ICE Magazine - January 2020 by MD Publishing

PROFESSIONALS

Decoding Reimbursement Challenges page 44

PRODUCT FOCUS

ULTRASOUND SYSTEMS

Director's Cut Imaging Industry Challenges page 52

page 37

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FEATURES

RISING STAR

Holly Robinson is ICE Magazine’s first “Rising Star.”

DIRECTOR’S CUT

In his first column, Mario Pistilli discusses his plan to touch on a wide variety of hot topics in the coming months.

COVER STORY

Why is it so hard to get paid for medical imaging services? The shifting landscape of reimbursement is complicated by increased regulation at the federal level, increased resistance at the payer level, and the steady pace of confusion at the provider and patient level.

OFF THE CLOCK

AHRA Past President Bill Algee is a rock ‘n’ roll fanatic with a podcast to prove it. Algee and fellow music lovers dedicated themselves to the genre through a podcast they christened “Ages of Rock.”

ICEMAGAZINE | JANUARY 2020

16 ADVANCING THE IMAGING PROFESSIONAL

JANUARY 2020

IMAGING NEWS

Discover the latest news from throughout the diagnostic and medical imaging world.

22 RSNA SCRAPBOOK

Were you at the RSNA conference in Chicago? Are you in our photos or do you want to see what you missed? Check it out inside.

37 WWW.THEICECOMMUNITY.COM

PRODUCT FOCUS

We share some of the newest ultrasound devices from the major OEMs.

ICEMAGAZINE

MD Publishing 1015 Tyrone Rd. Ste. 120 Tyrone, GA 30290 Phone: 800-906-3373 Fax: 770-632-9090

CONTENTS SPOTLIGHT 10

Publisher

John M. Krieg john@mdpublishing.com

Rad Idea Communication

In Focus Verlon Salley, MHA, CRA

Kristin Leavoy kristin@mdpublishing.com

Off the Clock Bill Algee and the Ages of Rock Podcast

Editorial

Company Showcase Summit Imaging

Art Department

NEWS

Vice President

John Wallace Erin Register

Jonathan Riley Karlee Gower Amanda Purser

Webinars

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

Webinar Wednesday Webinars Provide Insights

Linda Hasluem

Account Executives

PRODUCTS

Jayme McKelvey Megan Cabot

Editorial Board

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

Circulation Lisa Lisle

Digital Department Cindy Galindo Kennedy Krieg

Accounting Diane Costea

ICE Magazine (Vol. 4, Issue #1) January 2020 is published by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to ICE Magazine at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www.theicecommunity.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2020

Rising Star Holly Robinson

ICEMAGAZINE | JANUARY 2020

Market Report Global Ultrasound Market Boom Continues

Product Focus Ultrasound

INSIGHTS 50

Human Resources Connect Beyond the Dots, Connect the ‘Why”

Director’s Cut Imaging Industry Challenges Remain

PACS/IT Imaging Artificial Intelligence Will Replace Some Radiologists

Department/Operational Issues Does Your Organization Have An Imaging Strategy?

Coding/Billing AUC is Finally Here – What You Need to Know Today!

Emotional Intelligence Conflict Resolution 301: Five Steps to Conflict Resolution

RSNA Recap RSNA Unveils New Devices, Latest Technology

RSNA Scrapbook Photos from the 105th RSNA Scientific Assembly and Annual Meeting

74 78

ICE Break

Index ADVANCING THE IMAGING PROFESSIONAL

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SPOTLIGHT

RISING

STAR HOLLY ROBINSON FUN FACTS: Favorite hobby: Running 5Ks

Favorite show to binge watch: “Law and Order SVU”

Favorite food combination: Fish Tacos Secret skill/talent: Playing the piano and freehand drawing

ICEMAGAZINE | JANUARY 2020

ADVANCING THE IMAGING PROFESSIONAL

eet Holly Robinson, ICE magazine’s first “Rising Star” in the imaging field. Holly, 19, is from Dunedin, Florida. She attended Dunedin High School, where she was very involved in and team captain of the NJROTC Program. Holly is currently enrolled at St. Petersburg College in the Biomedical Engineering Technology Program and is a BMET Apprentice at GE Healthcare. She is expected to graduate college this summer. While she does not currently have a specialty in imaging, she has a great interest in the field that became stronger after she attended the 2019 ICE Conference in Clearwater.

best part of it is there are always new things to learn and discover. I like the fact that imaging technology will always advance and is a crucial part to diagnosis, as well as the start to being able to help patients.

ICE magazine learned more about Holly and her career path in a question-and-answer session.

A: I have only just begun, but the feeling that I will be potentially helping a patient is a great accomplishment in itself.

Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD?

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

A: I chose this field because I wanted a career that involves helping people with the use of technology. My goal is to help others, so working on medical equipment, including life-saving machines, is the beginning but most crucial part to it.

A: I plan to build my career with GE and to learn as much as I can during this year-long apprenticeship with them. After graduating, I will hopefully be with GE as a full-time employee while pursuing my four-year degree. My goal is to attend the University of South Florida in biomedical engineering and pursue biomechanics as an end goal. I was in NJROTC in high school, and I have met many amputees, so the area of prosthetics and the engineering side spark an interest in me. •

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: The thing that interests me in imaging is definitely nuclear medicine. Health care itself is such a huge field, and the

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Q: WHAT DO YOU LIKE THE MOST ABOUT YOUR POSITION? A: Even though I just started, I am excited that every day is different. There is always new knowledge to gain. GE really wants their apprentices to learn and gain real-world experience.

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

ICEMAGAZINE

SPOTLIGHT

Rad idea NICOLE WALTON-TRUJILLO

COMMUNICATION

e all know how important it is to communicate as a leader. We have busy schedules and although we make it a point to try and communicate that we are always available for our people; it is the little things that make the biggest difference. Every morning the first thing I do is check my schedule to see what may have changed overnight (it is amazing how many meetings get added when you’re not looking). I then send an email to all of my staff. I call it “The Morning Report,” yes I know I took it from Zazu in “The Lion King.” I say good morning and in one or two sentences I tell my people when I will be in or out of the office generally. For example, I have a meeting at the Palomino office this morning, but I should be back all afternoon. Or, I will be in the department all day but I may be in and out running a few errands. If you

ICEMAGAZINE | JANUARY 2020

need anything at Lowes or Office Max, let me know by noon. I also use these quick emails to remind people of staff meetings, or that I/a provider are providing lunch that day. Anything that I think may come in handy. I tested this theory out and did it for three months and then I did not do it for a week to see if it was noticed and the feedback was overwhelming. My people loved the emails and liked knowing quickly at a glance in the morning if I was going to be on site or not. That open communication was everything to them. It made them feel supported. • NICOLE T. WALTON-TRUJILLO, R.T.(R)(CT), BSRS, MBAH, MOL, ARRT, ASRT, NMSRT, X-ray and ultrasound modality manager for Desert Radiology. Share your RAD IDEA via an email to editor@mdpublishing.com.

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SPOTLIGHT

IN FOCUS VERLON SALLEY

BY JOHN WALLACE, EDITOR

AB Medicine Executive Director of Radiology Verlon Salley, MHA, CRA, takes the lead role in the development, orchestration and implementation of all enterprise-wide imaging services initiatives for multiple hospital campuses and the satellite sites associated with them.

Verlon Salley is seen with his parents Willie and Cherry Salley. His parents are role models whose health care careers introduced their son to the world of radiology at an early age. They recently celebrated their 50th wedding anniversary.

ICEMAGAZINE | JANUARY 2020

Salley is at one of the top academic medical centers in the nation. UAB Medicine is a recognized leader in quality patient care, research and training. Located in Birmingham, Alabama, UAB Medicine is consistently named among the best hospitals by U.S. News & World Report, which also ranks many of its medical specialties among the best programs of their kind in the United States. “We pride ourselves on being a destination facility for caring for the sickest patients, yet we treat all patients with the respect and compassion they deserve. From parking attendants and guest services representatives to nurses and physicians, UAB Medicine staff are courteous, well-trained professionals who put patients and their families first in everything we do,” the UAB Medicine website states. UAB Medicine provides a complete range

of primary and specialty care services, as well as the most up-to-date treatments and innovations in health care. It is anchored by UAB Hospital, which was established in 1945 as the teaching hospital for what is now the UAB School of Medicine. One of the largest and most advanced in the nation, UAB Hospital is the centerpiece of a sprawling medical campus that includes numerous research labs and clinics. Among those clinics is The Kirklin Clinic of UAB Hospital, which is home to dozens of medical specialties under one roof and is one of the largest outpatient centers in the nation. Salley, humble almost to a fault, received the 2017 AHRA Award for Excellence & Leadership. He is a deserving winner according to at least one former employee. Wade Wright, MBA, CRA, the executive director of clinical services at Marshall Medical Centers, noticed Salley’s leadership talents almost immediately. “He has always been about trying to improve morale in the workplace so that everyone enjoys coming to work,” Wright recalls. “He encouraged me through his leadership to form relationships with the other departments like IT and nursing. Since working with him, I’ve formed relationships with all departments. Now, I go above and beyond to help other departments work on projects and help them with things.” Salley’s focus on staff engagement is ilADVANCING THE IMAGING PROFESSIONAL

lustrated in detail in the 2017 article “Changing Culture Through Staff Engagement,” co-authored with Lydia Kleinschnitz and Marlon Johnson. Impacting change in workplace culture comes natural to Salley. In other words, his personality brings out the best in people. “His biggest impact on me was just to keep moving forward and encouraging me to go above and beyond,” Wright says about Salley’s innate ability to mentor and motivate those around him. “I don’t think I would be where I am without him. I would still be the diagnostic imaging director in North Carolina if I had not been motivated by him,” Wright adds. As it turns out, Salley could say the same thing. It was Wright who told him about the opening at UAB Medicine about three years ago. A conversation with Salley instantly puts one at ease. When asked about his accomplishments and prestigious career he says he cannot really explain how he ended up as the executive director of radiology at UAB Medicine. Born and raised in Fort Lauderdale, Florida, Salley was surrounded by health care professionals from the day he was born – at a hospital where his mom worked. “My dad was a nuclear medicine tech, and my mom was a patient care advocate at the hospital where I was born,” Salley says. “Hospital care stories were a part of my life.” Willie and Cherry Salley must have been proud of their son and his eagerness to be around health care professionals. An introduction to diagnostic imaging came early in life. Salley recalls frequent trips to work with his father, especially on the weekends. He says he mostly worked with mobile X-ray equipment, and Salley came to be a very popular assistant. “Everybody wanted to use Willie’s son to help them,” Salley says. “I did that in the summers during middle school and high school.” His education continued with a determined focus to achieve a goal that was not common in his extended family – a college degree. Salley didn’t stop there. He went on to earn a Master of Health Administration from Virginia Commonwealth University. After graduate school came a fellowship (or residency) where he was paid to be an intern. The idea is that you continue to learn WWW.THEICECOMMUNITY.COM

via on-the-job training. “I was rounding around the different departments of the hospital, but radiology just came natural to me because of my father. Although having never been a tech, I understood them because of my dad,” Salley says. “I didn’t set out to do that. It just happened naturally.” “I’m definitely happy it did,” he adds. Yet, he does not pigeonhole himself. “I don’t think of myself as a radiology executive. I think of myself as a hospital administrator who knows radiology really well. I try to talk to my peers in their areas and how it relates to radiology,” Salley says. “And then, how can radiology assist with that patient experience? A stay is more than just an MRI or a CT scan.” Salley’s many accomplishments do little to change his outlook. He says his greatest accomplishment happens at work, but it is not necessarily a part of his job description. “My greatest accomplishment is training and mentoring others to become radiology executives,” Salley says. “I allow them to be their own person. I never say, ‘Do it my way.’ I tell them to make a decision and learn from their mistakes.” “I’ve helped three or four technologists become directors,” he adds. He also shares his personal “recipe” for being a leader. “As a leader, for me, you have to have three things – competence, wisdom and you absolutely have to have empathy. Without those three things, in my personal opinion, you can’t be a leader,” Salley says. He explains it this way. Empathy fuels connections; feeling with people. Wisdom is the quality of having experience, knowledge and good judgment. Intelligence is knowing that a tomato is a fruit. Wisdom is knowing not to put it in a fruit salad. Competence is the ability to do something successfully and efficiently. He enjoys mentoring for the same reason he enjoys his job. “I’m a giver. I like to help people,” Salley says. “Being a radiology director allows me to help people.” Away from work, Salley enjoys spending time fishing and grilling. He and his wife, LaVonia, have a nine-year-old son named Cameron. Salley also has a 13-year-old son named Malcolm Jones from a previous relationship. •

VERLON E. SALLEY, MHA, CRA Executive Director of Radiology UAB Medicine

What is the last book you read? Or, what book are you reading currently? Current book I’m reading is “Grit” by Angela Duckworth Favorite movie? “Mr. Holland’s Opus.” This movie came out while I was in college. Makes me think of my Dad and how much he sacrificed for us (his family). What is something most of your coworkers don’t know about you? That I make an awardwinning BBQ sauce. Who is your mentor? My father. He has an excellent moral compass. What is one thing you do every morning to start your day? Eat breakfast. I never skip breakfast … NEVER! Best advice you ever received? The devil you know is always better than the devil you don’t. Who has had the biggest influence on your life? My father What would your superpower be? Reading people’s minds What are your hobbies? Bass fishing and grilling What is the perfect meal? Shrimp and grits with a nice slice of cheesy focaccia bread

ICEMAGAZINE

SPOTLIGHT

Off Clock THE

BILL ALGEE and the AGES OF ROCK PODCAST BY MATT SKOUFALOS

ince joining the Association for Medical Imaging Management (AHRA) in 1998, Bill Algee, CRA, FAHRA, has contributed to the organization at the directorship level, as a volunteer with its education foundation, and as a past president. That’s in addition to his day-to-day responsibilities as the director of imaging services at Columbus Regional Hospital in Columbus, Indiana. Behind the scenes, however, the soundtrack to this accomplished career has always been rock ’n’ roll. In 2015, 16

ICEMAGAZINE | JANUARY 2020

Algee and a pair of his friends and fellow music lovers dedicated themselves to the genre through a podcast they christened “Ages of Rock.” Four years later, the trio is closing in on its 200th episode; along the way, they’ve experienced a number of meaningful moments with the artists whose work matters the most to them. At the top of that list is the band KISS. The Detroit rockers formed the bridge between Algee and co-host Allen Tate. Algee introduced Tate to their third compatriot, his longtime friend Dennis Talbott, at a Judas Priest concert in 2015. Despite being separated by some 200 miles, with Algee in Indianapolis, and Tate and Talbott in Evansville, Indiana, they’ve built a rapADVANCING THE IMAGING PROFESSIONAL

Bill Algee and his son, Alex, met Gene Simmons in Chicago on November 9, 2009 through A&E connections.

port over Skype with each other and with some of their favorite musicians. Through it all, however, “KISS is our common thread,” Algee said. He’s followed the band since he was 10 years old, and saw them in concert for the first time at age 12. The date was January 23, 1978, on the Alive II tour; in the time since, Algee has 45 KISS concerts under his belt. It’s the kind of a starting point for conversations about rock ’n’ roll fandom from which “Ages of Rock” takes off. “Our theory about the podcast has always been three guys in a bar having some drinks and chatting,” Algee said. “Unlike other podcasts, it’s never scripted, and we do not edit anything unless it’s a technical issue. We just get on the phone, get on Skype, and see where it takes us. Sometimes it’s a rabbit hole, but for the most part it’s been great.” “Ages of Rock” is definitely geared to a 1980s, arena-rock audience. Guests have included Michael Sweet of Stryper, Mark Slaughter of Slaughter, Rudy Sarzo of Quiet Riot, Joel Hoekstra of Whitesnake, and Orianthi Panagaris of RSO and Alice Cooper. Although many of those performers are decades removed from the projects for which they’re best known, they have plenty of stories from the heights of their fame. Furthermore, many still tour and record new music, and when they’re making the rounds to promote their work, “Ages of Rock” is a friendly vehicle through which to connect with their fans. “The reason we all do it is because it’s not work,” Algee said. “It’s strictly downtime and figuring out if we can get somebody on the show. When you’re a small podcast, it’s hard sometimes. You never know when somebody’s going to say yes and you never know when somebody’s going to say no.” If anything, the podcast has shown its hosts that perseverance is critical in landing their most coveted interviews. Algee clearly remembers the feeling when he booked Jeff Pilson, the bassist WWW.THEICECOMMUNITY.COM

from Dokken and the current bassist and musical director of Foreigner. “I’m sitting at an event with my son in high school, and I got a message from Jeff Pilson,” Algee said. “It said, ‘I heard about your show, and I’d love to do it.’ I screamed and ran out the door. We try to not have those fanboy moments on the show, but it was really cool.” “I’ve always admired [Pilson],” Algee said. “He’s produced and written for a ton of people. He’s so dynamic.” The Pilson interview turned out to be one of Algee’s favorite episodes of the show, leading to a repeat visit from the bassist, while also opening the doors for a subsequent interview with Mark Kendall of Great White. “[Kendall] said he hooked up with us because he heard our Jeff Pilson interview, and he liked how it was so relaxed,” Algee said. “I don’t think we’ve had anybody on the show who’s been a diva; everyone’s been nice.” Amid the success he’s enjoyed thus far, Algee still has a lengthy wishlist of potential guests. They include Bruce Kulick of KISS and Grand Funk Railroad, Robb Halford of Judas Priest – and, of course, Gene Simmons of KISS. In addition to meeting some of the artists behind his favorite bands of all time, “Ages of Rock” has given Algee a chance to experience new music from artists he’d never otherwise have met. At the annual RocknPod convention of music podcasters in Nashville, Tennessee, the hosts got to experience the country music capital of the United States as taken over by “a bunch of metalheads,” he said. It’s where Algee met Thee Rock N Roll Residency, a supergroup of rockers

who hosts a weekly concert featuring a rotating stable of touring guests. (And yes, they’ve got a KISS connection: Thee Residency has backed both Ace Frehley and Gene Simmons’ solo tours.) After four years, Algee’s also learned that the world of rock music is a community. Most of the performers have encountered one another, or are familiar with one another’s work. Most of them still struggle to get paid for the work that they do. And those common threads have led to “some really good conversations,” he said. Tamping down “the fanboy moments” and remembering that “the men and women on the show are just people and they just want to be treated like people” has been critical to the success of the podcast, Algee said. “Most of them don’t want that whole superstar thing,” he said. “I’ve always kind of put them on a different pedestal from everybody else, but when you do get to meet them, they’re just people, and that’s how they want to get treated.” If you haven’t checked out “Ages of Rock” before, Algee recommends a handful of his favorite episodes to get you started. He noted that the conversation tends to be freewheeling and unscripted, and the language that follows from it isn’t for everyone. A few suggest highlights, that can be found at agesofrock.com, are: Episode 124 - Mark Kendall of Great White Episode 155 - Jeff Pilson of Dokken and Foreigner Episode 171 - Orianthi Panagaris of RSO and Alice Cooper Episode 186 - Strip Club Songs with Aaron Camaro of Decibel Geek •

Left to right, Dennis Talbott, Allen Tate and Bill Algee are the hosts of the Ages of Rock podcast.

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SHOWCASE high-quality replacement parts resulting in industry leading HTM performance benchmarks for time and cost savings. Summit Imaging worked closely with these customers to align our operations and business model with our customers’ needs. Looking back, we now understand that this was the beginning of an industry shift toward health care facilities developing internal HTM service departments. We are grateful to these early customers for leading us to operate in a manner that best served their needs, both then and now. This model of increasing reliance on in-house support services at medical facilities has now become the norm rather than the exception. Today, Summit Imaging continues to evolve in response to our customers’ quest for greater operational cost savings alongside improving patient care.

WHAT ROLE DOES TECHNOLOGY SERVE TO SUMMIT IMAGING? Technology has fundamentally changed the HTM industry and leading-edge technology development is a philosophy deeply embedded in Summit’s culture. To us, it is one of the very best methods to reduce diagnosis and repair times as well as streamline installation time and complexity. Simply stated, our strategy is to resolve complicated problems and package solutions in simple-to-use form factors for health care facilities to deploy. These technologies do require significant development resources in order to deliver seamless, high-quality solutions. Some of our solutions have been transformative for healthcare facilities and how they operate their HTM programs. Some of the most promising outcomes include: higher yield on first service success, reduced HTM service time, lower total cost of fault diagnosis and repair, and increased patient care capacities. In the past, health care facilities’ repair options were limited to full-service solutions. Today, HTM groups can service their equipment with the support of an organization like Summit Imaging and realize savings ranging from 60% to 80% relative to traditional service options. WWW.THEICECOMMUNITY.COM

Summit Imaging, alongside its health care facility customers, will continue trailblazing more support options for ultrasound equipment, mammography equipment and other medical devices that contain complex electronics. Future growth in the HTM industry will require ongoing development of innovative solutions that drive increased productivity and efficiency. There is a generational shift underway in the HTM industry. As the experience level of engineers and technicians decreases and workloads increase, the need for powerful, technology-based solutions like ours becomes even more vital.

efited. The application of 14 years of experience and advanced analytics tools has allowed Summit to collect and aggregate data, to utilize that information for better planning a customer engagement and to improve the quality of the products and technical support we provide our customers. Summit Imaging enjoys the industry’s best quality of product and best technical support metrics with a 93% accuracy rating for first time diagnosis amongst HTMs. We are proud of our performance and remain committed to continue to improve for the benefit of our customers and the patients they care for.

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Much of Summit Imaging’s technology is focused on repairing the sophisticated electronics of medical devices that are readily available when HTMs need it. Our core value proposition is delivering high-quality replacement parts that HTMs can install and, in the process, extend the mean time between failure, preventing additional unnecessary service calls. HTMs become very frustrated when they return to a recently repaired device only to find that the replacement part has failed again. It is abundantly clear to us based on our extensive experience with the healthcare technology management community, that the most precious resource for HTMs is time. We strive to help our customers fix things quickly, but most importantly to fix it right the first time. Summit Imaging has invested significant resources to ensure the products we sell and help our customers install last well into the future in order to prevent unnecessary service calls. In 2015, the company earned its initial ISO 13485:2016 certification for its Quality Management System (QMS) and has successfully passed annual certification audits every year since. Summit Imaging has deployed its QMS through integration with its cloud computing-based, Enterprise Resource Planning system to help us manage, streamline and enhance our operations. The impact to our organization has been dramatic and our customers have really ben-

Society needs healthcare technology management to continue advancing in order to deliver better patient care while simultaneously containing rising health care costs. One of the focus areas must be an emphasis on health care facilities delivering high-quality patient care at a sustainable cost. This is a direction we must pursue because without this HTM movement, we are exposed to the risk of ballooning costs, making quality health care out of reach to increasing segments of our population. One of the best strategies available for health care facilities seeking sustainable growth is to lower costs while concurrently maximizing their revenue generating opportunities. With health care facilities moving away from fully outsourced service models, it is clear they will increasingly need new solutions to expand their service capacity. Summit Imaging has always believed it is critically important to contribute to the welfare and evolution of the health care industry and we are excited to continue to evolve our current tools and develop new technological solutions to help health care facilities be in the best position to care for patients in need. • For more information, visit mysummitimaging.com

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FIRST U.S. INSTALLATION OF MAGNETOM ALTEA ANNOUNCED Northern Arizona Radiology in Flagstaff, Arizona, is the first health care facility in the United States to adopt the MAGNETOM Altea 1.5 Tesla (1.5T) magnetic resonance imaging (MRI) scanner from Siemens Healthineers. In addition to a wide, 70cm bore, the MAGNETOM Altea possesses several technologies, including BioMatrix patient personalization technology with the Select&GO Interface, which removes the need for anatomical landmarking to enable faster patient positioning. Additionally, Dot (Day Optimizing Throughput) technology automates the exam to support standardized, highly reproducible scan procedures. To accelerate routine examinations, Turbo Suite offers customized speed applications covering various areas of the body to reduce scan time by up to 50 percent without compromising image quality. “Siemens Healthineers is pleased to provide Northern Arizona Radiology with the MAGNETOM Altea, which features BioMatrix patient personalization technology that will help transform care delivery in radiology by providing consistent quality while improving patient satisfaction and workflow optimization,” said Jane Kilkenny, vice president of the magnetic resonance business at Siemens Healthineers North America. “The MAGNETOM Altea MRI scanner provides state-of-the-art capabilities in musculoskeletal, neurological, cardiac, and oncologic imaging, and expands the capabilities available to patients in Northern Arizona,” said James Skrocki, MD, radiologist, Northern Arizona Radiology. • FOR MORE INFORMATION, visit siemens-healthineers.com.co/magnetom-altea.

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ADVANCING THE IMAGING PROFESSIONAL

USEI DISPLAYS MONITORS AT RSNA U.S. Electronics Inc. (USEI) announced the release of a low-cost 5MP monitor (UMD5-21B01) for clinical review of high-resolution medical images. The product is intended for cost-sensitive customer seeking the higher resolution capabilities of a 5MP monitor, but not wanting to pay the premium for a diagnostic display with 510(k) clearance. USEI will also offer customization of the monitor for particular customer requirements. A workstation demonstrating USEI’s new 5MP monitor was on display at the annual Radiology Society of North America (RSNA) exhibition. USEI also offers XR-VUE imaging software for clinical review of DICOM images and UCAL-350 calibration software capable of calibrating any monitor to DICOM or other gamma curve settings. The monitor is offered in either an off-

white or gray bezel color. In other company news, USEI announced the release of its line of 24-inch monitors in touch screen (USE-24B23) and non-touch screen (USE-24B03) versions for the medical market. Each is available with a high brightness option. Target applications include modality displays, clinical review and surgical. Workstations demonstrating these medical imaging solutions were also on display at RSNA. Each workstation was powered by an HP computer with an NVIDIA P2000 graphics card. USEI also offers XR-VUE imaging software for clinical review of DICOM images and UCAL-350 calibration software capable of calibrating any monitor to DICOM or other gamma curve settings. •

RESEARCH HIGHLIGHTS NEED FOR RADIOLOGY STAFF EMPOWERMENT, WORKFLOW-FOCUSED INNOVATION Royal Philips has announced the key findings of the Philips Radiology Staff in Focus study. This new research sheds light on the pain points that exist specifically for radiology technologists and imaging directors working in the U.S., France, Germany and the U.K., and identifies areas where technology and informatics can deliver meaningful improvements to workflow, imaging results and patient and staff satisfaction. Across the four countries surveyed, radiology technologists and imaging directors expressed, on average, only moderate satisfaction with their jobs. With pressure on imaging departments mounting amid rising patient volumes and a global shortage of qualified staff, it is critical that health systems consider how to maintain or improve staff satisfaction to help minimize attrition. “The subject of burnout is a major topic of discussion in radiology, but there has not been sufficient focus on understanding the specific challenges faced by radiology technologists and imaging directors,” said Kees Wesdorp, general manager, diagnostic imaging at Philips. “These critical stakeholders have a direct responsibility for image acquisition and quality, operations, and patient care. As we develop imaging solutions that advance radiology through improved workflow and efficiency, data integration and AI, it’s important that we support radiology staff to provide the best to care to each patient.” While radiology technologists are quite clear about causes of inefficiency in their departments, many do not feel empowered to effect change. On average, 43% felt either “not at all empowered” or only “somewhat empowered” to effect change in their department. Imaging works as a system, and it can only deliver peak performance when all its stakeholders are empowered to do their jobs effectively. Imaging staff are on the front lines of patient care and it is essential to arm them with the right information to enable a workflow that gives them more time with patients. Focusing innovation efforts in these areas on the needs of

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imaging staff has great potential to improve workflow and throughput, enhance patient satisfaction, and decrease staff stress and burnout. When asked what the biggest barrier was for getting the image right the first time, technologists cited lack of patient preparation and patient information as the top contributor (37%). Technology factors (equipment quality and capability, mastery of the technology, and easeof-use of imaging equipment) were second highest (36%). Workflow and colleague support ranked third (27%). While staff consider many factors to be important to their job satisfaction, those they value most involve their ability to work as a team to deliver highly competent, patient-centered care. However, various demands for their time mean they cannot focus on these areas as much as they would like. The report offers insights from these key stakeholders about their top challenges, including sources of stress, technology confidence, and communication and information gaps, and how we can begin to address them more effectively. The Philips Radiology Staff in Focus report is based on a double-blind survey of 254 radiology technologists and imaging directors in the U.S., France, Germany and the U.K., and was conducted between May and June 2019. To download the report or to learn more about Philips’ solutions to support a precise diagnosis, visit: www.philips.com/radiology. •

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RAD AI LAUNCHES WITH $4M TO BUILD INNOVATIONS Rad AI, a startup transforming radiology with the latest advances in technology, announced its company launch and a $4 million seed round led by Gradient Ventures, Google’s AI-focused venture fund. Investors UP2398, Precursor Ventures, GMO Venture Partners, Array Ventures, Hike Ventures, Fifty Years VC and various angels also participated in this round. Founder Dr. Jeff Chang, the youngest radiologist and second youngest doctor on record in the U.S., was troubled by high error rates, radiologist burnout and rising imaging demand despite a worsening shortage of U.S. radiologists, so he decided to pursue graduate work in machine learning to identify ways that AI could help. After he met serial entrepreneur Doktor Gurson, they created Rad AI in 2018 at the intersection of radiology and AI. Built by radiologists, for radiologists, Rad AI is transforming the field of radiology with the inside perspective as its driving force. “Radiology is facing severe pressures that range from falling reimbursements to market consolidation. There is also a radiologist shortage that is exacerbated by rising imaging volumes nationwide. We help radiology groups significantly increase productivity, while reducing radiologist burnout and improving report accuracy. By working closely with radiol-

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ogists, we can make a positive impact on patient care,” said Chang. Rad AI uses state-of-the-art machine learning to automate repetitive tasks for radiologists so they have more time to focus on what matters: accurate and timely diagnosis for patients. The first product automatically generates the impression section of radiology reports, customized specifically to the preferred language of each radiologist. Initial customers have shown significant reduction in radiologist burnout, error rates and turnaround time – improving radiologists’ well-being and patient care. Rad AI’s current partners include Greensboro Radiology, Medford Radiology, Einstein Healthcare Network and Bay Imaging Consultants, one of largest private radiology groups in the United States, as well as other radiology groups that have yet to be announced. Product rollouts have demonstrated an average of 20% time savings on the interpretation of CTs and 15% time savings on radiographs – translating into an hour a day saved for each radiologist. With this new capital, Rad AI will build out its engineering team and expand the rollout of its first product to more radiology groups and customers. •

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SCIMAGE ENTERPRISE IMAGING LIVE AT NAVAL HOSPITAL ScImage Inc., a provider of Enterprise Imaging solutions, has successfully completed the installation of an enterprise system for diagnostic reading and reporting of radiology and cardiology studies at Naval Medical Center Camp Lejeune, a United States Navy-run facility located on Marine Corps Base Camp Lejeune in North Carolina. The site went live with cardiology in November 2018 with workflows for echocardiology and nuclear medicine with integrated post-processing, ECG, stress and holter. Radiology workflow went live in November 2019 and includes mammography, obstetrics, CT, CR, MRI, RF, DEXA and orthopedics. The enterprise project encompasses not only Naval Medical Center Camp Lejeune, but also remote reading of Radiology studies from Naval Health Clinic Cherry Point and seven outlying clinics. The enterprise system ar-

chives all studies to the Department of Defense’s Enterprise Clinical Imaging Archive (ECIA) and communicates with the DoD’s current EHR, Composite Health Care System (CHCS). ScImage is prepared for future HL7 integration with MHS GENESIS, having been the first cardiology PACS vendor to go live with the Wave 1 integration utilizing secure TLS 1.2 protocols. “ScImage’s agile PicomEnterprise solution offers workflows for all user types and needs, including integrating specialty Radiology and complex Cardiology procedures that have historically resided in their own data silos,” said ScImage’s CEO Sai Raya. “Leveraging a single database-driven core framework, our agile architecture and minimal hardware requirements provide our customers incredible cost savings, not only at the point of purchase, but also for long-term maintenance.” •

TECHNICAL PROSPECTS ADDS CT SCANNERS, MRI SYSTEM TO QA BAY Technical Prospects is expanding its quality assurance bay with the addition of two Siemens CT scanners and its first Siemens MRI system. The new equipment, which includes a Siemens Somatom Scope and a Siemens Somatom Perspective, will be used for training courses and parts testing beginning in quarter one of 2020. “With the new Siemens Scope and Perspective CT scanners and the Siemens MRI system, we are on the leading edge of the third-party market for training and quality assurance,” said Technical Prospects Director of Technical Engineering Kevin Brinkman. “We are training field engineers in preventive maintenance, troubleshooting and servicing with a hands-on approach that allows them to actually fix the newest equipment available.”The new training courses will cover the major system components that make up the Somatom Family system platform, with students engaging in discussions, lectures and labs centered on the core principles of operation, configuration and repair. • TO LEARN MORE about Technical Prospects’ complete suite of parts, training opportunities and support, visit TechnicalProspects.com.

EIZO RELEASES 2 MEGAPIXEL COLOR MEDICAL MONITOR EIZO Inc. announced the United States release of the RadiForce MX216, a 21.3inch 2 megapixel color medical monitor ideal for viewing medical charts, as well as monochrome and color medical images. It comes with unique features for improved ease of use and saving space in the reading room. The RadiForce MX216 is part of the RadiForce MX-Series – EIZO’s line of cost-performance, medical-grade monitors for clinical review and more. The monitor is the first MX-Series monitor to be compatible with the Hybrid Gamma PXL function, where both monochrome and color images can be displayed on the screen at the same time in the appropriate grayscale and gamma curve. Furthermore, it is equipped with EIZO’s unique Point-andFocus function which comes with the bundled RadiCS LE software. With Point-and-Focus, specific areas of the screen can be selected and highlighted which changes the brightness and grayscale tone to make focusing easier, and improving ease of use. The monitor also boasts a new cabinet design that is 23% smaller, for a slim and space saving design. With a smaller cabinet, the monitor takes up less space on the desk for more freedom of installation. •

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NEW CARESTREAM DIGITAL IMAGING OFFERINGS RECEIVE FDA CLEARANCE Carestream’s Dual-Energy imaging technology and its Focus 35C Detector with Image Suite Software have received 510(k) clearance from the U.S. Food and Drug Administration. Both technologies were showcased at Carestream’s booth at the 2019 RSNA annual conference. Carestream’s Dual-Energy application – powered by the company’s Eclipse image processing engine – utilizes two filter materials that are automatically switched between the highand low-energy exposures to produce a soft-tissue-only image with the bone structures removed, as well as a corresponding bone-only image. This differential filter approach optimizes both X-ray spectrums, achieving optimal dose efficiency. It also delivers outstanding image quality – at the equivalent patient exposure as a standard, non-Dual-Energy posterior-anterior chest radiograph. Carestream’s Dual-Energy technology has been approved for chest X-rays on its DRX-Evolution Plus System. “When performing a standard chest X-ray, you see both soft tissue and bone structures overlaying on top of each other,” said Carestream’s Sarah Verna. “Dual-Energy will help radiologists improve the specificity and sensitivity for chest diagnosis because of both material differentiation and the removal of overlapping anatomical structures.” Dual-Energy technology is another example of Carestream’s ability to use algorithmic results to provide better medical image quality and improve diagnostic capabilities, while keeping patient safety in mind.

“This technology takes two images in rapid succession but when you compare the total Entrance Skin Exposure to the patient, it’s the same as a standard PA chest exam. Dual-Energy does not expose the patient to more radiation,” Verna added. Carestream’s new Focus 35C Detector with Image Suite Software offers smaller facilities and specialty practices a budget-friendly way to tap the power of digital medical imaging. This highly economical retrofit solution combines advanced image processing with broad functionality, easily transforming an analog X-ray room into a full wireless digital radiography system. The Focus 35C Detector paired with Image Suite Software provide a mini Picture Archiving and Communication System (PACS), delivering a complete imaging package so the customer benefits from all the capabilities of a PACS without having to invest in all the features of a larger system. Carestream’s Focus 35C Detector is expected to be commercially available by the end of the year, while the company’s Dual-Energy technology is expected to be released in early 2020.•

KOPP DEVELOPMENT INC. ACQUIRES MEDNOVUS INC. FERROMAGNETIC DETECTION BUSINESS Kopp Development Inc. announced it has acquired Mednovus Inc. Ferromagnetic Detection business. With the acquisition, Kopp Development is expanding its MRI safety product line to include the hand-held FerrAlert Target Scanner line. With the addition of the hand-held detector products, Kopp

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now has a product for all aspects of MRI safety regarding the magnetic field of the MRI machine. In addition to the products and the FMDS technology, Kopp has acquired eight additional patents. Kopp now has 23 U.S. and international patents with more patents pending.

“I am very excited by this acquisition. Mednovus is a proven leader in the field. With over 2,000 detectors in use, their track record is well established. We intend to build upon this foundation to make the MRI experience safer for all,” Koop Development Inc. President Keith Kopp said. •

ADVANCING THE IMAGING PROFESSIONAL

EOS IMAGING ANNOUNCES 350TH SYSTEM INSTALLED EOS imaging announced that the EOS system has been installed at MU Health Care’s Missouri Orthopaedic Institute. The installation marks the 350th system installed worldwide. The Missouri Orthopaedic Institute is central Missouri’s largest freestanding orthopedic center, designed and built with the needs of orthopedic patients as its central focus. The center specializes in sports medicine, pediatrics, general orthopedics, hip and knee, spine and trauma care. The installation of the EOS system provides patients full-body, weight-bearing 2D/3D imaging at a radiation dose 50% to 85% less than digital radiology exams and 95% less than basic CT scans. “We are proud to announce that our 350th global system installation was achieved at Missouri Orthopaedic Institute and believe our technology complements the institute’s dedication to ensuring patients receive leading-edge care,” EOS imaging CEO Mike Lobinsky commented. “Our growing installed base in the United States and worldwide reflects the endorsement of our unique technology by healthcare providers dedicated to osteo-articular care. We will continue to deploy our low dose 2D/3D imaging solution to ensure more and more patients can benefit from it.” •

DOUBLE BLACK IMAGING ANNOUNCES CUSTOMIZED ERGONOMIC WORKSTATIONS The perfect radiology workstation merges ergonomics with safety, is adjusted specifically to you and reduces eye fatigue, wrist strain and the risk of repetitive motion injury. Double Black Imaging (DBI) has introduced new ergonomic workstations with customizable capabilities. These innovative options offer ergonomic features that emphasize productivity and efficiency, electronic height adjustability, plenty of power points for equipment and personal devices, sound reduction, task lighting and monitor mounts that will keep monitors at an ergonomic

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level for each user, with exquisite cable management. DBI will also offers the Verte Chair – which molds itself to the unique shape of the user’s spine – making this the ultimate solution for reading room comfort and productivity. Other ergonomic solutions from DBI include sit-stand desk conversions, monitor mounts, sound blocking technology, small carts, additional chair options and more. Double Black Imaging is able to provide a comprehensive workstation by combining our high-quality displays, CPUs, desks and space planning. •

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NEWS AVANTE HEALTH SOLUTIONS ANNOUNCES MANAGEMENT CHANGES Avante Health Solutions has announced that Sterling Peloso, president of Avante Ultrasound, has assumed the operating responsibilities of Avante Patient Monitoring. This expanded role will be in addition to his current duties at Avante Ultrasound and will provide greater continuity as the ultrasound and patient monitoring businesses continue to work more closely together. This management change comes as Andy Bonin, founder of Avante Patient Monitoring (formerly Pacific Medical), has decided to step away from the day-to-day operations and move into a strategic advisory role for the overall Avante organization. This new role will allow all of the Avante companies to capitalize on Bonin’s strengths focused around product development, strategic sourcing, supplier relations and business development. “I am proud to have built the leading patient monitoring business in the industry and excited about the future as we continue to execute on Avante’s growth

strategy of being the premier provider of all medical equipment solutions,” said Bonin. Peloso added, “As patient monitoring, ultrasound and the overall Avante organization continue to come together, I look forward to growing the collective businesses and providing a complete suite of products and services that is unmatched in the health care industry.” Steve Inacker, president and COO of Avante, said he believes that the newly announced changes will allow Avante to capitalize on the continued strengths of both leaders and put the company in the best position to provide enhanced services to its combined customer base. “I am pleased to announce these new responsibilities for Sterling as he continues to leverage his leadership capabilities, enthusiasm and dedication to grow both ultrasound and patient monitoring,” said Inacker. “In addition, I am excited that we will continue to benefit from Andy’s extensive engineering and sourcing acumen in his new role and

know that these management changes will allow both Sterling and Andy to be instrumental in the future success of Avante.” The Avante family of companies is comprised of: • Avante Ultrasound (formerly Global Medical Imaging and Ultra Solutions) • Avante Patient Monitoring (formerly Pacific Medical) • Avante Medical Surgical (formerly DRE Medical Group) • Avante Rental Services (formerly Integrated Rental Services) • Avante Oncology Services (formerly Oncology Services International) • Avante Diagnostic Imaging (formerly Transtate Equipment Company and Equipment Maintenance Solutions) Avante expects additional acquisitions to further expand across these platforms. • FOR MORE INFORMATION, visit avantehs.com.

ACCUMEN LAUNCHES NEW WEBSITE, EXPANDS RANGE OF TECHNOLOGIES AND SERVICES

Accumen Inc. has launched the new website accumen.com. When the company was founded eight years ago, it focused on improving laboratory performance. Its focus has broadened significantly since then as Accumen now works directly with hospitals and health systems, commercial labs and health plans to optimize all facets of health care performance. It helps to improve operational efficiencies, clinical outcomes and data performance. Those enhanced capabilities are described in detail on its new website. “Accumen is following such a vibrant growth trajectory that we felt it was important to take time to share our company vision with current and future clients so they can see where we are headed and how our latest acquisitions fit into that picture. Accumen has purchased three companies this year in different healthcare service areas and we anticipate even stronger growth in 2020,” said Accumen President and CEO Jeff Osborne. “As a result, we wanted our website to clearly describe the many new ways in which we can partner with hospitals and health systems, commercial labs, and health plans to deliver performance improvements throughout their businesses. I am proud to report that Accumen team members are now working with our clients across 34 states.” The three companies that Accumen acquired in 2019 are Halfpenny Technologies Inc., a provider of clinical data exchange platforms for health systems, commercial labs, and health plans; Patient Readiness Institute’s MyBloodHealth, a virtual, pre-operative anemia management solution; and 3DR Laboratories, the largest 3D medical image post-processing laboratory in the United States. •

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ADVANCING THE IMAGING PROFESSIONAL

CANON MEDICAL ANNOUNCES NEW DIGITAL PET/CT SCANNER Canon Medical Systems USA Inc. has introduced the Cartesion Prime PET/CT system, a new premium Digital PET/CT scanner designed to help health care providers deliver more personalized care. The Cartesion Prime Digital PET/CT system is comprised of Canon Medical’s new premium SiPM PET detector and the Aquilion Prime SP CT system for optimal PET/CT imaging and workflow with a patient and operator-centric design, along with innovative features to help clinicians guide their business with confidence, including: • Advanced silicon photomultiplier design with one-to-one coupling for increased clinical confidence. • Fast Time-of-Flight resolution for high-quality images and increased productivity. • Large axial field of view to provide fast scans and a comfortable experience for patients. The large axial field of view also improves the scanner’s sensitivity which can be used for dose efficiencies that can impact patients and operators. • Air-cooling technologies that support more attractive siting and long-term maintenance requirements compared

to water-cooled systems. “With our customers’ needs in mind, we developed the Cartesion Prime Digital PET/CT with advanced features that can help clinicians chart the right course for their patients’ care,” said Tim Nicholson, managing director, molecular imaging business unit, Canon Medical Systems USA Inc. “This advanced technology has led to image quality improvements, while optimizing dose efficiency to reduce patient risk and speeding up acquisition time for improved throughput. These innovations are part of Canon Medical’s commitment to continually provide meaningful improvement for today’s care, and for the future.” •

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HOLOGIC ANNOUNCES FDA APPROVAL OF 3DQUORUM IMAGING TECHNOLOGY, POWERED BY GENIUS AI Hologic Inc. announced that the U.S. Food and Drug Administration (FDA) has approved 3DQuorum Imaging Technology, powered by Genius AI. 3DQuorum technology works in tandem with Hologic’s Clarity HD high resolution imaging technology to reduce tomosynthesis image volume for radiologists by 66 percent. 3DQuorum technology uses Genius AI-powered analytics to uniquely reconstruct high-resolution 3D data to produce 6 mm “SmartSlices.” “Superior breast cancer detection begins with our superior imaging, and only Hologic offers a comprehensive breast health ecosystem that improves outcomes, reduces costs and increases patient and clinician satisfaction,” said Pete Valenti, Hologic’s Division President, Breast and Skeletal Health Solutions. “3DQuorum technology is the first of many products to come powered by our new Genius AI technology platform, which will further revolutionize cancer detection in the coming years. 3DQuorum technology delivers meaningful productivity gains for radiologists due to a significant reduction in read time.” 3DQuorum technology is available as part of the new Hologic Clarity HD Plus technology package for use with existing and future Hologic 3D mammography systems. •

ALPHA SOURCE GROUP EXPANDS Alpha Source Group (ASG) recently expanded its product offerings and geographic footprint to be better positioned to more quickly and efficiently meet the repair and maintenance needs of health care providers across the country. “Over the past year, ASG has implemented a strategic plan that enhanced their ISO capabilities in technical services, depot services and parts supply chain. The new model ensures that ASG is able to more quickly and efficiently respond to the service and repair needs of their health care customers, no matter how complex,” according to a press release. “In addition, ASG invested in its four strategically located centers of excellence around the country to create a service model that is scalable to meet the needs of larger health care systems.” “Our customers tell us they like how fast, flexible and friendly we are, and the proof is in our customer satisfaction rating which stands at 4.8 out of 5 stars,” said Vionnta Rivers, chief revenue officer for Alpha Source Group. “We can scale up quickly, cover the entire nation, and partner with anyone because of the depth and breadth of our knowledge across virtually all medical device brands. ASG gives providers peace

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of mind by helping them find the optimal way to manage their medical equipment repair and service needs.” “The new model provides for comprehensive, reliable, high-quality services that help health care systems keep costs predictable, minimize downtime and is also fully compliant with regulatory standards: ISO 9001:2015 and ISO 13485:2016. ASG’s customized solutions can also provide a comprehensive plan designed to keep equipment at peak performance and operating reliably as long as possible,” the release adds. ASG’s national team of expert field service engineers are trained to install, service and repair in a way that avoids impacting the day-to-day work of health care operations. In April, ASG hired Pete Strimaitis as senior vice president of service to lead that team. “Our customers are looking for ways to operate more efficiently, improve their quality of patient care and better manage costs,” said Rivers. “We’ve evolved to become the next-generation ISO to meet the needs of health care providers as the industry continues to transition from fee-for-service to a value-based model of care.” •

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POPULAR SESSIONS PROVIDE INSIGHTS T

he Webinar Wednesday series continues to be a popular source for continuing education material and ACI-approved credits.

The webinar also explored: After notice support and fix Finalization of advisory notice How a quality service provider can help HTM’s role in advisory notices Webinar Wednesday continues to draw The webinar received positive reviews and professionals from around the world. Since comments in a post-webinar survey. launching in 2014, thousands have benefitted “It was a good review on the basics and from the series with many obtaining credits what they mean. Recalls from equipment to renew certifications. manufacturers, how to handle them,” BioRecent webinars included information medical Technician C. Aron said. about ISO certifications, training and more. “It was a good reminder of what should be done when you receive an ADVISORY NOTICES alert/recall,” Biomedical ManThe Webinar Wednesday ager T. Forsch said. presentation “Medical “The information was valuEquipment Advisory Noticable because so many medical es – Impacts and Best Pracdevice alerts often get put tices” drew 171 attendees. aside, not intentionally, but they The webinar was sponsored do take time to follow through by Universal Medical and with. Sometimes the alerts get attendees were eligible to put aside or even forgotten receive 1 credit from the ACI. about. It is critical that all medIn the presentation, Craig ical device alerts have a follow Snodgrass, from Universal through flow process,” said B. Medical discussed medical Hayes, CBET. equipment advisory notices. “I wish this webinar had He shared definitions and been available 12 years ago – terminology as well as exuseful info for someone who C.Nowak, amples of advisory notices has just been given responsibilsenior director and potential problems. ity for recalls and alerts,” said P. Attendees learned what Phillipps, biomedical manager. to do when they receive an advisory notice “Good information from the OEM and and what to do if a department is down due customer viewpoint,” said J. Thielen, clinical to an advisory notice. engineer. • • • •

“Outstanding information very relevant to the field. The topic is timely and I hope many of my peers are paying attention.”

ICEMAGAZINE | JANUARY 2020

ADVANCING THE IMAGING PROFESSIONAL

PRESENTER EXPLORES ISO 13485 The Webinar Wednesday presentation “Practical Applications of ISO 13485 and What It Means for HTM Professionals” was sponsored by Innovatus Imaging. Attendees are eligible to receive 1 credit from the ACI. Dennis Wulf’s insightful presentation drew a crowd with 149 people tuning in for the live presentation, including at least one individual in Thailand. A recording of the webinar is also available online where even more people can access the material. Wulf, founder of Innovatus Imaging, presented a working understanding of what this quality certification means. He discussed why it matters for health care facilities and what to expect from repair providers that are ISO 13485 certified. He also spoke about those organizations that do not have the quality certification. Thanks to his more than 35 years of experience working with medical devices specializing in ultrasound, Wulf was able to provide valuable knowledge and advice. Attendees shared feedback via a post-webinar survey that included the question “How will today’s webinar help you to improve in your role?” “(The webinar) helped to put a new perspective on quality metrics. It had a big push for using the metrics to try and be the best organization you can be as opposed to just meeting the metrics because they are required,” Biomedical Engineer D. Nitinthorn said. “The speaker’s experience and expertise in the market sector will help in our planned addition of ISO 13485 to our current ISO 9001,” said S. Cushing, quality manager. “Dennis presented outstanding information very relevant to the field. The topic is timely and I hope many of my peers are paying attention to Dennis’ subject matter,” Senior Director C. Nowak said. “I will be using this content to help me understand the differences between ISO 9001 and 13485. I will also use the terminology to develop more concise policies and procedures,” said L. Robert, associate director. “We are in the process of ISO certification and it was good to hear other people’s perspectives on it and how long it roughly took till completion from the speaker,” Sales Director P. Byrne said.

The experts from Summit Imaging and the College of Biomedical Equipment Technology discussed industry dynamics shaping HTM professional development and continuing education. The demands placed on HTM professionals have increased exponentially based on technological advancements and other increasingly complex dynamics shaping the health care industry; consequently, HTM professionals need access to innovative education and training solutions designed to guarantee efficiency and patient safety. Following the webinar, attendees were asked, “How did today’s webinar meet your expectations?” Their responses are a testament to the continued growth and success of Webinar Wednesday. “This provided great insight about the industry needs today and into the future,” Field Service Engineer D. Banister said. “There was definitely some very eye-opening content in this webinar,” said F. McVean, business process engineer. “Informative. The HTM was discussed now and before. This is highly useful information particularly in managing today’s trend of technology in health care,” said E. Gonzales, biomedical engineer. “I am an international BMET/HTM student of CBET, and participating in this webinar was worth it,” said E. Enyi, chief biomedical technologist, Nigeria. “Great feedback on the current and future trends for education and the industry,” Technology Manager J. Ruiz said. “I learned some of the steps being taken to address the challenge of educating and preparing the current and future HTMs,” Supervisor G. Meikle said. “I was not aware of online biomed programs so that was good to know. Interesting conversation,” HTM Director T. Dess said. • FOR MORE INFORMATION about the Webinar Wednesday series, including a calendar of upcoming sessions and recordings of previous presentations, visit WebinarWednesday.Live.

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TRAINING AND EDUCATION FOR HTM EFFICIENCY The Webinar Wednesday session “The Impacts of Training and Education for HTM Efficiency” was eligible for 1 credit from the ACI. Presented by Summit Imaging and the College of Biomedical Equipment Technology, and sponsored by Summit Imaging, the presenters delivered great insights. WWW.THEICECOMMUNITY.COM

ICEMAGAZINE

Market Report Global Ultrasound Market Boom Continues STAFF REPORT

he diagnostic ultrasound market is set to exceed $7 billion by 2025; according to a new research report by Global Market Insights. A growing burden of chronic diseases worldwide coupled with a rapidly growing geriatric population base will drive the market growth over the forecast period. An elderly population highly prone to diseases due to various structural and functional changes will positively impact business growth. Furthermore, rising investments in improving health care facilities in developing economies will further positively impact the global diagnostic ultrasound industry growth. 34

ICEMAGAZINE | JANUARY 2020

Increasing birth rates in countries such as Germany and Russia will propel business growth over the forecast years owing to extensive use of diagnostic ultrasound during pregnancy. Ability of diagnostic ultrasound to detect anomalies in a babyâ&#x20AC;&#x2122;s position and actions inside the womb will further propel business growth in the foreseeable future. Moreover, rapid advances in ultrasound technology as well as systems will further spur the industry. However, dearth of skilled professionals and lack of training may hamper diagnostic ultrasound business growth over the analysis period. The 3D and 4D segment was valued at $1.8 billion in 2018 and is expected to have considerable revenue growth during the forecast timeframe. Rising prevalence of breast cancer will favor segmental growth due to extensive use of 3D ultrasound in breast ADVANCING THE IMAGING PROFESSIONAL

PRODUCTS

cancer diagnosis. Moreover, short duration obesity has escalated prevalence of chronic diagnosis and large data storage capabilidiseases in the region. Obesity is one of the ties will foster the 4D diagnostic ultrasound major risk factors for chronic diseases such as business growth. The focus of industry playCVD, diabetes and cancer. Rising prevalence ers on development of innovative imaging of obesity and associated diseases will thus techniques to provide accurate diagnosis will drive the regional business growth. further augment the industry size. The Asia Pacific market accounted for The compact/handheld segment will considerable revenue in 2018 and is estimatexperience 5.0% CAGR during the analysis ed to witness robust CAGR of 5.2% during period. Compact ultrasound devices are the forecast period. A large patient pool in lighter in weight and smaller in size than the the region will foster business growth. Rising conventional trolley ultrasound systems. Use disposable income in emerging economies of compact ultrasounds to provide point-ofsuch as India and growing awareness among care treatment to patients will surge its adop- people will further fuel regional industry tion over the forthcoming years. Moreover, growth. comparatively lower A Signify costs associated Research article with these devices, reports that 2018 due to elimination was a record year for of the huge setup, the world ultrasound will further drive the equipment marsegmental growth. ket, with revenues The cardiology increasing by 6.8%, segment accounted tipping the market MarketsandMarkets.com for over $1 billion in over the $7 billion 2018 and will show mark for the first significant growth time. over the coming years. Increasing use of di“Despite the backdrop of global economic agnostic ultrasound in cardiovascular studies uncertainty, the ultrasound market is forecast coupled with rising burden of cardiovasto continue to grow relatively strongly in the cular diseases will boost the industry size. coming years,” the report adds. Moreover, development in technology and Five trends Signify Research expects to potential benefits associated with the device impact the global ultrasound market in comto optimize cardiac diagnosis will further fuel ing years are new users of ultrasound, new the business growth. uses of ultrasound, emerging markets, handThe general imaging segment is anticiheld ultrasound and artificial intelligence. pated to witness substantial CAGR of 3.8% A report from MarketsandMarkets.com by 2025 owing to increasing use of diagnosalso predicts continued growth. tic ultrasound for examination of vascular, “The ultrasound market is projected to kidneys, abdominal, urology, gall bladder, reach $8.4 billion by 2023 from $6.3 billion pain management, liver, spleen and pancreas. in 2018, at a compound annual growth rate Significant technological improvements over (CAGR) of 5.9% during the forecast period,” the last few decades, in equipment as well as MarketsandMarkets.com reports. “Factors development of diagnostic ultrasound syssuch as the increasing prevalence of target tems, will foster its adoption thereby driving diseases, rising patient preference for minithe business growth. mally invasive procedures, technological adThe North America diagnostic ultrasound vancements, increasing number of diagnostic market accounted for more than $1.5 billion centers and hospitals, and growing public revenue in 2018 and is expected to grow exand private investments, funding, and grants ponentially over the forecast timeframe. High are driving the growth of the market during adoption of unhealthy diet, hypertension and the forecast period.” •

“The ultrasound market is projected to reach $8.4 billion by 2023.”

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GE HEALTHCARE LOGIQ E10

The LOGIQ E10 ultrasound system integrates Artificial Intelligence, advanced tools and enhanced workflow capabilities to enable clinicians to scan, diagnose and treat a wide range of patients across a broad spectrum of conditions. One of its newest applications, Breast Assistant, powered by Koios DS, automatically provides an AI-based quantitative risk assessment that aligns to a BI-RADS category. During an exam, if a technician spots a suspicious area in the breast image, after contouring the lesion, the technician clicks the Breast Assistant button on the console, and the AI tool automatically analyzes the lesion, generating a BI-RADS-aligned category and risk assessment within two seconds or less. The color-coded scale aligns to the likelihood of malignancy – in essence helping to “dial in” the BI-RADS assessment, to support the clinician’s decision-making.

*Disclaimer: Products are listed in no particular order.

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PHILIPS EPIQ Elite

The EPIQ Elite ultrasound system is a new premium ultrasound that combines the latest advances in transducer innovation and enhanced performance to improve clinical confidence and the patient experience. EPIQ Elite offers a range of diagnostic ultrasound solutions tailored to the needs of specific medical specialties, including Philipsâ&#x20AC;&#x2122; first solution for vascular assessment and diagnosis. The Philips Ultimate Ultrasound Solution for Vascular Assessment combines 3D and 4D imaging, a breakthrough simplified workflow and complimentary clinical tools to effectively assess and monitor vascular disease.

SIEMENS HEALTHINEERS ACUSON Redwood

Siemens Healthineers has announced a new member of the ultrasound family, the ACUSON Redwood. Built on a new platform architecture for enhanced imaging performance, the ACUSON Redwood is equipped with AI-powered tools to improve workflow efficiency. The ACUSON Redwood offers clinicians an affordable and efficient high-performing imaging solution with shared service capabilities to deliver premium imaging across various clinical departments within an organization. To maximize performance and value, the ACUSON Redwood shares a near identical user-interface and transducer compatibility with the ACUSON Sequoia. Siemens Healthineers ultrasound is transforming care delivery by offering more choices, precision and value for our customers.

HOLOGIC

Viera Portable Breast Ultrasound System The Viera Portable Breast Ultrasound System from Hologic Inc. is a wireless, handheld ultrasound device that delivers accurate, high-resolution diagnostic images at the point of care, enabling optimization of clinical workflow and patient pathway. The system seamlessly transmits images to smart devices and communication systems (PACS) in the office, exam room or surgical suite, and allows facilities to add interventional breast ultrasound services for a fraction of the cost of comparable cart systems. 38

ICEMAGAZINE | JANUARY 2020

ADVANCING THE IMAGING PROFESSIONAL

PRODUCTS

CANON MEDICAL SYSTEMS Aplio a-series

Canon Medical System’s Aplio a-series was designed with the imaging, ergonomics and workflow capabilities of Canon Medical’s premium ultrasound systems, delivering high performance for multiple clinical uses. The migration of iSense workflow and ergonomics features from the Aplio i-series makes the Aplio a-series smaller, lighter and easier to maneuver than previous Aplio systems. Advanced applications like iSMI and Differential Tissue Harmonics, available on the Aplio a550, along with a selection of highly versatile transducers on both systems, enable clinicians to cover a wide range of clinical areas with exceptional image quality.

KONICA MINOLTA HEALTHCARE AMERICAS INC.

5 WWW.THEICECOMMUNITY.COM

SONIMAGE

Designed for point-of-care diagnostic and interventional procedures, the SONIMAGE HS1 Compact Ultrasound System (pictured) and SONIMAGE MX1 Portable Ultrasound System deliver advanced functionality with superior image detail and contrast resolution. The HS1, with enhanced signal penetration, increased color flow sensitivity and improved resolution, is capable of detailed tissue differentiation, detecting structures as small as several hundred microns. The HS1 and MX1 feature one-touch image optimization and Simple Needle Visualization, an advanced algorithm that utilizes both the in-plane and out-of-plane methods to improve needle visibility. Konica Minolta’s UGPro Solution unites the latest ultrasound and procedural innovations with hands-on education for minimally invasive interventions. ICEMAGAZINE

FUJIFILM SonoSite

Imagine trying to start an IV in the arm of an infant who weighs less than 4 pounds, or an adult patient weighing more than 500 pounds. Imagine placing a PICC line in a small, squirming child. When you’re working with the smallest and most vulnerable patients, every single needle stick, and every single minute spent, truly matters. Fujifilm SonoSite’s point-of-care ultrasound systems allow clinicians to clearly visualize the vascular structures that they need to access in real-time. This promotes more accurate needle placement, which can lead to many fewer attempts needed. •

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Decoding

REIMBURSEMENT CHALLENGES W hy is it so hard to get paid for medical imaging services? The shifting landscape of reimbursement is complicated by increased regulation at the federal level, increased resistance at the payer level, and the steady pace of confusion at the provider and patient level. With new mandates coming due and fiercer competition for even fewer dollars, the next few years figure to be a proving ground in which new business and operational strategies are tested, often for hospitals and imaging centers to merely keep the revenue streams that they’ve established previously.

ICEMAGAZINE | JANUARY 2020

By Matt Skoufalos

Melody Mulaik, president of Revenue Cycle and Coding Strategies Inc. in Powder Springs, Georgia said that imaging services face “a continued squeeze” amid proposed changes to the Medicare Physician Fee Schedule by the Centers for Medicare and Medicaid Services (CMS). As CMS places an increased priority on primary care and telemedicine services, the agency has planned to increase reimbursement for evaluation and management (E/M) services in 2021. But because of Congressional budget neutrality rules, these changes will require cost offsets across reimbursements for other lines of service. Those changes will potentially shift revenues from physicians who don’t often bill for E/M – namely, radiologists and radiation oncologists, the ADVANCING THE IMAGING PROFESSIONAL

REIMBURSEMENTS

American College of Radiology (ACR), said – spurring its requests for Congressional intervention. “E/M services account for about one quarter of all Medicare dollars,” said William T. Thorwarth, ACR CEO in an October 1, 2019 statement. “The proposed CMS policy would reallocate tens of billions of those dollars, which goes beyond the appropriate scope of the power of the executive branch and rightly deserves to be debated in Congress.” “Even though we’re robbing Peter to pay Paul, there’s not enough to offset what they’re going to take away,” Mulaik said. Along such trend lines, she predicts that reimbursement for imaging providers will continue to be a target. At the same time as the proposed E/M changes are slated to be implemented, so too is the CMS Appropriate Use Criteria (AUC) program, which requires practitioners ordering advanced diagnostic imaging services – including CT, PET, MRI and nuclear medicine – to consult a qualified Clinical Decision Support Mechanism (CDSM). According to CMS: “A consultation must take place at the time of the order for imaging services that will be furnished … ultimately practitioners whose ordering patterns are considered outliers will be subject to prior authorization … claims that fail to append this information [the CDSM consultations] will not be paid.” Mulaik points out that the impact of these rules changes will only slow either the pace of services delivered for patients, or the reimbursements for imaging providers and radiologists who perform the services. (Physicians won’t lose out for not consulting the AUC when they order a study, but the imaging professionals who perform it can be penalized on the back end if they don’t.) Were CMS to target other lines of service for rate reductions, it’s possible that hospitals could make different choices to redirect their business operations. But because imaging services are such a profit center, there’s no way any provider would abandon them, she said. “What hospital’s not going to have a CT scanner?” Mulaik said. “They know everyone has to maintain imaging services. For some service lines, they can say ‘We as an organization are not going to choose to do that,’ but when it comes to core imaging services, every facility is going to have it. If you decrease reimbursements in certain specialties, organizations can just say, ‘We’re not going to do it.’ ” Imaging providers also must contend with patient steerage, Mulaik said. As insurance companies continue to negotiate with imaging centers for lower service fees, they steer patients away from certain providers and toWWW.THEICECOMMUNITY.COM

ward others based on profitability for the insurers. Those mechanisms might contain some costs, but they don’t guarantee that a patient gets the quality of service they are seeking. “Let’s say the insurer wanted you to go to an imaging center because it’s going to save [them] money,” Mulaik said. “I want to know what kind of equipment do they have? What radiologist is doing the interpretation? Most patients are not going to have that knowledge. To be clear, there are many excellent imaging centers in the market but it is not always easy as a consumer to make that differentiation. “At the end of the day, the contract is between the patient and the insurance company,” she said. “As an imaging provider, you don’t really get to have direct conversations with patients when their services are ordered. The downstream financial impact of that is there’s a lot of things it’s difficult to have an influence on. It’s a constant battle because you don’t always have those mechanisms

“At the end of the day, the contract is between the patient and the insurance company.” Melody Mulaik

to educate the patient.” Patient steerage by insurers has been billed as cost savings; Mulaik said that, more accurately, it can affect patient care. “Even though you’ve got a plan and a deductible, they can critique the patient’s decision after the fact, and even deny coverage when they have issued a prior approval,” she said. “When you look at the Affordable Care Act, insurance companies are limited to 15 percent for administrative costs, so they’re very motivated to be as lean as possible to make sure that they get that margin out of it.” Running lean is a sound operational principle, said Tom Szostak, director of healthcare economics at Canon Medical Systems USA. Although most health care providers view imaging services as a profit center, he believes they could improve revenues if they begin to regard imaging as a cost center instead. Szostak blames the reimbursement-incentivized ramp-up to electronic health ICEMAGAZINE

Melody Mulaik, president of Revenue Cycle and Coding Strategies Inc.

records (EHR) as having shifted the focus of the industry away from cost management, which he believes to have been a longer-term and more necessary goal in a value-based care model. “If you’re moving everyone to riskshare models, you have to become cognizant of costs,” Szostak said. “You’re going to know what is the impact to the contribution margin of the bundle, or the consolidated payment that you receive monthly, or the population that’s attributed to you that you’re managing the risk for. You’ve got to look at costs – per procedure, equipment, labor and real estate, single-use supplies, pharma.” Instead of focusing on fee-for-service models, Szostak believes imaging providers should consider their roles in the broader context of health enterprises that eventually will assume the broader risks of providing care for regional populations. It isn’t about layering additional services over top of what’s being provided in order to make more money, he said; instead, it’s about considering what’s the most cost-effective study for the complaints with which the patients present, which circles back to the concept of AUC. “Yes, we still have to keep our legs straddled in a value lane and a volume lane, but the volume lane is going to migrate into value,” Szostak said. “Kvetching about reimbursement for certain procedures is a transactional approach to health care, and it’s not what’s important if we’re focused on trying to address the issues around health

Tom Szostak, director of healthcare economics at Canon Medical Systems USA

spending. Imaging has got to figure out how to educate the provider community on what the right studies are that are supposed to be done based upon the presentation of the patient.” Along with appropriateness criteria and clinical decision support mechanisms, Szostak said cost containment also involves recapturing business lost in other barriers to patient access. For patients who don’t have access to transportation, he suggested that imaging service providers might consider eating

Sheila Sferrella, president of Regents Health Resources

form could. “I’d find a way to get paid and maximize my utilization in terms of scheduling, and ensuring that I don’t ever have to deal with no-shows,” Szostak said. Broadly, Szostak argued that one of the biggest obstacles to bringing up the bottom line in imaging is the slow pace of institutional change in health care. He faulted all levels of leadership in its “a very senior-tenured workforce” for their failure “to better equip for change.” “Radiologists need to become utilization managers and educators to those attending physicians, and everyone’s resistant to change,” he said. “Bandwidth is so limited in hospitals and health systems that they look at everything from an immediate need standpoint instead of a bigger, long-term vision.” “There’s no sense of urgency, and I think that change is overwhelming,” Szostak said. “I don’t think that administration is good at indoctrinating change, or educating mid-level management, directors, and even frontline personnel as to changes coming that will impact their business, and how to better equip for change.” Szostak also criticized employer-based health care plans for attempting to reduce their exposure to health spending by shifting those costs to employees, whose higher deductibles create bad debt for hospitals and service providers. If providers were better at managing costs, he reasoned, health spending might not be as high as it is in the United States. If spending continues to climb, it’s not inconceivable that all

“I’d find a way to get paid and maximize my utilization in terms of scheduling, and ensuring that I don’t ever have to deal with no-shows.”

ICEMAGAZINE | JANUARY 2020

Tom Szostak

the costs of rideshare opportunities to help get people in the door. Partnering with a transportation service (or providing one in-house) could guarantee that patients access services as scheduled. The same mechanism could potentially mitigate dropped appointments or, for multi-site providers, timeslots lost to confusion among patients as to where they are meant to arrive. Szostak also believes there might be an opportunity to reverse no-show losses by offering to fill those openings with last-minute bookings, similar to flying on standby. Such practices could help optimize utilization rates and engage patients with cash prices. And, if hospitals don’t develop such services, he argues that maybe a third-party aggregation plat-

ADVANCING THE IMAGING PROFESSIONAL

REIMBURSEMENTS

“When we looked at other regulations with our members, if you talked to 12 hospitals, there were 12 different workarounds for the processes.” Sheila Sferrella

lines of service will be affected more broadly and more substantially by federal price controls, Szostak said. Sheila Sferrella, president of Brentwood, Tennessee-based Regents Health Resources, believes that the biggest revenue hurdle for imaging providers to clear involves commercial payers. Sferrella criticized the imaging study authorization process as “broken at multiple levels on the payer side,” from the length of time required to secure approval for a study, to the costs associated with chasing down various parties involved in the process. For a start, authorization from a commercial payer takes a minimum of three days to obtain, she said, a timetable complicated by the fact that at least 20 percent of all studies ordered require a peer review and some other indeterminate percentage are denied out of hand. (Medicaid studies can’t even be ordered prior to assuring that patients qualify for care, Sferrella noted). Practically, she points out that in many institutions, imaging authorizations are faxed to a single server, which staffers then must access to call back their patients to schedule studies. Multiple people making multiple calls only adds to the length of time it takes to get the study ordered, authorized and get a patient scheduled, “and that’s if everything works correctly the first time,” Sferrella said. “I certainly think commercial payers could make the authorization process a whole lot easier,” she said. “It ought WWW.THEICECOMMUNITY.COM

to be electronic, and you ought to be able to get it back within two hours if all the information’s there. I see what’s being submitted, and they’ve got all the information they need in nine out of 10 cases. But the payers aren’t going to make it any easier.” The added step of AUC, which is handled by different people within an organization, can complicate this timetable by requiring further coding requirements in order to bill for Medicare reimbursement. Effective January 21, 2021, failure to address these requirements before performing a study is a surefire way to get payment denied. “At a minimum, it’s six different people touching a claim for appropriate use criteria,” Sferrella said. “You’ve got to have different processes for every claim, and different people having to touch every single one of those claims throughout the process: scheduling, registration, imaging, billing, coding and someone to send all the info to the rad group so they can bill or collect. “The government wants to talk about reductions in administrative burden, but they just keep piling it on,” she said. Sferrella noted that AHRA has been working with CMS to try to streamline the AUC process, hoping to derive an electronic tag that would flow through to the billing and claims processes automatically, but changing hospital and insurance forms is arduous and complicated work. “When we looked at other regula-

tions with our members, if you talked to 12 hospitals, there were 12 different workarounds for the processes,” Sferrella said. “In an imaging center, it doesn’t matter because you’re billing on a global bill. The issue is for radiologists who read at hospitals where they’ve got to get this information and provide it so they have that same G code and modifier to append to their bills.” And what happened when a patient presents with complaints that don’t correspond to the authorized imaging study? Practitioners are left with the choice of either performing the wrong-but-authorized procedure, or ordering a new authorization for the correct study and starting the process from square one. “That happens day in and day out because physicians don’t always know what the correct order is,” Sferrella said. “Part of it is trying to satisfy your referring physician and not wanting to upset them, but you do need some basic information to get the study approved. It’s that fine line.” •

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INSIGHTS

HUMAN RESOURCES BY KELLY PRAY

CONNECT BEYOND THE DOTS, CONNECT THE ‘WHY’ I t’s the dreaded question outside the office that subsequently always has a well-versed answer. “What do you do for a living?” Most of us give out a job title, followed by the organization we work for. If it’s not explicit in our title, we can expand on it through our job description, or reflect on the day-to-day tasks we do at work. For example, most imaging professionals diagnose, monitor, or treat medical conditions in the human body – it’s what they do. Expanding further on what we do, is how we do it. Imaging professionals may differ in approaches to how they diagnose or monitor a condition. They may differ in the products

ICEMAGAZINE | JANUARY 2020

used or project team structure to accomplish a set task. Internal variables like team dynamics or leadership style can impact the how. External variables like innovative technologies or groundbreaking research may additionally differentiate how one team does a task compared to another. Good leaders can anticipate these shifts and engage their teams to effectively adapt to their environment. Good leaders connect the dots for their teams, showing how to optimize doing the work that they do. Great leaders can connect beyond the what and the how. Great leaders can extend these dots to the why. Why are you reading this article? Hopefully, it’s for a reason beyond just sitting in the waiting room at your radiologist’s office. ADVANCING THE IMAGING PROFESSIONAL

As leaders, take the time to create a value proposition of your team. Depending on the size of the group you manage, collaborate with the group or individuals you work with to equip them to create their own value propositions.

There’s a reason, a value in why you’re taking the time to engage in this magazine. Why is this value important to you? Being grounded in defining value, defining purpose and connecting the “why” gets us closer to accomplishing goals with excellence. Good leaders will be able to define why they have chosen the pathway to becoming a leader and why they are working in the role they are currently in. Great leaders will be able to engage their teams to understand why they are executing the work they do. Do you know why your teams show up to work every day? Connecting beyond what they are doing and how they should do it is critical to ensuring engagement and productivity. Leadership author and organizational consultant Simon Sinek captures value propositioning with his concept of The Golden Circle in his book “Start with Why: How great leaders inspire everyone to take action.” Start with why, expand with how and close with what you are trying to accomplish. Using the Golden Circle, let’s take a look at a few examples of the differentiating factor of an effective value proposition: • I manage the Revenue Cycle Team, who collects on our accounts receivable. They use personal phone calls and require clients a quicker turnaround time than what our billing system requires to ensure timely processing. The organization needs a financial foundation to best WWW.THEICECOMMUNITY.COM

serve our customers. • I manage the Revenue Cycle Team, who builds the financial foundation to best serve our customers. They use personal phone calls and require clients a quicker turnaround time than what our billing system requires to ensure timely processing. They collect on our accounts receivable. • I run the front desk at a radiologist’s office. I greet customers, answer phone calls and check-in patients. I exist so that patients have the best possible start to their experience with their visit. • I guarantee patients have the best possible start to their experience with their visit. I do this by greeting customers, answering phone calls, and checking patients into their appointment. I run the front desk at a radiologist’s office. As leaders, take the time to create a value proposition of your team. Depending on the size of the group you manage, collaborate with the group or individuals you work with to equip them to create their own value propositions. It’s the same saying over and over that “people leave managers not companies.” People don’t leave what they do. They leave because they lose sight of why they do it. It is up to leaders to connect beyond the dots and ground their teams in “why.” •

Great leaders will be able to engage their teams to understand why they are executing the work they do.

KELLY PRAY is the enterprise change management lead at Children’s Hospital Los Angeles.

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INSIGHTS

DIRECTOR’S CUT BY MARIO PISTILLI

IMAGING INDUSTRY CHALLENGES REMAIN I

am thrilled to be given the opportunity to connect with my colleagues through ICE magazine. Director’s Cut will be a monthly column discussing concerns in the imaging industry from my perspective as an imaging director. I plan on touching on a wide variety of topics from general leadership, operational issues, and general industry hot topics in the coming months. I would like to take a little of your time to tell you a bit more about me and my motivations for embarking on this monthly column. I am currently the director of imaging and imaging research at Children’s Hospital Los Angeles which is located at the corner of Sunset Boulevard and Hollywood Boulevard in the area most commonly known as Hollywood. We are a 370-bed pediatric academic medical center. I have also worked on the adult side at Presence Saint Joseph Medical Center in suburban Chicago. I oversee all imaging modalities and all imaging research teams which are composed of about 250 employees. I have been in the imaging field for almost 30 years and started as a nuclear medicine technologist. I have an MBA focused on health care administration and business analytics from University of 52

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Saint Francis. I also completed a graduate education course in health care executive leadership at USC Keck School of Medicine. I am very involved in multiple organizations and serve on the national board of directors for AHRA: the Association for Medical Imaging Management. I publish and speak on leadership and imaging-related topics nationally. My involvement in the national imaging community has allowed me to hear concerns and challenges from colleagues around the country which is what I plan to bring to this column. The ICE magazine staff was able to join the AHRA at our recent annual meeting in Denver at which the future of the imaging industry was one of the topics discussed. While current trends predict volume growth over the next decade, that does not mean there are not significant challenges ahead. The biggest growth is projected in ultrasound and interventional radiology with minimal growth in general X-ray and a small decline in nuclear medicine. The big concern was the impact that high deductible health care plans (HDHCP) will have on imaging. The projection is that HDHCPs will adversely impact volumes as patients delay or avoid imaging due to deductible costs. It will also increase the price sensitivity of patients, and create more price shopping and insurance steerage. This means that hospital-based ADVANCING THE IMAGING PROFESSIONAL

imaging will be hit particularly hard and we will probably see price reductions in many of our hospital-based charge masters and the subsequent hit to the already thin hospital margin. We have not yet seen the full impact and current studies show that consumers are most reliant on their referring physician recommendations. This is changing and will continue to change as price transparency rules come into effect and as access to price information becomes easier. The transition to value-based care models and providers being held more accountable for total cost will also further drive down utilization. The insurance industry is also making authorization harder and the impending meaningful use criteria will soon be adopted by private payers. We have already seen Anthem-Blue Cross deny hospital-based care and other carriers offer financial incentives to subscribers to seek care at cheaper alternatives. There are also three other groups: independent referring provider groups, employers themselves and consolidated radiology groups exerting economic pressure on the industry. It is now, more than ever, that we need the very best and most well-informed leaders in imaging. Success into the future will depend largely on operational efficiency, WWW.THEICECOMMUNITY.COM

quality and pricing. As we all know, as the hospital bottom line shrinks so does access to capital equipment and staffing. Skillful use of staffing and equipment utilization will be required to an even greater degree. I anticipate even stronger connections with our vendor colleagues in the future to navigate some of these challenges together. I will be exploring some of these specific topics and others more in depth in future columns. One of my core beliefs is that a true leader makes those around them better. My motivation for writing this column is to, in some small way, contribute to my peers. I also want all patients everywhere to get the very best care and know that imaging leaders are a huge component in that. I am excited to dialogue with ICE readers through these columns and in person at the next ICE conference being held in Scottsdale, Arizona this February. Conference information is available at AttendICE.com. â&#x20AC;˘

The biggest volume growth is projected in ultrasound and interventional radiology.

MARIO PISTILLI, CRA, MBA, FACHE, FAHRA, is administrative director for imaging and imaging research at Childrenâ&#x20AC;&#x2122;s Hospital Los Angeles. He is an active member and volunteers time for ACHE and HFMA organizations. He is currently serving on the AHRA national Board of Directors. He can be contacted at mpistiili@chla.usc.edu

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IMAGING ARTIFICIAL INTELLIGENCE WILL REPLACE SOME RADIOLOGISTS

am not saying that imaging artificial intelligence can insert a catheter or place an empathetic hand on a patient and say, “You have cancer and I am here to help guild you through this journey.”

PACS/IT BY MARK WATTS

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I am saying radiologists and health care organizations that embrace artificial intelligence will replace those that do not. “Do not touch the patient. Analyzing heart rhythm. Please wait. Preparing shock. Move away from the patient. Do not touch the patient, a shock will be delivered in 3, 2, 1.” These are the voice commands provided by an automated external defibrillator (AED) in my CPR recertification class. I looked to my left and a 19-year-old registration clerk, a layperson in medical training, could accurately diagnose pulseless ventricular tachycardia and provide an advanced interventional treatment to save a life. The clerk’s skills are enhanced by the AED tool. This is the good kind of artificial intelligence. Right? Artificial intelligence (AI) has joined the list of imaging buzzwords that include interoperability, vendor neutral archive and blockchain. I would like to share, what is known, what is hype and work with readers to create useful AI imaging tools. There’s been an explosion in AI recently because of the convergence of four exponentials. The first exponential is Moore’s Law, every two years we have a doubling in computing performance. The second exponential is that every two years we have a doubling of the amount of data that we have because machine learning algorithms are very hungry for data. The third exponential is that we’ve been

working on AI for 50 years or so. The algorithms are starting to get better and teach each other. The fourth exponential is that every two years AI funding has doubled. We now have the computing power, the data, the algorithms and a lot of people working on the problems. The surviving radiologists’ workflow will be supported by imaging artificial intelligence (IAI). A future radiologist will sit or stand at a reading workstation and assume IAI has optimized the pre-imaging phase, the image acquisition, the reporting and post-reporting tools. These main areas are where I see potential for AI use.

PRE-IMAGING 1. Clinical Decision Support – tools at the requesting stage which may guide clinicians to the appropriate single best test or suite of tests for a given presentation or differential. 2. Optimized Scheduling – both within an enterprise and with patients to route appointments to the most convenient and efficient location and scanner to enhance productivity. 3. Enhanced Digital Communication with patients (including electronic consent) – tools to better prepare a patient with information about what a test involves, how to prepare for it and the importance to their overall treatment journey. The benefits of these measures would be to eliminate time wasted by poor scanner scheduling, reduce the incidence of noshows, and pump-prime the information a patient needs for a scan to when they are more receptive rather than during the stressful period of attendance as well possibly as reduced time and support needs during the ICEMAGAZINE

INSIGHTS scan (for example expectations for positioning, etc.).

IMAGE ACQUISITION STAGE

AI is like Tony Stark’s Iron Man suit. It takes someone, like the registration clerk, and makes them into a superhero!

1. AI-assisted image acquisition to reduce the time it takes to scan (for example multi-parametric MRI scans) and reduce the number of poor-quality images thus potentially also improving accuracy and need for recalls. 2. AI-assisted dose management – at a macro-level by reducing signal noise to improve image quality of lower dose scans, and at a patient level. 3. Real-time on-scanner image detection/ analysis. This itself could have several potential benefits. During my years at the Mayo Clinic in Scottsdale, Arizona each CT exam was reviewed by a radiologist before the patient was taken off the table. Generally, radiologists’ readings are “cold,” that is when the patient is no longer in the radiology department or usually not even in the hospital (outpatient scanning). Benefits of on-modality analysis may allow stratification for a critical finding that requires immediate/ urgent medical attention or abnormalities that require urgent/expedited reporting. 4. Normal scan – automated reporting of normal examinations for near-contemporaneous feedback to expedite management and provide earlier reassurance to patients. A subset of the above might be detection of changes to known pathology (for example a nodule or cancer follow-up) with either automation of “no change” or prioritization of “significant change” findings.

IMAGE INTERPRETATION AND REPORTING 1. Examination-Routing: Intelligence worklist management to ensure that examinations are reviewed as quickly and efficiently as possible by the appropriate person based on rules such as: • Urgent findings • Specialism • Key performance indicators/metrics • “Normal” pathways as alluded to above 2. Optimized Presentation of Imaging (ready for reporting): beyond the bane of a radiologist’s life that is “hanging protocols” and “relevant priors” more broadly 56

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this would be bringing appropriate investigations, clinical information and findings outside radiology to the reporter’s attention to enhance quality and reduce time wasted from multi-source hunting. 3. Lesion Segmentation and Tracking: I recognize there are about a million algorithms in development that profess to do this, but instead of “App stores” requiring human intervention to pull individual pieces of software to run and then needing user input to validate each nodule, options could include: • Hardwired into a natural workflow which (for example) automatically segments out lesions (across the entire image acquisition not just in individual body part models), measures them, detects changes in prior lesions and presents them as a summarized finding in the report. • On-demand Analysis Aid: humans are generally poor at differentiating between true positive and false positives and so algorithm segments “nodules” presented to validate might lead to overcalls. Instead an interactive tool might be activated on demand to provide a “second opinion” on a region of uncertainty instead of pre-marking multiple regions for a person to accept or reject. 4. Image Analysis Support: This might involve, for example, access to image libraries with suggestions of possible diagnosis of appearances based on pathognomonic features. More specifically, this might involve radionomics features to help classify tumors. Another example might include an analysis of the attenuation, enhancement characteristics or MR-signal profiles and suggesting the most likely etiology based on these parameters. Of course, we should also remember the more prosaic analysis of pathology on plain X-rays. 5. Natural Language Processing applications might be employed in various guises such as: • Improve the accuracy of voice recognition while reporting and correct typographical errors whilst reporting or deploy suggested-next methodologies to make reporting more efficient. • Automatic generation of report summary based on the body of the text, includADVANCING THE IMAGING PROFESSIONAL

ing details such as auto-inserting TNM stage based on descriptors of pathology. 6. Report-Creation: The next step from assisted reporting would be independent report creation modules. We are already seeing some of these in development in the breast radiology space but possibilities include: • Breast second reader applications – helping to address the massive shortage of radiologists. • Full template reporting – as we discussed in the image acquisition phase, if the analysis deems an examination is normal there is no reason this could not generate an appropriate report thus potentially massively reducing the reporting burden of the normals. Indeed, this could equally work with (for example) X-rays for fractures – coupled with appropriate routing of the reports. 7. Clinical Decision Support: Access to latest pathways and protocols to ensure a radiologist’s advice conforms to current standards (for example for lesion/nodule follow-up guidelines).

POST-REPORTING PATHWAYS This would involve various facets of automatic or optimizing routings of the report of its findings such as: 1. Automatic notification to responsible clinicians of critical findings. 2. Automatically scheduling a case to be discussed at the

next appropriate MDT. 3. Scheduling/requesting appropriate onward examinations based on the examination findings such as PET-CT or interval CT for nodules as per guidelines. The aim of the radiological journey with IAI is that it should result in greater efficiency in the end-to-end pathway without increasing the administrative burden on users to deploy it. The net result would be faster and more efficient patient-centric imaging. By considering some of the fully automated outcomes, we could also seek to redress the massive differential between imaging demand and capacity. AI is like Tony Stark’s Iron Man suit. It takes someone, like the registration clerk, and makes them into a superhero! And you could suddenly be doing things that are 10 times above your level and providing them much cheaper than anyone else could do it. Therefore, I think IAI will replace some radiologists. • MARK WATTS has over 20 years as an imaging professional with vast expertise in imaging informatics and IT issues. He has served in many roles in both hospitals and industry as a health care vice president, imaging director, and IT consultant. His knowledge and experience in the convergence of IT and imaging has made him a sought after author, speaker and consultant. He has authored a textbook on informatics and was a pioneer in the adoption and development of PACS and VNA technologies.

FOR YOU, MEDICAL IMAGING ENGINEERING IS A SCIENCE. FOR US, REPLACING PARTS IS AN ART.

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INSIGHTS

DOES YOUR ORGANIZATION HAVE AN IMAGING STRATEGY?

here continues to nology platform or vendor of be great interest in choice, albeit this is certainly a enterprise imaging factor. Consider that few, if any, (EI). We saw an emphaorganizations are still followsis related to sessions, ing their original imaging road roundtables, vendor maps. This is due to many difnarratives and provider ferent forces including mergers, interest at Society for acquisitions, vendor changes, Imaging Informatics in policy modifications, marMedicine (SIIM) just a ket changes and technology DEPARTMENT/ few months back. We innovation. Carefully adapting OPERATIONAL ISSUES to these shifts in an unstable are clearly in a phase of growing momentum in environment means spending BY JEF WILLIAMS achieving better outenough time on strategy, goals, comes, cheaper, more efficiently, more outcomes and philosophy. These foundations carefully and with a long view toward serve as guiding principles and indicators of the future success. ongoing success of an enterprise imaging initiaIncluding imaging as part of the patient jacket has always been top of mind with those of us who engage primarily with imaging service lines, but it is now becoming important to those in leadership for several reasons. First, it is the completion of the work with adopting EMR – adding all patient information to the patient jacket in a single platform or portal. Second, the sheer cost and complexity of imaging requires adopting newer technologies and innovations to achieve better business models. Third, policy is driving change in how we are, and will be, reimbursed; sharpening our data management models within imaging require better solutions. And finally, patient-driven care is rapidly approaching the point where it will bend the curve on business strategy and volumes. The success of this initiative will rest largely on the comprehensiveness of the organization’s self-awareness, the empowerment of a healthy governance structure, and the willingness to learn and adapt interactively throughout the project life cycle. Success is no longer built on the tech58

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tive. Finally, it is often said that everyone is approaching EI differently. Yes, this is true. But there are many things systems are doing similarly. We have standards, and we all deal with the challenges associated with proprietary formats, proprietary tags, immature IHE profiles, integration workarounds and supplementing solutions with peripheral technologies and workflow. There is much we can learn from each other’s experiences. We do well to avoid common mistakes. While we cannot “copy and paste” someone else’s specific strategy or road map to our own ecosystem, there are many lessons we can learn from each other. Moving our industry away from an “us versus them” mentality to a collaborative system of shared experiences will not only assist with greater local success, but ultimately reduce costs and risks associated with remediation of bad implementations. • JEF WILLIAMS, MBA, PMP, CIIP, is a managing partner at Paragon Consulting Partners.

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CODING/BILLING BY MELODY W. MULAIK

AUC IS FINALLY HERE – WHAT YOU NEED TO KNOW TODAY! A fter multiple years of delays the wait is finally over – well almost. January 1, 2020 ushered in the testing period of a program that been the topic of discussion for many years. During 2020, the Centers for Medicare and Medicaid Services (CMS) will not deny any claims solely based on the submission (or lack thereof) of Appropriate Use Criteria (AUC) reporting criteria. Beginning January 1, 2021, this will change as CMS will deny payment to both the facility that provided the imaging and the interpreting provider if the required AUC elements such as the newly established G-codes and modifiers are not reported. Ordering physicians and practitioners (“ordering professionals”) will be required to consult AUC for all advanced imaging studies billed under the Medicare Physician Fee Schedule (MPFS), the Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System, including those performed in a physician office, hospital outpatient department (including emergency department), IDTF or ambulatory surgery center. There are few exceptions to note. The AUC consultation requirement does not apply to imaging exams performed on inpatients and paid under Medicare Part A. It also does not apply to patients with emergency medical conditions as defined by the Emergency Medical Treatment & Labor Act (EMTALA), whether confirmed or suspected, or when the ordering physician or practitioner

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has received a hardship exception. Any ordering professional experiencing insufficient Internet access, EHR or CDSM vendor issues, or extreme uncontrollable circumstances (including natural or manmade disasters) will not be required to consult the AUC using a qualified CDSM. These circumstances will be self-attested at the time of placing the order. On July 26, 2019 Centers for Medicare and Medicaid Services (CMS) finally released the reporting requirements for Appropriate Use Criteria (AUC) consultation for Advanced Diagnostic Imaging exams. Beginning January 1, 2020 CMS has indicated claims processing systems will be prepared to accept claims with Current Procedural Terminology (CPT®) or HCPCS C code, for advanced diagnostic imaging along with a line item HCPCS modifier. The modifier will identify what level of the AUC was followed or to identify an exception to the program. Table 1 includes the modifiers for reporting under the AUC. If a claim includes modifier ME, MF or MG with the advanced diagnostic imaging service, a separate G-code is required to report which qualified CDSM consulting the ordering provider consulted when ordering the exam. CMS has indicated that multiple G-codes can be reported on a single claim. Each CDSM consulted by the ordering professional has a unique G-code for reporting on the claim form. The listing of the specific G-codes and the CDSMs they represent can be found in Table 2 in the MLN Matters MM11268: https://www.cms.gov/ Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/ Downloads/MM11268.pdf. This same transmittal also includes the full list of HCPCS ADVANCING THE IMAGING PROFESSIONAL

advanced imaging procedure codes which are included in the AUC program. This list has not been updated for the new 2020 nuclear medicine and PET codes so watch for an updated list. As you work with your ordering providers for a successful implementation keep in mind that for them taking the time to perform the AUC consultation is defined by CMS as a High-Weight Improvement Activity for the Medicare Access and CHIP Reauthorization Act (MACRA) quality program. Additionally, this activity is eligible for 10% bonus points in the Promoting Interoperability (PI) performance category. Also, the Cost Display for Laboratory and Radiologic Orders is defined as a Medium-Weight Improvement Activity, which is also eligible for a 10% bonus points award in the PI performance category. So, in addition to being compliant with a regulatory mandate, your ordering providers are getting some “credit” for the extra work involved in participating in AUC. Even though 2020 is a testing year, and there will be no financial impact to the claims submitted to CMS for advanced diagnostic imaging service, it is vital that you ensure that all the required system changes are in place and working correctly. In the absence of new guidance from CMS lack of compliance with these new guidelines will result in payment denials beginning on January 1, 2021. • MELODY W. MULAIK, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and

Table 1-HCPCS Modifiers for AUC Program HCPCS MODIFIER

DESCRIPTION

Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition

Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient Internet access

Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues

Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances

The order for this service adheres to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional

The order for this service does not adhere to the appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional

The order for this service does not have appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional

Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider

Coding Strategies Inc.

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INSIGHTS

CONFLICT RESOLUTION 301 FIVE STEPS TO CONFLICT RESOLUTION

n my first column on this subject I wrote about the five universal fears and how they get in the way of conflict resolution. The second column reviewed the need for good listening. In this column, I’ll go over the five steps for resolving conflict. I call this method the Relationship Ladder, and it works wonderfully – if the five steps are done in order. As a quick side note, this ladder works everywhere, both at work and in your personal life.

THE FIVE STEPS The five steps of this ladder are: 1. Focus on the other person 2. Seek to learn if you understood 3. Look for trust 4. Gently discover the truth 5. Establish hope My last column (on listening) outlined the first two steps of the ladder; focusing on the other person, and then seeking to learn if what you perceived is correct. By way of quick review, the first step is a non-speaking step. You’re simply asking yourself, “What is the other person thinking?” and, “What is the person feeling?” Is the person frustrated? Concerned? Thrilled? Disappointed? Identifying a problem? Is the person describing a solution to a problem? Expecting a particular action? Looking for help? Relaying information? The idea is to look past the words and strive to understand where the person 62

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is, both positionally (cognitively) and emotionally. Step 2 in the ladder prevents you from acting on assumptions. I found the best way to do Step 2 is by asking questions, such as, “If I understand you correctly, you’re concerned about the deadline?” By seeking confirmation, you’re allowing the person to say, “Yes, that’s it,” or, “No, not quite.” If the person says, “No, not quite,” ask the person to clarify and start Step 1 all over again. Some folks call these steps, “active listening,” and that’s exactly what it is. People can tell whether you’re truly listening or just going through the motions. True listening means paying attention to the entire person. Bonus: doing so builds trust, which is necessary for moving forward. The key to success in Step 2 is to communicate your understanding without criticism or judgement.

THE DANGER OF “I UNDERSTAND” In Step 2, be careful not to say, “I understand,” and “I know how you feel.” First, such phrases place the focus back on you, which violates Step 1. Second, people often have deep feelings and experiences you know nothing about, so you can never truly understand. Therefore, just saying, “I understand,” doesn’t mean it’s true. The other person can doubt you, and that doesn’t help with Step 3.

STEP 3: LOOK FOR TRUST Why must we look for trust? When disagreements and tension exist,

EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI people tend to have their guard up. They’re often experiencing the fears I outlined in Conflict Resolution 101: fear of criticism, failure, rejection, not getting what they want, or losing what they have. Quite often, people’s past actions have contributed in some fashion to the problem(s) being discussed. Not always, but it happens. Since Step 4 has to do with discovering the truth of a situation and Step 5 is about finding a solution, people first need to be a bit vulnerable, but they won’t go there unless they feel safe. How do you create a safe environment? You do Steps 1 and 2 without judgement. Like Step 1, Step 3 is a non-speaking step. You simply watch for signs of trust. Why is this important? Think of the oft-quoted axiom, “People don’t care how much you know until they know how much you care.” What are signs of trust? Commonly I look for people relaxing their voice or body posture. They may drop their shoulders, unfold their arms or sit back in a chair. Often you can just sense it. Another sign of trust is when a person takes a deep breath. These signs of trust are like an open gate. If you see them, the gate is open to move to Step 4. If you don’t see trust, stay with Steps 1 and 2.

STEP 4: GENTLY DISCOVER THE TRUTH In Step 4, notice the adverb, “gently.” If you jump too fast into discussing the truth of a matter, people often put their guard up again. I find it’s easy to move ADVANCING THE IMAGING PROFESSIONAL

ISO 13485:2016 CERTIFIED

into the truth of a matter by asking questions, such as, “What do you think is really going on here?” Let the other person speak first while you use the same active listening skills from Steps 1 and 2. You probably have an opinion you want to share, but I strongly recommend waiting. Follow the order of events outlined in Stephen Covey’s fifth habit: Seek first to understand, then be understood. Also, in Step 4, remember to keep the conversation focused on the present or the past. Do not discuss the future. Neither you nor the other person should be trying to fix anything yet, just keep the conversation focused on the truth of what has led up to the present situation.

this?” As before, you may have ideas, too, but hear theirs first. One successful technique is not locking into a permanent solution. Sometimes it’s better to enact solutions on a trial basis, such as for two or three months.

STEP 5: ESTABLISH HOPE

DANIEL BOBINSKI, M.Ed. is a best-selling

This last step is about creating a plan to move forward. Whereas Steps 1-4 have to do with the past, Step 5 is about finding a solution. Again, practice Covey’s fifth habit: Seek first to understand, then be understood, and do this by asking a question, such as, “What do you think we should do to fix

author and a popular speaker at conferences

OTHER RESOURCES If you’d like to see the Relationship Ladder explained with more detail, I invite you to visit the Imaging Community Exchange website, www.theicecommunity.com. On this site, in a 15-minute video I explain the five universal fears, the listening sins and the five-step Relationship Ladder. Next month, I will provide some real-life examples of how this tool has proven itself valuable in resolving conflict. •

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 Daniel through his website, www. MyWorkplaceExcellence.com.

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REFERENCES https://pediaa.com/difference-between-fear-

Fear of Criticism

and-phobia/

https://www.inc.com/scott-mautz/sciencesays-were-wired-to-fear-criticism-so-fix-it-

https://www.news.com.au/lifestyle/health/

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rellhealthcare.com healthcare@rell.com 704.739.3597 x3

with-these-6-tips.html

running-scared-how-phobias-form-and-howto-face-your-fears/news-story/7ad450f835b

Fear of Failure

f7ae59581a404c9a08f88

https://www.psychologytoday.com/us/blog/ the-squeaky-wheel/201306/10-signs-you-

https://www.verywellmind.com/theories-on-

might-have-fear-failure

BOOTH #102

the-development-of-phobias-2671514 Fear of Rejection https://www.psychologytoday.com/us/blog/

https://psychcentral.com/blog/

brainsnacks/201203/the-only-5-fears-we-

deconstructing-the-fear-of-rejection-what-

all-share

are-we-really-afraid-of/

http://www.unexplainedstuff.com/Mysteries-

https://stpauls.vxcommunity.com/Issue/

of-the-Mind/Phobias.html

Us-Experiment-On-Infants-WithholdingAffection/13213

http://www.jkennon.com/discipleship/5universal-fears/

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BY JOHN WALLACE

RSNA RECAP New Devices, Latest Technology on Display at Annual Meeting

he annual RSNA Scientific Assembly and Annual Meeting is a grand event each and every year. The 105th meeting held December 1-6, 2019 at the McCormick Place in Chicago was no different. It is impossible to see and do everything that is offered. However, thanks to exhibit tours and exclusive interviews the Imaging Community Exchange (ICE) magazine is able to share some of the exciting news from RSNA.

SIEMENS HEALTHINEERS Siemens Healthineers introduced two artificial intelligence-based software assistants in the established AI-Rad Companion family that are designed to free radiologists from routine activities during magnetic resonance imaging (MRI) examinations. The AI-Rad Companion Brain MR for Morphometry Analysis automatically segments the brain in MRI images, measures brain volume and marks volume deviations in result tables used by neurologists for diagnosis and treatment. The AI-Rad Companion Prostate MR for Biopsy Support automatically segments the prostate on MRI images and enables radiologists to mark lesions, facilitating targeted prostate biopsies. (AI-Rad Companion Brain MR for Morphometry Analysis and Al-Rad Companion Prostate MR for Biopsy Support are 510(k) pending with the FDA and not yet 64

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commercially available in all countries.) “With the new AI-based assistants, we are expanding our diagnostic offering to help our customers increase efficiency and improve the quality of care,” said Peter Koerte, head of digital health at Siemens Healthineers. “We firmly believe that AI will help physicians deal with their workload and benefit patients by helping physicians achieve an improved, patient-focused decision-making process. We demonstrated this at last year’s RSNA when we introduced the first application of the AIRad Companion focusing on CT for the chest region. At RSNA 2019, we present additional AI-Rad Companion applications for MRI examinations in the brain and prostate regions. Further applications for radiography and radio oncology will follow.” During a tour of the Siemens Healthineers space, Global Marketing Manager Artificial Intelligence Ivo Driesser discussed how three new products promote “decision making with the right information.” He said the AI-Rad Companion provides “information for radiologists at their fingertips” and “guiding eyes of doctor to area of interest.” “With our data, we support clinicians to make decisions,” Driesser added. Both new AI-Rad Companion software assistants can be used on MRI scanners from outside manufacturers and are available on teamplay, the Siemens Healthineers ADVANCING THE IMAGING PROFESSIONAL

The first CT scanner launching with the myExam Companion intelligent user interface concept, the SOMATOM X.cite uses the Vectron X-ray tube. In combination with a large 82cm gantry bore, the SOMATOM X.cite offers advanced imaging capabilities with an even greater focus on patient comfort. FOR MORE INFORMATION about Siemens Healthineers, visit theicecommunity.com/sie2019.

KONICA MINOLTA

ICE Editor John Wallace interviews Konica Minolta Healthcare Americas Inc. President and CEO David Widmann.

cloud-based platform that helps support compliance with the Health Information Portability and Accountability Act (HIPAA) and the EU General Data Protection Regulation (GDPR). The software is seamlessly integrated into the existing clinical workflow and is Digital Imaging and Communications in Medicine (DICOM) compliant. The clinical images and all supporting information can be made available automatically in the picture archiving and communication system (PACS). Teamplay is not yet commercially available in all countries. Siemens Healthineers Global Director Product Marketing Management Florian Belohavek discussed exciting CT offerings. The FDA-cleared SOMATOM X.cite is a premium single-source computed tomography (CT) scanner with the new myExam Companion intelligent user interface concept. The intuitive user interface of the myExam Companion guides the user through the exam workflow with precise questions about the patient, potentially enabling optimization of the state-of-the-art features of a premium CT scanner such as the SOMATOM X.cite. The myExam Companion combines available patient data such as gender and age with other user or machine-observable, patient-specific information – for example, a patient’s electrocardiogram (ECG) waveform for a cardiac study – to identify optimal acquisition and reconstruction techniques for each patient. Together, these innovations make the imaging process more efficient, compensating for differences in user experience levels and scan complexities on even the most complicated acquisitions, including coronary CT angiography (CTA) studies. WWW.THEICECOMMUNITY.COM

Konica Minolta Healthcare Americas Inc. President and CEO David Widmann spoke with ICE magazine about the company’s new innovations in data analytics, digital radiography, enterprise image and data management, ultrasound solutions and alternate care markets at RSNA 2019. “What we are really showing this year is how you convert imaging, genetics and clinical research into precision medicine,” Widmann said. He said the goal is to use technology to gather data to deliver insights for better clinical insights. X-ray that moves took center stage as Widmann said it “advances DDR.” Konica Minolta Healthcare unveiled the compact and efficient KDR AU Advanced U-Arm with the unprecedented image acquisition capability of Dynamic Digital Radiography (DDR), the next evolution in X-ray imaging that is pending FDA 510(k) clearance. DDR, or X-ray that Moves, provides a cine loop of rapidly acquired, diagnostic-quality images depicting full views of articulatory mobility. When applied in musculoskeletal (MSK) applications, clinicians can assess changes in relationship of bones, ligaments and other anatomical structures through full range of motion to evaluate shoulders, knees, wrists and spine. In addition to producing dynamic sequences, the KDR AU also provides standard medical images for all anatomies. Today, clinicians rely on observing external motion and static X-rays to assess spine and joint stability; DDR has the potential to revolutionize how patients are diagnosed and transform the care pathway. Emory Healthcare is the first health care institution in the world to install the KDR AU with DDR for orthopedic imaging. Bruce Ashby demonstrated DDR during a tour of the Konica Minolta exhibit. “We can do this for all joints,” he explained. “Dose is way, way down compared to X-ray – at least half if not more reduced,” he added. He said it is going to help with triple aim or the new quad aim to address speed, patient satisfaction, employee satisfaction and cost savings. “More time with the patient and less time with total exam,” Ashby explained. “The whole exam is six seconds and that is with AP, lateral and oblique.” ICEMAGAZINE

Ultrasound for diagnostic and interventional precision was another topic Widmann discussed. • FOR MORE INFORMATION about Konica Minolta, visit theicecommunity.com/km2019/.

HOLOGIC Hologic Inc. showcased its comprehensive portfolio of breast and skeletal health products, including screening, interventional, surgical, ultrasound and skeletal solutions at RSNA. Hologic continues to expand and strengthen its position in breast health, most recently ranking first in customer satisfaction, service and system performance on the 2019 IMV ServiceTrack Diagnostic Imaging report, an annual customer satisfaction survey on the medical imaging industry. “It’s been an exciting year for Hologic as we’ve continued to develop a comprehensive breast health ecosystem that impacts every step of the patient pathway from diagnosis to treatment,” Hologic Division President, Breast and Skeletal Health Solutions Pete Valenti said in a press release. “Today, we are the only manufacturer addressing the full continuum of care for breast health, and that is something we’re very proud of. As the trusted expert in breast Hologic Inc. showcased its portfolio of breast and skeletal health products.

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health, we appreciate the opportunity to educate and engage with thousands of health care providers at RSNA to demonstrate the clinical superiority of our solutions and the proven impact they continue to have on our customers and their patients.” Hologic continues to expand its product portfolio through insight-driven innovation and strategic acquisitions to address the entire clinical continuum of breast cancer diagnosis and care, from digital specimen radiography and stereotactic breast biopsy systems, to breast biopsy markers and surgical guidance systems. The company recently acquired SuperSonic Imagine, a pioneer in the field of ultrasound imaging, which markets ShearWave elastography with UltraFast technology for the detection of breast lesions. The latest version, ShearWave PLUS, available on the SuperSonic Mach 30 system, can visualize, analyze and quantify tissue stiffness in real time. In 2019, Hologic introduced new innovations to drive accuracy and workflow efficiencies, including 3DQuorum imaging technology powered by Genius AI, and Unifi Workspace. 3DQuorum technology works in tandem with Hologic’s Clarity HD high-resolution imaging technology to reduce tomosynthesis image volume for radiologists. Unifi Workspace is a comprehensive breast diagnostic reading solution designed to enable more informed decision making and improve workflow efficiencies for radiologists. Both products were on display at RSNA, alongside the company’s other screening, interventional, surgical, ultrasound and skeletal solutions. The Unifi Workspace is among the first workstations to unify all workstations into one. Hologic said it eliminates a radiologist having multiple screens for viewing images. Also, the 3DQuorum powered by Genius AI will reduce read time by about two-thirds which translates to about 1 hour per day. ADVANCING THE IMAGING PROFESSIONAL

FUJIFILM Fujifilm’s Synapse 7x, a next-generation, secure server-side viewer platform that extends across enterprise imaging areas, bringing diagnostic radiology, mammography and cardiology together through a single, zero footprint platform, and allowing for immediate content interaction regardless of dataset size, was on display at RSNA. Synapse 3D operates natively within the viewer, extending the same advanced visualization across radiology, cardiology and mammography, eliminating the need for third-party workstations. Synapse 7x is designed to take full advantage of Fujifilm’s open AI-enabled platform and use AI results natively within user workflows. Sara Osberger, senior director of marketing, enterprise imaging, is excited about the platform. “It is mind blowing to cardiologists because they are getting all of these radiology tools,” Osberger said in her interview with ICE. “Cardiologists are really going to benefit.” She said workflow efficiencies are another feature. “We are able to use AI algorithms to prioritize scans for radiologists to read,” Osberger said. “At RSNA this year, we are demonstrating 7 partner algorithms and 10 Fujifilms algorithms. It is an open platform for facilities to decide which to use.” “Fujifilm’s Synapse 7x promises to be a game changer for our U.S. health care providers. It’s a convergence of Fujifilm’s server-side technology and was designed to cover all the different areas of diagnostic visualization as well as meet the long-term goal of providing the richest possible visualization layer for an enterprise imaging solution,” said Bill Lacy, vice president of medical informatics at FUJIFILM Medical Systems U.S.A. Inc. “The robust technology is uniquely AI-enabled and integrated, and is presently unrivalled in the marketplace.” Paul Bojarski, market development director: acute care at FUJIFILM SonoSite Inc., was excited to share point-ofcare solutions, including SonoSite Synchronicity. The SonoSite Synchronicity workflow manager helps health care organizations optimize workflows, maximize financial return, improve quality assurance efficiency and streamline credentialing processes. Built specifically for POCUS, SonoSite Synchronicity workflow manager securely centralizes exam data and standardizes clinical workflow while delivering administrative efficiencies. FOR MORE about Fujifilm, visit theicecommunity.com/fuji2019.

LANDAUER and RAYSAFE LANDAUER and RaySafe, leaders in radiation safety and quality assurance, featured new products and services at RSNA in a joint booth. WWW.THEICECOMMUNITY.COM

The radiation safety and compliance solutions featured at the RSNA show included LANDAUER OPTIMIZE – a new, unique patient dose optimization solution that combines software and personal guidance from expert, dedicated medical physicists. OPTIMIZE is a cloud-based dose management solution with easy adoption by staff – only requiring about one hour a month to maintain. It features automated monitoring with customized analysis, right patient doses and maximum image quality. Developed by LANDAUER medical physicists, OPTIMIZE allows health care providers to focus on caring for patients rather than data – and to serve more patients safely, effectively and compliantly. ICE magazine interviewed LANDAUER OPTIMIZE designer Olav Christianson at RSNA. “We created a consulting service to help people understand data,” Christianson explained. “OPTIMIZE combines software with board certified physicists. This allows you to do some really innovative things.” “We get the data in real time and can monitor in real time,” he added. “Optimize is different because it is all about the service,” Jim O’Brien added. “We are encouraging them to outsource their compliance management for patient radiation.” RaySafe displayed the 452 Radiation Survey Meter, the i3 Real-time Dosimeter System and the X2 X-ray QA Test. The RaySafe 452 Radiation Survey Meter is a versatile, powerful tool that can be used for multiple situations, reducing the number of devices technicians need to carry, learn and calibrate. It is the ideal tool to measure radiation in a wide variety of applications, including finding spilled isotopes, measuring scattered radiation from X-ray machines and linear accelerators. The RaySafe 452 does ICEMAGAZINE

not require any corrections or manual settings, letting technicians focus on radiation protection rather than set-up. Magnus Smith said he received great feedback regarding the 452 Radiation Survey Meter during RSNA. “We offer a great versatility of products to measure low and high dose rate with a fast response time,” Smith said. “Making it a meter that can be used in any application.”

ROYAL PHILIPS At RSNA, Royal Philips harnessed the power of AI to create insights from the complete range of patient data, including pathology and genomics. Combining simplified workflows, strong clinical capabilities and AI, Philips’ patient-centered approach

Philips showcased its products and hosted presentations at RSNA.

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empowers health care providers to provide a precision diagnosis, leading to targeted therapies with predictable outcomes. “Philips has significantly extended its enterprise imaging portfolio through strategic investments in R&D and complementary acquisitions, all guided by the goal of enabling precision diagnosis,” said Rob Cascella, chief business leader for precision diagnosis at Royal Philips. “From capabilities in data integration and AI to completely renewed platforms across MRI and CT, our portfolio and our ability to shape solutions to meet health care providers’ needs is stronger than ever.” Recent research commissioned by Philips highlights the need for radiology staff empowerment and workflow-focused innovation. With pressure on imaging departments mounting amid rising patient volumes and a global shortage of qualified staff, improvements in workflow and efficiency, supported by data integration and AI, can improve the experience of staff and patients and, more broadly, enhance clinical outcomes while reducing costs. From reducing MR exam times by up to 50% to reducing the number of steps that a clinician needs to take for a 3D vascular ultrasound assessment from 10 to one, Philips is supporting improved workflow across its portfolio. At RSNA, Philips launched its next-generation enterprise imaging informatics solution. The introduction follows several years of strategic investments in R&D, AI and complementary acquisitions, resulting in a suite of integrated products that deliver a comprehensive platform designed to connect clinical capabilities and optimize workflows around every step in the patient’s journey. Philips is also launching IntelliSpace AI Workflow Suite, which enables health care providers to seamlessly integrate AI applications ADVANCING THE IMAGING PROFESSIONAL

into the imaging workflow. Part of Philips’ new enterprise imaging informatics solution, the comprehensive AI Workflow Suite provides a full set of applications for integration and centralized workflow management of AI algorithms, delivering structured results wherever they’re needed across the health care enterprise. Now available in North America, the Incisive CT integrates innovations in imaging, workflow, and lifecycle management, helping health care providers to improve the computed tomography (CT) experience for patients and staff, enabling smart clinical decision-making and increasing efficiency. With its industry-first “Tube for Life” guarantee, Philips will replace the Incisive’s X-ray tube at no additional cost throughout the entire life of the system, potentially lowering operating expenses by an estimated $420,000. The system also enables inter-operator consistency, increases uptime and decreases “time to results” by 19%. FOR MORE INFORMATION about Philips, visit theicecommunity. com/phi2019.

CHANGE HEALTHCARE Change Healthcare announced the latest milestone in its strategic initiative to build and implement its cloud-native Enterprise Imaging Network – the addition of four leading health systems as development partners. Hosted by Change Healthcare on the Google Cloud Platform, the network is the centerpiece of Change Healthcare’s enterprise imaging strategy. Built from the ground up to exploit the flexible nature of cloud services and delivery, the network will enhance and optimize medical imaging data – enabling providers to improve clinical, financial and operational outcomes. The four new provider partners are Bronson Health-

“The problem today with enterprise imaging on the cloud is that most solutions are not developed specifically for the cloud, but instead are lifted from legacy technologies and re-platformed.” Tomer Levy, general manager, Cloud Solutions at Change Healthcare

care, Community Health Systems Professional Services Corporation, Montefiore Nyack Hospital, University of Wisconsin School of Medicine and Public Health, and UW Health, Madison Wisconsin. Each partner will work with Change Healthcare to help accelerate development of the solution by implementing the platform as it is built and providing ongoing, real-world feedback. Collectively, these partners manage 124 hospitals with an annual imaging volume of over 5.6 million studies. They will migrate more than 66 million studies to the Change Healthcare Enterprise Imaging Network cloud, with over 2.8 petabytes being handled by the network. Customer implementations are expected to go live in the first half of 2020 as a fully-managed software-as-a-service (SaaS) solution from Change Healthcare. “The problem today with enterprise imaging on the cloud is that most solutions are not developed specifically for the cloud, but instead are lifted from legacy technologies and re-platformed,” said Tomer Levy, general manager, Cloud Solutions at Change Healthcare. “This means providers aren’t realizing the full benefits in improved care coordination, cost realization and reduced infrastructure complexity that true cloud-native solutions can provide. From the time we first partnered with Google Cloud, we’ve focused on building a solution that doesn’t simply replicate traditional on-premise systems, but delivers everything providers expect in an enterprise imaging service – plus clinical and operational capabilities that are only available through a true cloud-native SaaS platform.” The Change Healthcare Enterprise Imaging Network includes: • Imaging Archive: A vendor-neutral archive that centrally manages imaging studies from multiple locations, provides simple and secure access, and allows secure sharing. • Image Viewer: A diagnostic-quality viewer for clinical care teams that lets physicians and clinical specialists securely access patient images and reports at any time, from any place. • Imaging Analytics: A dashboard that presents nearreal-time data from across the enterprise to visualize historical results and trends, information to support clinical decisions, and predictive models for clinical planning. • Change Healthcare AI (Artificial Intelligence) Orchestration Services: A vendor-neutral platform that streamlines integration of multiple AI algorithms across multiple vendors. • FOR MORE about Change Healthcare, visit theicecommunity.com/ cha2019. FOR MORE INFORMATION, visit theicecommunity.com/rsna.

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RSNA SCRAPBOOK BY ERIN REGISTER

he 105th Radiological Society of North America (RSNA) Scientific Assembly and Annual Meeting was held at McCormick Place in Chicago, Illinois, December 1-6, 2019. Health care professionals from around the world gathered to â&#x20AC;&#x153;See Possibilities Together,â&#x20AC;? including plenary session speakers, technical exhibits, an expanded AI Showcase as well as the 3D Printing and Advanced Visualization Showcase. 1. RSNA 2019 included innovative science and quality education to improve patient health care and provided a setting for networking and exploring.

ICEMAGAZINE | JANUARY 2020

2. The ICE team met and networked with several clients, radiology personnel and many impressive imaging companies. 3. Over 50,000 people from all over the world,

including countries such as China and India, attended RSNA. 4. Ballroom dancers entertained attendees between the north and south exhibit halls.

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5. RSNA had two exhibit hall areas, a north and south hall, where attendees were able to easily network with several vendors and learn the latest advancements in the radiology field.

6. ICE Editor John Wallace interviewed a Fujifilm representative to discover the company’s latest news and advancements. 7. RSNA featured an AI Showcase, sponsored by Zebra Medical, where attendees were able to see AI in action with presentations on the latest topics in AI, machine learning and deep learning.

8. Oxford Instruments Healthcare’s Rachel Mullins and colleague posed for a picture at their booth. 9. Siemens Healthineers introduced its SOMATOM On.site CT scanner at RSNA. The scanner can be wheeled right into patient rooms for bedside exams, so the patient does not have to get out of the bed. •

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Science Matters COMPUTER VOICE:

“Good morning, Fidel”

The device takes Fidel’s elecctrocardiogram

“Please step onto the scale”

Scales measure how his body weight gently bobs up and down

Hold the metal bar and wait a moment” Artificial intelligence computer finds signs that Fidel's heart failure has worsened

Scales weigh heart failure Fidel is having a ballistocardiogram (BCG), a diagnostic test that researchers often used 100 years ago; it lost favor as medical imaging improved. Today, researchers are taking another look at it.

Congestive heart failure, gradual loss of ‘cardio’

Sensitive scales detect up-and-down oscillation of person’s weight The system measures forces generated as the heart ejects blood In heart failure, those forces form a distinct pattern

Heart rhythm Forces detected by BCG

The heart Coughing, fatigue loses pumping Shortness of breath ability and enlarges; fluid Fluid in and collects in body around lungs as circulation Swelling of abdomen weakens Swelling of ankles, lower legs Heart failure is NOT heart attack (suddenly blocked circulation to heart)

A failing heart slowly loses its muscular

strength; its walls gradually thicken and stiffen

Heart failure

is treated with drugs that boost the heart beat and remove fluid from the body

Healthy heart

Failing heart

Source: Omer Inan of Georgia Institute of Technology; IEEE Transactions on Biomedical Engineering journal; Physiological Measurements journal Graphic: Helen McComas, Tribune News Service

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Ice editorial board

INTRODUCING

Christopher Nowak

ICE Editorial Board member Christopher Nowak, CBET, CSCS, CHP, is the senior director of healthcare technology management at Universal Health Systems Inc. UHS owns and operates 28 acute care hospitals and numerous free-standing emergency departments, surgery centers and ancillary care facilities across the United States. The inventory for this program is over 106,000 devices with a value of over $1.6 billion. Christopher’s background includes expertise in healthcare technology, telecommunications and IT infrastructure, as well as medical device cybersecurity. Christopher has also has been a licensed pilot for nearly 40 years. He owns and operates a Beechcraft Bonanza aircraft, which he flies all over the United States! For more information, visit theicecommunity.com.

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MW Imaging Corp. p. 5 SOLUTIONS

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