ICE Magazine - March 2019 by MD Publishing

ADVANCING THE IMAGING PROFESSIONAL

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contents

ICE FEATURES

March 2019

“I believe that the lion’s share of mistakes we’re making in the U.S. MR industry today is cancelling people who could be safely scanned.” –Emanuel Kanal

32 Cover Story

rofessional of P 20 the month

Historically, most conversations about patient safety in medical

David Dacorro is among today’s pro-

imaging have focused on how to limit their exposure to unnecessary ionizing radiation. In recent years, a new wrinkle has emerged – how to safely image the growing number of patients with implanted medical devices and replacement joints.

fessionals who found their calling while serving in the U.S. military. The military provides excellent training and a wide variety of career fields to consider. Dacorro is a nuclear medicine clinical-radiation safety manager at the Naval Hospital Jacksonville in Jacksonville, Florida.

ICEMAGAZINE | MARCH 2019

ADVANCING THE IMAGING PROFESSIONAL

contents

ICE DEPARTMENTS

March 2019

news

people

products

insight

8 Imaging News

20 Professional Spotlight

36 Careers Center

16 Webinar Wednesday

22 Department Spotlight

24 Cardiac Imaging Spotlight

18 People on the Move

25 Cardiac Imaging Gallery 30 Tools of the Trade 31 Photo Contest

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

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38 Imaging Matters 40 Daniel Bobinski 42 Index

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Circulation

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Contributors

Digital Department

Kristin Leavoy kristin@mdpublishing.com

John Wallace jwallace@mdpublishing.com

Publisher

Art Department Jonathan Riley Karlee Gower Kathryn Keur

Jayme McKelvey Megan Cabot

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

Lisa Cover Melissa Brand

Cindy Galindo Kennedy Krieg

Webinar

Linda Hasluem

ICE Magazine (Vol. 3, Issue #3) March 2019 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.theicecommunity.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. ÂŠ 2019

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news

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

Mercy Hospital St. Louis Purchases Mevion Compact Proton Therapy System Mevion Medical Systems has signed a contract with Mercy Hospital St. Louis for the purchase of a MEVION S250i Proton Therapy System with HYPERSCAN Pencil Beam Scanning technology. Mercy Hospital’s David C. Pratt Cancer Center is a nationally accredited center, which provides outpatient treatment, radiation oncology and infusion services for the cancer patients throughout the Mercy hospital network. “We are very happy to be able to offer this powerful cancer fighting tool to our patients,” said Dr. Robert Frazier, MD, chairman of radiation oncology at Mercy Hospital. “At the Pratt Cancer Center we have been expanding the technologies that we can provide to our patients. Cancer comes in so many forms that having the right set of tools for each patient is critical. Adding protons gives us a new precision tool that is becoming the standard of care for certain tumors.” The proton system at Mercy Hospital will be incorporated directly into the existing radiation oncology department. Embedding proton systems is a more efficient approach enabled by the highly compact systems that Mevion provides. This design helps the hospital share existing resources and maintains a fully integrated continuum of care for patients. Mercy Hospital is purchasing a proton system with HYPERSCAN technology, which is the most advanced form of pencil beam scanning proton therapy on the market. Cleared by the FDA in 2017, HYPERSCAN enables a faster and sharper delivery of therapeutic radiation to tumors. The system’s advanced clinical capabilities in conjunction with its compact size and affordable design has changed the landscape of proton therapy. Today, more cancer centers are considering providing compact proton therapy to their patients because of the technology Mevion has advanced. “At Mercy, we are committed to ensuring the communities we serve have access to the most advanced and stateof-the-art treatment options. Our partnership with Mevion delivers on this promise to our patients and supports our physicians to provide the best care possible,” said Stephen Mackin, president of Mercy Hospital St. Louis. •

ICEMAGAZINE | MARCH 2019

ADVANCING THE IMAGING PROFESSIONAL

news

Acertara Acoustic Laboratories’ CEO Re-elected as MITA Ultrasound Section Chair Acertara Acoustic Laboratories has announced that Acertara CEO G. Wayne Moore has been re-elected as the 2019 Ultrasound Section Chair for the Medical Imaging and Technology Alliance (MITA), a division of the National Electrical Manufacturers Association (NEMA). In this role, Moore also serves as an ex-officio member of the MITA Board of Directors, as well as the co-Chair for the Output Standards Committee for the American Institute of Ultrasound in Medicine (AIUM). “I am honored to once again be elected to this role and look forward serving during a very important time in medical technology development, as well as the rapidly evolving medical device regulatory environment, both in the United States and in the European Union (EU),” Moore said. “In this role I was involved in multiple meetings with the FDA on issues ranging from servicing

and remanufacturing to reviewing and commenting on the new 510(k) Guidance document for ultrasound systems and transducers. As the CEO of an ultrasound probe testing device manufacturer, I was also involved in multiple meetings with IEC work groups developing standards for devices relative to the safety and efficacy of, and obtaining CE labeling for, ultrasound devices. I look forward to continuing this work during 2019.” •

SPBS Inc. Acquires Deccaid Services Inc. SPBS Inc., an employee-owned clinical equipment services company, has announced the acquisition of Deccaid Services Inc., an imaging service company with over 30 years of experience, specializing in all facets of the diagnostic imaging industry including equipment sales, service, installations, de-installations and evaluations. “The acquisition of Deccaid and its extensive knowledge base in the diagnostic imaging industry has uniquely positioned

SPBS Inc. to enhance the overall customer experience by offering a more well-rounded breadth of clinical equipment services to their current and future customers,” according to a press release from SPBS Inc. “This acquisition allows SPBS to fully enter into the high-end imaging services market as well as expand even further into our established tri-state presence,” SPBS CEO Jeff Daugherty states. “We are embracing our clients’ requests to add MR/CT services and now are more fully equipped

to provide a full asset management suite of care solutions for our customers and the care of the many patients that we indirectly serve in our communities nationwide.” “We’re excited to be a part of a growing and transformative company like SPBS and very much look forward to combining our many years of experience to offer our customers a comprehensive equipment and service solution platform,” Deccaid President Sal Aidone said. •

The InterMed Group Acquires Horizon CSA LLC The InterMed Group announced the acquisition of Horizon CSA LLC, a Mooresville, North Carolina-based provider of clinical engineering solutions for biomedical and imaging services at health care organizations. “Horizon is known for its unique approach to assessing then managing clients’ total costs for medical equipment servicing and administration and has built a reputation for quality that consistently generates the highest customer satisfaction ratings,” according to a press release. Horizon services include: biomedical equipment repair and maintenance services; clinical engineering services; imaging equipment repair and maintenance services; life-cycle management; inventory audit; service contract review; technol-

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ogy management; and clinical equipment planning and assessment. “Horizon’s passionate focus on delivering best-in-class medical equipment servicing and program management aligns perfectly with InterMed’s culture,” said Rick Staab, CHTM chief executive officer, The InterMed Group. “The Horizon team expands our technical skill sets and depth. The addition of the Horizon portfolio makes InterMed a sizeable player on the East Coast. We anticipate a smooth integration of these very loyal client relationships with very little change to service delivery other than offering additional services that we can now provide.” Horizon CSA Co-Owners Mike Marrow and Dale Allman expect a smooth transition. “We are very pleased to be joining The

InterMed Group, and completely confident that our employees will be comfortable with the culture and management. In addition to partnering with a recognized leader in this industry, InterMed provides additional resources for our growth, and enhances service offerings we can offer the Horizon clients,” they said. It is anticipated that Horizon’s operations will be quickly, and seamlessly, integrated enabling its customers to take advantage of InterMed’s broad array of modality services. In turn, InterMed will be able to offer a new best-in-class HTM program called “New Horizons,” a direct product of the integration of these two companies’ cultures. • For more information, visit www.intermed1.com.

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news

Tri-Imaging Solutions Achieves ISO 13485:2016 Tri-Imaging Solutions, a provider of imaging parts and training, has received ISO 13485:2016 certification from registrar Orion for its imaging parts, equipment and training services. To earn the certification, Tri-Imaging implemented a number of enhancements to its existing ISO 9001:2015 Quality Management System (QMS), culminating in a multi-day certification audit by Orion. The International Organization for Standardization (ISO) is the world’s largest developer and publisher of international standards for the implementation of QMSs and various other technical and operational standards. “Earning the certification demonstrates Tri-Imaging’s commitment to delivering the highest quality parts and service support to the medical imaging industry. They are now able to further ensure the effectiveness of their processes in following the same guidelines as medical device manufacturers,” according to a news release. The ISO 13485:2016 standard specifies the requirements that an organization’s QMS must meet to demonstrate its ability to provide medical devices and related services that consistently meet customer and regulatory requirements. “With the ISO 13485:2016 certification, customers can be confident that Tri-Imaging is dedicated to maintaining the highest level of quality, efficiency and responsiveness to achieve the company’s ultimate goal of superior customer satisfaction,” according to the release. “The ISO 13485:2016 certification recognizes that the policies, practices and procedures of Tri-Imaging ensure consistent quality in the repair and support services provided to clients.” Eric Wright, president of Tri-Imaging Solutions, was quick to give credit to his team. “The hard work and dedication to complete our certification in such a timely manner is a great reflection of the Tri-Imaging team,” Wright said. “Our strength comes from more than 320 years combined industry experience among this knowledgeable team.” Tri-Imaging is an independently owned diagnostic imaging parts, technical training, technical support and support services company for the diagnostic imaging market. •

ICEMAGAZINE | MARCH 2019

Valerie P. Jackson, M.D., Named President of RSNA Valerie P. Jackson, M.D., was named president of the Radiological Society of North America (RSNA) Board of Directors at the Society’s annual meeting in Chicago. An expert in the field of breast imaging, Jackson is the executive director of the American Board of Radiology (ABR), a position she has held since 2014. She previously served on ABR’s board of trustees from 2001 to 2010. Jackson received her medical degree in 1978 from the Indiana University School of Medicine, and completed her residency at the Indiana University Medical Center in 1982. Jackson is the Eugene C. Klatte Professor Emeritus and has had numerous academic appointments at Indiana University School of Medicine over the years, including lecturer, professor and chair of the department of radiology and imaging sciences. As president, Jackson will develop programs and initiatives that support RSNA’s mission to promote excellence in patient care and health care delivery through research, education and technologic innovation. “The RSNA annual meeting is the leading forum for the introduction of medical imaging technologies, and the increasingly international attendance at the meeting allows people from all over the world to share knowledge and ideas,” Jackson said. “RSNA continues to grow as a world leader in informatics and has become a critical convener for artificial intelligence, machine learning and deep learning. While the focus of my career has been predominantly in education, I plan to work hard to continue to advance RSNA in all of these areas.” In other news, James P. Borgstede, M.D., was named president-elect of the Radiological Society of North America (RSNA) Board of Directors. Also, Mary C. Mahoney, M.D., was named chair of the Radiological Society of North America (RSNA) Board of Directors. •

ADVANCING THE IMAGING PROFESSIONAL

news Clinical Collaboration Platform Manages Millions of Imaging Studies Carestream Health showcased its latest version of Vue Clinical Collaboration Platform at the HIMSS 2019 tradeshow in Orlando, Florida. The latest release of its Clinical Collaboration Platform includes a zero-footprint offering with additional modules, as well as report analytics using natural language processing (NLP) to enable data-mining of diagnostic reports for quality measures and research. “Carestream’s enterprise-wide solutions help customers simplify workflow and eliminate departmental imaging silos to improve care and lower costs. Today 4,800 health care organizations across 82 countries rely on our solutions and expertise,” said Andreia Beyer, Carestream’s director of global marketing and growth opportunities for healthcare information solutions. “Our modular enterprise imaging solution can an easily image-enable a facility’s EHR and offer providers a complete patient health record.” The Clinical Collaboration Platform allows providers of all sizes to consolidate, manage and seamlessly share images and reports across a health care enterprise. It features efficient diagnostic tools and native multimedia interactive reporting for improved clinical productivity; intuitive communication and collaboration tools to streamline operations; and advanced workflow orchestration capabilities and analytics to optimize cross-enterprise resource utilization. •

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Philips Launches Azurion with FlexArm Royal Philips, a global leader in health technology, has announced Azurion with FlexArm, to set a new standard for patient imaging and positioning flexibility for image-guided procedures. During increasingly complex interventions, clinicians need to quickly and easily visualize critical anatomy and identify changes to the patient during the procedure. Azurion with FlexArm includes a set of innovations that makes it easier for the clinician to perform imaging across the whole patient in both 2D and 3D. As the clinician moves the system, the image beam automatically maintains alignment with the patient, allowing more consistent visualization and enabling them to keep their focus on the treatment. “With FlexArm, Philips’ engineers have overcome near-impossible geometric

and mechanical barriers to enable clinicians to achieve clinical excellence in image-guided therapy,” said Barry T. Katzen, MD, founder and chief medical executive of the Miami Cardiac & Vascular Institute, Baptist Health South Florida (U.S.). “FlexArm enables us to dramatically optimize procedures around the patient: we can get the optimal view of what’s going on inside the patient without encumbering all of the clinicians that are working around the table. The result is an innovation that’s not only clinically important but also very simple and intuitive to use – a critical factor in the heat of a complex procedure.” Azurion with FlexArm’s innovative design provides exceptional flexibility and intuitive control. Powered by a unique smart kinematic engine, the system moves on eight different axes, all controlled with its single ‘Axsys’ controller.

Simulation tests with clinicians have demonstrated the system’s potential to significantly reduce the repositioning of the patient, staff and equipment to improve access for minimally invasive procedures, including those that enter the body through the patient’s wrist (‘radial access’), and to reduce the risk of unintentional pulling of wires and tubes, as well as significant time savings. The system is ideally suited for Hybrid ORs that cater to multiple specialties in one room, such as a combination of surgical and endovascular procedures. Since its global launch in February 2017, over 450,000 patients have been treated in more than 80 countries using a Philips Azurion system. The Philips Azurion 7 C20 with FlexArm is CE marked and has received 510(k) clearance from the U.S. Food and Drug Administration (FDA). •

CS Medical’s New Tool Fights HAIs CS Medical is pleased to announce the release of another tool that will assist health care professionals in their fight to reduce healthcare associated infections. For health care facilities that own the TD 100, the web-based in-service training program offers round-theclock training of staff charged with the reprocessing of TEE probes. For over a decade the TD 100 has been an effective tool in the reprocessing of TEE ultrasound probes by providing high-level disinfection in only 5 minutes. In order to ensure proper operation of the TD 100, an in-service training is completed at the conclusion of each installation and verification of operation. CS Medical service staff provides a step-by-step, hands-on training program for proper operation and preventative maintenance of the device. The web-based training portal provides the same training subject matter as directed by CS Medical staff, but is of12

ICEMAGAZINE | MARCH 2019

fered as an on-demand tool to meet competency requirements within a health care facility or outlined by The Joint Commission. The web-based training program includes a proficiency quiz and competency certificate upon completion of the program. ″We are extremely pleased to provide our health care clients with this new web-based training tool. Training is at the forefront to reduction of HAIs and by providing on demand staff training for use of the TD 100 plus the TEE Complete Care suite of products will continue to improve TEE probe care and patient outcomes,″ said Mark Leath, CS Medical president. ″We are committed to continuing our efforts to work with health care professionals and other professional organizations in the reduction of HAIs and increase awareness for a better and safer health care system.″ •

ADVANCING THE IMAGING PROFESSIONAL

news Merry X-Ray Acquires Conquest Imaging Merry X-Ray Corporation (MXR) has acquired Conquest Imaging. “The acquisition of Conquest Imaging further complements the capabilities and products that MXR is able to provide,” according to a news release. “The goal of Merry X-Ray is to be able sell and service any piece of equipment in a medical facility. Conquest gets us one step closer to that goal by allowing the MXR team to offer probe repair, replacement, and exchanges; parts repair (including multi-level board repair for multiple modalities); hands-on instructor lead training; portable ultrasound repair; and expanded field service capabilities.” “MXR is one of the most cost-effective sales organizations and

is considered one of the best third-party service providers,” according to the release. “We typically can beat OEM pricing by 20 percent and maintain OEM or better quality on our product offerings. The addition of Conquest Imaging will allow MXR to further drive down parts and service costs for our customer base,” according to the release. “We are thrilled to add Conquest’s capabilities to our portfolio of products,” said Ted J. Sloan, president of Merry X-Ray Corporation. “This continues our momentum in offering top level service and support for all diagnostic imaging systems.” •

Shimadzu Medical Systems USA Acquires CORE Medical Imaging Inc. Shimadzu Medical Systems USA, a subsidiary of Shimadzu Corporation, in order to further expand its health care business in North America, has acquired CORE Medical Imaging Inc. (CMI). CMI, with its head office in Kenmore, Washington, has successfully provided medical imaging products and service as an authorized dealer of several professional brands, such as Shi-

madzu, since the year 2000. CMI’s focus has been throughout the Northwest region of the U.S. and has established an excellent business reputation among its customers. In Shimadzu’s mid-term business strategy, its medical systems division aims to expand its business by further strengthening its position in the world’s largest medical market: the North American business. This acquisition is based on that key strategy. •

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Three Facilities Add Fujifilm DR Solutions FUJIFILM Medical Systems U.S.A. Inc., a provider of diagnostic imaging solutions with a comprehensive portfolio of digital radiography (DR) solutions, has announced that three more health care facilities across the United States have integrated Fujifilm’s DR solutions to help enhance clinical, operational and financial outcomes. “We are proud to partner with leading health care facilities to provide cutting-edge technology to aid in the diagnosis and treatment of patients,” said Rick Banner, senior director of marketing, FUJIFILM Medical Systems U.S.A. Inc. “Patients can be reassured that exams conducted with Fujifilm DR systems will be fast and comfortable. And radiologists can be confident that with Fujifilm, exams performed at a low-dose will provide the image quality needed to make informed decisions about the course of care for patients.” "The availability of Fujifilm's all-new FDR Go Plus is driving Fujifilm DR installations across the U.S. The new portable is meeting the demands of today's radiology professionals to facilitate exceptional care at the patient beside. Its compact and maneuverable design is versatile enough for tight spaces such as operating rooms, emergency departments and neonatal intensive care. The design even features added infection controls of Fujifilm's exclusive Hydro AG® coating on its detectors," according to a press release. Fujifilm’s complete portfolio of DR solutions includes detectors, portables and rooms, all designed to provide exceptional image quality at low dose. Recently, Fujifilm collaborated with health providers delivering its unique DR imaging solutions including Huggins Hospital (Wolfeboro, New Hampshire), John Hopkins All Children’s Hospital (St. Petersburg, Florida) and Los Angeles County Department of Health Services (Los Angeles, California). •

FDA Clears uEXPLORER Total-body Scanner United Imaging Healthcare has announced U.S. Food & Drug Administration (FDA) clearance of the uEXPLORER total-body scanner. uEXPLORER is the world’s first medical imaging scanner that can capture a 3D picture of the whole human body at one bed position. uEXPLORER was developed by United Imaging in partnership with the EXPLORER Consortium led by Simon Cherry, Ph.D., and Ramsey Badawi, Ph.D., from the University of California, Davis. uEXPLORER is a combined Positron Emission Tomography (PET) and X-ray Computed Tomography (CT) scanner that can image the entire human body at the same time. “This is truly a game-changing, revolutionary day for the advancement of medical technology,” said Jeffrey M. Bundy, Ph.D., chief executive officer of UIH Solutions. “The human images the uEXPLORER produces have been nothing short of astonishing, especially when one considers the very short acquisition times. This device will bring us into completely new areas of discussion with our customers, as we jointly re-think the role of PET in the North American health care system. We are thrilled to be able to start sharing it widely in the U.S.” The developers expect the technology will have a wide range of applications, from improving diagnostics to tracking disease pro14

ICEMAGAZINE | MARCH 2019

gression to researching new therapies. For example, uEXPLORER will be used to better visualize cancer that has spread beyond a single tumor site. Researchers also envision using the scanner to measure blood flow across the entire body, and study inflammation, infections and immunological/metabolic disorders. United Imaging developed uEXPLORER based on its latest hardware and software platform, focusing on not only delivering the target performances but also making such a large system more robust and user-friendly, resulting in technology that produces higher-quality diagnostic PET scans than have ever been possible. The first images from scans of humans using the new device were unveiled at the 104th RSNA Scientific Assembly and Annual Meeting in Chicago. “As we had originally envisioned the uEXPLORER will have a profound impact on clinical research and patient care,” said Cherry, professor in the UC Davis department of biomedical engineering and co-developer of uEXPLORER. “With this device, we will be able to ask and answer an array of new biological questions – that’s truly incredible for the future of health care for all of us,” Badawi, chief of nuclear medicine at UC Davis added. •

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WEBINAR WEDNESDAY Women in HTM Session Kicks off 2019 Webinars

ebinar Wednesday is off and running in 2019! The free “Women in Healthcare Technology Management” webinar was a huge success with 230 attendees for the live presentation plus more have viewed the recording online! The attendees for the live presentation are eligible to receive 1 CE credit from the ACI. The special 60-minute webinar focused on women in HTM. Men have traditionally dominated the field of engineering. Over the past 20 years, more women have entered the field, especially in the Healthcare Technology Management arena. Webinar Wednesday hosted an expert panel of accomplished women who hold leading roles within health care facilities and HTM-related companies. The presenters were Integrity Biomedical Services Owner/President Michele Shahbandeh, Huntington Memorial Hospital Clinical Technology Department Director Izabella Gieras, Medinas Health Founder and CEO Chloe Alpert, ZingBox Co-Founder and CTO May Wang and Penn State Health System Director of Clinical Engineering Samantha Jacques. The presenters provided a historical overview of women in engineering, shared their own experiences as well as highlighted other successful women in the field and their contributions. TechNation and MedWrench worked together to bring this webinar to the HTM community. Attendees provided overwhelmingly positive feedback in a post-webinar survey. “Working in the HTM field for about 25 years now, it felt great to hear so many of my concerns and personal goals were shared amongst the speakers today. I am happy to say that I have overcome so many obstacles 16

ICEMAGAZINE | MARCH 2019

through hard work, dedication and continuous education. Thank you for this great presentation and acknowledgement of women in the HTM field,” shared M. Garcia, Senior Medical Systems Engineering Technician. “I have been in the HTM field for 25 years. This is my first ever all-female led seminar relating to my career choice. Thank you for presenting,” E. Petrea, CBET, said. “The webinar was inspiring, as I was able to see and hear how others have succeeded in the field,” said D. Palumbo, Intermediate Technician. “As a fresh out of college, young professional, it is very reassuring to hear from individuals you can relate to who have achieved positions that reflect your ambitions,” shared E. Eichorn, Biomedical Intern. “As a female engineer, it was very refreshing to see this topic acknowledged and discussed. It was great to hear an overall perspective from in and outside of our field. The young lady that was 30 under 30 was very impressive,” said K. Ziemniak, Clinical Engineering Manager. “Truly amazing women of HTM, we should all be very proud of what they individually and collectively have accomplished and their contribution to the field. My guess is it took a lot of courage and determination that 'the majority of us' may never have had to demonstrate or prove,” said T. Cordes, Perioperative Clinical Engineering Supervisor. “Excellent webinar. It was the first I attended and I look forward to more in the future. All speakers were so well spoken, honest and knowledgeable,” shared J. Ruiz, Database Administrator. “As a woman in biomedical engineering, I am very familiar with the challenges. Listen-

ing to today’s webinar confirmed that I am doing the right things to stay visible to the team in a positive way, that I am adding value to the department, and that when I take a hard stance, because I believe in what I’m doing, to not go soft because others don’t agree. Thank you ladies! You all are a beautiful inspiration to just keep going,” S. McClinton, CBET, said. “Wow! Very impressed! Super group of leaders! Information was thoughtful, personal and spot on. I heard work hard, learn from others (male or female), keep moving forward and enjoy what you are doing. And, I totally agree. Well done Webinar Wednesday,” shared M. Pritchett, CBET. “The Webinar Wednesday series is a great learning experience. I’m very thankful that MD Publishing has these wonderful Webinar Wednesdays and that my boss is supportive in allowing me to register and attend any and/or all of them. This webinar was one of the best so far, being a female in a male-dominated field, I learned a lot in such a short period of time. I’m familiar with losing my passion and how hard it is to get it back, but I’m willing to work as hard as I can to prove that the passion is just buried,” said A. Hale, Biomedical Engineer. “Thank you so much for the information, listening to all of these successful women made feel again my passion for this career and that yes it is possible, as a woman, to find a place in the HTM field – even if you are coming from another country. The most important is to keep trying and never give up. Thank you,” said K. Castro, Biomedical Engineer. “The ‘Women In Healthcare Technology Management’ webinar was very empowering, inspiring and uplifting. A definite super charge that was well needed to start the new ADVANCING THE IMAGING PROFESSIONAL

year off,” said E. Jones, Biomedical Engineer. “As a woman joining the tech field I have experienced my share of stereotyping. The webinar has helped build a sense of camaraderie that I haven’t felt. The men I work with are amazing and have helped me feel included; but it’s nice to have another woman to share experiences with,” said A. Egan, BMET. “Webinar Wednesday is an amazing learning and growing experience. It gives insight and awareness of people, devices and issues that touch so many in the HTM community. I will forever be a fan,” said J. Newell, President, B.R.I.T. Tech Institute. Expert Shares Vendor Management Tips The Webinar Wednesday series continued to bring great educational material to HTM professionals with the Nuvolo-sponsored webinar “The Future of Healthcare Vendor Management” providing the opportunity for attendees to earn 1 credit from the ACI. The webinar featured Nuvolo Director of Solution Consulting Peter Goltz. He discussed and demonstrated ways that HTM organizations can manage their vendors in a modern CMMS system. He covered areas around vendor on-boarding and access to the CMMS system, vendor contract management, vendor scorecards and reporting and vendor service level management. Almost 300 biomeds from throughout the United States tuned in for the live presentation and more have viewed a recording of the session online. The attendees at the live presentation gave the webinar a 3.8 rating on a 5-point scale with 5 being the best possible score. WWW.THEICECOMMUNITY.COM

Goltz garnered positive feedback via a post-webinar survey in which the presentation was described as “informative” and “super relevant” by attendees. “Another informative webinar that helps show the effective use of CMMS technology to manage assets,” said J. Ruiz, Biomedical Engineering Manager. “Well done and super relevant,” shared M. Pritchett, Biomedical Technician. “I enjoy the way that Peter presented the use of Nuvolo to log the vendor paperwork,” explained D. Palumbo, Technician. “As always, with these types of webinars there is a value to the HTM field. Great information,” said L. Clifford, Area Manager. “The Wednesday Webinar series is a great way to learn of new developments in test equipment, software and medical devices,” D. Minke, BMET, said. “It’s nice to have access to such relevant biomedical-specific educational sources for free,” said J. Thielen, Biomedical Account Manager. “I truly enjoy the Webinar Wednesday series! I am able to listen to the webinar and work on equipment at my bench. No lost work time and I’m learning something new at the same time. Look forward to the next one,” S. McClinton, CBET, said. ICE For more information about the Webinar Wednesday series, including a schedule and recordings of previous sessions, visit WebinarWednesday.live.

A special thank you to the companies that sponsored these recent webinars.

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news

PEOPLE ON THE MOVE By Matt Skoufalos

SPBS Inc. of Flower Mound, Texas has added James Blandi as vice president of sales and marketing. Blandi brings more than 20 years of sales leadership experience in the HTM and imaging sector to the position, including time spent in managerial and executive roles with Insight Imaging, Shared Imaging, LFC Capital and SouthWest Medical Resources.

Nationwide Imaging Services Inc. of Manasquan, New Jersey, has added James Prout as its director of service sales and business development.

In a major realignment of its operations, Olympus has announced several executive appointments and reassignments. President and CEO Nacho Abia will now also serve as co-head of the newly created Olympus Therapeutic Solutions with Tomohisa Sakurai, who relocated from Tokyo to the United States

ICEMAGAZINE | MARCH 2019

The Center for Medical Technology Policy (CMTP) of Baltimore, Maryland has named President Donna Messner its new CEO, effective February 1. CMTP founder Sean Tunis will remain as a senior strategic advisor.

The Richardson, Texas-based National Partners in Healthcare (NPH) added David Hagey as CFO. Hagey joins NPH from Epic Health Services Inc., where he was CFO. Prior to joining Epic, he was president and CFO of IntegraCare, CFO of Accuro Healthcare Solutions, and vice president and controller of U.S. operations for United Surgical Partners.

Privia Health of Arlington, Virginia has added Paul Shenenberger as senior vice president of IT operations and CISO. Shenenberger was most recently the CIO and security officer of Summit Health Management of New Jersey. He has a decade of experience working as a healthcare technology executive.

in fall 2018. Executive Director of Internal Audit Richard Lebitz is the new global chief internal audit officer of Olympus. Mark Miller is its global chief communications officer, and will also serve as the regional head of communications for the Americas.

Outset Medical of San Jose, California has added Chief Medical Officer Michael Aragon and Vice President of People Operations Stacey Porter. Aragon spent 14 years in clinical practice and as a medical director for DaVita and U.S. Renal Care, and was the founding partner and president of North Texas Kidney Consultants. Prior to joining Outset, Porter served as the head of global talent development for Intuitive Surgical, and held leadership roles at VMware and Roche.

21st Century Oncology of Fort Myers, Florida has named Charlie Powell as its COO. Powell joins 21st Century Oncology from KentuckyOne Health in Louisville, Kentucky where he presided over physician enterprise and ambulatory services for Sts. Mary and Elizabeth Hospital. Powell has been CEO at Saint Thomas Health in Nashville, Tennessee, at Saint Thomas Heart, and as CEO of the Northeast Georgia Heart Center in Gainesville, Georgia and COO of the Piedmont HealthCare in Statesville, North Carolina. The La Jolla, California-based Salk Institute extended the presidency of Rusty Gage another five years. Gage has been on the faculty of the Salk Institute since 1995, and also belongs to the American Academy of Arts and Sciences, the National Academy of Medicine, the National Academy of Sciences, and the American Philosophical Society. Pronk Technologies Inc. has added Rick Walston, CBET, CHTM, as Product Specialist. Walston has more than 20 years of biomedical engineering experience, including several years in the U.S. Army. Walston previously worked for Adventist Health and was responsible for managing operating budgets of $13 million and an inventory of over $80 million.

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people By K. Richard Douglas

PROFESSIONAL SPOTLIGHT Believe in Yourself: David Dacorro, MBA, CRA, CNMT, NCT, NMTCB (CT)(RS), RT(N)(MR)ARRT

any of today’s professionals found their calling while serving in the U.S. military. The military provides excellent training and a wide variety of career fields to choose from. Sometimes a new recruit has no idea what might lie ahead as a career path until they stumble upon it while serving. That was the case for David Dacorro, MBA, CRA, CNMT, NCT, NMTCB (CT)(RS), RT(N)(MR)ARRT. Dacorro is the nuclear medicine clinical-radiation safety manager at the Naval Hospital Jacksonville in Jacksonville, Florida. He is certified in nuclear medicine technology, nuclear cardiology imaging, computed tomography (CT), magnetic resonance imaging (MRI) and is a Certified Radiology Administrator (CRA). It was early in his Navy experience that he discovered his calling. “I was first interested in the medical imaging field when I was stationed at my first duty station in Okinawa, Japan. I was assigned to a major health care facility at the time as a general duty corpsman and I noticed the radiology department. I observed all the techs being passionate at their job duties with how they took care of their patients before and after they got imaged. That’s when a light bulb went on in my head to become a medical imaging technologist,” Dacorro says. 20

ICEMAGAZINE | MARCH 2019

“I volunteered and shadowed at a busy radiology department, observed how passionate all the technologists were at their jobs and it sparked my interest to become a medical imaging technologist myself,” he says. He went through a formal nuclear medicine technologist program at the Medical Education and Training Campus, located at Joint Base San Antonio, Texas. The program was a joint services program with members of the Air Force, Army and Navy all in the same classroom. “I held several positions during my 12year tenure in the U.S. Navy, such as senior surgical technologist lead tech, main operating room manager, nuclear medicine technologist lead tech and now I am currently a radiology department manager for 65 civilian and military personnel,” Dacorro says. Dacorro admits that his biggest challenges have centered around setting priorities and transitioning roles. “A challenge, that I have encountered during my time in the U.S. Navy, is being able to balance my professional life with my personal life. I am a very ambitious and goal-oriented individual and sometimes I get so intense with achieving my next goal I get tunnel division and forget what really matters to me. Thanks to the love and support of my wife and dogs, I am able to counterbalance that tunnel vision by sometimes taking a break from what I am

"A challenge, that I have encountered during my time in the U.S. Navy, is being able to balance my professional life with my personal life." -DAVID DACORRO

trying to achieve and just spend quality time with my family,” he says. As an imaging manager, a special project Dacorro tackled was taking over leadership from someone who was handing over the reins to him. “I had to develop my own leadership style and develop professional relationships with subordinates, peers and those who are above me in the chain of command which were no easy tasks by all means,” he says. “Another hurdle that I had to overcome ADVANCING THE IMAGING PROFESSIONAL

people Favorite part of being an imaging professional? “Taking care of my patients by exceeding their expectations and being a great leader by leading by example to all my subordinates under my watch.”

was taking over the administrative portion of the job by taking charge of staff training and education, career development, staffing and updating standard operating procedures. The whole project was a bit overwhelming at first, but with the help of my mentors and self-determination, I was able to embrace adversity and conquer it with huge success,” Dacorro adds. Rough Seas Build Character Pets are part of the family in Dacorro’s home. When not on the job, Dacorro enjoys powerlifting/body building, playing with his dogs, watching competitive sports, Japanese anime, trying out new food, attending professional conferences, going to the beach and traveling and exploring new places. Dacorro was the subject of the “Member Spotlight” in the November/December 2018 issue of Radiology Management magazine in a piece titled: “Don’t Become Stagnant.” During his military career, he earned two Navy and Marine Corps Achievement Medals and one Navy and Marine Corps Commendation Medal. He says that these were for “all my hard work by making a positive impact at my previous duty stations.” Dacorro likens challenges to characWWW.THEICECOMMUNITY.COM

ter-builders. They are part of a learning process. “As I mentioned, I am a very ambitious and goal-oriented individual who strives in achieving success no matter what challenges or life situation that may and will happen during the course of my life. I am also a huge proponent of not being afraid to make mistakes. In fact, the mistakes you will make during the course of your career and life are the most significant lessons to learn from towards achieving ultimate success,” he says. “Going through adversity and challenges help build character/composure and there is a special saying that I always live by whenever I encounter a tough challenge; ‘A smooth sea never made a successful sailor,’” Dacorro adds. “In summation,” he says, “mistakes, challenges and adversity should never deter you away from achieving your goals, it should help propel you if you react in a positive way which will, in time, ultimately make you a stronger human being and you will realize that with hard work you can accomplish absolutely anything.” The military teaches many life skills and embracing them for life is key to growth and self-enrichment. ICE

GET TO KNOW THE PRO Favorite book Lord of the Rings series Favorite movie All Star Wars movies Favorite food Italian and Mexican Hidden talent Lifting heavy objects with great form What’s on my bench? A military collar device of the next rank should I get promoted, my certification pins/patches, picture of my wife and dogs, study guide of my next certification, a protein shake

ICEMAGAZINE

people By K. Richard Douglas

DEPARTMENT SPOTLIGHT Wilford Hall Ambulatory Surgical Center Imaging Service Team

he Joint Base San Antonio (JBSA) “services more DOD students than any other installation, more active runways than any other installation, houses the DOD’s largest hospital and only level one trauma center,” according to its website. The imaging service team in the Wilford Hall Ambulatory Surgery Clinic at Joint Base San Antonio, Lackland Air Force Base, Texas provide services in support of the Air Force’s basic military training mission, as well as to military beneficiaries across San Antonio, one of the largest medical markets in the military. “The 59th Medical Logistics Squadron Clinical Engineering Flight is the largest medical maintenance activity in the Air Force Medical System,” says SMSgt Christopher Espinosa, superintendent of Clinical Engineering at 59 MLRS/SGSKM. Espinosa says that they are responsible for medical and dental imaging equipment assigned at six geographically separated locations across San Antonio, Texas. “The organization is made up of 51 military/civil service and contract technicians. Three military and three civilian technicians make up medical imaging,” Espinosa says. “We are a part of a Joint Base San Antonio family so we also service three other bases in our city as well as bases in surrounding states,” he adds. The team takes care of several modalities across a large area. “The imagining equipment we service 22

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“We recognize that as technology advances, being up to date and knowledgeable is extremely important. Our process of procuring new equipment, including imaging systems, involves purchasing manufacturers’ service schools.” -TRACY WILHELM in our facility are spread throughout six facilities across San Antonio impacting nine departments which include pulmonary/ cardiology, emergency room, operating room, X-ray, CT, MRI, ultrasound, women’s health and mammography. We also provide technical support and annual calibration services to 15 facilities in a five-state area,” says Tracy Wilhelm. He is one of the group’s two main X-ray techs, along with SSgt Donnell Johnson. “We currently have four CTs and four MRIs, seven direct capture units, one rad flouro room, two portables, 10 C-arms, 100 dental intraoral units, 10 dental panograms and four dental CT units,” Johnson says. Espinosa says that the technicians have all been trained by specific manufacturers on modalities or military-provided ad-

vanced imaging courses. “Additionally, all active duty members rotate through the imaging section for hands-on unit-specific training. In addition, we have nine medical material personnel who procure all medical equipment used to support medical equipment,” he says. Johnson says that the team services a wide range of imaging medical equipment [including] dental X-ray, dental CT, mobile C-arms, diagnostic ultrasound and more complex units such as digital mammography, CT and MRI. He says that the purchase of all new equipment is driven by an in-house technical assessment section. The section works hand in hand with all users to identify requirements and develop market requirements. “Our Medical Equipment Management

ADVANCING THE IMAGING PROFESSIONAL

people

SSgt Kosei Carty, SSgt Malarie Eagle, SSgt Donnell Johnson and Mr. Rodney Dargan next to the GE MRI unit.

From left to right: Mr. George Maddox; Mr. Rodney Dargan; SSgt Malarie Eagle, SSgt Donnell Johnson; Mr. Tracy Wilhelm; and SSgt Kosei Carty. Standing next to the GE CT unit. Office procures funding and works with our contracting department to purchase systems. Our imaging section oversees installation and testing for all new systems,” Johnson says. The team is trained to handle most imaging equipment and only infrequently needs some support. “Our imaging team is trained on all imaging devices within our area of responsibility. Occasionally we will request manufacturer support for irregular issues which we determine beyond the normal request, this rarely is the case,” Johnson says. “With the exception of warrantied items with extended service agreements, our staff maintains our imaging devices,” Johnson adds. He says that with the use of the maintenance agreements, the team is allowed to sustain all of their medical treatment facilities’ imaging devices. The imaging staff stays up-to-date on changes in equipment through continuous training. “We recognize that as technology advances, being up to date and knowledgeable is extremely important. Our process of procuring new equipment, including imaging systems, involves purchasing manufacturers’ service schools,” Wilhelm says. “Ninety percent of our imaging equipment is maintained in-house without service contacts. The remaining systems are maintained through a shared maintenance WWW.THEICECOMMUNITY.COM

agreement where we attempt to rectify the issue prior to contractor intervention,” Wilhelm adds. Special Projects In addition to supporting the day-to-day well-being of airmen, other service members and their families, the imaging department has been involved in some important projects. “A new MRI was purchased for use to support medical research. The system will support normal patient care when not required for research. Many design requirements had to be developed, in collaboration with the primary user, manufacturer and construction company to accommodate health care accreditation requirements in addition to medical research protocols,” Wilhelm says. He says that thanks to the efforts of the imaging section, they were able to remove a 15-year-old MRI unit, accomplish all necessary construction modifications and install the new unit four weeks ahead of schedule. The team has also helped to problem solve. “We recently moved from a 60-year-old facility in to a new state-of-the-art clinic. The targeted timeline was to move 66 clinics/3,500 personnel in a 90-day period,” Wilhelm says. He explains that the new facility’s layout was much more constricted than the old facility.

SSgt Donnell Johnson next to the GE MRI unit. “This caused a lot of space and power issues. Most sections were satisfied with their decreased floor plans, but required the majority of equipment they had in the old building. This increased energy consumption in a confined space resulting in unexpected equipment breakdown and unstable facility power supply systems. Due to their knowledge, our BMETs were able to assist our customers with actual mission needs versus wants and pare down redundant equipment,” Wilhelm says. Wilhelm says that with the technological advances in medical equipment, they have had to adjust over the years to accommodate more medical devices which connect to the network. “Due to this increase, we have sent multiple technicians to school to earn their Security+ certification. This has allowed our techs certain admin rights to the network, resulting in not only better maintenance capabilities, but a better working relationship with our in-house IT dept,” Wilhelm adds. When away from the workplace, Wilhelm says that the team has multiple technicians involved with AAMI and CompTIA certifications. For those patients who require diagnostic imaging at Lackland Air Force Base, or any of the affiliated locations around San Antonio, they can know that the equipment needed for their care will be working thanks to a dedicated team of professionals. ICE ICEMAGAZINE

products

PRODUCT SPOTLIGHT Cardiac Imaging on the Rise

soon to be published report “Cardiac Imaging Market: Global Industry Trend Analysis 2012 to 2017 and Forecast 2017-2025” from Persistence Market Research predicts continued growth of the cardiac imaging market. “According to market experts, the increasing prevalence of cardiovascular diseases in the developing regions such as South America and Asia are driving the market growth,” according to Persistence Market Research analysts. “North America was observed to be the largest market due to updated reimbursement policies, easy accessibility to modern diagnostic and high diagnostic costs.” Echocardiography, angiography, nuclear cardiac imaging, computed tomography, cardiac positron emission tomography (cardiac PET) and cardiac magnetic resonance imaging (cardiac MRI) are the most common imaging modalities used for diagnosis and interventional cardiology, according to Transparency Market Research. Coronary catheterization is a minimally invasive procedure to access coronary circulation by inserting a catheter into heart through blood vessels in the leg. Cardiac CT is a less invasive option to coronary catheterization which involves injecting CT-visible dye, according to Transparency Market Research. Cardiac CT offers the advantage 24

ICEMAGAZINE | MARCH 2019

of minimizing the risk of arterial perforation and reduces the chances of infection at catheter injection site. In the late 1970s, CT scans required 2.4-sec for capturing an image, but development in electron beam technology has significantly reduced the time per scan. In addition, with the development of multi-detector scanners it has become possible to obtain 64, 128, 256 and more simultaneous slices adding more spatial resolution and diagnostic help to radiologists. “Echocardiography imaging is an optional ultrasound method of cardiac imaging and includes transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), stress echocardiography. Recently, 3D echocardiography is being used for cardiovascular imaging which is non-invasive, easy to operate and produces a much clearer image. Nuclear cardiac imaging is becoming a popular method which involves usage of a radionuclide – technetium Tc 99m sestamibi (MIBI). This non-invasive cardiac imaging method is considered to be one of the best methods to evaluate and diagnose a heart attack,” Transparency Market Research adds. It is estimated that the cardiac imaging software market is expected to grow at a compound annual growth rate (CAGR) of 8.17 percent during the fore-

cast period of 2017-2023, according to Market Research Future. “The global cardiovascular ultrasound (CVUS) market size is expected to reach $1.87 billion by 2025. It is anticipated to expand at a CAGR of 3.8 percent over the forecast period. Rising investment in Medtech industry, increasing R&D activities, and high prevalence of cardiovascular diseases are the key factors driving market growth,” according to an email from Rachel Thompson, senior manager, Research and Markets. “Benefits associated with cardiovascular ultrasound over conventional methods include quick recovery, reduced span of hospitalization, and fewer post-operative complications,” the email states. “These benefits along with rising geriatric population are expected to propel demand of cardiovascular ultrasound diagnosis over the forecast period.” “North America captured the largest market share in 2017,” it continues. “Favorable reimbursement framework and presence of a large number of industry players are some of the major factors which can be attributed to the regional growth. Rising geriatric population coupled with sophisticated health care infrastructure are expected to further fuel market growth in the region. Furthermore, increasing health awareness is driving the demand.” ICE ADVANCING THE IMAGING PROFESSIONAL

products

Canon Medical Systems USA Inc. Vantage Orian 1.5T The Vantage Orian from Canon Medical Systems USA Inc. leverages innovative technology to provide a more comfortable patient experience while performing cardiac exams. Thanks to the cardiac features included on the premium MR system and complete suite of contrast-free MRA techniques, clinicians are able to source cardiac data that wasnâ&#x20AC;&#x2122;t previously accessible. Clinicians can go a step further in their diagnosis with the CardioLine+ feature, the high-level tissue characterization and image analysis. Additional features include PSIR, T1 mapping, T2 mapping and the new k-t SPEEDER, which allows high frame rate cardiac cine and perfusion imaging with free breathing. â&#x20AC;˘

WWW.THEICECOMMUNITY.COM

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products

Fujifilm Synapse Cardiology Synapse Cardiology is the next generation, secure server-side rendering technology that will enable instant access of massive cardiology datasets. Coming in the summer of 2019, Synapse Cardiology Viewer will work within the most popular browsers while using less bandwidth throughout the enterprise. Developed with ongoing direction from cardiologists, Synapse Cardiology offers capabilities and tools that help streamline image review and reporting across all cardiovascular modalities including: adult echocardiography, pediatric/fetal echocardiography, ECG management (stress, resting, holter), non-invasive vascular, nuclear cardiology, cardiac catheterization, invasive peripheral vascular (IPV), electrophysiology (EP), cardiac CT and cardiac MR. â&#x20AC;˘

ICEMAGAZINE | MARCH 2019

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GE Healthcare CardioGraphe GE Healthcare’s CardioGraphe represents the world’s first dedicated cardiovascular computed tomography (CT) system. The first system designed specifically for high-performance cardiovascular imaging, CardioGraphe offers physicians an affordable and accessible solution to assess heart function and gather the anatomic detail required to plan procedures such as Percutaneous Coronary Intervention (PCI) and Transcatheter Aortic Valve Replacement (TAVR). It creates 3D images of the coronaries, valves, chambers and myocardium in one heartbeat and it can also perform CT angiography studies beyond the heart, including the aorta and carotids. The system’s rotation speed of 0.24 seconds and SnapShot Freeze intelligent motion correction software enables clinicians to treat the most difficult patients, including those with high or unstable heart rates. •

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products

Philips EPIQ CVx Built on the EPIQ ultrasound platform, the Philips EPIQ CVx cardiovascular ultrasound system is designed to increase diagnostic confidence and simplify workflow for clinicians in cardiac care. These enhanced features allow clinicians more time to interact with their patients, and reduces the need for repeat scans. EPIQ CVx combines TrueVue and the latest OLED monitor, providing clinicians with photorealistic renderings of the heart and depth perception through a new virtual light source that allows for a more detailed cardiac anatomy analysis. Featuring Philipsâ&#x20AC;&#x2122; Dynamic Heart Model algorithm with anatomical intelligence to produce a multi-beat analysis for adult patients, clinicians are able to automatically assess the dynamic measurements that occur during the cardiac cycle and provide patients with meaningful and predictive insights about their heart health. â&#x20AC;˘

ICEMAGAZINE | MARCH 2019

ADVANCING THE IMAGING PROFESSIONAL

products

Siemens Healthineers ACUSON Bonsai Ultrasound System The ACUSON Bonsai addresses the increasing demand for quality echo exams by providing a portable and quick system that maintains high-quality imaging and diagnostic confidence through user-friendly applications. The ACUSON Bonsai provides one-touch image optimization, eliminating the need for manual optimization on the part of the sonographer for improved workflow and image quality consistency. The system also comes fully loaded with a complete set of user-friendly cardiology applications for fast and easy handling of routine echo exams. Included applications such as “Auto EF” and “Auto IMT” help clinicians acquire measurements in one click, enabling quicker exams and consistent results. The ACUSON Bonsai is compatible with a comprehensive set of 14 TTE and TEE transducers. The ergonomic user design of the ACUSON Bonsai’s laptop and mobile cart system offers flexibility in scanning locations. The laptop is over 1.7 cm thinner than the industrial average, and its companion cart has a slim design and small footprint for maneuverability. • WWW.THEICECOMMUNITY.COM

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TOOLS OF THE TRADE ACERTARA Aureon

he proprietary Aureon™ is a new technology applied to more completely understand the functionality of a diagnostic ultrasound transducer by directly analyzing the acoustic pressure emitted from the transducer under test in real-time. Using exclusive 2D matrix technology that allows for the capturing of energy profiles of all types of probes including the latest 2D matrix arrays like the Philips X8-2t, X7-2t, and X5-1, the Siemens 4Z1C, and the GE 6TV-D and 4V-D probes, Aureon™ was specifically designed to be used in the hospital environment for Quality Assurance applications. ICE

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SCANNING THE

UNSCANNABLE

MRI SAFETY FOR PATIENTS WITH IMPLANTED MEDICAL DEVICES

By Matt Skoufalos

Historically, most conversations about patient safety in medical imaging have focused on how to limit their exposure to unnecessary ionizing radiation, the differences in treating pediatric and pregnant patients, or the importance of routine equipment maintenance and calibration. The bulk of those concerns have centered on modalities like computed tomography (CT) and X-ray, which employ ionizing (i.e., possibly harmful) radiation, but donâ&#x20AC;&#x2122;t necessarily apply to patients headed for ultrasound or magnetic resonance imaging (MRI) studies.

However, as the use of these modalities is expanded to a broader number of applications, a new wrinkle has emerged:

how to safely image the growing number of patients with implanted medical devices and replacement joints. These foreign bodies can interact differently with the energy fields produced by an MRI scanner, producing artifacts on the studies themselves, interfering with the normal operation of the implanted devices themselves, or possibly harming the patient by shifting them in the body. As the number of patients who receive a new hip or a stent or an insulin pump continues to climb, closer attention is start32

ICEMAGAZINE | MARCH 2019

ing to be paid to the composition of these materials and the effects of their interaction with imaging equipment. At the simplest level, clinical sites can establish patient protocols around the use of MRI equipment, but for the most part, patients are responsible for self-disclosing what and whether they have an implanted device, said Chris Farischon, the 1.5T product systems product manager for ADVANCING THE IMAGING PROFESSIONAL

Siemens Healthineers of Malvern, Pennsylvania. “I was scanned at a site recently, and was given an iPad and 30 questions to run down, and they got very specific as far as what types of implants did I have,” Farischon said. “Based on that screening, the site may make a determination as to whether that patient can be scanned under MR.” Before undergoing any medical imaging, a patient typically will change into a dressing gown, removing any clothing, jewelry, or accessories containing metal. Some sites may pass patients through metal detectors before scanning them, or may wand them with a handheld detector. But not every implanted device is made of a ferrous (iron-derived) metal, and some metals are safe to scan within certain energy thresholds. “A lot of this is dependent on the type of implant that the patient has,” said Philip Uptmor, Siemens Healthineers MR Clinical Product Manager for the Southeast Zone. “It’s also dependent on the hardware that you’re using to scan that patient. The [implant] manufacturers basically look at where the object is in the magnet, and how attractive it is to the magnetic field [of the MR unit].” Also of concern is whether an implantable device is active, WWW.THEICECOMMUNITY.COM

like a pacemaker, or passive, like a replacement knee. Some of these may interact adversely with the various energy sources at work in an MR scanner, while others may simply distort the image acquired in the study. The strength of the scanner (most devices are only cleared for use with 1.5-Tesla scanners, but the most powerful machines on the market can operate at nearly five times that strength) is another factor. Given the perceived risks of patient injury and the expense involved in damaging some of the most expensive equipment in the hospital, most clinicians and technologists err on the side of caution, and are more likely not to image a patient with an implanted device than to send one through a potentially hazardous scan. “I think medical communities have become very cautious,” Uptmor said. “You could very well have a patient show up that has an aneurysm clip, they don’t know that they have it, or they don’t know what the material is made of, and that clip could twist [during an MR study], and the patient could die.” There are some technological solutions to avoid the image distortion and artifact-generating side effects of scanning orthopedic implants, Farischon said. Siemens artifact reduction ICEMAGAZINE

SCANNING THE

Chris Farischon

Siemens Healthineers

Philip Uptmor

Siemens Healthineers

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software Advanced WARP includes Slice Encoding for Metal Artifact Correction (SEMAC), which preserves soft tissue diagnostic quality in patients with metal implants, and its Implant Suite for the MAGNETOM Aera MR scanner enables diagnostic imaging for patients with MR-conditional (able to be scanned within certain parameters) implants. Ultimately, it’s up to the individual sites, and sometimes the individual technologists, to decide who gets a study and who doesn’t, and training and protocols in this area are decidedly uneven. “Training until recently has been left to facilities, and facilities don’t always provide the best or most consistent training,” Uptmor said. “You’re probably going to have more of an issue at an outpatient clinic than a hospital; if an outpatient clinic isn’t sure, they just won’t do it.” “I think it’s a really big issue right now, and I wouldn’t be surprised if this becomes more heavily involved in the accreditation to become an MRI tech,” he said. The issue is one that will only become more relevant to resolve as clinical applications for MRI continue to expand, and the patient population for them with it. Imaging more and different (and aging) patients means more of them will have implanted medical devices, which necessitates that procedures around safe scanning must improve. “We have to get better at it than we have been,” said radiology consultant Tobias Gilk. “Unfortunately for patients with devices, every technological innovation of MR only serves to increase the risk factors. We want to use MR for a greater variety of examination types, a greater variety of patient types, and we’re doing it on magnets that are stronger, faster, more powerful.” “All of these inputs are incrementally ratcheting up the relative risk, and we really need to have a more com-

ICEMAGAZINE | MARCH 2019

prehensive strategy as to how we’re going to not simply play catch-up, which we’ve been playing for the past 20 years, and get ahead of changes in the marketplace,” he said. According to Gilk, the biggest holdup in resolving the issue is the lack of a comprehensive dialogue between the manufacturers of MR systems and those of medical devices. “When a set of MR conditions may appear to be absurdly restrictive, is that restrictive nature really a safety issue, or really a liability management issue on the part of the manufacturer, or a limitation of how the device was tested?” Gilk said. “They may say, ‘This is too risky, we want to cancel this patient,’ or they may say, ‘We’ll do the exam in this super-restrictive mode, and therefore we’re going to limit the amount of clinical information that we’re going to get from this scan, so we compromise the effectiveness of the MR scan,’” he said. Gilk believes that the more those changes are made to existing imaging protocols to accommodate patients with implanted devices, the greater the chance that their exams will take more time, throwing scheduling and workflow out of whack, or making the studies less effective or less efficient to provide. “There are all kinds of downstream consequences to these events,” he said. Gilk would like to see product support documentation that focuses less on insulating manufacturers from legal risk and more on supporting technologists in safely scanning patients with technical complications. “Unless you can match up magnet information with vendor implant information, the people in the middle are left being the Rosetta Stone, trying to bridge the gap,” Gilk said. “That gap can be fairly small and easy to bridge, or it can be enormous. It’s really the MR techs and the radiologists who have to say, ‘Yes, I feel comfortable imaging this patient.’”

Until device-makers resolve that disconnect, traversing that gulf is the responsibility of clinical care providers, who must digest the information from both sets of manufacturers in the context of each individual patient. Further complicating matters, clinicians that call either camp for advice on the interaction of specific devices with one another, are only allowed to receive FDA-approved guidance from the manufacturers. If their questions fall outside that guidance, vendors may simply decline to answer. “Even if the exam that the site wants to do is much safer in the grand scheme of things, the manufacturer can’t say so to the customer because it’s a medical use that has not been vetted and approved by the FDA,” Gilk said. “It’s not only just a question of not wanting the liability; it’s also a question of the way that our system is set up. Readily knowable truths about risk can’t be communicated to the providers because of the way that the FDA regulates product information.” “Providers are clamoring for information on these systems, and the two people they would turn to for help are legally prevented from providing them with that assistance,” he said. “The immediate solution is improving the skills of the clinical personnel.” The chief agency credentialing health care professionals in safe MR operation is the American Board of Magnetic Resonance Safety (ABMRS), an independent, not-for-profit organization founded in 2014 by radiologist Emanuel Kanal of the University of Pittsburgh Medical Center. ABMRS provides Magnetic Resonance Safety Certified (MRSC) credentials for professionals charged with overseeing the safety of magnetic resonance sites in three job areas: Magnetic Resonance Medical Director/Physician (MRMD), Magnetic Resonance Safety Officer

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(MRSO), and Magnetic Resonance Safety Expert (MRSE). The certification process is composed of formal examinations (one for each job), and certifications are valid for a decade. Since AMBRS began offering this in June 2015, more than 1,500 people have been certified. Manufacturers GE, Siemens and Philips have each provided grants to end-users to pay for half the cost of the ABRMS certification exam as well. Even as device operators continue to gain relevant knowledge about how to safely scan patients with implanted medical devices, patients’ knowledge about their own implants remains a key hurdle. Addressing that oversight means asking manufacturers to maintain patient databases as a redundancy for physicians and health systems that may not be adequately tracking their patients in the same fashion. “We’re past due for a persistent record that follows the patient,” Gilk said. “For hospital groups that have a uniform electronic health record (EHR), at least we can capture and retain that information for patient services received

implanted devices is another project of Kanal’s, a data simulation application called MagnetVision. It’s the backbone of his MR safety course (in addition to being Chief of the Division of Emergency Radiology at the University of Pittsburgh Medical Center, Kanal is also its director of MR services, and a professor of radiology and neuroradiology there), and represents data collected from manufacturers of 19 different MR systems in clinical use today. “The average radiologist does not understand some of the safety issues behind the modality, and certainly often does not understand the nuances behind the safety concerns regarding scanning a patient with a device, implant or foreign body,” Kanal said. “In MR, there are three different energy sources, and each has its own safety issues; where you are depositing that energy in this patient is not necessarily where the examination is centered.” Although MRI does not involve ionizing radiation like an X-ray or computed tomography (CT) scan, the modality can have potential health effects on patients who are improperly scanned, including

patient, position the device, implant or foreign body to match where it would be in the patient in front of you, and then position that patient how you would in the MR scanner at your site, and it will show you what energies he will be exposed to, and where they will be initially deposited.” By creating a visual guideline for each of the potential interactions between patient and devices – MagnetVision displays colored guidance from green to yellow to red to illustrate how safe the study would be to the patient – the application can define what technologists are trying to model with the push of a button. Kanal’s goal is to make it freely available to everyone working in the field, but to avoid legal liability stemming from its potential misuse, today MagnetVision is only provided to professionals who attend his safety courses, or those to whom he has personally taught the basics of MR safety and how to use the app. “The two things that are driving me are certification and standardization,” Kanal said. “I take the science world of the physicist, and try to turn it into the language of

“I believe that the lion’s share of mistakes we’re making in the U.S. MR industry today is cancelling people who could be safely scanned.” –EMANUEL KANAL

within the network. But anything out of network doesn’t get captured in the EHR unless someone jumps through flaming hoops of bureaucracy and technology.” “Patients are notoriously poor historians,” he said, “and for the patient who has to get an MRI every other year, the idea that we don’t preserve that information from exam number one to exam two to exam three is just really frustrating, especially when we essentially ask the patient to regurgitate the same information for each exam. The way in which we collect and use MRI safety information associated with an individual patient could not have been engineered to be much worse than it is.” One of the most promising approaches to addressing the knowledge gap in scanning patients with

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disrupting the normal function of their device, causing neurological or cardiac dysfunction, or even burning them. MagnetVision allows radiologists and technologists to simulate the effects of different MR machines on patients with different implanted devices by showing them where the energy fields created by the MR units would interact with their bodies in a given study. “I’ve gone to the manufacturers of these devices and asked them to provide me with the 3D field plots of the strengths of different energies, and converted that to visible colors on the screen,” Kanal said. “Whichever of the MR scanners it models, you can call them up and it shows you the components and what they expose. You can create a photorealistic model of your

the physician and the technologist.” If patients are turned away from imaging studies due to the presence of implanted devices, the alternatives aren’t always ideal, he said. If a requested MRI study is unnecessarily cancelled, that patient may then be sent for a higher-risk or more invasive alternative scan. “I believe that the lion’s share of mistakes we’re making in the U.S. MR industry today is cancelling people who could vbe safely scanned,” Kanal said. “I believe clinicians are being overly cautious, but the risk they’re limiting may be their own, and not necessarily that of their patient.” “It’s easy to say no,” he said. “It takes knowledge, understanding, and a willingness to apply it to say yes.” ICE

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CAREER CENTER Motivated Employees for Excellent Customer Service

maging service managers require a wide range of expertise, skills and knowledge to fulfill their specific dayto-day responsibilities. Additionally, it takes a very special type of leader to develop an environment that builds a loyal, motivated and productive team to accomplish the organizational goals and requirements that result in excellent customer service. Specific operational skills are crucial to effective operational and staff management. Most leaders have the skills to manage, but often forget some of the more important skills to achieve an environment to motivate and inspire employees. A critical element to a leader’s success is effective communication with their employees. Daily or weekly staff meetings are important, and newsletters are very effective. One quality of good leaders is to be visible and available to your staff. It is important to participate and be involved with your staff on a daily basis to build loyalty and reinforce your efforts to build a motivated team. Start each day with a smile and positive greeting to each employee. Exhibiting energy, enthusiasm and optimism goes a long way in demonstrating a leader’s confidence. A manager’s positive attitude and honesty will help create an environment of trust and loyalty. These characteristics provide the structure or environment to motivate and inspire employees and encourage workplace unity. Provide leadership and direction regarding departmental and organizational goals, vision, core values and objectives to achieve success. Share the organization’s mission and explain how the team’s actions and involvement will contribute to the success of the organization. Provide clear expectations and set 36

ICEMAGAZINE | MARCH 2019

specific standards to accomplish departmental goals. Provide a framework for employees to do their job, but do not micro-manage. Be prepared to step in and provide additional guidance as needed. Treat your staff with respect and recognize their contributions to the team. Create a climate of trust and encourage employees to speak up about issues. Offer solutions to problems, but also allow your staff to share their thoughts on acceptable solutions. Motivated and happy employees are essential to a cohesive team that contributes to successfully accomplishing their duties and to providing excellent customer service. Leaders should understand what motivates their employees if they want to inspire and energize the team. Get to know your staff, both professionally and personally. There are many other opportunities to build relationships and influence your team. Be creative and think of fun ways to involve your team in relationship building events. Build relationships within your department with birthday celebrations. Occasionally bring in bagels or donuts for the team to share. Have monthly socials such as Pizza Fridays, Breakfast Tacos, Tuesday Tacos, nclude healthy options such as fruit and salads. Involve your staff in the choices and help to make these social gatherings a success by allowing them to bring their favorite dishes. In addition to excellent communication skills, organizational skills are very important to manage your staff and stay on top of priorities. Juggling priorities throughout the day requires exceptional organizational skills. Efficient leaders can fulfill their specific managerial requirements while assisting others, creating an environment

Written by Cindy Stephens Stephens International Recruiting Inc.

that builds trust within the department. People often leave their jobs because they feel unappreciated as a member of the team or organization. Be sure to recognize personal and team accomplishments and reward employees for their dedicated efforts. Financial incentives such as a pay increase or bonus based on annual performance appraisals motivate employees, but it is just as important to provide incentives for good performance on specific tasks or projects. Demonstrate sincere appreciation for individual and team accomplishments with hand-written notes or verbal praise during staff meetings. Offer discount cards or free coffee at a local café or coffee stand. Take the team out for lunch or have it catered to the department. There are many ways to show your sincere appreciation and these “little things” go a long way when it comes to employee motivation and loyalty. There are many other ways to increase motivation. Empower your team to continue educational and professional growth and encourage creative feedback to improving customer service and departmental changes. Offer flex time to individuals who prefer to come early or stay later due to traffic or even for personal, family conflicts. A parent who has to drop off or pick up a student can take advantage of the flex time hours and not feel stressed about conflicts between work and family requirements. A happier, motivated team nurtures confidence, builds loyalty and improves productivity. Motivation is effective in leading a department to successfully provide excellent customer service. ICE ADVANCING THE IMAGING PROFESSIONAL

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IMAGING MATTERS

Written by John Garrett Director of a Clinical Engineering Department in CHI

The Training Matrix

eciding on what service should be brought in-house seems fairly straight forward at first look. However, like most things in life, it grows more complex as it develops. Sending team members to schools without a plan on implementation can quickly become a waste of money. That is why it makes sense to develop an overall training matrix that may change over time. It should consider all team members, equipment age, equipment variety, return on investment (ROI) and the ability to implement the training in a meaningful way. The first consideration should be how much money will sending the team member to a school save on contracts or outside service. When making these calculations there has to be an allowance for the cost of parts and shipping. A service history, if accurately documented, should provide a fairly accurate estimation. This is the same point that the practicality of a team member taking on a device should be considered. Even when other data is accurate in the development of the training matrix, the reality of adding another modality or device to the responsibility of a team member is often not considered. If the team member is running at maximum capacity, adding a responsibility may require that they drop a current responsibility and pass it to someone else. Is there a plan to get someone else trained for that responsibility? Is there a responsibility that will fall off because of updating equipment will remove old equipment? Can the individual train another team member via on-the-job training? An often missed consideration is the aptitude of the team member considered for training. There are individuals who have done very well as the go-to person for nuclear medicine

ICEMAGAZINE | MARCH 2019

cameras that have struggled with the realities of servicing CT units. Just as there are individuals that do well in general X-ray that cannot make a successful transition into a cath lab. There may be other training that is required to allow them to be successful. It may be time management, customer-service skills or how to deal with high-stress situations. Understanding the strengths of the individuals that make up the team can be critical to creating a good training matrix. If you have large contracts negotiated as part of a health care system, you need to know what your service contracts require. You may not be able to lower coverage, or may have longterm obligations that would negate any benefit of training. Finally, a good training matrix can be made better if there is in-house training included. This requires dedication and support from management. It might require calling in outside services to ensure time is protected for the training. This can be augmented by well negotiated service contracts. Many independent service organizations (ISO) will include on-the-job training or formal training for team members as part of the contract. A training matrix that shows a true maximum ROI and can be implemented properly requires a good deal of consideration and thought. However, once put into place it can make a huge difference to your organization and, as such, contribute to improving health care overall. ICE John Garrett has 20 years experience in imaging service including general radiation, mammography, CT and nuclear medicine. He has worked for third-party service companies, manufacturers, sales companies and in-house imaging teams.

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IS THERE REALLY ANY POWER IN POSITIVE THINKING? F

or the past 90 years or so, there’s been a lot of teaching that positive thinking affects our lives for the better. Books have been written about it. Motivational speakers fill stadiums and give dynamic presentations about it. On top of that, millions (and probably billions) of dollars have been spent as people try to improve their lives though learning how to think positively. But does the concept work? Does positive thinking really affect your life for the better? I dare say it does. Within reason. Despite the nay-sayers, facts are facts. Through the wonders of modern medical imaging we have learned that positive thoughts have different waves and forms than negative thoughts. But even without scientific evidence, when you walk up to people from behind, sometimes you can sense their mood – good or bad – even if you can’t see their face. So yes, I think it’s safe to say that our thoughts have an influence on our surroundings, and yes, there are ripple effects. Other medical findings show that our brains develop neuropathways that are created as a result of our habitual thinking patterns. That would align with what my first coach used to tell me: “Some people are addicted to negativity.” Think about it. If people focus on negative things all the time, their brains develop neuropathways that automati40

ICEMAGAZINE | MARCH 2019

cally tune in to the negative of a given situation. Maybe you know someone like this. I do. The gentleman I’m thinking of is always talking about what he doesn’t like. As an example, he went on a cruise for a week. He was treated like a king, enjoyed beautiful scenery and dined on sumptuous fare. But when anyone asked him how his cruise went, he’d spend 15 minutes talking about everything he disliked about the cruise. The man’s brain is simply wired to focus on negative things. So, what’s the alternative? If you think I’m talking about becoming all bubbly and upbeat like Anne of Green Gables after three triple shots of espresso, that’s not it. Positive thinking has to do with achievement thinking. From my perspective, it’s focusing on what you want instead of what you don’t want. It’s focusing on what you’re going to do instead of what you’re not going to do. For example, if I were to say, “Think of a red car,” chances are the image of a red car will pop into your head. Since at least 80 percent of the population is visually oriented, this should be true for at least 80 percent of you. The car could be any make or model, but it would be red. By thinking about what you want (in this case, a red car), you are giving your brain an expected end-result. Focusing on what you don’t want is not helpful, because the mind has no picture for “don’t.” For example, if I were

to say, “Don’t think of a blue car,” your mind, however momentarily, develops an image of a blue car. It might end up focusing on something beside a blue car, but there’s no purposeful focus on what you want. Where am I going with all this? There’s something else that neuroscientists have discovered: Our brains are always trying to reconcile our external reality with the words and pictures we have in our minds. Whether those words and pictures in our brains flop around aimlessly, or we put them there purposefully, if what we have in our heads is negative, things aren’t likely to turn out positive. This is why it’s hard to succeed if our mental thoughts and images revolve around negative phrases. For example, let’s say a guy arrives at work each day thinking, “I don’t want to get fired.” First, with a focus like that, people around him sense an uneasiness. Second, he will have a tough time deriving a sense of satisfaction from his work if he ends each shift thinking, “Whew – I made it through another day without getting fired.” If you think you’d like a little more power in your life, one thing you can do is answer the question, “What do you want?” Do you want a promotion? Do you want to be placed in charge of a project? If so, put those pictures in your head. Then, divide those bigger pictures into smaller pieces that you can work toADVANCING THE IMAGING PROFESSIONAL

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Written by Daniel Bobinski Workplace Consultant

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ward, and “see” yourself doing them. CLIENT SIGN–OFF: If pictures don’t do it for you, write out a clear description CONFIRM THAT THE FOLLOWING ARE CORRECT of what it is you want. Don’t write what you don’tPLEASE want. Write LOGO WEBSITE ADDRESS SPELLING what you want. Then, divide it into bite-size chunks and pri- PHONE NUMBER oritize it into steps. Rome wasn’t built in a day, and elephants are eaten one bite at a time. TRIM 3.25” When others sense you are moving toward something, they can sense your vibe and quite often it’s contagious. It’s very different from sending out feelings of negativity, uneasiness or worry. If you think you may have been stuck in neutral or perhaps even partaking in some negative thinking, know that you can make a shift. There may be some new neuropathways for your brain to write, but that will happen if you stay focused. You’ve probably heard it takes 21 days to change or form a new habit. That’s true if there are no emotional obstacles, but it can take three months or more to make changes if there are strong inhibitions. When I do management and leadership coaching, the three-month mark is usually when I see my clients experiencing significant, transformative breakthrough. You just have to stick with it and trust your brain to do its thing. •Biomedical •Tech Support So, to answer our question, yes, I do think there is power in positive (achievement) thinking, and no, it’s not a magic •Medical Imaging •Management wand. Remember what science has told us. Our brains are al•Field Support •Instructors ways trying to reconcile our external reality with the words •In-house •Service Sales and pictures we have in our minds. If that’s true, then we can choose the thoughts and pictures we want in our brains. And, in time, they will make us better than we are now. ICE

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– Daniel Bobinski, M.Ed. is a certified behavioral analyst, a best-selling author and a popular speaker at conferences and retreats. He loves teaching teams and individuals how to use Emotional Intelligence, and his videos and blogs on that topic appear regularly at www.eqfactor.net. Reach him at daniel@eqfactor.net or (208) 375-7606.

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Diagnostic Solutions p. 17

Webinar Wednesday p. 4

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