ICE Magazine May 2021 by MD Publishing

THEICECOMMUNITY.COM

MAY 2021 | VOLUME 5 | ISSUE 5

ADVANCING MAGAZINE

IMAGING PROFESSIONALS

GOING MOBILE

New, Portable Applications in CT for the Pandemic and Beyond PAGE 32

In Focus Angie Bush PAGE 12

PRODUCT FOCUS

Computed tomography PAGE 29

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RAD IDEA

Tips for staying engaged during COVID-19 hospital operations.

COMPANY PROFILE

Cal-Ray Inc., a Wisconsinbased independent service organization, is one of the companies making up American Medical Imaging LLC.

COVER STORY Portable CT continues to become more popular, especially amid the COVID-19 pandemic.

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ICEMAGAZINE | MAY 2021

ADVANCING THE IMAGING PROFESSIONAL

MAY 2021

IMAGING NEWS

The latest medical imaging news from around North America.

18 29

PRODUCT FOCUS

A look at some of the latest CT devices.

10 WWW.THEICECOMMUNITY.COM

RISING STAR

Banner Imaging Ultrasound Manager Pamela Garrison’s goals include earning her CRA.

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

Editorial Board

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

Rising Star Pamela Garrison, Banner Imaging

In Focus Angelic P. Bush, University of Texas Medical Branch

Rad Idea Stay Positively Engaged During COVID-19 Hospital Operations

Off the Clock Meggan Lilly, Paradise Valley Banner Imaging

NEWS 18

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

Company Profile Cal-Ray/American Medical Imaging

ICE Webinars Imaging Director Shares Culture Change Tips

PRODUCTS 28

Market Report Experts Predict CT Market Growth

Product Focus Computed Tomography (CT)

INSIGHTS 36

Coding/Billing Can I Bill a Visit?

Lisa Lisle

Digital Department

PACS/IT ADT, What Is Your Status?

Director’s Cut Relate and Substantiate

Emotional Intelligence How to Terminate an Employee

Rad HR Make Space for Grace

Roman Review Domino Courage

50 51 52 54

AMSP Member Directory

Circulation

Cindy Galindo Kennedy Krieg

Accounting

Diane Costea ICE Magazine (Vol. 5, Issue #5) May 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 | MAY 2021

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ICE Break Index

ADVANCING THE IMAGING PROFESSIONAL

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RISING

STAR FUN FACTS:

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Favorite Hobby: I love spending my free time with my husband and my 7-year-old daughter.

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ICEMAGAZINE | MAY 2021

BY ERIN REGISTER

orn and raised in Rancho Cucamonga, California, Pamela Garrison, 35, had a unique educational experience at West Coast Ultrasound Institute – attending school with her sister. “I had the greatest study buddy, my sister,” said Garrison, “We decided to go to school for ultrasound at the same time. I’m a registered diagnostic medical sonographer (RDMS) in both OB and abdomen and moved to Arizona for my student externship, where I had one of the best ultrasound mentors.” Garrison was hired by Banner Imaging as an ultrasound tech and, 12 years later, continues at the same place of employment. She is currently the associate ultrasound manager at Banner Imaging. ICE learned more about this Rising Star in a recent interview.

Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: The ultrasound field really piqued my interest. I originally went into ultrasound because I loved the OB part of it, but I’m so grateful that my career took me to the path I’m on in an outpatient imaging center where I get to do a variety of exams. ADVANCING THE IMAGING PROFESSIONAL

Pamela Garrison loves spending time with her husband and 7-year-old daughter.

Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: In my current position as an ultrasound leader, I love that I get to watch the techs on my team grow and develop their skills. I’m also a leader of our engagement team, and it’s motivating to know that one team can have such a powerful impact on an entire company. Through my years with this company, I’m thankful for the leaders who have pushed me harder and helped me get to where I am today.

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: The technology is always changing, there isn’t a day that goes by that you don’t learn or see something new, and I love that.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: My greatest career accomplishment would have to be moving to another state to take on a whole new career after graduating. Now, 12 years later, I’m in a leadership role.

Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS? A: My goals for the next five years are to become a registered vascular technologist (RVT) and also get my CRA. •

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ICEMAGAZINE

SPOTLIGHT

IN FOCUS ANGELIC P. BUSH

BY JOHN WALLACE

areer choices come in a variety of ways, but University of Texas Medical Branch (UTMB) Administrative Director of Radiology Angelic “Angie” P. Bush found her calling in a unique way. “I was a U.S. Air Force trained radiology technologist (4R0X1). I selected that as my field of study after having an IVP (intravenous pyelogram) and asking the rad tech a lot of questions. The field intrigued me,” Bush explains. Her career choice is a decision she does not regret. “The radiology field is a perfect combination of medicine, IT and innovation to constantly challenge my mind and keep me from getting stagnant,” Bush says. “Working at UTMB

has been one of the best blessings I have experienced because while we are an academic medical center, here we do not have a lot of the politics you would find in major medical centers. The doctors wear jeans and polos and ride bikes to work. Driving to work I see the sun rise over the ocean, and when driving home I see sea gulls and spoonbills lounging in the bay,” Bush says. She has benefitted from some great mentors throughout her career. “My first and greatest mentor is my mother, Maria Flores (many refer to her as ‘Momma Maria’ — a name my husband, Curt, gave her). She taught me anything worth having will cost you time, sweat, money or pain. If it doesn’t cost you one of these things, you will never truly appreciate it. You know, she

“I love mentoring imaging professionals. Mostly because I love to see that excitement in their eyes and hear that awe in their voices when something truly clicks for them.” – Angie Bush, Administrative Director of Radiology, University of Texas Medical Branch 12

ICEMAGAZINE | MAY 2021

ADVANCING THE IMAGING PROFESSIONAL

is right, and I truly value every opportunity that has come from my time, sweat, money or pain and take nothing for granted,” she says.” Second would be my husband Curt Bush. You see, while he and I have different approaches to our work, he has shown me what true balance is. I don’t have to work my fingers to the bone. I need to trust my team more. I always thought I did until it was pointed out that I hovered. Once I realized that, I have seen a transformation in my team and their confidence and mine. It has improved dramatically.” Bush pays it forward by serving as a mentor to others. “I love mentoring imaging professionals,” she says. “Mostly because I love to see that excitement in their eyes and hear that awe in their voices when something truly clicks for them.” Bush says she loves it when a mentee figures out something in their budgets or when they turn a troubled department around. “Some of my current mentees are radiologists. Yes, radiologists. Specifically, female radiologists. Let’s just say it takes a strong woman to be in this field, but sometimes strong women get a bad rap,” Bush says. “So, it’s important to surround ourselves with others who can relate and support each other. Some of that support means being honest with each other when we could have handled a situation better.” She has also served as a mentor to two successful children. “That is tricky,” Bush says when asked about her greatest accomplishment, “because if you ask me what my greatest accomplishment is as an open-ended question, hands down, it would be raising two outstanding, well-balanced and successful children. My son, Zavier McDonald, is a U.S. Air Force Airborne Crypto-Linguist and my daughter, Alexia McDonald, is a youth pastor at The Fellowship of the Woodlands Church in The Woodlands Texas.” WWW.THEICECOMMUNITY.COM

“As a career, my greatest accomplishments have been mentoring some amazing leaders that I truly respect like Dennis Indiero, who is now a director at Texas Children’s Hospital, and Susan Young, who is managing Lakeway Hospital imaging department in Austin,” Bush adds. “Encouraging people like Kadar Wallace who was a transporter at Houston Methodist Willowbrook, to see his potential and he now has a master’s degree and is providing well for a beautiful family.” Building up and supporting others is important to Bush. “I am glad you used the word ‘leadership’ versus ‘management,’” she says when asked about her approach to leadership. “Because that is the difference. Leaders should come to work every day trying to put themselves out of a job. What I mean is, share everything. Share the why behind your choices, be transparent, be vulnerable and, above all, be willing to make the right choice even if it is not the popular one. Many times, making the right choice is not popular and that means we have to walk a tight line. Are you doing your job or working to keep your job?” Bush is proud of her children and her husband and is excited about celebrating their fourth wedding anniversary in 2021. They will each be presenting a session at the upcoming Imaging Conference and Expo (ICE) in Fort Lauderdale, Florida. For more information, visit AttendICE.com. Life balance is a buzzword these days, but it is more than a trend for some. It is an important way to live to relieve and/or reduce stress. Bush adds to the concept with advice on how to stay young. “Live a life of adventure. Doing so keeps you young, keeps your mind sharp and promotes innovation,” Bush says. “If you don’t feed your own soul, you have nothing to give to your team. Remember that. Find out what truly feeds your soul and do it often. That will allow you the energy to share it with others.” •

ANGELIC P. BUSH

Administrative Director of Radiology, University of Texas Medical Branch What is the last book you read? Or, what book are you reading currently? “At Graves End” by Jeanine Frost Favorite movie? “Just Right” What is something most of your coworkers don’t know about you? I like to read vampire romance novels. Who is your mentor? My husband Curt Bush. He has taught me how to work smarter not harder and that I don’t have to have my hands in every aspect of all the work to know I bring value to it. What is one thing you do every morning to start your day? Drink two glasses of water with 1/7th OJ in it. Best advice you ever received? Think like a doctor. What would he/she want to know about this case? Who has had the biggest influence on your life? My mother, Maria Flores. What would your superpower be? To fly so I don’t have to walk. What are your hobbies? Traveling, diving, fishing and kayaking. What is your perfect meal? One I didn’t have to cook.

ICEMAGAZINE

SPOTLIGHT

Rad idea

BY JOHN BEALL

STAY POSITIVELY ENGAGED DURING COVID-19 HOSPITAL OPERATIONS

here is not a magic solution to keep employees engaged. I have looked. Much like everything else within our lives we must be able to juggle staying on top of the morale of our co-workers. To be successful and get through these times, it is one of the most important things we will spend time on. You can go to numerous websites and see what the importance of engagement is for the patient experience, attendance of staff and the longevity of the staff. You can also learn about all the different methods of getting them engaged. I myself tend to review the data from Gallup, the Society for Human Resource Management (SHRM) and Press Ganey to get an overarching view of what is going on and what others are doing to keep the spirit alive. First off, as a leader, I take the approach that the engagement starts with me. To be able to do this you need to ask yourself a few questions: • “How am I keeping engaged?” – Knowing what keeps you motivated through these unique times could help give others a means to find their own motivation if theirs do not coincide with yours. We are all human, so when we realize that our own mindset is not on track and where it needs to be, then knowing what motivates you can get you back on the right track.

ICEMAGAZINE | MAY 2021

• “Am I modeling the right level of engagement?” – To expect that others within your sphere of influence be engaged you must first model that expected behavior. Modeling from the leadership shows commitment to all and demonstrates that it can still be done despite what the world is throwing at you. With change management when you have leadership engagement and demonstrating a trait or action it has been proven that the rest of the staff will give the new way a chance. It helps to show them that there is something in it for them and they will often find what is their own stake in adopting that mindset. Let’s be honest, for some of your staff being positively engaged just might be an act of change management. You as leader, know your staff and adjust your methods of demonstrating engagement to fit each scenario. • “Do I know my people?” – If you do not know them as well as you believe you should, might I suggest that you review a great “Rad Ideas” article from a few months ago where Sandy Michalski showed how to use a “Getting to Know You” document for just that reason. You can cater the document to fit your own needs, but I loved the fact that it asked each person their preferred method of communication for work related topics. I like to ask if they know what their personality type is. If they do not, there are several free websites out there that they can go to. Something to consider when you are approaching how to encourage engage-

ADVANCING THE IMAGING PROFESSIONAL

ment with your staff is their work environment. The in-person direct care staff member versus your staff working virtually are in different levels of interaction. Knowing their personalities and how they are affected with everything may help with knowing the level of engagement that you may need to participate in with them. People tend to be social animals and while those on the front lines are kind of getting that interaction (behind PPE) a lot of the staff working virtually are not. This includes staff members who come in to work but sit behind closed doors down the hall and are only seen via video call meetings. Recently, I have noticed that many staff members have their cameras turned off. Maybe you can institute a day of the week like Friday where everyone must be on camera? You can call it the “Show Your Face Friday” meetings. This allows everyone to see each other and, believe it or not, it is kind of fun to see everyone occasionally … if only on a monitor. While this is not everything that you can do it is a great start toward positive engagement for you and your staff. If you would like to hear more and about engagement, I hope that you can join me at the Imaging Conference and Expo in Ft. Lauderdale, Florida this month! Find out more at AttendICE.com. • JOHN J. BEALL, MAA-HA, FAHRA, Health System Specialist-Strategic Planner, VA Puget Sound Health Care System Share your RAD IDEA via an email to editor@mdpublishing.com.

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SPOTLIGHT

Off Clock THE

MEGGAN LILLY, ARRT (S), RDMS, RVT, ULTRASOUND TECHNICIAN MEDICAL IMAGING LEAD, PARADISE VALLEY BANNER IMAGING BY MATT SKOUFALOS

or Meggan Lilly, a career in medical imaging was the beginning of the second act in her life’s work. Married at 20, Lilly was a stay-at-home mother of two and wife to her husband of 20 years, Jeremy, before beginning to focus her energies on a professional career. With their children fully in school, and Jeremy’s firefighting career well established, her husband turned to her and said, “Now it’s your turn to begin your dream job.” Meggan Lilly and her Fire Fighter husband, Jeremy, visit the Fallen Fire fighter Memorial in Colorado Springs, Colorado. 16

ICEMAGAZINE | MAY 2021

By 2016, Lilly had graduated from ultrasound school, and over the next few years, worked for a series of physicians before ending up at the Paradise Valley, Arizona location of Banner Imaging, where she is

medical imaging lead for the office, with a specific focus on women’s breast imaging. Lilly has held the position for less than a year, but in its demands – and, more broadly, within the Banner Health system overall – she’s found a niche that fulfills her professionally while leveraging a philosophy of “servant leadership,” with which she resonates personally. “We’re faith-led people,” Lilly says of her family. “At the heart, I’m driven by my faith and the confidence of who I am and who I’m called to be every day, and arising to that task, wherever it takes us, every single day.” To Lilly, that perspective involves attending to the needs of her patients and staffers with empathy, presence of mind and a willingness to shoulder the collective burdens of the group with which she’s interacting. “People want to feel heard; they want to know that you’re listening,” Lilly said. “We’re ADVANCING THE IMAGING PROFESSIONAL

Meggan Lilly serves at a Sedona Verde Valley Fire Fighter charity event.

all part of a team; we’re all individually enabled, but as we all work together for the patient, we’re a part of this huge, beautiful team that just puts all the pieces together.” Conversely, she said, “patients are in there because something’s hurting,” and their anxieties about their discomfort or health risks can give way to significant emotions. For patients, Lilly believes her role is “to smile, and attend to their needs, and give them the best possible care.” “I’m thankful to be a part of their care, no matter what it is for,” she said. “I assist in procedures and biopsies, and it’s a stressful time. We’re in there to console them, walk them through the process and be there through their time of care.” To Lilly, embracing a philosophy of servant leadership means being able to identify with the people she’s leading on a personal level, while addressing the demands of her job “without elevating myself above anyone else.” “I’m on the floor scanning and in the procedures just as much as my staff is,” she said. “Whatever the circumstance is, we’re going to get through it, one patient at a time. It’s just about how you respond to those circumstances and how you choose to deal with them. I think it’s just about being teachable and adaptable and pliable.” That same approach guides Lilly in her off-hours, which are spent supporting Jeremy’s work as a fire fighter-paramedic in nearby Sedona, Arizona. A common thread in their relationship is a desire to serve, and to care for others, and as Jeremy heads up the Sedona Verde Valley Fire fighter Charities, Meggan coordinates its volunteer efforts. Together, they support local community organizations serving youth, seniors and victims of natural disasters, but the bulk of their outreach involves coordinating immediate recovery efforts for families who’ve lost their homes in a structure fire. WWW.THEICECOMMUNITY.COM

“We all have needs right now, and insurance takes a while,” Meggan Lilly said. “We activate within 24 hours to respond to whatever the family needs.” That direct aid can come in the form of clothing, housing and relocation support, gift cards to replace household necessities, and other basic items that families often need right away after a sudden setback like a house fire. The biggest fundraiser the fire fighter charities organize annually is a charity golf tournament, the $20,000 budget for which is paid out of fire fighters’ paychecks directly. Meggan Lilly coordinates the event volunteers, who help host the tournament, “and make sure everybody’s having fun.” In addition, the charities help fund the Sedona Verde Valley Honor Guard, which provides escorts for departmental deaths, retirements or memorial activities. The guard also travels annually to the International Association of Fallen Fire fighters memorial in Colorado Springs, a trip it funds to support those affected by the loss of a loved one in the fire service. As if those efforts weren’t enough, through her non-denominational church in Peoria, Arizona, Lilly also participates in a monthly ministry outreach to prisoners in the local women’s jail in her community. Through those experiences, she meets with “women of all different walks of life,” from those awaiting trial to those serving time;

from those newcomers who welcome the opportunity for social interaction outside of their cells, to recurring worshipers who find strength in the services. “These are women who are grandmas, mothers; they’ve had careers, they’ve gone to school,” Lilly said. “They just made a bad mistake, or had a bad circumstance, and they’re having to fulfill the consequences for that. They’re hurting. They just want to be heard. They want to know that everything’s going to be OK; that their kids are being prayed for.” “We come to relate and identify that they’re just like us,” she said. “There’s nothing that makes us different. We’re there to console them, and be a positive influence, and encourage them that hope is not lost. It is a very dynamic and fulfilling experience.” When she’s not volunteering her time or caring for her family, Lilly also enjoys fitness and outdoor activities. She’s a powerlifter of 10 years, a travel enthusiast, and takes advantage of the natural beauty of Arizona as often as possible; activities that help renew her spirit and body amid the challenges of operating in at a high level and in a high-stress job. “During the pandemic, we’ve really just been focusing on our patients,” Lilly said. “A lot of the world shut down, but health care didn’t. At Banner, we never closed. We’re all getting through it.” •

Meggan Lilly, her son Dallan, her husband Jeremy and daughter Kaley smile for a photo at Horseshoe Bend in Page, Arizona.

ICEMAGAZINE

NEWS

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

ICE OFFERS 32 ARRT CATEGORY A CE CREDITS The Imaging Conference and Expo (ICE) is a conference dedicated to imaging directors, radiology administrators and imaging engineers from health care facilities. The 2021 conference being held in Fort Lauderdale, Florida on May 11 and 12 features valuable CE credits. ICE 2021 is approved for 32 ARRT Category A CE credits by AHRA. A breakdown of the CE credits is below: • CRES Study Prep I: 4.0 credits • CRES Study Prep II: 4.0 credits • Inspire, Encourage and Empower: 1.5 credits • How to be Resilient During Stressful Times: 1.5 credits • Creating an Efficient Radiology Value Stream: 1.5 credits • Interdepartmental Communication with Respect to Workplace Trauma to Imaging Clinicians: 1.5 credits • The Importance of Imaging’s Role in the Patient Experience: 1.5 credits • Verifying Image Quality-How to Use an Ultrasound Phantom: 1.5 credits • Developing Your In-House Service Capabilities: Executing a Multi-Year Plan: 1.5 credits • MRI Safety Standards and Recommendations: 1.5 credits

• Limes to Margaritas! – Employee Moral Post COVID: 1.5 credits • Leading with Cultural Sensitivity: 1.5 credits • Survival Guide for Imaging Engineers in the Cath Lab: 1.5 credits • 2020: A Space Oddity ... Or Opportunity: 1.5 credits • You Say Your Staff Is Not Actively Engaged … Are You?: 1.5 credits • 5 Simple Steps to Develop Better Action Planning – A Medical Imaging Capital Case Study: 1.5 credits • The Magic 7 Triggers to Yes: 1.5 credits • General Session Panel Discussion: A Look Back at 2020 and the Lessons Learned: 1.5 credits Whether it’s invaluable continuing education, productive networking or the exclusive exhibit hall, attendees 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, military members and students. • For more information, visit AttendICE.com.

KA IMAGING APPOINTS CHIEF MEDICAL OFFICER X-ray manufacturer KA Imaging has announced the appointment of Philip Templeton, M.D., FACR, to the newly created position of chief medical officer. A board-certified radiologist, Templeton brings over 38 years of academic and entrepreneurial medicine experience to KA Imaging. Templeton is most recently known as co-founder and chief medical officer of DocPanel Technologies. A graduate and valedictorian at the University of Rochester School of Medicine, he did his internship in medicine at the Georgetown University Hospital. His radiology residency was at

ICEMAGAZINE | MAY 2021

the University of Maryland, where he also served as chief resident. He undertook his Thoracic Radiology Fellowship at the Massachusetts General Hospital. He served as professor and chairman of University of Maryland Radiology for 10 years. Templeton was inducted as a Fellow of the American College of Radiology in 2000. Templeton’s appointment comes on the heels of the recent additions of two other seasoned industry veterans – Shawn Campbell as vice president of operations and Robert Moccia as vice president of sales, USA and Canada. •

ADVANCING THE IMAGING PROFESSIONAL

CARESTREAM LAUNCHES GLASS-FREE CESIUM DETECTOR Carestream Health has launched its first cesium glass-free medical detector. The Lux 35 Detector is a lightweight, glass-free wireless detector ergonomically designed with the comfort of patients and radiographers in mind, according to a news release. The cesium detector offers superb resolution, better detail and a reduced exposure dose as compared to gadolinium detectors, the release adds. The introduction of the Lux 35 Detector builds on the success of its glass-free detector in the rugged non-destructive testing market. Weighing around 5 pounds, the 14” x 17” (35 cm x 43 cm) Lux 35 Detector, with its glass-free sensor, is Carestream’s lightest detector to date. A lighter detector makes it easier for radiographers to transport while making rounds and performing bedside exams. •

UNITED IMAGING CELEBRATES FIRST DECADE United Imaging is celebrating its 10th anniversary globally. Founded in 2011, the company employs more than 6,100 people worldwide in more than 30 countries including North America, Europe, Asia and Africa. The company’s newest manufacturing facility opened in 2020 in Houston, Texas and comprises a global showroom, factory, training center and headquarters offices for the region. United Imaging’s installed customer base has grown explosively as the industry responds to its technology and its mission, with more than 13,000 installations across the world. The company has spent significant resources in the past year deploying CT scanners to help on the front lines of COVID-19 in nearly all of the markets in which it operates, ranging from India to South Africa to New York to Argentina to the Ukraine. •

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ICEMAGAZINE

NEWS PHILIPS PARTNERS WITH DiA IMAGING ANALYSIS Royal Philips and DiA Imaging Analysis Ltd., a provider of AI-powered applications for ultrasound, have announced a strategic partnership to deliver automated solutions to clinicians at the point-of-care. Philips’ ultrasound image quality combined with DiA’s AI library of automated solutions will help increase diagnostic confidence, operational efficiency and access to care for point-of-care customers in and out of the hospital. Philips continues to build suites of intelligent and automated enhancements integrated into radiology workflows across its portfolio to benefit customers and patients alike. By facilitating the development and integration of

AI-enabled applications, Philips aims to enhance its ability to deliver on the Quadruple Aim of better patient outcomes, improved patient and staff experiences and lower cost of care. The integration of AI applications within ultrasound technology can also help lead to improved access to care. DiA’s AI technology automates the process of manually capturing and visually analyzing ultrasound images. The company’s LVivo Toolbox includes a range of FDA cleared and CE marked automated AI-enabled apps focused on cardiac and abdominal ultrasound analysis to help support clinicians with varying levels of ultrasound experience. •

RACIAL, ETHNIC HEALTH DISPARITIES TOP PATIENT SAFETY CONCERN FOR 2021 As the nation marks one year since the start of COVID-19 restrictions, ECRI names Racial and Ethnic Disparities in Healthcare as its top patient safety concern for 2021. ECRI’s Top 10 Patient Safety Concerns for 2021 report relies on the analysis of more than 4 million patient safety events and the judgment of its patient safety and medication safety experts. “Clearly, racial disparities will not disappear overnight,” says Marcus Schabacker, MD, Ph.D., president and CEO of ECRI, the nation’s largest patient safety organization. “By profiling this issue, we are calling much-needed attention to this public health crisis.” Of the 10 topics in the report, eight are related to or exacerbated by COVID-19. ECRI’s full list of patient safety concerns for 2021 includes: 1. Racial and Ethnic Disparities in Healthcare: Differences may include frequency of screening for COVID-19 or other diagnoses, disease severity, complications, and deaths. 2. Emergency Preparedness and Response in Aging Services: Over 570,626 confirmed cases and over 112,383 deaths occurred in nursing homes as of February 1, 2021. 3. Pandemic Preparedness across the Health System: Government investigations, congressional reports and pandemic preparedness reviews warned that America’s healthcare system was woefully unprepared for a fast-moving infectious disease outbreak. 4. Supply Chain Interruptions: Limits on exports, plus shutdowns in countries that manufacture and produce

ICEMAGAZINE | MAY 2021

raw materials, resulted in delays for much-needed supplies. 5. Drug Shortages: The COVID-19 pandemic led to shortages in almost every drug class used for mechanical ventilation. 6. Telehealth Workflow Challenges: Event reports cited poor wi-fi, inappropriate monitoring, inadequate language services, and health privacy issues. 7. Improvised Use of Medical Devices: Modified devices, workflow, or systems may lead to serious safety and regulatory compliance issues. 8. Methotrexate Therapy: The weekly administration of this cancer drug – also in use for autoimmune diseases – leads to dosing and dosing frequency errors. 9. Peripheral Vascular Harm: Severe cases of injury and infection can lead to extended lengths of stay and antibiotic treatments—even death. 10. Infection Risk from Aerosol-Generating Procedures: The exposure risk from performing aerosol-generating procedures on suspected COVID-19 patients is very high. ECRI’s Top 10 Patient Safety Concerns for 2021 provides detailed steps that organizations can take proactively to prevent adverse incidents and is available for public download. ECRI is also hosting a complimentary Top 10 Patient Safety Concerns webinar on Thursday, March 18, to explain how the list can be used to enhance safety in healthcare organizations across all care settings. • For more information, visit ECRI.org.

ADVANCING THE IMAGING PROFESSIONAL

TECHNICAL PROSPECTS ANNOUNCES INTERACTIVE VIRTUAL TRAINING ACADEMY Technical Prospects, a leader in the medical imaging industry, is excited to announce the launch of its Interative Virtual Training Academy (IVTA) platform for all of its courses, modernizing how imaging engineers can access world-class training. Technical Prospects’ virtual training platform gives students identical content to in-person class instruction, offering attendees flexibility to choose between platforms or even a hybrid learning experience. While virtual, the training involves real-time instruction, with various opportunities for audio and visual collaboration. For example, students can interact through their desktop to the class’ virtual whiteboard, share documents and live stream. The only equipment required is a computer and an app that is free to download. “As the needs of imaging professionals continue to evolve, we knew we needed to develop a hybrid system that provides not only an online learning experience, but also a collaborative virtual classroom environment,” said Sam Darweesh, chairman of engineering and vice president of operations at Technical Prospects. “This training format offers advantages in comfort, confidence, and certainty in that students can be assured they will get

the most from their training.” As part of Technical Prospects’ well-known, robust training program, virtual courses are accredited by the Association for the Advancement of Medical Instrumentation (AAMI) and meet its rigorous guidelines, which include proper instructor licensing and training, maintaining sufficient levels of presentation skills, upholding an appropriate class format, utilizing a tailored approach and customer focus and much more. Students can earn up to 45 ACICEUs per class. Course programming is led by Darweesh. Before obtaining his master’s degree, he earned his bachelor’s degree in electrical engineering and is equipped with 20-plus years of experience as a CT and MRI senior engineer and subject matter expert. Darweesh has provided skilled recommendations to engineers in North and South America and has led major strategic projects on CT and MRI systems across the globe. Darweesh is also an adjunct professor of medical imaging, in addition to his collaborations with worldwide major independent service organizations. • For more information, visit TechnicalProspects.com.

BIOGRAPH VISION QUADRA EARNS FDA CLEARANCE Siemens Healthineers has announced Food and Drug Administration (FDA) clearance of the Biograph Vision Quadra, a positron emission tomography/computed tomography (PET/CT) scanner designed for clinical use as well as translational research – or the application of scientific research to create therapies and procedures that improve health outcomes. In this manner, the Biograph Vision Quadra expands precision medicine. In addition to the 3.2 mm silicon photomultiplier (SiPM) detector technology and Time of Flight (ToF) performance that are cornerstones of the established Biograph Vision PET/CT scanner, the Biograph Vision Quadra has an extended 106 cm axial field of view (FoV), which is four times the PET axial FoV of the Biograph

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Vision 600. These technological features deliver significantly increased effective sensitivity and allow the clinician to image the average patient dynamically from the top of the head to the thigh in just one position. Thanks to the scanner’s extended axial FoV, the clinician can examine patient anatomy during radiopharmaceutical uptake over time. The combination of SiPM detectors and extended axial FoV permits more anatomical coverage in one bed position than a standard PET/CT scanner, enabling fast scanning at low patient radiation dose. Since the Biograph Vision Quadra can be sited in the same clinical space as traditional PET/CT scanners, institutions do not need to build a large new room to house the scanner. •

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NEWS PROMAXO MRI PLATFORM RECEIVES 510(K) CLEARANCE The United States Food and Drug Administration (FDA) has granted Promaxo Inc. 510(k) clearance for its office-based MRI system. The 510(k) clearance enables practices and hospitals to accurately and seamlessly guide prostate interventions under the Promaxo scanner. The Promaxo MRI is intended for urologists and interventional/urologic radiologists to perform surgical localization of prostatic lesions under Promaxo MRI guidance in an office or outpatient surgical setting. Multiple validation studies have demonstrated the firstof-its-kind platform technology to be safe, accurate and effective. The Promaxo MR imager is currently being used under an investigational device exemption to perform targeted prostate biopsies at Mississippi Urology.

The company’s device has a limited fringe field and can be easily installed in an office with no shielding or facility upgrades. The truly open single-sided design, and quiet operation without the need for endorectal coils, leads to a comfortable patient experience. The MRI platform’s unique configuration is built upon an inherent z-gradient and array of permanent magnets arranged to provide a uniform in-plane magnetic field within the field of view. The product incorporates patented technologies to capture, reconstruct and display magnetic resonance images of prostate and surrounding tissues. The proprietary device leverages pre-programmed sequences and artificial intelligence to enhance image quality. •

FDA CLEARS GE HEALTHCARE OEC 3D GE Healthcare recently announced 510(k) clearance from U.S. FDA for OEC 3D, a new surgical imaging system capable of 3D and 2D imaging. OEC 3D will set a standard for interoperative 3D imaging with precise volumetric images for spine and orthopedic procedures, according to a news release. This new system combines the benefits and familiarity of 2D imaging with greater efficiency to increase access and usability to 3D. “We’re thrilled to introduce OEC 3D to clinicians who want amazing 3D volumetric images quickly during intraoperative procedures,” said Gustavo Perez Fernandez, president and CEO of GE Healthcare Image Guided Therapies. “Built on the successful OEC Elite C-arm platform, the familiar performance and functionality of the OEC 3D C-arm will make 3D imaging routine for complex spine and joint replacement procedures.” Developed in collaboration with health care professionals and institutions around the world, OEC 3D C-arm recently completed clinical evaluations in vivo and in simulated laboratory procedures. Clinicians involved commented on the excellent image quality of the 3D

ICEMAGAZINE | MAY 2021

volumes stating they were similar to what they expect from a CT scan. Additionally, the simplicity of performing both 3D as well as 2D imaging on OEC 3D was noted as an improvement versus current methods. •

ADVANCING THE IMAGING PROFESSIONAL

PLANMED TO DISTRIBUTE DISIOR MEDICAL IMAGING SOFTWARE IN U.S. Planmed will bring a new medical imaging software to the U.S. market. Paired with the Planmed Verity CT scanner, the Disior Bonelogic 2.0 software enables better and faster diagnostics for patients and generates time and cost savings for radiologists and clinicians, a press release states. The collaboration and distribution agreement between Planmed Oy and Disior Oy allows integrating Disior’s orthopedic analysis software with Planmed’s high-tech cone beam computed tomography (CBCT) scanner. Planmed Verity is a low-dose CT scanner which provides 3D images of upper and lower extremities. It was the first device in the market able to provide three-dimensional images of the foot and ankle region under natural load, an imaging technique now commonly known as weight-bearing CT (WBCT). WBCT scanners, such as Planmed Verity, alongside automated medical imaging software, such as Disior Bonelogic, are considered to be at the forefront of medical innovations for extremity orthopedics. Within

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the foot and ankle complex, WBCT is a proven tool in both European and American orthopedic clinics for the following common conditions: • Hallux valgus • Syndesmotic injuries and instabilities • Progression collapse foot deformity • Extremity arthritis Bonelogic allows for the complete orthopedic characterization of the foot and ankle, as well as the hand and wrist. The software provides mathematical models of a patient’s anatomy and metrics that describe the relationship between bones, which are essential to understanding the degree of pathology or trauma. •

MRI & CT Parts

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COMPANY PROFILE

CAL-RAY ACQUIRED BY UP-AND-COMING

AMERICAN MEDICAL IMAGING BY ERIN REGISTER

merican Medical Imaging LLC was established in January 2021 as a new business within the Innovation Institute, a health care incubator and leading provider of medical device and innovation solutions. AMI was created as a national partnership formed from a number of respected and experienced medical imaging technology sales and service companies across multiple regions of the country.

John Snyder, Cal-Ray Regional President

Within the Institute’s portfolio of businesses, AMI complements three other existing healthcare technology management (HTM) companies: Tech Knowledge Associates (TKA), Healthcare Technology Group (HTG) and MMS Multimedical Systems. With the addition of AMI to the HTM business sector of the Enterprise Development Group (EDG), a complete HTM solution was realized. “AMI will offer a comprehensive medical imaging technology solution to include conventional imaging systems (radiographic, fluoroscopic, portable, C-arms, etc.), mammography,

computed radiography and digital radiographic systems, ultrasound, CT, as well as magnetic resonance imaging (MRI),” Cal-Ray Regional President John Snyder explained. “We are also focused on IT, PACS, cybersecurity and AI solutions for our customers. All AMI regions will continue to grow their heritage, regional service and sales business, but with a new economy of scale and pool of internal, national resources and support.” Cal-Ray Inc., a Wisconsin-based independent service organization (ISO), was one of the companies recently acquired by AMI. Snyder provided ICE

ICEMAGAZINE | MAY 2021

with insights regarding the acquisition. Snyder said there are several compelling reasons Cal-Ray joined the AMI family of companies, which also includes Southeast Imaging, Radiology Services, Triangle X-Ray, EP Radiology Services and Proactive Technology Solutions. “The primary reason was that we felt this was the best thing we could do for my employees and customers,” Snyder stated. “Employee benefits have improved over what I could offer as an independent, small business.” Snyder added that the acquisition also changed Cal-Ray’s business dynamics. It is improving operations with more focus on what’s important to his customers, employees and strategic partners. “Those of us who have operated as ISOs understand the difficulties we are facing in an ever-changing market: technical staff shortages, increasing government regulation and market consolidation. The AMI partnership solves many of these issues while providing us with the resources to overcome current challenges and be prepared for larger ones in the future,” Snyder said. The acquisition was the best decision for Cal-Ray, but Snyder noted that challenges existed during the process. ADVANCING THE IMAGING PROFESSIONAL

“Certainly, every ISO has their own way of doing business,” he added. “Each is unique and independently minded in many ways. The hardest part for me wasn’t convincing the staff that this was the right thing to do or navigating through the business process requirements for joining the partnership, even though being ISO certified and registered as 13485 helped exponentially in meeting the data requirements for closing the transaction. The hardest part was personal, overcoming my love of being the sole owner of my business!” “Cal-Ray was conceived late in 1990 on a bar napkin in Solon, Ohio back when I was an instructor at RSTI. Starting as a sole proprietorship, it evolved over the past 30 years to be a S-Corp with numerous vendors representing and a quality-trained staff of professionals with a respected name in the industry,” he added. “However, the AMI model made it easier to overcome my concerns since, unlike many merger and acquisition models, AMI desires to

maintain the existing company culture, leadership, business relationships and staff that made the company successful in the first place.” Snyder is remaining on board as a regional president, managing Cal-Ray, a division of AMI. As for future goals, Snyder says Cal-Ray and all of the AMI divisions will work relentlessly toward the goal of becoming the premier source for medical imaging technology products and services in the U.S. “We will continue to partner with preferred OEMs and add to our portfolio of companies to meet and exceed our customers’ needs and expectations,” Snyder concluded. “Our long-term goal is to have a true national footprint with a presence in all key health care markets. Additionally, we are excited to be part of an all-inclusive HTM solution.” • For more information on American Medical Imaging, visit www.ami-ii.com.

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NEWS

IMAGING DIRECTOR SHARES CULTURE CHANGE TIPS T

STAFF REPORT

he ICE webinar “Are You Ready to Change Your Culture?” presented by Brenda DeBastiani, CRA, FAHRA, discussed ways to empower employees to identify system issues and “own” their work environment. DeBastiani identified behaviors and roadblocks that contribute to errors or bad outcomes that may have been preventable. She also shared how to promote a process where mistakes or errors lead to uncovering why the errors occurred, not automatically leading to punishment. DeBastiani is the director of imaging at Mon Health Medical Center in Morgantown, West Virginia. She is a lifelong Brenda DeBastiani learner who recently completed her Master of Business Administration and is a longtime member of the American Healthcare 26

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Radiology Administrators (AHRA). She serves as a member of the AHRA board of directors, is a noted speaker/ presenter, a textbook editor and holds a Lean Sigma Six green belt. She is among the imaging leaders who will be presenting sessions at the upcoming Imaging Conference and Expo in Fort Lauderdale, Florida. For details, visit AttendICE.com. The webinar was a hit with attendees scoring a 4.7 review or a 5-point scale. Attendees gained valuable insights including bonus information during a question-and-answer session. One attendee asked, “What have you done to ensure safety is a top priority from your employees?” “That’s a good question. I actually added a question to my interview form, asking the potential employees what their primary focus is when giving patient care? So, if the answer is anything other than safety, I ask additional probing questions to determine how aware they are of safety. If the applicant doesn’t really seem to care about safety I educate, and then I, kind of listen to them,” DeBastiani said. “And then I know if the person is the right one for the job or not because safety is number one in my book.” Another attendee asked, “How long does it take to actually change the culture?” “I think it probably takes a couple of years. Trust is big. So once your employees know that you’re there to fix processes, and not to point blame at them, then I think that will help them grow and want to help,” DeBastiani

said. “I make sure I’m always available by email or phone, so that if issues come up, I’m there as a resource. Our managers do the same. I think that speaks volumes, that we care about our employees and we’re there to help them.” “That wasn’t always the case. In years past, there were supervisors who couldn’t be reached, and thankfully, the culture has changed, even within our own management team. So that we are always there as a resource,” she added. “I think, you know, the first year we saw positive results on our score. Whenever they’re surveyed, but I think it’s even come further than that.” A recording of the webinar, including the Q&A session is available at ICEwebinars.live. After the webinar, attendees provided feedback via a survey that included the question, “Overall, how satisfied were you with today’s webinar?” “Very informative. Glad I was able to take the time during lunch and be part of it,” said Supervisor T. Banks. “Outstanding webinar!” Imaging Supervisor A. Davis exclaimed. “Really great presentation. I thoroughly enjoyed the thought-provoking information” Mammography Care Coordinator A. Harris said. “It was great! Information was very relevant to my job,” Radiology Manager M. Chambless said. • For more information about upcoming webinars and an archive of sessions available for on-demand viewing, visit ICEwebinars.live. ADVANCING THE IMAGING PROFESSIONAL

1 2 3 Register online to view our live webinars each month.

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Market Report Experts Predict CT Market Growth STAFF REPORT

he global computed tomography (CT) market size was valued at $5.53 million in 2018 and is projected to expand at a compound annual growth rate (CAGR) of 6.5% by 2026, according to a report by Grand View Research. The report forecasts $9.1 billion in revenue in 2026. The forecast is based on the growing prevalence of various lifestyles associated with chronic diseases such as cancer and cardiovascular conditions and increasing demand for advanced imaging solutions. These are some of the factors expected to drive the overall market growth. CT scans are critical diagnostic tools especially for lung cancer and traumatic brain injuries. The Centers for Disease Control and Prevention (CDC) reported that in 2013, more than 2.8 million people visited emergency department in the U.S. for traumatic brain injuries. CT scans are the only option to assess a patient’s condition during an emergency brain trauma event. Increasing demand for advanced assessment tools in an emergency department coupled with the growing number of ambulatory emergency care units are factors expected to have a positive impact on CT market growth, according to Grand View Research. According to NCBI, more than 70 million CT scans are performed in the U.S. and 5 million in the U.K. every year with an annual increasing rate of 10%, signifying the growth potential of CT in the overall medical imaging market. A steep rise in the application of CT scans and the use of CT scans for effective lung cancer screening are expected to boost the demand for CT scanners in developed as well as developing countries. The introduction of technologically advanced devices and development of accessories to enhance image quality obtained by conventional CT scanners are among major factors expected to fuel market growth. The introduction of advanced cone beam computed tomography (CBCT) systems is expected to be a major factor in widening the application of CT in modern diagnostic imaging. Dual source and artificial intelligence enabled CT scanners are expected to be important milestones in the market’s growth. Based on technology, the CT market is segmented into high, mid, low-end slice and CBCT. High-end slice (more than 64 slices) and mid-end slice (64 slices) sectors are 28

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expected to grow at a lucrative CAGR over the forecast period. An increasing incidence of cardiovascular disorders and demand for accurate diagnostic imaging solutions are expected to drive growth. High-end slice technology has comparatively 80% less radiation exposure than mid-end slice technology (64 slices) with a 16 cm imaging area helping in accurate diagnosis. High-end slice devices deliver detailed images in obese patients, the only factor expected to restrain the growth of this segment is the high cost of the high-end slice technology. However, improving health care infrastructure and improving financing ability should help overcome these challenges. CBCT is expected to grow at the speediest rate over the forecast period. Compact size, low radiation exposure, and low cost compared to conventional CT are some of the advantages associated with the technique. Growing applications of CBCT are expected to propel the overall CT market during the forecast period, according to the report. In terms of end-user, the global computed tomography market is segmented into hospitals, imaging centers and clinics. The hospital segment accounted for the largest market share in 2019. An increasing number of emergency admissions in hospitals and the growing number of surgeries performed each year has contributed to the market share. Moreover, CT scans serve as an effective tool for accurate diagnosis pre-operative and post-operative to determine the effectiveness of the treatment. The difficulty and risk associated in transportation of critically ill patients from a hospital to a third-party imaging center for CT scans, has forced hospitals to establish their own CT scan machines contributing to the growth of this market, according to Grand View Research. Ambulatory diagnostic centers are expected to grow at the speediest rate over the forecast period. According to OECD statistics, there is an approximate 14% increase in the total number of CT scanners per 1 million inhabitants in U.S. ambulatory diagnostic centers between 2015-17. It is expected to be a revolution in the market as it makes CT scans more affordable and accessible, the report indicates. A report from Mordor Intelligence also predicts global CT market growth. The computed tomography (CT) market was valued at approximately $6.1 million in 2020, and it is expected to reach $8.5 million by 2026, according to Mordor Intelligence. • ADVANCING THE IMAGING PROFESSIONAL

Product Focus

Computed Tomography (CT)

DUNLEE

DA200P40+LMB CT replacement tube The Dunlee DA200P40+LMB CT replacement tube has received FDA clearance. Featuring CoolGlide technology, the CT tube is an alternative to the OEM liquid metal bearing (LMB) replacement CT tube for GE Revolution Evo and Optima 660 CT scanners. LMB CT tubes are prized for their long life, made possible because the liquid metal bearing doesn’t create friction, so there is less wear. The DA200P40+LMB tube also features a quiet sound pattern for smooth operation and a pleasant patient experience. Each tube is built according to the highest quality and regulatory standards, and extensive testing confirms that it equals OEM tube performance. • For more information, visit dunlee.com.

*Disclaimer: Products are listed in no particular order.

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GE HEALTHCARE Revolution Apex with TrueFidelity for GSI

Powered with a new image chain, GE Healthcare’s Revolution Apex offers TrueFidelity for GSI, a first-ofits-kind Deep Learning Image Reconstruction engine to help transform image quality for dual-energy spectral CT. Utilizing a Deep Neural Network, the Deep Learning Image Reconstruction engine is trained to effectively differentiate and suppress noise in GSI projection data and produce dual energy TrueFidelity images with reduced image noise1, preferred noise texture2, enhanced contrast-noise-ratio3 and low-contrast-detectability4. Revolution Apex represents the next generation of intelligent CT scanners in the GE Revolution family. • For more information, visit gehealthcare.com. 1. Demonstrated in testing using the uniform section of the Catphan®600 with the CTP579 oval body annulus comparing pixel standard deviation in images reconstructed from the same raw data, at 0.625mm with DLIR-H and ASiR-V50% 2. As demonstrated in a clinical evaluation consisting of 40 cases and 5 physicians, where each case was reconstructed with both DLIRfor GSI and ASiR-V and evaluated by 3of the physicians. In 88% of the reads, DLIR for GSI’s noise texture was rated better than ASiR-V’s. 3. Demonstrated in testing using images of the CT ACR 464 Phantom (Gammex) and its 25 mm low contrast cylinderreconstructed from the same raw data with DLIR-L, DILR-M, and DLIR-H and ASiR-V 50%.

SIEMENS HEALTHINEERS SOMATOM On.site

The SOMATOM On.site is a mobile head computed tomography (CT) scanner from Siemens Healthineers that enables a critically ill patient to receive CT head imaging in the intensive care unit (ICU) while remaining in bed. Performing a CT head examination at the patient’s bedside can eliminate costly transports to the radiology department, which involve high staffing requirements and potential patient risk. With the SOMATOM On.site, Siemens Healthineers enables reliable and consistent image quality at the point of care, allowing customers to transform care delivery. The SOMATOM On.site offers easy scan setup, fast workflow, and integrated patient support accessories, for convenient and consistent patient positioning in the scanner. An intelligent user interface concept, myExam Companion helps the radiologic technologist navigate the examination for consistent results. An integrated drive camera enables real-time viewing on the built-in Touch UI display for easy maneuvering by the technologist. The scanner’s unique telescopic gantry design allows the radiation source to move away from the patient during scanning, while the base and the front cover of the gantry remain stationary. The SOMATOM On.site system design – with the telescopic, self-shielded gantry and attachable front and back radiation shields – reduces scatter radiation compared to CT scanners without this design and provides radiation protection for neighboring patients and staff. •

4. Evaluated using the body MITA CT IQ Low Contrast Phantom (CCT189, the Phantom Laboratory) with the CTP579 oval body annulus and a model observer with images reconstructed from the same raw data with DLIR-H and ASiR-V 50%.

ICEMAGAZINE | MAY 2021

ADVANCING THE IMAGING PROFESSIONAL

NEUROLOGICA SmartMSU with OmniTom Elite

NeuroLogica Corp. recently announced the immediate availability of its SmartMSU with OmniTom Elite CT scanner. This next-generation Mobile Stroke Unit (MSU) advances the technology available for stroke imaging on an ambulance. The OmniTom Elite multi-slice computed tomography (CT) boasts a small footprint and high-resolution image quality. The advancements of the scanner help to optimize diagnostic confidence, speed and workflow at the site for a potential stroke patient. •

UNITED IMAGING uCT (United Imaging CT) scanners

The uCT (United Imaging CT) scanners are low-dose systems with high image quality, from 20-160 slices, with Z-detector and workflow innovations standard. This enables a wide variety of patient and exam types like pediatric, CT angiography (CTA), patients with metal implants and cardiac examinations. Advanced applications and post-reconstruction analysis software are also standard. In addition to the United Performance Guarantee, the uCT portfolio offers investment protection and cost transparency with Software Upgrades for Life, an industry-leading program that provides all software upgrades throughout the product life cycle (performance enhancements and new functionality), at no additional cost, with or without service contracts. •

PHILIPS

Incisive CT Incisive CT helps you meet some of your organization’s most pressing challenges. Philips Incisive CT offers intellect at every step, from acquisition through results, and across all fronts: financial, clinical and operational. Like never before, operator and design efficiencies come together for wise decisions from start to finish with an unprecedented Tube for Life guarantee.1 1. Life of the product is defined by Philips as 10 years. Tube for Life guarantee availability varies by country. Please contact your local Philips sales representative for details.

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COVER STORY

GOING MOBILE New, Portable Applications in CT for the Pandemic and Beyond BY MATT SKOUFALOS

ICEMAGAZINE | MAY 2021

ADVANCING THE IMAGING PROFESSIONAL

“ Whenever we talk about portable CT, it’s really about bringing critical care imaging directly to the patient without having to transport the patient down to radiology.” – Dena Cunningham

s medical imaging devices continue to advance in terms of their precision and functionality, the better to be integrated across a seemingly limitless number of clinical applications, technology vendors aren’t only considering ways in which to bring imaging to new users, they’re considering novelties in bringing imaging to patients as well. Traditionally, stationary CT scanners are housed in securely constructed imaging suites, and patients are scheduled based on the ability of staff to turn the rooms over and prepare device settings for the next patient. However, given certain conditions in which it’s inadvisable to move patients, combined with clever safety workarounds brought about by the novel coronavirus (COVID-19) pandemic, product designers are now considering the value of adding functional mobility to the devices themselves, the better to cut down on infection risk, patient vulnerability and staff resources. “Whenever we talk about portable CT, it’s really about bringing critical care imaging directly to the patient without having to transport the patient down to radiology,” said Dena Cunningham, director of business development for mobile CT at Siemens Healthineers North America of Malvern, Pennsylvania. In addition to mitigating the impacts of cross-contamination among multiple patients (especially during the COVID-19 pandemic), and supporting infection controls in a hospital setting, transporting patients also requires personnel resources. It takes staffers away from other duties, adds to table time during potentially critical moments for patients, and exposes patients and staff to the possibility of additional adverse effects during the move. The 32-slice SOMATOM On.site CT WWW.THEICECOMMUNITY.COM

scanner from Siemens Healthineers – its first entry into the mobile CT market – aims to give ICU physicians the freedom to conduct vital imaging studies on patients without transporting them out of critical-care environments. The SOMATOM On.site CT is a small-format, portable device intended to conduct head imaging of patients suffering from strokes, head trauma, neurological conditions, or other conditions in which repeated, daily head scans are recommended. It’s especially useful for head imaging of patients whose conditions prohibit moving them, and for providing follow-up studies of patients who’ve been triaged. “Instead of moving critically ill patients to radiology, we’re able to keep them in their beds and provide the imaging,” Cunningham said. “That’s really our focus and our introduction into the market with a mobile CT.” Among the challenges of developing a self-contained, portable CT scanner are issues related to patient safety. Imaging equipment typically requires the construction of a heavily built room designed to insulate both patient and technologist against the effects of ionizing radiation. The front and rear gantries of the SOMATOM On.site system are self-shielded against radiation; once patients are placed within it, protective drapes can be secured around their heads, and technologists can remain

with them throughout the study. Its telescopic gantry houses internal scanner components that move away from the patient, cutting back on scatter radiation as compared with other mobile CT scanners. Integrated patient support accessories on the SOMATOM On.site include a head holder and body support for neuro imaging without bed adapters or special connectors for differently designed beds. Its motorized trolley and integrated camera enable operators to navigate more easily through crowded hospital hallways through a real-time display. Cunningham stressed that the SOMATOM On.site is “a true CT scanner” that won’t compromise on image quality for the sake of its added mobility. Its fan beam is “typical of what customers in imaging expect” of a stationary scanner, she said, and its 32-slice Stellar detector and dedicated X-ray tube offer a high level of detail (down to 0.8 mm slice reconstruction) in images captured through the study. “We have been asked for many years if we were going to come out with a portable CT,” Cunningham said. “We used a lot of existing components, and added new ones, like a telescopic gantry, which moves away from the patient to allow for positioning, and then back into place. This is very comparable to a stationary scanner you would have in the imaging suite.” ICEMAGAZINE

COVER STORY Cunningham believes that facilities featuring dedicated neuro ICUs, comprehensive stroke centers or teaching institutions with residency specialties could be among the earliest adopters of the SOMATOM On.site. Patients with neuro critical conditions and post neuro-interventional procedures comprise their first tier of potential beneficiaries of the technology. And although she doesn’t foresee it replacing stationary CT units, Cunningham does believe the value of a device like the SOMATOM On.site will prove itself to be a powerful accessory to the radiology departments of facilities that can demonstrate a need for it among their ICU patients, particularly in pandemic conditions, under which staff and time can be in short supply. “In some cases, this would be a standalone radiology purchase; in other cases, maybe a joint purchase with ICU,” she said. “It’s not just a benefit for the patient not being transported, it’s a benefit for the staff. If you can contain the patient in the ICU along with the staff, you’re not having that cross-contamination. By keeping the scanner in the ICU, you can clean it between patients.” Matthew Dedman, director of CT product marketing and operations for Siemens Healthineers North America, said that although the SOMATOM On.site will best serve a specialty market, he’s seen a lot of imaging equipment head into specialty markets in the recent past. “Increasingly, we’re seeing imaging being either installed directly in a specialty, like the emergency department, for example,” Dedman said. “I think that five to 10 years ago, you didn’t commonly see CT scanners directly installed in the ED. Now, as hospitals are con-

structing, it’s not a question of if CTs will be there, it’s how many.” “Increasingly, we are seeing cardiology want to purchase and operate their own CT scanner because of the high number of patients who require imaging,” he continued. “CT is moving closer to the site of care and intervention. If we have success with this first iteration, it’s logical that we could see other places where it would be applicable.” Cunningham also believes that specialty devices like the SOMATOM On.site could help other customers find their way into the broader family of Siemens stationary scanners, which Dedman described as “a very stable and active market just through normal replacement cycles.” “A lot of these markets are coming to us because they want to improve the patient care from the ICU perspective,” Cunningham said. “Then, when the radiology department hears about it, they might be familiar with our equipment. It could be that customers aren’t aware that we have a mobile CT because it’s new for us.” “I think we’ll investigate and see where the market takes us,” she said. “A lot of it is finding out what the customers need.” One of the first users of the SOMATOM On.site has been Dr. Mara Kunst of Lahey Hospital & Medical Center (LHMC), a 344-bed adult hospital in Burlington, Massachusetts. Kunst has been its neuroradiology section head since 2017, and is a decorated teacher with interests in stroke, artificial intelligence and quality improvement in neuroradiology. LHMC ticks a lot of the boxes Cunningham had identified in potential customers for the SOMATOM On.site: it’s a comprehensive stroke center and a

Level 1 trauma center with a large neurosciences practice, receiving patients from surrounding states for treatment of a broad range of concerns: stroke and trauma, brain tumors, demyelinating disease, and rare autoimmune and infectious etiologies. “Our goal in utilizing the portable CT scanner for our practice is to bring this potentially lifesaving imaging technology to the patient’s bedside, thereby limiting the risk of patient travel,” Kunst said. “Those risks are numerous, and include misplaced lines and tubes, disconnected monitoring equipment, and the disruption to the ICU by the removal of staff to accompany the patient to the CT scanner.” Urgent CT studies can be particularly useful for conditions like intracranial hemorrhage, stroke, impending herniation or the evaluation of a recent surgery, Kunst said. Bringing the scanner to the patient mitigates the impact of risks associated with moving patients facing any of those circumstances, she said, but also “translates to economic advantages as well,” in terms of staff resources and potentially faster, more accurate resolution of conditions that must be closely observed. That’s not to say that the SOMATOM On.site doesn’t demand its share of resources. Kunst notes that operating the portable unit requires a trained technologist and assistance from ICU nurses to help position the patient; she notes that those considerations should factor into any decision to add a portable unit to a practice. Kunst said that although she only used the device for head CT, “the scanner is capable of performing contrast enhanced exams and CTAs.” “I would, however, imagine limited coverage of the neck for CTA given the

“ Our approach to mobile is more that we want to make sure people have access to the CTs they need, not only for COVID right now, but also in general.” – Kaz Sato

ICEMAGAZINE | MAY 2021

ADVANCING THE IMAGING PROFESSIONAL

The GE Healthcare “CT in a Box” solution is a purpose-built product intended to support medical imaging demands in high-risk environments and could be seen as an alternative to an imaging trailer.

configuration of the scanner, depending on the patient’s anatomy,” she said. “Certainly, these technologies could prove useful in an interventional neuroradiology suite, prior to intervention or even in the operating room, although the clearest indication seems to be for monitoring of ICU patients,” Kunst said. “When not in use for these indications, it is capable of performing routine outpatient head CTs.” Adding the function of mobility to imaging technology doesn’t necessarily mean only incorporating it within the devices themselves. In the case of the “CT in a Box” solution from GE Healthcare, the manufacturer created a purpose-built product intended to support medical imaging demands in high-risk environments – like Wuhan, China, amid the onset of the COVID-19 pandemic. While the capital city of the Hubei province was rapidly becoming overwhelmed by thousands of patients who’d fallen ill with an as-yet-unknown ailment, clinical demands from overcrowded hospitals and their exhausted staffers led to the city constructing 16 “mobile cabin hospitals.” These pop-up facilities eventually supported some 12,000 patients and provided another 13,000 beds in the city, according to the Baltimore journal Medicine. GE Healthcare Beijing was invited to support these operations with medical imaging technologies like ultrasound, X-ray, and WWW.THEICECOMMUNITY.COM

CT, which were used to help diagnose and monitor patients. The company responded by rolling out an all-inone, portable CT scanning room that supported social distancing and safety requirements. From concept to design and production, the product was in use in less than 20 days; normally, a hospital can take two to three weeks simply to get a new CT system operational and compliant with required safety regulations. “If you were going to sell a traditional CT, you have to prepare the room, general construction has to happen; but in terms of the concept of the box, you can build that unit offsite, put the scanner in it, and then ride it to the site, drop it off, hook up power, and be up and running and not have to do room construction,” said Chad Smith, chief hardware engineer, CT, GE Healthcare. “It really gives you the versatility to get the CT up and running without having to impact internal operations.” Although the emergent conditions under which the CT in a Box was rolled out is unlikely to replicate itself in the United States, where the saturated market for medical imaging devices has its own economics, Kaz Sato, general manager of performance and value CT for GE Healthcare, said the U.S. imaging trailer business reflects a comparable circumstance in remote areas that need additional imaging capacity.

“The U.S. is one of the biggest trailer mobile markets,” Sato said; “we’re starting to see this in China, too. The real needs we saw from the pandemic in a global market is accessibility to CT, which is used to scan for COVID-19.” “Most importantly, patients need to be treated,” he said. “Imaging devices are one point of the workflow. It used to be that the patient got sent to the hospital, where other solutions were needed to access the patient. From a big vision perspective, it should be patient-centric treatment and workflow.” “Our approach to mobile is more that we want to make sure people have access to the CTs they need, not only for COVID right now, but also in general,” he said. “Rural [global] communities are using these CTs in a Box; we’re just focused on a different part of it.” The key to focusing on that expanded access could again center on the value and utility of mobility in imaging, Smith said; while it is one of the factors contemplated by design teams at GE, “overall, general workflow is key,” he said. “How we can make the scanners more efficient in the hospital?” Smith said. “Whether it’s mobile or AI technologies, camera-based technologies; anything that can provide the workflow, we want to work with our customers to gain insight into what areas are going to be the best to help them.” • ICEMAGAZINE

INSIGHTS

CODING/BILLING

BY MELODY W. MULAIK

CAN I BILL A VISIT? R

adiologists perform Evaluation and Management (E/M) services and may bill for them. However, it is important to distinguish between a separate E/M service, and the interaction with the patient that is related to and inherent in a procedure provided on the same date of service. E/M services provided on the same day as a minor procedure are generally included in the procedure payment. A separate E/M code should be reported only if the E/M service is significant, medically necessary and unrelated to the decision to perform the minor procedure. The National Correct Coding Initiative Policy (NCCP) Manual states that the fact that the patient is new to the physician is not sufficient in and of itself to support an E/M code. Documentation in the patient medical record must support the nature and level of the E/M service billed. Services performed to prepare for the patient visit, such as review of imaging reports, and services performed to complete the E/M service, such as writing prescriptions, are included in the reimbursement for the level of patient visit 36

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charged and not separately reported. Routine follow-up visits within the global period are included in the global surgical payment and not billed separately. No charges should be submitted to third-party payers for routine post-procedure visits during the global period unless the physician is part of the Medicare data collection project on global surgery, in which case the postop visit should be reported with code 99024. According to the National Correct Coding Policy (NCCP) Manual, the global payment for a major procedure includes postoperative E/M services performed during the global period that are “related to recovery from the surgical procedure” or “related to complications of the surgery.” Postoperative visits that are not related to the surgical diagnosis or to a complication of surgery can be reported separately. Visits for post-procedure complications are not included in the CPT® definition of the global surgical package, but they are included in Medicare’s definition and should not be billed separately to Medicare. Visits for treatment of the patient’s underlying condition (not recovery from a procedure) and visits for unrelated conditions are separately billable. They should be submitted with modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperaADVANCING THE IMAGING PROFESSIONAL

tive period). Note that modifier 24 is not required when the E/M service occurs after the global period ends. Follow-up visits that occur after the end of the global period are separately billable. However, the services must be medically necessary and reasonable for the patient’s condition. Special billing rules apply when an E/M service is provided in conjunction with a procedure. In many cases, the E/M service is included in the procedure and should not be coded separately. And in those situations when it is appropriate to submit an E/M code, a modifier may be needed to indicate the relationship between the E/M service and the procedure. The relevant modifiers include modifier 24 for

unrelated E/M service during the postop period, modifier 25 for significant separate E/M service on the same day as a procedure and modifier 57 for decision for surgery. There are potentially many opportunities for practices to bill for E/M services, but it is important to ensure that there is sufficient documentation, medical necessity and corresponding submission of the appropriate type and level of visit. Taking the time to review your current practices will yield potential increased revenues and ensure compliance. • MELODY W. MULAIK, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc.

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ADT, WHAT IS YOUR STATUS? PACS/IT/AI

BY MARK WATTS

“One critical issue in the U.S. health care system is that people cannot easily access their health information in interoperable forms.” – CMS

ICEMAGAZINE | MAY 2021

he U.S. federal government spent $35 billion to create electronic medical records (EMR) and digital information for coordination of care and payment. This effort helped digitize and document care “in” the health care setting. Admissions, discharge and transfer (ADT) are the three statuses within the health care EMR. A patient is “in” a health care setting after admission or registration. If the patient is registered in the emergency room and moved to an inpatient status this is a “transfer” in the EMR, a new location inside the health care provider’s care continuum. When care is completed, the patient is discharged out of the EMR status into the community. The patient is “out.” Now what? Who is care handed off to? Is the patient’s primary care physician aware their patient was treated in a hospital? In 2018 the Centers for Medicare & Medicaid Services (CMS) issued a new policy. It is 474 pages and is available at http://cms.gov/files/document/cms-9115-f.pdf “CMS are dedicated to enhancing and protecting the health and well-being of all Americans. One critical issue in the U.S. health care system is that people cannot easily access their health information in interoperable forms. Patients and the health care providers caring for them are often presented with an incomplete picture of their health and care as pieces of their information are stored in various, unconnected systems and do not accompany the patient to every care setting. Although more than 95 percent of hospitals and 75 percent of office-based clinicians are utilizing certified health IT, challenges remain in creating a comprehensive, longitudinal view of a patient’s health history. This siloed nature of health care data prevents physicians, pharmaceutical companies, manufacturers and payers from accessing and interpreting important data sets, instead, encouraging each group to make decisions based upon a part of the information rather

than the whole. Without an enforced standard of interoperability, data exchanges are often complicated and time-consuming.” “This final rule is the first phase of policies centrally focused on advancing interoperability and patient access to health information using the authority available to the Centers for Medicare & Medicaid Services (CMS). We believe this is an important step in advancing interoperability, putting patients at the center of their health care and ensuring they have access to their health information. We are committed to working with stakeholders to solve the issue of interoperability and getting patients access to information about their health care, and we are taking an active approach to move participants in the health care market toward interoperability and the secure and timely exchange of health information by adopting policies for the Medicare and Medicaid programs.” The goal is to provide for a longitudinal view of a patient’s health history. This policy calls for ADT status to be sent to patients’ primary physicians. Hospitals need this capability for success in value-based payment programs such as accountable care organizations (ACOs), where participants are financially at risk for costs associated with poor care transitions. Hospitals must satisfy three conditions relative to ADT event notifications: • First, its system has a fully operational notification system compliant with state and federal statutes and regulations for securely exchanging patient health information. • Second, its system sends notifications comprising, at minimum, of the name of the patient, treating practitioner and sending institution. Optional data can include diagnosis when permitted by law. Additional data elements are required when sending a C-CDA to deliver into the provider EHR workflows. • Third, its system sends notifications directly or indirectly through an intermediary a patient’s name at the time of a ADVANCING THE IMAGING PROFESSIONAL

patient’s registration in the emergency department or admission to inpatient services, and also prior to, or at the time of, a patient’s discharge and/or transfer from the emergency department or inpatient services to all applicable providers identified by the patient as primarily responsible for his or her care and require such information for treatment, care coordination or quality improvement purposes. For instances where a hospital cannot identify a primary care practitioner or a post-acute provider for a patient, CMS does not expect an ADT event notification to be sent. Instead, a hospital must be able to demonstrate that it “has made a reasonable effort to ensure that” the system sends the notifications to any of the following that need to receive notification of the patient’s status for treatment, care coordination or quality improvement purposes to all applicable post-acute care services providers and suppliers and: • The patient’s established primary care practitioner; • The patient’s established primary care practice group or entity; or • Other practitioners, or other practice group or entity, identified by the patient as the practitioner, or practice group or entity, primarily responsible for his or her care. CMS will develop new policies and procedures for surveyors to determine if a hospital is complying. CMS will examine 10% or 30-plus inpatient records. If out of compliance, hospitals will have 10 days to submit a plan of correction or risk CMS denial of payment or other sanctions.

INDUSTRY READINESS According to industry analysis of hospital reimbursement, nearly half of hospital revenue is tied to Medicare and Medicaid. Therefore, the ADT requirement carries significant weight for a hospital found to be in non-compliance by an accreditation agency or state survey. CMS contends that most hospitals can meet the mandate; however, the situation is bleak for those that have not made the necessary investments WWW.THEICECOMMUNITY.COM

to maintain or upgrade their health IT systems. The federal agency projects that 71 percent of hospitals were routinely sending ADT event notifications by 2018, even if the process was done manually. This means that 29 percent, nearly 1,400 hospitals, “will incur costs associated with updating or configuring their respective EHR systems for electronic patient event notifications.” CMS anticipates that approximately 394 CAHs – hospitals already operating on razor-thin margins – find themselves in the hot seat to make the technical changes necessary to comply by May 2021.

UNDERSTANDING TECHNICAL REQUIREMENTS For a rule that requires technical capabilities, it is short on specifics for standards and implementation, which provides an unclear path for hospitals to achieve compliance with the ADT requirement. What then is known about the technical infrastructure CMS anticipates Medicare and Medicaid hospitals to have? The final rule makes frequent mention of the HL7 Messaging Standard Version 2.5.1 – that EHR or other systems are to be assessed by their similarity to a widely used messaging standard used by certified EHR technology. CMS does note that HL7 messages are often sent using common forms of transport. CMS is encouraging the use of the most updated HL7 messaging, FHIR Release 4, or Direct Messages as a prime example. Direct Messaging is commonly used to send messages from one provider to another. Health information exchanges and networks also rely on Direct Messaging to exchange this information over the past decade, with some even claiming that their subscribers have already achieved compliance because of being connected. Direct Trust, the governing body for Direct Messaging, has created a workgroup to develop a standard for Direct Messaging protocols to deliver the ADT requirement. The federal agency claims that “virtually all EHR systems (as well as

older legacy electronic administrative systems, such as electronic patient registrations systems, and which we are including in this final rule) generate information to support the basic messages commonly used for electronic patient event notifications.” Many vendors, including hospital EHRs, are making this process easier by automating the event notification. This type of workflow will not depend on the administrative staff to spend time sending ADT messages for all patients that encounter an event at the hospital.

BEST PRACTICES FOR HOSPITALS Considering estimates about the ability of hospitals to comply with the ADT CoP, assumptions about EHR capabilities could easily lead to non-compliance. Here are the steps hospitals must take to avoid falling short of this CoP and running the risk of losing reimbursement from Medicare and Medicaid: • Identify established care relationships for patients • Match patient care events to ADT event notification recipients • Create ADT event notifications in real-time adherent to privacy and notification requirements • Deliver ADT event notifications to recipients • Maintain a log of ADT event notifications The onus is on hospitals to work with health IT partners – EHR developers, HIEs and HINs, and other data exchange service providers – to ensure that their systems are properly configured and functional and their procedures clearly demonstrate they have acted in good faith. But is baseline compliance sufficient to the task of truly transforming care coordination using ADT event notification? The EMR was a fundamental step in creating transparent health care as an operational document repository. ADT notification to the primary physician is a great idea if there is a primary physician to receive that notification. • MARK WATTS is the enterprise imaging director at Fountain Hills Medical Center.

ICEMAGAZINE

INSIGHTS

RELATE AND SUBSTANTIATE I DIRECTOR’S CUT BY LYDIA KLEINSCHNITZ

don’t know about you, but I get annoyed when I know there is an important task that I need to do but I just cannot seem to get to it because my task list is too long! There is always one more issue to take care of or something that seems to prevent me from doing the one thing I really want to do. The focus of this column is not how to be better at time management but about making sure, as a radiology leader or director, you do that one thing that can make all the difference for your team – rounding. I am not referring to the type of rounding that is done weekly or even daily, that type of rounding is done quickly without much staff interaction. I am referring to taking time to be intentional. To round, I must make sure that I designate time on my calendar to call upon my team and to visit the many areas for which I have responsibility. For me there are two main reasons to round in the department. First, if you round effectively it will help your team feel appreciated. Furthermore, it shows you care and that you

ICEMAGAZINE | MAY 2021

are approachable. Second, it is important to make sure processes that you think are in place are really occurring. It can be ground down to one word – validation. Rounding that meets these requirements is rounding that I like to call purposeful rounding that provdies time to relate and substantiate. This purposeful rounding isn’t just a time to say hello or to offer a casual, “How are you doing?” Questions should be specific such as, “I understand you were sick yesterday, how are you feeling today?” or “Do you have what you need to do your job today?” Other questions that verify specific processes or controls can be added; for example, request a demonstration of a workflow. Rounding is a great time to highlight any positive accomplishments that have occurred in that area or that a specific staff member has experienced, such as a work milestone or a new secondary registration. With specific questions you can help staff feel like an individual and not just another cog in the machine. You are also able to see and validate what processes they are using to complete tasks. This goes a long way to ensure you are knowledgeable as to what is occurring in the department and approachable as a leader, not just a name on an organizational chart. While rounding, if the person allows, I ADVANCING THE IMAGING PROFESSIONAL

sometimes take pictures when he or she is recognized for special accomplishments. I will share these moments with the entire team during all staff meetings. It is on the standing agenda for all staff meetings to review updates, review new policies and share staff recognition. This is one more way to show my support and appreciation. Rounding to relate and substantiate can take up to an hour and I prefer to do this type of rounding at least twice a month. I certainly cannot go through every department during that time, so I rotate through the different modalities during each trip. Taking the time to round with intention or taking the time to relate and substantiate can be a keystone towards building and sustaining a positive and effective workforce. • 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

HOW TO TERMINATE AN EMPLOYEE I

t’s been almost 10 years since Yahoo fired then-CEO Carol Bartz. You might think that’s old news, but it was the manner of Bartz’s firing that was unique. They simply called her on the phone and fired her. Thankfully, terminating people with a phone call hasn’t become common, but it still happens. What did we learn about Bartz’s termination? First, it wasn’t a heated argument that exploded into a “you’re fired,” but rather something the board knew they were going to do. Second, we learned that Yahoo’s board was merely trying to be efficient. Sorry, not a fan. I like what Stephen Covey says: “We can be efficient with things, but we need to be effective with people.” If we’re being effective as managers, terminating someone’s employment should rarely be a surprise event. Except for deal breakers such as theft and violence, a termination meeting should occur as a logical conclusion to a series of efforts to correct unwanted or unproductive behaviors. In other words, the employee should know that his or her termination is imminent because he or she has not made timely progress on issues that have been previously discussed. Granted, I’m not a lawyer, so bounce anything I say here off your corporate legal counsel and make sure whatever you do is in keeping with federal and state employment laws, but here’s how I recommend an employee be terminated if it must occur. First, employees need to know what’s expected of them. Reasons for termination should be outlined in a company’s policy manual. The manual should also outline 42

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the procedure the company will take when people violate policies. A common process is a verbal warning, then a written warning, followed by termination.

VERBAL WARNINGS When a serious problem is noted, have a meeting to give the employee an official verbal warning. Allow me to underscore the words, “official verbal warning.” In other words, the meeting needs to have a sense of formality to it. Just saying something in passing can often be misconstrued or not taken seriously, so something needs to be different. The employee needs to understand that he or she is being given an official verbal warning. And, although it’s a verbal warning, make sure the warning is documented in the employee’s personnel file. One common mistake at this step is only telling the person that he or she needs to improve or change. A better approach is to be specific about the errant behavior and what is expected. Also, instead of giving a one-way lecture, make it a two-way conversation so the employee has input, too. Make sure the employee is aware that if improvements are not made you will proceed to the next step in the disciplinary process.

WRITTEN WARNING Should the employee fail to improve, the next step is usually a written warning. In this document you should note that you have previously counseled the employee on the errant behavior and that because improvements have not been made you are issuing a formal written warning that continued errant behavior will lead to termination. As before, explore ways to help the emADVANCING THE IMAGING PROFESSIONAL

ployee improve. Also, establish a follow-up date to evaluate progress. Written warnings should always be signed and placed in an employee’s personnel file. Follow Up: On the follow-up date stated in the written warning, meet with the employee. If satisfactory improvements have been made or progress toward a goal is evident, congratulate the employee and provide additional coaching or assistance to help the employee stay on track. However, if the employee has not made satisfactory progress, chances are he or she knows it and termination will not come as a surprise.

TERMINATION If you know you’ll be terminating an employee, prepare ahead of time. In other words, have all the paperwork in order and do what’s needed to make the termination occur as smoothly as possible. You will definitely want someone else to be in the room while termination occurs. If things go sideways, you will need a witness. There’s no need to be a jerk or hard-nosed during a termination. A person is losing his or her employment, so at the very least, an atmosphere of civility is in order. That said, avoid being apologetic. It’s better to state that despite the efforts made, a termination must occur. Trying to soften the blow by dancing around issues only makes things more difficult, so keep this conversation brief and to the point. The decision has been made. All you’re doing at this point is taking care of the HR paperwork and formalities. The entire termination process should take less than 10 minutes.

WHAT NOT TO DO I have several acquaintances who were terminated in ways WWW.THEICECOMMUNITY.COM

that did not follow these guidelines. Sarah (not her real name) had been an assistant editor for a magazine, and she also wrote stories. After 10 years of faithful dedication, a new editor told her, “You need to write better stories or I’m going to let you go.” No advice was given. No definition of “better” was ever explained. Sarah asked for advice, but none was given. She even attended creative writing classes (that she herself could have taught) which she paid for out of her own pocket. After two months, Sarah was unceremoniously let go. Tammy (not her real name) was a highly respected childcare worker in a large nonprofit. A new assistant manager told Tammy one of her new responsibilities was getting more parents to volunteer on various projects. She succeeded, but each month she was told she wasn’t getting enough. No number was ever articulated, but several times she was told she needed to recruit “more” volunteers. Despite getting more parents to volunteer each month, after three months, Tammy was terminated without warning. Suffice it to say I lost respect for these companies when I learned of these stories. Check with your lawyer, but using the time-tested method outlined above is a whole lot better than abruptly terminating people without defined milestones. And, however you do it, try to avoid firing people over the phone. • 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 him on his office phone at 208-375-7606 or through his website at www.MyWorkplaceExcellence.com.

ICEMAGAZINE

INSIGHTS

RAD HR

BY KIAHNNA D. PATTON

MAKE SPACE FOR GRACE O

ver the past year, we have forgiven the guest appearances of pets, children and significant others who pop up in the background during those now routine and essential virtual meetings. This sort of forgiveness was quite a bit less common before March 2020, when the world as we knew it changed. Today we have a window into the worlds of our colleagues and other business associates from whom we previously would have seen only a lovely family picture on their desk. We notice what their kitchens look like, the art and foliage they use to decorate, the lighting that peeks out from carefully chosen drapes. We may even inadvertently see what they’ve done with the bathroom. For those who want an extra layer of privacy, we see them sitting in creative virtual backgrounds displaying the million-dollar home they wish they owned, we see the sunny vacation spot from where they’d like to be taking our call or the viral photo of a well-known politician bundled up on a cold winter day. Beyond this, we have also learned what I call “Pandemic Grace.” Let’s consider how we normalize 1) the extension of kindness and flexibility to our colleagues and 2) avoid allowing mistakes to derail and destroy careers.

WHAT IS THE FOCUS? The focus of this column are the general extensions of grace we can give to one 44

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another versus acts that are socially, and maybe even legally and morally, regarded as reprehensible. Also, we will not explore the broader topic of to whom our society typically grants grace because that is a much greater conversation that deserves its own platform. Perhaps one day I’ll explore that.

WHAT IS GRACE? Recently I wrote about TRICK, the method introduced by Esther Wojcicki to help us show up in the world as our best selves. The acronym represents Trust, Respect, Independence, Collaboration, and Kindness; the five fundamental values that help us become successful people. I’m going to hone in on the concept of kindness as it relates to grace. As a reminder, with kindness, we assume good intentions. And grace requires that we grant courteous goodwill. I can’t say what grace and kindness are without saying what they are not. In short, they are not about giving people carte blanche for bad behavior. They are also not about simply being nice to people.

HOW CAN THE LACK OF GRACE DERAIL A PERSON’S CAREER? Organizations with cultures that support long memories can be great for institutional knowledge retention but can backfire when some won’t allow others to grow and change. Consider how the lack of grace can block opportunities and derail what might have been a more successful career with an upward trajectory. What would happen if we shorten those memories? What if a 10-yearADVANCING THE IMAGING PROFESSIONAL

old mistake wasn’t incessantly used to demonstrate why a person cannot take on an important assignment? What if that mistake was not rehashed, and the person was allowed to live in a reality that granted them grace and allowed them to rebuild the confidence to be great? Self-efficacy matters! What if we threw out our judgments and cheered for that person? What would that say about who we are, and how might that impact how the other person shows up, is seen and sees themself?

WHAT DOES GRACE LOOK LIKE IN THE WORKPLACE? Imagine how much more your team could accomplish if individuals granted grace to one another, let go of the past and demonstrated confidence in one another. J. Richard Hackman, an organizational behavioral pioneer and expert in team dynamics, says that teams need a compelling direction, a strong structure and a supportive context. I propose that the supportive context is not limited to tangible resources, but extends to intangibles, like grace. I’ve seen quite a few companies be super proud of having a “no jerk” policy. Lisa Nichols and the law of attraction as explained in “The Secret,” suggest our brains miss the “no,” and the next thing you know your organization is running rampant with jerks. Jerks are the antithesis of gracious. I suggest having a kindness policy instead. And I believe there are companies where that idea is fully embraced. This is what it looks like: At Executive on the Go (EOG), owner Angele Cade and her partner, Brandon, have a staff of employees on whom they WWW.THEICECOMMUNITY.COM

place immeasurable value. She says, “We believe that if we support them in their goals, they will support us in ours.” For example, EOG (www.execonthego.com) allowed remote work before it was popular, and they created policies that included schedule flexibility. For one employee, that policy change made it easier for her to address personal struggles while still meeting work expectations. And because Cade showed kindness to the employee during a tough season of her life, she was a dedicated employee who willingly raises her hand to give extra help. A personal experience moved Cade to grant this type of grace. During a particularly devastating time in her life, the lack of support she received from “the place I dedicated my life and my best working hours of the day to was gut-wrenching. I looked at my own experience and allowed that to navigate how I would want to be treated, and it led me to create an environment and culture that is supportive.”

BEYOND PANDEMIC GRACE Let’s expand our use of kindness beyond granting “Pandemic Grace” to one another. Try it (with authenticity) and see what a positive difference it makes. As my coach says, “I 100 percent guarantee you’ll be successful” when you use kindness and grace to build employees and your business. Think about moments in your life when a little grace would’ve gone a long way, and give to others what you were, or wish you were, given. • 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

DOMINO COURAGE I

just love Ted.com. I fearful of speaking themselves? don’t have to read How welcome was this rean entire book to get ceived by those in charge? I great enlightening inforvividly recall a meeting where mation in relatively short I spoke up against a managevideos from interesting ment policy that was contrary speakers. In my usual to good customer relationships. quest for enlightenment, I got squashed like a grape for I came across a talk this. After the meeting a couple by Luvvie Ajayi Jones of colleagues quietly told me ROMAN REVIEW (luvvie.org), an “authey felt the same and comthor, speaker and digital plimented me on my courage. BY MANNY ROMAN strategist who thrives I have witnessed this strange at the intersection of behavior many times. comedy, technology and activism.” Ajayi Jones suggests that we strive to become Her talk “Get Comfortable with Being the first domino, the one that starts the process Uncomfortable” has received nearly six for others to be able to speak truth in uncommillion views. I will share some of her fortable circumstances. We must be capable of perspectives and suggestions with you speaking the hard truth when necessary. Be the in this column and, of course, add my one who speaks what others are thinking but are interpretation. afraid to say. Don’t let the system count on your Most of us wander through life uncomfortable with speaking the truth against the status quo. We may even be silenced by fear of consequences. Think of the last business meeting you attended. Did anyone speak up with a dissenting opinion, perhaps one shared by others who were 46

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silence to perpetuate an untruth. You have a duty to speak the truth especially when it is difficult. Ask yourself if your silence helps anyone. Silence is an affirmation, confirmation, agreement and encouragement of the present circumstances. She suggests that you ask yourself three questions about speaking up. “Did you mean it? ADVANCING THE IMAGING PROFESSIONAL

Can you defend it? Did you say it with love?” If the answer is yes to all three, then speak up and let happen what will happen. Telling the truth to those in power should not be sacrificial, it is our duty. Truth builds strong bridges to a common ground. Bridges not built on truth will collapse. I suggest one additional question: What is the worst that can happen if I tell the truth? Quite often, the actual consequences are not as dire as anticipated, however the benefits are much greater. So, how do we know what is “truth?” Having a well-defined value system will be instrumental in the evaluation of the “truth.” Values like integrity, honesty, genuine caring, loyalty, dependability, justice, etc. will provide an operational structure from which you will rarely deviate. Your value system will be a lens through which you can envision what could and should be. The value system will provide the courage needed to disrupt what is presently happening while searching for a “better” truth. It takes courage to be truthful. You were told as a child that if you have nothing nice to say, don’t say anything at all. That doesn’t apply here. That was to keep from hurting someone’s feelings in a situation of little consequence. Here

we are discussing situations of significance. We must find comfort in being the domino that encourages others to find their voices to speak out when the situation requires it. Ajayi Jones states that you may be among the most powerful in the room when you have that domino courage. Initiating a necessary discussion that drives toward a better situation should be a confidence-building process for everyone. The more you practice being that truth teller, the easier it becomes. Others will look to you for inspiration and encouragement. If you aspire to be or are a leader, telling the hard truth brings significant value to you and those you lead. You cannot be a great leader without the courage to be truthful. What if someone asks your opinion and you know that they don’t really want to know the truth? I will answer the question with my own question, “You asked, so you want to know the truth, right?” Their reaction will let you know what they really want. Be courageous and truthful and leave others better for having known you. •

“Be the one who speaks what others are thinking but are afraid to say. You have a duty to speak the truth.”

MANNY ROMAN, CRES is the AMSP Business Operation Manager.

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