FEBRUARY 2024 | VOLUME 8 | ISSUE 2
MAGAZINE
THEICECOMMUNITY.COM
ADVANCING
IMAGING PROFESSIONALS
BURNED OUT PAGE 34
The Deteriorating State of Mental Health in the Workplace
PRODUCT FOCUS Imaging Parts Page 29
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
JANUARY
8
15
22
29
FEBRUARY
5
Jan 8-19
Principles of Servicing Diagnostic X-Ray Systems (Phase 1)
X-RAY CERTIFICATE SERIES
12
19
26
4
Feb 5-16
11
MARCH
18
25
8
Week 2 Apr 8-12
15
22
29
6
27
3
10
JUNE
17
24
Philips Digital & Bucky Diagnost
2
9
SEPTEMBER 16
23
30
OCTOBER
7
Sep 9-20
14
21
28
NOVEMBER
4
11
18
25
2
DECEMBER 9
16
Week 1 Dec 9-13
Week 2 Dec 16-20
Nov 4-15
Oct 7-18
Oct 21-Nov 1
Sep 23-Oct 4
Dec 2-13
Nov 4-15
Sep 23-27
Nov 5-7
Oct 28-Nov 1 Sep 23-27
I Mar 11-15
Jan 8-12
Apr 2-5*
Feb 5-9
May 20-24
May 13-17
Injector Systems GE AMX Portable (IV, IV+) Mar 25-29
Apr 22-26
Shimadzu MobileDaRt Evolution Portables (Evolution EFX, MX7) Canon RadPro Digital Philips MobileDiagnost Digital
Apr 29May 3 Apr 29May 3
Fuji FDR Go & Go Plus
Feb 26Mar 1
OEC 9900 C-Arm OEC Elite (CFD) Flat Panel C-Arm
May 6-10
Mar 18-29
Multi-Product C-Arm OEC 9800/9900
Jan 22-26
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D
E
E
M
P
O
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R
N
I
D
A
Apr 8-12
L
Apr 29May 3
Philips Veradius C-Arm Philips BV Pulsera C-Arm
D
Lorad Multicare Platinum Breast Biopsy System GE Digital Mammography (1-week ESSENTIAL only) Apr 22-26
Hologic Selenia Digital Mammography Jan 29Feb 2
Hologic Dimensions 3D Tomo Digital Mammography Hologic MG Products: Affirm, SecurView, R2, ATEC Sapphire
Feb 5-9
Mar 6-8
Apr 15-19
Philips Epiq 5 & Epiq 7 (2.5 days) Philips iU22/iE33 (2.5 days)
E
Mar 11-13 Mar 13-15
Y
Nov 11-15
Sep 16-18 Sep 18-20
G Dec 2-6 Dec 4-6
Dec 9-11 Sep 30-Oct 11 Oct 14-25 Oct 28-Nov 1 Oct 14-25
May 6-17
Dec 2-13
Mar 18-29
Jan 22-Feb 2
Dec 2-13
N
Oct 7-11
Sep 11-13
Apr 8-19
Philips Brilliance Family
Aug 5-16
Mar 11-22
Sep 9-20
Jun 3-14
Jan 15-26
Apr 8-19
Dec 9-20
Jul 15-26
Oct 28-Nov 8
Feb 19-Mar 1 Feb 26Mar 1
Jun 3-7
Siemens Symbia Family Apr 22-26
CRES Certification Prep
EXHIBITS, PRESENTATIONS & NOTES
Oct 21-24
Jul 8-12
Siemens Definition Family
I
I
Y
Aug 12-16
G
V
Sep 30-Oct 11
A
Jun 17-28
Siemens Sensation Family
GE Excite & GEMS MRI Family (X)
Nov 11-15
Oct 14-18
D
Jun 3-14
GE Revolution & Discovery CT
Servicing Multivendor MRI Systems
S
Nov 4-8 Sep 23-Oct 4
Aug 26-30
Aug 19-23
Jul 8-12
Oct 28-Nov 1
R
Aug 5-9
A Jun 24-26
GE Logiq E9, Vivid E9 (2.5 days)
Principles of Servicing Nuclear Medicine Systems
Aug 19-23
K
Oct 28-Nov 1
O
A N
Oct 21-25
Sep 30-Oct 4
GE Optima, Brivo, VCT, LS, BS CT Family
Siemens MRI Family (Aera, Skyra, Espree, Avanto)
Nov 11-15
Sep 30-Oct 4
B
D Jun 19-21
Principles of Servicing Multivendor CT Systems
H
A
Jul 29-Aug 2
Jun 3-7
Y
Apr 29May 3
Siemens Inspiration or Novation Multi-Vendor Bone Densitometry Principles of Servicing US Systems (2.5 days)
A
T
Oct 7-11 Oct 7-11
L
Jul 29-Aug 2
C
Jun 3-14
Nov 18-22
Aug 26-30
N
GE Innova/IGS/Optima Family (21/31/4100, 3XX/5XX/6XX)
Nov 18-22
Sep 23-27
Jul 22-26 Jul 22-26
E
Jun 17-21
Philips Allura FD Family (FD10/FD20)
Aug 12-16
Jul 8-12
N
Apr 8-12
GE Optima XR200/XR220/XR240, & Brivo XR285 Digital Portables
NUCLEAR MEDICINE
26
Aug 19-30
Sep 16-20
Feb 26Mar 1
Siemens Ysio
Shimadzu RADspeed/RADspeed Pro
CRES CERTIFICATION
19
May 20-24 Feb 12-16
Private Practice X-Ray Systems (CPI CMP200 & Quantum Odyssey HF)
MRI
12 Aug 5-16
May 7-9 Jan 29Feb 2
Siemens Luminos Agile
CT
AUGUST
5
C.A.M. (Capital Asset Management)
Siemens AXIOM Luminos TF
ULTRASOUND
29
Sep 9-20
GE Proteus
WOMEN'S HEALTH
22
May 20-24
Philips Easy Diagnost Eleva
CARDIAC
15
May 14-16
Intro to Diagnostic Imaging & PACS For Managers & Sales Professionals
GE Precision 600FP
C-ARMS
JULY Jul 8-19
Jun 3-14
Feb 5-9
GE Precision 500D R/F
PORTABLES
8
May 13-24 Jan 29Feb 2
PACS Engineer/Administrator Certification (Phase 1) - eLearning PACS Engineer/Administrator Certification (Phase 2) - eLearning
GE Optima/Discovery/Definium DR Family: Optima XR640/XR646, Discovery XR650/XR656, Definium 6000/8000
PRODUCT SPECIFIC
1
Jun 3-14
Apr 8-19
PACS Troubleshooting (3 days) - eLearning
MANAGEMENT
20
Jun 17-28
Advanced Diagnostic Imaging Systems Analysis (Phase 4)
NETWORKING & DIGITAL INFO
MAY
13 May 6-17
Apr 15-26
Jan 8-19
Advanced Digital Imaging Systems Maintenance (Phase 3)
APRIL
1
Mar 18-29
Jan 22-Feb 2
Advanced Radiographic Systems Maintenance (Phase 2)
Week 1 Apr 1-5
Mar 4-15
Principles of Servicing Diagnostic X-Ray Systems (Phase 1) - eLearning
* Class Start Tues
Aug 19-30 Jun 10-14
Sep 9-13
Oct 28-Nov 1 Heartland Biomedical Society Aug 7-9 Omaha, NE
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FEATURES
40 DIRECTOR’S CUT
Being a leader in radiology is no walk in the park, right? The last few years have been like a rollercoaster, and we leaders feel the major bumps and workload.
34 COVER STORY
If the medical imaging world needed any clearer signal that its staff were on the edge of a breakdown, the data are practically screaming for culture change in a workplace culture that is high on burnout.
12 RISING STAR
Cook Children’s Medical Center-Prosper MRI Technologist Pariss Jackson is this month’s rising star.
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ICEMAGAZINE | FEBRUARY 2024
ADVANCING THE IMAGING PROFESSIONAL
FEBRUARY 2024
18 IMAGING NEWS
Catch up on the latest news from around the diagnostic imaging world.
29 PRODUCT FOCUS
Imaging parts are in the spotlight this month.
48
EMOTIONAL INTELLIGENCE
An incredible number of benefits are accrued from today’s technology, but just as with human personality traits, technological strengths have corresponding limitations.
THEICECOMMUNITY.COM
ICEMAGAZINE
7
CONTENTS
MD Publishing 1015 Tyrone Rd. Ste. 120 Tyrone, GA 30290 Phone: 800-906-3373 President
John M. Krieg john@mdpublishing.com
SPOTLIGHT
10
Kristin Leavoy kristin@mdpublishing.com
In Focus Kristen Ruf, RT(R)(ARRT)
12
Rising Star Pariss Jackson, MBA, RT(MR)(R), CRA, CPHQ, LSSGB
Vice President of Sales
14
Rad Idea Easy Tips to Keep Your Team Engaged!
16
Off the Clock Sadia Nasir, MBA, ARRT (R), (CT)
Vice President
Jayme McKelvey jayme@mdpublishing.com
Group Publisher
Megan Cabot megan@mdpublishing.com
Editorial
John Wallace
Editorial Board
Jason C. Theadore Nicole Dhanraj Melody W Mulaik Verlon E. Salley Rachel Thiesse-Yount Traci Foster
Sales
Emily Hise
Art Department Karlee Gower Taylor Hayes Kameryn Johnson
Events
Kristin Leavoy
Webinars
Linda Hasluem
Digital Department Cindy Galindo Kennedy Krieg Haley Wells
Accounting Diane Costea
ICE Magazine (Vol. 8, Issue #2) February 2024 is published by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visittheicecommunity.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. © 2024
8
ICEMAGAZINE | FEBRUARY 2024
NEWS
18
Imaging News A Look at What’s Changing in the Imaging Industry
PRODUCTS
24 28 29
Director’s Circle NEW Sponsored by Avante Health Solutions Market Report Product Focus Imaging Parts
INSIGHTS
40
Director’s Cut No Guilt with Switching Gears
42
PACS/IT/AI Synesthesia and AI
44
Coding/Billing Can we…? Probably not…
46
Medicine for the Soul Climate Change May Impact Mental Health
48
Emotional Intelligence Keeping Our Humanity in a Technology-Filled Workplace
51
Roman Review Stop Asking for Feedback?
57 58
ICE Break
Index
ADVANCING THE IMAGING PROFESSIONAL
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SPOTLIGHT
IN FOCUS KRISTEN RUF
G
roup Health Cooperative of South Central Wisconsin Medical Imaging Manager Kristen Ruf, RT(R)(ARRT), is CPR certified, an EPIC credentialed trainer, an EPIC super user and a Merge PACS super user. Yet, her most impressive qualification comes from her own medical journey.
Kristen Ruf’s personal experience gives her more compassion for patients.
10
ICEMAGAZINE | FEBRUARY 2024
“I have a unique background that I feel has given me a different perspective in the medical field. When I was 18 years old attending Madison College, on the waiting list for the radiography program and playing on the softball team, I was diagnosed with an osteosarcoma in my left humerus,” Ruf explains. “I underwent 10 months of chemo while being able to attend general college courses online. I have had numerous surgeries, two right hip bone grafts, a trapezius muscle transfer, two separate cadaver bone
implants, and I’m left with a very interesting humerus X-ray filled with plates and screws,” she adds. “After multiple complications and surgeries, I was pushed towards transitioning to a leadership role to phase out of direct patient care while still being able to work in the field I love,” she adds. “I have been the medical imaging manager in both a hospital and clinic setting. I thoroughly enjoy what I do and the ever-changing medical imaging field itself.” “Having gone through what I have has given me even more compassion and understanding of the overall patient experience within medical imaging. There are times when patients are in our department during some of the worst or scariest times of their lives. If we can help comfort and support them during these difficult times, it can make such a difference for the overall patient experience,” she says.
ADVANCING THE IMAGING PROFESSIONAL
“Here at Group Health Cooperative of South Central Wisconsin we strive for excellent patient care. I can say without a doubt that we have a great medical imaging team that is patient-experience centered and focused. I am happy to be a part of a team that provides such great dedication and care to our members,” she says. Her experience also provides Ruf with a great answer when asked about her greatest accomplishment. “My greatest accomplishment is overcoming cancer from an osteosarcoma, starting a family when I was told I may never have children, and pursuing my career in medical imaging eventually making my way into management,” she says. “I have been married to my husband, Christen, for four years. We have a seven-year-old daughter named Sadie. Our son, Cason, is five years old,” Ruf says. Ruf says that she takes an active approach to leadership. “I take a hands-on leadership approach. I wouldn’t ask or expect anyone else to do something that I could not or would not do myself. I try to offer support and encouragement for others to excel and succeed in what they do,” she says. “I am always open to listen to suggestions, feedback and new ideas. I am a firm believer in open communication and following through with closed loop communication. There are times I have received feedback or suggestions that I never would have thought of which I appreciate being shared. I strive
KRISTEN RUF
Group Health Cooperative of South Central Wisconsin Medical Imaging Manager 1. What is the last book you read? I am currently working my way through the Colleen Hoover book series.
to have our team here at GHC-SCW feel that they are valued and have a voice in our department.” Ruf says her leadership stye is a direct result of the support and knowledge she received. “Shara (Bacher) is hands down the best supervisor I have ever had. She sets a stellar example for what a dedicated, compassionate, knowledgeable and supporting supervisor represents. She helped me grow and offered guidance as I settled in and transitioned into my medical imaging manager role here,” Ruf says. “I am currently enrolled in a leadership keys program within our organization and will be assigned a mentor through that. I am looking forward to this experience and excited to see what I learn and gain from this program.” When asked what else she wants to share, Ruf focused on the imaging team she works with daily. “I love my job because there are always new challenges and learning and growth opportunities. Not a single day has the same repetition for me,” she says. “I am very thankful to be part of an amazing team here at GHC-SCW that makes patient care and the overall member experience a top priority which is held at such a high standard.” Ruf remains excited about her imaging and leadership role. The challenges she has overcome serve as proof that she will do what is needed for patients and her team. •
6. Who has had the biggest influence on your life? My family has been the biggest influence on my life. I have had to lean on them during some of the hardest times in my life and I have always felt that love and support from them. 7. What would your superpower be? If I could have any superpower, it would be to read people’s minds. A lot of people
2. Favorite movie? My favorite movie is “Hoosiers.” I am an
hold back what they are thinking or feeling for whatever reason
avid sports lover, especially college basketball. I love the story
it may be. I can appreciate open and honest feedback, so I often
behind the movie and how can you not root for an underdog?!
wonder what people are really thinking but not saying aloud.
3. What is something most of your coworkers don’t know
8. What are your hobbies? I enjoy a wide variety of hobbies.
about you? Most of my coworkers do not know that during
Spending time with my family is number one. I like to hunt
my chemo treatments I developed chemo toxicity which put
deer and turkey, fish, spend time outdoors, spend the day at
me into a coma for 12 hours. I don’t remember much of it. It’s
the lake on our pontoon, go on ranger rides, snowmobile or
something I never really bring up or talk about with others. I
sledding with the kids, reading, cooking and baking, gardening
view it as another hurdle I have overcome in life.
(my 81 year old grandmother is a big help while I still develop
4. What is one thing you do every morning to start your day?
my green thumb and plant vs. weeds knowledge), and spend
Coffee is a must for me. I am more of a night owl than a morning
time at the family cabin up north.
person, so coffee is my morning go-to to start off my day. I drink cold
9. What is your perfect meal? This is tricky for me to pick one meal.
brew coffee year-round even through our cold Wisconsin winters.
I consider myself a “foodie.” I enjoy many different types of food. I
5. Best advice you ever received? The best advice I ever
could eat Mexican or Italian foods every day and never get sick of
received is from the late and great Jimmy Valvano speech.
them. I love different appetizer foods and dips. I am a big fan of all
“Don’t give up. Don’t ever give up.” His outlook on life during
kinds of cheese which comes naturally being a true Wisconsinite.
his toughest moments is truly inspiring. I can relate this quote
My favorite go-to snack is a dill pickle when I can sneak one if
to many different aspects of my life. It’s also that little reminder
my son hasn’t eaten them all first. I enjoy the occasional after
that no matter what life throws at you just keep moving forward
dinner popcorn snack with my daughter.
and have faith it’ll all eventually work out.
THEICECOMMUNITY.COM
ICEMAGAZINE
11
SPOTLIGHT
RISING
STAR PARISS JACKSON
C
ook Children’s Medical Center-Prosper MRI Technologist Pariss Jackson, MBA, RT(MR) (R), CRA, CPHQ, LSSGB, is this month’s rising star. She holds certifications in radiography, MRI with ARRT as well as a Lean Six Sigma Green Belt. ICE Magazine recently found out more about Jackson and her work in Prosper, Texas. Q: WHERE DID YOU GROW UP? A: I’m from the Mitten State – Michigan. I relocated to Texas about 2 years ago. Q: WHERE DID YOU RECEIVE YOUR IMAGING TRAINING/EDUCATION? A: I completed my imaging training at Lansing Community College under the leadership of Brian Pickford. I had the honor of returning as adjunct faculty for the radiologic technology program in 2009 and MRI program in 2010. Pariss Jackson loves her job as an MRI technologist and wants to be a health care executive.
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ICEMAGAZINE | FEBRUARY 2024
Q: HOW DID YOU FIRST DECIDE TO START WORKING IN IMAGING? A: I’ve always wanted to work in health care, but was not sure in which field. I went and saw a counselor at Lansing Community College who went over all the specialties
ADVANCING THE IMAGING PROFESSIONAL
with me: nursing, sonography, surgical technology, radiography, etc. I chose radiography, applied and was accepted. Q: WHAT IS THE MOST REWARDING ASPECT OF YOUR JOB? A: Being the person to get the inside story! Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: Working in MRI imaging has been one of the most rewarding experiences of my career! It’s been so fulfilling to be able to capture and analyze images to help support the diagnosis and treatment of medical issues. I’m so proud to be part of a profession that is making a real difference in people’s lives. Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: One of the most interesting things about the imaging field is its constant evolution and the advancements in technologies used for capturing, analyzing and visualizing images. From medical imaging techniques like MRI and CT scans to satellite imagery and computer vision applications, the imaging field continues to push boundaries and unlock new possibilities. It plays a crucial role in various domains, including health care, astronomy, robotics and even art. The ability to capture and interpret visual data has revolutionized how we understand the world around us and continues to drive innovation in many industries. Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: Designing and developing curricula for students in the academic and clinical settings, providing them guidance and mentorship and watching them thrive in their imaging careers. Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS? A: Health care executive in a health system, fellow with the ACHE and AHRA, a published author, win a line dance award and go parasailing off the coast of Copacabana, Brazil. •
THEICECOMMUNITY.COM
FUN FACTS FAVORITE HOBBY: Line dancing FAVORITE SHOW: “Succession” FAVORITE FOOD: Popcorn FAVORITE VACATION SPOT: The Canary Islands-Tenerife 1 THING ON YOUR BUCKET LIST: Skydiving SOMETHING YOUR COWORKERS DON’T KNOW ABOUT YOU: I enjoy roller-skating.
ICEMAGAZINE
13
SPOTLIGHT
Rad idea
EASY TIPS TO KEEP YOUR TEAM ENGAGED! By Tricia Trammell, CRA, FAHRA, BA, R.T. (R)(M)(QM)(BS), BHCN
K
eeping an engaged team is no easy task in the ever-changing health care environment. The challenges our front-line staff faces are endless and the only thing people can count on is change. Both patients and health care organizations often push staff to their limits. So, how can leaders keep their teams engaged in such circumstances? If you are like me, you believe that employee engagement and patient satisfaction go hand in hand. It is difficult to have one without the other. An investment in employee engagement is an indirect investment in patient satisfaction. Here are some easy tips to try that have worked for me: • Keep your door open as much as possible. Let team members see you and know that you are available for them. (I always have snacks in my office to encourage people to come in. It gives me an opportunity to connect with them.) • Obtain a set of door handle tags for your office. My set includes “Out for Lunch”, “In a Meeting”, “Gone for the Day”, “Be Right Back”, “Please Come In” and more. The door tags bring clarity to anyone who may be seeking you out. • Call people by their name. People want to hear their name. It helps them feel recognized and validated. • Get to know your team members. Let them get to know you too. Relationships are not a weakness. They are a strength. • Ask your team for feedback and really listen. Act on the feedback you receive. • Celebrate your wins in a big way! Learn from your mistakes. 14
ICEMAGAZINE | FEBRUARY 2024
I once worked for a gentleman who said, “We win together, and we lose together.” He was right. That always stuck with me. I think when we all win, let’s really celebrate! When we all lose, I have the responsibility to make sure that both I and the team learn from the failure. • Be authentic, transparent and intentional. • Create a culture of psychological safety and encourage your team to bring their authentic self to work every day! OK, so maybe it’s not so easy. To be honest, employee engagement stays top of mind for me all the time. Our large academic institution recently did an engagement survey. My work group scored significantly over the institutional benchmark, so I asked them what makes this group/unit a great place to work? Here are a few of the gems: • “The autonomy to do the work I need to do without micromanagement allows me to feel that my contributions matter.” • “The diversity of the work group allowing me to get perspectives from individuals from different backgrounds is a strength.” • “Feeling respected and valued is important to me. I know that what I do matters to my patients, and I matter to my team members, and my leadership.” • – Tricia Trammell, CRA, FAHRA, BA R.T.(R)(M)(QM)(BS), CHBN, is imaging operations manager at UT Southwestern Medical Center. Share your RAD IDEA via an email to editor@mdpublishing.com.
ADVANCING THE IMAGING PROFESSIONAL
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SPOTLIGHT
Off Clock THE
BY MATT SKOUFALOS
A
s a young adult, Sadia Nasir first arrived in the United States from Pakistan in the late 1990s. She began pursuing a career in radiology, eventually becoming an administrator, and opening the radiology department of a Children’s Hospital in Texas. After 15 years in a leadership role, she began searching for ways to explore her hobbies and interests outside of the office. “I needed to do something else,” Nasir said. “I feel like my brain is too sharp to keep on doing the same-old, same-old. I wanted a hobby that is more exciting than just your profession.” As recently as half a decade ago, Nasir said she might not have even been able to contemplate anything other than work. For the first 10 years of her career, she maxed out her paid time off allotment annually, some 350 hours of unused time – until a life event dramatically revealed that her priorities were overdue for an adjustment. Nasir’s husband, a computer programmer, sustained a cardiac event driven by the level of stress at his workplace. It was the wake-up call Nasir hadn’t known she needed, but it changed her approach to work entirely. While her husband changed jobs, swapping out the high-intensity demands of software coding for the comparatively less strenuous work of a database administrator, she began finding ways to offload the workplace responsibilities that had kept her from taking any time away from the hospital. With 80-plus direct reports, the first challenge to address was the importance of delegating some of that workload to others. “I started hiring managers,” Nasir said. “Now I have two managers, and I cannot tell you how much I count on these managers. I gave one manager the radiation department, and non-radiation to the other. Whatever I 16
ICEMAGAZINE | FEBRUARY 2024
SADIA NASIR
learned, I started teaching them.” “That’s the best thing I did,” she said. “Having a strong team was the perfect balance I was missing five years ago. Radiology is my profession. How can I grow? These leaders are growing. Tomorrow, if it’s time for me to become something else, my radiology leaders will keep on growing.” While she sorted out her coverage at work, Nasir and her husband took some time to travel the globe. The couple had always said that they would explore the United States when they hit their sixties; before then, they wanted to explore the world. “We started our journey of traveling by connecting the countries we visited,” she said. “We went to Greece, Turkey, Switzerland, Germany, France, Scotland and Ireland. It was one of the most amazing trips, and you see how many different cultures you are touching.” “While I’m traveling Europe, I learn about how the economy’s turning,” Nasir continued. “There’s so much to learn while you’re outside the United States. So, I started learning about real estate.” Many Americans have a side hobby or a weekend pursuit, but not as many of them might describe a second career in that fashion as such – yet that’s how Nasir chooses to spend her time. With two children in college and weekends free, she began studying for her real estate license. Today, she applies her passion for organization and leadership focus to the residential and commercial real estate markets. She opened a small firm that focuses on helping buyers, sellers, and those whose properties are headed for auction or foreclosure to navigate the complicated world of property transactions. “It’s all about work-life balance,” Nasir said. “You’ve got to do more than just a job you are doing Monday through Friday, 8 to 5. My husband’s heart attack really opened my eyes to the fact that I am too young to not enjoy what I’m doing in my professional job.” ADVANCING THE IMAGING PROFESSIONAL
What attracted Nasir to the world of real estate was the potential to work in the field on weekends. During the day on Saturday and Sunday, she connects with her clients, tours properties and sets up meetings. The hours she keeps are her own to set and the workload is as manageable as she wants to make it. In the evenings, she still barbecues with the family. “My family is first, and my profession is second,” Nasir said. “I’m loving it. It’s not about buying and selling a house; it’s about helping others in a very different way.” The real estate market in her home of Houston, Texas, is turning over presently, she said; a function of high-interest-rate mortgage foreclosures and increasing demand for new homes. Nasir specializes in working with owners of distressed properties to help them find buyers and stay out of the foreclosure process; she also focuses on working with Spanish-speaking clients who need extra help navigating the ins and outs of the real estate market. “There are people in our community who have no clue how to start buying a home; the process and the paperwork are unbelievable,” Nasir said. “They are thankful that someone is explaining to them how to buy a house, or find a rental option while they are saving money for their first house.” “The day we start thinking only about money, there’s no THEICECOMMUNITY.COM
humanity; there’s no purpose in your life,” she said. “Real estate is about helping others. Money in business comes, but the satisfaction of helping somebody so they don’t have to put their house in foreclosure, or someone who is buying their first house and doesn’t know where to start, that is so satisfying.” Nasir can envision her life as a real estate agent expanding in retirement, but for now, she delights in finding opportunities to help new clients relocate into the home of their dreams, without anxiety or confusion about the process. “I hope that buying or selling any property, residential or commercial, would be so simple that anybody can do it,” she said; “right now it’s so complicated. There’s so many ways to help. Some people who have money are so lost they don’t even know where to start; I wish there was a simpler process so they could understand it.” Nasir doesn’t know where her real estate career may take her; for now, she’s simply trying her best and working to improve every day. But she’s definitely having a better time of things at work, and stress levels in the household overall have improved dramatically. “When I go home and I’m done with my day, I say, ‘Thank you, God,’ ” Nasir said. “Even if I’m doing five out of 10 things right, it’s such a satisfaction.” • ICEMAGAZINE
17
NEWS
Imaging News A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY
RESEARCH HIGHLIGHTS BREAST DENSITY AND MAMMOGRAPHY QUALITY SOFTWARE Volpara Health Technologies Ltd., a leader in software for the early detection and prevention of cancer, was featured in two peer-reviewed studies. The Joint AAPM Task Group 282/EFOMP Working Group, focused on modernizing breast radiation dose modeling, recently published a report outlining its new model in Medical Physics. The report, “Breast dosimetry for standard and contrast-enhanced mammography and breast tomosynthesis,” advocates for international harmonization of mammography dose estimates, by implementation of the new and improved model and methodology. The new model replaces assumptions of a homogeneous breast with a more representative fibroglandular tissue distribution and shifts to the use of percentage volumetric breast density (%VBD) to align with a clinically implemented breast composition metric. Volumetric breast density emerges as an essential input to facilitate patient-based radiation dose estimates. Volpara’s TruDensity algorithm provides reliable estimates of %VBD from 2D and 3D images across multiple mammography system makes and models. Ioannis Sechopoulos, first author of the report and chair of the Joint TG/WG remarks that he, “welcomes and encourages wide adoption of the new breast dosimetry model by the medical physics community and industry, to offer improved and consistent radiation dose estimates in mammography.” This new dose model will be integrated into Volpara’s TruRadDose algorithm, which analyzes a patient’s exposure to radiation from a mammogram, with the aim of ensuring
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patient safety while maintaining optimal image quality. Featured in European Radiology, a second peer-reviewed study investigates whether active use of Volpara Analytics software could help breast radiographers to improve their screening image quality. The paper “Using automated software evaluation to improve the performance of breast radiographers in tomosynthesis screening,” reports on analysis of a quality improvement project where radiographers and researchers from the breast radiology unit at the Veneto Institute of Oncology, encouraged active use of Analytics and led monthly face-to-face coaching sessions with each of six participating radiographers to review individualized feedback based on the objective breast compression and positioning quality metrics measured by Volpara’s TruPressure and TruPGMI AI algorithms. All radiographers improved their performance, with increases in quality scores of up to 16% compared to a baseline measurement. The study concluded that employing Volpara’s AI-driven software significantly enhances radiographers’ performance, thereby improving mammography quality and potentially leading to better screening outcomes for patients. The study’s lead author, Gisella Gennaro, notes that a key aspect of the project was to determine whether use of Volpara Analytics software by even the most senior radiographers, would be both accepted and beneficial. She comments that the quality of “all radiographers benefited from the personalized learning experience, with consistent and objective measurements that can be benchmarked against peers.”
ADVANCING THE IMAGING PROFESSIONAL
BUTTERFLY NETWORK ANNOUNCES MENDAERA AGREEMENT Butterfly Network Inc. and Mendaera have announced an agreement to commercialize a novel robotic system that is powered by Butterfly’s Ultrasound-on-Chip technology. Upon commercialization, the deal includes revenue share for every unit sold. Mendaera’s robotic technology is compatible with Butterfly’s proprietary semiconductor-based ultrasound device and connected via Butterfly’s software development kit – Butterfly Garden – creating a system designed to improve precision and consistency for a broad range of image-guided, needle-based interventions. This new category of robotics will increase access to high-quality interventional treatment, ultimately aiming to streamline patient care within a health care system burdened by workforce shortages and burnout. The companies anticipate FDA submission of the product by 2025. “Mendaera’s robotic system is perfectly suited to leverage Butterfly’s proprietary Ultrasound-on-Chip by benefiting from the wide array of ultrasonic sensing applications that only our chip can offer,” said Darius Shahida, chief strategy officer of Butterfly Network. “We are excited to welcome the Mendaera team as a Powered by Butterfly partner and believe our joint solution will expand Butterfly’s reach and clinical impact into the interventional space.”
“At Mendaera, we envision a world where high-quality intervention is available at every care facility, for each and every patient encounter. It was a clear choice for us to collaborate with Butterfly on our technology roadmap, given their unique and programmable Ultrasound-on-Chip platform and aligned mission to make ultrasonic imaging and intervention ubiquitous,” said Josh DeFonzo, co-founder and CEO of Mendaera. The news follows Mendaera’s August 2023 announcement of securing $24 million in Series A Funding, led by Lux Capital, with participation from Founders Fund, Operator Partners, Allen & Company, and Parade Ventures. Mendaera has also announced completion of the research and design process for this novel robotic system.
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19
NEWS
FDA CLEARS SOMATOM PRO.PULSE DUAL-SOURCE CT SCANNER Siemens Healthineers recently announced Food and Drug Administration (FDA) clearance of the SOMATOM Pro.Pulse, a dual-source computed tomography scanner designed to be more affordable for a wide range of health care facilities, including outpatient diagnostic centers. The scanner combines the power and speed of dual-source CT technology – two X-ray tubes and two detectors – with embedded artificial intelligence and user assistance features to deliver workflow efficiencies. Dual-source CT allows for high temporal resolution, which, along with scan speed, is important for cardiac CT scans to limit artifacts caused by breathing or cardiac motion. In recent years, interest in CT’s cardiovascular applications has increased in the U.S. This interest may be attributed in part to a 2021 decision by the American College of Cardiology (ACC) and the American Heart Association (AHA) to give cardiac CT angiography (CCTA) its highest
recommendation as a frontline test to evaluate patients with stable and acute chest pain who have no history of coronary artery disease. The AI-powered intelligent user interface, myExam Companion, combines patient data (including gender, height and age) and collects scan-relevant information such as heart rate or breath-hold capabilities to tailor a patient-specific scan protocol. The optional FAST (Fully Assisting Scanner Technologies) 3D camera automatically performs precise, consistent patient positioning. The SOMATOM Pro.Pulse has an air-cooled gantry, requires 31 percent less space for installation than the company’s previous dual-source systems, and consumes 20 percent less power than traditional water-cooled dual-source CT scanners. These features reduce the scanner’s installation and operational costs compared to similar scanners in the company’s portfolio.
ENLITIC, INFINITT BRING EFFICIENCIES TO RAD DEPARTMENTS Enlitic Inc., an innovator in data standardization, and Infinitt North America, a global enterprise imaging partner for medical institutions, have entered into contractual arrangements in respect of licensing Endex. This strategic commercial collaboration is aimed at advancing the standardization of medical imaging data. Enlitic’s data standardization software, Endex, will be integrated with the Infinitt PACS. Enlitic is dedicated to revolutionizing health care through the application of AI technology. Enlitic focuses the power of artificial intelligence into data management applications, enabling improved administration, processing and sharing of patient data throughout the health care ecosystem. For example, Endex uses artificial intelligence to make hanging protocols work more consistently. As a
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result, workflow is improved, and valuable time is reclaimed by not only radiologists but also PACS administrators, IT managers and technologists. Endex is a data standardization solution crafted to address the complexities and inconsistencies often associated with medical imaging data. Through the seamless integration of Endex with Infinitt, health care professionals and institutions can harness standardized medical images, significantly enhancing the efficiency and workflow of diagnoses. The partnership is poised to overcome challenges related to interoperability, data fragmentation, and data quality, historically impeding the effective utilization of medical imaging data and AI in radiology.
ADVANCING THE IMAGING PROFESSIONAL
AIS ADDS 2 FIELD SERVICE ENGINEERS Associated Imaging Services (AIS), a leader in nuclear medicine and ultrasound solutions since 1990, recently announced the addition of two field service engineers. Marvin K. Morales and Jewel Norris are the newest members of the AIS team. Morales is a native of Puerto Rico with a degree from Texas State Technical College and currently lives in Katy, Texas. He started his career as a field service engineer for Novamed Corp. in Pennsylvania where he maintained general medical equipment. AIS’s CEO, Grant Norris, had this to say about Morales, “I’ve known Marvin for a very long time and I’m very excited he chose to join our team. Marvin’s hard work and great customer service is going to be a perfect fit for our Texas customers.” Jewel Norris is from Wichita, Kansas and recently graduated from Tabor College. When asked why she chose AIS to start her career she said, “I chose AIS because of the family-like work environment, I grew up around AIS as my grandfather started the company and both my parents work here.” AIS’s COO, Mike Shepherd, had this to say about Jewel, “It’s an honor to have Jewel join our team and follow in her grandfather’s footsteps. I look forward to watching her grow in this role and am excited to see how she will be of great service to our customers.” Norris added, “Adding Marvin and Jewel to our team is very exciting, our customers deserve the best and that’s what we intend to deliver. We have more exciting news in the works and are thrilled about the future of AIS as we look to expand our footprint and our team.”
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ICEMAGAZINE
21
NEWS
RTI SHARES X-RAY QA TESTING PRODUCT RTI has made a groundbreaking advancement in X-ray Quality Assurance (QA) and testing by introducing a new X-ray meter, Mako, at the Radiological Society of North America Meeting. The next-generation multimodality X-ray meter has market-leading accuracy (±1.5 % kVp uncertainty) thanks to innovative new detector technology. Centered around efficiency, Mako provides a no-fuss experience, simple setup in all X-ray applications and fully wireless capability. The modular, future-proof system design provides ultimate configuration flexibility, with the widest-ever application range for X-ray quality assurance testing. When it comes to protecting patients and staff in medical X-ray imaging, regular and proper quality assurance and testing is paramount. Mako is not just a tool; it’s the complete tool belt in X-ray testing, protecting patients and medical staff from unnecessary X-ray dose while ensuring the best image quality and prolonging system lifetime. “This revolutionary product is a culmination of over 40 years of experience in X-ray quality assurance and testing, with Mako delivering the most advanced hardware platform, fully integrated into the industry-leading software and cloud solutions, for unparalleled efficiency and full traceability,” according to a press release. The modular, platform-based design breaks ground in performance for all medical X-ray applications, designed to excel across radiography, fluoroscopy, mammography, dental and CT applications, with seamless integration of a wide range of probes simultaneously.
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“The new Mako R/F Probe adds a superior dynamic range from low-to-high dose rates, and the system integrates non-invasive mAs capability, for an industry-leading solution in radiography/fluoroscopy applications. The Mako Mammo Probe covers the entire clinical kV range in mammography from 18-49kV with superior accuracy, whereas other mammography sensors are limited to 40kV. Mako also offers the ultimate test tool in dental X-ray applications, featuring a sensor that is four times narrower and yet more sensitive than leading competitors, offering superior performance even in narrow-beam X-ray. With the capability to integrate DAP, mAs, CTDI, Light and many other QA measurements, Mako is the ultimate solution for all X-ray QA applications,” according to the release. The “groundbreaking new technology” is complimented by RTI’s warranty program of up to 10 years and extensive calibration cycle, which, together with free online training programs and dedicated support, embodies the company’s vision of “Setting the standard for the Quality Assurance of X-ray imaging.” Dr. Michael Olding, head of product management at RTI Group, said, “Our meters must offer not only accuracy in measurement but also efficiency in the setup and performance. Only Mako offers this unique combination, with the advanced detector design possessing the best-ever sensitivity and accuracy while transforming the user experience with a no-fuss setup and streamlined data collection.” For more information, visit makobyrti.com.
ADVANCING THE IMAGING PROFESSIONAL
ICE2024 IMAGING CONFERENCE & EXPO FEBRUARY 18-20, 2024 • IRVINE, CA
AHRA APPROVES ICE 2024 EDUCATION ICE 2024 (Imaging Conference & Expo) meets all criteria and has been approved by AHRA: The Association for Medical Imaging Management for (26) Category A ARRT continuing education credits. Also, ICE 2024 (Imaging Conference & Expo) is set for February 18-20, 2024. It has been approved for 16 CEU credits by the ACI upon completion of the course only. The CRES Study Group 2024 (Part I & II) that is to run February 18-19, has been approved for 7.5 CEU credits upon completion of the course only. The Imaging Conference and Expo (ICE) is the only conference dedicated to imaging directors, radiology ad-
ministrators, and imaging engineers from hospital imaging departments, freestanding imaging centers and group practices. Whether it’s invaluable continuing education, productive networking or the exclusive exhibit hall, attendees have the perfect opportunity to enhance their careers and spend time with colleagues at ICE. As an added incentive, ICE conference admission is complimentary for all hospital employees, imaging center employees, active military and students. Register today at attendice.com/register. • Find out more at AttendICE.com.
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ICEMAGAZINE
23
INSIGHTS SPONSORED BY:
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CE Magazine contacted imaging leaders for advice regarding imaging parts to better understand how to limit imaging device downtime and maintain an efficient workflow. Leaders who replied to share helpful information are The Ohio State University Wexner Medical Center Associate Director of Inpatient Imaging Services Lauren Bergstrom, UT Southwestern Medical Center Director of Outpatient Imaging Services Robin Eastland, San Francisco Department of Public Health Vice President of Support Services Nader A. Hammoud and St. Luke’s Health System Health Technology Management Imaging Service Team Manager Dean Skillicorn. Bergstrom was assisted by The Ohio State University Wexner Medical Center Director Amy Gallatin and Facilities Imaging Equipment Specialist Robert Hinton.
Q: WHAT IS YOUR FACILITY’S PROCESS FOR ACQUIRING IMAGING PARTS FOR THE MAINTENANCE AND REPAIR OF IMAGING DEVICES? Bergstrom: We currently rely heavily on our clinical engineering department, who helps to manage and service over 42,000 pieces of equipment. When parts are needed, they primarily utilize PartsSource, a large marketplace supplier of medical supplies, equipment and repair services for the healthcare technology management (HTM) industry. We have multiple contracts with our vendors that we can leverage price of parts outside of warranty coverage. With our vendor agreements, we often qualify for significant discounts on OEM parts. Depending on the need and “hard to find” parts, we can request OEM or third-party through PartsSource and whenever possible we try to go with the OEM. There are times in which we cannot locate specialty parts or simply are not available fast enough. When this happens, we look to secondary third-party parts suppliers.
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Eastland: We have two basic means to acquire imaging parts for maintenance and repair. Most of the major imaging equipment is on OEM service contract and parts are included with the service. For any parts that are not part of the service agreement or for the imaging equipment we allow our biomed department to handle the service and maintenance, the biomed department acquires the parts through the various OEM vendors and third-party vendors. Hammoud: In general, it is part of a service agreement with the OEM. Outside of such an agreement, it would be mainly through third-party, issuing a requisition/PO for the needed part, with shipping speed identified ad hoc per the need. Skillicorn: We have several methodologies for acquiring parts that depend on our relationship with the vendor. We have full-service contracts which have parts included. We have support level/risk sharing agreements that do not have parts covered; this option allows us to access parts with a negotiated discount with the vendor, or access parts through our own research. We have equipment that is not covered; these devices allow us to use our own research and parts vendors. Q: WHAT IS YOUR EXPERIENCE USING OEM AND/OR THIRD-PARTY SUPPLIERS FOR IMAGING PARTS? Bergstrom: A majority of the time we consider OEM and I would bet that most organizations also look to OEM parts. However, due to competitive availability of OEM and often elevated price points we do have to look to third-party suppliers. A majority of the time, there are not issues with third-party parts. We have had scenarios that there have been issues with both OEM and third-party. It’s only the ones that we have had issues with that everyone hears about and builds a bad reputation.
ADVANCING THE IMAGING PROFESSIONAL
Eastland: We have had good experience with both OEM and third-party suppliers for imaging parts. Some of the third-party suppliers have provided even better pricing than the OEMs. Hammoud: Most OEMs’ parts are extremely expensive compared to reliable third-party vendors. Some third-party vendors have extremely low-quality parts though, so it is an art of balancing the need of quality parts and price. It is worth noting that some OEMs have programs that would provide OEM parts cheaper than third-party markets. Skillicorn: Interesting question, since COVID-19 derailed a lot of traditional parts ordering situations. The large vendors – such as GE, Philips and Siemens – all have multivendor parts programs that can assist in obtaining parts for any end-of-life system. Most third-party vendors have or are currently moving to ISO standards for quality to be in line with FDA standards. There are also vendors in the industry who do not use such practices. We use these processes to choose vendors for certain situations. Our experiences have been somewhat positive, specifically over the last year moving out of COVID-19 protocols where compromises to value chains for obtaining components caused a serious impact on availability and delivery time by OEMs and third-party parts vendors. Q: WHAT TIPS/ADVICE CAN YOU SHARE FOR AN EFFICIENT PROCESS? Bergstrom: There are all kinds of products out there which can make ordering the correct part difficult at times. One thing that has been important is to have an accurate inventory of our equipment with equipment identifiers including make, model, serial number and location within our imaging environments. As an example, you could have two identical ultrasound units, but one may be a slightly different model and require and slightly different part for the same function. In addition to special attention on specific model and parts identification, clinical engineering also has additional administration for issuing and tracking payment of parts so that the team is able to stay in the field helping to maintain and upkeep our imaging equipment. They also have dedicated staff for managing and maintaining our vendor agreements that we can quickly reference for warranty coverage. Eastland: We have tried service agreements that were more “global” – meaning one vendor oversaw the service for all equipment regardless of vendor. This
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process did not work well for us. We switched back to more OEM-based service contracts and this has worked much better for us. While the immediate cost of the contract might seem more expensive, we have experienced less downtime and therefore it has been more financially responsible. Hammoud: Most challenges in this domain are the availability and timeliness of parts. Sometimes internal processes can be the biggest hurdle an organization must overcome to have timely deliveries. So, identifying a special budget/risk pool with unrestricted access to healthcare technology or imaging engineers is a must-have process to ensure a part is ordered when a part is needed, and not 3 days later. Skillicorn: First and foremost, you must understand the requirements that FDA has in place for being an OEM, a remarketer, a remanufacturer and selling parts without doing rework on them. The differences are critical and need understanding to monitor vendors appropriately. Second, have processes around vetting and monitoring vendor performance for pricing, parts failures upon receipt (i.e. defective when received for installation), time to order to receipt, etc. Also, is the vendor ISO certified? What quality measures do they have? How are they with issues around parts ordering and delays? Are their processes simplistic or complicated? Use of this information will allow you to have a quality program around your vendor selection and prioritize the selection of parts from appropriate vendors. Q: WHAT IS THE BUDGETING PROCESS FOR IMAGING PARTS? Bergstrom: We have an extensive capital planning process for our organization in which we build capital requests over the course of the year and prioritize based on specific need. Our clinical engineering department has a dedicated focus on existing and future equipment planning. They are able to recognize service-related needs and help provide our administrators with equipment history and service data to make an informed decision on capital projections. Specifically pertaining to parts, the clinical engineering team also uses their own data to weigh cost analysis for their capital projections and are represented yearly in our organizational capital planning process.
Eastland: We budget for the service contracts which include most parts. Beyond that, we use historical information for the cost of parts that fell outside the contract adding a given percentage to match inflation.
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INSIGHTS
LAUREN BERGSTROM OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER
ROBIN EASTLAND UT SOUTHWESTERN MEDICAL CENTER
Hammoud: Historical last 12 rolling months. Skillicorn: Our process includes an annual target for expenditures that is based upon the past performance of equipment. To lower our contract outlay and future expenses, we also utilize methods to move costs from contract to in-house based; these decisions are based upon risk-sharing contracts. This approach is a more recent one we have implemented as we move forward with plans to train in-house staff to assume services on currently contracted equipment cost to avoid expenses in the future. Q: WHICH DEPARTMENTS ARE INVOLVED IN THE PROCESS OF ACQUIRING IMAGING PARTS? Bergstrom: Radiology and imaging administration, operational leaders, clinical engineering, IT, quality lead technologists, data analytics, modality managers, radiology chair and specific clinical modality physicians. Eastland: Biomed and imaging services are involved in the process for acquiring imaging parts. Hammoud: Healthcare technology/imaging engineers are the ones who would place the orders. Yet the imaging departments are usually the ones paying it out of their budget, so it will require their approval, then the purchasing department must create and submit the PO to the vendor. Skillicorn: There are four departments involved in our processes. We have an internal administrative team that assists with tracking parts acquisition and costs for efforts in cost reduction. Our team members fill out all PO requests and submit them to their manager for approval. These requests are then routed through our purchasing department for a PO to be assigned and a PO returned to the ordering service personnel for ordering. Once our parts are ordered, shipping and receiving will deliver them to our sites upon receipt from shipping vendors. Lastly, all of the cost information is tracked and documented in our financial system for budget review and financial analysis. 26
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NADER A. HAMMOUND SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH
DEAN SKILLICORN ST. LUKE’S HEALTH SYSTEM
Q: WHAT ELSE SHOULD ICE MAGAZINE READERS KNOW ABOUT IMAGING PARTS? Bergstrom: That parts are always more expensive than they seem and the recent COVID pandemic has made them hard to find and often takes longer to get, but this has been improving this year. And that we would not be able to acquire our imaging parts without the partnership with our clinical engineering department. Eastland: We have found keeping options open with both the OEM and third-party vendors helps to keep pricing competitive and to increase the availability of parts. We are fortunate to operate near a major international airport, but for more rural areas, working with the vendors to keep certain key parts close to the facility to help expedite repairs can also prove beneficial. Hammoud: For an immature in-house program for imaging maintenance, there will be trial and error to find the best vendor to use for parts (or even service), until you establish a well-defined, agreed-upon SLA with whoever your main parts provider is. Never settle on an exclusive source, keeping your options open will ensure you get the best deal every single time. Skillicorn: There are several areas to be very critical of when ordering and using used parts, specifically end-of-life products. Used tube and detector, imaging intensifier acquisitions should be done with the utmost care and research. Age will be critical in either of these components. Specifically, with regards to detectors and image intensifiers, image quality will be key to determining how long these components will survive in use. Understanding how long a used tube has been on the shelf could make a difference in how long that tube lasts, and the processes involved in installation, degassing, and calibration of such tubes. Be certain that any used components in this area are vetted appropriately before ordering them. • This month’s article is sponsored by Avante Health Solutions. For more information on this company, visit avantehs.com. ADVANCING THE IMAGING PROFESSIONAL
THE TOTAL PACKAGE HAS ARRIVED.
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Market Report IMAGING PARTS MARKET GROWTH EXPECTED STAFF REPORT
S
everal reports indicate continued growth in the medical imaging equipment market as well as the refurbished medical equipment market. The factors fueling the growth of those markets should also continue to power the expansion of the medical imaging parts market in coming years. Transparency Market Research reports that the global refurbished medical imaging equipment market size was recently valued at $7.1 billion. Refurbished medical imaging devices require parts which points to growth of the imaging parts market. “The global market is likely to progress at 9.1% CAGR during the forecast period, from 2022 to 2031,” the report states. “By 2031, the global refurbished medical imaging equipment market is anticipated to touch value of $18.3 billion. Due to the rising need for imaging devices for the diagnosis of numerous illnesses, the global market for refurbished medical imaging equipment is anticipated to expand quickly in the coming years. With the exception of a few illnesses, medical imaging technology including MRI, X-ray and CT scan scanners is widely utilized to identify practically every problem.” The performance of repaired and refurbished medical imaging equipment is on par with that of brandnew equipment, which is expected to propel these markets. Around the world, an increase in illnesses is increasing demand. Since they do not have to spend
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large amounts of money on new equipment, many hospitals rely on parts to repair devices in a health care facility or purchase refurbished medical imaging equipment. North America is expected to be a strong region of growth in the coming decade. “North America accounted for over 37% of the global market in 2021 and is expected to account for the largest revenue share in the refurbished medical imaging equipment market,” according to Transparency Market Research. “The region is anticipated to lead the global market during the forecast period. In North America, OEMs and third-party refurbishers are becoming more prevalent, which is likely to drive the regional market.” Global Market Insights reports that it expects the overall medical imaging market to grow at a compound annual growth rate (CAGR) of 5.5% from 2023 to 2032 after being valued at $40 million in 2022. Global Medical Insights also states that the North America medical imaging market is projected to experience a 5.3% CAGR from 2023 to 2032. The increased investment in new devices suggests that there will be a need for imaging parts in the future in order to maintain and repair devices as they age. Transparency Market Research, in a separate report, states that the global medical imaging equipment services market is expected to reach $29.2 billion by the end of 2031. Firms that provide medical imaging equipment services depend on imaging parts in order to serve their clients. •
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Product Focus IMAGING PARTS
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*Disclaimer: Products are listed in no particular order.
KEI MEDICAL IMAGING C781/C787 GRADIENT AMPLIFERS
The Copley 787/781 gradient set is one of most powerful and reliable gradients on the market. It is found on most of the Philips Ingenia and Achieva MRI platforms. They are water-cooled solid state high current linear amplifiers that are easily programable for a Panorama 1.0T, Achieva dStream and Ingenia 1.5T and 3.0T systems. KEI carries complete gradient amplifiers as whole used, tested cabinets and individual internal components, all ready for shipping. KEI has a large inventory of preowned Copley gradient amplifiers and Analogic refurbished RF decks ranging from 1.0T to 1.5T and 3.0T solid state amplifiers.
RAY-PAC
X-ray Tubes
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Ray-Pac specializes in overnight replacement of X-ray tubes. The company offers imaging equipment made by major OEMs at the best pricing in the industry. Its range of products includes Varex and IAE inserts. At Ray-Pac, they understand the importance of reliable medical equipment, which is why all of its products come with a 12-month warranty. Apart from replacement, RayPac also offers small repairs for tube leaks, re-pumping, stator replacement, and testing. The aim is to help customers stay competitive in the medical marketplace. Ray-Pac is located in Charleston, South Carolina, and have some of the best technicians in the X-ray tube replacement business. Ray-Pac’s owner and technicians have over 30 years of experience and some have more than 40 years of experience building some of the most trusted brands of 3” and 4” replacement X-ray tubes.
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PRODUCTS
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BLOCK IMAGING WISP
The WISP enables the OEC 9900 to transmit images wirelessly, eliminating the need for a direct Internet cable. At Block Imaging, they meticulously repair, test, and refurbish each WISP, equipping them with new cables and batteries, and restoring them to a like-new cosmetic condition for clients. Every WISP is delivered with a detailed installation manual to guarantee straightforward and effective setup.
FIRST CALL PARTS
Diagnostic Imaging Parts First Call Parts specializes in the meticulous refurbishment of diagnostic imaging parts. The process begins with sandblasting and repainting all covers and frames, ensuring a fresh, pristine appearance. In-house cable manufacturing ensures quality. First Call Parts replaces touch screens and displays with brand-new units for optimal clarity. Rigorous inspections and precision soldering, reflow, or Ball Grid Array technology are used to correct boards and board level components. Every part undergoes system installation, followed by comprehensive inhouse testing to ensure all functions meet stringent ISO 13485 standards.
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GE HEALTHCARE AIR Coils
GE HealthCare’s AIR Coil technology, featured in the recently launched SIGNA PET/MR AIR1, effortlessly conforms to the human body, thereby enhancing patient comfort. This technology offers a thinner, lighter solution, allowing for more accurate PET quantitation in contrast to conventional rigid RF coils. AIR Coils enable a simpler and faster workflow while maintaining excellent image quality, allowing for efficient scanning of complex anatomies and varied patient sizes. The increased adaptability of these coils allows for adjustable patient positioning. The softer, lighter and more flexible nature of AIR Coils not only improves patient comfort but also contributes to faster throughput, enhancing productivity and reducing scan time. 1 Not CE Marked. Not available for sale in all regions. SIGNA PET/MR AIR is a premium configuration of SIGNA PET/MR
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ADVANCING THE IMAGING PROFESSIONAL
CM PARTS PLUS
Gradient Amplifiers and Coils Those familiar with MRI know the scanner has the capability to produce images in the axial, sagittal and coronal planes. The combination of gradient amplifiers and coils use computer generated signals to provide location, direction and spatial resolution. The gradient amplifier provides amplification sufficient to excite the hydrogen protons at the desired region of interest. Since MRI is a non-invasive, soft tissue study researchers develop pulse sequences to produce images that enhance or suppress fat and water molecules. CM Parts Plus repairs gradient amplifiers on a regular basis.
INNOVATUS IMAGING
Ultrasound Probes & MRI Coils Innovatus Imaging is the ISO-13485:2016 certified premier repair provider for ultrasound transducers and MRI coils. Expertise spans the entire device life cycle – from design, development, and manufacturing, to sales, distribution, and service. With a legacy spanning 35-plus years and having restored more than 185,000 ultrasound probes and 40,000 MRI coils, Innovatus has accumulated tremendous amounts of data which serves as a massive knowledge base for continual improvement. The company operates an FDA-registered site for the design and manufacturing of ultrasound transducers and related products. Headquartered in Pittsburgh, Innovatus Imaging also maintains Centers of Excellence in Tulsa, Oklahoma and Denver, Colorado.
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MW IMAGING
Voyager Platform Power Module The Voyager Platform Power Module, also known as the VPPM, is located in the rear enclosure of the system. The VPPM is the main power supply for Epiq and Affiniti ultrasound systems. It provides an auto-switching AC power source for all voltages worldwide. The VPPM can house two batteries capable of powering the system in sleep mode during system transport for up to 45 minutes and in cases of accidental power loss. MW Imaging offers a standard 6-month warranty on all VPPM exchanges for end users. MW Imaging can be reached at info@mwimaging.com or 877-889-8223. • ICEMAGAZINE
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COVER STORY
BURNED OUT The Deteriorating State of Mental Health in the Workplace By Matt Skoufalos
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or as much as the shortage of incoming professionals is discussed as a deep-seated problem in the medical imaging space, perhaps some comparable amount of attention should be paid to what’s being done to retain their services in the field. The 2023 Medscape Physician Burnout & Depression Report showed 54 percent of radiologists are feeling the impact of burnout in their careers, a top 10 result among 29 physician special-
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ties surveyed for several years in a row. In a December 2023 survey of more than 18,000 academic physicians published in JAMA Network Open, nearly 40 percent of radiologists reported intentions of leaving their current jobs within the next two years, tied with critical care physicians for fifth among specialties surveyed. A March 2023 Journal of the American College of Radiology (JACR) survey of practicing radiologists within the largest coalition of wholly radiologist-owned, independently practicing diagnostic radiol-
ogy groups in America reported that “about one-half of radiologists were burned out, and just over one-quarter were professionally fulfilled.” If the medical imaging world needed any clearer signal that its staff were on the edge of a breakdown, the data are practically screaming for culture change in a workplace culture that is high on burnout, short on patience and in which professionalism has come to be defined as swallowing the small harms often perpetuated by other colleagues. ADVANCING THE IMAGING PROFESSIONAL
COVER STORY Tricia Trammell, imaging operations manager for the Moncrief and Las Colinas imaging clinics of UT Southwestern Imaging Services of Fort Worth, Texas, is a medical imaging technologist of 25 years. When she considers the climate of workplaces in her industry, Trammell said she believes that incivility among coworkers is rampant. Although the issue isn’t necessarily a novelty, its prevalence and intensity since the novel coronavirus (COVID-19) pandemic – and the workforce depletion that followed – “has unfortunately accelerated.” Regardless of the root of the problem, Trammell said the cost of failing to confront incivility in the workplace can create even greater concerns, from lost productivity to staff shortages to mistakes that can lead to negative outcomes for patients. “In health care, incivility can be downright dangerous because we have people’s lives in our hands,” she said. Author Christine Porath, who’s studied workplace incivility, especially in customer-facing professions, wrote on the subject in the Harvard Business Review. “Even amid a global health crisis in which frontline workers were heralded as essential and heroic, these employees still became punching bags on whom weary, stressed-out, often irrational customers (and sometimes fellow employees) took out their anxieties and frustrations,” Porath wrote. “This kind of incivility leads to negative outcomes not only for the workers who experience it directly but also those who witness it – all of which harms businesses and society.” Porath’s work described how reports of incivility are both on the rise, and leave a negative impact on those who witness them, even if they weren’t the original target of the behavior. After a global survey of 2,000 people in various industries, 76 percent of respondents reported having experienced incivility in the workplace at least once a month, and 70 percent reported having witnessed such incidents at work two or three times a month.
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“Merely being exposed to rude words reduces our ability to process and recall information,” Porath wrote. “Dysfunctional and aggressive thoughts (and sometimes actions) can skyrocket. Witnessing rudeness and triggers of incivility – such as reading a nasty comment on social media or listening to an argumentative interview – takes a cognitive toll, interfering with our working memory and decreasing our performance. And these disruptions can be catastrophic.” When coworkers decide that they just won’t communicate with one
A few pointers for bringing authenticity to the workplace: taking an interest in colleagues, using measured speech and behavior, taking ownership of mistakes, and being willing to forgive offenses and perceived slights from others - Tricia Trammell another because of a mutual dislike, or experiences of disrespect, they may simply remain silent instead of interacting at all. In that silence is a lack of shared information that could result in a delay of patient care, and blaming behaviors that follow. The antidote, Trammell said, is establishing a culture of psychological safety by encouraging employees “to bring their authentic selves to work every day,” and speaking up when they witness or perceive behaviors that
are incompatible with that goal. She described walking the line between being professional while being authentic in the workplace, and modeling the appropriate way to interact among the rest of her team. “I have multiple roles as a manager,” she said; “I refuse to not be my authentic self. It’s important for the team to know this is who I am, and we can still be professional all the time. Humans are going to make mistakes whether they’re 20 or 50, and we all have to have grace and extend forgiveness. And we also sometimes need a reminder that particular behaviors are inappropriate.” Trammell offered a few pointers for bringing authenticity to the workplace, including behaviors that generally boil down to: taking an interest in colleagues, using measured speech and behavior, taking ownership of mistakes, and being willing to forgive offenses and perceived slights from others. “I think the art of relationships is lost, and the lack of relationships breeds more incivility,” Trammell said. “It would be far more difficult to be more uncivil to someone you have a good relationship with. It’s not a weakness to have friendship with people; there is strength in friendships and relationships.” Wendy Dean, CEO and co-founder of Moral Injury of Healthcare, is a psychiatrist who studies distress among professionals in high-stakes environments. After having observed clinicians from across the country in different settings, Dean noted that they shared common struggles, and were reluctant to describe themselves as “burned out.” “These were people at the tops of their games; really sought after, brilliant,” she said. “They would all say almost the same thing, and they would almost use the same words: ‘I love my patients. I love the medicine that I practice. It’s everything else that’s grinding me to dust.’ ” Together with her colleague, Simon
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COVER STORY Talbot, Dean began exploring whether burnout might be an incomplete diagnosis, and the two discovered that the source of distress among health care professionals wasn’t just being overworked, although that was certainly a contributing factor. Professionals know they’re signing up for working long hours and attempting to achieve difficult results against sometimes long odds. What they hadn’t squared intellectually was the challenge in getting their patients access to necessary care. Rather than burnout, which is most commonly used to describe emotional fatigue, their experiences seemed to more closely match with the experiences of moral injury: bearing witness to acts that transgress deeply held moral beliefs and expectations. In short, physicians could manage being overworked, but not ethically compromised by the system they are working to uphold. “It really starts as betrayal by a legitimate authority in high-stakes situations,” Dean said. “You have a moment where you can either stand up, and push back and defend your deeply held moral beliefs and expectations, or you can acquiesce to that betrayal. We were hearing people saying, ‘I’m at this point where I either need to stand up and speak out, and risk everything that I’ve worked for, or I put my head down and do the best I can, but it’s going to eat at me if I do that.” When asked to compromise either
to live somewhere where you can’t get the amount of health care you need, where you need it, when you need it. That has now become a reality for us.”
WENDY DEAN
AUSTIN JOHNSON
TRICIA TRAMMELL
CEO and cofounder of Moral Injury of Healthcare
Consultation firm Executive Counseling of Lubbock, Texas
Imaging operations manager for the Moncrief and Las Colinas imaging clinics of UT Southwestern Imaging Service
their professional capacity or their moral code, health care professionals will disengage or become mistrustful of their leadership, Dean said, which means that they might experience a disconnect between what their organi-
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zations say they stand for and how they’re run in practice. When clinicians don’t trust their organizations, patients feel it; they trust the institution less, and they’re more likely to question the recommendations their clinicians make. The same impacts can be felt up the leadership chain, especially amid the environment of consolidation that has defined the health care space for decades. “These folks who used to be CEOs of their small hospital, they had authority and agency,” Dean said, “but when you roll them into a giant corporation, they become middle managers that no longer have the agency and authority to make the decisions they used to make.” In the radiology department, examples of moral injury can be found in challenges related to workflow, scheduling, and case volumes, among others. In the effort to hit peak efficiency, keeping scanners 95 percent booked has long been cited as a financial and productivity goal; however, that doesn’t allow for urgent cases to be seen in a timely fashion, and that can mean that people who are in pain suffer longer while awaiting care. “You have physicians saying, ‘I made a promise to take care of patients to the best of my ability without self-interest, and yet you are demanding that I put some other consideration before my
ICEMAGAZINE | FEBRUARY 2024
patients, which is the well-being of this organization,’ and that doesn’t comport,” Dean said. “Do we want profit to take precedence over patients? We have never had to imagine what it would be like
As disheartening as these challenges are, Dean doesn’t believe they’re insurmountable. But, she warns, the next decade is critical to shift the pendulum, because “we’re
COVER STORY
going to lose the last of those folks who lived in an era when right was valued.” “When you put somebody in a toxic system and they need to survive, they do whatever it takes,” she said. “If you take them into a different environment, those things go away.” “We need to have organizations with leaders who are committed to caring for those who care for their patients, who are transparent, who are authentic, who are human, who are trustworthy, who have aligned values, so the talk they talk is the walk they walk,” she said. “We need to acknowledge that this is really hard work that we do and that moral injury is a risk.” Licensed clinical psychologist Austin Johnson of the consultation firm Executive Counseling of Lubbock, Texas, believes that burnout is a cultural illness, and thus requires cultural approaches to remedy. Those health
care institutions that can leverage cultural and social dynamics to address such challenges will find greater successes rather than hoping to address individuals as outliers from the mean, he said. In con-
templating the major environmental factors that contribute to burnout, Johnson identified three clear challenges. The first is fatigue, or a complete loss of energy. The second is stagnation – a feeling that, no matter how hard you work, there’s no progress being made. The third is depersonalization, or the loss of individual identity in a greater, often oppressive, system. “When that sets in, that’s the danger zone,” Johnson said. “Factors that tend to go along with it are crazy expectations. Everybody is trying to make the absolute most of every single minute because the demand is huge.” To his thinking, the antidote to these circumstances involves exploring the cultural factors that set up people for failure in the workplace. They can be small, like the uncivil encounters that contribute to overall feelings of depersonalization, or they can be large, like the foundational questions of purpose and underlying meaning that have led many health care professionals to leave the field altogether. “Usually things that inspire a mass exodus of staff are surprisingly small things,” Johnson said. “Whenever they’re facing a burnout problem, which presents itself as a turnover problem, a lot of managers brains go first to money: ‘We can make them happy if we pay them more, or give them more PTO, or more money to hire more people.’ And whenever they’re feeling strapped for cash in the first place, that option feels closed.” Perhaps counterintuitively, Johnson said when the same question was put to a group of nurses – what would make your jobs easier? – their responses were all related to how they were treated interpersonally, not how much they were paid, nor how much time they were allowed away from the office. “When it comes to burnout culture, don’t overlook the power of non-monetary things,” Johnson said. “This is not me versus you; this is me and you
versus an extremely challenging set of circumstances. Anything you can do to signal we’re on the same side, you save money, time, energy, lives.”
“When it comes to burnout culture, don’t overlook the power of nonmonetary things. This is not me versus you; this is me and you versus an extremely challenging set of circumstances. Anything you can do to signal we’re on the same side, you save money, time, energy, lives.” - Austin Johnson Or, more simply put, the adage that “people don’t quit their jobs, they quit their bosses,” still rings true. “If you’re at the top, you can actively discourage bad manners,” Johnson said. “If you’re not at the top, positive reinforcement really does go a long, long way. What that means is you have to build a better radar system that pings so loudly whenever you get something different. Any time there’s a counter-example of people being treated poorly, you stop, let people know you notice, and how much you appreciate it on a personal level. It retrains your brain for what to look for and what to expect. In that act right there, you’re starting to slowly change the microculture around you.” •
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INSIGHTS
NO GUILT WITH SWITCHING GEARS DIRECTOR’S CUT BY NICOLE DHANRAJ
F
ebruary is still a time of year when we think about what 2024 has in store for us. Being a leader in radiology is no walk in the park, right? The past few years have been like a rollercoaster, and we leaders feel the major bumps and workload. It’s not all sunshine and rainbows; some days are just downright brutal. OK, OK, for most of us, sheesh, every day is brutal. Like the rest of the front-line workforce, radiology leaders are no strangers to quitting quietly. Many of you feel overly stressed and emotional about leaving your team behind and being stuck in decision-making. DOING MORE WITH LESS Work-life balance? We all want it, but sometimes it feels like trying to catch a unicorn. Most of us have accepted that there is no work-life balance, especially in this culture of doing more with less. There doesn’t seem to be joy and purpose and consequently we lose our spark, our passionate mojo. DON’T FEEL GUILTY It’s OK to admit it. Taking care of yourself is like putting on your superhero cape; you can’t save the day if you’re exhausted. Don’t be riddled with guilt. In this life, you have to put your oxygen mask on first. If you are stressed and tightly wound, what good are you to yourself, your family and your team? Switching jobs can be exhilarating, yet many leaders I’ve spoken to grapple with feelings of depression, withdrawal, and uncertainty about staying or leaving. Emotional struggles sometimes cloud logical
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decisions. Having experienced this multiple times, I’ve learned that prioritizing my vision for a fulfilling life is crucial. If a job impedes my well-being and happiness, it’s time to explore alternatives. OPPORTUNITIES AND SWITCHING COSTS I find it very surprising that many colleagues feel trapped in a job because they think opportunities are limited. There is a substantial ongoing shortage in radiology. The supply shortage ensures many opportunities. You just have to decide which opportunity you want to pursue. The challenge comes with weighing the switching costs, the costs to move geographic locations, uproot family, pack a house (I absolutely hate this!), the stress of change, and just the dread of starting over. WHAT DO YOU WANT? We are so good at making decisions for our department and team, but sometimes, when it comes to us, we are stumped in what we want to be when we grow up. Some leaders are tired of the leadership drama, and others just want to try something new. Whatever it is, the motivation to change has to be bigger than the challenges of the switching costs. Think about roles that you wanted to try, roles that brought you joy or just do something different. Dunno where to start? Try chatting with people in roles that intrigue you to gain insights to help you decide. THINK ABOUT WHERE YOU THRIVE Do you love the beach, mountains or maybe the quiet countryside? Your happy place matters. It’s like choosing the background for your computer. It makes a big difference. Consider what your area offers that protects you from burnout ADVANCING THE IMAGING PROFESSIONAL
and alleviates the pressure when you get bogged down by work. Thinking about where you want to live as well as the organization you want to work for, such as a trauma center, rural hospital, outpatient center, research university, for-profit, or nonprofit; the list is endless. Think about the places you have worked that you thoroughly enjoyed and pursue those opportunities where you will thrive! DO YOU NEED TO WORK? Many of you will be answering with a resounding, “Yes!” But leaders, just like superheroes, need some downtime. Maybe you’ve been working a ton, and it’s time to pause, even if it’s just for a little while. Create a budget to assess possibilities. Consider a temporary leadership role, working 9 months with 3 off – appealing, right? Your financial situation shapes choices, but remember, you also shape your finances. Even if now isn’t ideal, start planning to consolidate debt, manage expenses and take a short break. Hobbies, interests, social life and family should contribute to your overall life. Remember, you’re a human being, not just a human doer. Downtime is essential, even for go-getters like us. TAKING THE LEAP Deciding to switch jobs is a bit like choosing what flavor of ice cream to get. It can be challenging, but life is too short to be stuck with a flavor you don’t like. Trust yourself, make a choice and don’t look back. You need to make a decision and not let vacillation drain you. You have some excellent skills to make the best out of any situation. IS THERE A PERFECT MOVE? Not really. Life’s a bit like a game with unexpected twists. But you know what? You’re like the main character and can handle whatever comes your way. Have faith in your competency and confidence that you will make the best out of any decision. If THEICECOMMUNITY.COM
it does not work out, then rinse and repeat. You are not tied to one job – isn’t variety the spice of life? This is a personality preference, but in today’s world, we do not see the typical longevity of yesteryear. Five years seemed to be an average, but now it looks like 2 to 3 years is the new norm for staying at a job, if that long! DON’T WAIT FOR HAPPINESS. Delayed gratification works for some things in life, but not all the fun, good stuff needs to be saved for later. Life satisfaction can happen now. Don’t just wait for the next level or a specific stage of your life. Sheesh, we may be way too tired and broken to enjoy our golden years. Take a moment, look around and make sure you’re on the right path. You do have the choice to create the life you want on your terms. So, colleagues, you’ve got this! Life’s an adventure, and I don’t need to remind you that it is short, very short! You’re the main character and creator of your story. Make choices that bring you happiness and a sense of purpose. We have the freedom of choice, some harder to make than others, especially as we consider the team, the organization and our families. Try to focus on the choices that also work for you! If you are ready for a change, then go for it! Why not live your best life now? Wishing you lots of joy, high fives, and a fantastic journey in whatever you choose in 2024! It’s OK to think about what you want and what’s best for YOU! If you are trying to navigate your next move and you want an ear to help you see the tree through the fog, connect with me on LinkedIn! • Nicole Dhanraj, Ph.D., SHRM-SCP, PMP, GPHR, CPSS, CRA, R.T(R)(CT)(MR), is an experienced imaging director. ICEMAGAZINE
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INSIGHTS
PACS/IT/AI
SYNESTHESIA AND AI
BY MARK WATTS
A
rtificial Intelligence is not general intelligence. Current medical imaging AI has a narrow application.
This idea made me think about Kim Peek – the character that Dustin Hoffman played in “Rain Man.” Peek was born in Salt Lake City in 1951. He was not able to walk until age 4, could not button his own shirt. By age 18 he had a job doing payroll for a company with 160 employees. It took him only a few hours a week and he performed all the necessary calculations in his head. He had a measured IQ of only 87. He could read both pages of an open book at once. His left eye reading the left page and his right eye reading the right. Think books could be filtered into his brain in under an hour. He could provide instant driving directions between any two cities in the world, (before Google Maps) using near perfect recall and his prodigious mathematical calculating abilities, Kim could calculate the best routes in his head in an instant. He could recite any Shakespeare play verbatim. The card counting scene from “Rain Man” never happened but Peek did read a book on card counting and had all the mental faculties to perform that feat, but even a savant like Peek knew right from wrong There is another unusual mental gift that may help us understand AI and our understanding of it. Synesthesia is when you hear music, but you see shapes. Or you hear a word or a name and instantly see a color. Synesthesia is a fancy name for when you experience one of your senses through another. For example, you might hear the name “Alex” and see green. Or you might read the word “street” and taste citrus fruit.
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The word “synesthesia” has Greek roots. It translates to “perceive together.” People who have this ability are called synesthetes. Synesthesia isn’t a disease or disorder. It won’t harm your health, and it doesn’t mean you’re mentally ill. Some studies suggest people who have it may do better on memory and intelligence tests than those who don’t. And while it may seem easy to make up, there’s proof that it’s a real condition. One of the most common responses is to see letters, numbers or sounds as colors. You might also: • See or hear a word and taste food • See a shape and taste food • Hear sounds and see shapes or patterns • Hear sounds after you smell a certain scent • Hear sounds and taste food • Feel an object with your hands and hear a sound • Feel a touch when seeing someone else being touched. (This is called mirror touch.) This is where AI can help in health care. Not just seeing or hearing but in the combination of these receptors into a new langue to find patterns that our brain does not understand or that to which we cannot comprehend yet. Theragnostics is an example of of synesthesia thinking in medicine. I look forward to seeing how AI can broaden our perspective and understanding of the human body. I can see new and innovative treatments for human frailties that are not currently available. We must think differently and appreciate the savant in AI like we did Peek. Know the limitation and enjoy the expanded abilities. • Mark Watts is an experienced imaging professional who founded an AI company called Zenlike.ai.
ADVANCING THE IMAGING PROFESSIONAL
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INSIGHTS
CODING/BILLING
CAN WE…? PROBABLY NOT…
BY MELODY W. MULAIK
T
o be clear, I am a strong advocate for interventional radiologists appropriately billing for evaluation and management (E/M) services. Technically the E/M visit codes are available for use by all specialties but everyone must be mindful that all criteria of the code family must be met, the medical record documentation must support the billed level and type of service and the medical necessity for the visit must be clear. As radiologists continue to seek new streams of revenue, this goal must be balanced against compliant coding and billing practices. This column will focus on two types of visits that interventionalists may question whether or not it is appropriate to bill with the short answer being “probably not.” Practices should do a complete evaluation of all available authoritative guidance when making decisions regarding the appropriateness of billing for these services and not rely solely on this high-level overview. There are additional E/M visits/services that may also be in question and the same level of cautious approach should be applied. CRITICAL CARE (99291-99292) First, we will discuss critical care. The Centers for Medicare & Medicaid Services (CMS) has stated that “Providing medical care to a critically ill patient should not be automatically deemed to be a critical care service for the sole research that the patient is critically ill or injured.” The medical necessity to support critical care services must be clear and evident regarding the actual management of the patient at the bedside. Medicare claims data from 2022 reflects the top 5 specialties billing CPT® 99291 were emergency medicine, pulmonary disease, critical care (intensivist), internal medicine and nurse practitioner. Neither interventional radiology nor vascular surgery even made the list of specialties who provided these services. It would be highly unusual and an outlier in the data for an IR to bill for codes 99291 and 99292 routinely or with any frequency. Inappropriate billing of critical care services has been 44
ICEMAGAZINE | FEBRUARY 2024
a focus of the Office of Inspector General (OIG) who has conducted multiple reviews related to these services and the risk they present to CMS. The OIG notes the documentation of the critical care services is provided through the progress notes which document the total time spent dedicated to the patient on the date of encounter. This is time spent in direct care of the patient, it could also be spent in the time to assess the status of the patient, the results of tests and discuss with staff on the floor about the patient. During this time, the physician is solely focused on this patient, immediately available, and providing care to no other patient. Overwhelming the interventional radiologist (IR) may assess medical records, tests, converse with staff to understand the status of the patient, they are not providing medical services at the bedside for this critically ill patient. They are making the determination to provide a separate intervention, within a dedicated angio or other type of dedicated suite for which they will separately bill their services. The Society of Interventional Radiology (SIR) has a practice resource that references critical care1 and CMS provides examples for review that reinforces that it takes more than a critically ill to qualify for these services.2 Lastly, the American Medical Association (AMA) within their CPT® Assistant, March 2022 publication also addresses critical care services. If you are considering billing for critical care, review all of the authoritative guidance and resources to ensure compliance. COMPLEXITY ADD-ON CODE (G2211) CMS created a new HCPCS code (+G2211 - Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition) to account for complexity of services provided to new and established patients. CMS indicated they believe the updated definitions for CPT® 99202-99215 reflect the work provided in a “typical” office outpatient visit; however, for some specialties they do not adequately capture the resources associated with patient care. CMS indicated code G2211 is ADVANCING THE IMAGING PROFESSIONAL
intended to be used for services that are part of ongoing care to better account for the inherent complexity for all needed health care services and/or ongoing care related to a patient’s single, serious or complex condition. CMS emphasized the add-on code is not based on the characteristics of a particular patient, but rather the relationship between the patient and practitioner. The underlined words are key. In order to add G2211 there must be ongoing care of the patient’s complex condition. Seeing the patient in consultation or even performing a procedure and having a follow-up visit does not justify ongoing complex care. The first part of the add-on code, “continuing focal point for all needed health care services” describes a relationship between the patient and the practitioner, when the practitioner is the continuing focal point for all health care services the patient needs which is not a typical scenario for an interventional radiologist. The second part of the add-on code, “medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition” describes the relationship between the practitioner and patient for a specific type of condition(s). Unlike the first part of the code, described above, this part of the code is specific to a serious condition or a complex condition. The “ongoing care” describes the longitudinal relationship between the practitioner and patient but in
reference to a single, serious or complex condition. CMS provides the example of a patient with HIV who has an office visit with their infectious disease physician, as part of their ongoing care. Since the infectious disease physician is part of ongoing care and will have to weigh the same factors as the primary care physician in the above example during regularly scheduled visits, the E/M becomes more complex in nature due to the compound building of decisions and considerations for the patient. Even though the infectious disease doctor may not be the focal point for all services, HIV is a single, serious and/or complex condition. If the relationship between the infectious disease physician and patient is ongoing, G2211 could be billed. So, could an interventionalist bill +G2211? Maybe but highly unlikely unless their practice patterns are very unique. •
REFERENCES https://www.sirweb.org/globalassets/aasociety-of-interventional-radiology-home-page/practice-resources/globallsurgery-icn907166.pdf Medicare Claims Processing Manual, Chapter 12, Section 30.6.12 (Rev. 2997, 07-25-2014) https://www.cms.gov/Regulations-and-Guidance/Guidance/ Transmittals/downloads/R2997CP.pdf
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INSIGHTS
MEDICINE FOR THE SOUL CLIMATE CHANGE MAY IMPACT MENTAL HEALTH
I
n Finland, there is a clear increase in the number of sick days taken due to depression, anxiety and sleep disorders in October and November, whereas the number of absences is lower than expected between June and September. In late autumn, the number of sick days taken is almost twice as high as in the summer and about a quarter higher than in early autumn. On the other hand, manic episodes related to bipolar disorder occur more frequently than expected during the spring and summer, when there are more daylight hours, and less frequently than expected during darker times of year. The results can be found in a study funded by the Research Council of Finland. The study was conducted as a part of the Climate Change and Health research program. The aim of the study was to investigate the connection between changing light levels and mental health. It is expected that due to climate change, winters in Finland will become darker while summers will become brighter. During the study, Kela’s sick leave register was used to analyze the seasonal timing of a total of 636,543 sick leaves that were due to mental health reasons over a period of 12 years. The analyses examined whether the expected number of absences was above or below the expected number of sick leaves. • Previous studies have found that some people experience so-called winter depression (seasonal affective disorder) during the dark season. In addition to the typical symptoms of depression, kaamos depression involves an increased appetite and weight gain along with excess sleepiness, which means sleeping for longer and feeling tired during the day. The symptoms of winter depression can often be alleviated
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through bright light therapy, says Timo Partonen, a research professor at the Finnish Institute for Health and Welfare. Seasonal variation can increase workloads in the workplace and in health services particularly in the autumn, when the most common types of sick leaves – absences due to depression, anxiety and sleep disorders – are starting to occur often. • It’s also worth considering if there are other explanations for the phenomenon apart from a dark season. For example, is there an exceptionally high amount of psychosocial stress in the workplace during autumn, which then leads to an increasing number of sick leaves, says Professor of Psychology Marianna Virtanen. If climate change causes summers in Finland to become brighter and winters to become darker, the study suggests that depression, anxiety and sleep disorders could increase during the winter because of those changes. However, with the exception of sleep disorders, they could also become less prevalent during the summer. In the case of bipolar disorder, darker winters could alleviate the symptoms of mania, while brighter summers could exacerbate them. • REFERENCE: Virtanen M, Törmälehto S, Partonen T, Elovainio M, Ruuhela R, Hakulinen C, Komulainen K, Airaksinen J, Väänänen A, Koskinen A, Sund R. Seasonal patterns of sickness absence due to diagnosed mental disorders: a nationwide 12-year register linkage study. Epidemiol Psychiatr Sci. 2023 Nov 9;32:e64. doi: 10.1017/S2045796023000768 https://www.cambridge. org/core/journals/epidemiology-and-psychiatric-sciences/ article/seasonal-patterns-of-sickness-absence-due-to-diagnosed-mental-disorders-a-nationwide-12year-register-linkage-study/5842EB42FDC0667F6B710CF70EF1AA73
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INSIGHTS
KEEPING OUR HUMANITY IN A TECHNOLOGYFILLED WORKPLACE
L EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI
ooking back over the past 40 years, gains in technology have brought many benefits. Email has phenomenally increased the speed at which we can share documents and updates. WiFi opened the door to vast amounts of information without being tethered to a wall outlet. Video technology gives us ready access to online learning, plus the ability to conduct real-time meetings with people spread around the planet. An incredible number of benefits are accrued from today’s technology, but just as with human personality traits, technological strengths have corresponding limitations. Therefore, it is wise to be aware of the potential pitfalls so we can keep our humanity instead of letting technology supplant it.
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LET’S KEEP OUR HUMANITY A recent survey found that many workers feel taken for granted. It seems like a small thing, but actually it’s a big thing. The majority of workers stated that others expressing appreciation for their presence and contributions would lead them to be even more engaged. Unfortunately, the problem of workers feeling taken for granted is magnified by an over-reliance on technology. Let’s look at a few common issues. Over the years, I’ve observed the good, the bad and the ugly in workplace email usage. The good, as I said earlier, is the speed at which we can communicate and share documents. But research shows the average worker spends 2.6 hours each day reading, sorting and responding to email. That’s roughly 13 hours a week. And so, as we strive for efficiency in our email communications, a common occurrence is ADVANCING THE IMAGING PROFESSIONAL
to assume everyone understands the emotions and purposes driving our words. This easily creates problems because misunderstandings can happen quickly. Body language comprises 68% of interpersonal communication, and voice tone is 25%. Yes, only 7% of interpersonal communication is word choices. As you might imagine, and as you have probably experienced, that can lead to people ascribing meanings and intentions you do not have, and sometimes those misunderstandings fall quickly into a workplace wars of words. To counter the likelihood of that, I strongly recommend a policy of picking up the phone or getting on a video call to clear the air whenever two consecutive email exchanges in a thread show a misunderstanding. In other words, if a miscommunication occurs, and then occurs again after you tried clarifying the first, don’t take it any further via email. If you do, you run the risk of embedding a negative vibe, and those can have long-lasting effects. Just pick up the phone and clear up the misunderstanding. As soon as a phone call is made, not only does communication happen faster, but voice tone gets incorporated. That alone improves communication threefold. A video call increases communication clarity even more, because now facial expressions can be observed instead of imagined. The same prescription applies to unanswered emails. I’ve heard people complain about a co-worker not responding to an email, and stew over the matter for days while letting a bad vibe build up. I’ve even seen hurtful gossip damage workplace relationships, only to discover that the person never even saw the email. Pick up your phone to keep the human touch in your communications.
or nodding of one’s head, or even the difference between seeing someone actively taking notes or placing one’s pen down all can make online meetings less human. It’s incumbent on meeting facilitators or team leaders to learn what makes for good online meetings in their given situation. That said, gaps might persist. Since we’re talking about how to keep the human factor alive and well, to the extent that it’s possible, team leaders and meetings facilitators should connect with each team member in private dialog to learn what is appealing or not appealing in team communications. ONE SIZE DOESN’T FIT ALL In the same way that some people are outgoing while some are more reserved, we must acknowledge that some co-workers will find online meetings to be more productive while others will see them as a hinderance. Kurt is a guy who absolutely loves online meetings, because although he’s required to attend, he has little need to give input. From Kurt’s perspective, the majority of his meetings serve as status updates for him. While working remotely he can attend online meetings while getting other work done – something that would be socially unacceptable in a face-to-face meeting. Therefore, Kurt likes having online meetings because he can boost his productivity. On the other hand, Theresa is a huge people person who finds online meetings to be less productive. As mentioned above, Theresa is the type of person who makes connections with people one-on-one in the halls before and after meetings, sharing useful information and brainstorming ideas away from those who tend to take over a meeting. Theresa sees online meetings as inhibiting her productivity. All told, no magic method exists that pleases everyone. To keep the human factor alive in our technology-filled workplaces, managers and leaders need to pay close attention and identify what’s working well versus what’s not. Also, it’s not a one-and-done proposition. Collecting regular feedback allows leaders and meeting facilitators to keep the gears of communication running smoothly. The human experience is both precious and unique. Let’s not let it atrophy. •
To keep the human factor alive in our technologyfilled workplaces, managers and leaders need to pay close attention and identify what’s working well versus what’s not.
ONLINE MEETINGS Several years ago, when global events led many people to work from home, online meeting platforms became all the rage. Yes, they allow people from distant locations to connect to get work done, and yes, they provide many benefits beyond simple online chat or email. However, we run the risk of squelching our humanity if we rely on them too much. If you’ve worked in a place that has (or had) face-to-face meetings, you know that often the most effective conversations occur in the hallways outside a meeting room either before or after the meeting actually takes place. That beneficial phenomenon is often missing with online meetings. Additionally, virtual meetings minimize the non-verbal cues that people use to communicate about what’s being said. The raised eyebrow, the barely perceptible shaking
THEICECOMMUNITY.COM
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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ADVANCING THE IMAGING PROFESSIONAL
INSIGHTS
THE ROMAN REVIEW
STOP ASKING FOR FEEDBACK?
MANNY ROMAN
I
ran across an article titled “Stop Asking for Feedback” by Amanda Imber on the Harvard Business Review website. I was stunned!
How can you communicate if you remove a most important requirement of good communication? Good communication begins with the telling of the what and the why and then providing what can be expected of the message. Then we must ask for feedback to determine acceptance and or understanding of the message. The feedback is critical to ensure we do not leave behind a misunderstanding or worse allow for an unrealistic expectation. Feedback is a two-way street in that both parties need to “negotiate” the message back and forth with feedback. I contend that without feedback there is no true communication. Think of an email that is sent with no one providing feedback indicating what was understood. I had five of those today. Each required additional discussion to ensure understanding. One required a phone call to ensure the feedback process was immediate. Then, I read the article. It does not discuss the feedback process in normal communication. Ms. Imber discusses the instance when you might ask for feedback on a presentation for example. You might want someone to tell you how it went. She points out that according to research, feedback has little impact on our performance. “Over one-third of the time, it actually negatively impacts performance.” A study at Standard University which analyzed over 200 performance reviews found that compared to men women received feedback less likely to be tied to business outcomes and was more vague and more challenging to implement. The reason feedback is ineffective is that it looks backward (feedBACK). Feedback is attached to past behavior not related to the future. It is a what went wrong, or not quite right. Therefore, it is not rooted in future positive actions. In a study at Harvard Business School, participants were asked to provide either feedback or advice regarding a job application. Feedback providers gave more vague comments and general praise. Advice providers gave more critical and actionable comments. Advice givers suggested 34% more specific ways to improve THEICECOMMUNITY.COM
and 56% more general ways to improve. The conclusion is that people who asked for advice are more likely to use critical thinking to provide strategies that the recipient can use to improve. Here are the main points to consider when asking for advice: BE SPECIFIC IN THE TYPE OF ADVICE YOU ARE ASKING What specifically are you asking advice on? Are you asking to improve on an idea, a presentation’s content, your communication skills, etc. Rather than asking, “How was my presentation?” Ask, “What can I do to make my points more clear and interesting?” SHOW THEM THE WAY Ask about what can help you in the future to place them in that mindset to elicit more specific and actionable suggestions. Don’t ask what went wrong, ask how to improve in the future. Maybe the suggestions will necessarily take into consideration what went wrong, however it will not be the focus of the advice. GIVE A LITTLE NUDGE Do not accept vague and unproductive feedback. Nudge them beyond the “You did great!” Ask specifically what went well and what could be done to take the extra step towards better than great. ASK THE RIGHT PERSON Looking for truly valuable and implementable advice, then limit your advice giving pool. Be sure that those you ask will have the knowledge, wisdom and desire to help you improve. Those close to you may not be the correct group for any particular need. Don’t ask your mother for resume writing advice less she meets the knowledge and wisdom requirements. My advice: Surround yourself with great people both in business and personal matters and be sure to seek specific feedback from the correct group. Or … ask your social media network. • Manny Roman, CRES, is association business operations manager at Association of Medical Service Providers. ICEMAGAZINE
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Quote of the Month:
“You’re braver than you believe, stronger than you seem, and smarter than you think.” – A.A. Milne
Across 1 Mental state of focusing on the present moment 7 EEG and MEG are commonly used as imaging techniques to assess the health of this organ 9 Tungsten, for example 11 MIT specialty, abbr. 12 Eye part 13 Prepare, 2 words 15 Last summer mo., abbr.
Down 2 The I in MRI 3 Device that measures bone mineral density 4 Customer 5 Requirement 6 Surgeon’s artery opener 7 PET ____ ____: imaging method to detect a protein that has been linked to progressive brain atrophy and cognitive decline, 2 words
16 Devices used to visualize and examine the condition of the ear canal and eardrum
8 Nurse, abbr.
19 Time period for short
10 Records
20 CT scan used in dentistry to assess the quality of the jaw bone prior to placing an implant
14 Type of dye that enables clearer view of an internal structure in the body
22 Not operational
17 Arrange a number of devices or objects in a series or sequence
23 Giving out or emitting 26 Completed 27 Amount of radiation measured in rads 28 Power
18 Putting in position 21 Touch down times, abbr. 24 Weight measurement 25 Disposable hair ___ (for nurses)
Visit theicecommunity.com for the solution.
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INDEX
AllParts Medical p. 15
ADVERTISER INDEX Ray-Pac®
Intermed p. 55
Ray-Pac p. 60
KEI Medical Imaging p. 56
Summit Imaging p. 33
Althea-US p. 23
Brandywine p. 54
KMG p. 47
Radiological Service Training Institute p. 2
Lexicon MedParts p. 55 Chronos Imaging LLC p. 21
RTI Group North America p. 45 Maull Biomedical p. 50 Technical Prospects p. 4
CM Parts Plus p. 50 Metropolis International p. 53
SOLUTIONS
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GS Global USA p. 3
TriImaging Solutions p. 27
MW Imaging Corp. p. 43
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ICE Webinars p. 52
Innovatus Imaging p. 9 58
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