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Digital Efficiencies in the COVID-19 Pandemic

November 9, 2021

VISIONS spoke with Adj. Professor Dr. Thomas Bayer, Head of General Radiology, Professor Stephan Kloska, Head of Neuroradiology, and Stefanie Mattner, Chief Radiographer (Fürth Hospital, Germany).

Since mid-2020, the Radiology Department at Fürth Hospital (Klinikum Fürth) in Germany, has been working with two fully digital Adora DRi systems and three mobile X-ray units from Canon Medical. In this interview, Adj. Professor Dr. Thomas Bayer, Head of General Radiology, Professor Stephan Kloska, Head of Neuroradiology, and Stefanie Mattner, Chief Radiographer, discuss how the hospital has benefitted from the new systems, particularly during the COVID-19 pandemic.

Could you tell us a little about your hospital, specifically about the Radiology Department?

Dr. Bayer: Our hospital has more than 800 beds and the number continues to grow. Our X-ray Department is used for the entire spectrum of procedures – acute, elective, out-patient and in-patient. Fürth Hospital has a large A&E department that is located right next door to the X-ray Department. Due to this, our conventional X-ray units are in constant use for emergencies, even during the night and at weekends. We cover the entire spectrum of acute care, both for neuroradiological and general radiological indications.
Left: Adj. Professor Dr. Thomas Bayer, Head of General Radiology (Fürth Hospital, Germany). Right: Professor Stephan Kloska, Head of Neuroradiology (Fürth Hospital, Germany)

What demands does your department and its X-ray systems face?

Prof. Kloska: We have a very busy A&E Department, and a large proportion of our patients have restricted mobility. In addition, we have staff limitations; on some nights there is only one radiographer at work. This means that we need a system that enables patients to be positioned easily by one person alone. The functions of the Adora system – that requires no repositioning in Level 2 - are really helpful to us. In the first wave of the pandemic, about 50% of the COVID-19 cases in the region were treated at our hospital. During times of heaviest demand, we had up to 90 in-patients with COVID-19.

In that phase in particular, when the rush of patients with suspected COVID-19 was especially marked, and we needed to presort COVID-19 patients and suspected cases quickly. We were able to respond very fast in A&E using the Adora system.

You have fully re-equipped your department in the area of conventional X-ray diagnostics. Was there a specific reason for the switch to a fully digital system?

Dr. Bayer: Switching completely to a fully digital system was the only conceivable option for us. Nowadays, you simply can’t get by anymore without robot-based X-rays.

Prof. Kloska: Essentially, it would be true to say that switching to a fully digital system had been under consideration for quite a while. However, the pandemic was another factor that significantly accelerated the procurement.

“The functionality of the Adora system, which does not require repositioning on the 2nd level, therefore suits us very well.”

Prof. Stephan Kloska, Head of Neuroradiology.

Your bucky rooms were replaced by two Adora DRi systems. Are you happy with the new systems? What are their particular benefits?

Dr. Bayer: With the Adora system, we can adjust the imaging angle precisely whenever we need to, without having to reposition the patient – for axial images of both hip joints, for example. Effortless work processes, a well-thought-out, menu-driven system and fully automated positioning are a great help to our radiographers. The system can be operated remotely, without needing to get right up close to the patient. Particularly during the COVID-19 pandemic, with all the isolation processes and hygiene regulations that have to be observed, the fact that the system can be operated remotely is an important plus point.

Prof. Kloska: ... and we can work much more economically than with the old imaging plate system that we used to use.

“There is simply no getting around robot-based X-rays these days.”

Dr. Thomas Bayer, Head of General Radiology.
59-year-old male patient with periprosthetic fracture after hip replacement; Fig. left: image of the thigh using the stitching technique for preoperative planning, Fig. right: Post-OP documentation.

The mobile X-ray on the wards was also converted. Could you tell us about this experience?

Prof. Kloska: The mobile devices have significantly improved handling and workflows. The old system was working right at its limits. In the COVID-19 areas in particular, a lot of our activity is mobile, because then the staff only need to get changed once. With the old system we needed one cassette per patient that we had to read. Now we are spared all the bother of switching cassettes, and with worklists available wirelessly, we can also assign data direct to the individual patients.

Dr. Bayer: With the motorized units, we can move quickly around the hospital. And they fit into the lifts without any trouble, that’s an important argument. It means we can quickly pick up on the individual jobs from the wards and process them. To ensure that there’s no inflation in the use of mobile X-rays, our radiographers now carry out one ‘X-ray round’ for elective COVID-19 X-ray cases in the morning, and one in the afternoon.
59-year-old male patient with periprosthetic fracture after hip replacement; Fig. left: image of the thigh using the stitching technique for preoperative planning, Fig. right: Post-OP documentation.

Has this changed the workload for the staff?

Stefanie Mattner: Fundamentally, it’s a great benefit for us that with the Adora system we can spontaneously switch between beds and mobile operation. The logistical work involved has reduced significantly with the use of mobile devices on the wards. Instead of the cassettes, all we need to carry around now is a detector – it makes the handling process much simpler for our team. Alongside this, we can move the patients around quickly and under complete automation, which makes repositioning them, especially with obese patients, very much easier. And, of course, it’s much more convenient for the patients themselves.

How satisfied are you with the image quality and the reduced exposure to radiation?

Dr. Bayer: With a robotic system, you can get a perfect angle from the radiation source to the detector. That makes it a lot easier to get the ideal image quality at a much-reduced dosage.

Prof. Kloska: This all depends on the settings, of course, we needed to make some subsequent adjustments there. We changed the positioning and adjusted the measuring chambers, and the radiographers had to change their procedures somewhat. In the end we got the settings for the Canon Medical image processing to the point where the image and the dose reduction met our high expectations.
65-year-old male patient; Fig. left: emergency chest x-ray lying down if COVID-19 pneumonia is suspected, Fig. right: CT confirmation of the COVID-19 pneumonia on the same day.
Stefanie Mattner, Chief Radiographer (Fürth Hospital, Germany).

You work with special flat detectors. What particular characteristics do these have?

Dr. Bayer: The flat detectors are easy to operate and are self-explanatory.

Prof. Kloska: We’ve also had feedback from our radiographers that the flat detectors are not much heavier than the previous X-ray cassettes. For daily handling, that’s crucial, of course.

Stefanie Mattner: ... and with the recessed grips on the back, transporting them around is better. The risk of dropping them is significantly lower. Cleaning the flat detectors is uncomplicated, too, because they are very resistant to water. And let’s not forget detector-sharing: We have a total of six Canon Medical flat detectors of two different sizes in use in the hospital and they can all be used interchangeably with all Canon Medical systems, which provides great flexibility and increases reliability.
Stefanie Mattner, Chief Radiographer (Fürth Hospital, Germany).

How was introducing the new system under the more complicated conditions of the COVID-19 pandemic?

Dr. Bayer: That worked out successfully despite the exceptional situation. Canon has behaved in an exemplary manner. //
Fürth Hospital:
  • Fürth Hospital (Klinikum Fürth), Germany, is the teaching hospital for the Friedrich-Alexander University of Erlangen-Nürnberg.
  • It employs a staff of 2500.
  • It cares for approximately 58,000 out-patients and 42,000 in-patients a year.
  • The hospital specializes in Interventional Radiology and Neuroradiology. It performs all of the common, minimally invasive, radiological- and neuroradiological procedures.

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