The Top Five Trends Seen at ECR 2014

Ludovic d’Apréa, General Manager, Carestream

Ludovic d’Apréa, General Manager, Carestream

Once again we saw a variety of trends at the European Society of Radiology’s European Congress of Radiology (ECR) in Vienna. Medical imaging and healthcare IT presentations and technologies were abundant, but there were several trends that were seen more frequently than others. Tomosynthesis (for lung and breast imaging) was widely talked about. Dose reporting, efficiency, and reduction remains a popular topic, especially with the creation of ESR’s EuroSafe Imaging organization. On the healthcare IT side, mobile devices and rich reporting were popular topics, as was the efficiency of relying on the cloud for data storage and access.

Tomosynthesis: Do a quick search of “ECR 2014” and “tomosynthesis” and you are sure to see a slew of information about how the topic was discussed and presented at ECR. Multiple vendors presented their tomosynthesis offerings, while multiple poster presentations discussed the benefits of the technology in medical imaging. As more present on the benefit of digital breast tomosynthesis (DBT), excitement snowballs around the possibilities of improved image readings and diagnoses thanks to the 3D modality. As example of the benefits of lung tomosynthesis, one poster demonstrated a phantom study in which the tomosynthesis module presented more accurate node measurements than computed tomography (CT). It is clear that tomosynthesis is going nowhere and will is steamrolling in becoming a more prominent technology in medical imaging.

ECR 20

ECR celebrated its 20th year being hosted in Vienna, Austria.

Dose: Discussions related to dose at ECR centered around the launch of EuroSafe Imaging.  The launch took place as part of a session about radiation protection. The presentation included a segment by the ESR’s director of radiation protection, Dr. Madan Rehani and a panel discussion took place that included representatives from the IAEA, WHO, ICRP and other European and international organizations focused on protecting patients from the potential harms of overexposure to radiation. Radiation dose continues to be an important focus for radiographers and radiologists as they focus on providing the least amount of dose to create the appropriate images that will provide the best diagnoses.

Use of mobile devices: To say mobility is a popular topic would be an understatement. During ECR we posted about mobile device usage and how it is no longer a trend to expect down the road. Mobile device use is at an all-time high, and adoption will only increase. Dr. Ratib at the University Hospital of Geneva spoke in European Hospital about how physicians at his hospital now wonder how they worked in an age before mobile devices. The ease of accessing images and information via a tablet is improving efficiency, and allowing for an environment where being in-the-know can be possible in a matter of seconds. This is leading to both improved quality of care for the patient, and an improved patient experience.

Reporting: Creating radiology reports revolves around more than presenting numbers. Rich reporting is a must-have in today’s department, and it is because radiology is interacting with more departments and referring physicians who rely on more than the numerical reports. Images, videos, and robust graphs are vital to today’s radiology department. As the demands of radiology increase, so must the capabilities of the applications radiologists use to do their work effectively and efficiently.

Cloud: Storage capacities are filling up faster than facilities can manage them. As the volume increases, which it is doing exponentially as more images and videos are saved, facilities are looking to the cloud to provide the scalable, flexible, and accessible capabilities needed to effectively manage the vast size of data storage.

Overall, it was another exciting year at ECR. Attendees were enthusiastic and vendors provided impressive displays showing the latest and greatest in the industry. Now that ECR 2014 has come and gone, it is time to begin with ECR 2015.

Executive Perspective: How to Achieve Efficient Enterprise Data Management

Julia Weidman, Marketing Manager,  Healthcare Information Solutions, Carestream

Julia Weidman, Marketing Manager, Healthcare Information Solutions, Carestream

Enterprise data management is one of the biggest topics in healthcare IT today. It involves integrating various silos effectively into the ecosystem and presenting relevant clinical data to the physicians who require it at a moment’s notice. At HIMSS14, Carestream wanted a deeper insight into the real challenges at various clinical settings.

We worked with HIMSS Analytics to sponsor a panel—moderated by Jennifer Horowitz, Senior Director, Research, HIMSS Analytics—that consisted of four executives from health facilities in the U.S. and Canada. The panel offered insights that pertained to the successes and issues they have experienced when implementing data management throughout their organizations. The panel consisted of:

The discussion is about 45-minutes long, so if you are interested in only viewing particular segments, we have provided links to each of the questions asked throughout the discussion:

  • [01:05] Panelist Introductions
  • [02:56] HIMSS Analytics about radiology PACS data
  • [04:44] How would you characterize your organization’s approach to managing patient-related images? What are your plans to incorporate images into the electronic patient record?
  • [10:50] How are you alleviating image storage issues?
  • [15:54] Retention Policy: Are your organizations putting in place formal image retention policies and what do they include?
  • [19:38] Are any of the federal regulations like HIPAA and Meaningful Use affecting your image storage?
  • [20:37] Are you considering cloud technology?
  • [23:20] Workflow: How are you making sure images are accessible, and how are you managing the workflow?
  • [26:13] How are you managing remote access of images and the workflow?
  • [28:17] How do you assess and measure clinician satisfaction with the environment?
  • [34:22] What does your future state look like?
  • [36:20] Are you archiving telehealth consults?
  • [38:13] Audience question: Is anyone doing telepathology and streaming of the images?
  • [40:12] Audience question: What is the right infrastructure for patient engagement?
  • [43:33] Audience question: What is the size differential between streaming pathology data and a large imaging file?
  • [45:13] Audience question: Do you have any experience with cancer pre-screening, prostate pre-screening, and their image retention?

The entire panel discussion can be watched below, and we owe a big thanks to HIMSS for allowing us to sponsor such interesting, information-rich discussion.

Studies Have Proved the Benefits of Digital Breast Tomosynthesis: Now How Do We Change Referral Habits?

Dr. Harmindar Gill, Medical Director, Premier Women’s Radiology (Bonita Springs, Fla.)

Dr. Harmindar Gill, Medical Director, Premier Women’s Radiology (Bonita Springs, Fla.)

As a female radiologist, I have created a practice dedicated to women’s imaging that includes digital breast tomosynthesis (DBT), breast and body ultrasound, whole body bone density screening and other services. I also read breast MR images that are captured at another facility.

According to the American Cancer Society, 1 in 8 women will develop breast cancer during her lifetime—just over a decade ago the rate was 1 in 11 women. Genetics cannot account for this increase since 85 percent of breast cancer victims have no family history of the disease. There are a variety of factors that may be contributing to increased risk, including estrogen in our foods, post-menopausal hormone therapy and childbearing later in life. The good news is that the ACS reports death rates from breast cancer in the U.S. have dropped 34% since 1990.

I am an avid proponent of DBT because I believe it can assist in the effort to further reduce deaths from breast cancer. In my personal experience, I have found small lesions that I did not detect on other breast imaging exams and it also decreased the need to recall patients for additional testing. The ability for DBT to increase cancer detection rates and decrease recall rates has now been well documented through studies conducted across the country. In 2013 breast tomosynthesis captured attention and acceptance throughout the radiology community, as illustrated by the dozens of scientific presentations and poster sessions focused on DBT at RSNA 2013.

One RSNA 2013 presentation reported results from a study in which every patient since October 2011 was screened for breast cancer using DBT at Hospital of the University of Pennsylvania (HUP) in Philadelphia. The study’s lead author was Emily F. Conant, M.D., chief of breast imaging at HUP. Dr. Conant and five colleagues compared imaging results from 15,633 women who underwent DBT at HUP beginning in 2011 to those of 10,753 patients imaged with digital mammography the prior year. Six radiologists trained in DBT interpretation reviewed the images. The researchers found that compared to digital mammography:

  • Average recall rate using DBT decreased from 10.40 percent to 8.78 percent
  • Overall cancer detection rate increased from 3.51 to 5.25 (per 1,000 patients)
  • Overall positive predictive value for the group—the proportion of positive screening mammograms from which cancer was diagnosed—increased from 4.1 percent to 6.0 percent with DBT.

A prominent earlier study published in the June 2013 issue of the American Journal of Roentgenology documented the benefits of DBT by Dr. Stephen L. Rose and his colleagues at TOPS Comprehensive Breast Center of Houston, Texas. This study compared recall rates, biopsy rates, and cancer detection rates for six radiologists who interpreted 13,856 screening mammography studies without tomosynthesis and 9,499 studies with tomosynthesis.

For the group as a whole, the use of tomosynthesis resulted in:

  • Increase in invasive cancer detection rate from 2.8 to 4.3 per 1,000 screening examinations
  • Increased cancer detection rates from 4.0 to 5.4 per 1,000 screenings
  • A reduction in recall rates from 8.7% to 5.5%
  • Reduction in biopsy rates from 15.2 to 13.5 per 1,000 screenings.

As a result of my personal experience and the scientific studies now available, I advocate use of DBT for all screening mammograms—especially for patients with dense breasts, patients with BRCA gene mutation and those who have been previously diagnosed with breast cancer—because its three-dimensional imaging offers significantly enhanced visualization of breast tissue.

Now that we recognize the advantages offered by DBT, the challenge is to make tomosynthesis a mainstream screening protocol. It’s not enough for radiologists to recognize the value of tomosynthesis—physicians and gynecologists need to be educated about the benefits of this technology since these doctors account for a majority of the referrals for annual screenings and follow up exams.

Hear more about Dr. Gill’s practice and the importance of DBT below from RSNA 2013.

Why Multidisciplinary Teams are Becoming More Common in Europe

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

We have written before about the benefits of multidisciplinary teams. It was a popular topic at RSNA 2013 and continues to gain more ground in ECR 2014. In a recent panel discussion, researchers from Italy found that a multidisciplinary team focused on breast cancer diagnosis and treatment were able to see proven benefits thanks to the collaboration between radiologist, radiographers, surgeon, and pathologist.

The Italian medical professionals said that multidisciplinary team practices are sure to become more common and even crucial to providing effecting patient management. The team that presented consisted of Dr. Pietro Panizza, a radiologist at the San Raffaele Scientific Institute, radiology resident Dr. Sara Viganó from the same institution, radiologists Dr. Roberto Agresti and Dr. Laura Lozza from the Instituto Nazionale dei Tumori, and Drs. Biagio Paolini (pathology department) and Giulia Bianchi (oncology department) also from the institution.

The panel noted that multidisciplinary teams are not just important in breast imaging, but in all subspecialties of radiology. The collaboration that a multidisciplinary is based on provides the ability the better diagnose and treat patients as medical procedures become more complex. The panel noted that it is the responsibility of medical professionals to provide their patients with the highest quality of care possible and multidisciplinary teams can help ensure this.

As highlighted by AuntMinnie Europe when covering the panel, a multidisciplinary approach to care can result in the following:

  • Deliver a level of care that conforms to agreed standards and reflects national guidelines

  • Allow better adherence to evidence-based decisions

  • Create more coordinated patient care that can improve clinical decisions

  • Result in a better planning of the care pathway concerning primary and reconstructive surgery, chemotherapy, radiotherapy, and radiological assessments

  • Nurture shared decisions on clinical approved approaches, as well as get a consensus on newly innovative techniques or treatments

  • Define and coordinate follow-up strategies (i.e., postoperative, along with neoadjuvant chemotherapy, or for patients not surgically treated)

  • Boost time management due to cooperation and clearly defined pathways and guidelines

  • Improve patient involvement in treatment decisions

  • Help in problem-solving about organization and patient management

The panel concluded that the ability to work in a multidisciplinary team has allowed each member to analyze their limits and recognize where other team members are able to assist. This is the sort of self-awareness and humility that enhances the relationship and collaboration of the team, allowing for more opened minds toward different perspectives and medical interpretations.

The goal when creating and working in a multidisciplinary team is to establish a new mindset. The medical professional is no longer thinking as an individual, but as a member and contributor to a team. With this altered way of thinking, the team can effectively collaborate and ultimately provide the best care to the patients so that they receive the proper diagnoses and treatments.

Teleradiology Providing an Increasing Number of Opportunities in Europe

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

In January 2014, the European Society of Radiology (ESR) updated its white paper about best practices in teleradiology. The purpose behind this publication was to explain how facilities should best implement the services since teleradiology is becoming increasingly popular across Europe.

The ESR found that teleradiology is bringing new opportunities for both the users of the services and the providers. The main goals behind the white paper were broken down into five key messages:

  1. Teleradiology describes the provision of radiology services remote from the site where the images are obtained

  2. Teleradiology should form part of and be integrated with the wide spectrum of radiology services, and not a separate tradable commodity

  3. The quality of radiological reports and services delivered by teleradiology should not be less than those of local radiologists

  4. International quality standards for teleradiology need to be established

  5. Patients need to be fully informed when teleradiology is used

The ideas behind this white paper were meant to address members of the European Union, as well as the members of the ESR teleradiology subgroup, which was formed recently and served to update the original paper that was written in 2006.

As a testament to the advantages that teleradiology provides, AuntMinnie Europe reported on how Russia is seeing teleradiology as a way to bridge gaps in healthcare. In a “ESR Meets Russia” session on Friday at ECR 2014, it was explained how teleradiology is able to provide services to areas of the country that are not heavily populated. And while teleradiology services can take time to implement, the benefits they can provide pay back with many benefits.

The practice of teleradiology has come a long way in Russia. Today, departments, such as one in St. Petersburg that has been implemented it in its emergency department, is proving the evolution of the practice. Oleg Pianykh, PhD, an assistant professor at Harvard Medical School, said that teleradiology is eventually going to move beyond Moscow and St. Petersburg, and expand in scope across the country, in Siberia, for example, where the population is more scarce.

Pianykh explained to attendees in the ESR session that it is important not to take one successful teleradiology solution in a facility and think it can be duplicated in another facility. Each one is different and will requires a different strategy for planning and implementation. Resources must be optimized for every particular clinic and Pianykh said it is important to grow solutions from the bottom-up, based on the needs of a particular hospital.

The examples of teleradiology being implemented in Russia shows the benefits of such a service. When populations are more spread out, teleradiology will be able to bring the quality of service and care to areas that may not have access near by. It is this type of change in a healthcare system that has the potential to provide important benefits to diverse populations.

Mobile IT Earning its Place in European Radiology

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

In a recent article in European Hospital, Osman Ratib, MD, PhD, FAAC, Professor and Division Chair Department of Medical Imaging and Information Sciences, University Hospital of Geneva, talked about the future of mobile IT and the role it will play for radiologists in the future.

Dr. Ratib explains that radiologists will use mobile applications for on-call situations where they need to access studies quickly for review and that these applications are not used as often for final interpretation. Another point Dr. Ratib made was that it is often not the radiologists using the mobile devices, but the referring physicians, and other care staff. This is because these medical professionals need to access the images in situations where they are not close to a workstation. As an example, he said that surgeons often take the images with them into the operating room.

One type of application Dr. Ratib highlights is the web-based application where access to images enabled through a web portal and no data is actually stored on the medical–it remains stored on the servers. The advantages this offers is that it is easier to implement because access is granted with a web browser, and doing this allows for similar features to the desktop computer because all work is done via the web server, and both rely on the web browser for use.

The mobile trends are not just pointing to radiology, but all hospital departments relying on mobile devices in their everyday work. Dr. Ratib said that all of the physicians and staff in his hospital walk around with a tablet in their hands. Market penetration is continuously increasing, and while risks exist related to making sure patient dates remains safe and secure, the advantages that mobile devices are presenting are numerous.

Vue Motion

Image sharing is becoming increasingly popular on mobile devices among physicians.

As an example of this mobile access, Spire Healthcare in the UK recently upgraded their Carestream PACS to include cloud services. The mobile access, zero-footprint image viewer Vue Motion was part of this upgrade and an important application for physicians in the hospital. The fact that Vue Motion works across different platforms allows Spire to access images no matter what site they are located at within the 37 hospitals and 10 clinics that make up the health system. The physicians see the advantage due to the flexibility of the application and the patients experience the advantage too because this access allows for more efficient examinations.

Spire is not the only hospital experiencing these benefits. It is part of a wider trend where mobile IT and the advantages it provides are leading to more efficient and higher quality care. Dr. Ratib said that one day medical professionals will wonder how they ever worked without mobile devices, and with mobile adoption increasing as fast as it has, that day may arrive quite soon.

ESR’S EuroSafe Imaging: Supporting & Strengthening Medical Radiation Protection

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

ECR 2014 is hardly a day old and ESR has already made a splash with its new initiative, EuroSafe Imaging–a mission “to support and strengthen medical radiation protection across Europe following a holistic, inclusive approach.”

The necessity for this organization stems from the fact that cumulative patient radiation doses have reached levels never seen before, and these levels have resulted in cases of overexposure. Much of this exposure has come from computed tomography (CT) and its overuse in the medical imaging environment. Thanks to the evolution of technology, CT is now heading in the direction of becoming a simple radiograph, such as a chest X-ray.

With its mission in place, EuroSafe Imaging is currently in the process of creating a steering committee and has already taken part in projects in the area of medical radiation protection. The ESR has already worked with numerous organizations around the world on this topic. Projects with organizations such as the World Health Organization (WHO), the United Nations Scientific Commission on the Effects of Atomic Radiation (UNSCEAR), and the International Commission on Radiological Protection, has resulted in motivating countries to translate guidelines into their own languages, and creating methods to soliciting feedback and providing certification.EuroSafe

Another mission behind Euro Safe Imaging is to educate patients about medical radiation and how it affects them. This accomplished by explaining how everyone is exposed to small levels of radiation on a daily basis. ESR breaks this information down by providing details on how many months/years worth of everyday radiation is included in medical imaging procedures such as chest X-rays, CT, PET/CT, etc.

From these charts, patients can understand the relative harmlessness of a single exam. It becomes the mission of the radiologist to provide the patient with the right medicating imaging procedure, at the appropriate dosage (as low as possible without compromising image quality), while producing the best image possible for proper diagnoses.

Dose efficiency and patient safety have become increasingly common in the medical imaging industry and for good reasons. It is the role of medical professionals to keep patients safe while providing them with excellent care. EuroSafe Imaging from ESR is another excellent example of a professional association taking action to increase awareness and find solutions to this important issue.

[Infographic] Electronic Access & Medical Images: Are You Connected?

Saskia Groeneveld, Wordwide Marketing Manager, HCIS, Carestream

Saskia Groeneveld, Wordwide Marketing Manager, HCIS, Carestream

We have been talking about providing patients with electronic access to their medical images since mid-2013, and it is not a topic that is going to go away anytime soon. Patients want more control over their healthcare, and providing access to their information is a vital component to gaining that control.

The infographic below provides some statistics that prove patients want more access and control, and that electronic methods are the best ways to comply. Highlights include:

  • 80% of Americans with online access to their healthcare information take advantage of it
  • 65% of Americans who do not have access to their health information electronically say that it is important to have it
  • 2 out 3 people would consider switching to a physician who offers access to medical records through a secure internet connection

Along with these stats, we have collected additional data from a study commission with IDR Medical and via customer test cases where they allowed patients to use the Carestream patient portal MyVue. This information can be found in the final half of the infographic below.

Are You Connected Infographic

Guess the X-ray — March’s Image Challenge

Congratulations to the person who guessed February’s image correctly — it was a light bulb! Below is the image for March’s “Guess the X-ray”.  Please leave your answer in either the comment section below or on our Facebook page. The challenge will run until March 31 or until the first person correctly names the item in the image.  Good luck!

Sorry…Carestream employees and their agencies are prohibited from entering.

March Image Challenge

Why We Need Pediatric Radiologists

Cyrill Aschenbrenner, Regional Business Manager, Europe, X-ray Solutions, Carestream

Cyrill Aschenbrenner, Regional Business Manager, Europe, X-ray Solutions, Carestream

There was a recent interview on AuntMinnie Europe with Dr. Gabriele Hahn about the relative importance of pediatric radiology in Germany. In the interview, Dr. Hahn states that the number of practicing pediatric radiologists in Germany is declining and has been for about the past 20 years. She finds the trend troubling because pediatric radiology is a specialty that requires different knowledge than radiologists who solely capture medical images for adults.

Carestream recently published a blog post from Cincinnati Children Hospital’s (CCH) Radiology Department that talks about bringing in child life specialists to help with the imaging process for pediatric patients. The department does this because the specialist has a breadth of knowledge about child behavior that can help keep the patient calm and relaxed so the radiologist can capture the best image as efficiently as possible.

This is the sort of wisdom that applies to pediatric radiologists because they have a keener eye for issues that are relevant to younger patients. Dr. Hahn said in her interview that pediatric imaging practitioners give

Pediatric radiology requires the utmost care and delicacy, as patients' bodies are still developing at the time of imaging exams.

Pediatric radiology requires the utmost care and delicacy, as patients’ bodies are still developing at the time of imaging exams.

greater thought to radiation dose, an important pediatric imaging issue. The specialists’ techniques allow them to capture the best quality image while using the smallest level dose possible for the exam.

A trend we have seen throughout 2013, and will continue to see develop throughout 2014, is the need for interdisciplinary teams, and developing cultures engrained in thorough communication. With a practice as niche as pediatric imaging, practitioners must be consistently kept in the loop and sought for when pediatric patients require imaging exams. The partnership CCH demonstrated between the radiology department and child life specialist is the perfect example of this. If a child behavior expert is not available, then this strengthens the case for having staff solely dedicated to providing medical imaging exams for children.

What has been consistent throughout all discussions related to pediatric radiology is that a great deal of sensitivity and care is needed to effectively capture a high-quality image. Pediatric radiologists possess these characteristics and are sure to be vital for any facility’s that cares for young patients. Dr. Hahn offered this piece of information to further support the need for pediatric radiologists:

“From my lengthy experience as a pediatric radiologist, I can tell that a lot of colleagues, radiologists, and clinicians who have not had appropriate training find it difficult to reach the correct diagnosis or to come up with normal findings.” – Dr. Gabriele Hahn, AuntMinnie Europe, February 17, 2014.

At ECR 2014, pediatric imaging is sure to be a topic of great interest among attendees. Carestream will be demoing several products that address this trend such as our DRX-2530C wireless detector, and our IHE Dose Reporting software that transfers dose information from CR and DR systems directly to a facility’s PACS.