smell THIS finger

Posted by danny noonan | Filed under Rant


Digital Radiography: Are You Ready to Make the Switch (aroo)?

Anthony J. Fischetti DVM, MS, Dipl. ACVR

Department Head of Diagnostic Imaging

Animal Medical Center, New York

……………………………………………………………………

Digital radiography has revolutionized diagnostic imaging. In just the past 5 years, advances in technology have made the equipment more accessible for veterinarians practicing in both the larger hospitals and small practices.

Pros/Cons:

Advantages:

  1. Image quality is improved overall, even if exposure settings are not perfect (leeway for an acceptable image is greater than film).
  2. It saves time.
  3. It saves space (no more dark room, shelves for film, chemicals).
  4. Makes images easier to find (no misplaced films).
  5. Multiple people can view the same study at the same time, in different places (emergency practices can burn you a CD for your records; radiologist interpretations are just a click away).

Disadvantages:

  1. Expense.

Overview of Options:

Plates:

Computed Radiography (CR): CR plates are image capture devices, similar to the cassettes used in film-based radiography. Once an exposure is made, the cassette is removed from a tray, and placed in a reader (like a processor). This requires extra time and, apart from greater leeway with exposure settings, doesn’t generally save time. Image quality is excellent with CR and the price is very competitive relative to other options.

Direct (capture) Radiography (DR): Direct capture means that the image is automatically produced on a computer screen after an exposure is made. Unlike CR, DR does not require the extra step of carrying a plate to a reader. The parts in the machine stay put so there is no worry about dropping expensive equipment. Two types of DR are marketed to veterinarians:

1. Flat panel detectors.

2. Charge-coupled device (CCD).

The differences between these two types of DR are fast becoming blurred. Technology has brought the image quality of CCD close to that of a flat panel detector. The competitive market has brought the expense of flat panel detectors close to that of the generally cheaper CCD. The options provided by the manufacturers are numerous. Some are good. Others are awful.

Storage:

This is a highly neglected part of the digital radiography puzzle that must be considered before purchase. Medical digital images are much larger than the digital pictures you have from that trip to Las Vegas (by the way, those pictures should have stayed in Vegas!). The large file size of radiographs must be stored and easily found on a large, accessible server. The options are endless (on-site storage, off-site storage, web-based, do-it-yourself) and this is a way for vendors to keep the final price down. The bottom line is to research storage and viewing options (referred to as the PACS) to determine what is the best solution for you.

Computers:

Face it. Computers are a part of everyday life. You need computers for viewing the images. You should consider how many computers (workstations) you need. Where are you placing these workstations? Find a dimly lit room that is accessible to staff. High-speed internet connections are important for sending images to storage and for consultation. The software that is used for manipulating and searching for images is also important. Vendors may provide the software. Excellent free software options are also available on the internet.

Finally, the greatest DR machine in the world will display a mediocre image if the diagnosis is made on a poor quality monitor. Monitors are the common missing link to the investment in image quality and optimal diagnoses. I recommend investing in at least one medical grade (>2MP) color monitor for viewing radiographs.

Bottom Line:

Can you afford to make the switch now? Revenue calculations are available in the veterinary economics journals and web pages. These calculations give me a headache. I will generally ask veterinarians one important question to determine if further discussion is needed… “How many radiographic studies (thorax, abdomen, musculoskeletal) do you take per month?” A practice making less than 30 studies a month (at an average charge of $100 – 150/case to the client) is not performing enough exams to match the initial return on investment. However, a practice making more than 40 studies/month is ready. Savings on film, chemicals, time, and space can offset the extra expense of initial investment, service, and storage.

Researching what you truly need and don’t need is important. Ask the vendors what the 5-year monetary investment would be, not just the initial down payment. This allows you to consider warranty, servicing, and continued storage. What exactly do you get with those chronic, monthly service payments? Will they promise fast response if the unit is down? Where do my images go after five years? Will they remain easily accessible (remember the legal ramifications of this)?

Radiologists are important resources for consultation on a DR purchase. We spend much of our day reading radiographs from different hospitals. We hear the positive feedback and excitement of the veterinarians who made the right decisions. We occasionally hear horror-stories. Feel free to contact me if you have further questions. anthony.fischetti@amcny.org; 212-329-8782. Additional information regarding digital radiography can be found at these websites: www.animalinsides.com (Dr. Matt Wright sets us all right); www.acvr.org (the ACVR knows all); and www.aavr.org (American Association of Veterinary Radiologists is a new organization concentrating on education and futuristic veterinary radiology).

worthington

……………………………………………………………………

02-the-sweetest-thing

Permalink | May 17th, 2009

3 Responses to “smell THIS finger”

  1. marty Says:
    May 18th, 2009 at 9:29 am

    Do you say these things just to get my goat?! You know I’m a film x-ray guy. What the hell am I gonna do with all these lightboxes I have to sell?!

  2. danny noonan Says:
    May 18th, 2009 at 7:13 pm

    lightboxes are retro marty. people will pay top dollar even for non-functioning ones. you should look into beacon’s closet.

    i do wish you would just get with the times. you’ve been in the dark ages darkroom for way too long. snap out of it, as cher once said.

  3. inmyownlanguage Says:
    May 19th, 2009 at 1:06 pm

    you’re always in love danny…..moonstruck or no.

Leave a Reply