Diagnostic Imaging brings you daily coverage of RSNA 2021 live from Chicago. 

RSNA 2021 - Live Coverage From Chicago

Day 1

Case submitted by Clayton Sanders, M.D., and Soham Shah, M.D. on behalf of

C. Small bowel obstruction secondary to adhesions

D. Large bowel obstruction secondary to malignancy

Articles

Image IQ Quiz: Elderly Female with Abdominal Pain

The accuracy of intraoperative anatomical measurements can be a key factor in reducing the risk of postoperative complications and facilitating optimal outcomes. Now a new technology reportedly offers real-time digital measurements that can be incorporated into intraoperative videos.

Instead of eyeballing an approximate measurement or attempting to utilize an intraoperative ruler, surgeons may use the technology to make more precise tissue measurements by indicating points on the tissue with surgical tools, according to RSIP Vision, the manufacturer of the technology. The company noted the deep learning-based technology can provide an effective intraoperative complement to the use of third-party endoscopic imaging systems and medical robot manufacturers.

“Aside from simply viewing the image, our technology can use the surgical tools in the image as a virtual measurement device,” explained Ron Soferman, the chief executive officer of RSIP Vision. “Calibration is performed using a dedicated algorithm which extrapolates the camera parameters. Once the image is calibrated, we can perform accurate measurements within the field of view, even in 3D.”

The company cited sleeve gastrectomy as one example of a procedure in which this technology can be beneficial. Noting the importance of avoiding damage to the pylorus in this procedure, RSIP Vision says accurate digital measurement of the resection distance simplifies the surgery and lowers the risk of complications. Similarly, David Hochstein, M.D., who is affiliated with the Rambam Hospital in Haifa, Israel, said the technology may have an impact in trauma and acute care surgery cases that often require bowel resection.

“We must consider the balance between removing enough of the ischemic or severely inflamed intestine without risking short-bowel syndrome,” noted Dr. Hochstein. “Having an accurate and easy way to perform measurements within the image during the procedure will significantly increase our confidence and speed up the surgery.”



An emerging technology may help improve efficiency and outcomes of laparoscopic and robotic-assisted surgeries. 

Can Virtual Measurements Enhance Intraoperative Video Analysis?

Approximately 40 million magnetic resonance imaging (MRI) scans are performed annually in the United States, a statistic that underscores the value of the modality in helping providers diagnose a wide array of diseases. MRIs can aid in evaluating injuries of the back, knee, and other joints, identifying anomalies of the brain and spinal cord, and diagnosing diseases of the liver and other abdominal organs to name a few.

In contrast with other imaging modalities, MRI does not use ionizing radiation and is safe for patients and operators when used appropriately. To ensure patient and staff safety, health-care professionals must follow some important guidelines and invest in MRI technology that reduces patient anxiety. Accordingly, let us take a closer look at ways providers can enhance safety in the MRI room while boosting patient comfort and satisfaction during the MRI experience.

Providers should take several steps to ensure the MRI room and the exam procedures are as safe as possible for staff, patients, and clinicians.

Providers must place a priority on comprehensive training and building awareness of possible MRI hazards with key staff. MRI technologists must be thoroughly trained in MRI best practices and protocols. To ensure safety, it is incumbent on providers to seek out and use every training avenue available from the American College of Radiology (ACR) as well as manufacturer resources.

Providers also need to ensure there is comprehensive screening of all patients before they enter the MRI suite. This ranges from having patients fill out forms about their health and any medical devices or implants they may have to providing patients with a safe garment to change into before entering the MRI suite.

Easing patient anxiety is another way to improve safety. The less nervous a patient, the more efficient and quickly the scan will get done, increasing the odds of everything going smoothly and reducing the chances for error or accidents. Every patient and every situation are unique. However, there are several proven ways providers can enhance comfort with various patient populations.

Addressing Comfort for Overweight and Obese Patients

Over 73% of adults over the age of 20 were classified as overweight

 according to 2017-2018 data from the Centers for Disease Control and Prevention (CDC). Even more concerning, according to the same study, obesity affects 1 in 3 Americans and research suggests that by 2030, nearly 50 percent of older adults will be affected by obesity.

When it comes to MRI machines,bigger has proven to be better. The more at ease patients are during an MRI scan, the more likely the technologist can get the scan right the first time.

Choose equipment that increases the comfort quotient. Fujifilm’s Echelon Oval 1.5T MRI system has the widest bore available (74 cm) with the widest patient table (63 cm) for maximum patient comfort. This is ideal for patients of size as well as anyone who feels vulnerable, such as elderly patients and children.

Easing Anxiety Issues for Claustrophobic Patients

Claustrophobia, a fear of enclosed spaces, is relatively common with research estimating that 

approximately 2.2 percent of the population suffers

 from this anxiety disorder. The prevalence of claustrophobia is higher among women than men. In addition, people who may already struggle with general anxiety or experience panic attacks may be more susceptible to a fear of enclosed spaces.

Studies have shown that many people suffer from claustrophobic feelings while undergoing MRI. In fact,

 found that approximately 1 in 10 patients experience claustrophobia during MRI scans. Clearly, an MRI will not be a welcome procedure for the average claustrophobic patient.

Providers can address this problem by offering an open MRI experience. Fujifilm’s new Velocity MRI system defines what true open MRI is all about: the unique patient comfort and accommodation benefits of open-sided MRI combined with the workflow and image quality benefits of integrated RF coils and enhanced reconstruction technologies. The scanner’s unique, open gantry creates a spacious feeling for claustrophobic, bariatric, geriatric, and pediatric patients. Additionally, the Velocity MRI system’s open-sided gantry provides easy patient access for real-time interventional procedures.

In addition to the negative impact for patients, claustrophobia can also be damaging to a provider’s bottom line. When patients with a fear of tight spaces arrive for a scheduled MRI, all too often they cannot make it through the exam. This wastes valuable staff time and costs the organization money, not to mention the patient failing to get a scan and diagnosis. It’s a lose-lose situation. However, with a state-of-the-art open MRI, exposure to tight spaces during a scanning procedure is a thing of the past and everyone benefits.

Alleviating the Concerns of Geriatric and Pediatric Patients

Providers know their oldest and youngest patients are also their most vulnerable patients. The elderly and young children often have great difficulty enduring an MRI. These situations sometimes call for sedation. While sedating the patient is one way to ensure the scan gets accomplished, it can mean more staff, time, cost, and safety concerns.

Fortunately, there are many other ways to ease the anxieties of these vulnerable populations and reduce the need for sedation. As I mentioned earlier, wide bore and open machines keep patients comfortable, which can also help children—who have a harder time staying still—fidget less. That helps your technologist get a more accurate scan the first time.

Finally, quiet and calm go hand in hand.MRI machines can be terribly loud, which can be upsetting for many patients, particularly children and the elderly. Providers can offer noise-cancelling headphones or even invest in MRI sound systems that play music. Better yet, providers can choose MRI scanners that are already engineered to make less audible noise. Fujifilm’s Velocity 1.2T open MRI offers reduced noise scanning and soothing ambient lighting that help patients relax even more. A quieter machine reduces anxiety, which translates to a better patient experience and an opportunity for your technologist to get the best scan the first time.

Providers must always be vigilant when formulating, communicating, and implementing safety policies and procedures for MRI. In the MRI suite, safety should always be top priority. Moreover, patient comfort is the flip side of the coin. Better comfort equals increased compliance and better safety. Addressing both sides of the coin is a clear win for two parties: patients and providers.

Advances in MRI modalities and capabilities can facilitate optimal comfort and help alleviate anxiety for patients.

Essential Keys to Improving Safety and Comfort in the MRI Suite

Emerging research suggests that artificial intelligence (AI) may play a key role in reducing the breast cancer screening workload for radiologists.

retrospective study involving 4,310 women and a total of 5,182 digital breast tomosynthesis (DBT) procedures

, the authors found that utilization of an AI model to filter out normal DBT exams led to a 39.6 percent reduction in workload, similar sensitivity for detecting breast cancer (90.0 percent compared to 90.8 percent for radiologist-led screenings) and a 25 percent lower recall rate (6.9 percent compared to 9.2 percent for radiologists).

“We envision that implementation of this type of model within the clinic could affect three different levels: for radiologists, by reducing both workload and fatigue arising from routine clinical tasks; for health systems, by improving workflow and facilitating further introduction of DBT, especially where there is a shortage of breast radiologists; and for women, by reducing unnecessary recalls, stress, and exposure to radiation,” wrote Lisa A. Mullen, M.D., a breast imaging fellowship director and an assistant professor of radiology and radiological science at the Johns Hopkins University School of Medicine, and colleagues.

Researchers described the AI model as a mixture of 45 deep learning classifiers that processed the DBT views and five machine learning classifiers that processed clinical information. According to the study, researchers deemed a DBT exam positive or negative for cancer if there were corresponding biopsy findings within 12 months after the DBT exam.

, Liane E. Philpotts, M.D., F.A.C.R., a professor of radiology and biomedical imaging at the Yale School of Medicine, noted the “vast majority” of screening exams are normal, pointing out that in general, one out of every 200 breast cancer screening exams will result in a cancer diagnosis.

“It seems logical that many of these (normal screening exams) could be safely eliminated by an AI system, alleviating a large burden of screening volume,” wrote Dr. Philpotts.

Acknowledging the shortcomings of a modeling study, Dr. Philpotts emphasized that prospective studies are necessary to assess the merits of AI in breast cancer screening are essential prior to widespread use in clinical settings.

The study authors concurred, maintaining that future studies need to demonstrate “substantial evidence” prior to “trusting AI” with a role in breast cancer screening. They noted limitations to the study, including obtaining study data with devices from one manufacturer, and excluding patients with foreign bodies, such as implants, as well as women with a history of breast cancer.

In a simulated clinical workflow, researchers found the use of an artificial intelligence model significantly decreased the number of exams that required interpretation by a radiologist. 

Study Says AI Could Reduce Breast Cancer Screening Workload by Nearly 40 Percent

Case submitted by Rathachai Kaewlai, M.D., via 

Image IQ Quiz: What Does the PET/CT Image Reveal?

Could an emerging software enhance intraoperative radiographs during short-segment spinal stabilization procedures?

which recently garnered 510(k) clearance from the Food and Drug Administration (FDA)

, is a software that shows key cross-sectional views that are not attainable with the standard two-dimensional X-rays often employed by surgeons during surgeries to address short-segment spinal stabilization.

With availability from an on-cart, off-the-shelf PC, the VUZE System employs proprietary image processing to overlay a representation of tools shown on intraoperative 2D X-rays onto axial and sagittal images from a standard preoperative computed tomography (CT) scan, according to the manufacturer VUZE Medical.

Reportedly, more than 800,000 surgeries are performed annually in the United States to repair short spinal segments. David Tolkowsky, the CEO of VUZE Medical, said the VUZE System can be a key adjunct to intraoperative X-rays obtained during procedures that involve pedicle screw fixation, fusion, or vertebral augmentation with biological or synthetic cement.

“We are aiming to preserve the advantages of common X-ray guidance while addressing its shortcomings,” noted Tolkowsky. “Rising cost pressures and a growing aversion towards hospitalization in the age of COVID-19 are accelerating a shift of short segment surgeries from inpatient to outpatient and from outpatient to ambulatory settings. In such settings, reliance on X-ray guidance is high.”

Utilizing no cameras, sensors nor reference arrays, the VUZE System can be employed with standard surgical tools and implants without modifications or add-ons, according to VUZE Medical. In addition to intraoperative guidance, VUZE Medical said the software facilitates pre-op planning regarding implant sizing, entry location and trajectory determination.

As a potential complement to intraoperative X-rays, the imaging software may be beneficial for short-segment spine procedures performed in outpatient or ambulatory surgery centers.

New Imaging Software Gets FDA Clearance for Use in Short-Segment Spine Stabilization

I went on a little road trip this past weekend and spent about nine hours behind the wheel, which was more driving than I typically do in an entire month. I don’t get out much, given that I work from a teleradiology home office, not to mention the pandemic causing intermittent societal shutdown.

Long before COVID-19 entered the equation, I noticed an impact of the tele-lifestyle on my driving habits: I was far less hurried whenever I was on the road. No longer spending 50 to 60 minutes per day in a rush to and from work, I found what time I did spend behind the wheel was a much more laid-back, even relaxing affair.

In retrospect, the “gotta get there faster” feeling from my commute had infiltrated my standard driving mindset no matter where I was going. Removing the commute gradually fixed that. In the ensuing decade, I’ve mostly had to exert more effort to keep up with the speed limit rather than stay below it. Put me on a multi-state trek like this recent one, however, and I soon rediscover the gas pedal.

Regardless of whether I’m close to home and doing 40 on a 50 mph road or a couple-hundred miles away on an interstate highway, doing 75 in a 65 mph zone, I’ve noticed a commonality. As the great George Carlin once observed, anybody driving faster than me is a maniac, and anybody going slower is an idiot.

I have noticed this is not all that different from a lot of radiologists’ attitudes regarding work volumes. 

I read at a reasonable pace but that guy who goes slower than me is lazy.

I work pretty hard but my coworker burns through the work list way too fast to be doing a good job.

Every rad group, intentionally or not, has policies impacting the working speed of its employees. One determining factor is that all the work needs to get done, and it’s probably a good idea to reward those who do more of it. Another determining factor may be the notion that it is possible to burn through cases at such a pace that you’re no longer doing good work. I have seen groups stack all of their chips on either factor but most form a spectrum in between.

At the extreme end is pure “eat what you kill” pay-per-click compensation that rewards one for going faster. The only limit, per se, might be if you make a bunch of blunders that catch up with you at QA to the point where leadership taps you on the shoulder. Subsequently, you either slow down to improve or get canned, or you get sued into oblivion via medical malpractice.

The other extreme end of the spectrum might be a conventional flat salary gig in which nobody seems to pay attention to who does how much work. Under those circumstances, going as slow as possible could work in your favor. After all, you’re getting paid the same no matter what you do, and every case you read offers another iota of malpractice lawsuit risk, so why stress yourself?

Any number of mechanisms can fine-tune a group’s position in the spectrum. When I started doing telerad, for instance, my employer had a system wherein productivity-based pay dropped off at higher volumes. You still got paid per case and there was no hard “cap.” However, additional cases above a certain threshold were worth a few bucks less. There was more than one reason for this but for the purpose of this column, it made sense. This was a soft “speed limit” to disincentivize reading beyond a pace that many might consider unsafe or at least conducive to suboptimal work quality.

What constitutes “speeding” for a rad isn’t as readily defined as it is with motor vehicles. On the road, signs clearly display the upper (and sometimes lower) limits of what you should be doing. Disobey and you risk fines, points on your license, or worse.

In our field, there’s a recognition that everybody is different. What might be an unsafe working speed for one rad could be a typical day, or even slow or boring for another. Then there is the matter of environment and infrastructure. If you’re given a highly efficient workstation, a list of studies you’re good at reading, and a sequestered workspace where you won’t be disturbed, you have everything you need to go faster than a rad with a crummy PACS that frequently crashes, exams outside of his or her comfort zone, and a constant parade of clinicians, techs, and other rads knocking at the door and ringing the phone.

That said, our roadway system for speed limits seems overly simplistic. Of course, some drivers are more capable than others. Similarly, some vehicles are more reliably handled at higher velocity, are better equipped for safety in case of accident, etc. Plus, there are differences in driving conditions such as time of day/night, weather, who else is on the road, etc.

But a speed limit somehow gets determined for each road and it applies to everybody. I guess there’s really no other logistically sensible way to do it. Even if there were, our society likes to believe that everybody should abide by the same rules no matter how frequently that fails to be the case. If you merely suggested that someone with a better/safer car and proven superior driving skills should be allowed to go faster than others, you would probably get tarred and feathered for being an elitist.

I wonder how long it will be before some politico or other grandstander in the social arena decides to make this his or her 

. “We need to rein in these doctors! They get paid for each case they do. What is to stop them from going too fast and risking patients’ lives? The rest of society lives with reasonable speed limits because we know that driving too fast is dangerous. Why shouldn’t doctors have to live with the same rules we do?”

Probably the only reason it hasn’t happened already is that the whole fee-for-service system — and its “death by a thousand cuts” whittling away at reimbursements — depends on the notion that we can work a little more, a little harder, a little faster, to make up for each time radiology’s RVUs get hacked at. Take that away and the current radiologist shortage will look like a glut compared to what happens next.

Amid a landscape of reimbursement cuts, productivity-based pay, flat salary gigs and possible exposure to malpractice lawsuits, what is an optimal, efficient work pace?

Handling Work Volume: What Constitutes 'Speeding' for Radiologists?

As we get into some of the key takeaways from the paper, we’ll talk about some of the conclusions. The first was the advantage of 18F-fluciclovine in detecting curable localized disease in close anatomic relation to the urinary bladder, whereas gallium PSMA [68Ga-PSMA-11] fails because of accumulation of activity in the urinary bladder. However, 18F-fluciclovine is almost equivalent to 68Ga-PSMA-11 in detecting distant sites of prostate cancer. As we talked about on the previous slide, for most situations outside the urinary bladder area, 68Ga-PSMA-11 was superior. What key points resonate with you from this paper, Louis?

You asked about some nuance to reading it. That’s something that needs to be considered when we’re thinking about these radiotracers, because 1 radiotracer we believe outperforms the other when it comes to outside the bed. When we want to question the bed, 1 thing we need to do for any future study—we’ll talk about that when we think about things—is optimization of technique. How would we optimize gallium-68 or F18-fluciclovine PSMA [prostate-specific membrane antigen] to perform better locally? I can speak anecdotally. To optimize the ability to identify disease locally with PSMA, 1 thing you do is acquire images as some institutions have, like my own, beginning with the thighs going toward the vertex. You decrease the amount of radioactive tracer within the bladder. From a PSMA perspective, you also have the patient void when they come to the imaging facility and have the patient void right before getting onto the scanner. Those are 2 other things you can do to optimize the ability to visualize the prostate.

The other thing you need to do when you’re looking at these scans—and this is true when it comes to 18F-fluciclovine, from the ability to look at bone and with a nodal disease—is windowing. Windowing is crucially important. Everything in PET [positron emission tomography] is about background. If your background in the bladder is incredibly high, you’re not going to be able to see anything next to it. But if you’re able to window the bladder appropriately, you’ll have a higher likelihood of identifying local disease. One thing I was wondering about—Steve, I don’t know if you wondered this as well—is that I don’t believe the paper broke down the amount of local recurrence identified by prostatectomy vs radiation therapy. We have a number of patients we saw who had recurrent disease locally at the bed, but it wasn’t clear to me which number of patients were from the radiation therapy side vs the prostatectomy side.

Their numbers were so small that they were concerned that if they broke it in subset analysis down to such low numbers, they would not have favorable reviewing on the paper. Fifty-eight was obviously the largest series when this paper was published, and that in 2019. Obviously, there’s a lot more interest and a lot more availability of gallium-68 scanning in the way of PYL [18F-DCFPyL] PET, and you would imagine that there will be some United States–based publications doing this work. The limitation previously had been where you could get gallium scans. With the advent of doing PYL scans, you’d imagine that you might have some subset papers of postprostatectomy and postradiation therapy, and be able to tease out some of these answers about the differences between 18F-fluciclovine and PSMA PET to detect recurrences in prostate cancer.

Videos

Reactions to key findings from an article by Birgit Pernthaler, et al, that compared the use of 18F-fluciclovine with 68Ga-PSMA-11 imaging modalities to detect biochemical relapse in prostate cancer.

Key Takeaways: Head-to-Head Comparison of 18F-Fluciclovine and 68Ga-PSMA-11 in Prostate Cancer

A digital radiology detector is an integral part of your medical imaging system and workflow. The right detector can help improve efficiency and provide advanced imaging applications to help improve diagnosis and patient care.

But how do you choose the right DR detector? With different sizes, different scintillators and different software, the choices are almost as varied as options on a new vehicle. Given these challenges, here are some guidelines to help you choose a detector that fits your facility’s needs at a price you can afford.

The types of patients that are being imaged and the types of exams you are performing will influence the detector and software that you select.

When considering a DR detector, here are some questions to consider:

Are you providing imaging for pediatric patients? What about neonatal imaging?

Are you doing exams for bariatric patients, trauma patients or orthopedics? This will help determine the size of the detectors you need.

Do you need a detector with dynamic capabilities for fluoroscopy or a general imaging detector?

Dosing Considerations: How to Balance Exposure with Image Quality

The goal of every imaging department is to produce the best quality images with the least amount of dose to the patient. DR detectors that use Cesium iodide (Csl) have helped make that a reality.

A digital detector using Csl can offer up to a 30 percent dose reduction in comparison to gadolinium oxysulfide (GOS) detectors. This is especially important in pediatrics because children are more vulnerable to radiation-induced cancers. In addition, CsI has high efficiency to preserve the visualization of fine details for a more accurate diagnosis.

 uses Csl for these highly dose-sensitive little patients, and its smaller pixel pitch delivers improved image quality for diagnostic confidence. This small-format, wireless DR detector is also quick and easy to position in incubator trays, while providing fast performance for instant access to images. The 2530C also offers the benefits of Carestream’s X-Factor, allowing it to be shared with other Carestream DRX equipment. With its flexible positioning and easy handling, the DRX Plus 2530C is also ideal for orthopedic imaging.

Another option for limiting dose is our DRX-L Detector for long-length imaging. Capturing high-quality long-length images for a patient’s leg or spine radiographs can be difficult, especially with pediatric patients or patients with limited mobility. With the wireless DRX-L Detector, a long-length imaging exam can be completed with a single exposure in less than one second, and image preview is available in six seconds.

In comparison, image acquisition for multi-shot long length imaging can take 14 seconds or more. That time savings with the DRX-L Detector can mean a lot for a fidgety child or patient in pain.

Multiple exposures also require images to be stitched together for a complete image. With the DRX-L Detector’s single exposure capability, there is no need for stitching multiple images, contributing to more precise measurements for better diagnosis and treatment planning. This is another strong option to achieve the lowest possible overall exposure without sacrificing image quality. The DRX-L is also a shareable member of the DRX family of DR detectors.

Image processing software works hand in hand with the detector.

 provides a wide variety of enhancements to make X-ray exams faster, easier, and more productive. Some notable applications that we offer are:

Tube and line visualization, which accentuates peripherally inserted central catheter (PICC) lines, central venous catheter (CVP) lines, gastrointestinal (GI) tubes and more to help with a fast diagnosis.

Pneumothorax visualization, which accentuates the appearance of free air in the chest cavity.

Bone suppression, which enhances the visualization of soft tissue.

Automatic grid detection and suppression of grid artifacts.

SmartGrid, which gives the same image quality without the physical use of a grid.

Our Eclipse engine automatically adjusts and tailors image processing to provide noise suppression and detail enhancement, which makes the subtle abnormalities that can be difficult to detect much easier to see and diagnose. Our Eclipse image processing software is available on all our DR detectors.

Can The Detector Enhance Workflow Efficiency?

DR detectors, especially wireless ones, have exponentially decreased the amount of time it takes for radiographers to perform imaging exams, which has subsequently made X-ray imaging much faster and easier for patients.

With a digital detector, patient images that once had to be processed through a film processor or computed radiography (CR)reader are now available seconds after exposure. In addition, mobile imaging is becoming increasingly popular in facilities. Digital radiology gives an immediate image at the patient’s bedside. If additional exposures are required, there is no need to disturb the patient for a second time, saving precious time for both the radiographer and the patient. Before selecting your next detector, consider some key questions regarding your workflow.

• Will the detector be used for bedside imaging?

• Will detectors be shared among multiple rooms or mobile units?

• Where will the detectors be charged? If there are a significant number of bedside images, consider a portable that has in-bin charging on the unit.

Another way to improve workflow is to lighten the load. The Carestream Lux 35 Detector is a lightweight, glass-free wireless detector ergonomically designed with the comfort of patients and radiographers in mind. Weighing approximately five Lux pounds, the sleek Lux 35 Detector, with its glass-free sensor, is Carestream’s lightest detector to date. A lighter detector makes it easier for radiographers to transport while making rounds and performing bedside exams. The cesium detector also offers superb resolution, better detail, and a reduced exposure dose in comparison to gadolinium detectors.

Also note whether your patient load shifts between departments at different times. If yes, that is another reason to choose a detector that is shareable so it can go wherever it is needed most: rounds in the morning, an X-ray room during the day and the ER at night.

Lastly, do your radiographers move among different facilities? If they do, consider purchasing detectors and other imaging equipment that share the same software. That helps your radiographers be more productive. They can easily move from one device to another within your facility. It also means that when you add a new detector, radiographers can get up to speed quicker, which reduces training costs.

Get the Most Functionality and Flexibility for Your Budget

Of course, price matters, especially when one must contend with budget constraints.

Our Focus 35C/43C Detectors, with Image Suite V4 Software powered by the Eclipse engine, allows the benefit of DR without replacing your current equipment.

Specifically designed for smaller facilities as well as private and specialty practices, such as orthopaedics, chiropractic and veterinary, the Focus 35C/43C Detectors offer affordable options for going digital. Our wireless Focus Detectors with Image Suite Software offer a simple and intuitive user interface, automated workflow with uniform protocols, a Windows 10 Platform for added cybersecurity and other advantages to increase your productivity each day and support a higher standard of care for your patients.

Before purchasing any detector, it’s important to review all the features to ensure the right fit for your facility’s needs and optimal quality at a cost you can afford. I hope these guidelines will help you make an informed decision.

Editor’s note: This article has been adapted with permission from the original publication on Carestream’s Everything Rad blog at 

Essential factors range from dosing considerations and image quality to workflow efficiency and cost-effectiveness.

Guidelines for Choosing Your Next Digital Radiology Detector

The prompt and accurate results of an imaging study can be the difference between life and death. Yet the number of practicing radiologists in the United States is likely insufficient to meet the growing demand. This shortage is also projected to worsen, and according to the Association of American Medical Colleges (AAMC), the U.S. is projected to have a shortage of 17,000 to 42,000 radiologists, pathologists, and psychiatrists by 2033.

 On average, the number of imaging studies increases by a rate of up to five percent per year, but the number of radiology residency positions only increases by two percent.

This shortage has a dramatic impact on patient care. A shortage of radiologists leads to increased turnaround times for study results to be generated, which can negatively impact patient outcomes. One recent study found that radiology imaging delays are an independent predictor of length of hospital stay.

 Another recent study found it took more than three hours to generate a report from an average CT study with the radiologist being the bottleneck 42 percent of the time.

 This delay in clinically pertinent information can have a significant impact on patients. These delays needlessly burden health systems, patients, and insurers, and could be resolved by improved imaging coverage. Although the situation might appear dire, there are many potential solutions.

The first and most immediate solution would be an increase in the number of radiology residency positions.

 The number of positions is largely determined by Medicare, and there have only been marginal increases over the years in radiology. In 2006, there were 1,011 radiology residency positions. In 2020, there were 1,113 radiology residency positions. However, this slow increase has begun to change as Congress passed a graduate medical education (GME) expansion in 2020, which added 1,000 new residency spots, many of which are likely to be radiology positions.

Increasing medical student awareness of the specialty is another promising way to combat the shortage.

 Medical students often have little exposure to the radiology specialty, and a recent study found that only 35 percent had completed a radiology rotation by graduation.

 This could be remedied by promoting radiology as a core rotation in medical school as well as increasing the amount of radiology material that is covered during the preclinical curriculum. One study found that adding just 2.5 hours of radiology lectures to the first year of medical school significantly increased student interest in radiology, and increased the likelihood of students completing a radiology rotation later in the curriculum.

 This is a promising solution since more medical students interested in and matching into radiology could potentially reduce the impact of the radiologist shortage.

Another solution to this workforce challenge is achieving improvements in radiologist efficiency.

 Many studies have investigated potential methods by which radiologists can increase efficiency. Promising solutions include decreasing distraction and integrating the utilization of artificial intelligence (AI) in practice.

 Interruptions due to phone calls, emails, and consent forms can hinder a radiologist’s workflow, potentially leading to decreased performance and less informed consultations.

Reductions of these distractions through the use of reading room coordinators and enhanced communication workflows are often pursued as solutions for improving efficiency. Additionally, AI enables radiologists to perform their roles with greater efficiency. Although unlikely to replace the role of the radiologist, AI can be used to help with measuring lesions, comparing studies, and triaging scans that are at an increased risk of being urgent. One study found that AI could be used to select which chest X-rays were more likely to be abnormal, and then prioritized those for interpretation by radiologists.

 This method was able to decrease the average delay in interpretation of abnormal scans from 11.2 days to 2.7 days.

Although current trends in the number of practicing radiologists may seem concerning, the future is bright. There are many effective solutions to this problem, all of which are simultaneously being pursued. Many medical schools are integrating more radiology material into the curriculum, radiology residency positions are being expanded, and radiologists are becoming more efficient each year. These trends are promising for the future of the field and with sufficient action, the shortage can be addressed and possibly reversed.

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https://www.aamc.org/system/files/2020-06/stratcomm-aamc-physician-workforce-projections-june-2020.pdf

 . Published June 2020. Accessed January 20, 2022.

2. Smith-Bindman R, Kwan ML, Marlow EC, et al. Trends in use of medical imaging in US healthcare systems and in Ontario, Canada, 2000-2016. 

3. Courane S, Conway R, Creagh D, et al. Radiology imaging delays as independent predictors of length of hospital stays for emergency medical admissions. 

4. Perotte R, Lewin G, Tambe U, et al. Improving emergency department flow: reducing turnaround time for emergent CT scans. 

 2018 Dec 5;2018:897-906. eCollection 2018.

5. Prezzia C, Vorona G, Greenspan R, et al. Fourth-year medical student opinions and basic knowledge regarding the field of radiology. 

6. Branstetter B, Humphrey A, Schumann J. The long-term impact of preclinical education on medical students’ opinions about radiology. 

7. Dargan R. Artificial intelligence boost efficiency and quality in radiology practice. Radiological Society of North America (RSNA). Available at: 

https://www.rsna.org/news/2019/march/artificial-intelligence-boosts-efficiency

 . Published March 18, 2019. Accessed January 20, 2022.

8. Lee MH, Schemmel AJ, Pooler BD. Radiology workflow dynamics: how workflow patterns impact radiologist perceptions of workplace satisfaction. 

While current projections suggest a shortage of radiologists in the future, promising developments with radiology residency positions, medical student awareness of the field and AI-aided efficiencies could be game changers. 