When John Endres, DVM, prepared to launch his small-animal practice in central New York state 18 months ago, he was determined to do his homework before investing in digital radiography. Speed, reliability, flexibility and cost all were at the front of his mind. His decision to go with CR—a computed radiography system—says a lot about how a systematic exploration of options can lead to a good imaging fit. Dr. Endres, owner and operator of Compassionate Care Veterinary Hospital of Manlius, N.Y., chose Konica Minolta’s ImagePilot CR System. He decided on CR over DR after setting aside his wants and focusing on his practical needs. He knew he needed something other than a traditional film-and-wet-processing system because his hospital layout didn’t afford space for a darkroom. Plus he needed digital images so he could easily consult with and refer to specialists. He was impressed with the speed of the direct digital radiography systems he considered; some could deliver images in as little as six seconds, which would be a boon to large multidoctor hospitals, he noted. But Endres was opening a single-doctor practice, so he decided he didn’t need all that speed, considering that it came at a considerably higher price. “Speed is seldom the driving force of the images we take,” he says. “There are a lot of things that can slow down the workflow in a practice besides waiting a few extra seconds for a picture.” Different Features With his CR system, Endres still gets images in less than a minute, which is fast enough in most cases that he can make a diagnosis, show clients the problem and lay out a treatment plan without hearing complaints about the wait. DR systems work faster than CR because there is no cassette transport step; a sensor captures the image and sends it directly for viewing on a computer screen. Some practitioners and their technicians find they benefit from being able to evaluate an image and quickly retake it, if necessary. Typically, CR systems deliver digital images after they are processed through a cassette that includes a plate to capture the image, which is then read and digitized by a laser scanner, or CR reader. The digital image then can be viewed, enhanced, shared and stored using software. But with faster processing in mind, new technology such as that in the ImagePilot allows for one-button CR operation. “It’s self-contained,” Endres says. “We don’t have to handle the cassettes. The reader does all the work.” Another feature allows for consistent imaging, boosting the confidence of technicians and reducing the need for retakes. ImagePilot processing uses a single universal algorithm, based on bone as a provider of the best X-ray response. This eliminates the need to process images according to the body part and orientation of the animal. “With ImagePilot, you don’t have to be exact on animal size when selecting exposure techniques in order to get a quality image,” says Steve Eisner, marketing manager for digital products at Konica Minolta. “If there is over- or underexposure, the system compensates automatically.” Easy to Learn At first, Endres was concerned about how the system would work on a deep-chested dog. An early test arrived when he needed images of a Doberman, “and I worried about getting a good look at the structures of the midchest when I knew we would have to burn through the lungs. But everything turned out well.” He and his technicians have found that if the animal is positioned properly, they don’t have to see one image before taking the next. At installation, a half-hour orientation and about an hour more of hands-on exploration was all it took to get the techs comfortable enough to get started using the CR system, Endres says. As for the image quality, neither CR nor DR has a built-in advantage over the other, Eisner says. “With image quality, system reliability and support, you can run into problems with low-end systems no matter which way you go,” he notes. “The best CR can be just as good as the best DR, and the worst CR can be just as bad as the worst DR.” On flexibility of use, Endres sees an advantage of his CR system. The DR systems he looked at would have been fixed to an examining surface. With the CR plates, his technicians can take standing chest shots, relieving them of the need to confine the animal to the table. He also likes that his CR system combines patient registration, image acquisition, viewing and storage, saving him from having to buy separate Picture Archiving and Communication System (PACS) software. Lower Price Point The biggest upside of CR for Endres and his practice was the savings on the purchase of the overall system, he says. He priced DR systems at $80,000 to $100,000. His cost for CR was about $40,000. That difference on top of improvements in CR technology and software is getting the attention of practitioners, Eisner says. “Two years ago there was great hype about DR, but the truth is CR is a more mature technology,” he adds. “Veterinarians are realizing they can achieve a good five- to seven-year outlook on a purchase, which is just as much as on DR. “In seven years, who knows what digital will look like? I wouldn’t call CR a bridge to DR; I’d just call it a different way to go. Both are bridges to get from here to seven years from now.” The key for practitioners, Endres says, is to identify their needs and then do the research to find the best match. “Don’t get caught up in the hoopla that might be out there,” he advises. “We all like cool things, but the thing that matters most is practicing better medicine. Hopefully that’s the bottom line we all get to.” This Education Series article is underwritten by Konica Minolta Medical Imaging USA Inc. of Wayne, N.J. This article first appeared in the February 2010 issue of Veterinary Practice News.
