Governance, Mission, Growth

Digital DR Keeps Techs in the Exam Room
Region’s “Hot Spot” for BSGI

Digital DR Keeps Techs in the Exam Room

Ideal for the frightened child who can’t sit still unsupervised or for the person who is struggling with the pain from injured anatomy, a direct digital system from Quantum Medical Imaging allows technologists to stay close to patients who need comforting. Offering the same functionality at either tube-side or the Operator Control Panel (OCP) outside the room, the dual-panel Q-Rad-Digital System, including Canon digital panels, was recently installed at InterMountain Orthopaedics, located in Boise, Idaho.

Patients can certainly attest that the image acquisition process can be uncomfortable or even painful, due to patient positioning. They have to hold, or even be restrained in, that position until the image can be acquired.

Plus, “as we all know, there will be times when a repeat might be required due to motion or position inaccuracy, or sometimes when all of that is correct, there may be need for applying some other QA for annotation or slight contrast/brightness adjustment,” said Jim Miller, director of digital product development at Quantum.

Through technology called Tech-Vision, technologists have the choice to view and set up all exposure parameters at the tube side. In an effort to eliminate the back and forth from the OCP to the patient, the two-way generator communication allows techs to view the x-ray directly on an in-room color touch-panel mounted at the x-ray source tube assembly. This way, technologists can determine the QA decision prior to repositioning the patient.

Upon image acquisition, many DR operator consoles display a preview image, “and, as we sometimes describe it, ‘the world stops’ until the technologist makes an ‘accept’ or ‘reject’ decision,” Miller said. With Quantum’s system, the preview image is usually displayed within 3 seconds. In some situations, those 3 seconds are 3 seconds too long to leave a patient unattended.

“With that accept/reject decision available in-room at TechVision, under positive path workflow, the technologist does not have to wait for preview on the console and can instead rejoin the patient,” Miller said. “While attending or repositioning the patient for the next view, the tech can simply accept the image at TechVision such that the console is already preparing itself for the next view.”

The solution also offers automated preprogrammed generator exposure techniques for each body part to be examined. Miller praised the increased productivity, patient comfort, and image quality made possible through DR, as compared to hard-copy film. Additionally, he mentioned the decreased patient dose inherent in highly dose efficient scintillators. “The highly efficient scintillator translates to lower patient dose, which also translates to shorter exposure times, which also translates into minimized patient motion during the image acquisition.” Reduced dose is another benefit that’s key to the pediatric patient population.

The Q-Rad Digital Ceiling-Mounted System utilizes a floor-mounted tube stand with a 10-foot floor-mounted track, designed for flexibility. The systems are currently available for use throughout the world.

(l-r, seated) Michelle R. Straka, MD; Marcela Böhm-Vélez, MD, FACR; (l-r, standing) Thomas S. Chang, MD, FACR; and Barbara H. Ward, MD.

Region’s “Hot Spot” for BSGI

Weinstein Imaging Associates began performing breast-specific gamma imaging (BSGI) procedures in May 2007 and, to this day, is the only facility in the greater Pittsburgh area to offer the service.

More than 400 patients at the center have been evaluated with the molecular imaging technique, which is used as an adjunct to mammography. Theoretically a more direct indicator of the earliest evidence of pathology, BSGI looks at cells at the functional level. Like MR and also ultrasound, it is used in the assessment of patient symptoms in areas of concern, as well as guidance for biopsy. Yet the specificity for MR is lower with more false positives, said Barbara H. Ward, MD, a radiologist at Weinstein. She continued, “Many patients cannot tolerate or are not candidates for MRI, and insurance companies have strict guidelines regarding eligibility and coverage. MRI is an enormous investment in both monetary and physical terms.”

Because it is not limited by breast tissue density, BSGI is ideal for women with dense breast tissue or for those in whom imaging is either difficult or limited. Using the Dilon 6800, a high-resolution, small-field-of-view breast-specific gamma camera, manufactured by Dilon Technologies of Newport News, Va, emitted gamma rays are converted into images showing “hot spots.” These are more highly concentrated areas of radionuclide. Image acquisition generally takes up to 10 minutes.

BSGI comes with numerous benefits. It is well tolerated and has a small “footprint.” The four to eight images obtained, compared to the hundreds of images yielded by MR, are conducive to efficiency, with physicians reading fewer images. Also, it is covered by most insurance companies under standard nuclear medicine codes with a markedly decreased cost, relative to MRI.

Yet despite BSGI’s benefits, Ward points out that there are some associated challenges. In addition to the process of creating a “hot lab,” the group had to go through nuclear credentialing and licensing. Two mammography technologists were trained in intravenous injections and BSGI techniques, and physicians began to educate the surrounding medical community on the procedure and its advantages.

Furthermore, the fact that Weinstein is the only health care provider in their area to offer BSGI can cause some to question, Ward said: “If it is so great, why don’t the academic centers have it available?” In what she referred to as a “software challenge,” Ward mentioned that physicians can be skeptical and reluctant to embrace the new and unfamiliar.

“We faced this challenge by individual conversations with physicians, informational letters and brochures in mailings, and speaking at various local society meetings,” said Ward. “Of course, educating the patient and the subsequent ‘word-of-mouth’ message have been invaluable. Women who have experienced BSGI have been spreading the word in person, on TV news reports, and in newspaper articles quoting them.”

Nevertheless, local publicity, conference presentations, and recent articles in peer-reviewed journals have helped reinforce BSGI as a credible, and useful, modality. Even more helpful are the results. Out of 371 BSGI cases, the practice has diagnosed six cancers not previously detected, Ward said.

“Based on the response that we are seeing, the additional cancers that we have detected, the quality of care that it provides, and the growing awareness of its benefits, we think that the availability of BSGI will pay off in new business in the future,” Ward said. “BSGI has already served to bring new patients and new referring physicians into our practice, where patients receive a comprehensive diagnostic evaluation. The ability to offer a complete evaluation with definitive recommendations is invaluable to both the patient and their physician.”