Thanks to Codonics, Hospital For Special Surgery Has A Solution That Goes A Long Way
"The dry long film from Codonics provides the orthopaedic surgeon
the perspective and confidence in their measurements and angles, lost with the minified
image. It is the perfect solution for our orthopaedic needs."
In orthopaedic medicine, the ability to capture true-size images is essential.
At Hospital for Special Surgery (HSS), an elite medical center, pinpoint accuracy
using definitive tools enables surgeons to diagnose and treat delicate spinal and
potentially debilitating leg conditions with optimal success.
The importance of printing true-size images of spines and long bones came into
sharp focus earlier this year when the hospital, a leading orthopaedic and
rheumatology center located in New York City, replaced some of its existing dry
imagers with a series of Codonics Horizon® XL Multi-media
Dry Imagers - the world's only imager capable of printing digitally stitched images
onto one continuous piece of dry film up to 51 inches in length. The Department
of Radiology and Imaging has installed seven Horizon XL imagers in radiography
rooms throughout the extensive department over the past several months. Radiologists
and orthopaedic surgeons are pleased with the results.
"Dr. (Helene) Pavlov, our radiologist-in-chief, has carefully examined the film quality,
and she believes it's outstanding," said Edward White, Assistant Vice-President for
the Department of Radiology and Imaging. "Our surgeons are the ones who actually
look at the images on 36" or 51" film, which in the digital world has not been
available until now, and they recognize the quality."
Established in 1863, HSS is a world leader in musculoskeletal medicine. Performing
nearly 18,000 orthopaedic surgeries per year, the hospital was the site of the first
total knee replacement and a pioneer in the development of minimally invasive spine
surgery techniques designed to eliminate the need for spinal fusion. HSS has been
named by U.S. News & World Report as the top center in the Northeast for orthopaedics
and rheumatology for the past 16 years.
A key component of the hospital's longstanding success is the Radiology Department,
led by Helene Pavlov, MD, FACR. She and her colleagues - 12 radiologists and up to
seven fellows - complete an estimated 180,000 imaging exams per year. Important to
their success is the Codonics Horizon XL, which produces hard-copy images for
radiography exams, occasional CT studies and special procedures, including myelograms
and arthrograms.
The department "discovered" the Codonics imager when the system was shown during the
Radiological Society of North America (RSNA) Scientific Meeting in Chicago. At that
time HSS was not capable of digital images on 36" and 51" film. Instead, it was
minifying images to fit onto a smaller 14" by 17" piece of film. If a physician wanted
a true-size image, the image had to be acquired on a film/screen cassette combination
and developed in the dark room, the traditional non-digital radiographic process. As
a secondary option, surgeons often simply evaluated and diagnosed patients from images
that printed on a smaller-than-true-size image. They believed that evaluating minified
imageswas error prone. They needed another solution.
Codonics solved the dilemma. Following the 2005 RSNA meeting, HSS conducted intense and
quantified testing. Once performed and satisfied, HSS had three systems installed. The
immediate, overwhelming response from physicians on the quality of the images and the
improvement in the ease of diagnostic evaluation led to additional purchases. Within a
week a fourth system was added, then three more during the following months. A total of
seven are now in full operation.
Now, surgeons can view true-size images of complete spines and limb lengths from hip to
ankle on film more than four feet in length. This reflects the preferred practice of
viewing, much the way x-rays of the hand, foot and other areas of the body are viewed-in
true size.
"Codonics came in, we did measurements on skeletons and validated them. Dr. Pavlov reviewed
the images, did measurements and confirmed that we could validate against conventional
images of that same skeleton," White said. "The Codonics images were exact. When we
showed our surgeons a conventional image and a Codonics digital image side by side, they
found that their perspective was intact and they no longer had to be concerned about errors."
The exclusive Horizon XL model is a compact imager that instantly delivers images on
true-size diagnostic film for templating for use within the operating room. With the XL
imager, post procedure images can be printed and verified before the patient leaves the
clinic or center.
The system's 14" x 36" and 14" x 51" long film enables true-size images to be printed onto
one continuous piece of film, then folded to 14" x 17" for insertion into a standard-size
film jacket. Key uses of the imager include facilitating evaluation of the entire spine for
scoliosis, including idiopathic scoliosis and kyphosis - a curvature in the sagittal plane of
the body with the apex of the curve directed posteriorly - and the entire leg from pelvis to
ankle in order to determine leg length. The predominant procedures are for limb lengthening
or correction of angular deformity.
The Horizon XL also prints flawless images on clear and blue film, grayscale paper, and color
paper in a variety of standard sizes. Specifically, it is capable of generating 14" x 17" and
8" x 10" blue or clear film, low-cost grayscale paper prints in 14" x 17" and 8.5" x 11", plus
color in 8.5" x 11".
According to physicians, the long film is perfect for evaluating scoliosis, long-bone,
pediatric and adult spines, while the paper, too, offers huge conveniences. Codonics'
cost-saving DirectVista® Grayscale Paper can be read in room
light and is a great alternative to film for several applications.
To date, HSS has presented images on film. However, White expects his department to begin
presenting on paper in the near future, a capability that will add considerable convenience
to the way surgeons interact with patients and their colleagues. As the department goes
filmless, physicians will be able to explain diagnoses to patients in room light and share
information with referring physicians without having to access a view box. The implications
are far reaching, including a projected cost savings over film of up to 65%. "We certainly
intend to begin using that capability in the near future, and it will provide us with cost
savings in addition to what we've seen so far," White said.
There have been other benefits. "The system's small footprint saves the department precious
space, the cost of operation is minimal, little servicing is required, and Codonics' support
is timely," White said. Perhaps most important, physicians are viewing true size 36" or 51"
digital, diagnostic-quality images never before available, almost effortlessly, using the XL.
"The Codonics imager has proven essential for pre-surgical planning and post-op so that they
can track the progress of the patient," White said. "We didn't sacrifice any image quality
to use this system. The surgeons in particular are satisfied with the accuracy they're getting
for their pre-surgical calculations and decisions based upon that image, and they've been very
accepting with this transition from minified images."
He added: "Remember - miniscule measurement deviations using small reference points can result
in significant miscalculations when the image is scaled. Where leg lengthening is concerned,
that can be profound."
Certainly, any measurement error is significant. At Hospital for Special Surgery, the Codonics
Horizon has virtually eliminated the possibility of error, creating a new gold standard for
measurement - one that translates to an important reality: an elite orthopaedic center has become
even better, thanks in part to Codonics.
"The possibility of error, while remote, is now even less likely," White said. "That has given
our physicians added confidence as they diagnose and treat their patients. I'd say our ability
to acquire and print images in true-size contributes to our patient satisfaction, and we owe
some of that success to Codonics."