ICE Magazine September 2020 by MD Publishing

THEICECOMMUNITY.COM

SEPTEMBER 2020 | VOLUME 4 | ISSUE 9

ADVANCING MAGAZINE

IMAGING PROFESSIONALS

finance dance

Directo

r's Cut

DIFFICU CONVER LT SATION S P AGE 4 2

Variety of flexible moves exist for medical device purchases PAGE 36

PRODUCT FOCUS

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FEATURES DIRECTOR'S CUT IN FOCUS

Bon Secours Mercy Health (BSMH) Regional Director-Imaging Sandy Michalski career started with an aptitude test in high school.

One approach to difficult conversations is knowing that “people problems permanently persist.”

COVER STORY: FINANCE DANCE

Capital equipment purchases can be among the most complicated business decisions that any health care organization makes. However, even amid a pandemic there are a variety of flexible solutions.

RISING STAR

Alpana Patel Camilli has had a significant impact on her department during the ongoing COVID-19 pandemic.

ICEMAGAZINE | SEPTEMBER 2020

ADVANCING THE IMAGING PROFESSIONAL

SEPTEMBER 2020

PRODUCT FOCUS

The global contrast media market size is expected to reach $6.3 billion by 2025.

RAD HR

One of the ways to combat mis-utilization of talent is to have clear and distinct roles when pursuing an initiative.

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IMAGING NEWS

A roundup of diagnostic imaging industry news, trends and hot topics.

ICEMAGAZINE

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

John M. Krieg john@mdpublishing.com

Vice President

Kristin Leavoy kristin@mdpublishing.com

Editorial

John Wallace Erin Register

Art Department Jonathan Riley Karlee Gower Amanda Purser

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

CONTENTS SPOTLIGHT 10

Rising Star Alpana Patel Camilli, University of California San Francisco Medical Center

In Focus Sandy Michalski, Bon Secours Mercy Health

Rad Idea Daily Team Huddle and Touchpoint

Off the Clock Jacqui Rose, Upper Valley Medical Center and Miami Valley Hospital North

Company Showcase iMed Biomedical

NEWS 20

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

Webinar Wednesday Sessions Benefit Health Care Professionals

PRODUCTS 32

Market Report Global Contrast Media Market Growth Continues

Product Focus Contrast Injectors

INSIGHTS 40

Coding/Billing PET/CT or PET and CT?

Cindy Galindo Kennedy Krieg

Director's Cut Difficult Conversations - Asking Questions

Accounting

Banner Imaging Leading the Way for Best Practices in Imaging

Department/Operational Issues Strategy in Change

Rad HR Giving Innovation Infrastructure

PACS/IT Lessons Learned at 2020 ECR

Emotional Intelligence The Simple Way to Hire, Train and Retain Great Employees

54 55

AMSP Member Directory

56 58

ICE Break

Digital Department

Diane Costea

ICE Magazine (Vol. 4, Issue #9) September 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

ICEMAGAZINE | SEPTEMBER 2020

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SPOTLIGHT

RISING

STAR ALPANA PATEL CAMILLI

BY ERIN REGISTER

lpana Patel Camilli is the manager of diagnostic radiology at the University of California San Francisco Medical Center. She acquired an associate degree in 1994 after becoming a radiologic technologist and is currently working on a master’s of health administration. Camilli also has her Certified Radiology Administrator (CRA) credential from the AHRA. Today, she lives in Pacifica, California and manages the diagnostic radiology department at the UCSF Radiology, Helen Diller and Mt. Zion campuses. Camilli was nominated to be featured as a Rising Star by UCSF Medical Center Principal Radiologic Technologist Supervisor David Poon, who said Camilli has “made a significant impact in our department addressing the needs of COVID-19.” ICE learned more about this Rising Star in a question-and-answer interview.

Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: My brother is a neuro and interventional radiologist, and my uncle is a body radiologist. Several older cousins are radiologists and technologists. I’d say radiology is woven into our family story. I tried other majors in school and was not inspired. My brother recommended becoming a technologist, so I trusted his advice and applied to school. After the first few weeks in the program – imaging, caring for patients and working with technology – I realized this was the right path for me. I’ve never looked back since. 10

ICEMAGAZINE | SEPTEMBER 2020

Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: I like working alongside the technologists and patients. I also like that I can be and create the change within the department, inspiring my team to grow and be the change they’d like to see in the world and others. I like to make sure that I’m not so far removed as a manager; encouraging, supporting and helping the technologists reach their goals.

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: The ever-changing technology and dynamic way that radiology can be utilized to take care of patients interest me the most. It’s also very interesting working with departments outside of radiology.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN THE FIELD THUS FAR? A: My greatest accomplishment has been landing/earning a role where my particular skills can make a difference with a patient, a tech and within my community.

Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT FIVE YEARS? A: I want to continue creating dynamic and caring teams. I also want to ensure that those who seek success with integrity, a willingness to work and provide genuine care for our patients have a path to reach their goals. I’d also like to continue being a part of UCSF Radiology. They provide me with a path to care for and support our community. The director and management team is absolutely supportive and encouraging of my ideas and endeavors to continually improve not only the department but myself. • ADVANCING THE IMAGING PROFESSIONAL

Alpana Patel Camilli says her greatest accomplishments include making a difference in her community.

FUN FACTS Favorite Hobby: I am an avid birder. I also like cultivating a variety of orchids and succulents

Favorite Food: I love Mexican food, Turkish food and my mom’s homemade Indian food.

One Thing on Your Bucket List: My dad climbed to basecamp Everest at 70 years old; now that’s a bucket list item! I’d really like to visit Africa and Greece.

Any Secret Skills? I like writing fiction essays and have written many creative non-fiction stories about my grandparents’ lives in India for our family to share with younger generations.

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SPOTLIGHT

IN FOCUS SANDY MICHALSKI

BY JOHN WALLACE

hen it comes to health care professionals, it is not uncommon for individuals to possess an altruistic personality. They are often selfless and self-sacrificing. It is as if they are constantly the personification of the phrase often heard around Christmas: “It is better to give than to receive.”

A high school aptitude test jump started Sandy Michalski’s career.

ICEMAGAZINE | SEPTEMBER 2020

One such health care professional is Bon Secours Mercy Health (BSMH) Regional Director-Imaging Sandy Michalski. Her journey started with an aptitude test in high school. “I scored high in health care-related interests, and I knew I would choose a career in which I could help people. The day I injured my foot by stepping on a needle, I had an X-ray. When I peeked at the film (back then it was film), and saw the needle nicely lodged in my foot, I knew radiology was for me,” Michalski says. “I was fascinated by the technology and felt very cared for by the technologist who took my X-ray.” Many a technologist have launched a career by their interactions with patients. And, no doubt, Michalski’s approach to imaging and her many responsibilities will motivate more individuals to enter the field. It will

also motivate those already working within imaging to reach new heights. When asked why she loves her job, her answer was a reflection of her outlook on life. “I draw energy from other people. Building relationships is one of my strengths, and imaging touches so many aspects of the care continuum. I enjoy the opportunities to interact with folks in different roles, and work on aligning towards common goals. I feel great joy in collaborating with others in order to enhance the services we are providing, and the care we show to our patients,” Michalski said. “The organization I have dedicated my career to is a faith-based organization, and that foundation is what drives me to be better, and take good care of those in need, whether that is staff or patients.” “I believe that any thing that I have accomplished in my life, I did not do alone. However, I do feel a sense of accomplishment when a person I mentored as a student or tech early in their career, achieves their goals in their chosen profession; whether it is advancement within the imaging field, or something different,” she added. As an imaging leader, Michalski said it is important for her to adjust her approach to best connect with those she works with at BSMH. “Understanding how differently people learn, communicate, manage change, and their need for recognition is crucial in gaining buy-in. The only constant in health care ADVANCING THE IMAGING PROFESSIONAL

SANDY MICHALSKI

Regional Director-Imaging, BSMH-Toledo What is the last book you read? Or, what book are you reading currently? “Great on the Job” by Jodi Glickman Favorite movie? I’m a huge Marvel fan so currently it’s “Avengers: End Game.” The movies I will watch every time: “The Ten Commandments” and “Wizard of OZ.” What is something most of your coworkers don’t know about you? I’ve flown in a Huey Helicopter and been inside a M1 Abrams Tank.

Who is your mentor? Personally: my grandmother Professionally: Jason Theadore What is one thing you do every morning to start your day? Protein shake followed by a cup of coffee. Best advice you ever received? Don’t have regrets; that keeps you in the past, but rather understand what lessons you learned from that experience and move forward.

is change and being able to lead others through change is key,” she explained. “Realizing the difference between managing and leading is often lost. Having the ability to understand an individual’s viewpoint, and from what lens they are viewing a situation, helps me to tailor the approach and conversation.” Michalski stressed that one lesson she has learned during her career is the importance of planning as well as the vital role rest plays in being the best possible version of one’s self. “Be organized and deliberate in what you say and what you do. Learn how to positively influence and support others in order to build trust. When communicating, answer questions before they are asked. And, most importantly, learn to disconnect,” she said. “You cannot be affective if you are not firing on all cylinders.” Michalski added that it is also very important to be an active learner and stay abreast of what is happening in the industry. She said it is also important to work on one’s strengths and weaknesses. “Someone once told me I tend to over-analyze situations. I realized what I thought was a skill, caused me not to trust my gut. I have a strong intuition and was convinced to just go with it. Being self-aware is very important, WWW.THEICECOMMUNITY.COM

Who has had the biggest influence on your life? My “3” boys. They make me laugh, keep me grounded, are my biggest cheerleaders, and remind me life is short and enjoy the moment! What would your superpower be? X-ray vision – but seriously, teleportation. What are your hobbies? Gardening, birdwatching, sports (watching, not participating) What is your perfect meal? Anything tasty prepared by someone else.

Sandy Michalski draws energy from being around others, including her BSMH team.

take time to self-reflect and know your strengths and weaknesses. Share your strengths and work to improve your weaknesses,” she said. “Anyone can manage, not everyone can be a leader.” Away from work, Michalski has the “best” family. “My wonderful, supportive husband, Mark, of 27 years still makes me laugh out loud! He is retired and takes care of everything from the house to our beautiful yard, which helps me be able to relax after working long hours,” she explained. “I have two favorite sons; Ross is 26. He is one of the happiest,

loving-life people I know. He takes care of dogs that are being trained as service and therapy dogs and loves that he is doing something that will change someone’s life forever. Davis is 22 and will soon move to Indianapolis to begin a career in orthopedic medical device sales. We will miss him terribly. He is the calming influence on the family, a sports nut and has a great sense of humor. He is a true gentleman. And, we can’t forget Denver-Dog. He came into our lives as Ross’ therapy dog, but soon grew to be all of ours’ therapy dog.” •

ICEMAGAZINE

SPOTLIGHT

Rad idea

BY ERNESTO “ERNIE” CERDENA

DAILY TEAM HUDDLE AND TOUCHPOINT

eam communication and transparencies are more important than ever. A daily huddle provides an avenue to communicate effectively within your workforce before the day begins. The brief communication via phone, video call or in person, typically runs about 7 to 15 minutes. Brief discussions include important elements that will make up the day’s game plan. These items may include daily census, equipment issues, supplies or drug shortages, staffing model/ assignments, employee accomplishment/celebration, patient safety issues from the last 24 hours, anticipated issues within the next 24 hours and other items that are vital to operational efficiencies and excellence in patient care. The Daily Team Huddle is a best practice that every organization should emulate. Depending on the organization, the huddle may be called daily management system, daily touchpoint or daily briefing. During my tenure as a corporate director 14

ICEMAGAZINE | SEPTEMBER 2020

of radiology services at a hospital, I usually gathered the team around 8:15 a.m. to conduct the huddle. I usually rotated the employees to take the lead to foster employee engagement and embrace the process. We started by first recognizing employees’ safety catches. The other important component is identifying the current census and anticipated volume for the day to adjust to an appropriate staffing level to improve patient care. As a leader, on one hand, it is important to ascertain that the increase in volume matches the patient-staff ratio to ensure patient safety is achieved and mitigates patient care delay. On the other hand, the leader would adjust the staffing level when the census is down to achieve the desired staffing productivity level toward efficient imaging operations. Equipment downtime must be reported, more specifically in some modalities, without redundancy. Identifying outstanding equipment issues enables the leader to communicate to the in-house biomed engineering department or OEM to prioritize repairs. At MTMI, we perform daily touchpoints twice a day. The first one is at 8:30 a.m. to address any issues from the

courses held within the last 24 hours and any anticipated issues for the next 24 hours. Issues may include a student’s access to the program or a presenter’s issue with audio and video among other issues. We also discuss staff assignments for the day. These may include speakers’ presentation materials, content review, dry run, accreditation review and approval, customer service, marketing plan and strategies, and many action oriented items that are crucial to the day’s effective operations. The afternoon touch point is at 3 p.m. and is dedicated to review daily registration activity. The focal point of the brief huddle includes enrollment increase, course volume stagnation and strategies to identify the target audience and improve volume. Ultimately, the daily team huddle, or touch point, reinforces the importance of teamwork, forward thinking, formulation and execution of effective strategies to achieve set goals. • ERNESTO “ERNIE” CERDENA, Ph.D, MS RT (R)(CT)(CV), CRA, FAHRA, FACHE, is President at MTMI Global. Share your RAD IDEA via an email to editor@mdpublishing.com.

ADVANCING THE IMAGING PROFESSIONAL

SPOTLIGHT

Off Clock THE

JACQUI ROSE MBA, CRA, FAHRA, RT(R) BY MATT SKOUFALOS

hat do you do when you have an inclination toward service, an inner “science nerd” that loves technology, and a passion for learning? For Jacqui Rose, the answer turned out to be a career in health care. What started as a radiologic technology degree earned in 1988 evolved into a 32-year medical imaging career, 28 of which have been spent in management roles. Today, Rose is the director of medical imaging, telecommunications, IT, and lab at Upper Valley Medical Center and Miami Valley Hospital North, which are associated with the five-hospital Premier Health system, headquartered 16

ICEMAGAZINE | SEPTEMBER 2020

in Dayton, Ohio. Moreover, she is the 2019-2020 president-elect of the Association for Medical Imaging Management (AHRA). “When I was trying to decide what I wanted to do when I grew up, I knew I wanted to get into health care because I knew I wanted to help people,” Rose said. “I started in ultrasound, and found my love in diagnostic radiology. That fit my needs, and I was able to help others in a way that fit my purpose.” Rose also has found significant strength of purpose in her out-of-work volunteerism. While her children were growing up, she dedicated herself to their activities; as they entered their college years, she shifted her focus to her own professional sphere. She began lending her time to the AHRA Radiology Administration Certification

Committee (RACC), which oversees the Certified Radiology Administrator (CRA) certification program. After five-and-a-half years on the RACC, Rose was elected to the AHRA board of directors, and was named AHRA president-elect last year. In August 2020, she will assume the presidency of the organization. As she continues to develop a strategic plan for her upcoming term, Rose said she wants AHRA to explore ways to transform its operations to meet “the new norm” of a country in the grip of the novel coronavirus (COVID-19). “Although it doesn’t drive everything that we do, it really changed our perspective when COVID struck, and we realized we’ve got to be more nimble and agile to meet the needs of our members and non-members in a different way,” Rose said. ADVANCING THE IMAGING PROFESSIONAL

Jacqui Rose is active in Rotary Club.

“We’re looking at redesigning our approach for members and non-members,” she said. “We’ll be continuing on and building on what the AHRA diversity group has developed, and see how that fits into our transformation process for our association.” Diversity and inclusion are key areas in which Rose would like to see the association advance under her presidency. Rose said she would like to see “a transformed inclusion model that ensures the survivability of the association” so that it can sustain its operations in the future. “One of the things we realized loud and clear during COVID is that we have a solid foundation, but we can’t take that for granted,” she said. “We have to make sure that we sustain that for our members for the future. We’re going to be looking at everything we do and how we do it to make sure that our members and our customers are getting everything they need to be successful.” Beyond her work with AHRA, Rose also serves on the executive committee for the United Way of Miami County,

Ohio. She will be its second vice-chair next year, with a planned ascension to chairing the organization in a few more years. In addition, Rose is a longstanding member of the local chapter for the Troy, Ohio Rotary Club, of which she has recently been named vice president. Furthermore, she’s participated for years in a lunch buddy program, mentoring at-risk youth in the local school system through a series of lunch dates. Asked why she feels compelled to participate in so many organizations, Rose said, self-evidently, “It’s just giving back.” “I enjoy giving and spending time with others and learning and growing,” she said. “My mission and my purpose in life is to have a positive impact on every person I interact with. My other goal is to learn something from every person I interact with. All of these opportunities not only give me a chance to give back to my community, but also to learn and grow in new ways.” Rose’s perspective on service has been informed by the leadership roles she has assumed both at work and

in her private life. She believes her leadership of those she supervises influences their interactions “with people you don’t even see.” Rose views her role in terms of creating a place of safety and professionalism in a hospital setting where patients “are coming to us because they’re anxious and concerned.” “They know something’s wrong; they don’t know what it is,” Rose said; by definition, the imaging department is there to offer useful insight that can help make things better. A crafting hobbyist, Rose said she also tries to infuse workplace activities with “fun stuff that helps take the pressure off. “What we do is hard, and we all need that outlet,” she said. Rose also credits the love of her family – 24-year-old Alyssa is a third-year physical therapy doctorate student, and 27-year-old Brandon, a construction project manager – with fueling her pursuits. Her husband Tom is a design engineer who “keeps everything grounded and solid for me,” Rose said. •

Jacqui Rose (third from left) is president-elect of the Association for Medical Imaging Management (AHRA).

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ICEMAGAZINE

SHOWCASE iMed Biomedical

Leading the Industry in Biomedical Solutions

COMPANY SHOWCASE i

Med Biomedical Inc. (iMed) in May of this year announced its ISO 9001:2015 and 13485:2016 certifications. As part of the ISO certification process, iMed engaged in a rigorous audit of its product and service quality requirements. The FDA has conducted market research on third-party service organizations in the equipment repair industry and concluded that there is not enough information to determine if non-OEM organizations would negatively or positively impact patient safety or quality of care. Lastly, the FDA recommended that third-party service companies obtain an ISO certification to improve consistency of services and reduce liability. Becoming dual certified, showcases iMed’s dedication to the quality of the services and products it provides. “We continue implementing the ISO standard and keep looking for ways to improve. As a team, we will constantly look for opportunities to build and support the industry with products that are dependable yet coupled with innovation and creativity,” a press release from iMed states. ICE magazine recently interviewed iMed Biomedical Inc. Director of Operations Russender Powell to find out more about the company. 18

ICEMAGAZINE | SEPTEMBER 2020

Q: Can you share a little bit about your company’s history and how you achieved success. Powell: iMed Biomedical Inc. is leading the industry in biomedical solutions. Our company has a rich history while uniquely positioned as a market innovator by providing highly customized mission critical technology to both supply-side health facilities and demand-side medical supply distributors. While I am very proud of our heritage, I am more excited about our future. iMed Biomedical Inc. was built on the foundation of four guiding principles. Our guiding principles are designed to reflect our culture, values and beliefs. I am personally committed to uphold our principles in decisions that help shape our strategy, growth and success.

Q: What are iMed Biomedical’s four guiding principles? Powell: Our guiding principles are affectionately called the 4Ps. Our four guiding principles are as follows: • People Our goal is to hire, retain and reward talented, dedicated and intellectually curious people. Our people are the differentiator that distinguishes our company from the competition. • Product Build and support industry leading

RUSSENDER POWELL

iMed Biomedical Inc. Director of Operations

products and services – our products must be dependable yet coupled with innovation and creativity. • Purpose Develop an environment in which employees, customers and vendors feel connected to each other and our business. By giving of ourselves to others our lives will be enriched. • Profits As a result of delivering great products, produced and supported by great people that possess a sense of purpose, our customers will increase their profits. As a result of our customer’s success, we will increase our profits. ADVANCING THE IMAGING PROFESSIONAL

SPONSORED CONTENT

iMed Biomedical’s dual ISO certification illustrates the company’s dedication to quality.

Q: Can you tell our readers more about the ISO certifications? Powell: We obtained both ISO 9001:2015 and ISO 13485:2016. The primary difference between ISO 13485 and ISO 9001 for medical devices is the scope of these quality standards. ISO 9001 is the international standard which provides specifications for a quality management system which can be applied at any organization regardless of industry, product or service, or company size. ISO 13485 is a comprehensive management system specifically for the manufacture of medical devices.

Q: Why did iMed want to earn the ISO certifications? Powell: We obtained both certifications because we wanted to mirror the same standard and requirements that the OEM must meet to gain FDA clearance. Our certification is a testament to the care and diligence that we deliver to our customers daily in providing the best service possible.

Q: Can you briefly explain the ISO process? Powell: There is nothing brief about the ISO process. To start the ISO process, you must create a Quality WWW.THEICECOMMUNITY.COM

Management System (QMS) that includes your policies, processes and procedures to execute a core function of the business. Your management team will assign process owners for each core function of the QMS and monitor performance goals and execution. Each process owner will document non-conformance, maintain risk management records, and provide feedback to the team, which will guide toward continual improvement. Once you feel like you have established processes and procedures and data to show that your QMS is effective, reach out to a certified auditing firm to establish your audit plan and timeline.

Q: Can you describe the ISO process for refurbishing imaging parts? Answer: For parts that have been identified as having a high failure rate, we have work instructions that detail the steps to begin the repair and testing of each component of the unit. Once the appropriate tests are completed, qualifying parts are moved to the process of refurbishing. The refurbishing process begins with component and subcomponent checks; replace-

ment of worn parts with original spare parts, software updates with optional upgrades, individual configuration, and performance check comparable to a new system. Then, move to cleaning and disinfection.

Q: What did iMed learn during the process to help it better serve customers? Answer: We learned how to integrate a strategic review of customer feedback as well as our performance into our continual improvement plan. Also, there has been a move to better methods developed to obtain customer feedback from surveys and questionnaires. Risk assessment and terms agreement procedures to that have reduced customer complaints. Also, we have been able to provide service that is more prescriptive to our customer’s needs. •

FOR MORE INFORMATION, please visit imedbiomedical.com

ICEMAGAZINE

NEWS

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

MIM SOFTWARE INC. INTRODUCES MIM HARMONY MIM Software Inc. recently introduced MIM Harmony, a dedicated solution for peer learning, plan evaluation and practice improvement. MIM Harmony addresses many common shortcomings experienced by clinicians within the peer review process, including undetected plan errors, time constraints and a lack of standardized documentation. “Empowering effective collaboration is a critical piece in meeting current quality demands. However, the amount of constraints placed on clinicians today makes achieving this incredibly difficult,” said Andrew

Nelson, chief executive officer of MIM Software Inc. “MIM Harmony is intentionally designed to address today’s peer review constraints.” MIM Harmony’s intuitive worklist, task automation, reporting tools and analytics enhance multiple peer review formats, including chart rounds, contour rounds and one-on-one consults. Through easy access to treatment plan data and seamless capture of all peer activity, MIM Harmony elevates peer review to empower data-driven peer learning and practice improvement.•

RADNTX EXPANDS, ADDS 28 RADIOLOGISTS Radiology Associates of North Texas, P.A. (RADNTX) has announced that Tyler Radiology Associates and East Texas Radiology Consultants are merging with RADNTX. With this merger, RADNTX is welcoming 28 new radiologists, expanding the practice to over 200 physicians. RADNTX continues to be the largest private radiology practice in Texas and one of the largest in the nation with plans for continued expansion. Both practices decided to merge after connecting with RADNTX’s Independent Radiology Network (IRN). The IRN is designed to provide expanded resources and improved quality for private practice radiology practices throughout Texas and the surrounding states. Partnering

ICEMAGAZINE | SEPTEMBER 2020

with other high-performing regional radiologists is a foundational endeavor of RADNTX’s physician leadership. RADNTX’s goal through the IRN is to provide Texas-based radiology practices, who desire to remain independent and wholly physician-owned but require expanded service levels, access to RADNTX’s infrastructure. Through the IRN, RADNTX is able to provide practices with information technology services that include an integrated worklist driven platform, as well as billing and revenue cycle management, clinical coordination, increased sub-specialization, overnight final reads, quality and compliance programs, analytics and reporting, business services and more. Both practices ultimately decided to merge. •

ADVANCING THE IMAGING PROFESSIONAL

ASE ELECTS NEW PRESIDENT Judy W. Hung, MD, FASE, is the new president of the American Society of Echocardiography (ASE). She has served on the board of directors as vice president and president-elect prior to ascending to her one-year presidency. Hung shared her vision for the future of ASE on August 8, during the opening session of the ASE 2020 Scientific Sessions Virtual Experience. When asked about her upcoming presidency, she said “I see tremendous opportunity for ASE to advance its mission to be the leader of quality, education, innovation, research and advocacy in the field of cardiovascular ultrasound. ASE is currently well-positioned to adapt to the changing and challenging health care environment and to lead innovation in echocardiography through its international repu-

tation, organizational infrastructure, and commitment to quality and research. I have a deep admiration and belief in the goals and mission of the ASE and the dedication of my ASE member colleagues.” Hung is director of the echocardiography lab, division of cardiology, at Massachusetts General Hospital and professor of medicine at Harvard Medical School. She has a special interest in valvular heart disease, coronary artery disease and optimizing noninvasive cardiac imaging techniques to improve diagnosis and treatment of heart disease. Her research involves understanding mechanisms of valvular heart disease and development of novel therapies to treat valve disease. • For more information, visit https://bit.ly/2NNcL0l.

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FUJIFILM SONOSITE, EMF BATTLE COVID-19 FUJIFILM Sonosite Inc. and the Emergency Medicine Foundation (EMF), a 501(c)(3) nonprofit organization founded by the American College of Emergency Physicians (ACEP), have announced a partnership on the EMF COVID-19 Research Grant program. To support this program, FUJIFILM Sonosite is contributing a $90,000 research grant and soon to be released Sonosite PX point-of-care ultrasound (POCUS) systems. The COVID-19 pandemic has affected 188 countries, with over 10 million confirmed cases and 500,000 deaths as of July 2020. More research is critically needed to understand the pathophysiology of COVID-19 and how to manage patients for improved outcomes and reduced mortality rates. The goal of the EMF’s COVID-19 grant is to conduct research with the participation of emergency medicine physicians, and to provide high-impact, new knowledge to advance emergency patient care, improve response of healthcare EMS systems and protect emergency medicine health care professionals during pandemics. “From an early stage in this pandemic, we learned how frontline emergency physicians were using point-of- care ultrasound to assess this deadly illness. Despite their remarkable progress, we recognized more research was required as unfortunately the pandemic continues to grow,” said Diku Mandavia, MD, FACEP, senior vice president, chief medical officer of FUJIFILM Sonosite. “We’re proud to collaborate with ACEP and EMF in a time when we are still learning more about this disease and how to best care for patients. As a powerful and portable imaging modality that provides critical answers at the bedside, we believe point-of-care ultrasound can be integrated into more COVID-19 care pathways.” “We are grateful to have FUJIFILM Sonosite’s support to further investigate the role ultrasound plays in this catastrophic disease,” said David Wilcox, MD, FACEP, cChair of the EMF Board of Trustees. “For the industry to truly overcome COVID-19 and prepare for future pandemics, we must more specifically understand how diagnostic imaging innovations may improve the quality of care, as well as patient and staff safety.” • For more information, visit emfoundation.org/apply.

ICEMAGAZINE | SEPTEMBER 2020

JEFFERSON RADIOLOGY IMPLEMENTS iCAD PROFOUND AI PLATFORM Jefferson Radiology is implementing state-ofthe-art artificial intelligence software for digital breast tomosynthesis (DBT) to improve cancer detection rates and enhance overall quality of patient care. iCAD ProFound AI is an advanced deep-learning, cancer detection software solution that has been shown to detect more cancers, with fewer unnecessary callbacks, and in less than half the time. Jefferson Radiology is not only the first, but currently the only practice in the state of Connecticut to offer ProFound AI. “This new technology is revolutionizing breast cancer detection and has improved our workflow efficiency. This means more time with our patients, cancers detected earlier than ever before, and ultimately, better health outcomes for our communities,” said Diana James, MD, section chief of breast imaging at Jefferson Radiology. Incredibly powerful, the new software is designed to run while a radiologist is actively performing a study. As the physician reads a case, ProFound AI uses the latest in artificial intelligence, paired with pattern recognition technology, to assess each image and help identify potential areas of concern. It does this quickly using its algorithm that is trained with one of the largest 3D datasets available, while providing radiologists with potentially life-saving information, including Certainty of Finding lesion and Case Scores. “Combined with our highly trained, sub-specialized breast imaging team and our new suite of Genius 3D mammography units – the most advanced 3D mammogram available on the market, ProFound AI is the next step towards offering our patients, referring physicians and radiologists the best in breast imaging care,” said Luce Buhl, senior director of operations at Jefferson Radiology. The implementation was completed on June 2, 2020, and patients at each of the practice’s nine locations will benefit from this new technology. •

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LUNIT EXPANDS COLLABORATION WITH GE HEALTHCARE Lunit recently announced the expansion of its collaboration with GE Healthcare. This collaboration between GE Healthcare and Lunit will help make AI algorithms more accessible to clinicians, alleviate clinical strain and streamline workflows – supporting better patient outcomes. GE Healthcare recently introduced its Thoracic Care Suite featuring a collection of eight artificial intelligence (AI) algorithms from Lunit INSIGHT CXR. The AI Suite quickly analyzes chest X-ray findings and flags abnormalities to radiologists for review, including pneumonia, which may be indicative of COVID-19 as well as tuberculosis, lung nodules and other radiological findings. This collaboration between GE Healthcare and Lunit is one of the first of its kind to bring commercially available AI products from a medical AI startup to an existing X-ray equipment manufacturer – making Lunit INSIGHT CXR available via Thoracic

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Care Suite to GE Healthcare’s thousands of global fixed, mobile and R&F X-ray customers at point of sale. “As a startup company, our vision is to have AI to be recognized as the new standard of care,” says Brandon Suh, CEO of Lunit. “We have been applying our AI into various types of medical images. Among them, Lunit INSIGHT CXR is one of our major products that has been commercialized since a few years ago. To have our AI made available with a market-leading vendor like GE Healthcare – especially as part of the Thoracic Care Suite – is a significant advancement in delivering solutions to various customers within GE Healthcare’s install base and bringing us all one step closer to embracing AI as a part of today’s standard of care. We will continue to push forward and cooperate with market leaders through extended partnerships and collaborations, increasing the number of global use cases of our AI.”•

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HOLOGIC LAUNCHES CART-BASED ULTRASOUND SYSTEM Hologic Inc. has announced the U.S. launch of the SuperSonic MACH 40 ultrasound system, expanding the company’s suite of ultrasound technologies with its first premium, cart-based system. The new system features excellent image quality, standard-setting imaging modes and is designed to enhance efficiency and accuracy. “As the leader in breast imaging, we’re committed to delivering insight-driven solutions that optimize patient care across the full continuum of care for breast health – from screening to treatment,” said Pete Valenti, Hologic’s division president, breast and skeletal health solutions. “With the addition of the SuperSonic MACH 40 system, we’ve successfully built a comprehensive portfolio of innovative, standard-setting breast ultrasound solutions designed to better meet the needs of breast imagers. The SuperSonic MACH 40 system embodies our commitment to delivering future-oriented solutions and was designed to help health care professionals reduce unnecessary biopsies by eliminating re-scans, reducing lesion correlation time and improving overall diagnostic accuracy.” The SuperSonic MACH 40 system leverages exclusive UltraFast imaging technology – inspired by cutting-edge graphics innovations from the video gaming industry – to provide greater frame rates of up to 20,000 images per second. The technology also enables innovative imaging modes, without the trade-offs present in conventional systems. This forward-thinking, powerful architecture primes the system for future integrations and AI-driven innovations. The new system is further enhanced by exceptional B-mode imaging technology, which helps improve diagnostic confidence thanks to smoother images with reduced speckle, clearer images across all tissue densities

ICEMAGAZINE | SEPTEMBER 2020

and improved lesion conspicuity. It also features the third generation of shear wave-based elastography technology, ShearWave PLUS, which provides additional diagnostic information that may help with patient management, including diagnostic workup of breast lesions, lesion targeting during ultrasound-guided biopsy and lesion size measurement. Three innovative imaging modes come together in TriVu imaging, where morphology, stiffness and blood flow can all be analyzed simultaneously in the same image. “Hologic continues to expand its portfolio with the patient and clinician in mind, and that’s apparent with the recent SuperSonic Imagine acquisition and new innovations,” said Stacy Smith-Foley, MD, medical director of the breast center at CARTI in Little Rock, Arkansas. “The result has been a consistently growing suite of tools that truly complement each other and help me and my colleagues to efficiently care for our patients on a dayto-day basis across the entire breast health continuum.” Clinicians performing precision-dependent ultrasound-guided biopsies with the SuperSonic MACH 40 system can also enjoy enhanced control with Needle PL.U.S. imaging, which enables visualization of both the biopsy needle and anatomical structures in real time and predicts the needle trajectory. The SuperSonic MACH 40 system streamlines workflow with intuitive design and enhanced comfort. Thanks to the SonicPad multi-touch trackpad, the new system helps physicians focus on imaging without the distractions of unnecessary user movements, thus enhancing workflow and increasing patient throughput. The SuperSonic MACH 40 system is part of a growing portfolio of ultrasound solutions resulting from Hologic’s recent acquisition of SuperSonic Imagine. •

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Knowledge. Experience. Integrity. < / ŚĞůƉƐ ǇŽƵ ĚĞůŝǀĞƌ DZ/ ĂŶĚ d /ŵĂŐŝŶŐ ^ĞƌǀŝĐĞƐ ƚŽ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͘ KEI helps you deliver MRI and CT Imaging Services to your tŝƚŚ ŽƵƌ ƚĞĂŵ ŽĨ ƐĞƌǀŝĐĞ ĞŶŐŝŶĞĞƌƐ ĂŶĚ ŝŶǀĞŶƚŽƌǇ ƐƉĞĐŝĂůŝƐƚƐ͕ < / ŝƐ ǇŽƵƌ WŚŝůŝƉƐ ƌĞƐŽƵƌĐĞ patients. With our team of service engineers and inventory ĨŽƌ ƐǇƐƚĞŵ ƉĂƌƚƐ ĂŶĚ ĨŝĞůĚ ƐĞƌǀŝĐĞ͘ < / ƌĞĂĐŚĞƐ ĞǀĞƌǇ ƚŝŵĞ ǌŽŶĞ ĂŶĚ ǁŽƌŬƐ ƚŽ ŵŝŶŝŵŝǌĞ ĚŽǁŶ ƚŝŵĞ ĂŶĚ ĐŽƐƚůǇ ĚŝƐƌƵƉƚŝŽŶƐ ƚŽ ǇŽƵƌ ǁŽƌŬĨůŽǁ͘ WĂƌƚŶĞƌ ǁŝƚŚ < /͕ ĐĂůů ƚŽĚĂǇ͘ specialists, KEI is your Philips resource for system parts and

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Carestream Health’s ImageView software has received the Risk Management Framework Authority to Operate from the Department of Defense, paving the way MRI & CT Services MRI & CT Parts for streamlined installations for defense customers. Defense Health Agency (DHA) Cybersecurity Logistics (CyberLog), part of DHA’s Medical Logistics (MEDLOG) keimedicalimaging.com Directorate, is widely considered to have extremely Tel: 512.477.1500 rigorous cybersecurity requirements. Email: info@keimedicalimaging.com The Authority to Operate (ATO) process took six months to complete, a rare occurrence given heightened cybersecurity efforts across the globe. With the ATO in place, Carestream’s cyber team has received Knowledge. Experience. Integrity. accreditation for Carestream ImageView Software v.1 < / ŚĞůƉƐ ǇŽƵ ĚĞůŝǀĞƌ DZ/ ĂŶĚ d /ŵĂŐŝŶŐ ^ĞƌǀŝĐĞƐ ƚŽ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͘ tŝƚŚ ŽƵƌ ƚĞĂŵ ŽĨ ƐĞƌǀŝĐĞ ĞŶŐŝŶĞĞƌƐ ĂŶĚ ŝŶǀĞŶƚŽƌǇ ƐƉĞĐŝĂůŝƐƚƐ͕ < / ŝƐ ǇŽƵƌ WŚŝůŝƉƐ ƌĞƐŽƵƌĐĞ in the Department of Defense (DoD), with plans to ĨŽƌ ƐǇƐƚĞŵ ƉĂƌƚƐ ĂŶĚ ĨŝĞůĚ ƐĞƌǀŝĐĞ͘ < / ƌĞĂĐŚĞƐ ĞǀĞƌǇ ƚŝŵĞ ǌŽŶĞ ĂŶĚ ǁŽƌŬƐ ƚŽ ŵŝŶŝŵŝǌĞ ĚŽǁŶ ƚŝŵĞ ĂŶĚ ĐŽƐƚůǇ ĚŝƐƌƵƉƚŝŽŶƐ ƚŽ ǇŽƵƌ ǁŽƌŬĨůŽǁ͘ WĂƌƚŶĞƌ ǁŝƚŚ < /͕ ĐĂůů ƚŽĚĂǇ͘ support Veteran Affairs in the future. A productive keimedicalimaging.com collaboration between Carestream’s Cyber, Information Tel: 512.477.1500 Email: info@keimedicalimaging.com Technology and Governmental Solutions teams along Member of IAMERs with DoD authorities led to a successful ATO process. “Carestream has a long-standing history of dediNO FUR cation to cybersecurity, for both our commercial and LOOK TH ER government customers globally,” said Garrett Hunt. ley, director of government solutions at Carestream. < / ŚĞůƉƐ ǇŽƵ ĚĞůŝǀĞƌ DZ/ ĂŶĚ d /ŵĂŐŝŶŐ ^ĞƌǀŝĐĞƐ ƚŽ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͘ “Maintaining our ATO status and partnership with the tŝƚŚ ŽƵƌ ƚĞĂŵ ŽĨ ƐĞƌǀŝĐĞ ĞŶŐŝŶĞĞƌƐ ĂŶĚ ŝŶǀĞŶƚŽƌǇ ƐƉĞĐŝĂůŝƐƚƐ͕ < / ŝƐ ǇŽƵƌ WŚŝůŝƉƐ ƌĞƐŽ Department of Defense and the Defense Health Agency through a rigorous continuous monitoring programĨŽƌ ƐǇƐƚĞŵ ƉĂƌƚƐ ĂŶĚ ĨŝĞůĚ ƐĞƌǀŝĐĞ͘ < / ƌĞĂĐŚĞƐ ĞǀĞƌǇ ƚŝŵĞ ǌŽŶĞ ĂŶĚ ǁŽƌŬƐ ƚŽ ŵŝŶŝŵ is a top priority for Carestream. We are very proud to helpĚŽǁŶ ƚŝŵĞ ĂŶĚ ĐŽƐƚůǇ ĚŝƐƌƵƉƚŝŽŶƐ ƚŽ ǇŽƵƌ ǁŽƌŬĨůŽǁ͘ WĂƌƚŶĞƌ ǁŝƚŚ < /͕ ĐĂůů ƚŽĚĂǇ provide our nation’s service men and women with the very best clinical care through the use of our innovative imaging technology.” Tel: 512.477.1500 Email: info@keimedicalimaging.com Clinical acquisition software designed to support Member of IAMERs advanced applications, the ImageView platform enables health care systems and hospitals to enhance productivity and patient care while supporting Carestream’s GE • TOSHIBA • SIEMENS • PHILIPS state-of-the-art image processing. ImageView software is available with Carestream’s DRX-Evolution Plus System, DRX-Revolution Mobile X-ray System, DRX-Transportable System/Lite as well as GE • TOSHIBA the OnSight 3D Extremity Imaging System. • SIEMENS • PHILIPS

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COVID-19 HINDERS RADIOLOGY PRACTICES Private radiology practices have been especially hard hit by the COVID-19 pandemic, and the steps they take to mitigate the impact of the pandemic on their practice will shape the future of radiology, according to a special report from the Radiological Society of North America (RSNA) COVID-19 Task Force, published in the journal Radiology. The COVID-19 pandemic resulted in widespread disruption to the global economy. The resulting reduction in demand for imaging services had an abrupt and substantial impact on private radiology practices, which are heavily dependent on examination volumes for practice revenues. Examination volumes in radiology practices have decreased by 40%-90%. The volume reduction is anticipated to persist for anywhere from a few months to a few years. Private practice radiologists make up a substantial proportion of the specialty, accounting for approximately 83% of all practicing radiologists in 2019. The report describes specific experiences of radiologists working in various types of private practices during the initial peak of the COVID-19 pandemic and presents a detailed case study of a private radiology practice impacted by the pandemic. The authors outline factors determining the impact of the pandemic on private practices, the challenges practices have faced and the financial adjustments made to mitigate losses. “For many practices, caring for patients with COVID-19 increased the complexity of the financial impact,” said lead author Richard E. Sharpe Jr., M.D., M.B.A., senior associate consultant at Mayo Clinic in Scottsdale, Arizona. “Volumes of advanced imaging, a higher reimbursement service for many practices, were reduced while low reimbursement services, such as radiography, often increased. At the same time, performing these low reimbursement services in ways that minimized the risk of virus transmission to staff and other patients increased the time and resources required to perform these services. These challenges were often most pronounced in private practices that included a hospital-based component to their practice, and which cared for COVID-19 patients with moderate

ICEMAGAZINE | SEPTEMBER 2020

and severe symptoms.” In addition to financial burdens, tremendous variability in interpretations of state-level practice guidance existed, even in the early affected Seattle area. For example, some practices in Seattle maintained elective imaging appointments, while other groups only indicated plans to reschedule screening examinations. Still others requested that patients postpone all elective imaging. One group directed patients to reschedule only if they were symptomatic for coronavirus. In the report, Sharpe, along with coauthors Brian S. Kuszyk, M.D., and Mahmud Mossa-Basha, M.D., lay out strategic efforts that practices are making to their midand long-term plans to pivot for long-term success while managing the COVID-19 pandemic. Private radiology practices have crafted tiered strategies to respond to the impact of the pandemic by pulling various cost levers to adjust service availability, staffing, compensation, benefits, time off and expense reductions. In addition, they have sought additional revenues, within the boundaries of their practice, to mitigate ongoing financial losses. Some practices may opt to adjust employed physician contracts to better mitigate practice risk from potential future volume disruptions. Base salary may comprise a smaller portion of overall compensation, with the balance dependent on the overall financial performance of the organization and/or individual productivity. The longer-term impact of the pandemic will alter existing practices, making some of them more likely to succeed in the years ahead. Some groups may prove unable to survive the COVID-19 pandemic, potentially fueling trends either toward consolidation into larger radiology groups or toward increased employment by hospitals. “We anticipate that small radiology practices may be at greatest risk for consolidation with larger radiology groups that have a more diversified practice model regarding inpatient-outpatient mix, subspecialty service lines, and geography,” said Dr. Kuszyk, president of Eastern Radiologists in Greenville, North Carolina.•

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TURNER IMAGING SYSTEMS, SIEMENS HEALTHINEERS ANNOUNCE AGREEMENT Turner Imaging Systems has entered into a master resellers agreement which will add the Smart-C Mini C-Arm to the Siemens Healthineers portfolio of radiology and imaging products. With this agreement, Siemens Healthineers becomes the premium partner reseller to the hospital market and will focus on delivering the Smart-C to their hospital, IDN, GPO and military customers in the United States. International expansion will align with regulatory clearance to sell the Smart-C globally. The Smart-C Mini C-Arm, developed by Turner Imaging Systems, is a fully functional mini-C-arm system that is battery operated and hand-transportable, improving the way fluoroscopy is performed. The unique features of this device are its true flexibility to meet the needs of the operating room and field applications. Weighing only 16 pounds, the Smart-C Mini C-Arm can be hand-carried to the point-of-care and is battery powered for a completely wireless imaging procedure. With the high-quality imaging, system flexibility and no cords this device is revolutionary for today’s surgical settings. The agreement spans five years and provides Siemens Healthineers’ new and existing customers the opportunity to purchase this revolutionary technology through one of the world’s most respected diagnostic imaging companies. Turner Imaging Systems, based in Orem, Utah, recently received FDA 510(k) clearance of the Smart-C Mini C-Arm portable fluoroscopy X-ray imaging device. As a developer of advanced X-ray imaging systems, the inclusion of the Smart-C Mini C-Arm in the Siemens portfolio represents a significant milestone, not only for Turner Imaging Systems but also for the imaging community – patients and clinicians. •

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RAPID ASPECTS NEUROIMAGING SOLUTION RECEIVES CADx CLEARANCE FROM THE FDA RapidAI has announced that Rapid ASPECTS has received Food and Drug Administration (FDA) clearance as the first neuroimaging analysis device in the Computer-Assisted Diagnostic software (CADx) category. Rapid ASPECTS is the only neuroimaging product shown to improve physicians’ interpretations of Non-Contrast CT (NCCT) scans using a standardized ASPECT score. Validated through the rigorous FDA process, the use of Rapid ASPECTS automated score combined with the physician’s review of the scan, improves the accuracy of the ASPECT score calculation which is particularly important for less experienced readers. Based on the Alberta Stroke Program Early CT Scoring (ASPECTS) system, Rapid ASPECTS uses a validated machine-learning algorithm to automatically identify the ASPECTS regions of the brain and generate an ASPECT score to indicate early signs of brain infarction on NCCT scans – helping physicians identify areas of irreversible brain injury. By automating and standardizing this process, Rapid ASPECTS helps stroke teams across hospital sites and referral networks quickly assess patient eligibility for thrombectomy – enabling faster triage and transfer decisions that facilitate better patient outcomes. “Rapid ASPECTS represents the next AI-powered step forward in stroke imaging, and the groundbreaking CADx clearance from the FDA puts it in a class by itself,” said Dr. Greg Albers, professor of neurology at Stanford University, director of the Stanford Stroke Center and cofounder of RapidAI. “In addition to helping stroke teams with faster triage and transfer decisions, Rapid ASPECTS also improves the accuracy of typical readers.” •

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FDA CLEARS CANON MEDICAL 1.5T MR SYSTEM FOR AI-BASED IMAGE RECONSTRUCTION TECHNOLOGY Canon Medical Systems USA Inc. has received 510(k) clearance on its Advanced intelligent Clear-IQ Engine (AiCE) for the Vantage Orian 1.5T MR system, continuing to expand access to its new Deep Learning Reconstruction (DLR) technology. This technology, which is also available on the Vantage Galan 3T MR system and across a majority of Canon Medical’s CT product portfolio, uses a deep learning algorithm to differentiate true signal from noise so that it can suppress noise while enhancing signal, forging a new frontier for image reconstruction. “The Vantage Orian was designed to increase productivity while ensuring patient comfort and delivering uncompromised clinical confidence,” said Jonathan Furuyama, managing director, MR business unit, Canon Medical Systems USA Inc. “Now with the addition of AiCE, we’re elevating MR imaging capabilities for

ICEMAGAZINE | SEPTEMBER 2020

our customers by bringing the power of AI to routine imaging, allowing them to use techniques that weren’t clinically practical before.” To showcase how AiCE can help clinicians obtain higher signal-to-noise ratio, Canon Medical has launched an image challenge where visitors can compare images taken on the Vantage Orian 1.5T system using AiCE with standard 3T MRI images. 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. Capabilities include high-quality images, seamless integration into routine practice and preferred AiCE MR image quality over nonAI reconstruction images. •

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ICE

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ICE ANNOUNCES NEW FREE WEBINAR SERIES STAFF REPORT

maging Community Exchange (ICE) magazine launches its new ICE Webinars series this month! The free webinar series will provide quality educational information from industry leaders. MD Publishing, the publisher of ICE magazine, already offers free webinars through its other magazines TechNation and OR Today. ICE webinars, a cool series for hot topics, kicks off at 2 p.m. ET on September 15 with the inaugural presentation “Engaging Your Data - Making Analytics Work for You” by Jef Williams MBA, PMP, CIIP of Paragon Consulting Partners LLC. Williams is a respected member of the industry. He is also a monthly columnist for ICE magazine and sits on the publication’s editorial board. Moving forward, the ICE webinar series plans to host one webinar each month for the remainder of 2020. The plan is to hold the session at 2 p.m. ET on Tuesdays. ICE webinars will always be free thanks to generous sponsors. “It is important to us that we provide free education to the ICE community, whether that is a free subscription to the magazine, free conference admission for health care employees or free webinars,” MD Publishing Director of Sales Jayme McKelvey said. WWW.THEICECOMMUNITY.COM

“The purpose of ICE, whether we are speaking of the monthly magazine or the annual conference, has always been to foster a community for imaging professionals to share and exchange ideas on best practices, new technologies and professional development,” McKelvey added. “We felt that an ongoing webinar series would also be a perfect vehicle to help us continue growing the community created by the magazine and conference. The monthly webinars are also a great way to bring some of the articles in our magazine to life. Our first four webinars will feature ICE magazine writers. Much like the monthly magazine, we want these webinars to touch on a variety of topics that provide a full 360-degree view of what’s needed to lead or manage a successful imaging department. These webinars will touch on team building, task prioritization, data usage, leadership and more.” The ICE webinar series is seeking CE and CRA credentials from AHRA. At the time of this article, ARRT Category A CE credit is pending approval. These credentials are important to the webinar series, so that ICE can provide Certified Radiology Administrator (CRA) credits to help individuals seeking CRA renewal. • For more information, visit ICEwebinars.live for a calendar of upcoming live webinars. The website will also feature an on-demand library of webinars, so imaging professionals can access the webinars at their convenience. ICEMAGAZINE

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Market Report Global Contrast Media Market Growth Continues STAFF REPORT

n several radiology procedures, iodinated and gadolinium-based contrast media are used frequently. These agents are often crucial to providing an accurate diagnosis and are almost always effective and safe when properly administered. Gadolinium contrast media (sometimes referred to as an MRI contrast media, chemicals, or “dyes”) are chemical compounds used in MRI scans. When the gadolinium contrast medium is inserted into the body, it strengthens and boosts the accuracy of the MRI pictures (or images). It helps the radiologist to report more precisely on how the body works and whether there is any illness or abnormality present. The global contrast media market size is expected to reach $6.3 billion by 2025, rising at a market growth of 3.52% CAGR during the forecast period, according to a report from ResearchAndMarkets.com. “The contrast media market is still in the growing phase but will evolve significantly in the years to come. The factors attributing to market growth include an increase in image-guided surgical procedures, improvements in medical technology, an increase in diagnostic imaging and an increase in cancer and cardiac disorder rates,” according to the report. “Various factors such as the rise in acceptability for contrast agents and the increasing number of diagnostic centers that have expanded diagnostic imaging services contribute to the growth of the market,” the report continues. “Several advanced methods, such as the technologies used in MRI imaging is a gas microbubble, are likely to boost 32

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the market growth. Factors including growing investments in the contrast media market and the changes in the radiopharmaceuticals and health care sector are fueling the market growth.” A report from MarketsandMarkets also predicts growth. “The global contrast media market size is expected to reach $6.0 billion by 2024 from an estimate of $5.0 billion in 2019, growing at a CAGR of 3.8% during the forecast period,” according to the report. “Growth in the market can primarily be attributed to the increasing number of approvals of contrast agents, the rising volume of CT and MRI examinations globally, and the rapidly growing cancer and CVD population across the globe. Rising research activities on contrast agents and their applications are the key areas of opportunity in this market. On the other hand, factors such as side effects and allergic reactions, as well as the adverse effects associated with contrast agents are expected to limit market growth to a certain extent.” Based on indication, the market is categorized into cardiovascular disorders, cancer, gastrointestinal disorders, musculoskeletal disorders, neurological disorders and nephrological disorders. The cardiovascular disorders segment is expected to command the largest share and highest growth rate during the forecast period, according to MarketsandMarkets. “Improvements in cardiac MRI procedures in cath labs, favorable reimbursement policies for contrast media used in cardiovascular diagnosis and robust health care infrastructure in developed countries are some of the factors driving this segment,” the report states. Some leading players in the market include GE Healthcare, Bayer AG, Guerbet Group, Bracco Imaging S.p.A and Lantheus Medical Imaging. • ADVANCING THE IMAGING PROFESSIONAL

Product Focus Contrast Injectors

GE HEALTHCARE Pristina Serena Bright

Typically lesions identified with contrast enhanced mammography are sent to MRI for biopsy, but now with Pristina Serena Bright, the industry-first contrasted enhanced-guide biopsy solution, breast biopsy exams can now be performed with the same mammography equipment, with the same staff, and in the same room as the screening or diagnostic mammogram. When compared to MRI-guided breast biopsy, the potential benefits of contrast enhanced-guided biopsy include shortened procedure time, improved patient comfort and reduced cost for patients. Key to this this technology’s application is GE Healthcare’s SenoBright HD Contrast Enhanced Spectral Mammography (CESM), a diagnostic imaging tool that delivers high sensitivity for more accurate breast cancer diagnosis. By highlighting areas of unusual blood flow to help localize lesions that need to be biopsied, CESM biopsy – Serena Bright – helps improve radiologists’ diagnostic confidence with the goal of getting answers to patients as quickly as possible. •

Pristina Serena Bright will be commercially available in the United States in October 2020.

*Disclaimer: Products are listed in no particular order.

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GUERBET

Contrast Delivery Systems

MEDRAD

Stellant FLEX CT Injection System The MEDRAD Stellant FLEX CT Injection System addresses clinical and financial challenges of today’s evolving health care environment, including reduced operational budgets for hospitals which are creating the need for institutions to work more efficiently and economically, while maintaining quality patient care. Clinically, the key features of the Stellant FLEX were designed to drive workflow efficiencies, including: • Automated capture of contrast and injection parameters; reducing the number of manual tasks and potential errors • 150 mL and 200 mL syringe sizes with new beacon technology for easy visualization of fluids • Barcode identification, lot and expiry date information for increased accuracy and automation of documentation via a contrast barcode reader • Streamlined training program Financially, the TechCARE program allows radiology suites to maximize their CT equipment investment with flexible options for capital equipment purchasing. •

ICEMAGAZINE | SEPTEMBER 2020

Guerbet’s wide range of contrast delivery systems enables health care professionals to work efficiently, in any application. Each delivery system is built for optimal flexibility, efficiency and safety, ensuring that medical staff and equipment work together to provide excellent patient care. Guerbet offers a full line of injectors, prefilled syringes, consumables, digital solutions and service. •

3 ADVANCING THE IMAGING PROFESSIONAL

4 SIEMENS HEALTHINEERS Artificial Intelligence Solutions

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The SOMATOM go. CT platform – consisting of the SOMATOM go.Now, SOMATOM go.Up, SOMATOM go.All, and SOMATOM go.Top systems – was designed by Siemens Healthineers with feedback from over 500 medical professionals globally, who identified key characteristics of an ideal CT scanner. That feedback led to the development of not only key features such as the platform’s mobile, tablet-based workflow, including automated inline reconstructions, but also the gantry-mounted contrast injector arm – an alternative that addresses the cost and complexities of traditional pedestal- and ceiling-mounted injector solutions. Additionally, the SOMATOM go. CT platform’s FAST ROI (Region of Interest) feature automates detection of the aorta to help the technologist identify the optimal moment to begin contrast administration. •

ICEMAGAZINE

finance dance Variety of flexible moves exist for medical device purchases

BY MATT SKOUFALOS

ICEMAGAZINE | SEPTEMBER 2020

ADVANCING THE IMAGING PROFESSIONAL

apital equipment purchases can be among the most technically complicated business decisions that any health care organization makes. As economic conditions become increasingly volatile amid the global novel coronavirus (COVID-19) pandemic, those complications have only become more labyrinthine amid statutory shutdowns of health care facilities and corresponding slowdowns in the patient volumes upon which most imaging revenue cycles turn. However, in the midst of that chaos, a variety of flexible solutions exist for those entities looking to buy, lease or simply shop for new medical imaging equipment. Chris Fletcher, senior vice-president of national accounts for Crest Capital of Alpharetta, Georgia, said financial mechanisms aren’t constrained to the costs of a specific piece of technology itself. “Soft costs,” from installation and training to taxes and delivery fees, may comprise as much as 25 percent of a deal; financing options may even be leveraged for fees associated with extended warranties or service agreements. The majority of the items for which Fletcher oversees financing range in price from $20,000 to $250,000; many of his clients are private-practice imaging centers, who will seek coverage for everything from an X-ray machine to the furniture in the waiting room outside of it, to the signage on the building itself. “We finance any type of imaging equipment that a radiology practice would need, and it goes way beyond that,” Fletcher said. “We try to make it as easy as we can for our customers to get what they need.” Private financial companies like Crest Capital have found their niches in the medical equipment industry by offering lending terms comparable to those found at banks, save with fewer restrictions and greater flexibility, Fletcher said. Typically the only collatWWW.THEICECOMMUNITY.COM

eral of which his agency holds ownership is the equipment that’s being financed; a bank could ask for much more in return. “When you go to a bank for financing, the bank will finance it for you, and they’re going to give you the absolute rock-bottom lowest rate,” he said. “But they’re also going to slap a blanket lien over your entire practice. That means everything you own, the bank has a say in that.” “If you’re going to sell your old X-ray machine because you want to buy a new one, they’re going to have say over that,” Fletcher said. “They’re also going to require that you keep a minimum balance in the bank, typically 80 percent of the loan. If that’s the case, whose money are you actually borrowing?” “And they’re going to want you to re-qualify for the loan every year – which means do not have a bad year, because they’re going to be able to call in the loan if they think you’re having trouble,” he said. About the only customers with whom Crest Capital typically does not work are start-ups. Borrowers must show at least two years worth of business activity showing “decent credit and enough revenues that it makes sense to us,” Fletcher said; “that this company is growing and they need the funds.” “I like to say we make successful businesses more successful,” he said. “For most deals under $250,000, we ICEMAGAZINE

finance dance don’t even need your financials and your tax returns, you just need to fill out the application.” The price of that flexibility is a percentage point or two more on the loan, but as institutional lending rates are hovering around 6 percent for the most qualified borrowers, the market is “fairly friendly,” Fletcher said. Those rates shift based upon the federal funds rate, which is set eight times a year by the Federal Open Market Committee, the institution that establishes monetary policy from the U.S. Federal Reserve System. They also vary according to the presumed risk of the loan. That risk calculus depends upon a number of variables, from the financial strength of the borrower to the things like whether there’s a strong secondary market for the equipment being financed. In 2020, risk is also heavily influenced by the national response to the COVID-19 pandemic. Those conditions – weeks or months of cancelled or prohibited elective procedures and imaging studies, staffing depletions and payroll concerns, and intense new protocols around throughput and patient cohorting – can’t be overlooked in building out a loan, Fletcher said. “Almost all of our customers in the medical imaging space are seeing a decrease in patients, some as much as 50 percent,” Fletcher said. “[With] the new protocols involved, every appointment takes that much longer. You can’t put 10 people in your waiting room anymore.” Although the pandemic has surely affected the way companies are doing business, medical imaging space is a strong sector expected to rebound. “It’s a very necessary thing, imaging, and as technology moves forward, that industry will just get stronger, we feel,” Fletcher said. When choosing a lender, Fletcher advises borrowers to use the same discretion that financial companies do in vetting their customers: consider the ease of the partnership and the 38

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Variety of flexible moves exist for medical device purchases

terms of the deal as well as the speed at which it can move, and the goals of the loan. For equipment vendors, an independent financial partner can help qualify borrowers within a matter of hours. “When a vendor can show the machine, and can also say ‘payments as low as XYZ a month,’ that’s attractive to a lot of people, and if the rate is acceptable, it helps close deals,” Fletcher said.

leases and escrow agreements. Shorter-term leases let facilities use the equipment without having to spend the full purchase price up-front, deferring decisions to buy “until a time when more market variables may be known,” he said. “Historically, most providers have looked to lease health care assets over periods that range from four to seven years,” Biorkman said. “An advantage of shortening the duration of the lease

“When a vendor can show the machine, and can also say ‘payments as low as XYZ a month,’ that’s attractive to a lot of people, and if the rate is acceptable, it helps close deals.” – CHRIS FLETCHER Jon Biorkman, president of health care financial services for GE Healthcare of Chicago, Illinois, said that the COVID-19 pandemic has truly forced buyers of medical imaging equipment to completely re-evaluate not only their asset management plans but “the fundamental building blocks of corporate finance, capital budgeting, capital structure and working capital.” “Health system leadership teams are developing multiple scenarios to account for the future variability of operating and non-operating cash flows,” Biorkman said. “In many cases, a greater premium is being placed on current liquidity, both cash on the balance sheet and the ability to borrow.” As a result, Biorkman said some health care providers are looking for different ways to procure medical imaging equipment. Typical cash purchases or borrowing mechanisms are now being supplemented by new financing structures “that allow for future optionality, cash flow savings, and certainty of capital,” he said. Two such models are shorter-term

to one to three years is that the end-ofterm options (e.g., purchase, return or renew) occur at a time that may better align with market clarity.” Most leases don’t require an initial capital outlay by the customer, therefore preserving their cash reserves at a time when the business of health care is subject to the same unpredictability as the remainder of the global economy. “It’s a strategy to gain the ability to use the equipment today, while deferring a more ‘permanent’ decision,” Biorkman said. Escrow agreements allow buyers to “pre-fund capital” for equipment that is delivered at a later date, while locking in today’s interest rates, he said. “The goal is to match the size of the escrow agreement with health care equipment that is expected to deliver and install over the next six months,” Biorkman said. “This structure is attractive because a CFO doesn’t have to go through a full underwriting process for each equipment delivery, and the interest rate is set at the moment of ADVANCING THE IMAGING PROFESSIONAL

funding, thereby reducing future risk on both fronts.” A range of health care providers are taking advantage of these financing options across multiple imaging modalities, Biorkman said. They vary by credit rating and size, but their borrowing needs are driven by a few common themes: “liquidity, optionality and diversification,” he said. Preserving “liquidity” refers to the strategy of keeping available cash and revolving lines of credit, which allow businesses flexibility if patient volumes, reimbursement rates and the mix of payers become unpredictable. “Optionality” refers to financing structures that allow buyers to choose whether to buy a piece of equipment immediately or to defer a purchase until such time as they have a greater handle on business trends that can support such a decision. “Diversification” refers to the need for a variety of lending options supporting a company’s capital structure, the combination of debt and equity by which its overall operations and growth are financed. “Communication with financing relationships is as important today as it has even been, specifically the frequency and transparency of financial projections,” Biorkman said. He advised potential buyers of imaging equipment to “clearly articulate your financial situation prior to COVID, your current state and a projected future state.” “If health care was a focus industry for a lender before COVID-19, in many cases it is still a focus area today,” he said. “Committed lenders understand customer dynamics, including patient volumes, reimbursement mix, and competitive positioning, and the best ones clearly understand the underlying value of the health care equipment.” Recently retired radiology director Adrian Riggs of Roseville, California said that buyers should hew to the same underlying principles that have always guided any new equipment acWWW.THEICECOMMUNITY.COM

quisition. Customers should negotiate prices with equipment vendors before taking the package to financiers, particularly given the complexity of structuring an equipment deal and the work required to bring it together. He encouraged shoppers to explore the total cost of ownership (TCO) of any piece of equipment when planning an acquisition, including: service costs, parts replacement, routine maintenance, obsolescence protection, and any related construction and staffing needs that may accompany its installation and operations. Any quote should make its way through the clinical, facilities and financial departments – which often work in silos – and should include projected service costs for the next five to seven years. “It’s best if you have the operations executive and the purchasing folks together at the beginning to talk about TCO, because you have a built-in increase every year,” Riggs said. “The vendor might have a screaming deal on buying it, but it costs you more in the long run.” Riggs also recommended that prospective equipment purchasers decide whether financing or a non-capital lease is appropriate for their circumstances, as costs can escalate if customers continue to re-lease the same piece of equipment. As in home ownership, “it’s cheaper to buy than rent,” he said. “Liquidity is very important,” Riggs said. “We’re seeing a big hit in the revenue in the hospital system. When we had the big shutdown in March, we saw imaging modalities down 80 percent.” “The health system still had to take care of patients who were presenting with symptoms that needed to be imaged or needed to go to surgery,” he said. “It’s just the money-maker often is elective surgery, because they’re high-volume, lower-cost. Plus, we still have to have the staff; you can’t shut down.” Building out the capacity for

lower-cost, higher-volume studies, like bone density scans, X-rays or ultrasounds may not incur the same expenses of installing or replacing a high-end CT scanner or MR machine, but if patient volumes aren’t there – particularly during the pandemic – even those reduced revenues might not justify spending the money in the current financial climate. “We have this perfect storm of really reduced revenues but not a commensurate reduction in expenses,” Riggs said. “If you lose 50 percent of revenues but only lose 10 percent of expenses, it turns your books upside-down.” “I think everybody’s nervous about spending down their reserves at this point, and it would lead them to do financing in the short term,” he said. Tana Phelps, marketing manager at Cassling of Omaha Nebraska, an advanced partner of Siemens Healthineers, said her customers are definitely seeing a need for financing flexibility “more than ever” during the pandemic. “Right when COVID hit, there was a big need for mobile X-ray and pointof-care ultrasound,” Phelps said. “While everything else was grinding to a screeching halt, these were taking off. Certainly volumes have slowed, revenues have slowed and elective procedures have slowed.” Phelps also pointed out that equipment rentals can be a nice bridge in an uncertain economic climate, particularly if a facility is amid an upgrade and needs a mobile system to handle the load during construction. Instead of buying outright, equipment leases allow customers to apply payments toward the purchase price of a piece of technology. “We continue to try to be flexible,” she said. “We’ve seen people who have to completely abandon plans, people who had to slow them down, and we’re expecting a really busy quarter right now because they had to change their priority.” • ICEMAGAZINE

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PET/CT OR PET AND CT? P CODING/BILLING BY MELODY W. MULAIK

ositron emission tomography (PET) is a nuclear medicine study that creates cross-sectional tomographic (3D) images of the metabolic activity in the patientâ&#x20AC;&#x2122;s tissues. The scan is performed after intravenous injection of a radiopharmaceutical. The most commonly used agent is a form of radioactive glucose known as 2-[F-18] fluoro-D-glucose or FDG. Cancers can cause abnormalities of blood flow or metabolism before structural changes are visible, and for this reason PET can often detect cancer at an earlier stage than CT or MRI. Because of their clinically proven value, most organizations have either acquired their own PET scanner or have contracted to have one located at their facility. Because PET images do not provide anatomic detail, they are usually fused with CT taken at the same time. This allows the radiologist to pinpoint the areas of abnormal activity. CT and PET images can be fused (electronically combined) to create an image that shows the precise anatomic location of any hot spots. It is possible to fuse images that were taken on different scanners and/or at different encounters, but the

Extent of Study

ICEMAGAZINE | SEPTEMBER 2020

image is of better quality when the patient is in the exact same position for both scans. PET-CT scanners incorporate a PET scanner and a CT scanner in a single unit. All new PET scanners include an integrated CT scanner. The two scans are performed while the patient remains on the same table in the same position, and then sophisticated software fuses the images. There are machines that incorporate MRI images, but this article will focus solely on coding for CT technology. The majority of oncology PET studies are reported with codes 78811-78816. The code selection is based on the extent of the scan, the type of equipment utilized and/or the use of separate and distinct imaging studies (e.g., CT). PET studies without concurrent CT are reported with codes 78811-78813. PET-CT studies are reported with codes 78814-78816. The specific codes are shown in the quick reference table below: The big question is can you bill for a diagnostic CT during the same encounter as a PET scan? In most cases the CT scan performed as part of a PET-CT study is used only for anatomic localization and attenuation correction. However, PET-CT scanners are capable of producing CT scans of diagnostic quality, the equivalent of a study performed on a stand-alone CT scanner, and

PET

PET-CT

Limited area

78811

78814

Skull base to mid-thigh

78812

78815

Whole body

78813

78816

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sometimes the ordering physician will request a diagnostic CT scan in addition to the PET-CT. The imaging facility and the interpreting physician can bill for a diagnostic CT scan together with the PET scan when: • The diagnostic CT scan is medically necessary. • The diagnostic CT scan is ordered by the treating physician. • There is a separate CT acquisition (dataset) for the diagnostic CT scan. According to Clinical Examples in Radiology (Summer 2017), this typically involves administration of IV

contrast and potentially multiple CT data acquisitions. • The radiologist dictates a separate interpretation for the diagnostic CT scan. This should include the clinical indications for the diagnostic study. Beginning in the 2018 National Correct Coding Initiative Policy Manual CMS issued a new policy on coding for diagnostic CT with PET-CT. In short, they stated when a diagnostic CT scan is performed on the PET-CT scanner, the provider must report the PET scan using a code from series 78811-78813. These codes represent PET without concurrently acquired CT. The diagnos-

tic CT scan can be reported with the appropriate CT code, and modifier 59 or XU can be applied to the CT code. The guidance also states a CT code should not be assigned together with a PET-CT code unless the PET-CT and the diagnostic CT are performed on “separate pieces of equipment.” So, when this scenario occurs you should report the PET/CT scan with the appropriate 78814-78816 code and the diagnostic CT code. • MELODY W. MULAIK, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc.

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DIFFICULT CONVERSATIONS – ASKING QUESTIONS

I DIRECTOR’S CUT BY MARIO PISTILLI

reached out to some colleagues asking if they had any ideas for a topic for this article, and the overwhelming response was “difficult conversations.” Managing people is a very large part of what we do, and many times those conversations may be tough. It is what I term, “the Pistilli Law of P’s” which states that, “people problems permanently persist.” These problems generally occur because of the differences in perception, emotions or breakdowns in communication. A recent article in Inc. (Schneider, 2018) noted that 70% of employees were avoiding difficult conversations and that is a whole lot of avoidance going on. One technique that I have found really effective is what author Parker Palmer calls, “turning to wonder.” In my last ICE talk, I largely covered eight very high-value questions adapted from the book, “The Coaching Habit: Say Less, Ask more & Change the Way You Lead Forever,” by Michael Bungay Stanier.

THE KICKSTART QUESTION “What’s on your mind?” This is an effective opening question as it leaves room for a person to take the conversation in any direction they want. One of the reasons we avoid difficult conversations is that we don’t know where to start. This question is open and inviting and allows people to get to what is most important to them. You might have to tease it out by asking more probing questions such as; “What’s exciting?”; “What’s provoking anxiety?” or “What’s keeping you up at night?”

THE AWE QUESTION “And what else?” This question is powerful because it invites more insights or more 42

ICEMAGAZINE | SEPTEMBER 2020

wisdom. Three big reasons this question is so powerful are that it opens more possibilities, allows you to reign yourself in and buy yourself time. You can use this as a follow-up to the kickstart question to elicit even more information.

THE FOCUS QUESTION “What’s the real challenge here for you?” This is where you avoid the urge to jump in to fix it and spend time honing in on the problem. This question helps you slow down so you can later spend time solving the real problem not the first problem. This question allows you to cut through the fog created around the problem. One source of fog is that there may be many interrelated problems all popping up one after another – you might ask “If you had to pick one of these to focus on, which one here would be the real challenge for you?” Another source of fog is when the conversation turns to complaining about a person not in the room – if only he would do that or if only he wasn’t so lazy. Using this question to bring it back around by asking “So, what’s the real challenge here for you?” You cannot do anything about a person not in the room only coach the person in front of you. Don’t forget the AWE question as an add on to this – when the person talks about the real challenge for them and you sense that there is more ask the “and what else” question.

THE FOUNDATION QUESTION “What do you want from this conversation?” We typically make a lot of assumptions about what the other person may want. The best way to find out is to simply ask. At times, the person may not even know what they want and may say “I don’t know.” You then need to decide to continue the conversation or just end it right there and say “Would it be OK to give you some time ADVANCING THE IMAGING PROFESSIONAL

to think about what you want and get back to me?”

THE LAZY QUESTION “How can I help?” The power of this question is twofold; it forces your colleague to make a direct and clear request and also stops you from thinking that you know best how to help and leaping to the rescue. If you are afraid of asking this question because you are afraid of the answer then you need some self-reflection around why you don’t have the self-confidence to ask this. Sometimes the person may come back with some version of “I want you to handle this or solve this for me” essentially attempting to make their problem all your problem – don’t accept that. Instead you may try something like, “I do have some thoughts around this, but first I would love to know more about yours what you think a solution might be?” Use the questions we already covered such as the AWE question to drag out solutions from them. When you feel that they have exhausted their ideas and you can’t drag anything else out, then and only then, do you move to sharing your thoughts.

THE STRATEGIC QUESTION “If you are saying yes to this what are you saying no to?” This question is more complex than it sounds. You are asking people to be clear and committed to their yes. One way to clarify this commitment is to ask “ so let’s clarify WWW.THEICECOMMUNITY.COM

what you are saying yes to.” Then, follow up with “What would being fully committed to this idea look like?” The what you will say no to part is meant to uncover two types of no – the no of omission and the no of commission. The no of omission is simply what exactly is the thing you will omit if you say yes to this – If I say yes to this meeting I will not be available for some other meeting at the same time. The no of commission will likely take the conversation deeper and is about the things you will need to do in order to make the yes happen – it puts the spotlight on how to create the space, focus, energy and resources to make that yes happen. What projects do you need to abandon or postpone? What relationships might suffer (the people component)? Or, what habits would need to be broken (the pattern component)? Unleashing this question when engaged around a difficult conversation relating to taking on a project can be very powerful? It can show the employee that you don’t just care about shifting work but you care that they have what they need for a good outcome.

heard or did. This is the question that allows the person to pull back and gain insight. This also helps make the conversation more personal because you added the words “for you.” It allows you to ensure that the conversation didn’t leave any loose ends – if the person says nothing then the conversation is not over and you probe further by asking, “What do you think was missing?” If you want to go next level, share what was most useful for you personally – this exchange of learning only strengthens the bonds. We are often too quick to jump to conclusions. We are by nature fixers which is what got you were you are – we need to resist that urge by opening it for the other person to get their ideas out. Don’t be so quick to leap in and offer advice, ideas, suggestions or a recommended way forward. Even though we don’t fully know the issue or what may be going on for the other person, sometimes we are sure we have the answer they need. Try using these questions to open a true dialogue and do more listening than talking. The best leaders are worldclass listeners. •

THE LEARNING QUESTION

MARIO PISTILLI, CRA, MBA, FACHE, FAHRA,

“What was the most useful for you?” This is where you learn to wrap up conversations in ways that make you look great! People don’t necessarily learn best when they hear something or do something. Real learning comes when they reflect back on what they

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. ICEMAGAZINE

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BEST PRACTICES BY ALI KRONZ

LEADING THE WAY FOR BEST PRACTICES IN IMAGING: BANNER IMAGING Moving quickly and safely to achieve the core mission of health care

o much has changed in health care and the way in which care is delivered these last several months, but one thing that remains the same is our commitment to protecting the patients we serve, day in and day out. At Banner Health, we believe in our mission – health care made easier, life made better – and that belief holds true not just in the physical spaces where we deliver care, but also in the everyday touchpoints we have with patients. For example, when patients require medical imaging or radiology procedures such as ultrasounds, the process often requires technicians to enter specific data directly into the imaging device at the time the study occurs. In some cases, the way measured values are represented may not be consistent with reporting standards and must be normalized. That is, measurements may have been taken in centimeters, but the reporting templates require millimeters. The manual process of 44

ICEMAGAZINE | SEPTEMBER 2020

translating these figures from the imaging device and into the radiology reporting solution is not only time consuming, it can also introduce errors into the reports. Even one error can have drastic consequences for the patient, so accuracy is paramount. Now, consider that for an organization like Banner Imaging, where we complete approximately 600,000 outpatient imaging studies annually. We knew we had a significant opportunity to improve imaging workflows in ways that would let us move health care forward quickly and safely. Banner Health’s partnership with Nuance Healthcare, which has spanned 15 years, has enabled us to achieve the core mission in health care: providing the best care possible to patients. Specifically, at Banner Imaging, we have included Advanced Data Integration with ModLink in conjunction with our PowerScribe solution to automatically and seamlessly transmit normalized data from imaging devices directly into the appropriate fields in radiology report templates. While it’s true that voice recognition solutions can make this data import ADVANCING THE IMAGING PROFESSIONAL

Banner Health’s partnership with Nuance Healthcare, which has spanned 15 years, has enabled us to achieve the core mission in health care: providing the best care possible to patients. process seamless, we know that the most accurate way to get those values into the report is to do so directly from the modality. This auto-import capability means radiologists can focus on reading the exam, rather than interpreting figures, as well as on the clinical narrative, ensuring that all findings are clearly documented. It also saves time; our radiologists report that they can complete their interpretations about 15% faster than before, allowing us to quickly turnaround results to clinicians and patients. “Modlink has been one of the most positively impactful pieces of medical IT we have ever deployed in our practice. We use Modlink with customized digital worksheets, which displays the sonographer’s findings in an easy to digest format. These digital worksheets have replaced the paper worksheets used in our practice for the previous 15+ years. While these detailed paper worksheets were initially an improvement in the communication between the sonographer and radiologist, they weren’t perfect. Illegible hand-written numbers and comments from technologists were common, causing confusion for the radiologists and sometimes inaccurate reports which required addenda or calls to referring clinicians for clarification. With the implementation of digital worksheets, the problem of illegibility was solved,” said Dr. Brian Frohna. And when there’s an actionable finding, Banner Imaging radiologists WWW.THEICECOMMUNITY.COM

can take advantage of another PowerScribe integration – PowerConnect Actionable Findings, which captures those findings and automatically closes the loop with the referring clinician. This new workflow, which we will roll out in the coming weeks, will further help us enhance patient safety, reducing the risk of actionable findings falling through the cracks, ultimately advancing patient care. No longer will our radiologists rely on a range of unreliable methods to reach physicians (phone messages, waiting on hold, etc.). Instead, PowerConnect will create a seamless method of communication to ordering providers through automated and standardized processes, allowing the radiologist to rest assured that the patient is well cared for. This points to our initiative to continue improving the quality of care through our imaging process. As we continue to the lead the way in creating a “Safe Place For Care,” we at Banner Imaging know that there are so many ways to accomplish this goal. From enhanced screening and disinfection to protecting our physical spaces; to boosting our telehealth presence to protecting more patients’ wellbeing; and even to incorporating advanced technologies that make imaging workflows faster, more accurate, and safer, we’re committed to making sure our patients safely get the best possible healthcare they need. • ALI KRONZ, MHA, is the IT director for Banner Imaging. For more information, visit www.bannerhealth.com

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STRATEGY IN CHANGE DEPARTMENT/ OPERATIONAL ISSUES BY JEF WILLIAMS

ICEMAGAZINE | SEPTEMBER 2020

e are clearly entering a period of disruption that will reshape the way we provide care and conduct business. Whether it is federal policy, organizational restructuring (mergers and acquisitions) – or reimbursement changes – the next paradigm shift will bring radical changes to the way we deliver health care to patients.

and information systems. The risk here is that we have been lulled into complacency as organizational leaders who have stopped diligently crafting strategy or contributing to the executive and administrative conversation that leads to the marginalization of your service line as well as your leadership. What are we doing to prepare for a new paradigm that is coming – whether we are ready or not? We continue to store images in perpetuity at increasing costs and expansion of hardware – what are we One common thread that doing to build logic into our I’ve seen woven through the archives? Redundant and Even with marketplace of ideas is that ad hoc systems cannot be it is clearly not time for leadeasily supported in an intedecreasing ers to sit back and let the grated environment – what reimbursement, world go by. We have spent are we doing to simplify and the landscape a number of years managing standardize? Images have has not incremental change. With to be shared both internally technology fully adopted we and externally – how are we changed for have managed to maintain positioned to share data most since the growth and stability with simply, including patient adoption and minor adjustments. Most access? Image management stabilization of of us have spent the past has expanded beyond raseveral years managing dediology and cardiology into digital imaging partments and groups with ophthalmology, visible light and information small software, hardware and other specialties – how systems. and equipment procureare we prepared technically ments. Even with decreasing to manage all of that image reimbursement, the landdata and give access to scape has not changed for most since the our radiologists as they deem appropriate? adoption and stabilization of digital imaging Fee-for-service is changing – how are we ADVANCING THE IMAGING PROFESSIONAL

prepared for a shared savings reimbursement models? Outcomes and quality must be reported â&#x20AC;&#x201C; how do we access the necessary data in ways that are intelligent, appropriate and efficient? These are tough questions! They should make us uncomfortable. But addressing these issues is part of the leadership role we have chosen, and we owe it to our organizations to provide strategy and direction in meeting the growing challenges of imaging. The answers to these questions should be part of an imaging strategy. This is where governance can play a critical role within your organization. We have worked in silos for years managing our service lines but there is an emerging trend of shared leadership. Much of what we learned WWW.THEICECOMMUNITY.COM

from the implementation EHR governance within hospitals and outpatient centers can be applied to our imaging strategy. There is a growing trend toward collaborative governance in shaping organizational strategy. To say that we are in times of uncertainty is an understatement. Our world is changing around us. The way we deliver health care is changing, and the requirements of our roles as leaders is changing. Often we can be distracted by the urgent and ignore the criticality of what is important. While we cannot predict the future, we can certainly design a roadmap for success. â&#x20AC;˘

To say that we are in times of uncertainty is an understatement.

JEF WILLIAMS, MBA, PMP, CIIP, is a managing partner at Paragon Consulting Partners. ICEMAGAZINE

INSIGHTS

GIVING INNOVATION INFRASTRUCTURE C RAD HR BY KELLY PRAY

utting edge. Transformation. Innovation. The next best thing. In this new era of technology and entrepreneurship, organizations have begun to synonymize disruption with success. Be careful in your leadership and management of initiatives, that you do not lose sight of the infrastructure required to enable this success to happen. With a background in lean six sigma methodology, my most frustrating moments at work are when my efforts produce waste. This is not to say the quality of the product is poor – this is referring to waste inclusive of duplication, waiting time, unnecessary processing or mis-utilizing my team’s talent. Ever heard of the phrase, “operating at the top of license?” When we fail to provide the systems and processes in place for teams to succeed, we can often underutilize our employees’ skills, talent and knowledge. So, when we use words like “infrastructure” or “systems and processes,” what does this look like in execution? One of the ways to combat mis-utilization of talent is to have clear and distinct roles when pursuing an initiative. An easy-

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to-use system is a “RACI” chart, standing for Responsible, Accountable, Consulted and Informed. By clearly identifying the roles of everyone on an initiative, you can avoid mis-utilization of talent as well as ensure the job gets done. Remember that just as when everything is a priority, nothing is, so too when everyone is accountable, no one is. Project roles that enable success of innovation include the project manager, operational owner, subject matter expert, performance improvement consult and change manager. Before diving deeper, keep in mind that you don’t need to have separate individuals for each individual role. Similarly, these roles do not have to be held by one individual person. The project manager or project management team applies a structured approach to lead decisions for designing, developing and delivering the project objective. They manage the process of the innovation. In a sense, the project manager is accountable for the overall success of the project initiative. Project managers ensure work is delivered on time and in the budget to drive results and outcomes. They create customized and scaled approaches to align project objectives with overall organizational strategy. Additionally, project managers ADVANCING THE IMAGING PROFESSIONAL

ensure that senior leadership is kept informed of project milestones. While project managers are not responsible for executing the work, they ensure the accountability of the project team to deliver results. The operational owner is responsible for the ongoing process or operation that is being changed due to the proposed innovation or initiative. The operational owners are often direct managers or supervisors, and act as the liaison between the project team and end-user or front line staff. Operational owners and direct supervisors equip their teams to succeed on the overall success of the design, development and delivery of project initiatives. Subject matter experts (commonly referred to as SME) are responsible for equipping the project team with operational guidance and multidisciplinary lenses. SME are key stakeholders whose expertise or input is required to ensure successful delivery of project objectives. SME are often consulted to come up with the best possible solution for the project. The role of the operational owner can oftentimes be combined with the SME on smaller project teams. The performance improvement resource or team helps ensure that workstreams are streamlined and waste is reduced. They are consulted to leverage methods and problem-solving tools to improve all aspects of the innovation process. Often, the project manager can hold the role of the performance improvement resource, gathered that the project manager uses data, lean and/or six sigma knowledge to investigate and drive the change. The change manager or change management team helps apply a structured approach to enable others to address the personal impacts of the change. This role works with the project team to ensure impacted end users are prepared for and adopt the change. Similar to the performance improvement resource, the project manager can integrate change management into their project plans. All of these roles encompass what WWW.THEICECOMMUNITY.COM

it takes to have a successful project team. These roles help enable the innovation to happen. They do more of their work behind the scenes and are key sources of information and direction for leadership. This infrastructure supports the ability for you as a leader to prioritize workstreams. Prioritization is much easier to manage with data such as timeline, budget, scope and impact to the organization provided by the project team. As leaders, we are accountable for making the decisions to ensure adequate resources, scope and timelines support project results and outcomes. With the data provided by project teams, leaders must validate strategic alignment to ensure project objectives are tied to organizational benefits. In addition, leaders must actively and visibly participate in the initiative. Without properly supporting the initiative, those who are responsible for executing the work may view the effort as “innovation for innovation’s sake,” versus an organizational priority. By being attentive and visible for project milestones, employees will be empowered to support the initiative. Additionally, leaders should build support networks of other key leaders to disseminate the backing of the project. Lastly, leaders should be communicating directly to impacted teams throughout the project to ensure the organization is adequately prepared for the change. Long-term success is contingent on the rigor of managing the infrastructure behind the innovation. Without dedicated roles in project delivery and prioritization of the efforts they produce, innovation can have a detrimental effect on organizational success and culture. Without proper management of ideation, organizations are left with vision without the strategy. This may result in effort without execution, initiative fatigue or work that is either duplicative or combative to other projects at the organization. • KELLY PRAY is the Enterprise Change Management Lead at Children’s Hospital Los Angeles.

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INSIGHTS

LESSONS LEARNED AT 2020 ECR I

attended the European Society of Radiology’s virtual 2020 European Congress of Radiology (ECR). It was striking to see the 100 exhibits with imaging artificial intelligence being offered.

PACS/IT BY MARK WATTS

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There were 113 posters listed under the research title artificial intelligence (AI). Examples are: AI has been described as the use of computers to simulate the human’s intelligence, a characteristic intellectual process of human beings. Image recognition, image classification, segmentation of tissues and organs and localization of various pathologies are the main applications of machine learning in radiology. The implementation of AI in the field of medical imaging is continuously increasing, and there is a consensus that radiology is the most upfront branch of medicine regarding the use of these technologies. The number of publications related to AI in medical imaging, strengthen this belief, as there has been a dramatic increase in the papers regarding AI the past two years . However, some radiologists worldwide, seem to see AI as a threat to their profession, instead of welcoming this new technology. This belief is based on the fears that with the wide use of AI in radiology, there will not be any need for trained radiologists in the future. Many anxieties exist among radiologists, especially junior trainees, as some predictions see disciplines such as

radiology being replaced by AI in the future. Radiologists interpret large amounts of data daily, however, an overloaded workflow in conjunction with thousands of images can make radiologists more vulnerable to reporting errors. AI is a helpful tool for radiologists, as it can make the workflow faster and better. Besides, it can offer the advantage of quantitative information, such as Radiomics signatures. Therefore, as the European Society of Radiology (ESR) outlines, radiologists, and especially trainees, must not be afraid of AI applications. The lives of radiologists will change in the light of AI, however, AI will not be able to replace radiologists, as they are the only ones who can solve complex clinical problems. Education regarding AI must be implemented in the radiologists’ educational programs, to help radiologists feel safe and confident about the use of AI in medical imaging. A specifically designed questionnaire with 12 closed questions was distributed to all the radiologists on a large Greek island with imaging centers operating within the private and public sectors. Out of 22 active radiologists working on the island, 22 valid responses were received. The response rate was 100%. The participants were asked to define when they think AI will be implemented in clinical practice in Greece. Most of the responders (63.6%) answered that AI will need between 5 and 10 years to be widely used in Greece. Similarly, 27.3% of the responders reported that it will take more than 10 ADVANCING THE IMAGING PROFESSIONAL

years for AI to be in the daily life of Greek radiologists, while only 9.1% think that AI will have been implemented in clinical practice in less than 5 years. Within the literature, it is reported that high-income countries have already integrated AI in their health care systems. However, there is no widespread use of AI in Greece within the discipline of medical imaging. Therefore, systematic national strategy plans must be established to promote the integration of AI into health care in Greece. Regarding the level of knowledge, the participants have related to AI applications, exactly half of them reported being only a little informed about AI. In addition, the vast majority (95.5%) reported that they have not received any education regarding AI. However, almost all the responders (90.9%) reported that AI must be integrated into the educational programs of both radiologists and technologists in the future. This is in line with the recommendations of the ESR, as it strongly recommends that an AIbased module must be included in the educational curriculum of radiologists. This will be an effective way of training young radiologists how to benefit from AI applications and integrate them into clinical practice. The results about any past or present use of AI in clinical practice strengthen the belief that AI has not yet been widely integrated into medical imaging within the country. Specifically, most of the responders (63.6%) reported that they have not ever used AI during their career, while only 2 (9.1%) of the responders reported a serious experience regarding AI in clinical practice. Similarly, the scenery has not changed, as only 5 (22.7%) of the radiologists reported that they are currently using AI applications in clinical practice, while the vast majorWWW.THEICECOMMUNITY.COM

ity (77.3%) reported not using such applications. Despite the generally low level of knowledge regarding AI, a relatively positive perspective of AI was noted. Specifically, exactly half of the responders reported seeing the implementation of AI in radiology rather positively. Similarly, 9 (40.9%) of them reported positive thoughts about AI in radiology, while only 2 (9.1%) of them reported a neutral attitude towards AI. None of the responders reported having negative or rather negative perspectives of AI in radiology. Most of the responders (68.2%)

Regarding the level of knowledge, the participants have related to AI applications, exactly half of them reported being only a little informed about AI.

think that AI cannot substitute radiologists in the future and that their profession is not at risk from the implementation of AI in clinical practice. Similarly, 5 (22.7%) of them think that there is a possibility that AI will be able to replace radiologists in the future. Most of the responders (81.8%) believe that AI is a useful tool for radiologists, while 2 (9.1%) of them see AI as a moderate tool for them. Regarding the implementation of AI in clinical practice

in relation to the various imaging modalities, most of the responders (59.1%) believe that AI must be integrated into all the imaging modalities. This is justified within the literature, as AI-based algorithms can be used in computed tomography (CT), magnetic resonance imaging (MRI) and mammography to facilitate with image interpretation, characterization of lesions, diagnostic predictions, as well as for making radiation treatment planning faster and more accurate. Therefore, AI should be integrated in all imaging modalities to improve diagnosis, treatment and outcomes. In summary, the USA and RSNA can take away these key points: 1. This study noted a relative lack of knowledge and training regarding AI applications among Greek radiologists. 2. Currently, there is a lack of experience in using AI in clinical practice. 3. The majority of the responders seem to have positive perceptions of AI-based applications and most of them consider AI as a helpful tool for radiologists. 4. There is a consensus that AI will be widely implemented in Greek radiological departments within 5-10 years. 5. AI must be integrated into radiological education, and Greece must invest in AI-based algorithms to improve diagnosis, treatment and workflow. This is a limited study, but I think there are pearls of wisdom offered here. I look forward to creating an improved future in medical imaging with AI. Plan, train and use this tool. â&#x20AC;˘ MARK A. WATTS is the director informatics, technology and artificial intelligence and sales at Medical Technology Management Institute. ICEMAGAZINE

INSIGHTS

EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI

THE SIMPLE WAY TO HIRE, TRAIN AND RETAIN GREAT EMPLOYEES

n three decades of working with companies of all shapes and sizes, I’ve found a common tool can be used to hire, train and retain great employees. It’s a tool that exists in most workplaces, but it’s one of the most misused and underused tools I’ve ever seen. That tool is a job description. Scoff if you want, but my clients who use this tool properly do a great job at hiring, training and retaining great employees. In a nutshell, here’s how I recommend job descriptions be created and used: • Identify and prioritize the duties and tasks needed for successful job performance. • Use that job description to create interview questions. • Once a person is hired, use the job 52

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description as an outline for training. • Use the job description as a guide for ongoing performance management. Let’s examine each step.

CREATE AN ACCURATE LIST OF DUTIES AND TASKS To define the terms, a duty is a general area of responsibility, whereas a task is a specific action that, when combined with other tasks, fulfills a duty. Here’s a duty/task example taken from a Safety Director’s job description: Duty: • Oversee Emergency Response Teams Tasks: • Identify deficiencies in the emergency plan • Develop emergency response skills in office personnel • Create response teams and apADVANCING THE IMAGING PROFESSIONAL

point leaders • Educate all personnel on potential emergencies • Schedule and conduct emergency response training • Evaluate emergency team effectiveness A general guideline is to have between 5 and 14 duties for a job. The same numbers apply to how many tasks each duty should have.

DEVELOP BEHAVIOR-BASED INTERVIEW QUESTIONS In this next step, one reviews the duty and task list and identifies five or six questions to ask each candidate in a preliminary “phone screen” interview. The key here is to develop behavior-based questions, which are questions based on an applicant’s actual past experience (how did you handle “x”?), not on a hypothetical future possibility (how would you handle “x”?). Over the years I’ve learned that if you ask hypothetical questions you tend to get hypothetical answers. During an initial phone screen, you want to learn what an applicant actually did. Here’s an example of a behavior-based question for the Safety Director’s job: “Tell me about a time you scheduled and conducted training. What obstacles did you encounter? How did you overcome them?” Because this article is about the overarching purpose of a job description, I won’t dive too deep on the interview process. However, be sure to ask the same questions of each applicant you interview and assign a score to each answer. Applicants with the highest scores move on to the next phase of your hiring process.

USE THE JOB DESCRIPTION AS AN OUTLINE FOR TRAINING Once you’ve hired someone, a key to retaining that employee is having a clear method for training that person WWW.THEICECOMMUNITY.COM

on the requirements of his or her job. People want to know what’s required of them to succeed! As you might have guessed, the duty and task portion of a well-written job description serves as your guide for this. The following is an extremely brief overview for how each task from a duty and task list needs to be analyzed to create a plan for training: 1. What must the employee physically do to accomplish the task? 2. What must the employee know or understand to perform each behavior? 3. What must the employee be concerned about (safety, quality, etc.) to perform each behavior? As an example, let’s use the job description of a food service worker and analyze the task of “prepares menu items using established procedures.” What must the worker do to prepare menu items? • Read recipes • Measure ingredients • Operate kitchen equipment • Follow recipes What must the worker know and understand to do those things? • Show where each day’s menu is kept • Show where recipes are kept • Locate where all food items are kept • Show where the food is prepared • Show where cooking supplies and cleaning supplies are kept • State the operating procedures for each piece of equipment What must the worker be concerned about while doing those things? • State, explain and demonstrate proper food handling procedures • State, explain and demonstrate spill clean up and safety procedures • State, explain and demonstrate equipment and knife safety

USE THE JOB DESCRIPTION AS A GUIDE FOR ONGOING PERFORMANCE MANAGEMENT I am not a fan of generic job eval-

uations. Every position is different, and people want to know if they’re performing at an acceptable level for what’s expected of them. If they aren’t clear on what’s expected of them, there’s no way for them to know if they’re doing well. Research shows that only 7% of American workers understand how their work fits into the company’s vision and mission. That is not their fault. This is a problem because of managers either not telling them or not knowing themselves. Again, as you might guess, a well-written duty and task list fixes that. My recommendation is to replace annual performance reviews with quarterly performance management reviews. After all, who’s going to remember what an employee did 10 months ago? Using a simple check list, supervisors can grade each employee for each duty and task using the following scale: • Needs improvement • Meets expectations • Exceeds expectations • No longer applies Ideally, each employee will self-evaluate his or her own performance before meeting with his or her supervisor, and any differences will serve as a springboard for discussion. Evaluating employees according to their job description keeps everyone on the same page for what is expected. When employees know exactly what’s expected, performance improves, too! Bottom line, there’s a great tool available for finding, training, and keeping good employees. All we have to do is use the tool to its fullest potential. • DANIEL BOBINSKI, M.Ed. is a best-selling author and has more than 30 years’ experience as a workplace issues consultant and a management/leadership coach. Reach Daniel on his office phone, 208375-7606, or through his website, www. MyWorkplaceExcellence.com. ICEMAGAZINE

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