Purchasing insights for pediatric imaging
March 06, 2019
By Cris Bennett
In the radiology marketplace, pediatric facilities are looking to get the maximum return on their imaging investment without sacrificing patient outcomes and patient radiation dose. Adding to the complexity are requirements of Medicaid programs, insurance companies, and governing bodies like the Joint Commission and the American College of Radiology. In addition, patient satisfaction is a big key in today’s market to obtaining the largest reimbursement amount possible.
Computed tomography/magnetic resonance (CT/MR) imaging
Pediatric facilities typically go for the best of breed when it comes to imaging purchases. Facilities that already have a 1.5T MR may purchase a 3.0T MR both for its research capabilities and for advanced imaging features such as larger gradient fields, faster scan times, and cardiac imaging. Many facilities are opting for the detachable table, which allows easy transfer from the patient room to the MR suite. Also, facilities are choosing to purchase high-channel-count systems to take advantage of larger channel coils and advanced coils that allow for higher signal-to-noise and possibly faster scan times.
In CT, facilities are purchasing 128–256 slice systems to take advantage of the faster scan times, lower patient dose, enhanced stroke protocols, and coronary imaging. All these purchasing decisions affect patient outcomes, revenue, and, most importantly, patient satisfaction.
General radiology
In general, radiography facilities are focusing on radiation dose, patient safety, and comfort. The challenges in pediatric radiography include choosing the right protocol and having technical knowledge to allow for the shortest scan time achievable. The digital detector has aided the radiology department in reducing the radiation dose for pediatric patients.
Historically, vendors have not made radiography systems for pediatric patients. However, they have made modifications to accommodate pediatric exams. These accommodations include smaller panel sizes and panels that can fit into incubator bucky trays that can also be used in orthopedics.
We are also seeing software advancements that include gridless imaging with scatter correction that can be used on older and larger pediatric patients. Multiple vendors offer immobilization devices that allow the child to be still for the few seconds needed for the exposure. Use of these immobilization devices not only reduces time in the department but lessens the extra radiation dose that is given during repeat exams.
Interventional X-ray (IXR)
Interventional x-ray is a niche application in the pediatric space. Among the many factors that make interventional x-ray procedures challenging for pediatric patients are patient size, unusual anatomy, total blood volume, and radiation exposure limitations.
Biplane purchasing decisions include the need to limit radiation exposure and the amount of contrast medium injected. Biplane images can be obtained in two orthogonal planes simultaneously with a single contrast media injection. This allows for a reduced radiation exposure and limits the volume needed for the exam. Pediatric patients can exhibit abnormal anatomy that makes accurate visualization very important.
Over the years technology has improved to increase value in the interventional space. These advancements include faster imaging at lower frames-per-second with faster pulsing that reduces the overall radiation exposure. These systems can process images into a virtual 3D view that can be rotated to see anatomy in ways we have not been able to do in the past. Other advancements include innovative therapy and nonsurgical interventional techniques that expand life-altering and livesaving options to pediatric patients in need of advanced cardiovascular care.
Radiation Exposure
Radiation dose has always been a concern in the radiology space since the beginning – and even more so with children. Over time, more emphasis has been placed on radiation dose, but today’s technological advances have enhanced the ability to record radiation dose.
X-ray machines and CT systems are capable of recording radiation dose and adding it to the patient record through dose management software. This software is available through radiology vendors and even from third-party vendors. Dose management is especially important in the pediatric space because many children are subjected to numerous follow up CTs and/or x-rays during the course of treatment or in some cases throughout the rest of their lives.
Dose management software in association with an EMR (electronic medical record) makes it possible to track a patient’s radiation dose per exam and track the total dose the patient is being exposed to throughout their continuum of care and, ultimately, over their lifetime. This tracking ability helps us in our efforts to limit radiation exposure to both children and adults.
The goal is to enable the clinician to make appropriate decisions when it comes to imaging the child over the long term. The radiation dose calculations can be used to aid the provider in considering other imaging means to keep the child’s dose low without sacrificing outcomes. Among these are nonionizing radiation imaging techniques such as MR or ultrasound.
About the author: Cris Bennett joined MD Buyline in 2015 with more than 19 years of experience in medical imaging. He has a diverse background in general radiography, CT, MR and radiology IT.
In the radiology marketplace, pediatric facilities are looking to get the maximum return on their imaging investment without sacrificing patient outcomes and patient radiation dose. Adding to the complexity are requirements of Medicaid programs, insurance companies, and governing bodies like the Joint Commission and the American College of Radiology. In addition, patient satisfaction is a big key in today’s market to obtaining the largest reimbursement amount possible.
Computed tomography/magnetic resonance (CT/MR) imaging
Pediatric facilities typically go for the best of breed when it comes to imaging purchases. Facilities that already have a 1.5T MR may purchase a 3.0T MR both for its research capabilities and for advanced imaging features such as larger gradient fields, faster scan times, and cardiac imaging. Many facilities are opting for the detachable table, which allows easy transfer from the patient room to the MR suite. Also, facilities are choosing to purchase high-channel-count systems to take advantage of larger channel coils and advanced coils that allow for higher signal-to-noise and possibly faster scan times.
In CT, facilities are purchasing 128–256 slice systems to take advantage of the faster scan times, lower patient dose, enhanced stroke protocols, and coronary imaging. All these purchasing decisions affect patient outcomes, revenue, and, most importantly, patient satisfaction.
General radiology
In general, radiography facilities are focusing on radiation dose, patient safety, and comfort. The challenges in pediatric radiography include choosing the right protocol and having technical knowledge to allow for the shortest scan time achievable. The digital detector has aided the radiology department in reducing the radiation dose for pediatric patients.
Historically, vendors have not made radiography systems for pediatric patients. However, they have made modifications to accommodate pediatric exams. These accommodations include smaller panel sizes and panels that can fit into incubator bucky trays that can also be used in orthopedics.
We are also seeing software advancements that include gridless imaging with scatter correction that can be used on older and larger pediatric patients. Multiple vendors offer immobilization devices that allow the child to be still for the few seconds needed for the exposure. Use of these immobilization devices not only reduces time in the department but lessens the extra radiation dose that is given during repeat exams.
Interventional X-ray (IXR)
Interventional x-ray is a niche application in the pediatric space. Among the many factors that make interventional x-ray procedures challenging for pediatric patients are patient size, unusual anatomy, total blood volume, and radiation exposure limitations.
Biplane purchasing decisions include the need to limit radiation exposure and the amount of contrast medium injected. Biplane images can be obtained in two orthogonal planes simultaneously with a single contrast media injection. This allows for a reduced radiation exposure and limits the volume needed for the exam. Pediatric patients can exhibit abnormal anatomy that makes accurate visualization very important.
Over the years technology has improved to increase value in the interventional space. These advancements include faster imaging at lower frames-per-second with faster pulsing that reduces the overall radiation exposure. These systems can process images into a virtual 3D view that can be rotated to see anatomy in ways we have not been able to do in the past. Other advancements include innovative therapy and nonsurgical interventional techniques that expand life-altering and livesaving options to pediatric patients in need of advanced cardiovascular care.
Radiation Exposure
Radiation dose has always been a concern in the radiology space since the beginning – and even more so with children. Over time, more emphasis has been placed on radiation dose, but today’s technological advances have enhanced the ability to record radiation dose.
X-ray machines and CT systems are capable of recording radiation dose and adding it to the patient record through dose management software. This software is available through radiology vendors and even from third-party vendors. Dose management is especially important in the pediatric space because many children are subjected to numerous follow up CTs and/or x-rays during the course of treatment or in some cases throughout the rest of their lives.
Dose management software in association with an EMR (electronic medical record) makes it possible to track a patient’s radiation dose per exam and track the total dose the patient is being exposed to throughout their continuum of care and, ultimately, over their lifetime. This tracking ability helps us in our efforts to limit radiation exposure to both children and adults.
The goal is to enable the clinician to make appropriate decisions when it comes to imaging the child over the long term. The radiation dose calculations can be used to aid the provider in considering other imaging means to keep the child’s dose low without sacrificing outcomes. Among these are nonionizing radiation imaging techniques such as MR or ultrasound.
About the author: Cris Bennett joined MD Buyline in 2015 with more than 19 years of experience in medical imaging. He has a diverse background in general radiography, CT, MR and radiology IT.