For critically ill or post-surgical patients, transporting them to a dedicated radiology department is a demanding task. This is where bedside imaging comes in.
Despite how widely portable X-ray is used at the bedside, it has well-documented technical limitations. Images taken at the bedside are generally harder to read than those produced in a dedicated radiology suite, and distinguishing soft tissue from bone is not always straightforward.
Dual-energy X-ray technology has long been recognized for its ability to improve material differentiation compared to standard systems. However, dual-energy imaging systems are rarely used in bedside applications. Thanks to the Reveal™ 35C, made by KA Imaging, that could change.
Let’s examine why dual-energy has been missing until now and how KA Imaging’s Reveal™ 35C is changing what dual-energy can do in bedside imaging environments.
Bedside Imaging Is Still Limited
Bedside imaging environments are less controlled, with limitations in space, positioning, and radiation shielding that can affect image consistency, diagnostic clarity, and radiation exposure.
Portability is the most important factor in technology designed for bedside imaging, but portable X-ray machines operate at lower output power than fixed units, typically under 35 kW.
Bedside imaging is also complicated by patient positioning. Most bedside X-rays are taken with the patient in a supine position, which limits the range of views available. This can affect image contrast and may alter anatomical relationships, which complicates interpretation.
Dual-Energy X-Ray for Bedside Imaging: The Reveal™ 35C
Grand River Hospital in Kitchener, Ontario performs more than 150 bedside chest X-rays each month in its intensive care unit alone. To address the limitations of conventional portable imaging, the hospital began working with KA Imaging’s Reveal™ 35C as part of an ICU implementation initiative.
The Reveal™ 35C is a single-exposure, portable, digital dual-energy subtraction X-ray detector designed to produce three images from one exposure: a standard image, a soft tissue image, and a bone image. Because it captures all the information needed in a single exposure, the Reveal™ 35C avoids the motion-related artifact problem seen in dual-exposure dual-energy methods.
The detector is designed to operate using technique parameters and radiation dose levels comparable to conventional portable X-ray workflows. Clinicians and imaging teams do not need to significantly alter acquisition workflows to obtain the additional image sets.
The ICU implementation at Grand River Hospital explored how additional image information at the bedside could support portable imaging workflows in critical care environments. Clinicians reported improved visualization and reader confidence in certain bedside imaging scenarios, particularly when assessing chest anatomy, lines, and tubes in critically ill patients.
Observational findings associated with the implementation also suggested the potential to reduce downstream imaging utilization in select cases, supporting interest in expanding spectral bedside imaging workflows within the Waterloo Regional Health Network (WRHN), including the adoption of the Reveal™ Mobi Pro mobile imaging system.
Potential Clinical and Workflow Benefits
For bedside imaging environments, several potential benefits may result from having access to additional image information directly at the point of care. Experiences from the Grand River Hospital ICU implementation highlighted potential applications such as:
- Supporting image interpretation at the bedside
- Providing additional visualization of chest anatomy, lines, and tubes
- Supporting ICU monitoring workflows
- Reducing the need for repeat imaging in select cases
- Supporting more informed decisions regarding follow-up imaging
The Reveal™ 35C is designed to generate standard, soft tissue, and bone images from a single acquisition without requiring separate exposures or major workflow changes. This may help provide additional anatomical information while maintaining the speed and portability required in bedside imaging environments.
Key Use Cases for Dual-Energy Bedside Imaging
- ICU patient monitoring: Critically ill patients often require frequent chest X-rays to monitor changes in lung status, fluid accumulation, or heart size. Additional image information may support longitudinal assessment over time.
- Tube and line placement confirmation: Confirming the position of endotracheal tubes, central venous catheters, nasogastric tubes, and chest drains is a routine and critical component of ICU care. Additional soft tissue and bone image information may support assessment of device positioning.
- Monitoring pulmonary conditions: Conditions such as pleural effusion, pneumothorax, and pneumonia can be difficult to evaluate on standard portable X-rays due to overlapping anatomy and limited image contrast. Spectral soft tissue and bone images may provide additional visualization to support clinical assessment.
- Patients who cannot be safely transported: For patients on ventilation, those with hemodynamic instability, or individuals recovering from surgery, transport to the radiology department can introduce additional complexity. Technologies capable of providing more image information at the bedside may support care decisions without disrupting ICU workflows.
- Reducing repeat imaging: When portable images are difficult to interpret, repeat exposures or follow-up imaging may be required. Additional image information from a single acquisition may support interpretation in select bedside imaging scenarios.
Conclusion
By producing standard, soft tissue, and bone images from a single exposure, the Reveal™ 35C is designed to provide additional image information while operating within portable X-ray workflows and radiation dose levels comparable to conventional bedside imaging.
The implementation at Grand River Hospital’s ICU represents an early example of how single-exposure spectral imaging can be integrated into existing bedside imaging environments. As hospitals continue to look for ways to improve diagnostic confidence and workflow efficiency in critical care settings, technologies that expand the information available from routine portable X-rays may play an increasingly important role.
If you’re interested in learning more about Reveal™ 35C and bedside spectral imaging workflows, please contact our team.