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A New Frontier

Technological Advances are increasing the utility of DR

With many hospitals and imaging facilities in the United States having replaced CR—and, in some cases, film—with DR, the benefits of digital imaging can be more fully realized than ever before. These include improvements in workflow and staff productivity, high image quality, the ability to postprocess images for added information and clinical value, and the implementation of AI and machine learning.

In 2019, DR remains an important primary imaging technology that delivers the information physicians need to make a diagnosis or set a path for continued clinical investigation. Jay Aboujaoude, managing director of the X-ray business unit of Canon Medical Systems USA, says DR is a $2 billion segment and also the largest reimbursed segment in the United States.

Radiologist Paramjit Chopra, MD, founder of Midwest Institute for Minimally Invasive Therapies, or MIMIT Health, in Melrose Park, Illinois, notes that there is currently a very significant reimbursement penalty of 20% on Medicare claims for imaging exams with screen film X-ray systems.

“A new law has added a 7% reduction for computed radiography exams, which will increase to 10% in 2023,” Chopra says.

“Over the last four years, there has been a huge demand to change to digital imaging, so lots of facilities upgraded or purchased new DR equipment and the DR imaging platform,” Aboujaoude adds. “What a lot of users and facilities are looking for today are good images so the radiologists can see more and have simpler and better image quality.”

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Efficient Workflow The main procedures that MIMIT Health uses DR for are plain radiography and breast imaging. Chopra believes that DR accomplishes the dual goals of increased efficiency and better patient outcomes.

“It improves image quality at lower radiation doses and helps with workflow efficiencies to increase patient throughput,” Chopra says. “It generates a higher-quality image than CR or film systems. Lastly, it has a significantly lower radiation dose than its predecessors, balancing the equation that connects diagnostic certainty and patient safety.”

Vikram Krishnasetty, MD, vice president of Columbus Radiology, a Radiology Partners practice in Columbus, Ohio, says DR imaging is in widespread use among hospital facilities and is useful for quickly transferring imaging to subspecialty radiologists.

“It is being utilized in rural areas as well, due to the ease of use for teleradiology,” Krishnasetty says. “New applications are being developed in the AI realm of radiology. This ensures quality assurance and tracking at the time and site of imaging, which is only possible because of DR.”

Krishnasetty calls DR an essential part of the radiology workflow.

“It has decreased acquisition times and throughput and is an essential competency of the modern radiology department,” he says. “Manufacturers are always developing more versatile sensors with quicker load and acquisition times, and there are new quality control metrics that are enhancing the normal workflow. It is allowing radiologists to decrease radiation exposure, and there are new techniques that are decreasing radiation exposure.”

Joe D’Antonio, director of radiography, fluoroscopy, mobile, and twin robotic X-ray products at Siemens Healthineers North America, says the core technology is fairly stable now, with a move to wireless detectors seemingly being the standard.