Agfa CR 35-X

Computed radiography (CR) is a tried-and-true diehard for digital radiography studies, and a key cost-effective solution for all sizes of healthcare facilities. Rural hospitals, physician’s offices and imaging centers can link up with the resources at larger facilities. The range of offerings means there is something for everyone—in terms of functionality and price—and CR is an ideal way for facilities to pull the plug on film processing.

Christus Spohn Hospital in Alice, Texas, is one of three rural, sister facilities of the Christus system that went live with CR over three weeks last October. Paul Colburn, director of radiology, said the move had been in the works and it simply was his and the other facilities’ turn.

While the corporate preference is CR from Fujifilm Medical Systems, Colburn could have gone with another vendor if he chose. He was wary at first, but after making a site visit to another facility with the latest Fuji equipment, he was impressed.


Take a big gulp

Before implementation, Colburn found out what all the different users—physicians, nurses and unit clerks—needed in terms of ability to access information online. Once he made sure he could meet those needs, he and his team defined locations for each type of equipment—from plate readers to viewing stations. In most areas, the equipment could just hook into a PC, but each unit needed a high-definition monitor. After getting everyone trained and everything hooked up, “we picked a day, took a big gulp and pulled the plug on our processors,” he says. “No more film. It’s truly amazing.”

Although the physicians accepted the new equipment quite readily, they wanted someone else to look up exams and data for them at first. But after seeing how they could consult with a radiologist right there online, Colburn had no problems. “Department operations don’t change much with CR,” he says. It is primarily a physician satisfier and provides the ability to provide better patient care.


Transition for techs

Only one technologist at the facility had ever worked with CR before, Colburn says. The modality proved to be a big change for the staff of 16. It took them a few days to stop heading to the darkroom after each exam, he says, but they adjusted quickly. That space is now the PACS administrator’s office and will eventually become a dedicated chest imaging room.

Making the switch to CR was no small feat for the techs at Saint Joseph Health Services of Rhode Island, says Denise L. Driscoll, administrative director of radiology. They had little exposure to computers at all, she says. The organization has five DX-S systems and one CR 35-X from Agfa HealthCare. CR was implemented in the emergency department last October and then just last month, throughout the rest of St. Joseph and Our Lady of Fatima Hospital, both in Providence.

Implementation went very well, Driscoll says. “My techs are seasoned. [But] they don’t deal with computers very well.” She was surprised to find that they could pick up CR after just a week of training. “They love it. They realized that it’s much easier not having to leave a patient to develop films.” Meanwhile, the physicians are impressed with the images, particularly how sharp the extremities are.


A good rural resource

Once all the staff inside a facility gets accustomed to CR, it’s time to branch out. For Colburn, CR couldn’t help all affiliated physicians access images. Some of the physician offices in Colburn’s area don’t have high-speed internet connections and some only have one computer in the office, he points out. So, directing them to the internet or sending over a CD of images does no good. On the other hand, Colburn won new business from even more rural clinics because of the ability to access images online.

CR is just as important for more rural facilities to have as larger, urban hospitals, if not more so, says Colburn. “We’re stuck out here. If we get a bad trauma and need to consult with a specialist, this allows us to make that happen.” There are several hospitals in Corpus Christi, the closest city, which is about an hour away. Physicians in Alice can alert clinicians in Corpus Christi of a STAT patient and his or her condition, and send images.

“They can call in specialty surgeons and get ready before the patient ever hits the door. CR is very valuable for a rural facility and to its patients.” Colburn says he considers the preparations that can be made while the patient is en route are like gaining an hour toward saving a life.


Making the selection

During the CR selection process, St. Joseph’s Driscoll says they were looking for a quick system capable of shooting through hips and shoulders. After a site visit to Florida, the selection team was sold on Agfa.
 

Winthrop University Hospital in Mineola, N.Y., chose the single-vendor model with CR—opting to deploy Carestream (Kodak) CR in 2003.

Driscoll put the 35-X in St. Joseph’s, a rehab center, because it’s not quite as busy as the other hospital. The machine is slower, but about half the cost of the DXS, “a big determination,” she says. The other systems are located between critical care and cardiac care, where most portable exams are done—emergency, radiology and the OR. The DXS machines are single loader, which was enough rather than a multiloader, because of the speed at which it brings up an image.

Winthrop University Hospital in Mineola, N.Y., has had CR for at least nine years, says Administrative Director Enrico Perez. He has used equipment from several vendors over the course of his 15-year career. Winthrop moved exclusively to Carestream (formerly known as Kodak) in 2003. Using a single vendor was beneficial, Perez says, for staff education. “Your per diems get oriented to one workflow, and not different cassettes.”

The physicians are very happy with the CR images, Perez reports. The general radiologists use CR almost exclusively, and orthopedists and other physicians use CR for bone work and cassette work. The CR reader is in the emergency department, between two DR rooms.

Winthrop’s x-ray system is integrated with CR. Perez says techs can go up to the ICU and download cases on a system that has a wireless connection. He predicts more wireless technology will be adapted for larger images. As more facilities go enterprise-wide with their PACS, the biggest issues remain security and speed, Perez says. “A lot of that is dependent on whose PACS you have and how well [the systems] are all integrated.”


CR in the future

Although many hospitals seem intent on going all-digital at some point, CR isn’t going away anytime soon. “As long as the images are as good or better than digital [radiography], the costs are lower and it’s almost as quick as digital, CR will remain a viable alternative to DR,” says Driscoll.

Perez says Winthrop may eventually replace CR with DR, but “CR is going to continue to play a role. Unless the DR portables can make the receptor light and easier to maneuver, CR will continue to be easier for staff to use.” CR also will continue to be used in the OR because it is easier to manipulate. “We’re seeing more fluoroscopy being done in the OR, and CR will play an important role there,” says Perez.

For those facilities considering CR, Driscoll recommends looking at all of the different systems available. “What works for us won’t necessarily work in a different environment.”