IndiaMedToday Jan 2021

JANUARY 2021, VOLUME 5 ISSUE 1 `200 INDIA MED TODAY

OP RADIOLOGY PRACTICE Key considerations for building successful radiology centre for out-patients

JANUARY 2021

INTERVIEW Dr Sneh Bhargava

APPROACH Can Radiology NGO Save Patients’ Lives

PULSE

RADIOLOGY INSIGHT

Healthcare Interoperability – The people aspect

Practicing radiology during COVID pandemic

EDIT NOTE www.indiamedtoday.com

January 2021 EDITORIAL Editor Neelam Kachhap

Is an outpatient imaging centre your ticket to success

BOARD OF ADVISORS Dr Alexander Thomas Dr Girdhar Gyani

Sub-Editor

Dr Prem Kumar Nair

Sanjiv Das

Dr Bhabatosh Biswas

After residency when radiologists step into the real world

editorial@

Dr Alok Roy

they are full of dreams. Some of them look at outpatient

indiamedtoday.com ART & PRODUCTION WepApp Logic Shylesh

Ramesh Kannan

radiology service as a possible career option. But can all

CONSULTING EDITOR

young radiologists dare to dream big?. Starting a radiology

Dr Libert Anil Gomes

centre is a humongous task. It requires strategic and financial

Dr Salil Choudhary

planning and long gestation periods. Not all radiologists are entrepreneurs but yes most of them are passionate about

ADVERTISING Gunjan Chauhan

imaging and patient care.

gunjanc@indiamedtoday.com

Sadly, this aspect of radiology practice is not taught at any level

The Media Ant

to our radiologists. Many radiologists who started own centres

help@themediaant.com DIGITAL MARKETING Vivek Nair Sales & Strategic Partnership Sujit Kaushik sujit.kaushik@indiamedtoday.com EDITORIAL ENQUIRIES editorial@indiamedtoday.com CUSTOMER SERVICE: Subscription support and other assistance for readers subscribe@indiamedtoday.com ADVERTISING ENQUIRIES sales@indiamedtoday.com OFFICE 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 www.indiamedtoday.com IndiaMedToday expressly disclaims liability for errors and omissions in this publication. While we try to keep the information timely and accurate, we make no guarantees. The views and opinions expressed in the magazine do not necessarily reflect the official policy or position

said that the challenges regarding, capital expense, managing creditors, equipment emergency like MRI venting Helium; and dealing with crisis daily were exhausting their ability to manage such ventures. Had they known about the good, bad and the ugly of running a radiology centre they would be better prepared for the challenges ahead?

Our focus this issue has been on bringing such knowledge to young radiologists. Through our Cover Story we seek to highlight the key considerations for starting outpatient radiology centre. We bring you the story of Lucid Diagnostics Hyderabad and how they build a flourishing business.

We also have an enigmatic personal interview with the first female radiologist of India Dr Sneh Bhargava. We explore the situation of radiology centres post COVID-19 scenario and have experts share their experiences and expertise with us.

In the Approach section, we tell the story of a truly unique NGO working to train doctors and build capacity in resource-poor countries.

Our next issue will focus on cancer care and we have the president of a large oncology practice as guest editor. Look forward to the insights from world-renowned oncologist, surgeons and leaders and interventional radiologist who will outline the upcoming trends in this field.

of IndiaMedToday or the publication. Information on IndiaMedToday should not be used as a substitute for professional healthcare advice.

Readers are advised to always seek specialist advice before acting on

Do write back and let us know your feedback.

information contained in this publication. Never disregard professional medicaladvice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing.

Printed and published by M Neelam Kachhap, 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam Publishing (OPC) Private Limited, Printed at Supriya Print Art 143, Pragati Industrial Estate, N M Joshi Marg, Lower Parel West, Mumbai - 400011. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

Editor M Neelam Kachhap

JANUARY 2021

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CONTENTS

Facebook

Linkedin

26

14

28

INTERVIEW

INNOVATE

APPROACH

Taking the Road Less Travelled

Digital Twins Gain Traction in Healthcare

Can Radiology NGO Save Patients’ Lives

UPFRONT

18 COVER STORY

OP Radiology Practice

03 Editorial 05 Letters 06 News Roundup 31 Radiology Insight 37 Drive 40 Health - IT 43 Pulse 46 Best Buy www.indiamedtoday.com

CHECKIT OUT ONLINE

LETTERS

T

his has been a year for close collaboration with the medical fraternity is not only managing the pandemic but also working towards building foundations for a stronger medical devices sector. In solidarity with the needs of healthcare professionals, we kept our production facilities running and stocked our warehouses to ensure an uninterrupted supply of essential medical devices and worked in close collaboration with hospitals to educate on safe OPDs and surgeries even in tier 3,4,5 towns.

Anish Bafna, CEO, Healthium Medtech

The year 2020 has been a gruelling one for humankind, especially for those who were unable to support themselves due to lack of resources. In such trying times, Sightsavers ensured no lapse in the dispersal of services to those who need it the most – Persons with Disability. We made this possible by providing door to door eye screening services in Rajasthan and Uttar Pradesh. Apart from health, we ensured the education of children with visual impairment was not compromised and initiated tele education in various states such as Bihar, Orissa, West Bengal and Jharkhand.

These initiatives are building blocks in our approach towards collective healing and imagination of a more just and equitable society. We aim to carry this energy forward to 2021 and to ensure that people who are irreversibly blind are supported adequately to lead lives of independence and dignity.

RN Mohanty, CEO, Sightsavers, India The outbreak of COVID–19 pandemic has ravished almost all the spheres of life. Humanity has suffered the great deal. The pandemic crises have deeply impacted both the mind and body of the people across the globe. The destruction has posed the unimaginable and unprecedented challenges and people are looking for different ways and means to recover from these potential issues.

Anil Rajput, chairperson, ASSOCHAM CSR Council

The pandemic in the year 2020 was one such event that no business had predicted. Job economy is directly proportional to the growth of various industries and the impact was clearly visible. Factors including an overhaul of the work culture, dependence on digitisation as well as pandemic-led precautions and restrictions contributed to the uptick and downtick in hiring amongst key sectors. While the IT, BPO/ITES and Medical/ Healthcare sectors led the hiring in 2020, some sectors such as Hospitality/Travel, Retail and Auto are seeing a sequential revival after a sharp hit because of the pandemic. Since this year was more about transitions a navigations, we are looking forward to 2021 for sustainable growth in the job market.

Pawan Goyal, Chief Business Officer, Naukri.com There is no need to be panic about the new strain of COVID, it’s not as virulent as the reports are coming in. Over a period of time, our natural infection will also help protect us. Vaccines in India are about to be placed. Perhaps, we are moving towards Herd immunity because in India the cases are coming down. One of the classical examples is the Dharavi slum of Maharashtra. As far as the number of cases is concerned, it depends upon testing, and testing is very low in India as it’s just five thousand here. In the UK, genome sequencing (testing) is 1.4 lakh out of 2.5 lakh of the world.

Dr (Prof) Sanjay Rai, Professor, Dept. of Community Medicine, AIIMS, President, (IPHA)

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NEWS ROUNDUP Narayana Health, Mazumdar Shaw Medical Foundation launch BIRAC BIONEST

intelligence-powered cough analysis rapid

Narayana Health in association with Mazumdar Shaw Medical Foundation announced the launch of a physical incubator called Mazumdar Shaw Medical Foundation (MSMF) MedTech Innovation Centre – BIRAC BIONEST. A centre with a dedicated space of around 8000 sq ft Mazumdar Shaw Medical Foundation (MSMF) MedTech Innovation Centre – BIRAC BIONEST will help MedTech entrepreneurs who are looking to address affordability, access and innovation challenges in the healthcare ecosystem.

This initiative is a unique blend of medicine

The MedTech Innovation Centre will also augment further the initiatives undertaken

by Mazumdar Shaw Medical Foundation and Narayana Health towards identifying, mentoring and handholding entrepreneurs and innovators in their journey to success.

The space will facilitate close interaction and prototyping facility too for startups.

Aurobindo Pharma in agreement with COVAXX

HCG partners with Wipro

to fight COVID-19, for India and the United

HCG and Wipro have jointly developed Covigilent, an advanced artificial

COVAXX is currently conducting a Phase 1

Medtronic

6

January 2021

screening tool for COVID-19 which will be offered free of cost to a global audience.

The unique AI model will help in early detection and large-scale screening of patients using cough as a primary input. and engineering prowess towards cocreating innovation for the greater good.

The app helps in distinguishing the covid cough from other types of cough caused by seasonal bronchitis and pneumonia.

It captures cough signals using a simple ‘do

it

yourself’

recording

analysed

by experts to pick up subtle changes that are specific to COVID-19 patients without any intervention from healthcare professionals.

Aurobindo Pharma and COVAXX, a USbased company, have entered into an exclusive license agreement to develop, commercialise and manufacture UB-612, the first multitope peptide-based vaccine Nations Children’s Fund (UNICEF) agency. clinical trial for the vaccine candidate.

Under the signed agreement, Aurobindo Pharma has obtained the exclusive rights to develop, manufacture and sell COVAXX’s UB-612 vaccine in India and to UNICEF, as well as non-exclusive rights in other select emerging and developing markets. Aurobindo Pharma and COVAXX are partnering on clinical development, manufacturing and marketing of COVAXX’s vaccine candidate, UB-612. Aurobindo will manufacture the finished doses at its facilities in Hyderabad. Aurobindo has the capacity of manufacturing 220 million doses in multi-dose presentation and is building additional facilities to have a total capacity of nearly 480 million doses by June 2021.

Medtronic unveils innovation in surgery India Medtronic, a wholly-owned subsidiary of Medtronic, announced the launch of EEA Circular Stapler with Tri-Staple Technology — the first 3-row Circular Stapler with varied height staples.

The new Tri-Staple Technology comprises a sloped cartridge face that delivers less stress on the tissue. It also offers consistent performance over a broad range of tissue thickness and allows for greater perfusion into the staple line.

The EEA circular stapler with Tri-Staple

subsidiary has inked a licensing pact with

topline of Rs 750 – 800 Cr over the project

technology is indicated for use in colorectal

Menarini Group for commercialising its

term for NephroPlus.

procedures, where safer anastomosis (the

nasal spray Ryaltris across 33 countries

surgical connection between two loops

in Europe, including the Balkan region.

of the intestine) is required to avoid any

Under

leaks. The device has three rows of varied

Glenmark will be responsible for the

height staples to deliver 30 per cent more

continued development and regulatory

security to the staple line and requires 60

approval of Ryaltris in European markets

per cent lesser firing force in the operating

while

room as compared to current devices.

for the scientific information and the

Moreover, the device comes with improved

commercialisation of the product in those

audible and tactile feedback that enables

markets, following regulatory approval.

clinicians with better decision-making in

As part of the deal, Glenmark will receive

the operating room. Additionally, the tilt-

an upfront payment as well as launch and

top mechanism on the device facilitates

sales-based

easy removal during colorectal surgeries.

Menarini for Ryaltris sales.

and

NephroPlus forays into CIS market

clinical protocols to improve the quality of

The promise of higher security and greater perfusion at the staple line is expected to deliver better clinical outcomes for patients.

the

terms

Menarini

of

will

milestone

the

be

agreement,

responsible

payments

from

NephroPlus has expanded its footprint

The Government of Uzbekistan awarded NephroPlus the bid to finance, construct, equip,

train

personnel,

and

operate

four large dialysis centres in Tashkent, Karakalpakstan and Khorezm region to deliver quality dialysis services for over 1,100 patients. The government also has the right to add another 300+ patients to this programme as the need for dialysis care is increasing year on year. For this project, NephroPlus will establish a 100 per cent-owned local subsidiary, and the key resources from India will implement supervise

international

standard

dialysis care in the country.

Dr Alexander Thomas re-elected as AHPI’s National President

Baxter to invest Rs 100 crore in Ahmedabad

into the Commonwealth of Independent

US-headquartered

company

comprehensive dialysis programme for the

Association

Baxter will invest around Rs 100 crore to

Republic of Uzbekistan in a competitive

India (AHPI) has announced the name of

set up its global research and development

international bidding process. The 10-year

office bearers for 2021-22. Dr Alexander

(R&D)

a

tenured project will be signed between

Thomas

senior state government official said.

the Ministry of Health of the Republic of

National President, Dr Bhabatosh Biswas –

Currently,

and

Uzbekistan and NephroPlus. This high-

National Treasurer and Dr Girdhar Gyani to

development and information technology

value project is expected to generate a

continue as Director-General.

pharma

headquarters

in

Baxter

has

States (CIS) market. The company won the tender to build and operate the

Ahmedabad, research

has

of

Healthcare

been

appointed

Providers

as

the

centre in Bengaluru and a manufacturing unit in Ahmedabad where the company is manufacturing generic injectables.

MuDiTa Express Cargo signs MoU with SpiceJet MuDiTa a

Express

Cargo

Memorandum

of

has

signed

Understanding

(MoU) with budget carrier SpiceJet for distribution of COVID-19 vaccine across India,

the

express

logistics

services

provider said. MuDiTa Express has been transporting vaccines for major pharma companies such as Serum Institute, Sanofi India, Sun Pharma, Wockhardt, Glenmark, among others. Besides, it has also been involved in central government’s polio immunisation programme, a release said.

Glenmark inks pact with Menarini Group Glenmark

Pharmaceuticals

said

its

Dr Alexander Thomas

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7

NEWS ROUNDUP Aster DM Healthcare partners with Government of Cayman Islands

Gujarat govt launches startup ecosystem for Ayurveda

Aster DM Healthcare and Cayman Islands Government making

the

announced Cayman

an

agreement

Islands

Aster’s

clinical excellence hub for the Western hemisphere, serving the Caribbean Region, North America, Canada, Latin and South America.

The agreement will see Aster initially develop around 150-bed comprehensive, tertiary and quaternary care hospital, with an opportunity to expand in the future based on need, alongside an assisted living facility and healthcare university in the long-term. With this project, Aster aims to replicate its ‘Medcity’ concept which has proven to be highly successful as its flagship facility in Kochi, India. The team

The Government of Gujarat has launched a start-up ecosystem for Ayurveda and herbal innovation called Mind to Market (M2M). Shripad Naik, Union Minister of State in the Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy, Bhupendrasinh Chudasama, Education Minister, Gujarat, Himanshu Pandya, Chief Mentor, i-hub, Hanmant Gaikwad, Chairman, BVG India, Hiranmay Mahanta, CEO, i-hub launched the project at a recently held ceremony. BVG Life Sciences will mentor young researchers in the Rs 200-crore M2M project. An MoU was signed between Gujarat Government and BVG Life Sciences three months back.

According to the MoU, BVG Life Sciences will help young innovators in research to validate, mentor and market through this project.

Union Labour and Employment Minister Santosh Kumar Gangwar laid the foundation stone of a 100-bedded Employees’ State Insurance Corporation (ESIC) Hospital in Budgam district of Jammu and Kashmir.

The hospital being constructed for Rs 160 crore will be equipped with modern healthcare facilities and will have OPD, IPD, ICU, wards, diagnostic laboratories, operation theatre, disaster management facilities, in addition to an independent sub-station, an official spokesman said.

18TH DFSI and 6TH ADFS conference held in Chennai The

three-day

virtual

international

conference of “18th Annual Conference of Diabetic Foot Society of India (DFSI) & 6th Annual Conference of (International) Association of Diabetic Foot Association” was held recently in Chennai. The event was inaugurated by Dr Preetha Reddy, Vice-Chairperson

of the Aster Cayman Medcity – phase 1

J&K’s Budgam to get 100-bedded ESIC hospital

construction.

Lieutenant Governor Manoj Sinha and

Rajesh Kesavan, Secretary – DFSI, Dr VB

leading the project hopes to break ground by mid-2021, with the commencement

8

January 2021

of

Apollo

Hospitals

Group. Also, present on the occasion were, Arun Bal, President – DFSI, Dr

Narayanamurthy, VP – DFSI, Dr Venu Kavarpathu, President – ADFS, Dr Robert Frykberg, Scientific Officer and Dr Arvind Rajagopalan, Treasurer DFSICON2020 and other healthcare experts.

This year's conference (virtual) was attended by more than 4000 members from over 25 countries including the US, the UK, Italy, Netherlands, Singapore, South Korea, Tanzania and many more.

The three-day programme aimed to bring together all Indian and international specialities to come on one platform to discuss the opportunities and challenges faced by the medical fraternity in diabetic foot care.

Apollo Hospitals joins UAE’s Waterfalls Initiative The Apollo Hospitals Group has joined UAE’s Waterfalls Initiative for Continuous Education from the UAE to the world.

The initiative aims to train health and medical professionals around the world and empower them through building and strengthening their capabilities.

The Apollo Hospitals Group will support the Waterfall Initiative’s educational programme that includes specialised

lectures, seminars and workshops on vital topics in medicine, pharmacy, nutrition, public health, nursing, dentistry, and hospital management. 52 senior doctors from various reputed hospitals in India are joining the Waterfalls Initiative. FICCI and the Apollo Hospitals Group are the Indian partners for this initiative that aims to reach and empower one million health professionals worldwide.

Hospital, Saket will provide fellowships

Waterfalls Continuous Education is an initiative launched by Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of UAE and Ruler of Dubai. The initiative is being conducted under the supervision of Lt General Sheikh Saif bin Zayed Al Nahyan, Deputy Prime Minister and Minister of Interior and the Department of Behavioral Rewards at the Ministry of Possibilities in collaboration with INDEX Holding.

– Radiology Services, Max Super Speciality

Fujifilm India, Max Healthcare provide fellowships in breast imaging In line with their collaboration last year, Fujifilm India and Max Super Speciality

to train doctors in breast imaging and advance diagnostics.

The

brands

organised

a

felicitation

ceremony to celebrate the success of the pilot project and provide a certificate of completion to Dr Pragya Garg, MD, who has proficiently completed her fellowship in radio-diagnostics. The team under the guidance of Dr Bharat Aggarwal, Director Hospital, Saket and Dr Harit Chaturvedi, Chairman – Max Institute of Cancer Care will be taking this initiative forward and providing training to many other candidates in the field.

Doctors

are

being

trained

in

breast

mammography, breast MR and breast ultrasound techniques for six months through the Max-Fujifilm Collaboration fellowship programme. The programme is training two select radiologists per year towards the early detection of breast cancer.

Apollo Hospitals joins UAE’s Waterfalls Initiative The Apollo Hospitals Group has joined

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9

NEWS ROUNDUP UAE’s Waterfalls Initiative for Continuous Education from UAE to the world. The initiative aims to train health and medical professionals around the world and empower them through building and strengthening their capabilities. The Apollo Hospitals Group will support the Waterfall Initiative’s educational programme that includes specialised lectures, seminars and workshops on vital topics in medicine, pharmacy, nutrition, public health, nursing, dentistry, and hospital management.

52 senior doctors from various reputed hospitals in India are joining the Waterfalls Initiative. FICCI and the Apollo Hospitals Group are the Indian partners for this initiative that aims to reach and empower one million health professionals worldwide.

Waterfalls Continuous Education is an initiative launched by Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of UAE and Ruler of Dubai. The initiative is being conducted under the supervision of Lt General Sheikh Saif bin Zayed Al Nahyan, Deputy Prime Minister and Minister of Interior and the Department of Behavioral Rewards at the Ministry of Possibilities in collaboration with INDEX Holding.

J&K launches portal for certified pharmacists The Jammu and Kashmir administration launched a portal for online registration of certified pharmacists. As many as three candidates who had uploaded their

10

January 2021

documents on the portal were handed over certificates as Registered Pharmacist

by Financial Commissioner, Health and Medical Education Department, Atal Dulloo, an official spokesman said.

Biocon Biologics inks pact with CSSC in Tanzania

The Financial Commissioner, while appreciating the functioning of Pharmacy Council of Union Territory of Jammu & Kashmir, expressed hope that all stakeholders will get immensely benefitted by this initiative. Dulloo, who led the department during the coronavirus outbreak said that pharmacists play a pivotal role in the healthcare system and their contribution is critical towards mitigating sufferings of ailing masses.

the Christian Social Services Commission

Neuberg Diagnostics plans Rs 150 cr investment

Biotechnology major Biocon said its arm Biocon Biologics has signed a pact with (CSSC) in Tanzania, in continuation of its ‘Mission 10 cents’, an affordable insulins programme for low- and middle-income countries.

Tanzania will be the first country in Africa that will benefit from this collaboration between

Biocon

Biologics

and

CSSC,

Biocon said in a BSE filing.

Biocon

Biologics

is

helping

unlock

universal access to quality insulins in lowand middle-income countries (LMICs) by making recombinant human insulin (rhinsulin) available for less than 10 US cents

Neuberg Diagnostics announced its expansion plans in Delhi and Kolkata in Q4FY21. Dr Amrita Singh has been appointed as Chief of Lab Services for the region. She will be overseeing the company’s expansion and technical operations in North and East India. For expansion in these two regions, the company plans to invest up to Rs 150 crores for organic and inorganic business growth.

per day as a part of its ”Mission 10 cents”

The company aims to add another 10 labs in the next quarter and 30 labs by the end of next fiscal. It also plans to commence commercial operations in the US in the next quarter.

2035: Public Health Surveillance in India.

programme, Biocon said in a regulatory filing.

NITI Aayog releases ‘Vision 2035: Public Health Surveillance in India’ (NITI) NITI Aayog released a white paper: Vision The white paper was released by NITI Aayog Vice-Chairman Dr Rajiv Kumar, Member (Health), Dr Vinod K Paul, CEO, Amitabh Kant and Additional Secretary

Dr Rakesh Sarwal.

‘Vision 2035: Public Health Surveillance in India is a continuation of the work on health systems strengthening. It contributes by suggesting mainstreaming of surveillance by making individual electronic health records the basis for surveillance. Public health surveillance (PHS) is an important function that cuts across primary, secondary, and tertiary levels of care. Surveillance is ‘Information for Action’.

The document articulates the vision and highlights the building blocks. It envisions a citizen-friendly public health system, which will involve stakeholders at all levels, be it individual, community, health care facilities or laboratories, all while protecting the individual’s privacy and confidentiality.’

Anil Soni appointed as first CEO of The WHO Foundation

Anil Soni, CEO - The WHO Foundation role, Soni will accelerate the Foundation’s

Lack of basic water services put healthcare workers, patients at higher risk of COVID-19

Indian-origin global health expert Anil Soni has been appointed as the first Chief Executive Officer of the newly launched The WHO Foundation, which works alongside the World Health Organization to address most pressing health challenges across the world.

“work to invest in innovative, evidence-

Soni joins the Foundation from Viatris,

risk of COVID-19 and other diseases

Soni will assume his role as The WHO Foundation’s inaugural Chief Executive Officer on January 1 next year. In his new

a

where

because they use or work in healthcare

he served as Head of Global Infectious

facilities without basic water services,

Diseases.

warn WHO and UNICEF.

based initiatives that support WHO in delivering on its mission to ensure healthy lives and promote well-being for all,” the Foundation said.

global

healthcare

Around 1.8 billion people are at heightened company,

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11

NEWS ROUNDUP The report, Global progress report on WASH in health care facilities: fundamentals first, comes as COVID-19 is exposing key vulnerabilities within the health systems, including inadequate infection prevention and control.

an experience of more than 20 years in

Water, sanitation and hygiene (WASH) are vital to the safety of health workers and patients yet the provision of these services are not prioritised Worldwide, one in four healthcare facilities has no water services, one in three does not have access to hand hygiene where care is provided, one in 10 has no sanitation services, and one in three does not segregate waste safely.

Severance Robotic Institute, Seoul, South

Dr Jagadishwar Goud joins American Oncology Institute Group Dr Jagadishwar Goud has joined American Oncology Institute Group as National Head, Robotic Surgery Programme. Dr Goud has completed his MS from Osmania Medical College and M CH from Kidwai Memorial Institute of Oncology. he has

handling complex oncology cases. He is trained in robotic surgery at Roswell Park Cancer Institute, USA and Advanced Training in Robotic Colorectal Surgery and Neck Scarless Robotic Thyroidectomy at Korea.

NATHEALTH, Africa Healthcare Federation sign agreement Healthcare Federation of India and Africa Healthcare Federation (AHF) signed a Memorandum of Understanding (MoU) to increase healthcare collaboration between the two federations with potential to result in increased investment and business in healthcare between India and Africa. The agreement was signed at the India Africa Health Summit and was represented by medical and healthcare sectors, government, academia and development agencies. The MoU identifies specific

areas of partnership such as sustainable and medical value travel, infrastructure development for hospitals and diagnostics, training and research, skill transfer and artificial intelligence and manufacturing.

Everstone acquires stake in Calibre Singapore-headquartered, India-focussed private equity firm Everstone Capital has acquired a controlling stake in Calibre, a speciality ingredients player focussed on pharma, nutrition and personal care segments, in a reported Rs 1,000-crore deal.

Mumbai-headquartered Calibre, founded in 1984 by Ranjit Bhavnani in Gujarat, is a leading speciality ingredient player in the iodine derivatives, persulfates and perchlorates segments.

Though the companies did not disclose the deal value, a market source told PTI that the transaction is valued at around Rs 1,000 crore.

Fourteen healthcare start-ups win innovation challenge India-Sweden

Healthcare

Innovation

Centre virtually announced the winners of the Innovation Challenge, that aimed to identify and support innovative solutions that can impact the treatment of noncommunicable and communicable diseases and help regress critical problems in the

healthcare

India.

These

delivery winning

landscape

solutions

of

were

announced through a web conference

by Dr Harsh Vardhan, Ministry of Health and Family Welfare, Government of India.

Representatives from the 14 winning startups were also present at the inaugural event to exchange their vision that could improve the healthcare ecosystem in the country.

The

innovation

challenge

included

a

rigorous evaluation process by a panel of experts from AIIMS Delhi, AIIMS Jodhpur, ICMR, The Swedish Trade Commissioners office to India, AstraZeneca, AIM, C-CAMP and

other

partners.

This

committee

had shortlisted 14 compelling solutions including that of Dr Aakash Kohli, Aarogya Dr Jagadishwar Goud

12

January 2021

AI innovations, Adiuvo Diagnostics, Dr

Amit Goyal, Dr Bharat Choudhary, Biofi

partnership aims to ultimately create

combination

Medical-Healthcare

stronger healthcare systems that can face

Azelastine, and are indicated for the

Shell

the current and future challenges such as

treatment

Technologies), Dr Gautam Ram Choudhary,

pandemic management, quality of care,

Janitri Innovations, Jeevtronics, Qritive,

application of AI in healthcare and so on.

Qure.ai Technologies, and ThermaiScan

Glenmark to divest select anti-allergy brands to Dr Reddy’s

Technologies,

India,

Dozee

Blackfrog

(Turtle

Technology AB.

MGM Healthcare in MoU with LIBA MGM Healthcare has recently signed an

Glenmark Pharmaceuticals has entered into

a

definitive

agreement

with

Dr

of

of

Mometasone

seasonal

and

with

perennial

allergic rhinitis.

Dr Sanjeev Bhalla joins RSNA Board of Directors Dr Bhalla has served RSNA’s journals as an associate editor for Radiology:

CardiothoracicH Imaging since the journal’s

MoU with Loyola College’s Institute of

Reddy’s Laboratories to divest – subject

launch in 2018 and as assistant chair, then

Business Administration (LIBA). Rev Fr C

to

precedent

chair of the resident and fellow education

Joe Arun SJ, Director of LIBA and Harish

actions and closing activities – its brand

section of the RadioGraphics editorial

Manian, CEO, MGM Healthcare took part

Momat Rino (for Russia, Kazakhstan and

board from 2013 to 2020. He received

in the signing ceremony. It signifies an

Uzbekistan), Momat Rino Advance (for

academic collaboration in the areas of

RSNA’s Honored Educator Award four times

Russia), Momat A (for Kazakhstan and

teaching, training, curriculum development,

Uzbekistan),

research, internship and placements in the

Active (for Ukraine), along with rights to

field of healthcare management.

the trademarks, dossiers and patents for

The MoU seeks to create a new generation of

medical

and

allied

healthcare

completion

of

certain

Glenspray

and

Glenspray

the territories mentioned.

The divested brand and its extensions

professionals to face the ever-growing

represent

demands of the healthcare industry. The

Mometasone

two

types

of

mono-product

products, and

since 2014. A longtime, dedicated RSNA volunteer, Dr Bhalla served as a member of the chest imaging subcommittee of the Education Exhibits Committee (20072009), then as chair(2008-2012). He was the vice-chair, the chair of the Education Exhibits Committee from 2013to 2017.

He served as a member of the Refresher Course Committee and Education Council, as well as several RSNA workgroups, subcommittees and steering committees.

He has regularly served as the faculty and moderator for education sessions at RSNA annual meetings. Dr Bhalla is presidentelect of the Society of Thoracic Radiology and a Fellow of the American Society of Emergency Radiology. He is a trustee of the American Board of Radiology (ABR) and has regularly served as an ABR oral examiner. He was a Fleischner Society Inductee in 2019.

He is section chief of the Cardiothoracic Imaging Section at Mallinckrodt Institute of Radiology (MIR) in St Louis, Missouri, a position he has held since 2007. He is a professor of radiology in the cardiothoracic imaging section, and assistant residency programme director and vice chair for education at MIR. He is co-director of Body CT at Barnes-Jewish Hospital, BarnesJewish West CountyHospital and St Louis

Dr Sanjeev Bhalla

Children’s Hospital.

www.indiamedtoday.com

13

INTERVIEW

Taking the Road Less Travelled India’s first female radiologists, Dr Sneh Bhargava (90) looks back at an illustrious career and how her life encapsulates the essence of exuberance, of being a radiologist, in conversation with M Neelam Kachhap

Meeting an active nonagenarian is reason enough to be excited but when the nonagenarian is an enigmatic scholar and teacher, you know you have hit the jackpot. Alas! My meeting with Dr Sneh Bhargava (90), Medical Director, Sitaram Bhartia Institute of Science and Research, New Delhi; had to be a virtual one, due to COVID-19 scenario. Shattering gender roles, Dr Bhargava not only became a doctor but a radiologist at that. Her life is an amalgamation of ideas that have led to new awakenings not only for her but for all the budding doctors and scientists.

Dr Bhargava was born in 1930, to an educated family of Yudhister and Pyar Taneja. She enjoyed the privilege of equal opportunity and education and was moulded by her mother’s values and ideals. As a result, she chose to join one

14

January 2021

of the most renowned medical colleges for women, The Lady Hardinge Medical College, in 1948 to pursue an education in medicine. Dr Bhargava diligently sought new avenues to excel. This led her to embark upon a remarkable relationship after graduation with radiology and imaging, that has lasted for a lifetime.

She went to England in 1955, to further polish her skills and to learn from the leading figures in radiology at the time. Dr Bhargava’s career was well on track and when she returned to India she found work at Irwin Hospital, now LNJP as an assistant radiologist. It was then that the well-reputed AIIMS was established and Dr Bhargava became Assistant Professor, in the radiology department.

What mattered to Dr Bhargav was that she could carve out the curriculum and advise standards for the post-graduate programme in radiology. She was also instrumental in developing several sub-specialities and mentoring many students in research.

The capriciousness of institutional politics did not deter her growth and in 1984 she became the first and only female Director of the AIIMS. During six decades of her career, she has been a beacon of knowledge to her students. She values hard work and has been a lifelong learner. She has received several accolades and awards. She has been a member of many associations and chaired countless committees but what she holds dear is the Padma Shri, one of the highest civilian awards in India.

Here she talks about the field of radiology and imaging as she has seen it evolve and shares her journey with us.

You came into radiology in the 1950s. What was it like then?

Radiology then was a young speciality, X-rays having been discovered in 1895

by Roentgen a German Physicist. It was a revolutionary diagnostic procedure then. It turned medicine inside out and was the only imaging procedure available which could image in the human body the bones as white images and the air in the lungs as black. The rest of the human frame structures were varying shades of grey which the human eye could not differentiate. The subject was not popular and very few opted to specialise in it.

It recorded the three-dimensional human bodies on a flat plate- it was a science and technology advancement but did not contribute directly to healing a patient and that is why doctors who joined medicine to become healers did not opt for radiology in large numbers.

What got you interested in radiology?

Three things got me interested. Firstly I was fascinated by the fact that you could visualise bones and lungs with the

Dr Sneh Bhargava Medical Director, Sitaram Bhartia Institute of Science and Research, New Delhi

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15

INTERVIEW

Dr Bhargava celebrating birthday with colleagues

click of a button without using a scalpel to see the size of the heart which a stethoscope could not.

home, husband and children with a professional life i.e. creating a work-life balance because both are full-time jobs

Secondly, radiology was a new open field no takers but with the opportunity to rise quickly in the profession while most of my friends and classmates became registrars in obstetrics and gynaecology, I rose to become “assistant to the professor� a grade higher.

How has the role of the radiologist changed over the years?

Not following the commonly trodden path I could make my path and decided to walk the road to travel. Thirdly there were no night calls and you could have a comfortable family life and pursue other hobbies as well.

What were the challenges you faced while practising and as your career progressed?

In my professional life, the greatest challenges were to gain the confidence of my clinical colleagues that they could trust my reports. All doctors consider that they are the best for their patients and to convince them that back processing officers, as a radiologist is, can help them and guide them in a team spirit for the betterment of their patients, we do contribute.

In

16

my

personal

January 2021

life

balancing

a

The role of the radiologist has changed dramatically. Though progress in science and technology has changed many fields of medicine in the last six to seven decades the progress in imaging and radiology is perhaps the maximum change in how we practice medicine.

From being backed processing offices, we are now the epicentre for diagnosis and treatment, with all the multimodality cross-sectional imaging at our disposal and image guidance available for intervention and treatment.

What are the most common mistakes that are made that lead them to an incorrect diagnostic decision?

The most common mistake that is made is interpreting an image without full knowledge of the patient's history and physical examination and not understanding what the treating doctor wants from your report.

How can they be avoided?

Never interpret an image whether a plain X-ray, an ultra-sonogram, a CT or MRI images without knowledge of the history and physical finding. Also, the eye cannot see what the mind does not know therefore keep updated. You will not make mistakes.

How do you perceive radiology talent from India?

In terms of brainpower, our talent is amongst the best in the world but in terms of opportunities, we do not provide them much or provide motivation. The push and pull factors operate whether you work in the country or abroad. Why do they excel abroad?

How would you rate the research in radiology coming out of India?

Research in radiology is of two types- clinical and basic. Both require resources of time and money. We do not have either of these resources. The clinical load in the public health system is enormous and urgent and cannot be put off; it leaves you not enough time to devote to research because of the limited number of skilled personnel available to

handle either basic or clinical research.

Research cadres have to be created for meaningful research, who can work in teams about India specific projects. The structure of healthcare and education needs change. Function flaws from the form. We have not changed the form nor the resource. India spends only 0.91 per cent of GDP on health and it’s not fair to expect world-class research.

What advice would you like to give to young radiologists?

One of the timeless secrets is to love your work and have the fire in your belly to contribute to relieving human suffering with compassion and dedication. The subject is very wide now, choose your goal and pursue it to achieve excellence. There will be twists and turns in your careers but there is always room at the top.

Set the bar high for yourself; be prepared to be a learner all your life.

Whether in clinical practise or academic radiology you must keep updated for the sake of your patients and the profession. You should find your work rewarding, intellectually challenging and fun, and also your play and your leisure. Just pursue your vision of excellence.

to the academic and public health system and three decades to the private non-profit health care system and have enjoyed the trust of my clinical colleagues and patients alike. A typical day would include an exercise regime in the morning for 30-40 minutes and a healthy balanced diet. I believe these have kept me fit, healthy and happy.

Being healthy and happy I have been able to achieve a work-life balance of my professional and personal life as the wife of a busy physician and mother of two responsible and loving children.

This could not have been achieved without the care and co-operation of my parents, my husband, my siblings, my children, my colleagues and my students. I am grateful to them all and acknowledge their contribution with gratitude the rest of the day went in balancing professional and personal life.

What are your favourite books/movies?

I enjoy reading life improvement books that will enlighten and educate me and also the lives of great men.

On the lighter side, Agatha Christie and Perry Mason have kept me glued to them till the mystery is solved. I am not a movie buff.

Which is your favourite city?

Abroad it is London- you can enjoy history, art, culture and shopping. At home- Delhi, without its filth, politics and pollution you can enjoy history, art, cultures, intellectual discussions, shopping, varied national and international cuisines.

Is there anything you would have wanted to do differently?

If I did not pursue a career in contributing to human health I would have pursued a career in contributing to plant health- I love flowers, their thorns and their fragrance. Also, all the vegetation that makes our healthy diet.

I would have been a horticultural and floricultural scientist. Since I answered my calling as medicine I would want to change the structure of the healthcare system and give primary healthcare the topmost priority.

What gives you more satisfaction, teaching or clinical practice?

I am equally passionate about teaching and clinical practice. When I am teaching I know I am preparing the next generation. I am holding the torch to pass on to the future generation so that it burns brightly. When in clinical practice I know that I am contributing to healing humankind in need of help in a team spirit.

This provides me with a lot of satisfaction and I love and enjoy doing both and discharging my duties to the best of my ability.

What is a typical day like for you?

I have had six decades of active professional life; six decades devoted

Dr Bhargava, was conferred honorary membership by the Radiological Society of North America (RSNA) in 2018

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17

COVERSTORY

OP Radiology Practice Key considerations for building successful radiology centre for out-patients

M Neelam Kachhap 18

January 2021

COVER STORY

A

career

in

radiology

to imaging studies, but also has a

ensure economic benefits. “A radiology

imaging

is

a

therapeutic role in the form of minimally

centre is a costly affair and like any

dream for many young

invasive interventional radiology set-

other venture cost is one of the prime

MBBS

up.

considerations. However, during our

and

graduates,

lack

of

but

employment

opportunities crus many such dreams.

One option for budding radiologists is to start a diagnostic clinic but medical colleges do not impart such knowledge and doctors find themselves in an uncharted territory of setting up a practice.

While, of

the

technicalities

related

engineering,

building

concerns;

is

it

a

to

equipment, and

costly

safety business

largest

industry

and

is

Co-founder & Group President, Medica

needed by doctors to make informed decisions about care provision related prevention,

screening,

detection,

treatment and management.

The medical imaging business covers a broad range of diagnostic procedures starting from X-rays, ultrasound, CT scans, MRIs to radiology and bone density screenings. Scope of a modern radiology set-up is not only limited

Arvind

Karthik,

Managing

Director,

Assessment feasibility of the venture

for operations. Setting up such a facility

fastest-growing

pace. They provide the information

dreams die tragic deaths,” says Dr K

expenditures and technical expertise

the future,” says Ayanabh Debgupta,

care that are also growing at a rapid

financial analytics and thus many such

endeavour involving a heavy capital

one

one of the focal services in clinical

training, we are never exposed to such

Proscans Diagnostics.

requires careful planning and vision for healthcare

industries, diagnostic and imaging are

to

“An imaging centre involves a lot of

Hospitals.

“One should have a strong passion to build an institution and serve the health care needs of the community,” says Dr D Umashankar, Managing Director & Senior Radiologist, Prima Diagnostics (Yelahanka). “It is all about the patients and what we can do for them,” he adds.

As radiology systems and consumables are expensive the financial feasibility study of the planned centre is a must.

“Financial

feasibility

study

with real data and financial analysis should be the first step towards the venture,” says Dr Karthik. The market analysis provides a fair idea of the demand for imaging services and the wait time involved in getting a scan. A careful evaluation of the health-seeking

A lot of planning and considerations

behaviour and healthcare needs of

are required to start an imaging centre.

the region one plans to set-up an

Starting up an imaging centre requires

imaging centre should be done.

strategic planning in determining the

should assess the demand and supply

need for the services in the region and

of

feasibility of establishing the centre to

of healthcare services like hospitals,

diagnostic

services.

“One

Availability

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19

COVERSTORY standalone

and

existent

diagnostic

start with a small centre with few

pricing whereas others may end up

like

modalities and grow the centre over

paying more for the same MRI or CT. It

and

time,” he says. “The budget may vary,

is true that newcomers get the shorter

larger chains in the region is required.

starting with about Rs 15-20 lakhs for

end of the stick,” shares Dr Karthik.

Assessment of facts and figures will

an X-Ray centre to above Rs 11 crores

help arrive at a techno-commercial

for a centre with MRI,” he further adds.

market

involving

standalone

competitors

imaging

centres

feasibility,” shares Dr Karthik.

Funding Consideration Since setting up an imaging centre involves putting in a lot of money upfront before one starts making a

not buck and radiologists may end up

always been high and a cause of concern

paying huge sums of money for the

for many radiologist entrepreneurs. The

diagnostic equipment, Dr Karthik says.

radiology association did try to lobby

Identification of Location

for the cost to be curtailed but the effort did not pay off as equipment providers

several ways to raise funds. Banks

resisted

in

Besides,

provide

equipment

loans.

high-end equipment this trend will

The cost of imaging equipment has

profit, funding is crucial. There are India

Until a homegrown company makes

such the

imaging

is

bank would require huge collaterals.

Phillips (Dutch) and GE (American). This

“Banks hesitate to give out loans to

means that the cost of the equipment

newcomers, as they may not have huge

varies with the value of dollar and euro

property or background to provide as

against the rupees. This itself is a burden

collateral,” shares Dr Karthik. Partnering

as it may add lakhs to the planned

with fellow radiologists, pathologists or

budget if rupees value decreases add

easily locate the radiology imaging

business houses may be a good idea. “A

to that the taxes and freight charges.

centre their doctor recommended, then

partnership works where like-minded

The final cost of the equipment also

you lose the patient,” he adds. In fact,

professionals come together and pitch

varies from institutes to people. “There

the centre should also be accessible to

in with the funding and the business,”

is wide variation in the price offered

public transportation. Otherwise, the

says Dr Umashankar. Another, way

by the equipment provider. The price

centre would be limiting the patient

to fund the machine is through the

varies from customer to customer and

pool. Access to public transportation

Non-Banking

Companies

depends on the equipment provider.

also allows the staff to travel easily,

(NBFCs) loans which the equipment

Some customers may get competitive

which is a huge plus point.

NBFC loans through the equipment provider are very costly. “The NBFC interest rates are much higher than the banks. Also, the loan term is short which adds to the overheads. It may not be advisable for a new venture to get into such pressurised relationship,” says Dr Karthik.

So it may appear that a radiologist without a business background may find the task at hand difficult. Not necessarily says Dr Umashankar. “If the radiologist is first-generation with high levels of ambition, they could find the right investment partners. In the case of low investments, one could always

20

January 2021

Siemens

(German);

More specifically it should

manufacturers,

However,

equipment

patients.

equipment that runs into crores the

facilitate.

three

be accessible and convenient for the

mostly

manufacturers

by

market

a vital role in business. It needs to

However, considering the cost of the

Financial

ruled

recommendations.

Location of the imaging centre plays

be located nearby the healthcare hub of the locality/region easily accessible from clinics of referring physicians and hospitals. “Pick a location that’s easy to find and has adequate space for approach road and parking,” says Dr Umashankar. “If the patient cannot

Equipment Specifications “An imaging centre involves technicalities related to equipment, engineering, building and safety concerns; it is a costly business endeavour involving a heavy capital expenditures and technical expertise for operations”

Once the budget is done for the centre the equipment planning and procurement

starts.

Based

on

the

list of services determined for the centre,

appropriate

equipment

with

appropriate specifications should be acquired

to

provide

comprehensive

service as per the scope within the facility. Being mindful of competitive

Ayanabh Debgupta Co-founder & Group President, Medica Hospitals

pricing helps conserve the money so talking to seniors and a few existing players is important. During training and residency, radiologists are exposed

aesthetically proper but accommodates

Therefore, much thought needs to be put

all

requirements.

into the central infrastructure. Design

equipment for a particular modality.

The design of the modern medical

and build projects are better as it gives

“The availability of equipment parts,

imaging department must meet several

one the freedom to make room for all

the service and maintenance, reduced

seemingly divergent needs like :

requirement. Most of the radiology

downtime, good customer care and

• accommodate large, heavy, noisy technical medical equipment with extensive infrastructure and shielding requirements

to only a few equipment; this limits their knowledge of the best working

customer support are all crucial to the success of the radiology centre,” shares Dr Karthik.

“Other than the primary equipment, availability of support equipment like computer-based storage (PACS), injector, printer etc. and back-up equipment like UPS, server, inverter and resuscitation equipment like crash cart, medicine tray should also be considered and budgeted for,” says Dr Debgupta.

Building Specifications A well-designed facility is not that looks

the

other

prime

• meet the legal and statutory requirements mandated through prevalent Acts like AERB and PC PNDT Act for building clearance and approvals • create a safe, pleasant and efficient staff work environment including accessibility to all • comfort patients who are likely to

centres run on leased buildings, which may not be suitable for the radiology practice. A simple example is a building entrance that is elevated and accessible only

with

stairs.

People

visiting

radiology centre are mostly patients who may face mobility challenges. They may find the physical barrier of stairs uninviting.

Also,

disembarking

and

walking long distance from transport is also not recommended. So even if the building is already built, work needs to be done to the premises.

be anxious or uncomfortable, or a

Human Resources

combination of both

Good

practice

needs

reliable

staff

support. “The centre should have the qualified staff as per the scope of service provided. It should have the

“If the radiologist is first generation with high levels of ambition, they could find the right investment partners”

services

of

a

qualified

radiologist/

Dr D Umashankar, Managing Director & Senior Radiologist, Prima Diagnostics (Yelahanka)

be undertaken to collaborate and tie-

related medical practitioner registered with State/Central Medical Council of India, competent for interpretation and reporting and a qualified technician to operate the equipment. Efforts should up with clinicians and hospitals in and around the region of the centre for getting referrals,” says Debgupta. In fact, connections in the market with

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21

COVERSTORY doctors, hospitals and vendors are

associated with it and hence it is

statutory requirements. Plus, the needs

of

“Personally

required that proper care is exercised

of the employees and patients also have

meeting potential referring consultants

throughout the imaging centre including

to be considered,” shares Gupta.

and appraising them of the centre’s

building specifications and equipment

capabilities and unique skills is a

installation” says Debgupta. In this

must,” shares Dr Umashankar.

utmost

importance.

“To

regard, AERB has regulated a list of

establish rapport with doctors, constant

equipment specific guidelines for layout

discussions

that is mandated to adhere to obtain

about

the

cases

and

licence for operation. These equipment

feedback is also important,” he adds.

specific building layouts are available

Marketing

on the AERB website which should be

The

room

housing

the

equipment

should have an appropriate area to facilitate easy movement of staff and patient. Similarly, appropriate structural shielding should be provided for walls, doors, ceiling and floor of the room housing the equipment so that radiation exposures to workers and patients do

Appropriate marketing efforts should

adhered to while designing and setting

also

before

up the imaging centre. These guidelines

building and establishment to develop

specify details on space requirement,

an ideal marketing strategy and get an

building materials to be used, thickness

edge over established competitors.

of wall and ceiling for radiation safety,

Design and Build

floor types and materials to be used

After going through these considerations

and solid condition, the equipment

one has to think about the construction

is usually very heavy and bulky and

of the facility. The building or site

hence the soil capacity and access to

considerations for imaging centre are

the site is a crucial consideration while

different from a hospital imaging centre.

planning,” says Ajay Gupta, Architect

“The imaging facility must be designed

and

within

in

Project Advisory Platform. “The layout

“The high magnetic resonance areas like

the technology of medical imaging

of the facility would need to be

CT-scan and MRI scan rooms must be

and AERB (Atomic Energy Regulatory

designed by a professional. Dimensions

properly secured with locked entrances

Board) mandated regulations. Unsafe

of rooms may vary wildly depending on

to keep out unauthorised persons and

use

the equipment specifications and the

particularly

be

of

channelised

the

constraints

radiation

has

right

etc.

inherent

health

risks

“Site

logistics

Founder,

including

Knowledge

access

Squirrel,

not exceed the respective limits. The control console for imaging facilities like CT-scan and MRI should be installed in a separate room located outside but adjoining to the imaging room provided with appropriate shielding, direct viewing and oral communication facilities between the operator and the patient. The gantry and couch should be placed such that it enables the operator to have the complete view of the patient from the control room viewing window.

to

prevent

inadvertent

introduction of potentially hazardous metallic objects. The design of the area must also provide adequate venting if a superconducting magnet should quench,” cautions Debgupta.

Considering the advent of evidencebased medicine in clinical practice, evidence-based

design

has

spurred

measurable impact on service outcomes including

patient

performance

and

satisfaction, overall

staff

efficiency.

“Patient changing and staging areas should be designed for privacy and dignity. designed

Waiting for

spaces

personal

should details

be and

comfort, reasonably close to the exam spaces and facilitating a connection to patient utilities like toilets and drinking water facilities. Staff work areas should

22

January 2021

detection.

“The configuration of the

patient dressing, control room and the actual MRI cabin is critical so that the

“Financial feasibility study with real data and financial analysis should be the first step towards the venture”

smooth workflow is maintained,” says

Dr K Arvind Karthik, Managing Director, Proscans Diagnostics

• Scan Room: 21’-6” X 13’-4” with 8’-

Gupta.

General

Requirement

of

MRI

Suite

Dimensions for installing 1.5T models:

9” ceiling height (after shielding is installed) • Equipment Room:

11’-0” X 11’-

6” with 8’-0” ceiling height (after shielding) be designed to facilitate tasks and

“Since the patient lies down on the

ergonomics to ensure comfort and ease

back to be diagnosed, some interesting

of access to patients, service areas,

ceiling designs bring down the anxiety

radiologists and often the family,” says

levels of the patient. The ambience and

Debgupta.

lighting design of the MRI room should

Building for MRI

be done keeping patients anxiety in

Shipping and rigging of the system need

mind,” says Gupta.

to be negotiated ahead of time and

MRI is the heaviest of the equipment in

• Control is

Room:

typically

12’ ample

X

8’

(this

room

for

workstation, desk/chair, and a bit of storage)

are required in the system purchase.

the imagining centre so it is extremely

Supply lines, floor drains, and soil pipes

important to know about the weight

should be nonferrous. Copper or PVC is

capacity of the building. “Even the

acceptable. If building codes require a

lightest MRI is extremely heavy (6.8

sprinkler system, only brass or copper

tons) hence, we need to consider a

component should be used. All sprinkler

few critical criteria's like the weight

heads that penetrate the RF shielding

with accessory companies for those

capacity of the slab it is installed on;

must

purchases,” shares Debgupta.

the clear path for the equipment which

grounded.

comes in three parts to move and be

be

completely

electrically

“You need to ask the vendor to include power injectors, heart rate monitors, and MR safe infusion pumps on the purchase. One can save a substantial amount of money by directly dealing

It is important to ask the vendor for

The ability to view the patient during

all the details about siting the MRI

the MRI examination is mandatory. At

machine like freight charges, additional

Also, the radio frequency shielding

the threshold of the examination area,

rigging fees, and special ventilation

for the MRI room is critical and no

space must be provided for metal

or cooling that is required for the

installed in the space,” shares Gupta.

occupied spaces should be around it.

MRI facilities walls should be concrete with minimum steel reinforcement or constructed of wood with standard nails,

consistent

with

the

national

building code. The areas (rooms) of MRI facility, including the doors and windows, should be completely shielded by a continuous sheeting or wire mesh of copper or aluminium to improve the MR signal detection by reduction of the environmental radio frequency.

“For design of a good imaging centre, architect, client, engineering team, equipment planner and equipment vendor need to be in sync” Ajay Gupta, Architect and Founder, Knowledge Squirrel, Project Advisory Platform

The shielding must be continuous and include both of the ceiling and the floor.

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23

COVERSTORY

MRI machine. “Question the vendor about weight issues for installing in various locations of the facility is of paramount importance. A 3.0 T MRI requires additional floor support to handle the additional weight of the machine, and the vendor can provide with this information before acquiring the machine,” suggests Debgupta.

specifies Gupta.

physicist or radiation expert retained

The layout of rooms in an X-ray installation should be such that the number of doors for entry to the X-ray rooms should be kept to the minimum.

The unit should be located in such a manner that it would not be possible to direct the primary X-ray beam towards the dark room, door, windows,

by the facility. Shielding is based on the specific imaging equipment utilised and typically will involve several different lead

thicknesses

depending

upon

primary beam and secondary scatter radiation fields, surrounding occupancy factors and other considerations.

Legalities of Imaging Centres

CT and X-ray Specific Considerations

and control panel or areas of high

CT and X-ray are the second and third

“In the CT Scan rooms. radiation is

promulgated under the Atomic Energy

largest spaces needed in an imaging

either

a

Act, 1962, provides the legal framework

centre and have radiation exposure

radionuclide such as Iodine-131 is

for the safe handling of radiation

issues hence the walls have to be either

injected for complete anatomy imaging.

generating equipment. As per Rule 3 of

lead-lined or be thick enough to not

Typical energy levels range between

AE(RP)R-2004 it is mandatory for all the

transmit any radiation. “Rooms housing

120kvp

room

manufacturers/Suppliers/Users of X-ray,

diagnostic X-ray units should have

dimensions for CT scan should typically

CT-scan, MRI, PET CT equipment, to

walls where the primary X-ray beam

be larger in size from 18'0" x 20'0"

obtain requisite ‘Licence’ from AERB for

falls should not be less than 35 cm thick

and up to 24'0" x 32'0". These rooms

carrying out the imaging activities. The

brick or equivalent and there should

should have shielded walls, a large

employer shall procure NOC validated/

be a shielding equivalent to at least 23

x-ray glass control window at least

Type

cm thick brick or 1.7 mm lead in front

48" wide x 36" high for a clear view of

from authorised suppliers and after

of the doors and windows of the X-ray

patient and procedures,” says Debgupta.

obtaining

room to protect the adjacent areas,”

Shielding must be calculated by a

obtain a license for operation from the

24

January 2021

occupancy.

Atomic

Energy

(Radiation

Protection) Rules, 2004 [AE(RP)R-2004],

electrically

and

The

produced

150kvp.

Hence

or

Approved

X-ray

procurement

equipment permission

Competent Authority.

There are guidelines for ultrasound owners for registration and use of ultrasound machines and are applicable across India. “The owner needs to register,

at

least

three

months

in

advance, all the places where a USG machine whether a black and white or colour doppler machine is to be used.

efficiency. “It is vital to identify a

will be coordinated with utility and

credible architect and interior designer

optimum

to plan the imaging centre layout. They

design of a good imaging centre, the

should ensure compliance of local laws,

architect, the client and his bio-medical

building code; special requirement of

engineering team, equipment planner

patients, AERB, NABH guidelines etc.It

and most importantly the equipment

is also advisable to employ a credible

vendor need to be in sync to get the

site engineer to monitor ongoing work,”

right kind of space and with the perfect

says Dr Umashankar.

service,”

he

adds.

“For

configuration,” adds Gupta.

This registration is compulsory and

“Interior designers should be inducted

is regardless of the type of studies

on the impact of this technology on

intended to be performed on that

patients so that design and create

machine. All radiologists/sonologists/

internal spaces that are aesthetically

doctors using USG machines need to

pleasing, comfortable and can provide

have their names entered in the PC-

ease to patients in such potentially

PNDT certificate or on a separate sheet

high-stress

that must be displayed along with the

Debgupta.

PC-PNDT registration certificate. No

technology from overpowering design

considerably more, involve a high level

doctor other than the one registered

is for the architectural and design

radiations and greater human aspects

in that particular centre is supposed to

team to thoroughly understand both

involving patient safety and comfort.

use the machine installed there,” shares

the processes and the equipment used

Thus, to meet these demands imaging

Debgupta.

for medical imaging thus the medical

centres need to be designed not only

team like radiologists and technicians

considering technical development in

inputs should also be undertaken to

mind but also prioritisation on patient

understand how the design process

journey.

The PC-PNDT registration certificate has to be displayed in original in the reception area and the USG room.

environment,” “One

way

to

says prevent

Diagnostics and Imaging services are of great significance since medical practices are becoming increasingly reliant on digital imaging techniques for evidence based treatment. While imaging centres are often viewed as high technology enabled simple spaces they also cost

There should be a board, prominently displayed, with the message in English and

the

local

language

that

‘sex

selection and detection is not done in this Centre and is punishable under the PC-PNDT Act’. This should be displayed in the waiting area and the USG room.

No specific size for the message is suggested. A copy of the PC-PNDT Act should be maintained in the centre and needs to be displayed in the waiting room/reception area as well as in the USG room.

Know the People Who Build The design and build of imaging centres requires the involvement of architects, MEP and structural engineers, who are can create designs and spaces with appropriate radiation safety measures and layout specification as per AERB guidelines and service areas aligned as per process flow to maximise operational

www.indiamedtoday.com

25

INNOVATE

Digital Twins Gain Traction in Healthcare

Dileep Mangsuli, Executive Director at Siemens Healthineers

The use of digital twins will increase in the medical domain. Advances in underlying computational models will be increasingly applied to create an AIpowered personalised bio-physiological model of the patient to make medicine more precise and personalised.

Organ models, which are one of the computational models, simulate the structure, mechanics, and functions of organs, help virtually evaluate therapy options. Researchers have already modelled the functioning of a patient's heart using algorithms, which are trained on over 250 million annotated images, reports, and operational data.

This approach enables care providers to test therapies based on a set of patient parameters such as size, muscle contraction, and to see the outcome in the model.

26

January 2021

Digital Twin of the heart

Based on MR images and ECG measurements, digital twin technology simulates the physiological processes of a patient’s organ.

Virtual planning is used to visualise responses to treatment before the intervention.

Similarly, patient avatar models, which

enterprises will be modeled to enhance

are virtual representations of patients'

their

physical bodies' shape and structure,

This

are being used to enhance planning

department's

clinical and diagnostic procedures and

including the reception, registration,

improve the overall patient experience.

and waiting areas. Further, modelling

Further, the use of predictive models,

the flow and resources using data

which help estimate outcomes, help

captured on the movement of doctors,

diagnose conditions, will increase. For

patients,

example, the use of disease models,

valuable process-related insights. Such

which represent some or all of the

comprehensive digital twins of the

pathological processes observed in an

enterprise will be used to predict the

actual disease, to help treat conditions

outcomes of a specific scenario, perhaps

better,

a reorganisation of the patient flow

solutions

have to

enabled help

detect

developing COVID-19

conditions in patients.

performance includes

and

and

modeling spatial

efficiency. a

specific

dimensions,

equipment

provide

and clinical workflow in a particular department. Such models also enable

The use of the digital twin approach

care providers to perform operational

will be applied to improve operational

stress testing on a department or an

effectiveness. Key aspects of healthcare

entire hospital.

www.indiamedtoday.com

27

APPROACH

Can Radiology NGO Save Patients’ Lives Health4theWorld is leading the way in capacity building and training doctors in resource-poor settings

Health4theWorld solutions are

Seeing her grandparents and fellow

engineers, film-makers, movie editors,

villagers

marketing

during

medical

remote

locations

and most importantly the doctors and

in resource-poor communities

without adequate diagnostics prompted

patients in different countries. Health

worldwide by education and

Dr Bhavya Rehani to tread on an

experts

technology

unknown path. She launched a non-

institutions volunteer to teach through

profit

Health4TheWorld.

directed to promoting health

suffer

emergencies

in

organisation

Health4theWorld

to be able to address a few of the healthcare challenges she had witnessed first-hand. Through her NGO, Dr Rehani reaches out to the needy that are in dire need of health challenges besides teaching doctors and patients. Recently, during the RSNA annual oration in diagnostic radiology, she shared her story and aspirations.

Rehani

did

Massachusetts Harvard

her

fellowship

General

Medical

School

at

Hospital, and

while

to

leading

the

United

academic

Nations

Sustainable Development Goal (SDG) of ‘Ensure healthy lives and promote wellbeing for all at all ages,’ the solutions

by Health4theWorld are directed to promoting

health

in

resource-poor

communities worldwide by education and technology.

Technology played a pivotal role in Health4theWorld's

growth.

Armed

with innovative solutions using mobile applications,

San Francisco, she came across Dr Bill

virtual reality helped the NGO, bring

Dillon, a renowned neuroradiologist. She

health

also happened to meet Ankur Bharija

remote corners of the world. The

(her husband) and together the three

technologies focus on local needs and

of them embarked on a journey to help

are available in local languages, which

people overcome healthcare challenges.

are free of cost and are available in

October

2016,

Health4theworld

started with three board members and a couple of volunteers. Within a year, the organisation marked its presence in 22 countries having a group of 40 team

January 2021

Committed

15

working at the University of California

In

28

from

translators

The Tech Push

The Beginning Dr

professionals,

machine

learning

empowerment

and

hope

and to

Swahili, Nepali, French, Spanish, Filipino and English. The organisation is building the

largest

online

free

education

platform for medical care professionals in low resource settings.

members. The diverse team consists

Says

of doctors, nurses, therapists, software

technology, when used with love to

Dr

Rehani,

“We

believe

that

The Stroke App One

of

the

main

innovations

by

Health4theWorld was the launch of the stroke app which guides patients with useful tips and to make fast decisions in case of an emergency.

Apart from imparting education on stroke prevention, the app provides guidance on regular exercises for stroke patients. Using animations, the app leads the stroke survivors through a stepwise exercise regimen. The app is designed for different levels of mobility, as created by accomplished physical therapy experts. It also guides awareness signs of stroke so timely action can be taken, besides providing educational

tips

to

live

well

with

disability caused by stroke.

Says Dr Rehani, "We have created a mobile

application

for

empowering

stroke patients used virtual reality for education and machine learning for a chatbot which provides hope to patients.”

The Future The its

organisation health

has

curriculum

in

expanded all

major

Dr Bhavya Rehani

leading causes of death and disability

Health4theWorld

worldwide, including heart disease, HIV/ AIDS, cancers, dementia and maternal and child health. It has built a Massive

help others, can pave the path for the beautiful future of mankind."

Training and Education Leading experts from premier academic institutions have volunteered to create educational content for live talks and creation

of

the

academy

website.

Health4theWorld partners with doctors in different countries who are local change agents and champion change.

proceeds used for projects.

Online Open Courses (MOOC) repository

Health4theworld academy provides free

for health professionals, which will be

online education in medicine to remote

hosted

parts of the world which provides many

org soon.

online courses by health experts from

Striving to reach out to providers and

across the world to doctors/people in remote locations who in case of any emergency can save the life of someone.

on

academy.health4theworld.

patients in remote and under-resourced communities globally and design and provide sustainable solutions that fit

The organisation provides technology

the local needs is what Dr Rehani and

resources in 110 countries. Faculty

her team are looking ahead.

in 19 specialities from 25 academic

Says Rehani, “We will continue to

The organisation focuses on sustained

institutions

engagement with providers and patients

and

everywhere and all the services are

Health4theWorld Academy with more

disseminate reliable medical content

offered for free of cost to anyone,

than 500 videos posted since the last

and enhance wellbeing for anyone

anywhere and 100 per cent of public

five years.

anywhere.” the word starts abruptly

provide

asynchronous

weekly

learning

live

through

leverage

futuristic

technologies

www.indiamedtoday.com

to

29

APPROACH with providers and patients everywhere and all the services are offered for free of cost to anyone, anywhere and 100 per cent of public proceeds used for projects.

Health4theworld free

online

academy

education

in

provides medicine

to remote parts of the world which provides a number of online courses by health experts from across the world to doctors/people in remote locations who in case of any emergency can save the life of someone.

The organisation provides technology resources in 110 countries. Faculty in 19 specialties from 25 academic institutions and

provide

asynchronous

weekly

learning

live

through

Health4theWorld Academy with more than 500 videos posted since the last five years.

Next Issue

Cancer Care Focused Get Involved Get Covered (mail: editorial@indiamedtoday.com) 30

January 2021

RADIOLOGY INSIGHT

Practicing Radiology During COVID Pandemic

The entire healthcare apparatus has been

scans need to be carried out in the country

shaken by one of the biggest pandemics

because of COVID-19. The NHS would need to

of modern times. Priorities have rapidly

increase the number of radiology positions

changed,

where

elective

care

and

preventative tests such as mammography screening have been put on hold. This has

by one-third, which means that the country needs another 1,900 radiologists to work

led to even greater pressure on radiologists;

through the backlog from the coronavirus

first to cope with declining volumes and the

pandemic.

financial consequences of that, and then to handle the massive increase in the upcoming

On a positive note, these new challenges

exams post-COVID. Handling the imaging

imposed by the coronavirus have resulted

backlog is a huge challenge for radiology

in an increasing speed of adoption for some

during this second half of 2020.

technologies. From an enterprise imaging

A study by Dr Howard Forman and Dr

perspective, the pandemic has put new

Joseph Cavallo from the Yale School

demands on your IT systems and the vendors

of Management, published in April in

providing them, including new technical

the Journal of the American College of

functionality for working and collaborating

Radiology, concludes that the pandemic reduced

radiology

practices’

imaging

volumes by 50–70 per cent during a period

remotely in an efficient, secure way and for handling the post-COVID imaging back-log.

of at least three to four months. The two

But also, the pandemic has shown a need

authors describe the situation as unique

for the increased flexibility of the payment

since:

model for diagnostic IT systems, to better

“...economic

recessions

generally

tend to result in decreased health care

adjust costs to rapidly changing volumes.

expenditures, radiology groups have never experienced an economic shock that is

In this special issue focusing on radiology,

simultaneously exacerbated by the need to

experts speak about how the radiology

restrict the availability of imaging.”

sector has evolved over time and what

The Royal College of Radiologists in the

challenges

UK estimates that 850,000 MRI and CT

COVID-19 pandemic

did

they

face

during

www.indiamedtoday.com

the

31

RADIOLOGY INSIGHT Dr Deepak Patkar Director of Medical Services, Nanavati Super Speciality Hospital Head of Imaging Department President, Indian Radiological & Imaging Association

And now we have the new COVID variant!

It is supposedly more virulent than the previous strain but less lethal!

have become the frontline warriors in the battle against COVID. CT scan started playing an important role in the detection and confirmation of COVID-19. It has proven

When 2020 started the coronavirus was

to be extremely useful in situations where

just another emerging mutated strain of a

RT-PCR tests were negative or were not

previously existing one. While celebrating

available and clinical suspicion was high. It

the new year party little did we know that the virus would grip the entire globe in its clutches and here we would be welcoming 2021 seated on our couches.

Well, let’s keep our fingers crossed and

was also useful in ruling out other diagnoses in

positive

patients

with

worsening

respiratory status.

Radiology preparedness for COVID-19

hope for the best. We wish that Santa and

With limited knowledge and literature on

2021 bring with them relief in the form of a

the virus, to prepare ourselves and our staff

robust and reliable vaccine.

When I was studying radiology in the Topiwala National College Mumbai, my teachers would always be complaining about the newer technologies that they were not well versed with- CT Scan and MRI. So to begin with radiologists were considered

to

be

mere

photographers

reading some grey X-Ray films. Over the past two decades, radiology has emerged

Healthcare should be considered as an industry and should derive the same benefits and receive the same concessions and subsidies as other industries, especially radiology

as one of the fastest-growing branches of medicine. The advances in radiology are unparalleled and with the branching of the subject into various subspecialties ( interventional radiology, foetal imaging, onco imaging, MSK imaging, etc.) has made it an important part of patient care and disease management. All fields of medicine are in one way or the other dependent on the diagnostic capabilities of radiologists to guide them in further patient management.

Not just diagnostics, radiologists have also made a mark inpatient management and interventions.

During the past few months, radiologists

32

January 2021

was a daunting task. As frontline workers, we had to ensure the health, safety and preparedness of our department, our staff, patients and ourselves. Radiology departments had to be nimble in implementing operational changes to ensure safe and continued radiology services.

We had to : - Establish emergency management and infection control team. Whilst in India we do have experience with the higher rate of pathogenesis, this was something our generation had not seen before.

- Ensure rapid sharing of accurate and useful information and all infection prevention protocols are up-to-date. The world across, we shared our data and findings on an almost daily basis and kept a lookout for protocols released by the different radiology societies and colleges across the world.

- Reconfigure the radiology department by creating a new hybrid multitasking team.

When the nation went into a lockdown and the public transport services were disrupted it was practically impossible for healthcare workers to reach their workplaces. This was not so difficult for us because in normal times we do have the 'mama' filling in for the reception desk when they are on their mini breaks or the senior technician with long years of experience guiding the fresh radiology resident in positioning the patient and diagnosis.

-Take appropriate measures to provide adequate PPE to radiology unit personnel.

Train them properly about the donning and doffing of PPE. Before the PPEs started getting Made in India, not only radiology but all medical facilities were reeling under the financial burden of the extremely expensive PPE. - Be judicious in the use of radiology equipment and manpower. In the beginning suspect patients were scanned only when the wellbeing of the patient would have been compromised otherwise. But now it is faster and more reliable to run an HRCT scan on suspect patients to establish the disease than to wait out for the sometimes falsenegative RT-PCR tests.

- Streamline workflow- Segregating the 'normal' patients with the COVID infected

and taught them the topic to the best of my abilities. Sometimes my department was overflowing with more students from across the country and borders, than patients. That their valuable learning and training time was getting disrupted was causing me a lot of concern. But thanks to technology, that gap was sealed quickly.

Radiology is a tech-friendly branch and a lot of work is already going on in Research and development. Teleradiology is an important tool which radiologists use for reporting cases from across the world, while seated in the comfort of their workplace or home.

Teleradiology has been immensely helpful in the last few months when ‘work from home’ became the dire need of the hour.

These days no talk on technology can be complete without the mention of artificial intelligence. Advances in the field of AI reduce the pressures and workload on the radiologists and more importantly will help ones was the first important and difficult

family and home to support our patients

task. Special corridors and time slots were

and keep our facilities running. Each day,

created across the hospital and radiology

overcoming the fear of the existing crisis

department to keep patients away from

was a challenge for them. We took special

been highlighted during this pandemic

each other. Our sensitive radiology machines

steps to boost their morale.

especially in our country is the healthcare

needed to be cleaned and sanitised for the next patient. A suitable time gap had to be

But we have evolved. Now we are more

to fine-tune their skills and knowledge.

As I close, one particular aspect that has

sector. It requires watershed moments.

comfortable in dealing with the situation.

The government needs to focus more and

With all the necessary precautions of course!

come up with new policies in this particular

Indian radiologists not only across the

sector. Healthcare should be considered as

Radiology managers cannot overlook the

country but also the ones residing across

an industry and should derive the same

importance of their staff. We must ensure

the globe have done tremendous work in

benefits and receive the same concessions

that they remain calm and do not get

their chosen field. Our national body for radiologists, the Indian Radiological and

and subsidies as other industries, especially

overstressed

maintained between two patients.

Our co-workers and staff

Lionel Tim-Ee Cheng

Imaging Association is always working for the welfare of its members. During

radiology. In the past few months, radiology has faced several injustices in the form of capping of rates, without acknowledging

We had to take all precautions to protect

these unprecedented times when onsite

our staff and ensure that their morale is not

educational meets had to be halted, the IRIA

the high running and maintenance costs of

broken during these torrid times. Several

continued medical teaching through several

radiology setups, be it in corporate hospitals

got infected whilst on duty. The long hours

webinars. As the head of the association

or the stand-alone ones.

the staff had to stay in their PPE without the

this year I am proud to state we have

restroom breaks and so much as water left

conducted about 100 webinars in the past

them exhausted, irritable and less hopeful

months covering various sub speciality

each day. But they are our true warriors.

topics in radiology and programmes for our

all the losses that they had to face, and that

Every morning, when the entire world stayed

young residents. In my 30 years of practice,

in these past months quickly turn into a

at home, our staff members left behind their

I have always welcomed young students

bleak memory for them.

As we slide into 2021, I wish everyone a great new year and that they can overcome

www.indiamedtoday.com

33

RADIOLOGY INSIGHT Usha Goenka Director & Head, Dept of Clinical Imaging and Interventional Radiology Apollo Hospitals, Kolkata

Radiology is now not only a key diagnostic tool for myriad diseases but also has a pivotal role in prognosticating, treating and monitoring of diseases. We have many types of equipment in our armamentarium and these now come with a high anatomical resolution and sensitivity, maximising the diagnostic yield and this is critical and indispensable in any clinical setting.

Judicious use of the tools is however of utmost importance to society and mankind.

Radiologists have moved shoulder to shoulder with these technical developments; and have been an integral part of this revolution, thus ensuring the best minds behind best machines, to maximise the use of various healthcare resources for utmost clinical effectiveness.

Most commonly used diagnostic radiological examinations include: • Computed tomography (CT) including CT Angiogram (CTA).

• Flouroscopy for various special investigations of GI and Urinary tracts.

• Magnetic Resonance Imaging (MRI) including MR Angiography (MRA) and MR cholangiopancreaticography (MRCP).

• Plain X rays, including spine and chest x rays.

• Ultrasound and Doppler.

• Mammography and used for breast imaging.

• Positron Emission Tomography also called PET imaging, which is now an indispensable tool in cancer imaging and follow-up.

• Nuclear Medicine, which includes bone scan, thyroid scan and thallium cardiac stress test.

Using one or more of these diagnostic techniques, the radiologist helps in: • Diagnosing the cause of the patient’s clinical symptoms and manifestations.

34

January 2021

• Early pick up of various illnesses like breast cancer, heart disease or colonic cancers when they are still amenable to cure.

• Monitoring the response to the treatment being given for the disease.

The last decade has seen a paradigm shift in the management of various diseases due to the rapid speed in which the field of interventional radiology has progressed.

There has been a revolution both in the equipment and techniques of interventional procedures, so much so, that the minimally invasive surgeries performed by the much skilled Interventional radiologists have become the standard of care in a large number of disease conditions.

The last decade has seen a paradigm shift in the management of various disease due to the rapid speed in which the field of interventional radiology has progressed Interventional radiologists use imaging equipment like CT, USG and or Fluoroscopy to help guide accurate localisation of the disease and to reach this, with help of needles, guide wires, catheters and other specific tools in a precise manner, thereby helping in treatment, through micro incisions. This method reduces the morbidity and hospital stay in most situations, thereby making them costeffective alternatives to open surgeries. In this way, the interventional radiologists are very often involved in treating cancers or tumours, they help open blockages in organs and vessels, help treat back pains, liver

diseases, kidney problems, uterine fibroids and even brain haemorrhages and strokes.

Some of the examples of interventional radiology procedures are: • Catheter placement for venous access – Chemoports, PICC lines, Dialysis lines etc.

• Needle aspirations and biopsies of different organs and diseases under USG or CT guidance.

• Tumour ablation with radiofrequency ablation, or microwave ablation.

• Needle or catheter drainages of collections, pleuro-peritoneal fluids, abscesses.

• Vertebroplasty, kyphoplasty.

• Stent placements for blocked vessels: arteries or veins.

• Embolisation to control bleeding in any part of the body including GIT, kidneys, brain.

• Cancer treatment by Intraarterial Chemoembolization or Radioembolization.

• Opening up of the blocked biliary system in jaundice or blocked urinary tracts by stent placement.

• Uterine artery embolisation for uterine fibroids or arteriovenous malformations.

• Stroke management.

• Coil placement for aneurysms.

• TIPS procedure for portal hypertension, refractory ascites / pleural effusion and for variceal bleed refractory to endoscopic treatment.

We at Apollo Hospitals, Kolkata, have all Radiological Diagnostic and Intervention facilities under one roof and patient management is carried out in an integrated fashion with radiologist being an integral part of the patient management team, in all specialities.

Dr Sanjeev J Mudakavi Consultant Radiologist, Vikram Hospital Bengaluru

significant

radiology technicians who contracted the

distortion of the healthcare industry all over

disease and had to be quarantined. One

the world.

doctor and a transcriptionist also contracted

time of extreme confusion as patients had to be isolated even from their relatives who were understandably anxious about their

the disease and were quarantined. The staff

wellbeing.

has

Coronavirus

caused

The spectacle of people being tested with nasal swabs and treated in ICU by the healthcare workers are imprinted in the minds of most people. Equally involved in the process of the detection and treatment of the infected patients were the radiologists

shortage that resulted from the technicians contracting the disease caused significant disruption in the routine working and many had to work overtime to be able to provide the necessary services.

and radiology technicians who worked

The policies of lockdown and suspension

behind the scene workers.

of the public transport added to the woes

In the initial days of the pandemic, the

as the necessary personnel were unable

X-Ray films were done on all patients. Later the shortcomings of only taking X-Rays

to come to the hospital in the initial days as confusion reigned but as the days went

became apparent as many patients had

by alternate arrangements could be made.

a lung disease that was too subtle to be

However, the department and indeed the

appreciated on the chest X-ray alone and

hospital staff always went out of their way

Computed Tomography (CT) scans began

to compensate for any staff shortage and

to add value to the diagnosis. With more experience, came the classification and scoring systems that would determine the severity and hence prognosis of the disease.

The value of ultrasound in the detection of lung and pleural disease is well known and was tried in patients with COVID, but was soon given up as the risks of transmission of the disease to the person doing the scan and also transmitting the disease through

The fact that most of the patients in our hospital made good recoveries with very few fatalities is a matter of great pride for all of us as it is a reflection on the care provided. Another matter of great fortune is that all the hospital staff who had the disease recovered completely without any lasting after-effects.

Finally, the pandemic is showing signs of abating and the availability of a vaccine is very close. Hopefully, the COVID-19 infection will soon be conquered and the whole world will be healthier. Health is after all the real wealth.

The department and the hospital staff always went out of their way to compensate for any staff shortage and everyone worked hard and ensured that quality of care was never compromised

machine components could not be ignored.

In the radiology department, when patients infected with COVID-19 were to be imaged through

any

modalities;

of

there

these would

aforementioned be

doctors,

everyone worked hard without complaints.

As a result, the standards of care never suffered. The compassion shown to the healthcare workers was exemplary and very

technicians, transcriptionists, nurses and

gratifying.

other hospital staff who would have to

The number of people getting infected and

interact with them and were exposed to the disease.

Inevitably in our hospital, we had many

the fatalities were constantly highlighted by the news agencies and were causing a lot of panic throughout the country. It was a

www.indiamedtoday.com

35

RADIOLOGY INSIGHT

Dr Vikram Sanghi CEO and Radiologist, Health Plus

The growth of radiology in Indian diagnostic sector opens up plenty of opportunities for imaging centres. According to RedSeer, the Indian radiology market was worth Rs 8,000 crore approximately in 2016, and has been growing at 15-20 per cent CAGR. I did my MBBS, MD and DMRE from PGIMS Rohtak. Subsequently, I joined the

a billion people.

focus on reducing radiation exposure is

Under such of circumstances, I decided

increasing with innovative technologies

to contribute to the overall healthcare

coming into play. This augurs well not only

ecosystem by setting up my imaging facility.

for the patients, but also the radiologists

This vision was fulfilled in the year 2010

and the other imaging centre personnel

when I set up Health Plus Imaging Centre.

who are regularly working in radiation risk

The

environments.

advances

in

the

awareness

and

Edwards

technology in the diagnostics sector have

Memorial Hospital, (KEM) Pune to do a DNB

led to a rapid surge in demand affordable

in Radiodiagnosis. I spent several years

and high-quality digital diagnostics. There

as a resident doctor in the Department of

is a rising availability of imaging equipment

Radiology in Batra Hospital Delhi and also

in the secondary and tertiary healthcare

at Max Hospital in Saket. Early in my career,

sectors. A large number of existing imaging

to-date technologies and sharing of clinical

I realised that there was a tremendous scope

centres, especially in the non-Tier I cities,

information across specialities and regions

internationally

reputed

King

for radiology and diagnostics in India.

Radiology plays a critical role in the identification and treatment of critical illnesses health

alongside and

supporting

wellness

regular

requirements

of

the society. However, the radiology and imaging services especially CT scanners, MRI machines and other advanced imaging machines were not easily available beyond

The advances in awareness and technology in the diagnostics sector have led to a rapid surge in demand of affordable and high-quality digital diagnostics

the major metropolitan cities. Even in the

Another major change that we see today is the shift towards consumer-centric services in the radiology industry. There is a focus on personalisation of screening using the up-

through digital communication.

If we look at radiology’s potential from the perspective of the COVID-19 pandemic, it can empower the healthcare professionals in

improving

surveillance

of

diseases.

Monitoring the location, origin and severity of a disease to its eventual treatment, radiology

is

all

set

to

make

crucial

contributions.

metropolitan cities, the public healthcare

continue to use analogue and outdated

facilities

advanced

technologies which affect the quality and

Radiology is going to increasingly play a

radiodiagnosis facilities. Either the machines

speed of the outcome. Consequently, Indian

role in the healthcare industry. If we look

were not available in the government

imaging the industry is now focussing on

at radiology’s potential from the perspective

hospitals and healthcare facilities or they

hybrid imaging which is obtained by fusing

of the COVID-19 pandemic, it can empower

frequently

remained

two or more imaging technologies to create

dysfunctional due to inefficient handling.

a new system. By merging the best aspects

Until about a decade back, there were not

of multiple modalities, one can make the

even 1000 MRI machines, approx 3000 CT

diagnostic tests more accurate and reduce

Scanners and roughly 55000 USG machines

the risk of radiation exposure as well. As

its eventual treatment, radiology is all set to

in the country to cater to a population over

I see in the modern imaging industry, the

make crucial contributions.

36

severely

broke

January 2021

lacked

down

and

the healthcare professionals in improving surveillance of diseases. Monitoring the location, origin and severity of a disease to

DRIVE

Sine Qua Non From radiology to lab diagnostics, this spirited entrepreneur evolved the diagnostic landscape of South India. Meet Dr Sunitha Lingareddy, MD, Lucid Medical Diagnostics, as she narrates her story to M Neelam Kachhap it becomes clear why she is the Sine qua non to diagnostics in South India

Recognised and respected by her peers across India, Dr Sunitha Lingareddy, Managing Director, Lucid Medical Diagnostics started her entrepreneurial journey in 2006.

During that time, Hyderabad did not have many sophisticated equipment for radiology and imaging. This was the time when imaging and radiology was metamorphosing into new

configurations and forms as a result of innovative technologies and newer discoveries. Dr Lingareddy brought the first 64-slice cardiac CT to the region.

It meant saving time and unnecessary catheterisation procedures for patients.

Coming from a humble background, Dr Lingareddy had always dreamt of bringing technology closer to patients

www.indiamedtoday.com

37

DRIVE and she was determined to help patients get access to the best of technology in their towns. After she gave up her flourishing career as a consultant radiologist at the AIG hospital and decided to venture on her own; she started at the bottom and worked her way up, overcoming challenges and taking huge financial risks. In time, these risks paid off as her vision took shape. Today, Lucid Diagnostics offers a range of services that extend from radiology, pathology, histopathology, molecular diagnostic and even genetic testing.

Lucid Diagnostics’ success is evident from the number of tests it runs which are above the industry average. That the company is growing at a swift pace and is constantly being chased by private equity firms. Here Dr Lingareddy tells us how she created an opportunity to provide affordable diagnostics, creating thousands of job and enabling hundreds of doctors better diagnostics in the bargain.

In the beginning I was practicing radiology at Asian Institute of Gastroenterology (AIG) and thought of starting my own centre. This was around 14 years back. I saw an opportunity as there were no outpatient radiology centres. There were low end (0.2-0.3 tesla)MRI machines, single slice CT, a few dual slice CT. The market was not sophisticated and no one focused on ambience and patient experience.

Taking the First Step It was sometime in 2006, that, I discussed the idea with my husband Dr Phani Kumar Reddy Mallidi who had a successful business and medical practice. The idea for a young female radiologist to have an entrepreneurial aspiration was very adventurous, but at the same time exciting. The idea was also supported by my family, peers, teachers and mentors. Prof Subbarao was my teacher during my MD years and had a profound impression on me.

Dr D Nageshwar Reddy, Chairman, AIG was my mentor and very supportive when I left to start Lucid Diagnostics.

Building to Succeed We started with one centre and today

38

January 2021

Dr Sunitha Lingareddy Managing Director, Lucid Medical Diagnostics

we have close to 32 centres. We had to postpone work on a few projects due to the COVID-19 pandemic. As we speak, two more centres are coming up in Telangana. In addition, we run 1820 franchise and collection centres. We started with 15-20 employees and have 600-700 employees today.

Initially, we started with an imaging centre and then moved into lab diagnostics and hospital lab management. Currently, we are working on four major projects with corporate hospitals. We have all diagnostics under one roof including molecular diagnostics and genetic testing. We currently run the full array of test for COVID-19 detection; be it Antibody detection or RT-PCR or CB-NAT we are offering all tests.

Challenges and Risks India is a price-sensitive market and our capex for the first centre was quite high.

We were doing this for the first time and we could not price our services the way we wanted. We had to be competitive in the market. It was difficult to make sense financially. Breakeven looks like Mt. Everest – an unattainable goal.

Thankfully, we were supported by bank loans and that helped us along with the business family background that helped us set-up the business.

When you are a new brand, you face a lot of challenges to establish the brand. People have to gain faith in your reporting. Lucid was known for good quality reporting. In the early days, we were doing 10-12 MRI and 10-12 CT,

but we were focussing more on quality.

We invested in creating a good brand image which was focussed on quality; and we did a lot of speciality focussed marketing. We educated the fraternity and went for gastroenterology, oncology and orthopaedic specific marketing. Today, the bread and butter of any diagnostic centre would be CT brain, PNS and MR Brain and MR Spine.

We tried to differentiate, position ourselves to stand out with our service, infrastructure and diagnostics. The challenge was to do something different and relevant. We ended up creating an ecosystem and creating an environment for the business which help subsequent business and inspired others to walk the path to success.

Many Accomplishments In many ways, Lucid created history as it became the first to introduce a number of several industry innovations.

We got the first, 64-slice cardiac CT to Hyderabad. It was a fully-loaded system; we even had lung nodule detection for carcinoma at that time.

On the MR side, we were the first to start with knee cartigram. We introduced musculoskeletal radiology here which made a huge difference for the orthopaedic practice. For example, a condition called chondromalacia patellae is a condition where the cartilage on the undersurface of the patella (kneecap) deteriorates and softens. This was largely ignored by the clinicians at that time; event hough it was quite common in 30-40-year-old adults. We had the means to diagnose it at that time. We had a specialised software to analyse the cartilage and tell what the cartilage looked like which is not normally visualised on an x-ray.

On an MR you can see cartilage but you don’t get the values for diagnostics. This made a huge difference for the patients suffering from chondromalacia patellae and their treating orthopaedics.

additional cost, people did not want to invest in such supplementary equipment and the expertise to read such images was also not present. For me also it was a learning experience with breast cancer. Luckily, we had two major cancer institutes working with us. Both did a good amount of work in breast cancer and did not have in-house specialised imaging at that time.

Lucid became the ideal centre even for equipment manufacturers, who would showcase the diagnostic centre as the ideal centre to prospective clients.

We are among a handful of labs in India to have CAP and NABL accreditations.

We have received many accolades and awards both from industry and the government. We run a number of research projects. Right now we have a project on dementia, another on cortical blindness, which is IndoGerman collaboration between us and University of Salzburg, Germany.

In Future Lucid Diagnostics is dedicated to growing its business in South India, focusing on Andhra Pradesh and Telangana Tier-II and III districts; then moving on to Karnataka. We would expand and grow here then move to other states. We are not in a rush to grow, we want to start a centre establish the market and then move on to the next.

We usually prefer greenfield projects but we do not shy away from brown field projects. We are also looking for a few M&A opportunities to grow.

However, we do not want to indulge in PE as we are self-reliant at the moment.

Having said that, we also do not discard the notion of joining hands with equity firms in future. Maybe we have not found the right match. We have had the vision to bring in a fresh perspective and approach to diagnostics services in India. Our journey has just begun.

Lucid offered breast MRI with spectroscopy, which was unheard of at that time. In breast MRI, dedicated breast coil is required to obtain images of diagnostic quality which is an additional expanse. Due to the

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39

HEALTH - IT

Surging Growth and Danger of Cyber Crime in the Healthcare Sector

healthcare

The majority of the data under attack

industry saw a substantial increase in

in the healthcare sector is personal

the number of breaches and incidents.

data followed by medical data and

Out of 3,950 confirmed breaches, the

credentials. Criminals are after one

number of data breaches in this sector

piece of information – personally

came in at 521 versus 304, in 2018.

identifiable

Verizon’s Data Breach Investigative

protected health information (PHI).

Report

financially

Your PII or PHI may be collected or

motivated criminal groups continue

created by a healthcare provider,

to target the healthcare industry

health

via ransomware attacks. Lost and

information

stolen assets also remain a problem

a person’s name, address, phone

while basic human error is alive and

number, medical insurance details,

well in this vertical. Miscellaneous

beneficiary

errors, web applications and phishing

account

or

compromises

data, facial images etc. There is a

represented 72 per cent of breaches

tremendous amount of information

in the healthcare sector.

flow in Healthcare – prescription

In

Prashant Gupta Head of solutions South East Asia & India, Verizon

40

January 2021

2019,

the

global

revealed

business

that

email

information

insurer

or

can

(PII)

employer. usually

information, numbers,

and

The

contain

financial biometric

information pharmacies,

sent

from

billing

clinics

to

attacks, while in 2020, it has dropped

perpetrated by internal actors fall to

statements

to just 8.7 per cent. Does that indicate

48 per cent. However, this is a small

mailed, discharge papers physically

that insiders are no longer committing

percentage, and Healthcare remains

handed to patients, copies of identity

malicious actions with the access

the industry with the highest amount

and insurance cards filed and so on.

granted to them to accomplish their

of internal bad actors.

In my opinion, unless you really protect data at its core, no matter how many network-level protection or

jobs? Well, we wouldn’t go quite that far. However, it will be interesting to see if this continues as a trend when

As with many things in life, as one attack grows more prevalent, others begin to decrease. So the story

end-point level protections you put

next year’s data comes in.

in, it won’t keep you secured for too

Another change that goes along with

pattern.

long.

Healthcare organisations need

decreased insider misuse breaches is

graced the top three patterns in this

to conduct a proper risk assessment

the corresponding drop in multiple

sector, it took the gold this year. In

to prioritise investments and focus on

actor breaches. The healthcare sector

case you are curious, the top mistake

has typically been the leader in this

within healthcare is our old friend,

type of breach—which usually occurs

mis-delivery.

when external and Internal actors

This error tends to fall into two major

the issues that matter the most and mitigate the risk or bring the risk to an acceptable level. These organisations need to follow the defence-in-depth approach to safeguard their critical systems and data as our research tells us that by increasing the number of layered controls (in essence the number of steps that an adversary has to clear) to protect systems/data could be very effective in decreasing

goes with the miscellaneous errors

combine forces to abscond with data that is then used for financial fraud.

The multiple actor breaches last year were at 4 per cent, and this year we see a drop to 1 per cent. The 2019 DBIR reported a first in that the healthcare vertical had Internal actor

While

it

has

frequently

categories: • Someone is sending an email and addresses it to the wrong (and frequently wider) distribution—it’s a bonus if a file containing sensitive data was attached with their patients.

breaches (59 per cent) exceeding

•

those perpetrated by external actors

mass mailing (paper documents) and

(42 per cent). This year external actor

the envelopes with the addresses

In the 2019 report, we showed

breaches are slightly more common

become out of sync with the contents

privilege misuse at 23 per cent of

at

of the envelope. If sampling is not

the probability of occurrence of a data breach.

51

per

cent,

while

breaches

An organisation is sending out a

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41

HEALTH - IT Security Critical Security Controls to

systems, and

mailing process to ensure that they

provide you with a way to translate

those.

remain *NSYNC, then it’s bye, bye,

DBIR data into your security efforts.

bye

Here are the top controls that our

done

periodically

to

your

throughout

patients’

the

sensitive

information

data suggests will be worthwhile for

When thinking of the healthcare

most organizations.

vertical,

• Continuous

one

naturally

thinks

of

medical data. And, unsurprisingly, this is the industry in which that type of data is the most commonly breached. However, we also see quite a lot of both personal data (which can

vulnerability

to find and remediate things like vulnerabilities;

also

great for finding misconfigurations.

be anything from basic demographic

• Secure configuration ensure and

information to other covered data

verify that systems are configured

elements)

with only the services and access

and

credentials

stolen

in these attacks. The second most common

pattern

for

healthcare

is the web applications attack. As more and more organizations open patient portals and create new and innovative ways of interacting with their patients, they create additional lucrative attack surfaces.

Finally, we see a good deal of the Everything Else pattern, which is not unlike a lost and found for attacks that do not fit the criteria of any other attack pattern.

It is within this pattern that the Business Email Compromise resides.

If you’re not familiar with this attack, it is typically a phishing attack with the aim of leveraging a pretext (an invented scenario to give a reason for the victim to do what the attacker wants)

to

successfully

transfer

money (by wire transfer, gift cards, or any other means). Although these are common attack types across the dataset, it is a good reminder to Healthcare organizations that it isn’t only patient medical data that is being targeted.

Recommended best practices •

This year we’ve aligned our

findings with the Center for Internet

42

January 2021

• Boundary defense —Go beyond firewalls to consider things like network monitoring, proxies and multifactor authentication.

management — Use this method code-based

limit access to

needed to achieve their function.

• Data to

protection—Control sensitive

maintaining

access

information an

inventory

by of

sensitive information, encrypting sensitive data and limiting access to authorised cloud and email providers.

• Account monitoring—Lock down user

accounts

across

the

• Email and web browser protection

organisation to keep bad guys

lock down browsers and email

from using stolen credentials. Use

clients to give your users a fighting

of multifactor authentication also

chance when facing the Wild West

fits in this category.

that we call the Internet.

• Implement a security awareness

• Limitation and control of network

and training program —Educate

ports, protocols and services)—

your users, both on malicious

Understand what services and

attackers

ports should be exposed on your

breaches.

and

on

accidental

PULSE

Healthcare Interoperability – The People Aspect Without interoperability, vital patient health Information would be locked at the facility of care, resulting in fragmented health information which may not be available when needed. In this article, the author discusses how interoperability is made possible by the implementation of standards

“How is your mother doing?” asked Rahul, Sameer’s friend. “She is doing well. She is inhome care,” Sameer said. “Homecare!” exclaimed Rahul.

“Yes, after her surgery, the doctor advised us to keep her under homecare, for a few weeks, until she recovers and regains her strengths,” Sameer said.

“But, I think hospital stay would have been easier. Home care is hectic. Book appointments with doctor, measure and report vitals daily, schedule sample collection for tests, receive lab results and send lab results to the doctor, file receipts with insurance, call to check if the medicine is available in pharmacy or not, if available arrange for a pickup or drop. It’s hectic,” he sounded weary. “This is a very good use case for healthcare interoperability,” Rahul said.

Kumar Satyam Senior Software Architect, Speciality - healthcare Interoperability, Philips Innovation Campus

What is Interoperability?

During one's lifetime, a person visits many

The IEEE describes interoperability as the

healthcare facilities and doctors. Each

ability of a system or a product to work

encounter creates new health data, which

with other systems or products without

is in files either with the patient or with

special effort on the part of the customer.

the facility. In most cases, it is usually the

Interoperability is made possible by the

patient who is responsible for all record

implementation of standards.

keeping.

If we look around, there are plenty of

Without

examples of how interoperability has made our lives easy. An example is the standardised electric sockeat in the house.

Any electrical equipment (made for the country and in its power category) would fit into the socket easily, we do not worry about different sockets for each electrical device we buy. Similarly, we play music on

interoperability,

vital

patient

health Information would be locked at the facility of care, resulting in fragmented health information which may not be available when needed. Interoperability, on

the

other

hand,

transforms

this

fragmented and siloed health information into a federated and longitudinal health record of the person.

any media player of our choice using any

Interoperability provides value to every

sound system. Web can be browsed from

stakeholder in the health ecosystem. The

any browser ( chrome or firefox). All these

following table lists some benefits of

are examples of interoperability.

interoperability by stakeholders.

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43

PULSE Stakeholders

Benefits

Patient longitudinal records,

Care continuity, elimination of redundant testing, improved outcomes, Wearables, better privacy and security

Clinicians

Faster and more accurate diagnosis, decision support tools, access to information as needed

Hospitals

Administrative efficiency, eliminate paper and delays, disease registries, clinical trials and research, avoid vendor lock in

Insurance/payer

Faster settlement, improved efficiency, fraud detection, risk profiling

State

Population health surveillance, public health policy, strategic planning

Vendors exchange and

Standard interfaces, innovation in product, cost efficiency, level playing field repurpose health data for innovative services

The Human Factor

agendas and egos; resulting in the most

Today, technology is available to record,

acceptable version of the standard which

exchange and archive any kind of data

may not be the best or perfect.

instantaneously. Video, audio, document,

• Why should I share data? Why would third parties share data?

• Who will do the additional work?

Then we get to the implementers, who

• What about the data quality and

image exchange are part of our daily

are vendors who have the responsibility

lives; then why is it that healthcare

to implement the standards. Vendors may

interoperability is still a challenge?

choose to implement the standard in full

It is because Interoperability is not as much

or in part or with their add-ons as deemed

about technology as it is about people.

necessary by them. It is not uncommon in

Grahame Grieve, FHIR product director for

the field to find products having the wrong

HL7 International says “Interoperability is

implementation of the standard.

all about people.” “That’s because the real

Trust is an enabler of interoperability.

problems with interoperability are not

How often have we seen repeat tests

technical. They’ve never been technical.

being ordered for patients just because the

It’s the people that are the problem

physician or the hospital doesn’t accept

because IT systems are only extensions of

results from other physicians or hospitals?

the people who wrote them, who maintain

Challenges in Interoperability

What good would interoperability be in this

them, who use them. If you want two IT

Interoperability pays in the long run. There

case? Many interoperability projects get

systems to interchange data successfully,

is an upfront cost to implement Health

delayed because competing vendors at the

you’ve got to get alignment between the

IT systems, flexible and interoperable

site are not able to come to an agreement

people who write them, manage them,

systems are expensive. Cost recovery

about changes required and do not share

and use them. The technical challenges

may take time and depends upon several

information readily to unblock each other.

the system maintainers face when making

factors. Many benefits of interoperability

Businesses

changes are minuscule compared to the

sharing for competitive advantage.

problem of getting the various people to agree with each other,” Grieve writes in his blog post.

Let's

safe?

• What

is

information/data

the Is

legal/regulatory

there

a

regulatory

requirement to share?

• Who will pay for the IT setup/upgrade?

What is the business model?

are qualitative hence difficult to attribute a monetary value.

Last but not the least is interoperability’s impact on end-users and implementers.

Technical Lack

of

challenges. standards,

access

to

skilled

manpower combined with the absence of

management projects, which disrupt the

are defined by people, who are the best

existing work arrangements. Change is

and brightest in their domain but are

not welcome and hence finds resistance

also highly opinionated and have their

from the users and other parties impacted.

organisations interests to protect. Voting is

Several

often used for decision making among folks

management needs to be answered, such

Interoperability

with divergent views, conflicting priorities,

as:-

with multiple parties and the exchange

January 2021

standards.

• What if something goes wrong? Am I

framework?

Interoperability projects are like change with

data interpretation issues?

Standards

44

start

dissuade

standardisation, would it not cause

questions

surrounding

change

technical infrastructure like computers, software applications, various registries, network infrastructure etc are barriers to interoperability. involves

interacting

of sensitive patient and person data

• Have the right kind of people in the

Therefore privacy and security concerns

project team. The team needs to have

regulatory push are needed ingredients

deter any plans for interoperability.

the right mix of technical and political

for successful healthcare interoperability

acumen.

undertakings. NHP, NDHM, PM-JAY and

Globally HCIT technology is notorious for being inefficient, increasing the workload

• Set overall accountability.

of doctors and slowing them down. In

• Break the silos.

a country like ours, where the average time spent by a doctor with the patients

learning curve, disruption in routine and

creators,

platform

other IT-related factors and its apparent

developers, infrastructure providers,

why most doctors hate their computers.

app builders must be accountable for the functioning of the overall system

Overcome the Challenges

not just their part.

Following are some recommendations for

for

open

on industry participation and proactive support from the government.

“NDHM is timely, it will help accelerate the

digital

health

journey.

We

are

building critical infrastructure to enable interoperability, putting patients at the centre of healthcare and nurturing an active community of implementers. NDHM sandbox, devforum provides a platform to learn, build, test and interact with us and

Approach the interoperability initiative

point to point interfaces. Have a robust

one another," says Kiran Anandampillai,

as a change initiative.

certification mechanism to certify for

Advisor (Technology) at National Health

adherence to chosen standards. Develop

Authority.

• Define

clear

objectives,

formulate

policies and communicate.

• Have an open policy, be as transparent as possible.

• Provide a platform for people to ask questions, critique and contribute.

of

standards,

of these initiatives would largely depend

proprietary

temptation •

a

the

undertaking interoperability initiatives.

Go

and

push for digital healthcare. The success

penalise information blocking.

• Standards

alignment

focus on interoperability, data sharing and

cooperation and data sharing and

extra minute is akin to a crime. Add to it the

stakeholders

other govt. initiatives have brought the

• Design and align incentives to promote

is around two minutes, adding even one

case,

building

restrain

in-house expertise, nurture and leverage community. Build on collective experience, In the long run, interoperability pays for itself.

If the hospital, pharmacy, monitoring device, lab and insurance were using Interoperable software systems and if the stakeholders agreed to share records and

Healthcare interoperability initiatives are

automate workflows. Sameer would have

complex. Financial viability, a business

been a happy person.

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45

BEST BUY

GE Healthcare · Revolution CT Power

103 kW

Scan range

Gantry bore

80 cm

200 cm

COMPUTED TOMOGRAPHY Siemens Healthineers · Somatom Force Power

240 kW

Scan spees

Gantry bore

78 cm

Highlights • Bring image quality to the next level with Vectron X‐ray tube. (Replace with low dose early) • Kidney‐friendly scanning with significantly reduced contrast media amounts required (low kV imaging) • Ultra low dose and “free‐breathing” CT with outstanding native temporal resolution • FAST Integrated Workflow with FAST 3D Camera to get two steps ahead in patient positioning • Dual Source Dual Energy

Up to 737 mm/s

Siemens Healthineers · Somatom go.Top Power

75 kW

• Precise dose neutral Energy quantification to add tissue information to morphology • Temporal resolution: 66 ms (full body)

Canon · Aquilion One Genesis Edition Power

100 kW

Gantry bore

78 cm

• Best effective temporal resolution Highlights enabled by 0.28-second rotation • Gemstone Clarity Detector for 80 or speed combined with intelligent 160 mm detector coverage • Unique image chain hardware with motion correction for excellent cardiac Volume HD reconstruction imaging at any heart rate • ASiR-V – up to 82 percent lower dose • Aorta, heart and lung in just one second

Scan range

150 / 200 cm

Scan speed

Gantry bore

70 cm

Up to 175 mm / s

Highlights • The unique Mobile Workflow allows operation of the scanner from a wireless tablet • The GO technologies automate workflows with machine learning landmark detection • Low‐kV imaging, 10 kV steps , Tin • High temporal resolution for excelFilter and iterative reconstruction lent cardiac imaging and TBDE to enable dose‐optimized scanning improve diagnostic quality • The Stellar detector keeps electronic • TwinBeam Dual Energy (TBDE) noise low and increases dose efficiency • System footprint: 7.4 m²

Philips · IQon Spectral CT scanner

Highlights • AiCE (Deep Learning Reconstruction) • Artificial intelligence in scanning and processing • PUREViSION Optics imaging chain • 0.275 s rotation • 16 cm coverage • 640 slices/rotation • 0.22 mm spatial resolution

46

January 2021

• SUREPosition patient centring • Lateral table movement • 300 kg patient table • SEMAR (Metal Artefact Reduction) • Wide range of Cardiac and Dual Energy applications • Isophasic organ perfusion

Highlights • The world's first and only spectral detector solution delivering comprehensive, valuable diagnostic and clinical insights.

• Improved tissue characterization and visualization • Spectral results 100 % of the time, in one scan

• For the most challenging cases, routinely • Fully integrated with your current workflow, from scanner to PACS • And at low dose

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35

Hitachi · Scenaria View

Hitachi · Supria 16 / 32 Power

51 kW

Scan range

Gantry bore

75 cm

180 cm

Highlights • 5 MHU X Ray tube • Sub second scan time for all examinations • 0.675 mm minimum slice thickness • 75 cm wide gantry bore for improved patient experience • The compact footrpint needs small • Intuitive GUI design with 24-inch installation space wide monitor • New Iterative reconstruction algo• Slices per rotation: 16 / 32 rithm for low dose examinations • Field of view: 500 mm

Siemens Healthineers · Somatom go.Up Power

32 kW

Gantry bore

70 cm

Highlights • The unique Mobile Workflow allows operation of the scanner from a wireless tablet • The GO technologies automate workflows with machine learning landmark detection • Tin Filter technology enables ultra‐ low dose‐optimized scanning at the levels of conventional X‐ray • The Stellar detector keeps electronic noise low and increases dose efficiency

72 kW

Gantry bore

80 cm

Highlights • Open design concept with aperture diameter of 800 mm • New algorithms for iterative reconstruction: Intelli IPV • X-ray tunbe: 7.5 MHU equivalent to 45 MHU with Intelli IPV • Minimum scan time for all types of examination: 0.35 seconds • Minimum slice thickness: 0.625 mm

Scan range

200 cm

• Unique laterally moving patient table (total: 200 mm) • 475 mm wide patient table with weight limit of 250 kg • Slices per rotation 64 / 128 • Dual Energy Scan

Up to 42 mm / s

• First level cardiac assessment supported by calcium scoring evaluation • Wireless tablet and remote control • Slices per rotation: 64 with IVR • System footprint: 7.4 m²

Power

72 / 108 kW

Gantry bore

75 cm

Scan range

175 / 195 cm

Highlights • 5 MHU tube • Sub second scan time for all applications • 0.675 mm minimum slice thickness • Wide bore gantry for improved patient experience and operators’ practice • Compact footprint to maximize easiness of installation • Intuitive GUI with 24-inch color display • Advanced iterative reconstruction to • Slices per rotation: 64 / 128 allow low dose examinations • System Footprint: 13.5 m2

GE Healthcare · Discovery RT Gantry bore

90 cm

Highlights • 70 cm FOV • 85 cm extended FOV • Artificial intelligence in scanning and processing • AIDR 3D iterative reconstruction • PUREViSION low dose detector • 0.5 s rotation • 3.2 cm coverage • Up to 32 slices/rotation

36 January 2020

72 kW (84 kW optional)

Fujifilm · FCT Speedia HD Scan speed

Canon · Aquilion LB Power

Power

Scan range

150 / 200 cm

• 300 kg patient table • SEMAR (Metal Artefact Reduction) • SUREStart iterative bolus tracking • Respiratory gating • Iterative 3D Fluoro • Oncology table top

Power

55 / 100 kW

Gantry bore

80 cm

Highlights • Wide bore geometry (80 cm) • All tables TG66 compliant (225 and 295 kg max) • Up to 40 % dose reduction across the body with integrated ASiR reconstruction* • 4D gating reconstruction on the operator console

Scan range

170 cm

• Complete and easy to use RT simulation planning solution with SIM MD on AW • SmartMAR – raw data based metal atrefact reduction • Deviceless 4D – breath gating • 80 cm max FOV

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47

Philips · iCT Elite Slices per rotation Coverage Power

Toshiba · Aquilion PRIME Rotation speed Coverage Slices per rotation Slice thickness

256 80 mm 120 kW

Highlights • New Nanopanel Elite Detector – Enables low dose scanning • iPatient – Consistent image quality and improved scan time workflow Platform for delivering future CT discoveries like IMR • Syncright – CT / Injector integration

• IMR – Virtually noise free image quality.

2.7 x improvement in low contrast detectability index • iDose4 Premium Package

MAGNETIC RESONANCE IMAGING

Mindray Medical · MagSense 360 MRI System Gradient

25 mT / m

Slewrate

600 T / m / s

Channels

2

40 80 / 160 0.5 mm 0.35 s

Highlights • PURE ViSION detector • 78 cm bore • 2 mm @ 3 HU LCR • 300 kg patient load table • Lateral table movement (option) • AIDR 3D Enhanced iterative reconstruction • Iterative bolus tracking • Iterative 3D Fluoro (option)

• Adaptive Diagnostics • SEMAR (Metal Artifact Reduction) • Low dose Cardiac scanning (option) • Dual Energy at 50 cm FOV (option) • 14.8 m2 installation space

Siemens Healthineers · Magnetom Terra Gradient

80 mT / m1

Slewrate

200 T / m / s1

Channels

Up to 64 × 64

1 Maximum gradient amplitude and slewrate can be applied simultaneously

Highlights • World’s first 7T MRI scanner released for clinical use • Dual Mode – secure switch between research and clinical operation • 50 percent lighter 7 T magnet technology for easier integration into clinical environments • Double SNR for more precision • XR 80/200 gradients; 8 channel parallel transmit functionality in research mode • Submillimeter BOLD fMRI precision for pre-surgical evaluation • Latest applications available with syngo MR E12 software • Additional metabolic information with 23Na imaging and 31P spectroscopy

GE Healthcare · Signa Architect 3.0 T Gradient

44 mT / m

Slewrate

200 T / m / s

Channels

96 / 128

Highlights • Innovative InScan Technology • Advanced Gradient system Design • Ergonomic Design make you more comfortable • Multi-clinical Applications satisfied doctors requirement • Multiple coils selection make all examination reality

Highlights • Premium 3.0T MRI with 70 cm wide bore, detachable table and total digital imaging • Dedicated to high patient comfort and productivity with the latest Signa Works platform and new technologies like ViosWorks 7D Flow and HyperSense/HyperBand acceleration technique • Revolutionary AIR Technology with ultralight coils for brilliant image quality

48

January 2021

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Hitachi · ECHELON OVAL

Canon · Vantage Galan 3 T

Gradient Slew rate Channels

Gradient

34 mT / m 150 T / m / s 16 (32 )

33 / 45 mT / m

Highlights • Revolutionary design featuring a 74 cm spacious OVAL environment • WIT RF Coil System • Shaped around the human body • WIT Mobile Table • Workflow Integrated Technology (WIT) • WIT Patient Information Monitor

Slewrate

200 mT / m / s

Highlights • Patient friendly 71cm wide bore with 50 × 50 × 45 cm cylindrical scan area • High resolution imaging in daily practice with PURERF and Saturn gradient technology • EasyTech solutions for automated scan-planning and increased productivity • Silent scanning with Pianissimo Zen sequences

Channels

128

• M-power intuitive graphical user interface • Next generation scan techniques, MultiBand SPEEDER, Fast3D mVox, Olea Nova+ & free breathing examinations with Quickstar and k-t SPEEDER.

Philips · Ingenia 1.5 T S

GE Healthcare · MRgFUS & Signa Architect 3.0 T

Field strength Gradient Slewrate

Gradient

1.5 T 57 mT / m or 33 mT / m 208 T / m / s or 120 T / m / s

Highlights • Increase SNR by up to 40 % • As much as 30 % improvement in throughput • Plug-and-play expansion • Largest homogeneous FOV for a 70 cm bore

44 mT / m

• Significant reduction of routine tasks • The first-ever digital broadband MR system

Hitachi · Echelon Smart Plus Gradient

33 mT / m

Slewrate

130 T / m / s

Channels

32 / 128

Highlights • Focused, non-invasive thermal ablation therapy, combining highly energetic focused ultrasound (ExAblate) with MRI imaging • CE-certified for: Uterine fibroids, bone metastases, facets, essential tremor, tremor dominant Parkinson’s disease, neuropathic pain • MRI guidance for therapy planning, targeting and thermal feedback, with immediate results

Hitachi · Aperto Lucent O5 Channels

16

Highlights • New Signal Processing Platform with Iterative Reconstruction reducing the routine scan time by 30 percent in total.

• SynergyDrive optimizes the workflow with Hitachi’s “AI” technology (Auto- • SoftSoundSuite to reach more than Pose, AutoExam, AutoMIPclipping) 80 percent noise reduction

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Slewrate

200 T / m / s

Gradient

25 mT / m

Slewrate

55 T / m / s

Channels

2

Highlights • Wide, 320 degrees open permanent MRI system • Features top field strength amongst the permanent MRI systems presently • Fast processing chain allows increason the market ing patient throughput • Newly developed built-in technolo• Reduced running costs allowing fast gies keep Aperto Lucent delivering image quality comparable with entry return of investment • Field strength: 0.4 T level HF MRI scanner

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INTERVENTIONAL SYSTEMS Philips · BV Endura 2 Power II format

Pixel size

Detector

a-Si / CsI

160 μm

Detector

a-Si / CsI

Highlights This integrated system combines premium CT and ceiling-mounted angiography technology. The perfect diagnostic and treatment set-up for high-risk procedures in various interventional segments such as: • Interventional Oncology

Highlights • Unprecedented imaging capabilities with all the advantages of angiography, MR, and CT imaging • Patient transfer without repositioning for barrier-free intraoperative imaging • Innovative treatments that combine multiple imaging modalities in a single procedure

Canon · Alphenix Dual Plane Power

Canon · Alphenix 4D CT 100 kW

100 kW

3.15 kW 31 / 23 / 17 cm

Highlights • Versatile workhorse designed for routine and vascular interventions • SmartVision – a fully digital imaging chain including powerful image processing functions • High quality images at a low dose, time after time • Extended rotation • Optimally designed mobile view station providing a unique intelligent viewing concept

Power

Siemens Healthineers · nexaris Angio-MR-CT Power

100 kW

Pixel size

Detector

a-Si / CsI

194 μm

Pixel size

194 μm

• Trauma / Neuro / Stroke • General Vascular • Additional or Backup CT • Detector size: 30 × 30 cm / 30 × 40 cm The system is available with two different CT configurations: Aquilion One Genesis and Aquilion Prime

Highlights • A single room X-ray solution with two Designed for both diagnostic and C-Arms both with dedicated imaging interventional examinations. chains for interventional cardiac and • Space, time and dose saving technology are key design elements of the angiography procedures that share a Alphenix Dual Plane. common generator, table, monitors • Detector size: 20 × 20 cm / 30 × 40 cm and digital acquisition system.

Shimadzu · Trinias B12 / B8 unity edition GE Healthcare · Innova IGS 620 Power

100 kW

Detector

a-Si / CsI

Highlights • Smart gantry for optimal C-Arm positioning • High detector DQE and AutoEx for dose optimization • Complete integration of intravascular-ultrasound, FFR

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Power Pixel size

2 × 100 kW

Detector

a-Si / CsI

Pixel size

194 μm

200 μm

• InnovaSense patient contouring • Integrated large display monitor • Detector size: 20 x 20 cm (frontal/lateral)

Highlights • Detector size: 12" × 12" (30 × 30 cm) / 8" × 8" (20 × 20 cm) • Wide coverage for smooth operability • SCORE Pro Advance image processing technology • Unique pioneering imaging technology: motion-tolerant SCORE RSM

• SCORE StentView+Plus • SCORE CT • SCORE 3D • SCORE Navi / Navi+Plus • SMART design concept • Comprehensive dose management package

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GE Healthcare · Discovery IGS 730

Siemens Healthineers · Artis one Power

100 kW

Pixel size

Detector

a-Si / CsI

Highlights Intelligent operation is enhanced by a configurable head up display, allowing you to interact with the system in a completely new, intuitive way.

• Detector: as30, (1,560 × 1,420 pixels), • Small footprint of 25 qm2

184 μm

• Slim-line design for easy patient access • Ergonomic system controls for smooth table-side operation • Full patient coverage imaging up to 2.10 m • Integrated 3D-Imaging and review with acquisition rate up to 66 f / s

Medtronic · O-arm system Power

32 kW

Detector

a-Si - 2.0K × 1.5K

Pixel size

194 μm

Power

100 kW

MAMMOGRAPHY Hologic · 3Dimensions 70 μm (2D) / 140 μm (TOMO)

• Easy in use: All motions motorized, simple control panel • Position memory remembers four scan positions • Easy draping of the breakable gantry • Seamless integrating with StealthStation Navigation • Detector size: 30 × 40 cm

Hologic · Fluoroscan InSight FD Mini C-Arm imaging system Power

7,5 W (0,1 mA@75 kVp)

Detector

CMOS

Pixel size

75 μm

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Scan type

Scan angle

15°

3.7 s

Highlights A Breast Tomosynthesis Exam with Results Like No Other. Only the Hologic 3D Mammography exam: • Proven to detect up to 65 % more invasive breast cancers than 2D alone.* • The only mammogram FDA approved as superior for women with dense breasts compared to 2D mammography.

• More than 200 studies demonstrate the exam’s clinical efficacy.

Now you can have these clinically proven results with the new Hologic 3Dimensions 3D Mammography system. * Results from Friedewald, SM, et al. “Breast cancer screening using tomosynthesis in combination with digitalmammography.” JAMA 311.24 (2014): 2499-2507

Planmed Oy · Clarity 3D Pixel size

83 μm

Highlights The compact unit now features a redesigned monitor arm and rail for easy transportation and reduced OR workspace interference.

• High Resolution, Imaging Mode Option to utilize full detector resolution.

• Low Dose Rate Mode -Option to reduce dose rates by over 50 percent compared to auto mode, while still providing clinically equivalent images • Compact redesigned monitor arm and integrated keyboard

200 μm

Highlights • Laser-guided system for interventional radiology & cardiology as well as Hybrid OR • GE Detector Technology with High • Can be installed from 35 m². Neither Image Quality & Dose Efficiency ceiling nor floor mounted • Planning, implementation and evalua• Meets high hygienic requirements tion of PCI, TAVI, (T)EVAR and more

Pixel size

Highlights • Designed for surgery • 13s true 360° 3D scan – Fully mobile • Flexible intra-operative 2D- and 3D-imaging • Large 2D-image size and large 3D scan volume up to 40 cm width • Seamless integration in OR workflow

Pixel size

Detector

a-Si / CsI

Scan time

Scan angle

15°

13 s

Highlights • Digital mammography system for conventional 2D imaging, diagnostic imaging, stereotactic biopsies and Digital Breast Tomosynthesis (DBT) • Continuous Sync-and-Shoot tomosynthesis imaging method with iterative reconstruction and TomoMarker technology to enable sharp and artifact free images • Intuitive Planmed Clarity Flow touch screen based user interface

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Fujifilm · Amulet Innovality Pixel output

50 μm / 100 μm / 150 μm

Konica Minolta · AeroDR X30 Scan time

Scan angle

15° / 40°

4s/9s

Highlights • Unique new detector with Hexagonal pixels for fast, low dose examinations • Tomosynthesis: Dual angle approach to tomosynthesis, and its unsurpassed 50 micron pixel output, better support breast screening and diagnostic mammography needs • Intelligent AEC (iAEC) optimizes the X-ray dose for each breast type • Dedicated mammography acquisition Workstation (AWS)

R/F DIGITAL

Power

20 / 32 / 40 / 50 kW

Weight

Width

67 cm

Highlights • Fully integrated digital mobile X-ray system • Completely motorized and very easy to manoeuvre: can be controlled with one hand • The AeroDR detector can easily be stored and at the same time automatically charged in the bin, even during driving • 100 % wireless communication for effortless usage at patient's bedside

530 kg

• Retractable, telescopic column • Detector sharing with X-ray rooms

Mindray Medical · MobiEye 700 Mobile DR System Power

30 kW / 50 kW

Skanray Microskan DR

Weight

Width

47 cm

370 kg

2.8kW, 200kHz, 60mA with APR Highlights • Hand-held and integrated console for parameter setting and exposure control • 90° collimator rotation & tube-head rotation • Flat panel detector with ISS & Smart Switch technology with CsI (Cesium Iodide) Scintillator • 2304 x 2880 Pixels/150 μm pixel pitch •Approx 1 to 8 sec. Cycle time (wired mode); approx 11 sec. Cycle time (wireless mode) • Wireless standard - IEEE 802.11n, 5.2 GHz; Battery recharging time Approx. 3h

CARESTREAM DRX-Revolution

• Detector’s external size 384x460x14.8 mm/3.5 kg Suitable for NICU, ICU, Trauma, Ortho & Ambulance

Highlights • Marvelous Mobility with intelligent operation • Bionic design manipulator with eight high flexible mechanical joints • Superior Power management technology • Remote motion control and remote exposure control • 19 Inch Multiple-touch Screen

Siemens Healthineers · Mobilett Elara Max Power

Highlights • The tube head and collimator are smaller, lighter and better balanced, for easier use and faster positioning.

• Display screens are more responsive, with enhanced function, and redesigned to better protect against liquid ingress.

• Brakes and drive motors are quieter and less likely to disturb patients.

• Functional LED lighting provides the technologist with another point of visibility of system status.

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• Lighter and smaller • High reliability and compatibility • Detector auto-charging

35 kW

Footprint

127.8 cm (l) × 59.8 cm (w)

Highlights • High-end, fully digital mobile X-ray system • Compact system design, easy maneuverability, flexible positioning with the MAXreach arm and consistently high-quality images • Unique antimicrobial coating and easy-to-clean design • Intuitive and fully digital syngo FLC workflow, excellent wireless connectivity, virtual workstation and cybersecurity package

Weight

Approx. 380 kg

• The MAX effect: Combine with other MAX systems for additional benefits in standardization, savings and satisfaction • Detector: 35 × 43 cm (MAX wi-D) 24 × 30 cm (MAX mini)

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