DR Re-makes Radiography

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 - DR
Technologist Richard Rogers views a digital radiography image.
Source: University of California Davis Health System in Sacramento
Thousands of radiology departments and imaging centers across the country are in dire need of radiography makeovers. Though x-ray remains the bread and butter of radiology, outdated systems compromise efficiency, profitability and patient care.

Digital radiography (DR) can remedy the situation and provide a slim, sleek, efficient workflow. Enterprises across the country have demonstrated its power, adopting the technology and replacing legacy computed radiography (CR) and analog systems to improve workflow.

Clinical considerations

The University of Nebraska Medical Center (UNMC) in Omaha has been diffusing DR technology over the past four years and deployment has reached the emergency department (ED).

The ED needed a shot in the proverbial workflow arm to quickly gather a patient’s history and images. The key to ED imaging is speed to act on a decision, according to Jim McClay, MD, associate professor of emergency medicine at UNMC.

“For workflow, ED clinicians are presented with a history and need to gather the pieces of information relevant to make a decision,” says McClay. “A big piece of that history is an image from advanced modalities.”
Routine extremity injuries, one of the most common presenting complaints, generally require a quick exam and x-ray. With DR, physicians can view the image and make decisions before the patient returns to the department.

In addition, with DR, ED clinicians can manipulate images. “With the digital image, you can change the bone window, change the image contrast and zoom in to focus on smaller areas,” explains McClay. The advantage to the clinician is the comfort with the decisions, he says.

Economic efficiencies

Josh Laberee, director of operations at Orthopedic Associates of Fort Walton Beach, Fla., recounts that the three-location, eight-provider practice has seen financial gains due to DR’s efficiencies.

“X-ray used to be our biggest backlog,” says Laberee. “We used to run two x-ray rooms. Thanks to DR, we’ve been able to run imaging operations through one room and handle 30 to 40 percent more imaging volume than with conventional x-ray.” Since going live with the DR system in January 2008, Laberee shares that reduced storage and ordering costs have helped the practice save more than $35,000 annually (including cost of the x-ray system). For the three locations combined, 120 to 130 patients are imaged daily using DR and Orthopedic Associates has been able to save enough to pay off the systems over three years.

With 30,000 patient encounters annually and 80 percent of those encounters having an x-ray exam, the DR system has trimmed seven to 10 minutes from the average visit time for patients who get x-rays, Laberee notes.

Radiologists at the University of California, Davis (UCDHS) in Sacramento also have realized time-savings thanks to DR adoption. By eliminating the handling of a cassette, UCDHS’s radiologists are able to view a fully processed image in under 10 seconds. In addition, compared to a CR cassette detector, the flat-panel DR detector has reduced the radiation dose to the patient by more than 50 percent in most comparable cases, says J. Anthony Seibert, PhD, professor of radiology at UCDHS.

At UCDHS, a single radiographic room using integrated DR technology replaces 1.5 to 2 conventional radiographic rooms using cassette-based CR technology because of higher patient throughput and increased workflow efficiency, Seibert adds.

Portable power

UCDHS also is stepping up its DR game by positioning itself on the ground level for portable DR, according to Seibert. Portable DR allows technologists to take advantage of point-of-service image acquisition and quality control verification of patient-positioning at the bedside, improving efficiency dramatically compared to CR. “By adding a wireless portable DR system that can last more than 50 shots per battery charge, this system can allow instant image review at the bedside, and with wireless communication to the local area network available through routers on each floor, can immediately send the images directly to the PACS for immediate radiologist diagnosis after the images have been verified,” he says.

UCDHS is currently testing a wireless portable DR system, and plans for several more future purchases that will ultimately replace the CR cassettes and remote readers now used for bedside imaging.  

Take note from Seibert. Portable DR is taking radiology by storm. In the June issue of the American Journal of Roentgenology, Thomas Lehnert, MD, from the department of diagnostic and interventional radiology at the Clinic of Johann Wolfgang Goethe-University in Frankfurt, Germany, found that in a comparison study of 941 x-ray exams (474 with CR and 467 with DR), the average DR exam was 26 seconds faster than CR.

In Lehnert’s department, the legacy CR system has been completely replaced by portable DR. “Overall the workflow has been increased by using portable DR instead of CR, which means a time-savings of about 38 minutes daily,” says Lehnert.
“In the next few months, we will start with portable DR on our ICU and replace its CR system.”

Portable or not, as DR technology develops further, increased efficiency and enhanced diagnostic capabilities promise to re-make radiography.