ICE Magazine March 2021 by MD Publishing

THEICECOMMUNITY.COM

MARCH 2021 | VOLUME 5 | ISSUE 3

ADVANCING MAGAZINE

IMAGING PROFESSIONALS

PRODUCT FOCUS

Ultrasound PAGE 25

Trading (Surgical) SPaces Image-Guided Procedures Migrate to ASCs

PAGE 30

Rising Star Andrew Ellis PAGE 10

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FEATURES

DIRECTOR’S CUT

RAD IDEA

Lateral transfer airbed systems provide enhanced safety in the lateral transfer of patients for imaging procedures.

Pandemic generates a case of musical chairs and other issues for imaging departments.

COVER STORY

The COVID-19 pandemic’s impact on health care includes imageguided surgical procedures and trends involving ambulatory surgery centers and officebased laboratories.

OFF THE CLOCK

Diagnostic radiology technician Sandra Page enjoys two-wheeled adventures, especially when they support a good cause.

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16 ADVANCING THE IMAGING PROFESSIONAL

MARCH 2021

IMAGING NEWS

New ICE conference dates and FDA clearances are among the latest imaging news.

18 46

ROMAN REVIEW

Beginner’s luck and superstition are explored in this month’s column.

25 WWW.THEICECOMMUNITY.COM

PRODUCT FOCUS

The global ultrasound market is expected to reach $7.94 billion by 2024.

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 Jonathan Riley Karlee Gower Amanda Purser

Webinars

Jennifer Godwin

Account Executives Jayme McKelvey Megan Cabot

SPOTLIGHT 10

Rising Star Andrew Ellis, Banner Health

In Focus Mary C. Mahoney, RSNA Board of Directors

Rad Idea Safety FiRsT

Off the Clock Sandra Page, UNC Rex Healthcare

NEWS 18

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

PRODUCTS 24

Market Report Reports Predict Ultrasound Growth

Product Focus Ultrasound

INSIGHTS 34

Coding/Billing Patient Relationship Categories

PACS/IT Seeing Color and Diversity With Imaging AI

Director’s Cut COVID Challenge: Chairs

Lisa Lisle

Digital Department

Emotional Intelligence The Time Management Ink Blot

Rad HR Here’s the TRICK

Roman Review Luck and Superstition

48 49 50 54

AMSP Member Directory

Editorial Board

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

Circulation

Cindy Galindo Kennedy Krieg

Accounting

Diane Costea ICE Magazine (Vol. 5, Issue #3) March 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.

AMSP Member Profile: Associated X-Ray Imaging Corp.

ICE Break Index

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

ICEMAGAZINE | MARCH 2021

ADVANCING THE IMAGING PROFESSIONAL

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SPOTLIGHT

RISING

STAR ANDREW ELLIS BY ERIN REGISTER

FUN FACTS: Favorite Hobby: Traveling to see the world

Favorite Vacation Spot: Southern France

Favorite Food combination: Pizza and wine

1 Thing on Your Bucket List: Hiking the Waimea Canyon to the Napali Coast

Any Secret Talents? Hip-hop dancing

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riginally from Cincinnati, Ohio, Andrew Ellis, 38, is a diagnostic imaging engineer III at Banner Health. He received his bachelor’s degree in electronics engineering technology from DeVry University and began his career in 2003 with Hitachi Medical, learning MRI physics and open MRI. He eventually added PET and CT knowledge. In 2006, Ellis was recruited to Toshiba Medical (now Canon Medical), and in June of 2010 was promoted to a senior engineer position. In 2019, his husband was transferred to Phoenix, Arizona, so Ellis went to Banner Health, where he now specializes in CT. ICE learned more about this Rising Star in a question-and-answer interview. ADVANCING THE IMAGING PROFESSIONAL

Andrew Ellis is seen at the Blue Lagoon in Iceland.

Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: During my last year of college, I was intrigued with how my degree could be applied in the health care industry. Hitachi was recruiting for a position in the Toledo/Detroit area, and I ended up living there for almost three years. Detroit was a fascinating city, my experience both there and with Hitachi shaped my future greatly and made me a better leader and field engineer.

Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: Complex problem solving and the direct connection I have with technologists and caregivers are what I most enjoy. I absolutely love the challenge of solving difficult problems with electronics, and it carries over into my home life as well. If I can take it apart and fix it, I’m always up for a challenge.

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: There has been an evolution of imaging technology in CT WWW.THEICECOMMUNITY.COM

and MRI that leaves me intrigued and in awe. The scanners are always improving and becoming more powerful. There are constant opportunities to learn and grow. Medical imaging is one of the most fascinating careers in the world.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: I would consider my greatest accomplishment to be mentoring technologists in CT and MRI physics and seeing them pass their registry exams. The biggest accomplishment is through finding ways to give back.

Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT FIVE YEARS? A: My goal is to promote diversity, mentorship, volunteering and youth involvement in STEM programs and health care. I plan on pursuing Certified Radiology Equipment Specialist (CRES) and Certified Diversity Professional (CDP) certifications. I love learning and researching new imaging technology and seeing how the technology becomes integrated and utilized in our hospitals’ systems. • ICEMAGAZINE

SPOTLIGHT

IN FOCUS MARY C. MAHONEY

STAFF REPORT

ary C. Mahoney, M.D., was named president of the Radiological Society of North America (RSNA) Board of Directors on December 1, 2020 at its annual meeting in Chicago. Mahoney is the Benjamin Felson Endowed Chair and Professor of Radiology at the University of Cincinnati (UC) College of Medicine in Cincinnati, Ohio. Since 2016, she has served as chief of imaging services at UC Health in Cincinnati and is on the medical staff of several Cincinnati area institutions, including UC Medical Center, University Pointe Surgical Hospital, and West Chester Hospital in West Chester, Ohio. After graduating magna cum laude from Brown University in 1979, Mahoney received her medical degree in 1983 from UC College of Medicine and is a member of its honor

society, Alpha Omega Alpha. She completed her diagnostic radiology residency – serving as chief resident from 1987 to 1988 – followed by a fellowship at UC Medical Center. She said her decision to pursue a career in diagnostic imaging was the result of her desire to solve problems. “I was drawn to the problem-solving aspect of radiology,” she said. It is a decision that continues to reward her in many ways. One way her career rewards her is through interaction with her faculty and trainees, she said. Mahoney told ICE magazine that she has been fortunate to have mentors who helped her advance and she strives to provide the same leadership to others. “They encouraged me, gave me opportunities, let me spread my wings,” Mahoney said about her mentors. She added that she

“In shedding unconscious bias and embracing different perspectives, we strengthen our specialty and enhance the quality of care we provide to our patients.” – Mary C. Mahoney

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ADVANCING THE IMAGING PROFESSIONAL

is, “passionate about fostering the careers of young physicians.” As RSNA president, Mahoney will continue to focus on patient-centered care and support the society’s goal of fostering diversity, equity and inclusion in radiology leadership and practice. “I am honored to be part of an organization that actively supports women in radiology and works to promote diversity and inclusivity in its leadership, in its committees and in its programming,” Mahoney said. “We must ensure that our academic and society leaders reflect the diverse community we represent and strive to provide an equitable and inclusive community that serves the needs of all of our members. In shedding unconscious bias and embracing different perspectives, we strengthen our specialty and enhance the quality of care we provide to our patients.” Mahoney has published more than 90 peer-reviewed articles and 15 book chapters and has co-authored two books with an emphasis on breast imaging. She has served as principal or co-investigator on numerous funded grants, including several grants focused on imaging modalities and biopsy. She has given many scientific research presentations nationally and internationally and has been an invited lecturer at over 285 institutions and meetings worldwide. She is a graduate of the Executive Leadership in Academic Medicine program for women leaders in medicine. She has been instrumental in building the Advanced Imaging Core Lab at UC College of Medicine and the multidisciplinary breast center within UC Cancer Institute. Over the years, Mahoney has served RSNA in many capacities. She was the sciWWW.THEICECOMMUNITY.COM

entific session presiding officer from 2003 to 2009. She has served on many committees, including the Research and Education (R&E) Foundation Public Relations Committee and the Public Information Advisors Network. She has chaired the Public Information Committee, Patient-Centered Radiology Steering Committee and the Radiology Editor Search Committee. She joined the RSNA board in 2014. Mahoney has held committee or leadership positions in a number of other organizations, including the Society of Breast Imaging (SBI) and the American Roentgen Ray Society. She served on the ABR Board of Trustees from 2010 to 2015 and the ABR Board of Governors from 2015 to 2018 and currently serves on the American College of Radiology (ACR) Board of Chancellors. Mahoney is a fellow of both ACR and SBI and is a member of the Society of Chairs of Academic Radiology Departments. The recipient of many awards and honors throughout her career, Mahoney was recognized by ABR for her extraordinary service and dedication in 2008 and 2010. She was named a Health Care Hero finalist twice by the Cincinnati Business Courier and received a Marquis Who’s Who Lifetime Award in 2017. She was included on the “Best Doctors in Cincinnati” list, selected for inclusion in Top Doctors in America in 2019 and selected for “Top Doctors” by Cincinnati Magazine in 2020. Mahoney is a nationally recognized proponent and staunch advocate of patient-centered radiology. She has been involved in numerous initiatives campaigning to encourage and facilitate radiologists’ meaningful engagement in the patient experience. •

MARY MAHONEY

President, RSNA Board of Directors What is the last book you read? “Giver of Stars” Favorite movie? “Out of Africa” What is something most of your coworkers don’t know about you? I am a great cook. Who are your mentors? Val Jackson and David Dershaw What is one thing you do every morning to start your day? Walk Best advice you ever received? View every complaint as an opportunity. Who has had the biggest influence on your life? My father What would your superpower be? Beam myself from place to place What are your hobbies? Cooking, reading, traveling What is your perfect meal? Fresh fish, garden grown tomatoes with basil and corn on the cob.

ICEMAGAZINE

SPOTLIGHT

Rad idea SAFETY FiRsT

ennifer Holmes, M.S., R.T.(R)(CT), 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. Holmes applied on behalf of Baxter Regional Medical Center of Mountain Home, Arkansas. The grant will be used to purchase a Hovermatt lateral transfer airbed systems. These patient handling devices provide enhanced safety in the lateral transfer of patients for imaging procedures. The system uses air mattress technology to protect the integrity of the patient’s injury while reducing shoulder and back stress on the technologist. “Most of our patients are lateral transfers from a stretcher to a radiology exam table,” Holmes said. “These

ICEMAGAZINE | MARCH 2021

types of systems help patients feel safer and experience less pain during transfer. It also protects employees in situations where a proper patient transfer cannot be carried out due to lower staffing, specifically during third shift.” The ASRT Foundation and Jennifer Holmes, M.S., Canon Medical Safety FiRsT R.T.(R)(CT) 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.

ADVANCING THE IMAGING PROFESSIONAL

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SPOTLIGHT

Off Clock THE

SANDRA PAGE, RTR, MBS

QUALITY AND ELECTROPHYSIOLOGY MANAGER, UNC REX HEALTHCARE BY MATT SKOUFALOS

hroughout her 27-year career as a diagnostic radiology technician, Sandra Page has seen her field from the perspective of a wanderer and a homebody. Before honing her skills at UNC Rex Healthcare in Raleigh, North Carolina, Page worked as a travel tech, filling in staffing shortages in places as far-flung as Washington, D.C., Boston, Massachusetts and Hawaii. When she was given an opportunity to advance her career at WakeMed Health and Hospitals, Page decided to 16

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settle back down in Raleigh, accepting a cardiovascular imaging team lead position with the condition that she earn a bachelor’s degree within five years. Not only did Page complete that program through Excelsior College of Albany, New York, she pressed on, earning a master’s degree in health care administration and management from the University of North Alabama and a Lean Six Sigma green belt. Page parlayed that schooling into a new placement with the performance improvement department at UNC Rex, where she was assigned to manage programs that worked on reducing adult mortality throughout the hospital. Later, this work led her into a dual role, overseeing the Heart and Vascular HosADVANCING THE IMAGING PROFESSIONAL

Sandra Page is seen with Gary Preston. Preston was diagnosed with MS in 2008. He was at the end of his driveway with his walker and his yard and fence were full of inspirational signs. Page said members of her group stopped to thank him for cheering them on. He said he has done this since 2010 and thanked them for riding for a cure. He also said that when he dies his wife will put a wreath on the door. Page told Gary that she was not looking for a wreath and that she would be looking for him next year. He smiled and said, “OK, see you next year!”

pital Quality Programs as well as managing its electrophysiology department. The job “took the two things that I’m really passionate about and put them together,” she said. In addition to being an advocate for continuing education, Page’s focus on efficiency and performance improvement also expanded her appreciation of developing a worklife balance. At UNC Rex, she learned under Julia Woodson, a manager who believed that worker efficiency and quality of effort are diminished if staff are pressed to think about nothing else but their jobs. “She was the one who said ‘you’re ineffective after a certain amount of time,” Page said; “that you have to replenish your soul. You can’t have bright ideas and clear thinking if you don’t have a clear head. I have implemented that same philosophy.” For Page, that replenishment of soul and clarity of mind can be found with the wind in her face on the open road. An avid cyclist of some 11 years, she initially took up the hobby for the exercise. When she began to expand the range of her rides from four miles to 10, 20, and beyond, however, she found a crew of riders with whom to plot out much farther trips. “Another nurse and malpractice attorney were riding for diabetes from Raleigh to Southern Pines – about 85 miles – and they were going to spend the night, and then ride back the next day,” Page recalled. “They said, ‘Let’s train for this, and then fundraise for it.’” Page describes herself as always “down for some kind of a cause,” having ridden to fundraise for charities battling multiple sclerosis, diabetes, and cancer, as well as for the nonprofit Habitat for Humanity, which builds houses for those in need. That attitude of giving back has grown into a motivational cause for her larger group cycling activities. So, once a year, Page, her husband, and some of WWW.THEICECOMMUNITY.COM

their buddies mark out a week on their calendar to organize a long ride. “We start somewhere in the mountains of North Carolina, we camp along the way, and we cycle all the way to the coast,” she said. “One year we started in Sparta, North Carolina and ended in Cape Hatteras at a lighthouse on the Outer Banks. That year, that was 462 miles over seven days.” Often accompanying Page on those long rides is her husband of nine years, Robert, whom she hooked into riding not long after the two met. The couple travels together often, especially when tackling larger rides. Sandra Page’s bikes of choice are a manual-shift Fuji and an electronic-shift KHS; and although she’s no fan of mountain biking, she loves to ride a fat tire bike on the beach. And while the Pages are comfortable mapping out long-distance challenge rides, they may most often be found taking advantage of the 100 miles of paved, multi-use trail paths along the Raleigh Greenway. Some stretches, like the Neuse River Greenway Trail, provide nearly 30 miles of scenic riding through wetlands, historical sites and agricultural fields. “We’re really fortunate,” Sandra Page said; “you can do 50 miles one way or another and never be on a road near traffic. The breeze feels good, the

river looks good; you can look at that flowers, look at those trees, and look at wildlife. You don’t have to think about anything if you don’t want to, but if you are working on something, it helps. It’s a sense of accomplishment when you get done, and self-care is especially important during the [novel coronavirus] pandemic.” Rides like those, even if they’re just 45 minutes to an hour, offer Page a chance to get some fresh air and clear her head. Some days, they yield a needed adrenaline rush; on others, they provide a sense of calm and peace that help her refocus after a mentally intense day at work. In either case, they offer the key to the work-life balance that helps her stay fresh and able to meet the demands of a job that requires significant, sustained focus. “It’s kept me to a point where I feel like I’m healthy and I’m out there doing something for my health when I’m doing it,” Page said. “Some days you’re exhausted, and you get on the bike and you start spinning. If you’re sitting on the seat correctly and maintaining the correct posture, you can get a good core workout.” Where those trips have taken her nearly pales in comparison to where they may yet lead her. In 2020, the Pages had to forego a planned cycling trip down the Danube River in Germany due to the global pandemic; instead, they made a pilgrimage to Zion National Park. They’re still contemplating trips to Portugal, or California wine country, as much as their next ride down the Carolina coast; but, as Page says, “where it will take you – where you can go and do it – is part of those new experiences.” •

Sandra Page and her husband, Robert Page, stopped for a photo while crossing the Yadkin River near Elkin, North Carolina in 2017.

ICEMAGAZINE

NEWS

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

ICE CONFERENCE MOVES TO MAY The 2021 ICE Conference will be held May 11-12, 2021 at the Westin Ft. Lauderdale Beach Resort. 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 professionals 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 explains. “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,” Krieg adds.

The conference will keep the same schedule, exhibit space, speakers, class times and social events. Everything will simply transfer from February to May. ICE continues to be the only conference to combine leaders in imaging management with imaging engineers, providing an exclusive and unique community of key decision makers and influential imaging professionals. ICE is the perfect resource to grow and prosper, personally and professionally. • For more information, visit AttendICE.com.

AI METRICS IMAGING SOFTWARE RECEIVES FDA CLEARANCE AI Metrics LLC, a medical imaging startup focused on augmented intelligence to improve patient care, announced that the U.S. Food and Drug Administration (FDA) has granted 510(k) clearance for the company’s flagship image analysis platform. The first application on the platform, AI Mass, assists radiologists with image analysis and reporting of advanced cancer over time. The company’s innovative approach enables physicians to analyze CT and MRI scans in half the time of traditional methods. AI Metrics has successfully implemented augmented intelligence – the concept of using artificial intelligence (AI) to improve human performance. The AI Metrics platform utilizes AI-assisted workflows to improve accuracy and consistency, and dramatically reduce errors. “Our goal was to design a simple, intuitive platform in which radiologists could assess medical images from patients with minimal errors and a high level of accuracy, consistency, and efficiency,” said Dr. Andrew Smith, CEO and founder of AI Metrics. “To do this, we had to break free from outdated methods and create an entirely

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new image viewer that supports AI and best-practice workflows that generate crystal clear data and reports. We started with advanced cancer and lymphoma and are now broadening our platform to include early-stage cancers.” During clinical trials for novel therapeutics, a patient’s response to therapy is assessed over time using detailed criteria. Such criteria require highly controlled tumor measurements and calculations of percent changes in tumor size. In clinical practice, assessments are more subjective and lack standardization due to time constraints placed upon physicians. “We solved the efficiency and standardization with a combination of AI and guided workflows that capture the best aspects of clinical trials and bring them into clinical practice. This advanced technology completely changes the standard of care – for radiologists, oncologists and patients. As a practicing radiologist and researcher, I’ve envisioned for some time being able to use a system like this, and I am excited to see years of design work finally materialize into an incredible product,” Smith added. •

ADVANCING THE IMAGING PROFESSIONAL

CANON MEDICAL’S AI-POWERED, LARGE BORE CT RECEIVES FDA CLEARANCE Canon Medical Systems USA Inc. has received FDA clearance for the Aquilion Exceed LB CT system, giving clinicians the opportunity to see more during radiation therapy planning for accuracy, precision and speed. As cancer cases continue to increase in the U.S., providing clinicians with the latest technology for accurate simulation across treatment plans remains critical. The Aquilion Exceed LB supports fast and efficient radiation oncology workflows without compromising on patient position, image quality or reproducibility. Features include accuracy even in complex simulations through industry-leading capabilities, like the largest bore opening (90 cm), edge-to-edge extended Field-ofView (90 cm) reconstruction and wide detector coverage (4 cm). It also offer improved contouring powered by Artificial Intelligence (AI) with sharp, clear and distinct images from Canon Medical’s Advanced intelligent Clear-IQ Engine (AiCE) Deep Learning Reconstruction (DLR) technology. Expanded capabilities include how the Aquilion Exceed LB is also uniquely designed to

meet the needs of radiology departments requiring the flexibility to handle bariatric patients and challenging patient positioning, and with patient access and technology designed to streamline CT interventions. “The Aquilion Exceed LB was designed to push the boundaries of traditional simulation,” said Erin Angel, managing director, CT business unit, Canon Medical Systems USA Inc. “Deep learning reconstruction will give radiation oncology teams the confidence they need for accurate and precise planning across patients.” •

FDA APPROVES SENO MEDICAL’S BREAST CANCER DIAGNOSTIC TECHNOLOGY The Center for Devices and Radiological Health (CDRH) of the U.S. Food & Drug Administration (FDA) has granted Texas-based Seno Medical Instruments Inc. (Seno) premarket approval (PMA) for its diagnostic breast cancer imaging technology that helps physicians better differentiate between benign and malignant breast lesions. The company’s Imagio Breast Imaging System uses non-invasive opto-acoustic ultrasound (OA/US) technology to provide information on suspicious breast lesions in real time, helping providers characterize and differentiate masses that may – or may not – require more invasive diagnostic evaluation. The company’s OA/US technology combines laser optics and grayscale ultrasound to provide fused functional and anatomical breast imaging. The opto-acoustic images provide a unique blood map in and around breast masses, while the ultrasound provides a traditional anatomical image. Through the appearance or absence of two hallmark indicators of cancer – angiogenesis and deoxygenation – Seno Medical has shown that the Imagio OA/US Breast Imaging system will be a more effective tool to help radiologists confirm or rule out malignancy compared to traditional diagnostic

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imaging modalities – without exposing patients to potentially harmful ionizing radiation (X-rays) or contrast agents. In addition to the novel imaging provided by the Imagio system, Seno includes an AI physician decision support tool (the SenoGram) to aid in interpreting the new images that, along with training and certification, help radiologists make the transition from ultrasound alone to OA/US Imaging. The system is indicated for use by trained and qualified health care providers to evaluate palpable and non-palpable breast abnormalities in adult patients who are referred for diagnostic imaging breast work-up following clinical presentation or other imaging examinations such as screening mammography. •

ICEMAGAZINE

NEWS ELO INTRODUCES DICOMCOMPLIANT MEDICAL GRADE TOUCHSCREEN DISPLAYS Elo, a provider of interactive solutions, has announced a set of DICOM Part 14-compliant medical-grade touchscreen monitors designed to enhance clinical review for hospitals, clinics, pharmacies and health care providers seeking to speed their workflow with the benefits of interactivity. Sleek and durable, the 03-Series monitors deliver accurate image reproduction ideal for EMRs, image viewing, clinical collaboration and for integration into medical solutions. “From medical devices and operating theaters to nurse stations and patient rooms, Elo’s touchscreens expedite workflow and enhance patient engagement in a variety of health care settings,” said Jeff Fountaine, director of health care

at Elo. “It made sense to develop a DICOM-compliant touchscreen now, in response to provider demand and evolving software capabilities incorporating interactivity into traditionally static workflows.” Elo displays bring a fresh industrial design, feature set and price point enabling enhanced patient interaction at the point-of-care. From analyzing X-rays and scans to reviewing vitals, lab results and medical history, adding touchscreens into clinical review creates workflow efficiencies while improving the patient and provider experience. To ensure providers and patients can view clear, accurate and consistent medical images, Elo’s Medical Monitors are pre-calibrated to meet the American Association of Physicists in Medicine

KA IMAGING ANNOUNCES LEADERSHIP APPOINTMENTS Manufacturer KA Imaging has appointed Shawn Campbell as vice president of operations and Robert Moccia as vice president of sales, USA and Canada. Campbell has over 30 years of experience in business development and operational leadership. He served as an executive at GE Healthcare for 25-plus years. Most recently, he was the vice president of operations at Neurolign Technologies Inc. Skilled in operations and strategic planning, he will be a key contributor to KA’s growth. Moccia brings over 20 years of management experience in the medical device industry to KA Imaging. Prior to joining KAI, he held various executive commercial roles with GE Healthcare in the areas of ultrasound and mammography. •

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(AAPM) secondary display guidelines in compliance with the DICOM 14 GSDF curve. The new medical grade DICOM-compliant touchscreen monitors are available in 19-, 22-, 24- and 27-inch sizes and deliver a reliable, easy-to-sanitize solution with an IP-54 rating to seal out dirt, dust and liquids. An IEC 60601-compliant power supply comes standard along with Elo’s 3-year warranty. •

MITA APPLAUDS MCIT PROGRAM The Medical Imaging & Technology Alliance (MITA) in a press release applauded the Centers for Medicare & Medicaid Services (CMS) for its recently issued final rule concerning the Medicare Coverage of Innovative Technology (MCIT) program. As finalized, the rule will reduce the lag between Food and Drug Administration (FDA) marketing authorization and subsequent Medicare coverage for innovative medical devices. “The MCIT final rule is a major regulatory win – not only for MITA, which has actively advocated for swifter market access policies, but also for countless American patients who will now have expanded access to innovative, FDA-authorized medical solutions that would otherwise be left in limbo,” said Patrick Hope, executive director of MITA. Specifically, the final rule creates a Medicare coverage pathway that expedites patient access to innovative medical devices with FDA “breakthrough” designation. As finalized, the rulemaking grants a drug or device designated by the FDA as “breakthrough” with immediate, four-year Medicare coverage. •

ADVANCING THE IMAGING PROFESSIONAL

FDA CLEARS CIOS FLOW MOBILE C-ARM SYSTEM Siemens Healthineers has announced the Food and Drug Administration (FDA) clearance of the Cios Flow, a mobile C-arm designed for use by multiple disciplines in the operating room (OR) – including orthopedics, trauma surgery, spinal surgery, vascular surgery, and pain therapy – to increase the ease and efficiency of everyday imaging workflows for surgical interventions. This multidisciplinary functionality helps to ensure high-capacity system utilization, making the Cios Flow cost-effective. Additionally, its features enable easier, more efficient operation to improve patient care in the OR. The Cios Flow’s low weight, maneuverability, and intuitive touch-gesture interface simplify operation. When the user taps a challenging anatomical area on the preview image of the Touch User Interface, the SpotAdapt function automatically optimizes relevant imaging and

post-processing parameters such as brightness and contrast. Additionally, the Cios Flow offers Windows 10 security functions to help minimize cyberattacks targeting the system or patient data, as well as access and user management features to prevent unauthorized access and restrict sensitive data. Applications can be whitelisted to ensure that the user accesses only safe software from trusted sources. Patient data can be encrypted using BitLocker, and system changes can be tracked. “With the Cios Flow, Siemens Healthineers proudly offers customers a mobile C-arm system with broad multidisciplinary functionality as well as a robust level of cybersecurity to help enable secure, efficient operations in the OR,” said Lara Barghout, senior vice president of advanced therapies at Siemens Healthineers North America. •

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NEWS AIFORIA PARTNERS WITH PATHAN Pathan, one of the largest pathology laboratories in the Netherlands, has started a collaboration with Aiforia, a leading software company providing artificial intelligence (AI) solutions for medical image analysis. The aim of the partnership is to build clinically validated AI models to assist pathologists with primary diagnostics, enhance laboratory workflows to make faster and better-informed decisions to ultimately improve patient care. Pathologists around the world are facing an increasing burden as rates of disease continue to rise as a result of a higher life expectancy worldwide. Meanwhile the methods these health care professionals currently rely on are manual, sometimes time-consuming and subject to a certain degree of bias. Pathan’s pathologists alone handle about 110,000 requests a year. After adopting digital pathology in their lab to digitize their analysis, they are ready to add artificial intelligence to this workflow to optimize their output. “With this collaboration Pathan’s aim is to better understand the opportunities that AI can offer in the future organization of the diagnostic process, especially given the fact that the number of oncology patients will increase substantially over the next 20 years,” according to Arlinke Bokhorst, director of Pathan b.v. “With AI, Pathan expects to support pathologists with a toolbox of routine assessments, measures and recognition options to optimize their diagnostic workflow.” Artificial intelligence excels at image analysis, with

the potential to surpass human capabilities in speed and accuracy. The Aiforia Platform brings deep learning AI straight to the hands of medical experts with its intuitive software. Pathologists are able to create AI models to analyze images from any sample or disease, for example breast cancer, improving the accuracy and speed of analysis while producing quantitative and reproducible results for clinicians. The Pathan pathologists are working closely with Aiforia’s expert team of scientists to use Aiforia’s software to build clinical grade algorithms, or AI models, aiming to be one of the first to receive CE-IVD marking for these clinical applications. •

CARESTREAM EARNED 70 PATENTS IN 2020 Carestream Health earned 70 new patents in medical imaging in 2020 for advances in digital radiography, mobile imaging X-ray systems and other health care technology areas. Twenty-seven of the patents were awarded by the U.S. Patent and Trademark Office; an additional 43 patents were received in European and Asian countries. “Carestream’s 2020 patents are 70 more proof points of our ability to develop pioneering digital imaging technologies that meet the evolving medical imaging needs of our customers worldwide,” said Eugene Shkurko, intellectual property counsel at Carestream. “Our research and development team continually pursues innovations that have the potential to improve the delivery of care to benefit both patients and providers.” Patents earned by Carestream’s scientists and engineers in 2020 include:

ICEMAGAZINE | MARCH 2021

• Technology advances in Carestream’s growing portfolio of radiology imaging detectors with processing capabilities to calibrate and correct X-ray images in the detector before transmission • 3-D image reconstruction methods • New medical image capture technologies related to long-length imaging using a single X-ray exposure for full spinal and extremity imaging; and • Mobile X-ray cart technology that enables bedside imaging in selectable modes: projection radiography, tomosynthesis and fluoroscopy. Carestream’s broad product portfolio includes 2D and 3D digital medical imaging systems for general radiology and specialty areas such as pediatrics and orthopedics as well as digital laser imagers that output medical images to film. •

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FDA CLEARS MULTIX IMPACT C CEILING-MOUNTED DR SYSTEM Siemens Healthineers has announced FDA clearance of the MULTIX Impact C ceiling-mounted digital radiography (DR) system as well as the MULTIX Impact VA20, a new version of the established floor-mounted parent DR system. Economically priced, both systems expand access to high-quality imaging and enhance the patient experience. The MULTIX Impact C and the MULTIX Impact VA20 possess an intuitive operating system, versatile wireless detectors, motorized tube heads, and a free-floating, flat tabletop for easier patient access. With the X-ray tube’s touch user interface, the radiologic technologist can remain by the patient’s side for longer periods. And when in the control room, the technologist can continuously monitor the patient via the myExam 2D camera. The myExam Companion user interface on both systems provides proactive guidance to help technologists of any skill level navigate a radiography procedure. Combining available patient data with other user or machine-observable, patient-specific information, myExam Companion can identify optimal

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acquisition and reconstruction parameters for each patient and procedure. With myExam Companion’s camera-based Smart Virtual Ortho feature, the technologist can set the field of view and adjust exposure parameters on the touchscreen using a live camera image of the patient, so long-leg and full-spine examinations can be set up and performed more easily. The Auto Full-Spine and Auto Long-Leg Collimation features use automated, artificial intelligence-based body part detection and collimation to accelerate spine and leg examination workflows by analyzing the patient’s contour and adjusting the collimator blades in under half a second. “With this FDA clearance, Siemens Healthineers pushes the boundaries of what is possible in radiography,” said Niral Patel, vice-president of X-ray products at Siemens Healthineers North America. “We can now deliver both floor-mounted and ceiling-mounted options with automation, artificial intelligence, and safety features that expand our customers’ capabilities in digital radiography.” •

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Market Report Reports Predict Ultrasound Growth STAFF REPORT

ltrasound is an imaging modality that utilizes high-frequency sound waves to visualize organs inside the body. Apart, from imaging, the technique also guides health care professionals to conduct biopsies, monitor blood flow and assess the extent of damage after a heart attack. It is an industry that has witnessed steady growth in part because of the growing incidences of orthopedic and other internal injuries; an increasing geriatric population coupled with chronic illness; a steady increase in the number of hospitals; technological advancements in the development of ultrasound devices; and growing government, public and private investments for the development of new ultrasound devices. Further, significant opportunities from emerging economies and emergence of point of care ultrasound devices have boosted the adoption of ultrasound devices among health care facilities worldwide. The global ultrasound market will increase at a compound annual growth rate (CAGR) of 4.2% from 2019 to 2024 to reach $7.94 billion by 2024, according to a report from Meticulous Research. The ongoing trend of the development of application-specific ultrasound devices is among factors expected to boost the growth of the ultrasound market in near future. The global ultrasound market is segmented by product (ultrasound devices, probes, gels, others), technology (diagnostic ultrasound, therapeutic ultrasound), display (colored ultrasound, black and white ultrasound), portability (trolley-based, handheld/compact, point of care ultrasound systems), application (diagnostic and therapeutic applica24

ICEMAGAZINE | MARCH 2021

tions), and end user (hospitals, diagnostic imaging centers, ambulatory care centers and others), and geography. On the basis of technology, 2D ultrasound is identified as the most preferred standard technology for the diagnosis and identification of abnormalities. The report states that 2D ultrasound commanded the largest share of the global ultrasound market in 2017 owing to simplicity of procedure, low cost, mobile nature and provision of real-time images. On the basis of application, diagnostic application commanded the largest share of the global ultrasound market. The high share of this segment is attributed to the large volume of ultrasound diagnostic procedures performed for detection of various diseases. Recent technological trends in ultrasound are leading to contrast-enhanced imaging and with the advent of mobile technologies, the ultrasound will not remain confined inside hospital premises. Further, with the increase in computational power, ultrasound fusion imaging techniques are gaining significant traction, which will effectively explore the anatomical body parts and organs with the help of real-time ultrasound images. The increasing prevalence of heart diseases, gynecological disorders, and an increasing awareness regarding the harmful effects of radiation dose is driving the interest of manufacturers toward the development of more advanced ultrasound devices. A report from MarketsandMarkets also predicts growth. The report states that the ultrasound market is projected to reach $8.2 billion by 2025. Ongoing technological advancements in the field of diagnostic and therapeutic ultrasound imaging, availability of medical reimbursements for diagnostic ultrasound procedures in mature markets and the growing applications of emerging ultrasound techniques (such as Doppler ultrasound in vascular imaging and 3D/4D ultrasound in oncology) are driving the growth of ultrasound market. • ADVANCING THE IMAGING PROFESSIONAL

Product Focus

Ultrasound

CANON MEDICAL SYSTEMS USA Aplio i-Series and Aplio a-series

Designed with the same high-end imaging, ergonomics and workflow capabilities, Canon Medical’s Aplio i-series and Aplio a-series ultrasound platforms come complete with iSense workflow and ergonomics features as well as a selection of highly versatile transducers that cover a wide range of clinical areas with exceptional image quality.

*Disclaimer: Products are listed in no particular order.

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SIEMENS HEALTHINEERS

HOLOGIC

SuperSonic MACH 20 ultrasound system The latest addition to Hologic’s ultrasound portfolio, the SuperSonic MACH 20 ultrasound system, provides added clinical value for general and specialty ultrasound imaging, including of the breast, liver, muscles and tendons. It features excellent B-mode image quality and runs on the same UltraFast imaging technology that powers Hologic’s full line of SuperSonic ultrasound systems, allowing users to perform dynamic tissue stiffness evaluation with ShearWave PLUS elastography. Radiologists and sonographers also enjoy an intuitive, ergonomic user experience thanks to the SonicPad touchpad, which is designed to reduce examination time and operator fatigue and injury.

ACUSON AcuNav Volume ICE Catheter ACUSON AcuNav Volume ICE catheter, a product of Siemens Healthineers, enables clinicians to see more than ever before in Intracardiac Echocardiography (ICE) imaging.1 This innovative 4D Volume technology provides more information in one view in real time to accurately navigate, guide and measure with multiplanar reconstruction planes. It further improves procedural efficiency due to potential reduction of the need for general anesthesia as well as scheduling effort, staffing needs, procedural time and cost.2 1. Compared to ACUSON AcuNav V catheter and other solutions currently commercially available 2. Compared to TEE procedures, data on file

ICEMAGAZINE | MARCH 2021

ADVANCING THE IMAGING PROFESSIONAL

KONICA MINOLTA HEALTHCARE SONIMAGE HS2

The SONIMAGE HS2 is a next-generation, compact ultrasound system optimized for point-ofcare environments. It provides enhanced needle guidance with Simple Needle Visualization (SNV), superior image quality and high-resolution blood flow imaging. Improved Tissue Harmonics technology suppresses acoustic noise and increases both frequency and sensitivity for deep tissue and superficial imaging. When coupled with the company’s wide bandwidth L18-4 probe, users achieve exceptional image quality with improved fine details and contrast resolution for precision in diagnostic and interventional procedures. Konica Minolta’s touchscreen display simplifies operation with the ability to annotate and draw lines, notes or figures with a finger and save them for documentation and reporting.

GE HEALTHCARE Vscan Extend

The Vscan Extend is GE Healthcare’s handheld, pocket-sized ultrasound system that empowers clinicians to make focused assessments and accelerate treatment decisions at the point of care. It fits in the palm of a hand and is easy to use like a smartphone, helping clinicians take decisive action, refer patients quickly and reduce the overall cost of care. The system offers apps designed to help clinicians diagnose confidently and improve productivity. In the COVID-19 environment, Vscan Extend can help manage patients with respiratory conditions offering a dual-probe system that is simple to use with easy cleanability and portability, and on-device applications that support lung and cardiovascular ultrasound exams.

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COVER STORY

Trading (Surgical) SPaces Image-Guided Procedures Migrate to ASCs

ICEMAGAZINE | MARCH 2021

BY MATT SKOUFALOS

ADVANCING THE IMAGING PROFESSIONAL

mong the multiplicity of impacts of the novel coronavirus (COVID-19) pandemic on the U.S. health care system was the deferral of elective surgery procedures by patients either unable or unwilling to risk an encounter with COVID patients by coming into a hospital. Eventually, state-issued bans on elective surgeries relaxed, but the swath the virus continued to cut across the country did not. For many physicians and the patients in their care, the option of choice became a change of venue, transitioning cases to ambulatory surgery centers (ASCs) or office-based laboratories (OBLs) rather than hospitals that, in many instances, overflowed with COVID-19 patients. Whether they realized it or not at the time, those patients and practitioners were part of a broader trend in health care whereby surgical cases of lesser intensity are being safely migrated to those non-hospital environments, saving on expenses and delivering the same level of care. As defined by the U.S. Centers for Medicare and Medicaid Services (CMS), an ASC is described as “a freestanding facility, other than a physician’s office, where surgical and diagnostic services are provided on an ambulatory basis.” An “office” is “a location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, state or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis and treatment of illness or injury on an ambulatory basis.” Those definitions matter because, under the Medicare Physician Fee Schedule (MPFS), some physician services are reimbursed at different rates when provided in facility (mostly hospital inpatient) and non-facility (including ASC and OBL) settings. According to CMS, “the rate, facility or non-facility, which a physician service is paid under the MPFS is determined by

the place of service (POS) code that is used to identify the setting where the beneficiary received the face-to-face encounter with the physician, non-physician practitioner (NPP) or other supplier.” “When a physician performs in a facility like an ASC, Medicare pays the facility, not the physician, for the facility’s overhead expense,” wrote Kent Moore, senior strategist for physician payment for the American Academy of Family Physicians (AAFP) in a June 2015 blog post. “In turn, Medicare pays the physician less under the physician fee schedule because the physician did not have the overhead and much of the other practice expenses of the facility’s location of service,” including those non-surgical supplies and staffing that contribute to hospital costs. But as more and more procedures are qualifying for that non-facility reimbursement rate, including interventional radiology and image-guided procedures, physicians and hospital systems alike are retooling their business models to capture a greater share of the money that remains on the table. John Geer, director of OBL and ASC solutions at Siemens Healthineers North America sees the migration of image-guided surgical procedures from hospitals to ambulatory clinics as disrupting ongoing consolidation efforts among health systems nationwide. Geer stopped short of describing the procedural out-migration as an outright cannibalization of hospital revenues, instead noting that growth in the ASC/OBL sector is inextricably linked to questions of capacity utilization across a variety of environments. Many image-guided procedures are already cases for hospital outpatient

“

Medicare pays the physician less under the physician fee schedule because the physician did not have the overhead and much of the other practice expenses of the facility’s location of service. – Kent Moore

”

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COVER STORY

“

departments, but as more increasingly complex (and higher-reimbursement) cases work their way into the procedural pipeline, these can fill in some of the schedule gaps created by the movement of less complex, lower-reimbursement procedures to ASCs. “Legacy managed-care contracts used to be primarily between hospitals and referring clinics,” Geer said. “In today’s landscape, the patients, providers and payers all have varying incentives to look outside the hospital to have the work done. Hospitals can either continue to lose these cases and this revenue, or they can add an ASC to their ambulatory strategy: make their own, build one, buy one.” “A hospital can’t just go out and buy an OBL, but as these [CPT] codes continue to go out, you will continue to see that consolidation of ASCs being sold back to hospitals,” he said. “These folks, to supplement their top-line needs, either have to do more cases or get reimbursed more per case; even though we’re moving cases outside of the hospital, that doesn’t mean they aren’t also subject to rate cuts.” Geer’s colleague Joseph Riley, vice president of cardiology and interventional radiology for the advanced therapies business of Siemens Healthineers, foresees that the movement of image-guided procedures to ASCs won’t necessarily create new procedure volume for practitioners, but it can lead to better health outcomes for patients and at lower costs. This shift in where care is reimbursed is tantalizing enough for new money to enter the picture from private equity firms and hospitals, to expand the number of these centers. “Several models can work to grow access with these centers,” Riley said. “From entrepreneurial physicians to hospitals to joint ventures, there will be different ways to make these centers work. Studying the expansion of ambulatory surgery centers, the joint-venture model played a big role bringing together the hospital partners, physicians and management companies.” 32

ICEMAGAZINE | MARCH 2021

When elective surgeries can be done in an ASC and we can reduce the cost of that care for patients, private insurers or Medicare, and employers, we all win. – Rebecca Craig

”

Further complicating the picture for health systems is the fact that non-hospital surgical settings are governed by state-specific rules, in addition to CMS requirements, contributing to limited outright hospital ownership of ASCs (about 3 percent of the national market, Geer said); by comparison, 60 percent of ASCs are physician-owned. Whereas there wasn’t the incentive for a hospital to own one previously, now they are beginning to entertain the notion, particularly amid CMS’s incentivization of procedures conducted in settings with lower operational costs. “Medicare/Medicaid in the U.S. is a zero-sum game,” Geer said. “Rate increases in one code set are typically offset by rate reductions in another. There are alternative places of service where these cases can be done safely, which will gladly take a lower reimbursement rate because their overhead is lower.” “The train started rolling in the 1970s and ’80s, and as time moves along, more cars, in the form of procedures, are added to that train,” he said. Rebecca Craig is CEO of the Harmony Surgery Center, which has operated in Ft. Collins, Colorado, for the past 20 years. A JCAHO-accredited joint venture with UCHealth, the center is 50-percent physician-owned, but functions and operates independently from the health system. Throughout its four operating rooms and five procedure rooms, the facility manages a variety of cases that are appropriate for an ASC environment – GI, pain management, and surgeries such as hernia repair, sinus surgery, total joint replacements, gastric bypasses, back hardware placement – for which the facility is reimbursed at ambulatory surgery center rates.

In addition to dealing with private payers, Craig said about 39 percent of its volume is reimbursable by Medicare and 8 percent by Medicaid but acknowledges that the cost of setup – technology, equipment and supplies – and opportunity for reimbursement “is a limiting factor” in determining which cases its surgeons will handle there. “We have a lot of volume, but for the more complex procedures, whether we can do it really just depends on where Medicare has placed the reimbursement,” Craig said. Taken together with prospective patient volumes and scheduling availability, those reimbursement rates also inform capital equipment purchases, which are another component of which lines of business the surgery center offers. Harmony Surgery Center has five mobile C-arms that are frequently relied upon for completing a variety of procedures – and at an average cost of $165,000 apiece, they need to be in service frequently to justify the cost of those investments. Although vascular procedures are trending more and more in ASC environments, Craig says her center won’t seek to add the radiology equipment they require until it can also find cardiologists to perform them. “If you get your OR set up with that kind of equipment, you want to make sure you have the reimbursement to pay that equipment off,” she said. “We couldn’t add that specialty unless we had a set of committed cardiologists to bring their patients here; in our community, the cardiologists are employed by the health system, so they’re doing those procedures at the hospital.” In addition to certifying the availability of physicians, equipment, and ADVANCING THE IMAGING PROFESSIONAL

Trading (Surgical) Spaces patient volumes sufficient to offer a new line of service at a surgery center, Craig said that ASCs also take very seriously the quality of patient experience in their facilities. Without having to manage the multiple lines of service that a hospital does, ASCs can focus exclusively on surgical procedures and their outcomes. “Our specific focus on the customer is one of the hallmarks of our industry,” she said. “The hospital is for sick folks, and anything that can be transitioned to the surgery center will continue to be, which is why hospitals are opening surgery centers. The key is to pick the right site of service for the patients instead of funneling them into one place.” Moreover, Craig said, the health care landscape needs a cost-effective alternative to hospital-based care, and ASCs can provide that. When patients have a 20-percent copay for surgical procedures that can run into the tens of thousands of dollars, consumerism is another contributing factor to the growth in ASC business. “In the United States, we have been looking for ways to reduce the cost of health care for a long time,” she said. “When elective surgeries can be done in an ASC and we can reduce the cost of that care for patients, private insurers or Medicare, and employers, we all win.” Dr. Fadi A. Saab is the COO and director of cardiology and vascular medicine at Advanced Cardiac & Vascular Centers for Amputation Prevention. Saab co-founded the practice in Grand Rapids, Michigan, with his uncle, Dr. Jihad A. Mustapha, a fellow interventional cardiologist. They opened that site in 2018 together with an advanced-practice provider and a support staff of 10; as demand for their services increased, they launched a second center just 70 miles away, in Lansing, and a third in Las Vegas, Nevada in June 2021. Primarily, the facilities focus on limb salvage, but Saab said they perform all types of procedures necessary to treat advanced peripheral vascular disease. WWW.THEICECOMMUNITY.COM

Image-Guided Procedures Migrate to ASCs

“Many patients come to ACV as their last hope when they have been told by others that amputation is their only option,” he said. “Because of the advanced imaging modalities that we have at ACV, we are able to successfully treat these very challenging cases. “In the outpatient setting physicians can choose the proper products for patients because of no institutional limitations,” Saab said. Saab also believes there’s a broader push to perform ever more procedures in an outpatient surgery setting, not only for the “significant cost savings to the health care system and patients,” but also given safety and efficacy metrics that are “comparable, if not even better, than in the hospital settings.” “In my experience, patients love the convenience of undergoing procedures in a smaller, more focused care center,” he said. In addition to patient convenience, Saab said he’s seeing more and more physicians “moving away from hospital employment to open their own independent, patient-centered outpatient facilities.” “I see these physicians wanting to move back to delivering personalized patient care,” he said; “I see these centers as allowing physicians to achieve independence and personalized patient care.” To what degree those independent practices may come online varies regionally, Saab said; however, he added that those hospitals “that propagate a culture of cooperation and incorporation will be able to partner with independent and employed physicians alike.” For many physicians, the opportunity either to achieve that career independence that Saab described, or to clarify the terms of partnerships with their hospitals of choice, will only increase as CMS clears the migration of additional, typically inpatient procedures to ASCs. Catherine Ruppe, a nurse and consultant in the ASC space, has seen

an “across-the-board” migration of surgical specialties from hospitals to ASCs, which has given rise to more physicians considering the flexibility that might come with participating in an ASC, either as an owner or a parttime member of the team. A Certified Administrator Surgery Center (CASC) and the interim director of the Alaska Heart and Vascular Institute in Anchorage, Alaska, Ruppe oversees its operations as a hybrid space on the campus of Providence Medical Center through ECG Management Consultants. Four days out of the week, the institute operates as a catheterization lab, and on the fifth, it’s a surgery center that performs medical device implants. The United States is home to some 6,000 freestanding, Medicare-certified ASCs in the United States, Ruppe said, many in specialties that are often privately owned by physicians, including orthopedics, otolaryngology, gastroenterology and ophthalmology. She recommends that any physicians considering striking out on their own contemplate several factors that can play into the decision to do so, including patient volume, potential for future growth and available regional resources. Investors – be they hospitals, physician-entrepreneurs or venture capitalists – must project factors like market conditions, hospital support/ partnerships and patient selection criteria. The final piece of the puzzle may be working to educate patients about the options available to them in ambulatory settings and the potential for reduced out-of-pocket costs as well as greater creature comforts. Ruppe points out that those conversations, like many around the ASC model, will vary regionally. “It’s starting to happen at the payer level,” she said; “they’re driving patients to lower-cost of care sites, such as ASCs. There are incentives to do that, and hopefully you’ll be able to explain to your patient if they’re not savvy enough.” • ICEMAGAZINE

INSIGHTS

CODING/BILLING

BY MELODY W. MULAIK

PATIENT RELATIONSHIP CATEGORIES P

atient relationship categories and modifiers have been around for a number of years, but their utilization is not mandatory, and it is unclear when and if this will occur. The Medicare Access and CHIP Reauthorization Act (MACRA) requires CMS to develop patient relationship categories to classify the patient’s relationship with the physician or practitioner who is providing the service. These categories are used to evaluate the cost of care by linking resource use to the physician or practitioner who is responsible for it. This information will be crucial in developing new value-based payment systems. CMS has defined five relationship categories that describe the type of services the clinician is providing to the patient – continuous/broad services, continuous/focused services, episodic/broad services, episodic/ focused services, and diagnostic services requested by another clinician. Of these five categories it is anticipated that the two that will be utilized by radiologists will be X4 or X5. (See Table 1.) Radiologists whose practice is limited to diagnostic imaging will report most or all of their services with modifier X5 (Diagnostic services requested by another clinician). An 34

ICEMAGAZINE | MARCH 2021

example of this modifier is “the radiologist’s interpretation of an imaging study requested by another clinician.” Interventional radiologists’ services, on the other hand, will likely qualify for modifier X4 (Episodic/ focused services). The MPFS Final Rule states that claims submitted by physicians and practitioners for dates of service on or after January 1, 2018, should include the applicable HCPCS modifier. However, the use of the modifiers will not be a condition of payment during the initial learning period. CMS has not stated how long the learning period will last or when the use of the modifiers will become mandatory. As you utilize these modifiers, pay close attention to the total number of modifiers that you are using for a given study and the order they are listed. Payment modifiers should always precede those which are informational, so ensure proper placement of modifiers when submitting the claim. Once the threshold of five (5) modifiers is reached, a “99” must be appended as a modifier at the line-item level in block 24D and the individual modifiers listed in block 19 on the claim form. • MELODY W. MULAIK, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc. ADVANCING THE IMAGING PROFESSIONAL

INTERNATIONAL X-RAY BROKERS IS NOW AN AUTHORIZED DISTRIBUTOR FOR CUSTOM BUILT SURGICAL TABLES!

Table 1

MODIFIER

DESCRIPTION

Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period.

Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist’s interpretation of an imaging study requested by another clinician.

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PACS/IT/AI

BY MARK WATTS

SEEING COLOR AND DIVERSITY WITH IMAGING AI

ne of my medical imaging heroes, Herman Oosterwijk posted a picture recently on LinkedIn. It was a Throwback Thursday post. The picture was of a “revolutionary piece of equipment … a view station that mimicked the Alternator.” The Alternator was an X-ray film holding device that had panels that rotated up and down to expedite the reading process for the radiologist. The monochrome X-ray film holder format was mistakenly maintained in the early digital imaging transformation. This lack of awareness by the engineers led them to create a solution that was limited in application and growth potential. The monitors could not even see colors on the screen. In June 2020 a crisis erupted in the artificial intelligence world. Conversations on Twitter exploded after a new tool for creating realistic high-resolution images of people from pixelated photos showed its racial bias turning a pixelated yet recognizable photo of former President Barack Obama into a higher-resolution photo of a white man. Researchers soon posted images of other 36

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people of color being turned white. The conversations became intense to well-known AI corporate researchers, including Facebook’s chief AI scientist Yenn Lecunn and Google’s co-leader of AI ethics Timnit Gebru. They expressed strongly divergent views about how to interpret the tools error. A heated and multi-day online debate seemed to be dividing the field into two distinct camps. Some argued that the bias shown in their results came from bad (that is, incomplete) data being fed into an algorithm while others argued that it came from bad (that is shortsighted) decisions about the algorithm itself – including what data it was to consider. A lung screening AI algorithm in 2017 from Stanford was toted to outperform radiologists at diagnosing pneumonia. An issue developed when positive findings for “Bilateral Densities” were noted on all female chest X-rays. The original training data set had been comprised of only male students. Stanford researcher Pranav Raipurkar looked at the tendency for algorithms trained on proprietary or incomplete datasets to fail outside those friendly confines — that is, they do not generalize. As one example, he pointed to American-trained AI models for lung diseases that do not include tuberculosis (TB) in their labeling. TB is a ADVANCING THE IMAGING PROFESSIONAL

noted problem for the developing world, but less so in America, so scans of tuberculosis are not found in the training dataset. True democratization requires AI to work everywhere and for everyone, he said. Simply adding images of tuberculosis to American training datasets would help generalize — and therefore democratize — valuable AI to other parts of the world. Bias has plagued the artificial intelligence field for years. This particular AI tool’s black to white photo transformation isn’t completely unexpected. However, what the debate made obvious is that not all AI researchers WWW.THEICECOMMUNITY.COM

have embraced concerns about diversity. This is a fact that will fundamentally affect any organization that plays in the AI space. Also, there’s a question here that many organizations should pay attention to. Why didn’t it occur to anyone to test the software on cases involving people of color in the first place? I would argue that this is a case of invisibility. Sometimes people of color are present, and not seen. Other times the diversity population is missing, but that absence is not noticed. Part of the problem is that few people of color are working in the field

of AI. Black workers account for 2.5% of Google’s entire workforce and 4% of Facebook’s. Globally, only 22% of AI professional are female. Considering the growing role that AI plays in organizations’ business processes, in the development of products and in the products themselves, the lack of diversity in AI and the invisibility of people of color will grow into a cascade of crises. Issues will pile up one upon another, if these biases are not addressed soon. I have seen companies pull their advertising dollars from Facebook because of its poor handling of hate speech. I have seen companies issue moratoriums on the sale of facial recognition software, which had long been recognized as having built-in racial and gender biases. Due to the COVID-19 pandemic crisis – and the hasty adoption of AI to track COVID’s spread – we have a unique opportunity to institute change within the world of AI. We have an opportunity to rapidly improve the delivery of health care services with the assistance of AI. Success will be predicated on our mutual awareness that designing the solution without diversity will be like the doomed PACS systems without color, limited in application and growth potential. • MARK WATTS is the enterprise imaging director at Fountain Hills Medical Center.

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COVID CHALLENGE:

CHAIRS B DIRECTOR’S CUT BY LYDIA KLEINSCHNITZ

eing the director of an imaging department offers lots of rewards, but also sometimes presents its fair share of challenges. When you are a senior director of multiple sites, this tends to multiply both things. I am one of those senior directors and I have oversight of two hospital-based imaging departments along with seven satellite sites; these hospitals are busy city hospitals. One is a level I Trauma Center and, combined, the hospitals have over 1,370 beds. As you can imagine, this means our imaging departments are very busy – busy with inpatients and outpatients. We offer a wide variety of imaging that one would expect to find including X-ray, CT, PET/MRI, nuclear medicine, ultrasound, MRI and interventional radiology. The number of modalities is a factor that contributes to the number of outpatients, and their accompanying family members, who visit our department. I, along with my leadership team, had to focus on

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ADVANCING THE IMAGING PROFESSIONAL

maintaining a well-run reception area. We needed one that allowed the team to process patients as quickly as possible through to their ordered imaging as well as one that allowed a comfortable place for accompanying family members. It is always reassuring to see the reception area running smoothly and seeing support family or friends waiting in comfort. One thing you don’t want to see are people standing around with nowhere to sit and wait. At least that was the case before COVID-19 hit. With the pandemic, came the need to maintain social distancing to help limit any transmission of the virus. In the beginning, we limited outpatient care in order to conserve resources for those that were struck with the illness. As time went on, we found that in our region of western Pennsylvania we did not see that initial huge influx of COVID patients. Suddenly, we were trying to catch up with all those outpatients that we had placed on hold in order to deal with the pandemic. Our outpatient reception areas were at capacity – even with limits on how many people a patient could bring with them. Nothing seemed to ease the congestion we were experiencing. As a leadership team, we had to figure out a way to keep the six-feet gap between those that were waiting. Initially, we tried to turn chairs around or used chair hanging cards that designated chairs that should not be used. Low and behold, family members would turn the chairs around or sit on the cards. We ended up with squashed chair cards, disorganized chair rows that were trip hazards and complaints WWW.THEICECOMMUNITY.COM

that we were not really working to keep our patients safe by allowing unrelated people to sit so close together. It seemed to be an impossible task. How could we continue to offer critical outpatient services, allow those that accompanied patients to be comfortable and maintain safe distancing all in a limited space? A critical decision had to be made, one that as a senior director I never thought I would have to make. I had to enforce a limit on the number of people in our reception area and we needed to remove chairs from our reception areas. What a foreign concept, I was usually trying to find more chairs. Now, I was asking facilities to move chairs to unoccupied offices or unoccupied non-patient areas! Our team continues to make efforts to reach out to patients prior to arrival to remind them to bring only one support person. Our reception team offers other areas for family members to sit. Our techs and nurses attempt to minimize turnaround times. Patients and family are now able to successfully maintain social distancing. Complaints and fears have been decreased and we continue to provide services for our outpatients. I am hopeful that as vaccines are distributed, that soon, I will be able to reverse the chair count. I will be able to replace those chairs and provide a comfortable safe place for all to wait. I sure hope I can remember where I put those chairs. • LYDIA KLEINSCHNITZ, MHA, BSN, RN, is the senior director of imaging services at UPMC Presbyterian Shadyside.

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EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI

THE TIME MANAGEMENT INK BLOT E

veryone has 24 hours in a day, so why are some people more productive than others? The answer lies in what we choose to do with the time we have. The phrase most of us use when talking about prioritizing our schedule is “time management,” and although I won’t belabor the point, a more accurate phrase would be, “action management.” That’s because everyone gets 24 hours, and what we’re managing is our actions, not our time. That said, because time management is the more common phrase, let’s stick with that. Lots of companies sell time management systems, but anymore, I caution people to be careful when choosing one. A system that works well for one person doesn’t necessarily work for someone else. Years ago, I used to present Stephen Covey’s time management techniques in my team-building workshops. Yet, despite Covey’s method being heralded as a premier approach for optimal productivity, too many people were telling me they would never use his approach. After a few years of getting feedback like that, it eventually hit me: Time management is like a Rorsharch Ink Blot test. Every person views it differently. And so, I changed the way I conduct my workshops. Now, instead of laying out the “best” time management formulas, I present several dozen tips that people use for working more effectively and efficiently, and have 40

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people choose the five tips they believe work best for them. Then, I divide people into groups to discuss the pros and cons of the various suggestions. This provides them with an opportunity to re-evaluate and rethink their choices. Still, in the end, they need to identify five techniques they believe work best for them. Then, comes my next question: “How many of the five are you doing?” Rare is the person who is doing any of the five they chose. A few in each class are already doing one of their chosen five, but extremely rare is the person who is doing two or more of the five. If people aren’t doing any, my recommendation is always to start slow. Don’t jump into the deep end of the time management pool, choose just one or two techniques to get started. If people try starting all five right away, it’s a recipe for failure. Good progress can be made by implementing just one or two of the techniques. Let me also suggest that an accountability partner is tremendously helpful for staying with your chosen technique(s). This doesn’t have to be a formal relationship. A friend, co-worker or even a spouse will do.

TECHNIQUES HELPFUL FOR EVERYONE Despite me saying that your most effective time management techniques are unique to you, over the years I’ve found a few are helpful for just about everybody. The following ADVANCING THE IMAGING PROFESSIONAL

are some tips many of my clients find useful. In keeping with the ink blot theory, you may or may not choose to incorporate them. However, I urge you to consider them before writing them off. First up is planning. Probably the most effective action one can take to increase productivity is practicing weekly planning accompanied by daily adapting. Some people like planning on Sunday afternoon for the upcoming week. Others like to plan on Monday morning, while still others prefer Friday afternoon. Whatever time works best for you, the idea is to spend at least 10 or 15 minutes identifying the high priority tasks or projects due in the upcoming week and plugging those activities into your calendar. The purpose of weekly planning is to schedule your priorities. The number of urgent fires that flare up throughout the week can be greatly reduced if we schedule our priorities instead of merely prioritizing our schedule. The second half of the phrase I mentioned is “daily adapting.” There’s a useful military truism that applies here, which is, “No plan survives contact with the enemy.” This aligns with what President Dwight Eisenhower, former Supreme Commander of the Allied Forces in World War II, once said: “Plans are useless, but planning is essential.” The idea is that once the rubber meets the road, whatever plans we created will not go as planned. But the mere fact that we thought things through in a planning process enables our minds to deal better with the tasks at hand, and we can adapt easier as we press forward to making things happen.

THE EMAIL TIME VACUUM Computer terminals are funny things. Too many people believe that if they’re at a computer with a mouse in hand, they’re working. However, at least one study found that people WWW.THEICECOMMUNITY.COM

waste, on average, one hour each day while at their computer. In talking with clients about this, I’ve discovered that two of the biggest time wasters have to do with email, and they exist at opposite ends of a spectrum. The first problem is people spending too much time polishing an email. This is when people read and re-read emails, editing them to perfection before clicking the “send” button. The overwhelming majority of email is about receiving information or requesting information. If the basic questions are addressed, which are who, what, where, when, why and how, then the email is probably good enough. Click send and move on to the next task. I know a woman who sometimes spent several hours belaboring every word of an email before sending it, and her productivity suffered as a result. Make sure the appropriate basic information is included and click send. The second problem is found at the opposite end of the spectrum, and that’s having to request more information, or respond to requests for more information, because it wasn’t originally sent. Again, this time waster is resolved if people ensure the who, what, where, when, why and how questions are addressed as needed when sending communications. Why not identify one thing you can do better to improve your time management, and strive to make it a habit? Chances are your productivity will kick up a notch, and that helps your self-esteem as well as your value to your organization. • 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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INSIGHTS

Here’s the RAD HR

BY KIAHNNA D. PATTON

TRICK I

am raising a toddler, and for those of you who are parents, you know you need to have a few tricks up your sleeves to stop them from biting everything, jumping off of everything and generally testing the limits of life.

As a parent, I periodically scour the Internet and pick people’s brains to find guides that explain how to raise a model child – the child every parent wishes they had and the child every adult wishes they had been growing up. Despite my endless investigation, I remain biased. I know my child will grow up to be brilliant and fantastically successful no matter what. Nevertheless, in my search for greatness and my effort to add to my parental toolkit, I discovered Esther Wojcicki’s book “How to Raise Successful People.” It is a nice guide that chronicles the author’s own upbringing as well as that of her wildly successful children and the students she has impacted over her 35-plus year teaching career. Wojcicki introduced the concept of TRICK, an acronym for Trust, Respect, Independence, Collaboration and Kindness. She proposes that these are the “five fundamental values that help us all become capable, successful people.” 42

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Here’s the TRICK: • Trust: Allow for risk taking so that people can move toward empowerment and independence. • Respect: Support others as they pursue their goals by giving them autonomy and supporting their individuality. • Independence: After you have established trust and respect, independence then lends to self-control and responsibility. Those who have developed these qualities are able to cope with challenges and “feel in control even when things around them are in chaos.” • Collaboration: Allow for participation by “asking for their ideas and working together to find solutions.” • Kindness: Model kindness by extending forgiveness and gratitude, being of service to others and generally being aware of the world beyond your bubble. As you use TRICK, resist the urge to remove all barriers, with the exception of those that unnecessarily block progress. This idea leads me to one of Wojcicki’s quotes I am drawn most to: “Don’t take the challenges and growth away from our children. Painful and difficult experiences are often how we grow, so help them face those challenges and learn from ADVANCING THE IMAGING PROFESSIONAL

them. This is a lesson that we can translate into the work world. Make it safe for people to make mistakes and learn from them so they can grow, resulting in growth of your business as well. Use the TRICK values to persist even in the face of difficulty.” I’m drawn to that quote because it gives a nice link from childhood to adulthood application of TRICK. I’ll go out on a limb and espouse that for many of us, the challenge of being in the midst of a double pandemic of COVID-19 and racial trauma has us struggling to focus and be at our best as often as we’d like. This is where having a TRICK up our sleeves can help serve as a guide. In a business setting, these concepts are important. Here is what they might look like in practice: • Trust in the Workplace: Give an assignment and empower her to make her own decisions. When there is trust, she will have the courage and confidence to take prudent risks, leading to better decision making. Timely reward great performance. • Respect in the Workplace: Delegate meaningful work to your team members and allow them freedom to determine how the work gets done. Listen and ask them questions to show genuine interest and respect for each person’s individuality. WWW.THEICECOMMUNITY.COM

• Independence in the Workplace: Failure is a part of learning. Avoid the peril of perfection by embracing mistakes, supporting learning and allowing for revisions. Empower him to learn by doing things himself. Lay out what the end product should be, and allow him the freedom to use creative and deep thinking to chart his own path to your expected outcome. Empowerment and engagement can lead to incredible results. • Collaboration in the Workplace: Ensure all the necessary voices are included, regardless of position in the hierarchy, when making decisions that have broad impact. Remain curious. Ask team members for innovative ideas, and provide feedback. • Kindness in the Workplace: Assume good intentions. People who forgive more quickly tend to have stronger relationships. Forgiveness is good for your health. Personalize your expressions of appreciation and acknowledge contributions. As you think about who you want to be and how you want to show up in the world, consider incorporating the TRICK algorithm into your life plan. • KIAHNNA D. PATTON is senior human resources business partner at Children’s Hospital Los Angeles (CHLA) and a nonprofit founder.

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INSIGHTS

LUCK AND SUPERSTITION W

hile watching a superstition. Then, I received sporting event word that this column was due. with a neighbor, I don’t want to tempt fate so the subject of “beginrather than an informative and ner’s luck” came up. incisive column you get this. Since I play poker at a Superstition can be defined mediocre level, I shared as a notion maintained despite my wisdom and experevidence to the contrary. It is an tise regarding the luck unjustified belief in a supernatof a beginner. A newbie ural cause and effect leading does not yet possess to an unrealistic expectation. ROMAN REVIEW the knowledge of an This means that, although the BY MANNY ROMAN experienced individuaction or belief is inconsistent al therefore he will act with science, we act and hope improperly for the circumstance. This that the lucky charm and the rabbit’s foot will should be unfavorable for him, yet luck cause luck to happen (lucky for the rabbit that we shows up whenever it does. If you are only took one foot). I already told you that luck is there at the time then you benefit and random and you only need to be present when it the experienced guy justifies the result makes an appearance. by blaming beginner’s luck. By the way, How do we have so many superstitions? We I have never encountered the phrase were provided these wonderful gifts from even “professional’s luck.” Which also hapbefore birth. Did you know that when pregnant pens randomly. if you don’t eat the food the baby craves, it will Interestingly, the very next day, I received an email from Reader’s Digest discussing luck and 46

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be born with a birthmark shaped like that food. You better eat that octopus then. We parents are great at providing our children with an endless ADVANCING THE IMAGING PROFESSIONAL

supply of questionable wisdom: “Your face is gonna stay that way. It’s funny until somebody loses an eye. Black cats are bad luck. Don’t walk under a ladder.” Friends build on these: “Step on a crack, break your mother’s back. See a penny, pick it up, all day you’ll have good luck. But only if it’s heads up. A bird pooping on you is good luck.” There is no shortage of superstitions and luck enhancers. According to the Reader’s Digest article, as many as 17 to 21 million people in America are afraid of Friday the 13th. A gallop poll shows that 50 percent of the country consider themselves superstitious. People may not truly believe superstitions can cause anything however they continue to participate in them. You know you do. You know the feeling of unease or elation the superstition causes. If we cannot control the outcome, we rely on superstition to possibly influence fate in our favor. Well guess what. Science demonstrates the belief in superstition and luck actually may help our performance. In a study published in Psychological Science, golfers were given golf balls. Half of their participants were told that the golf balls were lucky. Those with the lucky golf balls made 35

percent more successful putts. Apparently, the belief that the golf balls were lucky made the golfers feel more competent and confident. Poker is a game of mostly skill, knowledge and experience with a bit of added random luck. The more experienced and successful players, the professionals, have no room for superstition, right? Wrong! An unexpectedly large number have superstitious quirks. Lucky card protectors, lucky starting cards, unlucky starting hands, unlucky seats, unlucky dealers, stacking of the chips, holding on to poker chip won from a “lucky” player. The worst advice ever: “Never count your money while you’re sitting at the table.” You absolutely need to know how much money you have on the table. Is there really anyone who does not have any superstitions or “lucky or unlucky charms” that provide a little anxiety or heightened expectation in certain circumstances? I doubt it. You don’t have to truly believe in luck and superstition to engage in the process. As for me, I personally believe that it is bad luck to be superstitious. •

“Is there really anyone who does not have any superstitions or ‘lucky or unlucky charms?’ I doubt it.”

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MANNY ROMAN, CRES is the AMSP Business Operation Manager.

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