Orthopaedics Associates in Grand Rapids Mich., prefers Carestream Health’s Directview CR for axillary images of the shoulder.

Sometimes considered merely a stepping stone on the path to DR, CR is filling important imaging roles at many facilities. Its flexibility and portability is particularly helpful with trauma patients and works well for smaller hospitals with limited resources.

Orthopaedics Associates of Grand Rapids in Michigan, a practice with 33 physicians covering several specialties, utilizes a mix of CR and DR systems that include the Carestream Kodak DIRECTVIEW CR 850 and 825 systems as well as the Kodak DIRECTVIEW DR 7500. “We use DR for many imaging exams, but prefer CR for foot and extremity exams as well as standing foot and ankle exams,” says Judy Zane, director of medical imaging.

 Most of the practice’s CR work initially came through the ER via trauma patients with multiple fractures. “You can’t manipulate them very much,” says Zane, so “we use CR for cross-table lateral work.” She also prefers CR for axillary images of the shoulder. For certain injuries, the patient can’t lean over the detector and extend the arm. “The goal is getting the image you need that will not make patients that uncomfortable.” They also have found that CR is better at obtaining Merchants view for sports medicine patients.

For long-length imaging, such as for scoliosis patients, CR allows a full view in one exposure as opposed to the three required with DR. The CR system itself stitches the images and, even with one exposure, different filters can be applied so that the end result does not include whited out hips or blacked out ankles or knees, she says.

After about nine months using the CR equipment, staff no longer had to pull jackets, Zane says. After the adjustment period, “it really does streamline the system.” Although it takes just as long, she says, to complete a study with CR, DR or analog equipment, “the front end and back end are definitely improved.”

Mary Black Memorial Hospital in Spartanburg, S.C., has been using Fujifilm CR and DR equipment since late 2004, says Beverly O’Sullivan, RT(R)(CT), director of Diagnostic Services. That includes the FCR Carbon XL and XG5000 systems. Although the facility has one DR system, they use CR in seven other rooms. “CR will continue to have a role here,” she says. “We’re a community hospital. We have limits, [in particular] more limited resources than a trauma center.” Most importantly, “our radiologists are very satisfied with the quality of the images.”

O’Sullivan advises others to research how well vendors’ imaging plates perform. “I have heard that others’ plates don’t last very long, break or have a lot of artifacts.” That has not been the case for this facility. Along with that is the vendor’s service and the expertise of its team—she suggests evaluating the down time experienced by other facilities, too.

For those organizations that plan to implement DR in the future, Zane recommends installing CR first. That gave the techs and radiologists a chance to become familiar with the digital equipment. Although it came with a large learning curve, “it was a nice transition,” she says.

Zane says that DR alone won’t drive CR into obsolescence. One location she manages currently uses three analog machines and rather than planning to replace all three with DR, CR very well may be the more cost-effective route.