Boning Up: Laser Imagers Connect Radiology & Orthopedics
aycan x-ray print
As the wave toward digitizing healthcare continues to surge, more dark rooms go dark as laser imagers replace these costly and space-consuming spaces. While imagers assist with all modalities and ‘ologies, orthopedics still relies most heavily on hard-copy images, and the imagers can help connect radiology departments to local orthopedic groups.

Meeting the hard-copy need

The three dark rooms at Woodland Healthcare in Woodland, Calif., went dark about three years ago when the facility deployed several Kodak Dryview 8900 laser printers along with a PacsSCAN Film Scanning System, says PACS Administrator Matt Granger. This 125-bed community hospital, imaging center and outpatient clinic, saw the imagers as a way to move into the digital age as well as eliminating the costs, manpower and chemical upkeep required for film.  

“While we use the imagers to print every modality—including CR, DR, ultrasound, MRI, CT and mammography—we most often print CR, DR and mammography, mainly due to the large number of requests from referring physicians,” Granger explains. “Many physicians [in our area] do not yet have a means of viewing images digitally at their facilities.”

To meet the need for large format film as well as to aid the analog-to-digital transformation, 350-bed Riley Hospital for Children in Indianapolis chose a Codonics Horizons XL imager, says Director of Radiology Nancy Davison. Each year, the facility completes about 100,000 imaging studies, although the imager is dedicated to DR.

Davison finds the variety of sizes available on the imager tremendously convenient. “If we didn’t have the ability to print a variety of sizes, we would have had to stay on an analog system for some of our studies. These options allowed us to make a true digital conversion.”

The 122-bed Greenbrier Valley Medical Center in Ronceverte, W. Va., installed an aycan printer about six months ago to “do away with the dark rooms as a cost-saving measure, which saves pennies on the dollar compared to film,” says Radiology Director Gary Mabry.

In addition to their economic value, printed images offer unique timeliness for severely injured patients, according to Granger. “Many times, when we send patients from our ER to a more severe trauma center, we will send a CD with images along with the film-based images, so wherever that patient ends up, the physician can rapidly examine the images and not be delayed by having to view a CD,” he says.

Acetate vs. paper

Just like some people prefer vanilla ice cream and others chocolate, the debate continues over which is better: acetate-based film or images printed on paper. “We looked into getting paper-based printing solutions because the printing costs are less, and to us, it seemed that the images were equivalent,” Granger says, “but our referring physicians did not feel comfortable with paper, especially the orthopedic clinics. For orthopedic surgical work-ups, the manual templating tools did not work as well with paper for that group.”

However, those providers who use a paper-based solution tout their cost-saving benefits, and seem untroubled by questions about image quality. “Instead of printing on film for a $1.20 per sheet, we print on paper, which can be stored in the patient’s chart, for pennies,” Mabry explains. He says that the biggest advantage of using paper is the cost-savings, followed by the ease of storage associated with paper-based images, and the equivalent diagnostic quality.

The film holdout: Orthopedics

For a lot of healthcare facilities and enterprises, orthopedics is the last holdout for film. Because of surgical planning needs, patient education and long-bone studies in particular, they prefer to work with film. That’s the case at Woodland, which produces approximately 60,000 studies annually. Requests for hard-copy CR and DR images come from the large, local orthopedic group.

Greenbrier, which produces approximately 53,000 studies annually, also prints orthopedic images more than any other specialty, because “orthopedic physicians appreciate the ability of having the physical images to communicate with their patients or take into surgery,” Mabry says.  

Similarly, at Riley about 90 percent of the requests for hard-copy images come from orthopedics, and within that specialty, “we primarily print images for scoliosis and long leg studies. The ability to produce and print scoliosis and long leg DR images really improves the overall quality,” Davison says.

While Riley continues to produce hard-copy images to meet orthopedic needs, Davison says she has noticed a decrease in requests for printed images from referring physicians in the area as the outlying facilities start to recognize the benefits of going digital as well. “However, it is still very helpful to have the ability to print, because oftentimes the surgeons wish to use the printed film, and if we did not have the imagers, we would be forced to return to an analog system,” she says.

Workflow & patient care improvements

Davison says going digital has allowed for greater efficiency and faster workflow.  “Our referring physicians have access to images which also benefits their workflow, especially without having to store and access films,” she says.

Mabry notes that the benefits go beyond assisting workflow. “In addition to the fiscal advantages, the aycan paper-based printer allows us to print only the images that the physician would need, instead of printing 30 unnecessary sheets,” Mabry says. “Plus, we use the printer for our other office needs, such as marketing brochures, allowing for multiple uses of the printer.”

“Having deployed the imagers has allowed us to improve patient care because we are able to access the images much more quickly than when we had to manually process them through a dark room,” Granger explains. “However, it also improves our workflow because we can just print on demand, and we can adjust the images before they are printed to ensure that they will just as we want them.”

In addition to the cost and time-saving benefits associated with eliminating film, Davison adds the “primary advantage of installing DR and the associated laser imager at Riley was the overall improvement in the quality of images. Improving the diagnostic quality, in my opinion, is 100 times more important than any money we’ve saved.”