Improving Orthopaedics with Digital Imaging

Jason Knox
Marketing Manager
AGFA Health Care
Toronto, ON

Traditionally reserved for a few departments in the hospital, PACS (Picture Archiving and Communications System) is growing to become an integral piece of information technology throughout the health care institution. One area that has relatively low PACS penetration is the orthopaedics department. Although orthopaedic surgeons are no strangers to digital technology, relatively few have embraced it and even fewer have integrated a digital planning workstation into their department. Despite the access to on-demand imaging with traditional PACS workstations, the reluctance to use this technology in orthopaedics exists largely due to feature sets that were not robust enough to meet the demands of planning.

PACS has evolved and its range of capabilities now extends beyond the traditional confines of radiology. Recently unveiled, PACS workstations have been enhanced with specialized orthopaedic tools to enable the orthopod to prepare for surgery at a new level of efficiency and precision.

More than just digital image display, new orthopaedic planning workstations allow doctors to measure, diagnose, and perform surgical planning with greater accuracy. These workstations can perform tasks ranging from simple planning to complex long leg deformity correction with osteotomy or a long-term study by using only well known medical methods for preoperative planning.

Understanding the Benefits

Dr. David Pollock, Assistant Professor at the Wake Forest University Baptist Medical Centre in North Carolina, was one of the first in North America to test the specialized orthopaedic digital workstations in his practice two years ago. Focusing on knee and hip replacements, Dr. Pollock appreciates the accuracy, access to template libraries and increased efficiency the specialized planning workstations have afforded his practice.

“Radiographic films are limited in their ability to project true anatomical size due to magnification. Manual calculation of the magnification factor is time consuming and opens the door to mathematical error,” says Dr. Pollock. The new orthopaedic workstations allow surgeons to automatically calculate the magnification, recalibrate images and match implant templates to the patient’s true size, eliminating manual calibration and time-consuming measurement exercises. “With the digital system, I can tell exactly the magnification based on the known diameter of the sphere that’s on the X-ray,” added Dr. Pollock.

Physically moving X-ray films from the radiology department to the orthopaedic department and operating room is time-consuming and cumbersome. “With digital, I don’t mess with any of that. I can template the images in my office, save them and pull up the images in the operating room. There is no waiting around for images to come from storage warehouses where they can be lost or damaged,” says Dr. Pollock.

Orthopaedic PACS workstations allow access to an archived library of electronic templates of prostheses. Surgeons can select a prosthesis from the library and electronically overlay them on the diagnostic image to select the exact implant. Leading-edge systems offer extensive template libraries from the world’s top implant manufacturers, lending access to thousands of multiple body parts, screws, nails and plates.

Not only do the orthopaedic planning workstations facilitate image and information access, they can help to reduce operating costs. Images are stored electronically reducing the dependence on film, while facilitating the same daily work traditionally performed on film. The need to stock all sizes and varieties of implants is also reduced with the preoperative features and ordering for just-in-time delivery. Furthermore, remote image access and planning in advance can help to reduce the number of “surprises” in the operating room.

Patients benefit from faster turnaround times and less time waiting for surgery. On-screen graphics help to focus discussion and facilitate communications between the patient and physician. The images can be stored within the patient’s EMR and sent throughout the network or later retrieved simply with the press of a button.

“I was on call recently and a resident contacted me at home from the emergency room. With the old system, communications was difficult without visuals and I wouldn’t know until I arrived at the ER what we were dealing with. So much time was wasted planning and waiting for surgery. With the orthopaedic planning workstation, I am able to bring the X-ray up on my home computer, decide on a plan and prepare for the operation. I do all this without leaving my home,” says Dr. Pollock.

The Vision

The vision of a fully digital orthopaedic department may seem idealistic, but realizing this vision is not always an arduous task. Many mid- to large-sized institutions have some form of a PACS system already installed, making deployment fairly seamless.

The challenge lies in finding the right technology to suit daily requirements. Most importantly, the workstation needs to be compatible with the institution’s PACS. Due to the DICOM standard, compatibility between vendors is rarely an issue. This will ensure smooth work flow and lessen the obstacles to installation. Secondly, seek out a supplier that will provide you with the total package. One that will install the system, maintain it throughout its lifecycle and work with technicians to train them on-site.

Dr. Pollock concludes, “Medical technology is transforming the health care enterprise everyday. The evolution of digital technology is allowing orthopaedics greater access to more precise orthopaedic measurement and calibration tools, cutting out inefficiencies and improving preoperative planning.”

Jason Knox is the Marketing Manager for Agfa Health care, a leader in developing and manufacturing digital systems, intended mainly for the graphics industry, health care, micrographics, motion picture and photography markets.

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