ICE Magazine June 2020

THEICECOMMUNITY.COM

JUNE 2020 | VOLUME 4 | ISSUE 6

ADVANCING MAGAZINE

IMAGING PROFESSIONALS

FASTER, SAFER, CHEAPER, BETTER The Growth of Minimally Invasive, Image-Guided Therapies PAGE 32

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PRODUCT FOCUS

MRI Systems PAGE 30

Director's C ut

Taking care of Grandpas PAGE 38

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FEATURES EMOTIONAL INTELLIGENCE

Increased stress levels can lead to depression. Here are a few things to alleviate stress.

48

COVER STORY

32

Interventional radiology offers lower complications, shorter hospitalizations and less mortality. It helps move a lot of care into the outpatient setting that previously would have required prolonged hospitalization.

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RAD IDEA

MRI safety is achievable with a range of products including some that do not require installation.

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ICEMAGAZINE | JUNE 2020

ADVANCING THE IMAGING PROFESSIONAL

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JUNE 2020

IN FOCUS

It is important to know that Jacqui Rose, MBA, CRA, FAHRA, RT(R), is a Buckeye fan and a role model for The Ohio State University motto “Disciplina in civitatem.”

26 WEBINAR WEDNESDAY

DIRECTOR’S CUT

I encourage others to spend time being clear with themselves about the personal why for their work.

30 PRODUCT FOCUS

A look at the growing magnetic resonance imaging market’s innovative products.

WWW.THEICECOMMUNITY.COM

Webinar Wednesday continues to deliver valuable knowledge to health care professionals.

38 ICEMAGAZINE

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

CONTENTS SPOTLIGHT 10

In Focus Jacqui Rose, Premier Health, UVMC

12

Rad Idea MRI Safety Products

14

Rising Star Amal Baida, Children’s Healthcare of Atlanta

Kristin Leavoy kristin@mdpublishing.com

16

Off the Clock Sam Maxfield, Banner Health

Editorial

NEWS

Publisher

John M. Krieg john@mdpublishing.com

Vice President

John Wallace Erin Register

Art Department Jonathan Riley Karlee Gower Amanda Purser

Webinars

Linda Hasluem

Account Executives Jayme McKelvey Megan Cabot

Editorial Board

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

Circulation

Lisa Lisle Jennifer Godwin

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

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ICEMAGAZINE | JUNE 2020

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

26

Webinar Wednesday Webinars Address Cyber Security and More

PRODUCTS 29

Market Report MRI Market Worth $8.18 Billion by 2027

30

Product Focus MRI

INSIGHTS 36

Rad HR Live Your Life by a Compass Not a Clock

38

Director’s Cut Taking Care of Grandpas

40

PACS/IT Changing for Good

44

Department/Operational Issues The Coming Tsunami

46

Coding/Billing Edits Take 2!

48

Emotional Intelligence Five Tips for Relieving Stress

52 53

AMSP Member Directory

55 58

ICE Break

AMSP Member Profile Brandywine Imaging, Inc. Index

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SPOTLIGHT

IN FOCUS JACQUI ROSE

I

t is important that you understand that Jacqui Rose, MBA, CRA, FAHRA, RT(R), is a Buckeye from The Ohio State University.

She is an avid fan of the football team and all things Ohio State. She is also a great role model for The Ohio State University’s motto “Disciplina in civitatem” or “Education for Citizenship.”

Jacqui Rose is president-elect of AHRA

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ICEMAGAZINE | JUNE 2020

Rose’s love for the Buckeyes began early in her life as an Ohio native. She said she was in a small family growing up with her mother and father in Troy, Ohio near Dayton. After high school, it was not long before she embarked on the “most magnificent four years of my life” as a student at The Ohio State in Columbus, Ohio. She earned a bachelor’s degree in allied science with an emphasis on radiologic technology. She then returned to her hometown to serve the community where she grew up. Rose eventually returned to school to earn a master’s degree from the University of Dayton.

Currently, Rose is the director of medical imaging, telecommunications, IT and lab at Premier Health, UVMC in Troy, Ohio.

She is also American Healthcare Radiology Administrators (AHRA) president-elect and will take office as AHRA president at the 2020 annual meeting in Boston. Her career journey began with a desire to help others.

MBA, CRA, FAHRA, RT(R)

“Much like most imaging professionals, I knew I wanted to help others, but I also have a side that thrives on technology,” Rose said.

“Imaging is the perfect union of compassion and technology. It’s not stagnant, but changes regularly and I do like change, most of the time. So, I immediately knew this profession would allow me to live my passion and purpose and I try to do that every day.”

She adds that she was quick to embrace her “inner nerd” and added that those who deny their inner nerd should “just stop it.”

She started out in a two-year radiology program.

“I found a love that really opened my eyes in radiology,” Rose explains. “That was in a two-year program and I looked to add a bachelor’s degree. I knew a bachelor’s degree would allow me to do more.”

“What drives me is being able to expand that circle of influence and impact hundreds of people,” she explains about what she likes about imaging.

“When I went into the workforce, I thought that would be the end of my formal education. I was in the workforce for about two years when I decided to head back for my master’s at University of Dayton.”

She was also spreading her wings in other aspects of her career and education. Rose joined AHRA in 1995, which is also the year she first became an imaging director.

“I found a second home with AHRA beADVANCING THE IMAGING PROFESSIONAL

Away from work, Jacqui Rose enjoys spending time with her family

cause they met all the needs that I had in my professional life,” Rose said.

The AHRA created the Certified Radiology Administrator (CRA) with the first certification test in 2002. Rose said she “let the inaugural test go,” and, in 2003, she sat for the exam.

“Thank heavens I passed it,” she stated.

“In 2010, I was elected to the Radiology Administration Certification Commission (RACC) that oversees the CRA credentialing. I served on that for five and half years. At that point, I was nominated for a position on the AHRA board. I accepted and was elected,” she added.

As a member of the board and during her upcoming tenure as AHRA president, Rose said she hopes to continue the work of the association.

“We work very closely with the CEO of the association and the team at AHRA to make sure what we are doing meets the mission, vision and values of the association for the members,” Rose said.

The AHRA Annual Meeting is scheduled to take place July 12-15 in Boston, Massachusetts.

The COVID-19 pandemic will have an impact on her term as president, but she is hopeful that the organization will be able to hold its annual meeting.

“The networking and connections at our annual meeting are what drive us and help us to get back in there and do the hard work that we do every day.

It feeds the soul of the people doing WWW.THEICECOMMUNITY.COM

the work,” she explains.

Rose is honored and excited to be the next AHRA president, but she says her greatest accomplishment starts at home.

“My greatest accomplishments include my amazing family, the fantastic team I have the honor to serve with every day and the privilege to be a part of AHRA, the association for medical imaging management. I draw strength and energy from all of them which fuels the passion and allows me to fulfill my life purpose. They are all my families,” she said.

“I have an amazing family that supports me and my goals because they embrace the commitment to serve others as I do,” she adds. “My son, Brandon, graduated from The Ohio State University with a degree in construction management and is a project manager with Dublin Building Systems in Ohio. His amazing wife, Omega, is expecting their first child this summer.

My daughter, Alyssa, is working on her doctorate in physical therapy at Mount St. Joseph University in Cincinnati, Ohio and her boyfriend, Austin, works at Siemens in Cincinnati as a software engineer. My husband, Tom, is a research and development manager in Dublin, Ohio and has been a tremendous support through our many years together.”

AHRA appears to be in excellent hands with Rose as president. She will be in a position to continue to help her radiology “family” amid a season of change. •

JACQUI ROSE

Director of Medical Imaging, Telecommunications, IT and Lab Premier Health, UVMC in Troy, Ohio What is the last book you read?

Or, what book are you reading currently?

“The Hero Effect” by Kevin Brown Favorite movie?

I am more of a musical lover and my current favorite is “The Greatest Showman;” I also love “Wicked” and “Phantom of the Opera.”

What is something most of your coworkers don’t know about you?

My middle name! It’s a joke in the department.

Who is your mentor?

Jim Hurak What is one thing you do every morning to start your day?

Start with a morning team huddle, then round with those who couldn’t be there.

Best advice you ever received?

From my mentor: “Always take the high road.”

Who has had the biggest influence on your life?

My mom.

What would your superpower be?

Courage to take on impossible things.

What are your hobbies?

Reading, spending time with my kids.

What is your perfect meal?

Chilean Sea Bass with anything.

ICEMAGAZINE

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SPOTLIGHT

Rad idea KOPP DEVELOPMENT INC.: MRI SAFETY PRODUCTS

K

opp Development Inc. supports MRI safety with high-quality products. Among those products are some that do not require installation and some that can be self-installed with remote guidance. The products include: • FerrAlert Target Scanner is a hand-held ferromagnetic detection system. It is the only ferromagnetic hand-held detection system presently available on the market. The Target Scanner is a high-demand product that has been successfully utilized in thousands of MRI departments including 20 top-rated U.S. hospitals.

• FerrAlert SOLO is a highly sensitive detector that is designed to be used as a prescreening solution to find very small ferromagnetic objects on patients and staff. It does not require any physical contact with the device itself nor with the patient. With a locational feature the ferrous threat can be quickly identified and removed without interfering with through put time or needing to perform invasive pat downs.

• GaussAlert is designed for medical equipment that is used in MRI rooms, such as ventilators. • Share your RAD IDEA via an email to editor@mdpublishing.com.

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ICEMAGAZINE | JUNE 2020

ADVANCING THE IMAGING PROFESSIONAL

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SPOTLIGHT

RISING

STAR

AMAL BAIDA

BY ERIN REGISTER

A

mal Baida, radiology manager of community operation and strategy at Children’s Healthcare of Atlanta, has over 20 years of experience in the imaging field.

Baida, 53, began working in the file room at Children’s Healthcare of Atlanta in 2001. From there, she moved on to become a radiology technical assistant, a radiology technologist, a diagnostic team lead, a diagnostic supervisor and is now in her current role as a radiology manager for four output centers and eight urgent care facilities.

“Amal has recently been putting herself out there to write and speak and is embarking on attaining her CRA,” noted Mario Pistilli, director of imaging services at Children’s Hospital Los Angeles. “She has shown to be a 14

ICEMAGAZINE | JUNE 2020

very passionate and committed leader looking to grow and advance her knowledge and career.”

ICE learned more about Baida in a question-and-answer interview.

Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: This is a great field of meeting people, helping others and making a difference in people’s lives.

Q: WHAT DO YOU LIKE THE MOST ABOUT YOUR POSITION? A: I love that I work in multiple areas and with a number of different teams. I enjoy staff engagement, benchmarking and marketing, productivity and operation, all while taking care of the kids and helping them smile.

Q: WHAT INTERESTS YOU ABOUT THE IMAGING FIELD? A: Relationships and teamwork are key driving factors for a happy work envi-

ronment. Losing my husband to cancer transformed my sadness and loss to a passion for helping others.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: Building a strong team of engaged staff and improving operations and productivity with a consistently high retention rate are my biggest accomplishments.

Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT FIVE YEARS OR SO? A: I am hoping to have the privilege to be a part of The Joint Commission body. I want to be part of a team whose goal and focus is to improve the health care of the public. I love the idea of collaborating with stakeholders to evaluate health care organizations to ensure they are delivering the highest quality of care. • ADVANCING THE IMAGING PROFESSIONAL

FUN FACTS Favorite Hobby: “Dabbing” with my kids Favorite Show to Binge: “Grey’s Anatomy” Favorite Vacation Spot: Los Angeles, California and Universal Studios

One Thing on Your Bucket List: I want to visit Switzerland.

Any Secret Skills or Talents? I love to sing. Watch out, “American Idol!”

Amal Baida (left) enjoys “dabbing” with her children.

WWW.THEICECOMMUNITY.COM

ICEMAGAZINE

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SPOTLIGHT

Off Clock THE

SAM MAXFIELD, SENIOR DIRECTOR OF FINANCE AT BANNER HEALTH

BY MATT SKOUFALOS

F

or triathlete Sam Maxfield, most days of the week start very, very early in the morning. By 4:30 a.m., he’s hitting the pavement, either on his Cervelo S5 bicycle, or in running shoes, putting as many miles behind him as he can before heading into the finance department of Banner Health Center in East Mesa, Arizona, where he serves as the senior director of finance.

In the evenings, he’ll log another five or six miles on the road, an hour or so in the water – or both.

All told, Maxfield exercises about 15 hours a week across all three disciplines: nine to 10 on the bike, three or four on foot, and one or two in the water.

After five marathons – three in Phoenix, Arizona and one each in Salt Lake City and St. George, Utah 16

ICEMAGAZINE | JUNE 2020

– Maxfield pushed himself to try his first half-Ironman: 70.3 miles distributed across a 1.2-mile swim, 56-mile bike ride, and a 13.1-mile run. This spring, he was scheduled to take on his first full Ironman triathlon, which is twice those distances, or 140.6 miles; due to the novel coronavirus pandemic, the event has been pushed back to September.

“Exercise has always been important, going to the gym five to six days a week,” Maxfield said; “but endurance athletics was never my thing.”

A former collegiate lacrosse player, Maxfield said he’d always admired marathon runners, but “never really committed to it.” However, about six years ago, as he was approaching his 30th birthday and 200th pound, Maxfield started to feel like he needed to make a greater effort to keep himself in shape.

“I said, ‘I have a feeling if I get over that 200-pound threshold, I’ll never get back under it,’” Maxfield said. “I started running and losing weight, ADVANCING THE IMAGING PROFESSIONAL

Sam Maxfield with his family, Brooke, Connor, Drew and Oliver, after finishing the 2019 St. George Half Ironman.

“They are my support and motivation,” Maxfield said.

and then I decided to do a marathon.”

Maxfield describes himself as “a competitive person by nature,” but only within his own self-measurements. A desire to quantify his fitness against baseline levels, and to chart his progress throughout weeks of training “scratches that itch,” he said.

“The other piece of it is more from a mental sanity standpoint,” Maxfield said. “Work is extremely busy. It’s a way to cope with a very busy life. It helps keep me levelheaded and stress-free.”

“Even though it does mean I’ve got less sleep and am consuming more caffeine than I probably should, I think the mental benefits are just as great if not greater than the physical benefits,” he said.

“On rest days, I feel like I’m dragging even more,” Maxfield said. “Training keeps me going strong throughout the day, even when I’m not exercising, and those benefits I can’t quantify. It’s become kind of a healthy addiction, keeping me focused, attentive in other areas of my life.”

Triathletes in other parts of the country can find their opportunities limited by weather conditions that Maxfield doesn’t often face living in Arizona. He can increase the intensity of his bike rides by adding in the elevation changes of large hills and small mountains in the local environment. He can train year-round, setting out earlier in the morning during hotter months, and modifying his training schedule depending upon the climate conditions. Since all Ironman swims are conducted in open water, he can even take a friend or his brother to a nearby lake to put in the time outdoors.

One of the most important aspects of his training is “bricks,” Maxfield, said: completing two exercises back-toback “to get your body used to changing from one sport to the next.” He’ll swim, then run, or bike, then run, at least two to three times during the weekdays; on the weekends, he’ll put together a three-to-four-hour bike ride and an hour-long run.

Of the three, he admits that running is “pretty brutal.”

“An hour on the bike versus an hour running, running is three to four times worse on you,” Maxfield said. “The majority of this is endurance. How long can you go? One of the toughest things to get down is nutrition. I’ll burn probably 4,000 to 5,000 calories depending upon how warm it is outside. How do you refuel without disrupting what you’re doing?”

Just as important as getting his biochemistry right is establishing the psychological resilience of a triathlete, Maxfield said. Overcoming the emotional roadblocks associated with the concept of logging 140.6 miles across three physical disciplines means breaking down mental barriers that the brain erects out of self-preservation.

“Everything’s possible,” he said. “When you set a goal and little milestones to achieve it, you can do anything. A few years ago, I could barely run five miles without being gassed.”

When he does his full Ironman this fall, Maxfield will be reuniting with a few fellow triathletes he met while at the WWW.THEICECOMMUNITY.COM

half-Ironman in St. George, Utah.

“When you find yourself bumping into the same person over a five-hour period, you start talking to them,” Maxfield said. “One was from New Hampshire, one from California; you meet some cool people.”

They all keep in touch via Strava, a social app used by endurance athletes to chart their individual performances and encourage one another at a distance. In St. George, however, all the competitors feel the support of the entire city, which “comes out and supports [the event] like crazy,” Maxfield said.

“It’s a huge race with people from all over the world, and it’s a fun one to do,” he said.

“Snow Canyon,” the centerpiece of the course, “is one of the most scenic rides of my life,” Maxfield said; “it’s beautiful.”

When he compares training mornings with those of his old routine – a quick breakfast before driving into the office – Maxfield says he’s got much more energy and alertness throughout his day, even as he puts his body through its paces. Three hours on the road between 5 and 8 a.m. opens his mind to things he wouldn’t ordinarily have the space in his day to contemplate.

“I’m not thinking about how fast I’m going on my bike, I’m just lost in my thoughts,” Maxfield said. “I feel like when I get to the office, I’ve already come up with solutions for problems I have.”

Of course, his workouts are all staggered against those of his wife, Brooke, who just completed her first triathlon in September 2019. As the couple balances their schedules around those of sons Connor, 9, Drew, 7, and Oliver, 3, the races themselves become something of a destination vacation.

“We pick places that are fun, get there early, and stay a few days afterwards to do fun things with the kids,” Maxfield said.

“That’s the challenge,” he said; “making sure I’m there for sports, church and other obligations. Life gets busy.” •

Maxfield bikes three or four times per week out in the Arizona desert. He enjoys the open roads and beautiful scenery.

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ICEMAGAZINE | JUNE 2020

ADVANCING THE IMAGING PROFESSIONAL

NEWS

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

KONICA MINOLTA HEALTHCARE INTRODUCES NEW PACS SOLUTIONS Konica Minolta Healthcare Americas, Inc. recently announced that Rede PACS, the company’s newest medical image management solution for specialty clinics, and Rede Mini PACS for ultrasound and X-ray image management are now available for purchase in the United States.

As medical imaging services expand at the point of care, particularly digital radiography and ultrasound, specialty care clinics and practices increasingly require solutions to view, share and manage patient images. Rede PACS and Rede Mini PACS are designed for specialty practices, such as orthopedic, urgent care and family medicine clinics, to provide the features and tools necessary to optimize and simplify imaging workflow.

Powered by the proven Exa Platform, Rede PACS provides fast access to images from any device scaled for the specialty care market. With an entirely web-based, Zero Footprint (ZFP) imaging software platform, Rede PACS offers full diagnostic toolsets and viewing capabilities from any computer. It delivers a solution optimized for centers with fewer than 20,000 imaging studies each year with a simplified installation and simplified tiered pricing based on annual study volume at an affordable price to get you started on day one.

Rede Mini PACS offers a smaller hardware footprint and is bundled with Konica Minolta’s X-ray and ultrasound systems. It is a cost-effective solution for specialty care providers that perform 2,500 or fewer imaging

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studies each year. Since it is web-based, Rede Mini PACS offers the same accessibility and sharing of medical images as Rede PACS, making it an ideal platform to collaborate across caregivers.

“Rede PACS and Rede Mini PACS fill the market need for cost-effective solutions that still provide the robust tools needed in specialty care,” says Tim Kearns, Strategic Marketing Manager. “It’s just one more example of how Konica Minolta is dedicated to providing imaging and informatics solutions that support more efficient patient care and help clinicians make better decisions, sooner.”

Available with both configurations, the ZFP viewer allows for immediate viewing on any device, including PCs, tablets and smartphones, from anywhere with no downloads, plugins or installations necessary.

With Server-Side-Rendering (SSR), data is not transmitted to the workstation, providing exceptional speed for loading images and reducing unwanted exposure to patient data. SSR also helps to reduce the workstation hardware technical requirements because the server is taking on the workload of image rendering, which can extend the performance of existing PCs. Rede PACS is also available as a cloud-based solution hosted in Konica Minolta’s state-of-the-art facilities with disaster recovery for a true Software as a Services (SaaS) solution. •

ICEMAGAZINE

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NEWS

20

RESEARCH: CHEST X-RAY ISN’T RELIABLE DIAGNOSTIC TOOL FOR COVID-19

CARESTREAM INCREASES PRODUCTION OF MOBILE IMAGING SYSTEMS DURING PANDEMIC

Chest X-rays are often used to detect infections in the lungs, but the world’s largest study of its kind finds it’s not a reliable way to diagnose respiratory infections caused by COVID-19.

The research team led by Dr. Michael Weinstock, an adjunct professor of emergency medicine at The Ohio State University College of Medicine, reviewed more than 630 chest X-rays of confirmed and symptomatic COVID-19 patients of a large urgent care company in New York and New Jersey. The radiologists determined the chest X-rays were normal in 58.3% of cases, and normal or only mildly abnormal in 89% of patients.

“Providers ordering a chest X-ray in the outpatient setting should be aware that a patient with symptoms of COVID-19 may have a negative chest X-ray and should manage the patient based on their symptoms,” said Weinstock. “Doctor’s should not be reassured by a negative chest X-ray.”

Additionally, the research in The Journal of Urgent Care Medicine found the chest X-ray results of COVID-19 patients differ from those of bacterial pneumonia patients. The abnormal chest X-ray findings of COVID-19 patients were more likely to be scattered diffusely throughout both of the lungs than typical pneumonia.

“This study reinforces what we’ve learned from our colleagues outside of the United States that the majority of patients with COVID-19 have mild symptoms and minimal evidence of disease on chest X-ray,” said Dr. Matthew Exline, associate professor in the department of pulmonary, critical care and sleep medicine at The Ohio State University College of Medicine and medical director of the medical intensive care unit at The Ohio State University Wexner Medical Center. “Hopefully this will help clinicians decide who would best benefit from hospitalization and any potential new treatments.”

Researchers are working on a second study to look at the outcomes of these patients and how it correlates to their chest X-ray results. •

In response to the need for critical care during the COVID-19 crisis, Carestream Health has increased production of its portable diagnostic imaging systems.

As unlikely facilities begin to function as urgent care units, Carestream’s DRX-Revolution Mobile X-ray System and DRX-Revolution Nano Mobile X-ray System bring the X-ray exam to the patient’s bedside, delivering high-quality digital radiography images to health care providers in real time to aid in patient diagnosis – whenever and wherever needed.

“Our manufacturing plants and warehouses are operating at full capacity with employees putting in long hours and extra days to support the health care professionals who are on the front line of this exhausting fight,” said Charlie Hicks, Carestream’s general manager for premium tier solutions. “Likewise, Carestream suppliers and partners are ramping up production to help support this humanitarian crisis.”

With the current physical distancing measures in place, Carestream’s mobile solutions play an instrumental role in limiting the spread of infection by providing bedside chest imaging, which is vital for patients afflicted with the coronavirus, a disease that often results in a respiratory tract infection.

The DRX-Revolution system has added features to help reduce contamination. Shelves located in each of the detector slots, within the bin, allow users to safely place protective bags on detectors. Flush-mounted displays limit fluid ingress and provide a smooth surface for easier disinfecting. Bar code scanners automatically input patient information when wristbands are scanned, allowing users to quickly start an exam with limited interaction between the patient and the equipment.

Carestream’s nonmotorized DRX-Revolution Nano Mobile X-ray System also provides chest and intensive care imaging, with a compact, lower-cost mobile unit and an ultra-lightweight design for easy maneuverability and arm positioning. •

ICEMAGAZINE | JUNE 2020

ADVANCING THE IMAGING PROFESSIONAL

RADLogics EXPANDS DEPLOYMENT OF AI-POWERED SOLUTION FOR COVID-19 RADLogics announced new worldwide deployments and installations of the company’s AI-powered solution to support chest CT imaging for COVID-19 patients. To respond to the growing pandemic, the company has now deployed its solution at hospitals and health care providers in China, Russia, Italy, Serbia and Brazil, and has engaged additional hospital systems and providers around the globe.

“Since we completed our initial research and shifted the company’s resources and AI expertise to focus on COVID-19 solutions, we’ve seen incredibly strong demand from health care systems and providers around the world. Our system has enabled these hospitals to enhance their ability to manage symptomatic patients – especially those with severe or worsening respiratory status,” said Moshe Becker, CEO and co-founder of RADLogics. “As we’ve seen in the surge of patients across the world, ERs and ICUs can become overwhelmed. Our solution improves patient care by providing doctors with a ‘Corona Score’ that provides clinicians automatic measurements of disease extent of COVID-19 patients, thus allowing doctors to better manage a patient’s treatment.”

Designed for easy integration and installation both on-premise and via the cloud – RADLogics’ algorithms are supported by the company’s patented workflow software platform that enables rapid deployment of

the solution at multiple hospitals using commercial cloud-computing resources through Amazon Web Services (AWS), that can process up to 1 million CT studies per day.

“Current epidemics are calling for new health care management approaches, and effective clinical management depends more on disease severity than on the virus identification,” said Dr. Sergey Morozov, MD, PhD, MPH, who serves as CEO of Moscow Diagnostics and Telemedicine Center. “We are looking forward to integrating RADLogics’ AI-powered solution across our hospital network throughout Moscow where imaging plays a crucial role in patient management – specifically chest CT. It allows defining symptomatic patients and stratifying them into mild, moderate and severe disease burden groups. This clinical risk assessment is greatly supporting decisions on treatment at home, at the hospital, or at the ICU – especially when PCR results are pending or repeatedly false-negative.”

Since announcing the findings of the initial study that RADLogics’ CT image analysis algorithm achieved a high level of accuracy for detecting COVID-19 on CT, the company has processed thousands of additional patient cases in China, Russia and Italy. Additional research and results on a dataset comprised with 110 confirmed COVID-19 patients from Zhejiang province, China is now available in preprint on arXiv.org. •

ALGOMEDICA LEADS EFFORT TO DEVELOP RAPID COVID DIAGNOSIS VIA AI AlgoMedica Inc. has announced its lead participation in a consortium of eight European institutions that have submitted a proposal to the European Union to help combat COVID-19. The consortium will integrate PixelShine, the artificial intelligence (AI) powered software that AlgoMedica developed to improve the quality of ultra-low dose computed tomography (ultra LDCT) imaging studies. The consortium is seeking funding from the EU to establish a standardized and quantitative procedure to enable improved and faster diagnosis of COVID using ultra low dose CT and medical imaging AI. To ensure the lowest possible radiation dose, chest CT scans are performed with ultra LDCT. LDCT is beneficial

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to patients because several CT studies are required during the COVID-19 diagnosis and follow-up process. Ultra LDCT images have more noise than conventional (high dose) CT scans. The consortium will implement PixelShine to eliminate noise from the ultra LDCT studies and ensure the best possible image quality. This is a critical step because image noise can mask pathology and make an accurate diagnosis more difficult. The images will then be analyzed

by InferRead CT Pneumonia, a deep learning and AI based product from InferVision. All scans will be read by radiologists from the Bio-Medico di Roma (UCBM) in Italy, the Groningen University Hospital (UMCG) in the Netherlands and Heidelberg University Hospital (UKHD) in Germany. •

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NEWS

FDA CLEARS AIDAN ARTIFICIAL INTELLIGENCE FOR BIOGRAPH PET/CT PORTFOLIO Siemens Healthineers has received clearance from the Food and Drug Administration (FDA) for its AIDAN artificial intelligence technologies on the Biograph family of positron emission tomography/computed tomography (PET/CT) systems, which includes the Biograph Horizon, Biograph mCT and Biograph Vision. AIDAN is built on a foundation of patient-focused bed design and proprietary AI deep-learning technology to enable four new features – FlowMotion AI, OncoFreeze AI, PET FAST Workflow AI, and Multiparametric PET Suite AI. Siemens Healthineers PET/CT systems with AIDAN offer enhanced protection against cyber threats via syngo Security – a security package for general regulatory security rules that enables compliance with the Health Insurance and Accountability Act (HIPAA).

Because each patient’s body habitus and presentation of disease is different, tailoring PET/CT protocols to produce the highest-quality diagnostic imaging information possible for each patient can be difficult and time-consuming. The standard one-size-fits-all protocol lacks personalization and is often of suboptimal quality.

FlowMotion AI uses continuous bed motion with ALPHA proprietary AI technology, which automatically detects anatomical structures, to recognize patient anatomy and automatically apply disease-specific protocol parameters based on individual requirements. FlowMotion AI eliminates the need for manual protocol entry and alignment.

The result is standardized protocols based on indication and personalized exams based on individual patient anatomy, to help enable fast, tailored and reproducible PET/CT exams. In this manner, FlowMotion AI expands precision medicine.

Following a PET/CT scan, the technologist must sacrifice time with the patient to manually create additional data ranges beyond the system’s axial images. AIDAN’s PET FAST WorkFlow AI automates and simplifies postscan tasks. It automatically performs fast image transfer and auto data export and creates picture archive and communication system (PACS)-ready data ranges. PET

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FAST Workflow AI saves valuable technologist time, reduces the possibility for errors, and provides physicians with information more quickly to permit faster interpretation of the exam.

Patient respiratory motion during a PET/CT exam compromises image quality and could negatively impact patient outcomes. The standard solution for respiratory motion management is not performed during every PET/ CT exam because it requires a longer scan time as well as a respiratory belt – which is awkward, time-consuming and unpopular with patients. OncoFreeze AI uses ALPHA technology and algorithms to allow acquisition of PET/CT images that are virtually free of respiratory motion utilizing 100 percent of the acquired PET counts, with no additional time added to the exam and no respiratory belt.

In PET/CT, standard uptake values (SUVs) alone may not be ideal for determining disease status, as patient diet and weight fluctuations result in variable SUV values. Multiparametric PET provides those coveted absolute numbers, but the exam can be cumbersome, and the requirement of arterial blood sampling can cause pain and put patients at risk. Multiparametric PET Suite AI offers a fully automated workflow that extracts the arterial input function automatically from acquired PET/ CT images, eliminating the unnecessary pain and risk associated with arterial lines and sampling. In addition to the standard SUV image, Multiparametric PET Suite AI provides clinical information for the patient report in the form of metabolic rate and distribution volume, further expanding precision medicine.

“The addition of AIDAN to the Siemens Healthineers Biograph PET/CT portfolio represents a significant advancement in AI application at the scanner level,” said John Khoury, vice president of the molecular imaging business at Siemens Healthineers North America. “With AIDAN, we use robust learning technology to accelerate and improve the planning, acquisition, and interpretation of PET/CT.” •

ADVANCING THE IMAGING PROFESSIONAL

FDA ISSUES ENFORCEMENT POLICY FOR IMAGING SYSTEMS DURING COVID-19 The Food and Drug Administration (FDA) plays a critical role in protecting the United States from threats such as emerging infectious diseases, including the Coronavirus Disease 2019 (COVID-19) pandemic. FDA is committed to providing timely guidance to support response efforts to this pandemic.

FDA is issuing this guidance to provide a policy to help expand the availability and capability of medical X-ray, ultrasound, and magnetic resonance imaging systems, and image analysis software that are used to diagnose and monitor medical conditions while mitigating circumstances that could lead to patient, health care provider, and healthcare technology management (HTM) exposure to COVID-19 for the duration of the public health emergency declared by the Secretary of Health and Human Services (HHS) on January 31, 2020, effective January 27, 2020, and renewed for 90 days on April 21, 2020, effective April 26, 2020.

This policy is intended to remain in effect only for the duration of the public health emergency related to

COVID-19 declared by the HHS, including any renewals made by the HHS Secretary in accordance with section 319(a)(2) of the Public Health Services Act (42 U.S.C. 247d(a)(2)).

Given this public health emergency, and as discussed in the Notice in the Federal Register of March 25, 2020, titled “Process for Making Available Guidance Documents Related to Coronavirus Disease 2019,” this guidance is being implemented without prior public comment because FDA has determined that prior public participation for this guidance is not feasible or appropriate (see section 701(h)(1)(C) of the Federal Food, Drug, and Cosmetic Act (FD&C Act) and 21 CFR 10.115(g)(2)). This guidance document is being implemented immediately, but it remains subject to comment in accordance with the agency’s good guidance practices. • READ THE GUIDANCE HERE: https://www.fda.gov/ media/137290/download.

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NEWS GLOBAL MEDICAL ALLIES SHARE LUNG ULTRASOUND SOLUTION FOR COVID-19 TRIAGE Dr. Robert L. Bard, a New York City imaging specialist, is collaborating with an international group of medical leaders including Dr. Danilo Buonsenso in Rome, Italy. Buonsenso recently published reports about “ultrasound equipment as an effective replacement of the stethoscope.” Buonsenso’s review presents the valid uses and benefits of lung ultrasound in identifying respiratory disorders that may be associated with COVID-19.

Currently, front line physicians in Italy and Spain are reportedly triaging with portable ultrasound units that reduce logistical problems of a chaotic environment and health care worker exposure.

Since imaging with CT or ultrasound is not diagnostic, determining who needs hospitalization is essential in a pandemic overwhelming medical providers. Buonsenso, at the viral epicenter in Rome, uses sonograms to decide who requires a CT scan.

The use of CT lung imaging for COVID-19 has been recognized as the diagnostic standard during the current epidemic. Meanwhile, experts find CT to have disadvantages like radiation exposure.

Respiratory distress creates motion artifacts on images that may simulate pulmonary inflammation.

Also, viral pneumonia is not diagnostically distinguishable from other viral inflammations in the lung so the argument for a screening modality is useful to separate the critically ill from those needing outpatient treatment. This review was stated

by Dr. Klaus Lessnau, author of “Chest Ultrasound” (Springer 2003) and employs both CT and ultrasound imaging in clinical practice.

Bard reviews international health care and technology updates as part of his continued research in the radiological society. This includes Buonsenso’s national reports about the COVID crisis and the expanded use of lung ultrasound as part of his investigation of children as clinically unaffected carriers.

“The global pandemic demands effective answers toward a cure as well as protection of health care workers on duty,” Bard said. “I have the highest regard for the European approach to problem solving both clinically and technologically … applying Dr. Buonsenso’s concept makes perfect sense to me and carries great value in our war against COVID-19.” •

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CIRS ADDS SALES MANAGER, PARTNER WITH ITALIAN COMPANY Roy A. Lowe, RT(R)(T), recently joined CIRS Inc. as sales manager. Lowe is an accomplished B2B/B2C medical device sales manager with 15-plus years of demonstrated sales success with multinational health care device companies, according to a press release.

Through relationships developed over many years, he is well known in the radiology and radiation therapy industry throughout the U.S. and internationally, the release states.

He also has a clinical background as a registered radiation therapist and medical dosimetrist working in both university academic and community hospital health care institutions.

Lowe is a graduate of the University of Tennessee graduate school of medicine with a degree in radiation science and medicine. He is a member of the American Registry of Radiologic Technologists and the American Association of Medical Dosimetrists.

“We are pleased to have Roy join our sales and marketing team,” states Mark Devlin, president of CIRS. “His experience and enthusiasm will help us expand the reach of our quality assurance, training and software solutions.”

Lowe will work from Charlotte, North Carolina, where he can effectively service CIRS OEM accounts, distribution partners and its international distribution network.

In other news, CIRS has signed an exclusive agreement with ELSE Solutions srl for the sale of CIRS ultrasound products within Italy.

ELSE, located in Italy and founded in 1990, has long-standing experience in producing and supplying equipment and services in the medical and industrial field. The company is organized into dedicated divisions with a highly qualified staff in nuclear medicine, radiotherapy, radiodiagnostics and radioprotection.

Their recent expansion into ultrasound now affords ELSE the opportunity to expand its product offering.

“We are very happy to have ELSE now representing CIRS ultrasound products exclusively in Italy,” states Lowe. “This partnership has developed over the years and we now have a strong presence throughout Italy.” • FOR MORE INFORMATION about ELSE Solutions srl visit www.elsesolutions.com.

ADVANCING THE IMAGING PROFESSIONAL

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Register online to view our live webinar series every Wednesday.

Watch recorded webinars online in our archives.

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NEWS

WEBINARS ADDRESS CYBER SECURITY AND MORE

T WEBINAR WEDNESDAY STAFF REPORT

he Webinar Wednesday series continues to deliver valuable knowledge and expert insights to health care professionals throughout the world. As of April 15, more than 3,000 people have registered for at least one free webinar.

‘VERY COOL’ CYBER SECURITY WEBINAR DELIVERS INSIGHTS The April 15 webinar “Is Your CMMS Cyber Security Ready?” from Webinar Wednesday was eligible for 1 credit from the ACI. More than 200 people attended the live presentation and even more have viewed a recording of the session.

The 60-minute webinar, sponsored by Nuvolo, addressed how to protect and manage medical and IoT devices using an integrated solution with Ordr and Nuvolo.

The webinar featured Ordr Vice President of Product Strategy Russell Rice as well as Nuvolo Senior Solution Consultants Kyle Holetz and Dustin Smith.

The trio discussed and demonstrated how integrating Ordr’s IoT and medical device security platform and Nuvolo’s cybersecurity-enabled CMMS solution can help individuals discover, risk-assess and improve the security and utilization of critical health care devices. With attacks on health care practitioners increasing during the COVID-19 outbreak, organizations must accurately inventory their devices, understand their risks and protect themselves from attacks like WannaCry, Bluekeep and ransomware before they impact the business.

The webinar also included a quick overview by Kaiser Permanente Ventures on why solving these problems is critical to health

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care organizations, and why they invested in both Nuvolo and Ordr.

Attendees enjoyed the webinar and shared positive feedback via a post-webinar survey, including answers to the questions, “Why did you attend today’s webinar? And, was it worth your time?”

“I am new to UPMC and wanted to learn more about any additional steps or precautions I need to be taking,” said K. Russo, radiology engineering specialist.

“I wanted to see how a CMMS platform could help in keeping an eye on the medical devices on a hospital network. Definitely worth my time,” Clinical Engineering Tech II M. Ramano said.

“We are supposedly getting Nuvolo in our health system, so I thought I’d see a bit of what we were getting. It was well worth my time. I think it does a lot more than we will ever utilize, but it’s nice to know we have options. It was a very cool webinar for sure,” said D. Salyer, BMET III. “I wanted to see the demo of the Ordr software package. This was a great presentation by industry experts,” Field Services Engineer D. Banister said.

“The threat of cyber-crime against medical facilities and equipment has become increasingly important. We need to know how to recognize and stop these threats,” said T. Stevenson, BMET II.

RETRIEVE DIAGNOSTIC INFORMATION The Webinar Wednesday presentation “Retrieve Diagnostic Information of Devices by Slaving the Hard Disk” presented by Summit Imaging CEO and CTO Larry Nguyen was eligible for 1 credit from the ACI. Often HTMs are called to service a device ADVANCING THE IMAGING PROFESSIONAL

following complaints from users of “Well done, I have this slave and use faults and codes. Commonly, HTMs it often to transfer files from one unit are blind to fault data making trouto another. I feel dumb for having not bleshooting and diagnostics of the used it for the purpose in this presenfailure extraordinarily difficult and time tation. Well done and thanks,” shared consuming.

Senior Instructor T. Bracewell.

As the webinar workbook explained, “Exceeded! The title of the webinar “Summit is committed to empowering did not capture the extensive scope HTMs to service their own equipment of the presentation,” Clinical Engineer to lower total cost of Technician L. DaFoe ownership and improve said. patient care. Join us for “This was great a webinar that educontent for the purcates HTMs to obtain pose. It would be critical fault informaa good addition to tion for immediate and provide some resources accurate diagnostics to to ghost a healthy hard return the device back drive in the future,” said to service as quickly as D. Banister, field service possible by slaving a engineer. hard disk to view criti“Was a very good cal service data.” look at how the drives K. Ferguson, Attendees were able store information and clinical engineer to learn how to: ways to retrieve it,” said • Slave common hard K. Ferguson, clinical drives to a PC or engineer. tablet.

“The content was • Gather error logs and system build perfect. I have worked with Summit information. over the years and Larry did not disap• Find system errors. point,” Manager Biomedical EngineerThe webinar was popular with 143 ing C. Langmeyer said. • live attendees. A recording of the session is available online.

FOR MORE INFORMATION about the A post-webinar survey garnered Webinar Wednesday series, including feedback and posed the question, a calendar of upcoming sessions and “How well did the content that was derecordings of previous presentations, visit livered match what you were promised WebinarWednesday.Live. when you registered?”

THANK YOU TO “It matched what I expected very well. There were some things I already OUR SPONSORS: knew, having used one of the USB to HD adapters before, but I still learned a few more things as well,” Biomedical Technologist O. Stephen said.

“Was a very good look at how the drives store information and ways to retrieve it.”

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Market Report MRI Market Worth $8.18 Billion by 2027 STAFF REPORT

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he global magnetic resonance imaging market size is expected to reach $8.18 billion by 2027, registering a revenue based compound annual growth rate (CAGR) of 5.9 percent during the forecast period, according to Grand View Research Inc. Rising prevalence of chronic diseases coupled with an increasing demand for early diagnostic techniques is projected to drive the growth. In addition, the growing adoption of less invasive diagnostic procedures is contributing to the magnetic resonance imaging (MRI) market growth. Moreover, an increasing number of clinical trials to understand the effectiveness and efficiency of MRI machines in various clinical applications is expected to boost the growth.

End-users, such as research institutes and universities are frequently studying the efficiency of MRI devices with high field strength such as 7T, 10T and 10.5T. A growing number of research studies will help unlock the potential usage and advantages of high field MRI machines for various preclinical as well as clinical applications.

“Currently, 7T MRI machines are only effective in brain and knee imaging, largely due to the absence of the advance coil required for these high field machines,” the report states. “Therefore, the development of advance coils to expand the application of 7T MRI machines is expected to propel the growth during the forecast period.”

Key market players are adopting various strategies, such as mergers and acquisitions, collaborations, and partnerships to gain a competitive edge.

Key findings from the Grand View Research report suggest: • The open system is anticipated to be the fastest growing segment during the forecast period due to its efficiency WWW.THEICECOMMUNITY.COM

to accommodate patients of all sizes without them feeling claustrophobic • The MRI market for neurological and brain disorders held the dominant market share in 2019, largely due to the high prevalence of neurological conditions and the demand for less invasive diagnostic procedure • The high field MRI segment is expected to experience the fastest growth over the forecast period, largely due to efficiency of the field strength to provide detailed diagnostic images • Ambulatory surgical centers (ASC) are expected to exhibit the fastest CAGR during the forecast period. Government initiatives to improve primary care is one of the major factors impacting the growth • In 2019, North America dominated the global MRI market in terms of revenue, owing to continuous research activities and high adoption of advanced techniques • Asia Pacific is anticipated to expand at the fastest CAGR during the forecast period, largely due to a rise in clinical studies for high field MRI machines Fortune Business Insights also predicts growth.

The global MRI systems market size was $7.1 billion in 2017 and is projected to reach $11.7 billion by the end of 2025, according to Fortune Business Insights.

“MRI holds the prominent share in diagnostic imaging due to advance spatial resolution and efficient image acquisition with superior imaging qualities,” according to the report. “The demand for MRI systems with 1.5 T in global MRI systems market is considerably high due to better value for money ratio in developed as well as emerging nations.”

“Moreover, rapidly increasing health care expenditure coupled with swiftly developing infrastructure in developed nations resulted in increased installation of new MRI systems,” the report adds. • ICEMAGAZINE

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PRODUCTS

Product Focus

1

*Disclaimer: Products are listed in no particular order.

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MRI

SIEMENS HEALTHINEERS MAGNETOM Altea

The MAGNETOM Altea 1.5 Tesla (1.5T) magnetic resonance (MR) scanner has a wide, 70-cm bore and BioMatrix patient personalization technology that includes the AI-powered Select&GO Interface, which enhances workflow productivity and removes the need for anatomical landmarking for faster patient positioning. Additionally, the scanner has Tim 4G and Dot (Day Optimizing Throughput) automation that supports standardized, highly reproducible scan procedures.

The MAGNETOM Altea also showcases the Turbo Suite acceleration packages, a series of customized speed applications for routine examinations of various areas of the body.

The optional Innovision in-bore infotainment system1 rides on the fixed or dockable table while immersing the patient in a unique exam experience.

1. The in-bore Infotainment system Innovision is still under development and not yet commercially available. Its future availability cannot be guaranteed.

ADVANCING THE IMAGING PROFESSIONAL

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GE HEALTHCARE SIGNA Premier

GE Healthcare’s ultra-premium system, SIGNA Premier, features a 70-centimeter bore, a 3.0T short-bore superconductive magnet, and the SuperG gradient coil – the most powerful gradient system GE has produced for a wide-bore, 3.0T system. SuperG is designed to provide the performance of a research-class 60-centimeter MR system in a 70-centimeter bore. SIGNA Premier now features an expanded suite of AIR Coils, an industry-first suite of RF coils that enable total freedom in coil positioning and handling during an MRI scan. AIR coils are 60 percent lighter than conventional coils, benefiting both patients and technologists.

CANON MEDICAL SYSTEMS USA INC. Vantage Galan 3T with Advanced intelligent Clear-IQ Engine (AiCE)

Advanced intelligent Clear-IQ Engine (AiCE), available on the Vantage Galan 3T MR system, uses a deep learning algorithm to differentiate true MR signal from noise so that it can suppress noise while enhancing signal, forging a new frontier for MR image reconstruction. AiCE was trained using vast amounts of high-quality image data and features a deep learning neural network that can reduce noise and boost signal to quickly deliver sharp, clear and distinct images, further opening doors for advancements in MR imaging. AiCE on the Vantage Galan 3T MR system is the world’s first fully integrated deep learning reconstruction for MR and is built directly into the scan protocols for seamless workflow.

Incorporating Philips’ breakthrough BlueSeal fully sealed magnet, the Ingenia Ambition 1.5T is the world’s first and only commercially available MR system to enable helium-free operations1, reducing the chance of potentially lengthy and costly disruptions, and virtually eliminating dependency on a commodity with an unpredictable supply. The Ingenia Ambition delivers high-quality images and performs MRI exams up to 50% faster with Compressed SENSE acceleration for all anatomies in both 2D- and 3D scanning. It also offers an immersive audio-visual experience to calm patients and guide them through MR exams.

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Ingenia Ambition 1.5T

1. The Ingenia Ambition 1.5T contains less than 0.5% of the helium of a conventional system and this is permanently sealed inside the device.

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ADVANCING THE IMAGING PROFESSIONAL

FASTER, SAFER, CHEAPER, BETTER The Growth of Minimally Invasive, Image-Guided Therapies

BY MATT SKOUFALOS

I

nterventional radiology [IR] dates back to 1964. In 2020, it is routinely employed in the diagnosis and treatment of an ever-increasing number of health conditions. By combining advanced image-guided techniques, the specialty offers physicians a variety of treatment alternatives to traditional approaches that can take a heavier toll on the patient.

“The catchphrase that we used to use a lot was ‘faster, safer, cheaper, better,’ and that’s not always true,” said Scott Trerotola, associate chair and chief of interventional radiology at the Hospital of the University of Pennsylvania.

“A lot of the things we do these days are actually more expensive than the alternative,” Trerotola said. “But that can be offset because interventional radiology offers lower complications, shorter hospitalizations and less mortality. It helps move a lot of care into the outpatient setting that previously would have required prolonged hospitalization.”

IR techniques have the potential to make significant differences in the lives of patients who would otherwise have received more painful, more invasive or less effective procedures.

Among its more common applications is uterine artery embolization (UAE) for the treatment of fibroids: non-cancerous growths that can cause women heavy, prolonged menstrual bleeding and pelvic pain. Prior to the adoption WWW.THEICECOMMUNITY.COM

of UAE, the only treatments available option is ensconced in national guidefor this condition were myomectomy lines. or hysterectomy – surgical removal of “The vast majority of patients who part or all of uterus. come to us come from knowledgeable For some women, “hysterectomy in and collaborative gynecologists, or particular may lead to [feelings of] loss they are self-referred from the Interof womanhood,” Trerotola said; “it’s a net,” Trerotola said. big procedure: six weeks-plus of recovUterine fibroids are non-cancerous, ery, very expensive and the potential but image-guided embolization is also for a lot of complications.” employed to starve the blood supply “Now women have the option to to cancerous tumors, both primary have embolization on an outpatient and metastatic, and is frequently used basis,” he said. “It’s just a needle puncto halt the progression of cancer in ture; we put a tube in the arteries, and patients awaiting a liver transplant, said block off blood flow, and the fibroids Trerotola’s colleague, Deepak Sudshrink on their heendra, founder own. [There’s] and director of usually no the DVT and hospitalization, complex venous and a faster disease program return to work.” at the Hospital of Despite the University of awareness of IR Pennsylvania. treatment for “You’re going uterine fibroids, to be on that however, Trerotransplant waiting tola said, the list for 18 months vast majority of to two years,” – Scott Trerotola such patients Sudheendra said. are still treated “What’s going to surgically. happen to that tu“Hysterectomy is one of the most mor while you’re waiting? With tumor commonly performed surgeries worldembolization, we can kill 98 percent of wide,” he said. “And although uterine the tumor and keep it under control as fibroid embolization isn’t a panacea, a a bridge to transplant.” large number of patients seen for the “In the patient who’s not a transcondition it’s employed to resolve.” plant candidate, you’re their only opYet, only a “tiny fraction” of women tion for controlling the tumor,” he said. are offered the option of a minimally Interventional oncology “has really invasive alternative even though that grown by leaps and bounds” since its

“ The catchphrase that we used to use a lot was ‘faster, safer, cheaper, better,’ and that’s not always true.”

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“ All other issues notwithstanding, from a patient perspective, I want it to be 100-percent safe, I want it to have zero complications, and I want it to be 102-percent effective.” he said.”

– Raymond Lanzafame

inception, Sudheendra said, and he foresees techniques on the horizon in the areas of “all kinds of cancers,” including pancreatic and breast cancer.

Trerotola agreed.

“The last frontier in our world was thought to be lymphatics, and Penn is Ground Zero for lymphatic interventions,” Trerotola said. “There aren’t that many body parts left to study, but people come up with new things.”

“People are exploring minimally invasive treatments for hemorrhoids, arthritis, and there’s even a research study going on with embolization of the stomach to treat morbid obesity,” he said. “Every time we think we’ve done it all, we keep finding new and interesting areas that are potentials.”

Another common application of minimally invasive, image-guided techniques involves dealing with an enlarged prostate. The same embolization techniques that can be used to help women with uterine fibroids to avoid hysterectomy can also help men avoid a more invasive transurethral resection of the prostate, or TURP procedure. In addition to the longer recovery time, TURP can cause residual bleeding, urinary tract infections, retrograde ejaculation and erectile dysfunction.

Conversely, prostate artery embolization (PAE) shrinks the prostate over weeks and months by restricting blood flow to the organ without destabilizing its tissue. Like the vast majority of IR procedures, it’s done under moderate sedation instead of general anesthesia, As America’s baby boomers contin34

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ue to age, Sudheendra believes more of them will rely on minimally invasive, image-guided procedures like PAE, or similar interventional radiology techniques to deal with chronic conditions such as arthritis.

“Imagine you’ve got a 55-year-old person with arthritis, but who doesn’t want to undergo a knee replacement,” he said. “You can get an IR treatment that may either cure it, or give you another 10 years before you need a knee replacement.”

Similarly, patients suffering from peripheral arterial disease can often avoid amputation with an IR procedure. And more often than not, Trerotola said, “the vast majority of this care is done on an outpatient basis or a single, overnight stay in the hospital,” which reduces costs for insurers, even if “it’s a mixed blessing” for hospitals that don’t earn diagnosis-related group (DRG) payments for inpatient services.

“You rob Peter to pay Paul,” Trerotola said – but that’s the price of advancing the quality of the work and improving patient outcomes.

As popular as minimally invasive, image-guided therapies and techniques are becoming, practitioners, whether in private practice or employed by a health system, should be considerate of what it takes to perform them, said Raymond Lanzafame, executive director and scientific chair of the Society of Laparoscopic and Robotic Surgeons.

Lanzafame, who considers himself “in the pioneer group” of minimally invasive technique practitioners, is a surgeon who has studied photonics for nearly 40 years and minimally invasive surgery for more than 30 years. As his career has traced the emergent arc of IR and minimally invasive surgical practices, he’s also guided institutions in the development and capitalization of such techniques.

Historically, Lanzafame said, minimally invasive techniques tend to be reimbursed at a lesser level than open surgeries, which can make them less financially attractive to institutions. Years ago, when academic hospitals started acquiring GreenLight lasers to perform TURP alternatives, at first, “it took a long while to convince the administrators that this needed to be done,” he said. Once the technology was available, institutions had the option of leasing or purchasing it; deciding which put themselves in a position to either be stuck with an expensive tool they seldom used, or to overpay for a rental that it would be cheaper to own.

“If I’ve got a $2 million robot, 10 percent of that purchase price becomes eaten up by maintenance annually,” Lanzafame said.

Aside from acquisition and upkeep, institutions purchasing high-end IR equipment must credential the physicians who will use it, and train and retain the non-physician staff who support them in its operation.

“If I’ve got this champion who wants to introduce a new technique or technology to the institution, how do I vet that?” Lanzafame said. “Is that individual qualified? Are there clinical studies?

Then you get into the various turf wars in the laparoscopic realm – people who attend a course, but don’t have privileges on different parts of the anatomy.

You’ve got some smearing and blurring of disciplines and lines.”

“All other issues notwithstanding, from a patient perspective, I want it to be 100-percent safe, I want it to have zero complications, and I want it to be 102-percent effective,” he said.

Not every patient is a good candidate for a minimally invasive intervention, however. Dr. Bret Wiechmann, a private-practice IR specialist with Vascular & Interventional Physicians of Gainesville, Florida, a founding member of the Outpatient Endovascular & Interventional Society (OEIS) and its current president-elect, said that a number of factors can complicate their suitability.

ADVANCING THE IMAGING PROFESSIONAL

Anatomy is typically one such reason. Wiechmann said some patients with abdominal aortic aneurysms (AAA) “don’t have a good landing zone for these [endovascular] devices” used to treat their conditions. Others “fail less invasive attempts” and must proceed to open surgery, he said; still others select a less invasive option “knowing that there may be a trade in procedural durability or long-term outcomes.”

“When these devices first came out 21 years ago, not everybody was a candidate for a less invasive approach to fixing an aneurysm,” Wiechmann said. “As the devices have improved and the technique has been more refined, then more and more people become candidates.”

Today, almost 70 percent of aortic aneurysms are treated with minimally invasive, image-guided interventions this way, “whereas in the beginning it was more like 30 to 40 percent,” Wiechmann said. Similarly, IR techniques for the treatment of peripheral artery disease can open blood vessels more urgently, delivering faster results “than putting somebody on a blood thinner, or just hoping that they get better on their own,” he said. In addressing stroke, another debilitating illness, he said, “we are able to quickly re-establish blood flow to the brain with the devices we now have available.”

Even for those patients who aren’t well suited for minimally invasive procedures, “one of the beauties of our specialty is that we work so collaboratively with other specialties,” Wiechmann said. “We get exposed to the procedural part of things, and we combine those aspects with managing the patients clinically. One of our specialties is to be able to apply all that knowledge.”

That collaborative ethic has been on display broadly since 2018, Wiechmann said, as IR has become “the most desired formal subspecialty in terms of residency and fellowship numbers,” a claim Sudheendra seconded.

“Worldwide, there are shortages in access to training, but in the United States, IR was the most competitive fellowship to get into last year,” he said. “That being said, no matter what specialty you get into, you will never learn everything in your residency training; the learning doesn’t stop.”

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“When it started, IR was a purely diagnostic specialty,” Sudheendra said. “All you did was tell the surgeons what was wrong with the patient. Now, 40 years later, someone comes in with massive internal bleeding, they don’t come to the surgeon, they come to us.”

Dr. Matthew Johnson, Director of Clinical Research and Director of Interventional Oncology in the Department of Radiology and Imaging Sciences at the Indiana University School of Medicine in Indianapolis, Indiana, said that despite its elevated profile and increasing prominence in the health care field, interventional radiology is “tough to conceptualize” and may suffer from a branding deficit.

“We operate on people through pinholes so we can do amazing things to them and have them not know, which is glorious, but makes it difficult for people to understand,” Johnson said. “If you operate on someone and they have a big incision, they have to do rehab, and they have a big scar – and they know something’s been done.” “[With IR procedures], all they might know is they have a Band-Aid on their neck and on their groin,” he said. “We’re working as a society to get people to understand that almost every patient can benefit from having IR involved in their care. We’re at the forefront, and we’re always there.”

Johnson said the IR “bread-and-butter procedures are things that everybody needs but nobody thinks about,” including installing ports, catheters and gastrointestinal tubes; performing hemodialysis, abscess draining and biopsies. He described these as “a service to the hospital and to patients,” as well as “things that are managed frequently by other doctors.”

To elevate the profile of the specialty means letting the rest of the universe of practitioners know “that we are there, that we want to be part of multidisciplinary care, and we want to be recognized as who we are,” Johnson said.

“There are thousands of us in the hospitals doing these things,” he said. “It’s our identity that we’d like to share.”

“How we grow the field is we grow people’s understanding of it,” Johnson said.

“You provide a great mousetrap, and then you provide people of knowledge of your mousetrap and what it can do for them.” •

Dr. Matthew Johnson, Director of Clinical Research and Director of Interventional Oncology at the Indiana University School of Medicine in Indianapolis

Raymond Lanzafame, executive director and scientific chair of the Society of Laparoscopic and Robotic Surgeons

Deepak Sudheendra, founder and director of the DVT and complex venous disease program at the Hospital of the University of Pennsylvania

Scott Trerotola, associate chair and chief of interventional radiology at the Hospital of the University of Pennsylvania

Dr. Bret Wiechmann, a privatepractice IR specialist with Vascular & Interventional Physicians of Gainesville, Florida ICEMAGAZINE

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INSIGHTS

LIVE YOUR LIFE BY A COMPASS NOT A CLOCK

M RAD HR JANEL BYRNE

Our lives are not moving any slower and it’s easy to fall victim to your calendar to the clock.

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onday morning hits – I open my phone and scroll through my calendar, releasing a heavy sigh as everything loads; booked in back to back meetings again. It doesn’t come as a surprise, as I have taken on more responsibilities in my leadership role. Even still, it can be discouraging to start my week knowing I will struggle to find the time to restore my personal comfort (i.e., my way of saying I need to use the restroom), let alone make any progress on significant projects for my organization. I have a feeling this experience may resonate with many of you.

Stephen Covey, author of “The Seven Habits of Highly Effective People,” responded to this shared predicament by saying, “we should live our lives based on a compass not a clock.” Covey succinctly articulates how we should structure each day with our goals dictating our actions, not our calendars.

Living my life by a compass this week would mean making progress on projects that further the strategic goals for my team and my organization (i.e., this big picture). Living my life by a clock is me in meetings from 9 a.m. till 5:30 p.m., putting out a lot of “fires” – and making zero progress when it comes to furthering big picture objectives.

Fortunately, it’s still Monday morning for me and I’m taking control of my compass to not be obliterated by the clock today. For me, my best brain power is in the morning sipping my coffee, so I must maximize this time with the truly important “stuff.” This is where I tap into a tool called the Eisenhower Matrix. Coined by former President of the United States, Dwight D. Eisenhower, the

Eisenhower Matrix is how he prioritized his vital responsibilities and decision-making by urgency and importance throughout World War II. With my calendar in front of me I take out a piece of blank paper, draw my matrix and take the next 20 minutes to plot out my day. In the top left quadrant, I identify the meetings/tasks for the day that are urgent and important. For today, this is my 1:1 with my leader to discuss critical feedback from our CEO about a conference we are planning for 500 of our organization’s leaders.

The conference is around the corner and its objective is to equip participants to be more effective in their leadership roles (which happens to be a key organization-wide objective).

In the top right quadrant, I list meetings/ tasks that are not urgent while still being important. My team is hoping to enhance a website that stores key policies, information and tools for leaders toward the end of this calendar year. This critical resource will additionally further the organization’s objective to equip leaders to be more effective, but it’s not urgent for today. I write a note to schedule time for myself and team to start brainstorming early next week. In the bottom left quadrant, I list meetings/tasks that are not important for me to do but are urgent. These are activities that can be delegated and, for today, includes two meetings about our organizational performance evaluation approach. Filling in this box is one of my greatest achievements as a leader. It can be challenging to truly hand responsibilities over to others and trust them to complete with excellence. As leaders, this quadrant is both an opportunity to add more “compass” time to your day while empowering your team to own, drive, grow and achieve new things. For example, I sent these two meetADVANCING THE IMAGING PROFESSIONAL

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ings to my direct report leading the project with an email saying, “I will not attend either meeting today – I trust your ability to lead this process and keep me in the loop when it comes to critical context. I’m also happy to join if my presence is needed – if so, please let me know the role you would like me to play so these meetings can achieve the desired objective(s).”

In the last quadrant, I list meetings/tasks that are neither urgent nor important. These are the items that I ultimately choose to not waste any brainpower on. For today, I completely remove myself from a standing policy meeting. I no longer have responsibilities in this realm and don’t see myself as a necessary (or valuable) contributor to the discussion. I send an email to the group informing them of my decision and leave it open to any questions or concerns – I’m always happy to hear if I’m missing how my involvement adds value (but am 99% sure I will not be missed!).

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MONTH Twenty minutes later, I have 3 additional hours of my Monday back Receive a FREE and am able to maximize my morning J F M A M J J A S O N D subscription to brainpower to prepare for my critical DESIGNER: JL meeting with my leader.

ICE Magazine The Eisenhower Matrix is just one of many prioritization tools out there.

The critical “aha” for me is my ability Stay up to date on to take control of my day, week, month news about the and year, especially when it felt like I had no control for so long. Our lives are ICE Conference not moving any slower or becoming less busy, and it’s easy to fall victim to your calendar – to the clock. Your Learn about brainpower is vital, especially as you upcoming lead others, so do what you need to truly live by your compass. • imaging webinars

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JANEL BYRNE, MSW, SHRM-CP, is an organizational effectiveness manager at Children’s Hospital Los Angeles.

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37

INSIGHTS

DIRECTOR’S CUT MARIO PISTILLI

TAKING CARE OF GRANDPAS I

have spent much time when coaching and mentoring others talking about focusing on your personal why. I encourage others to really spend time in being clear with themselves about their personal why for their work. I wanted to use this forum to share a story about an event that has shaped my personal why.

I was about 10 years into my career as a nuclear medicine technologist and, to be honest, probably suffering a bit of professional burnout. One day, I was having a very bad day.

It was what Judith Viorst would call “the terrible, horrible, no good, very bad day.” It was a day where I seemed to screw up everything I touched, and I had the most trying patients that day. Each patient was more disagreeable than the last and my mistakes just kept mounting until I finally got a quick break for lunch. I decided to run down to the cafeteria and grab something and hurried down the hall in a huff. I was walking so fast that my lab coat was billowing after me as I made my frustrated trek to the cafeteria. Then, I saw approaching me a little girl of about 5 or so walking hand

and hand with, I assume, her grandmother.

Something made me slow down a bit as we grew closer and when we were almost passing, the little girl’s blue eyes locked onto mine. She had tears welled up in her eyes, and it made me pause and force a smile.

They stopped and I knelt down to get eye level with the little girl, and she said to me in a quivering voice, “Are you gonna fix my grandpa?” I said, “Yes, that’s what we do, we fix grandpas.” The cutest little smile crossed her face and she looked up at Grandma with a look that said, “See, it’s gonna be OK.” I stood up and Grandma just looked at me and mouthed the words “Thank you” and we continued our separate ways down the hallway.

As I walked I was overwhelmed with that seemingly small interaction which has shaped me and my journey every day since then. You see what that little girl made me realize is that when you boil it down to the purest form that is what we do. We fix people. There are many things that happen that try and take our mind off of this.

Things like productivity, staffing issues, HR problems and the myriad fires in a day that try and keep us from fixing people. Through that noise, though, it still remains that what we should focus on is “fixing” people.

I also learned that day that all people deserve the very best care.

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ADVANCING THE IMAGING PROFESSIONAL

I also learned that day that all people deserve the very best care. This is not a political statement and I am sure there is room for debate about our health care system. What I mean is that sometimes we can get bogged down in frustration over this person or that person deserves our care or does not.

This can really be challenging when faced with the rude, demanding or ungrateful patient. By narrowly focusing on the why, that I am here to “fix people” and not be the judge of who deserves it or not, it made interactions with those challenging patients so much easier on me. You see, everybody is important to someone. That little girl’s grandpa might have been the grumpiest patient on the floor and might have been giving the nurse a terrible time. That nurse may have WWW.THEICECOMMUNITY.COM

been really frustrated and may not have even known that out there was a little girl with tears in her eyes worrying about her grandpa.

In my most challenging times, I often think back to that little girl and think somewhere there are people relying on me to do this so that their grandpa, grandma, spouse, sibling or child gets the very best care possible.

It is not just about the patient in front of you, but everyone connected to that patient that you owe your very best self. This is always a thought in every single important decision that I am faced with, what is best for the patient? For me, I think of the patient as the grandpa and picture that little girl in the hallway. This has become one of the greatest sources of self-satisfaction in my work in that I can relate every

task, no matter how small, back to the patient.

So, my dear colleagues and friends, the next time you are frustrated remember that you are fixing someone that is loved by someone else out there. Cut through the noise and distractions and remember your why.

When faced with those hard tasks, remember you owe it to those counting on you to do the right thing, no matter how difficult. • MARIO PISTILLI, CRA, MBA, FACHE, FAHRA, is administrative director for imaging and imaging research at Children’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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INSIGHTS

PACS/IT MARK WATTS

CHANGING FOR GOOD! EDITOR’S NOTE: This is Part 1 of a two-part series.

A

t this time, we are forced to change. We have an opportunity with the right leadership and alignment to make this a time of change for good.

When people talk about transformation in health care, they tend to focus on the work that needs to be done to move a health care organization forward, such as changing care processes. But that’s only half the story. Equally important is an assessment of a team’s readiness to take on transformation. And the best gauge of that lies in the question, “Is everyone in your organization aligned?”

When I ask this question to a qualified group of U.S.-based clinical leaders, clinicians and executives who are directly involved in health care delivery – they return a resounding “no.” In a recent leadership survey, “Providers, Executives, and the Power of Alignment,” it was observed that there is 40

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a remarkable gap in the alignment that respondents consider necessary between key stakeholders and the degree of alignment they perceive within their organizations. For instance, over 90% of respondents say it is extremely or very necessary for frontline clinicians and top executives (such as the CEO) to be aligned. Yet, only 30% consider their own health care organization to be extremely or very aligned among these stakeholders.

True alignment has numerous positives, not the least of which are better patient outcomes and organizational stability in a dynamic, changing health care marketplace.

To be clear, I am not conflating alignment with agreement. Not everyone is going to agree with every decision, but they must understand why certain decisions are made.

The survey results were bleak in this respect – only 21% of respondents say alignment approaches are formally stated in their health care organization, while just under a ADVANCING THE IMAGING PROFESSIONAL

quarter say the approaches are tacitly understood. Nothing this important should be left unstated. These findings, from personal experience and study, are not an acceptable foundation if you are to successfully transform your organization.

HOW TO ACHIEVE ALIGNMENT One place to start gaining alignment among key stakeholders is in the definition of the term. The largest share of my respondents say alignment is achieved when “the organization’s mission, vision and goals are supported by governance, strategy and incentives.” One in 20 label alignment as a “financial model that incents providers and executives toward common goals.” This result is unsurprising, since the predominant financial models today are not aligned with patients’ best interest, physicians’ best interest or even organizations’ best interest.

There’s huge overuse in health care that has at its root a payment system based on more tests and more procedures — a production model that doesn’t serve anyone well.

The next step is figuring out which stakeholders require the most alignment. According to my survey, these are frontline clinicians and clinical leaders such as the chief medical officer; 93% of respondents score their necessity of alignment as extremely WWW.THEICECOMMUNITY.COM

or very necessary. At the other end of the spectrum are executives and patients, for which 55% of respondents say alignment between the two is extremely or very necessary.

As you then chart the actual degree of alignment within your own health care organization, in comparison, you’ll see what needs to be bridged. In my survey, despite calling alignment between frontline clinicians and clinical leaders a necessity, only 36% of respondents say there is a high degree of alignment in their own organizations. That’s an incredible mismatch that must be addressed.

So, how can you drive your health care organization toward alignment?

I would suggest looking at it from two different perspectives: within the leadership team, and among the leadership team and clinical providers.

For both groups, agreement on vision and strategic plan is most important, according to our survey. Interestingly, my experience has found it far more important for administrative leaders to have clinical training/experience than for clinical leaders to have business training/experience. We think this is short-sighted, as new models will require clinical leaders to have business and financial savvy to make the most impact.

As you seek to align your own organization, physician compensation models are one place to start. Only a

quarter of respondents say physician compensation for employed physicians is extremely or very aligned with organizational strategy, mission and goals. With so many physicians turning to employment in recent years, the hiring organizations likely expected more alignment in exchange for putting salaries on their books. The situation is even worse with affiliated physicians, where only 10% are highly aligned.

Leaders and clinicians alike must evaluate the degree of alignment at every level of their organizations. Otherwise, as you dive deeper into health care transformation, you will encounter a lot of friction and wasted energy.

In the face of the new force in the transformation of health care delivery, it is important for us to consider the leadership and the alignment to change for good. • 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.

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INSIGHTS

THE COMING TSUNAMI N

o one could have we are about to encounter a predicted the potential tsunami of activity circumstances once the country reopens and of early 2020. We have business returns to what many been experiencing a peare calling the new normal. riod of disruption few of us have ever experienced HIGH VOLUMES or had to have dealt Almost every ambulatory clinic with. During this time of in the United States was either uncertainty, my company shuttered or has significantly DEPARTMENT/ has been having discusreduced its operations over the sions with many health OPERATIONAL ISSUES last two months. Some states care providers around have begun the process of

BY JEF WILLIAMS the country who are reintroducing non-emergent dealing with the COVID-19 crisis in varprocedures in compliance with modified shelter ious ways. In some instances, there is a in place and social distance policies. An early direct shift in operations toward mananalysis of the numbers and types of exams that aging and treating patients, while other were canceled or postponed during this pandemproviders are dealing with very large ic demonstrate that there will be a large period reductions in volume and having to lay of catching up. This is the tsunami of which my off staff and reduce operating hours. expert was referencing. Clinics that were already While much remains to be learned and busy can expect that they will need to scale to evaluated related to the information meet the demand that did not disappear, but we have been gathering during this simply was held in a queue until businesses retime, many organizations have begun opened. to process the impact both now and, in This means that organizations are going to the future, as it relates to the pandemic need to be prepared to bring staff back and at hand. potentially fast-track orientation for new staff Imaging departments have already begun to consider what will happen when business reopens. The impact to business reopening will be felt across all of the functional areas of delivering imaging services. This includes patient management, clinical workflow, operations, finances and technology. In a recent conversation I had with an industry expert, we discussed many of these things and how they should be addressed even in this time of uncertainty. Her prediction is that 44

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while considering modifications to their operating hours. This volume of exams and procedures will require longer working hours, longer operating hours, more technologists and clerical staff, and supplemental radiology reading resources. It is important for organizations to begin considering how they will ramp up to meet this demand as well as evaluating their current technology to ensure that a 20-40% increase in volume can be sustained and their technology can scale to meet that additional demand.

ADVANCING THE IMAGING PROFESSIONAL

STAFF MODELING In addition to scaling operations many organizations are already beginning to consider staffing models that meet the COVID-19 new normal. Some organizations in the United States have already separated staff into working groups in order to ensure that at any given time there is a percentage of this population of their staff that are not exposed in the work environment to COVID patients. The staff members are working alternate periods that meet the quarantine time requirements which ensures they are not infected. These staffing populations are then alternating shifts over 14 days to ensure that any outbreak does not affect the entire organization. Even within a population of working staff members there will need to be consideration for splitting shifts in ways that allow for clinics, hospital and radiology departments to open earlier and stay open later to accommodate the volume of images that will come when business reopens.

PATIENT FLOW The reopening of imaging centers and radiology departments will require a completely modified approach to patient throughput. We have lived with models that can no longer be sustained in a world where social distancing is required, and contamination can be life-threatening. Patient throughput begins with waiting rooms and it will be hard to imagine any future patient throughput model that requires people to sit within close proximity of others that could potentially be carrying the virus. This means that patient arrival will need to accommodate staggered arrival times, patients waiting in safe spaces, perhaps their cars, and awaiting a text from the front desk to notify WWW.THEICECOMMUNITY.COM

that they are ready to be arrived into the department.

The arrival and registration process will likely no longer include clipboards and paper which should drive adoption of digital pre-registration and easily sanitized kiosks. In many cases, organizations are looking for workflow models that include patient and technologist movement that reduces any touch points within the department as well as providing for 6 feet of distance between individuals. As most clinics and departments have narrow hallways and are often busy, and certainly will become even more busy in the period of catching up, some have introduced hall monitors whose job is monitoring people’s movement throughout the department. This includes ensuring that patient and technologists ingress and egress from examination rooms provides notification to ensure that all movement maintains social distancing.

TECHNOLOGY REQUIREMENTS Good technology is designed to support operations and patient care delivery. Many of the systems utilized in our imaging departments are designed for general workflow and do not accommodate for radical operational disruption. Now is an important opportunity to analyze current infrastructure and consider the various components of the technology stack and how it will scale and pivot to meet new demands.

Digital registration and moving away from paper entirely will likely become an important component of digital transformation in the very near future.

In addition, with expectations that image volumes will grow 20-40% until the backlog has been addressed, there will be a need to analyze all compo-

nents of one’s imaging solutions. From looking at the modalities and planned maintenance, to looking at PACS and viewing solutions, and addressing the amount of image sharing that will be required.

There has been a significant shift away from centralized reading and reading rooms to home and remote reading over the last two months.

Expect that change to continue to be a model most organizations adopt going forward. Until there is a vaccine, many people will be reticent to enter a working area where there are multiple people speaking and breathing. With many PACS solutions providing the ability for radiologist to read remotely it makes sense this would continue with only those radiologists necessary to be on site reading locally. Any distributed reading model must be able to accommodate the scaling increase of examinations which means technical support, reading workflow, image distribution, visualization and reporting are sufficiently considered.

CONCLUSION There is no standard that we can apply to what people are experiencing right now in medical imaging. Some have never worked harder or made greater personal sacrifices to meet the demand for treating patients. Others are struggling to ensure their organizations survive during this period of significant downturn. In any case, there is an opportunity now to begin preparing for the inevitability of a massive increase in imaging over the course of the next six months that could sustain well into 2021. • JEF WILLIAMS, MBA, PMP, CIIP, is a managing partner at Paragon Consulting Partners.

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INSIGHTS

CODING/BILLING MELODY W. MULAIK

EDITS TAKE 2!

W

e discussed some crazy new 2020 edits in a previous column and, fortunately, the Centers for Medicare and Medicaid Services (CMS) made some course corrections with the second quarter edits effective April 1, 2020.1 The most anticipated update was the change made to the CCI edit that bundled the Modified Barium Swallow Study into the Speech Pathologist code 92611. The deletion of the edit was published on April 1, 2020, but the effective date for the deletion is January 1, 2020. This means that CPT® code 92611 Swallowing Function with the Speech Pathologist and CPT® code 74230 Modified Barium Swallow can now be reported together and providers can expect their claims to be processed.

The other big area of concern was in nuclear medicine. On January 1, 2020, CMS implemented new Procedure-to-Procedure (PTP) CCI edits that bundled certain radiopharmaceuticals with Nuclear Medicine CPT® codes with the rationale listed as “Misuse of column two code with column one code.” Later in January, after reviewing this issue more closely, CMS made the decision to revise these PTP edits. These 46

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are the changes that were made for April 1, 2020, and made retroactive to January 1, 2020.

Although the specific radiopharmaceutical code edits vary slightly from one code to the next, some of the edits that were in place for 2020 have now been removed. It is important to note that not all of the edits for the radiopharmaceuticals have been removed.

• Bone and Joint Nuclear Medicine Studies (CPT® Codes 78300 thru 78315): As an example, the radiopharmaceutical edits for Tc-99m medronate (A9503), TC-99m oxidronate (A9561), and Indium 111 labeled autologous platelets (A9571), have been removed for 78300 bone and/ or joint imaging, limited area.

• Myocardial PET and PET-CT Nuclear Medicine Studies (CPT® Codes: 78429 thru 78434): An example of the radiopharmaceutical edits removed for the myocardial PET and PET-CT is as follows: Tc-99m medronate (A9503), Nitrogen N-13 ammonia (A9526), Tc-99m microaggregated albumin (A9540), F-18 FDG (A9552), Rubidium Rb-82 (A9555), and Xenon Xe-133 gas (A9558) no longer have edits with 78432 Myocardial PET perfusion and metabolic evaluation dual radiotracer.

ADVANCING THE IMAGING PROFESSIONAL

• Tumor Localization, Inflammatory Process or Distribution of Radiopharmaceutical Agent Nuclear Medicine Studies including planar, SPECT and SPECT-CT (CPT® Codes: 78800 thru 78832): This series of codes has the most CCI edit deletions. This code series had between 18 and 40 radiopharmaceutical edits deleted per code so the information should be reviewed in detail.

When CMS determined they were going to revise the edits, they advised providers that they had a few options: (1) Providers could choose to delay submission of claims for deleted edits until after the implementation of the replacement edit file (4/1/2020) with retroactive date of January 1, 2020.

(2) Providers could choose to appeal claims denied due to the PTP edits to the appropriate MAC including supporting documentation, or (3) Providers could resubmit claims denied due to these procedure to procedure edits after the implementation of the replacement edit file (4/1/2020) with January 1, 2020 retroactive date, as permitted by their local Medicare Administrative Contractor (MAC).

If you chose Option 1, you may now submit those claims and expect them to be processed for payment. If you have denied claims, you may now resubmit those claims with dates of service back to January 1, 2020 and expect them to be processed. • MELODY W. MULAIK, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc. 1. https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/ Version_Update_Changes

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INSIGHTS

FIVE TIPS FOR RELIEVING

EMOTIONAL INTELLIGENCE DANIEL BOBINSKI

A

STRESS

s we are all well-aware, the entire world has changed. I’m sure you’re also aware that these changes have increased our stress levels. Left unchecked, excessive stress can lead to depression, so I’d like to highlight a few things we can do to alleviate stress and strengthen ourselves mentally and emotionally.

In my previous writing on stress, I’ve described it as, “the sense that we are losing control.” Picture a guy named Matthew working at his computer and whatever app or program he’s using freezes up. Because Matthew has lost a bit of control in the situation his anxiety level may increase.

However, because it’s uncool for Matthew to say he’s lost a bit of control in the situation, he’ll tell us he’s “stressed.”

Apply that same concept to someone named Jessica either losing her job or being assigned extra hours in a potentially deadly work environment.

It’s safe to say Jessica would also sense a loss of control. Translated: she’s experiencing stress.

In a simplified way, if stress comes from the sense of losing control, I suggest that depression correlates to the sense of having lost control altogether. It’s a feeling of helplessness that may be accompanied by anxiety attacks in which the entire world feels like it’s falling in around you.

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ICEMAGAZINE | JUNE 2020

Despite our best efforts, we can’t be superman or superwoman at all times. In these stressful times, we all need a little help.

To assist with that effort, I enlisted the aid of Psychologist Lynn Laird of Healing Heart Counseling in Meridian, Idaho, to share some practical tips for alleviating stress. Here are five tips that she shared.

• Journaling. Laird says, “Understanding what we’re thinking about helps us understand what’s bothering us. Journaling helps us become more aware of our own thoughts. When under stress, many of us start to catastrophize things, and dwelling on worst-case scenarios can cause anxiety and even depression.”

Laird says that writing out our thoughts by hand is probably the best way to do journaling because the neuromuscular activity of doing so helps our brains process things more deeply, but that using a word processor works if you can’t take the time to write it out by hand.

Laird says one of her clients does his journaling on his phone.

After journaling, Laird says, “We can read back over our thoughts objectively and ask, ‘Is this even true? Do I know this is going to happen?’”

The act of journaling and then objectively thinking about what we wrote helps us to “clear our cache” of worry.

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Laird is also a strong advocate of “gratitude journaling.” She feels that when we’re surrounded with many negative things, it’s important to “pay attention to the things we’re thankful for.” She says the things we’re grateful for don’t have to be big things. “For example, I like sunsets,” Laird says. “I have opened my journal and written about a beautiful sunset – describing it and writing about how calming it was. It’s a very peaceful thing to write those things out.” Laird says we can always find something to be grateful for, and because humans tend to go where they’re focused, identifying things to be grateful for and focusing on them by writing about them can be very calming.

• Make a plan and strive to stick to it. “There’s a sense of normalcy in having a routine,” says Laird. “We can’t just lie down and say, ‘It’s over.’ We need to get ready for our life each day, whatever it may be.” Setting goals and establishing bigger pictures ideas are part of this. Writing out the goals and ensuring each one has a “by when?” attached to it helps us stay focused on accomplishing them.

For help with goal setting, Laird suggests doing an Internet search on S.M.A.R.T. goals.

• Keep moving. Movement and exercise are important for both physical and mental health. “If it’s OK to leave your house, get outside and get some sunshine,” says Laird.

“But even if you’re confined to an apartment, you can still get exercise. It requires a little more dedication, but it can be done.”

One suggestion Laird has for anyone confined at home is to open a window and do some kind of activity near the fresh air. “This might not be the best time to start an exercise routine, but I think it’s important that we don’t just sit down all day. Whether it’s cleaning our house or getting up and doing some stretches, our WWW.THEICECOMMUNITY.COM

bodies and minds are intertwined. Doing things physically gives us a sense of accomplishment, and that affects our mental health.”

• Do deep breathing. “This can be done anywhere at any time,” says Laird. “If we sense ourselves getting stressed or anxious, we can do this and it provides immediate relief.” The technique? “Inhale through your nose for a count of four, then hold that breath for another count of four. Then, exhale that breath through your mouth for a count of eight.” Laird says stress impacts our sympathetic nervous system, and deep breathing stimulates that part of our nervous system to provide instant relief.

• Find an accountability partner. “This tip helps with any of the things we’re doing to alleviate stress,” Laird says.

“Knowing you’re going to be checking in with someone is good for staying on track, and it also helps us maintain relationships.” Laird says that accountability can take many forms, such as a phone call, a Zoom or FaceTime meeting, or even texting.

In closing, Laird said that, “People may already know about these tips, but the question is, ‘Are they doing them?’”

I agree. It’s one thing to know how to do things, it something different to actually do them. I should add that Laird also suggested staying clear of excessive alcohol consumption, as that only masks stress and doesn’t truly alleviate it.

The most important thing is to be proactive. Even if our stress takes us to the brink of depression, we can still reach out to someone and say, “I could use some help.” • DANIEL BOBINSKI, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach Daniel on his office phone, (208) 3757606, or through his website, www.MyWorkplaceExcellence.com.

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Let’s Make Some History of Our Own AHRA Annual Meeting & Exposition

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AMSP

SPONSORED CONTENT

AMSP MEMBER DIRECTORY Associated X-Ray Imaging, Corp. www.associatedxray.com 800-356-3388

Brandywine Imaging, Inc. www.brandywineimaging.com 800-541-0632

Cal-Ray, Inc. www.calrayinc.com 920-233-6946

I M A G I N G Custom X-Ray www.customxray.com 800-230-9729

Health Tech Talent Management www.healthtechtm.com 757-563-0448

Interstate Imaging www.interstateimaging.com 800-421-2402

Medlink Imaging www.medlinkimaging.com 800-456-7800

Preferred Diagnostic Equipment Service, Inc. www.pdiagnostic.net 951-340-0760

Premier Imaging Medical Systems www.premierims.com 706-232-4900

Pro Diagnostic Imaging Systems by PTSI www.gofilmless.com 614-226-6490

Technical Prospects www.technicalprospects.com 877-604-6583

Radon Medical Imaging www.radonmedicalimaging.com 800-722-1991

The Association of Medical Service Providers (AMSP) is the premier national association of independent service and products providers to the health care technology industry.

Our large pool of modality specialists provide for lower costs and higher quality services for our customers throughout the U.S. Learn more at www.amsp.net.

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ICEMAGAZINE | JUNE 2020

ADVANCING THE IMAGING PROFESSIONAL

SPONSORED CONTENT

MEMBER PROFILE

BRANDYWINE IMAGING INC.

BY ERIN REGISTER

B

randywine Imaging Inc. was established in 1980

by Ronald Laird after working for Picker International for 14 years. Brandywine Imaging was founded to provide responsive and dependable service as well as a source for consumables to satisfy its customers’ needs.

“We are a dependable source of liveli­ hood for our employees and contribute to the stability and well-being of the community in which we are located,” said Bill Laird of Brandywine Imaging.

“Brandywine Imaging Inc. has been in business for nearly 40 years. Our service team has over 100 years of experience in both the X-ray and film processing fields.”

Brandywine Imaging is a founding member of the Association of Medical Service Providers (AMSP), the premier national association of independent service and product providers to the healthcare technology industry.

ICE magazine learned more about Brandywine Imaging in a recent interview with Laird.

Q:

How does Brandywine Imaging stand out in the medical imaging field?

Laird: The support we offer on our

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products is how we stand out in the medical imaging field. We pride ourself on quick response time to our customs’ service needs. Most Bill Laird, COO of our customers of Brandywine have direct access Imaging Inc. to our service personnel through cellphone and email.

There is no need to call into the office, scroll through a menu of options and hope someone receives their message.

With Brandywine Imaging, you get instant and direct support on all of our equipment. Over 95% of service calls have a technician on site the same day, and we have a quick turnaround service from the time of the call.

Q:

What are some of the services and products Brandywine Imaging offers? Is there a specific or new one you are excited about right now?

Laird: Brandywine Imaging has the ability to offer most of the different DR panels and X-ray systems on the market today. We sell and support many of the latest digital advancements in medical imaging. In addition, we offer installs and de-installs. We have, however, decided to limit our product line to only the top few manufacturers. We believe that the products you sell also reflect on your business. Our full line of

products can be found at brandywineimaging.com.

The latest product we are offering includes the new LG panel. The product is durable, affordable and wireless!

Almost everybody knows the brand LG, so there is a comfort level for our customers with the brand name alone.

Q:

What has been Brandywine Imaging’s biggest achievement?

Laird: Our biggest achievement has been the ability to adapt as our industry has evolved over the past 40 years.

Not only have we changed to meet the needs of our customers, but we have also kept the same high level of customer support that we strive to achieve and maintain.

Q:

Do you have any goals you would like to achieve in the near future?

Laird: Our main goal is to expand our customer base while maintaining the same high level of support. In addition, we hope to expand our portfolio of equipment so that we only offer the latest and highest quality equipment in the medical imaging industry. • FOR MORE INFORMATION about Brandywine Imaging, Inc, visit www.brandywineimaging.com. You can also reach Bill Laird, COO, by calling 610-444-5553 or emailing Brandywineimaging@comcast.net.

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ADVANCING THE IMAGING PROFESSIONAL

[QUOTE OF THE MONTH]

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Science Matters

Two tests for coronavirus These tests are used for detecting infections, including Covid-19, the disease caused by a novel coronavirus; the tests indicate different things and have different purposes.

Is viral DNA or RNA* present?

Has the body reacted to the virus?

PCR test (polymerase

chain reaction) amplifies genetic material from the virus in the person’s body so it can be detected

*Some viruses multiply their DNA; some spread their RNA (molecule related to DNA)

Swab taken from nose (for Covid-19) or mouth

No virus is present

but person may still be vulnerable to infection OR person has been infected, recovered and is now free of all traces of virus

COLLECTING A SAMPLE WHAT A NEGATIVE TEST MEANS

Virus is present • If person has symptoms, the symptoms are due to an active viral infection • If person does not have symptoms, an infection is under way and may cause symptoms later

WHAT A POSITIVE TEST MEANS

WHAT TESTING REVEALS

* Some viruses have DNA and attack by replicating it; some spread their RNA (a molecule related to DNA)

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ICEMAGAZINE | JUNE 2020

(antibody test) detects antibodies to the virus produced by an infected person’s immune system

Blood sample drawn

Person has not been exposed to virus and has not produced antibodies to combat it

Person has no immunity and may still become infected later

• If person has symptoms, they are due to some other virus or bacterium

Percentage of population that is currently infected

Serological test

HOW THE TESTS WORK

Person was exposed to virus

and made antibodies to it

• If person has symptoms, they are due to an active infection • If person does not have symptoms, person has been infected, has recovered and is probably now immune to virus Percentage of population that has been exposed

Source: US National Institutes of Health Graphic: Helen Lee McComas, Tribune News Service

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INDEX

ADVERTISER INDEX AHRA p. 50

Injector Support and Service p. 28

Richardson Electronics Healthcare p. 54

Innovatus Imaging p. 3 Association of Medical Service Providers (AMSP) p. 52

RTI Group North America p. 23 InterMed Group p. 43

Ampronix, Inc. p. 4 KEI Medical Imaging p. 51

CIRS Inc. p. 47

MedWrench p. 42

DIAGNOSTIC IMAGING & SURGICAL SOLUTIONS

Diagnostic Solutions p. 27

SalesMaker Carts p. 18, 54

Summit Imaging, Inc. p. 13

Multi Diagnostic Imaging Solutions Back Cover SOLUTIONS

TriImaging Solutions p. 9 Entech p. 18 MW Imaging Corp. p. 5 W7 Global LLC p. 43 Fluke/Landauer/RaySafe p. 2

iMed Biomedical

Leading the Industry in Biomedical Solutions

iMed Biomedical p. 51

58

ICEMAGAZINE | JUNE 2020

PM Imaging Management p. 37

Webinar Wednesday p. 25

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