Managing the Flow in Radiology

TIME Is of the Essence in Trauma Care
Making Clinical Imaging Trials More Efficient
Radiation Dose Awareness in Your Hand?Or Your Patient?s
Fujifilm, NFL Work Together to Ensure Draftees Are Fit

TIME Is of the Essence in Trauma Care

It?s no secret that time is of the essence when treating trauma patients, but often those precious minutes are squandered when imaging studies have to be retaken.

Boston-based lifeIMAGE has found a way to harness this crucial time and give it back to clinicians even before trauma patients arrive at their facility. The company?s Internet-based Trauma Image Management & Exchange (TIME) allows imaging studies to be electronically sent and received before a transfer to a trauma center is even initiated. The system delivers the study to an inbox similar to those found in commonly used e-mail services?such as Gmail or Yahoo?and builds on the company?s lila system, which was originally designed for nontraumatic, routine imaging studies.

TIME from lifeIMAGE allows imaging studies to be electronically sent and received before a transfer to a trauma center is even initiated.

According to company CEO Hamid Tabatabaie, TIME solves many of the problems typically encountered in sharing imaging studies between institutions?problems magnified by the ticking clock following a traumatic accident. Often imaging studies are simply burned onto a CD or DVD and attached to the patient.

While this may seem efficient, Tabatabaie said that many times these CDs or DVDs can?t be read by the receiving trauma center or, in more extreme cases, because the trauma center hasn?t seen the images ahead of time, clinicians there had no way of knowing the extent of the injuries, which, in tragic cases, could mean a patient was transported to the wrong facility. In either case, at the very least this means a loss of time and money.

Tabatabaie notes that in 53% of cases images have to be retaken for an average cost of $4,000?which often can?t be recovered by the trauma center. These costs can add up quickly. For instance, California typically has about 60,000 trauma cases per year. If half of those cases need to have their images retaken, that?s a cost to the system of a staggering $120 million?dollars that are rarely reimbursed by an insurance company.

TIME allows images to be received by the trauma team ?before the patient is in the ambulance,? said Tabatabaie. ?And they can see everything that?s going on with the patient [before they get there].?

The system?s key feature is its ability to share images in a user-friendly, efficient manner. First response sites that need to share diagnostic quality images with a trauma center using the system don?t need to purchase or deploy lifeIMAGE software or have a virtual private network (VPN) setup. With a simple Internet connection, imaging information can be instantly and securely shared with the receiving site?s trauma DropBox, where clinicians and administrators can preview and examine the images. The DropBox can be completely customized for a particular clinical team, so studies can be sent directly to a particular box, just like a run-of-the-mill e-mail account.

The company operates the service on the cloud through the EMC Atmos Online infrastructure, which allows the trauma center to download the image and incorporate it into its internal PACS and medical records system. The system is completely secure, requiring log-in credentials.

This saves time and money because the clinicians can prepare for the patient or redirect a case to a more appropriate treatment site while the ambulance is en route to the trauma center. And in the end?for trauma centers?time is its most precious asset.

?C.A. Wolski

Making Clinical Imaging Trials More Efficient

Clinical imaging trials can be complicated, labor-intensive endeavors. And often the most labor-intensive and stressful part of a study is accurately collecting and disseminating data?which in almost every case is delivered manually to trial administrators. This opens the door to lost data, corrupted or damaged files, and erroneous reports.

BioClinica?s WebSend can transfer and track medical images in real time, increasing the accuracy of data and saving money.

But a clinical trial management services company, BioClinica, has found a way to leverage the Internet to safely and accurately receive data electronically. The company?s WebSend can transfer and track medical images in real time, enhancing data quality with fewer site queries and, most important, reducing costs. The company manages trials at 11,000 sites in about 80 countries with the majority of data being sent on CDs via FedEx or other international package carriers.

BioClinica President and CEO Mark Weinstein notes that sending data via a package service is slow and expensive. WebSend saves money and time while preserving the trackability and security of data. The data is sent via a secure link.

But more crucial than saving a little time and money, WebSend also helps to increase the accuracy of the data being received by BioClinica, according to Weinstein, who says that about 15% of the old-fashioned hard data the company receives contains mistakes. Most of these are simple, honest errors that have to be reviewed and corrected.

Complementing WebSend is the company?s WebView, a solution designed to electronically share, blind, track, archive, and analyze medical images for clinical trials worldwide. Weinstein says that the WebView wizard allows for the repopulation of data and prompts the user to verify the accuracy of the data before transmittal, guaranteeing accuracy.

WebSend is simple to use, moving to the background once the transmittal button is pushed. If, for any reason, the data transmittal is interrupted?for instance by shutting down the computer from which it is being sent?the transmission will pick up where it left off once the computer or program is restarted, saving the trial administrator?s time.

Because the data is received more quickly and it has a higher level of accuracy, Weinstein says that it speeds up the quality review on BioClinica?s end. The system also gives the company flexibility in how it schedules the rules for the study?in terms of both access to the data and the way independent reviewers may be handling their reads. ?On our end, we can traffic the data better and move it more efficiently,? said Weinstein.

Because WebSend has a full audit trail, it makes all of the transmitted data regulatory compliant with government rules, aiding in the application for eventual clearance of a successfully tested new technology or technique.

While it?s still common to receive most data on CDs, Weinstein noted that recent natural disasters?namely, the eruption of an Icelandic volcano, which brought European air travel to a halt?may aid in the adoption of this secure, electronic technology. ?We did see a dip in packages that week,? he said.

WebSend was acquired by BioClinica in 2009 from Agfa HealthCare.

?C.A. Wolski

Radiation Dose Awareness in Your Hand?Or Your Patient?s

Due to recent media coverage, concerns about excessive medical imaging radiation overexposure and its effect on patients and health care professionals appear to be at an all time high. Of course, excessive radiation exposure concerns are nothing new, but what is new is the technology that can electronically keep track of one?s lifetime exposure to radiation and estimated cancer risk.

Modern examples of radiation awareness devices include the new Dose Aware system from Philips Healthcare, Andover, Mass.

Dose Aware incorporates a display inside the interventional suite and communicates to a wireless radiation detection badge clipped to the health care worker?s clothing. If the worker gets too much exposure during a fluoroscopic procedure, the display turns red. Similarly, an orange color indicates a lower level warning, and a green color indicates a safe level.

Dose Aware is also cumulative, so physicians don?t have to wait until the end of the month to be told they have too much radiation exposure. Medical administrators can also more readily manage their doctors and techs with real-time data, taking out a lot of the estimation and argument about which physicians need to reduce their shifts and exposure.

Dose Aware, however, is a targeted health care radiation monitoring device. Much less expensive and perhaps more intriguing is Radiation Passport for the iPhone/iPod Touch. The iPhone application from Tidal Pool Software, British Columbia, describes itself as an education and radiation awareness tool for patients; however, there is little reason why health care workers could not also use the application.

For just $3.99, iPhone owners can download a handheld application that will keep track of cumulative radiation exposure from a wide selection of medical imaging exams, dental exams, women?s imaging, CT scans, interventional scans, and more. In all, the application?s database includes values for 140 exams and procedures. Should you be a physician with a new device or a patient with an exam with specific dose, you are also able to enter customized procedures and corresponding millisievert (mSv) values.

In addition, Radiation Passport will calculate the person?s cancer risk associated with entered exams. The risk is based on several factors, including age and cumulative risk from background radiation due to lifestyle (plane trips, sun tanning) and location. However, like all estimates for radiation cancer risk, Radiation Passport bases its risk on extrapolations from atomic bomb data. That correlation is debated inside and outside the medical community, but it is the only data available.

Radiation Passport for the iPhon/iPod Touch is an education and radiation awareness tool designed specifically for patients.

Is all of this handheld radiation risk information useful or alarming to health care workers, let alone patients?

The answer is unknown, but these issues are discussed by Baerlocher, Talanow, and Baerlocher who provide a thorough description of the iPhone application and also discuss the value of Radiation Passport to patients and the possible effects on providing care.1

One issue is whether excessive patient awareness will be too much knowledge. That is, if patients are concerned about radiation exposure, they may refuse an imaging exam based on incomplete information.

The authors suggest that patient awareness is good and that patients need to have objective information in order to make informed, ?empowered? medical decisions. They further cite 2004 research that shows that physicians often underestimate the risks associated with radiation in diagnostic CT scans.2

While the authors do not conduct any studies on Radiation Passport, they do believe that its potential application(s) deserve to be studied. Their next step is a survey surrounding the issues of radiation risk and awareness. and will also be involved with the research.

Toward the end of their paper, the authors do conclude that ?concepts such as a nationally enforced radiation log analogous to Radiation Passport would be useful? and suggest that such a system could be incorporated into RIS/PACs and electronic medical record systems.

?Tor Valenza


  1. Baerlocher M, Talanow R, Baerlocher A. Radiation Passport: an iPhone and iPod Touch application to track radiation dose and estimate associated cancer risks. J Am Coll Radiol. 2010;7:277-280.
  2. Lee CI, Haims AH, Monico EP, Brink JA, Foreman HP. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004;231:393-8.

Fujifilm, NFL Work Together to Ensure Draftees Are Fit

As any football fan knows, statistics are a big part of the game?and most can rattle off the numbers of all of their favorite players. But TDs, rushing yards, and the number of sacks a player have achieved are only the tip of the data iceberg of the stats NFL officials examine at the beginning of their year.

They are also looking at the numbers delivered during the comprehensive physicals given to new and potential draftees every year. For the last quarter century, Clarian Health System?s Methodist Hospital has been there imaging future NFL stars to make sure they are healthy enough to put on the uniform of one of professional football?s 32 teams. But this year there was a slight change. Clarian was using a new PACS and digital x-ray system from FUJIFILM to capture images from knees, shoulders, spines, heads, and hearts.

Clarian made the switch to Fuji?s Synapse PACS and its XG5000 digital x-ray system in late 2009. And, according to Jim Morgan, Fuji?s executive vice president of marketing for the Synapse, the results were the imaging equivalent of a touchdown. ?From their point of view, the speed and reliability of the systems were very smooth,? he said. ?And there were no need for retakes.?

Part of the reason for the efficiency was the fact that Clarian had purchased the entire Fuji system. Instead of reading the images on site, they were pushed to Clarian?s Synapse where a specialist radiologist could do the interpretation. One of the reasons that the radiologists could readily read the images in the comfort of their Clarian offices was that the Synapse allows radiologists to manipulate the images themselves. ?Historically, with DR, the image processing is done by the technician,? said Morgan. ?When it is moved to the PACS, no more processing can be done. On the Synapse, the radiologist can reprocess the image.? This allows the radiologist to see more detail or zero in on a particular part of the anatomy, helping them to catch any hidden anomalies.

Physicians used Fujifilm?s Synapse PACS to view x-rays, MRs, and other medical examinations of potential NFL draft candidates.

This is crucial in the case of NFL draftees, many of whom are larger than the average patient. This allows the radiologist to compensate without having to retake the image or increase the radiation dose, making imaging safer for the patient.

While the number of imaging studies was relatively low?just 2,000 for the 300 players?Fuji had technicians on hand because the XG5000 was being used in its portable configuration. ?Quantity wasn?t a big deal for Clarian,? Morgan explained. ?The bigger deal was the quality?that the images were taken correctly and then sent to the correct radiologist at the hospital.?

Of the 2,000 imaging studies, 1,600 were general x-rays of knees, shoulders, spines, and extremities with the balance being MRIs and cardiac evaluations. The NFL predraft evaluation was performed at Lucas Oil Stadium in Indianapolis in late February. In addition to the medical evaluation, players were put through a series of drills and interviewed by coaches and doctors to evaluate their playing performance.

Reports gleaned from the initial imaging studies were later burned onto CDs and made available to NFL physicians and coaches.

While purchasing the package gave Clarian a distinct advantage in efficiently imaging the NFL draftees, the vendor-neutral Web-based Synapse is available as a standalone as well.

?C.A. Wolski