Documentation of ERCP images - Thermal prints, helios and laser hard copies

Free Standing endoscopy units may be equipped with fluoroscopic equipment separate from the main radiology department. Very often a digital C-arm fluoroscopy unit is used. This unit is capable of capturing images and storing them in the hard drive of the computer for subsequent review. Images can be selectively transfered to 3.5 in. computer diskettes for permanent storage or can be downloaded to different systems for documentation. We have looked at three image document systems: 1. Thermal printing system, 2. Heliospolaroid laser imaging system -laminated carbon copies and 3. Laser camera -Kodak 2180- silver impregnated copies for the documentation of ERCP procedures. We assessed the cost of the equipment and film, the quality of film for data interpretation and the time taken to print per film. Methods: Two images from twenty cases of ERCP procedures were selected and copied onto the three imaging systems. The size of the copies for Thermal, Helios and Laser were 4×4.5, 8×10, 14×17 inches, respectively. The images were reviewed independently by 8 biliary endoscopists and 1 interventional radiologist for the image quality and the ease of reading. A quality score is assigned: 1- unsatisfactory, 2- poor, 3- satisfactory, 4- good, 5- excellent. The ease of reading score: 1-difficult, 2-reasonable, 3-easy. Results: A total of 176 scores in each group were taken and the average score was calculated. Thermal Helios Laser quality score 2.8 3.6 3.8 ease of reading 1.7 2.2 2.3 p < 0.05*p > 0.05 1 printing (sec)/film 16 90 120 cost per film $ 0.20 $ 1.00 $1.00 cost per unit $ 5,000 $ 49,000 $95,000*compared to Helios & Laser; 1 compared to Helios Thermal prints could not be projected onto a screen but can be placed into the medical chart for documentation. It is the least expensive modality. Conclusions: 1. Image quality of the Helios system and the Laser camera are more preferable to Thermal prints for viewing. 2. The quality of laser prints is slightly better than Helios, but the cost of set up is double. 3. There is also a potential concern for disposal of silver waste products with the Laser Camera.