To the Rescue: DR in the ER

By Chris Gaerig

VCU Medical Center chose the CARESTREAM DRX-Evolution for its busy emergency department.

The Virginia Commonwealth University (VCU) Medical Center, Richmond, had a few goals in mind when they upgraded their emergency department’s imaging capabilities with the CARESTREAM DRX-Evolution suites: shorten patient turnaround time, improve image quality, and ease the workload on their staff. This, however, was no easy task for a 779-bed medical center with an emergency department that conducts upward of 43,000 x-ray procedures every year. However, with the Carestream system’s automated capabilities and the upgrade from a CR solution to a DR solution, the facility was able to achieve each of its goals.

“Our goal was to convert our emergency department from CR to DR to achieve image quality gains and faster access to patient images,” said Richard Fowlkes, diagnostic manager, VCU Medical Center. “After a thorough competitive review, we selected DRX-Evolution systems due to the excellent image quality, ease of use, and productivity enhancements. The wireless, cassette-size DRX-1 detector also delivers the flexible positioning we need for urgent trauma cases.”

The CARESTREAM DRX-Evolution suite features a 35 x 43 cm detector, which makes it mobile and easy to use. The low dose detector transmits images to the integrated operator console for viewing and manipulation—Fowlkes believes that the Carestream user interface is also far superior and user friendly, one of the reasons for the facility’s purchase of the DR solution. The system’s fixed table enhances workflow and productivity by aiding and simplifying patient positioning for a broad range of projections, and boasts a four-way floating top that can accommodate patients up to 600 pounds.

But chief among the facility’s concerns was improved image quality, something that the CARESTREAM DRX-Evolution suite was able to produce.

“The image quality is superior to what I have seen so far,” said Rhonda Reed, radiology supervisor, VCU Medical Center. “You will see an immediate difference between the DR and CR images. Our radiologists, ER doctors, surgeons, and other physicians agree the DRX-1 detector offers better image quality than CR. That quality improvement enhances diagnostic confidence and reduces the need for repeat exams.”

Another prime concern for the VCU Medical Center was expediting patient turnaround. Fowlkes hoped to decrease turnaround time from anywhere between 10 and 15 minutes, and estimates that with the implementation of the Carestream solution, the emergency department was able to do so.

“We wanted to improve our patient turnaround time,” said Fowlkes. “With CR, there are several steps we have to go through to view the images. We wanted to remove them to decrease our turnaround time by 10 to 15 minutes. DR would give us this opportunity, and our turnaround time decreased by 10 minutes.”

Finally, the facility wanted to lessen the workload on its staff. One way that they were able to achieve this was simply through the upgrade from a CR system to a DR one. Without having to download images from a CR system to a CR reader, the staff was able to eliminate walking time and energy. But the CARESTREAM DRX-Evolution suite also enabled them to view images immediately and reduced the amount of patient transportation that would occur with a CR system.

“When a CR system takes an image, you have to take the cassette to a CR reader to develop that image,” said Fowlkes. “With the DR unit, you are able to immediately see the image before a patient is moved or transported from the table. There’s no time waiting for the images to be processed.

“It has reduced the strain and stress on our staff technicians. Because the Carestream model is automated, they have to do less movement with the equipment and [that] takes a lot of physical stress off of them.”

Ultimately, it was the noticeable gains in image quality and therefore improved diagnostic capabilities that really sold the VCU Medical Center on the CARESTREAM DRX-Evolution suite. “I want to stress that the image quality is superior to what I have seen so far,” said Reed.

Giant Leap for Tiny Patients

By Chris Gaerig

While imaging any patient carries inherent difficulties, those challenges are significantly amplified in a neonatal intensive care unit (NICU). Aside from obvious dose concerns, disruption to a neonate’s state can be hazardous to their chances of survival. As such, finding a dose-conscious solution that can take images without disturbing the baby is crucial. This was the task facing the Scottsdale Healthcare and Medical Center.

The facility, which has been phasing out CR imaging solutions for several years, decided to outfit its NICU with Canon’s CXDI-60 DR detector. The small, portable detector weighs 5.5 pounds and is less than an inch thick. It is capable of acquiring high-quality images of a range of patients—from the NICU to bariatric patients—while offering dose control to physicians.

“I think for us, the biggest thing is reduction in dose,” said Julie Hughes, CRA system administrative director of radiology services, Scottsdale Healthcare and Medical Center. “That’s a totally patient-focused mind-set, but there are other advantages: our turnaround time and what our techs have to do in the morning to do their portables have been cut in half. That’s the operational benefit, but the big piece for me is the decrease in dose.”

Hughes notes a marked reduction in dose not only in the NICU, but also in other areas of the hospital, and without the aid of a grid, something the hospital staff had to use frequently during CR procedures.

The Scottsdale Healthcare and Medical Center is no stranger to Canon products. After making a concerted effort to upgrade all of their equipment piece-by-piece, the hospital repeatedly returned to Canon for their new systems.

When it comes to radiation dose, Canon?s CXDI-60 DR detector is gentle on infants.

“We probably have everything that Canon has ever manufactured,” said Hughes. “We started with DR products in 2004 or 2005. Every year, we’ve added to our total. It continues to give us great images.

“Every year, we looked at other DR vendors. Canon continues to be our vendor of choice. When we started looking at a new portable, there are various vendors out there, and we brought them in at that time. But it didn’t makes sense to introduce another vendor when we had great image quality, the technologists loved the portables, and they’re easy to manipulate and easy to move.”

Hughes also mentioned the operational benefits that the Canon solution affords the facility, including decreased walking time and a faster turnaround time.

“The detector probably reduced portable time in the morning by half,” said Hughes. “We would do maybe 70 to 80 portables in the morning, and it would take up to 3 or 4 hours with CR. Now, we can do that same number of portables in about 2 hours because it is so fast.”

But the NICU includes challenges that are specific to that department. Hughes wanted to find a DR solution that would cause as little disturbance as possible to the neonates. Through a simple retrofit of the NICU beds, which previously allotted space for an x-ray cassette, the hospital was able to integrate the Canon solution into the department.

“You’re usually in a confined space,” said Hughes. “There are many giraffe beds that you’re trying to maneuver around, so you want something that’s quick and agile. You also don’t want to disturb the babies. You don’t want to do anything to cause stress to that neonate. We’re able to slide the plate underneath the giraffe bed, so we don’t have to take the baby out of the bed. It’s the least stress for the babies because you don’t have to take them out of their warm environment. It’s a win all the way around.”

But Hughes knows that ultimately a successful imaging solution will both reduce dose and deliver quality images. With the Canon CXDI-60 DR detector, she believes they have gotten the best of both worlds.

“We’ve continued the dose reduction by lowering our technique, and the images are still coming out well,” said Hughes. “We started by reducing dose by 60%. That produced good images so we tried to go a little lower. I think we’re probably as low as we can go right now with this current plate technology.” And that’s a giant step when it comes to treating the littlest patients.

Digital Conversion Made Easy!

By James Markland

Southern California Orthopedic Institute (SCOI), a private orthopedic medical facility headquartered in Van Nuys with five satellite offices around the state, has acquired Konica Minolta’s REGIUS Digital Imaging Suite (RDIS) as a key component of their conversion to complete digital systems. The RDIS converts an analog x-ray suite to a fully digital operation. It includes a cassette-less DR for upright examinations with a cassette-based CR for table, stretcher, and portable studies, providing a great deal of imaging flexibility. The RDIS has been installed at SCOI’s Valencia clinic.

The REGIUS Digital Imaging Suite from Konica Minolta

The REGIUS Digital Imaging Suite combines the REGIUS 370 upright DR with either a Nano single plate and/or Xpress dual bay CR reader all operated by a Konica Minolta CS-3 Single Control Station. SCOI’s purchase included the REGIUS 370 DR along with three Xpress dual-bay CRs, two Nano single-bay CRs, and four DRYPRO laser printers. The new units replace 20-year-old analog installations.

Elizabeth Heredia (R) (M), lead radiologic technologist at the Valencia facility, says the new CR system definitely enhances workflow. “We perform about 20 CR scans a day, perhaps 30 on our busiest days,” said Heredia. “This is equal to the flow for DR operations.” Heredia points out that patient flow improved because of the need for less repetitive imaging. “This also affects radiation dose,” she said. “Since we make and view fewer images—and repeat images—to get the necessary results, there is a lower dose of radiation per patient.”

“Our concept behind the RDIS is to enable facilities to move from analog to digital in a cost-effective manner, with the flexibility and advantages of both cassette-based and cassette-less solutions,” said Darren Werner, digital radiography product manager, Konica Minolta. “A single control station for CR/DR with advanced image processing and automated software features combine to simplify user operation and improve staff productivity by reducing the number of steps to capture and process an x-ray.”

SCOI utilizes CR technology to examine the weight-bearing extremities: fractures in arms, hands, elbows, knees, etc. The DR technology is reserved for other applications, for example, the spine. “The Konica Minolta RDIS was the best fit for SCOI,” said Heredia. “CR technology is less expensive for certain applications. So price was a factor in our decision to go with Konica Minolta’s RDIS. We were looking for a balance of technology to handle all our requirements cost-effectively. We are expanding the use of CR technology to our other facilities as well.”

Training on the new CR equipment was something the facility needed to take into consideration. Heredia observes that technologists have to be trained to use the new equipment, body part by body part. “But it generally goes smoothly,” she said. “It takes about a week and a half to 2 weeks to get our people up to speed.” Maintenance is also an issue. “We find our maintenance requirements are lower with the Konica Minolta equipment. We receive maintenance service about once a year. All and all, we are happy with the acquisition.”

Agfa Ranks First in KLAS

By Chris Gaerig

Agfa HealthCare’s CR 30-X

Agfa HealthCare’s CR 30-X single-plate computed radiography (CR) digitizer was recently named the number one CR single-plate product in the “Winning with Service & Reliability: CR Review 2011” report by KLAS, a research firm specializing in monitoring and reporting the performance of health care vendors. The report, which was released on February 14, 2011, is a compilation of data gathered from Web sites, health care industry reports, interviews with health care provider executives and managers, and interviews with vendor and consultant organizations.

“We take great pride in providing our customers with top of the line customer service, but also in our ability to continuously offer new features in our CR lines,” said Greg Cefalo, US digital radiography business unit manager, Agfa HealthCare. “By combining our equipment with field support provided by both our dealers and Agfa HealthCare personnel, we will continue to offer customers the products and services they need to improve the delivery of patient care and streamline clinician workflow.”

For the “Winning with Service & Reliability: CR Review 2011” report, KLAS surveyed 148 participants from 123 facilities. Of the participants, the majority of those surveyed were imaging managers—58% of participants. Other titles that featured prominently in the report were imaging directors—28%—and technologists—11%. The distribution of facility sizes in the report was also varied: 45% of all facilities surveyed in the report feature anywhere from one to 200 beds; 35% have 201 to 500 beds; and clinics and 500-plus-bed facilities divided the remainder of the participating facilities.

The Agfa CR 30-X is a compact, tabletop CR system with a single-slot digitizer, and is intended for decentralized general radiography, military field hospital, orthopedic, dental, chiropractic, and veterinary use. The system features high image quality and provides seamless integration, from x-ray exposure to print or soft copy.

Using dedicated cassettes that are inserted horizontally—the CR 30-X supports all common cassette formats, including dental panoramic—the system requires minimal space and easily integrates in vans, trucks, and other mobile facilities. When you combine it with the optional universal x-ray shielding, the CR 30-X can also be used inside the x-ray room.

The CR 30-X scans at a spatial resolution of 10 pixel/mm and processes the image using MUSICA/MUSICA2, Agfa HealthCare’s patented image-processing software. By scanning the phosphor plate at the full width of 43 cm, the CR 30-X provides both high-quality images and high throughput.

The CR 30-X digitizer can be installed in a single day. Its LED technology in the erasure unit requires no additional electricity, making standard electrical outlets sufficient. The system also features a modular, component-based design, lowering the cost of maintenance.

Minimum requirements to use the CR 30-X digitizer include CR MD 4.0T General Cassette, CR MD 4.0 General Plate, and Agfa HealthCare’s image identification and quality control workstation NX.

Other vendors mentioned in the “Winning with Service & Reliability: CR Review 2011” report include Carestream, FUJIFILM, iCRco, Konica Minolta, Philips, and Radlink.

The KLAS report—written by Emily Crane and edited by Holly Wallace—is available for purchase on the organization’s Web site at