|Swissray ddR Modulaire and the IG5 1000 H table.|
There’s no doubt that digital radiography (DR) is fast replacing standard analog formats. As your personal film camera collects dust in your closet, conventional screen-film machines have begun collecting dust, to a certain degree. Digital technology is here to stay, and why not? It is faster, cheaper, environmentally friendlier and just as—if not more—accurate. A 2000 study in the American Journal of Roentgenology concluded that digital radiography met or exceeded the expectations and results of conventional radiography. And since then, the technology has continued to be refined.
But how much faster? How much better is DR?
Consider that old film camera again. Not only did you have to buy film, but you also had to pay for processing — even those photos that were misaligned, out of focus or otherwise unusable. While the photo store recycled some of the processing chemicals, most of them went down
The same thing happened with conventional radiography: There’s no more film, no more chemicals and there’s an increase in clinical efficiency. With increasing demand and increases in patient studies, time has become an aggressive factor in patient care.
DR in the clinic
Walt Zipprian, radiology manager of the orthopedic department at the Baylor College of Medicine in Houston, Texas, says that his clinic has seen a significant drop in radiography costs and increases in efficiency thanks to DR. Two years ago, Zipprian’s clinic changed buildings and at the same time deployed DR. The clinic went from a 10-room facility with 15 technologists to a three-room facility with four techs and still managed to increase efficiency — all because of the switch from conventional x-ray to DR.
Baylor uses the Siemens Medical Soulutions AXIOM Aristos FX and Multix M systems in the clinic, which were a significant investment, but have since proved their worth. At approximately $210,000 per room, the digital systems were double the cost of the conventional system setup of about $85,000 to $100,000 per room.
“Those machines are really suited for our practice,” Zipprian says. The systems also have saved money. “We’ve saved $7,000 to $10,000 per month in film, chemicals and plumbing alone.” he said. Staff reductions have cut payroll expenditures by 66 percent.
According to Zipprian, expenditures are down significantly, and efficiency is on the rise. “The [DR] machines have cut our time by two-thirds,” he says. “It’s been a win-win for everybody.” Patients benefit from that time savings as well. The quicker a tech can get an injured patient in and out of the exam room, the better.
Zipprian says that a plain film leg exam used to take five to seven minutes, with no re-shoots. Now, he says, that time is two minutes. Since it only takes one-third the time to perform each scan, the clinic can handle a higher caseload per day. “We see about 400 to 500 patients per week in the outpatient clinic,” Zipprian says. That is approximately a 33 percent increase over the conventional setup, with no film or chemical costs, and the reduction in labor costs. Since DR allows the tech to see images almost instantly, as opposed to waiting for each film to be developed, the tech can adjust the patient immediately for a re-shoot. Not only is time saved in the shoot itself, but the time it takes to re-shoot is virtually non-existent.
Service that works
Adapting to new technology and launching a totally new system wasn’t without its pitfalls however. Initially the department had some problems with the scoliosis software on the Aristos. But Siemens handled service calls right away. When some problems became too numerous for service calls, Zipprian says the vendor came in and replaced the entire system with new equipment. “I was really impressed with that,” Zipprian says. He adds that because it was a first-generation system, he expected some glitches. After a few prompt service calls, he says, all was taken care of.
While switching to DR was expensive initially for Baylor, Zipprian says the system will pay for itself in only three years.
Fewer units, higher volume
Dean Brown, CEO of the Alabama Orthopedics Clinic in Mobile, Ala., has had similar success switching to DR. Alabama Ortho also took the opportunity to go digital with the construction of a new facility. The clinic was able to pare down its x-ray systems from seven to two initially in 2003, with the addition of a third machine about six months ago. Alabama Ortho’s DR stable now includes three Swissray ddR Modulaire Digital Radiology Systems, the Long Leg Imaging Stand for long leg measurements, and the Weight Bearing Stand for weight bearing foot exams. They also have two MRI scanners.
Before switching to DR, Alabama Ortho’s caseload was approximately 25 to 35 patients per machine per day using seven systems, which has increased to 100 to 110 patients per machine per day using DR. “We’ve nearly tripled our caseload,” Brown said. “We see about 1,000 patients a week.”
While efficiency has certainly increased, so has patient volume. Alabama Ortho chose to keep most of its tech staff, which has allowed them to employ two techs per machine. During the transition to DR, there was only a 33 percent reduction in staff.
But the switch to DR offered more than savings to the bottom line. DR allows for instant re-takes of x-rays should a patient move, or the scan becomes otherwise unreadable. Scans that used to take about 10 minutes with analog machines now take about 2.5 minutes with digital, Brown said. This translates to better patient comfort as time on the table has been reduced by some 75 percent.
A leg up for orthopedics
DR also leads to better diagnoses. “Hairline fractures are easier to see with digital,” Brown said. Doctors, he says, have become better at diagnosing with DR, which also has allowed them to zoom in on an image. The transformation as it relates to orthopedics, Brown says, has been substantial. Alabama Ortho uses the Stryker PACS for image management. Additionally, doctors and techs are able to call up images wirelessly within the clinic to better aid in patient treatment and education.
Gavin Eiser, a technologist at Schenectady Radiologists/Ortho Centre in Schenectady, N.Y., says he can really see the differences between the old and new technologies almost side by side. Schenectady Radiologists currently operates two radiography programs, at separate locations, using one analog room and the other digital using Imaging Dynamics Company’s (IDC) Xplorer 1600 system.
Schenectady recently upgraded to DR and according to Eiser, operations “are definitely a lot quicker.” The new facility is up and running and things are moving quicker. Another element that Eiser points out is that switching to DR has lessened the fatigue of the technologists. Patient comfort is always a concern, but Eiser said that the old system took a lot out of the techs. Patient caseload is steadily rising due to the increased efficiency with the new equipment.
Perhaps a lesser-known benefit of switching to DR is image sharing. Where before couriers were needed to run films from clinics to hospitals and vice versa, that practice is all but obsolete. PACS now allows techs and doctors alike instant image access. “The speed in which the images can be sent from workstation to workstation using PACS is phenomenal,” Eiser says.
Devon Bloom, RTR, director of medical imaging at Huggins Hospital in Wolfeboro, N.H., says moving to DR has transformed the way his facility does business as well. Huggins also uses IDC’s equipment, and the Xplorer 2200 was installed last year.
“The Xplorer 2200 is a great product,” Bloom says. “We’ve seen a tremendous change in our department.” Bloom adds that the DR rooms are versatile and cost effective. Huggins has been able to reduce its radiology rooms from three to two, and again, productivity has gone up. Huggins and its satellites image approximately 32,000 patients per year using DR, compared to about 25,000 per year when they were using analog.
It’s clear. For a variety of healthcare facilities, the switch to DR has reduced costs, increased caseload efficiency, increased diagnostic capabilities and provides better, more streamlined care to patients.