Why do images like the fall of the Berlin Wall in 1989 become iconic? Is it because the idea of ‘bringing down borders’ resonates with all of us, as a chance to free our minds, our possibilities and potential? Boundaries and borders keep us apart and separate, when human development requires collaboration and sharing.
Healthcare also benefits from eliminating boundaries. Interoperability across hospital departments improves efficiency and productivity. Accessibility to patient information and collaboration between physicians lead to well-informed decisions and better patient care. This is why Agfa HealthCare is so committed to eliminating the boundaries in imaging; from providing high-quality images with excellent detail, to offering universal image and data sharing across departmental, facility, regional and technical boundaries. But the Berlin wall didn’t fall in a day, nor was it the work of just a few individuals.
Bringing boundaries down takes hard work, dedication and co-operation. We work with healthcare organizations around the world to remove unnecessary boundaries to image and data sharing and create access throughout the care continuum. We also support organizations such as Doctors Without Borders, which shares our commitment to making healthcare available to everyone who needs it – no matter where they are.
Evolutions in digital imaging have allowed great strides in diagnosis and patient care, and promise even more. What’s more, it is clear that over the next years, more and more images will come from outside radiology. These evolutions must be managed, and clinical workflows are needed to acquire, distribute and view disparate images and information. Our Enterprise Imaging solutions aim to take the data out of the silos and make it accessible.
In the end, images like the fall of the Berlin Wall speak to us as messages of hope, reminding us of what we can achieve together when we refuse to be limited by artificial boundaries and borders. And once these are gone, just imagine the boundless achievements that we can realize!
4 Blurred lines Max Rosen, Professor and Chair of Radiology at UMass Medical Centre, Worcester, explains how networks, accountability and technology are drawing imaging communities closer together
6 One VisiOn Kate Parkes, Radiology Clinical Systems Manager at Birmingham’s Children’s Hospital, explains how its installation of Agfa HealthCare’s ICIS View is the latest step on its path to the ultimate goal of having every image and report on one service
8 Brazilian hOspital sees prOductiVity take Off with iMpaX agility Chosen as a pilot site for this newest IMPAX solution, IGESP in São Paulo reaps the rewards of a completely unified imaging approach
12 a clear VisiOn fOr the future Of enterprise iMaging Michael Green, President and CEO of the Americas, Agfa HealthCare
16 dX-d retrOfit deliVers eXcellent iMaging and an enhanced patient eXperience Radiologie Wittlich details how the DX-D Retrofit delivers seamless integration in clinical processes and supports radiology assistants in managing time and tasks
18 digitally transfOrMing a histOric siBerian trauMa hOspital Irkutsk Institute of Traumatology and Orthopaedics improves diagnosis, patient care and workflow with broad range of digital solutions
22 iMpaX agility is My Office and i take it anywhere i want tO wOrk Integrated solution takes Sint-Rembert radiologists closer to clinicians’ therapeutic decision-making
24 winds Of change Chris Belmont, CIO of Ochsner Health Systems in New Orleans, explains how a combination of Hurricane Katrina and US health care reforms have put Agfa HealthCare’s ICIS solution to the test
28 fOcused On a digital future Sonya McKittrick, Greenville Health System’s ER coordinator explains how DX-D Retrofit is helping deliver time savings, and a high level of image quality and speed that makes it popular with users
30 technOlOgy cOrner Next generation MUSICA
32 reach fOr the stars Agfa HealthCare’s DR solutions deliver dose reduction potential to the children of New Zealand
36 anOther Brick in the digital wall fOr Multi-site hOspital ICIS View brings images and users closer together
38 frOM sMall acOrns Big trees grOw Susan Boulanger, Director of Imaging Services at Signature Healthcare in Brockton, explains how replacements to its 25+ year old technology have been heavily influenced by its trial of Agfa HealthCare’s DX-D 100 mobile solution
On the cover of this edition of THERE magazine:In 1989, radical political change in the Eastern Bloc led to the announcement that after years of physical division, all GDR citizens could visit West Germany and West Berlin. The Berlin Wall, one of the most potent symbols of the Iron Curtain, had finally fallen, leading to the reunification of Germany.
November 2013 Edition 15
Healthcare transformation, we’ll take you...
Bringing boundaries down
Marc De Fré
Director Marketing Communications
THERE 54 THERE
How networks, accountability and technology are drawing imaging communities closer together.
Is the world of imaging getting smaller or larger? How does evolving technology fit into an increasingly cost-conscious healthcare sector? Are private practices, community hospitals and academic centers colleagues or competitors? For Dr. Max Rosen, Professor and Chair of Radiology at UMass Memorial, these are questions that no longer have clear-cut answers, yet must absolutely be answered.
We had the opportunity to speak with Dr. Rosen, as he shared his perceptions of the future of imaging within the continuum of care. He explained how evolving technology has pushed healthcare providers to connect more closely with each other and the community, while also providing the solutions needed to support that collaboration.
Effective use of technology meets needs of increasingly cost-conscious healthcare sector “Over the past 20-30 years, we’ve seen enormous growth and innovation in imaging technology. But it’s been a very expensive evolution: the cost of imaging is becoming prohibitive. In parallel, the economic healthcare model has significantly changed. In the past, health insurance paid the imaging bills that were submitted, and the risk of unnecessary radiation wasn’t yet a topic of concern. When a patient was sent to a tertiary facility from a community site, we would often redo imaging already performed in the community.
“The situation is different today in many ways. Improvements in the technology mean that most community hospitals have the equipment to do high quality and sophisticated imaging. The result is that there isn’t always a clinical need to redo images when a patient is sent to a tertiary facility.
“Our challenge now is to find ways to make the most effective and cost-efficient use of the technology we have. It’s a challenge that requires new ways of working by pretty much everyone along the continuum of care.
In profile
Collaboration and networks improve the continuum of care
“Hospitals are forming networks that combine academic and community practices. Consider UMass Memorial: we have our academic department based at two hospitals in Worcester; and our health care system owns four community hospitals staffed by three private practice groups; plus we have our referring physicians from the community.
“Instead of a competitive relationship, properly constructed networks can facilitate a smoother workflow for everyone. In an ideal world, if one site (either academic or community) had too much work on a given day, the work could be spread across affiliated radiologists in the system, ensuring faster exam turn-around time. In addition, tertiary care hospitals are now interested in lowering the cost of outpatient imaging by moving it out of the tertiary care facility into the community.”
How enterprise imaging brings together imaging producers, consumers and patients
“For an integrated system to function smoothly, you need a seamless way to share images and data and to manage workflow, both within each hospital, and between affiliated sites, referring physicians and even patients. A vendor neutral archive (VNA) can group together each patient’s images from multiple sites, while other software can pull and consolidate the relevant clinical information from multiple databases. The radiologist shouldn’t have to hunt for images on multiple PACS systems or for relevant clinical information among multiple databases.
Our challenge now is to find ways to make the most effective and cost-efficient use of the technology we have. It’s a challenge that requires new ways of working by pretty much everyone along the continuum of care.”
“Dashboards should allow you to track an exam’s status, every step of the way. In between the time when the exam is ordered, the report is signed and the charge is sent to the insurer and/or patient, I want to be able to track the imaging study at each step of the process. Systems like this will help us achieve the goal of improving efficiency throughout the hospital and across departments. Use of automated systems, such as critical results reporting, can also help make radiologists more efficient. Imagine, for example, that every day each of UMass Memorial’s 40 radiologists spends one hour doing tasks that could be automated. That’s a total of 40 work hours: the equivalent of a week’s work for one radiologist. Finding answers in a commoditized healthcare market
“Hospitals are being held more accountable for the procedures they do and the costs they charge. One way this is being achieved is through the accountable care organization, or ACO. By fixing a cost amount for a patient’s care, there is no longer a financial incentive for additional imaging. Physicians must consider how additional imaging would impact the patient’s overall care. Of course, one of the necessities to do this successfully is to have good data – including performance measurements – and again good data sharing! In addition, patients are more price conscious and can now shop around for the non-emergency services they need, such as an outpatient MRI for back pain. They are involving themselves directly in their health care choices, and forcing the hospitals to respond.
“How hospitals interact and communicate with their patients is now more important than ever. I can schedule an appointment to have my car fixed on the internet; why can’t I schedule an appointment with my doctor? If hospitals are providing a service, they must act as service providers. This is what patients expect today.”
Biography
Graduating from Tufts University School of Medicine in 1986, Dr. Max Rosen completed a residency in diagnostic radiology at Boston Medical Center, followed by a fellowship in vascular and interventional radiology at Massachusetts General Hospital. He received his Master’s degree in public health from Harvard School of Public Health in 1999.
At Beth Israel Deaconess Medical Center Department of Radiology, he was actively involved in preparing the department for the development of accountable care organizations (ACOs). He was also responsible for expanding the community network for the department to optimize access, volume and revenue.
Dr. Rosen’s academic and research interests focus on the cost-effectiveness of medical imaging and the measurement of clinical outcomes.
Dr. Max Rosen Professor and Chair of Radiology at UMass Memorial Medical Center, Worcester, USA
Worcester, USA
Blurred lines
THERE 76 THERE
One Vision Kate Parkes, Radiology Clinical Systems Manager at Birmingham’s Children’s Hospital, explains how its installation of Agfa HealthCare’s ICIS View is the latest step on its path to the ultimate goal of having every image and report on one service.
The Trust’s vision has always been to have a hospital without walls, and while our consultants have always been able to have access from home via a VPN, they had to go into different systems to source different types of imaging and results. With Agfa HealthCare’s ICIS View that has been gradually changing.
“Birmingham Children’s Hospital has a history as an early adopter of new IT technology,” explains Kate Parkes. “As one of the first hospitals in the UK to adopt a full PACS system – as early as March 2003 we were completely digital – we are no strangers to using the latest technologies to enhance patient care and safety".
Birmingham Children's is one of the leading pediatric specialist hospitals in the UK, providing world-class health services for children and young people from Birmingham, the West Midlands and beyond. Specialist services include liver transplant surgery, cardiac surgery, epilepsy surgery, burns, major trauma, craniofacial surgery, blood and marrow transplantation, specialized respiratory and dermatology, neurology and cystic fibrosis and consultants frequently hold outreach clinics in the surrounding area.
Developing a hospital without walls “The Trust’s vision has always been to have a hospital without walls, and while our consultants have always been able to have access from home via a VPN, they had to go into different systems to source different types of imaging and results. With Agfa HealthCare’s ICIS View that has been gradually changing.”
Images can be seen anywhere in the hospital
“ICIS View was being launched at around the time that we were looking to install a solution that would allow us to show our really large laparoscopic videos without impacting on the performance of the Trust’s intranet as well. In addition, for studies such as endoscopy and laparoscopy, historically a lot of the information was stored on DVDs and it was often difficult to find the disc to review as there was no central store. There was a similar issue with ECG and pacemakers information; the reports were filed in the patients’ records or in a folder in the cardiac unit. Now they can be seen anywhere around the hospital. ”
Access to ICIS View has also had a fundamental impact on planning patient care says Kate Parkes. “It makes sure that when a child is seen by a multidisciplinary team (MDT), often with many specialties present, or when they are being discussed at the MDT meetings – which can often be as important as seeing the child – it is so much easier to flow all of the information through one service rather than having to keep switching between different systems.”
ICIS View also makes interaction with the patients and their parents easier ICIS View also makes interaction with the patients and their parents easier through its use of tablets. “We are rolling out ICIS View on Apple iPad mobile digital devices at the moment, and although this is still quite new it is definitely proving popular with the kids,” says Kate Parkes. “Children are very visual and they like looking at images on an iPad as it is familiar to them. If they can see something, then they can understand it, and children like to look at their images and see exactly what is what. They don’t have the fear that adults do and they are very inquisitive generally.
Real time images save time
“Also, it is a little bit more private than having it on a computer in the middle of the ward. The iPad can be taken to the bedside and while some parents obviously don’t want to see, anything that can help the child understand and be comfortable helps the parents. They can physically see changes and see improvements – or occasionally not – and it is all in real time. So, for instance, in the renal clinic or the liver clinic, they have their ultrasound and then they go back to clinic and get their results there and then. It means
children don’t have to come back for reports and follow up appointments and so saves time.”
As with any implementation of new technology, “there is a learning curve and often when you are the first to do something, there are teething problems,” admits Kate Parkes. “But, you also reap the benefits, especially if, as in our case, you have been involved in the Beta testing. We have had a say in how it looks, how it feels and how it works. And, as far as I know, we are the only site in the world that is running ClinApps*, a 3D software, on ICIS View and that has gone down really well with the clinicians here.
Our goal is all images and results from one source
“Our aim for our five-year plan is to pull all of our images into one source and then, following that, the results. We are still working with departments that haven’t worked with PACS before because they have never been required to – departments such as opthalmology and the respiratory department. It has been a huge learning curve as the departments have to follow very strict workflow and in some cases, like the heart investigation unit, they have had to change their entire workflow and how they interact. But our staff is very supportive of the changes and PUG, our PACS user group, enables them to make requests for developing additional functionality. We have pretty much developed PACS as far as we can without a vendor neutral archive but, hopefully, that is on the horizon as we have a bid into Government for funding to help make that happen. I am confident that when we are ready, the solution will be there.”Kate Parkes
Radiology Clinical Systems Manager
Birmingham, UK
Kate ParkesRadiology Clinical Systems Manager
THERE 98 THERE
Brazilian hospital sees productivity take off with IMPAX Agility Chosen as a pilot site for this newest IMPAX solution, IGESP in São Paulo reaps the rewards of a completely unified imaging approach.
21st century demands require 21st century technology
Since it was first founded in 1956, the IGESP hospital in São Paulo, Brazil, has experienced impressive growth. Two major restructuring projects have included the recent completion of two new buildings. Along with the hospital’s physical growth came increased patient throughput and greater complexity of cases referred to its doctors. “The patient profile has changed over the years, driving us to broaden our investments in new technologies,” explains Dr. Alcides Terrível, Vice President of IGESP.
The hospital carries out some 80,000 imaging exams each year, and requires a well-built and efficient system to support the enormous amount of data. So when the hospital was invited by Agfa HealthCare to join in a partnership program and become a pilot site for the new IMPAX Agility solution, they didn’t hesitate. “Our constant expansion has made it a natural necessity to implement a robust image and data management platform,” continues Dr. Terrível. “We already had an Agfa HealthCare computed radiography solution, and were very satisfied with it. Some of our staff also had experience with IMPAX RIS/PACS solutions in other hospitals. All of this, together with the proposed partnership, was decisive in our choice to implement IMPAX Agility.”
IMPAX Agility is the newest IMPAX solution. Its new and unique approach to imaging and data management delivers a completely unified imaging platform that provides PACS, reporting, advanced image processing and integration of clinical information all in one sophisticated solution. Text entry, digital dictation, transcription and speech capabilities are fully embedded for a seamless workflow, decreased complexity and increased productivity. Built based on observations of how radiologists work, it offers a highly intuitive user interface, for even greater productivity gains.
“A complete and radical change” towards greater productivity
For IGESP, the advantages of the solution were felt almost immediately, says radiologist Dr. Alexandre Oksman. “Before IMPAX Agility, reports had to be transcribed, corrected and only then signed. Now all of these processes are done at once. It has been a complete and radical change. What’s more, radiologists had to use two separate applications for visualizing images and writing reports. So the new, integrated structure has brought unprecedented agility to our hospital’s workflow!”
Dr. Terrível struggles to pick the single aspect he finds most useful in the solution: “I must say I am extremely pleased with everything, from the image visualization tools to the fantastic voice recognition, which allows a faster turnaround. With the electronic signature, reports are instantly available for the patients, who are our main focus of attention.”
From a radiologist’s point of view, Dr. Oksman is also excited about what has been achieved with IMPAX Agility: “The system allows us to integrate image visualization, report creation and image storage. With the worklists we can track the patient’s procedures and submit exams to specific radiologists, for a much more efficient – yet secure and targeted – flow of reports amongst the specialists. In fact, IMPAX Agility has completely fulfilled our expectations.”
The system has completely fulfilled our expectations, allowing us to integrate image visualization, report creation and image storage. Dr. Alexandre OksmanRadiologist
With the electronic signature, reports are instantly available for the patients, who are our main focus of attention. Dr. Alcides TerrívelVice President
Dr. Alcides TerrívelVice President
São Paulo, Brazil
THERE 1110 THERE
The implementation process was also extremely successful. Using a detailed pre-implementation plan, the Agfa HealthCare team reduced the completion time from six months to only two months. “We were able to continue our normal activities, and all of our staff’s questions about the new system were resolved during the initial training by the Agfa HealthCare staff,” says Dr. Terrível. “The technology is so intuitive,” he adds, “that newly-hired staff are being trained by their peers.” System updates, which currently happen once every three months on average, are fast and smooth, and don’t affect everyday tasks. “Plus, they usually take place during the very early hours of the day, when any disruption would be minimal,” Dr. Oksman reports.
Supporting growth and reducing costs
In terms of efficiency, Dr. Oksman emphasizes the positive impact of the comparative analysis enabled by the platform, which allows the user to gather more information from exams and consequently improves the quality of the reports. Financially, Dr. Terrível highlights a reduction in typing tasks in the hospital, higher radiologist productivity and cost savings in paper due to the significantly fewer corrections.
Both doctors agree the partnership with Agfa HealthCare has been extremely fruitful, defining it as an investment that has brought an excellent return. Dr. Terrível further believes this relationship has led the hospital management team to re-evaluate its growth strategies, especially regarding new technologies. “We are proud to be one of the hospitals chosen to validate the IMPAX Agility solution in South America,” he concludes.
We recommend Agfa HealthCare not only for its reliability and expertise in process execution, but for its
readiness to be a great partner. Dr. Alcides Terrível
Vice President
A united vision delivers maximum results
IMPAX Agility
• Unifies RIS, PACS, Reporting, 3D, Connectivity and Clinical Applications
• Uses a single data model to provide a seamless system offering relevant and varied clinical data in one platform
• Supports Agfa HealthCare’s vision of image management across healthcare functions
• Easily adds new applications like special visualization or MIP/MPR/3D
• Fully standards-based design (IHE, HL7 and DICOM) for integration into existing healthcare systems
Agfa HealthCare’s contribution A new, intuitive and unique RIS/PACS/ Reporting solution that helps improve the delivery of care.
• A completely unified solution designed to achieve clinical productivity and optimize total cost of ownership.
• Fast, trouble-free installation based on a comprehensive pre-implementation plan, that didn’t interfere with normal hospital functioning.
A Clear Vision for the Future of Enterprise Imaging In this article, Michael, President and CEO of the Americas, talks about the many changes he has witnessed, the biggest challenges CEOs and CIOs are facing right now, and how Agfa HealthCare is uniquely positioned to help them meet their ever-evolving enterprise imaging priorities.
When Michael Green first joined Agfa HealthCare 16 years ago, the imaging and IT landscape looked very different than it does today. Back then, 90% of healthcare organizations were still using film to capture diagnostic images, with the early adopters implementing picture archiving and communication systems (PACS). Fast forward to today and virtually all acute care hospitals in North America have PACS in place, with the majority of hospitals in Latin America only a few years behind. As these PACS implementations matured, radiologists remained key decision makers, but the management responsibility migrated to the IT department.
Imaging extends beyond radiology
“Hospitals with PACS generate huge volumes of images that need to be securely managed and stored,” explains Green. “The IT department has to take privacy and disaster recovery into consideration. When new systems are put into the hospital, they are tasked with migrating these massive image repositories. All of this can be very expensive and time consuming.”
Adding to this complexity is the fact that radiology is no longer the only department in the hospital generating images. Nearly every clinical discipline that a patient interacts with today has some form of imaging associated with it, from cardiology and women’s health, to dermatology, pathology and beyond. And clinicians across the healthcare enterprise want access to this steady stream of images. This reality is driving Chief Executive Officers (CEOs) and Chief Information Officers (CIOs) across North America to look at building the infrastructure to support information and image sharing across the enterprise.
Differing priorities drive strategies
“Meaningful Use is really driving a lot of healthcare IT strategies in the United States right now,” says Green. “The first phase of the regulation centered around a textual-based EHR. In stages two and three, imaging plays a much larger role. Complying with Meaningful Use means finding a way to incorporate images into the EHR.”
For smaller hospitals in the US, it can be challenging to find the funds to invest in large IT projects like building an EHR. This is fuelling a trend towards creating larger hospital groups that can share resources. In some cases, these hospital groups are also merging to benefit from the economies of scale.
In Canada, where universal healthcare has the provinces acting as single payers and providers for their entire population, this merging into groups has already happened to a large extent, in order to manage the system more efficiently and encourage collaboration.
“There is a move to have ‘centers of excellence’ where patients will visit one hospital for cancer treatment, another for cardiac care, another for childbirth, and so on,” says Green. “In such a system, it’s important for physicians at those hospitals to be able to share patient information and clinical images with one another in a streamlined way, in order to avoid duplicate imaging and deliver the most efficient, informed care.”
Green continues, “In Latin America, the larger hospitals are also looking at how to build efficiencies within their enterprise imaging. Over the next two or three years, once more of the smaller hospitals have their PACS systems in place, we expect that they will turn their attention towards how to expand their imaging capabilities in order to maximize the advantages.”
They are coming to realize that incorporating images into the EHR at an early stage is going to provide a much stronger return on investment than adding them later down the line.
We have the ability to connect up the site and the technology to display all images in the context of the EHR in a completely seamless way.
In profileMichael Green • President and CEO of the Americas, Agfa HealthCare
The Americas
THERE 1514 THERE
ICIS empowers an image-enabled EHR now
Anticipating this need, Agfa HealthCare has created a solution to link the variety of images from multiple departments across the enterprise into the EHR so that when a physician pulls up a patient’s record they have a complete clinical picture of the patient, with images and text all in one place. The Imaging Clinical Information System, or ICIS, has the power to provide a true enterprise-wide view of all imaging, no matter where or how it was generated.
“The great thing about ICIS is that it’s vendor neutral,” says Green. “So if a hospital is running unique PACS vendors in different departments, they don’t have to go in and make a huge investment replacing systems. ICIS can integrate all of the images, even those that don’t follow DICOM standards, in a central archive so that physicians can access them in the context of a patient’s entire medical record. They see the right image appearing in the context of the right patient record, exactly when and where they need it.
“Nobody else in the market has a solution like ICIS,” says Green. “Getting images from the multitude of systems in a hospital is very complex and, to be honest, not every company has the
experience and capability to do it. Other companies may be able to offer an image archive or a viewer, but we have both. We have the ability to connect up the site and the technology to display all images in the context of the EHR in a completely seamless way.” Forging value-added partnerships With so many healthcare organizations looking at building an image-enabled EHR, Agfa HealthCare has entered into a unique partnership with the Cleveland Clinic to make the process easier. MyPractice Imaging Services is a consulting service designed to help hospitals come up with a solid strategy for their enterprise imaging.
“The Cleveland Clinic has world-recognized clinical expertise and leadership in the application of integrated technologies in medical practice,” says Green. “We augment that with our advanced image management systems and technical support. The idea is that, together, we can help healthcare provider organizations maximize the value of their EHR investment.”
Another way that Agfa HealthCare is helping hospitals to manage their costs is in the area of IT solution management. Through a partnership with Dell™ in the U.S. they are offering a cloud-based
We purposely designed our Managed and Cloud Services so that any size of organization can take advantage of them
Image Archiving and Viewing service that allows customers to pay for each image as it is stored. Similarly, Agfa HealthCare’s PACS as a Service solution lets customers enjoy all the functionality of a market-leading radiology PACS without the major infrastructure investments.
“We purposely designed our Managed and Cloud Services so that any size of organization can take advantage of them,” explains Green. “Smaller organizations that don’t have the large IT departments are freed from investing in additional on-site technical resources. Large organizations can avoid making big hardware investments and taking up valuable clinical space with in-house data centers. By empowering these organizations to run in the Cloud, we are giving them business continuity, operational savings and complete peace of mind, thanks to built-in redundancy and disaster recovery.”
Unparalleled expertise in both imaging and IT
As enterprise imaging continues to change and grow, Agfa HealthCare is committed to staying one step ahead, anticipating which tools physicians need to provide comprehensive care to their patients, and which strategies CEOs and CIOs will follow to run their organizations as efficiently as possible. “Agfa HealthCare is the physician’s imaging partner. Wherever enterprise imaging has a role to play, we will be there,” says Green.
“There are other companies in this market that have IT solutions to offer, but they don’t have imaging embedded deeply in their DNA like we do,” says Green. “We’re experts in both the IT side and the imaging side of the business. We provide smooth workflow that keeps physicians focused on their patients. We have a long history of integrating our technology with any IT system and we are very experienced in presenting images to physicians in the format that they want to see them to make fast, accurate diagnoses. Whenever and however the needs of healthcare imaging and IT evolve, we are ready to get our customers where they need to go.”
Nobody else in the market has a solution like ICIS. Getting images from the multitude of systems in a hospital is very complex and, to be honest, not every company has the experience and capability to do it. Other companies may be able to offer an image archive or a viewer, but we have both. We have the ability to connect up the site and the technology to display all images in the context of the EHR in a completely seamless way.
THERE 1716 THERE
DX-D Retrofit delivers excellent imaging and an enhanced patient experience Wireless detector seamlessly integrates in clinical processes and supports the radiology assistants in managing their time and tasks.
More and more small and medium-sized hospitals are handing over the running of their radiology departments to independent radiology services. Radiologie Wittlich handles the radiology departments of the St. Elisabeth's Hospital in Wittlich, the Cusanus Hospital in Bernkastel-Kues, and the Maria Hilf Hospital in Daun. "We perform around 50,000 X-rays each year for inpatients and outpatients at St. Elisabeth's Hospital alone," explains Dr. Dirk Lommel.
In 2006, when re-equipping the practice, Dr. Lommel and his three colleagues at Radiologie Wittlich first considered implementing DR technology, "But we needed a solution for both intensive care and pediatric intensive care. So at that point we opted for Agfa HealthCare’s CR solutions. We knew, though, that in our next investment phase we would switch to DR."
Easy to install and get to grips with
The requirements for the DR system were clear: it had to be easy to integrate in the existing X-ray facility and offer very high image quality. Satisfied with their experience with Agfa HealthCare’s CR solutions,the practice selected the DX-D Retrofit with the wireless cesium iodide flat panel detector in cassette format, which offered impressive functionality and good value for money.
Implemented in September 2012, the DX-D Retrofit links to the IT network by WLAN and digitizes the existing Bucky table and wall stand with state-of-the-art DR technology. "The installation went very smoothly and we were able to integrate the system quickly and without problems," says Practice Manager and Chief IT Administrator Michael Lüpke.
Fast and flexible imaging, reliable diagnostics
The new solution has made a big impact for the radiology assistants, who find it straightforward to use, especially as it has the same user interface as the CR system.
DX-D Retrofit opens up a whole new world in radiology. The image quality is more brilliant. This helps enormously and results in a confident diagnosis
Dr. Dirk Lommel Radiologie Wittlich
DX-D Retrofit • Excellent image quality
• Improved patient experience
• Quick and easy to install
• Connection to RIS/PACS
They were also amazed by its speed, comments Chief Radiology Assistant Christa Martini. "Reading a CR imaging plate takes around two minutes. The DR detector takes seconds. We also save the time spent going back and forth to the digitizer.”
The time savings make an especially noticeable impact during on-call hours, says Dr. Lommel. "Weekends, we handle as many as 150 examinations. The duty staff member has to take care of the RIS administration, job processing and activity input alone. With the DX-D Retrofit detector system, the radiology assistants can manage their time more effectively."
“This also lets us enhance the patient’s experience, because when staff is more relaxed and has more time for the patient, it creates a better atmosphere,” concludes Christa Martini.
Wittlich, Germany
This lets us enhance the patient’s experience, because when staff is more relaxed and has more time for the
patient, it creates a better atmosphere Christa Martini
Chief Radiology Assistant, Radiologie Wittlich
Did you know... • The hospital in Wittlich offers a very wide range of services. All specialisms are covered, from gynecology, internal medicine, and gastroenterology to vascular, visceral, and thoracic surgery.
• Radiologie Wittlich operates three practices in different regions: St. Elisabeth’s Hospital, the Cusanus Hospital in Bernkastel-Kues, and the Maria Hilf Hospital in Daun.
THERE 1918 THERE
The cold and remote region of Siberia carries with it its own health challenges, many of which are addressed by the Irkutsk Institute of Traumatology and Orthopaedics. “The main challenges faced by our hospital are injuries and both congenital and acquired musculoskeletal abnormalities,” explains Nadezhda Pozdeyeva, Head of the Radiology Department. Over the past few years, the hospital has been transforming its radiology department by implementing a full series of Agfa HealthCare digital solutions. The goals of the project are to obtain more informative images, reduce radiation exposure to patients and staff, and improve the quality of diagnoses.
“Our region is experiencing some pretty disheartening trends towards increases in injuries and musculoskeletal problems,” continues Dr. Pozdeyeva. “It’s directly related to the life here: car accidents, workplace injuries and illnesses, and even icy footpaths – all play a role in increasing the number of injuries we see.” At the same time, fewer young people are being attracted to the medical profession, she says. The Russian Ministry of Health has also published requirements regarding the implementation of digital technology. All these factors contributed to a growing awareness within the Institute for the need to find solutions to improve the efficiency and effectiveness of the radiology department, by implementing advanced and modern digital imaging technologies.
Value for money, reliability, functionality, service & support
The Institute considered a number of companies, attending various conferences on radiology and imaging. “We had no experience of working with digital systems, but we were very willing to learn,” explains radiologist Juliana Pichugina. “There was a range of requirements for the new systems: the best value for money, reliability and functionality, and availability of service and support.” The hospital chose to acquire several direct (DR) and computed (CR) radiography solutions: the DX-D 300, DX-D 100 and DX-D 400, which is combined with a DX-G CR digitizer, for greater versatility.
A family of DR solutions to meet wide-ranging needs
The DX-D 100 is a mobile DR system that can be operated with one finger, yet provides high-quality images. “We use it in the trauma operating room, in order to check during operations that bone fragments match and to precisely position fixing and holding mechanisms. It also transmits the images directly to the desktops of physicians for diagnosis and archiving, via the Wi-Fi router we installed in the operating room.
The hospital uses the DX-D 300 multifunctional, fixed U-shaped DR system with the full leg full spine (FLFS) option to provide digital images of the lower limbs and spine. “This is especially convenient for planning surgery procedures using the IMPAX Orthopaedic Tools,” explains Dr. Pozdeyeva. “The DX-D 300 offers us a rich functionality, and we can use it with a gurney, which allows us to examine bedridden patients.”
For heavier patients, the universal DX-D 400 system has an elevating table that can be lowered to 50 cm above the floor, reducing the strain on the medical staff. “The speed to get the image on the screen is impressive – just 13 seconds. This is especially important when you understand that we need to perform multi-dimension images for each trauma patient,” Dr. Pozdeyeva highlights. The exam-independent, gold-standard MUSICA image processing software provides very high quality images, automatically analyzing the characteristics of each image and optimizing processing. “And using needle detectors for certain examinations also provides significant radiation dose reduction for the patients,” Dr. Pozdeyeva adds.
Image management suite with specialized tools for orthopaedics
The hospital also implemented the IMPAX SE suite with IMPAX Orthopaedic Tools, which is used to apply digital templates and to complete measurements in preparation for orthopaedic surgery. The SE suite is ideal for taking small enterprises from analog to digital. It offers a modular design that enables the manipulation, management and centralization of medical imaging data. A complete solution from the moment it is implemented, it requires no additional upgrades, making it a very cost-effective solution.
Digitally transforming a historic Siberian trauma hospital Irkutsk Institute of Traumatology and Orthopaedics improves diagnosis, patient care and workflow with broad range of digital solutions.
The speed to get the image on the screen is impressive – just 13 seconds. This is especially important when you understand that we need to perform multi-dimension images for each trauma patient.”
Dr. Nadezhda Pozdeyeva, Head of the Radiology Department
Our experience cooperating with Agfa HealthCare can be
characterized by: information availability, reliability and
responsibility.
Irkutsk, Russia
THERE 2120 THERE
A ‘historic’ installation
The implementation team faced a further unusual challenge: “The hospital building is a historic monument of the city of Irkutsk,” explains Dr. Pozdeyeva. “On the one hand, this meant we needed to preserve the building’s appearance as much as possible. But on the other hand, the engineering was extremely outdated. So before the installation, we carried out a complete check of the sub-floors, electric networks heating and water supply systems. These were then aligned with the requirements for the equipment installation. In a new building, of course, these modern requirements would be built in, so there would be no delay or additional costs.”
In addition, the implementation team had to ensure that the hospital and its patients were not impacted during the installations. By installing the DX-G digitizer for temporary use, the hospital could already carry out the necessary studies in digital format, using the wards’ X-ray machines. And despite these challenges, the team implemented all of the solutions in accordance with the delivery schedule.
“Together, these solutions have significantly enhanced our ability to diagnose, to plan operations and to transmit and store data in the network,” concludes Dr. Pozdeyeva. “Furthermore, our experience cooperating with Agfa HealthCare can be characterized by: information availability, reliability and responsibility.”
DX-D 400• Floor-mounted, for cost-effective and easy installation and use.
• Best-of-breed solid components, offering reliability and maximum uptime.
• Specially-tuned MUSICA, for gold-standard image processing, and NX workstation, for smoother workflow.
• Flexible configurations and options for every need.
• Can be combined with our CR systems, for even greater versatility.
Did you know... • The Irkutsk Institute of Traumatology and Orthopaedics was established in March 1946 to handle reconstructive surgery, traumatology and orthopaedics. Patients from the Second World War were treated within the institution. It is the only hospital specializing in traumatology and orthopaedics in Siberia and the Russian Far East.
Agfa HealthCare’s contribution• Close cooperation with hospital administration, physicians and technical service, as well as city authorities, to ensure that the stringent preparations were properly carried out.
• Delivery and installation of all equipment and solutions in accordance with the delivery schedule.
• Creative solutions to challenges such as the use of the DX-G during implementation to allow the hospital’s regular work to go on.
• An active role in the preparation of the rooms, acting in a coordinated way during equipment delivery and installation.
DX-D 300• Universal, flexible and affordable modality combining a single detector and fully motorized positioning, which increases productivity
• U-arm allowing lateral ‘cross table’ exams on rolling tables, for a number of configurations and increased patient and technologist comfort.
• Specially-tuned MUSICA, for gold-standard image processing, and NX workstation, for smoother workflow.
• Cesium Iodide DR detector technology offering potential for significant patient dose reduction.
• Complete versatility with optional CR/DR combination
The Radiology Team
These solutions have significantly enhanced our ability to diagnose, to
plan operations and to transmit and store data in the network.
Nadezhda Pozdeyeva, Head of the Radiology Department
The interface’s starting point is the powerful concept of hanging protocols. This determines how you see images from different modalities at the same time. “The combination of connected axial, coronal and sagittal planes constitutes a 3D view of the body from any perspective I want. Because all images are displayed according to preset hanging protocols, it provides a familiar way of looking at results to begin dictation.” Reporting macros avoid omissions, even if interrupted during reporting
“I can see the scanned original examination request form and use report macros that adapt as I complete the diagnosis. The macros considerably speed up reporting, helping to avoid omissions, even if I’m interrupted when reporting. During reporting, I tag key images that will form the basis of the image set which is provided to the referring doctor or clinician. If I need to add supportive viewpoints from external sources, the integrated internet browser takes me to any source I want. I can then simply add files or links to my report. This is my office and I can easily take it anywhere to continue working with Sint-Rembert’s server over a VPN connection.”
Radiologists now considered a sounding board for clinician’s diagnosis and therapy
The faster reporting speed and image support provided to clinicians has changed their working relationship with radiologists, underscores Dr. Biebau. With all images at hand, as well as those coming from the clinician’s modality, the radiologist is able to interpret images from a more holistic clinical perspective. As a result, he is more routinely asked to explain his view on certain studies with his knowledge of images from other modalities. “With IMPAX Agility at hand, we are more often considered a sounding board in support of the clinician’s therapeutic decision-making.”
Dr. Biebau has been working with Agfa HealthCare for many years, and this relationship lets his department keep abreast of the fast technology evolution in medical imaging. “It has enabled us to improve our service and increase productivity. With IMPAX Agility we can cope with the challenge of increasingly complex imaging and software developments, such as cardio- or angio-CT, which can be easily integrated. We are convinced Agfa HealthCare will be our partner on our path to the future of medical imaging.”
Did you know... • With four radiologists, Sint-Rembert hospital’s radiology department reported on 60,000 examinations in 2011.
• Saint Rimbert, or Rembert, was archbishop of Bremen-Hamburg from 865 until his death. Rimbert is revered as the Second Apostle of the North but his efforts to christen Denmark and Sweden suffered from resistance by the Vikings.
Agfa HealthCare’s contribution A new intuitive image management solution that helps improve the delivery of care while reducing costs.
Radiologists at Belgium’s Sint-Rembert general hospital were the first to test and approve the image display, workflow management and personalized settings of Agfa HealthCare’s new IMPAX Agility solution. It passed with honors, connecting the hospital’s radiology department with medical imaging of the future.
The radiology team at Sint-Rembert, situated between two major regional hospitals at Roeselare and Bruges, is young and enthusiastic. Under the direction of Dr. Geert Biebau, Head of Radiology and Medical Director of the hospital, three radiologists have been striving to provide top-notch care to their patients. A strong focus on technological advancements is key to their ability to meet the referring clinician’s expectations. Dr. Biebau knows this technology focus also requires accepting an increasingly digital dimension to all their activities. “We have embraced the idea that up-to-date digital technology is essential to providing the best patient care and most accurate information to referring doctors and clinicians.” Dr. Biebau’s team performs examinations at
the hospital site but, for MRI, they use facilities at nearby hospitals in Bruges and at the seaside. Most modalities, such as MRI, cardio-CT and mammography, require more intense involvement by the radiologist and also stretch the performance and ergonomic demands of the underlying PACS infrastructure. “This requires pushing the boundaries of processing speed, user-friendliness and flexibility,” says Dr. Biebau. “So when Agfa HealthCare proposed our testing their new integrated IMPAX solution, called Agility, we did not hesitate.”
IMPAX Agility appeals to medical professionals thanks to integration with patient information
Having used Agfa HealthCare’s IMPAX solutions since 2009, the radiology team opted to keep both solutions operational during the trial. Because they were familiar with IMPAX, the team did not need additional training prior to using IMPAX Agility’s interface. “It was a way to test, and if necessary, adjust the interface to make it the most intuitive interface possible.” Radiologist Dr. Frederique Van Robaeys explains the intuitive interface and the power of IMPAX Agility’s integration with other relevant patient information, retrieved from the RIS, HIS, medical patient record, nomenclature and lab result server, as well as the IMPAX archive. “I get all this information from IMPAX Agility’s interface, which means I no longer need to login anywhere else or wait for other applications to open.”
IMPAX Agility is my office and I take it anywhere I want to work Integrated solution takes radiologists closer to clinician’s therapeutic decision-making.
With IMPAX Agility at hand, we are more often considered a sounding board in support of the clinician’s therapeutic decision-making Dr. Geert Biebau, Head of Radiology
Sint-Rembert, Belgium
THERE 2524 THERE
The value of consolidating all medical images into one repository “Following Katrina, several healthcare providers decided to leave the market, so we acquired a number of hospitals and grew quite aggressively in a short space of time. At the same time, our information systems and organizational structure was not suited for a big health system – one that now numbers eight hospitals and 38 clinics – so we had to come up with a workable plan very fast,” explains Chris Belmont. “Our first actions were to consolidate resources and coordinate the radiology activities across all the different entities. Luckily, we also decided to do the same thing on the information system side instead of having each hospital purchase or acquire its own PACS environment. We had already been working with Agfa HealthCare and by electing to roll radiology together we solidified our partnership. Installing Agfa HealthCare’s integrated ICIS Store allowed us to consolidate medical images into one repository.” Accessibility from a single viewer
As the first organization to install the ICIS Store, Belmont admits, “The ICIS Store platform was never an issue for us. Our main concern was with getting the right viewer. When you have images that are black and white, color, motion, static, how do you make them accessible from a single viewer? To me, having multiple viewers would have been as difficult as having multiple platforms. It took us five or six tries to get a nice light viewer that is not a technology burden but Agfa HealthCare stuck with us and did a great job of getting us to where we are now with the viewer that we have.”
It is a solution that has already delivered major benefits.
A reputation for continuity of care
“At Ochsner we really stress continuity of care. So, if you see an Ochsner physician at the clinic, get admitted, and then go back to the clinic, all of the records follow you. It has been one of the big positives for our community, our patients and our physicians as well. We reduce duplicate tests and information is available as needed – we don’t have to call across town anymore to have it sent. It is a philosophy we have built our practice on and it is really paying off, both from a quality and a performance perspective.”
Of course, it helped that Ochsner had already been working with Agfa HealthCare on rationalizing records and imaging. “We had already consolidated everything from the clinics and the hospitals – some 20 sites – so the basic foundation was there, and we didn’t have to go out and select a vendor. It was more an expansion than a brand new installation.”
Meeting the challenge of doing more with less
However, it’s not just the winds of Hurricane Katrina that have influenced Ochsner’s recent course. The increasing demands made as a result of the Affordable Care Act, as well as changes that are altering the US healthcare payment structure, increasingly require organizations to do more with less.
Installing Agfa HealthCare’s integrated ICIS Store allowed usto consolidate medical images into one repository.
In 2005, when Hurricane Katrina devastated the southern United States, Ochsner Health Systems, based in New Orleans, had already begun consolidating its hospital and clinic operations. When the hurricane left a large number of local healthcare provider’s hospitals and clinics in ruins and local communities without essential healthcare facilities, Ochsner stepped in.
Winds of change Chris Belmont, CIO of Ochsner Health Systems in New Orleans, explains how a combination of Hurricane Katrina and US Health Care reforms have put Agfa HealthCare’s ICIS solution to the test.
New Orleans, USA
THERE 2726 THERE
“Every year, little by little, we receive less reimbursement for treatment so we are having to change how we look at healthcare”, says Belmont. “We need to look at how we deliver the same services at the same level of quality, but change the delivery model. And technology is going to have a huge impact in enabling us to support that.”
Meaningful Use a major benefit
To that end, one of the major changes Ochsner made last year was to have physicians become more meaningful users of the Electronic Medical Record. “Last year was kept simple”, says Belmont. “Can they do an electronic prescription? Can they view an image? 100% of our physicians were able to achieve Meaningful Use in their first year.
“Having that technology in place is now something we can build upon. Of course, just putting technology out there is not enough. We’ve spent a lot of time with our users, understanding it. We recognize that we have to help them migrate to it and help them understand the benefits. More importantly, we have to adapt the functionality to their work flows, so we now have a dedicated team – our Physicians’ Academy – to help with that part of the program.”
Taking time pays dividends
Although well on course for completion, Belmont says, “There are still parts of our
systems not yet consolidated – we are about 90% of the way there – but that is more to do with us taking our time to prevent too much disruption. And there are difficult decisions to be made, such as how long to keep images that already go back nearly 10 years; decisions that have to balance quality of patient care with cost and performance. But, overall, I think it is working out pretty well.
ICIS Store with ICIS View - “An example of the perfect implementation” “I think ICIS Store with ICIS View is an example of the perfect implementation. It’s actually one of the applications we don’t think about a lot because it works. It’s in the background and it runs, and we feel we get the value for the costs. We don’t talk about PACS anymore. We’re not doing many problem resolutions. It’s more about a growth and optimization strategy.”
And Belmont’s advice for anyone else considering a similar solution? “Aggregating images is definitely the way we go; as is putting them on a single platform. A lot of solutions say they can do that but we have found with the Agfa HealthCare solution that it really does work. It is kind of a non-event. When we elect to put a new type of image into the archive, a few people get together, they make a few decisions and then the data starts to flow. It couldn’t be simpler.”
Patients owning their records will be the industry game changer
Ultimately, Belmont believes that the real game changer will be when it is the patients, rather than the healthcare organizations, that own their records. “We need to make it very seamless so that the owner of the medical record – the patient – can walk into an office and say, ‘here’s a link. Go and pick up my images.’ We are still a little stuck in the fact that the organizations own the records but we need to migrate to where patients own their records. I think that’s the real game changer for this industry.”
ICIS View • Enables ‘anywhere, anytime’ access to images
• Provides secure access to standard healthcare data from existing workstations anywhere on the network
• Uses any popular internet browser and modest network connection
Agfa HealthCare supports medical school launch And improvement is something that has become a watchword at Greenville, with the launch three years ago of its own independently accredited medical school – the University of South Carolina School of Medicine Greenville; an initiative supported by Agfa HealthCare. As Dr. William Hines, Clinical Assistant Professor of Radiology and a retired interventional radiologist with over 40 years’ experience explains, “We recognized that in traditional medical schools, even after four years of study, many students lack the skills necessary to quickly adapt to post-graduate residency programs. We wanted to create a learning environment where there would be early clinical exposure coupled with training in the use of the electronic medical record, and with PACS.
“South Carolina ranks 43rd out of 50 states in the number of primary care physicians per capita; a key reason for that has been the state’s lack of capacity to educate students. Thanks to the medical school’s innovative approach, and the support of Agfa HealthCare in providing its IMPAX solution to the school, all students will be proficient in their use of PACS by the time they reach their third year of study. “With this improvement in education, we hope to make a fundamental change to both the provision of care and our graduates’ understanding of the social and environmental issues that impact health and health care; after all, disease doesn’t begin in the emergency room.”
Thanks to the medical school’s innovative approach, and the support of Agfa HealthCare in providing its IMPAX solution to the school, all students will be proficient in their use of PACS by the time they reach their third year of study. Dr. William HinesClinical Assistant Professor of Radiology
As Greenville’s only 24-hour Level 1 Trauma Center, Greenville Health System, based in Greenville, South Carolina, has recently upgraded its offering into “a highly integrated delivery system committed to transforming the delivery of health care and improving the health of its community”. A key part of that commitment is, wherever possible, to harness the power of new technologies and solutions that will help deliver on that promise. The DX-D Retrofit’s non-invasive, connection-only solution is part of that drive; delivering time savings and a high level of image quality and speed that makes it popular with users.
Cost-effective, fast, high quality images
For smaller organizations, particularly, the desire to go digital is one that has to be carefully balanced against clear and quantifiable cost benefits. As Sonya McKittrick, the ER coordinator explains, “One of the biggest issues for us when considering a new DR solution for one of our emergency rooms was that it needed to be demonstrably cost-effective. We did look at other potential solutions, but the DX-D Retrofit’s cost structure, combined with the image quality delivered by Agfa HealthCare’s MUSICA imaging software and the resulting speed of patient throughput, made it ideal for what we needed.”
Fast installation and easy to use
Ease of use was another key factor: “We have had a long relationship with Agfa HealthCare, so we were already familiar with using Agfa HealthCare’s IMPAX and CR systems. With the DX-D Retrofit, we required hardly any training at all. The solution was installed in less than a day and we were up and running virtually immediately.”
Delivers detail missing from other solutions
Greenville HealthCare System’s pediatric radiologist was a particular champion of the image quality provided by the DX-D Retrofit, as Sonya explains. “We do a good many skeletal surveys on children, particularly when there is a suspicion of abuse. With the DX-D Retrofit you can see small details and minute fractures that you might be unable to see on our other CR and DR solutions,” says Sonya. And, having had a taste of an effective DR solution, Sonya’s aim for the future is clear: “I hope by the time that I retire – in about three years’ time – that we will be fully DR! It really is a huge improvement.”
Focused on a digital future Sonya McKittrick, Greenville Health System’s ER coordinator, explains how DX-D Retrofit is helping deliver time savings and a high level of image quality and speed that makes it popular with users.
We did look at other potential solutions, but the DX-D Retrofit’s cost structure, combined with the image quality delivered by Agfa HealthCare’s MUSICA imaging software and the resulting speed of patient throughput, made it ideal for what we needed.” Sonya McKittrick, ER coordinator
Greenville, SC, USA
THERE 3130 THERE
The diagnosis is in the details With its larger dynamic range, the new version of MUSICA offers enhanced detail of images and consistency of visualization, especially for images with large differences in signal strength. Image processing is robust and the image is always optimal, independent of the exposure technique. “Subtle bone details often tend to fade in the vicinity of implant edges, but with the next generation MUSICA, these details are well preserved and easily visible. I compare it to being able to hear a pianissimo passage after an explosion,” says Piet Vuylsteke.
For example, in skeletal imaging, no artificial shadows show up next to long bones or metal implants, making subtle details of the interfaces more visible. Trabecular structure is presented with improved sharpness, and there is appropriate transparency in overlapping structures such as the carpal bones. In chest X-rays, details from the bones, the mediastinum and the lower part of the lung behind the diaphragm are revealed with better clarity, without impairing the lung visualization.
Jan Leeuws comments: “With MUSICA, we get more details out of an image, and in a more comfortable way. This supports the radiologist to make a confident diagnosis in a shorter time frame, improving the overall workflow of the department.”
Adapted to users’ real needs
To make sure that the image processing was optimally adapted to the needs of the users, the development team collaborated with regional and leading university hospitals worldwide, including different specialties such as pediatrics, chest, etc.
When developing the new software version, it was critical to be 100% sure that the intelligence built into the system renders images with optimal diagnostic information. “When we showed the radiologists the new version of MUSICA, they often got used to the new image presentation very quickly!” says Piet Vuylsteke. “Once you appreciate that level of detail, they said, ‘there’s no going back’.”
Technology CornerNext generation MUSICA*: more from each image
Interview with Piet Vuylsteke, PhD, Senior Researcher and Jan Leeuws, Business Unit Manager Digital Radiography
The introduction of MUSICA image processing software was a true technological breakthrough, offering automated, exam-independent digital image processing using contrast enhancement founded on multiscale mathematics. Now our next generation MUSICA, with its own technology advances including Fractional Multiscale Processing, takes us and our customers another big step forward.
Next generation MUSICA will soon be available for all of our CR and DR systems. Jan Leeuws and Piet Vuylsteke from Agfa HealthCare sat down to explain the technology behind it, and what it means for radiologists and other clinicians.
Consistently high image quality across all exams
“We developed the new version of MUSICA based on our commitment to enhancing imaging quality and in close collaboration with our customers. This launch keeps us in the forefront of technology, and allows us to continue meeting the evolving imaging needs of the healthcare sector, resulting from factors such as the ever-increasing success of our digital imaging systems,” explains Piet Vuylsteke, PhD, Senior Researcher.
It’s important to understand that the next generation MUSICA still offers all the benefits of previous generations, say the interviewees. “MUSICA is fully automatic, very easy to use and install, and gets maximum information from a clinical image, independent of the patient’s body size (adult, child or infant; slim up to obese) or of the exam type,” comments Jan Leeuws, Business Unit Manager Digital Radiography. “There is no need to configure the image processing
parameters for each exam, and the technologist doesn’t need to apply specific settings for each exam type and exposure technique. That hasn’t changed.”
Neither has our MUltiScale Image Contrast Amplification (MUSICA) mathematical principle. Developed in the 1990s, it has proven since then to be the most successful image processing technology for digital X-rays. “Our challenge is to take the best and make it even better! One of our key design goals was to let the users obtain consistently high image quality across all exams and all patients at all hospitals, while applying a minimal radiation dose.”
In the forefront of technology
To address this challenge, we have made some fundamental changes to the system’s substructure. “In order to nicely render the most difficult zones of an image, such as the abrupt transitions from low to high density areas, we have applied a new mathematical algorithm, called Fractional Multiscale Processing (FMP). With this algorithm, the image processing filters are further decomposed to elementary fractions, which are processed separately. As a result, we can represent the grayscale differences in a more natural way, without artifacts,” explains Piet Vuylsteke. FMP also eliminates the need for window level adjustment to enhance visibility of details.
Several additional improvements have been made in the mechanisms that adapt the contrast, noise and grayscale of the images. In general, the images are more homogeneous and pleasant to look at for the radiologist, as well as being enhanced and represented in a very consistent way. Another advantage of the next generation MUSICA is that it is even easier to install.
Better viewing of difficult areas • High level of detail in the mediastinum
• Sharp trabecular, carpal and cortical bone
• Balanced presentation of both soft tissue and overlapping bone structures
• Clear visualization of subtle details in the abdomen
• True representation of implants with clear bone interfaces
• No need for window level adjustment, resulting in very comfortable & fast reading
*Works in Progress
Sharper trabecular, carpal and cortical bone. Balanced presentation of soft tissue and all bone structures.
Better visualization of subtle details in the abdomen.
THERE 3332 THERE
As the only pediatric hospital in New Zealand, Starship Children’s Health is responsible for taking in all tertiary referrals from around the country. Diana Browne, Team Leader MRT, Starship Radiology explains how their new Agfa HealthCare DR solutions, with their balance of dose reduction potential and sharp resolution, are helping address the challenges posed by their smallest and least mobile of patients.
Starship Children's Health in Auckland is a dedicated pediatric healthcare service and major teaching center, providing family centered care to children and young people throughout New Zealand and the South Pacific. “We have a dedicated children’s Emergency Department, a big orthopaedic service – we do a lot of spine surgery – and respiratory and oncology departments,” explains Diana Browne. “In terms of capabilities, we have three general rooms; a fluoroscopy unit, MRI, CT, ultrasound, and we have nuclear medicine coming shortly.”
Starship’s first foray into direct digital radiography was its recently installed DX-D 600 room. “Having previously experienced the high quality imaging provided by Agfa HealthCare’s DX-G CR solution in our Neonatal Intensive Care Unit (NICU), that, as well as the potential for dose reduction, made the DX-D 600 an obvious choice for our first DR solution.
Agfa HealthCare is all about image quality
“When we were considering installing our DR room, we did our research,” says Diana. “We looked at similar solutions at our district health board and some of the Australian pediatric hospitals with whom we work. However, their solutions from another vendor were posing image quality vs exposure issues that required a ‘work-around’. With Agfa HealthCare’s image processing software MUSICA, no such compromises were required. I believe it’s because Agfa HealthCare’s solutions are focused on the image processing. They are experienced at being at the imaging end rather than the hardware end and have a long history that they can draw on.”
The perfect balance of dose vs resolution
Before making their final purchasing decision, Diana ran trials using the
The DX-D 600 is very easy to use and although there were a few new features, people quickly learned the processes that they need to follow to deliver the workflow
Reach for the stars Agfa HealthCare’s DR solutions deliver dose reduction potential to the children of New Zealand.
Auckland, New Zealand
THERE 3534 THERE
Did you know... Opened in November 1991, Starship was New Zealand’s first hospital built exclusively for children and young people. With a name chosen to appeal to its young visitors, and to reflect the main building’s design, the building’s central atrium has a rainforest theme with a playground. Each of its five levels is painted a different color that has a symbolic meaning: Aqua for the Pacific Ocean; Orange for land; Blue for sky; Yellow for sunshine; and Pink for health.
No borders. No barriers
DX-D 100, Agfa HealthCare’s mobile unit with portable digital detector. “Initially we did a trial with the DX-D 100 – and the images were excellent, comparable to our needle phosphor CR.
We also found that we could drop the dose a little bit because the resolution is so good.” An added benefit was its wireless stitching capabilities. “It allowed us to have a wireless detector in the table that also allows for stitching in a supine position. With most other vendors, if you want to be able to do long leg stitching or spine stitching you have to have a fixed detector,” says Diana.
Excellent installation and training support
As with any solutions, there has been a small learning curve and adjustments to working practices. “We have only had the DR room for a couple of months, so we still need to address some challenges – such as the best way to take images of babies while erect – but we will. It will definitely be worth it in the long run.”
And no challenge is too big when there is knowledgeable support at hand. “We have had excellent support from Agfa HealthCare throughout the installation and training,” says Diana. “The DX-D 600 is very easy to use and although there were a few new features, people quickly learned the processes that they need to follow to deliver the workflow.”
The change to workflow has been stand-out
As to the future, Starship is hoping to get another DR room before the end of the year to build on the already visible improvements in workflow that the DX-D 600 has delivered. “One area that workflow improvements have been particularly stand-out is during clinics,” says Diana. “When we have a busy fracture clinic we can have 70 to 80 patients and their families in the waiting room. Being able to X-ray them, see the image immediately and send them on their way, makes for a much better patient flow. It may seem a small thing but it makes a huge difference. “Things are going a lot more smoothly with one digital room. Two digital rooms will be fabulous!”
Another brick in the digital wall for multi-site hospital ICIS View brings images and users closer together.
While the advantages of digitalizing a hospital can be multiplied across a multi-site enterprise, the challenges can be magnified as well. That’s why CHIREC, with its six sites, in Brussels, Belgium, has a comprehensive strategy to become ‘paperless’. “Transforming CHIREC into a fully digitalized enterprise started in 2005, and will take us some 15 years in all,” comments Dr. Denis Goldschmidt. “IMPAX was a big brick in building our ‘digital wall’. Now ICIS View gives us the web-based viewing we have been waiting for.”
A fully digitalized hospital, to better serve patients
Dr. Goldschmidt has been heavily involved in the workgroup for CHIREC’s ongoing digital transformation – a cornerstone of CHIREC’s vision for the future, he explains. “This is what will allow us to provide better care for our patients, more efficiently, with fewer difficulties and fewer resources. It is a major transformation, and is changing the way we do medicine.”
The workgroup knew a web-based viewer would be an important part of this transformation. With its ‘anywhere, any image’ access, perfect integration into CHIREC’s own EHR (called bDoc), and ease of use for clinicians and radiologists alike, ICIS View fills an important gap for CHIREC.
If we want to have a complete view of the patient’s history, we must be able to share non-radiologic images, as well. As a surgeon, for example, I take photos in the operating room, and in fact there are images coming from everywhere. ICIS View lets us see all our images, from any department, from any of our sites.
Dr. Denis Goldschmidt,
Surgeon and Representative of the Medical Professionals to the IT department at CHIREC, Brussels, Belgium
ICIS View • Enables ‘anywhere, anytime’ access to images.
• Provides secure access to standard healthcare data from existing workstations anywhere on the network.
• Uses any popular internet browser and modest network connection.
• No software download or installation required.
Dr. Thierry Roger, one of the heads of the radiology department, comments, “It lets us really improve the service we provide to the hospital’s clinicians. Radiologists can, for example, check images from home when they are on call, without needing to come into the hospital. And the clinicians can see the image and the report immediately, side by side, which is what they want. So there is greater satisfaction.”
As Dr. Goldschmidt makes clear, though, ICIS View reaches far beyond the radiology department. “If we want to have a complete view of the patient’s history, we must be able to share non-radiologic images, as well. ICIS View lets us see all our images, from any department, from any of our sites. And we have a tool that helps us as a hospital achieve our long-term goals, while also providing an attractive advantage for our doctors. That is definitely a step in the right direction!”
Brussels, Belgium
Did you know... • CHIREC is planning to move all its Brussels sites to a single new site, called ‘Delta’, in 2017. It will have 500 beds, 1000 parking spaces, hotel facilities, a cafeteria, shops, a nursery, family accommodations and more. • CHIREC (EDITH CAVELL INTERREGIONAL HOSPITAL GROUP) gets its name from Edith Cavell, a British nurse and heroine working in Belgium during the First World War.
THERE 3938 THERE
As the oldest and largest in-patient hospital within its area, Signature Healthcare Brockton Hospital serves a diverse community of needs. The hospital is home to a transitional residency program, and has a full imaging department. Twenty-one surrounding communities are also served by Signature Medical Group, the largest multi-specialty and multi-provider physician practise group in the area with 11 sites, including mirrored services in CT, MRI, ultrasound, radiology and mammography.
“Some of our existing equipment is more than 25 years old, and while it has been the workhorse of the department, we decided the equipment needed to be upgraded and replaced,” explains Susan Boulanger. “At the same time, we also wanted to be able to put some additional tools into the hands of the people making time-sensitive clinical decisions. I was eager to add digital mobile solutions so that if you were in the Emergency Room doing a trauma exam or in the operating room suites, the image could come up on the screen instantly to enable the team to work quickly on that patient without having to wait. They could get a general view of what was happening even prior to the radiologist doing a final interpretation.”
The radiologists’ choice
Boulanger decided the most effective way to source the right solution was to undertake a series of trials. “We looked at three different models and did demos over a three- to four-month period. I then pulled 10 images from each mobile demo machine and showed them to different radiologists, asking them to judge on image quality alone.” The outcome was not what she had expected. “When we looked at image quality specifically, all of the radiologists picked the Agfa HealthCare images.”
MUSICA image quality was just stunning
While Boulanger was surprised: “I thought there would be more similarities between vendors”, the real difference was made by Agfa HealthCare’s image processing MUSICA. “The bone work was just stunning,” says Boulanger, “and the DX-D 100 has made a significant impact on our ability to care for critically ill patients. It allows physicians to make minor or even major changes immediately because the images are available instantly.”
Trials highlighted the excellence in image quality
The DX-D 100’s reputation was further enhanced when a power failure during a snow storm last winter resulted in it being used to support the rooms in the main radiology department for about 30 minutes. “For a brief period we were acquiring images only on the DX-D 30C, the DX-D 100’s portable detector, and the team thought these images were actually better than images taken on some of the other vendors’ permanently installed digital equipment. The images aren’t just superior for a mobile solution, but for a fixed room solution too, so when our most recent off-site location opened up we purchased a fixed Agfa HealthCare room – the DX-D 600, with Full Leg Full Spine capabilities.
The bone work was just stunning,” says Boulanger, “and the DX-D 100 has made a significant impact on our ability to care for critically ill patients. It allows physicians to make minor or even major changes immediately because the images are available instantly.
any location is critical to our success. With excellent quality images available to any radiologist at any location, we can manage workload more effectively and even out any peaks and troughs.”
Proactive and timely service support Boulanger admits the initial decision to go with a new vendor for such essential solutions posed important questions. “One area of consideration was no existing install base here for Agfa HealthCare. I was concerned about how much service support there would be and how that would work but they have been fabulous. They respond, they are timely; they stop in just to do routine checks. The service support and the working relationship with the service team are wonderful.”
Installing Agfa HealthCare solutions for image quality alone makes sense As a result, the relationship looks set to be a long and fruitful one. “We did the mobile units, then we did a fully automatic room, then we did a semi-automatic room. We have a five-year plan – and as we open off-sites and move things around, there is definitely a plan to continue to upgrade and replace equipment. Agfa HealthCare has become a vendor of choice for us; they have worked well with us, the installation process has been easy to manage and, just based on the image quality alone, installing more Agfa HealthCare solutions makes sense.”
DX-D 100 • Efficient mobile bedside imaging for improved patient comfort.
• DX-D 30C wireless detector for enhanced flexibility and improved infection control.
• Instant high-quality image capture.
• Immediate image validation, transfer and access (HIS/RIS/PACS integration).
• Specially-tuned MUSICA, for gold-standard image processing, and NX workstation, for smoother workflow.
• Dose reduction potential
• Indicated for pediatric and neonatal
• Easy handling of a broad range of general X-ray exams
From small acorns big trees grow Susan Boulanger, Director of Imaging Services at Signature Healthcare Brockton, Massachusetts, explains how replacements to its 25+ year old technology have been heavily influenced by its trial of Agfa HealthCare’s DX-D 100 mobile solution.
Full Leg Full Spine an invaluable resource
“Although we don’t have a high volume use for the FLFS – maybe a few times a week – when the need is there it is invaluable. The patient simply stands for a few seconds while you capture full, accurate images that don’t require multiple exposure stitching, so there is less room for error. It’s a really great piece of technology.”
DX-D 600 delivers better patient comfort Another major benefit of the DX-D 600 solution is the luxury of spending more time with the patient. “The technologist no longer has to step out. They can do all of their work in the vicinity of the patient; worklists, protocols, and so on, so it allows more interaction and increases the speed of performing the exam because of the immediacy of the images.
”Before we had the DX-D 600, typically, by the time the radiologist was reading the image, the physicians would be waiting to decide how to care for the patient. Now they are able to see that image within 20 seconds. Having the DX-D 600, with its two detectors, also decreases the amount we have to move patients around as we are able to image from the same equipment.”
Flexibility helps even out workflow The flexibility the DX-D 600 offers also pays dividends. “Our radiologists are often shared between several different locations and the need to maximize workflow effectiveness, share information and read images from
Brockton, USA
Susan BoulangerDirector of Imaging Services
Learn about Agfa HealthCare at www.agfahealthcare.com
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