eHealth Magazine October Issue

The Premier monthly magazine on the enterprise of healthcare in asia & the middle East volume 13 / issue 10 / OCTOBER 2018 / ` 100 / US $10 / ISSN 0973-8959

the Man on a

exclusive Interview Naveen Jain

Mission Director, National Health Mission, & Secretary, Medical, Health and Family Welfare, Government of Rajasthan

Meet the architect of â&#x20AC;&#x2DC;Daughters are Preciousâ&#x20AC;&#x2122; campaign, initiated for community engagement against female foeticide which is leading to an improved sex ratio at birth in Rajasthan

Cover Story

Radiology and Imaging Augmenting Patient Care

A Special Report

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october 2018 | Volume 13 | Issue 10

COVER STORY

Radiology and Imaging Augmenting Patient Care exclusive interview

technology Perspective

22 Dhruv Kapur Senior General Sales Manager, Ethicon, Johnson & Johnson Pvt Ltd 24 Ashok Arora CEO, NUTAS

Naveen Jain Mission Director, National Health Mission & Secretary, Medical, Health and Family Welfare, Government of Rajasthan

28 Chander Shekhar Sibal Executive Vice President Fujifilm India Pvt Ltd

ppp initiative in rajasthan 30 Empowering Healthcare Through Technology and Innovations

industry perspective 16 Dr Rajeev Boudhankar CEO Bhatia Hospital, Mumbai

a special report 4thAnnual 2nd Annual

20 Sushant Kinra Managing Director Carestream Health India Private Limited

Precious Daughters of inDia AWARDS

28 September 2018,

Technological Trends 34 Dr Akther Syed Consultant and Incharge Radiology and Imaging, Nayati Medicity, Mathura

Editorial Daughters of India Vital for Nation’s Growth Narrative India’s transformation wouldn’t have been possible without women participation. Today, there is hardly any field left out where girls have not proved their mettle. Thus, it’s all the more important to remember that these daughters are actually precious. Considering they are truly an embodiment of love, care, and sacrifice in every family, the eHEALTH magazine decided to highlight ‘Daughters are Precious’ campaign in Rajasthan and its prime mover Naveen Jain, Mission Director, National Health Mission, and Secretary, Medical Health and Family Welfare, Government of Rajasthan, in its latest issue. In an exclusive interview, the officer shares how he not only ideated the concept in 2016 but continues to leave no stone unturned to bring a real transformation in the public perception in Rajasthan despite age-old social and cultural prejudices. Thanks to his resolute efforts against female foeticide , the State has made significant progress in sex-ratio at birth. Through its cover story, our magazine has highlighted role of latest advancements in Radiology and Imaging in enhancing patient care. Titled ‘Radiology and Imaging Augmenting Patient Care’, offering an insight about how latest innovations like Tele-radiology, Digital Radiography and Mammography have played a crucial role in diagnosis of the disease and their possible treatment. We also have interviews of Sushant Kinra, Managing Director, Carestream Health India Private Limited, Dhruv Kapur, Senior General Sales Manager, Ethicon, Johnson & Johnson Pvt Ltd, and Chander Shekhar Sibal, Executive Vice President, Fujifilm India Pvt Ltd who talk about the latest in radiology and imaging field and what innovative solutions are coming up. The magazine also carries insightful articles titled ‘Radiology and Changing Facets of Technology’ by Dr Syed Akhter, Consultant & Incharge, Radiology and Imaging, Nayati Medicity, Mathura and ‘Rise and Impact of Advanced Imaging Technology’ by Dr Rajeev Boudhankar, CEO, Bhatia Hospital, Mumbai. The latest issue also carries a Special Report of 4th Healthcare Summit Rajasthan, highlighting viewpoint of healthcare luminaries on creating an ideal healthcare delivery model to provide best medical facilities in a costefficient manner. With such a bouquet of articles, interviews and stories, we hope this edition will evoke an invaluable response from our esteemed readers.

Dr Ravi Gupta Editor-in-Chief, eHEALTH magazine & CEO, Elets Technomedia Pvt Ltd ravi.gupta@elets.in

Cover Story

Radiology and Imaging Augmenting Patient Care

Technology has acted as a great enabler and improved the overall results in every field. In healthcare, it is proving to be a boon for people who used to be left out or utterly disappointed for want of being properly diagnosed. It used to happen due to absence of timely factual medical reports. The improved facilities of Radiology and Imaging have come as a great relief for such people to some extent, writes Mukul Kumar Mishra of Elets News Network (ENN).

oday, one can easily avail medical help what he or she could only dream of about 10-12 years ago. As case of chronic diseases like cancer, diabetes, heart related issues and strokes are on the rise, radiology and imaging are making a critical difference to determine the medical diagnosis. To detect life-threatening diseases at an initial stage so that radiologists can guide patients about accurate treatment, Diagnostic Imaging plays a crucial role. One needs to understand that the

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Indian healthcare is presently at an inflection point with focus shifting from prescriptive to preventive healthcare. Also, with the rise in the income of neo-middle class and quest for quality patient care, healthcare ecosystem is growing by leaps and bounds. Today, consumers are more aware of their healthcare and diagnostic needs. Digital technology has helped people to avail more customised solutions to monitor their health in a better way. Though latest advancements in Radiology and Imaging have enhanced patient care, the sector is not devoid

of challenges jeopardising healthcare delivery in totality. Disruptive technology and innovative solutions canâ&#x20AC;&#x2122;t be helpful until we have required experts to analyse huge amount of imaging volume (Number of scans, images, and amount of data) the latest high-tech equipments generate on the daily basis. With a population of over one billion people, India has radiologist strength of only 10,000, meaning the doctor and patient ratio being just 1:100,000. This can make anyone understand how difficult it is for the

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enhanced experience of treatment for millions of people across the globe,” says Dr Syed Akhter, Consultant & Incharge, Radiology and Imaging, Nayati Medicity, Mathura. Diagnostic Imaging plays an important role in giving insight about what is happening within human body. If a patient has an iota of doubt of cancer or malignancy, he or she goes for an imaging test to make the initial diagnosis and then subsequent imaging test for follow up treatment. The utilisation of radiology across the world is increasing to diagnose such life-threatening diseases at a right point of time so that quick treatment could be provided. With emerging trends and technology, it is interesting to see the tremendous scope that this sector has to offer. The world of imaging and technology is constantly evolving, thus opening up to a vast new world of innovations. Radiology has two parts one is diagnostic and other is interventional radiology. Diagnostic radiology helps healthcare experts to see structures inside your body. With diagnostic tools like Computed Tomography (CT), Positron Emission Tomography (PET imaging), Magnetic Resonance Imaging (MRI), Nuclear Imaging,

and Mammography, the radiologists diagnose the cause of underlying disease and direct patients what sort of treatment is needed. Interventional Radiology Interventional radiologists are those experts who use imaging to insert catheters, wires, and other small instruments and tools into your body to treat diseases like cancers or tumors, blockages in the arteries and veins, fibroids in the uterus, back pain, liver problems, and kidney problems. Doctors can use this technology to diagnose or treat conditions in almost any part of the body instead of requiring to directly look inside one’s body through a scope (camera) or with open surgery. The doctors make no incision or only a very small one in this procedure. Talking about interventional radiology, Dr M L Rokade, Consultant Radiologist, Jupiter Hospital, says: “The role of interventional radiology has expanded. Radiologists do angioplasty, tumor embolisation and various diagnostic and therapeutic procedure. An embolectomy done in the Golden Hour can salvage the brain function in a stroke patient.” “With the 128 and higher slice Mulislice CT scanners, diagnostic invasive angiograms are soon becoming past. Coronary CT scans now reveal coronary anatomy in exquisite details. Small segmental areas of narrowing and other vascular variants can be assessed. These scanners also overall increase the output due to faster scan acquisition times and recent advances help in reducing the patients radiation doses,” Rokade further stated.

cover story

radiologists to diagnose diseases with precision, which is first step in the direction of providing right treatment to a patient. Tele-radiology has proved to be a big boon to fill the gap existing due to mismatch between the availability of the radiologists and the number of images being generated. Another obstacle is inept manpower to handle these high-tech equipments it increases the risk of error during the course of the diagnosis. Reduction of radiation doses is another impediment which needs to be tackled. It not only poses huge risk for patients but also for radiologists. Both need to be protected against harmful radiation which otherwise makes them prone to several deadly diseases. Radiology gains relevance in the context of diagnosis, which decides the road ahead for treatment. With the rise in chronic diseases like cancer, diabetes, heart related issues and strokes, the sector holds huge significance. These are all conditions that require imaging or scanning at some point of time. “The modern-day advancement has influenced radiology. About 20 years ago, radiology was limited to X-rays. But over the years, conventional procedures have witnessed tremendous change for the better, leading to

Imaging Market India has come a long way since the first X-ray machine was imported in India in 1902, only seven years after it was discovered by a German Professor W.C. Roentgen. Today, we are at par with other developed countries as far

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october 2018

Cover Story

as latest technology and innovations in radiology are concerned. The global medical imaging devices market is expected to grow at a CAGR of 5.47% during the forecast period 2018-23. According to Zion Market Research, the global market will reach around $ 33.50 billion by 2021. The emergence of innovative technology such as 7T MRI equipment, high-slice CT scanners, 4D and 5D ultrasound imaging, and innovations in digital X-ray technologies is likely to boost the demand for medical imagining devices in the global market. Innovations rule the roost The Indian radiology market is also witnessing tectonic shifts with the major players trying to explore and penetrate the market in tier-II and tier-III cities. Tapping to this vast scope of advanced-diagnostics-at-affordableprices, radiology industry is witnessing an overhaul with respect to launching of cost-effective imaging equipments in the secondary and tertiary healthcare segments. The leading players like GE, Siemens, Philips and Fujifilm are launching next-generation medical imaging devices that help in prevention, diagnosis and treatment planning, and disease management. “Ultrasound has maximum usage in any hospital setting. Ultrasounds have become smaller to the size of palm top so that it is always available to the critical care consultant. Today ultrasound has changed the way we see the fetus with its 3D/4D capability,” Rokade said. “Liver cirrhosis can be diagnosed early with shear wave elastography both on ultrasound and MRI. Contrast enhanced ultrasound is now being widely used for assessment of tumors and various lesions. Digital image radiography and PACS (Picture archival and communication system) is the standard of a modern day radiology department.” Dr Rajeev Boudhankar, CEO,

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Bhatia Hospital, Mumbai, says there are cutting-edge imaging techniques that may become popular in the near future. He lists out some of the innovations happening across world on the front of diagnostics imaging. Pocket-sized hand-held ultrasound devices are predicted to replace the 200-year-old stethoscopes in near future. They can diagnose heart, lung and other problems more accurately than traditional stethoscopes. “Similarly, Hyperspectral imaging may provide a non-invasive diagnostic method that allows determination of pathological tissue with high reliability. This technology is in use in the defence sector and is now finding applications in the healthcare imaging Industry,” Boudhankar adds. A modality called Electromagnetic Acoustic Imaging has been making use of electro-magnetic and acoustic waves for diagnosis. It helps to identify various types of solid Cancers at early stages of development. Another technology Wafer Scale Mega Microchip enhances medical imaging techniques. It enables doctors to detect accurately the effects of radiation on cancerous tumours, thus helping early detection. The University of California, Berkeley and the Universidad Autonoma de Madrid of Spain have claimed to have made the use

of 3D Meta material to augment ultrasound images by a factor of 50X. If this technology becomes successful commercially, it would help current ultrasound investigations to capture high-resolution images for medical imaging in both diagnosis and interventional procedures.

Trends in Radiology and Imaging Tele-radiology It is one of the most useful discoveries in the field healthcare IT where radiologists, without being physically available on site, provide quality patient care. It fills the gap of mismatch of radiologists and the number of images that are being generated on the daily basis at various healthcare centres across country. Using this IT-enabled solution, the images can be transmitted to another location and reported immediately on real-time basis so that the emergency medical care can be delivered on that very moment when it is actually required to patients. “Kenya with a population of 43 million has only 200 radiologists. In rural Nepal, there are places where people travel almost two days for getting X-Ray. In that part of the world, machines are often outdated models and are the ones that have been

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Hybrid Imaging Technology It is referred to as the fusion of two or more imaging modalities to form a new technique. This not only improves the accuracy of a diagnostic test but also reduces the radiation exposure for patients. The most significant development in this regard has been the innovation of hybrid imaging systems like the PET/CT. This hybrid modality has been so successful that major imaging system manufacturers do not provide standalone PET systems any longer. Based on the success of hybrid PET/CT systems, hybrid PET/ MRI and SPECT/CT systems have also gained attention. These hybrid systems can provide precise images with better resolution compared to standalone systems. They can provide morphological as well as physiological information in just one examination.

Pocket-sized handheld ultrasound devices are predicted to replace the 200-year-old stethoscopes in near future. They can diagnose heart, lung and other problems more accurately than traditional stethoscopes

Automated CT Scanners These devices offer high image quality with improved spatial resolution and low radiation exposure to the patient as well as surgeons. These advanced CT devices have a simplified console, offer ease of operability, and provide affordable installation with minimal space requirements.

Digital radiography has tremendously improved the x-ray quality, speed and replaced all the boring Dark Room procedures, as these can be shared immediately for speedy diagnostic results. The conventional X- Ray used to take about half-an-hour for whole procedure while the digital radiograph can be acquired with just a click of a button while delivering a far better quality. “Our Full Field Digital Mammography – Amulet Innovality is the future of Mammography and certainly has much scope considering the rapid increase in the number of breast cancer cases going undetected in India. In order to provide timely diagnosis, Fujifilm has installed Amulet Innovality in several healthcare centers across the country,” says Chander Shekhar Sibal, Senior Vice President, Head of Medical Division, Fujifilm India Private Limited.

Digital Radiography and Digital Mammography

CT Angiography Traditional angiography takes several

PET – CT Positron Emission Tomography continued with CT scan images provides easy detection of even small tumors and metastatic information and also provide metabolic status of tumor as physicians get a better idea of what is going on and how to properly treat it and also help in monitoring chemotherapy.

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hours, requires sedatives and can even cause damage to vessels. But CT- Angiography takes 10-15 minutes without such risks. It can be used to image any artery in the body including brain, coronary, lung, kidney etc. with recent advances in CT angiography. It gives a picture which is threedimensional and is like actual arterial system in our body and is very friendly for clinicians to see the pathology.

cover story

donated. Web-based systems allow physicians to send and access images and reports from all over the world,” Akhter said.

Artificial Intelligence Can Be a Game Changer AI can play a pivotal role in intelligent workflow and capacity management. It can help make radiologists more efficient, properly prioritize care, and help distribute workloads for more effective use of resources. The modern technology can assimilate large amount of pattern recognition data into their systems and allow a computer algorithm to differentiate the normal from an abnormal image; detect certain lesions for example lung nodules, early-stage breast cancers or for instance the blockages in vessels such as embolism in the pulmonary arteries. If AI picks up the way it is destined, it will enhance Radiology and will lead to better patient care,” Sushant Kinra, Managing Director, Carestream Health India Private Limited said. “For Radiology and especially medical device companies like us, the biggest advantage is that we are the ones who are generating the data for AI. For example, our Digital X-ray or Computed Radiography equipment converts the analog information into digital data, which is what AI uses to process information. This demand for digital information will only increase,” he further stated. In essence, we can say Radiology and Imaging field is replete with innovations but that need to be leveraged with caution. Much needs to be done to harness this potent tool to provide holistic patient care.

eHEALTH Magazine

october 2018

exclusive interview

‘It’s Time to Realise How Precious are Daughters’

One should try to change the mindset first which actually takes years to be changed. But then somebody has to take the initiative. ‘Daughters are Precious’ (DAP) campaign was a very honest effort on our part to launch, says Naveen Jain, Mission Director, National Health Mission & Secretary, Medical, Health and Family Welfare, Government of Rajasthan, in an Exclusive Interview with Kartik Sharma of Elets News Network (ENN).

While taking reins as Mission Director of National Health Mission in Rajasthan, did you imagine saving daughters in female foeticide incidents will be the biggest mission for you some day? When I joined as Mission Director and Special Secretary, Medical Health and Family Welfare Department, Government of Rajasthan, in 2014, I never had such an idea. I had no inkling that I would work on the

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assignment of saving daughters from female foeticide. While working as Mission Director, I was always looking for some workable solutions that can work to bring positive results.

Spread over thousands of kilometers and having a huge population, Rajasthan is indeed a vast State. Isn’t saving girls from female foeticide a daunting task here? Rajasthan is the largest State of India

in terms of area. It is spread over from Thar Desert to Chambal area in eastern side. There are different customs and different historical backgrounds. In this wake, someone’s claim that he or she can ensure girls won’t be killed in one’s womb is unthinkable. We are finding solution for the same. PC-PNDT Act alone, which was introduced in 1994, was not sufficient to do this job.

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So, we thought of some out of the box ideas. It provided us many inputs. We started implementing the Act through PC-PNDT Bureau of Investigation. Then, we revamped the Mukhbir Yojna, that is sharing information with the administrative system by commoners about occurrence of any such incident i.e. gender selection and sex selective abortions. After revamping the scheme, information has started pouring in. In addition, a prize was also declared even for decoys. It was because the pregnant women were feeling insecure or they were not feeling motivated to give their best. When Mukhbir and Decoy Yojna were advertised very well by using good means of ICE, information poured in. Many decoy operations were conducted. With the help of power accorded to PC-PNDT bureau of investigation by the State Government, we would also visit neighbouring States. In this way, the entire process was started. We were able to save girls not only in Rajasthan but in neighbouring States as well.

Did you undertake any other initiatives other than PC-PNDT Act or enforcement? In 2016, we realised that enforcement of PC-PNDT Act or enforcing the Mukhbir Yojna or decoy operation were not enough to make a dent. We needed to go further. In September,

2016, we started ‘Daughters are Precious’ campaign. The campaign was flagged off by then Minister of State for Health in Central Government at 2nd Healthcare Summit Rajasthan organised by Elets Technomedia. Since then, the programme has gained popularity, reaching youths, schools, colleges, university and medical colleges. The philosophy behind entire campaign was that only youth could bring the change and they evoked the biggest ray of hope. It is like when these youths would achieve parenthood, they would not discriminate between son and daughter. This would make the real difference. In a civilised society, social problems should be solved within the society. One should try to change the mindset first which actually takes years to be changed. But then somebody has to take the initiative. ‘Daughters are Precious’ campaign was a very honest effort on our part to launch the drive.

Kindly shed some light on Daughters are Precious programme. How did it click in Rajasthan? When awareness programme -- Daughters are Precious (DAP) campaign was launched by us, we never thought that it would be a big success within two years. Initially, some health department officials and

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exclusive interview

‘Daughters are Precious’ (DAP)-1 features in India Book of Records

Many decoy operations were conducted. With the help of power accorded to PCPNDT bureau of investigation by the State Government, we would also visit neighbouring States

PC-PNDT Cell used to visit different institutions on Saturdays so that other works won’t get affected. We approached educational institutions and requested them to conduct our programmes. We apprised them about laws and historical data and informed them about various reasons why daughters were considered unwanted in families. Then, we sought youths’ feedback. Some video films and educational content were created for maximum public awareness. Youth attended various programmes conducted by us. They used to be involved in the process. Then we came out with the idea of Daughters are Precious (DAP) Rakshak in 2017. Slowly, we found that many youths, NGOs, even retired persons were interested to be part of this mission. The age ranged between 17 to 70 years. Right from a student to a retired person, all were ready to become a DAP Rakshak. That was biggest turning point. On 24 January, 2018,

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exclusive interview

the biggest event took place when we approached 6,400 institutions across the State. Over 11,72,000 students attended our DAP Rakshak programme which was a world record! We were able to convey the message that public awareness was the right way to bring the ultimate change in public perception.

How do you perceive success and foresee the future of DAP Rakshak? The biggest success of DAP programme is that it is not a pure Government programme. It is a programme where there is mobilisation of power of the Government. The entire programme is owned by DAP Rakshaks. Nobody is forced or given any kind of incentive. Here, people join the programme willingly. Now, people are visiting the field, they are targeting institutions. We have conducted one more phase in September, 2018. We have decided to do the programme in all the Gram Panchayats of Rajasthan as ‘Beti Panchayat’. It was the third

phase of DAP. First phase was held on 17 November, 2017. The second on 24 January, 2018 and third was in September-October, 2018. The response has been overwhelming. Our DAP Rakshaks were initially apprehensive, thinking villagers might not be interested to listen to them or they may have different take about female foeticide. We, however, found the urban concerns and rural worries were similar. All of us were on the same page, that daughters were missing not only from urban areas but also from rural areas and we needed to work on the issue. The response was tremendous. Over 8,00,000 people from 9,890 Panchayats joined the

programme. Many more were made volunteers. If we keep on doing the programme in such a way so that the youths and villagers are engaged, which is done on State-level, I think we can witness a lot of improvement. In the next phase, we should talk to urban population. In urban areas, the child-sex ratio is worse than rural areas. We are planning to talk to urban resident welfare associations, urban rotary clubs, and other NGOs. We should spread the message that daughters are precious and everybody has to work for their betterment. They are the God’s biggest gift and we need to work to protect them to exist.

What factors actually worked in terms of challenges of Rajasthan? As per 2011 Census, the child sex data has reduced to 888. It means in the age group of 0 to 6, on every 1,000 boys there were only 888 girls. While in 1981, 30 years ago, it was 954. In 30 years, we have lost 66 girls per 1,000 in the age group of 0-6. It means we killed so many

Naveen Jain delivering speech at a DAP awareness programme

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daughters in the womb. There has been a lot of female foeticide in Rajasthan. Now, when you see the child sex ratio or sex ratio at birth, we believe that in last five years a lot of work has been done. In 2021, we are confident when next census will be done, child sex ratio in the State would be one of the best in India. We will be able to show that numbers have improved a lot. We have a rough idea that child sex ratio will be somewhere 925 to 930, that is 37 percent increase of 2011 census at that time. This decade will see an increase in the sex ratio in comparison to last 30 years. It is not due to enforcement but also because of daughters are precious campaigns. Rajasthan will tell the world that daughters can be saved by changing the mindset and it can be changed with public awareness programme. If we explain the youth the logic behind anything and with due examples, they will understand and follow the suit.

Do you feel there is a need to implement such a campaign in many other States in the country as child sex ratio is big issue in some other States as well?

PC-PNDT Act is national act and daughters are to be saved in all States of India. Women and Child Development (WCD) Department of the Government of India has started a programme, Beti Bachao and Beti Padho programme. I think if that programme can be combined with medical and health department, a very good model will emerge out of it. It has started happening in Rajasthan. If WCD along with NHM and PC-PNDT Cell, work for an enforcement and awareness, it will work wonder. It has worked for Rajasthan. If these departments work together with proper strategies, keeping aside the ego, daughters will be definitely saved.

You started the campaign two years ago. Despite many responsibilities and lots of other works, what inspired you to start the campaign to make it a big success in the State like Rajasthan? I got married in 1998 and soon we had a daughter. When my daughter was born, I suddenly decided to appear for the Civil Services Exam, though that was a weird idea at that time. A section of people holds opinion that one

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Launching of ‘Daughters are Precious’ (DAP) campaign on 23 September, 2016 at 2nd Annual Elets Healthcare Summit Rajasthan in Jaipur

can’t explore options after marriage and having children. One goes with normal life and existing career after marriage and all. But I thought to appear for Civil Services Exam. At that time there were very few seats in Civil Services. Still I appeared and cleared the exam to become an IAS officer. Birth of my daughter was biggest reason behind all this efforts. My daughter inspired me. So, I have a special place for daughters in my mind. I think our daughters inspire us to do many good things whether we may acknowledge or mayn’t acknowledge. When I got this opportunity, as a collector, I tried to do my bit. Then, in 2014, when I got the chance at State level, I knew that this was time to make the biggest effort and things worked well too.

The problem is prevalent not only in villages or limited to rural areas only. Even among the urban population and educated class, the issue persists. What is your message to youth set to achieve parenthood soon? This problem is more common in urban areas, among educated and rich families. The issue is because of the preference to have a son. The perception is that a son will take care of the aged parents till their last time. Then there are some social customs of being cremated by son only, some religious taboos and a sense of insecurity about daughters, all these factors are responsible for decreasing child sex ratio. Urban areas are prone to female foeticide. I wish to tell the youth that the Government has lots of expectations from you. You can bring a great change in the society. I appeal to them not to go for sex check-ups. Be it a daughter or son, both are your children. Groom them to become best citizens of India. They should be encouraged and empowered to excel in different walks of life.

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Industry Perspective 16

Rise and Impact of Advanced Imaging Technology

edical technology is undoubtedly indispensable to the health and for improving quality of life of people. It has revolutionised healthcare from almost past three decades, allowing doctors to find disease earlier and improve patient outcomes. In a utopian world, it would have been possible to diagnose, treat and cure patients without causing any harmful side-effects. Since this is not possible today, the efficacy of medical imaging cannot be overstated considering it has enabled doctors to see inside a patient without having to cut them open. It has ensured early detection and treatment for cases such as lung, breast cancers etc. The chances of medico-legal issues too have been reduced due to delayed or incorrect diagnosis. There is some downside linked with the imaging technology. In the present era, the deterioration of skills during physical examination of patients has become much more evident. Conventional ultrasound imaging relies on good contact between the transducer and the skin, using acoustic coupling gel. Without this, the ultrasound beam encounters a large acoustic impedance mismatch between the transducer and the air in front of it, which prevents beam transmission. This limits the use of ultrasound in some clinical scenarios,

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including imaging of open wounds and during surgery, where sterile conditions are required. Now, researchers in Japan have demonstrated non-contact ultrasound imaging, where the transducers are separated from the skin by air. “The project is in its infancy, but the results to date have been very encouraging,” claims Gregory Clement, physicist and lead author of a study conducted at the University of ElectroCommunications in Tokyo. The non-contact technique exploits the greater focusing potential of ultrasound in air. A high beam intensity in air compensates for the low transmission of the beam across the air–skin boundary. The group’s approach uses a bowl-shaped transducer to focus an ultrasound beam on to a 5 mm spot at the skin surface. The spot generates a point source of ultrasound that when scanned over the surface of an object, can be used to perform diffraction tomography.“The method treats the skin surface as a ‘virtual’ transducer, allowing for a large effective number of sources and receivers, thus opening the potential for large regions to be imaged,” claims Clement. “Current medical probes can’t conform to the body, thereby limiting where they can be placed.” The team simulated and constructed a 40 kHz transducer prototype, comprising 400 elements arranged in a hemispherical array.

Dr Rajeev Boudhankar

CEO, Bhatia Hospital, Mumbai

After beam characterization and transmission measurements, they acquired images using the transducer and a broadband microphone receiver. In vivo, non-contact imaging of a hand was demonstrated with a conventional C-mode approach, which produces images for a fixed depth below the skin. The lowrange scan showed varying contrast between the anatomy containing mainly bone and that containing only soft tissue. Clement says that the group will continue the development and clinical testing of the non-contact imaging technique over the next few years. Ongoing work in the lab includes optimising the receiver to increase technique sensitivity and investigating

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There are some other latest cutting-edge imaging techniques that may become popular in the near future. Pocket-sized hand-held ultrasound devices are predicted to replace the 200-year-old stethoscopes in near future. They can diagnose heart, lung and other problems more accurately than traditional stethoscopes. Similarly, Hyperspectral imaging may provide a non-invasive diagnostic method that allows determination of pathological tissue with high reliability. There are chances that this would also lessen doctor’s liability and reduce indemnity insurance premiums. This technology is in use in the defence sector and is now finding applications in the healthcare imaging Industry. A modality called Electromagnetic Acoustic Imaging developed by the University of Oxford has been making use of electro-magnetic and acoustic waves for diagnosis. It helps to identify various types of solid Cancers in the early stages of development. Another technology that goes by the name Wafer Scale Mega Microchip developed by the University of Lincolnis also used to enhance medical imaging techniques. The University says that images that are produced by the chip will enable doctors to detect accurately the effects of radiation on cancerous tumours, thus helping early detection. Besides, there are two other universities – the University of California, Berkeley and the Universidad Autonoma de Madrid of Spain who have claimed to have made the use of 3D Meta material to augment ultrasound images by a factor of 50X. If this technology becomes successful commercially, it would help current ultrasound investigations to capture highresolution images for medical imaging in both diagnosis and interventional procedures. Another claim is by the University

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of Medicine, Berlin and MaxDelbruck Centre for Molecular Medicine, Berlin, who claims that they have produced a technology for capturing images of the beating heart in its MRI systems. They claim the magnetic field of resolution would be 1, 50,000 times the earth’s magnetic field. It would thus aid in clearly demarcating between blood and heart muscle, enabling early diagnosis of cardiac malfunction. Scientists at Japan’s Railway Technical Research Institute, Tokyo, too have managed to develop a palm-size superconducting magnetic system. This would make current MRI System into mobile imaging applications. Iron oxide nano crystal technology is being considered for use in medical imaging. Super paramagnetic iron oxide particles have a variety of applications in molecular and cellular imaging. Evaluation of some of the recent research has concerned cellular imaging with imaging of in vivo macrophage activity. As per the iron oxide nano particle composition and size which influence their bio-distribution, several clinical applications are possible. The use can be checked for detection of liver metastases in cancers, metastatic lymph nodes, inflammatory and degenerative diseases. Research is also on in the field of stem cell migration and immune cell trafficking, as well as in the areas of targeted iron oxide nano particles for molecular imaging studies. Another study that is under focus is that on the ultra small super paramagnetic iron oxide particles that are being researched as blood pooling agents for angiography, tumour permeability and tumour blood volume or steady-state cerebral blood volume and blood vessel size index measurements. 3D bio-printing has undergone seminal advancements in recent times. 3D bio printing is the process

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october 2018

Industry Perspective

faster acquisition techniques to reduce scan times. The ability to visualise processes that take place in the brain during the development and progression of Alzheimer’s disease also provides a powerful aid for diagnosing condition, monitoring treatments and testing preventive and therapeutic agents. With this aim, a research team at the National Institute of Radiological Sciences in Japan has developed a new type of imaging agent that enables visualisation of “tau-protein” within the brain of living patients. In patients with Alzheimer’s disease, tau proteins aggregate together and become tangled, while fragments of another protein, amyloid beta, accumulate into plaques. Tau tangles are not only an important marker of neuro-degeneration in Alzheimer’s disease, but also a hallmark of other neuro-degenerative disorders that do not involve amyloid-beta plaques. While imaging technologies have been developed to observe spread of amyloid-beta plaques within patients’ brain, tau tangles have previously not been easily monitored in living patients. The researchers have now developed fluorescent compounds called PBBs that bind to tau inclusions and can be visualised using positron emission tomography (PET) and optical imaging. They showed that the PBBs could detect tau lesions in a mouse and a living patient. In the clinical PETstudy, PBB revealed a strong signal in the hippocampus of a patient with Alzheimer’s disease, in contrast to PET images recorded usinga beta-plaque tracer. “PET images of tau accumulation are highly complementary to images of senile amyloid-beta plaques,” claims the Institute. This is of critical significance because tau lesions are known to be more intimately associated with neuronal loss than senile plaques.

Industry Perspective 18

of creating cell patterns in a confined space using 3D printing technologies, where cell function and viability are preserved within the printed construct. This technique allows high precision fabrication of biological structures encapsulating cells and bioactive molecules, with applications in areas such as tissue engineering, drug development and bio-sensing. Recent advances have enabled 3D printing of biocompatible materials, cells and supporting components into complex 3D functional living tissues. 3D bio printing is being applied to regenerative medicine to address the need for tissues and organs suitable for transplantation. Compared with non-biological printing, 3D bio printing involves additional complexities, such as the choice of materials, cell types, growth and differentiation factors, and technical challenges related to the sensitivities of living cells and the construction of tissues. 3D bio printing has already been used for the generation and transplantation of several tissues, including multilayered skin, bone, vascular grafts, tracheal splints, heart tissue and cartilaginous structures. Other applications include developing 3D-bioprinted tissue models for research, drug discovery and toxicology. Researchers at Siemens Corporate Technology have developed learningbased software that can identify and section out any organ in any digital medical image, irrespective of occlusions, angle of view, imaging modality, or pathology. The company says that this method can be used to synthesise a virtual high dose CT image from a low dose CT image, enabling reduction of the radiation dose to which the patient is exposed. Siemens has reportedly applied for a patent. The John Hopkins University has developed a procedure for precise characterisation of tumour

october 2018

burden and response to therapy from PET Scans. Although this method is awaiting patent approval, it is known to provide reliable and reproducible PET tumour boundary definition and metabolic tumour volumetric quantification over a wide range of tumour sizes and shapes and for various levels of PET radiotracer uptake. This method will help clinicians in diagnosis, staging and planning of radiotherapy and surgery as well as determining treatment response. It can also help in cancer therapy research. At the Ohio State University, researchers have studied a new method for performing CT-based elastography. This method estimates local displacement of tissue in response to a mechanical stimulus from highresolution images. It can also be applied to hard structures in the body like bone, teeth and cartilage as well as soft tissues. It can also be used to scan patients with pacemakers or metal implants that cannot undergo MR scans. A new technique has been developed by researchers at Philips that determines blood flow velocity. Philips has applied a patent for it. The

method uses ultrasound pulse at one location and the pulse is detected at a second location by an ultrasound receiver. The calculation is then done for flow velocity of blood in a blood vessel between the first and second locations. Barbados-based Synaptive Medical Company has developed a new technique for correcting warping in MR images caused by non-linearities in gradient field profiles. The patent for this new technique is pending. With so many advancements in technology, healthcare delivery has witnessed a tangible progress in terms of patient care. Nonetheless, use of high-end technologies has escalated the cost of quality healthcare facility. A section of people finds it tough to avail healthcare facility at increased price. High-out-ofpocket expenditure has become a big concern. The need of the hour is to calibrate both these factors i.e affordability and costly technologies, to ensure best healthcare facilities to the people at large.

The writer is Dr Rajeev Boudhankar, CEO, Bhatia Hospital, Mumbai

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Industry Perspective 20

‘Artificial Intelligence to be Game Changer in Radiology’ Radiology is transforming as a discipline. Artificial Intelligence is gaining a lot of attention and will be a key enabler for this sector. Digital technologies are transforming the way healthcare can be delivered. At Carestream, imaging innovation is an ongoing process, not a goal, says Sushant Kinra, Managing Director, Carestream Health India Private Limited, in an interview with Elets News Network (ENN).

Give us an overview of your company and its contribution in the healthcare sector. Carestream is a dynamic and global company with more than 100 years of leadership. We are an independent, worldwide provider of medical imaging systems and healthcare IT solutions; X-ray imaging systems for non-destructive testing; and precision contract coating services for a wide range of industrial, medical, electronic and other applications -- all backed by a global service and support network. When thinking of the world’s first proven wireless digital radiographic detector, the first packaged X-ray film, the first medical dry laser imager, or a unique new platform for mobile digital X-ray imaging, healthcare professionals around the world think of Carestream. We are one of the top global providers of digital radiography (DR) and computed radiography (CR) systems, with a track record for innovation, including the DRX family of DR systems – featuring the advanced, wireless DRX Plus Detector, compatible across all our DRX equipment. Our RIS+PACS,

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enterprise workflow, cloud-based services are installed at leading healthcare facilities worldwide.

How are these products and solutions helping the healthcare providers to augment patient care? Carestream has over 600 patents granted worldwide and we are passionately committed to do whatever it takes to help our customers achieve success. Our products are easy to use, highly reliable, and enable our customers to improve the quality and value of their products and services. In today’s rapidly changing environment, where the mandate to provide better outcomes has never been greater, we add value by delivering personalised, affordable and practical options to help our customers advance.

Carestream has been at the forefront of numerous technological advancements in radiology and imaging. What have been its prominent innovative products and solutions for the Indian market?

Sushant Kinra

Managing Director, Carestream Health India Private Limited

At Carestream, Imaging Innovation is not a goal – it’s an ongoing process

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as key stakeholders, have a task ahead to make this vision possible. This opportunity comes with lots of challenges and as always, we, at Carestream, are fully committed to ensure that we make this possible. We see an unparalleled opportunity to meet the growing needs of our customers and are committed to providing the best customer experience with all our products, systems and services.

What are the emerging opportunities and trends in the Indian Radiology and Imaging sector? How is Carestream contributing on this front? Digital technologies are transforming the way healthcare can be delivered. Radiology as a discipline is also transforming. I see that Artificial Intelligence (AI) is gaining a lot of attention and will be a key enabler for this sector. In India, we are also witnessing the transformation of healthcare with the Indian Government announcing various reforms. Ayushman Bharat is a fine example of this. This reform will add more than 40% of the population in the healthcare system towards the path of Universal Healthcare. We,

Industry Perspective

At Carestream, imaging innovation is not a goal – it’s an ongoing process. The Indian Healthcare market is extremely important to Carestream. We are extremely pleased to launch our new innovative MyVue Centre Kiosk for this market. The product has been designed specifically for India keeping our customer’s needs in mind. This is the second product which is specially designed for India. Our first product was Vita Flex, which has been a commercial success. Our new Kiosk addresses a complex issue of workflow and wastage. This product dramatically improves the turnaround time, reduces the overall cost, improves the quality of reporting and adds the convenience to the patient. Another product we are proud to highlight is the OnSight 3D Extremity System. Winner of the 2016 AuntMinnie Minnies Award for Best New Radiology Device this Extremity system offers exceptional potential for diagnostic value and image quality. We are extremely proud to be the innovation leaders in the industry and will continue to invest in the coming future.

How do you see the role of Artificial Intelligence in radiology and imaging? How is Carestream harnessing this technology? Artificial Intelligence (AI) will be a key enabler for the radiology sector. Although there are many debates surrounding it, there is currently some great work happening in this field. If AI picks up the way is it destined, it will surely enhance Radiology and will lead to better patient care. For Radiology and especially medical device companies like us, the biggest advantage is that we are the ones who are generating the data for AI. For example, our Digital X-ray or Computed Radiography equipment converts the analog

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Artificial Intelligence will be a key enabler for the radiology sector. Although there are many debates surrounding it, there is currently some great work happening in this field.

information into digital data, which is what AI uses to process information. This demand for digital information will only increase. We have already launched AI in our Health Care Information System products. With Machine Learning, we will be able to solve complex problems. That’s where we see a huge potential for our company.

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october 2018

Technology Perspective

‘Ethicon Elevating Standard of Care in Sub-Continent’ With tech-enabled solutions, Ethicon is committed to bring tangible benefits to patient care in India. We look at medical procedures with a holistic view by understanding the need from surgeons to develop better products, says Dhruv Kapur, Senior General Sales Manager, Ethicon, Johnson & Johnson Pvt Ltd, in conversation with Elets News Network (ENN).

With a tagline of ‘shaping the future of surgery’, how does Ethicon enables patients to live longer and cherish a more fulfilling life? We believe in pushing ourselves to improve standard of care. Ethicon keeps on improvising so that we can make people’s lives better. Ethicon philosophy, “One Patient at a Time” helps us to focus our energy on single patient at a time. Ethicon keeps on innovating and brings best in class products to the patients. A recent example is our collaboration with Google to form Verb Surgicals where we are working together on robotic platforms of surgery. It will change the way surgery will be done in future. These innovations will not only raise the standard of care for patients but also make lives of surgeons a bit easier. We at Ethicon believe that healthcare is founded not only on expertise but also on the credibility.

Research and evidence, bestin-class education and training, innovative products, are some of the hallmarks of the company. How do these help to elevate the standard of patients care? Ethicon is committed not for just making innovations but also to bring tangible benefits to patient care in India. We look at medical procedures with a holistic view by understanding the need from surgeons to develop better products, training the surgeons

october 2018

and then finding solutions to bring world class healthcare facilities in the market at an affordable range. The idea is to elevate the standard of medical care in the subcontinent. We are committed to build a patient centric environment.

Shed some light over Johnson & Johnson Institute on Wheels. One of our most recent investments has been in the Johnson & Johnson Institute on Wheels – This is an innovative learning delivery model where our institute (in the form of a Volvo Limo) travels to various parts of the country so that students and surgeons in the remotest areas have access to learning on the state of the art instruments. This will in turn help in overall improvement of standard of care in the country. In addition, it will make quality healthcare facility available to people at large.

Tell us about the market opportunity and challenges in the surgery field. There are still a whole lot of people in India who do not have access to quality healthcare. We are confident that the Government’s initiatives like Ayushman Bharat are going to make healthcare easily accessible and affordable to cater people with best medical facilities in their budget.

Dhruv Kapur

Senior General Sales Manager, Ethicon, Johnson & Johnson Pvt Ltd

The biggest challenge lies in reaching the vast demography of population especially people living in remote parts of the country. Each year we aim at penetration to the grassroots level so that we can partner in bringing world class healthcare facilities to the entire Indian diaspora. We try to come up with solutions which better suits people of Indian subcontinent. We conduct various studies to design unique and innovative tech-based solution to enhance level of patient care. Our professional education team works in tandem with the surgeons to overcome shortcomings and become an equal stakeholder in providing world class patient care.

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Technology Perspective 24

Innovations in Radiology for Tumour Therapy

NUTAS is a non-invasive ultrasound tumor ablation system & is an innovative solution where breast cancer patients are treated with HIFU technology. It has an advantage over the surgery as the former is an OPD procedure where patients don’t require hospitalisation at all, share Dr U K Ghosh (M.S.), Dr Sunil Malhotra (MD Radiology) and Ashok Arora, CEO, NUTAS, in conversation with Elets News Network(ENN).

What prompted you to come with such an innovative solution? Ashok Arora has been associated with the manufacturer of NUTAS in China since 2008 during the research, etc. and the CE certificate was granted in October, 2012 and it took two years to set up a NUTAS centre in Delhi, in April, 2014. NUTAS is proving to be a boon to women diagnosed with breast cancer. We have treated more than 350 breast cancer patients in our centre without any recurrence which speaks volume about the curative effect of the technology. It stems from the fact that no woman likes to go through the surgical knives of a surgeon especially when she knows that a technology is available now to treat her in an OPD for 100 percent breast conservancy. NUTAS is world’s first medical device which various surgeons were looking for Breast Conservancy to treat large number of breast cancer patients in India. There were more than 1,65,000 new breast cancer

october 2018

patients registered in 2016 in India.

Kindly brief us about this technology in simple terms which is touted as the safest way to treat benign and malignant tumours in breast. The NUTAS technology is based on a scientifically proven technology known as HIFU i.e. High Intensity Focused Ultrasound. Through high intensity sound waves, the energy is produced which is targeted by 3D Treatment Planning Software on the Malignant tumours. The cancer cells targeted by the ultrasound are burnt completely with real time monitoring by the doctors. No need of surgery here and it results in irreversible coagulative necrosis (Tissue death of cancer cells present in the tumour). It reduces further metastasis in the body. The HIFU technology is already in use in India and various other countries for treating Prostate Cancer and Uterine Fibroids. Various HIFU machines have been installed by Apollo Group of Hospitals for treating Uterine Fibroids but that

Ashok Arora CEO, NUTAS

can’t be used for treating Breast Cancer patients as it has not received the CE/USFDA approval by any other company so far.

What are the advantages of this modern technology in comparison to traditional ways of breast cancer treatment? How it fills in the blank of Ultrasound Tumour Therapy? NUTAS is the only device which fills in the blank of tumour therapy. It

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NUTAS -- A Boon to Breast Cancer Patients NUTAS is an innovation in the field of Radiology and a boon for surgeons & women who were looking for 100% Breast Conservancy to treat malignant tumour in breast and it can treat various solid tumours (benign / malignant) in breast in an OPD. Under local anesthesia by Surgeon and a Radiologist to target the tumour under the guidance of ultrasound color doppler with 3D treatment planning software, a high energy is produced by the sound waves which burns the tissues cell-by-cell, line by- line and layer-by-layer and results in irreversible coagulative necrosis and it is confirmed to the patient after 15 days of treatment. It is ideal to use in early /non metastatic stage and is equivalent to surgery and can be used in other advanced stages as a palliative treatment along with adjutant therapies and research on treating other solid tumors i.e. in liver, kidney, pancreatic and in pelvic area, etc. are under process to treat ( benign / malignant ) in CHINA. Breast cancer is no.1 killer disease in India. NUTAS will eliminate the need of surgery to treat various solid benign / malignant tumours as mentioned above with good ultrasound path.

How a breast cancer is developed? Breast cancer is a cancer that starts in the tissues of the breast and

Technology Perspective

was certified by the European Union in October, 2012 (TUV of Germany), after a long research of more than 12 years, with clinical validations on treating breast cancer patients for which CE0197 was granted. Now a woman can say no to Lumpectomy & Radical Mastectomy for 100 percent breast conservancy and femininity

The Symbol Indicating Stop Cancer

NUTAS is an innovation in the field of Radiology and a boon for surgeons & women who were looking for 100% Breast Conservancy to treat malignant tumor in breast

there are two main types of breast cancer: • Ductal carcinoma starts in the tubes of ducts that move milk from the breast to the nipple. Most breast cancers are of this type • Lobular carcinoma starts from

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the part of the breast called the lobules which produce milk Our MOTO is to reduce mortality rate due to breast cancer. If Indian Government can eradicate Polio from India then together we can reduce the mortality rate due to breast cancer by early detection and treating with NUTAS and it is in women’s hands only. Diagnosing Breast Cancer With regular breast self examination from the age of 20 years onwards once in a month, four-five days after your periods or on a fixed date every month for the detection of any lump or any other abnormalities, etc. Screening with SonoMammography for any lump, etc. as there is no radiation from ultrasound and it can locate a lump within the dense breast tissue as well. Ultrasounds are now available all over India in various private and government clinics, etc. for diagnosis as compared to Mammography X-ray machines. An ultrasound can also be extremely useful in helping the radiologist interpret a mammogram on both Fluid (A cyst) and Solid Tissue(A Tumor )appear the same

eHEALTH Magazine

october 2018

Technology Perspective

( White). Using ultrasound, the radiologist can look more closely at the white area and determine if it is a cyst or Solid Tissue. Together we can conquer breast cancer if it is made compulsory by the State / Union Government that every woman of over 20 years at least must have Ultrasono Mammography or Whole Body screening for any tumours to be located at least once in three to five years so that any tumour developing in the body can be further investigated and we can definitely catch the disease young enough to be treated by HIFU technology, as HIFU will replace surgery in this very centaury itself for various tumours to treat in OPD. PROMISING RESULTS ON BREAST CANCER STUDY WITH HIFU Dr Alessandro Napoli, M.D., Ph.D., assistant professor of Radiology at Sapienza University in Rome, presented the results of his study involving 12 patients with invasive ductal breast cancer. All patients were treated with FUS, and post-treatment, histological evaluation confirmed the absence of residual disease in the treatment area in 10 patients. Though this study is part of early stage research, Dr Napoli is hopeful that focused ultrasound will one day be a treatment option for women with breast cancer. The Doctors at Churchill Hospital in Oxford (Radcliffe Hospitals NHS) where Professor Sir Peter

october 2018

Morris, President of Royal College of Surgeons say Breast cancer patients’ lumps could instead be “zapped” with ultrasound, sparing them the trauma of breast removal. NUTAS is a Cancer Treatment of 21st Century Imagine being treated for cancer in an outpatient setting with no hospital stay, no surgery, no incision, no radiation, no side effects, no dysfunctions of limbs & organs (equivalent to surgery). It is a one-time treatment cost for the patients to go through, avoids the costly expenses of treatment of surgery, Palliative Radiation therapy and reconstruction cost of breast as it is a trauma for a women to live without her most precious organ, the breast. HIFU treatment has no side effects or any damaging side effects than conventional treatment with surgical procedure. HIFU can be used along with chemotherapy, radiotherapy, hormone & D.C. therapy, etc. for complete cure. HIFU replaces the need of surgery and is non-invasive.

How do you see the role of HIFU and robotics in the field of Radiology and Imaging? NUTAS is world’s first Robotic Remotely Operated Super Beam Ultrasound therapy which will soon replace surgery in treating various solid tumours in liver, kidney, pancreas, lungs, bone, brain etc. Clinical trials are going on with

Risk factors due to breast cancer are Lump change in size, Dimpling of the skin, A change in shape of nipple or Discharge, rash/ridges/pitting of breast skin ,Swelling or lymph nodes in the armpit, Low Vitamin D- levels

NUTAS system in China and other countries. No other companies have claimed till date that they too can treat breast cancer patients with the HIFU technology. Risk factors due to breast cancer are change in lump size, dimpling of the skin, a change in shape of nipple or discharge, rash/ ridges/pitting of breast skin, swelling or lymph nodes in the armpit, low vitamin D- levels, lack of exercise/ yoga,etc. Visit www.nutas.in.

Are you working on some other innovative technologies? Our team of doctors has taken exhaustive training on Echolaser which too is World’s1st Ultrasound Guided Percutaneous Fibre Optic Nd-Yag Laser 1064nm Wire Ablation System which can treat various solid tumours Benign / Malignant in Liver, Kidney, Pancreas, Lungs, Thyroid, Bone Tumor, Metastatic Lymph Nodes & Bile Ducts for a minor O.T. with or without local anaesthesia. For more information, visit: www.elesta-echolaser.com

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Technology Perspective

Fujifilm — Making India Future Ready in Diagnostic World With digital mammography and Synapse PACS (Picture Archiving and Communication System) like system, Fujifilm has carved its niche in radiology and Imaging field. It is committed to augment Indian healthcare delivery system enabling people to avail best patient care, says Chander Shekhar Sibal, Executive Vice President, Fujifilm India Pvt Ltd for Elets News Network (ENN). radiology for immediate reporting.

Chander Shekhar Sibal

Executive Vice President Fujifilm India Pvt Ltd

Fujifilm is one of the leaders in diagnostic imaging and information systems. How do perceive its contribution in Radiology and Imaging sector? Our products are best in terms of image quality. The major distinction is quality and reliability of our products. We have CR (computed radiography), DR (digital radiography) and digital mammography and Synapse PACS (Picture Archiving and Communication System). We have over 1,20, 000 CR systems installed worldwide. In India alone, we have 30,000 CR & Imagers installed. We have done digitalisation of X-Ray rooms across nook and corner of India through PPP with KRSNA in Assam and Himachal Pradesh and these sites are connected through tele-

october 2018

Shed some light over Synapse Enterprise PACS. What latest innovations have been made on this front? FUJIFILM Synapse is our onestop shop. With an integrated mammography, RIS and PACS solution, high end FDA approved 3D post processing applications cater to entire hospital departments right from Radiology, Cardiology, Surgery, Orthopaedics, Neurology, Urology, Dental and Maxillofacial, Podiatry, Forensic Science for Virtual autopsies. We have fully trained clinical and dedicated IT professional’s support team. Fujifilm offers a comprehensive approach to PACS customers. Synapse product range have very unique feature which enables Multi Site hospitals and diagnostic centres to use the interconnected workflows and imaging needs. Tele radiology comes as a default component in our Synapse PACS RIS offering. Fujifilm provides obsolesce protection for software under CME which is one of the best attributes of our approach.

What have been your innovative products and solutions on Radiology and Imaging front? Fujifilm India Pvt Ltd, a pioneer in the development and application of imaging and information innovations to healthcare technologies, partnered with different institutes all over India

for the installation of its 50 Micron 3D Mammography machine Amulet Innovality, a highly advanced breast cancer diagnostic machine that has made early detection of breast cancer a reality for women. Fujifilm’s FDR Smart F is a highquality Digital Radiography system. It delivers a user-friendly smart workflow for busy imaging centers. This flexible DR solution saves space and simplifies installation costs by eliminating ceiling height requirements and construction costs associated with overhead / ceilingmount x-ray systems. The ‘Fujifilm FDR Smart F’ features an ergonomically designed floor mounted tube stand to provide lighter and smoother movement for faster, more efficient workflow. It offers a choice of a four-way floating tabletop and a six-way elevating table, making it flexible for patients of all shapes and sizes. A wide variety of exams can be performed using the optional tilting wall stand. Non-ambulatory patients can be easily imaged in the seated position. The unique rotation bucky design helps avoid the risk of Flat Panel Detector drop-off and the rotating bucky also helps to image the patient horizontally or vertically (in chest bucky) and longitudinally or tranverse manner in the table, with a 14 x17 detector itself without the need for 17 x17 detector. The Grids also can be easily removed to meet different

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Give us an overview of recently launched product ELUXEO 7000 Series for early detection of gastrointestinal (GI) cancer. Early detection is the key to tackle any sort of cancer. If detected early at the first or second stage, the patient can be treated cost-effectively. Early detection increases patient’s life span but if it’s third or fourth stage detection, the cost of treatment goes very high, even the problem turning fatal at times. In India, major problem is late detection. Over 50 percent patients die within a year of cancer detection in India due to late detection. Here, we have new technology for targetted biopsy and early alarm. Up to a certain level treatment is possible if cancer invaded up to submucosa (second layer of gut wall). We recently launched a red dot awarded design Endoscopy system (ELUXEO – 7000 series), a first of its own kind of system in the area of flexible endoscopy loaded with four different coloured LED lights (blue,

blue violet, green, and red). To get white light all lights are channelised in single path (the technology called as multi -light), lights play vital role here. We take short/narrow wave length light to get micro surface pattern, BLI & LCI are unmatchable feature allows clinician to detect the growth early, which helps to save the life. We are into the very high-end systems with very high resolution scope with (Blue Light Imaging - BLI) and linked colour imaging (LCI). These systems go inside the body and give high resolution images to detect cancers at very early stage. This is useful for all types of gastro cancers including stomach cancer and colon cancers. Then we have CR system. We have a range of systems to detect cancers at an early stage. Not only that, after screening, advance detection, staging comes, we have endoscopic ultrasound system developed by FUJIFILM in-house with the best EUS scopes with shorter rigid portion reduce patient trauma, allow doctor the ease of working and maneuverability.

Why Fujifilm’s Amulet Innovality at several healthcare centers across the country is viewed as future of mammography? Fujifilm’s advanced tomosynthesis technology reveals the internal structure of the breast, simplifying the detection of lesions that gets overlooked in a routine mammography. Fujifilm is focusing on the Full Field Digital Mammography market and taking proactive steps to improve the early detection rate by conducting symposiums and spreading awareness. FFIN conducted a symposium in Delhi with Batra Hospital, Mumbai with NM Medical Center, Chennai with SRMC, Kolkata with Peerless Hospital, Vishakhapatnam with Vijaya Medical Center, Shimla with Indra Gandhi Medical College and Aurangabad with Government

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Overall, Fujiflm’s FDR Smart F is a great DR solution that offers efficient workflow and throughput with excellent Image Quality without any compromise and can suit different budgets and requirements of customers.

Technology Perspective

exposure requirements. The system offers host of advanced features like Automatic Exposure Control (AEC), DAP, Image Stitching, Cassette tracking, tilting wall bucky etc. so that customers can choose the features based on their requirement. The High Frequency Generator (40 / 52 / 68 / 82KW Variants) offers accurate power output. Depending on the customer budget, they can choose single or dual detector configuration with options of CSI / GoS Detectors. The Detector size (like 14 x 17 or 17x17) and wired / wireless configurations can be customised flexibly as per the user requirement. Fujifilm’s renowned digital image processing expertise, including Dynamic Visualisation, optimises image display based on recognition of contrast levels throughout the entire exposure field.

Medical College followed by press conference to generate the awareness about the cause. As part of ongoing effort to generate awareness about this cause, we have tied up with Pinkathon (women marathon) as a “Wellness Partner” and educate women how early detection saves life. We are installing mammography units in mobile vans to generate the awareness to the masses and screening women with potential risk of breast related diseases, e.g. Indian Cancer Institute at Delhi. To generate awareness, we also conduct patient awareness programmes in association with hospitals like Tata Memorial Centre ACTREC, NM medical Mumbai, Action Balaji Cancer Hospital Delhi, SRMC Chennai, Shankra Cancer Hospital Bangalore. We also launched the clinical case study book on digital mammography titled “Identifying Breast Cancer with 3D Tomosynthesis” written by Dr Shilpa Lad from NM Medical Mumbai.

eHEALTH Magazine

october 2018

PPP Initiative in Rajasthan 30

Empowering Healthcare Through Technology and Innovations A ccording to 2011 Census, Rajasthan had a population of 68.6 million, of which three-quarter live in rural areas. The State has a poverty level of 24.8 with infant mortality rate (IMR) 41, (National Family Health Survey -4 2015-16) and the maternal mortality ratio (MMR) 208 (Annual Health Survey -2012-13), which are above the national average. With poor socio-economic conditions, primary healthcare is a challenge in a geographic terrain like Rajasthan. Public health experts opine that while significant global resources have been focused on eliminating specific diseases like Polio, HIV/AIDS, TB and Malaria, relatively little has been done to strengthen primary healthcare in an integrated manner. The humble journey of WISH began with a vision to work towards improving the quality of primary healthcare services and access to these services for the under-served communities in India. WISH is implementing healthcare models through partnership with the State Governments, international agencies and the private sector by appropriately introducing promising healthcare innovations in the public health system in order to build an equitable, innovation-led and evidence-based quality healthcare system within easy reach of the underserved populations. WISH curated a unique innovation-led model to transform the under-performing Primary Health Centres (PHCs) into performing health and wellness centres in Rajasthan. The facilities are implemented through Public Private Partnership in lagging behind districts, located in remote areas, with difficult geography, high levels of poverty and poor health indicators. The foundation is operating in 14 districts with 24 rural PHCs and 99 sub-centers and 7 Urban PHCs. These centers are fully staﬀed with doctors, attendants, auxiliary nursing midwifery (ANM), general nursing midwifery (GNM) and other health workers. The centers are equipped with high-end medical services and technology, with well-maintained government-supplied pharmaceutical drugs and assured

october 2018

availability of healthcare services. While these health centers are equipped to treat and serve patients with all kinds of medical conditions, the main focus remains on family wellness, maternal and childcare and preventive and promotive healthcare.

WISH has been providing comprehensive healthcare services and sustained quality services since early 2015. Few achievements • The average out-patient volume of rural PHCs surged from 924 per PHC per month in 2014-15 to over 1,700 in 2018-19 and the average Institutional delivery per PHC per month increased by 60 percent during this period. • July 2015 to June 2018, the WISH-managed PHCs/SCs have provided OPD services to 19,57,720 patients and conducted 12,952 institutional deliveries. • Child immunisation indicators are improving along with ante-natal and post-natal visits.

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neonatal, child health and nutrition (MNCHN) and geriatric healthcare services round-the-clock, with referral and transportation mobility. Improvement in the health seeking behaviour by the community it serves, improvement observed in the knowledge and awareness on general communicable and non-communicable diseases. • Acceptability & Affordability: No social and cultural barriers amongst the community members in accessing the services. • Equity: Fair access of healthcare services by all segments in the community for a good healthy life irrespective of their economic and social status.

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IQVIA an external evaluation agency, with support from USAID conducted an“Evaluation of the Rural Model of Primary Health Centers in Rajasthan”. After having upgraded the worst-performing healthcare centers handed over to WISH in 2015, the evaluation was conducted on these centers against the well-performing healthcare centers run by the Government. The report revealed the effectiveness of the transformed healthcare centers which WISH was able to bring about through its innovations and technology-led services – The report reinforced the evidence- based work WISH has demonstrated on field, strengthening Primary healthcare services in Rajasthan. WISH aligns itself to the vision of National Health Policy 2017 (NHP2017) which calls for “comprehensive primary healthcare package which includes geriatric health care, palliative care and rehabilitative care services’ and these ‘facilities will be called Health & Wellness Centers’. The organisation began its work early this year, by transforming the existing Primary Healthcare Centers (PHC) into Health and Wellness Centers (HMW) in the region. WISH one of the first few organisations propelled its efforts in this direction “I envision WISH to contribute 100 Health and Wellness centers across Rajasthan, Madhya Pradesh, Uttar Pradesh and Assam by end of this year to support the grand vision of the government on Ayushman Bharat” said Sunil Wadhwani, founder of WISH Foundation in an interview. 11 centers and sub centers have already been transformed in Rajasthan. These Health and Wellness centers (H&WCs) not only connect the patients of hard to reach areas to a doctor through telemedicine via internet it also has a dispensing machine attached to dispense the medicines prescribed by the doctor at another location. WISH continues to service and excel and through its work and establishing H&WC aims to bring in – • Accessibility: Quality healthcare services to the population without access to doctors or medical services for approx. 200 diseases at HWC level covering maternal,

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PPP Initiative in Rajasthan

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eHEALTH Magazine

october 2018

PPP Initiative in Rajasthan

• Evidence: Ready to use disease profile of the population being served by HWC and assessment for framing appropriate policy and investment of public investment/ resources, reduction of the case load at PHCs, district hospitals and tertiary care facilities – also reduction in public sector expenses on these facilities • OOPE: Reduction of out-of-pocket expenditure, patient’s satisfaction and improved health. “I thank ELETS for awarding us with ‘Exemplary Service in Primary Healthcare in Rajasthan’, I would like to take this opportunity to thank all our partners who supported us in this dream and hope to continue the good work and achieve the grander vision for Healthy India,” said Rajesh Ranjan Singh, Chief Operating Officer, WISH Foundation.

By empowering our work and connecting populations with comprehensive healthcare services innovations are core to WISH work and have played a key role in making the Scale Rajasthan Programme a success. The organisation continues to introduce innovations in the field and piloting new innovations to bridge the healthcare service delivery gaps. These Innovations have been life savers – “I am grateful to this innovation SuCheck as I always believed I can’t have diabetes. This was a boon to me diagnosing the problem at right time and saving my life. Had I not gone for this check by now I could been surrounded with many health challenges. Me and my family would like to thank WISH Foundation for all the good work they are doing and help save my life,” Siddiqui,

october 2018

sarpanch (Deputy head of Village) of village Kondli Nadi, District Sawai Madhopur, Rajasthan. “Me and my child were saved because of Janitri as I never thought of any complications and believed will have a normal delivery. I owe our lives to WISH and all the good work they are doing,” Kavita from village Sobda, District Sawai Madhopur. “My ultimate WISH for WISH Foundation is to have a healthy India@80. Our goal is that by the end of 2027 when India turns 80 years young, that because of WISH interventions, at least 100 Million families have access to quality primary healthcare; two million families stay above the poverty line; one million pregnant women’s lives are saved; 50,000 infant deaths have been averted; and that we will have piloted 50 healthcare innovations,” said Founder Donor Sunil Wadhwani. Having more than nine million lives reach, WISH continues to work towards its vision to reach the goal as envisioned by the founder donor Sunil Wadhwani and continues to expand its work in other states like Assam, MP, UP, Chhattisgarh and Odisha apart from Rajasthan and National Capital Territory of Delhi, where WISH is the Knowledge Management and Technology partner for the Government of National Capital Territory of Delhi’s (GNCTD) Aam Aadmi Mohalla Clinics Programme (AAMC) providing technical assistance for eﬃcient management of the clinics and facilitates partnerships with a variety of private players and innovators jointly identiﬁed with the GNCTD. Furthering its steps, WISH has partnered with the National Health Mission, Government of Madhya Pradesh, to provide technical support to improve the health outcomes and assist in strengthening Health & Wellness Centre (HWC), non-communicable diseases, urban health, RMNCH+A WISH is also partnering with the Amalgamated Plantations (APPL) Foundation to improve maternal and child health outcomes in the PHCs of the tea garden estates in upper Assam for 1.5 lakh population in the 25 tea estates. This is a network of 25 PHCs and a 75 bed referral hospital at Chubwa. As a way-forward WISH aims to establish Urban Model of Health & Wellness centers across its working states, play a pivotal role as Technical Support Partner in Urban Health & HWC, build in Artificial Intelligence as a tool to strengthen primary healthcare.

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Technological Trends

Radiology and Changing Facets of Technology

T Dr Akther Syed

Consultant and Incharge Radiology and Imaging, Nayati Medicity, Mathura

october 2018

he modern-day advancement has also influenced radiology. About 20 years ago, radiology was limited to X-rays. But over the years, conventional procedures have witnessed tremendous change for the better, leading to enhanced experience of treatment for millions of people across the globe. Of the most recent achievements, the prominent ones can be mentioned as -- Digital Radiography and Digital Mammography, Ultra sonography, Remote viewing system, CT Angiography, Replacement of Exploratory Surgery, etc.

Digital Radiography and Digital Mammography Digital radiography has tremendously improved the X-ray quality, speed and replaced all the boring dark room procedures, as these can be shared immediately for speedy diagnostic results. The conventional X-ray used to take about half-an-hour for whole procedure while the digital radiograph can be acquired with just a click of a button while delivering a far better quality. USG: Ultra sonography works on the principle of getting echo from reflected sound waves. It has advanced

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Remote viewing system Radiology has advanced immensely over the years but the sad reality is that in India and many other countries a lot of people don’t have access to basic radiological procedure. Kenya with a population of 43 million has only 200 radiologists. In rural Nepal, there are places where people travel almost two days for getting X-ray. In that part of the world, machines are often outdated models and are the ones that have been donated. Web-based systems allow physicians to send and access images and reports from all over the world. CT Angiography Traditional angiography takes

several hours, requires sedatives and can even cause damage to vessels. But CT- Angiography takes 10-15 minutes without such risks. It can be used to image any artery in the body including brain, coronary, lung, kidney etc. with recent advances in CT angiography. It gives a picture which is three-dimensional and is like actual arterial system in our body and is very friendly for clinicians to see the pathology. Replacement of Exploratory surgery CT scan reduces negative appendectomy. It is very important in trauma patient where decision has to be taken from CT irrespective of the patient needs surgery or not. So reducing trauma caused by surgery and saving a lot of patients’ expenditure done on unnecessary surgeries. MRI MRI plays a crucial role in detecting pathology at its earliest. In stroke patients, it can detect the changes seen in Acute infarcts (a small localised area of dead tissue resulting from failure of blood supply) at its earliest.

Radiology has advanced immensely over the years but the sad reality is that in India and many other countries a lot of people don’t have access to basic radiological procedure

Technological Trends

tremendously over the years from 2D to 4D images and remote viewing systems of the present day. USG is very important imaging modality. It’s different from other imaging modality as it is real time and safer, as it does not involve radiations. USG has also advanced over the years with dopplers, guided needle placement elastography and many more.

Recent advances in MRI like spectroscopy magnetisation transfer and functional MRI plays a crucial role in deciding the management and type of therapy. MRI is radiationless and gives very accurate and minute details of pathology. PET – CT Positron emission tomography continued with CT scan images provides easy detection of even small tumours and metastatic information and also provide metabolic status of tumour as physicians get a better idea of what is going on and how to properly treat it and also help in monitoring chemotherapy. In brief, Radiodiagnosis has tremendously improved over the previous years. New technologies and better practices have made the field safer, less expensive and more efficient. (The writer is Dr Syed Akhter, Consultant & Incharge, Radiology and Imaging, Nayati Medicity, Mathura. View expressed are a personal opinion.)

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october 2018

Technology perspective

Artificial Intelligence’s Role in Tele-Healthcare

Surendr Singh

Senior Manager, Telemedicine Department, MGUMST, Jaipur

october 2018

echnology is fast making inroads in every sphere of life. The biggest example is the existence of computers. Thinking of leading the life away from computers’ influence may be unfathomable at least in cosmopolitan cities. We have been familiar to computer’s definition as “a machine or device that processes, calculates and operates based on the instructions provided by the software or hardware program”. But what if we find this machine is learning, understanding and determining things or issues on its

own based on the given data. Yes, one such computer or machine that makes an intelligent decision based on the given data is Artificial Intelligence or Machine Learning. In fact, artificial intelligence (AI) is a smart way to think computer-controlled robots or software, like intelligent people think. Whenever we buy or search online products on Amazon, the software owner sees a number of options in front of our screen according to the search. As well as, “you can like it” gives a long

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“A fast medical treatment system can save lives, and Artificial Intelligence is already doing its job.” While talking about health, artificial intelligence (AI) relations are also being prepared for a very important role to improve results in healthcare sector.

Also, the AI is being used for medicine manufacturing. It also predicts the side effects of different drugs. Medical professionals are often trained with artificial surgery simulators. AI is being also used to help clinical decisions in radiology. Cardiology and dermatology image recognition and speech recognition technologies have been upgraded by these forms of AI. Pediatricians are collecting data about children’s cough, software is being developed which will identify the disease according to a recorded cough sound. Due to the shortage of financial and medical resources, telemedicine can be a costeffective and better solution to provide medical facilities in remote areas of India. “Demand for telemedicine treatment is increasing in the world, So global health companies are increasingly moving towards the AI to reach the medical system to as many patients as possible.” Some companies have been working on developing efficient and intelligent software by

AI is being also used to help clinical decisions in radiology. Cardiology and dermatology image recognition and speech recognition technologies have been upgraded by these forms of AI

Technology perspective

series of results related to that search. It is an example of artificial intelligence. Today, artificial intelligence has become an integral part of our life. It is found everywhere even in the form of “siri” of apple or “virtual personal assistant” of Android. When we use our smart mobile phone, if we are logged in with Gmail, Google always keeps an eye on us. Google uses a machine language that compiles with any mobile application of the company, tracks user location, email, Google Chrome’s search option. Google knows what we are looking for on the Internet, what is our choice, Google keeps on watching all user’s information in combination with the user’s Mac ID and temporary IP address. And, based on all of these data, it gives results according to our interest.

analysing the various medical data of the patients, which may act as a virtual doctor system. It is a basically an artificial intelligence based expert system. The AI can advise the physician to determine which medication is to be tried or what treatment should be attempted. Because of Artificial Intelligence based on a self-learning system, makes physician more and more accurate. As a result, more and more patients can get appropriate treatment what they really require and on time. Its function is to diagnose the correct illness by analysing the symptoms described by patients, as well as to provide appropriate treatment for patient welfare.

Disclaimer: The Writer is Surendr Singh, Senior Manager, Telemedicine Department, MGUMST, Jaipur. Views expressed are a personal opinion.

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october 2018

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4thAnnual

2nd Annual

Precious Daughters of inDia AWARDS

28 September 2018,

a special report

october 2018

[ ehealth.eletsonline.com ] The Largest Portal on Healthcare Innovations in Asia and the Middle East

of inDia AWARDS 4thAnnual

28 September 2018,

& special report

Rajasthan Health Minister Kali Charan Saraf, State Health Minister Banshidhar Khandela, and MD, NHM & Secretary Health, Rajasthan Naveen Jain, Inaugurating Elets Healthcare Summit in Jaipur

When Rajasthan deliberated upon best practices in healthcare To delve into recent innovative practices in healthcare ecosystem, 4th Annual Healthcare Summit Rajasthan & Precious Daughter of India Awards was organised in Jaipur recently. Organised by the National Health Mission, Department of Medical, Health & Family Welfare, Government of Rajasthan along with Elets Technomedia, the healthcare festival confluenced policymakers, international experts and industry leaders to deliberate upon conducive policies and reaching out to people on the lastmile with healthcare services, its challenges and opportunities. The discussions also involved significance of technology and modern-day innovative solutions for healthcare. Inaugurated by Kali Charan Saraf, Minister for Medical, Health & Family Welfare, Government of Rajasthan, the conference witnessed one of the finest congregations of top luminaries of the healthcare world from across India. Other important dignitaries including Banshidhar Khandela, State Minister, Medical, Health & Family Welfare, Government of Rajasthan, Naveen Jain, Mission Director, National Health Mission and Secretary, Medical Health and Family Welfare, Government of Rajasthan, were also present at the Summit. They spoke about innovative healthcare practices in the State. Various enlightening sessions including ‘Public Private Partnership for Affordable Healthcare Delivery’, ‘Best Healthcare Practices and Innovations across the Nation’ and ‘Significance of Quality Healthcare and Quality Medical Education for Developing Healthcare Ecosysytem’ were organised at the conference in September. A special issue of eHealth Magazine, which has been highlighting the role of ICT in healthcare ecosystem for about 15 years, was also unveiled on this occasion by the Rajasthan Health Minister Kali Charan Saraf. Women from different walks of life were also felicitated with Precious Daughter of India Award for their exemplary contribution to the society on this occasion. Here is a glimpse of the Healthcare Summit Rajasthan:

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October 2018

of inDia AWARDS 4thAnnual

special report

28 September 2018,

Inaugural Session

Kali Charan Saraf

Banshidhar Khandela

Minister, Medical, Health & Family Welfare Government of Rajasthan

State Minister, Medical, Health & Family Welfare, Government of Rajasthan

We must appreciate the efforts of our incumbent Government in the area of healthcare sector. There was a time when Rajasthan was considered as a ‘Bimaru State’. Today, it is among developed States in terms of delivery of healthcare services. 20,000 paramedical staff and over 6,000 doctors have been appointed by the State Government to strengthen healthcare delivery across the State. In Rajastahn, we have over 17,000 Government healthcare facilities including PHCs, CHCs and District healthcare centers. We have decided to turn PHCs into ideal healthcare centers equipped with all required medical facilities.

Under the visionary leadership of our Chief Minister Vasundhra Raje and NHM Director Naveen Jain, Rajasthan has done a fabulous job in making healthcare accessible, affordable and cost-efficient. The State has taken a giant leap in women and child care. We have also improved sex ratio from 888 to 950 in four years, implemented 100 percent of the budget announcement. Percentage of institutional delivery has also increased to 80 to 90 percent. The State has successfully implemented PC-PNDT Act, under which many culprits have been sent into jail.

Naveen Jain

Mission Director, National Health Mission & Secretary, Medical, Health & Family Welfare, Government of Rajasthan

Rajasthan has been at the forefront of healthcare innovations. I can vouch that no concept appears to be new for Rajathan now. However, the scope of improvement always remains. The Rajasthan Government has always encouraged and supported innovative ideas. We have worked on both IT and non-IT innovative ideas to improve healthcare delivery across the State. The major reason of our success in healthcare is because of unflinching support of the State Government which bolsters our morale to do wonders in healthcare sector.

october 2018

Dr Kinny Singh

Mission Director, National Health Mission and Special Secretary, Government of Arunachal Pradesh

Arunachal Pradesh is gradually striding ahead in terms of providing efficient healthcare services to citizens of the State. We have recently launched a health insurance scheme, Chief Minister Arogya Arunachal Yojana, which will provide health insurance cover to all citizens of the State. To empower the district health societies, the State is providing a special flexi fund known as ‘Rogi Kalyan Kosh’. We have started State’s first medical college recently. It will help us to reduce staff resource crunch in the State. Model rural health research unit is also underway.

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Elets CEO Dr Ravi Gupta, delivering vote of thanks at Elets 4th Annual Healthcare Summit Rajasthan

Presentations on Healthcare Innovations

Dr Bulbul Sood

Vishal Mahajan

Country Director, JHPIEGO

Director -Sales Ethicon Johnson & Johnson Pvt. Ltd.

The objective of Asman was to reduce neo-natal and maternal mortality through innovative facility-based interventions. That enabled us to provide quality care during and immediately after child birth. As most deaths take place during child birth, quality care needs to be provided to both mother and newborn. In Madhya Pradesh, we are working in 42 facilites while in Rajasthan 39 facilites. We are providing technical assistance to the Government.

We have partnered with baby centers to launch m-Mitra which is training or giving advise to pregnant women. These are voicebased calls meant for women in rural areas, to tell them about the phases of pregnancies and precautions that needs to be taken during that time. We have MoU with the Government of Maharashtra and NIPER. We also worked with the Central Government for the eradication and supply of medicines for TB. We recently started institute on wheels which helps to train healthcare professionals in rural areas.

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Panel Discussion: Public Private Partnership for Affordable Healthcare Delivery

Rajan Vishal

R K Srivastava

Additional Mission Director, NHM, Department of Medical, Health & Family Welfare, Government of Rajasthan

Senior Advisor, Innovations for Public Health, Lords Education and Health Society (LEHS), WISH

It is compulsory for the Government to forge collaborative partnership with private partners and devise new innovative models to reach out to the people at large. For PPP model to be successful, collaborative relationship between partners is needed. Objectives and the terms and conditions should be clearly laid out. In Rajasthan, PPP model has worked well in the area of diagnostics, MRI services and other services. The model has made available good diagnostic services at affordable rates to general public.

Rajasthan is a rich State as far as PPP partnership is concerned. WISH is also having a good experience in such type of practices delivery modes. The footfall has increased, quality has increased, and the utilisation of services has also increased. The loading of primary health centers has decreased, and overall, there is an improved health outcomes. Wish foundation has got operation in 24 primary health centers and 100-plus subcenters in the State.

Dhananjay Kumar State Head GVK EMRI, Rajasthan

GVK EMRI is an example of PPP model. We started this journey in 2005 from six ambulances in Andhra Pradesh. Today, GVK EMRI is counted among worldâ&#x20AC;&#x2122;s largest service providers . We have 11,000 ambulances and are providing services in 17 States.

(L-R) Dr Bulbul Sood, Rajan Vishal, Vishal Mahajan, R K Srivastava, Dhananjay Kumar

october 2018

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Panel Discussion: Best Healthcare Practices and Innovations Across the Nation

Dinesh Kumar Goyal

M V Padma Srivastava

In medical field, there are a lot of things a country and the State like Rajasthan desires. Biggest challenges is to make healthcare delivery accessible to people especially to rural population. Despite having facility of all kinds of infrastructures like PHCs and CHCs, the very availability of doctors, medicines, equipment and timely delivery is still in poor state. PPP is the hope with which infrastructure and facilitiess could reach in rural areas. Successful model should be replicated across country.

We are facing challenges of both communicable and noncommunicable diseases like cancers, heart attacks, lung diseases and strokes. Every 20 seconds someone is having strokes and every two-minute someone is dying of strokes in India. Strokes are no longer limited to old people. Healthcare needs to be made optimal-available, accessible and affordable. It is not possible to tackle all brain attacks cases by neurologists as we have very few such experts; 2,000 only. We need someone who can provide golden-hour treatment in emergency.

Former Additional Chief Secretary Government of Rajasthan

Professor of Neurology AIIMS, New Delhi

Ashish Modi

Dr Manoj Kumar Shukul

Joint CEO, State Health Assurance Agency Government of Rajasthan

General Manager, AYUSH, State Programme Management Unit (SPMU), NHM, Government of Uttar Pradesh

Bhamashah Swasthya Bima Yojana is completely cashless scheme, providing an insurance cover of Rs 3.3 lakh per family for IPD treatment. It covers pre-existing illness also. Under such kind of schemes, the innovation lies in providing systematic support. Good practices have to be well-defined. Like Ayushman Bharat, we have private empanelled hospitals for providing quality healthcare services.

We were facing big issue of HR. We were not having required experts i.e gynecolosists, anesthetist, paediatricianss and all. So, we started a bidding model under which we decided to provide an honorarium of Rs 2.5 lakh. The objective was to attract experts to provide best healthcare services across the State. We are also running scheme â&#x20AC;&#x2DC;Sampoornaâ&#x20AC;&#x2122; for screening of cervical and breast cancer. We have facility of eHospital and telemedicine as well.

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Prakash Vir Rathi

Deputy General Manager and Regional Head Bank of Baroda, Jaipur

Health and wealth, both are very important for any country. Wealth can only be earned by ensuring good health. NHM Jaipur is doing splendid work in transforming healthcare delivery system across the State. The objective of good health can only be achieved by ensuring health of mother and child. We should allign our healthcare delivery system to give significant importance to this dimension.

(L-R) Dr Manoj Kumar Shukul, M V Padma Srivastava, Dinesh Kumar Goyal, Dr Kinny Singh, Ashish Modi, Prakash Vir Rathi

Panel Discussion: Significance of Quality Healthcare & Quality Medical Education for Developing Healthcare Ecosystem

Namit Soni

CEO Soni Group of Hospitals

We have implemented largest PPP project in India where we are doing more than 700 CT scans and MRIs. We are having 24-hour of reporting and having more than 16 radiologists associated with us. For quality, we definitely need a robust system but volume or the number of patients actually help us to improve quality during delivery of patient care.

october 2018

Dr Deepak Yaduvanshi Chief Advisor Manipal Hospitals

We have 18 commandants at group level which covers white range of processes which are critical to the care of patients. This starts right from the time of the patientsâ&#x20AC;&#x2122; entery into the system till delivery of services take place i.e lab investigation or radiological investigation and off course the outcome. This is the high-time we should move beyond the NABH/ NABL. We have to come up with our own intrinsic workable model which can be monitored and evaluated properly.

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Dr Pankaj Dhamija

Dr K M Bhandari

Quality in healthcare comprises three pillars i.e our patients, staff and the healthcare providers including hospitals. All three have to be taken care of so that patients get best care. Patientsâ&#x20AC;&#x2122; satisfaction is utmost important.

Mission of every healthcare system should be to provide quality healthcare at affordable price. Quality has to be maintained at government hospitals also. Manpower, infrastructure, quality of services, staff training, interaction with patients, safety measures, are most important aspects to look into. We are running skill training programme in our hospital where houses keeping staff, lab assistant and OT staffs are trained.

Chief Operating Officer Shalby Hospitals

Managing Director Bhandari Hospital

Dr U K Gupta

Dr F S Mehta

Professor NIMS University

Principal and Dean Geetanjali Medical College and Hospital

Each medical college has medical education unit. It is for training its teachers at nodal centers. Medical curriculum is going to be changed from next year and now it will emphasise on competency based education system. We are adding the attitude and communication model in new curriculum. We are providing early clinical exposure to our students and then putting them in real-life situation.

Healthcare system in India is undergoing a revolutionary change from knowledge-based education to the competent based education. Medical colleges should focus on providing skill based education. There are three parts of it. Medical colleges have to be provided with facilites and learning opportunity for the students to learn those skills and get feedback from teachers. Another important part is faculty which requires a lot of developmental programmes as well.

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Dr Arvind Sinha

Dr Sachin Jhawar

One of the important aspects of quality is continuum of care which is provided to patients. At AIIMS, Jodhpur, all the records of patients’ visit, OPD, have been digitised. We have developed some low cost solution for digitising including old records of X-Ray and CT scan patients. These records help doctors to know medical history of a patient.

We actually need quality to run our medical colleges and hospitals in a better way. Quality versus affordability is big riddle. Misnomer of quality at affordable price is not possible. You have to decide the standard and, at the same time, ensure cost is provided. Quality has certain price attached to it.

Head, Medical Superintendent AIIMS, Jodhpur

Director Apex Hospital

(L-R) Dr Deepak Yaduvanshi, Dr Pankaj Dhamija, Dr Sachin Jhawar, Namit Soni, Dr K M Bhadari, Dr Arvind Sinha, Dr F S Mehta, Dr U K Gupta

Women Safety -- Best Practice and Initiatives by Telangana State Police

Swati Lakra Inspector General of Police, Women Safety & Law and Order, Government of Telangana

Telangana police department has taken many initiatives for women safety. Two prominent ones being -- ‘She Teams’ and ‘Bharosa Centre’. The main objective of ‘She Teams’ is to curb harassment in the public place and nab offenders harassing women through Internet and social media. Bharosa centers are working as a support system to women and children who have been the victims of violence.

october 2018

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Healthcare Excellance Awards

Prakash Vir Rathim, Bank of Baroda

Dhananjay Kumar, GVK-EMRI

Dr Bulbul Sood, JHPIEGO

Dr Kinny Singh, MD NHM & Special Secretary Health, Arunachal Pradesh

R K Srivastava, LEHS, WISH Foundation

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Dignitaries and Delegates Visiting Stalls at EXPO

october 2018

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Precious Daughters of India Awards Ceremony

Precious Daughter of India awardees during a group photo-op

Prof Reena Vyas, SPC Government College Ajmer

Anjali Pathak, Director of Nutripulse

Asha Workers

DAP Rakshaks

Dr Yogita Sharma, Director P.Y.HC

Dr Meghna Shekhawat, Ayurveda Medical Officer

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Dr Kinny Singh,Special Secretary, Dept of Health, Arunachal Pradesh

Award presented on behalf of Kiran Mazumdar Shaw, Biocon

Prof M V Padma Srivastava, Neurologist, AIIMS

PCPNDT Coordinators

Rolee Agarwal, Income Tax Commissioner

Rukesh Kumari, Wish foundation

Award presented on behalf of Saina Nehwal, Indian Badminton Player

Sarla Verma, ANM

october 2018

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Swati Lakra, IGP, Telangana

Rupali Jagga, Playback Singer

Prof Suman Mittal, SMS Medical College

Karuna Singh, IPAS

Naveen Jain felicitated with 'Saviour of Girl Child' Award

Award presented on behalf of Lalita Kurulkar, Indian Classical Musician

Musical performance by renowned singer, Rupali Jagga

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Knowledge Partner

Healthcare Initiative 56

Pulse Healthcare Enabling People to Survive in Critical Times A group of young doctors in Hyderabad is treading the path of giving back to society in the best possible way – Preparing people to save lives in the golden hour of life. Here giving back means helping those whom others would not treat and who could not help themselves. In an interaction with Dr Aditya Vikram Kabra and Dr Srikanth, who head a social service group called Pulse Healthcare Associates, Sudheer Goutham of Elets News Network (ENN) finds more.

Tell us about your campaign community CPR. What made you to initiate this endeavor? Dr Srikanth and I (Dr Aditya Vikram Kabra) along with 18 other anaesthesiologist and critical care specialists have formed a group called ‘Pulse Healthcare Associates’. It has been catering people with Intensive Care Services (ICS) and Anaesthesia services at Neelima and Shalini hospitals in Hyderabad since last four years. Over this period, we have seen several cases where the relatively younger individuals were brought to the causality without adequate or no first-aid. On arrival at hospital, when the doctors resuscitate the patient, most of the times the patients regain heart activity but there is hypoxic (decreased oxygen supply) brain

october 2018

Dr Aditya Vikram Kabra

Dr Srikanth

injury leaving a relatively young patient in vegetative state (brain dead). It adds to the cup of woes to the family as well as to the society. In the backdrop of above incidents, we decided to come up with the initiative - Community

CPR where the common citizens are trained for CPR Cardio Pulmonary Resuscitation (CPR). We have many success stories of successful CPR done in the developed countries. It is sad that in our country the CPR is almost NIL and not in practice. It is estimated that about 60 per cent of world’s coronary artery disease patients are from South Asia who die relatively at a younger age. In addition, our country witnesses one death every four minutes because of road accident. Instead of whimpering about the change the country needs, it is important that we be the change. Under the guidance of our professors and our mentors - Dr Chandrashekar, Dr Satyanarayana, Dr Deepraj Singh and Dr Ramchandra Murthy, we

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Healthcare Initiative

came up with this initiative.

Would you throw some light on your team and its role towards the cause? We, as a team, called Pulse Healthcare Associates stand not only for treating or curing the diseases, but also to give equal importance in preventive care. We have also extended this programme at the construction sites in Czech colony of Sanathnagar in Hyderabad where we trained daily wage labourers in CPR. To our surprise, one of the workers among the lot trained by us saved the life of a road accident victim by giving him first aid before accompanying him to our hospital. There cannot be anything more satisfying than saving a life and that too one with preventable cause. To keep this programme in continuity and give it a reach, we associated it with GVK-EMRI (Dr Rajanarsing Rao and team) to leveraging its larger band-width. Our vision is also to train people in using AED (Automatic External Defibrillator) which is one of the key elements involved in successful resuscitation to a person with sudden cardiac arrest. AED is a very compact and handy tool which should be available at all important public locations like multiplexes, shopping malls , schools, railway stations etc. Through our initiative we urge the government and different NGO groups to help us in installing these at all these locations. Had these training been given to everyone and if there was an AED installed within the public reach, there could have been possibility of saving the life of one of the greatest scientists and ex-president of India, Dr APJ Abdul Kalam.

Tell us something about your training sessions for the trainee IAS officers of this country recently.

We recently got the opportunity to train the deputy IAS officers in first aid and CPR at Marri Chenna Reddy Institute of the Telangana State Government in Hyderabad. Since these are the future policy makers of a healthy India, we wanted them to understand and at the same time have first-hand experience at this programme. These future policymakers were given a detailed version of first aid in different conditions like snake bite , burns, insect bites and hands on cardio-pulmonary resuscitation (CPR) on a advance technology mannequin. The IAS officers found this training very useful.

What is the vision your team holds for the initiative and how do you think and intend to achieve it? We run the campaign with the slogan saying â&#x20AC;&#x153;At Least One Person In Each Family Should Be Trained In Doing Adequate And Good Quality CPR.â&#x20AC;? In order to maintain the continuity of the programme, we need support from all quadrants of society including media which is one of the strongest pillars for the betterment of society. It can help to create awareness and participation from the community. As a responsible citizen we want one and all to participate in this

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Our vision is also to train people in using AED (Automatic External Defibrillator) which is one of the key elements involved in successful resuscitation to a person with sudden cardiac arrest

noble initiative from all walks of life. Saving a life is the noblest thing of all. As an individual we need to be the change and contribute to create a better society. We as Pulse Healtcare Associates shall be conducting these programmes regularly at schools, shopping malls, gated communities, colleges and practically anywhere and everywhere.

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Ayushman Bharat: The Gamechanger for Building new Healthcare Ecosystem in India

To delve into innovative practices in healthcare ecosystem, Elets Technomedia along with eHealth is organising Healthcare Innovation Summit on 5th December, 2018. It will be one of its kind summit where healthcare stakeholders from South-Asiancountries will congregate and deliberate, assess and re examine the steps that need to be taken up to bring tangible progress in healthcare delivery

Key Attendees

Key Themes

• •

•

• • • • • • • •

Policy Makers from Govt of India & States Mission Directors National Health Mission, and Secretaries from States Ambassadors from 5 Countries Healthcare CEOs, CXOs ,CIOs/ IT Leaders and Specialised Doctors Insurance Solution Providers HealthTech Startups Healthcare IT Service Providers International Organisations NGOs/Development Partners Pharma leaders

• • • • • •

eHealth magazine features Ranking of North India’s Top Hospitals

Leveraging Technology for value based and quality community care Innovations in Public Health : Role of NGOs for providing healthcare to the last mile Challenges and opportunities in providing affordable healthcare under ayushman bharat scheme Innovations in Public Private Partnership for developing sustainable healthcare ecosystem Future of Primary healthcare service delivery in India Latest Innovations in MedTech and medical equipment industry Developing differentiated healthcare with skill based medical education

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