Speed, ease of use and increased revenue are only some of the advantages of digital radiography

It’s time to bring your customers in from the dark. The darkroom, that is. Not long ago, veterinarians had no choice but to rely on film-based X-rays, followed up with long sessions in the darkroom processing films with messy chemicals. Today, they can get practically instant images that are easier to read. This means better care for patients and shorter wait times for clients.

Why digital?
Since the first digital radiography systems became available in 2001 for equine imaging, the technology has continued to evolve. Today’s systems are designed for both horses and companion animals.

Digital radiography technology enables veterinarians to produce images without the use of film, chemicals or a darkroom. Images are captured on an electronic detector or screen, and then converted into a digital format, which can be displayed on a computer monitor. Advantages of digital radiography over traditional film-based systems include:

• No hazardous chemicals. Digital imaging eliminates exposure to fumes and the need to store and dispose of harmful chemicals.
• Cost savings. Darkroom space can be converted for other uses. Film and chemical costs are eliminated.
• Speed. Images are generated quicker, decreasing exam time and improving workflow.
• Fewer retakes. Images may be viewed immediately and enhanced as needed.
• Ease of use. Images can be immediately enlarged, enabling the evaluation of bone and/or soft tissue within a single exposure.
• Easy storage and transmission. Electronic storage makes it easy to access them, as well as add them to patient records or transmit them to other doctors.
• Enhanced productivity. Electronic storage eliminates the need for staff to file or search for films.
• Increased revenue. Faster service and improved capability for patient diagnosis can attract more patients to the practice.

In addition, a practice that is perceived as cutting edge, more efficient and environmentally safer should attract more staff and clients. (Source: IDEXX Guide to Digital Radiography.)

How it works
There are three types of digital radiography systems: computed radiography (CR), flat-panel detector (FPD) and charge-coupled device (CCD). Each system relies on different technologies to acquire digital images. By understanding how each system works and what benefits it offers, reps can steer their customers to the option best suited to their practice.
Computed radiography has been available longer than flat-panel detector and charge-coupled device, and therefore is the most widely adopted technology of the three. Priced from the low $30,000s to the mid $50,000s for higher-end systems, it also is the most affordable. CR is considered an indirect technology, because it converts X-rays to light as an intermediate step. Computed radiography systems use a coated screen, similar to a film cassette, to temporarily capture X-rays. The CR cassette is positioned below the animal (or in the Bucky tray) for exposure. It then is inserted into a digital scanner, which converts the latent image into a digital one. The coated screen is erased and can be reused for another X-ray. Images may be viewed within minutes of loading the cassette into the scanner.
Although the scanning step makes computed radiography less efficient than charge-coupled device or flat-panel detector systems, the lower cost makes it more affordable for practices with lower radiography volumes. And, CR systems may be retrofitted, such that veterinarians who have purchased a system a couple of years ago have the option of updating it rather than buying a whole new system.
Charge-coupled device technology is similar to digital camera technology. Essentially, the indirect system captures signals from one or more digital cameras, and then relies on computer software to piece together the images. CCD systems convert the X-ray image into a visible light pulse, with a fixed phosphor-coated screen. These systems require large optical projection boxes and lenses, which reduce the full-size image to fit a detector the size of a postage stamp. The detector, in turn, converts the image into digital values and saves the memory.
Although the process is faster than CR technology, CCD systems typically work with a specific model of X-ray table and are not easily retrofitted to existing tables. The price ranges from the mid $50,000s to $120,000 for a higher-end system.
Flat-panel detectors provide direct or indirect image capture within five to 10 seconds. As such, the technology is favored in high-volume practices. Flat-panel detectors employ a plate that replaces a conventional radiography cassette or film and eliminates the need for scanning. The plate absorbs the X-ray and directly generates an electronic signal, and the image appears on the computer screen within seconds.

DICOM, PACS and teleradiology
In order to help their customers understand the full advantages of digital radiography, sales reps should be prepared to explain concepts such as DICOM® and PACS. Digital Imaging and Communications in Medicine (DICOM) was developed by the American College of Radiology and the National Electrical Manufacturers Association as an interoperability standard imaging format. It enables various medical imaging devices to communicate and share images and/or supporting medical information. This means veterinarians can use different types of imaging equipment from different manufacturers, and all of the devices will communicate with one another.
DICOM is relatively new to the veterinary industry and has yet to be consistently adopted. So, reps should remind their customers to compare conformance statements from each of the vendors and check for such imaging capabilities as send, print, query and retrieve, compress and search.
Another term reps should understand is Picture Archiving and Communications Systems (PACS). PACS software enables the veterinarian to capture images, review them and make any necessary enhancements and store them in a centrally located database. At any time, the veterinarian can search for and retrieve the images and distribute them to clients, referring radiologists and/or colleagues.
PACS software should allow veterinary practices without on-site radiologists to consult with outside services (teleradiologists) for image interpretation. They send images to a referring specialist who reviews them, either as needed or on a regular basis, and provides the practice with feedback.

How to sell
Adding digital radiography can enhance the efficiency of your customers’ practice. It can also improve client satisfaction. Faster, easier imaging means patients spend less time under anesthesia, and clients spend less time in the waiting room. Precise digital images that can be enlarged and enhanced facilitate more accurate reading and diagnosis. And, by adding a viewing station in the exam room, veterinarians can more easily explain the pet’s condition to its owner.
One of the biggest objections veterinarians may have to adding digital radiography is the rather large price tag. Reps should remind their customers that it is a long-term investment and a key component to growing of their practice. Reps should also remind their customers of such tax laws as Section 179 (see related story), which can help defray some of the expense.

By asking the right questions, reps can initiate a productive discussion about the pros of adding digital radiography to one’s practice:

• “How well is your practice managing with film-based X-rays? What do you most dislike about it?”
• “On average, how many images does your practice take each week?”
• “Have you considered adding digital radiography? Are you aware of its benefits?”
• “Have you thought about how digital radiography can factor into your five-year investment plan?”
• “Are you aware of the tax law, Section 179, and how it can help defray the expense of adding new equipment?”

As your customers come to understand the advantages digital radiography offers, including the potential for keeping more revenue in-house, they may discover it’s one type of technology they can’t live without.

Editor’s note: Vet-Advantage would like to acknowledge the contribution of IDEXX Laboratories, Inc., and the IDEXX Guide to Digital Radiography to this article.

DICOM® is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communications or medical information.

Sidebar:

Evaluating the system

Distributor reps can provide value-added service to customers interested in digital radiography.

It’s a huge step for veterinarians to trade in their old X-ray films and chemicals for a high-tech digital radiography system. Why not make their transition as easy as possible? You can offer your customers a great service by helping them evaluate potential systems that best meet the needs of their practice. Encourage them to explore the following points with potential digital radiography vendors:

• Is the image of medical grade or diagnostic quality?
• Is the system user-friendly?
• Is a DICOM conformance statement available?
• Is the system compatible with the clinic’s existing X-ray table and generator?
• Does the system offer an open platform, enabling the clinic to work with a consultant or specialist of its choice?
• Does the system offer backup solutions?
• Does the software facilitate access to the original images and data?
• Can the images be annotated and enhanced?
• Can the images be archived and retrieved?
• Does the software provide a variety of image distribution methods?
• Does the software integrate with the clinic’s current practice management system?
• Does the vendor support both the software and the hardware?
• Are the vendor’s service contracts detailed and easy to understand?
• Are flexible financing options available?
• Does the vendor offer round-the-clock support?
• Does the vendor provide technical experts for installation and staff training?
• Are software updates offered as the technology evolves?
• Is the vendor veterinary-focused?

The more time veterinarians spend investigating a digital radiography system upfront, the fewer surprises they are likely to encounter down the road.