INTEGRIS Health is the parent corporation for INTEGRIS Baptist Medical Center, INTEGRIS Southwest Medical Center and Baptist Healthcare of Oklahoma, the latter a health care management company. With over 1,700 licensed beds and more than 1,600 physicians on staff, INTEGRIS Health is the state's largest Oklahoma-owned health system.

To sustain rapid growth, INTEGRIS BMC has totally renewed its physical facilities, but upgraded its core diagnostic imaging capabilities to all-digital. Three old radiographic rooms and one obsolete remote R&F system have been replaced by four GE digital fluoro rooms – 16-inch and 12-inch Advantx Legacy™ DRS R&F systems for general fluoroscopy and radiography, an Advantx TC digital tilting C-arm room for myelograms and interventional studies, and a GE Prestige ™ II remote digital R&F system for dysphagia studies, defecograms and similar studies.

This report examines INTEGRIS Baptist Medical Center's early experiences with digital imaging from the perspectives of planning and implementation issues confronted in executing this project.

Carol K. Yates, M.D.
Radiology Associates, Inc.
INTEGRIS Baptist Medical Center
Oklahoma City, Oklahoma, USA

Q: How did you come to choose the Legacy-D system?
A: We knew we needed to go digital and had been impressed with GE equipment. We visited Milwaukee and several clinical sites and liked what we saw.

Q: What did you especially like about the Legacy system?
A: Since it is digital it's much faster, cuts radiation exposure, and increases throughput. I also like the 16-inch image intensifier and the fact that I can see the millisecond exposure on the tower.

Q: Why did you select both 16- and 12-inch Legacies?
A: We got the 12-inch because we thought we needed it for peds patients. But if I had it to do again, I would get two 16-inch units because of the increased procedural flexibility the larger field of view provides.

Q: Was the learning curve difficult?
A: After the sites visits, I could have stepped in and started using it immediately. I can film studies myself and even do the post-processing if I have time. But the fluoro images are so much better that it's almost superfluous to take some of the films.

Q: So you've seen no discontinuity between the video image and the actual films?
A: Now, it's reversed. We have an old fluoro unit in our private offices where I can't see some things until I take a picture. But the Legacy digital fluoro image is so good that I'm almost afraid I'll miss getting something on the films.

Q: On a typical exam, are you faster or slower ?
A: Having total system control at the table-side makes me faster, much faster. I am probably 30-40% faster even though I'm doing more of the work myself.

Q: GE claims the Legacies can be operated with one hand. What has been your experience?
A: The system is very user friendly. I'm a left-handed person, so the ambidextrous control handle is wonderful.

Q: What do your radiologist colleagues say about the Legacy?
A: They all like it, too. There were some early image concerns related to the pre-set protocols. We went back to spotfilms until that was cleaned up and haven't had any complaints since.

Q: What has been the reaction from referring physicians?
A: There has been some really good feedback. They like the digital films and will even drop by when we are doing their studies.

Q: What are your expectations for the future?
A: Currently, our GI doctors are scoping everybody but that should decrease as managed care comes into this area and reimbursements fall. So I expect that our fluoro rooms to get even busier. Digital is also important because we are going to have even less technical help. Department staffing has already been cut by 25%, so we will be more and more on our own.

"I am probably 30-40% faster even though I’m doing more of the work myself."

Carol K. Yates, M.D.
Radiology Associates, Inc.
INTEGRIS Baptist Medical Center
Oklahoma City, Oklahoma, USA

J. Patrick Elder, R.T. (R) Chief Technologist
INTEGRIS Baptist Medical Center
Oklahoma City, Oklahoma, USA

Q: How have your new digital capabilities helped?
A: It saves us a lot of time. When we had 1970s-era equipment, we would do studies, take them to the darkroom and develop the 100mm spotfilms. If they didn't come out right or the camera jammed, we would spend a lot of time post-processing. With digital, what you see is what you get. And you don't lose your studies.

Q: Who participated in the digital acquisition process?
A: The department director at the time, Dr. Yates and I. But the others were most instrumental in purchasing the equipment and supervising the design of the new space.

Q: What kinds of issues did you encounter going digital?
A: With a different technology, you have to get away from the old protocols. We had to become more aware of technique and stay in a range where digital acquisition would be good. Our first digital rooms were regular Advantx equipment since Legacy was not yet available. The GE applications specialist told us to stay in the 10-60 millisecond range for optimal digital exposures. But even if we saw a sub-optimal fluoro image, we were usually too busy to go back and change the mA. Then the Legacies came with the millisecond readout and control on the fluoro tower, so you can check the exposure time whenever you want and change it right there. That's a great advantage because we other-wise might need a second technologist there just to monitor exposures.

Q: Are you able to schedule more patients in the Legacy rooms?
A: Each of our four digital rooms is unique and has found its own niche for different exams. The 16-inch Legacy room is especially useful for upper GIs because of its coverage and the fact that it can do all-digital overheads. The ERCP doctors especially like the 12-inch Legacy room because the room is larger.

Q: How do you allocate patients between the 16-inch and 12-inch Legacy rooms?
A: We primarily bought the 12-inch room for pediatric cases because we have a pediatric transplant program. So that is one key differentiator. If I have an upper GI and a barium enema at the same time, I will put the upper GI in the 16-inch room and the BE in the other room because, for most patients, you can image the entire stomach with the 16-inch intensifier. Otherwise, it is just a question of which room is available.

Q: How has your own staff reacted to digital imaging?
A: It has really boosted our egos. The acquisition of digital equipment and our understanding of it has elevated our visions of ourselves to a higher level. Before, we were the "barium techs." Now, we have nearly the same level of technical skills and equipment as cath lab technologists.

Q: What do you hear from the radiologists about the Legacy systems?
A: Dr. Yates will tell you that she doesn't need an x-ray technologist in there at all except to help get patients on and off the table. She really likes the rooms.

Q: What do you hear from her colleagues?
A: I guess the best thing about it is that I don't hear anything. In an institution like this, where I have fourteen radiologists who also practice at their private offices and at another hospital down the street, many of them don't get used to running the fluoro equipment. But I can take them into the Legacy rooms and show them how to run the equipment in 5-10 minutes. It's simple and easy to use. Some used to com-plain that they couldn't work in one of our old rooms, but they never say that about the Legacies. They like the equipment.

Q: What has the service history been?
A: As you can expect with this much GE equipment in the hospital, we have no problem with service. They come when we ask and take really good care of us. There are a lot more features on modern equipment, so more things can go wrong. The good thing is that the Legacies have no idiosyncrasies.

Q: After eight months of experience with the Legacies, you must have found something that you would like to change?
A: I don't know of anything I would change with the Legacies themselves. I just wish the rooms were larger.

"I can take them into the Legacy rooms and show them how to run the equipment in 5-10 minutes."

J. Patrick Elder, R.T.
Chief Technologist.
INTEGRIS Baptist Medical Center
Oklahoma City, Oklahoma, USA