Are Wireless Imaging Plates the Tipping Point for DR?

	Radiology technologist students at NCH Healthcare System in Naples, Fla., demonstrate how the wireless DR plate from a portable x-ray unit can be optimally positioned. Amber Stiers is standing, while Mitch Hartmann occupies the gurney.

In stroke care, the mantra is "time is brain." Similarly, time is of the essence in x-ray imaging. The more time spent waiting for an x-ray image, the more chance there is for a bottleneck in patient flow, which can lead to revenue loss, patient dissatisfaction, longer report turn-around times and suboptimal images. The latest generation of wireless digital radiography (DR) technology provides the efficiency, flexibility and clinical applications radiology departments need.

Solving the ER bottleneck

Prior to DR deployment, emergency rooms (ER) at NCH Healthcare System in Naples, Fla., were a constant source of backlogged patients, says Jim Bates, director of radiology. "Having a dedicated x-ray room with digital technology in the ER has paid off hugely," he says. "Before we switched to DR, we had more rooms and more technologists, but we were not nearly as fast as we are now." The next investment for the ER will be wireless imaging receptors.

NCH Healthcare System comprises North Naples Hospital and Downtown Naples Hospital. Between them, they have 600 beds, and in 2010, the radiology department performed nearly 91,000 exams on DR systems (Canon).  

The first area to go wireless was the OR because "there is no tether from the plate to the x-ray scanner, which reduces the risk of infection and contamination in a sterile field," Bates says. "I expect to upgrade all our systems with wireless plates because they are so flexible."  

Bates has an interesting conundrum. He will upgrade to more wireless plates when the conventional DR plates run their course. But they don't seem to want to die, he quips. "I have to wait for them to break in order to replace them," he says, adding that over the last six years of DR, comprising millions of exams, they have had only two plate failures.

At the 361-bed Heartland Regional Medical Center in St. Joseph, Mo., the ER has one stationary DR unit and two mobile units. The mobile units (GE Healthcare) have recently been upgraded with wireless imaging receptors (Carestream).

With the new configuration, the patient exam list appears on the portable unit, which reduces the chance of imaging the wrong patient. In fact, the facility has seen its error rate drop by half to less than 10 errors per 5,000 monthly exams, says Larry B. Kirschner, MS, radiology director at Heartland Regional. He adds,  "We catch them quickly when they are made."

Kirschner reports benefits in the OR as well. Surgeons no longer have to wait 10 to 20 minutes for the x-ray process to be completed. This has led to reduced surgical and anesthesia time for patients by an average of 20 minutes per case, he says. "Surgeons can do more [cases] per day or have shorter days, and we make better use of our OR."

A role for standard DR

Valley Imaging in West Covina, Calif., recently opened a radiography service line, which includes two x-ray rooms outfitted by Fujifilm Medical Systems. One room contains a model comprised of an x-ray tube mounted on a C-arm, while the other is a dual-detector wall and table bucky system.

The two digital imaging plates in the dual-detector system are not wireless, although Fuji is awaiting FDA approval on its wireless option. Valley Imaging COO Steve Mathis says he considered a wireless plate, but made his decision based on the quality of the technology and the price. In addition, he was wary of the potential to drop the wireless plates during operation as well as when the batteries are pulled at the end of a shift for recharging.

He admits the wireless option might be better in a hospital setting with multiple rooms where the techs are taking the plates from room to room. In his center, though, he has not found any situation where the tether from the plate to the machine has interfered with imaging. Also, it was a strategic decision to have a plate in both the table and wall bucky so there would be less handling and less of a chance to drop them.

Mathis says both units are ideal for the outpatient setting. "For the C-arm unit, patients can stand or sit in a chair next to the image receptor, which can be spun to obtain views that are 90 degrees apart. It's quick and very easy for the technologists to use."

With a dual-detector system, techs can remove the table plate to obtain better images of certain parts of the anatomy such as the hands or feet. Because the images are available to view in seconds, quality control is immediate. "If we don't need to repeat the exam, the patient can leave and images can be sent directly to PACS. The increased productivity helps because reimbursement is going down. The only way to offset that is to do the exam faster and with more efficiency," he says.

Buy now, save later

The main campus of the Ochsner Health System in New Orleans is a 525-bed hospital that performs 155,000 radiography studies annually, according to Ritchie Dupre, assistant vice president of radiology services. Ochsner Dupre is upgrading from CR to DR and has put in orders for GE's wireless imaging receptor, which will be available later this year.

Ochsner will have seven wireless plates: two for portable units, two each for dual-detector units and one for a single-detector chest x-ray unit. Dupree says he wanted to initially purchase wireless plates for both the wall and table buckys, and later, when he purchases more x-ray units, he will not necessarily buy more wireless detectors. "These seven plates are our foundation. We decided to spend the money now for the dual detectors and as we add more portable units or other rad units, we won't need to purchase detectors. We will share them in a way that makes sense geographically within the department."

Another selling point for Mathis was the ability to perform dual-energy subtraction with the system. "We use dual-energy subtraction for chest imaging and found tremendous value in finding nodules that we wouldn't ordinarily see with plain imaging," he says.

Many facilities are finding the switch to DR makes both economical and practical sense. The option to go wireless makes DR even more attractive. The latest generation of wireless receptors are easy to handle and sturdier than previous generations. The mantra is speed, but speed without quality would be useless. Wireless DR offers both.