Medical Dealer - May 2016 by MD Publishing

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“The exposure to the number of

“The use of reprocessed single-use is critical to

patients is so many that they get

many hospitals’ ability to sustain operations

to practice and they’re perfect.”

and deliver the best patient care.”

CONTENTS_Features 46 SINGLE-USE DEVICE OPTIONS

Cost savings, positive patient outcomes and patient safety continue to be the goals of health care facilities. Today, decision-makers are searching for ways to meet those demands and many are turning to single-use devices. As independent studies and FDA opinions have concurred, reprocessed single-use medical devices can provide a viable and cost-effective alternative to OEM products. One-time use disposable products also play a factor. We examine this trend and share insights from the industry.

60 PAY IT FORWARD Surgical technique is becoming a lost art, even to surgeons, says Dr. Maurice Chung, current president of the Society of Laparoendoscopic Surgeons (SLS). Chung says many younger residents may graduate from a program knowing minimally invasive surgical techniques, yet almost 90 percent of them don’t know how to suture. It is also a problem in developing countries where proper education is lacking. Chung has a plan to fix this problem and is working hands on to be a part of the solution.

Medical Dealer (Vol. 20, Issue #5 May 2016 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. 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. © 2016

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MEDICALDEALER 11

INDUSTRY UPDATE 14 News & Notes 18 OEM Updates 24 Block Imaging MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269 (800) 906-3373 Fax: (770) 632-9090 Publisher

John M. Krieg john@mdpublishing.com

MARKET ANALYSIS Radiology: Cardiac Imaging 29 Market Analysis 30 Product Showroom 33 Preferred Vendors

Vice President

Kristin Leavoy kristin@mdpublishing.com

Editor

John Wallace jwallace@mdpublishing.com

Med/Surg: Single-Use 37 Market Analysis 38 Product Showroom 42 Preferred Vendors

Art Department Jonathan Riley Jessica Laurain Kara Kronen

Account Executives Jayme McKelvey Andrew Parker Warren Kaufman

SLICE OF LIFE 54 The Other Side 56 Dan Bobinski 60 Pay It Forward

Contributors

Jim Fedele Matthew N. Skoufalos Dan Bobinski

Accounting

Kim Callahan

Circulation

63 Success Story 67 Marketplace 68 Categorical Index 70 Alphabetical Index

Lisa Cover

Web Department Betsy Popinga Taylor Martin Adam Pickney

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MEDICAL EQUIPMENT, PARTS & SERVICE

We Stay Up So You’re Never Down! Some things you just can’t plan for. Like wrecking your car at 2 AM, or uncontrollable pain well after doctors’ hours. In your job, you do plan to be able to help your patients 24/7. And that means having a trusted team you can call any hour of the day or night to keep your ultrasound equipment up and running. At Conquest Imaging, we not only have an experienced team of ultrasound technicians standing by, we preempt problems before they can happen. We research which parts have a high failure rate, and replace them on every reconditioned part, probe and system we sell, even if they are working perfectly at the time, assuring you are never down when your patients need you to be up.

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INDUSTRY UPDATE_News and Notes

Staff Reports

FIRST MOBILE STROKE UNIT WITH ADVANCED CT IMAGING CAPABILITIES LAUNCHED The University of Tennessee College regular electrical outlet access. and Europe use smaller portable CT of Medicine in Memphis, Tennessee scans that only image the brain (with- • The Mobile Stroke Unit is the first recently introduced the world’s most in the world to be staffed with out vessels) and also require the team comprehensive Mobile Stroke Unit, stroke fellowship-trained, doctorto move the patient for each slice (piccapable of conducting and producing ally prepared nurses certified as ture) that is taken. UT’s Mobile Stroke advanced quality imaging for stroke advanced neurovascular practiUnit provides the same number of diagnosis and noninvasive CT-angitioners, ANVP-BC. slices in high resolution as obtained ography with a Siemens SOMATOM • The Mobile Stroke Unit capacand expected in the hospital setting Scope CT scanner. ity includes the ability to transport since it is equipped with a dedicated This is the first time CT capabiltrainees and researchers intergantry that automatically moves the ities of this magnitude have been ested in building the science of early patient to obtain images. available in a mobile setting, creatstroke management. • Due to these advanced imaging the ability to diagnose and launch ing capabilities, the Mobile Stroke treatment including tissue plasminoThe UT Mobile Stroke Unit is funded Unit will be able to bypass hospigen activator (tPA) treatment and the through a public-private collaboratal emergency departments and potent blood pressure drug nicardiption for which more than $3 million take patients directly to endovascuine within the critical first hour time lar suites, operating rooms, stroke or has been raised, which will enable frame and select patients for endovasneurocritical units. operation for up to three years. The cular interventions, neurosurgery and • It is the largest mobile stroke unit in unit will operate 12 hours a day, one neuro-critical care directly from the week on and one week off. • the world, complete with an internal prehospital arena. power source capable of matching The combination of many firsts in terms of mobile application and utilization make this the most complete Mobile Stroke Unit in the world. The sophistication of the UT College of Medicine Mobile Stroke Unit means a patient will be prepped to go straight to the catheterization laboratory, Neuro Intensive Care Unit or Hospital Stroke Unit, bypassing a stop in the emergency department entirely. The Mobile Stroke Unit, weighing in at more than 14 tons, includes features and capabilities never before assembled for mobile deployment. These include: • A hospital-quality CT scanner with advanced imaging capabilities to not only allow brain imaging, but also imaging of blood vessels in the brain. Other Mobile Stroke Units in the U.S. 14 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

_News and Notes

ELITE BIOMEDICAL SOLUTIONS ACHIEVES ISO CERTIFICATIONS Elite Biomedical Solutions is proud to announce that it has obtained ISO 13485:2003 and ISO 9001:2008 certifications. The ISO 9001 certifies the Quality Management System for Design and Assembly of Electromechanical Products and Components. ISO 13485 certifies the Quality Management System for Medical Devices which includes Design and Assembly of Components to be used in various active, non-implantable medical products, recertification of OEM components, and service of active, non-implantable devices. The 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 and less-expensive alternative. “Obtaining both ISO 13485:2003 and ISO 9001:2008 shows the dedication and the commitment of the Elite Biomedical Solutions team. It is a true testament to the devotion and teamwork that radiates throughout all areas of the company. This achievement affirms the company’s attention to the quality management system, consistency, and customer satisfaction,” Elite Biomedical Solutions Co-Owner/Vice President Nate Smith says. Elite Biomedical Solutions received its ISO 13485:2003 and ISO 9001:2008 certifications from Eagle Certification Group, an ANAB-accredited company. Elite Biomedical Solutions supports hospital biomedical departments with new infusion pump replacement parts, re-certified parts, on-site services and repairs. Currently, its focus is infusion pumps, but it is quickly evolving to include patient monitoring and other modalities based on customer needs. • For more information about Elite Biomedical Solutions, visit elitebiomedicalsolutions.com. WWW.MEDICALDEALER.COM

CANON MAKES TOSHIBA MEDICAL SYSTEMS CORP. A SUBSIDIARY Canon Inc. has concluded a share transfer agreement with Toshiba Corp. concerning the acquisition from Toshiba of shares of Toshiba Medical Systems Corp. to make TMSC a Canon subsidiary. This transaction is conditional upon the clearance of necessary competition regulatory authorities. Under Phase V of its Excellent Global Corporation Plan, a five-year initiative launched in 2016, Canon aims to embrace the challenge of new growth through a grand strategic transformation. With regard to reinforcing and expanding new businesses in particular, which represents one of the important strategies to be carried out during this phase, Canon intends to cultivate its health care business within the safety and security sector as a next-generation pillar of growth. TMSC is one of the leading global companies in the medical equipment industry. Within the field of medical X-ray computed tomography (CT) systems in particular, TMSC is the overwhelming market share leader in Japan and has been steadily increasing its global market share. Additionally, TMSC is the only company in the industry with a broad product portfolio that spans diagnostic X-ray systems, magnetic resonance imaging (MRI) systems, diagnostic ultrasound systems and diagnostic nuclear medicine systems. The company also offers cutting-edge medical imaging solutions and in-vitro diagnostics aimed at individualized care. Through the agreement, TMSC will be welcomed into the Canon Group. By maximizing the combination of both companies’ management resources, Canon aims to solidify its business foundation for health care that can contribute to the world. The inclusion of TMSC into the Canon Group is expected to make possible several benefits, including accelerated entry into new fields; further improvements in quality through shared production technology; and expanded business domains through enhanced development capabilities. • MEDICALDEALER 15

INDUSTRY UPDATE_News and Notes

Staff Reports

STUDY: OEM DEVICES MORE LIKELY TO BE DEFECTIVE THAN REPROCESSED SINGLE-USE DEVICES ble to get superior quality for lower of reliability and value,” study Original equipment manufacturcost, while reducing the enviauthor Dr. Terrence J. Loftus, MD, er’s single-use devices (SUDs) may MBA, FACS, former Medical Direc- ronmental impact of health care have higher defect rates than comdelivery. Reprocessed SUDs are tor Surgical Services and Clinical parable reprocessed devices, a exactly the kind of value-driven study in Journal of Medical Devices Resources at Banner Health, said solutions health systems need in the report published in the suggests. The independent study today,” said Brian White, President, December issue of Journal of Medled by Banner Health was designed Stryker’s Sustainability Solutions. ical Devices. The findings are also to increase the data available on While Banner Health is a available for purchase at ASME.org. defect rates of reprocessed SUDs. long-standing customer of Study data was collected over a OEMs have historically claimed Stryker’s Sustainability Solutions, seven-month period in 2013 for two new devices have lower defect the study was conducted indetypes of bipolar and ultrasound diarates when compared to reprothermy devices used at Banner Health. pendently, and was not sponsored cessed devices. The FDA considers by a medical device manufacturer A total of 3,112 devices were included reprocessed SUDs that meet the or a third-party reprocessor.Susin the study – roughly 55 percent of FDA’s regulatory requirements tainability Solutions’ more than them were reprocessed devices and to be substantially equivalent to 2,500 U.S. hospital and health sysroughly 45 percent were new devices. new devices. The new study’s data tem customers saved $262 million Devices were determined to be defecsupports the FDA’s position and in 2015 and eliminated 12.25 miltive by a surgical team member when suggests that reprocessed SUDs they did not function in a manner con- lion pounds of medical waste from may actually have lower defect landfills. When hospitals purchase sistent with the intended purpose. rates than new devices. reprocessed medical devices, OEM devices were reported as defec“In the era of value-based purthey decrease the cost of health tive 4.9 times more frequently than chasing, medical devices that cost care and can re-direct these savreprocessed devices. twice as much and are reported to ings toward other initiatives that “Dr. Loftus’ study confirms that, be defective more frequently chalimprove patient outcomes.• with SUD reprocessing, it’s possilenge conventional definitions

16 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

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INDUSTRY UPDATE_OEM Updates

Staff Reports

CT TECHNOLOGY HELPS PHYSICIANS ACCURATELY PLAN TAVR PROCEDURES Accurate and precise anatomical the Aquilion ONE 320, Aquilion All Aquilion ONE Family systems information is crucial to successful ONE 640 and Aquilion ONE ViSION are XR-29 compliant and come TAVR procedures, and the advanced Edition. To improve workflow and standard with Toshiba’s complete technologies of Toshiba America make TAVR planning more efficient, suite of dose reduction technologies, Medical Systems Inc.’s Aquilion the systems feature wide detector including AIDR 3D Enhanced. ONE Family of CT systems deliver Volumetric Cardiac capabilities “Toshiba’s Aquilion ONE Family the visualization needed during and Toshiba’s Adaptive Diagnostics plays a critical role in TAVR planning. The system gives technology like the Variable Helical planning, with its unique ability to clinicians the image detail and Pitch (vHP), which automatically acquire anatomical and functional system flexibility required for changes from an ECG-gated to a data in a single heartbeat,” said planning and performing these non-ECG-gated acquisition during Dominic Smith, senior director, CT, procedures. Toshiba showcased a single helical scan, reducing IV PET/CT, and MR Business Units, these abilities in April at the 2016 contrast and radiation dose. Vital’s Toshiba. “The Aquilion ONE Family American College of Cardiology CT TAVR planning application can offers clinical and operational (ACC) annual meeting in Chicago. also be utilized to visualize and solutions that make work flow and The Aquilion ONE Family measure vascular anatomy for the contribute to many cost efficiencies features slices of 0.5 mm and comes evaluation, treatment and follow up by making pre-procedure TAVR in three configurations, including of aortic vascular disorders. planning more efficient.” • 18 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

_OEM Updates

INDIANA HOSPITAL INSTALLS NEW DR ROOMS, MOBILE X-RAY SYSTEM Franciscan St. Elizabeth Health-Crawfordsville in Indiana has installed two new room-based X-ray imaging systems and upgraded an existing portable system in an attempt to enhance the quality and productivity of its radiology services. The Indiana hospital is a member of Franciscan Alliance, one of the largest Catholic health care systems in the Midwest. A new Carestream DRX-Evolution will facilitate capture of complex imaging exams in the hospital’s emergency department, which captures several hundred X-ray images a day. The system’s wall stand is mounted on a rail, which expedites the capture of cross table lateral and other complex exams. Seriously ill or injured patients can be imaged in wheelchairs or on stretchers, which eliminates the painful process of moving them to a table. The DRX-Evolution also streamlines long-length exams by automatically capturing and electronically stitching the images together. The hospital also installed a Carestream DRX-Revolution Mobile X-ray System that captures a variety of exams in the ED as well as bedside exams for inpatients. The radiology staff often images inpatients with the mobile system instead of bringing them down to radiology, because it’s less stressful for patients and the images are rapidly available to radiologists and physicians. A DRX-Ascend system is used to image general radiology patients and provides additional capacity when multiple urgent care patients present at the same time.• WWW.MEDICALDEALER.COM

MEDICALDEALER 19

INDUSTRY UPDATE_OEM Updates

SIEMENS ANNOUNCES FDA CLEARANCE OF 3 NEW MOBILE C-ARMS Offering the flat panel detectors of Siemens Healthcare has announced that the Cios Alpha in the medium price the U.S. Food and Drug Administration segment, the new Cios Fusion mobile (FDA) has cleared three brand-new C-arm has two detector sizes – 30 cm x system models – Cios Fusion, Cios Con30 cm and 20 cm x 20 cm. It offers most nect, and Cios Select – in the company’s of the same software and hardware feaCios family of mobile C-arms. These tures of the Cios Alpha, including a new systems join a newly upgraded touchscreen remote that can be posiversion of Siemens’ established, tioned at the operating table to control ultra-premium Cios Alpha mobile the C-arm from within the sterile C-arm that cements Siemens’ leaderwork area. ship in flat-panel detector technology. The new Cios Connect mobile “With the addition of these three C-arm weighs just 547 pounds and new mobile C-arms to the Cios family, enables surgeons to perform a broad Siemens Healthcare is proud to build on area of applications. Software options our tradition of C-arm leadership,” said allow physicians to display individual Martin B. Silverman, Vice President images simultaneously in subtracted of X-ray Products at Siemens Healthand X-ray views, to optimize the precare. “Our Cios family offers customers a complete product portfolio that meets sentation of contrast and bone, and their needs, regardless of facility type or support a broad range of surgical needs. The new entry-level, user-friendly budget. These expanded mobile C-arm Cios Select mobile C-arm boasts an offerings represent another example easy-to-use push button interface for of how Siemens innovates to solve the fast workflow. It uses the image prodaily real-world challenges facing hoscessing algorithm IDEAL (Intelligent pitals and surgical centers.”

20 MEDICALDEALER | MAY 2016

Staff Reports

Dose Efficiency Algorithm) to provide continuous contrast and brightness adjustments as well as the automatic dose-performance adjustment that is available across the entire Cios family. The new version of Siemens’ established Cios Alpha mobile C-arm features a square flat-panel detector that helps users reach optimum levels of minimally invasive intervention in the modern surgical environment. Revised software delivers a large preview image that allows operating room staff to select appropriate image settings more easily. A new one-touch metal correction function compensates for metal image components to enable representation of surrounding tissue with greater contrast. And to mark anatomical structures, the Cios Alpha’s Live Graphical Overlay function – which formerly had been available exclusively to vascular surgery users – now can be used in all operating modes.•

MEDICAL EQUIPMENT, PARTS & SERVICE

_OEM Updates

NIHON KOHDEN DEBUTS LIVE VIEW PANEL Nihon Kohden has commercially Developed in collaboration with launched Live View Panel, a virCleveland Clinic, the Live View Panel tual care system that allows for the is composed of a control screen and simultaneous management of remote several adjacent data display screens. neuromonitored patients in real time The control screen organizes patient from a centralized location. Using Live information into color-coded “cards” View Panel, clinicians can for the first based on variables, such as patient time personally customize multiple location, acuity level, physician or electroencephalography (EEG) or poly- data modality, allowing a clinician somnogaphy (PSG) acquisition systems to monitor basic parameters of multo gather data most critical for each tiple patients simultaneously. With monitored patient. The information is one touch to any card, clinicians can displayed on a single, interactive conaccess more detailed patient-specific trol screen, with one-click access to data on an adjacent screen. The cards clinically relevant information that can also be rearranged via drag and can help speed interpretation and drop to suit clinician preference improve outcomes. and workflow.

NEW TRANSPONDER RECEIVES FDA 510(K) CLEARANCE AND CE MARK Varian Medical Systems has the Calypso system, guiding treatannounced a new Calypso 17G soft ment beams to precisely target tissue Beacon transponder that is tumors during treatment with med50 percent smaller than the preical linear accelerators, such as the vious version. The 17G device Varian’s Edge radiosurgery system. can help enhance the precision The Calypso System is the only of radiotherapy and radiosurgery device on the market that delivtreatments for cancer by providers real-time, continuous (25 Hz ing real-time, continuous tumor update rate), 3D tumor position position information, based on the information, improving confiimplanted transponders, and has dence that the prescribed dose received FDA 510(k) clearance and has been delivered to the tumor. CE mark. This increased precision can The size of a grain of rice, the enable treatment margin reducnew Varian Calypso 17G soft tistion, which can protect healthy sue Beacon transponder, can help tissue and reduce certain side enhance the precision of radiother- effects. The Calypso system, when apy and radiosurgery treatments used with the new 17G transponfor cancer by providing real-time, ders, delivers equivalent accuracy continuous tumor position inforand precision as compared to the mation, based on the implanted established 14G devices. transponders, and has received “With the precise targeting proFDA 510(k) clearance and CE mark. vided by Calypso technology, we Each Beacon transponder emits a are able to reduce treatment marnon-ionizing electromagnetic siggins and liver toxicity compared to nal that is tracked in real-time by conventional radiotherapy without WWW.MEDICALDEALER.COM

Data in the EEG cards includes patient identifier, location field, monitoring status, heart rate, saturation of peripheral oxygen (SpO2), as well as seizure count and seizure trend. PSG cards display apnea-hypopnea index, total sleep time, body position, continuous positive airway pressure (CPAP), and heart rate, SpO2 and sleep state, with trend options, including apnea/hypopnea, SpO2/desaturation, sleep stage, CPAP, carbon dioxide and heart rate. Audio and video can be played or displayed remotely from either acquisition system. Key information can also be provided on a Live View Panel at the local nurse’s station for additional oversight.

Calypso beacons,” remarked Neal Dunlap, MD, Radiation Oncologist, University of Louisville, Kentucky. The 17G Beacon transponders are commercially available. • For more information, visit http://www.varian.com/ news/calypso MEDICALDEALER 21

INDUSTRY UPDATE_OEM Updates

Staff Reports

PHILIPS INTRODUCES MR-ONLY SOLUTION FOR PROSTATE CANCER TREATMENT PLANNING IN U.S. Philips’ new MRCAT solution Royal Philips has introduced the first Current clinical practice often uses allows physicians treating prostate commercially available MR-only a combined approach using both MR cancer patients to adopt a singlesimulation solution indicated for and CT images, but this can lead to modality imaging approach that prostate cancer radiation oncology image misalignment and registration provides high quality soft-tissue treatment planning in the United States. uncertainties that could impact contrast for target delineation, as Philips has achieved 510(k) targeting and treatment. It also puts clearance from the Food and Drug pressure on patient burden, workflows well as density information for dose and costs. MR-only simulation not calculations. To produce the density Administration (FDA) for its MRCAT information standard for CT, Philips only alleviates additional scans for (Magnetic Resonance for Calculating has integrated fast and robust the patient, but improves physician ATtenuation) solution as part of imaging protocols to obtain CT-like workflow and could potentially its Ingenia MR-RT platform. This images on the MR console. Philips’ reduce provider costs, as compared imaging approach supports radiation to MR-CT workflow. MR-only simulation solution departments that want to rely on MRI has also received CE mark and is As part of its Ingenia MR-RT as their primary imaging modality for available globally.• platform for MR simulation, prostate cancer treatment planning.

22 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

INDUSTRY UPDATE_Block Imaging

By David Harns

REFURBISHED CARDIAC CT SCANNERS SOFTEN CMS REIMBURSEMENT CUTS

hether you are looking to add a cardiac CT scanner to your practice or upgrade your current CT scanner to one that will qualify for cardiac CT ACR accreditation and, thus, Medicare and Medicaid reimbursements, one thing is certain: The Centers for Medicare and Medicaid Services (CMS) have not made this any easier with continuing reimbursement cuts for medical imaging techniques in the Medicare Fee Schedule. In fact, CMS cuts – made every year since 2007 – combined with legislative cuts in the same time frame have reduced funding for many common examinations up to 50 percent. Yet, the obvious benefits of CT imaging for heart patients mean that doctors and medical providers alike will continue to use cardiac CT technology to help save lives. They will just have to do so in a more economically viable manner. That’s where the refurbished equipment industry comes in. We acquire used cardiac CTs and refur24 MEDICALDEALER | MAY 2016

David Harns

bish them to OEM specifications and – in essence – give them a second chance. In doing so, we give hospitals and imaging centers across the country the ability to serve their customers in a fiscally responsible way. Our organization can’t speak for every refurbished equipment provider but, depending on the model, buying refurbished can often save you between 30-50 percent of the cost of a new scanner. Not only are refurbished car-

diac CTs more affordable, they still meet the specifications needed to be reimbursed by both Medicare and Medicaid just like new scanners. For cardiac purposes, the CT scanner should meet or exceed the following specifications, per the American College of Radiology1: •Contrast-enhanced cardiac CT by MDCT, including CT coronary arteriography, a scanner capable of achieving in-plane spatial resolution ≤0.5 x 0.5 mm axial, z-axis spatial resolution ≤1 mm longitudinal, and temporal resolution ≤0.25 sec. •Non-contrast-enhanced MDCT for coronary artery calcium scoring may be adequately performed on a scanner with a temporal resolution of 0.50 second using prospectively ECG-triggered “step and shoot” sequential acquisition. • Tube heat capacity should be adequate. Minimum section thickness: should be ≤5 mm; but ≤3 mm for coronary calcium scoring and ≤1.5 mm for CT coronary arteriography. •Also, in order to maximize the CT interpretation, any CT scanner used for cardiac CT must MEDICAL EQUIPMENT, PARTS & SERVICE

_Block

allow display and interpretation of the full 12 bits (from -1,000 to 3,095 Hounsfield units) of attenuation information. Additionally the display FOV must be sufficient to assess the cardiovascular region of interest, and adjacent structures. Whether your preference is a water-cooled or air-cooled scanner, or if GE, Philips, Siemens, or Toshiba is the manufacturer you’re most loyal to, the refurbished equipment market can offer you scanner options that meet both the requirements of your equipment budget and the nation’s regulatory organizations. ACR-NASCI-SPR Collaborative Committee. “ACR-NASCI-SPR Practice Parameter for the Performance and Interpretation of Cardiac Computed Tomography (CT).” American College of Radiology. January 2014. Accessed January 15, 2014. http:// www.acr.org/~/media/ACR/Documents/ PGTS/guidelines/ CT_Cardiac.pdf. 1

DAVID HARNS is the Product Specialist CT for Block Imaging International.

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Call EDI today at 508-828-2970 for the best VALUE in remanufactured GE AMX-4+.

508-828-2970 597 Winthrop Street Taunton MA 02780

www.easterndiagnostic.com

26 MEDICALDEALER | MAY 2016

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Our processes have been perfected over a 25 year history J of F remanuM A M facturing GE AMX portables. You won’t believe the DESIGNER: difference from JL our competitors, and you won’t see the difference from new. We stand behind every product that leaves our facility. Every remanufactured system is sold with a full warranty and life time technical support.

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WHAT IS BLENDED LEARNING? At Tri-Imaging we offer blended learning that includes hands-on training at our Nashville, TN facility and education through our online platform. Reducing time away from your facility, without compromising the quality of your learning experience.

Now thatâ&#x20AC;&#x2122;s refreshing!

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EMPOWERING THE ENGINEER Tri-Imaging Solutions is a training institution and a parts company. It is not a parts company that offers training. Ask us about the difference!

VISIT WWW.TRIIMAGING.COM OR CALL 855.401.4888

PRODUCT FOCUS_Cardiac Imaging_Market Analysis

Staff Reports

CARDIAC IMAGING MARKET

ardiac imaging continues to evolve and become more important in the diagnosis and treatment of potentially life-threatening diseases and conditions. Different diagnostic imaging modalities bring unique tools to the table when it comes to generating images of the heart, including 2D, 3D and even 4D images generated by ultrasound devices. C-arms and other modalities also continue to be useful for medical imaging of the heart. Technavio, a market research company with global coverage, has prepared several reports on medical imaging and expects the global medical imaging market to exceed $37 billion by 2020, according to the research firm’s website. One Technavio market research analyst predicts that the global market for medical imaging will grow at a compound annual growth rate (CAGR) of nearly 5 percent by 2020, according to the research company’s website. “The growing focus on R&D to provide high-quality imaging for better diagnosis and treatment of diseases is a critical factor that drives the global demand for medical imaging devices during the forecast period,” according to a Technavio report. The report includes “a detailed segmentation of the global medical imaging market by equipment type (MRI, CT scanners, general X-rays, SPECT/PET, and ultrasound). It also outlines the market shares for key regions like the Americas, APAC and EMEA.” WWW.MEDICALDEALER.COM

One Technavio market research analyst predicts that the global market for medical imaging will grow at a compound annual growth rate (CAGR) of nearly 5 percent by 2020, according to the research company’s website.

“In this market research, analysts have estimated eminent factors, such as the advent of 4D medical imaging technology, to spur market growth during the forecast period. Since 4D imaging technology enables doctors

to create a 3D picture in real time, its augmented application in ultrasound systems will foster the prospects for growth in this market during the predicted period,” according to Technavio. The Technavio analysis provides a breakdown by imaging technology. “Being the foundation of diagnosis, medical imaging is witnessing huge popularity in the treatment of several medical conditions,” Technavio analyst Brahadeesh Chandrasekaran says on the company’s website. The report lists Siemens, GE, Philips, Toshiba and Carestream among the leading vendors in the global medical imaging market. It is a competitive market, especially in regards to new advances including those in cardiac imaging and other advanced products. The global aspect of the many original equipment manufacturers also increases the demand for market share. “This market is highly competitive due to the presence of many multinational companies that consistently focus on R&D to bring about product innovations. The major players in this market are focusing on value segments and advanced products that can provide high-quality imaging at a faster diagnosis time,” according to Technavio. “This growing focus on value segments will help vendors to bolster product sales during the forecast period.” MEDICALDEALER 29

PRODUCT FOCUS_Cardiac Imaging_Product Showroom

Staff Reports

MAY PRODUCTS: This month, Medical Dealer explores Cardiac Imaging.

PHILIPS iCT family of CT scanners

he Philips iCT family of CT scanners provides proven excellence in cardiovascular care, going beyond high accuracy in detecting stenosis to now also allowing physiological assessments. More importantly it enables these capabilities at low-dose, across a broad range of patients and with consistency. The Philips iCT can also be configured with Philips’ IMR – a model-based iterative reconstruction technique that defines a new era of CT image quality that opens pathways to confident diagnosis and low radiation risk. The industry-leading IMR image quality (low-contrast) reveals enhanced information previously not available on CT. Algorithmic optimizations combined with hardware innovations enable virtually noise-free results in less than 3 minutes, including for the most advanced applications, allowing benefits to be achieved routinely and across a broad range of patients. •

30 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

Cardiac Imaging_Product Showroom

SIEMENS ACUSON SC2000

he ACUSON SC2000 ultrasound system is engineered to go beyond basic cardiovascular ultrasound to deliver fast, actionable understanding. The True Volume TEE Release features innovations in simultaneous anatomy and blood flow visualization as well as valve modeling and quantification. With solutions for 2D and 3D transthoracic (TTE), transesophageal (TEE), and intracardiac echocardiography (ICE), the system delivers comprehensive, anatomically precise information to enable informed decisions without missing a beat. â&#x20AC;˘

WWW.MEDICALDEALER.COM

MEDICALDEALER 31

PRODUCT FOCUS_Cardiac Imaging_Product Showroom

Staff Reports

TOSHIBA Infinix-i

he Infinix-i offers unparalleled access, enabling clinicians to perform safer and more efficient exams with a C-arm designed to carefully move around patients and clinicians. Toshiba’s WorkRite technology maximizes workflow and throughput to ensure that clinicians are in an optimal ergonomic orientation during any procedure. The system also features comprehensive dose management tools such as the Dose Tracking System (DTS) and Spot Fluoroscopy to provide safer exams for patients and staff. •

32 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

ENGINEERED FOR LEARNING Staff Reports

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PRODUCT FOCUS_Cardiac Imaging_Preferred Vendors

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CARDIAC IMAGING

// Highly Skilled Training Staff to Maximize Your Understanding of Basic Imaging Modalities and Advanced Imaging Systems // Call 1.800.229.7784 to Register or View the 2016 Course Index and Schedule Online

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Because Quality Matters.

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Conquest Imaging Corporate Technology and Logistics Center 1815 Industrial Drive Stockton, CA 95206 Toll-Free: 866-900-9404 Fax: 209-942-2572 Email: mtomory@conquestimaging.com Website: www.conquestimaging.com Conquest Imaging delivers the highest quality ultrasound parts, probes, service, training and technical support in the industry. Powered by our exclusive Quality 360° reconditioning and testing processes and ISO 9001:2008 certification, you can count on cost effective ultrasound material support that outlast the others including the OEM. Conquest Imaging. Because Quality matters.

SEE OUR AD ON PAGE 23

Global Medical Imaging 222 Rampart St. Charlotte, NC 28203 Toll-Free: 800-958-9986 Phone: 704-940-7755 Fax: 704-940-7756 Email: info@gmi3.com Website: www.gmi3.com GMI sells, services and supports ultrasound systems, nuclear cameras and PACS networks across the USA. At GMI, we focus on one thing. Transparency. The truth is that we serve our customers with confidence knowing that we can provide the best experience in the industry. From sales to service and world class support, we have the products and services you need to support your business today and grow tomorrow. Call us today to learn how we can help your business.

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Government Liquidation 15051 N Kierland Blvd #300 Scottsdale, AZ 85254 Phone: 480-367-1300 Email: info@govliquidation.com Website: www.govliquidation.com Government Liquidation (GL) is your direct source for U.S. Government surplus. Sales are conducted via our online auction platform through internet auctions. GL invites you to purchase medical, dental and test equipment in a convenient environment at: www.govliquidation.com. Search our inventory as new items are added daily.

InterMed Group 13351 Progress Blvd. Alachua, FL 32615 Toll-Free: 800-768-8622 Phone: 386-462-5220 Fax: 386-462-5330 Email: sales@intermed1.com Website: www.intermed1.com

ENGINEERED FOR LIFE RSTI-EXCHANGE.COM

SEE OUR AD ON PAGE 7

RSTI EXCHANGE

// Visit RSTI Exchange Online and Shop Our Full Line RSTI Exchange of Pre-owned Equipment Terry Speth- VP Director of Sales // Ask About Our On-Demand Service, Parts Installations and Tech Support in Conjunction 30745 Solon Road with Parts Purchases // FOLLOW US ONLINE // Solon, OH 44139 SEE OUR // Access a Constantly Expanding Inventory of Parts AD ON in Stock for Most Manufacturers and Modalities Toll-Free: 800-229-7784 PAGE 34 // Phone: Call 440.349.4700 or Email 440-349-4700 Sales@RSTI-Exchange.com for Full Details Fax: 440-349-2053 SHOP // RSTI-EXCHANGE.COM Email: tspeth@rsti-exchange.com Website: www.rsti-exchange.com

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Engineered for Life; Born in 2001 out of RSTI’s used equipment sales and a desire to add new layers of support for our students, RSTI Exchange provides fully tested, certified and warranted used equipment and replacement parts for most imaging modalities and manufacturers. Technical support and parts installation services are also available in conjunction with parts sales.

SEE OUR AD ON PAGE 45,58,62

The InterMed Group is a premier provider of integrated technology management services. We are focused on enhancing the overall quality, cost, and confidence in your equipment administration. Our Biomedical, Ultrasound, X-Ray, and NucMed specialists and unique “Jump Teams” are empowered to deliver unmatched customer service and the industry’s best technology at competitive rates. We invite you to discover how our innovative technology, operational excellence, and deeply experienced and passionate professionals have earned us a blemish-free track record and sterling reputation for consistently exceeding our clients’ expectations.

SOLUTIONS

Tri-Imaging Solutions 10 Fant Industrial Dr. Madison, TN 37115 Toll-free: 855-401-4888 Email: sales@triimaging.com Website: www.triimaging.com

SEE OUR AD ON PAGE 28

Tri-Imaging Solutions is a replacement parts, equipment, service support, and technical training company. We provide quality tested imaging parts – and can even help to install, we buy-sell-move equipment, and provide technical support. All replacement parts come with a 90-day warranty. Available 24/7/365.

MEDICALDEALER 33

34 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

GE • Siemens • Phillips • Varian • Dunlee • Toshiba • Shimadzu

It’s About Time! It’s about YOUR time.

Your time is important! We understand that you need a quality X-ray tube “NOW”. Our 33 years of experience, devotion and service to our distributors is why our customers consistently depend on Ray-Pac for quality X-ray tube replacements. We have two of everything ready to ship in our Ray-Pac Inventory ARK. It will help you save time looking for your replacement X-ray tubes. With just one touch of a button our free mobile APP or web page shows exactly what’s available to ship today or tomorrow. East or West Coast, we are able to ship your order overnight!

It’s time you depend on Ray-Pac for quality replacement X-ray tubes made in the USA with genuine Varian® replacement parts.

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Interested in Becoming a Dealer? Visit www.BionetUS.com and Complete “Become a Dealer” Application. Bionet America, Inc. 2691 Dow Ave., Ste. B, Tustin, CA 92780 – 877-924-6638

36 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

HEIGHT 4.5”

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PRODUCT FOCUS_Single-Use_Market Analysis

Staff Reports

SINGLE-USE DEVICE OPTIONS POWER MARKET

he single-use device market in health care isn’t always a true “single-use” device market. More and more single-use devices are being reprocessed and used a second or third time to produce cost savings.

At the same time, some single-use devices are used one time and discarded. These types of single-use devices are becoming know as disposable medical devices. Brian White, President of Stryker Sustainability Solutions, spoke with Medical Dealer for this month’s cover story on single-use devices and explained that the market continues to take shape as it grows and attracts more heath care customers, including those from home health care. White forecasts that the purchase of reprocessed single-use devices will continue to be a useful tool for hospitals as health care systems prepare cost-effective and environmentally responsible avenues to meet their needs. He added that companies like Stryker are looking for more and more ways to improve medical device design to allow for effective reprocessing of OEM products to assist health care users as they plan equipment purchases that can include single-use devices ready to be used, reprocessed and used again. Medical device purchasers tell us they want to reprocess more expensive devices in the future, White said. “Hospitals are going to do more business with original manufacturers WWW.MEDICALDEALER.COM

that support their overall goals and less business with those that do not,” he said. “This means we will likely see an emergence of new devices that are engineered with reprocessing in mind. I believe it could become a real competitive advantage for original manufacturers that embrace this reality.” All this is happening amid market growth. “The global medical devices reprocessing market is growing at a CAGR (compound annual growth rate) of 19.3 percent between 2014 and 2020,” according to a Transparency Market Research report. “The global medical devices reprocessing market was recorded at $0.78 billion in 2013 and is expected to reach $2.58 billion by 2020.” According to the report, the global medical devices reprocessing market is primarily driven by the high level of cost savings generated by reprocessing devices instead of disposing of them. Another market driver is the increasing pressure on medical organizations to reduce the medical waste created due to environmental concerns. ReportsnReports.com expects the world medical disposables demand to increase 6.6 percent annually through 2018 and reach nearly $245 billion, according to a press release

“The global medical

devices reprocessing market was recorded at $0.78 billion in 2013 and is expected to reach $2.58 billion by 2020.” from PR Newswire. “The upgrading and enforcement of infection prevention standards, coupled with an expanding volume of hospital, surgical, and outpatient procedures, will promote overall gains,” according to the press release. “Among the major disposable medical supply product segments, dialysis disposables will post the fastest increases in global demand based on an expanding prevalence of end-stage renal disorders and the high frequency of therapeutic requirements,” the release added. “Other segments projected to command average or better worldwide revenue growth include incontinence goods, infusion and hypodermic devices, nonwoven products, respiratory supplies and devices, sterilization supplies, and various other offerings such as urinary catheters and accessories, first aid kits, ostomy appliances, transdermal patches, and waste disposal supplies.” MEDICALDEALER 37

PRODUCT FOCUS_Single-Use_Product Showroom

Staff Reports

MAY PRODUCTS: This month, Medical Dealer explores Single-Use Devices.

CURBELL OnePatient Disposable ECG Lead Wires

urbell’s disposable ECG offering is focused on ease of use. We know clinicians’ jobs are complex; therefore our disposable leads are simple. Adaptors are not required. Our disposable lead wires directly connect to existing patient monitoring equipment. Available in pinch or snap electrode connectors, they are interchangeable with reusable lead wires, saving on cost and waste. Additionally, OnePatient Disposable ECG Lead Wires can assist a facility in lowering hospital-acquired infections by cross contamination, thus improving patient care.•

38 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

Single-Use_Product Showroom

INTEGRATED ENDOSCOPY nuvis Single-Use Arthroscope

ntegrated Endoscopyâ&#x20AC;&#x2122;s nuvis Single-Use Arthroscope is the first FDA-approved disposable rigid endoscope available in the U.S. The nuvis never needs repairs, never infects a patient, never contributes to OR delays and never needs cleaning. Sold singly or in packs of 10, the affordable nuvis arthroscope features advanced, high-tech lenses made with the same technology and low-temperature glass used to mass-produce high-definition, low-cost optics for smartphone cameras. It features patented LED technology that provides improved white light at significantly lower temperatures than the fiber optic illumination used in conventional endoscopes, eliminating the need for fiber optic bundles and expensive xenon light bulbs. â&#x20AC;˘

WWW.MEDICALDEALER.COM

MEDICALDEALER 39

PRODUCT FOCUS_Single-Use_Product Showroom

Staff Reports

PACIFIC MEDICAL LLC Disposable Cables

acific Medical LLC provides the ultimate deterrent to HAIs in the form of disposable cables. Disposable cables have proven their worth as a reliable means in which to prevent cross-contamination from patient to patient, sparing health care providers from immeasurable burden. Pacific Medical LLC offers disposable cables right out of their dedicated facility, housing thousands of cables in stock. The company understands the pressure of cost-effective measures hospitals undertake, so they have made disposable cables easily accessible and highly affordable. â&#x20AC;˘

40 MEDICALDEALER | MAY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

Single-Use_Product Showroom

WELCH ALLYN KleenSpec LED Vaginal Specula

elch Allyn Inc. has extended its family of womenâ&#x20AC;&#x2122;s health solutions with the addition of KleenSpec Single-Use LED Vaginal Specula. The devices, which incorporate the distinctive color-coded handles used in other Welch Allyn specula, are designed for hospital emergency departments, labor and delivery rooms and urgent care centers. They feature an integrated LED light source that helps to provide enhanced visualization of the exam area by supplying uniform white light and is safely sealed away from the patient. The single-use LED vaginal speculum is designed to eliminate the time and expense of reprocessing metal specula and reduce the risk of cross-contamination. It is available in a broad range of sizes for all types of patients and is manufactured to deliver durability and reliability in a variety of hospital and urgent care settings. For information, visit www.welchallyn.com. â&#x20AC;˘

WWW.MEDICALDEALER.COM

MEDICALDEALER 41

PRODUCT FOCUS_Single-Use_Preferred Vendors

Staff Reports

PREFERRED VENDORS

ENHANCE YOUR CAREER WITH

SINGLE-USE ALCO Sales & Service Co. 6851 High Grove Blvd. Burr Ridge, IL 60527 Phone: 800.323.4282 Fax: 800.950.1167 Email: info@alcosales.com Website: www.alcosales.com

SEE OUR AD ON PAGE 27

Since 1952, our family has been providing quality medical equipment and replacement parts to the healthcare industry. We provide our customers with multiple ordering options. Our four “full line” catalogs and various “product specific” catalogs complement our new online ordering web site that offers over 70,000 products for your facility.

Paciﬁc Medical Repairs & Equipment SEE OUR AD ON 32981 Calle Perfecto PAGE 5 San Juan Capistrano, CA 92675 Phone: 800-449-5328 Fax: 800-369-9804 Email: info@pacificmedicalsupply.com Website: www.pacificmedicalsupply.com Experience our quality on all purchase and repairs: • Monitors • Modules • Telemetry • Patient Cables • Fetal Transducers

• Infusion Pumps • Endoscopes • O2 Blenders • Gas Analyzers • Suction Regulators

From a wide variety of OEMs: Philips, GE, Datex Ohmeda, Datascope and more. Call for OEM quality without the cost.

42 MEDICALDEALER | MAY 2016

Earn valuable CE Credits Recorded webinar and workbook available Learn from industry leading professionals Keep up with the industry’s latest technology All for FREE!

Visit www.1TechNation.com/ webinars to view the calendar for upcomming webinars!!

MEDICAL EQUIPMENT, PARTS & SERVICE

Looking to Buy Baxter Flo-Gard 6201 & InfusOR

AIV will buy your old Baxter Flo-Gard 6201 and Baxter InfusOR infusion pumps - no matter the condition. Call us today to see how much your old equipment is worth

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MEDICALDEALER 45

46 MEDICALDEALER | DECEMBER 2015

MEDICAL EQUIPMENT, PARTS & SERVICE

Promoting Cost Savings and Infection Prevention By Matt Skoufalos n any health care setting, the number-one issue in supply chain management is cost. As hospital budgets tighten and reimbursement rates become more contingent on quality of care, decision-makers are searching for ways to meet the demands of improved outcomes as well as to maintain their bottom lines. As independent studies and FDA opinions have concurred, reprocessed single-use medical devices can provide a viable and cost-effective alternative to original equipment manufacturer (OEM) products in many cases, and often at a significant price break. Yet the U.S. market for disposable devices is a multi-billion-dollar industry driven by fierce R&D competition and product-line expansion, particularly in the drug delivery, surgical supply and home health care segments.

WWW.MEDICALDEALER.COM

MEDICALDEALER 47

Single-Use Device Options

Among the fastest-growing segments of the disposable device markets are products used in dialysis, followed by “incontinence goods, infusion and hypodermic devices, nonwoven products, respiratory supplies and devices, sterilization supplies,” catheters, and first aid kits, according to a 2014 report from Global Research. At the same time, however, devices used in cardiovascular studies, surgery, orthopedics, and gastroenterology are reaching secondary customers thanks to device reprocessors. As that market increases in value, driven by cost considerations and innovation, hospitals and device-makers have an increasing number of equipment alternatives from which to choose. According to Dan Vukelich, President of the Association of Medical Device Reprocessors (AMDR), only an estimated 2 to 3 percent of single-use medical devices are capable of being reprocessed. Yet because several such devices are worth hundreds of thousands of dollars – from laparoscopic surgical tools to equipment used in cardiac catheterization labs – AMDR estimates that the health care savings of reprocessing those devices is approximately $3 billion annually. “Any cardiology catheter that is tossed in the trash is literally throwing away hundreds of dollars in raw materials or devices that could have been used to reduce the overall procedure cost for any individual case,” Vukelich said, “or it’s better spent on new equipment, or can help reach someone who wouldn’t otherwise have access to care.” Certain medical goods would never be viable candidates for reprocessing, Vukelich said – things like disposable surgical drapes, syringes, “or a lot of less durable plastics” – wouldn’t provide any significant return, either in terms of their dollar amount or because their construction is too fragile to withstand being reprocessed. For others, it’s a matter of building the proper channels around them. The intricate construction of laparoscopic devices, for example, makes them poor candidates for in-house disassembly and cleaning within 48 MEDICALDEALER | DECEMBER 2015

Dan Vukelich

“The more intricate devices get, the harder they would be to clean, so it makes it harder to make disposable versions. For those that we can reverse-engineer and ﬁgure out how to clean, we’re going to provide a competitive alternative.” – Dan Vukelich the hospital, but with reverse-engineering, reprocessors can break down, clean, and reassemble them. In so doing, the $400 price of a new-in-box ultrasonic scalpel falls to $200 for its reprocessed analogue. “The more intricate devices get, the harder they would be to clean, so it makes it harder to make disposable versions,” Vukelich said. “For those that we can reverse-engineer and figure out how to

clean, we’re going to provide a competitive alternative.” When reprocessed, even lower-cost, non-invasive items like tourniquet cuffs, pulse oximeters, and compression sleeves can introduce more dramatic cost savings on the strength of numbers. “Hospitals go through insane volumes of this stuff,” Vukelich said. “It may only go for $12 but if you can reprocess it for $6, you’re [not] irresponsibly throwing away resources.” In addition to going for about half the cost of new devices, the act of cycling in reprocessed medical devices further drives down equipment costs when they’re used ahead of OEM products by incentivizing hospitals to purchase fewer devices overall, Vukelich argues. “Use those first, and that will impact the number of new devices you have to buy, and then you’ll get a better sense of how many new devices you have to buy,” he said. “Not only is the reprocessing cost less, it causes competition in that you’re buying fewer new devices, and it causes downward pressure on prices.” Reducing the overall volume of inventory that’s cycled through a health care facility means less waste is produced, which Vukelich said represents a cost and an environmental savings, since medical device waste is “significantly more expensive to dispose of than general waste.” As fears of how to manage HIV-related infections have diminished with greater understanding of the disease, the clamor for single-use devices on the grounds of infection control alone has shrunk, Vukelich said. Instead, reprocessors work with their customers to install compatible device recovery systems to collect reprocessible devices, ship them off for sterilization, and return them to viable use. As an added benefit, all the reprocessed equipment is tested before it leaves the manufacturer, which means it’s guaranteed to work, versus the certain percentage of out-of-box failures with which any original equipment manufacturer must contend. MEDICAL EQUIPMENT, PARTS & SERVICE

“In many senses, reprocessors operate just like any other manufacturer,” Vukelich said. “It’s held to the same standard, and we get treated as a manufacturer vendor by the hospitals just like any others. We test or inspect every single device that comes off our line. We’re not reprocessing lemons here; we only let things that work out the door.” For manufacturers like OBP Medical of Lawrence, Massachusetts, however, the market for single-use medical devices is only growing. Matthew Traub, OBP Chief Marketing Officer and Executive Vice-President of Sales, said hospitals are interested in replacing as many reusable products as they are able to with single-use devices. “The reception that we’re getting from the market is yes, there is a need for this,” Traub said. “The cost of so many [materials and components] has come down so much that you can make [a device] as a single-use product.” “Any available opportunity to take a pre-existing device that is reusable and create a cost-effective, reliable, single-use

Hospital staff place medical devices into collection bins that are shipped to third-party companies for reprocessing.

offers a variety of advantages, Traub said. From the handle to the blade to the battery to the fiber optics that provide the light source within, the entire device has multiple points of failure that wear out at different paces and require various replacement components. As more cost-effective technologies like LED

“Any available opportunity to take a pre-existing device that is reusable and create a costeffective, reliable, single-use option, there’s a growing demand for a variety of reasons: patient safety followed by ease of use followed by cost.” – Matthew Traub option, there’s a growing demand for a variety of reasons: patient safety followed by ease of use followed by cost,” he said. “The antiquated way of a completely reusable device has gone through several waves of evolution.” Where once a device like a laryngoscope was historically entirely reusable, over time the marketplace created a less-expensive, single-use version that WWW.MEDICALDEALER.COM

light sources became available, designs improved, and the scopes became more cost-effective to manufacture as one-offs. “There’s no moving parts,” Traub said. “It allows the clinician to be free of cross-contamination and reprocessing. It ensures the efficacy of the device [and] it’s a more efficient way of doing business.” In the absence of single-use devices, reusable equipment can operate like

the disposable razor business, where, “they’re going to give you the handle or mark up the blades,” Traub said. He also argued that, perhaps counterintuitively, reprocessed devices may offer a higher associated cost per use of device. Whereas a single-use product may be purchased for $10 or less, the cost of a reusable device may approach $120-125 per use, as “the bulk of that associated cost is in the reprocessing of the device.” When medical devices cannot be reprocessed because their component parts can’t be disassembled or adequately cleaned, a single-use device may represent the only sensible clinical option. “You have to think about the safety of your device with your patient or clinician,” Traub said. “You want to provide a safe and reliable product with the best possible patient outcomes.” Many reprocessors describe their business lines as being superior to those of single-use because they lessen the volume of medical waste produced by the U.S. health care system. Traub points out that reprocessing isn’t a waste-free process, either, and creates chemical and packaging byproducts that must also be dealt with. The best way for manufacturers to address the environmental issues related to equipment production is holistically, he said; by collaborating with MEDICALDEALER 49

Single-Use Device Options

health care facilities to streamline their disposal efforts and finding new ways to increase the amount of recyclable materials involved in the production of the devices themselves. “You should be looking at the materials you’re using and checking the market to see if new materials have come out that you can incorporate into your products that offer the same reliability and effectiveness,” Traub said. “What are the parameters of recycling hazardous waste and what can it be used for? I think that it’s everyone involved’s responsibility to always be thinking about ways of reusing the system, everything from waste to product development and design.” Traub also countered the idea that OEM devices have a significantly high rate of out-of-box failures, citing ISO-certified manufacturing processes and quality inspections that are standard at many production facilities. He said these result in a negligibly small failure rate. “We have rigorous quality inspections, and any partner or any company that we choose to work with, we make sure that they’re ISO-certified as well,” Traub said. “Our failure rates are, for the most part, nonexistent.” Traub predicts future growth in the single-use device industry as manufacturers more closely integrate their offerings with the needs of customers. From home health care to ambulatory clinics to hospital settings, “the sky’s the limit,” he said. “We started off by identifying a few unmet needs here and there,” Traub said. “As we’ve built a customer base, there’s no shortage of ideas. The process starts on our end with looking at the market, determining what’s out there, and trying to determine where we can add value.” Some device manufacturers – including major corporations like Stryker and Medline – straddle the line between reprocessors and OEMs, a business strategy that takes advantage of the distinction between single-use and reprocessed businesses as being a manufacturer-chosen label. Brian White, President of Stryker Sustainability Solutions, said that hospitals 50 MEDICALDEALER | MAY 2016

Brian White

“The use of reprocessed singleuse is critical to many hospitals’ ability to sustain operations and deliver the best patient care." -BRIAN WHITE also have embraced both lines of products as an alternative to being forced to choose. “The use of reprocessed single-use is critical to many hospitals’ ability to sustain operations and deliver the best patient care,” White said. “Many physicians choose to use devices from Stryker’s Sustainability Solutions over original devices because they know Stryker reprocessed devices are substantially equivalent to original devices. They also understand this practice helps them reinvest reprocessing savings to other meaningful

patient care initiatives.” The two lines of business fit handin-glove; simply put, without OEM single-use devices, “there is no product pipeline for the reprocessing industry,” White said. Yet Stryker anticipates that the market for medical device reprocessing “still has tremendous growth prospects” and the potential to drive greater savings throughout the health care industry. Citing market studies from Millennium Research Group, Caris & Company, and Transparency Market Research, White said the reprocessing business is forecast to carry through the next several years at double-digit growth rates. “We expect the purchase of reprocessed single-use devices will continue to be a key strategy employed by U.S. hospitals that are demanding cost-effective and environmentally sound solutions to the challenges they are facing,” White said. “This [market] growth, which is two to three times faster than the overall med tech market, will be fueled by an increase in product types available from third-party reprocessing companies, geographic expansion, and deeper penetration into existing accounts that are motivated by this very effective supply chain initiative.” To that end, he said, companies like Stryker are seeking additional opportunities to better engineer OEM equipment for reprocessing, in addition to obtaining 510(k) clearance “for reprocessing some of the most expensive, highest-volume devices customers use today.” “Our hospital customers tell us they are interested in reprocessing more categories of higher-priced devices in the future,” White said. “Hospitals are going to do more business with original manufacturers that support their overall goals and less business with those that do not. This means we will likely see an emergence of new devices that are engineered with reprocessing in mind. I believe it could become a real competitive advantage for original manufacturers that embrace this reality.” MEDICAL EQUIPMENT, PARTS & SERVICE

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SLICE OF LIFE_The Other Side

By Jim Fedele

ANOTHER THREAT!? ust when I finally figured out how to comply with the RPT waivers and had a solid AEM program complete with evaluation, there appears to be a new threat to our ability to service equipment and provide value to our customers. On March 4 the FDA published a new Proposed Rule (PR) entitled “Refurbishing, Reconditioning, Rebuilding, Remarketing, Remanufacturing, and Servicing of Medical Devices Performed by Third-Party Entities and Original Equipment Manufacturers,” and is requesting comments on the proposal. As I dug into the document I found that “servicers” are identified in the rule, this could be interpreted to include anyone other than the OEM who is servicing the equipment, not just “refurbishers.” It feels like a daily fight to secure the right to service equipment our hospital and customers have purchased. On every equipment order we must remind the vendor to include service manuals, offer training and give us preventative maintenance procedures. I am amazed at how creative OEMs have become at trying to avoid complying with our requests. Their reasons go from overtly stating that they do not have service manuals to charging an annual fee to access. The aggressiveness of their responses and 54 MEDICALDEALER | MAY 2016

It feels like a daily fight to secure the right to service equipment our hospital and customers have purchased. On every equipment order we must remind the vendor to include service manuals, offer training and give us preventative maintenance procedures.

tactics illustrate how much money is in the servicing of equipment for the OEM. My guess is that the OEMs are squarely behind this new FDA proposal. When I learned of this proposal, I immediately contacted a couple of my friends in the refurbishing industry to put them on alert. As I discussed this proposal with them, they shared an additional opinion on what they thought was going on. They explained to me that when Congress passed the Accountable Care Act, buried in its 2,000 plus pages is a 3 percent tax that all medical equipment manufacturers must pay when they sell medical equip-

ment. My friends felt like there could be motivation to make refurbishers pay the tax also. It would be similar to buying a used car, you have to pay sales tax on it every time it changes hands. This proposal could be used to make that happen. However, as I studied the document, I did not see anything that referred to the tax. The document is focused around the claim that refurbishers of equipment and third-party servicers may not be qualified thus putting patients at risk. Fortunately there is research out there that proves that there is not a patient safety problem with refurbished equipment and third-party MEDICAL EQUIPMENT, PARTS & SERVICE

_The Other Side

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servicers. I would concede there are isolated issues where equipment being sold or serviced is not done in an ethical way. However, I do not believe the problem is big enough to warrant FDA regulation and intervention. I would argue that refurbished equipment helps patients. Having the option to purchase refurbished equipment helps facilities and doctors update their existing equipment with technology they can’t afford new. Refurbished equipment can also be used to expand services when the volumes do not support the cost of a new unit. Finally, third-party servicers and refurbishers provide competition in the marketplace which reduces cost and increases service satisfaction. So, what do we need to do? The website has background and details about how you should comment. I would also recommend that you involve your hospital administration so they can reach out to their respective associations to build a larger support group. At this writing, I am aware of many others meeting to discuss this and also provide some research information and guidance so we can be informed and professional in our comments. I am sure this information will be disseminating soon. All comments must be received by May 3. Below is The Food and Drug Administration (FDA or we) is announcing the establishment of a docket to receive information and comments on the medical device industry and WWW.MEDICALDEALER.COM

healthcare community that refurbish, recondition, rebuild, remarket, remanufacture, service, and repair medical devices (hereafter termed “third-party entity or entities”), including radiation-emitting devices subject to the electronic product radiation control (EPRC) provisions of the Federal Food, Drug, and Cosmetic Act (the FD&C Act). FDA is taking this action, in part, because various stakeholders have expressed concerns about the quality, safety, and continued effectiveness of medical devices that have been subject to one or more of these activities that are performed by both original equipment manufacturers (OEM) and third parties, including health care establishments. We are seeking comments from the widest range of interested persons, including those who are engaged in one or more of the activities noted previously or who utilize refurbished, reconditioned, rebuilt, remarketed, remanufactured, or third-party serviced and repaired medical devices. https://www.federalregister.gov/ articles/2016/03/04/2016-04700/ refurbishing-reconditioning-rebuilding-remarketing-remanufacturing-and-servicing-of-medical-devices?source=govdelivery&utm_medium=email&utm_source=govdelivery 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_Bobinski

By Dan Bobinski

USING USEFUL TIDBITS OF TRUTH

hort, pithy phrases that contain much truth have been around forever. Somewhere around 600 BC, Aesop is alleged to have said, “Better to be wise by the misfortunes of others than by your own.” About 250 years later, Aristotle wrote, “Misfortune shows those who are not really friends.” And about 200 years after that, Cicero told us, “Never go to excess, but let moderation be your guide.” Want to go back further? About 900 BC King Solomon gave us statements like, “A gentle answer turns away wrath, but a harsh word stirs up anger,” and “Plans fail for lack of counsel, but with many advisers they succeed.” And one of my favorites from Solomon is, “He who walks with the wise grows wise, but a companion of fools suffers harm.” Not surprisingly, we can go back further. In the “Instructions of Shuruppak,” also known as the Babylonian Counsels of Wisdom from 1500 BC, we find such useful phrases as, “Do not say evil things; speak well of people,” and “Reverence begets favor.” Although each of these sayings are just a few words, books could be written around each of them to expound upon their truths. One modern joy of these ancient morsels of truth is that each of them can easily fit into a 140 character tweet or be photoshopped into a Facebook meme, allowing us to share them with just about anybody. But while social media allows us to flood the world with these insightful axioms, they’re only valuable if we incorporate their truth

56 MEDICALDEALER | MAY 2016

Dan Bobinski Workplace Consultant

into our lives. This becomes easier if we do more than just nod and say, “Yep, that’s true.” They become valuable when we consider them in context with events from our own lives. For example, think about the great imagery that accompanies the phrase, “A turtle only makes progress when it sticks its neck out.” We can learn a lot from that symbolism. Even if we move slowly, by sticking out our necks, taking calculated risks and moving steadily forward, we can achieve our goals. This axiom about the turtle can be partnered with many similar sayings, such as: "No risk, no reward," or: "Nothing ventured, nothing gained," or: "A journey of a thousand miles begins with a single step." These are all great sayings, but if you really want to make such words of wisdom powerful for you, think back and find situations from your life in which those concepts

helped you move ahead or get out of a predicament. The more you can tie any statement of truth to your own experiences, the more useful (and valuable) it will be. Strong associations are best built through two channels, frequency or intensity. In other words, if you can associate an axiom to multiple events in your life, then your brain will make a solid connection with the value of that axiom. A similarly solid connection can be established if you can connect the axiom to an event that held strong emotions for you. Over the decades that I’ve been coaching and conducting management training, I've come up with several useful truisms to help people succeed. I’m listing a few of them here, along with a bit of explanation to help you find connections with your own life experiences. You'll go where you're focused. If you've taken a good driving course you've learned that whatever vehicle you’re driving or riding tends to go in the direction you're looking. The same principle applies in just about every aspect of life: You will move in the direction of your focus. If you're looking only at the trouble spots, you're likely to stumble. But if you're focusing on potential solutions and paths that lead to success, you're likely to achieve success. Think about it. When has this been true for you? Slower up front equals faster down the road. This is a helpful phrase for Type A personalities to memorize. Some people perceive the shortest distance between two points as being a straight line, but that is not necessarily

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_Bobinski

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The more you can tie any statement of truth to your own experiences, the more useful (and valuable) it will be. Strong associations are best built through two channels, frequency or intensity.

the case. When dealing with "slower moving people" (about 65 percent of the population), faster-moving people benefit by slowing down and working with others in ways that create harmony, not pressure. They're frequently surprised to find that it's true: The end result of moving slower up front is often faster results! I’m confident that with some thought, you will find situations from your life that are good examples of this axiom. Acknowledgement does not equal agreement. Good communication skills include being able to acknowledge someone else's point of view (think of some of the talk radio hosts you dislike because they fail miserably at this). Unfortunately, many people hold the mistaken belief that acknowledging someone's point of view is the same as agreeing. Not true! You may believe the moon is made out of blue cheese. I am quite capable of acknowledging your belief without agreeing with you. Has anyone ever respectfully acknowledged your point of view without agreeing with you? Think of when this saying has impacted your life, and stick it safely in your back pocket. The power associated with this axiom will help you be a better communicator. WWW.MEDICALDEALER.COM

Only make new mistakes. This saying goes hand-in-hand with a quote attributed to Theodore Roosevelt; "The man who never makes a mistake is the man who never does anything." The idea is that everyone makes mistakes. Unfortunately, some people keep making the same mistakes over and over. When have you chosen to learn, instead of staying stuck in a rut? By the way, the principle of learning from mistakes can also be tied to another one of my favorite sayings, "Good judgment comes from experience; Experience comes from bad judgment." To wrap up, whatever sayings permeate your mind are the ones that will influence your life. Therefore, knowing that you will go where you're focused, may I suggest selecting phrases to remember that will guide you in useful, productive ways. DAN BOBINSKI holds a Masters Degree in Training and Development, and is president of Workplace-Excellence.com and Everything-Training.com As a consultant, speaker, and trainer, he helps organizations of all shapes and sizes. He is also the author of several books, including the best-selling “Creating Passion-Driven

Teams.” Reach him at dan@workplace-excellence.com or 208-375-7606.

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SLICE OF LIFE_Pay It Forward

By Matt Skoufalos

THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS

round the world (sometimes, around the country) surgical technique is becoming a lost art, even to surgeons, says Dr. Maurice Chung, current president of the Society of Laparoendoscopic Surgeons (SLS).

A surgeon must learn how to suture before he or she is allowed to operate, Chung said; however, many younger residents may graduate from a program knowing minimally invasive surgical techniques, yet “almost 90 percent of them don’t know how to suture.” Even residents involved in prominent teaching programs in the United States may not know how to perform practical suturing, Chung said; moreover, many aren’t allowed to dedicate time from their training programs to learn because their obligations to their schooling or their employers do not permit it. “The fundamentals and the basics are not taught very systematically to all the residents,” Chung said. In an attempt to address that deficiency, Chung has made it the priority of his SLS presidency to proliferate contemporary techniques in minimally invasive surgery throughout regions of the world where it can do the most good. Starting in February 2016, SLS members began traveling to hospitals across the globe 60 MEDICALDEALER | MAY 2016

Dr. Maurice Chung is president of the Society of Laparoendoscopic Surgeons

to provide such education for free in the form of a tips-and-tricksstyle, two-day seminar. Starting out at the University of Toledo, the program will proceed to Hawaii, Puerto Rico, Colombia, Brazil, Croatia, Romania, and China, teaching residents first. “They are the ones who will go out and learn these techniques,” Chung said. “When they see what we do, they come and learn. So, we

start from teaching the youngest, and when the seniors come and see that, they learn from all of us.” The two-day instruction is divided into three parts: general surgery, gynecology and urology. Chung said his mission is to help young doctors learn how to prevent and manage complications by specialty; at the core of that understanding is a strong foundation in basic laparoscopy. The pivot system associated with traditional laparoscopy forces surgeons into motions that are completely opposite their natural inclinations, Chung said. To move up, their hands must go down; to move to the right, their hands must go to the left. The addition of suturing to the equation, a task that requires twisting and rotating, complicates matters further. Using a surgical robot allows for programming to overcome that deficit in real-time, but it also costs about $5,000 more per procedure for the privilege (at about $2 million to purchase, and around $150,000 in annual maintenance, the devices represent a significant capital investment). Chung reasons that teaching surgeons to perform unassisted laparoscopic surgery with a great degree of technique will offer the similar benefits with a less expenMEDICAL EQUIPMENT, PARTS & SERVICE

_Pay It Forward

Dr. Maurice Chung, third from left, is seen with a group during a training trip to Romania.

sive, more precise outcome: a surgical robot will produce an incision that is about 8 millimeters in length; traditional laparoscopy will produce one that is 5 millimeters in length. With proper training in mini-laparoscopic techniques, a surgeon can create an incision about only 3 millimeters in length, reducing scarring and recovery time for patients. Those techniques come in especially handy when surgeons are performing gynecological and urological procedures, and not just general surgeries, Chung said. Teaching residents “the basic fundamentals of how to get into the abdomen” requires multi-specialty coursework followed by a video discussion that offers a bigger picture of what to do or not do, he said. “A gynecology program is going to teach you how to prevent injury, but not as good as a general surgeon who may be able to give you some tips and tricks to learn how to repair or manage it,” Chung said. In addition to demonstrating superior technique and a valuWWW.MEDICALDEALER.COM

able skill set, Chung’s program is designed to help physicians in other parts of the world where healthcare facilities don’t have the money for surgical robots. In such places, education may be piecemeal, and laparoscopics may not be as popular for that reason. But even in more industrialized nations, like America, many health systems have compensated by putting surgical robots in every single city, which Chung said is like learning how to run without knowing how to crawl. “There’s a better outcome when the robot is not available,” he said. “The robot is an advantage. Laparoscopic surgery is a bit more tiring because you have to stand up. When you’re good, you can sit down and operate, and you’re not as tired for multiple surgeries.” In countries like China, for example, laparoscopic surgical robots are widely unavailable – the national inventory is something like 36 devices versus about 2,000 in the United States, Chung said – but the volume of patients seen by Chinese doctors gives them

a familiarity with proper surgical technique. As a result, he said, “in general, the Chinese do well in suturing.” “The exposure to the number of patients is so many that they get to practice and they’re perfect,” Chung said. “But the younger generation doesn’t get to practice and they struggle.” Robotic surgery still will play a prominent role in the future of the field, but laparoscopic techniques are fundamental, Chung said. So why shouldn’t a surgeon learn the basics in order to provide minimally invasive surgery when the robot is unavailable? “Mini-laparoscopic is more cosmetic and less painful for a small incision,” Chung said. “As a surgeon, you need to be more versatile, whatever the type of procedure.” “I’m not anti-robot, but I think the training system has to change,” he said. “How will the student learn if the attending (physician) doesn’t teach them the standard? It takes time to learn.”

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SLICE OF LIFE_Success Story

By Matt Skoufalos

XENEX GERMZAPPING ROBOTS

n addition to removing the barriers of denial based on pre-existing conditions and providing subsidized access to health care for millions of Americans, another of the chief tenets of the Affordable Care Act is tying reimbursements to health outcomes. Patients who heal up better are less likely to require additional care, and in turn reflect more efficient delivery of care, which places an emphasis on reducing the rates of infection associated with hospital stays. In America, hospital-related infections like MRSA, VRE, and C diff. kill more than 100,000 hospital patients a year and infect another 2 million annually, said Morris Miller, CEO of Xenex Disinfection Services. Perhaps most cruelly of all, the symptoms associated with such illnesses are unrelentingly painful. In any health care setting, housekeeping staff is the front line against hospital-acquired infections. Its task is to clean the room. Yet, housekeepers can only clear the rooms of the substances that they can see – and half the surfaces that contain those pathogens are often difficult to reach through hand-cleaning methods alone. When infectious superbugs that can put patients at fatal risk aren’t cleaned off, those germs can live in the environment for months at a time, Miller said. “It became very apparent to us that the majority of these infections are actually caused by the environment,” he said. “It’s making the patient sick and we can actually solve the problem. “If you could fill the room up like a bathtub with a [disinfectant] chemical and let it sit there for 10 minutes, I bet it would work,” Miller said. “But you can’t.” Instead, Xenex began testing products developed around the principles of germicidal photonics. Shortwave ultraviolet light deactivates the DNA of bacteria, WWW.MEDICALDEALER.COM

Hospitals using Xenex Germ-Zapping Robots have reported 50 to 100 percent decreases in their hospital-acquired infection rates after using pulsed xenon light technology for room disinfection.

viruses, and similar pathogens, destroying their ability to reproduce, and killing them when they attempt to do so. The company developed a xenon-based lamp that pulses across the entire spectrum of germicidal UV light waves. Housed within a shopping-cart-sized device that enables it to be pushed from floor to floor to clean hospital rooms with an automated cycle, Xenex christened its devices “germ-zapping robots,” and developed cleaning patterns to make sure that every surface in the room is “zapped” free of pathogens. “If it can be seen, it can be cleaned,” Miller said. “Anything that’s not visible, move it, flip it, run it while you go get the linens; it’s finished, and now the room is ready, cleaned, and disinfected.” After demonstrating the concept to a handful of hospitals, Xenex ran follow-up research that yielded conclusive results. In 2011, MD Anderson Cancer Center showed that the technology completely eliminated all instances of VRE in a test environment. Another study at the Central Texas Veterans Health Care System in 2015 showed that bleach-free cleaning with Xenex removed 95 percent of C. diff spores versus the 70 percent of C. diff spores removed with bleach cleaning alone. At Trinity Medical Center in Birmingham, Alabama, Xenex helped reduce surgical site infections by 100 percent. MEDICALDEALER 63

_Sucess Story

Xenex Germ-Zapping Robots utilize germicidal pulsed xenon light technology to quickly destroy germs and bacteria (such as MRSA and C.diff) on surfaces in health care facilities.

In all, a dozen peer-reviewed studies describing the efficacy of the technology have been published in scientific journals of infection control, infection prevention, and hospital epidemiology, each making the case for Xenex in real-world hospital environments. “The housekeepers become the heroes of the hospital because you’re giving them a tool that can help them solve the problem,” Miller said. “When you think about a 50-, 70-, or 100-percent drop in infection rates, 1.4 million of the 2 million don’t have to get those infections, and maybe 50,000, 75,000 people don’t have to die.” In addition to helping patients avoid infection, Xenex technology also helps hospitals save money. The 23 infections that Trinity Medical estimates the devices helped prevent also kept the center from 64 MEDICALDEALER | MAY 2016

spending another $460,000 in caring for sick patients. In comparison, the annual cost of a Xenex robot is about $40,000 across three years, Miller said. Martin Health System in Florida has four Xenex Germ-Zapping Robots. Michael Romano, M.D., inpatient medical director with Martin Health Physician Group, said Martin Health is “doing everything within our means to reduce the risk of infection, and believe these robots will play a significant role.” “It underscores our commitment to patient care and the community we serve,” Romano said. Central Valley Specialty Hospital (CVSH) is the first long-term acute care (LTAC) facility in California to use the new LightStrike Xenex robot. At CVSH, it is used in patient rooms, restrooms, equipment and procedure rooms, the gym, dining

rooms and pharmacy. “We want to do everything within our means to provide a clean environment to reduce the risk of infections,” said Gia Smith, RN, MSN, Chief Executive Officer of CVSH. “We are designed to provide care to medically complex patients, and we want to ensure that we provide them with a healing environment.” Xenex is working on the fifth version of its robot design in threeand-a-half years. The latest iterations of the devices connect with a webbased portal that allows customers to examine their progress in action. Next up is an expansion of Xenex technology to a global customer base that includes health centers in Spain, England, and South Africa. “It’s being used constantly,” Miller said. “It’s something we’re able to pursue every day, and we know that it works.” MEDICAL EQUIPMENT, PARTS & SERVICE

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CATEGORICAL INDEX ANETHESIA CIM med GmbH……………………………………………… 34

IMAGING Injector Support and Service, LLC……………… 67

ASSOCIATIONS IAMERS…………………………………………………………… 17

IMAGING/PARTS Ampronix……………………………………………………………6 Diagnostic Solutions…………………………………… 70 Eastern Diagnostic Imaging……………………… 26 InterMed Group……………………………… 45, 58, 62 Technical Prospects………………………………… 2, 65 Tri-Imaging……………………………………………………… 28

AUCTION/LIQUIDATION Government Liquidation………………………………7 BATTERIES Eastern Diagnostic Imaging……………………… 26 BIOMEDICAL AIV Inc.…………………………………………………………… 43 Conquest Imaging………………………………………… 13 Elite Biomedical Solutions………………………… 51 Global Medical Imaging……………………………… 23 iMed Biomedical…………………………………………… 67 InterMed Group…………………………………………… 58 Maull Biomedical Training, LLC………………… 62 Ozark Biomedical………………………………………… 45 CARDIOLOGY Bionet America, Inc.……………………………………… 36 RSTI Exchange……………………………………………… 34 C-ARMS Eastern Diagnostic Imaging……………………… 26 COMPUTED TOMOGRAPHY Dunlee……………………………………………………………… 10 East Coast Medical Systems……………………… 58 Ed Sloan & Associates……………………………………9 Exclusive Medical Solutions, Inc.……………… 55 KEI Medical Imaging Services…………………… 67 Metropolis International…………………………… 25 RSTI Exchange……………………………………………… 34 Technical Prospects………………………………… 2, 65 Tri-Imaging……………………………………………………… 28 Zetta Medical Technologies, LLC…………………8 CONTRAST MEDIA Injector Support and Service, LLC……………… 67 DIAGNOSTIC IMAGING Eastern Diagnostic Imaging……………………… 26 First Call Parts……………………………………………… 43 Injector Support and Service, LLC……………… 67 Multi Diagnostic Imaging Solutions…………BC ENDOSCOPY Endoscopy Specialists………………………………… 26 S.H. Medical Corporation…………………………… 27 GENERAL ALCO Sales and Service…………………………… 27,67 Eastern Diagnostic Imaging……………………… 26 Government Liquidation………………………………7 RSTI Exchange……………………………………………… 34

68 MEDICALDEALER | MAY 2016

INFUSION THERAPY AIV Inc.…………………………………………………………… 43 Elite Biomedical Solutions………………………… 51 LABORATORY Ozark Biomedical………………………………………… 45 LASER IMAGERS Multi Diagnostic Imaging Solutions…………BC MODULE/TELEMETRY Bio-Medical Equipment Service Co.…… 44, IBC MONITORS/CRTs Advanced Ultrasound Elec./AUE………………… 57 Ampronix……………………………………………………………6 CIM med GmbH……………………………………………… 34 Technical Prospects………………………………… 2, 65 MRI Carolina Medical Parts………………………………… 59 East Coast Medical Systems……………………… 58 Ed Sloan & Associates……………………………………9 Exclusive Medical Solutions, Inc.……………… 55 KEI Medical Imaging Services…………………… 67 RSTI Exchange……………………………………………… 34 Zetta Medical Technologies, LLC…………………8 MOUNTING SOLUTIONS CIM med GmbH……………………………………………… 34 NUCLEAR MEDICINE E. L. Parts, LLC………………………………………………… 59 Global Medical Imaging……………………………… 23 International X-Ray Brokers……………………… 26 RSTI Exchange……………………………………………… 34 PATIENT MONITORING Bio-Medical Equipment Service Co.…… 44, IBC Bionet America, Inc.……………………………………… 36 CIM med GmbH……………………………………………… 34 Gopher Medical, Inc.…………………………………… 43 Pacific Medical…………………………………………………5 PHANTOMS ATS Laboratories, Inc.…………………………………… 51 POWER SYSTEM COMPONENTS Interpower Corporation…………………………………4

PROBES/PROBE REPAIR Conquest Imaging………………………………………… 13 Global Medical Imaging……………………………… 23 ONLINE RESOURCES MedWrench…………………………………………………… 53 RADIOLOGY Eastern Diagnostic Imaging……………………… 26 First Call Parts……………………………………………… 43 International X-Ray Brokers……………………… 26 InterMed Group…………………………………………… 45 Maull Biomedical Training, LLC………………… 62 Metropolis International…………………………… 25 Multi Diagnostic Imaging Solutions…………BC Radon Medical LLC……………………………………… 51 Rayence, Inc.…………………………………………………… 16 RSTI Exchange……………………………………………… 34 Technical Prospects………………………………… 2, 65 Varian Medical Systems…………………………………3 RADIOLOGY PARTS InterMed Group…………………………………………… 45 Zetta Medical Technologies, LLC…………………8 RECRUITING Adel-Lawrence Associates, Inc…………………… 67 REPAIR/REFURBISH Advanced Ultrasound Elec./AUE………………… 57 AIV Inc.…………………………………………………………… 43 ALCO Sales and Service…………………………… 27,67 Ampronix……………………………………………………………6 Bio-Medical Equipment Service Co.…… 44, IBC Carolina Medical Parts………………………………… 34 Conquest Imaging………………………………………… 13 Eastern Diagnostic Imaging……………………… 26 Ed Sloan & Associates……………………………………9 Elite Biomedical Solutions………………………… 51 Endoscopy Specialists………………………………… 26 Exclusive Medical Solutions, Inc.……………… 55 Global Medical Imaging……………………………… 23 Injector Support and Service, LLC……………… 67 KEI Medical Imaging Services…………………… 67 MTC/Medical Technologies Co.…………………… 59 Multi Diagnostic Imaging Solutions…………BC Pacific Medical…………………………………………………5 Radon Medical LLC……………………………………… 51 Zetta Medical Technologies, LLC…………………8 REPLACEMENT PARTS Advanced Ultrasound Elec./AUE………………… 57 AIV Inc.…………………………………………………………… 43 ALCO Sales and Service…………………………… 27,67 Carolina Medical Parts………………………………… 59 Classic Diagnostic Imaging………………………… 44 Conquest Imaging………………………………………… 13 Diagnostic Solutions…………………………………… 70 Dunlee……………………………………………………………… 10 E. L. Parts, LLC………………………………………………… 59 Ed Sloan & Associates……………………………………9 MEDICAL EQUIPMENT, PARTS & SERVICE

Categorical Index Elite Biomedical Solutions ……………………… 51 First Call Parts …………………………………………… 43 Global Medical Imaging …………………………… 23 Government Liquidation ……………………………7 KEI Medical Imaging Services ………………… 67 MTC/Medical Technologies Co. ………………… 59 Multi Diagnostic Imaging Solutions ………BC Ozark Biomedical ……………………………………… 45 Radon Medical LLC …………………………………… 51 Technical Prospects ……………………………… 2, 65 Varian Medical Systems ………………………………3 Zetta Medical Technologies, LLC ………………8 STERILIZERS Government Liquidation ……………………………7 SURGICAL Eastern Diagnostic Imaging …………………… 26 Endoscopy Specialists ……………………………… 26 S.H. Medical Corporation ………………………… 27 SURPLUS MEDICAL Government Liquidation ……………………………7

Government Liquidation ……………………………7 Ray-Pac. ………………………………………………………… 35 Technical Prospects ……………………………… 2, 65 Zetta Medical Technologies, LLC ………………8 ULTRASOUND Advanced Ultrasound Elec./AUE ……………… 57 ATS Laboratories, Inc. ………………………………… 51 Conquest Imaging ……………………………………… 13 Diagnostic Solutions ………………………………… 70 Endoscopy Specialists ……………………………… 26 Exclusive Medical Solutions, Inc. …………… 55 InterMed Group ………………………………………… 62 ULTRASOUND PARTS Advanced Ultrasound Elec./AUE ……………… 57 AIV Inc. ………………………………………………………… 43 Conquest Imaging ……………………………………… 13 Global Medical Imaging …………………………… 23 InterMed Group ………………………………………… 62

VENTILATORS Government Liquidation ……………………………7 VIDEO Endoscopy Specialists ……………………………… 26 Multi Diagnostic Imaging Solutions ………BC X-RAY Classic Diagnostic Imaging ……………………… 44 Diagnostic Solutions ………………………………… 70 Eastern Diagnostic Imaging …………………… 26 Exclusive Medical Solutions, Inc. …………… 55 Government Liquidation ……………………………7 Ray-Pac. ………………………………………………………… 35 Rayence, Inc.………………………………………………… 16 Tri-Imaging …………………………………………………… 28 X-RAY PARTS Technical Prospects ……………………………… 2, 65

VCR REPAIR/SERVICES Advanced Ultrasound Elec./AUE ……………… 57 Conquest Imaging ……………………………………… 13

TUBES/BULBS Dunlee…………………………………………………………… 10

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ALPHABETICAL INDEX Adel-Lawrence Associates, Inc …………………………………………………………… 67 Advanced Ultrasound Elec./AUE ………………………………………………………… 57 AIV Inc. …………………………………………………………………………………………………… 43 ALCO Sales and Service …………………………………………………………………… 27,67 Ampronix ……………………………………………………………………………………………………6 ATS Laboratories, Inc. …………………………………………………………………………… 51 Bio-Medical Equipment Service Co.…………………………………………… 44, IBC Bionet America, Inc. ………………………………………………………………………………36 Carolina Medical Parts …………………………………………………………………………59 CIM med GmbH ……………………………………………………………………………………… 34 Classic Diagnostic Imaging ………………………………………………………………… 44 Conquest Imaging ………………………………………………………………………………… 13 Diagnostic Solutions ……………………………………………………………………………70 Dunlee……………………………………………………………………………………………………… 10 E. L. Parts, LLC…………………………………………………………………………………………59 East Coast Medical Systems ………………………………………………………………58 Eastern Diagnostic Imaging ……………………………………………………………… 26 Ed Sloan & Associates ……………………………………………………………………………9 Elite Biomedical Solutions ………………………………………………………………… 51 Endoscopy Specialists ………………………………………………………………………… 26 Exclusive Medical Solutions, Inc. ……………………………………………………… 55 First Call Parts ……………………………………………………………………………………… 43 Global Medical Imaging ……………………………………………………………………… 23 Gopher Medical, Inc. …………………………………………………………………………… 43

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Government Liquidation ………………………………………………………………………7 IAMERS …………………………………………………………………………………………………… 17 iMed Biomedical …………………………………………………………………………………… 67 Injector Support and Service, LLC ……………………………………………………… 67 InterMed Group ……………………………………………………………………… 45, 58, 62 International X-Ray Brokers ……………………………………………………………… 26 Interpower Corporation …………………………………………………………………………4 KEI Medical Imaging Services …………………………………………………………… 67 Maull Biomedical Training, LLC ………………………………………………………… 62 MedWrench …………………………………………………………………………………………… 53 Metropolis International …………………………………………………………………… 25 MTC/Medical Technologies Co. ……………………………………………………………59 Multi Diagnostic Imaging Solutions …………………………………………………BC Ozark Biomedical ………………………………………………………………………………… 45 Pacific Medical …………………………………………………………………………………………5 Radon Medical LLC ……………………………………………………………………………… 51 Ray-Pac. …………………………………………………………………………………………………… 35

Diagnostic Solutions is a customer service based parts provider that specializes in all imaging modalities and manufacturers. Created to offer hospitals and ISO’s a cost effective and time saving solution for ordering imaging replacement parts, equipment moves, ultrasound probe repair and on-site service.

Rayence, Inc.…………………………………………………………………………………………… 16 RSTI Exchange ……………………………………………………………………………………… 34 S.H. Medical Corporation …………………………………………………………………… 27 Technical Prospects ………………………………………………………………………… 2, 65 Tri-Imaging ……………………………………………………………………………………………… 28 Varian Medical Systems …………………………………………………………………………3 Zetta Medical Technologies, LLC …………………………………………………………8

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