Vidant Medical Center in Greenville, North Carolina, has 12 portable X-ray units to serve the 33,000 inpatients and over 266,000 outpatients that come to the facility for acute, intermediate, rehabilitation and outpatient care per year. Four of those units are GE Healthcare’s Optima XR220amx digital radiography (DR) systems.
 
To determine what kind of productivity benefits they were gaining from the DR systems, Vidant undertook a two-week study. Two technologists were randomly assigned the Optima XR220amx or the AMX-4 computed radiography (CR) system and given batches of six to 10 requisitions every morning shift and individual cases to handle on an ad hoc basis.
 
The technologists were able to complete batch rounds in half the time, individual cases were sent to the review station three times faster and images were reviewed in real time with three-second average image previews. As a result, the technologists were able to image a greater number of patients. “That immediacy, where people can look at the images and make sure from a QC perspective that they are fine and also make sure the physician is available to look at the patient’s condition, has improved,” says Sandra Sackrison, radiology system services line administrator at Vidant. “The turnaround time for patient care has really been a satisfier for physicians.”
 
The benefits of DR
Many facilities are starting to purchase DR systems over CR systems since they don’t require cassettes, generate faster turnaround times and provide better image quality. The University of Vermont Medical Center has four of Philips Healthcare’s DR systems and describes them as a “fixed room on wheels.” “It has definitely increased our productivity tremendously,” says Carol Kittredge, quality assurance technologist at the University of Vermont Medical Center. “Having the digital screen so we can see the image right away has been a pleaser for many of the physicians in the hospital because then they can review what they need, add more if they need to and then be done at the point.”
 
The technologists can now image body parts that they traditionally would have moved the patient on a table to image. Kittredge says that other than special functionality like fluoroscopy and tomography, the systems can do everything else that a fixed room can, and also with good image quality.
 
At last year’s RSNA annual meeting, Siemens Healthcare introduced its new Mobilett Mira Max, which features the DiamondView image processing software that generates images with comparable quality to fixed system images. It also features two new detectors that can be easily swapped between two portable systems or a portable and a fixed system with the MAXswap feature. The MAX mini-detector is 9.5 by 12 inches and the MAX wi-D detector is 14 by 17 inches.
 
“The customer does not have to purchase multiple detectors that would be used in more of a specialized clinical case,” says Joe D’Antonio, U.S. product manager for portable X-rays at Siemens. “Rather, they can share detectors between systems.” If the battery’s charge depletes on traditional systems, it usually takes about 15 to 20 minutes to recharge it so it can be used again, but the Mira Max can be plugged into wall power so that exams can be performed immediately. “There is virtually no scenario that can exist where you wouldn’t be available to shoot X-ray from a power perspective,” says D’Antonio.
 
Jay Hill, chief technology officer of detection and guidance solutions at GE, believes that portable DR systems will continue to evolve in two dimensions. The flexibility of the imaging will improve through different imaging modes and advanced fixed room applications, and the reliability and usability of the systems will also improve in terms of battery life, better wireless infrastructure connection and higher bandwidth.
 
“The beauty of moving to the digital world is that advanced imaging becomes a software problem,” says Hill. “Over the last 50 years we learned that software problems eventually get solved.” Although portable DR systems can now do many of the things that fixed room systems can, Hill believes there will always be a need for the positioning flexibility and precision of fixed systems. “Fixed room systems will always be ahead of mobile systems,” he adds. “I think there is always an inherent advantage for the more sophisticated imaging modes and more sophisticated acquisition in a fixed room.”
 
Better neonatal care
Imaging neonates can be a challenge because technologists need to be very conscious of radiation dose. Crouse Hospital in Syracuse, New York, installed Carestream’s DRX-Revolution Mobile X-ray System to improve care in the neonatal ICU (NICU). “We were looking for a DR system for the neonatal ICU because we do a lot of bedside portable radiography there and physicians need immediate results,” says Brad Hellwig, director of radiology at Crouse Hospital. “The DRX-Revolution has both a console and a tube stand screen so everyone can see where the end of the catheter is and check positioning of tubes and lines.”
 
The staff was able to reduce dose by more than half. It’s crucial to limit dose in the NICU because of the harmful effects radiation can have on neonates and also because they often need multiple X-ray exams. “The NICU babies tend to be some of the most radiographed patients that we have because their health condition changes so rapidly,” says Hellwig. “There are babies out there who get X-rayed every day and sometimes multiple times a day. Any small reduction in dose for them is critical.”
 
The system also features specialized pediatric software that helps the staff track techniques and exposures. It automatically displays the previous technique to ensure image consistency, which helps physicians detect any changes in the patients.
 
Retrofitting
The one downside of DR is that it’s much more expensive than CR. Because of that, some facilities are opting to purchase retrofit kits to convert their CR systems into DR systems.
 
Carestream’s DRX-Mobile Retrofit Kits are compatible with GE, Siemens and Shimadzu imaging systems and allow images to be shared with PACS and other systems. Konica Minolta’s Aero DR wireless digital flat panel detector system has a built-in roaming feature that allows it to be shared between portables and in other general radiography rooms.
 
Carestream recently launched its Carestream Motion Mobile, which is an analog system that can easily be converted to DR. Carestream decided it would be a better fit for emerging markets instead of the U.S., since most facilities in the U.S. are purchasing fully integrated DR systems.
 
Carestream believes that it’s a good option for customers that don’t want to purchase a DR system yet, but don’t want their investment to be obsolete in a few years. Motion Mobile began shipping to emerging markets in late October.
 
Lithium-ion batteries
Portable X-rays traditionally use lead acid batteries, but the industry is now moving toward lithium-ion batteries. Tesla, Toyota, Nissan and the rest of the major automakers were the first to push the use of lithium-ion batteries with their hybrid and electric vehicles.
 
“Typically the industry has used lead acid because it’s good at those things, but because of hybrid vehicles, lithium-ion is starting to get into that performance area,” says Hill. “It has its own advantages, but we’re starting to see some of the differences between it and lead acid erased.”
 
Hill adds that the industry used to think of lithium-ion batteries as light, portable, expensive batteries with a high cycle duty, and lead acid batteries as having heavy duty cycles, deep discharge, repeated usage and high power density, but that is starting to change. In addition, as more vehicles use lithium ion batteries, the cost is going to drop, says Hill. “That is a big deal, too, because it becomes more cost competitive, and as it becomes more power-density and discharge cycle competitive, it’s a much easier equation for us to rationalize going to lithium-ion batteries,” he adds.
 
Robotic portable X-rays
“It’s a little bit science fiction, because there are some practical difficulties to figure out, but you can imagine in the not-so-distant future automatic guided mobile X-ray machines that dispatch themselves from room to room based on some scheduling algorithm,” says Hill.
 
GE is currently working on a high-end interventional system that is automatically guided by robotic technology. Since hospitals are already using robotic technology to deliver supplies within the hospital, Hill believes that in the coming years robotic portable X-ray systems will also make their way into the clinical arena.
 
The only thing standing in the way is how to incorporate it into the workflow of the hospitals. “Figuring out how to integrate that into a clinical environment, with all of the people and the urgency and the chaos that goes on in the clinical environment, I think that’s probably as big a challenge as making a mobile that can drive itself around,” says Hill.
 
In addition, some hospitals might not want a portable X-ray that drives itself. The University of Vermont Medical Center’s Kittredge believes that it would diminish the personal side of health care. “I’m a little old school — I like to have hands on,” she says. “The robotics would not interest me now.” Even if portable X-rays don’t become robots, the technology has still come a long way in recent years. They can now image any patient and any body part, run on lithium-ion batteries, include many of the capabilities of fixed room systems and will be able to do even more in the near future.