Ideas in Hospital-Based Imaging

by Elaine Sanchez

Hospitals Queue Up for On-Cue
Bringing Talent to the Table
Big Benefits for Smallest Patients
Quality and Comfort for Breast Cancer Patients

Hospitals Queue Up for On-Cue

When you take NASA technology used with the Hubble Space Telescope and apply it to the health care industry, people take notice. That is exactly what Allocade Inc founder and CTO and former NASA computer scientist Don Rosenthal has done, and his On-Cue system was just installed commercially in the first of seven sites to be completed by the end of the year.

On-Cue is Allocade’s task scheduling software solution designed to help hospitals increase efficiency by reclaiming their unused capacity.

“Because hospitals typically operate in a chaotic environment with inpatients, outpatients, and emergency patients all vying for the same resources, delays and schedule changes can occur throughout the course of the day,” said Rick Smith, president and CEO of Allocade. “On-Cue is a dynamic rescheduling software application designed to help hospital departments better manage the frequent interruptions and schedule changes and, as a result, maximize resource capacity, reduce operating costs, and improve the overall patient experience.”

The Penisula Medical Center in Burlingame, Calif, a Sutter Health affiliate, became the first hospital to receive the commercial version of the On-Cue system when installation began in July and expanded to cover the emergency department (ED) by September. Within a day and a half, the CT department in radiology stopped paper scheduling, and within a month, they saw significant reduction in outpatient waiting times.

Penisula Medical Center CT technologist Keith Schoenbachler added, “Both patient and employee satisfaction are on the rise thanks in part to the streamlined rescheduling process. Patients are pleased because wait times have been reduced, and employees are no longer hampered by an ineffective system.”

Allocade had similar success with its beta test site installation of On-Cue at California Pacific Medical Center (CPMC) in San Francisco 2 years ago. Clinicians there reported a 12% increase in CT procedure volume, a 30% reduction in overtime, and a reduction from 40 minutes spent on the telephone coordinating patient data to less than 15 minutes. Also, the CT backlog went from 2 weeks down to a single day.

Once the testing phase was completed at CPMC, On-Cue became a permanent installation in the CT department and was also installed in the ED, allowing CT staff to be more responsive to urgent cases. The hospital has plans to continue expanding On-Cue in the radiology department to include other modalities throughout the hospital.

The On-Cue’s software basically works to schedule tasks along a 24-hour timeline. The user can input interrelated constraints such as those describing what tasks must be done first and how much time must be allotted between tasks. The software then generates a schedule that satisfies the constraints without oversubscribing the resources (equipment, staff, etc).

What sets On-Cue apart from its competitors is its Repair-Based Scheduling optimization. This is particularly well adapted for situations in which the planned schedule must be changed or rescheduled. On-Cue is able to provide a new schedule typically much faster than the original, thus allowing for real-time rescheduling in the hospital.

“By simplifying the rescheduling process, On-Cue allows our caregivers to be more responsive to patients,” said Jeff Gerard, regional executive officer for Sutter Health. “Instead of using a pen and paper to schedule and reschedule appointments, the technology helps us make real-time adjustments as conditions change throughout the day.”

—Ed Wilson

Bringing Talent to the Table

When vendors team up, it’s critical that both parties bring something to the table. Toshiba America Medical Systems Inc has partnered with surgical table manufacturer Maquet to help optimize specialized hospital surgical suites and offer a seamless transition from endovascular imaging to surgical intervention.

The partnership combines Toshiba’s Infinix-i™ system with Maquet innovative tabletops, which range from general surgery to radiology-specific tabletops. The Toshiba/Maquet hybrid operating room (OR) suite is the only hybrid solution to offer interchangeable tabletops.

By having a system in an OR that can perform multiple procedures, hospitals can optimize their surgical real estate for diagnostic and interventional imaging procedures as well as hybrid procedures that involve surgeons and interventionalists working together.

Because ceiling-mounted imaging systems are typically best suited for a hybrid OR setting, the Maquet tabletops match perfectly with Toshiba’s Infinix CC-i and Infinix VC-i systems. Unlike other imaging systems, there’s no need to install an after-market modification kit to allow it to work with the Maquet table, which is designed for surgery and the only one with interchangeable tops.

“Historically, many hospitals have attempted to use portable C-arm systems to fulfill these needs, but procedures are becoming more complex and the users have realized they need a real dedicated system. The Maquet table really brings us an advantage to this setting. If you want to utilize the room for general surgical procedures, you need a table that has joints that can bend with the body, for joints such as the neck, back, hip, and leg,” said Dick Werner, product manager for Toshiba American Medical Systems.

Werner said the idea for the partnership was conceived while Toshiba was working with John Cheatham, MD, director of cardiac catheterization and interventional therapy at The Heart Center of Nationwide Children’s Hospital, to develop tools for hybrid procedures specific to pediatric cardiac care. The hospital installed its hybrid system in June 2007, and since then interest in the concept has exploded, Werner said.

He said Toshiba realized a unique market by listening to its customer’s needs and the surgeons’ desires for a Maquet product. Even though the Maquet tabletops cost more than those of their competitors, it made financial sense for hospitals.

“For customers, it is easy to justify the extra cost for complete utilization of space,” Werner noted. “We’re very enthused that we’re on the right track here.”

According to The Heart Center’s codirector, Mark E. Galantowicz, MD, chief of cardiothoracic surgery and associate professor of surgery at The Ohio State University College of Medicine, “This hybrid operating suite by Toshiba and Maquet is designed specifically around the cardiac surgeon, cardiac interventionalist, and cardiac surgical patient, offering new advanced access and imaging in the operating room without having to move patients.”

In addition, physicians benefit from the Infinix VC-i and CC-i’s ceiling-mounted C-arm ensuring head-to-toe and fingertip-to-fingertip coverage, dose reduction technologies, dynamic FPD capability, and exceptional image quality.

“The Toshiba/Maquet hybrid solution will provide the added flexibility that hospitals are asking for today,” explained Kevin Gilroy, Maquet director of business development. “Various tabletops can be readily exchanged to accommodate interventional and surgical procedures, making these rooms more cost-effective. The staff can attach the correct tabletop for the specific case they need to perform without compromising patient positioning for procedures.”

—Verina Palmer Martin

Big Benefits for Smallest Patients

The Riley Hospital for Children, Indiana’s only comprehensive children’s hospital, has purchased Agfa HealthCare’s DX-S system for portable x-ray imaging. The system will be used on some of Riley’s youngest patients in the neonatal intensive care unit (NICU).

Agfa’s DX-S system is a portable CR offering highquality imaging.

When asked what drew the Riley Hospital to the DX-S system, Mervyn Cohen, MD, Eugene Klatte professor of pediatric radiology, had the following to say: “Having a convenient system that can combine superior image quality and enables portable x-rays to be completed without leaving the patient area was critical to our selection of a new imager for our NICU.” He added, “The improved image quality of DX-S can also decrease the number of exposures due to repeats caused by inadequate exposure technique.”

The DX-S is a computed radiography (CR) system featuring two breakthrough Agfa HealthCare technologies. The DirectriX needle-based detector significantly improves x-ray collection sensitivity. This allows high-quality images to be acquired with less radiation dose imparted to the patient. In addition, the Scanhead line-to-line CR simulation and light collection technologies allow the production of digital images in a few seconds. Together, these technologies enable a previously unseen level of performance from a portable CR system.

CR is a bit of an intermediate between the highly technical, expensive digital radiography (DR) systems in which images are digitized to the computer directly from the scanner, and the traditional analog systems in which images are formed from film exposure. CR does produce digital images but uses a cassette to temporarily store the data between the scanner and the computer. This can also allow greater flexibility with certain scans.

Nancy Davison, director of radiology at the Riley Hospital for Children, compared the new DX-S system to Riley Hospital’s previous portable CR system. “Our previous CR system was more than 10 years old. We wanted a system that provided lower dosage and would improve efficiency while maintaining continuity of care in the NICU. We were able to reduce the dose by 57% without compromising the image quality,” she said. Davison also added, “The technologists found the cassettes to be lighter than the previous system, which was very helpful in the workflow.”

The DX-S system installed at the Riley Hospital also includes MUSICA (Multi-Scale Image Contrast Amplification) Platinum, Agfa HealthCare’s most advanced automated digital radiography image processing software specifically tuned to enhance pediatric imaging.

MUSICA Platinum features automatic image enhancement that analyzes bones and soft tissue independently. This allows fast processing for images from varying examination types without sacrificing either contrast or density.

All portable imagers have highly collimated x-ray beams so that radiation is highly localized to a region of interest, and scattered radiation to hospital staff and nearby patients is minimized. Nevertheless, the DX-S’s improved collection efficiency and the subsequent decrease in exposure make scattered radiation effects even less of a concern. “Because of the decreased dosage to patients using the Agfa DX-S system, [scattered radiation dose] is of no concern.”

So 4 months after installation, how do the Riley Hospital physicians and staff feel about their new NICU imager? “There is overall satisfaction with the system and image quality, including our most difficult to please physicians,” Davison said. “We consider the Agfa DX-S system an excellent purchase because of the high detail provided and the decreased dosage to our most vulnerable patients, the newborn.”

—E. Wilson

Quality and Comfort for Breast Cancer Patients

To improve patient comfort and treatment for invasive and preinvasive breast cancer, Loma Linda University Medical Center has installed a dedicated breast MRI and integrated biopsy system at its Breast Health Center located in Loma Linda, Calif.

Aurora’s 1.4T Dedicated Breast MRI System features an integrated biopsy system.

Won Bae, MD, chief of breast imaging for outpatient radiology, said the Aurora 1.4Tesla Dedicated Breast MRI System offers patients the latest advances in prevention, detection, and treatment of breast disease for its patients. The only dedicated breast MR system approved by the FDA also has an integrated biopsy capability solely for breast MRI.

“We desired a state-of-the-art modality that would help our female patients feel more comfortable and, based on patient feedback, the Aurora Breast MRI was the machine that met both our needs as well as those of our patients,” Bae said.

Bae said the new MRI is beneficial for women with dense breasts or breast augmentation because abnormalities can be seen without the distraction of fat tissue.

“Furthermore, with the Aurora Breast MRI, we can accurately measure the volume and surface of tumors in women who are being treated by chemo or radiation therapy. This is the best advantage for patients already diagnosed with breast disease because it allows us to follow the progression of treatment and track the shrinkage of a tumor.”

Patient comfort is an important feature of the system for Loma Linda. The patient lies face down, arms forward, on a flared and contoured table, which minimizes the risk of patient movement and therefore reduces motion artifacts on the images. It also has a shorter scan time than other MRIs and its feet-first entry helps alleviate feelings of claustrophobia. Plus, the entire scan process takes only about 15 minutes to complete.

Another benefit is the system’s exclusive precision gradient coil design, which provides an elliptical “sweet spot” that images both breasts, including the chest wall and axillae, in a single bilateral scan without compromise in image contrast or resolution. This gives radiologists a bigger picture of the female anatomy, including the lymph nodes.

But what makes the Aurora Breast MRI system unique is the exclusive AuroraBiopsy™, the first completely computer-automated and fully integrated MR-guided biopsy technology on the market that accommodates all current core biopsy or vacuum-assisted biopsy devices. It provides physicians with easier medial and lateral access to the breasts.

The stereotactic guidance system directs the needle to the exact location of the lesion, which also is displayed on a computer screen. Because physicians don’t have to perform manual calculations and count grid squares to determine needle placement, it can reduce human error.

Further advantages of AuroraBiopsy are its ability to target multiple lesions in the same breast or both breasts in a single procedure. Breast stabilization paddles also provide wide access to sample all breast sizes.

Olivia Ho Cheng, president and CEO, Aurora Imaging Technology, said a primary consideration when designing the Aurora Breast MRI was to deliver increased patient comfort and a more efficient medical practice for breast health centers.

“We are proud that Loma Linda University Medical Center understands the importance of this advanced modality and that the Aurora Breast MRI is playing an integral part in the fight against breast disease, while also keeping patient comfort in mind.”

—V.P. Martin