Feature | January 31, 2012 | Candy Tretter, Director of Radiology Services

Switch to DR Improves Workflow

Converting its portable systems to DR improved staff productivity and patient care.

Blessing Hospital in Quincy, Ill., uses portable imaging in its ED, ICU and surgical suites. It recently switched to digital radiography for improved productivity.

Our hospital, Blessing Hospital in Quincy, Ill., recently implemented digital radiography (DR) systems in our general radiology rooms, emergency department (ED) and outpatient imaging center. We also retrofitted two existing GE portable imaging systems with DR detectors. We expected to achieve a more efficient imaging workflow — but the improvements were even more dramatic than we expected.

Our staff uses portable imaging systems for hospital rounds and in the operating room (OR), intensive care unit (ICU) and surgical suites. We have improved productivity and enhanced patient care in each of these areas after installing Carestream’s DRX detectors in our existing systems through use of the company’s DRX-Mobile retrofit kits.

Since portable exams are typically used for our most seriously ill patients, speed and image quality are particularly important. After converting from computed radiography (CR) to DR, clinicians can view the images seconds after capture on the portable system’s monitor. The imaging studies are automatically communicated wirelessly to our picture archiving and communication systems (PACS) for reading by radiologists.

The average time for a portable exam with CR was six to eight minutes, depending upon the location of the CR reader. Today, immediate image access — and eliminating the need to carry cassettes to a reader for processing — is an important advantage in all patient care environments.

In our ER, ICU and surgical suite, clinicians are pleased with both the speed and image quality offered by the DR detectors. In the past, CR images not only took longer to process, but also images sometimes had to be repeated. With DR, images are sharp and clear, so there are virtually no retakes. Having immediate access to images also offers the potential to shorten surgical times and increase capacity in our OR.

Enhanced Visualization of Tubes and Lines
Carestream’s Tube and Line feature is also extremely important. This feature reprocesses the original image (without requiring another exposure) to clearly display gastric tubes, feeding tubes, pneumothorax chest tubes and PICC lines. Cardiologists, surgeons and other clinicians report they can now clearly see the position of tubes and lines, which are difficult to detect on a standard radiographic image.     
Use of DR-based portables for hospital rounds has been a tremendous boost to both staff morale and productivity. Our staff conducts portable exams for selected patients between 3 and 5 a.m., so these images are ready for surgeons and other specialists who make hospital rounds at 6 a.m. The portables are then used for bedside imaging of inpatients whose physicians make rounds in the afternoon.

Some of the greatest productivity gains are achieved with inpatient portable exams because of the time it previously took to travel back and forth to the nearest CR reader. This time savings and the reduced number of steps involved for technologists, has greatly streamlined portable imaging on the floors. The time savings is particularly important for the third shift, where we only have one technologist on duty.
In the conversion from CR to DR, our staff has reduced technique and we estimate a 50 percent reduction in radiation exposure rates for our portable chest imaging. And since the DRX detector is cassette-sized, we are able to use our existing grids for overweight or obese patients.

Consistent User Interface Streamlines Imaging
An additional benefit of retrofitting our existing portable systems with DRX detectors is that the user interface is the same for all of Carestream’s DR systems. Our technologists work in multiple areas of our facility, so they are able to use the same screens and commands whether they are using a DRX-Evolution suite in the ED or using DRX-1 systems in our general radiology rooms. This consistent “look and feel” greatly improves productivity, boosts convenience for our techs and reduces training time. Ultimately, this user-friendly interface also contributes to a streamlined radiology workflow.

While we have three portable imaging systems, we elected to retrofit only two of them with DRX detectors. That has created a situation where no one wants to use the CR-based portable unit and miss the benefits of the immediate, high-quality DR images. Based on our experience, I would recommend that hospitals upgrade all their portables at the same time. It will eliminate competition for the DR-based portables and enable all portable systems to be fully utilized.

Transitioning to cassette-sized, wireless DR detectors throughout our facility enhances both the speed and quality of diagnostic images. This ultimately allows our clinicians to deliver exceptional patient care.

Candy Tretter is director of radiology services at Blessing Hospital, Quincy, Ill.


SIDEBAR: A Wide Marketplace for DR Solutions

Digital radiography (DR) has been an active technology segment in the past year. Not only are more facilities making a switch from computed radiography (CR) to DR, but also vendors are introducing new models and making improvements to increase their benefits even more. Following are a few recent introductions shown at this year’s RSNA meeting:

• Canon’s CXDI-70C is a new wireless, cassette-size DR system. It eliminates the sensor cable, which enables handling similar to current film-cassette X-ray systems. The model’s 35 x 43 cm effective imaging area offers the same dimensions as current ISO 4090-compliant film cassette models, allowing digitalization without the need to modify existing analog imaging equipment.

• Agfa HealthCare launched its automated DX-D 600 DR system in the U.S. market. The fully automatic, direct digital X-ray room system offers fully motorized auto-positioning. It features dual cesium iodide (CsI) DR detector technology located in the wall stand and table. It includes single or dual detectors and three configuration options: manual movement, semi-automatic movement with vertical and table tracking (both works in progress), and fully automatic positioning.

• Toshiba America Medical Systems Inc. enhanced its Radrex-I DR X-ray system with DICOM Radiation Dose Structured Reporting and Reject Analysis software. The DICOM feature automatically records radiation dose information for every X-ray exam, making it easier for hospitals to document, manage and evaluate overall dose usage. The Reject Analysis software documents accepted and rejected exposures. This allows radiology departments to view technologists’ technique and performance, reasons for rejecting an image and the number of repeat images.

• Fujifilm’s new FDR Go is its latest DR portable digital X-ray system. It will combine features of the FCR Go predecessors with the company’s advanced D-EVO portable flat panel DR technology. It is U.S. Food and Drug Administration (FDA)  510(k)-cleared and expected to be available for sale in the United States in early 2012.

• IMIX’s new cassette-size digital detectors include two Slimline HD2 panels, which utilize direct conversion technology, and the IMIX X wireless panel, a lightweight cable-free cassette. The Slimline HD2 series, available in 35 x 43 cm and 43 x 43 cm tethered panels, utilizes amorphous selenium direct conversion. This technology also comes in a 43 x 43 cm fixed detector. The IMIX X wireless weighs 6.3 pounds. Its ISO 4090-compliant cassette size fits any existing wall stand or bucky tray.

• Konica Minolta’s new portable X-ray upgrade kit turns portable X-ray systems into digital, wireless solutions. With a very small footprint, the Aero DR portable retrofit solution can be installed and stored inside the cassette storage bin. A built-in roaming feature allows any Aero DR panel to be shared and used between portable and general radiology rooms.

• Kubtec’s FDA-approved Digiview 250 is designed for portable imaging applications. Positionable with one hand, it is a tool for neonatal imaging, as well as the examination of extremities, and for use in mobile systems and general radiology applications. Packaged in a durable, custom-molded plastic housing with an integrated handle, the Digiview 250 is a CMOS X-ray panel system that weighs less than 7 pounds. The panel’s active-pixel CMOS photodiode array consists of more than 5 million pixels, while the low-noise, 14-bit digital output produces crisp, sharp images.

• Carestream’s second-generation wireless, cassette-size DRX detector weighs 7.9 pounds. It displays a preview image in less than four seconds; an optional three-second exposure mode improves medical imaging of larger patients and enhances image quality for healthcare providers with lower power X-ray generators. New features include longer battery life for imaging of up to 190 exposures or 14 days on standby mode.

• GE introduced a suite of advanced mobile radiology units called Optima XR220amx, Optima XR200amx and Brivo XR285amx, and more uses for its FlashPad digital wireless detector.

• Siemens showed its Mobilett Mira mobile digital system with a wireless detector, which recently received 510(k) clearance from the FDA and is commercially available.

• Philips showed its MobileDiagnost, a mobile DR solution with a wireless portable detector that facilitates diagnosis of immobile and critical patients. It became available in the United States last summer.


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