Going Wireless

At Sanford USD Medical Center, wireless DR is delivering on its promise to lower dose and improve workflow.

Digital radiography (DR) is no longer considered a “luxury technology” for many hospitals. While the cost of DR systems has declined in recent years (as it does with most “maturing” technologies), a fixed DR room remains an expensive proposition ranging from $200,000 to $250,000. However, the emergence of wireless DR technology is now making DR economically feasible to implement for many health care facilities, including ours.

Wireless DR technology combines the portability of computed radiography (CR) with the high image quality of a flat panel detector. CR has allowed many facilities to convert from analog to digital x-ray at an achievable price point. Although CR is an excellent digital choice for many types of x-ray exams, it does not provide the same level of image quality as a direct flat panel detector. Workflow is similar to that of film, so gains in productivity are minimal with CR compared to a flat panel detector (or DR). With concerns regarding patient exposure to ionizing radiation, many facilities are seeking to reduce dose levels, yet they also need a higher quality image—and DR offers this capability.

Deciding Factors

At Sanford USD Medical Center Sioux Falls in South Dakota, we currently have a total of nine wireless DR plates (Aero DR, Konica Minolta Medical Imaging) with the install of two portable wireless DR systems in our new Sanford Heart Hospital in March 2012. Four are assigned to x-ray equipment in the ER, while five are assigned to portable units and service different care areas, such the OR and the main patient care floors. CR units are in use in the main radiology department and at several outpatient sites.

We originally converted our analog systems to CR in March 2001. Our initial intent in implementing CR was to eliminate film and enable radiologists and other clinicians to access electronic medical images on PACS or at workstations situated throughout the hospital, such as the ER.

CR performed very well for us over the years. Our last CR installation (Xpress CR, Konica Minolta) in October 2010 has provided very good uptime and image quality; additionally, we were able to reduce the dose delivered to patients by 40% to 60% over the prior generation CR cassettes. However, as with any technology and equipment, we needed a faster system with lower dose to patients, so we decided to investigate the new wireless DR offerings.

Wireless DR offers several advantages over “fixed” DR plates. It can be used with existing radiographic equipment and can be brought to the patient’s bedside. With wireless DR, the images are transmitted to our PACS so they are accessible to radiologists, ER clinicians, or surgeons shortly after the image is captured, enabling more immediate diagnosis and review. Also, wireless DR plates bring benefits to our portable units. Using the same wireless plate, we can install wireless connectivity on the portable x-ray unit and, as with the fixed DR systems, remotely transfer the acquired images for review.

Several features were important in our decision-making process. In addition to a higher image quality, we also wanted to lower patient radiation dose. Reliability and durability of the plate was another key consideration as this could help reduce our total investment in DR. The user interface had to be intuitive and easy to learn in our transition from CR to DR. Finally, the manufacturer’s reputation for service and support was absolutely critical.

Positive Impact of Wireless DR

Upon implementation of the Aero Wireless DR, we immediately noticed the ability to reduce patient exposure to radiation dose without impacting image quality. The dose delivered to obtain the same quality image is considerably less—across all exam types, we are averaging 50% less dose than with CR. In fact, our biomed department had to reduce the auto exposure levels at the same percentage (50% less) for our DR systems. We have not experienced a degradation of image quality, and our radiologists have been very pleased with the results at this lower dose level.

Our solution uses a lithium ion capacitor rather than a lithium ion secondary battery used by other vendors. This capacitor provides discharge cycle life that is 100 times longer than that of a lithium ion secondary battery. The charge and discharge cycle life of a lithium ion secondary battery is 300 to 500 charge/discharge cycles. Konica Minolta expects the battery to have a life of 6 to 7 years. Our wireless DR plates also provide more exposures with each charge. With a 30-minute charge from empty, we can capture 120 images, or, if the capacitor has become almost exhausted, it can be used to take five or six pictures in an emergency by recharging it for approximately 3 minutes.

We were very pleased with the reliability of our Xpress CR systems from Konica Minolta, so it was natural to look to the same vendor for our DR system as well as a few others. DR plates, however, are more costly than CR cassettes, so we examined durability testing conducted by the vendors. Our wireless DR plates can be dropped from 30 inches without incurring damage. There is also no notch for replacement, which can become a weak point in the structural integrity of the FPD cassette. And though our wireless DR is durable, it is also lightweight at 6.3 pounds—a feature our technologists appreciate!

A key consideration for our facility was ease of use, including the design of the user interface. Training is an important aspect of any new technology implementation, yet we also are interested in technology that is easier to learn so our technologists can stay focused on what they do best—imaging patients. When we discovered that our wireless DR console had the same user interface as our existing CR, and that we also could control our existing CR and x-ray generators as well as the new wireless DR, we were sold.

Our final consideration was the “icing on the cake”—the vendor’s reputation. We had an excellent experience with Konica Minolta for service and support. Make sure your vendor is responsive to your needs—whether that is regular maintenance, service, or addressing your facility’s specific needs. Not all hospitals have the same requirements and workflow, so “one size does not fit all.” Keep this in mind for any imaging technology you consider and discuss what level of flexibility in product modification the vendor is willing and able to provide.

An example of this flexibility is the barcode reader for requisition that we had added to our CRs and to our wireless DRs. The barcode has the patient’s birthday and accession number, which is tied to the exam requisition. This ensures we are capturing the exact exam ordered and helps reduce errors.

Improved Workflow and Patient Care

Ultimately, the real test of new technology is the impact it has on patient care and clinical workflow. While CR has worked very well for us, it has not significantly decreased the time it takes between capturing the image and making it available on PACS. With each study captured, the technologist has to walk the cassette back to the reader for processing; also, if an area of anatomy is omitted or clipped, the technologist has to go back to the patient to retake the image, hoping that their positioning was correct the second time.

With wireless DR, we are able to view the image within seconds of the exposure, allowing us the ability to move the cassette slightly and retake the image immediately. Once our technologist ensures all areas of interest are well exposed in the image, they can immediately wirelessly transmit the study to PACS. If we can deliver images to the ER faster, then our clinicians can diagnose the patient injury or pathology quicker—and that’s just good for patient care.

For our trauma patients at Sanford USD Medical Center, not having to move them to another table to be imaged, but rather bringing the wireless DR to them, also helps speed up diagnosis. It is less traumatic and safer for the injured patient. Our techs are impressed that they don’t have to move the cassette for many common imaging exams, such as a hand or foot.

With certain procedures in the OR, we now use wireless DR instead of a C-arm fluoroscopic system that has a small (9 inch) field of view. We not only have a larger field of view, but the system delivers less dose and will provide the image clarity needed by our surgeons to view the surgical site. The images are primarily used to enable the surgeon to confirm the level they will operate at and help prevent wrong site surgeries.

Addressing Obstacles

Upon implementation of the wireless DR, one area that was more complicated than anticipated was the wireless networking of the plates. In our hospital, we have different wireless networks, and in order to use these plates in different care areas, each network had to be incorporated. When choosing a wireless DR manufacturer, obtain the necessary commitment from that vendor to ensure a smooth implementation of wireless connectivity. Postimplementation support and assurances that any issues will be addressed immediately or in a timely fashion should be a critical component in the decision-making process.

At Sanford Health, we have experienced greater imaging efficiency, higher technologist productivity, and faster image turnaround times for better patient care. By focusing on high image quality to implement lower patient dose, fast image reconstruction times, battery technology that enables more exposures on one charge, and an easy-to-use interface, we selected a wireless DR technology that enhanced our imaging services and allows us to deliver exceptional patient care.

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Greg Zerfas, RT(R), is Radiology Supervisor at Sanford Health.