases, installing a DR detector can deliver a rapid conversion to DR technology that makes high-quality images available in seconds.

Carestream offers three smart options to help customers in the United States move from CR to DR without a large upfront capital investment: rental, retrofit and trade-in. Continue reading

Whirlwinds of Change — What Can We Anticipate? Part Two

Digital Imaging and Healthcare IT Challenges: Advances & Trends for 2016

This post is a continuation of the piece that appeared here on EverthingRad on December 22, 2015. It covers additional imaging and IT trends projected for 2016.

  • Trends in Telemedicine

As Beth Walsh writes in Clinical Innovation + Technology, the use of telemedicine expanded significantly Image: View to the futureduring 2015. Now, REACH Health identifies telemedicine technology trends to watch for over the next year. Here are two of the most interesting:

Growing obsolescence of proprietary hardware and networks:  Proprietary hardware and networks were standard in the early in telemedicine technology. Now, providers are seeking more flexible solutions. Effective telemedicine can be powered by off-the-shelf PC components, standard, low-cost cameras and emerging networking standards such as WebRTC. These products allow providers to choose the most appropriate end-point – whether it be a high-performance cart, a PC or a mobile device such as an iPad or Android.

Richer clinical apps for physicians: To best recreate the bedside experience for doctors and patients, telemedicine solutions should support individual physician preferences. And, they should help healthcare organizations standardize treatment protocols. In response, telemedicine is becoming more adaptable, providing physicians the flexibility to specify how information is displayed and utilized – all within the boundaries of clinical protocols defined by the provider organization. More details here.

  • Digital Breast Tomosynthesis To Go Beyond Experimental

In October of 2015, Radiology Today published a piece on the present and future of digital breast tomosynthesis (DBT). Authors Lonnie Johnson, MBA, and Missy Lovell, BSN, RN, MBA report that DBT, due to its improved accuracy percentages in breast cancer screening, has already become more popular than digital mammography. Moreover, it requires fewer patient recalls for additional testing.

For these reasons, DBT is no longer regarded as investigational by most experts. Unfortunately, while CMS has made the decision to facilitate access to DBT exams by covering them, private payers have been slower to pay for exams – still perceiving the process to be experimental in nature. In turn, not surprisingly, this has created some difficulties for providers in balancing the demand for DBT with reimbursement.

Unfortunately, it takes time, evidence, and education for providers to accept state-of-the-art technology and approve for payment. A review and understanding of payer requirements and/or a discussion with the top payers is recommended to help DBT readily become readily accessible and reimbursable for patients who will benefit from it. More details here.

  • Sophisticated Imaging Technology Will Become Even More Dominant in NFL

The October, 2015 issue of Radiology Today placed a special spotlight on imaging the NFL – reporting how many teams are moving forward to bolster their capabilities with full digital X-ray, PACS systems and even MRI. The issue’s lead article, by contributor Beth Ortenstein, quotes Matthew J. Matava, MD – past president of the NFL Physicians Society, chief of sports medicine at Washington University, and head physician for the St. Louis Rams – as saying that all 32 NFL teams have X-ray units at their stadiums… and while some are older and some more advanced, all meet the requirements of modern imaging technology.

But bigger things are on the way: several teams, including the Buffalo Bills, Green Bay Packers, San Diego Chargers and San Francisco 49ers have bought Carestream DRX mobile and full-room systems for their stadiums. These systems are designed to accelerate weight-bearing, cross-table and tabletop studies of patients weighing up to 650 pounds, according to a Carestream spokesperson. What’s more, the recent agreement between the NFL and players to invest more heavily in player health is likely to accelerate this trend toward state-of-the-art being ready to go on game day. More details here.

For a closer look at Carestream’s full portfolio, please visit carestream/com. Part One of this article can be found here.

JianqingBennettBWJianqing Bennett, President, Digital Medical Solutions, Carestream Health

Diagnostic Reading #7: 10 Most Popular Blog Posts from the Second Half of 2014

CARESTREAM Touch Ultrasound System - 1Carestream has worked hard to provide content of value throughout 2014. We have used our blog to deliver information about Carestream technology, address major industry trends, and inform readers about the medical imaging and IT fields. In this edition of Diagnostic Reading, we look at our most read blog posts since July. The topics include, the recent unveiling of our newest technology, industry infographics, image quality, digital 3D mammography, and dose reduction.


Carestream unveiled its newest technology in Chicago at RSNA 2014. The CARESTREAM Touch Ultrasound System officially moved the company into the ultrasound market. This post contains information about the new technology, including images that explain its features and capabilities.


This infographic follows radiology reporting throughout history. It covers traditional hand written reports, transcribed reports, and voice recognition. Pros and cons of these types of report are listed. Ultimately, the evolution brings us to multimedia reporting and highlights its benefits.


Since being FDA approved earlier this year, radiologists are 58% more confident in their ability to read chest x-rays with bone suppression software. Since the software produces 2-D images rather than 3-D images, it also reduces the typical dose for patients receiving chest x-rays.


This Q & A with Marty Pesce asks questions about his experiences as an applications engineer for Carestream. The interview discusses the nature of a job as a radiologic technologist. Pesce also had the opportunity to answer questions about his personal experiences in the radiology field.


El Camino Hospital in Mountain View, California, has taken measures to dramatically track and decrease patient dose. The hospital attributes this success to their transition from CR to DR technology. It claims that better imaging software leads to less repeated imaging.


This post emphasizes the importance of Digital Breast Tomosynthesis (DBT), or 3-D mammography for women with dense breast tissue. Numerous studies are noted by the author, including a JAMA study that found that by using DBT, there was a 41% increase in the detection of possibly lethal cancers.


With hospital mergers becoming prevalent, this post suggests that interoperability will continue to be a challenge. The adoption of software such as CARESTREAM Vue Connect could ease the transition. Combining data allows for both institutions to access their own information, as well as having access to new patient information.


Seventy-eight percent of office based physicians use some sort of electronic health record system (EHR). This post addresses the possibility of  radiologists and physicians working together using RIS and PACS to document patient records. There are inevitable challenges, but ideally this could mean “one patient, one record.”


In a time when Americans find it difficult to afford medical bills, radiologists must be conscientious about cost. Inappropriate imaging exams and lack of quality drive up costs, this post discusses how imaging appropriateness and effective reading of images can reduce costs in the field of radiology. Additionally, the post addresses other ways that health IT can help lower imaging costs.


Innovative Radiology adopted CARESTREAM Vue Motion. Since the implementation, efficiency has been higher. Additionally, Vue Motion connected Innovative Radiology with more than 40 sites in early 2014.

Veterinary Medical Imaging: Give the Customer a Solution, Not a Problem

La versión española de este post se puede leer aquí.

Davis Sesma, IntechDavid Sesma is the managing director of Intech, company specialized in technical healthcare engineering, both in healthcare radiology and veterinary radiography. Moreover, Sesma has a degree in Physics and is an expert in veterinary clinical software.

Carestream and Intech have developed a system for veterinary radiology exams, with more than 500 veterinarians around Europe using the system. With his experience and knowledge, Sesma is the perfect person to explain the issues we see in veterinary medicine.

How does radiology works in veterinary science? Do you think that in recent years the level of this science has increased through new technological innovations?

Sesma: Currently, the most demanded diagnostic method in veterinary activities is the radiology. This science has become so important to the veterinarian sector that to be approved as a clinic center, they must have surgery and X-ray equipment.
Technological advances in this area in the last 25 years (specifically to veterinary radiology equipment, digital systems adapted to the needs of industry, etc.) have led to growth from 10% to 75% regarding veterinary centers with a registered radiology team. As for digital radiology systems, only 10 years ago, only large referral centers would have the equipment, whereas today over 50% of new businesses are provided with digital radiology systems when first opening.

How does new software affect conventional radiology techniques in the veterinary industry?

Sesma: The development of applications for the collection of radiology images for veterinary activities has significantly helped  to diagnose diseases and the appropriate treatment.  Having specific radiology filters for each animal and anatomical region have contributed to the reduction of repeated exposures, and has also led to reduced radiation dose. On the other side are the measurement tools and veterinary applications that allow for accurate diagnoses as efficiently as possible, while also optimizing cost reduction.

What is the most striking difference between the software for animals versus human beings?

Sesma: A veterinary treatment program is designed by veterinarians and responds to all the demands of the sector. In fact, every six months we incorporate new tools and modify some that have already been made, based on feedback we receive directly from customers

The biggest difference lies in the fact that the veterinary surgeon has a particular expertise. He is part radiologist, part internist, and part cardiologist and psychologist. So what we have always tried, and I think we have achieved, is to implement an intuitive computer program that is easy to use. We have moved away from the complicated PACS platforms for human images, which you have to be an expert to manage.

Our goal has always been very clear: putting the service veterinary diagnostic tools in place, and prevent veterinarians from having to continue to use out-of-date, ineffective software.

Veterinary Imaging from CarestreamCan Intech software also be used with unconventional pets?

Sesma: There are more and more households containing pets other than dogs and cats, resulting in increasingly frequent consultations with birds, rodents, reptiles, ferrets, rabbits, etc. There are already many clinics in Europe (of course in Spain) specializing in “exotic animals.” So in our software, we contemplate different tools and filters for dogs, cats, horses, reptiles, small mammals, rodents, birds, turtles and other reptiles for example.

Incorporating a new technology needs to be accompanied with a training session. Would you say that veterinarians can easily adapt to new technologies?

Sesma: If someone is used to a certain way of doing things, the problem is not for that person, it is for the company–it has failed to adapt to the client. Today, veteran professionals who have never handled a computer, send emails, take pictures, play “Candy Crush” and hold video conferences with their grandchildren. This has been achieved thanks to the new usable software that we find in today’s devices, be it tablet, smartphone, or PC. That’s what developers should do—solutions must answer your questions. Veterinarians who are committed to our company have learned the new technologies, without a doubt.

Is the same security applied to both people and animals, in terms of standard protocol and regulation?

Sesma: There is not a gap in legislation. In fact, the RD 1085/2009 plays under the same heading for veterinary and conventional radiology equipment for humans. So our quality standard and our manufacturing CE markings don’t discriminate in terms of security, whether the use of the equipment is for human or animal patients.

Which would you say are the biggest benefits in the partnership between Intech and Carestream?

Sesma: The win-win relationship. Both companies are in the same line of support and non- interference in each of our tasks. Carestream has given us the green light to carry 100% of the veterinary market and as well as the support of the product, which is considered by many veterinarians to be the best product in its class .

Guess the X-ray–June’s Image Challenge

Happy June! A new month means a new Image Challenge.

Last month we had another difficult image–eye makeup–but congratulations to the person who guessed it correctly. Below is the image for June’s “Guess the X-ray”. Please leave your comments below or on our Facebook page. The challenge will run until June 30, or until the first person correctly names the item in the image.  Good luck!

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

June Guess the X-ray Challenge

Q&A: Digital Breast Tomosynthesis

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream

Digital breast tomosynthesis (DBT) is becoming increasingly popular in healthcare, but there are still many uncertainties surrounding it. Below are common questions healthcare organizations are asking about DBT and it is my goal to provide as thorough and accurate of answers as possible to demonstrate this technology’s value.

1.   What is DBT and how does it differ from/compare to traditional mammograms?      

DBT is a mammography procedure that uses low dose X-rays to create a three-dimensional image of the breast. Also referred to as ‘3D mammography’, the tomosynthesis scanner partially rotates around the breast and takes about 10 to 15 images from many different angles. As with traditional mammograms, the breast is compressed during the exam. The radiologist can then view the breast tissue in narrow slices, similarly to CT scan images.

 2. What benefits does DBT provide to physicians and patients?

With two-dimensional mammography, overlapping tissue can mask suspicious areas. Since thin layers of breast tissue are viewed with DBT, the overlap is removed and abnormalities are much easier to recognize. Studies have shown improved tissue identification, improved tumor visualization, and a lower recall rate for additional testing. Because of this, digital breast tomosynthesis has the potential to improve on the accuracy of mammography.


3. What are the challenges health facilities face when implementing DBT?

Financial:  Cost is a challenge due to the lack of reimbursement.  As patients become more aware of the benefits that DBT can bring, they’re asking for it.  Even with the lack of reimbursement, many facilities are adding DBT to prevent a loss of patients to other facilities offering this technology, and/or to provide better patient care.

Technical: Technical challenges include the size and format of DBT data.  DBT images can be very large, several times the size of conventional mammograms, so the transfer and storage of this data can be challenging.  Additionally, some acquisition device vendors have been generating data in a proprietary format (due to the lack of a DICOM standard format in the past), and in some cases still storing data in a proprietary format.  This presents challenges for healthcare facilities looking to standardize their data or use a mixture of vendor products.

Product:  As healthcare facilities add DBT to their breast imaging procedures, many are finding that their existing storage and viewing solutions do not yet support this technology.  This presents the facilities with the challenge of how they are going to store and view this data.

Workflow: DBT creates more data than a a conventional mammogram, increasing the time to read a case.  Just like when digital mammography was first introduced, users are experiencing a learning curve with reading the images with the use of workstations and the tools they provide.   In addition, some workstation vendors have very limited, if any, tools to optimize the reading of DBT exams, which magnifies the challenge.

4. How do providers overcome these challenges?

Financial:  Some facilities are absorbing the costs by marketing the value of  DBT and bringing in more patients.  Others are charging the customer an extra fee to help offset the costs.

Technical:  The data size challenge is overcome by careful planning of the network infrastructure and storage requirements.  Acquisition device manufacturers are recommending a 1Gbps network to accommodate the image transfers, so facilities are either planning for this when building new or upgrading their existing infrastructure.  We have found that in addition to adequate network bandwidth, the use of lossless compression and intelligent routing/pre-fetching of data are extremely important to efficiently move such large amounts of data around transparently to the user.  This is especially true when reading is performed across multiple facilities and/or remotely.

Regarding the data format, DICOM now supports a new SOP Class that specifies how such data can be transmitted in a standardized format for interoperability between various vendors’ equipment.  Most acquisition device vendors have adopted this standard, but existing proprietary data, and in some cases newly acquired data, still remain in proprietary formats.  To address this issue, some acquisition device vendors are offering a service where the proprietary data can be converted to DICOM standardized data.  This needs to be planned for ahead of any implementation of DICOM compliant equipment, since the conversion process can take some time to complete.

Product:  Facilities that add DBT and find their existing solutions don’t support this technology are faced with either waiting for their existing solution to support this technology or purchasing another product that will provide such capabilities.  Due to the importance of DBT, many facilities are choosing to replace or adjunct their existing solution with a product that supports this technology.

Workflow: We believe the learning curve radiologists are experiencing with the DBT technology will decrease over time, just as it did with digital mammography when it was first available.

The tools provided by an equipment vendor can also significantly decrease the time to read a DBT exam.  It is important that a facility chooses a product with the appropriate tools to optimize their workflow.  This includes not only the basic tools that automatically scale and position both 2D and 3D images, but also advanced tools that can help localize pathology and allow one to quickly navigate both current and prior studies.  With conventional mammography, digital breast tomosynthesis, synthetic 2D mammography, and other mammography procedures being generated (e.g. breast US, breast MRI, etc.), workstations with hanging protocols that can support and display all of these in an efficient manner become extremely important as well.

5. What are the key points you hope attendees will take away from your panel discussion at SIIM? 

Although there are a number of challenges with implementing DBT, solutions exist for each challenge and that will only improve in time as the technology matures.  It is also important for attendees to plan their environment and product selections, knowing what challenges have been faced by others and how they have been resolved.

 Editor’s Note: Ron will be participating in a panel session on “Problems and Solutions in Breast Tomosynthesis” during SIIM 2014. The session will be held on Thursday, May 15 from 12-1 pm in Exhibit Hall B – Innovation Theater.

Guess the X-ray–May’s Image Challenge

Happy Spring! Last month we had another difficult image–a motorcycle helmet— but congratulations to the person who guessed it correctly. Below is the image for May’s “Guess the X-ray”. Please leave your comments below or on our Facebook page. The challenge will run until May 31, or until the first person correctly names the item in the image.  Good luck!

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

May's Image Challenge

[Whitepaper] How Can Bone Suppression Improve Chest Radiographic Images?

Helen Titus

Helen Titus, Marketing Director, X-ray Solutions, Carestream

Chest radiography is vital to diagnosing lung diseases. A high signal-to-noise-ratio (SNR) is crucial if an image is to be determined as appropriate for diagnosis, and it becomes the mission of the acquisition system to leave as much noise out as possible.

Bones, specifically the posterior ribs and clavicles, are the usual noise culprits in chest imaging. The ability to decrease that noise can provide radiographers with an improved, well-defined image, and allow the radiologist to make the proper diagnosis.

A tool such as bone suppression software allows the noise of the ribs to be significantly decreased and require no additional procedure or radiation dose. The software is designed to suppress the high-contrast bone structures while maintaining the contrast-detail level, as closely as possible to that of the original images.

Learn more about this technology and the process of Carestream’s Bone Suppression Software (having recently received FDA approval and being part of the Directview v5.7 release) in the whitepaper, Bone Suppression for Chest Radiographic Images.

[Webinar] Image Quality: Does it Matter, and How Should We Define It?

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Where is image quality? In the capture device? In the image processing? In the display system? In the brain of the viewer? Is it everywhere, or nowhere in particular?

These questions were answered recently in a webinar titled “Does Image Quality Matter?” by taking a closer look at the imaging chain.

Any imaging chain (also a medical one) contains five distinct functions:

  1. Capture (the creation of the image),
  2. Process (which itself consists of three sub-functions: preprocessing of the captured image, optimization for interpretation/viewing, and processing for the output device),
  3. Display (assuming a human is the viewer),
  4. Storage
  5. Distribution.

The answers depends on which image quality we mean: the objective image quality we can measure, the subjective image quality perceived by the viewer, or, particularly important in medical imaging, viewer performance using the image for some interpretation task.

In modern imaging systems, these three “flavors” of image quality are weakly, if at all correlated, which makes the prediction of one kind of image quality from another rather tricky, but also interesting.

The entire webinar has been embedded below. By the end, the questions asked at the outset should be answered, though the path to get to those answers may surprise you.

Guess the X-ray — March’s Image Challenge

Congratulations to the person who guessed February’s image correctly — it was a light bulb! Below is the image for March’s “Guess the X-ray”.  Please leave your answer in either the comment section below or on our Facebook page. The challenge will run until March 31 or until the first person correctly names the item in the image.  Good luck!

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

March Image Challenge