Solved: A Consistent and Simple DR/CR Interface

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Hospitals trying to send both CR and DR images to PACS, especially for the same patient, have encountered multiple problems in the past. CR and DR images acquired for the same diagnostic study, but through differing devices, might have been presented with a different look and feel because of the technologies with which they were acquired, delaying interpretation. The images might also have had differing exposure, contrast, and resolution, sometimes annoying and distracting technologists and radiologists.

More troublesome than the image problems themselves might have been the workflow delays that resulted when PACS administrators were forced to reconcile CR and DR images for the same patient into a single patient case. Technologists could also find themselves using different workstations and software tools, or creating an extra step by sending CR and DR images to a centralized workstation for quality assurance (QA) on those same datasets before they could even be sent to PACS.

Workflow delays in the radiology department were a problem that Russell E. McWey, MD, remembers well. At the Virginia Hospital Center (VHC) in Arlington, Va, technologists used to queue at a QA workstation waiting to process images, he says.

“There was a traffic jam. If you had five technologists QA-ing at the same station, it either went down or logjammed.”
—Russell E. McWey, MD

Now, McWey says, there are no logjams. Moreover, he adds, the consistency and quality of the hospital’s CR and DR images, once they reach the PACS, are so uniform that it’s doubtful that radiologists even know whether they are looking at CR or DR.

McWey, who is medical director of radiology and chief medical information officer for the Virginia Hospital Center, says that the DR/CR solution that the hospital relies on was developed by its PACS vendor, Fujifilm Medical Systems USA, Inc.

“We’ve been digital about eight years now,” he says. “My department has been totally digital for three years.” VHC was, McWey says, one of the first hospitals on the East Coast to install Fujifilm’s Synapse PACS. He says that going digital has been “a huge efficiency booster, about ten times better than I thought it would be.” All the prior examinations for a patient, whatever the modality, can be accessed and pulled together in seconds, he adds.

Four years ago, VHC moved into a new 330-bed hospital at a cost of $150 million. McWey says that another first with Fuji was scored when the new hospital became one of the first in the East to roll out Fujifilm’s SpeedSuite DR imaging system and its companion CR technology, FCR®.

“We have a good relationship with Fuji,” McWey says. “They tell us about their new products and we usually go with them. They’ve been very good, and [for SpeedSuite] they had a top-notch technical team.” It turned out that Fuji’s CR/DR solution was just what VHC had been seeking.

Enter the Flash IIP

As part of its SpeedSuite DR and FCR technology, Fujifilm has developed advanced image-processing software and a user console (in fact, a technologist and QA workstation) that it calls the Flash IIP (or imaging information processor).

The IIP is a clever device that allows DR and CR images for a single patient to be processed in the same patient folder and sent to the PACS as a combined dataset that makes up a single diagnostic examination. In the event that CR and DR images are ordered under different accession numbers, those FCR and FDR images can be combined into the same patient folder at the IIP prior to transmission to PACS.

Moreover, both the DR and the CR images are derived in a way that gives them consistent, uniform quality, McWey says. With a few clicks, the technologist or a QA specialist can evaluate and adjust the images and push them onto the PACS. Essentially, what Fuji did, in designing its system, McWey says, was use its image-enhancement processing for CR and apply that to the DR system, even though it uses a different acquisition technology.

One of the chief differences between DR and CR normally is that DR images are derived directly and electronically and can go straight to PACS. CR images, on the other hand are derived through the use of a cassette that registers the image on an imaging plate and must be processed to get the images ready for the PACS. Fujifilm’s technology, McWey says, “is CR adapted to a DR platform.”

SpeedSuite DR uses a phosphor-based detector to capture the image, but there’s no cassette. The image is immediately sent