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It is up to individual medical institutions whether to implement centralized or decentralized printing, and the reasons behind the decision are as varied as the facilities themselves. Both offer advantages that can be capitalized upon in the right situation, but only if the printer can handle the job. Which features can impede workflow? Which can boost it? Read on.
Trend Toward Decentralization
“There is a trend toward decentralized printing,” notes George Santanello, director of marketing of medical systems for Sony Electronics Inc (Park Ridge, NJ). “As the size of printers gets smaller, facilities can locate them in areas where exams are being performed or in control rooms,” he adds, remembering the days when wet printers required lots of space, frequently within a specified room that protected staff and the environment from chemical hazards.
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| Fuji’s Robert Neary suggests that the cost of extra film trays can be offset by savings in wasted film. |
Decentralization offers space advantages, but centralization can provide cost benefits, compares Jan Leeuws, global business unit manager for film and print at Agfa (Mortsel, Belgium). Centralized printers are generally larger and will require the transport of films to the various departments, depending upon the layout. However, having to buy one or two printers for centralized use can be more cost-efficient than purchasing a printer for every location where needed. “Both applications are used,” Leeuws says.
Says Robert Neary, national marketing manager of imaging systems for FUJIFILM Medical Systems USA Inc (Stamford, Conn), “If it’s a large department with lots of different modalities and many pieces of equipment?and they are indeed making a primary diagnosis from film?then a centralized setup makes sense.” However, with the trend toward PACS and diagnoses from soft copy, the demand to print film has decreased, and in institutions where film is printed solely for referrals, a decentralized architecture might make more sense.
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| According to Kodak’s Dan Bartlett, the decision whether to centralize or decentralize comes down to a site’s workflow as well as its short- and long-term needs. |
“Ultimately, it comes down to a site’s workflow as well as short- and long-term needs: Where are the modalities? What is the workflow today? What will it be tomorrow? Will patients be sent there?” notes Dan Bartlett, director of product management for digital output at Eastman Kodak Co (Rochester, NY). He adds that today’s dry printers can handle either situation, but certain features carry more value depending upon the architecture selected
Speed?Of the Essence?
Speed is one value that might not always be essential but is always convenient?as Santanello says, “We don’t like to wait for things.” Staff members might find themselves waiting by the printer at three different times:
1) Warm-Up. “Warm-up times can be very different for different products,” Leeuws says. “Direct digital imaging technology does not require warming up of the heated drums, so the printer can be ready in a few minutes. Dry laser images could require a half-hour or more. Protocols can often be arranged to fit this time in, but it can have an impact if the printer is turned on late.”
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| The DryPix 5000 from Fuji has a 65-second time-to-first-print wait for 14- x 17-inch films, of which it can print 130 films per hour. |
2) Time to First Print. This waiting period also shows a range in time-from as low as 45 seconds to more than 2 minutes. Larger film sizes, such as 14 x 17 inches, will fall in the higher ranges. Color images will take even longer, up to 41/2 minutes. Specific times vary according to product, film size, and color. Sometimes, a quick time to first print is a mere convenience; other times, it is more critical. At peak times or when a centralized printer is handling a lot of images, the time to first print can impact overall productivity. In the emergency department, it can impact the diagnosis: A shorter time to first print will result in faster application of treatment. However, if a physician is looking for a complete study or films are being printed for referrals or files, the time to first print need not be the fastest.
3) Throughput. Similarly, throughput will vary according to film size and color, with ranges from 50 to 240 films per hour. Typically, color films are a bit slower-closer to 20 films per hour. Higher throughputs are recommended for centralized printing environments. “You want to avoid a bottleneck at peak times,” Bartlett says. Facilities often determine that it is more important to avoid affecting service than to opt for shorter throughputs.
However, many imaging institutions are moving to PACS and soft-copy diagnosis, reducing the demand for printed films. “In the past, almost everyone focused on throughput,” Leeuws says. “But with multi-slice CT and MR generating high volumes of images, it is not feasible to print them all. As physicians print only the relevant ones, throughput becomes less important and access time more so.”
Things to Consider
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| The Sony UPD77MD is the company’s latest color printer. |
1) Smaller Footprint Compromise. The decisions made regarding throughput will very likely affect the printer’s footprint. Higher-throughput printers are generally larger. “To get 14- by 17-inch film moving at a rapid speed requires some room,” Bartlett says. Larger printers can weigh nearly 500 pounds and, with accessories, take up quite a bit of space. Decentralized setups generally use smaller printers but might have to compromise speed. For some environments, such as mobile imaging, the trade-off is obvious. Tabletop printers have reduced footprints, and those that print smaller film sizes can weigh as little as 55 pounds.
2) Film Sizes. Film size is influenced by the modality capturing the image. The five commercial sizes are: 8 x 10 inches, 10 x 12 inches, 11 x 14 inches, 14 x 14 inches, and 14 x 17 inches.
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| The Kodak Color Medical Imager 1000 prints full-color patient images. |
3) Film Goes In. “CT, MR, and ultrasound are usually printed on 14- by 17-inch film. CR, DR, and full-field digital mammography print images at true size and so require varying film sizes to avoid waste,” says Fuji’s Neary, who suggests the cost of an extra film tray is returned through savings on film. Agfa’s Leeuws suggests that selecting the film size to match the image is more economical than printing multiple images to one piece of film. Those purchasing a printer for a centralized environment are advised to have multiple input trays. Some models can have up to three trays online. Smaller models cannot typically accommodate as many sizes, but if dedicated to one modality or department, one or two film sizes will work.
4) Film Comes Out. Similarly, sorters and multiple output trays are recommended for centralized environments and for decentralized setups where it is beneficial to sort exams by modality, physician, or patient. Leeuws suggests that sorting is worth considering if it offers enough flexibility to sort specifically for one’s needs.
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5) Clear About Resolution. Another feature dependent on departmental need is resolution. Currently, resolution in the 320-dpi range is adequate for many modalities, although some, such as full-field digital mammography or extremity imaging, require higher values, around 600 dpi. For these modalities, higher printing resolution is required. But for images captured at lower resolutions, such as CT, MR, nuclear medicine, and ultrasound, experts agree that an image printed at a higher resolution will not reveal more diagnostic image information and might require interpolation of data. Matching the resolution to the modality is, therefore, beneficial, particularly in cases of centralized printing.
Cost of Ownership
Such features as higher resolution, multiple input and output trays, and faster speed will often require a greater initial investment, but it’s also important to consider ergonomics and calculate the cost of ownership. What is included in the warranty? In the service contract? What is the printer’s reliability? How about the vendor’s? Is the printer self-calibrating? What quality-control protocols exist? How much heat does it generate?
“Ultimately, the buyer needs to consider cost versus size versus speed versus image quality,” says Sony’s Santanello. “Some new products combine all of these features, so departments no longer need to compromise.”
Renee DiIulio is a contributing writer for Medical Imaging.
