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| Renee DiIulio |
Brent Colby, a physicist with MeritCare Health System (Fargo, ND), has overseen the institution’s switch to DR?a transition that followed the implementation of a PACS solution. MeritCare has roughly 16 CR systems and one DR with two more DR to be added. The goal is to become completely filmless while improving the efficiency of the facility’s imaging operations. “A previous analysis had found one neurosurgeon spending an hour tracking down one film?that’s one expensive hour,” Colby says.
Although it still operates 29 film processors, MeritCare has benefited from productivity gains that have nearly doubled since it converted to DR. “We tracked the exams from start to finish and found a two-to-one throughput with DR and CR,” he says. “We then checked our process and calculations a few times, because we didn’t believe it at first. But the productivity gains are real.”
Colby doesn’t have to evangelize?he’s preaching to the choir. Penny Maier, national marketing manager with FUJIFILM Medical Systems USA (FMSU of Stamford, Conn), notes that the adoption of digital X-ray technology is mid-70%. “Because of its flexibility, there is no reason why all imaging can’t be digital,” she says. “The market is evolving, with a trend toward smaller community hospitals investing in this modality following their conversion to PACS.”
Thinking of upgrading to CR or DR? Take the following into account.
Digital Drivers
“Facilities that bring PACS online need all of their modalities digitized to be able to transmit the images for reading,” says Elaine Bouchard, assistant manager of sales at Canon Medical Systems (Lake Success, NY).
If a facility just wants a digital image, a number of options are available at different price points. But knowing the facility’s other goals will help determine which modalities to bring in and how many.
“Generally, the move to digital is structured around the idea of improving workflow,” says Todd Minnigh, director of marketing for the Americas at Eastman Kodak Co’s Health Group (Rochester, NY). “Patient volume is up, and the hospital wants to use resources more efficiently while reducing lost films. There are now many ways to communicate an image without giving away the original film.”
First, customers need to consider what’s important: Image quality? Improved workflow and productivity? The durability and reliability of the system? Every facility has a list of criteria it works with and committees that review the purchasing information, which should include goals, expected benefits, specifications, features, the vendor’s track records, lifecycle cost, and, of course, purchase price.
Set Goals
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| CR systems come in all sizes. The Kodak single-cassette DirectView CR 850 System has a 25- x 29-inch footprint. |
Before making any large purchases, a facility or department should always look at the current workflow and then identify the steps and processes for exams. It can do this itself or hire an outside source. Some vendors have independent groups that can make objective recommendations.
Minnigh notes that Kodak’s evaluation services use a series of tools that include Six Sigma’s LEAN manufacturing and process engineering. “Using an outside source can lead to greater objectivity and freedom from legacy processes,” he says.
Facilities performing their own evaluations will want to create a checklist for patient exams, including every step?from getting the patient in the waiting room and into a gown, through performing the exam and sending the patient home. Says Bouchard, “I’ve seen studies that show 14 steps in a traditional analog exam reduced to six with Canon DR systems.”
Expect Benefits
The improved workflow can lead to increased revenue (through greater patient volume) or cost savings (through a reduction in expenses, such as associated staffing costs).
Quicker throughput means better patient care, with shorter waits and faster time to results. This aspect might not only improve patient outcome; it also can reduce discomfort or pain. Minnigh recounts how a trauma center in Tulsa, Okla, uses a ceiling-mounted
U-arm to scan immobilized patients in two series?one frontally and one laterally?without having to move the patients. “This eliminates a lot of pain,” he says.
The end results?images and diagnostic capabilities?also offer benefits, with users reporting increased satisfaction with postprocessing capabilities. According to MeritCare’s Colby, “Our doctors are seeing clinically significant anatomy that they didn’t see before. The images, particularly chest portables, are more consistent, and there is greater confidence that the image is correct and not due to a screen hiccup.”
Evaluate Product Features
A system must have the necessary postprocessing features to truly add value. What are the features needed by the department? Which should be on a wish list? What won’t be used?
It is important to consider the sophistication of the technology, Maier notes. Some of the postprocessing capabilities can be applied automatically, so the radiologists do not need to think about them. For instance, FMSU’s Flexible Noise Control removes noise automatically to enhance the image.
Minnigh suggests, “Customers also should ask themselves what primary market this item is designed for and how robust is it.” How reliable is the product, and what sort of downtime can be expected? Is it insulated from external influences, such as power outages or network downtime? “If a system is dependent on outside factors, then there is increased vulnerability,” he says, noting that additional components, such as an internal CPU or battery backup, can eliminate this dependence.
Adds Bouchard, “Comparing specs is not the best way to evaluate systems. Rather, facilities want to note how it will fit into their workflow.”
It also is a good idea to check how a new system will fit in with other systems already in place. According to the vendors, there are generally few compatibility issues, and companies can verify the systems with which they have previously worked.
“Because many of the DR adoptions are driven by PACS, facilities need to know that all the systems work together efficiently,” Maier says. “DICOM compliance provides a certain level of comfort with connectivity, but it does not mean it will always be perfect. Users might need to optimize the image.”
Vet the Vendor
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| Portable DR systems are making a debut. Canon’s CXDI-50G features a 14- x 17-inch imaging area and a weight of 10.6 pounds. |
Buyers should ask companies which vendors they have worked with previously, if compatibility is a concern, and how many installations of a similar type that the vendor has completed. The buyer should then check those references and speak to those customers about their experiences.
Buyers should consider such factors as reputation, reliability, service contracts, warranties, and market experience. What is the vendor’s and product’s track record? Is the vendor flexible?
“You want a real partnership with your vendor,” says Colby, who cites flexibility as a key component. MeritCare has worked with its vendor, Kodak, to make a customized solution, creating new configuration grids and even sending Colby to application school despite his atypical physics background.
Make Room
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Customization is particularly important for space issues. Smaller hospitals might not be able to expand their departments, so they must choose systems with smaller footprints, such as CR and DR.
“It’s a question of workflow and price,” notes radiologist Murray Reicher, MD, of the Radiology Medical Group (San Diego) and chairman of DR Systems Inc (San Diego). “CR units can serve multiple rooms, and DR can offer space savings if you use fewer rooms than were devoted to conventional X-rays.”
This is frequently the case. “When space is at a premium, you can reduce square footage using DR over X-ray, or you can increase the number of patients going through the original space,” says Colby, who notes that MeritCare has faced no major challenges in converting its existing rooms.
Time to Invest
The only reason Colby has not replaced all of MeritCare’s film processors is economic. “Some of our clinics only perform about 200 X-rays a year, so it becomes difficult to justify the expense,” he says.
According to Reicher, budget can be the biggest factor in making the switch to digital. “This area is one of the most undercompensated disciplines in medicine. Whether the exam is a $50 X-ray or a $500 mammogram, there are similar support expenses, such as those related to data storage and telecommunication,” he notes.
DR is more expensive than CR, so many facilities opt for a combination of the two, particularly if they want portability, which CR is better able to provide. “Typically, a budget will allow for just one DR system. CR is more flexible,” Maier says.
However, it doesn’t always have to be about money. Colby notes that administrators like the idea of reasonably low doses of radiation producing high image quality.
Calculate Cost of Ownership
Cost of ownership is also a factor that must be considered. Look at productivity in terms of reliability as well as the service and support infrastructure. How costly are the consumables? “CR plates can get expensive,” Reicher says. The only time you really have leverage to negotiate their price is at the purchase point of the system.”
Follow Through
Finally, buyers must verify that all of these factors have been considered. The items should be spelled out in a business plan, which Reicher advocates for the purchase of all capital equipment. Share the plan with staff, and let them know who will be part of the team moving forward. Then, follow through.
“You must plan the savings and ensure that it happens,” he says, citing the conversion of one X-ray room to CR as an example. Administrators projected that the conversion would allow the same volume of patients to be seen in two rooms rather than the four currently being used. But they made it happen by converting the two extra rooms to other uses rather than adopting a wait-and-see approach.
“They planned the savings, which you have to do,” Reicher says. If planned right, converting to DR could see similar eye-popping results.
Renee DiIulio is a contributing writer for Medical Imaging.
