SERAM: Guidelines for Renewal and Technology Update in Radiology

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The obsolescence of X-ray equipment and its fundamental role in diagnosis.

By:  Dr. Miguel Ángel Trapero, Hospital Universitario Fundación Alcorcón

Editor’s note: the Spanish Society of Medical Radiology (SERAM) recently published its “Guidelines for Renewal and Technology Update in Radiology,” in which it analyzes the situation of medical imaging equipment in Spain. In this interview for Everything Rad, Dr. Miguel Ángel Trapero, strategic manager of SERAM, explains some of the most relevant aspects of this report, with special emphasis on issues such as the obsolescence of X-ray equipment and its fundamental role in diagnosis.

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ER: SERAM recently published a report confirming that 59% of the X-ray equipment at the main Spanish hospitals is obsolete, and they are analog. What are the main reasons for this situation?

Dr. Miguel Ángel Trapero: The main reason is that the economic crisis has caused investment to fall. This means that devices have not been renewed, and they are older. But there is another reason. That is, until now, there has been no planning and no set of indicators to guide radiologists and managers about when to renew the equipment based on its age and usage.

To deal with this situation, the SERAM has developed, with collaboration from the Signo Foundation, the document “Guidelines for Renewal and Technology Update in Radiology”, which analyzes the current situation of diagnostic imaging technologies in Spanish public hospitals.

It also includes a series of recommendations to guide healthcare organizations on how and when to update or replace equipment. These recommendations include developing and maintaining complete records of all hospital equipment; establishing objective criteria for renewing the equipment; proving proper maintenance; and planning renewal needs in the medium term.

ER: How does this situation influence the services provided by radiologists?

Dr. Miguel Ángel Trapero: The obsolescence of the equipment has a direct impact on the quality of healthcare. For example, older equipment breaks down more and does not incorporate features that improve healthcare, such as faster testing, a substantial reduction in radiation doses, higher quality images, and new applications that allow a better diagnosis.

Applying digital X-ray systems allows us to double the productivity of radiology services in comparison to analog systems.

Using new conventional radiology devices instead of obsolete equipment can easily double simple radiology activity and serve 80 patients where only 40 were previously seen.

ER: What advantages does digital X-ray technology offer over analog?

Dr. Miguel Ángel Trapero: Digital technology offers important advantages over analog. The main ones are more reliable storage, better distribution, and higher image quality. With analog technology, the image is captured and then transferred to film, or is digitized indirectly through other devices to store it.

With digital technology that process is done directly, which saves a lot of time. Digital equipment allows us to store all images electronically and safely in the PACS to see them simultaneously in different places at the hospital, and check them from the clinical history.

Another important advantage is image quality. Digital equipment provides more information and, therefore, it offers better processing capability. The analog image is a fixed photograph. With the digital image, the radiologist can change the windows, improve brightness and contrast or zoom. This is a key element to make an appropriate diagnosis.

In short, digital technology guarantees better access, greater storage security, and the integration of information in the clinical history.

ER: With the incorporation of other technologies such as ultrasound, resonance or CT, what role do X-rays have in the diagnosis and treatment process?

Dr. Miguel Ángel Trapero: Conventional radiology (X-rays) is the first test that the patient has access to in a series of processes. According to our hospital’s data, it represents between 50 and 60% of the total medical imaging tests. Many times, it can solve the problem without having to resort to another examination, especially in non-severe trauma or pulmonary pathology. And, of course, it is the most common exploration in emergency radiology.

ER: What is the reporting process for X-ray tests? Do they always have to be reported by a radiologist?

Dr. Miguel Ángel Trapero: Although all tests, including those done for primary care or emergencies, should be reported, the current situation of the health system and the lack of radiologists make it difficult to report all simple radiology examinations. Therefore, our document “SERAM position on the need to report simple radiology” establishes priorities over certain tests that may not be reported, specifically X-rays requested for trauma: fractures and some orthopedic studies.

The limitation to be able to report all the tests is that there are not enough radiologists. For example, in emergency room shifts in general hospitals where there is usually only one specialist on call who must prioritize which tests he or she is required to report, like CTs or ultrasounds.

ER: In your opinion, how can the use of Information Technology and Image Management Systems improve the quality of diagnosis and overall information (radiology, clinicians, patients)?

Dr. Miguel Ángel Trapero: We radiologists have pioneered applying powerful information systems such as the RIS (Radiology Information System) and PACS (Picture Archiving and Communication Images), which are very important radiology elements in modern hospitals. When using digital radiology, you can also get more out of the post processing.

Finally, the Information System (IS) allows us to know in detail what we do and the improvements we can introduce in managing our service. They also substantially improve speed and safety. When they are in a file or on film, our access to the images is very limited. Having an information system gives us immediate access and prevents the tests from being lost.

Read the related blog on 9 Questions to Answer Before Researching Radiology Equipment.

Dr. Miguel Ángel Trapero is head of Diagnostic Imaging at the Hospital Universitario Fundación Alcorcón and associate professor of radiology at the Universidad Rey Juan Carlos.



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