· X-ray Storage and Delivery on Demand
· Fuji?s FCRm: Ready for the Road
· Mammographic Images: Addressing the Gray Area

X-ray Storage and Delivery on Demand

Bridging the physical and digital radiology divide, Starpoint Global Services, Chapel Hill, NC, has introduced a solution that allows for physical off-site storage of patient films and digital retrieval.

Through X-ray On Demand, radiology departments and practices can request films stored at the off-site Starpoint Information Management Center via telephone, fax, or a Web portal called RSWeb. The films are digitized and formatted into a DICOM, which can be read and archived by standard PACS, regardless of the vendor.

The digitized image is window leveled, and it can be combined with an indexing of patient demographic and exam information. Using a secure Virtual Private Network, films are sent directly into a hospital’s PACS, where they are available for analysis and comparison with existing digital images.

Matt O’Brien, national solutions engineer for Starpoint, said the company began in the records management industry in the same way their competitors started in the market: storing boxes and files, and physically delivering those requested. For this service alone, there is a significant demand in the health care space, he said.

“Records are misplaced and lost, and space is always at a premium within hospitals and centers,” O’Brien said. “Through our process of bar code labeling each patient’s jacket, we provide real-time tracking of all files under our stewardship and greatly reduce inefficiency and liability.”

When Starpoint began to see a trend toward PACS, the company decided to follow its customers’ lead and pursue more efficient technology.

“As opposed to our health care clients, who were aggressively pursuing more efficient technology, records management companies were more than content to sit idly by with a ?business as usual’ attitude,” O’Brien said. “We took a chance and hit a chord with the industry by investing in Kodak film digitizers, upgrading our IT security and increasing our data transmission capabilities.”

Later, Starpoint reinvested in additional Vidar digitizers with mammography capability, permitting its clients to obtain full-field digital mammography and select the image-acquisition device of their choice: CCD versus laser. O’Brien said clients appreciated the ability to work in an all-digital reading environment instead of interpreting from a computer screen and comparing to a light box. The largest benefit of the service is increased speed, productivity, and efficiency of departments and radiologists, according to O’Brien, who points out that Starpoint offers 30-minute guaranteed delivery of any study.

Roy Leyva, radiology coordinator at CHRISTUS Spohn Hospital Kleberg in Kingsville, Tex, agrees. Before utilizing the X-ray On Demand service, storage of archives at his facility was not easily accessible, especially after hours, he said.

In the hopes of finding a particular file, clerks were forced to rummage through files in four or five different areas. Even more, when removed from the department, patient films were not in temperature- and humidity-controlled environments. Since acquiring the Starpoint solution, workflow processes for Leyva have significantly improved.

“I can ask for a copy of film or a digital compressed e-file of data, or a light-speed transmittal of elected data onto my servers for instantaneous lookup and see,” he said. “The team at Starpoint is very customer friendly and offer presidential attention, regardless of my facility’s ?small size.’ “

Another benefit Leyva has enjoyed is the cost of managing films. Storage space at his facility is at a premium. In 5 years, millions of films would have to be digitized at a rate of what he estimates as 25 cents per film, plus the cost of equipment. Completing this monumental task in a timely manner would require much effort from personnel. For Leyva, Starpoint “was the only logical and cost-effective solution.” The pricing structure consists of three rates: a one-time fee to intake; a monthly fee per jacket; and a film digitization fee per sheet.

O’Brien added that Starpoint also integrates libraries of outside clinics that are connected into the hospital’s PACS, providing immediate seamless coverage to a network of institutions. The company also offers initial bar code labeling of jackets, keying medical record numbers, names, dates of birth, and last dates of service into the system upon inception of each film library. With Starpoint handling storage, facilities can reclaim space for new equipment and increase ROI.

Starpoint operates three sites, in Dallas and Chapel Hill and Wilmington, NC—”but that leaves a lot of miles between Starpoint and most of our clients,” O’Brien said. The company faces a perception challenge, with potential customers concerned about having their films stored in a completely different state.

“What we demonstrate is that geographic boundaries are no longer significant in today’s digital health care environment,” O’Brien said. “We have a lot of bandwidth coming into our sites with multiple T1s that allow us to digitize and transmit images within 30 minutes at any time, guaranteeing immediate service regardless of distance.

“Also, as a long-established records-management business we have environmental mediation strategies and systems that guarantee uninterrupted service even in the event of natural disasters.”

—Elaine Sanchez

Fuji’s FCRm is well suited to mobile units as it features a durable imaging plate.

Fuji?s FCRm: Ready for the Road

Mobile mammography units are new in some areas, but not in Fort Smith, Ark, where for 20 years St Edward Mercy Medical Center has sent a vehicle to schools, factories, and wherever else women can benefit from an exam. What’s new inside the hospital’s mobile unit is the equipment: the newly installed Fujifilm Computed Radiography for Mammography (FCRm), a digital system that eliminates the need for film and gives radiologists more options for analyzing images.

“It’s just like a photograph. You have a photograph in your hand from your high school yearbook; you can’t change it,” said Ruben Miller, imaging director at St Edward Mercy Medical Center. “But if you take a digital picture you can change it, make it brighter or darker, and see information you can’t see on a static photograph.”

More than 400 mobile mammography units are operating across the United States, and most use analog film systems, according to Fujifilm. While nearly 30% of mammography units in hospitals or other fixed locations have converted to digital technology, less than 15% of mobile units have made the switch, the company said.

Fujifilm obtained FDA approval for its FCRm system in 2006. Since winning FDA approval, the company has sold more than 500 units at hospitals and other fixed sites in the United States, and FCRm is the world’s most widely used full-field digital mammography system.

Earlier this year, Fujifilm announced it was making its FCRm system available for use in mobile units. Aside from St Edward Mercy Medical Center in Arkansas, the system also has been installed in mobile units operated by the Harris County Hospital District in Houston and St Joseph’s Hospital of Atlanta.

For St Edward, which got FCRm in its mobile unit in January, the system cost $162,000, Miller said. FCRm saves time for staff members, because with the old analog system they processed film for up to 2 hours each day, said Michelle Bonds, mammography manager at the hospital. “There’s no more developing films or anything like that,” Bonds said. “And we are getting much better-quality images than film.”

The unit’s staff can better evaluate the results for each patient by manipulating the image, such as by adjusting the contrast between light and dark. “You can look at it all the way from the skin line to the deep tissues,” Miller said.

Fujifilm offers Synapse, its own PACS, but FCRm will also work with other systems. St Edward has a PACS made by Hologic for the mobile unit, and the staff has no problem using that PACS with their new digital imaging technology. “Our file room isn’t growing,” Miller said. “We’ve got it all on spinning disc, so the archive is much, much better.”

St Edward Mercy Medical Center sends out the mobile mammography unit about twice per week, visiting hospitals, schools, factories, and businesses. On one trip, the unit will see anywhere from 10 to 50 patients.

Fujifilm officials say FCRm is the cheapest and best full-field digital mammography system for mobile units, because the imaging plate is durable enough to sustain the knocks and bumps of the road. Competing mammography systems rely on DR, while the Fujifilm system uses CR, which is still digital but can be adapted to existing x-ray equipment and is less sensitive to temperature changes. “Down south being hot and humid, and of course being in the north where it’s cold and dry, it can be a challenge to utilize DR digital in a mobile environment,” said Andrew Vandergrift, national marketing manager for Fujifilm Medical Systems USA.

—Alex Dobuzinskis

Totoku ME551i2 medical LCD display monitor

Mammographic Images: Addressing the Gray Area

When dealing with displays for radiographic images, it is common for people only to consider 2D resolution as a factor in selecting their desired solution. But the issue isn’t that black and white. So Quest International Inc has released an offering that addresses another important aspect—grayscale granularity.

Quest has introduced true 12-bit, grayscale mammographic images utilizing an Apple Mac system, OsiriX, and the Totoku ME551i2 medical LCD display, the only display able to interface with the new 64-bit version of the most advanced open-source PACS workstation DICOM viewer on the market.

Quest executive Laura Stothard explained that mammographic images are typically captured with 14-bit and truncated by the display system, and radiologists want a display that is as close to film as possible.

“Because Windows will only pass an 8-bit grayscale, there are visual limitations,” Stothard said, adding that most PACS systems operate on Windows-based PCs that only pass an 8-bit grayscale. “This is not an issue with Apple technology. Neither the Macintosh operating system, Os X, nor the PACS application, OsiriX, is limited to an 8-bit grayscale. Because these software limitations do not exist, the monitor becomes the determining factor. Since the displays we used in this solution have a proprietary color space conversion, making the 12-bit grayscale possible, the Mac treats the monitor as if it is a color display. In turn, the display converts the color data to high-bit-depth grayscale.”

In 2007, Quest was approached by a customer searching for a true 12-bit imaging solution, Stothard said. The company looked beyond the traditional Windows technology because of its inability to support the requirement, and naturally honed in on Apple.

Stothard said Quest’s research and development team, independent of any display manufacturer, reviewed specifications, tested parameters, and completely evaluated several displays, and arrived at the Totoku monitor.

“As the Totoku Master distributor for North America, we were pleased that a Totoku display is the only display on the market able to be integrated into the Mac and OsiriX imaging solution.”

Once the Totoku high-bit-depth functionality was confirmed, Apple approached Quest with an interest in the project and suggested that the OsiriX software development get involved.

OsiriX offers advanced 3D postprocessing tools, complete support for 4D imaging, and 5D imaging for cardiac PET/CT. Representing Quest’s first collaboration with Apple, the partners endeavored to provide the platform as part of a system that was both technically viable and cost-effective.

“The multifunctional features of the Mac and the freeware PACS application OsiriX make this imaging solution attractive to budget-conscious facilities,” Stothard said. “We are pleased to be part of a solution of this type. Advances in technology are great; accessible advancements in technology are better.”

—E. Sanchez