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May 10, 2004

Filmless Doesn’t Mean Paperless
By Dan Harvey
Vol. 5 No. 9 p. 12

In the early half of 2003, John Simon, MD, was in Germany on the kind of high-tech scouting mission someone who had recently established a medical imaging center might embark on.

As the medical director of newly opened SimonMed Imaging, Inc. in Scottsdale, Ariz., Simon journeyed to the Grosshadern Hospital in Munich to get an up-close look at the facility’s new multislice CT system. But as often happens on expeditions, Simon made a different discovery.

“I went there to look at their new CT scanner,” recalls Simon, “but one of the radiologists wanted to show me a new printer system that was part of their new technology. They all loved their new scanner, but they also really loved this new printer.”

The system that had so beguiled the German radiologists—and immediately captivated Simon as well—was something called the aycan X-ray–Print Solution, an imaging output system that prints high-quality medical images on standard paper. Simon thought that not only would it be cost-effective for his center (paper costs far less to print than film), but it would also provide a quick and easy way to communicate imaging information with his referring physicians—particularly those who bemoaned the advent of the “filmless” era. Simon decided he wanted one in his new imaging center.

New in the United states
At the time, the German company that manufactured the system—aycan Digitalsysteme GmbH, a European provider of paper imaging solutions for radiology—was just establishing its presence in the United States. The system became available through the Rochester, N.Y.-based aycan Medical Systems LLC. In May 2003, Simon’s center became the first in this country to install the system.

The aycan solution combines a high-resolution laser printer with a DICOM print server to produce any kind of medical image on plain paper (up to 11 X 17 inches) at near-diagnostic image quality. The system can also print in color for modalities that capture color images.

The FDA-certified medical communications device system integrates with hospital networks using the DICOM 3.0 standard, and images can be received from any modality and then printed. The software enables users to set defaults and adjust image quality output settings (eg, brightness, gray scale, contrast) for each modality.

Essentially, here’s how the system works: After an image is created by a modality, the DICOM print job is sent over the Ethernet to the aycan print server. The aycan software converts the print job into a PostScript file for printing. Finally, the image is printed by an aycan-certified printer, typically the Xerox WorkCentre M24 Color. “The image quality is excellent because of the aycan technology, as well as the Xerox printing system,” says Simon.
“We tested a lot of printers and chose the Xerox printer for its excellent print quality and cost-efficiency,” remarks Frank Burkhardt, director of U.S. operations for aycan. According to Burkhardt, the system can reduce film costs by up to 90%. Obviously, paper is substantially cheaper than film. “A sheet of film costs about $2, while a print on paper costs about 5 cents,” he points out. Paper also reduces the hidden costs of film, including the processing, handling, mailing, and archiving.

Keep Referrers Happy
In an age of increasing PACS implementation, many physicians are feeling a bit left out of the loop as far as images are concerned. While the digital capabilities enable onscreen viewing of images, as well as computer storage and archiving, many referring physicians are left without images they can actually hold in their hands. High-quality paper output typically satisfies referring physicians in terms of image availability and quality.

“In the past [before PACS], referring physicians received a report from the radiologists that included, in most cases, the film,” explains Burkhardt. “Now, because hospitals are going digital, the radiologists often only send out the report. Many referring physicians aren’t happy about that.”

The alternatives—CD-ROMS and pictures sent via computer—haven’t been well-received by the physicians. “CDs aren’t really handy or practical for some of them, and the other option requires a lot of IT [information technology] infrastructure. They don’t like that, either,” says Burkhardt.

Paper prints are a convenient and inexpensive way to share images. They are easier to handle than film and can easily be attached to reports. Physicians can quickly review the diagnosis right in their hands and, if they want, give copies to patients. A PostScript file can be attached to an electronic medical record. Further, no one has to worry about damaged film or replacing lost film images. Because of the convenience it offers, the system has the additional effect of streamlining workflow processes.

Simon’s facility is equipped with cutting-edge imaging technology, and he finds that the print system is logistically practical. “Our site is one of the first in the Southwest with a 16-slice scanner and cardiac MRI,” he says. “With advanced applications like that, we use workstations routinely. On an average CT study, we may have 1,000 to 1,500 images. On an average MRI study, we may have 500 images. In that setting, we use the aycan system or we use a CD. But the aycan system is very useful for referring physicians because many of them don’t like the CDs as much. We give them [paper prints] and they’re happy.”

Near-Diagnostic Quality
As for the printed images themselves, Burkhardt describes them as “near-diagnostic quality.” Simon says the aycan system is the first printing solution he has seen that provides such high quality, and he reports that the referring physicians he works with are very happy with the results. “When they first saw the images, their reaction was quite positive,” he recalls.

Implementation is a relatively simple matter that typically takes one day, says Burkhardt. Following initial setup, the system can be optimized for specific applications, including conventional and digital radiography, CT, magnetic resonance tomography, angiography, and nuclear medicine. The system is easy to learn and operate, too. “It’s just the click of a button,” says Simon. “The technologists like it because it gives them another option. The paper is much easier to deal with itself.”

— Dan Harvey is a contributing writer for Radiology Today.

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