Quality Improvement Neonatal Radiology

1. Quality ImprovementNeonatal Radiology

2. Introducing NeoRayTMThe first FDA approved Portable X-Ray System Specifically Optimized for Neonatal Application

3. Improving Quality Careof Neonates and X-Rays • Provide acute care in a timely fashion • Immediate results - X-Ray images displayed in 5 seconds of less • X-Ray images displayed on 19” monitor at incubator • Less “radiation dose” 50 to 70% less than CR technology • Early identification of new diagnosis or necessary intervention • Cost Savings • No need for additional personnel • No waiting for X-Ray images • No charges for unacceptable exposures • No need to repeat X-Rays (repeat order, phone call, return of radiology technician) • No film/cassettes - to change after each X-Ray exposure

4. Procedures That Would Benefit from NeoRayTM • Umbilical Catheterization (UAC & UVC) • Peripherally inserted central catheter • Chest tube placement • Needle aspiration • ECMO cannulation • Broviac placement • Surgical placement of abdominal drains • Endotracheal intubations • Duodenal tubes • Esophageal tube for hypothermia treatment

5. Diagnosis Benefits from utilizing NeoRayTM • Early diagnosis of life threatening illnesses • Pneumothorax, pneumomediastinum, pneumopericardium • NEC/ Bowel perforation • Congenital Diaphragmatic Hernia

6. Neonatologists Nurse Practitioners Nursing Residents Pediatric Surgeons Cardiovascular Surgeons Neurological Surgeons Personnel Benefits

7. Example of Cost/Time Saving Benefit • Decrease in nursing time • PICC insertion • Proper placement verified immediately versus multiple x-rays for readjustment of lines as well as multiple sterile dressing changes • Relief of stress/responsibility of radiology technician • Technician may have to return multiple times for repeat X-Rays occupying their time which may be needed elsewhere in the Hospital.

8. NeoRayTM • Highly portable • Battery powered • Outstanding Image quality • User friendly • Low X-Ray Dose • Small focal spot X-Ray tube • Low KW X-Ray Generator • Compact and light weight • Flat panel image receptor with integrated full function workstation

9. Workstation Features • Auto image Optimization • Automatic shutters • Image annotation • Measuring tools • Image enhancement tools • PACS Worklist • PACS network for storage • DICOM complaint

10. Highly Portable • Can be moved from incubator to incubator easily • Light weight - weights 8 times less than other battery powered portable X-Ray systems • Compact - X-Ray head fits under lid of giraffe when in open position • Small foot print

11. Image Receptor Panel • High resolution images • Less radiation • Compact size • Protected by outer case • Model Varian PaxScan 2520E • Receptor Type Amorphous Silicon • Conversion Screens CsI • Pixel Area 19.5 x 24.4 cm • Resolution 3.94 lp/mm • Scan Type Progressive • Data Interface Gigabit Ethernet • A/D Depth 14 Bit • Light weight Magnesium housing, shock and water resistant

12. Generator • Class HF Resonant Inverter • Battery Power App. 30 exposures • A/C Line Power 115 volts • kVp Range 40-80 kVp, adjustable in one kVp increments • mAs Range 0.1 – 30.0 • mA Range 10 mA fixed – Closed Loop Regulation

13. X-Ray Tube • Anode Type Stationary Anode • Filtration 2.7 mm al Minimum • Target Material Tungsten • Focal Spot 0.5mm • Anode Capacity 20,000 HU Storage • Target Angle 15 degrees

14. Workstation Hardware CPU Intel DuoCore 3.0G Hard Drive 10,000 RPM SAT 150G DICOM Format DICOM 3.0 Storage Media CD-R, DVD-R, USB Display 19” LCD Flat Screen OS Platform Windows XP Pro Image Processing Auto Collimation Annotation Tool Flip/Rotate/Invert Image Enhance

15. Collimation • Type Multileaf Adjustable • SID Indicator Tape Measurer • Angle Indicator Inclinometer • Positioning Device Laser

16. Support • Free software upgrade • National Dealer network • Online technical support • 24 hour technical support

17. Benefits to Neonates • Less stress • Decreased manipulation times due to repeat films, dressing changes, re-taping of ETT’s • Decreased interrupted skin integrity due to multiple dressing changes and tape removal • Eliminating additional dressing changes on central lines will eliminate the possibility of accidental removal of the line • Ability to receive immediate care during acute phases of their illness – examples: • Air leak diagnosis and immediate evacuation to include re-evaluation of therapies • Bowel perforation diagnosis followed by evacuation via needle aspiration and/or placement of drainage tubes by surgeon followed by re-evaluation of therapy

18. Benefits to Medical/Nursing Staff • Immediate results permitting adjustment in treatment modalities faster • Decrease nursing time for: • Re-entry of orders in computer • Re-positioning infant for repeat X-Rays • Repeated dressing out (sterile) for sterile procedures/dressing changes

19. Liability Benefits • Immediate results • minimizing adverse effects of a treatment (i.e. malpositioned central line) • No time delay in diagnosing acute changes or new diagnoses • Ability to repeat X-Rays immediately due to exposure problems or positioning, thereby minimizing time for an acceptable image • Less radiation than conventional x-rays

20. Problems with NeoRay Only one problem identified to date: Digital receptor is protected by a solid cover and will not fit in isolette film tray Digital detector must be placed directly under infant.

21. Ultimate Goal • Provide the highest standard of care possible to your neonates • Improve your neonates outcomes and enhance early discharge • Minimize procedure costs to hospital & patients