Ideas for Hospitals, Centers and Practices

By Elaine Sanchez

GE Offers CT Protocols Free of Charge
More Colors for Ultrasound
Family’s Fund-raising Brings Portable CT to DC
Mammo System Supports Charitable Mission

GE Offers CT Protocols Free of Charge

A child is more likely to receive one or more CT scans in their lifetime in today’s world than in previous generations, according to health care statistics.

In its ongoing effort to reduce CT radiation dose to all patients, especially children, GE Healthcare has sponsored the development of newly validated procedure-based protocols, which can now be downloaded free of charge from its Web site.

Mannudeep K. Kalra, Sjirk Westra, and Sarabjeet Singh, working with the Waukesha, Wis, company, have developed a dose-reduction solution that lowers radiation by accounting for a patient’s weight, scan type, number of prior CT studies, and 3D automatic exposure control. Parameters direct users to one of three “color zones,” the basis of procedure-based protocols. An automatically controlled exposure level within each color zone is determined by one of five weight categories.

GE Healthcare, which has long embraced the ALARA (As Low As Reasonably Achievable) principle, says the newly validated protocols signify the latest additions to its growing portfolio of dose reduction capabilities.

“With procedure-based zones, radiologists can control levels of radiation dose to the target region of interest in an efficient and seamless manner based on the three scan types: routine scans, a low dose option, or noncardiac CT angiography,” Kalra said. “Prior publications have shown that adjusting scanning protocols to patient size or weight, particularly for children, is an efficient method for reducing dose while maintaining diagnostic quality. Published literature also shows that mA and kVp are the most frequently adapted techniques for optimizing dose to patient size.”

Kalra and Singh found a lack of consistent use of procedure-based protocols in pediatric CT studies conducted on the same patients before and after their implementation. Initially, slightly more than half of chest CT and nearly three-quarters of abdominal CT studies were performed according to the procedure-based protocols. Following additional radiologist and technologist training, the compliance increased to 80%.  When the new protocols were fully implemented, Kalra and Singh saw a significant dose reduction without compromising the diagnostic utility of CT images.

“With children, it is particularly important to minimize dose from the CT scanner,” said Gene Saragnese, vice president and general manager of GE’s Global CT and Molecular Imaging businesses. “We implemented these protocols, as well as the entire CT 4Kids solution they’re part of, as ways for GE Healthcare to continue our leadership role in dose optimization while maintaining image quality. This is a delicate balance. Yet, we believe providing these procedure-based protocols at no charge will ultimately benefit all patients who receive exams on GE systems.”

GE Healthcare, a principal sponsor of the “Image Gently” campaign, joins the Alliance for Radiation Safety in Pediatric Imaging in raising awareness of the opportunities to lower dose in the imaging of children.

“In partnership with 13 societies and with help from companies like GE Healthcare, we’ve been able to use our messaging to affect clinical practice and make a real change for our children,” said spokesperson Shawn Farley.

GE’s protocols are available for free viewing and downloading at

More Colors for Ultrasound

Ultrasound equipment is a whole lot more complex than it used to be. Today’s manufacturers are adding sophisticated, colorful features that enhance patient care.

With the Senographe Essential, the center will provide mammograms to all women who need them, regardless of her insurance status or ability to pay.

The performance platform brings with it enhanced color flow sensitivity, wireless connectivity with a remote control, and workflow integration for multiple point-of-care application markets.

Paul R. Sierzenski, director of emergency medicine ultrasonography at Christiana Care Health System in Newark, Del, and president of Emergency Ultrasound Consultants, LLC, believes that just as every department has monitors, and every department performs bedside glucose testing, it won’t be too long before every department in the acute care setting in the United States will be using the point of care ultrasound.

Sierzenski has used SonoSite’s ultrasound product since the company launched in 1999. As a result, he has seen the technology grow from its early stages. Although he has not experienced SonoGT on the S Series, he has taken advantage of the offering on the company’s M-Turbo system.

“From the standpoint of a variety of disease states, we were looking for enhancement of color Doppler imaging,” said Sierzenski, whose department performs more than 10,000 ED ultrasounds a year. “[SonoSite’s technology] provides a much smoother, cleaner-looking color Doppler. That is important for us, given the fact that we do a great deal of vascular work, primarily things such as ultrasound-guided procedures. The value of that, to be able to clearly delineate the artery and vein to a degree, or to have color filling to help identify vascular structures from nonvascular structures, is critical.”

Specifically, the SonoGT technology allows for ColorHD, a proprietary, color Doppler algorithm that increases color, sensitivity, and frame rates. It works in parallel with multiple Turbo platform algorithms, such as SonoHD imaging technology, to give increased diagnostic information and better visualization of color flow.

It also adds an important tool for physicians working in sterile environments—the SonoRemote Control. The remote control increases ergonomic comfort and, through Bluetooth wireless technology, can be voice- or touch-activated. According to SonoSite, clinicians can adjust system controls remotely from within a 10-meter radius and can function within a sterile bag or sheath.

Furthermore, 802.11 b/g SonoRoam technology allows wireless image transfer from the S Series to a PACS system via DICOM and to a personal computer via SonoSite’s SiteLink, permitting clinicians to quickly access information from any location. The company says wireless connectivity has grown to become a critical component to reduce medical errors and speed time to diagnosis in point-of-care ultrasound.

New features in workflow integration include DICOM Storage Commit and DICOM Multi-Modality Performed Procedure Step for clinical integration of ordering scheduling, image acquisition, storage, viewing, and billing of patient procedures. Users can enter patient demographic information before, during, or after exams and enter DICOM Multi-Modality Worklist queries to the hospital information network. The product sports a new USB Bar Code Reader, powered through a USB port that enables clinicians to quickly enter and update patient information.

SonoGT lets physicians annotate images and on-screen body markers for improved documentation of studies and procedures on S Series products.

New transducer options include the C11x/8-5 MHz, for neonatal and abdominal exams; the L25x/13-6 MHz, for evaluation of globe rupture, intraocular foreign bodies, and retinal detachment; and the SLAx/13-6 MHz, for nerve and vascular scanning applications.

Customers can separately purchase SonoGT technology and upgrade existing S series using a software download from a USB thumb drive.

Family’s Fund-raising Brings Portable CT to DC

When a car hit 8-year-old Charles Reges on March 8, 2007, he was airlifted to Children’s National Medical Center (CNMC) in the District of Columbia, where he was diagnosed with a traumatic brain injury, a broken leg, and a bruised lung—injuries that necessitated multiple serial x-ray studies.

The compact CereTom is a high-speed, battery- and line-powered multislice CT scanner, optimized for scanning the head and neck.

Although Charles eventually recovered fully, transporting for head CT scans posed a clinical danger to the young patient, a risk that parents Mark and Sara did not want future parents of patients to weigh. Through their fund-raising efforts, CNMC now houses the first portable CT scanner in the nation’s capital.

“As a nurse and a mother, I knew that I had to do something,” Sara Reges said. “The risks inherent in removing our critically ill son from life support and transporting him from the pediatric intensive care unit to radiology and back was almost unbearable. I felt I had to do something. It means everything to me as both a mother and a nurse.”

According to a Cleveland Clinic study published last year in the Journal of the American Healthcare Radiology Administrators, transporting critically ill patients outside of the ICU is associated with a 13% morbidity rate. Research also found that adverse events occurring during transport for CT imaging were as high as 71%.

Instead of escaping the memory of the accident and the suffering it caused, the Reges family confronted it and looked to ease the agony for future parents. Involving family, friends, and other organizations, they organized a charitable campaign that brought the CereTom Portable CT scanner from Boston-based NeuroLogica Corp to the hospital in February. “We anticipate the portability of the CereTom to vastly improve our ability to offer timely diagnosis of intracranial disease processes outside the radiological suite (floor, PICU, ICU), as well as offer additional ability to perform ‘real-time imaging’ in the intraoperative setting,” said Robert F. Keating, MD, CNMC’s department of neurosurgery. “This tool changes the practice of neurosurgery as we currently know it.”

Lightweight and portable, the compact CereTom is a high-speed, battery- and line-powered multislice CT scanner, optimized for scanning head and neck. It boasts patient-centered technology that delivers high-quality noncontrast, angiography, and contrast perfusion scans in any hospital location, including the ICU.

“The thought that critically ill children at CNMC no longer have to be subjected to the risks associated with transport to and from the PICU in order to obtain necessary clinical information makes good sense,” said Sara Reges. “It has helped us close this chapter in our life knowing that two good things have come from something so horrific. First, we are extremely grateful to the staff at CNMC for allowing Charles a full and complete recovery. Second, we believe that the CereTom will ease the fears of future parents by decreasing the frequency of transport out of the safe cocoon that is the PICU and in so doing will allow necessary imaging studies to be done more quickly and more cost-effectively.”

Within its first week at the hospital, the scanner had already been used several times, including in the ICUs and operating rooms. “The Reges family inspires all of us in the way they’ve made it their cause to ensure that other children do not go through the pain and uncertainty that their child did,” said Sen John Kerry (D-Mass). “It is humbling to see so many different people and organizations come together for the greater good. I am extremely proud of the stellar team at NeuroLogica for its dedication to providing access to medical imaging to families everywhere.”

Mammo System Supports Charitable Mission

Over the years, the Cris Collinsworth ProScan Fund (CCPF) has touched the lives of thousands of women, including those involved in Pink Ribbon programs. Since its inception in 2002, the fund has raised more than $1.4 million through annual Pink Ribbon Luncheons.

Recently, the organization helped to bring a Senographe Essential digital mammography system to ProScan Pink Ribbon Center at Red Bank, Cincinnati, also known as ProScan Women’s Imaging Center. Made possible by a donation by the HCS Foundation, the scanner is GE’s latest full-field digital mammography system.

“While the HCS Foundation has been supporting health care projects for almost 50 years, we are particularly gratified to be able to help provide, through our good friends at the Cris Collinsworth ProScan Fund, one of the most advanced diagnostic instruments available to women who might not otherwise have access to it,” said L. Thomas Hiltz, HCS Foundation chairman. “Because its purpose is early detection, the impact of this equipment will be felt not only by the women who use it and their families, but throughout the health care delivery system.”

“Recognizing the center’s charitable mission, GE provided the digital mammography equipment on very favorable terms,” said Michael Howley, general manager, Americas, X-ray products.

The Senographe Essential features a 10- by 12-inch image detector, which represents the market’s largest field of view. Additionally, it offers ergonomic advances for imaging technologists and aims to make patients of all shapes and sizes more comfortable. Furthermore, it is designed for seamless workflow connectivity.

Describing the CCPF’s ongoing campaign for breast cancer awareness and early diagnosis, Howley said, “This organization is committed to patient care and has selected the most comprehensive system for breast imaging, with the lowest x-ray dose in the industry. We are glad this equipment will have a positive impact on the care of so many women in need.”

In addition to its support of ProScan Pink Ribbon Centers in other underserved Ohio communities, the CCPF is involved in the Pink Ribbon Mammogram Match program, which provides mammograms for low-income, uninsured women; Pink Ribbon Bag, a gift bag packed with items to provide hope to women newly diagnosed with breast cancer; Pink Ribbon Empowerment Program, an age-appropriate outreach program that empowers women to take charge of their health; and “Cruisin” for a Cure … Are You On Board, a program that provides transportation to and from mammogram appointments for women without access to personal vehicles or mass transit.