The imaging staff at Androscoggin Valley Hospital (AVH) in Berlin, N.H., knew the time had come to up their x-ray game when their 11-year-old computed radiography (CR) system began needing new imaging plates and maintenance. What they didn’t know was how fast, easy and cost-effective it could be to upgrade to superior digital radiography (DR) just by investing in the right DR detectors. In 2015, following comprehensive research, that’s exactly what they did.  

Now, one year and two Fujifilm FDR D-EVO II detectors later, the team is delighted with how far they’ve come. The hospital has been serving patients with faster and more comfortable exams, radiologists with topnotch image quality and the entire community with a technological stride forward.  

“Fortunately, the D-EVO II came along with its memory capability,” says Wayne Couture, the hospital’s director of imaging and cardiopulmonary services. “It instantly became the perfect solution to everything I was trying to achieve. We’re now able to have DR in both our x-ray rooms as well as with our portable radiography. For us, this technology was the solution to many upgrade challenges.”

The memory feature of which he speaks stores images inside the detector. This lets technologists borrow the detector for use with other x-ray devices like a portable or another x-ray room and capture and save those images inside the detector. When they’re done x-raying patients, the techs simply upload the images at a workstation. This capability lets them use the detectors wherever they’re needed. No special configuring or connections are needed, so the D-EVO II supplies a real “DR on demand” solution.

The techs can still use CR as a backup, as the same workstation software integrates with the Fujifilm CR system the hospital has been using since 2004.

“I didn’t necessarily have to throw away a capital asset that I purchased back in 2004 and still has some life in it,” says Couture. “The D-EVO II ended up providing a pathway forward, into full digital radiography, without my having to completely close the door on the older CR technology. It has been a perfect solution.”

Couture and colleagues’ experience with Fujifilm’s detectors over the past year stands as an example for other imaging departments and centers looking to make the DR leap as seamlessly and cost-effectively as possible.

A partner in quality improvement

AVH is a 25-bed critical access facility that serves as a community hospital for several towns in northern New Hampshire as well as two prisons (one federal, the other state) in the city of Berlin. iVantage Health Analytics recently named it one of the top 100 critical access hospitals in the U.S., and the American College of Radiology has accredited it for CT (of which it performed 2,700 exams last year), ultrasound (around 2,300), mammography (1,800) and MRI (1,100). The hospital also offers nuclear medicine—and x-rays some 12,000 patients per year.

In short, AVH is a small institution that punches above its weight class on behalf of its community. Couture suggests the secret of the hospital’s continued success is finding ways to optimize care quality while maximizing budgetary resourcefulness. It was with these purposes in mind that he recalls comparing Fujifilm’s FDR D-EVO II against other DR offerings on the market in 2013 and 2014.

The versatility afforded by the memory mode was a particular standout feature, he says, but the technology upgrade from CR to DR—and the company behind the leap ahead—promised to provide still more.

Couture and his staff had a longstanding rewarding relationship with Fujifilm to build on. Their existing Fujifilm FDX Console workstations would easily integrate with D-EVO II, helping them quickly learn DR while avoiding the costs and headaches of installing and learning new workstation hardware and software. And, importantly, the D-EVO II would allow them to dramatically reduce radiation dose.

“We have actually reduced radiation by 40 percent compared with CR,” says Couture. “That’s more than I thought we could do.”

A significant leap

Given Couture’s high level of satisfaction with D-EVO II’s performance bringing AVH into the digital radiography age, it’s no surprise to hear him announce his department’s next move.

“We’re planning to buy a third D-EVO II panel this summer,” he says. “We’ll leave the larger room with a panel in each tray and have a dedicated panel in the smaller room,” he says. At that point, there’ll be barely any movement of the panels at all, except for when a tech needs one for the portable x-ray unit.

 “A lot of my staff have been around long enough to remember working with film-screen x-ray,” says Couture, who began his imaging career as a technologist. “We’ve enjoyed all the major technological leaps. The leap to this DR has probably been the most significant.

Along with the lighter weight of the D-EVO II detectors, the techs like the devices’ tapered edges, which make it easy to slide behind patients, and their incorporation of Fujifilm’s Virtual Grid technology, which completely eliminates the need for cumbersome grids.

“We were all blown away by the Virtual Grid feature,” Couture says. “The first time I saw an abdominal x-ray done without a grid, and with Virtual Grid applied, it was for a very large patient. The algorithm gets applied, and you can’t believe how this technology can clean up scatter the way it does. You can read about how this works, but until you see it actually happen—let’s just say seeing is believing.”

Couture recalls an instance when Virtual Grid was needed with the portable because both x-ray rooms were full. The staff performed a kidney-ureter-bladder x-ray. Reading the study, the radiologist “couldn’t tell it wasn’t done on one of the radiographic units,” Couture says. “When I told him it was done with the portable and Virtual Grid, he was very impressed.”

The right DR move at the right DR time

As for technologist buy-in, AVH “abandoned CR almost instantly,” Couture says, once they saw how simple the transition would be—and how much better DR technology is versus what quickly became the “old way.”

“I am still a working technologist myself, and when I am x-raying a cervical spine or shoulder, the accuracy and time savings I gain is amazing,” he says. “The instantaneous image display that DR provides for repositioning the patient” is such that “none of the staff ever wants to go back to the clunky CR processes again.”

Starting this year, under the Consolidated Appropriations Act of 2016, the Centers for Medicare and Medicaid Services monetarily incentivizes imaging centers to take their radiography digital. Was this a factor in the timing of AVH’s acquisition of Fujifilm’s FDR D-EVO II?

Not really, Couture says. “We were already committed to make the change before the act passed into law,” he adds. “This wasn’t a panic-stricken purchase. We weren’t under the gun to make a decision. It was just a pathway that Fuji helped us take when we set out to convert to DR. It turned out to be the right conversion at the right time for the right reasons.”