The Roundtable: X-ray

This month, TechNation asked X-ray equipment experts to weigh in on the biggest issues affecting the purchase and maintenance of the equipment. Responders include Patrick Pyers, VP of Sales, Marketing & Business Development for Radcal; Matt Riche, Sales and Marketing Manager for Brandywine Imaging; and Larry Sheppard, Director of FirstCall Clinical Technology Services at East Texas Medical Center Regional Healthcare System. This month’s article begins with a look at the industry’s evolution from Larry Sheppard.

Many of us “old timers” may remember the days when X-ray departments required Dark Room Technicians to process X-ray films, whether it be from hand dipping films to loading/unloading cassettes and feeding them into X-ray film processors.

Later they were replaced by contraptions called daylight loaders that started shrinking the requirements for the dark rooms. Then came the major change with the birth computerized radiology (CR) to eliminate the need of flat film with digitized plates to transfer the image into a computerized image that could be sent to the radiologist for diagnostic review, sent to the physician for clinical review and archived in PACS or given to the patient on a stored media DVD.

There were more advantages than disadvantages with this technology swing where the beginning of “doing more with less” started to enter the picture based upon the efficiency factor taking place.

CR was the more affordable answer to facilities with existing equipment that was being converted from analog to digital processing. The most significant disadvantage for CR was the increased dose required to impose the image on the plate, but many would debate you on the elimination of retakes of exposures.

I believe that CR was designed as a stepping stone or a path to bigger and better technology, as we are starting to experience with digital radiography and the capability it gives to putting a diagnostic image in front of the radiologist in about 8 seconds at a lower radiation dose to the patient, making this the biggest trend in the diagnostic market today.– Larry Sheppard

WHAT ARE THE BIGGEST TRENDS RIGHT NOW IN THE X-RAY MARKET? HOW HAVE THEY AFFECTED PURCHASING?

Pyers: As one that is involved in all X-ray modalities, there appears to be much activity in CT, mammography and general CR and DR machines. From a diagnostic X-ray meter manufacturer’s perspective, there is a steady need for devices that can accurately measure on today’s machines. Older diagnostic meters have difficulties measuring on the newer machines and need to be replaced as new technology is developed. ISOs and clinical engineering departments find this as a challenge and an added expense for new X-ray test instruments. In many instances, purchasing a new meter is a necessity as faster and new low dose machines are developed. To service CR and DR machines, a good meter is required to be assured that the X-ray side of the imaging system is operating correctly.

Riche: The DR plates that are coming out are going to be the new thing. And the technology has been around long enough that it is coming down in price. There are numerous Asian manufacturers that have flooded the market with their own DR panels. The original hospitals that started off with CR systems are starting to hit end-of-life for their equipment and are looking into upgrading to DR. Radiology sales are down with the recent cuts to Medicare imaging reimbursement, and hospitals are looking to cut costs, so they will be looking into alternatives to the big OEMs’ equipment. You can get a single-panel DR system with a tethered panel for a lot less than a high-end CR now, and even the wireless plates are coming way down in price. I’ve seen wireless panels that cost around $50,000.

Sheppard: Patient dose reduction and patient throughput are in my opinion the biggest trends that we are facing. The diagnostic market is ever-changing in that the diagnostic X-ray work is still probably the bulk of the radiology department’s action. With the advances in CT with virtual colonoscopy and fluoroscopy along with the technology in the digestive disease centers, conventional fluoroscopy is a dying art and many smaller hospitals have discontinued offering the service, and most radiologists don’t have the volume of patients to be involved with it.

HOW HAVE THOSE CHANGES AFFECTED SERVICE OF THE EQUIPMENT?

Pyers: As these new machines are developed and released, the challenge of making accurate dose and kVp measurements begins. As in mammography, different target/filter combinations are introduced, and the service person needs to make sure their meter is calibrated for these combinations. Not all meters are calibrated for these combinations, especially the older diagnostic meters, nor do they have the capability of being calibrated for these combinations. New meters have recently been introduced that not only handle all the new target/ filter combinations, but also have the capability to utilize both solid-state sensors and ion chamber technology in one meter. As many know, the ion chamber is independent of these target/filter combinations for dose measurements, thereby eliminating any potential problems when using solid-state devices. But the choice is there, which can add simplicity and increased productivity when servicing X-ray machines. Non-invasive diagnostic X-ray meters have evolved from the large and complicated devices they once were. There’s no need to wheel all your test equipment around when today’s design allows one to simply include it in their laptop briefcase. The power of the laptop has transformed the latest diagnostic meter into a powerful data accumulation device, providing a wealth of waveform information with the end result of more accurate measurements of tube output.

Riche: Much of the CR equipment that is out there is reaching its manufacturer-deemed end of life, so hospitals are looking to independent service companies to keep the equipment going until the price of the parts outweighs the value of the system. With DR, you get much better image quality, and you can reduce your staff. You can get your image in three to seven seconds as opposed to CR, where the whole process might take you a couple minutes. You can be much more productive and do more patients with DR.

Secondly, there is very little in-field service you can perform on DR panels. Most of the issues are computer related, so we’ve shifted our service focus to IT. I’ve had to be sort of a PACS administrator for some of these facilities. We are 24-7 and can go to our association network, so we have a fast response time.

Sheppard: Servicing CR/DR equipment has brought on some changes. In the past with the more conventional radiologic technology, service personnel had to have more in-depth skill sets to include intense knowledge in mechanical  applications, electronics technology, and a more detailed experience in understanding of equipment physics for calibration purposes. Today, those skills are still valued and what had to be added to that is the computer skills and the ability to understand and correct any computer related problems that may prohibit premium performance of the equipment.