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interview I suchet singh

SEPTEMBER, 2012 | Vol 1, Issue 9, Pages 44

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under the scanner PACS enables seamless transmission of data and medical images in the healthcare space. Read on to know the past, present and future of PACS P 11 COLOR DOPPLER | SEPTEMBER, 2012

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under the scanner share market

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haring medical digital images information is not easy, even in this modern era. We also do not enjoy a seamless transmission of data and medical digital images in the healthcare space—among physicians, institutions or health systems. But PACS has the ability to deliver timely and efficient access to images, interpretations and related data and break down the physical time barriers associated with traditional film-based image retrieval, distribution, and display, writes Gunjan Patel

P 11-21 talking point user-friendliness the key Rajavel Subramanian, Regional Manager for India, South East Asia and Middle East, NeoRad AS, tells Jumana Engineer how there are many medical devices in the market that are clever but too complicated to use and how ease-of-use is the key to their products

P 22-23 london olympics 2012 and the gold goes to...

success scan awesome threesome

The Polyclinic located in the Athletes’ Village, set up by GE Healthcare provided athletes with access to excellent healthcare services besides showcasing next generation medical imaging technologies

Abhaya Babbar, Business Consultant to the CEO, Digitex Medical Systems, talks to Jumana Engineer about how they have become a well-known name in the field of importing and marketing medical equipment and healthcare solutions

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P 25-27 tech scan by the radiologist, for the radiologist Being a web-hosted software, RADSpa can be accessed easily by radiologists, physicians, MTs, administrators and patients, from any part of the world and thus it brings in the concept of mobile radiology which ensures ‘any-time any-where radiology’, writes A B Sivasankar

cd obit P 42 man who made humans transparent Joby Joseph pays last tribute to Robert S Ledlely, the man who invented the first CT scanner capable of producing cross-sectional images of any part of the human body, who died aged 86 on August 2, 2012, leaving a legacy his successor do well to match

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news scan event scan new product scan cd spotlight cd obit book scan

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dr. harkanwaljit singh saini @ fb Dr. Shirish Patwardhan a FOGSI member from Solapur has been sentenced to undergo 3 months imprisionment for not dispalying board (Sakal news) Be careful-god knows if we r ever going to have graded punishment for techincal lapses. We have failed on this count @ www.facebook.com/harkanwaljit. saini

The first thing you should consider is your schools accreditation. This is very important because you want to make sure you are getting the best possible training. Every single ultrasound technician training school must be accredited by the CAAHEP or a similar accrediting body in your state. The next thing you should consider

dr. smart ultrasound @ twitter.com

peter chang @ linkedin.com The World’s most complete directory of Medical Ultrasound Manufacturers has just been updated. To download the FREE version, an example of the directory, or to get more information, you can visit the website: www. globalsoundinc.com/Products.php @ www.linkedin.com/in/peterchang1234

diabetesman @ twitter.com Choosing an ultrasound technician training program and the five things you must consider: …below are five things you really should consider before choosing any ultrasound technician training program.

this is where you will actually be taught how to use your ultrasound equipment. Some schools spend a lot more time on your clinical experience than others. If you school is not spending a lot of time with hands on training, you may want to ask why… Log on to http://dlvr.it/1vFgMJ \ to read full article @www.twitter.com/diabetesymptoms

Ultrasound-guided injection of botulinum toxin in a patient with omohyoid muscle syndrome: A case report. To read the case report on http://bit.ly/R2eyb1. @www.twitter.com/UltrasoundSuply

krishnavardhan sirigere @ fb about your ultrasound technician training program is its focus. Some schools put more focus on how to work in a medical setting, while others focus more on learning the technology of sonography. Another very important thing that you have to consider is your practical learning experience. This is your hands-on training, and

Inspite of the stay on Gazette Notification of June 04, 2012 by the Govt. of India, the DHO of bagalkot district of karnataka has sent a common notice to all gyn and radiologists preventing to practice in more than two places. perhaps they are not aware. @www.facebook.com/krishnavardhan.sirigere

Color Doppler has made no change to the text in this section — Editor

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COLOR DOPPLER | September, 2012 Volume 1 | Issue 9 KERENG/2012/41766

editor-in-chief Joby Joseph joby@colordopplermedia.com publisher Niranjan Kumar K R M niranjan@indiaultrasound.com

care to share Markets have been revolutionizing the world since its evolution, either directly or indirectly, though social scientists, economists, anthropologists, etc might have a different opinion. The demand and need of the market drive the world through its varied manifestations. The markets are generally a world of commercial activity where goods and services are bought and sold, or, an area in which commercial dealings are conducted. No matter what is the medium, transaction of materials/goods is the activity of the market. The term has meanwhile received negative undertones, thanks to the Marxian ideologies. Nevertheless, we live in a ‘smart’ world where even ideas are available on your Google Play or iTunes. Market is with us and changing us on a daily basis, on a minute-by-minute basis to be more precise. However, even in this era, sharing information of medical digital images is not so easy. ‘We also do not enjoy a seamless transmission of data and medical digital images in the healthcare space — among physicians, institutions, or health systems. But PACS has the ability to deliver timely and efficient access to images, interpretations, and related data and breaks down the physical, time barriers associated with traditional film-based image retrieval, distribution, and display’. Hence, we believe, PACS is also a market, or more precisely a ‘share market’ that is changing the world. And, we are not waiting any more in promoting the revolutionary technology that brings all doctors in the country under one roof. Meanwhile, Color Doppler has joined hands with the XIII South Asian Conference on Clinical Ultrasonography in Practice 2012 (CUSP2012) which will be held at the Chennai Trade Centre from September 13 to 16 in a bid to make the knowledge available to our readers. Meet you next time with details from the venue of one of the biggest conferences on ultrasonography in the country. Till then happy reading.

Joby Joseph Editor in chief Follow me on twitter@editorjoby

copy editor Jumana Engineer jumana@colordopplermedia.com senior copy editors Deepa David design consultant Gireesh senior designer Rijo Jose rijo@indiaultrasound.com space marketing Joshy Joseph (GM) joshy@indiaultrasound.com Swetha G (Senior Executive) swetha@colordopplermedia.com Kishore Kumar P S (Executive) advertise@colordopplermedia.com Jithesh Kumar (Manager) jithesh@indiaultrasound.com Mahesh P (Manager) mahesh@indiaultrasound.com product marketing Manikandan Kachilote (GM) mani@indiaultrasound.com Prasanth K (Manager, Print) prasanth@indiaultrasound.com Hariharan V V (GM, Accounting) hari@indiaultrasound.com Praveen T (Production Manager) praveen@indiaultrasound.com coordinator Saraswathy M saraswathy@colordopplermedia.com COLOR DOPPLER 34/1347-A Florican Road, Malaparamba Calicut - 673009, Kerala, India   Phone : +91 495 2376661/ 62/ 64 /67 Fax : +91 495 2374745 Toll Free (India) : 1800 425 6366     Email : info@colordopplermedia.com   www.colordopplermedia.com Vision and opinions expressed in this magazine are not necessarily those of Color Doppler, its publisher and/or editors. Color Doppler does its best to verify the information provided but will not take any responsibility for the business moves taken by any reader on the basis of any article published in this magazine. No part of Color Doppler can be reproduced without the prior written permission of the publisher, Niranjan Kumar K.R.M. The rights to reproduce any information published in this magazine are vested with Color Doppler. The magazine is sold on the condition that the jurisdiction for all disputes will be courts/forums/tribunals at Kozhikode, Kerala. 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 A-One Offset Prints, Ramanattukara, Calicut-33 and Published at 34/1347A, Florican Road, Malaparamba, Calicut-673009. Editor: Joby Joseph.

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international trade fair and congress November 14-17, 2012

Dusseldorf: Medica, the world leader amongst medical trade fairs, is organizing an International Trade Fair with Congress – Medica 2012 from November 14-17, 2012 in Dusseldorf, Germany. Medica presents a remarkable portfolio of products, topics and companies, from innovative mall business to medium-sized companies and even global players. Specialists who wish to remain up-to-date in the area of outpatient and inpatient care make sure that they don’t miss this opportunity. For registration and other details, log on to www.visittradefairs.com.

international conference on bssi November 28 to December 1, 2012

Chennai: Indian Institute of Technology Madras is organizing the International Conference on Biomedical Systems, Signals and Images (BSSI), 2012 from November 28 to December 1, 2012 at the ICSR Auditorium situated on its campus in Chennai, Tamil Nadu. BSSI 2012 intents to provide an arena for researchers in academia and industry to deliberate on all current aspects of biomedical engineering and healthcare technologies. Indian Institute of Technology Madras is one among the foremost institutes of national importance in higher technological education, basic and applied research. For further details, call on +91 44 22574051/ 4073/ 5065 or email at biomedical@iitm.ac.in.

national diagnostic imaging symposium December 2-6, 2012

Florida: World Class CME in association with Institute of Medical Studies is organizing the national Diagnostic Imaging Symposium, 2012 to be held in Florida from December 2-6, 2012 at the Walt Disney World Swan and Dolphin Resort. This year’s conference will include 10 subspecialties, 40 faculty, 120 lectures, and 35 total credit hours. The symposium aims to attract physicians, military personnel, resident doctors, technologists, etc from various parts of the world. For details, log on to www.cvent.com.

course on women’s ultrasound procedure course December 3-7, 2012

Houston: The Advanced Health Education Center is conducting

a five-day program directed toward the performance of women’s ultrasound procedures from December 3-7, 2012 at its center in Houston, Texas. An integrated approach of lecture, demonstrations, hands-on scanning experience with models accomplishes the educational objectives. The basics of instrumentation and physics are reinforced in the laboratory. There will be both classroom presentation and hands-on scanning to provide for recognition of anatomy related to the female pelvis and various stages of gestation. Attention will also be given to OB/Gyn measurements utilizing both the transabdominal and endovaginal scan approach. Physicians who are at an entry level of ultrasound scanning and interpretation, sonographers or other health professionals learning OB/GYN ultrasound or cross training can avail the benefits of this course. For details visit www.store.aheconline.com.

exhibition on improving healthcare practices December 14 – 16, 2012

Mumbai: The 3rd edition of Hospital Build and Infrastructure India will open its doors in a new location from December 14 – 16, 2012 at Bombay Exhibition Centre, Mumbai, India. More than 4,000 decision makers and healthcare professionals will converge at Hospital Build & Infrastructure India 2012 to connect and explore cuttingedge technological developments, develop industry contacts, trade high-level healthcare business insights and explore some of the best business solutions available in the marketplace today. The exhibition is an excellent platform to exchange information, innovations, new trends and ideas to improve healthcare practices. For details, log on to www.hospitalinfra-india.com

intensive care and emergency medicine symposium January 6-11, 2013

Aspen: Colloquium Conferences is organizing the 3rd Annual Winter Symposium on Intensive Care and Emergency Medicine from January 6-11, 2013 at the Viceroy Hotel, Aspen, Colorado. This meeting will provide a comprehensive update of current topics in critical care and emergency medicine, aimed at neonatal, pediatric, and adult acute care practitioners. The symposium aims to provide an outstanding educational experience for its delegates. The conference will discuss the following: surgical approach to the difficult airway, transporting the critically ill patients, stress and its effect on the developing brain, acute coronary syndromes, safety in the ICU — opportunities for improvement, advances in haemodynamic and pulmonary monitoring, etc. For details, log on to www.colloquium.com.au

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

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fda proposes udi system for medical devices In response to requirements in legislation that passed the Congress with broad bipartisan support, the US Food and Drug Administration (FDA) proposed that most medical devices distributed in the United States carry a unique device identifier, or UDI. This system has the potential to improve the quality of information in medical device adverse events reports, which will help the FDA identify product problems more quickly, better target recalls, and improve patient safety. The FDA has worked closely with industry, the clinical community and patient and consumer groups and conducted four pilot studies in the development of this proposed rule. With certain exceptions, under the proposed rule, a UDI would include: A device identifier, which is a unique numeric or alphanumeric code specific to a

ge invests $7.5m in nanosonics GE Healthcare has committed to a $7.5 million investment in Nanosonics to further develop and distribute the firm’s ultrasound transducer disinfecting system. The investment is being made through the GE Healthymagination Fund. Nanosonics’ Trophon EPR transducer disinfecting system takes seven minutes to disinfect between patients, half the time of traditional disinfection techniques

us underused in teenagers with hypertension Despite guidelines recommending their use, echocardiograms and renal ultrasound are still not often used in adolescent patients with hypertension, according to a study published online in the Archives of Pediatrics and Adolescent Medicine. Current pediatric guidelines recommend laboratory tests and renal ultrasound for all pediatric patients with hypertension to rule out renal disease. In addition, echocardiograms are recommended to assess target organ damage. A team led by Dr. Esther Yoon reviewed echocardiogram use in adolescents and compared it with ECG and renal ultrasound by analyzing administrative claims data from the Michigan Medicaid program from 2003 to 2008. Of the 951 adolescents with “essential” hypertension (hypertension with unknown cause) and antihypertensive pharmacy claims, 226 (24 percent) had echocardiograms, 207 (22 percent) had renal ultrasound, and 478 (50 percent) had ECGs. The authors also found that boys, younger adolescents, those who had ECGs, and those who had renal ultrasound were more likely to receive echocardiograms. The patterns of ECG and echocardiogram use raise questions “about the level of familiarity, awareness, or agreement

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device model; and A production identifier, which includes the current production information for a device The FDA is proposing a risk-based, phasedin approach to implementation, focusing on the highest-risk medical devices first and exempting low-risk devices from some or all of the requirements. The FDA is proposing to exempt over-the-counter devices sold at retail; these devices generally have UPC codes in place. A UDI is a unique numeric or alphanumeric code that acts as a key to certain basic identifying information about a device, such as the name of the manufacturer and the type of device, and may represent certain other information about the device, such as its expiration date and batch or lot number. This information will be contained in a publicly available UDI database, and no identifying patient information will be stored in this device information center. with pediatric hypertension guideline recommendations, and the rationale behind these recommendations,” according to the authors. Further study is needed to understand the rationale behind the diagnostic tests chosen to evaluate target organ damage in adolescents with essential hypertension and to determine treatment effectiveness, the researchers concluded.

siemens, philips, ge score in klas ultrasound survey Ultrasound vendors who respond well to provider needs and market changes — including expansions in range of clinical use and growing volumes — receive higher satisfaction scores, according to a new study conducted by research firm KLAS. For the study, titled ‘Ultrasound 2012: Technology Improved, Usage Amplified,’ participants rated vendor performance in a range of scanning areas, including anesthesia/operating room, breast, cardiac, emergency department, intensive care unit/ neonatal intensive care unit, interventional, ob/gyn, oncology, orthopedics and musculoskeletal, pediatrics, and urology. Overall, except in pediatric scans, Philips Healthcare took the lead in performance. For orthopedic/musculoskeletal and urology scans, GE Healthcare scored well, and Siemens Healthcare scored high for oncology

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and urology scans, according to KLAS. Study participants expected ultrasound volumes to increase overall, especially for breast imaging and in the emergency department, the report found. For breast scanning, participants rated Philips, GE, and Toshiba America Medical Systems as the leaders; users of Philips and GE devices also reported satisfaction with these companies’ efforts to create better breast imaging applications. The KLAS study showed that Zonare Medical Systems and Siemens were falling behind the breast imaging pack.

The study also measured participants’ perceptions of ultrasound devices’ performance in four technology areas: ergonomics, penetration, mobility, and image quality. Zonare was shown to be the leader in mobility for the study, but the company’s z.one device lacks penetration, while Philips’ iU22 is less mobile but produces high image quality, according to the report. GE scored high across all four areas; Siemens scored well for image quality but scored lower than average on ergonomics and mobility. Toshiba also scored low on mobility and scored average in the other three areas, KLAS said.

Image storage is a necessity, no matter what option is chosen. As providers start to bring in more studies and the studies themselves increase in size, the need for storage will increase Ben Brown, imaging research director, KLAS, explain the importance medical image storage

Dr. Stephen F Ridley, MD, vice president and chief medical officer of Soma Management Inc., has been named the 2012 Jack H. Warren Emergency Physician of the Year by the South Carolina College of Emergency Physicians. Dr. Ridley was recognized by the statewide medical organization for his “innovative efforts and fearless dedication to the pursuit of patient safety and quality of care” in emergency medicine. Kaz Yamamura has been named as the new President of FUJIFILM Holdings America Corporation. In his new role, Yamamura will also serve as the new Chairman and Chief Executive Officer of Fujifilm North America Corporation, overseeing management of eleven Fujifilm companies that operate in the United States. He is also a member of the Board of Directors and Corporate Vice President for FUJIFILM Corporation. Prior to his newly announced position, Mr. Yamamura served for more than 36 years at Fujifilm. He has also served as Chief Financial Officer for FUJIFILM Europe GmbH. Dr. Dennis Davidson, MD, has been appointed Professor of Pediatrics at Stony Brook University School of Medicine and will serve on the medical staff at Stony Brook Long Island Children’s Hospital as Chief of Neonatology-Perinatal Medicine in the Department of Pediatrics. Dr. Davidson comes to Stony Brook Children’s from Hofstra University-North Shore LIJ Health System School of Medicine, where he served as Professor of Pediatrics, and The Feinstein Institute for Medical Research, where he was Principal Investigator, Inflammation and Immunology Center of Excellence.

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best for daily practice: ezono 3000 4GB internal memory 26.4 cm diagonal LCD touch screen (24 bit, 60 million colors) Digital broadband architecture 2x USB 2.0 ports, 1 Express Card port, built-in microphone. The eZono 3000 offers the unique feature of upgrading your eZono system regularly with the latest available features. For instance, recently the company launched the Open CueCards and their customers were able to transform their eZono 3000 systems by downloading the update on myEzono.com. The system therefore offers you a leading price performance ratio because it stays always up to date.

other features Proprietary Linux operating system Less than 20 seconds start time

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Zono 3000 is a revolutionary portable ultrasound system designed by German ultrasound manufacturing company eZono, for the needs of anesthetists. It accelerates the learning curve with their patented Cue Cards, a multimedia learning and workflow tool accelerating the learning curve in those applications - combined with excellent image quality. Furthermore the touchscreen of the system and the icon-based user interface significantly reduce complexity. Given its light-weight form-factor, fast boot time of under 20 seconds and 2 hours battery life, the eZono 3000 is ideally suited for every day clinical use.

facts and figures

Icon-based graphical user interface via touch screen Upgrade via USB for continuous improvement throughout its life time Store up to 30,000 images or 30 minutes of continuous video If you are looking for a system that grows together with your needs, then simply create your own CueCards, upload them onto your system and use them in daily routines. Or benefit from the company’s community of leading experts, providing an ever increasing stream of new CueCards for eZono 3000.

applications Regional Anaesthesia

Weight: 4.4 kg

Intensive Care

Dimensions: 32.4 cm x 28.2cm x 9.3 cm

Emergency Medicine

no more exam fear!

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ake studying for your ARDMS ultrasound physics exam easier with iSonographer – Ultrasound Physics Flashcards. If you are studying for the ARDMS/CCI exam or need help in class, the best way to make the grade is to use Study Guides, Texts Books and iSonographer – Ultrasound Physics Flashcards.

features

Simple and intuitive: Just download the app and begin studying within seconds Drill weak subjects: Over 575 ultrasound physics flashcards written in an easy to understand format Refresh old lessons: Covers each subtopic in the ARDMS & CCI content outlines Trusted author: Developed by an ARDMS certified ultrasound professional The app is available on iTunes for iPhone users while Android phone users can download it from Google Play.

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stable, effortless, simple: viewflex xtra ice catheter

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t. Jude Medical has received the FDA go-ahead to market its ViewFlex Xtra Intracardiac Echocardiography (ICE) Catheter in the US.  The device works in conjunction with the company’s ViewMate Z Intracardiac Ultrasound Console to allow for close-up visualization of the heart and blood flow within. St. Jude promises outstanding control of the catheter thanks to the single-handed operation that provides four-way tip deflection and self-locking steering.

features Stability, control and simplicity Large curvature radius provides increased control over viewing angles and positioning Steering angles to 120 degrees Integrates the market leading Agilis handle for precise single-handed control and full maneuverability during complex procedures Exceptional torsional control and tip response Powerful integrated diagnostic ultrasound system The ViewFlex PLUS ICE Catheter, together with the ViewMate Z Ultrasound Console, provides a full featured, high-fidelity imaging

system for best results Unlike fluoroscopy, ICE imaging displays crisp, clear images of anatomical structures Imaging modes: 2D, M-Mode, Pulsed Wave, Tissue Doppler Imaging, Continuous Wave, Color Doppler.

real-size, interactive 3d views: sectra visualization table

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ectra Visualization Table is a cutting-edge pre-operative planning tool for the complex orthopaedic cases. Real-size, interactive 3D views of the patient give the orthopaedic surgeon a unique possibility to become familiar with the specific anatomy prior to surgery. Without opening the patient, the surgical team can localize vessels, muscles and skeletal tissue and study their threedimensional relation and plan the surgery. The touch interface allows the surgeon to interact with the virtual body with the hands, as in the real surgical setting, which supports his or her tactile memory. This increases quality in surgery and reduces operation and rehabilitation time as unplanned issues can be avoided.

features Efficient communication tool The large monitor and intuitive touch interface of the Sectra Visualization Table support group discussion between medical teams, providing opportunity for new methods of collaboration between doctors. It is also an efficient tool for communication with patients and can be used for case acceptance of a particular procedure or simply for education and consultation by showing the patient´s own 3D scan in real-size. A new dimension in resident training Sectra Visualization Table can efficiently be used to support orthopaedist residents in their training. Going through a case in real-size together with the supervisor helps ensure the quality of surgery. It is also a valuable practical component of lectures or courses. Virtual dissection with real-life cases

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Sectra Visualization Table is the optimal complement when cadaver-based dissection courses is not available, or when the cadavers are very few. This way, teaching institutions can increase the exposure to anatomy and hands-on practice for every student and allow the students to do the virtual dissection over and over again, reducing the learning curve substantially. Efficient group interaction The 46” multi-touch screen allows users to interact with the virtual body in 3D simply by touching the screen. This way, tactile learning is supported which facilitates the learning process. Students and instructors can easily gather around the Visualization Table for group discussions and examinations and thanks to the unique format and touch interface, they can easily hand over command between them to even further enhance the group discussion. Enabling virtual autopsies Sectra Visualization Table reduces the need for invasive surgical procedures within forensics and pathology. High-performance volume visualization gives you a quick 3D overview of CT or MR data, and you can dig into detail without difficulty.

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The writer is a software engineer in Medical Imaging Research Projects for Larsen & Toubro and the founder of Biomedical Portal of World, www.bmeportal.ning.com

Sharing medical digital images information is not easy, even in this modern era. We also do not enjoy a seamless transmission of data and medical digital images in the healthcare space — among physicians, institutions, or health systems. But PACS has the ability to deliver timely and efficient access to images, interpretations, and related data and break down the physical, time barriers associated with traditional film-based image retrieval, distribution, and display, writes Gunjan Patel COLOR DOPPLER | SEPTEMBER, 2012

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When working toward the solution of a problem, it always helps if you know the answer — Murphy’s Law

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ou can walk with this question into a highly advanced, digital, state-of-the-art hospital or radiology imaging center and spend hours looking for someone who could answer it correctly. We all get used to buzzwords and acronyms, and rarely think about their meanings. Unfortunately, nothing distances you more from success than not knowing what you are dealing with! In Healthcare IT and Radiology, ‘PACS’ (Picture Archiving and Communication Systems) is a combination of hardware and software dedicated to the short and longterm storage, archiving, query/retrieval, media management, distribution, and demonstration of digital medical images from multiple modalities (Ultrasound (US), Magnetic Resonance (MR), Positron Emission Tomography (PET), Computed Tomography (CT), Endoscopy (ES), Mammograms (MG), Digital Radiography (DR), Computed Radiography (CR), Ophthalmology, etc.). Sharing medical digital images information is not easy, even in this modern era. We also do not enjoy a seamless transmission of data and medical digital images in the healthcare space—between physicians, institutions, or health systems. Just like other businesses, healthcare is also a competitive industry. Hospitals, radiology imaging centers, health systems, and clinics all vie for the same patient base. But other competing business entities seem to have had more success in leveraging the Internet to share information. Combined with available and emerging new mild technology, PACS workstation has the ability to deliver timely and efficient access to images, interpretations, and related data. PACS breaks down the physical and time barriers associated with traditional filmbased image retrieval, distribution, and display.

processes of the past The photographic and fluoroscopic processes first utilized in those early days are still being employed in one form or other, and will continue to be used into the foreseeable future. Static photographic film images displayed on a light box has been the main means of displaying radiographic images. However, many other types of displays are also being used. Moving images are utilized in angiography (film) and gastrointestinal (video tape) imaging. Paper was also used in the past (nuclear medicine) to capture an image and is seeing

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a resurgence today as a low cost storage medium. The image below illustrates a typical reading room, demonstrating the standard method of displaying radiographs in the past. A fixed, static, film image is backlit by a light box using two-three fluorescent bulbs. The printed film image is viewed and the radiologist, using all the available and pertinent information, makes his diagnosis. Before making that diagnosis, he may call on another colleague for consultation. If he feels the need for another opinion or occasionally,

A typical reading room, demonstrating the standard method of displaying radiographs at this time

Figure 2 he may also consult reference books dealing with different diseases. We can imagine the scenario two decades ago in hospitals, physician offices, radiology imaging centers and clinic information systems which have traditionally been very inward-looking; where healthcare data often resided in separate departments with minimal capability to be consistent or used with data from other departments. The medium for connecting systems was paper (or film), with a human interface used to carry and re-enter data generated from one system into another. Diagnostic radiology workstations allow radiologists to interpret digital radiology

images without printing film. Filmless reading provides a number of important advantages, including the ability to adjust the density of the image without requiring unnecessary study repeats. Though the radiographic film continues to be the most commonly used medium for storing imaging information, it has the disadvantages of being expensive; difficult to duplicate; and cumbersome to transport, store, and retrieve. There is also the possibility of data loss due to physical deterioration of the film over time. In Indian healthcare organization, the practice of medicine has changed drastically in the past 15 years, largely because of tighter practice standards, emphasis on efficient and accurate diagnosis and treatment, increasing incorporation of complex technologies, declining reimbursements, and a rapidly changing customer (population) base. The field of radiology is fortunate in that the speciality had a tremendous head start in the digital conversion of medical records. Radiology imaging techniques such as CT scan and MRI, which are based on digital technology, have been introduced and have found widespread application in medical technology. These studies allow physicians to examine the body in minute detail and enable rapid and accurate diagnosis of disease states. The computer science and technology revolution in society in general and in radiology specifically has resulted in a demand for the development of more versatile medical imaging display systems. One of the main requirements is that they should be able to exhibit, equally well, all the present image types and new ones that might be developed in the future. Another requirement is that they must be capable of integration into PACS. For over the last decade, majority of hospitals and private radiology practitioners have shifted from film-based image management systems to a fully digital (filmless and paperless) environment, not too dissimilar (in concept only) to converting from a paper film image to a digital storage form and display on console-based workstation (see in Figure 2). The universal format for PACS image storage and transfer is DICOM, which stands for Digital Imaging and Communications in Medicine, and is a standard that was developed to “promote communication of digital image information, regardless of device manufacturer” within a radiological environment. The standard is both a file format and a transfer protocol, and it is not tied to a particular manufacturer, hardware device, operating system or software application. Computed radiography, US, MRI, PET, CT, Endoscopy images (ES), are examples

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of modalities that have benefited from the introduction of digitalization. Film and film libraries have given way to modern picture archiving and communication systems (PACS) and highly redundant archives that tightly integrate with historical patient metadata derived from the Radiology Information System (RIS). As the benefits of digital images have become apparent, imaging modalities that have traditionally been analog-based have also begun evolving into digital systems. Devices such as magnetic tapes and optical jukeboxes are used for this form of storage. Offline storage media include magnetic tapes and optical discs that are stored elsewhere. This type of storage is typically used for longterm storage and for storing back-up data. As this type of storage is expensive, images that do not require immediate access are stored in near-line storage.

present times PACS is a key workflow tool in the functioning of radiology departments worldwide today, and its utilization is rapidly growing in India. A Department of Radiology produces several thousands of images every day. For example, CT Scanner or MRI scanner working at the rate of 2-3 examinations per hour produces approximately 200 images per hour, and it is not possible to classify these images in a JPEG or GIF format because it has a risk of loss of demographic data of the images (name of the patient, address, type of examination, hospital, date of examination, type of acquisition, imaging modality, clinical reports etc). The DICOM standard allows to make each produced image unique and to associate specific information to it. Thus each image is autonomous, if it is lost, reproduced or re-elected, it is always possible to identify formally its origin, the patient, the date, the series from where it comes, parameters of acquisition etc.

goes beyond radiology The many possible specialities where PACS can offer benefits include cardiology, ophthalmology, pathology, medical imaging, dermatology, trauma and endoscopy. As digital imaging uses the same modalities as radiology, PACS can be easily integrated with all modalities. RIS remains an option for laboratories and hospitals, where cardiology is performed by both radiologists and cardiologists. Future developments will include output from various specialties to be stored in PACS without integration of separate software. In the current years, unarguably, radiology is the most imaging dataintensive, technology-dependent and driven

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subspecialty of medicine. Hence it is vital to have a dedicated digital system to capture, store, evaluate and retrieve, print and re-use the available information. The best way to go ahead is to go digital. In the film radiography technique, the film serves a dual function,

Distributed computing is coming in the new forms as Grid and Cloud computing and all components are accessed via internet browsers. It allows consumers and healthcare IT businesses to use PACS applications without installation and access their personal files from any computer with internet access

both of a detector and storage media. In contrast, in digital radiography, the digital detectors only generate the images, following which the images are processed, archived and finally stored in a separate digital medium.

pacs architecture model The PACS architecture is the physical implementation of required functionality, or what one sees from the outside. There are different views, depending on the user. A radiologist typically sees a viewing workstation, a technologist a QA workstation, while a PACS administrator might spend most of his or her time in the climate-controlled computer server room. The composite view is rather different for various vendors.

pacs system components DICOM supported modalities DICOM network: It is responsible for all the DICOM-based communication with all kinds of imaging modalities, other PACS servers and DICOM workstations Storage and archiving system: The central storage device (archive) stores images and in some cases reports, measurements and other information that reside with the images PACS centralized server: The core hardware and network connected system PACS workstation: It provides interactive display of digital images with PACS viewer for radiologists to interpret the images and where the radiologist reviews the patient’s study and formulates their diagnosis Image storage database system: Responsible for managing the storage of all the information and images in the PACS system Image displaying tool: It provides easy mouse navigation (all operations like window levels, pan, zoom, and scroll are handled with one hand), real-time image manipulation (even in looping animations), and renders

reference images (3D, 4D projection of selected images) in all suitable views. With the tool we can browse and open local images, and convert DICOM image format to other image formats. Media management system: The physical storage like CD/DVD, USB stick or hard disk drive required to store the DICOM images of the PACS system Interfaces to RIS/HIS: Aggregates all the data of the patient from different departments and provides an end-to-end patient care workflow integrated through HL7 healthcare standard Web-based server for remote access: PACS include web-based interfaces to utilize the internet or a WAN (Wide Area Network) as their means of communication, usually via VPN (Virtual Private Network) or SSL (Secure Sockets Layer), along with always online storage and real-time multi-level backup Now as we move to a digital healthcare IT world, we have software capable of viewing these DICOM images online and doctors can remotely view/annotate these images. All this has become possible by the universal DICOM standard. The high volume of medical images is leading to scalability and maintenance issues with healthcare providers’ onsite PACS and network. Digital medical images are typically stored locally on modern PACS for retrieval and highly redundant archives that tightly integrate with historical patient metadata derived from the RIS (Radiology Information System). Many companies have their own custom additions to the DICOM standards and so two DICOM files from two vendors need not have the same contents even if they were for the same patient and output from the same medical device with the same resolution, settings and by ensuring the compatibility of the equipment and eliminating proprietary formats. The advent of PACS has allowed for digitally capturing, storing and retrieving medical images and other related information at any time, from anywhere. Replacing the traditional hard copy films used for radiology reports, PACS offers immense benefits in terms of saving costs and enhancing quality. PACS not just helps the hospital to go filmless by reducing cost of consumables like films, but also helps improve staff performance by increasing their productivity and managing workflows efficiently. Together with RIS, the productivity of a healthcare provider can be tremendously enhanced by bringing in efficiently managed solutions for multiple departments.

a peek into the future My research and study view is that the next decade will be a critical and, at the same

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Cloud Computing Cloud as a Service (CaaS)

Workstation

DICOM Virtual PACS DICOM Applications Software RIS IOS

PACS

Internet RIS

Mobile/Tablet

Physician

Hospitals

time, an exciting one for Indian radiology, with major challenges and equally major opportunities. In the future the existing technology framework model has to meet the basic needs of solid foundation with platforms and software to power and run robust of DICOM Image Management applications and supply services to end user. The challenge is to extend the reach of these technologies. Most importantly, India being a costsensitive market, the extent to which PACSlike technologies can evolve is limited. Hopefully, in future, healthcare providers will realize the need to balance costs with the benefits of IT implementation and opt for solutions like PACS for better delivery of care.

challenges in DICOM image management Radiology imaging center: Collecting DICOM and non-DICOM data from modalities Teleradiology center: Networking and remote data access Hospital organization: Getting your act together Image-processing laboratory: Consistent and complete data of medical digital images Expanding radiology system networks in healthcare institute, complex hardware, and the entire radiology DICOM workflow Any disaster and stored data availability – anytime and anywhere across the world India is one of the fastest growing medical imaging markets in the world. Ultrasound (US) is the most popular cross-sectional

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Modality

imaging modality in India and it has served the poor, as well as the rich equally well. There are about 50,000-55,000 US machines in India and in the next 10 years, the number is going to double. For the Indian radiologist running a small clinic, this is the most economically viable modality; charges per patient vary from Rs. 150-2000, depending on the indications. Based on the current trend of medical images, it is estimated that over one billion diagnostic imaging procedures will be performed in the United States during the year 2014, generating about 100 Petabytes of data. This high volume of medical images is leading to scalability and maintenance issues for healthcare providers in order to enable cross-system functionality and interoperability. DICOM and HL7 standards are now in use by majority of medical imagining hardware manufacturers and software (PACS, RIS, HIS) providers. In medical imaging, digitally connected world DICOM has improved the efficiency and effectiveness of clinical practice for radiologists and medical modality industry - improved images workflow, improved information accuracy and compatibility, improved digital images information availability anywhere and anytime.

technological trends India is a country of a billion people and fewer than 10,000 radiologists, a severely imbalanced ratio of 1:100,000 (the corresponding ratio in the US is 1:10,000).The

pace of innovation in the diagnostics industry will only accelerate further. The gadgets will get smarter, faster, and more patientfriendly. We think of instant, convenient and highly secured communication in order to improve the medical images workflow. DICOM defines a method of medical images communication in RIS, as well as various other equipment of digital medical imaging software’s and radiology modalities. Thus, the standard makes it possible for the equipment to communicate remotely through a network, media (disk or tapes) and internet. We are on the verge of entering a new and inspirational era in diagnostic imaging, one driven by digital radiology and powered by the internet and information technology. Telemedicine is a broad term encompassing all methods where the doctor-patient interaction is not on-site and some form of telecommunication is used. Also called telehealth, online health, or e-health, telemedicine has made long strides since its inception. Teleradiology is a branch of telemedicine in which telecommunication systems are used to transmit radiological images from one location to another. Interpretation of all noninvasive imaging studies, such as digitized x-rays, CT, MRI, ultrasound, and nuclear medicine studies, can be carried out in such a manner. Distributed computing is coming in the new forms as Grid and Cloud computing and all components are accessed via internet browsers. It allows consumers and healthcare IT businesses to use PACS applications without installation and access their personal files from any computer with internet access. Today in market, some of the vendors of DICOM solutions and PACS services provider follow Cloud Computing services model for medical digital images application solutions and point-of-care services to hospitals, radiology imaging centers and healthcare organization. The imaging revolution and advance solution is the Cloud Computing Technology which will solve this situation for DICOM images management for any modality. DICOM on cloud is bringing the on-demand software model to your desktop or mobile and tablets, in a single login environment. Furthermore, the cloud computing promises lower cost, high scalability, availability and disaster recoverability which can be a natural solution for some of the problems we faced for long-term medical image archiving. Based on your specific needs, you can turn on new functionality over the Internet immediately. Sharing studies with a colleague is just one click away. No CDs, VPNs and DICOM data feeds. Just one-click access to all your imaging data and imaging colleagues.

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philips, nuvodia join hands Philips Healthcare plans to team with radiology informatics firm Nuvodia in a bid to broaden its PACS user base. In a deal designed to appeal to rural hospitals, smaller institutions, imaging centers, orthopedic centers, and oncology practices, customers will be able to purchase Philips’ IntelliSpace PACS on a fee-per-study basis through Nuvodia. Hardware, software, and fullservice maintenance will be included, according to Philips. Nuvodia’s eRadiology secure cloud will host and maintain the system database. Onsite image storage with full access to all system features will be available through unlimited Webdeployable enterprise and diagnostic workstations, Philips said. As an option, customers will also be able to use Nuvodia’s eRadiology program, which enables physicians to digitally send images to medical specialists for consultations, the company said. Import medical images and patient studies, assure the imports and correct demographic data are properly imported into PACS. Indian PACS and radiology solution is here, the users can access DICOM images from Cloud RIS or Cloud PACS server resources via the Internet from anywhere, for as long as they need, without worrying about any maintenance or medical digital images management of actual resources of local or connected network. Besides, DICOM images databases in cloud are very dynamic and scalable. PACS server is a medical imaging technology which provides economical storage of, access to your Cloud PACS from any web connected computers, unlimited access to your stored images and reports from multiple modalities and accepts DICOM and non-DICOM objects. It connects with unlimited number of viewing computers, tablets, and smartphones for anywhere, anytime, any device viewing and reporting without synchronization or ‘orphan’ study issues. The disaster recovery solutions and no additional hardware requirement on a cloud computing platform and solutions enable rapid implementation of RIS or PACS for image management in solutions.

radiology and beyond Contrary to what the name might imply,

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there is no ‘one-size fits all’ PACS solution. Radiology PACS is very different from a Cardiology PACS or Endoscopy PACS due to the intricate nature of each imaging discipline and workflow requirements. Even within the same clinical discipline, there exist different levels of PACS implementation; the adoption of a small scale PACS involving only one modality (e.g. ultrasound only) will be very different from a hospital-wide implementation consisting of all medical imaging modalities. Traditionally, the term ‘Enterprise and Integrated PACS’ in the world of medical imaging refers to PACS implementation of a large hospital- level or a ‘cluster’ (between hospitals) implementation. However, in pace with changes in landscape and technology, enterprise imaging has taken a new meaning with the rapid adoption of digital image acquisition and archiving out of the radiology department, ‘multidisciplinary’ PACS at a hospital, or cluster wide implementation has now become the ‘next big thing’ and the crusade in search of the perfect Enterprise PACS is starting to attract visibility from all major imaging informatics solution providers. There are many logical reasons of Enterprise and Integrated PACS for all radiology imaging.

of the systems) Increased usability: A properly designed Enterprise PACS will provide a standardized user interface. While it may sound insignificant, the availability of a unified user interface can make a huge difference in terms of reducing the learning curve and easing the change management process, effectively increasing the adoption and utilization rates to speed up returns of investments on both tangible and intangible aspects. Data integrity and ‘business intelligence’: An Enterprise PACS deployed on a single database will eliminate the issues commonly faced by other implementations with multiple databases

pacs market According to Clearstate, a premier life sciences research consulting firm based in Singapore, the market size for the year 2008 in growth markets clearly reflects the rising demand for imaging modalities in both radiology and interventional cardiology segments in the Asia region. Radiology India – USD 380 million Indonesia – USD 67 million Interventional Cardiology China – USD 770 million

example of pacs adaptation Enterprise PACS Digital archiving

Hospital PACS Departmental PACS

Modality specific Mini PACS

Filmless environment

The advantages include: Cost savings: Every PACS solution incurs cost from hardware to software licenses. Consolidating the hardware (servers, storage, networks etc) will not only result in savings from reducing the number of physical equipment but also reduces electricity and air-conditioning needs. Elimination of duplicate software licenses (operating systems, databases, anti-virus, monitoring utilities) and manpower (for maintenance, support and ongoing upgrades

India – USD 249.3 million The increasing dependence on imaging modalities for effective diagnosis, coupled with digital medical imaging success stories and case studies of how an effective implementation of PACS in the radiology discipline can significantly increase productivity across the entire image life cycle, while reducing consumables and other operational costs, has heightened the interest and adoption of the technology among other medical imaging disciplines.

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Suchet Singh, Chief Executive Officer, Srishti Software, shares his views on healthcare sector which is moving towards automation and how PACS is fast becoming a tool for bringing different technologies together

Suchet Singh

future is

here

What are the major requirements of Indian hospitals and healthcare institutions as far as RIS-PACS is concerned? Indian hospitals and healthcare industry are highly valuefocused. Hence, the key requirements are — ­ the solution should be cost competitive, have high interface with third party applications, easy to use for end users and must conform to global standards of healthcare. What do you focus on while designing RIS-PACS solutions for Indian hospitals and healthcare institutions? Our RIS-PACS solution is a generic platform that is designed to be easily deployable across nations and usage. We have emphasized on ease of use, maximizing price-performance and virtualization of patient image records. Our RIS-PACS virtualization solution delivers medical collaboration of different specialists across locations simultaneously. This helps in multiple faculty consultations including remote locations. By integrating to OT cameras, OT images can be streamed live for cross consultations. Virtualization helps medical tourism wherein the referring doctor can also the view the same images that the attending doctor is viewing and consult thereby. The RIS-PACS Solution makes life of a PACS administrator a lot easier since there is just one server to maintain. What are the ways by which the workflow in RIS-PACS leads to improvement in productivity? Work-flow in RIS-PACS solution stores images electronically, thus helping hospitals save a lot on operational cost. Before the implementation of RIS-PACS, hospitals employ human resource

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to file images physically for in-patient files. Post implementation, they can channel their resource to a different area, improving their efficiency. Since RIS-PACS enables attaching patient medical records and report electronically to their files, it is easier for doctors to send them within the hospital to experts/ consultants and also outside the hospital for second opinion. They can even store data for their record and reference. Finally, electronic storage of data enables them to store the images in their archive, which can be revisited by them at any point of time for reference without the fear of physical damage to reports. What are the major challenges that you face while doing business in India? How does the ever-increasing taxation on healthcare facilities in India pose as a hurdle for companies in delivering quality healthcare products and solutions? Implementation of RIS/PACS poses certain challenges, especially when it requires integration with third party solution. For this, we are dependent on appropriate technical support from the vendors of the third party for the smooth integration. Any inadequate support and coordination leads to delay in the implementation timeline and would create a possible risk to the project. How beneficial have your RIS-PACS solutions been to your clients? Can you cite an example? The best example is that it enables patient x-rays and other images to be digitally attached to patient electronic medical record and be sent outside or within the hospital to consultants/

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experts for second opinion within minutes. Also since the whole process of filing the images is automated, there is little chance of error which could be life threatening in some cases. Do your clients have an option of customizing their PACS solution before buying? PACS solution comes with product releases every three months and incorporates most of the buyer’s requirement. In this way the customization becomes minimal and customer gets all the features readily available in our standard PACS solution. How does Srishti’s RIS-PACS solution get integrated with the external HIS solutions? Our RIS-PACS solution can be completely integrated with external HIS solutions. The system uses what is called an ‘Integration Engine’ and an ‘Enterprise Service Bus’ to communicate to third party software. To put it in simple terms, Integration Engine acts as a platform for the HIS Solution and the third party software to communicate by converting both their languages into a common language. After conversion, the Enterprise Service Bus communicates the meaning to each side and aides them to understand and work in sync with each other.

We stand out from our competitors because our solutions have been designed after extensive market research on typical pain points that radiologist/administrative staff of hospitals struggle with. PARAS-RIS solution enables ease of use, price performance and virtualization of patient image records

What does make Srishti stand out from its competitors? We stand out from our competitors because our solution has been designed after extensive market research on typical pain points that radiologist/administrative staffs of hospitals struggle with. PARAS-RIS solution enables ease of use, price performance and virtualization of patient image records. How do you manage to stay ahead of the game with the rising competition in the market, especially from MNCs? We believe in listening to our customers and constant innovation as a driver to business development. What will be the future of PACS in India (and globally)? How fast is this market growing? The future of PACS looks promising. Recently, healthcare segment has been witnessing a trend towards automation and IT system adoption. Initially hospitals used to outsource radiology procedures to outpatient clinics. Now in a bid to save cost and offer integrated services, they are evolving their own radiology divisions. In the wake of this shift, we definitely see PACS fast becoming a tool for coming together of different technologies. How do you plan to make the best out of it? We are working on evolving many futuristic models to improve patient care. We are confident that our relentless focus on listening hard, innovating along the industry trends and excellent after sales support will help us drive revenue and gain market share. Srishti Software’s future plans for their clients? Srishti will continue to engage with clients, implementing PARAS in their hospitals successfully, driving user adoption and providing after sales support. On the development front, we are working on many futuristic models that would contribute in improving the quality of patient care.

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one for all,

all for one Color Doppler lists a few PACS solutions providing single access point for images and data

improving overall work efficiency

N

ovaPacs from Novarad is a proven PACS system, increasing radiology efficiency through a completely mouse driven viewer, a fully customizable interface, and a set of easily accessible advanced features. The best web-based technology with both thin client and zero client solutions that utilizes high level streaming, imaging algorithms, and proprietary methods for distributing large data sets quickly Absolutely full-featured viewer; robust and scalable. Always improving, to remain one of the best products available User-friendly, easy to learn and completely customizable with buttons, toolbars, menu

hotkeys, and mouse settings that follow the user wherever they go Images and reports available anytime, anywhere, via any web browser, PDA, or smart phone Their full diagnostic viewer is available from any computer in the world and is feature rich, including advance hanging protocols, MIP, MPR, and voice annotation. Workstations that include the ability to have one-click voice recognition dictation from the PACS All upgrades included at no additional fee so that you can always afford to stay current. Continued affordability with no extra fees, increases only related to inflation, and fair pricing practices Novarad always provides three copies of all

images. Two copies are online and on-site and one copy is off-site. This means you have no extra costs for disaster recovery.

seamless connectivity to HIS, RIS, CIS and/ or EMR systems. Centricity PACS-IW enables your entire clinical staff to access patient images and data from anywhere, via web access, at anytime. Authorized users get immediate access to prior and current exams for ideal comparison. Regardless of where a procedure was performed, access is simple

and fast. Centricity PACS-IW allows you to improve communication and cooperation with your referring physicians. Automatic email notification informs them when their studies and reports are available. Your referring physicians can have immediate and secure, digital access to studies and reports, regardless where they were performed.

with pacs towards ehealth

C

entricity PACS-IW by GE Healthcare is a web-based solution for all modalities and healthcare environments. With its advanced and easy-to-use technology, Centricity PACS-IW is the PACS of the future, but delivered today, and is based on the latest international guidelines such as those developed by IHE and DICOM. With strict compliance to industry standards and the comprehensive IHE framework, Centricity PACS-IW seamlessly interfaces a full range of hospital, radiology and clinical information systems. The 100 percent web-based PACS-IW architecture enables easy administration from anywhere, via web access. It is scalable to your needs and allows you to start small and grow big. Virtually an unlimited number of user and modality licenses can be added. Client application installation is effortless, freeing up administrator time for other activities. Bring your images and results to life through

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taking healthcare to next level

E

nterprise InstaPACS from Mediff Technologies is a customizable webbased PACS solution for multi-hospital networks. It is a central archive that stores high quality DICOM images and reports related to Radiology, Cardiology, Nuclear Medicine, Echo-Cardiology, Orthopedics, etc, sent from remote centers.

features Enterprise InstaPACS takes healthcare to a much higher level and increases productivity. Referring specialists can view DICOM images within a few seconds as streaming technology is progressive and prioritizes the streaming of clinically important data (images on demand) As medical specialists can access DICOM images remotely and send back the diagnosis within minutes, general physicians can start treating patients at once, instead of waiting for a specialist to arrive at the hospital The viewer includes readymade report templates and patient history for quick reporting. Macro support in reports makes textual entry faster Enterprise InstaPACS’ interface is intuitively obvious i.e. easy to use and understand without extensive training It brings down costs of IT and administrative tasks by managing enterprise workflow and global work lists efficiently. By archiving DICOM images in the database, physical film archives need not be maintained. Non-DICOM images can be converted via a DICOM converter A workflow manager manages the workflow efficiently. Quick access to medical images leads to faster diagnosis, quicker report turnaround times, and high patient turnover. You can increase the hospital’s outpatient capacity, increase productivity of physicians and specialists, and optimize utilization of hospital resources.

anytime, anywhere pacs

M

edPac Systems PACS is a complete web-based PACS system implemented with the latest web technologies and architectures. Web based PACS DICOM viewer works on any browser (Firefox, Internet explorer, Safari, Opera) on any operating system (windows, mac or Linux) and even works on your Android or IPad tablet browsers. There is no need of installing any software

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made for busy imaging departments erner ProVision PACS workstation is a PACS solution that gives you extensive image viewing and analysis capabilities with a simple, intuitive user interface. The system offers one-touch workflow and advanced post-processing tools. Cerner ProVision PACS combines extensive image viewing and analysis capabilities within a simple, intuitive user interface. And an accompanying solution, Cerner ProVision Workstation (CPW), the viewer for ProVision PACS, helps radiologists increase productivity by presenting pertinent information. The Cerner ProVision Workstation features advanced-viewing protocols, fully customizable toolbars and completely configurable shortcuts. The solution’s volumetric viewports and ability to redefine the thickness and spacing of even the largest CT series make it the future of imaging. Use this comprehensive solution to enable effective enterprise-wide image management, maximize your

productivity and improve your accuracy. ProVision PACS is the only imaging workstation even the busiest imaging departments need. It helps breast imaging radiologists enhance productivity and patient outcomes. A one-stop center for all clinical workflow needs, Cerner ProVision Workstation allows radiologists to review studies from all modalities on one workstation. Users view images as soon as the system receives them. Any image within a series is instantly available upon display. Procedure based licensing gives you unlimited usage of the workstation across the enterprise. Your upgrades will be automatic and installed with no down time and no need to touch every workstation. Increased adoption through customization tools with easy-to-use viewing protocol setup Greater access to information with a wide range of tools that you can compartmentalize into user-specific toolbars for easy access Improved efficiency with minimal mouse movement and dramatically reduced “clicks” needed to do tasks.

within or outside the hospital. PACS server has inbuilt disk monitoring system which will make sure that the disks are replaced even before they are crashed Supports up to 12 TB online storage (disks are mirrored so no loss of data) and supports integration with offline storage and network attached storage Inbuilt RIS along with audio reporting with intuitive customizable work list for all Is HIPAA compliant, making the patient data secure and HL7 integration with HIS

or HMS is a breeze The intuitive web interface has some of the most advanced image processing tools like MPR, scout lines, LUT, measures, customizable layout, comparison of different series full screen mode, keyboard shortcuts, printing, annotations, pan, zoom, magnifying glass, shutters, invert and cine loop The web-based reporting with audio reporting make reporting easy and improves reporting quality.

C

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streamlined to save time

I

ntelliSpace PACS Radiology R4.4 from Philips Healthcare features ondemand delivery of diagnostic quality images with relevant viewing tools and clinical applications for your care team. Philips IntelliSpace PACS Radiology optimizes the display layout, organizes patient timeline history, automates image hanging protocols, and provides customizable functionality and keyboard shortcuts to help clinicians focus on the images rather than the system. features Intuitive graphical user interface – An intuitive GUI provides quick access to the patient’s radiological history, including diagnostic reports, exam notes, clinical history, and images. Customizable tools – Easily configure

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the application environment based on personal preferences. Mammography display – Optimizes viewing conditions when inverting or windowing, and reduces the need to zoom. Teaching and presentations – Communication among colleagues is improved with persistent presentation states, ‘drag-and drop’, and multi-page organization. Workflow features – Shared worklists of exams for presentations, and OR or ICU scheduling result in streamlines workflow. Smart display – Universal X-ray exams are automatically stacked. Ultrasound exams are displayed in page mode with auto-play loops. MR multi-dimensional series are automatically split. Advanced visualization powered hangings – Hangings can include multiple MPRs or even MIP/3D and 4D. Easy-to-build AV-powered hangings feature ‘drag, drop and save’ functionality. Smart exception handling – Drag and drop extra images into your hanging or save as a new hanging if useful. Easily share and communicate – Save your results in a preset freestyle movie or secondary capture bookmark to show referring physicians.

enhanced standard of patient care

C

arestream Vue PACS provides one workspace for the clinical tools and applications physicians and radiologists need to report anytime, anywhere. Carestream Vue PACS is an imagemanagement solution offering clinicians an unprecedented accessibility to images anywhere in your facility—as well as to those in offsite satellite locations, doctors’ offices, even to physicians who are at home or traveling. These capabilities dramatically increase workflow and make virtual consultations faster and easier than ever before. This supports an enhanced standard of patient care: because the faster images are read, the quicker diagnoses can be made and the treatment can begin. features Accessibility: Gain fast, single point of access to critical tools, patient data and images anywhere, regardless of location Productivity: Rapid image access, interpretation and dictation speeds workflow and increases productivity Clinical edge: Real-time volumetric matching and automatic registration within your viewer means increased diagnostic confidence Performance: Advanced system performance enables enterprise-wide review, simple data management and access Scalability: Vue PACS scalable design lets the system grow along with your needs and helps eliminate the threat of technology obsolescence.

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zero footprint solution

P

ACSHealth is an interactive and intuitive web-based, zero footprint solution that ensures optimal performance of your global PACS. Provides a customizable centralized dashboard with real-time monitoring of system and database status not available

with your current PACS system Gives immediate isolation and notification of database inconsistencies and errors — before it inhibits workflow Offers a unique GUI to query transactional audit logs — ensuring compliancy with HIPAA/JCAHO regulations Delivers system reports and data quickly

and accurately — reducing turnaround time, unnecessary oversight and increasing data integrity New functionality that calculates the system’s overall health. The PACSHealthScore is based on weighted contributions from system caused anomalies and user caused anomalies on a scale between 0 and 1000.

next gen pacs system

F

ujifilm’s next-generation medical imaging and information management system, Synapse allows the archiving and distribution of vast amounts of image information from all modalities, managing it all with a single system. With the first comprehensive PACS with next-generation Web technology, Synapse utilizes the latest Wavelet compression technology for on-demand compression and access of large files quickly and easily regardless of location. Synapse has revolutionized the management of radiology imaging services, supporting image diagnosis with high-quality images, numerous image processing features and easy operation, affording exciting new possibilities in this rapidly evolving medical field. With VMware virtualization, Fujifilm can offer its customers the performance, reliability and scalability they need in a cost-effective and efficient manner. Testing shows that Synapse performs very well in a VMware virtualized environment, and scalability becomes simply a matter of deploying additional virtual machines when more capacity is required. For reliability, Fujifilm extends its existing DR and BC solutions by leveraging VMware technologies to eliminate planned downtime during system upgrades, ensure that each Synapse server has the resources it needs to perform well, and provide failover in the event of unexpected downtime.

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meeting specific needs of an enterprise

I

MPAX 6 is a next generation PACS from Agfa Healthcare, designed to streamline your enterprise workflow and deliver increased efficiency and productivity to your hospital or care facility. It is a single workflow-based system that can serve your needs within, and outside, the walls of your facility. By providing an electronic workflow system, streamlining study reviews, offering a persona-based design, and enabling improved reporting and results distribution, IMPAX 6 adapts to your specific needs, by working the way you want to work. Web-deployable for remote access enables you to access from virtually any location, local or remote IMPAX 6 features, data presentation and workflow systems which can be adapted to meet the specific needs of an enterprise The solution efficiently combines network bandwidth and the Web to communicate between the client and the core. It utilizes a 3-tier architecture

consisting of a data layer (IMPAX core), business logic layer (application server) and presentation layer (IMPAX client). This architecture lets you access multiple data sources with a single query With a digital connection to modalities, departmental systems and hospital information systems, you get an integrated view of patient data. IMPAX 6 scales from a single box solution to a multi-facility environment capable of fulfilling the needs of any enterprise, radiology department or imaging center.

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Rajavel Subramanian, Regional Manager for India, South East Asia and Middle East, NeoRad AS, tells Jumana Engineer how there are many medical devices in the market, which are clever, but too complicated to use and how ease-ofuse is the key to their products

user-friendliness

the key ive us a short profile of your company NeoRad is a spin out from the Rikshospital (National Hospital) in Oslo, Norway. A close cooperation with the radiology department has led to the development of several products. NeoRad is a founding member of the Oslo Medtech cluster and its leading product, SimpliCT has won the prestigious Design Award price from Norway’s Design Council Board. It is a Medtech company leveraging its relationship to Oslo University Hospital to create new products that would improve the quality of well-established medical procedures. NeoRad has operations worldwide through a set of selected distributors and to further strengthen its global presence has recently opened an Indian office which is led by me. What products are manufactured by your company? NeoRad’s two main products are focussing on the interventional radiology segment. SimpliCT is an interventional guidance device for use in both CT and advanced 3D angio labs (Cone Beam CT), for non vascular interventions such as biopsies, ablations, drainages, infiltrations etc. It uses a laser beam to significantly improve the accuracy of computed tomography (CT/CBCT)-guided puncture procedures. Simplify is a needle holder for interventional procedures. With it’s affordablility, ease of use, and flexibility it is a great tool for a radiologist. Being detachable, one can easily attach the needle holder during the procedure or convert back to freehand should that be preferred. The range of needles or catheters are from 11G to >20G.

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Is there a particular technology to your products? Please give some details. Our focus is on the functionality and need of the interventional radiologists. We use both laser and ultrasound technology in our products. SimpliCT uses laser beam for navigation, which is a new technology in the market and is compatible with all brands of CT machines.

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Through our set of key opinion leaders we will stage work-shops and hospital visits so that other colleagues may learn the benefits of our system. We expect good growth in India and surrounding areas following the strategic move to open an office in the Indian sub-continent

What makes your products stand out from the rest? Ease-of-use is key to our products. There are too many medical devices, clever, but too complicated to be useful. We believe we have found the right level of sophistication and ease of use.

The integration of a respiratory monitor into our basket of navigation tool products will further reduce the procedure time and associated radiation. It may open up for even more advanced image guided procedures.

Tell us about NeoRad’s skin attachable ultrasound transducers. Invented by consultant radiologist Knut Brabrand, MD at Rikshospital, the special transducers are developed to solve particular problems using common ultrasound technology. These will have the ability to see inside the body and monitor different parameters. One project is about monitoring CT contract media injections to avoid painful extravasations (injections outside the vessel) and another project is about monitoring the respiratory movements of a patient to increase accuracy in needle placement, radiation oncology or fusion imaging. How long has it been that NeoRad is functioning in India? NeoRad just opened it’s Indian office this summer and the good news is that we are already installing our first few systems in key reference sites. We expect good growth in India and the surrounding areas following the strategic move to open an office in the Indian subcontinent. How do you expect to tackle competition in the market? Again we would like to point out the ease of use of our systems and need for advanced technology in medical field, especially in Interventional Oncology. Currently these procedures are done by free hand and it needs a lot of expertise. With SimpliCT any radiologist can perform CT-guided procedures accurately and comfortably. What will be your approach towards customers to make a mark in the market? Through our set of key opinion leaders we will stage work-shops and hospital visits so that other colleagues may learn the benefits of our system. What are NeoRad’s plans for India? NeoRad plans to use the Indian office as a hub to generate sales all over Asia. Following the increase in sales may justify opening a separate production line in India. What new products are in the pipeline? What can the medical field expect from NeoRad in the near future?

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We know how much you love your smartphones and tabs. Now available is Color Doppler, India first and exclusive magazine on ultrasound technology. Download your very own copy of Color Doppler and read on the go Log on to http://www.magzter.com/IN/Color-Doppler/Color-Doppler/Education/

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techscan

The writer is the Vice President Sales and Marketing, TeleradTech Pvt Ltd, with offices in Banglore, Karnataka and New Haven, Connecticut, USA

A B Sivasankar

R Being a web-hosted software, RADSpa can be accessed easily by radiologists, physicians, technicians, administrators and patients, from any part of the world and thus brings in the concept of mobile radiology which ensures ‘any-time, anywhere radiology’

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ADSpa is a radiology workflow software developed by a Radiolo­ gist (RAD) for Radiolo­gists! It addresses every aspect of radiol­ ogy environments, be it in a hospital or an independent diagnostic chain, spread across a region. RADSpa’s uniqueness is its capacity to integrate all the characters of a radiology set up, namely the radiologists, administrators, data entry operators, medical transcriptionists (MTs), physicians and most importantly, the patients. With a customizable workflow, this software is a combination of PACS (Picture Archiving and Communication System), RIS (Radiology Intelligent system) and automated teleradiology module. This is software for the future. Being a web-hosted software it can be accessed easily by the radiologists, physicians, MTs, administrators and patients from any part of the world and thus brings in the concept of Mobile Radiology or Pocket radiology which ensures ‘Any Time, Any Where Radiology’. Telerad Tech Pvt Ltd is the technology start up arm of Teleradiology Solutions (TRS), a global teleradiology company in operation since 2002, with offices in America and India. Telerad Tech derives its domain strength from TRS. As the name ‘RADSpa’ indicates, it is a

Radiologist Spa, in the sense that it creates a comfortable and convenient ambience for the RAD to work. The radiologist need not be physically present in the centre to report about his/her studies. He can report on the move, from his laptop or an iPad. The latest version of RADSpa is available on iPad, iPhone etc, (recently FDA has cleared the DICOM image reporting on the iPad), this contributes to the RAD’s overall productivity in terms of number of studies and quality, but more importantly it is critical for trauma reporting, which facilitates the consulting physician to decide on the mode of treatment to be employed in saving the life of the patient.

radspa flow diagram RADSpa Intelligent Assigner assigns the study by taking into account the type and priority of the study, expertise of the radiologist, availability of the radiologist, etc. The rules of radiologist’s assignment can be set by the administrator. The product minimizes the number of clicks for the radiologist from image capture to report generation, and is clutter-free and intuitive in displaying image and patient information. Auto-Reconcile automatically checks and reconciles the study information from the image data and the order data. Any errors are reported back to the sender. It saves

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techscan meet the telerad tech Telerad Tech has been founded by a group of technology innovators and eminent radiologists with the focus to develop products and solutions to address the gaps and needs of Healthcare IT in general, and radiology automation systems in particular. Having partnered with a leading tele-radiology institute and led by technologists with background in developing and deploying automated solutions, Telerad Tech has the best mix of domain understanding and technology prowess to implement technology solutions to solve the radiology workflow problems. The products are developed, tested and piloted in the radiology ecosystem and hence equipped with providing the most efficient, radiologist friendly work-flow. Telerad Tech has won the ‘Best Picture Archival and Communications System Award’ as a part of prestigious NASSCOM-KPMG Healthcare IT Awards and also Medicall 2011 ‘Product Innovation Award’. The company envisions to be the global work-flow provider of choice for radiologists and radiology service providers radiologists’ time in case of missing images or incorrect orders. The study is made available to radiologists only when it is ‘ready to be read’ and the study read time can also be tracked. RADSpa collaboration integrates ‘context based communication’ technology where a radiologist can communicate on a study with a peer radiologist, physician, MT through a parallel work-session, chat, voice or video conferencing. Study/image sharing feature between the RAD and the physician’s desktop enables quick feedback and conclusion of study, thereby improving trauma patient care. RADSpa is available on the cloud for those who would not prefer upfront investment; the software can be hosted on the cloud on Software as a service (SAAS) model. For the benefit of the user, Telerad Tech has partnered with DeepWell Archival Services for vendor neutral archival of medical images as a part of its workflow enhancement. RADSpa is flexible for user defined customization i.e., to suit an individual work culture and is also scalable in the future.

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RADSpa is Health Level Seven (HL7) compliant and hence easy for integration with any Hospital Information System (HIS) or Laboratory Information System (LIS) or Electronic Medical Record (EMR) which is HL7 compliant. Being a Health Insurance Portability and Accountability Act (HIPPA) compliant ensures patient privacy and data security. In the last two years RADSpa installations have come up globally. FDA-cleared, CElisted, the product is now used by nearly 50 clients in USA, Europe, Middle East and India. As the product is conceptualized by a radiologist for radiologists, every aspect of the product function is tested by the parent company Teleradiology Solutions (rated as No 1 National Teleradiology provider in USA). The iterated feedback from the radiologists helps in product enhancement and is incorporated as a continuous version up gradation.

highly compatible Further RADSpa is compatible with third

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techscan party utilities like advanceed clinical 3D reconstruction software, voice recognition systems (Dragon medical software) for radiology reporting, digital signature etc, thus adding to its versatility. Integrated SMS service alerts the radiologist, physicians on pending studies, while assisting the patient on the readiness of his/her report. Though RADSpa is built on Windows platform, it is not browser dependent i.e. it can work in Google Chrome, Firefox etc, in addition to Internet Explorer. Quality audit module ensures a periodic random check of the radiologist report quality, radiographer productivity, MTs consistency. Audit trial captures all the events (study arrival time, reported time, physician collaboration issues etc). Quality audit enhances the centre’s profile. Management Information System (MIS) presents business data analyses in the form of modality utilization, SLA (Service Level Agreement) Vs TAT (Turn Around Time), and revenue generation etc, for the

management to understand the status of business. This facilitates better management of the facility. Teaching module, with the ability to create its own quiz, CME programs etc, and which gets built around the studies pushed into the system, is very useful in a teaching environment especially in the medical colleges. The latest and presently the first in the country, i.e. RADSpa in telemedicine, facilitates upload of DICOM studies as a part of tele-presence consultation. Cisco, one of the big names in networking and telepresence, has integrated RADSpa into its health presence platform and Telerad Tech is a managed service partner to Cisco Health Presence 2.1. Super speciality clinic Telerad RxDx which is a group company of TRS is engaged in Tele- consultation for over 20 PHCs in the state of Karnataka and Madhya Pradesh and has done more than 2500 tele-consultations in the past year.

indicative RADSpa deployment diagram

mobile radspa Telerad Tech in partnership with IBC has produced Mobile RADSpa, a next generation radiology automation on mobile. Mobile RADSpa is an integrated and collaborative solution that automates RAD Workflow and DICOM imaging at the convenience of a mobile. Features: Fully integrated RIS/PACS platform Connect to RADSpa server over mobile Download a case Conduct a Study on mobile with support of Dicom Imaging Log findings Sync with RADSpa server and be updated Create and share studies over mobile Voice dictation With Mobile RADSpa, the RADSpa Radiology Intelligence System has been seamlessly extended for mobile access with user interface and PACS Imaging optimized for mobiles

An environment with ‘n’ number of centres, n Radiologists, n Modalities, n Physicians, n MTs and any number of patients

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techscan

more than meets the eye Mohammed Ameel

U Mohammed Ameel summarizes the physics, technology and clinical applications of ultrasound biomicroscopy used in the field of ophthalmology making information clearer by three times as compared to normal ultrasound

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ltrasound biomicroscopy is a type of ultrasound eye exam that makes a more detailed image than regular ultrasound. High energy sound waves are used to create a sonogram that helps in detection of glaucoma, cysts and neoplasm of the eye. Moreover it is used in the evaluation of trauma and foreign body in the eye. It allows the examination of anatomy and pathology including the anterior segments, obscured by overlying optically opaque anatomic or pathologic structure. This technique also provides critical information on biometric regarding anterior segment structures, including the cornea and its related layers and the anterior and posterior layers. This technique is in use since more than a decade and a half, inspite of more advanced techniques like transducer arrays and pulse coding coming into existence. This technique faces competition with the new techniques like Optical Coherence Tomography (OCT) and Magnetic Resonance Imaging (MRI), which provide superficial location of the eye providing a virtual test bed for ophthalmologists. The MRI provides better contrast and resolution but is expensive, inconvenient and slow. Whereas OCT is cost effective, convenient and provides better results, although it is susceptible to intervening optically opaque structures, including normal anatomy. Ultrasound provides real-time crosssectional images, in a very cost effective

manner, even in the presence of optically opaque intervening structures. The use of ultrasound in ophthalmology diagnosis started in 1950, with the advent of A-Scan and B-Scan ultrasound modes. Although there have been huge improvements in scanning, data processing and display technologies in the past six decades, the centre frequency of ophthalmic ultrasound since its inception has been at or near 10MHz. This frequency of 10 MHz is although very useful in detecting much ophthalmological pathology, but its resolution is not as good as OCT. Ultrasound biomicroscopy involves much higher frequency of ultrasound (i.e. 35–60 MHz) as compared to conventional B-Mode scanners. This results in better resolution and penetration depth of about 40 mm, thus making it a better tool for diagnosis.

physics of us biomicroscopy To completely understand and appreciate the capabilities of ultrasound biomicroscopy, we need to understand the physics involved in it. Ultrasound consists of waves of compression as well as refraction, propagating through a medium. The wavelength and speed of sound are related by the formula c = vλ, where ‘c’ is the speed of sound, ‘v’ is the frequency and ‘λ’ is the wavelength. The speed of sound is related to the medium’s composition and temperature, but it is largely independent on frequency. Acoustic reflection occurs at interfaces between regions of different acoustic impedance, and attenuation

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techscan

Ultrasound biomicroscopy involves much higher frequency of ultrasound (i.e. 35–60 MHz) as compared to conventional B-Mode scanners. This results in better resolution and penetration depth of about 40 mm, thus making it a better tool for diagnosis

increases exponentially with both tissue depth and frequency. The ultrasound probe has a transducer of piezoelectric crystal, which contracts or expands accordingly, as and when an electric voltage is placed across it. This is communicated through the fluid where the transducer is contacted. Ultrasound probe can be focused by placing an acoustic lens over the surface of the transducer or by forming piezoelectric material into a curved material of appropriate radius. After emitting the pulse, the transducer waits for the echo to return before it emits another pulse. Echoes interact with the piezoelectric element and then the same is amplified and processed to form images and form biometry.

clinical applications Ultrasound biomicroscopy is suitable for viewing all possible anterior segment anatomy and pathology including the cornea, iridocorneal angle, anterior chamber, iris, ciliary body and lens. Hence this technique is useful in detecting corneal diseases, glaucoma, cysts and tumors as well as lens implants. Mostly these tests are performed with fluid filled sclera shell, they may also utilize a waterbath, a membrane enclosed tip applied to the eye after topical anesthetic or even through closed lids. The ability of ultrasound biomicroscopy

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to visualize the posterior chamber is useful for assessment of the position of crystalline lens and lens implants. The crystalline lens usually gives specular surface reflectivity with minimal eternal echo. Nuclear and cortical cataracts can be readily visualized by ultrasound biomicroscopy as regions of elevated internal reflectivity. Following cataract surgery, ultrasound biomicroscopy can detect retained nuclear fragments posterior to the iris plane. Haptic position can be determined in situations where unexplained pain, bleeding or other complications occur following posterior chamber lens implantation. The biometry of the anterior segment can be measured by UBM systems that encompass the entire anterior segment. This allows preoperative evaluation of the position of the sulcus plane before cataract surgery, facilitating estimation of postoperative intraocular lens position.

other technologies Several technologies now exist for imaging of the anterior segment, including OCT and scanning slit-lamp systems. Each method has its particular advantages and disadvantages in relation to each other and to ultrasound biomicroscopy. All of the above optically based systems are limited by the presence of optical opacities, either in the form of normal anatomy (iris, sclera) or pathology (hyphaema, pigmented lesions). Optical systems, however, require no fluid coupling to the eye, and are thus easier to use. They also naturally lend themselves to alignment by provision of a fixation target and an optical image of the eye during scanning, which is not the case for ultrasound systems other than the Artemis. Optical systems also offer high-speed 3D scanning of the anterior

segment, facilitating biometric analysis of corneal thickness and anterior chamber dimensions.

what the future holds Current ophthalmic ultrasound biomicroscopy systems use focused, single-element transducers because of the complexity and expense of fabrication of high-frequency array transducers. Highfrequency annular arrays consisting of a few concentric piezoelectric rings are relatively easy to fabricate, however, and by use of synthetic focusing can greatly extend the depth-of-field compared with single-element probes. Although annular arrays must still be mechanically scanned to obtain a 2D image, this is not the case for high-frequency linear arrays now under development. However, their lack of radial symmetry reduces lateral resolution in the elevation axis compared with that of an annular array. In the longer term, it is possible that 2D high-frequency arrays based on micro-electromechanical systems constructed by chip fabrication techniques or other technologies may be realized. This would allow synthetic focusing, beam symmetry and electronic beam steering for nearly instantaneous 3D imaging of the anterior segment. Ultrasonic imaging of the eye has been undergoing progressive development for over a half century. It may thus be surprising that ultrasound technology is still undergoing rapid advances in many directions. Diagnostic imaging of the eye will be the beneficiary of these technologic innovations. The writer is a Biomedical Engineer at the Era's Lucknow Medical College and Hospital

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Abhaya Babbar

Digitex Medical, established to promote the world’s best healthcare technologies for Indian customers, nurtures a strong commitment to quality, technology and customer utility. Abhaya Babbar, Business Consultant to CEO and Manager — Sales, Digitex Medical Systems, talks to Jumana Engineer about how the company has become one of the well-known names in the field of importing and marketing of world-class medical equipment and healthcare solutions

A

jay Babbar, CEO and founder of Digitex Medical always dreamt of an organization which brings in the best-in-class cuttingedge healthcare technologies to the Indian consumers and with the advent and growth of Digitex, his dream came true. The company was incorporated in December 1989 with its head office in New Delhi, and an aim to promote the world’s best healthcare technologies in the Indian market. As the country opened up its doors to liberalization in 1991, Digitex Medical opened its first branch office in the capital city of Rajasthan, Jaipur. From then on, Digitex Medical has strived towards becoming the ‘best’ among the importers and marketers of world-class medical equipment and healthcare solutions. In the last two decades, the company has earned robust growth in its functional domains. Digitex Medical has inked remarkable corporate tie-ups with leading multi-national companies such as Hewlett Packard, Agilent Technologies, Phytis AG, BioDiamond Stents, Equidyne Solutions and Philips Electronics India during these

years. These strategic tie-ups have helped Digitex Medical promote products in the field of interventional cardiology, obstetrics and gynecology, radiology and imaging and endocrinology. Over the years, the company has managed to equip all critical care areas in a hospital environment such as ICUs, CCUs, NICUs, PICUs, OT, Step Down OTs and Emergency Care leading its way to a sustainable growth. Digitex Medical aims to rank among the top five healthcare solution providers in India in the MSME category and establish newer quality benchmarks for maximum consumer satisfaction and delight by creating an ethical work culture. According to Abhaya Babbar, Business Consultant to CEO and ManagerChannel Sales, “India in the 21st century has a lot to offer to people who believe in the ‘grand India’ theory. There are tremendous opportunities for careers to be made and brands to be invented. There are opportunities for development of new age Tatas, Birlas and Ambanis.” “With India being at the centre-stage of global economic and trade forte, there’s great internationalization happening of India as a

awesome

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brand. The globe realizes the vital role of our country, its businesses and the people who will play enterprising role in the next two decades to follow.” In 2010, Digitex Medical has pushed the next gear in synchrony to company’s vision of becoming a pan-India player. The company has joined hands with three global healthcare companies- BTL (United Kingdom), UTAS (Ukraine, Europe) and BISTOS (South Korea), for increasing its foothold in the Indian market. With these alliances, the company has added a totally new range of medical products and supplies supported with international credentials. Besides these India distribution tie-ups, Digitex Medical has regional agreements with RESMED (Australia) and AMDL (India) promoting Cardiac Science, Unetix, Criticare and Mediaid brands for specific markets. Company’s product portfolio includes Cardiology, Anesthesia, Respiration, Ob-gyns, Radiology and Imaging and OT Products, Accessories and Consumables. The company is involved in domain specific medical consulting projects such as ICU designing, hospital development, manpower recruitment and management services. These consulting assignments help create greater value and comparative edge for the company against the competition thus creating its niche in the market. Digitex Medical has segmented its market into private, government and corporate accounts. “Our company is a pioneer when it comes to doing business in the private hospital segment. In the last two decades, we have been exceeding expectations of our customers by promoting cutting edge medical products and services in this segment. With our strong commitment to quality, technology and customer utility, Digitex Medical has promoted only the best brands in the Indian market.” “Today, there are more than 500 private hospitals, 2000 physicians/medical specialists and more than 10,000 products that we have sold in the private market alone,” says Babbar. “We believe in human values. We at Digitex work towards creating everlasting robust relationships. We do this by exhibiting highest level of professional work culture and customer delivery. We work to create our own philosophy and our own way of mutual benefit and progression,” says Babbar. Besides impressive presence in private healthcare services sector, Digitex Medical has been consistently working on internalizing the intricacies of the government business. For the same the company has ramped up its operations by investing in physical

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infrastructure, updating technology and manpower resources to manage business in the government sector. Lately, company is working on central/ state/autonomous body projects. Major focus is on Delhi, Punjab, Haryana, Uttar Pradesh, Jammu & Kashmir, Gujarat and Andhra Pradesh markets. The company is also pursuing opportunities in defence procurements and is working on getting enlisted with the recognized bodies to push for greater market share in this segment. By April, 2015, Digitex Medical aims to diversify into real estate and retail businesses with medical and hospitality as their frontline business. Digitex Medical’s management is committed to making it a household panIndia brand, illustrating growth, prosperity and real value. Understanding the intricacies the of government business, Digitex Medical team is effectively strategizing its operations to meet the needs. The company is ramping up its operations by investing in physical infrastructure, technology and manpower resources to manage the new business segment. The company is actively working on building relationships with Department heads, Administrative heads, functional and support departments to understand purchase requirements and present effective products and services. With massive privatization and corporatization of healthcare industry in India, there’s a league of giant corporate

Today, there are more than 500 private hospitals, 2000 physicians/medical specialists and more than 10,000 products that we have sold in the private market alone

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21st century has a lot to offer to people who believe in the ‘grand India’ theory. There are tremendous opportunities for careers to be made and brands to be invented

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companies that have entered the Indian market which has brought in superior medical services and healthcare facilities to millions of Indians. “Corporate chains such as Apollo, Max, Fortis, Medanta, Escorts, Artemis have consistently invested in medical purchases to meet their business needs.” “Today, their appetite for consumption of branded medical products and supplies are growing around 25 percent annually which means companies like Digitex Medical have enough potential to cash cow on this growth drive,” says Babbar. “Keeping pace to this every changing market dynamics, our company has been consistently re-working its marketing strategies to suit the needs of changing market conditions. Our company is consistently working on Revenue Storm Account lead strategy to cater to the needs of such hospitals and establish itself among the list of preferred suppliers,” he adds. Holding true to these management style facts, the company has commissioned a hospitality project in Delhi-NCR establishing a 6000 sq. feet guest house facility. It has launched its first e-commerce beta site: www. digitexstore.com in May, 2012. Moreover, the company is implementing ISO9001-2008 quality system for scaling up its management practices to meet and exceed industry standards. In the future, the company plans to launch its private label under the Digitex brand name in Healthcare (Electronics) market. Also, it

next is what The company is working on following initiatives in this fiscal ISO9001-2008 compliance for management practices Launch of e-commerce website-www. digitexstore.com with ATL promotions as part of marketing strategy Delegate participation in World’s largest healthcare exhibition — Medica Dusseldorf, 2012 this November Launch of DIGITEX brand products in Anesthesia and Cardiology divisions by April, 2013 Expansion of distribution network to 20 cities all over India by end of 2012 Opening of two regional offices by end of 2012 Addition of Radiology Equipment such as Ultrasound, Color Doppler and C-Arm by end of 2012 Diversify into new sector, majorly real estate and retail envisages an aggressive distribution network in as many as 20 cities across India by the end of 2012 to put forth its business to the next level.

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Ajay Babbar President/Founder Director and CEO of Digitex since 1989 Corporate Responsibilities International alliances, supplier communications, strategy and business development, legal/compliance, finance management, investor relations and corporate social responsibility. Career Span An electronics engineer turned entrepreneur, Ajay Babbar started his career with M/s Blue Star Limited in the year 1983, marketing high end medical equipments in the field of cardiac monitoring and imaging. During this period, Ajay Babbar marketed products by some of the world’s biggest conglomerates such as Hitachi (CAT Scanners, Ultrasound Scanners, X-Rays Systems and Angiography systems), Hewlett Packard (Cardiac & Imaging products), Technicon Auto Analyzers (Bio chemistry analyzers) and Nicolette (Evoke Potential Systems).

L to R: Abhaya Babbar, Ajay Babbar, Akshay Babbar

Abhaya Babbar

Akshay Babbar

Business Consultant to CEO since November, 2010

Executive Assistant to CEO since Nov, 2010

Corporate Responsibilities

Corporate Responsibilities

Strategic management, business development, brand development, organization competence building, business excellence, internal audits, technology & process automation, industry alliances, human resource management and policy execution.

Business Development- Product Sales and Customer Services, IT consulting, strategic management, business excellence, web-marketing and creative media.    

Career Span Abhaya has earned MBA in International Business from Amity International Business School. He holds Bachelor in Business Administration from Amity Business School. He has worked in Management Consulting, Finance and Business Excellence for four years before joining Digitex. His last stint was with Birlasoft (a $1.2 billion C.K. Birla Group Co.) working on financial planning and analysis and six-sigma practices for statistical process control and revenue assurance.

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Career Span Akshay has earned MSc in Business Information Technology Systems from Strathclyde Business School, United Kingdom. He holds Bachelor in Computer Application from Indraprastha University. He has worked with Nucleus Software Exports at American Express before joining Digitex in November 2010. At American Express, Akshay was instrumental in developing and implementing in-house web-based applications for process automation and change management. 

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Color Doppler would like to thank all the participants for registering for our ‘Best Diagnostic Imaging Center Award’

than the best Thank you for registering Color Doppler will get back to you soon with the Top 10 list. Stay tuned.

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The Polyclinic located in the Athletes’ Village, set up by GE Healthcare, the worldwide sponsor of 2012 Olympics, provided athletes with access to excellent healthcare services besides showcasing next generation medical imaging technologies

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the gold goes to...

G

E Healthcare, alongside the London Organizing Committee of the Olympic and Paralympic Games (LOCOG), showcased the broad range of medical imaging technologies they supplied for the care of competing athletes at London 2012. The equipment, which was housed at the main Polyclinic located in the Athletes’ Village in the Olympic Park in Stratford, provided up

to 16,000 athletes and team officials staying in the Village during the Olympic Games and 6,200 athletes and team officials during the Paralympic Games access to excellent healthcare services. Technologies featured include magnetic resonance imaging (MRI), ultrasound, X-ray, electrocardiogram (ECG), IT and monitoring systems. As a company, GE Healthcare has been working closely with medical leaders at

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the London 2012 Games to advance the use of advanced medical imaging technologies to optimize and improve athletic performance as competitors strive for medal winning status. John Dineen, CEO of GE Healthcare said, “We are delighted to be able to provide a broad range of our latest healthcare technology for the London 2012 Polyclinic. In line with GE’s ‘healthymagination’ vision and its commitment to sports medicine, these technologies provided insight into athlete health, as well as offered wider benefits for the general public. The use of technologies that helped monitor the health of Olympic athletes was used before, during and after the London 2012 Games.” As worldwide sponsor of the London 2012 Olympic Games, GE Healthcare has been working closely with LOCOG, to provide significant support from a healthcare standpoint and offer the world’s Olympic and Paralympic athletes access to state-of-the-art imaging facilities. Bettina Fitt, Country Manager UK and Ireland, GE Healthcare commented: “We are very proud to have a long standing legacy of working with sports doctors and helping to equip them with GE’s latest medical imaging technologies giving them the tools to aid in early diagnosis and monitoring of injuries, which can help treatment to be personalized and timing for return to the competition arena be more accurately predicted. In addition, as a proud sponsor of the London 2012 Olympic Games we also hope our work with the Olympic Games will provide us with new insights into how our technologies can help give physicians the information they need to treat the general public.”

equipment in the polyclinic Particular GE Healthcare technologies that were in use at the Olympic Polyclinic included: A GE Discovery MR750w wide bore 3T MRI scanner and an Optima MR450w wide

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app for healthy practices In June 2012, GE launched a new app called HealthyShare that allows people to engage their Facebook buddies and challenge each other to exercise more, eat better, and make smarter and healthier choices. The app offers exercise routines by US Olympians Kevin Durant, Alex Morgan, Michael Johnson, and Summer Sanders to get started. “HealthyShare is a terrific way to connect with friends and family and achieve health and well-being goals,” Johnson wrote in Men’s Fitness. “I care about people and want them to live a healthy and active lifestyle so I’ve included my workout routine in this app so we can achieve better health together.” The first stops on the road to good health can be the kitchen and the fridge. One challenge, which was launched, makes you “eat like a rower.” Starting after that, drop the bacon and donuts, and pick up eggs, fruit, oatmeal and whole grain toast for breakfast. You can also tone your arms with cans of soup so that you can flex a bow like an Olympic archer. On August 11, which was the Olympic modern pentathlon day, a challenge was launched where you can test your endurance and do cardio activity of your choice for 30 minutes. Run, swim, power walk, or do the elliptical machine. If you need a break, walk, but do not stop! HealthyShare keeps evolving and GE and Facebook are adding new features and challenges. For GE, the app fits inside healthymagination, a program focused on technology innovation and also on fostering new smart ways to healthy living.

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bore 1.5T MRI scanner, both with GEM Suite. These are designed for a better patient experience because the area where the patient lies is wider than in conventional scanners, and more comfortable to lie on thanks to GEM Suite of Coils which refers to the patient friendly, flexible ‘coils’ that embrace the patient, helping to minimize anxiety and motion during an exam by naturally following the contours of the human body. Each system offers exceptional image quality. A Discovery 750HD CT scanner offers high quality, detailed imaging of bones, joints and muscles, providing clinicians with improved image clarity with the ability for them to lower dose which in turn assists clinicians in providing a confident diagnosis to patients. GE Healthcare’s Discovery XR656 wireless, digital x-ray system, VENUE 40 and LOGIQ E9 ultrasound systems, which help doctors diagnose musculoskeletal injuries, completed the Polyclinic’s radiology offerings, with three MAC 5500 ECG diagnosis systems also on hand to help analyse, monitor and interpret heart rhythms. GE Healthcare IT’s Centricity RIS/PACS systems stored the patient’s imaging records, enabling a quicker diagnosis through availability of the complete electronic record. LOCOG Chair Seb Coe said, “We have always put athletes’ needs at the heart of the Games. When they are preparing for the most important moment in their sporting careers, it’s vital they are in peak condition with all the support they need. We have aimed to give that medical support to help them deliver their best performance. Our sponsors and our medical team who are experts in their field have played a vital role in achieving this and I thank them for their ongoing support.” By making a wide range of medical technology available for use within the Olympic and Paralympic Village and all of the sporting events being held at the Olympic Park, clinicians were better able to

diagnose potential injuries earlier or simply monitor treatment, with a view to ensuring athletes are able to return to their sport as quickly as possible, helping them to stand the best chance of winning a medal for their country. In addition to the technology supplied to the Olympic Polyclinic. GE is also providing a legacy gift to the local community in East London in the form of £4.5 million of healthcare technology for a new neonatal unit at the official Olympic hospital — Homerton University Hospital, opened in December 2010. This is designed to help tackle the local problem of high levels of mortality among new born and premature babies, with the aim of making a positive impact for years to come. GE is a sponsor of the British Triathlon Federation (BTF) and has been working closely with the athletes and the team’s Performance Director to help the members of the elite team achieve marginal gains in performance and enhance their prospects of winning medals at London 2012. In addition, also for the care of the Olympians, ultrasound systems were made available at Weymouth (Sailing) Eton Dorney (Rowing), and the Greenwich

(Equestrian), while for the general public, over 200 defibrillators were located at different venue sites in case of emergency.

about ge and olympic games GE is the exclusive provider of a wide range of innovative products and services that are integral to staging a successful Olympic Games. GE works closely with host countries, cities and organizing committees to provide infrastructure solutions for Olympic venues including power, lighting, water treatment and transportation. GE also supplies local hospitals with diagnostic imaging equipment and healthcare IT solutions like ultrasound, MRI and electronic medical record technologies to help doctors treat athletes.

COLOR DOPPLER | SEPTEMBER, 2012


ultrasound guided regional anesthesia

U

ltrasound technology is enabling anesthesiologists to perform regional anesthetic procedures with greater confidence in accuracy and precision. With improvements in visualizing neural anatomy and needle movement, ultrasound guidance improves patient safety and operating room efficiency. This book offers a detailed, stepwise approach to this technique, identifying pearls and pitfalls to ensure success. Chapters are organized into four sections. The first section provides the basic principles behind ultrasound guided regional anesthesia, setting a strong context for the rest of the book.

Authors: Stuart A. Grant and David B. Auyong Format: Spiral-bound Print length: 192 pages Publisher: Oxford University Press, USA Language: English Price: $ 99

a practical handbook to ultrasound-guided injections

A

straight forward, easy reference to the most common injection sites, photos displaying patient and probe positioning, high resolution ultrasound images with needle visualization and clinical tips and ‘pearls’. It has become important to establish practical and effective tools for training in this skill set. The goal of this book is to meet this educational need by providing a pictorial guide to the most routine musculoskeletal injections. By demonstrating steps to mastering simple principles of needle visualization and injection technique, it is our goal that this book will help guide practitioners to proper and efficient utilization of this invaluable tool.

Author: Victor M Ibrahim Format: Paperback Publisher: CreateSpace Vol. 1 (May 29, 2012) Print leagth: 78 pages Language: English Price: $ 80

emergency cross-sectional radiology

C

ross-sectional imaging plays an ever-increasing role in the management of the acutely ill patient. There is 24/7 demand for radiologists at all levels of training to interpret complex scans, and alongside this an increased expectation that the requesting physician should be able to recognise important cross-sectional anatomy and pathology in order to expedite patient management. Emergency Cross-Sectional Radiology addresses both these expectations. Part I demystifies cross-sectional imaging techniques. Part II describes a wide range of emergency conditions in an easy-to-read bullet point format. High quality images reinforce the findings, making this an invaluable rapid reference in everyday clinical practice. Emergency Cross-Sectional Radiology is a practical aide-memoire for emergency medicine physicians, surgeons, acute care physicians and radiologists in everyday reporting or emergency on-call environments.

Authors: Daniel Y. F. Chung, Dipanjali Mondal, Erskine J. Holmes and Rakesh Misra  Format: Paperback Publisher:  Cambridge University Press; 1 edition (May 21, 2012) Print length: 232 pages Language: English Price: $55

COLOR DOPPLER | SEPTEMBER, 2012

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ivf info, new delhi IVF India has been established with the sole aim of providing moral, emotional, ethical and most advanced technical support to couples trying out to find a solution in maze of infertility. The center has state-of-the-art facilities for IVF and a fully functional laboratory for diagnostic and therapeutic tests. facilities @ ivf info > Intrauterine Insemination (IUI) > In Vitro Fertilization (IVF) > Intracytoplasmic Sperm Injection (ICSI) > Surgical Sperm Retrieval

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> Frozen Embryo Replacement Cycle > Donor Gametes > Pelvic Ultrasound > Tubal Patency Test > Follicular Monitoring > Semen Analysis > Hormone Tests > Diagnostic and Operative Laparoscopy > Hysteroscopy Contact: Dr. Kaberi Banerjee C-453, Chitranjan Park, Ground Floor, New Delhi - 110019. Ph: + ( 9 1 ) - 9 8 7 1 2 5 0 2 3 5 , 9871096615. E-mail: indiaivf@gmail.com. Website: www.ivf-services.com

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CONTRIBUTORS CHECKLIST

1. Editorial articles for regular columns from pre-approved contributors or columnist. 2. Editorial materials giving prime importance to hospital industry including professionals and management in ultrasound. 3. Discussions and policy trends in ultrasound business should be included in the article. 4. Without pointing towards company or product, concepts and trends are to be specified in articles 5. Should include relevant diagrams, illustration tables, photographs, of 1300-1500 words in articles 6. Innovations, inventions and information about your products and services are invited along with brochures. 7. Editorial Calendar will be published earlier so that market focusing topics will be announced in advance. 8. In e-mail,large attatchments above 1MB,must be avoided 9. Articles may be edited for brevity, style, relevance.

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man who made humans transparent Joby Joseph (follow the writer on twitter@editorjoby

H

e believed in what others could not imagine; he dreamt what others could not visualize; he walked two steps ahead; he treaded zigzag trajectories while others were scared to come off parallel roads; he made possible what others believed impossible… and eventually he made humans transparent! It was Robert S Ledlely, the man who invented the first CT scanner capable of producing cross-sectional images of any part of the human body, who died aged 86 on August 2, leaving a legacy his successor do well to match. Ledley did not invent CT technology nor did he produce the first CT scanner. He just added an exciting dimension to what the British scientist Godfrey Hounsfield, who is generally considered the father of CT, had discovered by projecting an X-ray beam through the human body from all directions and creating a 3D image using the data with the help of a computer. Hounsfield’s first commercial scanner was capable of scanning only a patient’s head. Later, in 1974, Ledley and team developed the first whole-body machine — called the Automatic Computerised Transverse Axial, or ACTA, scanner. It was not a simple, one-stretch process as there was no model of any kind for it, as Ledley himself recollected in a 1998 Georgetown Magazine article. While he was working on the prototype for the CT scanner, the engineer he was working with wanted specifications about the signal the scanner would emit, he wrote. “I’ve never done it before, I didn’t have the foggiest idea,” Ledley recalled in the article. “So he says, ‘Well, how can I make [it work] if I don’t know what the signal is going to be?’ ” Stumped, Ledley said “You want a number? I’ll give you a number: 10. Ten of whatever it is. … And he made it for 10, then adapted it for the actual value.” The man, who bridged the gap between the electronics equipment and biomedical technology, often started with a pie-in-the-sky idea and ended up with an invention that furthered the medical profession. As is often the case, the biomedical engineers responded with some incredulity to his new device: “When I built the CT scanner not only did people say that it couldn’t be done, but six months after it was completed and we had scanned maybe 1,000 patients, somebody published an article that said ‘It can’t be done.’ I was already doing it!” he

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recollected. The year in which the device was discovered, he established the Digital Information Science Corporation and started selling the machines for $300,000 per unit. In 1975, he sold out the company to Pfizer, after obtaining the patent for the ACTA scanner. Pfizer dominated the world market for scanners in the mid 1970s. Later, designing next generation devices based on Ledley’s model – General Electric, Ohio Nuclear and Siemens took over the market. Robert Steven Ledley was born on June 28 1926, in the Queens District of New York. After studying Physics at Columbia, he was trained in Dentistry at New York University, but returned to Columbia to take Masters degrees in Physics and Mathematics. In 1951, during the Korean War, he served as a researcher in the Army Dental Corps. After his discharge from the Army, he went to work in Washington at the National Bureau of Standards’ Dental Materials Section, where he also helped his wife —Terry Wachtell — get a job, as a programmer on the Standards Eastern Automatic Computer (SEAC). It was she who introduced him to computers to which he became increasingly fascinated. He learned to program the computer by studying the manuals and programs — punched out on long strips of paper tape — that his wife brought home. Before long, Dr. Ledley was working directly with the SEAC with special emphasis on the role that computers might play in solving biomedical problems. In 1959, he co-published a ground-breaking paper in Science, entitled Reasoning Foundations of Medical Diagnosis, which introduced computer research techniques to medical researchers and physicians. Next year, he founded the National Biomedical Research Foundation (NBRF), a non-profit organization to promote the use of computing methods among medical scientists. He began working on CT scanner in 1973. He served as president of the NBRF and continued to work there until his retirement, receiving many patents. He was inducted into the National Inventors’ Hall of Fame in 1990 and awarded the National Medal of Technology and Innovation in 1997. He founded many globally accepted journals. The peer-review journal Pattern Recognition, for which he remained the editor until 2010, was one among them. In 1947 he married Terry Wachtell, who survives him with two sons. Rest in peace, Robert S Ledlely.

COLOR DOPPLER | SEPTEMBER, 2012


COLOR DOPPLER | SEPTEMBER, 2012

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Registered with RNI under No:KERENG/2012/41766, Postal Reg No: KL/CT/206/2012-2014, Posted at Calicut RMS on 26, 27th of every month

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COLOR DOPPLER | SEPTEMBER, 2012

DIGITEXMedical-Success Story Coverage  

ColorDoppler (leading Ultrasound Magazine) covers DIGITEXMedical under its Success Story Column, under September, 2012 issue.

DIGITEXMedical-Success Story Coverage  

ColorDoppler (leading Ultrasound Magazine) covers DIGITEXMedical under its Success Story Column, under September, 2012 issue.

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