Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.
BLOG: Rural Imaging Requires Affordable And Versatile Equipment
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Access to healthcare by rural-living Americans can be difficult. Part of the reason is the wide geographic expanse.
According to the U.S. Census Bureau, rural America covers about 97 percent of U.S. land. It is home to about 60 million Americans — about 19 percent of the U.S. population. Many travel 50, 60 or more miles to urban health care facilities to get specialty care or even a computed tomography (CT) or magnetic resonance (MR) exam.
More Than Inconvenience
Having to travel long distances creates “heathcare disparities and impedes … normal, healthy lives,” according to the National Rural Health Association (RHI). In some Wisconsin counties, the RHI may send healthcare workers to some homes to measure residents’ weight and body mass index, blood pressure, blood glucose and cholesterol. This outreach — along with telehealth, whereby remote patients may visit physicians digitally — can help meet some challenges of rural healthcare.
But to get needed health information, access to radiography, ultrasound, CT and MRI may be needed. This is especially so in emergencies, which often occur in rural America. Farmers often do not visit physicians except during emergencies, according to the RHI. And rural children are prone to firearm injuries and poisoning.
Adding Imaging Modalities That Make Sense
Equipment value increases with versatility. Some rural sites have added MR and CT scanners that can handle patients regardless of size, complaint or disposition. Star Valley Medical Center in Afton, Wyo., replaced a mobile MR with a stationary one.
Being on-site, the MR scanner can handle urgent cases, according to administrators. The increased accessibility helped relieve the backlog created by dependence on a mobile MR — a problem that had forced some patients to drive 70 miles to Jackson Hole for MR exams. And the oval bore of this 1.5T MR scanner accommodates bariatric and claustrophobic patients better than a circular one. Similarly, OGH Imaging in Grand Coteau, La., installed an extra-wide (75cm) bore CT with the goal of getting patients to try rural care at OGH in lieu of traveling to a big-city medical center.
The Need For Versatility
Vendors are also designing versatility into the staples of medical imaging. Agfa’s DR800 supports both radiography and fluoroscopy in a single room. The DR800 can generate skeletal radiographs as well as those of the thorax and abdomen — and can perform fluoro exams, such as barium studies, arthrograms, myelography and catheter placement.
Similarly versatile, a Hitachi ultrasound system may support different capabilities, depending on its configuration. When the ARIETTA 70 is outfitted with different transducers, general radiology, urology, cardiology, even surgery support are possible. When paired with the SOFIA table, the platform can perform 3-D breast ultrasound to image dense breasts, which may hide cancers. (In the U.S., as many as half the women ages 40 to 74 have dense breasts, according to the Susan G. Komen Breast Cancer Foundation.)
“We build our systems on common platforms that have broad appeal. So (our products) fit into a rural community health system, which has to take care of everyone from geriatrics to pediatrics to claustrophobics to obese patients,” said John Waddell, senior vice president of sales and marketing at Hitachi Healthcare Americas.
Hitachi distributes its own ARIETTA-based systems. But, under a license with Agfa, the company also sells the DR800. “Having a universal room that can do radiography and fluoro in a digital environment with a high degree of uptime and small overall footprint — rather than needing duplicate rooms — can be a real advantage to rural facilities.”
Affordability — or Forget It
Imaging equipment has to be affordable, Waddell told me. That can be tough for rural facilities. Which is why Hitachi has developed financial options for rural customers. “We balance capital as well as operating expenses,” he said. “We structure the economic factors for the rural customer.”
Staff training can also be an issue, particularly when adding an unfamiliar modality or radically boosting performance. A lot can change, for example, when replacing a CT scanner that delivers 16 slices per rotation with one that delivers 64 or 128. Cardiology and neurology applications — even minimally invasive interventions — become possible. Clinical extensions like these can uncover new sources of revenue. But to be successful, their development must be carefully planned.
Greg Freiherr is a contributing editor to Imaging Technology News (ITN). Over the past three decades, Freiherr has served as business and technology editor for publications in medical imaging, as well as consulted for vendors, professional organizations, academia, and financial institutions.
Editor’s Note: The coming two installments of this four-part series will recount how specific rural sites have leveraged equipment versatility in MR and CT, as well as ultrasound and X-ray.