University of Colorado Hospital

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ClearRead Bone Suppress utilized on every chest X-ray image detects disease with certainty, speed, and in a cost effective manner

Background
Peter B. Sachs, M.D., Section Chief of Thoracic Imaging and Vice Chair of Informatics, University of Colorado Hospital (UCH) and Anschutz Medical Campus, joined the hospital system in January 2010. An advocate of soft tissue imaging, he had considerable experience with dual energy subtraction (DES) from his prior institution, but hadn’t yet tried Riverain software, which uses proprietary pattern recognition and machine learning technologies to produce a bone-suppressed, soft tissue image from a conventional chest X-ray image.

UCH had neither technology at the time he arrived but, with Dr. Sachs’ encouragement, the institution became an evaluation site for Riverain software in the spring of 2011. “My personal feeling is that anyone reading chest films needs some type of bone suppression support,” said Dr. Sachs, who now views the technology as an essential part of his daily workflow.

The software immediately enhances any adult chest X-ray image after capture from upright or portable imaging machines, without the need for additional imaging equipment. It seamlessly integrates into any digital radiology department, offering universal connectivity with existing PACS, and can be used to improve the visibility and detection rates of focal densities, including nodules.

Affordable Solution Compared to Dual Energy
ClearRead Bone Suppress is a strictly software solution, so it can easily be applied to every X-ray device in the facility for one fixed cost, whereas dual energy subtraction is hardware-based and can only be applied on designated X-ray devices.
“ClearRead Bone Suppress is a lot less expensive than dual energy. It provided us with a cost-effective solution to bone suppression,” said Dr. Sachs.

Safe and Effective in Detecting Lung Nodules
“One of the huge advantages to ClearRead Bone Suppress is that there is no additional radiation exposure, as opposed to a dual energy study where you’re doing a second exposure to create the image,” Dr. Sachs said. “With ClearRead, it’s simply a software manipulation. You can use it on every single study — and we do.”

The result, he said, has been improved lung nodule detection, including finding cancers that otherwise would have been missed.
“My personal feeling is that anyone reading chest films needs some type of bone suppression support.” – Dr. Peter B. Sachs University of Colorado Hospital and Anschutz Medical Campus “Certainly in our practice we absolutely have had proven cancers where, when we were reading the study, we did not see them until we looked at the bone-suppressed image.” – Dr. Peter Sachs Note confirmed malignant lung nodule visible in the upper right lung on the ClearRead Bone Suppress image. Original Bone Suppress Increases Confidence and Decreases Reading Times
In the first four months of 2012 alone, more than 20,000 X-rays were evaluated by UCH radiologists using ClearRead Bone Suppress. Through this evaluation and eventual sale, radiologists at UCH found the software helped them to make confident clinical decisions, even helping to speed up some of their reading times.

“If anything, ClearRead Bone Suppress speeds me up a bit,” said Dr. Sachs. “Because I have the suppressed image I can actually spend a little less time looking at the conventional image, or trying to reason through difficult areas on the conventional image. If I think there might be a lesion hiding behind a rib I can go to the bone suppression and, most of the time, feel comfortable that I have an answer.”

Extended Use Outside of Nodule Detection
ClearRead Bone Suppress is also helping UCH radiologists spot other potentially life-threatening conditions. “We’ve found that, as with dual energy, it’s good for finding subtle pneumonias and subtle pneumothorax,” Dr. Sachs said.

As an early adopter, Dr. Sachs saw the technology progress. Riverain Technologies credits the feedback from the evaluation sites and experts such as UCH and Dr. Sachs — a radiologist with more than 20 years of experience who trained at the University Hospitals Case Medical Center in Cleveland — with significantly influencing the direction and refinement of the advanced technology for chest X-ray applications.

According to Dr. Sachs, even as CT doses drop, software that improves visibility of conventional X-ray images will remain of value. “It’s not going to be physically possible to scan everybody with CT that we now do with chest X-rays. As chest radiologists we are vulnerable for missing lung cancers on chest X-rays in large part due to the superposition of bone structures. Anything we can do to make ourselves more accurate is critical.”

Showcase: University of Colorado Hospital Named the best hospital in Colorado by U.S. News and World Report, the University of Colorado Hospital is the Rocky Mountain region’s only academic medical center. The health system – the largest multi-specialty practice in the region and a leading tertiary care and referral center – includes advanced facilities on the Anschutz Medical Campus in Aurora, six primary care clinics and many specialty clinics. About University of Colorado Hospital Note enhanced visibility of pneumonia located in the upper right lung with the use of ClearRead Bone Suppress Original Bone Suppress Dr. Sachs received no compensation from Riverain Technologies for his participation in this showcase.

About University of Colorado Hospital

Dr. Sachs received no compensation from Riverain Technologies for his participation in this showcase.

“My personal feeling is that anyone reading chest films needs some type of bone suppression support.”

– Dr. Peter B. Sachs
University of Colorado Hospital and Anschutz Medical Campus

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