Generating revenue from X-ray waste.

According to Betts Envirometal, experts in precious metal recovery from waste streams, and a provider of 'total waste management' solutions, 'disposing of hospital wastes isn't usually a glamorous subject, unless, of course, you know how to make money from it'. As general manager, Simon Hundal, explains, the company is seeking to 'revolutionise' how the NHS treats certain waste streams, and, in doing so, to encourage NHS Trust directors and governance managers to check their compliance with patient data retention guidelines as far as medical X-ray film, in particular, is concerned.

Comparison between different cost devices for digital capture of X-ray films: an image characteristics detection approach.

A common teleradiology practice is digitizing films. The costs of specialized digitizers are very high, that is why there is a trend to use conventional scanners and digital cameras. Statistical clinical studies are required to determine the accuracy of these devices, which are very difficult to carry out. The purpose of this study was to compare three capture devices in terms of their capacity to detect several image characteristics. Spatial resolution, contrast, gray levels, and geometric deformation were compared for a specialized digitizer ICR (US$ 15,000), a conventional scanner UMAX (US$ 1,800), and a digital camera LUMIX (US$ 450, but require an additional support system and a light box for about US$ 400). Test patterns printed in films were used. The results detected gray levels lower than real values for all three devices; acceptable contrast and low geometric deformation with three devices. All three devices are appropriate solutions, but a digital camera requires more operator training and more settings.

Filmless versus film-based systems in radiographic examination costs: an activity-based costing method.

BACKGROUND: Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC) method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. METHODS: We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views), knee (three views), wrist (two views), and other. Indirect costs were allocated to cost objects using the ABC method. RESULTS: The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. CONCLUSIONS: The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients.

Economic evaluation of computed radiography comparing to film method in quality control of general X-ray machine at Phramongkutklao Hospital.

OBJECTIVE: To evaluate the efficiency of quality control performance for a general x-ray machine between computed radiography (CR) and film method. MATERIAL AND METHOD: CR performance as a quality control method for a general x-ray machine was compared to the film method. Two raters independently analyzed the result of quality control from both methods. Economic evaluation was performed by cost-minimization analysis. All data (result for quality control and cost) were collected from Phramongkutklao Hospital from August 2007 to January 2008. RESULT: Quality control performances of a general x-ray machine by using CR and film method were equivalent. Interobserver agreement for analysis of quality control measurements was almost perfect. Unit cost, test performance time, radiation dose for quality control by CR were less than the film method (p < 0.001). CONCLUSION: The performances of quality control of a general x-ray machine done by the CR method are more efficient than the film method. Using the CR method for quality control performance of the general x-ray machines will save cost enormously.

Soft copy using image processing in place of hard copy for detection of subtle pulmonary lesions: is it actually cost-effective?

PURPOSE: To comparatively assess the interpretation performance of hard-copy versus soft-copy presentations for detecting subtle pulmonary lesions and to estimate soft-copy cost-effectiveness. METHODS: Computed radiography was used to obtain images with a 1,600x 1,200 matrix having 8 bits of gray-scale definition. The two separate image formats (hard and soft copy), which consisted of 60 chest radiograph combinations, were shown to five board-certified radiologists. The costs of hard copies, chemicals, waste disposal, and labor were calculated. RESULTS: The mean accuracies and Az values were 0.63 (hard) vs. 0.64 (soft) and 0.657 (hard) vs. 0.729 (soft), respectively. Reading one set of hard copies took on average 8.0 sec less than reading soft copies (30.3 vs. 38.3 sec). Estimated savings resulting from replacement of hard copy with soft were US$128,004 per year or US$6.20 per patient at our hospital. CONCLUSION: Conversion from hard copy to soft copy, using image processing, is feasible and cost-effective.

Transition from film to electronic media in the first-year medical school gross anatomy lab.

For the benefit of the first-year gross anatomy students, we digitized and published on a Web site images that had been collected over a 30-year period. We provided a CD-ROM (compact disk, read-only media) containing the image set in higher quality format to students and faculty. We supplemented basic images with hot topics such as CT angiography, virtual colonography, computer-aided diagnosis, and 3D post-processing. Full motion video and moving JPEG (Joint Photo Expert Group) animations were integrated into the atlas. On the post course questionnaire medical students reported that the images on CD-ROM were helpful during the course and for review prior to examinations. Faculty and medical students used the CD-ROM for problem-based learning sections and facilitator training. The images were clear and easily projected during review sessions and were useful for the small group sessions, where they served as examples of normal anatomy.

[The place of radiography in endodontic treatment carried out in general practice in Dakar]. / Place de la radiographie dans les traitements endodontiques réalisés en omnipratique à Dakar.

An investigation conducted over dental surgeons of 52 dental offices in Dakar and it's near suburb (40 from private sector and 12 from public and quasi-public) has shown that the use of retro-alveolar radiography during endodontic treatment was not systematic, due to the price of retro-alveolar film, waste of time and relative facility of the endodontic treatment of monoradicular teeth. The preparatory negative is favored (32.70%) particularly by private dental surgeons, who use two retro-alveolar films for endodontic treatment: pre and post operative radiography (30%). The immediate post operator control is executed only in case of post-operator pains by public and quasi-public dental surgeons (16.67%) with one retro-alveolar film on average for the endodontic treatment; at term any radiographic control is done. Three retro-alveolar films per endodontic treatment were exceptionally used (9.61%) and offset incidences (15%) are not much used as well as support-films (angulators). The retro-alveolar radiography is still a reliable guide for a clinical success in endodontic treatment with a minimum of three retro-alveolar films and offset incidences.

Radiology goes filmless.

PROBLEM: Long turnaround time for radiology reports, unacceptable percentage of misplaced films. SOLUTION: Installation of hospitalwide PACS, implementation of voice recognition dictation system, upgrade of RIS. RESULTS: Rapid and significant improvement in reporting times, virtual elimination of misplaced films, integration of radiology services throughout the enterprise. KEYS TO SUCCESS: Detailed financial model and needs assessment, commitment by management and staff, well-planned implementation, choice of vendor that provides total solution and support.

Economic analysis of a filmless system based on the hospital information system.

A filmless system (FLS) based on a picture archiving and communication system (PACS) equipped with UNIX work- stations and a local area network (LAN) specialized for viewing radiographs has not been deemed acceptable, for reasons of economics. However, personal computers (PCs) have recently become more powerful, to the point where PCs approach UNIX workstations in terms of capabilities. As a result, a PC-based image viewing workstation (IVW) has sufficient functions for practical use. Diagnostic resolution is not equal to that of film, but is comparable. Since the hospital information system (HIS) includes many PC terminals connected by a LAN, the cost problem can be resolved by using these PC terminals as the IVWs. In order to investigate the practicability of this idea, two types of FLSs using HIS facilities were designed: one is a system based on the use of high-resolution cathode ray tubes (H-CRTs), and the other is based on the use of conventional CRTs and radiologist reports, minimizing the number of H-CRTs. The total costs of the two systems were analyzed. As a result, the former FLS was found to be about 15% more expensive than the latter, which was less expensive than a film-based system (FBS). However, whether the FLS is more profitable than the FBS from the viewpoint of hospital management strongly depends on the medical insurance system.

Digital x-ray systems. Part 1. An introduction to DX technologies and an evaluation of cassette DX systems.

Film is an effective means for capturing diagnostic information. However, film images cannot be easily integrated into a digital communication system. Thus, as the number of healthcare facilities moving toward a digital work-flow increases, so too does the interest in digital x-ray (DX) systems, which produce images as collections of digital data, rather than as static films. In this first part of our two-part series on DX systems, we present an overview of DX technology, we review the cost factors to consider when deciding whether to invest in DX technology, we offer guidance to help facilities determine which type of system--cassette or cassetteless--will best meet their needs, and we evaluate cassette DX systems from four suppliers. Part 2 of our series, which features an evaluation of cassetteless DX systems, will be published later this year. Our testing of DX systems identifies whether a system can provide at least the same amount of diagnostic information as a screen-film system while significantly increasing the efficiency of operations. We found all the evaluated systems to be effective, but we rank the systems from two suppliers above the others because their user interfaces allow easier and more efficient operation.

Radiotherapy review on national surgical adjuvant breast and bowel project (NSABP) phase III breast cancer clinical trials: is there a need for submission of portal/simulation films?

In all National Surgical Adjuvant Breast and Bowel Project (NSABP) breast cancer trials in which patients are treated with lumpectomy and postoperative breast irradiation, the quality assurance requirements dictate submission of a completed radiotherapy data form with the stated administered doses, the volumes treated, treatment prescription and daily treatment record sheets, dosimetry and calculation sheets, isodose distributions on the breast contour, photos of the patient in the treatment position, and portal or simulation films. A review of radiotherapy data on 1,982 patients who had lumpectomies accrued to seven recent NSABP breast cancer studies revealed only 2 patients who were judged to have inadequate fields. In both cases, a very small portion of the breast tissue was not included in the irradiated volume as demonstrated by the submitted films. On this basis, it was argued that submission of portal or simulation films for patients receiving postlumpectomy breast irradiation is not necessary. However, there was concern as to the incidence of patients with a possible excess amount of lung tissue included in the irradiated volume. To address this concern, the amount of irradiated lung was determined for the first 208 patients who had lumpectomies, with submitted data entered into the recent NSABP pathologic node-positive protocol B-28. Current NSABP radiation therapy guidelines suggest limiting the thickness of the irradiated lung in the portal beams to < or =3 cm. Only two patients (<1%) were found to have >3 cm of irradiated lung tissue in the treatment volume. Portal film submission is a considerable inconvenience to the individual institutions and is costly in terms of shipping, handling, and storage. These results indicate that submission of portal films is not a necessary part of quality assurance in NSABP breast cancer protocols. The NSABP has therefore eliminated the requirement for routine submission of portal films in protocols for which radiotherapy is not part of the test question.

Small changes, vendor partnerships drive down hospital's imaging costs.

Imaging departments offer great potential for cost reductions. That's what Baptist Hospital of Miami found out when they put their operation under the microscope and solicited assistance from some of their vendors. By paying attention to the details, the hospital reduced costs by more than $500,000 a year. Find out how.

Enhancing availability of the electronic image record for patients and caregivers during follow-up care.

PURPOSE: To develop a personal computer (PC)-based software package that allows portability of the electronic imaging record. To create custom software that enhances the transfer of images in two fashions. Firstly, to an end user, whether physician or patient, provide a browser capable of viewing digital images on a conventional personal computer. Second, to provide the ability to transfer the archived Digital Imaging and Communications in Medicine (DICOM) images to other institutional picture archiving and communications systems (PACS) through a transfer engine. METHOD/MATERIALS: Radiologic studies are provided on a CD-ROM. This CD-ROM contains a copy of the browser to view images, a DICOM-based engine to transfer images to the receiving institutional PACS, and copies of all pertinent imaging studies for the particular patient. The host computer system in an Intel based Pentium 90 MHz PC with Microsoft Windows 95 software (Microsoft Inc, Seattle, WA). The system has 48 MB of random access memory, a 3.0 GB hard disk, and a Smart and Friendly CD-R 2006 CD-ROM recorder (Smart and Friendly Inc, Chatsworth, CA). RESULTS: Each CD-ROM disc can hold 640 MB of data. In our experience, this houses anywhere from, based on Table 1, 12 to 30 computed tomography (CT) examinations, 24 to 80 magnetic resonance (MR) examinations, 60 to 128 ultrasound examinations, 32 to 64 computed radiographic examinations, 80 digitized x-rays, or five digitized mammography examinations. We have been able to successfully transfer DICOM images from one DICOM-based PACS to another DICOM-based PACS. This is accomplished by inserting the created CD-ROM onto a CD drive attached to the receiving PACS and running the transfer engine application. CONCLUSIONS: Providing copies of radiologic studies performed to the patient is a necessity in every radiology department. Conventionally, film libraries have provided copies to the patient generating issues of cost of loss of film, as well as mailing costs. This software package saves costs and loss of studies, as well as improving patient care by enabling the patient to maintain an archive of their electronic imaging record.

Image is everything.

Digital imaging is transforming the practice of radiology. But provider organizations face many technical and financial challenges on the road to becoming filmless. Their own reluctance to let go of the film habit is making the transition to digital images difficult. And the complexity of the myriad technologies, as well as the high prices delivery systems and hospitals still must pay to acquire them, are slowing the march toward filmless radiology departments.