The Right Fit

Today?s vendors offer affordable, customizable CR/DR solutions for providers of every size.

From the modest community hospital to the large university institution, health care systems across the country are adopting more advanced technologies to deliver enhanced quality of care for their patients.

In the world of radiography, that means updating dated analog systems with available options in computed radiography (CR) and digital radiography (DR). While costly price tags deter some hospital administrators from biting the x-ray bullet, others decide to purchase solutions that meet their own unique needs.

The following case studies demonstrate how capital investments made economic sense for two different CR/DR users.

NorthShore Health Center: Making Sure the Price Was Right

When x-ray tech Sue Geary began her job at Skokie Hospital, part of NorthShore Health Center in Illinois, in May 2009, it was not only her first day in new surroundings but also her first time working with DR.

The solution in place was the SomaRad from IMIX Americas Inc, Sterling, Va. It is equipped with the IMIXhorizon Focus Series Detector, a high-resolution 9 MP CCD detector, an image and acquisition workstation that allows for review within 10 seconds of exposure, and an IMIXSomaRad Positioner that offers fully motorized movements.

For Geary, a seasoned vet with 20 years of experience, it was a welcome departure from the traditional process.

“I came from an orthopedic practice, and we actually had to develop our own film,” she said. “In traditional radiology, you carry the films, they are very heavy, and it’s cumbersome. You have to wait to develop the film to secure your images. Plus, the patients have to wait. With DR, there are no cassettes and no challenges. Everything is very simple, easy to use, and there’s no wait time.”

NorthShore CEO Jan Wilson explained that the price was right when it came to bringing the SomaRad to the then-newly opened Skokie Hospital. The DR solution cost approximately $250,000, with its competitors in the market around the $265,000 to $300,000 range. But she said that was not the only factor in her decision.

“Everything is going to be digital,” Wilson said, adding that the wait time associated with traditional x-ray was “unacceptable.” She continued, “Why would we buy analog again?”

After examining several models, NorthShore was ultimately pleased with the SomaRad’s ability to streamline the reading process. Furthermore, patients’ comfort levels while undergoing imaging exams was improved. Instead of waiting for film to develop to see whether a retake is needed, the SomaRad acts like a digital camera. “As soon as you take [the x-ray], the images just pop out,” Geary said. Wilson was so impressed with the efficiencies produced that she purchased a second unit for another one of their clinics that was being converted to an all-digital x-ray department.

As far as the transition was concerned, Geary admitted that it took some adjustment and creativity to become accustomed to the technology, particularly the positioning of patients.

“It was a little awkward at first because when you’re used to traditional radiology, your machine is set up differently, you have a wall Bucky, everything moves independently,” she said. “With the SomaRad we have, it works as one unit, and everything moves together in conjunction. It took a little bit of maneuvering for positioning, getting used to doing it differently. This is going to be my 20th year of x-ray, and I have to say, it probably took me about a couple of weeks [to adjust] because I had to think a little bit outside the box.”

Another challenge is determining return on investment. “Because we are a community health center, it’s hard to predict ROI,” Wilson said. “We don’t have as many people who are insured; we have a lot of Medicaid, which pays a lot less, so sometimes all we get is the fee to read them.”

To take care of financing, NorthShore applied for and received a capital improvement grant from the federal Health Resources and Services Administration. Still, Wilson maintains that the hospital would have purchased the SomaRad units regardless of whether they were given the federal monies.

“I would definitely say it’s worth it,” Geary said. “It was one of the best moves because it’s so highly efficient. If [other health care facilities] would come and look at the machine to see how functional it is, I think it would sell itself.”

Wilson offered a word of caution for other hospitals that are still contemplating making the digital leap. “I would say that they will be different if they stick with analog because it will be outdated,” Wilson said. “Everybody’s going digital. The technology is improving so much that they are going to be behind the times because nobody wants those kind of x-rays anymore.”

Valley West Community Hospital: Finding a Customizable Solution

Inside Valley West Community Hospital, a member of the KishHealth System in Illinois, a time capsule existed within the facility’s radiographic room.

“Some of the parts to that room were from 1975,” said Janey Ciontea, RT (R, M), manager of diagnostic imaging. “It was just an old room that became harder to get repair parts for. So we started preparing our budgets and had budgeted upgrading our radiographic room to possibly DR.”

Because Valley West’s sister hospital, Kishwaukee Community Hospital, also had a room that required replacement, the two managers from both radiology departments worked as a team to discuss what their options were to move forward with a possible DR purchase. “Through the conversation, we learned about this opportunity with Agfa in the DR room, with also the possibility of improving our CR system,” Ciontea said.

Specifically, the hospital now carries the DX-D 500n, a direct radiography x-ray suite from Agfa HealthCare, as well as a brand-new CR digitizer. The DX-D 500n’s generator interfaces with the company’s NX workstation and Musica software system, products with which Valley West was already familiar.

That’s because prior to its latest DR purchase, Valley West was already equipped with CR, having made the decision to go filmless in 2004. “The health system had made a commitment early on for the CR environment in the radiology service areas, so we’ve been well versed in CR and we had a long-term relationship with Agfa,” Ciontea explained.

During a meeting of the Radiological Society of North America in 2009, Valley West reached out to various vendors and described its unique needs. “I personally contacted Agfa and wanted to discuss what our options there were from Agfa because we had been so invested with its CR and PACS product,” Ciontea said. After a site visit to look at the equipment used in the Quantum Room, Valley was impressed with the quality. “We also loved the NX workstation that our techs were currently using for CR, and we saw it as a simple way for us to go into the DR room,” she said. “Our techs already knew the majority of the image interface on the DR site.”

Even though Valley West went filmless within 2 to 3 days, activating its PACS and CR at the same time, Ciontea said she could not think of any difficulties they encountered. “Everything was tested in place,” she continued. “Our sister hospital had the exact same equipment. So our infrastructure already existed. It was a seamless transition. On one patient we did film and the next patient the CR was set in and we started performing CR.”

Benefits of the DX-D 500n system include an integrated generator and image storage folder on one computer screen, the ability to perform a full-field review of the image, and a small footprint that is more eye-appealing. Technique selection takes place as the patient data is pulled off the worklist. The product also interfaces with the hospital’s RIS system to recognize the exam.

Overall, Ciontea believes the technology will increase the number of patients per day the facility sees. “When you have an influx of patients, you will process those patients through in a more time-efficient manner,'” she said. Most importantly, she said the image quality is a “leap year” from the hospital’s old CR equipment.

Explaining further the key difference between the old and the new, Ciontea said, “In the DR environment, there is an image that displays within 3 to 4 seconds after the exposure, and the entire image is available for final review within 10 more seconds. So within 13 to¹⁵ seconds, you have a full quality image to do your assessment if you need to do a repeat. In our old CR environment, it was a 63 to 70 second process for the images once they started to be digitized.”

In terms of ROI in the general radiographic environment, Ciontea pointed out that purchases will be in the room for 10 to 15 years. “That’s the ROI. You’re going to buy a high-quality room that will be reliable, giving you the monitoring technology existing in the market at the time of purchase that is upgradeable,” Ciontea said. Longevity is therefore a crucial factor in selecting a product. “When we were evaluating the different pieces of equipment, we looked at rooms that were around for 6, 7 years and we looked at what shape the equipment was in,” she said.

Flexibility for redundancy and peace of mind also made the investment worthwhile. The imaging department no longer needed to worry about dropping CR equipment or facing a workstation software error because the workstation can be converted to stand-alone with one simple tablet attachment.

Ciontea concludes that it just made financial sense to trade out the old CR system for the new CR system and acquire DR because it allowed for a decrease in the total amount of equipment.

“Because of the 13-second image display on the CR itself, we were able to cut back on the number of cassettes,” she said. “We went from three digitizers to one digitizer because if we lost our CR, we could still perform DR in the radiographic room. Our overall operational budget for service contract equipment decreased significantly because I didn’t have to have all the equipment that I needed once before. This was a no-brainer.”

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Elaine Sanchez is a contributing writer for Axis Imaging News.