With any PACS rollout, there is the promise, the dream of becoming a filmless, digital environment. But eliminating film does not eliminate the fact that people are still printing—the question is to what extent and in what format.


Supplying demand

Del Donaldson, clinical systems analyst at Advanced Diagnostic Imaging (ADI) in Waterloo, Iowa, says that even with a PACS in place, the facility is primarily still printing film. “We are doing more business by printing film compared to other facilities that are trying to decrease film costs,” he says. “Film is getting a lot more use here than paper,” he adds, because referring physicians in the area, as well as one of the hospitals in town, do not have digital reading capabilities and commonly request studies on film. Donaldson just purchased his second Sony laser imager because the first one he bought three years ago was just “worn out from printing more than 100,000 film studies.”

They have two Sony FilmStation laser imagers and just last year added a Sony Color DICOM printer to support MR, CT, nuclear medicine, ultrasound and PET/CT. One FilmStation, located at the main ADI site, prints on 14x17 film, while the second one, housed at the University of Northern Iowa, has a dual tray which prints 8x10, 10x12, 11x14 and 14x17 films. They’re currently only using the paper printer for PET/CT studies since many of the images are color—which are printed in color for referring physicians’ review, he says.

Down the road, Donaldson says ADI will most likely start printing less film but “we have the capability with Sony that as the demand for film decreases in our area, the demand for paper will increase and we will be ready.”


Cutting costs

Frederick Memorial Hospital (FMH) in Frederick, Md., is a 250-bed community hospital in the Baltimore suburbs with three full-service imaging outpatient centers that perform about 200,000 procedures annually. FMH deployed the aycan x-ray-print solution for multimodality diagnostic images about a year ago to replace film usage at the hospital, according to Brian Petrie, FMH’s telemedicine administrator.

“With four aycan imagers at each facility within the hospital system, combined with our PACS roll out, we have been able to reduce film usage by 60 to 70 percent,” Petrie says. “PACS [brought on] the significant drop, but aycan helped it to drop even more.” Petrie says the hospital was spending close to $200,000 per year on film and now they are spending close to $50,000 per year. “Aycan has really helped us to achieve the cost savings we were looking for,” he says.

FMH chose the aycan solution because it was a true DICOM printer that could print directly from any modality. With the quality of the print and size of paper also comparable to film size, Petrie says it is a “great way to replace film.”

He also says referring physician feedback has been positive—“they like having a piece of paper that they can fold and place in a patient’s chart,” he says.

“Film is on its way out,” says Petrie. “Pretty soon there is not going to be the demand for film due to the proliferation of data that are hitting the medical field—not only in medical imaging, but for patient records as well.”


Doing whatever it takes

“You cannot really say that you will never print again,” says Becky Lamberth, RT, (R) (MR), director of radiology for Plaza Medical Center, a 225-bed hospital in Fort Worth, Texas. She says it does not come down to a need to print, but instead to one thing: customer satisfaction. “If that is what our physicians want, then let’s give it to them,” she says.

Lamberth says that when they converted to PACS and began shopping for a CD/DVD burner, they found that some of their referring physicians were not interested in getting a CD—they wanted the image in hand. “We were looking for a combination of how we could print on paper and a CD burner and we came across Codonics, who offered us the Horizon Imager paper printer and the Virtua CD burner,” she says. The facility purchased both at the same time in June 2007 and has since purchased a second unit for use in the cath lab.

Horizon prints on paper that is FDA approved for diagnostic reads. “Meaning, when we print it out, it is no different than film,” Lamberth says. “If PACS crashed and that is all we had, our radiologists can use that to make an interpretation.”

The system can print an 8x10 color image; 8x10 and 14x17 black and whites; and if necessary, can print on 14x17 film. “It is so interchangeable, so seamless to use—we can honestly say that we can make anybody happy,” she says. “It does not matter what the referring physician wants, whether it is paper, film—we never say we can’t provide what they need. We always tell our physicians ‘Whatever it takes.’”


Staying accredited

To answer the call of the high resolution needs of digital breast imaging while supporting a multi-modality imaging center, West Coast Radiology Centers (WCRC) chose the Konica DP 793. Internally, WCRC is a fully digital practice—“we print films mainly for our referring physicians,” says Executive Director Tim Chavez. They have four Konica DP 793’s at their four imaging centers in Orange County, Calif.—three multimodality clinics and one comprehensive breast center that outputs approximately 100,000 studies per year across multiple modalities.

“We have a web-portal-available RIS/PACS from Merge [and this is how] approximately 25 percent of our referring physician’s access images. WCRC continues to print film for the majority of the referring physicians,” he says. “As an MQSA and ACR-accredited facility, we required a [laser imager] system that would provide the resolution needed for breast imaging, and stability to maintain excellent image quality across the practice.”

Chavez says the other big advantage of buying several of the same systems is redundancy. “Due to the networking capability of the Konica imager, we have a back-up system in place if one of our four products goes down. If it goes down, we can print to any of the other locations—we will never be in the situation where we can’t print.”


Finding the solution

Whether printing to film or paper, laser imagers offer a critical solution to the lingering need for hard copy images from specialists, referring physicians and patients. The key many facilities have found is estimating printing volumes and what the community and referring physicians want.