Case Study: Embracing Digital Radiography

A health center changes the rules of pediatric imaging

Through a child's eyes the world looks bigger, brighter and sometimes scarier. Children have an innate way of taking a relatively ordinary task and turning it into an extraordinary adventure.

This tendency can often play to their advantage; if you're dealing with a situation such as having an X-ray – a source of anxiety for even grown-ups – it can be an overwhelming feat.

At Mary Bridge Children's Health Center in Tacoma, Wash., we welcome some of the state's youngest patients to our three-floor outpatient care facility each day.

We understand how traumatic a trip to the physician's office can be and have worked tirelessly to create a welcoming environment for the children, their families and our entire staff. From the moment a patient steps inside, one aspect is clear – everything from the wallpaper to the technology in the labs was designed with a child in mind.

This includes a state-of-the-art imaging suite equipped with two Malvern, Pa. Based-Siemens Medical Solutions Axiom Multix M digital radiography (DR) systems.

Like facilities across the country that are taking the leap from conventional radiography to digital, Mary Bridge is finding DR to be the ideal solution for our imaging needs, especially in a pediatric environment.

DR has helped us make the entire experience of having an X-ray not only more pleasant for children, but also more efficient for our technologists and administrators.

Less Anxiety, Easier Imaging

In a pediatric setting, studies need to be completed with the least possible anxiety to the patients and their families. Children coming in for an X-ray have likely been through some type of trauma.

They're hurting and scared: the last thing they want is to be separated from their parents and left alone while the technologist steps away to perform quality control on the radiographs.

The main objective when planning for digital radiography at Mary Bridge was to increase our efficiency so that we could make the X-ray experience as short and painless for the children as possible. We wanted to allow our technologists to be more patient- and family-focused.

DR has helped us achieve this goal. And it has also allowed us to better care for children during and after the exam.

Our imaging area is set up with two digital radiography rooms that share a central post-processing control area. This configuration helps our technologists better expedite patient studies.

Exams are completed efficiently, and our patients are not left on the imaging table for any longer than absolutely necessary. It also allows more time for our technologists to interact with the child's family – something that's crucial when you're dealing with young children.

The flexibility of digital radiography gives us the freedom to have a technologist with the patient at all times. We work in teams of two, so one technologist will perform the study requested while the other remains with the patient. This way, we can help put the child at ease and minimize fidgeting, which often causes the need for repeat exposures.

The design differences in technology make digital radiography well suited for pediatric imaging. Unlike conventional radiography systems that are often bulky and intimidating, our Multix M systems offer a design that is much more accommodating. Also, we are able to review images in less than three seconds, which makes a drastic difference.

Maintaining Patient Composure

Anyone who has spent time with children will acknowledge they are very anxious and curious creatures. They can move from one activity to the next without so much as a moment's notice.

One of our biggest challenges in pediatric imaging is to keep a child's attention and have them stay still long enough to get good, diagnostic images for the radiologist.

Fortunately, our digital radiography systems feature a mobile flat detector. The flexibility of the detector allows us to image our patients while obtaining digital images from virtually anywhere in the room.

The detector can be placed directly on the floor for weight-bearing studies, on the table, or even in a patient's wheelchair or bed. It all depends on what's the most comfortable for the patient. Often, this means we can utilize the room without putting constraints on the patients.

Another important consideration is radiation dose when you're dealing with children. Our DR systems allow us to set the appropriate techniques for the requested study while maintaining a low radiation dose to the patient.

The systems have preprogrammed settings for all of our study views, which helps to better facilitate the imaging process. Also, this benefit prevents repeated views, which translates into less radiation exposure to the patient.

Transitioning the Technologists

Even for a seasoned RT, the thought of transitioning from conventional radiography (CR) to DR can be daunting. At Mary Bridge, two of our technologists have a total of more than 60 years of experience in CR.

Initially, we were concerned about our technologists embracing DR, simply because of their years of experience with traditional film/screen positioning and techniques. But they quickly proved us wrong and made the transition to DR very simple.

The Multix M system design has the look and feel of a CR system. The only difference is that the detector is positioned instead of a film or CR cassette. This, in turn, allows the technologists to obtain even the most challenging images.

We can also perform quite a few advanced applications, such as scoliosis imaging, on the system.

Another aspect of this transition has been increased patient attention and satisfaction. No longer do we have to say "we'll be back in five minutes" while we go to the darkroom to check the films.

With digital radiography, an image can be viewed on the in-room monitor in less than three seconds and if there is a positioning issue, we can perform a retake immediately.

Additionally, we have more flexibility with the images and the post-processing step is virtually eliminated. The software applications with the digital systems allow us to easily correct and adjust the images for easier viewing.

Increasing Productivity Gains

Digital radiography was an investment in a new technology for Mary Bridge. But we've already started to see a significant increase in productivity in the department. We currently image approximately 50 to 60 patients a day between our two Multix M systems.

And that's not even a quarter of the capacity that these systems can easily handle. This means that Mary Bridge can significantly increase our patient census without adding any additional resources; this is important as it allows us to utilize these resource dollars elsewhere.

Routine studies used to take a long time to complete with conventional radiography, making the children fidgety and anxious. This is now a thing of the past. For example, a typical bone survey with conventional X-ray could take up to an hour to complete.

The majority of that time would be spent moving back and forth between the imaging room and the processing area to perform quality assurance on the study performed.

With DR, we've virtually cut the exam process time in half. Now we can register, change and X-ray our patients – and process their images – in about a half an hour.

Since we can obtain the images almost instantly, our radiologists can read the studies and have the reports out to our referring physicians faster. This has decreased the time the patient waits to discuss the outcome of the study.

As a result, a lot of the administrative burdens associated with the conventional radiography processes have been relieved, thus enabling us to accept more walk-ins. After all, you can't always choose when you're going to need an X-ray.

A Promising Future

In the less than two years since Mary Bridge has opened, we've seen a 20 percent to 30 percent increase in patient volume. Our patients are spreading the word about our outpatient care facility and new patients are coming from all over the state.

Digital radiography gives us the flexibility to handle this increased patient volume now and into the future.

But that's really secondary – we measure our success on the relationships that we're able to build with our patients and their families. Trust is a big part of what we do and children are our top priority.

The bottom line is these systems allow our technologists to be more focused on the patients and achieve one-on-one patient care. With that, we can establish a true bond with not only the patients, but their families, as well.

— Christina Bryarly, RT, is the radiology manager at the Mary Bridge Children's Health Center in Tacoma, Wash (www. multicare.org). Questions and comments can be directed to editorial@rt-image.com.