ICE Magazine February 2021 by MD Publishing

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FEBRUARY 2021 | VOLUME 5 | ISSUE 2

ADVANCING MAGAZINE

IMAGING PROFESSIONALS

in focus Kim evans PAGE 12

PAGE 32

Changes on the Horizon What the outcome of the 2020 elections could signal for the national medical imaging agenda

PRODUCT FOCUS

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COVER STORY

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ICEMAGAZINE | FEBRUARY 2021

ADVANCING THE IMAGING PROFESSIONAL

FEBRUARY 2021

NEW DATES!

14 RAD HR

IMAGING NEWS

The latest industry news and updates from around the nation.

Here are some tips that can help change organizational culture and make it sustainable.

PRODUCT FOCUS Check out some of the latest radiation safety products.

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ICEMAGAZINE

CONTENTS 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

Rising Star Justin Armstrong, Banner Health, Medical Imaging Senior Manager in Northern Colorado

In Focus Kim Evans, Vice President of Imaging, ChristianaCare

Rad Idea Safety First

Off the Clock Sheila DeBastiani, RT(R), supervisor/Educator, WakeMed Invasive Cardiology

NEWS 14

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

ICE Webinars First Webinar of 2021 Covers ‘Essentials of Imaging Informatics’

Jonathan Riley Karlee Gower Amanda Purser

Webinars

PRODUCTS

Jennifer Godwin

Account Executives Jayme McKelvey Megan Cabot

Editorial Board

Manny Roman Christopher Nowak Jef Williams Josh Laberee Jason Theadore Nicole Walton-Trujillo

Market Report Radiation Monitoring, Safety Market Recovery Expected

Product Focus Radiation Monitoring

INSIGHTS 36

Coding/Billing Waste Not

Circulation

limbing the Mountain of Data for Effective CT Dose Optimization, C Sponsored by Banner Imaging

Digital Department

PACS/IT Burn out and the High Cost of Not Engaging Healthcare Workers’ Mental Health

Emotional Intelligence What Makes a Good Job Application?

Rad HR Keeping Culture Change Sustainable

Department/Operational Issues Good Leadership Qualities

Director’s Cut Modern Radiation Protection Practices

Lisa Lisle

Cindy Galindo Kennedy Krieg

Accounting

Diane Costea ICE Magazine (Vol. 5, Issue #2) February 2021 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. © 2021

SPOTLIGHT

ICEMAGAZINE | FEBRUARY 2021

Roman Review Progress

52 54 58

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ICE Break Index

ADVANCING THE IMAGING PROFESSIONAL

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SPOTLIGHT

RISING

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JUSTIN ARMSTRONG

Justin Armstrong enjoys time with family when not at work.

FUN FACTS Favorite hobby: Spending time with my family, especially camping

Favorite Vacation Spot: Camping in the Rocky Mountains

Favorite Food: I grew up on a family farm, so I love steak!

One Thing on Your Bucket List: My family is Italian, so one thing on my bucket list is to go to Italy. 10

ICEMAGAZINE | FEBRUARY 2021

ADVANCING THE IMAGING PROFESSIONAL

BY ERIN REGISTER

patient number one. Now, I’m able to pass that passion on to the technologists, and leading has been very rewarding for me. I also like the business side of the medical field. Learning and growing everyday makes my current role a great deal of fun.

rom Sterling, Colorado, Justin Armstrong, 39, has been in the imaging field for 18 years. Armstrong has an associate’s degree of applied science in diagnostic imaging and is registered in X-ray and CT. He is currently the Banner Health Medical Imaging Senior Manager in Northern Colorado.

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: All of the technology interests me. From when I first started in X-ray and we had to develop film to where it is today keeps it fun and interesting.

Armstrong was nominated as a “Rising Star” by Banner Imaging Services CEO Jason Theodre. ICE learned more about him in a question-and-answer interview.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: I would say starting from a front-line technologist in X-ray, to cross-training and CT/MRI, then to my current role as a senior manager is my biggest accomplishment. Also, being part of an organization that really focuses on growing their employees to their career aspirations is very beneficial. Being able to lead a patient-focused, engaged team is also at the top of my list.

Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: I have an older brother who is in the medical imaging field. When I graduated high school, I wasn’t sure what I wanted to do, and my brother asked me to do a visit to the X-ray school he attended. So, I did. Shortly after the visit, I knew X-ray was what I wanted to do. I got accepted to the X-ray program and started my career.

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

Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION?

A: I am just rolling with whatever happens. I’ve been a medical imaging leader for the past 10 years and really enjoy it. I am happy in my current role, but am open to wherever life takes me. •

A: I love being a leader. Patient care is always number one, and I felt when I was on the front lines, I always made the

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SPOTLIGHT

IN FOCUS KIM EVANS

hristianaCare Vice President of Imaging Kim Evans, MS, FABC, CRA, entered the field of medical imaging with a desire to help others. She had patients in mind as she began her career and still does. Today, as an imaging leader, she also enjoys being able to help those she works with as well as colleagues throughout the nation.

“I started as a radiologic technologist because I wanted to work with others, but also care for and help people. I was

especially intrigued and attracted to the physics of imaging in combination with the opportunity to provide direct patient care. I soon transitioned into education in radiologic technology and then eventually joined the administration team within our imaging department,” Evans said. She credits continuing education as one reason for her ability to grow and advance in the imaging field. Evans said she still enjoys the ability to help patients. “I was fortunate to continue my education during my career and that has prepared me well for each of my

Kim Evans addresses the administrative team in front of the huddle board.

ICEMAGAZINE | FEBRUARY 2021

expanding roles. The imaging field has so much more to offer than I envisioned when I first began my career. I also love the impact our field has in that we touch almost every patient in some way,” she said. “While the technology has certainly evolved, I still find fulfillment in the interactions with both my fellow employees – whom we at ChristianaCare refer to as ‘caregivers’ – and also our patients.” When asked about her greatest accomplishment Evans shares a two-part answer that illustrates the importance of work-life balance. “From a personal perspective, family is my greatest accomplishment and treasure: my husband who is my life partner of 36 years and best friend, my sons and their families now with my two grandchildren. Now that my children are parents, I reflect with gratitude that I had the privilege of contributing to them becoming good people,” Evans said. “Professionally, my greatest accomplishment is to have had the opportunity to work hard and make a difference in the lives of others. That includes coworkers, patients, teams and industry colleagues. It is highly rewarding. Imaging has propelled me to learn more, to seek to understand more, and then to work hard to operationalize those concepts. Through my

ADVANCING THE IMAGING PROFESSIONAL

KIM EVANS

Vice President of Imaging, ChristianaCare What is the last book you read? Or, what book are you reading currently? I am a voracious reader. I read both audio books and traditional books every day and especially love historical fiction. I am presently finishing “The Moment of Lift” by Melinda Gates and “America’s First Daughter” by Stephanie Dray. I recently indulged in and loved “Where the Crawdads Sing” by Delia Owens.

colleague, Stephanie Cooper and would absolutely call her my mentor.

Favorite movie? Hmm. I prefer to read. Can’t even think of one.

Who has had the biggest influence on your life? For me, this is about family and faith.

What is something most of your coworkers don’t know about you? My husband and I are big DIYers. We’ve gutted and renovated homes extensively. I’m pretty impressive with power tools! LOL

What would your superpower be? Mind reading.

What is one thing you do every morning to start your day? Pray and exercise. Oh, and lots of coffee in between! Best advice you ever received? The Golden Rule – treat others as you want to be treated. Just be kind.

What are your hobbies? Reading, cooking, hiking and hanging with the grands!

Who is your mentor? I learned the most from my former

What is your perfect meal? Fresh seafood with lots of veggies and a decadent dessert!

experiences and leadership – and while I still have much to learn – I hope to instill the same curiosity and thirst for knowledge in others.” As a lifelong learner, Evans enjoys the difficult opportunities that may cause headaches while also pushing her to grow as an individual. “I love the challenge of my current job and every role I have had over my career. Every day I learn something new and my personal performance expectations elevate. I love working alongside colleagues across our organization and industry who share a common vision,” Evans explained. “I still love to care for people and make a difference and in my organization, we serve together guided by our values of excellence and love. I feel that is the opportunity I have every day – to do what I need to do. Do it well and love and care for those I serve.” As someone who has risen through the ranks of medical imaging, Evans places importance on being accessible to everyone she works with and being a mentor. “First, I want to be a leader who is approachable and willing to listen. I strive to listen actively and seek to understand in order to help my team,” she explained. “I also want to be a proven leader who is willing to work

hard and commit to being exceptional today and even better tomorrow. These are a few of the values and behaviors in my organization that keep motivating me to lead with courage and empathy. Again, through the COVID-19 pandemic, I grew in my leadership especially in telling the truth with courage and also in being decisive. As things changed frequently and we assumed good intentions, I needed to remain open and humble enough to acknowledge change and be supportive of the caregivers affected.” She added that mentors have empowered her a great deal and she enjoys paying it forward to the next generation of imaging leaders. “I am very fortunate to know and to have known many strong women in leadership who have inspired me and urged me to grow throughout my career. I learned the most over time from my former colleague Stephanie Cooper and would absolutely call her my mentor. I followed her each step in my career learning business basics, finance and business development along with many new facets of imaging,” Evans said. “Stephanie retired almost two years ago and while our leadership styles were different, it felt strange not having her present to discuss ideas and problems. That led me to become more

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decisive and to trust my own abilities. She taught me to do my research and thoroughly understand the field.” “I needed to become the imaging resource and needed to be able to speak with confidence and to be prepared to help others understand the field,” she added. “To this day, that advice has served me well. As for mentoring others, I have a team of leaders whom I hope find me helpful and inspirational in equipping them for each of their own leadership journeys.” Evans said she continues to learn every day and is thankful for the many opportunities that allow her to interact with individuals who present unique opportunities to gather knowledge about a wide range of topics from various perspectives. “I learn so much through others. I serve as a Radiology Administration Certification Commissioner, a member of the Innovation in Imaging Council with the Association for Medical Imaging Management, and a Diagnostic Imaging Council member with our group purchasing organization. Each group of people I have the privilege of serving alongside with provides me with new knowledge and perspective that I might otherwise have missed. There is much to say about effective networking,” she said. • ICEMAGAZINE

NEWS

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

ICE MOVES TO MAY: NEW DATES DESIGNED TO BOOST ATTENDANCE Mark your calendar, the conference dedicated to imaging directors, radiology administrators and imaging engineers is moving to May 11-12 in sunny Ft. Lauderdale Beach, Florida. “MD Publishing and Imaging Conference & Expo (ICE) would like to inform everyone that we have decided to postpone the 2021 ICE Conference originally scheduled for February 11-12, 2021 with the new dates confirmed for May 11-12, 2021 at the Westin Ft. Lauderdale Beach Resort,” an email from parent company MD Publishing stated. The new ICE 2021 dates are designed to allow for increased participation from attendees and imaging vendors. “The dates were pushed back 90 days to allow more attendees to be able to travel due to COVID-related restrictions. Imaging directors and service professional have indicated they are eager to register for ICE 2021, but cannot travel at the current time; giving them 90 more days should ease up their travel issues,” MD Publishing President John Krieg explained. “We do not want to compromise the integrity of the event, so we felt it was best to postpone rather than hold the event without the attendance vendors would expect,” the email added. The new dates will also allow the ICE team to best deliver a quality conference that meets everyone’s expectations. “Everyone can expect the same stellar education, vendor time and networking with fellow imaging colleagues from all over the country, learning and sharing valuable information to grow and prosper personally and professionally,” Krieg said. “We have chosen the earliest and most convenient dates that ensure the Westin Ft. Lauderdale can accommodate our guests in a manner that ICE patrons expect,” the email adds. The conference will keep the same schedule, exhibit space, speakers, class times and social events. Everything will simply transfer from February to May. Continuing education is a key element of the annual conference. ICE has been pre-approved by the ACI for up to 9 CEUs. The CRES Study Group and Prep Class has been pre-approved by the ACI for a total of 7 CEUs. (NOTE: In order for an attendee to claim the CEUs on their

ICEMAGAZINE | FEBRUARY 2021

ACI journal, they’ll need a certificate of completion from each of the listed events that they have attended to attach to their journal.) Whether it’s invaluable continuing education, productive networking or the exclusive exhibit hall, every attendee will have the perfect opportunity to enhance their careers and spend time with colleagues. As an added incentive, ICE conference admission is complimentary for all hospital employees, imaging center employees, members of the U.S. Armed Forces and students.

EDUCATION ICE offers valuable continuing education with certification from ACI. AHRA certification is pending approval. Building on the success of previous conferences, ICE offers worldclass presentations and instructors.

EXHIBIT HALL Don’t miss the opportunity to interact with some of the industry’s leading companies all in one exhibit hall. Representatives will be available at each booth to explain how they can help imaging professionals perform their roles and responsibilities even better when they return to work.

NETWORKING ICE continues to be the only conference to combine leaders in imaging management with imaging engineers, providing an exclusive and unique community of key decision makers and influential imaging professionals. ICE’s networking events serve as the perfect resource to grow and prosper, personally and professionally.

FUN The conference’s unique atmosphere and signature events provide ideal venues for fun while also boosting one’s education, adding industry-leading professionals to one’s list of contacts and creating lifelong friendships with colleagues from throughout the nation. • For more information, including registration, visit AttendICE.com.

ADVANCING THE IMAGING PROFESSIONAL

NEWS ICE, AHRA CONGRATULATE THE NEWEST (CRAS) CERTIFIED RADIOLOGY ADMINISTRATORS The Fall-2020 CRA Exam period was not immune to COVID-19 related issues. A number of testing sites were closed, and many fall 2020 candidates needed to reschedule their exam to the spring 2021 testing period. ICE Magazine joins AHRA in sending congratulations to the fall 2020 class of Certified Radiology Administrators (CRAs). There are currently 1,124 CRAs and CRA-Retired. “The following 44 individuals passed the challenging and knowledge-intensive exam to become CRAs,” according to AHRA. “These individuals may now proudly be recognized by the credential ‘CRA’ after their names. Being publicly recognized as having mastery in medical imaging is just the beginning for these newly appointed CRAs. We’re excited to see their ongoing contributions to imaging, health care and our society that depends on the health of both. Well done CRAs! Congratulations! And thank you for your contributions.” The fall 2020 class of CRAs is made up of Marion

Anderson, Tracey Banks, Kelly Biscay, Chandler Bowser, Brittany Byers, Craig Carr, April Cihura, William Conlee, Ruth Cooper, Ernest Cruz, Chris Dixon, Stephen Doerner, Vaughn C. Eason, Lisa Ettrup, Jane Fry, Ian Haralson, Bridget Hill, Lisa Carol Hyde, JoAnn Kelsey, Jeramie Knapp, James Lane, Melissa Marx, Eric Mcfadden, Charlie McInroe, Mary Jennifer Meeks, Starla Merrifield, Jose Miranda, Jeffrey Murad, Tina Nelson, Erin Nieves, Amy Peronace, Brad Potter, Lisa Riecks, Andrew Ruiz, Crissy Schnick, Lyle Smith, Chad Smith, Timothy Smith, Rebecca Stueber, Jenny Sturgeon, Ramiro Torres, Vanessa Vargas, Nancy von Borzestowski and Amanda Wagoner. The CRA exam tests specific knowledge and skills necessary to lead an imaging team and manage the wide range of tasks involved in imaging management throughout a range of practice settings. • For more information about the CRA credential, visit www.CRAinfo.org.

MXR IMAGING ANNOUNCES DISTRIBUTORSHIP AGREEMENT, PRE-OWNED PRODUCTS MXR Imaging Inc. has agreed to a distributorship agreement with Sonoscape Medical Corp., an award-winning ultrasound manufacturer. The agreement grants MXR Imaging the non-exclusive right to sell ultrasound equipment including software, product demonstration and technical training of MXR personnel to service the ultrasound units. The new agreement allows trained MXR field service engineers to provide service and maintenance on Sonoscape units. “Sonoscape’s brand is known for quality and innovation and is expected to make an even larger footprint in ultrasound in the coming years. We are happy to be a part of this expansion and the chance to offer Sonoscape’s technology to our customers,” says Ted Sloan, president of MXR Imaging. “Providing newly manufactured equipment that can be installed, maintained and serviced by our field engineers immediately while still under the warranty period, provides our customers with complete continuity of the relationship post warranty – something they can’t get with just any OEM.” The distributorship includes current and future technology including, but not limited to, Sonoscape models E1, E2, X5, P40, P60 and S60. Also, MXR Imaging Inc. has announced its Platinum Certified Pre-Owned brand of products. The Platinum Certified products go through a doc-

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umented multi-point process which includes extensive testing and replacement of parts and components of pre-owned diagnostic medical products. The Platinum program’s standards adhere to MXR’s quality management system which is certified ISO 13485:2016. MXR’s first products to be released under the Platinum Certified program are pre-owned CT, PET/CT and MRI systems. Key requirements for certifying preowned CT, PET/CT and MRI systems under the program include a 100-point refurbishment checklist to bring the equipment to “as new” status and come with a one-year warranty. In addition, MXR Imaging has added ultrasound to its Platinum Certified Program. Under the Platinum program, all products undergo a documented process that includes the extensive testing and replacement of parts and components of pre-owned diagnostic medical products. For years, MXR Imaging has been successfully selling GE, Philips, Siemens and Sonosite systems as certified pre-owned ultrasound, both portable and cart-based units. Under the recently launched Platinum Certified brand, these ultrasound systems will now adhere to standards set by MXR’s ISO 13485:2016 certified quality management system and includes parts and labor warranty. • For more information, visit mxrimaging.com.

ICEMAGAZINE

NEWS FDA CLEARS COMPRESSED SPEEDER FOR 3D EXAMS Hospitals and institutions are continually looking for ways to improve diagnostic imaging throughput, especially in today’s environment where disinfection of systems and rooms in between patients is crucial. Now, Compressed SPEEDER technology has been FDA-cleared for 3D sequences on Canon Medical Systems USA Inc.’s Vantage Orian 1.5T MR system, so clinicians can expect to scan faster in many clinical scenarios. Compressed SPEEDER 3D boosts MRI scan times during 3D sequences for exams such as surgical planning and orthopedic applications by reconstructing full resolution images from under-sampled data through iterative reconstruction. The innovative technique overcomes many of the limitations inherent to traditional

parallel imaging and allows for greater acceleration. The system can even further accelerate exams with Fast3D, a new technique that can be used in combination with Compressed SPEEDER 3D to help make exams even quicker. Compressed SPEEDER is available as an option in an all-new new version of M-Power software for the Vantage Orian 1.5T, which is also available with Fat Fraction Quantification, an application integrated directly onto the system’s console to help clinicians image and quantify fatty liver disease. The application acquires six MR echoes at once, allowing for quick diagnoses, detailed severity grading, disease monitoring and treatment response, all in alignment with QIBA standards.

In other news, Canon Medical Systems USA Inc. earned top awards for CT and MR service according to data gathered during IMV’s 2020 ServiceTrak customer surveys. The award in each category is given to imaging system providers that receive the highest percentage of highly satisfied customer responses. •

BANNER IMAGING ASSUMES OPERATIONS IN NORTHERN COLORADO Banner Imaging and Radiology Imaging Associates have signed an agreement to jointly operate outpatient imaging centers for Banner Health in Northern Colorado. Banner Imaging, a wholly owned subsidiary of Banner Health, is made up of four outpatient imaging centers in Northern Colorado. The organization began with 23 ambulatory imaging centers in Arizona. Banner Imaging will focus on providing an exemplary customer experience. The four sites in northern Colorado are Banner Imaging Greeley (formerly Summit View Medical

ICEMAGAZINE | FEBRUARY 2021

Commons), Banner Imaging Greeley Breast Center (formerly North Colorado Medical Center Breast Center), Banner Imaging McKee Breast Center (formerly McKee Breast Center) and Banner Imaging Skyline (formerly Skyline Imaging-Skyline MRI). Nearly 50 employees already working for Banner Health at the four sites will transition to become Banner Imaging employees under this new agreement. Banner Imaging is contracted with Radiology Imaging Associates (RIA) to offer professional reading services. Banner Imaging centers offer

a complete range of advanced imaging services, including CT scans, MRIs and mammograms. The facilities offer digital-imaging technology, highly trained subspecialized radiologists and a patient-centered environment. “We are fortunate to partner with exceptional radiologists who have been providing patient-centered care in Colorado for more than 50 years,” said Jason Theadore, Banner Imaging’s chief executive officer. • For more information, visit www.BannerHealth.com.

ADVANCING THE IMAGING PROFESSIONAL

CLARIUS WIRELESS SCANNERS PROVIDE CONTINUOUS BATTERY POWER Clarius Mobile Health has introduced the Clarius 2-in-1 Charging Station HD, which offers a constant supply of battery power by charging the wireless Clarius HD ultrasound scanner and spare battery simultaneously. “The 2-in-1 Charging Station is perfect as you don’t have to remove the battery to charge it and it can function as a stand for the unit. Having the ability to have an extra battery ready to go is also a huge perk for this unit. This 2-in-1 charging station completes the kit nicely,” says Dr. Alan M. Hirahara, MD, FRCSC, an orthopaedic surgeon specializing in arthroscopic shoulder surgery and sports medicine in Sacramento, California. The Clarius 2-in-1 Charging Station combines a charging dock for both the Clarius HD handheld scanner and a spare battery, with LED indicators that display color-coded charge levels. Clinicians who only use the scanner for short bursts of time can return their wireless scanner to the station to keep it charged, eliminating the need to replace the battery between uses. The new charging station is available in the United States for $179 at the Clarius online store. Clarius CEO Laurent Pelissier said the Clarius Charging Station was developed in response to some customers seeking continuous power and a place to

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dock their charger when not in use. “Many of our users who are scanning patients continuously or travelling to areas where electricity isn’t always available, appreciate the flexibility of having a swappable battery. Others who only use the scanner for 15 minutes at a time were looking for a way to charge the scanner without removing the battery. We’re happy to provide this new flexible and compact solution.” Clarius batteries provide up to 60 minutes of scanning time and can be quickly replaced with a fresh battery. Instead of a swappable battery, competitive handheld ultrasound systems incorporate a permanent battery that can take up to 5 hours to charge from empty. Some handheld systems also rely on the power from the mobile phone or tablet. The Clarius product line up includes 10 handheld ultrasound scanners designed for a wide range of medical specialities. They are used in hospitals, private practice and veterinary clinics around the world. No-subscription pricing with each scanner includes unlimited cloud storage for image management for unlimited users, a 3-year warranty, Clarius Live telemedicine and forever-free software updates. The scanners offer unparalleled high-definition imaging and fast frame rates made possible with the latest piezo electric technology. •

ICEMAGAZINE

NEWS CLEARVIEW TRANSPARENT RADIATION SHIELDING MARKET GROWS Radium Incorporated in Waynesboro, Virginia was awarded a patent for their proprietary shielding solution branded as ClearView Radiation Shielding in 2019. ClearView was developed in 2016 and first used in early 2017 by a chemistry department in a nuclear plant to perform analysis of radioactive water samples during a refueling outage. That was just a start for the ClearView product line. As of today, ClearView Radiation Shielding is used by half of the nuclear plants in United States. Radium is currently expanding business into Mexico and Canada. Radium is actively developing novel products aimed at minimizing occupational dose exposure for the healthcare industry and radioisotope manufacturers. With collaborations at University of Wisconsin-Madison, University of Michigan-Ann Arbor, Memorial Sloan Kettering Cancer Center and Stanford University for testing new products, Radium continues to innovate in worker radiation protection. ClearView Rolling Shields are being used at several hospitals across the United States for inpatient radiotherapy such as I-131 mIBG for treatment of pheochromocytoma and neuroblastoma, cancers found in the adrenal glands. Usually lead (Pb) shields, weighing approximately 1,000 pounds are used to create a barrier protecting hospital staff and family from the patient who is undergoing such treat-

ment. The lead shields are extremely heavy and have to be moved large distances by nurses, with some shields not having handles. Incidents have been reported of lead (Pb) shields slipping out of hand while transporting them from storage into a patient room. A nuclear medicine manager of a hospital in California recently said, “we have to absolutely get rid of these lead (Pb) shields.” In addition, using lead shields makes the patient to feel they are locked in a box, which results in an unpleasant patient experience. Medical centers have reported that anxious patients often refuse therapy due to such reasons resulting in failure to receive lifesaving treatment. The ClearView Rolling Shields allow the patient to see and interact with their family and the hospital staff. This significantly helps relieve patient anxiety as reported by Mott Children’s Hospital at University of Michigan, Ann Arbor. The ClearView shields are about half the weight of traditional lead shields (peer reviewed published data) providing adequate protection from radiation. Being lighter and allowing ease of communication, these shields have become a preferred choice by several doctors, nurses and nuclear medicine technicians. Lead shields also come in fixed sizes, while ClearView Rolling Shields are almost always custom made. Hospitals using two 1,000 pounds shields now use two shields, each 285 pounds. •

GE HEALTHCARE, ST. LUKE’S UNIVERSITY HEALTH NETWORK ACCELERATE BREAST CANCER CARE GE Healthcare announced St. Luke’s University Health Network in Pennsylvania will pilot the nation’s first rapid diagnostic breast cancer center model. The One-Stop Clinic breast care model, which originated at the Gustave Roussy Cancer Center in France, has been shown to improve clinical outcomes and speed up breast cancer diagnosis and treatment planning. In 2019, GE Healthcare and Premier Inc. announced plans to collaboratively work with a Premier member health system to open the first One-Stop Clinic model for breast cancer in the U.S. The multi-modality approach is designed to provide patients with a coordinated journey from the initial appointment through diagnosis and treatment plan in one location and with one team – all in a significantly shorter timeframe. The goal is to reduce the time between when a patient receives an abnormal screening mammogram and a confirmed cancer diagnosis and treatment plan. Studies show the length of time between mammogram and the first surgical consultation can average 26 days. GE Healthcare and Premier Applied Sciences selected St. Luke’s as an ideal pilot site as they have already implemented a five day, streamlined diagnostic imaging flow

ICEMAGAZINE | FEBRUARY 2021

process. Once the One-Stop Clinic is fully operational, the goal is to reduce this time to 36 hours or fewer. Premier’s role is to create the training and operation materials that St. Luke’s will utilize to implement this model. The three parties will work together to share these learnings with other health systems in the future. “Reducing the time to diagnosis for breast cancer patients will become a reality in 2021,” said Roni Christopher, DHSc, vice president of design and implementation for Premier. “We are incredibly proud of the work we have done thus far with GE Healthcare and St. Luke’s, and are excited to help expand this innovative care model to more patients across the country.” The St. Luke’s One-Stop Clinic has already begun piloting the workflow and expected to open to in 2021. The flow of clinical care will start with a mammogram and biopsy, as needed, followed by pathology, conclusive diagnosis and treatment planning. Worldwide, additional One-Stop Clinics are in development by GE Healthcare with several new clinics planned in the year to come. To date, more than 25,000 women have participated in One-Stop programs in France and Colombia. •

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HOLOGIC ADDS 3D BREAST ULTRASOUND IMAGING TO SUPERSONIC MACH 40 SYSTEM AND ACQUIRES SOMATEX Hologic Inc. announced that 3D ultrasound imaging is now available on the SuperSonic MACH 40 ultrasound system. Clinicians can now access high-resolution B-mode and ShearWave PLUS elastography 3D volumes, which are designed to enhance diagnostic certainty. With the 3D volumetric data acquired on the SuperSonic MACH 40 system, clinicians can see areas of interest from a new perspective. Breast tissue can be visualized in any scanning plane of the 3D volume, including coronal or C-plane. MultiSlice display allows these 3D volumes to be viewed slice-by-slice, while MultiPlanar display virtually reconstructs the slices in any orientation using the acquired and stored volume. The system’s volumetric transducer allows users to easily and rapidly acquire these 3D images with no resolution loss, regardless of where a lesion is located within the breast.

In other news, Hologic Inc. has completed the acquisition of SOMATEX Medical Technologies GmbH, a leader in biopsy site markers and localization technologies, for approximately $64 million. The company was previously owned by E-Med Solutions GmbH, Berlin, a group of investors led by German private equity company Westlake Partners. The transaction supports Hologic’s strategy to provide a comprehensive suite of innovative solutions across the continuum of breast health care. Specifically, SOMATEX’s differentiated products will enable Hologic to strengthen and further expand its breast marker portfolio, which has been growing consistently. As a result of the acquisition, Hologic will also enhance its sales presence in Europe by expanding its direct channel in Germany and its network of regional and international distributor partners. •

MTMI LAUNCHES MRSO PROGRAM MTMI launched a comprehensive Magnetic Resonance Safety Officer (MRSO) Program in late January to help address a critical need for safety in MRI health care imaging. It is designed to provide the necessary educational competency and knowledge to individuals responsible for the safe clinical and technical operations under the MRI environment. There are over 30,000 MRI studies being performed in the United States each year, according to the U.S. Food and Drug Administration (FDA). While MRI is considered one of the safest medical imaging modalities, its powerful magnet can pose potential injury or risk to patients, relative companions, staff and operators. “MTMI is excited to offer this new, world class program that can help manage MRI safety” stated Ernie

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Cerdena, president of MTMI “And as an added benefit we are able to deliver this high quality 16-hour course for an affordable price of $499.” The program also includes MR Safety topics assessed by the MRSO Certification Board Examination offered by the American Board of Magnetic Resonance Safety (ABMRS). Furthermore, the program enhances the hospital and imaging center’s compliance with the Joint Commission requirements relative to the standards provision in medical imaging services. The course is taught by MTMI’s highly experienced instructors who are practicing safety officers and teach through case studies and real world experience. • For more information about this program visit mtmi.net.

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SPOTLIGHT

Rad idea SAFETY FiRsT

andace Ray, B.S., R.T.(T), recently received a Safety FiRsT grant to implement an initiative that will elevate patient and technologist safety in the workplace. Funded by Canon Medical Systems USA Inc. and administered by the ASRT Foundation, the Safety FiRsT program awards two ASRT members per year a grant of up to $7,000 each to improve radiologic technologist safety in their departments. Ray applied on behalf of Baton Rouge General Pennington Cancer Center. The grant will be used to purchase a ceiling lift for patient transfer in the facility’s busiest radiation therapy treatment unit. “My team and I are so grateful to receive this safety

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grant,” said Ray. “By installing a ceiling lift over our treatment room table, we can create a safer environment for our radiation therapists and our patients. The installation will set a new standard for patient safety in radiation oncology in the greater Baton Rouge area, and our patients and therapists will be safer every single day.” The ASRT Foundation and Canon Medical Safety FiRsT grants are funded by a grant from Canon Medical. The ASRT Foundation is the philanthropic arm of the American Society of Radiologic Technologists, the world’s largest radiologic science association. The ASRT Foundation supports and empowers medical imaging and radiation therapy professionals and students to pursue opportunities that improve patient care. • Share your RAD IDEA via an email to editor@mdpublishing.com.

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SPOTLIGHT

Off Clock Sheila DeBastiani, right, is seen at the Mount Airy Ukulele Festival.

THE

SHEILA DEBASTIANI, RT(R), SUPERVISOR/ EDUCATOR, WAKEMED INVASIVE CARDIOLOGY BY MATT SKOUFALOS

uring work hours, Sheila DeBastiani is a supervisor and educator in the invasive cardiology unit at WakeMed Health and Hospitals in Raleigh, North Carolina, supporting a busy service line that touches patients of all ages and all walks of life.

Sheila DeBastiani enjoys teaching others, especially at the St. James UMC Ukelele Camp. 22

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Fittingly, however, when she’s not on the WakeMed campus, DeBastiani is still touching hearts, although her instruments of choice are musical, not medical. A talented performer on the bass, guitar, and ukulele, and a self-described “dabbler” in mandolin and dulcimer, DeBastiani shares her gifts with audiences throughout the broader community, not only as a performer, but also as a teacher. ADVANCING THE IMAGING PROFESSIONAL

“I’ve been playing guitar since I was 13, and I picked up ukulele about four or five years ago,” she said. “My husband got me one for my birthday, and I’ve had a lot of fun with it. If I want to play something more reflective or more serious, I stick with the guitar, but if I want to have fun, I play the ukulele.” Like any musician, DeBastiani has her influences, and when it comes to the ukulele, there’s none greater in her life than Jake Shimabukuro. In 2010, the Japanese-American virtuoso told CNN that the ukulele is “the instrument of peace,” and that if everyone played it, the world would be a more harmonious place. “I bought into that,” DeBastiani said. “I’ve given several people ukulele lessons and they’ve done quite well with it. It’s trans-generational. It’s a pretty easy instrument to play, and you can sit down with someone for a half-hour and they’re able to play a song.” When DeBastiani was first learning how to play the ukulele herself, she didn’t know anyone else to play along with, so she decided to try to recruit some compatriots through her worship community at the St. James United Methodist Church of Raleigh, North Carolina. After posting in the St. James newsletter and church bulletin, about five fellow congregants took her up on the offer. They ranged in age from seniors to children, and after a little while, the circle expanded to include folks from beyond the church itself. Retirees and working-age people, grandchildren and grandparents, siblings and friends; they all came together to play. The universal appeal of the instrument and the scope of its reach soon became evident to her. The way that people stuck with it and continued to play thanks to her tutelage was “something that’s very humbling,” DeBastiani said, and she has more than a few stories of what those efforts have done for her students. “When you’re teaching somebody, you don’t really know the impact that you’re having on them,” DeBastiani said. “One of my young friends started out, a sophomore in high school, and he and his mom did ukulele camp with me. From the ukulele, he transitioned to the WWW.THEICECOMMUNITY.COM

guitar and the bass guitar.” “When he delivered the message at church, he said he’d always liked music, but never thought much about playing until he started with the ukulele. He said the reason that music means so much to him is he found his way to Christ on Thursday nights in the music room, and started out with the ukulele,” she said. “The takeaway from that is everybody experiences things in different ways,” DeBastiani said. “Whenever you reach somebody, you’re able to reach them, through whatever barriers they might have, through music. It’s really humbling.” At 13, DeBastiani herself was taught guitar by a fellow parishioner at her church, and she has repaid that gift at St. James UMC by educating a dozen or more teenagers in the youth praise band there. To her, the lessons are a part of ministry, so she never charges for them; the only catch is that her students must agree to perform in the church band. In her own practice, DeBastiani plays for pleasure about an hour a day, and more when she’s rehearsing for a gig. A fan of folk rock, she claims James Taylor, Joan Baez and the Nitty Gritty Dirt Band as influences on her performance. In addition to playing, she enjoys singing and musical arrangement, and her own repertoire includes “Will You Remember Me,” “Drift Away,” “Make You Feel My Love,” “Teach Your Children,” and as a native West Virginian, “Take Me Home, Country Roads.” There’s also a point at which her musical and professional lives have intersected, and it began some 13 years ago when the WakeMed vice president of heart and vascular services asked DeBastiani to coordinate performances of Christmas music in the building lobby to give patients and their families an infusion of holiday cheer. It’s grown so much since that in 2019, she booked 30 different performances there in the course of two weeks. Players hailed from the facility itself as well as from throughout the broader community of musicians in Raleigh. The 2020 season was much scaledback because of the novel coronavirus (COVID-19) pandemic – only stringed

instruments, and only two to three performances per day – but that tradition that comforts so many of their patients remained intact, “this year of all years, when we need more than we normally do,” DeBastiani said. “It’s my most favorite thing about my job,” she said. “It’s a wonderful thing to be able to offer to our patients and their families.” Despite the pandemic, DeBastiani has continued her lessons with the teenagers in her church group, albeit over FaceTime. It’s important for her to mitigate the risk implicit in in-person gathering, but for her it is even more important to keep them connected via performance. “I really have grown to care very deeply for these people and I wouldn’t want to do anything to put them in jeopardy,” she said. “I meet with them on Thursday nights, and I like that. By Thursday, you’re kind of tired from the week, and being able to play music revitalizes you.” “I just want them to know that somebody out there cares,” DeBastiani said. “They’re going through a ton, and somebody cares.” •

A fourthgrader sent Sheila DeBastiani this note on her birthday.

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NEWS

STAFF REPORT

FIRST WEBINAR OF 2021 COVERS ‘ESSENTIALS OF IMAGING INFORMATICS’

CE webinars started 2021 with “Essentials of Imaging Informatics” presented by Kenneth Fazzino, Senior Director of Envision Physician Services. Fazzino discussed the imaging informatics subspecialty of radiology that is designed to improve the efficiency, accuracy and reliability of radiologic services within the medical enterprise. Essentially every aspect of a radiologist’s workday involves some form of communication: calling a colleague for patient history, reviewing images with a clinician, teaching a trainee, producing reports and justifying an examination to a third-party payer. As leaders of clinical teams navigating the impact and language of IT projects can be daunting. All of these events fall under the purview of imaging informatics and, all of them, along with image interpretation itself, can become more efficient with the proper tools. The webinar provided a general knowledge of imaging informatics to help attendees succeed. In his presentation, Fazzino taught attendees how to: • Identify and discuss the basics of imaging informatics • Identify and discuss the relevance of radiology initiatives • Discuss and identify the patient experience • Discuss and identify the physician experience • Discuss and identify the administrator expectations 24

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• Obtain general knowledge of relevant terminology • Understand how IT interacts with billing elements • Identify recent and upcoming IT tools The webinar was a hit with a 4.3 rating on a 5-point scale with 5 being the best possible score. The first webinar of 2021 drew 35 attendees that included an imaging director, MRI technologist, diagnostic imaging manager, interim radiology director, Siemens lead engineer and trainer, director of imaging, radiology supervisor/PACS administrator and more. In a post-webinar survey, attendees provided additional feedback. The survey included the question, “Overall, how satisfied were you with today’s webinar?” “Ken is an excellent speaker and I learned a lot from this presentation,” shared J. LeRose, interim director, radiology. “Hoping to attend many more in the near future as the info shared was very informational,” said M. Santamaria, accounts relationship manager. “Information applicable to my role and new radiology equipment planning,” said P. Slemp Sr. contract administrator, capital planning.• For more information, including recordings of previous webinars and a schedule of upcoming presentations, visit ICEwebinars.Live.

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Imaging Device Experts Provide Un-Biased Advice National Distributor of Imaging Devices Uses Innovative Approach to Address Unique Issues at Medical Facilities

he purchase of medical imaging equipment represents one of the most significant financial decisions that health care providers undertake. When done well, imaging device selections can improve their diagnostic and interventional services as well as streamline staff workflow and training. Additionally, thoughtful purchasing can lower service and maintenance costs. However, with increasing frequency, these considerations are lost in the complexity of larger corporate decisions, such as mergers and acquisitions of competitive entities. Far too often, legacy equipment carries with it costly consequences that can take years for a business to recover from. MERGERS & ACQUISITIONS Through acquisitions, patient facilities not only inherit equipment, but can be locked into service and maintenance contracts they did not originally choose. 26

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Ongoing consultative support by MXRâ&#x20AC;&#x2122;s Imaging Technology Experts helps clients identify areas of improvement beyond equipment itself

In these situations, health care providers may find themselves managing multiple service contracts from a wide variety of OEMs over multiple locations. Coupled with this, equipment training becomes a nightmare along with inefficient workflows. How does a health care provider quickly get a handle on all these moving parts? Is it possible? One solution provider believes it is.

units as well as unique services for their clients. Their position provides the freedom to offer an impartial opinion of their clientâ&#x20AC;&#x2122;s situation and needs. In this way, MXR can prescribe imaging device and services without bias, guiding clients to precise imaging solutions to maximize their patient care and efficiencies while mindfully streamlining costs.

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MXR Imaging Inc. has decades of expertise across all leading imaging device brands. For years they have worked with clients to successfully understand their needs. Their national service and distribution network affords access to new and refurbished

A unique service MXR provides clients is ongoing consultative support from imaging experts. These imaging technology experts engage with clients to evaluate potential areas of improvement (i.e., workflow, asset management, ADVANCING THE IMAGING PROFESSIONAL

MXRâ&#x20AC;&#x2122;s extensive imaging portfolio includes CT, MRI, PET/CT, ultrasound, and general radiology imaging equipment for hospitals, imaging centers, chiropractors, orthopedic practices, family physicians, large practice imaging departments and veterinarians.

legacy equipment). Identified projects can contain multiple elements beyond equipment itself. Many of these surrounding project components can be addressed through MXR. Some of these components include room design, equipment selection (new, upgrade or certified pre-owned), applications training, legacy equipment decisions, mobile imaging service needs and service support contracts.

with regulators and achieving the certification is assurance that a company meets certain quality management system expectations defined within the standard. MXR Imaging is FDA-compliant, certified ISO 13485:2016, and highly values patient care and safety within each of their client facilities.

BUDGET CONSTRAINTS When acquiring imaging devices, overcoming budget constraints requires exploring beyond traditional capital equipment budget paradigms. This can include standardization of equipment purchases that level buying power and reduce the cost of implementation due to a common and repeatable construction and logistic process either with a single vendor or through joining a group purchasing organization. Many facilities are also using the restructuring of the purchase process to encompass a decentralized approach. In this model, capital expenses can be mapped to full revenue streams and patient encounters.

For over 60 years, MXR Imaging Inc. has been providing imaging products and services to health care. Always the innovator, they originally offered film and chemistry to their customer base. MXR then quickly expanded into offering consumable and durable goods to the health care market. Next, as their geographic coverage expanded beyond southern California, MXR began to pursue imaging equipment sales and support as well. Their current portfolio encompasses general radiology, CT, PET/CT, MRI, ultrasound as well as consumable/durable goods, and equipment service support. Recent further refinement of their portfolio has added probe repair, coil repair and mobile imaging. â&#x20AC;˘

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According to the Healthcare Supply Chain Association 2020 report, GPOs have become more important than ever. Just as hospitals have sought to engage their organizations with GPOs, MXR Imaging has been solidifying vendor agreements with members of the leading GPOs in the country.

PATIENT CARE AND QUALITY In the last two decades, the medical device regulatory environment has evolved significantly. Medical device companies selling products to the U.S. market must have a QMS in place that meets FDA 21 CFR Part 820 Quality System Regulations. Adhering to ISO 13485:2016 is an accepted approach WWW.THEICECOMMUNITY.COM

The MXR Platinum Certified Preowned brand is creating opportunities for equipment upgrades for increased image quality with certified, warrantied equipment.

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PRODUCTS

Market Report Radiation Monitoring, Safety Market Recovery Expected STAFF REPORT

he “Medical Radiation Detection, Monitoring and Safety – Global Market Trajectory & Analytics” report predicts growth.

The global market for medical radiation detection, monitoring and safety is expected to slump by 4.6% in the year 2020 and thereafter recover to reach $1.2 billion by the year 2027, trailing a post COVID-19 compound annual growth rate (CAGR) of 4.7% over the analysis period 2020 through 2027. Radiation monitoring remains an integral part of good health practice in medical facilities performing radiation therapy and diagnostic activities. Stringent safety regulations aimed at safeguarding the health of patients, medical physicists, radiologists and nuclear medicine technicians has long been the primary growth driver. The pandemic has necessitated the prioritization of health care infrastructure for COVID-19 patients, affecting other patients across the world. As a result, hospitals across the world have been advising patients to delay elective and non-urgent diagnostic imaging and surgical procedures, including X-ray, CT, MRI and many other radiation and radiologically dependent procedures. Consequently, the consumption of radioactive material for these procedures has been witnessing significant slowdown. Suspension of diagnostic and therapeutic radiology services amid the COVID-19 pandemic has significantly impacted medical radiation detection, monitoring and safety. With low patient throughput in radiology labs worldwide, the market is expected to slump by a painful -4.6% in the year 2020. The majority of radiation exposure in the medical field is on account of fluoroscopic imaging, which leverages X-rays to achieve cinematic and dynamic functional imaging. Fluoroscopy finds applications in several specialties such as gastroenterology, vascular surgery, interventional cardiology, interventional radiology, urology and orthopedics. In comparison to other medical diagnostic procedures, cardiac cath labs with electro-physiology and angiography result in the highest X-ray 28

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radiation dose. There is long-term exposure for lab technicians and physicians in these areas to low levels of scatter radiation. While the benefits obtained from using X-rays in these labs surpasses the risks, the staff is prone to the scattered radiation from the skeletal structure of the patient. X-rays constitute high energy photons in the electromagnetic spectrum. X-rays have the capability to ionize atoms and breakdown molecular bonds. This ionization generates free radicals, which are chemically active compounds that can cause indirect damage to the DNA. Patients and medical staff can have exposure to X-ray radiation through direct exposure to the beam or due to scattered X-rays. As scattered X-rays lose a portion of their energy in the scattering process, the energy resulting in the tissues from scattered X-rays is lesser than that from the source of the X-ray. Radiation doses are expressed in three ways. The absorbed dose refers to the radiation that results in an object and is calculated in mGy (milligrays). The comparable dose is measured, taking into consideration the radiation exposure specific to the organs and the sensitivity of the organ to the radiation, and is measured in mSv (millisieverts). The effective dose is also expressed in mSv. 20mSv/annum is about 2-3 pelvic and abdominal CT scans or background radiation of 7-9 years. Exposure over this limit averaged over a period of five years has been linked to a 1 in 1,000 lifetime risk of deadly cancer. For physical protection from radiation various kinds of personal protection equipment (PPE) can be used. Certain fluoroscopy suites include lead acrylic shields (ceiling-suspended), which can lower doses to the neck and head (by a factor of 10). Portable rolling shields can safeguard personnel in interventional settings and operating rooms. If used accurately, mobile shields are said to lower the effective radiation dose by over 90%. In situations where shielding with the use of a physical barrier is not possible, personnel need to use leaded aprons for safety. These aprons are made available in various thicknesses such as 0.5mm, 0.35mm and 0.25mm. Aprons that go around the body are considered to be better than front aprons, due to the former’s better coverage. • ADVANCING THE IMAGING PROFESSIONAL

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Product Focus

Radiation Monitoring

TEXRAY

Radiation Protective

Texray, a Swedish technology and innovation company, has invented the only radiation protective textile in the world to address the growing need for comfortable and functional personal protection garments. Texray comes as a HeadPeace, which reduces radiation exposure to the upper section of a patientâ&#x20AC;&#x2122;s head. Texray also comes as a new invention of thyroid protection; a MindPeace. With its extended panel, it reduces radiation exposure to thyroidea and the middle section of a patientâ&#x20AC;&#x2122;s head. When combining the two protective garments from Texray an additional 74% reduction for ionizing scatter radiation may be reached.

MRIEQUIP

Non-Ferromagnetic Gurney with Wrap-Around-Rail System The new Non-Ferromagnetic Gurney with Wrap-Around-Rail System (Part #ST-5300) effectively and, most importantly, safely transports patients from one end of the hospital to an MRI suite. It is perfect for transporting children and distressed patients. The removable head and foot rails can be stored underneath the stretcher, making them easily accessible and quick to attach or detach. It is MR conditional up to 7T or less and passes all ferromagnetic detection systems. It comes ready to be equipped with optional accessories like IV pole holders and O2 tank holders. This fully enclosed gurney is an allin-one solution for safe transportation in and out of MRI suites.

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3 CARR CORPORATION

LSL Lead Shield Line The Carr LSL Lead Shield Line has been manufactured by experienced engineers since 1946 and offers the epitome of safety, convenience and functionality. It has full side-to-side and top-tobottom protection. For example, the shield leaves no gap at the bottom where radiation can pass through to the operator. Horizontal protection does not stop at the vertical supports, instead, the protection is integral to the supports. The Carr LSL shields can be mobile, wall mounted or stationary and have 10-inch by 12-inch lead windows. They are available quickly with a 2- to 3-day lead time being typical.

FUJIFILM FDR AQRO

Fujifilmâ&#x20AC;&#x2122;s FDR AQRO is a unique mini point-of-care digital X-ray system with the flexibility to image anywhere. To ensure exceptional image quality at gentle patient dose, the system comes standard with Fujifilmâ&#x20AC;&#x2122;s premium core technologies. Combining advanced detector technologies such as patented ISS, Dynamic Visualization and Virtual Grid simulation image processing, the system is able to lower dose 20-50%. Its ultra-low power design and 12-hour battery can easily handle high patient caseloads and remote environment uses. Additionally, its smooth sealed surfaces and special antibacterial coating, bring added infection controls for isolation and infectious disease uses.

*Disclaimer: Products are listed in no particular order.

ICEMAGAZINE | FEBRUARY 2021

ADVANCING THE IMAGING PROFESSIONAL

MARSHIELD

Glass and Acrylic Mobile Radiation Shielding Barriers MarShield offers standard and custom-designed glass and acrylic mobile radiation shielding barriers. These barriers are designed to reduce harmful radiation while maintaining an â&#x20AC;&#x153;open conceptâ&#x20AC;? environment through safety lead glass window viewing panels. The glass barrier features an optically clear safety lead glass panel that is durable and shatter-resistant while offering a wide field of view. The lead acrylic viewing panel provides excellent visibility, is shatter resistant and durable, ensuring a long life under heavy use. MarShield can work with clients to design a custom mobile radiation shielding barrier in a virtual CAD environment.

5 RAYSAFE

452 Radiation Survey Meter

MATTER FABS MatterVault

Matter Fabs offers traditional radiation shielding that has protected people for many years and is very excited to introduce the patent-pending MatterVault. The MatterVault addresses many improvements that were sorely needed in the industry. The MatterVault wall structure meets or exceeds all requirements. It is very cost effective and quick to build with temporary to permanent uses. It is 90% reusable and easily relocated. It is so eco-friendly that it also allows for Leed points overseas. It also means reduced material costs and freight costs to the building site.

The RaySafe 452 is a powerful survey meter that measures ionizing radiation in a wide variety of applications such as finding spilled isotopes, measuring scattered radiation from X-ray machines, and linear accelerators. The meter does not require any corrections or manual settings, letting individuals focus on radiation protection rather than set-up. Data can easily be transferred for further analysis with the PC software RaySafe View, which is included with the meter. The intuitive interface shows all parameters in one view, and all measurement data is stored automatically. One device for every situation means less to carry, learn and administrate. That equals less expense, more efficiency and time savings.

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ICEMAGAZINE

COVER STORY

Changes on the Horizon What the outcome of the 2020 elections could signal for the national medical imaging agenda By Matt Skoufalos

ICEMAGAZINE | FEBRUARY 2021

ADVANCING THE IMAGING PROFESSIONAL

COVER STORY

t the conclusion of one of the most protracted, contentious and tumultuous election seasons in recent memory, Americans selected a new president and several new federal legislators. As they prepare to begin the business of governing the nation, the eyes of the country are upon them; watching just as closely as anyone else to see where their priorities will fall are all corners of the medical imaging industry. Among the most intensely avowed – if least able to be substantiated – positions of the Trump administration has been deregulation, “and it’ll be interesting to see if that’ll continue under the new administration,” said Greg Morrison, M.A., R.T.(R), CNMT, deputy CEO of the American Society of Radiologic Technologists (ASRT). However, one of the most significant priorities from ASRT for the last several years has been seeking legislative efforts to help establish licensing and certification around the operation of medical imaging equipment, particularly modalities that rely on ionizing radiation. This issue has taken on greater significance in recent years, as non-imaging providers, from physicians’ assistants and nurse practitioners (NP) to physical therapists, have begun seeking access to order, perform and interpret diagnostic imaging studies. Without sufficient education and training, Morrison fears that those providers could make mistakes that could have lasting implications for patients. “At the state level, and even at the federal level, CMS has opened regulations in this time of COVID to provide access to [imaging studies to] mid-level providers, particularly to the NP and physician’s assistants,” he said. “Certain lab work and therapies outside of medical imaging they’re perfectly educated in, and competent to be involved in those areas. But when it comes to medical imaging, I do not believe that they have enough eduWWW.THEICECOMMUNITY.COM

cation to perform radiology studies, let alone radiation therapy studies, or interpret those or be involved in that process without additional education,” Morrison said. In the absence of a federal statute in place that could certify the competency of an imaging professional in all 50 U.S. states – or the legislative willpower to deliver one – ASRT has refocused its efforts on developing responses to various initiatives at the state government level. (The Consumer Assurance of Radiologic Excellence, or CARE, bill was introduced eight times in the U.S. House of Representatives between 2000 and 2013, and six times in the U.S. Senate; it never cleared both houses at the same time, and by 2014, ASRT had shifted its attention to individual state legislation.) Among the biggest concerns at the society is the notion that state lawmakers working with various trade organizations could access imaging studies and therapies without appropriate understanding of how those modalities work and how to interpret their results. “When it comes to radiology, we – Greg Morrison need a clearer understanding of what [these providers] mean when they say ‘diagnostic tests and therapies,’ ” Morrison said. “They are not sufficiently trained in radiology. PTs want to order imaging studies, but the language we see in state bills is vague enough that it may be understood as PTs also wanting to perform and interpret them, too. Saying ‘imaging studies,’ the language may be open enough to order CT or MR that in most instances would not be applicable to physical therapy. “We have worked to assist the physical therapy lobbyists with some language with the hope that they’ll limit ordering to plain film radiography,” he

said. “I think the PTs are seeking to just be able to order studies, but it comes down to what their bill language looks like, because it may allow them to do much more. Once something is in legislation or regulation, it’s much harder to go back and change it.” Only 11 U.S. states don’t require their own licensing or certification from a nationally recognized certification body for imaging technologists to work in the field. Some don’t require licenses to work in radiation therapy and nuclear medicine, and only four states (New Hampshire, New Mexico, North Dakota and Oregon) require sonographers to be licensed in order to work with ultrasound equipment. In the coming years, ASRT is working to introduce or re-introduce bills around the areas of medical imaging expertise in various states across the country, including

“ At the state level, and even at the federal level, CMS has opened regulations in this time of COVID to provide access to [imaging studies to] mid-level providers, particularly to the NP and physician’s assistants.”

Alabama, Alaska, California, Georgia, Michigan, Missouri and Pennsylvania. “I think the case for ensuring that the public has access to individuals who are appropriately educated, clinically competent, certified and licensed enhances patient care and ensures that appropriate radiation exposure processes are taking place is, in our mind, a very important issue,” Morrison said. “Radiation has been deemed a carcinogen, so it’s important that the people who operate the equipment have a complete understanding of what goes on behind the scenes and what happens when you engage the imaging ICEMAGAZINE

COVER STORY or therapy unit,” he said. “And it’s an understanding of what can happen as radiation is cumulative over a person’s lifetime.” ASRT, like every imaging specialty group, is also paying close attention to the evolution of rules changes to federal reimbursement fee schedules amid the constraints of Congressional budget neutrality rules. The tug of war over resources – namely, the expansion of evaluation and management monies at the expense of specialty physician practice areas, including radiology – has become more high-stakes, particularly as almost every aspect of health care is working to rebound from the impact of the novel coronavirus (COVID-19) pandemic. In the medical imaging space, that’s meant shuttered operations for a quarter of 2020, widespread layoffs and furloughs, and the perception that imaging staffers aren’t frontline workers at risk of contracting infectious diseases. “We’re fighting that battle everywhere we can to ensure that technologists in this profession, and the profession of medical imaging and radiation therapy as a whole, are being recognized as frontline workers,” Morrison said. “Every patient with suspected COVID gets a chest X-ray; they may get a CT scan.” “We continue to be actively involved in the return-to-care movement, getting people back in for screening exams with the understanding that they need to be done in a COVID-safe environment,” he said. “Exams should not be put off. Increases in the number of undiagnosed cancers that will have occurred because of this nearly 10 months of folks not being seen will ripple; those folks will now require more care when it could have been prevented, which will only drive up costs.” Among the most frustrating aspects of advocacy work “is the slow-moving or even stagnant nature of these things, with nothing really getting done,” Morrison said. “It just feels like Washington is doing very little because there’s always something that seems to take the focus 34

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off our issues,” he said. “It’s one of those areas where medical imaging doesn’t need to feel like the Lone Ranger, either. Everybody, no matter what your profession is, is in the same boat.” In addition to the change in leadership of the U.S. presidency, Kit Crancer, vice president of public policy at Center for Diagnostic Imaging (CDI) of Minneapolis, Minnesota, said he’s waiting to see how the legislative priorities of the new Congress unfold in a house of government that likely will have to reach across the aisle to get its business done. “What Biden is going to be able to achieve on the health care front, he’s either going to need to achieve with bipartisan support, or through the rule-making process, or through executive order,” Crancer said. “I think that’s going to limit a little bit of what he can achieve as far as his agenda goes.” In such an environment, Crancer is skeptical of sweeping health care reforms being enacted (“I think it takes a public option off the table,” he said), but more modest reforms – like rolling back the Trump administration’s promotion of short-term health plans, or perhaps trying to eliminate the work requirements that some states have put into Medicare expansion waivers – might make headlines. Even with a Democratic vice president breaking potential vote ties in the U.S. Senate, committee processes are likely to be divided affairs. “It’s a little bit tougher to move things, and that probably moderates Biden’s agenda,” Crancer said. “But within this latest [COVID] stimulus bill, the thing that I was encouraged by is that you did see [Nancy] Pelosi and [Mitch] McConnell and [Kevin] McCarthy and [Chuck] Schumer work together; a cobbling-together of a bigger package than what anyone thought possible before the election. I was impressed to see that there was this bipartisan understanding that we needed to do something for the American people.” Crancer also said he anticipates the possibility that McConnell’s relationship with Joe Biden could become another

point upon which to build consensus, potentially clearing a path for more bipartisan bridge-building. “These are two individuals who’ve referred to each other as friends over the past couple years,” Crancer said. “I think you’re going to see a warmer relationship between the two of them than Mitch and Trump ever enjoyed.” Of course, for any of those priorities to come to the fore will require broad efforts to quell the spread and impact of the pandemic, which “is difficult for folks to see beyond,” particularly amid a lack of uniform federal response under Trump, Crancer said. As state governments have had to more directly manage a lot of their pandemic efforts for testing, sourcing personal protective equipment (PPE), and distributing vaccines, they are likely to remain the governments on which health care practitioners focus their attention until the pandemic – and the regulatory efforts that accompany it – is under control. Indeed, he foresees “a lot more activity at the state level than congressionally” during the next election cycle because only Minnesota has a divided state legislature; in every other state in the nation, a single party controls both of its legislative bodies, which means national policies are more likely to be shaped at a state-by-state level as lobbyists seek to work with governments that are friendly to their priorities there. “If you don’t see a plurality in congress, oftentimes you’ve got downhill sledding if you’re a special interest group, which makes it a heck of a lot easier to get things done at the state level,” Crancer said. Alternatively, he said, operating in multiple states “is incredibly difficult” for health care entities, particularly during the pandemic, which has given rise to “layers and layers of bureaucracy.” “We receive orders from different counties, cities, states, on a daily basis, as they’re trying to find ways to appropriately deal with the pandemic,” Crancer said. If the Biden administration can move the national pandemic response past ADVANCING THE IMAGING PROFESSIONAL

COVER STORY “Many private insurers have onerous processes that can delay or deny access to radiopharmaceuticals. It can be incredibly frustrating when dealing with insurers to be told that FDA-approved medicines are experimental – it’s a huge waste of physician time.” – Richard Wahl the slate of action items at the federal government level, there are several other critical issues that could be next up on the agenda. Crancer said in December 2020 that he’s curious to see if Congress will extend the moratorium on the sequestration cuts beyond the three months included in the recent stimulus bill; likewise, he’s also hopeful that legislators will offer up “a significant focus” on telemedicine and health care information security. “A lot of Americans received their first telehealth visit over the past eight months; I think that’s probably with us to stay,” Crancer said. “And I hope that we see a lot more focus on security from the next administration because there are some vulnerabilities in our system that have been exposed as of late.” “I hope that we get some more focus on it, and try and empower consumers to take control of their health information, too,” he said. “I think it’s a lot easier for consumers to understand the value of it, and demand that their information be protected from foreign government assets if they actually have access to it themselves.” As valuable as such initiatives can be to the American people, Kavita Patel, nonresident fellow in economic studies at the USC-Brookings Schaeffer Initiative for Health Policy in Washington, D.C., said the questions about whether they’re taken up by policymakers hinge entirely upon who’s going to advocate for them. Concerns about health care information security and surprise medical billing are easy enough to grasp; more detailed and nuanced issues like ASRT’s certification concerns, or negotiations WWW.THEICECOMMUNITY.COM

over CMS reimbursement rates and budget neutrality are more complex and challenging to distill into action. “I think the only way these nuanced issues get the consideration of lawmakers is when it’s easy to communicate,” Patel said. “The fact that these are complex issues makes it harder. You get buried in something broader, like E&M, or you end up being unable to effectively communicate what you’re doing.” “I think people tend to get too much in the weeds because they’re content experts, and then they don’t really know how to communicate this to people who are dealing with domestic policies,” she said. “The most precious commodity on the Hill is time, and anything you can to do position your issue helps.” If those issues are difficult ones for which to drive consensus, given their obscurity, then pushing for additional support of nuclear medicine is an even taller task, said Richard Wahl, MD, president-elect of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and director of the Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis, Missouri. Approval of new radiopharmaceuticals by the U.S. Food and Drug Administration doesn’t automatically equate to CMS reimbursement for the procedures that use them. Moreover, some “pass-through” reimbursement approvals are temporary, lasting for only a couple of years; when the passthrough period ends, Medicare reimbursement rates can drop precipitously, which effectively limits patient access to them. And there’s little relief when it comes to insurers, which often erect

their own barriers to reimbursement of the vital drugs. “This is a big problem,” Wahl said. “These strange rules, which are related to available funds, mean that when the pass-through period ends, reimbursement rates drop over a cliff. It really limits patient access to what are life-changing, therapy-changing innovations.” “This is an important opportunity for us to work on with the incoming administration,” he added. “Medicare is already paying for some of these procedures, but the private sector is not. Many private insurers have onerous processes that can delay or deny access to radiopharmaceuticals. It can be incredibly frustrating when dealing with insurers to be told that FDA-approved medicines are experimental – it’s a huge waste of physician time.” Amid other potential federal policy shifts, Wahl said SNMMI will be waiting to see whether the new legislature and presidential administration will devote resources to the continued support and investment required to advance nuclear medicine, from research to job training and staffing of imaging facilities across the country to sourcing of the isotopes behind the radiopharmaceuticals themselves. “Molybdenum-99 is an important ingredient, and maintaining an adequate supply is quite a challenge,” Wahl said. “If you run out of it, you can’t do nuclear medicine. Some of the new radioisotopes, like actinium-225, are in limited supply as well. Diagnostic and therapeutic isotopes will require continued government investment.” Regardless of who’s in power, Wahl believes that “legislators – whether Democrat, Republican, socialist, independent or libertarian – want people to have health care and don’t want to see it limited by poor patient access to technology.” “Continued investment in the science that drives radiology is important and offers great opportunities,” he said, “but we need to continue to invest in the medical imaging infrastructure as well to continue with the work.” • ICEMAGAZINE

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WASTE NOT CODING/BILLING

BY MELODY W. MULAIK

t is easy to focus on big dollar items when looking for potential lost revenue in an imaging center or department, but sometimes it is the little things that can add up to big money. There is sometimes an opportunity to bill for “waste” in imaging; however, the opportunities usually lie in imaging centers rather than hospital facilities. Regardless of your type of facility, it is important to review your documentation and billing practices to ensure you are not leaving revenue on the table and are reporting discarded waste appropriately. In certain circumstances Medicare will pay for leftover drugs, including contrast materials and radiopharmaceuticals, which must be discarded or “wasted.”1 This policy applies only to single use vials (SUVs), which are containers intended to be used for a single patient. When part of an SUV is administered to a Medicare patient and the remainder cannot

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be used for another patient, and has to be discarded, the provider may bill Medicare for the entire SUV. The patient’s medical record must indicate the quantity that was administered to the patient and the fact the remainder was discarded. The HCPCS modifier JW (Drug amount discarded/not administered to any patient) was created for the purpose of reporting discarded waste and can be utilized by physicians, IDTFs and hospitals for their outpatient claims. The Medicare policy on discarded drugs is limited to separately payable Part B drugs that are designated as single-use or single dose on the FDA-approved label or package insert. It does not apply to multiple-dose containers. Wastage from multiple-dose (bulk) containers is not billable to Medicare. In the case of a hospital paid under the Medicare Outpatient Prospective Payment System (OPPS), packaged drugs are not subject to modifier JW. Most contrast agents and diagnostic radiopharmaceuticals are packaged under OPPS, and therefore hospitals are not ADVANCING THE IMAGING PROFESSIONAL

required to apply modifier JW to these agents. Providers who are paid separately for contrast and diagnostic radiopharmaceuticals, such as physician practices and IDTFs, must apply modifier JW. CMS states hospitals must apply modifier JW to separately payable drugs with status indicator G (Pass-through drugs and biologicals) or K (Nonpass-through drugs and nonimplantable biologicals, including therapeutic radiopharmaceuticals), regardless of what revenue code they are reported under. Modifier JW should not be applied to codes that are defined as per study dose, since those codes include any amount that is needed for the study. Most diagnostic radiopharmaceuticals are reported with “per study dose” codes and therefore are exempt from modifier JW. Also, modifier JW does not apply when the dose administered is less than the HCPCS billing unit. When it is appropriate to bill for drug waste, two codes must be submitted on the claim, one for the quantity of drug that was administered and one for the amount that was wasted. Modifier JW WWW.THEICECOMMUNITY.COM

should be applied to the HCPCS code for the wasted portion of the drug. For example, code Q9966 represents low osmolar contrast material, 200-299 mg/ ml iodine concentration, per ml. If an IDTF administers 120 ml from a 150 ml single use container, and the remainder of the container is discarded, the IDTF should report as follows: Q9966 x 120 and Q9966-JW x 30. With regard to the charge (dollar amount) for the wasted drug, CMS states, “General billing rules may require a charge be included on each line on the claim. Also, each MAC that processes claims may have specific billing policies or guidance for certain items or services where there is no national billing guidance from CMS. Please contact your local MAC for further billing information.” •

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CLIMBING THE MOUNTAIN OF DATA FOR EFFECTIVE CT DOSE OPTIMIZATION BY PAUL HANNY, PH.D., DABR

erforming half a million CT exams each year, Banner Health organized a team to make significant radiation dose decreases while maintaining diagnostic image quality. Radiologists, CT technologists, medical physicists, radiation safety officers and medical imaging directors meet monthly to review the mountain of CT data. Using Bayer’s Radimetrics, CT scan parameters are organized and displayed into dashboards that compare every aspect of the CT scans. To identify steps to take to optimize the dose, Banner Health exports the CT data from Radimetrics and creates monthly reports that focus on scan parameters that offer the greatest opportunity to keep the image quality and reduce the dose. 38

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In Banner Health, the desire for CT dose reduction grew from medical imaging department staff, radiologists and managers from 48 medical centers and imaging centers. They viewed the importance of keeping the doses low while maintaining diagnostic quality, tracking CT doses, comparing them to benchmarks and automatically entering the doses in the patients’ medical records. A systemwide approach is key to leveraging support between facilities. Banner Technology Management/ ENTECH and the Banner Medical Imaging Clinical Consensus Group (CCG) organized the systemwide approach. Bayer Radimetrics was the platform chosen to gather the data, organized it into dashboards, create alerts and enter dose into electronic records. Radimetrics could handle the mountain of CT data collected daily, and Bayer’s continued support in training and troubleshooting made the

process easier. Using Bayer’s recommendations, we organized our efforts and formed a system oversight group that reports to the CCG. The oversight team includes program administrators, imaging managers, radiologists, diagnostic medical physicists, CT super users, clinical data specialists and radiation safety officers. This team meets monthly to focus on developing, implementing and managing the people, processes and technology of the radiation dose reduction initiatives with the goal of sustaining an enduring, flexible program. We formed a CT super user group of those managing the alerts and protocols daily. The super user group meets monthly to discuss issues with the database, protocols, dashboards and alerts. The super users at each site, along with the radiologists and medical physicists, make the changes to reduce the dose and review the outcomes. ADVANCING THE IMAGING PROFESSIONAL

Early challenges included the amount of data, making sure it was clean data that we could use to make decisions, and that it was accurately transferred. Every clinic had unique protocol naming conventions, which led to a master lexicon of protocol names. Occasionally, after a CT unit’s preventive maintenance, the protocol names reverted to the previous names and were rejected or unreported. The super users regularly check the protocol names and scans to make sure Radimetrics accept them. To take the data to an even more practical level, we exported data from Radimetrics and created facility-specific reports that identified the most likely scan parameters that we could change to reduce the dose. We wanted a visible scoreboard that easily compares each facility CT with the same model to see how much the protocols varied.

Additionally, the monthly reports show dose trends for head, chest, abdomen/ pelvis, sinus and neck CTs. Pediatric scan data are grouped by age and weight. The reports compare CTDIvol and Dose-Length-Product to national benchmarks, plus compare Size-Specific Dose Estimates (SSDE) and patient doses using ICRP 103 tissue weighting factors. Our reports promptly identified the CTs operating in low-dose mode and the scanner models that tended to deliver higher doses for the same protocol. The scoreboard shows the mAs, kVp, rotation time collimator, and pitch, and indicates the scan parameter that gives the best opportunity to lower the dose for each CT. Continuing challenges include staff turnover, adding to and removing CT units from service, refining the protocols to be reviewed and ensuring the

data is accurate. Banner ENTECH and Bayer training reduce the impact of these changes. We saw an increase in chest and abdomen CT doses during COVID-19 peaks due to patient population changes. Although total scan numbers were lower during this time, the protocol names ordered by attending physicians were within 1% of pre-COVID months. Health care system-wide, effective dose optimization is realized using a multilayered approach. Success doesn’t happen without a commitment from the clinic through corporate-level, good data that is accurate enough to make decisions and gathering feedback to continually improve and refine the program. • PAUL HANNY, Ph.D., DABR, is a medical physicist and corporate radiation safety officer at Banner Health.

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BURN OUT And the High Cost of Not Engaging Health Care Workers’ Mental Health PACS/IT/AI

BY MARK WATTS

think the use of simple direct communication via SMS messaging can help address burnout and keep our staff whole during this stressful time. “Referral bonus of $7,000 for an RN who will work in ICU” the ad read. How do we connect and keep our teams engaged and well? My friend and former employee called me to announce, “Mark I am retiring, I don’t know if I want to or can keep coming here every day!” This decision was accelerated by the current health care crisis. About 20 percent of doctors are considering retirement or change in careers, some research is pointing to a PTSD-like response by health care and frontline workers to the stress of their everyday work. What can be done? What happens when providers turn into the patients in need of support and care? How can an employer express care and compassion to an employee who carries the emotional weight of this unprecedented time? A friend recounted that a nurse walked off the floor in the middle of a shift because she was offered more to work somewhere else. How do we treat the needs of our employees and reduce our cost of delivery of services? Employment, as with almost all health

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care, is voluntary. Patients choose when to engage in care, when to take medicine (if they choose to) and whether to return for follow-up visits. Without adequate patient engagement and care that centers on patients, their management can be challenging, especially for chronic diseases. Mobile health (mHealth), the application of mobile technology for the provision of health care support to patients and care providers, has shown great promise. mHealth is increasingly being integrated into existing health care systems to improve access, engagement and delivery of health services. However, the vast majority of proposed mHealth solutions have not been tested. Many have not adopted the core value of patient-centered care that is critical in improving the quality of services and long-term patient health outcomes. Instead, mHealth is commonly used as a reminder. May I suggest WelTel Inc. (www.weltel. org) a Canadian-led patient communication and outpatient case management tool that is recognized as a world leader in the field of mHealth. This health technology solution was initially designed to address the problem of adherence for patients initiating antiretroviral therapy (ART) in Africa (Lester et al., 2010). WelTel has since expanded its application to include a wide range of other ADVANCING THE IMAGING PROFESSIONAL

conditions and settings including primary care; tuberculosis; asthma; maternal, newborn, and child health; as well as preventative health in different regions across North American, African and European countries. WelTel uses mobile phones and SMS at the base of its pyramid through an interactive tool for care providers to communicate and engage directly with their patients. In the last two decades, WelTel has led the global medical field in evidence for outpatient digital clinical support by focusing on patient communication as the priority followed by monitoring and reporting. With over $4 million dollars in research and development, WelTel’s rapidly growing service platform is currently in its fifth iteration. It has been created based on patient and provider preferences. WelTel has undergone several iterations after using the hierarchy of evidence evaluation framework adopted for digital health solutions. The evidence suggested that empowering patients through self-efficacy is more effective at improving health outcomes than monitoring alone. WelTel offers a patient-centered care solution because it was specifically and purposefully designed for patient engagement from its inception. The WelTel solution works by encouraging the patient to self-manage and gives them critical access to care when needed. This enforces and reinforces long-term provider-patient relationships for engagement and patient-driven self-management. Based on field research with patients and frontline providers to inform preferred messaging content, frequency, and process, the system sends automated text message check-ins to registered patients asking them: “How are you?” on a weekly basis (or at any other frequency). The patient can respond by text with “OK” or “Not OK” to indicate a need for communication with the health care provider who can respond using text, voice or video outreach WWW.THEICECOMMUNITY.COM

when appropriate. The communications are captured via a Web interface that is mobile device. It is friendly and organized for intuitive provider access and clinical workflows (provider case management). The system records all communications and patient-centered care plans can be noted. A video component has been integrated for optional use in settings where smartphone access and sufficient data connections are available. However, the base of the pyramid approach, both economic and digital, is maintained by ensuring access to the platform through basic cellphones to ensure access for any user. In addition, WelTel can send a patient clinic appointment reminders via SMS. Provider-side alerts tailored to specific patients can be shared between different colleagues who operate in team-based care settings. Overall, the system’s ability to triage urgency of patient-reported issues can help identify which patients require additional support and when. I see this system as a tool that can be deployed to check on the mental status of health care workers via a daily text check in. If the worker needs help the connection to support services already established through employ assistance programs is engaged. This could be deployed via secure cloud technology in 60 days and save lives and careers. If one ICU nurse stays on your staff, the program pays for itself. I am concerned about the metal health of health care workers and any tool to assist them to be resilient during this pandemic I am open to. Take care of your self and each other, we can make it through this together. • MARK WATTS is the enterprise imaging director at Fountain Hills Medical Center.

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EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI

WHAT MAKES A GOOD JOB APPLICATION? L

et’s face it, sometimes you’re in a job and it’s not a good fit. Moving on may be the best option, but it’s important to do it wisely. What follows is a checklist of what I look for in a job application when companies ask me to help with their hiring process. However, you can also turn this around and use the checklist to review applications coming into your organization.

TAKE TIME TO DRAFT A GOOD COVER LETTER Most people devote a lot of time to polishing their resume, asking others to suggest improvements and provide a critical review. This is not usually the case with cover letters, and it shows. Because of that, I always ask for applicants to send cover letters, as they give me a much better insight into what kind of person I might be looking at. My recommendations for cover letters are: • Make it a letter, not a paragraph. A cover letter represents how you would draft a letter to a client. If all I get is one or two paragraphs that tell me how wonderful you are, I won’t be impressed. A cover letter is an opportunity to personalize yourself, to show me you’ve done a bit of research into the company and the position for which you’re applying. I’m looking for three-to-five paragraphs, and 42

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if you can list specific accomplishments that match the job requirements listed in the job ad, extra kudos to you. That scores points with me. • Keep it professional. Over-familiarity doesn’t impress, and neither does over-confidence. One applicant recently wrote, “It would be in your best interest to interview me.” My IMMEDIATE reaction was, “Oh, really?”, and the resume instantly found itself in the reject pile. I don’t care how qualified someone might be technically, all positions require a modicum of manners and informing me that something is in my best interest is NOT good manners. Unless the job description asks for someone with an over-inflated ego, such over-confidence is almost guaranteed to lead to an instant rejection. • Pay attention to your grammar. It amazes me how many applicants start each sentence in a cover letter with the word “I”. If the word “I” starts each of your sentences (“I was instrumental in …” “I received such-and-such an award …” “I am eager to …” etc.), it suggests you will correspond with others in a similar way. That’s not impressive, especially for senior positions. It’s a given that the cover letter is supposed to talk about you, but many ways exist to structure sentences without starting with the word “I”. If you can’t think of any, ask other people for help. ADVANCING THE IMAGING PROFESSIONAL

TAKE TIME TO ADJUST YOUR RESUME Resume reviewers are not only looking for reasons to interview you; they’re also looking for reasons not to interview you. Therefore, while it’s a good idea to ask others to critique your resume and offer suggestions, you’ll also want to make sure your resume matches each job description as best you can. In other words, customize your resume each time you submit it. But don’t forget to proof it before hitting “send.” I recently received a resume for a high-level finance position in a large nonprofit organization, but the resume stated that the person believed his skills would be of great benefit to Amazon.com.

OTHER RESUME TIPS • Keep your formatting consistent. If you capitalize all the words in your current job title, then capitalize all the words in ALL your job titles. Another example: If you use “space/dash/space” to separate years of employment (e.g., 1998 - 2005), then do that on EVERY date. Inconsistencies stand out and look like you have poor attention to detail. Choose one formatting standard and stick with it. • Tell me you want the job I’m advertising. I’m a fan of creating a specific “Objective” as the first line item and drawing a direct correlation to the position for which you’re applying. If the job ad is for “Director of Operations,” then you gain great advantage by stating your objective is to be a director of operations in that specific industry. Conversely, if your objective is generic, such as, “To provide quality results that make an impact in the work environment,” or worse yet, if you don’t list an objective at all, you lose points. • Put the most pertinent information on the top half of the first page. I want to think “WOW” in the first six seconds, and the “wow” factor should link to results you’ve WWW.THEICECOMMUNITY.COM

achieved. Rare is the job that requires a bullet-point list of all the computer programs you can use. Instead, list four or five bullet points that provide specific accomplishments and use direct verbiage from the job ad if possible. • Keep resumes to one or two pages. A one-page resume may not be enough to list all your accomplishments and how they correlate to the requirements listed in the job ad. I am quite content looking at a two-page resume, or even two-and-a-half pages. One applicant’s seven-page, nine-point font resume went straight to the “thanks-but-no-thanks” pile. Reviewers don’t have time to read a book. If you think you need that much space to demonstrate that you’re qualified, you aren’t qualified enough in the “professionalism” category. • Don’t include your photo or a personal logo. These days, reviewers often look at your social media and they will find out what you look like. Unless you’re applying to be a model or a graphic designer, photos or logos will not impress, and unless asked for, including them indicates you don’t understand what it means to be professional. These are most of the factors I consider when reviewing job applications. Obviously, other reviewers will have different preferences, so you might consider this list a starting point for discussion if you’re embarking on a new job search. And, like I said, if you review resumes as part of your job, perhaps this list will help you identify higher-quality applicants. • DANIEL BOBINSKI, M.ED. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach Daniel on his office phone, 208-375-7606, or through his website, www.MyWorkplaceExcellence.com.

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KEEPING CULTURE CHANGE SUSTAINABLE O RAD HR

BY KELLY PRAY

rganizational culture is a complex concept involving values, communication, leadership, processes and behavior. Changing organizational culture can seem like a daunting task, especially if you’re not sure where to start. In order to make changing organizational culture successful, it’s important to set yourself and your organization up to make it sustainable. First and foremost: align strategy to the culture. Ensure that the culture you are trying to promote enhances the ability to meet your organizational objectives. Align organizational values to best support the mission and vision of where you are headed. Prioritize projects and initiatives that are aligned with the cultural change you want to see.

ENSURE YOUR LEADERS ARE LEADING THE WAY

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DEFINE KEY ACTIONS AND BEHAVIORS Culture can be a difficult concept to articulate throughout an organization. Oftentimes cultural descriptors such as “trusting,” or “collaborative” are thrown around – without the rigor of defining what these look like in actual practice. Define key actions and behaviors that you want to see in the culture change. If you want a trusting culture, define what that looks like. For example: leaders share financial updates to frontline staff, or feedback loops are established to ensure staff trust that their voices matter. Collaborative cultures may involve committee-driven decision making, multidisciplinary project teams or perhaps meetings where staff feel free to speak up.

Leaders must embrace and adopt the culture that is changing before expecting the organization to follow.

Leaders must embrace and adopt the culture that is changing before expecting the organization to follow. Remember, each individual will be required to undergo behavioral change in order to create lasting organizational change. Culture change involves the sum 44

of the parts of each individual embracing and adopting the change. Without leaders modeling key actions and behaviors and actively communicating these expectations to their employees, your changes will not be as sustainable.

MEASURE WHAT SUCCESS LOOKS LIKE AND STICK TO IT What does success look like for your culture? In defining key actions and behaviors, ADVANCING THE IMAGING PROFESSIONAL

Knowledge. Experience. Integrity. < / ŚĞůƉƐ ǇŽƵ ĚĞůŝǀĞƌ DZ/ ĂŶĚ d /ŵĂŐŝŶŐ ^ĞƌǀŝĐĞƐ ƚŽ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͘

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how can you quantify success in achieving MRI & CT Services MRI & CT Parts these outcomes? If you are looking for a more trusting culture, perhaps structure employee engagement surveys to reflect trust (for example: I feel safe to speak keimedicalimaging.com up in a meeting, even when I disagree Tel: 512.477.1500 with the team). In addition to employee Email: info@keimedicalimaging.com engagement surveys, leverage project deliverables to best meet the needs of the culture you’re trying to accomplish. Scope high-priority projects to include an objective that matches defined actions INTERNATIONAL X-RAY BROKERS IS and behaviors. In order for cultural change to stick NOW AN AUTHORIZED DISTRIBUTOR it must be reinforced. To reinforce these FOR CUSTOM BUILT SURGICAL TABLES! < / ŚĞůƉƐ ǇŽƵ ĚĞůŝǀĞƌ DZ/ ĂŶĚ d /ŵĂŐŝŶŐ ^ĞƌǀŝĐĞƐ ƚŽ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͘ successes, adhere to what I like to refer to tŝƚŚ ŽƵƌ ƚĞĂŵ ŽĨ ƐĞƌǀŝĐĞ ĞŶŐŝŶĞĞƌƐ ĂŶĚ ŝŶǀĞŶƚŽƌǇ ƐƉĞĐŝĂůŝƐƚƐ͕ < / ŝƐ ǇŽƵƌ WŚŝůŝƉƐ ƌĞƐŽƵƌĐĞ as the double-sided coin of accountability. 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 How are you celebrating the success of keimedicalimaging.com your employees who are demonstrating actions and behaviors that match the new Tel: 512.477.1500 Email: info@keimedicalimaging.com culture? Conversely, how will you hold them Member of IAMERs < / ŚĞůƉƐ ǇŽƵ ĚĞůŝǀĞƌ DZ/ ĂŶĚ d /ŵĂŐŝŶŐ ^ĞƌǀŝĐĞƐ ƚŽ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͘ accountable if key actions or behaviors are tŝƚŚ ŽƵƌ ƚĞĂŵ ŽĨ ƐĞƌǀŝĐĞ ĞŶŐŝŶĞĞƌƐ ĂŶĚ ŝŶǀĞŶƚŽƌǇ ƐƉĞĐŝĂůŝƐƚƐ͕ < / ŝƐ ǇŽƵƌ WŚŝůŝƉƐ ƌĞƐŽƵƌĐĞ missing from your ideal future state? Change is successful when it is sustain- 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 able. Ensure organizational culture aligns with operational strategy, equip leaders to manage changing the culture with their teams, clearly define what the culture Tel: 512.477.1500 Email: info@keimedicalimaging.com change looks like and hold individuals acMember of IAMERs countable for these successes. Be patient TOSHIBA • GE • PHILIPS • SIEMENS AND MORE! as you work through these approaches – organizational culture change often takes ALL MANUFACTURES & MODALITIES years to implement, and continual effort PUTTING CUSTOMERS FIRST SINCE 1987 to reinforce. •

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GOOD LEADERSHIP QUALITIES P A leader doesn’t need to be the smartest person in the room.

racticing do have entire shelves in leadership is a my study filled with the something we leadership books I’ve read are all responsible and marked up along the to pursue. Leaderway). There are so many ship plays a role in important axioms that all facets of life and transcend the frameworks work, and I’ve found of position and industry it is embedded in in what makes a great nearly every aspect leader. One that I learned DEPARTMENT/ of how we deliver early on and really can be OPERATIONAL ISSUES considered a foundational and support health BY JEF WILLIAMS care. Leadership is characteristic of effecnot necessarily a tive leadership is simply: positional role or based on title, Become a lifelong learner. although that is certainly a part of The idea of lifelong learning came after how we define and evaluate good years of pursuing degrees and certifications. and effective leadership. Beyond I was conditioned to approach learning as a positional leadership there is perpersonally enriching experience but still as sonal or relational leadership. This largely transactional. As a student we put in is the role we play based on inforthe time, we glean the knowledge necessary mal, yet important, roles we play to excel and ultimately are rewarded with in providing guidance and support a degree or certification. While most of us of others around us. Most of us continue to pursue ongoing education as a will serve in both of these types of means to maintain our credentials, that in leadership roles along our career itself is not what is meant by the spirit of path for colleagues, direct reports, lifelong learning. Rather, there is a more hoour own leadership teams and palistic and expansive quality to great leaders tients. It’s important that we take who never stop learning. There are several the time to study and understand characteristics I have discovered from those the qualities of a good leader. who I choose to emulate in my own ongoing Early in my career I pursued personal and positional leadership roles. I found the pursuit to be challenging and always stretching my abilities. There are hundreds of great books and programs available to anyone who wants to study leadership. I’ve read more of these books and attended more of the seminars that I can recall (although I

ICEMAGAZINE | FEBRUARY 2021

development that help determine the value of the pursuit of lifelong learning.

CURIOSITY Learning requires curiosity. That seems simple enough and maybe self-evident. But the truth is too often we engage in learning activities that are not driven by curiosity. Consider the number of seminars, webiADVANCING THE IMAGING PROFESSIONAL

IES? B E E R LOVE FABOUT A HOW nars, books or conferences you have engaged with that did not pique your curiosity. When we are faced with information that doesn’t match our curiosity appetite we struggle to effectively consume, retain or implement content. We multi-task or let our mind wander, if we complete the content at all. Curiosity drives the pursuit of understanding. While this includes ongoing education in our field of expertise, it expands well beyond maintaining credentials and niché expertise. Curious leaders pursue many channels of knowledge and find links and values that can be translated. Some individuals I know pursue history, or science, or human behavior, or organizational development topics – the list is as big as your local library or online content. Several years ago, I began attending a conference that has nothing to do with my profession and nearly nothing to do with health care. But I was curious about the content and technology related to this annual event. I found early on that while there were very few direct links to my career or industry, the information and themes had plenty to teach me. I’ve attended every year for over a decade (this year will be virtual) and find it to be one of my favorite events as it feeds my curiosity, forces me to learn new things and, ultimately, makes me a better leader.

HUMILITY A leader doesn’t need to be the smartest person in the room – that is reserved for those with insecurity. Humility is inherently required in effective leadership and foundational in lifelong learning. One must approach learning from a position of openness. While many of us are experts in our field, there is always opportunity to grow. Organizations understand the value of continuous improvement (call is Six Sigma, Lean or Kaizen) and we as people should also practice the self-awareWWW.THEICECOMMUNITY.COM

ness required to learn. As you consume information from a position of humility you find that there is always something to take away. Perhaps in an entire book or conference you may find much of the information less than compelling. But when you come with humility there is nearly always something to take away. One form of learning most of us struggle with is criticism. I’ve read that criticism often comes from the wrong person or at the wrong time or in the wrong way. Often, it comes in all three forms at the same time. Our natural inclination is to discount or dismiss criticism. But when we practice humility, we are able to set aside the emotional component or perhaps deficient transaction by which that criticism came and evaluate where there are things to be learned. However, this requires humility.

PERSEVERANCE Lifelong learning is a lifelong endeavor by definition. Becoming a learner for life is a philosophical ideal that will likely ebb, and flow based on other events and forces in our lives. But when a leader determines to take this approach, she will come back to learning as a critical way of growth and fulfillment. It’s a form of self-care that propels us into becoming better versions of who we are. This can include setting regular goals or tasks to ensure we continually make the time to explore new avenues or topics. Regardless of the specifics, good leaders always come back to learning as a way of life. It permeates how we engage those around us. It drives our desire to explore new ideas. It pulls toward broader, and greater, understanding. And ultimately, we become more effective leaders. • JEF WILLIAMS, MBA, PMP, CIIP, is a managing partner at Paragon Consulting

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DIRECTOR’S CUT BY BETH ALLEN

MODERN RADIATION PROTECTION PRACTICES I

“As professionals, it is expected that we have the latest information regarding radiation safety and protection.”

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am the director of clinical operations for Banner Imaging in Phoenix, Arizona. I am honored to be able to be a regular contributor to this publication that has become a resource for imaging professionals. I began my radiology career in 1985 at a VA hospital in Fargo, North Dakota. I left the cold weather a few years later and moved to Arizona. I crossed trained into CT and eventually moved into management about five years ago. I share this information not only to introduce my background, but to illustrate how long I have been in radiology and how things have changed. In April of 2019, the American Association of Physicists in Medicine (AAPM) released a position statement that updated the recommendations regarding the routine use of fetal and gonadal shielding for medical imaging. The previous practice recommendations had not changed for many years. I recall how much this shielding was emphasized during my training. Proper shielding was a required part of each exam that we were graded on.

According to the latest information provided by the AAPM, gonadal shielding is no longer necessary and may do more harm than good. During the AHRA Virtual Annual Meeting in August, I attended a flash session that laid out the reasons these recommendation changes occurred. The practice of gonadal shielding for children and patients of childbearing age was introduced over 70 years ago. The beliefs regarding harm to a patient’s future children or infertility have not proven true. Shielding will not eliminate exposure caused by scatter radiation and if the shield is not in the correct location, it can obscure anatomy necessary to diagnosis. Due to advances in technology, the radiation required to produce an image is greatly reduced to the point that it may not be enough to affect the body at all. Through the years, the practice of fetal and gonadal shielding has not changed much. It is what patients have come to expect. With this change in philosophy from the AAPM, our technologist can expect to get questions regarding this change in practice and we should be prepared to deliver answers that will educate our patients and put them at ease. These recommendations have been ADVANCING THE IMAGING PROFESSIONAL

endorsed by the ACR, Image Gently and physicist groups across the world. This effort has been dubbed CARES – Communicating Advances in Radiation Education for Shielding. A committee was formed to publish a list of FAQs and suggested talking points for health care professionals, patients, and parents and guardians. The CARES team has indicated that if not using shielding would result in the patient refusing the exam, we should use it. Old habits die hard. Technologists and patients alike may feel uneasy accepting this new information. It is similar to when we were told that we no longer needed to ask patients if they were allergic to shellfish. At first, it was difficult to trust that this was going to be alright and there was no correlation to the contrast and shrimp. Eventually, we got over it. Every so often, there is a story in the media regarding radiation exposure for patients. It may be on the news or Dr. Oz. Often the media uses examples from exposure to victims of the atomic bomb. This can increase the number of questions we receive. Radiation exposure from medical imaging has made incredible advances. We have adopted the ALARA principle and technology has focused on reduced radiation exposure for the last 20 years. Digital radiology and advancements in CT have changed the way we image. We still need to be responsible in the way we utilize

medical imaging. Referring physicians weigh risk verses benefit for our patients; radiologists guide our protocols; and technologists strive to be accurate and efficient in producing images. As professionals, it is expected that we have the latest information regarding radiation safety and protection. I encourage you to share this information with your team. It will be up to us to educate our communities on the positive changes that have occurred within our profession and make them feel safe. I appreciate the opportunity to share my thoughts and ideas in this column. We have a talented team of imaging professionals at Banner Imaging that I will tap for expertise and collaboration to keep this timely and relevant. My days are filled with adapting to all the changes that are thrown our way. Health care will never be the same. We bob and weave to take care of our patients and our teams. Through all the turbulence, we find new ways to improve and excel. Not to mention, we try to enjoy ourselves along the way. I wish I had a witty tagline to close this column, but for now I will just ask you to take care of yourself and each other. • BETH ALLEN, RT(R)(CT) CRA, is the director of clinical operations at Banner Imaging.

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PROGRESS I

recently became aware of this quote from George Bernard Shaw: “The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man.”

However, I extract great meaning from Mr. Shaw’s insightful quote. For the sake of my explanation, I will call the “reasonable” man Joe and the “Unreasonable” man John. Joe mostly follows the rules and does not want to rock the boat unless a significant event occurs. John is more restless always observing and imagining ROMAN REVIEW how things could be different. BY MANNY ROMAN At first, I thought this was a There are probably more Joes great statement explaining in the modern world because the birth of all progress and there are more restrictions and innovation. I had a found affirming words from constraints as children. Joes find an easier trana renowned writer to something that I believed. sition to adulthood and employment. The Johns For a very long time, I have been convinced that also find a way to adapt however they are more children who are obedient to rules, regulations inconvenienced by the constraints. and directives will be well-suited to function withDuring my many years in life and business, I in the constraints of adulthood and business. As have seen many Joes and many Johns as I am children they may be provided limited freedoms sure you have. Joes are the quiet ones at the of mind and body. Those who are unruly and willmeetings. They will only dissent if an issue is of ful would be the entrepreneurs and the creators great importance to them otherwise, they go of the jobs that the other group would occupy. with the flow. Joes methodically perform their They would either be provided with the menassigned tasks without questioning the mission tioned freedoms or would just take them. This is, or the authority. Joes are the good followers that of course, within reason. Some of these kids from “leaders” often praise as necessary for accomboth groups wind up in jail. plishment of the mission. Then, I thought about the words that were Johns are more participative in nature. In used in the quote and had a little more difficulmeetings they ensure that their opinions are ty with the statement. I am confident that the heard and even enjoy differences of opinion. literal translation would not achieve the intended Johns seem to always look for ways to think meaning by Mr. Shaw. The words “reasonable and differently about things as well as to do them unreasonable” are antonymous and, in this case, differently. The really courageous Johns may would keep a “reasonable” man from causing question the mission itself. Problems become progress and an “unreasonable” man from adaptchallenges. This reminds me of something I once ing to norms. heard. “What does one do when there’s no way 50

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ADVANCING THE IMAGING PROFESSIONAL

George Bernard Shaw

out of a situation? If there’s no way out, the best thing is to find a way further in.” These behaviors are not mutually exclusive as implied by Mr. Shaw’s quote. The behaviors are on a continuum and at any given time Joes can be Johns and vice versa. Significant emotional events can push us to extremes, however, each one of us has tendencies toward a Joe or a John. I believe that there is no requirement for a special innate talent to be either. We all have talents and tools that we use every day in everything we do. Since we are speaking of behaviors, they can be learned. What is important is to identify where we live on the “JoeJohn Scale” and determine if we are content there. If not, we can take steps to slide in the desired direction. We may not all be in the position to change the entire world; however, we are all in the position to aid and even cause progress. It does not matter if we are the leader or the follower. Even small improvements in our professional and personal environments cause efficiencies and satisfaction. I don’t place Joe and John one above the other. I do recommend that in the personal development aspect we should all be looking for ways to cause progress toward the enhancement of self-happiness. So, I guess, in this case be a John.• MANNY ROMAN, CRES is the AMSP Business Operation Manager.

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