In Imaging
Pages 82
A compendium on the latest in radiology
JANUARY 2014
| terareco
• Advanced 3D workstation and clinical applications for Cardiac, Vascular, Oncology, Liver, etc. • Leading Independent 3D workstation and software solution provider in India. • Global Leader in Enterprise Advanced Visualization
n.com
• Over 4,500 installations globally and over 9,000 iNtuition licenses deployed • Over 15,000 physicians accessing TeraRecon application • 7-time Frost & Sullivan Award Recipient
!"#$ $%& (#)*" ( )+(,
*-"! !
!"#$ $%& $1 11(#0$ $-#+% 2*")*" 2 " -.#% %/0(#*% %- "$3 3#+(+4 4! 5+" "62-$-#+%2 !"#$% '(() *+,-.% /0 012'-0,0/ /01% /30452 2)016(7% 8+ +890- @ ### #??A !" $:#; :;; % <=$ > # #<<<#% <>;?# # #"""# $%& &'(" !"#$!%#$&&'(%)*!'$+,&&"! :
EDITOR’S NOTE IN IMAGING | JANUARY 2014
Viveka Roychowdhury, Editor viveka.r@expressindia.com
Channeling a collective conscience
A
ssociations like the Indian Radiological & Imaging Association (IRIA) have positioned themselves to be lobby groups for the concerns of their members but they must also strive to be the collective conscience of their fraternity. Thus I hope the theme of the 67th Annual Conference of IRIA, 'Better imaging for healthier life' will resonate in all discussion halls and give this year's focus groups, private practitioners and post graduate students, a lot of food for thought. These two groups today find themselves bearing a disproportionately large share of the responsibility of accurate and fast diagnosis, especially when traditional diagnostic tools like pathology prove inconclusive. Take tuberculosis for instance. Controlling TB in India has been successful on a few counts but we have a long way to go: the country accounts for nearly a third of the global TB burden, with
JANUARY 2014
approximately 1.8 million new cases reported every year. It is no wonder that the top three most cited articles in IRIA's peer reviewed journal, the Indian Journal of Radiology and Imaging (IJRI), all focus on TB. The use of non-invasive imaging techniques like PET/CT and MRI is particularly crucial in difficult-todetect TB infections like musculoskeletal TB or central nervous system TB. In cases of musculoskeletal TB, faster detection followed by treatment is crucial because it can prevent permanent destruction of joints and skeletal deformity. As these techniques and equipment continue to evolve, they offer hope for the millions of TB patients in India. No doubt, IRIA is doing its bit. Among the many ‘firsts' at this year’s meet, Organising Chairman of the 67th IRIA, Dr Bhupendra Ahuja informs us that each presenter has been asked to spend 10 minutes of their session sharing important tips on how to efficiently report
one's diagnosis. The idea is to promote effective reporting in order to increase efficiency of radiologists and we hope this practice continues at all subsequent IRIAs and indeed other events patronised by this elite tribe. (See Dr Ahuja’s interview, on pages 37-38). Our cover story (Dose management: An urgent need; pages 12-21:) analyses yet another key concern area. But even with the attraction of the Taj Mahal, IRIA 2014, Agra initially proved to be a tough sell, thanks to the fluctuating dollar-rupee exchange rates. It took Dr Ahuja nearly six months to convince exhibitors to participate, but inspite of these initial hiccups, I strongly feel that Dr Ahuja and his team will be more than happy with the turn out. Simply because no medical imaging company can ignore the sheer size of the three big emerging markets of China, India and Brazil. Question is, can we grow with our conscience intact?
IN IMAGING 7
IMPRINTLINE Presented By
In Imaging A compendium on the latest in radiology
JANUARY 2014
Chairman of the Board Viveck Goenka Editor Viveka Roychowdhury* Assistant Editor Neelam M Kachhap (Bangalore) Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Delhi Shalini Gupta MARKETING Deputy General Manager Harit Mohanty Assistant Manager Kunal Gaurav PRODUCTION General Manager B R Tipnis Production Manager Bhadresh Valia Sr Executive- Scheduling & Coordination Rohan Thakkar Photo Editor Sandeep Patil DESIGN National Art Director Bivash Barua Deputy Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Layout Vivek Chitrakar CIRCULATION Circulation Team Mohan Varadkar Copyright The Indian Express Ltd. All rights reserved. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.
HEAD OFFICE Express Healthcare Kunal Gaurav The Indian Express Ltd, 1st Floor, Express Towers, Nariman Point, Mumbai-400021 Tel: 67440519/502 Fax: 022-22885831 Mobile: 09821089213 E-mail: kunal.gaurav@expressindia.com kunalexpressindia@gmail.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express Ltd, Basement, Express Building, 9 & 10 Bahadur Shah Zafar Marg, New Delhi, 110 002 Direct Line: 011-2346 5727 Board Line: 011-2370 2100-107 Ext-727 Mobile: 09999070900 E-mail: ambuj.kumar@expressindia.com Our Associate Dinesh Sharma Mobile: 09810264368 E-mail: 4pdesigno@gmail.com CHENNAI Dr Raghu Pillai The Indian Express Ltd, New No.37/C (Old No.16/C) 2nd Floor, Whites Road, Royapettah, Chennai - 600 014 Board line: 28543031/28543032/ 28543033/28543034 Fax: 28543035 E-mail: raghu.pillai@expressindia.com BANGALORE Khaja Ali The Indian Express Ltd. 5th Floor, Devatha Plaza 131, Residency Road Bangalore - 560 025, INDIA Tel: 22231923/24/41/60 Fax: 22231925 Cell: 09741100008 E-mail khaja.ali@expressindia.com
HYDERABAD E Mujahid The Indian Express Ltd, 6-3-885/7/B, Ground floor V.V. Mansion, Somaji Guda Hyderabad - 500 082 Tel: 040-23418673/23418674/ 66631457 Fax: 040-23418675 Cell: 09849039936 E-mail: e.mujahid@expressindia.com KOLKATA Ajanta Sengupta The Indian Express Ltd Express House, NH-6 , Mouza - Prasastha & Ankurhati, PO - Salap, P.S.- Domjur Dist - Howrah -711409 Tel: 91- 33-66043842 Fax: +91 -33-66043825 Cell: 09831182850 Email: ajanta.sengupta@express india.com KOCHI Dr Raghu Pillai The Indian Express Ltd, Sankoorikal Building, 36/2248, Kaloor, Kadavanthara Road, Opp. Kaloor Private Bus Stand, Kaloor - 682 017 Tel: (0484) 2343152, 2343328 Fax: 2343153 E-mail: Kochi.bpd@expressindia.com raghu.pillai@expressindia.com COIMBATORE The Indian Express Ltd, 1st Floor, 731, Avinashi Road, Opp. PRS Grounds, Coimbatore-641 018 Tel: 2212157/2216718/2216732 E-mail: bpdcbe@vsnl.in JAIPUR The Indian Express Ltd, C-7, Dwarika Puri, Jamna Lal Bajaj Marg, C-Scheme, Jaipur - 302001 Tel: 0141-370002/371272 Telefax: 91-141-376606
BHOPAL The Indian Express Ltd, 6, Vidya Vihar, Professors Colony, Bhopal - 462002 Madhya Pradesh Tel: 0755-2661988 AHMEDABAD Kunal Gaurav The Indian Express Ltd 3rd Floor, Sambhav House, Nr. Judges Bungalow, Bodakdev Ahmedabad - 380 015. Tel: (91-79) 26872481/82/83 Fax: (91-79) 26873950 Mobile No: 09821089213 E-mail: kunal.gaurav@expressindia.com kunalexpressindia@gmail.com
Important: Whilst care is taken prior to acceptance of advertising copy, it is not possible to verify its contents. The Indian Express Ltd., cannot be held responsible for such contents, nor for any loss or damages incurred as a result of transactions with companies, associations or individuals advertising in its newspapers or publications. We therefore recommend that readers make necessary inquiries before sending any monies or entering into any agreements with advertisers or otherwise acting on an advertisement in any manner whatsoever.
*Responsible for selection of news under the PRB Act.
8 IN IMAGING
JANUARY 2014
CONTENTS
IN IMAGING | JANUARY 2014
12 Dose management: An urgent need
With more evidence mounting against ionising radiation, hospitals need to put comprehensive dose management programmes in place to balance patient safety, radiation dose and image quality
22 One-on-one Dr Balaji Ganeshan, Scientific Director, TexRAD
27 One-on-one Dr Richard Hausmann, President and CEO, GE Healthcare MRI
30 Department Scan RGCI: At the forefront of technology
34 Tech Scan Printing simplified
IRIA 2014 Special
37
One-on-one Dr Bhupendra Ahuja, Organising Chairman, IRIA 2014 Also featuring:
10 IN IMAGING
39 40 43 44 46 48 52 58 60 62 63
Vertex Medical
66 69 70
Medion Healthcare
Esaote Zenith Imaging Systems Terarecon Allengers Medical Systems Konica Minolta Sanrad Medical Systems NeoRad Unfors RaySafe Natureâ&#x20AC;&#x2122;s Global Services FUJIFILM Sonosite
Bergen Healthcare CIVCO Medical Solutions
JANUARY 2014
REDUCE SSARY UNNECE E! R EXPOSU
Measurement solutions for diagnostic X-ray EQUIPMENT
PATIENT
Unfors RaySafe offers a complete lineup of solutions to perform quality assurance and service of diagnostic X-ray machines.
RaySafe S1 is a dose management solution for improved quality control with dose and image quality tracking.
• • • • • •
State-of-the art precision Easy to use High productivity Durable, small and lightweight Multi- and single modality Scalable solutions
• Increased patient safety • Lowered patient dose • Reduced costs for unjustified and repeated exams • Improved regulatory compliance • Simplified reporting
Unfors Instruments has changed its name to Unfors RaySafe.
Unfors RaySafe (India) Pvt. Ltd 21. Blue Chip Ind. Estate No 1 Golani Industrial Complex, Waliv Vasai (E) Distr. Thane 401 208 Maharashtra state, India
Phone: +91 250 3246144 Fax: +91 250 2455934 infoindia@raysafe.com www.raysafe.com
COVER STORY
DOSE MANAGEMENT: AN URGENT NEED With more evidence mounting against ionising radiation, hospitals need to put comprehensive dose management programmes in place to balance patient safety, radiation dose and image quality BY M NEELAM KACHHAP
P
atient safety is of utmost importance in medicine. Having realised that patient safety may be compromised while engaging new technology, radiologists world over are now trying to reduce radiation dose given to patients and eliminate unnecessary radiation exposure. The concern is that new technologies arebeing used increasingly today. Technologies like fluoroscopy, nuclear medicine and computed tomography are being used more often than they were used 10 years
12 IN IMAGING
ago. In addition, growing obesity has mandated the use of larger radiation doses as effective dose received by the patient is greatly affected by the size of the patient. One of the most discussed and debated concerns with radiation exposure is the risk of cancer associated with it. Although, there is wide disagreement about the extent of cancer risk; experts agree that there has to be a balance between benefits of imaging scans and risks posed by them. Calculating the risk to patients is a complex process that often does not generate any clear
answers. Yet, radiation dose management is gaining popularity among Indian hospitals. â&#x20AC;&#x153;There is reasonable, though not definitive, epidemiological evidence that organ doses in the range from 5 to 125 mSv result in a very small but statistically significant increase in cancer risk,â&#x20AC;? says Dr Sharad Maheshwari, Diagnostic Radiologist, Kokilaben Dhirubhai Ambani Hospital, Mumbai. â&#x20AC;&#x153;These results come primarily from studies of approximately 30,000 atomic-bomb survivors who were several kilometres away from the explosions JANUARY 2014
COVER STORY
IN A STUDY, BERRINGTON DE GONZALEZ ET AL ESTIMATED THAT APPROXIMATELY29,000 FUTURE CANCER CASES COULD BE RELATED TO CTSCANS PERFORMED IN THE US IN 2007 ALONE
and were thus exposed to low doses,” Dr Maheshwari explains. In a study, Berrington de gonzalez et al estimated that approximately 29,000 future cancer cases could be related to CT scans performed in the US in 2007 alone. In India, there is considerable buzz regarding radiation dose reduction and management, but this somehow fizzles out at the operational level. “At the operational level, there is scope for improvement in the radiation safety processes followed by many institutions,” says Raveendran Gandhi, Senior Director, Radiology, Philips India. “At the operational level, technologists and doctors who operate CT scanner machines should be well qualified and adequately trained on the radiation aspects and should be aware about radiation dose delivered to patients for every investigation conducted on the equipment. Optimum quantity of dose should be delivered for CT tests adhering to as low as reasonably achievable (ALARA) principle for obtaining diagnostic quality images,” he explains. Apart from this, on-site monitoring and site inspection during installation of the facilities and accessories, proper equipment installation, optimised use of radiation protection devices, radiation checks by integrating with equipment vendors should be mandatory to minimise dose to 14 IN IMAGING
GOALS FOR RADIATION PROGRAMMES ■ Gathering radiation dose data ■ Monitoring, analysing and finding
best practice ■ Visualising radiation dose data
(multidisciplinary team approach) ■ Appropriate use of radiation ■ Keeping pace with technology
operators and public from CT scanners. Presence of site radiation safety officers, training of the operators, planning and implementing QA processes and SOPs as well as conducting periodic radiation safety checks are essential requirements in the process of efficient radiation safety management. These multiple tasks will require on-going expert interactions and engagements from members of radiation facilities with regulators who will guide and be empowered to conduct regular monitoring for ensuring safety compliance. “Ionising radiation is a double edged sword and has harmful effects such as causing infertility, radiation burns and cancer on prolonged exposure or on exposure beyond a permitted threshold,” opines Dr R Chandrasekar, COO and Chief
Radiologist, Yashoda Hospital, Hyderabad. “Careful handling, dose optimisation and strict adherence to the safety guidelines are of utmost importance in ensuring that its harmful effects on patients and hospital staff are minimised,” he adds.
Radiation dose management programme at hospitals The most systematic way to track, report and monitor radiation dose and eliminate unnecessary exposure is to develop a comprehensive, radiation dose management programme. “Radiation dose management starts with a conscious choice by institute/hospital to educate, monitor and maintain optimal radiation dose. Besides acquiring the right technologies, the focus should be on education and sensitising the staff on the benefits of radiation management and radiation safety,” says Sanjay David, Business Head-CT Scanners, Siemens Healthcare, India. “CT dose management relies on the ability of institutes/hospitals/organisations to adequately educate, monitor and maintain CT radiation. This forms the core of right dose management and radiation safety,” he adds. “The primary focus of such a programme is to optimise radiation procedures and associated processes in order to ensure minimum use of radiation to patient,” says Gandhi. “Operators should adhere to JANUARY 2014
COVER STORY
There is reasonable, though not definitive, epidemiological evidence that organ doses in the range from 5 to 125 mSv result in a very small but statistically significant increase in cancer risk’ Dr Sharad Maheshwari, Diagnostic Radiologist,Kokilaben Dhirubhai Ambani Hospital,Mumbai
established safety measures during radiation procedures. Hospitals should focus on training operators and employees regarding radiation effects, safety features, and safety devices, as well as encourage them to use radiation monitoring devices such as TLD badges. Hospitals need to have an established radiation monitoring system in place, including documented standard operating protocols (SOPs) for the entire radiation testing procedures,” Gandhi further adds. In India, Atomic Energy Regulatory Board (AERB) has the mandate of ensuring radiation safety. “As per AERB regulation, it is essential for hospitals offering CT scans to have documented procedures and programmes for radiation safety,” explains Gandhi. “The programme JANUARY 2014
should be managed by a certified Radiation Safety Officer (RSO). Periodical safety assessment reports should be recorded and reports should be submitted to AERB. Operational licenses are required for the facility, equipment installation and continuous operations of CT scanners in hospitals. These regulations are essentially compelling in nature to implement effective radiation safety programmes,” he further adds. Talking about the guidelines followed to minimise radiation at Mumbai's Kohinoor Hospital, Dr Priya Darshan Chudgar, Consultant Radiologist, Kohinoor Hospital says that CT exams must be appropriately justified for clinical need. All technical aspects of each CT examination must be optimised. The most dose-efficient technique should be used to achieve
Hospitals need to have an established radiation monitoring system in place, including documented SOPs for the entire radiation testing procedures Raveendran Gandhi Senior Director- Radiology, Philips India
IN IMAGING 17
COVER STORY
Careful handling, dose optimisation and strict adherence to the safety guidelines are of utmost importance to minimise harmful effects of radiation on patients and hospital staff Dr Chandra sekar COO and Chief Radiologist, Yashoda Hospital,Hyderabad
Radiation dose management starts with a conscious choice by nstitute/hospital to educate, monitor and maintain optimal radiation dose SanjayDavid Business Head-CTScanners, Siemens Healthcare,India,
18 IN IMAGING
the target image quality. For instance, these are the techniques followed at Kohinoor Hospital: : ■ Justification of the CT examination from referring physicians ■ Not using unnecessary CT examinations (e.g., whole-body screening) ■ Optimising the dose performance of detector, collimator and beamshaping filter ■ Using manual technique charts or automatic exposure control systems to adapt the dose to patient size, and select the appropriate tube potential ■ Improving data processing and image reconstruction to gain more information from each study and avoid repeat examinations Expressing his views, Dr RK Gupta, Director & HOD – Department of Radiology & Imaging, Fortis Memorial Research Institute, Gurgaon, says, “It is very important to use protocols with reduced radiation to ensure optimal image quality with minimal radiation. All children below 16 years of age should not undergo diagnostic procedures which use radiation including CT unless it is absolutely justified and indicated and we do not have options like USG, IR imaging, optical and MR imaging for those investigations.”
Goals of dose management programmes Dose management programmes involve collaborative efforts of the entire radiology department. Elaborating on the topic Dr Maheshwari says, “The radiology department has certain guidelines which have been posted on the intranet and are available for radiology staff, including radiologists, resident radiologists (assistants/ associates), DNB students and
technologists. The technologist and residents radiologists have been trained and sensitised to radiation protection and urged to follow the guidelines wherever possible without compromising diagnostic quality.” He further points out five primal goals for these programmes: Gathering radiation dose data: It is the first step in the optimisation process. Typically, dose data is collected when a cause for concern is raised for some reason or as a recurring quality control measure. A more systematic approach and a permanent solution is required for automated collection of dose data from all modalities. Monitoring, analysing and finding best practice: A dose monitoring solution is required to implement ALARA principles. In-depth analysis, benchmarking between different modalities, different hospitals, or even different technologists and doctors leads to developing best practices. Visualising radiation dose data (multidisciplinary team approach): Showing the dose level will create a curiosity about dose. That is an important first step in raising the discussion and finding the optimal balance between dose and diagnostic quality. The interest in dose monitoring needs to spread from the physicists to radiologists, technologists and clinicians. With the dose information at hand, better decisions can be made, answering questions such as: Which type of follow-up examination is optimal? Given the higher dose level, is the CT exam really necessary or is a regular X-ray sufficient? JANUARY 2014
COVER STORY
Appropriate use of radiation: It is an important patient safety and quality issue. Radiation dosemanagement programmes should focus on determining the right test at the right dose in a timely fashion. Ensure that the test is clinically indicated; avoid duplicate tests; and make sure alternative tests, such as an ultrasound or magnetic resonance imaging, are not viable options. Keeping pace with technology: Another challenge is the fast pace of technological development. In many instances, the technology is not being used to its fullest extent to help reduce radiation exposure. Forming strong vendor relationships and participation in training for technologists can help overcome this challenge.
Most important for dose management programme Most dose management programmes look at appropriate justification for ordering and performing each procedure, and careful optimisation of the radiation dose used during each procedure. Explaining the process further Dr Maheshwari lays down the following points: Justification and optimisation Setting a goals to use imaging only when the potential clinical benefit outweighs the potential risk and to strive for an imaging examination that delivers the lowest dose necessary to obtain the desired information: In short, we must aim for justification and optimisation of each imaging procedure Standardisation is crucial Professional organisations, including JANUARY 2014
American College of Radiology (ACR) and the American College of Cardiology (ACC), have developed and are working to disseminate imaging referral criteria, called “appropriateness criteria” or “appropriate use criteria,” associated with a number of medical conditions. However, criteria for appropriate ordering of medical imaging exams have not yet been broadly adopted by the practising medical community. Ensure the right test Enhance communication between ordering physicians and radiologists to ensure that the right test is ordered based on an individual patient's needs and diagnostic requirements. Ensure the right dose Conduct a periodic check of imaging equipment to ensure proper functionality. Adopt "ALARA” guidelines set forth by the US Nuclear Regulatory Commission. Develop low dose protocols. Develop a process to review dose protocols on an annual or biannual basis to ensure that protocols are followed. Examine cases in which protocols were not followed and provide education to prevent future occurrence. Increase patient awareness Empower patients with information and tools to help them and their physicians manage their exposure to radiation from medical imaging in the short term, even before longer-term changes take effect. Developing comprehensive radiation dose-management programmes to track, report and monitor patients' exposure. Patients can be provided with a medical imaging record card that tracks the type of test performed, the date and location of the test and the radiation dose
CTexams must be appropriately justified for clinical need.All technical aspects of each CTexamination must be optimised and the most dose-efficient technique should be used Dr Priya Darshan Chudgar, Consultant Radiologist. Kohinoor Hospital,Mumbai
It is very important to use protocols with reduced radiation to ensure optimal image quality with minimal radiation R K Gupta, Director & HOD – Department of Radiology & Imaging,Fortis Memorial Research Institute,Gurgaon
IN IMAGING 19
COVER STORY
Technology of dose management There are numerous tools for dose management. In fact, various vendors have inbuilt software and mechanisms to manage and reduce radiation dosage like: ■ X-ray beam filtration ■ X-ray beam collimation ■ X-ray tube current modulation and adaptation ■ Patient body habitus (automatic exposure control) ■ Peak kilovoltage optimisation ■ Improved detection system efficiency ■ Noise reduction algorithms ■ Iterative reconstruction
Sharing responsibility Most equipment manufacturers today are torchbearers of dose management and have focused 20 IN IMAGING
MOST EQUIPMENT MANUFACTURERS TODAYARE TORCHBEARERS OF DOSE MANAGEMENT AND HAVE FOCUSED SERVICES FOR DOSE REDUCTION AND MANAGEMENTFOR THE DOCTORS
services for dose reduction and management for the doctors. “CT dose management relies on the availability of dose data and adequately educated personnel. These two aspects are at the core of right dose management, which further optimises dose reduction,” says David. “We have applied the ALARA principle to its true spirit while designing our low dose diagnostic machines. We strive to excel in this field by extensive research and regularly come up with latest technologies in reducing radiation dose in our new and existing diagnostic devices,” says Gandhi. Some of the initiatives by leading equipment manufacturers are: JANUARY 2014
COVER STORY
IN FUTURE, BETTER SOFTWARE SYSTEMS ARE EXPECTED THATWILLHELP RADIOLOGISTS ANALYSE IMAGES MUCH BETTER AND AVOID UNNECESSARYRADIATION EXPOSURE TO PATIENTS Siemens Healthcare DoseMAP - Siemens CT Dose Management Programme: Provides functionalities like CARE Analytics to report, document and analyse dose. It lets the user access dose values per case, per examination type or per patient. Additionally, access to scan protocols can be restricted to protect the set dose levels and to prevent unauthorised changes to the scan parameters. EduCARE: It bundles dedicated trainings from Siemens that focus on key technologies and their application in clinical practice. Exclusive tutorials, webinars, e-trainings and brochures cover a wide range of topics related to achieving the right dose. Optimize CARE CT: It is a crossmodality consultancy programme offered by Siemens Customer Service. Over the course of the programme, Siemens professionals guide users towards optimising the use of radiation in order to reduce dose. Through onsite and offsite support and trainings, users learn how to use the right dose technology to deliver the right dose levels for every patient.
Philips Healthcare iDose4 is an iterative based reconstruction technology recently introduced with Philips CT scanners through which the machine is enabled to reduce radiation dose up to 80 per cent without compromising on the quality of images it delivered. iDose4 is also capable of improving the image quality at low radiation dose! The JANUARY 2014
company claims to has shipped more than a thousand iDose4 Scanner upgrades within a short span of its inception into the market. This technology is among the most successful low dose imaging technology in the CT industry which got widely appreciated by the entire radiology community. Philips CT received excellence in radiology award from AuntMinnie.com (the "Minnies" awards recognise excellence in radiology) which picked out the iDose4 Premium Package as the Best New Radiology Software during RSNA 2012. “Dose-Aware” is a radiation exposure monitoring device which Philips developed for cath lab operators. This device will provide live feed about total exposure the operator received during a cath lab procedure to avoid unnecessary exposure to radiation.
GE Healthcare GE Blueprint: Launched in June 2012, GE Blueprint offers a comprehensive approach based on an assessment of a healthcare provider’s technology, people and processes and helps identify breakthrough imaging technologies, system-specific solutions and processes, and comprehensive imaging “blueprints” to help providers achieve low-dose, high-definition diagnostic capabilities. GE Blueprint’s goal is to work with healthcare providers to reduce their average patient exposure by up to 50 per cent, based on longitudinal tracking of average dose.
DoseWatch, enables radiologists to measure, track and optimise patient radiation dose over time. It is a webbased dose monitoring software used to capture, track and report radiation dose statistics directly from the imaging device, multi-modality and vendor agnostic. Doctors can produce sharp, focused diagnostic images, all while keeping dose levels as low as reasonably achievable (ALARA). DoseWatch monitors cumulative dose over time, and prevents excessive medical radiation exposure.
More to come The healthcare industry in India is undergoing rapid changes. Radiology is also evolving. It has many important clinical uses and can provide significant benefits. But the concerns related to CT, fluoroscopy, and nuclear medicine imaging procedures are also real. In future, better software systems are expected that will help radiologists analyse images much better and avoid unnecessary radiation exposure to patients. “The future will bring newer machines with advanced automatic exposure control techniques that select the appropriate tube potential and then modulate the tube current to reduce radiation dose. With ever-increasing computational power, iterative reconstruction will be implemented in daily clinical practice, which may lead to substantial image quality improvements and radiation dose reduction,” Dr Chudgar predicts. mneelam.kachhap@expressindia.com
IN IMAGING 21
ONE-ON-ONE
‘TexRAD is a novel measurement tool that enhances the ability of diagnostic imaging’ Sophisticated technology has greatly helped cancer treatment and care in rescent years. However, these technologies generate a lot of data that needs to be analysed quickly and effectively to translate into better care for the patient. A UK based company has found a way to maximise the information that can be obtained from the diagnostic images without subjecting the patient to additional procedures. TexRAD is a software application that analyses the textures in existing radiological scans to assist the clinician in assessing the prognosis of patients with cancer. M Neelam Kachhap interacts with Dr Balaji Ganeshan, Scientific Director, TexRAD to know more about the possibilities of this software
What is medical image processing? Medical image processing is the branch of medical imaging associated with quantitative analysis and visualisation of medical images of numerous modalities such as Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), Computed Tomography (CT), or microscopy to extract, enhance and display information that could be used by medical imaging professions (engineers, physicist and clinicians radiologists) to diagnose, monitor and treat medical disorders. What led you to analyse textures of radiological images? Heterogeneity of the tumour microenvironment (e.g. tumour blood supply) is a well-recognised feature of malignancy that is associated with adverse tumour biology. A heterogeneous blood supply will also impact on treatment response due to poor delivery of chemotherapeutic agents to areas of low vascularity. Hence, a non-invasive imaging method for assessment of tumour heterogeneity could potentially provide a biomarker for prognosis and treatment response. Visual analysis of diagnostic images is largely based upon evaluating 22 IN IMAGING
BALAJI GANESHAN, Scientific Director TexRAD
TEXRAD IS ANOVEL MEASUREMENTTOOL THATENHANCES THE ABILITYOFDIAGNOSTIC IMAGING (CT,PET,MRI) TO CONTRIBUTE TO TREATMENTDECISIONS FOR PATIENTS WITH CANCER AND OTHER DISEASES
morphological information such as size and shape. Image perception and identifying relationships between perceived patterns and possible diagnosis heavily depend on radiologist’s knowledge, analytical skills, memory, intuition and diligence. However, the human visual system has difficulties in discriminating textural information such as coarseness and regularity that result from local spatial variations in image brightness. Furthermore, quantitative information from images is becoming increasingly important within radiological practice as it makes the process more objective. This however is not possible through visual analysis and therefore requires computer-based algorithmic processing. Texture analysis is a vital component of medical image analysis because it is difficult to classify human tissues via visual assessment based on shape or grey-level information. Also, improvements in texture analysis techniques would increase the extracted information enabling better quantification of differences in appearance inaccessible to the naked eye. How was TexRAD born? Most initial texture analysis work JANUARY 2014
ONE-ON-ONE (prior to TexRAD) was focussed on tissue segmentation and identification of tissue as benign or malignant. There was very little work on assessing prognosis, disease-severity and treatment-response/prediction, which was more challenging and less developed. This was in fact the basis of my PhD research at the University of Sussex which started in October 2004 to develop a texture analysis algorithm for patient risk-stratification (‘personalised-medicine’), which could be used as an adjunct (confident decision-making) in routine clinical (radiological) practice. The texture analysis algorithm developed was novel in its approach within medical imaging and a patent application was made in 2007 to protect the invention (currently granted in a few jurisdictions). This generated some initial interest among few prestigious institutions in UK and Europe which led to us developing a research software prototype of the texture analysis. Further interest and scientific publications demonstrating its usefulness in cancer imaging and lack of a commercially available texture analysis software platform led to the spinning out of the company (TexRAD www.texrad.org was incorporated in February 2011) with a number of partnering companies, university and individuals: ◗ Imaging Equipment (Distributor of radiopharmaceuticals Nick Stevens – Managing Director) ◗ University of Sussex (Dr Ian Carter – University Director) ◗ Dr Balaji Ganeshan (Scientific Director, Inventor, Senior Research Associate at the University College London) ◗ Cambridge Computed Imaging (medical software developing company – Mike Hayball, Technical Director) ◗ Miles Medical Pty (Prof Ken Miles – Consultant JANUARY 2014
Radiologist & Nuclear Medicine Physician, Co-inventor, Professor of Medical Imaging, University College London) The current academic base for TexRAD is at the Institute of NuclearMedicine, University College, London. What does the TexRAD software do? How does it do it? TexRAD is a novel measurement tool that enhances the ability of diagnostic imaging (CT, PET, MRI) to contribute to treatment decisions for patients with cancer and other diseases. To date, diagnostic imaging systems have generally enhanced fine detail with the aim of optimising
anatomical resolution. However, experience from the automated identification of military targets has indicated that important discriminatory information is to be found within coarser variations in image brightness. If pronounced, these variations can be perceived as abnormalities of texture. TexRAD employs filters to specifically highlight these coarser features (radii 2 -12mm) and uses histogram analysis to quantify the filtered images. How is this information used for risk assessment of a cancerous tissue? Clinical research applying TexRAD to a range of tumours IN IMAGING 23
ONE-ON-ONE
(lung, oesophageal, colorectal, breast, prostate, renal cell cancer) has identified biological correlates of known prognostic significance and shown the ability of cross-validated threshold texture values to stratify patients by prognosis and/or treatment response. What are the other ways in which this software helps oncologists/researchers? Modelling studies have demonstrated that the use of TexRAD to analyse medical images for quantifying tumour heterogeneity acquired in routine clinical practice can potentially impact clinical decision and assist the clinicians (e.g. oncologists), making, for example, suitability for cancer chemotherapy (use the TexRAD information as an adjunct/additional prognostic factors in Adjuvant! Online), improving the ability to accommodate patient preferences and to save costs of inappropriate treatment that might have been selected using existing methods. Why is information on tumour heterogeneity crucial to oncologists today? This software is particularly generating a lot of interest in doctors working with thoracic malignancies,renal cell carcinoma, haepatocellular carcinoma.Why? These malignancies are some of the most common cancers worldwide, and in India. Their prognosis is also poorer. With early risk-stratification and optimised treatment, the overall outcome for patients with these cancers can be potentially improved. Imaging generally forms part of the first diagnostic test in detecting these cancers. Hence there will be great 24 IN IMAGING
TEXRAD DOES NOT REQUIRE SPECIALISED IMAGING PROTOCOLS TO BE ADDED TO EXISTING IMAGING AND THE BARRIERS TO UPTAKE ARE THEREFORE LIKELYTO BE LOW. TEXRAD HAS COMPARABLE OR SUPERIOR PROGNOSTIC PERFORMANCE AND LOWER COSTTHAN SERUM OR PATHOLOGICAL BIOMARKERS value if novel imaging biomarkers can be developed for early riskstratification. Research using TexRAD on CT has shown the ability to sub-select metastatic renal cell cancer patients who will respond well to a specific type of targeted therapy (anti-angiogenic drugs which are not only expensive but toxic) from those who will not; for whom another form of treatment may be beneficial. Research using TexRAD on CT has shown the ability to identify poor prognostic (reduced-survival) lung cancer patients (at the time of staging) and haepatocellular carcinoma patients from good prognostic cases, potentially assisting the clinician to optimise treatment strategies for better patient outcome. What has been the customer experience with TexRAD? Are any hospitals in India
using this software? We have been working with prestigious clinical and research institutions around the world and the interest and feedback has been encouraging. The interest in TexRAD has been gaining a lot of momentum as a novel research tool (to enhance research output and establish novel clinical applications) leading to the development of a potentially useful clinical tool. This is evident from the increasing number of high-impact research papers and conference publications from the TexRAD user community, an indication of the acceptance of TexRAD within the scientific community. (http://www. texrad.org/index.php?option=com_conten t&view=article&id=4&Itemid=5) Additionally, the very recent research work undertaken by Tata Memorial Hospital has recently shown the potential application in cervical cancer prognosis and response assessment. Anything else you would like to add. This high level of performance verification undertaken for TexRAD is unusual, if not unique, amongst imaging biomarkers. TexRAD does not require specialised imaging protocols to be added to existing imaging and the barriers to uptake are therefore likely to be low. TexRAD has comparable or superior prognostic performance and lower cost than serum or pathological biomarkers. TexRAD is therefore well placed to fulfil the need for readily available prognostic biomarkers to underpin stratified medicine. mneelam.kachhap@expressindia.com
JANUARY 2014
The diagnosis is in the details. Addressing the radiology departmentâ&#x20AC;&#x2122;s need for high-quality, high-productivity image capture systems, we offer a rich portfolio of DR solutions empowered by MUSICA image processing software, from mobile to affordable and fully automated,high-performance DR rooms.
Insight. Delivered. Agfa HealthCare India Pvt. Ltd. Technosoft Knowledge Gateway, 2nd Floor, B-14, Road No-1, Wagle Industrial Estate, Thane (West)- 400 604 Email for enquiries: sales.india@agfa.com Mumbai 022-40642900
New Delhi 011-41510858
Kolkata 033-22820745
Chennai 044-42125263
Learn about Agfa HealthCare at www.agfahealthcare.com
IRIA 2014 SPECIAL | ONE-ON-ONE
â&#x20AC;&#x2DC;In India, we have over 1500 MR systems in the market averaging at about 1.2 MRs per million peopleâ&#x20AC;&#x2122; As GE Healthcare celebrates 30 years of MRI at RSNA, having made its first installation in Asia for the recently launched Silent MR, Dr Richard Hausmann, President and CEO, GE Healthcare MRI, sheds more light on the market and new technologies from the company, in an interaction with Shalini Gupta
How huge is the MRI market globally (in absolute terms)? By how much is it growing? What are the growth drivers? We estimate that the market globally is about $5 billion in equipment. Overall it is a growing market. Globally we see CAGR of 4-5 per cent per year. Growth is very inhomogenous,whereas the developed markets like Europe, US and Japan are pretty much flat and slowly growing, the big growth regions are China, India and Brazil. Emerging countries are growing at 10-15 per cent. While new applications drive growth in developed countries, in emerging countries it is coverage. In countries such as Germany, Europe, Japan and US, most of the new scanner sales are replacements of existing equipment, whereas in emerging countries, it is additional scanners. The imaging market is still dominated by ultrasound,X ray etc which make up more than 50 per cent of the share of the market while MRI occupies close to 12 per cent of the market.Why? The use of MRI is growing globally due to its sensitivity and therefore unique properties as a diagnostic tool. However, it does lag behind other imaging technologies, especially in JANUARY 2014
DR RICHARD HAUSMANN President and CEO, GE Healthcare-MRI
THERE IS A TREMENDOUS OPPORTUNITYFOR MR GROWTH IN INDIA. WE CONTINUE TO INVESTAND INNOVATE IN LOWERING THE TOTALCOSTOF OWNERSHIP OFMRIS
countries like India. The MR market typically grows about 1.5-2 times the GDP growth in India. Secondarily, as the adoption of the ultrasound and CT equipment increases, we will continue to see increased adoption of 1.5T systems in tier II and III towns. There is a lack of knowledge of MRI in certain markets that inhibits its usage and it also has a higher total cost of ownership. We are constantly innovating and looking for new techniques to lower total cost of ownership to increase access to MRI as well as train new users of MRI. What is the MRI penetration in India vis-a-vis markets such as US and Europe.Also throw some light on the systems in use. In the US market, there are about 25 MRs for every one million persons and in Europe, the figure stands at 15 MRs. In India, we have over 1500 MR systems in the market and averaging at about 1.2 MRs per million people. There is a tremendous opportunity for MR growth in India. We continue to invest and innovate in lowering the total cost of ownership of MRIs. We see the market adoption of 3T MRIs increasing. On the other hand, the worldwide market for 7T systems has decreased over the last few years IN IMAGING 27
IRIA 2014 SPECIAL | ONE-ON-ONE
because of the costs associated with 7T installs. Both preowned and refurbished Gold Seal MRIs as well as entry level 1.5T systems will continue to grow in rural and community practices every year for the next decade. How much is cost and pricing a challenge? We are differentiating and have different models for different market segments. We clearly see a value market segment which is looking for more robust entry level scanners which can fulfill most of the tasks needed at a much lower price point. We are serving that market as much as the need for high end scanners which are more expensive. In between, there is a huge market for performance scanners, used as day to day scanners by hospitals and clinical practitioners. We have a range of MRIs from $ 6000 to $ 6 billion. How is the shortage of liquid helium supposed to affect the business? How do you plan to overcome this challenge? There is currently a shortage of helium but we have recently seen some relief. Helium supply is a strategic priority that we plan for in our business. We anticipated the recent shortage earlier this year and are constantly working to make sure it doesn’t affect our ability to deliver MRI systems to our customers. For example, we’re building a new 5,000sq ft helium liquefaction facility (50 new jobs; $17 million investment) in Florence, South Carolina. We left no stone unturned as it’s an absolute 28 IN IMAGING
IN INDIA, 70-75 PER CENT OFTHE MARKETIS 1.5TMR TECHNOLOGIES AND 25-30 PER CENT OFTHE MARKETIS 3.0T MR TECHNOLOGY. WE SEE INCREASED ADOPTION OF1.5TSYSTEMS IN TIER II AND III TOWNS AND 3.0TSYSTEMS IN TIER I TOWNS
priority for us to continue to ship our systems around the world so that doctors can treat their patients. Tell us about the sales of Brivo MR355 Inspire launched this year for emerging markets? We introduced Brivo MR355 and Optima MR360 1.5T systems in the year 2009 and it had been a great success in India and other emerging economies. We have already sold 1000 systems in this product line. Both of these systems are green MRIs with broadband technology. In India, 70-75 per cent of the market is 1.5T MR technologies and 25-30 per cent of the market is 3.0T MR technology. We see increased adoption of 1.5T systems in tier II and III towns and 3.0T systems in tier I towns. How are you dealing with reimbursement cuts in the US due to
changing healthcare reforms? We are constantly looking for ways to improve productivity for customers so they can optimise their throughput at the same quality. For example, our new software platform, DV24.0, improves productivity by up to 30 per cent compared to previous versions. All of our customers with our DV platform, including those in the US, will receive this software upgrade, which will help them improve productivity and therefore lessen the blow of reimbursement cuts. How do you see the market for paediatric imaging in India? The neonatal MRI concept is in the research and development phase, there is nothing in product yet. However, we see an MRI that is compatible with the neonate environment especially useful in hospitals having more than 25 beds in neonatal ICUs. Again, this technology is just a concept at this point but it’s an opportunity we see where MRI could help diagnosis of these fragile patients. Tell us about MAVRIC and how do you see foresee a market for the product in India? How many installations by now? MAVRIC SL is for MR imaging of patients with MR conditional metal implants. In India alone, there are more than 100,000 new knee and hip and joint replacements being done routinely; this will continue to increase as major orthopaedic centres start utilising more and more joint replacement surgeries. We strongly believe that these patients need to be continuously monitored post joint JANUARY 2014
IRIA 2014 SPECIAL | ONE-ON-ONE
replacements using a non-invasive and non-ionising imaging such as MAVRIC SL. The feature is very useful in imaging soft tissue and bone loss around metallic implants. We have already launched this in India in October 2013 and we expect to have five installs by end of the year in major academic institutions. Tell us also about Ideal IQ and why did you find it relevant in the Indian context. Have you organised any awareness drives on the same? How many installations in India till now?
WE ARE CONSTANTLYLOOKING FOR WAYS TO IMPROVE PRODUCTIVITYFOR CUSTOMERS SO THEYCAN OPTIMISE THEIR THROUGHPUT ATTHE SAME QUALITY. FOR EXAMPLE, OUR NEW SOFTWARE PLATFORM,DV24.0, IMPROVES PRODUCTIVITYBY UPTO 30 PER CENTCOMPARED TO PREVIOUS VERSIONS
TICI TECH
Medical Solutions
shalini.gupta@expressindia.com
o.
tall N
ur s
o Visit
In India, one in five adults are considered obese and one in three children are considered obese as well. There are several states like Punjab, Kerala, Delhi, Gujarat where obesity is a major reason for various diseases. With IDEAL IQ, you can get noninvasive FAT and IRON quantification in the liver in less than a 16-second exam. We have organised awareness campaigns through specific CME events across India and have more than 10 installations in India.
392014 IA
in IR
First of its kind X-Ray Tube Reloading Facility in INDIA
Training & Education
MRI • CT Scanners • C-Arms • X-rays • Cath Labs • Mammography • Ultrasound • BMD • RIS/PACS • CR/DR • Spare Parts & all accessories
Diagnostic Imaging Solutions
"Growing to Serve Serving to Grow"
Consulting Planning Systems & Parts
Logistics
Exclusive Distributor IAE X-Ray tubes for entire India Distributor MINDRAY ultrasound for Punjab & Himachal Pradesh
JANUARY 2014
TICITECH MEDICAL SOLUTIONS (P) Ltd. D-124, Phase—7 Industrial Area 160055 Mohali Punjab (INDIA)
Tel / Fax : +91 172 4663603 Email : citech.india@ citech.ch
IN IMAGING 29
DEPARTMENT SCAN
RGCI: AT THE FOREFRONT OF TECHNOLOGY With the patient at the centre of its philosophy, the Rajiv Gandhi Cancer Institute and Research Center, New Delhi is setting new standards in patient care with newer applications in radiology BY SHALINI GUPTA
R
ajiv Gandhi Cancer Institute and Research Center (RGCI & RC), New Delhi, started in 1996 primarily as a cancer diagnostics and treatment hospital geared for tertiary care and today stands as a pioneering institute in the field of cancer research and treatment. The hospital which acquired NABL (2011) and NABH (2012) certification was the first globally to qualify for ISO 9002 and 30 IN IMAGING
14001 certification in 2001. Express Healthcare was keen to find out what the radiology department of this hospital is upto and hence paid a visit to find out more. Located on the ground floor, in the A block of the hospital and 2nd basement in the C Block, it offers easy access to patients. Armed with linear accelerators, simulators, high dose rate remote after loading Brachytherapy system, dedicated treatment planning computers and mould room to
fabricate lead shields and templates in house, it is intricately networked to CT scan and MRI with DICOM image transfer capability. Talking about the early days, Dr AK Chaturvedi, Director, Radiology says, â&#x20AC;&#x153;We acquired the first state-of-the-art stereotactic mammography machine from Siemens (Mammomat 3000) soon after our inception. It was a sophisticated breast diagnostic system which could do biopsy of lesions.â&#x20AC;? He added that even AIIMS JANUARY 2014
did not have one that time. Today the digital version takes its place of pride, a newer more advanced system that integrates a small field digital mammography (SFDM) with digital breast tomosynthesis (DBT) and results in computer generated good quality images that are clearer and hence help in better diagnosis. The department prides itself in having a fully functional PACS with secure private cloud storage in a complete digital environment that JANUARY 2014
ensures reports are generated within a day, optimised imaging protocols conforming to international practice with a focus on clinically oriented reports and carrying out most bed side interventional procedures. Care is also taken to ensure patient management through active participation in multi-speciality clinics (held on a daily basis) and tumour board meetings. â&#x20AC;&#x153;The radiologist plays an important role in staging the disease and detailing
its exact extent which is a driving factor for treatment by the physician. This includes evaluation of the treatment being given to understand its responses so that the physician can either change the dose or suggest an alternative course,â&#x20AC;? adds Dr Chaturvedi. With more than 200 radiofrequency ablations (RFA) to its credit, the department is a pioneer in the treatment which is ideal for patients with local tumours IN IMAGING 31
DEPARTMENT SCAN
THE HOSPITAL'S REPUTATION IN IMAGE GUIDED INTERVENTIONS IS EVIDENT BYTHE NUMBER OFREFERRALS COMING IN FROM MULTIPLE HOSPITALS ACROSS THE COUNTRY or those who have failed conventional therapies. Not only does it save the trauma associated with surgery, but also reduces hospital admission time to a day or so. RFA is performed under CT guidance and combined with chemotherapy for best results. The hospital's reputation in image guided interventions is evident by the number of referrals coming in from multiple hospitals across the country, most of which are carried out on an outpatient basis. Another technique called Transarterial Chemo Embolisation (TACE) therapy involves administration of chemotherapy directly to the liver tumour via a catheter that reduces many side effects of traditional chemotherapy that is given to the whole body. Apart from the ultrasonography (USG) guided fine needle aspiration cytology (FNACs) and biopsies (with yield rates as high as 96 per cent), stereotactic biopsy procedures and guided wire localisations are also performed. A state-of-the-art MR guided biopsy system takes care of any abnormalities detected on MR mammography. Last year saw the addition of TrueBeam technology for the first time in Northern India at RGRC. The advanced radiotherapy device dynamically synchronises imaging, patient positioning, motion management, and treatment delivery with precision. With applications in all modalities including Image Guided Radiotherapy, Radiosurgery (SRS, 32 IN IMAGING
SRT) Intensity-Modulated Radiotherapy (IMRT), Volumetric Intensity Modulated Arc Therapy (VMAT) and Stereotactic Body Radiotherapy (SBRT) along with conventional and 3-D conformal radiotherapy. “We have breached the stratosphere of operative technology with the addition of cutting edge technology of Da Vinci robot assisted surgery and addition of four more modular operation theatres,” informs Dr Chaturvedi. Touching upon the merits of
functional imaging, he further elaborates how PET CT scans have changed the course of management of cancer. “So far in radiology, the focus was on studying the internal composition of the body, whether through CT scan, X-Ray. However, certain molecular changes also need to be mapped. A PET CT scan gives structural image with a superimposed functional image detailing the metabolic processes in the body which leads to better insights into the disease.” An 18 channel, high gradient
JANUARY 2014
DEPARTMENT SCAN
1.5T MRI performs dynamic studies and multiphase angiographic studies alongwith venography, MR spectroscopy, perfusion, diffusion imaging and mean curve analysis functions for evaluation of complex cases. Breast imaging is routinely performed with a high resolution breast coil with advanced software available for analysis of post contrast kinetics of mass lesions. The machine is equipped with a unique â&#x20AC;&#x2DC;total imaging matrixâ&#x20AC;&#x2122; (TIM) technology making it possible to combine the elements for more than one coil for optimal imaging. Currently the department has 10 radiologists and five more in training. Almost 12 students have passed out so far as a part of its postgraduate DNB programme in radiology (3-year residency) accredited by the National Board of Examinations, New Delhi which started in January each year. Apart from this, it runs a one year fellowship programme in oncological radiology for radiologists certified by IMA academy of medical specialities, a short term training programme in radiology (two to four weeks) recognised by the Indian Radiological & Imaging Association (IRIA) and Indian College of Radiology as well as diploma courses in X-ray and medical Imaging Technology for technicians (two-year programme recognised by Delhi Medical Association). Dr Chaturvedi is currently working on a project for early detection of breast cancer under International Atomic Energy Agency (Vienna) and recently conducted a workshop in interventional procedures for radiologists in Malaysia. All in all, the department, with its cutting edge technology supplemented with training and research, looks poised for growth. shalini.g@expressindia.com JANUARY 2014
IN IMAGING 33
TECH SCAN
PRINTING SIMPLIFIED DICOMJet software and printer solution, offered in India by RSG Infotech, emerges as a cost effective paper printing solution that can substantially reduce the cost of medical imaging | BY LAKSHMIPRIYA NAIR
A
intensive operation is printing medical images to specialised and expensive film printers supporting the DICOM protocol, a universallyused communication standard in the medical imaging world. The growing realisation among hospitals and imaging centers on the necessity to reduce every-day costs, and X-ray films imply high production, storage, shipping and disposal costs have caused them to look for more cost-effective alternatives to this mode of printing. RSG Infotech, a company offering the cutting edge Apple technology in the business segments of video, film, broadcast, audio, graphics, photo and print, is now offering a cost-effective alternative to expensive films in the form of DicomJet, software, alongwith an appropriate Windows-compatible printer. This printer is being touted as a high-quality and cost-efficient
dvances in medical imaging technologies have opened up new avenues to improve and enhance healthcare diagnostics and thereby delivery. A report released by marketsandmarkets.com states, “The global diagnostic imaging market is expected to grow from $20.7 billion in 2010 to $26.6 billion by 2016, at a CAGR of 4.2 per cent from 2011 to 2016.” India’s imaging market is also on an accelerated growth path. While the benefits accrued from various imaging technologies like CT, PET/SPECT, MRI etc cannot be denied or overlooked, it is equally true that they have also contributed to rising healthcare costs. Imaging machines are not only expensive to buy but also to maintain. Their operational costs are quite substantial. One such capital-
DICOM printing solution for the radiology department and the other hospital departments. Rupesh Pandey, GM, RSG Infotech explains the benefits of this printer and they include: ◗ Seamless integration in any DICOM network ◗ In small imaging center, DICOMJet can be coupled even with a single modality supporting DICOM print ◗ Dramatic cost reduction (from hundereds of rupees per copy to Rs 20-25 per copy). ◗ Near-diagnostic print quality ◗ Easy filing, storage, shipping and disposal of paper printouts ◗ Environment-friendly He also informed that the printer is, gradually yet steadily, gaining acceptance in the Indian market. Ruby Hall Hospital and Sahyadri Hospitals in Pune, Ayush Hospital in North India etc are some of the places
User ratings scale: 1-5 ( 5 being the highest) Name of the respondent
Technology
Performance of the product
Image quality
User-friendliness
Value for money
Dr Anirudh Kohli
4
4
5
5
5
Bomi Bhote
4
4
4
4
5
34 IN IMAGING
JANUARY 2014
TECH SCAN
TECHNICAL FEATURES Some of the key features of the DICOMJet software: ◗ Full DICOM 3.0 compliance: DICOMJet exactly reproduces the behavior of a fullfeatured DICOM film printer (DICOM Print SCP) on your office printer. ◗ Supports up to 20 simultaneous DICOM associations. ◗ High-quality grayscale and color print: produced images are of near-diagnostic quality. ◗ Fully customizable layout, header, footer and logos on the printed sheets. ◗ Advanced management of DICOM print jobs,which can be saved, previewed and re-submitted in a second time. ◗ Advanced support for true-size printing.
where the printer has been installed. Express Healthcare, in its Tech Scan section, chose to review this product looking at its potential, and garnered some user reviews to understand the product and its usability in the Indian market.
Simplifying operations Dr Anirudh Kohli, Chief Radiologist, Breach Candy Hospital and Research Center is one of the users of the printer. He has been using it for the last six months and sharing his experience he says, “Prior to DICOM print solution, we needed JANUARY 2014
to outsource our printing requirements as we did not have an in-house high quality printer since it was expensive. Outsourcing entailed having a runner boy to carry the files on a CDs/pen drives to the commercial printer and receive physical prints back, resulting in a turn around time of a day, now the turnaround time is five minutes. In medicine, a faster turnaround time directly impacts patient care many fold.” Bomi Bhote, CEO, Ruby Hall Hospital informs, “Our printer got installed in July, since then we are using it very aggressively and our
average print per month is more than ten thousand.” He further adds, “Prior to DICOM Print, we used to have different printers for different modalities, both for film and paper. Now since we get print from a single printer we can expect consistent quality across all modalities.”
Beneficial features Talking about the features that he finds most helpful, Dr Kohli says, “There is no need to save the image in file into other formats such as TIFF/JPEG 2000 etc, where due to the compression there is bound to be IN IMAGING 35
TECH SCAN
AN IMPORTANTASPECT IS THE COST OFA DICOM PRINT AS COMPARED TO CONVENTIONALLASER FILM; THE SAVINGS ARE NEARLY IN THE RANGE OF80 PER CENT! some loss of resolution. The image is uncompressed, providing the best resolution - again patient management is impacted by quality of imaging. An important aspect is the cost of a DICOM print as compared to conventional laser film; the savings are nearly in the range of 80 per cent!! This can dramatically impact patient cost as laser film costs are the largest consumable expense in imaging studies.” Adding further he says that the DICOM print, the crystal clear image quality, the ability to print both colour and grey scale and of different sizes are some of the unique features of the product. Bhote says that printing high quality greyscale and colour images directly from the modalities are the unique features of the DICOM printer. His says, “One single printer for both greyscale and colour images and also radiologist can print positive or key images straight from PACS workstation for reporting.”
Recommendations for improvement Both the users have no complaints from the product so far. However, Dr Kohli gives his suggestion for enhancing the product and says, “The sky is the limit- - but if grey scale imaging can match laser film imaging totally it would be a boon as the savings would be dramatic.” Bhote feels, “In India, this technology is in the nascent stage but it has got opportunity to evolve.” 36 IN IMAGING
Paper print taken from the DICOM printer
A promising technology While the technology and therein the product is yet to take off completely in the country, it definitely offers a good alternative to expensive film printing. Going by the good reviews received
from the users of the product, it is to be expected that soon more and more healthcare may opt for it in a bid to reduce their operational costs without compromising on quality. lakshmipriya.nair@expressindia.com
JANUARY 2014
IRIA 2014 SPECIAL | ONE-ON-ONE
â&#x20AC;&#x2DC;This year our focus is on private practitioners and post graduate studentsâ&#x20AC;&#x2122; The 67th Annual Conference of Indian Radiological & Imaging Association is going to be held at Agra and is just around the corner. Dr Bhupendra Ahuja, Organising Chairman, IRIA 2014 share his experience preparing for the event. He also updates on the new introductions for this year, in conversation with Raelene Kambli.
What does it mean to be the organising chairperson of IRIA 2014? I have had prior experience in organising the IRIA event in 2005. I was the Organising Secretary then. Therefore, I was aware of the requirements and responsibilities associated with organising such a big radiology event. I feel very fortunate to be apart of the organising team and I hope to make this event a big success. How long have you been preparing for this annual meeting? What are the challenges faced so far? Our preparations are on since last year. All members of the IRIA are mostly private practitioners and so we already have an extremely busy schedule; therefore we need a lot of time to organise this event. Since I am the Organising Chairperson for this year, I knew what was needed. I first started with organising the scientific programme. Now organising the scientific programme isn't an easy task. It has to maintain the theme and also focus on disseminating the right message that JANUARY 2014
DR BHUPENDRA AHUJA, Organising Chairman, IRIA 2014
OUR THEME FOR THIS YEAR IS 'BETTER IMAGING FOR HEALTHIER LIFE'. THIS THEME IS CHOSEN MAINLYBECAUSE DIAGNOSTIC IMAGING HAS BECOME APRIME SOURCE FOR CLINICAL DIAGNOSIS OFANY MEDICALCONDITION
we intend to give to our delegates. Moreover, organising a scientific programme needs like minded people to come together, hence we prepared a team of six to eight members who would be in charge of the scientific programme. This time we have a faculty of 108 people for the scientific programme. The most biggest challenge this year was to convince trade exhibitors. The fluctuation of the US dollar and the falling Indian rupee had made exhibitors reluctant to participate in IRIA 2014. It took us nearly six months to convince them. What are the highlights of this year? What is the theme selected this year? Conference is one way of updating on the latest happenings in the field. Nearly 800-900 post graduate students attend this conference year on year and so all through these years our focus has been to create opportunities for providing information on the latest in the field to these students. Apart from from post graduate students we have also had our scientific programmes designed keeping in mind the IN IMAGING 37
IRIA 2014 SPECIAL | ONE-ON-ONE
private practitioners attending the conference. This year our focus is on private practitioners and post graduate students. Therefore, our theme for this year is 'Better imaging for healthier life'. This theme is chosen mainly because diagnostic imaging these days has become a prime source for clinical diagnosis of any medical condition. How will this year's event be different from past events? Is there anything new that will be introduced this year? Year on year IRIA receives a good response, both from the delegates and the exhibitors. So every year we have to introduce some unique. Here is a list of new things introduced this year: ◗ While maintaining this year's theme, we have asked every speaker to dedicate 10 minutes of their session towards giving important tips on how to efficiently report one's diagnosis. The idea is to promote effective reporting in order to increase efficiency of radiologists. ◗ This year we have cut down on
38 IN IMAGING
WE HAVE ASKED EVERYSPEAKER TO DEDICATE 10 MINUTES OF THEIR SESSION TOWARDS GIVING IMPORTANTTIPS ON HOWTO EFFICIENTLY REPORTONE'S DIAGNOSIS. THE IDEAIS TO PROMOTE EFFECTIVE REPORTING IN ORDER TO INCREASE EFFICIENCYOFRADIOLOGISTS the number of halls. We have kept three halls dedicated to sessions related to system and three halls dedicated to modality. ◗ We have also increased the time limit of the conference. The conference this year will begin at 9 am and end at 6 pm. ◗ Workshops have been included in the session itself to save time. Moreover, all ultrasound sessions will be in the form of live workshops. Since ultrasound is a live branch
we have kept five workshops dedicated to ultrasound. ◗ The most unique introduction this year is our new website, which is highly interactive platform for delegates and the speakers to communicate. This website can also be accessed through mobile phones. Delegates can ask questions during the session using the mobile app on our website. This will also save time and give an opportunity to every delegate to ask their question. ◗ Also, we have received this year, 600 oral presentation, 480 poster presentations which is a very encouraging response. We are going to have 25 e-stations as kiosks and 25 PCs and laptops with categorised presentations and papers for the delegates to browse and read through. What are your expectations from IRIA 2014? This year we expect a very good response. We have already received more than 2000 registrations for our scientific programme and all our exhibition stalls have been booked. raelene.kambli@expressindia.com
JANUARY 2014
IRIA 2014 SPECIAL
PRE-OWNED MEDICAL EQUIPMENT: AN AFFORDABLE OPTION GPS Shekhawat, Director, Vertex Medical highlights the advantages of pre-owned medical equipment and in particular mammography and BMD-DEXA equipment
M
ost of the diagnostic centres and hospitals always look forward to own a mammography and BMD-DEXA equipment apart from X-ray, ultrasound etc., but due to low patient turnover and high capital investment, they are not able to do so. Pre-owned medical equipment is a great option for hospitals, diagnostic centres and clinics where the budget does not allow to invest in a new equipment. There are many facilities in tier II and tier III towns which would like to offer mammography and BMD-DEXA to the patients, but due to the heavy investment required and very unlikely to break even. At such places the average patient turnover is one or two cases per day. As both mammography and BMDDEXA are relatively new concept to such towns. In this situation the with pre-owned and refurbished equipment they can start offering the facility to patients and practitioners at almost half or sometimes one third cost of the new equipment which helps them to break
JANUARY 2014
GPS SHEKHAWAT, Director, Vertex Medical
even faster. This helps the patients to reduce the cost and travelling time required to visit the place in another city which offers such examination facilities. New medical equipment is a huge investment that depreciates at an alarming rate. Pre-owned medical equipment is much less expensive and depreciates less quickly. In most developed countries where the hospitals are replacing the analog mammography systems and moving to digital mammography systems. The analog mammography systems are still in good working condition. The same are cleaned and calibrated to the OEM specifications and installed at
diagnostic centres which can work well with low cost of ownership. These systems are always less expensive to maintain. Likewise, the BMD-DEXA is also upgraded from the pencil beam to fan beam systems due to high patient throughput. The pencil beam systems are still have good results and can offer good image quality with relatively very less dose. New mammography and BMD are huge investments that depreciate at an alarming rate. Pre-owned medical equipment is much less expensive and depreciates less quickly. This means the pre-owned equipment will be affordable and hospitals have more capital to invest on other needs. Pre-owned and refurbished mammography as well as BMD-DEXA can be the answer to any diagnostic centre and hospital's needs who are looking for affordable solutions. Contact: Tel: 011-41612370 Mobile: +91 8800899361 Email : gps.shekhawat@vertexmedical.in
IN IMAGING 39
IRIA 2014 SPECIAL
ESAOTE INTRODUCES NEW G-SCAN BRIO, E-MRI BRIO RELEASE 2 PLATFORM The former is a revolutionary MRI approach for weight-bearing MRI and musculoskeletal applications while the latter can substantially speed-up the MRI examination
E
saote introduces the new G-Scan Brio, a revolutionary approach for weightbearing MRI and musculoskeletal applications, which allows clinicians to increase diagnostic accuracy and confidence. Based on the experience of first generation of G-Scan systems, G-Scan Brio is a 2nd generation weight-bearing MRI system with a new look, new ergonomics and new acquisition techniques. Unlike a multipurpose MRI, all aspects of the G-Scan Brio system, from coils to user interface, have been developed and optimised to specifically perform musculoskekeletal MRI examinations with a focus on efficiency and patient comfort. Patient setup is easily accomplished by a single operator, featuring a touch screen display on the gantry showing realtime images of the joint assuring fast and accurate positioning. “The G-Scan tilting MRI allows clinicians to study all the joints and the entire spine either in clinostasis (supine) or in orthostasis (weightbearing), because magnet and patient
40 IN IMAGING
G-SCAN BRIO IS NOT ONLYA UNIQUE SYSTEM FROM ACLINICALAND DIAGNOSTIC VIEWPOINT BUTITIS ALSO EASY TO SITE AND VERY ECONOMICALTO RUN table can rotate from 0° to 90°. This method has provided several advantages for diagnosis and also for medical-legal aspects,” said Prof Giuseppe Monetti, Professor and Chair, Department of Diagnostic Imaging “Nigrisoli” United Hospitals, Bologna (Italy) and Director of the International School of Musculo skeletal Ultrasound. He further added, “In fact, the study of ligamentous structures if performed only in clinostasis doesn’t allow a correct definition of the eventual functional failure of these structures. In orthostasis there is almost a constant finding: the marked deflection of a
ligament, as usually observed in anterior cruciate ligament. The same concept can be applied in the study of eventual meniscal dislocations, disk herniation, vertebral anterior and posterior-listhesis, as well as eventual reactive bone marrow edema, evident exclusively under weight-bearing.” G-Scan Brio is not only a unique system from a clinical and diagnostic viewpoint but it is also easy to site and very economical to run. The low break even point of G-Scan Brio is fully in line with the economical constraints of today’s healthcare environment making it an optimal investment also for the private clinic. Easy installation, ease of use, low maintenance technology, low energy consumption, nocryogens, and remote service: all equal a smart investment. Together with the G-Scan Brio, Esaote introduces the new E-MRI Brio Release 2 platform, a combination of acquisition and reconstruction of 2D sequences that substantially speed-up the MRI examination, emphasising high image quality. The biggest benefit of this particular technology is the reduction of scan time without compromising image quality.
JANUARY 2014
IRIA 2014 SPECIAL
REACHING FOR THE ZENITH OF SUCCESS The company has an installed base of 100 odd ultrasound system, 25 mammography systems, 25 C-Arms and 50 Color Doppler Unit
Z
enith Imaging System is a group of professionals with years of experience behind them in sales, maintenance and servicing of medical diagnostic imaging equipment. It is a unique, solution-oriented company to meet all of your needs in medical diagnostic equipment. The company aims at providing prompt, cost effective and quality services for the equipment supplied by them. They maintain an exhaustive inventory of spares, and if required the spares can be procured from their associates in the country and abroad. They have established themselves as the people for whom service comes
JANUARY 2014
ZENITH AIMS AT PROVIDING PROMPT COSTEFFECTIVE AND QUALITY SERVICES FOR T HE EQUIPMENT SUPPLIED BYTHEM
first. Over a time, it has gained association with highly reputed customers and are grateful to their customers for their overwhelming support since nearly two decades of the company's existence. After pioneering the field of sales and service of refurbished CT and having established a installed base of around 150 CT Scanner spread over whole of India, it has recently added permanent magnet MRIâ&#x20AC;&#x2122;s to their list of modalities. In addition to it, they have an installed base of 100 odd ultrasound system, 25 mammography systems, 25 C-Arms and 50 Color Doppler Unit. The CEO, PC Sharma, a graduate from University of Roorkee, is a well known figure in the field of diagnostic radiology. Born of humble origins, with his utter dedication and hard work, he founded the company two decades back, and since then Zenith Imaging system has grown to have presence in every major city of North India. The installed base of the company extends to Delhi, UP, Uttarakhand, Haryana, Punjab, Rajasthan, MP, J&K, Orissa, Karnataka, Bihar and West Bengal. Contact Zenith Imaging System 218 Vidya Vihar, West Enclave; Pitampura , New Delhi-110034 IN IMAGING 41
IRIA 2014 SPECIAL | ONE-ON-ONE
‘TeraRecon deploys a software solution which can be used for all imaging modalities’ Pranav Shah, Regional Sales Manager – India, TeraRecon talks about his company' agenda for the Indian market in 2014, its software solution and its agenda for the forthcoming IRIA 2014, in an interaction with Lakshmipriya Nair What is TeraRecon's agenda for the Indian market in 2014 and howwould IRIA2014 help in achieving it? TeraRecon is a leading independent provider of advanced visualisation and 3D reconstruction software in India. 2013 was a very successful year for TeraRecon with installations at some of the best medical colleges and big medical institutes. We would like to take this momentum forward in year 2014 and target big medical institutes with high volume and busy radiology departments where there is scarcity of workstations. Our products would enable every radiologist in the department to run our software application and make use of advanced clinical tools for decision making. We have noticed that most of these leading medical colleges and institutes would have multiple CT and MRI scanners and from different vendors. The modality bundled workstation is usually associated with the same scanner and on majority time occupied by radiology technicians giving rare chances for the radiologist and young students to work on them. TeraRecon brings in a unique value proposition being a Vendor Neutral and deploys a software solution which can be used for all your imaging modalities and provide a single window where doctors can do post processing, review and diagnosis. This software solution is based on concurrent user licensing and 42 IN IMAGING
PRANAV SHAH, Regional Sales Manager, India, Terarecon
IN YEAR 2014, WE WOULD LIKE TO TARGETBIG MEDICALINSTITUTES WITH HIGH VOLUME AND BUSYRADIOLOGY DEPARTMENTS WHERE THERE IS SCARCITYOF WORKSTATIONS
can be configured so that several doctors can simultaneously perform advanced reconstruction on their individual computers. IRIA has always been the best conference for medical imaging and attracts doctors from various parts of India. This year we would like to reach out to as many doctors as possible and try to educate them on options available for 3D reconstruction software rather than getting locked down to those modality bundled workstations. Any new launches slated for IRIA2014? There are two new products, other than our core product iNtuition, which we are looking forward to promote at this IRIA 2014. ✦iReview: Vendor Neutral Multimodality 2D/3D/4D viewer. ✦iEMV: Zero foot print, browser based distribution of images across the healthcare enterprise. There are new clinical modules added to our core product iNtuition and we would be also demonstrating these applications on liver/lung segmentation, cardiac MRI, 4D Perfusion, DTI, etc. What are the opportunities and challenges that are peculiar to the Indian radiology market? The Indian medical imaging market brings in lots of opportunities for an independent 3D software company like TeraRecon. As JANUARY 2014
Esaote Asia Diagnostic Pvt Ltd., DLF IT Park, A-44 & 45, Tower-C, Ground Floor, Sector- 62, Noida - 201 301, Uttar Pradesh, India. Tel: +91 120 4732444 Fax: +91 120 4750148 e-mail: info@esaote.in www.esaote.com
India’s leading independent
multi-user workstation & solution
TM
vnm
iNtuition Workstation Introducing the most powerful multi-user advanced visualization 3D workstation based on client-server architecture. Up to three simultaneous users can access an unparalleled suite of clinical applications anywhere, anytime across the radiology department.
Enterprise iNtuition Solution Introducing award winning Enterprise Advanced Visualization platform “iNtuition” for needs of a high volume and large healthcare enterprises. iNtuition platform can be customized so to offer multiple concurrent users from a scale of 3 to 50 users licenses and even more. All the users can simultaneously access an unparalleled suite of clinical applications anywhere, anytime across the healthcare enterprise.
Key Benefits: •
Simultaneous access for radiologists, technologists and referring physicians
• •
Enterprise-wide access Multi-modality support & Vendor Neutral
•
Efficient iNtuition customizable 3D protocols
•
Multi-modality support
•
Unparalleled suite of advanced clinical applications
•
Integration with majority of PACS
•
Segmentation Analysis & Tracking (e.g. Lung Nodule Analysis)
Application Features Clinical Features •
Vessel Analysis (including Coronary)
•
Calcium Scoring
•
Calcium Scoring
•
Flythrough (e.g. Colonoscopy)
•
CT & MR Cardiac Function
•
Lung/Colon SphereFinder (e.g. CAD)
•
Fusion for CT/PET and other modalities
•
Multi-phase MR Review
•
Time Density Analysis (e.g. Perfusion)
•
CT/CTA Volume Subtraction
•
Parametric Mapping (e.g. Breast MR)
•
Conferencing & Collaboration
•
Liver Volumetry & surgical planning
•
Volumetric Histogram
terarecon.com | info@terarecon.com TeraRecon, Aquarius, iNtuition and the iNtuition logo are trademarks of TeraRecon, Inc. Copyright© 2014 TeraRecon, Inc. All rights reserved. 121913AQ-A-EXHC-A1
IRIA 2014 SPECIAL | ONE-ON-ONE mentioned earlier, there are huge medical institutes in India which have multiple scanners from different vendors with scanning facilities at different places in the hospital. In such situations, radiologists have to keep moving from one scanner to another and reach out to those bundled workstations. Instead what they would want is a simplified workflow and get any images, anywhere and at anytime! TeraRecon is here to tap this opportunity and offer our award winning products. Another big opportunity we see is partnership with PACS companies for advanced 3D tools. Most of the PACS players would have good 2D viewer and occasionally advanced 3D tools which again would prompt a user to get up from his PACS viewing station and go on to the modality bundled
workstation for advanced processing. Instead what they would want is the advanced 3D processing capabilities on their individual PACS viewing station so that they can address all their image viewing and processing needs on the same station. With every opportunity there comes a challenge and the biggest challenge or task if I may say for us is to make the user think beyond the software solutions provided by modality companies which could many times not fully featured, vendor specified and does not give end users a streamline workflow. We have been constantly educating customers on this front and to an extend we have been successful but it is long way to go! How does Terarecon's offerings
differ from its counterparts and how adapted are they to the Indian radiology market's requirements? TeraRecon is the only independent medical imaging software company which competes with giants of medical imaging. The existence of the company itself proves that we have a better value proposition to offer than our counterparts and our installations at some of the leading medical institutes in India showcases the faith of users in our product. The most important is the flexible licensing policy from a single user license to massive 50 concurrent users or beyond. The other important differentiation is our broadest suite of advanced clinical applications for cardiac, vascular, neuro, oncology, liver, lung, etc. lakshmipriya.nair@expressindia.com
ALLENGERS TO LAUNCH DIAGNOSTIC SYSTEMS AND TECHNOLOGY-BASED SOFTWARE AT IRIA 2014 An eco model of its fixed DR system, the 'DigiX eco' and a light weight mobile DR system 'RollX DR' would be launched
A
llengers, a Chandigarh based medical equipment manufacturer which was founded in the year 1987, has always been instrumental in bringing cost effective solutions for the medical fraternity, be it X-ray systems, C-arms, Mammography, Lithotripters, Cathlabs, TMT, OPG, Monitors and the latest being the DR Systems and 46 IN IMAGING
softwares. Allengers has also got the privilege to be selected for the PHD Award 2013 by the PHD Chamber Jury out of many esteemed companies from all over the country. During IRIA 2014, Allengers would be launching an eco model of its fixed DR system, the ‘DigiX eco’ and also a light weight mobile DR system the ‘RollX DR’. With the launching of these DR systems like RollX DR and
DigiX eco, Allengers has further embarked upon a mission to provide cost-effective imaging solutions, thereby enabling healthcare centres to adopt them at very reasonable prices. The future of radiography will be digital and technology-based. The pace at which the digital radiography (DR) is advancing is noteworthy. DR is the fastest digital imaging JANUARY 2014
IRIA 2014 SPECIAL
technology available at this time, as in this speed can be used not only to improve the healthcare facilities productivity but also to save the patients time. So keeping this in mind, Allengers is all set to also launch and introduce during IRIA 2014 a software based technology: ◗ Allen Cloud PACS ◗ Dual Energy Subtraction Allengers ‘All Cloud PACS’ is a web-based PACS server with a distributed mirrored image database. The technician at the modality (Digital X-Ray, CT, MRI, Cath Lab) can upload diagnostic images to the server. The All Cloud PACS database is easily accessed by using a simple browser (Internet explorer, Firefox, Chrome). It can also be accessed through a smartphone with a browser. New fast streaming technology enables images to be viewed almost instantly. It is a truly web-based PACS, no software is required to be installed in the PC. The user (radiologist) requires only a user name and password. The radiologist can view images and report directly on the browser. Uploaded report will be downloadable at the modality only in the pdf’ format so that no alterations can be made. Also digital or scanned signature can be added to the report. This will enable a truly filmless environment. Allengers’ All Cloud PACS has multilayer security and firewall so that patient confidentiality is maintained. Security features and accessible information can be JANUARY 2014
configured as per user requirements. Accounting and MIS features ensure that a ‘pay-per-patient’ model can be easily adopted. Not long ago, the idea of sharing radiological images and exams using the Internet seemed impractical. Patients worried that secure information within their personal health records would be compromised, and radiologists found it cost-prohibitive. But times have changed. A growing consensus believes that a constellation of tools, located remotely but connected by the Web, is the solution to securely and cost-effectively sharing the health records. Although in the US, this concept is already there, yet in India it is going to be a new concept and is bound to grow leaps and bounds as it is going to be an efficient computing infrastructure for all healthcare facilities. As such Allengers All Cloud PACS is going to be instrumental in providing filmless radiology and distance radiology services helping hospitals to scale with ease and manage resources in a
much better way. ‘Dual Energy Subtraction’ is an advanced application for Allengers flat panel true digital radiography systems. A PA/AP chest radiograph exam is performed with the acquisition of 2 images at different energy levels less than three seconds apart and the application generates four views: ◗ A standard low kV radiograph ◗ A high kV radiograph ◗ A soft tissue image with the bones subtracted ◗ An image of the bones and any additional calcified structures. Dual Energy separates bone tissue and soft tissue, allowing radiologists to view these in separate radiographic images. It eliminates obstruction from overlying bones and provides more information on calcification content. Ability to detect pulmonary nodules and multiple metastatic lesions is highly improved with Dual Energy Subtraction. The technique is helpful in visualising small lesions that may be obscured by bone. This versatile application software is being commissioned at Mahajan Imaging Centre, Defence colony, New Delhi. With RollX DR, DigiX eco, All Cloud PACS, etc Allengers continues its passion for excellence and commitment in providing cost effective solutions be it DR or the other medical diagnostic equipment. Contact Allengers Medical Systems S.C.O 212213-214, Sector 34-A, Chandigarh - 160 022, Website: www.allengers.com IN IMAGING 47
IRIA 2014 SPECIAL
AERO DR - DIGITAL WIRELESS RADIOGRAPHY SYSTEM High Image Quality and Lower Doses Scintillator Direct-Contact Technology
We succeeded in creating a new technology whereby a CsI scintillator is made to contact directly over a TFT*1 sensor panel without any protective layer in between them. This technology has made it possible to guide the light emitted fromthe scintillator to the photodiode without causing the light to be dispersed at the interface with the TFT sensor.
High Image Quality and Lower Doses
even at a low dose. It is considered therefore that the AeroDR is effective to reduce the amount of radiation exposure. At the same time, we achieved the wider dynamic range of DR comparable to CR. This means that in radiography of shoulder joints, for example, the AeroDR permits describing the skin line accurately even when the radiographic conditions change alongthe way.
Easy Workflow and Reliability Universal Solution for the Existing X-ray Room
Integrated Control Station CS-7
CS-7 can control not only the AeroDR detectors but also X-ray generators and Konica Minolta existing CR family. No need to operate the X-ray console to adjust X-ray exposure conditions.*5
Quick Preview and Smart GUI The AeroDR detector is the same as an ISO 4090 compliant film cassette in size so that it will fit any existing wall-stand or table bucky tray
After exposure, a preview image immediately appears on the display of
Shared FPD Solution AeroDR can be used anywhere withâ&#x20AC;&#x153; the Shared FPD Solutionâ&#x20AC;?. As soon as AeroDR is registered to any Xray room, AeroDR will be ready to use in the X-ray room immediately.
The optimal combination of the AeroDR detector using a KonicaMinolta CsI scintillator combined with the newly developed lownoise readout ICs delivers a high detective quantum efficiency (DQE) 48 IN IMAGING
the new CS-7 console in less than two seconds. The CS-7 has a user-friendly graphic interface adding new and powerful proprietary functions. GUI design can be modified to customer preferences flexibly, succeeding the conventional console design. JANUARY 2014
IRIA 2014 SPECIAL Power-saving Technology Patient safety is of primary importance, therefore the lithium ion capacitor, the world newest technology, was adopted as a battery technology which has many exhausted in emergency, Aero DR gets over 10 images by the capacitor being recharged for only three minutes.
Light-weight & Durable Light weight Wireless FPD (14'' X 17" and 17" X 17" ) The AeroDR Detector is lightweight FPD weighing as little as 2.9 kg
advantages despite of demanding a lower power consuming panel design, which has been overcome by employing low power ICs and a powersaving control.
Sealed and Protected Scintillator In order to prevent the CsI crystal from being deformed by local concentration of external force, a double-glass structure in which the
New Battery Technology Achieves Light-weight yet Rigid Body The lithium ion capacitor has a charge and discharge cycle life that is tremendously longer than a lithium ion battery and does not markedly decrease in capacity even after it has continuously been used for many years. Therefore, it is possible to be built in to AeroDR and also friendly to the environment. In this case, the structure of the cassette case has become so simple that it is possible to significantly reduce the weight of the cassette and increase the mechanical strength of the cassette.
Reliable, Rapidly Rechargeable and Long-Life Battery The lithium ion capacitor, which charges quickly in a battery charger or through a tethered connection, has a long charge and discharge cycle life that does not need to be replaced during the expected life cycle of the detector. If the capacitor gets JANUARY 2014
the battery is incorporated in the cassette (it need not be replaced), it is unnecessary to provide the case with a notch for battery replacement which reduces the rigidity of the case. Because of this, the cassette case that is appreciably light in weight has sufficient rigidity. Thanks in part to the buffer effect of the built-in battery, the load bearing performance of the cassette is the same as that of our CR cassette.
(14" X 17" panel) / 3.6 kg(17"X 17" panel) and supports wireless networking which transmits captured images to the console. Technologists can easily perform non bucky exams such as tabletop or cross table projections.
Durable Monocoque Structured Cassette We adopted the "Monocoque case" to ensure trouble-free operation even under substantial shock or load. Since
CsI scintillator glass plate and the TF T panel glass plate are overlapped and sealed together is adopted for AeroDR. The double-glass structure not only enhances the load-bearing performance but also prevents the scintillator edge from being deformed by a mechanical shock (e.g., fall or striking of the cassette) and the TFT sensor panel glass plate from being broken. Contact Konica Minolta Tel: 022-61916969 Email : sales@mi.konicaminolta.in IN IMAGING 49
IRIA 2014 SPECIAL
KONICA MINOLTA: SHOWCASING SONOSCAPE'S SOLUTIONS Sonoscape offers an eclectic range entry level B&W ultrasound systems to high-end colour Dopplers
K
onica Minolta Healthcare India now offers Sonoscape's range of ultrasound systems in the Indian market. Sonoscape is a leading and innovative manufacturer of a wide range of entry level B&W ultrasound systems to high-end colour Dopplers. With its mission of â&#x20AC;&#x2DC;Caring for life through innovationsâ&#x20AC;&#x2122; Sonoscape provides a wide range of products to cater to various segments in radiology, gynaecology, general imaging and cardiovascular imaging. With over 1000 installations in the country today, Konica Minolta can boast of providing the best in imaging at affordable cost. Sonoscape ultrasound systems are well known for their excellent image quality and colour pick-up, stable and robust hardware and trouble free operations for years.
SONOSCAPE ULTRASOUND SYSTEMS ARE WELLKNOWN FOR THEIR EXCELLENT IMAGE QUALITYAND COLOUR PICK-UP, STABLE AND ROBUST HARDWARE AND TROUBLE FREE OPERATIONS FOR YEARS
50 IN IMAGING
Safeguarding your heart because life is full of emotions With high resolution imaging, modern interface and quantification tools help our customers strongly for cardiac studies. Sonoscape offers extraordinary colour and CW Doppler sensitivity which enhances your confidence in cardiac imaging. features like tissue velocity imaging, tissue Doppler imaging and easy stress echo workflow helps you in the best of cardiac imaging.
Offering and reaching out to every point of care
Offering greater confidence in general imaging Customers can count on Sonoscape's advanced ultrasound platform to provide superb image quality. Intuitive user interface and fast scanning response for your scanning convenience. With its stateof-the-art high channel platform, Sonoscape ultrasounds provide high
image resolution and penetrations. User friendly interface allows simplifying the daily work flow. Features like micro-scanning technology, compound imaging, panoramic imaging gives quantified tools for your best imaging practices.
S2/S6/S8
Sonoscape's premium linear image quality gives you an indispensable tool in your point of care applications which include regional nerve block, musculosketal and rheumatology. Sonoscape's high frequency platform upto 15Mhz allows superficial Image quality to be perfect. High sensitive power Doppler diagnoses superficial flow much quicker and easier. JANUARY 2014
IRIA 2014 SPECIAL
Protecting your investments With Sonoscape's extremely rational design and reliable manufact uring activities, all the products give the highest level of performance without requiring any special care. Added to that, Konica Minolta's widespread service team ensures quick and flexible solutions. Sonoscape product reliability and design methodology allows easy and constant upgrade of your imaging parameters keeping you updated with the latest in imaging techniques. The products are designed trouble free and also designed for easy repairs and after sales services. Konica Minolta offers basic entry level B/W models A5 and A8 which are digital imaging ultrasound systems with 12 and 15 â&#x20AC;&#x153; LCD displays. In the colour Doppler segment Konica Minolta offers entry level solutions with its portable colour Doppler S6 with 15" LCD display and SSI 4000 which is a mobile model. In the mid range segment, Konica Minolta offers S20 which offers high density probe offering excellent imaging. In the cardiology segment offered is a light weight portable system S8 which incorporates a 15" LCD display. To go to the higher segment, new models S30 and S40 have been recently launched providing an unmatched imaging levels which cover every clinical imaging requirements. JANUARY 2014
S20
SSI 4000
S40
S30
IN IMAGING 51
IRIA 2014 SPECIAL | ONE-ON-ONE
We are leaders in refurbished equipment sales in India Ratish Nair, CEO, Sanrad Medical systems speaks on the refurbished equipment market in India, its opportunities and challenges as well as his companyâ&#x20AC;&#x2122;s plans to leverage the potential of this market, in an interaction with Raelene Kambli How does the refurbished equipment market operate? What is the size of the refurbished medical equipment market in India? A large part of Indian population does not have access to quality healthcare due to very high costs. The healthcare service providers view refurbished medical equipment as an alternative to new equipment. The demand for refurbished medical equipment is increasing in India, as the healthcare service providers are focusing on Indian rural markets. Coupled with cost sensitivity, the demand for refurbished medical equipment is growing rapidly. The refurbished equipment market operates similar to other new equipment business, except for the fact that the business is concentrated more in the tier II-III towns/cities. Presently, the refurbished market is approximately 20 per cent of the overall equipment sold and almost 30 per cent of the sales in the private sector. Name the major growth drivers in Indiaâ&#x20AC;&#x2122;s refurbished medical equipment market? Lower cost of refurbished equipment and increasing occurrence of diseases are the major drivers for the growth of refurbished imaging equipment. It aids small and medium healthcare institutions to provide advanced treatment at lower rates. Refurbished equipment gives an 52 IN IMAGING
RATISH NAIR Chief Executive Officer Sanrad Medical Systems
PRESENTLY,THE REFURBISHED MARKET IS APPROXIMATELY 20 PER CENTOFTHE OVERALLEQUIPMENT SOLD AND ALMOST 30 PER CENTOF THE SALES IN THE PRIVATE SECTOR
opportunity for the customers to purchase latest technology products for their clinic or hospital. Refurbished medical imaging equipment is likely to be the most viable and affordable alternative to otherwise expensive highend equipment. In case of individual, corporate or private healthcare institutions, it is necessary to control the budget for new and latest medical equipment and they in turn purchase refurbished equipment which benefits the economy, increases patient satisfaction, reduces electronic and toxic waste and improves overall healthcare quality throughout the world. Buying refurbished equipment can save you sometimes over 40 per cent of what you would normally pay for brand new equipment. It allows you to own top brand equipment at a low price. It also provides same performance level as that of new equipment and comes with full warranty. It is always best to purchase used and refurbished medical equipment from a reputed vendor, who will ensure that the medical equipment you buy are fully refurbished and tested under Original Equipment Manufacturer (OEM) specifications. For continued growth of refurbished equipment in the Indian market, it is very essential for a refurbished equipment supplier to have complete knowhow of the product and good infrastructure to support the maintenance and repairs of the JANUARY 2014
IRIA 2014 SPECIAL | ONE-ON-ONE
equipment. The demand for refurbished equipment are mainly in the high value segment viz. CT scanners, MRI scanners, cath labs., etc. Which cities have a high demand for refurbished medical equipment? The demand for refurbished medical equipment are more in developing states, specifically in states where infrastructure and healthcare facilities are growing fast. An approximate zone wise assessment indicate that the northern states in India are leading in volumes of refurbished equipment sales. What are the opportunities and challenges in the refurbished equipment business in India? Some cringe at the very mention of used or pre-owned. Whether it's in the eyes of the buyer or the seller, the patient or the healthcare provider, there is often a negative association connected to these terms. Whatever we may call it, ‘remanufactured, reconditioned, re assembled refurbished, pre-owned’, plainly speaking it comes under one class 'second hand' or ‘used' equipment. Sometimes the customer reaction is justified. There are certainly instances where refurbished equipment will fail every other day or may not meet quality standards. Also, there will be some 'fly by night' operators, in any business for that matter, who will 'join the game' just for profit, causing suffering and loss to customers as well as patients. Just a few of these types can do severe damage to reputations of genuine vendors in the refurbished medical equipment business. It may be very difficult for some hospitals to equip themselves with the latest medical devices, but they still want to be the best possible healthcare providers. Their reputation and JANUARY 2014
SANRAD HAS AMAJOR SHARE OFTHE MARKETDUE TO ITS TECHNICALSKILLS, EXCELLENTAFTER SALES SERVICE AND COMMITTMENT TOWARDS SUPPLYING GOOD QUALITYEQUIPMENT standing in the medical community depends on these factors. However, they simply are not able to afford the newest state-of-the-art medical equipment like CT scanners, MRI scanner or any other equipment necessary to perform their basic functions. In such circumstances, refurbished medical equipment supplied by genuine vendors are good alternates for most of them. If good quality refurbishment processes can be created with the active support of the manufacturing company, then refurbishing equipment in India will definitely give a tremendous boost to the business as costs can be greatly reduced as compared to refurbishing at facility abroad. To start a good quality refurbishing facility in India it is essential to have the involvement of the parent company manufacturing these goods, and that practically seems to be difficult presently. Moreover the present tax rates are much higher for manufacturers as compared to direct imports. What is SANRAD’s market share within the refurbished equipment sector? SANRAD is a pioneer in the refurbished equipment sector, and has a major share of the market due to its technical skills, excellent after sales
service and committment towards supplying good quality equipment. SANRAD is not only a wellrecognised brand for medical imaging equipment, but also has turned into a concept by itself. This concept embraces a range of customer support systems that have been designed for cost conscious customers in India for a market that is both technology oriented and demanding. Our reference customers are key growth initiators in our business. It is important for the customers to check with existing user of the same equipment about the vendor, equipment, spare parts, failures, service support etc. We do not sell old technology equipment that are used more than five to six years. SANRAD invests in extensive training, and development of knowledge driven manpower on all ranges of CT Scanner models including the newest versions. The lead engineers at SANRAD are trained at Japan. SANRAD believes in customer relations, which is our core value, and we ensure that the equipment delivers the same output as a new one, we have the largest inventory of spare parts in the country and offer them ex-stock to our customers, wide network of service support. Our wide network of service offers fastest response time for customer support and is acclaimed as the best in the industry. The most important benefit that SANRAD offers its customer is a ‘First Service and Pay Later’ attitude that has been crucial for keeping the systems running at more than 98 per cent efficiency and saving many lives today. As part of the SANRAD culture, our engineers and marketing professionals understand the customers requirements, cost and business pattern. Based on those factors we help the customer select an appropriate model of equipment to IN IMAGING 53
IRIA 2014 SPECIAL | ONE-ON-ONE
meet all their imaging requirements. This is one of reasons for our success and hence our customers are growing year on year. As a reputed vendor we feel that its our moral responsibility to support the performance of our equipment and supply spare parts at least seven to eight years from installation and above all cater to the safety of the customersâ&#x20AC;&#x2122; investment. This adds to our credibility within the industry. As a preferred service provider, SANRAD believes in building relations with the customers, and the key people belonging to medical fraternity, through trust, integrity and emphasis on quality. What are the parameters considered while designing refurbished medical equipment at SANRAD? Due to complex nature of the
54 IN IMAGING
equipment, the after sales support, quality of the product provided by the vendors directly impacts the reliability. Most important parameters being considered by SANRAD are age of the systems, emphasis on latest technology of the equipment, upgradability of systems, ease of availability of spare parts, actual users review in terms of stability of product and installation base in international market. Indian customers demand latest technology equipment supported by proper technical service with and assured 95 per cent + uptime for equipment and this is the key to future business. Where do you see this market in the next five years? India is the biggest market in Asia for refurbished medical devices. M&M predicts Asia will be the most lucrative
market for refurbished devices in the near future. India is one of the largest emerging medical equipment markets in the world. It is estimated to grow at a rate of 15 per cent with a Compounded Annual Growth Rate (CAGR) to exceed $4 billion by 2015. The increased need can be attributed towards growth in medical tourism, increase in health budget, rise in population associated with increase in lifestyle diseases and growing economy have led to stupendous demand for medical devices. As a country, we are cost conscious and still evolving strategies towards managing toxic wastes. Refurbished medical equipment allows for affordable machines without sacrifice of quality. More and more customers are using refurbished equipment just like a new equipment. raelene.kambli@expressindia.com
JANUARY 2014
IRIA 2014 SPECIAL | ONE-ON-ONE
TESTIMONIALS
DR SANTOSH PRABHU,
DR NITIN KADAM,
Managing Director, Matrix Diagnostix, Kolhapur
Managing Director, MGM Hospital, Vashi, Navi Mumbai
Why did you opt for refurbished medical equipment rather than new equipment? I chose to incorporate refurbished imaging system at my centre because at an affordable cost I get to use state-of-the art technology that gives me excellent image quality as well. Among refurbished medical equipment players, what parameters did you use to choose the supplier of your choice, in this case Sanrad? SANRAD's solid reputation of supplying high quality refurbished equipment with excellent service backup and minimum down time as well as availability of necessary spares with the company.
Why did you opt for refurbished medical equipment rather than new equipment? Most of the high end medical equipment are imported from abroad, and I feel we should use our resources wisely and prevent meaningless waste of our earnings. Moreover a good quality refurbished system of a desired equipment has the same specification and functionality as that of a new system. Moreover the lower capital cost of these equipments enables us to sustain the overheads of maintaining such highly sophisticated units thereby offering patients services at affordable costs.
There are many contentions related to the quality and durability of refurbished equipment, how would you justify the same? Our facility has been using refurbished equipment for last 13 years. We have zero problems with it provided you choose the right vendor. Otherwise, if you have a wrong vendor (and there are many fly-by-night operators in this segment) beware of them ... it’s a nightmare !
Among refurbished medical equipment players, what parameters did you use to choose the supplier of your choice, in this case SANRAD? We see major three parameters in choosing the right equipment: ✦ Equipment has to be of latest technology, not very old. ✦ System should be sturdy with proven performance ✦ Technical competence and efficient after sales service of supplier
JANUARY 2014
In the case of SANRAD we feel that they are the only company strongly committed to the above conditions. There are many contentions related to the quality and durability of refurbished equipment, how would you justify the same? I personally use refurbished CT scanners supplied by SANRAD since last 15 years and I must say with pride that they provide good quality latest technology equipments with excellent after sales service. Companies like SANRAD have played a major role in establishing the confidence of healthcare industry professionals in refurbished equipment. With a good saving in capital cost, considering the vast installation base of SANRAD, I feel they have helped our country save more than RS 150 crores in foreign exchange. Also, the re-use of high end medical equipment reduces e-waste and helps in preventing CO2 emissions produced during the manufacturing processes. IN IMAGING 55
IRIA 2014 SPECIAL | FACILITY VISIT
SANRAD MEDICAL SYSTEMS: CARVING A NICHE IN RADIOLOGY MARKET M Neelam Kachhap visits Sanradâ&#x20AC;&#x2122;s Peenya facility in Bangalore to gain a better insight on the refurbished medical equipment industry
P
eenya, Bangalore is considered to be one of the largest industrial areas in Asia and houses some of the most reputed medical and pharma companies in India. Sanrad Medical Systems, the largest refurbished radiology equipment provider in India, has also found a home here. It recently unveiled a unique 5000 sq ft facility in Peenya, on the outskirts of Bangalore, to address its growing business needs.
The beginning Sanrad had a humble beginning in the economic capital of India, Mumbai in 1994. Initially, the company offered maintenance services and later started selling refurbished Toshiba CT scanners. Since then the company has become the fourth largest medical imaging equipment company in India. It is the only Indian company in the radiology imaging market, that stands tall among reputed MNC. With about 70 employees and offices across the country the company has more than 400 installations under its brand. The founder and CEO, Ratish Nair says, "I was working with third party, involved in sales and service of Toshiba Medical Systems and 56 IN IMAGING
realised that the customers had various issues concerning these highend equipment. These equipment were mostly present in larger cities."In an effort to bring such high end equipment closer to smaller cities by reducing costs, we introduced high-end refurbished equipment from Japan," he adds.
Unusual partnership Sanrad works with reputed MNCs based in Japan, Korea and China. "We have had a long association with T-MED corporation, Japan, that deals in refurbished Toshiba CT scanners," informs Nair. The other companies partnering with Sanrad are MDT, USA; ISOL, Korea; and XinAo MDT, China. "The products are imported to the Peenya facility and then sent to the client, where it is installed," explains Nair. "After installations we provide full service and annual maintenance contracts (AMCs). Our best marketing is done by our own satisfied customers and our prices are reasonable. In fact, we do not end the relationship with a sale, in fact our relationship starts with every new sale and lasts for life," he adds. Stressing the robust after-sales service, he says, "We are known for our prompt services. None of our machines have down-time in days.
We understand that time is of essence in our business. In fact down-time does not only mean losses but also life of the patient. No client has to send a second reminder for service or maintenance. It is done promptly. We are always stocked with spares."
The products The company is known to provide factory refurbished CT scanners and MRIs. "Our portfolio consists of single, four and 16 slices CT scanners as well as permanent open MRI models in 0.3T and 0.45T from MDT, US," says Nair. Soon the company would start rolling 1.5T MRIs from the Bengaluru facility. "We are working with a Korean company to start sales of fresh equipment in India. This is a powerful 8/16 channel subsystem with fully automated scan operation." informs Nair. "We work with an independent Quality Assurance company that certifies our products after installations," he further adds.
In future Sanrad has ambitious expansion plans for the future. The facility at Peenya will be expanded in the coming months to add around 5000 sq ft more to the existing facility. The new facility will house the new X-ray division, that will oversee the JANUARY 2014
The products are imported, refurbished and transported to clients for installation
Operations and strategising in progress
The Sanrad team at Peenya Facility, Bangalore
marketing and sales of new DR systems in the Indian market. The company also plans to venture into equipment software development in future. Sanrad will also look at jointventure manufacturing in future JANUARY 2014
where the non-Indian partner will provide the technical know-how and Sanrad will provide infrastructure, manpower and finance, Nair informed. mneelam.kachhap@expressindia.com
IN IMAGING 57
IRIA 2014 SPECIAL
NEORADâ&#x20AC;&#x2122;S SIMPLICT- SIMPLIFYING CONVENTIONAL CTGUIDED INTERVENTIONS SImpliCT will help in reducing the number of needle position confirmation scans, effectively reducing radiation dose both to the patient and the interventional radiologist
N
eoRad AS is a medtech company leveraging its relationship to Oslo University Hospital in Norway to create new products that improve the quality of well-established medical procedures. Neorad is the first company to come up with the guidance system for CT guided interventions in early 2000 . Its lead product, SimpliCT, a laser guide for image guided interventions, has been sold to over 50 hospitals and clinics both in CT and advanced 3D angio labs (Cone Beam CT), for non vascular interventions such as biopsies, ablations, drainages, infiltrations etc. Simplify is a novel releasable needle holder. It can support any straight needle or catheter from size 12G in any angulation. If the need arises to disengage the device, simply unscrew the clip and unfold the arc.
SimpliCT NeoRad has invented SimpliCT, a
SIMPLICT HAS BEEN SOLD TO OVER 50 HOSPITALS AND CLINICS BOTH IN CTAND ADVANCED 3D ANGIO LABS (CONE BEAM CT),FOR NON VASCULAR INTERVENTIONS SUCH AS BIOPSIES, ABLATIONS,DRAINAGES, INFILTRATIONS ETC laser-based navigation solution for CT guided interventions, such as ablations, nephrostomies, biopsies vertebroplasties and nerve blocks. By marking the patient entry point and simply setting the SimpliCT laser with the angle of the preferred needle
Tumor Ablation Biopsy Abscess Drainage SimpliCT offers precision laser guidance for image-guideded interventions mentioned above
58 IN IMAGING
path, the intervention can be performed keeping the needle hub withing the laser light. SimpliCT is set with the angles obtained from the CT software, and will reqiure no additional software or workstations. Ceiling suspension provides easy positioning of the device. Recently SimpliCT has been put to use with advanced Cone Beam CT Interventional systems. For systems providing 3D needle path trajectory planning SimpliCT can be used to visualise the needle trajectory, replacing fluoroscopy in the C-arm Bulls Eye View (entry point view) position. The net effect of applying SimpliCT to your practice will be a reduced number of needle position confirmation scans, effectively reducing radiation dose both to the patient and the interventional radiologist.
Benefits of SimpliCT â&#x2014;&#x2014; Works with CT and Cone Beam CT
Spinal Intervention
JANUARY 2014
IRIA 2014 SPECIAL
◗ Easy installation with Mavig Portegra2
ceiling system ◗ Reduced radiation dose to operator
and patient ◗ Facilitates procedures in z-axis
(angulation plane or gantry tilt) ◗ Fewer needle passes per patient ◗ Quicker procedure ◗ Safer procedure ◗ Improved patient comfort
For Cone Beam CT: The opportunity to use the laser for visualisation of the needle angulation instead of fluoroscopy
Installations More than 250 installations globally and last summer, NeoRad started the Indian operations with B Rajavel Subramanian as its head. SimpliCT is installed in few key centres of India like , Chirstian Medical College , Rajiv Gandhi Cancer Institute , Delhi , Manipal Hospital , Bangalore, Apollo Chennai etc.. Key radiologists from Global Hospitals Chennai, BIR Chennai, Stanley Medical College Chennai, Raoyapettah Hospital Chennai tried SimpliCT and gave positive feedbacks Chirstian Medical College, Vellore is the first customer to buy SimpliCT in Asia and CMC has done a pilot project on the product, which proved reduction of radiation to both patients and clinicians. The company also started their South East Asian operations from Singapore, Tan Tok Seng Hospital in Singapore as a referral centre for NeoRad . Neorad also plans to introduce a standalone system for treatment planning with needle navigation and ablation. Contact B Rajavel, Vice President-Sales , India, and South East Asia NeoRad India, 33 PVN Appartments , Sadullaha Street,T Nagar , Chennai-17, Website: http://neorad.no Tel: 91 9442851148 Email: b.rajavel@neorad.com JANUARY 2014
IN IMAGING 59
IRIA 2014 SPECIAL
RAYSAFE S1 DOSE MANAGEMENT SOLUTION Rahul Sanghavi, VP-Marketing and Anna Wanland, Marketing & Communications, Unfors RaySafe explain how RaySafe S1 helps in radiation control
W
hen it comes to radiation control, there are three important areas to be considered: quality assurance of the X-ray equipment, minimisation of radiation exposure to medical staff and dose management for the protection of patients.
The challenges The number of X-rays taken around the world is increasing continuously and consequently radiation doses to patients are also rising. It is more important than ever to try and reduce unnecessary radiation – while keeping the necessary radiation as low as possible! In addition, healthcare institutions are at the same time faced with a three-fold challenge: ◗ Proving compliance with regulatory requirements ◗ Demonstrating the best practices in dose management ◗ Reducing costs RaySafe S1 is one simple answer to these challenges!
Raysafe s1 dose management solution RaySafe S1 is a patient dose tracking software that helps to lower patient dose and improve process quality in the diagnostic X-ray imaging process. Based on the DICOM standard, 60 IN IMAGING
RaySafe S1 extracts dose information from different X-ray modalities, such as CT. It is a scalable solution that can be used by anyone involved in the diagnostic imaging process, such as referring physicians, radiologists, radiographers, medical physicists and radiation safety officers. Depending on your role, the RaySafe S1 will present information relevant for your needs.
Dose reduction and increased patient safety Presuming that you have a calibrated X-ray machine in optimal working condition, the next step to
promote dose reduction is justification. Is the exam justified? The benefit of the exam needs to be balanced with the risk, and not everyone is familiar with how to interpret this concept into practice. RaySafe S1 can help referring physicians in the justification process by providing referral guidelines. This will help the physician identify the most suitable exam and to be aware of the dose involved. It is also important to take the patient’s previous exams into account, as they contribute to the accumulated dose. RaySafe S1 lets hospitals access the patient’s dose history, to increase their safety. JANUARY 2014
IRIA 2014 SPECIAL
IN RAYSAFE S1, RELEVANT STATISTICS ARE VISUALISED AND CUSTOM-MADE REPORTS CAN BE EASILYGENERATED FOR REPORTING TO THE RELEVANTAUTHORITIES
The second step for protecting patients from unnecessary dose is optimisation. Is the image quality at its best, using as little radiation as possible? RaySafe S1 helps to achieve dose and image optimisation through providing checklists and reminders for the operator. When using optimal settings the number of retakes are minimised and optimal dose is promoted. Thirdly, control is also necessary in order to reduce radiation dose. Is your radiology department as whole working optimally? Do you know what doses your patients are receiving? RaySafe S1 not only records patient dose during procedures; it can send automatic notifications in case an exposure level exceeds a pre-set value. It also lets the radiologist feedback on the image quality. While visualising dose, quality and waste-scan statistics with RaySafe S1, the trends indicate the effectiveness of quality protocols and exam protocols. The statistics presented in RaySafe S1 can also help you monitor staff and equipment performance, which in turn lets you identify lab problems or training needs at an early stage, supporting the X-ray department to work at its best.
Cost reduction In the past, it was easy to see how many waste-scans occurred in any JANUARY 2014
radiology department: you would just look at the amount of films in the bins! But today, many waste-scans go unnoticed in the era of digital radiology. RaySafe S1 solves this problem by tracking the number of waste-scans, while the checklists and reminders help to reduce them. With less unjustified and repeated exams, RaySafe S1 can help radiology departments reduce costs and become more productive.
for its intuitive usability and innovative design.
Regulatory compliance
About Unfors RaySafe
In RaySafe S1, relevant statistics are visualised and custom-made reports can be easily generated for reporting to the relevant authorities. Such reporting is often based on Dose Reference Levels; a baseline dose value per type of procedure. Development of DRL requires a large statistical base, something which RaySafe S1 handles with ease as it can access historic dose data from the DICOM system. Once DRLs are set, hospitals can use RaySafe S1 to check their current performance against the DRL values and continuously lower the patient doses.
Unfors RaySafe provides a comprehensive solution for the X-ray room consisting of products which collect radiation information, add value and share it in an easy-to-understand way with all relevant stakeholders. User friendliness combined with state-of-the-art technology and maximum accuracy form the backbone of the RaySafe’s product range, serving the company’s mission to help people avoid unnecessary radiation and to establish a better radiation safety culture wherever people encounter radiation.
Award winning design
Contact Unfors RaySafe (India), 21, Blue-Chip Ind. Estate No. 1 Golani Industrial Complex Waliv, Vasai (E) – 401 208 Tel: +91 250 324 61 44 E-mail: infoindia@raysafe.com
In addition to measurement accuracy, products from Unfors RaySafe are well-known for their ease of use. This has been acknowledged whenRaySafe S1 received the prestigious RedDot design award 2013
IN IMAGING 61
IRIA 2014 SPECIAL
NATURE’S OFFERINGS Its radiology focus is on radiation protection garments
N
ature’s Global Service, established in 1995, has been growing from strength to strength in the field of radiology equipment. The CEO, Tarun Bhateja, a young and dynamic entrepreneur is a pioneer who has constantly introduced latest state of the art technological innovations in radiology at lower prices vis-à-vis his competitors, thus creating a niche for himself and his company.
Apron Front
Apron Back
View Box
Olympus Roll
Focus areas in radiology Nature's Global Service (NGS) is a highly reputed ISO 9001:2008/ISO 13485, CE certified manufacturer and exporter of medical equipment. Its radiology focus is on radiation protection garments manufactured under the brand name X-Shield. It manufactures, using high quality technology, light weight and lead free aprons. As a recent advancement in radiation shielding, NGS has introduced light weight, trendy, flexible, unbreakable, certified radiation shielding vinyl apparels under its brand X-Shield. This range of apparel include cath labs apparels, lead glass, ceiling and table shields. Nature’s Global exports products to all over world, especially to countries like China, Taiwan, Europe, US, Africa and Middle East. The company is also manufacturing X-Shield LED viewers in India. X-Shield’s X-Ray Film LED Viewer with 25mm thickness comes 62 IN IMAGING
OKI—DICOM Paper printer first time in the world
with a film activation sensor, digital dimmer and energy saver. It is being manufactured in India for the first time.
New launches in radiology Another innovative launch is the DR – Retrofit Kit System for upgrading the existing analog X-Ray machines of any make with wireless technology for instant imaging. It consists of a DR cassette of 17x17 inches (portable, just 3.8 kg in weight) complete with a control box, Dicom application software and a Dicom compatible mono/colour printer that can be used for hard copies on plain paper, glossy paper, or plastic sheet or to copy the images with reports, etc. on CD. It can be used in the existing bucky or the wall stand for taking chest X-Rays too. Its cost can be recovered in two years’ time and is a
boon for government hospitals if used as filmless/paperless which is the purpose of DR i.e.saving recurring cost of expensive X-Ray films to recover the cost of DR upgradation kit. The company’s dealerships include: ◗ Varian CT scan tubes for all CT Scan Machines including GE, ◗ Mitsubishi thermal paper and printer ◗ Sony thermal paper and printer ◗ OLYMPUS110S normal density and high gloss thermal paper ◗ Atlaim DR Systems OKI—Dicom printer paper based (more information at www.atlaim.com) Contact Tarun Bhateja A-3; New Rajinder Nagar; New Delhi Tel: +91-11-28741437 E-mail: tarun@atsequipments.com Website: www.xrayglobal.com JANUARY 2014
IRIA 2014 SPECIAL
FUJIFILM SONOSITE'S FUTURISTIC SOLUTIONS FUJIFILM SonoSite’s technological advancements are expanding utility of point-of-care ultrasound in India
D
iagnosis essentially means examination and developing opinion about uncertainties. Within the medical industry, it holds a vital stage for check-up and then after treatment. The faith of a patient in the diagnostic findings is based on the fact that an accurate judgement determines to be a boon to the patient. Moreover, timely care of millions of critically ill patients in India is a challenging task in prehospital and intensive care settings. The accompanying high morbidity and mortality in emergency cases means that accurate decision making is imperative. Globally, clinicians are appreciating the benefit of point-ofcare (POC) ultrasound in treatment of patients in such critical situations. POC ultrasound has transformed the way of managing emergency situations. A two-minute ultrasound examination can save a life by reducing the time of diagnosis and treatment.
JANUARY 2014
PAVAN BEHL Director and GM India & Middle East FUJIFILM SonoSite India
FUJIFILM SonoSite India, the pioneer of cutting-edge ultrasound tools, works towards bringing quality point-of-care ultrasound to the patients in hospital and out of hospital through our cutting-edge products and educative training workshops. The ultrasound systems that the company offers enhanced image quality and aids diagnostic confidence of the healthcare physician. The compact, lightweight design with a high resolution screen and easy to use feature of these
systems make easy for physicians to give hand-on training to the beginners on POC ultrasound usage. “Our ultrasound systems have the best battery back-up with a very less boot-up time, thereby serving the greatest need in point-of-care imaging in various emergency departments. SonoSite’s various products available in the market are dedicated to bring high quality ultrasound to patients.” said Pavan Behl, Director and General Manager - India & Middle East, FUJIFILM SonoSite India Its recently launched POC ultrasound system, the X-PORTE ULTRASOUND KIOSK has defined a moment in the next phase of SonoSite’s innovation strategy and is an important milestone in SonoSite’s ongoing effort to improve access to POC ultrasound visualisation. As told by Behl, “FUJIFILM SonoSite considers physician education and training so critical in the use of POC ultrasound, that it IN IMAGING 63
IRIA 2014 SPECIAL
THE X-PORTE ULTRASOUND KIOSK HAS DEFINED A MOMENT IN THE NEXT PHASE OFSONOSITE’S INNOVATION STRATEGYAND IS AN IMPORTANTMILESTONE IN ITS ONGOING EFFORTTO IMPROVE ACCESS TO POC ULTRASOUND VISUALISATION
The Edge® ultrasound system’s enhanced image quality aids your diagnostic confidence. A solid aluminum core helps to protect your investment for the long term. And a splash-resistant silicone keyboard makes cleaning and disinfection that much easier. With the Edge® ultrasound system, you have access to a new generation of POC ultrasound visualisation.
integrated education and learning in its newest generation of POC ultrasound: the X-Porte Ultrasound Kiosk.” He said, “We believe that education and training combined with technical talent, critical decision making ability, and Imagination together make POC ultrasound a lifesaving tool and improving care delivery and patient satisfaction in India. For this purpose, we have partnered with leading Indian institutions, associations and medical centres to provide POC ultrasound training to physicians, nurses and other clinicians and helping deliver the best possible care to the society. Going forward, we plan to hold many more similar workshops in various cities to provide education and training to physicians wanting to integrate point-of-care ultrasound in their daily practice.” The kiosk was created to serve a broad spectrum of users, from novice to advanced, and represents an entirely new design and use paradigm for ultrasound. Through its easily customisable touch-screen 64 IN IMAGING
The M-Turbo® ultrasound system offers striking image quality. Our most versatile system for abdominal, nerve, vascular, cardiac, venous access, pelvic, and superficial imaging. The M-Turbo® ultrasound system gives you striking image quality with sharp contrast resolution and clear tissue delineation. This ultrasound equipment lets you visualise details, improving your ability to differentiate structures, vessels and pathology. S Series™ ultrasound machines are the industry’s first mountable ultrasound. They offer a zero footprint and can be mounted on a wall, the ceiling, or a stand. Our mountable ultrasound systems have a simplified control that let you focus in on your target areas in a matter of seconds. High-resolution images help you see exactly where to perform procedures and allow for accurate diagnoses when treating patients. The S Series ultrasound machines are built to meet U.S. military standards for durability. They boot up quickly, are lightweight, and are built with intuitive designs for ease of use. The NanoMaxx® ultrasound system combines best-in-class performance with affordability and simplicity. With its uniquely simple control, highquality diagnostic imaging, color power Doppler and color-flow velocity, the NanoMaxx® ultrasound system helps physicians make clinical decisions or guide interventional procedures. Not only is the NanoMaxx a portable ultrasound machine, it uses proprietary technology so you can optimize many system settings at the touch of one dial.
JANUARY 2014
IRIA 2014 SPECIAL
X-PORTE PUTS ATYOUR FINGERTIPS LEADING-EDGE CAPABILITIES AND ONBOARD EDUCATIONALRESOURCES,SUCH AS STEP-BY-STEPTUTORIALS VIEWABLE SIMULTANEOUSLYWITH LIVE SCANS
interface, X-Porte puts at your fingertips leading-edge capabilities and onboard educational resources, such as step-by-step tutorials viewable simultaneously with live scans. X-Porte incorporates a breakthrough, proprietary beamforming technology: XDI (Extreme Definition Imaging). This signal analysis algorithm shapes X-Porte's ultrasound beam to pinpoint precision. The result? Artefact clutter is substantially reduced while contrast resolution is significantly enhanced. To maximise the utility of the XDI technology, X-Porte delivers optimum usability and interoperability through its groundbreaking visual learning guides. The kiosk integrates highresolution ultrasound imaging synchronously with 3D animations that enable “any user, any time of day” to make the most of the operating the technology. These learning modules can be used simultaneously with live scanning to optimise in-the-moment JANUARY 2014
performance and user consistency. Its slender profile makes it easy to move alongside beds and exam tables for point-of-care imaging. For portability and durability during transport, X-Porte’s screen folds down and its stand lowers making XPorte even more compact for navigating busy corridors. This unique design was developed by SonoSite in partnership with Henry Ford Hospital Chair of Surgery Scott Dulchavsky, MD, PhD, who has pioneered medical training tutorials for astronauts. Real-time learning on the product enables any and all members of a healthcare team— nurses, mid-level providers, and even a physician-hospital administrator— to be empowered to take advantage of X-Porte's high-performance visualisation. The highly cleanable, sealed user interface was designed with minimal crevices to facilitate optimal infection control. The glass surface has been tested against incidental spills and allows cleaning with a wide range of disinfectants without deteriorating the surface over time. IN IMAGING 65
IRIA 2014 SPECIAL
PRINTER PERFECT Medion Healthcare now brings you a world class colour printing solution from DNP, Japan, introducing fotolusio range of printer model DS 80. DNP has revolutionised dye sublimation printing with DS 80 printers
D
S 80 printers are compact, desktop, high-speed, highquality printers, which can be connected to any imaging modality. The first thing to consider when thinking about DS 80 printers is its outstanding print quality, which helps to offer excellent prints. DS 80 offers unparalleled reliability and ergonomic design for easy access and front loading of media. The front access panel makes maintenance easier and less time-consuming. DS80 printers use an exclusive internal print method that safeguards the paper from exposure to dust and other contaminants. The printers feature a cartridge-based ribbon supply that makes loading fast and easy. DS Series printers are competitively priced, high-resolution printers that produce rich print quality that display full colour details and smooth gradation. The lamination layer on the media provides resistance to fading, fingerprints, water, ozone and dust. The best part of owing DS 80 is that it is a complete dry process printer. Unlike other printing solutions it does not use any kind of ink or cartridges that require frequent replacement and does not offer consistent print quality. DS80 printers offer the same reliability print quality for years together since it 66 IN IMAGING
command. It is so simple that within less than a minute the print is ready to be delivered. Especially for ultrasound applications, DS 80 is ideal as it offers direct connectivity to an ultrasound system using USB. So, as a standalone printer, it can be just connected to your ultrasound system. requires very low maintenance and needs no replacement of ink cartridges. DS 80 printers offer seamless connectivity in a network to all the imaging modalities. It gives the flexibility to format prints directly from the available modality workstation with just a print
Contact Konica Minolta Healthcare India Office no. 515, C- wing, 5th floor, 215- Atrium Centre Andheri (E), Mumbai- 400059 Tel- +91-22-61916900/61916969 Email: nikunj@mi.konicaminolta.in JANUARY 2014
IRIA 2014 SPECIAL | ONE-ON-ONE
‘We have always been industry first in offering the latest in technology’ Nikunj Gada, Executive Director, Konica Minolta Healthcare India shares details about the company's plans for 2014, their agenda for IRIA 2014, the radiology market in India and more, in an interaction with Express Healthcare
What is your agenda at IRIA 2014? As Konica Minolta, we are displaying our complete range of CR systems, AeroDR panels (17x17, 14x17 & 10x12), mobile DR System, AeroRad system, as well as our entire range of ultrasound systems, from entry level B&W ones to the high end colour doppler systems. We expect to be a crowd puller as Konica Minolta is striving to provide complete imaging solutions required for a general diagnostic centre. We aim to be a one-stop shop in this arena and provide efficient and single point of after sales services. Our main focus for IRIA would be to give a message to the imaging service providers that Konica Minolta would be a strong single point partner to meet their basic imaging needs. How is the radiology market in Indian shaping up vis-a-vis the global market? Radiology market in India has grown well in 2013 and not much impact was seen in sales. However, compared to the global markets, digital radiography (DR) JANUARY 2014
NIKUNJ GADA Executive Director, Konica Minolta Healthcare India
OUR MAIN FOCUS FOR IRIAWOULD BE TO GIVE AMESSAGE TO THE IMAGING SERVICE PROVIDERS THAT KONICAMINOLTA WOULD BE ASTRONG SINGLE POINTPARTNER TO MEETTHEIR BASIC IMAGING NEEDS
systems didn’t see as much growth as expected. In the same period, Konica Minolta’s AeroDR system was widely accepted by market because of its technology strong points against competition. AeroDR sales have picked up fairly in 2013 and we have very good sales numbers registered at some of the most premium hospitals in India that are added to our customer base. Apart from our DR products, CR sales increased with our Sigma Package making the volumes in the affordable entry level segment. Ultrasound sales picked up quite well and we won three major government projects which has created high volume install base for Konica Minolta’s ultrasound systems. How does Konica Minolta plan to leverage the opportunities in the Indian radiology market? As Konica Minolta, we have our major focus on Digital Radiography Solutions and AeroRad DR Systems should be the focus of Indian imaging market for the next three to five IN IMAGING 67
IRIA 2014 SPECIAL | ONE-ON-ONE
years. Our leading edge technology in flat panel detectors and our strength of providing a wide and affordable range of AeroRad systems will be the key point to drive sales in the Indian market. Our main focus remains on achieving a leadership position in digital radiography systems, in the coming two years. What are your plans for the Indian market in the New Year? In 2013, Konica Minolta has launched a series of new products in the digital radiography markets. Our most innovative launch was the 17 x 17 wireless AERO DR panel which again is a technological innovation within itself. Launched alongside was 10 x 12 inch, wireless AeroDR panel for orthopeadic and paediatric imaging. Apart from DR retrofit solutions we have launched a series of AeroRAD DR systems with a variety of X-ray combinations. Our AeroRad System Series starts from the most simplest radiography system with
Supported models: GE’s AMX-4 and AMX-4Plus, Siemens’ Mobilett ❈ In some cases,it can be used along with other portable X-ray system. Please contact your Konica Minolta sales representative for more details
68 IN IMAGING
OUR LEADING EDGE TECHNOLOGYIN FLAT PANELDETECTORS AND OUR STRENGTH OF PROVIDING AWIDE AND AFFORADABLE RANGE OFAERORAD SYSTEMS WILLBE THE KEYPOINT TO DRIVE SALES IN THE INDIAN MARKET. OUR MAIN FOCUS REMAINS ON ACHIEVING A LEADERSHIP POSITION IN DIGITALRADIOGRAPHY SYSTEMS,IN THE COMING TWO YEARS
32KW to high end fully motorised ceiling systems with generator capacities of 80KW. Konica Minolta introduced AeroSync technology in generator 2nd AeroRad panels which can be easily integrated in any make of mobile X-rays and fixed X-rays where physical connection of X-ray system is not required. How does Konica Minolta differentiate itself from the competition? High technology and the latest in technology has always been Konica Minolta’s design strategy. We have always been industry first in offering the latest in technology. Since the beginning of digital radiography solutions with CR systems. Konica Minolta had technology which the competition are not offering even today. Talking about of AeroDR cassette type flat panel detectors, we are again offering the most advance technology with our AeroDR being the lightest flat panel detector in the world still making it the most durable panel in the world. AeroDR, with its unbeatable inhouse CSI technology, offers the highest image quality while claiming 50 per cent lower doses. AeroDR offers the flexibility of having a wired and a wireless panel instantly in all sizes . AeroDR is the only flat panel detector in the world to provide an integrated Lithium Ion Capacitor power bank which doesn't require frequent change of batteries as in our competitors’ products, allowing optimised use with reduced recurring cost which is a kind of hidden cost for the buyer. JANUARY 2014
IRIA 2014 SPECIAL
BERGEN HEALTHCARE: BRINGING PROGRESS TO RADIOLOGY Rajinder Kumar, Chairman & MD, Bergen Healthcare elaborates on how his company is bringing the best in the field of medical diagnostic X-Ray quality assurance and X-Ray dosimetry, computed tomography, nuclear magnetic resonance (NMR) education, learning and experimentation
A
t the time when India’s radiology fraternity is gathering at the 67th Annual Conference of IRIA in Agra, it gives us utmost pleasure to launch our product range as representatives of distinguished European producers to serve the following verticals; ◗ X-Ray Quality Assurance solutions ranging from easy check up to Complete QA to Deep QA produced by our Principal M/s RTI Electronics AB, Sweden (www.rti.se). ◗ Education and experimentation equipment in radioimaging, ultrasonic topics, magnetic resonance and nuclear medicine produced by our Principal M/s Phywe Systeme GmbH and Co.KG,Germany (www.phywe.com)
Introduction to Bergen Group of Companies In 1979, while watching the simultaneous sunset and sunrise in the town of Bergen in Norway, the idea of providing bundled services required in electronic manufacturing in India germinated in my mind. This vision was given professional reality when Bergen Associates was formed in 1983. Initially set up as a conduit for the supply of European machinery to the Indian electronic industry, the JANUARY 2014
company introduced into the Indian market international quality and excellence in the field of manufacturing, assembly and testing of printed circuit board. And today, with our mission, to 'Care our customers with a difference', we are a group of companies having diversified presence in the field of offering solar power, energy generation solutions and healthcare. With the product range offered by M/s RTI, Sweden we are prepared to offer Q.A. solutions to following areas of radio-imaging; ◗ Intraoral ◗ Panoramic ◗ Computed tomography ◗ Cone beam CT ◗ Mammography ◗ Radiography and fluoroscopy ◗ Scatter and leakage The Black Piranha X-Ray meter with accessories makes X-ray QA easy and fast. Connection is automatic – just plug n play. The Quick Check feature identifies the probes you insert and selects the optimum Piranha settings for your measurements – sit back and let the Piranha do the work! As far as our Principal M/s PHYWE, Germany is concerned, across the globe they are one of the preferred producers and suppliers of
all products and services needed for the teaching of science and technical applications in schools, colleges and universities and have specific solutions to teach applications in radio imaging, magnetic resonance, ultrasonics, nuclear medicine and other related topics. Our corporate mission is to serve with the product range of Phywe for learning and education of medicine topics. It is to support our commitment towards improving lives and transforming healthcare. This goal is accomplished by bringing European and global advancements in high quality education that increases the knowledge, competence and performance of physicians and other allied healthcare professionals. The solutions and devices uniquely qualify to support and influence the continuum of educational activities of physicians from beginner level and post-baccalaureate to clinical practice. Contact M/s Bergen Healthcare New Delhi Tel:+91 11 2592 0283~86 Fax: +91 11 2592 0289 E mail: rajinderk@gmail.com; r.chaudhry@bergengroupindia.com; IN IMAGING 69
IRIA 2014 SPECIAL
NEEDLE GUIDANCE SOLUTIONS FROM CIVCO To provide customers with better ultrasound solutions, Consort Overseas now offers general purpose needle guidance solutions from CIVCO
S
afe Efficient Guiding Patient Care,” is the motto of CIVCO Medical Solutions (CIVCO). With its roots in the US and Europe, CIVCO is partnering with Consort Overseas to expand into emerging markets, such as India. Celebrating a milestone, CIVCO has provided customised ultrasound needle guidance solutions and infection control covers and drapes for over 30 years. To provide customers with better ultrasound solutions, Consort Overseas now offers general purpose needle guidance solutions from CIVCO. These needle guidance systems utilise a two-part system consisting of custom reusable biopsy bracket and a disposable snap-on needle guide. The needle guides are designed for single-use, minimising the risk of cross-contamination. These needle guides include Infiniti Plus for accurate in-plane positioning during vascular access and regional anaesthesia procedures. Also, Ultra-Pro II, UltraPro 3 and Ultra-Pro e needle guides provide a safe, reliable and efficient tool
for ultrasound guided puncture procedures including catheter placement, core tissue biopsy and fluid aspirations. Also available are out-ofplane needle guidance solutions such as the Sonosite L25 and AccuSite. Designed specifically for the SonoSite L25 transducer, the SonoSite L25 needle guide provides clinical confidence for central line placement and nerve blocks. AccuSite provides clinical confidence for catheter placements and offers the most complete depths in the industry including: 0.5, 1, 1.5, 2, 2.5, 3 and 3.5 cm. In addition to general purpose, Consort also offers CIVCO’s Endocavity needle guides which are created custom for transrectal and transvaginal ultrasound transducers. Disposable Endocavity needle guides are designed for single-use, reducing the risk of cross contamination. These endocavity guides attach securely to the transducers locating features for increased patient safety throughout the procedure. CIVCO’s reusable endocavity needle guides are made of stainless steel and are recommended
for tissue biopsy, fluid aspiration and treatment procedures. Reusable needle guides require proper cleaning and sterilisation of the devices between patients.
Needle tracking systems CIVCO’s new electromagnetic needle tracking systems allows physicians to clearly visualise and accurately track the tip of the needle in real time.
e-trax needle tip tracking system eTRAX features an electromagnetic sensor embedded in the needle tip which provides an accurate 3D anatomical roadmap for tracking the tip of a needle under real-time, imageguided navigation. eTRAX may be used with devices for applications such as core tissue biopsies, fluid aspirations and vascular access and regional anaesthesia procedures.
Virtu trax instrument navigator VirtuTRAX gives physicians the ability to turn any rigid instrument into a tracked device. Virtu TRAX can be used in applications such as ablations, drainage and therapeutic delivery. Contact: Anupam Agarwal, Director, Consort Overseas Pte. Ltd. Caroline Myrand, Director, APAC Sales, CIVCO Medical Solutions Email: consort_overseas@yahoo.com Website: www.civco.com
70 IN IMAGING
JANUARY 2014
A-1/114, SECTOR 7, ROHINI, NEW DELHI- 110 085 PH: 011 27041032/33 CELL: 9310706077/9868129521/ 9313806077/ 9971610060 E-mail : pcsharma@zenithmedical.in; richieksharma@zenithmedical.in, info@zenithmedical.in
New
We also provide the Quality Assurance (QA) services as per AERB guidelines for all X-ray based equipments i.e.X-ray, CT, cathlab, DEXA, Mammography, OPG, C-ARM etc.
HYDERABAD | KOLKATA | JAIPUR | BANGLORE | CHENNAI
Radcal Survey Meter Easily measure scatter & leakage
Ion Chamber
Survey Meter
Model: RSM
Portability • Convenience
OVERVIEW – The Radcal Survey Meter (RSM), pressurized ion chamber meter, provides highly sensitive measurements of exposure or dose. It can simultaneously display the rate and either integrated value or highest rate (peak) seen by the instrument. The integrated value or peakrate can be reset using one of the four convenient front panel mounted buttons. The impressive 256K color display provides an optimized presentation of the data and is accompanied with icons informing the user of the active functions and instrument status. All logged data can be written in csv format to a standard USB thumb drive for convenient retrieval by a PC spreadsheet or database program. Alarms are manifested using color changes on the display and an acknowledgeable audio output. All Radcal Survey Meters can be used for a variety of medical and health physics applications. They are ideal for measuring exposure rates from leakage and scatter radiation around diagnostic and therapeutic x-ray rooms. Make the Radcal Survey Meter your next choice in the most advanced survey meter available today.
Options Dimension Interface Package: Audio Jack Output: Alkaline Battery Pack: Carrying Case:
see website for more details
PN: 4293-763 PN: 4293-891 PN: 4543-028 PN: 2310330
ROSALINA
ADVANCED RADIOTHERAPY 127, Bussa Udyog Bhavan, Tokershi Jivraj Road, Sewri (W), Mumbai - 400 015 Tel : +91 22 24166630 E-mail : support@rosalina.in Website : www.rosalina.in
THE GOLD STANDARD IN RADIATION MEASUREMENT 426 West Duarte Road Monrovia, CA 91016 USA T: (626) 357-7921 F: (626) 357-8863 www.radcal.com
© 5/2013
E N
! W
FDA 510(k), CE mark
Gauge range 12G - 25G
Allows patient breathing
Apply or remove with needle inserted
Adjustable for easy angling of needle
Simplify sterile needle holder
Place holder
Secure Needle
Adjustable in any position
Phone: +91 (944) 28 511 48 Email: rajavel.subramanian@neorad.no www.neorad.com
1000â&#x20AC;&#x2122;s of patients treated using SimpliCTTM laser guidance.
SimpliCTTM works with any CT scanner. No integration necessary. System is mounted on standard ceiling suspension units and could be up and running in minutes.
FDA 510(k), CE mark
1) Laser guidance in combination with needle path planning reduces fluoroscopy time and patient radiation dose in cone-beam CT needle interventions M.Kroes1, S.J.Braak2, M.J van Strijen2, W.Busse1, Y.L. Hoogeveen1, F. de Lange1, L. Schultze Kool1; 1 Radiology, Radboud University Nijmegen, Netherlands;2 Radiology, St. Antonius Hospital, Niuwegein, Netherlands (SIR 2012, abstract No. 68)
Patient study confirms dose savings without increasing procedure time.1
Contact: Mr. Rajavel Subramanian Regional Manager - INDIA , South East Asia & Middle East NeoRad AS
Ready!
SimpliCTTM Pointing Laser aligned and set at correct angle with C-arm in progress view position.
With laser Bi planar real time tracking of needle is possible. As long as the needle hub is within the laser light, the angulation is correct. The C-arm stays in progress view.
Without laser: For any straight needle intervention the C-arm will have to be moved back and forth between entry point (bulls eye) view and progress view to verify the needle angulation and progress.
Cone Beam CT needle intervention:
SimpliCTTM Pointing Laser aligned and set at correct angle.
This allows easy positioning and greatly reduces the number of needle corrections and confirmation scans.
The SimpliCTTM laser is set with the calculated needle angulation. As long as the needle hub is within the laser light, the angulation is correct.
CT needle intervention:
Copyright Š 2012, NeoRad AS
Tachyon Medical System Private Limited Making A New Era For Refurbished Machines……
“ONLY One Company in India combines strength of Original Equipment Manufacturer with deep savings of a Third Party Service provider. You pay less for high quality CT, MRI and other Radiology equipment backed by top notch Industry engineering expertise. Since 1992, Tachyon Medical System Private. Limited has positioned itself as a prime Service Provider and Supplier of refurbished medical equipment. WE SOURCE ALL OUR EQUIPMENT THROUGH OUR OFFICE IN NEW YORK, SINCE 1992. We are FDA registered in USA . With over 80 years combined experience in medical diagnostic industry, we are poised to offer the best. Our partnership will help you provide better human care, through better medicine."
Corporate Office : 1, Nyaypuri, Minar Road, Karnal (Haryana) 0184-2260291, 2270291
Email : tachyonmedical@gmail.com http://www.tachyonmedicalsystem.tradeindia.com/
AMERICAN HEALTHCARE TECHNOLOGIES, INC. NEW YORK NY 10118. USA. Tel: 212 537 4783, Email: info@ahtiny.com
New from Varian Interay:
Replacement tubes for your GE CT! GE Lightspeed®VCT Varian’s MCS-8064 replaces D3191T, D3192T, D3193T, D3194T, 2219500-3, 2291563-2 Over 20 years AEG manufacturing experience
GE LightSpeed®Plus • Varian’s MCS-6074 replaces D3186T, Backwards compatible with D3182T, D3172T, D3152T • 6.3 mHU 200 mm target • Supports 0.5 second full scans
GE ProSpeed/Solarix NP BrightSpeed®Solarix 350 • GS3576P replaces D3112T, D3119T 120,000 scan warranty • GS3576S replaces D3142T, D3149T 120,000 scan warranty • Loaded in original housings
GE CT/e - ProSpeed Ai • GS2276 replaces D3162T, D3169T 80,000 scan warranty
For more information go online for a datasheet, or contact your preferred dealer.
Europe
India
USA
Varian X-ray Products Germany TEL 49-2154-924-980 FAX 49-2154-924-994 sales-xray@varian.com
Varian Medical Systems International India Pvt Ltd Unit No.33,Kalpataru Square, Off Andheri Kurla Road,Andheri(East), Mumbai-400059 India Tel +91 22 67852200/2210 Fax +91 22 28385614 CELL +91 9987540900
Varian Interay 1-800-INTERAY TEL 843.767.3005 FAX 843.760.0079 interay.sales@varian.com
www.varian.com/interay
All trademarked terms are property of the respective manufacturer. LightSpeed® and BrightSpeed® are registered trademarks of GE Corporation.