Carbon nanotube technology increases portability and image quality; and is more energy efficient.
We are constantly bearing witness to important advances in the development and applications of medical technologies. However, it is not so common for there to be changes of a disruptive nature that lend a completely new orientation to a technology, either through new applications or through forms of use. However, this is happening now in medical imaging with the introduction of carbon nanotube technology (CNT).
(A) DRX-Revolution tube head and collimator assembly, ~56 cm (22 in.) in width and weighing 75 kg (165.3lb). (B) DRX-Revolution Nano tube head and collimator assembly, ~32 cm(12.5in.) in width and weighing 7 kg (15.4 lb).
Until the discovery of carbon nanotube technology, introduced worldwide by Carestream, X-ray devices used a vacuum ampoule. This is a device similar to a bulb with tungsten filaments that are heated to more than 1,000 degrees Celsius to generate the electrons necessary to produce the X-ray image.
“Cold” carbon nanotube technology yields energy efficiencies
Although the historical contribution of the vacuum ampoule is priceless, it has limitations that carbon nanotube technology helps to solve. One is energy efficiency. Heating equipment at high temperatures uses an excessive amount of energy and requires the use of additional systems for cooling, such as fans (rotating anodes) or coolants. This contributes to the overall size and weight of the ampoule. Furthermore, because electrons are “boiled off”, approximately only 1 percent of the energy produced by a vacuum ampoule is transformed into usable electrons.
Carbon nanotube technology, on the other hand, is a “cold” technology. The production of electrons is not achieved by heating the filament, but rather by the application of an electric field. Also, electrons are focused at the tips of the carbon nanotubes. There is a much higher percentage of electrons used toward the creation of an X-ray image. Finally, unlike vacuum ampoules, CNT does not need to be cooled, thus contributing to a much smaller, lighter-weight tube.
The benefits of this new technology are not limited to energy efficiency. They also are relevant in terms of the portability of digital X-ray equipment, image quality and, by extension, patient safety and comfort.
Carbon nanotube technology increases portability and image quality in medical imaging; and is more energy efficient.
Carbon nanotubes weigh 75 percent less than current tubes. This reduction enabled Carestream to develop an extremely small and lightweight mobile digital imaging system, the DRX-Revolution Nano. It weighs only 100 Kg., 80 percent less than other mobile imaging equipment, such as the DRX-Revolution that uses a vacuum ampoule.
Like the DRX-Revolution, the DRX-Revolution Nano can become an X-ray room “on wheels”. It can be transported manually, fits easily in an elevator, and has sufficient autonomy to perform a full day’s work without needing to be plugged in to an electric source.
Another important benefit – that goes beyond purely technological developments- is that these qualities allow imaging professionals to provide better care to patients, whether at their bedside, in the ICU, or in paediatric wards.
It is likely that the cathode with incandescent filament, which was the origin of all radiogenic production, has its days numbered. Carbon nanotube technology – which is totally disruptive – will begin to emerge as a replacement, allowing a reduction in the weight of the equipment, an improvement in ergonomics and, through the processing software, a further reduction in radiation doses received by patients.
Rafael Fernández is the Product Manager of Carestream Health Iberia. He originally presented this content at the 32nd Congress of the Spanish Society of Medical Radiology (SERAM).
The DRX-Revolution Nano is available for commercial sale in the United States and Canada. Dates for availability in the European Union will be announced soon.
Diagnostic imaging can be a critical step in treating patients as early as possible.
Sometimes, patients suffering from a rare disease experience a delayed diagnosis. The delay can enable their condition to further advance, possibly jeopardizing their quality of life and, in some cases, life expectancy. By the time the correct diagnosis has been determined, these patients have usually been forced to visit several different doctors, adding to their frustration and uncertainty, and to their loved ones.
To help bring attention to Rare Disease Day (1) on Feb. 28, we are highlighting the success seen with radiology in diagnosing rare diseases and helping patients get treatment as early as possible.
Medical imaging can play an important role in diagnosing rare diseases.
Enhancing diagnostics in diseases of the lung
Although diagnostic scans can sometimes show ambiguous results, a combined technique known as a PET-CT scan has shown success in detecting cardiac sarcoidosis. This is a rare disease that is unpredictable by nature and whose cause is unknown. Nearly 50% of those affected fail to be diagnosed (2) in their lifetime.
Recently, the University of Illinois at Chicago (UIC) developed a new combined PET-CT scan technique that incorporates a 72-hour high-fat, low-sugar diet before images are taken. According to the article in Imaging Technology News, “researchers were able to diagnose cardiac sarcoidosis much more accurately and could diagnose cases that would not have been picked up using the usual 24-hour high-fat, low-sugar protocol normally prescribed before the combined PET-CT scans.” (3) Researchers are now using this technique to study the relationship between cardiac sarcoidosis and sarcoidosis that may have spread to other areas of the body.
Medical imaging also helps to detect other diseases of the lung. Exposure to toxic dust led to a massive influx of industrial workers being diagnosed with rare lung conditions like silicosis and black lung disease. One of the most deadly airborne contaminants still impacting industrial workers to this day is asbestos, a mineral that was heavily used throughout equipment and scattered across worksites. These fibers attribute to nearly 3,000 cases of mesothelioma (4) annually. It is an extremely rare and difficult cancer not only to detect, but also to treat and manage.
CT is the most common method for detecting malignant pleural mesothelioma.
Research has found that if a patient has endured long-term exposure to asbestos, radiographic imaging can be effective (5) in assisting doctors with identifying malignant mesothelioma. However, results can point to a number of different diagnoses including adenocarcinomas, lymphoma, and several other chronic lung conditions. This is because chest radiography can detect non-specific abnormalities such as cancerous masses, pleural effusions and pleural thickening, suggestive of mesothelioma only if the patient has a high-risk history.
CT remains the most common method for detecting malignant pleural mesothelioma. However, radiologists might need to combine other techniques like MRI and PET scans in order to interpret the images accurately. Although results may require further research, a study from 2014 (6) concluded that screening high-risk workers could greatly aid in the mortality rate for those exposed to asbestos and should be utilized accordingly.
Looking toward the future of earlier detection
Radiographic efforts have been vital to early detection; however, results may not provide doctors with all the information they need to make the right call. Combining forces with Artificial Intelligence (AI) could help fill this gap by reducing errors and providing radiologists with pre-screened images, saving time for both specialists and patients.
Researchers from Great St. Petersburg Polytechnic University in Russia demonstrated just how powerful the combination could be through an AI software dedicated to lung cancer (7). This intelligence system can not only differentiate between benign and malignant tumors, but also has the uncanny ability to read CT images as quickly as 20 seconds.
Anna Meldo, head of the Radiology Department, explained, “Many different objects may be detected on the CT images, so the main task was to train the system to recognize what each of the objects represents. Using the clinical and radiological classification, we are trying to train the system not only to detect tumors, but to distinguish other diseases similar to cancer.”
This recent study demonstrates just how powerful artificial intelligence can be when combined with radiology, helping critically ill patients perhaps gain an earlier diagnosis. In addition, the nature of AI allows the system to self-improve and with every new CT image that it reads. As a result, it is expected to become more efficient in detecting lung abnormalities.
Although early detection has been a major hurdle for rare diagnoses, diagnostic imaging is playing a critical role in helping patients move into the treatment path sooner.
Lauren Eaton is a writer dedicated to educating the public about the dangers of asbestos and the cancers that can develop as a result of exposure.
Read the blog to learn about Industrial Diagnostics Company’s program to increase access to earlier screening for fibrosis.
Revisión de medio año de los principales Blogs de Everything-Rad.
¿Cuáles son los blogs más populares en imágenes médicas? A medida que llegamos a la mitad del año, Everything Rad repasa los blogs que este año fueron los más visitados por nuestros 15,000 visitantes mensuales.
No es sorprendente que los blogs más populares, y los temas que más publicamos, se refieran a los avances en la captura e informes de imágenes médicas. Del mismo modo, no es sorprendente que a los profesionales en imágenes médicas también les interesen los blogs sobre el impacto de la tecnología en su profesión y en los pacientes. Nuestros blogs durante la primera mitad de 2019 se dividieron en 3 categorías:
Desarrollo en imágenes de Rayos X e Informes
Opiniones de radiólogos sobre la adopción de tecnología
Hasta el descubrimiento de la tecnología de nanotubos de carbón, introducida en todo el mundo por Carestream, los dispositivos de rayos X utilizaban una ampolleta de vacío. Este es un dispositivo similar a una bombilla con filamentos de tungsteno que se calientan a mas de 1000 grados Celsius para generar los electrones necesarios para producir la imagen de rayos X.
LA tecnología de nanotubos de carbono, por otro lado, es una tecnología “fría”. La producción de electrones no se logra calentando un filamento, sino mediante la aplicación de un campo eléctrico. Además, los electrones se enfocan en las puntas de los nanotubos de carbono. Existe un porcentaje mucho mayor de electrones utilizados para la creación de una imagen de rayos X. finalmente, a diferencia de las ampollas al vacío, la CNT no necesita ser enfriada, lo que contribuye a un tubo mucho mas pequeño y mas liviano. De hecho la tecnología de nano tubos de carbono produce un 80% de reducción de peso.
A) Cabeza de tubo DRX-Revolution y conjunto con el colimador, con un ancho de ~56 cm (22 in.) y un peso de 75 kg (165.3lb). (B) DRX-Revolution Nano tube head and collimator assembly, ~32 cm(12.5in.) in width and weighing 7 kg (15.4 lb).
Los informes interactivos y multimedia están disponibles en las estaciones de trabajo de radiología hoy en día, sin embargo, muchos informes de diagnóstico por imágenes siguen estando basados en texto. De hecho, el formato de los informes de imágenes médicas creado por la mayoría de los departamentos de radiología no ha cambiado mucho en más de 100 años.
Los informes multimedia, hipervínculos, imágenes clave y otras funciones que mejoran la productividad están disponibles hoy en el módulo de informes de Carestream Vue Reporting .
El modulo de informes proporciona datos comparativos que son interactivos y tienen un rico contenido multimedia que proporciona acceso al informe y las imágenes clave asociadas. Para las ubicaciones que no tienen acceso a un visor de empresa (por ejemplo una cirugía de medicina general), proporcionamos un PDF encapsulado con este contenido, con enlaces interactivos a un portal de pacientes. El informe interactivo puede ayudar a facilitar la comunicación entre las partes interesadas, permitiendo a los médicos colaborar interactivamente con los pacientes.
En el futuro, el modulo será compatible con la base de conocimientos. Según el contenido del informe, podría incluir enlaces a los materiales de referencia en líneas relacionadas.
Las radiografías de tórax móviles a menudo se realizan en pacientes con enfermedades agudas que son demasiado críticos o inestables para ser trasladados a una sala de imágenes de rayos X. Para estos pacientes, las radiografías móviles de cabecera pueden ser la única opción para imágenes médicas. Sin embargo, la imagen de tórax móvil tiene algunos inconvenientes potenciales.
Uno de ellos es la degradación potencial de la calidad de imagen debido a la dispersión de la radiación. Este fenómeno ocurre con mayor frecuencia cuando se toman imágenes de áreas más gruesas del cuerpo, como el tórax, especialmente si la colimación no está lo suficientemente cerca. Específicamente, cuando los rayos X penetrante el tórax, un porcentaje de los fotones se involucra en las interacciones de Compron y hace que la radiación se disperse. Esto compromete la calidad de la imagen al introducir una señal de fondo de baja frecuencia cargada de ruido que crea una bruma. El resultado es una imagen con contraste y detalles reducidos. Creando el potencial de vasculatura oculta, infiltrados y otras patologías.
Recientemente, Carestream introdujo un software que reduce los efectos dañinos de la dispersión de la radiación en una imagen, lo que ayuda a mejorar el contraste de la imagen cuando no se utiliza una cuadricula física anti-dispersión. El software de Carestream llamado SmartGrid, utiliza un algoritmo avanzado que calcula la dispersión de baja frecuencia distribuida a lo largo de una imagen y la reduce.
Constantemente se introducen nuevas formas de tecnología en las imágenes médicas, lo que a menudo conduce a mejores opciones diagnosticas y terapéuticas. Sin embargo, la nueva tecnología también puede ser una fuente de frustración especialmente cuando no funciona correctamente o no se comprende bien. Superar estos obstáculos requiere la participación de todo el departamento de radiografía, tanto de los profesionales de la salud individuales como de sus gerentes.
En abril, Everything Rad publicó un blog sobre un estudio sobre las ideas, opiniones y percepciones de la tecnología de los radiólogos; y oportunidades para aumentar su adopción. El estudio, realizado por Sil Aarts, profesor asistente, del departamento de investigación de Servicios de Salud, Países Bajos, establece recomendaciones para el departamento de radiología y radiólogos individuales, a fin de aumentar la adopción.
Los radiólogos, técnicos en medicina nuclear y radioterapeutas en el estudio, dijeron que valoran los desarrollos tecnológicos no solo para realizar el negocio principal de su trabajo, sino también en relación con otros aspectos como la documentación, la comunicación y el soporte físico.
Según los participantes, todos los desarrollos tecnológicos deben estar en el mejor interés del paciente. Los participantes también señalaron la necesidad de recibir mas capacitación dirigida a aumentar el conocimiento relacionado con los desarrollos y dispositivos tecnológicos. Esto debería, según estos profesionales de la salud, ser facilitados por los gerentes de sus departamentos.
El congreso Europeo de Radiología (ECR) es un foro equivalente al evento RSNA de Norteamérica. Aunque hubo 80 sesiones sobre inteligencia en la ECR 2019, el tema que surgió a menudo en las conversaciones y en las sesiones a las que asistí el primer día fue el factor humano de muy baja tecnología pero muy importante. Los “humanos” son tanto los pacientes que reciben la atención como los radiólogos que los cuidan.
“Mantener al paciente y su atención al frente de nuestra atención es un enfoque para nuestra asociación y para nuestros radiólogos. Hemos asegurado que la tecnología que utilizamos es el estándar de oro, pero a veces dejamos de lado el enfoque en el paciente” Dijo Rodrigo García Gorga, radiólogo y secretario general de la sociedad española de geografía y técnicos en radiología.
Usar/ver la necesidad de un formulario de consentimiento firmado como una cortesía común para extender al paciente y como una forma de generar confianza entre el radiólogo y el paciente. El verdadero propósito del consentimiento informado es garantizar que los pacientes y/o sus representantes reciban información relevante que faculte sus decisiones de salud.
Continuar usando/compartiendo información en papel del paciente sobre radiología. Poner la información por escrito mejora la transferencia de información a los pacientes. También actúa como una ayuda de memoria para pacientes y cuidadores.
Tener en cuenta los valores del paciente. Los radiólogos, al igual que otros proveedores de atención médica deben considerar que los valores de un paciente son probablemente diferentes de los suyos; y que sus valores influirán en las decisiones del paciente sobre su cuidado.
“Los pacientes pierden su identidad rápidamente cuando ingresan en el entorno hospitalario” dijo la Dra. Studwick en su presentación sobre “Capacitación en prácticas basadas en el valor (VBP) para radiólogos. “VBP nos recuerda que diferentes personas tienen valores diferentes. Además, los valores de una persona pueden variar de un encuentro a otro, según la situación y como se sientan ese día. Además los pacientes pueden valorar cosas muy diferentes de varios practicantes. Por lo tanto, es importante no hacer suposiciones sobre como se siente un paciente o lo que podría ser importante para ellos. Cada paciente debe ser considerado como un individuo.”
La tecnología del equilibrio avanza con el toque humano. Sospecho que esto seguirá siendo un tema común en Everything Rad durante la segunda mitad del año-
¿Qué leíste o experimentaste en radiología durante la primera mitad del año que fue interesante? Por favor comenta abajo.
What are the most popular blogs on medical imaging? Everything Rad reviews which blogs written this year in the first half of 2019 were opened the most by our 15,000 monthly visitors. The most popular blogs are about advances in medical image capture and reporting.
It is not
surprising that the most popular blogs – and the topics we published the most –
are about advances in medical image capture and reporting. Likewise, it is not
surprising that medical imaging professionals also were interested in blogs
about the impact of technology on their profession, and on patients. Our blogs during
the first half of 2019 fell into 3 categories:
Until the discovery of carbon nanotube technology, introduced worldwide by Carestream, X-ray devices used a vacuum ampoule. This is a device similar to a bulb with tungsten filaments that are heated to more than 1,000 degrees Celsius to generate the electrons necessary to produce the X-ray image.
Carbon nanotube technology, on the other hand, is a “cold” technology. The production of electrons is not achieved by heating a filament, but rather by the application of an electric field. Also, electrons are focused at the tips of the carbon nanotubes. There is a much higher percentage of electrons used toward the creation of an X-ray image. Finally, unlike vacuum ampoules, CNT does not need to be cooled, thus contributing to a much smaller, lighter-weight tube. In fact, carbon nanotube technology yields 80 percent weight reduction.
Figure A shows a DRX-Revolution tube head and collimator assembly, ~56 cm (22 in.) in width and weighing 75 kg (165.3lb). Figure B shows a DRX-Revolution Nano tube head and collimator assembly, ~32 cm (12.5in.) in width and weighing 7 kg (15.4 lb).
Another popular blog discusses radiology reporting. Interactive, multi-media reporting is readily available within radiology workstations today – yet many diagnostic imaging reports remain text based. In fact, the format of medical imaging reports created by most radiology departments has not changed much in over 100 years.
Interactive, multi-media reporting is readily available today – yet many diagnostic imaging reports in remain text based.
Multi- media reports, hyperlinks, key images, and other productivity-enhancing features are available today in Carestream’s Vue Reporting module.
The reporting module provides comparative data that is interactive and has rich multimedia content providing access to the report and associated key images. For locations that do not have access to an enterprise viewer (e.g. a GP surgery), we provide an encapsulated PDF with this content, with interactive links to a patient portal. The interactive report can help facilitate communication between stakeholders, enabling clinicians to collaborate interactively with reporters.
In the future, the module will be able to support Knowledge Base. Based on the content in the report, it could include links to related online reference materials.
Mobile chest X-rays are often performed on acutely ill patients who are too critical or unstable to be transported to an X-ray imaging room. For these patients, bedside mobile X-rays can be the only option for medical imaging. Yet, mobile chest imaging has some potential drawbacks.
One of them is the potential degradation of image quality due to radiation scatter. This phenomenon occurs most frequently when imaging thicker areas of the body – such as the chest – particularly if collimation is not in close enough proximity. Specifically, when the X-rays penetrate the chest, a percentage of the photons engage in Compton interactions and cause radiation to scatter. This compromises image quality by introducing a noise-laden, low frequency background signal that creates a haze. The result is an image with reduced contrast and detail, creating the potential for obscured vasculature, infiltrates, and other pathology.
Recently, Carestream introduced software that reduces the damaging effects of scatter radiation in an image – helping to improve the contrast of the image when a physical anti-scatter grid is not used. Carestream’s software, called SmartGrid, uses an advanced algorithm that estimates low-frequency scatter distributed throughout an image and reduces it.
Everything Rad readers were interested in new technology for reducing scatter.
New forms of technology are introduced constantly in medical imaging, often leading to enhanced diagnostic and therapeutic options. However, new technology also can be a source of frustration, especially when it is not working properly or not well understood. Overcoming these hurdles takes involvement from the entire radiography department － the individual healthcare professionals as well as their managers. The widespread impact of technology made this article one of the most popular medical imaging blogs so far this year.
In April, Everything Rad published a blog on a study about radiologists’’ ideas, views and perceptions of technology; and opportunities to increase its adoption. The study, conducted by Sil Aarts, assistant professor, Department of Health Services Research, the Netherlands, lays out recommendations for the radiology department, and individual radiologists, to take to increase adoption.
The radiographers, nuclear medicine technologists, and radiation therapists in the study all said they value technological developments not only to perform the core business of their work, but also regarding other aspects such as documentation, communication, and physical support.
According to the participants, all technological developments should be in the best interest of the patient. Participants also pinpointed a need to receive more training aimed at increasing knowledge related to technological developments and devices. This should, according to these healthcare professionals, be facilitated by the managers of their departments.
How can imaging professionals keep pace with the adoption of new technologies?
The European Congress of Radiology (ECR) is a forum equivalent to North America’s RSNA event. Although there were 80 sessions on artificial intelligence at ECR 2019, the topic that surfaced often in conversations and in the sessions I attended on day one was the very low-tech but all-important human factor. The “humans” being both the patients receiving the care and the radiographers who care for them.
“Keeping the patient and their care at the front of our attention is a focus for our association and for our radiographers. We have assured that the technology we use is the gold standard, but sometimes we leave the focus on the patient behind,” said Rodrigo Garcia Gorga, a radiographer and general secretary of Sociedad Espanola deGraduados y Tecnicos en Radiologia.
Keeping patients at the center of care was another popular blog on medical imaging.
Using/viewing the need for a signed consent form as a common courtesy to extend to the patient and as a way of building trust between radiographer and patient. The true purpose of informed consent is to ensure that patients and/or their representatives are provided with relevant information that empowers their health decisions.
Continue to use/share patient information about radiology in paper form. Putting the information in writing enhances the transfer of information to the patients. It also acts as a memory aid for patient and carers.”
Take patient’s values into consideration. Radiographers, like other healthcare providers, need to consider that a patient’s values are likely different from their own; and that their values will influence the patient’s decisions about their care.
“Patients lose their identity quickly when they come in to the hospital environment,” says Dr. Strudwick. “VBP reminds us that different people have differing values. In addition, one person’s values may vary from one encounter to another, depending on the situation and how they are feeling on that given day. Also, patients may value very different things from various practitioners. Therefore, it is important not to make assumptions about how a patient is feeling or what might be important to them. Each patient must be considered as an individual.”
Balancing technology advances with the human touch. I suspect this will remain a common theme on Everything Rad throughout the second half of the year.
What did you read or experience in radiology during the first half of the year that was interesting? Please comment below.
Katie Remis is the editor of Everything Rad. She is also Carestream’s Worldwide Social Media Manager. Reach her at Katie.Remis@Carestream.com
Having two diagnostic technologies in a single system can generate cost-savings in several ways.
Today, success in healthcare demands delivering better care, for more patients, at a lower cost. That’s a tough challenge. Small wonder that hospitals and imaging centers are looking outside the box for new ways to improve their productivity and outcomes.
One growing trend that has developed in response to this need is the design and adoption of dual-modality systems. The idea is simple: buy a single system and gain two sets of capabilities for one price. Recent years have seen the introduction of systems combining computed tomography (CT) with single-photon emission computed tomography (SPECT) for the assessment of cancer patients. Other dual solutions include a cardiovascular system that integrates CT capabilities with X-ray angiography imaging.
Carestream’s Entry: The DRX-Excel Plus System
Carestream’s DRX-Excel Plus is one of the latest dual-modality solutions to enter the market. Designed specifically for large hospitals and imaging centers, it combines both fluoroscopic imaging and general radiology capabilities in one compact unit – at a very attractive price. It then delivers exceptional ROI over time with dual-modality flexibility and productivity features.
The DRX-Excel Plus delivers ergonomic design and attention to detail to help ensure patient comfort and user productivity. A focus on efficient system operation accelerates workflow. And high-resolution image capture and processing support excellent image quality and fast, confident diagnoses.
Want to learn more about this innovative two-in-one solution? Check out these videos, showing the Excel-Plus in action during a range of different fluoroscopic and general X-ray exams – a Barium Swallow chest X-ray exam, as well as studies for knee arithriogram, long-length imaging X-ray and upper GI radiology exam workflow. #fluoroscopy #dualmodality #xrayequipment
Sarah Verna is Carestream’s Worldwide Marketing Manager for X-ray Solutions.
Five key elements to help solve difficult and complex issues.
Personally, I believe that innovation lives within everyone. We all have “invented” things, only to discover someone else already had the idea. Think of it this way: If you did not know it existed, then in effect you invented it too. You just were not the first to document the idea. The mental process is the same. Timing is the only difference. So maybe you won’t get a patent on this idea. It still reveals you have the creative mind of an inventor.
I also believe that a core principle of innovation can be found in nature – for example in the phenomenon of the cross-pollination of plants where strengths of two individual plants contribute to the creation of a third, unique plant. Likewise, when humans innovate, we often take ideas we are familiar with in one context and combine them with challenges and ideas from another context to create an entirely new solution. Integrating different perspectives and points of view give us this power to invent.
Motivating innovation
Innovation lives within everyone!
Without question the motivation to innovate is within everyone as well, and shows itself when we encounter a problem we need to solve. We address it in a unique way based on our own personality, thought patterns, and experiences. It also has to do with why we are solving the problem at all. For example, if your boss or your teacher directs you to solve a problem, you will do it …and call it work. But if you choose your own problem to solve – one that is personally meaningful to you, then the process can be quite engaging. Even joyful.
Think about it – the games and hobbies we play for fun are actually challenges in creative problem solving. Whether fishing or Minecraft, we are engaging in creative problem solving.
The technology of today is built on the inventions of yesterday. It truly is the act of creative problem solving that advances us all and improves the human condition. Had we never invented anything, we would still be living in trees or caves. But gradually, humans developed ways to create fire, metal, and wheels, then on to machines, electronics, and so on. This led to the level of advanced technology we have today – which of course is nothing compared to what we’ll have tomorrow. Every little innovation we make is a tiny piece of the foundation of our future.
Necessities in medical imaging
“Necessity is the mother of invention”, or so the old saying goes. But what qualifies as a necessity? For hospitals and imaging centers, there are myriad needs and problems in many different areas: long patient wait times in X-ray departments… the need for more effective infection-control measures… goals for higher patient satisfaction… the need for and both physician and employee retention – and the list goes on.
Let’s start with the problem of long patient waiting times. If you consistently find a hundred people crowded in to your waiting room at 3:00 p.m., the answer is not to make a bigger waiting room. The hospital has the capacity to handle those hundred people. By 3:00 a.m. there will be no or very few people still waiting. So all 100 people that were waiting in there this afternoon will have been taken care of. The problem is that people show up at a rate and at times that cause bottlenecks.
If we borrow an innovation from manufacturing we would consider the idea of Takt time. The idea is to make every step of the production process the same length, so there are no bottlenecks. So rather than look at the size of the waiting room, the facility should look at the amount of time that each step in the process takes If it takes longer, for example, to register someone than it does to shoot the images, then that could be the issue. If it takes longer to do the examination then it does for the patient to change clothes that could be an issue. If the facility can redesign the various steps to be the same in terms of time duration, then the process would begin to move very efficiently.
I think of this like the steps on an escalator. Each person on the escalator goes up the escalator at the same speed the steps moves. The next step appears; the next person steps on the step and off they go. Each step in the process takes approximately the same amount of time. If you could regulate a hospital’s imaging process in a similar way, then that would really make things run efficiently.
Now, the preceding was a very simple example. What happens when the attempt to innovate involves highly difficult and complex issues? In such a situation, I believe there are five key elements that we should focus on.
Todd Minnigh gave a presentation on innovation at AHRA 2018.
Innovation element #1: diversity
First, we need to have diversity – diversity of thinking, diversity of people, diversity of ideas. This allows for a cross-pollination of various perspectives and experiences that a broad spectrum of individuals bring to the party. So if you’re the person that’s often tasked as the problem-solver, consider engaging folks that have different backgrounds to help you address the next problem that arises.
Innovation element #2: fearlessness
The next ingredient is fearlessness. You have to be brave, because you’re inevitably going to come up with ideas that people won’t like. They’re going to laugh, and ask how could that possibly work? They won’t understand what you can see clearly as the solution. Just don’t take it personally, and remember they’re not being critical of you. Simply persevere and show them the value of your innovation. Once they understand they’ll be more receptive the next time around – and, you’ll be less sensitive to their initial objections.
Innovation element #3: insight
The third of the five key elements in innovation is insight, or what is commonly referred to as domain knowledge. Even if you don’t initially understand the problem situation in its entirety, if you keep studying it you will learn more and more about it and eventually become more expert.
Innovation element #4: tenacity
Fourth, innovation requires incredible tenacity. You have to stick to it. Don’t give up. Keep working on that new idea. Not perfect yet? Rework it from a fresh perspective. Keep trying different approaches and modeling them in your mind. This is easy to say and difficult to do – stick to it and keep coming back to it. You will find a solution.
Innovation element #5: passion
The fifth key principle of innovation is passion. It’s the passion for solving the problem which will supply you with tenacity to keep going – to keep ideating, even when progress is slow and you become discouraged. Remember, if you keep thinking about the problem, and you keep visualizing it and you keep working on it… if you’re reading about it in books, researching it on the internet, talking to other people, writing things down, drawing pictures, laying out plans, letting it rest for awhile then coming back to it again… the passion that motivates you will eventually bring you to the solution.
Conclusion
To summarize, there are many, many pressing problems we face that need solutions. To help develop the innovative solutions they need, you need five components in the mix: diversity, fearlessness, insight, tenacity and passion. You have to be open, you have to be encouraging to yourself and to others. You have to focus on problems that you are truly passionate about solving, or you won’t have the drive you need to keep slogging away.
And remember, if the solution you come up with is even a little bit better than what existed before, you have played a crucial part in improving the human condition and making everyone’s life just a little bit better – and you’ve proven yourself a successful innovator!
How do you motivate yourself and your team to innovate? I’d like to hear your ideas!
Todd Minnigh is Vice President of Global Service Sales at Carestream. Todd delivered a presentation on innovation at the 2018 American Hospital Radiology Administrator’s Conference (AHRA).
How the Ministry of Health in Oman helps imaging professionals keep their knowledge and skills current.
Mrs. Asya Al-Lamki, Consultant Radiographer, Department of Imaging & Intervention, Ministry of Health, Oman.
Advances in technology impact many areas of healthcare, including diagnostic imaging. Staying current with new technology requires a commitment to continuing education for radiology. Otherwise, we might miss advancements that could contribute to a patient’s quality care and well-being.
The Ministry of Health in Oman partnered with Carestream to hold an advanced hands-on digital radiology workshop.
For this reason, the Oman Medical Specialty Board (OMSB), the governing body in Oman, requires all medical staff to enhance their knowledge and skills by obtaining a certain number of accredited points annually. This is usually accomplished by attending different educational programs relevant to their fields.
Although re-certification is not required for radiographers, they also need to keep their knowledge and skills up to date. Ongoing education helps them stay current with advancements in imaging procedures and in imaging equipment.
To assist our radiographers with their continuing education, we recently partnered with Carestream to hold an advanced hands-on DR (digital radiology) Workshop in Oman. The lead instructor was Carestream’s Clinical Development Manager/Product Line Manager, Martin Pesce, RT, R.
Continuing education in radiology contributes to more use of DR features
Ongoing education helps radiographers stay current with advancements in imaging procedures and in imaging equipment.
Mr. Pesce showed participants how to use the features within their DR machines more efficiently and effectively. He also explained when and how to calibrate the detectors, do quality control tests, and how to use the correct exposure indicators. The topics of pediatric radiography imaging and dose monitoring also were covered in the DR workshop.
Mr. Pammi Sreenivasa Chary, Senior Radiographer and Key Operator at Royal Hospital, Muscat, said the training made him realize that “most of the functions were not used effectively,” prior to the training. He added that he believes the workshop will help the department improve pediatric radiography imaging and dose monitoring.
“This seriously helped me to understand and update about the latest technology on our DR system,” added Mr. Khalid Mohammed Al Mahrooqi, Clinical Tutor, Oman College of Health Sciences, Muscat, Oman. “It helped familiarize me with optimization tools that are available and how they can shape our daily practice.”
Training contributes to well being of radiographers
The training also contributed to the well being of our radiographers who work with ionizing radiation that can be harmful to them as well as the patients if not used properly. Mr. Pesce gave a thorough review of the factors that are important in radiation protection. These included collimation and the use of correct exposure indicators to help ensure the safety of the operators and patients, as well as produce good image quality.
Of course, patient well being is our priority. However, another advantage of continuing education in radiology is that we are making better use of the equipment we have invested in. Carestream’s workshop will help us to use the equipment to its fullest.
Hands on workshops like this help our imaging professionals keep their knowledge and skills up to date, enhancing the general diagnostic quality and supporting the Ministry’s goal of improving patient care.
Mrs. Asya Al-Lamki has been working in medical imaging for nearly 17 years; four years in the United Kingdom and the remaining years in Oman’s Ministry of Health. Mrs Al-Lamki worked as General Supervisor Radiographer in Khoula hospital, and was Senior Lecturer in Radiography at the Institute of Health Science (College of Health Sciences). She is currently working in the Directorate General of Specialized Medical Care as a Consultant Radiographer in the Department of Diagnostic and Intervention.
Medical imaging providers in LAR are adapting to new workflows.
In the upheaval of the COVID-19 pandemic, healthcare providers in Latin America were presented with new challenges to deliver medical imaging to their patients. Some of the challenges still persist, while others are emerging.
Everything Rad ask three knowledgeable representatives from our Latin American region—Ricardo Martin del Campo Fonseca, regional business manager, Carestream Health; Samuel Siller Ruiz, director, Medica Siller; and Fernando Sales, director, Tiradentes Saúde—about the challenges and trends in medical imaging in LAR for the remainder of 2021.
Everything Rad: What are the top challenges facing medical imaging providers in LAR?
RICARDO: A primary challenge is a need for safer workflows and faster imaging studies with more intelligent and customized systems that can handle the peaks of demand. Another major challenge is the adoption of new digital technology to support telehealth, especially by older generations who have more experience in analog technologies. There’s a significant portion of the population that doesn’t have access to the internet, so the availability and resources needed to support patients this way presents real challenges.
A significant trend is increased adoption of digital radiography.
SAMUEL: More imaging centers are moving toward digital radiography. One of the drivers is that it enables remote radiological interpretation by healthcare providers.
FERNANDO: One obstacle is price increases in taxes and the dollar. As an example, there are increased prices for film which is challenging for customers who are looking for cost reductions. Also, there is more competition in healthcare. Patients are looking for better efficiency and service, so there are lots of initiatives surrounding health and patient-care satisfaction.
Everything Rad: How has COVID-19 impacted medical imaging?
RICARDO: COVID-19 fueled growth in the digital imaging market in a number of ways. One, clinical staff needs to have images readily available in the patient room, so portable digital radiography units took a leading role due to their simple and mobile workflows.
Another reason for the increase in the use of our mobile systems is because they help reduce the risk of cross contamination, not only between patients, but also across different areas of hospitals and temporary clinics that were established for the health emergency.
SAMUEL: There was definitely an increase in chest imaging—and much of it was concentrated in CT—with decreases in exams for limbs and lower limbs. The decrease led to the closing of small imaging centers. And everywhere, the workflow changed with respect to the safety protocols required.
FERNANDO: COVID decreased the number of mammography, ultrasound, and MRI exams. But there were more digital tomography and X-ray exams, so workflows were concentrated in those modalities.
Everything Rad: What new modalities or workflows is the market interested in this year, and why?
Ricardo Martin del Campo Fonseca, Regional Business Manager, Carestream Health.
RICARDO: We continue to see the demand for digital modalities, with a strong preference for Carestream’s mobile units, in addition to our digital upgrades designed for analog systems. These systems allow customers to upgrade their equipment while optimizing their investments. Imaging centers want the benefits of digital technology.
SAMUEL: Mobile equipment and wireless detectors are of high interest, due to COVID-19 issues.
FERNANDO: Our customers are always looking for feature-rich products at an affordable cost. The market also is interested in new modalities and workflows that offer more productivity for exams, so that they can use them outside clinics and hospitals—basically, modalities that reduce the need for patients to go to a clinic or hospital.
Everything Rad: What questions about COVID-19 and imaging are you hearing the most?
RICARDO: There were three main concerns at the beginning of the pandemic. First was about proper procedures for cleaning and disinfecting equipment to help avoid cross contamination (1). The second was about the software support Carestream could provide, such as our pneumothorax and bone suppression software, to help doctors provide faster and more accurate diagnoses. And the third was about the availability of our mobile systems. The demand for mobile units tripled and there was certainly a shortage of components globally.
SAMUEL: At the end of the day, people weren’t asking us about COVID-19. They were basically focused on the new health regulations and protocols surrounding the virus to avoid contagion.
FERNANDO: Most of the questions we’re hearing are about what’s ahead in imaging technology solutions for COVID-19 and other exams.
Everything Rad: What new or upcoming regulations in LAR will have impact on medical imaging?
RICARDO: The priority for local governments continues to be tracking COVID-19 cases. There was a lot of concern about hospital capacity, so another priority is establishing vaccination plans across the countries in the region.
In addition, there is a lot of focus on public healthcare, which is driven by an increase in budgets to equip and upgrade medical technologies to better serve patients and increase the number of beds in each region or country.
SAMUEL: We believe that the regulations of Cofepris and the Secretary of Health, which regulate hospitals and smaller imaging centers, will become much more strict. The new regulations for traditional and mobile X-ray equipment will be maintained to help with COVID-19 patients, which will have economic impacts. In some cases, the regulations will also have economic effects on imaging centers and their staff, especially smaller centers, because the new regulations require extra steps in workflows for infection control.
FERNANDO: The new and upcoming regulations will allow for more procedures to take place outside of clinics and hospitals, and there will be new tools for these.
Everything Rad: How is COVID-19 impacting your interactions with healthcare providers? How are you accommodating their concerns at this time?
RICARDO: An important part of our interactions continues to be virtual, through mobile applications such as WhatsApp, which has always been popular. But due to COVID-19, we have used more tools, including video, to deliver personalized experiences to our customers. On the other hand, we are beginning to notice a new reality, in which the personal interactions with our clients are returning. We are taking all the available safety measures. It seems that the new norm will be a combination of virtual and personal interactions, with clients and for educational activities.
SAMUEL: Interaction has definitely changed—part of it is digital and via telephone, of course. But the protocols for visiting customers have become more rigid and difficult. As long as we delivery quality equipment on time and use the established safety protocols, our customers are satisfied.
FERNANDO: COVID-19 has changed the way we work with our customers, because none of them allowed us to visit them in clinics and hospitals. But we definitely used other wats to maintain our relationships, using remote presentations by computer, cell phone and others.
Everything Rad: What do you think will be the lasting changes of COVID-19 in medical imaging?
RICARDO: It seems that the rapid adoption of digital technology has arrived and occupied a permanent place in the market, whereas before there was a gap between analog and digital, and customers were hesitant to change. But the pandemic made the benefits visible. It helped provide the fast and streamlined workflows that clinicians needed, along with software support to help with clinical decisions, dose reduction and image quality. Another big change is the level of attention to biosecurity, this will be a decisive factor in solutions throughout the market.
SAMUEL: As long as COVID-19 is with us, printing may increase, because radiology exams are necessary for diagnosis.
FERNANDO: I think customers will continue to make investments in technology—in equipment and other products for medical imaging.
Editor’s note: It’s clear that digital and mobile radiology devices are truly having their moment in the wake of the COVID-19 pandemic—and that they’re increasingly being adopted by customers in Latin America. Recent research backs this up. The Modor Intelligence report, “South America Portal X-ray Devices Market – Growth, Trends, COVID-19 Impact, and Forecasts (2021-2026). states that:
“In the present scenario, the adoption rate of digital X-ray systems is not (or close to) 100%, in spite of their advantages over analog systems. However, this scenario is expected to change soon, and the X-ray devices market is likely to be almost completely dominated by digital X-ray systems in the future.” (2)
The Modor report also points out that the increase in the geriatric population is helping to drive this growth in digital radiology—which is a key factor in populations worldwide.
Carestream applies Artificial Intelligence to improve medical image quality.
In some ways, the path to improving X-ray image quality seems pretty straightforward. There are three fundamental components of image quality: noise, sharpness, and contrast. The complexity comes from the fact that the sharpness and the noise are intertwined. Traditional noise reduction introduces blurring–which degrades image sharpness and might remove important anatomical information. Conversely, the more an image was sharpened, the more noise was enhanced. “Denoising an image” is a challenge that medical imaging scientists have been grappling with for some time.
Carestream is pleased to share that our team of imaging scientists have successfully broken this tight, interdependent gridlock and have “separated” image noise from sharpness. We call this groundbreaking technology “Smart Noise Cancellation” or SNC.
Objective testing demonstrated that SNC processing enables a 2X to 4X noise reduction in flat areas, preserves high frequency sharpness, and improves contrast detail.
How does this advance X-ray image quality? SNC significantly reduces image noise while retaining fine spatial detail [i]–there is no degradation of anatomical sharpness. When SNC is applied, it produces images that are significantly clearer than with standard processing. It also provides better contrast-to-noise ratio for images acquired at a broad range of exposures. And when combined with our SmartGrid software, it promises benefits in gridless imaging where the removal of scatter typically leads to an increase in noise appearance.
We believe this technical breakthrough will be especially beneficial for the high-contrast detail necessary for MSK imaging. For example, in a bone exam it is important to visualize the trabecular bone pattern help rule out a fracture. With its ability to separate anatomical detail from noise, SNC can remove noise while maintaining the fine trabecular structure, easing the interpretation of the exam.
Smart Noise Cancellation is an optional feature of our ImageView Software, powered by Eclipse, the intelligent platform that serves as the backbone of Carestream’s image processing. The synergy of SNC along with Eclipse results in image quality that is truly remarkable.
Reader study demonstrates that SNC improves image quality
Objective measurements and subjective ratings demonstrate that SNC processing can reduce noise while simultaneously retaining fine spatial detail. Objective testing demonstrated that SNC processing enables a 2X to 4X noise reduction in flat areas, preserves high frequency sharpness, and improves contrast detail. More specifically:
A 2x to 4x noise reduction in flat areas is attainable;
High contrast sharpness is preserved;
A 10% to 20% improvement in contrast-detail scores on the CDRAD 2.0 phantom is attainable.
Additionally, in a blinded Clinical Reader Study utilizing board certified radiologists:
89.5% of all study ratings showed a slight to strong preference for SNC processed images.
64% of the diagnostic quality ratings improved based on the RadLex image quality rating scale.
56% of the diagnostic quality ratings improved from “limited” or “diagnostic” to “exemplary”.
In a blinded Clinical Reader study, 89.5% of all study ratings showed a slight to strong preference for SNC processed images.
In summary, the subjective assessment by board certified radiologists yields a strong signal that Eclipse with Smart Noise Cancellation significantly improves image quality and is strongly preferred.
We understand that the desired level of noise is subjective (e.g. some radiologists expect to see a certain degree of noise in images which assures them that the patient was not over exposed). For this reason, SNC allows a facility full control over the amount of noise cancellation and exposure to minimize dose while meeting their desired image quality.
Download the clinical Reader Study below.
The Noise Reduction Percentage feature is available to the user on the Image Processing Preference Editor and enables the key operator to set the amount of noise that is removed from 100% (the full noise field) to 50% (half magnitude of the noise field).
Another strong benefit of Smart Noise Cancellation is that it provides the ability to deliver images that are consistently of high quality. This gives imaging facilities more tolerance of acquisition variables – like the skill level of the radiographer – that can possibly negatively impact image quality.
Applying Artificial Intelligence (AI) to improve medical image quality
How did Carestream’s team of imaging scientists achieve this groundbreaking advance in X-ray imaging? The short answer is through a great deal of persistence and by leveraging Artificial Intelligence. Carestream is a leader in using AI for noise cancellation with X-ray images.
Smart Noise Cancellation is the first step in the image processing chain after receiving the raw images from the detector before any other image enhancements. It uses a deep convolutional neural network [ii] (CNN) that is trained to predict a noise-field from an input image. The CNN was trained using low noise/high noise image pairs of clinical patient, cadaver, and anthropomorphic phantom images representative of general radiography.
Let’s break this down into less-technical language. We presented the AI-based CNN a series of the same diagnostic image – one with high noise, the other with low noise. We created the series of high noise anatomical images by injecting noise into it. Our “noise injection technology” is what I like to refer to as “our secret sauce”. Through deep learning on a massive number of images, the CNN learned the levels of noise, the desired level of noise, and then how to separate the noise to produce images that are significantly clearer than with standard processing.
It was really exciting for our team to achieve this long-pursued target level of noise reduction that delivers improved image quality, increases contrast-to-noise, and ultimately produces easier-to-read radiographs that will not only aid diagnosis, but could help alleviate physician fatigue.
SNC enables imaging professionals to better optimize radiation dose
SNC processing is another important step forward in the direction of ALARA – “as low as reasonably achievable”. The guiding principle of ALARA is that imaging is performed with a dose just high enough to confidently achieve diagnosis.[iii] SNC enables medical imaging professionals to lower radiation dose without loss in image quality when compared to our standard image processing. This is especially important in neonatal and pediatric imaging where imaging at the lowest possible dose is critical.The objective measurements present reasonable evidence that dose reduction is possible, potentially up to 2X for detectors using CsI scintillators. A dose reduction study is forthcoming to further explore the capabilities of this new and exciting technology.
Improving image quality is a daily pursuit for Carestream’s team of imaging scientists. We are excited to have overcome this difficult challenge of image denoising, and we are gratified to know that our Smart Noise Cancellation imaging software can help our customers in healthcare take care of their patients.
Carestream imaging scientists who contributed to the development of Smart Nosie Cancellation are Karin Toepfer (Ph. D.), Lori Barski (MS), Jim Sehnert (Ph. D.) and Levon Vogelsang (Ph. D.).
Jim Sehnert (Ph. D.) is an imaging scientists at Carestream Health. He has more than 25 years of experience in X-ray imaging and holds more than 20 patents.
Telehealth and teleradiology centres have seen a significant uptake in volumes during the pandemic. They play an important role as patients could receive services virtually and providers embraced working remotely.
In December 2019, China reported an outbreak of the acute respiratory disease in Wuhan & the World Health Organization (WHO), compelled by the sheer ferocity of the spread declared it as a ‘Pandemic’ (an epidemic of an infectious disease that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals) on 11th March 2020. In India, we all recall the sudden spread from March 2020 and the resultant lockdown to contain the virulent spread.
The virus – SARS-COV-2, popularly known as COVID-19 or simply Coronavirus, is undoubtedly the biggest healthcare crisis our generation has seen. Like any other pandemic management, the first step was to accurately diagnose it amongst symptomatic patients.
Radiology or Diagnostic Medical Imaging offers a wide range of tools and techniques for detection, staging, and defining treatment modalities for disease management. In the case of Coronavirus, the role of chest imaging, including baseline X-ray and the HRCT or ‘High Resolution Computed Tomography’ of the Thorax or Chest became important as an imaging modality that provided a sensitive and specific investigation for the detection of the virus.
Mobile imaging has played an important role in limiting infection and providing point of care imaging throughout COVID .
HRCT Chest findings in COVID-19 and the CT Severity Scoring (CTSS) reveal the extent of damage to the lungs by the COVID-19 virus. The CT can also show Pneumothorax & Pleural Effusion even before they manifest clinically. Especially in India, further clinical examinations led to the detection of underlying co-morbidities such as chronic lung disease or heart failure.
All this clinical information was supremely important for Physicians treating the virus to determine virus severity and helped guide their treatment for multiple therapies, which included managing complications that surfaced in the entire diagnosis process.
The Radiology team across the country have had their fair share of constraints while being at the forefront of COVID diagnosis. Given the overwhelming number of patients, the Radiologists have had to overcome challenges such as lack of CT Scan machines especially in semi-urban and rural areas, patient management (particularly moving patients on oxygen support for Medical Imaging) and adhering to infection control protocols in crowded set ups (which can have an impact on their own safety and wellbeing).
While the Central and State Governments significantly scaled up their procurement of CT Machines and Hospital Infection solutions, certain innovations also got scaled up in the radiology field to help manage the large volume of patients. These included Telehealth, Bedside Imaging and Research on Artificial Intelligence & Deep Learning.
Telehealth or teleradiology centres have seen a significant uptake in volumes during the pandemic. They play an important role as patients could receive services virtually and providers embraced working remotely. Moving forward, with increasing Interoperability electronic health records, picture archiving and artificial intelligence solutions will help Radiologists in such pandemic management.
Healthcare facilities worldwide are embracing mobile imaging owing to its contribution to patient care (transferring critically ill patients to the radiology department can cause complications for the patient). Bedside or mobile imaging saw a significant scale up as it provided the added advantage of portability, quick diagnosis and patient and staff safety. A portable X-ray unit also helps capture an image at a patient’s bedside in lesser time than it would take to move a patient to an X-ray room. Images can be viewed by a physician immediately on the unit’s console.
Research in radiology has also accelerated in the field of Artificial Intelligence and Deep Learning. By incorporating DL algorithms & AI tools in the medical imaging equipment, medical device companies strive to help radiology departments reduce human error and make sound clinical decisions by aiding radiologists to spot anomalies in human tissue at the peak of the disease.
Beyond the clinical work, COVID-19 led physical and mental fatigue has led to greater attention to employee burnout. Radiology departments are beginning to address this concern by providing adequate staffing, fostering camaraderie and building organizational resilience.
Public health infrastructure, in general, was not ready to face a challenge like the novel Coronavirus back in March 2020. It would be prudent for all healthcare stakeholders to come together and create new business models to prepare for the next public health crisis and form long-term symbiotic partnerships with the MedTech industry to robustly confront such pandemic in the future.
Nikhel Goel is the General Manager of the India Cluster, Carestream.
This article was originally published in BW Healthcare World. It is republished here with the permission of the publication.
