Armed Forces Hospital Hamburg, Germany customer story - Philips ...

Faster and more flexible
Working more efficiently through wireless digital radiography
Who/Where
X-ray department, Hamburg Federal
Armed Forces Hospital, Germany
The Challenge
To create an X-ray room in which
patients can be examined quickly,
effortlessly and without any major
transfers taking place
The Solution
DigitalDiagnost digital X-ray system
with additional portable, wireless
portable detector
Particularly for routine examinations such
as radiography, digital devices with wireless
portable detectors offer a lower X-ray dose
of radiation and improved image quality
while making the work significantly easier.
"It is quicker, it is easier to operate and,
most importantly, the image quality is an
improvement over the imaging plate systems
that we have been using until now," summarizes
radiographer Slawomir Skrzypczak. He works
closely with the DigitalDiagnost system in
the radiology department of the Hamburg
Federal Armed Forces Hospital, and he is
thoroughly impressed.
What's more, he is not alone: Since the
radiology department of the Hamburg Federal
Armed Forces Hospital set up its new X-ray
room with DigitalDiagnost technology
including a wireless portable detector, all of
the department's radiographers prefer to use
this device. It features three detectors: an
in-table detector, a wall-mounted detector
and a wireless portable detector.
"This gives us the widest range of options,"
says Slawomir Skrzypczak. According to
Slawomir Skrzypczak, it also allows them
to examine patients in the most precise way
possible, while ensuring the procedure is
fast and comfortable for the patient. This
technical innovation is not only an advantage
for military personnel, but also for civilian
patients, as the Hamburg Federal Armed
Forces Hospital forms part of the civilian
healthcare system of Hamburg as well.
"This technical innovation
is not only an advantage
for military personnel, but
also for civilian patients."
For example, let us consider a bed-ridden
elderly lady who has recently had an operation
on her knee and needs to be X-rayed — a
routine examination. The head radiographer,
Elisabeth Wolking, already possesses all of
the relevant patient data — the radiology
information system has sent it to the
DigitalDiagnost system. All Ms. Wolking needs
to do is to select the examination protocol
at the system's intuitive and easy-to-use Eleva
user interface which already contains all
exposure settings as pre-sets, leaving her with
more time to look after the patient. There is
no need for her to expend time and energy
transferring the patient on to the examination
table and causing her unnecessary pain. Instead,
the radiographer completes the examination
using the wireless portable detector by placing
it in the bed under the patient's knee. The
joint is painful and must be moved as little as
possible. Elisabeth Wolking puts the X-ray tube
in position; with the lowest possible X-ray dose
of radiation automatically pre-set, she can now
easily take the exposure.
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She has to wait just five seconds before
the image she has taken appears on the
application workstation monitor in front of
her. After ensuring the quality of the image
is sufficient, she can now conclude this part
of the examination. The image data is sent
directly to the internal PACS image archiving
system and both Dr. Hans-Michael Schlegel
COL MC. and the surgeon operating on the
knee can access the X-rays immediately.
"Working wirelessly improves
hygiene around the
hospital bed."
"I am grateful we have the wireless portable
detector, particularly when examining
patients who must be monitored," explains
Slawomir Skrzypczak. "They are already
connected to so many cables and tubes, so
it's good that I don't have to keep my eye on
a bulky device cable." It's also inevitable that
cables come into contact with the ground,
which may bring pathogens into the patient's
bed. Working wirelessly therefore improves
hygiene around the hospital bed.
The wireless portable detector also comes
into its own when examining the increasing
numbers of heavily overweight patients.
If they are so severely injured that they
cannot lie or sit on the examination table
under their own power, they must be lifted
onto it by the radiographers. If the X-ray is
taken using the wireless portable detector,
the patients can remain in their wheelchair
or on their stretcher and the radiographers
do not need to do any heavy lifting.
This is especially useful for X-rays of the
extremity and thorax. "Of course, we could
take X-rays like these using a cassette-based
X-ray system, but it would be nowhere
near as easy and, above all, would not offer
this level of quality and speed," affirms
Slawomir Skrzypczak.
In this regard, the wireless portable
detector not only offers the greatest degree
of flexibility — the combination of wallmounted
and in-table detectors allows
superior X-rays to be taken, e.g. X-rays of
the pelvis in the event of a neck of femur
fracture. "On one level, we can take X-rays
using the in-table detector as before, but on
a second level, we can also take axial images
without any trouble," explains Skrzypczak.
The vertical stand is so flexible that it can
be moved closer to the patient along with
the mobile examination table, so that images
can be taken at a 90-degree angle. "During
this time, the patient lies on the examination
table and must not be moved. This means we
do not cause the patient unnecessary pain."
The image quality of devices that were
previously used in the department was
not so good, particularly when it involved
radiography of large objects, for example
pelvis X-rays. "We used to find X-rays like
these rather difficult," confirms Slawomir
Skrzypczak. Digital processing using the
image processing software UNIQUE
(UNified Image QUality Enhancement) has
made the system less sensitive to exposure
problems. This is an important factor for
radiographers to consider. "After all, we
want to take X-rays at the lowest possible
X-ray dose of radiation so that the patient
is protected, but we also want to get the
best possible images."
"We do not cause the patient
unnecessary pain."
Slawomir Skrzypczak can now scarcely
imagine working without the digital, wireless
system — and he is not the only one. In
fact, if the radiographers had their way, all
of the X-ray systems workstations would
be equipped with a wireless portable
detector, as Dr. Hans-Michael Schlegel
COL MC. confirms: "I have never seen my
radiographers be so enthusiastic about
a device after such a short time."
Overtable X-ray of
the lower extremity
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Dr. Hans-Michael Schlegel COL MC.
with the wireless portable detector
What makes you stand out from other
hospitals or specialist clinics?
One of our definite plus points is that we
use state-of-the-art equipment. This puts
patients at an advantage as they are subjected
to a lower X-ray dose of radiation during
examinations. As a Federal Armed Forces
Hospital, we operate certified quality
management procedures. I am convinced that
we give more of our time to patients and can
use the full range of medical diagnostic and
treatment options available. This hospital
brings together a host of different disciplines.
There is a flat hierarchy and the level of
interdisciplinary cooperation is good. The
result is that our patients are satisfied. We
often get the feedback that we are friendlier
towards them than other hospitals.
Interview
Dr. Hans-Michael Schlegel COL MC., Chief
Physician of the radiology department at the
Hamburg Federal Armed Forces Hospital
Dr. Schlegel, Hamburg Federal Armed
Forces Hospital has been treating
civilian patients since 1969. Since
2006, it has been part of Hamburg's
emergency service network. To what
extent do emergencies determine
the course of your working day?
127 of our 307 beds are currently available
for civilian patients. Particularly at night,
emergencies determine the day-to-day
operation of our radiology department.
They make up around 80% of the cases we
deal with. They are primarily older people
who have fallen. We then provide further
treatment for 90% of these emergencies.
How important is treatment of civilian
patients in your department?
Up to now, the majority of our patients
are military personnel, as patients are
transferred to us from all military clinics in
the region. This will probably change when
the military is restructured and the relative
proportion of civilian patients increases.
Unfortunately, there is some bad news for
patients covered by public health insurance:
We can only diagnose them as an emergency
case or if they are in-patients. Out-patients
must be covered by private health insurance.
However, this does not make us any different
from other radiological departments that do
not have an X-ray clinic, as statutory health
insurance patients are the exception here.
Are there any particularly tricky cases
that are difficult to examine with
conventional X-ray equipment?
Definitely traumas with older people.
Very often, they are not overly mobile
and sometimes not as mentally alert
as they once were. This used to make
examinations quite difficult.
But now that we have the wireless digital
detector, it has become much easier:
The patients can simply sit or lie down,
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Bed X-ray of the lower leg using the wireless portable detector
and the examinations are much quicker,
which reduces patient waiting times. There is
no read-out required as with cassette-based
systems, meaning we save two to three
minutes per X-ray. As the data is transferred
digitally, I can see straight away whether an
image has been successful. This saves a lot of
time, particularly during routine X-rays.
What advantages do the new digital
X-ray system and the wireless portable
detector offer you from a diagnostic
point of view?
The exposure is simply better, meaning the
image quality is better too. X-rays that used
to be complicated or virtually impossible,
such as axial neck of femur X-rays, are now
no trouble at all. This means we can give
a much clearer diagnosis.
In what circumstances do you still use
the cassette-based X-ray device?
When the digital detector is unavailable.
Until recently, we were still using the
cassette-based X-ray system in the intensive
care unit, but only because the wireless
connection for the digital device did not
reach that far.
How have organizational processes
been changed by the X-ray system?
We streamlined the radiology department
some time ago. Now things are more likely
to run to schedule, as procedures such
as the read-out process of cassettes are
omitted. The time we save can be spent
on patients.
Do you save on costs compared with
the old system?
If we can replace the imaging plate system
completely, then yes. However, we need to
safeguard against failure. But our first task is
to check whether we can get rid of imaging
plate technology completely from our dayto-day
working processes. We hope this will
happen in the not-too-distant future.
What features would you like a future
wireless portable detector to have?
The detector could be flatter. But above all,
it would be nice if it were suitable for use in
extreme environments such as Afghanistan.
To do this, it would need to be lighter and
smaller, and the entire X-ray system would
have to be waterproof, dust-proof and
able to withstand temperatures of –20 to
+50 degrees Celsius. Then there would be
no need for us to read out the cassettes,
as we have been doing until now.
In addition, the data could then be
transferred quickly to a larger medical
facility. In difficult cases, for example,
specialists can then be consulted
at this facility.
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DigitalDiagnost TH/VM in the
Federal Armed Forces Hospital
Clinic Profile
Radiology Department, Hamburg
Federal Armed Forces Hospital
Offering 307 beds, Hamburg Federal
Armed Forces Hospital is one of the five
largest military hospitals in Germany and
is located in Hamburg's Wandsbek district.
It is the largest military treatment facility
in northern Germany and is a key part of
Hamburg's civilian healthcare network.
Since January 2007, it has been an academic
teaching hospital affiliated with the University
Medical Centre Hamburg-Eppendorf (UKE).
Department VIII — Radiology sees itself
as a service provider for all other in-house
departments as well as for patients who
require immediate out-patient treatment.
As well as patient safety and accurate
diagnoses, the department aims to provide
patient comfort and rapid availability
of diagnostic findings. Naturally, the
department offers an on-call radiology
service for urgent examinations. It also
carries out X-ray rounds that not only
strengthen support for other departments,
but are also used to provide training. What's
more, it organizes lectures that are certified
by the German Medical Association. The
hospital is entirely "film-less," meaning
image data is created, distributed and saved
digitally. The report that corresponds to
each image can also be loaded quickly and
easily and saved on CD-ROM if necessary.
The range of services offered by
Department VIII — Radiology includes all
conventional X-ray procedures (excluding
mammography and angiography):
• Computed tomography (MS spiral
CT scan)
• Digital radiography and digital archiving
and distribution system (PACS)
• Magnetic resonance tomography (MRT)
including the possibility of examining
patients on mechanical ventilation
• Sonography
• Needle aspiration biopsies and punch
biopsies
• Facet joint infiltrations
• Periradicular therapy
Its diagnostic focus is on:
• Stage diagnosis of germ cell tumors
of the testicles and of tumors in the
head and throat
• Medical imaging of diseases of the
temporomandibular joint
• Imaging of injuries to the
musculoskeletal system
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4522 962 71281 * MAR 2011
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