Feature | October 09, 2006

Why Computed Radiography Consistently Makes it to Home Plate

Some contend that CR merely is an intermediate step to DR from traditional X-ray film. Why are they right or wrong?
Wouldn’t you want to X-ray a patient and have the image instantly available for interpretation without any additional time or effort? Of course you would. DR not only makes your life easier, it also makes you more productive, but at a cost. Current DR technology is expensive and unless the high cost can be offset by increased patient throughput, it is not economically justified. We are accustomed to the falling cost of consumer electronics, but medical products rarely achieve the volume savings of consumer products. We live in a digital age and radiology in all of its embodiments from central radiology to urgent care centers to podiatrists and chiropractors will go digital using the most cost-effective technology. For the private office and low-volume user, say 25 X-rays or less per day, that will be CR for the foreseeable future.
CR supporters maintain that plate scanning tends to be less costly, involves fewer compatibility and configuration challenges with existing equipment and requires less education and training than DR. Are they exaggerating or really on target? Why?
In principle, a well-designed CR system and user software should not be any more difficult to use than a well designed DR system and user software. Both systems have wider exposure latitude than X-ray film so it is almost impossible to over or under expose an image. On the other hand, an interesting thing is happening in mammography.
The two FDA-approved systems for mammography were both DR using two different plate technologies. To use these systems required a new radiation source as well as receptor with the consequent cost. The FDA has now approved a CR system for mammography. It not only utilizes the existing X-ray sources; it also allows CR plates from other X-ray modalities to be scanned. This looks like a case where, even though it requires one more step than DR, CR delivers a lot more ‘bang for the buck.’
Does CR make more sense for outpatient care facilities and smaller or rural hospitals than it does for larger or urban hospitals? Why?
DR costs significantly more than CR. That cost difference can be justified by increased productivity. For example, if more patient throughput is desired you can achieve that by purchasing additional rooms of X-ray equipment and hiring additional RT(R)s or you could purchase DR systems and handle more patients per hour with the same X-ray equipment and staffing. In fact, the latter solution might prove to be the most economical in the long run.
But what if your patient load is easily handled by your existing X-ray equipment and staff, as might be the case in a small hospital or urgent care center? It is unlikely that you could ever recoup the high cost of DR, but a lower-cost CR system can reduce your film and processing costs while providing the digital advantages: easy storage and retrieval and electronic communication of X-ray images.
How challenging is it for outpatient care facilities to convert to CR from traditional film?
Step 1: Replace X-ray film cassettes with storage phosphor plate cassettes.
Step 2: Expose, usually as if it were 400-speed film.
Step 3: Scan plate instead of processing film.
The imaging chain for CR is so much like X-ray film (although it is a dry system) that there is virtually no learning curve. CR software is written to be intuitive to use. Initial software training should be at least a couple of hours with follow-up at a later date. If you can send and receive your own e-mail you should be able to run CR software.
Digital imaging is a technology that the end-user likes. There is no darkroom, processor, chemistry or disposal of chemistry and no storing and searching through stacks of X-rays. Images can be sent via the Internet to radiologists or colleagues. If a patient wants copies of their X-rays, just burn them on a CD.
How does a best-of-breed CR manufacturer like ALLPRO compete with the larger, broader-lined manufacturers offering CR technology?
ALLPRO Imaging is successful because we identify niche markets where our engineering and manufacturing expertise allow us to offer products with reasonable prices and high capabilities. We concentrate on the private office market. I recently attended a lecture by a marketing executive from one of those very big companies. Not only were private offices not on his radar, hospitals of less than 100 beds were not in his plans. That leaves a significant market for companies like ALLPRO.
ALLPRO, along with our parent company Air Techniques Inc. (founded in 1962) just moved into a new, custom-built 200,000-square-foot headquarters in Melville, NY. We proudly design, manufacture and support our products in the U.S. From our sales rep group to our training staff to our technical service department, we are all dedicated to responsive support of our products to our dealers and end-users. I might argue that it is exactly because we manufacture a limited number of products that we are able to offer superior support that is unmatched by the larger multiproduct companies.
When larger manufacturers that offer products spanning multiple areas – including DR – claim that CR is here to stay and will ‘peacefully co-exist’ with DR and they fully support its progress, what does that say to a best-of-breed manufacturer like ALLPRO, as well as the marketplace in general?
First of all, there is a recognition that both DR and CR produce high-quality images and that the adoption of either modality will yield cost savings and efficiency benefits to the end-user compared to X-ray film and chemistry.
Secondly, it validates the concept of using the correct tool to perform a specific task. In some cases the higher cost of DR will be offset by volume efficiency savings. In other cases the lower cost of CR can be justified even by low volume users.
Just because engineers and market analysts call CR a ‘mature technology,’ does that mean there’s little or no room for innovation? Why? What could still light a fire under CR, aside from cost and operational sufficiency? Are footprint or workflow improvements the secret? Is a hand-held CR unit totally out of the realm of possibility? Why?
Simply because our engineers thoroughly understand how to create a latent image on a storage phosphor plate and to read out that image doesn’t mean that the physical mechanisms to do so have all been invented. As LED and CCD technology change and improve I expect that novel plate readers will continue to be invented. Hopefully, these will be able to be sold at lower prices so that even very low volume users will have the benefits of digital imaging.

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