InImaging January, 2015 by Indian Express

In Imaging Pages 60

A compendium on the latest in radiology

JANUARY 2015

Introducing the new

First of it's kind innovation in CR For first hand experience and to take the DIY challenge visit

IRIA 2015/BOOTH#B21

CAN INSTALLING AND SERVICING YOUR CR BE AS EASY AS CHANGING A LIGHT BULB?

!"#$ $%& (#)*" ( )+(,

*-"! !

$%& $1 11(#0$ $-#+% 2*")*" 2 " !"#$ -.#% %/0(#*% %- "$3 3#+(+4 4! 5+" "62-$-#+%2 !"#$% '(() *+,-.% /0 012'-0,0/ /01% /30452 2)016(7% 8+ +890- @ ### #??A !" $:#; :;; : % <=$ > # #<<<#% <>;?# # #"""# $%& &'(" !"#$!%#$&&'(%)*!'$+,&&"!

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

WHAT IS YOUR REQUIREMENT??? • • • • • • • • • • • • • • • • • • • • • • • • •

•

Connect two or more centers real time; report multiple centers from single central place? Use single machine as workstation in day & Teleradiology server in night? Wish to automatically download the cases in home station? Reduce turn around time? Report the cases on android/windows devices while out of center? Don’t want to invest in apple everywhere? Want the system “that just works”!!! Without fearing virus & crashes? Do advance processing over cost effective workstation, which just cost 10% of brands? Intelligent system which don’t require technicians /staff involvement? Reducing the chances of human errors? On maternity leave but don’t wish to halt practice? Should be non-disturbing too, just downloading on its own? Don’t want to wait for every case to get downloaded? Also can I use dragon dictate on my mac? Advanced 3d on tele-reporting end? Can I tele-report from any computer or just one in which you put software? Reporting angio, neuro cases on tele? Concern about advanced CT MRI PET processing features & image quality. Don’t want to download case for small decisions like to take contrast scan or not? Don’t want to Download the same case again & again for review? (Multiple downloads of same case?) Professional solution with multiple Internet lines? Solution that don’t fail if one of the lines is down? Total Teleradiology company datacenter? Total PACS/RIS system? Machine that acts as Teleradiology server workstation & storage system as well? Full value to my money? Running around with hardware guy, software guy & networking guy, just to find out what is the problem? I think; I need consultation right from choosing right Internet service provider? Something that comprehensive? Already have old mac & OsiriX but not usable/optimally usable? Just wish to upgrade? Wish to get proper application training? I think my old machine can be utilized much better? Just want to see demo first! Fade up with fly by night retail vendors who don’t know medical perspectives? Want the advance technology but don’t want to get financially exploited? Why doesn’t apple have dedicated representation for medical domain? Is there any? Does OsiriX work with my cathlab/cbct/sonography? What does it do for me? Can I have 3d printing solution based on Apple OsiriX? What can I do? Can I use DICOM compliant paper printing with color 3d, which will save my films?

JUST REACH YOUR PHONE & DIAL 8308 533 533! JUST REACH THE EXPERTISE, WHICH IS NOW TRUSTED BY 350+ INSTITUTIONS, PAN-INDIA!!! ______________________________________________________________________________________________________

ACTON ENGINEERING

A-304, HRISHAB, VIVA SWARGANGA, VIRAR WEST, MUMBAI, MAHARASTRA, INDIA PIN: 401 303. CUSTOMER CARE: 8308 533 533, E MAIL: info@actoneng.com

EDITORâ&#x20AC;&#x2122;S NOTE IN IMAGING | JANUARY 2015

Viveka Roychowdhury, Editor viveka.r@expressindia.com

The entrepreneurial bug

ne of the important 'flavours' at IRIA 2015. Kochi seems to be an accent on the younger lot of radiologists. This explains the sessions offering guidance to exam going post graduates and young radiologists entering practice. Which is why Dr David Yousem, co-author of a well-read book on this topic: "Radiology Business Practice: How to Succeed," will also be addressing delegates at India's largest annual gathering of radiologists. Since this issue of In Imaging will be distributed at the IRIA event, we decided to provide further inspiration to radiologists, both young and not-so-young, who are caught in the internal debate of taking the plunge into flying solo or playing it safe. We feature the success stories of three radiology enterprises, which started small and may still not be too big in terms of turnover but seem to have ridden out the initial rough road and found their rhythm. We tried to figure out their success mantras in the hope that others may learn from their experiences. In this we feature three

JANUARY 2015

enterprises with their leading lights: Dr Himadri Sikhor Das, Director & Radiologist, Matrix, a unit Of Apace Imaging & Diagnostic Centre in Guwahati (pages 14-15); Dr Umashankar D, Chief Radiologist at Padmashree Advanced Imaging Services , Bengaluru (pages 16-19) and Dr Ruchira Marwah and Dr Atul Marwah, the promoter couple behind Mumbai's Medcare Institute of Diagnostics (pages 20-22). All three examples have one thing in common: the right attitude to risk, which is to embrace it but only after preparing a good business plan. Dr Umashankar sums it up best when he says that this is a chance to be your own boss. But all start up radiologists will face two major road blocks: real estate and finance. After these are smoothed out, managerial issues take centre stage, be they with talent sourcing, training and retention. Balancing financial resources to grow into a profitable venture as well as providing care to the maximum number of patients also calls for having a blend of financial acumen tempered with compassion. While Dr Umashankar does this by

going the volumes route and grooming freshers. Entrepreneurs have to be ready for personal sacrifices in the initial years. For instance, both promoters of Medcare Institute of Diagnostics reinvest their salaries into the business to reduce the cost burden on the enterprise. Radiology entrepreneurs who dare to live their dream off the beaten path of the major metros and choose smaller towns are faced with another set of infrastructure issues. For instance, Dr Das of Guwahati lists regular power supply as a deciding factor while choosing the location for the imaging centre. All these hurdles come after cutting through the red tape that is India's bureaucracy, in the quest for clearances from a number of government agencies. Entrepreneurship is not for the fainthearted. Therefore we need to celebrate these success stories and hold them us as role models for the fraternity. Do write in to us with more such inspiring examples of radiologists who have succeeded against all odds.

IN IMAGING 9

CONTENTS

IN IMAGING | JANUARY 2015

12 COVER STORY Success Mantra in Radiology Biz

14 Interview Dr Himadri Sikhor Das Consultant Radiologist and Director, Matrix (A Unit of Apace Imaging & Diagnostic Centre) Guwahati

16 Interview Dr D Umashankar Chief Radiologist Padmashree Advanced Imaging Services Bengaluru

20 Interview Dr Atul Marwah & Dr Ruchira Marwah, CoFounders, Medcare Institute of diagnostics

26 Research Portable Ultrasound to Detect Potential Heart Attacks and Stroke

30 Insight Digital Radiography: A New Era in Dental Radiology

One-on-one Dr K Mohanan, Organising Chairman, IRIA 2015

One-on-one Sushant Kinra, Country Business Manager of Carestream India

One-on-one Kiran Phuria, Director-Marketing, Medx Technologies Also featuring:

10 IN IMAGING

Varian

Medion Health

Konica

Sanrad

CareStream

Acton Healthcare

JANUARY 2015

IMPRINTLINE Presented By

In Imaging A compendium on the latest in radiology

JANUARY 2015

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 Pune Shalini Gupta MARKETING REGIONAL HEAD- WEST Harit Mohanty Manager Kunal Gaurav PRODUCTION General Manager B R Tipnis Production Manager Bhadresh Valia 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 MUMBAI: Kunal Gaurav The Indian Express Ltd Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821089213 Email Id: kunal.gaurav@expressindia.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express Ltd Business Publication Division Express Building, 9&10, Bahadur Shah Zafar Marg, New Delhi- 110 002 Board line: 011-23702100 Ext. 668 Mobile: +91 9999070900 Fax: 011-23702141 Email id: ambuj.kumar@expressindia.com CHENNAI Yuvaraj Murali The Indian Express Ltd Business Publication Division New No. 37/C (Old No. 16/C) 2nd Floor, Whites Road, Royapettah, Chennai- 600 014 Board Line: 044- 28543031/2/3 044- 42285522 Mobile: +91 9710022999 Fax: 044- 28543035 Email id: yuvaraj.murali@expressindia.com

BENGALURU G.M. Khaja Ali The Indian Express Ltd Business Publication Division 502, 5th Floor, Devatha Plaza, Residency road, Bangalore- 560025 Board line: 080- 49681100 Ext. 108 Mobile: +91 9741100008 Fax: 080- 22231925 Email id: khaja.ali@expressindia.com

HYDERABAD E.Mujahid The Indian Express Ltd Business Publication Division 6-3-885/7/B, Ground Floor, VV Mansion, Somaji Guda, Hyderabad – 500 082 Board line- 040- 66631457/ 23418673 Mobile: +91 9849039936 Fax: 040 23418675 Email Id: e.mujahid@expressindia.com KOLKATA Ajanta Sengupta The Indian Express Ltd Business Publication Division JL No. 29&30, NH-6, Mouza- Prasastha & Ankurhati, Vill & PO- Ankurhati P.S.- Domjur (Nr. Ankurhati Check Bus Stop) Dist. Howrah- 711 409 Mobile: +91 9831182580 Email id:

Mobile: +91 9821089213 Email Id: kunal.gaurav@expressindia.com BHOPAL Ambuj Kumar The Indian Express Ltd F-102, Inner Court Apartment, 1st Floor, GTB Complex, Behind 45 Bungalows, Bhopal - 462 003 Mobile: +91 9999070900 Email id: ambuj.kumar@expressindia.com JAIPUR Ambuj Kumar The Indian Express Ltd S2, J-40, Shyam GHP Enclave, Krishna Marg, C-Scheme, Jaipur- 302 001 Mobile: +91 9999070900 Email id: ambuj.kumar@expressindia.com

ajanta.sengupta@expressindia.com

KOCHI Yuvaraj Murali The Indian Express Ltd Ground Floor, Sankoorikal Building, Kaloor – Kadavanthra Road Kaloor, Kochi – 682 017 Mobile: +91 9710022999 Email id: yuvaraj.murali@expressindia.com

COIMBATORE G.M. Khaja Ali The Indian Express Ltd No. 205-B, 2nd Floor, Vivekanand Road, Opp. Rajarathinam Hospital Ram Nagar Coimbatore- 641 009 Mobile: +91 9741100008 Email id: khaja.ali@expressindia.com AHMEDABAD Kunal Gaurav The Indian Express Ltd 3rd Floor, Sambhav House, Near Judges Bunglows, Bodakdev, Ahmedabad - 380 015

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.

JANUARY 2015

IN IMAGING 11

COVER STORY

12 IN IMAGING

JANUARY 2015

IN IMAGING 13

COVER STORY

‘Embrace the newer, emerging technologies’

Radiology is Dr Himadri Sikhor Das’ lifeline and he is very particular about doing it right. So he decided to turn his passion into a thriving business and has been successful in doing so. The MD of Matrix is also the Nominated Central Council Member of Indian Radiological & Imaging Association (IRIA), Assam State Branch. He is also involved with many national and international academic and voluntary bodies. M Neelam Kachhap, catches up with him to know more about his illustrious career 14 IN IMAGING

JANUARY 2015

COVER STORY

I HAVE AVERYSIMPLE PROBLEM SOLVING FORMULA.ITIS TO UNDERSTAND THE PROBLEM,ADDRESS ITCORRECTLYAND THEN TRYTO FIND ASOLUTION BYPLUNGING HEADLONG INTO THE MATTER RATHER THAN LOOKING OUTFOR SHORTCUTS.

Why did you opt for radiology in your postgraduation (PG)? I was working as a Junior Resident in the Department of Surgery at Dr RML Hospital ,New Delhi when the idea kicked in. I used to accompany the patients admitted in my ward to the radiology department where I became friendly with the Senior Residents. I was fascinated by their vast knowledge of anatomy and patho-physiology of many diseases. Over time I was introduced to various state-of-the-art equipment and other aspects of radiology. Eventually, I decided to pursue a course in Radiology rather than General Medicine, which was my earlier choice. Tell us about your first job. My first job as a radiologist was at a diagnostic centre in Gurgaon. This was for a very brief period. I used to travel from South Extension, which was about 45-50 km away, to Gurgaon everyday for the love of radiology. At the centre, I mainly reported CT scans. The owner of the diagnostic centre was also a radiologist who was very senior and had studied the subject many years earlier. So he did not know much of CT. He was otherwise a very nice person and made me feel at ease. I also reported X-rays, did USGs and Colour Doppler examinations. though not too many in JANUARY 2015

numbers. You have your own practice now. How was the journey from job to entrepreneurship? The journey has been very exciting, full of ups and downs of life. The initial years were very taxing but over the years, as I became more experienced, the stress levels came down substantially. Earlier, any issue like machine breakdown, staff absenteeism or reduced patient footfalls due to any reason would be a cause of serious concern. Then, over the years, I realised that these factors are inherent in all practices and gradually learnt to cope with these types of working problems. What are the benefits of having your own practice? Well, there are many but primarily freedom. Having the freedom and flexibility of running a centre without any hindrance or pressure from any higher up is definitely a benefit. Also, the freedom to set working protocols as you desire is an additional benefit. What are the challenges in setting up a radiology lab? There are many challenges. First and most important is the finance aspect i.e., to secure funding for buying the machines. Secondly, to find a decent place to set it up, as location is the most important

consideration for any business. One important thing which may not be a problem in metro cities is regular power supply, obtaining power needed for running these machines. Also, the usual teething problems of obtaining clearances and no objection certificates (NOCs) from various government agencies like Labour Commission, Pollution Control Board, Fire Safety, Health Centre Establishments, etc. How did you deal with these challenges? I have a very simple problem solving formula. It is to understand the problem, address it correctly and then try to find a solution by plunging headlong into the matter rather than looking out for short cuts. What is your message to students aspiring to pursue PG in radiology? My message to the younger generation looking to obtain a PG degree in radiology is to work very hard in the initial years so that the basic concepts regarding disease anatomy and pathology are rock solid. Try to find out which modality suits one best and pursue it relentlessly. Embrace the newer, emerging technologies and changes in all existing modalities which are taking place all over the world. mneelam.kachhap@expressindia.com

IN IMAGING 15

COVER STORY

â&#x20AC;&#x2DC;Imaging is now becoming the new physical examinationâ&#x20AC;&#x2122; Dr D Umashankar has nurtured his imaging business like his child, planning the centre, buying equipment and handpicking staff. Now, he is ready for the next phase where he envisions that his business will grow by leaps and bounds. He talks about the business and his strategies for success, with M Neelam Kachhap

What made you choose radiology for your PG? I was always fascinated by technology and right through my undergraduate course I slowly gathered its place in medicine. I began to realise how certain cutting edge technology can radically transform healthcare, both in diagnosis and treatment of patients. When I finished my MBBS, way back in 1993, healthcare technology was booming. Ultrasound, CT scans and MRI scans were beginning to change the way clinicians looked at patients. An entirely different perspective was evolving, impacting how an accurate diagnosis could be made with 16 IN IMAGING

absolute confidence. I wanted to be a part of this revolution. A short posting in radiology during internship made me realise that it was my true calling. Tell us about your first job. After completing my post graduation, I wanted towork with state-of-the-art technology. So, I joined Apollo Hospitals, Chennai as a Resident. It is here that I got to see and work on the latest CT, MRI and other newer imaging modalities. I was paid a measly salary, as was the norm in those times, but the shiny equipment made me gloss over this. Also gratifying was the rewarding JANUARY 2015

COVER STORY

WE’RE BASICALLYDOCTORS’DOCTORS BECAUSE THE PATIENTS DON’TCOME TO US DIRECTLY. WE (RADIOLOGISTS) ARE THE PROBLEM SOLVERS,AND ALOTOFTHE TIME, WHATEVER WE SEE AND SAYIS GOING TO SIGNIFICANTLYDETERMINE THE COURSE OF THE PATIENT’S MANAGEMENT experience I had during my tenure there. You have your own practice now. How was your entrepreneurial journey? The journey has been very memorable so far. I happened to meet the right people at the right time. They had faith in my abilities and supported me in setting up and running a diagnostic centre. Then, we had a Colour Doppler and an X-ray machine, firsts in the state. The idea was to be at the forefront of technology and deliver the best to our patients in terms of quality at very affordable cost. Our team brainstormed about this incongruity about quality and affordability and came to the conclusion that, the only way to do this was through ‘numbers’. Newer machines cost a lot of money and we had to recover this without resorting to market gimmicks. Now, we have grown by leaps and bounds and have cutting edge imaging technology under one roof, including, but not limited to, MRI, CT, 4D ultrasound, digital mammography, digital radiography, PACS etc. Many of these have been firsts in the state . What are the benefits of having your own practice? You are your own boss. You set the trend and live up to it. That was the JANUARY 2015

main attraction about setting up my own practice. We’re basically doctors’ doctors because the patients don’t come to us directly. Our clinical colleagues have a patient, and then they have a problem that they can’t solve without our help. They send the patient to us for a scan to get an answer to the problem he or she has. We are the problem solvers, and a lot of the time, whatever we see and say is going to significantly determine the course of the patient’s management. What are the challenges of setting up a radiology lab? Two main challenges in setting up a state-of-the-art radiology lab were capital and real estate. At this stage, I started realising that I was about to face something I was not taught in medical college, i.e., financial management and personnel management. Initially getting our project financed was a huge hurdle to cross but then as we grew in size and were planning to expand, getting specialised manpower proved to be a bigger hurdle, more so, people who shared our concerns on affordability, high technology and practising ethical medicine. How did you deal with these challenges? Initially, when we approached nationalised banks to finance our projects, they looked very formidable.

But then persistence, hard work, determination and a strong belief in our abilities forced the bank officials to see our side of the story and willingly fund our dreams. The other challenge, manpower, was tackled by picking up freshers and assiduously grooming them to our exacting requirements. What would you like to say to students aspiring to take radiology PG? I would like to strongly recommend radiology as a career to anybody who would care to listen to me. I would be delighted to have somebody come by and experience in real time how much satisfaction there is in being a radiologist. They will be able to experience first hand, how over the last 20 years, most of the significant diagnostic efforts in healthcare has shifted from history and physical examination to imaging. Imaging is now becoming the new physical examination. I know for sure that we, radiologists, make a significant difference for our clinical colleagues who are struggling to help their patients. We know we make a difference in the patients’ lives, and in our community. Even when things are hard, you feel good about what you’re doing, all the frustrations are tolerable, because you feel like what you’re doing is worthwhile. mneelam.kachhap@expressindia.com

IN IMAGING 19

COVER STORY

Two powerful people, one unbeatable business After earning enough goodwill in the field of radiology for almost four decades, Dr Atul Marwah and Dr Ruchira Marwah established the Medcare Institute of diagnostics in Mumbai. Their tale has several learning lessons for aspiring radiology entrepreneurs. Raelene Kambli meets the dynamic duo

20 IN IMAGING

JANUARY 2015

COVER STORY

OURS IS ASERVICE-CENTRIC MODEL.I AM THE FOURTH GENERATION DOCTOR IN MY FAMILYAND SO I HAVE BEEN RAISED WITH THE KNOWLEDGE THATMEDICINE IS APROFESSION MEANTTO SERVE PEOPLE.OUR BUSINESS STRATEGYALSO REVOLVES AROUND THIS IDEOLOGY Tell us about your business model. What makes it different from other imaging diagnostic centres? Medcare Diagnostics is a tie-up with Sushrut Hospital in Chembur, Mumbai. The uniqueness of Medcare Diagnostics is that you will fill find all diagnostic imaging facilities under one roof, to cater to the patientâ&#x20AC;&#x2122;s healthcare needs and convenience. PET-CT, nuclear medicine, radiology and pathology are some of the pivotal facilities available at Medcare Diagnostics. Our centre is equipped with the latest cutting-edge technology which helps in giving its doctors and patients the best possible results in comparison to other diagnostic centres in the city. We can confirm that from Parel to Pune you will not be able to find similar facilities. Ours is a service-centric model. I am the fourth generation doctor in my family and so I have been raised with the knowledge that medicine is a profession meant to serve people. Our business strategy also revolves around this ideology. We have patients coming to us from all strata of the society. We also treat poor patients for free. What led you to venture into radiology entrepreneurship? After pursuing our graduation and post graduation from respected JANUARY 2015

institutes, we worked with some government hospitals. Later, we went on to work with corporate hospitals such as Bombay Hospital, Seven Hills and Umrao Hospital in Mumbai. Thinks were going fine, however, we realised that beyond a point we were not able to really translate our thoughts, our convictions into action. For example, if we had poor patients coming to us for help, it would take a long process to actually get permissions to diagnose them. So we decided to establish our own

diagnostic centre. What were the road blocks in this process? Setting up your own business is not a cake walk. It involves a lot of skill. The biggest road block was real estate and finance to set up the centre. In a city like Mumbai itâ&#x20AC;&#x2122;s difficult to get a place easily. Moreover, we needed a lot of finance, especially to buy equipment. And our basic principle was that we will not compromise on equipment , we would rather IN IMAGING 21

COVER STORY

VIABILITYIN RADIOLOGICALIMAGING BUSINESS IS ACHIEVED WHEN YOU HAVE A GOOD BUSINESS PLAN.THE STRATEGYUSED IS ALSO IMPORTANT.WE ALSO BELIEVE THATBEFORE STARTING YOUR OWN SET-UP,ARADIOLOGISTSHOULD WORKWITH AN HOSPITALOR AN IMAGING CENTRE own sometimes is not viable.What is your opinion on this? Well, viability in radiological imaging business is achieved when you have a good business plan. The strategy used is also important. We also believe that before starting your own set-up, a radiologist should work with an hospital or an imaging centre. It is important to make your name. Once you have earned a good name among patients and fellow radiologists, it becomes easier to venture out and do something new. Coming back to making the business viable, I feel the strategy should be earning in volume, than value. Nevertheless, high quality should be maintained.

compromise on interiors. Some of the equipment cost around Rs 35 lakh, so the returns on that equipment should be around Rs three lakhs for a monthly survival. The other challenge was getting trained manpower. How did you overcome the challenge of real estate? We decided to tie-up with Sushrut Hospital which allowed us to set up our centre in 1000 sq ft area. Also, since this hospital is located in the centre of the city, we could easily target patients from across the city. How did you manage to attract financers? Since setting up a radiology centre means investing a a lot of money, we needed some financers. Luckily, the name we earned in the industry helped us to find financers and we also had to take a loan. We had the experience and people knew about our work so they believed in our project. We have a company called Clearmedi who have financed our business model. And how did you manage to get the desired manpower? We had to network and convince experts from within the sector to join us. Now these trained professionals have become the biggest support for the smooth functioning of our centre. 22 IN IMAGING

What are the benefits of starting your own centre? Running your own business means a lot of effort, but it has its own set of advantages. Firstly, it gives you the freedom to think and take business decisions on your own. Secondly, it gives you a wide scope for your practice. Some experts feel that doing a radiology diagnostic business on your

So how do you manage viability? One way to do it is to reduce cost burden. For this, we both reinvest our salaries into the business. So this reduces a little bit of the cost burden. The other way is to work in volume without compromising on quality. Also, we feel proud to say that some of the top-notch, internationally trained doctors from Mumbaiâ&#x20AC;&#x2122;s leading hospitals are associated with us and serve as our faculty members. Having trained faculty also helps us provide the best quality services while ensuring that every doctor get a break. We follow a SOP system in order to provide good service to our JANUARY 2015

COVER STORY

WE FEELTHATADIAGNOSTIC BUSINESS NEEDS TO BE PROCESS DRIVEN AND SHOULD NEVER BE RUN BYASINGLE PERSON,THIS COULD HAMPER THE FUNCTIONING AND VIABILITYOFTHE BUSINESS

environment so that people who work with us also get to learn new things.

patients and also it helps in maintaining efficiency. Therefore, we can earn in volumes as well.

If a practising radiologist would wish to start his/her own set-up, what should be the strategy to attract investors? If somebody is trying to make money overnight, then this is not the field to invest in. We feel that the way forward is through public-private partnerships (PPP). Also, the financers should not own and run the business. It should be run and owned by radiologists. This is because we believe that doctors having their own expertise will be in a better position to under their patientsâ&#x20AC;&#x2122; requirements and deliver the services accordingly. This, in turn, will fetch the business a good name as well as profits.

What about giving the equipment a break? The equipment also gets its share of rest. Normally we do not have patients during the nights , except if there is an emergency. Your business is still young.According to you, when will you break even? It has been around two years for our business now and we are going very strong. We perhaps may break even in two to three years. What is your strategy for success? Should it be a one-man show or not? We feel that a diagnostic business needs to be process driven and should never be run by a single person, as this could hamper the functioning and viability of the business. Running a diagnostic business, you must have come across ethical issues. How did you deal with this? We are very strict with our morals. In our centre we do not entertain any one who would provide us with any kind of cut-practice. We get our work by our name. In fact, we don't even have a marketing team. And the truth is that people who follow the cut-practice are actually a JANUARY 2015

What are your plans for the future? Our plan is to continue growing in every possible way. We also wish to raise money by way of private equity in order to expand further in the coming year. handful. We personally believe that cut-practice does not help you to prosper. How do you market yourself? We conduct CMEs, and workshops for this. We also go out to medical colleges and give lectures. Here, we try to create an academic

What is your message to radiologists who aspire to venture into entrepreneurship? Gain experience before you start your own business. Experience should be in the form of clinical as well as managerial know-how. raelene.kambli@expressindia.com IN IMAGING 23

IRIA 2015 SPECIAL NEWS

Radiologist recommendations for chest CT have high clinical yield Findings show that radiologist RAIs after chest X-rays represent valuable contributions to patient care A NEW STUDY published online in the journal Radiology, reveals that considerable percentage of patients who are recommended by radiologists for chest computed tomography (CT) to evaluate abnormal findings on outpatient chest X-rays have clinically relevant findings, including cancer. Researchers said the findings show that radiologist recommendations for additional imaging (RAIs) after chest X-rays represent valuable contributions to patient care. RAIs, which have grown 200 per cent since 1995, have attracted scrutiny in recent years as healthcare moves from volume-driven to value-based payment models. The scrutiny makes it increasingly important for the radiology community to validate the clinical impact of its work, said study author, Dr Tarik K Alkasab, from Massachusetts General Hospital and Harvard Medical School in Boston. “There has been a great deal of research on how radiologists recommend an imaging exam, but little on what comes out of the exams that they recommend. Prior studies were very broad, so in our study we tried to focus on a specific clinical scenario,” said Dr Alkasab. Dr Alkasab and colleagues looked at chest X-rays, one of the most common outpatient diagnostic imaging studies performed in the US. As many as half of all RAIs arising from thoracic 24 IN IMAGING

diagnostic exams are prompted by chest X-rays. The researchers combed through more than 29,000 reports of outpatient chest X-rays performed at a large academic centre over one year to identify studies that included a recommendation for a chest CT. They found that radiologists interpreting outpatient chest X-rays made recommendations for CT in 4.5 per cent of cases—a result in line with existing research. Increasing patient age and positive smoking history were associated with an increased likelihood of a chest CT recommendation. When the researchers looked at the chest CTs obtained within one year of the index chest X-ray, they found that 41.4 per cent detected a corresponding abnormality requiring treatment or further diagnostic workup. One in every 13 yielded a corresponding abnormality representing a newly-diagnosed,

INCREASING PATIENTAGE AND POSITIVE SMOKING HISTORYWERE ASSOCIATED WITH AN INCREASED LIKELIHOOD OFACHESTCT RECOMMENDATION

biopsy-proven malignancy. “In this era of concern about radiation dose risk, these findings suggest that the extremely low predicted risk of radiation-induced cancer associated with a chest CT is orders of magnitude less than the potential clinical benefits,” said study co-author Dr H Benjamin Harvey, from Massachusetts General Hospital and Harvard Medical School. “If ordering physicians see a recommendation for chest CT, they need to ensure that the patient gets the recommended imaging,” added Dr Harvey. More than one-third of patients in the study group who were recommended for follow-up chest CT did not receive the exam within one year—an oversight that could result in missed or delayed diagnoses, the researchers said. “More research is needed to understand the possible reasons for the less-than-optimal adherence to RAIs after chest X-ray. One thing we’re looking at is how the recommendation language affects recommendation adherence,” Dr Harvey said. The researchers hope that their study helps improve awareness of the importance of follow-up CT. “These results show that radiologists should be confident their recommendations are adding value and protecting patients,” said Dr Alkasab. JANUARY 2015

IRIA 2015 SPECIAL

Mammography made easy with new device It would reduce pain by standardising the pressure applied in mammography RESEARCHERS HAVE developed a new device that may result in more comfortable mammography for women. As per a study, standardising the pressure applied in mammography would reduce pain associated with breast compression without sacrificing image quality. Mechanical compression of the breast in mammography often causes discomfort and pain and deters some women from mammography screening. An additional problem associated with compression is the variation that occurs when the technologist adjusts compression force to breast size, composition, skin tautness and pain tolerance. Over-compression, or unnecessarily high pressures during compression, is common in certain European countries, especially for women with small breasts. Over-compression occurs less frequently in the US, where undercompression, or extremely low applied pressure, is more common. “This means that the breast may be almost not compressed at all, which increases the risks of image quality degradation and extra radiation dose,” said Woutjan Branderhorst, Researcher, Department of Biomedical Engineering and Physics, Academic Medical Center in Amsterdam. Overall, adjustments in force can lead to substantial variation in the amount of pressure applied to the breast, ranging from less than three kPa to greater than 30 kPa. JANUARY 2015

Dr Branderhorst and colleagues theorised that a compression protocol based on pressure rather than force would reduce the pain and variability associated with the current forcebased compression protocol. Force is the total impact of one object on another, whereas pressure is the ratio of force to the area over which it is applied. The researchers developed a device that displays the average pressure during compression and studied its effects in a double-blinded, randomised control trial on 433 asymptomatic women scheduled for screening mammography. Three of the four compressions for each participant were standardised to a target force of 14 dekanewtons (daN). One randomly assigned compression was standardised to a target pressure of 10 kPa. Participants scored pain on a numerical rating scale, and three experienced breast screening radiologists indicated which images

THE RESEARCHERS DEVELOPED ADEVICE THAT DISPLAYS THE AVERAGE PRESSURE DURING COMPRESSION AND STUDIED ITS EFFECTS

required a retake. The 10 kPa pressure did not compromise radiation dose or image quality, and, on average, the women reported it to be less painful than the 14 daN force. The study’s implications are potentially significant, Dr Branderhorst said. Pressure standardisation could help avoid a large amount of unnecessary pain and optimise radiation dose without adversely affecting image quality or the proportion of required retakes. “Standardising the applied pressure would reduce both over- and under-compression and lead to a more reproducible imaging procedure with less pain,” Dr Branderhorst said. The device that displays average pressure is easily added to existing mammography systems, according to Dr Branderhorst. “Essentially, what is needed is the measurement of the contact area with the breast, which then is combined with the measured applied force to determine the average pressure in the breast. A relatively small upgrade of the compression paddle is sufficient,” he added. Further research will be needed to determine if the 10 kP a pressure is the optimal target. The researchers are also working on new methods to help mammography technologists improve compression through better positioning of the breast. Co-authors on the study are Jerry E de Groot, Mireille Broeders, Cornelis A Grimbergen and Gerard J den Heeten. IN IMAGING 25

IRIA 2015 SPECIAL RESEARCH

PORTABLE ULTRASOUND TO DETECT POTENTIALHEARTATTACKS AND STROKE Recent research reveals that portable ultrasound can reveal plaques in peripheral arteries that may lead to heart attacks and strokes before symptoms arise, in both developed and developing country settings

study of portable ultrasound carried out in the US, Canada and India has revealed the potential of this technology for detecting plaques in peripheral arteries that can lead to heart attacks and stroke before symptoms arise, in both developed and developing country settings, allowing preventive treatment in those affected. The study, published in Global Heart (the journal of the World Heart Federation), is by Dr Ram Bedi, Affiliate Assistant Professor, Department of Bioengineering, University of Washington, Seattle, WA, US, and Professor Jagat Narula, Editor-in-Chief of Global Heart and Icahn School of Medicine at Mount Sinai, New York, US, and colleagues. Numerous studies have shown that it is possible to assess subclinical atherosclerotic cardiovascular disease (ASCVD) using ultrasound imaging. Since more portable and lower cost ultrasound devices are now entering the market, along with increased automation and functionality, it may be possible in future to routinely examine people with ultrasound to establish any ASCVD present before symptoms emerge, so that future disease can be prevented, for e.g. using medication. In this study, ASCVD was determined using ultrasound of both the carotid arteries (those in the neck) and the ileofemoral arteries (entering the top of

26 IN IMAGING

the leg). The findings were summarised in an index called the Fuster-Narula (FUN) Score. Data were gathered from four cohorts, two Indian and two North American. In India, screening with automated ultrasound imaging was conducted over eight days in 941 relatively young (mean age 44 years, 34 per cent female) asymptomatic volunteers recruited from the semiurban town of Sirsa (Haryana) and urban city of Jaipur (Rajasthan) in northern India. The cohort from Sirsa was recruited because all participants had already undergone aggressive lifestyle changes (smoking cessation, no alcohol, vegetarian diet, physically active lifestyles, daily meditation). To compare the imaging findings with traditional risk factors, two cohorts (481 persons) were recruited from primary care clinics in North America (one in Richmond, Texas, US, the other in Toronto, Canada). Apart from the same ultrasound examinations

given in the Indian cohort, comprehensive ASCVD risk factor data was gathered from the participants. All of them were self-referred asymptomatic individuals (mean age 60 years, 39 per cent female). Data collected included cholesterol levels, blood pressure, glucose level, weight, height, smoking and family history. These people were attending clinics for routine health check-ups in most cases. Effectiveness of established ASCVD prevention guidelines was then compared to results from direct imaging. In India, ultrasound revealed plaques in at least one artery in almost a quarter (24 per cent) of those examined; 107 (11 per cent) had plaques in only the carotids, 70 (seven per cent) in both the carotids and iliofemoral arteries, and 47 (five per cent) had plaques in only the iliofemoral arteries. If just the carotids had been examined, 177 (19 per cent) of the asymptomatic subjects would have been identified with plaques; by adding

IN THIS STUDY,ASCVD WAS DETERMINED USING ULTRASOUND OFBOTH THE CAROTID ARTERIES (THOSE IN THE NECK) AND THE ILEOFEMORALARTERIES (ENTERING THE TOP OFTHE LEG).THE FINDINGS WERE SUMMARISED IN AN INDEXCALLED THE FUSTER-NARULA(FUN) SCORE JANUARY 2015

IRIA 2015 SPECIAL

2.00mm

1.38 mm

FIG 1: A sample screenshot.This is an example of the protocol followed. In this 33-year-old male subject, the left carotid of the subject was scanned in the transversal plane (short-axis view) from the base of the common carotid up through the bifurcation.An atherosclerotic plaque (focally elevated intima-media thickness [IMT] protruding into the lumen by >1.5 mm) was found in the bulb region, and this was marked up (A).The far-wall IMT of the common carotid approximately 1 cm from the flow-divider was then measured and recorded in the longitudinal plane (long-axis view) (B).The examination was repeated on the right carotid, but this time no plaque was identified.The corresponding transversal (C) and longitudinal (D) images are illustrated

the iliofemoral examination, 47 additional individuals (five per cent of the total) were identified with plaque. Older age and male sex were associated with the presence of plaque both in urban and semiurban populations (the much higher levels of smoking in men could account for their higher risk). Data from the American and Canadian clinics showed that 203 subjects (42 per cent) had carotid plaque; 166 of these (82 per cent of those with plaque) would not have qualified 28 IN IMAGING

for lipid-lowering therapy such as statins under widely used guidelines known as ATP III (Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel]) guidelines. Using the recently published more stringent ATP IV guidelines, 67 people (one third of those with plaque and 14 per cent of the total US/Canadian cohort) individuals with carotid plaque would also have failed to qualify for treatment.

In addition, the study revealed 34 people in the US/Canada setting who qualified for treatment under ATP III but did not have any plaques, and this number increased to 81 under ATP IV (if receiving treatment such as statins, these people could be said to be overtreated, since no plaques were evident). The authors say, â&#x20AC;&#x153;Our study shows that automation in ultrasound imaging technology allows even non-expert users to rapidly evaluate the JANUARY 2015

IRIA 2015 SPECIAL INSIGHT

FIG 4: Plaque distribution by arterial site from study in India.Atotal of 11.3 per cent of subjects had carotid involvement only (case 16); five per cent had iliofemoral artery involvement only; 7.4 per cent had both carotid and iliofemoral artery involvement; and the total number of subjects eligible for medical intervention was 23.8 per cent (case 19) on the basis of ultrasound imaging.F,female; IMT,intima-media thickness; M,male

presence of subclinical atherosclerosis in a large population. Detection of sub-clinical atherosclerosis is further enhanced by inclusion of the iliofemoral artery examination.” They add, “It seems that plaque information from ultrasound images may serve as a guide for initiating medical intervention regardless of the availability or knowledge of traditional risk factors. Our results further suggest that not only in low- and middle-income countries, but even in the developed nations, ultrasound images may help refine strategies for medical intervention. It might however still be too contentious to suggest that risk factors–positive and imaging-negative asymptomatic subjects may be spared JANUARY 2015

from medical intervention. Conversely, arguments against initiating medical intervention on risk factors–negative and imaging-positive asymptomatic subjects become harder to justify.” In a linked comment, Dr Tasneem Z Naqvi, Professor of Medicine , Mayo College of Medicine and Division of Cardiology, Scottsdale, Arizona, US, adds, “This study shows that the assessment of subclinical atherosclerosis by a portable, user-friendly bedside tool is feasible in large populations and the technique of carotid ultrasound imaging and IMT assessment could be adopted by novices after an eight-hour crash course.” She concludes that the study shows that vascular ultrasound

imaging technology is ripe and the previously existing barriers like poor resolution, cumbersome protocols, need for off line processing and need for expert performer no longer exist. However, she says that the study does not address whether this imagingbased approach would save more lives than the risk-based approach. “We need to ponder if treating nearly 50 per cent of the adults with statins with a risk scoring algorithm is more appropriate versus treating only those who have subclinical atherosclerosis based on comprehensive and readily available, cheap and simple screening method,” she says. The study makes a compelling argument in favour of imaging for screening, she states. IN IMAGING 29

IRIA 2015 SPECIAL INSIGHT DR AARTI SHARMA KAPILA General Manager â&#x20AC;&#x201C; Quality and Dental Administration, Clove Dental

DIGITAL RADIOGRAPHY: A NEW ERA IN DENTAL RADIOLOGY Dr Aarti Sharma Kapila, GM â&#x20AC;&#x201C; Quality and Dental Administration, Clove Dental, shares insights on the advent of digital radiography in dental radiology and its advantages

igital radiography is one of the most important advancements in dental radiology. The dawn of the digital era in dental radiography came in 1987, when the first digital radiography system called RadioVisioGraphy, was launched in Europe by the French company Trophy Radiologie. The inventor of this system was Dr Francis Mouyen. He invented a way to employ fibre optics to narrow down a large X-ray image onto a smaller size that could be sensed by a charge-coupled device (CCD) image sensor chip. Even though digital radiography has been available in dentistry for more than 25 years, it has not been accepted by all dental practitioners due to various reasons. Some people are reluctant to make the change because they are unsure of what to expect during the change-over period and what type of problems they may encounter. The main difference in the digital radiography is that the film is replaced by an image receptor. Two major types of image receptors are available: 30 IN IMAGING

charge-coupled device (CCD) and storage phosphor (SP) systems. Although the X-ray source used could be same, the dose is much lower than conventional film radiography because in digital imaging, the receptors are highly sensitive sensors that require considerably less radiation exposure than film. Digital dental images are acquired through three methods: the direct method, indirect method and semiindirect method. The direct method uses an electronic sensor placed in the mouth to record images. The indirect technique uses an X-ray film scanner to view traditional dental X-rays as

THE MAIN ADVANTAGE OFDIGITALRADIOGRAPHY OVER CONVENTIONAL RADIOGRAPHYIS THAT MANYTASKS ASSOCIATED WITH FILM USE ARE SIMPLIFIED OR ELIMINATED

digital images. The semi-indirect digital technique combines a sensor and scanner to convert dental X-rays into digital film. The most commonly used method is the direct method.

Types and uses of digital dental radiographs Digital dental radiographs can be taken inside (intraoral) or outside (extraoral) the mouth. Intraoral X-rays, the most commonly taken dental X-ray, provide great detail and are used to detect cavities, check the status of developing teeth and monitor teeth and bone health. Extraoral X-rays do not provide the detail of intraoral X-rays and are not used to identify individual tooth problems. However, they are used to detect impacted teeth, monitor jaw growth and development, and identify potential problems between teeth, jaws and temporomandibular joints (TMJ), or other facial bones. If we compare, a traditional radiographic image is composed of radiolucent (dark) areas in which the silver grains in the emulsion are densely packed and radiopaque areas in which JANUARY 2015

IRIA 2015 SPECIAL

the grains are more dispersed, having been washed out during the film processing. Although a digital image seen on the screen as a collection of brighter and darker areas very much resembles the traditional film-based image, the nature of a digital image is completely different. A digital image, on the other hand, is composed of a set of cells that are called ‘pixels’ arranged in rows and columns. Digital images can be altered after they have been produced. This is achieved by altering the pixel values, which can change certain characteristics of the image. This is called ‘image processing.’ As compared to conventional radiography, digital radiography has many additional advantages. The main advantage of digital radiography is that many tasks associated with film use are simplified or eliminated. Decreased radiation dose: Digital radiography systems reduce radiation exposure to patients by up to 50 per cent compared to film-based systems. Although film-based radiography systems are indeed exceptionally safe, digital radiography conforms to the very important ALARA principle (as low as reasonably achievable) more precisely than film-based radiography. This is a radiation safety principle for minimising radiation exposure to both patient and operator by employing all reasonable means possible. One of the advantages of digital imaging is that once acquired, the image can be changed and viewed in a variety of ways using image enhancement software. Common enhancements tools include: ❖ Image processing ❖ Black/white reversal ❖ Zoom ❖ Digital substraction radiography Image processing helps in the JANUARY 2015

Digital radiography I : Bitewing X-ray image

Digital radiography II : Colour contrast on digital X-ray images which helps in more definitive diagnosis

optimisation of contrast and brightness of an image. It can help to rescue an image in which exposure conditions were not optimal and thus prevent the need for a remake, saving the patient

from an extra dose of radiation. It is also possible to adjust the contrast and density of an otherwise correctly exposed image to optimise the recognition of caries or the assessment IN IMAGING 31

IRIA 2015 SPECIAL

of periodontal bone lesions. It is reasonable to assume that in the near future, software for digital radiography will include tools to optimise contrast and brightness automatically for specific diagnostic tasks. The black/white reversal option allows one to view structures by inverting or reversing the image so that radiolucent structures appear radiopaque and vice versa. This tool may be useful in visualising the trabecular pattern of bone and pulp canal and chamber anatomy. Another simple but effective tool is the ability to zoom in an image. By using a twofold or three-fold magnification, the user can recognise details more easily. Digital substraction radiography is a technique used to determine qualitative changes that occur between two images taken at different points in time. This procedure allows us to distinguish small differences between subsequent radiographs that otherwise would have remained unnoticed because of over-projection of anatomical structures or differences in density that are too small to be recognised by the human eye. Applications of digital substraction radiography in general practice include diagnosis and follow-up of periodontal bone resorption, assessment of bone levels around implants and then progression of healing of periapical lesions. Edge enhancement converts contrast gradients into a texture that is visible as a shape. The human eye recognises shapes better than it does small contrast gradients. This ability allows the practitioner to detect, for instance, the point of an endodontic file in an image more easily.

Other advantages â?&#x2013; Eliminates the need for the darkroom and chemical processing: 32 IN IMAGING

Digital radiography III: X-ray image showing RC treated tooth with crown

Digital radiography IV: Orthopantomogram X-ray image-OPG

This is one of the biggest advantages of digital radiography. A dark room requires additional space in the dental clinic. So it adds to the expenses. The management of chemical waste that is produced in a dark room is a difficult task. The elimination of chemical processing helps the dentist to manage the dental clinic more efficiently and it also makes a digital imaging system more eco-friendly. â?&#x2013; Time saving: Digital radiography is fast. The images we take are ready to view in less than one second after

shooting. But in the case of conventional radiography it takes a minimum of five to eight minutes to develop the film. If a processing error occurs in the dark room (over- or under-developed radiograph), the radiograph will need to be repeated, as the faulty processing makes the film-based radiograph useless for a diagnostic procedure. â?&#x2013; Teleradiography: The transfer of a digital image to a distant site is called teleradiography. In order to accomplish this task, the sender and JANUARY 2015

IRIA 2015 SPECIAL

Digital radiography V: Wall mounted long cone X-ray emitting device

Digital radiography VI: Wall mounted short cone X-ray emitting unit

receiver must be able to generate an image that can be read by various software programmes or have the same software. Teleradiography has the potential for off-site consultation, insurance submission and improved access to care for patients in remote locations. â?&#x2013; Extreme importance of digital radiography in implantology: When accomplishing implant placement, using conventional radiography is a major inconvenience, as the entire aseptic procedure is disrupted and time is wasted while the clinician awaits the development of the films several times during the implant placement procedure.

systems. Sensors are the weakest part of the system due to their relative rigidity and thickness (approximately 5 mm); they can cause discomfort or pharyngeal reflex in patients. The viewable surface area is smaller than the total size of the sensor and sometimes sensors are not universal and interchangeable between different systems. Digital sensors canâ&#x20AC;&#x2122;t withstand heat sterilisation; therefore they require complete coverage with

Disadvantages of digital radiography Like any other technology, digital imaging also has some limitations. The initial cost of purchasing and setting up the equipment, as well as the cost of training staff members how to use the equipment represents a disadvantage of digital imaging JANUARY 2015

AS ANEWTECHNOLOGY, DIGITALRADIOGRAPHYIS CONSTANTLYIMPROVING AND THERE ARE MANY ADVANTAGES TO ITTHAT CANNOTBE ACHIEVED BY FILM-BASED RADIOGRAPHY

disposable plastic sleeves. In conclusion, digital radiography is an excellent alternative to filmbased radiography and continues to grow in popularity. The diagnostic accuracy achieved with digital radiography is as good as with film in most cases, and the disadvantages associated with earlier types of equipment have been resolved with advances in technology. New software tools are under development by researchers and manufacturers to improve the diagnostic outcome of digital radiography. An area that is continuously under development is the application of artificial intelligence (AI) to the interpretation of digital radiographs. Digital radiography is becoming popular among dental practitioners. As a new technology, it is under constant improvement and there are many advantages to digital radiography that cannot be achieved by film-based radiography. So, it has the potential to replace film-based radiography completely. IN IMAGING 33

IRIA 2015 SPECIAL PREEVENT

Kochi to host IRIA 2015 The event would focus on the latest advancements in the field of radiology and imaging

THE 68TH annual conference of IRIA will be hosted by Kerala chapter of IRIA. It will be held from January 29 to February 1, 2015 at the Hotel Le Meridien in Kochi. It will comprise various segments for radiologists including a scientific programme oriented to practising radiologists and focussed on sub-speciality work. Wide ranging academic feast including workshops, lectures, paper/poster presentations, image interpretation with audience response and orations will also be part of this conference. It will also consist of prime time sessions offering guidance to exam going PGs and young radiologists entering practice.

Some highlights of IRIA 2015 would be: ■ ICRI CME featuring outstanding

programme ■ All you wanted to know- foetal imaging/infertility and breast imaging sessions ■ Separate session on contrast enhanced ultrasound featuring the leading lights in India From basics to routine practice and beyond ■ Introducing dialysis fistula imaging and intervention ■ Great panel of national and

faculty on Day-1 ■ ASNR & AIRP workshop ■ Onco imaging and PET-CT ■ Innovative neuroradiology

programme featuring case studies and mini-workshops ■ Comprehensive sessions on HCC, integrating imaging, interventional treatment and recent advances ■ Listen, learn and do! Step by step 'How I do it' session on basic CT/US guided procedures by experts ■ A to Z. Full day single hall MSK 34 IN IMAGING

ACADEMIC FEAST INCLUDES WORKSHOPS, LECTURES,PAPER/POSTER PRESENTATIONS,IMAGE INTERPRETATION WITH AUDIENCE RESPONSE AND ORATIONS

international speakers ■ Special interactive session planned in collaboration with National Board of Examinations specifically to help and enhance performance in MD/DNB PG exam. ■ Starting your practice: A special session offering perspectives for young radiologists seeking to set up their practice. Advice from seniors who are at the top of the ladder! ■ Seminar on business in radiology by Prof David Yousem Contact Dr K Mohanan IRIA 2015 Secretariat IMA House, Stadium Link Road, Kathrikadavu, Kaloor Kochi-682 017 Mob: +91 85890 54499 Email: iria2015kochi@gmail.com Website: www.iria2015.com JANUARY 2015

IRIA 2015 SPECIAL ONE-ON-ONE

â&#x20AC;&#x2DC;This year our focus is on young radiologistsâ&#x20AC;&#x2122; The 68th Annual Conference of Indian Radiological & Imaging Association (IRIA), to be held at Kochi this year, is just around the corner. Dr K Mohanan, Organising Chairman, IRIA 2015 speaks about his preparation for the upcoming event and gives an update on the focus areas this year, in conversation with Raelene Kambli

What does it mean to be the organising chairperson of IRIA 2015? The opportunity to organise IRIA 2015 was given to us two years ago. My role involves looking after the overall operations, organisation and policy making process. I have had prior experience in organising the IRIA event, earlier in 1994, therefore, I was aware of the requirements and responsibilities associated with organising such a big radiology event.

able to raise enough funds to organise the event.

DR K MOHANAN, Organising Chairman, IRIA 2015

How will this year's event be different from past events? This year since our focus is on young radiologists, we have created a platform wherein post-graduates will be presenting around 1000 research papers. And what's more interesting is that all of these papers will be screened on 25 plasma TVs during the sessions. Also, these papers will be uploaded on our website which will be available for one year i.e. till the next IRIA meeting.

What is the rationale behind choosing Kochi as the destination to hold the IRIA 2015? Kochi is a good destination for manufacturers as well as post graduate students. How long have you been preparing for this annual meeting? What are the challenges faced so far? We have been preparing for the event since the last two years in a concerted manner. Our team has been dedicated to providing the best platform for radiologists, students, manufacturers and hospital CEOs at this year's IRIA. Speaking about the challenges, the biggest hurdle that we crossed was of raising funds. We had to build a feasible strategy to attract exhibitors and sponsors. However, with the help of our technology partners we were 36 IN IMAGING

What are the highlights of this year? What is the theme selected this year? Our focus this year is to attract as many as post-graduates and young radiologists as possible. The idea is to encourage post graduates and young radiologists to take up entrepreneurship.

THE MAIN FOCUS OFTHE SCIENTIFIC PROGRAMME IS TO DISCUSS ON TOPICS SUCH AS THE PNDTACT AND SAFE RADIATION DOSE

Is there anything new that will be introduced this year? This year we will have in all around eight halls and Hall No 8 will be dedicated to exhibitors were they can showcase their selective innovative products and also conduct workshops. Moreover, we have realised that decisions about hospital equipment is taken mainly by hospital CEOs, JANUARY 2015

IRIA 2015 SPECIAL ONE-ON-ONE

HIGHLIGHTS OFSCIENTIFIC PROGRAMME: WE HAVE CREATED APLATFORM WHEREIN POST-GRADUATES WILL BE PRESENTING AROUND 1000 RESEARCH PAPERS

Day 1 MD/DNB Examination: Featuring Dr Bipin Batra, Executive Director of NBE, this session is meant to address the concerns of PGs about the exams starting with how to prepare, how best to write the theory and tips to shine in the practicals

therefore we have invited them as well.

Day 2 How I do it -Basic Intervention: Experts will explain step by step how to do biopsies in the chest, abdomen, how to do simple drainage procedures using seldinger technique, and how to do TRUS biopsy.Apart from this, an expert from UK will speak on uterine artery embolisation

What is the main focus of the scientific programme planned for this year? The main focus of the scientific programme is to discuss on topics such as the PNDT Act and safe radiation dose. Who are the key speakers and faculty? In all, we have 50 international faculties and 200 national faculties. What are your expectations from IRIA 2015? We have worked very hard towards organising this event. We hope to make this event successful in every way. raelene.kambli@expressindia.com

JANUARY 2015

Starting your practice: Dr Harsh Mahajan will speak about financing options. Also, Dr Radesh, will explain the trend of selling radiological practice to corporates

Day 3 Master Class: Speakers from all over the country will conduct CMEs Liver imaging and intervention: Entire liver session will be solely dedicated to all aspects of imaging, problem solving and management of hepatocellular carcinoma. Experts from every major institute in the country will cover everything from guidelines to advanced imaging to TACE, RFA and TARE. Intervention talks will be in a 'How to do it' format by the foremost experts in the country.We promise you that this session will be comprehensive MSK: A single hall will be dedicated to this session conducted by experts from UK and the best from all over India

IN IMAGING 37

IRIA 2015 SPECIAL ONE-ON-ONE

‘Our vision is to add value to our customers’ business’ Carestream has been on the cutting edge of healthcare technology in the imaging space in India since 1991. Sushant Kinra, in his recently acquired position as Country Business Manager of Carestream India, speaks to Lakshmipriya Nair, about how the company will continue to thrive in this frequently changing business environment What is the potential for growth in the Indian healthcare sector? Healthcare expenditure in India is around one per cent of the total GDP, while it is 17 per cent in the US. Both of these percentage spends are extremes. India’s healthcare spends is expected to reach around 2.5 per cent in near future. In light of government expenditure going up, we are quite certain that the nation’s healthcare sector is poised for take-off. As a matter of fact, compared to other sectors, we foresee more opportunities emerging in healthcare, going by the very nature of the criticality of service it offers. Given that you foresee a huge opportunity in this sector.What is your vision for Carestream India? Our very presence in a sector that is poised for growth is an opportunity in itself. For Carestream, our vision is to add value to our customers’ business. We, on our part, have to therefore understand the entire workflow at customers’ end to position our solutions in a way that addresses the challenges. Carestream has to be positioned such that we cater to changing needs, which in turn translates into higher customer satisfaction. 38 IN IMAGING

SUSHANT KINRA Country Business Manager, Carestream India

WE FORESEE MORE OPPORTUNITIES EMERGING IN HEALTHCARE,GOING BY THE VERYNATURE OF THE CRITICALITYOF SERVICE ITOFFERS

What methodology is Carestream adopting currently to achieve this vision? At present, my area of attention is overall organisational behaviour. Currently, we are present in the area of medical imaging in all segments – from small, medium to large imaging centres. We have to capitalise on this presence and keep tapping into our potential here. For this, we have to structure our organisation such that we optimally address this entire segment and go as closer as possible to our customers. The needs of a smallsized imaging centre in a small town may be different from those of an imaging centre based in a metro. How we address this diverse spectrum of needs through innovation in structure and solutions, would be my yardstick for success. This is also my immediate priority. What market opportunities and trends do you witness in India’s radiology market? A very obvious trend is the shift from analog to digital technology. This transition alone has created immense value for our customers. As an example, look at the photography space. In this space, the shift from the Continued on Page-40

JANUARY 2015

IRIA 2015 SPECIAL ONE-ON-ONE

‘In the next 6 months we are releasing high capacity X-ray systems’ Kiran Phuria , Director – Marketing, Medx Technologies, talks about Medx Technologies' product focus and the company's plan for the year ahead with Raelene Kambli Tell us about MedxTechnologies’s contributions in the field of radiology? Medx Technologies, has been formed by a team of eminent engineers who have been in the Indian radiology market for the past two decades. Using their expertise in creating solutions for the past two decades, at Medx technologies we have designed and develop latest technology products which are in line with international specifications. Currently, at Medx Technologies we have a complete range of high frequency general X-ray systems, mobile X-ray systems and mobile C-arm imaging systems which are way ahead in terms of technology comparing to the existing products being marketed by competition. What is MedxTechnologies’s focus area in the field of radiology? What are the latest trends in this field? For the past many years basic X-ray imaging market in India itself didn’t see any major changes in technology and almost things were stagnant with low frequency systems being the basis of imaging. With digital imaging becoming affordable from 2008 we have seen a change and this digitation process has brought about a change in the basic imaging technology as well. With the need of better imaging quality, high frequency x-ray systems have JANUARY 2015

KIRAN PHURIA Director – Marketing, Medx Technologies

WITH THE NEED OF BETTER IMAGING QUALITY,HIGH FREQUENCYX-RAY SYSTEMS HAVE BEEN GAINING MAJOR ACCEPTANCE IN THE NEWSALES

been gaining major acceptance in the new sales. The latest trend in X-ray imaging ofcourse has been digitisation using CR but is now changing pace towards Direct Radiography (DR) Systems. To be in line with future market requirements, at Medx we have a range of DR solutions from the affordable series to the highest end technology products to meet a variety of customer needs. For high-end imaging requirements, Medx Technologies has collaborated with a few European and US companies to get technology from them and produce affordable systems in India. What is the USP of MedxTechnologies's imaging products? At Medx Technologies, our main focus has been in developing high frequency generators which are more stable to Indian power supply conditions and are future ready for DR solutions. We have been quite successful in doing this as we can boast that our high frequency generators have been working past three years without any voltage stabiliser requirements and a single day breakdown in the worst parts of the country where electricity is not stable. Our dream to provide affordable Continued on Page-40 IN IMAGING 39

IRIA 2015 SPECIAL ONE-ON-ONE Continued from Page-38

Nothing is more important... analog to digital cameras had created a tremendous value in terms of high quality workflow and reduction in overall cost. We have been strong on the analog platform and now also have a strong portfolio in digital technology. Our strength would lie in continuing to make the switch seamless. Which key result areas are you focussing on in your new role as Country Business Manager of Carestream India? In the short term, I would like to drive our focus back to gaining market share, in both, analog and digital space. While the former is a declining market, I believe, we can still continue to gain overall market share. The digital terrain is expanding; gaining market share is almost a foregone objective for us in this area. My priority is to position

ourselves as the number one in analog and digital market space, which can only be achieved if we meet our clientsâ&#x20AC;&#x2122; changing needs and are quickly receptive to their transient nature. IRIAis a great platform to connect with right people in the medical imaging market.What are you planning to showcase at this event? At the IRIA 2015 conference, we will be launching Vita Flex CR, a complete plug and play CR system that gives power in the hands of customers. The spotlight would also be on our flagship product DRX Revolution - a complete X-ray system on wheels. DryView 6950 Laser Imager, a new premium laser imager that outputs images from CT, MR, digital mammography and other imaging modalities onto radiographic

films, would be another highlight of the event. At this platform, we will also showcase our innovative new workflow solution, Managed Printing Solutions that takes care of complete medical printing needs of imaging facilities, allowing them to focus on their core business. What message you would like to give to Carestream stakeholders? Our prime message is that Carestream is determined to assure customer satisfaction. Assurance of employee satisfaction is also critical to our growth. If we can achieve both, we would meet our objectives. However, at Carestream, nothing is more important for us than our relationship with customers. lakshmipriya.nair@expressindia.com

Continued from Page-39

In the next 6 months ... technology is the basis of our product designs. We try to develop and create new technologies keeping in mind the vision to make it affordable. With some of our products released, we can surely say that we offer some higher end solutions at nearly 40 per cent lower cost than similar spec products available from the international market. What is your opinion of the radiology market in India? As said earlier, Indian radiology market for ages has not seen a sea change and the same is now taking place. Specifically talking about X-ray imaging there would be over 40,000 plus low frequency systems currently 40 IN IMAGING

in use and many of them would be over 10 years. With new technology the market potential and growth is too high as most of the age old systems and old technology systems may be replaced with newer technologies in the next 5 years. So with the ongoing changing trend we see a big opportunity in the Indian

OUR DREAM TO PROVIDE AFFORDABLE TECHNOLOGY IS THE BASIS OFOUR PRODUCTDESIGNS

imaging radiology market. What are your business plans for 2015? We already have a basket of products to offer which range from the lowest end mobile X-ray to 50kW high frequency systems. This covers 80 per cent of the general market demand in India. For 2015 we have a lineup of new products which are currently undergoing necessary certification and would be commercially released soon. In the next six months we are releasing high capacity X-ray systems with 65kW & 80KW, range of high end DR solutions, higher end C-arm imaging systems with cardio-vascular imaging capabilities. raelene.kambli@expressindia.com JANUARY 2015

IRIA 2015 SPECIAL

RADIOLOGY SOLUTIONS FROM VARIAN Vivek Phalle, Business Head, SAARC Countries, Imaging Components Business, Varian Medical Systems International India elaborates on his company’s recent offering, a wireless flat panel detector and its advantageous features arian Medical Systems is a premier supplier of X-ray imaging components including tubes, digital detectors, image processing software and workstations for use in medical, scientific, and industrial settings, as well as for security and non-destructive testing. As the world’s largest independent supplier of X-ray tubes, Varian has a bonded warehouse facility in India where CT scan X-ray tubes are available in the inventory for rapid shipment. Varian recently launched a Flat Panel Detector 4336W which is a dual band detector licensed for use in most global markets. PaxScan 4336W – Wireless Flat Panel Detector: The PaxScan 4336W wireless flat panel X-ray detector features Varian’s proprietary, advanced wireless technology with state-of-the art, sixth generation architecture incorporating 16-bit data acquisition, which enables rapid image acquisition. The lightweight, cassettesized, portable (43 x 36 cm) detector is optimised for dose efficiency and very low electronic noise. “The new wireless panel joins Varian’s extensive line-up of dose efficient image detectors that have been optimised for a broad spectrum of applications. The high speed data

42 IN IMAGING

VIVEK PHALLE, Business Head, SAARC Countries, Imaging Components Business, Varian Medical Systems International India

AS THE WORLD’S LARGEST INDEPENDENTSUPPLIER OF X-RAYTUBES,VARIAN HAS A BONDED WAREHOUSE FACILITYIN INDIAWHERE CT SCAN X-RAYTUBES ARE AVAILABLE IN THE INVENTORYFOR RAPID SHIPMENT

transfer rates, (up to 170 Mbps) makes it possible to transmit image data in real-time across a reliable wireless link, producing a preview in as little as two seconds,” said Vivek Phalle, Business Head for Varian’s India Imaging Component Business. “Having a CT tubes inventory in India, significantly enhances our ability to serve our Indian customers on an expedited basis. We’re able to offer regional product and support services, which help increase our customers’ competitiveness in the marketplace,” adds Phalle. JANUARY 2015

IRIA 2015 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

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 timeconsuming. 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

JANUARY 2015

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 Fax- +91-61916996 IN IMAGING 43

IRIA 2015 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 along the 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) 44 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 2015

IRIA 2015 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

Battery expected life 20,000 charge/discharge cycles Battery charging time empty to full

Within 30 minutes (when using the AeroDR Battery Charger) Within 60 minutes (when using the dedicated wired cable)

Number of exposures on battery

17”x 17” : 189 images/5.2 hours 14”x 17” : 200 images/5.5 hours 10”X 12” : 146 images/4.0 hours *Under conditions that the interval between studies is five minutes and three images are captured in each study, assuming 20 seconds for each exposure to position a patient

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" ) advantages despite of demanding a lower power consuming panel design, which has been overcome by employing low power ICs and a powersaving control.

The AeroDR Detector is light-weight FPD weighing as little as 2.9 Kg

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 CsI scintillator glass plate and the TF T

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 2015

under substantial shock or load. Since 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

panel glass plate are overlapped and sealed together is adopted for Aero DR. 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: Tel: 022-61916969 Email : sales@mi.konicaminolta.in IN IMAGING 45

IRIA 2015 SPECIAL

FACILITY VISIT

SANRAD MEDICAL SYSTEMS: CARVING A NICHE IN RADIOLOGY MARKET

eenya, Bengaluru 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 Bengaluru, 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 MNCs. 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 46 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 2015

The products are imported, refurbished and transported to clients for installation

Operations and strategising in progress

The Sanrad team at Peenya Facility, Bengaluru

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 joint-venture manufacturing in future JANUARY 2015

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 47

IRIA 2015 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 Express Healthcare

How does the refurbished equipment market operate? What is the size of the refurbished medical equipment market in India? A large part of the 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 48 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 2015

IRIA 2015 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 2015

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 49

IRIA 2015 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 itâ&#x20AC;&#x2122;s 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

50 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, easy 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 an 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 compound 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 2015

IRIA 2015 SPECIAL

CARESTREAM TO DISPLAY COMPACT VITA FLEX CR SYSTEM AT IRIA Reportedly, the system can be operated vertically or horizontally to address need for image processing in compact spaces

arestream intends to introduce its compact new Vita Flex CR system that reportedly delivers great image quality and can be positioned virtually anywhere in a healthcare facility. This new system’s design enables it to operate vertically as well as horizontally, so it can process CR cassettes sitting on the floor, a tabletop or desktop or even from the back of a van. The Vita Flex CR system will be on display at the 2015 Indian Radiology Imaging Association (IRIA) conference. The affordable Vita Flex CR system can process multiple cassette sizes including: 8 x 10 in., 10 x 12 in., 24 x 30 cm, 14 x 14 in. and 14 x 17 in. This new system is expected to address the diverse needs of imaging centres, private practices, urgent care facilities, smaller hospitals and mobile imaging operations, as well as orthopaedic, veterinary and chiropractic providers. Vita Flex CR is designed with three modular components to make it easy to install and service. It is available with a choice of two throughput rates— either 30 or 45 plates per hour. A touch screen allows users to quickly and easily select desired body parts and views to speed the imaging

JANUARY 2015

VITAFLEXCR IS DESIGNED WITH THREE MODULAR COMPONENTS TO MAKE IT EASYTO INSTALLAND SERVICE.ITIS AVAILABLE IN EITHER 30 OR 45 PLATES PER HOUR process. Technique information can be acquired automatically, eliminating the need for manual entry and the

possibility of inconsistent X-ray exposures among different users. A veterinary offering is also available and includes specialised software and cassettes. “Like our other Vita CR systems, this new model is designed to help facilities of all types and sizes move smoothly and affordably to digital imaging. Carestream’s Image Suite software plays a pivotal role in that transition by providing a comprehensive package of image capture and management capabilities for a very affordable price,” said Amit Singh, Carestream India, General Manager for X-ray Solutions. IN IMAGING 51

IRIA 2015 SPECIAL PRE EVENT

Medical Fair India 2015 to give a fillip to the Indian medical industry It would be held from March 21-23 at Pragati Maidan, New Delhi MEDICAL FAIR India 2015, in its 21st edition will showcase the latest technological advancements in a vastly diversified medical sector. It is the flagship brand of Medica and the world’s largest annual medical event. It will be held in Düsseldorf, Germany from March 21-23, 2015 at Pragati Maidan, New Delhi and would prove to be the bellwether amongst the medical events in the country. The current edition of Medical Fair India comes with a special focus on hospital infrastructure and planning. It is expected to witness participation from over 20 countries with dedicated country pavilions from the US and the UK, Germany, Taiwan, Korea, Belgium, China, Italy, Malaysia and Singapore. The event will have nearly 500 exhibitors from India and abroad showcasing their products and services which will help visitors to identify new providers, new agents and joint venture partners. It is aimed at sourcing out new products and technologies and to find new suppliers for stakeholders in the medical industry. Medical Fair India 2015 will be attended by a wide spectrum of medical experts like doctors, practising physicians, veterinarians, dentists, physiotherapists and ergo-therapists. The visitor profile will also include professionals like hospital directors/managers, hospital owners, hospital administration managers and staff, medical specialists, superintendents and service providers. Biologists, microbiologists and 52 IN IMAGING

biochemists from the research community along with general service providers like process engineers, NGOs for rehabilitation aids, distributors, visitors from academics and universities, as well as visitors from government and international agencies will also be part of the event. For the first time in the country, the event will have specific conferences on hospital infrastructure and planning with the theme of ‘Challenges and Solutions in Hospital Planning’. The second conference will be on ‘Medical Device & Technology’ with the theme of ‘Connect, Engage and Explore’. Medical Fair 2015 aims to serve as a perfect platform to network with thousands of healthcare professionals along with generating business and increasing sales. The conference topics and speaker sessions will provide valuable insights on new trends which could widen the customer base and help companies to stay ahead of competition. With participation from international companies and other countries,

MEDICALFAIR INDIA2015 INTENDS TO WIDEN ITS SPECTRUM AND NOT JUSTBE SEEN AS A MEDICALDEVICE TECHNOLOGYEVENT

building relations to gain access to India and the sub-continent will be facilitated. Some key associations supporting the event are Indian Association of Physical Medicine and Rehabilitation, Association of Healthcare Providers (India), Association of Diagnostic Manufacturers of India (ADMI), Medical Surgery and Healthcare Industry Trade Association (MSAHITA), Apollo Hospitals Group, Indian Association of Sports Medicine, and Fortis Healthcare along with others from the UK, Germany, Korea. “Medical Fair India would act as an enabler in bringing the entire medical fraternity on one platform where suppliers and buyers from different segments of the industry will congregate and do business. The two-day technical conference shall bring together eminent speakers from the medical fraternity who shall deliberate on vital issues being faced by healthcare industry professionals,” said Udo Schürtzmann, MD, Messe Düsseldorf India. He further said, “India has embarked on a journey of healthcare services transformation. The present Indian Government has introduced structural reforms and has re-emphasised its vision to create the access for improving healthcare services and to provide affordable healthcare for all.” Contact Shilpa Kabra Mob: 9766705129 Email: shilpa@mutualpr.com JANUARY 2015

IRIA 2015 SPECIAL

KONICA MINOLTA: SHOWCASING SONOSCAPE'S SOLUTIONS Sonoscape offers an eclectic range entry level B&W ultrasound systems to high-end colour Dopplers

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 WELL KNOWN FOR THEIR EXCELLENTIMAGE QUALITY AND COLOUR PICK-UP, STABLE AND ROBUST HARDWARE AND TROUBLE FREE OPERATIONS FOR YEARS

JANUARY 2015

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. IN IMAGING 53

IRIA 2015 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. 54 IN IMAGING

S20

SSI 4000

S40

S30

JANUARY 2015

BUSINESS AVENUES

IN IMAGING

Clutter or Comfort ... Aren’t you still missing something ?

Soft Tissue Biopsy Tray includes:

A ready to use Sterile Kit for Biopsy, obviates the ancient method of sterilizing and assembling all the components. Saves time & labour.

Marketed & Distributed by

SPECTRAMED 562-563 George Rathinam Road, 1-D G.G. Nagar Nerkundram, Chennai - 600107 Ph - 044 - 35357576, 26561337

Email: spectramedindia@gmail.com

• One (1) multi-compartment tray with prep well • Syringe, 3 cc with 25 g x 5/8" needle • Luer lock syringe, 6 cc • Luer lock syringe, 20 cc • Needles: 22 g x 1-1/2" and 20 g x 1-1/2" • Lidocaine hydrochloride, USP, 1%, 5 ml • Scalpel • Two (2) prenumbered specimen vials with caps, 10 ml • Six (6) frosted microscope slides • Ruler, 6” • Two (2) sponge sticks • Four (4) gauze pads • Two (2) towels • Fenestrated drape with adhesive strip • Bandage • Two (2) patient ID labels • CSR wrap

A PG in Biopsy !

Packed 10 Trays / Case

www.spectramedin.com

JANUARY 2015

IN IMAGING 55

BUSINESS AVENUES

56 IN IMAGING

IN IMAGING

JANUARY 2015

BUSINESS AVENUES

JANUARY 2015

IN IMAGING

IN IMAGING 57

BUSINESS AVENUES

IN IMAGING

Advertise in

Business Avenues Please Contact: ■ Mumbai, Ahmedabad: Kunal Gaurav 91-9821089213 ■ Delhi: Ambuj Kumar 91-9999070900 ■ Chennai: Yuvaraj Murali 91-9710022999

58 IN IMAGING

■ Bangalore: Khaja Ali 91-9741100008 ■ Hyderabad: E.Mujahid 91-9849039936 ■ Kolkata: Ajanta 91-9831182580

JANUARY 2015

New from Varian Interay:

Replacement tubes for your GE CT!

GE CT/e - ProSpeed Ai GS2276 replaces D3162T, D3169T New 80,000 scan warranty

GE ProSpeed/Solarix NP • GS3576P replaces D3112T, D3119T New 120,000 scan warranty • GS3576S replaces D3142T, D3149T New 120,000 scan warranty • Loaded in original housings

GE Sytec SRi • GS2176 replaces D3122T, D3129T New 80,000 scan warranty

MCS-6074 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 • Calibrates like the original

For more information go online for a datasheet, or contact your preferred dealer.

X-ray tubes delivered from stock in India. 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 9987540900 Fax +91 22 28385614 CELL +91 9987540900

Varian Interay 1-800-INTERAY TEL 843.767.3005 FAX 843.760.0079 interay.sales@varian.com

“All trademarked terms are property of the respective manufacturer.”