For over a century, since William Conrad Roentgen, diagnostic medicine has been
using x-ray film and developing chemistry as the foundation to produce radiographic images. Within the
last decade, technological achievements have ushered in a revolutionary new age of digital reproduction.
Two major branches of digital imaging have emerged in the medical marketplace.
CR (Computed Radiography)
Sometimes called Cassetteless Radiography, actually a misnomer, CR still uses special cassettes
to render a computerized image. Instead of using conventional film/screen detection, a special
image plate is inserted permanently into the special cassette. Ionizing radiation produces ionizing
patterns in the imaging plate (IP) corresponding to tissue and bone density. Instead of unloading
film into a processor, the technologist feeds the cassette into a digitizing decoder or "Reader".
The ionizing patterns on the plate are then converted into digital information and assembled by a
PC and special processing software to produce an x-ray image in a matter of seconds. CR still requires
manual transport of each cassette as in days past, but the need for film and chemistry and two
minute processing time is thus eliminated. CR offers considerable cost advantage over Direct Radiography,
and most film companies are supporting this mode, as it offers a familiar environment to the
technologist, and they can still market cassettes.
DR (Direct Radiography)
With Direct Radiography (DR), the patient is placed on the table as usual, but
from there on, the examination procedure is much different. A permanent receptor has replaced
the conventional bucky, and as soon as the x-ray is terminated, the receptor immediately
feeds the acquired digital information to the processing system (PC) without the need for cassette
transport. Consequently, films can be taken as fast as the patient be positioned, dramatically
reducing the length of the exam, resulting in increases in productivity by an order of
magnitude. However, until recently, the extremely high cost of the image receptors, made only by a few manufacturers, has
kept the acceptance level down to only the high-volume hospitals and imaging centers.
As with any new emergent technology, the "new" finally wears off, and the rules of
supply and demand take over. Initially, the high cost of CR equipment could not be realistically
offset by any kind of savings offered by the elimination of film and chemistry. However,
as production techniques have improved and demand has forced the increase of sales, prices have been
moderating. Supply cost savings can now be effectively applied to payout and up-keep
of a CR unit. Imagine the payments on a standard SUV weighed against
your normal monthly x-ray supply and processor maintenance expenses. There probably would not
be a lot of difference.
Taking Your Work Home - Not a popular phrase back in the '70's, but necessary in
the fast moving environment of our new millenium. Now, patient information and images
at the practioners' office is instantly available at home, 24 by 7. Thanks to Picture Archiving
and Communications Systems (PACS), and high speed internet, all patient image information is
organized and stored in logical sequence allowing viewing from a remote location.
HIPAA - Protection of patient information has become a hot-button for legislators,
and the entire health industry. Digital imaging processing systems based on the DICOM standard
provide for various levels of redundancy to protect against the loss of patient data. Examples
- Backup to CD or DVD for off site storage. (Small facilities, least expensive method)
- Removable transportable hard drives. (Medium sized clinics)
- Large arrays of hard drives with automatic backup features. (Imaging centers & small hospitals)
- Off-Site rental data storage facilities, with restore capabilities. (All facilities)
- Time Is Money
- 1) Bottom line, digital imaging means less time spent with the
examination. In a busy work environment, this translates to less waiting time and less
processing time for the anxious patient. It also means more patients can be processed in the
same given amount of time. The technologist may then devote remaining time to other duties.
- 2) No longer will loan films have to wait for the U.S. Postal service or hand delivery. Images may
be zipped off to referring physicians via e-mail and received instantaneously for comment.
- - - - - -
- MORE RECENT IMPORTANT DEVELOPMENTS:
-- THERE IS NOW PROPOSED LEGISLATION WHICH REDUCES OR ELIMINATES GOVERNMENT REIMBURSEMENT FOR X-RAY FILM USED IN DIAGNOSTIC RADIOLOGY. THIS LEGISLATION IS ALSO STEPPING DOWN REIMBURSEMENTS FOR USE OF CR DIGITAL PROCESSING EQUIPMENT, AND FOCUSING ON DIRECT RADIOGRAPHY (DR) AS THE PRIME DIAGNOSTIC MEDIA.
RADCO IMAGING HAS PARTNERED WITH MEDLINK IMAGING AND OTHERS TO PROVIDE ACCESS TO DIGITAL DIRECT RADIOGRAPHY AT SUBSTANTIALLY LOWER PRICES THAN HAVE EXISTED IN THE PAST SEVERAL YEARS. YOUR INCREASING EXPENSE CATAGORY FOR FILM AND CHEMISTRY COULD BE USED TO PAY FOR A DIGITAL SYSTEM IN A SHORT PERIOD OF TIME. THERE MAY ALSO BE TAX BENEFITS FOR MEDICAL EQUIPMENT PURCHASES.
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