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ICE FEATURES
September 2018
“We want to do something better, more advanced, to make sure that we’re not treating MRI safety as another layer that we’re slapping on top of existing processes. Developing a knowledge and competency woven into patient care has an orders-of-magnitude impact.” – Tobias Gilk
Professional Imaging Superheros: Putting 24 Spotlight 36 Patients First Patient safety is a big component when it comes to the imaging department at health care facilities. Thanks to creative minds and available grants health care facilities are able to explore new avenues for providing patient safety measures. Many of these new approaches are then adopted by other health care facilities throughout the U.S.
Wendy Stirnkorb is the director of imaging services at Regional West Medical Center in ScottsBluff, Nebraska. After attending a radiology course in college she fell in love with imaging because it combines her love of science, physics
Company Showcase
626 is a virtual one-stop shop for imaging service. It can be such a comprehensive solution provider because of its talented people and its technology. While many in the space offer a point solution (e.g. best GE CT service in the state), 626 offers a turn-key product regardless of manufacturer, modality or region. Page 18
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ICE DEPARTMENTS
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11 Imaging News
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41 Imaging Matters
16 Webinar Wednesday
26 Department Spotlight
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23 People on the Move
30 X-ray Tube Gallery 34 Tools of the Trade
42 Imaging Service 101 44 Daniel Bobinski 46 AHRA Scrapbook 50 Index
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ICE Magazine (Vol. 2, Issue #9) September 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
Technical Prospects Announces Fall and Winter 2018 Training Schedule Technical Prospects, a company in the health care imaging industry specializing in Siemens equipment, has announced its fall and winter 2018 training class schedule. Courses delve into topics including computed tomography, fluoroscopy, radiography and more. The courses are offered online and in person at Technical Prospect’s state-of-the-art facility. Students will further their Siemens Medical Imaging equipment knowledge and skills through structured lessons and hands-on labs taught by experienced instructors. Classes offered in September include: Online: Intro to CT – September 4-28 This online course will provide students with a working
knowledge of the terminology and principles of CT components and circuitry. Fluoroscopy: Servicing Siemens Fluoroscopy Systems – September 11-20 Students in this course will learn to service the major system components included in the Image Intensifier-based Luminos TF, Sireskop SD and Uroskop Access system platforms. Radiography: Siemens Aristos FX/MX – September 18-27 This course will cover the major system components that make up the Aristos FX/MX system platforms. • For more information, visit TechnicalProspects.com.
Innovatus Imaging Unveils Centers of Excellence Innovatus Imaging CEO Dennis Wulf has announced the creation of three centers of excellence that will drive the company’s ongoing development of new technology, products and synergistic services around its core competencies of ultrasound probe repair, specialty probe design and manufacturing, MRI coil and digital/computed radiography. The centers will operate under the direction of Innovatus Imaging President and Chief Operating Officer Bill Kollitz. The Ultrasound Transducer Repair Center of Excellence will be headquartered in Tulsa, Oklahoma. The MRI and CR/DR Centers of Excellence will be headquartered in Pittsburgh, Pennsylvania. The Engineering, Testing, Regulatory Compliance and Manufacturing Center of Excellence will be headquartered in Denver, Colorado.
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This move is a continuation of the Innovatus long-term strategy to combine knowledge and resources through the combination of three leading independent organizations – Bayer Multi Vendor Service, Wetsco and MD Medtech – to accelerate advancements in design, manufacturing and service standards within the imaging industry. “By organizing our talent around business lines, we can streamline operations and pass the efficiencies and savings on to providers, ultimately allowing them to better serve the diverse needs of patients,” Wulf said. “It’s all part of a bigger picture to improve health care processes and access for all parties involved.” “This new organization of our intellectual capital and business operations allows us the freedom to expand our ca-
pabilities to do more for the industry as a whole, serve health care providers better and further develop innovative solutions and products for the present and future,” Kollitz said. Executives leading the customer experience, service delivery and technology portfolio management for customers will be Cam Conklin, vice president, global sales and marketing; Matt Tomory, vice president, ultrasound; Joseph Habovick, vice president, MRI; and Tracy Schrecengost, vice president, radiography and europe operations. Innovatus also has an operations and service center in Maastricht, the Netherlands. • For more information, visit www.innovatusimaging.com.
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Pulaski Memorial Hospital Installs Canon Medical Systems’ Vantage Titan/Zen Edition 1.5T Patients in Pulaski County, Indiana now have access to quiet, comfortable MR exams via the installation of the Vantage Titan/Zen Edition 1.5T from Canon Medical Systems USA Inc. at Pulaski Memorial Hospital. Pulaski Memorial, a critical access facility that was previously using a mobile unit to conduct MR exams, is the first health care provider in the U.S. to install the system. The facility is leveraging the system to conduct musculoskeletal (MSK) and neuro exams, as well as expand its abdominal imaging capabilities. “We knew we needed a new MR system that would significantly improve comfort for our patients, while also giving our clinicians high-quality images so that they could expand the types of imaging exams
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our facility performs, without undergoing a steep learning curve,” said Aleta Cable, MR technician, Pulaski Memorial Hospital. “The Titan/Zen Edition 1.5T delivers on all of our needs. Since installing the system, even our most claustrophobic patients find the system more comfortable and extremely quiet. And feedback from our clinicians who use the system has been enormously positive.” The Vantage Titan/Zen Edition 1.5T delivers a complete suite of tools to help clinicians make accurate diagnoses. The system features workflow enhancements and patient comfort tools, including Pianissimo Zen, which makes scanning even more quiet by reducing sound during acquisition. It also improves workflow for
difficult procedures like cardiac, neuro and spine exams with EasyTech, which standardizes workflow with automatic positioning while delivering consistent image quality. “We are committed to providing our customers with the diagnostic imaging tools that fit their business and clinical needs, while also improving the patient experience,” said Dominic Smith, senior director, CT, PET/CT, and MR Business Units, Canon Medical Systems USA Inc. “With the Vantage Titan/Zen Edition, clinicians at Pulaski Memorial have access to the high-quality images necessary to make an accurate, confident diagnosis, while also delivering a comfortable experience to patients.” •
ADVANCING THE IMAGING PROFESSIONAL
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Health System Buys R/F System with Next-Generation Features Willis-Knighton (WK) Health System in Shreveport, Louisiana has purchased a Carestream DRX-Excel Plus radiography/ fluoroscopy (R/F) system to improve workflow, reduce manual actions by technologists as well as help to reduce dose. “We viewed a demonstration of the DRX-Excel Plus system at another hospital and we liked what we saw,” said Garon Gaspard, assistant director of radiology at WK Pierremont Health Center, where the system is being used. “Our technologists appreciate the system’s next-generation features that deliver enhanced flexibility and greater productivity. This system also offers lower dose
than our previous X-ray system.” Productivity-enhancing capabilities offered by the DRX-Excel Plus include a positioning pedal that allows the operator to have their hands free – which is helpful for interventional exams – and a remote control that can move the table from anywhere in the room. A built-in 17 x 17 inch flat panel detector delivers high spatial resolution and detail. Gaspard said the system’s automated controls, motorized movement and ability to lower the table to about 19-21 inches are helpful for positioning, as well as patient comfort and safety. “At Willis-Knighton, we take a great deal
of pride in providing the highest quality of patient safety and patient care,” he said. The R/F imaging system also features a 72-inch source-to-image distance to allow routine chest imaging without the need for a ceiling tube or wall stand. The table will support patients weighing up to 585 pounds. A built-in video camera and microphone in the console allow technologists to continuously monitor each patient’s position and talk to patients during the procedure. WK Pierremont also uses two Carestream DRX-Revolution Mobile X-ray Systems to capture a variety of inpatient exams as well as imaging patients in the ICU, ER and rehabilitation area. •
Healcerion Introduces SONON 300L to U.S. Market Healcerion launched the SONON 300L handheld ultrasound device in the U.S. market following FDA approval of the wireless device for primary care providers. It provides flexible ultrasound technology at a lower cost than a traditional ultrasound machine, with a user interface anyone can learn in minutes. “SONON 300L is smaller and easier to use than any other ultrasound technology in the U.S. market. It allows PCPs to be more efficient and effective with instant insight to diagnose or refer a patient to a WWW.IMAGINGIGLOO.COM
specialist,” Healcerion Founder and CEO Dr. Benjamin Jeongwon Ryu said. SONON 300L is an advanced diagnostic imaging device that can be used anywhere, with an app downloaded from the Google Play or Apple App Store. It uses a paired tablet or smartphone as a display, where images can be analyzed and shared quickly. The entire device weighs only 13 ounces (370 grams) and has a rechargeable lithium-ion battery, Wi-Fi connectivity and 3G/LTE cellular capability. SONON 300L also supports medical
imaging protocols including DICOM and PACS. Using intuitive finger-touch controls to operate, it provides rapid, accurate diagnostics to improve patient care and improve efficiency. SONON 300L has a 3-hour continuous scanning battery life. It also provides a new diagnostic ultrasound option for retail clinics, urgent care centers, mini-hospitals, home health care providers and rural and third-world regions where cost, space and mobility requirements had previously put traditional ultrasound out of reach. • ICEMAGAZINE
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FUJIFILM Joins Preferred Pediatric Program FUJIFILM Medical Systems U.S.A. Inc. announced that its pediatric digital X-ray solutions have been added to the Preferred Pediatric Program with Vizient Inc., the largest member-driven health care performance improvement company in the country. As a previously awarded supplier, Fujifilm will now offer its pediatric imaging solutions through the Vizient Preferred Pediatric Program, which is designed to support pediatric caregivers with high-quality products, services, analytics and value-add offerings. Products included in the Preferred Pediatric Pro-
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gram are FDR AQRO, mini portable digital X-ray system, FDR D-EVO II Csl digital X-ray detectors, FDR D-EVO GL, the world’s first single exposure long-length detector and the all new FDR Go PLUS, mobile digital X-ray system. “Fujifilm DR solutions are engineered to provide gentle dose without sacrificing image quality and even assist in infection controls with an exclusive antibacterial coating – making them ideal for imaging pediatric patients,” said Robert Fabrizio from FUJIFILM Medical Systems U.S.A. Inc. “We are honored to participate in the Vizient Preferred Pedi-
atric Program. We look forward to working with Vizient members to provide imaging solutions that help enhance safety in pediatric imaging.” Fujifilm’s portables are available with the option for kid-friendly graphic decals to help calm patients and their parents during approaching exams. Vizient represents a diverse membership base that includes academic medical centers, pediatric facilities, community hospitals, integrated health delivery networks and non-acute health care providers and represents approximately $100 billion in annual purchasing volume. •
TEE Camera Assist Device System Receives FDA Clearance Visura Technologies has received 510(k) clearance from the FDA for its TEE Camera Assist Device (TEECAD) system. TEECAD’s single-use disposable camera attaches to a transesophageal echocardiogram (TEE) ultrasound probe allowing physicians to view the upper airway and esophagus during probe placement for safe intubation. TEE is a common cardiovascular procedure, performed more than 500,000 times annually in the U.S., in which an ultrasound probe is placed in the patient’s esophagus to capture high-resolution ultrasound images of the heart valves and atria. Physicians currently place TEE probes blindly, guided by physician feel and patient cooperation, potentially resulting in failed intubations that can lead to cancelled therapeutic procedures and major complications such as esophageal or pharyngeal perforation. Visura Founder Dr. David Marmor, a noninvasive cardiologist and experienced TEE operator, said, “TEE-related complications and failed intubations can be dangerous for patients and have costly ramifications for
hospitals. The recent proliferation of catheter-based structural heart interventions reliant on TEE imaging has led to growth in procedural volume and an increase in the age and risk profile of patients, increasing the need for visual guidance for safe TEE probe intubation. We look forward to clinically introducing our device.” The TEECAD system consists of a single-use disposable camera carrier that removably attaches to the TEE probe, and a separate viewing system display that allows the physician to view real-time images from the camera to visually assist with safe probe intubation. The clearance of Visura’s first TEECAD camera carrier is for use with the Philips X7-2t probe. The company plans to develop additional models compatible with other TEE probes available in the market. Established in 2015, Visura Technologies is a medical device company dedicated to improving the safety and success of transesophageal echocardiography procedures. •
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WEBINAR WEDNESDAY Highly Rated and Free CE Credits
T
he TechNation Webinar Wednesday series continues to provide some of the best free education available to HTM professionals as proven via reviews from actual webinar participants. The recent UMRi-sponsored webinar “Nuc Med 101 – A Technical Perspective” was eligible for 1 CE credit from the ACI for those who tuned in to the live presentation. A recorded presentation is available online. The webinar, which was attended by 264 individuals, received a 4.2 rating with 5 being the best possible rating. The 60-minute webinar featured Universal Medical Training Support Manager and IT Manager Mike Hill. He started with the basics by answering the simple question “What is nuclear medicine?” He followed up with a look at radioactive material concepts, fundamentals of diagnostic and therapeutic nuclear medicine. He also compared nuclear medicine with other imaging modalities (CT/MRI/X-ray) and discussed gamma cameras. Universal Medical has nurtured a business philosophy founded on offering comprehensive nuclear medicine equipment services at a reduced price. Universal Medical’s products and services include, new and reconditioned nuclear imaging systems, quality parts, equipment service, training courses for health care technology managers, camera system moves, technical and clinical support, flexible financing options, and more. Attendees shared testimonials in a post-webinar survey in which they applauded the session and the overall webinar series. “This was my first Webinar. I learned a lot from this session. This was very informative and supportive for the people that are working in this field. Mr. Michael con-
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ICEMAGAZINE | SEPTEMBER 2018
cluded a lot of the information and data in very short duration. He is an expert in his field. Thank You,” said S. Shah, a field service engineer in Pakistan. “This presentation was great for providing basic fundamental knowledge for HTM professionals who don’t have any experience with nuclear medicine technology,” Staff Biomedical Engineer B. Tellis said. “I truly appreciate Webinar Wednesdays. The various topics discussed are well presented, informative and helpful,” said J. Wisniewski, BMET. “This webinar was a real good overview of the basics, looking forward to part two, Senior Biomed M. McLain said. “It’s always a pleasure listening to the Wednesday webinars, bravo,” Senior Biomed M. Wujek said. “Enjoyed the seminar. It was helpful and informative. I will pass the info on to the other technicians in our shop,” said G. Allen, BMET. “Great information, concise and instructor made it easy to follow,” Director of Biomedical Engineering R. Coombs said. “Good scientific background on the terminology one will be exposed to in a functional imaging department,” said R. Larkin, principal, Larkin Consulting. “I felt the seminar was a excellent introduction to nuclear medicine,” said G. Myers, manager of biomedical imaging services. “Excellent presentation leading to basics of nuclear medicine gamma camera imaging. Evokes a lot of interest amongst budding imaging support FSE entrants,” Director of CTM M. Janakiraman said. “Wonderful way to increase your knowledge and get CEUs in the process. These are a must for the older technician,” Senior Biomed Technician W. Hallman said.
“As the newest member of the clinical engineering department, the Webinar Wednesday series has provided much needed information and insight into starting my new professional path into nuclear medicine,” Field Service Specialist P. Garcia said. “Webinar Wednesdays is a great way to supplement the struggles of continuing education. It is a major factor in helping technicians grow in the field and learn of topics that they may not get daily exposure to,” BMET Supervisor E. Clark said. “This was the best webinar I ever attended. The presenter was very knowledgeable and prepared,” Clinical Engineer M. Mappes said. “Although I don’t work with nuc med yet, this Webinar Wednesday was informative and helped eliminate some reservations I had about working with nuc med equipment,” Biomed R. Marek said. “I think Webinar Wednesday is a great initiative in continuing education. Our field is ever-changing and the need to keep knowledge current is extreme,” CE Account Manager H. Herbert said. ICE For more information about the webinar series, including a calendar of upcoming presentations and recordings of previous sessions, visit WebinarWednesday.live. A special thank you to the company that sponsored this month’s webinars.
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THE WORLD MOVES FAST. WE MOVE FASTER.™
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26, as a brand, was born on June 26, 2012 (6/26) when two, soon to be friends and partners from Long Island, New York met at a hospital while each’s first son was born. The company was officially launched 2-years later. 626 had an original focus on performing time and material service work for medical imaging parts suppliers, which led into contractual service agreements with imaging centers, OEMs and ISOs throughout the United States. 626 is currently the fastest growing service provider in our space. 626 Holdings CEO Phil Revien recently shared more about the company with ICE magazine. Q: What are some advantages that 626 has over the competition?
Phil Revien, CEO
Revien: We are a virtual one-stop shop for imaging service. We can be such a comprehensive solution provider because of our talented people and our technology. While many in the space offer a point solution (e.g. best GE CT service in the state), we offer a turn-key product regardless of manufacturer, modality or region. Q: What are some challenges that the company faced last year? How were you able to overcome them? Revien: Growth brings problems; fun problems, but problems. Recruiting and retaining best-in-breed engineers will always be a challenge. Readiness for growth; having the right engineer in the right place is a challenge. We have met the challenge by building a culture based on family and customer focus. We believe we are the employer of choice for talent. We also acquired Walsh Imaging in November 2017 which was instrumental in improving our service capabilities for our customers in the Northeast. Q: Can you explain 626’s core competencies and unique selling points?
Michael Fischer, CFO
Revien: 626’s core competency is imaging service delivery, 24/7/365. We are highly differentiated as we do all modalities and all manufacturers with a simple call or click. While we operate 24/7/365, we do not charge a premium for after-hours or holidays. We also do much of our PM work after-hours so as to not affect patient throughput. We operate with a patient first mentality. Q: What product or service are you most excited about right now? Revien: We have developed, and will soon commercialize, an exciting software and service for remote diagnoses and virtual service, cross-modality; cross-manufacturer. Q: What is on the horizon for 626? How will it evolve in the coming years? Revien: We are refreshing our brand as we reposition the company from service, to soft-
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Your Uptime. Our Obsession. ware and service. We are also in acquisition mode. We are seeking great individuals to add to our team that will enhance the customer experience. Also, we are seeking companies we can partner with to improve our service delivery ability and market share. Q: Please share some company success stories with our readers – one time that you “saved the day” for a customer. Revien: In February 2018, a Fort Lauderdale imaging center, owned by Akumin, was struck by a vehicle. The accident toppled the lone MRI in the facility. 626 was called at 7 a.m. and we deployed our CTO and a top engineer to the site. Our team arrived at 8:30 a.m. and had the system put back together and scanning patients by 1 p.m. Q: Please tell us a little about the 626 facility. Revien: 626 relocated our corporate headquarters to Delray Beach, Florida this July. The 12,000-square-foot facility is a mixed-use space with an office and warehouse. We also have a sales and marketing office in Akron, Ohio and the Walsh facility in Pompton Lakes, New Jersey is 11,000 square feet of warehouse and office. Q: Can you share some recent changes to the company, inventory, services and etc.? Revien: We acquired Walsh Imaging in November 2017. We hired Kevin Gill as our COO in June 2018. We are positioned well for both organic and inorganic growth. Q: What is your company’s mission statement or what is most important to you about the way you do business? Revien: 626 thrives on providing comprehensive equipment services and building long-lasting customer relationships. Our number one goal is that every service event is completed with the highest quality workmanship and exceptional customer service. Your complete satisfaction is our obsession. 626 does not aspire to make a living, we aspire to make a difference.
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Q: Is there anything else you want readers to know about your company? Revien: 626 is very involved in the community and in charitable giving. Partner Michael Fischer started Drops of Hope in 2006. Drops of Hope provides transportation for pediatric cancer patients and their families to and from the hospital. Drops of Hope sends a limousine fully equipped with the latest video games, kid-friendly movies, snacks, beverages and more. This specialized service provides relief for parents who can enjoy the ride with their child and not worry about traffic, congestion, parking or any other concerns. This is a special service for these special children. Drops of Hope has a primary project with Rooms of Hope. Rooms of Hope is dedicated to enhancing the healing process of chronically ill children by providing positive and imaginative bedroom environments. It gives special attention to the medical, physical and emotional needs of each child by adding special touches that personalize the rooms and fulfill their dreams! ICE
We’re here to help! To find out how 626 can build a custom imaging equipment service solution for you and the patients you serve, contact us today!
1395 NW 17th Avenue Suites 113 & 114 Delray Beach, FL 33445 sales@WeAre626.com 800.516.0990 www.WeAre626.com
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the medical product support network “An excellent resource. It’s my first stop when I have a question or need information. An asset to any technician’s toolbox.” –Mark Cooper, Legacy Medical Imaging
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Our number one goal is that every service event is completed with the highest quality workmanship and exceptional customer service. Your complete satisfaction is our commitment.
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We’re here to help! To find out how 626 can build a custom imaging equipment service solution for you and the patients you serve, contact us today!
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1395 NW 17th Avenue Suites 113 & 114 Delray Beach, FL 33445 sales@WeAre626.com 800.516.0990 www.WeAre626.com
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ADVANCING THE IMAGING PROFESSIONAL
PEOPLE ON THE MOVE By Matt Skoufalos
1.
Through its merger of Bayer Multi Vendor Service, Wetsco and MD Medtech, Innovatus Imaging has named Cam Conklin its vice president of global sales and marketing, Matt Tomory its vice president of ultrasound, Joseph Habovick vice presient of MRI, and Tracy Schrecengost its vice president of radiography and European operations.
2.
Siemens Healthineers has named Jorge A. Branco Filho vice president of the installed base development/syngo business line for North America. Branco joined the company in 2009 as the west zone CT business manager, and later became northeast zone ultrasound manager; most recently, he was modality regional vice president for the Boston region. Branco holds a bachelor’s degree in electrical engineering from Centro Federal de Educacão Tecnológica (CEFET), a master’s degree in marketing from Pontificia Universidade Catolica, and a master’s degree in finance from Instituto Brasileiro de Mercado de Capitais (IBMEC), all in Brazil.
3.
Guerbet LLC USA has named Richard Hines head of its North American Interventional Imaging II sales division. Hines was previously a regional manager under Guerbet’s full line sales division for five years. He holds a master of business administration from Monmouth University, as well as a bachelor of science in radiologic science from Thomas Edison State College.
4.
The U.S. Oncology Network added Marcus Neubauer as its CMO; network president Michael Seiden will continue to lead the network as its president. Neubauer has been a practicing medical oncologist for 20 years, most recently in the network’s Kansas City practice. He has been its vice president and medical director for payer, clinical services and value-based care.
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07
5.
Novuson of Bothell, Washington has named Derek Khorsand its CMO. Khorsand is a resident physician of interventional radiology at the University of Washington Medical Center.
6.
Accuray Incorporated of Sunnyvale, California named Joseph E. Whitters to its board of directors. Whitters also serves on the boards of PRGX Global Inc. and InfuSystem Holdings Inc. He previously served on the boards of Analogic Corporation, Air Methods Corporation, Mentor Worldwide LLC and Omnicell Inc.
7.
HCA Healthcare of Nashville, Tennessee has named Allen Harrison president of Methodist Healthcare System. Harrison is currently CEO of Methodist Hospital and Methodist Children’s Hospital in San Antonio, replacing the retiring Jaime Wesolowski, who had been president of Methodist Healthcare System since 2007.
8.
The Boston, Massachusetts-based Caliber Imaging & Diagnostics Inc. named Karen Howe its CFO. Howe has spent 14 years in the high-tech, manufacturing and financial services sectors with companies like Ernst & Young and PricewaterhouseCoopers. She was most recently the primary financial lead at Soleo Communications.
Find weekly installments at imagingigloo.com
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people
By K. Richard Douglas
PROFESSIONAL SPOTLIGHT Making a Positive Difference: Wendy Stirnkorb, CRA, RT (R) (MR), MRSO, MRSCTM
A
long the historic Oregon Trail is the Scotts Bluff National Monument. The monument is run by the National Park Service. Imagining the hundreds of thousands of pioneers who used the Oregon Trail in the mid-1800s, to emigrate west, visitors to the Scotts Bluff National Monument can get a feel for a portion of the journey. Scottsbluff is a city in the western part of Nebraska with a population of just over 15,000. The city is home to the Regional West Medical Center. Wendy Stirnkorb, CRA, RT (R) (MR), MRSO, MRSCTM, is the center’s director of imaging services. Originally, Stirnkorb was studying to be among the ranks of those ordering diagnostic images when life happened. “I was a non-traditional student, returning to a pre-med program following having my son. I quickly realized that I really did not want to spend the next 10-plus years of his life in school,” she says. “As I was trying to decide where to go from that decision, one of my classmates invited me to attend one of her radiology courses with her to see if I was interested. I fell in love with imaging. Where else can I combine my love of science and physics with the art of photography? I applied to the radiology program at the University of South Alabama and was accepted, beginning my imaging career,” Stirnkorb adds. Her radiography education and training came from a challenging combination of coursework and, later, a prestigious medical hospital. 24
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“I learned radiography through the radiologic sciences program at the University of South Alabama (USA); a stringent and selective program. Approximately 63 hours of prerequisites in English, biology, physics, history and several humanities are required before you are even accepted into the program, and this is followed by 24 consecutive months of the professional component of the program, for another 70-84 semester hours, depending on one’s course of study. Maintenance of a high GPA and adherence to a professional code of ethics is also required,” Stirnkorb says. She says that clinic hours, and handson patient care hours, are included in this. “I am fortunate in that USA provided students, through agreements with local hospitals, several different clinic rotation experiences,” she adds. Her work experience in imaging started while still in college as a weekend staff technologist at an outpatient clinic that was part of a mobile infirmary in Mobile, Alabama. Closer to graduating, she worked at Thomas Hospital and picked up a lot of knowledge from colleagues there. “I worked there for three years as a staff technologist, growing the volumes due to extended hours and relationship building with the emergency department physicians. I was seeking advancement opportunities and I found the opportunity to grow with a position in Wisconsin with Mayo Clinic,” Stirnkorb says. “I was interviewed and offered the position of MRI supervisor for a Mayo Clinic
hospital in Eau Claire, Wisconsin. I worked there for nearly eight years, growing the business line, enhancing MRI patient safety and learning from good leaders while working with amazing technologists,” she adds. “This experience gave me the oppor-
“I fell in love with imaging. Where else can I combine my love of science and physics with the art of photography?” -WENDY STIRNKORB
tunity to move to my next position in academia at the University of Chicago Medicine. I served a fantastic team of MRI technologists and radiologists there as the MRI imaging manager. Managing multiple facilities, with different patient populations with some of the most cutting-edge research and technology in the world was an amazing experience,” Stirnkorb says. After about two years, she was approached to come to Washington, D.C., to be the assistant director of imaging services at Sibley Memorial Johns Hopkins Medicine. “This experience was amazing,” she says “I expanded my knowledge base and my skill set outside of diagnostic imaging and MRI to include interventional radiology, cardiac cath lab, CT, nuclear medicine ADVANCING THE IMAGING PROFESSIONAL
people Favorite part of being an imaging professional? “My favorite part of being an imaging professional is helping patients who are experiencing perhaps one of the worst days by providing them answers safely, in a timely manner, with compassion and respect — and I get to do this with fantastic technology, science and art.”
Wendy Stirnkorb shows students the proper positioning and collimation for a scoliosis X-ray exam.
and PET/ CT, as well as leading the imaging RNs and assisting the director with departmental leadership in sleep, non-invasive vascular lab and breast health,” she says. Today, Stirnkorb is a registered radiologic technologist, a registered MRI technologist, a board certified MR safety officer, a certified radiology administrator and a project management professional. She is also pursuing a doctorate in leadership and development. Pastimes and Honors When not working at the medical center, imaging is one of Stirnkorb’s pastimes as well. “I shoot pictures, playing with light and exposure times to create art,” Stirnkorb says. She also writes technical articles and plays the saxophone. She also enjoys learning about others through culinary experiences. “I am fascinated by different cultures and how sharing a meal can bridge those differences. We all have to eat, so exploring culture through food is a great way to understand a culture and a people,” she says. “I am married to my husband, Fritz. We have one son, Kendall, and our granddaughter. My granddaughter is five and wants to be a ninja ballerina cardiologist when she grows up,” Stirnkorb jokes. Recognition for all of the training and WWW.IMAGINGIGLOO.COM
experience has not passed Stirnkorb by. She recounts the personal gratification of working in the teaching environment and an honor from her alma mater. “Part of the pleasure of working in academia is the opportunity to be a part of an innovative team. As a member of the MRI team at the University of Chicago Medicine, I was fortunate to work with our musculoskeletal division chief, Dr. Scott Stacey, to develop, practice and implement a protocol for visualizing minor tears to the cartilage of the wrist, often very difficult to visualize and diagnose,” she says. This year, her alma mater, the University of South Alabama, inducted her into the Hall of Fame for the Pat Capps Covey College of Allied Health Professions. “This honor is my proudest award,” Stirnkorb says. What drives Stirnkorb as an imaging professional? “My sole professional purpose is to make a positive difference in the lives of patients and my team. I attempt to achieve that purpose by modeling safe patient care behaviors and by being the kind of leader I needed/wanted when I was a newbie,” she says. It sounds like that purpose has been fulfilled. ICE
GET TO KNOW THE PRO Favorite book My two favorite books are “Atlas Shrugged” by Ayn Rand and “The Art of War” by Sun Tzu Favorite movie My favorite movie is “Star Wars” – the original one Favorite food Almost all Asian foods with a preference for Japanese due to the art of preparation and presentation Hidden talent I write poetry – and it’s now no longer “hidden.” What’s on my bench? • Strawberry Crystal Light... I have stashes in my planner, my car, my travel bags – it might be an addiction. • A quote by Eckhart Tolle reminding me to be present in the moment • Sticky notes • My day planner to keep me on track • Music. I have music playing in the background all day (80s hairbands, country, jazz, 90s grunge and the Beatles – everything from Aerosmith to ZZ Top).
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DEPARTMENT SPOTLIGHT Intermountain Healthcare Imaging Equipment Service (IES) Program
S
itting just south of Salt Lake City, Utah is the city of Midvale. Part of Salt Lake County, it is a city of more than 33,000 and close to the Great Salt Lake. Midvale is the location for the clinical engineering department for Intermountain Healthcare and its imaging program. Headquartered in Salt Lake City, Intermountain Healthcare consists of approximately 1,400 employed primary care and secondary care physicians. The not-forprofit health system has hospitals in Utah and southeastern Idaho. In 2017, Intermountain Healthcare had four hospitals on the Truven Health Analytics top 100 hospitals list. “The clinical engineering department at Intermountain Healthcare consists of 125 personnel, covering 23 hospitals, over 185 clinics, and all homecare equipment,” says Mike Busdicker, MBA, CHTM, system director of clinical engineering for Intermountain Healthcare. “The Imaging Equipment Service (IES) Program is managed by Jeff Koford and has a total of 17 imaging service engineers. These service engineers cover imaging equipment within a geographic area and 26
ICEMAGAZINE | SEPTEMBER 2018
will cross over lines of responsibility to assist in the repairs and service of equipment. The IES Program operates as a separate program within the overall function of Clinical Engineering Support Services,” Busdicker says. The IES Program includes 50 CT scanners, 40 MRI units and over 3,500 individual pieces of imaging equipment. Busdicker says that the imaging service engineers are divided up into modality specialties that include general X-ray, ultrasound, ancillary equipment, CT scanners, mammography and nuclear medicine. Beyond covering all of these modalities, he says that the groups do not presently service linear accelerators, cardiac cath labs or MRI units. “Our program was a brand-new start up in 2012 and we did not have any imaging service engineers on the team. Since that time, we have added 17 service engineers, reduced contracts by over $10 million and built cooperative relationships with internal and external customers,” Busdicker says. “Much of our success is ensuring we move at the right speed in taking on the service of the imaging equipment. It is a
By K. Richard Douglas
process involving all the right personnel to include organizational leadership, clinical caregivers, finance, frontline service personnel and our suppliers,” he adds. The 17-member service team has to keep up their training skills to service such a broad spectrum and large inventory of imaging equipment. “We have built solid relationships with suppliers that provide the training needed for this type of equipment. Our collaborative relationships include manufacturers, independent service organizations and other training institutions,” Busdicker says. “Each year, we provide organizational leadership with a report demonstrating the value the in-house staff brings to Intermountain Healthcare through the training of our in-house staff. This includes financial savings and cost avoidance, but just as important, we document value brought to the treatment and care of patients,” he says. He says that the imaging service program is sure to track response times, repair times, uptimes, service repairs impacting patient care and caregiver satisfaction. How involved is the team in the purADVANCING THE IMAGING PROFESSIONAL
people
The Imaging Equipment Service Program at Intermountain Healthcare serves 23 hospitals in Utah and Idaho.
“Much of our success is ensuring we move at the right speed in taking on the service of the imaging equipment.” —MIKE BUSDICKER, MBA, CHTM
chase, planning and construction of the system’s radiology/cardiology equipment? “The IES Program is very involved in the life cycle management of the imaging equipment. Each year, imaging services comes together for a five-year capital planning strategy and our IES program director is a vital part of the committee,” Busdicker says. “They provide data and information on asset history, performance, serviceability, reliability and supplier collaboration. Also, the IES program director takes part in the modality evaluation teams and provides a service perspective on the equipment beWWW.IMAGINGIGLOO.COM
ing evaluated,” he adds. The clinical engineering department has a medical equipment service contract specialist. Busdicker says that this person is involved with the contract and purchasing process for all suppliers – general medical and imaging equipment. “The contract specialist reviews terms and conditions, the payment process, renewals, initial contract discussions, participates in quarterly business reviews, tracking of performance in relation to contract terms and validation of contract value,” he says. Crunching Data for Improvement The imaging team at Intermountain is continuously seeking to hone the process of maintaining equipment and providing maximum uptime. “The IES Program has instituted a process to perform a root-cause analysis (RCA) on all equipment downtimes deemed excessive,” Busdicker says. “The RCA involves all individuals and companies associated with the down equipment. This can include the frontline caregivers, service engineers, IES Program leadership, suppliers, supply chain and
continuous improvement. The goal of the RCA is to positively impact the repair process, improve reliability and limit equipment downtime. Results of this project include the local stocking of high-usage parts, increased monitoring of equipment performance, enhanced training of service personnel and a better team approach to the service of critical and non-critical equipment,” he adds. Beyond the good work they do during business hours, the imaging team, and their larger contingent of CE colleagues, stay involved. “The Clinical Engineering Department at Intermountain Healthcare is actively involved as an institutional member of AAMI and ACCE. Also, department personnel are involved with NH-ISAC, MD Expo, ICE, ACHE, AHRA and HIMSS,” Busdicker says. With the large inventory of imaging equipment and the many facilities to service, the relatively young service group accomplishes a lot to serve the patient population in Utah and southeastern Idaho. Their self-assessment process means continuous improvement. ICE
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• • • •
products
PRODUCT SPOTLIGHT Reports Predict X-ray Tube Market Growth
X
-ray tubes are electrical devices used for generating X-rays. Acceleration and de-acceleration of electrons help in the achievement of the process. X-rays were first discovered in the 19th century and the field of radiology was created because of the availability of X-ray sources. X-ray tubes act as a converter of a specific energy. It receives electrical energy and changes it into heat and x-radiations, heat being the unwanted product of the process. Conversion of electrons into photons lead to the production of X-radiation. The global X-ray tube market was valued at $2.31 billion in 2016 and is expected to reach a value of $3.32 billion by the end of 2022, growing at a projected CAGR of 5.32 percent during the forecast period of 2017-2022, according to a news release from Business Wire. The growth is fuelled by factors such as rapid technological advancements in X-ray tube technology over the past few years, changes in lifestyle and an increase in cancer and other disease incidences. The presence of many manufacturers in the market has lead to an evolution of technologies for better image quality. The fastest growing
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markets for X-tay tubes are North America, China and Europe. Mordor Intelligence also predicts continued growth in the market. “As of 2017, the global X-ray tube market was valued at $2.42 billion and is expected to reach a value of $3.3 billion by 2023, registering a CAGR of about 5.21 percent during 2018-2023 (the forecast period). An X-ray tube is a device that produces X-rays when subjected to an electric charge. Increasing technology advancement is one of the primary factors that is driving the growth in
With an increase in medical cases and diagnostic equipment, the demand for X-ray tubes in medical imaging is growing, which is, in turn, driving the market growth. demand for X-ray tubes. The application of X-rays has drastically expanded beyond the field of medicine, over the past few de-
cades,” according to Mordor Intelligence. “With innovations in electronics, the size of a system has decreased, immensely. With the availability of compact systems, X-ray machines are being used in various fields, such as airport security, baggage scanning, metallurgical applications, etc. In addition, the increase in medical cases and accidental injuries around the globe is influencing the market’s growth. With an increase in medical cases and diagnostic equipment, the demand for X-ray tubes in medical imaging is growing, which is, in turn, driving the market growth. However, the presence of stringent and strict regulations by FDA, across the globe, for manufacturing and designing X-ray tubes have created additional costs for manufacturers, while becoming a barrier for new entrants. These factors are restraining the market growth.” Also, the Associated Press reported in June 2018 that U.S. President Donald Trump imposed tariffs on hundreds of Chinese products — from X-ray tubes to incinerators. The Chinese government responded with its own measures aimed at U.S. products. This could impact the overall market. ICE
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products
GE Healthcare Performix™ VCT Plus The Performix™ VCT Plus tube with liquid bearing technology provides up to twice the tube life compared to ball bearing technology. It reduces wear and extends tube life by using liquid metal versus a traditional plated metal ball. It enables continuous spinning of the liquid bearing to enable faster scanning since the rotor is already spinning. Upgrade to the Performix™ VCT Plus with liquid bearing technology for up to twice the tube life allowing you to optimize your scanner’s uptime and reduce disruptions from tube replacements. Performix is a trademark of the General Electric Company.
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ICEMAGAZINE | SEPTEMBER 2018
ADVANCING THE IMAGING PROFESSIONAL
products
RAY-PAC Shimadzu Replacement X-ray Tubes Ray-Pac has extended its product lines to include the Shimadzu single and dual focal spot portable X-ray tube units used throughout hospitals, emergency rooms, operating rooms and patient rooms. Ray-Pac uses RAD II inserts for Shimadzu portable dual and single model with focal spots of 0.7/1.3, 14.5-degree target and 0.7, 14.5-degree target. Ray-Pac also manufactures the RX-80 and RX-85 tube units using Varex inserts for radiographic and fluoroscopic rooms.
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products
Richardson Healthcare ALTA750 Replacement CT Tube The ALTA750 is 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. 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. *All product and company names are trademarks or registered trademarks of their respective holders. Use of the trademarks is solely for identification purposes, and does not imply any affiliation with or endorsement by the trademark holders.
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ICEMAGAZINE | SEPTEMBER 2018
ADVANCING THE IMAGING PROFESSIONAL
products
Varex Imaging ROT 360 Replacement Tube The ROT 360 Replacement Tube is a direct replacement for the Philips SRO 2550 or SRO33100 in the ROT 360 housing for RAD, RF, surgery, mobile applications. It features a high-performance glass/metal tube with equivalent OEM heat units 325kHU or 500kHU.
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products
TOOLS OF THE TRADE Unfors RaySafe RaySafe X2 Solo
U
nfors RaySafe has introduced the RaySafe X2 Solo product line featuring sensors that are ready for measurement without special settings. Based on the same technology as the multimodality RaySafe X2, the X2 Solo offers the user-friendliness and performance to meet all quality assurance or service measurement needs for specific X-ray modalities. RaySafe X2 Solo is available in two models: X2 Solo R/F for all radiography and fluoroscopy measurements and X2 Solo DENT, tailor-made for dental X-ray applications including a new holder for panoramic. RaySafe X2 Solo speeds measurements by eliminating unnecessary steps like positioning the sensor, choosing a setting or interpreting results. The sensors are orientation independent so technicians simply place the sensor in the X-ray beam and turn on the instrument. The rest is automatic – no menus or special settings needed. ICE For more information, visit www.raysafe.com.
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ICEMAGAZINE | AUGUST 2018
ADVANCING THE IMAGING PROFESSIONAL
MEDICA 2018 Inter national Trade Fair
www.mdna.com/trade-shows/details/medica
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12 - 15 November 2018
The World Forum for Medicine International Trade Fair boasts around 130,000 visitors from 125 countries. MEDICA will take place at the Messe Düsseldorf Fairgrounds. TTI Travel is pleased to offer specially priced HOTEL accommodations to MEDICA exhibitors and visitors. All hotels offer easy access to the fairgrounds.
Phone: 866.674.3476
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The InterMed Group Jump Teams LET THE INTERMED GROUP’S SERVICE TEAMS COME TO THE RESCUE WHEN YOU NEED AN EXTRA HAND. • General Biomed support • Preparation for Joint Commission review • Catch up on a backlog of PM's in multiple modalities • Tailored Inventory Applications - assistance with facility acquisitions, large volume equipment purchases, facility moves, audits & confirmations • Coverage during education/training programs, conventions, medical leave, vacations, etc. • Custom programs tailored to your specific needs 13301 US Hwy 441 Alachua, Florida 32615 Toll-Free: 800-768-8622 Office: 386-462-5220 Email: Sales@intermed1.com Website: www.intermed1.com
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BIOMEDICAL IMAGING ASSET MANAGEMENT JUMP TEAMS
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IMAGING SUPERHEROS P U T T I NG P A TI E NTS F I RS T
W
hen children must undergo medical procedures, imaginative play can be a key component in their care. Distraction, misdirection and theatrics are tools that many practitioners will use to build rapport with pediatric patients, and they’re equally applicable in the imaging suite. That’s why in 2013, the Children’s Hospital of Philadelphia (CHOP) launched its “Brave Kid Capes/Super Hero Support,” a superhero-themed program that added a narrative element to medical imaging treatment for children. CHOP sees some of the most high-risk pediatric patients in the country and, like many pediatric specialty centers, is renowned for its sensitivity to families in its care. But the Super Hero Support program wouldn’t have gotten off the ground without the support of outside investment from Association for Medical Imaging Management (AHRA) and its Putting Patients First grant program. Entering its eleventh year, Putting Patients First has handed out more than $600,000 in support of 64 grant programs at health care facilities across the country. The program was established in 2008 as a way to support patient safety and comfort initiatives that otherwise might not get off the ground in cost-cutting environments, and to seed those ideas that could prove reproducible in comparable settings. It is funded by Canon Medical Systems USA of Tustin, California. Cathy Wolfe, senior director of strategic communications and market intelligence for Canon, has been
involved in Putting Patients First since its early days. She describes the program as one of the company’s longest-lasting and most successful collaborations. “We have a very strong focus on investing in the communities in which we operate,” Wolfe said. “Patient safety and education are critical concerns. We believe very strongly in the AHRA and we also believe very strongly in patient comfort. Any place where we can be supportive, we’re happy to do that.” Eight grants are awarded annually through the program, six of which are $7,500 awards. Two of those are given to projects that improve patient safety or comfort in pediatric imaging, two are given for projects that improve overall patient safety, and two are given for oncology-specific imaging projects. Putting Patients First also awards two $10,000 grants to a hospital system or integrated healthcare delivery network (IDN) in the areas of patient safety or cybersecurity. Applications are accepted annually through October, and then are awarded based on the determinations of a selection committee. The focus of the funded programs has evolved over time (the cybersecurity and oncology grants are recent additions), as the needs of the industry have changed. Wolfe said those changes are the result of the close collaborations among Canon, AHRA and its membership. “We have to figure out where can we have the biggest impact,” she said. “We wanted to provide grants that would be able to impact the institution, but also do it at a level that a variety of institutions can benefit. AHRA selects submissions that align with the program, and meet their objectives as well as ours to have an impact with a local institution.”
imaging SUPERHEROS PU T T IN G P A T I E N T S F I RS T Once the grants are awarded, funded programs report back on the results of their work within three to six months. Many of those reports are collected in Radiology Managament, the AHRA professional journal. Canon marketing teams support AHRA in producing some of the supplemental materials associated with the program, including interviews with grant recipients, which are shared in the hope of proliferating the successes of the programs. “Part of the intention of the program is that this gets shared with other members of the AHRA,” Wolfe said. “You’ll see that something done at one institution sometimes gets picked up at another institution; you’ll see a lot of organizational learning.” Wolfe said the success of Putting Patients First has pushed other institutional
“
O ne of the biggest things we learned was to be involved as much as you can, but give the real ownership to the organization. We consider this part of our commitment to our industry and to patients.” - Cathy Wolfe
partnerships, including Safety FiRsT, Canon’s provider safety collaboration with the American Society of Radiologic Technologists (ASRT) Foundation. Founded in 2015, Safety FiRsT awards a pair of $7,000 grants for medical imaging and radiation therapy practitioners annually. Wolfe said it’s continuing to build over time, for which she credits the tight integration of the two organizations. “I think the thing that differentiates these programs is to really be a partner of the association we’re working with,” she said. “Our objectives, your objectives — where can we come together? What’s something that’s more creative but a good opportunity for the institution to advance their care and also their education?
“A lot of organizations will just give money and are not really involved in the creation of these programs,” Wolfe said. “One of the biggest things we learned was to be involved as much as you can, but give the real ownership to the organization. We consider this part of our commitment to our industry and to patients.” AHRA President Bill Algee, director of imaging services at Columbus Regional Hospital in Columbus, Indiana, said Putting Patients First grants help fill an important stopgap role in imaging budgets. “I believe all hospitals are suffering from this,” Agee said. “We have this list of equipment needs, or other program needs, and we only have X number of dollars. Something’s got to give, and you try to figure out what are must-haves versus things that are nice to do. That’s where the challenge comes in. Sometimes small-dollar ticket items make a huge impact. With this [grant money], they’re going to get the program off the ground.” Agee said AHRA vendor partnerships and collaborations like Putting Patients First are “extremely important” to the advancement of industry-wide priorities in medical imaging, including dose monitoring and reduction, patient education and the often overlooked value of patient comfort to the quality of an imaging study. In facilities where environmental factors are secondary or tertiary priorities, grant programs can do significant work in improving patient comfort. “It doesn’t do a patient any good to come in, and they can’t get their exam done because the room’s too cold or the light’s too bright,” Algee said. “A lot of patients have sensory issues; it’s a lot more challenging than one might think.” In 2011, Cincinnati Children’s Hospital leveraged an AHRA grant to purchase tablets that can be used to calm pediatric patients during an imaging exam instead of anesthesia. The ability to distract and mollify children without the use of heavy sedatives was a technological opportunity that could be met with a one-time infusion of cash. Six years later, the Carti Cancer Center in Little Rock, Arkansas used a Putting Patients First grant to purchase blanket warmers for
patients undergoing PET scans. In such a setting, it’s not uncommon for a patient to wait 45 minutes to an hour in an isolated room to be injected with a contrast agent for the scan. That’s a long time to spend in an air-conditioned room wearing only a dressing gown, Algee said. “Historically, what we do in imaging is take people’s clothes off when they come in the door,” he said. “For years and years, we never thought about putting blanket warmers in imaging departments. You don’t want to X-ray with the blanket on the table, but if you put the blanket on the table, it warms the table first.” Another grant, awarded in 2017, went to Massachusetts General Hospital in Boston to pay for in-bore lighting and a cinematic projector for pediatric patients and their parents during imaging studies. Again, Algee said the equipment could help reduce patients’ anxiety, and possibly eliminate the use of anesthesia. The focus on environmental sensitivity is something that he’s observed having an impact in his own hospital, where a recent remodel of the nuclear medicine suite included “a patient experience enhancement room” with special lighting and ceiling-mounted speakers. Those additions are patient-focused, but they have an effect on the staff and their ability to be able to treat patients, Algee said. “It doesn’t look like any other room you go in,” he said. “When I walked by there, I immediately felt relaxed. I think it takes that weight off you. That creates an environment where the staff and patients can connect on another level. If the patients are calmer because of one of these experiences, that helps the staff to remain calm as well.” Patient safety can also be improved by improving cancer detection rates, an area in which Algee foresees future potential for innovation through artificial intelligence, either via software solutions or other automated processes. Grant programs like Putting Patients First may play a role in expanding those mechanisms. “All of those screening programs are based on early detection, that’s putting patients first,” Algee said. “There are scholarships out
Children’s Hospital of Philadelphia’s “Brave Kid Capes/Super Hero Support” program is a great example of adding a narrative element to medical imaging treatment for children.
there, but you have to apply for them, and you have to know that they exist. The biggest obstacle is people taking the opportunity and just going for it.” MRI safety consultant Tobias Gilk, of ferromagnetic detection system manufacturer Metrasens, said programs like Putting Patients First work best when they collaborate directly with health care practitioners and clinical staff to solve industry problems. Combined with the scope of small-scale grants, Gilk said the initiative has a high success rate because it enables people working in the field to advance the practice by meeting specific, niche needs in grassroots ways. “You need to find what you need to do at your institution,” he said. “Facilities really sponsoring these small seed projects… all of that has gotten harder to do internally, which I think is a tremendous shame.” “I hope that more facilities and health care groups see this, and begin to say, ‘It is worthwhile investing in our people, investing in our processes,’” Gilk said. “They should do that for their people in-house, or let other groups take up the banner that Canon has really led with.” Gilk, who specializes in MRI safety training, said he’d like to see patient safety concerns come to the fore through expanded professional development, embracing an organizational safety chart and expressing broader practice goals through specific, personalized patient needs. The best way he foresees that happening is by expanding training to allow staffers to “feel comfortable with that kind of responsibility,” improving the overall safety of the environment. By exceeding minimum an-
nual safety benchmarks, institutions advance their overall success. “We want to do something better, more advanced, to make sure that we’re not treating MRI safety as another layer that we’re slapping on top of existing processes. Developing a knowledge and competency woven into patient care has an orders-of-magnitude impact.” Gilk believes the Putting Patients First focus on pediatric needs will also help advance those goals in adult care, because best practices in the broader setting seem to emerge from such environments. Focusing on walking patients through the process of getting a scan before it happens not only reduces the use of anesthesia and improves image quality, but also can improve patient satisfaction scores and, ultimately, revenues and reimbursements. “With most things in radiology, we can look at pediatric settings and seeing what they’re doing that will hopefully be more comfortable in the adult world 10-15 years from now,” he said. “If they have a child specialist and can do play simulation with respect to using the MRI — this is what it sounds like, this is what it looks like, let’s practice holding still — those things can have a remarkable impact for reducing anxiety, reducing anesthesia. “Nobody is happy about getting an MRI,” Gilk said. “To start out, not being pleased that you have a diagnosis, then you compound that with the fact that a lot of patients have anxiety about medical tests, and we layer on these stressors, and it makes the process
“
harder for the patient, harder for the facility.” Gilk also noted that the expanded focus on environmental factors plays a big part in the diversity of patient populations who present for study. Today, specialists may see trauma patients, emergency patients, nonverbal or non-communicative patients, and may be performing more complex medical procedures on them. Making sure staff are fully trained in safety protocols is a critical piece of that puzzle, but so is presenting staff and patients with a calm environment to smooth the entire process.
I hope that more facilities and health care groups see this, and begin to say, ‘It is worthwhile investing in our people, investing in our processes,’” - tobias Gilk “The ground has shifted under our feet, and the risk factors have shot up and up and up,” Gilk said. “It puts the people who actually deliver care — the technologists, the radiologists, and the medical physicists who support them — in the crosshairs, because they have to make more decisions for patients who have a greater degree of complications. “We need to give folks the resources to make better decisions,” he said. “At its core, that comes down to teaching them the information that they need to have to be able to make the better decisions.” ICE
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insight
IMAGING MATTERS Staff Retention Myth
A
s the average age of the Field Service Engineer (FSE) increases and the demand for qualified service personnel increases there is an ever-growing need to retain qualified individuals to service diagnostic imaging equipment. There are a number of strategies that are being employed with varying degrees of success. Throughout the medical industry there is a big push for employee engagement. A Gallup poll indicated that about half of all employees are not engaged with the job they do every day. What that translates to is that about half of the people in the workforce are doing the work for money alone with no further interest in the company
Over 75 percent would leave for the right offer and roughly 70 percent would take a pay cut for the “ideal job.” that employs them. Polls show that over 75 percent would leave for the right offer and roughly 70 percent would take a pay cut for the “ideal job.” The answer given to address this challenge is “employee engagement.” Employee engagement is often touted as the single requirement to ensure retention. I need to impress that employee engagement is critical. An FSE needs to feel WWW.IMAGINGIGLOO.COM
connected to the work that they are doing. They need to understand the importance of what they are doing. They need to understand how the work translates into positive outcomes for patients and the company or hospital. The employee has to trust the person who serves as their manager or director. Knowing the person you report to will support you and help you develop is invaluable. The work environment should create a workplace that is, at the very least, a good place to go work every day. All of these aspects and others are important to retain qualified personnel. However, it is a myth to believe that compensation is not important. If a big enough offer is made, an FSE will go to work somewhere else even if it is reluctantly. When someone has the opportunity to increase their income significantly, it is unrealistic to expect them to pass on the opportunity without some serious thought. It is unrealistic to believe that culture and engagement alone will prevent them from leaving for the higher pay. Health care as an industry is focusing on employee engagement. So, taking a higher paying job does not preclude the individual from going to another location that is also focused on engagement. So, what can be done to mitigate the migration of your quality personnel to other companies or hospitals? First, cultivate a good working environment that will engage employees. There are a number of books as well as extensive training available on creating culture in the workplace. Next, know who is competing for your personnel. Watch the open job positions and know what they
Written by John Garrett Director of a Clinical Engineering Department in CHI
pay. Make sure that you are compensating properly compared to the hospitals and companies around you as well as compared to anyone that might want to “fish in your pond.” As there are fewer qualified people available, the demand will drive up the average compensation. Finally, start recruiting for the industry. Not just for your company or hospital. They will benefit from the growth in the industry. Get involved in career days at high schools. See if you can create a scholarship for people who are looking to get into the field. In short, start creating a new pool of qualified candidates so that the needs of the company or hospital as well as the industry can be met now and in the future. 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. ICEMAGAZINE
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Is There a Future for Imaging Service Engineers?
I
n the past decade or so, I have had a few apprentice imaging engineers that wonder if they made the right career choice after a couple of months on the job. They wonder if their job is even going to exist in the near future. They observe how reliable the new scanners are and notice most manufacturers have been reducing the frequency of preventive maintenance calls specified in manuals. And, they start learning about the remote diagnostics and password lockout schemes that reduce the effectiveness of a non-OEM field tech. The vision that the OEMs have been striving toward for years, to capture all the aftermarket revenue and reduce or eliminate the need for field engineers, becomes clear to them. The need to have a bachelor’s degree in electronic engineering to do field service of scanners has been eliminated already. The days of a field engineer using an oscilloscope and soldering iron are long gone. The Field Replaceable Units (FRUs) of today are boards and sometimes modules made up of several boards. Many companies, especially OEMs, are using remote monitoring that will “phone home” to the service center when a problem is detected. They can use the Internet to do diagnostic testing and perform some repairs such as applying software updates without having to dispatch a field service person. Many scanners are designed to automatically 42
ICEMAGAZINE | SEPTEMBER 2018
repair one of the most common problems we see these days, software corruption. There are some systems that now have diagnostics on steroids; artificial intelligence (AI) that can automatically switch on a replacement part or redundant circuit built into the scanner when the diagnostics detect a failure.
“As long as there are nurses and careless scan techs, there will be broken devices that need to be fixed.”
Ultrasound systems are becoming small enough to be shipped to a depot for repair, and a couple of companies have systems that are made to be modular and easily disassembled, so that the customer can do all the field service themselves. At least one OEM has an MRI scanner that has the entire image processing subsystem off-site, connected to the gantry and magnet through the World Wide Web, enabling one tech at the factory to maintain several custom-
ers’ units. There is no doubt that our jobs have changed quite a bit over the years with improvements in the scanner designs. A field engineer could only handle 25 or 30 ultrasound systems in the late 1980s, and now most that I know are servicing 250 to 300 units. In the early days we needed a field engineer for every MRI scanner. (Those scanners were called NMR in the beginning, but “nuclear” in the name freaked out some customers.) At that time the imaging engineer needed to be able to use a spectrum analyzer and do calculus, even to do a PM! Now a Siemens MRI system has a built-in PM routine that is mostly automated, with animation showing which phantom to use and where to place it on the gantry. They can be PMed by a 12 year old! However, despite all those great strides in reliability and serviceability, as new field engineers get more experience they begin to realize something most of us know. Our jobs are safe for a while. As an HTM manager told me years ago, “As long as there are nurses and careless scan techs, there will be broken devices that need to be fixed.” Almost all scanners in use today still require a skilled and experienced service technician to perform maintenance and replace parts. (And most of the technologists and doctors I know are not going to agree to be twisting screws and replacing electronic modules anytime soon, anyway!) There ADVANCING THE IMAGING PROFESSIONAL
Still think you can get some mileage out of your “end-of-life” Nuclear Medicine camera? are also problems like poor AC mains, network issues and RFI/EMI noise that cannot be easily be diagnosed or fixed without specialized knowledge and experience. But we should expect the scanners and the parts to keep getting more reliable and smaller (with the possible exceptions of RF amplifiers, X-ray tubes and gantries). One effect of the changes in designs and service strategies is that the skill level requirements for different field service jobs are becoming more stratified. Some field representative jobs with OEMs do not require an electronics background these days, in some cases companies will not even consider hiring someone with advanced electronics knowledge for the job. The big manufacturers tend to hire customer service reps who are generally intelligent people, often with a liberal arts degree, that get some training
before they go into the field, and a lot of technical support once they do. The remote support center does most of the troubleshooting of problems using their advanced diagnostic tools and training. And there are service specialists for each modality, typically with an advanced degree and/or a lot of field service experience, that go on-site for the more technical jobs. The future of imaging engineers has changed quite a bit and will almost certainly continue to evolve. As long as humans are using the scanners, and we can get the tools and documents we need at a reasonable price (as we are legally entitled) or can continue to reverse engineer the equipment enough to service it in spite of the OEMs’ lockout strategies, I believe that field imaging engineer jobs will be secure for quite a few years to come. ICE
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insight
DO YOU HAVE THIS WORKPLACE DISEASE?
O
ver the past four decades, I’ve observed a serious problem in the workplace. Actually, I think it’s a disease, but those who have it rarely know they have it. I call this disease Adult Syndrome, because it affects so many adults. Like other diseases, Adult Syndrome has several variants: Type I and Type II. However, each type leads to the same result: decreased levels of productivity. After reviewing some of the symptoms listed here, you may find that you are infected. In fact, you may be infected with both types. If you find this to be the case, you may need to spend extra time addressing the cure. TYPE I Adult Syndrome: Imagined Understanding This form of the disease is carried by those who imagine that because they are adults, they should already understand what someone is saying before they say it. One indicator that someone has this variant of the disease is they frequently use the phrase “I know.” Interestingly, this variant of the disease affects people trying to hide the fact that they don’t know something, mainly because they’re afraid they’ll appear inferior for not being omniscient. Warning: Type I Adult Syndrome can be acute in people holding supervisory positions. Case Study #1: A budding manager is sitting in a class learning how to calculate financial returns for a capital investment. Although he doesn’t fully understand the process, he acts like he does and doesn’t say a word when the instructor asks, “Any questions?” Case Study #2: A production manager hears that there are problems happening in production, but doesn’t ask anyone about the details. Based on his years of working in the plant, he believes he already knows what’s causing the problem. The manager sends out 44
ICEMAGAZINE | SEPTEMBER 2018
a memo that outlines mandatory changes to how things are to be done from that point forward, but his solutions don’t fix the problem. Case Study #3: A senior employee is reassigned to a new position about which he has little knowledge. He makes light of the training he receives and, accordingly, his productivity never reaches acceptable levels. His supervisor calls him in to review the job requirements, then asks if the employee understands what’s required. Being a senior employee who doesn’t want to appear inept, the employee says, “Yes.”
Curing adult syndrome is possible, but the treatment can be a tough pill to swallow. The best antidote is a large, thick slice of humble pie.
TYPE II Adult Syndrome: Intentional Deflection This variant of the disease is rooted in self-preservation. It fools observers by redirecting attention when the infected person doesn’t know – or doesn’t want to know – the answer. Case Study #1: When asked to evaluate what went wrong with a certain project, a project manager strives to maintain his reputation. He goes through the motions, then pins the blame on a junior employee. In this case, the infected manager is concerned that others might see a flaw in his quality control
Written by Daniel Bobinski Workplace Consultant
methods, and he doesn’t want to look inept to his peers. Case Study #2: In a training class discussion on how to solve a particular problem, a person makes a recommendation that would never solve the problem being discussed. When the instructor begins to discuss alternative approaches, the person continually interrupts with “yeah, but…” and keeps implying that his solution should be acknowledged as being OK. Case Study #3: A worker with a problem comes to a manager, but the manager has no clue about how to solve it. Not wanting the worker to know this, the manager interrupts, saying if the worker can’t solve this simple problem, he can be replaced by someone who can. In all these cases, the infected people want to be seen as someone who has what it takes, but Adult Syndrome causes them to miss out on key opportunities. Curing Adult Syndrome is possible, but the treatment can be a tough pill to swallow. The best antidote is a large, thick slice of humble pie. I’m not talking about groveling. Humble pie is simply a dose of reality taken with some introspection. Sadly, too many people deny humility’s healing powers, viewing it as a weakness rather than a strength. Those who hold such views would benefit from listening to business consultant and marketing expert Ira Williams, who says, “To be humble is not to be weak – to be humble is to be strong.” These are fresh words with a ADVANCING THE IMAGING PROFESSIONAL
powerful, age-old meaning. Sadly, they are glossed over by too many adults in today’s business world. Additional treatment for Adult Syndrome includes increasing one’s ability to exercise patience. Another part of treatment involves genuinely considering another person’s point of view. In his book “Why Don’t You Want What I Want? How to Win Support for Your Ideas without Hard Sell, Manipulation, or Power Plays,” author Rick Maurer says we need to be willing to be changed by listening to another person. I should point out that Maurer’s advice doesn’t mean we should desire to be changed, but rather that we are willing. Misunderstanding this difference is why many continue to suffer from Adult Syndrome. Essentially, if we are willing to listen to someone else and realize we are not om-
niscient, the symptoms of Adult Syndrome begin to fade away. When that happens, working relationships become healthy, and productivity goes up. Bottom line: You can help eradicate Adult Syndrome in your workplace. Just listen to others with a willingness to learn and, if necessary, be changed. As Ira Williams says, it’s not a sign of weakness, but a position of strength. ICE In addition to blogging about emotional intelligence at eqfactor.net, 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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AHRA Scrapbook
AHRA 2018 SCRAPBOOK T
he AHRA 2018 Annual Meeting and Exposition was held July 22-25 in Orlando, Florida, at the Gaylord Palms Resort & Spa. The four -day event attracted over 1,000 medical imaging leaders, offered 70-plus educational sessions and the opportunity to meet with 150 exhibitors. Industry peers from across the nation came together to gain insight into health care services, tools and trends that will impact patients and facilities. Next year’s conference will be in Denver, Colorado, from July 21-24, 2019. ICE
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7 ADVANCING THE IMAGING PROFESSIONAL
AHRA Scrapbook 1. AHRA attendees gather for a Hot Spot drawing at the RadSite booth inside the exhibit hall. 2. The Imaging Community Exchange (ICE) and MedWrench were excited to exhibit at this year’s conference. Megan Cabot and Jayme McKelvey of ICE Magazine and Alex Wright of MedWrench greeted attendees. 3. This little monkey encouraged attendees to drop their business card into a drawing for various prizes at the ApronCheck.com booth. 4. Scott Nudelman (left), COO and Danny Mobley (right), vice president of sales of The InterMed Group, visit with Jayme McKelvey at the ICE booth. 5. Samsung showcased its growing portfolio of advanced medical technologies for computed tomography, digital radiography and ultrasound systems. 6. LANDAUER joined Fluke Biomedical and RaySafe as a result of the Fortive acquisition in late 2017. 7. Alex Wright of MedWrench demonstrated its free product support network to AHRA attendees. Learn more on medwrench.com. 8. ICE advertiser Oxford Instruments exhibited at this year’s AHRA 9. Megan Cabot received a demonstration of Hitachi’s SOFIA for whole breast imaging. 10. Zetta Medical Technologies promoted their national equipment sales and service on GE, Siemens, Toshiba and Philips imaging equipment at this year’s conference. 11. While in Orlando for AHRA, the ICE sales team visited the new home for Injector Support and Services. Learn more about this company by visiting injectorsupport.com. 12. RTI representatives were on hand to inform AHRA attendees about their quality assurance solutions for X-ray modalities and facilities 13. Putting for prizes! Attendees were able to participate in a fun putting contest at the Advanced Data Systems booth. 14. Megan Cabot of ICE chats with AHRA attendees about the 2019 Imaging Conference and Expo, February 17-19. More details on AttendICE.com. 15. Seimens Healthineers exhibited at AHRA 2018 to tell attendees how they can be the trusted partner of health care providers worldwide, enabling them to improve patient outcomes while reducing costs. 16. Levon Vatian, customer loyalty engineer at Samsung, visits with Jayme McKelvey at the ICE booth.
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E7886X Š
by Ray-Pac
The long awaited and competitively priced Ray-Pac Toshiba replacement is now available. Ray-Pac’s KL-7886 is a direct replacement for the Toshiba E7886X and comes with our 12 month full replacement warranty. Ray-Pac is committed to keeping up with the ever-changing technology in quality X-ray tube replacements.
Additional Toshiba Replacements E7239, E7242, E7252, E7254, DRX-3724
Call Ray-Pac at 843.767.8090 for more information. RAY-PAC
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www.Ray-Pac.com 7290 Pepperdam Ave., N. Charleston, SC 29418 - USA