F i e l d Strength

Changing how the world looks at MR.

ExamCards boost efficiency in radiology departments

Measurable improvements obtained in Trier, Houston, Utrecht

This article is part of Field Strength Issue 25 May 2005

ExamCards boost efficiency in radiology departments

Free-of-charge, Internet-enabled NetForum Community offers ExamCard sharing and fast updates
ExamCards represent complete, ready-to-use clinical strategies that include a sequence of scan protocols and explanations. In the near future, hundreds of Philips MR users will routinely download and upload ExamCards to and from their MR systems via the Internet and Philips NetForum Community. Presently, many clinical sites are already benefiting by converting their protocols into ExamCards. In this article, we highlight the achieved and projected improvements obtained by Brderkrankenhaus (Trier, Germany), St. Lukes Episcopal Hospital (SLEH) / home of the Texas Heart Institute, (Houston,Tex., USA) and University Medical Center Utrecht (Utrecht, the Netherlands).

ExamCards available on Achieva, Intera R11, and Panorama 1.0T contain a wellstructured list of scans that compose a multi-sequence examination, along with icons indicating scan status, actions needed and upcoming acquisitions. ExamCards shorten overall exam time, require minimal interaction, reduce training requirements and make it easy to share protocols with colleagues. For a routine examination, the operator simply selects the appropriate ExamCard, and all scans for the study immediately appear in the Exam window, enabling the complete clinical study to be started with

the touch of a button. The ease of scan preparation using ExamCards simplifies the process, even for inexperienced operators, helps prevent errors and enables an automatic alert to preferences of a particular radiologist. The free Internet-enabled NetForum Community strengthens the concept because it facilitates download of bestpractice ExamCards directly into a departments MR scanner, permitting users to benefit from others experience. A downloaded ExamCard can be used in its original form or customized to suit another preference or clinical need.

ExamCard for quantitative flow.

ExamCard for routine brain examination.

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St. Lukes Episcopal Hospital (SLEH) streamlines CVMRI scans and other studies
Soon after SLEH obtained ExamCards functionality, in 2004, the medical center had converted all of its over 60 MR protocols to ExamCards, among which are also additional ExamCards downloaded from Philips. In SLEHs cardiovascular MRI program, ExamCards are helping novice technologists and streamlining the overall scanning process, says CVMRI technologist Mercedes Pereyra, R.T. ExamCards make it much easier to do an examination, because the roadmap is already laid out for you, she says. All the sequences that you need to use for a given exam are there, so youre not going to forget a T1weighted sequence or a specific view of the heart. Moreover, in an ExamCard, similarities between scans are stored and used to streamline planning. All scans of the same orientation, for instance, are planned concurrently. If desired, the scanner can also automatically set up the scans so that they all have the same anatomical coverage Essentially now, you plan every orientation only once, adds Raja Muthupillai, Ph.D., Philips senior clinical scientist based at SLEH. And that geometry information is
Before ExamCards: 50 minutes

With ExamCard: 35 minutes

"ExamCards can turn inexperienced techs into skilled users in a very short time and will standardize everyone's technique."

Use of ExamCards shortens examination time.

inherited across the contrast parameters. Many clinical procedures require multiple contrast images from the same location. For example, they may use the same axial slice with T1- and T2-weighted scans and FLAIR sequences its planned once and then the same number of slices automatically propagates between contrast parameters. Thats a big help. With ExamCards, minutes of dead time spent loading protocols and planning scans have been eliminated, Pereyra explains. Once you set up the views on the interactive sequence, then all the views you need for subsequent scans, e.g. different types of tissue characterization or T1-/T2weighted or sinus images, have already been inherited, she explains. While ExamCards make routine neuro, body, musculoskeletal imaging very easy, even for more challenging studies such as imaging the cardiovascular system, ExamCards are definitely more advantageous, Pereyra says. It makes a big difference in planning time. Everythings easier. In some routine examinations, ExamCards reduced scan time from 50 minutes to just 35 minutes.

Raja Muthupillai, Ph.D., Mercedes Pereyra, R.T. and Scott Flamm, M.D.

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Advantages of using the RVOT ExamCard at SLEH

BBRVOT

Black blood right ventricular outflow tract view (RVOT) obtained as part of the arrhythmogenic right ventricular dysplasia (RVOT) ExamCard protocol. A series of oblique axial images are planned perpendicular to the long axis of the RV to view the free wall of the RV in cross section. A mid ventricular slice (both black blood and cine) is shown below.

Net Forum
w w w. p h i l i p s . c o m / n e t f o r u m
Visit the MRI NetForum Community to download the SLEH ExamCard used to make these images.

BBOblAx:

One of a series of T2-weighted blackblood oblique axial images depicting the right ventricular free wall with high spatial resolution.Via the ExamCards feature, this oblique axial geometry is automatically passed on to the bright blood Balanced FFE cine imaging sequence to help the clinician to directly compare the morphologic features of the black blood images with the wall motion information obtained from the cine images.

BFFEOblAx-Dias:

Diastolic and systolic frames from the high temporal resolution Balanced FFE cine sequences obtained at the same location as the black-blood oblique axial images. There was no-additional planning required to acquire this image due to the ExamCard set up.

Clinical sites are free to define their own sets of ExamCards by naming and organizing them in folders and by adding comments and/or sample images that can be displayed on an adjacent ExamCard window, Dr. Muthupillai notes. ExamCards are electronically exchangeable between sites by email or memory stick or downloadable from the NetForum Community site on the Internet. Modifying an active ExamCard is done by simply changing, deleting or adding a scan. A scan may be added by drag-and-drop from the database window or a previous examination to the active exam window.

Slice location and orientation are automatically adapted when a scan is dragged into the active window. ExamCards are customizable to local needs. In our ExamCards, we implemented a pause immediately after the cine sequences that allows us to change the inversion time for the ensuing viability sequence, Pereyra says. So, it alerts us that it is time to get involved at that point during the imaging procedure. With ExamCards the learning curve to start using the scanner is extremely short, Pereyra says. Even a new MR technologist is

able to run a well-developed ExamCard after a training period ranging from only a few days if the technologist uses the on-board tutorial to just a few hours if a live over-theshoulder demonstration is available. We truly can turn inexperienced technologists into skilled users in a very short time and most importantly, ExamCards will standardize everyones technique so were conducting our scanning in a consistent manner for every patient, she says.

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Process optimization at heart of Brderkrankenhauss use of ExamCards

Before ExamCards, often we had two technologists working in parallel doing the same jobs, which is inefficient, Prof. Busch says. However, the ease with which ExamCards enables a single technologist to handle all scanning details, enables a second technologist to work with the RIS and prepare the paperwork for the next patient.
Prof. Hans-Peter Busch

"The use of ExamCards has enabled our center to employ its technologists more efficiently."

According to Prof. Hans Peter Busch, Head of Radiology at Brderkrankenhaus (Trier, Germany), there are two major ways to improve MRI efficiency: increase throughput with the same or do the same with less. In the Brderkrankenhaus, the use of ExamCards has enabled the center to employ its technologists more efficiently.

Intimately involved in the development of ExamCards and the first clinical site to use them, Brderkrankenhaus began using ExamCards in May 2004 and now has an inventory of about 150 ExamCards. These include virtually all of the hospitals protocols, ranging from routine examinations to more complex procedures, such as MobiTrak and whole body scans. Brderkrankenhaus is an international reference center for MobiTrak and whole body scanning. Radiologists here have already uploaded some of their ExamCards to the Philips NetForum to share them within the user community, and others will follow. In addition to greater departmental efficiency, Prof. Busch is optimistic about the prospects for standardization of technique among technologists. This makes sense not only from a practical standpoint, but also to avoid problems associated with experience gaps between individual technologists, he says. What if coverage for a night emergency case, for example, is assigned to a less experienced technologist, he says. ExamCards compel adherence to a set clinical protocol and will ensure standardization across skill levels.

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University Medical Center Utrecht teams up in ExamCards / NetForum project.

In a clinical setting, keeping protocols up to date is critical, Dr. van Leeuwen says. This is where NetForum presents a solution, enabling easy and timely downloads of ExamCards directly into the scanner. So this is ideal for updating ExamCards comparing your own procedures with ExamCards contributed by other clinical experts or getting new or alternative ExamCards that were not yet available on your system, he notes. When ExamCards developed by Philips users worldwide are submitted to NetForum, all users worldwide can benefit from the joint experience of the user group. I particularly have confidence in this, because ExamCards on NetForum will be peer reviewed by an editorial board of clinical and Philips experts. The concept of ExamCards and their download / upload as enabled through the NetForum Internet Community is brilliant and something that will transform workflow in the radiology department, Dr. van Leeuwen says. There is so much potential in the Philips MRI systems, and I strongly believe that this ExamCards NetForum setup will help to realize the best results on each of them.

Maarten van Leeuwen, M.D.

The Philips philosophy is very good, says Maarten van Leeuwen, M.D., UMCU radiologist. We perform scanning based on ExamCards, and this is complemented by the ability to download ExamCards via the NetForum Community on the Internet. We can easily exchange ExamCards from one system to another via email or by using a USB memory stick.

University Medical Center Utrecht,The Netherlands.

"I strongly believe that the ExamCards/NetForum setup will help to realize the best results on each Philips scanner."

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Koninklijke Philips Electronics N.V. 2005 All rights are reserved. Reproduction in whole or in part is prohibited without the prior written consent of the copyright holder. Philips Medical Systems Nederland B.V. reserves the right to make changes in specifications and/or to discontinue any product at any time without notice or obligation and will not be liable for any consequences resulting from the use of this publication. This reprint comes from Field Strength issue 25: 4522 962 00981/781 4522 962 00991/781 (USA)

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