Discover how X-ray technology
is changing the future of diagnostics.
By Jennifer LeClaire
The chiropractic technique hasn’t changed much over the past decade, but
the diagnostics have. This low-tech industry is going high-tech with newfangled
X-ray systems designed to save time and money while providing more accurate
results. While many offices still have old-fashioned X-ray machines, the future
is digital and it’ll be here sooner than you think.
Indeed, X-ray technology has changed dramatically since Conrad Roentgen first
introduced the concept in 1895. We’ve seen sonograms, magnetic resonance
imaging and now direct digital radiography (DR), a process by which digital
images are acquired directly after the exposure has been made, is promising
to revolutionize diagnostics.
DR Benefits
“One hundred years from now people will probably be amused that we ever
used film to capture skeletal images,” says Fred Fischer, vice president
of Hicksville, N.Y.-based All-Pro Imaging, a manufacturer of imaging systems
for the medical marketplace. “Digital imaging costs less than using film
because you don’t have to build a darkroom, buy chemistry, store or duplicate
the film.”
And those are only a few of the myriad of benefits digital imaging systems provide.
With digital imaging there is no purchase or repair of X-ray processors, no
chemistry disposal, no searching for lost films, no ruined film when someone
accidentally opens the darkroom door, no retakes due to poor quality, and no
need to release your original images.
More importantly, digital imaging offers increased patient safety because the
exposure to radiation is limited by as much as one-third. Interpreting the film
is also easier since digital images allow you to drop out the background organs
in the chest that can cloud your view of the spine. You can also adjust the
contrast and density or magnify the image to make specific areas more visible
or even display them in 3-D. Then you can save different versions of the enhanced
file on your hard drive.
Digital imaging is nearly instantaneous. Digital exams can be conducted two
to four times faster than traditional film-based X-rays so busy chiropractors
can increase patient throughput. “Digital radiography allows you to put
the skeletal image up on your viewing monitor within seconds,” says Jay
McElhannon, regional sales manager for Springfield, Mo.-based Healthcare Manufacturing
Inc. (HCMI), an equipment manufacturer for the chiropractic industry. “Then
you can take that image and instantly send it via e-mail to a radiologist, store
it on your hard drive or burn it onto a compact disc.”
| Digital
Imaging offers economy and efficiency Digital imaging, in either the computed radiography (CR) or the digital radiography (DR) format, has the potential for tremendous costs savings, enhanced patient safety and spectacular clinical utility. The dollars-and-cents side of this question is deceiving at first glance. A good quality X-ray machine is going to run about $25,000. The HCMI DR system is expected to hit the market at about $50,000. Your first reaction might be, “Why would I pay twice as much for something to generate the same old X-ray beam?” The short answer is, you shouldn’t on the X-ray production side, but you should on the X-ray image capture side. Once you make the leap into DR the following expense items are things of the past: film, processors, chemicals, envelopes, X-ray storage, X-ray copying, staff time in the darkroom and looking for films. If you are looking at making the switch from film to DR at the time you are designing an office, the savings becomes even greater. Imagine not having to allow space for a darkroom and X-ray storage space, or deal with darkroom plumbing and the demands of a light-free environment! Costs favor the digital format. So does the clinical utility. Once you have an exposed film that has been properly processed you have a fixed image. You can get a little more information out of it by changing the illumination involved but it is a rather unalterable image. In the digital environment you can enlarge the image, alter the contrast, alter the density, reverse the image (change from a negative image to a positive image) and then you can save a limitless number of variations of the image – all with the click and slide of your mouse. When it comes to copying images it is a 30-second process that costs 15 cents to accomplish. The best part of the entire discussion is that with digital imaging you can reduce your exposure factors between 30 percent and 40 percent. Cheaper, better quality images, more useful images and less hassles for everyone – the benefits are endless! - Gerard Clum, D.C. |
McElhannon makes a good point about the advantages of distributing digital images.
Film-based X-rays have to be duplicated, which requires additional supplies
and, moreover, time. With DR files, patients, insurance companies and other
healthcare professionals can receive duplicates within seconds after requesting
them. “In the past, only one individual at a time could review a patient’s
X-rays,” explains Dimitrios Spigos, M.D., chair of radiology at Ohio State
University Medical Center. “With digital imaging, everyone on the healthcare
team can view X-rays simultaneously in different locations and reach a consensus
about the best treatment.”
Affordable DR?
HCMI will be releasing the world’s first DR system designed specifically
for chiropractic applications by the beginning of next year. The new system
will include a 100 kHz high frequency X-ray generator and control, direct digital
detector, acquisition computer with monitor, X-ray tube and all other items
to make a complete X-ray room operational.
The system will also feature automatic exposure control and anatomical programming
as standard features. While most DR systems run $300,000 to $500,000, McElhannon
says HCMI’s system will retail for about $50,000. McElhannon predicts
chiropractors can achieve a return on that investment with as few as 12 X-rays
a week through the company’s lease program. After a dozen exams the X-rays
are 100 percent profit.
Once you have the digital image, you can use International Diagnostic Technologies’
DXAnalyzer Professional software to manipulate any the file with a myriad of
options. The software has been tested to be accurate to 0.0023mm (the Roentgenometric
standard for the naked eye is 0.2mm) thereby satisfying the insurance industry’s
demand for proof that chiropractic works.
“The insurance industry is demanding that we prove chiropractic works,”
says Donn Bauer, D.C., founder of International Diagnostic Technologies, an
X-ray digitizing software developer in Dallas. “First, they want us to
prove that an injury has occurred. Then they want us to prove that we can objectively
locate it and effectively treat it. Digital technology can help us do prove
these things.”
“Future versions of the software will be able to demonstrate a possible
outcome assessment and treatment plan with protocols,” says Bauer. “The
patients’ digital analysis will be processed while comparing the collective
database, which includes age, height, weight, gender, genetic heritage, type
of injury, subjective complaints and objective findings to recommend possible
delivery of force vectors on the computer screen, before the patient is placed
on the table. Then a CAD rendering of digitized X-ray images in 3D motion will
be placed on a functional walking pelvis.”
Digital vs. Computed
For DCs that want to transition into the digital age, but can’t afford
to shell out that kind of money, there is another option called computed radiology
(CR). This is much less expensive choice because it takes a retrofit approach
in which the original equipment is enhanced by removing the bucky and installing
a digital recording plate to replace the film in the cassette. CR solutions
are much more feasible for small offices, but still offer some of the same benefits
of a filmless X-ray. Retrofits typically cost about $50,000-$70,000.
With radiography moving toward digital imaging, practice management programs
are emerging to make X-ray storage quick and convenient. This modern software
goes above and beyond the note taking and billing functions found in first-generation
programs by allowing chiropractors to store documents of various types, including
digital X-rays.
“Our E-Z BIS Office software package allows chiropractors to store graphical
images like X-rays and photos, along with other patient files,” says Tonio
Cutrera, sales manager for Lafayette, La.-based EZ BIS, a custom chiropractic
software manufacturer. “This feature saves the DC time because they can
open one file from any computer on their network and find all the patient documents
in one place.”
The Traditional Approach
But Joey Leffel, marketing manager for Summit Industries, a Chicago-based manufacturer
of diagnostic radiographic equipment, stresses that direct radiography is still
in its infancy stages. “No one wants his clinic to be the one that finds
out what is wrong with the new technology,” she says. “But you can
buy a quality machine with high-frequency capability that allows you to take
quick exposures for patient safety, and then retrofit for CR when you are ready.”
These high-tech solutions are still much more expensive than the old-fashioned
machines; and traditional film radiology has not gone by the wayside. More than
60 percent of U.S. hospitals and imaging centers continue to use radiographic
film as the primary method of capturing X-ray imaging exams, according to a
recent Kodak survey of more than 400 healthcare providers. That’s why
Kodak developed of a new medical imaging X-ray film that will produce the same
excellent image quality available today with only half the radiation dosage
currently required.
The film also will feature an increased “speed” that will reduce
the need for retakes due to patient movement during exposure, further contributing
to reduced radiation for patients. “In the past, a decrease in radiation
dose usually involved a sacrifice in image quality,” says Betsy Guffey,
product line manager, film systems, Kodak’s Health Imaging Group. “This
new film is designed to work with less radiation while maintaining high standards
for image quality.”
Companies like Del Medical Imaging manufacture modern equipment like ChiroEz
Plus designed with chiropractor input to offer precise positioning and alignment,
which is a major contributing factor to high quality X-rays. This model features
time-saving single motion positioning that can reduce positioning time by up
to 80 percent. The X-ray tube moves on a structural steel cross-arm to provide
rigidity. These features help assure fewer repeats, less film waste and faster
throughput.
Regardless of the system you invest in—digital, computed or film—there
are a few tips common to any radiology purchase. A warranty and comprehensive
after-sale service is the baseline for any sale, for example, and steel construction
is preferable to avoid corrosion, especially in film environments where dark
room chemicals could cause damage over time. X-ray equipment is not an every
day purchase, so be sure to understand what your needs are today—and in
the future—before investing.
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