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contents

ICE FEATURES

40 ACR Accreditation

July/August 2017

28 Department Profile

ACR accredits hospitals as well as freestanding imag-

The DCH Health Systemâ&#x20AC;&#x2122;s 23-member

ing centers, and retaining an ACR certification requires the

clinical engineering department includes

establishment and maintenance of an ongoing QC pro-

a five-member group of imaging special-

gram supervised by a qualified medical physicist. We look at

ists referred to as Imaging Equipment

the role of imaging service professionals when it comes to

Specialists. The department services the

accreditation.

three hospitals owned by DCH. The three DCH hospitals have more than $54 million of imaging equipment. Team DCH team also cover the equipment at three other hospitals as a third-party provider.

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ICE DEPARTMENTS

July/August 2017

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12 Industry News

26 Professional Spotlight

45 Accreditation 101

20 People on the Move

28 Department Spotlight

31 Digital X-Ray Product Focus

22 Webinar Wednesday

48 Imaging Matters

32 X-Ray Gallery 39 Tools of the Trade

50 Imaging Service 101 52 Career Center 54 Bridging The Gap

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ICE Magazine (Vol. 1, Issue #3) July/August 2017 is published by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to ICE Magazine at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.imagingigloo.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. Â© 2017

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IMAGING NEWS A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

ProbeHunter Expands into the UK The ProbeHunter team, the Scandinavian-developed system for quality assurance of ultrasound probes, has announced that the business is expanding. Imaging First Ltd. in Manchester, UK, is representing ProbeHunter in England and Ireland. Imaging First will offer ultrasound probe testing services as an accredited provider that will suit both NHS services and independent operators. Imaging First is positioned to offer an

end-to-end specialist service dedicated to “all things ultrasound.” This includes system sales, distribution, repairs, Q&A, servicing and consultancy. “In our continuing growth for patient safety, the ProbeHunter Network is expanding and soon additional new distributors for other countries will be announced. The ProbeHunter product line is a leading global provider of ultrasound probe testing systems. A Quality Assurance system like ProbeHunter,

testing ultrasound probes in daily use, will increase quality of care, save hospitals cost and increase patient safety,” states BBS Medical AB CEO & founder of ProbeHunter Björn Segall. •

Technical Prospects Receives ISO 9001:2015 Certification Technical Prospects has received ISO 9001:2015 certification for the disassembly, repair, refurbishment, quality assurance, technical support, and technical training of medical imaging of products. “Technical Prospects, a company specializing in Siemens medical imaging equipment, continues its commitment to providing quality Siemens parts, training and support through ISO 9001:2015 certification,” according to a news release. “For over 20 years Technical Prospects has been committed to providing customers with quality Siemens medical imaging parts, training and support. Providing parts that meet OEM specifications is an essential element in keeping customer equipment up and running,” the release adds. “To accomplish this goal, Technical Prospects uses quality assurance procedures to include: testing parts on complete systems in quality assurance bays, running multiple electronic tests and visually inspecting parts to ensure they meet specifications before placing them in the hands of customers.” The ISO certification is just one ave12

ICEMAGAZINE | JULY/AUGUST 2017

nue Technical Prospects uses to achieve quality results. “The company’s commitment to quality is also evident in its electrostatic discharge (ESD) prevention measures. Team members wear ESD grounding devices in every step of part preparation from harvesting to shipping in order to protect parts from electrostatic damage,” according to the news release. “The company’s commitment to quality is carried through with its unique packaging; some of the best packaging standards in the market according to customers. For large-heavy parts, Technical Prospects handcrafts custom crates that integrate the components minimizing the potential for shipping damage. These detailed measures help the company achieve one of the lowest part DOA rates in the market.” The company also offers training. “Technical Prospects’ commitment to quality continues with its training program that is ISO 9001:2015 certified. Training courses are led by industry professionals with over 100 years of imaging experience,” according to the release.

“Courses are a blend of classroom lecture and hands-on lab training.” Recent student Roy Morris, director of biomedical engineering at the International Children’s Heart Foundation commented, “Technical Prospects has one of the best training labs I have seen with world-class instructors. The training is very organized and methodical with full-hands-on-training.” Technical support is another ISO-certified service provided by the company. Every day, Technical Prospects’ engineers and technicians assist customers with part identification and guide engineers in the field on troubleshooting procedures. “We pride ourselves in providing excellent post-purchase support of the parts we sell,” Jeff Rindfleisch, vice president of operations stated. •

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KUBTEC Granted Additional Patent KUBTEC has announced that the U.S. Patent Office has granted the company an additional patent for its technology used for breast specimen imaging using 3-D tomosynthesis. The patent, Specimen Radiography with Tomosynthesis in a Cabinet (Patent Number 9,642,581 B2) was issued on May 9, 2017 and refers to technology currently embodied in the KUBTEC Mozart System, the only intraoperative specimen imaging system to use 3-D Tomosynthesis to give breast surgeons a superior view of their surgical margins. A recent study has demonstrated that the use of this technology enables significant reductions in surgical re-excision rates when compared to the more traditional 2-D planar imaging. “This patent is recognition that our continued investment in new technology specifically for breast cancer specimen imaging is resulting in new products that really make a difference to people’s live,” KUBTEC CEO Vikram Butani said. “As the health care market shifts its focus to reimbursement based on quality of care and patient satisfaction, we are positioned to provide solutions that impact these metrics by improving surgical accuracy and reducing avoidable re-hospitalizations for breast cancer patients.” •

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Richardson Electronics Sells PACS Display Business Richardson Electronics Ltd. has announced the sale of its picture archiving and communication systems (PACS) display business, including the Image Systems brand, to Double Black Imaging. The Image Systems product portfolio includes 2MP, 3MP, 5MP and 6MP color and grayscale displays. Included in the sale is Image Systems proprietary calibration software, known as CFS, which is designed to simplify the conformance and calibration of all Image Systems diagnostic and clinical use displays. This ensures DICOM compliance and proper calibration throughout their life cycle. Double Black Imaging is a provider of PACS displays for the diagnostic and clinical display market. Double Black Imaging was launched in July of 2002. The company is privately held by the Lloyd family in Colorado and Minnesota. •

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Fujifilm Synapse Mobility Enterprise Web Viewer Nets ATO FUJIFILM Medical Systems U.S.A. Inc. has announced that its Synapse Mobility Enterprise Web Viewer has been granted Authority to Operate (ATO) on networks in the U.S. Department of Defense (DoD). The DoD awards an ATO according to a risk-based framework that analyzes a technology’s security controls within their IT environment. “We are proud and gratified that Fujifilm’s Synapse Mobility Enterprise Viewer is now authorized for use at the U.S. Department of Defense,” said Johann Fernando, Ph.D., chief operating officer, FUJIFILM Medical Systems U.S.A. Inc. “This ATO is a major accomplishment for Fujifilm and testifies to our ongoing commitment to bringing to market innovative technology that adheres to the most stringent security standards.” After completing a thorough security assessment, the DoD determined that Synapse Mobility can be configured to meet its controls for Risk Management Framework. Specifically, Synapse Mobility can be configured to meet the DoD 8500 series and DISA STIG requirements. DoD controls are customizable and implemented as part of an organization-wide process that manages information security and privacy risk. The controls address a diverse set of security and privacy requirements across the federal government and critical infrastructure, derived from legislation, executive orders, policies, directives, regulations, standards, and/or mission/business needs. •

Change Healthcare Tapped Enterprise Imaging Partner Schneck Medical Center in Seymour, Indiana, has selected Change Healthcare as its new partner for enterprise imaging. Change Healthcare, which combines most of McKesson Technology Solutions with substantially all of legacy Change Healthcare, offers capabilities that will deliver wide-ranging financial, operational and clinical benefits to payers, providers and consumers. At Schneck Medical Center, McKesson Radiology and vendor-neutral Conserus workflow solutions will replace legacy systems and unify workflow across multiple radiology PACS systems in use by the hospital and its care centers. Together, these solutions will give clinical users a next-generation radiology PACS and workflow tools that will enhance communication and quality across the hospital. The solutions enable hospitals and clinics to acquire and distribute medical images across the enterprise. McKesson Radiology offers a solution with clinical depth, characterized by disease-specific display protocols and embedded advanced visualization to help improve radiologists’ productivity and efficiency. Conserus Workflow Intelligence will enable Schneck Medical Center to improve communication and collaboration within its radiology department and with its contracted radiology group. •

Carestream Health Receives Contract From Vizient Inc. Carestream Health has received an Innovative Technology contract from Vizient Inc., for its Carestream OnSight 3D Extremity System. Vizient is the largest member-driven health care performance improvement company in the country. The contract was based on a recommendation of hospital experts who serve on one of Vizient’s member-led councils. Innovative Technology contracts are reserved for technologies that demonstrate an ability to enhance clinical care or patient safety, and those that improve an organization’s care delivery and business model. The OnSight 3D Extremity System performs high-quality, low-dose 3D extremity exams using cone beam CT (CBCT) technology. In addition to being compact and easy to install, it captures high-quality 3D images including weight-bearing exams of lower extremities under normal load conditions. Unlike traditional CT systems, the CBCT system has a large-area detector that can capture a 3D image of the patient in a single rotation, which takes 25 seconds. “This three-year contract will allow Vizient members the ability to streamline workflow and productivity by capturing onsite 3D exams, making a diagnosis and discussing treatment options with patients in a single visit,” said Helen Titus, Carestream’s worldwide marketing director for X-ray and ultrasound solutions. “This workflow is also more convenient for patients and can result in faster diagnosis and treatment.” •

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Samsung Launches Versatile Ultrasound Systems Samsung introduced the HS50 and HS60 ultrasound systems in May at the American College of Obstetricians and Gynecologists annual meeting in San Diego. “With the introduction of the HS50 and HS60, Samsung is able to bring the exceptional image quality and penetration that our high-end customers have come to expect and rely on to a wider audience,” said Phil Sullivan, president and CEO for Samsung NeuroLogica. “With its smaller footprint and affordability, it will allow more clinicians to provide their patients the very best of care.” The HS50 and HS60 feature hybrid beamformer technology that works in conjunction with Samsung’s advanced Digital Signal Processing to provide clear, detailed images that help clinicians confidently diagnose and care for their patients. Advanced 3D/4D technologies provide additional diagnostic views to help support clinical decision making and treatment planning, and workflow enhancing and time-saving tools allow the clinician to focus more on their patients instead of the system. The well-rounded capabilities of the HS50 and HS60 make them a great fit for many different practice types, including obstetrics and gynecology, general imaging and MSK. •

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BC Group, RTI Forge Distribution Relationship BC Group International Inc. and RTI Electronics Inc. have announced a partnership between the two organizations for the distribution of the RTI Imaging product line. BC Group is a leader in manufacturing, servicing and selling biomedical testing equipment and RTI is a leader in manufacturing, servicing and selling imaging testing equipment. “BC Group is excited to add the RTI product line to our BC Market Place offering. BC Marketplace provides over 75 product lines of test equipment and tools in addition to our extensive offering of BC Biomedical products,” said Mel Roche, President of BC Group. “We have been looking to expand our Marketplace offering to include imaging test equipment for some time now. With RTI’s great reputation and outstanding product offering, it is the perfect product line to fill out our one-stop biomed shop concept.” All the RTI and BC Biomedical products are online at www.bcgroupstore.com. •

Acertara Adds Johns Hopkins Physicist to Team Acertara, an independent ISO/IEC 17025:2005 accredited medical ultrasound acoustic measurement, testing, and calibration laboratory, and ISO 13485:2003 certified probe repair and new product development facility has announced the addition of Nicholas Ellens, Ph.D. to the Acertara team. Ellens will oversee the expanding acoustic power testing lab and will expand upon the capabilities of Acertara’s research and development team. “I’m excited to join such a highly-accomplished team like Acertara and for the opportunity to grow the acoustic power measurement laboratory the same way the company continues to strengthen its reputation – through a steadfast dedica16

ICEMAGAZINE | JULY/AUGUST 2017

tion to providing the health care market with best-in-class services and advanced technological solutions,” said Ellens. Ellens joins Acertara directly from the Johns Hopkins University Department of Radiology–Division of MR Research faculty. His research at Johns Hopkins University included projects such as focused ultrasound used to deliver medications across the blood-brain-barrier, and MR-guided high intensity focused ultrasound (HIFU). Ellens earned his Ph.D. from the University of Toronto where his thesis was on electronically steered phased arrays for focused ultrasound surgery applications. Prior research includes work conducted at various institutions including Sunny-

brook Research Institute, Harvard University and the Department of National Defense. Additionally, Ellens is a widely published author on focused ultrasound. “We continue to add to our world-class team at Acertara and I am absolutely thrilled to welcome Nick to our team,” said G. Wayne Moore, president and CEO of Acertara. “The addition of Nick further underscores Acertara as the premier supplier of acoustic testing services and products.” • ADVANCING THE IMAGING PROFESSIONAL

news

Great Hill Partners Acquire PartsSource PartsSource has been acquired by Great Hill Partners, a leading growth-oriented private equity firm. The acquisition will allow the company to accelerate its sales and marketing investments and further position the company to execute on its growth plan. “PartsSource’s e-commerce technology has disrupted a workflow that has historically been offline, allowing providers to maintain their facilities efficiently and more cost effectively,” said Mark Taber, a managing partner of Great Hill. “We are delighted to partner with Phil Settimi and the entire PartsSource team to help them continue to expand their market leadership.” Founded in 2001, PartsSource’s core electronic spend management platform automates the procurement process of medical parts and supplies from product sourcing to financial settlement, incorporating proprietary analytics to optimize compliance, efficiency, cost and quality. In addition to automating the highly complex workflow associated with procurement, the company created and maintains the industry’s only online, fully integrated parts procurement marketplace. PartsSource facilitates more than 1.5 million transactions annually by connecting thousands of suppliers and OEMs to over 3,300 hospitals worldwide. “PartsSource has experienced rapid growth in recent years

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and has emerged as the leader in the medical supplies procurement space, empowering our customers to drive costs out of the health care delivery system while improving outcomes,” said PartsSource CEO Phil Settimi, M.D. “We are pleased to collaborate with Great Hill, who will offer both the experience and resources to fully maximize the value of our health care solution, while maintaining our commitment to first-class customer service, innovation and quality.” “We believe PartsSource has tremendous growth potential as procurement teams within health care seek ways to digitize their workflows via a one-stop-shop for medical parts and supplies,” Rafael Cofiño, a partner with Great Hill Partners, added. “It has been exciting to watch them build the online category leader.” PartsSource will join Great Hill Partners’ portfolio of health care companies including Qualifacts, RxBenefits, PlanSource, Passport Health Communications (acquired by Experian for $850 million), SterilMed (acquired by Johnson & Johnson) and bSwift (acquired by Aetna for $400 million). Additionally, Great Hill has extensive experience in e-commerce and electronic marketplaces, including companies such as Wayfair, The Shade Store, Cliq Studios and Momondo (acquired by The Priceline Group for $550 million). •

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Refurbished Parts for GE Diagnostic Imaging Equipment Now Available from GE Healthcare Demand for quality used parts has increased as hospitals and health care systems have become more sophisticated about medical equipment maintenance and management. Now more than 10,000 types of refurbished parts for GE diagnostic imaging equipment are available as GoldSeal parts from GE Healthcare. Hospital in-house service departments can find GoldSeal parts alongside new GE parts online at ServiceShop.gehealthcare.com, or obtain by phone (800-558-2040) or through a GE Concierge Parts Agent. GoldSeal parts are designed to deliver on quality, compatibility, and value. Every GoldSeal part goes through an extensive validation in an ISO 13485 certified process to ensure quality and performance. GE uses proprietary testing methods designed by GE engineers to validate GoldSeal parts, including MR coils and X-ray tubes. GoldSeal parts meet original specifications and are compatible with the GE system revision they were designed for. GE Healthcare is developing a large inventory of GoldSeal parts, which now includes more than 10,000 Gold-

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Seal part numbers covering GE CT, MR, nuclear medicine, PET, ultrasound, vascular, and radiography. Many are available to ship same or next day. GoldSeal parts are a reliable option for pre-owned parts at an attractive price, and may help extend the lifecycle of aging systems in need of hard-to-find parts. “Hospital service departments are looking for a trusted source of quality, affordable parts that are quick and easy to find and obtain. We are excited to introduce GoldSeal parts at AAMI 2017 and expand our support to in-house teams in this way,” said Joe Shrawder, president and CEO of GE Healthcare Global Services. This new offering expands GE Healthcare’s GoldSeal portfolio, now in its 20th year, beyond refurbished diagnostic imaging systems to include refurbished service parts, MR coils and X-ray detectors. GE Healthcare’s GoldSeal initiative extends quality health care equipment, and now parts, to places that might not otherwise have access due to budget constraints, while cutting waste and helping make the world a greener place. •

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PEOPLE ON THE MOVE

Hologic of Marlborough, Massachusetts has added Charles J. Dockendorff to its Board of Directors. Dockendorff is a former EVP and CFO for Covidien, having joined Tyco Healthcare, its Kendall Healthcare Products segment, as a controller in 1989.

As a result of its acquisition of the medical imaging business of PerkinElmer Inc. Varex Imaging Corporation has made Brian Giambattista SVP and GM of X-ray detectors for the company’s combined imaging detector business. Giambattista has been president of the PerkinElmer medical imaging business since 2008. Rick Colbeth, the former Varex GM of X-ray detectors, has been promoted to SVP of Engineering of its X-ray detector business.

Acertara of Longmont, Colorado added Nicholas Ellens to oversee its acoustic power testing lab. Ellens joins Acertara from the Johns Hopkins University Department of Radiology MR research faculty, where he worked on focused ultrasound and MR-guided high intensity focused ultrasound (HIFU) projects.

Angela Alistar has been named medical director of medical oncology at Atlantic Health System Cancer Care of Morristown, New Jersey. Alistar is a translational research specialist, and joins Atlantic Health System from the Wake Forest School of Medicine, where she led the 20

ICEMAGAZINE | JULY/AUGUST 2017

GI oncology team. She is a member of the American Society of Clinical Oncology, the American Society of Hospice and Palliative Care Medicine, and the American Society of Hematology.

In its acquisition of C.R. Bard Inc., BD (Becton, Dickinson and Company) of Franklin Lakes, New Jersey will create a new business, BD Interventional, to which Bard employees will report. Bard chairman and CEO Tim Ring will join the BD Board of Directors, as will another Bard director as yet unnamed. BD is also promoting Tom Polen from EVP and president of the BD Medical Segment to president of BD; he will oversee BD’s Medical, Life Sciences and new Interventional segments.

Richard S. Isaacs has been named executive director and CEO of The Permanente Medical Group (TPMG) and president-CEO of Mid-Atlantic Permanente Medical Group (MAMPG) of Oakland, California. Isaacs succeeds Robert Pearl in both roles as well as co-CEO of the National Permanente Executive Committee of The Permanente Federation. He has served as physician in chief for the Kaiser Permanente South Sacramento Medical Center since 2005.

Brainlab AG of Munich, Germany has announced that CFO Joseph A. Doyle plans to retire after nearly 20 years with the company. Doyle joined Brainlab as VP in

1998, and two years later was promoted to CFO; he was also the company’s COO from 2001 to 2009. After his retirement, Doyle will remain with Brainlab as an advisor.

Shockwave Medical of Fremont, California named Doug Godshall its president and CEO. Godshall was CEO and director of HeartWare International Inc., which was acquired by Medtronic in August 2016. At Boston Scientific, he was president of vascular surgery, vice president of business development, and a member of its operating committee. Godshall replaces Shockwave Medical co-founder, Daniel Hawkins.

Cleveland Clinic President and CEO Toby Cosgrove is stepping down after nearly 13 years at the helm. Cosgrove plans to vacate his post by the end of 2017, but has been invited to continue with the organization in an advisory role. Cosgrove helped the Cleveland Clinic grow into the largest employer in Ohio, with nearly $9 billion in annual revenues and a staff of more than 50,000. The search for his replacement is underway, and according to the organization, will result in the hiring of a practicing physician. ICE

Send us your news, email editor John Wallace at editor@mdpublishing.com

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WEBINAR WEDNESDAY Series Reaches New Highs

he Webinar Wednesday series continues to receive rave reviews and reach new highs as more and more people in the HTM community login for the presentations. The presentation “Nuclear Medicine Service: A Guide for Selecting the Right Service for Your Facility” sponsored by Universal Medical was described as “excellent.” “An excellent balance of well-organized and delivered prepared comments covering [a] range of issues in maintaining nuclear medicine system with a panel of in-house experts at Universal Medical that offered excellent responses to questions,” attendee Rob D. wrote in his post-webinar survey. “Nuclear Medicine Service: A Guide for Selecting the Right Service for Your Facility” also offered attendees the opportunity to earn 1 CE credit from the ACI. Craig Snodgrass, National Service Manager at Universal Medical, did an outstanding job providing information to attendees. He discussed choosing an independent service provider, selecting the ideal type of service contract, best practices one should be performing, and using fully reconditioned parts versus “as is” used parts. The webinar concluded with a Q&A session. Another recent webinar, “Innovations in Ultrasound System Diagnostics,” dealt with the diagnostic imaging portion of HTM. The webinar, which was sponsored by Summit Imaging, was eligible for 1 CE credit from the ACI. Summit Imaging Manager of Global Education and Training Kyle Grozelle discussed new and emerging tools and skills 22

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to troubleshoot and diagnose equipment in-house effectively. He explained how this approach to servicing and maintaining ultrasound equipment allows for a lower cost and reduced downtime. He showed how to use tools available in any biomed shop along with the knowledge of technicians to examine common symptoms and errors. Grozelle also discussed the instal-

tic,” Lee W. said. “This webinar would fall under fantastic and it grabbed my interest enough to send an email to my boss inquiring about the hosted product.” “Great webinar on further in-house and third-party ultrasound service, that is not dependent on the OEM,” Robert M. wrote. “This was a great webinar for me as a biomed who is very new to the ultrasound

“ The Webinar Wednesday series provides a valuable service to the in-house service personnel by making quality information available at no cost and not having to travel to a training session off-site.” Stan R. lation of common parts that sometimes require additional steps and configuration to restore a system to working order. He set aside time to answer questions posted by webinar attendees. At the conclusion of the presentation, attendees had gained knowledge and skills that enable them to diagnose a wide variety of ultrasound equipment as well as the resources to repair a system to full functionality. “I’ve attended several webinars over the years and they offer such a convenience in the material. Some are good, some great and some are simply fantas-

field. I am also happy to hear that Summit Imaging has such great support for us biomeds. Nice to find another company to call when we have equipment down. I am passing on their info to all my other co-workers,” Stephanie S. said. The Bayer MVS sponsored webinar “Mitigating Catastrophic TEE Transducer Failures Through Process Analysis” was a hit with 716 attendees. Bayer Multi Vendor Service Technical and Clinical Specialist Ted Lucidi, CBET, shared proven methods of reducing catastrophic TEE transducer failures. Rather than merely presenting attendees with ADVANCING THE IMAGING PROFESSIONAL

common modes of failure, he provided root cause analysis from a clinical point of view. The outcome was that webinar attendees are now able to audit clinical environments, perform gap analysis and recommend process improvements that will ultimately impact the severity of, frequency of and cost of supporting these sensitive devices. The program Lucidi shared has been proven to reduce catastrophic failures and, until the webinar, has been exclusively available to customers of Bayer Multi Vendor Service. Attendees shared their thoughts about the webinar via a survey. “The webinar was very informative on provided cost-saving techniques regarding the TEE probes,” Kim B. wrote in her survey. “This is the fourth webinar I have attended. All have been interesting. Some of the subjects, including this one today, do not pertain to equipment I am responsible for; but I always gain some valuable knowledge,” Richard W. said. “This webinar was the best one I have attended so far. It was not just a sales pitch and the information that I learned will surely help me in my future endeavors,” Charles K. wrote. The overall TechNation Webinar Wednesday Series continues to receive compliments after each session. “These Webinar Wednesdays are not only a great way to obtain CBET recertification credits but are no doubt a great educational development tool, especially for smaller organizations that might not WWW.IMAGINGIGLOO.COM

get as much training/cross education from other employees or surrounding areas. This helps limit the cost to maintain your accreditation as well,” Brian J. wrote. “We don’t get much new technology training as biomeds. Webinar Wednesday has been a great tool for me to get my technicians a little more information than they had the day before,” Paul N. shared. “The Webinar Wednesday series is the awesomesauce on my pancakes,” Jewel N. exclaimed. “Just when you think you’ve got your bases covered, TechNation webinars add knowledge to your technical database,” wrote Justin R. “The Webinar Wednesday series provides a valuable service to the in-house service personnel by making quality information available at no cost and not having to travel to a training session offsite,” Stan R. shared. “If Siskel & Ebert were still alive, they would both give Webinar Wednesdays two thumbs up,” Michael N. wrote. “TechNation has become my number one source for on-the-job education,” Tim B. said. “I find the Webinar Wednesday to be full of vital information. The variety of topics that they cover should keep everyone looking at what is being offered next,” Joe D. wrote. ICE For details about the Webinar Wednesday series, including a schedule of upcoming presentations and recordings of previous sessions, visit 1TechNation. com/webinars.

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PROFESSIONAL SPOTLIGHT Jay McDaniel

ranciscan Alliance, a 140-year old faith-based health system, was founded by the Sisters of St. Francis of Perpetual Adoration. At one time, the health system was known as the Sisters of St. Francis Health Services, but later became Franciscan Health. Franciscan Health serves the needs of patients in Indiana, Illinois and Michigan through a network of 14 hospitals and several medical practices. Jay McDaniel is a radiation equipment specialist in the clinical engineering department with Franciscan Health. He specializes in Philips CT and GE MRI and is responsible for two imaging centers and three hospitals in the Carmel, Indianapolis, Greenwood and Mooresville areas. He cut his engineering teeth in the U.S. Marine Corps. “As an enlisted officer within the USMC, I advanced in my career as a mechanical engineer, where I worked extensively on heavy equipment. Unfortunately, my career in the USMC came to an abrupt end after sustaining some (non-combat) injuries that left me hospitalized for nearly a year. This provided me with ample time to evaluate my life outside of the service. After discussing my transition into civilian life with a counselor, I chose a career path in radiologic imaging equipment,” McDaniel says. His decision led to an associate degree in BMET from Purdue University. After that, he earned a bachelor’s degree in EET, where he completed levels 1, 2 and 3 of basic X-ray school at DITEC as a research and study elective. 26

ICEMAGAZINE | JULY/AUGUST 2017

Jay McDaniel

RADIATION EQUIPMENT SPECIALIST

“Immediately after school, I began my career working for Marconi. Marconi was eventually purchased by Philips Medical, which began my career with Philips. With Philips Medical I was mainly tasked with servicing CT equipment and general X-ray equipment,” McDaniel says. “Eventually, after getting married and starting a family, I began to be drawn to a career path that kept me closer to home with more consistent hours. Thus, I began my career at Franciscan Alliance servicing CT, MRI, ultrasound and PET systems,” he adds. Beyond Imaging Service and Repair It was during his college time that he was able to find entry into the biomed and imaging field.

“I became acquainted with an individual in college who was working as an IT support within a local hospital. This individual was able to pass along some people to contact within the imaging field. So through basic networking, I was able to navigate into the imaging field and biomedical services,” McDaniel says. McDaniel sees himself as as a biomed and imaging specialist as well as a patient advocate. He said he never loses sight of who the final beneficiary is for clinicians and those who repair and maintain imaging equipment. “Going from field service to inhouse, I have been able to learn how down systems effect patient care and can become stressful for the techs,” he says. “So, I feel like sometimes I need to be a patient advocate to other departments, vendors and techs when they don’t understand how it can affect patient care.”He points out that when you work on imaging equipment, there are companion systems that are co-dependent and important to understand. “I also work on workstations for the 3D lab and troubleshoot networking issues. As an ‘in-house’ service engineer, I have had to learn about other systems that went along with the MRI and CT systems. For example, the radiofrequency enclosures of the MRI suite and advanced radio interface with CT/MRI systems. I have also had to advance my knowledge within advance room designs such as Philips Care Suite package,” McDaniel says. ADVANCING THE IMAGING PROFESSIONAL

Jay McDaniel and his wife, Tracey have two children, Cora, 11 and Matthew, 13.

GET TO KNOW THE PRO Favorite book: The book of John Favorite movie: Anything with super heroes or “Star Wars.” Getting in that Cardio It should be no surprise that a Marine would engage in fitness as a pastime. “I am an avid bicyclist looking to completing my first assault on Mt. Mitchell and completing the RAIN ride (Ride Across Indiana) a few times which is a 160-mile ride across Indiana in a day. Also, RAGBRAI (The Register’s Annual Great Bicycle Ride

fessionals. He sees MedWrench as a good resource for his colleagues and is happy to see biomeds sharing information that is helpful to others. He was recently selected as a MedWrench Guru of the Month. Asked about what ICE readers should know about him, McDaniel stresses dedication and the well being of patients. “I really believe in our hospital

Favorite food: Anything Mexican even more so if it comes with free chips and salsa. Hidden talent: Not sure if it’s a talent, but I love to cook. I would like to go to cooking school when I retire and help out at the local soup kitchens. Favorite part of being an imaging professional:

“So, I feel like sometimes I need to be a patient advocate to other departments, vendors and techs when they don’t understand how it can affect patient care.”

“I really love when I know a work around or how to fix an issue so a patient doesn’t have to be rescheduled and they can find out what is wrong with themselves faster. The less stress a patient has, the quicker they can recover.” What’s on my bench?

Across Iowa), which is a week long ride across Iowa. I also enjoy running and swimming and golf,” he says. McDaniel has a family of four. ”I have a very supportive wife Tracey and two kids; Matthew and Cora ages 13 and 11,” he says. McDaniel is also active in the MedWrench forum where he shares his experience and knowledge with other HTM proWWW.IMAGINGIGLOO.COM

mission statement about patient care. I always answer my phone; even if on PTO or off working hours. If there is a chance I can help one patient receive faster and better care, I will do my best to help out,” he says. With devotion like that, patients receiving care at a Franciscan Health facility know that it is not just the clinicians who are dedicated to their care. ICE

The center on my desk is my 27-inch monitor along with an Interstate battery car that I won at the Indiana biomed conference and a Bluetooth speaker to listen to music as I do my paperwork. This is not on my desk, but I am very proud that I just got done stripping and waxing my own office floor.

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DEPARTMENT SPOTLIGHT DCH Health System Imaging Equipment Specialists

here have been people who have joked that there is a city in Alabama where the elephant’s tusks are loose, paraphrasing an old Groucho Marx joke. That may not be the most accurate description of Tuscaloosa, which actually got its name from the Choctaw Indian words for warrior “tushka” and black “lusa.” The name describes a legendary Indian chief, who died in 1540, named the Black Warrior. The city is located on a river also named for the great chief. The city has nearly 100,000 residents and is home to the University of Alabama. One of the health networks providing care to residents is the DCH Health System, which serves patients throughout West Alabama. The DCH Health System includes DCH Regional Medical Center, Northport Medical Center and Fayette Medical Center. The health system’s 23-member clinical engineering department includes a five-member group of imaging specialists referred to as Imaging Equipment Specialists. The CE department is headed by director Deron Crotts. The imaging group is managed by Alan L. McDuff. The department services the three hospitals owned by DCH and three other hospitals as a third-party provider via contracted service. The three DCH hospitals have more than $54 million of imaging equipment. 28

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The main facilities include one 600-bed, one 300-bed and one 150-bed hospital and a spine care clinic. “We service eight CT, seven MRI, eight gamma cameras, two linear accelerators, 68 radiographic units, and 53 ultrasound units,” McDuff says. “We do not have any mobile units. We operate out of the main hospital and cover two outlying hospitals and one clinic, all with the same operational model.” The imaging group is trained to service a number of imaging modalities and an archiving system. “We repair and perform PMs on PACS, ultrasound, nuclear medicine, radiographic, fluoroscopic, angiographic fluoroscopic, heart cath fluoroscopic, CT, MRI, and linear accelerators,” McDuff says. The imaging team was first started 27 years ago when McDuff was hired to work on X-ray equipment. “I assumed responsibility for three general X-ray rooms in the emergency department. That grew over all those years to a team of five Imaging Equipment Specialists,” he says. The imaging group is able to stay current on the latest technology by negotiating training into purchase contracts. “When a department in the hospital begins the purchase process for a new piece of imaging equipment, we are included in the discussion to determine

what will be the projected cost of ownership,” McDuff says. Well-Trained Team The imaging group takes a strategic and budget-minded approach to training. Shared knowledge and cooperation with OEMs makes this work. “When we compare the cost of a full-service contract over several years to the one-time cost of training, we will routinely purchase manufacturer training with the purchase. So, if a more advanced platform arrives with the new purchase, we will acquire the expertise to maintain it as well,” he adds. “In addition, we also utilize a simple process of cross training. If one technician is more proficient with a procedure, he will give a quick in-service for the rest of the team. Also, a lot of on-the-job training with the manufacturer’s assistance, if needed. Having a ‘shared service’ agreement with some of our vendors, makes this a wonderful opportunity to learn and grow at an affordable rate,” McDuff adds. There are a few types of equipment that the team does not service according to McDuff. “We do not service ‘laptop’ ultrasound units or ultrasound transducers. We would have to invest in ‘computer’ technicians and specialized equipment. I just can’t see the return versus time/expense,” he says. ADVANCING THE IMAGING PROFESSIONAL

The DCH Health System Imaging Equipment Specialists team includes, from left, Alan McDuff, Bryan Howell, Cameron Guin, John Sawyer and Jerome Hammonds (not pictured)

Purchasing Advice Bringing the expertise of the imaging service professionals to the table during the purchasing process offers a lot of upside. After all, when evaluating the lifetime cost of a piece of equipment, and its reliability, it’s good to include those who are in the know. “Our group is fully involved in the purchase, planning, and construction of all of the imaging equipment we service. The purchase considerations include our team’s vendor comparison, ease of service, dependability, etcetera,” McDuff says. He says that the planning and construction involvement assures nothing is done or is left out for ease of use or maintenance. “The ultimate decision on service contracts is up to the directors of radiology, cardiology, etcetera. We do play a major role in analyzing the service offerings to WWW.IMAGINGIGLOO.COM

determine cost of ownership and best value for the money spent. We are responsible for maintaining our equipment at optimal quality and dependability, but at the most economical way,” McDuff says. McDuff says that as a parts purchaser they shop for the best price from many third-party vendors. “We typically do not use any third-party labor,” McDuff says. “We do provide user training that covers safety, error reporting, and emergency measures pertaining to the equipment. All of the Imaging Equipment Specialists are manufacturer trained on all of the modalities I listed. We go beyond first look on all calls but with our shared-risk model, we can call the vendor for help, either phone or on-site.” Along with their colleagues in CE, the imaging service team has tackled some special projects along with a disaster preparation project to ensure the continuation of service.

“The PACS network, specifically the wire plant and switch configuration, has been an exclusive CE design and implementation project. We designed a standalone wire plant so the radiology department can operate autonomously, on generator power, if a disaster occurs,” McDuff says. “This was demonstrated in April 2011 when a tornado destroyed all incoming power and most communication into the hospital. Over 1,000 radiology exams were completed and read in a 12-hour period, without failure,” he adds. “With the advent of digital radiography, the PACS network becomes the master link of all work flow.” Having a specialized imaging team within this clinical engineering department has been a benefit to the health system and the people of West Alabama. Imaging Equipment Specialists – the name says it all. ICE ICEMAGAZINE

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DIGITAL X-RAY PRODUCT SPOTLIGHT Digital X-ray Market Continues Climb

igital X-ray continues to grow in popularity, especially amid motivating factors such as reimbursement rates. Digital X-ray systems comprise the same basic parts as analog X-ray systems including X-ray sensors, amplifiers, image processing computers and displays. The demand for digital X-ray systems is growing at a significant rate since the procedure forms the basis of diagnosis and also the treatment of various medical conditions. According to Technavio analysts, the global market for digital X-ray systems will grow at a CAGR in excess of 13 percent by 2020. MarketsandMarkets predicts the digital X-ray market will reach new heights in the future. “The global digital X-ray market is expected to reach $10.46 billion by 2020 from $6.15 billion in 2015, at a compound annual growth rate (CAGR) of 11.2 percent from 2015 to 2020,” according to a MarketsandMarkets report. “Among the various applications, the general radiography WWW.IMAGINGIGLOO.COM

segment is expected to account for the largest share of the market,” according to MarketsandMarkets. “The general radiography market includes

reach $11.1 billion by 2021, at a CAGR of 13.2 percent,” according to Mordor Intelligence. “The global X-ray market is dominated by computer radiography

to reach $1.08 billion and is expected to reach $1.72 billion by the end of 2024,” according to Transparency Market Research. The market for mobile digital

“ The global digital X-ray market is expected to reach $10.46 billion by 2020 from $6.15 billion in 2015, at a compound annual growth rate (CAGR) of 11.2 percent from 2015 to 2020.” chest imaging, orthopedic applications, cardiovascular imaging and other applications. Chest imaging segment is projected to grow at the highest CAGR from 2015 to 2020. The high growth of chest imaging segment can be attributed to the increasing incidence of lung diseases.” Mordor Intelligence also predicts continued growth in the digital X-ray market. “The global digital X-ray market is estimated to be worth $5.9 billion in 2016 and is expected to

X-ray systems as they are relatively less expensive than digital radiography X-ray systems and entail less retraining of medical practitioners.” Transparency Market Research also calls for continued growth in the flat panel X-ray detector market. “The global flat panel X-ray detectors market is being projected at a CAGR of 5.9 percent in terms of value from 2016 to 2024. The market’s revenue at the end of 2016 was calculated

X-ray systems is projected to grow at a 7.1 percent CAGR during the next nine years, with North America continuing to be the dominant market, according to the market research firm Future Market Insights. MarketsandMarkets lists the key players in the digital X-ray market and includes Carestream Health Inc., Fujifilm Medical Systems, GE Healthcare, Hitachi Medical Corp., Philips Healthcare, Siemens Healthineers and Toshiba Medical Systems Corp. ICE ICEMAGAZINE

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CARESTREAM DRX-Evolution Plus The Carestream DRX-Evolution Plus includes a motorized wall stand with a bucky angulation feature that expedites crosstable and other complex exams. The standard table simplifies patient positioning and an optional table supports patients up to 705 pounds. A motorized overhead tube automatically tracks detector movement for fast source-to-detector alignment, which reduces fatigue and repetitive stress injuries for technologists. A remote control lines up the X-ray tube to either bucky to further streamline the imaging process. The system features an extended tube column, high-performance generator, and DRX Plus Detectors that can be shared with other DRX imaging systems. â&#x20AC;˘

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Fujifilm Medical Systems FDR AQRO FDR AQRO is a complete digital x-mobile X-ray system that combines all the elements necessary to maximize maneuverability, generate high-resolution images, and deliver low patient dose in a variety of point-of-care settings. The system offers the low dose acquisition capabilities of Fujifilmâ&#x20AC;&#x2122;s FDR D-EVO II, ISS and noise reduction circuitry, combined with Virtual Grid image processing software which allows acquisition of images without a physical grid. FDR AQRO is equipped with an exclusive Fujifilm engineered mini generator, a compact tube head incorporated onto an ultra-lightweight, durable mini mobile cart. Additional features include an integrated touchscreen and X-ray control panel that articulates and swivels for easy viewing from any angle and can run up to 12 hours on its lithium batteries or plugged into wall power. FDR AQRO will be made commercially available in the U.S. upon receipt of FDA clearance. â&#x20AC;˘

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Philips CombiDiagnost R90 The CombiDiagnost R90 is a remote controlled fluoroscopy system in combination with high-end digital radiography. It is a consistent performer for all DRF studies. Its cutting-edge digital radiography capabilities convert a traditional fluoroscopy room into a high throughput 2-in-1 solution. The CombiDiagnost R90 supports fast, confident diagnoses with excellent image quality using Grid Controlled Fluoroscopy (GCF) and Dynamic UNIQUE image processing. The remote controlled tiltable table (-90° to +90°) is ideal for all standard fluoroscopy studies. Additionally, the tabletop can hold a patient weighing up to 626 pounds without restricting movement. Excellent dose management features benefit both patients and staff. •

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Siemens Healthineers Multix Fusion Max The Multix Fusion Max digital radiography system from Siemens Healthineers supports a full range of clinical applications, including general X-ray, trauma and emergency, chest screening, tabletop examinations, and high-throughput general X-ray. The system helps small- and medium-sized hospitals and clinics obtain the right configuration for their patient mix. Users can swap detectors with all radiography, fluoroscopy, and mobile systems in the Max family, boosting detector uptime and department-wide utilization. The MAXcharge feature prevents battery-related workflow interruptions since the MAX wi-D detector automatically charges when placed the table bucky or wall bucky. The ergonomic bucky wall stand enables headto-toe imaging for standing, sitting or stretcher patients. â&#x20AC;˘

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GE HEALTHCARE Optima XR240amx with FlashPad HD digital detectors The Optima XR240amx with FlashPad HD digital detectors is a mobile X-ray system designed for use in critical and complex environments such as the ER or the NICU where it can be impractical to get important diagnostic insights from a fixed radiography room. A maneuverable design and small footprint allows the Optima to fit seamlessly in tight spaces. Flashpad HD next generation detectors enable clinicians to see fine details with exceptional contrast. The Optima XR240amx is a mobile X-ray system health care providers can rely on to make each patient the point of care. â&#x20AC;˘

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Equipment Service & Quality Control in ACR Accreditation By Matt Skoufalos

or imaging professionals and the health care systems within which they ply their trade, there are few organizations that carry the weight of the American College of Radiology (ACR). Among its various strategic interests, the society is dedicated to process improvement in the field of medical imaging, and one of the mechanisms by which it seeks to raise that bar is through imaging equipment evaluation and certification. ACR accreditation is not only beneficial for patients, but can have an impact on decisions involving equipment service and purchasing as well. The ACR accreditation process requires that a medical physicist annually survey each imaging device in a given institution, performing detailed tests and evaluations of its capacity to meet the college’s program requirements for any of 10 different modalities, including CT, MRI, mammography, ultrasound, nuclear medicine, radiation oncology, and stereotactic breast biopsy. The physicist’s assessments follow 40

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quality control manuals outlining procedures and performance criteria for each, and they can be tested by the use of an imaging phantom as well as case studies. Facilities have 45 days from the receipt of their testing materials from ACR to complete all requirements; once returned, the results are returned within 60-90 days. A successful application results in a certificate of accreditation that’s valid for three years; about eight months before its expiry, ACR will send along a renewal notice to the facility, and the process begins again. But even beyond the purposes of the accreditation survey, close collaboration among a medical physicist and the institutional partners who select, service, and replace the equipment in question is critical to maintaining the quality of the device, said Krista Bush, ACR Senior Director of Accreditation. “An ongoing quality control program must be established and implemented under the supervision of a qualified med-

“ An ongoing quality control program must be established and implemented under the supervision of a qualified medical physicist.” – Krista Bush, ACR Senior Director of Accreditation ical physicist,” Bush said. “It is essential that the medical physicist work closely with service providers when equipment problems are identified to ensure that any repair enables the equipment to meet the quality requirements.” ADVANCING THE IMAGING PROFESSIONAL

Passing the ACR accreditation only means that the certified equipment meets the minimum requirements for accreditation. If accreditation is denied, there may be any number of reasons why: poor image quality, technological or protocol issues, equipment malfunctions, failure to follow testing requirements, or even problems with the phantoms used for the purposes of the accreditation process. But even a denied accreditation can help a facility make important improvements, from imaging protocol revisions, device repairs, improved preventative maintenance schedules, adding or changing service agreements, or retiring malfunctioning equipment from use. Sites have the option to retest the areas they are deficient in to achieve accreditation. Proper maintenance of the equipment is one element to ensure quality and safety. The evaluation of equipment performance as part of an ongoing quality control (QC) program can be instrumental WWW.IMAGINGIGLOO.COM

in building a business case to justify the purchase of new equipment. What’s more, documentation of QC – including acceptance testing, annual survey, routine QC tests, and preventive maintenance – is often a governmental regulation. Most importantly, a routine QC program provides an opportunity for education and practice quality improvement. ACR accredits hospitals as well as freestanding imaging centers, and retaining an ACR certification requires the establishment and maintenance of an ongoing QC program supervised by a qualified medical physicist. Those facilities that pass accreditation across all modalities offered can consider an application to become an ACR-certified Diagnostic Imaging Center of Excellence (DICOE), a designation that requires documented routine preventive maintenance, quality control records, and an annual medical physicist survey. Kari Prince-Adams is senior director of imaging services for Piedmont Fayette

Hospital in Fayetteville, Georgia. Among the other benefits to ACR accreditation, Prince-Adams said it helps elevate the profile of her community hospital in the city of 16,000. “It’s a good marketing tool to use, to say your equipment is accredited with the ACR; your techs are registered techs,” Prince-Adams said. “All our certificates are framed and in our waiting room. We definitely push that as a way of saying we are approved at the highest level of quality, and the ACR approves that as well.” “I’d really like to see all facilities get ACR accredited,” Prince-Adams added. “It does nothing but help the patient. We are giving radiation to patients; I think only the highest-quality technologists and equipment would be used. It’s always been an expectation that all our equipment gets accredited. We do it so often now that it’s not anything different or exciting.” Piedmont Fayette is ACR-accredited in a number of imaging modalities, and its ICEMAGAZINE

Equipment Service & Quality Control in ACR Accreditation

“ [The in-house imaging service team is] very on top of keeping our equipment maintained before ACR has anything to do with it. Your images do have to be of high quality or they send them back.” – Kari Prince-Adams, Senior Director of Imaging Services

equipment maintenance is handled by an in-house imaging service team that manages two MR machines, four CT scanners, seven X-ray machines, 10 ultrasound units and five mammography machines. Even with each device on a different schedule for accreditation review, the application process is streamlined and more easily managed internally at Piedmont Fayette “because it’s an expectation,” Prince-Adams said. “[The in-house imaging service team is] very on top of keeping our equipment maintained before ACR has anything to do with it,” she said. “Your images do have to be of high quality or they send them back.” If the imaging machines are functioning appropriately, then they will return images that can meet the ACR standard, which tells Prince-Adams a few things: first, that the equipment is in good working order, and second, that the radiation doses her patients are receiving are within appropriate limits, “and that’s what ACR is checking,” she said. “Best practices, quality, safety – it all goes hand-in-hand,” Prince-Adams said. “You want to make sure your 42

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equipment doesn’t produce too much radiation, and you want to make sure you get the best image.” Just as it’s an expectation that her department documents its processes for the ACR review, Prince-Adams said the imaging staff at Piedmont Fayette also track and monitor the amount of ionizing radiation each patient receives in his or her electronic medical records. Despite the extra step, the safety metric contributes to better health outcomes, as the information is shared with other directors system-wide. “I think ACR was really the first to look into dose reduction, and that was the first thing we tackled,” Prince-Adams said. “Some of our X-ray equipment at the time could not measure dose.” Dose monitoring also has helped inform decisions around medical equipment, including when and whether to retire outdated systems, what features to look for in purchasing new imaging devices, and the timing of their maintenance, Prince-Adams said. Since Piedmont Fayette has switched to an in-house maintenance crew, the department has been

able to synchronize its repairs, eliminate a variety of outside service contracts, and establish a ticketing system that allows decision-makers to more closely track device management issues, she said. This information also contributes to annual capital budget planning; although the in-house, five-year plan typically favors replacing older equipment first, dose reduction is always a factor in the decision. “Pretty much anything that’s the oldest is what we try to replace as quickly as possible,” Prince-Adams said, “but everyone’s on a different cycle with equipment – when you purchase it, when you get accredited.” Although the process can be stressful for those who are trying to submit the best-quality images for consideration, Prince-Adams said the ACR standardized process is clearly documented, and that the hospital refers to its website for support as well as to its own internal resources, which include an ACR ambassador and monthly, system-wide meetings among the Fayette radiologists. In addition to hitting their marks with the imaging phantoms, Prince-Adams suggests that departments that come across an interesting case might want to flag the file for sharing with ACR at accreditation time. “Sometimes it’s difficult,” she said; “you have to have so many types of a certain study that you have to send in. If we do a new procedure, you want to keep that up so that we can remember.” As president of diagnostic imaging at Digirad of Poway, California, Virgil Lott is frequently called upon to provide institutional consultancy on the ACR accreditation process. Lott said it differs from other accreditation surveys for its high emphasis on image quality and patient services moreso than other certifications. As a result, he said sometimes institutions can get stuck on some of the ADVANCING THE IMAGING PROFESSIONAL

The ACR accreditation process includes radiation dose assessments. These are especially important for pediatric imaging patients.

technical aspects of the process, and may call on Digirad for help. “Unfortunately, they often hire a physicist who may or may not be familiar with our brand of camera and how to operate it, and we often get involved with acquiring these images so they’re done correctly,” Lott said. “The ultimate goal is to have the right equipment working in the right way for patient imaging.” To his thinking, the two things that can most affect the success of an ACR accreditation application are the frequency of preventive maintenance – at least twice annually, Lott said – and the completion of data quality controls by in-house technologists. By mandating that the staff who operate the machine day in and day out be involved in certifying its compliance with ACR standards, he believes the people who know the equipment best will be able to acquire the best images with it. “If those things are done, then generally the testing for the ACR images is right on track,” Lott said. “What I do see periodically is when a customer has trouble meeting their ACR [benchmarks], they might make a decision to go into a service contract because they get better overall maintenance throughout the year. It’s important to maintaining our customers’ equipment that we follow the standards and don’t shortcut them in any way; that PMs are done to the OEM requirements.” Lott said that guidelines incorporated within the ACR requirements help improve institutional processes beyond merely meeting the standards of the accreditation application. When frequency of equipment maintenance is connected with an accredited body like ACR, it is typically an improvement over existing protocols and procedures, meant to improve patient safety and care. Implementing such standards doesn’t negatively affect operations, and can help WWW.IMAGINGIGLOO.COM

“ Being a regulated industry, our equipment has to be regulated by the FDA,” Lott said. “We [also] have to be ISO-compliant, and both those organizations require that we produce a product that is compliant and able to do the patient imaging that it’s designed to do.” – Virgil Lott, President of Diagnostic Imaging, Digirad

lengthen equipment lifespans, especially as they’re taken into consideration by equipment manufacturers in the development of their products, he said. “Being a regulated industry, our equipment has to be regulated by the FDA,” Lott said. “We [also] have to be ISO-compliant, and both those organizations require that we produce a product that is compliant and able to do the patient imaging that it’s designed to do.” “ACR rules are not new,” he said. “Their guidelines are published, they’re understandable, and they fall in line with the way the OEMs build and design their equipment. A lot of times as we look at new equipment designs, we’re taking account that we fall into those parameters as we set up our chronic requirement specification, our software requirement specifications, and our customer requirement specifications.” ICE FOR MORE INFORMATION about ACR accreditation, read a companion article submitted by the American College of Radiology on the ICE website at http://imagingigloo.com/acr-accreditation-101/

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ACCREDITATION 101 How ACR accreditation impacts equipment maintenance and service

EDITOR’S NOTE: This is an excerpt from an in-depth article about accreditation submitted by the experts at the American College of Radiology (ACR). To access the complete article, visit http://imagingigloo.com/acr-accreditation-101/

ith today’s focus on patient-centered care, accreditation programs for diagnostic imaging have emerged as vital initiatives to enhance quality and safety, especially for modalities that depend on advanced technologies such as CT, MRI, nuclear medicine, and PET. The gold seal of the American College of Radiology (ACR) — ACR accreditation — lets patients know that a hospital, clinic, or imaging center has gone through a rigorous review process to ensure it meets nationally accepted standards. When patients choose an ACR-accredited facility, they also know that the equipment used is appropriate for the test or treatment they will receive, and that the facility meets or exceeds quality assurance and safety guidelines.

How Does the ACR Accreditation Process Work? ACR accreditation is an educational process of self-assessment and peer review. The ACR accreditation process documents that your facility meets accreditation requirements for equipment, medical personnel, and quality assurance. Critical elements of the process include clinical and phantom image quality review, as well as radiation dose assessments. The ACR streamlined application process has cut approval time in half, with accreditation evaluation typically completed within 90 days of image submission. Here’s how it works:

What Does It Mean for a Facility to Be Accredited by the ACR? The ACR awards accreditation to facilities for the achievement of high practice standards based on peer-reviewed assessment of clinical and phantom images, as well as radiation dose. Evaluations are conducted by board-certified radiologists and medical physicists who are experts in the field. The ACR accredits facilities in ten modalities, including CT, mammography, MRI, nuclear medicine and PET, and stereotactic breast biopsy. The educationally focused accreditation process is based on the ACR Practice Parameters and Technical Standards, which were developed to ensure appropriate radiologic care for patients. Why Do Facilities Need to Be Accredited? Achieving ACR accreditation is not only the right thing to do for patient quality and safety, it also helps your facility meet governmental and third-party payer criteria and protect your reimbursements. In 2012, the Medicare Improvements for Patients and Providers Act (MIPPA) mandated that providers of CT, MRI, breast MRI, nuclear medicine, and PET exams that bill under Part B of the Medicare Physician Fee Schedule be accredited in order to receive payment for the technical component of these services. CMS requirements for accreditation include personnel qualifications, image quality, equipment performance, safety standards, and quality assurance. WWW.IMAGINGIGLOO.COM

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Materials submitted for accreditation review are sent to volunteer reviewers. For clinical images, the ACR requires evaluation by two radiologist reviewers. For phantom images, one or two medical physicists provide evaluation. If you receive a deficiency, you will have a dedicated ACR support team to discuss your options to appeal, withdraw, repeat, reinstate, retest, etc. And, you can contact ACR if you have any questions throughout the accreditation process. What You Need to Know About Phantoms ACR phantoms are scanned by a technologist or physicist. If performed by a technologist, a medical physicist should check all images and data forms. Depending on the modality, ACR phantom measurements may include: • CT number calibration • Low-contrast (CNR) • Spatial resolution • Uniformity • Artifacts For dose testing on CT units, the dosimetry must be performed by a medical physicist. Dose testing includes: • CTDIvol • Reference values and pass/fail criteria Phantom submissions may include: • CT ACR phantom (Gammex) and dosimetry phantom images • MR phantom (JM Specialty Parts), including: • L arge phantom for whole body magnets • Small phantom for extremity magnets • N M and PET ACR-approved phantoms (Data Spectrum) Why Quality Control? A key aspect of achieving accreditation rests in the proper maintenance and functioning of imaging equipment to ensure quality and safety. Routine QC can help ensure that your equipment 46

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The Quality and Safety section (acr. org/Quality-Safety) of the ACR website also provides access to Practice Parameters and Technical Standards, Appropriateness Criteria, the National Radiology Data Registry, the Education Catalog, and numerous other resources.

Phantom images should be round and uniform. A cracked crystal should never be used for patient imaging. operates appropriately to achieve the necessary image quality. A continuous QC program is essential to identify problems before the diagnostic utility of the equipment is significantly impacted. The evaluation of equipment performance as part of an ongoing QC program can also be instrumental in building a business case to justify improved service contracts or the purchase of new equipment. What’s more, documentation of QC—including acceptance testing, annual survey, routine QC tests, and preventive maintenance—is often a governmental regulation. How to Prepare for Accreditation The ACR has dedicated and readily accessible resources to help sites prepare for accreditation. Start with ACR accreditation website (acraccreditation.org), where you’ll find a wealth of easy-to-access online information that serves as a comprehensive guide to the requirements for each program. For each modality, you can also find all the latest articles, announcements, and frequently asked questions (FAQs) regarding accreditation.

What Happens After Accreditation? Imaging facilities are accredited for three years. For MIPPA modalities, each accredited facility will go through an unannounced site visit during the three-year accreditation period. Sites can be visited by an ACR representative and/or CMS at any time during the three-year accreditation period. How can you prepare for unannounced site visits? The ACR provides a detailed toolkit designed to assist gathering and maintaining documentation that is required for accreditation. The toolkit can also be used to prepare pre-accreditation and/or post-accreditation onsite surveys. Expert Help to Guide You Along the path to accreditation, ACR experts are standing by to guide you every step of the way. With our expert staff of experienced technologists and the assistance of more than 250 board-certified radiologists and qualified medical physicists, the ACR has provided successful and timely accreditation for nearly 40,000 facilities nationally. ICE Contact American College of Radiology 1891 Preston White Drive Reston, VA 20191 Accreditation Hotline: 800-770-0145 www.acraccreditation.org

ADVANCING THE IMAGING PROFESSIONAL

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IMAGING MATTERS The Challenges of a PM Specialist

here are certain challenges facing the imaging community in general, and while some of these impact the development and implementation of a PM specialist, the single biggest challenge may be finding an individual with enough experience to fill the position without a large investment of both money and time. The challenge is just filling open imaging positions in general, but the upside is that it allows you to build the training of the individual to meet your needs. Building the person you need for the position has become more achievable in the last few years. During the Imaging Conference and Expo(ICE) 2016 there were a number of ISOs that were willing to discuss PM only classes. To start from scratch, you take a BMET or someone with an excellent electronics background and get them general X-ray service, general CT service, perhaps even general MRI or Nuc Med service training as your needs dictate. Let them work with the first shift crew for several months to learn as much as possible about the specific equipment they will be servicing. Then, have them trained to perform PMs. There will be a great temptation to have the currently trained in-house personnel train the PM specialist on how to perform and complete PMs. It is a trap. Any shortcuts or bad habits that may have been developed due to the constraints of time and pressure will be passed on. A set training schedule with a training agenda in a controlled environment is the way to go. The best option will be the ISO. Have 48

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them develop a PM training that meets your needs. These companies make their living and continue to thrive and grow by being better than the manufacturer. They know what fails most, what needs the most attention, and how to get the longest life out of the equipment. When they develop training, it is based on experience and giving the customer the best ROI. This will be reflected in the training. Depending on the required time for training, scope of equipment, and the ability of the individual you hire as a PM Specialist, it may be possible to get training for multiple unit PMs in a package deal. The key here is that the PM specialist does not need to be a product expert. The

Written by John Garrett Manager, Clinical Engineering at Catholic Health Initiatives.

There will be a great temptation to have the currently trained in-house personnel train the PM specialist on how to perform and complete PMs. It is a trap. Any shortcuts or bad habits that may have been developed due to the constraints of time and pressure will be passed on. PM specialist only needs to know enough to perform a PM safely and properly. This means proper cleaning, calibration, lubrication, and identification of high failure parts that may need to be replaced or monitored. Since the PM specialist will not be expected to make any major repairs, the training will be shorter than the complete training the modality expert would receive. The other challenge that will be faced

is keeping a PM specialist working an off shift. There are those that would jump at the chance to work a third shift, however, that is not the majority of the workforce. The tools to maintain the position as a desirable position may vary from company to company, however there are a few things that most can offer. Working four 10-hour shifts a week or three 12-hour shifts a week allows for more free time away from work. This may ADVANCING THE IMAGING PROFESSIONAL

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ORLANDO, FLORIDA OCTOBER 5-7, 2017 attract a more experienced individual who does not want the hectic lifestyle that is often offered in the world of imaging, yet likes the work itself. It is also great for those who may want to further their college education or have interests that can be pursued best during normal business hours. If there is some shift flexibility, that may be even more enticing. It may even be viable as a part-time position. For an ISO or larger hospital system it might be offered as a path to advancement. Three or five years as a PM specialist will lead to CT or MRI specialist on day shift. With the understanding that if they like the position of PM specialist after that three or five year completion, they can opt to stay in that position. Finally there is money. Not only shift differential, but as much as a 20 percent higher base than other imaging positions can still easily show a significant ROI. When running a ROI calculation for a hospital system that has seven hospitals, two standalone ER locations, and multiple imaging systems the numbers were staggering. If they hired a PM specialist to perform PMs on only MRI and CT units full time, paid that person 50 percent more than the highest imaging pay rate as an hourly rate and sent them to training costing $100,000 for the first year. The ROI in the first year was over $300,000 in downtime for PMs alone. That is if the PM specialist sat and drank coffee after the CT and MRI unit PMs were completed. If they performed other PMs, every other modality added was an increase in ROI. Actually getting a PM specialist implemented can be another item that needs serious consideration. This will typically WWW.IMAGINGIGLOO.COM

be something that has to come from the top down. The administrator or manager who can see real savings and improvement to patient care will drive the creation and retention of the position. There may be some resistance from the current inhouse imaging team as there can develop fiefdoms around modalities or departments. This may require demanding or emphasizing the team environment. Sensitivity to concerns about downsizing and job security is a must and should be addressed. Ideally, for an in-house team, someone may step into the role allowing for a new hire to fill their previous roll. The first steps are to get real numbers. What is the average income per hour of the MRI, CT, cath lab during a normal work day? Most radiology directors can tell you how much they lose per hour per unit if it is down during normal working hours. How long is the PM per the manufacturers service manual? How many do you have, how far are they spread out? How much overtime have you been paying to have PMs done due to late starts? Do you end up paying for service while you perform a scheduled PM? Add all of that up to see what number you need to get a real ROI. Chances are that a larger hospital system, or large imaging group, will see immediate, real, significant ROI as well as improved patient care. ICE – John Garrett has 20 years experience in imaging service including general radiation, mammography, CT, and Nuclear Medicine. He has worked for third-party service companies, manufacturers, sales companies and in-house imaging teams.

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IMAGING SERVICE 101 A

nyone who has been servicing imaging systems for any length of time has had the unfortunate experience of getting a bad part. When the part is needed to get a down system running again, it can be one of the worst days in a service engineer’s life. You spent time troubleshooting the fault, and when fairly sure of the part you need, you get the part on order before the shipping deadline. You inform the customer that you’ll be “back in the morning with the part.” Looking forward to the satisfaction of getting the system back up, you pick up the part the next morning and head to the customer site. You put the replacement part in, boot up the system, and … the system still doesn’t work! What happened? Is the part bad? Is it the wrong version for the system? Did you fail to identify the correct part in your troubleshooting? Is there another part that also needs to be replaced? Even worse than not being sure what went wrong, you are going to have to tell the customer that the system still isn’t working. Even if you have already established good credibility with them, they are going to wonder if you really know what you are doing. They are probably going to get questions from their boss and their internal customers about who it is they have chosen to maintain the device, and they may force you to call in the OEM field engineer. You may even be asked where the part came from. Unless it came from the OEM, which is very possible because even the manufacturers sometimes ship parts that don’t work, you can’t do much more than tell them you will be back tomorrow to continue the service call. When an event like this happens because the part was defective, it reinforces the importance of having a good parts supplier. Most manufacturers have prohibitively high pricing on replacement parts, in large part to scare customers into buying a contract from them. That also means that buying an OEM part is a last resort for most of us. So what constitutes a “good” supplier? Assuming that you want to get parts that work out of the box and are reliable, and not just the cheapest one you can find, what characteristics can you use when evaluating and selecting an aftermarket parts supplier? 50

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Technical support Find a parts supplier that can help you identify the failing part and the version of the part that you need for your particular system. If they really know what they are doing, they should be able to provide the information you may need to install that part. There are companies that will sell you the part without making sure you have the passwords or other information you need to install it, and are happy to charge you a restock fee when you return it. Be concerned if the company that sells you a part doesn’t ask questions about the hardware and software version of the

Written by Jim Carr Director of Services and International operations for AUE

system on which you are working. They are probably just a “broker” that is buying from another company and reselling to you. Hero kits If you are unable to be sure if you have identified the part(s) that you need to fix the problem, are you able to get a hero kit of two or more parts in order to make sure you can fix it on your next visit? What, ADVANCING THE IMAGING PROFESSIONAL

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if any, restocking fees are you going to be charged for the unused parts you return.

If possible, visit the supplier so you can see for yourself what they are doing. I can tell you from experience that it can be very informative to even ask the question about doing a site visit. Your parts suppliers can make you, or break you.

Testing An important factor is how the supplier tests the parts they sell. You want a part that was tested in the same type and version of system that you are repairing. Find out how the parts company does that. Do they have testbeds they use for testing? Are they able to configure the part to the same version as you need? How long do you (and your customer) is how long the they burn-in the part? partNEEDED lasts once you have installed it. PROOF APPROVED CHANGES Warranty CLIENT SIGN–OFF:

Quality The warranty period can be an indicator Everyone makes mistakes. But what do of the confidence the company has in the they do when something goes wrong? PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT parts they sell. Be careful, though, since Ask the company if they have a corrective LOGO that sell PHONE NUMBERaction system, WEBSITE some companies you on the and for someADDRESS examples longer warranty seem to find ways to not of recent ones they have experienced. A honor that promise. What is important to company with a strong quality manageWIDTH 7”

PROOF SHEET

ment system investigates DOA (Defective on Arrival) and warranty failures with the intention of making sure it never happens again. If possible, visit the supplier so you can see for yourself what they are doing. I can tell you from experience that it can be SPELLING GRAMMAR very informative to even ask the question about doing a site visit. Your parts suppliers can make you, or break you. ICE

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CAREER ADVICE

Effective Leadership Qualities to Deliver Excellent Customer Service

ffective leadership is essential to delivering quality customer service and is becoming more challenging than ever for radiology professionals in today’s unpredictable health care environment. Competition is tough, and patients go where they feel most comfortable. While attempting to satisfy compliance and regulatory issues, the radiology professional is also struggling with the many demands that come with a health care administrator and leader. Here are some leadership qualities needed to be an effective and successful radiology professional in today’s challenging health care environment: • You must be passionate about what you do, about taking care of patients, staff and everyone who comes through the doors. They are customers. • Your leadership defines the culture of your department and demonstrates the quality of service you want delivered. Lead by example and encourage others to stay motivated and positive while providing quality patient care. • Show employees how much you appreciate them. Appreciation for hard work builds morale and inspiration. Create immediate and positive feedback on excellent jobs completed, and share this note of appreciation with the rest of the staff. Establish performance goals 52

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and lines of responsibility with built-in compensation rewards when specific goals are met. Recognize specific contributions and accomplishments on an on-going basis, not just during performance reviews. • B e caring and nurturing. Empathy and compassion go a long way. Implement practices that lead to outstanding patient care and customer service. • Lead others to be flexible and accept new ideas and new methods. Set the direction for your staff by embracing technological advances and changes. • Maintain open communication. Always be a good listener and let people speak openly without feeling they will regret speaking their mind. Visit with staff and patients. Welcome suggestions for continuous improvement, especially for patient care services. • D elegate appropriately. Focus on important tasks. Remain focused on priorities, stay organized and ensure employees are performing their functions appropriately. • H ave a clear vision of your department and customer service strategy, and communicate it to your staff. Your leadership and customer service strategy should create an environment that is welcoming, compassionate, consistent and

Written by Cindy Stephens Stephens International Recruiting, Inc.

competent. Patients need to feel special. • Hire staff that fit a customer service orientated culture. People coming into the department need to feel welcome and should be treated with the utmost respect. Patients should leave the department feeling they had a positive experience. The staff must have excellent listening skills, empathy and be able to treat patients with dignity and respect. • Ensure continuing education is a priority in your department. Keep staff trained and continuously strive for quality customer service. It starts with hiring the right people, and continuous training ensures the culture is carried through. Foster a mentoring program within ADVANCING THE IMAGING PROFESSIONAL

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This tide of change has been building for many years and is now ready to come crashing on shore. Its benefits will be many and will drive a new era of healthy competition in both the OEM and ISO service market sectors. your department to promote continuous training. • Remain humble. Admit mistakes or when you don’t know something. Ask for advice if needed. You may be surprised with how much knowledge others have and it provides them an opportunity to assist in problem-solving. • Ensure your team has the tools it needs. Look at ways to ensure your budget includes these tools in future budget cycles. • Build loyalty through great customer service. Health care is a small world when it comes to good or bad reputations. When someone gets treated with exceptional care, it usually does not go unnoticed. Soon the word gets out about the “special treatment” a person received during their recent visit to a radiology department. Of course, it can easily go the opposite direction very quickly with just the interaction of a rude receptionist or employee. People want to go where they feel comfortable and WWW.IMAGINGIGLOO.COM

welcomed. Make this a priority in your training so you build loyalty in the community. • E nsure the radiology department fosters a friendly and warm culture. Use music and lighting to create an environment that will comfort patients and make them feel at ease. Have current magazines available for men and women, and books for children. If you have room in the reception area, add a corner with a few toys to entertain young children who are there with a parent. Make it easy for these patients to want to return. • I f there is a dispute or a disruptive person, resolve the situation discreetly but promptly. Remain calm and, if necessary, help influence the participants to approach the situation in positive and professional manner. Often, a steady, calm approach is all it takes to settle someone down and accept an answer that they are not happy about. • A sk for patient feedback on patient

experience postcards that the patient can complete while in the department or mail from home. Use the feedback to collect data, share results with staff, and improve your customer service strategy. If you receive patient contact information, be sure to contact the patient and thank them for their input. Make it personal and ensure the patient knows their input was very important and vital to your continuous customer service training of your staff. • Have the ability to change your leadership style to successfully meet a specific goal or outcome. Leaders today are learning to adjust their interactions with different generations such as Baby Boomers, Gen-Xers, or Millennials because each generation has its own way of communicating and being incentivized. Be aware of the best ways to interact with these generational groups and you will be very successful in leading them. Your leadership sets the direction and it takes a dedicated leader to continuously build excellent customer service. To be an effective radiology leader in today’s challenging health care environment, keep these leadership qualities in mind your department will deliver excellent customer service, resulting in a rewarding experience for your customers and staff. ICE ICEMAGAZINE

insight

BRIDGING THE GAP THE DR FLAT PANEL HEAT WAVE

“S

ummer in the City – back of my neck getting dark and gritty,” yes as the season is heating up so is the continuing push and influx of direct radiography (DR) equipment into the imaging landscape. Forced obsolescence of analog radiography (i.e. film-screen) and CR imaging receptor technology by way of CMS reimbursement reductions that began in January is fueling the mass exodus. The reductions also support the invasion of DR flat-panel equipment into the “New Frontier of Imaging.” This imaging technology receptor evolution is the theme for this edition of “Bridging the Gap.” Joining us are two very experienced professionals Director of Radiology Jennifer Hughes and Imaging Engineer Roger Jones. The “imaging receptor” transformation can be traced back through the years via various technology circles and their resulting timelines. Now, the onslaught of DR technology being infused as the “standard” for all radiographed procedures enters us into yet another. When posing this conceptual thought to Hughes and Jones their comments were very similar in response – the quality of acquiring the “best” radiographic images without the “quantity” of exposures is still a mind-boggling breakthrough in not only a patient process flow perspective but an awesome “groundbreaking” advance toward reducing dose to the patient. All new advances, however, can come 54

ICEMAGAZINE | JULY/AUGUST 2017

with new challenges from equipment service and financial budgeting perspectives. This holds true for the “DR wave” of new flat-panel equipment flooding the imaging department landscape. The first, and foremost, abyss that must be leaped over is the hefty capital acquisition cost of this technology and tethered to it are “new” impact costs related to service, software updating and IT integration – yikes! Hughes’ immediate comment regarding these added costs, “I can’t, if at all, recoup these costs from our patient imaged billing. Yes, my profit margins will shrink to fund these new incurred expenses and the only offset that may help is if patient volumes increase as a result of this technology and improves process efficiencies and flows.” Let’s talk a little more about these “new service costs hurdles” that Hughes and her peers are scrambling to neutralize on their budgets. This concern was posed to Jones who quickly pointed out two very ominous cost factors. The first being the general replacement cost of a DR flat panel detector which ranges from $60K to $90K, the second is that in order to “cover” or “insure” the unforeseen cost of a flat panel detector the only offering from original equipment manufacturers’ today is that of a expensive full-service agreement. Hughes added that “with analog or CR” imaging equipment, the service costs are relatively low, but with DR flat

Written by Alan Moretti Healthcare Technology Management Advisor

panels in the equation those service and maintenance costs go up by a factor of 10 or more! Jones said that DR flat panels are mostly maintenance free. They do not have moving parts which should result in less service labor hours, reduced reliance on the need for replacement parts and a higher level of equipment reliability – i.e. “Really Good Uptime!” History shows us that as technology advances, change and adaptation can be the hardest portion of that curve. This phenomenon is demonstrated over and over in all that we encounter and as painful as it may seem in the beginning, we relish and prosper via those advances that soon become our common state of functionality. Rock on DR! ICE ADVANCING THE IMAGING PROFESSIONAL

OVER 20 YEARS OF EXPERIENCE IN TALENT ACQUISITION FOR THE MEDICAL EQUIPMENT SERVICE INDUSTRY. EMPLOYER SERVICES • Talent search and acquisition • Talent retention and training • Workforce planning

CANDIDATE SERVICES • Career placement • Career advising • Resume critiques • Interview training

JENIFER BROWN Jenifer@HealthTechTM.com Ph: 757.563.0448 | www.HealthTechTM.com WWW.IMAGINGIGLOO.COM

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ADVANCING THE IMAGING PROFESSIONAL

index AUE

ADVANCED ULTRASOUND ELECTRONICS

D E FINING THE S TAN D ARD

THE JDIS GROUP

Advanced Ultrasound Electronics p. 50

CT • MRI • PET/CT • MOBILE

JDIS Group p. 4

PM Imaging Management p. 24

Summit Imaging p. 11

Technical Prospects p. 13, 15, 17

American Collage of Radiology p. 44

KEI Med Parts p. 21

Premier Imaging Medical Systems p. 21 Tenacore p. 6

Bayer Healthcare p. BC

KEI Medical Imaging Services p. 38

Diagnostic Solutions p. 23

MEDICAL

Rad Rays, LLC p. 5 The Intuitive Biomedical Solutions p. 21

SYSTEMS

TECHNOLOGIES LLC

Dunlee p. 8

Medical Systems Technologies p. 38

Radiology Business Management Association p. 55 SOLUTIONS

Tri-Imaging Solutions p. 30 MedWrench p. 59

Radiology Data p. 25

Field MRI Services p. 19

Health Tech Talent Management p. 55

Webinar

Medical Imaging Technologies p. 24

RSTI/ Radiological Service Training Institute p. 7

Wednesday

Webinar Wednesday p. 47

X-ray Parts, Inc p. 24

PartsSource p. 2 RTI, Inc. p. 19 Injector Support & Service p. 38 Philips Healthcare P. 3

ICEMAGAZINE | JULY/AUGUST 2017

Stephens International Recruiting Inc. p. 51

ADVANCING THE IMAGING PROFESSIONAL

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