Our journey to digital radiology
By Martin Monahan, DC

Like so many of our colleagues, my father and I have been watching the development of digital radiology for several years.

We have pondered the same questions as you: Why, when, if, and how? Almost a year ago, we took the plunge by installing PACS and DR technology in three of our five Florida-area offices. By the end of the year, we will complete the process by installing digital technology in our remaining clinics.

Since our entry into the digital world, we have never looked back — and the benefits to our practice are greater than we ever expected they would be.

Our practice began when Dad graduated from Life Chiropractic in 1974. When I joined the practice in 1990, we still only had one office, but since 1998 we have expanded our practice to five offices in the Jacksonville, Fla., area.

Our practice focuses on wellness with an integrated MD and DC approach. We have seven doctors in our group, as well as 13 additional health and business support staff.

Before our move to digital technology, each of our offices had a typical film-based x-ray setup, film processors, and a variety of film view boxes. We took mostly 14-inch by 17-inch images, but also used the 14-inch by 36-inch format.

To provide the most efficient workflow, two staff members were involved in the imaging process. They helped properly position patients, take x-rays, process films, label images, annotate the anatomy, and file films.

On average, a typical seven-view study took 25 minutes to complete. Today, with our PACS systems, it takes approximately five minutes — a time savings of 80 percent.

As our equipment aged and costs of operations increased, we began to consider our options. Outsourcing radiology was never an option, but we had to find a more efficient imaging process that would allow us to increase the quality of patient care.

The imaging choices were CR or DR technology. We focused on DR because it allowed us to speed up our workflow, and since our doctors are always involved in taking x-rays, we wanted a system that best utilized their time.

The next decision was the PACS — the system for storing, distributing, and viewing x-rays. We discovered there were many choices — systems that allowed us merely to view the x-rays on the DR monitor to systems that provided a very complex, networked system. We chose a cost-effective system to meet our needs.

We have been very pleased with our decision to move to digital for the following reasons:

• Long-term cost savings. We knew we had to upgrade our imaging equipment, but like most physicians, we felt a digital solution was going to be too costly.

Clearly the initial outlay is greater than that for a film-based operation, but with the elimination of darkroom costs and a 50 percent reduction in the time to take the images and number of staff members needed to take x-rays, the ongoing cost savings from going digital have quickly eliminated the initial system price differential.

Looking toward the future, it is clear our digital operation will be less expensive to operate than our old, film-based practice.

• No retakes. Not only does the system eliminate the need for retakes (which saves our practice significant costs), it also reduces patient radiation exposure.

Patient positioning is easier with our new x-ray equipment, and the viewing tools provided by the PACS allow us to get more out of the images via the ability to use the dynamic range of the digital image to gain diagnostic value from our new system.

• Increased quality of our centers’ work environment. The disappearance of the darkroom, its chemicals, and film storage hassles have improved the work environment for all staff members by doing away with some of the least desired work tasks.

Equally important, the ability to have instantaneous access to patient films has eliminated one of the most disruptive aspects of our medical practice — hunting for patient records.

• Improved patient care. Not only can the reduction of radiation be measured by the elimination of retakes, as we gain more experience with our digital equipment and the tools provided by our PACS’ diagnostic workstation, we are also finding we can lower the radiation dose. (This may also result in longer life for our x-ray tube, another possible cost savings.)

More significant is the ability to apply image-manipulation tools to the images with our PACS. Some would argue the resolution of film images is better than digital, but the ability to zoom, change the image contrast and brightness (window/ level), and apply measurement tools, lines, and angles far outweighs the resolution issue for us.

• Better patient education. Our PACS allows us to make measurements and annotations quickly so we can provide our diagnosis to patients almost immediately and in a manner that clearly helps them understand our planned course of treatment.

• Marketing advantage. We did not consider this when making our decision to move to digital imaging. However, it has been an unexpected and welcomed result.

Our patients understand the significant investment we have been willing to make and are impressed we have chosen to be a leader in patient care. When they see how quickly we can produce quality diagnostic images and how eager we are to bring them into the diagnostic process by showing them their high-quality images, they gain an additional level of comfort that they have chosen the correct course of treatment.

Having digital imaging in our practice is something that separates us from most of our competition and it, unexpectedly, has been something we will include in our community-wide marketing.

Drs. Martin Monahan (right) and his father, Clark V. Monahan, operate five clinics in the Jacksonville, Fla., area. They can be reached by phone at 904-215-5788 or through their Web site, www.monahanclinics.com.