December 2012

Mobile X-Ray Is Moving to Direct DR — Hospitals Discuss Why They Switched
By Dan Harvey
Radiology Today
Vol. 13 No. 12 P. 36

As radiography transitions to direct digital radiography (DR), mobile X-ray is rolling in that direction, too. DR’s improved image quality, potential for reduced dose—through improved detective quantum efficiency—and nearly instantaneous images captured at the bedside can contribute to more efficient patient care.

Many organizations are deploying mobile DR technology, but its implementation is not cut-and-dried. Take, for instance, Avera McKennan Hospital & University Health Center based in Sioux Falls, South Dakota, which includes clinics and hospitals in five states.

“Within this organization, some entities are slower on the mobile DR curve,” says Keith Miller, MBA, DFRT(R), assistant vice president of imaging services. “Our governing philosophy is that we want the best for the patients, but at the same time we understand that there has to be a level of return on investment, one that has to make some financial sense. We realize that DR is the much more expensive option, but the entire organization is moving in this direction, albeit some are still using CR.”

Avera is moving toward DR in the hope of improving time efficiency. “This relates to patient care, which is the underlying reason for deployment,” Miller says. “Whether it’s deployed in ICUs or NICUs, the technology is far superior to CR.”

Affordability Improving
Avera was a relatively early adopter of CR, so it’s natural for the organization to make an early migration toward DR in its radiography rooms and mobile units. It uses X-ray systems from both Fujifilm and GE Healthcare. “Within our organization, implementation—or turnover from CR to DR—relates to dollars afforded to each entity,” Miller says. “Technology must be cost justified. We operate in a rural area, so does it make financial sense to put in DR technology?”

It’s a number-crunching situation. Factors that need to be considered, Miller says, include operational costs and maintenance service agreements. Within that number crunching comes the amount of labor as well as the length of exam. “You’re looking at three to five seconds with DR as opposed to the 50 seconds with CR. A facility needs to do the math.”

Volume, as Miller indicates, is another important consideration. “The overall picture involves this equation: Ongoing expense must justify the initial capital investment, which can be considerable,” he says. “In larger facilities, the cost can be justified, because of size and volume.”

This leads to some important questions. “Does it make sense for a 15-bed hospital to have DR technology when CR technology is quite adequate? What if you have just one technologist? What if volume isn’t high enough? Why pay all of the extra expense in insurance and maintenance costs when CR will serve the need?” Miller asks.

The efficiency DR can provide is not just an economic factor; it can also be a patient care factor. “Staff will be more efficient, as they can do more because the technology is quicker,” Miller says. “Further, the digital format allows you to do pretty much anything you want to do, as far as image manipulation.”

But he offers this caveat: “Don’t necessarily think that you must have DR over CR. You’re not going to be losing that much resolution, and CR remains an excellent diagnostic tool. But DR makes a department much more efficient.”

Efficiency Gains
Chris Vineyard, RT(R), chief technologist at the University Health System of San Antonio, which has deployed Carestream technology, echoes Miller’s points about DR: “better productivity, better patient safety, and nearly instant viewing of images, which translates into better patient care.”

Vineyard describes why his organization shifted in the DR direction: “We wanted to get away from the CR environment, which means you don’t have to go into elevators and bring images down to other floors, and you don’t need to process images and send them to PACS.

“With CR, someone on the 12th floor of our institution will create an image and take the cassette and the portable downstairs—waiting for the elevator, of course—and then have to process the image, do the QA [quality assurance], and send it to PACS and then go into another computer system to complete the study for the radiologist to do the formal reading,” Vineyard says. “With mobile DR, everything can be accomplished at bedside. With CR, you’re looking at about 10 to 20 minutes. With DR, you’re looking at five seconds. That’s why physicians love it.”

While CR certainly provides quality digital images, Vineyard notes that it still involves some of the old film cassette workflow. ”Images are placed on that phosphorus plate, and each of those plates must be taken for the processing and then it goes into PACS,” Vineyard says. “So while CR is like a [direct] digital image, it is still almost like having to move film cassettes. With DR, that’s no longer necessary.”

Vineyard also reports some other financial benefits from DR. “Every year, we purchased CR cassettes and inserts, and every year we had to budget thousands of dollars to replace worn inserts or broken cassettes,” he says. “With DR technology, that’s no longer the case. Expect a five-year life before even having to replace a DR detector.”

That makes Vineyard conscious of the expense. “Look at the advantages,” he says. “You’re not running your people all throughout the facility, so you’re looking at more efficiency. Here’s an example: Every morning we have to run through the ICUs to do chest X-rays, and I once needed six people to do that. Now I have two people who can do the same amount of work in the same amount of time. The savings are huge.”

University Health System first found the technology’s value in its emergency department. “We experienced delays with regards to trauma images and then the processing and PACS placement,” Vineyard recalls. “With trauma situations, minutes—even seconds—can mean life or death. The instantaneous images that result from DR technology provide a tremendous advantage. Now, we are realizing the benefits also in the OR [operating room] suites, where it saves time for both surgeon and patient.”

Vineyard looks at the future of DR technology. “In the United States, health systems that deal with critically ill patients are going to have to give a hard look at this technology,” he says. “In fact, I expect that all facilities will move in this direction. It’s just a matter of time.”

Look what happened with CR, he notes: “When that technology was introduced, everyone went from film to CR in three to five years. I believe that you’re going to see the same thing happening with the shift from CR to DR. Look for DR to become a new standard.”

— Dan Harvey is a freelance writer based in Wilmington, Delaware.