DR Breathes New Life into Radiography
Image courtesy of Carestream Health
The writing on the wall for 2009 is clear. DR will see a resurgence. The reasons behind DR’s rebirth are multi-faceted. In the current ultra-tight economic climate, facilities need to squeeze every ounce of productivity out of their modality investments, and radiology’s workhorse is a workflow winner.

Since DR is still the technology producing about 70 percent of imaging studies in radiology, efficiency is especially key. Plus, a lot of early DR adopters are eyeing new systems with a wider variety of applications, automated features, faster exam times and expected throughput. Many sites that invested in CR over the last decade as a stopgap measure are now turning to DR. Take for example Integris Southwest Medical Center in Oklahoma City. The DR convert slashed standard two-view chest studies from eight to 10 minutes with CR to a lightening fast sub-two minutes with DR.

No doubt, wireless flat-panel detectors are sure to further boost the market in 2009. DR’s latest innovation weds portable convenience with DR efficiency. The forecast? The new year looks like a perfect storm for digital radiography. “Hospitals that aren’t looking at digital plate technology today are already behind the curve,” opines Bill Broaddus, director of radiology at Central Baptist Hospital in Lexington, Ky. Read on to find out about pioneers’ specific goals, how they tackled their deployments, what they gained and how they plan to take advantage of DR’s latest offerings.

Putting patients at the forefront

Western Baptist Hospital in Paducah, Ky., is one of the few DR-only sites in the country. The hospital started deploying CR in 1997, and by 2003 decided to transition to DR. The rationale was two-fold, says Director of Diagnostic Imaging Bob Seely. “We wanted to keep techs in the room with patients, and we also wanted to increase patient throughput.” CR falls short on both fronts. Not every room is equipped with a CR reader, so techs must leave patients on the table as they bring the cassette to a reader to review images. A patient might fall off the table or become agitated or concerned while the technologist is out of the room, which means some CR studies require a workflow-busting two technologists. During a DR study, technologists review images at the side of the table, increasing patient safety and comfort. At the same time, patient throughput is increased because the image review is immediate.

Between 2003 and 2007, Western Baptist Hospital purchased 26 Canon Medical Systems digital plates including its CXDI 40-EG, CXDI 40-EC and CXDI-50G systems. All general diagnostic imaging rooms are equipped with three digital plates: one in the table, chest plate and a tethered plate. The hospital also added a digital plate for the overhead tube in its digital fluoroscopy suite, and the final phase involved digital portable imaging.

The hospital has achieved its initial goals with the DR project, says Seely. Patient safety is enhanced as the technologist remains with the patient through the entire imaging process. What’s more, throughput and efficiency have increased because techs no longer carry plates back and forth to the reader. The project satisfied the hospital’s fiscal objectives as well. “Without Canon retrofits, we would not have been able to justify the cost of DR for the entire department,” states Seely. And the hospital continues to gain financially. In the last four years, diagnostic radiography volume increased by 3,500 exams annually, while their FTE techs by four.

Tackling turnaround time

Integris Southwest Medical Center operates one of the busiest emergency department in Oklahoma, performing 10,500 trauma x-ray exams annually. Over the last nine years, the hospital gradually rolled out CR and DR throughout radiology and the ER. “CR improved the analog approach in the ER,” admits Dee Tucker, director of radiology. By 2007, however, trauma patient volume had escalated to a point that demanded a more efficient solution. “We knew DR was necessary to meet our goals,” says Tucker. The hospital needed to increase patient throughput with a system that facilitated fast, organized workflow. Economics also played a critical role in the decision to deploy DR as the hospital needed a system that minimized obsolescence. “We can’t afford to replace systems every few years,” states Tucker.

After scouring the market, Integris Southwest Medical Center invested in the Carestream Health DR 7500 for its DR suite. Before the ER could harness the throughput of the new system, the provider needed to remodel the trauma suite. The Carestream digital detector offers a wide range of motion, moving along and behind the table or at the head of the table. The mobility improves flexibility for trauma studies and eliminates manual repositioning of the tube. But the setup also requires additional space at the head of the table, forcing the hospital to relocate DR support cabinets and the technologist control panel to an adjoining area.

The hospital achieved its goals with the DR room. Turnaround time is greatly reduced, says Tucker. For example, lumbar spine studies that took 15 to 20 minutes with CR technology are completed in five to 10 minutes. Anecdotally, patients are released from the ER sooner with less wait time and increased responsiveness from clinicians. In fact, in the last Press Ganey review the hospital’s ER patient wait time ranked in the 99th percentile.

The next step: portable wireless DR

The DR resurgence is primed to continue and even accelerate with wireless flat-panel detectors likely to fuel growth in the next two years. Currently, most hospitals rely on CR for portable applications, but innovative sites like Integris Southwest Medical Center are eyeing wireless DR options. A handful of hospitals have already deployed wireless radiography in stationary arrangements.

Central Baptist Hospital was one of the first sites in the country to deploy Siemens Healthcare Ysio wi-D wireless detector. The hospital deployed the detector in a new x-ray room. The goal, says Broaddus, was to maximize efficiency, versatility and image quality, and Ysio wi-D fits the bill on all fronts, addressing many shortcomings associated with CR and conventional DR. Although CR improves on analog radiography, it remains fairly labor intensive. And while DR offers productivity improvements over CR, it lacks the versatility of film because the digital plate is tethered to the wall stand or table, making it difficult or impossible to acquire certain studies, such as lateral hips. In contrast, wireless DR plates boost flexibility and productivity.

Technologists can use the 14 x 17 inch plate in a wide array of configurations: in the bucky, on the table or floor or to image patients on stretcher or in a wheelchair. Image quality remains consistent. “Techs don’t have to shoot at the center of the plate for the best exposure. Images can be acquired on one end or the side of the plate. It’s more efficient and requires less positioning,” shares Broaddus. Plus, one tech can remain with the patient during the entire exam, eliminating the need for a second tech to stay with the patient during some trauma studies. After the tech acquires the study, images are wirelessly transmitted to the unit for review.

One month into the deployment, Broaddus reports that Ysio wi-D provides “considerably faster” throughput than the hospital’s other DR rooms. He credits the system’s motorized tube head and organ specific programming that moves the system to 1,000 different positions with the touch of a button with boosting wireless throughput.

Broaddus handily addresses one of the potential downsides of wireless radiography: battery life. The hospital invested in two plates each with an eight-hour battery life that recharge when placed in the bucky. “That’s triple redundancy,” states Broaddus.

Western Baptist Hospital bypassed the wireless detector deployment for portable DR, opting to invest in Canon CXDI-50G digital plates. Although the detector isn’t wireless, the portable panel incorporates a wireless router, which provides the same functionality as a wireless detector. That is, the technologist selects a patient from the portable worklist, completes the exam and immediately downloads to the image before proceeding to the next patient. “It’s a huge improvement over the portable CR process,” shares Seely. Portable CR typically is plagued by hefty time lapses between image acquisition and images review because each plate must be brought to the reader and verified before being sent to the physician.

Advice from the field

  • Vendor agnosticism pays. “In any given year, a vendor may introduce a system with new features that best meet your needs,” says Tucker. Integris Southwest Medical Center lives and breathes vendor neutrality with recent installations of Carestream Health DR 7500, GE Healthcare Definium 5000 and Philips Healthcare Digital RF systems.
  • A gradual rollout can facilitate familiarity with DR and streamline projects. What’s more, it’s easier on the purse as a complete overhaul can be pretty pricey, says Seely.
  • Technologies are outdated within a matter of years. “Invest in leading-edge technology like wireless flat panels on the front end to remain current and save dollars on the back end [via reduced upgrade costs],” says Broaddus.

The right tech at the right time

DR is the new game changer. Radiology’s core technology is poised for a breakthrough. There are multiple options on the market, allowing every kind of department to devise a solution to best meet its needs. What’s more, each option provides essential throughput and productivity gains. Sites in the CR or analog world can retrofit rooms with a wide array of DR plates to tiptoe into a more productive, patient-friendly digital environment. DR’s latest and greatest—wireless flat panel detectors—offer new levels of freedom and flexibility.  

Looking to Wireless (and ultra-flexible): Streamlining DR
Healthcare facilities aiming to wed wireless flexibility and DR can select from a host of options.

Although not technically wireless, Canon Medical Systems CXDI-60G 9 x 10-inch, portable DR sensor features a detachable cable to simplify patient positioning. It weighs 5.9 pounds and is less than an inch thick.

Carestream Health DRX-1 encompasses a wireless cassette-sized digital DR detector designed to provide flexible positioning and enhance efficiency and patient comfort. The 8.5-pound detector can be used wherever it is needed—in the wall stand bucky, table bucky or for tabletop shots and other difficult views. It has an on-board rechargeable battery or external battery charger. DRX-1 is a work in progress expected to be available in the first quarter of 2009.

Another non-wireless, but ultra-flexible option, is the GE Healthcare Optima XR640. The system features a moveable detector designed to handle radiographic applications using a single, portable flat-panel digital detector that can either be inserted into the table or the wallstand for traditional imaging or removed and used in a digital cassette mode for tabletop, cross-table or other portable imaging.

Designed to provide instant image display on Eleva workspots, Philips Healthcare Eleva Wireless flat-panel detector is a cable-free system that can be handled and positioned like a cassette. This detector is designed to be integrated into Philips DigitalDiagnost rooms and the Practix Covenio DR mobile DR system. The detector is pending FDA clearance. 

Siemens Healthcare Ysio wi-D combines integrated and wireless mobile detector technology into a single system. The wireless detector handles like a cassette and can be removed from the table for exposures that are difficult to take using a fixed detector. Ysio is available as a wall stand with an integrated detector, a wall stand and table system with a wireless detector or as a mixed detector solution for high throughput and flexibility.

A Tale of Two Deployments: Retrofit vs. the New Suite
The current economic climate further exacerbates the pressure on healthcare providers to contain costs while providing the highest quality patient care. There are two primary approaches to DR cost containment. Hospitals can retrofit an analog or CR room or invest in an entirely new system. Recent DR converts took very different approaches to the process, yet each is satisfied with its path. They recently shared the pros and cons.

Western Baptist Hospital in Paducah, Ky., faced three choices for its CR to DR transition: replace existing rooms with multiple plate technology in each room, replace rooms with single-plate technology or retrofit existing rooms with multiple-plate technology. A careful financial analysis showed that the retrofit option would be the most cost-effective approach. That’s because a retrofit lets the site keep existing equipment—wall stands, tables and generators. Because radiography infrastructure had not yet reached the end of its life span, the retrofit option provided the most bang for the buck, says Director of Diagnostic Imaging Bob Seely. During a retrofit, the vendor replaces the bucky with a digital plate and adds a computer and monitor for image review and transmission to the RIS/PACS, reducing the overall acquisition cost while allowing the site to benefit from enhanced DR technology.

Seely’s colleagues at Central Baptist Hospital in Lexington, Ky., employed a different model, outfitting a new room with wireless DR technology. “All of the hardware and software is fully integrated and interfaced, and there’s little cabling. Mix and match or add-on components don’t provide the same level of efficiency,” says Bill Broaddus, director of radiology, who adds that current investments must last seven to 10 years to be cost effective. Buying the most advanced technology available minimizes obsolescence and maximizes lifespan. “The department has to live with technology for a long time. It’s important to purchase the best equipment you can when you have approval,” advises Broaddus.

It’s important to weigh factors outside of technology during the financial evaluation. Equipment depreciates, but staff doesn’t. Systems that allow imaging departments to provide quality service with less staff are in economic order. All DR systems—retrofits, new projects and wireless detectors—help sites optimize tech staff.