ICE Magazine December 2023 by MD Publishing

DECEMBER 2023 | VOLUME 7 | ISSUE 12

MAGAZINE

THEICECOMMUNITY.COM

ADVANCING

IMAGING PROFESSIONALS

PAGE 32

LEADERSHIP VACUUM Where are the next generation of medical imaging leaders, and how do we find them?

PRODUCT FOCUS CONTRAST IMAGING PAGE 27

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FEATURES

40 DIRECTOR’S CUT

Leaders should not operate alone, carrying personal and professional burdens in isolation. It is neither healthy nor needed.

32 COVER STORY

In this cover article, we explore where the next generation of medical imaging leaders will be and how to find them.

14 RISING STAR

Jaimee Herchler loves helping the SJMC teams grow and flourish.

ICEMAGAZINE | DECEMBER 2023

ADVANCING THE IMAGING PROFESSIONAL

DECEMBER 2023

18 IMAGING NEWS

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

27 PRODUCT FOCUS

A look at some of the latest contrast imaging devices.

EMOTIONAL INTELLIGENCE

Dealing with 'difficult' people often means working with 'different' people.

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ICEMAGAZINE

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

John M. Krieg john@mdpublishing.com

Vice President

Kristin Leavoy kristin@mdpublishing.com

Vice President of Sales Jayme McKelvey jayme@mdpublishing.com

CONTENTS SPOTLIGHT

In Focus Bryan J. Henderson

Rad Idea Mindful and Meditative Huddles: Promoting Team Wellness

Rising Star Jaimee Herchler

Off the Clock Tony Marini

Group Publisher

Megan Cabot megan@mdpublishing.com

NEWS

Editorial

John Wallace

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

Editorial Board

Webinars Presenter Shares CT Turnaround Tips

Jason C. Theadore Nicole Dhanraj Melody W Mulaik Verlon E. Salley Rachel Thiesse-Yount Traci Foster

Sales

Emily Hise

PRODUCTS

26 27

Art Department Karlee Gower Taylor Hayes Kameryn Johnson

Product Focus Contrast Imaging

INSIGHTS

Events

Coding/Billing: It’s Edit Time Again

Webinars

Emotional Intelligence Dealing with ‘Difficult’ People

Digital Department

Director’s Cut Who’s In Your Village?

PACS/IT/AI FDA Approves New AI for Imaging

Diane Costea

ICE Magazine (Vol. 7, Issue #12) December 2023 is published by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290.

DEI Considerations for Breast Cancer Screening in the Transgender Community

Roman Review Lead or Follow

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ICE Break

Kristin Leavoy

Linda Hasluem

Cindy Galindo Kennedy Krieg Haley Wells

Accounting

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. © 2023

Market Report

ICEMAGAZINE | DECEMBER 2023

Index

ADVANCING THE IMAGING PROFESSIONAL

2023-2024 Course Schedule

CHECK OUT OUR COURSE CALENDAR! Improving the quality of diagnostic imaging service through knowledge, education and Fully Engaged Hands-on Learning™.

TRAINING COURSE TITLE

SEPTEMBER 11

OCTOBER 16

Sep 11-22

Principles of Servicing Diagnostic X-Ray Systems (Phase 1)

NOVEMBER

DECEMBER

JANUARY 15

FEBRUARY

Jan 8-19

Feb 5-16

MARCH

Dec 11-22

Week 2 Apr 8-12

Sep 11-15

Apr 15-26

Jan 8-19

Apr 8-19

Oct 30-Nov 10

Advanced Diagnostic Imaging Systems Analysis (Phase 4)

PACS Engineer/Administrator Certification (Phase 2) - eLearning

MAY

13 May 6-17

Mar 18-29

Jan 22-Feb 2

Nov 27-Dec 8

APRIL

Week 1 Apr 1-5

Mar 4-15

Week 2 Nov 13-17

Oct 30-Nov 10

Advanced Digital Imaging Systems Maintenance (Phase 3)

PACS Engineer/Administrator Certification (Phase 1) - eLearning

NETWORKING & DIGITAL INFO

Nov 27-Dec 8 Week 1 Nov 6-10

Sep 25-Oct 6

Advanced Radiographic Systems Maintenance (Phase 2)

Oct 16-27

Principles of Servicing Diagnostic X-Ray Systems (Phase 1) - eLearning

X-RAY CERTIFICATE SERIES

May 13-24 Jan 29Feb 2

Sep 18-22

Dec 19-21

PACS Troubleshooting (3 days) - eLearning

May 20-24

Feb 5-9

May 14-26

C.A.M. (Capital Asset Management)

MANAGEMENT

Nov 14-16

Intro to Diagnostic Imaging & PACS For Managers & Sales Professionals GE Optima/Discovery/Definium DR Family: Optima XR640/XR646, Discovery XR650/XR656, Definium 6000/8000

May 6-10

Oct 2-6

Jan 29Feb 2

May 20-24 Feb 12-16

GE Precision 500D R/F GE Precision 600FP Oct 30Nov 3

GE Proteus Sep 11-15

Philips Easy Diagnost Eleva

PRODUCT SPECIFIC

Oct 2-6

Philips Digital & Bucky Diagnost Sep 11-15

Siemens Ysio

Feb 26Mar 1

Mar 11-15

Jan 8-12

Apr 8-12

Siemens AXIOM Luminos TF Oct 9-13

Siemens Luminos Agile Shimadzu RADspeed/RADspeed Pro

Oct 16-20

Feb 5-9

Private Practice X-Ray Systems (CPI CMP200 & Quantum Odyssey HF)

T H A N K S G I V I N G

Injector Systems GE AMX Portable (IV, IV+) GE Optima XR200/XR220/XR240, & Brivo XR285 Digital Portables Shimadzu MobileDaRt Evolution Portables (Evolution EFX, MX7)

PORTABLES

Canon RadPro Digital Philips MobileDiagnost Digital Fuji FDR Go & Go Plus Multi-Product C-Arm OEC 9800/9900 OEC 9900 C-Arm

C-ARMS

OEC Elite (CFD) Flat Panel C-Arm Philips Veradius C-Arm Philips BV Pulsera C-Arm GE Innova/IGS/Optima Family (21/31/4100, 3XX/5XX/6XX)

CARDIAC

Philips Allura FD Family (FD10/FD20)

L A B O R

Sep 25-29

Oct 16-20

Oct 23-27

Nov 6-10

Nov 13-17

Oct 2-13 Sep 25-29

D A Y

Nov 6-10

Oct 16-20

Oct 2-13

Lorad Multicare Platinum Breast Biopsy System GE Digital Mammography (1-week ESSENTIAL only)

Oct 2-6

Hologic Dimensions 3D Tomo Digital Mammography

C H R I S T M A S

Dec 4-15

N E W Y E A R S

Mar 25-29

Apr 22-26

Feb 26Mar 1

Jan 22-26

Jan 29Feb 2

Apr 8-12

Multi-Vendor Bone Densitometry Sep 13-15

Philips Epiq 5 & Epiq 7 (2.5 days)

ULTRASOUND

Philips iU22/iE33 (2.5 days)

Dec 6-8

Sep 18-20 Sep 20-22

Dec 11-15

Mar 6-8

Apr 29May 3

Oct 23-27 Apr 8-19

Oct 16-27

Philips Brilliance Family

May 6-17

Oct 23-Nov 3

Siemens Sensation Family

Nov 6-17

Siemens Definition Family

Mar 18-29

Oct 2-13

Servicing Multivendor MRI Systems

Mar 11-22

Dec 11-22 Oct 16-27

Siemens MRI Family (Aera, Skyra, Espree, Avanto)

Jan 15-26

Nov 27Dec 1

Siemens Symbia Family Oct 23-27

CRES Certification Prep

EXHIBITS, PRESENTATIONS & NOTES

Apr 8-19 Feb 19-Mar 1

GE Excite & GEMS MRI Family (X) Principles of Servicing Nuclear Medicine Systems

NUCLEAR MEDICINE

Apr 15-19

Mar 11-13 Mar 13-15

Oct 9-20

GE Revolution & Discovery CT

CRES CERTIFICATION

May 6-10

Sep 25-Oct 6

GE Optima, Brivo, VCT, LS, BS CT Family

MRI

Apr 29May 3 Apr 29May 3

Apr 22-26

Feb 5-9

Dec 11-13

GE Logiq E9, Vivid E9 (2.5 days) Principles of Servicing Multivendor CT Systems

OPEN

Apr 29May 3

Siemens Inspiration or Novation

Principles of Servicing US Systems (2.5 days)

May 20-24

Mar 18-29

Oct 9-13

Hologic MG Products: Affirm, SecurView, R2, ATEC Sapphire

May 13-17 CLOSED

May 13-17

Oct 23-27

Hologic Selenia Digital Mammography

WOMEN'S HEALTH

Apr 2-5*

CEAI Sep 6-7 Chicago, IL

NCBA Sep 13-15 Duluth, MN

Dec 4-8

Feb 26Mar 1

MD Expo Oct 29-31 Orlando, FL

Apr 22-26 * Class Start Tues

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SPOTLIGHT

IN FOCUS

BRYAN J. HENDERSON

ryan J. Henderson, Ph.D., MBA, BSRT(R), is the director of radiology, cardiology, neurology and radiation oncology at Valley Presbyterian Hospital in Los Angeles, California. His radiology career journey began across the country in Florida.

Bryan J. Henderson, Ph.D., MBA, BSRT(R), is the director of radiology, cardiology, neurology and radiation oncology at Valley Presbyterian Hospital in Los Angeles, California.

ICEMAGAZINE | DECEMBER 2023

“Growing up as an active kid in South Florida, I was always playing outside and getting injured. Whether I was playing sports or trying to outrun an alligator, I was always getting hurt,” Henderson says. “Needless to say, I saw my fair share of emergency rooms and spent a good amount of time in radiology departments, which really sparked my interest in health care.” “I’ve always enjoyed working in health care and especially with the elderly population and I’ve learned that age is just a

number,” he adds. “Interacting with geriatric patients is a daily reminder of just how fragile life really is and it teaches you to be humble and to never take anything for granted.” Thus far, he says that his greatest accomplishments include his family and becoming a doctor. “I set new goals every year; for me, the finish line just keeps moving. I cherish my family and my friends, but I am most proud of the things that are not easily achieved in life, such as becoming a doctor, writing a book and traveling the world,” he explains. Looking ahead, Henderson sees great things in store for diagnostic imaging. “Imaging technology continues to evolve at an exponential rate, it seems like we’re experiencing new technological breakthroughs on an annual basis,” he says. “This is both exciting and intimidating. I look forward to

seeing what artificial intelligence can bring to the world of imaging services, but I’ve also seen all the Terminator movies and may be a little skeptical.” As far as leading others, Henderson is like a lot of imaging directors. “I’m a big proponent of servant leadership and leading by example. I believe that my employees work with me, not for me, and that a leader should never expect their staff to do something that they wouldn’t do themselves,” he says. “If you cultivate the joy of working, your staff will follow.” He also believes in mentorships. “I’ve learned from many health care executives over the years, but the one I’ve learned the most from was a hospital CEO named Gus Valdespino. Gus was vital to my successful development as a health care leader, as he taught me the fundamental traits of good communication, delegation and decision-making, while also teaching me the importance of emotional intelligence,

empathy and self-awareness,” Henderson says. He also points to his family for some great guidance. “My family tree is awesome and amazingly supportive of each other. Although my family is small compared to most, we are extremely mighty. Every year we pick a new location and get together for a family reunion,” he says. “I am truly blessed to have them all in my life. His travels have also sparked a desire to give back to the less fortunate. “After traveling to some of the most remote parts of the world and visiting several underprivileged health care facilities, my wife and I decided to launch the Henderson Heart Foundation, a nonprofit organization dedicated to donating used medical equipment and supplies to some of the most impoverished areas around the globe,” Henderson says. “It’s amazing what a small group of people committed to changing the world for the better can do. For more information, please visit our website www.HendersonHeartFoundation.org.” •

BRYAN J. HENDERSON Ph. D., MBA, BSRT(R)

1. What is the last book you read? I read constantly, but I haven’t read any new books over the last year, as I’ve been busy writing and publishing my first book, which is on the topic of patient satisfaction in health care. My book is titled “Satisfaction Guaranteed?” and it’s now available on Amazon. 2. Favorite movie? “The Shawshank Redemption” 3. What is something most of your coworkers don’t know about you? I just visited my 75th country and I’m excited for my next journey later this year, which will be to my 7th and final continent, Antarctica. 4. Who were your mentors in life? I’ve been blessed with many mentors in my life. Growing up, my grandparents taught me well. My grandfather preached the importance of higher education, hard work and perseverance; while my grandmother was the ultimate hostess and taught me how to cook and entertain a crowd. I was exposed to the best of both worlds. 5. What is one thing you do every morning to start your day? I always make my bed. This way, if I only make it downstairs to the couch, at least I’ve accomplished something that day. 6. Best advice you ever received? Travel while you’re young, because your money will return, but your time won’t. 7. Who has had the biggest influence on your life? Well, other than a plethora of scholars and teachers, my parents were very influential in my life. My mother taught me how to read, but my father taught me to question everything that I read, so I would say that both my parents were huge influences in my life and both are responsible for the man I am today. 8. What would your superpower be? I wish I could fly or have unlimited good health. 9. What are your hobbies? I enjoy spending time on my boat and scuba diving during the summer months and snowboarding during the winter months and, of course, traveling around the world with my wife. 10. What is your perfect meal? My palate has quite the range, I’ve enjoyed everything from Ibiza’s Sublimotion to a Florida Waffle House. But honestly, the perfect meal for me depends on where I’m at in the world as different countries and cultures offer such contrasting varieties of cuisine. Enjoying a meal is not just about the food, it’s also about the people that you’re sharing a meal with. Food might not be the answer to world peace, but it’s a start.

WWW.THEICECOMMUNITY.COM

ICEMAGAZINE

SPOTLIGHT

Rad idea MINDFUL AND MEDITATIVE HUDDLES: PROMOTING TEAM WELLNESS

BY NICOLE DHANRAJ

ot too long ago, I came across a video featuring a physician leading his team in a mindfulness and brief yoga exercises session before starting a procedure. Back then, I wasn’t particularly inclined towards such practices in the workplace. However, more recently, I’ve experienced the positive effects of meditation and mindfulness. Now, I find myself strongly advocating for these practices, especially in our high-stress work environments. Consider incorporating yoga into your leadership huddles, but it isn’t just about introducing a trendy wellness practice; it’s about equipping your team with a powerful tool for destressing, getting centered and enhancing focus as they start their day. Wow, it has done wonders for me, especially with having emotional control, clarity and focus to start the day. I have heard staff stress out about the day even before it begins, so adding yoga, even in short bursts, can help lower stress hormones like cortisol. By taking a few minutes to practice yoga together, your team can shed the stress of the morning rush and

ICEMAGAZINE | DECEMBER 2023

step into the meeting with a clear and calm mindset. Team members are more likely to be mentally present, actively listen and contribute thoughtfully without being crabby, stressed or disengaged in starting their day. In the hustle and bustle of leadership, it’s easy to lose touch with your inner self and the present. We are focused on what happened yesterday and what the future state looks like, so meditation and yoga help team members reconnect with their bodies and emotions and help us get through the present. So, consider adding meditation, mindfulness and even some yoga moves to your huddles. It’s a holistic approach to start the day right, not to mention help the team rid the tension and negativity flowing out of their minds and bodies. By reducing stress, enhancing focus and getting centered, you’re elevating your leadership and nurturing your team members’ well-being, ensuring they’re ready to face the challenges and opportunities ahead with clarity and resilience. Pause to regroup and refocus … go ahead and give it a try! • Share your RAD IDEA via an email to editor@mdpublishing.com.

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SPOTLIGHT

RISING

STAR JAIMEE HERCHLER

aimee Herchler, R.T.(R)(M)(ARRT), holds a Bachelor of Science in Radiologic Sciences from The Ohio State University. She currently serves as a Radiology Supervisor-Breast Health, MRI, Nuclear Medicine and Ultrasound at St. John Medical Center. ICE Magazine recently found out more about this Rising Star with a Q&A. Q: WHERE DID YOU GROW UP? A: I grew up in LaGrange, Ohio and attended Keystone School District. Currently, I reside in Vermilion, on the Lake that is Erie.

Jaimee Herchler serves as a Radiology SupervisorBreast Health, MRI, Nuclear Medicine and Ultrasound at St. John Medical Center. 14

ICEMAGAZINE | DECEMBER 2023

Q: WHERE DID YOU RECEIVE YOUR IMAGING TRAINING/EDUCATION? A: I originally started my college education off at Ohio University, with the intentions of going into nursing. After a year of studying, I transferred to The Ohio State University to explore other medical degrees. There, I completed my Bachelor of Science in Radiologic Sciences and Technology as well as my secondary courses in mammography. I am currently licensed by ARRT in Radiography and Mammography. Q: HOW DID YOU FIRST DECIDE TO START WORKING IN IMAGING? A: Once I had an inside look at the real world of nursing and

ADVANCING THE IMAGING PROFESSIONAL

not the glorified “Grey’s Anatomy” version, I changed my roadmap and looked into radiology. I thought the idea of being able to look inside the human body was so fascinating and all of the different avenues in the job field itself that I could explore! Radiology struck my interest, but mammography had me convinced that I was in the right field for me. Q: WHAT IS THE MOST REWARDING ASPECT OF YOUR JOB? A: I would have to say the most rewarding aspect is watching the people and teams grow together and form a unity, all while expanding their skill sets. When first starting as supervisor here, I had an entire staff turnover in MRI aside from a few employees. We hired some new staff, cross trained others, and through all of the bumps in the road, everyone kept chugging along. Today, we have a successful, fully staffed, well-oiled engine on our hands. They have all developed and grown into independent employees, but at the same time work cohesively together. People have stepped up into unspoken roles, taken leadership under their belts and they all communicate so well with each other. It is rewarding to be able to take a step back to see where we were, how far we have come, and the goals we have planned for the future that will finally come to fruition. Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: I love being in the supervisor position because it lets me stay connected to my teams, but also in that middle field in management where my voice is heard and matters. My voice of reason comes from my employees and their input. Everything I do and work towards has one goal in mind: to improve my employees’ work life here and listen to the people with the boots on the ground. They know firsthand how we can improve our department and grow as a whole. When they feel like they are being heard and see the results, it gives me that confirmation that I am right where I need to be. Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: I think it is fascinating how diverse the imaging field is and how they continue to keep growing and discovering new imaging techniques. We have grown from X-ray film to cassettes to digital imaging and 3D reconstruction. We are able to actively watch a patient swallow barium and track where it goes in the esophagus. We have 3D technology for breast imaging so we can look throughout the pesky dense breast tissue to see if there are any underlying cancers. We have the ability to inject radiation into the human body and watch is disperse and track the radioactive activity. It is simply, but complexly, very interesting how much the field of radiology has evolved over the years and how fortunate we are to be able to utilize it for our patients to give them the best care and roadmap to diagnosis and treatment.

WWW.THEICECOMMUNITY.COM

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: In my 7 years of being a registered technologist, I have had the opportunity to grow my career professionally, at an accelerated rate. I quickly went from being a mammography technologist to a clinical coordinator at Summa Health Breast Center within my first 6 months. From there, I opened a brand new breast center in a new facility and coordinated rooms, staffing, equipment, schedules, etc. When I came to UH after starting my family, I took a PT mammography technologist role and knew I wanted to continue to do more. There were rumblings that the supervisor role would be opening up and I thought this was my chance; I knew I had the skills, knowledge and mindset to be the team’s co-leader. I was blessed with this opportunity and have helped to continue the growth and success of our radiology department here at SJMC. •

FUN FACTS FAVORITE HOBBY: Hanging out with my family (cliché I know, but my little one is so fun!) FAVORITE SHOW: “Schitt’s Creek” FAVORITE FOOD: Salad FAVORITE VACATION SPOT: Holden Beach, North Carolina 1 THING ON YOUR BUCKET LIST: Go whale watching in Maine SOMETHING YOUR CO-WORKERS DON’T KNOW ABOUT YOU: My dream in life is to open a wedding venue.

ICEMAGAZINE

SPOTLIGHT

Off Clock THE

TONY MARINI, BA, CNMT, R.T.(N)(MR)(CT)(ARRT) BY MATT SKOUFALOS

t the outset of his college education, Cleveland native Tony Marini was primed for a career in dentistry. However, upon arriving at Cleveland State University, Marini was so moved to follow his passions as a writer that he ended up completing a degree in journalism and creative writing instead. After graduation, however, Marini’s work in the field of advertising revealed itself to be much less fulfilling than he had originally anticipated. A friend who worked for the Cleveland Plain Dealer encouraged him to return to school to study medicine, the better to position himself for a career in medical or technical writing. So, at 27, Marini left the ad world and enrolled in the nuclear medicine program at the University of Findlay in Findlay, Ohio. Although he’d intended to leverage that education into a different writing career, early exposure to patient care during his clinical studies taught Marini first-hand how much joy and fulfillment there was to be found in that work. A year later, he graduated, and went right to work at Lakewood Hospital, a community hospital in Lakewood, Ohio as a nuclear medicine technologist. He’s never looked back since. “It is really very rewarding,” Marini said. “I still am a staff technologist. I still love being a staff technologist. I love doing patient care. It’s a good feeling to be able to provide a service to the community; I really do enjoy it.” After 10 years at Lakewood Hospital, Marini was recruited by a friend to join the team at UH Parma Medical Center in Parma, Ohio, where he’s logged another 23 years as a nuclear 16

ICEMAGAZINE | DECEMBER 2023

medicine technologist. He still enjoys patient care, and still enjoys writing: throughout his imaging career, Marini has maintained freelance work covering fitness, wellness, and physical and mental health topics for various media outlets. All along, however, Marini had always harbored a desire to write a children’s book, but he couldn’t quite pin down the subject until one year, it appeared, unprompted, at a holiday gathering. “I used to read ‘‘Twas the Night Before Christmas’ to some friends of mine on Christmas Eve,” he said. “On the back of the book was a little blurb about the Christmas pickle; the ornament that you put on the tree. A friend of mine was like, ‘Tony, that’s your book!’ ” The legend of the Christmas pickle is a convoluted one; some researchers trace its lineage to Germany or Poland; others say it’s a story that has been reverse-engineered from the American experience of Christmas. As a practical matter, it plays out like this: someone hides a pickle-shaped ornament among the boughs of the family Christmas tree, and whomever spots it first is believed to get good luck throughout the coming year (and sometimes, an extra gift). The challenge comes from picking out the green ornament against the backdrop of the green tree. For Marini’s story, he embraced the malleability of the Christmas pickle lore to craft “Pennie the Christmas Pickle,” a tale tinged with traces of Hans Christian Andersen’s storytelling. It centers on a young girl “who wants to do something great in life,” he said. “She struggles to find what that would be, and her siblings make fun of her along the way, but she believes in herself,” Marini said. By the end of the book, Santa Claus uses his Christmas magic to turn Pennie into the proverbial and enduring ChristADVANCING THE IMAGING PROFESSIONAL

Photo 1: Award winning basket of vegetables from Tony’s garden. This basket won a ribbon at the Cuyahoga County Fair. Photo 2: Pennie, the Christmas pickle is a children’s book about a cucumber that becomes the famous Christmas Pickle. Photo 3: There is even a costumed character of Pennie Pickle! She is active in many holiday parades throughout the country. Photo 4: Cover of Tony’s new book “Trotter, the Thankful Turkey.” The book will be released in 2024. Photo 5: Tony Marini holding his book “Pennie, the Christmas Pickle.”

mas pickle. Marini filled out the remainder of the book with a package of activities for children, and lush, full-color illustrations from visual artist Tom Fox of Buffalo, New York. The two collaborated remotely on the project, which Marini self-published, and which he has been promoting through public and community events. “Book writing is like one percent; the rest is marketing,” he said. “I go to libraries and schools and read to children. It does take a lot of work, but it’s very rewarding. There is nothing more enlightening than seeing children light up when you read the book. It’s so much fun.” Now Marini is hard at work on a second children’s holiday novel, “Trotter the Thankful Turkey.” He’s again working with Fox on the illustrations for a book that will tell the story of how Trotter transforms from a self-interested bird into a neighbor who learns to embrace the love of his community. “A huge storm comes through town, and all his feathers get blown away,” Marini said. “So everyone in the community comes together to clothe him and give him feathers, and he then becomes a very humble turkey.” As he comes close to readying Trotter for publication, Marini is again winding up the mechanisms of promoting the work: pitching libraries, schools and bookstores; listing the title on Amazon.com, and providing copies for local gift shops. For as much work as it’s been, the lead-up to releasing his second title “feels pretty incredible,” Marini said. WWW.THEICECOMMUNITY.COM

“It’s almost like giving birth to a child,” he said. “This is real. And [collaborating with Fox is] exciting because, in your brain, you might have one type of vision of what you think it’s going to be, and the artist comes up with something much better than you thought.” Neither is Marini completely wrapped with “Pennie the Christmas Pickle.” Currently, he’s penning an adaptation for the stage with his friend, Julie Gilliland, in parallel to preparing for the launch of “Trotter the Thankful Turkey.” “I still have that bug for writing,” he said. “You never get rid of it; when you’re a writer, it’s hard to give it up. But I would like to continue to do more children’s books. It hasn’t completely got off the ground yet because of my schedule, but we are about halfway through getting it done.” When he’s not behind the writer’s desk, Marini can be found in his garden, cultivating organic crops for his home dinner table, or at the patient bedside, helping people navigate through the anxiety of their appointment. Gardening brings him a meditative, contemplative peace, while writing feeds his need for creative expression; both are instrumental to his enjoyment of life. “That’s one thing you learn about working in a hospital,” Marini said; “you’ve got to enjoy life.” • For more information about “Pennie the Christmas Pickle,” visit penniepickle.com.

ICEMAGAZINE

NEWS

Imaging News

A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

COPYRIGHT OFFICE SEEKS MEDICAL DEVICE EXEMPTION RENEWAL Recently, the U.S. Copyright Office published a notice in the Federal Register that it is recommending that the Librarian of Congress consider some petitions for renewal of the exemptions that were granted in 2021 from the Digital Millennium Copyright Act (DMCA) prohibition against circumvention of technological measures that control access to copyrighted work. The repair of medical devices is among the items listed. In a summary on the Federal Register website it states, “The United States Copyright Office is conducting the ninth triennial rulemaking proceeding under the Digital Millennium Copyright Act (DMCA), concerning possible temporary exemptions to the DMCA’s prohibition against circumvention of technological measures that control access to copyrighted works. In this proceeding, the Copyright Office is considering petitions for the renewal of exemptions that were granted during the eighth triennial rulemaking along with petitions for new exemptions to engage in activities not permitted by existing exemptions. On June 8, 2023, the Office published a Notification of Inquiry requesting petitions to renew existing exemptions and comments in response to those petitions, as well as petitions for new exemptions. Having carefully considered the renewal petitions and comments received, in this Notice of Proposed Rulemaking (NPRM), the Office announces its intention to recommend all but one of the existing exemptions for renewal. This NPRM also initiates three rounds of public comment on the newly proposed exemptions. Interested parties are invited to make full legal and evidentiary submissions in support of or in opposition to the newly proposed exemptions, in accordance with the requirements set forth below.” In a section titled “Q. Computer Programs—Repair of Medical Devices and Systems” the document reads, “Five organizations filed petitions to renew the exemption to ac-

ICEMAGAZINE | DECEMBER 2023

cess computer programs that are contained in and control the functioning of medical devices or systems, and related data files, for diagnosis, maintenance, or repair (codified at 37 CFR 201.40(b)(15)). The Office received three comments opposing renewal, discussed further below. Four of the petitions provide evidence of the continuing need and justification for the exemption. For example, Avante states that “the use of TPMs in medical systems and devices is widespread among the types of systems and devices” and that manufacturers “have developed new systems that further restrict access to use of necessary software tools.” TTG Imaging Solutions asserts that the exemption is “crucial to ensure the availability, affordability, and timely repair of medical devices, which directly impacts patient care and healthcare accessibility.” And both Metropolis International and TriMedx testify that they relied on the current exemption to refurbish and repair medical systems. The petitioners have personal knowledge of and experience with this exemption; each either repairs, maintains, services, or sells medical systems and devices for entities in the healthcare industry. The Office received opposition comments from the nonprofit American Consumer Institute (“ACI”), the Medical Imaging & Technology Alliance (“MITA”), and Philips North America, LLC (“Philips”). Opponents assert that the repair exemption “undermines the maintenance and repair standards laid out by the U.S. Food Drug Administration (FDA) for the equipment employed in patient care” because independent servicers conducting repairs are “neither regulated nor monitored” by the FDA.[108] The complete document, including all of Section Q, is available at tinyurl.com/bddwr4zy.t

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ICE 2024 OFFERS OUTSTANDING EDUCATIONAL SESSIONS The 2024 Imaging Conference and Expo (ICE) offers outstanding educational sessions approved by ACI. Registration is currently open and FREE for hospital employees, active members of the military and students. ICE 2024 is set for February 19-20 in Irvine, California. The CRES Study Group, an 8-hour prep course split into two sessions, is also available for an additional fee. It has been approved for 7.5 CEU credits upon completion of the course. The FREE educational sessions cover a wide range of topics including radiation safety, photon counting CT, management, leadership and more. Along with the valuable educational sessions, attendees will be granted access to an exhibit hall packed with high-quality solutions that will empower them to do their jobs better. Networking sessions at ICE always deliver a fun and professional atmosphere for connecting with peers. These events are often just as valuable, if not more valuable, than the educational sessions with attendees learning from each other as they discuss common problems.

ICE 2024 is the 10th anniversary of the conference and everyone is invited to attend a celebration at 5 p.m. on Tuesday. This will be the perfect venue to cap off another successful conference and a decade of providing imaging professionals a unique event designed to bring imaging leaders and service professionals together. For more information, visit AttendICE.com.

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GE HEALTHCARE, BARDA TO DEVELOP AI-AUGMENTED ULTRASOUND TECHNOLOGY GE HealthCare has signed a $44 million contract with the Biomedical Advanced Research and Development Authority (BARDA) — part of the Administration for Strategic Preparedness and Response (ASPR) within the U.S. Department of Health and Human Services (HHS) — to develop and obtain regulatory clearance for next-generation advanced point-of-care ultrasound technology with new artificial intelligence (AI) applications. Technology resulting from this jointly funded program will help health care professionals at all skill levels rapidly diagnose and provide timely treatment for patients with lung pathologies and traumatic injuries to the abdomen, chest and head. Trauma is a leading cause of death in the United States posing an enormous burden to health care systems and society. Trauma patients’ survival is dependent on receiving timely and appropriate care. Injury detection and triage of trauma patients play key roles in successful patient care and resource management, both in everyday situations and in mass casualty events. Technologies that expedite care, including detection, evaluation, and decision-assist capabilities, potentially increase patients’ chances of survival. “Point-of-care ultrasound is an essential tool in emergency situations to help clinicians quickly get the answers they need when treating patients,” said Roland Rott, president and CEO, ultrasound, GE HealthCare. “We are grateful and excited for the opportunity to partner with BARDA to contribute our expertise in ultrasound and AI applications to develop innovative solutions for identifying a range of traumatic injuries and lung pathologies. Our collaboration has the potential to enhance the ability of clinicians to provide timely care for trauma patients even in the most dire scenarios.”

ICEMAGAZINE | DECEMBER 2023

As part of the collaboration with BARDA, GE HealthCare will build new technology to expedite trauma triage and treatment, potentially transforming the standard of care. GE HealthCare will build upon its existing pointof-care ultrasound technology portfolio to develop an advanced probe and ultrasound system together with novel AI technology to ease acquisition and interpretation of ultrasound exams for users of all skill levels, thereby increasing the number of capable users and making delivery of care more efficient. The proposed devices will cover indications for multiple injury types: blunt and penetrating trauma, head trauma, lung injuries (including blast lung), as well as multiple lung pathologies encountered outside trauma care such as those seen in infectious diseases. GE HealthCare will develop technology and AI applications to be compatible with select point-of-care ultrasound systems from its product portfolio to facilitate rapid assessment of patients across a wide range of environments and care settings. This project has been supported in whole or in part with federal funds from the Department of Health and Human Services; Administration for Strategic Preparedness and Response; Biomedical Advanced Research and Development Authority (BARDA), under contract number 75A50123C00035. Also, GE HealthCare recently announced FDA 510(k) clearance of Allia IGS Pulse – the latest addition to the company’s image guided system (IGS) offerings. Allia IGS Pulse (pictured above) features a new imaging chain engineered to provide exceptional imaging at the right dose for visible impact in complex cardiology interventions regardless of patient size.

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MITA APPLAUDS CMS DECISION The Medical Imaging and Technology Alliance (MITA) applauds the Centers for Medicare & Medicaid Services (CMS) for its decision to remove its national coverage determination (NCD), and end coverage with evidence development (CED) for positron emission tomography (PET) beta-amyloid imaging. Medicare coverage determinations for PET beta-amyloid imaging will now be made by the Medicare Administrative Contractors (MACs) and Medicare Advantage (MA) plans. “Numerous published studies involving thousands of patients clearly support that beta-amyloid PET scans improve the clinical management of patients with cognitive impairment, so it is a welcome decision to retire CED and expand access to beta-amyloid PET imaging,” said Patrick Hope, executive director of MITA. “This technology is a critically important, non-invasive way to assist doctors in diagnosing Alzheimer’s disease and allows for better informed treatment decisions. MITA looks forward to working with CMS on efforts

to educate Medicare contractors for transparency, clarity and seamless coverage for all Medicare beneficiaries.” Amyloid PET scans are a critical tool that enables clinicians to identify and confirm the presence of amyloid plaques and ensure appropriate treatment. While there is concern among providers and patient stakeholders that the decision may lead to uncertainty on coverage and possible claim delays following the end of CED, MITA is encouraged by the statement in the final decision memorandum by CMS that “Based on the evidence, we believe there will be consistent coverage across regions for appropriate Medicare patients.” MITA calls on CMS and the MACs to work with neurology and Alzheimer’s disease stakeholders to ensure there is seamless and consistent coverage for amyloid PET. MITA looks forward to working with CMS, the MACs and Medicare Advantage plans on implementation of coverage for beta-amyloid PET.

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NEWS CLARIUS DEBUTS DUAL-ARRAY WIRELESS HANDHELD SCANNER Emergency physicians attending the ACEP23 conference in Philadelphia were the first to see the new Clarius PAL HD3, a wireless handheld whole-body ultrasound scanner combining phased and linear arrays on a single head. This device offers superior image quality and exceptional versatility for real-time imaging of both superficial and deep anatomy at the bedside, making it suitable for a wide range of clinical applications while improving workflow continuity. It’s as compact as an iPhone and works seamlessly with iOS or Android devices, ensuring easy mobility from patient to patient. Clarius PAL HD3 has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) and is available in the United States for $5,395 plus $595 for the first year of membership. “The Clarius PAL is a big breakthrough for Clarius and for clinical ultrasound in general. Integrating the phased and linear array means you only need one transducer for 95 to 99% of the studies at the

bedside,” says Dr. Tom Cook, an emergency physician and ultrasound educator who practices in South Carolina. “I work at a hospital with a big trauma center and being able to carry just one scanner to the bedside to get the best high-quality image to scan every part of the body in a few minutes is incredibly powerful. Everybody’s very, very excited about it in my department.” With the broadest frequency range in a handheld ultrasound scanner, Clarius PAL HD3 is the only whole-body handheld scanner to deliver high-resolution images from the skin down to 40 cm of depth. Health care professionals can perform whole-body ultrasound exams without the need to swap devices or to transport bulky systems between rooms, especially in critical care settings like the emergency room. Clarius PAL HD3 is the 11th wireless handheld ultrasound scanner in the Clarius specialty ultrasound lineup.

NANOX, VAREX TO ADVANCE NANOX.ARC MEDICAL IMAGING SYSTEM NANO-X IMAGING LTD has entered into a manufacture and supply agreement with Varex Imaging Corporation. Varex will supply X-ray tubes utilizing the Nanox digital X-ray source for the Nanox.ARC system. The agreement was entered into after Varex completed, over the last several months, an assessment of Nanox’s novel digital X-ray source. The Nanox.ARC is a 3D tomosynthesis multisource imaging system that uses a proprietary and novel digital cathode X-ray source that Nanox believes can achieve the same functionalities as legacy X-ray cathodes, while allowing for lower-cost production than existing medical imaging systems. The company’s holistic, end-to-end imaging solution integrates the Nanox.ARC and Nanox’s teleradiology services, and, in the future, Nanox intends to add artificial intelligence (AI) technology for a seamless continuum from image capture through AI analysis and interpretation by trained radiologists. “We are pleased to announce our manufacturing and supply agreement with Nanox. This agreement reflects our belief in the future importance of cold cathode technology,” said Sunny Sanyal, chief executive officer of Varex Imaging. “Together, we aim to advance medical imaging technology, reduce costs and make a meaningful impact on global health care. We look forward to a fruitful and innovative journey ahead.”

ICEMAGAZINE | DECEMBER 2023

Under the agreement, Nanox may order X-ray tubes from Varex for use in its Nanox.ARC system. Varex agreed to manufacture and supply the X-ray tubes in exchange for payment therefor in the form of a revenue-sharing fee (subject to a minimum annual amount per system) based on the company’s pay-per-scan revenue from Nanox.ARC systems using Varex X-ray tubes worldwide. Subject to receipt of requisite local regulatory clearance, Nanox has also agreed to use Varex X-ray tubes in a minimum percentage of all Nanox.ARC systems that are deployed and operating. On April 28, 2023, the company received a 510(k) clearance from the U.S. Food and Drug Administration to market the multi-source Nanox.ARC (including the Nanox.CLOUD, its accompanying cloud-based infrastructure), as a stationary X-ray system intended to produce tomographic images of the human musculoskeletal system adjunctive to conventional radiography, on adult patients. This device is intended to be used in professional health care facilities or radiological environments, such as hospitals, clinics, imaging centers and other medical practices by trained radiographers, radiologists and physicians. Representing a major advancement in X-ray tube technology, Nanox.ARC is a multi-source digital 3D tomosynthesis system that utilizes novel, cold cathode X-ray tubes, which the company intends to offer using an innovative pay-per-scan business model. •

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NEWS

PRESENTER SHARES CT TURNAROUND TIPS STAFF REPORT

he ICE webinar “Improving Abdominal CT Turnaround Time in the Emergency Room” presented by SSM Health Director of Clinical Operations Jessica Chambers, MHA, RT(R)(CT), was eligible for 1.0 ARRT Category A CE credit by the AHRA. Chambers has 22 years of imaging experience with her career starting with the U.S. Air Force as a radiology and CT technologist. After an honorable discharge in 2007, she continues her career with SSM Health as the director of clinical operation imaging services, with oversight of three hospitals and four outpatient imaging centers. Chambers took attendees on a process improvement journey in CT, to demonstrate how her facility went from an average turnaround time of 130 minutes down to 70 minutes for abdominal CTs with oral contrast. The goal of sharing the struggles and successes is to provide ideas to take back to CT departments and reduce the turnaround time for abdominal pain patients and reduce the overall length of stay in the ED. The webinar’s objectives included being able to identify gaps with performing abdominal CTs in the emergency department that cause extended delays, review initial state data, follow the process improvement pathway, review results and discuss results. Seventy-nine people registered for the webinar with 48 logged in for the live presentation. A recording of the webinar is available for on-demand viewing at ICE-

ICEMAGAZINE | DECEMBER 2023

webinars.live. Attendees were asked “Why do you join ICE webinars?” “ICE webinars also provide relevant and meaningful information as it pertains to the field of imaging,” said Angela Harris, mammography care coordinator, Harris Health System. “ICE always provides quality and timely education and topics,” Nancy Godby, director of radiology, Cabell Huntington Hospital Inc. To present a webinar, fill out the form at theicecommunity.com/apply-to-present. ICE webinars continue in 2024 and check out the upcoming ICE conference for additional continuing education opportunities. The Imaging Conference and Expo (ICE) is the only conference dedicated to imaging directors, radiology administrators, and imaging engineers from hospital imaging departments, freestanding imaging centers and group practices. ICE offers valuable CE credits and, keeping in line with successful conferences in the past, offers comprehensive educational opportunities for attendees. Whether it’s invaluable continuing education, productive networking or the exclusive exhibit hall, attendees will have the perfect opportunity to enhance their careers and spend time with colleagues. As an added incentive, ICE conference admission is complimentary for all hospitals, imaging centers, military and students. Find out more at AttendICE.com. •

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PRODUCTS

Market Report CONTRAST MARKET GROWTH EXPECTED

STAFF REPORT

rand View Research reports that the global contrast media market size was valued at $5.8 billion in 2022 and is expected to grow at a compound annual growth rate (CAGR) of 3.29% from 2023 to 2030. Growing prevalence of complex comorbidities and long-term diseases has led to an increase in diagnostic imaging tests including ultrasound, X-rays, and advanced imaging technology such as MRI and CT scans. For instance, in November 2019, GE Healthcare received the U.S. FDA approval for Clariscan, a contrast agent used for macrocyclic MRI. These products help in identifying the need for perioperative scans prior to surgeries and treatment in interventional procedures are likely to boost market growth. According to National Health Council, in 2020, nearly 157 million people in the U.S. were affected by chronic diseases, out of which around 81 million had multiple conditions, which is indicative of high incidence of chronic conditions. Grand View Research discussed the market more in a summary report. “The prevalence of chronic conditions with multiple comorbidities is higher among older adults. According to the National Council on Aging, nearly 80% of people aged 65 & above suffer from at least one chronic condition with almost 70% of Medicare beneficiaries suffering from more than two chronic conditions and nearly 77.0 million people in the U.S. are estimated to be aged 65 & above by 2034,” the report states. “Furthermore, according to a report by American Heart Association, the incidence of heart failure is increasing in the U.S., and it is one of the leading causes of death in the country. In 2020, approximately 659,000 people died due to cardiovascular diseases in the U.S. By 2030, the number of people with heart 26

ICEMAGAZINE | DECEMBER 2023

diseases is estimated to increase by 46%,” it adds. Grand View Rresearch says that the COVID-19 outbreak had a detrimental influence on the contrast media market. “As a result of the pandemic, health care systems have been severely stressed. Health care providers and institutes were ordered to stop performing medical evaluations and elective surgical operations to conserve health care resources for COVID-19 patients and avoid the spread of the disease,” the report states. “For instance, during the early months of the pandemic, diagnosis of heart illnesses fell by roughly two-thirds over the world, as countries and patients focused on COVID-19. Similarly, screenings for colon, breast, prostate, and lung fell by 75%, 85%, 75%, 74%, and 56%, indicating a revenue drop in 2020.” Mordor Intelligence issued a report with similar findings. “The contrast media market size is expected to grow from $5.37 billion in 2023 to $6.13 billion by 2028, at a CAGR of 2.71% during the forecast period (2023-2028),” according to Mordor Intelligence. The health care system has witnessed enormous challenges as a result of the COVID-19 pandemic, Mordor Intelligence adds. “All outpatient treatments were postponed or restricted during the COVID-19 pandemic to reduce the risk of viral transmission, as most chronic pain therapies were regarded as non-urgent. Conversely, a chest CT scan is a prominent procedure used in the diagnosis of COVID-19. The first study on CT diagnosis of COVID-19 patients was published in the Lancet Journal in January 2020,” the report adds. “Since then, the chest CT for pulmonary embolism has been increasingly used for a prognosis of the disease, as they are efficient in both alternative diagnoses and identifying complications of COVID-19. Thus, the market for contrast media is estimated to expand during the forecast period.” • ADVANCING THE IMAGING PROFESSIONAL

Product Focus

Contrast Imaging

HOLOGIC

Breast Health Contrast Technology I-View 2.0 Contrast Enhanced Mammography (CEM) technology is an alternative to breast MRI that provides equivalent diagnostic performance.1,2 The technology acquires a pair of high- and low-energy images in rapid succession to eliminate the structural background, and display regions of abnormal blood flow. Patients report preferring CEM over breast MRI thanks to its faster procedure time, greater comfort and lower noise level.3 The technology can easily be added to any Selenia Dimensions or 3Dimensions mammography system, allowing clinicians to expand their contrast capabilities using existing mammography equipment. When I-View 2.0 Contrast Enhanced Mammography is paired with Affirm Contrast Biopsy software, the technologies allow clinicians to target and acquire tissue samples in lesions identified with CEM where a correlate may not be found on a FFDM, DBT or ultrasound image. The contrast agents used are the same as the ones commonly used in standard CT examinations. REFERENCES 1.

Chou C, Lewin J, Chiang C et al. “Clinical Evaluation of Contrast-Enhanced Digital Mammography and Contrast Enhanced Tomosynthesis-Comparison to Contrast-Enhanced Breast MRI” Eur J Radiol. 2015 Dec; 84(12):2501-8. [Epub 2015 Oct 1].

Jochelson M, Dershaw D, Sung J, et al., Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma, Radiology 266 (3) (2013) 743–751

Hobbes M, Taylor D, Buzynski S et al. “Contrast-enhanced spectral mammography (CESM) and contrast enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preference and tolerance” J Med Imaging Radiat Oncol. 2015 Jun;59(3):3005. [Epub 2015 Apr 21].

*Disclaimer: Products are listed in no particular order.

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PRODUCTS FUJIFILM

Contrast-Enhanced Digital Mammography In 2022, FUJIFILM Healthcare Americas Corporation received 510(k) clearance for Contrast-Enhanced Digital Mammography (CEDM), an emerging modality that combines digital mammography with the administration of intravenous contrast material. Fujifilm’s CEDM offering uses a dual-energy technique performed after the IV administration of an iodinated contrast agent to identify abnormalities on the basis of angiogenesis, as well as morphologic features and density. The physiologic information provided by CEDM is similar to that provided by breast MRI, without the added time or expense of conventional breast MRI protocols. The combination of morphologic and physiologic information provided by CEDM has been shown to provide superior sensitivity and specificity in diagnosing breast cancer when compared with digital mammography alone.

CARESTREAM

DRX-Excel Plus System Fluoroscopy provides excellent image quality and supports a wide range of exams. Carestream has specifically optimized this technology for large hospitals and imaging centers with its Carestream DRX-Excel Plus System. The DRX-Excel Plus System combines the power of fluoroscopy and general radiology in one compact unit to deliver high-resolution images for an accelerated workflow while offering a wide range of exams. It also delivers accelerated workflow, high-resolution images and easy, convenient operation. It is available as a dRF configuration with a single, flat-panel digital detector for both RAD and fluoroscopy. Recent enhancements to the DRX-Excel Plus System include an Adam console to fully integrate the dRF system with LLI auto-stitching capability; a redesigned graphic user interface with ergonomic features for a better user experience and a faster workflow; a dynamic digital flat panel detector with higher resolution and higher DQE; and an overhead tube crane and wallstand bucky as additional options to extend the system’s capabilities.

*Disclaimer: Products are listed in no particular order.

ICEMAGAZINE | DECEMBER 2023

ADVANCING THE IMAGING PROFESSIONAL

SIEMENS HEALTHINEERS myExam Companion

The NAEOTOM Alpha photon-counting computed tomography (CT) scanner as well as the SOMATOM X. and SOMATOM go. CT platforms from Siemens Healthineers feature myExam Companion, an intelligent user interface that uses clinical language and easy-to-follow visuals to enable even inexperienced users to find the optimal combination of parameters for every patient and procedure. Dual Energy spectral imaging and CARE kV help the radiologic technologist maintain or improve image contrast-to-noise ratio while reducing the amount of contrast media for each patient. Together with GO technologies, these CT scanners deliver personalized imaging for precise dose and contrast media optimization. The combination of CARE Contrast III and predefined default contrast media protocols¹ with myExam Companion clinical decision trees offers a holistic contrast media management solution, increasing process efficiency and supporting standardization in quality of care by permitting common management of CT scan and contrast injection protocols. The Check&GO intelligent algorithm flags problems with scan coverage and contrast distribution. The FAST ROI (Region of Interest) feature identifies the correct location for the ROI placement for bolus tracking with a target accuracy of nearly 100%. Additionally, an integrated, gantry-mounted injector arm addresses the cost and complexities of traditional pedestal- and ceiling-mounted injector solutions. Finally, the SOMATOM Drive and SOMATOM Force Dual Source CT scanners also offer FAST Bolus2 for optimized contrast media management. FAST Bolus enables automated, personalized scan trigger delays to show a more uniform contrast attenuation compared to fixed post-trigger delay scans

¹ The FDA does not endorse the factory contrast protocols over the range of drug administration options provided in the drug label. ² FAST Bolus is not approved for pediatric patients.

UNITED IMAGING uMR OMEGA

Whether your MR imaging needs require a traditional contrast injected approach or a more modern-day non-contrast imaging technique, United Imaging provides the solutions you need to offer advanced clinical imaging in today’s ever-changing health care environment. The uMR OMEGA is a world-class 75 cm, ultra-wide-bore 3T MRI with a 60 cm field of view and ultra-high homogeneity for impeccable skin-to-skin fat saturation and consistent image quality. The system includes an industry-leading table weight capacity of 680 pounds, powerful 45/200 gradient performance, and a calming starlight environment for enhancing the patient experience. The Angiography Clinical Application Package includes specialized sequences, protocols, and workflows for the fastest and most comfortable vascular examinations, with and without contrast. Empowered by amazing uAiFI technologies, the uMR OMEGA can perform complete high-resolution exams in under 100 seconds utilizing AI-assisted Compressed Sensing (uAI ACS). With All-In Configurations and Software Upgrades for Life, the uMR OMEGA allows you to expand your current angiography examination services now and into the future, so you will never fall behind with outdated technology. • WWW.THEICECOMMUNITY.COM

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COVER STORY

LEADERSHIP VACUUM Where are the next generation of medical imaging leaders, and how do we find them?

ICEMAGAZINE | DECEMBER 2023

ADVANCING THE IMAGING PROFESSIONAL

COVER STORY BY MATT SKOUFALOS

eaders in the medical imaging space tend to fall into one of two categories. The first are former technologists. Passionate about their work, but often promoted into management roles without any formal leadership training, the tone set in their departments typically begins and ends with their own inclinations and personal experiences from years spent in the field. The second group, from among which many top-level executives are sourced, can be people with some sort of business leadership background, but not necessarily any specific experience in medical imaging; maybe not even in health care. They have business training, but no practical understanding of the day-today mechanics of the job their subordinates do. Set against the backdrop of a high-volume or high-stress work environment that places exceptional burdens of time and responsibility upon management-level positions, it’s easy to see why it can be a fraught proposition to sit in the captain’s chair at any level of the workplace. With technologist-level careers commanding strong salaries in a labor-driven market, mass retirements of baby-boomer-aged workers, and general transitions out of all manner of careers through the Great Resignation from the national labor force, leadership in the medical imaging space is in flux. Elena Danilova, executive director of clinical development at the Gurnick Academy of Medical Arts in San Mateo, California, is an MRI technologist who sees medical imaging leadership as managing the obligations of the workplace, including its cultural expectations. “Right now, I see two types of leaders,” Danilova said. “The first are leaders because of seniority. Often, they have no specific education, training or innate leadership skills. Sometimes they use sticks and carrots to get work done. Their primary focus is meeting deadlines and completing tasks by any means.” “The second type of leaders are developed from imaging enthusiasts: they went to professional imaging school and possess required and specific training. Those leaders might frame how things should be done based on their feelings, knowledge of the current needs and trends, and experience,” she added. Danilova foresees future imaging leaders emerging from imaging schools, or programs tailored to develop leadership skills specific to the imaging environment. She came from just such a program, and looks for some common characteristics of emergent leaders among students in her classes. After a strong command of practical skills in the field, those imaging professionals with the most innate potential for leadership demonstrate an analytic curiosity about how things should be done. They keep themselves accountable for their studies and the quality of their education, and when they graduate from imaging school, Danilova recommends that they continue their education comprehensively, and soon. “Some of those technologists are very ambitious and they want to grow; they want to make things better,” she said. “They’re willing to go to school, receive their bachelor’s degrees, and go back in the field and lead.” “Leaders have to have the right personality,” Danilova said. “If you want to make good, positive changes, you have to stand up for yourself; know how to manage people, how to delegate, and don’t micro-manage people.” Importantly, Danilova also stressed that effective leaders demonstrate self-reliance, and model the approaches they want their staff to follow. Leadership requires the additional strategic thinking that supports effective team-building. Setting the example you wish others to follow establishes trust because it WWW.THEICECOMMUNITY.COM

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COVER STORY shows an equal willingness to take on any delegated task, no matter how unpleasant, and provides a basis for support that is built upon compassionate and empathetic understanding. “If I ask somebody to do something, I have already done it,” she said. “If I’m not an expert in something I’ve assigned to you, how can I assess or evaluate the job you did? I need to know it first, I need to give you adequate training, and then assign the task to you.” “You can only give me quality work if you know how to do it, if you’re confident, and if you are skilled in what you’re doing,” Danilova said. Perhaps most significantly, she said, the best leaders understand that they won’t hold their titles and positions forever. Another component of leadership involves planning for exiting the leadership role, which means fostering the professional development of the people they manage that show potential for leadership. “A good leader cares about their people, and tries to find a way to bring educated and passionate people to their team,” Danilova said. “They look for good leaders in their team, and they try to develop new levels of leaders, so they’re not afraid to be outshined or replaced. If it’s about tomorrow, the organization should not suffer any hiccup in operations.” Henry Ford is quoted as having said, “The only thing worse than training your employees and having them leave is not training them and having them stay.” More recently (and affirmatively), the same concept was framed by Richard Branson as, “Train people well enough so they can leave; treat them well enough so they don’t want to.” Danilova sees the wisdom of both quotes as it applies to managing people. “I always tell my partners, we need to raise the right people who will take care of us,” she said. “The bottom line is, we’re people. We’re getting older; we’re going to retire. 34

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We’re going to have MRIs and CTs and X-rays, and when you go to the hospital, how do you want to be treated? Do you want to have artists in their field, or people who want to do a job and go home?” Suzieann Bass, associate professor and program director for radiography, management and education at the University of Texas MD Anderson Cancer Center, said it’s important for leadership hopefuls to identify positive examples of leaders in their lives, and learn from those examples. At an academic institution like hers, there’s no shortage of standout professionals in the field, and two of them – Aziz Benamar, executive director of operations for diagnostic imaging; and William Undie, professor and associate dean of academic affairs — she cites as servant leaders who set clear expectations and never stop improving. “Aziz is a visionary,” Bass said. “He’s a really big proponent of how education can change; how to advance the imaging department through students. He’s passionate about the department; he looks at every avenue to develop his people.” Bass described how Benamar and Undie established STARS, a talent pathway program at MD Anderson, whereby students working for the division as assistants can then transition into CT and MR technologist roles upon graduation. That way, they roll seamlessly into employment already knowing the institutional culture, the ins and outs of their departments, and the equipment used in their roles. In working with Undie, Bass said she’s grown tremendously by following the example set by the behavior he models in the workplace. Watching how Undie handled volatile situations with a calm demeanor inspired Bass to fortify her emotional intelligence, and to realize that the concept of servant leadership requires a holistic appraisal of the impact of individual attitudes within the workplace.

“Now I’m in a leadership role, and now I get it,” she said. “It’s ‘we,’ not ‘me,’ and there’s some times that I have to step back and say, ‘How is it going to impact everybody?’ The students, my team – everybody’s under stress. I have to think about the other people in the program.” “When students go through our program, they’re getting those servant leadership skills,” Bass said. “They’re getting different types of leadership. They’re saying, ‘This is not the type of leader I want to be,’ or ‘This is the type of leader I want to be.’ We know the education is reliable and valid because it’s what the managers and leaders are doing in their everyday life.” Bass also said she’s picked up valuable leadership insights from past AHRA (the Association for Medical Imaging Management) CEO Edward J. Cronin Jr. Her participation in AHRA over the years was guided by Cronin’s efforts to empower medical imaging professionals to take steps into leadership roles within their institutions through the AHRA basic leadership academy. “For me that was what was needed so you can see what the leaders go through; so that you can see that having an education and getting your bachelor’s degree has an impact later on,” Bass said. “Just having the experience is not all it is anymore. You have to have that education piece behind it.” Finally, Bass pointed out that getting the best out of a leader also means fostering an institutional culture of psychological safety and preventing burnout. “When you have someplace where they really look at making sure that your workplace is positive, and they make sure you’re safe, they work at eliminating unconscious bias and emphasizing inclusivity, it really makes a difference in how happy you are when you come to work every day,” she said. “It is essential for fostering that sense of pride and ownership. I love where I work.” ADVANCING THE IMAGING PROFESSIONAL

COVER STORY Nicole Dhanraj, chief strategist of the 424 Business Group, warned that without institutional cultural shifts to create psychologically safe and welcoming workplaces, she deeply doubts those same institutions can develop the next generation of leaders. Health care senior leaders must reevaluate their understanding of leadership obligations in a postCOVID-19 world, learning from the Great Resignation and embracing that healthy workplaces are built on qualitative values, not quantitative ones. “There should not be an expectation that as a leader, you’re going to work 80 hours a week,” Dhanraj said. “You don’t get a gold star for going on four hours of sleep. We need to move away from that mindset, and establish healthy work-life boundaries for our team and their leaders.” “So many of my colleagues are having Sunday evening anxieties because of the dumpster fires they have to deal with on Monday,” she said. “You’re not supposed to conquer the world by yourself. We need to approach our operation through incremental steps aligned with the organizational strategic vision.” Part of the same process by which strategic vision is developed involves regarding moves into different leadership roles along a similar, incremental process. Dhanraj spoke about the “huge leap” that she took in transitioning from a technologist role to a director position, and the high stakes associated with the prospect of failure therein if someone is not fully prepared to meet the demands of their job. “We’re so broken in health care,” she said. “If a new leader makes mistakes, and they’re really drowning due to the high workload, they’re going to look less competent and be less successful. Instead, we should ensure our WWW.THEICECOMMUNITY.COM

next generation leaders have a better career plan, and formalize that plan. Especially with today’s generation and work options, why is it that we cannot be flexible, or adjust positions to what employees want? We need to consider a new work culture if we want to attract the next generation of leaders.” “We’re supposed to be allowing experimentation and failure, but organizations are not open to having people learn and make mistakes,” Dhanraj continued. “Organizations promote Just Culture; a majority of organizations actually follow Just Culture. Yet at the end of the day, many employees in Just Culture settings face disciplinary action for their mistakes. Nobody wants to go into leadership because they don’t want to get the blame when something goes wrong, and they certainly don’t want the level of stress associated with the leadership position.” Dhanraj also believes part of the problem is inherent to the do-it-all attitude that underpins the values of a successful imaging professional. “If your senior leaders tell you to do something, imaging leaders are of the mindset to get it done at whatever cost,” she said. “We get the work done because we’re known to do what it takes to make things work.” “We are groomed to be very reactive, jumping to perform the exam in front of us,” Dhanraj said. “When front-line staff are put into leadership positions, they quickly jump into activities, as opposed to strategically thinking about a course of action. We’re all so gungho in doing things that nobody’s really pausing to strategically think about things, or question our senior leaders.” One possible antidote to that mindset is a concept of provocative curiosity, an approach that Dhanraj said inspires leaders to look beyond what’s going on and question what could be instead.

Employees who believe that their concerns won’t be addressed eventually stop alerting managers to issues that could be intercepted before they worsen; the cumulative cost of that discouragement means that staff disengage and withdraw altogether. Instead, she believes that the medical imaging space should develop formalized, industry-specific mentorship programs to position the next generation of leaders for practical effectiveness in such roles. “You already have the next generation of leaders, but nobody’s willing to give them a chance, or spend ample time to train them,” she said. “We need to proactively help our newer leaders navigate their own thinking and recognize opportunities to grow their mindset and overall knowledge. That’s how you develop leaders who will want to stay and lead radiology into tomorrow.” •

“YOU’RE NOT SUPPOSED TO CONQUER THE WORLD BY YOURSELF. WE NEED TO APPROACH OUR OPERATION THROUGH INCREMENTAL STEPS ALIGNED WITH THE ORGANIZATIONAL STRATEGIC VISION.” - NICOLE DHANRAJ

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INSIGHTS

CODING/BILLING

BY MELODY W. MULAIK

IT’S EDIT TIME AGAIN T

he beginning of the year always brings new coding changes as well as other changes, such as updates to the Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI) guidelines and coding edits. It is important that you review the new guidelines and edits to identify their potential impact to your charge capture process within your organization. The manual is located on the CMS website at the end of this article. To get into the details of diagnostic radiology edits you should first read Chapter 9 which includes guidelines for diagnostic radiology services. This chapter contains a great deal of helpful information. Interventional services are covered in other chapters corresponding to the procedure codes for those services (vascular, biliary, etc.) Anyone involved with, or responsible for, ensuring radiology coding and charge capture should download a copy of the latest version of the manual and review it carefully. The manual is updated each year in the fourth quarter for the coming calendar year, and in December CMS will post the 2024 version of the manual. To make it easier to identify the changes from year-to-year CMS highlights the information with red text for additions and red strikethroughs for deletion. When you see red, that’s your cue

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to stop and read carefully because the information is either new or revised. Other payors also use bundling edits. Commercial payors and managed care plans may use some or all of the CCI edits and may also use their own proprietary edits that are not part of CCI. Typically, the edits consist of pairs of codes that should not normally be reported together. When the two codes are reported by the same provider for the same patient on the same date of service, the provider will receive payment for the higher-paying code that appears in Column 1 of the edits and will not be paid for the lower-paying code that appears in Column 2. This type of edit is referred to as a Procedure-to-Procedure (PTP) edits. The majority of radiology edits fall into this category. The PTP edits also include mutually exclusive code pairs. These are pairs of services that cannot reasonably be performed at the same anatomic site or same patient encounter. With mutually exclusive code pairs, the lower-paying code is in Column 1 of the edits, so the provider will be paid only for the lower-paying service. There are very few radiology edits that are classified as mutually exclusive. Each code pair has a modifier indicator that shows whether the edit can be bypassed with a modifier. If there are situations when it is appropriate to report the two codes on the same day – for example, if the procedures were performed during separate encounters

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or on different anatomic areas – then the code pair will have modifier indicator 1, meaning that the provider can use a modifier to show that the services were separate and distinct. However, if the code pair has modifier indicator 0, this means there are no circumstances under which Medicare would ever consider both services to be separate and distinct, and the Column 2 service will be denied even if a modifier is applied. A second type of edits is the Medically Unlikely Edits (MUEs). According to CMS, MUEs are automated prepayment edits that help prevent inappropriate payments. An MUE for a HCPCS/CPT® code sets the maximum units of service allowed by Medicare for a single beneficiary on a single service date. In addition, MUEs do not exist for all procedure codes. CMS develops MUEs based on anatomic considerations, HCPCS/CPT® code descriptors, CPT® coding instructions, established CMS policies, the nature of the service or procedure, the nature of equipment used to complete the procedure, and clinical judgment. The third type of edits to the CCI collection are called Add-on Code edits. These edits consist of a list of add-on procedure codes together with their recognized base codes. Finally, the manual notes that although the base code and the add-on code will normally have the same date of service, there may be unusual circumstances where different dates of service apply. You can find all of the CCI edit files by scanning the QR code below. Edits can create confusion and frustration for anyone involved in the coding and charge capture process for radiology services. It is critical that the individuals responsible for reviewing patient charge information be very familiar with the edits and how they should be handled for radiology services. It is not as straightforward as determining whether we can bypass an edit. We must look to authoritative guidance to drive our decision-making process. Communication between radiology and revenue cycle staff is key and it should be viewed as an ongoing dynamic process. •

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CCI EDIT FILES ICEMAGAZINE

INSIGHTS

EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI

DEALING WITH ‘DIFFICULT’ PEOPLE

ll too often, when people tell me about their workplace troubles, frequently those problems are exacerbated by someone referred to as “difficult.” There’s a philosophy I share when I hear this and it goes like this: 1. People are not difficult, they’re different. 2. The thing that makes working with these people difficult is that we’ve not yet learned to communicate in ways that work for them. You’re probably thinking, “But you don’t know my coworker!” Yes, people are complex creatures, and you are correct. I don’t know your coworker. But I do know ways to adapt so that interactions are less “difficult.” Every person has unique cognitive preferences, which involves what we notice, how we process information and how we make decisions. We also have behavioral tendencies, which involves a blend of how we approach problems, how we influence others, how we follow rules and how we prefer the pace of our day to go. When we pair up nearly 20,000 possible cognitive styles and 20,000 possible behavioral styles we get hundreds of thousands of personality possibilities. But wait, there’s more. Everyone also has a different blend of motivations, some of which are innate and some of which are learned. Add those to our multi-dimensional model and we get more than 130 trillion possible personality combinations. Each person has a unique fingerprint, so it makes sense that we also have unique personalities. Thankfully, even if we only understand the basic categories, we can make great strides when working with different styles. HOW DO WE DO THIS? The first key to success in dealing with “difficult” people is realizing that we have choice in how we deal with them. We can criticize differences, or we can choose to see the value in them. One of the best ways to make headway in this is to become a student of styles. Why? Because to work effectively with so-called difficult people, we need

ICEMAGAZINE | DECEMBER 2023

to be able to adapt. Think about it. If we maintain our own unique style and don’t adapt, and someone else maintains a different style and also doesn’t adapt, then we have two people who see each other as difficult. However, if even one person reaches out and adapts, then forward progress becomes much easier. If you’re like me, you failed telepathy in high school, and that means we need to become students of the different styles so we can better understand the different ways people can be. The better we get at understanding and adapting to the different styles, the fewer “difficult” people we’ll encounter. COGNITIVE STYLES I mentioned earlier that people notice different things, process information differently and also make decisions in different ways. Cognitive assessments identify our tendencies in these areas, including the Myers-Briggs Type Indicator and the Keirsey Temperaments Sorter. If you’re on a tight budget, a free online resource to learn about these areas is the 16 Personalities assessment. In addition to the areas mentioned above, you will also learn about the different ways people get and spend energy. The key to success when studying any of these is to remember that no good or bad exists for any plot point on any graph. Every preference has strengths and every preference has blind spots. The best way to approach these differences is to choose to value the differences instead of criticizing them. BEHAVIORAL DIFFERENCES As mentioned, each person also has a preference for approaching problems, influencing others, following rules and maintaining workday pace. The DISC language best describes the different ways these preferences manifest. Of all the personality arenas, the DISC behavioral styles are the easiest to learn because they are observable. DISC is an acronym for the preferences measured in DISC assessments.

ADVANCING THE IMAGING PROFESSIONAL

• • • •

D – Dominant in the face of problems and challenges I – Influencing people and contacts S – Steady in pace and consistency C – Conscientious in policies and constraints People have preferences toward or away from those descriptors. When we learn the DISC language it becomes easier to recognize the different styles and because each style has a different communication preference, when we recognize them, it’s easier to adapt. MOTIVATIONAL STYLES Perhaps the most complex facet of personality is motivations. That’s because we all have innate (or natural motivations) and also learned (or imprinted motivations). Natural motivations are on par with what are known as Multiple Intelligences, a theory proposed 40 years ago by Harvard professor Howard Gardner. His work transformed the fields of psychology and education, plus dare I say, workplace teams, if we realize the value of what Gardner discovered. Gardner identified nine different areas of intelligence: • Verbal-linguistic • Mathematical-logical • Musical • Visual-spatial • Bodily-kinesthetic • Interpersonal • Intrapersonal • Naturalist • Existential Why do I count these different types of intelligence as motivators? My perspective is people are naturally motivated to do and learn more in areas where they have natural intellect. For example, if a person scores strong in Naturalist Intelligence, that person will be innately motivated to do and learn more in things having to do with nature. Learned motivators are formed in our early childhood through events that create an emotional imprint. Six basic continuum exist in this arena, and imprints in these areas drive our behavior. • Theoretical – Driven by the discovery of truth and knowledge • Utilitarian – Driven by practicality, usefulness and ROI • Aesthetic – Driven by form and harmony • Social – Driven by a desire to help others • Individualistic – Driven by personal power and influence • Traditional – Driven by a sense of order and structure As mentioned, the motivational spectrums become complex, but they’re super valuable to know because if we know what we’re looking for, we can minimize the uncommonly high level of “difficulty” that can exist between people with differing motivators. Bottom line, to deal better with so-called difficult people, the best staring point is to become a student of what makes each of us tick. • 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

DIRECTOR’S CUT BY NICOLE DHANRAJ

WHO’S IN YOUR VILLAGE? W

hat a year it has been! For many of us, last year, like the year before, and the year before … battered and bruised us. Have you caught your breath yet? Are you questioning will this year be better? Leading has become more challenging than ever. We often find ourselves in the trenches, navigating the complexities of our roles, drinking from the firehose, intermittently questioning or even cursing our chosen path, and sometimes silently rethinking our career. Amid the chaos, we must remember this – we’re the ones who lead our team to make the magic happen. But making magic is a daunting task, not meant for the faint of heart. While many of us are built to last and to withstand a lot, we should not operate alone, carrying personal and professional burdens in isolation. It is neither healthy nor needed to suffer in silence. THE COURAGE TO CONTINUE Winston Churchill said, “Success is not final; failure is not fatal: It is the courage to continue that counts.” For me, my support system is made up of close friends and colleagues. They are on speed dial, and I know the ones I can call when I need a kick in the behind, some kind words or to nudge me back to reality. Regardless of its shape, a robust support system can work wonders, helping us: • Relieve Emotion: An outside perspective is always helpful to tame emotions and handle situations logically and with poise. • Make Better Decisions: Complex issues require diverse perspectives, and

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•

a support system can offer fresh insights and solutions that lead to more informed and thoughtful decisions. Rekindle Our Mojo: When we are checked out, despondent, or ready to throw in the towel, encouragement from peers can rekindle our mojo and help us to maintain our focus or refocus our perspective on the mission. This is not easy work. We need a village to cheer us on! Bounce Back from Setbacks: When setbacks occur (as they inevitably do, especially at the right times – NOT!), a support system can help us rebound with resilience and move through the process quicker. Give Strength and Confidence: Intermittent reminders of what a good human we are, and our excellent work are so critical to help us find the strength and confidence in these trying times!

WHO’S IN YOUR VILLAGE? Building your village is not a one-time task but an ongoing journey. As imaging professionals, we evolve in our roles, and continue to face new challenges as we grow both personally and professionally. Consequently, our support needs may change over time. Here are some folks I recommend you add to your village. The Realist: Maybe when your heart is being too hopeful, you are being taken advantage or just have your head stuck in the clouds for too long, these folks help you see the facts and manage realistic expectations. Though I struggle with the face value of reality, these are much needed people in my life. They ground me often, I hate the stench of reality.

ADVANCING THE IMAGING PROFESSIONAL

The Dreamer: Gosh I love these people, they list and fire my inner dreamer. When I think big, they help me think bigger and make no dream sound too far-fetched to accomplish. Dreamers are the perfect ones when you are feeling low or questioning your purpose. For me, I love dreaming. It is a way to help rekindle and refuel my raison d’etre! The Mentor: Over the years, it has been a struggle to find mentors either because I was introverted, or people just didn’t want to share their knowledge. But as I learned the art of asking for help, as well as connecting with people, I have a group of people that I tap into their experience and wisdom to provide guidance, share insights and help navigate challenges. The Cheerleader: Can you imagine your own personal cheerleading team? It is possible! People who just love you for what you are doing and continue to give you accolades and words of encouragement. This is a much-needed boost especially when emotionally drained, it helps you stay in the fight! The Challenger: Man, o man, these people sometimes make you question everything you know with the intent of growing you. They are tough on you, probably make you cry but they are much needed people in your life to shape you in the esteemed professional with phenomenal values, work ethics and a higher-level perspective of yourself. THE BIG V Imaging leaders are heroes, and the big V word is hard to get used to trying. We are often not vulnerable because the fear of judgment, rejection, or burdening others with our problems can be paralyzing. However, when we open up to others, we forge deeper connections and build stronger relationships, and wow, how smoother navigating this bumpy leadership life becomes! Here are some ways you can reach out for support: • Talk to a trusted friend or colleague: Building trust especially if we had prior challenges is tough, but don’t use past experiences to make a generalized statement about trust. Having someone to listen without judgment or offer a shoulder to lean on is priceless. Sharing experiences and even a few jokes can lighten the load. Sometimes, after a meeting that has me gritting my teeth, I text a friend in my “village” to tell me a joke or remind me of my super powers and all of the time that simple gesture alleviates my frustration.

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•

Consult a therapist or coach: Professional guidance can provide a fresh perspective and valuable tools for managing stress and making decisions. I was apprehensive of this approach, but these folks have real clinical strategies you can use to navigate situations, not to mention help you answer difficult questions as you craft the life/job you want. Journal or blog: “I can shake off everything as I write; my sorrows disappear, my courage is reborn,” is a quote from Anne Frank. Writing down your trials and strategies in a blog format help not only you but can inspire and assist others facing similar challenges. I wasn’t one to journal until recently. It has offered an outlet and a place to reflect. It helps me dig deeper into my thoughts and feelings. It has been rewarding and seemed to have allowed me to understand myself and thus know the areas to do more self-improvement. Engage with family: Some find solace in confiding in loved ones. Sharing your experiences can foster understanding and empathy and give them a sense of value in supporting you. For the most part I have kept my family out of my work challenges, but as I opened up more, and sought their perspective, it has offered relief.

HERE FOR YOU Remember, you’re not alone. We’re all in this together, navigating the complexities of radiology directorship. Let’s face the challenges together. We’re leaders, the best of the best. Together, we can build a brighter future for radiology. Key being together! Yeh, there are some wolves amongst us, but some are genuine people that care for you and want to see you thrive. I’m here for you too. If you ever need a listening ear, a shoulder to cry on, or simply someone to remind you how awesome you are when others aren’t seeing it or saying it, please don’t hesitate to contact me and list me as your village member – and yes on speed dial! As an imaging leader, our village is essential and a lifeline for success and resilience in these trying times. I urge you to create your village, and don’t hesitate to say, “I need an ear, or shoulder.” • Nicole Dhanraj, Ph.D., SHRM-SCP, PMP, GPHR, CPSS, CRA, R.T(R)(CT)(MR), is an experienced imaging director.

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INSIGHTS

PACS/IT/AI

FDA APPROVES NEW AI FOR IMAGING

BY MARK WATTS

he FDA has published a new list of approved artificial intelligence/machine learning products. This compilation is not intended to provide an exhaustive or all-encompassing reference for medical devices incorporating AI/ML technology. Rather, it serves as a catalog of such devices spanning various medical disciplines, primarily drawn from information found in the summary descriptions of their marketing authorization documents. Key observations from this compilation: The insights we’re about to delve into have been derived from both publicly available information contained in the summary descriptions of marketing authorization documents and aggregated data from internal sources. It’s important to note that the publicly accessible summaries don’t encompass the entirety of the information often included in the full submissions, which can run into thousands, if not tens of thousands, of pages. Additionally, these summaries are typically composed by the application submitters, reflecting what they consider significant, which may not consistently encompass details about AI/ML techniques and other insights regarding broader trends. Growth trends: The year-over-year expansion of AI/ ML-enabled medical devices showed a deceleration in 2021 (15%) and 2022 (14%) following a substantial increase of 39% in 2020 compared to the previous year (2019). Projections for 2023 anticipate a significant growth of over 30% when compared to 2022. Distribution across medical disciplines: In the calendar year 2022, a notable 87% of the devices listed in this compilation were authorized in the field of radiology (122 devices), followed by 7% in cardiovascular (10 devices), and 1% each in neurology (2 devices), hematology (1 device), gastroenterology/urology (1 device), ophthalmic (2 devices), clinical chemistry (1 device), and ear, nose, and throat (1 device). 2023 authorizations: Up until the end of July 2023, 79% of the devices authorized this year fall under the

ICEMAGAZINE | DECEMBER 2023

category of radiology (85 devices), with 9% in cardiovascular (10 devices), 5% in neurology (5 devices), 4% in gastroenterology/urology (4 devices), 2% in anesthesiology (2 devices), and 1% each in ear, nose, and throat (1 device) and ophthalmic (1 device). Radiology dominance: Radiology stands out not only for having the highest number of submissions but also for exhibiting a consistent and steady rise in AI/ML-enabled device submissions compared to other specialties. Machine learning models: Machine learning models featured in these devices exhibit a wide spectrum of complexity, ranging from shallow models with fewer than two hidden layers to more intricate deep learning models. Hybrid approaches: A notable trend is the increasing adoption of hybrid approaches in model design. This approach combines various algorithmic methods to achieve the desired outcome of a safe and effective medical device. For example, some devices utilize one model for feature generation and another for classification. A few that I find of interest in radiology are: •

iCAC is a software device intended for use in estimating presence and quantity of coronary artery calcium for patients aged 30 years and above during routine care. The device automatically analyzes non-gated, non-contrast chest computed tomography (CT) images collected during routine care and outputs a visual representation of estimated coronary artery calcium segmentation (intended for informational purposes only) and both exact and four-category quantitative estimates of the patient’s coronary artery calcium burden in Agatston units. The output of the subject device is made available to the physician on-demand as part of his or her standard workflow. The device-generated calcium score or score group can be viewed in the patient report at the discretion of the physician, and the physician also has the option of viewing the device-generated calcium segmentation in a diagnostic image viewer. The subject device output in no way replaces the original patient report ADVANCING THE IMAGING PROFESSIONAL

or the original chest CT scan; both are still available to be viewed and used at the discretion of the physician. The device is intended to provide information to the physician to provide assistance during review of the patient’s case. Results of the subject device are not intended to be used on a stand-alone basis and are solely intended to aid and provide information to the physician. In all cases, further action taken on a patient should only come at the recommendation of the physician after further reviewing the patient’s results. • The Radiation Planning Assistant (RPA) is used to plan radiotherapy treatments for patients with cancers of the head and neck, cervix, breast, and metastases to the brain. The RPA is used to plan external beam irradiation with photon beams using CT images. The RPA is used to create contours and treatment plans that the user imports into their own Treatment Planning System (TPS) for review, editing and re-calculation of the dose. Some functions of the RPA use Eclipse 15.6. The RPA is not intended to be used as a primary treatment planning system. All automatically generated contours and plans must be imported into the user’s own treatment planning system for review, edit and final dose calculation. • Irregular Rhythm Notification Feature (IRNF) is a software-only mobile medical application that is intended to be used with the Apple Watch. The feature analyzes pulse rate data to identify episodes of irregular heart rhythms suggestive of atrial fibrillation (AFib) and provides a notification to the user. The feature is intended for over-the-counter (OTC) use. It is not intended to provide a notification on every episode of irregular rhythm suggestive of AFib and the absence of a notification is not intended to indicate no disease process is present; rather the feature is intended to opportunistically surface a notification of possible AFib when sufficient data are available for analysis. These data are only captured when the user is still. Along with the user’s risk factors the feature can be used to supplement the decision for AFib screening. The feature is not intended to replace traditional methods of diagnosis or treatment. The feature has not been tested for and is not intended for use in people under 22 years of age. It is also not intended for use in individuals previously diagnosed with AFib. • Gleamer device is intended to aid in the detection, localization and characterization of fractures on acquired medical images (per 21 CFR 892.2090 Radiological Computer Assisted Detection and Diagnosis Software For Fracture). • The intended users of BoneView are clinicians with the authority to diagnose fractures in various settings including primary care (e. g., family practice, internal medicine), emergency medicine, urgent care, and specialty care (e. g. orthopedics), as well as radiologists who review radiographs across settings. In summary, this compilation provides valuable insights into the landscape of medical devices incorporating AI/ML technology across diverse medical disciplines. While the growth rate of such devices has varied over the years, the field continues to evolve, and radiology remains a frontrunner in terms of submissions and growth. Additionally, the complexity of machine learning models and the use of hybrid approaches are notable aspects of this evolving field. • Mark Watts is an experienced imaging professional who founded an AI company called Zenlike.ai. WWW.THEICECOMMUNITY.COM

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INSIGHTS

DEI BY MARISSA M. FORRAY, MD, SARAH A. KONOPNICKI, DO, KYU K. JANA, MD, AND SAVANNAH J. PARKS, M.ED., LBSW

CONSIDERATIONS FOR BREAST CANCER SCREENING IN THE TRANSGENDER COMMUNITY

he U.S. Preventive Services Task Force (USPSTF) is an independent national body of experts that develops guidelines using evidence-based medicine to improve the health of the population nationwide by finding and preventing progression of disease. Current guidelines from 2016 directing recommendations for mammography are based on research involving cisgender women. Screening for cisgender women ages 40-49 years of age is targeted towards those with increased risk of breast cancer, including a family history of first degree relative, such as a parent, sibling or child. For the general population, the largest benefit is found when testing is completed every two years from 50 to 74 and may be altered based on shared decision making between patient and physician. These recommendations are being reviewed and are expected to be updated soon based on new research. As of May 9, 2023, the publicized rough draft of recommendations has expanded screening of the general population to as early

ICEMAGAZINE | DECEMBER 2023

as 40 or 45 and as late as 79. As such, many medical and research associations, including the American College of Radiology (ACR), have recommended screening starting at 40-45 years of age for the general population of cisgender women. These breast cancer screening guidelines are developed based on large population studies that do not consider the diversity of gender non-conforming patients. Due to the paucity of large-scale studies and epidemiologic evidence, we are left to make screening decisions based on limited data. Currently, there are no strictly defined screening recommendations for breast cancer in the transgender patient population. An added complication in establishing screening guidelines for transgender women is the heterogenous delivery of gender-affirming therapy and individual hormone fluctuations. When considering lack of evidence combined with lack of education about transgender patients in our medical system, it is important to discuss breast cancer screening of this often-neglected population. Breast tissue development typically peaks around 2-3 years following

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initiation of hormone therapy and contains breast ducts, lobules and acini. Transgender women receiving hormone therapy are subject to the same benign findings as cisgender women, such as cysts and fibroadenomas. Specifically, transgender women receiving hormone therapy for any length of time have shown development of denser breast tissue when compared to cisgender women. It is important to note that breast tissue development in transgender women is physiologically different from gynecomastia in cisgender men, as the latter results from hyperplasia of the ductal and stromal tissue. Breast malignancies have been identified amongst transgender women, emphasizing the need for screening guidelines. The most comprehensive study done on breast cancer risk and hormone therapy in the transgender population was conducted in the Netherlands. It is important to note that many studies, including this one, may contain bias as population diversity is limited by a range of factors. It was found that transgender women receiving hormone treatment have a 46-fold higher risk of breast cancer than cisgender men. Still, breast cancer risk was lower than in cisgender women with an incidence ratio of 0.3. Additionally, breast cancer risk increased with the duration of hormone therapy, but this would not necessarily change screening recommendations. Overall, the breast cancer characteristics in transgender women were similar to that of cisgender women. The risk of breast cancer in transgender women was previously thought to be greatest after 5 years of receiving hormone treatment, leading some physicians to initiate breast cancer screening in transgender women at the 5-year mark. However, hormone therapy regimens vary widely, as do hormone levels of individuals. These proposed guidelines also do not consider patients who stop taking hormone therapy for a variety of reasons, later to re-start their regimen. Breast development is also not one-size fits all, with peak breast density often reached before the 5-year mark. As such, the World Professional Association for Transgender Health (WPATH), the leading institution for transgender care worldwide, recommends screening transgender women per USPSTF breast cancer guidelines developed for cisgender women. This recommendation is also extended to other gender diverse people who were assigned female sex at birth who have retained natal breast tissue and are not receiving hormone therapy. There are several considerations in deciding wheth-

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er to screen annually versus every other year, and whether earlier screening is indicated. While tools such as the Gail Model from the National Institute of Health (NIH) can help decide on earlier or more frequent screening, they fail to include the transgender population in its algorithm. It is essential to discuss family history, smoking history, obesity, alcohol use and presence of breast prosthesis to make decisions with the patient. Testing for BRCA1 and BRCA2 should be considered in patients with strong family history of gynecological and breast cancers. Transgender women who have undergone gender-affirming breast procedures should undergo mammogram screening per the guidelines discussed previously. While breast implants have not been found to increase rates of breast cancer, they may obstruct full visualization of breast tissue, leading to missed diagnoses. Implant-displaced views should be obtained to decrease the chances of missing a lesion. It is additionally important to identify the type of breast augmentation that was done. While illegal in the United States, there have been cases of injections of free substances, such as silicone, that pose their own unique subset of imaging difficulty and medical complications. Particle injection has the potential to result in sclerosing masses that may make tissue visualization difficult both on mammogram and ultrasound. Contrast-enhanced breast MRI is more sensitive in differentiating between benign granulomas and malignancy. Therefore, a detailed history of breast augmentation should be obtained to determine the optimal screening modality. The evidence is equally lacking in general breast cancer screening guidelines in transgender men that have undergone top surgery. These individuals typically have subtotal mastectomies with residual breast tissue left in the axillary region to generate the aesthetic outcome of a contoured and masculine chest. Research reviewed by the ACR has generated recommendations using data derived from high-risk cisgender women after comparable surgeries who undergo prophylactic mastectomies. As such, it is presumed that transgender men have a similar risk of developing breast cancer, which is < 2%. The Netherlands study confirmed that transgender men receiving testosterone therapy are at a lower risk of developing breast cancer when compared to cisgender women. Again, WPATH recommends that transgender men follow the same guidelines as their cisgender peers in that those with significant family history be screened appropriately.

ICEMAGAZINE

INSIGHTS Transgender and gender-diverse individuals (TGD) have historically been marginalized socially and economically which has led to significantly greater health disparities compared to cisgender individuals.

Transgender and gender-diverse individuals (TGD) have historically been marginalized socially and economically which has led to significantly greater health disparities compared to cisgender individuals. Health disparities include, but are not limited to, a lower prevalence of insurance, fewer socioeconomic resources to manage out-of-pocket medical expenses, increased chronic physical and mental health conditions often caused by minority stress, and discrimination in the health care setting. Lack of awareness, knowledge, sensitivity and bias from health care professionals leads to poorer health outcomes for this community. Many TGD individuals have been mistreated or disrespected by health care staff in the past, causing fear, mistrust and reluctance to seek future care. To provide care that supports and affirms this population, health care professionals should have a better understanding of TGD individuals including their identities and communication needs. Tips to create a more affirming setting and practice for TGD individuals include: • Collect information on the individual’s pronouns and chosen name, which may be different from the name on their insurance, medical records and identification documents. Use the correct name and pronouns, even when the individual is not present. • Only ask questions necessary to a TGD individual’s care. • Apologize when misgendering mistakes are made. Even after an apology, an individual may still have a negative reaction, so it’s important to remember that many TGD individuals have experienced discrimination, making it difficult to trust. • Only discuss an individual’s TGD identity with those involved with providing care, which is consistent with privacy rules for all patients. • Provide single occupancy “all gender” bathrooms. • Provide training to all staff on culturally affirming communication and have policies in place to hold any staff accountable for discriminatory comments against TGD individual

conforming, and otherwise gender diverse individuals. Breast cancer screening in the entire population is an essential part of providing good-quality care. Based on the information discussed in this article, the overall recommendation would be to treat transgender people the same as their cisgender counterparts. Currently, our best evidence lacks the diversity and nuances that impact the health outcomes of our transgender population. •

In total, more research is needed to fully understand the risks of breast cancer in relation to various gender-affirming treatments across the spectrum of the population, including transgender, gender non-

• World Professional Association for Transgender Health:

SOURCES: • ACR Appropriateness Criteria® Transgender Breast Cancer Screening https://pubmed.ncbi.nlm.nih.gov/34794604/ • Affirmative Services for Transgender and Gender Diverse People- Best Practices for Frontline Health Care Staff • https://www.lgbtqiahealtheducation.org/publication/affirmative-services-for-transgender-and-gender-diverse-peoplebest-practices-for-frontline-health-care-staff/ • Breast Imaging in Transgender Patients: What the Radiologist Should Know: https://pubs.rsna.org/doi/full/10.1148/ rg.2020190044 • Breast Imaging of Transgender Individuals: A Review: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC5773616/ • Breast cancer development in transsexual subjects receiving cross-sex hormone treatment • https://pubmed.ncbi.nlm.nih.gov/24010586/ • Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807311/ • Health Care for Transgender and Gender Diverse Individuals • https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/03/health-care-for-transgender-and-gender-diverse-individuals • Health and Health Care Access in the U.S. Transgender Population Health (TransPop) Survey • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613303/ • Incidence of breast cancer in a cohort of 5,135 transgender veterans • https://pubmed.ncbi.nlm.nih.gov/25428790/ • Patient-Friendly Summary of the ACR Appropriateness Criteria: Transgender Breast Cancer Screening: https://www.jacr. org/article/S1546-1440(21)00933-9/fulltext

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Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. WPATH, 2022.

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10/15/23 4:04 PM

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INSIGHTS

THE ROMAN REVIEW MANNY ROMAN

LEAD OR FOLLOW

somehow wound up on a large number of emails from “leadership gurus.” A common theme appears to be that everyone should strive hard to be a leader. Leadership is the ultimate goal for all and anyone not yearning for this prize has no ambition and will end up an unhappy follower. Leadership is where the money is. These are my interpretations so I can justify the following dissertation since, as usual, I have some conflicting opinions. I am reminded of an incident a long time ago. A student told me that what he wanted was to be a great bench technician, do his job and then go home to his family. At first, I thought as the gurus propose: “No ambition.” Then, I realized what was meant: “My happiness lies elsewhere.” What a concept! Not everyone wants or needs to be in charge. On Game of Thrones, the irritated Lord Commander says to John Snow, “Do you want to lead someday?” Snow said “Yes.” The Lord Commander then said, “Then learn how to follow.” This was a profound statement to me. (I am easily impressed.) How can anyone be a leader that has not first learned to follow? Yet, there are very few, if any, followership gurus. To truly understand leadership, one must first learn how to be led. We need to allow others to contribute to our unique skillset by being attentive and adaptable. Great followers inspire great leaders and great leaders inspire great followers. I am amused by the interview question, “Where do you want to be in five years?” If the reply is not, “In you seat” or some such reply it demonstrates lack of the requisite ambition. Personally, I don’t ever recall asking that question in interviews. I was attempting to fill a position with the best qualified for that position. My position was already filled. I wanted to hear that the person would be the best instructor and that he would ensure to meet and even exceed expectations. I have a controversial opinion regarding leadership that has caused much discussion with some who believed themselves to be natural-born leaders. Leadership might just

ICEMAGAZINE | DECEMBER 2023

be highly situational. What would the results have been if General Patton and General MacArthur had been in each other’s role during World War II? As I write this in the middle of October, current world events will determine how our leaders respond and determine how they will be judged. Different situations require different leadership skills. Since leadership is a skill, it can be learned. By our training definition, learning is “a relatively permanent change in behavior.” Therefore, leadership is an observable behavior. Knowledge alone is not enough. It is the application of knowledge and experience, applied in specific situations, that determine leadership. Having followers is also a requirement. Management and leadership are often incorrectly interchanged. Management deals with the completion of tasks in correct fashion while leadership is a process of influencing people toward a greater accomplishment of goals and objectives. A leader must have a great understanding of the goals, objectives and directions that need to be followed. Leadership guru John Maxwell on leadership, “Leadership is not about titles, positions or flow charts. It is about one life influencing another.” This definition applies to followers as well. Leaders are not only found at the top, they are everywhere in an organization and in life. The bench tech from above demonstrated leadership and influence with his statement. His influence on me and others who heard him was profound. He nudged me into accepting that not everyone wants to be at the top and yet everyone influences others, sometimes towards the good and sometimes towards the bad. He inspired me to place this statement at the end of my formal presentations: “Always to leave others better for having known you.” I wish I could remember his name. So, am I a leader? Of course I am. So are both of you who read this far and those who did not, as well as those who turn the page when they see me on it. My lovely wife, Ruth, says that I am still a leader … of the old people I hang with these days and that I’m a natural. Happy Holidays. • Manny Roman, CRES, is association business operations manager at Association of Medical Service Providers.

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SCIENCE Waldo MATTERS– Ralph Emerson Across 1 Interlinking of medical devices which has led to the need for increased cybersecurity protections 7 The liquid form of this gas is used in MRI systems (Symbol) 8 Protective secretion in the nose and throat 9 Imaging exam to evaluate the urinary tract 13 Soure of solar power 14 Single 15 Pulse ___ 17 Dosage amount, abbr. 18 The p in bpm 20 Income after expenses 22 Checking for the presence of disease or infection 24 Visual representation, as on a monitor 27 Valuable person 29 Technique using X-rays to diagnose breast tumors 31 Datum on a patient’s form 33 Carpal ____ syndrome 34 Vital gas in pulmonary function

Down 1 The C in CAGR 2 Special place in the market 3 Makes certain 4 Confidence: vital factor to foster in employees 5 Pulsating 6 Passing vote 10 Regret 11 Operating 12 Location indicator 16 Basketball’s three-point line, e.g. 19 Diagnostic test for breast cancer, abbr. 21 Vitamin B 23 High frequency form of electromagnetic radiation 25 Another word for transducer in ultrasound testing 26 Organization representing management at all levels of hospital imaging departments, abbr. 28 Top 29 Cambridge campus, briefly 30 A while back 32 Exist

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