InImaging January, 2016

In Imaging

Pages 60

A compendium on the latest in radiology

JANUARY 2016

Barco radiology and mammography displays Raising the bar in diagnostic imaging

Meet Nio and Coronis – two families of diagnostic displays that are ideal for high-quality imaging of diagnostic modalities. Available in color or grayscale. Starring 2 million or 5 million pixels – or anything in between. And packed with innovative features that make your image look the best it can. It’s why Nio and Coronis are indispensable in any radiology department.

FROM INDUSTRY-STANDARD TO BENCHMARK

Nio

Coronis

on-demand calibration and quality checks

fully automated QA & calibration

front-of-screen sensor

intelligent multi-sensor technology with patented I-Guard

uniform luminance (on pixel area level)

per pixel uniformity correctior (on pixel level)

MODI MEDICARE, 4/102, DEEP SUNIL, GARODIA NAGAR, GHATKOPAR(E), MUMBAI - 400 077 +91-22-2506 5664, +91-98670 01110

www.barco.com/healthcare

• • • • • • • • • • • • • • • • • • • •

MAKE A WISH THIS 2016!!! & DIAL A SANTA 8308 533 533.

UNDER 10 LAKHS? IN MY CENTER? PRE- OPERATIVE MODELS SAME DAY? HIGHLY ACCURATE PLAN MODELS? EDUCATIONAL ANOTOMY MODELS? PATIENT SPECIFIC MODELS? IMPLANT GUIDES? DRILL GUIDES? ORTHRO DENTAL EVERY MODEL? COSTING SAME AS THAT OF FILMS?

MEDICAL 3D PRINTING

A-304, HRISHAB, VIVA SWARGANGA, VIRAR WEST, MUMBAI, MAHARASTRA, INDIA PIN: 401 303.

VIRUS FREE TELERADIOLOGY? TELERADIOLOGY UNDER 1.5 LAKH? DTI/PERFUSION/DIFFUSSION/fMRI? METAL ARTEFACT REMOVAL? INTER-CENTER CONNECTIVITY? 3D MPR/ANGIOS AT TELE REPORTING TELE ACCESS ON ANDROID? RACIST COMPARISON ON MAC? DICOM FILM & PAPER PRINTING? TOTAL PACS/RIS/HIS INTEGRATION? 1.5 L INCLUDING APPLE COMP? UNLIMITED STORAGE & RETRIEVAL

WORKSTATIONS & TELERADIOLOGY

EDITOR’S NOTE IN IMAGING | JANUARY 2016

Viveka Roychowdhury, Editor viveka.r@expressindia.com

AWAKENING THE CLINICIAN IN EVERY RADIOLOGIST

L

ike all professions, radiologists have their favourite T-shirt slogans. Take for instance the tongue in cheek: 'We don't see it in black and white but in different shades of gray'.

Or, 'Radiologists see things in you, other people can't'. This humour masks a more prosaic reality: a profession striving for dignity and recognition, outshined by star cardiologists and transplant surgeons. Over the years, radiologists have had to be content with offices in the basement, and rarely get face time with patients beyond the imaging procedure itself and thus most often stay faceless. This low profile has cost the profession in many ways, from losing talent to other more high profile specialities to a low morale among radiologists themselves. But the Indian Radiological & Imaging Association (IRIA) has been trying to change this perception. Since the last few years, their annual conference has striven to include sessions for young radiologists. For instance, among the many ‘firsts' at IRIA 2014, each presenter was asked to spend 10

minutes of their session sharing important tips on how to efficiently report one's diagnosis.

Similarly, the following year, IRIA 2015 at Kochi focussed on younger radiologists with many sessions offering guidance to exam going post graduates and young radiologists entering practice. The January 2015 issue of In Imaging thus focused on radiologists who had decided to turn entrepreneur and profiled three profitable imaging enterprises.

Continuing the soul searching, the theme of IRIA 2016 is 'Redefining Radiologist- A true clinician'. In a hard hitting article, Dr Bhavin Jankharia, one of the organising chairmen for this edition, reminds the fraternity that they are ‘doctors first and radiologists second.’ (In Imaging, January 2016, ‘A true clinician’; pages 1113). His concern that radiologists are being reduced to 'image readers' is very valid; so is his warning that "people expect more from those who provide them services."

While the business case for radiology as a segment will always remain strong, Dr Jankharia's argument resonates with the

situation facing most IT majors in India. Companies who relied on providing the cheapest 'coders' realised, some too late, that there will always be another company, or country, who can do it cheaper.

Unless each radiologist upgrades to the next level of service, they run the risk of becoming obsolete.

Radiologists need to demonstrate that they can go beyond the imaging report and add value to the overall diagnosis by translating information into knowledge that will enrich the diagnosis. Earning a place during the clinical consult will be tough but imaging experts can prove that their inputs can guide treatment decisions towards a more effective and efficient use of resources. If radiologists step into this new role, it will free up hospital beds as patients get cured faster; doctors will be able to treat more patients and most definitely, patients and their caregivers will be able to get back to their lives faster, hopefully without sinking more into debt.

Let’s hope IRIA 2016 takes many steps towards this win-win scenario.

CONTENTS IN IMAGING | JANUARY 2016

10

COVER STORY

14

NEWS

Redefining the radiologist: A true clinician

Dr Vijay M Rao appointed as Chair of RSNA's Board of Directors

17

Research Subsolid lung nodules pose greater cancer risk to women than men

REDEFININGTHE RADIOLOGIST

ATRUE CLINICIAN 32

30

39

Research Study: 3D MRI shows early signs of stroke risk in diabetic patients

19

INSIGHT Radiology business in India: A growing sphere

22

IRIA: THE JOURNEY SO FAR

22

18

IMAGING TECHNIQUES MR imaging of neurometabolic disorders

19

27

IMAGING TECHNIQUES USG assessment of rheumatoid arthritis: State-of-the-art

30

ONE-ON-ONE

39

ONE-ON-ONE

CHANDAN NAPHADE General Manager – XRS Solutions Carestream Health India

DR DEEPAK PATKAR Head, Department of Imaging, Nanavati Superspeciality Hospital

ALSO FEATURING: 42 Sanrad Medical Systems

47

Agfa Healthcare

48 Konica Minolta

52

Modi Medicare

55 Varian Medical Systems

56

Fujifilm India

58 Zenith Medical Systems

8 IN IMAGING

JANUARY 2016

IMPRINTLINE Presented By

In Imaging A compendium on the latest in radiology

JANUARY 2016

Chairman of the Board Viveck Goenka Sr Vice President-BPD Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bengaluru Assistant Editor Neelam M Kachhap DESIGN National Art Director Bivash Barua Asst. Art Director Pravin Temble Senior Graphic Designer Rushikesh Konka Artist Vivek Chitrakar, Rakesh Sharma Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Dr Raghu Pillai - South Harit Mohanty - East & West Marketing Team Douglas Menezes G.M. Khaja Ali Ambuj Kumar E.Mujahid Arun J Debnarayan Dutta Ajanta Sengupta PRODUCTION General Manager B R Tipnis Manager Bhadresh Valia Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar Copyright The Indian Express (P) 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 Douglas Menezes The Indian Express (P) Ltd. Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821580403 Email Id: douglas.menezes@expressindia.c om Branch Offices NEW DELHI Ambuj Kumar The Indian Express (P) Ltd. Business Publication Division Express Building, B-1/B Sector 10 Noida 201 301 Dist.Gautam Budh nagar (U.P.) India.

Board line: 0120-6651500.

Mobile: +91 9999070900 Fax: 0120-4367933 Email id: ambuj.kumar@expressindia.com Our Associate: Dinesh Sharma Mobile: 09810264368 E-mail: 4pdesigno@gmail.com CHENNAI Arun J The Indian Express (P) Ltd. Business Publication Division 8th Floor, East Wing, Sreyas Chamiers Towers New No 37/26 (Old No.23 & 24/26) Chamiers Road, Teynampet Chennai - 600 018 Telephone (Board): +91 44 24313031/32/34 Fax: +91 44 24313035 Mob: +91 9940058412 Email id: arun.j@expressindia.com BENGALURU G.M. Khaja Ali The Indian Express (P) Ltd. Business Publication Division 502, 5th Floor, Devatha Plaza, Residency road, Bangalore560025 Board line: 080- 49681100 Ext. 108 Mobile: +91 9741100008

Fax: 080- 22231925 Email id: khaja.ali@expressindia.com HYDERABAD E.Mujahid The Indian Express (P) 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 (P) 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: ajanta.sengupta@expressindia.co m KOCHI Arun J The Indian Express (P) Ltd. Ground Floor, Sankoorikal Building, Kaloor – Kadavanthra Road Kaloor, Kochi – 682 017 Mobile: +91 9940058412 Email id: arun.j@expressindia.com COIMBATORE G.M. Khaja Ali The Indian Express (P) 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 Nirav Mistry The Indian Express (P) Ltd. 3rd Floor, Sambhav House, Near Judges Bunglows,

Bodakdev, Ahmedabad - 380 015 Mobile: +91 9586424033 Email Id: nirav.mistry@expressindia.com BHOPAL Ambuj Kumar The Indian Express (P) 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 (P) Ltd. S2, J-40, Shyam GHP Enclave, Krishna Marg, C-Scheme, Jaipur- 302 001 Mobile: +91 9999070900 Email id: ambuj.kumar@expressindia.com

Important: Whilst care is taken prior to acceptance of advertising copy, it is not possible to verify its contents. The Indian Express (P) 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 2016

IN IMAGING 9

Picture used for representational purpose only

IRIA 2016 | SPECIAL |

10 IN IMAGING

JANUARY 2016

COVER STORY

REDEFINING THE RADIOLOGIST

ATRUE CLINICIAN Dr Bhavin Jankharia, Radiologist and Partner, Picture This by Jankharia, emphasises on the importance of radiologists as clinicians who play vital roles in the practice of medicine

JANUARY 2016

IN IMAGING 11

IRIA 2016 | SPECIAL |

W

hen I was a resident in Lokmanya Tilak Municipal General Hospital (LTMGH), I was denied a room in the RMO quarters by the warden, who told me that those who were in paraclinical branches did not deserve individual rooms…we would only get duty rooms. I was livid because even as a resident, I could see that we, radiologists were clinical doctors, not just some 'paraclinical' people.

A 'clinician' is defined as 'a doctor having direct contact with the patients rather than being involved with theoretical or laboratory studies'. In what part of the universe does this not make radiologists, 'clinicians'?

Radiologists themselves also perpetuate this 'paraclinical' meme.

Virtually every radiologist, when speaking of other physicians and surgeons will say, “the clinician called me” or “when a clinician asks us to do this, we must…”. Invariably, my first instinct is to stop the person and say, “we too are clinicians…”. I use ‘physicians’ or ‘surgeons’ or ‘referring physicians/doctors’ or sometimes ‘treating doctors’, but never clinician to denote that ‘we’ are therefore something else or different.

When a radiologist does a barium study, he/she is a clinician. Every radiologist who does an ultrasound study is a clinician. Every radiologist who speaks to or deals with a CT scan or MRI patient is a clinician. Every radiologist who intervenes and treats or does procedures and biopsies, etc. is a clinician.

You can of course choose to be ‘paraclinical’, by hiding in a room full of monitors and doing teleradiology for remote locations, with nothing 12 IN IMAGING

COVER STORY

but images being thrown at you one after the other on the work-flow list alongwith a brief history, if at all, working hard to meet the 6-10 cases per hour deadline. Any idiot can be an 'image reader' and if that is all we choose to be, sooner rather than later, machine-based interpretation and artificial intelligence will make us redundant. Or as is already

answering these questions in a relevant way.

For e.g. a patient with interstitial fibrosis on a CT scan can have a report given in one of two ways. The firstway is to say that there is interstitial fibrosis…advise clinicopathologic correlation and leave the onus of clinical interpretation of the fibrosis on the referring doctor. The

happening, we become commoditised, easily replaceable by someone who can read an MRI knee two minutes faster than the previous person, without a real understanding of 'why' that particular patient had the knee study done in the first place.

We must realise that we are doctors first and radiologists second.

And, as doctors who work with patients, though we interface with them using machines and instruments, our responsibility continues to be alleviating pain and suffering as well as helping in the management of the patient’s problem. This means to understand at all times why the patient is with us, why that particular study has been ordered, what is the information the referring doctor and/or the patient wants from us and working towards

other is to sub-classify the fibrosis, and to then use the clinical history (smoker/non-smoker, connective tissue disease or not, occupation, etc) to arrive at a specific diagnosis or differential, which will tell the referring doctor and the patient that you are interested in making a difference and are more than just a reader of images or radiology signs and patterns.

Being a clinician also means taking responsibility. It means that if the patient or the doctor asks whether a particular test is relevant or not, to be honest and truthful and to suggest better alternatives if they exist, even if it means loss of business.

Being a clinician means having clear systems and processes that put patient safety at the top and prevent JANUARY 2016

IRIA 2016 | SPECIAL |

accidents related to radiation, contrast media, pregnancy, etc.

It also means that the focus of the practice is around the patient at all times to ensure that the correct test is done, the area in question is covered in detail, pathology picked up is covered in its entire extent, all the necessary parameters have been mentioned in the report and that a CD of the images is handed over.

Being a clinician also means that after a biopsy or intervention is over, we follow up with the patient regularly, depending on the situation to make sure that everything is fine.

The clinical context is always critical and understanding that is the key to being a good radiologist, someone who other physicians and surgeons respect and a person they will turn to in times of need. It means understanding a few things about the management of the conditions we deal with so that the report can be tailored accordingly. For e.g. knowing that a malignant bone tumour like osteosarcoma will be treated by limb salvage using a megaprothesis. This will ensure that the correct measurements are taken, a whole limb survey is done, the films have the scale on them for the surgeon to measure as well, and the patient is given soft copy images on a CD for the surgeon to look at on his/her workstation for more accurate measurements.

As more and more physicians and surgeons start interpreting their own scans or performing their own studies, the only way we can stop being 'glorified technicians' is to be relevant to them‌to be better than them and be able to use the clinical information that we garner to interpret the images better than them JANUARY 2016

COVER STORY

DR BHAVIN JANKHARIA Radiologist and Partner, Picture This by Jankharia

IFRADIOLOGISTS DO NOTHAVE THE DEPTH OFKNOWLEDGE THAT COMES FROM A CERTAIN AMOUNTOF SUB-SPECIALISATION AND DO NOTWORK TOGETHER AND BE VISIBLE IN PATIENTCARE AND MANAGEMENT,THEYSTAND AGOOD CHANCE OFBEING ONE OFTHE FIRST CASUALTIES OFATTRITION

and thus add value to the management of the patient.

In institutes, this has therefore led to the radiologists being central to various disease management groups (DMGs) that now work in concert to provide holistic care to a patient. A malignant bone tumour in such a tumour board is typically discussed by a team consisting of a medical oncologist, pathologist, radiation oncologist, orthopaedic oncosurgeon and the radiologist, sitting together and discussing the management options, so that a more inclusive and cohesive decision is taken. This is where the radiologist becomes redefined, a super-clinician and a part of the decision making team to enhance patient care.

The times are changing. People expect more from those who provide them services. Physicians and surgeons want more from those they rely on to give them information. And if radiologists do not have the depth of knowledge that comes from a certain amount of sub-specialisation and do not work together and be visible in patient care and management, they stand a good chance of being one of the first casualties of attrition. Yes, as long as the PC-PNDT laws in our country continue to make those who do ultrasound prized commodities and as long as the use of crosssectional imaging continues to rise by 15 per cent year-on-year, there will be work. But work without respect, without involvement and without having the feeling of being indispensable, is just drudgery.

We radiologists need to come out of our closets, out of the 'dark-rooms' of our minds and take centre-stage positions. It’s time we became the clinicians we were always meant to be.

IN IMAGING 13

IRIA 2016 | SPECIAL |

NEWS

Dr Vijay M Rao appointed as Chair of RSNA's Board of Directors She is a global authority on head and neck imaging and also recognised for her health services research in radiology

DR VIJAY M RAO has been named as the chair of the Radiological Society of North America (RSNA) Board of Directors recently at the Society's annual meeting in Chicago. A global authority on head and neck imaging and also recognised for her health services research in radiology, Dr Rao is The David C Levin Professor and Chair of Radiology at Jefferson Medical College of Thomas Jefferson University in Philadelphia. A graduate of the All India Institute of Medical Sciences (AIIMS), Dr Rao has remained on the faculty at Thomas Jefferson University since completing her residency there in 1978. She was appointed associate chair for education in 1989 and vice chair for education in 2000.

In 2002, she became the first woman chair of a clinical department in the university's history. She is a Trustee of the Thomas Jefferson University Hospital System/TJUH. "RSNA is recognised for innovation in informatics and information technology.

As Chair, I will work with the Board to advance patient care initiatives, focusing on quality, safety and efficiency in a patient-centered model of care through implementation of IT tools, in partnership with industry. I will also work with Society leadership to find ways to leverage IT tools to provide educational resources of the RSNA at point of care for 14 IN IMAGING

radiologists," Dr Rao said.

Dr Rao has published more than 200 papers, 250 abstracts in medical literature, and a dozen book chapters, and she co-edited MRI and CT Atlas of Correlative Imaging in Otolaryngology. She is a sought-after lecturer and educator and has given nearly 200 invited lectures at academic universities and meetings worldwide.

Dr Rao has served on the editorial boards of multiple journals, including Academic Radiology, Journal of the American College of Radiology and American Journal of Roentgenology.

She has served as a manuscript reviewer for Radiology, American Journal of Neuroradiology, American Journal of

Roentgenology, Academic Radiology, Neuroradiology, Pediatrics and Health Affairs. She served as editor of ASHNR News in 2001.

An RSNA member since 1981, Dr Rao has led numerous courses and sessions at RSNA annual meetings and served on the Health Services Policy & Research subcommittee of the RSNA Scientific Program Committee. She has served the RSNA Research & Education (R&E) Foundation in a number of roles, including member of the Board of Trustees since 2008.

Dr Rao has held committee or leadership positions in a number of major radiologic organisations, including the American Society of Neuroradiology and American College of Radiology, and regional organizations. She has served as President of the American Society of Head and Neck Radiology, the American Association for Women Radiologists and the Association of Program Directors in Radiology, which bestowed on her its Distinguished Achievement Award in 2006. She is also the 2014 recipient of the gold medal award, presented by the Association of University Radiologists, and the Marie Sklodowska-Curie Award, presented by the American Association for Women Radiologists.

EH News Bureau

JANUARY 2016

IRIA 2016 | SPECIAL |

RESEARCH

Subsolid lung nodules pose greater cancer risk to women than men In contrast, the relative risk of lung cancer for solid nodules was comparable for both sexes WOMEN WITH a certain type of lung nodule visible on lung cancer screening CT exams face a higher risk of lung cancer than men with similar nodules, according to a new study which was presented at the annual meeting of the Radiological Society of North America (RSNA).

“We know there are differences in cancer risk among different lung nodule consistencies, but we were unaware of any published reports that looked at the differences in lung cancer risk for nodule subtypes between women and men,” said study lead author Phillip Boiselle, from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Mass.

For the new study, Dr Boiselle and colleagues reviewed CT scans from the National Lung Screening Trial (NLST), a large, randomised control study that demonstrated the value of CT screening in reducing lung cancer mortality. The NLST included more than 40 per cent women, giving the research team a rare opportunity to look for statistically significant differences in lung nodules and lung cancer between the sexes.

The researchers characterised all CT-detected nodules measuring four to 30 millimeters by consistency using the NLST database and calculated the

JANUARY 2016

RESEARCHERS CHARACTERISED ALL CT-DETECTED NODULES MEASURING FOUR TO 30 MM BYCONSISTENCY USING THE NLSTDATABASE AND CALCULATED THE RELATIVE RISK OF DEVELOPING ALUNG CANCER FOR EACH NODULE CONSISTENCYSUBTYPE relative risk of developing a lung cancer for each nodule consistency subtype.

Out of 26,455 participants, 9,994, or 37.8 per cent, had a positive screen at one or more points during the trial.

Women with ground-glass nodules had a significantly higher relative risk of lung cancer than men with the same type of nodules, and a similar trend was observed for part-solid nodules. In contrast, the relative risk of lung cancer for solid nodules was comparable for both sexes.

Part-solid nodules had the highest predictive value of cancer in both sexes, whereas solid nodules had the lowest predictive value in women and ground glass nodules had the lowest predictive value in men.

“The main difference we found was that women were 50 per cent more likely than men to have ground-glass nodules and, when these nodules were present, women had a substantially higher risk of developing lung cancer,” Dr Boiselle said.

Current lung cancer screening guidelines do not take into account gender differences when managing nodules of different consistencies.

While more research is needed before changes are made to clinical practice, the results suggest that women with ground glass nodules may need closer follow-up than men.

“By looking at the rate at which lung cancers grow on serial CT scans, we can develop a better understanding of how often to obtain follow-up CT scans in men and women,” Dr Boiselle said.

The researchers plan to continue studying the NLST data to further understand the significance of these cancers, especially with respect to their influence on lung cancer mortality.

EH News Bureau IN IMAGING 17

IRIA 2016 | SPECIAL |

RESEARCH

Study: 3D MRI shows early signs of stroke risk in diabetic patients Researchers used 3D MRI to study the carotid arteries for evidence of intraplaque haemorrhage (IPH), an indicator of advanced atherosclerotic disease PEOPLE WITH diabetes may be harbouring advanced vascular disease that could increase their risk of stroke, according to new research presented at RSNA, this year. The findings suggest that arterial imaging with 3D MRI could be useful in helping to determine stroke risk among diabetics.

For the new study, researchers used 3D MRI to study the carotid arteries for evidence of intraplaque haemorrhage (IPH), an indicator of advanced atherosclerotic disease.

“A recent analysis of multiple studies has shown that people with carotid artery narrowing and IPH have a five to six-times higher risk of stroke in the near future compared to people without,” said study author Tishan Maraj, imaging analyst at Sunnybrook Research Institute.

Dr Maraj and colleagues focused their study on people with diabetes, a group already facing a significantly increased risk of strokes with worse outcomes than the non-diabetic population. They used 3D MRI to investigate the prevalence of carotid IPH in 159 asymptomatic type II diabetic patients, average age 63, recruited from a dietary trial between 2010 and 2013.

18 IN IMAGING

THE RESEARCHERS FOCUSED THEIR STUDY ON PEOPLE WITH DIABETES,AGROUP ALREADYFACING A SIGNIFICANTLYINCREASED RISK OFSTROKES WITH WORSE OUTCOMES THAN THE NON-DIABETIC POPULATION Of the 159 patients imaged, 37, or 23.3 per cent, had IPH in at least one carotid artery. Five of the 37 patients had IPH in both carotid arteries.

IPH was found in the absence of carotid artery stenosis, or narrowing, and was associated with an increased carotid artery wall volume as measured by 3D MRI. “It was surprising that so many diabetic patients had this feature,” Dr Maraj said. “We already knew that people with diabetes face three to five times the risk of stroke, so perhaps

IPH is an early indicator of stroke risk that should be followed up.”

“While 2D MRI has been used for more than a decade to identify and characterise carotid artery plaques, the 3-D method brings an extra level of imaging power,” Dr Maraj noted.

“The advantage of 3D MRI is you can image the entire carotid artery and pinpoint the area of interest over a shorter period of time compared with multiple 2D sequences,” he said.

Dr Maraj emphasised that the study did not look at outcomes for the patients and did not draw any conclusions on whether people with IPH will develop carotid artery blockages more quickly than those with no IPH present. However, it is already known that blood is a destabilising factor of plaque that promotes rupture, setting off a chain of events that can lead to a stroke.

Dr Maraj informed that although there is no treatment for IPH at this time, identification of it may help with risk stratification and could even have applications in the non-diabetic population.

“Even though you can’t treat IPH, you can monitor patients a lot more closely,” he said.

EH News Bureau

JANUARY 2016

IRIA 2016 | SPECIAL |

INSIGHT

RADIOLOGYBUSINESS IN INDIA:

AGROWING SPHERE

Dr Suresh Kuppuswamy, Head - Mass Wellness, Skanray Technologies, outlines the growth of radiology business in India and predicts the opportunities which will emerge in this sector in the times to come

H

ealthcare, one of the fastest growing sectors in the country, is poised to reach $200 billion by 2018, driven by increasing expenditures on health by both the private and public sectors. Rising income levels, increasing awareness on health and insurance penetration are seen as the key drivers of the Indian healthcare industry. Currently, the estimated spending on healthcare is around five per cent GDP and it is expected to remain at the same level until 2018.

The story of double digit growth rates and access to the best global treatment practices masks the striking disparity between the rural and urban healthcare. While the urban areas are clogged with small clinics, nursing homes and tertiary care hospitals, the rural segment, where 70 per cent of the population resides, find it difficult to have access to basic primary care. The quality of care accessible in urban areas of India compare with the best of the world. Renowned tertiary care hospitals lay claim to the best and the latest medical equipment to affirm their international outlook. In JANUARY 2016

DR SURESH KUPPUSWAMY Head - Mass Wellness, SkanrayTechnologies contrast, patients in rural areas travel several kilometres to get a simple chest X-ray or liver function test done. As much as 70 per cent of the payments for healthcare services is paid out-ofpocket (OOP) by the patients, thereby significantly denying access to most diagnostic procedures.

Radiology market: Brimming with potential The market can be categorised into

LACKOFRADIOLOGISTS AND CAPITALINTENSIVE EQUIPMENTARE HAMPERING THE PENETRATION OF DIAGNOSTIC IMAGING CENTRES IN THE HINTERLANDS OFINDIA

four main segments as private hospitals, medical colleges, government hospitals and diagnostic centres. While the government readies itself to permit 200 medical colleges to open in the next 10 years and cover the shortage of doctors, a significant portion of the demand for radiology products is expected to contribute to this segment.

Increasing number of small private hospitals in tier-II cities and towns are the other major contributors to this projected growth. Radiologists-cumentrepreneurs who were running large number of standalone imaging centres in the past used to be at the forefront of technology adoption and flaunt the latest in imaging technology. But recently, this sector has started witnessing signs of consolidation with some large players starting to look beyond the established of markets of tier-I cities for their expansion and growth.

Focus on return on investment in these diagnostic chains would drive the demand for imaging equipment which are affordable. These machines would offer just good enough specifications yet would IN IMAGING 19

IRIA 2016 | SPECIAL |

INSIGHT

X-ray

CT and MRI

Ultrasound

Growth of CT and MRI The rural-urban gap in the primary healthcare scenario exists where access to diagnostic imaging is concerned as well. This divide is extensive in speciality investigations such as CT and MRI. Shortage of radiologists and capital intensive CT and MRI equipment are the two main factors that hamper the penetration of diagnostic imaging centres into the hinterlands. While shortage of radiologists haunt even the developed world, many Indian companies have been pioneers in providing teleradiology solutions to resolve this problem. Increase in the scale of domestic demand will definitely turn attractive for these home-grown teleradiology companies and should help in tiding over the radiologists’ shortage crisis over the next decade. But unless CT and MRI scans are made affordable, their access to majority of the population will 20 IN IMAGING

remain elusive.

The newer models for enabling access seems to be driven by business innovation rather than by technological innovation. Large government hospitals with a significant demand for CT and MRI investigations have outsourced the imaging functions to private companies thus de-risking themselves from high capital requirements, high maintenance costs and technological obsolescence. The medical device manufacturers have started offering pay-per-use and leasing options for their CT, MRI and packaged solutions to cater to the new private

HEALTHCARE IS ONE OF THE FASTEST GROWING SECTORS IN INDIA. IT IS POISED TO REACH

200

$

billion

come with options for an upgrade in the future. The demand for high-end specification devices from this segment will be subdued as compared to in the past.

hospitals that are PE-funded and highly influenced by the asset-light business model.

Progress of ultrasound Ultrasound remains the pillar of imaging investigations even today.

While the technology itself has undergone several advancements and refinements, the potential benefits of this in the Indian healthcare landscape will be highly muted because of the regulatory curbs restricting the use of ultrasound by only registered practitioners. The existing norms of Pre-Conception and Prenatal Diagnostic Techniques (PC & PNDT) Act have ensured that portable ultrasound technology is not explored to its maximum potential in its point-of-care applications, while it has become a norm in most other countries.

India is predominantly a young country and the requirement for ante-natal ultrasound investigations alone is huge. Elsewhere, sonographers absorb this demand and make sure that ultrasound is not a bottleneck in the process of delivery. However, the concept of a JANUARY 2016

IRIA 2016 | SPECIAL |

sonographer is practically impossible in India with the current restrictions . It is surely an impediment when it come to improving access of this technology to a larger section of the society.

Technology can itself be the tool for automated monitoring and widen the range for ultrasound applications. Ultrasound experts opine that developing ultrasound scanners that record each and every sonogram and stores them in a central repository for scrutiny when required will ensure voluntary compliance and make it much easier to automatically peruse all ultrasound tests. This, in turn, will eliminate the restrictions on its use in other specialities.

If a more practical method of monitoring and scrutinising is brought under the ambit of the PCPNDT Act, then the market potential for ultrasound will rapidly multiply several times from the current level.

X-rays X-ray technology in India is a couple of decades behind than our global counterparts, with most of the hospitals still using outdated twopulse technology. The imaging industry across the world has moved on to the next generation DC technology which comes with demonstrated benefits on leakage radiation and image quality but the price-conscious Indian industry is yet to make this shift. The entry of manufacturers such as Skanray have addressed both these issues with an element of innovation. The DC X-ray systems from Skanray not only rank higher in their safety parameters JANUARY 2016

INSIGHT

and performance but are highly affordable as well.

The demand for mobile X-ray systems will mainly come from the nursing homes and smaller hospitals as well as the ICUs and emergency wards of the larger hospitals. The demand for fixed X-ray systems, though not as high as that for the portable systems, will be driven by medical college hospitals and large hospitals. The market is also witnessing a shift from the conventional film-based systems to CR and DR systems driven by the need to enable teleradiology practices in hospitals. Integrated mobile CR and DR solutions seem to making their way into small clinics, ICUs, OTs, emergency rooms and ambulances. Affordable retrofit DR solutions are increasingly driving the market towards embracing digital X-ray solutions.

Companies like Skanray are differentiating themselves in the market by providing products with maximum performance, low total cost of ownership and extensive service capabilities which are the key parameters that the customers are looking forward from their

THE MARKETIS SEEING ASHIFTFROM FILM-BASED SYSTEMS TO CR AND DR SYSTEMS,DRIVEN BY THE NEED TO ENABLE TELERADIOLOGYPRACTICES ACROSS THE HOSPITALS

association with device suppliers.

Emerging business models Large private hospital networks with their cumulative strength running into several thousand beds, find it almost impossible to manage their medical equipment purchase and maintenance. This has given rise to healthcare technology management organisations (HTMOs) which specialise in equipment lifecycle solutions and maintenance to ensure that there is minimum downtime and with a plan in place to de-risk the hospital from technological obsolescence. Large private hospitals will gradually move to this model and the HTMOs will gain in strength to play a significant role in the healthcare technology marketplace.

Increasing financial pressure on hospitals, consolidation in the industry and active professional healthcare management personnel are factors which highly influencing the way purchasing decisions are taken. Stress is being laid on not just the cost of purchase but also on the cost of maintenance and obsolescence risks. Brand image is no longer the only deciding factor and the companies which address the concerns of the hospital industry are emerging as preferred suppliers. Agile companies with lower overheads and significant advantages in R&D costs are perfectly positioned to seize this massive opportunity to create a mark for themselves in a market that once shied away from thinking beyond a few MNCs. IN IMAGING 21

IRIA 2016 | SPECIAL |

IMAGING TECHNIQUES

MR IMAGING OF NEUROMETABOLIC DISORDERS Dr Madhuri Behari, Director & HOD - Neurosurgery, Fortis Flt Lt Rajan Dhall Hospital, Vasant Kunj, shares insights on the potential of MRI as a strong tool for diagnosis of neurometabolic disorders

T

he potential of magnetic resonance imaging (MRI), functional MRI (fMRI) and magnetic resonance spectroscopy (MRS) to detect changes in brain metabolism and activation of specific brain areas during activities and presence of altered metabolic products under both physiological and pathological conditions is used to study/detect diseased state and to understand brain functioning in disease and in health.

MRI studies are done using transverse plane (T1) and longitudinal plane (T2) relaxation modes in which the time taken for the protons or hydrogen molecules to return to longitudinal relaxation when radio frequency waves are applied to T1 or relaxation of spins from transverse plane towards T2. These are very technical terms and better left to the specialists. For most of us, it is important to understand that when a tissue or body is placed in a strong magnetic field, it causes movements of omnipresent hydrogen molecules inside the tissue of a very small magnitude. Once the magnetic field is stopped the hydrogen molecules return to the original position or 22 IN IMAGING

DR MADHURI BEHARI Director & HOD Neurosurgery, Fortis Flt Lt Rajan Dhall Hospital,Vasant Kunj

what is known as relaxation. Time taken to return to relaxed position is different for different tissues and this property is utilised to form images of structures in brain and other organ systems.

Now that we have understood how MRI works, let’s attempt to understand its utility in detecting various metabolic disorders of brain.

METABOLIC DISORDERS ARE DISORDERS OF CARBOHYDRATE METABOLISM, LIPID AND AMINO ACID METABOLISM AND DISORDERS WHERE HANDLING OF IRON AND COPPER ARE IMPAIRED

Broadly brain disorders can be classified as given below: ✦Vascular ✦Neoplastic ✦Traumatic ✦Demyelinating ✦Metabolic/endocrinologic ✦Infective ✦Deficiency/nutritional ✦Neuro-degenerative ✦Neurotransmitter related (psychiatric) Having said that, invariably all disorders have metabolic disturbance which is what MRI can detect easily.

For e.g. when blood supply in a major artery is interrupted, the main problem is that the lack of blood supply causes infarction of that part of brain supplied by that artery. In addition, there is a cascade of reactions, followed by generation of inflammatory molecules leading to accumulation of acidic byproducts due to an aerobic metabolism. An MRI can detect these changes. In case there is partial blockage of an artery, death of tissue does not ensue. Ischemic changes which result can also be detected. In addition, when there is haemorrhage in the brain due to rupture of a weak JANUARY 2016

IRIA 2016 | SPECIAL |

blood vessel, blood extravasates into brain and can be visualised easily.

However, this accumulated blood undergoes changes over time and can be observed several years thereafter due to presence of heme products.

Indeed these can be detected throughout one’s life.

Metabolic disorders When we speak of metabolic disorJANUARY 2016

IMAGING TECHNIQUES

INVARIABLY,ALL DISORDERS HAVE METABOLIC DISTURBANCE. MRI CAN BE USED TO EASILY DETECTTHIS

ders, characteristically we are talking about disorders of metabolism, which are usually genetic and are usually seen in children. These are disorders of carbohydrate metabolism, lipid and amino acid metabolism and some rare disorders in which handling of copper (Wilson’s disease) or iron is impaired (neuro-degeneration with brain iron accumulation - NBIA). Due to accumulation of copper/iron in brain in these disorders, there is neuro degeneration, atrophy, loss of choline (present in neurons) and accumulation of lipids (due to neuronal loss). In all these disorders, the proportional accumulation or loss and location of chemicals help to clinch the diagnosis.

In degenerative disorders/vascular diseases presence of glutamate, N-acetylaspartate (NAA)/creatine (Cr) ratios were significantly lower in AD patients compared to both MCI and normal control. (MI)/Cr ratios measured from the posterior cingulate VOI were significantly higher in both MCI and AD patients than controls. The choline (Cho)/Cr ratios measured from the posterior cingulate VOI were higher in AD patients compared to both MCI and control subjects. Using segmented MR images, we corrected regional cerebral metabolic rates for glucose for PVEs to evaluate the effect of atrophy on uncorrected values for brain metabolism in AD patients and healthy control subjects.

In patients with chronic liver disease causing encephalopathy (encephalopathy is the state where brain is affected and patient may become drowsy/excessive sleepy/ unconscious/comatose), changes are seen in brain, which are different from normal as well as people with IN IMAGING 23

IRIA 2016 | SPECIAL |

hepatic disease but without encephalopathy. The technique of water-suppressed stimulated-echo hydrogen-1 MR spectroscopy for detection of cerebral glutamate, glutamine, glucose, N-acetyl-aspartate, choline metabolites, (phospho) creatine, and myo-inositol shows elevation in cerebral glutamine levels, a 23 per cent reduction in choline metabolite levels, and more than 50 per cent reduction in cerebral myo-inositol levels. In some patients with liver disease but without clinical chronic hepatic encephalopathy, reduction in the myo-inositol level and elevation in the glutamine concentration can be observed. This may indicate that these patients may be on the threshold of developing encephalopathy.

Biotin-responsive basal ganglia disease is an autosomal recessive, treatable underdiagnosed neurometabolic disorder, usually occurring in children and associated with basal ganglia involvement. It should be suspected in paediatric patients with unexplained encephalopathy whose brain MR present sub-acute encephalopathy that can cause death if left untreated. Neuroimaging features of this disorder are also characteristic. Brain MR imaging shows bilateral lesions in the caudate nuclei with complete or partial involvement of the putamen and sparing of the globus pallidus in all cases. 80 per cent cases also show discrete abnormal signals in the mesencephalon, cerebral corticalsubcortical regions, and thalami, whereas 53 per cent of advanced cases show patchy deep white matter involvement. The cerebellum is also affected in13.3 per cent of cases.

Signal abnormalities of the mesen24 IN IMAGING

IMAGING TECHNIQUES

BROADLY BRAIN DISORDERS CAN BE CLASSIFIED AS GIVEN BELOW: ✦ Vascular ✦ Neoplastic ✦ Traumatic ✦ Demyelinating ✦ Metabolic/ Endocinologic ✦ Infective ✦ Deficiency/ nutritional ✦ Neuro-degerative ✦ Neurotransmitter related (psychiatric)

cephalon, cortex, and white matter usually disappear after treatment whereas the caudate and putamen necrosis remains unchanged.

Depression Depressive symptoms showed positive covariance with peri-genual, anterior cingulate cortex and amygdalar activity. In contrast, anxiety was negatively associated with activities in all the regions, except for dorsal striatum. The findings identified brain substrates of affective dysregulation as potential targets for therapeutic intervention.

Orbitofrontal rCMR glc abnormalities in MA abusers may also reflect a serotonergic deficit because of low levels of serotonin.

Drug abuse A dopaminergic deficit in infragenual Anterior Cingulate Cortex, therefore may produce the local metabolic defect. Alternatively, defective Cerebral Metabolic Rate glucose (CMR glc) in the Orbito Frontal Cortex may reflect striatal dopaminergic deficiency as demonstrated by correlation between striatal dopamine D2 receptor availability with orbitofrontal regional Cerebral Metabolic Rate glucose (rCMRglu).

In conclusion, we find that several disorders which affect brain, be it due to metabolic or other non metabolic causes all lead to changes in the brain. Depending on what is the cause, these changes are observed in different parts of brain.

Magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS) and functional MRI (fMRI) are strong tools and are emerging as promising tools in the diagnosis and study of metabolic brain disorders.

JANUARY 2016

IRIA 2016 | SPECIAL |

IMAGING TECHNIQUES

USG ASSESSMENT OF RHEUMATOID ARTHRITIS: STATE-OF-THE-ART Dr Vijay Rao, Consultant Rheumatologist, Manipal Hospital Bengaluru elaborates on the use and benefits of ultrasound to evaluate and monitor rheumatoid arthritis

M

usculoskeletal (MSK) ultrasound was once the sole province of the radiologist but in recent years it has been introduced into routine clinical practice by an increasing number of rheumatologists. It is a powerful tool not only for evaluating joint and soft tissue pathology but also for facilitating interventions such as aspiration and injection. Its applications continue to grow.

A traditional method of monitoring the joint disease of patients with rheumatoid is X-rays, whereby images are produced by exposing photographic film (radiographs). This technique has proven useful for doctors to follow the course of joint destruction. The early development of discrete bony destruction (erosions) is associated with more severe rheumatoid. While standard X-ray radiographs contribute substantially to the clinical evaluation of rheumatoid arthritis, they do lack some sensitivity early in the course of JANUARY 2016

DR VIJAY RAO Consultant Rheumatologist, Manipal Hospital Bengaluru

the disease. This means that substantial joint destruction must happen before changes on the standard X-ray test become apparent.

Modern treatment for rheumatoid arthritis is frequently directed at early disease. Accordingly, efforts to establish methods for early diagnosis of the disease have increased. Several radiographic imaging modalities have been explored, including magnetic resonance imaging (MRI) and ultrasonography. MRI scanning has been found to be sensitive as an indicator of early rheumatoid joint destruction, but it is very expensive and not widely available.

Ultrasonography is an attractive method of imaging because of its low cost, absence of harmful radiation, and rapidity of imaging. Recent

advances in ultrasound image technology have allowed the development of sonographic equipment for imaging inflamed joints in patients with rheumatoid arthritis.

History The first report on the use of ultrasound in a rheumatology clinic – to assess the knee in rheumatoid arthritis (RA) – was published over 30 years ago. Since then, further technical advances and the falling cost of equipment have paved the way for MSK ultrasound to become an integral part of routine clinical practice. Today, training in ultrasound is a compulsory part of rheumatology postgraduate medical education in Germany and Italy and courses as well as programmes have been established in most American and European countries. In 2005 up to 90 per cent of UK rheumatologists reported that they used ultrasound in the management of rheumatology patients, with 30 per cent performing it themselves.

IN IMAGING 27

IRIA 2016 | SPECIAL |

Advantages Ultrasound allows real-time imaging that can be carried out in the clinic or at the bedside. It is non-invasive and non-radioactive. Hence it allows the assessment of several joints in a relatively short space of time. The running costs are low and it is largely immune to the metal artefacts that can cause difficulties with magnetic resonance imaging (MRI) and computerised tomography (CT).

Ultrasound also enhances the doctor–patient consultation as it provides an immediate visual aid to help educate the patient about their disease.

Disadvantages These advantages are counterbalanced by the initial cost of equipment, the time and cost of training and the lack of available time to perform ultrasound in a busy clinic.

Ultrasound cannot see into or beyond 28 IN IMAGING

IMAGING TECHNIQUES

bone. It has limited resolution for deeper joints (such as the hip) and the patient’s body habitus may sometimes make examination difficult. There are also valid concerns about the standardisation of examinations by different ultrasonographers and how best to assess and certify competency.

Technical aspects Ultrasound uses reflected pulses of high frequency sound to assess soft tissue, cartilage, bone surfaces and fluid-containing structures. The basic principle of ultrasound is that the denser the material the sound wave is passing through, the more reflective it is and the whiter (or echoic) it appears on screen. Water is the least reflective body material. Sound waves pass straight through water and it appears black (or anechoic) on screen. Greyscale or B-mode ultrasound displays the different intensities of echoes in black, white and shades of grey

(Figure 1). Doppler ultrasound uses the principle that sound waves increase in frequency when they reflect from objects (such as red blood cells) that are moving towards the transducer (red signal) and decrease when they are moving away from the transducer (blue signal). Power Doppler ultrasound measures the amplitude of the Doppler signal (which is determined by the volume of blood flow) and superimposes it on the greyscale image, thereby depicting increased micro vascular blood flow (Figure 2 ).

There are several basic requirements for successfully introducing ultrasound into your clinical practice: A basic knowledge of the physics of ultrasound, a detailed knowledge of relevant anatomy, an ability to evaluate ultrasound findings in a clinical setting, ready access to ultrasound equipment, suitable equipment for imaging small joints and access to a mentor.

Equipment There has been a progressive improvement in imaging definition and the size, portability and cost of sonographic equipment over the last 10 years. There are several important considerations while selecting a machine such as: Cost: Cost relates directly to image resolution and quality but the cost of equipment is falling and the quality is improving. A basic system can be purchased for approximately £30,000 but a top-of-the-range machine, with several different transducers, may cost as much as £150,000. It is a good rule of thumb to try and purchase the best machine that you can afford, but before you buy, insist on borrowing a demonstration model for several days JANUARY 2016

IRIA 2016 | SPECIAL |

so that you can try it out on a number of your patients. This way you will be able to compare the machine’s performance with its competitors in a number of different clinical situations.

Image resolution and quality: The choice of probe size and frequency depends on the size and depth of the structures of interest. A higher frequency probe (10–20 MHz) will have a smaller field of view with high resolution but poor tissue penetration, making it ideal for small superficial structures. The reverse is true for lower-frequency probes (<7.5 MHz). Modern machines are equipped with multi-frequency transducers. 3D probes are now available but are not yet widely used in general rheumatological practice.

Transducer design: Probes may be annular, radial or linear. Linear array transducers are the preferred option for most MSK scanning.

Equipment size and portability: Portability is an advantage for multisite use. However, larger, less mobile systems can achieve better image quality for not much more cost.

Colour and power Doppler: These options are essential. It is important to test the Doppler tool on a system before purchasing to see if it is sensitive enough for the detection of small joint synovitis. A good sign of a very sensitive system is the ability to detect blood flow in the normal nail bed or small distal arterioles in normal fingers.

Software options : On most machines, a variety of software options are available to enable the user to develop a personalised system.

Most MSK ultrasonographers will be happy with a basic package but more advanced options include panoramic imaging, contrast-enhanced software, JANUARY 2016

IMAGING TECHNIQUES

MSKULTRASOUND HAS REVOLUTIONISED THE PRACTICE OFMANY RHEUMATOLOGISTS BUT SIGNIFICANTRESOURCES ARE REQUIRED TO ESTABLISH A CREDIBLE SERVICE vascular packages and 3D scanning.

Other equipment: Acoustic gel will be needed for general scanning, and sterile gel with a probe sheath for ultrasound-guided injection. Many variables can influence the image obtained with ultrasound, including the type of machine, transducer settings, transducer pressure and patient position. It is best to adopt a standard scanning protocol to ensure reproducibility. All images should be interpreted in the light of the clinical history and examination.

Uses of ultrasound in rheumatology Ultrasound has many uses in the diagnosis and management of MSK disorders. It can: (a) measure the extent of anatomical damage and inflammation in early arthritis, (b) assess the course of inflammatory disease, (c) determine therapy efficacy, and (d) allow direct guidance for joint and soft tissue injection.

MSK ultrasound is consistently superior to clinical examination at a variety of locations, even in the

performance of basic clinical skills such as detecting the presence of knee effusion. However, MSK ultrasound complements clinical examination but does not replace it and all findings should be interpreted in the light of the clinical examination. A significant advantage of MSK ultrasound over MRI, CT and scintigraphy is the ability to hone in on the area of symptoms or clinical abnormality with the ultrasound probe immediately after clinical examination. This has the further advantage of improving the operator’s knowledge of regional and functional anatomy, leading to a better understanding of pathological processes and improved clinical examination skills.

Conclusion MSK ultrasound has revolutionised the practice of many rheumatologists in the past decade but significant resources are required to establish a credible service. The initial investment in equipment and training is substantial and it can be difficult to find time in a busy outpatient clinic to perform ultrasound. However, the application of ultrasound has the potential to deliver accurate and early diagnoses, monitor disease and facilitate intervention in the clinic to the benefit of our patients.

Appropriate training is essential and standardisation of training and assessment is well under way. Issues of concern regarding validity and reproducibility are being addressed.

MSK ultrasound is a continuously expanding field and the advent of increasingly powerful machines and 3D ultrasound is likely to further extend its applications in rheumatology.

IN IMAGING 29

IRIA 2016 | SPECIAL |

ONE-ON-ONE

CHANDAN NAPHADE General Manager – XRS Solutions Carestream Health India

‘As DR technology continues to evolve,we foresee a bright future for it in India’ Chandan Naphade, General Manager – XRS Solutions, Carestream Health India, in an interview with Express Healthcare, throws light on the current trends and demands of DR technology and its future growth in India. He also speaks about Carestream's latest offerings in this space that provides a competitive edge to the company. Excerpts:

30 IN IMAGING

O

ver the years, the DR industry has witnessed various evolutions. What are the latest trends in the industry?

Hospitals of all sizes, imaging centres, orthopaedic facilities, trauma and urgent care centres and other facilities, are increasingly shifting to wireless DR technology these days. As a result of the ongoing evolution of DR technology, significant advances are being made in image quality, reliability, productivity and ease of installation. Some other advances are detectors with higher JANUARY 2016

IRIA 2016 | SPECIAL |

resolution and the ability to reduce Xray exposure to patient. To support dual energy and tomosynthesis exams, some advanced applications, as well as other emerging technologies, Carestream offers its new generation DR systems, such as Carestream’s DRX-Evolution Plus.

What are the latest offerings by Carestream?

Carestream Health is known for developing new medical imaging products and healthcare IT solutions. While we continue to add new products in these categories, we are also expanding into ultrasound and radiography/fluoroscopy imaging solutions.

Few latest additions made in our portfolio are new digital X-ray detectors, two premium ultrasound systems, mobile X-ray and a new radiography/fluoroscopy platform.

These new systems by Carestream serve a broad range of healthcare providers. They provide improved quality information of medical imaging exams, while enhancing productivity and ease of use. Our product developers used our customers' feedback and worked day and night to develop features that meet various diagnostic imaging challenges prevails across the world.

Some other new imaging products that form a part of our portfolio are: ■ New CARESTREAM 3rd generation DRX Plus 3543 and DRX Plus 3543C wireless X-ray detectors.

■ CARESTREAM DRX-Excel and DRX-Excel Plus radiography/digital fluoroscopy systems.

■ CARESTREAM Touch Prime and Touch Prime XE ultrasound systems that capture images for radiology, OB/GYN, musculoskeletal and JANUARY 2016

ONE-ON-ONE

AS ARESULTOF THE ONGOING EVOLUTION OF DR TECHNOLOGY, SIGNIFICANTADVANCES ARE BEING MADE IN IMAGE QUALITY, RELIABILITY, PRODUCTIVITYAND EASE OFINSTALLATION

vascular applications.

These new systems ensure improved productivity and ease of use, as well as enhance the information quality provided by medical imaging.

How does Carestream identify and address the current demands of customers?

We have a medical advisory board that comprises thought leaders across the globe. We use the ideas of our advisory board and customers’ feedback to find out the new capabilities needed to meet the current demands of customers. For instance, based on our customer feedback, we added a significant design feature in our new DRX-Evolution Plus platform. An overhead tube column extension, added to this platform keeps the system at a distance suitable to

capture standing ankle and feet in high-ceiling rooms. Earlier, healthcare facilities had to invest heavily to lower their ceilings for accommodating these systems, but with our newly added design feature, this cost can be avoided now. Our new higher patient weight table addresses the challenges involved in imaging of bariatric patients.

Our DRX-Revolution Mobile X-ray system not only helps overcome the challenges of existing mobile systems but also addresses various imaging needs. Based on the inputs of several radiology administrators/directors and technologists, we have incorporated some revolutionary capabilities in the system - a long tubehead to provide access to patients in crowded rooms; a small footprint with a touch-screen display that enable technologists stay at the bedside; a collapsible column for clear visibility and a dual motor drive for effortless movement of the system.

What does the future holds for DR? As DR technology continues to evolve we foresee a bright future for it in India. We have made this technology affordable with our tiered portfolio of room-based systems.

Now even smaller-volume healthcare providers like community hospital, imaging centres, urgent care centres and orthopaedic practices can smoothly shift from CR to DR without worrying much about the transitioning cost and complexities.

Our room retrofitting service and mobile imaging systems help healthcare providers upgrade to wireless DR technology without disturbing their existing investments.

IN IMAGING 31

IRIA 2016 | SPECIAL |

HISTORY OF IRIA

IRIA:

THE JOURNEYSO FAR IRIA has had a glorious background and is looking ahead to play its role in the advancement of radiology and imaging throughout Asia and SAARC countries.

With the 66th edition of IRIA coming soon, Express Healthcare traces the journey of the association from the beginning ....

PASTPRESIDENTS IRIA

1947

1948

1959

1966

KP MODY

P RAMA RAO

RF SETHNA

VED PRAKASH

T

he 'Indian Radiological Associationâ&#x20AC;&#x2122; was formed in Calcutta in the year 1931 under the aegis of late Dr Ajit Mohan Bose and Dr Subodh Mitra as the Founder President and Founder Secretary, respectively. The first meeting of the association, held on April 21, 1931 in Calcutta, was attended by Capt M Mukherjee, Dr

32 IN IMAGING

KB Ghosh and Dr Moitra.

April 1932 witnessed the eighth session of Indian Medical Association and the Indian Radiological Association met as the radiological section of IMA under the chairmanship of Dr MD Joshi. In his speech at the event, Dr Joshi stressed the need for sound radiological education in India. In 1934, the

radiologists met again at a sectional meeting of the Conference of IMA, held at Mumbai with Dr KP Mody in the Chair.

In March 1937, the Indian Radiological Association was registered under Act XXI of 1860, with the Registrar of Joint Stock Companies, Bengal Registration No 6644 (1936-37) with a total JANUARY 2016

IRIA 2016 | SPECIAL |

membership strength of 24. During the war years, the activities of the association declined and came almost to a standstill. Yet, due to the vigorous and ceaseless efforts of Dr P Rama Rao, Dr Santhan Krishnan Pillai and Dr KM Rai of Madras, the activities were resumed and thus the assocation was reborn.

The first Annual Congress of Radiology was held in 1946 at Madras under the leadership of the President, Dr MD Joshi and Secretary, Dr P Rama Rao. There were 130 members in the association at that time.

HISTORY OF IRIA

Manjunath Rai. Excellent scientific papers and material were published and circulated to all the members through this journal. Dr KP Modi, Dr KM Rai, Dr AN Menon, Dr ML Aggarwal, Dr MG Varadharajan, Maj Gen SK Dhawan, AVSM, Dr MS Joshi and Dr Om J Tavri were some of the Editor-in-Chiefs of IJRI. The journal has won many awards for excellence in medical printing and it was rated as the best journal amongst all medical journals in India. The journal has also received the International Code No ISSN-0970-2016.

oration was instituted after the cherished memory of one of the renowned Indian bio-physicists and the first honorary member of the association ‘Sir Jagadish Chandra Bose’. Every year, it is to be delivered at the Annual Congress of Radiology and is awarded to a renowned radiologist.

In 1968, during the 21st Annual Congress the Indian Radiological Association at Bangalore, Dr LH Athalea moved a resolution to institute an oration in the name of ‘Dr Diwan Chand Aggarwal Memorial

1967

1970

1973

1977

LH ATHLE

KN KAMDAR

LR PARTHASARATHY

SANTOSH CHAWLA

Gradually, the association expanded to other states giving rise to a wide network of state branches and chapters.

Official Publication Indian Journal of Radiology (IJRI) became the voice of the association since it was born in 1947 under the joint editorship of Dr P Rama Rao and Dr K JANUARY 2016

Memorial Medals & Awards Another landmark in the history of the Indian Radiological Association was the introduction of ‘Sir Jagadish Chandra Bose Memorial Oration’ in the year 1948; a contribution to the advancement of medical radiology.

Late Dr Barceley, popularly known as “Father of British Radiology” was the first orator in the year 1951. This

Oration’ for his contribution to the association. He had also served as the President of the IRA in 1957. The members of family of late Dr Diwan Chand Aggarwal created an endowment for the oration. It was started in the year 1969 and Dr A N K Menon of Madras delivered the first oration. Since then, many eminent radiologists from India and all over IN IMAGING 33

IRIA 2016 | SPECIAL |

HISTORY OF IRIA

1978

1979

1981

1983

SATYAPALAGGARWAL

OP BHARDWAJ

SNEH BHARGAVA

LT GEN VV S PRATAPA RAO

1984

1985

1990

1993

VP LAKHANPAL

PROFARCOT GAJARAJ

MAJ GEN S K DHAWAN

SK AGGARWAL

the world have delivered this oration.

In 1977, during the 30th Annual Congress of IRA at Chandigarh â&#x20AC;&#x2DC;Dr KM Rai Memorial Orationâ&#x20AC;&#x2122; was instituted by the family members of late Dr KM Rai. Due to his efforts, IRA was reborn in 1946 and the First Annual Congress of Radiology was held at Madras, which in turn led to a spurt of scientific activities in radiology. He was instrumental in starting the Journal (IJRI) in 1947 and was the Associate Editor for the same.

Dr OP Bhardwaj of New Delhi delivered the first oration in the 34 IN IMAGING

year 1978.

In 1980, Dr Ashoke Mukherjee Award was started by IRA, instituted by the family members of late Dr Ashoke Mukherjee to encourage young radiologists to take up new investigations and research in the field of radiology in India.

Competitive, scientific, original work was selected and presented in the Annual Congress by young radiologists. Then the committee appointed by the President would select the best paper out of the lot and award the radiologist who presented

it. Dr Pramod Kolwadker of Nagpur was the first recipient of this award in the year 1979.

IRA also started two travelling fellowships for young radiologists to do advance training in reputed institutions of India and now both travelling fellowships are awarded

by ICRI. Indian College of Radiology Indian College of Radiology was established as a teaching (academic) wing of the Association in 1976 by Late Prof PK Haldar and Dr KN Kamdar.

JANUARY 2016

IRIA 2016 | SPECIAL |

HISTORY OF IRIA

1993

1994

1995

1998

SAMIR BANERJEE

RK GOUTALIA

MUKUND S JOSHI

PRAMOD KOLWADKAR

Prof PK Haldar was the first Founder Chairman of the college followed by Dr KN Kamdar.

In 1981, with Prof Arcot Gajaraj becoming the Chairman, academic activities were given an added impetus and an attempt was made to organise as many CME programmes as possible throughout the year in different parts of the country to generate interest in imaging among the post-graduates as well as the clinicians. Dr Samir Banerjee, Secretary of the College and Dr GR Jankhania, Treasurer has improved the administrative and academic activities of the College. In 1984, under the Chairmanship of Dr GR Jankhania, it became mandatory to 36 IN IMAGING

conduct four to six CME programmes prior to the Annual Congress. In 1986, at Jaipur, a convocation was held to award fellowship of ICR to the Founder Members of the College.

Under the Chairmanship of Dr Samir Banerjee, a new chapter linked with Royal College of Radiologists, London, UK began and a team from R. C. R., UK visited India and delivered one-day CME session at Hyderabad (1990) and at Pune (1991).

Prof NG Gadekar-Key Note Address (Memorial Oration) and Prof Mihir Mitter Memorial Oration were instituted under the umbrella of â&#x20AC;&#x2DC;Indian College of Radiology & Imagingâ&#x20AC;&#x2122; in 1988 and 1998 respectively.

These orations are awarded to the

radiologists of the country who have excelled in academics as well as in teaching and developing the science of imaging. Dr Harnam Singh Mid-Term Teaching Session was introduced with the donation from Dr Harnam Singh.

Recently, Prof VP Lakhanpal Gold Medal has been introduced for the best academic contribution in the field of radiology and imaging.

Dr Mukund Rahalkar, Secretary of the College, took a keen interest in the improving quality of CME Programmes including the film reading sessions. Prof Kakarla Subba Rao, Chairman of ICRI for six years further improved the quality and quantity of the teaching sessions and conducted them in small places all JANUARY 2016

IRIA 2016 | SPECIAL |

HISTORY OF IRIA

1999

2000

2012

2014

PROF KAKARLA SUBBARAO

SK SHARMA

HARSH MAHAJAN

BHAVIN JHANKARIA

over India. Under his Chairmanship, a Text Book on â&#x20AC;&#x2DC;Diagnostic Radiologyâ&#x20AC;&#x2122; in two volumes was published.

The College is doing an excellent job in conducting CME programmes all over India. The College has also started a news bulletin for better communication, publishing up-dates on new imaging modalities, forthcoming CME programmes, views from readers etc. Many more awards were introduced in the college by the present team of office bearers such as the Prof JM Pinto Award, Onco Imaging Award, Best Research Paper Award, Dr Rao Award instituted by Dr Prasanna Rao etc. Every year a theme is given by ICRI, selected by the Executive Committee and approved JANUARY 2016

by General Body, ICRI. Credit hours for CME is prepared by ICRI recommended by Prof Kakarla Subbarao and approved by ICRI and IRIA. Change in the name of the Association It was felt rightly that there has been tremendous change in the modalities of imaging all over the world and our Association must effectively reflect it with a name which will speak for itself.

Therefore, the Indian Radiological Association became The Indian Radiological & Imaging Association (IRIA). The Journal and the College were also renamed accordingly as IJRI and ICRI.

Affiliation with International Societies IRIA has been a member of the International Society of Radiology and a member of the Asian and Oceanian Society of Radiology as well. IRIA and ICRI has formulated a curriculum and syllabus for MD (RD) and DMRD and submitted to the MCI for recommendation to all the universities and medical colleges in India.

Thus, IRIA has been growing from strength to strength over the years to play a siginificant role in the advancement of radiology and imaging throughout Asia and SAARC countries.

IN IMAGING 37

IRIA 2016 | SPECIAL |

PRE EVENT

IRIA 2016 to be held in Odisha Intelligentsia from across the country and abroad will share their work and experience in various sub-specialities of radiology

The inaugural session of IRIA 2014, held in Agra

INDIAN RADIOLOGICAL & Imaging Association (IRIA) has been promoting the study and practice of diagnostic radiological and imaging modalities as well as other related sub-specialities/superspecialities. It actively organises periodical meetings, CME programmes and conferences in related subspecialities/super-specialities.

The 69th Annual conference of IRIA is being organised by IRIA Odisha State chapter at Bhubaneswar. It is slated to be held from January 21-24, 2016 at Hotel Swosti Premium. The venue is a fivestar hotel conveniently located in the heart of the city. It also boasts of a large convention centre where renowned conferences of FOGSI, ASICON, APICON and 38 IN IMAGING

THIS YEAR'S CONFERENCE WILLBE ON THE THEME REDEFINING RADIOLOGIST: ATRUE CLINICIAN. ITIS EXPECTED TO BE ATTENDED BYMORE THAN 3000 DELEGATES

from across the country and abroad will share their work and experience in various sub-specialities of radiology. A wide ranging academic feast including workshops, lectures, paper/poster presentations, image interpretation with audience response and orations will also be part of this conference.

Like most of its predecessors, IRIA 2016 too is expected to be attended by more than 3000 national and international delegates.

PEDICON were held.

This year's conference will revolve around the theme - Redefining radiologist: A true clinician. Scientific deliberations will form the core of the congress. Reportedly, intelligentsia

Contact Organising Comittee JK Diagnostics N 5 / 98, IRC Village, Nayapalli Bhubaneswar â&#x20AC;&#x201C; 751015.

Tel: 0674 â&#x20AC;&#x201C; 2360441 Mob: 09438554441 Email: iria2016bbsr@gmail.com JANUARY 2016

IRIA 2016 | SPECIAL |

ONE-ON-ONE

DR DEEPAK PATKAR Head, Department of Imaging, Nanavati Superspeciality Hospital

T ‘Refurbished MRI systems fulfil the need for high qualityupgraded scanning system at affordable prices’ Dr Deepak Patkar, Head - Department of Imaging, Nanavati Superspeciality Hospital speaks on the advantages and disadvantages of using refurbished equipment at their hospital

JANUARY 2016

ell us something about your journeyin the radiologybusiness?

After finishing my MD Radiology and DMRD from Nair Hospital and TN Medical College (Mumbai), I trained in advanced radiology at Guy’s Hospital, London. Presently, I am the Head of Imaging Department at Nanavati Superspeciality Hospital, Mumbai. I am also a non-working shareholder in a few diagnostic centres in NaviMumbai, Pune and Nashik.

I am also the Director of Telediagnosys Services, dealing in teleradiology with clients in US, Africa and Middle East. I have over 150 publications in various national and international journals. I am also the present Chairman of the Indian College of Radiology. I have been a postgraduate teacher for CPS and DNB radiology since the past 14 years.

What is the model you have chosen to provide qualitydiagnosis?

Quality diagnosis in radiology depends on two important factors; one IN IMAGING 39

IRIA 2016 | SPECIAL |

ONE-ON-ONE

is quality images and the second is expertise of the reporting radiologist.

Out of these acquiring optimal quality images is of prime importance, as the diagnosis cannot be made unless artefact free proper images are acquired.

Radiology is one of the most rapidly evolving branches of medicine. One has to always keep their knowledge as well as machineries updated to cope with these advances. We have always ensured this as a part of our model in radiology practise by choosing high-end, latest MRI, CT and ultrasound machines for our centres. There are various medical pathologies in which the diagnosis can only be made with application of advanced sequences like arterial spin labelling, diffusion tensor imaging, metal artefact reduction sequences, time resolved imaging of contrast kinetics etc.

These sequences require minimum field strength of 1.5 Tesla and show significant improvement with higher field strengths. In all our apex centres we have installed 1.5T and 3.0Tesla MRI systems, minimum 16-slice CT scanners and ultrasound machines with good quality colour Doppler, 3D/4D facilities and with minimum four to five ultrasound probes of various frequency range. We take care of our reporting radiologist by means of stringent selection criteria, baseline training programmes and uniform and elaborated reporting format. We organise and encourage our radiologists to attend various national and international level conferences to update their knowledge.

warranties along with software and hardware upgrades, refurbished MRI scanners are a good cost-effective alternative.

What are the pros and cons of using refurbished equipment in a hospital?

There is rise and growth of this incredible market of high quality refurbished equipment. We have mainly used refurbished equipment in private diagnostic centres than hospitals. The 40 IN IMAGING

THE BIGGESTADVANTAGE OFREFURBISHED EQUIPMENTIS AVAILABILITY OFOPTIMALQUALITY SCANNERS AT AFFORDABLE PRICE

biggest advantage of refurbished equipment is availability of optimal quality scanners at affordable price.

During a troubling economy, all types of business and organisations suffer, including hospitals and medical facilities.

Purchasing equipment is inevitable at times, especially if the current equipment is broken with no chance of repairs or replacements to save it.

Instead of turning to buying new equipment, hospitals can choose to purchase refurbished MRI and CT scanners to lighten the financial burden.

Even though having the most technologically advanced equipment is ideal, refurbished MRIs and CT scanners perform just as well, if not better, and produce the same results as brand new equipment. Even lease facilities are available with this equipment, which could be specifically useful for hospitals if they need the scanners on temporary basis.

The limitation with these systems may be that these might not be at par with the latest advanced scanners and sometimes software and hardware upgradation may be an issue. However, today with options like site planning, fresh factory painting, professional installation and comprehensive

What are your parameterswhile choosing refurbished equipment ?

For MRI we always prefer 1.5 Tesla and higher field strength magnets. For CT minimum of 16 slice scanners are preferred. We indent to buy these capital intensive MRI machines with latest and updated software, comprehensive warranties and optimal image acquisition.

How does refurbished MRI equipment support your business model?

Refurbished MRI systems are a boon to private diagnostic centres. They fulfil the need of high quality upgraded scanning system at affordable prices.

Does it help in increasing productivity of your department?

It surely does increase our productivity.

These equipment are well covered with maintenance warranty and upgraded with latest software. Even one can plan of centre expansion by using two to three refurbished scanners rather than single new equipment at comparable expenses.

Which companyprovide you with these refurbished products?

For 1.5T MRI, we trust only Phantom Healthcare based in New Delhi.

Whydid you choose to buyrefurbished equipment from this particular company?

Phantom Healthcare has always provided best quality equipment at competitive prices. They have given us prompt and effective post purchase services and upgradations. Their engineers are technically qualified and installation quality is always superior.

JANUARY 2016

IRIA 2016 | SPECIAL |

VALUE ADS

SANRAD MEDICAL SYSTEMS:

SPREADING TECHNOLOGY

OVER THE past 18 years, the name Sanrad has become synonymous with affordable and reliable services for medical imaging equipment in India.

Sanrad is a pioneer in the industry for services of CT & MRI equipment and is widely acclaimed by the medical fraternity for its excellent customer relationship. Sanrad has installed more than 370 refurbished Toshiba CT scanners in India, with highest uptime and cost effective services.

The name Sanrad is a wellrecognised brand for medical imaging equipment. It has also become synonymous with low maintenance cost concept. This concept embraces a range of customer support protocols that has been designed for cost conscious customers of India.

Sanrad maintains the largest inventory of CT scan parts and it is probably the biggest in Asia. With 42 IN IMAGING

service bases equipped with tools, technical backup of available spare parts and a skilled and efficient team of engineers we are able to provide excellent quality service to our customers.

With is its high end products like the recently introduced Refurbished Toshiba 1.5T MRI System and highly efficient Refurbished Toshiba 64 Slice CT System, Sanrad takes technology

“MOSTOFTHE DIAGNOSTIC IMAGING EQUIPMENT BUSINESS IN OUR COUNTRY WAS CONTROLLED BYTHE MULTINATIONALS.TODAY, WE ARE PROUD THATWE DICTATED THIS CHANGE AND BROUGHTTHE STATE OFARTTECHNOLOGY WITHIN THE REACH OF EVERYONE.CUSTOMERS THOSE WHO HAVE EXPERIENCED US,WOULD SWEAR BYOUR PURPOSE AND EXISTENCE” - RATISH S NAIR, CEO and its accessibility to greater levels.

Sanrad maintains the largest inventory of CT scan parts and it is probably the biggest in Asia. With service bases equipped with tools, technical backup of available spare parts and a skilled and efficient team of engineers we are able to provide excellent quality service to our customers.

JANUARY 2016

IRIA 2016 | SPECIAL |

VALUE ADS

NEWLY INTRODUCED REFURBISHED TOSHIBA 1.5 MRI SYSTEM Sanrad has taken a forefront in supply and maintenance of MRI systems. With and already existing product range of permanent MRI systems, Sanrad has recently introduced yet another product in this category that is The Refurbished Toshiba 1.5T Super Conducting MRI. ◗ Silent magnet with painissimo technology that reduces sound by 90 per cent. ◗ Patient comfort taken to next level with the additional features of wide bore, patient camera monitoring and user friendly interface. ◗ Optimum scanning technique and high image quality

THE REFURBISHED 64 SLICE CT SCANNER THE refurbished Toshiba Aquilion 64 slice CT scanner is a multi-slice helical CT system that supports whole body scanning and comes with work flow enhancing software that delivers unsurpassed image quality, improved dose management and superior patient care. ◗ Selectable slice thickness for accurate diagnosis. ◗ Optimum for cardiac scanning with Breath holding techniques and ECG gating available. ◗ Applications of sure technologies available in the software, allow feasible options in the scanning. ◗ Dose reduction technologies and high image quality.

Contact: Sanrad Medical Systems; 1,Manek S.V Road, Santacruz (West), Mumbai-400054, India Ph: +91-22 26006060,26494702 Email: info@sanrad.in Web: www.sanrad.in JANUARY 2016

IN IMAGING 43

IRIA 2016 | SPECIAL |

VALUE ADS

Pay-per-use rental scheme for CT and MRI systems Aucnet Sanrad India Private Limited is a joint venture between Aucnet Medical Inc of Japan and Sanrad Medical Systems of India to supply, install and maintain high end medical diagnostic equipment from Japan. The unique pay-per-use model is designed for immediate start-up of diagnostic centres, without heavy capital investment or worries of expensive recurring maintenance costs. Express Healthcare interviews Atul Sasane, CEO to understand the benefits of this scheme

ATUL SASANE CEO, Aucnet Sanrad India What are the challenges faced by imaging diagnostic centres in India?

The number of imaging diagnostic centres is increasing, driven by strong demand as modern treatment increasingly depends on inputs from imaging centres. To keep up with the growing competition, centres have to 44 IN IMAGING

maintain equipment to cover multiple modalities – from X-ray, DR, ultrasound, CT scanner to MRI systems. Costs of such equipment, particularly CT and MRI are high.

Arranging the finance for procurement is daunting, and the most difficult part. Annual maintenance costs of these equipment are almost unaffordable for most customers. Any lapse in maintenance can result in breakdowns having severe impact on the operation of the centre, leading to huge revenue loss with every hour of down time of the machine. All these issues are multiplied for customers who own and operate multiple diagnostic centres.

In order to minimise the risk and difficulties to the customer, we are providing a complete solution to cover finance, installation, training and maintenance packaged in one simple ‘pay per use’ rental fee.

What is pay-per-use rental solution offered by Aucnet Sanrad India?

We supply and install our CT/MRI

All costs inclusive plan ◗ Pricing designed as per usage ◗ Includes delivery to site ◗ Installation costs included ◗ All maintenance costs included ◗ Parts replacement costs included ◗ Tube replacement costs included ◗ Toll-free support number JANUARY 2016

IRIA 2016 | SPECIAL |

machine imported from Japan, as suitable and desired by the customer.

Cost of machine procurement, installation, annual maintenance, and even cost of replacing parts (in case of failure) is borne by us. The customer need not worry about any of the issues related to the machine. This takes off a huge burden so that customers can focus on optimising operations of the centre and clinical matters.

How is it different from the leasing solutions offered by manufacturers and finance companies?

Leasing solutions are based on charging interest on the cost of the equipment. Eventually the customer ends up paying the full cost of the equipment plus the interest cost for the term of the lease.

Aucnet Sanrad India is not a financing company, so our solution is not based on charging interest.

Instead, we share revenues with the customer, based on usage of the equipment. In this way we share the risk and rewards. Thus, for a low usage in any month, the total rental fee for that month will be lower. Another difference is that we bear all the costs related to the machine, including parts. In case of CT machines, replacement of X-ray tube is a major issue. Customers have to keep a constant watch on the condition of the tube to ensure smooth operation of their centre. We take full responsibility of the tube replacement also, which is one of the major advantages of using our pay-per-use rental. All costs related to the machine are covered in a single per slice fee.

There are no hidden costs, and customers can be assured that the machine in their premises is always in best operating condition, at our JANUARY 2016

VALUE ADS

Whyuse pay-per-use?

100 per cent financing: No down payment, unlike other financing.

Maintain cash: Hold on to cash so it can be used for other areas â&#x20AC;&#x201C; expansion, improvements, marketing or R&D. Manage risk: Mitigate the uncertainty of investing in equipment your business needs, until it delivers a return.

Hedge against inflation: you don't pay the total cost of equipment up front in today's dollars.

Plan expenses: For cash flow and business cycle fluctuations. Maintain greater certainty in budgeting by setting customised rent payment to match cash flow and even seasonal cash flows.You pay only for what you use.

Keep up to date with new technology: Acquire more and better equipment than you could have without financing and even upgrade or replace it within the term.

Avoid getting stuck with out-of-date equipment: We bear the risk of the equipment from becoming obsolete. responsibility.

Can you explain in more simple terms about the benefits of pay-per-use solution?

As a simplistic comparison, our payper-use solution is like riding a taxi, whereas a financing solution is like buying a car. When we ride a taxi, we only focus on going from point A to point B, without even thinking about the hassles of owning or maintaining the taxi. Our solution also offers the same peace of mind to owners and operators of imaging diagnostic

centres. They can focus on the scan, while we take care of all other hassles related to the machine.

Will customers end up paying more if they use the equipment more?

No, the pay-per-use rental fee is based on a variable tariff card. For high usage the rate per slice goes down. So customers end up paying a lesser portion of the patient scan fee to us.

More the number of patients seen by the customer, more is the share of the scan fee which he gets to keep for himself.

How do you ensure that the machine will be working in good condition?

Masayoshi Yamamoto, President of Aucnet Medical, Japan, also stresses the importance of growing business through customer satisfaction. Only the best quality equipment is handpicked for pay-per-use in order to reduce the overhead cost of IN IMAGING 45

IRIA 2016 | SPECIAL |

VALUE ADS

This benefit is fixed and is not related to the revenue which the equipment is generating.

In case of pay-per-use, the full amount which is paid out as rental fee is treated as expense, for tax benefit.

Since pay-per-use fee is linked to business volume, more the patients seen by the customer, more is the tax benefit.

MASAYOSHI YAMAMOTO Director

maintenance.

Our partners Sanrad Medical Systems will support us for all installation and maintenance activities. As you are aware, Sanrad are the leaders and the most trusted name for supply and maintenance of CT and MRI. Sanrad’s infrastructure and skilled manpower ensure that the machine which we offer is always leading edge, and maintained in the best condition.

What are the tax benefits of pay-peruse as compared to the benefit of claiming depreciation when purchasing equipment?

When a customer purchases equipment, he can claim tax benefit for depreciation of the value of the equipment. However, according to the tax regulations, there is an upper limit on the maximum depreciation that can be claimed by the customer.

Usually the limit is only 15 per cent of the residual value of the equipment.

46 IN IMAGING

Is this solution suitable for the new and emerging imaging diagnostic centres?

New and emerging diagnostic centres face the biggest challenges in finance for procurement of CT and MRI systems. Not only is the total capital cost large, but the lending and leasing terms are also harsh on these newcomers. But at the same time, established diagnostic centres also have to keep upgrading their equipment and in many cases have to start satellite centres to cater to their increasing work load.

Our solution is the best option both for centres who are starting from scratch, as well as for established centres for machine replacement/ upgradation. Long and tedious negotiations with manufacturers, finance companies, service providers are eliminated. Instead there is only one simple ‘pay-per-use’ contract.

Where do you see this market in the next five years?

Initially, we are offering this solution in Western and Southern parts of India and would slowly scale up to cover whole of India. As the costs of imaging diagnostic equipment keeps rising, pay-per-use rental solution will become the preferred solution for most of the entrepreneurs in the medical profession.

Contact: Atul Sasane Phone: +91 22 2600 6060 Mobile: +91 9820703371 Email: sasanea@ns.aucnet.co.jp

JANUARY 2016

IRIA 2016 | SPECIAL |

VALUE ADS

INNOVATIVE CR 10-X EPS

FROM AGFA HEALTHCARE It has been designed to flexibly fit the real financial flows of healthcare facilities of any size TOO OFTEN, high infrastructure, equipment and service costs plus a slow return on investment are preventing healthcare providers from adopting advanced technologies such as digital imaging. Now, Agfa HealthCare has developed a new product combining technology with finance that lets even facilities with a low volume of imaging benefit from the higher quality images, increased productivity and smoother, more efficient workflow that computed radiography (CR) provides.

EPS – Easy Payment Scheme – has been designed to flexibly fit the real financial flows of healthcare facilities of any size, so you can adopt a brand-new CR 10-X system right away. You pay as you go, with a fixed down-payment followed by equal and regular installments, keeping your up-front capital investment low and your cost management easy. There is no need for a bank loan or complex paper works.

A full digital package With EPS, you get a full digital package up-front, including: ◗ A brand-new CR 10-X EPS digitizer: an affordable CR solution that makes no compromises on image quality, offering a convenient and fast workflow ◗ A new NX workstation: the radiographer's image identification and JANUARY 2016

quality control tool, with an intuitive user interface ◗ MUSICA image processing software: Agfa HealthCare’s ‘gold standard’ intelligent, automatic and body-part independent image processing, with superior contrast detail ◗ New CR MD1.0 general imaging plates and cassettes ◗ A new DRYSTAR 5302 imager: tabletop, two online trays that can support any of the five media sizes, direct digital imager designed for a decentralised workflow ◗ Three years of comprehensive warranty that takes care of the system against unexpected service costs And paying the installments is easy, through the web-based interactive portal. Each payment ensures your use of the system through to the next

installment date.

CR 10-X digitizer ◗ Affordable and efficient CR solution offering high image quality ◗ Intelligent MUSICA image processing ◗ Convenient and fast workflow ◗ Robust yet easy to install and maintain ◗ Fits in small spaces and is suited for mobile applications ◗ Smart image plate handling that reduces wear and tear Contact the nearest Agfa HealthCare office to know more about stepping into digital imaging, with EPS 402, 4th Floor, Nitco Biz Park, Plot No. C/19, Road No. 16, Wagle Industrial Estate, Thane (West) - 400604, India Tel: +91 22 40642900 / 29 Email: sales.india@agfa.com IN IMAGING 47

IRIA 2016 | SPECIAL |

VALUE ADS

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) 48 IN IMAGING

the new CS-7 console in less than two seconds. The CS-7 has a user-friendly graphic interface adding new and powerful proprietary functions. GUI design can be modified to customer preferences flexibly, succeeding the conventional console design.

JANUARY 2016

IRIA 2016 | SPECIAL |

VALUE ADS

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 2016

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 49

IRIA 2016 | SPECIAL |

VALUE ADS

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 DS 80 PRINTERS are compact, desktop, high-speed, high-quality 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 requires very low maintenance 50 IN IMAGING

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. 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 command. It is so simple that within

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 JANUARY 2016

IRIA 2016 | SPECIAL |

VALUE ADS

KONICAMINOLTALAUNCHES

AEROSCAN DIGITAL ULTRASOUND SYSTEMS KONICA MINOLTA Healthcare India recently introduced the AeroScan range of digital ultrasound systems in India. It covers a wide range of entry level B&W ultrasound systems to highend colour Dopplers which are innovative and intuitive. The Aeroscan range caters to various segments in radiology, gynaecology, general imaging and cardiovascular imaging. With AeroScan, Konica Minolta Healthcare India can boast of providing the best in imaging systems at affordable cost.

These systems are created for excellent image quality and colour pick-up, stable and robust hardware as well as trouble free operations for years.

Greater confidence in general imaging AeroScan’s advanced ultrasound platform provides superb image quality, intuitive user interface and fast scanning response. With a state-of-theart high channel platform, AeroScan ultrasounds provide high image resolution and penetrations. Userfriendly interface simplifies the daily work-flow. Features like micro-scanning technology, compound imaging, panoramic imaging give quantified tools for best imaging practices.

Safeguarding the heart With high resolution imaging, modern JANUARY 2016

interface and quantification tools help customers for cardiac studies.

AeroScan CD 30 and CD 40 offer extraordinary colour and CW Doppler sensitivity that enhances the users’ confidence in cardiac imaging. Features like tissue velocity imaging, tissue Doppler imaging and easy stress echo workflow help offer the best in cardiac imaging.

Reaching out to every point-of-care AeroScan’s premium high density linear probes give users an indispensable tool for point-of-care applications which include regional nerve block, musculosketal and rheumatology. A high frequency platform upto 15Mhz allows superficial image quality to be perfect. High sensitive power Doppler makes diagnoses of superficial flow quicker and easier.

Protecting investments With AeroScan's rational design and reliable product quality, all products give the highest level of performance without needing any special care.

Konica Minolta widespread service team also ensures quick and flexible solutions. Product reliability and design methodology allows easy and constant upgrade of imaging parameters

keeping one updated with the latest in imaging techniques. The products are designed to be trouble-free and for easy repairs as well as after-sales services.

The AeroScan range offers basic entry level B/W models, B1 and B2 digital imaging ultrasound systems with 12 and 15” LCD displays. The colour Doppler segment offers entry level solutions with its portable colour Doppler CD10 with 15" LCD display and CD20 which is a mobile model. In the mid-range segment, Konica Minolta offers CD30 that comes with high density probe offering excellent imaging. wide angle transvaginal probe with 200o field of view, easy GUI with quick selection on 8” touch screen LCD display, panaromic imaging and upgradable to 3D/4D imaging.

CD 30 offers industry’s first inbuilt battery back up in a compact mobile system which gives an added advantage.

IN IMAGING 51

IRIA 2016 | SPECIAL |

VALUE AD

Modi Medicare introduces MEDMAMMO

An independent FFDM mammography workstation Med Mammo is a mammography diagnostic workstation which combines ease of use and high performance features.

MEDECOM’S MED MAMMO is enhancing reading and image management for diagnostic mammography. Breast imaging and women’s health clinics will benefit from Medecom’s fifteen years of radiology and image workflow experience.

With Medecom’s Med Mammo breast imaging workstation, one can include reading of tomosynthesis images and other multi-modality radiology examinations in the regular mammography reading workflow. This significantly increases efficiency as the need to move to a dedicated modality workstation is eliminated.

Med Mammo is among the first digital mammography solutions to offer support for import and review of the tomosynthesis DICOM format.

Multimodality with relevant prior matching Users benefit from Med Mammo’s multi-modality support to pre-fetch clinically relevant priors including ultrasound, MRI and tomosynthesis, to be displayed side-by-side with the mammograms.

Each imaging study is 52 IN IMAGING

vendor on a single client interface.

automatically associated with the corresponding modality imaging functions such as, measurements, stitching, MIP/MPR and modality display protocols. This ensures that they are hung with the precise tools according to radiologists’ preferences for optimal viewing and diagnosis.

Mammography studies from multiple vendors are automatically scaled and aligned to ensure optimal side by side comparison. Medecom has improved this critical element of digital mammography reading, to make it possible to view and report on all forms of breast imaging (MRI, ultrasound, digital breast tomosynthesis and X-ray) from any

A complete digital mammography solution In order for you to take full diagnostic advantage of the tomosynthesis format you need to ensure the support of tomosynthesis images throughout the digital mammography workflow. This requires modules that complement legacy radiology systems to ensure compatibility or extend functionality offered by the new tomosynthesis format.

Medecom provides tomosynthesis support throughout a vendor neutral, digital mammography, product line.

Medecom's digital mammography modules include storage, reporting, printing, CD/DVD archive and Electronic Image Exchange.

Compliant with the regulatory requirements and standards in many countries, Med Mammo is a true alternative to any manufacturer’s workstations.

Contact Jigish B Modi Ph: 2506 5664, 98670 01110, Email: modimedicare@gmail.com Skype: modi.medicare JANUARY 2016

IRIA 2016 | SPECIAL |

VALUE AD

Myrian XL Onco

A leading solution for oncology follow-up

THE UNIQUE solution for multi modality oncology follow-up, Myrian XL-Onco is the culmination of eight years of development of the Myrian platform.

Dedicated to oncology follow-up, it manages the sequencing of tasks essential for the management of the cancer patients with elevated efficiency and in strict compliance with the international RECIST rules, consensually established by European, Canadian and American authorities.

The Cheson protocol whose parameters can be set by the user is also available.

Myrian XL-Onco was developed and validated jointly with leading French experts. It makes Intrasense a world leader in oncology follow-up software applied to medical imaging.

It is intended for routine clinical practices of hospitals treating cancer patients as well as for pharmaceutical companies and CROs in the framework of phase I, II and II clinical trails to evaluate anti-cancer JANUARY 2016

patient's cancer by comparing the latest examination to prior results.

This follow-up involves key steps managed by the software that considerably simplifies the radiologist's work.

therapies.

Original technologies Automated retrieval of prior exams, dedicated clinical workflow obeying RECIST rules, automatic 3D registrations of examinations in elastic mode, automated production of reports and graphs.

Applications It is used to follow the course of a

First rate partners The best specialised cancer teams contributed to the development of this module. They are: ■ Curie Institute (Paris, France) ■ Pitie-Salpetriere (AP-HP – Paris Public Hospitals Authority) (Paris, France) ■ Hopital Europeen Georges Pompidou (AP-HP – Paris Public Hospitals Authority) (Paris, France) ■ Civil Hospices of Lyon (HCL) (Lyons, France) ■ Montpellier University Hospital (Montpellier, France) Contact Jigesh B Modi Phone: 25065664, 9867001110 Email: modimedicare@gmail.com Skype: modi.medicare IN IMAGING 53

IRIA 2016 | SPECIAL |

VALUE ADS

VARIAN MEDICAL SYSTEMS -

IMAGING COMPONENTS Varian has a bonded warehouse facility in India, where CT scan X-ray tubes are available for rapid shipment VARIAN IMAGING COMPONENTS is a premier supplier of X-ray tubes, digital detectors and image processing workstations for X-ray imaging in medical, scientific and industrial applications and also supplies highenergy X-ray devices for cargo screening and non-destructive testing applications. 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 for rapid shipment. Having a CT tube inventory in India, significantly enhances the company’s ability to serve its Indian customers on an expedited basis.

Advanced Wireless Flat Panel Detector Technology The PaxScan 4336W wireless detector features Varian's proprietary, advanced wireless technology with state-of-the art, sixth generation architecture incorporating 16-bit data acquisition.

The panel is optimised for dose efficiency and very low electronic noise.

The wireless platform is a dual band 2.4/5GHz panel with high speed data transfer rates up to 170Mbps and a 2 – 3.3 second preview time. It also has on-panel diagnostics and a built-in shock sensor. The panel is a lightweight 3.4 kg with battery, and has a removable tether/service cable. These innovative

Vivek Phalle, Business Head, VIC, India

technologies allow customers to take full advantage of superior digital image quality with the capability of higher throughput, significant workflow efficiencies and the potential to enhance patient care and comfort .

Varian’s flat-panel detectors, X-ray tubes and Nexus image processing software and workstations are optimised for fast patient throughput, flexibility, and usability.

JANUARY 2016

IN IMAGING 55

IRIA 2016 | SPECIAL |

VALUE ADS

OPEN LETTER FROM FUJIFILM’S MANAGEMENT: EXCERPTS Dear Customers, As 2016 has been arrived, on behalf of everyone at Fujifilm, I would like to wish you and your family a very Happy New Year. I foresee that the coming years will strengthen our relationship further.

I thank you for your continued support in making us your number one choice for your computed radiography (CR) and imagers. In the year 2015, we have successfully launched microSKAN DR, Mobile DR, SKAN DR U-arm, Prima Tm – Mammography CR. We have received an excellent response from your side.

FCR Prima Tm is the latest addition to FUJIFILM’s popular range of computed radiography systems. As a global leader, FUJIFILM has been introducing new products to address the changing need of customers in India. There has been a growing demand for mammography CR since healthcare providers want to offer all the facilities under one roof. FCR Prima Tm is the most suitable option as it offers mammography cassette reading at 50 micron resolutions. The space-saving design is important since healthcare facilities can no longer afford huge spaces. The dust-free mechanism ensures that the equipment is protected from dust. We have recently installed Prima Tm with more than 50 customers in India. Fujifilm logo is ‘Value from Innovation’ and we would keep on providing products and services which would enhance your image quality and work-flow while delivering the least X-ray dose to patients.

We also launched our new product - Amulet Innovality, Full Field Digital Mammography System, empowered with highly advanced technologies embracing TFT panel with hexagonal close pattern structure, which results in 50 micron pixel resolutions to detect cancer at the onset.

We have received an order for eight Amulet - Full Field 56 IN IMAGING

Digital Mammography till date.

They are: ◗ Tata ATREC, Navi Mumbai ◗ Tata Memorial Hospital, Vizag ◗ NM Medical Centre, Khar ◗ Mahajan Imaging, New Delhi ◗ Rajiv Gandhi Women & Children Hospital, Pondicherry ◗ Batra Hospital & Research Centre, New Delhi ◗ MNJ Hospital Regional Cancer Centre, Hyderabad ◗ Indira Gandhi Medical College, Shimla I thank you for giving us a chance to install our product at your prestigious hospitals and diagnostic centres.

Fujifilm brings you a lot of innovative products and services. We are continuously evolving our selves to provide better, faster and quality services to our customers. We are focussing on our SYNAPSE Picture Archiving and Communication System (PACS) and Clinical Workflow Manager (CWM), and Radiology Information System (RIS) for enterprise solutions in bigger hospitals which would bring efficiency and quality in diagnosis. We have also launched iWeb Teleradiology solution for small diagnostic centres and nursing homes, so that one radiologist can report X-rays from four to five centres sitting on his workstation.

We would like to thank you for your continued support and for the confidence that you have placed in our products.

Please continue to share your feedback, queries and new requirements with us on medical@fujifilm.com and give us the opportunity to serve you in the best manner possible.

Best Regards, Chander Shekhar Sibal HOD, Medical Division, Fujifilm India JANUARY 2016

IRIA 2016 | SPECIAL |

VALUE ADS

ZENITH MEDICAL SYSTEMS

GROWING FROM STRENGTH TO STRENGTH Zenith specialises in GE’s refurbished CT scanners ranging from single to multi-slice modalities ZENITH MEDICAL SYSTEMS, in its 21 years of existence and through hard work and dedication, has built a unique solution-oriented organisation for providing sales, maintenance and servicing of medical diagnostic imaging equipment.

As the medical diagnostic scenario continues to evolve each day, its goal remains consistent, to provide hasslefree, cost effective, quality services for the its equipment. Towards this endeavour, it strives to maintain an exhaustive inventory of spares. It also ensures that if required the spares can be procured from its associates in the country and abroad. The company also tries to maintain a team of professionals for whom healthy running of equipment with minimal down-time remains the first priority.

They believe in the principle that ‘service comes first’ to any other thing.

Zenith specialises in GE’s refurbished CT scanners ranging from single to multi-slice modalities and in 20 years it has an installed base of nearly 200 CT scanners spread across India.

58 IN IMAGING

PC Sharma, Founder, Zenith Medical Systems

IN 20 YEARS OF EXISTENCE,ZENITH MEDICALSYSTEMS BOASTS OFAN INSTALLED BASE OFNEARLY200 CT SCANNERS SPREAD ACROSS INDIA

The company is veered by the expert guidance of PC Sharma, a well known figure in the field of diagnostic imaging. Sharma floated Zenith Medical Systems two decades ago and introduced the concept of refurbished CT scanners to the Indian radiological market for the first time ever. Since then the company has not looked back and has paved its way to become renowned as a leader in the field of refurbished GE CT scanners.

JANUARY 2016