Technological advances have allowed portable X-ray systems to become more sophisticated than ever. Newer systems are combining small size with increased maneuverability. Today, battery power, automated programming and computed radiography also are making portable systems easier to use than ever.
Small changes, big differences
Though the basic design of a power supply and an X-ray tube haven’t changed radically in recent years, manufacturers continue to refine portable X-ray machines and add new features and conveniences.
“The display is digital now, which allows you to be a little more specific in your technique,” says Tracey Shifflett, radiologic technologist at Johns Hopkins Bayview Medical Center (Baltimore). “The size of the machines has changed, too. The new machines are a lot smaller, a little more convenient and compact. Some of the manufacturers have added nice features, such as places on the machine to store supplies or a place for a technique chart.”
Anne Marie Keevins, special products division manager for Siemens Medical Systems Inc. (Iselin, N.J.), credits improved technology, such as higher frequency generators, for the development of smaller, more compact and more portable mobile radiographic equipment “without compromising power.”
At Philips Medical Systems North America (Shelton, Conn.), Tom Giordano, business unit director for radiographic products, concurs. “The volume and the weight of the unit has gone down considerably with the introduction of high-frequency technology,” he adds.
An example of a smaller, more lightweight system is DynaRad Corp.’s (Valhalla, N.Y.) Phantom, a 1.25-kilowatt system, weighing only 95 pounds. “They are truly portable units,” says David Engle, president of Del Medical Systems Group (Valhalla), parent company of DynaRad. “They fold up and can be put into the back of a van or station wagon and taken right to the patient’s bedside.”
Customers who wanted larger machines asked for help moving them and manufacturers responded by adding self-propelled motors. Portability is more important than ever, as these machines are employed in a number of different arenas. While still the workhorse of the ICU, portable X-ray also is used in nursing homes, medical clinics, home healthcare settings, correctional facilities and sports arenas.
Engel says he saw a television show on forensics and recognized a Philips unit being used to X-ray bones on-site. The military also purchases a number of portable X-ray systems.
“We’ve sold systems to the Navy for use in sick-bays on board ship,” Engel adds. “Because they’re compact and fold up, they can be folded and stood in the corner of sick bay until they’re needed.”
Savings efficiencies
The cost of a portable X-ray system is about 25 percent of the cost of installing a complete X-ray room. This factor makes them practical for sports locker rooms and smaller clinics. Portable X-ray also often is the best solution in locations where it would be difficult, even dangerous, to move the patient to an X-ray room in a different location, such as an ICU or nursing home.
Taking X-rays outside of an X-ray room presents special challenges, which portable systems must address. No. 1 is maneuverability. In response to this need, manufacturers have begun offering machines with articulated arms.
For example, Philips’ PMX-2000 has an arm that more resembles a human arm. The shoulder, elbow and wrist can move to enable the technician to position the arm more precisely. GE Medical Systems’ (GEMS of Waukesha, Wis.) VMX and VMX Plus have an articulated, counter-balanced arm that permits 90-degree rotation for simplified positioning. Friction locks automatically maintain the arm positioning, eliminating the need for manual locks.
Adding battery power to machines not only makes them more portable, it allows them to be used in locations where wall plugs are not readily available. Newer, longer-life batteries mean machines can be ready to go whenever they’re needed. The rechargeable battery on GEMS’ AMX-4+ can produce up to 50 exposures on a single charge.
New innovations
With the need for durability, portability and maneuverability addressed, manufacturers have begun to add features that make portable X-ray machines easier to use than ever. For instance, Philips offers machines with an automatic programming option which can store four different routines. If a pediatric chest X-ray is needed, for example, the tech only has to press one button. All settings are pre-calibrated and the machine is ready to go. Philips also offers a remote control option which allows the technician to operate the machine from anywhere in the room.
GEMS offers an optional automatic exposure control on its VMX series machines, which automatically compensates for variations in patient thickness and opacity.
Most manufacturers offer customized machines. Customers choose the power level, arm design, articulated or robotic arms, battery or wall power and other options to create a machine that meets their needs and budgets.
Some manufacturers also offer specialized units for pediatric and surgical use. DynaRad manufacturers a compact unit specifically for pediatric special care units and neonatal nurseries.
“This compact unit can be easily maneuvered in the tight space of a neonatal unit,” Engel explains. “The focal spot of the X-ray tube and the power of the unit are designed for very short exposure times, allowing the machine to capture the rapid heartbeat and respiration of premature infant, and also limiting radiation exposure to these babies.”
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Portable X-ray providers cope with market |
| The Balanced Budget Act of 1997 initiated sweeping changes to the Medicare system, the effects of which are still being felt today by many portable X-ray providers.
“The Balanced Budget Act of 1997 brought about the prospective payment system (PPS) for skilled nursing facilities,” explains Zach Evans, president of Mobile Medical Services Inc. (St. Joseph, Mo.) and immediate past president of the National Association of Portable X-ray Providers (NAPXP of St. Joseph). “This brought financial trouble for nursing homes and many went bankrupt. The portable X-ray market is about 85 percent dependent on Medicare. The largest share of this business is going into nursing homes.” In June, Evans spoke before the U.S. House of Representatives’ Small Business Committee about the effect of PPS and other Medicare changes on portable X-ray providers, particularly those serving rural areas. Under PPS, skilled nursing facilities receive a flat daily rate for each patient, of which providers are supposed to pay for all services to that patient, from the cost of daily care to special services, such as portable X-ray. Those nursing facilities which haven’t folded as a result of PPS regulations have often reduced payments to providers, Evans maintains. Medicare reform also has eliminated or reduced travel reimbursements for certain services. Evans says that portable X-ray providers have coped with these cutbacks by reducing or eliminating some services. “My company once offered 24-hour a day, seven-day a week service to all patients,” Evans says. “We have been forced to cut our services to patients located outside a 25-mile radius to between 8 a.m. and 3:30 p.m. Monday through Friday.” Despite payment cuts and loss of nursing home clients, many portable X-ray providers that have adapted have begun to flourish. With many larger firms exiting the portable X-ray business, smaller companies, such as the 85-member NAPXP, have seen an increased demand for their services. “Since all of the big players in portable X-ray are falling by the wayside, many of the smaller businesses are expanding,” Evans says. “There is obviously a need for our services. It saves Medicare money, since the only alternative is an ambulance ride to the hospital.” Many portable X-ray providers are adding new services that are not as dependent on Medicare, such as ultrasound and bone densitometry. Private industry, churches and civic groups have started hosting bone density screenings, much as they have done in the past with mammograms. NAPXP is lobbying for reinstatement of transportation costs associated with providing certain tests and for a return to direct reimbursement for their services from Medicare, rather than having to rely on nursing homes for payment. |
In some states, because of the low exposure levels, nurses are allowed to operate the machine.
The growth of non-invasive surgery techniques has led to an increased demand for portable fluoroscopic systems for use in the surgery suite. Systems, such as Siemens’ Siremobil and Philips’ BV series, help guide surgeons before, during and after surgical procedures. These systems are used in general, orthopedic, neurological and vascular surgery, as well as in pain management, such as lumbar injections.
“The technology has changed considerably in the last few years,” says Rich Martin, Philips’ surgery service product manager. “We used to use a lot of analog technology and conventional camera tubes. Over the past few years, we’ve improved to where we’re using CCD technology, similar to what is used in consumer cameras, but at a more superior level. We’ve incorporated computers into the system, that help improve the overall performance of the machines. This allows us to be able to branch off into other areas, such as vascular and cardiac work, that we hadn’t been able to touch with the older type machines.”
Aesthetic innovations
Other new developments are designed to make X-ray units less imposing and frightening to patients, especially children. Siemens’ Mobilett Plus HP portable X-ray unit can be enhanced with decals to make it resemble a giraffe.
“This was an idea of the product manager in Sweden,” explains Keevins. “The slim lines, flexibility and long reaching arm of the system really enable the system to ‘dress up’ as a giraffe. The concept was well received by customers. Since the system travels the halls of a hospital, it helps lighten the mood and cheer up the patients, both young and old. The amazing thing is that even the Navy has expressed interest in the giraffe decal.”
As more hospitals move to PACS (picture archiving and communications systems), computed radiography (CR) and digital radiography (DR) in X-ray rooms, portable systems have begun to offer CR options.
“The number of images that have to be retaken [with analog systems] is rather significant in ICUs and ERs where portables are used,” Philips’ Giordano notes. “You don’t have a table and it is difficult to position the patient. Couple that with the fact that one of the biggest strengths of CR is virtual elimination of retakes. A marriage made in heaven is the combination of CR with the mobile unit, because you bring the strength of one product with the weakness of the other and you end up with a very powerful device for use in ERs and ICU.”
Portable DR
Though DR is the most advanced technology for X-ray rooms, it still is in the future for portable systems. In current digital X-ray technology, the electronics are etched onto glass, which is very fragile and very expensive.
“If you think about where these mobile units are being used, they’re run all over the hospital,” Giordano says. “They frequently get crashed into corners. The marriage of the digital panel with the mobile unit has a while to go, primarily because of the ruggedness necessary for mobiles.”
Another challenge in adapting digital radiography to the portable environment lies in developing a digital plate that is thin enough to slide beneath an immobile patient. In X-ray rooms, the digital electronics are contained in the X-ray table.
“We perceive that the digital plate technology will wind up taking over a significant part of the market share in dedicated X-ray and high-volume bucky rooms, because that’s where it really shines,” Giordano says. “It will have a difficult time taking over the portable environment. That’s where we believe CR will live.”
Thus, the challenge for manufacturers will be to integrate CR and DR so that a user who sits at a console to review images will perceive they’re coming from the same device. “That’s a little bit of a challenge,” Giordano says. “A lot of us are working on that issue.”
Manufacturers continue to look for ways to improve and refine portable X-ray technology. And they’re enlisting the people who use their equipment to help them. For instance, GE has customer advisory groups to help design new equipment.
Companies also are changing the way they market their equipment. All the major manufacturers have websites where potential customers can learn about equipment and options available. GEMS recently added the ability for customers to order equipment directly from their website. (See e-commerce feature.)
On the surgery side, technology is growing to meet the needs of new applications. Philips is developing a combination pre-operative spiral CT and intraoperative fluoroscopy machine to produce 3D images in the operating room.
