Cd august issue by Color Doppler

August, 2013

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Interview: Jeffrey M Bundy | p15

Magnetic Magic:

Siemens ultrasound CEO elaborates on companyâ&#x20AC;&#x2122;s future plans for Indian market

Focus: Recent trends in MRI

Vol 2, Issue 8, Pages 44

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India's First Complete Medical Imaging Magazine

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Creativity in Healthcare

inside scan

COLOR DOPPLER | August 2013 | Volume 2 | Issue 8

P18 | under the scanner

Magnetic Magic Magnetic Resonance Imaging (MRI), one of the safest methods of looking into a human body in detail, has revolutionized the diagnosis and treatment of diseases with no ionizing radiation threats. Riding on its advantages over other imaging modalities, MRI is set for a giant leap with more technologies being introduced into the segment every day, writes Rini Baby Thottil

P15

p15 | wordsworth

The Future Sound of Ultrasound A trendsetter in the healthcare industry, a single source offering customer products and solutions for the entire range of patients care, Siemens is on a mission to provide faster, better and cost-effective healthcare measures. Jeffrey M Bundy, CEO, Ultrasound, Siemens Medical Solutions, USA Inc, shares company’s future plans for Indian ultrasound market

p26 | talking point

“We Change Perceptions” Zonare acquisition is a big boost for Mindray and it will help the company to establish its position in the high-end radiology segment at a faster pace,says Ashwani Raina, Deputy Director at Mindray India

P13

p29 | product focus

Freedom from Dilemmas

columns

Acuson Freestyle, the ultrasound system from Siemens with wireless transducers, breaks the conventional norms in order to provide maximum mobility and flexibility while scanning. It brings a new level of ease-of-use besides providing superior image quality

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p40 | view point

Right Image at Right Dose Based on the company’s reliable, high-performance Innova platform, Innova 2100-IQ (Optima Edition) offers excellent image quality and dose efficiency at a lower price point and total cost of ownership, says Shireesh Sahai

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COLOR DOPPLER | August, 2013 Volume 2 | Issue 8 KERENG/2012/41766 editor-in-chief Joby Joseph joby@colordopplermedia.com publisher Niranjan Kumar K R M niranjan@indiaultrasound.com

editor’s note Equations for Patient Care An equation for me has no meaning unless it expresses a thought of God

design editor Gireesh gireesh@colordopplermedia.com

— Srinivasa Ramanujan, (The Man who Knew Infinity, A Life of the Genius Ramanujan by Robert Kanigel)

client relationship manager Saraswathy M saraswathy@colordopplermedia.com

An equation says that whatever is on the left side of the equal sign is equivalent to what is on the right. The world is being run on many equations that eventually convert themselves into applications purified by Research and Development. Equations, simply, are shortcuts to complex mathematical problems but they also have a social facet with many issues demanding their creation that improvise the life of human being on this planet called Earth.

chief correspondent Jumana Engineer jumana@colordopplermedia.com copy editors Rini Baby Thottil rini@colordoppleronline.com Ria Lakshman ria@colordoppleronline.com senior designer Sohan V K sohanvishnu@colordopplermedia.com designer, new media Amit Sudhans amit@colordoppleronline.com manager—product & HR Kishore Kumar P S kishore@colordopplermedia.com assistant manager, IT Swetha G swetha@colordopplermedia.com manager, accounts Hariharan V V assistant, accounts Shahana P shahana@colordoppleronline.com

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Color Doppler is now trying to formulate an equation that medical imaging manufactures do follow in the country through frequent interactions with heads who lead bandwagon for social changes through technological innovations in the country. Often, better patient care and cost effectiveness are placed on the right side of the equal sign in the equations that are followed by almost all the company. Any compromise in quality, even if it is for a good cause, will adversely affect the end result while any attempt on cost cut will bring the technology to more patients spread across the rural and urban areas of the country. How to reduce the cost without losing the quality is where the thrust should be given as far as the Indian conditions are concerned and the companies are now on the right track. With Siemens announcing Acuson Freestyle’s entry into the Indian market, it is all set to revolutionize patient care. By removing the impediments of wires, Acuson Freestyle establishes a new equation for user friendliness especially in areas such as point of care. In this issue, we bring to light how Siemens in general and Acuson Freestyle in particular revolutionise the patient care. Basically, the power factor differentiates a developing or under developed country from a developed nation. India is no different with frequent power failures. Hence, the medical equipment has to be made power efficient to keep the machine running at unfavourable conditions. GE healthcare has set a new bench mark with the introduction of its Green MRI concept and it is now trending across the globe. Meanwhile, Mindray is all set to change the perception on Chinese products with the acquisition of Zonare. The acquisition is likely to ‘help in establishing the companies’ position in the high-end sector’ as Ashwani Raina, Deputy Director at Shenzhen Mindray Bio-Medical Electronics Co. Ltd, pointed out in an interview with Color Doppler. Whatever the final equation be, Indian medical imaging sector is rapidly growing and developing aimed at better patient care driving on the cost factor and technology improvements. And, these equations should express a thought of patients. Meet you next month with more innovative products line up, till then happy reading.

Joby Joseph Editor-in-chief Follow me on twitter @editorjoby

Printed, published and owned by Niranjan Kumar K R M, 3/1614 C, Sridevi Niranjan, Near 6th Rly Gate, Nadakkave Post, Calicut-673011 and Printed at Anaswara offset Private limited, 48/2123-c Perandoor Junction, Elamakkara, Cochin 682026 and Published at 34/1347-A, Florican Road, Malaparamba, Calicut-673009. Editor: Joby Joseph.

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‘Samsung Connect’ launched The endless desire to battle at the forefront of technological innovations in the field of healthcare has leveraged Samsung to Samsung Health and Medical Equipment business (Samsung HME Biz). The successful journey is at another juncture with the launch of “Samsung Connect” – a quarterly newsletter. The newsletter will announce the readers about the upcoming products, services, user reviews, events and global news from Samsung ‘family’. Enriched with the messages from the

visionaries of Samsung corporate, the first Samsung Connect newsletter is an adornment to the Samsung HME’s efforts on social networking websites such as Facebook, Linkedin and Twitter. The newsletter intends to cross borders to a wide array of devoted minds in the medical industry. Samsung Connect will provide a snapshot of the digital revolution that is yet to unveil from the assiduous R&D interiors of Samsung. The threshold of success for Samsung is customer satisfaction and this newsletter is an extended bridge to reach them.

Carestream receives FDA clearance for new low dose compact wireless digital radiography detector It is time to bid adieu to high dose radiography detectors. Carestream Health, the worldwide provider of dental and medical imaging systems received Food and Drug Administration (FDA) approval for its new wireless digital radiography detector. The new detector, which is suitable for multiple applications, is capable to produce high quality, low dose pediatric X-ray exams. Helen Titus, Carestream’s Worldwide X-ray Solutions Marketing Director explains that the smaller detector can enhance patient care for premature babies and infants in the pediatric ICU. “It can fit into a tray located underneath an incubator, so technologists can obtain the images needed to monitor the condition of these fragile babies without moving them—which is an important benefit”,

she said. The smaller size (25 cm x 30 cm) and the high DQE (detective quantum efficiency) will release only lower dose radiation than computed radiography cassettes or gadolinium scintillator detectors. Thus, the hospitals can use the new detector to capture extremity and other general radiography exams. In orthopedic and general radiographic imaging, the detector will aid in positioning for tabletop exams, especially

in the examination of knee, elbow, skull and other exams that may require a patient to hold the detector. Flexibility is another advantage of the new detector. Dubbed as DRX 2530C detector, it can be used with any member of the DRX family of room-based and mobile imaging systems. Diana L Nole, the President, Digital Medical Solutions, Carestream said that the new invention is a result of the demand from healthcare providers worldwide for a smaller detector. “We will continue to expand our highly rated DRX imaging systems with new capabilities that address the patient care requirements of imaging services providers and their patients,” she added.

Mobisante all set to strengthen its presence in point-of-care ultrasound market Recently, the Washington based medical device company Mobisante announced the first closing of its Series A Financing. The syndicate included the W Fund and a group of Angel investors including several members of the Alliance of Angels. The financing will enable the company to expand its sales and marketing efforts to popularize its pointof-care ultrasound among the target

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audience. The decision came soon after the joining of two new members to Mobisante’s executive team - Marcus Y Smith as Chief Financial Officer and Dr. Bradley N Younggren as the Chief Medical Officer. Prior to Mobisante, Smith was the Chief Financial Officer of SonoSite, whereas Younggren served at Madigan Army Medical Centre. Loretta Little, the

Managing Director at WRF Capital, will also join the Mobisante board. With this, Mobisante expects to do another closing soon. “Companies like Mobisante are critical to improving access to affordable health

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news scan care. They are at the cutting edge of digital health and the convergence of consumer and health care technologies,” said Dave Eva, CEO of Avenue Medical Products, LLC, a Mobisante partner that leases its devices to surgeons and clinicians.

Covidien bisects medical devices and pharmaceuticals divisions Covidien pharmaceuticals, a leading provider of healthcare products has separated its drug business and medical imaging business. Now the drug business will be run as a separate company named Mallinckrodt. The new Covidien plans to focus on medical imaging diagnostics from 1st July 2013. The decision, which was announced much earlier in December 2011, is an effort to execute a more focused business plan for Covidien resulting in robust growth. On analyzing the sales figures of Covidien during fiscal 2012, the decision can be justified. The data says that the company has produced nearly $10 billion sales during 2012, evenly from US and non-US markets. Out of this, 80% of the company sales emerged from medical devices and only 20% were earned from medical supplies. Covidien plans to maintain its long-term financial goal of mid-single digit sales growth and double-digit adjusted EPS growth over time. There are also plans to leverage strong cash flow for long term profitable growth. It also stays committed to return 50% of its free cash flow to shareholders annually. In a statement given by the Chairman José E. Almeida it is said that the separation will enable the Covidien to concentrate on new product development and market expansion. “Covidien is well positioned to deliver on its strategic initiatives, including broadening innovation focus, aggressively managing its portfolio, capitalizing on emerging markets opportunities and optimizing spending to provide for investments in innovation and growth,” said Mr. Almeida. “We are maintaining our longterm financial goals and will continue to

target top-line growth at or above the markets in which we compete,” he added wishing success to Mallinckrodt, which is all set to run as an independent business.

Bad habits cost $33.9 billion annually to healthcare market: Study In an interesting research findings released by GE Healthcare, it is found that the bad habits and wrong lifestyle choices are contributing an approximate of $33.9 billion annually to the costs related to cancer. On the other hand, the healthcare industry could potentially save a total of $25 billion every year, if the bad habits are typically reduced. The bad habits mentioned in the study are smoking, alcohol consumption, poor nutrition and physical inactivity. The study was conducted by GfK Bridgehead on behalf of GE Healthcare in May and June 2013. The market chosen for the study were ten developed and developing countries. According to the results, USA is the highest contributor to the cost of treating cancer with a staggering 54% of the total $33.9 billion. This amounts to $18.41 billion. USA is followed by China with 25.3% ($8.57 billion), France, Germany and Turkey at 4.4% ($1.5 billion). The markets such as Brazil and Saudi Arabia have lower annual costs of cancer with mere 1.1% and 0.3% respectively. Apart from the cost factor, the study reveals some interesting causes that lead to cancer. According to the study, frequent inactivity of the body along with poor nutrition in men can increase the risk of developing colon cancer to an astounding 61%. This implies that the costs of treating colon cancer add up to $160 million worldwide. “The cumulative global cost of bad habits revealed in this research is staggering. I am encouraged by the potential savings that could be achieved by all of us just making a few small lifestyle changes and committing to a personal monitoring schedule,” said Jeff DeMarrais, Chief Communications Officer, GE Healthcare. He also said that the data reinforces the reason why GE’s annual ‘#GetFit’ campaign is so important in driving

education and awareness of the link between healthy choices, early diagnosis and the possible risk of cancer. The study thus calls for the need of a healthy lifestyle, such as maintaining healthy weight, proper diet and not smoking. However, the data shows that the bad habits are prevalent in all markets. Among the 10 countries, 25 percent of the population in seven countries constitutes regular smokers. France and Turkey have the highest number of smokers with 31% of adults smoking. GfK Bridgehead, which is a leading strategic healthcare industry, is a global market research provider for healthcare companies and works in partnership with many major companies. In order to develop this data, GfK has used clinical data from various countries and has also used data from the World Health Organization.

FDA clears Siemens low dose Mammomat T Inspiration Prime Edition Food and Drug Administration (FDA) has given clearance to Siemens new Mammomat T Inspiration Prime Edition mammography system. The new device claims to reduce patient’s radiation exposure level to up to 30% compared to conventional mammography systems. Unlike the conventional mammography devices, there is no scatter radiation grid in the new device. Instead, the device uses Siemens new reconstruction algorithm named as Prime (Progressive Reconstruction Intelligently Minimizing Exposure). The Prime algorithm automatically corrects the scattered radiation and recalculates the image using the primary radiation itself, enabling the physicians to receive high quality image without using high dose radiation. The device claims other features such as greater comfort, easy-touse, high speed and reliability. COLOR DOPPLER | AUGUST, 2013

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7th Congress of Asian Society of Cardiovascular Imaging August 16-18, 2013

Color Doppler is the official media partner at Fetal Medicine 2013, EMCON, the annual meet of Society for Emergency Medicine India, HospiArch 2013 and PACE 2013

Beijing: The 7th Congress of Asian Society of Cardiovascular Imaging will be held on August 16-18, 2013 in Beijing, China. The event will cover a wide-range of issues in the field of cardiovascular imaging and will discuss the latest advances in scientific research, educational courses and cutting-edge technologies. For details, log on to www.asci2013.org

Fetal Medicine 2013, 2nd global forum of SFM August 30-September 1, 2013

Hyderabad: The Society of Fetal Medicine’s (SFM) second global forum — Fetal medicine 2013 — will be held at Hyderabad from August 30 to September 1, 2013. The primary objective of SFM is to promote and enhance education and research in fetal medicine and facilitate rapid translation of research findings into clinical application. The society encourages and organizes continuing professional education programs, promotion of public awareness, advocating standards of practice and enunciating clinical and technical guidelines. For details, log on to www. fetalmed2013.com

5th National Conference of Society of Emergency Medicine, India September 6-8, 2013

Pondicherry: PACE 2013 (Programme on Advances in Critical care & Emergency), the 5th National Conference of Society of Emergency Medicine of India (SEMI) is going to be held at the JIPMER auditorium in Pondicherry from September 6-8, 2013. The conference aims at enlightening doctors on the current trends in Emergency Medicine and Critical Care which will help them achieve better outcomes in their Critical Care and Emergency Departments. For details, log on to www.pace2013.co.in

15th Annual Meet of Society for Emergency Medicine, India November 16-20, 2013

Kozhikode: EMCON 2013, the 15th Annual Conference of SEMI (Society of Emergency Medicine of India), will be held in Kozhikode, Kerala at the Vythiri Village from November 16-20, 2013. EMCON 2013 aims to bring together national and international personalities from around the globe, the true leaders in the field, whose passion and fervour drive the development of emergency medicine, the fastest growing speciality of medicine in the world. Emergency physicians, residents, paramedics as well as physicians and surgeons from all walks of medicine will be enriched by the scientific workshops, plenary sessions, and resident-to-resident discussions. For details, log on to www.emcon2013.com

International Telemedicine Conference, Jaipur November 29 – December 1, 2013

Jaipur: The 9th International Conference of Telemedicine will be held on November 29 to December 1, 2013 at the Mahatma Gandhi University of Medical Sciences and Technology in Jaipur. Telemedicon offers a boosting energy into the existing telemedicine system for improvement in the access remote areas like villages and hard core terrains, where access to basic healthcare is of primary concern. For details, log on to www.telemedicon13.com

Registration starts for Ultrafest 2014 to be held at Mumbai April 18-20, 2014

Are you organizing an event? Inform us, we will give you much-needed publicity. For details: info@colordopplermedia.com

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Mumbai: Ultrafest 2014 will be held at The Renaissance, Powai, Mumbai from April 18-20, 2014. The focus of the 6th edition of Ultrafest will be on Emergency Ultrasound. Many acclaimed speakers from India and abroad will enlighten the gathering on a wide array of topics such as Emergency Ultrasound Infertility, Gynaecological and Fetal Ultrasound. For details, log on to www.msbiria.org

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Cordless Ultrasonic Dissection System: Sonicision

ovidien, one of the global healthcare products leaders dedicated to innovation and long-term growth has introduced the world’s first cordless ultrasonic dissection system, Sonicision. Sonicision delivers similar clinical effectiveness associated with ultrasonic energy offering faster dissection and reduced visual obstruction, in addition to unique benefits from the industry’s first cordless design. The system has recently won the 2013 Medical Design Excellence Award (MEDA), one of the medical technology industry’s highest honors.

The system also delivers better thermal spread, vessel burst pressure, hemostasis, seal time and blade temperature. It offers fingertip control of clamping, articulation, rotation, firing and opening, reducing unwanted motion during all stapling actions, with unlimited articulation within the 45-degree left/ right range. This enables surgeons to place the device where they want it and keep it there throughout the stapling application. The system can be used in procedures where Covidien Endo GIA reloads are indicated, both in minimally invasive and open surgery.

Product Benefits

Surgical Specialties

Sonicision cordless ultrasonic dissection system is a hand-held, battery-operated surgical instrument developed for soft tissue incision and hemostasis in the wide array of surgical procedures. The innovative device provides high frequency ultrasonic vibrations, which simultaneously cut and coagulate tissue. The system offers freedom of movement during the surgical procedure and increases mobility without impacting the user’s OR footprint. The design, featuring one button with two power settings helps in staying focused on the field. Quick and simple set up of the system takes approximately 15 seconds.

Clinical Benefits

The system has been shown to deliver faster dissection through tissue and less plume for improved visibility in the surgical field.

Sonicision can be utilized in surgical specialties that include general surgical procedures, bariatric, colorectal, gynecology and urological surgical procedures.

Economic Benefits

The Sonicision system helps in reducing overhead costs with no maintenance schedule. The system is also easy to adopt with no large capital outlay. Sonicision decreases the carbon footprint of generators used in the operating rooms and reduces surgical set up time. The user can experience intuitive assembly and freedom from cords, cables and hassles by using the Sonicision system. With its new ultrasonic development, Sonicision, Covidien has enhanced its product portfolio across the energy spectrum.

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Reduced Radiation Dosage: Xmplar-dr

odox Systems, a South African X-ray system manufacturer has come up with a low radiation dose X-ray system that takes a full-body scan in just 13 seconds. Developed in the 1980s and ’90s, Lodox’s critical imaging technology was mainly intended for the use in South Africa’s Diamond mines to avert smuggling. A quick full body scan was done with this scanner to detect as a minimum of one carat or fifth of a gram of diamonds and keeping the safety factor in mind, the scanning is done with the lowest possible X-ray dose. The system was first developed by De Beers to scan miners coming from their shift so as to detect concealed or swallowed diamonds. Later, the University of Cape Town’s biomedical engineering and radiology departments also joined to do further research on adjusting the system. Xmplar-dr, the latest of the Lodox full-body X-ray scanning systems, offers a number of technological advances for trauma emergency and forensic pathology centres. It employs Linear Slot Scanning Technology to provide radiographs of the entire body in just 13 seconds without using stitching or re-takes of any kind. It produces images at just 0.12mGy entrance dose to the patient as well as the attending staff and provides excellent COLOR DOPPLER | AUGUST, 2013

image quality that is equivalent to or better than conventional radiography systems. The system also has a rotating C-arm that helps in obtaining images at any angle from 0° (AP) to 90° (lateral). It is also very easy to operate and allows complete two-view examinations in less than five minutes. The Xmplar-dr system includes custom image viewing and manipulation software, contained in the Diagnostic Viewing Station. This software application allows zooming, cropping and annotation of images. The system is operated by a novel userinterface which aids the operator to take the best images in the shortest amount of time. During emergency, the system speeds up the resuscitation process by at least 15 to 20 minutes. It has made the scanning process less traumatic for the patients. Its low radiation dose makes it much safer for both patients and medical staff and is also safe for pregnant women in trauma situations. It also reduces autopsy X-ray times. In short, the system serves as a model for digital radiology that rapidly and safely provides clinicians with high quality X-ray.

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Multi-slice, Low Dose CT: Aquilion RXL

quilion RXL is a new wholebody multi-slice helical CT system with a 32 mm wide detector from Toshiba and presents the latest state of technological innovation in multi-slice CT technology. The RXL is the latest addition to Toshiba’s Aquilion family. The CT system delivers routine low-dose scans for each patient in a wide variety of clinical examinations with unsurpassed workflow. The system provides the industry’s best low-contrast resolution of 2mm at 0.3 percent with low exposure dose.

Meet the technology: AIDR 3D Aquilion RXL brings the most advanced radiation dose reduction technology to the 16-detector row CT system with Toshiba’s Adaptive Iterative Dose Reduc-

tion 3D (AIDR 3D). AIDR 3D lowers radiation dose compared with conventional scanning, aiding clinicians in accurate diagnoses and treatment planning. It is a sophisticated algorithm designed to work in both the raw data and image data spaces, reducing noise while attempting to maintain image quality. The system also features Toshiba’s NEMA XR 25 Dose Check Software which improves user awareness of the radiation dose administered to patients.

Ensuring lowest dose

Additionally, Aquilion RXL incorporates Toshiba’s sophisticated suite of SURE Technologies increasing clinical capabilities and significantly improving productivity. With the integration of AIDR 3D into SURE Exposure controls, radiation exposure is automatically reduced before

the scan, ensuring that the lowest possible dose is employed for the specific diagnostic objective irrespective of the size or shape of the patient.

New console architecture

Aquilion RXL incorporates a new console to improve productivity and optimize workflow and is a combination of single or optional dual console configuration, 3D advanced visualization on console, 0.5 second rotation standard and high-speed image reconstruction. This new console architecture accelerates the process of providing the information required for making the best treatment decisions throughout the workflow. The CT system also features highperformance MegaCool X-ray tube and advanced Quantum detector enabling fast helical scanning of the entire body. COLOR DOPPLER | AUGUST, 2013

wordsworth

Jeffrey M Bundy Ultrasound plays a bigger role in India than it does in many other countries. A couple of things that I have observed in the Indian market are the rising demand for quality healthcare and the increasing number of patients. The numbers of patients that physicians in India see on any given day is huge. The demand for high-end ultrasound is high as it is so important to make an accurate diagnosis.

iemens has exemplified the journey of excellence in the Indian healthcare market. With inexorable commitment to quality, unswerving dedication to consumer satisfaction and exceptional standards of service, Siemens etched its name as an innovator, a trendsetter and a market leader. From the invention of world’s first real-time ultrasound system to various state-of-art technologies in imaging, the company has an array of first-of-its-kind products to its credit and the Acuson Freestyle ultrasound system – world’s first ultrasound system with wireless transducers – is the latest on the list. This pioneering technology ought to create revolution in medical imaging by improving workflow in point-of-care settings. A visionary leader, Jeffrey M Bundy, CEO, Ultrasound, Siemens Medical Solutions, USA Inc, tells Color Doppler about this new-edge technology and how the company intends to revolutionize the Indian healthcare market with it. With his

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17-year voyage in the healthcare industry, Bundy sees India as an expanding market with a consistent beat for innovations. He firmly supports Siemens Healthcare’s mission to provide the first-class healthcare to Indians at the lowest possible cost. Thanks to its exceptional standards of service, Siemens is leading the technology innovations across the globe. How is the Indian ultrasound market different from the markets of rest of the world? Siemens has a strong name in medical imaging segment and is spread across the world. As a person who travels around the world a lot, I tried to understand different markets to better define our priorities and understand what we can do to support our local teams. It is, indeed, very good for me to get out and meet the customers in every country. Ultrasound plays a bigger role in India than it does in many other countries. A couple of things that I have observed in the Indian market are the rising

wordsworth demand for quality healthcare and the increasing number of patients. The numbers of patients that physicians in India see on any given day is huge. The demand for high-end ultrasound is high as it is so important to make an accurate diagnosis. From physician to physician, the requirement and price range may vary, but they all demand the best equipment with the most sophisticated technology. For example, Acoustic Radiation Force Impulse Imaging (ARFI), used in our Virtual Touch technologies, has taken off in India and became very important in the diagnosis of liver disease. Our Virtual Touch technologies will continue to bring more comprehensive results in India.

What kind of R&D strategies has Siemens deployed for the Indian market? Siemens had realized the importance of Research and Development long ago, and we have pioneered in this area. As a hi-tech company, the name Siemens means innovation in every market. Since Siemens Healthcare has introduced the sector initiative â&#x20AC;&#x2DC;Agenda 2013â&#x20AC;&#x2122; to strengthen its innovative power and competitiveness, our R&D also takes into account the increasing cost pressure

on healthcare systems. We are further extending our portfolio of systems in the middle price segment to make advanced healthcare technology more accessible, like on our Acuson X700 ultrasound system. In India, patients pay for healthcare themselves and they want to get the best quality for their money. We are striving hard to provide the best quality at the lowest cost and our efforts have been supported by our decades-long R&D. The highly-innovative Acuson Freestyle Ultrasound system introduced with wireless transducers, has created ripples in the global ultrasound market. How do you see it and how long will it take to reach the Indian market? Acuson Freestyle is a new and exciting technology and will be available soon in India. Other than eliminating the impediments of cables in ultrasound imaging, how different and efficient is Acuson Freestyle in ultrasound imaging? The difference between talking over the telephone sitting in your house versus

the use of mobile phone in your pocket is huge. It may just be one thing, but it really can change a lot. We are glad that we are the first in making wireless ultrasound systems and we will continue to make necessary adaptations. We expect to have followers in the market place and that is what we need to do to be a trendsetter. The main focus of the Acuson Freestyle system is in the OR environment or the interventional environment. The Acuson Freestyle system eliminates transducer cables in an already crowded environment. The current transducer cable on traditional ultrasound systems limits itself in terms of where it can be placed considering the fact that the transducer cable should not cross over the patient within the sterile field. By eliminating the cables, the system can be placed on either side of the patient without compromising the sterile field, providing a more ergonomic environment for physicians. Integrated on the transducer are system controls which reduce the need for additional personnel to operate the system outside of the sterile field. Removing the cable is not as simple as it sounds. We had to develop a high data

We are committed to selling our products only to PNDT-registered institutions and physicians. We have only done this so far and will only be doing that in future

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wordsworth rate radio called ultrawideband (UWB). It operates on very high frequency and very low power so it won’t interfere with other equipment. One of the benefits of low power is that the battery life is high as the consumption is relatively low. We can operate the system for 90 minutes with one battery. All the batteries are rechargeable and interchangeable and thus you will have an alternate battery if the current one is depleted. Which are the areas other than intervention radiology where Acuson Freestyle will make a difference? In line placement, central line placement, local anesthesia, etc. and our customers have started to consider the use of the Acuson Freestyle system anywhere they have guided procedures. There are other ideas that we will continue to look into as well over the coming months and years. PNDT regulations in India are high. Confusions also remain on many areas such as the ‘ban of portable device’. How does Siemens see these regulations? The Government makes the regulations, we comply with them. We are committed to selling our products only to PNDTregistered institutions and physicians. We have only done this so far and will only be doing that in future. It is our duty to comply with the regulations. These regulations make sure that only companies with strong standards can win in the market and we support it. The ultrasound sector in India is changing every day and now that you have introduced wireless transducers in the market, how is it going to make a difference in the future innovations of Siemens? We have a trend of making electronic things smaller and compact. The introduction of the Acuson Freestyle system is a big step forward in continuing this trend. There is a common belief that Siemens is not much into the ultrasound business, (at least in Indian market). How do you see this? Siemens is extremely committed to driving and leading innovations in the ultrasound business. Wireless transducers COLOR DOPPLER | AUGUST, 2013

our Virtual Touch application will help us tap the full potential of the ultrasound market in India.

We are the pioneers in ultrasound and we understand the needs in the ultrasound segment. We also have a large group of experts around the world including our service teams who, with the service they provide, take care of our customers are an example of this innovative spirit. When we look at the general imaging market in India, the diagnosis of the liver, we are driving the use of Virtual Touch technology (ARFI) which is changing the way medical practices are being developed. Physicians are now seeing Virtual Touch technology as a viable alternative to biopsies in many cases. We have also taken an approach that is very different from other typical image processing methods. In image processing, typical approaches look at contrasts -- the lights and darks in the image of a tissue. For example, in CT, different tissues can be segmented relatively easily using Hounsfield units. This is not an easy task in MRI and ultrasound. Siemens, rather than following a trend, took a different approach a few years ago. We have employed a machine-learning approach of artificial intelligence to segment the data. Using a database of input from expert users, the images are segmented exactly like an expert does, and the system can continually learn and improve. These techniques are employed especially in the cardiology and OB/GYN arenas where efficient quantification is key. We have gained on market share in India lately - however, there is of course still a lot of potential for expansion for us. I strongly believe that just those outstanding, advanced technologies like

New Siemens technologies are penetrating the market every day. But not many are aware of their comprehensive capabilities. How can the end-users of these technologies be made aware of their potential uses and what are the measures taken by Siemens so as to achieve it? Education is extremely important. I want our technology to be used correctly to achieve maximum benefits. We offer training courses – both at clinical and application levels -- and are proud to have a highly professional team to train our customers and engineers. Our Asian Users Club for Virtual Touch technology brings the most knowledgeable users together to learn, not just from us, but from the community of clinicians who are using our technology. There are a group of physicians from Mumbai who are part of the user club and are involved in training other users. Training is something that we have a responsibility to do and we do it together with our partner physicians and I think that is more effective. Ultrasound market across the globe is facing a rapid growth. The competition is also intense. How is Siemens tackling it? We are the pioneers in ultrasound and we understand the needs in the ultrasound segment. We also have a large group of experts around the world including our service teams who, with the service they provide, take care of our customers. As a company, we are committed to the imaging segment. A primary aim is to provide the best quality care at an affordable cost. Siemens machines are costly than any other machines in the Indian market. Has this, in any way, affected you? Our goal is to provide the best equipment and allow physicians to practice at the lowest cost. Being a provider of quality healthcare, we look at the total workflow of the system and how quickly a physician can get to those answers. And as I said earlier, our aim is to provide the best quality care at an affordable cost.

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Magnetic Magic

Image Courtesy: GE Healthcare

Magnetic Resonance Imaging (MRI), one of the safest methods of looking into a human body in detail, has revolutionized the diagnosis and treatment of diseases with no ionizing radiation threats. Riding on its advantages over other imaging modalities, MRI is set for a giant leap with more technologies being introduced in the segment 20

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Rini Baby Thottil I cd news agnetic Resonance Imaging (MRI), being a distinctive, noninvasive imaging modality which allows direct, multiplanar imaging and the possibility of obtaining biochemical information, has far reaching real and possible clinical applications. It has been an important clinical diagnostic tool since the 1980s. The usefulness of MRI is best explored and realized in the central nervous system compared to Computed Tomography. The use of ionizing radiation in medical imaging has always been a matter of concern. MRI, free from all the ionizing radiation effects, also gained an edge because of its superior contrast differentiation between muscle, fat, vessels, ten-

num in the global market. As of the first quarter of 2013, the global market for these systems is worth $ 4.13 billion and is expected to grow at a rate of 4.56 per cent each year, reaching approximately around $ 5.24 billion by 2018. The report states that North America dominates the market with 40 percent share, followed by Europe. Improved spending capability and physiciansâ&#x20AC;&#x2122; inclination towards MR imaging over other imaging modalities are raising the demand for this modality in Asia. It holds huge growth potential, particularly in countries with large population base such as India and China. The MRI market in Asia is expected to grow at a rate of 5.2 percent each year. High-field and very high-field whole body tunnel scanners lead the market as they provide additional applications previously unavailable and greatly improve

MRI Market in India

The medical imaging equipment market in India has been witnessing a considerable growth for a long time, mainly due to the coming up of more healthcare units including hospitals and diagnostic centers. Increase in health insurance and per capita disposable income has also made MRI examinations more affordable. Public-private partnership, reduction in import duties for medical equipment and various government health insurance schemes are also contributing to the

Indian MRI market witnessed a tremendous growth of 8 percent during the last four years growth of MRI market in India. MRI market in India is the largest medical imaging equipment market in the country. The market has grown at a rate of 8 per cent during the last four years. A recent study conducted by a medical intelligence company, GBI Research, reports that Indiaâ&#x20AC;&#x2122;s MRI market is expected to grow from $85 million to $148 million by 2018. The number of MRI machines per person across India is significantly low when compared to that of developed nations. But the introduction of alternative, cheaper components is bringing down the prices and boosting the sales of MRI machines in India.

Imaging Capabilities

dons, ligaments, cartilage, cortical bone, marrow bone space, and the lot. Besides, the new, reliable cardiac gating techniques open the way for promising studies of cardiac anatomy and function.

Global MRI Market

A recent study of the global MRI market reports that the technology and the market impact of existing and emerging MR systems have a huge growth potential in the coming five years. Over 3,500 units are being sold per an-

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imaging resolution and quality. MRI has secured an important place for itself in the global healthcare market with many multinational companies including GE Healthcare, Siemens, Philips, Toshiba and Hitachi, being its major suppliers. The demand for MRI systems is anticipated mostly from private hospitals compared to public hospitals. The rising incidence of cardiac diseases, neurological and oncological cases is another reason for the increase in demand for MR systems.

MRI exhibits brilliant demarcation of soft tissues and bony tumors, and is very helpful in detecting avascular necrosis of bone. MRI also provides unparalleled details of the menisci, ligaments, and cruciates. The sensitivity of MRI to soft tissues and bone disease processes, its capability to identify dislocations and fractures. Its multiplanar imaging ability helps in imaging complex anatomy such as the elbow, wrist, foot and ankle.

Neurological Imaging

Sensitivity and first-rate presentation of contrast between various anatomical structures have made the imaging of brain using MRI surpass the detection of

under the scanner diseases using CT. Unlike CT, the studies of the posterior carnial fossa conducted using MRI are more well-defined, as MRI is not subject to bone artifacts that obscure abrasions, particularly those in the cerebellar-pontine region. MRI of the spine offers more diagnostic information for appraisal of primary and metastatic tumors of the spinal cord. By employing orthogonal and oblique slice planes along with various selection of tissue contrast, MR presents a highly effectual substitute to X-ray myelography and the risks associated with intrathecal contrast injections.

Vascular Imaging

The noninvasive MR imaging method, MR Angiography (MRA) has been proven successful in the evaluation of vascular diseases without the uneasiness and the risk associated with using iodinated contrast agents and catheters used in traditional angiography. It has been instrumental in the examination of acute vascular processes and acute head trauma.

Facial and Neck Imaging

MRI demonstrates the finest soft tissue details of facial and neck structures. Presurgical, pre-radiation treatment planning and follow-up are improved by MRI’s capacity to delineate anatomical boundaries, determining both size and extension of abrasions.

Abdomen and Pelvis Imaging

MRI of the liver provides matchless sensitivity to pathology in recognition of primary and metastatic liver tumors. MR imaging techniques allow the imaging of the abdomen within a single breathhold. MRI also offers high-resolution imaging of the adrenals, kidneys, pancreas and spleen for diagnosis of tumors, infections and other vascular anomalies. MR imaging of the pelvis offers the advantages of improved soft tissue discrimination and absence of bone artifacts.

Chest and Cardiac Imaging

The anatomy of the chest offers contrast, well-suited for MRI structures such as fat, muscle, lung and flowing blood. Cardiac gating techniques provide motion-free imaging for diagnosis of vascular, as well as nonvascular pathology by capturing the images at the same point all through the

MRI scanning is free from the threats of ionizing radiation. They cause no pain and are free from short-term or long-term tissue damage of any kind cardiac cycle. Imaging of the cardiac chambers in the long and short axis is made possible with dual-angle oblique capability, along with pulse sequences designed to accentuate flowing blood. MR imaging is also used for the evaluation of thymus and disease processes of the thoracic inlet.

Types of MRI Scanners

Different types of MRI scanners have been developed over the course of time. The tunnel shape of the regular MRI has been a factor that caused anxiety among certain patients. As a solution, Open MRI scanners with no enclosed tunnels have been developed. Open MRIs also provide an option for scanning larger size patients who would not fit in the tunnel of the regular MRI scanners. The regular MRI scanners produce a creepy, clicking and whirring noise that arouse anxiety in some patients. The advanced silent MRIs have markedly reduced noise under a wide range of scanning conditions. Environment-friendly MRI machines that consume less energy have also been

developed. They reduce the carbon footprint, thus contributing to saving the planet.

MRI in Pediatrics

MR imaging has potentially broad applications in pediatric practice. It has shown increased sensitivity in abrasion detection in many disease processes. In order to obtain the highest quality MRI results, the pediatric patient has to be completely still during the scan and sedation may be required so as to attain this. Sedation is also helpful if a pediatric patient is claustrophobic. If sedated, the patient will be monitored at all times by a machine that checks the heartbeat, breathing and oxygen level. As MR does not use ionizing radiation, it is relevant to conduct repeated examinations in children.

Safety Concerns

Every year, nearly 10 million patients undergo MRI procedures. MR imaging has been proven extremely safe as long as proper safety precautions are taken. The absence of ionizing radiation removes the possible concerns associated with X-ray pictures and CT scans. MRI procedure produces no pain and causes no shortterm or long-term tissue damage of any kind. The powerful magnetic field of the scanner can attract certain metallic objects known as ‘ferromagnetic ‘objects, causing them to move suddenly with great force towards the centre of the MR system. This may cause potential risk to the patient or anyone in the way of the COLOR DOPPLER | AUGUST, 2013

under the scanner object. Hence, it is very important to remove metallic objects such as watches, jewelry, etc. before entering for MR scan. There are certain screening procedures that will help the technologists and radiologists in identifying the presence of metallic implants and materials so that special precautions can be taken. The MRI examination is cancelled in some cases when there is a particular implant or device in the patientâ&#x20AC;&#x2122;s body. For example, the magnetic field of the scanner can damage a cochlear implant or cause a cardiac pacemaker to malfunction. The contrast dye used can cause reactions in some persons. MRI scans are also not widely recommended for pregnant

women unless in an urgent situation. Although the scan is considered to be safe, the long-term effects of strong magnetic fields on a developing baby are still being studied.

Specialist MRI Market

Recently, niche markets have started to concentrate more on extremity imaging comprising whole body system providers for breast imaging, and also smaller compact systems for imaging arms, wrists, knees, ankles, etc. Dedicated scanners are, therefore, efficient and cost effective solution to satisfy this market. Other applications of dedicated MRI systems include clinical trials or veterinary purposes for small companion pets or zoo animals.

Future of MRI

MRI has definitely been the most flexible of all the diagnostic imaging modalities. Commercial products for simultaneous acquisitions, such as PET/MRI, are already in pipeline. Resolving current issues in the MRI market such as market barriers of tight R&D budgets, high costs of MRI scans and alternate cooling systems will result in considerable growth of the industry. The technology developers are exploring many new applications, especially those involving cardiac and breast imaging and this would definitely help MRI evolve into a highly sophisticated medical imaging tool in the coming years.

World Wide Open!

very single day, a substantial number of MRI examinations are being done at different places across the globe. The proven efficiency of this imaging modality in providing detailed images of the brain, spines, pelvis and joints has made it a widely accepted modality when compared to the rest of the contemporary imaging alternatives. The image and resolution produced by MRI are quite detailed and can detect tiny changes of structures within the body. The conventional MRI scanner has the structure of a tunnel surrounded by an enormous circular high-field magnet. The patient is placed on a movable bed and is inserted into the torpedo-shaped tunnel, in order to conduct the examination. However, studies have proven that the very sight of this enclosed tunnel-shaped scanner creates feelings of claustrophobia among approximately 15 per cent of those who undergo MRI scanning. Fright of suffocation and restriction prohibits nearly two million people from undergoing MRI examinations annually.

Claustrophobia and Anxiety

Claustrophobia can result in panic attacks, hyperventilation, sweating and nausea. For some, the prospect of having to lie flat in a constricted enclosed tunnel can trigger the phobia for the first time. The loud clicking and whirring sound produced by the machine adds to their worries. This anxiety caused by the MRI systems result in either the panicked patients terminating the procedure and leaving the room immediately, even before the doctors can have even a single examination or in necessitating the use of conscious sedation.

Structure of Open MRI

The Open MRI machine was developed as a solution to all these problems. The open machine has a larger opening

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compared to the conventional one. The diameter across the closed MRI is around two feet whereas the distance across Open MRI system is over five feet. This machine not only changed the milieu of an enclosed tunnel examination, but reduced the clicking and whirring noise as well. Besides these, some systems also provide an option for imaging in various positions and series of movements. Unlike the regular MRI machines, Open MRI machines provide ample open space for patient comfort. Open MRI machines could accommodate patients of larger size which was not possible in the regular MRI machines with narrow tunnel. With the coming in of Open MRI systems, the problems caused while scanning children, confused patients or those unable to lie supine and still for the required time were resolved as well.

Types of Constructions

The types of constructions include Semi Open high field MRI scanners, Open Low field MRI scanners and Advanced Open MRI scanners. Semi Open high field MRI

under the scanner scanners provide an ultra short tunnel. The patients lie with their head in the space outside the tunnel. Open low field MRI machines have a wide open design. For example, an Open C-arm scanner is shaped like two large discs separated by a huge pillar. This scanner provides the patient an open-sided feeling and the ample space available around them allows a wide range of positions. Though Open low field MRI scanners are patient friendly, they do not operate as fast as closed MRI scanners and do not produce higher resolution image with finer detail like the closed MRIs.

Advanced Open MRIs

Open MRI technologies have improved over the years and gifted the contemporary medical field with Advanced Open MRI scanners. They come as a combination of the highfield strength, newest gradient technology and wide open design. With the advent of these scanners, scans of patients in upright, weight-bearing positions have become possible.

Silence is Golden

licking, ticking, humming, whirring, buzzing, hissing, swishing and whooshing sounds are all around us. Some are in harmony with man while some increases the flow of adrenalin, triggering anxiety in some. Certain noises are from nature, the control of which is beyond our limits, and some are manmade and can certainly be managed. Though MRI has proved to be a flexible tool for medical imaging, it does produce a lot of noise. The clicking and whirring noise generated by the machine increases anxiety among some patients which can increase general stress levels and aggravate stress-related conditions such as high blood pressure. For those patients who repeatedly have to undergo MRI examinations, continued exposure to this sound does not lead to habituation; in fact it worsens the effects. The process of MRI takes around thirty minutes to one hour to complete. Several fast scan techniques have been developed to reduce scan times and are now commercially available. As scanning has become faster, with it increased the sound levels. The person undergoing the scan has to continuously listen to sound level of 90 to 110 decibels produced by the machine which is not a pleasant experience. The question is where is this noise coming from. The noise is caused by the vibration of the gradient coil due to the Lorentz forces generated by the current in the coil, which is placed in a strong magnetic field. The vibration of the gradient coil is transmitted mainly through the air and through solid structures. The Silent MRI systems were developed keeping the noise trouble in mind. They employ special noise reduction techniques to interrupt both airborne and solid vibration propagation. The advantage is that noise can be reduced without affecting the quality of the imaging performance of both normal and fast scan techniques. Toshiba has introduced a unique noise reduction technol-

Upright MRI is an example of Advanced Open high-field MRI machines. The ground-breaking design of the scanner provides an option for patients to simply walk in and be scanned. The scanner allows the imaging of all parts of the body in the weight-bearing state. The scanner is designed in such a way that the unique patient handling system moves the patient into the magnet and positions the desired anatomy in the centre of the magnetic field. The scanner is also equipped with the facility to rotate the vertically-oriented patient into a horizontal position. Open MRI machines are developed not as a competition to the conventional MRI scanners, but as alternative means for scanning mainly those with anxiety and claustrophobia. With Open MRI scanners, many patients have come to realize that they always have the ‘final say’ when it comes to what type of MR machines they have their examination completed on.

ogy called ‘Pianissimo’. It is employed in Toshiba’s Vantage MRI systems. With this breakthrough technology, an acoustic noise reduction of more than 90 percent of conventional MRI systems can be achieved. The cutting of noise by 90 percent is equivalent to the noise reduction of being 40 meters away from the source of noise. Pianissimo is a ‘triple cut’ noise reduction technology and surrounds the gradient magnetic coil in vacuum space. The cut separates the gradient coil from the magnet structure, thereby reducing the noise. This separation provides independent suspension for the vibrating gradient coil. GE Healthcare has also recently developed a noise reduction technology- Silent Scan. It is a combination of two new developments. Silenz is a new 3D scanning and reconstruction technique which is effective in bringing down the acoustic noise. The Silenz technique is combined with GE Healthcare’s proprietary design of the high-fidelity MR gradient and RF system electronics. The noise is eliminated at its point source and provides a more relaxing scanning environment to the patients. Noise reduction technologies, to a great extent, do not affect the function of the gradient coil. In turn, they have an indirect positive effect on the image quality. Patients experience lower noise levels when the noise reduction methods are employed and they are relieved from the shock effect caused by the sudden activation of the gradient coils. COLOR DOPPLER | AUGUST, 2013

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Green Revolution Increasing operating costs, global warming and concern over the reduction of energy footprint made many hospitals in India to go green

Karthik Kuppusamy Director-MR, GE Healthcare India

id you know that ‘going green’ is a trend for hospitals in India? Skyrocketing fuel and energy costs, global warming, organic food, reducing energy footprint, ‘the green machine’ continues to gain momentum throughout our daily life. But did you know that ‘going green’ is also a trend for hospitals? The green as a trend is catching on as hospitals strive to reduce toxins and waste, lower energy bills and achieve a healthy, healing environment. In 2008, GE’s Signa HDe, 1.5 Tesla MRI received the first ‘ecomagination’ status for a healthcare imaging system. It is not possible for every product to receive this distinguished designation. By employing efficient gradient and electronics design as well as innovative

Extensions of an existing imaging room to accommodate a large MRI are costly and also difficult. GE Brivo MR 355, MR 360 and Optima MR 360 Advance use small footprint and consume 20 percent less space compared to the previous generation MRIs

water cooling technology, the SignaHDe became the most energy efficient 1.5T MRI system. GE healthcare has since then continued its pursuit and brought out more energy efficient 1.5T MRI systems in the form of Brivo MR 355, MR 360 and Optima MR 360 Advance.

Customers love it ‘green’

For any outpatient MRI centre, or a diagnostic centre, it is very important to keep a check on the operating expenses, keeping in mind today’s healthcare environment. Many healthcare providers

who install an MRI believe that it is possible to run an efficient and profitable MRI suite with the help of the right technology. The search of such healthcare professionals ended with GE Healthcare’s ‘green machines’. Let’s take a look at why are hospitals and diagnostic centres in the country are looking up to GE’s energy efficient MRIs – Brivo and Optima scanners. Precious space: For most hospitals and diagnostic centres, space is a precious commodity. This is particularly true in urban areas where space is at a premium and many services are packed in limited available space of the centre. Extensions of an existing imaging room to accommodate a large MRI are costly and also difficult. So, if you are able to fit an MRI that does not compromise on the image quality into a standard radiography suit, why will not hospitals/diagnostic centres choose that? The Brivo MR 355, MR 360 and Optima MR 360 Advance use small footprint – 25 square meters for siting. It is 20 percent less space consuming compared to the previous generation MRIs.

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under the scanner When less is more: Brivo and Optima MRI systems use 34 percent less energy when compared to the previous generation of MRI systems. It reduces electricity usage by about 60,000 kWh per year, per unit, which is equivalent to an annual electricity consumption of 360 households* in India under normal operating conditions. For an MRI suite, it amounts to Rs.3.6 Lakhs of electricity savings per year and that also converts into reducing over heads to a huge extent. Now if we add to this the savings from lowering UPS/generator capacity, the operating costs are further reduced. Improved productivity and precision: Brivo and Optima MR systems provide outstanding high definition image quality while keeping energy consumption very low. The new express coils and intuitive controls simplify the operations, streamline scanning time and preserve signal-tonoise ratio and achieve coverage and depth of penetration. Thus the result is – high quality diagnostic images that make GE Healthcare a world leader in MRI systems.

How Do We Do That?

Innovation is the key. GE Healthcare’s engineering teams have identified several opportunities to reduce power consumption. By incorporating unique overnight ‘sleep mode’, efficient gradient and electronics design, as well as innovative cooling technology, our team reduced the system’s energy consumption during both operating and non-operating hours. Optima MR360 Advance skillfully balances technology, a broad array of clinical applications and refined workflow capabilities. The system reduces total cost of ownership through energy-efficient technology — uses up to 34 percent less energy than previous-generation systems. The Brivo MR355 reflects our efforts to make advanced diagnostic technology more accessible. But affordability does not mean you compromise on scanning range and high-field quality. The MR355 is engineered to deliver clean, crisp imaging that can help you make definitive diagnoses for your patients. At the same time, it offers simple, user-friendly operations. Brivo MR355 helps minimize

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operating costs through efficient workflow, energy savings and reliability. “We purchased Brivo MR355 1.5T from GE Healthcare more than two ago. This Green MR is a great investment. It keeps giving us returns on our investment. After tremendous savings on the system’s installation, we are now saving on an average Rs.30,000/every month owing to its low power requirement and hence reduced power bills. At the same time the Brivo MR355 provides High Definition MR imaging,” said Dr. Mohit Bhargav, Consultant Radiologist, Civil Lines MRI at Sant Parmanand Hospital, Delhi. India has about 1400 MRI systems installed as on today. 75 percent of all MRIs purchased here are 1.5 Tesla MRIs and customers have shown a strong interest in going for greener MRIs that can lower their total running costs and higher economical gains. Since mid-2011, 100 hospitals /diagnostic imaging centers had opted for greener MRI technologies and all the 100 chose GE for offering the best energy efficient 1.5T MRI systems. What is fascinating is that it is not a trend limited to urban areas. Whether it is a metro or tier II – Tier V, customers are unanimous on their preference for lower operating costs and lower total cost of ownership. So these systems are reaching smaller towns like Balasinor in Gujarat; Ghaziabad in Haryana; Salem in Tamil

Nadu; Meerut in UP, Solapur, Ankola in Maharashtra etc. in addition to places like Mumbai, Delhi, Bangalore, Chennai, Kolkata etc. The hospitals/diagnostic imaging centers that have purchased greener technologies are seeing sustained improvement in their operating costs. Dr. Deepak P Patkar, HOD and Consultant Radiologist – PET- CT and MRI Center, Dr. Balabhai Nanavati Hospital, Mumbai said, “Brivo MR355 1.5T fits within the space constraints of any low-field scanner easily. This is a Green MR as it consumes less power. Now, we have a high performing, high definition image quality MR scanner and for which, we did not have to break the walls for expansion or stop our operations for a longer time. This has proven beneficial for our patients as well as our investments.” Many of the hospitals and imaging centers run 24/7 making them one of the largest energy consumers. Electricity costs are always on an upward scale and in many towns electricity is not available for as many as 13-15 hours a day. Hence saving money is not the only imperative, but saving energy for a brighter tomo rrow is equally important. At GE Healthcare, we recognize that being a sustainability leader is more than creating products that provide environmental and operating benefits to our customers.

*Average of Rs.1000/- per household considered as a monthly expense.

“We Change Perceptions” Zonare acquisition is a big boost for Mindray as a company and ultrasound modality in particular, says Ashwani Raina, the Deputy Director at Shenzhen Mindray Bio-Medical Electronics Company Limited. He adds that the acquisition would help the company in establishing its position in the high-end radiology segment at a faster pace. He is in conversation with Color Doppler about Indian ultrasound market, Zonare acquisition and more...

eyond being a generator of massive sales figures, India is an auspicious hub for innovations. Global healthcare providers spin on this beat of the country, unveiling their quest for excellence in the market. Among innumerable players, Mindray Medical India Private Limited stands tall with the title “Provider of the best price and performance”. By rooting in every state and region with minute, yet remarkable moves, Mindray established a finest network across customers. Keeping unparalleled growth and dedicated customer satisfaction as the keys to success, Mindray glides seamlessly in the market. Recently, the company acquired Zonare Medical Systems, the leader in high-end radiology segment. The R&D of Mindray strives to make the products a true reformer of people’s life, thereby offering them new dimensions of healthcare. In this interview, Ashwani Raina, the Deputy Director at Shenzhen Mindray Bio-Medical Electronics Company Limited, discloses Mindray Bio-Medical’s unsaid present and future, with a humble note that “We change perceptions.” What is Mindray’s strength in the

Indian market? Is it the cost or technology? Our strength is technology combined with cost. Indian market is different and demanding, and patients are looking for the best at affordable cost. Our research and development has been the hallmark to deliver this combination which makes us favorite among the customers. Mindray has acquired Zonare Medical Systems. How is this deal going to boost Mindray’s capacity for highend ultrasound? Will it be helpful in increasing the acceptability among higher-end ultrasound users? Zonare acquisition is a big boost for Mindray as a company and ultrasound modality in particular. It will truly help us in establishing ourselves in the high-end radiology segment at a faster pace though we have already made a good impact with DC-8. We have already gained acceptability among a reasonable number of high-end users, but still we do have a lot to achieve and this acquisition will surely help us further in achieving our goal. How does this acquisition provide Mindray with a better access to a welldeveloped global direct sales force?

We still have our management working on this and you will hear more about this soon. According to you, how strong will be the market acceptance of a combined company product and what are your expectations regarding demand for combined products? I am very confident about this acquisition. It will work as a catalyst and will help us to achieve our vision. Neverthe-

Zonare acquisition is a big boost for Mindray as a company and ultrasound modality in particular. It will truly help us in establishing ourselves in the high-end radiology segment at a faster pace though we have already made a good impact with our DC-8 ultrasound system

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less, let me put this humbly. We have been the most fastest growing ultrasound company in the last three years in India and by the end of this year, we clearly want to consolidate our position as the top third player in the Indian ultrasound market . There is always a perception that Chinese technology is inferior to technology developed in developed countries. Has this in any way affected Mindray’s global market? Perceptions matter for sure. I won’t deny, but if we look at Mindray’s Global presence, it speaks volumes today. The impact that we are making today is purely because of our superior products, technology and global reach. Our R&D centers situated across the globe including US and Europe provide us access to global markets. I see perceptions changing very fast in our favour. How do customers look at the performance of Mindray devices in India? This question can actually be answered by our users, but let me be very candid. A vast majority of them are highly satisfied with our products and we are seeing a trend where these users recommend our products to their colleagues. Our constant pursuit resulted in all our customers using our products to their full potential. Ultrasound markets are not homogeneous. Policies and regulations vary

from country to country. Being one among the top contributors to the field of medical imaging in India, have the regulations in the healthcare sector in India, in any way, affected the services that you render? We must and are upholding the policies and law of the land. We cannot think of conducting business rebelling the regulations. Apart from the law, the mind set of the people has also to change and we are hoping for that. What are the efforts taken by Mindray to tap the untapped areas in the healthcare sector with your R&D activities? We deliver nearly four to six new products across different segments each year and will continue to do the same. We spend 10 percent of our sales revenue into R&D every year. Many of our products have won prestigious awards at different global platforms. One example is DC N3, a whole body color Doppler system with four port connectivity, battery backup, 4D imaging and many other advanced softwares at an attractive cost. A lot of exercises are being put behind the introduction of a new product into a market. For a global brand like Mindray, markets vary in size and revenue. What are the marketing strategies executed by Mindray

Perceptions matter for sure. I won’t deny, but if we look at Mindray’s Global presence, it speaks volumes today. The impact that we are making today is purely because of our superior products, technology and global reach while introducing a new product in the Indian market? We have recently inaugurated one of our finest corporate offices in Gurgaon, NCR. It has a state-of-the-art show room where our customers can find out a good deal about our products. We make our presence felt at different conferences across India and abroad as well showcasing our technology. We have established KOLs who help us to continuously conduct CMEs across regions. As we grow, we have to take our marketing initiatives to the next level. In September 2013, we are conducting multiple events in India in association with international luminaries such as Dr. Philippe Jeanty from USA, a pioneer in the field of fetal ultrasound.

We are upholding the policies and laws of the land. We cannot think of conducting business rebelling the regulations. Apart from the law, the mind set of the people has also to change COLOR DOPPLER | AUGUST, 2013

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product focus

Freedom from Dilemmas: Acuson Freestyle Acuson Freestyle, the ultrasound system from Siemens with wireless transducers, breaks the norms of conventional ultrasound systems in order to provide maximum mobility and flexibility while scanning. It brings a new level of ease-of-use besides providing superior image quality

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product focus

Kavita Mangotra Manager Application Support, US Business Healthcare Sector, Siemens Ltd.

he Acuson Freestyle ultrasound system is designed to meet the unique needs of point-of-care practitioners during ultrasound guided procedures. Developed with pioneering technology from Siemens, this is the first point-of-care ultrasound system with wireless transducers. The system provides maximum mobility and flexibility while scanning, brings new level of ease-of-use and provides superior image quality. The Acuson Freestyle system facilitates the use of advanced ultrasound technology into clinical fields requiring sterile environment, such as interventional radiology, anaesthesiology, critical care, cath lab or emergency care. Wireless transducers expand the ultrasound into new and emerging applications such as administering nerve blocks, enhancing vascular access and improving target localization through ultrasound guidance during therapeutic interventions and biopsies or draining cysts. Normally a transducer is connected to the ultrasound system via a cable. This setup sharply restricts the operatorâ&#x20AC;&#x2122;s freedom of movement. In addition the controls on the ultrasound unit are not sterile and in some cases need to be operated by a second technician. Acuson Freestyle eliminates the need of cables and provides easier and more flexible scanning because there is no cable tethering the system and transducers together. Freedom from cable weight or torque allows for greater ease in obtaining accurate transducer and needle positioning during point-of-care procedures. Acuson Freestyle has an 8GHz ultrawideband (UWB) high data rate radio technology which provides exceptional real time wireless imaging and prevents interface with other electronic equipment. Multiple antennas on the transducer and

system dedicated to reliable high speed data transmission. Built-in transducer controls allow easy access to real time operating functions. The user can operate upto three meters (9feet, 10 inches) away from the main system which is typically longer than a cabled device. To reduce the amount of data transferred between the transducer and the system without degrading the image quality, the system uses synthetic aperture technology. With this technology each individual pixel in the image is digitally focused once itâ&#x20AC;&#x2122;s been transmitted to the console. As opposed to the traditional acoustic transmit focusing method, which requires users to manually focus on a region of interest, the Acuson Freestyle systems synthetic focusing provides automatic uniform focusing throughout the entire field of view resulting in a superior image quality. The Acuson Freestyle system weighs 4.8Kg. (10.5 pounds) and has a 38 cm (15 inches) high resolution LED display with high contrast ratio and wide viewing angles. The system can be mounted easily on a lightweight cart and also operates on battery power and has a quick boot up and

shut down time (less than 30 seconds). Its compact console design requires minimal space in patient room or procedure room. The wireless probes gives a much faster way of getting things prepared as it gives you more flexibility about positioning the system in relation to the probe without being worried about the cables. Elimination of cables is particularly helpful in operations or during invasive procedures in which the needle visualization needs to be monitored using ultrasound technology. The Three wireless transducers available for the Acuson Freestyle system are lightweight, ergonomic and rechargeable. Wireless alert system helps keep track on transducer locations. Light weight and ergonomic transducers are easy to prepare for sterile procedures. They help reduce the risk of contaminating the sterile field during ultrasound guided procedure. The system also comes with a spare battery pack that recharges at a charging station on the back of the system while the other one is working. The unit covers a range of general imaging, vascular and high frequency applications such as musculoskeletal and nerve imaging. Freestyle Ultrasound System truly allows you to find your freedom.

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Right Image at Right Dose

Shireesh Sahai Director, South Asia, Interventional, Surgery & X-Ray, GE Healthcare

century earlier very few people died of heart diseases. In due course of time, heart diseases have become the number one global killer owing mainly to today’s changing lifestyles. The age of technology has made life easier and made people more prone to heart diseases. If statistics are taken into consideration, India has the highest number of cardiovascular patients in the entire world – 62 million. Among them, 37 percent belong to the age group of 20 to 40 years. Shireesh Sahai, Director, South Asia, Interventional, Surgery & X-Ray, GE Healthcare, opines, “In western countries, only four percent of cardiovascular patients belong to this age group. So here, the disease is striking early and about half of these cases are triple vessel, which means the severity is much higher. The first step in diagnosing and treating a cardiovascular disease is doing an angiogram or angioplasty. This is where the cath labs come into picture.”GE Healthcare’s Innova 2100IQ (Optima Edition) is a cost effective, dedicated interventional cardiology (IC) system designed to meet the growing need for basic IC procedures. Based on the company’s reliable, high-performance Innova platform this system offers excellent image quality and dose efficiency at a lower price point and total cost of ownership. “Within one and a half years of launch, our Innova 2100-IQ and IGS 520 have made huge inroads in the Indian market, metro cities and even in tier I and tier II COLOR DOPPLER | AUGUST, 2013

cities. In almost all the states of the country we have installed at least one of these machines. In Kerala itself, we have installed our Innova 2100 (IQ) Optima edition in Fathima Hospital, Calicut, and Holy Cross Hospital, Kottayam,” says Sahai. Innova IGS 520 is an image-guided system for cardiovascular and interventional imaging in the Cath Lab. With this system, the company has succeeded in developing a huge customer base with big hospitals and medical institutes like the Madras Medical Mission, Madras, the BM Birla Heart Research Center, Kolkata, Dr.Tejas Patel –APEX, etc. being their clients. Assessing the deployment of stents during angioplasty procedures is critical for minimizing the risk of future adverse events. But accurately assessing stent deployment, or gauging stent placement in relation to existing stents, can be highly challenging with conventional fluoroscopic imaging. StentViz is a fully automated processing technology that improves clearly the image quality of stents from cine X-ray acquisition and is applicable almost without any additional steps or costs. Sahai explains, “StentViz –Enhanced Stent Visualization Software provides exceptional stent visualization, with easy, one-button activation. The All India

Institute of Medical Sciences is currently using this software on our Innova system and according to the doctors it has increased their clinical confidence with immediate and routine control of stent deployment.” The right image at the right dose has become crucial in today’s times. The IGS 520 features DoseSense, a comprehensive set of dose management tools that further extend dose efficiency. Sahai says, “Our 2nd generation of IGS system focuses on dose reduction. In a typical cath lab log, the patient, the operator and the doctor are all subjected to radiation dose.” “With the new feature that we have introduced in our machines, we can actually visualize how much dose we have given at what point and act according to that. We are talking about close to 69 percent reduction in dose, in comparison with available systems in the market, thus being the best in the market.” “Cardiac disease is the single biggest disease burden for the clinicians in India. It is a complex issue, but we will not shy away from complex issues and wants to take it head on through innovations. We are at work for a healthier India” he said. “We will do this by bringing the full breadth of imaging and monitoring technologies to provide earlier answers for earlier treatment for the people of India,” he added.

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Believe and Achieve: PACE 2013 PACE 2013 is designed to help future emergency physicians to rediscover their talents with a commitment to achieve better outcomes, says Organising Secretary Dr. Arjun Sundaram

ith rapidly increasing revenue and employment opportunities, healthcare system is one of the fastest growing sectors in India. According to a market report released by Pricewaterhouse Coopers (PwC), the Indian healthcare system is worth nearly $40 billion by 2012. The sector is constantly evolving in terms of technology, clinical trials, role of private players and drug manufacturing. However, the escalation has failed to hide an important blemish in the sector – the lack of a proper emergency medical care system. Sadly, India is a country where every three minutes an Indian dies in road accident. Most of these deaths were avoidable, if the country had a quick and efficient emergency medical care system. A vehement act to the scenario is finally on its toe, from National Medical Centre, a multi-specialty medical care centre located in Pondicherry. The hospital has collaborated with the Society of Emergency Medicine of India (SEMI) and Emergency Physicians India to organize PACE 2013 (Programme on Advances in Critical care & Emergency), the 5th National Conference of SEMI from September 6 to 8, 2013 at the JIPMER auditorium in Pondicherry. The conference intends to enlighten the doctors on the latest trends in emergency medicine and critical care. The Organizing Secretary, Dr. T. Arjun Sundaram MD (Emergency and Critical Care Physician, New Medical Centre, Pondicherry, talks to Color Doppler about PACE 2013, about its objective, what participants can expect and more. How is PACE 2013 going to be different from that of the earlier ones? PACE 2013 will elaborate on the current trends in emergency medicine and critical care. Emergency medicine is an emerging

gations.

We are trying to emphasize on uniform training, especially with paramedics across all hospitals throughout the country. This is prevalent in developed countries

Dr. Arjun Sundaram, Organising Secretary, PACE 2013 specialty and in this conference, we will encourage the upcoming emergency and critical care physicians to make important decisions in the emergency department and ICU. It will strongly emphasize that emergency physicians should be empowered with important clinical decisions to improve patient outcomes. The theme of PACE 2013 is ‘Believe and achieve’. Please elaborate more about the selection of the theme. The theme will help future emergency physicians rediscover their talents with a commitment to foster sustainable development in the future. It will encourage people to investigate, innovate and discover areas in which the field of emergency and critical care can develop in the Indian scenario. How important is the role of Emergency Medicine and Critical Care in the contemporary medical scenario? With established protocols in every aspect of treatment, it can improve patient survival to a great extent. With evidence based treatment, we can not only reduce patient mortality, but also reduce hospital stay and costs on treatments and investi-

Emergency Medicine is in its infancy in India compared to other medical specialties. How efficient, do you think is the responsive and timesensitive emergency medical system in India? The response to an emergency call will be on par with other countries in the near future. What India would require is not only better medical care, but also better regulated traffic. The public should be educated on how to give way for an ambulance. The Police and the Governments will have to work very close with the emergency departments to ensure a swift transport of critically ill patients. The face of the emergency medicine and critical care specialties have evolved through years in the Indian healthcare segment. What do you think will be the future of both specialties in India? The future for both critical care and emergency medicine would be very promising. But with better prospects come added responsibility. Right decisions have to be made at the right time. How different is the condition of emergency medicine and critical care division in a developing country, such as India than that of a developed country? There is not much difference in the quality of treatment in India compared to other countries. We are trying to emphasize on uniform training, especially with paramedics across all hospitals throughout the country. This is prevalent in developed countries. In India, people respond late to the emergency compared to the people in developed countries. In emergency, the earlier you turn up, better are the chances of survival. Public has to be made better aware about the emergency signs and symptoms. COLOR DOPPLER | AUGUST, 2013

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