Digital radiography (DR) allows radiologists to quickly get excellent images using a low dose of radiation. For sick, traumatically injured patients, the ability to move the equipment around them is crucial. And, rapid access to the images can help doctors make life-saving treatment decisions as quickly as possible. Space, training and physician buy-in are some of the challenges facilities face when implementing DR.
Erlanger Health System, based in Chattanooga, Tenn., installed two Kodak 9000 DR systems earlier this year. The organization was ready for DR and decided on the Kodak 9000 for several reasons, says Blaine Morris, RTR, CRA, MBA, administrator of radiology services. “The DR 9000 is designed specifically for the ER,” he says. It has electric tables that can be moved in and out of rooms easily and it is battery operated so no one has to step over wires when working on critically-injured patients at the level I trauma center. And, the physicians can more easily get images that used to involve carefully positioning the patient — a challenge when there might be tubes and suction in place.
Erlanger rebuilt its emergency department specifically to accommodate DR. The facility already had Kodak CR systems installed in several locations. However, the emergency department had two x-ray suites originally built in the 1960s. The remodel made the space more efficient. The radiologists were moved out of a large reading room and into the main department so the space could be used for DR.
Sticking with one vendor
Morris says they went with Kodak DR because “the Kodak interface with the CR is real simple. It looks the same so training the techs was a lot more effective. And, the fact that we could process CR plates at the DR console was very nice.”
DR has satisfied Erlanger’s trauma residents’ desire to see images immediately. “They want to see images even while the procedure is going on,” says Morris. That speed has increased efficiency to the point that many inpatients are now brought to the ER for imaging procedures. “We have extra capacity there and we take advantage of it,” Morris says.
Moving to DR with the same vendor already providing CR is a popular strategy. Geisinger Health System in Danville, Pa., installed Fuji’s Velocity DR more than a year ago, says Sally Womer, coordinator of quality improvement and business development for radiology. The system already used Fuji CR and Womer went with Fuji DR because “they could guarantee that the images would be identically matched to the CR images.”
The primary goal was speed, she says. And, they wanted a room specifically designed for the sickest of the sick so they could get any image without having to move patients. DR provides both.
The quick image processing also makes DR more dose efficient, says Morris. Rather than spending time processing plates, clinicians can look at an image in less than 60 seconds. “If you need to repeat something because of positioning, you know it right away,” he adds.
Perfect for pediatrics
One patient population that really benefits from the lower radiation and excellent images offered by DR is children. Children’s National Medical Center (CNMC) in Washington DC recently installed flat-panel direct digital radiography from Swissray International—across from the emergency department and within orthopedics, two of the facility’s busiest areas. Although users are just wrapping up their learning curve now, Technology Manager Bruce Dietrich says he expects to see “greater throughput as we progress with more use.”
CNMC chose Swissray for its unit specifically designed for pediatrics. And so far, the radiologists are very happy with the images.
DR offers double the resolution at half the exposure, says radiologist Raymond Sze, MD, which is “a big deal for children as we’re always looking for opportunities to reduce radiation dose.” Another plus is the improvement in workflow since technologists don’t have to use cassettes and go back and forth between different pieces of equipment.
The most problematic areas for both CR and DR, Sze says, are images of baby hands and ribs, particular premature babies. “Those are areas for which we need the best possible technique.” In tiny patients, it can be difficult to get the resolution needed to see tiny fractures.
For a facility with very busy pediatric imaging population and service, child abuse is a major concern. “Oftentimes, radiologists are the first to raise the flag,” Sze says. “Looking out for child