1. One room that has it all
Combined DR and fluoroscopy solution helps staff
do their best for patients
Who/where Duke Children’s Hospital and Health Center is a hospital within a hospital at
Dr. Donald P. Frush, Pediatric Radiologist
and Chief of Pediatric Radiology the Duke University Medical Center in Durham, North Carolina. Supporting
Dr. Caroline Carrico, Pediatric
Radiologist and Assistant Professor over 175,000 pediatric outpatient visits a year, Duke Children’s is consistently
Eric Porter, Technical Administrator
Anja Ancarana, Pediatric Radiological ranked among the top pediatric specialty programs throughout the country.
Technologist
Duke Children’s Hospital and Health Within the Pediatric Radiology Department for the quality of care that they are going to
Center, Durham, North Carolina, USA
Part of Duke University Medical Center of Duke Children’s sits a two-in-one Digital receive at Duke. “We simply have to be able
Radiography and Fluoroscopy (DRF) room to provide them with excellence in diagnostic
that fits in quite well in this busy and highly capabilities that includes both the equipment
regarded environment. This one room and our own expertise”.
Challenge incorporates Philips latest digital radiographic
Complement Duke Children’s and fluoroscopic technology and helps Duke’s
commitment to delivering
compassionate world class patient care pediatric radiologists and technologists
with state-of-the-art digital radiographic perform a wide range of applications.
and fluoroscopic technology. Find
equipment that maximizes staff By selecting this DRF configuration, Duke’s
efficiency, helps shorten exam time, personnel are able to provide confident
delivers outstanding clinical results, and
at the same time helps minimize X-ray diagnostic results to referring physicians
dose to their predominantly pediatric quickly, efficiently, and in a way that minimizes
patient population.
the radiation exposure their patients receive.
Challenges associated with pediatrics
Dr. Donald Frush, Chief of Pediatric
Solution
Philips two-in-one DRF room solution, Radiology points out that Duke’s pediatric
a full digital radiography and fluoroscopy patient population poses some specific
room. With a digital vertical stand and
overhead tube assembly for radiographic challenges. “These patients are often quite ill
exams, an EasyDiagnost Eleva for and the amount of time that they can spend
fluoroscopic studies, with an additional
static digital flat detector built in the away from their care facility is sometimes
table for radiographic use. very limited. They may be getting multiple
radiographic studies and our need to monitor Dr. Donald P. Frush performs a fluoroscopy study
carefully the amount of radiation they get in the DRF room
during fluoroscopy is very important,” he
says. He also notes that his patients and their
parents have extremely high expectations

2. Equipment to deliver optimal care Children’s equipment selection process.
Duke Children’s overriding commitment “For this particular room,” Mr. Porter
to providing the absolute best care for explains, “we asked for input from several
their patients was a key driver in helping quarters internally.” Both the pediatric and
them decide which technology to choose adult radiologists, as well as the technologists,
when upgrading their radiographic and were asked to participate. Each group worked Eric Porter, Technical Administrator
fluoroscopic capabilities. independently to come up with their own for the Department of Radiology
recommendations. Of the final decision,
Mr. Porter recalls, “Both from the children’s While there are three different possible
“We needed to have a way to
side of it, as well as the adult side of it, and DRF configurations available from Philips,
maximize our use of time from the technologists, everybody came Duke Children’s features a vertical stand,
and efficiency” back with the same recommendation, with a large 17 x 17” digital detector, and a
independently. They all preferred the Philips.” ceiling suspended X-ray tube. There is also
Reviewing their top priorities, Dr. Frush an EasyDiagnost Eleva fluoroscopic system
says, “We had to have state-of-the-art New approach to maximize efficiency which includes an identical static digital
dose reduction technology, certainly Philips ability to combine the latest DR detector located in the table as well.
Grid Controlled Fluoroscopy was a must. and fluoroscopic capabilities into a single The Duke staff can perform the full range
of digital radiographic exams with the wall
unit. The EasyDiagnost Eleva handles all
fluoro studies. However, when the fluoro
unit is not needed, the Scopo control tower
can be moved up to the head end of the
table and parked back and out of the way.
This allows for routine radiographic studies
to be accomplished right on the table using
the overhead tube assembly and the table’s
digital detector.
“It allows much more efficient
use of technologists’ time”
The digital vertical stand increases the range of applications
Dr. Frush reports, “Having radiography
in the same room where you are able
We had to have equipment with optimal room represents a new approach in room to provide fluoroscopic evaluation is
image quality. We needed to have a way to configurations. The concept was to help a tremendous advantage in terms of
maximize our use of time and efficiency. And institutions better utilize their radiography efficiency. It allows much more efficient
we needed to have DR capability.” Dr. Frush and fluoroscopy rooms and improve their use of technologists’ time and control
also pointed out that the ability to integrate overall workflow. Radiographic cases can of patient flow. I think it is very, very
the new equipment with the department’s come in at any time, but most fluoroscopic helpful to have these centralized so that
existing PACS was a key criterion. studies are scheduled for the mornings. it decreases the extra efforts that are
Eric Porter, Technical Administrator for the Consequently the fluoro system and the made for obtaining both these kinds of
Department of Radiology at Duke University room itself may often be under used the evaluations.” In describing the expanded
Medical Center, was actively involved in Duke rest of the day. capabilities of having a digital detector in the
2

3. vertical stand in the same room with the Ms. Ancarana points out that the digital when their child is undergoing an examination,
fluoro unit, Mr. Porter notes, “This makes equipment gives her more confidence that we have equipment that has state-of-the-art
the room especially useful because of the she’ll get an excellent image the first time, dose reduction technology and that we are
multitasking and multi-procedure use of reducing the need for retakes. “The image watching out for the welfare of their children.”
the room.” Additionally there is just one quality in the DRF room is outstanding.
investment needed to profit from two kinds The UNIQUE system that they use to Understandably the radiologists and
of reimbursements. process their images is very detail oriented. technologists at Duke have high praise for
Subtle things are caught and seen much easier the DRF room’s EasyDiagnost Eleva system
now.” Since there’s no film or cassettes to and its grid controlled and pulsed fluoroscopy
“My workflow has improved
handle, she has more time to focus on her technologies. These techniques from Philips
tremendously because of the patients. “The DRF room enables me to are regulated by a highly advanced in-pulse
instant images” spend quite a bit of time with my patients, control circuit that optimizes each pulse
because I’m not having to leave the room to independently. Immediately, within the first
Digital workflow saves time run films or view images in a different area. pulse, the beam´s penetration is optimized to
The technologists clearly appreciate the time The computer system is all in one place. provide the relevant diagnostic information.
savings they are achieving with the digital And I can talk to the patients and see them
aspects of the DRF room. The speed of the whole time,” says Ms. Ancarana. This allows the radiologists to reduce the
the digital radiographs, the inherent image X-ray dose to the patient while still achieving
quality optimization, and the fact that they Technologies that reduce X-ray dose outstanding image quality in their exams.
accomplish these with minimum exposure to Duke Children’s is very interested in taking Referring to the need to reduce cumulative
patients are benefits they freqently mention. full advantage of their new equipment’s dose radiation to their patients, Ms. Ancarana
Anja Ancarana, Pediatric Radiological limiting technology. Dr. Frush sees this as a says,”These are just kids and we don’t want
Technologist at Duke Children’s, says, “I key objective in their overall mission. He says, them to carry too much dose from their
believe that the digital room with the digital “I have to personally know that we are doing childhood into their adulthood. The Grid
detectors has made my life as an X-ray tech everything we can to minimize the dose to Controlled Fluoroscopy carries an 85%* less
a lot easier. My workflow has improved children. That we can reassure parents that dose rate. And we’re very proud of that.”
tremendously because of the instant images,
because we can see them faster, we can
send them out to the radiologist faster.
The clinicians can see the images faster,
everything is digital and we can let our
patients go back and be seen by the clinicians
that need to be seeing them.”
“The DRF room enables me
to spend quite a bit of time
with my patients”
Technologist Anja Ancarana prepares the EasyDiagnost Eleva for a fluoroscopy procedure
3

4. the console on the fluoro equipment in the DRF room, Dr. Frush concludes, “All of our
room to be very user friendly in making needs have been met in terms of combining
those quick adjustments.” a state-of-the-art digital radiography system
with a fluoroscopy system, and the ability
Another feature of the EasyDiagnost Eleva to interface quite easily with a PACS that
that the Duke radiologists find very useful is is from a different vendor. And I have to
FluoroGrab. Dr. Carrico says she uses it to say with the Philips (equipment) and the
easily capture key images at critical points image quality I have been very pleased with
in the study. “Most of our studies are single what we’ve seen, both in the room and the
contrast examinations. The fluoro store translation of this information to our PACS.”
images obtained during the study or from
the last image hold are quite often more
“The best thing is the dose
than adequate quality for diagnosis.”
She adds that it’s very helpful to be able to saving for our patients”
Dr. Caroline Carrico, Pediatric Radiologist
select the images right from tableside, using
and Assistant Professor
the tower control or the remote control. Ms. Ancarana says simply, “We as
Both Dr. Frush and Dr. Carrico value the technologists actually gravitate towards
Dr. Caroline Carrico, Pediatric Radiologist feature which allows collimation using the the room now. It takes beautiful pictures, it
and Assistant Professor, believes the option last image from the fluoro frame grab. has an ease of work with it, and it’s a good
of doing certain complex studies in the new As Dr. Frush explains, “I particularly like the room.” She also believes the room is helping
DRF room is a real advantage, explaining, ability to collimate the examination without them do the best for their patients. “The
“It is beneficial to have a fluoroscopy unit that having the fluoroscopy on. This allows us to room allows us to do exams in a very very
lets us manipulate the pulse rate and other target ideally what we are looking for and timely manner, and allows the patient to
parameters during the exam. With pulsed substantially decreases the radiation dose.” be in and out of the room in a very fast
fluoroscopy we are able to both reduce our time frame.”
patients' exposure to ionizing radiation and A room that works for staff
to still perform high quality examinations." and patients Dr. Carrico’s conclusion on the benefits of
By all accounts, the DRF room at Duke the DRF room for her and her patients,
Duke configured their EasyDiagnost Eleva to Children’s Hospital and Health Center is “I appreciate having that unit. I think it works
start fluoro exams at a very low pulse rate enhancing the staff’s efficiency and their quite well. The best thing is the dose saving
(two pulses per second) with the option of ability to deliver the highest level of care for our patients. Kids have an amazing spirit.
increasing the frequency, all the way to 30 to their patients. The Philips equipment has They are very special, and they touch your
pulses per second, if needed. With complete proved a good fit for the challenges that are heart, so we try and do our best for them.”
tableside control the radiologists have the inherent in pediatric radiology. Mr. Porter
ability to change the pulse frequency, and describes the DRF room as the “unit of
other variables during the procedure to choice” since its installation. He credits the
ensure they achieve the necessary diagnostic ease of use and efficiency, especially as it
information. Dr. Frush emphasizes, “I find relates to the digital rad. In describing the * results may vary
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