Laser Imagers: Hard Facts on Hard Copy

As a central component to the sharing of imaging data, laser imagers provide critically important functionality in radiology departments and free-standing imaging centers, whether printing to film or paper. Reliability, excellence in image quality, and compact size are some of the factors that clinicians evaluate in selecting the appropriate system for their needs and setting.


Image clarity a priority

Tom Waters, RT(R), staff technologist at Orthopedic Sports Medicine in North Broward, Fla., works in a center where clinicians provide care to professional team members from the Miami Dolphins and Florida Marlins. They experience a high volume of orthopedic x-rays using protocols that have been established by the respective professional organizations, such as the National Football League or Major League Baseball, that often require three to four views of specific anatomic structures. When a player has a “known” former injury, the examination of affected bones and joints becomes even more stringent. Typically their staff perform numerous physical exams, and imaging studies include views of shoulders, knees and elbows.

When it came to making the decision about a printer for their Agfa CR 75 unit, they consulted with other users and were told that they should consider a printer that would normally be used with CT or MRI because they require that high level of detail. 

“We saw we were losing information on a regular printer, and when we sent the images to a hospital with a high-resolution printer, we could see the information again,” Waters says. As they recognized that the detail they lost was not just subtle findings but significant and important data, they knew they had to select a printer that would meet their stringent requirements. “We couldn’t afford to lose information because we often ship our images to specialists in other areas for consultation.”

They used their need for high-resolution images as the basis of their selection of the Agfa DryStar 5302 to print films on blue or clear film. Blue-base film seems to be the physician preference.


Software-based approach

Forsyth Radiological Associates in Winston-Salem, N.C., employs 32 physicians in three free-standing imaging centers, all of which utilize the aycan paper print solution for multimodality diagnostic images.

Forsyth’s PACS administrator, Denise Beeson, explains that their physicians provide professional reading services for many local practices, and they have found aycan to be quite effective as a system used to communicate with referring physicians. They offer either CD or paper prints. “The feedback we have gotten from referring physicians is that they really like the paper and the flexibility it provides, because even with an 11X17 size, they can fold it and place it in a patient’s chart, or patients can easily take that with them to another physician.”

Besides that advantage, Beeson says their prints are used in the operating room, especially for those patients having a computed tomography angiography (CTA) study. The CTA 3D reconstructions can be printed in color on the Xerox printer and are an excellent reference for surgeons.

Beeson explains that they have configured their network so that each printer is attached to a print server that resides in their primary location and any PACS workstation can print DICOM through the print servers. Their Konica CR units as well as some 3D workstations are set up to print directly to the printer. Each imaging center has its own printer. “The actual printer is by Xerox and could be used as a network printer, but we have made it a dedicated image printer that no one can use it for other things.”

Aycan recommends a configuration that flows from the medical imaging modality image capture with DICOM print job output to the server where the aycan software converts that data into a Postscript print file that is sent to a certified aycan printer such as the Xerox WorkCentre M24 where the paper print is created.  The company notes that the cost of printing on paper is significantly less than the cost of printing to film.


Versatility in a compact unit

John Litchney, MBA, who has been a radiology administrator for 27 years notes several positive features for their Codonics Horizon Multi-media Imagers to print paper copies of a wide variety of imaging studies including neuro MRI and CT, orthopedics and pulmonary x-rays. They have been using Codonics imagers since 1999.

One of the features they appreciate is the compact size and versatility because it can print to a variety of media sizes and paper or polyester film, so it is not a single function printer. The Horizon is capable of printing in color, which they find beneficial for aortograms, intracranial studies and CTAs. 

Additionally, Litchney notes that he appreciates the “smart card” that resides within the printer. “If the network goes down or you need to change out a printer, all you have to do is pull out the credit-card-sized smart card and put it into the new system. You get everything including the defaults that are stored in the smart card.” They print from individual modalities in many cases, but sometimes they print from their PACS. 

If a printer should require service, Codonics simply replaces the machine, rather than attempting to repair onsite. 

“A radiologist would want to know he or she can get diagnostic quality images on strong and resilient paper, and an IT professional would be interested in the fact that it is ‘plug and play,’” Litchney notes.


Heavy-duty usage

David C. Held, radiology service engineer at University Community Hospital in Tampa, Fla., describes his facility as a 431-bed hospital with 120,000 imaging studies a year. They are in the process of reducing their print load and are now down to about 3,000 a month, primarily provided to referring physicians. They use their Kodak printers (they have two 8700s and two new 8900s) for all modalities including CT, MRI, nuclear medicine and CR.

Their 8900s are in the primary radiology department with one in the main control area and the other in the film file room where it gets particularly heavy use. They have found these systems to be extremely reliable despite heavy usage. “It is easier when you run two printers, because if there is a long CT case, you can use both printers for efficiency,” he says.

Held notes they have found the sorters on these printers to be a vital option from the standpoint of efficiency. The printer sorts images by modality so when a professional is looking for a study, he or she only has to look in one bin.

While they print everything on the same size film (14X17), the printer is capable of using three different sized films in each of the three drawers.


Reliability is a key issue

Given that printing studies could serve as a bottleneck to a busy practice if the printer were to be unreliable, finding an imager to meet their needs was important to Paul Hagen, CEO of Sharp & Children’s MRI Center in San Diego, Calif.

He selected the Sony FilmStation to print their 1,600 MRI studies each month. They average about 7,500 sheets of film per month on the printer, which they have found to be very reliable with few “jams.” Besides that important operational aspect, Hagen appreciates the compact configuration of this printer because floor and shelf space is at a premium in their center and FilmStation offers either horizontal or vertical configuration for installation.

The economics are important in this era of cost containment in healthcare. Using Sony blue thermal film, Hagan has experienced a 30 percent reduction in the cost of films and calculates that he will pay for the machine over three and a half months.

Finally, their center is connected to two hospitals and each uses a different PACS. The FilmStation has proven compatible with all networks in the system. 


Conclusion

It’s impossible to overestimate the importance of laser imagers in busy imaging departments. They serve as a vital link to provide images to referring physicians and specialists when only hard copy will do. The requirements are great: excellence in image quality, reliability of the system regardless of demands, versatility of system capabilities within economic boundaries. Finding the right laser imager for a given practice may take some time, but will prove well worth the effort.