At Animal Insides and Sight Hound Radiology we get loads of emails from veterinarians who are having problems with their digital radiography situation. Image problems, installation problems, technician problems – you name it. The following are “SOS emails” from veterinarians looking for help. The SOS file is a feature column in the Animal Insides Newsletter .
SOS: They installed my CR system and now my x-ray machine is broken
Question:
I bought a CR system and I was told that it would work with my x-ray machine. Now that it is installed, my vendor tells me that the CR system does not work because by x-ray machine is broken. My x-ray machine worked fine before the install. Did they break my machine during the installation?
Answer:
Although CR, Flat Panel DR, and some CCD DR systems can be retrofit to existing x-ray machines, that does not mean that they should be retrofit onto ANY x-ray machine.
X-ray machines don’t last forever. In many cases, x-ray machines doesn’t just stop working. Many die a slow and frustrating death; giving inconsistent results while they are dying. Retrofitting a digital system into an x-ray machine that is on the downward spiral may uncover problems that you didn’t know existed when you were using film.
One common problem we see with old x-ray machines is that the x-ray tube (i.e the part that makes the radiation) is past due for replacement. While it is dying, you will encounter fluctuations in the radiation output from your x-ray machine. These fluctuations may be tolerated by film screen radiography (or cause veterinarians to buy a digital system in the first place) but they are not tolerated by most digital radiography detectors. To make matters worse, some digital radiography systems will require more radiation than film radiography. Older x-ray tubes may not be able to handle the increased load required by digital radiography.
How do you know if your x-ray machine is capable of a retrofit? Unfortunately, you will never know for sure until you install your digital system. Before retrofitting any digital radiography system onto an “old” x-ray machine, have your x-ray technician run some diagnostics on the tube, timers, and other components to try to determine if a retrofit is possible or if you should buy a new machine.
Don’t expect too much from the diagnostics. Nobody will tell you how long your x-ray machine is going to last. There is just no great way to determine how much life is left in your x-ray tube.
SOS: The install is botched, my machine is broken, and the salesperson wants to get paid? What do I do?
Question:
I need some assistance. I recently had a digital radiography system installed but it does not work. The vendor is asking for payment but I don't think I should pay. Here is the situation:
- They told me that the problem with the images was the grid but I put in a new grid and the images are no better.
- All small animal images are labeled as pelvis when they reach my workstation.
- The images get changed somehow between the computer in radiology and my workstation. They look good at the processor and then need adjustment at my computer.
- The skull algorithms are wrong. When a skull is processed it comes out white.
- The viewing station is not hooked up like we talked about. I had to pay someone just to hook up to the internet.
- There is $1000 extra for delivery which was never on any quotes I had.
What should I do?
Answer: Rule #44578 clearly states that you should never pay in full until your system is installed, configured, and working properly. You followed this rule and now you see why it is important.
Digital radiography systems are not plug and play. These systems require a lot of technical know how and training to make them function properly. Be sure that you follow the installation day check list and do not pay in full until things are working properly.
Most problems we see at the time of configuration are simple configuration issues. This was exactly the situation in this case. Unfortunately, the vendor and veterinarian nearly came to blows before manufacturer could diffuse the situation.
Veterinarians are also strongly advised to know who they are buying their system from and be sure to buy from a company with a good service record.
SOS: My machine is broken and now my vendor wants $10,000 per year for a service contract they never told me about
Rule #33: All computers blow up eventually. Digital radiography machines are computers. They will blow up.
Unlike other computers and traditional x-ray machines (in most cases) the only company who can fix your problem is your vendor. If you are like most people, you recoil in horror when you realize that your vendor can charge you whatever they want and you have to pay it. Furthermore, if your vendor disappears on you or cannot fix the problem, your broken digital x-ray machine might very well become the worlds most expensive radiation emitting paperweight.
Some vendors are very forthcoming during the sales process and clearly and concisely discuss service contracts and maintenance agreements. Other vendors somehow fail to mention that $10,000 per year service contract until you have a problem that needs to be fixed. It appears that their thinking is that if you don't ask about service contracts they won't tell you about them.
Don't let this happen to you. Before purchasing a digital radiography system, you must know:
- Who will you call if there is a problem?
- Who is responsible to fix the machine?
- How long before a service engineer will be on site?
- How long before it will be fixed? Do not fall for the percent guaranteed uptime routine
- What happens if the vendor does not fulfill their part of the bargain?
- How much does it cost? It would be wise to consider the 5 year cost of ownership and include the service contract in your calculations.
- Are software upgrades included in the service contract? You WILL need software upgrades eventually.
Click here for more information on service contracts
Question: I do not have a digital radiography system but the local emergency clinic does. They send copies in jpeg form b/c I am unable to open the DICOM form. Is there DICOM software that I could download and have better quality images?
Comment: Woe is the referring veterinarian whose local emergency hospital does not consider the referring veterinarian in their digital radiography purchase. This is becoming a large problem in veterinary medicine.
Your comment about the image quality is interesting. In most cases, if the images you receive are crummy it is because the image is crummy and not because of the file format. Alternatively, you might need a new monitor to view the images. A worn out old 17 inch LCD will make any images look bad. If you can confirm that you are using a good quality monitor in a dimly lit room to view your images, I would contact your emergency clinic with your concerns about the image quality.
All emergency and referral clinics must consider the end user I their digital purchase. All digital systems installed in a referral hospital must:
- Be able to burn a DVD that conforms with the DICOM interchange media profile. We will be testing vendor DVD’s at this year’s showdown for compliance.
- Include an autoloading DICOM viewer. This viewer should not install software on the computer in order to run. Many veterinary hospitals have their computer system “locked down” and wont allow users to install software.
An alternate to giving pet owners DVD’s is to allow users to login to a hospital server or remote archive. This can be an effective way to distribute images to referring veterinarians; however, many of these systems require users to install viewers to be able to access the images. As stated previously, m0any veterinary hospitals have their computer system “locked down” to prevent viruses, spy ware, etc. and users will not be able to view the images because they cannot install the viewers. Although the idea of a remote archive to view the images sounds like a good one, in practice, web access of images is often a somewhat less than satisfactory experience for the user.
SOS – My rads are gone:
A reader writes: Hi, thanks for any help you can give me. I have the XXXX CR system and use XXXX. My whole system is new; 6 months. I have had 2 major hard drive crashes. My last one has resulted in the loss of all my rads over the last 3 months. I am frustrated and confused…
Comment: Unfortunately, hard drive crashes and corrupt data are part of the game with digital radiography. It sounds like the reader took steps at protecting her data but we hear similar stories every few weeks. Digital radiographic images are part of the medical record and they must be preserved. Ideally, images are backed up off site as a DICOM object. There are a number of remote archival services available*. Other possibilities to help protect your data include redundant hard drives (RAID) in a server or manual backup to an external drive.
A good starting point for this discussion is to define a backup. Simply put, a back up is a copy of all the data you consider valuable. This copy should be external to the system you keep your primary (also called, “live”) data on. It should not be a drive contained within the system you work on. A second internal drive is helpful, but anything that happens to your system, happens to that drive as well.
Several vendors sell a RAID 1 server with their digital radiography systems. Vendors may refer to this configuration as a “mirrored hard drive.” Unfortunately, a mirrored hard drive does not satisfy our definition of a backup so a mirrored hard drive is not a substitute for a secure data backup. Mirrored hard drives are designed to increase up time and limit recovery time. They are not designed as a data backup system. All changes made on a mirrored hard drive system happen to both drives instantaneously. In the case of any data corruption such as seen with viral infections, accidental deletions, or operating system errors all of the data on both drives will be toast. A mirrored hard drive will only protect you in the case of a mechanical hard drive failure in which case you can swap out the broken drive.
In my experience software failures, deletions, and data corruption are as common as mechanical hard drive failures. Therefore, a mirrored hard drive will prevent down time on your system but is probably not an ideal way to backup your data.
An additional concern is the quality of the hardware you are purchasing. All cars
are not created equal and neither are computer parts. If your vendor sells you a crummy piece of hardware are you going to know the difference? Have your IT personnel evaluate every piece of hardware that you purchase. Saving a few bucks on a crummy piece of hardware will cost you in the long run.
If you are going to go it alone and backup everything locally, be sure to work with an IT person so you have someone on your side in case of a disaster. Swapping out a drive sounds pretty simply but some IT expertise is recommended.
*Full Disclosure: Readers should be aware that I am involved with a teleradiology and image archival business at www.dvminsight.com. We have an excellent product at a great price but users are encouraged to do their research and look into any remote archival service that is available to them.
This comment was prepared with the generous help of Stephen Walters CTO of www.dvminsight.com
