Increasing the efficiency of accessing portable CR images - and introducing portable DR - is on the minds of many healthcare facilities wanting to maximize the all-too-tight time of their techs and take advantage of their PACS investment.

Portable x-ray can be a tremendous workflow challenge. Techs need to transport systems throughout the hospital to image patients and get the studies to the main department or specialists for reading. It's hardly efficient.

Hospitals everywhere are attempting to infuse some efficiency into the portable arena. For years, CR has served well as the sole solution, but other options are on the horizon. Canon Medical Systems offers two mobile DR systems: the recently introduced CXDI-50G (14x17-inch imaging area) and CXDI-31 (9x11-inch imaging area). Shimadzu aims to get into the game with the MobileDaRT Plus, a private-label version of the Canon CXDI-50G system, which is pending FDA clearance. Other solutions may come on the transmission end; a few hospitals are tapping into wireless networks to more efficiently route studies to clinicians.

DR could be a great solution to the portable efficiency conundrum. A system could travel with a tech, and the tech download images to workstations or PACS via a built-in DICOM port, eliminating time-consuming trips back to the department.

Is this scenario ready for prime time? Not exactly. But Scott and White Hospital in Temple, Tex., aims to pave the way. The hospital recently implemented a Canon CXDI-31 for portable neonatal exams.

PORTABLE DR IN ACTION

The Scott and White approach to digital portable connectivity is fairly straightforward. After the tech completes the exam, a cable in the back of the system is plugged into a network port to transmit images to the PACS and printer. This approach, however, is a temporary measure.

Radiology Manager Raymond Rodriguez envisions real-time wireless transmission via a wireless node incorporated in the CXDI-31. Instead of plugging into the network, techs would transmit images wirelessly, providing physicians with images in 3 to 5 minutes instead of the 15 to 20 minutes typical of CR-PACS portables.

Rodriguez's IT colleagues insist on evaluating bandwidth requirements, security and potential interference before giving the plan a green light. The department also needs to verify that wireless technology can transmit diagnostic-quality studies, which can range from 5 to 11 megabytes (MB) for DR and 5 to 7 MB for CR. Rodriguez is confident about the wireless-portable DR combination and expects to implement the new solution within one year.

Rodriguez is not alone in his quest to implement a wireless solution. A few hospitals are tapping into wireless to transmit portable images to ER physicians, who can review images via a Tablet PC or PDA instead of a workstation. These devices don't display diagnostic quality images, but do provide handy access to review images.

PORTABLE CR & EFFICIENCY

The tried-and-true avenue to portable efficiency is CR. The efficiency gains associated with portable CR partially depend on how techs review portable images before routing them to radiologists and clinicians.

Portable CR requires that techs take each cassette to a reader, which may be centralized in the main department or decentralized throughout the hospital. Many hospitals opt for centralized readers, but strategic placement of readers in high-volume portable areas can facilitate faster image review and provide workflow gains as techs no longer run to the department for processing and QA. These decentralized workflow gains need to be balanced with cost as each portable reader costs $75,000 to $90,000.

Whether a hospital installs centralized or decentralized readers, portable CR allows hospitals to maximize their PACS investment. In many cases, portable CR is deployed after the hospital has invested in PACS. Without PACS, studies can be sent via the network to a DICOM printer. Alternately, a PACS site using a portable analog system can digitize each film to be read on PACS, but that requires an investment in a digitizer and an extra workflow step. Other justifications for transitioning from analog to CR for portable include:

• Productivity gains
• Decreased processing time
• Elimination of chemistry costs
• Elimination of lost film
• Enhanced clinical care with more timely reading