Get ready for digital X-rays: Here are the benefits

Digital X-rays will revamp the way you give care in the ED by improving accuracy in reading films, getting patients out the door faster, and accessing old films instantly, predicts Matthew Rice, MD, JD, an ED staff physician at the department of emergency medicine at Madigan Army Medical Center in Fort Lewis, WA.

When ED patients have X-rays taken, the films are put in a special machine that digitizes them. A computer scanner reads the X-ray plate and stores it in a database.

Digital X-rays have improved the ED’s overall efficiency and enhanced the ability to move patients through faster, notes Rice. "With this system, we are saving at least 25% of throughput time for the average patient that needs an X-ray. This has made a tremendous difference in our ability to provide care to patients 24 hours a day." (See Guest Column on the impact of digital X-rays, p. 47.)

Madigan Army’s ED was one of the first places in the country to use filmless X-rays, Rice notes. "It’s easy to see the benefits, once you get used to looking at a computer screen instead of a light board," he says. "More and more hospitals are moving to it every year."

Here are some benefits of digital radiography:

Previous X-rays are easier to access.

Obtaining information from radiology in the past has been time-consuming, and X-rays were sometimes lost, says Rice. "Now it’s as easy as going to a file in the computer and pulling up the old X-rays from a patient, so you can compare past and previous results," he explains.

There is significant cost and space savings.

Savings are mostly computed in terms of the film saved, according to Brian Duggan, MSN, RN, a senior consultant for information technology aggregation for Premier in Charlotte, NC. "Each film costs about $2.50. The standard cost savings is estimated at 80% of a hospital’s film budget," he adds. "That savings would be the payback figure used to calculate return on investment."

About a tenth of the storage space is needed, since films are digitally stored, notes Rice. "Right now, all of the films we’ve taken for the last nine years will fit into the space of a large room stored on hard disks, as opposed to the size of an entire house," he says.

Also, money is saved in not having to buy X-ray film or developing fluid, and staff aren’t needed to file films and retrieve them 24 hours a day, he says.

X-rays are better quality.

"The digital equipment uses techniques that allow you to get a better film the first time you take it," says Rice.

Patient flow is improved.

Since films are better quality, the number of films redone is reduced by approximately one-third, says Rice "The fewer films you take, the quicker you can get patients moving through the system," he adds.

The process provides good opportunities for education.

Films can be stored in a database of teaching files, so that a set of chest X-rays or CT scans can be shown to staff right in the ED, without having to retrieve old films. "It’s easy during slow times to have educational sessions, because you can sit by the computer with staff and review interesting X-rays," notes Rice.

Typically, there will be two 21-inch monitors side by side for comparison purposes, says Duggan. "These screens are very high-resolution and cost less than $1,500 each," he adds. "The cost is dropping rapidly, and many radiologists have similar units in their homes so they can perform filmless reads from the comfort of their own home."

Nurses can access patient films instantly on computer monitors in the ED, instead of having to ask someone to retrieve an old film, which could take up to an hour, Rice explains. "We can pull up the patient’s previous film and compare them side by side on two computer monitors to see if there are any changes," he says.

You can change or enhance the image.

Previously, you could only use a magnifying glass or lights to enhance an X-ray, Rice says. "But with digital X-rays, you can modify them. You can blow a section up or change the contrast, so you can pick up things that may have been missed."

For example, when looking at a cervical spine film, the fifth or sixth cervical vertebrae might be difficult to see. "Now, we can change the contrast so we see enough of a outline that it’s not necessary to do the film over," says Rice. "By enhancing the film, we can see the bones clearly to ensure there is no fracture. Likewise, you can enhance films of long bone fractures to check for small cracks."

Patients need fewer X-rays.

Because fewer films have to be repeated, digital X-rays are safer for patients. "If you have to expose a patient to only one film instead of several films, that is safer," says Rice. "There is about a 20% greater accuracy in reading films because of computer enhancement."

For more information on the benefits of digital X-rays, contact:

Brian Duggan, RN, MSN, Premier, 2320 Cascade Pointe Blvd., Charlotte, NC 28208. Telephone: (704) 733-5753. Fax: (704) 357-1469. E-mail:

Matthew Rice, MD, JD, Department of Emergency Medicine, Madigan Army Medical Center, Building 9040, Fitzsimmons Drive, Tacoma, WA 98431. Telephone: (253) 968-1250. Fax: (253) 968-2550. E-mail: