ICE Magazine July 2022 by MD Publishing

JULY 2022 | VOLUME 6 | ISSUE 7

MAGAZINE

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FEATURES

DIRECTOR’S CUT

Research and data from Press Ganey advise leaders that employee engagement is critical to productive and efficient work environments. Employees who share ideas, and participate in projects, are invested in the operation and any departmental improvements.

COVER STORY

Imaging professionals face six reimbursement concerns in coding, denials, timely processing, validation of charges, accuracy of payments, and auditing. Addressing each involves dedicating time and attention to a checklist of critical factors and repeating as needed.

RISING STAR

Bradford Harrold, CRA, CIIP, ARMRIT, serves as the associate director of imaging administration at UT Southwestern.

ICEMAGAZINE | JULY 2022

ADVANCING THE IMAGING PROFESSIONAL

JULY 2022

23 IMAGING NEWS

Catch up on the latest news from around the diagnostic imaging world.

EMOTIONAL INTELLIGENCE The research is clear. The main difference that separates top performers from average performers is emotional intelligence.

29 PRODUCT FOCUS

The global digital X-ray market is expected to reach $16.4 billion. The major factors driving the growth of this market include an increasing geriatric population as well as favorable government regulations.

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ICEMAGAZINE

CONTENTS MD Publishing 1015 Tyrone Rd. Ste. 120 Tyrone, GA 30290 Phone: 800-906-3373

SPOTLIGHT

In Focus Tobias Gilk

John M. Krieg john@mdpublishing.com

Company Showcase The InterMed Group

Vice President

Rising Star Bradford Harrold

Rad Idea Pebbles: A Strategy for Team Engagement

Off the Clock Mariah Garcia

President

Kristin Leavoy kristin@mdpublishing.com

Group Publisher

Megan Strand megan@mdpublishing.com

Editorial

John Wallace

Art Department Karlee Gower Taylor Powers Kameryn Johnson

Events

Kristin Leavoy

Webinars

webinar@mdpublishing.com

Digital Department

NEWS

PRODUCTS

28 29

Cindy Galindo Kennedy Krieg

Accounting Diane Costea

Editorial Board

Laurie Schachtner Nicole T. Walton-Trujillo Mario Pistilli Jef Williams Christopher Nowak

ICE Magazine (Vol. 6, Issue #7) July 2022 is published by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to ICE Magazine at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. 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. © 2022

ICEMAGAZINE | JULY 2022

Imaging News A Look at What’s Changing in the Imaging Industry

Market Report

Product Focus X-Rays

INSIGHTS

Diversity Why D.E.I?

Director’s Cut A Reflection of Employee Engagement

[SPONSORED] Summit Imaging No-Risk, No Downside: Ultrasound Transducer Repair Services

Rad HR Use Transparency to Your Advantage

48 Chew On This

Health Care Can Learn from Credit Card Companies

Emotional Intelligence Emotional Intelligence Is Learnable – Here’s The Framework

PACS/IT 10 Things to Consider When Changing an AI Vendor

Roman Review The Surprise Post

56 60 62

ICE Break AMSP Member Directory

Index ADVANCING THE IMAGING PROFESSIONAL

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SPOTLIGHT

IN FOCUS TOBIAS GILK

BY JOHN WALLACE

obias Gilk, M.Arch, MRSO, MRSE, is a senior vice president at RADIOLOGY-Planning (RAD-Planning), but he may be best known as a design specialist and MRI safety guru. It was his study of “design” that led him to the realm of imaging. One thing led to another and he soon found he had become an expert on MRI safety.

Tobias Gilk, M.Arch, MRSO, MRSE, is a senior vice president at RADIOLOGY-Planning

ICEMAGAZINE | JULY 2022

He explains that a “long series of left-hand turns” – like those made by NASCAR drivers – are what his career path resembles. “Through a long series of lefthand turns … seriously! I applied to get my master’s in architecture with the intention of becoming a designer of live theater buildings,” Gilk recalls when asked how he entered the imaging field. “I suppose I should have looked at the job prospects for theater designers before starting architectural school, but once I was there I realized that this was a very unlikely career path. After I graduated with my master’s in architecture I was resigned to be a ‘regular’ architect, and the summer I started with my first firm I was essentially ‘gifted’ to the local hospital to be their resident architect from our firm.” “Quickly I became the hospital’s go-to radiology designer, and designed MRI, CT, and gamma camera suites. Through that, I fell in love with radiology and – in particular – MRI,” he adds. “In 2002, I was designing another MRI suite when the original ACR white paper on MRI safety came out, and the hospital directed me to incorporate the physical safety

requirements,” Gilk continues. “This was the beginning of me falling down the rabbit-hole of MRI safety, and that project led me to a deep interest in MRI safety.” When asked about his greatest accomplishment, Gilk paused to think before answering. “This is hard to think of when I regularly think of what more I want to accomplish, but there are several things I am very proud of. I’m deeply proud of the building of RAD-Planning … a specialty firm that does the work that I love most,” he says. “I’m also very proud of having helped in the development of planning and design standards for radiology facilities, including for FGI, U.S. Department of Veterans Affairs, Department of Defense and best practices for facility MRI safety design for the American College of Radiology. And I’m also deeply proud of having helped to found the American Board of MR Safety and furthering MRI safety knowledge and practice.” He was reluctant to name a mentor, instead insisting that many people have helped him throughout his career. “There are so many people who have helped me, I’m a bit skeptical

ADVANCING THE IMAGING PROFESSIONAL

answering because I know that I’d inadvertently leave people off. But in the spirit of the question, I’ll identify a couple of key mentors. For my architectural professional career, my boss/partner, Rob Junk, has taught me so much about both design and the practicalities of being an architect. I’m forever in his debt for that,” Gilk says. “For my radiology focus, I owe a similar debt of gratitude to Dr. Emanuel Kanal who has been a friend and collaborator on many MRI safety efforts. I’ve been wrestling with the question of mentoring others. I’ve worked myself into a fairly narrow niche and I’m still looking for individual(s) who have a similar interest.” His leadership style is one with a keen focus on working with like-minded individuals. “I have the luxury in my line of work of focusing on widely shared values … making spaces that provide high-quality, safe and efficient care. I find that clearly identifying

shared values and common goals at the beginning of a project helps to minimize friction. Of course, tough decisions always need to be made, but when those decisions are clear in the context of the shared values and goals, they become less painful,” Gilk explains. “My leadership approach is primarily about cultivating a team with a shared vision that is central to everything we do.” Looking into a crystal ball, Gilk sees more change on the horizon for diagnostic imaging. He predicts the usual pros and cons of new technology will exist in the future. “The current labor shortage in imaging is likely to trigger some significant shifts that will be long-lasting. We’re seeing the big OEMs starting to market remote scanning capabilities. Continuous acceleration of imaging hardware means more potential for volume/throughput, which will put many hospitals in conflict with hospital designs laid out decades ago,” Gilk explains.

“Consider the patient preparation infrastructure difference for a 60-minute MRI exam and if the newest MRI scanner can do many patients in 15-minutes? We’ve focused massive attention on accelerating hardware, but not similar attention to accelerating our buildings, staff and operational models. I imagine the next 5 years or so will bring both great pain and innovation in imaging management.” When asked why he loves his job, Gilk replies, “How could I not? I get to do work that allows me to exercise both my brain and creativity and improve the quality of care that patients receive as well as improve the safety of patients and caregivers.” Away from work, he is an extremely proud father, a husband and pet owner. “I’m married and we have an amazing daughter who is finishing her undergrad … plus two cats and a dog that we dote on,” Gilk says. •

TOBIAS GILK M.Arch, MRSO, MRSE

1. What is the last book you read?

5. Who has had the biggest influence on your life?

Right now, I’m reading “Platform Revolution” because it really speaks to some of the challenges (and answers to those challenges) that I think radiology is wrestling with in our COVID-rebounding radiology world.

This would probably be my mom. She’s always been a bit of an iconoclast, rarely afraid to chase her passions, even if they lead into uncharted territory. I think that without her influence and example I wouldn’t have had the confidence to try the crazy career detours that have led me to where I am.

2. Favorite movie? I watch movies for such different reasons, so I have different favorites. I’m a sci-fi geek, and I love “The Fifth Element” and the whole Lord of the Rings series for adventure-escapism. Then there are movies where the visuals are so stunning they just live rent-free in my mind, from “Lost in Translation” to the recent “Dune.”

6. What would your superpower be? A superpower I currently have? An inability to accept “no win” as a possible outcome. I’m willing to out-work, out-wait and out-scheme pretty much anyone who wants to stand between me and what I want. Things are only impossible until the first person does them. If it’s a superpower I wish I had, I think my recent schedule demands that I say teleportation.

3. What is something most of your coworkers don’t know about you? Most people don’t know my “origin story” as an aspiring theater designer, but I think my coworkers do. But I suspect that most of them don’t know that I once attended a women’s college (as a male scholarship student). 4. What is one thing you do every morning to start your day? Coffee and quiet time. I like the silence of the morning when I’m the only one up in the house. I’ll nurse a cup of coffee and catch up on emails that came in overnight and look at my calendar for the next day or two before getting rolling.

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7. What are your hobbies? I’m an “on-again, off-again” distance runner (I’m “off-again” at the moment). I enjoy cooking, and home improvement projects that produce levels of dust that aggravate my wife (not that I like aggravating my wife … I just like the bigger projects that seem to have that effect on her). 8. What is your perfect meal? I like meals full of flavor … whether on bone china, picnic tables or from styrofoam takeout containers.

ICEMAGAZINE

SPOTLIGHT

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To add value, InterMed is also able to offer new and pre-owned equipment to clients. InterMed provides clients with capital planning reports along with assessments of existing equipment to identify capital replacements that will best benefit the client. InterMed then also provides the clients with options to consider if they choose to move forward with a replacement. Many years ago, InterMed established the JumpTeamsTM program as it saw the demand for temporary skilled technical talent. Whether a facility is trying to fill in for vacation time, adding skills for a recall or supplementing staff until a full-time technician is hired, the InterMed JumpTeamsTM can provide partners with qualified staff. PANDEMIC (COVID-19) Like many, InterMed’s ongoing challenge during the COVID-19 pandemic is to keep all team members safe and healthy. That includes mental health as well as physical health. InterMed is still dealing with the toll COVID is having on the nation’s health care and front-line workers. Through all the challenges and unknowns InterMed has faced, the company found that a positive mindset is key to overcoming any obstacle. Working its way through the pandemic actually made InterMed stronger as a team, as an organization and, most importantly,

for its customers, as a partner. InterMed embraced the challenges and turned them into opportunities to improve. The dedication to the safety of the InterMed team, its partners and patients is part of InterMed and continues to inspire everyone within the company to bring the best every day in every way. MEDICAL DEVICE SECURITY ENVIRONMENT There is not a day that goes without the industry hearing about another health care cyber security attack. In today’s environment, hackers see health care as an easy target. The FDA issued a warning that other countries have made it clear that they are targeting health care. The three main areas of concern are: • IT – The facilities network infrastructure (servers, computes, switches, routers and Wi-Fi) • IoT – Internet of Thing, the other devices that communicate on the network (phone systems, video camera systems, cellphones, tablets, etc.) • IoMT – Internet of Medical Things. This is a subset of IOT and includes medical devices such as imaging devices, patient monitors, infusion pumps and lab devices. Most larger facilities have IT and IS departments and they mainly focus

ADVANCING THE IMAGING PROFESSIONAL

InterMed employees stay current with hands-on field training both internally and with OEMs to provide the best service to their partners.

on the IT/IoT devices. This approach often leaves the IoMT devices at risk to vulnerabilities. Smaller facilities may not have an IT/IS team, leaving their entire network at risk. The biggest risk to IoMT is that there are still many facilities, regardless of size, that do not have a plan in place to evaluate currently known vulnerabilities, mitigate the risk, thus reducing their risk score. The first step is training your biomed teams and a good inventory connected and connectable devices. InterMed has solutions to fit the needs of its clients no matter size or where they are in their cybersecurity journey, a journey that begins at procurement and last through the life cycle of the device. STAFFING CONCERNS AND SOLUTIONS The industry has been facing a shortage of qualified technical talent for many years, with a large population approaching retirement age and a shortage of

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new technicians joining the workforce. Over the past couple of years, COVID has amplified the issue, with many highly experienced technicians choosing to retire. With an increased focus on addressing staffing challenges, InterMed continues to successfully recruit and maintain the most qualified individuals as part of the InterMed team. InterMed’s internal philosophy of constant and never-ending improvement is really highlighted by its training and educating all employees to be the best at what they do. THE INTERMED GROUP GROWTH InterMed continues to grow rapidly as customers feel the impact a real partnership approach can bring to them. There has always been a strong dedication to finding solutions to customers’ problems, at all levels of the organization. InterMed’s flexible programs ensure its teams are focused on what makes a difference for each partner. The goal is to become the number one independent service organization in the

market and in the industry for healthcare technology management services. InterMed has all the services and technical skill sets to provide each element of service needed, from infusion pumps to MRI. Over the past 10 years InterMed has grown, expanding from its headquarters in Florida, throughout the East Coast, midwestern and southwestern United States. InterMed looks to its relationships with customers as partnerships and becomes involved in the community. InterMed’s official charity is Tyler’s Hope for a Dystonia Cure. Dystonia is a neurological movement disorder with over one-third of dystonia patients being children. InterMed and Tyler’s Hope are committed to finding a cure for dystonia. InterMed won’t stop until a cure is found. The company carries this focus into all that it does, working to bring hope to healthcare. At The InterMed Group, the team knows the industry will continue to evolve, so InterMed will continue to create solutions for tomorrow’s challenges. •

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SPOTLIGHT

RISING

STAR BRADFORD HARROLD

radford Harrold, CRA, CIIP, ARMRIT, holds a Bachelor of Science in Health Sciences, with a focus on administration. He currently serves as the associate director of imaging administration at UT Southwestern. However, he is not a native Texan. He was born at Oak Knoll Naval Hospital in Oakland, California and grew up in the Bay Area. His journey to an imaging career began after a previous job exposed him to the possibilities. “I was an emergency room technician and part of that entailed transporting patients to radiology. This allowed me to observe the workflows of each modality. I spent time with the various technologists and asked what they did and didn’t like about their jobs. It seemed like an interesting and growing field, so I decided to pursue it,” Harrold recalls. ICE magazine recently found out more about this rising star via a question-and-answer session. •

Bradford Harrold is the associate director of imaging administration at UT Southwestern.

ICEMAGAZINE | JULY 2022

Q: WHERE DID YOU RECEIVE YOUR IMAGING TRAINING/EDUCATION? WHAT DEGREES/CERTIFICATIONS DO YOU HAVE? A: I attended Gurnick Academy of Medical Arts (San Mateo campus) where I received a diploma in MRI technology. After completing the program, I became dual certified in MRI by sitting for and obtaining both ARMRIT and ARRT (MR) certifications. A

ADVANCING THE IMAGING PROFESSIONAL

few years later, I added both the Certified Radiology Administrator (CRA) and Certified Imaging Informatics Professional (CIIP) certifications. Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: The complexity of MRI with all the parameter tradeoffs is what drew me. Of course, it didn’t hurt that it’s non-ionizing radiation! Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: As an associate director, I get to have fun by solving problems and developing people. Overcoming difficult challenges while developing strong relationships is very rewarding. I view my responsibility as a leader to put processes into place that enable our front line staff to give exceptional patient care. Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: Imaging will be the key in many emerging fields: precision health and artificial intelligence are two that come to mind. I’m fortunate to be surrounded by world-renown physicians and the best technologists here at UTSW because our culture embraces these innovations. This academic mindset – to continually be pushing ourselves to be better, working together makes it easy to go to work every day. Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: I’m very proud of putting together a multi-year, three-day symposium focused on MRI safety. We had 200 attendees spanning five states and 34 medical centers resulting in 65-plus newly certified MR safety officers (technologists), experts (physicists) and medical directors. Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS? A: Obtain my MBA!

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FUN FACTS FAVORITE HOBBY: Jiu-Jitsu and reading FAVORITE SHOW: Sci-Fi and fantasy FAVORITE FOOD: Mexican (you can’t beat fresh, spicy salsa!) FAVORITE VACATION SPOT: Maui 1 THING ON YOUR BUCKET LIST: Cage dive with sharks off the Great Barrier Reef in Australia SOMETHING YOUR COWORKERS DON’T KNOW ABOUT YOU: I’ve read the Bible cover to cover.

ICEMAGAZINE

SPOTLIGHT

Rad idea BY MARIO PISTILLI

PEBBLES: A STRATEGY FOR TEAM ENGAGEMENT

n the March 2020 issue of ICE magazine, I wrote about the concept of a flowing stream as an allegory for leadership and that in our leadership journey there are pebbles and sometimes boulders that block our stream. The pebbles in our way impede us from achieving our best results. For a technologist those pebbles may take the form of equipment needs, staffing needs or process improvement needs. It is the accumulation of these pebbles, rocks and boulders that lead to frustration and reduced engagement. Sometimes they led to the acceptance that “it’s just the way things are around here.” One of the other team member concerns that often shows up on surveys is around the desire of employees to have a voice and a say in decisions. Staff members want to be heard and can add tremendous value to decisions. To combine these two concepts, we instituted a “Pebbles List” and a monthly “Pebbles Meeting” for each department at Children’s Hospital Los Angeles (CHLA). The “Pebbles List” is a spreadsheet we developed in 18

ICEMAGAZINE | JULY 2022

which we elicited answers from staff to the following question: “What are all the things (pebbles) in the way that slow you down or prevent you from doing your best?” We had these conversations repeatedly – either one-on-one or in groups. Also, many ideas came from working side by side with our teams and seeing what they went through on a daily basis. The (pebbles) issues fell into some broader categories by which we organized our list: equipment, staffing, IS, roles and workflows. The spreadsheet also contained a column to list the specific issue: who was responsible, status and due date. We learned some very interesting things from staff in each of these categories. Under equipment, for example, the staff said we don’t have a wheelchair compatible scale in radiology and must hunt for one when it is needed. I asked why nobody said anything previously and they said that they thought we couldn’t get one. This was an easy one and we ordered the scale right away. Of course, staffing is a more complex issue to solve. You likely cannot just add full-time employees (FTEs) but not everything is always really about FTEs. We learned some of the pebbles were around having the right staff allocated at the right places and times. ADVANCING THE IMAGING PROFESSIONAL

So, we instituted three-times-a-day staffing huddle to reallocate staff where it is needed based on how the day is going. This item was also an opportunity to openly communicate with teams regarding the constraints and difficulties in finding candidates. The “Pebbles Meeting” was attended by any staff that could rotate in and out and was a chance for staff to get updated on the status of items as well as contribute potential new items. The meetings turned into a great mechanism to help hold me and my managers accountable to work on items as we knew we would be reporting out to staff on progress. We decided as a group during the meetings what should make it to the list for us to work on and did not put one-time things or personal staff issues on the list but only those things that were frequent and had a wide impact. Items that did not fit that were best dealt with on an individual basis. Some of the more complex issues, such as depart-

ment staff scheduling issues, were given to volunteer staff workgroups to find their own solutions with their leader. For example, the radiology staff was unsatisfied with the call schedule and a group was given the task of devising a method for call scheduling. The workgroup members did an amazing job of finding their own solution. The “Pebbles” concept turned into a great way for us to communicate more effectively, be accountable, solve problems and improve engagement. The list is visible to everyone, and it has seemed to energize some and show that they really do have a voice. The meetings show that we really can remove some of the obstacles in the way of providing the best care. • Mario Pistilli is the administrative director, imaging services at Children’s Hospital Los Angeles. Share your RAD IDEA via an email to jwallace@mdpublishing.com.

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SPOTLIGHT

THE

Clock MARIAH GARCIA BY MATT SKOUFALOS

ack when she was a college student growing up in New Jersey, Mariah Garcia was on a pre-law track, at the insistence of her parents. But by her own admission, “school wasn’t going that great, and I didn’t really enjoy it.” “I wanted to get into medicine, but I didn’t see myself going into med school,” she said. “At the time, you could be a doctor or a nurse, and I didn’t know whether I wanted to go that route.” Instead, Garcia took a job as a night receptionist at an MRI center, and started hanging out with the imaging technicians in the office. In no time at all, she fell in love with MRI. “Nobody comes to a career show at your grade school and talks about this career; I didn’t know the technology was there,” Garcia said. “The first time I saw an MRI machine, it looked like Star Trek. You’re able to see patients’ bodies and what’s going on; I was mesmerized by it, and fell in love with it. I asked the techs, ‘What do I have to do to do this?’ ” On the recommendation of her coworkers, Garcia worked her way through X-ray school, earned her certificate, and received an invitation to take on a role at the imaging center where she’d began in reception. She learned MRI on the job, starting slow, but making steady progress. Within a year, she was running studies on her own.

ICEMAGAZINE | JULY 2022

All the while, Garcia continued to work as a session vocalist and live performer, singing with a party band, Zanadu, and backing up studio artists during recording sessions. Monday through Thursday, she worked in medical imaging, but the weekends, she worked in music. Zanadu played throughout the tristate area (New York, New Jersey and Pennsylvania), covering radio hits and other songs. Garcia’s fluency in Spanish and Portuguese also meant that the group was invited to play special events for families of those cultures, but her heart always pulled her towards R&B and the ‘70s radio hits of her youth. “A lot of it was word of mouth, especially in New Jersey,” she said. “I was born in Switzerland, and my parents are Spaniards, so I grew up with a lot of guitar influence. I loved power ballads, and then rock music, ‘70s, and disco. I love Heart, I love Pat Benatar; those power vocals from that time.” While her imaging career grew, Garcia also met Yadira, a Konica engineer and the woman who would become her wife. However, when Yadira fell ill and needed a heart transplant, the couple decided to move away from the East Coast for a slower pace of life in the Southwest. They landed in Arizona, and Garcia took a break from performing to focus on Yadira’s health. In 2010, Yadira underwent a successful heart transplant, and now, 10 years later, she’s in good health, and they both work for Banner Imaging. “She’s doing fantastic,” Garcia said. “She wanted to

ADVANCING THE IMAGING PROFESSIONAL

Mariah Garcia is in the Band NoBody Big.

give back, and now she’s in medicine.” Yadira’s recovery also meant that Garcia could slowly rejoin the music scene. In Arizona, however, she would have to reinvent herself with a new lineup and new repertoire to match the interests of venue owners and clubgoers. Her new band, NoBody BIG, performs classic rock and radio hits from the 70s and beyond. “It’s hard to get gigs out here, but once you establish a really big venue, you can usually have a pretty regular following,” she said. “That’s why we called ourselves NoBody BIG.” “What I enjoy about this is the way we pick our music,” Garcia said; “taking you back to your high school and college years. We pick songs that transcend you back to those times. The fans who follow us are people who I call my age now, so we all grew up in the ‘60s, ‘70s and ‘80s.” “Growing up in Newark, there was a lot of R&B, but out here in Arizona, there wasn’t, so we switched over to classic rock,” she said. “We do Journey, Tom Petty, Melissa Etheridge, Motown, ’70s, ’80s, ’90s. For the most part, we take a song, pick it apart, and make it our own.” Although the live music scene in her community is still growing, Garcia said NoBody BIG enjoy strong support from her coworkers and colleagues at Banner, and the band wins over new fans at every show. “We have a great time getting everybody to come out with their families,” she said. “It builds camaraderie, brings people together and relieves stress.” Although Garcia believes she could have kept up

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Mariah with her wife, Yadira.

with a recording career as a younger person, she’s content with her imaging career trajectory, and has no intentions of giving up performing on the side. “I’m 50 now, and it’s getting a little harder to get up there and do a four-hour gig,” she said. “It gets a little difficult as you get older, but I’m going to do it as much as I can, and then once I’m good, I’m good.” Moreover, after 25 years in MRI — 10 with Banner — Garcia’s professional experience is also relied upon in her role as a lead tech. “You have more responsibility to make sure things are running properly, and make sure your techs are trained and they have the support they need,” she said. “I love teaching new things, and as the technology comes out, just growing with it.” •

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Just because you don’t have the room or budget to build a full MRI, CT or PET/CT suite does not mean you can’t have those capabilities at your facility. Our Interim Medical Imaging solutions are completely mobile, can be parked and set up just about anywhere, and can remain at your facility for as long as you need them – be it a few days or a few weeks.

When you’re ready to show the world you’ve arrived, you’re ready for our Fixed Base Medical Imaging solutions. Whether you need a permanent suite or a modular external structure for MRI, CT or PET/CT capabilities, our full array of turnkey options will have you covered from planning and construction, to equipment purchasing and staffing.

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ICEMAGAZINE | JULY 2022

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ADVANCING THE IMAGING PROFESSIONAL

NEWS

Imaging News A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

BAMF HEALTH, UNITED IMAGING CELEBRATE TOTAL-BODY PET CLINIC FOCUSED ON THERANOSTICS United Imaging has announced that the uEXPLORER, the company’s state-of-the-art digital two-meter total-body PET/CT, is being installed at the Doug Meijer Medical Innovation Building in Grand Rapids, Michigan. This site on “Medical Mile” is where innovator Bold Advanced Medical Future (BAMF) Health chose to locate the country’s first theranostics clinic to install a total body PET; this center and the uEXPLORER system will be focused on how molecular imaging and theranostics are used in the diagnosis and treatment of disease. Key leaders were on hand May 9 to witness the gantries roll into the cutting-edge facility. BAMF Health broke ground on the clinic, radiopharmacy, and North American headquarters at Michigan State University’s Grand Rapids Innovation Park in August 2021, where it expects to treat thousands of cancer patients from around the country. “This is a milestone and a win for patients above all else,” asserted Jeffrey Bundy, Ph.D., CEO of United Imaging Healthcare Solutions. “BAMF Health is absolutely revolutionizing cancer and disease treatment here in the U.S., and the way they have intentionally designed their facility and brought our technology into play to focus on the idea of getting from diagnosis to treatment in the same day is game changing. That’s why they are ideal partners to use our medical imaging equipment: they believe as we do that

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the unique capabilities of our technology serve a higher purpose and can help them take patient outcomes to a different level.” United Imaging’s uEXPLORER is the world’s first and only medical imaging 3D scanner capable of capturing the entire human body in a single bed position. As part of United Imaging’s all digital PET/CT portfolio, uEXPLORER accomplishes total-body (two-meter) imaging in one acquisition in 30 to 240 seconds, while allowing for fast and continuous tracking of tracer distribution in blood, organs and tissues throughout the body. The uEXPLORER offers unparalleled support for pharmacokinetic studies and radiation dose evaluation and has a wide range of applications, from improving diagnostics to tracking disease progression to enabling research of new therapies. For example, uEXPLORER can be used to better visualize both the primary cancer mass and metastis dynamically at the same time. A uPMR 790 will also be installed this summer. The uPMR 790 PET/MR has at its core the innovative uEXPLORER technology. It integrates the strengths of next-generation SiPM-based HD TOF (time of flight) with a 32 cm axial FOV (field of view) and 3T MRI with the United Compressed Sensing (uCS) platform. These technologies taken together redefine clinical PET/MR imaging. •

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NEWS

PHILIPS MR 7700 RECEIVES FDA 510(K) CLEARANCE Royal Philips has received FDA 510(k) clearance for its new MR 7700 3.0T MR system. “This latest break-through MR innovation from Philips delivers unmatched performance and precision for both research and advanced clinical diagnostics, helping to address the Quadruple Aim,” according to a press release. “The XP gradients of MR 7700 provide high accuracy to support a confident diagnosis for every patient with Philips’ highest quality diffusion imaging and advanced neuroscience, supporting improved patient care and lower costs. MR 7700 expands scanning capabilities with a fully integrated multi-nuclei imaging and spectroscopy solution to explore new clinical pathways, without sacrificing clinical imaging workflow or wide-bore patient comfort, to enhance the experience of both staff and patients.”

With the easy-to-use interface of the MR 7700, scientists and clinicians can now access the scanner without compromising workflow. Driven by seamless integration of multi-nuclei capabilities, the new MR 7700 allows radiologists to image six different clinically relevant nuclei across all anatomies, offering the ability to increase diagnostic confidence and add important metabolic information to MR exams to help tackle complex research programs and improve clinical decision-making to help provide improved patient care. With its AI-driven smart connected imaging, optimized workflows and integrated clinical solutions, MR 7700 helps to improve MR department productivity, enhance patient and staff experience, and deliver high quality diagnostic imaging. •

JEFFERSON RADIOLOGY IMPLEMENTS TELE-ULTRASOUND Jefferson Radiology has implemented advanced telemedicine software for its diagnostic ultrasound appointments. “Collaboration Live, a tele-ultrasound software by Philips, will dramatically improve patient access by enabling radiologists to connect with patients virtually and in real-time. Breast imagers can now provide an expert diagnosis, instantly answer questions, and request additional imaging from a sonographer – all from a high-definition virtual desktop,” according to a press release. “This new software provides patients with access to some of the best sub-specialized radiologists in the country. At a time when there is a national shortage of breast imagers, this new software is critical towards getting patients the care they need,” says Diana James, MD, head of breast imaging at Jefferson Radiology. “Radiologists get the instant ability to walk into a patient’s room and consult with them face-to-face, with no wait time and with the same level of care and support. What it is doing for accessibility is incredible.” •

ICEMAGAZINE | JULY 2022

ADVANCING THE IMAGING PROFESSIONAL

BRUKER LAUNCHES NOVEL 7 TESLA AND 9.4 TESLA PRECLINICAL MRI MAGNETS At the ISMRM 2022 conference, Bruker announced the launch of 7 Tesla and 9.4 Tesla conduction-cooled Maxwell magnets for its preclinical magnetic resonance imaging (MRI) systems portfolio, according to a press release. Following the success of its BioSpec Maxwell 3 Tesla model, the new range of Maxwell 7 Tesla and 9.4 Tesla magnets eliminates the need for liquid helium or nitrogen refills, while offering high-field sensitivity and resolution for advanced preclinical MRI and PET/MR research. “The new BioSpec Maxwell MRI portfolio incorporates high-performance technology into easy to use systems for a range of preclinical applications, with simplified siting, installation and maintenance, as typically no building modifications are necessary. The systems offer a small-footprint and low maintenance that combines touchscreen ease of use with full MR imaging flexibility,” the release states. Preclinical imaging for non-invasive in vivo imaging on small rodents provides researchers with

high spatial and temporal resolution in research applications including oncology, neurology, cardiology and infectious diseases. The high stability of Bruker MRI systems creates sharp and clean images, critical when examining minuscule areas in high-resolution anatomical imaging of mouse brains, or when performing functional MRI (fMRI). The smart BioSpec Maxwell magnet technology features reliable supervision with multiple built-in sensors. In the event of a power outage or cooling disruption the Maxwell magnets remain at field for a minimum of six hours, and can be auto-cooled and auto-charged via push button operation. The new Maxwell conductively cooled magnet technology is available at three field strengths for different requirements: 3 Tesla, 7 Tesla, and 9.4 Tesla, all with 17 cm bore diameter, high-performance gradient systems, and options to add a PET accessory for PET/MR research. For more information, visit Bruker preclinical imaging. Bruker preclinical imaging systems are for research use only (RUO). •

INTELERAD EXPANDS LEADERSHIP TEAM Intelerad Medical Systems recently announced the appointment of two new executives to its leadership team. A.J. Watson has been named chief product officer, and Paul Johnson joins as Intelerad’s new chief delivery officer. The strategic new hires further advance the company’s ongoing commitment to provide exceptional client experiences and satisfaction, particularly as Intelerad expands its suite of solutions for the enterprise imaging market. They will focus on integrating the leading solutions from recently acquired brands,

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including Clario, Ambra Health, Digisonics, HeartIT, and LUMEDX. “As Intelerad continues to grow and scale, we’re excited to welcome these talented executives to the team, joining us as we further shape the growth and innovation for our company, our clients and the healthcare industry at large,” said Mike Lipps, CEO, Intelerad. “Our expansion of talent and capabilities underscores Intelerad’s deep commitment to ongoing product innovation and client satisfaction.” •

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NEWS DEEPHEALTH, QUANTIB AI TOOLS OBTAIN FDA CLEARANCE RadNet Inc., has announced that it has received FDA clearances for its DeepHeatlh Saige-DX mammography and Quantib Prostate 2.0 MRI artificial intelligence (“AI”) algorithms. Saige-Dx, a more advanced successor to the FDA approved Saige-Q worklist triage software, is a cancer detection tool that enables radiologists to more effectively detect the presence or absence of breast cancer with the use of artificial intelligence. DeepHealth’s new AI technology automatically identifies suspicious lesions in mammograms and assigns a suspicion level to each finding and to the entire case. It helps detect and diagnose breast cancer earlier while reducing unnecessary recalls. Quantib Prostate is an AI-based software solution that advances the MRI prostate reporting workflow

and is accessible directly from the radiologist’s reading station. The solution comes with a suite of tools to improve reporting quality and speed, including AI-based segmentations and volumetry, PSA density calculation, precise registration and movement correction, one-click segmentation of lesion candidates, PIRADS scoring support, and standardized reporting to facilitate easy and comprehensive communication of results. FDA 510k special clearance has been given for a major upgrade to the solution (from release 1.3) that now includes fully automatic prostate zone segmentation (in addition to prostate gland segmentation) and automated initiation of localization of lesions on the PI-RADS sector map. •

FDA CLEARS WEARABLE, AUTOMATED 3D BREAST ULTRASOUND iSono Health Inc. recently announced U.S. Food and Drug Administration (FDA) clearance of the company’s ATUSA System for breast imaging, a first-of-its-kind compact automated whole breast ultrasound system featuring a unique wearable accessory and an intuitive software for automated image acquisition and analysis. “Breast cancer is the leading cause of cancer death among women worldwide, and one in eight women will be diagnosed with breast cancer in their lifetime. We founded iSono Health with the vision to enable earlier diagnosis and treatment for breast cancer to save women’s lives, and this FDA clearance is a major step to fulfilling that vision,” said Maryam Ziaei, Ph.D., co-founder and CEO of iSono Health. Designed to offer enhanced efficiency, consistent accuracy and a comfortable patient experience, ATUSA’s patented technology makes 3D breast ultrasound imaging accessible to patients and physicians at point of care. In just two minutes, the portable ATUSA system automatically scans the entire breast volume, independent of operator expertise, and offers 3D visualization of the breast tissue. The ATUSA system is designed from the ground up to seamlessly integrate with advanced machine learning models that will give physicians a comprehensive set of tools for decision making and patient management. This is the first of several intended FDA submissions for the company. Currently, iSono Health is conducting prospective case collection studies to further validate various deep learning models integrated with ATUSA software to aid clinicians in localization and classification of breast lesions. •

ICEMAGAZINE | JULY 2022

ADVANCING THE IMAGING PROFESSIONAL

Are you ready for the power of integrated medical imaging training?

You asked for help growing your career to the next level. We’ve answered. Over the past several years we have seen a talent shortage in the medical imaging service industry. The need for skilled professionals receiving training in an environment where less time away and greater flexibility is becoming the standard. Technical Prospects Training Academy is offering the most advanced training and support for today’s imaging engineers. This program is fully accredited by AAMI. Plus, graduates receive ongoing mentorship from one of our highly experienced engineers.

Our Integrated Training Program is led by the most experienced and knowledgeable instructors in the industry. With decades of knowledge servicing the most advanced and complex systems in the world. Our AAMI certified instructors are ready to pass on their expert knowledge to you and your team. The program is a collection of mentor-led courses that combine one week of theory-centric, remote learning via our Interactive Virtual Training Academy (IVTA) followed by a second week of intensive hands-on lab training at our world-class training center in Appleton, Wisconsin. Are you ready to learn from AAMI-certified imaging professionals with decades of experience on the most advanced imaging systems in the world? Get started by downloading our latest training calendar today.

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PRODUCTS

Market Report STAFF REPORT

he global digital X-ray market is expected to reach $16.4 billion by 2026 from an estimated $11.1 billion in 2021, at a compound annual growth rate (CAGR) of 8.1% from 2021 to 2026, according to a report by MarketsandMarkets. The major factors driving the growth of this market include the increasing geriatric population and growth in disease incidence as well as favorable government regulations, investments and initiatives, the report states. “The advantages of digital X-ray systems have played a key part in their adoption; their speed and accuracy, as well as quick processing times, allow for significantly higher patient screening volumes than earlier. This has pushed companies to focus on product development and innovation. However, these systems are priced at a premium, which slows their greater adoption. Other factors such as declining reimbursements, lack of infrastructure, particularly in developing and underdeveloped countries, and potential risks associated with radiation exposure are also expected to hinder the growth of this market,” according to MarketsandMarkets.

ICEMAGAZINE | JULY 2022

“The global medical imaging market size was $36.19 billion in 2020 and is projected to grow from $37.97 billion in 2021 to $56.53 billion by 2028, exhibiting a CAGR of 5.8% during the forecast period. This information is provided by Fortune Business Insights, in its report, titled, “Medical Imaging Market, 2021-2028.” According to the Fortune Business Insights analysts, the growing occurrence of chronic conditions such as cardiovascular, neurology disorders and several others, pooled with the readjusting health care systems have resulted in an augmentation in prominence on primary diagnosis. The medical X-ray market size valued at $13 billion in 2020 and is expected to witness 5.7% CAGR from 2021 to 2027, Global Market Insights states. The report states that a surging burden of chronic diseases such as cancer, neurological diseases, dental problems, cardiac diseases, and musculoskeletal disorders will spur the market growth. “Moreover, due to the increasing incidence of COVID-19, the need for effective diagnosis and treatment has also surged globally. Several market participants in the medical device manufacturing industry are working continuously to escalate the production of medical X-ray devices to meet the growing needs of health care providers for imaging solutions,” according to Global Medical Insights. • ADVANCING THE IMAGING PROFESSIONAL

Product o F cus X-RAY

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CARESTREAM Lux 35 Detector

Carestream’s Lux 35 Detector is a lightweight, glass-free wireless detector ergonomically designed with the comfort of patients and radiographers in mind. The cesium iodide (CsI) detector offers superb resolution, better detail and a reduced exposure dose as compared to gadolinium (GoS) detectors. Weighing around five pounds (including the battery), the Lux 35 is totally redesigned with ergonomic features including beveled edges, rounded corners and built-in finger grips for less strain and stress on radiographers and a more comfortable exam for patients. The sleek Lux 35 is Carestream’s lightest detector to date, making it easier for radiographers to transport and perform beside exams.

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PRODUCTS

2 FUJIFILM FDR Cross

FDR Cross is Fujifilm’s new, novel hybrid c-arm and portable X-ray solution. The dual-function system is the first of its kind to offer real-time fluoroscopic and radiographic image capture on a single platform, reducing the need to bring in additional imaging equipment for essential procedures. FDR Cross features an innovative pivoting tube head and removable detector design enabling greater freedom of X-ray imaging comparable to a portable X-ray system. It’s compatible with Fujifilm’s latest ultra-light weight, glass-free, FDR D-EVO III detectors allowing configuration in 10x12”, 14x17” and 17x17” sizes – enabling an imaging area up to twice the size of standard c-arms. FDR Cross features a maneuverable and ergonomic design that is fully wireless for up to eight hours, and more than 150 pounds lighter than conventional compact c-arms. For more information, visit https://bit.ly/FujifilmFDRCross.

HOLOGIC

Fluoroscan InSight Mini C-arm Extremities Imaging System The Fluoroscan InSight Mini C-arm extremities imaging system is designed to facilitate greater positioning, flexibility and convenient mobility in a compact unit. The system provides diversified imaging options for extremities imaging, including single press X-ray exposure. It incorporates a rotating flat detector with 180-degree swivel, enabling imaging of long bones, and is designed to help minimize radiation by preventing patient and surgeon exposure to the unused area of the detector. The high-resolution flat detector technology offers a streamlined thin profile with superb image quality and dose optimization. For more information, visit www.Fluoroscan.com.

*Disclaimer: Products are listed in no particular order.

ICEMAGAZINE | JULY 2022

ADVANCING THE IMAGING PROFESSIONAL

KA IMAGING Reveal 35C

KA Imaging’s Reveal 35C is a solution for better mobile imaging – especially in challenging environments like the ER. The Reveal 35C X-ray detector provides high-quality DR images (up to 75% DQE), with the added benefit of offering dual-energy images in mobile applications. According to the company, it’s the only mobile DE solution currently available, using the same dose, same source and same workflow as a regular X-ray. Reveal’s dual-energy images can be used for better visualization of line and tube tips, retained surgical objects, pneumothorax, bedside pneumonia, among other applications.

SIEMENS HEALTHINEERS Multitom Rax

The Multitom Rax Twin Robotic X-ray system from Siemens Healthineers enables a wide range of examinations in multiple clinical areas – from emergency medicine and interventional to pain management and orthopedics, and from conventional 2D radiography to fluoroscopy examinations and angiography applications – all in one room using one X-ray system. The system permits the acquisition of 3D natural weight-bearing images. Its new True2scale Body Scan feature allows low-dose full-body slot scanning of the patient in seated, standing or supine positions. True2scale Body Scan is designed to benefit orthopedic practices when tracking spinal conditions and surgical planning.

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COVER STORY

PLUGGING

LEAKS BY MATT SKOUFALOUS

ICEMAGAZINE | JULY 2022

ADVANCING THE IMAGING PROFESSIONAL

COVER STORY

very imaging practice relies on a comprehensive reimbursement process to maintain its bottom line. From the largest and busiest to the smallest and least utilized setting, the fundamental, underlying mechanics of the medical imaging space turn on timely payments after services are rendered. With budgets tightening and a need to maximize patient throughput, it can be a secondary challenge to ensure that the work that’s been scheduled and done is also paid for. Sara Nofziger-Drew, client relations director at HealthPro Medical Billling of Lima, Ohio, believes that shoring up deficiencies in the revenue cycle requires a vigilant eye, attention to detail and a lot of internal communication among key players throughout the organization. “You can avoid leaks, identify them and resolve them so they don’t continue to happen,” Nofziger-Drew said. “But first you have to identify those errors in the system that are creating those leaks.” Nofziger-Drew describes six specific concerns as “the prime revenue cycle areas where reimbursement is lost.” They are coding, denials, timely processing, validation of charges, accuracy of payments, and auditing. Addressing each involves dedicating time and attention to a checklist of critical factors and repeating as needed. The first among these – coding and denials – are potentially the easiest items on which to find clarity. If a payment is denied for want of an appropriate code, practices should review the study to discover whether any internal errors were made in billing codes. “Could they have gotten something wrong?” Nofziger-Drew asked. “Was there something else that should have been dictated by the radiologist? Are they monitoring to see if the coding is accurate, and what denials are taking place from that coding? Just because it might not have been paid by the insurance company, doesn’t mean it shouldn’t have been paid.” Denials offer what Nofziger-Drew WWW.THEICECOMMUNITY.COM

described as “the greatest opportunity” for revenue recapture, despite being among the most commonly cited volume expenses to address. The best way to avoid claim denials is to prevent them, which is difficult to achieve when insurers deny as much as 30 percent of all bills for services out of hand on first submission. That’s according to the Centers for Medicare and Medicaid Services (CMS), which also notes that as much as 60 percent of those denied claims may go without being resubmitted. Couple that with Nofziger-Drew’s calculation that it can cost a radiology practice $25 just to work a denial, and it’s easy to see why this void in the revenue cycle is the most difficult to fill. “One of the things we preach is, once you identify a denial, go back and determine why it happened,” she said. “Then make sure that every scan that gets completed gets billed, because it doesn’t always get through to the billing system. A prior authorization doesn’t mean that a payment is going to be made.” Neither does simply being alerted to a denial mean that it will be addressed. Nofziger-Drew noted that a dedicated

by payers on the first submission – and statistics say that one in three won’t be – that can affect providers’ ability to collect on the work they’ve performed. Any edits to the coding or billing processes could require the claim to pass through multiple hands, adding delays to the process, and jeopardizing a chance at timely payment. “If they have any edits, that could go through multiple people,” Nofziger-Drew said. “If the people take time in between, you’re delayed getting it out the door.” Any issues that could result in the denial of payment must be resolved within a contracted time limit, so whether that’s as many as 120 days or as few as 60, the work involved in addressing any problems must be completed within that window. As Nofziger-Drew said, even 60 days can become a short amount of time. “That’s the reason timely processing becomes important,” she said. “You need extra time to do that; hospital systems need [more] extra time to do that.” Validation of charges or charge capture involves ensuring that radiologists are billing for every procedure that they

That’s the reason timely processing becomes important. You need extra time to do that; hospital systems need [more] extra time to do that.” - Sara Nofziger-Drew team of experts is often needed to help process any claim denied out of hand, and that means retaining people who are familiar with every step of the procedure involved, and compensating them for their determination to see it through. “When you’re looking at people who don’t believe they’re paid what they’re worth to work a denial, it doesn’t happen,” she said. Intertwined with coding and billing are details surrounding the timely processing, the work done to ensure that reimbursement for services is received in a timely fashion. If claims aren’t processed

performed. Just because a radiologist signs off on a report doesn’t mean it actually gets done, Nofziger-Drew said. “Once it’s ordered, it’s got to get to the practice management system,” she said. “There are always scans that get lost that don’t get billed. Maybe it’s not huge, but if the reimbursement was $2,000 or $5,000, that can be a salary, or half a salary, or equipment or supplies that are needed.” Another way to recapture potentially lost revenue is to certify accuracy of payments; that is, to be sure that the payments received match the contractICEMAGAZINE

COVER STORY ed amounts outlined in the agreements between service providers and payers. Nofziger-Drew notes that this simple detail, if overlooked, can be the cause of significant revenue shortfalls when volume procedures are involved. “Somebody needs to validate that if the contract says they should be getting $X for a CT scan, that they’re getting it,” she said. Finally, the first and last tools in the revenue recapture process are the same: auditing. Organizations of every size must routinely review their entire billing procedures from soup to nuts to certify that the whole of the system is working as intended. Its functionality can change in any single aspect as well as in terms of overall performance, particularly whenever staff turn over.

Just how much can be recaptured through a successful, thorough auditing of discrepancies within the system depends upon where the breaks occur. Nofziger-Drew believes that the bulk of preauthorization denials can be avoided before any service is performed by simply establishing preventative steps prior to scheduling the study. “If you change the process going forward, where a patient does not have an imaging service that needs a prior authorization until X, Y, and Z are completed, you’re likely going to avoid 90 percent of those denials,” she said. Upon whose shoulders does that work fall, however? Nofziger-Drew said that depends upon the practice environment – and on the presence of healthy, multi-level, inter-departmental communi-

the various systems this data is housed in. In a world of labyrinthine, ever-changing rules that dictate how, when, and whether your practice gets paid, Johnson believes the most important thing to manage is prior authorization and front-end tasks. “All these procedures by the utilization management companies, or the commercial payers – they’re going to tell you what you can do and what you can’t,” he said. “They’ve got rules, algorithms, and guidelines, and you’ve got to follow them. It’s a game you’re constantly navigating, and the problem is it’s eating up staff time.” To Johnson’s thinking, the more complex the system by which reimbursements are determined, the more points of failure; compounding those vulnera-

Practices have to invest in people who are trained in revenue cycle, and who understand the ebb and flow and consistency of radiology volumes, as a starting point.” - Dennis Chaltraw “If it was a human that was touching something, and that human has changed or forgotten to pass the knowledge on, then you have a break in the process,” Nofziger-Drew said. If an audit reveals the need for any changes to be made, then those edits should be identified and enacted, and then added to the practice management system to ensure that the same mistakes aren’t repeated. Supervisors should then review system reports individually “to make sure the money’s coming in,” Nofziger-Drew said. “You can’t automate too much because things break,” she said. “If they audit the billing process, they’ll find out where the leaks are, and then back up to the front side to prevent those leaks from happening.” “[It’s about] putting in checks and balances, and then continually auditing the process to make sure they’re not losing [money],” she added.

ICEMAGAZINE | JULY 2022

cation within a health system. “You have to build relationships,” she said. “It takes time. It’s an investment, but once you’ve made that investment, then the people are willing to do the work. That’s how you connect with people. That’s how you can improve the process for everybody. Build relationships with the finance team, with the billing department, with radiology, so they’re working together without just putting more work on the billing department. Even the coding department; you’ve got to build the relationship. If the coding department felt they had a relationship, they would come back and say you’re not going to get paid on this. If somebody doesn’t tell you there’s a problem, you don’t know.” Jordan Johnson, chief information officer at Oncospark of Dallas, Texas, said that the best way to shore up reimbursement leaks within an imaging practice is by finding a partner who understands how to use relational financial data and

bilities are the limitations of the people tasked with navigating them. One of the most overlooked factors in that calculus, he noted, is that the people upon whose labor much of the work and payment depends on are often underpaid and in short supply. “You’ve got people doing this for so many specialties [in a single health system], and how much time can they do it in?” Johnson said. “The people who control the most money are paid the least, so their level of commitment varies. You can’t expect somebody making $16 an hour to care at the level I do as a service-line administrator. It is more than a productivity mill, these are oftentimes sensitive cases that can be very complex.” “The biggest request I get as a consultant is staff,” he said. “I never thought that would happen, but we’re staffing people for these tasks now. They’ve had turnover; they’re not pay-

ADVANCING THE IMAGING PROFESSIONAL

COVER STORY

DENNIS CHALTRAW ing people appropriately; people have quit. It doesn’t mean patients have stopped. It’s expertise, and it’s knowing how to navigate the system.” If Johnson believes the biggest challenge in plugging reimbursement leaks comes down to staffing, Dennis Chaltraw, director of revenue cycle management at Oregon Imaging Centers in Eugene, Oregon, thinks it’s about getting overwhelmed by the sheer volume of procedures and the work it takes to interpret them. However, by his reckoning, that’s also wherein the guidance to manage the problem lies. “Whatever size practice you have, there’s a lot of challenges because there’s so many moving pieces, including payer rules, governmental rules and patient demographics,” Chaltraw said. “The beauty of radiology has a lot to do with the volume of procedures and the consistency of those volumes,” he said. “Unless you add a hospital or another modality, your volumes remain wonderfully consistent in this business; therefore, you should be able to pick out outliers when things veer from the norm – if you’ve got people who are trained to do that.” “Practices have to invest in people who are trained in revenue cycle, and who understand the ebb and flow and consistency of radiology volumes, as a starting point,” Chaltraw said. “I think the industry, over the last five years, has begun to recognize that you have to have somebody focused on revenue

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SARA NOFZIGER-DREW cycle start to finish. The people who invest in revenue cycle folks can rest assured that someone’s looking at their accounts receivable.” Chaltraw also pointed out that, in high-volume practice environments, even the smallest inconsistencies in reimbursement policies can compound the problem quite rapidly. His practice, which includes 24 physicians and six physicians’ assistants, generates upwards of 500,000 procedures annually. With the revenue generated at that scale, that amounts to significant cash flow, which can easily mask some underlying flaws. “If you’re doing 500,000 procedures a year, even though the money is consistent and you’re paying pretty good salaries, the opportunity to leave money on the table is significant,” Chaltraw said. “Five percent of $50 million is a lot of money. Two percent of $50 million is a lot of money. One percent of $50 million is a lot of money.” Even in practices where that kind of volume (and revenue) aren’t in the discussion, it’s just as meaningful to recapture potentially lost revenue, Chaltraw said, because physicians are already liable for all the work they do anyway. By his reckoning, “they carry that risk, so they might as well get paid for it.” “It’s still revenue lost,” he said. Chaltraw’s focus is on achieving the highest rate of “clean” claims – those paid on the first submission to a payer – for his physicians. Anything lower than a clean claim rate

JORDAN JOHNSON of 90 to 95 percent means providers are leaving money on the table. To him, the clean claim rate is an indicator of the financial health of a practice. “The average claim payment is in the 21- to 22-day range,” Chaltraw said. “Payers pay very quickly; if you give a billing company a valid diagnosis, they’re going to pay the claim. If I can’t get the claim paid within 60 days with no interaction on first billing, there’s something wrong.” When claims are denied, Chaltraw said it’s equally important to have an aggressive appeals process in place; one that includes boilerplate letters for outright denials, medical necessity or authorization issues. Even if a claim is denied on medical necessity, he also said it’s important to make sure that it’s not written off without a second review for acceptable signs and symptoms. “It should be put back in my lap so that I can develop that,” Chaltraw said. “Maybe 80 to 90 percent of the time I can find a compliant, valid diagnosis by reviewing medical records.” “If you have people who don’t know how to manage medical necessity, that’s a problem,” he said. “To me, the secret of denial management is focusing on things that aren’t paid. I care about denials that have been paid, for trending purposes, but I place much more urgency on denied imaging services when no payment has been made.” •

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DIVERSITY BY VERLON E. SALLEY

WHY D.E.I?

iversity, Equity, and Inclusion (DEI) is a culture that everyone should strive to implement. The question is, “How does it benefit your organization?” Let us explore the facts: •

Companies with diverse management teams have 19% higher revenues. • Diverse companies are 1.7 times more likely to be innovation leaders. • 67% of job seekers say diversity is an important factor when considering a company. • 85% of CEOs say that having a diverse workforce improves their bottom lines. What are the sources for this information? How Diverse Leadership Teams Boost Innovation (bcg.com); Why Diversity and Inclusion Has Become a Business Priority – Josh Bersin; Recruiting a Diverse Workforce | Glassdoor for Employers; and 18th Annual Global CEO Survey: A marketplace without boundaries? Responding to disruption (pwc.com). These statistics come from researching companies from all industries. Is health care that different than other industries that we can ignore glaring opportunities to gain more revenue, FTEs and innovation? No, we cannot. A widely accepted theory by Peter Drucker is, “If you cannot measure it, you cannot improve it.” That certainly holds true in hospital operations. Without quality measures, patients could have a less desired outcome. Without a budget, a hospital could have terrible financial margin. Without benchmarks, a radiology department could lose productivity and efficiency. All this is true. Therefore, I ask the question. Does your hospital keep track of the facts and set strategy and goals to achieve a

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better work experience and financial position? The facts and statistics I refer to is your organization’s workforce. What are the demographics of the market area you serve and how does your organization’s workforce reflect those demographics? Who are you recruiting and hiring? How are you training them? Who is your leadership? What are their strategies to ensure they reflect the community they serve? Statistics you should know and measure include: • The percentage of males and females in your workforce • The percentage of minorities in you workforce • The percentage of males and females among your leadership • The percentage of minorities among your leadership • The percentage of minorities that are the recipients of promotions • The demographics of those that leave your organization Once you know these things about your organization, you can develop strategies to reflect the population you serve and increase diversity, equity and, most importantly, inclusion within your organization. Moreover, if you are a leader within your department, you can develop your own strategies and you know and understand these statistics. Some think that workforce development is the job of the human resources department in their organization. I offer a different level of accountability. Workforce development is an opportunity for leadership of any and every organization to strive to achieve inclusion and a quality patient experience. Do not wait for direction to do what is just. Just do it! •

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DIRECTOR’S CUT

A REFLECTION OF EMPLOYEE ENGAGEMENT

BY NICOLE DHANRAJ

t’s our annual employee engagement time! As I discuss this topic with senior leaders and we prepare for the engagement survey, I reflected on my efforts within the last year with my management and front-line team. I have some insightful thoughts about engagement to share in this month’s column. Why is engagement important to organizations? Research and data from Press Ganey advise leaders that employee engagement is critical to productive and efficient work environments. Employees who share ideas, and participate in projects, are invested in the operation and any departmental improvements. When employees are engaged, work is enjoyable, and patients are not only happy but are provided safe care and increased quality of service. Engagement is therefore a reflection of our leaders and the overall effectiveness as a team and thus organization. Organizations use engagement scores to identify leadership strengths and opportunities to address. Will we have engaged workers all the time? In our current volatile and chaotic operation, I questioned myself and colleagues on the possibility to have engaged workers. Is this even a reality in today’s operation? We now live in an environment where we are seeing new faces every 13 weeks. Travelers are focused on living their best lives with increased compensation, and work-life balance. They come in to assist the organization to the best of their ability but are not necessarily invested to help support change

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nor are most thinking about the future state of the organization. Temporary travelers are satisfied and get the work done but are not necessarily engaged. Even without travelers, is employee engagement a focus of the current workforce? Does it depend on the generation of the workforce, or the new health care environment we operate in? I am curious to see how engagement morphs over the next few years. Many of us mix up lack of engagement for disengagement. However, a person who is not engaged is neither disgruntled nor actively looking to resign from their job. They exist to fulfill their job requirements sometimes at the bare minimum or just “doing their thing” effectively. Then, some are actively disengaged and dissatisfied. These employees are often identified by their lack of initiative, unwillingness to work extra, frequent complaints from the team, absenteeism, and poor quality or lack of pride in their work output. In addition, these employees can be negative and unmotivated. Their attitude and bare minimum work output can affect the team often instigating an epidemic of negativity and dissatisfaction. Underlying reasons for disengagement As organizations obtain focus on engagement, leaders need to understand the root cause of this disengagement to tackle it effectively. Some possible causes I have learned over the years include: 1. Life stressors. Navigating through personal challenges causes stress to bubble over into work and cause

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disengagement due to noncorns. The bad periods may last work events that consume their more than a few days, and they attention. may need to work through that Misinformation or lack of inforindependently. mation. When there is ambigu8. Burnout and fatigue. The long ous information about the operhours, challenges, critically ill ation, staff attempt to fill in the patients, and doing more with blanks which may be inaccurate fewer resources take a significontributing to misperceptions cant toll on employees. Some and thus negativity. are just trying to survive and Unable to process negative have no energy for anything emotions, or no outlet to share else within the operation. their feelings. When staff is unable to manage their emotions, Strategies leaders can use to improve they may withdraw and appear engagement in a chaotic and volatile disengaged. imaging environment Facing decision dilemmas. • Show that you care. Spend time When staff is contemplating rounding. Get to know the huleaving or staying, they may man behind the worker. Human become stressed as the employconnection is amazing and has ee is unable to navigate decipowerful long-lasting effects to sion-making productively. include generating loyalty. Learning Lack of recognition. When an more about the team; who they employee has done something are, what makes them happy, and significant for the organizawhat causes them grief, anger and tion but there is no recognidisappointment in the organization tion for the efforts, or perhaps will allow you, as a leader, to build someone else got the recoggenuine connections. Relationship nition, they may be angry, and building is a lifelong journey. Keep disappointed. at it, don’t expect to form these Inequity in compensation. This relationships overnight. This can is prominent in our current take even longer if the team experihealth care climate where perenced “bad” leaders. manent staff are performing the • Allow employees not to be ensame work, training travelers, gaged. It’s OK. Remember, people and in some cases contributing are not meant to be fixed. When more to support the operation your team members are ready to but are not paid the same as be engaged, they will bounce back. the travelers. Or perhaps the Sometimes you have to allow them incentives are not sufficient to the space to be rebellious, dissatismatch their efforts. Theories like fied or disengaged. As long as it is the expectancy and equity thenot affecting the overall operation, ory help us to understand why give your staff the space to survive staff experience hurt, and anger before they can thrive. when evaluating their efforts • Have crucial conversations, espeand the return of their efforts in cially with those that are showing the form of compensation. signs of infecting the department. Going through stuff. Some Avoid accusatory conversations days are good, and some days but instead, try to understand what are bad. It is not every day that is causing the negative behavior employees feel like the world is to manifest. Consider starting the filled with rainbows and uniconversation with “I noticed you

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are not yourself lately, is there anything I can do to help, something we can work out together?” • Learn how they feel appreciated. I sent a survey to ask simple questions such as your favorite snack, what you like to do when you are off, and what recognition and a thank you look like to you. I try to memorize these so that when I chat with employees, I can speak directly about what matters most to them. At a recent conference, there was a conversation about giving employees gift cards. One comment was that an employee may feel insulted by a gift card of a certain value. Some of us were shocked at the comment but this provided testimony to how important it is for leaders to know what strategies are effective in making their team feel appreciated. Appreciation and recognition are not a one size fits all approach. • Use champions and ask for help from valuable resources. Employee health and wellness, motivational speakers or staff sharing positive stories are all small ways that can help plant positive seeds to improve attitudes and overall mindset. You do not need to deploy strategies on your own. Use champions to support engagement initiatives. Keep in mind not everyone is ready to internalize messages so there must be continued efforts to use champions over time. • Be vulnerable. Often leaders are hesitant to be vulnerable with their team. It is a risk but depending on the situation, and the maturity of your team, consider being vulnerable. Letting your team know that you are genuinely doing your best to support them and sometimes you may not get it right, or may overlook a celebration, or may not meet their expectations. I often remind my team to prod me if there is something I have overlooked, or

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if an action is taking too long to happen. The operation has competing demands, so I ask to let me know the priority of an issue so that it is addressed in a timely fashion. Engage senior and lateral leaders. Engagement is not just for imaging managers and directors. It is a leadership team effort. The active presence of senior leaders and directors from other departments is beneficial. Staff will notice the involvement of everyone and recognize the collaborative effort to be better together. Do not make promises. If staff is waiting on improvement in working conditions, pay, updated equipment, improved processes, or any other requests to increase their satisfaction and keep them engaged, keep them informed every step of the way without making promises. Sometimes when leaders relentlessly advocate for staff and the operation, C-suite leaders may not be ready to act upon an initiative which can cause significant disappointment to staff if a promise you made goes unfulfilled. Don’t stop trying. Do not be discouraged if engagement scores are not where you were anticipating based on your efforts. Everyone in your team has their individual expectations of us as leaders. Sometimes we may fall short of meeting all of those. Consistency in your engagement efforts is key Listen to and acknowledge employees’ voices. Act on their suggestions and solutions, and follow up on what they shared. When employees present ideas consistently and it is not acted upon, they will lose interest and become disengaged. You may not be able to act upon every idea or suggestion, but you can certainly let them know the status of whether

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•

the idea will be temporarily tabled. Maintaining their passion and spirit is key to engagement. Evaluate the workload. Doing more with fewer resources increases negativity and frustration which spread like wildfire. Check-in with staff to understand their workload and any negative consequences they may be facing and address it immediately, or at least establish a plan of action with a timeline. Learn about their goals. Don’t wait for evaluation time, but do frequent check-ins so you have an idea of what they are seeking in their jobs. This way you can identify those who are thirsty to give more, and those that may need to “take a knee” to rejuvenate and re-energize. Take the time to celebrate milestones both big and small. This is one of the best ways to acknowledge their efforts. Engage in regular feedback. Waiting for an annual survey is not ideal. Quarterly feedback, impromptu one on ones, or staff focus groups throughout the year will assist in ensuring you are attentive to your team and taking timely action. Work in the trenches with your team. There is no greater testimony to supporting your team than working side by side with them. Walking the talk and leading by example inspires and motivates others tremendously thus increasing their level of commitment and engagement.

I share with you these strategies I have tried or continue to try with and without success. What a year it has been! There have been more downs than ups, but I give myself some slack for not always getting it right or just purely not being able to meet the demands and expectations of everyone.

As a leader, I want to be attentive to everyone, and every aspect of the operation. With the never-ending flow of challenges, I did not have that opportunity to spend the time in areas that I wanted to, as I was drinking from the operational firehose for the majority of the year. What I realized from continuous efforts to improve engagement in an operation riddled with challenges is that: • You have to keep trying. Repeat old strategies that you thought did not work. Communicate your efforts and ask for feedback. • Ask staff for their input on what is meaningful to them, and what engagement looks like to them so you can ensure focused efforts. Employee engagement is not just spearheaded by one person. It takes a village to improve employee engagement. • If you end up with disengaged employees, it is OK to be OK with these employees. As a leader, we need to understand where our folks are mentally. Provide the space they may need while disengaged for their own healing and recuperation. • Accept that engagement scores are not a complete picture of your effectiveness as a leader. • Engage in continuous feedback which you can act upon to help increase the effectiveness of your engagement efforts. Remember, there is no foolproof one size fits all strategy, but it is imperative that we display an unwavering commitment to trying multiple strategies to support our staff, especially as we navigate the challenging health care environment we face. • Nicole Dhanraj, Ph.D., SHRM-SCP, PMP, GPHR, CPSS, CRA, R.T(R)(CT) (MR), is a radiology systems director for Northern Arizona Healthcare.

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ealthcare facilities are constantly facing spending constraints and always seeking new cost-saving strategies. Ultrasound transducers, including complex TEE transducers, experience some of the highest failure rates in medical imaging due to their high utilization and constant handling. As a result, damage happens frequently requiring either repair or replacement. Summit can uniquely address this problem. We extend our comprehensive repair capabilities to our customers without any costly fees. Summit has realized approximately 80% successful repair yields, and the customer is only charged upon successful completion of an approved repair. Over 99% of transducer repairs last beyond the sixmonth warranty period. Much of these achievements are due to a time-tested ISO 13485 Quality Management System governing the repair activities of Summit. 44

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The value proposition is that for every probe successfully repaired (80% of the time), the customer can potentially save thousands of dollars, an achievement that our customers tell us is an industry best. Risk mitigation continues after the customer receives their transducer from Summit Imaging. Summit’s products and repair services come with a standard six-month warranty. Our use of OEM trans-

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RAD HR

BY KIAHNNA PATTON

USE TRANSPARENCY TO YOUR ADVANTAGE

’ve yet to have an employee say that I didn’t give them all the information I could in my 20-plus-year career. Even in the most extreme cases, including lawsuits, employees made it known that I took their concerns seriously and provided a level of transparency they weren’t accustomed to. Yes, even in human resources, you can be transparent. And when there is information you can’t divulge, be transparent about that. Know that you cannot control others’ thoughts despite your efforts. What you can do is be honest and as open as possible. I’m a big believer in transparency. Being in HR, it is not always feasible or advisable to tell everyone everything. In cases where it is ill-advised, I say, “I cannot tell you that.” Unfortunately, some opt for spinning the truth or outright lying instead, neither of which I support. Being open with others can be terrifying, especially when you have not built a connection, biases are at play, and there is no trust. What must be present for transparency to work and be safe? Let’s look at transparency in just a few situations you may face at work – interviewing, dayto-day working, and being a leader. TRANSPARENCY IN THE INTERVIEW PROCESS I once received advice from a recruiter to reframe why I left a company. I understood their position, considering the age-old adage that one should never say anything negative about a previous company during an interview. I also understood that reframing was not true to who I am, and more importantly, my journey is my story to tell. While working with this trusted advisor, I feverishly wrote down all of their advice about how I should spin

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the story of why I left my previous employer. Then, I had an interview with one of my dream companies. I could not, in good faith, be less than transparent about my reason for leaving. So, I did something scary yet freeing. I told the hiring manager that I wanted to try something with her. Keep in mind that I did this knowing a bit about the organization’s culture, which they claimed included transparency as a core tenet. I gave her the unedited and messy version of why I left. Something happened that others may think is unheard of. She empathized with what I went through and thanked me for being honest. It was a moment that led to openness from her and a great start to our employment relationship – one with transparency and honesty from the start. Some cases don’t go as well as mine. Many of us have read about and experienced an interviewer’s archaic thinking that no one should say anything less than glowing about their previous employer. And some of us interviewees poorly construct our stories during the interview. Those things matter. What also matters is telling the truth. TRANSPARENCY DAY-TO-DAY Have you ever worked with someone or known someone who never tells you the whole story? I have a friend with whom this is a running joke. He frequently leaves out what I consider essential information that would help me understand the five-minute story he’d just told. I’d be scratching my head and rearranging all of the information in my head to make sense of it. I felt confused and a bit deceived and that I’d wasted a lot of valuable time. Imagine if this happened to you frequently and intentionally at work. How might you feel about the person or people who display the behavior? How might it impact how you approach your work?

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How much or less trust might you have in the information provided to you? How much additional effort would be required to get the information you need to do your job? How might it impact your engagement at work? TRANSPARENCY AND LEADERSHIP We’re often taught in business school that we should be able to make sound decisions as long as we have most (let’s say 80%) of the information we need. Not a problem if the missing 20% will not materially change your decision. I worked for a company where the lack of transparency and the idea that most everything should be kept “close to the vest” was routine. The consensus of quite a few employees was that the leadership was composed of liars who didn’t trust employees with the truth, which would inevitably unfold later. Leaders decided to tell part of the truth and position it to make them look good while hiding the material 20% that would have armed employees with what they needed to make the best decisions. These scenarios call to mind the role of safety and truth in transparency, which impact how we communicate with and respond to others. We carry our life experiences and truths with us to work. For that reason, let’s consider how biases can impact a person’s exercise of and the recipient’s receipt (or non-receipt) of transparency. While there are many biases, I’ll point out just a few with examples, including: • Confirmation Bias – As I knew it would happen, when I gave all of the information at my last company, people shared what they should not have. I asked them to keep the information confidential. For that reason, I cannot be transparent at my new company. • Availability Bias – I saw something like this happen at another hospital, so we have to take it seriously. • Attentional Bias – I see that XYZ department has phenomenal financial results, so I can ignore the feedback that the leaders are bullying employees and creating a hostile work environment. We can do several things to overcome biases. The first is to be aware of them and think about how they might be influencing your thinking. A second is to analyze your thinking. Consider the factors that influence how you make decisions. Maintain a level of curiosity that will allow you to challenge your biases and seek multiple perspectives. Resolving these things will set you on a path to overcome your biases and trust and be more transparent with others. • Kiahnna D. Patton is human resources professional with experience in the health care sector as well as a nonprofit founder.

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CHEW ON THIS BY KEITH CHEW

HEALTH CARE CAN LEARN FROM CREDIT CARD COMPANIES

ealth care has long struggled with detecting and addressing medical errors. It’s been more than 20 years since the groundbreaking U.S. Institute of Medicine’s piece To Err is Human and, as an industry, we’re far from achieving zero errors. However, there are things that we can learn from a most unexpected place, the credit card in your pocket. Credit card companies have been making significant advancements in finding and managing anomalous activity, which the industry refers to as “fraud.” While the issue of detecting medical errors is quite different from detecting credit card fraud, both fields face similar challenges – the detection of behaviors that stray from the norm. Credit card companies have risen to the challenge and are investing in what will be a $63 billion global fraud detection and prevention market. These new programs have led to recent and projected decreases in existing credit card fraud claims in the United States. As these efforts develop, what can health care leaders learn from the work being done by credit card companies? REVIEW EVERYTHING, SMARTLY Fraud detection systems have been around since the 1990s. In the past, the systems heavily depended on static rules that only reviewed a small sample of credit card transactions. For a long time, the promise of new technology

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failed to deliver, like the health care industry’s experience with EHRs. The root of the problem for credit card companies was a high technology infrastructure barrier, coupled with the fact that automation and algorithms had yet to reach a level of maturity that could deliver scalable value. In addition, early fraud warning systems were simplistic, relying on human-coded rules which failed to account for the myriad of situations in the real world. This combination of factors led to incorrect approvals on unlawful activity while blocking legitimate transactions, and costing, according to some estimates, $118 billion in lost revenue. Rules-based checking led to inaccurate and costly consequences that no credit card company nor hospital wants. A corollary to this in today’s EHR age are the constant warnings coming from EHR systems based on limited data streams. Unfortunately, this has led to the widespread problem of alert fatigue in many health care systems, wasting time and frustrating health care practitioners. Today, the credit card industry’s modern solutions are addressing both problems. Leading fraud detection systems can review every transaction and use state-of-the-art artificial intelligence models with higher sensitivity and specificity. This new paradigm of analysis detects fraud in a way that hand-written rules could not and, equally important, does not trigger as many distracting false positives. In health care, clinicians and leaders know the pain of hearing and seeing a multitude of alarms from the EHR and other medical devices,

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many of which are more distracting than helpful. For example, America’s leading credit card companies use fraud detection systems to meaningfully reduce risk exposure, act more efficiently,and help customers transact in this dynamic world. Taking inspiration from the credit card industry, health systems can find value in moving beyond the old models of reviewing a small sample of clinical actions. Instead, they can leverage new technologies, such as AI used in the quality workflow to catch medical errors and improve patient safety. ADDRESS THE END-TO-END WORKFLOW In complex systems such as hospitals or financial institutions, detection is the first step. The finding must be verified, and the appropriate parties must be notified for insights to be helpful. Here, credit card companies’ best practices can be a source of learning. When a credit card transaction is deemed at risk of being fraudulent and thus declined, there was, in the past, a long and arduous process to prove innocence or guilt, often driving good customers away. With their new fraud detection tools, credit card companies caused significant problems for case investigators later in the process. The key was to think about and address the continuum of the entire issue. With hospital patient safety initiatives, such as peer review in radiology, identifying the medical error is simply the first step. In fact, another type of medical error that commonly occurs is an error in communication and coordination, where information critical to patient care is not seen or is not passed along. Hospitals can benefit from thinking about the handoff of information and assessing communication workflows so that dangerous medical errors do not go unresolved. Efficiently validating and then communicating the error to the appropriate parties is where value is realized in all industries. More recently, credit card compa-

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nies have implemented advanced case investigation management systems that make it easier for fraud agents to resolve fraud risks accurately and quickly. These tools integrate data across the relevant systems and help the user focus on the most critical cases first. The manual processes are automated, and the right people are updated. One case study found a 50% increase in productivity, and another saw a reduction in fraud by 25%. In health care, AI tools can empower staff to take a similar approach to reduce medical errors once they are detected. The key lesson here is that investing in an integrated infrastructure through which medical errors are communicated is as important as finding the medical errors themselves. Today’s credit card industry has evolved to use advanced tools integrated with common-sense workflows to find and address anomalies. The health care industry can learn much from these lessons by implementing AI and communication tools that ensure that the right team members are empowered with the right insights to act on and prevent future medical errors. Health systems can leverage these cross-industry learnings by asking a few questions: • What percent of your clinical decisions get a second look? • What is the administrative burden to “right the wrong” and improve patient safety, and how might you reduce that burden with better communication processes and tools? • Where are the weak points in your end-to-end workflow for communicating errors and improving patient care?

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Join us next month as we look to the skies and see what we can learn from the airline industry about managing errors. • Keith E. Chew, MHA, CMPE, FRBMA, is a principal with Consulting with Integrity.

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EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI

he research is clear. The main difference that separates top performers from average performers is emotional intelligence (EQ). In technical and middle management positions, two-thirds of top performers were found to have strong EQ and one-third didn’t. It’s even more important in positions of senior management and leadership, where four-fifths of top performers in these roles had strong EQ, whereas only one-fifth didn’t. This metric alone tells us that EQ is a valuable skill, and what’s great is it’s learnable. THE DEFINITION Emotional intelligence can best be described as the ability to perceive and assess one’s own and other people’s emotions, desires, and tendencies, and then make the best decision – in the moment – to bring about the best win-win for everyone concerned. To break that down, two skills are required up front; being able to perceive and assess. Perceiving is the ability to notice. It is what we see and sense. We need to be able to see and sense what’s going on inside of us as well as see and sense what’s going on in others. The second skill is being able to assess. Synonyms could be process, or to make sense of, or to understand. In other words, once we’ve noticed something,

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EQ IS LEARNABLE – HERE’S THE FRAMEWORK we need to be able to make sense of it. The second part of the EQ definition identifies what we are to perceive and assess, and that is emotions, desires, and tendencies. Let’s break those down, but let’s do it in reverse order. Our individual tendencies are what we “tend” to do. When speaking of tendencies, it means one’s preferred cognitive approaches, preferred behavioral approaches, and preferred “drivers,” or motivators. We shouldn’t put people in a box, because people adapt situation by situation depending on what they perceive will be the best thing to do in a given situation. However, people do have preferred tendencies in each of these areas, and this is what we should perceive and assess in our interactions with others. TENDENCIES TO CONSIDER Let’s do a flyover of the three areas of tendencies that deserve the attention of good EQ practitioners. Keep in mind that each area described is a “spectrum,” meaning it’s not either/or. The descriptors are provided simply to help you understand how the tendencies can play out. Cognitive Approaches: • Energy/Interactions – a tendency to prefer being alone or with other people • Information Input – a tendency to notice mainly the here and now versus noticing the future implications of what’s going on now

•

Processing – a tendency to process information rather stoically and objectively or to process it in a way that emotions are visible • Decision-Making – a tendency to make decisions right away or a to put off decisions until more data is collected Behavioral Approaches.: • Problems – a tendency to solve problems right way or to let them solve themselves • People – a tendency to verbally influence others to a particular point of view or a tendency to keep quiet and let people arrive to conclusions on their own • Pace – a tendency to juggle multiple projects and appear somewhat hectic or a tendency to be steady and methodical and appear focused • Procedures – a tendency to know and follow the rules or a tendency to shrug off or blatantly ignore rules if they don’t seem to make sense Preferred Drivers/Motivators.: • Knowledge – a tendency to either acquire as much truth and information as possible or a tendency to rely on past experiences and learn new things only when necessary • Utility – a tendency to maximize the return on investment or a tendency to perform work with little expectation of personal return

ADVANCING THE IMAGING PROFESSIONAL

•

Surroundings – a tendency toward living and working in balanced and harmonious environments or a tendency towards having environments focused on objectivity and functionality • Community – a tendency to be altruistic and generous in all circumstances or a tendency to be helpful and supportive only for specific situations • Power – a tendency toward status, control, and personal freedom or tendencies toward being more supportive and collaborative without a need for personal recognition • Life Systems – tendencies toward having a defined system for living versus a tendency to be more flexible and carefree Allow me to reiterate that we need to perceive and assess our own tendencies as well the tendencies of the people with whom we’re interacting. The next thing to perceive and assess are desires. This is the short way of

saying we should notice and understand what we want and what other people want. Said another way, when working with others, those practicing good EQ must be consciously aware of what he or she is trying to achieve as well as what other people are trying to achieve. Is it the same? Is it different? Good emotional intelligence means perceiving and understanding everyone’s desires because what everyone wants needs to be factored into the decision-making process. The final thing to perceive and assess are emotions – our own emotional state, and also the emotional state of others. I say it this way because our emotions can change. We might have tendencies, but again, they can easily change. To be effective with emotional intelligence, we need to understand that emotions can significantly impact how someone responds in a situation. For example, fear is a powerful emotion. If we consider Maslow’s hierarchy of needs, physiological and safety needs are the foundation. Therefore, if people fear for

RTI X-ray QA solutions for multimodalities

their safety – their health, their property or the safety of their family – the are likely to be quite self-protective in their decisions. This can be a good thing or it can be a bad thing, but that is something for the person practicing EQ to decide and factor into the decision-making process. Emotions can powerfully impact a situation, so being aware of everyone’s emotional state aids greatly in making wise, emotionally intelligence choices. Those with strong emotional intelligence also practice win-win thinking, but that’s a topic for a different column. • Daniel Bobinski, who has a doctorate in theology, is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach him by email at DanielBobinski@ protonmail.com or 208-375-7606.

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INSIGHTS

PACS/IT

BY MARK WATTS

10 THINGS TO CONSIDER WHEN CHANGING AN AI VENDOR

uying an imaging artificial intelligence is a commitment. The partnership between you and your vendor is much like a marriage, with both parties entering the relationship with certain assumptions and expectations. Over time, however, shared values and direction may diverge, making you wonder if it’s right to stay together. The relationship you have with your vendor can mean the difference between an innovative, always-on system with happy users or a system that fails to meet users’ expectations. I am offering up this list of “top 10 signs it’s time to consider changing your Imaging AI vendor.” 1. Continuous substandard service and poor support: The customer success/service relationship is a key differentiator with any AI company. While the sales department often establishes the initial contact, it is typically the service organization that continues to manage the relationship after the sale is made. Once the sales group collects its fee, is the love gone? A responsive customer success/service organization is the key to keeping your system up in the event of any issues that arise. 2. Poor vision for the future: It is key to understand where your vendor is heading from a strategic per-

ICEMAGAZINE | JULY 2022

spective and that it has a strategy for continually embracing innovative technology and not just fork-lifting architectures every five years. You need to enjoy the market benefits of hardware advancements and reductions in cost. Moore’s Law states that storage should be twice the size every 18 months for the same market price. If your vendor seems unconcerned about the single points of failure or has no strategy to handle disruptive innovations like archiving thin slice data or supporting new imaging modalities, it might not be the right vendor for you. 3. Your vendor keeps getting bought out: If your sales rep calls you and asks for a job referral, you should be somewhat concerned. It’s often preferable for technology companies to have a solid roadmap for their products that spans a multi-year horizon. Ask yourself why the company was bought out in the first place. Companies that are dealing with a merger or acquisition can become distracted from their true mission, which is providing innovative technology products. If you have more than three business cards with different company logos for your sales rep, you might want to start worrying. 4. Lack of open standards and interoperability: When reviewing a vendor’s technology solution, it’s important to understand how the various components can be put together. Over time, the ability of a

system to integrate with other hospital systems becomes more and more desirable. Proprietary solutions for storage or other systems architecture can force you into a complex configuration that requires multiple vendors and a high cost to sort out. Vendors that commit to open standards understand the value in flexibility and interoperability as you migrate and integrate systems over time. Proprietary interfaces mean higher cost, vendor lock-in and an inflexible environment for any changes. 5. Confining licensing model: It is difficult to expand and grow the use of your AI if your vendor is still in a per-user fixed seat license mode. Your vendor should understand AI is growing in use and that any model that restricts your ability to roll it out could damage your department’s reputation. Solid vendors offer cost-effective alternatives, such as site licenses, so that you can add users and grow over time. The days of being tethered to workstations should be over by now. 6. Internal vendor chaos: Does it seem like your vendor is confused depending on which company representative you talk to? Lack of corporate alignment may prove to be a good reason to shop the market. If it appears as though the engineering department is not talking to service, it may be a sign that the company is too big or unfocused and not getting good feedback from customers. If the only

ADVANCING THE IMAGING PROFESSIONAL

way to get a response from your vendor is by calling a senior executive, it may be time to move on. 7. No commitment to the IHE roadmap: IHE builds upon HL7, DICOM and other standards to help make them plug-and-play. If your sales representative looks confused when you ask for IHE requirements and asks you to spell it out for him/her, be very afraid. By now everyone in the industry should have heard of IHE and a sales rep that has never heard of it might be working for a vendor that is not very interested in best practices for integration. A commitment to participation in the IHE connectathon and a mention of IHE on the vendor’s website or mission statement can indicate a strong belief in the benefits of standards and interoperability. Be concerned if your vendor bases its business model on nickel-and-diming you with proprietary integration. 8. Poor system reliability or performance: If you click on a patient image, go to lunch, and return to find your image still hasn’t loaded, it’s time to look at another vendor. If your system is moving slowly now, imagine what will happen when you add that new multi-slice CT scanner. Your vendor should keep you in the slipstream of technology by introducing products with high-fault tolerance and limited points of failure. 9. You are buying AI hardware on eBay: If the technology stack to support the AI product is not compatible with your legacy information technology, it may be time to look for another vendor or upgrade your AI. Consider cloud-deployed solutions they have historically had great reliability. Remember that equipment failure rates increase with equipment age and repairing your older systems become more costly over time. You should not be forced to buy “new” computer equipment from your AI vendor that is no longer available in the general market. 10. Poor understanding of your needs: It’s important that vendors understand that your system should be able to grow, and change based upon your changing needs. New functions five years ago should become core functions today. Whether your hospital purchases a new CT scanner or adds a new imaging center, it’s nice to know that your vendor has a flexible cost and technology model in place to make things work. They say that 50% of marriages in the United States end in a divorce; mistakes are made in selection. Learn to make a better choice and spend time learning so that you can invest in a successful product and relationship with your imaging AI vendor. •

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Mark Watts is an experienced imaging professional who founded an AI company called Zenlike.ai.

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ADVANCING THE IMAGING PROFESSIONAL

INSIGHTS

THE SURPRISE POST THE ROMAN REVIEW MANNY ROMAN

received an email from LinkedIn informing me that I had been mentioned in a post by Michael Powers, MBA. CHTM, CDP, CMDA. My initial response was, “Oh, Oh, What did I do now?” The picture looked very familiar. However, when you get as old as I am, you have met everybody’s twin, maybe twice. I clicked the “Join the Conversation” button. I recognized Mike and remembered his face. Mr. Powers has been named to the prestigious AAMI Fellows Class of 2022. This recognition is not given lightly. The eight Fellows “have provided substantial service and contributions to the health technology field” and are recognized “for the depth and breadth of their accomplishments in seven core areas: professional experience, education, technical contributions, presentations and publications, professional participation, certification, and awards and honors.” Visit AAMI.org for additional information. On the post, Mr. Powers expressed how honored he is to receive the award and then proceeded to thank an elite group of industry professionals “…who have shepherded me along my journey … ” The named people have been enhancing the HTM industry since before it was named HTM. Then, I saw where I was mentioned. “Also, many thanks for the inspiration & encouragement to give back to the industry to Manny Roman at an MD Publishing Imaging Community Exchange conference in Indianapolis many years ago.” I truly was shocked. Many years ago is really many years ago. I have been relatively retired for over 10 years and attend few shows and conferences. I was so very pleased to have had a positive influence on such an accomplished individual. Then, it occurred to me that influence is in fact the correct word here. Influence does not cause things to happen. An

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individual uses and molds life’s sequence of influential moments and other resources to guide his future. Here is my response to his post: “Congratulations, Michael, and thank you for the kind words regarding our meeting in Indianapolis. As we progress through life, we encounter many opportunities to influence others and it is always gratifying to see them achieve great success. That said, it is they who put in the work to make it happen and they (YOU) who deserves the credit. Pass your influence on to others and enjoy your life. Continued success my friend.” So, I of course have some advice for the young and the old timers. Young people, pay close attention to those who came before you. Listen to their stories and advice and guidance. Look to be influenced in your path through this great industry. Actively seek out mentors and others who will be eager to enhance your understanding. Learn from their errors, however be sure to understand why they are errors and ascertain how to remedy them. You experienced people, pay close attention to those who will follow you. Seek to understand what drives them and how you can influence them to achieve success and even greatness in this rewarding industry. Tell them the stories. Tell them of the successes and the errors that have been made. Teach them how to make good decisions and hold themselves accountable for the outcomes. People talk about legacy. Legacy is what you leave behind: An inheritance of your experience, knowledge, attitude, understanding, caring, etc. Knowing that you shared it with others makes it all worthwhile. Leave others better for having known you. As for me, I am relatively content in my semi-retirement. Mike’s post enhanced that. He remembered my name. Most people now refer to me as, “Remember that guy, what’s his name, you know, Ruth’s husband.”• Manny Roman, CRES, is association business operations manager at Association of Medical Service Providers.

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ADVANCING THE IMAGING PROFESSIONAL

Science Matters

Where hydrogen fuel comes from

Vehicles using hydrogen gas for fuel are clean – releasing no carbon, but only water vapor as exhaust – and a fuel cell that consumes only hydrogen gas can generate electricity,

Many sources

A simple fuel H2

Two hydrogen atoms tied together (hydrogen gas) ...

react with oxygen (O2) to form water (H2O) and release heat

Four recipes for making it ELECTROLYTIC

THERMAL (Steam reforming)

Electric current splits water into oxygen and hydrogen

SCIENCE MATTERS

Electrolyzer

Most common method (95%) High-pressure steam reacts with methane or other hydrocarbon, producing hydrogen

Natural gas, methane Gases distilled from coal Diesel fuel, renewable liquid fuel Nuclear reactor by-products Biomass (gases from plant material) Renewable power (solar, wind etc.)

Reforming plant

SOLAR-DRIVEN

Sunlight

Oxygen

• Photobiological: Modified photosynthesis by bacteria or green algae

Fermenting container Water

Hydrogen

• Photoelectrochemical: Special semiconductors split water molecules

BIOLOGIC

Bacteria or tiny algae break down organic matter like biomass (plant material) or wastewater, creating hydrogen

• Solar thermochemical: Concentrated sunlight, metal oxides, break down water Truck runs on electricity generated from hydrogen gas in its fuel cell Source: US Department of Energy; TNS Photos Graphic: Helen Lee McComas, Tribune News Service

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ICEMAGAZINE

Imaging Jobs

NOW AVAILABLE htmjobs.com

“

Companies like ours have such a difficult time finding qualified candidates for field service roles that it just made sense to publish our opening with HTMJobs. – K. White, HR/Compliance Manager

”

LOOKING TO FILL A POSITION? Visit htmjobs.com/start-posting/ to post a job. Companies that post with us:

MXR Imaging, OSF Healthcare, First Call Parts, Associated Imaging Services, Medical Imaging Solutions, Renovo Solutions, TRIMEDX, Canon Medical Systems, Cal-Ray, Banner Health, Agiliti and Sodexo HTM and many more!

ICE2022 IMAGING CONFERENCE & EXPO FEBRUARY 20-22, 2022 • NAPA, CA

CT/MRI/PET-CT Field Service Engineer

Radiology Equipment Technician

Zone Support Specialist-CT

CT/MRI/PET-CT Field Service Engineers will travel and execute all required service requests, including repairs, planned maintenance, equipment de-installations and installations. Must have the ability to troubleshoot and accurately resolve technical issues with the use of laptop and other equipment. Must be familiar with CT/MRI/ PET-CT medical equipment. OEM or third party training/experience preferred

The Radiology Equipment Technician II (RADT II) performs scheduled maintenance and repairs of a wide variety of medical imaging devices & systems at multiple locations. Examples of these imaging devices & systems are; Portable radiographic, portable fluoroscopic, radiographic unit digital and conventional, radiographic/fluoroscopic digital & conventional Ultrasound, mammography, molecular imaging systems, bone density, etc

Provide modality-specific technical service support within a prescribed zone to Customer Engineers (CE) for resolution of complex customer situations. Recommendations and actions should be focused to drive the Zone to technical self reliance.

VIEW FULL DETAILS www.htmjobs.com

Imaging Service Specialist

Imaging Field Service Engineer III

Diagnostic Imaging Equipment Services Engineer II:

In your role as a Banner Health Diagnostic Imaging Equipment Technician II, you will work in a fast-paced, and rewarding environment with state-of-the-art technology that directly impacts the patient experience. We provide a robust orientation program to set you up for success. Opportunities for employee development include project and time management, temperament training, leadership academy topics, and vendorprovided technical training.

An Imaging Service Specialist (ISS) performs and documents planned maintenance and repair of medical diagnostic imaging equipment and associated systems with under the supervision from service management to perform the required duties. The ISS must demonstrate an advanced working knowledge of and ability to use the required test equipment and have the electronic and mechanical knowledge and skills.

The Field Service Engineer III is responsible for maintaining the customer’s high-end medical imaging equipment, including systems applications, quality control, calibration, operating system support, applications support, software support, technical support, and troubleshooting.

VIEW FULL DETAILS www.htmjobs.com

Imaging Service Engineer 1

Customer Support Engineer II MRI/CT

X-Ray Service Engineer

Under direct supervision, this person will inspect, repair, maintain, and calibrate basic diagnostic imaging equipment, devices, system, and instruments. Interact on a routine basis with other clinical health providers in the identification of technology-based problems. Participate in on-the-job training programs regarding technical, administrative, and customer service requirements.

The Customer Support Engineer II installs, inspects, troubleshoots, repairs, calibrates and verifies the performance of medical imaging equipment including, but not limited to: MR and CT systems, general radiographic rooms, portables, mammography, ultrasound, bone density and supporting equipment. MIS is looking to hire a multi-vendor MRI/CT and XRAY Engineer – preferred OEM would be Siemens / Toshiba. This is not an entry level role.

First Call Parts has been providing customers with quality replacement imaging parts since 2009. We pride ourselves in developing a top-notch reputation in the imaging industry as delivering the best in diagnostic imaging replacement parts. We specialize in the sale of refurbished/tested and used, Philips, Siemens, and GE in the Cath/Angio, R/F, and RAD modalities.

VIEW FULL DETAILS www.htmjobs.com

AMSP

AMSP MEMBERS Offering the best reliability and support in the medical industry, just for you.

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Expert Engineers. Complete Support. Exceptional Quality. Complete Customization. One Point of Contact.

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I M A G I N G

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care technology industry. Our large pool of modality specialists provide for lower costs and higher quality

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services for our customers throughout the U.S. Learn more at www.amsp.net.

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ADVANCING THE IMAGING PROFESSIONAL

X-R AY T UBES & P ARTS FOR M EDICAL I MAGING E QUIPMENT

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ICEMAGAZINE

INDEX

AHRA p. 43

ADVERTISER INDEX The InterMed Group p. 15

Association of Medical Service Providers (AMSP) p. 60

International X-Ray Brokers p. 54

AllParts Medical p. 15

KA Imaging p. 19

PM Imaging Management p. 53

p 47.

Avante Health Solutions p. 4

Metropolis International p. 22

KEI Medical Imaging p. 61

Ray-Pac® Ray-Pac p. BC

RIchardson Healthcare p. 47

Banner Imaging p. 3 KMG p. 22

CM Parts Plus p. 54

Diagnostic Solutions p. 49

Mammo.com p. 2

RTI Group North America p. 51

Summit Imaging, Inc. p. 39

Maull Biomedical p. 33

Technical Prospects p. 27

MIT Labs p. 45

TriImaging Solutions p. 5

SOLUTIONS

HTMJobs.com p. 58

ICE Webinars p. 63

Injector Support and Service p. 14 62

ICEMAGAZINE | JULY 2022

Medical Imaging Solutions p. 9

MedWrench p. 32

W7 Global, LLC. p. 61

X-Ray America, LLC p. 33 ADVANCING THE IMAGING PROFESSIONAL

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ICE Magazine July 2022

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In Focus

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