RESUMO
With the implementation of the PACS in the hospital, there is an increasing demand from the clinicians for immediate access and display of radiological images. Recently, our hospital has installed the first wireless local area network (WLAN)-based direct digital radiography (DDR) portable radiography system. The DDR portable radiography system allows wireless retrieval of modality worklist and wireless transmission of portable X-ray image on the console to the Picture Archiving and Communication System (PACS), via WLAN connection of wireless fidelity (Wi-Fi). The aim of this study was to analyze the workflow and performance between the WLAN-based DDR portable radiography system and the old practice using conventional portable X-ray machine with computed radiography (CR) system. A total of 190 portable chest X-ray examinations were evaluated and timed, using the conventional portable X-ray machine with CR from March to April of 2012 and using the new DDR portable radiography system on December of 2012 (n = 97 for old system and n = 93 for DDR portable system). The time interval of image becoming available to the PACS using the WLAN-based DDR portable radiography system was significantly shorter than that of the old practice using the conventional portable X-ray machine with CR (6.8 ± 2.6 min for DDR portable system; 23 ± 10.2 min for old system; p < 0.0001), with the efficiency improved by 70 %. The implementation of the WLAN-based DDR portable radiography system can enhance the workflow of portable radiography by reduction of procedural steps.
Assuntos
Redes Locais , Sistemas de Informação em Radiologia , Fluxo de Trabalho , HumanosRESUMO
INTRODUCTION: Portable radiography traditionally has been performed with a conventional portable x-ray unit with computed radiography (CR) system (conventional-CR combo), and off-site processing of the exposed CR cassettes was time-consuming. The direct digital radiography (DDR) portable x-ray system, with the digital image immediately available for review and wireless transmission as the key merits, is newly installed for portable radiography. Thus, the work flow of portable radiography is changed. This study was performed to quantitatively investigate the performance of portable radiography using the DDR portable x-ray system and conventional-CR combo in terms of efficiency and work flow enhancement. METHODS: One hundred ninety portable x-ray examinations were timed for each procedural step using conventional-CR combo (n=97) and the DDR portable x-ray system. The following key performance indicators were designed for measuring the performance of portable radiography quantitatively: "examination duration," "time for image becoming available in PACS," "postacquisition processing time," and "manpower deployment time." RESULTS: Productivity was raised by 96% using the DDR portable x-ray system. "Examination duration" using the DDR portable system was significantly faster (P < .0001), with a mean calculated time of 13.4 ± 7.6 minutes for the DDR portable system and 25.2 ± 10.9 minutes for conventional-CR combo. The "time for image becoming available in PACS" was significantly shorter than that of conventional-CR combo (P < .0001), with a mean time of 6.8 ± 2.6 minutes for the DDR portable system and 19.2 ± 9.7 minutes for conventional-CR combo. The "postacquisition processing time" was measured with slight differences, with a mean time of 2.2 ± 1.1 minutes for the DDR portable system and 1.9 ± 1.0 minutes for conventional-CR combo (P = .1064). Because more portable x-ray examinations could be performed when using the DDR portable x-ray system in each round of service, the mean "manpower deployment time" when using the DDR portable x-ray system was longer (ie, 82.6 ± 46.8 minutes for the DDR portable system and 24.5 ± 11.9 minutes for conventional-CR combo). CONCLUSIONS: By using the new DDR portable x-ray system with work flow changes, the performance of portable radiography was improved in efficiency and work flow was enhanced. Furthermore, the four defined key performance indicators in this study may help provide a framework for measuring the performance of portable radiography in other institutions.
RESUMO
BACKGROUND CONTEXT: Multifidus cross-sectional area was often measured in chronic low back pain (LBP) patients to estimate the muscle activity for spinal stability. However, such estimation may be inadequate as the contribution of muscle elasticity in muscle activity is ignored. In vivo quantitative data on multifidus elasticity is therefore important for the study of muscle contractile function in response to motor control for spinal stability in chronic LBP patients. PURPOSE: The purpose of this study was to quantify the elasticity, cross-sectional area, and fat area of the multifidus for the contractile function and the distribution of deformable muscle tissue and nondeformable fat tissue at different postures in patients with and without chronic LBP. STUDY DESIGN/SETTING: This is a prospective study. Force-deformation data of the multifidus were acquired using ultrasound elastography. The anatomical changes of the multifidus were measured on the cross-sectional images of the multifidus acquired using B-mode ultrasound imaging. PATIENT SAMPLE: The sample comprised 12 adult male patients with chronic LBP and 12 asymptomatic male controls. OUTCOME MEASURES: The outcome measure was the elasticity of the multifidus at the L4 level for the assessment of muscle contractile function when patients were in the prone, upright, and 25° and 45° forward stooping positions. The cross-sectional area and fat area were also measured on the B-mode ultrasound images of the multifidus acquired at the same vertebral level and the postures. METHODS: With the patients in each of the prone, upright, and 25° and 45° forward stooping positions, ultrasound elastography and B-mode ultrasound imaging were performed on the left and right multifidus at the L4 level. The elasticity of multifidus indicated by the effective Young's modulus was derived from the force-deformation data acquired using ultrasound elastography. The cross-sectional area and fat area were assessed on the B-mode ultrasound images. The effective Young's modulus, cross-sectional area, and fat area were analyzed with multivariate general linear model analysis to investigate the possible effects of LBP and posture. RESULTS: There was an increasing stiffness of multifidus demonstrated by increasing effective Young's modulus from the prone to upright position and 25° and 45° forward stooping positions. Differences in multifidus stiffness between chronic LBP patients and asymptomatic controls were shown in the upright and 25° and 45° forward stooping positions but not in the prone position. The cross-sectional area of the multifidus increased from the prone position to the greatest value in the upright position and decreased in 25° and 45° forward stooping positions. Smaller multifidus cross-sectional area was demonstrated in chronic LBP patients than that in controls at all postures. No effect of posture on fat area within the multifidus was shown although the fat area within the multifidus was larger in chronic LBP patients. CONCLUSIONS: Different, changing patterns of elasticity and cross-sectional area were identified in the multifidus in relation to posture. Increased stiffness of multifidus in response to the physiologic range of static loads and smaller cross-sectional area was characterized in the chronic LBP condition for spinal stability. Ultrasound elastography offers in vivo assessment of muscle contractile function of deep trunk muscles, which benefits the future investigation of the neuromuscular regulating mechanism in LBP. It can also be applied to refine the palpatory skill for the physical assessment in sports training and physical therapy.
