Medical Dealer - October 2015 by MD Publishing

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CONTENTS_Features 48 DEVICE MANAGEMENT GOES GLOBAL

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Medical Dealer (Vol. 19, Issue #10) October 2015 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to Medical Dealer at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.medicaldealer.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2015

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Mammography INDUSTRY UPDATE 14 News & Notes 20 Company Showcase: BMX-RAY MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269 (800) 906-3373 Fax: (770) 632-9090 Publisher

John M. Krieg john@mdpublishing.com

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Editor

John Wallace jwallace@mdpublishing.com

Art Department Jonathan Riley Jessica Laurain

24 OEM Updates 28 Block Imaging

MARKET ANALYSIS Radiology: Mammography 31 Market Analysis 32 Product Showroom 37 Preferred Vendors Med/Surg: Operating Tables 41 Market Analysis 42 Product Showroom 45 Preferred Vendors

Account Executives Jayme McKelvey Andrew Parker Warren Kaufman

Contributors

Jim Fedele Matthew N. Skoufalos Dan Bobinski

SLICE OF LIFE 64 The Other Side 68 Off the Clock 72 Pay It Forward

Accounting

76 Dan Bobinski

Web Department

82 Marketplace

Kim Callahan

Betsy Popinga Taylor Martin

84 Categorical Index 86 Alphabetical Index

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MEDICAL EQUIPMENT, PARTS & SERVICE

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INDUSTRY UPDATE_News and Notes

Staff Reports

BLOCK IMAGING PARTS & SERVICE AMONG FASTEST-GROWING PRIVATE COMPANIES Block Imaging Parts & Service is e-Commerce website in the next few on Inc. Magazine’s 34th annual list weeks. This platform will make thouof the 5,000 fastest-growing private sands of parts available online, at the companies in America. Inc. Magaclick of a button, to customers worldzine selected Block Imaging for the wide. list, in recognition of having achieved Block Imaging Parts and Service a growth rate of 133 percent over the has added a wide array of offerings past three years. to its replacement parts and equip“I cannot thank our team and our ment service programs over the last business partners enough for the year with plans to roll out more in the work that we’ve done together to near future. Examples include Service build one of the best imaging parts Sight, a wearable, smart glasses techand service businesses in the world,” nology for remote diagnostics, and said Jason Crawford, President of a growing library of online training Block Imaging Parts and Service. “We courses that empower field service are passionate about extending the engineers to expand their capabililives of people by extending the life ties and help medical facilities meet of medical imaging equipment globOSHA requirements quickly and ally, and it’s beyond encouraging to affordably. Innovations like these led see that passion continue to grow to the tremendous growth rate that through our products and our team.” drew Inc. Magazine’s attention and Block Imaging Parts and Service even more options for the mediearned Block their spot on the list hopes to maintain the growth trajeccal imaging community. To that end, of America’s fastest-growing private tory of the last three years by adding they look forward to unveiling their companies. •

MITA NAMES ZIEHM IMAGING INC. CEO CHAIRMAN OF THE BOARD Nelson Mendes, the ufacturers, innovators within the imaging space President and CEO of and product developers. are second-to-none, and Ziehm Imaging Inc., was The alliance represents will be invaluable during recently elected to serve companies whose sales his tenure.” as the Chairman of the comprise more than 90 “I am humbled Board for the Medical percent of the global marand honored with the Imaging & Technology ket for medical imaging appointment which I Alliance (MITA), which is technology. have accepted and which a branch of the National “We are delighted that represents the highest Electrical Manufacturers Nelson has agreed to serve position in our indusAssociation (NEMA). as Chairman of the Board try’s national association, MITA is the leadfor our alliance,” said Patrick respected by regulaing organization and Hope, Executive Director tors, legislators, major collective voice of medof MITA. “His extensive hospitals and mediical imaging equipment, industry experience and cal associations such as radiation therapy and knowledge of innovation RSNA, AAOS, among othradiopharmaceutical man- and product development ers,” Mendes stated. •

14 MEDICALDEALER | OCTOBER 2015

Nelson Mendes

MEDICAL EQUIPMENT, PARTS & SERVICE

_News and Notes

ECOLAB AGREES TO ACQUIRE SELECT ASSETS OF SWISHER HYGIENE Ecolab Inc. has reached an agreement to acquire the U.S. operations of Charlotte, N.C.-based Swisher Hygiene Inc. for approximately $40 million in cash. Swisher Hygiene provides hygiene and sanitizing solutions for the foodservice, hospitality, retail and health care markets. Sales in 2014 for the operations included in the agreement were approximately $176 million. “We look forward to welcoming Swisher Hygiene employees and customers to Ecolab, and growing with them as we work to make the world cleaner, safer and healthier,” said Douglas M. Baker, Jr. Ecolab chairman and chief executive officer. Founded in 1986, Swisher Hygiene has 1,000 employees in the U.S., primarily in field sales and service, and serves approximately 30,000 businesses. Swisher Hygiene offers a range of products and services for the institutional foodservice industry. The transaction is expected to close in the fourth quarter of 2015, subject to Swisher Hygiene stockholder approval and customary closing conditions. •

4MED CO-FOUNDER OFFERS CONSULTING SERVICE 4med Imaging Solutions co-founder Vyto Kab is expanding on the company’s consulting business. “4med Imaging Solutions, a provider of CT and MRI services, today announced plans to segregate and expand its consulting division business into a separate company,” according to a press release. Kab is selling his interest to 4med co-owner Michael Abboud to focus his “efforts on a new consulting services company in the health care technologies area.” For 20 years, Abboud has worked in the radiology industry and will use that knowledge in his leadership role at 4med to focus on the core business of providing full-service, highend digital imaging services to health care organizations with the goal of optimizing uptime and minimizing cost of ownership of digital imaging assets. Peter Calistri will serve as interim CEO of 4med and spearhead the transition. •

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HEALTHMYNE ANNOUNCES FDA CLEARANCE OF IMAGING INFORMATICS PLATFORM HealthMyne has announced 510(k) clearance from the U.S. Food and Drug Administration (FDA). The new imaging informatics platform is designed to streamline clinical decision support and integrate with enterprise PACS and vendor-neutral archives using industry-standard formats. HealthMyne’s team has leveraged previous clinical and commercial success within image management to create this innovative software foundation. The new system directly aligns with the American College of Radiology (ACR) Imaging 3.0 initiative which addresses the radiologist’s emerging role as diagnostic imaging consultant to all clinicians, both before and after the imaging encounter. “Having a strong diagnostic imaging platform cleared by the FDA is the first step in our vision of bringing imaging informatics to mainstream health care,” said Praveen Sinha, CEO of HealthMyne. “Significant achievements are being realized elsewhere through clinical data aggregation and analysis, yet imaging has gone largely untapped. As an example, the potential impact of streamlined patient cohort comparison on personalized medicine is truly exciting.” HealthMyne will be exhibiting (North Building, Hall B, Booth 8310) at the Annual Meeting of the Radiological Society of North America in Chicago from November 29 to December 4, 2015. •

MEDICALDEALER 15

INDUSTRY UPDATE_News and Notes

KUBTEC PATENT PROMOTES STRONG PROGNOSIS FOR THE FUTURE OF BREAST CONSERVING SURGERY Kubtec has announced that the U.S. Patent & Trademark Office has issued Patent No. 14/503,130 for the technology incorporated into the Mozart System with TomoSpec Technology. This patent recognizes that the Mozart System with TomoSpec Technology, the world’s first portable 3-D Digital Specimen Tomosynthesis Imaging System, is unique in its field. The Mozart System with TomoSpec Technology allows surgeons to bring 3-D tomosynthesis imaging directly into the operating room for lumpectomy and partial mastectomy procedures. It gives surgical teams the ability to make faster and more precise intraoperative determinations of the successful excision of tumor margins. Prior to the Mozart System with TomoSpec Technology, surgeons were restricted to less effective modes of multiple 2-D imaging, or waiting while a specimen was transported from the operating room to another location for 3-D analysis. During Breast Cancer Awareness Month, Kubtec will be exhibiting Mozart System with TomoSpec Technology at the European Union Society of Breast Imaging (EUOSBI) in London, October 2-3, 2015. •

Staff Reports

PFIZER RECEIVES CLEARANCE FOR HOSPIRA ACQUISITION Pfizer Inc. has announced that the U.S. Federal Trade Commission terminated the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, with respect to Pfizer’s pending acquisition of Hospira. The FTC’s clearance is contingent upon Pfizer’s commitment to divest four U.S. sterile injectable assets, including Acetylcysteine, Clindamycin, Voriconazole and Melphalan. In addition, Pfizer announced that Brazil’s Superintendency-General of CADE has published its unconditional clearance decision. “We are pleased to have received these final regulatory approvals for our pending acquisition of Hospira,” said Ian Read, Chairman and Chief Executive Officer, Pfizer. “We now look forward to combining our two companies and expect the transaction to close in early September.”

TERARECON APPOINTS JEFF SORENSON AS PRESIDENT TeraRecon, a leader in advanced visualization and enterprise medical image viewing solutions, has announced leadership changes designed to strengthen the company and position it for the next phases of growth and solution development. Venkatraman Lakshminarayan, who served as CFO since 2005 and CEO since 2014, has stepped down to pursue other interests. Jeff Sorenson, who will lead the company as president, succeeds him. Sorenson joined the company in 2004 and was most recently SVP of sales and marketing. “TeraRecon is unique because it offers a complete and truly vendor-neutral 3D advanced visualization suite which can be extended to serve the medical image viewing needs of the entire health enterprise,” Sorenson stated. “I am excited to serve our valued customers and to drive innovation in this new capacity as president.” On the heels of three large enterprise iNtuition advanced visualization wins in early August, the company also reported a marked increase in iNteract+ interoperability and enterprise image-enablement projects. In addition, the anticipation of the feature-rich iNtuition software release is driving an increase in software maintenance renewals. •

16 MEDICALDEALER | OCTOBER 2015

MEDICAL EQUIPMENT, PARTS & SERVICE

_News and Notes

ENMET CELEBRATES TWO MILESTONES ENMET is proudly celebrating 45 years of creative gas detection solutions. Environmental Metrology Corporation (ENMET) was founded in 1970 by Dr. Verne Brown. The company originally produced gas detection equipment for vehicular applications and then expanded into new markets, manufacturing portable gas detectors for industrial applications. On July 10, 2014, ENMET Corporation was acquired by Chicago-based private equity firm Benford Capital Partners, LLC and became ENMET LLC. It has been an exciting year at ENMET as it celebrates one year under new ownership. ENMET continues to offer a wide range of continuous multi-channel fixed systems, respiratory air monitors and portable detectors for a variety of hazardous gas conditions. The company also designs custom engineered detection systems using its ISO 9001/AS9100C quality system for clients with unique applications. •

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TEMPLE UNIVERSITY HEALTH SYSTEM, GE HEALTHCARE SIGN COLLABORATION AGREEMENT Temple University Health System (TUHS) and GE Healthcare have announced a collaboration between a health care technology company and an academic medical center that aligns incentives to promote value by providing higher-quality radiologic imaging services more efficiently at a lower cost. The new arrangement targets improvements in specific operational, clinical and financial outcomes, putting TUHS on the cutting edge of delivering high-value imaging services across a health system and making GE Healthcare a pioneer in what could become a preferred business model over the next few years. Under the seven-year agreement, TUHS and GE Healthcare will work together to achieve performance goals enabled by new technology and industry best practices. TUHS will modernize its radiological imaging equipment with state-of-the art technology from GE, while also benefitting from enhancements, including data storage and retrieval, service contract consolidation and consultation to optimize scheduling and workflow efficiency. The arrangement includes financial incentives aligning the parties toward realizing shared objectives, including a targeted $39 million in operational savings over the life of the contract. “Like many health systems throughout the country, Temple University Health System faces clinical, operational and financial demands. GE Healthcare understands these market challenges, and we are dedicated to helping customers deliver the best outcomes in today’s environment,” said Jeffrey Immelt, Chairman and CEO of GE. “GE is honored to work with Temple University Health System in this strategic alliance designed to improve operational and clinical outcomes while reducing costs by $39 million.” The strategic arrangement between TUHS and GE Healthcare applies to the radiology departments at Temple University Hospital’s Main, Episcopal and Northeastern campuses; Fox Chase Cancer Center and Jeanes Hospital. •

MEDICALDEALER 17

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INDUSTRY UPDATE_Company Showcase

Special Advertising Section

BMX-RAY M ax Ende began BMX-RAY in the winter of 2010 with a set of tools, a goal, a plan and a prayer.

“My goal was to offer the imaging engineer a service designed for him or her. Everyone in our industry knows that the imaging departments of hospitals are demanding environments and naturally demand high performance from the technical staff that services their equipment,” Masters says. “The problem is that imaging techs are under a big gun when patient care is impacted when the X-ray equipment that they are responsible for maintaining is down or under-performing.” “My company’s philosophy is to craft solutions around targeted equipment issues that engineers can quickly solve with lowcost solutions,” Masters explains. “We began with collimators and expanded into foot switches, generator control consoles, table controllers, table tops, tube chillers, etc.” In its fifth year of business, BMX-RAY is an aftermarket medical imaging device company poised to make a bigger name 20 MEDICALDEALER | OCTOBER 2015

for itself in the ISP and biomed markets. “We saw the need for an alternative to high-cost medical imaging parts and devices to which independent service providers, in-house biomedical engineers and end-users were subjected to in our industry,” President of BMX-RAY Inc. Max Ende says. “Our team of engineers has over 30 years of experience and within 24 hours, they can have a part repaired and ready for use,” he says. “This high level of efficiency distinguishes BMX-RAY from other companies who offer similar services.” More than that, Masters said, the company is able to offer competitive pricing at a savings of about 50 to 60 percent, greatly reducing the amount of money its customers might spend fixing the equipment sent to its shop — while getting repairs completed faster as well. “We do not have the attitude that we have competitors. Like golfers, we strive to perfect our own game and let others do what they can with theirs,” Masters adds. “We constantly strive to perfect our processes to provide high-quality service.” BMX-RAY initially focused its efforts on creating a depot repair service

Siemens and GE Proteus test bays.

“My company’s philosophy is to craft solutions around targeted equipment issues that engineers can quickly solve with low-cost solutions.” for medical imaging controls and collimators, but has expanded its service portfolio to include other significant technologies in the imaging market. A shift within the industry has kept BMX-RAY busy. “The challenges over the last few years is a rapidly and drastically changing industry,” Masters says. “There are mergers, acquisitions, emerging buying

groups and hospital closings that are a bit difficult to keep up with but we have found that through the many changes the relationships we have built are still intact and this has helped us.” BMX-RAY offers repairs on the GE, Lytron and Solid State MR chillers, among other major cooling systems, at its 10,000-square-foot facil-

MEDICAL EQUIPMENT, PARTS & SERVICE

BMX-RAY_Company Showcase

ity. With half that space dedicated to an electronics repair shop, mechanical machine shop and rework shop. The facility also offers the company room

providing a cost-effective and highly reliable service. So far we have been able to accomplish this, and we work very hard to maintain or exceed our goals.”

Max Ende repairing a GE collimator.

to grow and add services for additional devices. Creating a more diversified product portfolio has been instrumental to the success of BMX-RAY, Ende said, but so has improving upon its ability to deliver what clients require with attention to detail, superior workmanship, efficient processes and a commitment to quality. “The men and women in the biomedical field are already under enough pressure to meet their respective goals of safe and excellent patient care before you factor in regulatory demands,” Masters says. “We endeavor to ease some of those demands by WWW.MEDICALDEALER.COM

One way in which BMXRAY has been able to adhere to its high standard of excellence, Masters said, has been an attempt to transcend the traditional boundaries of competition in the marketplace. He said that’s because the company boasts “a unique ability to do things that other companies are just not set up to do.” “What we do is evaluate certain pieces of high-value, high-failure hardware that we can create a process around, and sell the service,” Ende states. “There are some items we won’t do simply because someone else

is already doing it and they do a very good job,” he says. “What we do is find an item that no one is doing and develop the processes and quality controls around that.” What makes BMX-RAY able to meet the demands of its clientele is its commitment to speed, quality and reliability, Masters said. The company offers a one-day turnaround time for most repairs and refurbishment jobs — an unparalleled level of service in the industry. “That’s what we base our business on — quality parts, reliable, prompt repair time and the willingness to get it done,” he says. At BMX-RAY, adherence to an ISO 9001:2008-based quality management system also goes a long way toward establishing a culture of repeatable processes and reproducible results that underscore its long-term commitment to quality, continuous improvement and customer satisfaction, Masters says. He credits the staff at BMX-RAY with being able to meet customers’ needs, including warehouse manager and chief machinist Alex Dubois. “I can give him the most mangled-up mess of a collimator cover, and he gives it back looking like it came from the factory,” Masters says. He also has kind words for his colleagues, office manager Bevvie-Del Ende, “who keeps everything from falling apart,” and Stephen Ende, who helps

“The men and women in the biomedical field are already under enough pressure to meet their respective goals of safe and excellent patient care before you factor in regulatory demands. We endeavor to ease some of those demands .”

in the warehouse and teardown shop. In living the values you might expect from a family business, Masters says, BMX-RAY “fosters a team approach to problem-solving and preventive action by empowering all employees to be quality ambassadors.” “If you need a reliable repair option on a Siemens, GE, Philips or Swiss Ray parts, then give us a try,” Masters says. FOR MORE INFORMATION, about BMX-RAY, visit www.bmx-ray.com. MEDICALDEALER 21

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INDUSTRY UPDATE_OEM Updates

Staff Reports

STERIGENICS INTERNATIONAL INVESTS $10M TO EXPAND IRRADIATION FACILITY Sterigenics International, a global provider of contract sterilization capacity going forward.” sterilization, gamma technologies and medical isotopes, “Growing customer demand is driving this has announced a $10 million expansion at their Gurnee, expansion,” said Philip Macnabb, President of Sterigenics Illinois facility, to add a new gamma cell. The irradiator International LLC. “With this addition we are adding will be ready for customer product validation in October gamma processing capacity of up to 5 million cubic feet of this year, with production to follow immediately. per year in the Midwest.” “Aligning our capital investments to support our The cell is modeled after Sterigenics’ other tote customers’ growth strategies has always been a top systems with the dimensions of 24 x 48 x 40 inches. priority for our company,” said Michael Mulhern, The product overlap system is extremely efficient and CEO of Sterigenics International. “Customers can provides the capability to process numerous dose ranges expect Sterigenics to continue to add valuable global and a wide variety of densities. •

FRESENIUS KABI WINS AN EXCELLENCE AWARD Fresenius Kabi, a global health care company that specializes in medicines and technologies for infusion, transfusion, and clinical nutrition, received a 2015 Supplier Excellence Award from HealthTrust. HealthTrust represents more than 1,350 member hospitals. HealthTrust, which selected nine suppliers as 2015 award winners, named the winners at the 2015 HealthTrust University Conference and Vendor Fair earlier this year. Each year, HealthTrust members vote on Supplier Excellence Award winners based on product quality, customer service, on-time delivery, billing accuracy and price/value. “The Fresenius Kabi team is honored to be named a Supplier Excellence Award winner,” said John Ducker, president and CEO of Fresenius Kabi USA. “We see it as a privilege to support the vital mission of HealthTrust’s member hospitals and other sites of care. Our purpose and values as a company are focused on delivering the best value to our customers.” •

24 MEDICALDEALER | OCTOBER 2015

ZEISS EARNS FDA 510(K) CLEARANCE OF OCT ANGIOGRAPHY TECHNOLOGY ZEISS Medical Technology has announced that its AngioPlex OCT Angiography is the first such technology to receive 510(k) clearance from the U.S. Food and Drug Administration. With a single additional OCT scan that takes just seconds on the CIRRUS HD-OCT system from ZEISS, ophthalmologists can now utilize optical coherence tomography (OCT) images to assess the blood vessels (vasculature) of the retina at a depth and clarity never available before. AngioPlex OCT Angiography delivers high-resolution, depth-resolved visualization of the separate layers of the retinal and choroidal vasculature – without the need for an injected contrast dye, as is standard with fluorescein angiography (FA). The information provided by these images is clinically impactful, because progression of retinal diseases is often accompanied by changes in the vasculature of the eye. In age-related macular degeneration (AMD), diabetic retinopathy, central retinal vein occlusion and other vascular conditions, AngioPlex OCT Angiography can complement traditional FA and become a safe and efficient part of routine eye care, potentially enabling earlier detection and management of micro-progressions. In addition, AngioPlex is powered by Optical Micro Angiography (OMAG) Algorithms to provide ultra-clear vascular images. OMAG is an image processing technique that takes full advantage of not only amplitude but also phase OCT signal data to deliver the highest-quality OCT angiography images. AngioPlex OCT Angiography is available on the CIRRUS 5000 HD-OCT platform , allowing ophthalmic practices the flexibility to easily integrate vascular imaging with standard OCT diagnostic imaging. • MEDICAL EQUIPMENT, PARTS & SERVICE

_OEM Updates

NEW DRX PLUS DETECTORS AVAILABLE IN U.S. AND EUROPE Carestream Health has introduced a third generation of DRX detectors that are faster and lighter than previous generations and offer a host of features to help users achieve higher productivity and improved image quality. The new Carestream DRX Plus 3543 and DRX Plus 3543C detectors have received FDA 510(k) clearance and are available in the United States and Europe. These detectors will soon be available in other countries as they receive regulatory approvals. Carestream’s DRX Plus 3543 Detector is designed for general radiography imaging while the DRX Plus 3543C cesium iodide detector offers benefits for pediatric and other dose-sensitive applications. The new generation of DRX Plus detectors continue Carestream’s design that enables each DRX detector to work with all other DRX systems within a provider’s environment. These detectors also can be inserted into almost any existing X-ray system to deliver enhanced functionality. “Our new detectors offer functionality designed to address health care providers’ current imaging challenges – everything from the need for enhanced image quality to faster availability of the full-resolution image and longer battery life per charge,” said Helen Titus, Carestream’s Worldwide Marketing Director for X-ray Solutions and Ultrasound. “Our ultimate goal has always been to help health care providers enhance patient care.” The new detectors offer higher DQE (detective quantum efficiency) to enable improved image quality and lower dose. In addition, the newly designed detectors can be submerged in one meter of water for 30 minutes without failure, which achieves IPX Level 7 rating for liquid resistance and the IEC standard 60529. A reduced weight and thinner profile allows even easier handling. Battery life has been significantly increased in the new detectors to enable more imaging between battery changes and a battery hot swap now allows a quick battery change without a reboot. •

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MEDICALDEALER 25

INDUSTRY UPDATE_OEM Updates

Staff Reports

HOSPIRA ANNOUNCES FIRST INSTALLATION OF PLUM 360 INFUSION SYSTEM WITH HOSPIRA MEDNET Hospira Inc. has announced the first instalMedNet drug library.” lation of the Plum 360 infusion system with Hospira is a leading provider of safety-foHospira MedNet at Shannon Medical Center in cused medication management systems. The San Angelo, Texas. The Plum 360 infusion sysPlum 360 infusion system includes unique tem, supported by the new Hospira MedNet features designed to address challenges that version 6.1 safety software, is the latest addition hospitals face daily as they work to improve the to Hospira’s portfolio of next-generation smart safety of intravenous medication administration. pumps. These include a secondary line that connects “Hospira is excited to partner with Shannon directly to the PlumSet cassette, enabling the Medical Center on the launch of the new Plum pump to be programmed with two compatible general infusion device,” said Cynthia Ansari, medications in either concurrent or piggyvice president, U.S. Marketing and Software, back delivery. The secondary line, delivered Medical Devices, Hospira. “This marks another through channel B of the pump, also integrates important step on Hospira’s journey towards with the electronic medical record (EMR) sysoffering the newest, most advanced line of infu- tems through Hospira’s IV-EMR interoperability sion devices available. Designed with close solution. The secondary line enables air manattention to the clinical needs of our customers, agement that does not require disconnecting the the Plum 360 infusion system delivers advanced line from the patient, which helps reduce the capabilities to enable clinical excellence, includ- potential for contamination. • ing automatic default into an enhanced Hospira

VARIAN MEDICAL SYSTEMS TO EQUIP CONSORTIUM WITH PROBEAM SYSTEM Varian Medical Systems has entered into an agreement with New York Proton Management LLC, a consortium of New York health care institutions, to operate The New York Proton Center, the first proton facility in New York state. Varian will provide the center, which will have four treatment rooms and a research room, with its ProBeam system, as well as 10 years of service for approximately $115 million. The center, which will be located in Manhattan, is expected to open for treatment in the first half of 2018. Varian expects to book the equipment portion of the order in the fourth quarter of this fiscal year with the remainder of the order to be booked in accordance with the company’s policies over the term of the agreement. Under an agreement with MM Proton I LLC, the project developer, Varian’s international subsidiary in Switzerland will provide $91.5 million in project financing, including a six-and-half-year $73 million senior first lien loan at 9 percent interest and a six-and-half-year $18.5 million subordinate loan at up to 13.5 percent interest. Other lenders for the $242.7 million in total project loans include JPMorgan Chase Bank, N.A. and an affiliate of The Goldman Sachs Group, Inc. The project facility is managed by Murphy & McManus, a Boston-based developer of health care and life science facilities and Norton Travis of NLT Advisors served as project coordinator on behalf of the consortium. “We are excited to be part of an innovative and cooperative initiative by leading cancer clinicians to provide patients in the New York area and around the world with the most advanced proton treatment capabilities,” said Dow Wilson, Varian president and CEO. Varian’s ProBeam system with Dynamic Peak Scanning is uniquely capable of high-speed intensity modulated proton therapy (IMPT) which is a precise form of proton therapy. The Varian installation will include its ARIA information management system and Eclipse treatment planning software. •

26 MEDICALDEALER | OCTOBER 2015

MEDICAL EQUIPMENT, PARTS & SERVICE

_OEM Updates

MEDLINE EXPANDS SOUTH CAROLINA PLANT An estimated five to 18 percent of health care workers have allergies to natural rubber latex. As such, a growing number of health care facilities are eliminating products made with latex. To support the increased demand in latex-free alternatives, Medline is expanding its Honea Path, South Carolina, production facility that produces a synthetic polyisoprene material called Isolex by 30 percent. The company is a global manufacturer and distributor of medical supplies and clinical solutions. This latest expansion represents the fourth since Medline began operations at this location in 2004. It is slated to come online in March 2016 and will create about a dozen new jobs for the area. “We are pleased to continue to be part of the Honea Path community and proud to create materials made in America while helping to support the country’s manufacturing workforce,” added Bottcher. •

GE HEALTHCARE RECORDS ANOTHER FIRST GE Healthcare is the first company ful screening program, and requires with a low dose computed tomography collaboration with imaging partners to (CT) lung cancer screening option that bring technology to bear for this puris cleared by the U.S. FDA for lung can- pose. The FDA’s clearance of these CT cer screening. scanners for this purpose illustrates Both the U.S. Preventative Services that commitment.” Task Force (USPSTF) and the Centers Physicians using low dose CT for for Medicare and Medicaid Services lung cancer screening will now have (CMS) recommend the use of low dose access to the benefits from a screening CT lung cancer screening for high-risk indication, including GE Healthcare’s individuals. new low-dose screening reference Additionally, Medicare has protocols. These new protocols are taiapproved insurance reimbursement lored to the CT system, patient size, for its beneficiaries who are eligible and the most current recommendafor the use of low dose CT lung cancer tions from a wide range of professional screening in high-risk patients. Early medical and governmental organizadetection from an annual lung cancer tions. Now, qualified GE Healthcare screening with low dose CT in highCT scanners can be confidently used risk persons can prevent a substantial by physicians within their FDA cleared number of lung cancer-related deaths. indications for use, delivering low “Bringing low dose CT screening dose, short scan times, and clear and to patients at a high risk for lung can- sharp images for the detection of small cer will reduce death from the most lung nodules. These nodules are critdeadly cancer worldwide,” said Dr. Ella ical in identifying lung cancer at its Kazerooni, chair of committee on lung earliest stages when it is the most cancer screening, American College of treatable and curable. Radiology. “Performing low dose CT The landmark National Lung with attention to high image quality at Screening Trial (NLST) was conthe lowest radiation exposure to detect ducted at 33 medical institutions with early cancer is at the core of a success- over 53,000 older, otherwise healthy WWW.MEDICALDEALER.COM

patients at high-risk due to smoking history. Half of the participants were screened using low dose CT, the other half were screened using chest X-ray. The trial demonstrated that the use of low dose CT screening decisively reduced the mortality rate from lung cancer by 20 percent compared to use of chest X-ray. The NLST also revealed a significant 6.7 percent reduction in the rate of death from any cause using low dose CT screening. All new 64-slice and greater CT scanners, and virtually all of the 16-slice CT scanners that GE Healthcare sells, are qualified systems and will include the screening option. The solution that GE Healthcare developed is also available to thousands of qualified GE scanners currently in use, increasing access to the quality scanners that satisfy both patient and physician needs. The new protocols are able to utilize GE Healthcare technologies such as ASiR, ASiR-V and Veo that are designed to reduce image noise, which is undesirable for physicians looking for small nodules. •

MEDICALDEALER 27

INDUSTRY UPDATE_Block Imaging

By Jordan Batterbee

DIGITAL MAMMOGRAPHY DETECTORS COMPARED

CESIUM IODIDE VS. AMORPHOUS SELENIUM

systems using α-Se detectors are generally found in a higher price bracket that may preclude facilities working under tighter budget constraints.

igital technology in general represents a step forward in mammography image quality from analog systems. Even so, there is a spectrum of image resolution levels within the digital set. One of the several determining factors in digital image resolution is the chemical composition of the detector. Two of the most commonly used compounds in digital mammography detectors are cesium iodide (CsI) and amorphous selenium (α-Se). Each of these compounds is used in one of two image capture methods: indirect X-ray conversion and direct X-ray conversion, respectively. Indirect Conversion Some of the earlier digital mammo models, such as the GE Senographe 2000D or the Fischer SenoScan use indirect conversion flat panel detectors made with cesium iodide (CsI). In these detectors, X-rays are converted in a two-step process. X-ray energy is collected by the CsI and converted into light photons. The light photons are then transmitted and converted to electronic signals by a photodiode array. This process is less efficient and results in some light scatter during conversion. This light scatter, in turn, can reduce image resolution. 28 MEDICALDEALER | OCTOBER 2015

Jordan Batterbee

Direct Conversion Later systems like the Hologic Selenia series or the Siemens Novation use direct conversion flat panel detectors made with amorphous selenium (α-Se). In these detectors, X-rays are converted in a one-step process. The layer of α-Se in the detector absorbs the X-ray energy and converts it to an electronic signal directly (hence the name). Based on the efficiency of direct conversion and its elimination of light scatter, α-Se detectors are able to offer the advantage of higher image resolution than panels using indirect conversion through CsI. The disadvantage of direct conversion systems is their price. Because the technology is newer and provides higher quality images,

The Takeaway When it’s all said and done, if a piece of medical imaging equipment is FDA-approved for use with patients, it is capable of producing diagnostic-quality images. CsI panels and α-Se panels both fit the bill in that regard. Digital mammography systems using CsI detectors are reliable, affordable, still very common, and certainly more efficient than analog systems. However, better image quality reduces the likelihood of repeat scans and false positives. Given the sensitive nature of the screenings mammography equipment is generally used for, this reduction empowers a facility to provide a better, more consistent level of care for patients. If your facility’s capital equipment budget has enough room for it, the purchase of a mammography unit with an α-Se detector is a consideration that is well worth your time, for image quality and an improved patient experience.

JORDAN BATTERBEE is the Content Manager at Block Imaging.

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PRODUCT FOCUS_Radiology_Market Analysis

Staff Reports

MAMMOGRAPHY DEVICES MARKET TO EXCEED $980 MILLION

reast Cancer Awareness is at an all-time high thanks to the marketing idea to adopt the color pink to call attention to the fight against this sometimes fatal disease. The campaign has brought about awareness, served to raise funds for breast cancer research and powered innovation for more advanced tools to detect, diagnose and fight the disease. “Substantial support for breast cancer awareness and research funding has helped improve the screening and diagnosis and advances in the treatment of breast cancer. Breast cancer survival rates have increased, and the number of deaths steadily has been declining, which is largely due to a number of factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease,” according to the Mayo Clinic website. A recent report by Research and Markets indicates that the global mammography market will exceed $980 million by the conclusion of 2020. “The global market for mammography devices is poised to reach $983 million by the end of 2020 growing at a CAGR of 5.6 percent,” according to the report. “Mammography is a detailed type of imaging that customs a low-dose X-ray system to inspect breasts. A mammography exam, called a mammogram, is used to support in the early detection and diagnosis of breast diseases WWW.MEDICALDEALER.COM

in women. An X-ray (radiograph) is a noninvasive medical test that helps physicians analyze and treat medical conditions. Imaging with X-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging. Three recent advances in mammography include digital mammography, computer-aided detection and breast tomosynthesis.”

intelligence provider GBI Research. The report states that the U.S. will continue to hold the dominant share, with its overall market value forecast to exceed $925 million by 2020. Furthermore, U.S. 3D systems revenue will rise from $99.2 million in 2013 to just over $757 million by 2020, representing an “impressive” compound annual growth rate (CAGR) of 34 percent, while 2D systems sales will decline at a negative CAGR of 4 percent.

U.S. sales of 3D systems will increase yearon-year during the forecast period and will overtake the falling 2D market next year, according to the GBI report. These advances in mammography technology will help fuel the market as health care facilities upgrade to more advanced devices in the fight against breast cancer. A similar report by GBI Research expects even more growth in the mammography market. “The Americas’ mammography systems market value will increase from approximately $390 million in 2013 to $1.1 billion by 2020, driven primarily by the uptake of 3D systems in the U.S. and healthy demand for 2D systems in Canada, Mexico and Brazil,” according to business

“The remarkable expansion of the U.S. market will be caused by continuous replacement of 2D systems with 3D systems,” Srikanth Venkataraman, Senior Analyst for GBI Research, said. U.S. sales of 3D systems will increase year-on-year during the forecast period and will overtake the falling 2D market next year, according to the GBI report. The gap will continue to widen thereafter, although the U.S. 2D space will still be worth over $168 million by 2020, more than the entire Canadian and Mexican mammography markets combined. MEDICALDEALER 31

PRODUCT FOCUS_Radiology_Product Showroom

Staff Reports

OCTOBER PRODUCTS : This month, Medical Dealer explores Mammography.

HOLOGIC Genius™ 3D Mammography™

enius™ 3D Mammography™, available only on the Hologic Selenia® Dimensions® system, is the first 3D mammography (breast tomosynthesis) exam approved by the FDA as clinically superior to traditional mammography. Genius 3D exams are clinically proven to significantly increase invasive cancer detection while simultaneously reducing unnecessary patient recalls. With Genius 3D, doctors are able to scroll through images of the breast like pages of a book and see fine individual details more clearly, no longer hidden by overlapping tissue. As a result, doctors are finding invasive cancers earlier when they are easier to treat and fewer women are called back for additional testing. • 32 MEDICALDEALER | OCTOBER 2015

MEDICAL EQUIPMENT, PARTS & SERVICE

Mammography_Product Showroom

FUJIFILM Aspire Cristalle

spire Cristalle combines Fujifilm’s extensive research, expertise and experience to offer a new, advanced digital mammography system that optimizes image contrast and dose across all breast types. Aspire Cristalle is an excellent choice when considering investing in your next full-field digital mammography system. Aspire Cristalle’s innovative technology is designed to increase detector life, help improve technologist throughput, and ensure consistently high-quality images. Fujifilm’s renowned uptime is backed by 24/7 remote monitoring and diagnostic services For more information, visit: www.fujimed.com •

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MEDICALDEALER 33

PRODUCT FOCUS_Radiology_Product Showroom

Staff Reports

GE HEALTHCARE SenoClaire3D Mammography

enoClaire digital breast tomosynthesis allows visualization of breast lesions and microcalcifications without increasing the dose compared to a 2D exam. Every day, more and more radiologists make the choice to offer a healthy breast tomosynthesis to their patients with the only FDA-approved digital breast tomosynthesis with the same low dose as a 2D FFDM exam. The step-andshoot tube motion preserves sharpness and avoids image blur. SenoClaire grid in 3D reduces scattered radiation while preserving dose and performance. SenoClaire images are compatible with major PACS systems. â&#x20AC;˘

34 MEDICALDEALER | OCTOBER 2015

MEDICAL EQUIPMENT, PARTS & SERVICE

Mammography_Product Showroom

CARESTREAM Vue Mammo

arestream’s Vue Mammo workstation and Vue PACS allow reading of traditional mammograms, breast ultrasound, breast MRI, digital breast tomosynthesis (DBT) or general radiography exams from a single desktop. Carestream’s DBT module includes improved workﬂow capabilities and the display of DICOM-compliant 2D synthetic views that are generated from the 3D dataset. A new slabbing tool combines slices of a DBT series, while allowing the user to choose different rendition modes and slab thicknesses. In scientific studies, radiologists have reported that this capability can help visualize calcifications and decrease reading time. •

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MEDICALDEALER 35

PRODUCT FOCUS_Radiology_Product Showroom

Staff Reports

SIEMENS HEALTHCARE MAMMOMAT Inspiration with Tomosynthesis Option

he breast tomosynthesis add-on option for the MAMMOMAT Inspiration and MAMMOMAT Inspiration PRIME Edition digital mammography systems uses an algorithm that reconstructs multiple 2D breast images into an approximation of a 3D image to enable detection of tumors hidden by overlapping breast tissue. In tomosynthesis mode, the MAMMOMAT Inspiration X-ray tube rotates in a circular motion around the breast to acquire an image every two degrees while moving through an angular range of 50 degrees; the resulting 25 projections are reconstructed as 3D digital breast tomosynthesis images. â&#x20AC;˘

36 MEDICALDEALER | OCTOBER 2015

MEDICAL EQUIPMENT, PARTS & SERVICE

PRODUCT FOCUS_Radiology_Preferred Vendors

Staff Reports

PREFERRED VENDORS

MAMMOGRAPHY

Classic Diagnostic Imaging, LLC 1333 Highland Road, Ste. F Macedonia, OH 44056 Toll-Free: 866-818-9729 Phone: 330-425-4400 Fax: 330-425-4525 Email: sales@classic-imaging.com Website: www.classic-imaging.com

SEE OUR AD ON PAGE 39

Classic Diagnostic Imaging is a world leader in medical device refurbishment and repair. Classic offers an extensive inventory of quality used and refurbished parts and equipment. Our focus includes Mammography, Rad/Flouro, and portable units across all major manufacturers. From free tech support to rapid-fire response, Classic simply redefines medical service.

SEE OUR AD ON PAGE 38

DigitecMedical 753 Winer Industrial Way, Ste. F Lawrenceville, GA 30046 Phone: 770-995-0050 Fax: 770-995-8553 Email: info@digitecmedical.com Website: www.digitecmedical.com Digitec Medical is a different kind of after-market medical equipment company because we focus exclusively on mammography. That focus makes us the ultimate resource for mammography sales, service, and parts.

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SEE OUR AD ON PAGE 47

J & M Trading, Inc. 409 Space Park North Goodlettsville, TN 37072 Toll-Free: 866-568-7234 Phone: 615-851-4229 Fax: 615-851-1842 Email: SmartMedSolutions@gmail.com Website: www.jandmtrading.com 35,000 square feet of quality tested parts, tubes, systems and ideas for diagnostic imaging, including but not limited to: X-ray, CT, MRI and NucMed. We provide repairs and deinstallations, and tube reprocessing. Continuous 24x7/365 customer service. All parts warrantied and ready to ship same day. Competitive pricing and discounts throughout the year.

Metropolis International LLC Leon Gugel 21-11 44th Avenue, 3rd Floor Long Island City, NY 11101 Phone: 718-371-6026 Fax: 718-371-6032 Email: info@metropolismedical.com Website: www.metropolismedical.com

SEE OUR AD ON PAGE 65

Metropolis International LLC is one of the largest stocking dealers of all types of quality pre-owned diagnostic imaging equipment. With over 45 years of combined industry experience, we work with all X-ray, C-arms, CT, Mammography, DEXA, MRI, Ultrasound systems. Located in New York, in a large warehouse, we provide Vendors, Dealers and End-Users, with equipment and services that are second to none!

MEDICALDEALER 37

PRODUCT FOCUS_Radiology_Preferred Vendors

Multi Diagnostic Imaging Solutions 990 E. Cedar Street Ontario, California 91761 Toll-Free: 800-400-4549 Phone: 909-591-6444 Fax: 909-591-5293 Email: sales@multiimager.com Website: www.multiimager.com

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Staff Reports

TROFF Medical A Subsidiary of Helms Enterprises, Inc. 2 Stoney Nob Drive Hendersonville, NC 28792 Toll-Free: 800-726-2314 Phone: 828-697-1086 Fax: 877-727-1764 Email: parts@troffmedical.com Website: www.troffmedical.com

SEE OUR AD ON PAGE 61

Founded in 1983, Multi Imager specializes in the latest TROFF Medical houses more than 25,000 in-stock, x-ray, imaging technologies including PACS, DR, CR, X-Ray, CT, portable x-ray, C-arm, R&F, radiographic, CT, MR, nuclear C-Arms as well as a full line of surgical equipment for outmedicine, and mammography system parts for Philips, fitting today’s modern operating rooms including tables, PROOF APPROVED CHANGES NEEDED General Electric, Picker, Siemens, Lorad and OEC. We are lighting, sterilization and much more. committed to providing high quality medical and imaging • Sales of New and Refurbished CLIENT SIGN–OFF: parts at a fraction of the OEM prices. TROFF Medical is • Rental Programs & Financing highly tested…always trusted. • Factory Trained & Certified PLEASESupport CONFIRM THAT THE FOLLOWING ARE CORRECT • Technical • Training LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR • Parts

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PRODUCT FOCUS_Med/Surg_Product Showroom

Staff Reports

OPERATING TABLE MARKET EXPECTED TO GROW

perating tables are a basic and important part of health care delivery around the world. An increased worldwide awareness of the need for quality health care as well as the increased life spans of individuals in developed nations are among factors that attribute to the growing number of surgeries being performed each year. The operating table market is a segment of the global operating room equipment market that continues to show growth. Researchers predict the market will continue to reach new heights through 2020. “The global operating room equipment market is growing substantially due to increasing investment in research and development for the expansion of technologically advanced equipment, rapid transformation from conventional to hybrid operating rooms and growing medical tourism in emerging economies,” according to a report from P&S Market Research. “Massive unexplored market in operating room equipment industry of developing economies are creating ample opportunities for the operating room equipment market to grow at a considerable rate in coming years.” “The advanced research and development facilities, and innoWWW.MEDICALDEALER.COM

“Specialty operating tables are expected to grow at the faster rate during the forecast period due to increasing demand for specialty operating tables.” vative product developments by the companies are propelling the growth of the operating room equipment industry. Operating rooms are exclusively tailored rooms in a hospital to execute surgical operations and boost better patient care,” the report adds. “In addition, technologically advanced equipment enhances operational efficiency by endowing health care professionals and surgeons. It comprises of especially designed equipment, such as operating tables, operating room lights, high-resolution and high-definition surgical imaging displays, and surgical booms.” The operating table segment of the overall operating room equipment market is expected to see growth over the next five years powered by new advances and an increase in the number of surgeries being performed. The operating tables segment of the market is also the largest in terms of market size, according to P&S Market Research. “Operating tables are further segmented on the basis of types as

standard operating table and specialty operating tables. Specialty operating tables are expected to grow at the faster rate during the forecast period due to increasing demand for specialty operating tables,” according to the report. In addition, an increasing number of ambulatory surgical centers, an increasing prevalence of chronic diseases, and increasing health care expenditure are also stimulating the growth of the operating table market. However, the high cost of tables and equipment and the presence of alternatives, including refurbished or used operating room tables, are limiting the growth of the overall operating room equipment market to some extent, according to P&S Market Research. Geographically, North America will be leading the global operating room equipment market in the coming years, due to demand created by the increasing number of operating rooms and the introduction of technologically advanced equipment. MEDICALDEALER 41

PRODUCT FOCUS_Med/Surg_Product Showroom

Staff Reports

OCTOBER PRODUCTS : This month, Medical Dealer explores Operating Tables.

SKYTRON 1602 Essentia

he 1602 Essentia provides 180° top rotation, thereby achieving extensive surgical and imaging access at the head and foot end of the table. A simple turn of the handle rotates the table independent of the base – allowing for quick imaging set-up when the C-arm is stationed at the foot end of the table. The table also features one-touch positioning options such as 90° back-up, 500-pound articulation capacity and seamless integration with accessories. Battery power assures operation even in case of power loss. This versatile and high-performing surgical table is an ideal solution for a diverse range of operating rooms and surgery centers. •

42 MEDICALDEALER | OCTOBER 2015

MEDICAL EQUIPMENT, PARTS & SERVICE

Operating Tables_Product Showroom

STRYKER OPERON D860

he OPERON D860 offers exceptional lift capacity and height adjustment to accommodate almost any working level, allowing for gentle patient positioning and safety no matter the surgical discipline or body type. Key benefits include an industry-leading patient weight capacity of 1,250 pounds and the greatest vertical range on the market with a 22.6-inch minimum height and a 46.4-inch maximum height. The D860 offers a lateral imaging window of 18.3 inches with carbon fiber table surface construction, multiple therapeutic surface options and InstaDriveâ&#x201E;˘ increases mobility and maneuverability. â&#x20AC;˘

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MEDICALDEALER 43

PRODUCT FOCUS_Med/Surg_Product Showroom

Staff Reports

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"These just aren’t radiographic procedures that we’re doing, these are procedures with people with real complaints, real diseases, and they always need to keep that patient at the forefront of their mind."

48 MEDICALDEALER | OCTOBER 2015

MEDICAL EQUIPMENT, PARTS & SERVICE

GETTING TO THE BOTTOM OF

LOW-DOSE PRACTICES BY MATT SKOUFALOS

In the decades since the build-out of the medical imaging infrastructure in the United States, the question of accessibility to services has followed closely analysis of the amount of ionizing radiation administered to patients via CT scans, X-rays and other medical imaging procedures.

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MEDICALDEALER 49

LOW-DOSE PRACTICES

cording to the study “Ionizing Radiation Exposure with Medical Imaging,” by Edward B. Holmes, 85 percent of the annual average dose

of ionizing radiation experienced by the worldwide population comes from natural, background sources; the remainder is “almost exclusively provided by medical ionizing radiation.”

That means the last 15 percent is also the quotient that people have more of a shot at managing, which the medical imaging community has done for some time through professional training and public safety programs. One of the more prominent efforts is Image Wisely, the dose optimization public safety campaign launched by the American College of Radiologists (ACR) and the Radiological Society of North America (RSNA). Image Wisely started in 2010 as an effort to lower “the amount of radiation used in medically necessary imaging studies and [to] eliminate unnecessary procedures,” according to the program. Dr. James Brink, Radiologist in Chief at Massachusetts General Hospital, was one of its founding co-chairs. Along with that endeavor, the ACR has worked to broaden adoption of best practices for radiation dose management through data-driven as well as marketing approaches, including the ACR Dose Index Registry, which guides appropriate use of medical imaging through “the power of pooled data,” Brink said. The ACR Dose Index Registry was launched in May 2011. It aggregates a DICOM feed of patient-specific dose data from participating sites throughout the medical imaging 50 MEDICALDEALER | OCTOBER 2015

community in the United States, and allows facilities that contribute to the database to compare their specific information with those of others. As of February 2015, information on 24.4 million CT scans had been reported by 787 participating facilities. The data allows comparisons among peer institutions broken down by such dichotomies as rural and metro areas, private and academic settings, and geographic regions, which highlights the relative performances of facilities throughout the country. Even for top-of-the-line institutions, Brink said, the findings were astonishing. “At MGH, we pride ourselves on being very dose-conscious,” Brink said. “When we entered the registry, we discovered a couple exams that showed that we needed to review and revise our protocols. “In a recent study of registry dose data from CT scans for kidney stones, only two percent of exams performed nationally were performed with a ‘low dose’ as defined previously,” Brink said. “The registry was valuable in calling attention to how we’re doing with dose reduction efforts as a country.” The difficulty in examining the data, Brink determined, is that there’s no set of extrapolations they provide

that might ultimately shape the way hospitals and imaging centers handle imaging dose protocols. The information is useful for painting a national picture of how scans are done and for identifying areas in which the low-dose guidelines are being followed – but just observing that they aren’t being followed in one place or another doesn’t automatically identify any specific set of issues. Rather, it may lead observers to conclude any of a number of things about the installed technology base in a given area, some idiosyncrasies about the nature and volume of patient studies ordered, or even the level of education of some of the imaging professionals in a given region. What the data did show, in Brink’s estimation, is the need for the country to become more aggressive in its approach to dose reduction, the better to comprehensively address the issue. One complicating factor is America’s national obesity epidemic. Because adipose tissue requires a higher level of radiation to penetrate, he said, imaging dose is more intense for areas of dense tissue. For exams that produce the same level of image noise, he said, the dose difference between a 60-kilogram and a 100-kilogram individual increases exposure to ionizing radiation threefold, and the dose to the internal organs twofold. Another consideration is the difficulty physicians can have identifying a health issue with low-dose imaging when they fear a more serious diagnosis might be missed. “Surveying data in the registry, my hypothesis is that fear of missing important findings is the most likely reason why people may be hesitant to adopt a low-dose protocol,” he said. “One way to approach this is to create two protocols: one that’s a standard dose and one that’s low-dose.” MEDICAL EQUIPMENT, PARTS & SERVICE

In discovering kidney stones, for example, only 2 percent of physicians used a low-dose scan, according to the dose index registry, “because people don’t want to risk missing a critical diagnosis, such as appendicitis, for which a low-dose scan may not be diagnostic,” he said. “If you come to the ER and you have severe pain in your abdomen, and it’s unclear whether you’re passing a kidney stone or you have appendicitis or diverticulitis, many radiologists are hesitant to reduce the dose,” Brink said. “A low-dose scan is fine for kidney stones because it’s easy to find them on a noisy image. To have a different protocol for

radiation on patients, staff and practitioners. As the Assistant Director of Environmental Health and Safety at North Carolina State University in Raleigh, North Carolina, Orders helps to design and implement safety protocols that form a basis of education for the next generation of imaging professionals. She is most concerned that the advent of automated processes on low-dose-configured scanners can create a false sense of security if technologists who operate such equipment only rely on the devices’ default settings. Because linear, non-threshold, low-dose radiation is too low to have discernible effects, she said, the concern

radiation was as low as it could have been. That assumes the system itself is working the way it’s supposed to. In my opinion, you should question the cogs in that system, operationally. If you don’t rely on a computer algorithm to correct a final image, you had to understand the technology and the tools to do it.”

“In a recent study of registry dose data from CT scans for kidney stones, only two percent of exams performed nationally were performed with a ‘low dose’ as Dr. James Brink

patients who have known stone disease would help, because stones can be seen reliably using a lower dose.” BUTTON-PUSHERS VERSUS TRAINED PROFESSIONALS Dr. Amy Orders spends a lot of time considering the question of how best to mitigate the impact of ionizing WWW.MEDICALDEALER.COM

deﬁned previously." for safety experts becomes whether technology that promises a low dose of ionizing radiation could nonetheless inadvertently expose patients to additional or unnecessary radiation. “If it’s algorithmically corrected, then a radiologist is going to see it as an acceptable film,” Orders said, “but that doesn’t mean that the actual

Supplemental professional campaigns like Choose Wisely and Image Gently are valuable tools in and of themselves, Orders said. But they’re only as useful as they can be when everyone involved in the delivery of an imaging study – from the requesting physician to the patient to the technologist administering the scan MEDICALDEALER 51

LOW-DOSE PRACTICES

"In my opinion, you should question the cogs in that system, operationally. If you don’t rely on a computer algorithm to correct a ﬁnal image, you had to understand the technology and the tools to do it.”

– is clued into his or her role in the process to mitigate risk. To fill in those gaps, Orders said that training in ALARA processes is imperative. ALARA stands for “As Low as Reasonably Achievable.” It’s a radiation safety standard that bridges employee behavior, supervisory oversight, and patient advocacy – or, as Orders said, which has “both people components and administrative components.” “ALARA is minimizing anything that can go into repercussions from radiation,” she said. “It’s the patient, the staff, the faculty, the public behind the walls. Minimizing radiation dose has different contexts for different people. It’s a series of things that have to go together [and] the three different levels should have three different responsibilities.” All dose mitigation and optimizing practices are couched in some basic mantras, Orders said: minimizing time on the table, maximizing 52 MEDICALDEALER | OCTOBER 2015

distance from the source of the radiation, and maximizing shielding from the radiation. To minimize the dose of radiation issued also implies that stakeholders are maximizing the situation, she said; “doing everything they can to protect themselves.” Whether interrupting or cancelling a study that would exceed safety thresholds, being aware of posted signage in radiation areas (and following their instructions), or familiarizing themselves with the latest published literature on dose safety, stakeholders in the imaging suite should be prepared to check their assumptions at the door and engage in dialogue. “Having a few moments to educate yourself is one of the harder parts of ALARA,” Orders said. “There’s this big discrepancy between the people who know how the machine works and the people who work the machine. They may have gotten a two-hour in-service but they just were told, ‘Push button A’

Amy Orders

because the button correlates with A, B, and C.” At the heart of the matter, Orders believes, is a tension between the need to deliver reproducible results and the push for personalized, patient-centric, outcome-focused medicine. Complicating the issue is a relentless desire to optimize system processes, not only to compete with the throughput demands of a busy imaging department, but also to make the complex equation of operating such a facility economically feasible. “It takes more effort on an administrative side,” she said. “If you’re trying to get people through in a timely fashion, quality can suffer. When the systems are set up correctly … the human error factor is minimized.” BUILDING BETTER HABITS Julie Gill, Department Chair and Associate Professor in the Allied Health Department at University of MEDICAL EQUIPMENT, PARTS & SERVICE

Cincinnati Blue Ash College, said that the only way she knows to prepare her students to comply with ALARA best practices is by certifying that they comprehend the basic tenets of patient safety and image capturing throughout the course of their education, and then building upon those central supports by constantly returning to them. “We continually emphasize radiation protection and quality communication, because if there’s going to be any breakdown with the patient, it’s going to be because somebody didn’t tell someone something,” Gill said. “We emphasize communication with the patient – so much so that we do have scripts that we ask students to use in certain situations.” The first thing a technologist should do is check to certify that a study requisitioned matches the patient’s chief complaint, Gill said. “It’s amazing how often it doesn’t coincide, and if we as technologists go ahead with that, we do a procedure on a patient that doesn’t need to be done,” she said. “It’s as simple as saying ‘Why are you here today?’ ” “Patients don’t realize that they can refuse the X-ray or that they can ask for other options,” she said. “Ultrasound and MR don’t use any ionizing radiation whatsoever. They may take a little longer, but they can provide the same diagnosis without ionizing radiation.” From there, technologists are educated to inquire about the pregnancy status of their patients to assure that no fetal radiation exposure occurs. Some of those inquiries can lead to “a confidential or very private meeting with the patient,” she said. “We communicate; we emphasize that these just aren’t radiographic procedures that we’re doing, these are procedures with people with real complaints, real diseases, and they WWW.MEDICALDEALER.COM

always need to keep that patient at the forefront of their mind,” Gill said. “In today’s world of maximizing productivity with reduced staff, some of that just gets forgotten.” Gill’s next priority with her students is certifying their understanding of the techniques that coincide with producing a quality radiographic image. Far from being button-pushers, she said, students must comprehend that “voltage and amperage do different things inside that X-ray tube, and they influence the image, and we control those.” Spending time with the students to make sure that they know how to set those controls helps them get an image that is “not too grainy, not too blotchy,” she said. “We teach the student the things that they have control over, like collimation, [which is] making the field size as small as possible and providing a quality image,” Gill said. “Using the correct image receptor; again, that sounds very rudimentary, but the size and type of image receptor influences the quality of the radiographic image. Shielding the patient. Providing the patient with correct instructions. Explaining the exam so they know exactly what we’re doing and why we’re doing it; sitting still, holding their breath, not moving.” “All of these we’re doing to help avoid repeat images,” Gill said. “That helps to reduce radiation exposure and lowers the dose. If we can get into the students’ heads that ‘I need to do this routinely,’ then before we even get into patient dose, we can say, ‘I’ve got this covered.’ ” Gill, like Orders, is a firm advocate of certification and re-training programs to help keep imaging professionals abreast of technological and process changes in what is a very dynamic field. Technologists who grew up with film screens and who

now use digital imaging may not have mastered the educational theory behind digital imaging or low-dose technologies, she said. Fortunately, the American Registry of Radiologic Technologists (ARRT) has decided to put a 10-year cap on the professional certifications of technologists who took their exams on or after January 1, 2011. Three years before their certifications would expire, technologists are required to take a continuing qualification requirements (CQR) self-assessment based on the current content specifications of the certifications they hold. If that self-assessment reveals deficiencies, then the ARRT provides the technologist with suggestions and requirements to access some continuing education related to the identified deficiencies. “My assumption is some of those deficiencies will be in the theory and science of digital imaging,” Gill said. “Then those technologists will need to get some sort of current education that is approved by the ARRT to educate them on the equipment they are currently using.” “That is our certification agency saying, ‘We know once you’re certified, you’re not necessarily always competent. Imaging technology changes more than any other allied health field. We’re going to help you stay current,’ ” she said. MEDICALDEALER 53

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CORPORATE PROFILE

ELITE BIOMEDICAL SOLUTIONS

he Mission of Elite Biomedical Solutions is to provide the medical community cost-effective solutions for

their clinical needs by collaborating with hospital biomed departments to identify key replacement parts and, in turn, engineer a higher-quality, less-expensive alternative.

HEALTH CARE MARKETPLACE Elite Biomedical Solutions is honored to be a part of the health care marketplace and to help play a significant role in this industry. Health care professionals serve our family members, friends, and all of those in need of health care daily. We are grateful and thankful for their service and commitment. HUMBLE BEGINNINGS Elite Biomedical Solutions’ story is yet another American success story in the making. Elite started in the basement of a co-owners’ home, with eight employees and a commitment to one another to build something great. These eight employees worked together at a previous company that closed and together they chose to continue to grow their vision. In just three years, they have doubled their size to 16 employees and moved into a new 10,000-square-foot corporate 56 MEDICALDEALER | OCTOBER 2015

office. Additionally, they have two depot repair centers to help assist their customers’ repair needs. They also offer a large infusion pump product portfolio, have established trusted business partners, and have built strong customer relationships. With a strong faith foundation, Elite’s owners are driven by a desire to serve their employees, customers, business partners, and communities. “We strive to improve the lives of our employees, customers, business partners, and communities one day at a time.” WHO THEY ARE Elite Biomedical Solutions supports hospital biomedical departments with new infusion pump replacement parts, re-certified parts, on-site services, and repairs that keep clinical equipment performing at optimal levels. Currently, their focus is in the area of infusion pumps, but is evolving

quickly into new modalities based upon their customers’ requests. EBS offers one of the largest (infusion pump) replacement parts portfolio, meeting the challenges and needs of an expansive base of health care customers. “What sets us apart is our emphasis on collaboration – working closely with hospital biomedical technicians, independent service organizations, homecare providers, and distributors to create innovative solutions that improve equipment uptime,” Vice-President/Co-Owner Nate Smith said. The Elite team has a vast amount of experience in the health care industry (specifically IV therapy, manufacturing, quality, and product development engineering). The executive team has extensive health care leadership experience, in strategic acquisitions, in manufacturing, in quality, and in product development. The company finds itself serving an industry that is looking for their blend of expert experience. Vice-President/ Co-owner Nate Smith attributes the company’s early success and continued advancement in a shifting health care landscape to the company’s mission of customer collaboration, its outstanding employees, and its expert insights. This three-pronged approach MEDICAL EQUIPMENT, PARTS & SERVICE

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“We strive to improve the lives of our employees, customers, business partners, and communities one day at a time.”

provides security and a peace of mind to its growing list of satisfied customers. Quality engineering, design engineering, and product development engineering are three vital aspects of the company’s approach to serving health care professionals and supporting the nation’s heath care industry. The company’s greatest expenditure of both time and investment goes into these three critical aspects of the company. “We continue to advance our in-house reverse engineering capabilities, metrology inspection, and design capabilities with the acquisitions of the latest technology available in the market. Our quality control and manufacturing teams WWW.MEDICALDEALER.COM

utilize the best manufacturing practices available in our day-today operations, inspecting and performing rigorous testing to verify functionality and conformance to the specifications,” Nate Smith said. Additional testing is performed following the specific manufacturer’s instructions for product compliance and acceptance, which can be found in their service manuals’ acceptance criteria. “Our customers can have absolute confidence that they are working with a partner that maintains product reliability and customer satisfaction, keeping patient safety always as our primary focus,” President/Co-owner Jeff Smith said. “With that said, we have learned very quickly the

challenges that come along with this responsibility and accountability, in meeting our patient safety focus.” THE REAL HEROES Elite Biomedical Solutions says their heroes are their talented employees. “We have the right employees on this team,” Nate Smith said. “They consistently overachieve and are passionate about quality, company values, and our customers. In addition, they care for one another and are driven to build something great. To put it simply, the Elite team truly believes in what they are doing and are a direct reflection of the company’s signature tagline: ‘Real Needs. Real Partnerships. Real Solutions.’ ” MEDICALDEALER 57

CORPORATE PROFILE SPECIAL ADVERTISING SECTION

OUR VALUED CUSTOMERS Elite Biomedical Solutions, would like to thank their customers. “It is an honor to work with you to meet all of your replacement parts’ needs,” Nate Smith said. “We are priviledged to work with such outstanding individuals as well as organizations. Our company realizes, you have a choice when making your purchasing decisions and are greatly appreciative that you have chosen us to help meet those needs. Together, we can continue to focus on high-quality, cost-effective solutions to better serve our health care community!” WHAT IS NEXT FOR ELITE The growth and continued success add to the excitement at Elite Biomedical Solutions. This young company continues to add new customers, employees, and business partners while exceeding their expectations on sometimes a daily basis. Managing growth has been their largest obstacle. They are already closing in on maximizing their new corporate office space. “We will continue to hire the right talent, improve our customer relationships, and to advance in all areas with the latest and greatest technology,” Nate Smith added. ELITE GIVES BACK “We live in the greatest country in the world. Sometimes, we have more opportunities in one year, than many people from less fortunate countries have in a lifetime. With this privilege, should also come responsibility and generosity to do more for one another, especially for those less fortunate than ourselves.” President/Co-Owner Jeff Smith said. 58 MEDICALDEALER | OCTOBER 2015

Elite Biomedical Solutions, is using its success to help others by giving back to the community. They have established Elite GIVES BACK, a program that is involved with several different charities and foundations. Here is just one example: “Pancreatic cancer research is near and dear to our hearts here at Elite Biomedical Solutions,” Nate Smith said. “Don Swett, one of our initial investors, who was a stepfather, and a stepgrandfather to some of the employees here, lost his battle to pancreatic cancer

in November 2014. In honor of him, Elite Biomedical Solutions supports research efforts to combat this deadly disease. Don believed in our vision and it was his belief in us that helped launch our company.” FOR ADDITIONAL INFORMATION ABOUT ELITE BIOMEDICAL SOLUTIONS, visit www.elitebiomedicalsolutions.com. The company will be exhibiting at MD Expo in Las Vegas, October 21st-23rd. Please stop by Booth 402 to find out more about the company. MEDICAL EQUIPMENT, PARTS & SERVICE

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SLICE OF LIFE_The Other Side

By Jim Fedele

OBSOLETE? O

ne of the great values a good Biomed program brings is the ability to keep equipment running long after the manufacturer deems it obsolete. In the past it was not uncommon for equipment to be 10 to 15 years old before manufacturers stop supporting it. However lately I have experienced many issues with equipment that is five years old or less. For example, recently an OR table developed a minor leak and needed some attention. My tech who normally works on the equipment was on vacation so we opted to call the vendor in to take a look at the problem. The field service rep came in and found the issue; a hydraulic line had developed a leak and needed to be replaced. However, the hydraulic system in the table was declared obsolete by the OEM and he could no longer get the part. I was surprised, as we had purchased the same model table less than a year ago. When I asked him about it he said they changed the hydraulic system about five years ago. I was a little frustrated as the company never communicated this to me and now we are faced with purchasing a new table for $30,000. At this point I asked if he could give me the bad line so I could see if we could find one ourselves. I did a quick Internet search and found a local company that specialized in hydraulics. I took the 64 MEDICALDEALER | OCTOBER 2015

In the past, I would start telling customers to start planning for replacements when equipment was eight years old. I knew, that in most cases, we could get a solid 10 years out of a device. Now, I feel like we need to start talking at year five. line in to them and they built me a new line in three days. The cost of the new line was $50 and it works perfectly â&#x20AC;&#x201C; problem solved. The second issue that occurred was with a rather new monitoring system. Due to some catastrophic failures with some in-room monitors I was finally able to convince the department manger to budget for some backup equipment for this year. I secured a quote from the OEM, pushed the capital request paperwork though our process and the new monitors arrived as ordered. My team and I were very happy to have the backup set of monitors to help eliminate shutting down a patient room due to a broken monitor. However, we would soon be disappointed. To our surprise, the new monitors came with a new version of software that was not compatible with the other monitors in the unit. Unfortunately we found this out while trying to replace a monitor that had failed. I

immediately expressed my frustration to the salesperson, his boss and the service manager. I explained to them that given the $1.5 million we have spent with them this needs to be rectified as soon as possible. After a half dozen meetings, they agreed to update the software on all our monitors to make them compatible with the backup equipment. We were purchasing another 27 monitors for another project and we used that purchase as leverage. We are in the process of kicking off the software upgrade. I am hopeful it will solve our problem and allow us to use our newly acquired backup equipment. These two issues have proven that my old process of just looking at the age of equipment is no longer good enough to plan for equipment obsolescence. In the past, I would start telling customers to start planning for replacements when equipment was eight years old. I knew, that in most cases, we could get a solid 10 MEDICAL EQUIPMENT, PARTS & SERVICE

_The Other Side

BEST CHOICE IN IMAGING SYSTEMS years out of a device. Now, I feel like we need to start talking at year five and anything that relies on software may need to be upgraded or replaced sooner. I know this is going to be frustrating for customers because in some instances the department is just becoming proficient and comfortable with the monitors around year four or five. These situations also make utilizing the secondary market for repair parts to extend the life of equipment more difficult. When the software is not backward compatible it makes finding replacement equipment very difficult. The software level can also make it difficult to find replacement parts on the secondary market. The secondary market is always what I use to purchase parts for equipment that is not supported by the OEM. I am not sure how I will mitigate these issues in the future. I know I will still try using the secondary market for parts, but I’m not sure how I can keep customers informed about potential issues. I consider asset planning to be one of the most important aspects of a good biomed department. I will need to alter my methods for evaluating equipment for replacement in the future. If you happen to have any ideas please feel free to share your ideas. JIM FEDELE, CBET, has been with Medical Dealer magazine for more than 12 years. He is currently the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/or comments by email at info@mdpublishing.com.

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SLICE OF LIFE_Off The Clock

By Matt Skoufalos

CARISSA PIETZSCH A As the Global Community Manager for the Fluke Corporation of Everett, Washington, Carissa Pietzsch works to manage a consistency of her customers’ experiences across social and traditional media platforms.

“I’m able to stay very close to the customer and hear what’s going on in their world and interact with them in that way,” she said. To cultivate those relationships successfully, Pietzsch relies on an ability to connect fairly quickly with a variety of people from different backgrounds on a daily basis. Once the day is over, however, it’s her connection to the natural beauty of the Pacific Northwest on which Pietzsch most often relies. “I think people, what they have in common, is being able to get out,” she said. “Living in the Seattle area, there’s so much out here. I’m outside every chance I get. I’m at least very close to a mountain most of the time.” There’s hiking in the summer (“I tend to stick around the Cascades” because “there’s a lot of awesome trails out here,” she explains), and snowboarding in the winter (“Stevens Pass is arguably one of the best resorts out here”). Pietzsch’s love of the outdoors even drew her from Seattle to suburban Ballard, Washington, where, on the banks of Puget Sound, she’s taken up stand-up paddle-boarding for relaxation. “It’s a big surfboard, and you get an oar and kind of paddle around,” she explains. “It’s all fun or falling 68 MEDICALDEALER | OCTOBER 2015

“You can’t really describe what it’s like until you do it. When you’re staring at the ground from

13,000 feet up, it’s quite a different experience. We had a great view of Mount Hood.”

off. It’s kind of a time where I don’t have to be serious, or really try.” Yet for as much as she savors the tranquility of nature, Pietzsch unrepentantly nurtures a thirst for action sports. Those competing impulses were married the day she cashed in her 21st birthday present. Although she’d booked one of the earliest appointments of the day, Pietzsch spent most of it just waiting to make her first leap out of an airplane. It was a good three or so hours from her Washington home to Molalla, Oregon-based Skydive Oregon. Once she arrived, Pietzsch was treated to an hour-long safety course on how not to get injured in her first skydiving attempt. Next, it took three hours and then some before the cloud cover burned off enough to satisfy her instructors. Even for a woman who self-identifies as “hav[ing] some thrill issues,” there was ample opportunity in the interim to catch a case of cold feet. “You definitely had some time to re-think that choice in the few hours,” Pietzsch said. The clock finally expired at 13,000 feet.

There were about eight others on her flight, Pietzsch recalls, all in tandem “because it was, I’m pretty sure, close to everyone’s first jump,” she said. When they made the jump (“You actually roll out of the plane, you don’t jump,” Pietzsch said), hers was the second pair out of the plane, and Pietzsch found herself wishing they’d have been more toward the back. “Right when they open the door, they try to make everyone get out as soon as possible,” she said. “It happened so fast.” Freefall was a surprisingly easy 30 seconds halted by a jolt of panic at the instant her parachute deployed (“That’s the time when you’re making sure it’s up there all right; [that you] don’t see any holes,” she said). Those feelings were soon assuaged, and Pietzsch transitioned into a seven-minute glide back down to Earth, with a sublime view of the surrounding countryside along the way. “You can’t really describe what it’s like until you do it,” Pietzsch said. “When you’re staring at the ground from 13,000 feet up, it’s quite a different experience. We had a great view of Mount Hood.” MEDICAL EQUIPMENT, PARTS & SERVICE

Pietzsch had invested in the photo package “to make sure that I proved to people that I did jump out of the airplane,” she said. For best results, the photographer told her to “make sure that I gave him a thumbs up every time he saw me in the air.” “So I have all these pictures where you can see fear on my face, but I’m giving two thumbs up,” Pietzsch said. Tandem landing for a novice jumper means lengthening into a straight-legged, seated position so your partner can touchdown feetfirst without interference (“I have pictures with my feet straight out where we’re still 500 feet from the ground or so,” Pietzsch said). Another critical element is the timing of that first phone call. “It wasn’t until after that I told my family I went,” Pietzsch said. “I wanted to give it a try, and I would do it again. I’m not afraid of heights.” WWW.MEDICALDEALER.COM

Of course, three years removed from the experience, she can’t wait to go back. With her little sister’s 21st birthday fast approaching, Pietzsch has the perfect excuse. “We’re probably going to go sometime in the spring,” she said. “If you go when it’s too cold, you have to wear these ridiculous windsuits.” Even after another skydiving adventure, there’s still room on Pietzsche’s bucket list for a few more thrills. For instance: she’s presently scouting locations for a bungee jump. So far, Europe is at the top of the list. “There’s a lot of great places out here, but I’m looking at something abroad,” she said. “I don’t know quite yet, but that’s my goal.” Until then, “my next big thing is going to be heli-skiing,” which Pietzsche said is “when you jump out of a helicopter and onto a mountain. “I’ll be snowboarding down,” she said. MEDICALDEALER 69

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SLICE OF LIFE_Pay It Forward

By Matthew N. Skoufalos

VIRTUAL HEALTH

ew York, New York-based Virtual Health began as a result of the experiences that its founder-CEO, Adam Sabloff, underwent as a caregiver for his mother during her battle with lung cancer. After she died, Sabloff began to consider ways in which her condition could have been ameliorated by a more proactive health care system, said Virtual Health CTO Jack Plotkin. His mission then turned to building a technology-based company that could make it possible to have that proactive view of the patient. “When we started out, population health management as a term didn’t exist,” Plotkin said. “Everything was very siloed, and it reflected the specialization in health care as a whole.” In the time since, however, the regulatory shift spurred by the Affordable Care Act has encouraged greater patient engagement, collaboration, and coordinated interventions, and made specialized service coordination platforms like those developed by Virtual Health “much more relevant and important” in the improvement of care delivery, Plotkin said. The only trouble is that such platforms are often either rigidly specific to the environment in which they operate, or prohibitively expensive for many of the nonprofit, service-oriented organizations that need them most. The world of developmental disabilities represents an especially poignant example of just such a deficit, Plotkin said. Given the variety of staffers that may interact with a multiply handicapped person, much of the data they gather is still entered in pen-and-paper formats and on 72 MEDICALDEALER | OCTOBER 2015

specific forms; the absence of a consistent framework makes it difficult to study and analyze. Organizations that have ventured into the space with their own, proprietary software, or with modifications to an existing software product, have run up against many of these challenges, Plotkin said. “There are two contributing factors: that the technology is out of date, or it’s not standardized,” he said. “Usually, I have to use software in whatever way it’s been set up. What if it only partially meets my needs? I either have to use what the software allows or I go to the vendor and request a change and they charge me a lot of money for it.” Instead – and at a reduced price – Virtual Health developed a custom-tailored version of its software for use by Edwin Gould Services for Children and Families in Brooklyn, New York. Founded as an organization with the aim of helping orphans and children from families of need, Edwin Gould also serves developmentally disabled adults, many of whom may be placed in restrictive facility settings with multiple caregivers. These patients may exhibit certain behaviors, from aggression to sexually or social inappropriate behaviors to elopement, the incidence of which it is the job of staff to reduce, Plotkin said. By incorporating the vast clinical data associated with patients – from staff encounters to documentation of conditions, diagnoses, immunizations, medications, procedures, admissions, as well as social, behavioral, and environmental information – into a comprehensive software framework, Virtual Health helped Edwin Gould to create a more

“The ultimate goal is to help these individuals become a bit healthier, and help address their developmental difficulties to the broadest extent possible, and then identify how these interventions are effective. Then you can overlay analysis, graphs and charts to visually represent the impact of various interventions and what’s been happening in the population.” complete picture of its patients, eventually reducing the number of behavioral incidents observed. “You have to create a framework for recording data so different staff members interacting with these individuals are able to record data in a consistent format,” he said. “That’s a challenge in itself; there’s specific MEDICAL EQUIPMENT, PARTS & SERVICE

_Pay It Forward

forms and assessments. We provide a technology platform that serves to pose that structure.” That software mechanism enabled staff to report their observations and the successes of client interventions, as well as allowing them to analyze how those interventions affect the frequency of the behaviors for which clients receive services. “The ultimate goal is to help these individuals become a bit healthier, and help address their developmental difficulties to the broadest extent possible, and then identify how these interventions are effective,” Plotkin said. “Then you can overlay analysis, graphs and charts to visually represent the impact of various interventions and what’s been happening in the population.” “It’s really about creating a framework around particular interventions, recording the outcomes, and seeing if they were effective or not,” he said. “It’s about using research approaches in order to identify some actionable interventions and best practices.” As patterns in the client behaviors WWW.MEDICALDEALER.COM

and staff interventions emerged, Plotkin said, Edwin Gould was better able to identify certain best practices for the clients in its care, thereby improving the overall health outcomes of persons served by the agency, and ultimately reducing its costs. “Behaviors that were happening multiple times per hour or multiple times per day, we were able to drive that down to once a week or once a month, which is a revolutionary outcome,” Plotkin said. Simply put, he said, “Somebody who’s improving over time requires less restriction [and enjoys a] better quality of life.” Virtual Health also offered similar special consideration to Parker Jewish Institute, a skilled nursing facility on the campus of the North Shore-LIJ Health System in Arverne, New York. There, Virtual Health platforms supported a state-funded senior supportive service called Parker at Your Door, which helps coordinate care for elderly patients, many of whom rely upon Medicare and Medicaid. Virtual Health also reduced its

service rates in working with Parker Jewish Institute for Health Care and Rehabilitation, which serves about 50,000 seniors in its Project Independence program in Hempstead, New York. Project Independence is one of the only municipal programs in the country designed specifically to provide supportive services to seniors in the community – care coordination, financial assistance, help with household maintenance – on a subsidized basis. Without the support of adjusted costs and the flexibility of its modified software platforms, some of the most vulnerable clients at the fringes of the health care system – children, the elderly, and the developmentally disabled – would not have benefited from the efficiencies that the datadriven analysis of Virtual Health provides to the programs that serve them. “We so fervently believe in the mission, and each of these clients has told us, ‘Virtual Health is the only one that has the software that works for us,’ ” Plotkin said.

MEDICALDEALER 73

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SLICE OF LIFE_

By Dan Bobinski

MULTITASKING AND EMAIL – BLESSINGS OR BURDENS?

ave you noticed that some people get a lot accomplished while others operate at a hectic pace but have little to show for it? It seems counterintuitive, but one reason for lower productivity may be too much multitasking During a recent training session, a group of middle managers told me how their days always felt chaotic. They described bouncing from task-to-task, and struggling to meet deadlines was their norm. Their dilemma of trying to find effective time management techniques is somewhat ubiquitous. The problem, in my opinion, is that time management is like an inkblot: A technique that’s effective for one person may be totally useless for someone else. In other words, no magic bullet exists. No single technique works for everybody. And despite all the hype given it, multitasking has proven to be highly overrated. In fact, researchers have discovered that bouncing back and forth between tasks actually lowers effectiveness and productivity. I first became aware of this during a conversation with Robert Croker, the recently retired chair of the Human Resource Training and Development Department at Idaho State University. Croker, who is certified in brain-based learning, says that the brain is not designed for multitasking. 76 MEDICALDEALER | OCTOBER 2015

Dan Bobinski Workplace Consultant

“It’s a common misconception that a brain is like a computer,” Croker says. “A computer is designed to multitask. The human brain is not designed to function optimally in a multitask environment.” The myths of multitasking are further discussed in the Journal of Experimental Psychology and in the science journal NeuroImage. Research appearing in these publications reveals that each time a person switches back and forth between tasks, the brain goes through several time-consuming activities, and jumping back and forth between tasks can take four times longer to accomplish them – simply due to the time required for switching mental gears. Furthermore, research shows that the quality of completed tasks becomes severely diminished when

trying to do two tasks simultaneously. As an example of this, just think about how your driving decisions are diminished when you’re talking on a cellphone. OK, so if multitasking isn’t all it’s cracked up to be, which time-management techniques, if any, are truly helpful to the majority of people? It turns out there is one old-fashioned technique that helps most people get maximum productivity, and that’s better planning. Yes, even in this age of techno-wizardry, the best universal productivity tool is spending time thinking through tasks and prioritizing what needs to be done. The simple act of thinking things through enables one’s brain to “see” the needed actions, and the act of prioritizing appears to magically pave the way for making things come together more rapidly. In reality, it’s your brain’s amygdala (a small lobe in the center of your brain), not magic, that’s making things come together better. But it feels like magic! Another universally helpful time-management tip causes many people to shudder, but it allows for better planning (depending on what time of day you plan), and better execution. This tip comes from workplace-organizer guru Julie Morgenstern, and it’s simply this: Don’t check your email first thing in the morning. You heard that right: Your first MEDICAL EQUIPMENT, PARTS & SERVICE

Not on our watch! activity once you get to work should not be checking email. Morgenstern says productivity will go up if you create a task-list first (or better yet, create it the evening before), and get straight to accomplishing those high-priority, revenue-generating tasks when you first get to work. Granted, I realize that some jobs are heavily email dependent, but most positions are not, despite what many may think. If your job absolutely demands an email check first thing (such as to check for urgent memos from the boss), it’s best to set a three-minute egg-timer, check your email, and close out the email when the timer goes off. Now before you write off this idea as hare-brained, know that the group of managers I mentioned earlier squawked pretty loudly when I first suggested they not check email first thing. They all insisted the idea was “not possible.” Well, God must have a great sense of humor, because on the Monday following my workshop, their company’s email server was down. And it wasn’t just down for the morning; their email was not available for the entire day. Later that week when I met again with the managers, their leader admitted, “We got so much work done this past Monday – I think we should make every Monday a ‘no-email day.’ ” I’m not suggesting ignoring email for a whole day, but their happenstance did prove Morgenstern’s point. The idea is to simply set aside time at the beginning of your day, evaluate the work before you, then ask yourself, “What are the highest WWW.MEDICALDEALER.COM

priority tasks I need to accomplish? If there was only one ‘must-do’ item on my to-do list, what would that one thing be?” Morgenstern recommends getting that profit-generating work done – and she means “done” as in task accomplished – before switching on your email. But even after completing your most important task, stopping to check email multiple times throughout the day requires an awful lot of brain switching – a.k.a wasted time. One highly effective workplace I know of established a policy to check email only three times a day. At 11 a.m. so they can dedicate an hour to written correspondence before lunch; at 1 p.m. to reply to any follow-up responses; and again at 4 p.m. so they can make adjustments to their next day’s schedule. They tell clients and vendors up front of this policy so everyone knows what to expect. The bottom line in all of this is that multitasking has been shown to make us less effective, not more. And although email can be a huge time-saver, it can also be a huge timewaster if we become its slave instead of its master. DAN BOBINSKI is a certified behavioral analyst, author of the best-selling “Creating Passion-Driven Teams” and president of Workplace-Excellence.com. His latest book is “Removing Obstacles to Success.” He travels internationally helping organizations of all shapes and sizes. Reach him at dan@workplace-excellence.com or 208375-7606.

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MEDICALDEALER 83

CATEGORICAL INDEX

ANESTHESIA Paragon Service…………………………………………… 18

Radiology Data……………………………………………… 83 TROFF Medical……………………………………………… 61

APPRAISAL Valcon Partners, LTD…………………………………… 62

ENDOSCOPY Bulb Direct Holding, LLC……………………………… 55 Capital Medical Resources………………………… 83 Elite Biomedical Solutions…………………… 56-59 Endoscopy Specialists………………………………… 61 HMB Endoscopy Products…………………………… 55 S.H. Medical Corporation…………………………… 22

ASSOCIATIONS IAMERS…………………………………………………………… 40 AUCTION/LIQUIDATION Government Liquidation………………………………7 JD Imaging Corp.…………………………………………… 83 Shattuck, LLC………………………………………………… 22 BATTERIES Eastern Diagnostic Imaging……………………… 74 Holden Battery Services……………………………… 78 BIOMEDICAL Conquest Imaging………………………………………… 13 Global Medical Imaging……………………………… 29 InterMed Biomed………………………………………… 71 Maull Biomedical Training, LLC………………… 62 Medical Specialties Distributors……………… 46 Quantum Biomedical…………………………………… 70 CARDIOLOGY J & M Trading…………………………………………………… 47 Southeast Nuclear Electronics………………… 62 Southeastern Biomedical, Inc.………………… IBC C-ARMS Eastern Diagnostic Imaging……………………… 74 COMPUTED TOMOGRAPHY BC Technical, Inc.…………………………………………… 19 East Coast Medical Systems……………………… 75 Ed Sloan & Associates………………………………… 70 German Electronics……………………………………… 81 International Medical Equipment & Service………………………………………………………… 52 J & M Trading…………………………………………………… 47 KEI Medical Imaging Services…………………… 83 Metropolis International…………………………… 65 MIT/Medical Imaging Technologies…………… 79 Mobilescan Imaging……………………………………… 79 Technical Prospects……………………………………… 17 Tri-Imaging……………………………………………………… 23 DATA MEDIA Radiology Data……………………………………………… 83 DIAGNOSTIC IMAGING Digirad Corp..………………………………………………… 82 Eastern Diagnostic Imaging……………………… 74 J & M Trading…………………………………………………… 47 Multi Diagnostic Imaging Solutions…………BC

84 MEDICALDEALER | OCTOBER 2015

GENERAL ALCO Sales and Service………………………………… 60 Bulb Direct Holding, LLC……………………………… 55 Eastern Diagnostic Imaging……………………… 74 Global Risk Services……………………………………… 66 Government Liquidation………………………………7 Harvest Right……………………………………………………9 Kent Elastomer Products, Inc.…………………… 39 PartsSource………………………………………………………4 Puma Export, Inc..………………………………………… 54 Shattuck, LLC………………………………………………… 22 Valcon Partners, LTD…………………………………… 62 IMAGING ICE/Imaging Community Exchange…………… 30 IMAGING/PARTS Ampronix……………………………………………………………6 BMX-RAY…………………………………………………… 20-21 Diagnostic Solutions…………………………………… 67 Eastern Diagnostic Imaging……………………… 74 InterMed Ultrasound…………………………………… 46 InterMed NucMed………………………………………… 75 J & M Trading…………………………………………………… 47 PartsSource………………………………………………………4 Technical Prospects……………………………………… 71 Tri-Imaging……………………………………………………… 23 TROFF Medical……………………………………………… 61 INFORMATION TECHNOLOGY Tesseract………………………………………………………… 60

Bio-Medical Equipment Service Co.…………… 63 MONITORS/CRTs Advanced Ultrasound Elec./AUE………………… 77 Ampronix……………………………………………………………6 Technical Prospects……………………………………… 17 TROFF Medical……………………………………………… 61 MRI BC Technical, Inc.…………………………………………… 19 Carolina Medical Parts……………………………………5 East Coast Medical Systems……………………… 75 Ed Sloan & Associates………………………………… 70 Field MRI Services………………………………………… 83 Independence Cryogenic Engineering……… 66 KEI Medical Imaging Services…………………… 83 Medical Systems Technologies………………… 61 MIT/Medical Imaging Technologies…………… 79 Mobilescan Imaging……………………………………… 79 NUCLEAR MEDICINE BC Technical, Inc.…………………………………………… 19 Digirad Corp..………………………………………………… 82 E.L. Parts, LLC………………………………………………… 67 Global Medical Imaging……………………………… 29 InterMed NucMed………………………………………… 75 International X-Ray Brokers……………………… 78 J & M Trading…………………………………………………… 47 Southeast Nuclear Electronics………………… 62 PATIENT MONITORING Bio-Medical Equipment Service Co.…………… 63 BiTech Medical……………………………………………… 47 MedEquip Biomedical………………………………… 78 Pacific Medical…………………………………………………8 Quantum Biomedical…………………………………… 70 Southeastern Biomedical, Inc.………………… IBC USOC Medical………………………………………………… 67 PHLEBOTOMY Kent Elastomer Products, Inc.…………………… 39

INFUSION THERAPY Medical Specialties Distributors……………… 46

PROBES/PROBE REPAIR Conquest Imaging………………………………………… 13 Global Medical Imaging……………………………… 29

LABORATORY MIT/Medical Imaging Technologies…………… 79 Harvest Right……………………………………………………9

ONLINE RESOURCES ICE/Imaging Community Exchange…………… 30 MedWrench…………………………………………………… 82

LASER IMAGERS Multi Diagnostic Imaging Solutions…………BC

RADIOLOGY Asset Management Associates, LLC………… 22 Eastern Diagnostic Imaging……………………… 74 German Electronics……………………………………… 81 Holden Battery Services……………………………… 78 International X-Ray Brokers……………………… 78 InterMed Ultrasound…………………………………… 46

MAMMOGRAPHY Digitec Medical Service Corp.……………………… 38 MODULE/TELEMETRY

MEDICAL EQUIPMENT, PARTS & SERVICE

Categorical Index

InterMed NucMed ……………………………………… 75 J & M Trading………………………………………………… 47 JD Imaging Corp. ………………………………………… 83 Maull Biomedical Training, LLC ……………… 62 Metropolis International ………………………… 65 Multi Diagnostic Imaging Solutions ………BC Radon Medical LLC …………………………………… 70 Technical Prospects …………………………………… 71 TROFF Medical …………………………………………… 61 Varian Medical Systems ………………………………3 RADIOLOGY PARTS Clear Image Devices LLC …………………………… 54 InterMed Ultrasound ………………………………… 46 InterMed NucMed ……………………………………… 75 J & M Trading………………………………………………… 47 TROFF Medical …………………………………………… 61 REPAIR/REFURBISH 2D Imaging, Inc. ………………………………………… 83 Advanced Ultrasound Elec./AUE ……………… 77 ALCO Sales and Service ……………………………… 60 Ampronix …………………………………………………………6 Bio-Medical Equipment Service Co.………… 63 BiTech Medical …………………………………………… 47 Carolina Medical Parts …………………………………5 Conquest Imaging ……………………………………… 13 Digirad Corp.. ……………………………………………… 82 Digitec Medical Service Corp.…………………… 38 Eastern Diagnostic Imaging …………………… 74 Ed Sloan & Associates ……………………………… 70 Elite Biomedical Solutions ………………… 56-59 Endoscopy Specialists ……………………………… 61 Field MRI Services ……………………………………… 83 German Electronics …………………………………… 81 Global Medical Imaging …………………………… 29 Independence Cryogenic Engineering …… 66 International Medical Equipment & Service ……………………………………………………… 69 KEI Medical Imaging Services ………………… 83 MedEquip Biomedical ……………………………… 78 Medical Systems Technologies ……………… 61 MIT/Medical Imaging Technologies ………… 79 MTC/Medical Technologies Co. ………………… 47 Multi Diagnostic Imaging Solutions ………BC MW Imaging ……………………………………………………2 National Ultrasound ………………………………… 79 Pacific Medical ………………………………………………8 Quantum Biomedical ………………………………… 70 Radon Medical LLC …………………………………… 70 Southeast Nuclear Electronics………………… 62 TROFF Medical …………………………………………… 61 USOC Medical ……………………………………………… 67 REPLACEMENT PARTS 2D Imaging, Inc. ………………………………………… 83 Advanced Ultrasound Elec./AUE ……………… 77 ALCO Sales and Service ……………………………… 60

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AllParts Medical ………………………………………… 63 Carolina Medical Parts …………………………………5 Classic Diagnostic Imaging ……………………… 39 Conquest Imaging ……………………………………… 13 Diagnostic Solutions ………………………………… 67 Digirad Corp.. ……………………………………………… 82 Digitec Medical Service Corp.…………………… 38 E.L. Parts, LLC ……………………………………………… 67 Ed Sloan & Associates ……………………………… 70 Elite Biomedical Solutions ………………… 56-59 Global Medical Imaging …………………………… 29 Government Liquidation ……………………………7 Independence Cryogenic Engineering …… 66 International Medical Equipment & Service ……………………………………………………… 69 J & M Trading………………………………………………… 47 KEI Medical Imaging Services ………………… 83 MTC/Medical Technologies Co. ………………… 47 Multi Diagnostic Imaging Solutions ………BC National Ultrasound ………………………………… 79 PartsSource ……………………………………………………4 Radon Medical LLC …………………………………… 70 Southeast Nuclear Electronics………………… 62 Technical Prospects …………………………………… 71 TROFF Medical …………………………………………… 61 Varian Medical Systems ………………………………3 RESPIRATORY Medical Specialties Distributors …………… 46 SERVICE CONTRACTS Global Risk Services …………………………………… 66 SOFTWARE Radiology Data …………………………………………… 83 Tesseract ……………………………………………………… 60 STERILIZERS Government Liquidation ……………………………7 InterMed Biomed ……………………………………… 71 SURGICAL Bulb Direct Holding, LLC …………………………… 55 Capital Medical Resources ……………………… 83 Eastern Diagnostic Imaging …………………… 74 Endoscopy Specialists ……………………………… 61 International Medical Equipment & Service ……………………………………………………… 69 S.H. Medical Corporation ………………………… 22

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SURPLUS MEDICAL Government Liquidation ……………………………7

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TUBES/BULBS AllParts Medical ………………………………………… 63 German Electronics …………………………………… 81 Government Liquidation ……………………………7 International Medical Equipment

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MEDICALDEALER 85

CATEGORICAL INDEX

& Service ……………………………………………………… 69 J & M Trading………………………………………………… 47 Technical Prospects …………………………………… 71 ULTRASOUND 2D Imaging, Inc. ………………………………………… 83 Advanced Ultrasound Elec./AUE ……………… 77 Clear Image Devices LLC …………………………… 54 Conquest Imaging ……………………………………… 13 Diagnostic Solutions ………………………………… 67 Endoscopy Specialists ……………………………… 61 Global Medical Imaging …………………………… 29 InterMed Ultrasound ………………………………… 46 Mobilescan Imaging …………………………………… 79 MW Imaging ……………………………………………………2 National Ultrasound ………………………………… 79

ULTRASOUND PARTS Advanced Ultrasound Elec./AUE ……………… 77 Conquest Imaging ……………………………………… 13 Global Medical Imaging …………………………… 29 InterMed Ultrasound ………………………………… 46 VCR REPAIR/SERVICES Advanced Ultrasound Elec./AUE ……………… 77 Conquest Imaging ……………………………………… 13 VENTILATORS Government Liquidation ……………………………7 VIDEO Endoscopy Specialists ……………………………… 61 Multi Diagnostic Imaging Solutions ………BC

X-RAY Asset Management Associates, LLC ……… 22 BMX-RAY ………………………………………………… 20-21 Classic Diagnostic Imaging ……………………… 39 Clear Image Devices LLC …………………………… 54 Diagnostic Solutions ………………………………… 67 Eastern Diagnostic Imaging …………………… 74 German Electronics …………………………………… 81 Government Liquidation ……………………………7 Holden Battery Services …………………………… 78 MIT/Medical Imaging Technologies ………… 79 Tri-Imaging …………………………………………………… 23 X-RAY PARTS J & M Trading………………………………………………… 47 Technical Prospects …………………………………… 71 TROFF Medical …………………………………………… 61

ALPHABETICAL INDEX 2D Imaging, Inc. ………………………………………… 83

Field MRI Services ……………………………………… 83

MIT/Medical Imaging Technologies ………… 79

Advanced Ultrasound Elec./AUE ……………… 77

German Electronics …………………………………… 81

Mobilescan Imaging …………………………………… 79

ALCO Sales and Service ……………………………… 60

Global Medical Imaging …………………………… 29

MTC/Medical Technologies Co. ………………… 47

AllParts Medical ………………………………………… 63

Global Risk Services …………………………………… 66

Multi Diagnostic Imaging Solutions ………BC

Ampronix …………………………………………………………6

Government Liquidation ……………………………7

MW Imaging ……………………………………………………2

Asset Management Associates, LLC ……… 22

Harvest Right …………………………………………………9

National Ultrasound ………………………………… 79

BC Technical, Inc. ………………………………………… 19

HMB Endoscopy Products ………………………… 55

Pacific Medical ………………………………………………8

Bio-Medical Equipment Service Co.………… 63

Holden Battery Services …………………………… 78

Paragon Service ………………………………………… 18

Biomedical Equipment Services LLC.……… 75

IAMERS ………………………………………………………… 40

PartsSource ……………………………………………………4

BiTech Medical …………………………………………… 47

ICE/Imaging Community Exchange ………… 30

Puma Export, Inc.. ……………………………………… 54

BMX-RAY ………………………………………………… 20-21

Independence Cryogenic Engineering …… 66

Quantum Biomedical ………………………………… 70

Bulb Direct Holding, LLC …………………………… 55

InterMed Ultrasound ………………………………… 46

Radiology Data …………………………………………… 83

Capital Medical Resources ……………………… 83

InterMed NucMed ……………………………………… 75

Radon Medical LLC …………………………………… 70

Carolina Medical Parts …………………………………5

InterMed Biomed ……………………………………… 71

Ray-Pac ………………………………………………………… 10

Classic Diagnostic Imaging ……………………… 39

International Medical Equipment & Service ……………………………………………………… 69

S.H. Medical Corporation ………………………… 22

Clear Image Devices LLC …………………………… 54 Conquest Imaging ……………………………………… 13 Diagnostic Solutions ………………………………… 67 Digirad Corp.. ……………………………………………… 82 Digitec Medical Service Corp.…………………… 38 E.L. Parts, LLC ……………………………………………… 67 East Coast Medical Systems …………………… 75 Eastern Diagnostic Imaging …………………… 74 Ed Sloan & Associates ……………………………… 70 Elite Biomedical Solutions ………………… 56-59 Endoscopy Specialists ……………………………… 61 Exclusive Medical Solutions …………………… 85

86 MEDICALDEALER | OCTOBER 2015

International X-Ray Brokers …………………… 78 J & M Trading………………………………………………… 47 JD Imaging Corp. ………………………………………… 83 KEI Medical Imaging Services ………………… 83 Kent Elastomer Products, Inc. ………………… 39 Master Medical Equipment ……………………… 54 Maull Biomedical Training, LLC ……………… 62 MedEquip Biomedical ……………………………… 78 Medical Specialties Distributors …………… 46 Medical Systems Technologies ……………… 61

Shattuck, LLC ……………………………………………… 22 Southeast Nuclear Electronics………………… 62 Southeastern Biomedical, Inc. ……………… IBC Technical Prospects …………………………………… 71 Tesseract ……………………………………………………… 60 Tri-Imaging …………………………………………………… 23 TROFF Medical …………………………………………… 61 USOC Medical ……………………………………………… 67 Valcon Partners, LTD ………………………………… 62 Varian Medical Systems ………………………………3

MedWrench ………………………………………………… 82 Metropolis International ………………………… 65 MEDICAL EQUIPMENT, PARTS & SERVICE

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