Feature | June 12, 2008 | Rick Dana Barlow

Productivity, Speed Driving Orthopedic Imaging Modalities

Technical capabilities, workflow try to keep pace with aging, athletic patient base.

A more active and athletic constituency, coupled with an aging demographic prone to bone health challenges, represents a double-edged sword for orthopedic imaging providers.

These outpatient imaging centers not only have to keep pace with increased demand but also keep abreast of the latest technological developments to improve workflow and facilitate higher throughput. From computed tomography to digital X-ray to extremity and open magnetic resonance imaging, outpatient imaging facilities face a plethora of options that will influence success.

So Outpatient Care Technology tapped the expertise of several executives at the leading manufacturers of imaging modalities used for orthopedic procedures to gauge their outlook on market demand and technology trends.

How does an outpatient facility determine which modality is the most effective or optimal choice for orthopedic imaging?

Mark Zdanowicz, orthopedic sales manager, Agfa HealthCare, Greenville, SC

The decision-making process begins with the specialty of the center. Other factors, such as patient volume, reimbursements of demographic population, sometimes even physical limitations of the building, then assist in the filtering process. The site weighs all of these factors and decides what modalities will best serve and aid in patient care for the next five years.

Todd R. Minnigh, worldwide director of marketing, Digital Radiography, Carestream Health Inc., Rochester, NY

Our orthopedic customers tell us that types of exams and patient volumes drive their choice of imaging equipment. Some orthopedic practices report that DR systems provide better images of the back and lumbar spine than CR systems, but they typically use CR systems for foot and extremity exams, and also for standing foot/ankle exams. Carestream Health’s DR 7500 system is popular with orthopedic practices because it features a choice of one or two detectors and can be configured with a wall stand and/or table.

Patient volume also plays a role. Large practices may use DR for most exams due to its increased productivity and employ CR systems for standing exams and a few other specialized exams.

Penny Maier, director of marketing, Imaging Systems, FUJIFILM Medical Systems USA Inc., Stamford, CT

X-ray has long been the standard modality for diagnosis in orthopedic imaging due to its diagnostic capabilities as well as its low operational costs. Digital X-ray offers the same flexibility to address the wide variety of required exams in an orthopedic practice – from scoliosis and long leg imaging to spine and extremity exams – but additionally provides improved image enhancement capabilities, making it an excellent solution for orthopedic practices of all sizes.

Pierre R. Niepel, Ph.D., national director, Ambulatory Care Solutions, Siemens Medical Solutions USA Inc., Malvern, PA

The choice for orthopedic imaging equipment is similar to any clinical imaging decision. How can the quality of care be improved and the cost of care delivery reduced at the same time? Imaging equipment has clinical benefits and specific costs associated, but the choice also depends on the typical population needs in local areas, size of the outpatient imaging center and location.

According to IMV, 99 percent of all orthopedists routinely order general X-ray procedures. X-ray equipment is used for evaluation of osteoarthritis, upper and lower extremity trauma, rheumatoid arthritis or for pre-surgical planning and follow-up imaging to surgical repairs, as well as overuse injuries.
MRI is the second most frequently used imaging modality. The typical procedure mix includes bone cancer imaging, pre-surgical planning (especially for spinal surgeons), trauma conditions and diagnoses of osteoarthritis. Concerning future utilization, the highest growth potential for MRI will probably be with specialist orthopedics in sports medicine and spinal surgery.

CT technology is also widely accepted as a fast and accurate imaging technology, which, in contrast to MRI, is typically used for trauma conditions. CT is also used for pre-surgical planning. Another widespread technology is DEXA for bone mineral density measurement or fracture risk. PET/CT can be ordered to evaluate oncology cases, which can include bone tumors and metastatic bone disease.

Which patient base represents the driving force for orthopedic imaging technology adoption in the future – the active and athletic crowd or the aging demographic – and why?

ZDANOWICZ: The driving force of imaging technology is predominantly the aging population, but many practices adopting new or updated imaging technology serve both demographics. The Bureau of Labor Statistics has published studies showing how the aging population will grow exponentially in the next few years, while the number of orthopedic surgeons will not change significantly. This shift drives the need for productivity improvements, from the use of technology as well as from the utilization of technical staff.

MINNIGH: The aging population will drive a dramatic increase in orthopedic imaging studies as well as other imaging exams and healthcare procedures. According to 2000 U.S. Census data, the number of citizens 64 years and older is projected to increase from 12.5 percent of the population to 20 percent by 2031. At the same time, the percentage of working adults 20-64 years will decline by 25-30 percent. Fewer workers and an aging population will drive providers to increase productivity and efficiency.

MAIER: Young and old are quite active and even athletic in this day and age so orthopedic practices need to be able to address the unique needs of a wide range of patients with their imaging technology. Digital X-ray is a modality that offers this flexibility and extends diagnostic confidence regardless of the patient’s age or type of injury. And although the aging demographic will require more surgical procedures, many physicians also use digital X-ray to help them in pre-operative planning for any orthopedic procedure.

NIEPEL: Orthopedic specialists diagnose musculoskeletal and spine disorders and injuries. Advanced imaging technologies support and enable faster safer and more accurate diagnosis and therapy. The patient bases that represent the driving force for orthopedic imaging technology adoption include the aging population and age-related conditions, such as osteoporosis, fractures, hip and knee replacement surgery. At the same time, sports-related injuries grow the demand for trauma diagnosis. A third trend is toward obesity, which also contributes to more orthopedic diseases and injuries.

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