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contents
ICE FEATURES
July 2018
“Most of the hospitals have in-house service and in-house physicists, so they already have some type of a plan to review their protocols to watch out for this situation.”
42 XR-29 Updates/Struggles
– Mahadevappa Mahesh
rofessional P 28 Spotlight
XR-29 is intended to ensure providers are monitoring patient exposure to
Jeff Davishas been interested in
radiation and takes aim at facilities using old systems, using monetary awards
electronics since he was a teen
to encourage them to upgrade. How do these practices impact the service
and after a few decades work-
and life cycle of imaging devices?
ing on automotive electronics he became a imaging service professional. He began his career as a parts changer while attending col-
Department
The imaging team at Banner Health has more than 450 years combined experience. The 37-member team is dedicated to medical imaging and radiation/oncology service. Page 30
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lege and moved into the role of technician after graduation.
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ICE DEPARTMENTS
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12 Imaging News
28 Professional Spotlight
46 Career Advice
20 People on the Move
30 Department Spotlight
33 Probe/Transducer Product Spotlight
22 Webinar Wednesday
34 Probe/Transducer Gallery 40 Tools of the Trade
49 Imaging Matters 50 Imaging Service 101 52 Daniel Bobinski 54 Index
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ICE Magazine (Vol. 2, Issue #7) July 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. © 2018
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IMAGING NEWS A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY
DR 800 Multi-purpose Digital Imaging System Receives FDA 510(k) Clearance Agfa has received FDA 510(k) clearance for its DR 800 multi-purpose imaging system. Offering one solution for radiography, fluoroscopy and advanced clinical applications, the DR 800 supports the role of radiology in the value-based care organization with increased versatility, functionality and efficiency. “The DR 800 has been designed to enable imaging departments to meet today’s growing demand for fluoroscopy, without requiring multiple investments,” said Louis Kuitenbrouwer, vice president imaging division of Agfa. “This versatile solution supports radiology within the care continuum, where informed diagnosis and treatment decisions are important for value-based care. We are very pleased with the FDA 510(k) clearance for its DR 800, which is a real step forward in ensuring radiology has the solutions it needs to handle the challenges of the evolving health care model.” The DR 800 comes standard with Dynamic MUSICA, for both static and dynamic (moving) images. This image processing software also enhances noise suppression, offers excellent brightness control, reduces veiling glare and plays a significant role in enabling potential dose reduction. MUSICA processes fluoroscopic images with high-quality and low-dose features. This workflow enrichment integrates the XERO universal viewer – which provides secure access to images from different departments and sources, in one view
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ICEMAGAZINE | JULY 2018
– in the MUSICA workstation. Collaboration features, such as instant messaging and clinical dialogue, enhance consultation on study acquisition between radiologists and radiographers. The DR 800 offers a three-in-one digital imaging solution. It can handle a full range of radiography (including static exams and tilting exams) and fluoroscopy exams (including barium studies, arthrograms, cystograms, myelography and catheter placement, etc.), without requiring multiple investments. Its 180 cm SID enables uncompromising chest
imaging. The highly customizable DR 800 can be equipped with high-frequency fluoroscopy generator options of 50, 65 or 80 kW, a console for patient-side positioning, a wireless console for remote control, a compressor cone and an auto-switching anti-scatter grid. EasyStitch technology enables full leg full spine exams, while LiveVision technology allows for dose-free remote positioning. Use of Cesium Iodide (CsI) detector technology combined with MUSICA image processing offers highspeed, high-resolution imaging and enables the potential for dose reduction. •
ADVANCING THE IMAGING PROFESSIONAL
news Dicom Systems Releases Load Balancer Designed for Accelerated DICOM Application Performance Dicom Systems Inc. has officially released the Dicom Systems Load Balancer designed specifically for DICOM traffic. The Dicom Systems Load Balancer is the latest module from the Enterprise Imaging Unifier platform, an interface engine designed for workflow, archiving, cloud and AI enablement. The load balancer has already been deployed at Desert Radiology (DR) which operates eight outpatient locations and serves 12 hospitals throughout Southern Nevada. Because of new strategies to reduce vendor hardware footprint, diagnostic imaging providers can chose the Dicom Systems Load Balancer and High Availability for more efficient ingestion. “Load balancing our DICOM traffic required a level of sophistication and flexibility that Dicom Systems was able to rapidly deploy. Our enterprise workload is now balanced by a set of algorithms which boosts IT resources and reinforces our commitment to delivering the highest quality care to patients,” said Paul J. Smith, chief information officer for DR. Benefits of the Dicom Systems Load Balancer listed in a press release include: • Full configuration and management for optimized DICOM image caching, compression, faster application delivery and scalability. • Pre-built, easy-to-use templates for agile deployment in Enterprise Imaging. • Provides an accurate, up-to-date health check on application and server performance. • Available for license as a standalone module or part of the Dicom Systems Enterprise Imaging Unifier platform. •
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news
The InterMed Group Acquires M.I.T. The InterMed Group has announced the acquisition of Medical Imaging Technologies Inc. (M.I.T.). The InterMed Group is a provider of integrated health technology management services, providing an array of asset management options to its clients. “From comprehensive equipment planning and administration to strategic coverage of key divisions or modalities in support of in-house, OEM or hybrid solutions, they tailor their services to enhance the overall quality, cost, timeliness and confidence in our clients’ technology management,” according to an InterMed press release. “I am excited about the capabilities and enhancements to the service coverages for CT services this deal represents. MIT
is a great cultural fit for us with their focus on quality services with integrity. MIT has a solid reputation in the southeast for great service and a belief in always bringing the best,” The InterMed Group CEO Rick Staab said. “Together, this acquisition allows The InterMed Group to deliver end-to-end customer service solutions, offering high adaptability to integrate both current and new customers referred in. M.I.T. has been providing top quality products and service for over 30 years by selling and servicing CT, MRI and X-ray equipment. They provide a full line of services that can be individually tailored to meet each of their customers’ needs and together with The InterMed Group will be able to ‘Bring the Best’ as well,” according to the press release. •
MR Solutions Introduces Continuous PET Detection System Traditionally PET imaging has been offered with one, two, three or even four rings of detectors with gaps between the rings. MR Solutions is offering continuous PET detection thus avoiding any artifacts caused by the gaps between the rings. “We can now provide a continuous detector which is customized to the length of the scanner,” MR Solutions CEO David Taylor said. “These arrays can be incorporated into our clip-on PET scanners for sequential multimodality imaging on both our MRI scanners and our recently launched CT range of scanners. The PET scanner is also available as an insert inside the bore of the cryogen-free MRI scanners for simultaneous PET/MR images.” All of the PET scanners, both clip on and inserts, can be used as a standalone scanner. The MR Solutions’ PET scanners provide a resolution below 1mm. “MR Solutions is dedicated to providing better imaging solutions to researchers across the globe. Technology is constantly improving and when you spend a great deal of money on a scanner which is going to have to last many years researchers want the lat-
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ICEMAGAZINE | JULY 2018
est technology,” Taylor said. MR Solutions is an independent manufacturer of preclinical MR technology and is a market leader for preclinical superconducting cryogen-free MRI systems, and spectrom-
eters for clinical MR scanners. MR Solutions has offices in the UK, North America and Asia as well as a network of agencies across the world. •
ADVANCING THE IMAGING PROFESSIONAL
news Richardson Healthcare Announces ALTA750 Replacement CT Tube Richardson Healthcare, a Division of Richardson Electronics Ltd. has announced the ALTA750 – a new CT tube manufactured by Richardson Electronics that is designed for use as a replacement tube for the Toshiba/Canon Medical Systems CXB-750D/4A tube (also known as the Varex Imaging MCS-7078). The ALTA750 is a new CT vacuum tube loaded into an OEM housing assembly to ensure full compatibility with the OEM CT system. Richardson Healthcare has run extensive life testing of the ALTA750 on OEM CT scanners, including clinical sites running up to 50 patients per day. The ALTA750 is designed to meet or exceed the performance of the original OEM tube. “Richardson Healthcare is committed to providing hospitals and third-party service providers with unique parts and training solutions, including significant investments in high-value components like the new ALTA750 replacement CT tube,” said Pat Fitzgerald, executive vice president and general manager of Richardson Healthcare. “We are now one of a few global companies with the design and manufacturing capabilities necessary to successfully produce CT tubes.” To optimize and increase the life of a new ALTA750 tube, Richardson Healthcare includes a heat exchanger and new HV cable kit as a complete package. The ALTA750 has a prorated 12-month or 200,000 rotations limited warranty, whichever comes first. The tube is certified as compatible with an extensive list of OEM scanners ranging from the Toshiba/Canon Aquilion series through the first-generation Toshiba/Canon PRIME CT scanner.
For a limited time, Richardson Healthcare will provide a 90-day complete satisfaction guarantee: Every new customer for the ALTA750 will receive a 90-day, no-questions-asked, complete satisfaction guarantee on their first tube purchased. Product returned during this period will be eligible for a full refund of the purchase price paid. The new ALTA750 tube is also available through the P3 Preferred Parts Partnership program, including a capitated-risk option that provides parts and tubes in exchange for a fixed monthly fee. •
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Nicklaus Children’s Hospital Becomes First Children’s Hospital to Acquire OmniTom Nicklaus Children’s Hospital in Miami, Florida, is the first children’s hospital in the nation to acquire the OmniTom mobile CT scanner from NeuroLogica, a subsidiary of Samsung Electronics Co. Ltd. The OmniTom is the world’s first medical device delivering high-quality non-contrast CT scans at the patients’ bedside with omni-directional wheels, collecting real-time data on pediatric patients. The OmniTom is intended to improve the hospital’s workflow efficiency goals by eliminating the need to transfer pediatric patients to the radiology department, reducing potential risks associated with moving patients, as well as reducing the time it takes to produce a scan by more than half. “At Nicklaus Children’s we value the importance of investing in technology that enhances comfort and safety for our patients. The OmniTom is a step towards that continued commitment, by reducing the amount of radiation children are exposed to while
enhancing safety for some of the most critical patients in our care,” said Sheryl Selinsky, director of radiology at Nicklaus Children’s Hospital. The OmniTom offers improved workflow while enhancing safety with smart sensing collision-avoidance sensors, visually warning the user of obstructions and stopping the OmniTom before an incident occurs. Its larger bore size will also allow for scans of more than just heads and necks, as well as increase safety for intubated patients who have many lines, says Nicklaus’ CT Section Chief Sherif Ayoud. In addition to improving safety, OmniTom delivers high-quality non-contrast axial and helical CT, CT angiography and CT perfusion scans at the point-of-care.
The combination of rapid scan time, ultra-small footprint, and immediate image viewing makes the OmniTom an indispensable tool when caring for critically ill patients. •
FDA Clears Robotic Ultrasound System
Neural Analytics Inc. has received FDA 510(k) clearance for its NeuralBot System, a robotic assistance technology that automatically adjusts orientation and position of its ultrasound products under the guidance of a health care professional. When used with its previously cleared Lucid M1 Transcranial Doppler Ultrasound System, can assist clinicians to non-invasively monitor a patient’s brain blood flow characteristics and can provide information to diagnose a variety of neurological disorders. 16
ICEMAGAZINE | JULY 2018
“Progress in treating neurological disorders has lagged due to a lack of available low-cost and objective patient diagnostic information. This has resulted in misdiagnosis, treatment delays and additional health care expenditures for patients suffering neurological disease,” said Robert Hamilton, Ph.D., co-founder and chief scientific officer of Neural Analytics. “Our new technology can assist a health care professional – when an expert technician is not available – with the collection of blood flow data to assist clinicians in efficiently triaging patients for appropriate treatment.” Neural Analytics will immediately commercialize the NeuralBot System with its currently available Lucid M1 TCD System in the U.S. as the “Lucid Robotic System.” The Lucid Robotic System, when used for a transcranial doppler ultrasound procedure for patients suspected of neurological disorder, is reimbursable by Medicare/Medicaid and most private payers. •
ADVANCING THE IMAGING PROFESSIONAL
Still think you can get some mileage out of your “end-of-life” Nuclear Medicine camera?
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The Carestream DRX-Revolution Nano Mobile X-ray System, designed by Micro-X Ltd, received the Good Design Award Best in Class in Product Design which is one of the highest honors for design innovation in Australia. The annual Good Design Awards are based on market success, excellence in architectural design, digital and communication design, business model innovation, social impact and design entrepreneurship. Rob Williams received the award on behalf of Carestream at the Sydney Opera House at the 60th annual Good Design Awards ceremony along with key MicroX staff. The DRX-Revolution Nano Mobile X-ray System utilizes Carbon Nano Tube technology to deliver significantly reduced size and weight when compared to existing mobile X-ray systems. The ultra lightweight design allows for easier positioning in cramped critical care areas such as the ICU and NICU. The Good Design Awards Jury commented that “The design and engineering team has tackled a health care problem with an innovative and ground-breaking solution – rather than bringing a patient to the equipment, the equipment is brought to the patient. Simple idea but extremely difficult to execute. The end result is a revolutionary product where the benefits are huge: smaller footprint, lighter weight and greater maneuverability that saves space in hospitals, aids in patient comfort and provides greater flexibility around mobile and field hospital solutions. Every element and touch point has been meticulously designed and detailed. The articulated arm is well balanced over the range of motions required and the large aperture for taking the X-ray images is easy to move around and lock in place. This is a brilliant design solution with a very high standard of manufacturing and carefully considered raw materials selection. Good design and innovation at its best.” The DRX-Revolution Nano Mobile X-ray System is scheduled for availability in Australia in the third quarter of 2018. It is currently available in the United States and Canada, and will be available in other countries as international regulatory approvals are completed. •
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showcase
SEE BEYOND: A New Approach to Device Repair, Service & Development Innovatus Imaging sees beyond boundaries to help health care professionals provide better patient care. The company offers the widest breadth of repair capabilities, taking a holistic approach by coupling reverse engineering and rigorous testing to ensure the highest quality of repair and yield rates. The company’s knowledge and experience spans the entire life cycle of medical imaging products – from design, development and manufacturing to distribution, sales and service. “We have documented, verifiable experience and can point to results across the board that demonstrate this expertise,” said Dennis Wulf, chief executive officer. “Our commitment to R&D and constant innovation help our customers serve their higher purpose – delivering exceptional patient care.”
PROBE REPAIR Customers partner with Innovatus because of the company’s unparalleled expertise in ultrasound probe repair. And it’s that expertise that enables Innovatus to see beyond the ordinary. Yielding exceptional repair rates within the third-party industry, the company’s foundation for comprehensive ultrasound repair services is built with customer care, knowledge and experience. “Our team brings experience from the clinical environment,” said Bill Kollitz, president and chief operating officer, “so we understand and can often anticipate customer challenges to improve efficiency.” The Innovatus probe repair services include TotalRepair – a 100% guaranteed repair solution on 140 popular ultrasound probes. The program also allows customers to elect to SWAP
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at the repair price; the company was the first in the industry to offer a program of this kind. This is one way Innovatus gives its customers peace of mind – knowing they will be back up and running as quickly as possible. Innovatus was first to offer repairs for 3D/4D probes among non-OEM service providers. The company uses proprietary repair processes and tooling for oil handling and replacement to ensure longevity. The company also repairs transesophageal echocardiography probe (TEEs), including advanced repair capabilities on 3D/4D TEE probes like the Philips X7-2t and GE 6VT-D. Rather than using a one-size-fits-all technique, Innovatus diagnoses the problem and disassembles each TEE to identify and rectify damage caused by fluid invasion often missed by other repair processes. The company’s culture of continuous improvement includes investment in research and development to constantly enhance the organization’s device repair capabilities. Innovatus also has an FDA-registered site for the design and manufacturing of specialty ultrasound probes. “We have the mindset of a device manufacturer. We understand the thinking and processes used in manufacturing and incorporate it into everything we do, including service and repair,” Wulf said.
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SPECIAL ADVERTISING SECTION
MRI REPAIR The company knows MRI coils from the inside and out. Leveraging more than a quarter-century of experience as a coil manufacturer credited with numerous coil patents, the company is the leader in third-party coil repair. With extensive electrical, mechanical and cosmetic repair capabilities, paired with one of the most extensive loaner inventories in the industry, Innovatus makes the repair process as simple as possible so health care providers experience maximized uptime.
CR SYSTEM AND DRY FILM PRINTER SERVICE Innovatus offers incomparable field service for CR systems and dry film printers so health care providers can extend the life of their equipment and
showcase
“SEE BEYOND” help optimize their bottom lines. Comprehensive services are available for CR systems and dry film printers made by Agfa, Carestream/Kodak, and Fuji. From preventative maintenance to emergency response, Innovatus offers quality repair service and delivery in the field where – and when – it matters most.
DIGITAL RADIOGRAPHY When customers are ready to transition to digital radiography, the company offers the MVi-DR retrofit solution, which is designed to seamlessly integrate and convert a conventional X-ray room or portable unit into a digital radiography system. The team at Innovatus is highly trained, and can help walk providers through the steps of upgrading their suite.
It’s more than a slogan for Innovatus. It’s the guiding vision for three companies that came together as one to provide best-inclass imaging devices and repair services. Formed in September 2017, Innovatus is the result of three former companies – Bayer MVS, Wetsco Inc., and MD MedTech – joining forces to draw on their combined expertise. Innovatus launched the new face of its combined global brand at the start of 2018. At the same time, the company underscored its renewed focus – to push past conventional boundaries in the medical imaging device industry, and to empower health care professionals to take patient care to the next level. Headquartered in Pittsburgh, Innovatus maintains operations in Tulsa, Denver and the Netherlands. ICE
FOR MORE INFORMATION, VISIT WWW.INNOVATUSIMAGING.COM
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PEOPLE ON THE MOVE
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By Matt Skoufalos
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The American College of Radiology has elected Geraldine McGinty as its board chair, the first woman to hold the position in the history of the organization. McGinty has previously served as vice-chair of its board of chancellors, chaired the ACR commission on economics, and is an editorial board member and reviewer for the Journal of the American College of Radiology. Also elected were Vice-Chair Howard B. Fleishon, President James A. Brink and Vice President Marta Hernanz-Schulman. The Atlanta Center for Medical Research has promoted director of operations Eric Riesenberg to CEO. Riesenberg has been an advisor to the board since 2001 and became its director of operations in 2008. Memorial Hermann Health System of Houston, Texas has promoted Brian Dean, executive vice president of academic affairs and service lines for the system and CEO of the Memorial Hermann-Texas Medical Center campus, to executive vice president and CFO of the health system. Greg Haralson, senior vice president and CEO of Memorial Hermann Southwest Hospital and Memorial Hermann Sugar Land Hospital, will assume Dean’s former role. Haralson, in turn, will be replaced by Malisha Patel, vice president of operations at Memorial Hermann Southwest.
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Jackson Healthcare of Atlanta, Georgia named Robyn Smith senior vice president of human resources and Travis Dommert its senior vice president of talent development. Smith is a member of the Society for Human Resource Management (SHRM) and a graduate of Kennesaw State University with a degree in management. Dommert was formerly president of Jackson Health IT, and holds an MBA from Emory University and an engineering degree from Northwestern University.
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Caliber Imaging & Diagnostics Inc. added Doug Leahy as vice president of reimbursement and health economics.
The National Comprehensive Cancer Network of Fort Washington, Pennsylvania has named Wui-Jin Koh its senior vice president and chief medical officer. Koh is a board-certified radiation oncologist, professor and medical director for radiation oncology at Fred Hutchinson Cancer Research Center/Seattle Cancer Care.
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Dune Medical Devices of Alpharetta, Georgia has appointed Alan Bond as CFO. Bond has made a career in finance in the medical device industry, having previously worked with McKesson and Given Imaging.
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Banner Health of Phoenix, Arizona has added Francisco Arabia as a physician executive of advanced heart failure and mechanical circulatory support. Arabia will also serve as professor of surgery at the University of Arizona College of Medicine-Phoenix, with a joint appointment at the University of Arizona College of Medicine-Tucson. Arabia holds a medical degree from the University of Pennsylvania School of Medicine. The American Urological Association (AUA) of Baltimore, Maryland promoted Finance Director Barbara Hartford to CFO, succeeding the retiring Mark Campobello, CPA. Hartford’s background also includes public accounting roles with KPMG. She holds a bachelor’s degree from the University of Baltimore and a master’s degree in accounting forensic studies from Stevenson University. BD of Franklin Lakes, New Jersey has added three new segment presidents in Medical Segment President Alberto Mas, Life Sciences President Patrick Kaltenbach and Interim Interventional Segment President Bill Tozzi. Prior BD interventional segment president John Groetelaars has joined Hill-Rom as its president, CEO and a member of its board of directors. He succeeds retiring president-CEO John J. Greisch. Groetelaars spent a decade at C.R. Bard, including as group president from 2015-17, and has also worked for Boston Scientific, Guidant Corp. and Eli Lilly.
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Privia Health of Arlington, Virginia has named Shawn Morris its CEO. Morris joins Privia from Cigna-HealthSpring, where he was president and COO. He has managed physician-led IPAs, a multi-specialty medical group, and began his career as a public accountant working with physician practices.
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The Denver, Colorado-based National Jewish Health Board of Directors has named attorney Rich Baer its board chair, succeeding Blair Richardson, who remains with its executive committee of the board. Baer is chief legal officer for Liberty Media Corporation, and has been executive vice president and chief legal officer of UnitedHealth Group. Baer is a 1979 graduate of Columbia University and a 1983 Duke University law school graduate.
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Varex Imaging Corporation of Salt Lake City, Utah, has added Walter M. Rosebrough Jr. to the company’s board of directors. Rosebrough is president-CEO and a director of STERIS plc; he has been president and CEO of Coastal Hydraulics Inc., and spent 20 years with Hill-Rom Holdings Inc., including as its president and CEO.
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PaxeraHealth of Boston, Massachusetts has added Warner Pyne III as vice president of U.S. sales and Paul Dandrow as
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CTO. Pyne’s career includes appointments at Philips Medical Systems, Dynamic Imaging, and Fuji Medical Systems; most recently, he was national sales specialist for NTT DATA Services. Dandrow has held business development positions with InSiteOne Inc., Superior Consultant Co., and was Global Delivery Director for NTT DATA/Dell Services.
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626 Holdings has named health care industry veteran Kevin Gill its new chief operating officer. Gill joins 626 Holdings after serving as director of national sales at Philips Healthcare NA-AllParts Medical Division. Gill earned a bachelor’s degree in business administration from State University of New York College at Oswego and an MBA, Executive Management from St. John’s University.
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news
WEBINAR WEDNESDAY X-ray QA and the Drive for Efficiency
T
he recent webinar “X-ray QA and the Drive for Efficiency” received high ratings from attendees as well as several compliments in a post-webinar survey. The RTI Group-sponsored webinar drew almost 200 attendees and received a 3.9 rating on a 5-point scale with 5 being the best possible rating. Participants were eligible for 1 CE credit from the ACI. This 60-minute webinar featured RTI Group International Sales Manager Lee Evans. He provided an overview of X-ray quality assurance by looking at how technology has driven efficiency over the past 20 years. “Great overview of X-ray technology,” Biomed G. Fraser said. “This webinar was simple but very informative. It was very straight to the point and had good flow. I’ve been a BMET for about 15 years now, and for the past year I’ve been teaching students, my future co-workers. I love Webinar Wednesday webinars. No matter what the topic is I always learn something. If not for me, for my students,” BMET Instructor J. Seriosa said. “Informative and to the point. Great way to pick up quick information on a relevant subject,” Biomed Engineering Team Leader W. Younkin said. The Conquest Imaging-sponsored webinar “Testing of New Technology Ultrasound Probes” attracted 292 registrations and each individual who attendeed the live webinar was eligible to receive 1 CE credit from the ACI. The webinar featured Conquest Imaging Senior Director of Technical Operations Bob Broschart. He explained how ultrasound probes often get damaged over time. He said there can be tremendous savings in probe
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damage and high-level repair costs if facilities know what to look for and if they proactively test probes. Just like many medical devices, lower level needs that go unaddressed can result in costly repairs down the road. In this webinar, attendees learned what to look for as well as information about the newest technology and best-practices for proactive probe testing. The webinar received high marks via a post-webinar survey. “This Webinar Wednesday was very helpful and full of information relevant to servicing ultrasound equipment. The presenter was obviously knowledgeable and passionate on the subject and had up-to-date info on current and emerging technologies,” Imaging Specialist R. Marek said. “Many thanks for this, it was very enlightening regarding new technological advancements in probe designs,” Biomed D. Aloyo said. The recent Nuvolo-sponsored webinar “How to Create a Single System of Record for HTM and Healthcare Facilities” adds to the great education offered through the Webinar Wednesday series. Participants not only gained valuable knowledge, they were eligible for 1 CE credit from the ACI. The 60-minute webinar featured Nuvolo Senior Director for Solution Consulting Ben Person. Many hospitals run several legacy CMMS applications for the clinical engineering and facilities departments. This webinar discussed how Nuvolo Facilities EAM enables HTM and facilities teams to work together on a single platform, with its modern, cloud-based CMMS alternative. Webinar attendees learned how to align
HTM/clinical teams with facilities to innovate health care facilities management and improve workplace experiences. They also learned how to create a single system of record and engagement for significant application consolidation as well as how to easily route work orders to improve productivity. Attendees praised the session in a post-webinar survey. “I am always willing to learn about the biomedical field. This webinar was well done! Ben is a great speaker and very knowledgeable,” wrote C. Donmoyer, Biomed Manager. “First webinar I have attended and was not disappointed. The system in question seems to be a very great system and I would hope to actually utilize it one day,” said J. Townsend, Biomed. “Today’s webinar was educational and very well presented. It was quite informative. I highly recommend for others to attend these webinar sessions,” shared S. Chand, Biomed. 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 companies that sponsored this month’s webinars.
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showcase
We are different, in a really good way
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ummit Imaging is a technology-enabled service organization that repairs and supports ultrasound and mammography imaging equipment in the Healthcare Technology Management (HTM) industry. A unique combination of
electronic component level hardware understanding, service software development and an extraordinary team allows the organization to lower total cost of ownership for health care facilities without compromising the safety and performance of the medical devices repaired and supported. Founded in 2006, the organization has grown into an award-winning place to work, according to the ratings given by Seattle Business Magazine. Taking care of its employees and empowering them to focus on caring for the customers has earned Summit Imaging an incredible reputation when it comes to quality and HTM support. What is even more exciting is that the expertise in both software and hardware enables Summit to rapidly expand support to more imaging modalities and give health care facilities an alternative to lower their total cost of ownership and maintain high quality of care for their patients.
How Summit Imaging lowers total cost of ownership for health care facilities Quality – ISO 13485:2003 and why it matters The customers of Summit Imaging have shared that the only way to sustainably lower total cost of ownership is through quality products and services. Today, patients are more informed than ever with the ease of access to quality metrics of health care facilities. If patients suffer harm to their health or undergo an unpleasant or unprofessional experience during their health care interactions, the care-giving institution’s rating will go down, potentially depriving it of the patronage of discerning consumers and unnecessarily reduce Medicare and Medicaid revenues. ISO 13485:2003 is an international standard that specifies the requirements for a quality management system (QMS), where a medical device support organization needs to demonstrate its ability to provide customers with medical devices and related services that con24
ICEMAGAZINE | JULY 2018
sistently meet customer expectations and regulatory requirements applicable to medical devices and related services. The primary objective of ISO 13485:2003 is to facilitate harmonized medical device regulatory requirements for quality management systems. Summit’s QMS has been ISO 13485:2003 certified for over three years, allowing the organization to scale operations and improve quality as health care facilities continue to grow and consolidate suppliers to optimize their operations. Warranty Summit Imaging has already established new industry standards with a 6-month warranty on all products. This has dramatically reduced the operational risk for customers. It is capable of providing such a generous warranty through methodical execution of its ISO 13485:2003 QMS.
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“We love our health care facility customers and their patients. We will continue to lead with the industry’s highest quality standards for our customers to lower their total cost of ownership.” – LARRY NGUYEN
“We are learning that as we trail blaze new service methods and techniques that it is our moral responsibility to share with our customers for them to improve and lower their total cost of ownership.” – KYLE GROZELLE
Eliminate unnecessary outsourced service costs The Technical Support Team at Summit Imaging is available 24 hours a day, seven days a week. The main goal of the organization is simple: to remotely assist HTMs to get equipment up and running in the least amount of time. This remote assistance model supports the on-site HTMs, making them the quickest to respond, diagnose and resolve down equipment by leveraging Summit’s technical expertise. Average diagnosis time is under five minutes, and every call is answered in an average of less than two rings. This relationship with HTM customers eliminates unnecessary outsourced service costs and maximizes equipment uptime. The organization has deployed an expanded Version 3.0 of Adepto™, a patent-pending software that has a highly useful set of tools, utilities and other valuable functions that work with multiple leading ultrasound system platforms that are otherwise locked down with proprietary passcodes. Functions including system configuration adjustments, retrieving diagnostic error logs and performing calibrations are only a few of the features of this industry-changing software. This software eliminates outsourced service costs and reduces hundreds of downtime hours, thereby increasing revenue potential for health care facilities. HTMs report that 3 to 48 hours of downtime per service call is saved as a result of using Summit’s Technical Support in conjunction with Adepto™. Effective HTM and user training Summit aims to partner with its health care facility customers to support their training needs in servicing their own ultrasound and mammography equipment. During each training session, HTMs will be taught the way to accurately diagnose and service ultrasound systems and eliminate unnecessary outsourced service costs. The curriculum formulated by the organization covers additional critical topics HTMs need to know to minimize equipment downtime, including image quality based on image standards decided by the chair of diagnostic ultrasound at Seattle WWW.IMAGINGIGLOO.COM
University, a top-ranked diagnostic medical sonography university. An increasingly popular course has been ultrasound transducer handling. These classes, typically conducted on site, cover topics applicable to a sonographer’s practical use of a transducer and the manner in which the image quality impacts their workflow. Proper care methods and techniques are presented to help prevent unnecessary problems. Attendees will interact with disassembled ultrasound transducer components and learn about the common vulnerabilities of damage, and the relationship of the two to the functionality and the performance of the equipment. Online video tutorials have been created by the Summit Technical Support Team to aid HTMs in servicing a rapidly growing volume of equipment. These videos have been made available on YouTube and can be viewed for free at any time. Gaining knowledge through the videos has resulted in reduced equipment downtime, as the HTMs are more capable of resolving the problems with the help of a practical and proven approach. We want to make a positive difference in the HTM industry with education and awareness The organization has been requested by its health care facility customers to share insights on the many aspects that make Summit unique. Summit continues to work with them to produce YouTube videos that educate and create awareness on topics such as risk mitigation, organizational development, quality standards, image quality and a host of other topics where there is lack of information in the HTM community. YouTube has been an effective platform for the organization to easily articulate and share knowledge and findings with the HTM industry. Summit’s goal is to improve quality for the industry to best serve patients and provide them the quality of care they expect and deserve. The more the community knows, the more improvements can be made. The YouTube channel of the organization can be found at youtube.com/summitimaging. ICE ICEMAGAZINE
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SAVE THE DATE!
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Webinar Wednesday series is a great way to expand your education and earn CEUs in a convenient format. - D. Minke, BMET
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people
PROFESSIONAL SPOTLIGHT The Right Attitude: Jeff Davis
S
ometimes the people who read Popular Electronics as a kid or who watched a radio be returned to life after a session with the soldering gun turn out to make a career of it. The fascination with electronic gadgets, and knowing your way around a circuit board, are addictive. For Jeff Davis, who is a medical equipment repair technician with Network Imaging Systems Inc. in Charlotte, North Carolina, this is how it all started. “My fascination with electronics began as a teenager, when I visited my uncle’s radio repair shop. I soon began subscribing to any electronics magazine I could find. When I figured out how much I enjoyed fixing things, my career path was decided,” Davis remembers. “After 30 years in the automotive electronics repair business, I was looking for a new challenge. I received a call from Network Imaging Systems, after they found my resume posted on a job board, and I was thrilled to 28
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find they were willing to train me as a biomedical equipment technician,” he says. Davis had already earned an associate degree from Virginia Western Community College in Roanoke, Virginia and then a Bachelor of Science in electrical engineering technology from the University of North Carolina at Charlotte. “While I did not study biomedical equipment technology in a formal setting, my background in troubleshooting electronic circuits was very beneficial in learning to troubleshoot CT and MRI machines. After I was hired by Network Imaging Systems, Brent Hull directed my training with a combination of physics (electrostatics) study and on-the-job training,” Davis says. Before becoming an imaging service professional, Davis began his career as a parts changer while attending college and moved into the role of technician after graduation. “I’ve also been a quality engineer, a di-
By K. Richard Douglas
“I love problem solving and will work through problems until they are solved.” vision manager, and I’ve run my own service company. I’ve been fortunate to wear many hats during my career and I’ve been able to bring all the skills I’ve learned along the way to my role at Network Imaging Systems,” he says. Being good at detective work has proven to be an asset when working on imaging systems. “My biggest strengths are in troubleshooting electrical circuits, such as power supplies. I also don’t get frustrated easily, which is an asset in troubleshooting complex systems. I love problem solving and ADVANCING THE IMAGING PROFESSIONAL
Favorite part of being an imaging professional? “The best part of my job is that I’m always learning something new. Working in both the CT and MRI areas is both challenging and highly rewarding. I enjoy helping people, and by keeping this equipment in the best operating condition possible, I’m supporting diagnostics so health care professionals can give the best possible care to their patients.”
GET TO KNOW THE PRO Favorite book “The Adventures of Tom Sawyer” by Mark Twain Favorite movie “Avengers: Infinity War” Favorite food Pizza with everything Hidden talent Audio engineer
Jeff Davis Imaging Professional
will work through problems until they are solved,” Davis says. Entry into imaging has presented a few challenges as has a trailer lift gate. “Understanding the physics behind the MRI was a challenge in the beginning. It’s important to understand the theory behind the machine in order to troubleshoot when there is a problem,” Davis says. “One project I spent a good deal of time on was a lift gate circuit in a mobile CT trailer. We had acquired a mobile CT trailer that had an inoperative lift gate. The wiring had been removed and I had to recreate the wiring diagram to create the interface between the lift motor and the switches and lights in the trailer,” he adds. Mixing Sound and Accomplished Family When not on the job, Davis mans the mixing board and spends time with family. “I love music and I’ve been a part-time WWW.IMAGINGIGLOO.COM
sound engineer for my church, Lake Forest Church in Huntersville, North Carolina, for more than 20 years. I’ve enjoyed mixing for several blues artists such as Larry McCray, The McCrary Sisters, and Grammy Award-winner Mike Farris. I also love to ride my Harley-Davidson on North Carolina’s country roads,” he says. Davis can talk shop at home and at least part of the family will know exactly what he is talking about. “I’ve been married for 27 years to my wife, Carol, an electrical engineering technology instructor at Central Piedmont Community College,” he says. “My oldest son, Bradley, just graduated from North Carolina State University in biomedical engineering. My middle son, Hunter, will be a sophomore at UNC Charlotte in the fall. My youngest son, Jackson, is a sophomore in high school and loves to play electric guitar,” Davis says. Asked what readers should know about
What’s on my bench? “My favorite tool is my Fluke multimeter but, honestly, my day doesn’t start without a good cup of coffee. Also, I like to have my Hakko 808 de-soldering gun close by when a circuit board needs a repair. My laptop contains wiring diagrams for the various pieces of equipment I might need to troubleshoot so it’s essential to keeping equipment downtime to a minimum. A good non-metallic tool set is a must for MRI work.”
him, Davis opines his perspective on work and problem-solving. “I never met anyone I didn’t like and I work well with everyone. I have a very laid back personality and I’m generally a very happy person. I love my job and the people I work with. I know there’s always a solution if you work the problem long enough,” he says. When an MRI or CT is down in North Carolina, Jeff Davis can be dispatched to get it working again. And, if there is a concert venue nearby, he can get the sound just right too. ICE ICEMAGAZINE
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people By K. Richard Douglas
DEPARTMENT SPOTLIGHT Banner Health Imaging Team
H
ow many imaging teams can claim centuries of experience? If you are the imaging team at Banner Health, you have the green light to do just that. The team has more than 450 years combined experience. The 37-member team is dedicated to medical imaging and radiation/oncology service. “The imaging team is led by Director of Diagnostic Imaging Support Services Sherman Abernathy in Arizona who is flanked by three senior managers; Jon Morgan, Guillermo ‘Memo’ Valles and Jack Plummer,” says Perry Kirwan, MSE, CCE, vice president of technology management for Banner Health. “In Colorado, the team is led by Todd Lowe, senior director of technology management/ENTECH. He oversees all of the non-imaging and our ENTECH operations for all states outside of Arizona,” Kirwan says. Banner Health is one of the largest nonprofit hospital systems in the country. The system consists of a 5,500-bed integrated health delivery network headquartered in Phoenix, Arizona and operating in six states. The integrated delivery network (IDN) consists of 28 acute care hospitals ranging in size, scope and complexity from small, rural facilities to quaternary academic medical centers and every size and flavor of community medicine facility in between. The team has a large inventory of equipment to manage. They provide service to 132 fixed X-ray rooms, 123 portable X-ray units, 77 R&F rooms, 189 C-arms, 59 cardiac cath labs, 26 interventional radiology labs, 94 CT scanners, 10 PET enabled technologies, 43 nuclear medicine cameras, 30
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44 MRIs, 109 mammography systems, 643 ultrasound units and 19 radiation oncology systems (linear accelerators, tomosynthesis, image-guided surgery). The team’s training comes by way of OEM, third party and through cross training. “Our pre-purchasing processes are highly structured to provide OEM training as much as possible,” Kirwan says.
Big hospital systems provide big projects and the Banner imaging team has met that challenge head on. “Most purchases come with a minimum of two-year warranty so that there is time between initial commissioning and warranty expiration to train our engineers. This is critically important for brand new models that enter the marketplace as there typically are no third-party resources that we can turn to for training, service and parts,” he says. He says that the occasions where such an approach is not possible, they utilize many reputable third-party sources to help supplement training. “Third-party training has been invaluable in training engineers into imaging or upgrading their current skills. It has also been valuable to help us take over service on imaging modalities that are added to the inventory via acquisitions. Cross train-
ing is a key feature in skill development as well in that we expect engineers that are formally trained to teach other engineers via a see/learn one, do one, teach one approach,” Kirwan adds. “Our operations budget for training ranges from $200-$250,000, however the value of training that we receive in any given year is almost double that (taking into account negotiated service schools, etcetera),” he says. Big Projects Big hospital systems provide big projects and the Banner imaging team has met that challenge head on. “In the last 24 month, the imaging team has been involved with several high-profile projects including the building of two large academic medical center tower projects that are about $900 million and include about $40 million in new imaging equipment,” Kirwan says. “Both projects are happening simultaneously which creates some challenges on bandwidth when mixed with the routine service volumes. These projects feature a mixture of new implementation and relocation of existing systems,” Kirwan adds. Radiation dosage has become an important focus in health care and the implementation of procedures to monitor it are critical. The imaging team has executed procedures to monitor it enterprise wide. “This system has the ability to receive dose specific information from imaging modalities injected with PACS information to help provide information relative to the radiation dose that a patient receives. This is an area that a fair number of facilities canADVANCING THE IMAGING PROFESSIONAL
David Lawler, Diagnostic Imaging Tech III, works on a Siemens CT at Banner Thunderbird.
James Brown is a MRI Service Engineer at North Colorado Medical Center.
not quantify because they cannot measure it and that is the beauty of the software in that it shows an organization its baseline level of performance and most people, including us, are shocked by what we see and what we didn’t actually know,” Kirwan says. “Data analyzed from the system have played a large role in helping medical physics and radiologists standardize imaging protocols across the IDN in modalities like CT. The ability to measure dose performance enables knowing whether the organization is really performing in the spirit of ALARA or Image Gently/Wisely. Notifications can be configured as well to alert clinical and business leaders when certain thresholds are exceeded. This work was recently recognized at one of our academic medical centers by TJC as being a best practice,” Kirwan says. He also says that the team is involved in implementation of a business analytics solution that holds the promise of helping better optimize the clinical and WWW.IMAGINGIGLOO.COM
business operations of all of the medical imaging departments. “This system has unique and vendor agnostic connectivity to the imaging modalities, radiation dose monitoring, PACS, RIS and other BI related systems in the IDN to provide access to departmental performance through an easy to use dashboard,” Kirwan says. He says that the dashboard contains information about custom set key performance indicators (KPIs) relating to the utilization, usage and performance of the connected systems as a whole while also enabling a specific modality to be examined in greater detail. “The data set further includes access to technologist level information to help identify insights into how the systems are used, what features are/aren’t utilized, and outlying issues that might require further training,” Kirwan adds. The team also helps manage and commission between $10 and $15 million of re-
Shelia Thomas, Diagnostic Imaging Tech I at Banner University Medical Center -Tucson works on a Shimadzu Rad Speed table.
fresh replacement imaging capital per year just for good measure. The imaging team has also recently developed a workflow to help the internal development and construction department, as well as contracted design team consultants (architects and engineers), make decisions on how to supply incoming power to medical imaging modalities. “These decisions aren’t to deviate from manufacturing specifications but to provide additional clarity on what can be on normal versus emergency power, when other power bridging and/or conditioning provisions are required, and how this information needs to be incorporated within the physical plant of a given facility, etc. This is information that the manufacturer specifications do not define because they are locally based decisions,” Kirwan says. Big hospital systems demand big service teams and the imaging team at Banner Health fills those big shoes with centuries of expertise to keep diagnostic imaging online. ICE ICEMAGAZINE
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products
PRODUCT SPOTLIGHT Probe/Transducer Market Growth Continues
A
s ultrasound imaging becomes more and more common for a variety of medical reasons the probe/transducer market will continue to grow. Innovations and new technological advances are powering widespread use of ultrasound for more and more diagnoses and treatments. The global ultrasound market is estimated to reach $6.86 billion by 2021, according to a report by MarketsandMarkets. The market is forecast to grow at a compound annual growth rate (CAGR) of 5.2 percent during the forecast period. “The growth in this market can largely be attributed to factors such as rising patient population base for chronic and lifestyle-related disorders (coupled with a growing geriatric population that is at greater risk of target diseases as compared to adults); technological advancements; and growing market demand for minimally invasive diagnostic and therapeutic techniques (including ultrasound),” according to the report. The global ultrasound market is also getting a boost from the continued development of markets in Asia. “Emerging markets (such as China and India) are offering high growth opportunities for WWW.IMAGINGIGLOO.COM
market players in the ultrasound industry. The rising incidence of chronic and infectious diseases, increase in awareness related to minimally invasive procedures, and continuously rising health care expenditure in the Asia-Pacific region are the key factors driving the demand for ultrasound in emerging nations. In order to leverage the high growth opportunities in these emerging nations, leading market players are expanding their presence in these countries,” according to the report. A summary report from Transparency Market Research also hints at continued growth for the global ultrasound market. “Ultrasound transducers use non-piezoelectric principles such as magnetostriction and diaphragm principle used for fabrication of transducer arrays. Cardiac ultrasound transducers are available in different sizes and shapes in order to be used outside the echo lab. However, new developments in ultrasound technology and cardiac ultrasounds allow imaging at the cellular or molecular level, paving the way for earlier diagnosis and treatment of diseases,” according to Transparency Market Research. “High prevalence of diseases such as cardiovascular diseases, geriatric population with bypass surgery, rising patient awareness
programs, growing research and development initiatives for heart diseases, and increasing demand for diagnostic imaging devices are the major factors driving the cardiac ultrasound transducers market,” according to Transparency Market Research. According to the World Health Organization (WHO), cardiovascular disease is a leading cause of death globally. “Growth in technologies such as biochips, catheter implantation, small hand-held or pocket-sized ultrasound systems, and increase in use of advanced software applications available for measuring the protocol of the ultrasound test are likely to fuel the growth of the cardiac ultrasound transducers market,” according to Transparency Market Research. “North America dominates the global cardiac ultrasound transducers market due to sophisticated infrastructure with modern software modalities, patient awareness programs and high per capita health care expenditure,” according to the report. Major players operating in the global cardiac ultrasound transducers market include Siemens Healthineers, Esaote SpA, GE Healthcare, Fujifilm Sonosite Inc., Samsung and Canon Medical Systems USA Inc. ICE ICEMAGAZINE
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products
Canon Medical Systems USA Inc. Aplio i-series Ultrasound Enabling health care providers to utilize a cost-effective, safe and less invasive solution for a wide range of exams, the premium Aplio i-series ultrasound platform from Canon Medical Systems USA Inc. delivers quick imaging for efficient diagnoses and faster triage with an ultra-high frequency transducer. The Aplio i-series’ 24 MHz transducer enables clinicians to visualize more with superior detail and definition. The platform is a highly advanced and scalable ultrasound solution including the Aplio i700, Aplio i800 and Aplio i900. The systems feature iPerformance technologies that deliver extreme processing power and the iSense design provides intuitive ergonomics to boost productivity.
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products
Carestream Touch Ultrasound Carestream Touch Ultrasound systems include a family of transducers for a wide range of imaging applications. Advanced Smart Connect technology provides increased sensitivity and efficiency, with improved scanning across a broad variety of body types. Four transducers can be connected simultaneously to any of four ports via pinless connectors. A unique Smart Select button allows quick, one-touch transducer activation and the single touch of a button allows freezing, storing and printing of images.
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products GE Healthcare Voluson E10 The Voluson E10 from GE Healthcare encompasses the most advanced imaging capabilities combined with efficiency and security features to help clinicians provide confident patient answers, faster. Its new innovative imaging technologies include Radiantflow – a new standard of color Doppler for an easy and fast visualization of even the tiniest of vessels – and the next generation of HDlive, revealing unique anatomical perspectives and amazing detail. The eM6c probe is the world’s first commercially available curved matric electronic 4D probe designed specifically for women’s health. This revolutionary probe opens new possibilities for exceptional care with ultra-fast volume rates, flexible imaging formats and excellent resolution in routine women’s health exams to complex fetal echocardiography.
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Philips eL18-4 Transducer The Philips eL18-4 transducer is an ultra-broadband PureWave transducer, allowing fine-elevation focusing to deliver exceptional detail resolution and tissue uniformity for a broad range of clinical solutions, including thyroid, breast, testicular, musculoskeletal, vascular, bowel, pediatrics and obstetrics. The eL184 transducer provides more definitive information about tissue stiffness, elevating diagnostic confidence. Additionally, Philips MicroFlow Imaging detects blood flow in small vessels yielding important information about tissue microcirculation. Precision biopsy reduces needle blind zones and supports the ability to enhance the display of needle reflections, elevating clinician confidence during interventional procedures. This specifically benefits difficult to image patients.
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products
Siemens Healthineers ACUSON SC2000 Z6M True Volume 3D TEE Probe The ACUSON SC2000 Z6M True Volume 3D TEE Probe is engineered to arm you with a complete, anatomically precise picture of your patient’s heart for informed clinical decisions without missing a beat. It features sophisticated imaging tools, such as true real-time volume color Doppler (90 x 90) and rapid, automated valve modeling to deliver the reliable, actionable knowledge you need in the moments when it matters most.
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ADVANCING THE IMAGING PROFESSIONAL
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he Dynamic Cardiac Phantom is a precision instrument that simulates the realistic motion of an average human heart. It provides known, accurate and repeatable 3D motion of a solid heart model inside the tissue-equivalent thorax phantom. The phantom is designed as a comprehensive image analysis tool for calcification detection, iodine contrast resolution and ECG signal gating. The cardiac phantom is constructed from a tissue equivalent thorax body, moving rod with a solid tissue equivalent heart inside, motion actuator, motion controller and CIRS Motion Control software. The 3D movement of the heart is controlled by CIRS Motion Control software, which is installed on a Windows PC or Laptop. The software comes loaded with three basic motion profiles that are specific to different anatomical parts of the heart and one correlated ECG profile. The software can overlay respiratory motion with cardiac motion to account for total displacement of the heart. The respiratory motion can mimic either breath hold or continuous breathing of a patient. ICE For information, visit www.cirsinc.com.
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ICEMAGAZINE | JUNE 2018
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BY MATT SKOUFALOS
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ICEMAGAZINE | JULY 2018
S T R U G G L E S &
29
U P D A T E S
XR
ADVANCING THE IMAGING PROFESSIONAL
JACOBY ROTH WAS JUST TWO-AND-A-HALF YEARS OLD WHEN HE WAS SENT FOR A CT SCAN AT THE MAD RIVER COMMUNITY HOSPITAL IN ARCATA, CALIFORNIA. THE TODDLER HAD FALLEN OFF HIS BED, AND WAS COMPLAINING ABOUT NECK PAINS, ACCORDING TO THE
NEW YORK TIMES. HIS FATHER, PADRE, SAT WITH THE CHILD IN THE IMAGING SUITE, HOLDING JACOBY’S HEAD STILL WHILE HE WAS SCANNED FOR MORE THAN AN HOUR. ACCORDING TO THE TIMES, IT WAS ONLY WHEN PADRE BECAME CONCERNED ABOUT THE LENGTH OF TIME THE SCAN WAS TAKING THAT IT WAS INTERRUPTED. I NVESTIG ATO RS FO UN D THAT T H E T E C H N OLOGIST H A D S C A N N E D THE CH I LD 151 TIME S IN THE SAME A R EA, PR OD UC IN G R A D IAT ION BU RNS T H AT LATER SURFACED ON HI S FAC E , A N D D R A MAT IC A LLY IN C R EAS I NG HIS L IKELIHO OD OF DEV E LOPIN G C A N C E R . T H AT WAS IN 2 009. THE SAME TIMES REPORT ALSO RECAPPED THE DISCLOSURE BY CEDARS-SINAI MEDICAL CENTER IN LOS ANGELES THAT YEAR, “THAT IT HAD MISTAKENLY ADMINISTERED UP TO EIG HT TIMES THE N O R MA L RA DIAT I O N DOSE TO 206 POSSIBLE STROKE VICTIMS OVER AN 18-MONTH PERIOD DURING A PROCEDURE INTENDED TO GET CLEARER IMAGES OF THE BRAIN.”
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X R - 2 9 :
T
hose high-profile cases and others like them were catalytic elements in the push for greater adoption of patient safety standards in the use of ionizing radiation, one of which is the NEMA XR-29 (MITA Smart Dose) Standard. Developed to mitigate the number and severity of accidents in the course of receiving a CT scan, XR-29 took effect in 2016. Medical physicist Mahadevappa Mahesh characterizes XR-29 as a positive development for the imaging industry, and credited medical physicists and imaging device manufacturers with contriving a solution to the problem of imaging dose management. A professor in the Russell H. Morgan Department of Radiology and Radiological Science at Johns Hopkins University in Baltimore, Maryland, as well as the chief physicist at Johns Hopkins Hospital and an ACR fellow, Mahesh said the standard resolves a number of important controls for the appropriate management of CT.
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&
S T R U G G L E S
bursement portion of their bill to the Centers for Medicare and Medicaid Services (CMS). In 2016, when that 15 percent penalty was enacted, one-third of the existing U.S. CT install base was already compliant with NEMA XR-29, one-third could be brought into compliance with an OEM software update or third-party vendor upgrade, and one-third wouldn’t be able to be upgraded to compliance, according to the Medical Imaging & Technology Alliance (MITA). The third of these has created some issues for equipment operators, Mahesh said, especially as the standard has different financial implications for unaffiliated outpatient imaging centers and physician offices serving Medicare patients. “There is a financial aspect to the whole thing,” he said. “Clinics have to invest in some new equipment. That has been an ongoing issue, especially when revenues in hospitals are going down, and they have to scramble in the yearly budget to accommodate this regulation, since each scanner has to be upgraded.” Ambulatory clinics were likeliest to feel the sting, not only from the perspective of limited capital purchasing resources, but from that of the two-year compliance onramp, during which reimbursement penalties jumped from 5 to 15 percent. Most of the XR-29 tenets – CT dose check, automatic exposure controls and DICOM structured reporting – require more than a software upgrade to correct. That means that fixes come down to disposing of one of the most expensive pieces of equipment in the imaging suite or investing in a third-party apparatus to perform some of those auxiliary functions. “That’s a lot of software upgrades in order to provide a structured dose report for each patient,” Mahesh said. “If a clinic goes in the direction of getting a new scanner, that’s where the heartache comes into the picture.” Although imaging equipment lifecycles can run from eight to 10 years, scanners with pre-XR-29 functionality may have their useful life cut short, even if they essentially have no other impediments to their operation. They could otherwise have functioned normally for an extra decade, and in the context of rural and community hospitals, many of them may still have been repurposed to other uses. Even reselling the scanners within the U.S. market doesn’t offer as much opportunity to recoup sunk costs because of the devices being out of compliance. “From the point of view of the user, here’s a product that’s very good for our pa-
“CLINICS HAVE TO INVEST IN SOME NEW EQUIPMENT. THAT HAS BEEN AN ONGOING ISSUE, ESPECIALLY WHEN REVENUES IN HOSPITALS ARE GOING DOWN.” Under it, scanners must provide: • DICOM radiation dose structured reports at the conclusion of a scan; • a pre-scan dose check, which estimates radiation dose prior to the initiation of a study, and provides dose notifications and dose alerts when a scan exceeds those boundaries; • automatic exposure controls (AECs) that automatically adjust the amount of radiation necessary to get a high-quality image (and which can reduce dose); • different pre-loaded reference protocols for pediatric and adult studies. CT studies conducted on devices that do not comply with this standard are subject to a 15 percent reduction in the technical reim-
U P D A T E S
tients, but I’m at a loss because some clinics have to incur so much expense to do this thing,” Mahesh said. “The issue is to find the revenue in a very short amount of time. “If I’m a small clinic owner, I’m really at a disadvantage on how to go about this issue,” he added. Purchased directly from the OEM, a new CT scanner could cost around $1 million, with a refurbished 64-slice scanner coming in at about half that amount, Mahesh said. Ballpark figures for upgrades are around $30,000 to $100,000 – not immaterial, but not as much as buying a new unit. These fixes are temporary solutions for smaller operators until their CT scanner reaches the end of its useful life and they can buy a new one. But Mahesh also points out that scrambling to upgrade the scanners so they’re in compliance may affect budget timelines for the upgrading of other equipment. And, these aftermarket solutions may require separate service contracts that may become future stumbling blocks. “Depending on what the third party accomplished, sometimes the manufacturers do not like to have that interaction with the scanner,” he said. It’s also difficult to track where CT scanners in need of upgrade might be, or their current functionality. According to national data, Mahesh said about 8 percent of the U.S. install base of CT scanners offered fewer than 16 slices in 2015; among them, he doesn’t know how many are in outpatient settings. “Eventually, it’s not going to be a problem because in the next couple of years, hospitals are going to buy new equipment,” Mahesh said. “Most of the hospitals have in-house service and in-house physicists, so they already have some type of a plan to review their protocols to watch out for this situation.” Furthermore, as valuable as XR-29 compliance is to an institution in terms of patient safety, health outcomes, and full reimbursement, there is little in the way of enforcement to the standard, and little paper trail to evaluate the efficacy of the changes the statute has driven. Until there’s a Joint Commission survey or other investigation into institutional compliance, imaging departments are dependent upon the technology working the way it’s intended to keep patients safe. “As a medical physicist, I worry about that,” Mahesh said. “An administrator wants his system to be compliant, but more important than that, we have to make sure these work properly. “Dose check features are very helpful, because that’s what led to unnecessary radiation injuries to patients,” he said. “The role of the medical physicist is increasing ADVANCING THE IMAGING PROFESSIONAL
in any setting to make sure the scanner is operating correctly [and] to have a critical role in making sure the patients are scanned properly.” A CMS spokesperson said there have been no delays in the rollout of XR-29 compliance monitoring, but also notes that, short of self-reporting, the agency “has tasked the Advanced Diagnostic Imaging Accrediting Organizations with providing CMS with periodic verification of non-compliant CT systems owned or operated by their accredited ADI suppliers.” CMS also acknowledged that a “small percentage of Advanced Diagnostic Imaging (ADI) suppliers” with non-XR-29-compliant equipment have elected to purchase new scanners, “even though their older equipment could be upgraded with a manufacturer’s software upgrade or third-party vendor upgrade solution.” The agency breaks those down into operators of systems less than 15 years old, which “have elected to upgrade their CT systems with a manufacturer’s OEM software upgrade for little or no cost,” and the approximately one-third of the install base that is too old or unable to be OEM-upgraded. CMS noted that only two suppliers of aftermarket compliance solutions, MedicVision, and Zetta Medical, exist, and that the cost of those products might be significant for some operators. Despite these potential hardships, the statute and its mandate offer zero wiggle room. “The NEMA XR-29 requirements are a statutory requirement created by the legislature,” the spokesperson wrote. “Therefore, we are mandated to implement these requirements as written by Congress. We cannot ‘rethink’ the plan or change the requirements of the statute based on people’s reactions.” From the OEM perspective, the XR-29 rollout has been largely seamless, especially as the equipment manufacturers that directed its implementation drafted the technical fixes driven by the statute. Ken Denison, Executive MICT Digital Marketing for GE Healthcare, said that on the back end, a lot of that smoothness came from an early opportunity to update the company’s device installed base “as soon as we could, all the way back to our earliest, 16-slice scanner.” Denison said more than 80 percent of its installed devices have been updated. Some, like its single-slice, four-slice, and eight-slice systems could not be brought up to code, but that didn’t mean they weren’t operational. Many were being used for biopsies or WWW.IMAGINGIGLOO.COM
other interventional procedures that were exempted from the legislation. Instead, Denison said the biggest compliance hurdle was defining what documentation users might keep on-hand should they be required to demonstrate proof of their compliance with XR-29. GE Healthcare created a compliance letter for every device in its inventory, made them accessible to its internal teams, and created a self-serve website for customers to check their device’s compliance against the GE device ID database, and download verification letters. “The only straggling challenges we have are systems that change hands,” Denison said. “If it gets resold to a new owner, and the new owner wants another letter saying that it’s compliant, we get the odd call. But we’ve never had someone call in a panic saying, ‘CMS audited us.’ A lot of this is because we were pretty proactive in communicating.” GE Healthcare can also tell from software release versions whether a system it services or inspects is XR-29 compliant, and the company keeps an internal checklist of “anything that hasn’t changed hands yet,” Denison said. He said GE Healthcare “updated almost 100 percent” of those CT scanners in its install base, and has kept records of each update. Those systems that have changed hands most commonly have their compliance evaluated when a new owner contacts the company for a letter of compliance. Furthermore, Denison said the XR-29 statute hasn’t affected the GE resale business, as just about everything it’s reselling has either been upgraded to compliance with the standard, or retired. Older, fewer-slice scanners simply don’t have a great deal of value to the business these days. “There just isn’t a market for those systems that aren’t compliant,” Denison said. “There was maybe an increase in older systems for a year, or a year-and-a-half, but nothing that dramatic. There just weren’t that many devices in the market. At the time we did these updates, anything we weren’t able to update to be compliant was at least 12 to 15 years old. The average lifespan [of a CT scanner] was seven or eight years.” From the perspective of GE Healthcare, the look into its own inventory was the jumping-off point for the entire exercise of XR-29 rollout, Denison said. What the company found was that even if older scanners weren’t used for diagnostic work, they were
being repurposed for other opportunities. “I think we were mostly surprised to find out that many of them were still in hospitals,” he said. “When we picked a random sample, that’s where we found out that a lot of hospitals still have a [legacy CT] system where they’re doing interventional work, which aren’t covered under the [XR-29] legislation.” “It’s a suitable purpose for those older devices, and a lot of people had taken an older system and had put it in use anyway,” Denison said. If there’s any concerns, Denison said they focus on driving greater adoption of the variety of functions the upgraded scanners offer, including preset dose-check values and dose warning notifications. Licensed protocols ship with most new systems at the time of purchase for no extra charge; for systems in the GE Healthcare installed base, there is a nominal cost for systems to upgrade. “I know there’s frustration on the part of physicists that many sites aren’t taking advantage of the things that XR-29 affords them,” Denison said. “We license protocols that are optimized for our new CT scanners, and those include preset dose check values that our customers can use, that are not only optimized for the system but give them the appropriate warnings and notifications should the techs make any mistakes at the time of scan.”
THERE’S BEEN NO REPORTING OF PATIENTS RECEIVING EXCESSIVE DOSE RADIATION SINCE THE INITIAL INCIDENTS THAT LED TO THE CRAFTING OF XR-29, WHICH LEADS HIM TO CONCLUDE, “IT’S WORKING AS ADVERTISED.” At least anecdotally, since the statute has been implemented, Denison said there’s been no reporting of patients receiving excessive dose radiation since the initial incidents that led to the crafting of XR-29, which leads him to conclude, “It’s working as advertised.” “What we see is it’s been working as planned,” he said. ICE ICEMAGAZINE
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insight
CAREER ADVICE Resume Writing Tips
A
ll the mergers and acquisitions in the radiology equipment service industry may have you seeking a new opportunity or advancement. I find that for many imaging service professionals it has been years since they put a resume together. So, here are my guidelines for resume writing: Rule #1: Never have more than two-pages • The two-page rule applies only if your past experience and background relates to the position for which you are applying, if not, then one page! • The tendency for most candidates is to put critical information on the second or third page, where it might separate from the first page, or not even be read at all. • Although you might think your credentials warrant an autobiography, the majority of technical hiring managers don’t have the time to read more! Rule #2: Beware of fancy fonts • Using fancy fonts in your resume might demonstrate graphic arts talent, but will rarely get you an interview. Neither will your photo, unfortunately. • Your resume will be emailed or copied to others and fancy fonts are often difficult to read. Plus, oftentimes you will be asked to also apply online where you want a legible resume to copy and paste. • Employers may think there’s an underlying reason for sprucing up your resume – not enough related background, perhaps? • Enlarging and bolding your headings with adequate spacing between topic areas will make your resume more powerful and easier to read. Rule #3: Use bullets, not paragraphs • Keep the text short and easy to read. • In describing your experience and positions, always start with an action verb. Use present and past tense when possible. • Each statement or point you are making should be one line. • By starting with an action verb and keeping the statement to one line, your message will be powerful and to the point. Rule #4: Lose the fluff • When you describe yourself or your past experience in your summary or work history section avoid using “fluffy” phras46
ICEMAGAZINE | JULY 2018
Written by Jenifer Brown Health Tech Talent Management
es. These do not hold any weight with employers as they are deciding whether or not to interview you. Examples of such phrases are: “I’m a people person.” “I’m dedicated.” “I’m hard working.” “I’m loyal.” • These may be noteworthy attributes, but employers will not believe them until they actually witness them on the job. • Instead, fill you resume with facts. Rule #5: Beef it up; never make it up • Summarize or highlight years of experience, a specific skill set, and/or cost savings at the beginning of the resume (in bulleted format). • List all training certifications with a separate heading “Training Certifications.” NOTE: If you have a lot of these, use a separate sheet just for training! • List your degree(s) and related educational courses under a separate heading. • List awards or commendations, if they are industry-recognized or unique, under a separate heading. • List organizations and affiliations that are recognized by your industry under a separate heading. • The candidate who fictionalizes a university degree may be in trouble if the hiring authority has a relative who actually graduated from the school. • The candidate who claims to have experience with certain equipment or software may be embarrassed if a prospective employer asks for a mini-demo at the interview. NOTE: The only personal comments on a resume should pertain to your ability to speak other languages or willingness to relocate or travel. Overall comments and suggestions • Check your final draft for spelling and grammatical errors and inconsistencies. The last place you would like to see your resume go is into the “round file” (trash) due to this. • There are many resume formats available via the Internet, but be careful to choose a format that allows you the flexibility to present your credentials to your best advantage. • If you can’t find a suitable and adaptable format, create your own. It might not be easy, but you will be more likely to obtain your objective – an interview! ICE ADVANCING THE IMAGING PROFESSIONAL
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ADVANCING THE IMAGING PROFESSIONAL
insight
IMAGING MATTERS Equipment End of Life; What it Means to You
I
n a stuffy hospital boardroom with lukewarm coffee, two directors of different departments have come to do battle in their modern day quest. One will feel the thrill of victory, the other will taste defeat and suffer lingering reminders that they failed in their quest. That modern day quest for hospital managers and directors everywhere is the search for the elusive and almost mythical treasure known as “capital funds.” Those dollars drive political maneuvering, calculated numbers manipulation and virtual battles of epic proportion. All so that a department can receive funds to buy new equipment. One of the big sticks used as justification is the end-of-life (EOL) letter. The letter says that the equipment has reached the end of the manufacturer’s expectation of useful life. The one justification bigger than EOL is the end-of-support (EOS) letter. The EOS states that there will be no more parts or service available from the manufacturer for the unit in question. The perception by the user is that the equipment will simply break and no longer function. The department will be forced to turn away crowds of patients due to the inability to provide a service and the hospital will cease to function. It is true that for some items the EOL and EOS mark the passing of an era. This is more typical for biomedical equipment and niche imaging products than most diagnostic imaging products. If you have a general rad room, CT, cath lab or MRI made by Philips, GE or Siemens the EOL and EOS are really more of a suggestion than a true EOL/EOS. For diagnostic imaging equipment, the WWW.IMAGINGIGLOO.COM
EOL and EOS are also tools to drive sales of new equipment. It is part of an overall marketing strategy for any major company. Planned obsolescence is part of the marketing plan of all manufacturers, not just those of consumer goods. To be clear, there is nothing wrong with a marketing plan that drives development of better more reliable technology. However, the cost to value of a purchase has to be considered. There were CTs in use that were 4 slice that had seen EOL and EOS long before they were taken out of service. Many were still in use and serving a purpose until CMS stopped reimbursement for any CT lower than 16 slice. This was possible due to the support and parts available for that equipment. The support just comes from somewhere other than the manufacturer. There are many independent service organizations (ISOs) that can support equipment far beyond the EOL or EOS of the manufacturer. Often this makes more sense than simply replacing equipment. If you have a Lightspeed CT, there is enough support from ISOs that they could be maintained for the foreseeable future. You can buy replacement workstations from the ISO or new covers to help with marketing and appearance if you need that. The same is true of the Ecam nuclear medicine camera. For the Ecam there is even a FDA approved upgrade that takes the operating system to a Windows 10-based system that solves many cyber vulnerabilities. These are just two examples of many. However, upgrading and extending the useful life of equipment doesn’t help the
Written by John Garrett Director of a Clinical Engineering Department in CHI
manufacturer. They need to sell new and shiny things. Even if there is no real advantage to the purchaser. Does your hospital need a new 256-slice CT to replace the 16or 64-slice? Probably not. Keeping the total ownership cost down is one advantage to extending the life of diagnostic imaging equipment. It helps the hospital or imaging center keep costs lower. However, with capital being difficult to obtain, extending the life of a unit that is well supported and does the work it needs to do allows those capital dollars to go to areas that are objectively in real need of new hardware. 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 inhouse imaging teams.
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ADVANCED ULTRASOUND ELECTRONICS
DEF IN IN G THE STAN DAR D
IMAGING SERVICE 101
Written by Jim Carr Director of Services and International Operations for AUE
FDA Decision Doesn’t Mean We are Scot-free
U
nless you are a lawyer or work for a regulatory consulting company, the FDA announcement in the May report FDARA 710 that they do not intend to place additional regulations on “third-party servicers” was undoubtedly good news. Some hospital executives and HTM professionals may not realize how adversely the budgets of imaging departments might have been affected had the decision gone the other way. And, the general public has little or no idea that such a huge change was being proposed, one that even the FDA believes would have contributed to higher health care costs. There is a reason many of the OEMs were lobbying hard and using NEMA to push for stronger oversight. Based on my 45 years of experience working for both OEMs and ISOs, it has almost nothing to do with safety. It is part of ongoing attempts by some manufacturers to burden independent service organizations (ISOs) with more regulations and the added costs that come with them, in the hopes of creating virtual monopolies for their service businesses. Don’t expect the OEMs and special interests to stop that pursuit, which means we need to pay heed to the FDA report. The primary reason the FDA stated for their decision is that there is not sufficient evidence to conclude there is any real 50
ICEMAGAZINE | JULY 2018
It is important for ISOs to consider what the FDA report says about the actions they intend to take as a result of their findings. threat to public safety as a result of servicers, including servicing by third-parties. They found that most valid complaints regarding service would actually fall under the category of remanufacturing, based on the FDA definitions for those activities. They also stated that the continued availability of third-party entities to service and repair medical devices is critical to the U.S. health care system. Thank you to the folks from the FTC, AAMI and all the hospital executives and clinical engineering directors who provided comments and attended the workshop to help the FDA understand that! However, the FDA report does not mean ISOs have gotten off scot-free, without any cost or responsibility. The existing regulations and costs for third parties will continue, such as the existing federal and state regulations regarding X-ray systems. And all ISOs that claim to sell or repair scanners need to understand that they can be inspected by the FDA at any time, whether registered with FDA or not.
It is important for ISOs to consider what the FDA report says about the actions they intend to take as a result of their findings. Their number one action is to “promote the adoption of quality management principles.” Many of the comments received by FDA from third-party entities and OEMs talked about the importance of having a quality system that meets one of the international standards. In March, an FDA director stated that the FDA is interested in further harmonization of the Quality System Regulation and ISO 13485:2016. I doubt that 21 CFR Part 820 (QSR) will ever be completely dropped, but that is a big hint as to what the FDA expects from third parties. It is hard to disagree. If done correctly, having a quality management system leads to higher customer satisfaction and increases profits. Plus, if your company can’t pass an ISO 13485 certification audit, your chances of surviving an FDA inspection are pretty slim! ADVANCING THE IMAGING PROFESSIONAL
Another action that FDARA 710 states the FDA intends to take is to clarify the difference between remanufacturing and servicing. That would be very helpful, especially since the regulatory requirements for a remanufacturer are much more onerous. The FDA report says they also will encourage the strengthening of cybersecurity practices. Another point to take note of in the FDA report is how they monitor the safety of service activities. One of the main methods the FDA uses to monitor potential safety issues are MedWatch reports by hospitals and Medical Device Reporting (MDRs) by OEMs. The report says their reasoning behind not requiring tighter regulation in this area is that most reports lack detailed information that is needed to analyze the complaint, and also because the FDA knows there is “potential under reporting of events.” Even though MDR reporting is not required, there are good reasons for a third-party company to have a formal complaint reporting and investigation procedure. It is a key process in an ISO 13485 certified quality system, and it gives a service engineer a way to document a potentially dangerous situation. Imaging techs might encounter a potentially dangerous situa-
tion caused by a bad design, poor quality parts or an inability to repair the system because of a lack of AIAT information from the OEM. It can also be very helpful to have a documented investigation in the event of a lawsuit against your company or a “for cause” FDA investigation. Rather than being seen as a reprieve from further regulatory requirements, the FDA report should be used as a roadmap for MVS and ISO companies to follow in order to avoid unnecessary and burdensome regulatory oversight. If you have not read the entire report, at least read section 6, the summary of key issues and ongoing activities. The key action FDA identified for third-party entities is to develop or improve a quality management system. And make your quality system legit; get it certified by a medical device auditor. Make sure your company is trained and compliant with HIPAA, and be cautious when making network connections to scanners, especially if you use them for servicing. Doing the right things and having good processes and documentation does not guarantee that there won’t be regulatory problems, but not doing it puts yourself, your company and, more importantly, patient safety at risk. ICE
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FIVE TIPS FOR GIVING POWERFUL PRESENTATIONS
W
e’ve all been there. We’ve all endured dull, mind-numbing presentations. In fact, in a recent survey of 1,500 business professionals, more than 25 percent said they had attended presentations that were so boring they’d fallen asleep! That said, not everyone is good at giving presentations. And regardless of skills learned, research has shown that only four percent of the population is comfortable speaking in front of an audience. One phrase I often use in my Train-TheTrainer workshops is, “The ability to stand up and talk does not a trainer make.” Still, just about everyone must give presentations from time to time, so allow me to jump right in and offer some time-tested advice that might help. Obviously much more can be said than what we have room for here, but take these five tips to heart and your presentations should have some added impact. 1. Prepare Don’t just nod your head on this one and move on. I mention this first because it really is the most important thing you can do. The more time you spend preparing for your presentation, the better it’s going to come off. Know how you’re going to open, how you will introduce your topic, how you will transition between sub-topics, and how you will close. If you don’t think these things through, chances are slim that things will go smoothly during your actual presentation. A good first step in preparation is answering some basic questions. Who is your audience? What, exactly, will your presentation be about? What does your audience already know about the topic? What new informa52
ICEMAGAZINE | JULY 2018
tion do you have for them? What is the best way to connect the new information with what they already know? How long will you present? Will you have a projector available? If so, what images will help you convey your main points? Those are just a few of many questions to ask (and answer) in the preparation phase. Also be sure to make a good outline so your topic flows logically. 2. Create and/or gather your materials Will you provide handouts? Will you need graphs or charts? Think about how things would look to the person sitting in the back of the room. If using PowerPoint (or similar), look for good photos that convey your information, and also use limited words on your slides (think Steve Jobs). It’s not uncommon for good presenters to spend hours finding just the right photos, and limiting text to 10 or fewer words on a screen. Sometimes more text is unavoidable, so don’t be afraid to make more slides out of a longer piece of text. One of the things audiences despise is a wall of text. You wouldn’t sit through a television program that did that, and your audience won’t like it either, even if it’s in bullet points. Something else to consider is the variety of materials you’ll use. If you’re giving a short five-minute presentation, this is not as important. But for longer presentations, the more you can stimulate your audience visually, the more they will be impacted by what you have to say. Visual aids can include handouts, white boards, flip charts, PowerPoints and 3-D models. Use whatever you like, but you’ll have a much stronger connection with your audience
Written by Daniel Bobinski Workplace Consultant
if you use at least three different media, especially for longer presentations. 3. Practice a lot, and picture yourself giving the entire presentation Practice at least once per day and don’t stop even when you can do it confidently. Also, if you can mentally “see” yourself presenting successfully, your chances of success go way up. Some Olympic athletes spend time imagining themselves doing an event in addition to their actual physical practice. Research has found that the mental practice can be just as effective as real practice. Other presentation tips: Decide where you will you stand in relation to the screen or your other visual aids, and never, ever turn around and read from a screen. Always face the audience. 4. Practice your eye contact Studies show that body language comprises anywhere from 50 to 90 percent of commuADVANCING THE IMAGING PROFESSIONAL
insight “ Not everyone is good at giving presentations. And regardless of skills learned, research has shown that only four percent of the population is comfortable speaking in front of an audience.” nication (depending on the study), so if your body language is not making a good connection, your presentation is lacking punch. Eye contact is perhaps the most powerful component of body language. In all my years of teaching Train-theTrainer courses, I’ve found the best way to help people connect with an audience is by using the concept of “one thought per pair of eyes.” In other words, connect with one person’s eyes (preferably someone who’s giving you positive visual feedback) and finish your thought. Then, move on to someone else and finish the next thought. By using this method, you connect better with your entire
audience, because your audience sees you connecting and then they feel connected, too. I have my clients practice this at home by making eye contact with anything (a pillow, a lamp, etc.) and finishing their thought before moving on to another object. You will perform as you practice, and this is a powerful technique for practicing eye contact. 5. Wrap up with a brief review Even if you go through your entire presentation without a flaw, you’ll leave your audience hanging if you neglect a quick review of what you’ve covered.
Your audience will feel like they got a complete package if you tell them up front what you’re going to cover, then cover it, and then wrap up with a brief review of what you covered. The phrases “In conclusion,” or “As I wrap this up” are great segues for you to summarize what you covered. Never introduce new material in your conclusion – just review the main points of your presentation and then finish up. Remember, no presentation was ever ruined by being too short, but thousands have been ruined by being too long. When you’re done, you’re done, so wrap it up. And if you follow these tips, chances are your audience will remain wide awake and engaged. ICE 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.
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index
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AUE
Global Medical Imaging p. 32
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Ray-Pac®
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Webinar Wednesday
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p. 27
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Exclusive Medical Solutions, Inc. p. 41 54
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KEI Medical Imaging Services p. 47
Retrieve Medical Equipment p. 47
X-ray Parts, Inc p. 13
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