Computed radiography systems, often in combination with PACS, are bringing cost reductions in film, FTEs, file room space and repeat studies, and driving efficiency and exam turnaround time in imaging centers and across entire healthcare enterprises as well. Six facilities share their real-world productivity gains.

Radiology departments throughout the country are considering whether or not productivity gains justify the deployment of computed radiography (CR), whether in clinic-based settings or across a multi-institutional enterprise. For clinicians interested in taking advantage of the overall benefits of digital image distribution in a filmless radiology practice, CR offers a variety of productivity advantages through increased efficiency for technologists and clinicians, and cost reductions for the enterprise.


SPEEDING DIAGNOSIS

Cathy Lechnir, administrative director for radiology at Gundersen Lutheran Health System in LaCrosse (Wis.), describes the benefits of their Fujifilm Medical Systems CR installation. While their first SmartCR unit was installed in an outlying clinic in December 1996, they completed the conversion to a filmless department in July 2003 utilizing the Fuji Synapse PACS. The institution employs a robust network with a Gigabyte backbone and 100 Megabytes to the desktop that they describe as redundant and reliable.

Although the advent of digital image management brought immediate, they have continued to see advantages gains for their technologists and physicians. Because they have several different physical sites, in the past a radiologist would travel to an offsite facility, read x-ray studies for three hours, wait for intermediate steps to completing a report, and then move to another site. Radiologists have recognized productivity gains by having the images come to them, allowing them to stay in one location to interpret studies for a full day rather than waste "windshield time" driving from site to site.

"We have a PACS workstation on all of the hospital floors and in the clinics," says Lechnir. Once an image is processed, it becomes accessible immediately to both the radiologist and the referring physician. For example, in the NICU, once the x-ray is taken and put through the CR processor, the neonatologist and the radiologist can see the results simultaneously.

Susan Einerwold, clinical manager for diagnostic radiology at Gundersen, cites reduced workplace stressors for their technologists, especially in the critical care areas of trauma, intensive care, cardiac care and surgical departments.

"There's a decrease in stress for the technologist due to the fact that images are readily available for providers with multiple viewing options," says Einerwold. This enables the techs to concentrate on performing exams and patient care rather than film management.


EFFICIENT READS

Similar productivity gains are described by Sally Womer, radiology quality improvement coordinator at Geisinger Health System in Danville, Pa., for their Fuji CR system they installed two years ago.

The enterprise includes two major medical center hubs with several clinics within a 75-mile radius. The efficiencies afforded by immediate access to digital images has enhanced patient care in their outlying clinics as well as their intensive care units that physically are located at distant sites within the hospital. Womer describes that although their ICUs are located in the same building, they're a block and a half away from the radiology department.

"Our docs used to come in and spend the first two hours of the day out of the radiology department [reading films in the ICUs]," says Womer. Now, they select studies from the list on the PACS, read those images in the department and move to other activities.


OUT OF A JAM

Jeff Pustejovsky, assistant administrative director of radiology at the Carolinas Medical Center in Charlotte (N.C.), installed a Konica Minolta Xpress Dual-Bay CR system in the fall of 2003, after having systems from other manufacturers for several years in their four hospitals in the county.

He describes the speed of processing time as a major benefit. "We didn't want our people to have to wait in line to be able to run a cassette."

With their own radiology engineering group, Carolinas Medical Center has found efficiencies too, in installing the same equipment across the enterprise so the engineers are only required to learn one system.

One of the other features that impacts their productivity is the ease of clearing cassette jams. "No matter who you buy from, you're going to have cassette jams," Pustejovsky explains. "With this one, we can clear them ourselves." This translates into fewer service calls with resulting down time.

Although their clinicians approved the image quality, and the PACS engineers appreciated the mechanical aspects, Pustejovsky says that the ease of use for their technologists is what he thinks makes this a successful product. They found their techs could learn to use it within 15 minutes.

"Another advantage is the way it handles data. It streams the data as it's reading it to the CS-1," he says. "Other systems acquire all of the data and then push it over the network as one big package. This streams it live, and it takes 24 seconds at the slowest rate."


TRACKING STUDIES

Lloyd Gill is the administrative director of radiology at Saint Elizabeth Medical Center in Edgewood (Ky.), that utilizes Konica Minolta CR systems as well. They have a total of eight Xpress CR dual-bay readers, installed in March 2003, to manage their 90,000 x-ray procedures per year. They began by installing one unit, followed by training, and then they installed seven other units linked to their McKesson PACS.

While they have experienced significant productivity gains among their technologists, Gill cautions that it takes the radiologists some time to become more efficient with this system when changing from film-based practice. That's because they must compare the new soft-copy version to old studies on film. The benefit is that they don't need to request repeat exams as frequently because they can adjust the images. As time goes by, the prior exams will all become digital, and therefore they will have fewer and fewer films to compare.

Gill describes an exam code-mapping feature where Konica programs into the computer routine views that an institution normally uses for specific x-ray studies.

"When you purchase the system, you tell Konica the views you take with each procedure, and they map that into the computer, so when the name and exam come from the RIS into the system, and you select the name from the worklist, it brings up that exam and those views," Gill says. "A barcode marks the cassette, and when you pull up the name, the exam is there." The primary benefits of this feature are reduced error rate and more efficient loading of exams.


TURNAROUND TIME TUMBLES

Arthur F. Crowe, RT(R), administrative director of radiology for Central Suffolk Hospital in Riverhead (N.Y.), describes their roll-out of CR in this mid-sized community hospital with several remote sites, covering a 400-square-mile service area.

They began the CR project with an Eastman Kodak DirectView CR 800 in their emergency department to facilitate reading x-rays for trauma cases. Before placing this unit in the emergency room, it took approximately 16 minutes to process a film study. Throughout the next year, they documented a 15 percent reduction in turnaround time to 12.9 minutes per study, prior to a PACS install.

The success of this pilot project resulted in a full deployment of PACS and CR throughout their entire department in February. Using the Kodak DirectView PACS System 5 for storage and management of digital patient images and related information, the Kodak DirectView CR 950 multiloader system and the CR 500 in the operating room, they provided complete CR coverage throughout the institution. At this time, they have seen another 10 percent decline in their turnaround time for all radiology studies.

"We've had extreme clinician satisfaction because they're able to review images in a quick and orderly fashion," says Crowe. "And our reject/repeat rate is hovering at 0.9 percent [mostly from malpositioning], and we have a student x-ray program."

Their network has a Gigabit fiber backbone connecting 5 LAN closets with 10/100 MB switched to the desktop. The majority of the 250 networked devices connect at 100 Megabits. The radiology system runs on a Sun Microsystems platform, and the network is configured with 15 servers within a combined Microsoft NT Domain and a Novell NDS Tree.

A corollary benefit involves their quality assurance program, where the CR system tracks each user and monitors the quality of technologist performance.

"We don't want techs who over-or under-expose patients, so we have a 'real time' snapshot of how our techs are doing," concludes Crowe. Given their tech training program, having this monitoring system in place provides valuable feedback for educational purposes.


RECONFIGURING STAFFING

Gary Woodruff, AART, BA, HSA serves as PACS administrator and technical manager at Novato Community Hospital in California, where they have been using Philips Medical Systems CR equipment for the past three years. They have a PCR 500 single-plate reader and PCR AC 5000 high speed multi-cassette readers. Their enterprise includes two hospitals and two clinics, where they complete 185,000 x-ray exams per year.

The facility has gained efficiency in reducing file room staff in two different facilities. Before deployment of the CR/PACS system, they had 8.5 FTE (full time equivalent) personnel in the file room, with a current staffing rate of 2.5 FTEs. They were able to reduce staff through natural attrition, rather than necessitating lay-offs. In addition, they reduced their weekend technician staff from 1.5 FTE to 1 FTE while absorbing a 50 percent increase in study volume facilitated by digital imaging.

The film budget, too, saw a significant cost savings. The combined film budget for both hospitals plunged from $550,000 to $65,000. Still another benefit came in the re-configuring of file room space to provide office and support function rather than merely film storage.


CONCLUSION

The addition of CR functionality to an institution's radiology practice holds the promise of productivity gains, and ultimately, reduced costs once the capital expenditure is complete. Digital images offer clinical advantages in the flexibility of review they afford. Each institution must weigh the pros and cons for their individual circumstance to determine whether or not productivity gains outweigh any negative aspects of deployment.