Interesting New X-Ray Technology in National Imaging Professionals Magazine 24X7 Featuring Rapid X-Ray!
By Chris Hayhurst
Imaging equipment has come a long way over the last 12 months, and 2017 promises more of the same
Leave it to a heavyweight like the Massachusetts Institute of Technology (MIT) to get an imaging equipment specialist thinking about what eventually might be.
“If anyone is doing interesting research in this field, it’s them,” says Chris Salberg, CEO of Minneapolis-based Rapid X-Ray and Biomedical Engineering. “They’re looking at a way to generate x-rays in an entirely new form that creates less heat and has far better resolution than what we have currently.” On top of that, Salberg adds, “it’s probably going to be less expensive to manufacture—which means we might actually see it put to use.”
That technology, in fact, involves shooting photons at a sheet of pure carbon called graphene, and then using the surface waves that are created at impact to generate pulses of radiation. The radiation, the MIT researchers noted in the journal Nature Photonics, would be similar to what one might expect from a laser beam. Furthermore—and as the MIT news office put it at the time—“the new system could, in principle, create ultraviolet light sources on a chip,” as well as “table-top x-ray devices” capable of producing beams “that now require huge, multimillion-dollar particle accelerators.”
“It’s going to be interesting to see how that proceeds,” Salberg says now, almost a year to the day after their research was published. “It might be two or three years down the road, but it could be a way to significantly reduce unnecessary exposure to radiation.”
“Sink or Swim” for Biomeds
Meanwhile, Salberg says, he’s more than happy to continue about his business of digital x-ray sales and service—and doing everything he can every day to keep up with the technologies that are already coming out. “Imaging is always changing,” he says. “That’s one of the biggest hurdles engineers have to overcome—the fact that year to year there are so many new innovations. If you don’t want to fall behind, you have to stay on your toes. You have to take the time to learn how things work.”
The biggest change he’s noticed over the last decade has been on the “computer and computer-software side of things, and the applications the software is in charge of running,” says Salberg, who prior to launching Rapid X-Ray was the lead imaging equipment specialist at the University of Pittsburgh Medical Center. Digital radiography (DR) and computed radiography (CR) have been widely available for years, he notes. “But all the various software, programs, and 3D imaging—and now we have 4D imaging as well—all of that’s on the software end, and it’s constantly evolving.”
Because of that, Salberg says, the imaging service engineers that work for him are as fluent in their IT skills as their knowledge of the equipment itself. “When you get a call saying that a CT scanner won’t send to [the] PACS, you can’t just wait for IT to come around. You have to try to figure it out yourself.” His team, he says, has taken self-study training courses through the Computing Technology Industry Association (CompTIA) to become proficient and certified in a variety of imaging-relevant IT applications. “They’ve had to,” he says. “Because when it comes to the computer side of imaging systems now, it’s either sink or swim. You learn it or you’re out.”
The Showroom Floor
That same line of reasoning will presumably lead at least a few biomeds to Chicago this month for the annual meeting of the Radiological Society of North America (RSNA), where more than 600 different companies with imaging-related products will put their latest equipment on display, and where right next door they’ll have their pick of hundreds of imaging educational courses.
The idea, of course, would be to get that “first glimpse” of what’s to come—and perhaps, if as Salberg recommends, “your biomed department has a say when it comes to the equipment your facility purchases”—to investigate what these new systems require in terms of their service and maintenance. “You want to make sure you have access to their service software and their training schools. And if you find that a manufacturer locks independent service organizations out, you should take that into account” if it’s important to your organization.
So what can we expect at RSNA 2016? It would be impossible to run through every new product, so instead here’s an innovation snapshot from just a few of the companies on the exhibitor list.
Ready for the Future
At Rochester, NY-based Carestream Health, “innovation has always been important as it’s the only way to remain relevant in the marketplace,” says Sarah Verna, the company’s global marketing manager for x-ray solutions. Likewise, she says, their overriding philosophy—“right for today, ready for tomorrow”—means that every new product the company creates is designed to be adaptable not only to a facility’s future growth, but also to future technological breakthroughs.
“Our goal is always to offer systems that will work over the long run and that can be expanded as necessary according to each organization’s needs,” Verna says. “And when we roll out software updates or updates to a system, they’re going to be add-ons—you won’t have to purchase a whole new room.”
While she “can’t yet divulge” the technologies Carestream has in store for 2017, Verna says she can shed light on some of the areas the company focused on over the last year. One clear highlight for 2016, she notes, was their new DRX-Excel Plus radiography/fluoroscopy system, the first of which was installed at Crossett, Ark.-based
Ashley County Medical Center in April. The ergonomic system includes a foot pedal that allows for hands-free positioning and a remote control for moving it around a room.
But its most intriguing innovation is how it saves space. “It has a combination of both fluoroscopy and general radiography capabilities in one compact unit,” Verna says, which means facilities don’t have to devote separate areas to each system. “Most places aren’t doing fluoroscopy studies eight hours a day, seven days a week. This lets you do your general radiography in the same space, so that room never has to sit idle. It lets you keep things more streamlined and more efficient.”
Another recent innovation for Carestream is its DRX-Evolution Plus DR room, the next step up from the company’s DRX-Evolution. In this case, Verna says, it’s in part about the table, which can hold much more weight than previous models; but it’s also about the LED lighting, its “enhanced pediatric capabilities” (The table can be lowered to accommodate kids.), the extended tube column that “makes it ideal for sites with high ceilings,” and the fact that in the near future it will also permit specialized applications like dual-energy imaging and digital tomosynthesis.
Meanwhile, Verna adds, Carestream’s third generation of wireless (or fixed) DR detectors (the “DRX Plus” line), all of which are compatible with the DRX-Evolution Plus room, are “lighter and faster” than previous models and provide better image quality. Last year, Carestream released the “3543” (35 cm x 43 cm); the new version is the larger-format “4343,” which is especially useful for bariatric patients.
And then there’s the last line Carestream introduced in 2016: the DRX Core suite of detectors, which the company began shipping in late August. “The DRX Core is really geared toward smaller clinics, urgent-care facilities, and imaging centers where they might only have one room for imaging,” Verna says. “It’s also an easy way to go from CR to DR” before Medicare, in keeping with the Consolidated Appropriations Act of 2016, which reduces reimbursement for CR in 2018.
Focus on Value
Another company that is keeping a close eye on the reimbursement landscape is Malvern, Pa.-based Siemens Healthineers. “The shift toward value-based purchasing has certainly had an impact on our engineering efforts,” says Michael Wendt, senior vice president of diagnostic imaging for Siemens Healthineers North America.
“So our emphasis right now is on things like stability, reproducibility, and ways to standardize” imaging examinations across multiple platforms. For instance, he posits, “How can we ensure that at an examination done on a Tuesday morning at one facility is just as good as another conducted on a Sunday night at a second facility?”
The answer, Wendt says, involves reducing variability. “We’re making our equipment more interchangeable, easier to test, and easier to manage, repair, and maintain.”
In the last year alone, Wendt says, Siemens introduced the Multitom Rax Twin Robotic x-ray system (displayed at RSNA 2015), the Magnetom Amira 1.5 Tesla MRI system (cleared by the FDA in January), and the Biograph Horizon PET/CT system (also cleared in January). Their Somatom Drive CT system just received FDA clearance at the end of August. And back in May, with a device the company calls the Mammomat Inspiration, Siemens became the first to offer health care providers a standalone 3D screening and diagnostic mammography system.
Still, Wendt thinks the BMET crowd would be most interested in the Multitom Rax. “It’s essentially two robots that are synchronized with each other,” he says. “One carries the detector; the other carries the tube.” As for their other devices, the dual-source Somatom system enables rapid and “precise diagnostics” and includes a new tin filter and low-voltage capabilities that help it reduce x-ray dose. And the Biograph Horizon uses 4 mm crystal scintillators to create higher light output that leads to better image resolution.
“All of our scanners include an integrated and automated quality-control feature that you can run overnight,” Wendt says. “It lets you make sure they’re up to the standards you’ve set so that all of your exams are of the same quality.”
Changing the Game
It’s unlikely that many companies at November’s meeting will roll out as many products as Tustin, Calif-based Toshiba America Medical Systems. “We’ll have a new launch for every imaging technology we offer, including CT, MR, ultrasound, vascular, and x-ray.” says Satrajit Misra, Toshiba’s vice president of marketing and strategic development. “It should be a robust RSNA.”
At Toshiba, Misra says, “our entire innovation thought process is based around the ‘made for life’ philosophy, which fundamentally revolves around addressing our customers’ biggest pain points.”
Toward that end, the “game-changing” CT technology they display at RSNA will help caregivers “do faster triage of high-risk conditions” like stroke, heart attacks, and trauma; their MR system will “take the concept of patient experience and comfort to a completely new level”; and their vascular system will allow surgeons to do their work from “any direction and any angle,” Misra says. Similarly, Toshiba’s ultrasound and x-ray rollouts will include platforms that allow for greater flexibility and better image quality.
Finally—and of particular interest to biomeds—Toshiba will showcase “imaging intelligence tools” that can analyze equipment utilization across an entire enterprise. “You’ll be able to see your entire ecosystem of Toshiba machines and their data so you can track trends and optimize performance,” Misra says. “We see that capability as critical in this environment—not only in terms of maximizing your return on investment, but also when it comes to what’s good for your patients.”
That focus on ROI and patient outcomes is high on the list of priorities at Irvine, Calif-based Ampronix as well, says Nausser Fatholli, the company’s CEO. “We’re always trying to develop new products that are more cost-effective than what’s already on the market and that help our customers do their jobs better.” Their new Hybridpixx display, he notes, is one example of such a technology.
Released in September, the device is meant for use in hospital catheterization laboratories. “It’s less than half the price of similar products from our competitors, but it has better luminance and it’s much lighter, so it’s easier to handle during installation or maintenance.”
So what’s in store for the future at Ampronix? According to Fatholli, they’re already developing a new version of the Hybridpixx—a patent-pending model the company describes on its blog as having “an ingenious design that garners all the advantages of 4K UHD display, while mitigating the dangers associated with a single large display.”
As Fatholli explains, “it’s not good when a monitor goes out during a procedure.” Their upgraded design, which they hope to release soon, is a two-sided monitor that can be easily flipped around so if one screen goes out the other can be used instead. “The monitors work independently of each other with completely different circuitry,” he says.
And for those who want to give the new Hybridpixx a try? The easiest way to do that, Fatholli says, “is to come find us at RSNA.”
Chris Hayhurst is a contributing writer for 24×7. For more information, contact chief editor Keri Forsythe-Stephens at email@example.com.
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Will your x-ray reimbursement go down? Probably!
Awesome article from Auntminnie! Read on!
Medicare to cut analog x-ray payments starting in 2017
February 8, 2016 — As part of a push to nudge U.S. healthcare providers to adopt digital radiography (DR), the Medicare system will begin reducing payments for exams performed on analog x-ray systems starting in 2017. The year after that, sites using computed radiography (CR) equipment will also see payment reductions.
Medicare payments will be reduced by 20% for providers submitting claims for analog x-ray studies starting in 2017 under a provision in the Consolidated Appropriations Act of 2016, which was enacted into law in December 2015. Starting in 2018, payments for imaging studies performed on CR equipment would be reduced by 7% for the next five years, and 10% after that.
While the law’s provisions on analog x-ray are expected to have a minor impact due to the small number of traditional systems still in operation in the U.S., the reductions in CR payments could have a much broader effect: More than 8,000 CR units are still in service in the U.S. All of these systems must be replaced or imaging facilities will experience payment reductions.
Transforming the oldest modality
The adoption of DR over the past two decades has transformed medical imaging’s oldest modality, enabling bread-and-butter x-ray images to be acquired quickly and then easily transferred into PACS for distribution, interpretation, and archiving. Before DR arrived, many facilities upgraded their x-ray equipment with CR, which replaced film-screen cassettes with imaging plates that can be carried to a reader for digital output.
The provisions inserted into the Consolidated Appropriations Act are designed to speed the transition of U.S. healthcare providers toward digital radiography by changing the Hospital Outpatient Prospective Payment System. Classified as a “special rule,” it specifies a 20% cut starting in 2017 to the technical component of reimbursement for an x-ray taken using film.
The cuts for CR are phased in over time, starting in 2018. Payment for the technical component of an x-ray acquired using computed radiography will be reduced by 7% during the years 2018 to 2022 and by 10% after that. Complete text of the act can be viewed by clicking here.
Origins of the provision began about a year ago, when the American College of Radiology (ACR) began working with various manufacturers, in particular Varian Medical Systems, according to Cynthia Moran, ACR’s executive vice president of government relations, economics, and health policy.
While Varian is best known for radiation therapy systems, it also manufactures DR panels for inclusion into new OEM x-ray systems and offers DR retrofits for installed analog and CR x-ray systems in the field.
The DR provision was originally inserted into the 21st Century Cures Act, legislation proposed in 2015 that among other things would have repealed the Multiple Procedure Payment Reduction (MPPR). The controversial MPPR rule was implemented by the U.S. Centers for Medicare and Medicaid Services (CMS) in 2012 and reduced reimbursement by 25% for imaging studies performed on the same body part on the same patient in the same imaging session.
ACR worked with vendors, including Varian and the Medical Imaging and Technology Alliance (MITA), on getting the DR provision inserted into the Consolidated Appropriations Act in exchange for their support in reducing the MPPR cut, Moran said.
“They supported us in us trying to get MPPR payment reduction passed, and so we partnered with them to go to Congress to see if they would do the two imaging provisions and handle them at one time,” Moran said.
While it’s tough getting any proposed legislation through Congress, Moran said the two provisions were attractive because they will save the federal government $350 million over the next 10 years. In the case of the DR provision, the savings will come from lower Medicare payments being made to hospitals operating analog and CR equipment.
How much will the legislation affect U.S. hospitals? Not much when it comes to analog x-ray, as the number of film-based systems operating in the U.S. has fallen to miniscule levels, according to market research firm IMV Medical Information Division.
In its 2013 x-ray market report, IMV projected that fixed analog general x-ray rooms made up just 1% of the installed base at U.S. hospitals, down from 5% in 2010. Indeed, the decline in the analog installed base was so great that in its 2015 report IMV didn’t bother to ask radiology administrators how many analog units they were still operating, according to IMV Senior Director Lorna Young.
“So few people have film that it’s not worth talking about,” Young said. “I think film in the installed base has gone virtually to nothing.”
CR offers a different story. While still considered digital, the technology lacks the workflow efficiency of DR, and sales have been declining over the years. While CR made up 55% of new digital x-ray sales in 2006, that number fell to just 6% in 2015, with the rest of digital x-ray sales made up by DR, according to IMV.
Still, years of strong CR installations mean that the technology still makes up a significant part of the installed base of digital x-ray systems, unlike analog x-ray, Young said. In IMV’s 2015 report on the x-ray market, the firm estimated that there are 16,775 fixed general x-ray systems installed at hospitals in the U.S. (a figure that does not include mobile units or systems installed at outpatient locations). Of that total installed base, some 8,545 systems are CR.
Click image to enlarge.
Imaging facilities will therefore have to decide whether to spend the money to upgrade their CR equipment to DR, or swallow a 7% to 10% reduction in payments for x-ray studies. Many of these facilities are located in rural areas, with less access to the capital needed to buy new equipment.
In its 2015 x-ray market report, IMV said that 62% of hospitals were already planning to buy either a new x-ray system or a DR retrofit kit in the coming years. Of these, 70% of sites with fixed CR systems are planning purchases, Young said, while only 34% of sites with fixed DR are making purchasing plans — perhaps indicating their satisfaction with the newer technology.
Converting to DR will produce workflow and efficiency gains — as well as lower radiation dose — for the U.S. hospitals that finally make the switch to fully digital operation, according to ACR’s Moran.
“Clearly analog is felt to be antiquated and not helpful. CR is clearly less antiquated, much more in use, and has many advocates for it, but even that market is moving fairly quickly to digital,” she said. “This policy just furthers that along.”
For Varian’s part, the company sees its support for the legislation as adding impetus to a positive trend in healthcare, according to Spencer Sias, vice president of communications and investor relations at the company.
“We believe that digital imaging makes it possible to lower the cost per procedure by allowing for higher throughput in imaging centers,” Sias told AuntMinnie.com. “We eliminate the need to buy, process, develop, and store film. That is a very good thing in an age when the cost of medicine needs to be held in check.”
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