Portable x-ray may be a routine technology, but at a 554-bed hospital serving a sicker-than-average patient population, and housing a Level 1 trauma center and Level 1 burn center, there is nothing routine about the need for fast, reliable, portable x-ray capabilities.
That’s the case at Legacy Emanuel Medical Center in Portland, Ore. The hospital is also a Level 3 NICU, a certified stroke and cardiac-care center—and a place of hope for many patients with multiple co-morbidities who might be in dire straits if not for the availability of high-quality portable x-ray at the bedside.
Last year Legacy Emanuel’s imaging services department set out to standardize its portable x-ray equipment and replace its older analog systems with digital radiography (DR). This month the department’s manager, Tommy Williams, RT(R)(CT) ARRT, and staff technologist Cerise Whitten, RT(R), describe the process of selection and implementation in a case review published by Fujifilm.
Noting that, prior to the project, only four of Legacy Emanuel’s 15 portable x-ray units were DR, Williams and Whitten write that their team went looking for “that hard-to-find combination of a technologically savvy, user-friendly and durable system” as their units are used “all day, every day, in some of the most extreme environments.” Their wish list also included high image quality and dose reduction.
The team evaluated six vendors and considered a variety of options. They decided on Fujifilm’s FDR Go, largely on the strength of its Virtual Grid feature, although they also liked its small footprint, maneuverability in tight spaces, low-dose capabilities and exam tools. They went live with three of these systems last February in Legacy Emanuel’s adult ER/trauma unit, complementing an existing FDG Go in the institution’s Randall Children’s Hospital.
Virtual Grid made the choice a natural one, as it adapts image processing to replicate grid use, reducing degradation of image quality caused by scatter radiation.
At the same time, “we can’t compromise image quality—our emergency physicians and surgeons depend on these images to make the right patient treatment decisions quickly and safely,” the authors write. “We’ve also found that Fujifilm’s Virtual Grid can help reduce artifacts due to a misalignment of the tube to the detector angle.”
With Virtual Grid, the techs have achieved better workflows and fewer repeat exams. “Our clinical workflow is also streamlined,” they write. “[O]ur surgeons now rely on that instant image processing to make decisions on whether a patient needs immediate surgery, should be intubated or should receive a chest tube. In fact, our neurosurgeons now specifically request the FDR Go interoperatively for any surgical lateral spine cases.”
Zeroing in on cutting the need for costly and dose-increasing do-overs, they write, the department has lowered its exam repeat rate from 7-8 percent several years ago to 4.2 percent today. This has given the team the confidence to set a target of under 2 percent for all portable DR exams.
Ongoing training plays an important role in the high image quality and low repeat exam rate, Williams and Whitten explain, adding that Legacy Emanuel’s techs recently completed a refresher course. “[T]hey all echoed their amazement that one button—the orange VG—does it all in one simple step. To understand Virtual Grid, you really have to see it in action—it’s not smoke and mirrors.”
The authors state that the team is using Virtual Grid in 90 percent of all portable chests and 75 percent of abdomens.
As for dose management, they have used FDR Go to cut patient dose by 70 percent, the authors write, adding that they have reduced dose by 30 percent when moving from computed radiography (CR) to DR and 17 percent when moving from another vendor’s DR to the new FDR Go.
Meanwhile, comparing nongrid to grid and Virtual Grid studies, they discovered that, on an average 150- to 200-lb. patient, nongrid (chest) studies averaged 90 kVp @1.6 mAs, actual grid studies for patients up to 350 lbs. averaged 110 kvp @ 8-10 mAs and Virtual Grid landed in the middle, averaging 110 kvp @ 5 mAs. These results demonstrate that “we can lower patient radiation dose on the FDR Go with the Virtual Grid or when using a standard no-grid technique,” they write.
“The FDR Go with Virtual Grid has withstood the rigors of our hectic, 24x7 emergency/trauma department,” Williams and Whitten conclude. “It has been bumped, jostled and stressed to the max, yet it continues to generate exceptional image quality and keeps up with our ‘crazy medicine’ workload.
“Virtual Grid is an unbelievable clinical application that helps us swiftly image even the most critically ill and injured patients and delivers the high-quality images that our clinicians depend on each day to keep saving lives.”