CR Successes

This month we're saluting achievements in radiology department efficiency derived from computed radiography with a series of five case studies from a variety of types of healthcare facilities around the country and in Israel.

We're highlighting a full-service tertiary care hospital in Portland, Ore. (110,000 imaging procedures, 48,000 of which are radiography based) that touts CR-based time-savings of 20 percent and a drop in repeat film rate to 1 percent from 4 percent; a big Midwestern healthcare clinic in Wichita that has seen 30 percent productivity gains among x-ray techs thanks to a combination of CR and PACS, as well as radiologist report turnaround time dip to near immediate to four-hour report access from 24 to 48 hours; remote, 200-bed Beaufort Memorial Hospital, which has two radiologists reading 85,000 exams a year, has seen great efficiency gains thanks to small footprint, dual-bay CR system; Frankford Health Care System in urban Philadelphia has taken advantage of a 20-percent boost in productivity thanks to CR - helping it deal with a 10 percent decline in staffing and 10 percent increase in exam volume; and one of Israel's largest hospitals, 2,000-bed Sheba Medical Center, has seen CR distributed workflow savings in the OR of up to 30 minutes per exam or two to three hours each day, depending on the radiology workload.

CR Brings Remote Sites into PACS at Wichita Clinic

By Larry Leopold, R.T., Radiology Manager, Wichita Clinic, Wichita, Kan.

Located 200 miles southwest of Kansas City, the Wichita Clinic (Kan.) is one of the largest privately owned healthcare clinics in the Midwest. At the main Murdock facility and 11 satellite sites located around the greater Wichita area, the clinic efficiently handles 580,000 patient visits and 103,000 procedures a year - all between the hours of 8 and 5, Monday through Friday.

Wichita Clinic began its journey towards PACS early. In 1997, seeking to save on film costs, the clinic began with a small-scale server and two workstations from Agfa, installed in the Murdock facility. The physician-owners saw cost savings and productivity improvements right away, so the process continued with Agfa until Murdock was completely filmless in 2002.

Physician response was overwhelmingly positive. They loved the image availability on their computer monitors using Agfa's WEB1000, and the ability to consult simultaneously with a radiologist. PACS, for them, meant faster, more accurate diagnoses, better patient care, and increased productivity. Radiologist and Chief Medical Officer Steve Taylor commented that his life is much more efficient since PACS. "With no downtime between cases; and we never spend time looking for old film. Best of all, it allows the radiology department to provide better patient service."

In the meantime, however, physicians at the outlying clinics were still operating on the old system - in which the patient would be screened at the satellite site, yet would have to wait 24 to 48 hours for a diagnosis while the twice-daily courier service ferried images to Murdock and radiologists' reports back. That sometimes meant, if you were a patient at a branch site, and you had pneumonia or a hairline fracture, you could have a long wait.

As a first step, the brand new facility, the Northeast clinic, was outfitted with Agfa's ADC Solo CR system when it was built in 2000, but the need was increasing to connect the other outlying sites into PACS. Agfa's range of CR systems, designed to serve the largest to the smallest facilities, provided the financial solution for Wichita. In 2002, an Agfa ADC Compact was purchased for our larger Bethel-Newton clinic 30 miles to the north, and ADC Solos for the Carriage Park and Mapleridge sites, bringing four of the off-site locations digital by the end of 2003. Today, Agfa's initia system is being considered as a CR solution for those remaining sites that perform fewer than 200 radiology procedures a month.

The new turnaround time for radiologists' reports, ranging from immediate to four hours, has been cited as a huge benefit by physicians at the outlying sites. Mark Springer, MD, a pediatrician at Wichita's Carriage Park facility, says, "For subtle findings where a radiologist's expertise is critical, such as a possible fracture in a child's growth plate, the delay used to be a big problem. Now I can call up a radiologist while the patient is still in my office, and we can look at the film together." Beyond the improved customer service and patient care, the Wichita clinic has realized many other benefits of bringing CR to the satellites, among them a 30 percent increase in productivity by x-ray techs who no longer have to be secretary and file person.

With Volume Up, Staff Down - CR Boosts Productivity at Frankford

By Mike Dolan (RT) (R) & Tom Stride, Radiology Supervisor and Chief Technologist & Director of Medical Imaging & Informatics, Frankford Health Care System, Philadelphia, Pa.

Faced with expanding volumes and a shrinking staff, our facility elected to upgrade our computed radiography (CR) systems to enhance productivity and ease of use. Improved image quality was an added benefit.

Productivity gains were especially critical because our Torresdale campus has experienced a 10 percent growth in imaging studies over the last year. At the same time, we have two fewer full-time radiographic technologists on the day shift. Fortunately, our new CR platform equips us with the 20 percent boost in productivity that's required handling a 10 percent decrease in staff and a 10 percent increase in volume.

A new KODAK DIRECTVIEW CR 950 multi-cassette system now serves seven exam rooms at our 239-bed hospital - capturing and processing approximately 100,000 imaging studies a year. The CR system manages information from 16 cassettes simultaneously and accepts eight cassettes at a time.

Fully featured remote operations panels located in every exam room enable our technologists to input patient and cassette identification, and perform the full image review in the exam room near the patient. Images are available for review in as little as 30 seconds. We estimate that CR technology delivers an average time-savings of up to five minutes per exam over a film-based system.

Image quality is also improved. Our radiologists report that they are seeing better diagnostic detail in these images, which we attribute to the image quality captured by the new CR platform and the vendor's image enhancement software. As a result, our repeat rate is at its lowest level ever - 2.2 percent.

When evaluating new CR systems, we paid particular attention to the operator interface because ease of use plays a critical role in maximizing productivity. We also carefully evaluated the ability of the CR system to interface with our existing McKesson PACS and Cerner RIS. Thanks to a seamless integration between our PACS and CR platforms, patient and exam information is entered with a single bar code scan.

Our new CR system also has privacy-enabled features, including user identification and authentication and automatic logout, which assist our facility in meeting the requirements of HIPAA.

CR transforms patient productivity at Legacy Good Samaritan

By Susan Dorsey, B.S., R.T.(R), CRA, Imaging Manager, Legacy Good Samaritan Hospital & Medical Center, Portland, Ore.

Legacy Good Samaritan Hospital & Medical Center (LGSH) in Portland, Ore., is a full-service tertiary-care hospital, conducting 110,000 imaging procedures annually, including 48,000 radiological exams. When the facility set out to implement Fuji computed radiography (FCR), we hoped to improve image quality, reduce costs, enhance efficiency and raise customer satisfaction. What we discovered was that with careful planning and effective, department-wide communication, CR can be deployed with ease and its benefits fully realized.

The Installation: The first step was to learn as much as possible about the CR installation process. Which components should be purchased and what were the footprints? Where would they be placed to best enhance workflow? How would we assure redundancy?

Fuji specialists did a walkthrough and made product and layout recommendations. A decision was made to purchase two FCR 5000 high-capacity CR readers for our main radiology area, and two SmartCR units, designed for distributed applications, for surgery and for the ICU. Flash IIP workstations were located in each of the five control rooms, which has ultimately maximized workflow efficiencies. Technologists select the patient and exam menu, perform the exam, then place the exposed cassette in the reader - all the time staying in the room with the patient and also improving throughput.

Additional readers and imagers also were placed in other strategic areas of the main department, including our tech core area where our radiology rooms exit into a central work area. A point-to-point connection was established between the Flash IIP, CR reader and laser imager in the tech core as an ultimate fail-safe mechanism to assure continuous uptime. With all of the equipment in place and a feeling of confidence that we had a fully redundant system, we moved to the implementation.

Staff Preparation: In preparation for the CR rollout, we selected computer-savvy, change-oriented technologists to observe the technology in use at nearby facilities employing the systems. The technologists' goal was twofold: identify any work pattern changes necessitated by CR, and gain a general confidence with the system.

As our go-live date approached, we held a series of meetings to help the technologists prepare for CR. We explained how the readers work, what changes in workflow to expect, and the reasons for the CR implementation. It was important to gain the technologists' support prior to implementation, so we engaged them and helped them to understand the benefits CR would provide.

Going Live: The first task on our go-live date was loading the auto-exam procedure codes in the Flash IIP workstations, enabling users to pre-select the order in which they wish to view exams. This is a tremendous time-saving feature that provides for procedure codes to accompany patient names on the worklist, so technologists do not need to select the type of procedure or the order of exams because they are transferred directly from the RIS.

Next, an imaging specialist from the vendor began the training. By the end of only eight hours, all technologists, including weekend and night-shift staff were using CR exclusively - no more film. By the end of the first CR-only day, the technologists removed old cassettes from radiology, and within two weeks, we were so confident with CR that we removed all radiology processors and silver reclaimers, along with darkroom plumbing and drains.

The End Result: The many benefits of transitioning to CR were immediately apparent. Radiologists, referring physicians, nurses and even respiratory therapists were delighted with the ability to manipulate the CR digital images by window and leveling, and performing energy subtraction for line placements and other procedures. Orthopedic physicians were especially complimentary of the exceptional CR image detail.

Beyond quality, the increase in patient throughput and productivity is key. Previously, we considered the installation of another radiographic room to keep pace with growing procedure demand, but with CR, our exam throughput has increased enough for us to rethink this plan and save our scarce capital dollars.

The material gains in procedure room throughput that we have noted are primarily due to the near-instant availability of the "first-up" images. We now see images within just 20 seconds or so, versus the vast time we were spending on film processing. This eliminates the need to keep the patient in the exam room while we verify film quality. Additionally, our repeat film rate has dropped from 4 percent to less than 1 percent. So, we estimate, conservatively, a time-savings of more than 20 percent.

Overall, CR has delivered all our desired outcomes. Improved image quality, cost reductions, workflow enhancements, and heightened customer satisfaction have all been realized for Legacy Good Samaritan Hospital & Medical Center.

When Remote, Reliability Must Follow: CR at Beaufort Memorial

By Sherry A. Dubatowka, PACS Administrator, Beaufort Memorial Hospital, Beaufort, S.C.

An important goal of all hospitals is to choose diagnostic products and systems that deliver the best quality and provide the greatest reliability. That's a given. But hospitals that happen to be relatively remote, like Beaufort Memorial, have an extra challenge because 24/7 uptime is not just a goal, but an absolute necessity.

Beaufort Memorial Hospital is a 200-bed acute and sub-acute hospital center on the Atlantic Intercoastal Waterway between Savannah, Ga., and Charleston, S.C., in Beaufort, S.C., and although we're the largest hospital between those two metropolitan cities, we're still pretty much here on our own. (We also happen to be one of the few hospitals in the country with its own emergency dock.) Fortunately, we have partnered with Konica Minolta Medical Imaging for computed radiography, and currently enjoy the quality and reliability of the Xpress CR dual-bay system and the DRYPRO 752 compact dry network imager.

In addition to its reliability, the Xpress CR has proven to be incredibly user-friendly. All staff members who process images have been able to do so on the new system after just a 15 to 20 minute training session. Currently, we have three of the new units in our main Radiology Department and one in an outpatient Radiology section in an adjacent facility. All four CR units have been programmed so that our technologists can identify a plate on any one station and process it through any of the processing units.

The CR units were installed in concert with our new PACS, enabling us to optimize what we can do with the processed images. It enables our radiologists and other medical staff to have immediate access to images throughout the facility, and even in their offices. Our specially trained "super-users" were vital in helping us switch over exclusively to CR, almost instantly.

While we've been up and running with CR for just under a year, we can already see that the number of procedures we perform annually - which had been increasing over the last five years by 15 to 20 percent - will now increase even more. At Beaufort, we always accommodate our patients (in the past, though, there were often great delays), and now we can accommodate them in a much timelier fashion, making the unpleasant experience of undergoing a test a little more bearable. Plus, there have been no delays based on downtime or service issues.

It's not only more bearable for our patients, but for our staff as well. In fact, since the installation of the Xpress CR, we have noticed that our Radiology Department is a lot less chaotic. The workflow is smoother and tension level has diminished substantially. And we have a pretty large staff, so this kind of progress is important to us. We have 65 people in the department (technical and support), and two radiologists who read about 85,000 procedures a year.

Our mission at Beaufort is to deliver superior healthcare to our patients and improve the health of our citizens. Just because it's a small community miles from larger cities doesn't mean we can't turn that mission into a reality. CR is one piece helping us do just that.

Divide & Conquer: Sheba Boosts Workflow with CR

By Zeev Rotstein M.D., M.H.A., Director, Sheba Medical Center, Tel Hashomer, Israel

Divide and conquer was the tactic that put Sheba Medical Center, one of Israel's largest hospitals at 2,000 beds, on the road to increased x-ray imaging efficiency and a completely filmless work environment. Sheba, also known as Tel Hashomer, is located eight miles outside of Tel Aviv in Tel Hashomer, Ramat Gan.

While digital conversion delivers major workflow improvements, often these benefits do not become a reality immediately and are not seen equally throughout the hospital. The full value of digital technology is not achieved simply by changing image data format. Sheba Medical Center's Chief Radiologist, Professor Jacob Yitzhak - along with hospital and departmental management - believe that successful conversion must also involve an analysis of the resulting workflow and the procedures that generate and analyze the data.

This opinion prompted Sheba to look for a more innovative answer to boost workflow in select locations. Sheba found this in a unique compact and affordable desktop CR system from Orex Computed Radiography. Orex offered us superior image quality, compact size, advanced connectivity and a host of user-friendly features at a good price point. Because of its size and price, Sheba was able to place additional CR scanners in rad rooms located a significant distance from the Radiology Department, creating a distributed CR (D-CR) environment.

Sheba is a busy, large suburban hospital that went almost fully digital six years ago. It uses centralized CR systems for eight rad rooms. The CR units are connected to separate PACS, an older IBM system which is in the process of being replaced by a new Philips PACS and another unit. The two PACS are tied to the Radiology Department and to the hospital network, allowing image viewing in physician offices such as orthopedists, surgeons and referring physicians.

This has enabled almost the entire hospital to go filmless. Workflow was significantly improved enterprise-wide - with several notable exceptions. Sheba's operating room (OR), located in another wing of the hospital and a 10-minute walk from Radiology, was one problem area. The busy department that serves 29 operating theaters, performs 20 to 30 x-ray studies daily for 150 surgical procedures, and workflow was extremely inefficient. Chief Technologist Yossi Vered, who manages day-to-day departmental workflow, explains that when OR needed an x-ray, on-call technologists would walk from Radiology across the entire hospital carrying the cassettes needed for an exam. After taking images using our existing mobile x-ray unit, Vered says, the tech would have to go back to the central CR scanner in Radiology to process the cassettes. From there, the images were sent over the PACS to the OR for reading.

With the CR system in the OR, images are processed where they are acquired, saving techs constant walking back and forth between the two departments. Surgeons can see the results within minutes over the PACS. Frequently the process is even faster with doctors reading directly from the quality control (QC) station in the OR area. Surgeons need not even re-scrub when resuming the procedure.

Now, CR plates are stored right in the OR. Vered explains that after the scanner reads an image, the plate is automatically erased and ready for the next exam. He notes that the system's distributed workflow saves significant time - up to 30 minutes per exam or two to three hours per day, depending on the load in the OR and Radiology Department where the images are read - and makes a difficult job much easier.

Sheba placed a second Orex CR in its Rehabilitation Department, which is located in a separate building about a half mile from the central hospital where Radiology is based. The CR unit generates about 20 images daily for orthopedic applications and for chest and abdomen imaging of ventilated patients. Because of its distance from Radiology and the need to use a mobile x-ray unit for ventilated patients, prior to the CR installation, this was the only hospital department still using film.

The new onsite CR is connected to the PACS, fully integrating department images into the hospital digital system. Orthopedic surgeons can immediately read studies in their offices and compare them with previous patient images. Images are then sent over the PACS to a radiologist for a simultaneous read.

The hospital is considering putting additional systems in other departments such as Neonatal and Oncology. The ability to add accessories for specific clinical applications makes CR a powerful and affordable solution to boost workflow throughout the hospital.