ICE Magazine April 2023

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FEATURES

EMOTIONAL INTELLIGENCE

Listening is definitely a learned skill, and people who master it tend to do better in life. But an equally valuable skill, especially for managers and leaders, is evaluating.

COVER STORY

The health of DEI initiatives – much like the health of the vulnerable populations at the fringes of broader health care access itself – hinges on commitment to meaningful change in its various forms, and providing the resources, both financial and otherwise, to achieve it.

RISING STAR

Tripler Army Medical Center

Noncommissioned Officer in Charge of Nuclear Medicine Richard Simpson was born in a small town in Alabama but grew up in Tacoma, Washington.

IMAGING NEWS

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

PRODUCT FOCUS

The PACS and RIS market is expected to reach $5.97 billion by 2029.

PACS/IT/AI

Design thinking is a humancentered approach to innovation that starts with what is desirable from a human point of view.

ICE2023

IMAGING CONFERENCE & EXPO

ICE ROCKS NASHVILLE

BY JOHN WALLACE

Music City has another hit on its hands –the ICE conference!

The 2023 Imaging Conference & Expo sold out early. The packed exhibit hall was just the beginning of the successful event hosted by MD Publishing. MD Publishing Vice President Kristin Leavoy, CMP, reported close to 450 people in attendance at the imaging conference with 80 exhibits.

“The 2023 Imaging Conference & Expo truly felt like a pre-pandemic event,” Leavoy explained. “Attendance was up, the exhibit hall had to be expanded to accommodate more vendors and the number of attendees in an imaging supervisor, manager or director role was higher than ever!”

“We turned a corner with this year’s event as we had several new attendees and vendors who decided to attend either because of the close proximity or because they hadn’t been to a conference in several years and wanted to get

back out and connect with colleagues,” she added. “It was so refreshing to see new faces!”

Representatives from companies echoed Leavoy’s sentiments.

“There seemed to be a lot more foot traffic then in previous years. We received a lot of great contacts,” USOC Medical’s Amy Hobbs said.

First-time attendee Earl Morris Jr. from Harrison County Hospital was blown away by the conference.

“It was way better than I could have imagined. I didn’t know what to expect to begin with but as soon as I got there, everyone was very welcoming,” Morris said. “I think there were many companies that provided a lot of insight about how they could help out. Being new to the industry, it was very helpful to make some connections.”

Imaging leaders appreciated the signature leadership summit and reverse expo.

“This year’s conference far exceeded my expectations, I left with ideas to build upon within my own departments and new imaging friends to bounce ideas off of. The vendor expo was a good mix of companies, and I was able to establish a few new rela -

“As it has in the past, I always walk away with suggestions and/ or contacts that I will immediately implement and others I will keep in contact with for future projects. 2023 did not disappointment”

Angelic Bush, MSRS, RT, FAHRA

FEBRUARY 17-19, 2023 • NASHVILLE, TN

tionships with companies I had never heard of before,” Director of Clinical Operations-Imaging Services Jessica Chambers, MHA, RT(R)(CT), said.

She said she left ICE with solutions she is ready to implement in her department.

“I have already been in touch with a couple companies,” Chambers said. “One booth gave me some great information regarding a new PET isotope and I am currently working on getting it added to my portfolio so we can offer this scan to our patients. I also was able to connect with a few companies that I currently am doing business with but never have met in person so it’s always nice to reinforce your business relationships in person.”

Angelic Bush, MSRS, RT, FAHRA, administrative director imaging services at The University of Texas Medical Branch at Galveston, agreed.

“As it has in the past, I always walk away with suggestions and/or contacts that I will immediately implement and others I will keep in contact with for future projects. 2023 did not disappointment,” Bush said. “I will be looking into my departments DNFB and also working with the vendors to have a contact for MR coil repair and they actually have loaners! So excited!”

“I found two vendors who not only repair MRI coils but will also send me a loaner while they are fixing it,” she added. “Also, there is a vendor who has a product that ‘cleans’ the electricity coming into my equipment. This is very important for my rural hospitals and my seaside hospital as I know the electricity is dirty.”

“I would tell them it’s a great conference to attend,” Chambers said when asked what she would tell someone thinking of attending an ICE conference. “Many imaging directors aspire to attend RSNA however the scale of that conference is so large it can be overwhelming. This is a more intimate setting that actually allows you the time and setting to connect with different leaders and companies that you will actually continue to benefit from when you return to work. While conferences are typically geared towards CEU credits and exhibit halls the biggest benefit in my opinion is the networking. ICE builds networking events into the conference and I think that is huge for us attendees!”

The 2023 conference’s success was also made possible because of the many sponsors who support the event. Sponsors included CM Parts Plus (show bags), Technical Prospects (Leadership Summit breakfast), Tri-Imaging Solutions (Leadership Summit dinner) and Tristate Biomedical Solutions (badge/lanyard).

Sunny California is the next stop for ICE. The 2024 Imaging Conference & Expo is scheduled for February in Irvine, California.

Morris has a message for anyone thinking about attending.

“Do it, you never know who you will meet, and it could help you with your current role at your organization,” he said. •

For more information, visit AttendICE.com.

LUIS A. CARVAJAL

FOCUS IN

Luis A. Carvajal, EdD, MPA, CMLSO, RT (R) (CT) (QM)

ARRT, holds a Doctorate in Organizational Leadership and Education. He is also a Florida Department of Health FL DOH Educational Provider. In the imaging world, Carvajal is the director of regulatory affairs for Jackson Health System–Miami Dade County Public Trust.

His career began thanks to a kind gesture from a college buddy.

“A classmate invited me to a radiology program open house while attending college in New York. Since I was about to complete college pre-medical requirements, I was informed by the radiology school counselor that I met the prerequisites needed prior to a mandatory entry exam,” Carvajal recalls. “Lo and behold, my radiology career started at Bellevue School of Radiology Technology in New York City.”

His successful career includes many accomplishments, but like many imaging professionals he ranks a more personal item as his top achievement.

“My greatest accomplishment is the day I married my wife, Jina, and becoming a parent. Thanks to my wife’s support, I have been able to achieve graduate and postgraduate

degrees,” Carvajal says.

“Regardless of accomplishments, family comes first. My family consists of my daughter, Melina, a high school student and a Jackson Health System volunteer during the summer. My daughter is fascinated with the world of ophthalmology. Ever since her first glasses prescription, she was amazed how ophthalmologists diagnose and treat eye and vision conditions. My wife is an elementary and preschool teacher. She prefers to teach preschool because it is the most critical years of a child’s life, language, motor and social skills,” he adds.

“In my professional career, first as an educator, I have been able to witness our radiology technology program graduates further their careers by becoming physicians, physician assistants, practitioners and nurses. Still, I get calls from the ones in radiology administration leadership positions to advise them on management issues, labor shortages and other problems,” he says.

Looking back, he is thankful for his college classmate and a career that he loves.

“As a health care leader, my number one priority is always toward patient safety and thus support, help and facilitate processes to build positive relationships across the organization.

Luia A. Carvajal is director of regulatory affairs for Jackson Health SystemMiami Dade County Public Trust.

I am grateful to regulatory affairs leadership for the willingness to help me whenever needed and thus allowing me to exceed my goals. Patient safety begins with care; to me care means creating a culture of safety and respect to build a healthy environment within an organization,” Carvajal explains.

His approach to leadership is molded after one of the great military minds.

“Robert E. Lee on Leadership: Executive Lessons in Character, Courage, and Vision’ was one of the first books I read in my graduate school journey. General Lee insisted on the desire to communicate with his commanders on a personal level and openly expressed concern, sympathy and acceptance of others,” Carvajal says. “My leadership approach is to connect positively and consistently with everyone all across the organization in a friendly way; always-offering help, always engaged, demonstrates eagerness to help in any situation. A leader is always open to learn from mistakes and find opportunities to make the organization better.”

“A leader has to demonstrate confidence in a skill, yet always be eager to learn,” he adds. “A leader needs to be humble; it does not portray arrogance relative to a skill level and is always eager to share knowledge with others. Col-

LUIS A. CARVAJAL

EdD, MPA, CMLSO, RT (R) (CT) (QM) ARRT

1. What book are you reading currently? “Generations” by Strauss and Howe is a book I have read and will be reading because of the evolution of the different generations and upcoming editions. The incoming medical-radiology workforce is comprised of Millennials and Generation Z, so as a leader one has to know the workforce diversity, racial diversity of Gen Z and Millennials as well as parenting trends that begin to adapt to a more racially diverse society. Nowadays our hospital system is having quarterly web conferences by bringing speakers or subject matter experts on management and society issues to provide insights on preparing us for the changing workforce and marketplace. The first one was Kim Lear, a writer and researcher who explores how emerging trends impact the future of our workforce and marketplace.

2. Favorite movie? ”The Addams Family.”” My daughter is a die-hard Jenna Ortega fan especially after the Netflix series “Wednesday.”

3. What is something most of your coworkers don’t know about you? I played professional baseball in the minors with the Saint Louis Cardinals right after high school for 3 years. I love baseball; I am a die-hard Yankees fan because of the proximity of New York-Columbia Presbyterian Hospital in New York City, a hospital I worked as CT-IR technologists to the old Yankee Stadium. My wife used to pick me up after work and then take the cross-town bus to the Bronx. Now living in Miami, I support the Marlins.

4. Who is your mentor? My mentors are Dr. Gary Danton and Senior Director of Regulatory Affairs Elvira Nasaysayan because both set clear expectations, and require and maintain accountability of self, the team, and other stakeholders to ensure goals are met. I have

leagues should seek out a leader and view him/her as open and willing to help others.”

When asked to look into his crystal ball and predict the future of imaging, Carvajal mentions technology and artificial intelligence.

“Technologies are becoming increasingly complex and increasingly interconnected,” he says. “Extreme cooling with liquid helium is essential for the operation of MRI magnetic coils. Nowadays a vendor introduced a magnet that requires only 0.5% of helium compared to conventional MR systems. Addressing helium shortage through innovation is key to secure the future for all MR patients.”

“In addition, today we have the first FDA-cleared portable magnetic resonance imaging (MRI) system capable of providing neuroimaging at the point of care,” he adds. “The imaging artificial intelligence industry presented at the recent RSNA annual meeting is growing by integrating AI into diagnostic imaging. For instance, AI can assist neuroendovascular surgeons pinpoint a patient stroke lesion from home prior to coming to a hospital and thus improve the efficiency and quality of care of a patient. Time is brain.” •

learned to lead by example by being open to receiving feedback to learn and grow. One has to learn to build positive relationships across the organization and collaborative decision-making among stakeholders with diverse backgrounds and interests.

5. What is one thing you do every morning to start your day? I pray every day before leaving for work and when I arrive back home.

6. What is the best advice you ever received? Put your emphasis and strengths in areas that one as a leader can control.

7. Who has had the biggest influence on your life? After my mother passed away during college, my godmother had the biggest influence on my life. She was there for me 24-7, always calling me and giving me advice about everything? Even after I married, my daughter and wife became her children. My godmother passed 4 years ago at the age of 104 years old.

8. What would your superpower be? Reading. I love to read. During my college years, I was accustomed in New York City during winter season to go to Barnes and Noble bookstore grab a book and a coffee and find a corner to sit. On Saturday nights, wait for The New York Times and Daily News Sunday paper delivery. I enjoyed William Safire’s Sunday Times Magazine crossword puzzle. The puzzle used to take me roughly a week to complete because it was a challenge?

9. What are your hobbies? My favorite hobbies are to ride my road bicycle along the Beach Boardwalk and long walks through any local park.

10. What is your perfect meal? My perfect meal is my personal smoothie composed of oatmeal, almond flakes, strawberry, blueberry, a scoop of peanut butter and almond milk. When in season, I grab a couple of mangoes from my patio instead of berries.

Rad idea

BY TED VANDERLAAN, J.D., R.T.(R), VICE PRESIDENT, STRATEGY AND INNOVATION: GURNICK ACADEMY

LAWS OF PERFORMANCE

Ip icked up my phone on the first ring as I saw it was my front desk calling. The strained voice on the other end, “Can you come down right away? We have a very upset patient who is about to throw a fit!”

When I came around the corner to the front desk, I saw a very agitated patient who was clearly unhappy. I smiled and reached out my hand to introduce myself and asked her if she would like to go somewhere where we could talk.

We sat down and I just asked her to tell me what was going on. I listened and acknowledged her frustration. Though unspoken, I knew she was embarrassed because part of the issue was caused by her.

She was doing exactly what made sense to her. Paraphrasing the first law in Logan and Zaffron’s, book “The Three Laws of Performance” is that people will always act according to how the situation occurs to them. This is true 100% of the time. Whenever someone does something that does not make sense to you, whether it is a patient, employee or co-worker, realize that their actions do make sense to them. If we take the time to be aware of this truth, then we can take the next steps to understanding them and resolving the situation.

Knowing this first law also lets us take out the judgment of the person whose actions are causing uncomfortableness at that moment. We must get out of our own head and step into theirs. In doing so we can understand the genesis of the issue.

The second law is how a situation arises in language. The patient’s frustration arose in language that the front desk person realized was going to turn into a fit if it was not addressed. “This place sucks”, “I would not bring my sick dog to your department”, “I would not send my worst enemy to this joint”, “You people are heartless.”

In this moment, we see the first two laws in all their glory.

After listening to her and really getting where she was, I had a decision to make. I excused myself and went to talk with my staff. We were booked that day. Could we possibly fit her in if we made an adjustment or two? The team put their heads together and made a plan. They could get her in within 45 minutes and she would have to wait.

Returning to our unhappy patient I started out by saying, “We have a plan.” Her face and shoulders immediately relaxed as she waited to hear the plan. We were able to get the next two patients finished quicker and could get her in in about 45 minutes. In the meantime, here is a coffee card that you can take downstairs and get something from the coffee cart in the lobby. She smiled. I had applied the third law. “Future-based language transforms how the situation occurs to people.” I painted a new future that completely transformed how the difficult situation occurred to her. It was not magic because I am not a magician. I cared enough to listen, to understand what her situation was and had the power to create a future that transformed how the situation occurred to her.

Whether engaging with a patient in your imaging department, a coworker or an employee, the application of “The Three Laws” is an effective way to guide you through difficult conversations and change the default future into a new future. First, as leaders, we need to step back and get that the person’s actions totally make sense to them. Then, we accept that and not judge them for it. From there we can realize the words they are using arise from how that situation occurs to them.  Finally, we have the opportunity to create a new future with language that actually generates a future for them to live into. It does take some time to develop these techniques and is well worth the effort! •

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RISING STAR

RICHARD SIMPSON

Tripler Army Medical Center Noncommissioned Officer in Charge of Nuclear Medicine Richard Simpson was born in Florala-a small town in Alabama on the state line with Florida. He moved across the country at a young age and grew up in Tacoma, Washington. ICE found out more about this rising start in a recent Q&A.

Q: WHERE DID YOU RECEIVE YOUR IMAGING TRAINING/EDUCATION?

A: Military Education Training Campus (METC) and Weber State University. Clinical phase: Madigan Army Medical Center (MAMC).

Q: HOW DID YOU FIRST DECIDE TO START WORKING IN IMAGING?

A: I was given three job offers within the military (LPN, radiology technologist and respiratory technologist). After reviewing each of the jobs I found that radiology had more interesting options that I wanted to get into.

Richard Simpson is a rising star in the imaging field who enjoys deep dives away from work.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR?

A: My greatest accomplishment within the imaging field is training new soldiers on anything imaging and passing down all the knowledge that I have gained within my 9 years of being a radiology technologist. I have had the pleasure of training over 100 students within my career.

Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS?

A: My goal for the near future is to challenge the ARRT and recomp on all my CT exams to attain my CT registry as well. •

Any place that has water to scuba dive in.

1 THING ON YOUR BUCKET LIST: Base jumping

SOMETHING YOUR COWORKERS DON’T KNOW ABOUT YOU: I still manage to keep up with my American Sign Language (ASL) skills, even being in the Army.

Clock Off THE

PAUL BENJAMIN, MBA, R.T. (R)

OPERATIONS MANAGER, RADIOLOGY AND PAIN MANAGEMENT, AHUJA AND BEACHWOOD MEDICAL CENTER, BEACHWOOD, OHIO

BY MATT SKOUFALOS

Throughout his childhood, Paul Benjamin spent many hours at his uncle’s house while his mother worked. Together, they would work, side by side, tinkering at the bench, building toys, dollhouses and various projects. Benjamin credits his uncle with fostering his sense of curiosity and an interest in working with his hands, which led to a lifelong love of woodworking, a career as an Air Force mechanic, and provided the skill set that underpins his work in the radiology space as well.

“I’ve always liked to tinker with my hands,” Benjamin said. “I started making stuff, and it just stuck.”

The first project he ever made, an end table, took a long time to complete, “and it was really, really basic,” Benjamin said. Nevertheless, he was so proud of his efforts that the table was a mainstay of the household, used forever “just out of pure stubbornness.” (It still lives in his attic, Benjamin said, because he still can’t bear to part with it.)

In the years since that first table, Benjamin has honed his skills many times over in a woodshop where his proficiency – and tool collection – accumulated over time. The garage workshop that he built when first married to his wife, Suzy, grew into the basement workshop that he enjoys today with the addition of dust collection systems. To the table saw, sanders and router with which he began his work, Benjamin added more at a rate of about one new tool per job, he said.

“Starting out, I was an x-ray tech,” he said. “I saved up

for a planer; probably got that five years into it. That does help quite a bit when you’re trying to build furniture.”

Choosing which projects to pursue typically involves sorting through friends’ requests.

“Someone will say, ‘Hey, can you make me this?’ ” Benjamin said. “I like figuring things out. I’ll have somebody send me a picture of what they want, and then I’ll figure out how to make something from nothing.”

When he’s building for himself, however, Benjamin’s focus is always on craftsman-style furniture. Hallmarks of the craftsman style in furniture are an emphasis on high-quality, functional work. Pieces typically feature precision joinery, carefully defined details, and the use of durable, upscale woods, like mahogany and cherry, Benjamin’s favorite wood to work.

“I like the way it smells,” he said; “I like the grain to it. It’s a hard wood, but it’s not so hard that it’s terrible to work with.”

From a woodworking perspective, “the old saying, ‘measure twice, cut once,’ ” is top of mind when employing the craftsman style, Benjamin said.

“You have to be very, very precise in setup, so when you start doing the cuts, you don’t waste a bunch of wood, especially with some of the nicer pieces,” he said. “It looks really nice, but it’s simple. It shows off the craftsmanship.”

Benjamin’s portfolio of finished projects includes patio sets, kitchen and living room tables, and built-in cabinets surrounding the fireplace in his own home. Most of his pieces feature finished edges, but he has made a liveedge, Maple slab desk for his son. Benjamin sources much of his wood from Amish lumberyards in the Northern Ohio region that he calls home, but he’s also completed

projects with reclaimed barn wood that’s more than a century-and-a-half old. They are “solid Maple, super-thick beams,” Benjamin said.

Not every project ends well: for as sharp of a table as he can fabricate, don’t ask Benjamin to make you chairs. “I’m just not good at it,” he said.

Comfortable with his limitations, however, Benjamin said the biggest benefit to his “sawdust therapy” is the release it affords him after long days as the operations manager for radiology and pain management at the Ahuja and Beachwood Medical Centers in Beachwood, Ohio.

During his day-to-day, Benjamin oversees the radiology and pain management departments at Ahuja and Beachwood as well as four satellite imaging centers. The network is also in the end stages of constructing a second, outpatient hospital within the next three weeks, and Benjamin has roles to play in the planning and execution of the project.

“If I have a rough day at work, sometimes just going down and starting to tinker on stuff, just putzing

around, is my release,” Benjamin said. “Lately with the project here at work, it’s not as often as I would like.”

Benjamin does appreciate the practical application of his woodworking skill set in the radiology world. The methodology of his approach to problem-solving and critical thinking in both environments complements the work he does in each.

“Woodworking gets you to think of things in a chronological, step-by-step order,” Benjamin said. “That translates very well with radiology capital projects, and even day-to-day operations. It just makes you think things through and create the steps. That’s the one thing that it has taught me that I’ve used for work.”

Once the capital project is completed, Benjamin believes he’ll have more time to dedicate to woodworking projects at home. His sons are

both enrolled in college, at Mount Union and Ohio University, respectively; and while they may not necessarily take up woodworking the way he has, the family does enjoy outdoor activities together, from kayaking to taking in the sunshine. •

Paul Benjamin says that his woodworking skills help him as an imaging professional because it teaches problem-solving and critical thinking.

Imaging News

A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

SAMSUNG INTRODUCES UPGRADED WOMEN’S HEALTH ULTRASOUND

Boston Imaging, the United States headquarters of Samsung’s digital radiography and ultrasound business, has introduced the HERA W10 Elite; the premier model of the HERA platform for obstetrics and gynecology that provides clinicians with a suite of powerful artificial intelligence (AI) tools and clinical applications to advance the diagnostic experience.

“Women’s health is a fast-growing field that requires state-of-theart equipment for patient care. The HERA W10 Elite will bring visionary change to Obstetrics and Gynecology with sophisticated image processing and an ergonomic-friendly design,” said Tracy Bury, women’s health ultrasound business leader, Boston Imaging.

The HERA W10 Elite may assist clinicians in receiving greater insight in diagnosis with its intuitive visualizations, precise analytic features and fast operation. The revolutionized system has also been updated from its predecessor in a variety of aspects, including:

• Advanced MV-Flow: To display the intensity of blood flow, it provides 2D and 3D visualization of microcirculatory and slow blood.

• Larger OLED Display: The display area has been increased by 57%, while the OLED screen realistically represents black colors making it well-suited for diverse ultrasound image characteristics.

New Transducer: The EV2-12 allows visualization of the fetal heart and brain starting at eight weeks endovaginally.

The system is also equipped with enhanced AI features, such as:

• HeartAssist: Provides measurement results and automatically classifies an ultrasound image into measurement views required for fetal heart diagnosis.

• ViewAssist: Automatically classifies ultrasound images and annotates the structures for convenient measurement (16 new views added).

• BiometryAssist: Enables clinicians to measure fetal growth parameters with a single click while maintaining exam consistency.

GE HEALTHCARE TO ACQUIRE CAPTION HEALTH

GE HealthCare has signed an agreement to acquire Caption Health Inc., a privately owned artificial intelligence (AI) health care leader that creates clinical applications to aid in early disease detection, using AI to assist in conducting ultrasound scans. With Caption AI applications, ultrasound examinations can be easier and faster, enabling a broader set of health care professionals to conduct basic echocardiogram exams. This technology can help detect signs of diseases like heart failure in at-risk patients across doctors’ offices, the home, and alternate sites of care, potentially preventing hospitalizations and supporting improved clinical outcomes.

GE HealthCare Ultrasound President and CEO Roland Rott said, “Guiding ultrasound users during examinations with the help of AI is of growing importance, especially as we reach a broader set of health care professionals. Caption Health’s AI applications help enable reliable, consistent ultrasound examinations to deliver more precise diagnoses, improved treatment decision-making and ultimately improved patient outcomes. This tuck-in acquisition will help expand affordable access to ultrasound imaging to novice users and is aligned with a broader shift to precision care globally.”

Caption Health CEO Steve Cashman said, “We are incredibly proud of the technology we have built and together with GE HealthCare, look forward to bringing this

technology to more patients across the globe. Combining our AI applications with GE HealthCare’s ultrasound devices will help accelerate our mission to detect disease earlier, when an easily obtained diagnostic image can be a great equalizer to health quality and outcomes. This will ultimately help us reduce costs and enhance care.”

Karley Yoder, chief digital officer, ultrasound at GE HealthCare, who will integrate Caption Health into the broader digital ecosystem of GE HealthCare, said, “We couldn’t be more excited to partner with the Caption Health team to increase access and accelerate growth of ultrasound. Caption Health will first be integrated in the point of care and handheld business portfolio to advance ultrasound adoption, with expanded future use cases as well.”

As part of this acquisition, Caption Health will continue to provide management and administrative services to affiliated medical services providers (collectively referred to as “Caption Care”). By providing trained technicians across the country equipped with the Caption Health AI technology to perform cardiac ultrasounds in alternate sites of care and, in the future, in the comfort of patient’s homes, Caption Care service is intended to support early diagnosis and detection before diseases like heart failure become more difficult to treat.

DIA SECURES FDA CLEARANCE FOR NEW AI-POWERED SOFTWARE

DiA Imaging Analysis announced that the U.S. Food and Drug Administration (FDA) has cleared LVivo IQS, a new AI-based vendor-neutral software solution that enables ultrasound users to acquire high-quality interpretable cardiac ultrasound images that can be used to make better clinical assessments of the heart.

High-quality cardiac ultrasound image acquisition can be challenging due to the constant motion of the heart and its deep location in the chest, as well as the user expertise that varies between ultrasound users and settings.

DiA’s new LVivo IQS - Image Quality Score provides real-time image quality feedback while scanning the left ventricle of the heart to assess the heart’s performance. The software uses colors and numerical scoring to indicate the quality level of the image as it is being scanned, helping users to produce optimal interpretable images for more accurate and reproducible analysis of the heart.

“LVivo IQS is the first of DiA’s 9 FDA-approved software solutions that empowers health care professionals with real-time feedback to enable the capture of high-quality ultrasound images,” said Hila Goldman-Aslan, CEO of DiA Imaging Analysis, “By harnessing the power of AI, our full suite of software solutions helps ultrasound users overcome two major challenges in the field – scanning high-quality images and accurately analyzing them. This holistic approach aligns with our mission of leveraging AI to make ultrasound image capture and analysis processes smarter and more accessible.”

The FDA cleared LVivo IQS following a clinical study that demonstrated its safety and efficacy. The results demonstrated high agreement between the LVivo IQS AI’s quality score feedback and the ability to obtain clinically interpretable images as evaluated by Cardiologist specializing in echocardiography. 91% of images saved by point-of-care residents using LVivo IQS, were found to be clinically interpretable images by the Cardiologist.

“For precise heart diagnosis and treatment, high-quality cardiac ultrasound imaging is necessary in both point-of-care and other settings,” said Dr. Lior Fuchs, senior intensive care physician at Soroka Medical Center in Israel and principal investigator of the LVivo IQS study. “LVivo IQS AI software will assist us in obtaining faster and clearer images to aid our real-time clinical decision-making process.”

STUDY LOOKS AT AI AND NLP

The study “Clinical Implementation of a Combined AI and NLP Quality Assurance Program for Pulmonary Nodule Detection in the ED Setting” was recently highlighted in JARC.

The stated objective reads, “This quality assurance study assessed the implementation of a combined artificial intelligence (AI) and natural language processing (NLP) program for pulmonary nodule detection in the emergency department setting. The program was designed to function outside of normal reading workflows in order to minimize radiologist interruption.”

The study’s results were as follows:

“Out of 19246 CT exams, 50 exams (0.26%) resulted in

secondary review. 34/50 (68%) reviews resulted in addenda. Of the 34 addenda, 20 patients received instruction for new follow up imaging. Median time to addendum was 11 hours. The majority of reviews and addenda resulted from missed pulmonary nodules on CT exams of the abdomen and pelvis.”

In conclusion, “a background QA process utilizing AI and NLP helped improve the detection of pulmonary nodules and resulted in increased numbers of patients receiving appropriate follow up imaging recommendations. This was achieved without disrupting in-shift radiologist workflow or causing significant delays in patient follow for the diagnosed pulmonary nodule.”

STUDIES: ENHANCED ULTRASOUND SUPERIOR TO MRI FOR DIAGNOSING CERTAIN LIVER AND KIDNEY TUMORS

Contrast-enhanced ultrasound (CEUS) is more accurate and reliable than MRI for examining certain liver and kidney nodules, according to two new studies published in the Journal of Ultrasound in Medicine (JUM) and highlighted by the International Contrast Ultrasound Society (ICUS).

“We found that CEUS is a better and less expensive first-step evaluation for newly discovered liver nodules,” said Dr. Stephanie Wilson, principal investigator of the liver CEUS study, which followed 196 patients at the University of Calgary for two years. Wilson is a clinical professor of radiology and gastroenterology at the University of Calgary and co-president of ICUS.

“CEUS found malignant or pre-malignant diagnoses that would likely have been missed or delayed if we had not used CEUS in these patients,” according to Wilson.

“In addition, CEUS quickly and reliably identified benign lesions and pseudo-lesions, sparing these patients the costs and risks associated with unnecessary downstream testing and procedures,” she added.

This study shows that CEUS scans are at least equivalent if not superior to MRI for evaluating these liver lesions, and CEUS should be the first investigation for nodules found on surveillance for liver cancer, according to Wilson.

She called upon the American Association for the Study of Liver Diseases (AASLD) to include CEUS in its liver imaging guidelines, along with MRI and CT.

Meanwhile, an Ohio team reviewed clinical data over a 10-year period to assess the accuracy of CEUS diagnoses of benign kidney nodules in 341 patients. Their blinded analysis found that none of the CEUS diagnoses changed during that period.

“Our data confirm that when CEUS determines a kid-

ney mass is benign, the mass is benign and no further follow up is needed – sparing the patient from unnecessary downstream tests, anxiety and costs,” according to Dr. Richard G. Barr, the lead author of the kidney CEUS study. Barr is a professor of radiology at the Northeast Ohio Medical University and treasurer of ICUS.

CEUS is a non-invasive imaging tool that is safely and routinely used worldwide to help identify and characterize cancers, diagnose heart and vascular disease, monitor chronic gastro-intestinal diseases and monitor therapy.

Ultrasound contrast agents are administered intravenously to enhance the images produced by ultrasound scans, allowing for visualization of abnormal microvascular blood flow patterns in real time.

“It is important to remember that ultrasound contrast agents do not contain iodinated dye and do not harm the kidneys, making CEUS the examination of choice for patients with renal insufficiency,” according to Dr. Barr.

“In addition, CEUS allows for improved visualization of enhancement patterns in real time, the thin slice thickness of CEUS allows for evaluation of small nodules, multiplanar imaging allows for improved visualization and confirmation of enhancement, and multiple doses may be used during the same examination to provide an opportunity to image the lesion thoroughly,” Dr. Barr said.

Since kidney masses are often found on imaging for other indications, CEUS offers an essential imaging option because it is safe, accurate, low-cost, radiation-free and can help these patients avoid additional unnecessary tests and surgery, he added.

CHEST CT SHOWS LUNG ABNORMALITIES TWO YEARS AFTER COVID

Chest CT revealed persistent lung abnormalities in patients two years after COVID-19, according to a study published in Radiology , a journal of the Radiological Society of North America (RSNA). This is the first research paper with two-year follow-up data on COVID-19 lung effects.

Globally, more than 600 million people have recovered from COVID-19, but concerns remain that some organs, especially the lungs, may suffer long-term damage after infection.

Qing Ye, M.D., and Heshui Shi, M.D., Ph.D., from Tongji Medical College of Huazhong University of Science and Technology in Wuhan, China, and colleagues set out to assess residual lung abnormalities in patients up to two years post-COVID-19 pneumonia. They also looked at the correlation between residual lung abnormalities and changes in lung function.

In this prospective study, 144 patients (79 men and 65 women, median age 60) discharged from the hospital after SARSCoV-2 infection between January 15 and March 10, 2020, were included. Three serial chest CT scans and pulmonary function tests were obtained at six months, 12 months and two years after symptom onset.

Residual lung abnormalities after discharge from the hospital included fibrosis (scarring), thickening, honeycombing, cystic changes, dilation of the bronchi and more.

Over two years, the incidence of lung abnormalities gradually decreased. At six months, 54% of patients showed lung abnormalities. On two-year follow-up CT scans, 39% (56/144) of the patients had lung abnormalities, including 23% (33/144) with fibrotic lung abnormalities and 16% (23/144) with non-fibrotic lung abnormalities.

“In particular, the proportion of fibrotic interstitial

lung abnormalities, an important precursor to idiopathic pulmonary fibrosis, remained stable throughout follow-up,” the authors said. “Therefore, the fibrotic abnormalities observed in our study might represent a stable, irreversible pulmonary condition, such as lung fibrosis, after COVID-19.”

The remaining 88 cases (61%) showed no abnormalities. Patients with lung abnormalities on CT were more likely to have respiratory symptoms and abnormal lung function. The proportion of individuals with respiratory symptoms decreased from 30% at six months to 22% at two years.

At two-year follow-up, the most common respiratory symptom was exertional dyspnea or shortness of breath (14% [20/144]), while mild and moderate pulmonary diffusion—which refers to how well the air sacs in the lungs are delivering oxygen to and removing carbon dioxide from the blood in the tiny blood vessels that surround them—were observed in 29% (38/129) of patients. Pulmonary diffusion was regarded as abnormal when diffusing capacity of the lung for carbon monoxide was less than 75% of the predicted value. The researchers suggest that persisting residual symptoms and abnormal lung function could be related to the patient’s ongoing lung damage.

“Long-term and functional consequences of chest CT findings post-COVID-19 are largely unknown,” the authors said. “Our prospective study found that 39% of participants had persistent interstitial lung abnormalities at two-year follow-up, which were associated with respiratory symptoms and decreased diffusion function.”

The authors advise that patients with residual lung abnormalities or respiratory symptoms after COVID-19 should be followed up to detect and manage pulmonary changes and functional impairment.

Serial transverse CT scans in a 67-year-old man with moderate COVID-19. (A) CT scan obtained on day 10 after onset of symptoms showed bilateral mixed pattern of ground-glass opacities and consolidation (*) in both lower and upper lobes. (B, C, D) Images obtained at 6-month, 12-month and 2-year follow up, respectively, showed persisting subpleural, bilateral linear, and curvilinear bands (white arrows) in both the lower and upper lobe. This patient did not report residual respiratory symptoms and had normal diffusing capacity of the lung for carbon monoxide (85%) at 2-year follow up.

BRACCO ANNOUNCES VUEWAY TRIAL

Bracco Imaging recently announced that Wellstar Health System is among the first establishments in the nation to trial VUEWAY (gadopiclenol) injection, a recently FDA-approved macrocyclic gadolinium-based contrast agent (GBCA) for use in magnetic resonance imaging (MRI). Gadopiclenol needs only half the dose compared to other GBCAs in approved indications in the U.S. to accomplish the same image clarity due to the fact that it has the highest relaxivity of all GBCAs compared to approved GBCAs.

“We are honored to stand alongside these prestigious leaders of the medical community for the first VUEWAY injections, after FDA approval,” said Fulvio Renoldi Bracco, vice-chairman and CEO of Bracco Imaging. “We’re particularly excited about our innovations in contrast imaging because of the wide-reaching impact across disease categories with 30 million MRI scans conducted annually, globally. That these institutions have prioritized offering VUEWAY injection, a novel next-generation MRI contrast agent, reinforces the potential value VUEWAY injection will provide in patient care and diagnostics.”

VUEWAY (gadopiclenol) injection received FDA approval on Sept. 21, 2022, for use with MRI in adults and pediatric patients aged two years and older to detect and visualize lesions in the central nervous system (brain, spine, and

associated tissues) and the body (head and neck, thorax, abdomen, pelvis, and musculoskeletal system).

Two recent Phase III trials sharing similar methodologies and endpoints demonstrate the efficacy and safety of gadopiclenol in MRI of the CNS (the PICTURE trial) and of the body (the PROMISE trial). Combining study populations, over 500 individuals had MRI scans compared when done with gadopiclenol at half the dose of a conventional agent, gadobutrol, at full dose. Even with the lower dosage, blinded readers rated gadopiclenol scans as having comparable image quality.

VUEWAY injection is manufactured in the U.S. by Liebel-Flarsheim Company LLC in Raleigh, N.C. VUEWAY injection is approved for use in adult and pediatric patients aged 2 years and older with magnetic resonance imaging (MRI) of the CNS ((brain, spine, and surrounding tissues) and the body (head and neck, thorax, abdomen, pelvis and musculoskeletal system). •

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Market Report

STUDY: GLOBAL PACS, RIS MARKET TO GROW

In a Transparency Market Research Inc. study, in 2018, the global PACS and RIS market was worth $2.63 billion and 42,874 units based on volume. The global market is likely to rise at 5.3% compound annual growth rate (CAGR) during the forecast period, from 2019 to 2027. Increasing government demand for product digitalization and growing health concerns are expected to drive the future market outlook for PACS and RIS.

Governments all around the world are promoting the use of PACS and RIS for thorough and precise analysis of a patient’s health since they understand the value of health care IT. The handling of a large volume of patient data and openness in the medical insurance claim procedure are all improved by health IT systems in addition to user friendliness. The U.S. Government promotes the use of hospital information systems as well as other health care IT technologies in hospitals.

EMR systems are becoming more widely used in both office-based and hospital-based practices. PACS and RIS are in greater demand since they enable electronic storage of medical images. The RIS and the PACS for the caregivers are effectively ensured that the images are accessible electronically.

The PACS manages, obtains, stores and transmits the medical pictures. It is used to communicate and show diagnostic pictures in the field of radiology. The RIS records billing data and orders for radiological imaging. It is used in conjunction with PACS and vendor-independent archives (VNAs). RIS manages image files, invoicing and documents. In the years to come, it is projected that the rising popularity of this technology will encourage expansion of the PACS and RIS market on a global scale.

The need to incorporate images of patients with health information sharing networks and electronic medical records is anticipated to offer the global PACS and RIS market a significant boost in the coming years.

The most recent industry innovation is cloud-based PACS

solutions, which is expected to account for a considerable market share for PACS and RIS. In the coming years, it’s expected that they will emerge as one of the most popular products available. It is also expected to account for the largest revenue share in the PACS and RIS market during the forecast period.

PACS and RIS are being utilized increasingly often in a range of health care areas and for high-value categories including cardiology, orthopedics and oncology. PACS and RIS market demand analysis estimate such extensive use of these systems is likely to work in favor of the global market.

Maximize Market Research (MMR) also predicts market growth.

The PACS and RIS market was valued at $3.42 billion in 2021, and it is expected to reach $5.97 billion by 2029, exhibiting a CAGR of 7.23% during the forecast period 20222029, according to an MMR report.

“The global PACS and RIS market is primarily driven by increased investments in automation and digitization in the health care industry. Increased demand for digital images such as X-rays, MRI, ultrasonography and digital pathology is a major driver, as picture archive and communication (PAC) allows for easy access and low-cost storage of digital images,” according to MMR. “PACS provides low-cost access to a variety of source modalities, including computed tomography, positron emission tomography and plain X-Ray film. The benefits of PACS over traditional picture storage, display and distribution, such as time savings and digitization, have enhanced the demand for PACS across the health care business.”

“The PACS has a wide range of uses in diagnostic centers, clinics and hospitals since it allows for easy digital image storage while removing the need for hard copies. During the forecast period, the market is likely to benefit from rising government and corporate investments in digitalizing health care systems to reduce costs and boost profits,” MMR states.

“Furthermore, the need for RIS and PACS among health care workers is being fueled by remote access via smart phones. In the coming years, the market is likely to be driven by rising government spending in the building of strong IT and telecommunications infrastructure,” according to the report. •

STAFF REPORT

Product Focus

PACS and RIS

VIZ.AI

Viz Radiology Suite

Viz.ai has announced the introduction of an AI-powered radiology suite, specifically designed to alert the radiologist in their workflow of suspected diseases, prioritize worklists and connect care teams in real-time. The Viz Radiology Suite integrates into the picture archiving and communication systems (PACS) of health care organizations to securely facilitate access to imaging data across departments and streamline patient diagnosis. The Viz Radiology Suite provides a mobile and web image viewer with AI-powered notifications directly to the worklist, and integration with PACS, enabling efficient care coordination. Furthermore, Viz.ai provides a wide range of FDA-cleared algorithms across neurovascular, vascular and cardiology diseases.

SECTRA PACS

The first Sectra PACS installation was in Sweden in 1993 and now, the company has more than 2,000 sites worldwide. The radiology module is an integral part of Sectra’s enterprise imaging solution, also comprising VNA and imaging modules for cardiology, orthopedics, ophthalmology and digital pathology in one single system. The radiology module, Sectra PACS, has been named “Best in KLAS” for the ninth consecutive year in the U.S., third consecutive year in Canada, and for a first-time in Asia/Oceania.

ROYAL PHILIPS Vue Motion 4

Philips Enterprise Viewer – Vue Motion –won KLAS Research’s “2022 Best in KLAS Universal Viewer (Imaging)” award. The Philips Enterprise Viewer module eliminates the need to download software for medical data or image viewing. The viewer can be embedded in the EHR and patient portal to enable authorized users across the enterprise to quickly and easily view patient data and images with a single log-in. It can be integrated with industry standard DICOM archives or XDS repositories to ensure clinicians have access to current or prior images, reports, video and waveforms studies and other patient data whenever and wherever needed.

INTELERAD IntelePACS

IntelePACS brings simplicity and scalability to complex environments, providing a robust platform for storing, retrieving and routing medical images for high-volume, disparate organizations. Combining secure communications and compression technology, IntelePACS maximizes productivity and security, enabling greater patient care. Highly customizable and known for its interoperability, IntelePACS is available in the cloud to elevate productivity, security and agility.

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BROADENING VIEWS

Diversity, Equity and Inclusion in the Imaging Space

BY MATT SKOUFALOS

Across America, the past few years have seen the social and cultural issues related to diversity, equity and inclusion (DEI) elevated to a prominence comparable to the Civil Rights era of the 1960s. Institutions from law and government to business, athletics, the arts – and, of course, health care – have all striven to address long-held assumptions and implicit biases within their work.

In a June 22, 2022 article from the Harvard T.H. Chan School of Public Health, Katherine J. Igoe noted “an explosion of organizations creating DEI offices, equity officers and other commitments to formal improvement.” What’s more meaningful than their establishment itself, Igoe wrote, is laying the groundwork for their sustainability.

“But beyond this important moment, where organizations see this as a hot-button issue worth paying attention to, how are these groups or individuals set up — or not, as the case may be — for actual success?” Igoe wrote. “How have they been integrated into an organization? Is their work sustainable in the long term and, if so, what are effective predictors of success? Are adequate resources being allocated?”

In many instances, the health of such initiatives – much like the health of the vulnerable populations at the fringes of broader health care access itself –hinges on commitment to meaningful change in its various forms, and providing the resources, both financial and otherwise, to achieve it.

As the DEI chair for the Association for Medical Imaging Managament (AHRA), Karen L. Stewart, senior clinical applications analyst in the IT department at Penn Medicine/Princeton Health, said her committee is working to help communicate the importance of diversity, equity and inclusion in the medical imaging space by relating experiences from their distinct, individual backgrounds.

“We’re trying to come up with ways to put personal spins on these issues,”

Stewart said. “We want to have everybody treat everybody with respect and dignity. We’re trying to promote kindness, and to take everyone as an individual and not as a class.”

“I like being able to make things show up on X-rays that you wouldn’t know are there by just looking at a person,” she said. “You should be curious about other people. You should want to know traditions, or something about them, because it will help you understand them better. That’s really what we’re trying to do right now: understand how somebody’s feeling who isn’t treated the same way. You’re there providing a service for them; you need to let them know how you are doing the things to make them better.”

“We need to go to the uncomfortable spot,” she said. “What we’re trying to do is get people to understand that DEI is not a race thing, it’s not a sex thing, it’s not a kid and an adult thing. It’s about being nice to people and respecting them. And if you show the respect, you get the respect.”

Adopting a culture of inclusivity is particularly critical for a segment of health care that not only needs to diversify, but also has been losing professionals at an unsustainable clip, like so many other pieces of the global economy during the Great Resignation. A February 2022 message in the American College of Radiologists Bulletin described a radiology labor shortage owing to professionals aging out of practice, enduring high rates of burnout, and only half of radiology, radiation therapy, and nuclear medicine training programs at full enrollment.

“RTs are becoming a rate-limiting factor for many of our practices,” ACR Board of Chancellors Chair Howard B. Fleishon wrote. “In discussions with our allied health partner societies, some contributing factors include wages, concerns about safety during the pandemic, limited advancement opportunities, and a lack of respect and support compared with nurses and other health care workers. Clearly, we can and should do more to help support our valued allied health colleagues.”

To Stewart, the opportunity to engage on the basis of cultural differences represents a departure from the kinds of interactions that professionals were coached to have in the workplace even a few years ago. Expressions like, “I don’t see color,” which at one time may have been a sanitized attempt to express an absence of bias, have become viewed as examples of cultural erasure rather than inclusion.

“What it would mean is ‘I won’t treat you any differently,’ ” Stewart said; “what I’m finding is. I probably did, and didn’t realize it.”

Stewart believes that one key to bringing more young people into careers in medical imaging and its paraprofessional fields is finding ways to connect with them by telling authentic and personal stories about how medical imaging offers a career that matches their individual needs.

“When it came time for me to go to school, my parents said to me, ‘We’re sending your brother to school because he’s the man, and he’s going to take care of the family,’ ” Stewart said. “I chose to go to X-ray school and got my associates and bachelor’s degrees at night. This was a career that allowed me to be a mother as well as a professional. What people don’t understand is when they’re needed,

“What we’re trying to do is get people to understand that DEI is not a race thing, it’s not a sex thing, it’s not a kid and an adult thing. It’s about being nice to people and respecting them. And if you show the respect, you get the respect.”

- Karen L. Stewart

how they’re needed and how you can accommodate a work-life balance.”

Gail C. Christopher, D.N., executive director of the National Collaborative for Health Equity, said that the way to end health inequity involves understanding its connections to environmental and social conditions in America – which, given the distinct history of the country, “have a long legacy in racial hierarchy.” The Collaborative works to build coalitions to address that legacy of inequity, as well as leveraging research, data and information systems to reframe discussions of health inequities, from documentation to developing quantifiable goals for closing those gaps.

The hallmark project whereby the Collaborative works to achieve those goals is called the Health Opportunity and Equity (HOPE) Initiative, which uses interactive data tools to track social determinants of health and health outcomes by race, ethnicity and socioeconomic status.

“What’s unique about HOPE is that it has a framework of what you need to do to make things better,” Christopher said. “We wanted to see if local communities can take a data-driven approach and recognize what it takes to achieve goals. They were able to make changes in areas of environmental justice and access to housing.”

By designing the framework of the HOPE Initiative to be broad, it has been able to be adopted in a variety of environments, from college campuses to various professional organizations to neighborhoods and municipalities, Christopher said.

The greatest aim of the Collaborative, however, and the one that requires the most inertia to implement, is what Christopher called “a Truth Process for

America,” which would parallel reconciliation work done in 45 other countries across the globe “to grapple with our centuries of enslavement of people.”

“Some people say slavery has existed since antiquity, but we were the first nation to both racialize enslavement and maintain it for consecutive centuries,” Christopher said. “We really need to come to grips with that as a society, and not view its legacy today as if it has nothing to do with the past.”

top level of the organization, there has to be this collective commitment to say, ‘We want to change these outcomes and patterns because they’re grounded in the legacy of racism.’ ”

To get there requires diversifying institutional leadership, building systems of accountability within individual organizations and the field of medicine more broadly, and maintaining a commitment to continuous improvement on these very deeply rooted issues.

“In the moment right now, there’s a tremendous investment in inequity and every federal agency has been mandated to look at their work, and come up with a plan to do something about it, but it could all disappear in two years,” Christopher said. “We have to reach the broader community. We have to change the way of thinking and feeling about one another, and we have to see that it’s all in our mutual interests to do this work.”

Taking on such a transformative process relies on a handful of principles, including narrative change, racial healing and relationship building. Christopher believes that “by making a deep connection to our common humanity,” it is possible to explore how hierarchies of human value are institutionalized in segregation that exists in legal, economic and criminal justice systems.

“The question is, how do we mitigate these structural realities?” she said.

“I think we have to be honest about these realities, and then decide what do we do to reduce the risk of mistrust or stereotypes. We have to be willing to analyze our patterns in institutions. Physicians have to go through some training and awareness, and you have to put systems in place within the organization for checks and balances. At the

Most critically, she said, the work of repair begins with an inward-looking eye towards healing the self.

“We can’t relate to others in ways that exceed the way we relate to ourselves and our self-worth,” Christopher said. “That’s why the strategy is grounded in lifting people up rather than tearing them down. If you don’t have a grounded self-concept, you’re not going to see others as having value either. You build relationships, you build trust, you lift up everyone in the process, and you’re able to see the collective benefit. If America’s going to work as the beautiful experiment that it is in self-rule, we’ve got to do this work.”

Carla Brathwaite, DEI program manager at ACR, and team lead of the Radiology Health Equity Coalition, said organizations like hers are working to address issues of injustice and racism

“A more diverse health care workforce population improves the quality of care for all.”

- Carla Brathwaite

in health care that are microcosmic of comparable disparities in the world at large. During the novel coronavirus (COVID-19) pandemic, when the health care system was overwhelmed and under-staffed, the social protests that erupted with the death of George Floyd at the hands of Minneapolis police also provided a backdrop for the disparity among Black and Latin Americans – groups that sustained a disproportionately higher rate of death from COVID than other Americans did.

In response to these conditions within the field of health care and society at large, the Coalition was

screening and support their patients.”

Among health professionals, DEI concerns overlap with those related to the delivery of care and health equity at large. Beyond improving access to care, DEI involves addressing broader community issues – things like cultural competency, socioeconomic barriers, food deserts, imaging resources in safety net hospitals. Approaching issues such as these, even as well-understood as they are, can be daunting to contemplate. To Brathwaite, the solutions lie in forming critical community partnerships involving experts in nonprofits and other industries.

collaborative approach instead of working in silos. Small wins lead up to big wins.”

Wins, to Brathwaite, can be seeing improvement in health outcomes for specific patient populations, getting more patients to follow up on appointments, or increasing screening rates among high-risk groups. Making connections with community health organizations so that radiology practices can get their hands on those populations that have been medically underserved? That’s a win, too. She argues for the business case behind implementing community

convened by members of various entities within the imaging world.

“We honed in on patient care and increasing access to medical imaging, radiological care and radiation oncology therapies in underserved populations,” Brathwaite said. “In asking what can we do to support underserved communities, we created a roadmap and resource guide on how to partner with community health organizations. We’re fairly new, but there’s more work to do. We will continue to raise awareness, build partnerships and network to support community health organizations that want to build access to

“We don’t have to fill every role,” she said. “Partnerships are really the only way. If you get into the web of school districts being under-resourced, we can’t solve that problem, and we definitely can’t solve it on our own, but how about we partner with organizations that are more adept at working with vulnerable populations?”

“We can handle making sure our standards are up to par, making sure the quality of imaging is consistent, and holding ourselves accountable for the delivery of care, wherever that care is delivered,” she said. “The approach that we should take is a

health outreach workers in hospitals and departments as being the same for that of partnering with outside organizations: it strengthens the relationships that drive the delivery of care to those who most need it.

“We’re looking for ways of engagement,” Brathwaite said. “Individual professionals can make sure that we’re up to par with our training cultural competency – how you deal with different populations, language barriers, accessing a diverse set of patients. A more diverse health care workforce population improves the quality of care for all.” •

Karen L. Stewart, AHRA DEI chair, senior clinical applications analyst in the IT department at Penn Medicine/ Princeton Health

Carla Brathwaite, DEI program manager at ACR, and team lead of the Radiology Health Equity Coalition

Gail C. Christopher, D.N., executive director of the National Collaborative for Health Equity

BY BETH ALLEN DIRECTOR’S CUT

DISCOVER ONE’S REAL COLORS

Pretty early in the life of a newly created Banner Imaging, our CEO had our senior leadership team participate in a Real Colors workshop. This workshop uses a personality type test that identifies where you fall in regard to four “color” profiles. According to the realcolors.org website, this information can be used to “understand human behavior; uncover motivators to each temperament and improve communication with others.”

There are four personality types common to all people – Gold, Green, Blue and Orange.

Our workshop guide explained these types using an analogy of the implementation of the space program.

Gold is for the executives in charge of the program. Responsible, organized, respect the rules.

Green is for the engineers that will get the details right. Logical, analytical, focused.

Blue is for the media that will share the news. Emotionally driven, creative, enthusiastic.

Orange is or the astronauts. Adventurous, competitive, welcomes change.

It all starts with a small booklet with a series of tests that will help identify which color traits are most prevalent to each individual. Of course, we all have a little bit of each color but usually one or two are more dominant. The workshop presenter helped us understand each of the colors better. We split into groups based on our dominant color and it was hysterical to see how we all performed the tasks we were asked to do exactly as we would be expected to.

We had to make lists of qualities each group found important. The gold group put those lists in two organized rows, basic and to the point. The green team was very specific, and the answers were not always as expected. The blue list was all over the paper – not really in a list. All the different colors of markers were used and I believe there were a few “i”s dotted with a heart. The orange team was quick to complete the task. I just remember that it involved something about most likely to jump out of a plane.

We did this again for our extended leader team. It has been very beneficial to understand which color each of these leaders identify with. This is helpful when trying to assign projects. Who has the skills that will get this to the done bin the most efficiently? We know better what to expect from each other. We understand why someone may react in a certain way. It also helps to identify the colors of our team members and what each individual needs from their leader to be successful.

Our health system has found benefit in this program to help encourage better communication and collaboration. Some of us have a banner beneath our email signature to help those we are communicating with understand which color we are so we can find a way to work together more efficiently.

We are getting ready to send another group of emerging leaders through this training. I love to guess which color someone is prior to training and then find out if I am correct. So far, I have usually been right.

To be successful, we need all the colors. Think back to the space program analogy. All parts of that team are important, and we are not all cut out for each of those jobs. Thank goodness that our team has “gold” people to manage the spreadsheets and it isn’t left to me. Not that I can’t do it if I must. I just won’t like it. I am blue, followed by orange, then green and not a lot of gold. I am not your spreadsheet person.

I will handle the “people” stuff. I am sure that has been apparent in these columns. I do think this training has been a big benefit to our team, especially when we were putting together a new company. We still discuss the color types, and it has been three years since we did the training. We are investing in this workshop for our new leaders to equip them for success. It is presented in a dynamic, entertaining format and definitely worth the time. I recommend you check out the website for more information. Thanks for all you do! •

Beth Allen, RT(R)(CT), CRA, is the director, clinical operations at Banner Imaging.

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CODING & BILLING

BY MELODY W. MULAIK

PHE IS OVER –NOW WHAT?

After three long years, the COVID-19 public health emergency (PHE) will officially end on May 11, 2023. This ending begins the transition back to many pre-COVID regulations, some go into effect immediately on May 12, while others will phase out at the end of 2023 or 2024. To assist in understanding which waivers and provisions are ending, changing or remaining, the Centers for Medicare and Medicaid Services (CMS) has begun to release updates to their extensive frequently asked questions (FAQs) document. Most of the waivers and provisions don’t impact radiology services but there are a few that should be reviewed, as they may impact your organization.

The biggest area of impact for radiology relates to the relaxation of direct supervision requirements. To account for physicians who may have been covering areas due to quarantining, the overwhelmed health care system due to high patient volumes, and limited physicians to supervise, CMS allowed for direct supervision of diagnostic tests, physicians’ services which included services provided incident to in the office setting, and some hospital outpatient services, to be provided using real-time audio/video capabilities. CMS reiterated in the CY 2022 Medicare Physicians Fee Schedule (MPFS) final rule, on December 31 of the year the PHE ends the physician will be required to be physically present to meet the direct supervision guidelines as they were prior to the public health emergency. In short,

this means that unless CMS makes a regulatory update this year, effective January 1, 2024, direct supervision must be provided in accordance with the guidelines that were in effect prior to the PHE. There is the potential that CMS will address this issue during the CY24 rule making process so be on the look out for information and updates.

Another factor that impacts the relaxation of current guidelines is the Consolidated Appropriations Act of 2023, the government budget for the year, that was signed into law on December 29, 2022. This Act contains several provisions regarding the end of the PHE and several of these related to telehealth services changed components which were finalized in the Consolidated Appropriations Act of 2022.

The impact of all of the changes may vary based on your organization’s scope of practice and focus. Following are items that may impact radiology services and should be evaluated to ensure compliance.

ENDING MAY 12, 2023

1. Virtual check ins and e-visits for new patients

2. Telehealth via any non-public facing application

Even though telehealth visits will continue for another 18 months after the end of PHE, the technology used to conduct the visit will be required to be HIPAA compliant. The waivers and extensions which allowed telehealth visits to be performed with non-HIPAA compliant technology will end on May 12. Providers who expect to continue providing services will need to verify the technology they are using is HIPAA compli-

ant and document this, or they may be subject to legal fines and penalties.

Some other specific waivers ending as well include:

ENDING DECEMBER 31, 2023

3. Telehealth visits performed from provider’s home reporting the facility address

ENDING DECEMBER 31, 2024

4. Telehealth services available in any geographic area in the United States

5. Patients able to continue receiving telehealth services from their home

6. Audio-only encounters via telephone evaluation and management services

CMS updated the telehealth list of services on February 13, 2023 to remove the column designating the different phase out timelines for the approved codes. The full list can be

found at, https://www.cms.gov/Medicare/Medicare-General-Information/ Telehealth/Telehealth-Codes.

OTHER CHANGES

Virtual presence of the teaching physician which has been allowed for all teaching settings will change. Teaching physicians only in residency training sites located outside of a metropolitan statistical area may direct, manage and review care furnished by residents through audio/video real-time communications technology. This change definitely impacts many radiology residency programs.

Practitioners wishing to practice in any particular state must adhere to the state guidelines regarding licen sure, the waivers initially setup by CMS could not and do no overrule any state specific requirements.

The modification for the same locum tenens to provide coverage

longer than 60 consecutive days during the PHE, whether the arrangement is reciprocal billing arrangements or fee-for-time compensation arrangements, will revert to original guidelines. On the 61st day after the PHE ends, the regular physician must use a different substitute physician or return to work at their practice.

As it gets closer to May 11, it is likely there will be more information from CMS regarding the ending of the waivers and extensions. It is important to discuss and address any relevant items within your organization to ensure understanding by providers and staff as this may be significant changes for some organizations as compared to

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� PROJECT PLANNING & MANAGEMENT

� NEW OR USED SYSTEMS

� CONSTRUCTION & PERMITTING

� SYSTEM REMOVAL & INSTALLATION

� SUITE DESIGN & MODIFICATIONS

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MSHS, CRA, RCC, RCCIR, CPC, COC, FAHRA, is the president of Revenue Cycle Coding Strategies LLC.

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BY MARK WATTS PACS/IT/AI

DESIGN THINKING AND AI

In my effort to explain artificial intelligence (AI), I am struck by how hard it is to explain human intelligence.

For us to use AI effectively we must have it perform a task that we value in human intelligence. How is that task selected?

I would suggest using designed thinking to understand the “right” questions or tasks for AI to accomplish.

Design thinking is a human-centered approach to innovation that starts with what is desirable from a human point of view, along with what is technologically feasible and economically viable. There are six phases in the design thinking process:

• Frame a question

• Gather inspiration

• Generate ideas

• Make ideas tangible

• Test to learn

• Share the story

This seems like a rational approach for AI task selection. In health care we may want to track a patient’s journey from start to finish.

1. Choose a process or journey that you want to map.

2. Write down the steps. Make sure to include even small steps that may seem trivial. The goal is to get you to consider the nuances of the experience that you may normally overlook.

3. Organize the steps into a map. Display the steps sequentially in a timeline. The map may include branches to show alternative paths in the patient journey. You could also use a series of pictures or whatever method fits your data.

4. Look for insights. What patterns emerge? Anything surprising or strange? Question why certain steps occur, the order they occur in, and so forth. Ask yourself how you might innovate with AI each step.

5. If possible, show the map to people familiar with the journey and ask them what you’ve overlooked or gotten out of sequence. Think about a trip to the hospital’s emergency room. Of course, the most important moment is at the point of care when the doctor is diagnosing the problem or delivering treatment. But when people complain about (or, less commonly, rave about) their emergency room experience, it’s not usually the skill of the doctor they are talking about. A simple version of the design thinking patient journey might include moments like these:

• Experience pain or discover the symptom.

• Consider home treatment versus going to the hospital: the go/no go decision.

• Choose transportation to the hospital.

• Arrive and park (or pay the taxi, etc.).

• Enter the hospital and find the emergency room.

• See the triage nurse.

• Fill out the insurance forms.

• Wait. And wait some more.

• Get ushered into a treatment room.

• Put on an uncomfortable hospital gown and wait some more.

• See multiple preliminary nurses and technicians.

• See the doctor for an assessment and sometimes preliminary diagnosis.

• Undergo additional blood tests, X-rays, and so forth.

• Receive a firmer diagnosis, which can lead to getting instructions for home care, an outpatient procedure, a prescription, a follow-up appointment with a general practitioner or specialist, or admission to the hospital.

As you lay out every step, ask yourself how you might use AI cost-effec tively innovate and turn the ordinary experience into something extraordinary.

Because emergency health care is often high anxiety, I have discovered that patients are calmer if you spell out only the journey ahead. It sometimes called “journifying” the journey – taking an amorphous or scary process and breaking it down into tangible, predictable steps. I have found “journifying” helps people not only in the emergency room, but in any number of health care situations: taking your newborn home from the hospital, going in for surgery, or beginning a new treatment regimen.

The pathways or journeys in health care can be improved by the thought ful application of AI.

Through designed thinking your organization will make better choices for this new tool. •

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

DON’T BELIEVE EVERYTHING YOU HEAR

Listening is definitely a learned skill, and people who master it tend to do better in life. But an equally valuable skill, especially for managers and leaders, is evaluating. Just like we say, “Don’t believe everything you read on the Internet,” another useful axiom is “Don’t believe everything you hear.”

EMOTIONAL INTELLIGENCE

BY DANIEL BOBINSKI

In education, evaluating is considered a higher order thinking skill. The cognitive skills considered to be fundamental are remembering, understanding and applying, whereas the higher order skills are analyzing, evaluating and creating.

Synonyms for evaluating include appraising, judging, critiquing and weighing, and the better one can perform these skills, the more likely one is likely to make good decisions.

PITFALLS OF NOT EVALUATING WELL

Multiple reasons exist for why people don’t want to evaluate things they’re told. Maybe they’re too busy or they work under too many deadlines. Maybe they fear that what they discover will lead to disappointment or other people feeling uncomfortable. Maybe a person could lose some money. Whatever the reason, if people fail to evaluate and thus make bad decisions, the result is practically guaranteed to involve discomfort and disappointment.

Consider the following true story (names have been changed to protect the

innocent – and the guilty).

Sarah was working as a vice president of sales for a company in the Northwest. Her tenure in the industry was well-known and because her team always produced good results, her CEO was fine with Sarah doing consulting work on the side.

In early 2020, about the same time that COVID-19 arrived on the scene, Sarah’s CEO told Sarah she’d need to cut her sales team by 20 percent. Sarah did not want to do this, as she and her husband were well off, and anyone she let go would have a difficult time finding work.

Sarah told her CEO that instead of cutting people from her sales team, she herself would step down. Besides, one of the companies that had been using her as a consultant had been whispering that they would love for Sarah to come work for them.

And so, a deal was struck. Sarah would resign so that everyone on their sales team could keep their jobs, and then she would work for the company that was courting her. Sarah didn’t want to call attention to the arrangement, so the only people who knew what was going on were Sarah, her CEO and the HR manager.

Ironically, COVID lockdowns were put in place the same week that decision was made, and everyone in Sarah’s company was told to work from home. The only people allowed into the building were those who worked the help desk, the CEO and, of course, HR.

The HR manager, Clarise, was good friends with Sarah, and since Sarah would no longer be employed there, Clarise offered to box up her personal items and bring them to her, which is exactly what happened.

A few weeks later, Sarah started working for her new company. She was looking forward to vibrant synergy with her new co-workers, because that’s the vibe she experienced there when working as a consultant. She got along with everybody.

Strangely, during her first week on the job, Sarah could tell something was wrong. Instead of vibrant synergy, some people were keeping their distance. Curious as to why this was, Sarah approached her new CEO and brought up the matter. His response? “Don’t worry about it. It was something we learned about your past, and I really don’t want to rehash the past. It’s over and done. You’re here now, so let’s get things going here.”

Because some people remained leery of Sarah, she brought up the matter to the CEO several more times over the ensuing months. But each time her new CEO said the past was the past and he didn’t want to rehash it.

THE TRUTH COMES TO LIGHT

It was almost a year into Sarah’s time with her new company that she finally learned the story that nobody wanted to discuss. Peter was another vice president there, and he got to talking with Sarah at their company’s annual retreat. In a sidebar conversation by the lake, Peter let down his guard enough to say, “I’m sure things would be going smoother for you here if you hadn’t been fired from your last job.”

Sarah’s eyebrows shot up. “Fired? I wasn’t fired.”

“That’s not what we were told,” said Peter. “I know the guy who runs the help desk there. He told me all about how you were fired and escorted directly out of the building … that the HR manager had to pack up your desk and bring your personal items to you outside – because you weren’t allowed back into the building.”

Sarah was stunned. None of that was true. In her mind, she played back the events.

She unselfishly gave up her own job so that the people on her sales team could continue to feed their families and pay their mortgages.

Clarise did Sarah a favor by saving her a 40-mile drive and delivered her belongings.

The guy at the help desk saw Clarise packing up Sarah’s things and taking them out of the building. It was purely a guess on his part that Sarah had been fired. It wasn’t true, but that’s what he thought.

As Sarah thought it through, she realized that Peter was not guilty of lying. However, he was guilty of not evaluating what he was told. The same was true about her CEO. The price? A greatly reduced sense of comradery and definitely lower levels of productivity.

None of what happened was necessary. However, gossip, conjecture and misunderstanding combined with a lack of curiosity and analysis damaged both a company and a career.

It leads us back to that wise saying; don’t believe everything you hear. A little analysis and evaluation, which would have required only a phone call or two on the part of Peter or the CEO, would have changed so many things.

In closing, it would be wise to remember that evaluating is a learned skill, and those who master it tend to do better in life. •

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.

THE ROMAN REVIEW

MISSING FRIENDS

As I write this column, the ICE Imaging Conference is being conducted in beautiful Nashville, Tennessee. I am not there and I realized that I am missing the people and friendships that we have nurtured over the many years of attending industry shows and conferences.

I don’t miss the travel hassles, nor do I miss the standing at a booth waiting for people. I miss the relationships building and camaraderie that these venues present to all attendees. An amazing part of this experience is that even though you may not see or speak to someone for months, as soon as you see them, you begin right where you left off the last time. It’s as if there was no break in between.

Then my thoughts go to: Are these people close friends or close business acquaintances? In my opinion true friendships are generally few and sometimes rare.

So, what are the rest of the people in your life? There exist many degrees of friendships and kinds of friendships. We may have many family members whom we love, yet there are always a very few special ones to us. It is the same way with our friends. We love them all, however a few just seem special to us. You cannot force friendship any more than you can force family members. Special friendships just happen. So, what follows are some observations on friendship.

Some friendships last only as long as it takes for one person to get what they want from the other. This is the Manipulative friendship where the question is, “What can you do for me?” The used person feels betrayed and the other person moves on to the next victim. Sometimes the used person allows himself to be used to retain the friendship. Ruth has this quote taped to her computer, “Don’t make someone a priority that only considers you an option.”

Some friendships are situational where friends are friends in specific situations or locations. When we attended the multitudes of shows and conferences in this industry, we had many friends during the shows. When we returned home, we did not keep up with most of them. This is the Business Associate friendship.

Another form of friendship is the Reciprocity friendship. One person helps another in some way and the helped individual feels a debt of gratitude. The friendship may last only as long as the debt is unpaid.

There is the Abusive friendship where an individual will do whatever is required to retain the friendship, even in the face of evidence that the recipient of the friendship is not deserving. The abused just keeps coming back for more and thus reinforces the abuser’s bad behavior. People stay in abusive relationships all the time.

A Conditional friendship is one where one person is allowed to remain in the relationship only as long as he continues to provide a requisite value to the other. When the individual’s value disappears or even diminishes, the other person begins the process of extracting himself from the relationship. When the conditions change, the relationship is done.

Unconditional friendship is one where there are no strings attached. The individuals work together symbiotically for the good of the friendship. The hearts and minds are open and sacrifices are made on behalf of the friendship without expectations. Although it may occasionally take effort to maintain this friendship, things mostly just appear to happen naturally. This friendship goes on and on effortlessly without regard for who may be benefitting the most at any particular point in time.

I am confident that there exist many other types of “friendships” and many variations of the ones I describe here. Is there a point to all this? Maybe. If I provided some food for thought, then I did well. If I brought attention to a faulty relationship or two, then I did well. If I brought attention to true friendships in your life, then I did well. If you think I am a rambling old man, then You did well.

To those friends and family that are now wondering where you stand, stop wondering. Believe me when I say that there is a chance that you just may be in the Special category. Let’s avoid an awkward moment by not discussing it further. •

Manny Roman, CRES, is association business operations manager at Association of Medical Service Providers.

MANNY ROMAN

ICE2023

IMAGING CONFERENCE & EXPO

FEBRUARY 17-19, 2023 • NASHVILLE, TN

ICE SCRAPBOOK

ICE 2023 was a hit from the start. The exhibit hall sold out early. A packed exhibit hall was just the beginning of the successful event hosted by MD Publishing. Approximately 450 people attended the imaging conference with 80 exhibits. Imaging leaders from throughout the United States benefited from continuing education sessions, networking opportunities and more.

1. Tri-Imaging’s Eric Wright and Wanda Legate are all smiles with MD Publishing President John Krieg at the ICE 18 Leadership Summit Dinner. Tri-Imaging sponsored the dinner.

2. Signature networking events are a special element of the ICE conference.

3. An ICE attendee tries to win a bottle of bourbon at the KMG booth.

4. The popular Reverse Expo brings leaders together.

5. ICE Editor John Wallace poses for a photo with door prize winner Greg Goll and Chill the polar bear.

6. Keynote speaker Brian Parsley delivered a great talk.

7. UHS Senior Director of Information Services and Healthcare Technology Management Chris Nowak shakes hands with Beekley Medical’s Elizabeth Santoro during the Reverse Expo.

8. The HTM Jobs duo Kristen Register and Sydney Krieg had a booth next to MedWrench’s Emily Vitkovitsky, Joanna Manjarrez and Starr Smith.

9. John Drew presents “State of the Industry, Paths to Entry and Current Trends” at ICE. It was one of several popular continuing education sessions.