MeritCare Health seeks lower dose, faster diagnosis

The MeritCare Health System is committed to using digital imaging technology to deliver better patient care. Our two hospitals in the Fargo, ND, area have a combined total of 583 beds. We also operate two dozen outpatient clinics that serve patients in rural areas throughout North Dakota and Minnesota.

Managing the installation of imaging platforms for a geographically dispersed healthcare system with 330,000 to 350,000 imaging procedures a year is challenging. Imaging volume is normally a deciding factor in DR placements, but in our environment other issues sometimes take priority.

As an example, our initial DR placements are in outpatient facilities, although we plan to implement DR in our hospitals in the future. We installed two DR systems at an outpatient clinic that conducts 26,000 diagnostic exams a year, most coming from the clinic's orthopedic surgeons and other specialists. The productivity offered by DR was a factor in our placement decision, since this location is expected to maintain a very high rate of growth: Diagnostic exam volumes increased 25% in the last two years. Similar increases are expected again since the physicians' offices have been expanded and now house additional orthopedists, rheumatologists, and podiatrists. We also have a multicassette CR system at the clinic to perform long-length imaging exams.

Delivering better care for our pediatric patients was the goal when installing a DR system in a clinic that contains an imaging center and pediatricians' offices. When we conducted studies to measure the radiation dose of DR, CR, and two screen-filmsystems, DR technology showed a marked dose reduction over other methods. In addition to reduced dose, the DR model we chose also offers flexible positioning that allows the child to sit in a parent's lap for most exams. Our pediatric specialists say the system offers excellent display of clinically important information, so specialized pediatric exams, including imaging surveys to evaluate the possibility of child abuse, are referred to this clinic.

We also installed a DR system in a rapidly growing clinic located 90 miles west of Fargo. Installing DR at this clinic made good financial sense because it reduced remodeling costs while providing greater workflow capacity within a very limited footprint.A fleet of CR systems provide digital imaging at our hospitals and 12 of our 24 outpatient clinics, including all six clinics in the Fargo area. These CR systems handle volumes that range from several hundred to several thousand patient exams a year.

A multicassette CR system serves three exam rooms in each hospital's radiology department and handles processing for portable exams. Additional CR systems provide digital imaging for the operating and emergency rooms. While we have evaluated installing DR in the emergency area and radiology departments, we are coordinating installation of imaging technology with the new construction and remodeling projects that are under way and in the planning stages at these sites.

Placement of CR systems in the remote outpatient clinics is generally dictated by volume and new construction. Any new or renovated facility is scheduled for a CR system unless it warrants DR technology instead. As we upgrade higher volume clinics from single-cassette to multicassette systems, we repurpose entry-level CR units to other clinics that are still operating with screen-film technology.

We value the advances offered by digital imaging technology and employ it to not only boost staff productivity, but also to enable better patient care with lower dose and faster diagnoses. With CR and DR in place, our PACS can electronically transmit studies from remote sites to a centralized site for reading. This creates much faster report turnaround times for our regional clinics and allows radiologists and other specialists to discuss difficult cases with clinicians while viewing patient images at their respective locations.

Ms. Holmen is tradiology manager, and Mr. Colby is a physicist, both at In-Town Regional in Fargo, ND.