ICE - June 2018 by MD Publishing

ADVANCING THE IMAGING PROFESSIONAL

JUNE VOL.2 NO.6

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ICE FEATURES

June 2018

“ The modalities or systems that we provide have sensors that give feedback all the time; based on that feedback we can identify changes and trends in system functional behavior and predict early breakdowns before the customers recognize them.”

36 The Long View

rofessional P Spotlight

The common sight of medical imaging systems in every aspect of health care

Nicole T. Walton-Trujillo’s expe-

illustrates the importance of these devices. The goal is to keep the imaging

riences as a patient along with

devices maintained to prevent downtime which could hinder the patient expe-

a desire to learn and excel are

rience as well as revenue. Maintaining imaging devices is the task of service

among the reasons she went

engineers who can use remote service options along with big data to increase

back to school and continues

uptime, efficiency and overall equipment life.

to serve as a patient advocate, among other roles, at Cathedral

Department

The imaging service team at Ohio State University Wexner Medical Center is responsible for 21 CTs, 19 MRIs, seven cath labs, six EP, three hybrid suites, seven IR suites, hundreds of mobile ultrasound systems, several portable C-arms and more. Page 24

WWW.IMAGINGIGLOO.COM

Rock Desert Radiology in Las Vegas, Nevada.

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ICE DEPARTMENTS

June 2018

news

people

products

insight

10 Imaging News

22 Professional Spotlight

41 Imaging Matters

18 People on the Move

24 Department Spotlight

27 X-ray Product Spotlight

21 Webinar Wednesday

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

34 Tools of the Trade

Vice President

Kristin Leavoy kristin@mdpublishing.com

Editor

John Wallace jwallace@mdpublishing.com

Publisher

John M. Krieg john@mdpublishing.com

43 Imaging Service 101

28 X-ray Gallery

Art Department Jonathan Riley Karlee Gower Kathryn Keur

Account Executives Jayme McKelvey Lisa Gosser Megan Cabot

Contributors

K. Richard Douglas Matthew N. Skoufalos Jim Carr Cindy Stephens John Garrett Daniel Bobinski Jenifer Brown

44 Daniel Bobinski 46 Index

Accounting Kim Callahan

Circulation

Lisa Cover Melissa Brand

Digital Department Cindy Galindo Travis Saylor Jena Mattison

Webinar

Linda Hasluem

ICE Magazine (Vol. 2, Issue #6) June 2018 is published by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to ICE Magazine at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.imagingigloo.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. Â© 2018

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

FDA Clears Siemens Healthineers Systems The FDA cleared the SOMATOM Edge Plus computed tomography (CT) system from Siemens Healthineers in early April followed by the SOMATOM go.All and SOMATOM go.Top computed tomography (CT) systems in mid-April as well as the latest version of the SOMATOM Force, the flagship dual source computed tomography (CT) system from Siemens Healthineers. The SOMATOM Force now features the new FAST (Fully Assisting Scanner Technologies) Integrated Workflow, which helps ensure precise patient positioning. A key component of the FAST Integrated Workflow is the all-new FAST 3D Camera, which fits above the patient table and uses artificial intelligence and deep learning to enable automatic, precise and consistent isocentric positioning of patients. Touch Panels fitted on the gantry allow staff to leverage this automation at the push of a button while remaining close to the patient during scan preparation. The new SOMATOM Force also offers iterative metal artifact reduction (iMAR), enabling users to significantly reduce artifacts caused by metal implants, artificial joints or pacemakers. Additionally, the improved Image Reconstruction System (IRS) of the SOMATOM Force reconstructs up to 70 images per second with iterative reconstruction. The new FAST Integrated Workflow with the FAST 3D Camera also will be available with the SOMATOM Drive dual source CT system. The SOMATOM Edge Plus computed tomography (CT) system features the FAST (Fully Assisting Scanner Technologies) Integrated Workflow with the FAST 3D Camera – the first patient

ICEMAGAZINE | JUNE 2018

positioning system powered by artificial intelligence. Additionally, the new scanner allows for automated scan preparation, improved diagnostic confidence, and customized patient dose, making it ideal for high-volume practices and emergency imaging environments. “Siemens Healthineers is excited about the potential of the SOMATOM Edge Plus with FAST Integrated Workflow to help health care providers improve workflow and patient management,” said Douglas Ryan, vice president of computed tomography at Siemens Healthineers North America. “The integration of artificial intelligence into patient positioning not only improves image quality but also expands precision medicine by reducing unnecessary variability for health care providers.” The SOMATOM go.All and SOMATOM go.Top computed tomography

(CT) additions to the company’s go. CT platform expand its concept of patient-centric mobile workflow, which is controlled via tablet and remote, into advanced clinical fields and applications such as cardiology, CT-guided intervention, and dual energy CT. “With the FDA clearance of the SOMATOM go.All and SOMATOM go.Top, Siemens Healthineers offers a comprehensive, user-designed suite of cost-effective CT scanners to perform a wide range of clinical tasks, from routine procedures to advanced clinical applications,” said Ryan. “With its revolutionary changes to workflow and reliability, our SOMATOM go. CT platform is transforming care delivery, helping health care providers realize CT’s full potential to deliver high-quality imaging examinations while also reducing total cost of ownership.” • For information, visit www.usa.siemens.com.

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news Airo CT Pediatric Applications Receive 510(k) Clearance Mobius Imaging LLC announced that it has received 510(k) clearance for its Airo Mobile CT Imaging System for pediatric applications. The Airo Mobile CT Imaging System previously received 510(k) clearance in 2013 for non-pediatric imaging and is used in intraoperative, image-guided procedures in neuro-spine surgery. Airo diagnostic images also continue to be utilized for supporting applications in brachytherapy, radiation therapy and surgical imaging. “The ability to provide Airo Mobile CT imaging for pediatrics is an important milestone in the company’s ability to offer solutions for additional clinical segments and applications,” accord-

ing to a press release. “Pediatric patients can now receive the clinical benefits of Airo CT imaging for diagnostic and intraoperative procedures.” “There is an unmet need in being able to provide safe and reliable CT imaging for pediatric patients during various clinical procedures,” explained Gene Gregerson CEO of Mobius Imaging. “CT systems must be designed and validated for safety and efficacy using different protocols than would be appropriate for adult patients. We are delighted to now be able to offer the benefits of Airo Mobile CT imaging to clinicians and their pediatric patients.” •

Varian Expands Capabilities of Halcyon Treatment System

Varian is incorporating new imaging technologies in the Halcyon 2.0 treatment system to expand its capabilities and ability to deliver high-quality cancer care globally. “First announced in May 2017, Halcyon is revolutionizing the clinical workflow and simplifying and enhancing virtually every aspect of image-guided intensity modulated radiotherapy (IMRT),” according to a press release.

“Halcyon 2.0 will feature kV Cone-beam CT (CBCT) and Iterative CBCT imaging for better soft tissue definition.” “We have been very happy with the strong positive response Halcyon has received from the global cancer care community,” said Kolleen Kennedy, president of Varian’s Oncology Systems business. “By working closely with our clinical partners, we have been able to quickly evolve the Halcyon system with these new imaging technologies, provide a pathway to adaptive radiotherapy and continue our efforts of advancing high-quality and cost-effective cancer care worldwide.” “Halcyon provides highly targeted

radiotherapy on a platform that’s intuitive for clinicians and comfortable for patients. The streamlined workflow requires only nine steps from the start to the end of treatment compared to up to more than 30 steps with older technologies. Halcyon is well suited to handle the majority of cancer patients, offering advanced treatments for prostate, breast, head & neck, and many other forms of cancer,” according to the release. Halcyon 2.0 is currently a work in progress and not available for sale. • For information, visit www.varian.com/halcyon.

Merry X-Ray Acquires Nationwide Imaging Services Inc.

Merry X-Ray Corporation (MXR) has announced the purchase of Nationwide Imaging Services Inc. Nationwide is an international broker, re-conditioner/re-seller, parts-supplier and servicer of medical imaging equipment. Nationwide founder Rob Manetta, also a founding member of the International Association of Medical Equipment Remarketers and Servicers (IAMERS), WWW.IMAGINGIGLOO.COM

had recently led Nationwide to achieve ISO 13485:2016 certification, the medical device specific quality certification. “Nationwide brings a robust access to re-conditioned medical imaging equipment as well as an international presence to our rapidly expanding suite of offerings to the medical imaging market,” MXR President Ted Sloan said. “With our extensive network of new equipment distributorships, acquisitions in late 2017 of Universal Medical Systems and Consensys Imaging Service, combined with Premier Imaging just last month and now Nationwide, we’ve established a comprehensive portfolio of imaging equip-

ment and service solutions that include new and re-conditioned equipment offerings to hospitals, imaging centers, physician offices, stand-alone ERs and veterinarians across the U.S.” “We’re very excited to join the MXR family,” Manetta said. “Our regulatory-compliant equipment and parts are now fully complimented by Consensys Imaging Service, also a regulatory-compliant service company. Furthermore, with access to MXR’s vast network of customer relationships accumulated over the last 60 years, we see unlimited growth potential.” •

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Technical Prospects Announces Summer Training Schedule Technical Prospects, a member of the health care imaging industry specializing in Siemens equipment, has announced its summer 2018 training class schedule. The classes, held both in person at Technical Prospects’ facility and online, cover a variety of topics including computed tomography, fluoroscopy, radiography and more. Courses offered by Technical Prospects feature structured lessons, hands-on labs and experienced instructors, helping engineers further develop their Siemens Medical Imaging equipment knowledge and skills. Classes offered for June, July and August 2018 include: • Online: Intro to CT – June 4-29: This course will provide students with a working knowledge of the terminology and principles of CT components and circuitry. • Computed Tomography: Siemens Sensations – June 5-14: During this course, students will learn about major system components that make up the Sensation Family system platform, specifically covering 10-,

16-, 40- and 64-slice systems. • Fluoroscopy: Siemens Luminos Agile – June 12-21: This course covers servicing the Luminos Agile system platforms and focuses on the major system components that make up the flat detector panel-based fluoroscopic system platform. • Online: Intro to X-ray – July 2-27: This course will provide students with a working knowledge of the terminology and principles of the basic circuitry of an X-ray generator, production of X-rays, receptor devices and test equipment. • Radiography: Siemens Multix MT/TOP/ PRO – July 10-19: Students will learn about the major system components that make up the Multix Family of systems consisting of the MT, TOP and PRO platforms. • Angio/Cath Lab: Siemens Arits Zee/ dFC/FA – July 10-19: This course discusses the major system components that make up the flat detector panel digital and image intensifier-based analog Artis Zee/dFC/FA system platforms.

TECHNICAL

PROSPECTS

Experts in Siemens Medical Imaging

• Online: Siemens syngo – August 1-28: Students will learn about the major components that make up the syngo software platform. • Radiography: Siemens Ysio – August 7-16: During this course, students will discuss servicing the new digital Ysio system platforms with a focus on the major system components and the Siemens flat detector panel technology. • Computed Tomography: Siemens Emotion – August 21-30: This course covers the major system components that make up the Emotion 6/16 system. Instruction includes all three major variations: the 2003, 2007 and 2010 series of systems. • For more information, visit TechnicalProspects.com.

MedStar Georgetown to Offer Proton Therapy with HYPERSCAN Technology For the first time, cancer patients in the Washington, D.C. metropolitan region have access to the latest cancer-fighting technology, proton radiation therapy, now available at the MedStar Georgetown University Hospital Proton Therapy Center. Proton therapy is more precise and targeted than conventional radiation. It works by using pencil beam scanning, similar to a 3D printer, to match the tumor’s exact shape and size with superior accuracy that eliminates the exit dose of traditional radiation, and spares healthy tissue. MedStar Georgetown offers the Mevion S250i with HYPERSCAN technology, producing beams that are sharper

ICEMAGAZINE | JUNE 2018

than previous proton systems. Proton therapy with HYPERSCAN is also faster than other proton systems, benefiting patients whose treatment includes holding their breath. “I am extremely excited to be able to offer this latest advancement, proton therapy, to my patients,” says Brian Collins, MD, a radiation oncologist and clinical director of the new proton therapy center. “It’s clear that this treatment will help to improve the clinical outcomes for our cancer patients and decrease their side effects when radiation is needed.” “In certain cases, proton therapy can be a game changer,” says Keith Unger, MD, radiation oncologist at MedStar

Georgetown. “It allows us to treat cancers where traditional radiation might not even be possible.” •

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news

Fujifilm Debuts Surgical Visualization Systems Fujifilm New Development U.S.A. Inc. has introduced new surgical visualization systems, marking its entry to the growing minimally invasive surgery market in the U.S. The company plans to expand the current realm of minimally invasive tools, leading the way in developing the next generation of products designed to handle more sophisticated surgeries. “As a comprehensive health care organization focused on the entire continuum of care – prevention, diagnosis and treatment – the minimally invasive surgical space is an appropriate market segment for Fujifilm,” said Takaaki Ueda, president and chief executive officer, Fujifilm New Development U.S.A. Inc. “Drawing on Fujifilm’s core technologies and expertise gained over many years in digital radiog-

raphy, endoscopy, women’s health, ultrasound, and healthcare IT, Fujifilm is well positioned to bring innovations to the industry.” FUJIFILM New Development U.S.A. Inc. will be led by Stephen Mariano as vice president and general manager, and Scott Barfield has been named vice president of business development. The product portfolio is targeted to surgeons and clinicians who perform surgical procedures in a range of medical specialties. The following systems are now available in the United States Fujifilm Ultra-Slim Video Laparoscope System and Fujifilm Full High Definition Surgical Visualization System. • For more information, visit www.fujifilmholdings.com.

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news Carestream Begins Shipping Upgraded Clinical Collaboration Platform Carestream Health is now shipping an upgraded version of its Clinical Collaboration Platform that is designed to both expedite and enhance radiology reporting workflow. The platform features a new rule-based Workflow Orchestrator that first directs imaging exams to the most appropriate radiologists based on priority, subspecialty, relationships and availability. As desired turnaround times get close, the studies are exposed to a broader group of available radiologists to satisfy service-level agreements. The Orchestrator’s workload balancing also helps ensure prompt delivery of reports to referring physicians. “We have created a next-generation workflow for reading imaging studies that boosts productivity and responsiveness,” said Neville Skudowitz, Carestream’s global director, commercialization and strategic development for healthcare information solutions. “This intelligent solution enhances the quality of the report by having exams read by the right radiologist as dictated by their qualifications and areas of expertise.” •

MR Solutions expands preclinical scanner range with CT scanners MR Solutions is broadening its range of preclinical scanners with the launch of four CT models. This new range of CT scanners is designed to operate alone or with the clip on PET and SPECT imaging systems developed by MR Solutions for their range of MRI scanners. The MR Solutions family now includes six cryogen-free MRI scanners with a range between 3T to 9.4T, five PET which include clipon and within the bore and two SPECT. “The new range of CT scanners have industry-leading high contrast and high resolution with zoom facilities. The company is the

only manufacturer to offer a comprehensive range of preclinical cryogen-free MRI and CT systems with unparalleled structural imaging and completely interchangeable imaging modalities – PET and SPECT – between the two core imaging platforms. The PET and SPECT units can also be used as standalone scanners,” according to a press release. All of the systems use common motorized beds and carriers to facilitate “quick and easy movement” between MRI and CT scanners. Dr. David Taylor, founder and chairman of MR Solutions said, “As with all of our innova-

tion this was prompted and discussed with the world leaders in preclinical scanning. Their number one requirement is having the highest resolution but particularly important is the interchangeability of the various scanning modalities and the ability to have common carriers for rapid transfers.” MR Solutions is involved with orders from academic and government laboratories across the world with the first deliveries scheduled for later this year. • For more information, visit

Acertara, Johns Hopkins Team Up for Focused Ultrasound Study Acertara has announced that its research and development team has partnered with Johns Hopkins University for a study through a research grant from the Focused Ultrasound Foundation. The study will determine if focused ultrasound can be used to increase drug delivery to the bladder wall. Nicholas Ellens, who oversees the acoustics power testing lab at Acertara, was instru-

ICEMAGAZINE | JUNE 2018

mental in securing the research grant. “If effective, this technology could be used to treat a variety of bladder diseases, including bladder cancer, with minimal side effects to the patient,” Ellens said. “Bladder cancer is the fourth most common cancer among men and this technology has the potential to improve the survival rate of many thousands of people throughout the world.”

This early stage research is being conducted on rats by the research team at Johns Hopkins and Acertara, but the team is hopeful to translate the technology to humans quickly. Updates will be published on the Focused Ultrasound Foundation website (www.fusfoundation.org) throughout the year. • For more information, visit www.fusfoundation.org.

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news Aquilion Precision Receives FDA Clearance Canon Medical Systems USA Inc.’s newly FDA-cleared Aquilion Precision is a Ultra-High Resolution CT system (UHR CT). The system can resolve anatomy as small as 150 microns and is designed to provide more than twice the resolution, typically seen only in cath labs. Containing an allnew detector as well as tube, gantry and reconstruction technologies, the system may make it possible to help expand visualization of disease thanks to new features that offer improved image detail. The Aquilion Precision CT system features dose efficiency with detector channels that are only 0.25 mm thick. This, combined with substantial improvements in scintillator quantum efficiency, detector circuitry and other DAS components, results in a dose-efficient detector with ultra-high resolution capabilities. The system features one of the smallest Focal Spot Tubes at 0.4 mm x 0.5 mm and a routine 1024 x 1024 Reconstruction Matrix. “The increased amount of information delivered by the Aquilion Precision opens new doors for health care providers,” said Dominic Smith, senior director, CT, PET/CT, and MR Business Units, Canon Medical Systems USA. “The system delivers higher resolution images than other systems on the market, enabling customers to deliver better patient care.” •

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Conquest Imaging Announces Portable Depot Repair Conquest Imaging – a provider of ultrasound parts, probes and service – has announced the expansion of its capabilities to support the portable ultrasound needs of the health care industry. SIMPLIFY, Conquest’s repair program announced last year, will now include portable depot repair with an upfront flat rate pricing structure, providing health care delivery systems access to immediate repair for out-of-warranty portable systems. “With the completion of our depot repair lab in Indiana, we offer a fast turnaround time for the repair and new flat rate pricing,” Conquest Imaging Senior Director of Technical Operations Bob Broschart explains. “What this means to our customers is they can just send in their

portable, knowing the cost to repair and eliminate both the quote and evaluation step. We can turn their repair around in 3-5 days, providing the fastest, simplest portable repair solution available.” The recent addition of the portable depot repair lab is part of Conquest Imaging’s ongoing effort to strategically build and expand the company, according to a news release. With the lab’s completion, efficiencies are streamlined, and repair costs reduced. Adhering to Conquest’s Quality Assurance 360 standards, the new depot repair lab administers the Quality Management System that allows Conquest to offer its best-in-class warranty of 6 months, the release adds.

Because Quality Matters ISO 9001:2015 CERTIFIED

Specializing in SonoSite portable systems, for a limited time only Conquest is offering free evaluations for the probes of every SonoSite portable system sent in for repair. • For more information, visit conquestimaging.com.

Avante Health Solutions Welcomes EMS

Avante Health Solutions has announced that Equipment Maintenance Solutions (EMS) will be joining the Avante family. Founded in 2008 in Ferndale, Michigan, EMS provides MRI and CT service, sales, parts and rentals. Avante Preisdent Steve Inacker said that EMS further strengthens Avante’s overall reach and capabilities. “We are focused on strategic consolidation in a fragmented industry,” Inacker said. “EMS is a perfect addition to our teams in terms of their culture and commitment to quality products and services.” EMS President Seth Davis said he is excited about the opportunities the new partnership will create. “We share a common vision for superior client service, a team-oriented and supportive culture for our employees, and

ICEMAGAZINE | JUNE 2018

growth in a changing health care environment,” Davis said. “We think our clients will be very eager to access the many service and product solutions that the Avante family of companies provide.” The EMS service portfolio is primarily in the midwestern United States, but EMS is also a national provider of service, parts and equipment rentals. “EMS is an ISO-certified company that provides best-in-class service, equipment, and parts to a variety of major health systems, hospitals, physician groups and other providers,” according to an Avante news release. EMS is the newest member of the Avante Health Solutions overall portfolio that includes Global Medical Imaging LLC, DRE Medical Group Inc., Integrated Rental Services Inc., Oncology Services International Inc., Pacific Medical Group Inc. and Transtate Equipment Company Inc. • For more information, visit www.equipment-maintenance-solutions.com.

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PEOPLE ON THE MOVE By Matt Skoufalos

Find weekly installments at imagingigloo.com

Integrated Oncology Network Holdings LLC of Newport Beach, California, has named Ryan E. White its executive vice president and corporate compliance officer. White was most recently the compliance officer for DaVita Health Plan of California, and has worked in senior compliance and legal roles at Allergan Inc. and McKesson Corp.

Three Rivers Provider Network Inc. of Las Vegas, Nevada has hired Bryan Hunziker as senior vice president of business development and partnerships. Hunziker has worked with Intracorp, CCN/First Health, StrataCare Inc., Prime Health Service Inc., MCMC and Preferred Medical Network. He holds a bachelor’s degree in psychology from Oregon State University and a master’s degree in social services from San Diego State University.

Albert Einstein College of Medicine of Bronx, New York has named Gordon Tomaselli its Marilyn and Stanley M. Katz Dean, effective July 1, 2018. Tomaselli was most recently chief of the division of cardiology and co-director of the heart and vascular institute at Johns Hopkins University School of Medicine. He is a cardiac electrophysiologist, and succeeds Allen M. Spiegel, who has served as dean since 2006.

Omnicell Inc. of Mountain View, California has added Chief Commercial Officer Scott Seidelmann, the founder and CEO of radiology analytics provider Candescent Health. Seidelmann has been co-founder and CEO of Radisphere Inc. and has worked with Merrill Lynch and Ericsson Venture Partners.

Lucile Packard Children’s Hospital of Stanford, Connecticut has added former Yahoo! President and CEO Marissa Mayer to its Board of Directors. Mayer also serves on the boards of Walmart, the San Francisco Museum of Modern Art, the San Francisco Ballet, and the Forum of Young Global Leaders at the World Economic Forum.

The newly launched US Radiology Specialists of Charlotte, North Carolina has named John Perkins as CEO and a member of the board of directors. Perkins was most recently CEO of Bio Products Laboratory, and has been executive vice president of global commercial operations for Talecris Biotherapeutics. US Radiology Specialists is a joint venture of Charlotte Radiology and health care investment firm Welsh, Carson, Anderson & Stowe.

ICEMAGAZINE | JUNE 2018

Roger Benz and Tom Harris, CEO/co-presidents of Concordance Healthcare Solutions of St. Louis, Missouri will retire by the end of 2018, and mid-2019, respectively. Harris will serve as CEO Emeritus after Benz steps down; both will serve on the company’s senior advisory board thereafter. Concordance Chief Strategy Officer Lisa Hohman will be promoted to CEO. Dave Myers, chief customer officer of Seneca Medical, will be promoted to president and COO; Concordance COO Jaysen Stevenson will become president of its government division.

Methodist Medical Group of Richardson, Texas has named Michael W. Bukosky its senior vice president and COO. Bukosky was most recently chief administrative officer of USMD Holdings Inc. and president of USMD Physician Practice Management; he has been CEO of University of Louisville Physicians in Louisville, Kentucky, and executive vice president and chief administrative officer of Carle Clinic Association in Urbana, Illinois.

Silver Hill Hospital of New Canaan, Connecticut has named John Santopietro its president and medical director. Santopietro was most recently chief clinical officer of behavioral health and psychiatry chair at Carolinas HealthCare System in Charlotte, North Carolina. A board-certified psychiatrist and neurologist, he serves on the boards of the American Association of Community Psychiatrists, the National Suicide Prevention Lifeline, and the American Hospital Association’s Governing Council of the Section for Psychiatric and Substance Abuse Services. Santopietro is a member of the Medical Directors Institute of the National Council for Behavior Health and the National Crisis Services Task Force.

Broward Health Imperial Point of Fort Lauderdale, Florida has named Jonathan E. Watkins its CEO. Watkins was most recently COO at Kaiser Foundation Hospitals & Health Plan, has been vice president of clinical operations and COO of Medical North Hospital in Memphis, Tennessee, and holds a master’s degree in public administration with a certification in health administration, as well as a bachelor’s degree in health care administration and planning from Tennessee State University.

The Medical Device Innovation Consortium (MDIC) of Arlington, Virginia named Pamela Goldberg its president and CEO. Goldberg was formerly director of the Center for Entrepreneurial Leadership at Tufts University, from which she has a bachelor’s degree as well as a Stanford University MBA.

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WEBINAR WEDNESDAY

Nuclear Medicine Panel Discussion Session Popular

niversal Medical rolled out a team of experts from the recent Webinar Wednesday presentation “Why A Reconditioned System Might Be Right for You.” The webinar, which was sponsored by Universal Medical, provided expert insights into nuclear medicine. The live webinar was attended by 155 people and the presentation is currently available online at webinarwednesday.live. The expert panel of representatives from Universal Medical, who fielded questions about reconditioned systems after their presentation, included Senior Vice President and Chief Operating Officer Jason Kitchell, Vice President of Corporate Quality & Customer Support Services/Clinical Support Specialist Nik Iwanwi, Evaluation Program Director Chad Watson, Senior Product Manager Craig Diener, National Service Manager Craig Snodgrass and Production Manager/Quality Manager Kevin Borror. Topics discussed included camera capability requirements, clinical requirements, financial requirements, reimbursements, parts availability, maintenance and more. Universal Medical’s products and services include new and reconditioned nuclear imaging systems, parts, equipment service, training courses for health care technology managers, camera system moves, technical and clinical support, flexible financing options and more. The Universal Medical presentation was well received by those in the industry. “Great presentation, always good to WWW.IMAGINGIGLOO.COM

know of new third-party companies and their quality,” Biomed Manager D. Sanchez shared. “Even though, the nuclear cameras don’t pertain to me in my role, it was interesting to listen. There are always service, quality control issues, support issues that carry across all equipment lines,” wrote Senior Biomed S. Gardner. “This Webinar was presented in a unique and comprehensive manner. Some information presented was new to me and I gleaned a substantial amount of information in this webinar. The panel giving the presentation was knowledgeable and their contact information was made available for further discussion of what was presented today,” said K. Ongchango, CBET. “Great webinar for biomedical technicians who have run into issues with purchasing and maintaining nuclear imaging systems on a tight budget,” said Biomed F. Mishchuk. The Webinar Wednesday sessions continue to receive positive reviews. “Webinar Wednesday has helped me get the needed credits for recertification. In the process I have learned about new products, services and, of course, new ways to perform my job better. Thanks for continuing to provide great quality webinars,” wrote Biomed L. Shelman. “I always enjoy the Webinar Wednesday series. They are equally entertaining and informative. The content is always relative to what we as HTM professionals do on a daily

“ Great presentation, always good to know of new thirdparty companies and their quality.” -Biomed Manager D. Sanchez

basis,” Healthcare Technology Management Director S. Brow said. ICE For more information about the webinar series, including a calendar of upcoming presentations and recordings of previous sessions, visit WebinarWednesday.live.

A special thank you to the company that sponsored this month’s webinar.

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By K. Richard Douglas

PROFESSIONAL SPOTLIGHT Achieve and Believe: Nicole T. Walton-Trujillo, R.T.(R) (CT), BSRS, MBAH, MOL, ARRT, ASRT, NMSRT

ometimes, it requires the perspective of the patient in need of compassion to see the best in the clinician or imaging technician. It can be the soft skills, that are such an important part of their jobs, which can bring a patient the most comfort and emotional help when they need it. “I am a cancer survivor. I was working in business for well over a decade and was diagnosed in that time with Non-Hodgkin’s Lymphoma and later ovarian cancer. Those were some dark and scary times,” says Nicole T. Walton-Trujillo, R.T.(R)(CT), BSRS, MBAH, MOL, ARRT, ASRT, NMSRT, imaging site manager for Cathedral Rock Desert Radiology in Las Vegas, Nevada. “Yet, what was obvious to me, was that the people in the imaging department were the only people who didn’t look at me with ‘that’ look. You know the one, that ‘Oh you have one foot in the grave’ look. They treated me like a normal person like everyone else and gave me the best level of patient care I had experienced in that time of my life,” she says. Walton-Trujillo says that experience changed her life. She remembers going 22

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home after her 10-year anniversary of being healthy and cancer free and looking at her family and saying it was time for a change. “I literally took my life like an EtchA-Sketch and started over. I went back to radiology school. I got my education and started my career in the imaging profession and it was one of the best decisions I have ever made. I now get to guide the growth of others in leading change and the patient experience,” she adds. She went back to school and graduated from the PIMA Medical Institute in Albuquerque, New Mexico. “Within a couple of months of getting my initial X-ray license I self-studied to get my CT license and then started my bachelor’s degree program in radiologic sciences, once again with PIMA,” Walton-Trujillo says. The more specialized focus on education did not stop there. “I knew that once I had mastered the ability to work full time, raise a family and achieve my bachelor’s; I went ahead and attained my master’s in business administration in health care as well as my master’s in operational

“Having time for patient care to be done correctly comes from creating an understanding of why we do what we do.“ leadership/project management,” she says. Walton-Trujillo’s areas of specialty are CT and dose protocols. “But, my biggest specialty is patient care,” she says. “Having time for patient care to be done correctly comes from creating an understanding of why we do what we do. Creating an alignment plan that can help create the foundation for change. When the frontline clinician understands why we do what we do, why decisions are made, it is easier to create the buy in for change processes. This is something I excel in,” Walton-Trujillo says. Surmountable Obstacles What’s even more remarkable about ADVANCING THE IMAGING PROFESSIONAL

Favorite part of being an imaging professional? “The ability to lead change and guide the growth of those in my charge. I am constantly working towards the patient experience. I know what it feels like and want all our patients to feel that sense of support, humor and compassion with an underlying trust in skills and knowledge.”

GET TO KNOW THE PRO Favorite book: “If Disney Ran My Hospital” and “My Iceberg is Melting” Favorite movie: “Captain America Winter Soldier” Favorite food: Sushi and movie theater popcorn (a little kettle corn on the bottom and regular popcorn on top) Hidden talent: Singing What’s in your van? Star Wars AT-AT mug Trauma sheers Family photo Fidget spinner iPad

Nicole T. Walton-Trujillo Imaging Professional Walton-Trujillo’s achievements is that she is deaf. Her drive and tenacity has sidestepped this “disability.” “The biggest challenge I have faced in my career has nothing to do with my career. I am a deaf woman. I lost my hearing about 25 years ago. I wear bilateral cochlear implants and those allow me to manage through my day,” she says. “I read lips and work very hard to understand and communicate in the world around me. I was determined that I would not ever be passed up for a job or promotion out of fear that my hearing loss would be a hindrance to any job or task. Through intelligent concessions (like sitting where I can read lips) and making sure I can still WWW.IMAGINGIGLOO.COM

function reading lips and being aware of my environment, it has never become an issue in what I do.” Walton-Trujillo says she is fortunate to have a strong and supportive family. “I have been blessed to be married for over 17 years to Don — who still makes me laugh every day — and am the proud parent of my son, Mark, who is an Intermediate EMT-C who is working toward his paramedic license and his amazing wife (my new daughter), Jamie, who is a NICU nurse,” she says. When away from work, she can be found at the dance studio practicing ballroom dancing. “I know you are thinking, how can you dance if you can’t hear the music? But, I can still feel the base line — it’s amazing. I work out at the studio 3-4

days a week and have competed nationally in the past year. It is the one place that I do not have the luxury of thinking beyond the dancing. It is impossible to worry about the department or the work on my desk or how many emails have piled up since I last checked it,” Walton-Trujillo says. “My parents are still a significant part of my life and it amazes me that no matter how old I get, I am lucky enough to be able to bounce ideas and situations off them for sound advice,” she adds. It seems like that advice has paid off as Walton-Trujillo has danced past challenges to make a contribution to the imaging profession. ICE

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DEPARTMENT SPOTLIGHT Ohio State University Wexner Medical Center Imaging Team

ffiliation with a nationally known university brings with it some expectation that there will be an extra helping of imaging equipment to manage. That is the case for the imaging team at the Ohio State University Wexner Medical Center. Along with their colleagues in CE, they have 1,400 total beds, over 90 locations, seven hospitals and more than 10 outpatient centers to cope with. Ohio State University, located in Columbus, Ohio, is a 148-year-old top-20 public university. It includes several other campuses distributed across the state of Ohio. Besides the medical center, the university is home to the Ohio State College of Medicine. At a prestigious center of medicine such as this, imaging is a big component of diagnosis and teaching. Managing that imaging equipment is a well-trained imaging team. “We have a staff size of 42 with seven of those dedicated to imaging. Imaging and biomed are integrated entities within our entire clinical engineering department,” says Richard Eldridge, associate director of clinical engineering, who heads up the imaging team. “We are responsible for the medical equipment – biomed and imaging – of the entire Ohio State University Wexner Medical Center Campus,” he says. The imaging team is responsible for 21 CTs, 19 MRIs, seven cath labs, six EP (1 EP hybrid), three hybrid suites, seven IR suites, more than 300 mobile (ultrasound) systems, more than 25 portable C-arms, over 15 portable X-ray and more than 20 fixed systems. 24

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All imaging team members are thoroughly trained from day one. “We believe in training and education. We have really invested internally on our staff. We utilize OEMs for specific training on modalities and also send junior employees to radiology/ fluoroscopy-specific training to establish a good foundation of general imaging knowledge,” Eldridge says. “We work with our purchasing and individual departments on the purchases of new equipment and negotiate clinical engineering training in the purchase. We also have our staff bring back that knowledge from the service school and cross-train their peers. They give in-services at our weekly meetings demonstrating troubleshooting ideas and overviews of what they have learned,” Eldridge adds. The imaging team strives to bring as much service in-house as possible and training is key to that goal. The group is also involved in the purchas-

“ We believe in training and education. We have really invested internally on our staff.”

ing and planning processes as well as finding ways to effectively budget. “We are very involved in the purchase and project construction in radiology/cardiology. We work hand in hand with the team and offer advice on room layout and equipment purchases based on what we are seeing from the service end,” Eldridge says. “We work with our purchasing department to negotiate and benchmark our service agreements. We look at all aspects of the contract tiering model. We are constantly looking for strong third-party sources for parts,” he adds. He says that money can be saved, but there has to be an evaluation process before breaking away from the OEM. “Quality, warranty, loaner availability and speed are four key components for utilizing third-party parts. You may be able to save money, but if the quality isn’t there and there is a delay in receiving your parts, you will quickly lose any money that you have saved in the form of lost revenue,” Eldridge explains. “We are also involved in every aspect of medical equipment – including on the user training side. We try and work closely with our physician and medical professional partners and listen when there is a potential issue,” he says. He says that they would first-look into the equipment and maintenance side of things, but if there is more training that needs to be done, they work with administration and the vendor to help relay that information.

ADVANCING THE IMAGING PROFESSIONAL

The Ohio State University Wexner Medical Center Imaging Team maintains an array of equipment.

Brain Storming and Details When you’re affiliated with a major university, it only makes sense to help expose engineering students to the often overlooked field of imaging service and HTM. “We have worked with the Women in Engineering group at The Ohio State University and have set up tours through clinical engineering. This encompasses all aspects of engineering from electrical engineering to biomedical engineering,” Eldridge says. “This has allowed us to not only talk about what we do, but to show the engineering students what we do and how we work together with physicians and medical staff to improve patients’ lives. This has opened up job shadowing and an increase in interest in clinical engineering and an increase in job applications for our student program,” he says. The imaging team has also showed their resourcefulness in coming up with an ingenious way to problem solve. “We were approached by [the] research [department] who had acquired a piece of equipment that required a large pressurized gas tank to be utilized for a procedure to be performed in an MRI. The challenges were apparent in regards to where to store and house the gas tank in relation to the MRI,” Eldridge says. “Imaging worked with [the] research [department] and evaluated the specifications of the gas tank that was needed. After WWW.IMAGINGIGLOO.COM

brain storming some ideas, we realized that we use compressors to seal the MRI bladder style doors. That compressor met the specs of the gas requirements for the system and was much smaller. We only had to run a tubing set into the MRI and kept the compressor safely in the control room,” he says. The team has integrated certain tasks into their procedures to assure that things work correctly, stay secure and to avoid accidental damage. “For older systems, that have ‘dryer hose’ cable covers, we converted over to a military grade ‘Dura Wrap’ that allows the user to access the wires by pulling the Velcro apart. Otherwise you need to disconnect one or both sides of many cable connections. Also, the Dura Wrap can be added over rips and tears,” Eldridge says. “We do morning rounding that assures working systems and gives us a face-to-face connection with our customers. We install Plexiglas covers on all large screen displays thus reducing accidental hits to a bump, not a cracked display,” he says. “If a screw does not have a lock washer, we add thread locker. This, in most cases, prevents slippage/loose components due to transport. Cable management is always beneficial for cosmetic and service accessibility. We come in after the install is completed to make sure things are done to our expectations,” Eldridge adds.

Richard Elridge serves as the leader of the imaging service team

Leadership is also involved in the imaging profession away from the workplace. “I am currently a member of the Vizient Diagnostic Imaging Council. I have served as vice chair and chair of the council. I am a mentor to two OSU college of engineering students through the Diversity, Outreach and Inclusion Program (DOI),” Eldridge says. “My co-associate director, Anthony McCabe, sits on a Vizient Cyber Security Task Force.” While immersed in a learning environment, this imaging team is participating at both ends; teacher and student. With such a large inventory of assets, they are proving to be an important asset to a health care environment that requires excellence from all participants. ICE ICEMAGAZINE

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ADVANCING THE IMAGING PROFESSIONAL

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PRODUCT SPOTLIGHT Global X-ray Market Growth Continues

iagnostic X-rays provide a look inside the body as medical professionals look to uncover issues and make appropriate treatment decisions for patients. Patients have been able to have an X-ray taken for over 100 years and it continues to be a valuable health care tool. New technology, safer devices and procedures are just a few of the factors contributing to the continued growth of the global X-ray market. “The market for X-ray devices and procedures is poised to witness steady growth in the years to come owing to innovations and investments from health care giants. Research in reducing the effects of radiation can also create a safer atmosphere for the industry in near future,” according to Partha Dutta from Grand View Research. “Concerns about safety regarding the exposure to radiation of X-ray devices has always been around. Rising complexity of X-ray procedures has forced health care professionals and medical device manufacturers to take note of this threat and take appropriate actions.” Smart technology and advancements in intelligent machines are also impacting X-ray devices and procedures. “As artificial intelligence makes inroads into the health care sector, it is also set to influence medical imaging techniques. It is expected to bring radiologists closer to digitization. As of now, artificial intelligence is anticipated to assist X-ray imaging in terms of capacity management and workflow organization. This disruptive technology can make radiologists efficient and help them save time when it comes to collecting and organizing data, prioritizing health care and distributing caWWW.IMAGINGIGLOO.COM

pabilities. Artificial intelligence will help radiologists use these resources more effectively,” Dutta writes. “The global market for X-ray devices and procedures is set to witness steady growth in the forthcoming years. Advancements in regulations like Merit-Based Incentive Payment System (MIPS) and Medicare Access and CHIP Reauthorization Act (MACRA) have created challenges in terms of reimbursement and reporting,” Dutta reports. “The rising adoption of medical X-ray generators in stent replacement, malignant cancer cells and locating blocked arteries among others will boost market growth to 2024. The market was worth $1.46 billion in 2015.” A press release announcing a new report from ResearchAndMarkets.com echoes the market growth prediction. “The global digital X-ray devices market is expected to witness a compound annual growth rate (CAGR) of 10.9 percent during the forecast period (2018-2023). The growing health care budget would positively impact the digital X-ray market in the emerging nations. Thus, manufacturers, such as Siemens Healthcare, GE Healthcare, Philips Healthcare, and Toshiba Medical Systems Corporation, can find significant growth opportunity in the emerging markets,” according to the press release. However, OEMs will face challenges. “The digital X-ray devices are quite expensive and, hence, the sale of new digital X-ray equipment is limited. It is further being affected by the increasing use of refurbished devices by the people. Since refurbished devices cost much less, they are preferred more by people and are used in most of the emerging markets.

Therefore, the sales of refurbished devices are more which is affecting the market of the digital X-ray devices which is leading to lesser sales of these devices,” according to the press release. A March 2018 report from Zion Market Research takes an in-depth look at the global X-ray market. According to the report, the global medical X-ray market was valued at approximately $10.6 billion in 2017 and is expected to generate revenue of around $15.4 billion by the end of 2023, growing at a CAGR of around 6.40 percent over the next five years. “North America dominates the medical X-ray market due to increasing incidences of chronic diseases, favorable reimbursement policies and growing geriatric population base. Furthermore, North America was the largest geographical market for computed radiography and direct radiography technology due to the large patient pool,” Zion Market Research reports. “Europe is the second largest regional market and is expected to show significant growth in the years due to growing research and development activities and increasing demand for early diagnosis of chronic diseases. Factors such as increasing accessibility to health care facilities in the region and rising medical tourism, are also expected to contribute to the growth of the market in this region.” Some of the key players in the market include GE Healthcare, Philips Healthcare, Siemens Healthineers, Carestream Health and Samsung Electronics. Major players are frequently engaged in mergers and acquisitions to retain their market share and diversify their product portfolio. ICE ICEMAGAZINE

products Carestream DRX-Revolution Nano Mobile X-ray System Carestream Health’s DRX-Revolution Nano Mobile X-ray system is a lighter weight, non-motorized system that is easy to maneuver and position for patient imaging. It complements the Carestream DRX-Revolution Mobile X-ray System, which is designed to capture inpatient, outpatient and ER exams at facilities of all sizes. The new DRXRevolution Nano system includes fully integrated digital workflow, Carbon Nano Tube technology and an advanced lithium iron phosphate battery that contributes to longer life. It offers a sleek design with enhanced visibility both over and around the system. It has a compact footprint and total weight of about 220 pounds that makes it easy to maneuver and position in tight spaces. It offers a choice of wireless detectors including Carestream DRX-1, DRX Core, DRX Plus and DRX 2530C detectors in several sizes. •

Canon Medical Systems USA Inc. Ultimax-i FPD The Ultimax-i FPD multipurpose system from Canon Medical Systems USA Inc. enables health care providers to perform complex procedures within an R&F room space. The system maximizes clinical versatility by providing routine radiography, urology, orthopedic, G.I. pain management and routine angiography lab capabilities. The large flat panel detector, along with other dose management features, can help clinicians limit repeat radiation exposure to provide safe and efficient exams. As the industry’s only tilting C-arm multipurpose system, the Ultimax-i FPD has intuitive complete local and remote control consoles, and the ability to position the tube above or below the patient. •

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FUJIFILM Medical Systems USA Inc. FDR Go PLUS The all-new FDR Go PLUS mobile digital radiography (DR) system is redesigned for a more proficient mobile exam experience and now includes a retractable, telescopic column with one of the lowest park positions on a full size portable to provide optimal visibility while traveling. The system features easy, smooth and quiet positioning movements, increased dedicated storage areas, an extra-large display for fast, easy bedside previews and many more valuable new enhancements. The redesign combines an efficient, versatile, compact system with Fujifilmâ&#x20AC;&#x2122;s trademark image quality and dose performance of the FDR D-EVO II detectors, advanced image processing (Virtual Grid simulation software and Dynamic Visualization II options) and mobile imaging shortcuts to expedite workflow for enhanced patient care. â&#x20AC;˘

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Philips ProxiDiagnost N90 ProxiDiagnost N90 continues to improve on Philips promise of providing cost-effective and accessible solutions designed with all patients in mind, helping to enable increased clinician productivity and more confident diagnoses. Room utilization is optimized by the system’s 2-in-1 DRF capability, performing nearby fluoroscopy and digital X-ray exams. Patient throughput is enabled by Philips low-dose Grid-Controlled Fluoroscopy and Dynamic UNIQUE image processing, which provide excellent images in real time. For pediatric examinations, Philips Grid-Controlled Fluoroscopy (GCF) enables a dose rate1 reduction up to 68 percent2 compared to Pulse Controlled Fluoroscopy (PCF), depending on patient type and clinical application. •

1. Dose rate determined according to IEC 60601-2-54, 203.5.2.4.5.102, System set up: detector format 43 x 43 cm (17 x 17”), patient type children, 0.1 mm Cu + 1 mm Al filter, reduced dose and pulsed slow fluoroscopy mode with 2 pulses/s, Phantom: 5 cm (2 in) PMMA 2. Relative difference of two reference air kerma rates between system with GCF and system with PCF

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GE Healthcare Optima XR240amx with FlashPad HD Digital Detectors GE Healthcare’s latest mobile X-ray product, the Optima XR240amx with FlashPad HD Digital Detectors, enables clinicians to see exceptionally fine detail and has a maneuverable design and small footprint for complex care environments like the ER or NICU. It is a high-resolution, pediatric-capable mobile X-ray system and offers seamless X-ray imaging support for carefully controlled neonatal environments like the GE Healthcare Giraffe Carestation incubator. The system’s small tube design allows for easy positioning above the Carestation’s canopy and the detector can slide directly into its base. The FlashPad HD next generation detectors are thin, light and designed for durability. Both the system and detectors have dependable power management technology allowing two detectors to be charged simultaneously in-bin, with or without grids attached, taking the guess work out of detector battery charging for on-the-go, in stand-by mode or plugged in charging. •

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Samsung GC85A Samsung’s GC85A premium fully digital X-ray system provides the same image quality with half the radiation. Samsung’s engine S-Vue 3.02 received FDA clearance last November for use at 50 percent dose reduction for adult chest exams. Constantly working to lower dose exposure is a top priority for radiologists and health care professionals, and the GC85A’s dose reduction represents a breakthrough in medical imaging technology. When it comes to dose management, precision is key. The GC85A incorporates Samsung’s Image Post-processing Engine S-Vue 3.02 that provides spatially adaptive multi-scale processing and advanced denoising technology delivering quality images with only half the dose. •

* The dose reduction in GC85A digital chest radiography is based on limited phantom and clinical study results. Only routine PA chest radiography for average size adults were studied, excluding pediatric patients.

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

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TOOLS OF THE TRADE Radcal Accu-Gold Touch Series

he Accu-Gold Touch Series is Radcal’s newest line of stand-alone instruments. These measurement systems incorporate a large capacitive for a bright and straightforward user experience. In addition, the Accu-Gold Touch provides access to the full lineup of Accu-Gold sensors. The Accu-Gold Touch provides the accuracy and reliability you’ve come to expect from Radcal in an economical package. Alternatively, the Accu-Gold Touch Professional Series provides wired and wireless computer interfaces. Using the Accu-Gold Windows application, users are able to access a rich set of advanced capabilities such as automated Excel-based reporting and waveform analysis. Current Accu-Gold system users can explore the Accu-Gold Touch conversion option. ICE

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THE UBIQUITY OF MEDICAL IMAGING SYSTEMS IN EVERY ASPECT

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T H E I R A P E X P R E D AT O R S TAT U S AT T H E T O P O F T H E B I L L I N G C H A I N .

aintaining both is the task of service engineers as much as it is clinical specialists, and the area of practice at which both intersect is the issue of connectivity. Imaging has long been a nighthawk game, thanks to remote support technologies, but in the field of device management, it’s a rel- work of an onsite engineer. In 2005, the ative newcomer. Once leveraged, however, company rolled out Guardian in response the value of big data to uptime, efficiency to the increasing complexity of the work and overall equipment life becomes some- done in technologically advancing imaging thing close to indispensable. Mark Lothert, suites like interventional cardiology rooms head of product in service business man- and catheterization labs. agement for Siemens Healthineers North “Patient safety and criticality is exAmerica, traces the foundations of tremely high in such environments, Guardian, the company’s remote and that’s how Guardian started,” service solution for imaging Lothert said. modalities – including CT, MR, Guardian began with data angiography, molecular imagcollection and analysis, meaing, and fixed X-ray to remote suring “changes in the systems service offerings that began in that our users don’t even recthe mid-1980s with telephone ognize,” Lothert said; analyzing dial-up networks. Initially, Lothpatterns in equipment failure MARK LOTHERT ert said, remote service offerwith high-level software that reSIEMENS HEALTHINEERS ings took a reactive approach veals “an indication that someNORTH AMERICA to the task and, even then, they thing might fail in the future.” mostly supported the break-fix “That is basically what it is

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today,” he said. “The modalities or systems that we provide have sensors that give feedback all the time; based on that feedback we can identify changes and trends in system functional behavior and predict early breakdowns before the customers recognize them.” Keeping equipment functioning to the best of its ability doesn’t only mean charting trends in opaque data sets. It also involves limiting table time for patients in the most vulnerable and critical of settings, while scheduling planned maintenance to preserve maximum uptime. After Siemens saw the value of enhanced analytics to its angiography and interventional lab systems, the company grew Guardian support to cover CT equipment, particularly in non-emergency settings. Such deployments gave the company an added install base for supporting its products as well as an opportunity to enrich the offerings of the solutions themselves. Guardian adds an average value of 10 percent to a service

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contract, Lothert said; he also suggests that the value of the added uptime could total hundreds of thousands of dollars annually, depending upon the procedures done.” “Usually all systems nowadays come with a certain uptime guarantee around 95 percent,” he said. “That missing 5 percent could still be 10 to 12 days a year. If you increase uptime by 1 percent, you reduce the loss of revenue by about $100,000. Being predictive allows us to schedule planned downtime. “We commit to a higher uptime where the customer can measure us,” Lothert said. “That means going from 95 to 98 or 99 percent. Customers can measure it from a confidence point of view, and are holding us accountable to it.” Lothert believes the future of remote online service management will be both

As vendors develop better ways to measure that wear and tear on medical equipment, and develop improved sensors that can report data from potentially affected components back to service banks, they’ll also be working to hone and automate the analytics that make sense of it, too. “A lot of data means nothing,” Lothert said. “It’s just data; it’s not information, it’s not insight. You need something behind it that analyzes the data, recognizes patterns, and compares it to a normal database.” Remote monitoring services can log and anticipate system failures and schedule preventive maintenance work; the precision of accompanying analytics software also mitigates the impact of the false positives and false negatives that can turn up. These solutions can also help calibrate and remotely update service and security pro-

equipment, working with a vendor that offered remote online service was a priority. “We knew that we were going to an L1 trauma facility status,” Correa said. “Having a system in place that was allowing us to monitor the scanners from a remote area was of benefit to us.” Banner Desert Medical Center performed 65,000 CT scans in 2017, and since installing Siemens CT scanners with Guardian, “we’ve not been down for a prolonged time, except for maintenance and a preventive quick fix,” Correa said. “If we’re down, it’s for a very short duration of time, as Siemens is diagnosing the problem from their remote monitoring center,” she said. “It allowed us the ability to detect the issue well before the facility even knew there was an issue. Siemens is well aware before even the technologists

K E E P I N G E Q U I P M E N T F U N C T I O N I N G T O T H E B E S T O F I T S A B I L I T Y D O E S N ’ T O N LY MEAN

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proactive and predictive, customized to the specific uses of a given facility, and maybe even the specific demands of individual departments. He likened it to the conventional wisdom around an oil change every 3,000 miles. Such planned changes don’t take into account specific considerations about your vehicle itself – whether you use the right gas, whether your commute is routinely short or long trips, how hard you drive the vehicle – that would either lengthen or shorten the amount of time needed between service appointments. “That is the way it will go with monitoring,” Lothert said. “To show how the system is being used, where you have wear and tear, and whether it’s the right time to do preventive maintenance or replace parts.” 38

ICEMAGAZINE | JUNE 2018

MAINTENANCE

PRESERVE

tocols, saving technicians more time onsite as well. “You can produce remote software versions much easier than having a service manager onsite loading CDs or DVDs to put software on,” Lothert said. “It’s extremely important for safety-relevant bug-fixes, where remote access makes it much easier and quicker. The big difference is the real-time monitoring, which requires people to sit at computer desks and look into error logs and alarms and alerts from all the systems that are installed.” Gladys Correa, director of medical imaging and radiation oncology at Banner Desert Medical Center/Cardon Children’s Medical Center in Mesa, Arizona, said that when her facility was looking to upgrade its imaging

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have had a chance to recognize a problem.” “We have a very busy ER,” Correa said. “Where our CT scanners sit, we needed them running. That was a no-brainer for us.” Correa said her in-house service engineers have also been trained from the ground up in remote online monitoring, which allows them to train with the equipment vendor directly, creating “a seamless operation.” “We don’t even remember that the software is in place until there’s a problem,” she said. That level of smooth integration is precisely what clients are looking for from their equipment vendors, said Josh Hanna, vice president of remote service technology for ADVANCING THE IMAGING PROFESSIONAL

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GE Healthcare Global Services: tube – one of the most expenoptimizing asset performance sive, sophisticated and freas well as clinical performance quently changed-out compomanagement. nents on the device – can add “I think people are very fato its lifespan. miliar with how we should use “Remote connectivity can JOSH HANNA the connectivity to improve tell you if that warm-up’s beGE HEALTHCARE uptime of your asset,” Hanna ing done,” Hanna said. “It can GLOBAL SERVICES said. “Increasingly customers tell you when certain parts are are coming with a want to look going to fail. We can’t cover at all of CT. How are those assets perform- everything, but we can cover lots of failure ing? Am I utilizing them right? You can give modes.” me the data that says, ‘I can redirect that “Every product we ship has connectivipatient outcome.’” ty,” he said. “The design for how you gather “By having a connection, hospitals can that data is predicated upon connection.” say, ‘Are we using the best protocol at the Remote connectivity can also help simbest time?’ We’re also on the cusp of learn- plify repairs by allowing technicians to ing to help radiologists be more accurate. download device information prior to makWe see this trend of leveraging technology ing repairs, to identify replacement parts for clinical optimization, as well,” he adds. beforehand, and to coordinate and strateThe biggest vendors in the imaging gize around the maintenance process. space all offer remote online service opAs Hanna puts it, “When the field engitions for their equipment, and Hanna neer arrives at the same time as the part, said that, increasingly, he encounters an that saves you quite a bit of time. The fact “around-the-globe expectation of remote that we can download information might service” in every aspect of the space. mean that we know what part you need re“We’ve got hundreds of thousands of placed before you arrive onsite.” systems around the globe, connected all Remote software also lets service techaround the globe,” he said. “Those connec- nicians troubleshoot problems from a distions allow us to meet those uptime and tance. GE imaging equipment makes use productivity connections that our custom- of iLink Systems software, which connects ers rely on for their convenience. This is not clinical staff with remote equipment supa new technology, nor a new expectation in port at the push of a button. Hanna said the industry. You almost can’t differentiate its remote technicians are veteran field yourself in the market through connectivi- service personnel whose expertise is still ty. For the big OEMs, if you’re not connect- available on demand. ed, you’re not competing.” “Some of our best technical people are Each of the “big three” imaging equip- our remote engineers,” he said. “You’re ment manufacturers supports its tech- getting someone who’s calling you nology with a remote monitoring service: with 30 years of experience, and that Siemens’ is called Guardian; GE’s is called person is logged into your scanner, OnWatch; Philips’ software is called Om- and is watching what you’re doniSphere. They all perform similar basic ing, and can also look at the very functions – advance warning of technolog- technical logs that you’ve got,” ical miscues, alerts for things that break, he said. “I can see if you’ve got and scheduling warrantied service calls. a problem with your voltage; Beyond those maintenance and upkeep I can see if you’ve got a probfunctions, Hanna said the analytical com- lem with your table.” ponents of the software can also defer Hanna predicts that the maintenance by optimizing equipment added functionality of future usage. The simple act of warming up a CT remote optimization solu-

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tions won’t be limited to repairs; instead, he foresees it becoming another asset for clinical improvements. Aggregating anonymized data allows other insights to percolate while contributing to a generalized understanding of the technological landscape of the imaging space. “I think the insights we’re going to gather on the clinical side is amazing,” Hanna said. “It would be very comforting to me to know the radiologist is looking at my scan along with an algorithm that’s comparing my scan with thousands of other scans in the world. How we use connection and data together, and the modern architecture of databases and the cloud, has enormous implications for clinical outcomes.” By the same token, analytics can improve service offerings by delivering “fleetwide” parametric data, he said. As vendors work to differentiate their offerings from one another, and to more tightly integrate their service delivery to specific contractual terms, Hanna anticipates “some bifurcation of offerings” along customer-defined lines. “You’re going to see some break/fix, your basic uptime, contracts signed for operating,” he said, “but then I think there’s going to be a whole other piece: a partner that’s going to help me manage my assets. How these assets perform, how they’re used and maintained, leads to better clinical outcomes. On the slope, I think we’re in a time of improvement.” ICE

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insight

IMAGING MATTERS Point of Sale Agreements

alesmen and saleswomen have an ever growing number of stereotypes and jokes made about them that may seem a bit too on the nose. We have all heard about the sales representatives who promise the moon and deliver mud. It is clear that the goal of a sales rep is to sell something and make a profit. Yet the offerings they put forward are rarely considered in a logical manner. There is a psychology to selling. There are several books that address techniques of selling and most are built around relationship building and “selling the sizzle not the steak.” There are also some profound manipulations of prices and payment schemes that may involve quantum physics, time travel and new math. In short, the make-up of most sales reps are technical lingo, bright smiles, concerned consultant, industry buzz words and mathematic magician. For the most part, industry regulation has prevented the sale of snake oil. However, a salesperson can throw some in if it will close the deal. OK, so not all sales reps fit that caricature. However, it is important to remember the sole purpose of the sales rep in your presence. They exist to sell you things. Things that you need, things you might be able to use and things that are totally useless no matter how interesting that item may seem. They may WWW.IMAGINGIGLOO.COM

have what you need at an outstanding price. It may be a good deal. But make sure you don’t lose sight of the fact that you have to be fully engaged and consider what purchases are being made and what purpose they serve. There has been a big push in the area of medical imaging to have five-year point-of-sale maintenance agreements. These include discounts to the purchase price. The reality is that this “discount” is no more than moving part of the capital expense into the repair budget. With very few exceptions, the first three to five years after the warranty of any imaging equipment is the best time in the life cycle of the equipment to use a time and material approach instead of carrying a contract. It will have the fewest breakdowns and least amount of downtime because it is still new. If you have an in-house imaging service team, this is the least expensive time to own the equipment – unless you get sold a point-of-sale agreement. The manufacturer knows that the least expensive time for them to cover a full-coverage contract is in the first five years. So, they can discount the sale price if you commit to a long-term contract at the time of sale because they know that they will have a huge margin in the service contract. You will have to run your numbers, and consider your

Written by John Garrett Director, Clinical Engineering at Baylor St. Luke’s Medical Center

individual situation. However, I believe that a point-of-sale agreement is almost never a good way to spend your money. Buying the equipment with a smaller discount and serving in-house or via time and material is almost always a better decision. ICE John Garrett has 20 years experience in imaging service including general radiation, mammography, CT and nuclear medicine. He has worked for third-party service companies, manufacturers, sales companies and in-house imaging teams.

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ADVANCING THE IMAGING PROFESSIONAL

insight sponsored by:

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DEF IN IN G THE STAN DAR D

IMAGING SERVICE 101 Taking Ownership of Your Customers

usiness studies have shown that taking ownership of a problem is the most important factor in achieving high levels of customer satisfaction and retention. Great companies develop processes and deliver training to make sure that every employee in the customer service chain feels responsible to resolve the issue. World-class customer service is when companies like Zappos and Southwest Airlines develop a “one-touch” culture, where each employee not only takes ownership but is also enabled to fix the customer’s problem (at least, within defined limits). Nordstrom has some of the best examples of empowered ownership, such as the true story of the building services team, a.k.a. janitors, spending hours sifting through vacuum cleaner bags to find a customer’s lost diamond ring. Taking ownership is a job requirement for almost all of us, but personal improvement gurus point out that how well one accepts responsibility is the key element to a successful career. Sometimes that even means accepting ownership for a problem that was actually created by the customer, like the lost diamond ring (again, up to some limit). If you always accept the responsibility to take action and follow-up, and you are able to get results; your customers will be confident and know that you really care. What does it mean in imaging service these days to take ownership of your job and your customer? With all due respect to Nordstrom’s and Zappos, ownership of a problem in the world of imaging service can be a bit more complicated and challenging. To a great extent, it depends on your role in the imaging service chain. Some companies have technicians who WWW.IMAGINGIGLOO.COM

specialize in doing the preventive maintenance calls, usually as a way to use less expensive people for that work and to train new imaging engineers. Arguably, if the PM procedures from the OEM are good and the PM tech does them well, the customer would see that person more than the service engineer. Many companies use a tiered approach to solving service calls, with the call center dispatch operator being considered the first tier. At Acuson, we trained each dispatcher to use our knowledge-based tech support system in order to solve the customer’s problem without having to transfer them. If they were not able to solve it, they would “warm transfer” the customer, so that they would not have to repeat all their information again, to the person who was most likely to be able to solve the problem. That next call might be to a tier 2 (level 2) remote service engineer, who was also trained to take ownership of the problem and try to solve it. The call might ultimately go to the assigned field tech, sometimes to install a part that the remote service engineer had identified as faulty and sometimes to do more troubleshooting. This approach helped improve the efficiency of our field engineers, who had a higher cost basis than the other service employees, and improved the time to repair, as well. It is important for companies that use this type of tiered level approach for service to have integrated service reporting systems and well defined roles for the employees. And it needs to be clear who owns the problem or service call at any given point, and who is responsible for communication and follow-up with the customer. Even if many problems can often be fixed remotely, or the PM tech sees the scanner and customer more often than anyone else, or if the

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

HTM department is outsourcing the service to the OEM or an ISO, most companies and customers still consider the assigned field technician or the onsite clinical engineer to be the ultimate owner of the scanner and customer. That responsibility is often referred to as being the “primary” for the scanner. For in-house imaging engineers, you may be the person doing the PMs and there may be an outsourced company doing the repairs, but I bet the hospital staff still considers you to be the “primary.” To assure timely and efficient communication with the customer, the name of the primary should be made clear to all involved. The primary owner of the scanner is typically responsible for doing follow-up, to make sure that actions have been identified and are taken, and that the repair is completed. If I was the user-owner of an imaging system, I want to know which one person has accepted the responsibility to keep my scanner in good and safe operating condition, and is going to make sure it is back up ASAP when it breaks. As a member of the service delivery process for a scanner, I take ownership for any actions assigned to me and make sure the primary service engineer is informed. And when I am the primary service engineer, I follow-up with the customer at each step and make sure my customer’s issues are resolved, to make sure I do not lose the opportunity to have that responsibility. ICE ICEMAGAZINE

insight

MANAGERS: THINK LIKE A GARDENER A

s we transition from spring to summer, many of us are spending time in our gardens. As for me, I’m growing fewer vegetables this year, but I’ve put in a couple of flower berms that require my attention. Regardless of whether you’re tending flowers or vegetables, certain things need to get done on a regular basis for your garden to do well. Interestingly, there are some parallels and truisms for gardening that also have application for managers. One such truism is that gardeners don’t make seeds grow. The genetic coding inside each plant does that. I know this sound elementary, but stay with me. Because gardeners recognize that seeds have within them the genetic coding that’s needed for growth, gardeners know their job is to create the conditions that seeds need in order to sprout. As a result, they are always inquisitive about the conditions of their garden. Is fertilizer needed? More water? Less water? Are the plants getting enough light? Are there any unwanted pests or diseases? Gardeners ask these questions and make any needed adjustments because they know things won’t go well if they simply give a plant an intimidating look and bark out a command to “grow!” In the same way that a gardener can’t make seeds grow, a manager cannot motivate people. The word motivation literally means “a reason to move,” and because people have their own reasons to move, everyone already has motivation. It’s built into them, just like the genetic coding within a seed. 44

ICEMAGAZINE | JUNE 2018

What’s strange is when we see managers bark at their employees, telling them to get motivated. They usually get the same result as gardeners telling a plant to grow. Isn’t it curious that we accept behavior in managers that we would laugh at in a gardener? Let’s take a look at the root of this alltoo-frequent problem. Whenever a manager is frustrated by a perceived lack of motivation, either the manager hasn’t figured out – nor inquired about – the employee’s motivations, or the manager has created an environment that squelches the employee’s natural drive. The solution is twofold: discover and create. I’m amazed how many managers talk among themselves, saying things like, “I can’t seem to get Jack motivated.” Even if managers take the initiative to ask other managers, the best they’re going to get is a guess. The most effective way to discover what motivates Jack is to ask Jack directly! It is not difficult to engage a person in conversation and ask about his or her interests. Another problem might be that the manager is inadvertently stifling Jack’s motivation. I call this creating an environment that’s demotivating. Fixing this can be a delicate process, but a good manager works to improve his or her management style, striving to learn how his or her actions and attitudes are impacting others. This often begs the question “What conditions should we create?” Unfortunately, there is no one-size-fits-all an-

Written by Daniel Bobinski Workplace Consultant

swer. What motivates one person may not motivate the next. And, as much as it’s hard to fathom, just because something motivates us doesn’t mean it will, or even should, motivate anyone else. Every person has different reasons for working, and those reasons are as individual as the person. The good news is that managers have an advantage over gardeners. Whereas plants can’t speak up about what’s going on, team members can communicate! Managers can ask questions and learn what conditions will be best for optimal employee performance. The key, though, is to be inquisitive. We must ask. We must observe. But more important, we must want to know. Let me repeat that last one: We must want to know. If you are a manager and you don’t want to know what motivates your employees, then perhaps it is time to reADVANCING THE IMAGING PROFESSIONAL

“ T he key, though, is to be inquisitive. We must ask. We must observe. But more important, we must want to know. Let me repeat that last one: We must want to know.” consider whether you should be in a managerial role. Assuming you want to be an effective manager, I strongly recommend you discover what conditions your team needs to be their best, and work to create those conditions. Moving on to another gardening analogy, you probably know that gardeners select plants appropriate to the purpose and location of their gardens. For example, if a garden is in full sun, gardeners choose plants that do well in sun. If the area is mostly in the shade, then plants are chosen that prefer shade. In the same way, managers must be aware of the purpose of their team and select employees that will best fulfill that purpose. After all, a gardener doesn’t buy just any old plant for a flower garden. If the garden is for flowers, gardeners shop only for flowers, and look for the best they can find. Similarly, a manager should have clear job descriptions for all the positions on the team, plus have a good interview strategy to identify the best possible applicants. Pulling weeds is another good analogy. In a garden, weeds use up a lot of soil nutrients and water, thus diminishing what’s available for the plants that are supposed to be there. In the workplace, weeds represent rumors and non-productive attitudes that deplete energy away from the real work that must be done. A manager should work to eliminate rumors and poor attitudes to get the best levels of productivity. Of the several analogies listed above, I believe the most important parallel is to be inquisitive. I don’t know any managers who majored in clairvoyance. Personally, three months ago I didn’t know much about some of the flowers I selected for my new berms, but a bit of study and some questions to experts helped me create conditions to get beautiful flowers. The bottom line in all this is to be curious and get feedback on the conditions of your workplace. Seek to learn how it could be better by asking employees what conditions they’d like to be able to perform at their best. Then, by tending to those conditions, it’s very likely your workplace will thrive. ICE

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888-298-1207 Daniel Bobinski, M.Ed. runs two businesses. One helps teams and individuals learn how to use Emotional Intelligence. The other helps companies improve their training programs. He’s also a best-selling author and a popular speaker at conferences and retreats. Reach him at daniel@eqfactor.net or 208-375-7606. WWW.IMAGINGIGLOO.COM

john@medimagetec.com www.medimagetec.com

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index

Exclusive Medical Solutions, Inc. p. 20

Adel Lawrence Associates, Inc. p. 46

AUE

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p. Front Cover

KEI Med Parts p. 46

Global Medical Imaging p. 15

Inrayparts.com p. 40

Health Tech Talent Management, Inc. p. 20

InterMed Group p. 35

D E F I N I N G TH E S T AN D A R D

Advanced Ultrasound Electronics p. 43

Carolina Medical Parts

Innovatus Imaging

KEI Medical Imaging Services p. 46

p. 5

Diagnostic Solutions p. 42

Medical Imaging Technologies p. 45

Injector Support & Service p. 17

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index

DIAGNOSTIC IMAGING & SURGICAL SOLUTIONS

Multi Diagnostic Imaging & Surgical Solutions p. 2

PM Imaging Management p. 35

RSTI/ Radiological Service Training Institute p. 4

Stephens International Recruiting Inc. p. 40

MW Imaging Corp. p. 26

TTI Travel p. 35

Varex Imaging Corporation p. 6

Radon Medical LLC p. 42

Summit Imaging p. 9

Webinar Wednesday p. 47

Ray-PacÂ® Oxford Instruments p. 3

Ray-Pac p. BC

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Tri-Imaging Solutions p. 19

X-ray Parts, Inc p. 13

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