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.

Equipment Solutions for European Medical Imaging Budgets

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

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

The dynamics of the European economy are quite diverse, and even more so when looking into the healthcare systems across the nations. Back in November, Frost & Sullivan released a report commenting on how Europe was about to experience a large increase in the use of refurbished medical equipment due to limited hospital budgets across the continent, particularly in Southern Europe.

For perspective on how much growth we will see in this area, Frost & Sulllivan found that the market earned revenue of $417.6 million in 2012 and estimates this to reach $582.3 million in 2019. The major goal behind this trend being that hospitals and health systems need to save money on their technologies, but still need to perform a high volume of procedures at a high level of quality. While the growth appears to be inevitable, Frost & Sullivan said that there are challenges present:

“The market, however, presents its challenges. For instance, reimbursement laws across some European regions, such as France, compel reimbursement to be cut by half if the equipment is older than five years. This forces some hospitals to purchase new equipment. Moreover, regulations in certain countries such as Romania and Bulgaria restrict hospitals from purchasing old equipment using state funded loans. Because almost all public hospitals are covered by the state, they opt for new systems over refurbished models.” – Frost & Sullivan, 12 November 2013

The health systems that cannot purchase refurbished equipment have other options to handle the increased demand for volume and quality of procedures. Many are looking at the ability to streamline processes by upgrading pieces of their imaging systems instead of purchasing entirely brand new ones.

The ability to move from analog to computed radiography (CR), or from CR to digital radiography (DR), has become easier and more affordable. This has allowed for radiology departments to improve their imaging processes and also not spend a large portion of their budgets all at once.

At Carestream, the phrase “Right for Today, Ready for Tomorrow,” is a mantra for us when it comes to X-ray solutions. Not only does it keep us focused on providing customers with the technologies needed to handle high volumes and provide top-notch image quality, but it also prepares them for any future upgrades needed without having to overhaul entire systems.

For example, a health system is working with CR equipment and is looking to make the move to DR, but can’t afford a brand new system. Instead of buying a complete DR system, the radiology department can purchase DR retrofit kits that are meant to convert CR systems to digital with the simple conversion to new software and wireless DR detectors. It is a quick, easy, and affordable for the facilities that are constrained by budgets, but must still provide the top level of quality and care to patients.

Carestream will be featuring and demoing its DR equipment at ECR 2014, which you can read more about on our event page. The video below provide additional background about making the switch to DR.

[Webinar] Does Image Quality Matter?

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

You would think that the answer to this question would be an easy “yes,” but it is not as clear-cut as you would believe. The reality is that many factors influence actual and perceived image quality. A so-called “poor” image detector can still produce good-quality images, while a “good” detector can easily produce poor-quality images. The bridge between the detector and its images involves exposure techniques (e.g., kV, mAs, filtration, anode, dose, etc.), image processing (e.g., optimization, compression), and the characteristics of the display system itself. Finally, the observer at the end of the imaging chain also plays a critical role..

On March 4, I am going to be conducting a webinar for members of the Carestream VIBE user group that will seek to answer the question, “Does Image Quality Matter?” The definition of image quality often differs from person to person, depending on whether the focus is on objective evaluation, subjective perception or task performance.  This makes the subject of image quality both interesting and complex.

The webinar will attempt to reduce this complexity by focusing on three basic questions about image quality:

  • What is it?
  • Where is it?
  • Who should care, and why?VIBE_Graphic_1_2

To answer these questions, we’ll look at the contributions to image quality from detector performance (e.g., contrast, spatial resolution, noise), from image processing (preprocessing, display optimization), and from display performance (e.g., perceptual linearization, calibration). At the end, we’ll also examine the role of observer performance (e.g., human visual system characteristics) in the final determination of image quality.

At the end of the webinar, attendees will have a clear understanding of what we/they mean when we/they say “image quality” and how it may differ across its three main categories—objective, subjective, and performance-based.   Attendees will also understand the important role that the observer plays in determining the success or failure of an imaging chain. By the last slide, attendees will be able to answer with greater confidence the question “Does image quality matter?” and be able to explain the complex balance of factors in the imaging chain that makes this simple question significantly deeper than might first appear.

You must be a Carestream customer to join the VIBE user group. If you are a customer and would like to join, you can click here.

If you would like to register for this webinar, please click here.

Preparation and Support is Key to Safe Imaging with Pediatric Patients

Alexander Towbin, MD, Neil D. Johnson Chair of Radiology Informatics, Cincinnati Children's Hospital (left), and Catherine Leopard, Child Life Specialist, Cincinnati Children's Hospital (right)

Alexander Towbin, MD, Neil D. Johnson Chair of Radiology Informatics, Cincinnati Children’s Hospital (left), and Catherine Leopard, Child Life Specialist, Cincinnati Children’s Hospital (right)

Patient comfort has always been an important component of the medical imaging process. However, when a child is the patient, comfort becomes vital. There are many components of medical imaging that can intimidate children, or be downright scary for them. Like many other pediatric radiology departments, the Radiology Department at Cincinnati Children’s Hospital employs child life specialists to help support our patients and their families before, during, and after their radiology appointment.

Child life specialists are trained professionals who work with our patients and their families to assess and understand each individual’s specific psychosocial needs. They then work collaboratively with the radiologist and technologist to ensure that the procedure goes smoothly and that high-quality, diagnostic images are produced.

Successful pediatric imaging is dependent on proper preparation before the procedure.

There are many things that can be done to help pediatric patients and families prepare for a radiology procedure. In our department, child life specialists often first contact a patient’s family by phone before the appointment to discuss developmental information, stressors related specifically to the radiology examination or other important information the family believes might impact their child’s ability to cope positively during the procedure. Obtaining this information ahead of time allows us to adequately prepare for our patients so that we can provide them the best experience possible.

We believe that it is important to provide our patients’ and their family information about the radiology procedure in a manner that they can understand. In order to do this, child life specialists first assess a child’s developmental level as well as his or her current mood and anxiety level. Once this assessment is made, child life specialists use appropriate pictures, videos, medical dolls, sample medical equipment and/or models to help prepare the patient for what he or she will see, hear, feel and experience during the radiology examination.

2530C DRX

Pediatric imaging always requires the utmost care and preparation to ensure the image is properly captured and the patient remains comfortable.

The education process can begin either before the examination is scheduled or after a patient has arrived. For example, children who are scheduled to have a MRI at Cincinnati Children’s can come to the Radiology Department beforehand to tour and “practice” the scan. They can see the MRI room, lay in the scanner, and hear the sounds the MRI scanner makes. All of this preparation helps to answer questions, build the patient’s confidence, and ultimately leads to the successful completion of the MRI.

We have found that when children are appropriately prepared for an examination they are able to more successfully cope with the experience. While it is important to produce high quality images in order to accurately diagnose disorders, we believe that it is just as important to perform the examination in a way that is supportive of the patient and family. These two goals can only occur when members of the radiology department work together as a team. We use these principles every day to make the imaging experience as stress-free as possible for children and their parents.

When playtime leads to a lesson: a case study.

An example that illustrates this point occurred recently in fluoroscopy. A 4-year-old boy arrived in our department for an upper GI examination. After assessing the boy, the child life specialist discovered that the large and confining space of the fluoroscopy camera was scary for him. In order to help calm the boy’s fears, the child life specialist played with him, using the camera to play hide-and-seek. This helped the child to become more familiar with the equipment and feel less overwhelmed. The child life specialist then spoke with the technologist and radiologist discussing the patients fears and offering suggestions (such as slowly moving the tower and keeping it a little higher than normal) to lessen his stress and anxiety.

During the study, the child life specialist engaged the patient in play and directed that play in specific ways to help the patient achieve the necessary positioning and cooperation for the imaging. This attention to the boy’s fears helped him to easily get through the examination. This kind of supportive experience has a lasting effect on our patients and allows them to gain confidence as they undergo repeat examinations.

Collaboration between child life specialists and parents can keep children at ease.

We encourage parents to be involved in their child’s care throughout the Radiology appointment. Parents can help prepare for an examination and soothe their child during the procedure. Parents can use the Cincinnati Children’s Radiology website to learn accurate information about their procedures. They can also view pictures of CT and MRI equipment with kid friendly explanations so that children can become familiar with the process before their appointment. As part of the preparation process, a parent can demonstrate what the child will need to do. Children look to their parents for clues on how to handle new experiences, so when the parent practices first, it helps the child to think, “If Mom or Dad did it, so can I.”

When a child is scared, we know that a parent can make him or her feel better. We encourage parents to stay close to their child during most examinations and encourage them to hold hands, sing, or play throughout the procedure. Literature supports that when parents are given good information on what to expect during the procedure and are given an active role to play, their stress is lessened, which ultimately lessens the stress of their child.

Child life specialists have a central role in the Radiology Department at Cincinnati Children’s Hospital helping us to better care for our patients. We see their impact every day in the smiles of children and their parents.