CR in Orthopedics

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Agfa's DX-SX-rays are a life blood of orthopedic medicine, and for years, plain-film x-ray has been the gold standard. However, more practices are installing computed radiography (CR) and experiencing the benefits: reduced imaging costs, improved workflow efficiencies, expedient information delivery, and simultaneous access to images and clinical information by multiple users. CR brings the advantages of compact design, a lower price point than its digital radiography cousin, and a variety of specialized views tailored just for orthopedics.

Rolling out CR office by office was a successful strategy for M &M Orthopedics in Downers Grove, Ill. The orthopedic practice includes five office sites, and its staff consists of 18 orthopedic surgeons, two podiatrists, one physical medicine and rehabilitation specialist, and six physician assistants.

Specializations include general orthopedics, fracture care for children and adults, sports medicine, joint reconstruction, hand, spine, foot and ankle, arthroscopic surgery, and pediatric orthopedics. Approximately 100 patients are imaged per day, per site, and 75 percent to 80 percent of these patients get x-rays, says COO Mary Jane Munley.

Once deciding it was time to go digital, M &M Orthopedics rolled out a Fujifilm Medical Systems’ XG5000 CR system, which is a high-capacity, multi-plate reader, at a site that was moving its office to a larger facility. Once up and running, CR has been implemented at M &M’s four remaining locations. Fuji’s XL OrthoCR system is used at locations that x-ray a smaller number of patients.

M&M favored CR over DR because of the cost. With CR, M &M could still use its current x-ray imaging equipment, as CR uses conventional x-ray equipment to perform imaging studies, replacing the film in the cassette with a reusable imaging plate that is read by a laser after exposure, yielding a digital image on the user’s computer.

The imaging technology quickly proved to be a valuable investment for the organization. A multi-site practice, patients generally choose which M &M facility to visit based on their schedule and convenience, says Munley. With digital images and PACS, internet-based image distribution eliminated the need to transport large amounts of plain-film to various sites.

“Another reason we wanted CR [and PACS] was the storage aspect of radiographic film,” says Munley. “It’s heavy, bulky, and you need a lot of space to store it. As medicine and healthcare progress, you want to be able to use your square footage to care for patients rather than store x-ray film.”

Munley also emphasizes the value of CR’s imaging and processing speed. “Technologists take the x-ray, put it in the reader, and [the image] comes up almost immediately,” says Munley.

CR from a tech’s point of view

Premier Orthopedics in Nashville, Tenn., has been using CR and PACS for nearly two years, and one distinct advantage to the technology is the electronic storage and retrieval of images, says Edie Manning, RT(R). Manning is the primary radiologic technologist at Premier Orthopedics. With one x-ray unit and a Fujifilm CR reader, Manning is able to image, on average, 65 to 70 patients daily. “Our facility is really busy,” she says. “A slow day for us might be 30 patients.”

When Manning needs to refer to prior films to get a better understanding of a patient’s orthopedic condition, she accesses the PACS. Prior to CR, Manning would have to travel down the hall to the file room, locate the patient’s chart, and then view the plain-films on a lightbox.

“Now I get the chart for the order, go to the computer, pull up the patient’s last image and I am looking at it in five seconds,” says Manning.

Another element Manning likes about CR is its speed. In a hard-copy environment, Manning could image four patients in 30 minutes. With CR, the same number of patients can be imaged in 15 minutes. But Manning admits it took her some time to accept the analog-to-digital transition. “I had a hard time with it at first,” she explains. “I did not want to go digital. We were so good with hard-copy x-ray. To me, we had a system that worked perfectly.”

However, after going live with CR, it took Manning only a few days to adjust to using filmless cassettes and looking at the images on a computer screen. “Within two days, I was excited about the change to digital.”

“The benefit of digital is not necessarily the image itself,” opines Manning. “It’s more the speed and accessibility it brings to orthopedics. We put patients