ICE Magazine November 2023 by MD Publishing

NOVEMBER 2023 | VOLUME 7 | ISSUE 11

MAGAZINE

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ADVANCING

IMAGING PROFESSIONALS

S M A L L V I C TO R I E S Finding Gratitude in Difficult Moments PAGE 36

PRODUCT FOCUS PEDIATRIC IMAGING PAGE 33

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FEATURES

16 OFF THE CLOCK

Jeremy Tolaro believes in self-improvement and tries to share that approach with his children. He also enjoys being outdoors and in nature.

36 COVER STORY

At the turn of the season, we asked a handful of medical imaging professionals to share with us, in their own words, the people, moments, and things that have kept them grounded and grateful in 2023.

26 GUIDE TO RSNA

The Radiological Society of North America (RSNA) 109th Scientific Assembly and Annual Meeting’s theme for this year Leading Through Change.It will be held at McCormick Place Chicago, Nov. 26-30, 2023.

ICEMAGAZINE | NOVEMBER 2023

ADVANCING THE IMAGING PROFESSIONAL

NOVEMBER 2023

18 IMAGING NEWS

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

33 PRODUCT FOCUS

A look at the latest in pediatric imaging.

EMOTIONAL INTELLIGENCE

Approximately 18 percent of workers are actively disengaged. Be sure to read on to see what can be done to improve things.

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ICEMAGAZINE

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

John M. Krieg john@mdpublishing.com

Vice President

Kristin Leavoy kristin@mdpublishing.com

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CONTENTS SPOTLIGHT

In Focus Brian Fox, MBA, FACHE, FAHRA, CRA, RT(R)(MR)

Rising Star Elizabeth Kim

Rad Idea 7 Stress Busters

Off the Clock Jeremy Tolaro, Radiology Supervisor, UH St. John Medical Center

Group Publisher

Megan Cabot megan@mdpublishing.com

John Wallace

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

Editorial Board

Guide to RSNA RSNA Readies for 109th Meeting

Webinars Webinar Addresses Constructive Criticism for Gen-Z

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

PRODUCTS

32 33

Market Report

Product Focus Pediatric Imaging

INSIGHTS

Webinars

Director’s Cut Beyond Conventional Wisdom: Rethinking Staffing Agencies

Digital Department

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PACS/IT/AI Breast Cancer Imaging and AI

Emotional Intelligence Keeping Employees Engaged

Roman Review Fomo, Jomo, & Fomomo

53 54

ICE Break

Linda Hasluem

Cindy Galindo Kennedy Krieg Haley Wells

Accounting Diane Costea

ICE Magazine (Vol. 7, Issue #11) November 2023 is published by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www. theicecommunity.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2023

NEWS

Editorial

ICEMAGAZINE | NOVEMBER 2023

Index

ADVANCING THE IMAGING PROFESSIONAL

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SPOTLIGHT

IN FOCUS BRIAN FOX

BY JOHN WALLACE

rian Fox, MBA, FACHE, FAHRA, CRA, RT(R) (MR), is the executive director of radiology and patient transport at Barnes Jewish Hospital, BJC Healthcare.

Brian Fox is the executive director of radiology and patient transport at Barnes Jewish Hospital

ICEMAGAZINE | NOVEMBER 2023

His journey into the imaging world began as a desire to give back. He wanted a career that not only allowed helping others but one which had that attribute listed in the job description. “When looking for careers and professions, I always wanted a service-oriented profession that supported community,” Fox explains. “Initially, I was leaning towards teaching when my mom who is a nurse introduced me to different fields in health care. I completed shadowing in a radiology department and never looked back. I love the service and care technologists provide as an integral part of the health care team. In addition, the technology and innovation we work with is amazing, our field is one blended in art and science.” When asked about his greatest accomplishment he lists family first, including two adult children.

“My wife, Marcela, is in imaging as well, she is a mammography technologist. I am always inspired by the commitment and professionalism of our front-line team members in health care,” Fox says. Second, after family, he says his greatest accomplishment is “supporting and seeing professional growth of future leaders in imaging.” “It’s a pleasure listening and learning about someone’s passion and providing support and visibility” Fox explains. “With early careerist, it’s important to create a safe learning culture to learn from failures and build confidence. Allowing bold choices as they prepare for career progression. I enjoy participating in learning environments with AHRA and ACHE obtaining fellowship status with both is an accomplishment.” The people he works with are one of the main reasons he continues to love the career field he selected after that job shadowing experience years ago. “In my current role it is a privilege to work with extraordinary teams. When I look around the room, I am honored and humble to work with visionary leaders who are transforming imaging and improving health care,” Fox

ADVANCING THE IMAGING PROFESSIONAL

says. “I appreciate opportunities imaging leaders bring to influence and impact systems and programs to improve the delivery of health care in our communities.” Fox says he strives to be a servant leader. “My leadership style is grounded in servant leadership. This was instilled early in my career from my graduate program and my time as I transitioned from bedside to imaging leadership roles at UTSW,” Fox says. “I feel like I won the lottery when UTSW hired me as an MRI technologist many years ago early in my career, I was able to work in an academic medical center focused on lifelong learning and development. It’s important to be present and authentic, the attention of civility and kindness is important in leadership. Christine Porath and Marshall Goldsmith are fantastic resources for additional reading.” Looking into his crystal ball, Fox predicts an exciting future in the imaging realm. “It’s energizing to spend time with future imaging leaders. The passion, curiosity, creativity and talent the future leaders are bringing forward positions

a bright horizon for imaging,” Fox says. “Imaging will make a meaningful impact to disparities in care for our communities with thoughtful leadership. It’s important work and wonderful to see accreditation agencies bringing new requirements to reduce these health care disparities. We have an opportunity to model and lead efforts with health-related social needs ensuring all members of our communities receive high-quality health care, the innovations with imaging as part of the care pathways will bring importance to listening and gain understanding to support this work.” Work is important, but work-life balance is vital. Fox does consider his family his greatest accomplishment. “I’m blessed to have my wife, Marcela, and our children as my anchor. Taylor, our daughter, who recently graduated from the University of Oklahoma is working with a marketing firm in Dallas. Josh, our son, who is finishing his last year at Oklahoma State University,” Fox says. Each fall the family has fun with college football as they become a house divided. “With each team I work with, I

BRIAN FOX

MBA, FACHE, FAHRA, CRA, RT(R)(MR)

share the importance of family,” Fox adds. “There was an image that went viral recently that frames this well within this context – 20 years from now, the only people who’ll remember if you worked late, are your kids. Spending time, supporting and being present with my family is important to me. As a college football fan, I have enjoyed visiting my kids’ universities and experiencing the community and energy of a campus on game day.” When asked what else he wants to share with ICE readers, Fox stressed helping others. “I am passionate about helping people connecting with the resources to develop and support them. I’ve benefited from those who have helped and supported me, and it gives me purpose to do this for others,” he says. “I enjoy system level work with a lens on organizational behavior and interdependency of our teams. Two formative resources early in my career development was the work by Eliyahu M. Goldratt, ‘The Goal’ is a fantastic read, and Dietrich Dorner, ‘The Logic of Failure,’ are great introductions to system level thinking approaches.” •

challenge yourself with professional growth, Third, be kind, we all need support at times. I remember the transformational leader, UTSW Radiology Department Chair Robert Parkey, MD, sharing

1. What book are you reading currently? “The Long Fix” by Vivian

with me when I began a new leadership opportunity, we develop

S. Lee, MD

more than film (this was many years ago in a time before PACS and

2. Favorite movie? “The Incredibles” (the first one) 3. What is something most of your coworkers don’t know about you? Most of my coworkers and colleagues know I’ve completed marathons and several half marathons (favorite distance). What they don’t know is how average I am, at best! It’s been a struggle and I’m not fast – never have and never will be, and that is OK. 4. Who is your mentor? Currently, I’m excited as I am waiting for a match from the ACHE mentor program. 5. What is one thing you do every morning to start your day? Habits and routine are important to me; I follow the work of James Clear closely. I start each day with the following: A short read and plan my day while I drink a glass of water then hot tea followed by a coffee. I avoid emails and social media until I have reflection on the day ahead – which sets the day. 6. Best advice you ever received? First, be patient and intentional with professional development. Second, be uncomfortable as you

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digital informatics). This simple statement made a profound

impact and has stayed with me over the years. We have an obligation to develop and prepare those who will come after us. 7. Who has had the biggest influence on your life? Three actually … my grandmother, my mom and my wife. 8. What would your superpower be? Control time – not time travel per se. While I can control what I do with my time – there are times I’d like to pause and enjoy moments longer. 9. What are your hobbies? Traveling, watching and following my sports teams (Oklahoma Sooners, Dallas Cowboys, Texas Rangers and Dallas Stars) with family and friends. Running and cycling, the communities and support towards an individual goal (target race) helps me recharge and provides self-care. 10. What is your perfect meal? Pozole or carne asada tacos. Fresh seafood is a perfect meal as well.

ICEMAGAZINE

SPOTLIGHT

RISING

STAR ELIZABETH KIM

lizabeth Kim is radiology research manager at Children’s Hospital Los Angeles. Her imaging education started after a 6,000 mile trip from South Korea to Minnesota where she earned a Bachelor of Arts in Chemistry from University of Minnesota-Twin Cities. Kim continued her education earning a Master in Health Delivery Science (MHDS) from Cedars-Sinai and an Master of Business Administration (MBA) from Boston University. ICE Magazine found out more about this rising star with a question-and-answer session. Q: WHERE DID YOU GROW UP? A: I was born and raised in Seoul, South Korea. I emigrated to the U.S. to attend college.

Elizabeth Kim is the radiology research manager at Children’s Hospital Los Angeles.

ICEMAGAZINE | NOVEMBER 2023

Q: HOW DID YOU FIRST DECIDE TO START WORKING IN IMAGING? A: From a young age, I was fascinated with the concept of medical imaging. Following this interest, I volunteered in high school at a nuclear medicine department at Samsung Medical Center in Seoul, South Korea, where I curated nuclear medicine scans for research studies.

ADVANCING THE IMAGING PROFESSIONAL

Q: WHAT IS THE MOST REWARDING ASPECT OF YOUR JOB? A: I can contribute to various levels of physician/faculty success as well as their program success by orchestrating the team and interacting with various stakeholders.

FUN FACTS

Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: It is a unique position requiring a balance between clinical and community needs.

FAVORITE HOBBY: Tennis

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: Imaging is a unique field in health care giving access to contribute to several disease groups with cuttingedge and evolving technologies.

FAVORITE SHOW: “The Bear”

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: My greatest accomplishment has been building teams and contributing to team members’ professional growth. Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS? A: My long-term goal is to be in a role where I can bring maximal positive impact to people and processes involved in delivering high-quality care and researchdriven solutions to improve human health. •

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SPOTLIGHT

Rad idea BY LAURA PURDY, MD, MBA

7 STRESS BUSTERS

ong-term stress is an issue that impacts millions and can have dire consequences if it goes unchecked. Having a strategy and prioritizing stress management is crucial to improving stress reactions and living a higher quality of life. The good news is that we can do plenty of things to help keep stress in check. There are times when stress is going to be there no matter what, and it may be unavoidable, but we have to take steps to minimize the impact it has on our lives. If you don’t give stress the attention it needs, it can impact your health, and then you will be forced to prioritize that potentially bigger problem. According to the National Institutes of Health, stress that lasts a long time can harm your health. Some ways it can impact one’s health include weakening the immune system, so people get sick more often, have digestion problems or trouble sleeping, and headaches. Stress has also been linked to the development of such severe conditions as depression, anxiety, heart disease, high blood pressure and diabetes. The key is learning how to cope with the stress so that it won’t have a long-term impact. Here are 7 stress busters to help everyone manage and thrive: • Make self-care a priority. Most people, especially women, are busy taking care of the needs of everyone around them yet neglect their self-care. That needs to change so that self-care becomes a priority. WWW.THEICECOMMUNITY.COM

• Do a self-evaluation. Think about what is missing and what needs to change, and then move toward that. If it’s something that needs to be added, then work toward adding it. If it’s something that needs to be removed, then make that happen. • Engage in self-calming activities. Daily, do at least 10-15 minutes of a calming activity you enjoy. This can be yoga, meditation, journaling or simply sitting on the back porch listening to the birds. Shut everything out and only do that one thing. • Be sure to exercise regularly. While you have repeatedly heard about the importance of being physically active, it has to be said. Being physically active helps to melt away stress and improve quality of life. Keep moving! • Be mindful of consumption. This goes not only for what you eat that may make you feel better or worse but what you listen to, watch on television, read, etc. At times, social media and news, for example, can make people feel more stressed or even depressed. • Pace yourself. Everyone is in a hurry for everything, and all that does is lead to more stress. Learn to say no, go slow, plan ahead and avoid the rush. • Treat yourself. If the funds allow for it, get a massage once a month. Research studies find that massages help to reduce stress and anxiety and are positive for one’s mental health.• Share your RAD IDEA via an email to editor@mdpublishing.com. ICEMAGAZINE

SPOTLIGHT

Off Clock THE

JEREMY TOLARO, RADIOLOGY SUPERVISOR, UH ST. JOHN MEDICAL CENTER BY MATT SKOUFALOS

rowing up in Westlake, Ohio, Jeremy Tolaro was seldom far from UH St. John Medical Center (then St. John and West Shore Hospital). His mother worked as an outpatient registration secretary there, and when Tolaro turned 17, he joined her at the facility. After starting in its cafeteria, Tolaro moved on to the radiology department within six months, where he pulled, filed, and stored radiology films. Between that work and the kindness shown to him by the technologists in the department, Tolaro soon began learning about image processing and how files are communicated to physicians’ offices. Soon he discovered the path on which his own career would flourish. Since earning his bachelor’s degree in health sciences at Cleveland State University – and with the exception of a year off to attend nuclear medicine school at the University of Findlay, where he earned his CMNT – Tolaro’s entire career has been mostly built within the Uni16

ICEMAGAZINE | NOVEMBER 2023

versity Hospitals health system. He credits a natural curiosity and interest in learning how things work with helping him succeed in the roles in which he found himself. “All I really wanted to do was learn things,” Tolaro said. “UH St. John gave me an opportunity to be lead tech just because I was always asking questions. I’d already learned how to order supplies, make schedules, work on quality assurance, and help with state inspections, so it was kind of a natural transition.” “A couple years after that, a very similar thing happened with a supervisory position,” he said. “I wasn’t looking for leadership, but I wanted to learn how to do a little bit more, and it was a natural transition. Now I’m getting my master’s degree.” Tolaro believes that his interest in self-improvement, and not any specific desire for a leadership role, opened the doors for his professional advancement. But by being curious and challenging himself intellectually in the workplace, he was rewarded for his innate inclination towards education. “I still think that’s important,” he said. “Whether you have leadership goals in mind, or any sort of advancement, it’s got to come from a genuine place of curiosity, and a

desire to get better and do more. If that works in my favor and leads to another advancement, then fantastic. But I enjoy what I’m doing now, and want to make sure that I’m the best I can be at it so that I can continue to get that satisfaction from the job. If I just wanted to clock in and clock out, and not do anything else, I wouldn’t be where I am.” Those are lessons that Tolaro works to confer to his six- and eight-year-old children. Their interests are as varied as their moods, and include sports like gymnastics, soccer and football. When he’s not ferrying them to and from practices, games, and competitions, Tolaro enjoys spending time with them outdoors. An avid sportsman who appreciates hunting, fishing, and boating, he’s eagerly anticipating the day when they join him in pursuit of those experiences. “The house I grew up in was on two acres of land, and the back acre was all woods,” Tolaro said. “It backed right up to one of the metro parks in the Cleveland suburbs, so growing up, I had access to the woods; that’s what we did for fun.” When Tolaro’s parents said, “Go out and play,” he and his friends took advantage of the suburban Ohio metro parks system within a mile of his home. They spent hours walking ADVANCING THE IMAGING PROFESSIONAL

Jeremy Tolaro enjoys spending time with his children when not a work. He also loves being outside surrounded by nature.

through the woods, making trails, constructing bike paths, and finding their fun in the great outdoors. It instilled within Tolaro a love of wild places and communion with nature that he’s passing on to his children. Today, when he wants to get out to nature, he has options. If he’s feeling nostalgic, he can retrace his steps through the local parks, head to a friend’s property for hunting, or swing up north to go boating or fishing on Lake Erie. If all of those are too far out of the way, he’s equally happy to step outside to his back deck and enjoy some time under the pergola. “Whatever’s close and convenient; whatever strikes your fancy that day,” Tolaro said. “When I’m going with my kids, it’s a way to have some quality time, and catch fish, and make it more exciting.” Tolaro hunts deer for venison; during archery season, he’ll use a crossbow, but during gun season, he prefers a muzzle-loading, one-shot rifle WWW.THEICECOMMUNITY.COM

to keep things challenging for himself. “I have used shotguns and lever-action rifles,” Tolaro said, “but for me, there is more sport to the muzzle-loader. The gun part isn’t as important as the sport and the hunt. If I went to 100-percent using a crossbow, it wouldn’t change a thing, except I’d have to wait even longer for the deer to get closer. I don’t really believe in trophy hunting, but if a trophy comes up, we’re going to take advantage of it.” Deer hunting starts early in the day, at least 90 minutes before sunrise. Tolaro will climb a tree, set up a deer blind, or otherwise position himself out of sight in the pitch black, so he can be ready to go before the sun rises. As day breaks, his favorite part of the experience is hearing the woods come to life amid that tranquility while sun streaks across the sky. His second-favorite moment is when a deer approaches. “It’s totally quiet, totally peaceful, and you get that every single time

you get into the woods,” Tolaro said. “You’re zoning out, or almost meditating, and when you hear or see movement, you’ve got to wait until that deer gets into a position where you can take a shot. That adrenaline is building that whole time.” For Tolaro, the experience of hunting and fishing is as much about hands-on self-sufficiency as any other chore, from repairing a household appliance, changing out his car’s brakes, or cooking his own meals. He enjoys the satisfaction of a job done well, and by his own two hands. “There’s two types of people who hit the lottery,” Tolaro said: “someone who would never do anything for themselves again, and me, who would go out and buy the tools and learn how.” “Always be active,” he said. “Try to do something; try to learn something. I like being the guy that, if it needs to get done, I’m able to do it. I want to keep learning and getting better so that I continue to be that guy.” • ICEMAGAZINE

NEWS

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

ICE2024 IMAGING CONFERENCE & EXPO FEBRUARY 18-20, 2024 • IRVINE, CA

ICE ANNOUNCES 2024 CONFERENCE SCHEDULE It’s official! The 2024 Imaging Conference & Expo includes a 10th anniversary celebration in beautiful Irvine, California! Mark the calendar now for February 18-20 and join colleagues at The Hyatt Regency Irvine (formerly Hotel Irvine) for networking, continuing education, exhibit hall and a party on the lawn. The celebration kicks off on Sunday, February 18 with registration starting at 2 p.m. and a Drinks & Hugs Happy Hour from 5 to 6 p.m. Registration opens back up at 7 a.m. on Monday with education, lunch, keynote and exhibit hall grand opening for all attendees and vendors. Monday also includes a busy day for Leadership Summit participants with a delicious breakfast followed by a reverse expo and leadership summit. Education continues on Tuesday morning and afternoon with exhibit hall hours sandwiched in the middle from 11:30 a.m. to 2 p.m. The 10th anniversary of the ICE conference concludes

ICEMAGAZINE | NOVEMBER 2023

with a Party on the Lawn at 5 p.m. The Imaging Conference and Expo (ICE) is the only conference dedicated to imaging directors, radiology administrators, and imaging engineers from hospital imaging departments, freestanding imaging centers and group practices. ICE offers valuable CE credits (pending approval) and, keeping in line with MD Publishing’s successful conferences in the past, offers comprehensive educational opportunities for attendees. ICE continues to be the only conference to combine leaders in imaging management with imaging engineers, providing an exclusive and unique community of key decision makers and influential imaging professionals. ICE is the perfect resource to grow and prosper, personally and professionally. For more information, visit AttendICE.com.

ADVANCING THE IMAGING PROFESSIONAL

MAYO CLINIC ENTERS INNOVATION COLLABORATION The Mayo Clinic and GE HealthCare have announced a strategic health care collaboration for research and product development programs aimed to transform the experience of patients and clinicians in the practice of radiology and the delivery of novel therapies. The Strategic Collaboration for Innovation in Medical Imaging and Theranostics comprises Mayo Clinic and GE HealthCare scientists, technology developers, clinicians and other health care providers. The collaboration seeks to better equip clinicians with technology to precisely diagnose and treat medical conditions and personalize the patient experience at each step of their care journey through the clinical translation of novel technologies and approaches to medical imaging and theranostics. “We are at a critical time in health care – technology is rapidly evolving, and we have a responsibility to drive health care capabilities through clinical translation and adoption of advanced technologies,” says Matthew Callstrom, M.D., Ph.D., chair of radiology at Mayo Clinic in Rochester, Minnesota. “This collaboration brings our research and clinical teams’ expertise and feedback closer to product development and commercialization of innovation, ultimately accelerating the rate of translation of our research to patient care and offering greater opportunity for global impact.”

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Building upon a long history of research collaborations between the two organizations, the alliance will deepen the collaborative efforts by focusing on four core areas: 1. Rapidly accelerating the development and clinical translation of advanced magnetic resonance (MR) technologies and techniques, transforming patient care through artificial intelligence (AI) enabled exams from order to report. 2. Transforming cancer care through precise imaging and dosimetry of highly targeted theranostic agents and enabling broader access through more efficient radioisotope production. 3. Making diagnostic and interventional ultrasound easier and faster to use and read, while advancing automation and quantification to improve patient access, consistency of care and clinician experience. 4. Improving the patient imaging experience across the care continuum by leveraging multi-modal data, AI and digital health platforms that together streamline clinical operations and support more personalized diagnosis and therapy. •

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NEWS

GE HEALTHCARE INTRODUCES VSCAN AIR SL

GE HealthCare recently announced the launch of Vscan Air SL – a handheld, wireless ultrasound imaging system designed for rapid cardiac and vascular assessments at the point of care to help clinicians accelerate diagnoses and treatment decisions. The latest addition to the Vscan product suite, Vscan Air SL features GE HealthCare’s proprietary SignalMax and XDclear technology that provide high levels of penetration, resolution, and sensitivity in imaging performance with an industry-leading single crystal transducer technology. With cardiovascular disease the most prevalent disease worldwide often presenting in emergency situations, prompt diagnosis and treatment can be vital. The portable, wireless Vscan Air SL is designed to enable clinicians to efficiently collect and view crystal clear cardiac and vascular images at the point of care. By streamlining these workflows and avoiding overloading traditional radiology resources, clinicians can expedite care decisions to help patients receive treatment plans right away when time is of the essence. “Having ever more powerful handheld ultrasound is a game changer for patient care,” said Guy Lloyd, M.D., FRCP, consultant cardiologist at Barts Heart Center, University College London Hospitals and clinical director for cardiovascular diagnostics and investigations. “Whether on the ward or in general practice, being able to provide high-quality imaging at the point of care means rapid diagnosis and rapid treatment.” With Vscan Air SL, clinicians have a pocketsized, portable tool that allows for clear, wholebody scanning and secure viewing of images. In addition, through Vscan Air + Digital Tools, clinicians have access to subscriptions that can connect them to a suite of easy-to-use solutions designed to improve workflow with secure collaboration, image and device management features. “Vscan Air SL enables clinicians to make quick cardiac assessments and adds to our broad portfolio of ultrasound technologies to help further inform clinical decision making at the point of care,” said Dietmar Seifriedsberger, global general manager, point of care and handheld ultrasound at GE HealthCare. “This newest innovation demonstrates our commitment to providing integrated solutions resulting in better standard of care delivery – and ultimately helping clinicians improve patient outcomes.” Vscan Air SL is currently commercially available in key countries throughout Europe and Asia as well as Australia and New Zealand. In the United States, Vscan Air SL is 510(k) cleared by the U.S. Food and Drug Administration and will become commercially available this quarter.

ICEMAGAZINE | NOVEMBER 2023

ADVANCING THE IMAGING PROFESSIONAL

AHRA INTRODUCES NEW EXECUTIVE DIRECTOR In an email to members, AHRA President Becky Allen, CRA, announced a new executive director for the organization. The email reads as follows: “On behalf of the Board of Directors of AHRA: The Association for Medical Imaging Management, I am writing to let you know about a couple of exciting changes for our association. AHRA has hired Jason Newmark, BA, MHA, CRA, FAHRA, as our new Executive Director, effective October 23. Jason is new to association leadership but not new to AHRA. He has been an active member since 2005 and served on the Board of Directors for seven years as the Finance Director from 2012 to 2015 and then as President from 2016 to 2017. Additionally, in 2020, he was awarded the Jim Conway Gold Award for significant contributions to the association. In addition to being an established AHRA leader, Jason brings over 20 years of healthcare leadership experience working with administrative and clinical staff at all levels, with a significant focus in medical imaging. During his tenure at Baystate Health, he rose to the role of vice president of diagnostic services, where he oversaw systemwide laboratory and medical imaging services. In his most recent role as principal at ECG Management Consultants, he led the firm’s laboratory and medical imaging advisory practice, working with numerous health systems and provider groups to develop multi-year strategic and capital plans, enhance operations, improve access to services, and drive financial improvements. The Board of Directors would like to thank Interim CEO Nancy Green for her leadership and support of

our organization through a time of transition and her willingness to stay on until Jason officially becomes the new executive director. Recently, we made the strategic decision to partner with Smithbucklin, the leader in association management and a proven partner for healthcare associations, to serve as our association management firm, effective September 1. AHRA is deeply committed to our mission to educate, develop, mentor, and provide resources to medical imaging professionals. We selected a partner that will position us to not only deliver on that promise to our members, but also to conceive of and deliver new value, programs, and benefits to keep pace with the changing healthcare and technology landscape. Amid this transition, and under the leadership of Jason Newmark, we are committed to continuing to deliver exceptional member value and connection to the high-quality, actionable, and timely professional practice resources and information you have come to rely on from this diverse and passionate community. This summer we celebrated our 50th anniversary, and together we are looking forward to another 50 years of offering opportunities to image leaders to connect, grow, and learn. We thank you for your continued support and engagement, as well as for your passionate devotion to medical imaging and overall healthcare management.” The email also stated that as of September 1, AHRA’s new address is 2001 K Street NW, Suite 300 North, Washington, DC, 20006. You may continue to reach AHRA at 978-443-7591 or memberservices@ahra.org.

GE HEALTHCARE AWARDED $44 MILLION AI GRANT GE HealthCare recently received a grant from the Bill & Melinda Gates Foundation for more than $44 million to create user-friendly, artificial intelligence (AI)-assisted ultrasound imaging auto-assessment tools. These tools will seek to aid health care professionals – even those without specialized training or experience with ultrasound – with clinical decision information to support more effective obstetric and lung screening ultrasound scans across maternal and fetal care as well as pediatric lung health, with a goal of expanding access to low-and-middle income countries (LMIC) and across diverse sites of care. Caption Health, a leader in medical AI acquired by GE HealthCare in February 2023, will design this technology to run across a range of ultrasound devices and

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probes, including lower-cost handheld devices. “We are proud and excited to have received this grant from the Bill & Melinda Gates Foundation to make ultrasound more accessible in low- andmiddle income countries. Ultrasound is an essential tool for screening and diagnosis of various medical conditions, including the health of expectant mothers and managing respiratory diseases,” said Roland Rott, president and CEO, ultrasound, GE HealthCare. “However, a key limitation is the guidance of lesserskilled users to effectively apply affordable point-ofcare ultrasound in their care environment. This grant will help bring Caption Health’s leading AI technology customized to more users, and therefore contribute to increased access to higher-quality medical care.”

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NEWS BRACCO IMAGING ANNOUNCES AGREEMENT WITH SUBTLE MEDICAL Bracco Imaging S.p.A., a global leader in diagnostic imaging, and Subtle Medical Inc., a leading innovator in artificial intelligence (AI)-powered image acquisition, have entered into a global agreement in the field of magnetic resonance imaging (MRI). This global agreement will begin primarily in the United States, where Bracco Imaging distributes its portfolio of products and services through its subsidiary, Bracco Diagnostics Inc. Contrast-enhanced MRI involves the use of contrast agents to highlight specific tissues or abnormalities, providing better visualization and more detailed information. Exploring and harnessing the power of AI in this context could lead to more accurate and efficient image interpretation, enhanced diagnostic capabilities and optimized patient care. Through this strategic partnership, Bracco Imaging and Subtle Medical can leverage mutual intellectual property to make progress toward achieving these ambitious goals.

“The combination of Bracco’s expertise in contrast imaging and Subtle Medical’s deep-learning technology, when applied to MR imaging, will undoubtedly benefit physicians and their patients,” said Fulvio Renoldi Bracco, vice chairman and chief executive officer of Bracco Imaging S.p.A. “Through this partnership, we will strive to redefine the boundaries of diagnostic precision and efficiency, unlocking new possibilities and bringing additional value to our already-unique MRI portfolio.” “Subtle Medical is pleased to partner with a global leader in contrast development and commercialization such as Bracco,” said Enhao Gong, chief executive officer of Subtle Medical Inc. “This agreement represents a significant milestone for both companies, as we join forces to empower medical professionals and improve outcomes for patients worldwide with Subtle Medical’s platform and innovative suite of AI products for MRI and beyond.”

DIRECTMED PARTS & SERVICE ACQUIRES TECHNICAL PROSPECTS DirectMed Parts & Service has acquired Technical Prospects LLC. Founded by former Siemens engineer Robert Probst, Technical Prospects has operated from its facility in Appleton, Wisconsin, serving customers across the U.S. and internationally for nearly 30 years. Since the company’s founding in 1997, Technical Prospects has been the leading parts supplier for Siemens imaging equipment, with coverage across multiple modalities. Today, the business provides timely, cost-effective parts, training, and service solutions, driven by a continued commitment to quality and dedication to customer service. Technical Prospects is led by president and CEO Jeremy Probst who has spent 20-plus years in the medical imaging and engineering field. “From our initial discussions with the DirectMed team, it was clear how closely our missions aligned to extend the life of medical imaging equipment and lower costs for health care providers,” said Probst. “This partnership with DirectMed will provide Technical Prospects with expanded resources to deliver an even higher level of service and expertise to our customers. This will include a greater breadth and depth of parts, full systems, and technical support. After almost 30 years of independent operations, we are excited to partner with DirectMed for our next chapter of growth.” Brad de Koning, president and CEO of DirectMed

ICEMAGAZINE | NOVEMBER 2023

TECHNICAL

PROSPECTS

Experts in Siemens Medical Imaging

commented, “The team at DirectMed has long viewed Technical Prospects as the leading aftermarket Siemens imaging parts and service company in the U.S. The opportunity to partner with them supports our vision of becoming the most trusted resource in aftermarket diagnostic imaging equipment. We are all very excited to begin working with Jeremy and the Technical Prospects staff and expanding the DirectMed breadth of capabilities. There will be no immediate changes to the Technical Prospects brand, the Appleton operations, or the level of commitment to their customer base.” Tanner LoRusso, vice president of sales for DirectMed, added, “Partnering with Technical Prospects not only expands our scope of parts and systems offering given their deep Siemens expertise, but widens our parts modality coverage further in cardiac cath lab, ultrasound, mammography, fluoroscopy, and radiography. Technical Prospects’ mission of providing the medical imaging community with pre-owned, high quality, and cost-effective imaging parts aligns directly with our own. We are looking forward to working with Jeremy and the rest of the Technical Prospects team in achieving our shared goals.”.

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MITA CALLS FOR POLICY CHANGES IN COMMENTS TO CMS The Medical Imaging & Technology Alliance (MITA) recently submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to proposed rules on the Physician Fee Schedule (PFS) and the Hospital Outpatient Prospective Payment System (HOPPS). In its proposed HOPPS rule, CMS requested input from the community on how HOPPS packaging policy for diagnostic radiopharmaceuticals has impacted beneficiary access. MITA has long advocated for ending the policy packaging for diagnostic radiopharmaceuticals. Citing reduced patient access to such products, Patrick Hope, executive director of MITA, said, “MITA strongly supports establishing separate payment based on Average Sales Price (ASP) methodology for diagnostic radiopharmaceuticals in the CY 2024 Final Rule. MITA urges CMS to make such a change in the final rule, as there is sufficient evidence presented by MITA and others to make this long-overdue change immediately.” In addition to addressing separate payment, among other things, the letter also provided comments on: • Adoption of a measure on excessive radiation dose or inadequate image quality for diagnostic computed tomography (CT) in adults; • Add-on payment for highly enriched uranium radiopharmaceuticals; • Software as a service (SaaS) procedures;

• Finalizing a proposal to assign Fractional Flow Reserve derived from CT; and • Revisions for payment indicator breast localization codes. In a separate comment to the proposed HOPPS, MITA said CMS’s remedy to its payment policy for 340B-acquired drugs from 2018-2022, per the District Court’s order, would impose another automatic 0.5% payment reduction on HOPPS services for the next 16 years, in addition to the 2.0% sequestration reduction now reinstated post the Public Health Emergency (PHE). These cuts would come at a time when hospitals continue to struggle to regain the volume of outpatient services provided, including medical imaging services, prior to the pandemic. In comments to the proposed PFS, MITA expressed concern for proposed deep cuts to physician payments, that, if not reversed, will result in a three percent payment cut to radiology, a three percent cut to nuclear medicine, and a four percent cut to interventional radiology. In its letter, MITA said the consistent downward pressure on physician payment will result in significant challenges for beneficiary access and the ongoing viability of physician practices. Beyond urging CMS to fix physician reimbursements, MITA applauded CMS policy methodology to reimburse providers using artificial intelligence, algorithms and other software based on cost and matching with an appropriate APC code.

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NEWS

AI PERFORMS COMPARABLY TO HUMAN READERS OF MAMMOGRAMS Using a standardized assessment, researchers in the UK compared the performance of a commercially available artificial intelligence (AI) algorithm with human readers of screening mammograms. Results of their findings were published in Radiology, a journal of the Radiological Society of North America (RSNA). Mammographic screening does not detect every breast cancer. False-positive interpretations can result in women without cancer undergoing unnecessary imaging and biopsy. To improve the sensitivity and specificity of screening mammography, one solution is to have two readers interpret every mammogram. According to the researchers, double reading increases cancer detection rates by 6 to 15% and keeps recall rates low. However, this strategy is labor-intensive and difficult to achieve during reader shortages. “There is a lot of pressure to deploy AI quickly to solve these problems, but we need to get it right to protect women’s health,” said Yan Chen, Ph.D., professor of digital screening at the University of Nottingham, United Kingdom. Chen and her research team used test sets from the Personal Performance in Mammographic Screening, or PERFORMS, quality assurance assessment utilized by the UK’s National Health Service Breast Screening Program (NHSBSP), to compare the performance of human readers with AI. A single PERFORMS test consists of 60 challenging exams from the NHSBSP with abnormal, benign and normal findings. For each test mammogram, the reader’s score is compared to the ground truth of the AI results. “It’s really important that human readers working in breast cancer screening demonstrate satisfactory performance,” she said. “The same will be true for AI once it enters clinical practice.” The research team used data from two consecutive PERFORMS test sets, or 120 screening mammograms, and the same two sets to evaluate the performance of the AI algorithm. The researchers compared the AI test scores with the scores of the 552 human readers, including 315 (57%) board-certified radiologists and 237 non-radiologist readers consisting of 206 radiog-

ICEMAGAZINE | NOVEMBER 2023

raphers and 31 breast clinicians. “The 552 readers in our study represent 68% of readers in the NHSBSP, so this provides a robust performance comparison between human readers and AI,” Chen said. Treating each breast separately, there were 161/240 (67%) normal breasts, 70/240 (29%) breasts with malignancies, and 9/240 (4%) benign breasts. Masses were the most common malignant mammographic feature (45/70 or 64.3%), followed by calcifications (9/70 or 12.9%), asymmetries (8/70 or 11.4%), and architectural distortions (8/70 or 11.4%). The mean size of malignant lesions was 15.5 mm. No difference in performance was observed between AI and human readers in the detection of breast cancer in 120 exams. Human reader performance demonstrated mean 90% sensitivity and 76% specificity. AI was comparable in sensitivity (91%) and specificity (77%) compared to human readers. “The results of this study provide strong supporting evidence that AI for breast cancer screening can perform as well as human readers,” Chen said. Chen said more research is needed before AI can be used as a second reader in clinical practice. “I think it is too early to say precisely how we will ultimately use AI in breast screening,” she said. “The large prospective clinical trials that are ongoing will tell us more. But no matter how we use AI, the ability to provide ongoing performance monitoring will be crucial to its success.” Chen said it’s important to recognize that AI performance can drift over time, and algorithms can be affected by changes in the operating environment. “It’s vital that imaging centers have a process in place to provide ongoing monitoring of AI once it becomes part of clinical practice,” she said. “There are no other studies to date that have compared such a large number of human reader performance in routine quality assurance test sets to AI, so this study may provide a model for assessing AI performance in a real-world setting.”

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109TH MEETING STAFF REPORT

he Radiological Society of North America (RSNA) 109th Scientific Assembly and Annual Meeting is the world’s leading annual radiology forum. It will be held at McCormick Place Chicago, Nov. 26-30, 2023. This year’s theme is Leading Through Change. “Radiology has long led medicine in showing how we can embrace change by seeking innovation,” said RSNA President Matthew A. Mauro, M.D. “Change will always be present in the practice of medicine, and the manner in which we adapt to change will determine our success in the future.” The exceptional RSNA 2023 plenary session programming focuses on navigating transformative change in health care. At the opening session, Mauro will take the stage to deliver his president’s address, “Leading Through Change,” which will explore how radiology professionals can 26

ICEMAGAZINE | NOVEMBER 2023

be intentional and proactive while guiding teams and organizations through change. “In health care, we are not only experiencing change in the advances in medical science and technical innovations that are occurring with increasing frequency, but also in the many aspects of the delivery of health care – payment models, patient expectations, delivery systems, competition, and a challenging and changing labor market,” Mauro said. “But radiology is well poised to continue its leadership in moving health care forward across all of these domains.” Also at the opening session, Howard Chrisman, M.D., will present “History Never Repeats Itself, But It Does Often Rhyme.” Vin Gupta, M.D., will speak Nov. 28 on “The Future of Healthcare Delivery: Considerations for Patients and Providers,” and on Nov. 29, Jocelyn Chertoff, M.D., M.S., presents “Understanding and Revitalizing the Radiology Workforce.” The Image Interpretation Session,

moderated by C. Douglas Phillips, M.D., on Nov. 27 offers a cross-disciplinary opportunity for attendees to test their knowledge beyond their areas of expertise and follow along as a panel of experts identify abnormal findings critical to making accurate diagnoses and recommending additional studies or procedures. Julius Chapiro, M.D., Ph.D., and Anna Shapiro, M.D., will host “Oncology Imaging and Interventions: The Radiology Jeopardy,” a lively interactive game show experience, on Nov. 29. The RSNA/AAPM Symposium: “Together We Can Make a Difference,” held on Nov. 30, will focus on successful collaboration between radiologists and physicists in technical developments and clinical translations in medical imaging. The symposium will be moderated by Guang-Hong Chen, Ph.D. Popular sessions like Case of the Day and “Fast 5” will offer engaging experiences for attendees. The Discovery Theater will feature informative presentations and entertainment.

ADVANCING THE IMAGING PROFESSIONAL

The robust RSNA 2023 program delivers scientific sessions from every subspecialty, including cutting-edge sessions on hot topics in radiology research, and a comprehensive educational curriculum with a wide variety of CME opportunities for radiology professionals to advance in their specialties. RSNA 2023 also offers the ultimate radiology show floor for demonstrating the latest medical imaging technologies in CT, MRI, artificial intelligence (AI), 3D printing and more. Currently, there are 574 confirmed exhibitors occupying more than 378,800 square feet of exhibit space. Attendees can explore the expansive AI Showcase and Theater, sponsored by AIRS Medical and Bayer Calantic Digital Solutions. The AI Showcase, featuring the latest AI advances and applications, currently has 83 exhibitors occupying over 30,300 square feet. The showcase is also home to the Imaging AI in Practice demonstration and the RSNAI Resource Center. Also located in the exhibit halls are the 3D Printing and Mixed Reality Showcase, the First-time Exhibitor Pavilion, Educators Row and Recruiters Row. New this year is the RSNA Career Resource Center, which can be found in Recruiters Row. Here, attendees can view the lineup of inspiring, career-focused presentations, take advantage of open seating for networking and mingling or find a space to work. As part of its commitment to creating an inclusive experience for all radiology professionals, RSNA continues to offer Camp RSNA – onsite childcare that has been in operation for more than 20 years. Open to children ages six months to 12 years, Camp RSNA is available free to RSNA members and available to non-members for a nominal fee. RSNA 2023 Virtual Access provides access to nearly 100% of all annual meeting programming. Virtual Access is ideal for those who cannot attend, as well as for attendees who wish to maximize their onsite experience. Several registration packages are available for RSNA 2023, including in-person and virtual access, in-person only, virtual only, and a technical exhibits pass. Hotel reservations are available. Special discounted meeting rates have been negotiated at nearly 60 hotels. • Visit RSNA.org/annual-meeting for more information and to sign up to receive future updates.

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

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

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WEBINAR ADDRESSES CONSTRUCTIVE CRITICISM FOR GEN-Z STAFF REPORT 27

M E M O R I A L D A Y

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he recent ICE webinar “Mastering the Art of Feedback: Constructive Criticism for Gen-Z in the Healthcare Field” presented by Avinash Dhanraj, CAPM, PSM1, SEC+, recorded the highest number of registrations and attendees thus far in 2023. The session had 113 individuals register with 55 logging in for the live presentation. A recording of the webinar is available for ondemand viewing at ICEwebinars.live. Attendees left the session with an understanding of how to cultivate motivational strategies tailored to Gen-Z employees. They also learned how to decode the nuances of Gen-Z’s communication preferences and mold feedback techniques that encourage growth. Attendees can now comprehend the values, motivations and work styles of Gen-Zers in the health care field and align them with organizational goals. Dhanraj also explained how to design a feedback loop that fosters trust, encourages open dialogue and promotes professional development. During a question-and-answer session, Dhanraj shared additional insights. One person asked about social media use while at work. “It’s inevitable that social media is just going to become more prominent in society, and therefore, leading, communicating in person is going to get more and more difficult,” Dhanraj said. “So, when it comes to working around social media, really, the only way to

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be away from the temptation, or the addiction, or the messages, is to cut it out entirely for the workday.” “If you have a phone policy in your institution, your office, that’s going to be the best way to ensure that your employees are truly focused on what matters,” he added. “And you don’t have to rule with an iron fist.” Another question was, “What kind of positive feedback does Gen Z find valuable?” “Does Gen Z prefer the standard and 9 to 5, or do they prefer telecommuting hybrid, etcetera?” was another question answered during the Q&A session. Attendees provided feedback via a survey that included the question, “Why do you join ICE webinars?” “I wanted to understand a different perspective on potential employees,” said Michael Moore, radiology supervisor, UH Cleveland Medical Center. “Interested in a Gen-Z point of view in the workforce and was it consistent with my ideas and thoughts,” said Lisa Youngblood, radiology supervisor, University Hospitals Cleveland Medical Center. “Was interested in this topic, I work in health care and education and felt this was an opportunity to learn more communication skills,” said Amanda Atkinson, instructor, CCWA. “I wanted insight on this new generation because I’m dumbfounded by the stuff I hear from them,” shared Suzanne Dodson, supervisor of CT scan, Cleveland Medical Center. • For more information, visit ICEwebinars.live.

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Market Report Reports Predict Pediatric Imaging Market Growth STAFF REPORT

he global pediatric imaging market size was valued at $6.8 billion in 2019 and is projected to expand at a CAGR of 7.6% during the 2020-2027 forecast period, according to a report from Grand View Research. An increasing demand for advanced health care practices in pediatric care, the rising number of surgical procedures, and government initiatives to raise awareness and increase the reach of novel pediatric imaging techniques are the key factors driving the market, according to the Grand View Research report. “Moreover, increasing focus of market players on new product development and strategic collaborations to develop advanced pediatric imaging modalities is expected to propel the market growth. High radiation risk particularly in pediatric patients, which may result in the occurrence of cancer and high installation cost are some of the factors that may hinder the market growth,” the report adds. Grand View Research adds that technology advances will impact this market in coming years. “Adoption of advanced technology in different health care settings including hospitals and pediatric specialty clinics is anticipated to have a significant effect on the overall market growth in developing as well as developed regions. For instance, in August 2018, Lucile Packard Children’s Hospital Stanford established a new surgical center that includes a novel hybrid operating suite and enables immediate evaluation of post-surgical interventions,” the report states. “Such advancements help increase patient safety significantly and minimize the overall turnaround time as well as hospital stay, thus reducing overall treatment cost. The overall price of advanced technologies is anticipated to deflate with the availability of next-generation microchips, thus boosting the adoption of these imaging devices, especially in developing countries.” The rising number of premature births, expanding incidence of pediatric diseases, and high demand for

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preventive care and imaging solutions are some of the factors driving the demand for novel pediatric imaging systems, Grand View Research adds. According to the Centers for Disease Control and Prevention (CDC), around 9.2 million children in the U.S. are admitted to the emergency department from accidental injuries such as falls, road traffic and burns. The inability of pediatric patients in explaining specific problems significantly enhances the use of effective pediatric imaging solutions. Moreover, increasing cases of birth defects requires effective imaging technologies to minimize complications. Magnetic resonance imaging (MRI) accounted for the largest market size owing to increasing demand in hospital settings combined with technological advancements, according to the Grand View Research report. “Advanced fast scan methods such as single-shot technique and gradient-echo provide faster and clearer images. These techniques are specifically helpful in pediatric imaging where patient-operator compliance is minimal,” the report says. “In September 2019, researchers from the University of Colorado, School of Medicine identified a new imaging method named fast MRI, which was effective in analyzing pediatric Traumatic Brain Injuries (TBI), thereby eliminating risks related to ionizing radiation exposure and anesthesia.” The ultrasound segment followed magnetic resonance imaging and is expected to grow at a lucrative rate during the forecast period, Grand View Research reports. The growth can be attributed to factors such as easy availability of imaging devices, skilled professionals, affordability, and frequent launch of new products that are specifically tailored for pediatric patients. Data Bridge Market Research analyses that the pediatric imaging market which was $3.6 billion in 2021, would rocket up to $6.7 billion by 2029, and is expected to undergo a CAGR of 8.10% during the forecast period 2022 to 2029. Allied Market Research reports that the global pediatric radiology market was valued at $5.6 billion in 2021 and is projected to reach $8.8 billion by 2031, growing at a CAGR of 4.7% from 2022 to 2031. •

ADVANCING THE IMAGING PROFESSIONAL

Product Focus Pediatric Imaging

FUJIFILM

FDR D-EVO III G80i The FDR D-EVO III G80 ultra-lightweight detector is Fujifilm’s latest breakthrough in pediatric long length imaging. Featuring a 17×32 inch field of view and weighing just 12 pounds, the detector brings added portability for spine and leg surgery uses, along with traditional upright and supine long length exams. The detector is designed to simplify procedures with its single exposure, instant acquisition and display capabilities. Its Hydro AG protective antibacterial coating provides added safety in infection controls and sterile field uses. Fujifilm’s proprietary Irradiated Side Sampling (ISS) is designed to capture high resolution images while reducing dose, which is critical for pediatric patients.

*Disclaimer: Products are listed in no particular order.

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PRODUCTS

GE HEALTHCARE

AMX Navigate Mobile Digital X-ray

GE HealthCare works to design technology to enhance the patient experience – including pediatric patients. As the entry point to diagnostic imaging, GE HealthCare’s next generation AMX Navigate mobile digital X-ray now includes an added Adventure Series experience designed for pediatric patients. The mobile system also includes the next iteration of Quality Care Suite 2.0 to enable the delivery of high quality, radiologist-ready images for every patient – including pediatric patients. The collection of AI algorithms includes the capability to analyze three pediatric anatomies, a first for GE HealthCare X-ray AI, including “babygrams.” In cardiology settings, 3D ultrasound visualization is critical in improving diagnostic confidence, understanding patients’ heart morphology and guiding interventions. 9VT-D, the world’s most compact 3D mini TEE probe, is suitable for a broad range of interventional cardiology procedures, helping improve access to smaller patients including pediatrics as small as 5 kg, and potentially eliminating the need for general anesthesia in adult interventions.

SIEMENS HEALTHINEERS MAGNETOM Mini

The MAGNETOM Mini from Siemens Healthineers is a miniature mock-up of the company’s MAGNETOM Sola 1.5 Tesla (1.5T) MRI scanner. It maintains the same proportions as the original scanner, with a sliding tabletop that can be manually moved in and out of the “magnet” bore. Also, the MAGNETOM Mini up model features two buttons that, when pressed, play prerecorded sounds of three different MRI sequences: One button plays sounds associated with conventional MRI sequences, and the other button plays the sounds of sequences associated with the Quiet Suite feature, which reduces scan-related noise. Radiologic technologists, nurses, education specialists and other MRI specialists can use the MAGNETOM Mini to educate pediatric patients on the MRI process and its associated sounds to reduce potential anxiety.

HYPERFINE INC. Swoop System

Hyperfine Inc. has reimagined brain imaging with the Swoop system – a powerful brain MR imaging platform that physicians can use to make clinical decisions when and where it matters most. The Swoop system is the first and only portable FDA-cleared brain imaging system that combines ultra-low-field magnetic resonance imaging (MRI) with proprietary artificial intelligence. Clinicians can make timely clinical decisions without waiting for access to an MRI and without the costly, disruptive risks of patient transport. The Swoop system fits in elevators and through doorways and plugs into a regular electrical outlet for use in various clinical settings, providing brain imaging in almost any health care environment. Clinicians have the vital images they need to manage and monitor patients for better care and outcomes, quicker discharges and more efficient use of staff and hospital resources.

ICEMAGAZINE | NOVEMBER 2023

ADVANCING THE IMAGING PROFESSIONAL

UNITED IMAGING

uCT ATLAS for Ultra-Low Dose Pediatric Imaging

A magnetic resonance imaging (MRI) scan can be an intimidating experience for children and their parents, especially when they don’t know what to expect. A distressed child can also prove challenging for health care teams. The Philips Scan Buddy app, launched in 2022 as part of the Pediatric Coaching initiative within the Philips Ambient Experience portfolio, aims to reduce anxiety by preparing young children ahead of their MRI scan. This helps to diminish the stress of an unfamiliar environment and reduces the need for sedation. Providing an interactive gamified experience, the app includes learning objectives supporting the child to be scanned awake by introducing kids to procedures and sounds in an easy-to-comprehend way. They are guided through the full process, what the machine looks like, and how it’s used. This innovative technology strives to empower children and help overcome the existing anxieties common among pediatric MRI patients.

The uCT ATLAS is an ultra-premium CT scanner with up to 16 cm of high resolution (220 microns) zDetector coverage and up to 640-slices per rotation. Whole organ pediatric anatomy can be captured with reduced motion due to the 0.25s rotation speed, while an 82 cm ultra-wide bore and 700-pound. table weight capacity accommodate all types of patients. Born with AI, this system features the uAI Vision 3D camera and utilizes industry-leading AI-empowered technologies throughout the system, offering precise imaging and ease of use for routine to advanced applications, including cardiac, acute care and trauma. Utilizing uAI technologies, pediatric radiation dose can be kept extremely low by combining Auto ALARA mA, Auto ALARA kVp, a 60 kVp setting, uAI Organ Based Dose Modulation, and uAI AI-IR a deep learning reconstruction. The uAI Vision 3D Camera will automatically detect the patient’s position on the table, automatically move the anatomy to isocenter, and predict the scan range for the selected protocol. As part of the All In Configurations, the uCT ATLAS comes fully configured with all available software features and advanced applications. This gives the flexibility to use these features immediately or in the future, allowing users to expand their clinical services without additional investments in software.

CARESTREAM

DRX Plus 2530C Detector

Carestream offers a suite of integrated hardware and software solutions tailored to the specific demands of pediatric imaging and recommendations of government agencies. The solutions contribute to the optimal pediatric imaging outcome at every stage of the imaging chain. Solutions include the CARESTREAM DRX Plus 2530C Detector, engineered to fit easily into a neonatal incubator X-ray tray; Pediatric Image Optimization and Enhancement software designed to automatically adjust and tailor the image-processing parameters for any one of the seven pediatric body-size categories; and the DRX-LC detector to capture high-quality, long-length images of legs or spine (for scoliosis exams) in a single exposure. •

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COVER STORY

S M A L L V I C TO R I E S Finding Gratitude in Difficult Moments By Matt Skoufalos

We asked imaging leaders what they are thankful for in 2023. Here’s what they said. 36

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ADVANCING THE IMAGING PROFESSIONAL

COVER STORY

WH AT AR E YO U THA N K F U L F OR? It’s a question that many of us don’t of its energies on her recovery. necessarily pose outside of a moment Coder was away from work from Ocof grief, or of deep reflection, or an ef- tober 2022 to February 2023, worked fort to distract ourselves from our pres- remotely for a month from February to ent circumstances. But at the end of March, and then returned to her Rochone calendar year and the beginning ester, Minnesota onsite office in a hybrid of another, it’s natural to take stock of capacity mid-March. During that time, things, even if only out of habit. More- her department was changing dramatiso now than maybe ever, in the age of cally, shedding personnel to retirements, the Great Resignation, as America has onboarding new ones, and creating redefined its relationship to work, many another brand-new position, all in the professionals balance ephemeral ques- time she was away from the office. tions like these against their measure of “I have 16 employees with 60 years of material goals. At the turn of the sea- combined longevity here at Mayo Clinic son, we asked a handful of medical im- retiring,” Coder said. “One was an analyst aging professionals to share with us, in of 40 years who’d built our application their own words, the people, moments, and also ran the department as an IT and things that have kept them ground- person; we had to change that position ed and grateful in 2023. and split up the roles For Jamie Coder, opto make sure it fit job “For imaging, erations manager for en- 2024 is an exciting descriptions. Staffing terprise radiation safety was an issue for us just period. We have at the Mayo Clinic, the like in radiology.” good people on our weight of an unpreceWhile Coder and her teams delivering family rallied around dentedly difficult year for her family was tempered extraordinary care Zoe, her department by the support and lead- and support to our rolled along, navigating ership of her multistate through the personnel patients.” team of professionals. changes until she was “As a leader, you alable to work remotely - Brian Fox ways hope that your from Denver, Colorateam will rise to the occasion, and excel do, where her daughter was receiving with or without you,” Coder said. “My rehabilitative care. Throughout it all, she team showed resiliency, teamwork, and felt supported at the highest levels by thrived while I was unexpectedly out for her colleagues. multiple months. Maintaining a quality “Mayo Clinic has just done remarkradiation safety program in a large enable with support and allowing me to terprise across four states is not an easy work,” Coder said. “My director batask, but my team knows the importance sically told my administrator that he of collaboration, communication, and in- didn’t care if I worked from Mars. I’ve fluence to help drive safe practices in re- only been in this role a year, so to search and clinical practice.” have that camaraderie and support In October 2022, Coder’s daughter, with a new work group was really Zoe, was in a devastating car accident important. They let me disconnect the that left the high-achieving student entire time; they took it on between rebuilding her life after a traumatic my leader and the staff themselves. brain injury. Suddenly, the intense They’re high professionals.” demands of managing a multisite radiIn the meantime, Zoe has continued ation safety program melted into the to make small, steady improvements as background, as the family focused all she works to regain some semblance

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CELEBRATING THE MOMENTS In October 2022, Jamie Coder’s daughter, Zoe, was in a devastating car accident that left the high-achieving student rebuilding her life after a traumatic brain injury. Suddenly, the intense demands of managing a multisite radiation safety program melted into the background, as the family focused all of its energies on her recovery. Coder remains grateful to have had the flexibility to have been there for her daughter in the most critical moments that followed her injury.

“We’re THANKFUL that she’s here. We’re living today as today. You can’t control anything else. We just literally focus on today. There’s no real past, no real future, there’s just today. WE CELEBRATE THE MOMENTS.” She will always be forever grateful to their family, friends, community and Mayo Clinic for the support and love.

“That’s your goal as a leader: to hopefully instill that ability to keep plugging on and hang in there; hopefully times get better. In the workplace you have to want to look for it, too. The negatives can engulf you. I had to be human, and they had to deal with a very human situation with their leader, and they did it with GRACE.” ICEMAGAZINE

COVER STORY of the life that was taken from her in an instant. Coder remains grateful to have had the flexibility to have been there for her daughter in the most critical moments that followed her injury. “In our situation specifically, we’re lucky enough that we got past the point where we know she’s going to have a quality of life,” Coder said. “Physically, she’s trying to walk again, and we’re getting some steps in. She only has three credits left to graduate even after losing her entire junior year – we call it Zoe 2.0 versus Zoe 1.0 – but it’s hard not to think of what we lost.” “It was a crazy time,” she said. “We’re thankful that she’s here. We’re living today as today. You can’t control anything else. We just literally focus on today. There’s no real past, no real future, there’s just today. We celebrate the moments.” Even in the most trying of moments, Coder said she believes her circumstances offered her an opportunity to see the best of what people can be. The professionalism of her coworkers both upheld the stated values of worklife balance in her workplace and gave her the peace of mind that her career could be rightly put on pause while she tended to her daughter. Coder said she also feels her bond with her husband has never been greater; he knows how to keep her upright when she feels weak. She will always be forever grateful to their family, friends, community and Mayo Clinic for the support and love. “That’s your goal as a leader: to hopefully instill that ability to keep plugging on and hang in there; hopefully times get better,” Coder said. “In the workplace you have to want to look for it, too. The negatives can engulf you. I had to be human, and they had to deal with a very human situation with their leader, and they did it with grace.” Mario Pistilli, executive director of imaging services at Children’s Hospital Los Angeles, said that the effort displayed by his team during the past calendar year and stretching to the outset of the novel coronavirus (COVID-19) pandemic has made him thankful for their 38

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resilience, not only in the workplace, but amid the other demands of the day. “It’s presented an array of challenges and successes that really have reshaped my understanding of patient care and teamwork,” Pistilli said. “First, I’m really thankful for the resilience displayed by our imaging teams. Our team’s flexibility and adaptability have shown their collective resilience and the ability to adapt to future challenges.”

“The manner in which our team members looked out for each other – sharing resources, emotional support – these acts of kindness show that we’re not just colleagues but a community joined by a shared mission.” - Mario Pistill “We had to navigate staffing shortages and logistical challenges like getting supplies, and it was great to see other departments pitching in to make sure care wasn’t compromised,” he said. “It was nice to throw some scrubs on and pitch in when we needed it. It reinforced the centrality of patient-focused care and solidified the collaborative approach. I hope we can keep these lessons with us.” Although Pistilli acknowledges that the intensity of the trials of the past few years will fade with time, he believes that the recollection of what was best about the human spirit in enduring them can be kept alive; namely, by acknowledging how the sacrifices colleagues made for one another were personally meaningful, not just in the moment, but thereafter. Better still, he believes that behind that acknowledgment is an ability – and willingness – to do something different when a need is understood and voiced. It’s the very essence of teamwork and collaboration at a human level. “These memories will fade over time,”

Pistilli said. “We have to keep it alive by recognizing the little things: saying, ‘I appreciate that you stayed late,’ or ‘I appreciate what you did for me’; whatever it is, being thankful for each other, and remembering that we did take care of each other. To say, ‘We have things that we can do better together,’ we have that core collegiality where we can do that, whatever those things are.” “I remember staff reaching out and asking, ‘Who’s got toilet paper?’; bringing in grocery items; working double shifts or more when their colleagues or family were out with COVID – and they never really complained,” he said. “That was a constant. There were so many moments where the team worked together to figure out how they were going to keep the area staffed, and knowing who was going to do what, and they did a great job of coming together on their own and figuring out how they were going to make that work.” “The manner in which our team members looked out for each other – sharing resources, emotional support – these acts of kindness show that we’re not just colleagues but a community joined by a shared mission,” Pistilli said. “All these things remind us why we entered into the profession in the first place, which is to make a difference in people’s lives.” Moreover, the underlying challenges of working in pediatrics, which include not only managing patients but their families and guardians, are significant; as Pistilli noted, the stakes are very high. “We have a very high proportion of really sick kids, and a patient population that is complex and really can’t be done elsewhere, and our teams know that,” he said. “It’s not really an option for us to say, ‘We’re not going to have CTs today if you have some really sick child in the PICU.’ We’ve got to get it done somehow.” As the executive director of radiology and patient transport at Barnes-Jewish Hospital in St. Louis, Missouri, Brian Fox said he’s thankful for the hope medical imaging will continue to deliver. “There’s hope for dementia treatment that we haven’t seen before, and ADVANCING THE IMAGING PROFESSIONAL

COVER STORY imaging plays a crucial role in theranostic treatments to patients with prostate cancer, and expanded access to breast cancer screening programs,” Fox said. “For imaging, 2024 is an exciting period. We have good people on our teams delivering extraordinary care and support to our patients.” Like Pistilli and Coder, Fox is equally grateful for “the sense of community in radiology” that has underpinned staff morale in the workplace, not just in the darkest hours of the COVID-19 stressors, but, in a more general sense, across the continuum of a health care industry that is adapting to challenges, doing more with less during shortages, and finding new ways to lead after a period of historic stress. “There’s things that they faced that we haven’t seen in our lifetimes,” Fox said. “When you go through this trauma together, I don’t think we’ll know the impact and what was done there for a couple years. It’s still early on; as we research and start to reflect, it’s going to be interesting to see. There are things I didn’t think we’d ever see. Generationally, you have to respect that everyone went through this, and that everyone responds differently.” Fox is also pleased to see that, beyond merely suffering through the pain of the pandemic and the toll that it’s taken on teams like those he manages, the medical imaging world is adapting to the lessons learned from those extreme circumstances. These include, in no particular order: the value of remote work in the clinical space, recruiting and retaining qualified staff in a labor market shortage, and an

emphasis on the value of a compassionate approach to all manner of challenges paired with efforts to address the underlying issues they reflect. “It’s been wonderful to see the collaboration in coming together and supporting each other, I think there’s lessons,” Fox said. “We have opportunity to listen and learn, leaning into authentic leadership and empathy with teams we support. The upcoming year looks very hopeful and promising.” Brenda DeBastiani, director of imaging at Bravera Health Spring Hill of Spring Hill, Florida, said that beyond merely being thankful for any specific moment or metric of her past year, she’s working to maintain “an attitude of gratitude” through and through her experiences in the office. Foremost among the ways she’s been best able to do that has been through finding an employer that values everything she brings to the table in her approach to the job. “I work for a CAO (chief administrative officer) who thanks me for doing my job,” DeBastiani said. “I’ve not always experienced that in my career. It’s really refreshing to have somebody who listens, thanks me, and puts things in place to help me be more effective in my role.” “I’m also thankful for having a great team that I work with who are so resilient,” she said. “They go above and beyond for

“Personally, I’ve worked to let go of things that I can’t control. I think that helps you to be more resilient and see things through a brighter lens.

the patients. I am so thankful I have a team like that. Professionally, I couldn’t ask for anything more than a good boss and a good team.” “I think people are still looking to get that joy back in their heart after all they experienced in the pandemic,” DeBastiani said. “Personally, I’ve worked to let go of things that I can’t control. I think that helps you to be more resilient and see things through a brighter lens. The only reason I went into health care was to help people. Now that I’m giving direct patient care again, I love it.” As a board member and past president of AHRA, the Association for Medical Imaging Management, DeBastiani is also thankful for the longevity of her professional organization, which celebrated its 50th anniversary this year. “At our annual meeting in July 2023, I was so grateful to see so many of the past AHRA presidents there,” she said. “Many told me that they felt so grateful and so appreciated. Our celebration wasn’t focused to honor just one particular group. We honored our current, past and new members. Everyone felt included, and they felt valued. Whenever we had our gala, it brought our AHRA staff, design team, and board so much joy to bring something that our members could appreciate too. Our celebration was very special, and I am so honored to have been a part of it.” •

The only reason I went into health care was to help people. Now that I’m giving direct patient care again, I love it.” - Brenda DeBastiani ICEMAGAZINE

INSIGHTS

BEYOND CONVENTIONAL WISDOM: RETHINKING STAFFING AGENCIES

I DIRECTOR’S CUT BY NICOLE DHANRAJ

n the complex landscape of the health care industry, where costs seem to rise continuously, one substantial area of expenditure often goes unnoticed: the high salaries paid to staffing agencies. While these agencies provide valuable services by rapidly filling positions and simplifying the recruitment process, their services come at a high price. As a director, it hurt me to stomach these costs, especially when the organization was not open to raises or increased bonuses to help with the expanding workload. I questioned then and continue to do so now, why are we OK with paying staffing agencies these high salaries? Why don’t we pay health care professionals directly higher wages or incentives? I think it’s time we step back and question whether this practice is sustainable in the long run. After all, shouldn’t we be diligently exploring alternative solutions to address the budgetary pressures we face? As leaders, we are responsible for thoughtfully considering innovative approaches that can effectively manage and mitigate the impact of these formidable costs. Why aren’t we doing this as an industry? OK, so what are some potential solutions? Here are my thoughts.

DIRECT SOURCING: A VIABLE SOLUTION Direct sourcing offers an alternative approach that warrants serious consideration. Unlike the traditional reliance on staffing agencies, direct sourcing involves cultivating an organization’s talent pool and establishing direct relationships with professionals. This approach offers a better 40

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understanding of the needs and aspirations of health care professionals but also eliminates the need for hefty staffing agency fees. Moreover, direct sourcing doesn’t demand a disruptive overhaul of existing practices. It’s a seamless integration that can bolt onto your current program without causing any disruptions. This strategic long-term solution empowers employers by giving them more control over their workforce. Some organizations offer help with this if you cannot do it alone. They bring key technology players to the table, providing a roadmap for program success and help health care institutions to reap the rewards of direct sourcing without exhausting internal resources for implementation and management.

INVEST MONEY WHERE IT MATTERS MOST The savings that would otherwise be funneled into staffing agency fees can be reinvested where they matter the most: the health care workforce. This includes • Helping provide tuition to upcoming students would make it more affordable for people to pursue a health care career. This would help to increase the number of qualified imaging professionals available, not to mention support DEI initiatives, especially if we go out to the community and use a pull strategy by offering scholarships to high school students or freshmen in college. • Increasing wages by 25-30% of what we are paying agencies would help to attract and retain top talent in the health care industry. This could improve the quality of patient care and reduce the mass exodus we continue to experience.

ADVANCING THE IMAGING PROFESSIONAL

• Increase the kitty for the goodies and gifts that help show our gratitude to our staff throughout the year. • Help us fund the equipment, renovations and other department needs to increase morale, employee satisfaction and workflow.

A WIN-WIN PROPOSITION Redirecting agency labor costs is not just about cutting costs; it’s about cultivating a thriving health care workforce that drives patient care quality to new heights. Organizations can build a stronger sense of community and alignment by fostering direct relationships between employers and health care professionals. This, in turn, leads to improved patient experiences and more favorable patient outcomes. We can’t be content with the status quo of channeling significant funds into staffing agencies. We should now ponder a paradigm shift toward direct sourcing and reinvestment in our imaging workforce. As leaders

and decision-makers, we must consider the long-term implications of our budget-busting choices.

PROACTIVE APPROACH It is not complicated. The answer lies in taking a proactive approach, questioning conventional practices and embracing innovative strategies. Let’s not just be OK with how things have always been; let’s drive positive change and a healthier, more sustainable health care industry. The concern of whether we will have a future workforce is real. So, what do you think? It’s time to start considering reducing our reliance on staffing agencies and investing in our health care workforce. This is the only way to ensure that we get the best value for our money and that patients receive the best possible care. • Nicole Dhanraj, Ph.D., SHRM-SCP, PMP, GPHR, CPSS, CRA, R.T(R)(CT)(MR), is an experienced imaging director.

MRI SERVICE, SALES & Imaging Service Solutions is a global provider of OEM quality pre-owned and refurbished medical imaging parts. ISS specializes in supplying parts for Philips and Siemens MRI and CT scanners. Established in 2009 in Baltimore, MD, we proudly work closely with hospitals, service providers, and manufacturers globally.

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INSIGHTS SPONSORED CONTENT

REVOLUTIONIZING HEALTH CARE WITH CUTTING-EDGE ULTRASOUND TECHNOLOGY: APPLICATIONS, MAINTENANCE & TRANSDUCERS

I BY TODD DENNIS, CLINICAL APPLICATIONS MANAGER

n the ever-evolving landscape of healthcare technology, ultrasound has proven to be an invaluable tool. The application of ultrasound technology in health care is continually advancing, offering new possibilities and improvements for patient care. This article delves into the latest ultrasound software applications, Avante’s commitment to advancing ultrasound technology, the impact of increased ultrasound usage on maintenance, the choice between new and refurbished transducers, and how to select the right repair provider. NEWEST ULTRASOUND SOFTWARE APPLICATIONS Health care facilities are increasingly adopting cutting-edge ultrasound applications to enhance patient care. One of the most notable advancements is the integration of artificial intelligence (AI) in ultrasonic image analysis. AI applications in ultrasound encompass detection, diagnosis or classification, and segmentation. These innovations empower clinicians to perform more precise image analyses, leading to faster and more accurate diagnoses While AI integration holds great potential for reducing examination time, improving accuracy, and elevating image quality, it is crucial to note that AI should not replace human oversight. Instead, it should complement the skills and expertise of health care professionals, ensuring the highest standard of care.

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AVANTE’S COMMITMENT TO ADVANCING ULTRASOUND TECHNOLOGY Avante’s relentless commitment to remaining at the forefront of innovation in the medical industry is embodied by our ARTS (Advanced Repair and Technical Solutions) department. Within this specialized unit, our primary focus is on advancing our imaging capabilities, like our current focus on the X5-1c Philips Transducer. Through initiatives like the enhancement of retermination capabilities, lens replacements, and the continuous expansion of our repair expertise, we reaffirm our dedication to providing unparalleled services. This steadfast commitment aligns with our overarching mission to continuously elevate our service offerings and solidify our position as leaders in the field, particularly in the context of the cutting-edge X5-1c Philips Transducer.

IMPACT OF INCREASED ULTRASOUND USAGE ON MAINTENANCE With ultrasound technology becoming integral to nearly every medical specialty, health care facilities are witnessing an increase in ultrasound usage. This rise in demand has led to the dispersal of ultrasound systems throughout the entire facility, with a diverse range of medical professionals using them. However, this expanded usage also results in increased wear and tear on ultrasound probes and transducers, leading to higher service requirements. Regular maintenance and proper handling are essential to ensure the longevity and effectiveness of these critical components. ADVANCING THE IMAGING PROFESSIONAL

NEW VS. REFURBISHED TRANSDUCERS When considering the purchase of ultrasound transducers, health care facilities can choose between new and refurbished options. Each has its pros and cons: New Transducers • Advantages: New transducers offer state-of-the-art technology with the latest features and advancements. • Drawbacks: Being new, they are priced higher by the OEMs and facilities may incur high service charges once the initial warranty expires. Refurbished Transducers • Advantages: Refurbished transducers provide nearly all the capabilities of new ones at a significantly reduced cost. They often come with extended warranties and competitive pricing. • Benefits from Avante: Avante offers certified restored transducers, built-in warranties, and loaner transducers to minimize downtime during repairs. The choice between new and refurbished probes/transducers depends on a facility’s budget and specific needs.

CRITERIA FOR SELECTING A REPAIR PROVIDER Selecting the right repair provider for ultrasound transducers is crucial. While OEMs tend to replace rather than repair, third-party ISOs like Avante offer repair options. When choosing a repair provider, consider the following criteria: • Experience: Ensure the provider has extensive experience with various manufacturers and models. • Certification: Verify that the provider’s quality management system is certified to ISO 13485:2016 standards, ensuring safety, effectiveness, and reliability.

STRATEGIC CONSIDERATIONS FOR ULTRASOUND TRANSDUCER PROCUREMENT AND MAINTENANCE When it comes to making well-informed choices regarding ultrasound transducers, it is essential to involve the individuals who will be using them in the acquisition process. This collaborative approach not only facilitates the alignment of specific requirements with the selected equipment but also minimizes potential misunderstandings. In conclusion, remaining up to date with the latest ultrasound software applications, efficiently maintaining ultrasound transducers, and making well-informed decisions regarding their procurement and servicing stand as essential pillars for health care facilities committed to delivering top-notch patient care. By choosing trusted partners like Avante, health care providers can significantly elevate the quality and efficiency of ultrasound technology within their practices. • For more information about Avante’s ultrasound repair and service capabilities, call one of our experts at 800-979-6742 or visit avantehs.com. Todd Dennis is a Clinical Applications Manager for Avante Health Solutions, with over 20 years of diagnostic ultrasound industry experience. WWW.THEICECOMMUNITY.COM

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INSIGHTS

BREAST CANCER IMAGING AND AI PACS/IT/AI

BY MARK WATTS

reast Cancer Awareness Month (October) always brings a focus to prevention and detection for breast health. I wanted to discuss the latest findings from literature and conferences and how artificial intelligence (AI) in imaging is fitting into current care delivery. The potential uses of AI in breast cancer imaging are rapidly expanding – moving beyond simple detection to improving detection and diagnostic accuracy, reducing workloads, reducing the need for unnecessary biopsies, and predicting response and guiding treatment decisions. Of course, some of the advances are closer to becoming a part of standard care than others. And, while numerous studies have been conducted, they are still retrospective, based primarily on existing data sets. A further challenge in the use of AI is how ready the general public is to accept having a “machine” in charge of their diagnosis. A 2021 survey of 922 Dutch women found that 77.8% opposed standalone AI readings for mammography and 17% opposed even joint radiologist and AI readings. Similarly, a 2020 U.S. Food and Drug Administration (FDA) public workshop on the use of AI in imaging did not support the use of standalone AI in mammography. Still, perceptions can change rapidly, as can research. The following is a brief review of some of the available literature on AI in digital mammography, digital breast tomosynthesis (DBT), ultrasound, and magnetic resonance imaging (MRI), keeping in mind that the field is changing and what we talk about can quickly become dated.

DIGITAL MAMMOGRAPHY Interest in AI tools in mammography was jump-started in 2016 by the DREAM Challenge. This was an open, crowdsourced challenge to decrease the rate of false positives in mammography. Ultimately, the best teams working together did not beat radiologists’ accuracy, but the challenge moved the momentum forward for the use of AI in breast cancer screening. Ensuing studies have looked at both AI system accuracy as a standalone reader and its uses in conjunction with radiologists. In 2021, the UK National Screening Committee commis-

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sioned a review of AI systems to detect cancer in digital mammograms. In 34 of 36 (94%) studies, AI systems were less accurate than a single radiologist, and all were less accurate than a consensus of two or more radiologists. The systems also lagged in the false-negative rate, as, although they could effectively screen out the normal mammograms, they missed between 0% and 10% of cancers detected by radiologists. Other trials have proved more successful for standalone AI. One trial that included 2,652 exams interpreted by 101 radiologists compared results with standalone AI. In this trial, the AI system proved statistically noninferior, with an average area under the receiver operating characteristic curve (AUROC) of 0.840 vs 0.814 for the radiologists. Trials looking at the use of AI in conjunction with radiologists may point the way toward the most promising working models, including a triage model or a decision-referral model. In each, the goal is for the AI to help streamline the process, perhaps marking those scans that were straightforwardly negative versus those that were indeterminate, enabling the radiologist to spend more time on the less clear scans. A retrospective trial compared mammographic examination results from 240 women interpreted by radiologists and by radiologists with AI support. The area under the curve (AUC) was higher in the group using AI support (0.90 vs 0.87 unaided); furthermore, sensitivity increased with AI support (86% vs. 83% without; P=0.046), and the reading time for both groups was similar. A large German study sought to explore a decision-referral approach by examining more than 1 million digital mammography studies. Comparisons of unaided radiologist readings and AI standalone showed that AI standalone was less accurate than the average unaided radiologist. In contrast, a decision-referral approach, in which the radiologist read the scan after the AI system did, improved on radiologists’ sensitivity by 2.6% and specificity by 1%. The AUROC in those cases was 0.982. In two studies of a triaged workflow, 47% to 60% of readings were triaged, with a 0% to 7% missed cancer rate. One of the trials tested two workstreams – a no-radiologist workstream and an enhanced assessment where the AI software was the final reader. The standalone stream successADVANCING THE IMAGING PROFESSIONAL

fully detected cancers in the lowest 60% threshold, while using the AI software as the final reader increased cancer detection for the challenging cases. The second trial set AI threshold scores to determine whether some exams could be read only by the AI software. When they set the cut-off at 2 (scored between 1 and 9 for likelihood of tumor), they lowered the number of positive tumors missed to 1%. A meta-analysis from 2022 of 14 articles covering more than 180,000 cases demonstrated that standalone AI could achieve or exceed human reader detection performance. For those that included triage, they found that up to 91% of normal mammograms could be identified, while missing 0% to 7% of cancers.

DIGITAL BREAST TOMOSYNTHESIS The possibilities for AI in digital breast tomosynthesis (DBT) are very promising, both for accuracy and for decreasing reading times. Here, AI is being investigated for diagnostic purposes as well as screening. In a review of more than 12,000 cases with 24 readers, the concurrent use of AI by radiologists improved accuracy – AUC was 0.85 for AI vs. 0.8 for human readers – while reducing reading time by 52.7%. The use of AI by the readers was associated with increased sensitivity (8.4% improvement; P < .01) and specificity (6.9% improvement; P < .01). Much of the promise of AI in DBT lies in its ability to both reduce reading time and make lesions stand out better from the adjacent normal breast tissue (lesion conspicuity).

ULTRASOUND

MAGNETIC RESONANCE IMAGING Dynamic contrast-enhanced (DCE)-MRIs have a high sensitivity in detecting breast cancer, but they also lead to increased numbers of unnecessary biopsies. Therefore, one of the big promises for AI in MRI is to reduce the number of unnecessary biopsies. Prediction models from the DENSE trial based on clinical characteristics and MRI findings were found to prevent 45.5% of false-positive recalls and 21.3% of benign biopsies without missing any cancers. Another model used a deep learning system to predict the probability of breast cancer in DCE-MRI exams. This deep learning system had a high standalone performance (equivalent to radiologists) and led to a 20% reduction of unnecessary biopsies in Breast Imaging Report and Data System (BI-RADS) 4 lesions. The search to decrease the number of unnecessary biopsies has also led to AI exploration in cases with the BRCA mutation, which have a high rate of benign biopsies. In one retrospective study, a ML model improved diagnostic accuracy from 53.4% with consensus BI-RADS to 81.5%. Other avenues being explored include the use of AI-enhanced MRI to aid in molecular subtyping as well as in identifying phenotypes and tumor gene expressions, and ultimately in the prediction of treatment response and recurrence score.

A further challenge in the use of AI is how ready the general public is to accept having a “machine” in charge of their diagnosis.

FDA-approved systems designed to improve accuracy of ultrasound for breast cancer diagnosis are commercially available, and trials have demonstrated benefit from AI systems. A retrospective review of 900 breast lesions had readers read the cases twice, four weeks apart – once with ultrasound only and once with ultrasound plus an AI system. AI-based decision support improved accuracy of lesion assessment, with mean reader AUC for ultrasound alone of 0.83 vs. 0.87 with AI decision support. A large study out of NYU used an AI system to identify malignant lesions on more than 288,000 exams to evaluate whether the use of AI could reduce false-positive findings. The AI system was able to automatically locate the malignant lesions – a development meant to increase confidence in the findings and to decrease the interpretation times. In the study, the AI system had a higher AUROC of 0.97, and the use of it for radiologists decreased their false-positive rates by 37.3% and requested biopsies by 27.8% while maintaining the same level of sensitivity.

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Based on results like these, the study authors explored a triage approach where the AI system would sort the cases to those with very low probability of malignancy that would not be read by a radiologist to those with a low level of suspicion (read by a radiologist) and those with moderate to high level of suspicion (enhanced assessment). This approach, which still needs to be validated, would allow radiologists to spend more time on suspicious findings.

CONCLUSION As with all technology, there is a gap between the initial excitement of what the technology can do with the reality of putting it in practice, and then ultimately sorting it out as we figure out the actual capabilities. We are in a space where the research is developing rapidly and programs are commercially available. The FDA has created a list of AI/ML-enabled devices that is periodically updated on its website to try to keep up. We also need to see prospective studies and data validation as well as work through legal, ethical and regulatory issues before AI becomes a full partner in breast cancer imaging. • Mark Watts is an experienced imaging professional who founded an AI company called Zenlike.ai.

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INSIGHTS

EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI

KEEPING EMPLOYEES ENGAGED

hat if I told you that only about 32 percent of U.S. workers claimed to be engaged in their work? Would you be surprised? According to a recent Gallup poll, it’s true. They also found that approximately 18 percent of workers are actively disengaged. Even though these are national averages, companies with numbers like this run the risk of dealing with damaging problems. What follows are some common negative impacts that can occur when workers are disengaged. If you find that any of these exist in your workplace, be sure to read on to see what can be done to improve things.

DIMINISHED WORK OUTPUT AND QUALITY When employees aren’t engaged, they’re less likely to do their best. This can result in lower quality work and lower levels of productivity. Disengaged employees also exhibit less enthusiasm and they avoid challenges. This can lead to stagnation in organizational growth.

INCREASED EMPLOYEE TURNOVER An atmosphere in which employees are disengaged often leads to an attitude that the grass is greener somewhere else. This leads to higher turnover rates and that gets quite expensive. In talking with HR specialists in multiple industries, I’ve found their typical perspective is to look at how much money an employee was earning annually, and that will be the approximate cost of replacing that employee. Furthermore, high turnover rates can adversely affect team morale, and that brings its own set of expensive, cascading problems.

DECREASED CLIENT SATISFACTION Employee engagement has a direct bearing on client 46

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satisfaction and revenue. Since disengaged employees are less likely to provide exceptional customer service, this can lead to reduced customer satisfaction and loyalty.

THE NEED TO KEEP EMPLOYEES ENGAGED Solid employee engagement affects production, quality, staff retention and client satisfaction for the better. Knowing this, one would think that companies would go all out to ensure all their employees are plugged in. Unfortunately, many reasons can exist for why companies don’t do this, but one of them is often because nobody ever taught managers and supervisors how to do it. If managers and supervisors are looking for a reason to get employees engaged, the financial incentive alone should be a solid reason. According to Gallup’s comprehensive analysis, business units or work teams with the highest levels of employee engagement exhibited a 21 percent higher profitability rate compared to those in the lowest quartile. Additionally, companies boasting highly engaged workforces have a 17 percent higher productivity rate than average.

5 WAYS TO GET EMPLOYEES PLUGGED IN What follows are five things managers and supervisors can do to help employees become and remain engaged in their work. Obviously, people will need competitive financial compensation, but look over the list that follows and choose two or three that you think you can do better to help improve your work environment. Then start doing them. Even if you believe your workforce is currently engaged, there’s always room for improvement. 1. Connect employees to your organization’s mission and values This requires a genuine curiosity on your part. It’s hard to know the personal and/or professional motivations for each employee on your team if you’re not genuinely curious. As the saying goes, people don’t care how much you know until they know how much you care. ADVANCING THE IMAGING PROFESSIONAL

But to connect the motivations of each person with the organization’s mission and values, you’ll also need to know your company’s mission and values – by heart. People want to be a part of something bigger than themselves, and if your team members don’t see that in you, they aren’t usually inclined to plug in themselves. Also, this can’t be a one-and-done. Mission and values need to be communicated and connected clearly and consistently. 2. Provide opportunities for growth Skill development is a huge draw for many people, so provide opportunities for training and cross-training. This not only gives people a sense of pride and accomplishment, it also makes your workforce stronger and more capable. Growth opportunities also come when someone is given responsibility over a special project. Anything that increases a person’s sense of responsibility, ownership and autonomy is usually helpful. 3. Build trust Trust is a critical component of employee engagement, and you build trust by being trustworthy. This includes being transparent, communicating openly, and following through on commitments. If employees see you as deceptive or duplicitous, trust drops and so does engagement. So keep promises. Express appreciation. Listen with empathy. Give genuine compliments. Also provide help and assistance when you see it is needed. There’s much more that can be done to build trust, but this list is a good start. 4. Provide regular feedback and recognition Providing feedback and recognition could easily be listed as actions that build trust, but employees who receive regular feedback and recognition are reinforced and empowered to stay on the right track, so it does much more than build trust. Whether it’s through one-on-one conversations or in team meetings, recognition and feedback help provide the guidance that helps people want to remain successful. In addition to feedback, recognition can be given through awards, bonuses or public acknowledgement. Just be sure that your feedback is specific and timely. Saying something like, “You’re doing good work” during an annual performance review is fairly useless, as it is neither specific nor timely. WWW.THEICECOMMUNITY.COM

5. Foster a positive work environment This suggestion requires you to first define a positive work environment. Believe it or not, asking employees their opinion on this goes a very long way. That said, several things to consider include efforts on the part of management that enable a good work-life balance and encourage teamwork. This can include flex schedules (if possible), such as allowing people to swap workdays if an important family event is coming. For example, doing what’s possible to ensure employees can attend their children’s school or sporting events helps establish a work-life balance, as does providing health and wellness programs and resources for mental health. Good training on conflict resolution helps with both home life and work life. Bottom line, bad employee engagement can be really bad, and good employee engagement can be really good. And nine times out ten, it’s the supervisors and managers who set the tone for which direction it’s going to take. • 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. ICEMAGAZINE

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INSIGHTS

THE ROMAN REVIEW MANNY ROMAN

FOMO, JOMO & FOMOMO

friend recently told me that their young son, about five years old, suffers from FOMO. Fear of Missing Out (FOMO) is extensively used to describe a characteristic often exhibited by people. FOMO is driven by the expectation that if you miss out on something it will disappear and you cannot get it back. Or something more desirable will appear after you accepted something. In my research, I found some interesting facts with which I will now bore you. The term FOMO was first introduced in 2004 to describe what was observed on social networking sites. It is now in the dictionary. British psychologists defined it “as pervasive apprehension that others might be having rewarding experiences from which one is absent.” Translation: We get irritated when others have fun without us. FOMO is considered a negative reaction that may cause a sense of inferiority, loneliness or even anger. FOMO makes us feel that we must not be connected enough and makes us compulsively attempt to maintain social connections. Maybe we don’t belong. Social media is both a cause and a relative “cure” for FOMO. The ease of access makes us anxious that we may be missing an important posting or event. At the same time, this access serves to provide validation and comfort, in some instances, that we are informed and accepted. According to some research, although instant interactions with peers on social media is prevalent, young adults are feeling lonelier and more disconnected than ever. Some conjecture that the absence of the nonverbal cues (body language) is a major contributor to this. (I have always touted the importance of nonverbals in my writings and presentations). I conjecture that the above discussion applies to older adults as well, not only the younger crowd since social media is not new. Although the term was first described to explain social media, it has nicely migrated to normal everyday life as WWW.THEICECOMMUNITY.COM

demonstrated by the five-year old above. Probably, we are all predisposed to FOMO, it just was not yet defined as such. So … what is the JOMO in the title you ask? The Joy of Missing Out (JOMO) describes a group of people who are very happy not engaging with others all the time. These people are fully present and engaged in their own lives. They do not compare themselves to others and are not concerned that others may be having more fun. However, some research indicates that JOMO may not be as calming as expected. JOMO may cause even more anxiety. A study by Washington State University psychology professor Christopher Barry, Ph.D., found that only 10 percent of JOMOs did not have social anxiety. Even some of these 10 percent JOMOs expressed symptoms of loneliness. Maybe FOMOs and JOMOs share some of the same issues while also experiencing different ones. I personally suffer from FOMO although not in the social media way since I rarely participate (if you have grandchildren you may not want to know what they are posting). I glance at every one of the myriad of emails in my junk folder to be sure I don’t miss something important. I contribute to the group lottery pool because I don’t want to miss it when it hits and all my friends disappear to scattered islands. So … what is the FOMOMO? I have a Fear Of Making Others Miss Out (FOMOMO). An example: When we host our group of old people, I am very concerned that I will not invite everyone. Even if, for that particular function, some should be left out. I do not want to be the cause of FOMO. Ruth sends people birthday and anniversary cards and has FOMOMO that she will miss someone and cause them FOMO. I suggest that you also suffer from FOMO. If you read this far, you demonstrate FOMO that I may say something important, entertaining or intelligent. In this instance, I do not FOMOMO. • Manny Roman, CRES, is association business operations manager at Association of Medical Service Providers. ICEMAGAZINE

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ACROSS

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1 Recently approved FDA device: _______ endoscope

1 The D in RDI technology

8 Light sensitive integrated circuit that captures images by converting photons to electrons, abbr.

2 Helping hand

9 Relating to the stomach area 10 Features of Tracmotion, 2 words 14 Unwanted hazy appearance in an image 15 Jumbled together 17 Naval rank, for short 18 “I” problem 19 Pioneer in the use of x-rays and fluoroscopy simultaneously to examine a baby’s heart and lungs, Helen _____

3 Patient record 4 Able to be heard 5 Statistics 6 Act of connecting things 7 Device for examining a body cavity 11 The T in ____ and Color Enhancement Imaging 12 Blood type 13 CTA is the imaging of choice for this organ per some studies

21 An angiogram can ____ problems with heart vessels

16 Office computer

23 Lungs’ location

20 Secretion organ, e.g.

25 Science of body structure

21 SPION-based cell ____ing using magnetic particle imaging

27 Possess

22 Battery terminal

29 Slow and apathetic

24 Over-heating

30 Stores

26 Approved! 28 Madison’s state, abbr.

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