Tech nation sep 2015 by Md Abdul Haleem Bahadur

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vol 6

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

SEPTEMBER 2015

TRAINING OPTIONS FOR HTM PROFESSIONALS 21st Century Solutions

16 Biomed Adventures

Boat Restoration

Roundtable 34 The Computed Tomography

Bulletin Board 66 MedWrench Industry Resources for Medical

Equipment Professionals

The Only True Alternative to the OEM

CT • MR • PET • NM Service • Systems • Parts

www.BCTechnical.com 888-BCTECH1 (228-3241)

Editors Note: TechNation recently received an email from Anthony J. Coronado regarding his Biomed 101 article in the July issue of the magazine that we wanted to share with our readers. “I would like to express my gratitude for the opportunity to write the Biomed 101 article. Methodist Hospital just went through a successful TJC survey and during the EC interviews I presented the article and showed our practice utilizing FEMA. The surveyors were extremely impressed and asked for a copy of the article and our practices to be nominated as best practice for other HTM Programs to learn from. The TJC surveyors basically stated that Methodist Hospital’s HTM program is years ahead of everyone else. The article helped me during my survey and I wanted to express my appreciation to your magazine.” You can find the article online at www.1technation.com/thebench.

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

T HE ROUNDTABLE - COMPUTED TOMOGRAPHY This month TechNation reaches out to CT experts to find out the latest about this medical imaging technology, including some of the challenges the industry is facing in 2015. Our insiders also share some helpful tips to consider when purchasing a CT.

TRAINING OPTIONS FOR HTM PROFESSIONALS Anyone with an Internet connection can enrich their knowledge and skill set from sources around the world. While the traditional classroom setting remains a popular option for education, a Wi-Fi connected device is another avenue for obtaining knowledge. TechNation looks at training and education options for HTM professionals in the 21st century. Next month’s Feature article: Right to Repair: Overcoming Obstacles

Next month’s Roundtable article: IV Pumps

TechNation (Vol. 6, Issue #9) September 2015 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to TechNation at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. TechNation magazine is dedicated to providing medical equipment service professionals with comprehensive, reliable, information concerning medical equipment, parts, service and supplies. It is published monthly by MD Publishing, Inc. Subscriptions are available free of charge to qualified individuals within the United States. Publisher reserves the right to determine qualification for a free subscriptions. Every precaution is taken to ensure accuracy of content; however, the information, opinions, and statements expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher.

SEPTEMBER 2015

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INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Warren Kaufman Jayme McKelvey Andrew Parker

p.12 p.14 p.16

ART DEPARTMENT

Jonathan Riley Jessica Laurain

P.20 THE BENCH

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Roger Bowles K. Richard Douglas Patrick K. Lynch Todd Rogers Manny Roman Cindy Stephens Karen Waninger

CIRCULATION

Bethany Williams

WEB DEPARTMENT

Betsy Popinga Taylor Martin

ACCOUNTING

Kim Callahan

P.12 SPOTLIGHT

p.20 p.22 p.25 p.26 p.28 p.31 p.32

Department Profile: Biomedical Engineering Department at Piedmont Atlanta Hospital Professional of the Month: Hector Gonzalez Biomed Adventures: Boat Restoration ECRI Institute Update AAMI Update Tools of the Trade Webinar Wednesday Biomed 101 Industry News: FBS Shop Talk

P.50 EXPERT ADVICE p.50 p.52 p.54 p.56 p.58

Career Center Ultrasound Tech Expert Sponsored by Conquest Imaging The Future Patrick Lynch Roman Review

P.60 BREAKROOM

EDITORIAL BOARD

p.60 p.62 p.66 p.70

Patrick Lynch: Biomed Support Specialist at Global Medical Imaging, patrick@plynch.us

p.69 Index

Manny Roman: manny.roman@me.com

Karen Waninger: Director of Clinical Engineering at Community Health Network in Indianapolis KWaninger@ecommunity.com Eddie Acosta: A Clinical Systems Engineer at Kaiser Permanente, Northern California, Fastedy99@yahoo.com John Noblitt: Program Director at Caldwell Community College & Technical Institute in North Carolina jnoblitt@cccti.edu

MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

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DEPARTMENT PROFILE Biomedical Engineering Department at Piedmont Atlanta Hospital By John Wallace

iedmont Atlanta Hospital continues to deliver health care options to the capitol city and beyond with facilities throughout the state of Georgia. “For more than a century, Piedmont Healthcare has been a recognized leader in delivering expert care,” according to the hospital’s website. “Last year, Piedmont served nearly two million patients – performing over 44,000 surgeries, delivering 8,000 babies, providing 471,695 outpatient encounters, completing 235 organ transplants and handling nearly 250,000 emergency room visits. For most, that would be a great track record. For us, it’s a good start.” “At Piedmont, we believe it’s always time to get better,” the website adds. “Time to build on our reputation of excellence and enhance our services to deliver a whole new level of compassionate care, and time for discovering new treatment options while providing technology and tools that give patients the information they need – and the voice they deserve in choosing their health care.” What started as a single hospital more than 100 years ago is now an integrated health care system of five hospitals and close to 100 physician and specialist offices across greater Atlanta and North Georgia. A vital part of the health care system’s growth and a strong protector of its

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reputation is its Biomedical Engineering Department which is a part of the Supply Chain division. Under the direction of Biomedical Engineering Manager Steve Kelley and the system’s Senior Director Jeff Allen, an 11-member crew of “biomeds” and five imaging specialists maintain about 11,000 devices in the flagship hospital in Buckhead, Ga. They are part of a team that supports more than 28,000 devices throughout the system. The biomeds on the team at Piedmont Atlanta include Bill Andrews, BIT, BMET II; Willie Briggs, LSO, BMET III; Wayne Durden, BMET III; Isaac Faraco, BMET I; Scott Garrett, BMET III; Wayne Morris, BMET II; Albert Price, BMET II; Randy Ragan, BMET III; Mark Southerland, BMET IIII; Russ Walker, BMET I; and Dennis Picou, BMET II. The members of the Atlanta imaging team are Darryl Evert, Mike Ragan, Mitch Robertson, Albert Davis and David Boak. They are under the direction of Jeff Seiler. Seiler joined Piedmont as the manager of biomedical imaging in April 2015. This group of talented imaging specialists are responsible for 350 pieces of equipment including devices for CT, MR, mammography, nuclear medicine, ultrasound and more. They are currently involved in a major project – the installation of a new catheterization laboratory or cath lab within Piedmont Heart Institute at Piedmont Atlanta. The Imaging team has created a cost savings of approximately $5 million over the past three years.

SEPTEMBER 2015

Piedmont Atlanta Hospital serves almost 2 million patients a year.

PIEDMONT PROMISE Communication is key to success in almost every profession, and it is not taken for granted at Piedmont. The biomedical engineering department holds a daily Safety Huddle meeting where they discuss problems they have experienced with equipment or issues they have encountered in the various departments that could impact patient care. Each day they also discuss the Piedmont Promise and go around the room to see if anyone witnessed a positive interaction or outcome in the past 24 hours. “For more than a century, Piedmont has been caring for patients, and caring about them. We’ve earned our reputation by treating patients and their loved ones the way we’d want to be treated. By listening and genuinely hearing. By alleviating pain, by also alleviating fear. It’s what separates us from any other health care organization out there,” according to the website. “The (Piedmont) Promise defines our belief that every person who walks into a Piedmont Healthcare facility should be cared for in a

Randy Ragan, BMET III, specializes in respiratory

genuine, respectful and heartfelt way, and treated by some of the world’s best doctors using the latest medical technology.” At a recent meeting, Southerland shared a concern. “The UPS in the lab went out a couple of times on the Siemens analyzer in the lab,” he said. Briggs shared an update regarding an ongoing project. He is working with the electrophysiology lab on a complete rebuild and upgrade of the room. Briggs said the work is the result of some electromagnetic interference and EKG artifact during heart ablation cases. “We are running a complete dedicated circuit for every critical device,” Briggs said. “There are more than 40 circuits. The manufacturer is custom designing the interior of a boom electrically and shielding-wise.” It is a project generating interest from other facilities. “Other facilities are contacting us and following our progress,” Briggs said. “It is a very long and very involved process.” The project includes the shielding of the floor and is a very expensive project but one that illustrates the system’s mantra that safety comes first. “They correct electrical anomalies in your heart. They measure microvolts and micrograms in your heart,” Briggs

The Biomedical Engineering Department at Piedmont Atlanta Hospital maintains more than 28,000 devices.

explained. “Our electrophysiologists need a clear picture.” “We are doing everything we can to create the best environment for them,” he added.

TEAMWORK Kelley sees the department as a part of a team with a goal to provide patient safety and good outcomes. The biomedical engineering department provides cost savings along the way with “in-house repairs, second sourcing of parts, new construction design support, training,” Kelley said. It is all for the “general support of quality patient care,” he adds. Training is another important aspect of the system’s biomedical engineering operations. “We feel that training is necessary to keep costs down. We identify educational opportunities and run them through a justification process,” Kelley said. “Our goal is to pick the ones that provide the most cost-savings opportunities. We also do a lot of in-house training and cross training.” Another part of the department’s overall success is the ability to work with the many departments throughout the hospital. Kelley said the team has worked with each department to help them gain a sense of ownership regarding the

equipment and devices that they use. “We have changed the culture here over the past two years. We had to work consistently to get the equipment users to be a part of our equipment management program and take responsibility to look at the PM due stickers and notify us,” Kelley said. “We also went to an online work request system and really stuck to our guns when it came to logging work orders. The process is now working smoothly, and we’re giving back notification to the users to keep them informed.” This process has prompted additional communication. “We have anesthesia, ventilators, laser, perfusion, and patient monitoring specialists as well as a separate imaging support group in biomed,” Kelley explained. “We assign areas to each tech so the nurses in that area get to know their biomed.” Jo Lenyk with infection prevention at Piedmont Atlanta shared another example of the communication and teamwork emphasized by Kelley and the department. “Steve makes rounds with us regularly, at least once a week,” she said. “They reassure us they are following the manufacturers’ recommendations.” “They do a great job,” she added.

SPOTLIGHT

The Only True Alternative to the OEM

CT • MR • PET • NM Service • Systems • Parts

www.BCTechnical.com 888-BCTECH1 (228-3241)

34 42

TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

Next month’s Roundtable article: IV Pumps

SEPTEMBER 2015

1TECHNATION.COM

INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Warren Kaufman Jayme McKelvey Andrew Parker

p.12 p.14 p.16

ART DEPARTMENT

Jonathan Riley Jessica Laurain

P.20 THE BENCH

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Roger Bowles K. Richard Douglas Patrick K. Lynch Todd Rogers Manny Roman Cindy Stephens Karen Waninger

CIRCULATION

Bethany Williams

WEB DEPARTMENT

Betsy Popinga Taylor Martin

ACCOUNTING

Kim Callahan

P.12 SPOTLIGHT

p.20 p.22 p.25 p.26 p.28 p.31 p.32

P.50 EXPERT ADVICE p.50 p.52 p.54 p.56 p.58

Career Center Ultrasound Tech Expert Sponsored by Conquest Imaging The Future Patrick Lynch Roman Review

P.60 BREAKROOM

EDITORIAL BOARD

p.60 p.62 p.66 p.70

Patrick Lynch: Biomed Support Specialist at Global Medical Imaging, patrick@plynch.us

p.69 Index

Manny Roman: manny.roman@me.com

MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

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Did You Know? The Vault Bulletin Board Parting Shot

Like us on Facebook, www.facebook.com/TechNationMag

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HAVE YOU HEARD? CONQUEST IMAGING IS NOW ISO 9001:2008 CERTIFIED!

Because Quality Matters.

ULTRASOUND |

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PROBES

SERVICE

866.900.9404

TECHNICAL SUPPORT

TRAINING

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DEPARTMENT PROFILE Biomedical Engineering Department at Piedmont Atlanta Hospital By John Wallace

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SEPTEMBER 2015

Piedmont Atlanta Hospital serves almost 2 million patients a year.

Randy Ragan, BMET III, specializes in respiratory

The Biomedical Engineering Department at Piedmont Atlanta Hospital maintains more than 28,000 devices.

explained. “Our electrophysiologists need a clear picture.” “We are doing everything we can to create the best environment for them,” he added.

SPOTLIGHT

PROFESSIONAL OF THE MONTH Hector Gonzalez By K. Richard Douglas

oing through HTM training, there may be one particular piece of advice from an instructor that hits home and stays with a biomed. Hector Gonzalez, CBET, a biomedical technician in the Biomedical Technology Services Department with Baylor Scott & White Healthcare in McKinney, Texas is no exception. Gonzalez has repeated the story many times.

“While attending the biomed program back in school, my professor focused on the importance of the quality of our work, and every week, he would remind us that it could be one of our family members who could need a piece of equipment that we’d serviced,” Gonzalez recalls. “While on my first year as a biomed I was working as a field technician for mechanical ventilators and those words from my professor about the quality of work always stood in the back of my mind. To my surprise, that same year my father fell ill and had to be intubated,” he says. “When I walked to his ICU room for the first time and stood next to the ventilator, before even looking at my dad, I saw that the initials on the service/PM stickers were ‘HG’ Hector Gonzalez.” “I felt a relief, as I knew that my father was on a ventilator that was serviced by me, and thankful to my professor and his teachings about quality of work, it was a top-serviced ventilator,” he adds. That experience only served to reinforce the choice of profession that Gonzalez had made. The advice given in the classroom had practical application in the real world. As happens so often, Gonzalez’s entry

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into the field was happenstance. He went to a community college, still not certain what career field to choose. “As I was browsing through their catalog, the Biomed Engineering Technician program caught my interest,” he says. “When I started reading through the description, I knew that was exactly what I wanted to do. It sounded like a new challenge every day. I have been in the field for 12 years now, it hasn’t disappointed me yet.” After entering the program, Gonzalez was amazed at how in-depth it went into the anatomy and physiology of the human body. “I asked myself so many times through the two-year program, why are we studying all this if we are going to be biomed technicians, not nurses? It wasn’t until I was in the field that I realized how much of that knowledge was necessary to perform our jobs correctly,” he says. “Now I wish that we could have [had] more time to spend on those subjects.” One particular challenge that Gonzalez encountered was mastering the language and terminology used by biomeds, since English is not his first language.

SEPTEMBER 2015

HECTOR GONZALEZ CBET, Baylor Scott & White Healthcare

“I attended biomed school back in Puerto Rico and all my classes were in Spanish, so when I moved back to the states, it became my biggest challenge. I have to say that I have met a lot of great people in this field that have helped me through my career,” he says. “To all of you ‘Thank You,’ for your patience and for taking the time to help me grow as a professional.” After leaving Puerto Rico at 17, Gonzalez joined the Army. He wanted to see the world. He had lived elsewhere in the U.S. before settling in Texas. He had been stationed at Fort Hood at one time. Asked about career growth experiences that he remembers, Gonzalez recalls a time from a former position that involved implementing a new network and required cooperation between IT and biomed.

FAVORITE MOVIE:

“Harry Potter: Order of the Phoenix”

FAVORITE BOOK: Harry Potter series

FAVORITE FOOD: Puerto Rican food

HIDDEN TALENT: None, LOL!

FAVORITE PART OF BEING A BIOMED:

“That we are the unknown help for the patients, but we have a great impact on their recovery.”

WHAT’S ON MY BENCH Laptop Blackberry Spectralink Phone Screw Driver Bubble Gum

Hector Gonzalez is assigned to the surgery department at Baylor Scott & White Healthcare in McKinney Texas.

“When we installed the HL7 server, which is the server that translated the information from the physiological side of the equipment to the networking side, we had to work with biomed and IT, as far as getting the configuration together and that took a lot of steps between the two departments and all the parties involved,” he recalls. Gonzalez started his HTM career as a critical care equipment field support engineer. In the meantime, he has held various positions from entry level biomed to biomed manager. These days, he is assigned to the surgery department as the OR biomed but he tackles the duties of a general biomed as well. “As biomeds, we wear a lot of different hats, and that’s one of the things I love about our profession; there is something new every day,” he says.

RECOGNITION Everyone who goes to work and does a job appreciates some recognition. Gonzalez has been fortunate to have earned several awards. Among them are the Texoma Healthcare Systems Spirit Excellence Award in 2004, the CREST

Services Rising Star Award in 2005, Team of the Year award in 2005 and PRIDE award in 2012, the Baylor Scott & White Healthcare CEO Service Excellence Award and the Five Star Spirit award during 2013 and 2014. He was also awarded the Service Excellence Award last year. Gonzalez’s willingness to get involved may have also saved a life. “I went to a Philips training earlier this year, and as I went for an afternoon run along the San Francisco Bay, I was stopped by this sweet lady. I was surprised when she told me that she had people following her and that they were going to harm her,” Gonzalez recalls. Initially, he thought it was a joke or a set-up for a reality TV show. He looked around for a camera crew before realizing that the woman was very serious. “I sat with the lady and tried to find out what was going on. She asked me what she could take over-the-counter to end her life,” he says. “Right after that, she told me she wanted to jump off the bridge, and she looked off towards the bridge. At that point, I contacted 911, and the police arrived almost instantly and they took

control of the situation.” Gonzalez is always looking out for the safety of others.

AWAY FROM WORK One hobby Gonzalez really enjoys is running. He tries to run twice weekly for about 10 to 11 miles in about an hour and 20 minutes. The extreme heat of the Texas summers keep him to these limits. “When the fall comes around, I ramp it up to four times a week with three 11-mile runs and a 14-mile run at the end of the week. My best time was 16 miles in one hour and 51 minutes,” he says. “I have a beautiful family of five. My wife is very supportive of what I do at the professional level, and in my personal life. I have three beautiful young teenager daughters, two of which are in high school and one in middle school. My six-year-old son is in first grade,” Gonzalez says. His family is important to him and continues to serve as motivation at work. Gonzalez’s employer can be sure that he will give 110 percent because he knows that it could be a family member who depends on his work.

SPOTLIGHT

BIOMED ADVENTURES Boat Restoration K. Richard Douglas

oung guys who like to work on their cars are sometimes referred to as “motor heads” or “gear heads.” They love modifying cars or motorcycles, often with the intent of making the vehicle faster. The ability to work on engines, suspensions, transmissions and other components is a skill that stays with them well into their older years. Although the technology might advance, the basic principles remain the same. Wherever an engine-powered vehicle is found, there is the potential for a project. The inspiration for one of these former “motor heads” was a 1970s-era Aristocraft boat. Randy Ragan is a BMET III who works for Piedmont Hospital Atlanta. Ragan’s affection for boats and his affliction with restoring cars and motors intersected when he had the chance to buy a weather-worn old boat. “I got interested in boats when I was very young. My father had a small boat and would take us fishing quite often,” Ragan recalls. “I remember how much I used to love riding in the boat. I was always kind of a motor head growing up. In high school I had a 1969 Road Runner and then in college I found a 1968 R/T Charger with the 440 Six Pack motor. I restored them both and thought I would have them forever. But I got married, and we started a family, so I ended up selling them to get a house,” he says.

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Ragan felt like it was the responsible thing to do at the time. A couple of years later, his fiscal responsibility was challenged when a friend offered him the opportunity to buy that old ’70s-era boat for an exceptionally good price. “I thought this would be great for taking the family out on. Well when I went to check it out, it was pretty rough and literally had 20 foot trees growing out of it. I have always been able to see the potential in things, so I hooked it up, and towed it home,” Ragan says. “I put a lot of work into that little boat. Pulling the motor, redoing the interior, you name it; seems like I did it to that boat. But, when I was done, it was the coolest little family boat ever.” Since that experience, Ragan has gravitated toward Sea Ray boats. He has completed several boat restorations, each a little bigger or a little nicer than the last. “I have also restored one boat for a

SEPTEMBER 2015

Randy Ragan loves to fish and restore old boats.

friend of mine. Usually I go for the classic mid-70s style, nice lines and thick hulls. I really enjoy taking something that is beyond what is practical for most and turning it into something that is truly nice,” he says.

A DIAMOND IN THE ROUGH “My last project started when I noticed a boat at the place where I was storing my boat at Lake Lanier. I had seen this boat for about a year or so and never

Randy Ragan restored this 23-foot boat after buying it for $600.

saw it move. It did not have a ‘for sale’ sign on it, but it was obvious that it was not being used,” Ragan says The boat was a 23-footer and had a little cabin. Ragan was sure that if he could get it for the right price, it could be a great boat. He made several calls over a year’s time before finally hearing back from the owner. “He mentioned that it had been several years since he had it on the water, so he took it to a mechanic and the news was not good,” Ragan says. “He then said the motor was frozen and so he was not sure if I would still be interested. I said yes and we agreed to meet and discuss the sale,” Ragan adds. “Before he hung up the phone he asked ‘What will you give me for that little boat?’ I thought for a second and had an idea of what my maximum price was, but with him waiting on the line, I just said ‘Well I don’t want to insult you, so you tell me what you want for it and I will tell you if I can do it or not.’ Best move I ever made,

because he came back and said that with a bad motor, and [since] it has been sitting for that long; ‘I guess I would have to get at least $600 for it.’” Ragan got hard at work restoring his new prize. He swapped the old 305 engine for a 5.7 liter 350 four-barrel, that he found in a boat junkyard. He converted it to electronic ignition. He made many improvements and updates. He even redid all of the weathered teakwood features of the craft by sanding and resealing them. “So after a whole lot of sweat equity, I now have a pretty nice boat that we can sleep on and take out for long weekends and overnight adventures,” Ragan says. “The funny thing is, when I first brought this boat home, my wife was like; ‘Why do we need another boat?’ I explained ‘but honey this one has a place to sleep in it.’ She was not impressed. But now that it is done, we love it,” Ragan says. “ Now she is talking about getting an even bigger

Randy Ragan’s attention to detail can be seen in these before (top) and after (bottom) photos.

one to restore with a kitchen and larger downstairs, etcetera, etcetera.”

HTM EXPERIENCE IS APPLICABLE With the mechanical skills he learned growing up, supplemented by the troubleshooting and electronics skills learned as a biomed, Ragan found the perfect skill set for boat restoration. “I am a BMET III and have 20-plus years of experience in the medical field. I have worked on it all, including X-ray, but now I work in the CVOR and specialize in respiratory. The team that I work with at Piedmont Hospital Atlanta is great. We all work hard, but we still have a lot of fun,” Ragan says. Not every hobby lets you quietly float on a lake, but this BMET found a way to employ many skills, with some sweat equity, and make it happen.

SPOTLIGHT

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ECRI UPDATE

The 3-D Printing Buzz: Should You Make Room for 3-D Printers in 2015?

hree-dimensional (3-D) printers are all the rage in health care these days. So much so that the U.S. Food and Drug Administration (FDA) held a major town hall meeting in October 2014 to explore potential regulatory issues. With some analysts predicting that U.S. hospitals will buy an average of two 3-D printers each in 2015, how should health facilities respond?

To answer that, it would help to know exactly how 3-D printers are being explored for use in health care. The list includes making anatomic patient-specific models for planning and practicing delicate surgery before the real procedure, fabricating custom implants for patients, and creating human tissues and organs by layering cells. Amid developments, FDA is asking questions and seeking to define its appropriate role in regulating 3-D printing in health care, trying to strike a balance between protecting patient safety while not stifling innovation in emerging health care technologies.

3-D PRINTING: THE BASICS Designers use computer-aided design and 3-D modeling software to plan the printing process, which builds objects from plastic, metal, or other materials by adding successive layers onto each other until the object is complete. Essentially, 3-D printers build products from the bottom up by heating raw materials to facilitate spraying them through a nozzle or jet to create multiple layers in thin slices as directed by software instructions. The

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3-D printing process contrasts traditional reductive manufacturing that subtracts from a wooden block or other raw material to reach a finished product. Numerous 3-D printers are commercially available, ranging widely in size, complexity, and price from tabletop models for hobbyists under $1,000 to large industrial models, which range in cost from tens of thousands of dollars to a million dollars, but no standards have yet emerged for clinical applications of 3-D printing. Companies marketing 3-D printers that are purportedly well-suited for health care applications include 3D Systems, Inc. (Rock Hill, South Carolina, USA) and Stratasys, Ltd. (Eden Prairie, Minnesota, USA). HP (Palo Alto, California, USA) has announced plans to introduce a “revolutionary” 3-D printer in 2016 that promises faster and cheaper printing options than those currently available.

EFFECTS ON HEALTH CARE DELIVERY AND PATIENT OUTCOMES One of the most dramatic examples of 3-D printing’s potential to directly alter patient care occurred at the University of

SEPTEMBER 2015

Michigan, where a surgeon and a biomedical engineer used 3-D printing to create customized, bioresorbable airway splints to treat severe tracheobronchomalacia, a rare but potentially fatal softening of tracheal and bronchial tissue leading to collapsed airways with no real curative therapy. They completed the procedure in two children (as of November 2014) under FDA compassionate use exemptions. In March 2014, investigators at University Medical Center Utrecht (The Netherlands) reported a 23-hour surgery to implant the first complete 3-D printed skull in a 22-year-old patient with a progressive, bone-thickening disorder. Elsewhere, collaborators at Princeton University (New Jersey, USA) and Johns Hopkins University (Baltimore, Maryland, USA) completed a proof-of-concept study using 3-D printing to create bionic ears that interweave biologic tissue with functional electronics. A University of Toronto (Ontario, Canada) team is evaluating the feasibility of 3-D printing sheets of skin grafts using a burn patient’s own cells. At Children’s National Medical Center (Washington, D.C., USA), pediatric cardiologists and surgeons are using

3-D-printed models to study congenital heart defects to plan intricate corrective surgeries in children.

THE EVIDENCE STORY At this point, most published data on 3-D printing are limited to case reports and very small case series describing early 3-D printing experience. Most reports involve craniofacial and mandibular surgery and dental procedures. Typically, these reports describe 3-D printing used to create detailed surgical models and templates to facilitate surgical planning, with fewer reports describing 3-D-printed models for cardiac, neurosurgey, and orthopedic surgery. To a lesser extent, the clinical literature cites 3-D printing to create customized implants used in craniomaxillofacial and mandibular surgery and dental surgery. A couple of studies compared 3-D-printed ankle-foot orthoses to conventionally fabricated orthoses.

COSTS, REIMBURSEMENT, AND REGULATION At this stage, how 3-D printing might affect health care costs overall remains unclear. Ultimately, costs could be affected by how 3-D printing is regulated. According to General Electric Aviation (Cincinnati, Ohio, USA), which has been using 3-D printing and additive manufacturing since the 1990s in some form to produce jet engines, 3-D printing can potentially allow faster and cheaper development of new products compared to traditional manufacturing techniques. Manufacturers and hospitals could view 3-D printing as a cost-cutting technique that allows them to reduce product inventory costs with more “just in time” production. From a regulatory perspective, among the questions FDA raised at an October 2014 public meeting on 3-D printing were whether the 3-D printing process fundamentally alters raw materials’ chemical or biomechanical properties in unforeseen or unsafe ways. Some patient safety issues raised included printer calibration and

maintenance, sterilization, infection risk, and risk of delamination of layered print products over time. Other questions raised included whether FDA might consider hospitals to be manufacturers — held to the same regulatory standards — if and when they use 3-D printing to create individualized implants for patients. THIS ARTICLE IS EXCERPTED FROM ECRI Institute’s 2015 Top 10 Hospital C-Suite Watch List. The full white paper contains more guidance on 3-D printing and other novel, new, or emerging technologies. To download the full C-Suite Watch List, visit www.ecri.org/2015watchlist. For more information on ECRI Institute’s evidence-based health technology assessment or consulting services, contact communications@ecri.org, or call (610) 825-6000., ext. 5889.

INTERESTED IN ADOPTING 3-D PRINTING TECHNOLOGY? Use the following as your to-do list. • Closely monitor FDA moves to regulate 3-D printing in health care, particularly 3-D printing done by hospitals, so your facility does not risk running afoul of regulations. • Assign teams in your health system to keep current about 3-D printing research in their clinical fields. • Evaluate the feasibility of establishing a 3-D printing program at your facility and the applications that might make the most sense for your patient populations and clinical service lines (e.g., enhanced surgical planning, customized orthotics).

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AAMI UPDATE

Donor Support Sparks Scholarship Program Growth

he AAMI Foundation is expanding the Miller Scholarship Program to offer financial support to more students of healthcare technology management (HTM).

The scholarship program – which has awarded two, $2,500 scholarships each year over the last six years for a total of $30,000 – will begin awarding five, $3,000 scholarships each year starting in 2016. The AAMI Foundation Board approved the expansion of the program in June, following news that the program had exceeded its $500,000 fundraising goal. Professionals in the education community were delighted by the expansion. “Wow, this is fantastic news,” said Roger Bowles, professor and department chair at Texas State Technical College. “Many of our students are working while going to school and scholarships make it possible for them to complete the program in a shorter amount of time.” Beginning in 2016, the Awards Committee will award five, $3,000 scholarships to: • Up to two individuals studying to become a biomedical equipment technician (BMET) • Up to two individuals studying clinical engineering • One individual studying to become a health systems engineer or equivalent. The systems scholarship reinforces

1TECHNATION.COM

AAMI’s commitment to achieving a goal under its 2015-2017 Strategic Plan, which seeks to advance a systems approach to healthcare technology. The Strategic Plan calls on AAMI “to build competencies and promote education opportunities for the workforce to support a systems approach to healthcare technology.” Specific criteria for that scholarship will be developed by the end of 2015. “The beauty of the scholarship program is that we are helping students who deserve and need financial support, and almost every penny goes to the students. We keep the marketing and other administrative costs to a minimum,” said Steve Campbell, AAMI’s chief operating officer. Steve Yelton, an educator who serves on the Executive Committee of AAMI’s Board, said the program’s growth underscores AAMI’s commitment to the HTM field and will also publicize HTM as a career option. “As we promote the scholarship opportunities along with the HTM career path, additional students will investigate HTM and many will pursue it,” said Yelton, professor at Cincinnati State Technical & Community College. The expansion of the scholarship program is made possible thanks to support from dozens of AAMI’s

SEPTEMBER 2015

corporate and individual supporters, including recent donations of $5,000 or more from Alpha Source Inc., Fresenius Medical Care, the Japanese Medical Instrumentation Association (JSMI), PartsSource, UL, the Dalton Foundation, Replacement Parts Industries, Sodexo, AAMI President Mary Logan and Trabue Bryans from BryKor LLC. To learn more about the scholarship program, including how to donate, visit www.aami.org/scholarship.

AAMI LAUNCHES HEALTH IT STANDARDS INITIATIVE AAMI has launched an initiative to develop American National Standards applying to health service provider organizations and vendors that develop, implement or use health information technology (HIT) software and systems. AAMI HIT1000, Risk Management Practices for Health IT, will define a process to identify the patient safety hazards associated with health IT, to estimate and evaluate the associated risks, and to control or mitigate these risks. AAMI HIT2000, Application of Quality Management Principles to Health IT, will identify and prioritize the appropriate quality system principles necessary to create, deliver, and utilize health IT safely and effectively. The work will commence with an invitation-only meeting on Oct. 20 with key stakeholders to seek input and explain the plan of work. An open inaugural meeting of the new AAMI Health IT Committee will follow the next day. Several recent studies and reports by

patient safety organizations and government agencies have called for the application of risk management practices and quality management principles to manage and mitigate risks and deliver consistent, high-quality HIT products and services. While general quality system and risk management principles are covered in many existing standards, these standards do not offer the sector-specific detail needed for the HIT sector or provide the requisite focus on patient safety, health and security. On the other hand, well-developed quality systems and risk management standards for medical devices – such as ANSI/AAMI/ISO 13485 and ANSI/AAMI/ISO 14971 – are intended for use in a highly regulated environment, which does not exist in the United States for nonmedical device HIT. In addition, the latter standards do not take into account the very different life cycles of HIT or the special risk conditions created when such IT is custom implemented and configured in the field. According to Joe Lewelling, AAMI’s vice president of emerging technology and health IT, the creation of HIT sector-specific standards and guidance is not intended to supplant existing quality management systems or risk management frameworks; rather it is intended to establish consistency and consensus on the minimum requirements for such frameworks and practices, enabling HIT vendors to assess their existing systems and improve them if necessary. “In the absence of defined minimum standards, the industry will be judged by its worst actors,” Lewelling said. The AAMI work is being pursued alongside a related effort to develop a body of standards for HIT software and systems under the joint auspices of ISO/TC 215, Health Informatics, and IEC/SC 62A, Common aspects of electrical equipment used in medical practice. Lewelling noted that domestic standards are needed to address specific conditions of the U.S. market, but said he hoped they can be developed faster and then be used as source documents in international efforts.

PODCAST LIBRARY GROWS AAMI now has a dozen episodes in its complimentary series of podcasts focusing on healthcare technology. The podcasts feature interviews with experts on a variety of topics, including how to build a stronger HTM department, the future of preventive maintenance, the opportunities and challenges of digital health, imaging trends and risk management. The podcasts can be accessed through iTunes, TuneIn, and Stitcher, as well as on the AAMI website. They’re easy to enjoy at your desk or on the go. No registration or login is required. The podcasts are developed in partnership with the studios of Healthcare Tech Talk. You can view the full library of AAMI podcasts at www. aami.org/newsviews/Podcasts.aspx

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SEPTEMBER 2015

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Available in two sizes, this new accessory attaches directly on the back of the 10-series plastic storage cabinets. No tools are required. The bracket helps users consolidate small parts cabinets in a high-density hanging cabinet system. MORE INFORMATION IS AVALIABLE AT: www.akro-mils.com

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SEPTEMBER 2015

1TECHNATION.COM

Webinar

Wednesday

WEBINAR WEDNESDAY Session Provides ESU Testing Tips

ore than 300 people attended the Webinar Wednesday presentation “10 Best Practices for Electrosurgical Unit Testing” by Jerry Zion. The free webinar, sponsored by Fluke Biomedical, featured 10 tips for electrosurgical unit testing and the different modes of electrosurgery testing, a look at test procedures and how to complete testing safely and efficiently.

Zion provided an in-depth review of this important process. He discussed why annual ESU testing matters and explored global testing standards. A highlight of the webinar was the list of top 10 ESU test tips that Zion outlined during the presentation. A few of the tips were: • Always refer to the manufacturer’s service manual • Plan a consistent inspection frequency • Adopt a formal standardized test procedure • Include additional tests for comprehensive testing • Be mindful of test leads while testing He also pointed out one reason for the importance of ESU testing is that the devices can pose a threat to patients and operators via burns due to surgical fires and burns due to reduced dispersive pad contact with patient skin. Burns can also occur due to the inappropriate placement of the patient return (dispersive) pad. Electrical microshock is another danger that was covered during the webinar. Zion answered several questions during an informative Q&A session after his presentation and shared a link to a white paper on electrosurgical device testing.

1TECHNATION.COM

“These webinars really help our three-man ISO receive training and information about technology. It also helps us satisfy our state PE requirements for training hours.” - Roy W. Attendees gave the webinar good reviews in a post-webinar survey emailed to participants. “The best practice tips are excellent and will ensure we meet CMS and JC requirements,” Richard S. wrote about Zion’s webinar “Today’s webinar was excellent! Very pertinent and valuable information that will be utilized in our ESU PMs,” Melissa W. wrote. Many attendees were thankful for the Webinar Wednesday series. “These webinars really help our three-man ISO receive training and information about technology without having to attend trade shows (which is very expensive for small companies). It also helps us satisfy our state PE requirements for training hours,” Roy W. wrote.

SEPTEMBER 2015

“Participating in TechNation’s Webinar (Wednesday) for the first time is a worthy experience. As a biomedical engineer, it is of great help in our hospital to gain knowledge especially about risk reduction related to medical technology. Please continue to give webinars as it is of great help to our hospital,” Albert V. wrote. Almost 4,500 people have registered for Webinar Wednesday sessions in 2015 with an average attendance of 314 people per webinar. A recording of the webinar is available online at http://1technation. com/10-best-practices-forelectrosurgical-unit-testing/. THE SCHEDULE FOR UPCOMING WEBINARS: is online at www.1technation.com/webinar-calendar/.

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1TECHNATION.COM

BIOMED 101

Time (and Technology) Marches On By Michael O’Brien

believe it is beneficial to pause and reflect periodically, so that we can appreciate and celebrate our accomplishments and perhaps set some new goals. The topic of this column is to examine the remarkable technological changes we have all witnessed. It’s typical to discuss things that have occurred in one’s lifetime but, times have changed, and we now see remarkable advances in just a portion of a lifetime. We are all aware of the technological changes we’ve seen in our personal lives. The telephone, to me, is an amazing example of this rapid change. I’m dating myself here, but I remember rotary telephones – one per household. The only way you could connect to more than one person was by using a party line. Touchtone phones were only a modest improvement. Today we carry around something that we call a phone, but it’s obviously much more than that. It can be used to communicate to multiple people instantly and in numerous ways from nearly anywhere in the world. That is remarkable for the short span of time it has taken to occur. For the younger crowd, just the change from sending texts on your flip phone to the versatile smartphones we use today is a great example of the rapid pace of change. The technological improvements in health care came to mind recently when I accompanied my wife to an appointment with a radiologist to review mammography images. This was not an ideal situation, but I was pleased to see the difference in the quality of the images when comparing studies from

1TECHNATION.COM

just a few years ago. I was also impressed by how much information was available for us to review together, so easily, in an office setting. I have worked in hospitals since the early 1980s, starting as a maintenance engineer and then beginning my biomed career in 1987. At that time, we still had a supply of vacuum tubes in our shop. I am certain that we did not have any equipment that still used vacuum tubes, but it was not that far off in the past. I learned some of my troubleshooting skills in that first biomed role by replacing transistors and diodes, and by locating a failed logic gate and replacing the integrated circuit. I enjoyed the challenge of that type of troubleshooting but very little of that activity happens any longer. Some of the technicians I worked with in those days were much more experienced than I was, and had used part of a transistor to replace a failed diode when they did not have the required component. Budgets were pretty small and they had to make due where they could. I know that doesn’t happen any longer. In those early days, we were repairing equipment to the component level, but

SEPTEMBER 2015

MICHAEL O’BRIEN Secretary, Oregon Biomedical Association

“There were a number of quarterly and semi-annual inspections required back in the early days and now we have equipment such as anesthesia machines and ventilators that only require annual maintenance. We spend more time now doing performance assurance rather than actually replacing parts during PM activities.”

the high-resolution LCDs that we use today. Radiology PACS has greatly improved the ability to share and review diagnostic information. Ultrasound APPROVED CHANGES NEEDED images PROOF used to appear pretty murky and unclear to the untrained observer, but CLIENT SIGN–OFF: now provide great clarity. CT scanners PLEASEaCONFIRM THE FOLLOWING ARE CORRECT have also improved great dealTHAT in this LOGO to multi-slice PHONE NUMBER WEBSITE ADDRESS time, from single-slice scanners and improved post-processing capabilities. In my early years as a biomedical technician, not every hospital had MRI scanners and relied on mobile scanners. I’ve observed the changes in the equipment we service as well. Reliability has improved and adjustments are made through software instead of adjusting potentiometers to calibrate devices. Changes have occurred to Preventive Maintenance requirements as well. There were a number of quarterly and semiannual inspections required back in the early days and now we have equipment such as anesthesia machines and ventilators that only require annual maintenance. We spend more time now doing performance assurance rather than actually replacing parts during PM activities. In conclusion, I think we need to pause and take a little time to appreciate the tremendous changes we have been a part of, and to consider the positive impact this has had on the capabilities of our health care system to provide higher-quality care for our loved ones. We all need to continue our efforts to learn more and grow our skills in order to support the technological advances that are still to come.

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the density of equipment used in hospitals was much less than what we see today. We were just starting to use Computerized Maintenance Management Systems – CMMS. I worked with technicians that had trouble accepting the CMMS and preferred the flipbook of index cards, which were used to track Preventive Maintenance. One inspector asked a technician how he knew a piece of equipment was due for a PM and he said he had to flip through his books to check. The CMMS was clearly more efficient and those PM cards disappeared along with many other paper forms we were using at the time. We were just starting to get involved with networked patient monitoring equipment. I remember attending biomedical association meetings where vendors would explain the Ethernet to us so that we could learn to support those early critical care networks. Although the technology used for many of the parameters in patient monitors has not changed dramatically, the systems are much more sophisticated. Integration has dramatically changed the workflow for clinical staff and has also increased our responsibilities and challenged the skills needed in order to successfully manage those enterprises. As I mentioned, there has been a dramatic change in imaging capabilities over this period of time. This is not limited to diagnostic imaging. I would include the improvements in cameras used in surgery and endoscopy as well as the change from CRT based monitors to

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INDUSTRY NEWS

FBS Celebrates 30 Years with Annual Symposium

Staff Reports

egistration is open for the Florida Biomedical Society’s 2015 Symposium. The annual conference for clinical engineers and biomeds features educational opportunities, networking events and an exhibit hall at Disney’s Coronado Springs resort in Lake Buena Vista, Florida, as the organization celebrates its 30th anniversary.

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More than 60 exhibit booths have been reserved for the 2015 Symposium. The exhibit hall promises to have the latest technology and industry leaders ready to answer questions about their products and services. The educational tracks feature experts from the HTM world with more than 15 different sessions focusing on everything from hospital beds and O2 blenders to a variety of diagnostic imaging topics. For a complete list, visit www.FBSOnline.net. Networking opportunities are also on the agenda at FBS 2015 with an exhibit hall grand opening and happy hour, a beach bash vendor reception, breakfast, lunch with vendors and an exhibit hall happy hour. All of the networking opportunities are

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made possible thanks to sponsors. Extra events include a mini-golf tournament benefitting Tyler’s Hope for a Dystonia Cure on Thursday, Oct. 1. There is an added fee to participate in the mini-golf tournament. The annual FBS Golf Tournament will be held at Falcon’s Fire Golf Club on Friday, Oct. 2. Contact FBS for more information about the cost of the tournament. An added feature is a group trip to Epcot on the evening of Saturday, Oct. 3. An additional charge may apply for this event. A complete schedule and preview is available at www.FBSOnline.net

SEPTEMBER 2015

1TECHNATION.COM

SHOP TALK

Conversations from the TechNation ListServ Q:

Not trying to stir the pot, but I just received a call from our surgery department, and they asked me what “politically correct” term they should use instead of “slave monitor.” Apparently a doctor made a comment about how we need to adjust our terminology. I didn’t know exactly what to say, other than “remote monitor.” I recommended they check with human resources, as that department would be better at what is/isn’t “politically correct.” Has anyone else had to come up with a new nomenclature for “slave monitor” or other similar terms that need to be adjusted?

Yes, I think it’s odd that people use that term. Just the other day someone said “the room where the slaves are.” I call it secondary video.

I use the term “remote video” or “overview display” and most people ask me, “What is that?” When I describe it to them, then they correct me, “Oh, you mean a slave display?” Yes, and then they get it. My apologizes. I mean no disrespect.

I would probably just go with remote monitor or secondary monitor.

A: A:

Um … how about “dominate and secondary?”

There are no politics in electronics. The technically appropriate word is “slave monitor.” “Dummy terminal” is also technically appropriate, though it will likely bother some as well.

1TECHNATION.COM

Try these substitutes: remote, repeater, secondary, clone or mirror. Just to name a few. You’ve got to love our politically correct world.

My first thought on this was along the lines of “you have got to be kidding me,” having been engaged in several long Facebook debates lately concerning political correctness. I won’t go any further into those conversations; it was just funny timing. I decided to do a quick web search for politically correct terminology for the technical term “master/slave.” What I found were quite a few suggestions, but no real replacements that were as clear concerning the relationship between the items. I also found that Los Angeles apparently had a PC field day about 11 years ago even going as far as having all city employees cover up any equipment tags they had that carried the master or slave label. At that time, they were widely ridiculed over it. I can remember the first time I saw the label a couple of decades ago; I was adding a second hard drive to my computer, and the labels for the jumpers on the original drive and the new drive contained the terms along with the mapping for the jumpers in each case. As soon as I saw that there was no doubt in my mind what it meant, nor was there any doubt as far as how I needed to set the jumpers. I don’t feel that “primary/ secondary” or any of several other recommendations are near as clear. Perhaps “driving/driven?” Either way, I saw where someone had just a little fun with it and suggested a few that I thought were humorous. Just for a little levity,

SEPTEMBER 2015

here they are “Overlord and Minion” or “Hero and Sidekick” or “Big Boss and Lackey” or “Captain and Sailor.”

A: A: A:

Secondary monitor would work as well. Assist monitor.

Maybe you should use “Thing 1” and “Thing 2.” I apologize to all of you who associate with “Thing.” I mean no disrespect.

It never ceases to amaze me how childish some members of our society have become. Is anyone truly offended by a monitor being referred to as a slave monitor? Do we really need to start checking with human resources anytime a technical word or phrase has the potential to be twisted, or over analyzed into something that possesses even the slightest possibility of offending the most overly sensitive of us? Please tell me we haven’t slid that far into PC purgatory.

We’ve run into issues with our COWs (Computers on Wheels), where we’re now required to call them WOWs (Workstations on Wheels), because it didn’t seem politically correct to use the term “COW.” It seems to be an ongoing adjustment, and I’m sure something else will come up once we figure this out. In the meanwhile, we’re probably going to stick with primary and secondary for the display nomenclature.

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A: A:

Mother/Child.

These are not people. They are machines. A slave is not a racist term. It is about one machine taking commands from another. There is no need for political correctness.

I agree with you. I understand about being “politically correct” but really a monitor? I have been calling attached (secondary monitors) in imaging “slave monitors” for my entire career. I call it “slave monitor” I guess now I have to call it “the exact duplicate secondary monitor.” First for me, but I have never been one to be politically correct, so I am leaving it as “slave monitor.”

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hospital is required to purchase directly. CLIENT SIGN–OFF: If the internal foam or bladder CONFIRM THAT THE FOLLOWING ARE CORRECT replacementPLEASE outweighs the cost of the 877.902.2688 | www.digirad.com LOGO willPHONE NUMBER WEBSITE ADDRESS SPELLING mattress, the hospital buy the

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mattress replacement.

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We repair beds and stretchers. The mattress should be replaced unless it has a replaceable outer cover. PUBLICATION

MEDICAL DEALER TECHNATION We repair beds and stretchers. We repair the broken bladders inside BUYERS GUIDE OTHER the beds. If the outer covering has tears or is MONTH letting fluids ingress, we replace the outer covering, or if we need to, the bladders. J We F do M not A “patch” M J mattresses. J A S O We have had a hard time lately with a DESIGNER: JL that uses a whole certain model of bed bunch of those “pillows” running in the seat section.

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Sounds like to me we are in fact sliding into purgatory. I looked up slave monitor in the dictionary for the meaning, which stated; a device that is controlled by or that duplicates the action of another similar device (the master device). The word slave like other English words, has more than one meaning. The brakes on a car are controlled by a master cylinder, which in turn operates the smaller slave hydraulic cylinders at the wheels. Hard drives for a PC can be configured as master or slave. What about daughter boards that plug into mother boards in multi-board electronic equipment? Let us not forget about piggybacked circuit boards and piggyback breakers. The list goes on and on.

Q: A:

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We have to replace.

THESE POSTS are from TechNation’s ListServ. Go to www.1technation.com/ listserv to find out how you can join and be part of the discussion.

It is truly out of control and it seems to be getting worse. What is this world coming to?

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ROUNDTABLE

Computed Tomography

his month TechNation reaches out to CT experts to find out the latest about this medical imaging technology, including some of the challenges the industry is facing in 2015. Our panel includes Scott Anderson, Director, Technical Operations, Ed Sloan and Associates; Paul M. Fernandez III, Regional Service Manager, Consensys Imaging Service; Leon Gugel, President, Metropolis International LLC; Sarah Lee, Vice President of Sales, Medical Imaging Technologies Inc. (M.I.T.); Jeremy R. Probst, Chief Operating Officer, Technical Prospects; Nathan Struiksma, Field Service Manager, Southwest Medical Resources; and Randal Walker, Vice President CT and MR, BC Technical.

1TECHNATION.COM

NOVEMBER 2014 SEPTEMBER 2015

WHAT ARE SOME OF THE LATEST ADVANCEMENTS IN CT EQUIPMENT AND HOW WILL THEY IMPACT THE MARKET?

Anderson: Dose reduction awareness is one advancement that has been in the spotlight lately. Throughout my career this has been a hot-button issue for me. In my travels, I was always amazed at the wide range of techniques used for the same protocol, even on the same model of scanner. When the high power systems became the norm, the techniques rose to match the systems capabilities but didn’t necessary improve image quality which led to over exposing patients. The pros for dose reduction is obvious, the cons are that some older mulitslice scanners won’t be retrofitted and will get pulled from service even though they are still fully functional and viable scanners if they were used correctly.

Anderson: When buying any expensive piece of medical equipment you should do your homework. Before you sign on the dotted line, have an expert inspect the system. You wouldn’t buy a used $200,000 car without getting it checked by an expert. Use a reputable vendor that stands by what they sell, if possible get a warranty. It is always a good idea to check for parts (tubes included) and service cost and availability. What may seem like a good price for a scanner today may cost you in the long run if operation costs are high. Cavet emptor.

Fernandez: Low dose options in the hardware and post image processing are reducing patient exposure to ionizing radiation. XR29 has generated focus on radiation dose reduction while maintaining image quality. Some methods include increasing the slice count and reducing scan times. Other improvements include advanced reconstruction, improved time-saving workflow enhancements and advanced detector technology. The result is improved patient care. Struiksma: One of the latest advancements in CT equipment has been dose-tracking software to accurately calculate patient dosing during a CT exam. The OEMs have also started to release their own dose-tracking software on their latest versions of equipment. Walker: Low dose will impact CT over the next few years. NEMA, The Joint Commission and ACR are all weighing in on the responsibilities of the technologist, doctor and hospital in minimizing the radiation the patient is exposed to while still providing good early detection/diagnosis.

WHAT ARE SOME OF THE BIGGEST CHALLENGES OF PURCHASING AND MAINTAINING CT EQUIPMENT TODAY?

Fernandez: The obvious challenge is budgeted funds which dictates whether to purchase new from the OEM or a used/ refurbished scanner. If purchasing new, remember to account for the cost to repair after the warranty period ends. Many new systems will not have the option to be serviced by most third-party organizations so the OEM may be the only option for service and parts (premium cost.) If purchasing a refurbished unit, be sure to do your homework on: • Who is selling the equipment? • Do they have qualified FSEs that can install and offer continuing service? • Is the X-ray tube available in the aftermarket or only through the OEM? • Do they have access to quality (FDA-compliant) parts at reasonable costs? • Can you obtain a service history on the pre-owned equipment? Maintaining the equipment comes down to negotiating a reputable, affordable and FDA-compliant service agreement. Obtaining an equipment uptime of 95 percent or better, with adequate on-site response times as well as high Mean Time Between Failures (MTBF) to help ensure high patient throughput, are all critical factors to consider.

THE ROUNDTABLE

Gugel: The high cost of tubes and certain other specific parts, especially when systems are not properly maintained in the first place, are some of the biggest challenges when it comes to CT equipment. Lee: Government regulations like XR-29. If you don’t want reimbursements to be cut you have to comply and some people are having to buy new CTs altogether or having to pay a lot to get the software to make it compliant. They could come out with new regulations at any time that cost more money. Probst: Today’s high-tech CT scanners require expensive X-ray tubes and service contracts. The cost of service (OEM, in-house, alternative) and availability of X-ray tubes, parts and technical training are among the challenges health care facilities face. In an effort to lower cost, you are seeing a shift away from OEM service contracts. If a facility understands the risk factor, they will make an educated decision to assume more risk and – in most cases – save money over time. Struiksma: One of the biggest challenges in servicing CT equipment would be parts availability, cost and reliability. Walker: The balance between the price of the equipment and the technology that is being acquired versus the reimbursement for the clinical studies that can be accomplished is the issue in purchasing CT. The challenge in maintaining the CT is two-fold: 1. Getting the best cost to value you can get from a service provider. 2. Maintaining the equipment as long as possible before changes in regulation or technology hamper your ability to get reimbursed or to maintain your patient base. In the cost to value proposition, each facility has to measure its ability to deal with risk (i.e. tube replacement or equipment failure) to the cost to mitigate that risk by signing a service agreement.

1TECHNATION.COM

SCOTT ANDERSON

Director, Technical Operations, Ed Sloan and Associates

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A REPUTABLE THIRD-PARTY CT EQUIPMENT PROVIDER? Anderson: The easy answer is reputation, the third-party industry is relatively small and with a few phone calls one can usually find a provider that will suit their needs. One of the biggest things people look at today is the field service engineerer’s training, while this is important it shouldn’t be the only question. Training is great mind you but if you haven’t worked on the system you were trained on in four years, experience trumps training. I also ask for insurance verification from vendors. Fernandez: At minimum, they should have a documented quality management system in place. If possible seek out organizations that have taken the additional steps to become and maintain certification to ISO 9001:2008 and/or ISO 13485:2003. This will ensure the organization has well-defined processes and procedures for consistently servicing and obtaining parts that meet various

NOVEMBER 2014 SEPTEMBER 2015

PAUL M. FERNANDEZ III

Regional Service Manager, Consensys Imaging Service

regulatory requirements governing medical devices. Are the Field Service Engineers certified to install, PM and maintain your equipment? If FSEs are certified, how do they maintain this certification? Does the company have a service escalation process? What is the company’s on-time PM completion percentage? Check references and be sure to inquire about reliability. Gugel: Service and the ability to work with software systems, not just the mechanical components is important. Lee: Make sure you call multiple references. Some people are one-man shows and that is fine if they know what they are doing and only have a couple of customers, but you don’t want your CT to break and them be on another site and not have someone to send to fix yours. Also, some people say they refurbish CT and all they do is paint the covers. Then, if it starts breaking a lot they give the rest of the third-party companies a bad name. So just make sure they have a good reputation

requirements. If buying a used unit is a viable option, do your homework and you can save a lot of money using a reputable third-party provider. Also focus on maximizing your productivity by identifying proven legacy CT systems which have reliably provided high image quality and don’t just assume “more slices” is better for your needs. Gugel: Price, capability and expected life usage are all things to consider.

LEON GUGEL

SARAH LEE

President, Metropolis International LLC

Vice President of Sales, Medical Imaging Technologies Inc. (M.I.T.)

Probst: I would look for a provider with processes that are tried and true. If they refurbish equipment take a tour and evaluate the people, facility and processes as you are making a large investment. If you are buying used equipment with a turn-key installation review the company’s project management program and ensure they have seasoned engineers, room planning drawings and a contract that protects both parties. Reputable companies stand behind the equipment that they sell with either a warranty or service contracts.

for the customer to see and scan on the system during refurbishment and prior to delivery of the scanner that they purchased. Three, a field service team that can properly support the warranty and the unit for service after warranty.

Struiksma: One of the most important things to look for when choosing a third-party provider is, can they deliver what they offer? There are a lot of options to choose from and some of those options look great on paper but you need to do some investigation and see what resources they have in place in order to accomplish the job. Walker: Three things highlight a quality, independent CT equipment provider. One, the facility and the staff to do a quality remanufacture of the CT. Two, the ability

WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING CT?

Lee: Use a third-party if the company has a good reputation. It will save you a lot of money purchasing equipment and service from them. Also, third-party companies are not huge like the OEM so they still care about the customer. Usually when you call they will be on the way immediately to check it out instead of pushing you to the back burner for a little while. Probst: If you are buying pre-owned or refurbished equipment you have the luxury of looking for models that have excellent after sales support by the third-party market. Many times the most cost-effective equipment up front is not the most cost-effective to support. There are many differences in a “refurbishment” or “reconditioned” piece of imaging equipment. Make sure to do your homework and ask the key questions that will set one vendor apart from another.

Anderson: Reputation is the biggest key for me. It doesn’t matter how big or small the provider is, to me it’s can I count on them to be fair and reliable? Cost shouldn’t be the sole determining factor for service or procurement, sometimes you do get what you pay for. An example would be if I could get a tube changed for $3,500 and it gets done right in seven hours versus two days for $2,000, I am paying the extra $1,500.

Struiksma: Realistic needs versus the latest and greatest. In purchasing and servicing you need to evaluate your needs and get what fits your needs best. Much like shopping for a used car you can get a brand new, big impressive car that may feel great but in the long run it may be better to get the less impressive car with better reliability. They both drive down the road, but do it in a different way.

Fernandez: Get an overall understanding of the department’s needs prior to making a purchase. Knowing what is important to them will help steer the purchase including their post install service

Walker: Seeing and scanning on the unit you are purchasing assures that you and your staff are getting the system that meets your needs. Purchasing from someone who won’t or can’t let you see

THE ROUNDTABLE

JEREMY R. PROBST

NATHAN STRUIKSMA

RANDAL WALKER

Chief Operating Office, Technical Prospects

Field Service Manager, Southwest Medical Resources

Vice President, CT and MR, BC Technical

your system can be problematic at the time of installation completion and system turnover. It is better to have the chance to get all of your concerns addressed prior to paying the final payment.

WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK IS IMPORTANT FOR BIOMEDS TO KNOW ABOUT CT EQUIPMENT? Anderson: If you’re serious about servicing CT scanners, I would suggest the following steps. 1. Thoroughly read the safety section of that system’s service manual. 2. Find an experienced mentor and tag along on some PMs, even if it’s on your own time, it will pay dividends later. 3. Read, read and then read some more, start with the theory. 4. Once you have some exposure and feel comfortable, book a class with a company with trainers who have real experience on that system, you don’t want a lesson plan reader. Fernandez: One critical factor in properly maintaining CT systems is to complete comprehensive PMs per manufacturer’s

1TECHNATION.COM

recommended schedule and checklist. A CT combines ionizing radiation, sensitive imaging detection circuitry, high torque motion assemblies and, in some cases, liquid cooling plumbing. It’s very important to remember personal safety, including radiation hazards and compliance with all state and federal regulations (state registration, timely submission of 2579 forms, etc). Depending on whether the unit is air or water cooled, there will be different preventative maintenance requirements. Know your torque specs. Over/ under-tightening can lead to metal strain, loose assemblies and equipment failure. Also, another very important tool you have is your ears – listen to the pitch, oscillation, and rhythm during high-speed rotations. An experienced ear can identify problems not found in other test results. Gugel: Systems must be able to be easily serviced and maintained with parts – not just purchased from a cost-only basis.

way when they call the service engineer they can already have an idea of what the problem is and thet can bring the parts to fix it when they come. Probst: It is important to be aware of third-party companies providing specific technical training on many manufactures CTs. Along with training having access to X-ray tubes (alternative/new/pre-owned), quality-tested parts and technical support will help lower the overall service cost significantly. Our company focuses specifically on Siemens however there are many others offering GE, Toshiba and Philips support. Walker: Like all electronic systems it is important to have the most reliable system you can get. Partnering with a company that will let you see your system prior to delivery and one that is flexible in providing the biomed staff training for first response on repair should be a deal breaker for those that can’t meet the grade.

Lee: It helps save the department time and money if one of the biomed personnel can learn to do first call that

NOVEMBER 2014 SEPTEMBER 2015

THE ROUNDTABLE

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TRAINING OPTIONS FOR HTM PROFESSIONALS 21st Century Solutions BY K. RICHARD DOUGLAS

n the age of the Internet, when everyone and every database can be connected and accessed, the opportunities for learning are abundant. Anyone with an Internet connection can enrich their knowledge and skill set from sources around the world or in their backyard. While the classroom remains the quintessential place to expand one’s knowledge, the computer chair or easy chair will suffice as well, with a Wi-Fi connected device or a home PC.

ith many W for-profit educational outlets implementing biomedical programs, it’s good to know there is a standard which they should be following. Over time, these standards will be invaluable for both students and employers.

JOHN NOBLITT

M.A., Ed., CBE Caldwell Community College

Whether in a college classroom, technical school or online, training helps further one’s knowledge, improves a professional’s value to an employer and adds to an HTM professional’s technical skill set. It all goes to the bottom line of professional competency and can aid in career growth. Whatever the venue for training, there should be a recognized standard according to Caldwell Community College Program Director, John Noblitt, M.A. Ed., CBET. “With AAMI publishing the core curriculum standard for biomedical education, this allows potential students to make sure that the education they receive meets industry standards,” he says. “These standards are also useful to employers, as they can tell if a college has implemented the standard and what information is being covered in a potential employee’s educational track.” “As the last several years has created an explosion in biomedical programs, some form of standard needs to be implemented, and I thank AAMI for leading the charge on that front,” Noblitt adds. “With many for-profit educational outlets implementing biomedical programs, it’s good to know there is a standard which they should be following. Over time these standards will be invaluable for both students and employers,” he says. Noblitt says that the next step in this process is to have all programs, that have 44

1TECHNATION.COM

- John Noblitt implemented these standards, become certified through ABET and AAMI.

KEEPING THE CLASSROOM RELEVANT Technical capabilities and troubleshooting acumen may be central to the training and education of a new HTM professional, but other skills play an important role as well. Those who develop the curriculum for HTM training programs need to tweak their offerings as the field changes. “Early in the process of developing the program, I asked prospective employers what skills were important for them to see in potential employees. Without exception, employers bemoaned the lack of soft skills demonstrated by employees at every level,” says Giovanna A. Taylor, B.S., MHSA, director of the Biomedical Technology/ Medical Devices program at St. Petersburg College. “They pleaded with us to find a way to prepare students who not only had technical skills, but solid soft skills. The key skills they wanted prospective employees to demonstrate were: be on time, put down the cellphone, speak and write in full sentences, know how to work on a team, and have critical thinking/problem solving skills,” Taylor explains. Giovanna says that the answer to the needs of the employers of HTM professionals was to include these non-

SEPTEMBER 2015

technical, non-electronics elements in an academic program. Her program was developed with an advisory board of experts from the medical device industry, the local HTM biomedical association and clinical engineers from a local health care system. “I immediately went to work designing a program that would help students develop these skills,” she says. “So how did we do this? First, we developed a course that focused solely on job readiness skills, such as resume writing, interviewing skills, job searches, portfolio development, etcetera. While this was a good start, I felt that soft skills needed to be embedded into the curriculum, so students are required to work on group projects, develop and demonstrate personal presentation skills through class assignments, volunteer at local hospitals, participate in professional organizations and attend professional conferences.” The program also requires students to interview managers at local companies and invites guest speakers into the classroom to help students understand the realistic expectations of potential employers. There is a field experience element to the program as well, as part of a job readiness course. Roger Bowles, MS, EdD, CBET, department chair/professor in the Biomedical Equipment Technology Department at Texas State Technical College, says that today’s HTM

professional has many options for obtaining training and that more, in terms of a time commitment, isn’t necessarily better. “Recently, I remember reading a discussion on one of the forums about which four-year degree a currently working BMET should pursue. I think the guy asked whether an IT-related degree would be better than an engineering technology degree (he already had an associates in biomedical equipment technology),” Bowles says. “I believe the consensus was — and I totally agree — that diversification would be better than getting a more advanced engineering technology degree. I think biomeds these days have a variety of options for furthering their formal education,” he adds. “At least here in Texas, there are many state universities that offer degrees with online options that are much less expensive than the heavily advertised for-profit schools. Degrees in technical management, information systems, business, etcetera, are all good options depending on where the individual sees his or her career going.” Changes seen in the HTM field, in addition to a focus on soft skills, have been the drivers for the evolution in the program that Noblitt directs. “The program here at Caldwell has changed over the years by mostly adding ‘networking’ classes. However, I feel more focused training in networking needs to take place so the students see a more seamless transition from medical device troubleshooting to network troubleshooting and how much networking will affect their lives in their new career,” Noblitt says. “We have also implemented some assignments and learning outcomes that will strengthen the students’ verbal and

ROGER BOWLES

M.S., EdD, CBET Texas State Technical College

written communication skills,” he adds. “I often see students that are pretty good technically, but struggle with communication issues and these students have a hard time finding employment as they seem to be incapable of selling themselves in an interview.” For students who are in the St. Petersburg, Florida area, the Waco, Texas area or the Hudson, North Carolina area, the programs at St. Petersburg College, Texas State Technical College and Caldwell Community College make for a solid classroom experience. The classroom remains the basis for HTM education and career entry.

TURNING TO THE INTERNET Advances in technology, and the Internet in particular, have revolutionized many approaches to training and educating participants with distance learning. One method that has been exploited productively, and that has garnered a lot of popularity in many occupations, are webinars. AAMI University is a popular online destination for education and training related to the development and use of medical devices and technologies. The classes and curriculum have been developed in close consultation with industry leaders, regulators (including the FDA), The Joint Commission and subject matter experts,

according to AAMI. AAMI wants healthcare technology management (HTM) professionals, and other staff at health care delivery organizations, to know they can find a host of learning options, covering everything from medical equipment maintenance to sterile processing to the development of soft skills. To browse their course catalog visit university.aami.org The course offerings include everything from “Quality System Requirements and Industry Practice” to “Radiation Sterilization for Medical Devices” to “Best Practice Recommendations for Infusion Pump-Information Network Integration.” The webinars, publications and on-demand courses are part of 151 such offerings. Another good source for online training is ECRI Institute. Several times a year, ECRI Institute’s Health Devices Group conducts interactive web conferences on medical device-related topics of interest to the health care community. These sessions combine advice from ECRI Institute’s experts with real-world insights from hospital guest speakers to help health care organizations tackle issues such as dealing with medical device safety hazards, making smart device purchasing decisions, and best practices for managing medical technologies. Recent topics include ECRI Institute’s Top 10 Health Technology Hazards list, Ebola, equipment preparedness and alarm-related problems. TechNation’s Webinar Wednesday series is another popular option for remote learning. “TechNation’s Webinar Wednesday series is now in its second year and the program has far exceeded my expectations,” says Jayme McKelvey, sales representative and webinar marketing manager at MD Publishing. “Our 75-minute webinars touch on pertinent

TRAINING OPTIONS FOR HTM

information within the HTM Community. We seek out leading manufacturers, as well as popular HTM leaders, to help bring top-quality education to the series.” McKelvey says that most of the webinars are eligible for 0.1 CE credits from the ICC. She says that the average attendance per webinar has grown 108 percent from last year. “This means we are awarding certificates of attendance to more HTM professionals,” she says. “Convenience is important to us too. Attendees can join our webinars from their computer, tablet or smartphone. We record our webinars and post the video to www.1technation.com should the 2 p.m. ET start time not be conducive to someone’s schedule,” McKelvey explains. Just beyond the halfway mark for the year, the participation rate in the webinar series has already matched the total attendee numbers for 2014. “That stat alone proves the popularity for Webinar Wednesday is rapidly flourishing. I am enthusiastically waiting to see what’s in-store for the rest of this year, as well as the future of Webinar Wednesday,” McKelvey says. Attendees continue to give the series positive reviews. “As busy as my schedule is, I always make time for this webinar series. It has provided me with valuable information – both new and refreshed – that I use on a regular basis,” one biomed wrote in a post-webinar survey.

CERTIFICATION TRAINING In many professions, some type of certification training, and testing completion, indicates a thorough knowledge of the profession and often a commitment to continuing education.

1TECHNATION.COM

JAYME MCKELVEY

Sales & Webinar Marketing Manager MD Publishing

Certification is a part of the HTM profession as well and includes exam completion paired with work experience. The certifications are for biomeds, imaging engineers and laboratory equipment specialists. Falling under the umbrella of professional development, the three primary certifications under consideration by HTM professionals include Certified Biomedical Equipment Technician (CBET), Certified Laboratory Equipment Specialist (CLES) and Certified Radiology Equipment Specialist (CRES). For those in management and quality assurance, there are also the Certified Healthcare Technology Manager (CHTM) and the Certified Quality System Manager (CQSM) designations. The first three certifications cover understanding physiological principles, safe application of biomedical equipment and theory of operation. Another source of certification training is from Noblitt. The BMET program director has developed the training to be available online. “Currently there is a study process with many resources for the CBET certification exam. Within a year, there will be assistance for those seeking certification as a CRES or CLES and the new CHTM exam,” Noblitt says. “This training opportunity uses many resources to prepare

SEPTEMBER 2015

individuals for the certification process with review materials, practice exams, podcasts, blogs and live review sessions with myself and other certification seekers.” Noblitt says that it is his goal to have certification seekers commit to a six-month study process with the intensity of the review increasing as the exam date approaches. He says that he is a firm believer that cramming for the exam is a good way not to pass and that a slow steady review process will produce better retention of the exam preparation materials. His resource can be found at www.htmcertifications.com. Organized group study, or self study, are the methods used by most HTM professionals to prepare for one of the exams. The benefits aren’t only a structured review of all the material, but also an overview that considers what is actually included in each exam. “We (CABMET), do a review course for CBET, CRES and CLES. The test(s) has been updated to include an IT section of the test. We have updated our review to include a class dedicated to IT review. We also have meetings that cover technology advances. Some of our meetings will be available soon by Webex recording,” says Dave Scott of the Colorado Association of Biomedical Equipment Technicians and the go-to guy for CABMET’s study group. “[The] CABMET Study Group is now in its second decade. We have been able to help close to 2,000 people get their certification in that amount of time,” Scott says. “We have had several members of our group get the highest scores on all three of the tests year after year. I think we are the leader in the industry for certification prep. Our results speak for themselves.” Scott will lead a CBET Review course at the upcoming MD Expo in Las Vegas. The one-day session starts at 9 a.m. and ends at

We have been able to help close to 2,000 people get their certification in that amount of time,” Scott says. “We have had several members of our group get the highest scores on all three of the tests year after year. I think we are the leader in the industry for certification prep. Our results speak for themselves

DAVID SCOTT

CBET, Study Group Organizer, CABMET

- David Scott 4 p.m. The interactive review session will help attendees brush up for the CBET test. This review will cover all aspects of the test. The organization that created the CBET certification offers many resources online for every facet of each of the HTM-related certifications. AAMI’s website provides many resources that encompass everything you need to know about certification. A good starting point is www.aami.org/ certification/. One of the many benefits of local HTM associations and societies is the many training opportunities that exist for members. Sometimes those association groups are able to project their experience into the local market to provide training to others. “Our organization is in the beginning stages of establishing an Education Advocacy group,” says Keith Waters, president of the Oregon Biomedical Association. “The committee will work with the local community college BMET students in bringing in current Healthcare Technology Management (HTM) professionals to give free lectures on different aspects of HTM that they do not get through their text or labs during class.” Waters says that the committee will offer support to manufacturers of medical equipment by helping to fill seats in classes they offer locally. “Such as when Philips comes to town

with a monitor repair class,” Waters explains. “It is my hope that they communicate to the OBA and we can ensure that every seat is filled. This may increase the number of classes that are held locally versus having to travel to other cities.” The MD Expo, hosted by MD Publishing, also offers training opportunities. The bi-annual conference includes an education component with wide-ranging topics and expert instructors. The MD Expo has proven to be a mainstay source of education for more than a decade. The next MD Expo is being held in Las Vegas this October. For more information, visit MDExpoShow.com. MD Publishing offers educational sessions for medical imaging service professionals at the Imaging Expo. The recent 2015 conference in Indianapolis was featured 24 continuing education credits approved by the American Society of Radiologic Technologists (ASRT).

MILITARY TRAINING Of course, no story about HTM training would be complete without mentioning the Department of Defense BMET training program that is a tri-service effort. The Medical Education and Training Campus Biomedical Equipment Training Program provides training for more than

400 military service members from the Army, Navy, Air Force and international students annually, according to those who run the program. The basic BMET program is 41 weeks – 205 training days – in duration and is comprised of 12 courses. Each course is 17 days in length. Students receive eight days of didactic lecture followed by nine days of hands-on performance based training. Navy students complete an additional five courses totaling an additional 13 weeks of training, according to the program’s outline. The BMET Program also offers 10 functional courses ranging from four to 20 days in length. These functional courses provide training on items such as computer-based medical systems, telemedicine systems, mammography systems, advanced radiography systems, ultrasound, advanced sterilization systems, radiographic acceptance procedures, computed tomography systems, medical maintenance management and advanced field medical systems. For those getting their HTM training through the military, or the many civilian opportunities, the choices for furthering ones HTM education, or preparing for a career in the field, are extensive. Look for further refinements in the evolution of HTM training, whether you are sitting in a classroom or your easy chair.

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CAREER CENTER How to get People Hired By Todd Rogers

ast Thursday, I received a call from one of our hiring managers asking for an update on the status of a position she has open.

TODD ROGERS Talent Acquisition Specialist for TriMedx, Axess Ultrasound, eProtex and TriMedx Foundation

1TECHNATION.COM

She had several questions: “How many candidates do we have?” “Are we running ads on XYZ site?” “What are we doing with the schools?” My answers were pretty straight forward: “Two, no, and nothing.” Initially she was shocked and even a little frustrated. However, I took the opportunity to explain to her that the three sources that she mentioned rarely show results for the kind of position that she’s trying to fill. Alternatively, what we are doing involved other avenues which have proven time and time again to produce high-quality candidates who typically matriculate into productive and loyal employees. The call ended with her being pleasantly surprised and assured that although it doesn’t move at lightning speed, our system works and it works consistently. How do we find people for jobs? A better question might be, how do we get found by talented and dedicated people? Alternatively, how do talented and dedicated people look for and secure good jobs? The answers to these questions are contained herein. So, whether you’re a hiring manager or a job seeker, the following paragraphs will give you a glimpse into the matchmaking venues where job seekers unite with employers.

SEPTEMBER 2015

Four years ago, we undertook an examination of how our employees found their way to our payroll. We randomly selected 25 people and investigated how each one was introduced to TriMedx as a potential employer and subsequently how the initial contact was made between that person and someone here who lead them to an employment offer. If you’re reading this from the perspective of a job seeker, this should serve to help you apply your time and resources of the most productive methods of getting in front of potential employers. If you’re an employer, you might be wise to apply your time and resources with the hopes of securing the highest caliber of talent. Of the 25 people we selected, only one person was the product of a third-party recruiter (a.k.a. “headhunter.”) Admittedly, our company occasionally uses third-party recruiters from time to time; we have relationships with about a dozen of them and I personally get about 1-2 resumes each week from this talent channel. Of the nearly 400 people we hired that year, we used headhunters fewer than 10 times. We next identified six people who were discovered (and eventually hired) by having a resume published in a career database (AAMI, CMIA, CareerBuilder, etc …) Databases are fairly precise in what they deliver, but they are time consuming for the recruiter-user. They also have a price that is difficult to justify; annual user licenses are about $8,000 to $10,000 depending on the site. Niche sites are much lower but they also have talent pools that are much smaller.

Seven people came to us as a result of seeing an advertisement posted on a career site, LinkedIn, or any of the dozens of sites which are niche or are cross-posted from larger sites. The lesson here is, the good-ole-fashion “help wanted” sign still draws them in. But, there’s a catch to this one. We weren’t able to determine which advertisements were responsible for the original contact. In several cases, it was a specific job ad that drew a person in but when that person got hired, in many cases it was for a completely different job. What can be inferred is that advertisements produce hires but the connection is frequently indirect. One person was hired as a result of a college job fair. This was someone who walked up to our table at his respective campus and nervously handed his resume to one of our recruiters. He was interviewed over the course of two weeks and went on to be hired into our managertraining program. Ten people were hired through word-of-mouth referrals. This almost always proves to be the biggest bang for the buck. We do pay a referral incentive to our employees which certainly goes a long way at drumming up collective recruiting efforts across the enterprise. The simple fact is, word-of-mouth referred employees tend to be the most productive and they tend to remain in their jobs the longest. This metric is a little tricky in that the who-told-whom about a job is difficult to determine. Many of those conversations happen in private. Sometimes referral conversations happen between people who don’t work here; I interview someone who’s not a fit but he tells his buddy about the job who is a fit. His buddy goes to our career site and applies and we are never made aware that a word-of-mouth referral ever occurred. (Side note, there is only one casualty in word-ofmouth recruiting: the ego takes a slight bruise if the referred person doesn’t stay on long term, but that’s just how business works). As you can see, there is more than one way for an individual to find a job or for a company to find an employee. It is important to take note of what works well and use it to your advantage. No process is perfect, but some have proven to work better than others. Don’t limit yourself to one approach, but do be mindful of which ones get the best results.

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The Alphabet Soup of Ultrasound Accreditation Organizations By Matt Tomory

his article has touched on the American College of Radiology (ACR) requirements for ultrasound but I would like to dive deeper into the alphabet soup and look at the different organizations out there that encompass ultrasound accreditation.

Beginning with ACR, changes were made in 2014 to their requirements which include the frequency of required evaluations, inspections of the systemâ&#x20AC;&#x2122;s display, geometric accuracy as well as the main interpretation display if located on-site. For more information, please visit the ARC Ultrasound site at: http:// www.acr.org/Quality-Safety/ Accreditation/Ultrasoud. Another common organization is the American Institute of Ultrasound in Medicine (AIUM). Their maintenance and quality control standards are listed on their website www.aium.org and include: 1. Systems must be maintained in good operating condition and undergo calibration at least once per year. 2. Systems must be maintained annually, according to the manufacturerâ&#x20AC;&#x2122;s specifications or more frequently if problems arise. 3. There must be routine inspection and testing for electrical safety of all equipment.

MATT TOMORY Vice President of Sales & Marketing

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These standards are somewhat dated as most contemporary systems do not have calibration features accessible to service personnel but the requirement to maintain the system annually according to the OEM specifications is similar to the new Centers of Medicaid and Medicare Services (CMS) requirements for Preventative Maintenance. Looking at the cardiac and vascular side of ultrasound imaging accreditation organizations, we have the Intersocietal Accreditation Commission (IAC) which now encompasses the Intersocietal

SEPTEMBER 2015

Commission for Accreditation of Vascular Labs (ICAEL) and Intersocietal Commission for Accreditation for Echo Labs (ICAVL) accredited organizations. The quality control and maintenance standards listed on their website http:// www.intersocietal.org/intersocietal.htm require: 1. Recording of the method and frequency of equipment maintenance. 2. Establishment of a policy for routine safety inspections. 3. Establishing a cleaning schedule for the system and transducers. 4. The accuracy of the equipment should be tested annually using a phantom. This requirement stands out as it is the only time a tissue mimicking phantom is required (We use the line of ATS phantoms at Conquest Imaging due to quality, performance and durability). 5. Beginning December 31, 2015, IAC will require electrical safety testing of transesophageal transducers (TEE) between each use similar to The Joint Commission (TJC) requirements. The variety of organizations, changing standards and the fact that within a hospital you could potentially have several accreditation organizations overseeing a single facility or even department makes compliance challenging. FOR MORE INFORMATION or assistance, please email Matt Tomory at mtomory@conquestimaging.com.

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THE FUTURE Full Circle By Michael Overcash

ithin the last two years I changed jobs. I had the privilege to start my biomed career 20 years ago as a field service technician at a local X-ray repair shop. It almost ruined my career before it ever got started. But, luckily, I got the opportunity to move to an in-house shop at a hospital. This provided the resources and support to solidify my decision to become a biomed.

MICHAEL OVERCASH Biomedical Equipment Technology Instructor

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Now, after working in the field, I have returned to the school where it all started as an instructor. It was not an easy decision, but one that I am glad I made. As the statement goes, “I have come full circle.” My main goal is teaching the basics. Keep it simple. My students often hear me say, “put your eyes on it.” It is amazing what you see when you simply step back and take in the whole picture. I learned this through experience and usually learned it the hard way. Numerous times I would dive into the power supply before checking that the power switch was turned off or worse the unit was simply unplugged. I remember a time when I was called to change a collimator bulb in an X-ray unit at a local clinic. I replaced the bulb and still no light. I then proceeded to completely dismantle the collimator into a million pieces. Lets just say after the third day of being down the clinic X-ray tech was not a happy camper. As I was beginning to question my ability as a technician, I noticed a metal box on the wall not far from the collimator. It had the same manufacturer name as the collimator. I also noticed a fuse holder in the top of the metal box. Come to find out that was the power supply for the collimator and the fuse was indeed blown. If I had just opened my eyes a little wider, a three-day job would have been a 10-minute fix. Instructing students can be a challenging experience, but it is very rewarding when I see the light bulb go off and the learning begins. Using my own experience and training, I try to prepare students for the challenges ahead and the pitfalls to avoid. I try to teach them the acronyms and slang they will hear in a hospital setting. I had no idea what a

SEPTEMBER 2015

bovie was the first time I was asked to repair one from surgery. I had a student just recently say what a sense of accomplishment he got from repairing a piece of equipment during his internship at a local hospital. I know that feeling. Biomeds play an important role in every health care organization. This seems to get overlooked as most of the population does not think of the medical equipment needing repair. But it does and needs repair often. That is why we need quality-trained technicians in the field today. The equipment is becoming more sophisticated but the basics are still there. Knowing how to use your multimeter, how to use the test equipment, and how to read a schematic are just a few of the basics that will be used during a biomed career. But, most importantly, customer service is huge. Treating customers with respect and kindness is vital to this field. Communication is also important. Let the customers know what is going on during each step of the repair process. Emails, texts, phone calls, smoke signals, anything to inform the customer when the equipment will back up and running. Back to the basics. Back to where my career began. What a fun and rewarding time the past 20 years have been. Being a biomed is great, and I look forward to the next 20 years and helping the next generation of technicians become a valuable asset to health care organizations. MICHAEL OVERCASH is a Biomedical Equipment Technology instructor at Texas State Technical College’s Waco campus in Waco, Texas.

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PATRICK LYNCH

How do you do your PMs? By Patrick Lynch

have looked at the PM (Preventive Maintenance) practices for many hospitals. I am scared by what I see in many places.

PATRICK K. LYNCH, CBET, CCE Biomedical Support Specialist for GMI

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As we all know, there are hundreds of different types pf patient care equipment. When you factor in the different manufacturers and models, there are literally thousands of different items which we are asked to maintain. A major part of the job of an HTM professional is to perform scheduled (or routine) maintenance on these items to make sure that they are operating in a safe, reliable, accurate and predictable manner. This is how quality patient care can be maximized. Can we expect HTM professionals to remember each and every test procedure for each and every different item of patient care equipment in the hospital? No way. It is for this reason that we are asked to either follow the manufacturer’s recommended maintenance procedures, or develop our own written and controlled procedures which standardize and guide the technicians through the testing and checkout process. HTM shops have several ways of managing their PM procedures. Here are a few: 1. Some have a blanket statement that refers the technician to the manufacturer’s literature for the PM procedure to be completed. 2. Some reproduce the manufacturer’s procedure in their CMMS (computerized maintenance management software) system to make it available for the technician when the PM is due. The original PM may either be retyped or

SEPTEMBER 2015

scanned into the computer. 3. Some have a master PM book, which has master copies of all PM procedures. The technicians carry this around and refer to this book to see which tasks to perform when a PM is due. 4. Still others have no reference, merely telling the technician to perform the manufacturer’s PM. Whichever of these processes you might use, it still requires each shop to research the PM requirements for every different model of equipment in the PM program and figure out how to make the substance of it available to the technician performing the work. I believe this is ineffective and inefficient for a couple of reasons. First, there is a tremendous amount of redundant work being done for each one to research the very same model of equipment to determine the PM procedure. Second, there is a lot of variability in the work philosophy from manager to manager, so the amount of detail will vary according to who is doing the review and determination. I recommend the following: Let’s create a central repository for PM procedures for medical devices. This repository can then be accessed by anybody, modified at their discretion, and provide a starting point that is much easier to use and access than researching hundreds of individual manufacturer service manuals. It would work like this: First, we would have to assemble a committee to set some guidelines for the creation of the PM procedures. They might have to be different for general biomedical, imaging laboratory and IT equipment.

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Next, we would need a repository for the procedures. I was thinking that MedWrench at MD Publishing might be the perfect place, since they already have most equipment models identified and could simply add a tab under each one for “PM Procedure.” Different people could contribute their procedures to the repository, under the appropriate review and scrutiny. People could then comment on the individual procedures, in case there was something left out or in error. If a system like this could be created, it would relieve the pressure on everybody to create their own procedures and provide access to streamlined, appropriate procedures that everybody can use. This should also keep CMS, DNV, TJC and others happy. Anybody have comments of suggestions on this plan? Anybody want to be a part of the planning for it?

THE ROMAN REVIEW

Decisions Decisions By Manny Roman

ccording to multiple sources on the Internet, the average amount of remotely conscious decisions an adult makes each day equals about 35,000. In contrast, young children only make about 3,000 decisions each day. We know this is true. As the commercial said, “You can’t put anything on the Internet that isn’t true.”

MANNY ROMAN CRES, Founding Member of I.C.E. imagingigloo.com

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Obviously most of these decisions are not earth shattering: Coffee instead of soda, burger instead of taco, etc. Some decisions require additional analysis and effort. I want to discuss these. First let’s define a decision as: A choice made (a conscious act) between alternative courses of action (requiring action) in a situation of uncertainty (in spite of uncertainty). This means that a decision is a choice and that some action must be taken as a result of the decision (taking no action is an action). A decision is made in an environment where the result of the decision is uncertain. You just can never be absolutely sure of the outcome. You will only truly know if it was the right decision after it is made and implemented. A decision is a commitment of resources today for expected results tomorrow. This is a good time to point out that if you made the right decision using the available information, the arrival of new information, after the decision, does not make the decision bad. New information may make the outcome or result unfavorable. It does not make the decision bad. If you used a good decision-making process while making the decision you made the correct decision for the circumstances. Few decisions are made with full knowledge of all future consequences. Any discussion of decision-making requires the discussion of personalities

SEPTEMBER 2015

since a person’s personality greatly influences their particular decisionmaking process. This includes the information gathering, the information evaluation, how much information is needed, how quickly the decision is made, loyalty to the decision, readiness to accept/admit fault, and many other things. Here are the general decisionmaking issues of the four major personality types. Extroverts are intuitive, decisive, quick to conclusions, not fact oriented. They are quick, emotional and make direct gut-decisions. Information gathering and analysis is boring to them. They are likely to change the decision quickly in the face of new information without much analysis. Analyticals are the opposite type to the extrovert. They are logical and indecisive needing much more information since they are very fact oriented. They hesitate to make decisions fearing that they do not have all the facts. New information after the decision is made requires much analysis. It serves to make the point that the decision was made without proper analysis in the first place. Pragmatics are very logical and decisive. They do not look to be creative and are not people oriented. Once the decision is made, it’s made. They tend to stick with it even in the face of new information. Don’t ask a pragmatic how the people will be affected since this did not receive much consideration.

Amiables are the opposite of the pragmatic. They are very considerate of others, hesitant to make the tough decisions and very people oriented. The amiable’s concern is how the decision will affect the people and they will agonize over this. So you see, that different personalities require different information, analyze that information differently and look for different outcomes for different reasons. As a decision-maker, you should try to identify where you are relative to the above descriptions. Are you slowed by concerns for how your decision will affect others? Are you quick to decisions because you do not want to perform the boring information analysis? Do you prefer to make quick, unemotional, fact-based decisions? Do you feel the need to gather all the possible information and to have contingency plans in place? You can imagine, for example, an amiable and a pragmatic making a decision together. The amiable has a great deal of concern for others and wants to spend time analyzing that. The pragmatic wants to get to the decision quickly and unemotionally based on available facts. The amiable will think

the pragmatic is insensitive while the pragmatic will think the amiable is wasting time on mushy stuff. So what does all this mean? Our personality type influences our own decision-making process. Add another person or two to the mix and the process becomes more complex. In my opinion, the most effective way to get to a decision is to begin with well-defined objectives that are specific and measurable. Ensure that the agenda concentrates on moving all discussion toward those objectives. Give everyone involved a specific time limit to make their point. Then, make the decision. A very important point regarding group decision-making is that, once the decision is made, all those involved agree to “murder the unchosen alternatives.” This does not mean to forget that there were other alternatives. It means to commit your time, talent and tools to supporting the chosen option. Realize that it is human nature to look for evidence against the decision if you did not agree with it and resolve to look for ways to support it. The alternative is to sabotage the decision, cause chaos, and go find another job.

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THE VAULT

o you consider yourself a history buff? Are you widely regarded among coworkers as an equipment aficionado? Here is your chance to prove it! Check out “The Vault” photo. Tell us what this medical device is and earn bragging rights. Each person who submits a correct answer will be entered to win a $25 Amazon gift card. To submit your answer, visit 1TechNation.com/vault-september-2015. Good luck!

LAST MONTH’S PHOTO The heating element out of a Gomco model 765A Thermonic Drainage Pump. The photo was submitted by Mark Fountain from UC Davis Medical Center. To find out who won a $25 gift card for correctly identifying the medical device visit 1TechNation.com.

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BULLETIN BOARD

new resource where medical equipment professionals can find all the information needed to help them be more successful! The easy to navigate Bulletin Board gives you access to informative blogs, expos and events, continuing education opportunities, and a job board. Visit www.MedWrench.com/BulletinBoard to find out more about this resource.

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(check only one) m Clinical, Biomedical or Radiology Engineer m Biomedical Equipment Technician m Service/Support Manager m IS/Network Manager m Purchasing Manager m Sales/Marketing Manager m Department Administrator/ Director or Manager m Other (please specify) _______________________________________ _________________

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2. What is your company’s primary business? (check only one) m Hospital or Clinic m Medical Equipment m Computer/IT Equipment m Dealer or Distributor m Multivendor/Independent Service Organization m Depot Repair m Education/Training m Consulting m Other (please specify) ____________________________ ____________________________

SEPTEMBER 2015

3. Please check the statement that best describes your role in purchasing products/technolgy: (check only one) m Make final decision m Specify/recommend m No part in purchasing

4. Type of facility/business: (check only one) m ISO m OEM m Self Employed m Other (please specify) _________________________ _________________________

INDEX

What do you love about

2D Imaging………………………………………… 29 Ph: 800.449.1332 • www.2dimaging.com

Maull Biomedical Training………………………… 53 Ph: 440.724.7511 • www.maullbiomedical.com

4med………………………………………………… 57 Ph: 888.763.4229 • www.4med.com

MedWrench…………………………………………64 Ph: 866.989.7057 •www.medwrench.com

AIV Inc.……………………………………………… 24 Ph: 866.656.0755 • www.aiv-inc.com

MIT/ Medical Imaging Technologies……………… 53 Ph: 800.723.4776 • www.mit-tech.com

AllParts Medical…………………………………… 27 Ph: 866.507.4793 • www.allpartsmedical.com

National Ultrasound……………………………… 51 Ph: 888.737.9980 • www.nationalultrasound.com

Ampronix…………………………………………… 19 Ph: 888.700.7401 • www.ampronix.com

Pacific Medical LLC………………………………… 7 Ph: 800.449.5328 www.pacificmedicalsupply.com

AMX Solutions………………………………………48 Ph: 866.630.2697 • www.amxsolutions.com

PartsSource, Inc.…………………………………… 39 Ph: 877.497.6412 • www.partssource.com

BC Group International, Inc. …………………… BC Ph: 888.223.6763 • www.bcgroupintl.com

Philips Healthcare………………………………… 55 Ph: 800.229.64173 • www.philips.com/mvs

BC Technical, Inc.…………………………………… 8 Ph: 888.228.3241 • www.BCTechnical.com

Prescott’s Inc.………………………………………64 Ph: 800.438.3937 • www.surgicalmicroscopes.com

BMES/Bio-Medical Equipment Service Co.……… 61 Ph: 888.828.2637 • www.bmesco.com

Pronk Technologies………………………………… 5 Ph: 800.609.9802 • www.pronktech.com

Conquest Imaging………………………………… 11 Ph: 866.900.9404 • www.conquestimaging.com

Radcal Corporation………………………………… 57 Ph: 626.357.7921 • www.radcal.com

Digirad Corp.………………………………………… 33 Ph: 877.902.2688 • www.digirad.com

Rieter Medical Services……………………………65 Ph: 864.948.5250 • www.rietermedical.com

ECRI Institute………………………………………49 Ph: 610.825.6000 • www.ecri.org/alarmsafety

RSTI/Radiology Service Training Institute……… 4 Ph: 800.229.7784 • www.RSTI-Training.com

Ed Sloan & Associates……………………………… 63 Ph: 888.652.5974 • www.edsloanassociates.com

RTI Electronics, Inc. ……………………………… 55 Ph: 1.800.222.7537 • www.rtigroup.com

Elite Biomedical Solutions………………………… 61 Ph: 1.855.291.6701 www.elitebiomedicalsolutions.com

Sage Services Group………………………………59 Ph: 877.281.7243 • www.SageServicesGroup.com

Engineering Services……………………………… 18 Ph: 330.425.2979 ex:11 • www.eng-services.com First Call Parts……………………………………… 23 Ph: 800.782.0003 • www.firstcallparts.com Global Medical Imaging…………………………… 2 Ph: 800.958.9986 • www.gmi3.com Global Risk Services………………………………… 63 Ph: 630.836.9000 x.110 www.globalrisksservices.com

Siemens Medical Solutions USA, Inc.…………… 3 Ph: 1.800.743.6367 • www.usa.siemens.com

$100 POKER CHIP

Southeast Nuclear Electronics……………………65 PH: 678.762.0192 • www.southeastnuclear.com

at MD Expo Vegas, or a pizza party for your department!

Southeastern Biomedical………………………… 27 Ph: 888.310.7322 • www.sebiomedical.com Stephens International Recruiting Inc.………… 51 Ph: 888.785.2638 • www.BMETS-USA.com Summit Imaging…………………………………… 6 Ph: 866.586.3744 • www.mysummitimaging.com

ISS/ Injector Support & Service, LLC……………… 24 Ph: 888.667.1062 • www.digirad.com

Tenacore Holdings, Inc.…………………………… 41 Ph: 800.297.2241 • www.tenacore.com

InterMed Biomedical… 31Ph: 800.768.8622 • www. intermed1.com

Tri-Imaging Solutions………………………………30 Ph: 855.401.4888 • www.triimaging.com

International Medical Equipment & Service…… 21 Ph: 704.739.3597 • www.IMESimaging.com

USOC Medical……………………………………… IBC Ph: 855.888.8762 • www.usocmedical.com

JD Imaging Corp.…………………………………… 33 www.RadiologyAuction.com

Valcon Partners……………………………………65 Ph: 815.477.1000 • www.valconpartners.com

INDEX

Send us a video telling us your favorite part of MD Expo and you could win a

Soaring Hearts Inc…………………………………48 Ph: 855.438.7744 • www.soaringheartsinc.com

ICE/Imaging Community Exchange………………40 www.imagingigloo.com

KEI Med Parts……………………………………… 29 Ph: 512.477.1500 • www.KEIMedPARTS.com

MD Expo and TechNation magazine are holding a special video contest!

Visit

1TechNation.com/ VideoContest for full details and to submit your video!

SEPTEMBER 2015

1TECHNATION.COM

“ You set a goal to be the best and then you work hard every hour of every day, striving to reach that goal. If you allow yourself to settle for anything less than number one, you are cheating yourself.” – Don Shula, Hall of Fame Football Coach

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SEPTEMBER 2015

BREAKROOM

U LT R A S O U N D L E A K A G E T E S T I N G Are your patients at risk? Is your equipment being damaged? Are you IAC Section 2.2.3B compliant? BC Group’s ULT-2020 is the Solution:

Protects your patients

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O p t i o n al P ri n te r Fully Automated Testing: One Button Test Mode Complete test in less than a Minute Automatic Self Tests Multiple Data Points Easy to Read Pass/Fail

Old rubber pad adapters can damage your probes. Our “Soft Touch” connectors prevent costly repairs.

Old Rubber Pad

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Phone: 1-888-223-6763 Email: sales@bcgroupintl.com Website: www.bcgroupintl.com ISO 9001 & 13485 Certified ISO 17025 Accredited