If service, patient safety, and profit weren’t incentives enough, now hospitals and imaging clinics have another inducement to go digital: the Obama administration’s federal health care stimulus plan, which stresses health care IT and electronic medical records.
Steven Mendelsohn, MD, says, “The only choice to make is whether you go with DR or CR. Still using film makes no sense.” Mendelsohn is medical director of Zwanger-Pesiri Radiology, which operates eight imaging clinics in Long Island, New York. Deciding where to put DR and when to use CR depends on the practice and needs to be analyzed, Mendelsohn adds. “There is no one solution,” he says.
To make a long history short, CR preceded DR as a way to capture x-rays electronically, but CR uses a removable-plate image-capture system that is a lot like film-based radiography in that a plate must be transported to a reader, where it can be made into an image. DR, on the other hand, contains the image receptor permanently embedded inside the table or wall-mounted surface against which the patient lies or stands. With DR, the image is available on a monitor in the radiography room within seconds, and the technologist can verify it and send it to PACS from the radiography room itself.
Because DR allows the technologist to stay right in the room with the patient, both speed and patient safety are enhanced. Instead taking x-ray plates or CR cassettes outside the room to be fed into an x-ray processor or CR reader, the technologist can remain with the patient and will know almost immediately whether the image was acquired correctly. Nonetheless, CR has its place, and any hospital or clinic should do its homework on where and how CR might be deployed, as Mendelsohn suggests.
Weighing the Advantages
Mendelsohn says that Zwanger-Pesiri experimented with both CR and DR in different offices, finding that CR was twice as fast as film and that DR was twice as fast as CR, making DR four times faster than film. Mendelsohn stresses that this is a seat-of-the-pants assessment because conditions, patients, and technologists vary so much. “It’s hard to give a real number,” he says.
Getting radiography digitized so that it can go on PACS and become part of the electronic medical record is not for the financially faint of heart, although in the long run, savings on film, film rooms, and film staff; workflow efficiencies; and referrer goodwill probably offset outlays for DR and CR.
Price is certainly a factor to consider in deploying DR technology. Facilities should strategically examine their workflow patterns and caseloads to determine whether CR or DR would constitute the more cost-effective route to digital imaging. Statistics on the long-term costs of equipment ownership and on the equipment's service history (and costs) should also be examined. Both CR and DR offer improvements in workflow, cost savings on consumables, and reduced staffing requirements.
One strategy for DR deployment is to do it first, before competitors do. That’s what Zwanger-Pesiri Radiology did with its eight clinics. Back in the mid-1990s, when Zwanger-Pesiri began to move away from film, it was a leader. “We were very early with DR in two offices, then we had CR in two offices, and subsequently, we went with DR in the next four,” Mendelsohn says. “We have DR now at all our sites; we have CR in four.”
Initially, Mendelsohn says, Zwanger-Pesiri put DR in the two clinics that were its busiest and CR in the two where the patient volume was lowest. Later, it added the Unity SpeedSuite DR system from Fujifilm America Medical Systems, Stamford, Conn, at other sites, and it now uses CR at some sites principally for fluoroscopy, gastrointestinal and barium-enema studies, and patient overflow from any bottlenecked DR rooms. “A fully digital fluoroscopy unit is very expensive, and this way, we can do it less expensively by using CR,” he adds.
When it initially installed the Fujifilm DR system at its busiest site, Mendelsohn says, Zwanger-Pesiri was able to downsize from five radiography rooms to one, plus a fluoroscopy room with CR. “We are doing two, three, or four times the volume with only two rooms, instead of five,” he says. “It gave us a lot more real estate.” For a time, Zwanger-Pesiri used one former radiography room for CT, but it has now converted all three to ultrasound, Mendelsohn adds.
“DR enables us to perform studies much more quickly,” he says. “The technologist can