Since computed radiography (CR) emerged in the United States roughly 25 years ago, the digital x-ray technology has continued to evolve in terms of diagnostic image quality, affordability and portability. More recently, prices of CR systems have fallen and adoption has increased. Many healthcare facilities who didn’t have CR have felt the time is right to invest in it as CR is a need for large hospitals and academic medical centers as well as community hospitals and imaging centers. Its decreased size, lower price points and flexibility have it on the purchasing must list of many.
Flexibility and productivity at critical points of care
Administrators at Henry Medical Center, a 215-bed, not-for-profit community hospital in Stockbridge, Ga., recognized the need to have CR’s flexibility and productivity at the critical points of care within the center, specifically, the CCU, the ER, and the neonatal ICU.
The center took a multi-year planning and adoption approach for the move to digital, says Glenda Fabra, RT, R, MHSA, PACS administrator at Henry Medical. The first step, in 2004, was purchasing CR for the ER. Over the next two years, the facility budgeted to install one unit per year.
As they planned for more CR systems to be added, Fabra says administrators looked to the new integrated ITX-560 system from their CR vendor, Carestream Healthcare. It is “proving to be extremely popular, especially for portable exams,” she says. For example, if a patient needs a chest x-ray for line placement, Fabra says the study can be done at the point of care with the physician waiting to look at the image at the bedside. As soon as the technologist completes the study, the physician at the bedside can see if the line is in place and if not, he or she can adjust the line and then take a second image to verify.
“There are a lot of advantages with portable CR,” she says. Portable CR is well suited for the center’s CCU, ER, and neonatal ICU (NICU), Fabra adds, because the image waiting times are eliminated, which is critical for better patient care in these areas. “Doctors love the immediacy of the images and techs are able to check each image immediately after taking it, which speeds image availability and reduces retakes. No one misses having to carry stacks of cassettes to the radiology department for processing and patient data entry,” Fabra says. “From a tech’s point of view, they enjoy knowing that all they have to do is use one cassette to process and look at the image before leaving the bedside—you literally process as you go.”
Another consideration is moving towards PACS. Henry Medical Center is planning to transition to a McKesson PACS this spring. It’s an “advantage to have your department ready for [PACS] by converting to CR and/or DR prior to PACS,” she says. “If you can put that into place before, it can make the PACS transition a little bit smoother.”
Providing critical care within a niche market
Quality X-ray Mobile Services in Nashville, Tenn., provides digital mobile x-ray, ultrasound, and bone density scans, EKGs and wireless holter monitoring to healthcare facilities, correctional institutions, industrial facilities, sports teams and corporations across central Tennessee, from Cookville to just east of Memphis.
Each mobile van acts as a mobile office, allowing x-rays to be taken, processed, and transmitted on-site, reducing the time from completion of the x-ray exam to receipt of the final report. Greg Ward, president and owner, decided it was an opportune time to change over his 11 mobile x-rays to portable CRs from Fujifilm Medical Systems USA to accommodate the approximately 4,000 portable studies done per month across the state.
“We have eight [vans] in Nashville already [using] portable CRs and two have already converted to Fuji’s FCR Carbon system,” Ward says. He plans on converting the remaining digital units to the same system.
When Ward looked at making the jump to digital, DR was too expensive for his business model. For the price of CR, he knew could put more systems in the vans than with DR. “I also did not want to rush to be the first since there are always bugs to be worked out when new technology arrives on the scene,” he says.
Aside from CR’s portability advantage in sometimes critical-care environments, Ward appreciates that the plates work more like analog film techniques, but with higher quality images—which is always a challenge in a mobile setting, he says. When studies are completed, they are sent to Advanced Diagnostic Imaging, a radiology group based in Goodlettsville, Tenn., via a VPN connection, where radiologists can immediately view the images to determine if they need to be re-done or if the patient should be sent to the hospital.
“The key to our success is [good] response time and report turn-around times. We asked ourselves ‘what will enable us to give the quickest turn-around time and the quickest response to our community?’” Ward says. “We have found that with the portable CRs from Fuji.”
Moving forward
There has been a real trend away from a centralized location for CR and facilities are beginning to look for options that offer portability coupled with a smaller design that enables the placement of digital x-ray wherever it is most productive—whether under a table in the exam room or even inside a van.
Facilities looking into a CR investment need to examine the organization’s pain points—whether they be ER, ICU or imaging on the go and determine a budget. They should ask the questions—what problem are we trying to solve and what goal are we trying to achieve with digital x-ray? In some facilities or departments, DR will make more sense, such as higher throughput environments where they want to see a higher return on investment. But if an organization wants increased flexibility, portability and the ability to do a variety of exams, then CR fits the bill. Other times it is a mix of both technologies that makes good sense.