Anyone going digital

Re: Anyone going digital

Philip Balchin — Fri, 05 Mar 2010 18:01:21 GMT

"[quote user="Stephen Ashman"]

The trouble with dicom files is that they are often too huge (in memory size) to be emailed, which means you need to send a cd, which defeats the object of getting a *quick* specialist opinion

[/quote]

Directly from easyIMAGE, our medical image diagnostic/archiving software, you are able to send an email which will automatically include a hyperlink to a web based location. As soon as the email is sent, the original Dicom image or ultrasound/endoscopy video etc is automatically uploaded to the web based location. The recipient receives the email,selects the hyperlink in the email and is automatically taken to the image online. As web based images (Dicom or not) generally look of a lower quality when viewed via a browser ( Internet explorer /Firefox/Safari etc) the recipient can chose to download the image/video to their computer. The download includes easyIMAGE viewer so the recepient does not have to worry about finding the correct software and then is able to see exactly what is visible at the practice where the image was taken.

Re: Anyone going digital

Alan Tevendale — Sat, 07 Nov 2009 11:13:44 GMT

Nothing changed at the practice as yet but I'm currently looking at a deal combining both a new ultrasound with digital xray. Probably going to cost approx £460/month to get the digital xray so shouldn't cost much more than we are spending at the moment on servicing/chemicals etc and save a fortune in time.

I'll let you all know when things start happening

Re: Anyone going digital

Greg Axsel — Fri, 06 Nov 2009 16:01:04 GMT

Alan, care to tell us the outcome of your saga??

Re: Anyone going digital

Hannah Wynne Richards — Thu, 08 Oct 2009 12:34:40 GMT

I've just burnt 3 rads on a disc, and e-mailed them Far less time than taking conventional rads to the PO , and no time at all in transit

Wynne

Re: Anyone going digital

Stephen Ashman — Thu, 08 Oct 2009 10:39:41 GMT

The trouble with dicom files is that they are often too huge (in memory size) to be emailed, which means you need to send a cd, which defeats the object of getting a *quick* specialist opinion

Re: Anyone going digital

Mike Martin — Thu, 08 Oct 2009 09:23:09 GMT

Yes, I guess its interesting to see a viewpoint from a different place.

[quote user="Martin McDowell"]It also might make sense writing instructions on websites like your own on the acceptable formats that your workstation can read. This would also apply to digital ECG readouts as well.[/quote]

With all the UK digital ECG machine manufacturers (there's not many) they will let me have a copy of their software - if a new one appears on the market via a submission, I chase it down and get it. The manufacturers are aware that they need to provide a system where their own client has the factility to email a file for a second opinion.

In the radiography world - I'm not sure why its not the same? But in a few cases, the images come bundled (embedded) in their own software and I can't open the image files independantly, except by using that software....and then the ....how does this one work....learning curve. It can be frustrating and time consuming. But in the presumption I'll get more from that practice, I put the effort in to work it out. Some I like and some I hate. So, yes, I get some practice to save the files as TIFFs and that works to, if that vet knows how to do that.

There definately needs to be in place in practices with digital x-rays, regular training sessions on how to email files. But when I speak with them there tends to be a reliance on a particular vet who's willing and knows how to do it.

Re: Anyone going digital

Martin McDowell — Wed, 07 Oct 2009 17:51:35 GMT

Interesting reply Mike, just shows I don't have much experience in digital x-rays.

As far as the cost quality is concerned I hope this will all be following the standard Morre's law and that we will be seeing even better machines for much less money.

As far as the format of the images is concerned I am not surprised that DICOM (link to Wikipedia) is not the default as it is an accepted standard for digital images in medicine. Other than that you could always use hi res image formats like tiff. I presume in our practice it would all come down to the more IT oriented vet to write simple instructions on how to do that.

It also might make sense writing instructions on websites like your own on the acceptable formats that your workstation can read. This would also apply to digital ECG readouts as well.

Re: Anyone going digital

Mike Martin — Wed, 07 Oct 2009 16:19:29 GMT

There was a useful review in In Practice in July.

Abby Caine Practical approach to digital radiography In Pract. 2009 31: 334-339. http://inpractice.bvapublications.com/content/vol31/issue7/index.dtl

[quote user="Martin McDowell"]Its easier to send them to a specialist for review,[/quote]

It should be, shouldn't it?

Well, in reality, there are a lot of different software programmes and a lot of vets in practice who are not techno-philes. So in our experience, the vet who wants to send the urgent chest film by email, doesn't know how and the vet that does is off.

When received, we then have a fairly steep learning curve in nagivating through all the different software programmes. If they all came as simple DICOM files we could open, it would make life easy, but they don't. So you need to check with the supplier, how easy is it to sent a file to a Specialist (of course they'll say easy...its called a sales pitch ) but on the demo day, acutally do it. Send a file to your Specialist and see how easy it is for both you and the Specialist.

[quote user="Martin McDowell"]digital system allow you to correct problems with exposure with digital image corrections - similar to the ones you can find in Photoshop.[/quote]

Somewhat, but not as much as you would think.

We've not gone digital yet. I think it will be like digital cameras. They'll get more powerful (better contrast and spacial resolution) and cheaper in time. I'm aprehensive about the CR systems, because vet practices are generally dusty/hairy places and I suspect that will get into the processing box. I suspect I'd prefer DR therefore, but they're the expensive ones. I think most Uni s have gone digital and their machines are amazing. But we also receive them from various practices and there is a scary range of quality out there.

Re: Anyone going digital

Martin McDowell — Wed, 07 Oct 2009 15:35:44 GMT

Haven't gone digital in our practice but would be great. There are articles available on the net about this, you can try the Idexx website. As I understand there are 2 different systems. One using a digital cassete that needs to be put through a special digitiser. The image then appears on your screen.

The other, much more practical system is, when the signal is received in the film and transfered directly via cable to the monitor. This is called DDR (direct digital radiography).

I know there are differences between the two systems in the x-ray image, something was mentioned regarding the resolution. I find DDR the only practical solution as you do not need to remove the film from under the animal to have it developed. If you need minor adjustments you just move the film slightly.

Also both digital system allow you to correct problems with exposure with digital image corrections - similar to the ones you can find in Photoshop. Of course there is also the lack of films and you can store the image with the clients record on the server. calling it up should be a matter of a few clicks. Its easier to send them to a specialist for review, no nasty chemicals and as I see from the above post, happier nurses.

Surely that last one alone is worth the switch No? Was that just me?

Re: Anyone going digital

Alan Tevendale — Wed, 30 Sep 2009 14:42:02 GMT

Thanks for all the replies again, lots of good advice. Cheers!

Re: Anyone going digital

James Allsop — Wed, 30 Sep 2009 14:34:23 GMT

I remember a letter in vet times about 18-24months ago by an ortho cert (cant remember which) reporting that cheap digital setup is not good as he had problems with some of the films sent to him for interpretation and found them of v poor quality. Having spoken to other 1st opinion vets who have gone digital their experience has been very good. I would certainly consider it if needed to change xray machine. Would suggest that you ask rep if they could take you to a couple of practices already using that machine and see how they are getting on and the quality of films.

Re: Anyone going digital

Hannah Wynne Richards — Wed, 30 Sep 2009 13:47:45 GMT

3 additional advantages of going digital. I do more X rays as I can promote them with a clear consciounce - I know they will advance my knowledge of the case. Doing away with the dark room has freed up valuable space, and my nurses HATED cleaning the automatic processor. In fact they have both threatened to kill me if I ever went back to one !!!!

Further altruistic advantage it's a lot less damaging for the environment

Disadvantage - if I get a duff X-ray, I can't blame nurse or environmental temp (manual processing ) or gone off chemicals (automatic processing ) The only possible reason is I have chosen the wrong exposure !!!!

Wynne

Re: Anyone going digital

Alan Tevendale — Wed, 30 Sep 2009 11:42:46 GMT

and bring on the MRI

Re: Anyone going digital

Alan Tevendale — Wed, 30 Sep 2009 11:42:00 GMT

Thanks for the replies.

It's the x-ray generator that has broken so yes I am aware that we will still need to replace this but the whole episode has forced us to look at how much we do actually spend on xrays.

At the moment we are doing an average of around 90 films per month so it's looking fairly attractive to change as our costs are pretty high right now.

My main problem now is that I know absolutely nothing about the different systems available and what they would involve for the practice.

Re: Anyone going digital

Laurence Webb — Wed, 30 Sep 2009 10:48:17 GMT

Is it the X-ray generator or the developer that's broken down? Lots of systems are based on digital 'plates' so you still need a standard X-ray machine. There are some all-in-one systems but they are pretty expensive.

We replaced our chemical X-ray processor about a year ago with another chemical one. We did look at digital but the capital investment and servicing fees made conventional developing a better financial option. We also got a bunch of freebies thrown in (2nd hand plates etc) as hospitals are now entirely digital so there's lots of cast-offs around . In a larger practice with higher X-ray throughput then digital would have been more attractive as the servicing fees would have been less than the cost in plates/chemicals. Shame, as I really fancied going digital!

I'm sure as time goes on and the costs of digital fall then our chemical processor will become obsolete. Mind you, in 20 years every practice will probably have their own MRI/CT!

Re: Anyone going digital

Hannah Wynne Richards — Wed, 30 Sep 2009 10:40:24 GMT

Further advantage to digital. If I'm uncertain how to interpret, I can e-mail to RCVS Specialist and get an expert 2nd opinion instantly-I can recomend Dr Jerry Davies.

My own interpretation skills have improved as a result

Wynne

Re: Anyone going digital

Hannah Wynne Richards — Wed, 30 Sep 2009 10:08:52 GMT

2 years ago I bought an Agfa CR30-X Absolutely brilliant for soft tissue work The rads are amazing. Expensive, so I increased radiography charges, but there are savings on chemicals, both buying and disposing. Owners have'nt complained about the charges, as they can see the quality for themselves.Not so good for orthopaedics, as can't estimate pin sizes b4 opening up

Wynne