ICE - November/December 2017

ADVANCING THE IMAGING PROFESSIONAL

NOV/DEC VOL.1 NO.5

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Handling Generational Transition in the Imaging Workforce P.40

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Insight

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contents

ICE FEATURES

Nov/Dec 2017

“ Most of the experts we’ve run

into are very willing to share what they know with the next

A F T E R T HE

person that’s up and coming, especially if they’re not being forced out.” – GAVIN BARTON

40 After The Boom

24 Professional

The passing of the Baby Boomer generation will have an outsized

Intermountain Healthcare’s

impact in the field of health care technology and imaging service

Nate Gottwald is a valuable

departments. As its population continues to age, the demands that

and experienced imag-

boomers will place on the health care industry and its resources will

ing service engineer in the

continue to increase at an outsized rate just as more people from

Imaging Equipment Ser-

this same generation retire from the imaging service industry.

vices Department. His boss says Gottwald “is great with his customers and very will-

Corporate Profile: Ray-Pac

Ray-Pac now has a YouTube video and a hands-on instruction class to tech dealers and installer how to effortlessly calibrate a Shimadzu Portable using the new RADII insert. Page 36

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ing to keep learning new equipment.”

ICEMAGAZINE

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contents

ICE DEPARTMENTS

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18

Nov/Dec 2017

26

30

news

people

products

insight

10 Industry News

24 Professional Spotlight

30 CT Product Focus

45 Imaging Matters

18 ICE 2018

26 Department Spotlight

31 CT Gallery

47 Career Center

34 Tools of the Trade

48 Imaging Service 101

20 People on the Move 22 Imaging Webinar

MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269 Phone: 800-906-3373 Fax: 770-632-9090

51 Bridging The Gap

Vice President

Account Executives

Editor

Contributors

Kristin Leavoy kristin@mdpublishing.com

John Wallace jwallace@mdpublishing.com

Publisher

John M. Krieg john@mdpublishing.com

Art Department Jonathan Riley Karlee Gower Sarah Sutherland

Jayme McKelvey Lisa Gosser

K. Richard Douglas Matthew N. Skoufalos Jim Carr Cindy Stephens John Garrett Alan Moretti Jenifer Brown

Accounting Kim Callahan

Circulation

Lisa Cover Laura Mullen Melissa Brand

Digital Department Cindy Galindo Travis Saylor Jena Mattison

ICE Magazine (Vol. 1, Issue #5) Nov/Dec 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. © 2017

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ICEMAGAZINE | NOVEMBER/DECEMBER 2017

ADVANCING THE IMAGING PROFESSIONAL

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news

IMAGING NEWS A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY George Mills Leaves The Joint Commission After nearly 13 years as the director of engineering at The Joint Commission (TJC), George Mills, a familiar and widely respected figure in the healthcare technology management (HTM) community, left the accreditation organization on Oct. 6 to join JLL, a professional services firm.

As director of healthcare technical operations, Mills will oversee teams focused on quality and compliance, plant operations and facility management, safety, supply chain management, healthcare project and development services, and energy and sustainability.

Throughout his 32-year career in the health care industry, Mills has worked to make patient environments safer and healthier. His presentations at the AAMI Annual Conference & Expo have routinely drawn standing-room-only crowds, and his “Ask George” column in AAMI’s journal BI&T was a popular feature.

Mills will continue to serve as a member of AAMI’s Board of Directors.

Acquired Firms to be Consolidated in New Innovatus Imaging Corporation.

The private equity firm Resilience Capital Partners has announced that a fund managed by the firm has acquired three medical device service and manufacturing units. The units acquired by Resilience Capital Partners are the Multi Vendor Service (MVS) unit of Bayer’s Radiology business; Wetsco Inc.; and MD MedTech LLC (MDMT).

All three businesses – MVS, Wetsco and MDMT – are being combined and will operate under a new holding company, Innovatus Imaging Corporation.

The fund also has reached a definitive agreement to acquire the European operations of MVS, based in Maastricht,

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the Netherlands. This transaction is expected to close by March 31, 2018. In the interim, Innovatus Imaging will continue to serve European customers through a transitional service agreement with Bayer.

Ensuring continuity, Innovatus Imaging will draw its leaders from the senior ranks of the acquired companies.

Pittsburgh-based MVS previously was part of Bayer’s Radiology business. It is a market leader in the third-party servicerepair business for radiology devices, including ultrasound probes, magnetic resonance imaging (MR) coils and computed radiography readers, dry film printers and the sale of digital radiography detectors.

ICEMAGAZINE | NOVEMBER/DECEMBER 2017

MVS has been a frequent customer of MDMT, purchasing its ultrasound probe replacement components.

Tulsa-based Wetsco is a leading thirdparty ultrasound probe repair provider that has an exclusive alliance with MVS since 2008, specializing in repair and capability development on standard and 3D/4D probes.

Based near Denver, MDMT designs and manufactures specialty medical ultrasound products for the OEM, thirdparty repair and research markets. • For more information, visit www. resiliencecapital.com.

ADVANCING THE IMAGING PROFESSIONAL

news

Trisonics Names Among Fastest Growing Companies Trisonics has been named to the Central Penn Business Journal’s 21st annual list of the Top 50 Fastest Growing Companies in Central Pennsylvania. This is the third time that Trisonics has achieved this milestone.

In order to be eligible for consideration, companies were required to show revenue of at least $500,000 in each of the fiscal years ending 2014, 2015 and 2016, as well as revenue growth in 2016, as compared to 2014. For-profit entities that are headquartered in Adams, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Perry or York County were eligible for nomination.

The presenting sponsor of the program, Baker Tilly, calculated the nominations and then ranked the companies according to revenue growth over the three-year period. Both dollar and percentage increases were taken into consideration.

This ranking formula led to the list of 50 winners. •

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Pictured are Trisonics CEO Jennifer Riner (left) and Director of Business Development April Lebo.

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news

Conquest Imaging Challenges Cost for High Quality Parts Conquest Imaging has dropped several top-selling ultrasound part prices as much as 40 percent challenging health care delivery systems to compare prices and quality against other ultrasound providers.

The Transparent Pricing Challenge invites any member of a health care facility to survey ultrasound parts pricing. If another ultrasound vendor has the same part with the same warranty, Conquest Imaging will match the price of that part. Purchasing a part under the challenge also provides the buyer with a six-month warranty, free technical support, part number matching, same-day shipping for orders received before 4 p.m. PT and a pre-paid FedEx return label for the exchange core.

Conquest Imaging introduced Transparent Pricing earlier this year with pricelists of top-selling parts and probes on their website and applied the same model in SIMPLIFY, Conquest’s Probe Repair program. Having pricing available at a glance, allows ultrasound part and probe buyers to order necessary parts immediately to repair a down system and eliminate the quote step.

Transparent Pricing was created to offer health care delivery systems an alternative to quotes for ultrasound parts and probes. By providing pricing up front, without eliminating services such as part number matching or technical support, Conquest saves the buyer time without compromising great service. •

Because Quality Matters.

Enhancements to CT Advance E.D. Imaging Health care providers now have access to fast and safe E.D. CT imaging with enhancements to the Aquilion ONE/GENESIS Edition from Toshiba Medical, a Canon Group company. The enhancement to the premium CT system offers Model-Based Iterative Reconstruction (MBIR), which significantly improves low-contrast detectability and high-contrast spatial resolution with Toshiba Medical’s FIRST MBIR, as well as workflow and efficiency tools.

New clinical, operational and safety enhancements include: • Quick Whole Body Scanning: Toshiba Medical’s exclusive three-phase Variable Helical Pitch (vHP3) helps clinicians assess the whole body more confidently with just one scan. vHP3 allows for scanning three different parameters and helical pitch setting within distinct anatomical areas, in a single breath, with one contrast injection, improving image quality and workflow while potentially reducing IV contrast and radiation dose.

• Helps Clinicians Possibly Diagnose Early Stroke Sooner: Neuro FIRST MBIR improves high-contrast spatial resolution and low contrast detectability in the brain, opening doors for the possibility of seeing early signs of stroke with CT. • Fast Scans with Automated Table Positioning: SUREPosition accurately centers the patient within the gantry without clinicians having to physically adjust the patient or repeat a scanogram.

The Aquilion ONE/GENESIS Edition offers dynamic volume CT imaging ideal for trauma and life-threatening conditions like heart disease and stroke. The system features an optimized beam spectrum based on PUREViSION Optics, combined with PUREViSION Detector and FIRST (MBIR) reconstruction, offering superior image detail and resolution and up to 82.4 percent dose reduction. Additionally, the system features SURESubtraction iodine mapping for routine exams, such as liver or oncology exams. •

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ICEMAGAZINE | NOVEMBER/DECEMBER 2017

ADVANCING THE IMAGING PROFESSIONAL

news

Hologic Introduces More Comfortable Mammogram Hologic Inc. has announced the commercial availability of its new SmartCurve breast stabilization system, which has been clinically proven to deliver a more comfortable mammogram without compromising image quality, workflow or dose. The SmartCurve system is available exclusively with Hologic’s Genius 3D Mammography exam.

For years, women have reported avoiding regular mammograms due in large part to the fear of discomfort associated with breast compression. In fact, a recent survey of 10,000 women found that fear of physical discomfort was the top reason cited for avoiding a mammogram by women who never had one. With this in mind, Hologic’s research and development team, led by Tracy Accardi, global vice president of research and development, set out to reduce breast pain without compromising image quality or exam accuracy.

The SmartCurve system features a proprietary curved surface that mirrors the shape of a woman’s breast to reduce pinching and allow better distribution of force over the entire

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breast. The system also features proprietary image processing algorithms that ensure the preservation of image quality and accuracy. The SmartCurve system, combined with the fastest 3D mammogram available, makes the Genius exam the obvious choice for women wanting a more accurate exam that is also more comfortable.

In a recent clinical study comparing the SmartCurve breast stabilization system to traditional flat paddle compression, the SmartCurve system improved comfort in 93 percent of women who reported moderate to severe discomfort with standard compression. In addition, 95 percent of those surveyed would recommend facilities that use the system. The system includes options to accommodate a majority of women and breast sizes, and can be used with Hologic’s MammoPad breast cushion for even greater comfort.

The SmartCurve system is available standard on Hologic’s new 3Dimensions mammography system and as an enhancement option to existing Hologic Selenia Dimensions systems. •

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news Mammography System Allows Patients to Control Compression GE Healthcare has announced FDA 510(k) clearance of an industry-first, patient-assisted mammography device that literally puts women in control of their mammograms.

Senographe Pristina Dueta is an innovative remote control that allows women to manage their own compression during the exam performed on the company’s new mammography system, Senographe Pristina.

In traditional mammography, the technologist performing the exam compresses the patient’s breast, often causing discomfort.

Patient-assisted compression allows women to control the application of compression to minimize the perceived pain and discomfort

often associated with a mammogram. After the breast is properly positioned by the technologist, the patient can use a handheld wireless remote control to command Senographe Pristina to adjust the compression paddle based on the patient’s comfort level.

Patient-assisted compression is the newest comfort feature available on Senographe Pristina, a totally redesigned mammography system that has replaced traditional design with rounded edges and a thinner image detector to create a more pleasant experience for women as well as armrests that position women to relax rather than tense up during the compression and image acquisition process. •

Shared Imaging Provides Mobile Diagnostic Imaging Technology to Kelsey-Seybold Clinic Shared Imaging, a provider of diagnostic imaging technology and services, has announced its partnership with Kelsey-Seybold Clinic (Houston, Texas) in delivering comprehensive solutions via a unique functional service business model. Through this model, Shared Imaging provides Kelsey-Seybold with seven mobile medical coaches (three MRI, three CT and one PET/CT), along with clinical staffing, maintenance and service, and ongoing operational oversight.

As the nation’s first designated accredited Accountable Care Organization with 20 clinics, more than 400 physicians in 55 medical specialties, and serving more than 500,000 patients in Greater Houston, Kelsey-Seybold’s goal is to provide patients with high-quality care that is cost-effective and convenient.

“The partnership we have with Shared Imaging allows us to bring high-end imaging closer to our patients, without having to bear the cost of a fixed unit in each of our multiple locations,” said John Lyle, vice president of operations at Kelsey-Seybold. “Our patients

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ICEMAGAZINE | NOVEMBER/DECEMBER 2017

appreciate having imaging services within their community. They realize that without mobile imaging service, they would have to travel to another location.”

From determining the right technology to customizing financial terms and managing day-to-day operations, Shared Imaging works with health care providers to deliver market-focused diagnostic imaging solutions.

The long-standing relationship between Kelsey-Seybold and Shared

Imaging began in 2004. The organizations recently extended their contractual agreement in which Shared Imaging assumes ownership of the technology and provides it to Kelsey-Seybold for a monthly fee.

This model, which allows providers to retain the technology for much shorter term lengths than with a capital purchase, has allowed Kelsey-Seybold to upgrade all of its CT, MRI and PET/CT systems provided by Shared Imaging after using the previous technology for less than three years. •

ADVANCING THE IMAGING PROFESSIONAL

news TrueFusion Structural Heart Disease Feature Receives FDA Clearance The Food and Drug Administration (FDA) has cleared TrueFusion, a new cardiovascular application from Siemens Healthineers that integrates ultrasound and angiography images to guide cardiac teams when administering treatment for structural heart disease. Available on the new Release 5.0 of the ACUSON SC2000 cardiovascular ultrasound system, TrueFusion is designed to maximize not only interventional cardiology procedures but also routine diagnosis and follow-up of patients with structural heart disease.

With cardiovascular imaging applications such as TrueFusion, as well as laboratory and point of care diagnostics solutions in addition to therapy guidance tools, information technology (IT), and services, Siemens Healthineers innovates to improve outcomes and reduce costs in cardiovascular care.

WWW.IMAGINGIGLOO.COM

Treatment options for structural heart disease are evolving rapidly.

Increasingly, these minimally invasive procedures involve multimodality imaging and multidisciplinary clinical teams. To reliably diagnose structural heart disease and perform these complex interventions, clinical teams need detailed, real-time imaging information – specifically, real-time soft tissue and blood flow information from echocardiography as well as 2D imaging information from fluoroscopy – to be visible in one view for common orientation.

Addressing the need for fused images, the new TrueFusion application sends anatomical and functional markers as well as valve models from the ACUSON SC2000’s True Volume transesophageal echocardiography (TEE) transducer to

an Artis with PURE angiography system, overlaying ultrasound information with live fluoroscopy images to navigate structural heart procedures.

By directly and seamlessly integrating coregistration of Artis fluoro and ACUSON SC2000 echo into the workflow via machine learning-based probe detection and automated registration updates, TrueFusion enables clinical teams to identify soft tissue-based structures that are provided directly from the integrated ultrasound system. With TrueFusion, not only can echocardiographers and interventionists better communicate and achieve more intuitive anatomical orientation during challenging procedures, but clinical teams potentially can reduce contrast usage and procedure time as well as patient and clinician X-ray exposure. •

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news

CIRS Launches New MRI Distortion Check Software MRI Distortion Check is a new, cloud-based solution designed to quickly and automatically quantify distortion in MRI images. Used in conjunction with CIRS MRI Grid phantoms, the software provides the capability to quickly and accurately measure distortion throughout the entire image volume.

After automatically detecting thousands of grid intersections, the software registers either a CAD or CT scan ground truth to these MR detected control points. An interpolation is then performed to generate 3D distortion vector fields.

Results can be reported in a variety of output formats including scatter plots, contour plots, box and whisker plots and DICOM overlays that can be imported to TPS or other third-party software. The software algorithms will work with any grid configuration and CIRS employs proprietary 3D printing techniques that enable easy modification of grid phantoms to meet customer requirements.

“With this new and innovative solution to measuring MR distortion, we are excited to present our customers with a seamless, efficient workflow starting from phantom setup through image acquisition and detailed analysis. Results and trends can be monitored by machine, MR sequence, phantom or any combination of the same,” states CIRS President Mark Devlin. • For more information about the MR Distortion Check Software, visit www.cirsinc.com.

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ICEMAGAZINE | NOVEMBER/DECEMBER 2017

ADVANCING THE IMAGING PROFESSIONAL

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news

ICE2018 IMAGING CONFERENCE & EXPO FEBRUARY 16-18, 2018 • LAS VEGAS

IS A WHOLE NEW CONFERENCE

T

he Imaging Conference and Expo (ICE) continues to evolve to meet the needs of the diagnostic imaging service community. One exciting development is the decision to move the annual conference to earlier in the year!

This year’s conference will also be held at an exciting new location!

NEW DATES AND LOCATION ICE 2018 is now in February – providing a far better month for the entire industry.

It is an ideal time for a warm weather destination and eliminates obstacles to provide for increased attendance from leading imaging service professionals and directors from across the country!

ICE 2018 will be held February 16-18 at the M Resort in Las Vegas.

PREMIER KEYNOTE ADDRESS “Health Economics: Market, Policy and Trends” is the title of the keynote being presented by Toshiba America Medical Systems Director of Healthcare Economics Tom Szostak. He will discuss how a new Republican administration with a Republican Congress has a different vision for health care and health policy in America than the previous administration. As well as ask the question, what does the future hold for health spending/ policy and reform in the United States?

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“ I’ve learned a lot through the educational seminars. It gave me exposure to different modalities that I did not have before including MR and CT.” Ryan Kishun, Biomedical Imaging Engineer

NEW EDUCATIONAL TRACK ICE 2018 features two different educational tracks including a new track for imaging directors! Each educational time-slot offers two presentations specifically for imaging directors, and two for imaging service engineers. This means there are nine (9) classes for management and nine (9) classes for service. These classes showcase the latest trends, technology and information in the imaging industry from leading experts! ICE 2018 is seeking approval for more than 27 hours of potential CEUs, including two super sessions and the keynote address!

CRES PREP CLASS This class meets a high demand. This eight-hour course is designed to teach the experienced service professional the requisite knowledge necessary to suc-

ICEMAGAZINE | NOVEMBER/DECEMBER 2017

cessfully pass the radiological portion of the CRES test. The subjects include radiation physics, radiation safety, anatomy, physiology, X-ray equipment use, CDRH compliance testing, electronics and troubleshooting. Sample testing during this program helps to reinforce good testing techniques and confidence in the process.

WHAT PEOPLE ARE SAYING “First of all, it’s, I think, a good size. You have an opportunity to visit all of the exhibitors that you can’t always get to at larger meetings. So, that is good. The exhibitors are very focused on what you are interested in, so the information that you get from them is valuable, focused and right on point. It is a great opportunity to network because the variety of people who attend and the fact that a lot of the attendees are very influential ADVANCING THE IMAGING PROFESSIONAL

news

2018 CONFIRMED ATTENDEES INCLUDE: • Director of Diagnostic Imaging, St Luke's Magic Valley • Senior Radiology Advisor, Select Specialty Hospital • Manager Clinical Engineering, Good Samaritan Hospital • Director of Imaging, SSM Health St Joseph Hospital St Charles • Manager Imaging Services, Texas Health Resources • Biomedical Equipment Support Specialist, Lovel Federal Health Care Center • Medical Systems Equipment Technologist, Palmdale Regional Medical Center • Healthcare Technology Management Imaging Services, Texas Health Resources • Director, Clinical Engineering, Adventist Health Florida Hospital and active in other advocacy organizations is just an added bonus.” – Andrea D. Browne, Ph.D., DABR, Diagnostic Medical Physicist Department of Engineering, The Joint Commission.

“The biggest benefit is networking. There is so much you can learn, especially from different companies, from training, from parts (suppliers) and also getting to know what other hospitals have in store for the future.” – Jina Walls, Department of Veterans Affairs, Indianapolis, Indiana.

“I’ve learned a lot through the educational seminars. It gave me exposure to different modalities that I did not have before including MR and CT. I am looking forward to heading back to work and applying what I learned. (ICE) is probably one of the best things you can do. It’s laid back, it’s fun, it’s informative. The networking opportunities here are tremendous.” – Ryan Kishun, Biomedical Imaging Engineer, New York-Presbyterian Hospital.

“If you are a hospital employee, I would say one of the main reasons to attend an ICE conference would be to come to these seminars and take home knowledge of where the industry is going, especially around things like developing trends and our new quality management systems that are coming from the FDA or other governing organizations.” – Kyle Grozelle, Manager of Global Education and Training, Summit Imaging.

REGISTER TODAY Hospital employees and students can register for FREE by using the VIP code 18ICEMag. To register online or for additional information, visit AttendICE.com.

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• Director of Radiology, Peterson Regional Medical Center • Director of Imaging and Dean of the School of Radiology, Regional West Medical Center • System Director, Intermountain Healthcare • Regional Director, Adventist Health • Lead Biomedical Imaging Systems Technician, Summerlin Hospital Medical Center • Manager Imaging Engineering, Fairview Health Services • Biomed Imaging Manager, NY Presbyterian Hospital • Director of Cardiovascular and Imaging Services, Houston Healthcare • Director of Radiology, Excelsior Springs Hospital • Director of Radiology, HCA: Las Palmas Medical Center • Director Biomedical Engineering/Imaging, Cape Code Hospital • Director of Healthcare Management, Corona Regional Medical Center • Corporate Director, Healthcare Technology Management, Universal Health Services, Inc. ICEMAGAZINE

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news

PEOPLE ON THE MOVE

02

05

06

07

By Matt Skoufalos

1.

Resilience Capital Partners of Cleveland, Ohio has acquired the medical device service and manufacturing units of Bayer (Wetsco Inc.) of MD MedTech LLC (MDMT), and MVS, and will merge them as Innovatus Imaging Corporation. Innovatus will be led by CEO Dennis Wulf, former president of Wetsco and MDMT CEO. MVS general manager Bill Kollitz will become its President and COO, and MDMT co-founder, COO, and VP Michael LaBree will serve as CTO.

2.

George Mills, director of healthcare technical operations at The Joint Commission, is leaving the organization to join professional services firm JLL. Mills will continue to serve as a member of the board of directors of the Association for the Advancement of Medical Instrumentation (AAMI).

3.

The American College of Radiology (ACR) has named Etta D. Pisano chief science officer of its Center for Research and Innovation. Pisano is founding chief of breast imaging in the department of radiology and vice dean for academic affairs at the University of North Carolina School of Medicine, dean of the medical school at the University of South Carolina, and was most recently vice chair of research in the department of radiology at Beth Israel Deaconess Medical Center and professor at Harvard. Pisano has also chaired the ACRIN Breast Imaging 20

Committee for 10 years, and was principal investigator of the Digital Mammography Screening Trial (DMIST). She is also a past president of the Association of University Radiologists and American Association for Women Radiologists, a gold medalist of the American Roentgen Ray Society and Radiological Society of North America.

4.

The Washington, D.C.-based National Association for Proton Therapy has named Scott Warwick its executive director. Warwick has spent more than 20 years working in comprehensive cancer, radiation oncology, and proton therapy operations.

5.

The Kaiser Permanente School of Pasadena, California has named Mark A. Schuster the founding dean and CEO of its School of Medicine. For the past 10 years, Schuster has been the William Berenberg Professor of Pediatrics at Harvard Medical School, chief of general pediatrics, and vice chair for health policy in the Department of Medicine at Boston Children’s Hospital. He leads the Center of Excellence for Pediatric Quality Measurement.

6.

Cleveland Clinic has named Tomislav Mihaljevic as CEO and president, succeeding Toby Cosgrove on January 1, 2018. Mihaljevic joined Cleveland Clinic in 2004 as a cardiothoracic surgeon; since 2015, he has been CEO

ICEMAGAZINE | NOVEMBER/DECEMBER 2017

of Cleveland Clinic Abu Dhabi. Mihaljevic earned his medical degree from the University of Zagreb in Croatia and moved to the United States in 1995 to join Brigham and Women’s Hospital in Boston. He is the author or co-author of more than 145 articles in medical and peer-reviewed scientific journals, holds a patent for a minimally invasive cardioscopy surgical system, and won the 2006 and 2007 Cleveland Clinic Innovation Awards.

7.

HCA Healthcare of Nashville, Tennessee, has named Ashley Johnson CFO of its 85-hospital American Group, replacing Rick Shallcross, who is retiring after 25 years with the company. Johnson has been CFO of the HCA Capital Division and for several of its hospitals, including Presbyterian/St. Luke’s Medical Center in Denver, Colorado; Memorial Hospital in Jacksonville, Florida; and Central Florida Regional Hospital in Sanford, Florida.

Johnson is a CPA with bachelors’ degrees in accounting and management from the University of Central Florida.

8.

Long Beach Memorial Hospital of Long Beach, California has named Ikenna Mmeje its COO, replacing Tamra Kaplan, who will become COO at Miller Children’s & Women’s Hospital Long Beach.

Both hospitals are members of the Memorial Care system.

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9.

Sheppard Pratt Health System of Baltimore, Maryland, has named Karen Robertson-Keck its vice president of human resources. Robertson-Keck joins Sheppard Pratt from MedStar Franklin Square Medical Center, and her appointment follows a number of internal promotions at the facility. Tom Hess has been promoted from special assistant to the president to chief of staff, former director of marketing and public relations Jessica Kapustin is now chief marketing officer, and director of lean transformation Antonio DePaolo is now chief transformation officer.

10.

D. Neil Hayes has been named Scientific Director of the UTWest Institute for Cancer Research, a joint initiative of the West Cancer Center and University of Tennessee Heath Science Center of Memphis, Tennessee.

Hayes will direct and drive funding for translational research in cancer treatment there, recruiting scientists to the center as it drives towards an NCI designation.

Hayes was most recently co-leader of the University of North Carolina Lineberger Clinical Research Program.

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ICEMAGAZINE 21 10/17/17

2:57 PM

news

WEBINAR WEDNESDAY Taboo Topic

T

he recent Webinar Wednesday presentation sponsored by Summit Imaging left a lasting impression on members of the HTM profession.

More than 300 people registered for the insightful and “eye-opening” webinar “How Low-Quality Remanufactured Parts Inside Medical Devices Increase Total Cost of Ownership” presented by Larry Nguyen, CEO & CTO at Summit Imaging and Kyle Grozelle, manager of global education and training.

“This was an eye-opening webinar disclosing some of the undesirable actions being taken in the industry in the repair of medical equipment. I appreciate the tips on what to look out for and how to vet potential suppliers of repair services,” Biomedical Engineer George S. wrote in his post-webinar survey.

Participation in the presentation was eligible for 1 CE credit from the ACI. Nguyen and Grozelle discussed how low-quality repaired ultrasound replacement parts and transducers impact health care facilities’ total cost of ownership. The webinar informed health care professionals how to reduce unnecessary risk and potential resulting liabilities as well as equipment downtime, by learning how low-quality remanufactured components can significantly impact the performance and safety of medical devices. These low-quality medical devices are rarely disclosed to health care facilities and negatively impact clinical engineering budgets and patient care.

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Attendees shared their thoughts on the webinar in a survey and expressed gratitude for the information and insights.

“Thank you to the Summit team for discussing a taboo topic that is not so well know to the entire industry,” Biomedical Engineer Jesse H. wrote.

“As an engineer at a company that provides replacement and re-certified parts, I feel proud that our company is able to de-

tight budget and want to continually update their knowledge in the field,” Pacific Biomed Services President Stan B. said.

“It is my first time attending this webinar site and at the end, I was fascinated with this new type of method. I am from México and I was able to obtain valuable information from my desk,” Biomed Jesus L. shared.

To find out more about the Webinar

“ As an engineer at a company that provides replacement and re-certified parts, I feel proud that our company is able to defend our products through validation and verification testing and our QMS through ISO13485 certification.” – Jackie R. fend our products through validation and verification testing and our QMS through ISO13485 certification,” Quality Engineer Jackie R. said.

“The Webinar Wednesday series makes me more confident in my biomed profession,” wrote Biomed Technician Pavel G. “I think these are great tools for service engineers who do not have access to training due to location or for those on a

ICEMAGAZINE | NOVEMBER/DECEMBER 2017

Wednesday series, including a calendar of upcoming webinars and an archive of previous presentations, visit 1TechNation. com/webinars. 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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people

By K. Richard Douglas

PROFESSIONAL SPOTLIGHT Imaging Expertise and Home Improvement: Nate Gottwald

B

ased in Salt Lake City, Utah, Intermountain Healthcare is a health care system comprised of 22 hospitals, more than 185 clinics and approximately 1,400 physicians. The health system serves patients in Utah, southeastern Idaho and surrounding areas. Intermountain was established in 1975 and currently has 37,000 employees.

One of those employees is Nate Gottwald, an imaging service engineer in the Imaging Equipment Services Department.

Speaking of Nate, his boss says that “he is great with his customers and very willing to keep learning new equipment.” Gottwald has over 15 years in the field and has been with Intermountain for more than five years.

“I graduated from the University of Utah with a bachelor’s of science in information systems. While this degree doesn’t necessarily directly relate to servicing imaging equipment, what I’ve found is that nowadays nearly every imaging device consists of two things; some kind of image acquisition equipment, and a computer or computers to capture, process, and store the images. Because of this, as well as the networking of these devices, my degree has helped immensely,” Gottwald says.

Gottwald started out in IT, but a friend piqued his interest in imaging service.

“Out of college, I worked as IT support for a small medical equipment leasing business.

At the same time, a friend was working for AGFA, as a field engineer, servicing computed radiography equipment, doctor reading 24

“ I’ve done all of the framing, electrical, mechanical and plumbing work. A few times I have surprised myself.”

stations and enterprise PACS servers,” he says. “He showed me some of what he did, it looked interesting so when a position there came open I applied and was hired.”

After he had worked at AGFA for about two years, the company went through two reduction in force events, according to Gottwald. He was caught up in the second round and was laid off.

“I put my feelers out and was soon picked up by GE Healthcare. They had an opening in my area for an ultrasound field engineer. I really enjoyed working on ultrasound systems; I did that for six years,” he says.

“I heard that our largest contracted hospital was starting an in-house imaging

ICEMAGAZINE | NOVEMBER/DECEMBER 2017

service program; they had already taken on the X-ray devices and ultrasound was next.

I saw this as an opportunity to work for a local company rather than a large company like GE Healthcare, where sometimes it felt like you were just a number. I also saw an opportunity for growth into other modalities, where at GE I was pigeon-holed into ultrasound,” Gottwald adds.

He applied at Intermountain Healthcare in 2012 and got the job.

“Right away, they started cross training me on X-ray devices; it was great to learn something new,” Gottwald says.

“In 2015, I became a CT service engineer.

This was a little intimidating at first, but Intermountain did a great job making sure I had all of the right tools and the necessary training from third parties and the OEMs. The stress level is definitely higher with CT, but I’ve really enjoyed working on them. I work on GE and Toshiba CTs,” he adds.

Taking on Challenges Transitioning from an OEM to an in-house department allowed Gottwald to experience both worlds. He points out that with an OEM the resources are limitless.

“I had access all the way up to the engineers and developers who designed the systems,” he remembers. “Working in-house requires more ingenuity in troubleshooting and doing repairs.

While Intermountain has done a great job getting me the training and tools I need to do my job effectively, it is definitely more of a chalADVANCING THE IMAGING PROFESSIONAL

Favorite part of being an imaging professional?

“Technology in medical imaging is growing by leaps and bounds; it’s awesome to see what’s happening and to work on the new technology.”

GET TO KNOW THE PRO Favorite book “The Grapes of Wrath” is the first book I remember that I started reading and had a hard time putting it down. More recently my favorite books are “Lone Survivor” and “The Longest Day.” Favorite movie “O Brother Where Art Thou?”

Favorite food Prime rib or the Cowboy pizza from Papa Murphy’s

Nate Gottwald Imaging Professional

lenge when you’re not working for the OEM.” “I remember when I went to training at RSTI, Dale Cover told us that he had seen several hospitals go in-house for their imaging equipment maintenance and repair. He said that the only ones that were successful were the ones that weren’t constantly calling in third-party companies and OEMs to complete their PMs and repairs,” Gottwald says.

Cover’s insight has really stuck with Gottwald.

“I’ve always tried to keep escalations to outside vendors to a minimum. Sometimes this requires me to go outside my comfort zone, if I’m asked to work on a piece of equipment, that I’m not very familiar with or haven’t worked on for a while, but this attitude nearly always pays off,” Gottwald adds.

Away from the Imaging Equipment Food and home improvement have been on Gottwald’s off-hours calendar. A truck project could be in the future as well.

“I’ve recently taken up smoking … meats,” Gottwald jokes. “I purchased a pellet smoker WWW.IMAGINGIGLOO.COM

Hidden talent

this spring and have been trying out different woods with different meats. I think that so far, the family favorite is my cherry-smoked chicken wings. With the weather turning cooler, this week I will be cold smoking some cheese. It’s been a fun and tasty hobby.”

Over the last four years, all of his free time has been spent finishing his basement.

“I’ve done all of the framing, electrical, mechanical and plumbing work. A few times I have surprised myself, when I look at a task that seems beyond my capabilities, I’m able to do the research to know the building codes, etcetera — yes, I took out a building permit — and I’m able to get it done, sometimes with a little help from YouTube.”

After the basement project, a truck might be in the offing.

“I’ve always liked working on cars. In high school, I began restoring my dad’s old ’66 GTO. After the basement is done, I’d like to find a ’69 Chevy K10 pickup to restore,” Gottwald says.

He has been married for 12 years and has four daughters ranging in age from 6 to 11.

Having four young daughters, I know the names of all the Disney princesses.

What’s on my bench?

• Coke Zero • hard drive docking station • DeWalt Gyroscopic electric screwdriver • JIS screwdriver set (to work on Toshiba CTs because if you don’t use a JIS on Toshiba’s screws you will round the heads) • “How to work on CTs for Dummies” • Star Wars action figures

“I haven’t told them, but my goal is to have the basement finished before the oldest becomes a teenager, so I have a place to hide. I’m right on target,” Gottwald says.

Those girls have a talented dad and Intermountain has a resourceful CT service engineer. In a couple of years, look for him in the basement. ICE ICEMAGAZINE

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people

By K. Richard Douglas

DEPARTMENT SPOTLIGHT Advocate Health Care Imaging Service Team

T

here’s something impressive about a contingent of 19 imaging service professionals dedicated to keeping 5,000 devices operational and fine-tuned.

Those impressive numbers are even more notable when you consider that this imaging team, and their system manager, are part of a clinical engineering program that is 97 people strong.

Mark Newell is the system manager of imaging and the health system that his team supports is Advocate Health Care in Downers Grove, Illinois. Advocate’s clinical engineering department is made up of imaging and biomedical technicians, clinical engineers, business office staff and site managers, according to Newell.

“Operationally, we are part of the clinical engineering department, but are operated and managed as a system-based team versus a site-specific team when it comes to actual service and dispatching,” Newell says.

“We utilize an on-call process for imaging-only service, and have divided our sites amongst two primary service zones. Savings and turn-around on equipment has been very positive based upon the metrics we monitor.

We track all repair and inspection work in one database, which in turn helps us to manage all costs and labor to the asset level and look for trends and opportunities,” Newell adds.

Advocate Health Care is the largest health system in the state of Illinois. The faith-based, not-for-profit system includes 12 acute-care hospitals and almost 400 sites of care. Last year, two of those hospitals were named among the Top 100 Hospi-

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“ In perspective, $2.7 billion of our organization’s annual $6 billon patient care revenue is generated by the diagnostic imaging and radiation therapy equipment our team supports.” tals by Truven Health Analytics.

“In perspective, $2.7 billion of our organization’s annual $6 billon patient care revenue is generated by the diagnostic imaging and radiation therapy equipment our team supports,” Newell says.

Newell says that the team supports 10 hospitals, one critical access facility, and two embedded children’s hospitals, along with about 60 offsite locations that offer some type of imaging service (radiology or cardiology).

He says that many of the hospitals are Level I trauma centers, so there is a higher acuity patient mix, and for clinical engineering labor impact – a higher count of equipment per bed than most hospitals.

“For a high-level count of larger equipment, we currently support 64 CT scanners,

ICEMAGAZINE | NOVEMBER/DECEMBER 2017

33 MRI units, 35 cath labs, 18 IR labs, 600 ultrasound units, 42 nuclear cameras, 64 digital mammography units, 13 radiation oncology systems (Linacs, Tomo, Cyberknife), 169 dye injectors, 85 C-arms, 77 portable X-ray machines, 105 general rad units, 23 dental units, 9 cysto units, 6 PET, 10 SPECT and 15 digital specimen scanners,” Newell says.

He says that they still have about 100 CR units in use, but have purchased several dozen DR panels for converting many of the portables and fixed general rad rooms to full digital capability.

The team doesn’t yet support MRI, but is moving toward a shared-support model in the near future.

Training and In-house Savings The group has proven that keeping imaging service in-house has resulted in substantial savings.

“Since 2014, we have insourced over 5,000 hours annually of vendor-billable labor. Between hiring and training staff, reassessing support strategies, aggressive second sourcing, use of competitive price-matching, and renegotiating service agreements, we have reduced our per-transaction and per-asset support costs, along with steadily raising the measured equipment reliability year over year. Net savings annualized is just over $3.4 million per year off prior per-asset run rates,” Newell says.

The team’s training needs are a mixed bag of OEM, third-party and on-the-job training.

“Between credits and outright purchases, we spent almost $200,000 last year on the imaging team for technical training. We normal-

ADVANCING THE IMAGING PROFESSIONAL

The Advocate Health Care Imaging Service Team maintains over 200 devices.

ly average about $100,000 a year. All training justifications are based upon projected return-on-investment, the organization’s operational needs and current manpower capacity,” Newell explains.

“Our team participates at the local and system level for equipment planning, construction, and part of the pricing negotiations for capital. Our team is solely responsible for negotiating, holding, and paying for all service contracts and related repair costs,” Newell says.

He says that they also centrally manage negotiations for sourcing and price-matching with vendors for parts and labor.

“We do provide limited user training directly, and are part of the process to help identify when additional clinical user training may be required by the manufacturers,” he adds.

“From the equipment perspective, we have staff trained on nearly every item.

Many members of the team have a mix of manufacturer and third-party work experience, military training, and formal service schools and degreed programs.”

WWW.IMAGINGIGLOO.COM

Figuring It Out In the problem-solving area, the imaging team has donned their detective hats more than once.

“We have worked with the clinical staff and the manufacturers to determine when an issue is actually the device — as an example, hardened beam quality contributing to a poor clinical image — versus the manufacturer assuming it was just the clinical users picking the wrong presets (which was also occurring and discovered when we monitored some cases),” Newell says.

“We have seen issues where new product is purchased that is similar to older product but must be used differently. An example was with a cardiac ultrasound unit – we had the manufacturer bring in a different trainer and directed them to approach it as if the clinical users never used the brand before…this helped resolve initial assumptions that were being made by both the trainer and the clinical customer.”

Newell remembers one challenge that was vexing at first. There was an issue where there

were power problems with an off-site MRI in a leased building.

“The clinical users thought it was the MRI unit and the building’s maintenance supported the argument. What tipped us off that it was a bigger issue than just the MRI was that when we rounded with the customer we also talked with other people in the leased building – the other tenant’s lights were flickering and they were on a different circuit,” Newell says.

“We brought in an outside electrical contractor and found out the substation in the building had multiple connection problems.

Our electrician addressed it with the building maintenance staff and the problems went away,” he adds Away from work, the team has some staff who are members of the Clinical Engineering Association of Illinois as well as membership with AAMI and ECRI. When it requires big resources to handle a lot of imaging equipment, and keeping an eye on the budget, the imaging services team at Advocate Health Care gets the job done every day. ICE

ICEMAGAZINE

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ICEMAGAZINE | NOVEMBER/DECEMBER 2017

Join us at RSNA, North Hall 8104

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products

CT SYSTEM PRODUCT SPOTLIGHT Market to Exceed $12 billion

T

he market for computed tomography (CT) systems, which are used to generate detailed images of structures inside the body, is set to rise from just under $3.6 billion in 2016 to around $12.1 billion by 2023, representing a compound annual growth rate of 18.2 percent, according to research and consulting firm GlobalData.

The company’s report states that this rapid growth, which will occur across 39

covering medical devices, explains, “The improving capabilities offered by high-slice systems will lead to hospitals upgrading from low-slice scanners as automated work flow and enhanced image quality remain important driving factors of the market.”

“Although in the past researchers have warned of the over-utilization of CT due to radiation concerns, the number of CT examinations has

“ Although in the past researchers have warned of the over-utilization of CT due to radiation concerns, the number of CT examinations has remained steadily high in recent years.” major markets, will primarily be driven by an increased interest in high-slice CT systems due to wider applications and improved patient throughput, heightened usage of CT, particularly in countries with emerging economies, and strong anticipated growth in the number of annual CT scans due to increasing disease burdens and aging populations.

Sarah Janer, GlobalData’s analyst

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remained steadily high in recent years.

New technology offers ever-improving capabilities such as lowered radiation dose, high-resolution images and spectral imaging,” Janer adds.

In the coming years, companies will need to offer product portfolios that meet these demands. Indeed, providing systems with a wide range of imaging applications and economical prices will

be vital for key players in the global CT systems market.

In terms of the competitive landscape, the CT systems market has remained relatively stable recently.

Siemens Healthineers held the largest share early in 2017 with almost a third of the market, while GE Healthcare had just under a quarter and Philips Healthcare over a fifth of the present CT space.

“Recently, Siemens Healthineers has engaged in strategic moves that could risk the company’s market lead, such as its 2016 rebranding from Siemens Healthcare to Siemens Healthineers and its decision to separate from its parent company,” Janer notes.

“GlobalData expects this could also allow the company to engage in new modes of innovation. Toshiba Medical ranks consistently close behind the top three companies, and after their recent acquirement by Canon, it is likely their market share will remain stable throughout the forecast period.”

Another recent report also predicts continued growth in the global CT market.

Computed tomography (CT) systems market had revenues of $4.3 billion in 2016 across the 39 major markets and by 2023 the global CT systems market will increase to $12.1 billion, according to ReportsnReports.com. ICE

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products

GE Healthcare Revolution Family of CT Systems GE Healthcare continues to invest in the Revolution family of CT systems which are built out of its passion to enable technologies that allow you to reach the right diagnosis, effortlessly. Each product in the Revolution family is designed to deliver four key benefits: diagnostic confidence, patient care, financial performance and clinical excellence. By designing with patient and health care provider needs in mind, Revolution family of CT scanners are scalable to meet imaging needs today and tomorrow. Revolution CT is designed to bring unique capabilities to improve the clinical excellence of CT imaging including diagnostic confidence of image acquisition, cutting edge applications with advanced capabilities through the convergence of whole organ coverage, speed, image quality and spectral imaging all in one CT system. Revolution CT with GSI Xtream is the first volume spectral CT technology designed to improve small lesion detection, tissue characterization and metal artifact reduction, with a simplified workflow you can make part of your daily practice. The entire GSI (Gemstone Spectral Imaging) experience has been enhanced from scanning to reconstruction to visualization. Enabled by innovations such as Gemstone Clarity detector, volume coverage and fast kV switching, only GE can deliver this breakthrough. GSI Xtream helps you diagnose disease with more confidence, which could ultimately put patients on the right treatment path sooner. •

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ICEMAGAZINE | NOVEMBER/DECEMBER 2017

ADVANCING THE IMAGING PROFESSIONAL

products

Philips IQon Spectral CT As the world’s first spectral detector-based CT, the Philips IQon Spectral CT delivers multiple layers of retrospective data in a single, low-dose scan empowering clinicians to improve clinical confidence that may impact quality outcomes. There’s a clear advantage to making the right diagnosis in the first scan, which provides a better patient experience while achieving economic objectives. The Philips IQon Spectral CT helps extend the benefits of spectral data to all patients, providing answers for even the most challenging scenarios. Being able to achieve diagnostic confidence, even in the most problematic situation, can help provide better experiences and improve clinical care.

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products

Siemens Healthineers SOMATOM go.Up Created with extensive customer feedback, the new SOMATOM go.Up CT scanner from the company’s SOMATOM go. platform offers simpler, user-guided workflows for more standardized results and reduced variability. The system’s wide detector provides up to 64 slices, and offers faster scanning as well as tin filtration, which is important for lung imaging. Mobile workflow is controlled via tablet and remotely to increase patient interaction. The system uses some of the lowest radiation doses achievable for a CT of this class. •

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ICEMAGAZINE | NOVEMBER/DECEMBER 2017

ADVANCING THE IMAGING PROFESSIONAL

products

Toshiba Medical Aquilion ONE/GENESIS Edition The Aquilion ONE/GENESIS Edition maximizes the patient experience during CT examinations, and through intelligent examination protocols, provides excellent image quality with low radiation and contrast dose tailored to each and every patient.

The system features an optimized beam spectrum based on PUREViSION Optics, PUREViSION CT Detector and FIRST (MBIR), improving high-contrast spatial resolution up to 129 percent (2.29 times), while reducing radiation dose up to 82.4 percent. With AIDR 3D reconstruction times up to 80 images per second and FIRST reconstruction, exams are fast and safe for patients.•

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products

TOOLS OF THE TRADE

Unfors RaySafe

RaySafe Pro-Slit Phantom

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nfors RaySafe, the global leader of X-ray quality assurance solutions, introduces the RaySafe Pro-Slit Phantom and the RaySafe Pro-Stand. The RaySafe Pro-Slit Phantom is a slit camera for accurate measurement of the focal spot size according to IEC 60336:2005. Its design enables repeatable and accurate measurements and the possibility to measure the size of any focal spot with one tool. Use the RaySafe Pro-Stand (not included) to enable easy and repeatable measurement setup. The RaySafe Pro-Stand is an adjustable stand that is designed to make focal spot measuring procedures easy to perform, as well as ensuring accurate results. The Pro-Stand can be used with the slit camera, RaySafe pinholes, and can also be used for manual HVL measurements. The Pro-Stand comes in a basic version which includes adjustable height from 350 mm to over 600 mm (wide range of magnification) and adjustable horizontal positioning. The full version additionally offers, tilt functionality of 10 degrees, positioning tool for easy setup and a heavy duty rugged case for safe transportation. ICE

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ICEMAGAZINE | NOVEMBER/DECEMBER 2017

ADVANCING THE IMAGING PROFESSIONAL

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profile ÂŽ

EDUCATION

THE KEY TO X-RAY TUBE REPLACEMENTS

U

sing YouTube or Classroom Instruction to successfully calibrate Shimadzu Portables with the new Ray-Pac RADII INSERTS

Ray-Pac now has a YouTube video and a hands on instruction class to teach dealers and installers how to effortlessly calibrate a Shimadzu Portable using the new RADII insert.

The Ray-Pac video includes each step of the calibration process. Ray-Pac provides a spec sheet that has pre-calibrated settings for each mA station for their Shimadzu Replacement Portable X-ray tubes. The videos are clear and concise and show the step by step process on how the installers can enter the pre-calibrated settings on the Shimadzu single and dual filament portables.

The making of a YouTube video used for easy calibration of a Shimadzu Portable A Ray-Pac technician being filmed demonstrating how easy it is to calibrate a Shimadzu Portable thru the keypad by following the calibration sheet that Ray-Pac provides with all their Shimadzu portable X-ray tube replacements.

Ray-Pac has a trained technician to help installers with any questions or difficulties they may have during their calibration process.

Go to Ray-Pac.com/video

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ICEMAGAZINE | NOVEMBER/DECEMBER 2017

ADVANCING THE IMAGING PROFESSIONAL

SPECIAL ADVERTISING SECTION

profile

Ray-Pac pre-calibrates all Shimadzu replacement X-ray tubes by hand to minimize calibration errors.

Below is a sample of our calibration sheet provided with the Shimadzu Dual. It’s imperative to enter all of the data on the sheet provided. Watch our video and see how easily this can be entered through the key pad.

METHOD 1

METHOD 2

Two Methods used to input the data Method 1 involves taking off the side panel. Then the user must flip dip switch SW3-8 on the NEX-H board. This allows the user to Immediately enter the calibration mode.

Method 2 only requires use of the keypad. It involves pressing the two buttons shown in sequence within three seconds.

For more information on these methods watch our YouTube video.

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profile Video instruction for Distributors and Installers for RADII on Shimadzu Portables ©

Ray-Pac felt it was a beneficial service to our customers to be able to see how to properly calibrate their new X-ray tube.

One of the best techniques for learning how to calibrate is visual. Our customers can learn from watching a easier way to calibrate their equipment through You Tube. You Tube has quickly become the clearest way to actually see the proper calibration method and the results have been phenomenal.

Ray-Pac offers In-House Shimadzu Calibration Classes.

Open to Distributors and Installers of Shimadzu Portables

©

by Ray-Pac

Ray-Pac’s FREE two-day class and certification on how to calibrate the new

RadII Inserts for Your Shimadzu dArt and Art Portables from Ray-Pac. ©

Spend the day with us at Ray-Pac and learn to calibrate all single and dual calibration steps of your Shimadzu Portable and by day two get our certification.

Our Class is FREE If you attend our Shimadzu Calibration Class, you will receive a $1,000 credit towards your next purchase of a

$1,000 Ray-Pac Cash

Shimadzu dArt or Art X-ray tube Replacement from Ray-Pac by

©

by Ray-Pac

attending the Charleston Class.

This offer is valid thru 12-29-2018

Shimadzu Purchase Voucher It’s simple... Take our 2 day Calibration Class you’ll receive a voucher to submit with your next Shimadzu replacement order. Send in with your payment to deduct $1,000 off your next purchase of a Shimadzu Portable Replacement from Ray-Pac.

Use our voucher to get a $1,000 credit towards your next purchase of a Shimadzu Portable Replacement X-ray tube from Ray-Pac if you attend the class in Charleston, SC.

Reserve your class NOW! Call Ray-Pac at 843.767.8090 Available weekly starting January 2018 or go to our video instruction on YouTube at www.RayPac.com/video 38

ICEMAGAZINE | NOVEMBER/DECEMBER 2017

ADVANCING THE IMAGING PROFESSIONAL

Portables and C-Arms in stock atprofile Ray-Pac. SPECIAL ADVERTISING SECTION

Committed to Quality and Education

ORIII and ORIIIB

AMX 4

Everything Ray-Pac produces is put through AMXa stringent 4+ series of tests to ensure quality. X-ray tubes that do not meet Ray-Pac specifications will not leave their facility. Ray-Pac has a top notch crew that believes that quality comes first.

Ray-Pac offers a wide variety of diagnostic X-ray tube replacements along with the Shimadzu Portable. Ray-Pac also offer Shimadzu RX-80’s and RX’85’s. Ray-Pac uses Rad-21 and Rad-60 inserts in these housings.

Ray-Pac offers many more X-ray tubes than just Shimadzu. Ray-Pac also offers GE, Siemens, Phillips, Varian, Dunlee, Toshiba, and of course Shimadzu. ICE

Ray-Pac maintains a large inventory of X-ray tubes.

We keep a current inventory status on our website for dealers and installers to see what is available NOW to ship today.

Shimadzu Portables Ray-Pac Product Number

Focal Spot

Target Angle Heat Unit

Shimadzu Portable (KL-70) 0.7U163CS-36

0.7

14.5°

300 kHU

Shimadzu Portable (KL-70) 0.7/1.3U163C-36

0.7/1.3

14.5°

300 kHU

ORIII (RAD-99)

.3/.6

10°

300 kHU

ORIIIB (RAD-99B)

.3/.6

10°

300 kHU

AMX 4 (RAD-10)

.75/1.25

16°

300 kHU

AMX 4+ (RAD-11)

.8

14°

196 kHU

©

by Ray-Pac

(Single Focus) (Dual Focus)

Ray-Pac is committed to keeping up with the ever-changing technology in quality X-ray tube replacements.

Ray-Pac®

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AF TER THE

Handling Generational Transition in the Imaging Workforce

By Matt Skoufalos

A

s in so many aspects of American life, the passing of the Baby Boomer generation will have an outsized impact in the field of health care technology. As its population continues to age, the demands the boomers will place on the health care industry and its resources will continue to increase at an outsized rate as well.

In a 2014 article published by the Association for Medical Imaging Management (AHRA), Carole South-Winter points out that the national population of seniors (aged 65 and older) will increase 50 percent by 2020, requiring more imaging professionals to handle the added demand.

“Persons 65 and older utilize imaging services approximately twice as often as persons between the age of 45 and 64, and more than three times as much as persons ages 20-44,” South-Winter notes. “This demographic shift combined with the number of aging professionals in allied health, who are expected to retire at a faster rate than new technologists entering the field, will result in major staffing shortages. …

The vacancies in the workforce will be vast.”

In the face of this generational change, finding, training, and installing the next crop of qualified imaging service professionals is one of the foremost concerns.

Todd Minnigh and Steven Kralles work in Carestream Health’s Global Customer Care Organization. Minnigh is its global service sales director, while Kralles is

director of global field service. Both say they’ve seen the writing on the wall for some time as relates to the advanced aging of the service technician base of the business. Kralles describes “an extremely high percentage of our team” as being older than 60, and another, significant portion are in their fifties. He described the changing demographics as “a major issue for us.”

“It’s a number that’s never gone away, and we’ve tried a number of different strategies,” Kralles said.

Companies that lose industry veterans either look to woo them away from competitors or find comparably skilled replacements from a parallel field, Kralles said. But with the number of qualified technicians spread across a variety of places of employment, those tactics haven’t restocked the talent pool, only reshuffled the proverbial deck chairs around it.

Compounding the problem is what Kralles described as “a steep increase” among biomedical technician teams at hospitals that number among his major customers.

As those institutions continue to draw

from among a limited field of qualified technicians, it presents another competing option against which employers find themselves struggling to make strides.

“The pull into these [hospital] biomed positions is a nice job for someone as they get up in years,” Kralles said.

As an alternative, Kralles said Carestream began seeking younger candidates wherever possible, trying to draw from the military, biomedical and technical colleges, and industries that required electromechanical skill sets. In doing so, he said the company has expanded its view of what a potential candidate might be.

“We hire a lot of different people from a lot of different angles,” Minnigh said.

“Sometimes they’re coming from school, sometimes they’re coming from another industry, and sometimes they’re from a competitor. We’ve had a couple people who didn’t come up through the typical channels, and they had the right skills.”

“We’re looking for a base of technical experience in many different areas; people who’ve had discipline in a lot of environments,” Kralles said. “Somebody who’s passionate about the customer is going to get our attention in the hiring process.”

Along with finding the right candidates, Carestream has intensified its training processes to devote additional resources to bringing its service technicians up to speed on its equipment, processes and company culture. Kralles said its service technicians don’t go into the field on their

AF T E R THE

own until after at least a year of technical education at its Rochester headquarters, where they “spend quite a bit of time, product by product,” before going into the field with an experienced engineer. Older, more experienced engineers oversee their newer counterparts to help them build consistency at their work. Furthermore, field engineers are also partnered with members of the sales team, the better to educate them on how to cultivate deeper client relationships.

“Learning never ends in these jobs,” he said. “Even the individuals who’ve been at this for 30 years still come into Rochester for training on an annual basis. It’s bigger than just being a technical guy out there on your own. I think it helps people be more attached to the company and stay here as a career point.”

Competitive salaries and benefits comprise only one aspect of what’s needed to retain that top-tier talent; in a market with wage pressures, opportunities for lateral mobility are abundant. In response, Minnigh said employers like Carestream have needed to find additional ways to invest in their workers. Beyond the extensive continuous training program, its employee development process invites staffers to consult with their managers to outline a plan for their future and to identify pragmatic steps they could take to achieve it.

“People tend to stay for many years,” Minnigh said. “We let people grow into management jobs, and some of them have gone into sales jobs. People become experts on these products. It takes a long time to acquire that, and you know that if you were to change horses you’d have to start all over again.”

In addition to recruitment, retention, and training, Carestream devotes resources to helping older staffers mentor their younger counterparts ahead of retirement.

By using mentorship to bring the new hires up to speed, the company is working to insulate itself against the generational brain drain that comes from losing older, veteran staffers. Kralles said Carestream

42

“ We let people grow into management jobs, and some of them have gone into sales jobs.

People become experts on these products. It takes a long time to acquire that, and you know that if you were to change horses you’d have to start all over again” TODD MINNIGH

has invested in the creation of knowledge databases that help retain that information for future use.

“We don’t have knowledge that is only trapped in these individuals, but the biggest thing we lose is their experience in these particular customer locations, and the broadness of things that have happened,” Kralles said. “I talk to my managers more than anything else about maintaining and recruiting individuals for the team. Getting people in ahead of retirements so we can have them learn from the people who are going out has been very important to our success.”

“When you see somebody who’s about to retire, you know that day is coming,” Minnigh said. “You can start to prepare other people, queue up folks, and get

ICEMAGAZINE | NOVEMBER/DECEMBER 2017

them the same kind of exposure that that person has.”

Gavin Barton, managing director of The Leonard-Barton Group of Boston, Massachusetts, said the mass retirements of boomer-aged workers in many fields results in the forfeiture of what his group calls “deep smarts,” the business-critical, experience-based knowledge that experts accrue over decades of working in any field. Deep smarts involve skills based around decision-making and systematic thinking, and are different from book knowledge, Barton said.

“When it comes to how to get things done, how to move through an organization, there’s a lot there when people walk out the door that walks out the door with them,” he said.

The Leonard-Barton group has analyzed labor trends in public utilities, aviation, energy, and engineering, among others; all fields in which a lot of technical learning it transmitted digitally, even in the design processes. As efficient as such models of skill transmission are, they can fall apart at the implementation stage, Barton said, because they don’t turn on the greater sense of context that veterancy affords.

“The way the pieces fit together, how certain materials work with other materials; that kind of stuff you don’t get together until you get your hands on it,” he said. “That kind of tacit field knowledge isn’t as prevalent when people come into a field industry. These aren’t always the sexiest jobs, but people have such extreme knowledge of how these systems work over time.”

Beyond their deep-smarts knowledge, veterans in any line of work benefit from “know-who,” Barton said – that is, the social capital they build up over years, and which isn’t immediately transferrable to a replacement. To that end, Barton said companies in transition don’t just need to acquire the Rolodexes of employees who are leaving, but a deeper list of to whom they go for answers.

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“If you look at it as a process, what’s the business-critical stuff that we keep, who’s got it, and what are the steps to transfer that,” he said. “What we’ve seen has been very successful is experts doing classes on certain situations. The expert will say, ‘Here’s the situation, how would you handle it?’ Then they come up with their options and say, ‘This is what we did,’ and discuss it, figure it out, and pass that along.”

When it’s time for an employee to ride off into the sunset, Barton suggests it’s better to incorporate the individual’s retirement into as much of a long-range plan as possible to allow for the passage of their knowledge to those who are next in line for the job. By bringing along subordinates to shadow their predecessors for as long as possible, clients will become more comfortable with that hand-off, Barton said; his phrase for that process is “accelerated apprenticeship,” which can be the mechanism for transferring “tacit, business-critical knowledge” within as few as six months to a year.

“There are a number of people who are already excellent mentors, and are very open and willing to share,” Barton said.

“Then you have the other side that are keeping everything close to the vest [because] knowledge is power. Most of the experts we’ve run into are very willing to share what they know with the next person that’s up and coming, especially if they’re not being forced out. The more face time you can get between people, we think it’s much more effective.”

Losing the knowledge of prior generations can stymie an organization that would otherwise be poised for growth, or set one that’s stable back a number of years; he pointed to one client that was poised to lose a collective 27,000 years of knowledge within the next five years due to retirements. The generational brain drain can also hamstring a company that needs the help to continue to innovate. Barton likened the quality of the information lost in such circumstances as the difference between knowing how to Google the answer to a problem and possessing the deep personal knowledge of how to resolve it.

“What do you want to do to keep your business thriving and growing?” Barton said. “A lot of innovation comes off some of that past knowledge as well. It doesn’t happen in a vacuum. You need to take a long view of this because you can’t pass everybody on the open market. We’ve got to figure out what it is we’re going to need, and who’s got it.”

Tim Stephens, executive recruiter and vice-president of operations at Stephens International Recruiting, said medical equipment repair and service suffers from being “an older field” that isn’t well-known outside of the health care space. Typically, as high-schoolers’ career choices are shaped, they’re exposed to electrical or mechanical engineering degree programs, or paths in process or product development, not the kind of “break-fix” work of an imaging service technician, Stephens said.

“It’s not as well known, which is one of the reasons for the

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“ Most of the experts we’ve run into are very willing to share what they know with the next person that’s up and coming, especially if they’re not being forced out. The more face time you can get between people, we think it’s much more effective.” GAVIN BARTON shortage,” he said; “and there’s not as many schools as there used to be [offering] training at the associate’s [degree] level.”

As a result, Stephens foresees greater entry into the profession from peripheral careers. In addition to its staple reserves of ex-military biomeds, he thinks the field may get a boost from hospitals that could cross-train professionals from other specialties, most likely information technology (IT), or shift some technicians who have familiarity with patients in a clinical environment. He said he’s also found that many companies are willing to invest in retraining technicians to specialize in medical imaging equipment service. With more high-quality positions available than there are qualified candidates, companies with a roster of stable talent don’t want their staffers “to get poached or discouraged, or look at other jobs out there,” Stephens said.

“If you’re willing to move, then you can definitely punch your ticket,” he said. “Talking to these engineers, their wage scale goes up and they know their value. If you can train your employees, they’ll be a little more prone to sticking around knowing they’re on the same team and in it together. Some programs have a nice capital budget for training, and a lot of times those people are the most loyal.”

For those technicians whose resumes aren’t yet fully padded out, Stephens recommends continuing education as a starting point. Among those certifications that should be more commonly available, he suggests attaining A+ and Net+ “to position yourself for the next great job.” Seeking imaging-specific training may require a greater out-of-pocket investment, either for tuition, or for the travel and boarding costs to attend a training center.

“I know some folks want to get into radiology but there’s not many schools around that have an imaging program,” he said. “It might behoove you to pay out of pocket to go to that training.” ICE ICEMAGAZINE

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IMAGING MATTERS The Big Push

T

here is a big push by a number of large companies to make aggressive moves into the multi-vendor market. This is a manufacturer or large Independent Service Organization (ISO) taking over the imaging service of a hospital, health system or imaging group. For the manufacturer, it allows an inside track on big iron sales such as computed tomography, magnetic resonance imaging, catheterization laboratory and even general X-ray.

For the ISO that specializes on clinical engineering (CE), it is more often a third-party solution to biomedical service as well as imaging service. The various equipment manufacturers also offer CE solutions. This is very big business that deals with multiple revenue streams.

There are a few primary considerations that come into play when the idea is put forth that perhaps an outside entity can save money on equipment service and repair costs compared to an in-house program. First, an efficient and well-run in-house program is most often the most cost-effective solution. There are, of course, exceptions. However, usually the in-house service, when operated properly, will be the most cost-effective option.

Why then do hospitals or health systems choose the outside entity?

The reality is that most medical CEOs, COOs and CFOs do not understand how clinical engineering works or what they do.

They have a vague notion, but no real understanding. They see numbers. With reductions in reimbursement, more regulation, and the size of the average repair budget.

The numbers can become the focal point.

Without an understanding of what level of service is being received, they assume all service will be maintained at the same or improved levels. This is typically not the case. A company has to come into the health WWW.IMAGINGIGLOO.COM

system and make a profit. An in-house program does not make a profit. This is a fact that is often overlooked. The ways the numbers are calculated, the way the service is managed and the resulting quality must all be considered to ensure that the decision makers make an informed decision.

This requires the in-house program to consistently take a hard honest look at the program they are running. Is unnecessary cost being avoided? Is the quality of service maintained at the highest level? To run the best in-house system requires constant vigilance. Review of processes, documentation, and ensuring that sources for parts, tech support, training and service are reviewed and held to the highest standards. This is an ongoing process that is never finished.

For the individual field service engineer, this means the days of coasting into retirement are gone. The field service engineer needs to ensure that the lowest overall cost for quality service is being received by the health system up to the day they finally set the tool bag down for the last time. For the manager, this means constantly reviewing available

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

sources for parts, service, tech support and training. The manager also has to keep everyone that reports to them accountable for the best service at the best price. For the CEO, COO and CFO it means hiring directors and managers who can get the lowest overall cost for the best quality service, and letting them do their job. 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.

Currently, he is manager of clinical engineering at Catholic Health.

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CAREER ADVICE Retaining your Radiology Service Team

W

e often hear that there is a shortage of skilled and trained diagnostic imaging service engineers(DISE). However I cannot help but wonder and comment, what about taking care of your existing DISEs or team so that they do not leave for “greener pastures.”

In today’s marketplace, diagnostic imaging service engineers are often overworked and/or over extended by covering vast territories or a massive number of radiology equipment. There used to be more specialists who serviced one OEM vendor of equipment for one to two modalities.

In today’s world many of them are now asked (or required) to service multi-vendor or even multi-modalities of radiology equipment. This is caused not only by the aging and retiring cycle of that population, but also by employers not replenishing the workforce when they had downsizing layoffs in order to save on costs. So, in essence, these DISEs are doing more with even less support.

I have found, from providing talent for this industry for over 20 years, that many employers think that a DISE left them because of a higher salary. Yes, that issue is WWW.IMAGINGIGLOO.COM

There used to be more specialists who serviced one OEM vendor of equipment for one to two modalities. In today’s world many of them are now asked (or required) to service multi-vendor or even multi-modalities of radiology equipment. important in that you have to be competitive and compensate in the salary ranges that are standard in today’s marketplace.

You also need to ensure that those salary base ranges take into consideration and differentiate the cost of living especially in economically expensive areas like California or New York City.

However the number one reason for leaving a job that I hear over and over again from DISEs is that they really want a better work/life balance and quality of life. They say that they are tired of their large workload, territory, or travel that oftentimes does come with additional

Written by Jenifer Brown Health Tech Talent Management

support. The number two reason (which to me goes hand-in-hand with the first reason) is that they want to feel appreciated with their work valued. They do not want to be treated like a number or just a means to a dollar. The third reason I hear is that they are not getting enough training so that their skill set stays as current as possible and aligned with today’s technology. I know this is a tough one for employers. I hear all the time that if they spend all that money on training the DISEs they become more viably skilled and could leave for a better opportunity. If you, the employer have all of those other aspects (competitive salaries, normal workload or territory with support, demonstrated appreciation of value) in place for your DISE team plus some training, then you are the better opportunity! ICE ICEMAGAZINE

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IMAGING SERVICE 101 A

rguably the most important objectives of an imaging engineer’s job are about safety; making sure the equipment is safe for use, and ensuring our personal safety on the job. Virtually all of us face threats to our health on the job every day and some of those risks can be life threatening. The types of risks and their severity varies depending on the modality of the scanner. As we gain experience and confidence it is human nature to get a little lax, and sometimes we even make jokes about safety.

When I was in school, I remember a sign in the laser lab that said, “Do not look into laser with good eye.” Unfortunately, I have experienced some wake-up calls about the importance of safety during my career. The worst was at Technicare in the mid-1980s, when a rookie CT engineer was killed during a PM because he didn’t properly bleed off the voltage in the transformer tank.

In the USA and most countries, your employer is responsible for providing information, tools and equipment regarding your personal safety on the job. The manufacturers of the equipment (OEMs) also have a responsibility, to publish user and service documents that warn of potential risks and dangers, and explain how to mitigate them. Ultimately though, we are each responsible for our own safety.

The risks to personal safety vary, of course, with the type of scanner on which you are working. MRI scanners may have the most personal safety factors. There is the magnetic field, which can accelerate metal objects toward the gantry with deadly speed and force. The RF amplifiers have such high voltages that you don’t even need to touch the anode of the RF tube, it will come out and get you! There is also risk of a helium quench when working on MRI systems, and of a magnet explosion when filling the cryogenic chamber of the magnet.

CT scanners and X-ray systems have dangerous high voltages in the generators and tubes as the major risk. There are mechanical risks, as well, especially with the spinning gantries of CT. Ionizing radiation does not cause immediate effects and once was thought to be safe even for fetuses. Now, we 48

wear those detectors because we know the cumulative effect can cause cancer.

Nuclear medicine has some shock hazards and some scanners have serious mechanical risks. There are also risks from the radioactive isotopes that are used. And if you are working on PET scanners, you have the combined risks of CT and nuclear scanners.

Ultrasound systems probably have the least risk to personal safety of any scanners, but there are still ways you can get hurt. Some ultrasound units have user interfaces that raise and lower and other pinching risks. The electrical shock risks in ultrasound systems are relatively low (especially now that CRTs have almost disappeared). There are some dangerous voltages found in the switching and transmitter power supplies, which are called “high voltage” in ultrasound systems. These high voltages are typically from 200 to 400 VDC with ripple. I sometimes make light of the term high voltage when it is used in ultrasound; X-ray and MRI systems have thousands of times more energy. However, in school we were taught those voltages can be the most lethal, so they really shouldn’t be taken lightly.

There are some on-the-job risks that are universal to imaging engineers. All AC

ICEMAGAZINE | NOVEMBER/DECEMBER 2017

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

mains voltages can be dangerous and we should always follow the Lock-Out, TagOut (LOTO) procedure appropriate for the scanner. Other omnipresent risks are the dangerous microbes, both bloodborne and otherwise, that have become a part of our world. Wearing personal protective equipment (PPE), properly disinfecting equipment prior to servicing (and sometimes during), and the simple but important act of washing and sanitizing your hands should become routine.

And perhaps the most dangerous part of many jobs is driving from one site to another, while all the time people are calling or sending you text messages. Let’s all pledge to not succumb to the distractions of our smartphones and endanger ourselves and the lives of others.

At this time of year we often give thanks for our lives, and wish others good health in the coming year. It is a good time to resolve to not become complacent, to heed warnings in service manuals, glove up and scrub, use LOTO techniques, discharge those anodes and check your work. To quote a line from an old TV show: “Let’s be careful out there!” ICE Jim Carr is Director of Service and International Operations for AUE. He may be contacted via email at JCarr@auetulsa.com.

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BRIDGING

THE GAP RSNA 2017: Why You Need To be There!

T

he theme of RSNA 2017 – Explore. Invent. Transform. speaks volumes to not only this annual pinnacle event of the imaging community but lends one to experience the continual evolution of this great industry and invites investigation through innovation.

So why is this annual imaging and scientific event so important for the HTM imaging professional to consider attending? This is a fair question and one that many times may have halted approval from your boss. Let me share a few thoughts around the reasoning.

This year’s RSNA Imaging and Scientific Conference, estimated to feature over 650 exhibitors ranging from a start-up company to the major original equipment manufacturers is only one of the many facets which allow a “look into the window” of imaging technology advances both present day and in the future. Add workshops and virtual conference sessions and the constant flow of professional networking is justification for attendance at this granddaddy of imaging conferences.

There will be several showcases and two that I believe are a must see for HTM imaging professionals are the “Start-up” and “Artificial Intelligence (AI) - Machine Learning” showcases. The WWW.IMAGINGIGLOO.COM

“Start-up” showcase will provide attendees an opportunity to engage with emerging imaging product companies enabling them to be “early adopters.”

A) and machine learning showcases will be a very popular technology exhibit area - get there and soak it in as this is the future of imaging!

RSNA is an annual springboard the OEMs use to launch their latest and greatest in new heavy metal imaging technology. Siemens Healthineers and Toshiba America Medical Systems will be showcasing new 3T MR technology.

Cannon and Virtual will be launching new products in direct radiography (DR) technology and “newcomer” Samsung continues to splash the imaging market with products that are capturing the interest of many.

So, have I piqued your interest enough to motivate your attendance at this year’s RSNA in Chicago? Hopefully so and I look forward in seeing you perusing the exhibit hall, sitting in on the many “free” education and product sessions. Don’t forget the most powerful portion of all conferences of this stature – networking with clinical imaging users, physicists and technical support colleagues. Please feel free to look me up at RSNA 2017. I’ll be there November 26-December 1. Let’s chat a bit as we walk the hall together! ICE

Written by Alan Moretti Healthcare Technology Management Advisor

ICEMAGAZINE

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index AUE

ADVANCED ULTRASOUND ELECTRONICS

DEFI N I N G T HE S T AN DAR D

Advanced Ultrasound Electronics p. 48

PartsSource, Inc. p. 17

Stephens International Recruiting Inc. p. 53

Injector Support & Service p. 46

AllParts Medical p. 5

Philips Healthcare p. 2

Summit Imaging p. 9

International Medical Equipment & Service p.21

American College of Radiology p. 3

THE JDIS GROUP

PM Imaging Management p. 50

Technical Prospects

Premier Imaging Medical Systems p. 57

The Intuitive Biomedical Solutions

p. 11

CT • MRI • PET/CT • MOBILE

JDIS Group p. 44

Ampronix p. 23

p. 50

KEI Med Parts p. 57

Diagnostic Solutions

Radiology Data p. 52

p. 53

KEI Medical Imaging Services p. 49

SOLUTIONS

Tri-Imaging Solutions p. 54

Ray-Pac® Dunlee p. 28

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Ray-Pac p. 36-39, BC Unitek Training p. IBC

Medical Systems Technologies p. 50

Field MRI Services p. 46

MedWrench p. 56

Health Tech Talent Management, Inc. p. 35

58

RSTI/ Radiological Service Training Institute p. 4

Varex p. 6

X-ray Parts, Inc p. 49 Medical Imaging Technologies p. 35

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RTI, Inc. p. 49

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