Long-view digital radiography improving the lives of pediatric orthopedic patients

The Radiology Department at Driscoll Children’s Hospital in Corpus Christi, Texas, didn’t need a nudge from Washington, D.C., to upgrade to digital radiography (DR). With one exception, the department’s x-ray rooms were fully DR-capable as of last year; Centers for Medicare and Medicaid Services (CMS) said it would start reducing payments for analog X-ray in 2017 and for computed radiography (CR) in 2018.

The exception was long-view radiography. The incentive to bring this, too, into the DR fold came from the not-for-profit hospital’s commitment to provide first-rate, fiscally responsible care to the 170,000-plus children visits, whose families turn to Driscoll Children’s Hospital each year.

“We serve children throughout South Texas all the way down to the Rio Grande Valley,” says Ernest Chavez, MBA, and Driscoll Children’s Hospital Director of Radiology Service. “Our first goal is always patient care, comfort, and safety.”

Adding that the department X-rays between 10 and 20 children each week for scoliosis and hip-to-ankle leg diagnostics and monitoring, Chavez recalls seeing Fujifilm’s FDR D-EVO GL detector – all 17 by 49 inches of it – at RSNA in 2015 (U.S. FDA 510 (k) cleared in November 2015). “As soon as we looked at it, we didn’t need to be sold on it,” he recalls.

The on-the-spot decision by the Driscoll Children’s Hospital’s contingent at RSNA 2015 was also spurred by the product’s promise of single-exposure and ultrafast image capture – vitally important when imaging squirm-prone children – along with word of its very high image quality and very low radiation dose exposure thanks to Fujifilm’s Virtual Grid intelligent image processing.

Finally, they knew the FDR D-EVO GL could only make image acquisition smarter, faster, and easier than it was ever going to be with CR or multiple-exposure DR – both of which they’d been using to get their spinal and long-leg images.

A year and a half after they began using the panel daily for scoliosis and long-leg imaging, Chavez and two colleagues filled in Imaging Innovation on how well the FDR D-EVO GL has been living up to its promises.

Faster, sharper, safer

Chavez, who clearly came to the conversation prepared with data, gets right to the numbers that reflect efficiency and productivity gains made since the installation.

“It was taking us from 15 to 30 minutes – with an average of 21 minutes – to do the CR for scoliosis images,” he says. “Once the technologists became comfortable working with the new detector, we got it down to six minutes, on average. So we are knocking these out really quickly.”

They’re also doing fewer repeat image acquisitions, Chavez says, because the children have less time to start feeling antsy or uncomfortable and move around. “That,” he says, “is huge.”

As for image quality, the Radiologists are thrilled. “Right off the bat, our Chairman of Radiology said, “This is our standard now. I don’t want you using anything else,” Chavez says.

The doctors are all the more enthusiastic for knowing the image quality has so noticeably improved along with a reduction of radiation doses.

For anteroposterior radiographs of the spine, they’ve been averaging about a 45 percent reduction in radiation with FDR D-EVO GL as compared to CR. For lateral spine images, they’ve seen their doses drop 29 percent.

Radically reduced radiation

“Managing radiation dose on behalf of your patients is a top priority at Driscoll Children’s Hospital,” says Elisa Constante, the Department’s Quality Management Coordinator. A 17-year technologist herself, she now focuses much of her energy on helping to maintain dose standardization, such that the radiation levels start to fluctuate over time.

“We’re X-raying some of these children from the time that they are neonates until the time they are 25 years of age in some cases,” Constante says. “We have our standards in place because, prior to going digital, we had to come up with our own techniques for CR based on the patient’s measurements to make sure one tech wasn’t using 32 mAs where the other tech might be using 5o.” It’s fine to start out with a mA range as your aim, she says, as long as you end up with the same dosage for each clinical indication.

“We take the concern about radiation dose very seriously,” Constante adds. “When we hire a new technologist fresh out of school, we remind them that this is pediatrics and our patients will probably be exposed to a lot radiation over their lifetime. They are reminded that dosage is cumulative, so you really have no clue how it is going to affect them in life. You want to get them off to a good start from the beginning.”

Constante says that, for the scoliosis patients, the department had been using an average of 32 mAs for a set of posterioranterior/anteroposterior x-rays with CR. With the FDR D-EVO GL, they’re using half of the dose.

There’s something else Constante likes about the Fujifilm system: its space-saving size. “We didn’t have to convert a room and dedicate it just to scoliosis,” she says. “It’s just a great design.”

Less patient discomfort, greater efficiency

Radiologic Technologist Allison Guajardo has been working in Driscoll Children’s Hospital Orthopedic Clinic for nearly a decade and a half. She’s closely attuned to the discomfort pediatric patients are often in when they come for spine and hip-to-ankle X-rays. More than a few are in post-surgery pain.

“The FDR D-EVO GL capability that helps optimize patient care the most is the single exposure, for sure,” she says. “It’s a great advantage to pediatric imaging. We have a lot of patients between 1 and 18 years old who aren’t able to hold steady. That single exposure is so quick-it really helps us achieve an optimal image. We just get the patient up there, take the images and it’s over before they even have a chance to start to move.”

Guajardo adds that the department’s previous digital radiography system required three exposures compared to the one exposure with the Fujifilm, which reduces the chance of a repeat due to motion.

“We also have a lot of patients who have cerebral palsy,” she says. “They don’t have muscle tone, so they can’t control their movement. The Fujifilm system really helps with that, to get a quick exposure for those patients.”

Not surprisingly, the quick exam times have helped the department make gain in Radiology workflow and patient throughput. “Efficiency and productivity have improved greatly since we started using the Fujifilm system,” Guajardo says.

“When you take a single shot, there’s no chance of incorrectly stitching together separately acquired images, for example.” This was a not an uncommon problem in the past, when, for example, taller teenagers would come in for hip-to-ankle imaging and need more than one exposure to cover the whole view, Guajardo explains.

“I can’t wait to get another FDR D-EVO GL,” she says. “That would help the workflow even more.”