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Wednesday/April/09
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THE DIGITAL WORLD - YOUR OPTIONS
Wednesday/April/09
THE
DIGITAL WORLD - YOUR
OPTIONS
The following is a brief description of the types of
Digital Capture available:
The advent of digital imaging has
created an overwhelming interest and many questions on
the part of many Practitioners. Just as with
radiographic equipment, there are multiple choices in
capturing digital images.
CR
- (Computed Radiography) Systems “Cassettes
Required”
DR - (Direct Radiography) Systems “No Cassettes Required” - Two Types:
Type 1 - CCD (Charged Coupled Device) Systems:
DR - CCD Utilizes a digital image receptor, similar to a digital camera. The digital receptor is energized by the x-ray beam and read by a high resolution camera. The image is displayed on a monitor within 7 to 10 seconds. The CCD receptor in the DCChoice for Chiropractic replaces your wall unit. The CCD receptor for the DRds mounts into the base of the table and moves along the table base. The CCD receptor is coupled with the tubestand to provide the ability to move the CCD receptor and x-ray beam rather than have to jostle the patient in the imaging path. Patient positioning is further enhanced when the optional float top table is added.
Type 2 - DR (Direct Radiography) Flat Panel Detector Systems. These technologies are typically found in hospital and Orthopedic settings.
All Del Medical Digital Imaging
Systems -
(1,539,560 bytes) pdf
Clearly there are many advantages to digital imaging.
For most, the ability to manipulate and share the image electronically along with elimination of the darkroom are on the top of the list of reasons to consider digital imaging. Digital imaging is quickly taking hold in the medical, chiropractic and veterinary markets as costs have declined and the need for pruductivity has increased in the last year.
Please contact a Jones X-Ray Representative for more details.
Email JXR
THINGS TO KNOW - YOUR TRANSITION TO DIGITAL
Wednesday/April/09
THINGS TO KNOW ABOUT YOUR TRANSITION TO
DIGITAL
ALL AMERICANS Are supposed to have electronic health records (including X-Ray's) by 2014 under a goal set by President George W. Bush. His administration has funded the U.S. Office of the National Coordinator for Health Information Technology, but has otherwise relied on private industry to spur wider use of information technology in the health sector.
ELECTRONIC RECORD KEEPING AT YOUR FINGERTIPS. It is estimated that by 2014, United States health care professionals will be required to make their records instantly accessible to anyone with proper authorization, including pharmacists, physicians, insurance companies, and patients.
YOUR MOST IMPORTANT LINK
- What does film actually cost me?
- Is Your Practice Ready for Computed Radiography?
- Digital Facts
- Thinking about Digital
- Digital FAQ
International Atomic Energy
Agency
ALSO CONSIDER...
- The economic stimulus bill signed into law by President Bush on February 13, 2008 provides some exciting benefits for business!
- One provision substantially increases the amount that small businesses can deduct for certain capital equipment expenditures from $128,000 to $250,000.
- A second provision allows for bonus depreciation in 2008 on certain capital equipment expenditures purchased this year that would normally be depreciated over many years.
ALL AMERICANS Are supposed to have electronic health records (including X-Ray's) by 2014 under a goal set by President George W. Bush. His administration has funded the U.S. Office of the National Coordinator for Health Information Technology, but has otherwise relied on private industry to spur wider use of information technology in the health sector.
ELECTRONIC RECORD KEEPING AT YOUR FINGERTIPS. It is estimated that by 2014, United States health care professionals will be required to make their records instantly accessible to anyone with proper authorization, including pharmacists, physicians, insurance companies, and patients.
YOUR MOST IMPORTANT LINK
Radiation Control
Program
Other
helpful links:
Registering your System? Need forms? Preparing for an
Inspection?
Just
go to the JXR Public Service
page
There is also great information on our
Digital Facts
page
Please contact a
Jones X-Ray
Representative for more details.
Email JXR
DR VERSUS CR DIGITAL
Wednesday/April/09
DR vs CR - Keep an eye on DR!
Please contact a Jones X-Ray Representative for more details.
- DR has greater sensitivity than CR. Meaning lower levels of radiation. On an identical exam, a CR radiation dosage is four times greater than DR.
- DR is more efficient and significantly faster than CR. DR allows a higher throughput of patients each day.
- DR has better performance in resolution and image quality than CR.
- DR transfers the X-ray directly to a digital signal. CR gets the X-ray image transferred to the plate, and from the plate, to the reader.
- A DR image is dynamic. A CR image by definition is very much like a static film image. (Although you can manipulate the image in CR, you will face limitations on how CR data is used with advanced applications).
- CR is old technology. DR is new technology.
- CR cost has been an advantage over DR in the past. However, today advances in DR technology are becoming more affordable while providing less radiation, greater work-flow capacity, higher resolution, and wider dynamic range when compared to CR.
Please contact a Jones X-Ray Representative for more details.
Email
JXR
CURRENT DIGITAL COST ESTIMATES
Wednesday/April/09
DIGITAL TRANSITION COST - COMING DOWN
There are many meanings for digital radiology… and when it comes to digital capture, there are also many questions.
The first system is called an Indirect System. CR systems are placed into this category of systems. The intermediate step for CR (Computed Radiography) is to convert x-rays to light. CR systems use a film-less cassette which contains a phosphor plate to store the image and a reader to convert and process the illuminated image into a digital image. CR systems can range from $ 40,000 to $75,000.
The second system is called a Direct System. CCD and Flat Panel systems are placed in this category. Both of these technologies transfer the captured data from its source straight to the computer within seconds of the exposure. So, CCD can also be referred to as Direct Digital.
The CCD (Charged Coupled Device) receives the data by utilizing one or more high mega pixel cameras to capture the image. The image is captured directly from an illuminating plate that replaces the traditional cassette. The digital image from the CCD camera is imported to the acquisition software for manipulation and storage. Complete Digital CCD X-ray system range from $ 85,000 to 125,000 and up.
The Flat Panel, also known as Direct Digital Radiology.
Along with, the CCD systems - there is no need to utilize cassettes. DR systems convert x-rays directly from a digital detector panel into a digital image. DR is considered a “Direct” conversion process. These systems can range from $ 220,000 and up.
Please contact a Jones X-Ray Representative for more details.
There are many meanings for digital radiology… and when it comes to digital capture, there are also many questions.
- What is the difference between the types of digital systems?
- What are the differences between CR Digital, CCD Digital and DR Digital?
- What are the price points for these systems?
The first system is called an Indirect System. CR systems are placed into this category of systems. The intermediate step for CR (Computed Radiography) is to convert x-rays to light. CR systems use a film-less cassette which contains a phosphor plate to store the image and a reader to convert and process the illuminated image into a digital image. CR systems can range from $ 40,000 to $75,000.
The second system is called a Direct System. CCD and Flat Panel systems are placed in this category. Both of these technologies transfer the captured data from its source straight to the computer within seconds of the exposure. So, CCD can also be referred to as Direct Digital.
The CCD (Charged Coupled Device) receives the data by utilizing one or more high mega pixel cameras to capture the image. The image is captured directly from an illuminating plate that replaces the traditional cassette. The digital image from the CCD camera is imported to the acquisition software for manipulation and storage. Complete Digital CCD X-ray system range from $ 85,000 to 125,000 and up.
The Flat Panel, also known as Direct Digital Radiology.
Along with, the CCD systems - there is no need to utilize cassettes. DR systems convert x-rays directly from a digital detector panel into a digital image. DR is considered a “Direct” conversion process. These systems can range from $ 220,000 and up.
Please contact a Jones X-Ray Representative for more details.
Email JXR
IMPROVING DIGITAL IMAGES
Wednesday/April/09
CR/DR Image Quality: Issues and concerns - Tips for
improving digital X-Ray images
4/12/2007 - By: Herman Oosterwijk, OTech, Inc.
Because of the inherently different technologies that are involved, it is not trivial to ensure that digital images, as generated by either digital or computed radiography (DR/CR), are presented to physicians in a format similar to what they are used to in the hard-copy (film) world. It is not sufficient to merely match the functionality and presentation of film; because of the digital nature of CR and DR technology, it is even more important to capitalize on the advantages that this digital media provides.
For healthcare professionals who are jumping into digital radiography, it is important to understand image quality issues. This article lists the most common issues and describes how to be prepared for them.
Use of different techniques
One cannot use exactly the same exposure techniques (kVp, mAs) as one uses for film. Unfortunately, there is no "golden rule" because technique changes vary for each manufacturer. Even for a particular manufacturer, it depends on the type of screen or detector that is used.
Vendors are introducing new technologies, such as double-sided CR plates, and new compounds for their screens so that the sensitivity is increased. In general, CR plates appear to require a greater dose to get to the same level of image quality; however, as stated, it depends heavily on the plate manufacturer. The bottom line is that changes are very likely needed; ignoring this can definitely impact your image quality. Work closely with your vendor to implement a new set of techniques.
Danger of 'dose-creep'
CR/DR image acquisition is very forgiving. That means that an exposure that would have been too light or too dark -- under- or overexposed and possibly requiring a retake in the film world -- is still usable in the digital world. However, incorrect exposure in either direction is not a good thing: too few photons create too much noise in the image, while too many might reduce contrast. Because immediate feedback is missing (the image is always generated with proper contrast), the tendency appears to be that technologists are gradually increasing the exposure. In addition to having an impact on the image quality, there is definitely an inverse impact on patient radiation and safety. A QA/QC process is needed to monitor this.
QA/QC process
A QA/QC process is critical, not only to monitor for dose creep, but also to ensure that the proper processing is applied (yes, the software can -- in isolated cases -- apply image processing in a nonoptimal manner). In addition, one might have to apply shutters, rotate and/or flip images, and apply an appropriate window width level. In most cases, a QA tech or technologist supervisor initially performs this role. Eventually, this job is pushed back to the technologists performing the exams, assuming they had plenty of opportunity to be trained.
Reject analysis
In isolated cases, the image undergoing QA could be deemed to be unsatisfactory. This could be due to patient movement, the required anatomy is not shown, improper technique was used, or several other reasons. In the film world, the number of rejects was easy to track -- one could just review the contents of the "reject" bin and do an analysis. The equivalent of the reject bin is the recycle bin on the workstation; however, someone needs to review these rejects, match them with the technologist performing the exam, analyze the results, and, on a monthly basis, schedule retraining and/or make changes in workflow to reduce these occurrences in the future.
A process is needed, which could depend on the CR or DR vendor's architecture. For example, some institutions mark the images with a specific reject code and send them to the PACS in a way that they end up in a special directory, some institutions save them on the QA workstation, some save them at the CR/DR unit, and so on.
Differences in image processing
Particularly with DR systems, there is a wide range of image processing those results in a different "look" to the image. One has to realize that detector behavior is quite different than the response of a film to x-ray energy. In many cases, the output of the detector is linear, which means that to match the look of what this image would look like if it had been taken on a film, the vendor has to apply image processing and/or lookup tables (LUTs) to the data. Imagine that you have two different systems from two vendors, and you need to compare images that are taken on these systems -- they could very well look quite different. Even if all your digital x-ray equipment is provided by one vendor, there is the distinct possibility that a patient will bring in their previous images on a CD, which may have been taken on a system from a different vendor. One solution to this challenge is to configure your digital systems to have them send the unprocessed data with the applicable LUT as part of the image header, and then have viewing software that can apply either the original or a universal LUT to these images.
Collimation is critical
The impact of scatter radiation is even more pronounced on CR, and particularly on DR. If one does not properly collimate the area to be exposed, the result is unacceptable image quality. This is especially important with imaging extremities. Thorough training of the technologists is necessary.
Improper body part selection
Each body part is processed with specific algorithms to optimize specific data characteristics of that anatomy. This means that if one accidentally selects a chest study as an extremity study, the resulting image will look unsatisfactory. It is possible to go back to the acquisition device and reprocess the raw data to end up with a better image. Again, proper training of the technologists is critical to avoid these types of issues.
Hanging protocols are important
One could consider the presentation of images on a screen as part of image quality. A specific hanging protocol for a physician could require the posteroanterior (PA) view to be on the left screen, and the lateral (LAT) on the right. However, in the ICU one might want to compare all PAs with one another, which is different than how they are presented in the ER. In addition, some physicians might want to see the images in their own preferred order. For an outsider, this might seem like a minor issue; however, for a radiologist, who has been trained to look at images in a certain position in a certain order, this is a major issue. Hanging protocols often depend on information that is available in the image header, such as "Series Description" or "Body Part," to generate the proper order. This information is generated through user interaction and/or data entry at the CR/DR technologist console. Proper training and the awareness of the impact of incorrect selections by the technologist are crucial.
Cassette cleaning is critical
This is especially important for CR. The cassettes that are used typically collect dust. This can be seen on the images, and can even damage the plates by creating scratches if it gets inside the CR readers. The solution is quite simple: once a month, or more often if the environment is dusty, take each plate out of its cassette and clean it with alcohol or a vendor-recommended solution. Someone must be assigned to this task -- the imaging librarians working in the file room might be a good resource for this job.
Monitor quality needs to be monitored
This is not only applicable for CR/DR but for any digital modality -- consistency and integrity can only be achieved if soft-copy monitors are regularly calibrated. In many cases, flat-panel displays can be remotely monitored and/or automatically configured to start the calibration process -- for example, every Sunday at midnight. If there is no automatic monitoring, someone needs to do it manually.
Conclusion
The implementation of CR/DR introduces several new activities, which should be properly documented as a set of policies and procedures that spell out exactly who is doing what and when, which also can be used as the basis for training. Having these policies and procedures in place is an important step toward eliminating most issues that occur commonly when introducing CR and DR technology.
Please contact a Jones X-Ray Representative for more details.
4/12/2007 - By: Herman Oosterwijk, OTech, Inc.
Because of the inherently different technologies that are involved, it is not trivial to ensure that digital images, as generated by either digital or computed radiography (DR/CR), are presented to physicians in a format similar to what they are used to in the hard-copy (film) world. It is not sufficient to merely match the functionality and presentation of film; because of the digital nature of CR and DR technology, it is even more important to capitalize on the advantages that this digital media provides.
For healthcare professionals who are jumping into digital radiography, it is important to understand image quality issues. This article lists the most common issues and describes how to be prepared for them.
Use of different techniques
One cannot use exactly the same exposure techniques (kVp, mAs) as one uses for film. Unfortunately, there is no "golden rule" because technique changes vary for each manufacturer. Even for a particular manufacturer, it depends on the type of screen or detector that is used.
Vendors are introducing new technologies, such as double-sided CR plates, and new compounds for their screens so that the sensitivity is increased. In general, CR plates appear to require a greater dose to get to the same level of image quality; however, as stated, it depends heavily on the plate manufacturer. The bottom line is that changes are very likely needed; ignoring this can definitely impact your image quality. Work closely with your vendor to implement a new set of techniques.
Danger of 'dose-creep'
CR/DR image acquisition is very forgiving. That means that an exposure that would have been too light or too dark -- under- or overexposed and possibly requiring a retake in the film world -- is still usable in the digital world. However, incorrect exposure in either direction is not a good thing: too few photons create too much noise in the image, while too many might reduce contrast. Because immediate feedback is missing (the image is always generated with proper contrast), the tendency appears to be that technologists are gradually increasing the exposure. In addition to having an impact on the image quality, there is definitely an inverse impact on patient radiation and safety. A QA/QC process is needed to monitor this.
QA/QC process
A QA/QC process is critical, not only to monitor for dose creep, but also to ensure that the proper processing is applied (yes, the software can -- in isolated cases -- apply image processing in a nonoptimal manner). In addition, one might have to apply shutters, rotate and/or flip images, and apply an appropriate window width level. In most cases, a QA tech or technologist supervisor initially performs this role. Eventually, this job is pushed back to the technologists performing the exams, assuming they had plenty of opportunity to be trained.
Reject analysis
In isolated cases, the image undergoing QA could be deemed to be unsatisfactory. This could be due to patient movement, the required anatomy is not shown, improper technique was used, or several other reasons. In the film world, the number of rejects was easy to track -- one could just review the contents of the "reject" bin and do an analysis. The equivalent of the reject bin is the recycle bin on the workstation; however, someone needs to review these rejects, match them with the technologist performing the exam, analyze the results, and, on a monthly basis, schedule retraining and/or make changes in workflow to reduce these occurrences in the future.
A process is needed, which could depend on the CR or DR vendor's architecture. For example, some institutions mark the images with a specific reject code and send them to the PACS in a way that they end up in a special directory, some institutions save them on the QA workstation, some save them at the CR/DR unit, and so on.
Differences in image processing
Particularly with DR systems, there is a wide range of image processing those results in a different "look" to the image. One has to realize that detector behavior is quite different than the response of a film to x-ray energy. In many cases, the output of the detector is linear, which means that to match the look of what this image would look like if it had been taken on a film, the vendor has to apply image processing and/or lookup tables (LUTs) to the data. Imagine that you have two different systems from two vendors, and you need to compare images that are taken on these systems -- they could very well look quite different. Even if all your digital x-ray equipment is provided by one vendor, there is the distinct possibility that a patient will bring in their previous images on a CD, which may have been taken on a system from a different vendor. One solution to this challenge is to configure your digital systems to have them send the unprocessed data with the applicable LUT as part of the image header, and then have viewing software that can apply either the original or a universal LUT to these images.
Collimation is critical
The impact of scatter radiation is even more pronounced on CR, and particularly on DR. If one does not properly collimate the area to be exposed, the result is unacceptable image quality. This is especially important with imaging extremities. Thorough training of the technologists is necessary.
Improper body part selection
Each body part is processed with specific algorithms to optimize specific data characteristics of that anatomy. This means that if one accidentally selects a chest study as an extremity study, the resulting image will look unsatisfactory. It is possible to go back to the acquisition device and reprocess the raw data to end up with a better image. Again, proper training of the technologists is critical to avoid these types of issues.
Hanging protocols are important
One could consider the presentation of images on a screen as part of image quality. A specific hanging protocol for a physician could require the posteroanterior (PA) view to be on the left screen, and the lateral (LAT) on the right. However, in the ICU one might want to compare all PAs with one another, which is different than how they are presented in the ER. In addition, some physicians might want to see the images in their own preferred order. For an outsider, this might seem like a minor issue; however, for a radiologist, who has been trained to look at images in a certain position in a certain order, this is a major issue. Hanging protocols often depend on information that is available in the image header, such as "Series Description" or "Body Part," to generate the proper order. This information is generated through user interaction and/or data entry at the CR/DR technologist console. Proper training and the awareness of the impact of incorrect selections by the technologist are crucial.
Cassette cleaning is critical
This is especially important for CR. The cassettes that are used typically collect dust. This can be seen on the images, and can even damage the plates by creating scratches if it gets inside the CR readers. The solution is quite simple: once a month, or more often if the environment is dusty, take each plate out of its cassette and clean it with alcohol or a vendor-recommended solution. Someone must be assigned to this task -- the imaging librarians working in the file room might be a good resource for this job.
Monitor quality needs to be monitored
This is not only applicable for CR/DR but for any digital modality -- consistency and integrity can only be achieved if soft-copy monitors are regularly calibrated. In many cases, flat-panel displays can be remotely monitored and/or automatically configured to start the calibration process -- for example, every Sunday at midnight. If there is no automatic monitoring, someone needs to do it manually.
Conclusion
The implementation of CR/DR introduces several new activities, which should be properly documented as a set of policies and procedures that spell out exactly who is doing what and when, which also can be used as the basis for training. Having these policies and procedures in place is an important step toward eliminating most issues that occur commonly when introducing CR and DR technology.
Please contact a Jones X-Ray Representative for more details.
Email
JXR
IS YOUR PRACTICE READY FOR DIGITAL?
Wednesday/April/09
IS YOUR PRACTICE READY FOR DIGITAL?
By: Gerard Clum, DC, President, Life Chiropractic College West
The college received a tremendous number of calls and e-mail following the publication of the first article on this subject, "Life West Makes Waves With New Digital Radiography System.
Most of the inquiries were related to the conversion of film-based X-ray systems to a computed radiography environment, and the related costs. This article addresses those considerations.
Computed radiography (CR) is an interim step between traditional film radiography and digital radiography. The process of converting to CR has been described as a "retrofit" approach. In any retrofit project, elements of the original environment are maintained, while the particular enhancement is merged with the existing systems or structures. Conversion to CR from film-based radiography fits this model.
The ultimate conversion to a digital environment of diagnostic imaging is a direct-capture system, whereby the digital signal created by the penetration of ionizing radiation passes directly into the computer system. The interim method between film and direct capture is CR. The reasons to go to a CR technology, as opposed to a direct-capture technology, are predominately cost-related. The bottom line: CR is cheaper than direct-capture.
The "retrofit" approach to moving into digital-image capture and retrieval makes the most sense in a medium or large chiropractic clinic environment. In the small-office environment, it does not make economic sense to convert to CR. That being said, each practitioner needs to set the return-on-investment (ROI) that is comfortable and acceptable in his or her operations. The clinical ROI is a no-brainer: If cost weren't an issue, it would be wise for everyone to convert to CR.
In the retrofit model, your X-ray machine, transformer, bucky, etc., do not change one iota. The change is in the medium used to capture the image. In the CR format, film is no longer used, and image capture is accomplished by means of a digital recording plate that replaces the film in your standard cassette.
Logically, if film is not used, neither are a darkroom or its associated chemicals. This is an important aspect of evaluating the ROI question. How many direct expenses (film, chemicals, supplies, parts and labor) and indirect expenses (staff time, etc.) are eliminated in a CR environment? As savings mount with respect to these items, the cost of CR conversion becomes relatively less of a burden.
The next functional aspect of the CR conversion is a change in exposure factors. CR utilizes higher kV and lower MA. In the film environment, the patient is overexposed and the image "developed-up" to the desired point. In CR, the patient is underexposed and the computer enhances the image up to the desired level.
The darkroom part of the process is replaced by a "digital reader." This is a device that fits on a desktop and is somewhat larger than a laser printer. The cassette is brought to the area of the digital reader (it can be opened in a white light environment), and the digital card is removed and passed through the digital reader in the same fashion as a document would be fed into a fax machine. A 14"x17" scan takes approximately 55 seconds to "read." Following the collection of data from the digital card, the card is exposed to a bright fluorescent light, which cleans or erases the image formerly retained on the card. The digital card is then reloaded into a cassette and used between 3,000 and 5,000 times. The life expectancy of the digital card depends on how carefully it is handled.
Because bright fluorescent light is used to clean the digital card, it is smart to limit or remove fluorescent or bright incandescent light from the area where the exposed card will be removed from the cassette and fed into the reader.
By the time you have closed the cassette, the digital image of the X-ray exposure is available on the monitor of the computer system accompanying the digital reader. At this point, the identifying data of the patient, office, etc. are added to the image and you are free to go about enhancing, marking and copying the images to various media.
It was noted earlier that CR was less expensive than direct-capture digital radiography. In the direct-capture environment, the bucky or table top has sensors embedded to accomplish the task of the digital reader card and digital reader; moreover, the data go directly into the computer and an image is generated.
The cost of a CR retrofit is similar in nature and expense to purchasing a luxury automobile: The more features you want, the more money you will spend. These "features" include the number of workstations to be added to your configuration; a scanner to convert existing film images to digital images; "stitching" software that allows you to take a 14" x 17" A-P cervical-thoracic image and a 14"x17" lumbopelvic image and "stitch" them into one full spine image; and a projection system for reviewing images in a larger format/setting.
The sticker price on a CR retrofit is comparable to a well-equipped Lexus-about $45,000-$50,000, or about $1,000 a month on a 60-month lease.
There are several points in the life cycle of a practice at which conversion to CR makes greater sense. For example:
Please contact a Jones X-Ray Representative for more details.
By: Gerard Clum, DC, President, Life Chiropractic College West
The college received a tremendous number of calls and e-mail following the publication of the first article on this subject, "Life West Makes Waves With New Digital Radiography System.
Most of the inquiries were related to the conversion of film-based X-ray systems to a computed radiography environment, and the related costs. This article addresses those considerations.
Computed radiography (CR) is an interim step between traditional film radiography and digital radiography. The process of converting to CR has been described as a "retrofit" approach. In any retrofit project, elements of the original environment are maintained, while the particular enhancement is merged with the existing systems or structures. Conversion to CR from film-based radiography fits this model.
The ultimate conversion to a digital environment of diagnostic imaging is a direct-capture system, whereby the digital signal created by the penetration of ionizing radiation passes directly into the computer system. The interim method between film and direct capture is CR. The reasons to go to a CR technology, as opposed to a direct-capture technology, are predominately cost-related. The bottom line: CR is cheaper than direct-capture.
The "retrofit" approach to moving into digital-image capture and retrieval makes the most sense in a medium or large chiropractic clinic environment. In the small-office environment, it does not make economic sense to convert to CR. That being said, each practitioner needs to set the return-on-investment (ROI) that is comfortable and acceptable in his or her operations. The clinical ROI is a no-brainer: If cost weren't an issue, it would be wise for everyone to convert to CR.
In the retrofit model, your X-ray machine, transformer, bucky, etc., do not change one iota. The change is in the medium used to capture the image. In the CR format, film is no longer used, and image capture is accomplished by means of a digital recording plate that replaces the film in your standard cassette.
Logically, if film is not used, neither are a darkroom or its associated chemicals. This is an important aspect of evaluating the ROI question. How many direct expenses (film, chemicals, supplies, parts and labor) and indirect expenses (staff time, etc.) are eliminated in a CR environment? As savings mount with respect to these items, the cost of CR conversion becomes relatively less of a burden.
The next functional aspect of the CR conversion is a change in exposure factors. CR utilizes higher kV and lower MA. In the film environment, the patient is overexposed and the image "developed-up" to the desired point. In CR, the patient is underexposed and the computer enhances the image up to the desired level.
The darkroom part of the process is replaced by a "digital reader." This is a device that fits on a desktop and is somewhat larger than a laser printer. The cassette is brought to the area of the digital reader (it can be opened in a white light environment), and the digital card is removed and passed through the digital reader in the same fashion as a document would be fed into a fax machine. A 14"x17" scan takes approximately 55 seconds to "read." Following the collection of data from the digital card, the card is exposed to a bright fluorescent light, which cleans or erases the image formerly retained on the card. The digital card is then reloaded into a cassette and used between 3,000 and 5,000 times. The life expectancy of the digital card depends on how carefully it is handled.
Because bright fluorescent light is used to clean the digital card, it is smart to limit or remove fluorescent or bright incandescent light from the area where the exposed card will be removed from the cassette and fed into the reader.
By the time you have closed the cassette, the digital image of the X-ray exposure is available on the monitor of the computer system accompanying the digital reader. At this point, the identifying data of the patient, office, etc. are added to the image and you are free to go about enhancing, marking and copying the images to various media.
It was noted earlier that CR was less expensive than direct-capture digital radiography. In the direct-capture environment, the bucky or table top has sensors embedded to accomplish the task of the digital reader card and digital reader; moreover, the data go directly into the computer and an image is generated.
The cost of a CR retrofit is similar in nature and expense to purchasing a luxury automobile: The more features you want, the more money you will spend. These "features" include the number of workstations to be added to your configuration; a scanner to convert existing film images to digital images; "stitching" software that allows you to take a 14" x 17" A-P cervical-thoracic image and a 14"x17" lumbopelvic image and "stitch" them into one full spine image; and a projection system for reviewing images in a larger format/setting.
The sticker price on a CR retrofit is comparable to a well-equipped Lexus-about $45,000-$50,000, or about $1,000 a month on a 60-month lease.
There are several points in the life cycle of a practice at which conversion to CR makes greater sense. For example:
- If you are completing tenant improvements (TI) on a leased facility and you can forego the expense of a darkroom design, plumbing, processor, chemicals, etc.
- If you are completing the design of a new office, you can eliminate the construction costs of a darkroom and its associated expenses. You can also eliminate, or generally minimize, your space allowance for film storage. If construction costs run $150 a square foot, 300 square feet dedicated to film storage pays for the CR system.
- If you are upgrading or replacing your processor and/or cassettes, CR can be a more reasonable transition.
Please contact a Jones X-Ray Representative for more details.
Email JXR
DIGITAL F.A.Q.
Wednesday/April/09
FREQUENTLY ASKED QUESTIONS:
Can I upgrade my current x-ray system?
To upgrade an existing system to direct digital it should be a high frequency (Hfq) system with anatomical programming. Most Hfq systems work very well with the DCX detector. Minor adjustment may be required on some generators.
What is DICOM?
DICOM (or Digital Imaging and Communications in Medicine) is a standard developed by the American College of Radiology and the National Electrical Manufacturers Association. The standard was established to meet the needsof manufacturers and users of medical imaging equipment for the exchange of data on standard networks. Already accepted across all medical fields, DICOM simplifies the development for all types of medical imaging. “DICOM-compatibility” simply means that different users of different imaging devices will be able to smoothly exchange information. (More info at http://medical.nema.org)
What is a PACS system?
PACS (or Picture Archive and Communication Systems) is used by the radiology and diagnostic imaging industry to manage information and images electronically. The system is responsible for acquiring, transmitting, storing, retrieving, and displaying digital images and related patient information from a variety of imaging sources, and communicating the information over a network.
Do I need a PACS system?
This will depend on your clinic set-up. If you have a multi-doctor clinic with multiple viewing stations, it is best to have a PACS environment. Not only will the PACS help manage all of the patient files for the multiple doctors, it will also act as your image storage facility.
Do I need additional networking brought in my X-ray room?
You will need a network jack in your x-ray room for the “acquisition station” computer. This computer needs to be networked into the “Virtual Viewbox” workstation computer. This can be done as an independent connection that does not link in with any other networking or it can be linked in with an existing network. The main goal is for the two computers to communicate without interruption.
Please contact a Jones X-Ray Representative for more details.
Can I upgrade my current x-ray system?
To upgrade an existing system to direct digital it should be a high frequency (Hfq) system with anatomical programming. Most Hfq systems work very well with the DCX detector. Minor adjustment may be required on some generators.
What is DICOM?
DICOM (or Digital Imaging and Communications in Medicine) is a standard developed by the American College of Radiology and the National Electrical Manufacturers Association. The standard was established to meet the needsof manufacturers and users of medical imaging equipment for the exchange of data on standard networks. Already accepted across all medical fields, DICOM simplifies the development for all types of medical imaging. “DICOM-compatibility” simply means that different users of different imaging devices will be able to smoothly exchange information. (More info at http://medical.nema.org)
What is a PACS system?
PACS (or Picture Archive and Communication Systems) is used by the radiology and diagnostic imaging industry to manage information and images electronically. The system is responsible for acquiring, transmitting, storing, retrieving, and displaying digital images and related patient information from a variety of imaging sources, and communicating the information over a network.
Do I need a PACS system?
This will depend on your clinic set-up. If you have a multi-doctor clinic with multiple viewing stations, it is best to have a PACS environment. Not only will the PACS help manage all of the patient files for the multiple doctors, it will also act as your image storage facility.
Do I need additional networking brought in my X-ray room?
You will need a network jack in your x-ray room for the “acquisition station” computer. This computer needs to be networked into the “Virtual Viewbox” workstation computer. This can be done as an independent connection that does not link in with any other networking or it can be linked in with an existing network. The main goal is for the two computers to communicate without interruption.
Please contact a Jones X-Ray Representative for more details.
Email JXR
CONSUMER DISPLAYS
Wednesday/April/09
Consumer displays compare well with medical-grade
displays
By Erik L. Ridley
AuntMinnie staff writer
November 27, 2007
CHICAGO - While medical-grade displays offer a longer life span and superior consistency over time, the growing capabilities and significantly lower cost of consumer displays may offer a more compelling PACS display alternative, according to research presented at the 2007 RSNA meeting.
Consumer displays "are ten times cheaper and more easily procured and replaced," said Dr. David Hirschorn of Massachusetts General Hospital in Boston. Hirschorn discussed his two years of experience with using consumer displays for PACS during a scientific session Tuesday.
In terms of the issue of luminance degradation, medically marketed displays come with lots of "overhead," or extra brightness capability, and a feedback mechanism that allows them to maintain a constant light output. This is typically a brightness of 400 to 500 cd/m² over the life of the display, about five years, Hirschorn said.
"Over the lifetime of the display, the light output is constant, and that's wonderful," he said.
Consumer displays, however, have no overhead and no feedback mechanism. As a result, light output slowly decays over time, Hirschorn said.
"We found in practice that most of our displays start out at about 450 cd/m², and fall to about 375 cd/m² over about 18 months," he said.
The American College of Radiology (ACR) still says 170 cd/m² is the minimum standard, "but no clinical radiologist wants to read a chest x-ray at 170," Hirschorn said. "We've found that if you give us more light, we will see more. We will pick up more pulmonary nodules, we will see more pneumothoraces."
As a result, the useful life for these displays for radiography was about 18 months, he said.
In addition to its effect on white level, luminance degradation would seem to have an effect on calibration precision, as the DICOM part 14 grayscale display function is a nonlinear function of the display's black and white levels, he said. As such, target values should change as the display gets dimmer and the calibration should be "thrown off."
In practice, however, the divergence from the curve was not significant within these limits, Hirschorn said.
The researchers have noted a few artifacts from their use of consumer displays, including burn-in. That effect has been reversible after leaving the monitor off for a week, he noted.
Another effect, called yogore, consists of broad smudgy bands on the screen. This is not reversible, however, and the manufacturers replaced the units, Hirschorn said.
Medically marketed displays offer the advantage of ease of calibration and conformance checking, consistent light output, and a slightly higher number of pixels (3 megapixels versus 2.3 megapixels), Hirschorn concluded. Consumer-marketed displays, however, offer color (although high-brightness displays are also available now from medical display vendors), are significantly cheaper, and easier to purchase and replace, he said.
"You're talking about $600 for a monitor that lasts 18 months," Hirschorn said. "Even if I throw it out every year, I still don't come anywhere close to spending the amount of money that I would spend on a medically marketed display."
Please contact a Jones X-Ray Representative for more details.
By Erik L. Ridley
AuntMinnie staff writer
November 27, 2007
CHICAGO - While medical-grade displays offer a longer life span and superior consistency over time, the growing capabilities and significantly lower cost of consumer displays may offer a more compelling PACS display alternative, according to research presented at the 2007 RSNA meeting.
Consumer displays "are ten times cheaper and more easily procured and replaced," said Dr. David Hirschorn of Massachusetts General Hospital in Boston. Hirschorn discussed his two years of experience with using consumer displays for PACS during a scientific session Tuesday.
In terms of the issue of luminance degradation, medically marketed displays come with lots of "overhead," or extra brightness capability, and a feedback mechanism that allows them to maintain a constant light output. This is typically a brightness of 400 to 500 cd/m² over the life of the display, about five years, Hirschorn said.
"Over the lifetime of the display, the light output is constant, and that's wonderful," he said.
Consumer displays, however, have no overhead and no feedback mechanism. As a result, light output slowly decays over time, Hirschorn said.
"We found in practice that most of our displays start out at about 450 cd/m², and fall to about 375 cd/m² over about 18 months," he said.
The American College of Radiology (ACR) still says 170 cd/m² is the minimum standard, "but no clinical radiologist wants to read a chest x-ray at 170," Hirschorn said. "We've found that if you give us more light, we will see more. We will pick up more pulmonary nodules, we will see more pneumothoraces."
As a result, the useful life for these displays for radiography was about 18 months, he said.
In addition to its effect on white level, luminance degradation would seem to have an effect on calibration precision, as the DICOM part 14 grayscale display function is a nonlinear function of the display's black and white levels, he said. As such, target values should change as the display gets dimmer and the calibration should be "thrown off."
In practice, however, the divergence from the curve was not significant within these limits, Hirschorn said.
The researchers have noted a few artifacts from their use of consumer displays, including burn-in. That effect has been reversible after leaving the monitor off for a week, he noted.
Another effect, called yogore, consists of broad smudgy bands on the screen. This is not reversible, however, and the manufacturers replaced the units, Hirschorn said.
Medically marketed displays offer the advantage of ease of calibration and conformance checking, consistent light output, and a slightly higher number of pixels (3 megapixels versus 2.3 megapixels), Hirschorn concluded. Consumer-marketed displays, however, offer color (although high-brightness displays are also available now from medical display vendors), are significantly cheaper, and easier to purchase and replace, he said.
"You're talking about $600 for a monitor that lasts 18 months," Hirschorn said. "Even if I throw it out every year, I still don't come anywhere close to spending the amount of money that I would spend on a medically marketed display."
Please contact a Jones X-Ray Representative for more details.
Email JXR
"TO BE, OR NOT TO BE" (DIGITAL)
Wednesday/April/09
The Key to the answer is Don't Rush!
Have you ever purchased a new gadget only to see it replaced by a newer better gadget at a lower price? Then a different technology comes along that totally replaces your gadget with a gadget that does the same thing as your gadget did but renders your gadget useless!
There is a a complete open-source software package for viewing and manipulating digital X-Ray Images on your PC. This software works only on Macintosh computers and It is absolutely incredible and did I say FREE! I have demoed it. Make sure to click on the users link once your at the OsiriX site for the list of centers using this software. Does the Radiology Department of UCLA, California, USA ring a bell?
I use Mac's (although not long ago I couldn't type my name without help and spell check). Now I have 3 Mac's personally and have converted Jones X-Ray to the OSX platform. I happen to think that Mac's are the best tool for digital radiology. They have always been known for their capabilities in graphic's. Not to mention the fact that Mac's are less prone to viruses, crashes and blue screens of death. They are a much more stable platform, only my opinion, there is always more then one way to slice bread...
My point is this, It used to be a matter of which processor to buy, which film to use, "Which service company shall I call".
As we move to Digital the choices are to many to list here. Technology is changing fast and that is especially true in radiology. Mainly because it was a late bloomer. All the digital tech hit the consumer market first and has migrated to medical imaging fairly recently. It has only now made it's way to private practice medicine at anywhere near a reasonable price (if making a revenue off of taking X-Ray's is important to you). The open-source software that I mentioned earlier was written by doctors for doctors.....FREE! Others (for windows) are also available. It's as easy as a google search. Here is what is hard to swallow. I have seen vendors (locally) sell this same thing for upwards of $50,000. That does not include hardware!
BUYER BEWARE! YOU HAVE MANY OPTIONS!
Don't let the whirlwind of technology change keep you from maintaining a focus on your practice. Just step back, take a breath, make a plan and stick to it. even if that means doing nothing for now or at least until the technology improves, stabilizes and prices come down.
Have you ever purchased a new gadget only to see it replaced by a newer better gadget at a lower price? Then a different technology comes along that totally replaces your gadget with a gadget that does the same thing as your gadget did but renders your gadget useless!
There is a a complete open-source software package for viewing and manipulating digital X-Ray Images on your PC. This software works only on Macintosh computers and It is absolutely incredible and did I say FREE! I have demoed it. Make sure to click on the users link once your at the OsiriX site for the list of centers using this software. Does the Radiology Department of UCLA, California, USA ring a bell?
I use Mac's (although not long ago I couldn't type my name without help and spell check). Now I have 3 Mac's personally and have converted Jones X-Ray to the OSX platform. I happen to think that Mac's are the best tool for digital radiology. They have always been known for their capabilities in graphic's. Not to mention the fact that Mac's are less prone to viruses, crashes and blue screens of death. They are a much more stable platform, only my opinion, there is always more then one way to slice bread...
My point is this, It used to be a matter of which processor to buy, which film to use, "Which service company shall I call".
As we move to Digital the choices are to many to list here. Technology is changing fast and that is especially true in radiology. Mainly because it was a late bloomer. All the digital tech hit the consumer market first and has migrated to medical imaging fairly recently. It has only now made it's way to private practice medicine at anywhere near a reasonable price (if making a revenue off of taking X-Ray's is important to you). The open-source software that I mentioned earlier was written by doctors for doctors.....FREE! Others (for windows) are also available. It's as easy as a google search. Here is what is hard to swallow. I have seen vendors (locally) sell this same thing for upwards of $50,000. That does not include hardware!
BUYER BEWARE! YOU HAVE MANY OPTIONS!
Don't let the whirlwind of technology change keep you from maintaining a focus on your practice. Just step back, take a breath, make a plan and stick to it. even if that means doing nothing for now or at least until the technology improves, stabilizes and prices come down.
Jones X-Ray is committed to providing digital
alternatives to our customers.
We currently have products that will completely amaze
you. Stay tuned...
Please contact a
Jones X-Ray
Representative for more details.
Email
JXR
DIGITAL X-RAY MAKES HEADWAY BUT...
Wednesday/April/09
Digital X-Ray makes headway, but traditional
radiography remains useful
You have taken the BIG STEP... You've gotten rid of the
processor, film, chemical, and those... Processor Guys!
Now you have an image that looks like this...
Don’t rush into thing's.
Technology is rushing at you fast
enough!
All
forms of radiography are moving toward an all-digital
environment.
And despite the heavy use of CT, the common x-ray still
has its place in orthopedics, trauma, and other areas.
Within
the next few years,
according to one study, more than 50% of x-rays that
are now film-based will be digital. Converting to
digital imaging is usually associated with a desire to
implement a PACS network to save money and space, and
with the need to maintain an archive of studies to
satisfy HIPAA requirements. And RIS and HIS integration
goes hand in hand with PACS as healthcare continues its
quest for full digitization.
Digital
images can
be acquired with cassette-based computed radiography
technology (CR) or direct radiography (DR) systems. CR
captures digital images on a (Cassette like) receptor,
typically using storage phosphor technology. DR
involves direct capture of images on a flat-panel
digital plate that sends an image to a display system
or a PACS for archiving. With the later DR, the image
stays in a digital form and is not switched back to an
anolog form. This is optimum.
CR
is less expensive but typically does not offer the same
productivity benefits
and cost savings as DR. As the technologist must handle
cassettes. CR can be a good solution for smaller
institutions with fewer studies, and it provides a
useful transition from film to digital. DR becomes more
profitable than CR only when the productivity of each
is optimal.
THAT WAS EASY BUT NOW DR PRICES ARE FALLING FAST! WHAT
DO I DO?
Consider this. I
purchased 3 computers for my personal use all within
the last 1 1/2 years. All have been replaced with newer
models 3 times since my purchase. In the last or most
recent replacement the processors changed to Intel
causing all software to change. This is in a stable
name like Macintosh. Consider the windows platform,
Vista is coming (they keep saying) what will have to
change then? Recently one of the biggest
vulnerabilities in windows history was discovered that
effects platforms back to windows 95 and before!
Combine this with the fact that CR could possibly fall
by the way side as DR comes down in price.
With
increasing implementation of DR,
integration of DR and CR can be a challenge. Exposure
control and other parameters must be similar so that
image density, lightness and darkness, and other
crucial elements don't vary from CR to DR.
A
number of factors are
key to a seamless conversion to digital, whether it is
done gradually or all at once. Facilities should assess
their imaging needs, gather budgeting information,
compare vendors and the options they offer, and then
put their plans into action.
I
think picking the right company to
become your imaging partner is as important as the
equipment, hardware and software that you choose!
Creating a Imaging team is how to win in this game!
Jones X-Ray can help you to configure the most cost
effective solution possible. Even if that solution, for
now at least, means just"waiting a little longer"...
Please contact a
Jones X-Ray
Representative for more details.
Email
JXR
