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Moving from chemical to digital processing

by
01 November 2011, at 12:00am

TALLY CLIFT traces her practice’s progress from chemical development of x-rays to digital processing and is now convinced the transition is a no-brainer

HERE at Scott Veterinary Clinic we like to think of ourselves as a mixed, forward-thinking practice treating animals from stick insects to elephants. We are always keeping an eye on the most recent technological and clinical advances in veterinary medicine but we need to be persuaded of the benefits before making any changes, especially those involving a large capital outlay. When I joined Scott and Cox in 1990, our radiology equipment consisted of a fixed unit over the second operating table and a mobile unit for our ambulatory equine and zoo work (although we did once have an anaesthetised tiger transported through the streets of Bedford for a full set of x-rays!).

Broom cupboard

The films were developed in a broom cupboard underneath a light covered in red sellotape. The chemicals were in knee-high rectangular bins and there was scarcely enough room to bend over to drop the films into the developer, fixer and water. We had no stopwatch readable in the dim light so had to rely on counting “elephants” (seconds) or someone with a stopwatch
outside the door. The quality of the resulting radiograph depended not only on the positioning and exposure factors but also on the factors that affected the chemicals such as when they were last replenished, the ambient temperature and how many x-rays had been developed that day. There was much frustration when, despite the positioning being perfect, the film came out in shades of grey and non-diagnostic or scratched from difficulties of placing the film into the metal suspension holders. This was bad enough if it caused a sick animal to have a longer anaesthetic but was a disaster if the x-rays had been taken in the field under sedation or anaesthetic. A few years later we became Scott Veterinary Clinic and moved to purpose-built premises with the joys of automatic processing. This was a big
step forward but proved to be problematic. Bedford has very hard water and the processor was continually building up lime scale and algae, leading to many scratched or dirty films and high maintenance costs both in call-out charges and nurse time, stripping the processor down up to three times a week. By the autumn of 2007 we had been watching the development of digital radiography with interest for some time. We were excited by the improved image quality and the ability to manipulate the images. We had gone as far as having demonstrations of two machines: one computed radiography (CR) and one direct (DR). We found the CR system cumbersome to use (it involved manual removal of the “films”), noisy and slow. The DR system would have been excellent for our ambulatory equine and zoo work but was prohibitively expensive for our size of practice and budget.
In October 2008 we became aware of two newer CR systems. We
approached both companies for further details and chose to trial the Carestream Classic through BCF. This choice was in part due to the system itself and in part due to our satisfaction with BCF over purchase and support with our mobile ultrasound unit bought years before. During the trial period we found the Carestream Classic quick and easy to use with the unloading and loading of the cassettes fully automated. The BCF Image-Care Picture Archiving Communication System (PACS) with its ability to manipulate, measure and store images was exciting but we
did feel not fully intuitive. The initial figure BCF gave us to work with was a capital outlay of £35K. This included nine cassettes of varying sizes to allow us to carry on our radiographs in the field (only two or three would have been required for our small animal and exotic work alone). By leasing the system this worked out, amazingly, to a £2,700 saving per annum! This took
into account the service and maintenance costs of both machines, the consumables used by the automatic processor, the
purchase of x-ray films and the disposal costs of silver waste and spent chemicals. These potential savings increased once we had
finalised the deal with an acceptable discount. Once the system had been installed it quickly became apparent more cost savings could be made in the massive time savings. The system needs no
routine maintenance except for dusting of the screens and keyboard! The majority of exposures are of diagnostic quality first time (as long as positioning is correct) and the display even gives you an “exposure factor” which indicates if you could have improved the exposure and helps you improve your x-ray taking skills. 

Rapid training

Training of new staff members on developing takes seconds. The training of the BCF Image-Care (PACS) package takes a little longer and we are still discovering new things it can do. The ability to get a specialist opinion within the hour through e-mails leads to better vet-client communication from the outset in complex cases and more focused treatment plans. In the twoand- a-half years we have had the system we have only had three problems. The first was a week after installation when we could see the images on the Carestream screen but couldn’t send the images to the PACS system for storage. One phone call saw Craig on our doorstep out of hours to fix it. The second problem was my growing dissatisfaction with the degree of pixeling on the Image-Care (PACS) screen when you tried to magnify thoracic images. When this wasn’t sorted to my
satisfaction by twiddling the software, BCF upgraded my monitor
free. 

Faulty modem

The last problem appeared more serious when we couldn’t view images as they were developed. Again one phone call to BCF, a few questions and the problem was traced to a faulty modem. A new one was on my desk the next morning and BCF talked me
through the replacement procedure over the phone with  immediate success. After a year a further saving was made when it was time to renew the service contract. After discussion with
BCF, we were advised to risk dropping it to the lowest level as faults were so rare. We have not (yet!) regretted this decision.
I only have one frustration and that is that the Carestream Classic is touch screen and the PACS is mouse driven. Many times we have been prodding the PACS screen and wondering why nothing was happening! I believe a touch screen is now available. With the benefit of hindsight the transition to digital from chemical is a no-brainer. The cost savings have exceeded our expectations but, almost more importantly, we save time on a daily basis leading to less frustration (I can’t remember the last time we had to retake a set of equine x-rays) and better
patient care.