CVC 2008 Highlights: What to consider when considering digital radiography

We are in the digital age! Demand for conventional processors and film-screen radiographic equipment is decreasing. There are fewer small wet-chemical processor manufacturers, and the number of people who repair these processors is decreasing. In addition, radiographic film, which used to be a premier business for major U.S. companies, is now mostly imported. The processing chemicals used in traditional radiography are now being regarded as toxic waste; more regulations are being placed on their disposal, which will increase purchase and disposal costs and, thus, decrease demand.

Victor T. Rendano Jr., VMD, MSc, DACVR, DACVR-RO

GOING DIGITAL: THE PROS AND CONS

It is fortunate that digital radiography has several advantages over traditional radiography:

• Unlike traditional radiography, which takes a lot more time to process an image, with direct (DR/CCD), or cassetteless, digital radiography, we can see the image on a monitor in seconds.

• With digital radiography, we are able to manipulate the image electronically to help improve its quality if it is not pristine. So if you obtain poor-quality radiographs with traditional radiography, you will likely love digital radiography. If you obtain good-quality radiographs now, you will probably like digital radiography. If you already obtain perfect radiographs by using the traditional method, you may not like digital since the best-resolution images are still produced with traditional radiography. However, the exposure latitude (ability to produce a diagnostic radiograph over a much broader range of exposures) is greater with digital radiography than with traditional radiography. Thus, you will likely have fewer retakes because of underexposure or overexposure. Also, even though you give up a little in resolution compared with traditional radiography, it is typically overcome by improved contrast resolution and the ability to see the image immediately after it is taken.

• Digital radiography does not require a dark room—or wet-chemical processors, film storage bins, or radiographic viewers.

• With digital radiography, when you want a second opinion, you can send the radiographic study quickly and directly to your peers or to a specialist rather than waiting on the postal service or laboratory courier to deliver it.

• Digital radiography has transformed the imaging capabilities of mobile practitioners because some digital systems provide images in the field within seconds.

The disadvantages of digital radiography are the equipment's initial expense and its relatively rapid loss of value because of ever-improving technology, and the time involved in learning how to use the new equipment.

IS NOW THE RIGHT TIME?

Some practitioners are hesitant to transition to digital radiography because the technology is always changing and they do not want to invest in equipment that may soon be obsolete. Similar to the trend with digital cameras and computers, digital radiographic imaging equipment has gotten better and less expensive. Digital radiographic equipment purchased five years ago for $120,000 has been replaced with better technology that costs $75,000—i.e. more for less! But there is going to be a point at which you have to get into it, and we are at that point.

Some questions to ask yourself before you decide to switch: Will digital radiography make my life easier? Can I keep my current radiographic unit and retrofit the system for digital radiography, or do I need to buy new x-ray generating equipment plus a digital detector? How many computer work stations and monitors will I need? Can I afford digital radiography?

If you are considering retrofitting your x-ray generating equipment, it is important to make sure the equipment is functioning properly and will meet the performance demands required by the digital detector system. If your equipment is on its last leg and you marry it to a new piece of equipment, you may burn out the x-ray tube or have other problems. In addition, if the marriage doesn't work correctly for any reason, it may be harder to have one company take responsibility for the problem. If you buy a new unit (x-ray generating equipment, digital detector, computers, software, etc.) from one company, that company is obligated to resolve any problems during the warranty period.

READY TO SWITCH NOW WHAT?

Once you decide you are ready to pursue digital radiography, it's time to tackle the toughest question: What unit should I buy? There are three major types of digital systems—CR, Flat Panel DR, CCD. Each system has advantages and disadvantages, such as how long it takes to create an image, how much the system costs, how easy it is to repair or replace, what components are required (cassettes, dry processor), and whether the system can be used in more than one radiographic unit.

To educate yourself about all of the possibilities, start visiting vendors and asking the sales representatives plenty of questions: What will you do for me after I buy (e.g. inclusive warranty, preventive maintenance)? Am I obliged to buy a service contract? If so, how much will that cost and what is the service turnaround time for repairs? What will it cost to update the technology or software? Does the digital system use the standard medical image file format DICOM (Digital Imaging and Communication in Medicine), and does the vendor meet the minimum standards for DICOM conformance? Does the system store data easily? How do I back up my images and data independent of the company that sells me the equipment so that no one outside my hospital can have access to this data? If I do not like the system, how much time do I have to return it?

To protect yourself, before you sign the purchase order make sure everything you have been told and promised is in writing. Remember, in most contracts the large print gives you something and the small print takes it away—so read the small print! Also, for litigious reasons, you are better protected if the vendor has a home base in your state.

If you have the opportunity to visit the vendor's manufacturing plant or place of business, you should make the trip. You are more likely to see the good and the bad. Things to ask yourself: Does the business look productive, progressive, and clean? Are the people who work for the company polite, knowledgeable, and professional? Does the vendor have inventory on hand to replace a part that needs repair or replacement? Do I think the vendor will still be in business in five years?

In addition to vendors, be sure to contact veterinarians who own the units you are most interested in buying—you can usually get names from the vendor. What do they like about the system? How hard is it to use? Have they had any problems reproducing images? How attentive has the vendor been to their needs after the sale? Ask the veterinarian to send you a few images—this will let you know if the vendor helped the veterinarian become Internet savvy? Do you like the images? How easy is it to manipulate, store, and send the images? Often you will get your best information from the technicians who are using the equipment, so talk with the key support people who use the unit routinely. In addition to helping you make a decision about the unit, they may be available to visit your hospital to show your staff the ins and outs of using the equipment if you do purchase the unit.

As a digital equipment evaluator, I routinely have practitioners tell me about their experiences with digital radiography. These experiences are generally positive. When I do hear about a negative experience, it's usually because practitioners didn't ask the hard questions and didn't do enough comparative research before buying, so make sure you are a conscientious consumer. Seeking independent advice from a veterinary radiologist is money well spent. This technology is one of the biggest investments a practice will make, and doing your homework will pay dividends in the long run.

Victor T. Rendano Jr., VMD, MSc, DACVR, DACVR-RO

Veterinary Multi-Imaging PLLC

3100 North Triphammer Road

P.O. Box 159

Lansing, NY 14882