Managing the Flow in Radiology

Carestream Designs Cassette-Size DR Detector
Partnering: Digital Planning for Orthopedics
CardioPACS Solution: Flexible Image Access

Carestream Designs Cassette-Size DR Detector

The expense of replacing the x-ray room stops many in their tracks during their quests to implement digital radiography.

“Many facilities delay installation of DR until an x-ray room is at least 10 years old to justify the cost,” said Todd R. Minnigh, senior director Care-stream Health’s digital radiography business.

Carestream just unveiled the industry’s first wireless DR detector to be used with existing wall stand or table-based Buckys.

Carestream Health, Rochester, NY, looks to eliminate this cost concern through its new wireless, cassette-size CARESTREAM DRX-1, a work-in-progress system that fits into both wall stand and table-based Buckys.

Minnigh explained that a DR room can cost anywhere between $245,000 and $655,000, and it doesn’t handle the entire suite of procedures, he said. “This is a really significant investment and proposes a considerable obstacle in the event that you’re not already changing the room,” he added.

Under development over the past 3 years, Care-stream’s new technology marks a significant change, Minnigh said, because the company has eliminated all of the hurdles that had prevented people from moving into DR in the past, “things such as room renovations, cost of retrofitting, or simply the cost of completely replacing a room.” The price point for Carestream’s new system is expected to be about $125,000, which is up to 75% less than the cost of installing a new DR imaging system or retrofitting a room.

Providing a rapid, affordable conversion for those with radiographic film or computed radiography systems, the CARESTREAM DRX-1 System consists of a console and a wireless 14- by-17-inch cassette-size digital radiography detector. Incorporating all of the components for a DR detector and power source into the standard cassette was a challenge, Minnigh said, but the company’s innovators prevailed.

“Our design team miniaturized the required circuitry and developed a compact removable and rechargeable battery as a power source,” Minnigh said. “We knew the batteries needed to be removable so they could be recharged while the DR detector remained in use. Our detector is designed to capture 90 images on a single battery. We market a charger that accepts up to three batteries so facilities can use a single DR cassette all day and all night if needed and never run out of power.”

The system boasts a number of benefits. One, it does not require any modifications to existing analog equipment, which makes for lower installation costs. It is also fast, with the ability to deliver high-quality preview images in less than 5 seconds. Lastly, it is designed to exhibit flexibility of use; it can be used anywhere it is needed, such as the wall stand Bucky or table Bucky, or for tabletop shots and other difficult views.

“One detector for the room can do a great deal of work with very limited movement of the cassette,” Minnigh said. “Because it’s DR, it stays in the Bucky. You don’t have to take it out and transport it back to a reader like you would with a CR cassette or back to the dark room like you might with a film cassette.”

Suitable for general radiology, trauma, orthopedics, and virtually all other x-ray exams, the 8.5-pound detector is up to 30% lighter and up to 50% smaller than other portable detectors.

The detector includes a console, which can assist with image capture, preparing preview images, image processing, and full-resolution display. Images can be transmitted as DICOM files to a PACS or storage device. Security is provided through a point-to-point network connection using industry-standard wireless security methods. “Once the images are transmitted to the DR console, they are communicated over the hospital’s network like any other modality and employ existing security features,” Minnigh said.

The CARESTREAM DRX-1 system, which will make an appearance at this year’s annual meeting of the Radiological Society of North America, is expected to be available in the first quarter of 2009.

Elaine Sanchez

Partnering on Storage Management

TeraMedica Healthcare Technology, Milwaukee, has announced a new partnership with Caringo Inc, Austin, Tex. The two companies will work together on a more cost-effective approach to management and storage of medical images and health information, combining TeraMedica’s Evercore with Caringo’s CAStor.

“We’ve known about TeraMedica for a while,” said Derek Gascon, vice president of marketing at Caringo. “We’ve been very impressed with what they were doing to provide an infrastructure across different PACS members and modalities. Coupled with a storage technology like CAStor, it’s a very effective infrastructure for handling medical images. One of the things we always see is how much new storage health care customers need, and how much of a challenge that storage is to manage. TeraMedica felt that the integration would give customers an affordable, comprehensive means of managing medical images.”

CAStor works by leveraging the customer’s existing hardware to implement a scalable, affordable storage cluster. “It’s a software-only approach to storage,” Gascon said. “It will run on any x86 hardware architecture, so it gives companies freedom of choice when it comes to commodity server hardware. We can build clustered storage on commodity server hardware packages, starting as low as one terabyte and building up to hundreds of terabytes and beyond.”

Evercore provides instant access to medical images pulled from the existing EMR, along with digital content like demographic data or electronic reports. “TeraMedica’s Evercore software complements Caringo’s CAStor by enabling access to medical images and other clinical digital content in a typical hospital environment with multiple vendors,” said Jim Prekop, president and CEO of TeraMedica. “The joint solution delivers an enterprise approach to providing a comprehensive clinical-classification content middleware and storage management model.”

The integration between the two products is through an http interface, Gascon explains. “Evercore is natively integrated with CAStor on an open protocol that will be supported long into the future,” he said. “It allows applications to send custom meta data elements to be stored with content for however long it’s going to be maintained. There are some very unique things that can be done in terms of putting meta data into a CAStor object.”

Because the two platforms are integrated on an open protocol, customers have the same flexibility with Evercore that they would have with CAStor alone—the freedom to choose the systems and hardware platforms they prefer without being locked into proprietary technologies. This makes image access and storage especially easy to manage. “This really is a self-managing, self-healing environment,” said Gascon. “There’s not a tremendous amount of overhead necessary in order to manage a cluster.”

The two products will not be packaged together, but can be purchased and implemented at the same time. “Customers look to TeraMedica to recommend a storage environment, and our customers are asking our advice on technologies like Evercore,” said Gascon.

In the future, Caringo hopes to implement similar integrations between CAStor and products from other vendors in the health care sphere. “We’re actively talking to a number of vendors,” said Gascon. “We see great opportunities to work together with PACS vendors and modalities, and we also see opportunities with other vendors within the space.”

Cat Vasko

CardioPACS Solution: Flexible Image Access

Getting the physical report back in a patient’s chart had been a major challenge at the Cardiac and Vascular Center, part of St Peter’s Hospital in Albany, NY. Each year, the busy center performs 800 cardiac surgeries, 900 interventional procedures, and approximately 3,200 diagnostic procedures. It also has a large electrophysiology department that performs more than 2,000 annual studies.

Another difficulty resided in expenses relating to clerical support, which was required for the process, program director Steve Cameron said. The facility also experienced system inefficiencies, and physicians did not have the flexibility to view echocardiograms and cast digitally from anywhere inside, or outside, the institution.

Seeking help, the center decided to turn to a vendor with whom they had a relationship since 1980. LUMEDX Corp, Oakland, Calif, and its CardioPACS solution worked wonders for the facility.

“Our number one accomplishment was to make our physicians more efficient,” Cameron said. “They are now able to view all clinical information on a patient with a single sign-on and a single patient lookup in our institution,” Cameron said. “The medics worked with our IT department to embed their software into the clinical information system supplied by the hospital. Therefore, the physician can view all clinical information, including all reports performed in cardiology, through a single sign-on.” The information, including the films for catheterization and echocardiography, is also available via WebEx, he said.

Cameron explained that cath lab reports, which had previously been using an AIM picklist, now were being completed by the physicians immediately after the case, electronically signed, and distributed to the floors’ referring physician medical records. The center also procured an interface from LUMEDX to its physician’s offices so that once the reports are completed, they are dropped electronically into their medical records. Reports are customizable, Cameron said, so they could accommodate a physician’s individual needs.

The center also procured an interface from LUMEDX to its physician’s offices so that once the reports are completed, they are dropped electronically into their medical records. Reports are customizable, Cameron said, so they could accommodate a physician’s individual needs.

The center is currently in the process of installing the latest 5.0 version, equipped with a fully integrated suite of applications, modules, and interfaces. Furthermore, physicians will have the ability to view diagnostic-quality images in real time from any network-connected PC—in the OR, cath lab, private offices, or remote outreach and mobile clinics. According to LUMEDX, CardioPACS 5.0 is a multimodality, scalable, and vendor-neutral solution that easily integrates with other systems, such as EMR, HIS, and PACS.

Cameron said the center is working on enabling physicians to read their reports remotely, so that if they are practicing at multiple hospitals, they don’t need to be physically at St Peters to read its reports. “With the diminishment of physician reimbursement, making [doctors] more efficient and [requiring] less time for travel are in both our benefits,” he said.

“Once the system is completed, we believe this will give us a market advantage over other institutions in our area,” Cameron said. “We also see the need to move quickly into the electronic medical record based on where CMS and our government are going to make a major focus on electronic medical records. If we can make it easier for our physicians to make the transition again, we will hope that they will choose our hospital to bring their patients to.”

E. Sanchez