In Imaging December, 2012

In Imaging

Vol 4 No. 5 l Pages 82

A compendium on the latest in radiology

December 2012

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Vol 4 l No. 5 l Pages 82

IN IMAGING | DECEMBER 2012

EDITORIAL

Expanding the horizon As the industry gears up for the 66th annual conference of the Indian Radiological & Imaging Association (IRIA), India's largest radiology and imaging event, we decided to focus the IRIA special edition of In Imaging on the growth drivers of this segment.

The very fact that IRIA 2013 is being held in Indore (as opposed to previous editions at Hyderabad, Delhi, and Ahmedabad, to go back three years) is significant because it proves that the radiology business is venturing beyond the main metros of the country. Our cover story, 'Radiology: Looking beyond metros' analyses growth drivers, emerging business models and identifies key Tier II 'hot spots' like Jaipur, Lucknow, etc followed closely by Tier III cities like Dehradun, Meerut.

With a mix of strategies like increasing awareness through CMEs and also re-jigging products for these markets, companies are already reaping the results of these forays. For instance, Siemens has its ZIB (Zero Installed Base) strategy well in place and today has a presence in almost 525 districts of the country.

Another not-to-be-missed story in this IRIA special issue is our Spotlight on Dr Arjun Kalyanpur, CEO of the

OUR COVER STORY, 'RADIOLOGY: LOOKING BEYOND METROS' ANALYSES THE GROWTH DRIVERS, IDENTIFIES KEY TIER II 'HOT SPOTS' LIKE JAIPUR, LUCKNOW, ETC FOLLOWED CLOSELY BY TIER III CITIES LIKE DEHRADUN, MEERUT AND PROFILES EMERGING BUSINESS MODELS

Bangalore-based Teleradiology Solutions. He may be an 'Accidental Pioneer' but his success story is a saga of turning adversity into opportunity and steadfast belief in his vision. Entrepreneurs in the healthcare sector might glean valuable insights on how Dr Kalyanpur became synonymous with teleradiology solutions in India.

One great example of his attitude is the way he went about changing the stereotypical negative image of outsourcing to India. Once he was able to convincingly prove that nighthawk remote-based radiologists actually improve service and productivity of US-based hospitals, without resulting in job losses, Dr Kalyanpur was able to change the tide of media coverage and public opinion as well.

As always, we look forward to feedback on this issue's contents. Do tell us who you'd like to see in the 'Spotlight' or other sections of In Imaging.

Just like the push beyond the metros and Dr Kalyanpur’s example of charting new territory, may 2013 be a year of new opportunities and expanding horizons.

Viveka Roychowdhury viveka.r@expressindia.com

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6 IN IMAGING

DECEMBER 2012

CONTENT IN IMAGING | DECEMBER 2012 COVER

STORY

Radiology:Looking beyond metros Radiology players in India are charting a path to Tier II and Tier III cities for augmenting their growth. A closer look at the reasons for this growing phenomenon PAGE 14

'We make our products cost effective and readily accessible' Vivek Phalle, Business Manager-India, X-Ray Products, Varian Medical Systems International India speaks about the company's latest products and their contributions for the Indian radiology market PAGE 32

'Tomosynthesis is the new gold standard in breast imaging’ Dr Arvind K Chaturvedi, Director Radiology, RGCI&RC, talks about the recently installed Digital Breast Tomosynthesis at RGCI&RC and its advantages PAGE 33

Evolution of radioactive therapy in cancer treatment Dr Manish Chandra, Senior Radiation Oncologist, Jupiter Hospital gives a run-down on the history of radiation therapy in cancer and the various happenings which contributed to its progress PAGE 38

14

IRIA 2013 Special It promises to be an event that will bring together distinguished international and national radiology experts PAGE 46-73

25

66

NEWS

UK laboratory develops interesting foetal ultrasound image technology The technology developed by Sense My Baby Laboratories offers very advanced ultrasound images UK company, Sense My Baby Laboratories is about to launch a technology that can display any existing ultrasound image with great clarity.

T

Obstetrics and director of the Harris Birthright Research Centre for Fetal Medicine at King's College Hospital, was the first to privately review the pioneering work and confirm that the imagery was the most advanced one he has ever seen stating, "The images are absolutely stunning and the detail is truly amazing�.

The new technology provides a game-changing advancement in ultrasound image recognition and is poised to provide parents with a unique opportunity to see their baby's face like never before.

"We are rapidly changing the way that expectant parents see their children for the first time. This is a pivotal moment in the life of any parent and we're delighted to be leading the industry in making it as memorable a moment as possible," Torres-Cabrera concludes.

The technology is due to become commercially available within weeks. â– Before and after Sense My Baby(TM) using CEIP-Corrective Enhancement EH News Bureau Imagery Program. he company's founder, Dr Lissette Torres-Cabrera, pioneered the technology after having experienced complications during the pregnancy of her first child three years ago. She informs, "The most amazing aspect of our Corrective Enhancement Imagery Program (CEIP) is that the mother doesn't require a special scan, any regular 3/4D scan is all that's needed.

The system is able to re-engineer existing imagery to create an ultraclear image, allowing you 'for the first time' to see your unborn baby from within the womb with remarkable detail. It's the closest thing to seeing your baby before birth."

DECEMBER 2012

Using 'structural' information from the original image, data characteristics are analysed and the system is able to differentiate between the degraded image area and that of a higher resolution - the latter being the area that is isolated and then captured. These images are then individually enhanced using CEIP, before being re-engineered to create a layering effect—where required the orientation of the image is changed to facilitate the reconstruction.

Leading industry experts are already showing an interest in the technology. Professor Kypros Nicolaides, the world's leading authority on

IN IMAGING 11

NEWS

Siemens launches ultrasound breast analysis software It supports quick and detailed review of 3D and 2D breast ultrasound images

S

iemens Healthcare introduces syngo Ultrasound Breast Analysis, a software application for offline review of images, volumes and clips produced with the Acuson S2000 Automated Breast Volume Scanner (ABVS) and the Acuson S2000 ultrasound system. The software reportedly offers comprehensive image processing and reporting tools designed to improve breast ultrasound quality and workflow. It can be installed on existing computers in medical practices or hospitals, allowing physicians to analyse and process 2D and 3D ultrasound images inside or outside the reading room. The syngo Ultrasound Breast Analysis software is expected to contribute to increasing Siemens’ innovative power—a key component of the Healthcare Sector’s Agenda 2013 two-year global initiative.

Siemens claims that the syngo Ultrasound Breast Analysis software is optimised for breast ultrasound workflow, making 2D review and 3D data analysis easy and comfortable. The other features that the software offers include image analysis and reporting with tools for data review in one place and streamlined reports that support the American College of Radiology (ACR) BI-RADS US Lexicon Classification Form [1] – offering standardised reporting to allow faster, easier communication with referring physi-

12 IN IMAGING

cians. Users can import DICOM data for review, editing as well as annotating and archiving of patient reports. In addition, the software provides standardised results that permit physicians to compare images with future or past findings.

The software application can be

installed on a wide variety of hardware, including a laptop or desktop system, a department’s local picture archiving and communication system (PACS), and/or vendor-neutral archives. ■ EH News Bureau

DECEMBER 2012

NEWS

ASE and GE Healthcare to teach use of ultrasound technology in India Medical outreach partners with local hospital to bring innovative technology and education to India

N

early 12 months after their first collaborative medical outreach project, the American Society of Echocardiography (ASE) and GE Healthcare (GE) are in rural northwest India again to utilise advances in cardiovascular ultrasound technology to enhance medical education for healthcare providers caring for the underserved populations in India.

A team of ASE member sonographers and physicians travelled to New Delhi to train Indian physicians in image acquisition while testing the possibilities of remote medical education. The educational event is collaboration with Medanta—The Medicity located in Gurgaon, NCR. An additional team of ASE sonographers is assisting in training via the internet and StatVideo’s EchoBoxes, equipment designed to stream cardiac ultrasound images over the Web. Twenty Indian physicians are receiving training on-site, while half of the physicians are also benefitting from additional training by ASE sonographers providing real-time instruction remotely from the US. This technology, is assisting them to see the images the Indian physicians scanned, providing the ability to

DECEMBER 2012

instruct the physicians on improved acquisition in real-time.

The healthcare providers have included two new corporate sponsors CoreSound Imaging and StatVideo, to expand the reach from the rural setting with long-distance, webbased technology to the remote sonographers. The project was organised

by Dr Partho P Sengupta, a New York-based cardiologist, a member of the Board of ASE, and the India liaison for ASE. The local training was coordinated by Dr Manish Bansal, Medanta—The Medicity.

“This educational activity sets a benchmark in delivering innovative internet-based teleconsultation and teleeducation program to physicians,” said Dr Sengupta. “The physicians registered for a novel training module: Value of Interactive Scanning for Improving Outcome of New Learners (ASE-VISION). This programme ushers newer training possibilities in integration of tele-echocardiography with activities that range from real-time online assessments, long distance consultations, information sharing and education of physicians in remote areas of the world.” ■ EH News Bureau

Philips puts up a good show at RSNA

R

oyal Philips Electronics showcased several new features for existing image modalities that deliver clinical benefits to customers while simultaneously answering the economic challenges clinicians face worldwide, at the 98th annual meeting of the Radiological Society of North America (RSNA) held in November this year.

“We know that customers around the globe are facing economic struggles and purchasing decisions may be uncertain,” said Gene Saragnese, CEO of Imaging Systems at Philips. “Philips understands these challenges and is committed to continually improving access to the best care possible and helping clinicians to improve patient outcomes. We do this by providing upgrades and enhancements that meet these challenges, which allows our customers to improve on the existing imaging system investments they have already made,” he added.

At RSNA, Philips also offered its dStream broadband technology that will enable current Philips MR users to switch to digital broadband MRI for the majority of analogue Philips MR systems. The technology builds on the existing MR magnet and is a cost-effective way to provide digital broadband MRI, claims the company. ■ EH News Bureau

IN IMAGING 13

C O V E R

S T O R Y

RADIOLOGY: LOOKING BEYOND METROS Radiology players in India are charting a path to Tier II and Tier III cities for augmenting their growth. Raelene Kambli takes a closer look at the reasons for this growing phenomenon and the opportunities awaiting the players within these cites

T

he radiology sector in India is at an inflection point, poised for significant growth in the coming years.

Growing demand for healthcare services, increasing knowledge about evidencebased diagnosis coupled with raising awareness of available advanced technology are few key determinants that have propelled growth for the radiology market in India. According to a report published by Millennium Research Group (MRG), the Indian market for diagnostic imaging systems is currently witnessing a strong growth rate each year. In 2011, the diagnostic imaging market witnessed an average growth rate of nearly nine per cent. It also predicts that the market would reach almost $830 million by 2016.

So far, Tier I cities like Mumbai, Bangalore, Delhi, Chennai, Hyderabad

and Kolkata have been the prime markets for the radiology sector. However, these megalopolises are slowly getting saturated. In such circumstances, radiologists, imaging diagnostic chains and radiology equipment majors are now vying to tap Tier II/III cities as they have the potential to match with the larger cities in market size. Several research reports demonstrate that these cities have progressed significantly, offering an optimistic outlook for the country. So, what makes these beta cities more business friendly?

KEY DRIVERS FOR GROWTH Several demographic factors, rapid urbanisation leading to constant economic development and saturation of progress in metro cities are some of the aspects that draw radiology players to venture into these semi-urban

areas and small towns. “Additionally, over the last 10 years, awareness about preventive healthcare among people has increased and this in turn has lead to growing demand for good quality healthcare services. Therefore, as demand for healthcare services increases so will the demand for radiological diagnosis and this leads to the growth of diagnostic and imaging centres within these areas,� believes Dr Anupama Dudhani, Radiologist, Hinduja Healthcare Surgical, Mumbai.

Dr Harsh Mahajan, President, IRIA and Honorary Radiologist to the President of India, also feels that Tier II and Tier III cities have huge potential for the radiology market players, especially for the local and mid-sized players. According to him, these cities represent an area of under served need, with a growing demand for

Looking at the favourable circumstances available in the market, many radiology players are chalking out a strategic plan to venture into Tier II and III market

COVER STORY improved health services and infrastructure.

“With increasing prosperity and growing middle class in Tier II and III cities, the propensity to spend on healthcare is growing rapidly. As a result, quite a few private and corporate healthcare providers are expanding their reach in these cities. Venture capital firms are also making significant investments with large size portfolios in the healthcare sector. The whole idea is to provide accessible and affordable healthcare in these cities,” opines J Sunderrajan, Head – Strategy and Business Development, Siemens Healthcare.

Speaking about the main factors responsible for drawing the the attention of the market players, Dr Ashwin Garg, Interventional Radiologist, Sri Balaji Action Medical Institute says, “Firstly, these areas are largely untapped markets. Plus, in recent times, these places are having improved physical infrastructure, better government support, and well-connected communication network which are essential for any kind of industry.

We are also witnessing a lot of other businesses moving into these smaller cities. The other advantage is the improving lifestyle within these cities and towns. This has created a new set of customers for the healthcare industry.” Dr Garg also feel that the boom in the medical tourism industry is a another driver for growth of the radiology segment in the Tier II and III cities. “Medical tourism is helping a lot in the rapid progress of the radiology market as well. Over the last few years, medical tourism has gained a lot of momentum in India. Indian market is providing the care at about one-

16 IN IMAGING

India is in need of innovative radiology products and services that can be made available to all at an affordable cost Dr Harsh Mahajan, President, IRIA third of the cost as compared to other countries. This, in turn, is making India a popular medical tourist hub in Asia. Medical tourists are now coming to smaller cities like Gurgaon or Faridabad to seek good quality and cost-effective healthcare and radiology services at a competitive price, thus opening many avenues for the radiology sector,” he chips in.

Further, as per a FICCI study, India needs to add huge number of beds for providing satisfactory healthcare.

Hence, many new hospitals would be established in Tier II and Tier III cities and this would open new markets for

radiology companies.

Apart from increasing demand for healthcare services, new advancements in radiology are also contributing a lot in the rapid progress of the radiology market in these areas.

Experts reveal that earlier the radiology market entered the Tier-II and III with X-ray services and then ultrasound services were brought in.

However, now technologies such CT, MRI, PACS and digital radiology are also available in these cities.

Explaining how advanced technology has fostered growth for the radiology segment within the beta cities, Dr Garg quips, “Modern equipment with high quality, high-end features and tools for faster diagnosis are getting introduced in this market. For example, X-ray imaging equipment market is witnessing a major shift from analog to computed radiography (CR) and digital radiography (DR). Few years ago, ultrasound systems were only confined to radiology department. But now increasingly a number of other departments like cardiology, gynaecology, urology, critical care, emergency medicine, operating theatres etc. are showing interest in offering ultrasound services for various clinical applications. Hospitals, mainly the government owned, are therefore purchasing units for different departments. Introduction of teleradiology has also acted as a boom to the radiology market, especially in these regions.”

Speaking of technology acting as a key driver, Sunderrajan shares examples of the products that Siemens introduced in the Tier II and III cities in the last few years. He informs, “Imaging centres and hospitals from

DECEMBER 2012

COVER STORY the Tier II and III cities have started adopting high-end equipment in their radiology department. For instance, one of India’s first 128 slice CT scanner called Definition AS+ was launched in Coimbatore, the second Hybrid OR system of Siemens was installed in Nagpur, the first 1.5T MRI called MAGNETOM Essenza was launched by Siemens in Surat, many such examples evidently show how technology is driving the radiology sector in these cities.”

All the above factors indicate that there are various factors propelling growth in the radiology industry within the smaller cites of India and leaves a lot of room for further progress. The industry seems to be surrounded with many opportunities that can take the radiology and imaging services in India to the next level.

“Tier II/III markets can be the future growth drivers for consumer durables given the growing disposable incomes, rising aspirations of people to own quality products. We are seeing the improved infrastructure support that the government is providing with respect to the development of these cities. Private healthcare in these cities is now getting corporatised with the aim to reach closer to the people and provide best care closer to home. These corporate healthcare chains are setting hospitals on the hub and spoke model in various tier II cities. To target high rural population which is having moderate per capita income, we would be witnessing huge investment in healthcare and thus in radiology in the next decade,” predicts Dr Garg. So, if opportunities are galore, what is the nature of the market currently?

DECEMBER 2012

To target rural population..., we would be witnessing huge investments in healthcare and thus in radiology in the next decade Dr Ashwin Garg Interventional Radiologist, Sri Balaji Action Medical Institute MARKET AT PRESENT Jaipur, Lucknow, Nagpur, Pune, Jalgaon, Meerut, Phagwara, Kochi, Bhopal, Ludhiana, Faridabad, Chandigarh, Agra, Amritsar and Nashik are the Tier II cites that are currently witnessing a surge of activity in this field. Picking up pace are Tier III cities such as Dehradun, Meerut, Muzaffarnagar, Gurgaon, Noida, Greater Noida, Thiruvananthapuram etc. Many new imaging centres run by local radiologists have mushroomed in a span of three to five years. Imaging and diagnostics chains such as Metropolis Health Services, Suburban

diagnostics, NM Medical, Lifecare Diagnostic Centres etc. are also foraying into these markets. On the other hand, radiology equipment manufacturers and distributors are leaving no stone unturned to introduce equipment that suits the needs of their customers within these markets.

Radiology equipment manufacturers such as Allengers, Sonosite, Carestream, Modi Medicals, Toshiba, Fuji and many more have made the most of the opportunities available in the Tier II markets. These players have introduced advanced imaging systems that cater to the needs of radiology departments and imaging centres, both big and small. Equipment majors such as GE, Siemens and Philips are also showing interests in these market.

MARKET TACTICS Looking at the favourable circumstances available in the market, many radiology players are chalking out a strategic plan to venture into these market. “Indian radiologists in general are very tech-savvy and very knowledgeable. So the companies are targeting the hospitals and radiologists.

They are conducting seminars across India to share advanced radiology imaging techniques and solutions with their customers as well as organise training programs for radiographers.

Some of the equipment companies are now making direct presence in India with their own sales and service teams covering all the states of India. Few companies are even developing products according to the needs of semi urban and rural areas like an upgradable retrofit solution, Carestream DRX1 System for Digital radiography.

There are other foreign companies

IN IMAGING 17

COVER STORY which are in collaboration with local companies to build equipment keeping in mind the Indian buyers. Some PPP models are also being created to make radiology and imaging available to the rural sector,” briefs Dr Garg.

Elaborating on the strategy,adopted by Siemens to tap Tier II and III cites Sunderrajan explains, “Siemens started an initiative called Zero Installed Base or ZIB, where we target districts that have no imaging equipment – either of Siemens or of the competition. This strategy has helped Siemens to expand its geographical reach and today we have presence in almost 525 districts of India. Moreover, we are also fostering our R&D efforts to come up with highly innovative and at the same time more cost-efficient imaging equipment.” Sharing Siemens' plans for 2013 he adds, “Siemens Healthcare’s global initiative of Agenda 2013 entails objectives like expanding our regional presence in the fast-growing emerging markets and further extending our portfolio of systems in the middle price segment.”

At the same time, because of the huge costs involved in establishing the radiology machines, various companies are providing financing options so that a hospital can make significant purchases such as a CT or MRI machine, thereby to increase access in healthcare as well. Hence, many equipment majors are introducing refurbished imaging equipment in these markets. Refurbished medical imaging equipment serves as an affordable alternative to otherwise expensive high-end equipment. It gives an opportunity for the customers to purchase latest technology products for their clinic or hospital at a lower price. In fact, more and more corporate hospitals in the beta cities are opting for alternatives to cut down on capital investments. Refurbished equipment companies such as Sanrad and Master Medical Equipment have 18 IN IMAGING

ment Dr Mahajan replied, “These machines are normally FDA approved machines. Radiologists opt for these machines as they are not in the position to invest in high priced imaging systems. When they buy these re-used machines they feel that at least they are providing a service which was not available to people earlier. Personally, I feel opting for these machines could risk a patient's life. One needs to be very careful while purchasing these systems. All safety parameters, especially the radiation dose levels should be checked prior to buying these equipment.”

Imaging centres and hospitals in Tier II and III cities have started adopting high-end equipment in their radiology department J Sunderrajan, Head - Strategy & BD, Siemens Healthcare been leading the race. Year after year, these companies introduce various refurbished CT Scanners and MRI machines at an affordable cost. This also indicates a growing market for refurbished equipment within these cities.

On the other hand, Dr Mahajan sees a growing trend of deploying reused equipment in these markets. He informs, “There are many local medical imaging equipment companies who sell re-used radiology machines to hospitals and imaging centres.

These machines are available at a price which is half the cost of a new equipment and provides reasonable, quality services. However, adopting re-used equipment within hospitals and imaging centres could also mean risking patients' lives. When asked on the risks involved in using these equip-

OVERCOMING OBSTACLES If there are opportunities, challenges are bound to be there as well.

Major challenges that cloud this budding industry include lack of skill manpower, legal and regulatory issues and growing need for huge investment. Dr Dudhani urges medical education institutes to introduce diploma courses in radiology and imaging operations. She says that introduction of such courses can add to the human resources in this field. “India is in need of innovative radiology products and services that can be made available to all at an affordable cost,” points out Dr Mahajan. Talking on the legal issues concerned, Dr Mahajan feels that systematic guidelines and proper regulations can be instrumental in keeping a check on all fly-by-night operators in this field. Dr Garg, on the other hand, stresses that introducing teleradiology services in all Tier III cities and rural areas of India can help sow the seeds of success in radiology.

All these small measures, if incorporated, can indeed bridge the gaps within the industry. Moving forward, it is estimated that 2013 will definitely see more and more radiology players investing in Tier II/III cities. ■ raelene.kambli@expressindia.com DECEMBER 2012

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062310_AQ_A-II_INDIA_A1

SPOTLIGHT

ACCIDENTAL PIONEER His flagship company has pioneered the business of teleradiology in our part of the world. Now Dr Arjun Kalyanpur is taking it a step further by marrying his first love academics to new found love, technology creating innovative business opportunities. M Neelam Kachhap witnesses the partnership and gets his take on being an entrepreneur and more

DECEMBER 2012

E

leven years ago, when radiologist Dr Arjun Kalyanpur and paediatric cardiologist wife Dr Sunita Maheshwari returned to India, they had no idea that they were embarking on a roller-coaster ride which would result in a flourishing business that many would want to clone.

In fact, it was not so much a business idea than a way to re-connect to his patients and alma mater Yale where he practised before coming back to India. A system by which Dr Kalyanpur, being at Bangalore, would read and report radiology findings and interact with clinicians on patients diagnosis and treatment course. Today, he is joined by 45 radiologists around the world who do the same.

Arjun Kalyanpur, CEO of Teleradiology Solutions (TRS), is a name to reckon with. A pioneer in teleradiology in India, Dr Kalyanpur and Dr Maheshwari own a bunch of businesses other than TRS such as an IT company Telerad Tech, small clinic

IN IMAGING 21

SPOTLIGHT RxDx, as well as two NGOs Telerad Foundation and People4People.

Now Dr Kalyanpur, a true academic at heart, has found a way to be part of cutting edge research via his new venture, Image Core Lab (ICL). He is also planning to jump right back to teaching via e-learning modules and webinars through his teaching website radguru.net.

RELEVANT HISTORY In 1999, when Dr Kalyanpur returned to Bangalore, not many opportunities greeted him. Most private hospitals were already staffed and he "did not want to simply open a diagnostic centre and do ultrasound scans", rather he preferred to wait for a good opportunity, which came when he took over the position of the Chief Radiologist at Sri Sathya Sai Superspecialty Hospital in Whitefield, Bangalore. During the same period, inconvenience and difficulty of radiologists working night shifts at Yale, led him to the idea of nighthawk radio-diagnosis services from Bangalore.

The idea shaped into a pilot project that led to him publishing a paper on 'Evaluation of JPEG and Wavelet Compression for teleradiology trasmission'. However, the project came to a screeching halt after a lot of questions were raised about radiologists losing jobs to off-shore radiology and patient safety. "I personally did not feel that this was an issue at all given that I was a US trained radiologist myself and had only brought my own job back to India with me,� he clarifies.

And he is right. A certified American Board of Radiology doc-

22 IN IMAGING

tor, he is armed with a degree from AIIMS, a fellowship in abdominal imaging from Cornell University and another in neuroradiology from Yale.

DEVIATION FROM STANDARD PROTOCOL Not to be bullied by negative connotations, Dr Kalyanpur tackled the situation in his own way and changed the adversity into an opportunity. "During the 2004 US elections, the media made a great deal out of off-shoring jobs and we came under the focus of all the newspapers and TV channels. We felt that the best way to deal with this was to be open and to present the positive side of what we were doing, which was running a high quality radiology service from a different time zone which allowed for higher radiologist productivity and quality and therefore better service to US hospitals at night. As a result of this approach, the media scrutiny actually came to work in our favour, and resulted in a lot of positive publicity and visibility for us," he shares.

Undoubtedly, he has proved to the world, through consistent performance over the past 10 years, that high quality reporting, of a calibre equal or superior to that provided by western companies, can be delivered from India using the day/night time advantage.

FIGHTING SPIRIT On the home front, he was tackling issues with infrastructure in terms of power, internet connectivity and bandwidth. Today, technology

has become affordable and simple and no one could be happier than Dr Arjun Kalyanpur. Back when Dr Kalyanpur started reading radiology images first from home and then from a hired a room at a call centre technology was his biggest ally and enemy. Making calls to America and the bandwidth for their online service was expensive along with diffused software and regular power cuts. Security was another handicap.

In addition he had to manage other activities like fighting off acquisition bids. He received offers from a big IT company in Bangalore to buy his incubating business. "When we were less than an year old, one of the large software companies approached us with an acquisition offer. We were initially tempted, as the offer seemed attractive at the time, but our Board advised us to decline the offer, given that we had the potential to build something of great value on our own, as we had the necessary domain knowledge and understanding of teleradiology. The advice our board gave us at the time was that a technology company should really be our vendor and not our owner. So we said no thank you to the technology company and moved on. In retrospect the advice from our Board was excellent," he shares. He fought his way through and worked endlessly to change his dreams into reality.

CLEAR READ Just like the tortoise in Aesop's Fables 'Tortoise and Hare’ story, the companies grew slowly and organically. Today, it has become one of the most successful teleradiology business around the world.

DECEMBER 2012

SPOTLIGHT

The company that started in a corner of his house with two employees has become the best in 'Klas' teleradiology provider in America. With radiologists based in Israel, US, Europe and India, it covers over 150 hospitals in 20 countries globally. It recently started covering hospitals in Africa - Tanzania, Nigeria and Djibouti.

In 2005, the company became the first healthcare organisation outside Singapore to be accredited by the Ministry of Health of Singapore and provides teleradiology services to 11 medical centres in Singapore under the National Healthcare Group.

In the same year, it became one among the first teleradiology companies to be accredited by The Joint Commission, a US-based organisation that accredits healthcare facilities.

DECEMBER 2012

The company was showcased to US President Barack Obama during his visit to India in November 2010 as an example of innovation in action.

Teleradiology Solutions is a company with a difference. It has evolved from being a pure nighthawk US teleradiology group to being at the forefront of several innovative technology and healthcare initiatives. For the coming decade, TRS aims at adhering to its new title –“Best in Klas”, innovating continuously, reaching needy patients around the world and widening its scope globally to include all facets of technology and health - teleradiology, telecardiology, tele-medical, e-teaching, telemedicine and more.

NEW VENTURES The birth of Image Core Lab (ICL) is an extention to Dr Kalyanpur's aca-

demic acumen. Imaging has long been used in therapeutic drug development, particularly in the early phases of drug development (e.g., phase 1 and phase 2 trials). More recently, imaging studies have been proposed for use in phase 3 trials, often as a component of the primary or secondary endpoints. Presumably then ICL is a logical step ahead for TRS. "A few years ago, we were contacted by an oncology research centre in the US who requested us to interpret scans performed to track patient response to an investigational cancer therapy. The success of this project led to the launch of Image Core Lab (ICL), our venture dedicated to imaging in clinical research," shares Dr Kalyanpur. "This is a new and exciting venture which is of particular relevance in the rapidly growing and

IN IMAGING 23

SPOTLIGHT evolving field of clinical research.

“Especially for the clinical trials industry today as the regulatory requirements to standardise data have led to the strong need for centralised imaging where robust protocols are followed and continuous training takes place to ensure consistency, accuracy and reliability of image analysis," he adds.

ICL leverages the strong in-house radiological expertise and the decade-old experience of Teleradiology Solutions in global multi-site teleradiology and its technology wing, TeleradTech. ICL provides services in the protocol development and study design stages of global clinical trials, as well as in activities such as site coordination and site training.

Although Kalyanpur is completely dedicated to TRS he misses teaching and the academic environment.

"What I liked about Yale was the academic environment, the support for research, and love for teaching that all the professors manifested. Also the energy of the teaching conferences, where anyone could state an opinion and question a senior without fear of rebuke. This, to me, is the great thing about the American academic system, " he states.

Despite this he finds time to go back to his books. “I do love teaching, and in fact have lot of opportunities to practice it even today. We conduct regular CME courses in topics such as emergency radiology, cardiac imaging and advanced MR imaging, as well as PG refresher training courses, which are very popular. And through our teaching relationship with the Sri Sathya Sai Institute, I am involved in

24 IN IMAGING

postgraduate teaching in the DNB programme there,” he reveals.

He feels that the internet is the best medium for spreading education in the field of radiology, and for addressing the shortage of radiology educators. Their teaching website (www.radguru.net) provide a rich archive of teaching material for radiology postgraduates as well as practising radiologists. "We also use YouTube as a medium for sharing our expertise. In addition, through our Cisco-driven e-learning portal, we conduct and are developing a curriculum of e-lectures on all subjects within radiology by international and domestic faculty and we are happy to be the pioneers in this space".

NOVEL LANDMARKS Recently, Telerad Foundation, announced that the total number of radiology scans read pro bono for poor patients in remote areas of

India crossed 20000 this July. “God has given us a lot, we are blessed to be able to use our domain knowledge for those who are less fortunate.” he says.

Telrad Tech’s flagship work-flow improvement productivity solution“RADSpa” has over 50 installations worldwide and this year they launched the RADSpa version 3.1.

Telerad Tech is also the managed service provider for Cisco’s HealthPresence telemedicine platform in India and started operations in Eastern India benefiting more than 100 patients.

Over the last decade, Kalyanpur has superposed himself indelibly onto teleradiology solutions, and thereby onto Indian telemedicine.

Then again he has been exigent in his mission to deliver taking TRS to new heights. ■ mneelam.kachhap@expressindia.com

DECEMBER 2012

DEPARTMENT SCAN

Radiology at Columbia Asia: A consolidated effort Columbia Asia, with ‘The Columbia Asia Radiology Group (CARG)’, effectively demonstrates how to offer quality radiology services by optimising expertise, standardising protocols, as well as sharing learnings and best practices, informs Lakshmipriya Nair

A

fter analysing the radiology department of Kohinoor Hospital, Mumbai in the October 2012 issue of In Imaging, it is the turn of Columbia Asia Hospital, Bangalore to come under our scanner. It is one of the hospitals in Columbia Asia group’s chain of 16 medical facilities spread across India, Malaysia, Vietnam and Indonesia.

Following the group’s strategy of targeting neighbourhoods, rather than the central cities, Columbia Asia Hospital in Bangalore is built in Hebbal and a multi-speciality hospital catering to the rapidly advancing middle-income group.

Focussing on the radiology department in this hospital, Columbia Asia Hospital in Hebbal reportedly has a full-fledged department offering radiology services to its patients from 2005. Dr Harsha Rajaram, General Manager, Telemedicine,

DECEMBER 2012

IN IMAGING 25

DEPARTMENT SCAN Columbia Asia Hospitals informs that since then, every subsequent hospital of Columbia Asia has a radiology department housed in its premises.

Over the last three years, all the individual radiology departments of this hospital chain have been connected to form a larger, virtual radiology group – The Columbia Asia Radiology Group (CARG). It collectively serves all the Columbia Asia Hospitals and other external radiology departments as well. This consolidation has augmented the hospital's capacity as well as helped to optimise expertise and ensure 24 x 7 x 365 days coverage for the benefit of its patients.

INFRASTRUCTURE Planning and designing a radiology department requires considerations in terms of infrastructure. The radiology department at Columbia Asia's Hospital in Hebbal, Bangalore gets a good score when it comes to infrastructure. Dr Rajaram informs, “Work flow considerations — patient (inpatient, outpatient) and staff movement, image flow, and proximity of radiology to other needy departments like emergency were considered during designing the department. In addition, peak load management and resource optimisation were also prime considerations.” He also informed that a lot of thought was given to ensure patient comfort and many visual, kinesthetic and auditory aspects were taken into account to ensure that every patient is made to feel safe and comfortable. “Design and training considerations are made keeping in mind that patients are generally distressed, traumatised and disoriented when they come into the department,” says Dr Rajaram. Other practical considerations like availability of water, restrooms next to the ultrasound room, aesthetics and audio aids in MRI etc are also features that are part of the radiology 26 IN IMAGING

department at Columbia Asia.

INVESTMENTS AND RETURNS The investments in the radiology department of Columbia Asia have been made to ensure smooth, effective and efficient working of the department. It is also done with an objective the funds allocated should be put to optimum utilisation. Hence, Columbia Asia Hospitals conduct an analysis which includes clinical relevance, technical assessment and financial feasibility before investing in the equipment. Similarly, an investment in PACS, RIS and integration with HIS ensures ease for clinical care and patient flow. Thus, a lot of planning is done before investing in the radiology department. “Budgets for the radiology department are allocated based on the strategy and Columbia Asia standards,” informs Dr Rajaram.

EQUIPMENT AND TECHNOLOGY Equipment forms the spinal cord of a radiology department. Hence, choice of equipment must be relevant to the medical specialities offered by the hospital and must enhance the diagnostic efficiency of the clinicians.

Hence, every Columbia Asia hos-

An ongoing monitoring system which includes MRI screening, radiation monitoring procedures (TLD, Scattered Ray survey, LEAD Apron Monitoring system) are defined and followed at the Columbia Asia Radiology Group (CARG)

pital is equipped with an X-ray machine, two ultrasound machines and a CT machine. Availability of an MRI is based on the need of the population which the hospital serves. A PACS system has been installed in the hospital to ensure that all the images and reports are available at the point of care. The teleradiology software installed in all the departments help to enhance connectivity and easy access to expertise round the clock. “The departmental design, patient flow and appropriate use of technology to ensure safety and aid clinical care have been the key features of our department. PACS, work-flow solutions and integration with HIS and EMR have made our hospitals completely filmless. It has also ensured that the images are available to the clinician the very movement it is acquired, aiding faster clinical care and seamless patient management,” claims Dr Rajaram.

PERSONNEL The importance of skilled and trained personnel is of paramount importance to ensure smooth functioning of any department. It is same for the radiology department as well.

Hence, Columbia Asia Hospital, Hebbal has a full fledged team of professionals working in its radiology department to ensure that its patients receive quality service is the best possible manner.

Headed by Dr Shalini Govil and Dr Harsha Chadaga, the staff employed in the radiology department at Columbia Asia comprises: ● Radiologists ● Technical Staff (radiographers and technicians) ● Administrative staff Each department’s administration is handled by a radiology manager appointed by the local hospital.

The team’s role involves assuring DECEMBER 2012

DEPARTMENT SCAN

Efficiency to take care of the variable load across hospitals ● Complete spectrum of sub speciailties services (neuro radiology, musculoskeletal radiology, etc.)

A good working team of radiologists across the radiology department at Columbia Hospitals have helped the management to consolidate the CARG which serves all the patients seeking radiology services as well as provide reporting services to over 30 non Columbia Asia clients with the same standards of service delivery. All the external clients and the Columbia Asia hospitals are serviced by a common work bench which enables 24/7 coverage and subspeciality services to all the clients. It has also helped the hospital chain to standardise protocols, process●

28 IN IMAGING

es and reporting as well as helped to share learnings and best practices.

SAFETY Safety is a prime consideration where hospitals, especially the radiology departments are concerned. A far as the safety measures at Columbia Asia’s radiology department is concerned, Dr Rajaram informs, “Atomic Energy Regulatory Board (AERB) regulations and MRI zoning principles are some infrastructure considerations that are strictly adhered to while designing and building the department. An ongoing monitoring system which includes MRI screening, radiation monitoring procedures (TLD, Scattered Ray survey, LEAD Apron Monitoring system) are defined and

followed. Continuous training and appropriate signage ensures staff and patient awareness and adherence to these procedures.” Thus safety is given paramount importance and all the needed safety measures are in place at the radiology department of Columbia Hospital, Hebbal.

All in all, the radiology department at the hospital is a well-planned unit.

Its smooth functioning is ensured by efficient staff who is assisted by good infrastructure and new-age technology alongwith standardised procedures and proper protocols. ■ lakshmipriya.nair@expressindia.com

To be featured in the next

Department Scan of In Imaging, email the editorial at viveka.r@expressindia.com DECEMBER 2012

TECH SCAN

THE CAPSULA X FACTOR Known for being a high-quality, user-friendly FCR system, Capsula X has been gaining popularity among radiologists, finds Raelene Kambli

R

adiology is a dynamic field and its progress over the years has been noteworthy. Right from the discovery of the first X-ray scan to the latest intervention in digital imaging modalities, there have been tremendous amount of advancements in this field. One such advancement is the computed radiology (CR) which typically refers to cassettebased technology that uses a scanning/reader mechanism to extract information from the exposed cassette. A CR system uses unique image receptors to capture an analogue image as well as sophisticated readers to process the image and convert the information into a digital format. Some of the advantages of incorporating a CR system is that it eliminates the use of costly chemicals and resulting hazardous waste, provides an adaptable image medium, reduces other consumables that film-based systems require and ensures technicians' health and safety. But, the biggest advantage of this system is that it helps to streamline the workflow and offers greater flexibility in staffing options, which may help offset the substantial costs associated with acquiring the system.

As a result of their affordable price and proven reliability, ease of installation and use, CR systems have quickly become the prevalent means to digitally capture X-ray images for many

DECEMBER 2012

smaller hospitals, imaging centres and speciality practices.

In this edition we seek opinions of users who have incorporated Fujifilm’s CR system—Capsula X. Capsula X is said to be a high-quality and compact FCR for broad range of diagnostic imaging. It is smaller and lighter than other available systems in the market and hence its name, which means 'a small box' in Latin, is quite apt. This system is developed using Fujifilm's vertical cassette loading method, with which workspace is reduced compared to previous horizontal insertion models.

The makers claim that the product doesn't need a silver based film, chemicals, dark room storage or specially trained staffs to manage this modern equipment. According to Fujilfim, Capsula X also reduces the amount of radiation to the body and often allows the physicians to see everything they need on a single exposure. Faster image acquisition and image previews can be made available within seconds.

Because of the digital nature of the images, there is no degradation from continual viewing as there can be with X-ray film.

Other advantages claimed include more finely focussed results from the process as well as greater placement accuracy, which leads to less need to re-do exposures.

Some of its technical features are

mentioned below: ● Small enough to fit anywhere footprint 0.22 sq m, height 0.81 m ● Easy operations viewed on small monitor ● Supports various diagnostic imaging sizes (7 sizes including 15 x 30 cm) ● FCR Capsula X processing 43-72 images per hour is optimal for remote or low volume areas with less demanding work-flow.

After understanding the features of Capsula X, we analysed its features and reviews some important aspects that facilitate its users in their workflow on daily basis.

Performance: Sturdiness and consistency of output are very essential parameters to look for while evaluating the performance of an equipment.

So, we asked users how Capsula X rates where these features are concerned. Elaborating on the same Dr SP Ganeshan, MD, Hitech Diagnostics, Chennai informs, “Capsula X is an extremely good product. I am very impressed with the speed of this system. With the help of this system one can perform around 280 scans per day which is a high number. Each scan takes around 45-60 seconds which a quite quick. The system is quite a reliable and robust instrument as it performs with consistency. This product is able to sustain various environmental conditions in India as well.” Dr Sujeet

IN IMAGING 29

30 IN IMAGING

DECEMBER 2012

TECH SCAN Dattar, Dattar Diagnostic Center also agrees that Capsula X is a sturdy system. He goes on to say that he had purchased the Capsula X six years back and the system provides accurate results even today. “Capsula X is a very durable CR system. There is no limit to the number of scans one can take using this product. It saves a lot of time and streamlines our work-flow.

The software incorporated in the system is very efficient and above all it reduces the workload of the technician,” he adds. Dr Santanu Mitra, Head of Diagnostic Department, Sodani Hospital & Diagnostic Centres is also very pleased with the perform-

chasing the product, training is also provided to the personnel to operate the product.

Image quality: The image quality of the system is said to be of high diagnostic value. Users find the resolution and contrast of the images extremely good. The product has a dedicated image processing software to enhance the image quality. Dr Mitra appreciates the quality of images that are produced by the system. He says, “Capsula X is a multi-faceted system which helps technicians to procure good quality images.” Dr Ganeshan is of the opinion that the images that are derived from Capsula X is much better

User ratings in the scale of 1-5 ( 5 being the highest) Name of the Doctor

Techno logy

Durability

Image quality

Userfriendliness

Value for money

Dr Sujeet Dattar

4

5

5

5

4

Dr Santanu Mitra

4

4

5

5

4

Dr SP Ganeshan

4.5

4

4

5

4

ance of the system. He says that he has been using Capsula X for the past couple of years and his work flow has improving after that. However, Dr Mitra also points out that the system is a sophisticated system and needs trained professionals to operate it.

User friendliness: On the technology front, the users find the software quite adaptable. They are of the opinion that the software incorporated in the system are less complicated and therefore makes it easy to handle. The users opine that the product requires minimum intervention once all the organ processing parameters are set.

Dr Ganeshan informs that while pur-

DECEMBER 2012

than those produced by the other CR systems which he has used. He says, “I have been using other systems as well but the image quality that I have received from Capsula X is quite high.”

Further, the users find the image display parameter adjustments very flexible. They say that these parameters can be customised as per the users' needs. The image processing parameter plays an important role in the main output of the film.

Benefits to patients: With the new imaging plate replacing conventional films, radiation dose is reduced and this is very beneficial to the patients. Users feel that this option has

brought them respite as they are now confident that they can ensure low dose radiation exposure to patients as well as technicians.

Cost effectiveness: It is an expensive product. Yet, users are able to achieve ROI over a period of time.

When asked about the profitability of the product, Dr Mitra, replies, “A product's cost effectiveness depends mainly on the turnover gained from the product over a period of time. Returns on investments from imaging system is gained on making profit from volumes and this where this Capsula X becomes cost effective because this system has an excellent characteristic of increasing the number of scans per day.” Dr Ganeshan and Dattar also agree on this point.

Thus, the users seem to be satisfied with the product. However, they claim that though the system seems to perform very well, offers good quality images and is user-friendly, there is scope for improvement. All three users state that the software will need upgradation over a period of time. Dr Mitra, says, “As the system grows older its applications become slow. That's why there is a need to upgrade the software with time.” Adding to this, Dr Dattar says, “Fuji needs to upgrade their software so that the system can allow for a whole spine X-ray, which is not available currently.”

The product is slowly gaining popularity. It is to be seen that Capsula X has already made its way in examination, diagnosis and treatment methods through its features. Radiologists are opting for it in preference to the older style film X-rays for non-destructive examination. ■ raelene.kambli@expressindia.com

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INTERVIEW

'WE MAKE OUR PRODUCTS COST EFFECTIVE AND READILY ACCESSIBLE' Varian Medical Systems' X-Ray Products Group (Varian XRP), a leader in X-ray technology is well-known for providing high-quality, safe, long lasting and cost-effective X-ray devices. In India, Varian XRP has a strategic business support plan. Along with a sales and support office in Mumbai, Varian XRP has a bonded warehouse in India that facilitates rapid response to the urgent delivery needs of Indian customers requirements. Vivek Phalle, Business Manager-India, X-Ray Products, Varian Medical Systems International India speaks about the company's latest products and their contributions for the Indian radiology market, in conversation with Raelene Kambli Tell us about Varian's contributions in the field of radiology?

Varian Medical Systems', X-Ray Products Group (Varian XRP) is a premier supplier of tubes, digital detectors, and image processing workstations for X-ray imaging in medical, scientific, and industrial applications. Varian XRP has extensive experience in providing highquality, safe, long lasting and cost effective X-ray devices to the worldwide diagnostic imaging markets.

Varian XRP serves original equipment manufacturers and a network of independent service providers in

32 IN IMAGING

Varian's flat panel detectors, image processing software and specialised hardware enables higher throughput and a lower cost on a per exam basis

the diagnostic imaging industry.

Some examples of our leadership are the development of the anode end grounded (AEG) architecture for Xray tubes, flying focal spots in CT applications, metal centre section of X-ray tube inserts providing less off focus radiation, and longer tube life.

Varian is a pioneer in these fields, enabling greater power and continuous throughput in a smaller and lighter medical diagnostic X-ray tube. Varian continues to lead the industry in providing unique solutions for dynamic digital applications continued on page-34

DECEMBER 2012

INTERVIEW

'TOMOSYNTHESIS IS THE NEW GOLD STANDARD IN BREAST IMAGING’ According to experts, tomosynthesis addresses two major concerns with screening mammography: missed cancers and false positive rates. Unlike a screening digital mammogram, breast tomosynthesis captures multiple, low-dose images from different angles around the breast. Recently, Rajiv Gandhi Cancer Institute & Research Centre (RGCI&RC), Delhi, became the first exclusive cancer care provider in North India to install the Digital Breast Tomosynthesis. M Neelam Kachhap talks to Dr Arvind K Chaturvedi, Director Radiology, RGCI&RC, to find out more about this new technique.

How many breast cancer patients do you get in a month? How many mamograms are done in a day/month at RGCI & RC? In a day, we do about 12 to 15 mammograms. In a month, approximately 30 new breast cancer patients come to RGCI. In Indian metro cities, breast cancer appears to be the most widespread cancer among women— even leaving behind cervical cancer.

Why did you choose to install this new machine at the hospital?

We installed this new machine to remain at the forefront of technology

DECEMBER 2012

and for more accurate diagnosis of breast cancer.

Digital Breast Tomosynthesis is a step forward in breast cancer detection which can help spot cancers in dense breasts also as the breast is virtually sliced into multiple images in this imaging procedure.

The X-ray arm sweeps in an arc over the breast to capture 30-40 images of each breast. The number of biopsies is drastically reduced as compared to after a mammography and the images are acquired in a single compression.

Is tomosynthesis the new gold standard in breast cancer imaging?

Yes, I think it is the new gold standard in breast imaging, particularly for dense breasts. The conventional monogram technology delivers a twodimensional image of the breast which is then followed by continual investigation and at times unnecessary biopsies. Especially in the case of breasts with higher density which are composed of pockets of dense tissues surrounded by fat, overlapping of tissues makes it critical to judge the tiny spots called micro calcifications, and other subtle signs of early cancer.

How much does the machine cost

IN IMAGING 33

INTERVIEW as compared to a mammography machine?

The tomosynthesis machine costs about 250 per cent more than normal mamography machines.

Are there any room specifications to install this machine?

The room specifications are same as for mammography.

As compared to mamography what radiation doses the patient is exposed to during tomosynthesis exam?

Compared to mamography, the patient is exposed to almost same radiation dose during tomosynthesis.

What

is

the

accuracy

of

tomosynthesis as compared to mamography?

Tomosynthesis has about 70 per cent higher accuracy in dense breasts imaging. The accuracy comes down if the breasts are very fatty where mammography also does a good job.

When do oncologists suggest tomosynthesis?

Is it done simultaneously with mamography for all patients?

Oncologists usually requests for tomosynthesis when mammography creates a doubt or when breast density is high.

How long does it take for tomosynthesis imaging?

The entire procedure from undress-

ing and changing into a gown will take about 10 minutes while the actual exposure lasts only a few seconds.

What are the benefits of tomosynthesis for the patients?

The patient will benefit from a confident diagnosis and early detection of breast cancer. Also unnecessary biopsy is avoided due to accurate diagnosis using this technique.

How much would this tomosynthesis examination cost at RGCI & RC? It would cost Rs 3000 for tomosynthesis and Rs 4000 when tomosynthesis is done in addition to mammograhy. â– mneelam.kachhap@expressindia.com

'WE MAKE OUR PRODUCTS COST EFFECTIVE AND READILY ACCESSIBLE...' continued from page-32 for radiology.

What is Varian's focus area in the field of radiology? What are the latest trends in this field?

Varian Medical Systems has proven performance in designing and manufacturing the critical components that enable high quality and dependable imaging systems in the radiology market. We specialise in Xray tubes, flat panel digital detectors, image processing software and specialised hardware that provide solutions which enable our customers' success.

This market has learned to expect Varian to develop and manufacture X-ray tubes and detectors to meet the ever increasing technology requirements for higher resolution imaging, faster patient throughput, longer life, smaller dimensions and greater efficiency.

34 IN IMAGING

Where would you rank the Indian radiology market, in comparison with the other markets, globally?

The high level of service requirements combined with a competitive environment, makes the diagnostic imaging market in India different and unique. Varian will continue to focus on our customers' success by providing high quality critical components that offer real value to the imaging community in India.

What are the innovations that Varian wishes to bring to India?

Varian is committed to provide our Indian customers exceptional value with quality products and X-ray tubes from local inventory. We have a dedicated facility able to guarantee rapid supply and valuable service to the India radiology market. We stock medical X-ray tubes for immediate delivery throughout the India region.

By having inventory in India as well as a responsive technical and marketing team, we make our products cost effective and readily accessible to the Indian market.

We work closely with equipment manufacturers in India to customise and develop solutions that enable them to compete within India and in the global marketplace with world class technologies. Varian's flat panel detectors, image processing software and specialised hardware enable digital radiography which enables higher throughput and a lower cost on a per exam basis. Our high quality Xray tubes support higher continuous power and shorter duty cycles that provide higher throughput and greater efficiency for more productive imaging systems, with a lower overall cost of ownership. â– raelene.kambli@expressindia.com

DECEMBER 2012

INTERVIEW

'TELEMEDICINE WILL ESSENTIALLY BRIDGE THE URBAN-RURAL MEDICAL DIVIDE' Aravind Sitaraman, President - Inclusive Growth, Cisco Systems discusses about telemedicine, its benefits, the challenges and opportunities for telemedicine in India and Cisco's solutions for this market, in an interaction with M Neelam Kachhap India is one of the early adopters of telemedicine so why do you think that it has not taken off in a big way in India?

Telemedicine has existed in the healthcare landscape for over a decade and its benefits are only now being recognised. However, there are many factors contributing to the very modest adoption of telemedicine in India.

The major issue that we need to overcome in this country is a mind-set that we need to use only those technologies that we have created. During the Cold War era, this mindset was valid but that era died about 15 years ago and the world has moved on.

Secondly, we need to adopt technologies that will not infuse complexity in the edge because that would make maintenance and scaling a major challenge.

Thirdly, there is the basic infrastructure issue—power, networking availability, ecosystem players etc.

Fourthly, we need to normalise the telecommunication rates that resonate with the rest of the world. This DECEMBER 2012

is especially true for humanitarian applications.

Fifth, we need to create an incentive system for the government and private doctors to participate in telemedicine since they view it as a direct challenge to their livelihood.

These challenges present a country like India with an excellent opportunity to innovate and choose the latest technology to advance its healthcare needs, in turn creating a large number of jobs in rural areas.

This will not only address the healthcare needs of the country but also inject money into rural areas in a responsible and scalable manner.

Tell us about Cisco's role in shaping the telemedicine industry in India?

On an average, India has one doctor for 1700 citizens while the optimal average should be one doctor for 600 citizens. In some cases, the ratio is up to 25,000 citizens to a doctor. The US has one doctor for 350 citizens. If India aspires to be a superpower, we need to increase the number of doctors by six times. This is

impossible as no country can organically grow their medical population six times and meet quality. Even if we do drastically increase this number, there are very less chances that these educated doctors will want to live in a remote area that is without basic infrastructure, education, healthcare, and a marketplace.

That’s where our telemedicine technology comes into the picture.

Our solution virtually delivers a doctor, specialist, or a super-specialist to a patient in a remote area through networking technology. The interaction between them is through a video using a vernacular language. The doctor can read and see all vital tests that are done on a patient. The patient can interact with the doctor as if he is present in the same room.

Finally, the doctor can dispense a prescription or recommend a course of treatment that can be taken by the patient just as he would in a real-life situation. This fundamentally balances out the doctor-citizen imbalance which we see in India as well as the urban-rural divide in terms of IN IMAGING 35

INTERVIEW resource availability.

Our solution is significantly different from other offerings in this space.

For one, we provide a very scalable video-based architecture delivered securely from a cloud using our latest collaboration technologies.

For another, we offer an end-toend project management, reporting, and technology support for our customers. We do not believe in selling our equipment and disappearing.

Can you tell us about Cisco’s HealthPresence telemedicine platform, hardware, installation and bandwidth requirements?

The Cisco healthcare solution leverages the network as a platform, and combines advanced audio, video, and third party medical devices to create a high quality clinical consultation environment enabling doctorpatient consultation remotely.

Primary healthcare centres (PHC) or community healthcare centres in rural areas are connected to the district hospital or a super-speciality hospital that hosts the healthcare solution. The key process that is followed is as below: ● Patients visit the paramedic at the village primary health care centre, which has the patient Point of Diagnosis (PoD) installed. ● The paramedic initiates a call to the remote doctor at the district hospital that has the Doctor PoD. The remote doctor instructs the paramedic at the PHC to record patient’s vitals and other clinical data using the third-party medical tools connected to the PoD. Once recorded, data is then transmitted over the network to the remote doctor, on a real time basis. ● The doctor conducts the consultation remotely, makes a diagnosis and prescribes appropriate treatment.

While the platform can perform 36 IN IMAGING

well from about 256kbps, to get the optimal user experience we insist that the installation should have about 1mbps. The whole interaction is managed out of a cloud with some specialised software at the edge.

What are the implementation issues in telemedicine ?

Cisco’s approach to solving the healthcare problem that countries like India face is a radical departure from conventional thought. Governments have tried to increase the number of doctors, offer incentives or coerce them to go rural areas, and also use alternative or traditional medicine.

All these have failed since it is virtually impossible to get a doctor who has spent an enormous amount of money to acquire a degree to live in rural conditions where there is little education, speciality healthcare, marketplace, or public services. Traditional medicine works very well as a preventive solution but cannot handle the modern issues created by industrialisation.

With our solution, we are not getting the country to catch-up with the developed nations. We are providing a platform for the nation to leapfrog into the future and dramatically improve the human development indicators. However, we do face many issues:

Telemedicine is an area that will essentially bridge the urban-rural medical divide. It virtualises the doctors in the city and delivers quality medical care to citizens in rural areas

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Firstly, we have to first convince many to accept that conventional methods do not work and we need to embrace technology as means to deliver doctors virtually.

Secondly, the lack of infrastructure in rural areas is also a major challenge. In many areas, there is little or no stable power. Lack of Internet connectivity is an issue but the government is working to resolve this.

We do not have adequate trained personnel to manage the systems that are deployed; however, we see this as an opportunity to create rural employment for such an ecosystem. We need to normalise the telecommunication rates that resonate with the rest of the world.

This is especially true for humanitarian applications.

Thirdly, we need to offer incentives to the doctors in the rural areas to participate in this solution lest they view this offering as a threat to their livelihood.

Fourthly, patients are also used to having the doctor touch them and talk to them. While doctors do not even need to see the patient for a large number of cases, this psychological dependency is a hurdle.

Tell us about telemedicine deployment in India. How many projects have moved beyond the pilot stage?

Over the past decade, the country had inaugurated over 60 pilot projects and none of them survive today.

This is primarily because we chose to adopt satellite-based delivery of these services when the whole world was moving towards fibre-based delivery of network. India has to contend with teledensity and other fundamental issues of telecommunications before it embarks on fibre. In India, we have over a million route-kilometre of fibre. With such an infrastructure, going back to satellite-based delivery of telemedicine would be going back DECEMBER 2012

INTERVIEW in the past; akin to using records to play music in the age of iPods.

We have piloted the medical solution in two states and seven districts.

The Cisco healthcare solution has currently been implemented in Raichur, Shimoga, Chitradurga, Gwalior, Sehore, Datia and Chindwara in partnership with the governments of Karnataka and Madhya Pradesh. As of December 10 2012, we have conducted 21,500 speciality and super-speciality consultations. We have contributed to the reduction in maternal mortality and infant mortality rates.

Women and children form over half of the patients who use the system. We have used the same infrastructure to educate pregnant women on what to expect during pregnancy. We have also conducted special workshops to identify children requiring special attention and educating their parents on how to handle such children.

It is said that telemedicine would make healthcare affordable. Can you share with us how affordable is a teleconsultation as compared to physical doctor consultation?

Through our solution, we provide a very scalable video-based architecture delivered securely from a cloud using our latest collaboration technologies at the cost of $1 per consultation for technology. We typically orchestrate, create, manage, and incentivise the ecosystem that includes government, service providers, content providers, system integrators, and equipment maintenance partners. We offer an end-toend project management, reporting, and technology support to our customers.

DECEMBER 2012

Without this facility, the rural poor would have to spend huge amounts of money to go to the district hospital or urban centres. By using this facility, they can get a better handle on what their issues are. This will help them then prioritise on where they should go to get treatment or understand which government mechanism to tap for funding to aid their treatment.

This saving for the rural poor has not yet been computed and we need to look at it as if this amount is added back to the GDP since the money is available at the hands of the citizen to spend. When we factor in this saving, the cost of telemedicine comes free.

we will see the benefits of telemedicine multiply manifold.

Unfortunately, though the cost of telemedicine is often lower, the infrastructure cost to provide telemedicine facility is often high. This high cost acts as a hindrance to the development of the market along with the lack of interest from patients and doctors restraints the growth of the market. It's a bit of an uphill climb, but we are much more excited about the prospect now and see immense potential in this industry.

India has no option but to embrace telemedicine to provide medical care services to its citizens.

Telemedicine market in India is said to grow at a CAGR of 20 per cent.

What are the factors for this growth?

As mentioned earlier, the growth in the past decade has been modest, most pilot projects are nonexistent today.

We do have a high proportion of population that suffers from diseases like diabetes and asthma. Also, rural areas lack good medical facilities and hence the concept of telemedicine is very well accepted in the developing areas. The advent and continuous investment of high speed internet and telecommunication has made telemedicine possible and this is a factor for the continued growth of the market in these regions. The cost associated with telemedicine is often lower as compared to conventional healthcare and hence is a positive factor for the development of the market. Add to this the indirect saving we infuse into the hands of the rural citizens to spend on other essentials and

Telemedicine has been trumpeted as the great healthcare hope for rural India, has it been able to achieve this yet? Your comments Telemedicine is an area that will essentially bridge the urban-rural medical divide. It virtualises the doctors in the city and delivers quality medical care to citizens in rural areas.

Adopting the latest technology will propel this adoption further and will result in better human development indicators as well as jumps in the gross domestic product through indirect savings for the citizen. This will also result in better cash flow in rural areas and rural employment.

If the country wants to safeguard the health of its citizens and bring them into the economic mainstream as productivity constituents, we have to embrace telemedicine. If we do it right, I see that telemedicine centres will be ubiquitously present in India in the next five years. â– mneelam.kachhap@expressindia.com

IN IMAGING 37

IMAGING TECHNIQUES

EVOLUTION OF RADIOACTIVE THERAPY IN CANCER TREATMENT

X

-ray and radioactivity were discovered in last decade of 19th century in Europe. Not only do they resemble in many physical characteristics, they were also discovered very close to each other in 1895 and 1898 respectively. Medical use of both X-ray and radioactivity soon after. X-ray was used for preliminary diagnostic imaging and radioactivity was used to treat superficial skin cancer. With further technological advancement, higher energies of X-ray could be generated.

This led to the use of X-ray in treating deep-seated tumours. However, early 20th century proved that these techniques can cure cancer but may cause cancer as well.

This led to further refinement in the techniques and equipment delivering radiation for treatment. It has steadily improved since then and today, radiation is delivered precisely to destroy cancer cells while saving the normal tissues around them.

Radium discovered in 1898 was the main radiation-delivering isotope used in the treatment of cancer till mid1900s. But with radium kept getting costlier, difficult to procure and people become aware of the health hazards to the health workers. So, cobalt was then developed as an alternative and the first Cobalt 60 unit was installed in 1951 at the University Hospital in Saskatoon,

38 IN IMAGING

Dr Manish Chandra Senior Radiation Oncologist Jupiter Hospital

DR MANISH CHANDRA, SENIOR RADIATION ONCOLOGIST, JUPITER HOSPITAL GIVES A RUNDOWN ON THE HISTORY OF RADIATION THERAPY IN CANCER AND THE VARIOUS HAPPENINGS WHICH CONTRIBUTED TO ITS PROGRESS

Canada. This machine treated 6728 patients before it was decommissioned in 1972.

Parallel to this, there was a major revolution in the field of linear accelerators which had grown from low voltage to very high voltage beams. The first mega voltage linear accelerator was installed at the Stanford University in 1956. The iconic photograph of a twoyear-old child suffering from Retinoblastoma (tumour of the eye) receiving treatment is still kept by the Radiation Oncologist (Fig 1).

During the same time there was a renewed interest in internal radiation therapy known as brachytherapy (radiation therapy started with brachytherapy but later shifted its focus to external beam radiation therapy). In 1940s there was considerable development in the field of brachytherapy, mainly for gynaecological cancers, prostate cancers and superficial skin cancers.

The primary advantage of Linear Accelerator over Cobalt unit was short treatment time as well as uniform and higher dose rate. The limitation of the accelerators in the early years was its fixed gantry, but by 1960s, this problem was also resolved.

Linear accelerators became the preferred mode of treatment along with electron beams. Its use was limited because of higher cost and frequent breakdown. Till 1980s linear accelerators and Cobalt units were fighting for their superiority in terms of treatment delivery, stability and cost effectiveness.

In late 1970s computer started infiltrating medical equipment and linear accelera-

DECEMBER 2012

IMAGING TECHNIQUES

A 2-year-old boy - the f irst patient to receive radiation from the original medical linear accelerator at Stanford tor took the full advantage of it. In early 1980s, cobalt unit were replaced by linear accelerator in Western countries. After a decade, cobalt units were limited to only third world countries.

There is no denying that computers changed our life and it had an impact on radiation therapy as well. After adopting the computer with open arms, it changed completely in over a decade (mid 1980s to mid-1990s).

With better linear accelerators it was possible to deliver a uniform dose to the designated site and could shape the beam with lead blocks. However, the preparation of these blocks was a very labour-intensive and difficult

DECEMBER 2012

task. Then, Multi-leaf collimator came into picture in mid-1980s, though it was conceived way back in 1965. It changed the complete dynamics of linear accelerators. 3-D conformal treatment became the basic treatment and then graduated to intensity modulated radiation therapy (IMRT).

Imaging in radiation therapy was not far behind and it too was simultaneously improving over the years. It evolved from film-based imaging to digital imaging and then to conebeam computed tomography. Then, when some thought there is nothing else in radiation therapy to be explored, cone beam computed

Hand with Rings: print of Wilhelm Rรถntgen's first "medical" X-ray, of his wife's hand, taken on 22 December, 1895 and presented to Ludwig Zehnder of the Physik Institut,University of Freiburg, on 1 January 1896 tomography with low voltage radiation emerged, offering diagnostic quality of images.

It is a pleasure to work in this golden era of radiation oncology where an oncologist can offer treatment that can be delivered to the patient with minimal adverse reactions. Popular to the contrary belief, radiation therapy in this era is completely safe to the health worker and the dosimetry analysis has shown that radiation oncologist health workers receive the least amount of occupational radiation as compared to other health workers (cardiology, operation theatre, orthopaedics and radiology)

IN IMAGING 39

IMAGING TECHNIQUES

Radiation unit at Jupiter Hospital TECHNIQUES THAT CAN BE USED WITH CURRENT MEDICAL LINACS: With the current trend using linear accelerator a variety of treatment techniques are possible.

Some of the techniques as follows 1. 3D Conformal Radiotherapy: Through the advancement of imaging technology, enhanced images of the body allow for programming of treatment beams to conform better to the shape of a tumour. Hence treatment is more effective and side effects are reduced. By treating with large numbers of beams, each shaped with a multileaf collimator (MLC) or cerrobend block, radiation dose is delivered uniformly and conformally to the tumour.

2. Intensity Modulated Radio

40 IN IMAGING

therapy (IMRT): IMRT is one of the latest advancements in radiation therapy. This new approach to treatment allows for dose sculpting and even distribution of delivery to avoid critical structures while delivering precise uniform treatment. In this technique, the multileaf collimator (MLC) moves and modulates the radiation as the linac treats the patient 3. Stereotactic Radiotherapy & Radiosurgery (SRT): SRT is a threedimensional navigational technique to target the tumour volume with very low to minimal dose to the surrounding normal tissues.

4. Dynamic Adoptive Radiother apy (DART): Imaging, in the field of radiation therapy, has improved a lot and this led to evaluation of the

tumour dynamically during the treatment and adapt as per the regression and change in the tumour size.

5. Image Guided Radiotherapy (IGRT): As the name suggests, it is the technique where we use image guidance to deliver radiation therapy.

I am really privileged to have my wish list of the latest and complete radiation therapy unit at Jupiter Hospital in Thane, to treat the patient in the best way possible.

The field of radiation oncology is going to see many more new changes in the years to come and future of radiation therapy appears to be image-guided and adaptive.

In the next decade, the only mode of treatment delivery in radiation therapy would be image-guided. â–

DECEMBER 2012

IMAGING TECHNIQUES

THORACIC IMAGING FOR BOERHAAVE’S SYNDROME

T

horacic imaging is one of the advanced imaging techniques for evaluation of chest and lung diseases. It is an active service with close relationships with internal medicine, pulmonary and critical care, medical oncology, bone marrow transplantation, cardiology divisions, and

Dr Santosh Konde Consultant Radiologist Aditya Birla Memorial Hospital

Sagittal reconstructed oral dynamic CT scan revealed leak of oral contrast from esophagus (arrow) with pneumomediastinum

DECEMBER 2012

DR SANTOSH KONDE, CONSULTANT RADIOLOGIST, ADITYA BIRLA MEMORIAL HOSPITAL GIVES AN INSIGHT INTO THORACIC IMAGING, ITS ROLE IN DIAGNOSIS AND TREATMENT OF BOERHAAVE’S SYNDROME AND THE ADVANTAGES THAT IT OFFERS OVER OTHER IMAGING TECHNIQUES

cardiac and thoracic surgery services.

Thoracic radiology is a speciality in radiology that looks at the structure of the lungs and heart. It uses the following imaging modalities: X-Ray plain films, ultrasound, MRI, CT, and fluoroscopy.

Need for thoracic imaging also occurs with conditions such as emphysema, pulmonary fibrosis, pulmonary embolism, diffuse lung disease, small airway disease, pulmonary nodules, dyspnea, pneumonia, and tuberculosis. In short, it includes lung disease, thromboembolic disease, and thoracic malignancies as it also incorporates functional imaging of the lung and cardiac imaging.

In addition to conventional chest radiographs and CT, advanced imaging techniques include high-resolution CT scans for the evaluation of focal lung processes, diffuse lung disease and tracheobronchial pathology; digital and advanced multiplebeam equalisation radiography; and thoracic interventional procedures such as lung/mediastinal fine-needle aspiration and pleural drainage, and MR imaging of mediastinal and paracardiac pathology.

Without the advance technique of thoracic imaging it would have been difficult to diagnose these diseases. Recently, at the our hospital thoracic imaging was very helpful in the diagnosis of spontaneous esophageal perforation i.e Boerhaave’s syndrome, in a 59-year old male. The patient had no prior medical illness or addictions

IN IMAGING 41

IMAGING TECHNIQUES

Axial oral dynamic CT scan revealed leak of oral contrast from esophagus (arrow) with pneumomediastinum and bilateral pleural effusion and was referred to the hospital due to progressive breathlessness and severe lower chest pain lasting over three days. Boerhaave’s syndrome is a condition, which is not easily diagnosed and usually confused with other diseases. Thoracic imaging goes a long way in the diagnosis of these kinds of diseases and curing it.

The patient was admitted to the hospital and put on oxygen support with IV fluids and antibiotics to address his complaints. A chest Xray was done which revealed pleural effusion and hydropneumothorax.

Patient was then immediately admitted in the ICU. On the left side, intercostal drain was inserted 42 IN IMAGING

and 800 ml sero-purulent fluid was drained.

Without wasting time, an urgent CT thorax with esophagogram was planned by the doctors with heamogram/biochemistry. Finally, the CT Thorax revealed esophageal rupture i.e Boerhaave’s Syndrome. After consultation with medical gastro specialist it was decided to cover the self expandable esophageal stent to close the perforation and thoracoscopic pleural drainage and toileting while feeding the jejunostomy at the same time. Post surgery elective ventilation was provided along with medicines. On the second day of surgery the patient was weaned off and extu-

bated, he was shifted to the ward on the fourth day of surgery. Oral feeds were started after contrast study ruled out leakage and was then gradually increased. ICD removed on the tenth day (right) and twelfth (left).

The patient was discharged on 21 POD. Esophageal stent was removed one month after the surgery.

Thoracic imaging improves the presentation of the organ by capturing two distinct images on a single sheet of double amulsion film with one exposure. This further assists in improving patient care with superior chest examinations without changing techniques or equipment. ■ DECEMBER 2012

EVENTS LISTING 66th Annual Conference of Indian Radiological & Imaging Association Date: January 4-7, 2013 Venue: Daly College, Indore MP Organiser: Madhya Pradesh State Chapter of IRIA Topics: An excellent scientific and educational programme comprising topics covering all spectrums of radiology such as diagnostic imaging, interventional radiology and molecular imaging Speakers: Distinguished inter-

national and national experts from the radiological field Contact: Dr RK Sodani, Organising Secretary, 203, Morya Center, 16/1, Race Course Road, Indore-452 001 Tel: +91 731 2430608, +91 88899 44415 Email: iria2013@gmail.com, rksodani@iriaindore2013.com Website: iriaindore2013.com

Post Graduate Refresher Course (PRC) Date: January 11-12, 2013 Venue: Department of Radiology & Paul Brand building, CMC Hospital, Vellore, Tamil Nadu

be available from 5th November 2012 at http://home.cmcvellore.ac.in Speakers: Faculty of Radiology, CMC

Organiser: Department of Radiology, Christian Medical College, Vellore

Contact: Dept of Radiology, Christian Medical College, Vellore, Tamil Nadu-632004

Topics: Highly selected theory oriented lectures; Practical mock exams in small groups; PACS work stations for rapid fire sessions; Limited to 60 candidates. Applications will

Tel: 0416-2282027 Email: radio@cmcvellore.ac.in cmcprc@gmail.com Website: http://home.cmcvellore.ac.in

The Annual Conference of the Indian Society of Interventional Radiology Date: February 14-17, 2013 Venue: Kovai Medical Centre and Hospital, Coimbatore Organiser: The Society of Interventional Radiology (US) Topics: The Society of Interventional Radiology (US) will be co-partnering this meeting and a full delegation will be representing the DECEMBER 2012

Imaging in Cancer Drug Development Date: 13-14 March 2013 Venue: The Copthorne Tara Hotel, London, UK Organiser: SMi Group Topics: The event will focus primarily on oncology imaging modalities and applications in pre-clinical case studies, clinical imaging applications and innovations in imaging technology Speakers: Bert Windhorst, Head Radiopharmaceutical Chemistry, VU University Medical Centre; Francois Lassailly, In-vivo Imaging Specialist, Cancer Research UK; Peter Eggleton Medical Director, Merck; Prash Krishna, Director Oncology, Clinical Development, Eisai and Werner Scheuer, Research Leader Preclinical Imaging, Pharma Research and Early Development, Roche Diagnostics

American Society to help postgraduates in india connect to centers in US for fellowships and training. there will be hands-on training exclusively for post graduates students which will be co-attested by both SIR and ISVIR

Contact: SMi Group, 2nd Floor South, Harling House, 47-51 Great Suffolk Street, London

Contact: Dr Mathew Cherian

Email: events@smi-online.co.uk

Website: http://isvir13.com/

Opening hours: 9.00 17.30 (local time) Tel:+44 (0) 20 7827 6000

IN IMAGING 43

PRE EVENT

NOMINATIONS INVITED FOR HEALTHCARE & PHARMA HR OF THE YEAR, HARNEEDI TREE AWARDS 2012 Instituted to honour HR professionals in the healthcare and pharma fraternity, HR of the Year, HarNeedi TREE Awards 2012 is the vision of HarNeedi.com, with Padmashree Dr DY Patil University as Knowledge Partners and Express Healthcare and Express Pharma as exclusive media partners

E

xpress Healthcare, Express Pharma and Padmashree Dr DY Patil University along with HarNeedi.com have teamed up to honour the HR professionals who have contributed relentlessly and continue to propel Indian healthcare and pharma industries on a growth path.

As India's number one job-site for healthcare and pharma professionals, HarNeedi.com is an offering from Makro Group launched in 2007 to address crucial manpower solutions to these two industries.

Through keen observation of recruitment trends over the years, HarNeedi.com has acknowledged the immense challenges and contributions of HR professionals and therefore instituted the HR of The Year HarNeedi TREE Awards 2012.

Explaining the thought process behind the Awards, Mahesh Malneedi, CEO, HarNeedi.com said, “Today HR plays a dynamic role to hunt, recruit, manage and retain human resources for an organisation. In fact HR is like a tree, supporting thousands of professionals who dwell and grow along and get introduced, impacted, mentored and climb on the ladder of success.”

Dr Sanjay Oak, Vice Chancellor, Padmashree Dr DY Patil University 44 IN IMAGING

opines, “HR plays a silent and vital role in both healthcare and pharma industries. Such events will not only boost the HR leaders but also provide an excellent platform to discuss current and future HR problems and solutions.

Gaurav Malhotra, MD and CEO, Patni Healthcare, also a member of panel of judges explained the crunch, “Talent attraction, retention and development are key challenges in healthcare today and it would be exciting to see and analyse how the HR managers successfully manage.”

The panel of judges comprises Dr Sanjay Oak, Vice Chancellor of DY Patil University, Mumbai; Gaurav Malhotra, MD and CEO Patni Healthcare; Viveka Roychowdhury, Editor, Express Healthcare and Express Pharma and Sudhir Bahl, Co-Founder and CEO, Irene Healthcare, Kawaljeet Oberoi, Chief Nursing Officer, Gleneagles Khubchandani Hospitals; Biblob B Banerjee, GM HR, GSK, with more confirmations in the pipeline.

Nominations are invited from the pharma and healthcare fraternity nationally for various categories.

The nominations will be put through a stringent procedure where they will be screened on various parame-

ters by the panel of judges.

“The entire healthcare and pharma community is invited to nominate HR professionals. Here I see an opportunity for industry to display its solidarity by honouring our HR professionals.

We hope the HarNeedi TREE Awards 2012 will serve as an appreciation and salutation to help our HR colleagues shine and grow into a much bigger tree to accommodate more and more talent,” mentioned Richard D’silva, Senior Marketing Manager, HarNeedi.com explaining the process and procedure followed for these awards.

“Being associated as knowledge partners with HarNeedi TREE Awards 2012, we stand to applause the selfless work being performed by HR personnel in both the sectors,” stated Dr Nitin Sippy, Asst Professor and Course In-charge - MBA Health and Hospital Management, D Y Patil University.

The awards will be announced and given away during a conference focussing on HR issues prevalent in the healthcare and pharma sectors.

Dates and venue will be announced shortly.

For nominations and more details visit:http://www.harneedi.com/ind ex.php/hr-awards ■ DECEMBER 2012

PRE EVENT

IMAGING IN CANCER DRUG DEVELOPMENT: A MUST VISIT EVENT To be held from March 13-14, 2013, in London, this year's agenda features key industry professionals and experts in cancer drug development

S

Mi's 9th annual conference on Imaging in Cancer Drug Development will bring together key opinion leaders in the field of oncology and imaging to provide attendees with a comprehensive look into current advances in oncology imaging. This an unique opportunity to witness presentations on the current developments surrounding: oncology and diagnostic imaging modalities, drug development and clinical development alongside networking with key industry professionals.

To be held at The Copthorne Tara Hotel, London Kensington, this event will provide attendees with a complete view of the field and will focus primarily on oncology imaging modalities and applications in preclinical case studies, clinical imaging applications and innovations in imaging technology.

BENEFITS OF ATTENDING THE EVENT This year's agenda offers an opportunity for debate and resolution of key challenges currently facing the field. This will encourage attendees to discuss growth in the field and exchange ideas, therefore driving the field forward and ensuring sufficient treatment of the key issues surrounding oncology imaging and drug development. Moreover, the event serves as a platfrom for networking with key industry professionals and experts in cancer drug development from acade-

DECEMBER 2012

mia. Some of the scientific presentations which will be presented at the event include: ● Latest non-invasive imaging modalities for translational research ● Future aspects of oncology imaging including Cerenkov and hybrid systems ● Current role of PET, SPECT and CT in cancer imaging alongside overcoming challenges faced ● Novel target identification with biomarkers in diagnostic imaging ● Latest developments in oncology drug discovery including HTS of kinase inhibitors ● Practical tools for business expansion in the current economic climate SPEAKERS AT THE EVENT ● Bert Windhorst, Head, Radiopharmaceutical Chemistry, VU University Medical Centre ● Francois Lassailly, In-vivo Imaging

● ● ●

Specialist, Cancer Research UK Peter Eggleton, Medical Director, Merck Prash Krishna, Director - Oncology, Clinical Development, Eisai Werner Scheuer, Research Leader Preclinical Imaging; Pharma Research and Early Development, Roche Diagnostics

WHO SHOULD ATTEND This event is unmissable for Chief Executives, Chief Scientific Officers, Presidents, Senior Vice Presidents, Vice Presidents, Heads, Senior Directors, Directors, Clinicians, Principal Scientists, Research Fellows, Principal Investigators, Managers, Project/Team Leaders in Imaging and Translational Medicine, Molecular Imaging, Cancer Research, Pre-clinical and clinical Imaging, PET Research, Medical Imaging and many more faculties. ■ IN IMAGING 45

IRIA 2013 SPECIAL

SANTOSH CHAWLA

SATYAPAL AGGARWAL

1977

1978

O P BHARDWAJ 1979

SNEH BHARGAVA 1981

IRIA:THE JOURNEY SO FAR VED PRAKASH 1966

IRIA has had a glorious background and is looking ahead to play its role in the advancement of radiology and imaging throughout Asia and SAARC countries. With the 66th edition of IRIA coming soon, Express Healthcare traces the journey of the association from the beginning ....

T

P RAMA RAO 1948 Past Presidents IRIA

46 IN IMAGING

he 'Indian Radiological Association’ was formed in Calcutta in the year 1931 under the aegis of late Dr Ajit Mohan Bose and Dr Subodh Mitra as the Founder President and Founder Secretary, respectively. The first meeting of the association, held on April 21, 1931 in Calcutta, was attended by Capt M Mukherjee, Dr KB Ghosh and Dr Moitra.

April 1932 witnessed the eighth session of Indian Medical Association and the Indian Radiological Association met as the radiological section of IMA under the chairmanship of Dr MD Joshi. In his speech at the event, Dr Joshi stressed the need for sound radiological education in India. In 1934, the radiologists met again at a sectional meeting of the

Conference of IMA, held at Mumbai with Dr KP Mody in the Chair.

In March 1937, the Indian Radiological Association was registered under Act XXI of 1860, with the Registrar of Joint Stock Companies, Bengal Registration No 6644 (193637) with a total membership strength of 24. During the war years, the activities of the association declined and came almost to a standstill. Yet, due to the vigorous and ceaseless efforts of Dr P Rama Rao, Dr Santhan Krishnan Pillai and Dr KM Rai of Madras, the activities were resumed and thus the assocation was reborn.

The first Annual Congress of Radiology was held in 1946 at Madras under the leadership of the President, Dr MD Joshi and Secretary, Dr P Rama Rao. There DECEMBER 2012

IRIA 2013 SPECIAL

LT GEN V V S PRATAPA RAO

VP LAKHANPAL

MAJ GEN S K DHAWAN

1983

1984

1990

were 130 members in the association at that time. Gradually, the association expanded to other states giving rise to a wide network of state branches and chapters.

lence in medical printing and it was rated as the best journal amongst all medical journals in India. The journal has also received the International Code No ISSN-0970-2016.

OFFICIAL PUBLICATION Indian Journal of Radiology (IJRI) became the voice of the association since it was born in 1947 under the joint editorship of Dr P Rama Rao and Dr K Manjunath Rai. Excellent scientific papers and material were published and circulated to all the members through this journal. Dr KP Modi, Dr KM Rai, Dr AN Menon, Dr ML Aggarwal, Dr MG Varadharajan, Maj Gen SK Dhawan, AVSM, Dr MS Joshi and Dr Om J Tavri were some of the Editor-in-Chiefs of IJRI. The journal has won many awards for excel-

MEMORIAL MEDALS & AWARDS Another landmark in the history of the Indian Radiological Association was the introduction of ‘Sir Jagadish Chandra Bose Memorial Oration’ in the year 1948; a contribution to the advancement of medical radiology. Late Dr Barceley, popularly known as “Father of British Radiology” was the first orator in the year 1951.

This oration was instituted after the cherished memory of one of the renowned Indian biophysicists and the first honorary member of the association ‘Sir Jagadish Chandra Bose’. Every

DECEMBER 2012

year, it is to be delivered at the Annual Congress of Radiology and is awarded to a renowned radiologist.

In 1968, during the 21st Annual Congress the Indian Radiological Association at Bangalore, Dr LH Athalea moved a resolution to institute an oration in the name of ‘Dr Diwan Chand Aggarwal Memorial Oration’ for his contribution to the association. He had also served as the President of the IRA in 1957. The members of family of late Dr Diwan Chand Aggarwal created an endowment for the oration. It was started in the year 1969 and Dr A N K Menon of Madras delivered the first oration. Since then, many eminent radiologists from India and all over the world have delivered this oration.

In 1977, during the

S K AGGARWAL 1993

SAMIR BANERJEE 1993

MUKUND S JOSHI 1995

S K SHARMA 2000 IN IMAGING 47

IRIA 2013 SPECIAL

R F SETHNA

L H ATHLE

K N KAMDAR

1959

1967

1970

LR PARTHASARATHY 1973

K P MODY 1947

48 IN IMAGING

30th Annual Congress of IRA at Chandigarh ‘Dr KM Rai Memorial Oration’ was instituted by the family members of late Dr KM Rai. Due to his efforts, IRA was reborn in 1946 and the First Annual Congress of Radiology was held at Madras, which in turn led to a spurt of scientific activities in radiology.

He was instrumental in starting the Journal (IJRI) in 1947 and was the Associate Editor for the same. Dr OP Bhardwaj of New Delhi delivered the first oration in the year 1978.

In 1980 Dr Ashoke Mukherjee Award was started by IRA, instituted by the family members of late Dr Ashoke Mukherjee to encourage young radiologists to take up new investigations and research in the field of radiology in India. Competitive, scientific, original work was selected and pre-

sented in the Annual Congress by young radiologists. Then the committee appointed by the President would select the best paper out of the lot and award the radiologist who presented it.

Dr Pramod Kolwadker of Nagpur was the first recipient of this award in the year 1979.

IRA also started two travelling fellowships for young radiologists to do advance training in reputed institutions of India and now both travelling fellowships are awarded by ICRI. INDIAN COLLEGE OF RADIOLOGY Indian College of Radiology was established as a teaching (academic) wing of the Association in 1976 by Late Prof PK Haldar and Dr KN Kamdar. Prof PK Haldar was the first Founder Chairman of the college followed by Dr KN Kamdar.

In 1981, with Prof Arcot Gajaraj becoming the Chairman, academic activities were given an added impetus and an attempt was made to organise as many CME programmes as possible throughout the year in different parts of the country to generate interest in imaging among the post-graduates as well as the clinicians.

Dr Samir Banerjee, Secretary of the College and Dr GR Jankhania, Treasurer has improved the administrative and academic activities of the College. In 1984, under the Chairmanship of Dr GR Jankhania, it became mandatory to conduct four to six CME programmes prior to the Annual Congress. In 1986, at Jaipur, a convocation was held to award fellowship of ICR to the Founder Members of the College.

Under the DECEMBER 2012

IRIA 2013 SPECIAL

PROF ARCOT GAJARAJ

R K GOUTALIA 1994

1985 Chairmanship of Dr Samir Banerjee, a new chapter linked with Royal College of Radiologists, London, UK began and a team from R. C. R., UK visited India and delivered one-day CME session at Hyderabad (1990) and at Pune (1991). Prof NG Gadekar-Key Note Address (Memorial Oration) and Prof Mihir Mitter Memorial Oration were instituted under the umbrella of ‘Indian College of Radiology & Imaging’ in 1988 and 1998 respectively. These orations are awarded to the radiologists of the country who have excelled in academics as well as in teaching and developing the science of imaging. Dr Harnam Singh MidTerm Teaching Session was introduced with the donation from Dr Harnam Singh.

Recently, Prof VP DECEMBER 2012

Lakhanpal Gold Medal has been introduced for the best academic contribution in the field of radiology and imaging.

Dr Mukund Rahalkar, Secretary of the College, took a keen interest in the improving quality of CME Programmes including the film reading sessions.

Prof Kakarla Subba Rao, Chairman of ICRI for six years further improved the quality and quantity of the teaching sessions and conducted them in small places all over India.

Under his Chairmanship, a Text Book on ‘Diagnostic Radiology’ in two volumes was published.

The College is doing an excellent job in conducting CME programmes all over India.

The College has also started a news bulletin for better communication, publishing up-

PRAMOD KOLWADKAR

PROF KAKARLA SUBBARAO

1998

1999

dates on new imaging modalities, forthcoming CME programmes, views from readers etc.

Many more awards were introduced in the college by the present team of office bearers such as the Prof JM Pinto Award, Onco Imaging Award, Best Research Paper Award, Dr Rao Award instituted by Dr Prasanna Rao etc. Every year a theme is given by ICRI, selected by the Executive Committee and approved by General Body, ICRI. Credit hours for CME is prepared by ICRI recommended by Prof Kakarla Subbarao and approved by ICRI and IRIA. CHANGE IN THE NAME OF ASSOCIATION It was felt rightly that there has been tremendous change in the modalities of imag-

ing all over the world and our Association must effectively reflect it with a name which will speak for itself.

Therefore, the Indian R a d i o l o g i c a l Association became The Indian Radiological & Imaging Association (IRIA). The Journal and the College were also renamed accordingly as IJRI and ICRI. AFFILIATION OF INTERNATIONAL SOCIETIES IRIA has been a member of the International Society of Radiology and a member of the Asian and Oceanian Society of Radiology as well.

IRIA and ICRI has formulated a curriculum and syllabus for MD (RD) and DMRD and submitted to the MCI for recommendation to all the universities and medical colleges in India. ■ IN IMAGING 49

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IRIA 2013: OFFICIAL MEETING GROUND FOR INDIAN RADIOLOGISTS It promises to be an event that will bring together distinguished international and national radiology experts

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he Indian Radiology and Imaging Association (IRIA) is organising its 66th annual conference from January 4-7, 2013 at Daly College, Indore, Madhya Pradesh. The event will be hosted by the Madhya Pradesh State Chapter of IRIA. The annual conference of IRIA has become the official meeting ground for the Indian radiologists to exchange their professional experiences, discuss the recent advances, know about the state-of-the-art technology in radiology and imaging sciences and educate the young radiologists and residents. IRIA has been growing continuously by integrating new developments and involving more and more radiologists, not only from India but from all over the world. An excellent scientific and educational programme covering various fields of diagnostic imaging, interventional radiology and molecular imaging, is being prepared to meet the expectations of the visitors to IRIA 2013.

It promises to be an event that will bring together distinguished international and national experts from the radiology field, who will present their experience on topics covering all spectrums of radiology.

In this regard, a comprehensive scientific programme is also designed.

This event will be an opportunity for the participants of all sub-specialities to attain knowledge about cutting edge technology. In addi50 IN IMAGING

Last year’s visitors being informed about IRIA 2013 tion, this event will be an ideal forum for networking and building lasting relations with participants from different parts of the country. ●

HIGHLIGHTS OF THE SCIENTIFIC PROGRAMME: ● A galaxy of National and International faculty ● Accreditation by M.P. Medical Council and Royal College of Radiologists ● Symposia on Radiology Journalism ● PG Teaching Course by

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American Institute for Radiologic Pathology, a programme by the American College of Radiology Pre-conference workshops Daily plenary sessions Orations, debate and image interpretation sessions by International faculty.

"Meet the Professor" sessions for residents and students ESR Presents, AOSR Presents, Case of the Day Posters, Exhibits, Competitive Scientific Papers ■ DECEMBER 2012

IRIA 2013 SPECIAL

AIMING FOR THE TOP Allengers, a firm dealing in diagnostic range of medical equipment has made a name for itself through quality products and consistent service

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llengers, an Indian company headquartered at Chandigarh, is a leading Indian manufacturer covering a wide spectrum of diagnostic range of medical equipment. Established in 1987, it claims to have been revolutionising the medical world for the last 25 years.

As per its customers, Allengers has emerged as finest world class company and a major force to reckon with. The reasons being: ● The only Indian medical equipment manufacturer company bestowed with the “National Award – 2010” from President of India through Ministry of MSME. ● The only Indian manufacturer having the largest manufacturing set up in India, spread over an area of 36,000 sq. m. ● More than 21,000 installations based across the globe, speaks volumes about its customers

C-ARM (Trolley less ) DECEMBER 2012

●

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trust in brand “Allengers”.

The only Indian company that enjoys the market share of around 35 per cent in the Indian market and having CAGR of 27 per cent per annum for the last five years.

The only Indian company that launched India's first mobile digital radiography system in the year 2011.

The only Indian company that launched India's first indigenous range of Cathlabs in the year 2004.

The only Indian manufacturer having battery powered mobile X-Ray machines (2.5 KW to 30 KW).

The only Indian manufacturer having the largest range of high frequency X-ray machines (2.5 KW to 100 KW).

The only Indian company that

Full Field Digital MAMMOGRAPHY

exports to 65 countries in the continents of Africa, Asia, South America, Europe, Middle East Countries and Commonwealth Independent States (CIS). ● It was awarded with the EEPC awards for the years 2009-10 and 2010-11.

Allengers is best known in the industry for excellent after sales services due to a strong network of 43 sales and service centres in India and 65 abroad.

“Passion for Excellence” in everything that do is the sole mantra for its perpetual growth, claims the company. It further states that in a country where health is still not within the reach of poor, Allengers has been continuously striving hard to provide world-class products and services at affordable prices and its sole aim is to ensure superb quality, greater access and affordable treatment for all.■

MOBILE DR (RollX DR ) IN IMAGING 51

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'WE'RE CONSTANTLY EVOLVING OUR PRODUCTS' RK Narang, Executive Director - Sales, Allengers Medical System shares the company's perspective about the Indian radiology market, the company’s growth plans and its association with India's premium radiology event, IRIA 2013, in an interaction with Raelene Kambli When did Allengers enter the Indian market and with which products?

Allengers, an independent and highly specialised medical device manufacturer, is not only focussed on developing need of the hour medical equipment but is also focussed on providing value for money equipment. As a think tank, the company processes technical knowledge into new medical products and solutions for users and patients. Today, by virtue of its inhouse R&D and QC setups it covers a broad spectrum of diagnostic range of medical equipment. This includes a wide range of X-ray machines (HF/LF), C-arms (HF/LF), DR systems (mobile/fixed), cathlabs (mobile/fixed), mammography (digital/non-digital), DSA systems, remote controlled RF table, lithotripter, OPG, monitors, EEG, EMG, ECG, TMT, PACS and HMS. What is your opinion about the Indian radiology market?

52 IN IMAGING

As far as the Indian radiology market is concerned, it is a capitalhungry and labour-intensive market. So in this era of healthcare reforms and budget restrictions, long-term planning is required to manage it. In this regard, a growing proportion of radiologists' existing workload will be performed by IT systems, technologists, and teleradiologists. Radiology services will be provided by referring physicians and radiologists. The demand for diagnostic and image interpretation services in radiology is growing rapidly all over the world due to digital technology and especially due to tele-radiology. The pace of growth of the Indian radiology market is very good and the Tier I and metro cities are increasingly becoming hot spots for the radiology market.

Currently how has Allengers been faring in the Indian market?

All our product developments consistently take into account the criteria laid down by CE and AERB

and we have recently applied for FDA authorisations as well. In the near future we would further make inroads in the US market as well. As per our customers, Allengers has emerged as a fine world class company and a major force to reckon with.

With the passage of time, we are increasing our footprints as we enjoy the market share of around 35 per cent in the Indian market and have a CAGR of 27 per cent per annum in the last five years. Also, Allengers is the only Indian company that exports to 70 countries in the continents of Africa, Asia, South America, Europe, Middle East Countries and Commonwealth Independent States (CIS). And as we have applied for FDA, we would make a strong foothold to enter the US market in a big way and this will help us to stand at an equal platform with other major multinationals.

What is your opinion about the radiology sector within the Tier-II DECEMBER 2012

IRIA 2013 SPECIAL and III cities of India?

The Indian healthcare infrastructure is grossly underdeveloped especially in the Tier II and Tier III cities of India. In simpler terms, these comprise of cities that are just beginning to wake up and take form. The ratio proportion of facilities versus patients seeking medical advice and diagnosis is highly imbalanced in these regions.

But a transition has started happening now as the healthcare facilities have started making inroads across the length and breadth of the country which is definitely a very positive trend. For facilitating growth of Tier II and Tier III cities, state and local governments should further provide facilities to attract companies which would transform these cities into business havens and thus make them India’s fastest growing cities in a matter of a few years.

What market opportunities and trends do you witness in the Tier II and III radiology markets in India?

As more and more companies are investing into these cities, the per capita income, lifestyle and infrastructure (healthcare and residential) are developing in a healthy way and thus is a welcoming change. As far as Allengers is concerned we are developing key referral centres and key opinion leaders as ambassadors which will give us a strong foothold while entering Tier II and Tier III cities.

Tell us about your association with IRIA 2013?

IRIA’s annual conference is now established as the key meeting platform for those involved in medical imaging professions. The conference provides an excellent opportunity to network with others with similar interests, to hear and discuss the views of acknowledged experts, to DECEMBER 2012

take part in trade conferences, workshops and courses and to present ones own work through a short communication or poster.

Allengers’ association with IRIA has always been very encouraging and educative with mutual interest for both the radiological fraternity and the trade. All the efforts and hard work, which is being put in by the organising committee, to make this mega event of IRIA 2013 a successful one is highly appreciable.

What are the products that you are going to showcase at the event?

Any launches during the event?

We're constantly evolving our products to increase our competitiveness. Hence, during IRIA 2013 we are going to showcase digital mammography, C-Arm with integrated trolley (trolley less) apart from other products like the EEG, EMG, monitor, etc.

Considering the basic market requirement is to come up with more technological advanced products at affordable prices, bearing in mind that usability is going to be an important issue, and that the diagnostic equipment should be user friendly, we are launching a very unique model of Mobile DR the “RollX DR”.

This is a 15 KW/200mA unit, is light weight with sleek design and functions on standard 15 amperes wall socket. RollX DR can be configured with either WiFi or Wired detector and the system has full DICOM connectivity. The use of digital technology in diagnostic medical imaging is rapidly expanding. All medical facilities which aim to streamline work flow should only aim towards having a DR, in order to encounter the increased challenges in the future as images through a DR are and would be increasingly and quickly

managed through PACS. Also DR definitely has an advantage over the CR due to its reliability to handle larger patient load by greater ease of use and elimination of cassettes.

What are your expectations from IRIA 2013?

As always IRIA has aimed at creating awareness of the latest equipment in the market, especially during their conferences nationwide.

These conferences are aimed at creating awareness on the advantages of deploying the latest equipment in improving comfort for patients and reducing time-to-recover. As a company which is in the manufacturing of medical imaging equipments, being a trade participant on the IRIA platform gives us more vision to bring out more imaging products and that too at affordable prices and we look forward to having a more mutually beneficial association.

What are your future plans for Allengers?

We are planning for the manufacturing of CT and MRI which are at present in the development stage. With our launch of RollX DR, a fully integrated cost effective mobile DR, Allengers has added another feather to its cap. Through this model the user can now further have access to procure a state-ofthe-art mobile DR system at lower cost but with the facilities which truly would assist him now and in the future.

We have also opened our own office in Durban, South Africa to increase our market share in SADCC region. In the near future, we shall also develop medical equipment based on the most promising technological approaches. ■ raelene.kambli@expressindia.com

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IRIA 2013 SPECIAL

TELE HEALTH SCENARIO IN INDIA A B Sivasankar, Vice President-Sales & Marketing, TeleradTech gives an insight on the telehealth scenario in India and measures to improve the situation

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he poor ratio of radiologists to the country’s population is accelerating the necessity for telereporting and helping radiologists report more studies per day, enlarging the scope of healthcare. Teleradiology as a concept is slowly gaining acceptance by the same people who initially perceived it as a threat to their practice. We find a majority of present day Indian radiologists telereporting radiology studies in methods that are not compliant with international standards and practices.

Health Information Portability and Accountability Act (HIPAA) ensures that the patient`s health information is protected while allowing the flow of health information to provide and promote high quality healthcare. In India, where there is no enforcement of HIPAA, non-standard technology, designed and created by local vendors, are being used for tele-reporting.

Some of the popular tele-reporting techniques are through e-mail attachments, dropbox.com etc., which being highly insecure, violate HIPAA. In Western countries, these methods of reporting are punishable by law.

The high investment cost on technology (both software and hardware) is a major reason for radiologists to look at cheaper solutions which end up compromising the quality of care and the privacy of the patient.

Although hardware costs have dropped substantially, the cost of bandwidth is still high and network infrastructure more oriented towards urban rather than rural localities.

More advanced 3G/4G technologies will help in making high quality, and 54 IN IMAGING

cost effective bandwidth available in rural areas where the number of radiologists is abysmally low as a ratio of the general population.

Integration of the radiology workflow with a telemedicine platform, plus the addition of smart medical devices which monitor the patient`s vital parameters like ECG, pulse, BP, temperature and heart beat using an electronic stethoscope is an important development in the healthcare scenario. The patient can also upload the radiology scan/study images (both DICOM/JPEG), which will enable the teleconsulting physican located anywhere in the globe to decide on the future course of medication for the patient. The teleconsulting physician could also be a teleradiologist , from whom the patient can get a second opinion on his/her case.

The Cisco Health Presence (CHP) integrated with Teleradtech`s radiology work flow software, RADSpa is a unique platform which includes the above feature as a value addition to the remote patient-healthcare delivery

system. Teleradtech has deployed this integrated technology in few remote centres of the country. The solution combines a high definition video and advanced audio platforms coupled with the patient`s medical data to create an environment similar to the one a patient experiences when visiting a doctor. The system is flexible with minimum infrastructure and dedicated space. It can be set up anywhere, a village`s public health centres (PHC), corporate offices, homes, mobile medical vans etc.

Telmedicine modules can be one to one tenant (point to point) or one to many tenants or multi-point enabling concurrent sessions with a robust monitoring solution for hardware and application failures. The product is highly secure and HIPPA compliant. A user friendly interface with the option to integrate the hospital information systems (HIS), lab information system (LIS) or electronic medical records (EMR).

Few states like Karnataka, Madhya Pradesh, Maharashtra etc., have set up teleconsulting units to reach out to population living in Tier-II and Tier-III cities. This needs to be extended to all states through the public private partnership (PPP) or corporate social responsibility (CSR) models. Active government support by taking the local population into confidence through awareness programmes and health camps is required.

All these measures combined with uninterupted internet connectivity and power supply will help to create a medical revolution, uplifting the quality of life of millions of Indians. â– DECEMBER 2012

IRIA 2013 SPECIAL

CONCEPT IMAGING: QUALITY WITH AFFORDABILITY Concept Imaging offers a range of medical equipment to suit varying requirements

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oncept Imaging marked its presence in the year 1998 as one of the best established traders and retailers of an array of medical equipment. The organisation is based at New Delhi (India).

Owing to their professionalism, technology and business acumen, they have been able to garner a huge client base across the domestic market. With the help and assistance of the professionals working in the company, they have been able to carry out after-sale services in a sound manner. Since 2007, the organisation is also engaged in importing patient monitor/ pulse oximeters/ECG machines.

Moreover, they have recently added Aneroid B.P instruments to the range (one of the most demanded instruments in hospital). The professionals make sure that the consignments are delivered within the stipulated time. The organisation involves in different roles in the market from an importer to supplier to distributor to exporter to service provider and trader.

MOTTO “Superior quality, cost effectiveness, and impeccable service” COMPANY'S SUCCESS MANTRA Organisation works keeping some important points in mind that gradually leads to the success.

The points are: ● Experienced R&D department DECEMBER 2012

range is reliable and safe.

The products offered are as follows: ● Multi Parameter Patient Monitor (Superview 8.4 inches) ● Multi Parameter Patient Monitor (Superview 10.4 inches) ● Multi Parameter Patient Monitor (Superview 12.1 inches) ● Multi Parameter Patient Monitor (Superview 15 inches) ● ECG Single Channel Machine ● Foetal Monitor ● Syringe Pump ● Foetal Doppler ● Lcd Based B.P. Instruments ● Wall-mount B.P. Instrument ● Aneroid B.P. Instrument

Sanjeev Malhotra Director, Concept Imaging Large product line Provide customised solutions They make sure that the quality of products that offered to the clients are at par with the international quality standards. ● ●

PRODUCT OFFERED A leading importer and service provider of an array of medical equipment for professionals which is in compliance with the requirements of the market and the latest trends. They also make sure that the products are procured from the reputed manufacturers, so that the

CLIENT SATISFACTION Concept Imaging constantly works towards the achievement of optimum client satisfaction and thus ensure that the products offered are quality assured. They also make sure that the range is safe and is also offered at most competitive prices. The procuring agents make sure that the vendors are reputed and trusted manufacturers of the market. Owing to the quality of the products, it has won a prominent stature nationwide.

Professionals follow ethical and transparent business policies and thus are able to win over the trust of their clients. For the convenience of clients, they offer them easy payment modes and also ensure on-time delivery. Moreover, the prices of the products are affordable and economical. ■ IN IMAGING 55

IRIA 2013 SPECIAL

BIONATION IMAGING: QUALITY WITH AFFORDABILITY Bionation Imaging has earned a good repute in the market with its eclectic range of refurbished medical equipment

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ionation Imaging, a service provider, buys, sells, and trades refurbished, used medical imaging equipment from all of the major OEMs such as Siemens, GE, Toshiba, Philips etc.

The group specialises in refurbished, used CT, and used mobile CT scanners, used mammography, used C-Arm image intensifiers as well as other medical imaging equipment. Its medical imaging equipment services include consultation, trade inspection, site planning, installation, de-installation, financing, training, delivery, evaluations, and more. It came into the limelight in 2012 but the CEO and main promoter of the company has been active in the radiology field since 1998 and has more than 14 years of experience. Most of the company’s team members are also technically qualified and have good knowledge of these products. Since last 15 years it is supposedly the "best" in refurbishing equipment in the market. The company projects itself as a one-stop solution for medical imaging equipment needs of its clients and believes in offering them a variety of options whether they are looking to purchase a MRI, CT, mammography or any other imaging system modality.

The company assures that it will design a turnkey solution tailored to fit the imaging and budgetary 56 IN IMAGING

several quality tests at every stage of production to confirm that each and every product it deals in, offers the best and precise performance. The company has earned the trust of its clients from all over the world. And it strives to maintain international quality standard with each and every product, and all its operations adhere to ISO certified norms.

The company assures that its clients can opt for its range without having any iota of doubt about its quality. needs of its clients.

MISSION Complete medical diagnostic solutions under one roof.

BELIEF "Serving Human Globally" DESCRIPTION The brand is kept popular by the continuous endeavour to improve the quality of products. The company claims that it is their mission to innovate products and technology, enriching the quality of lives of patients. The company performs

PRODUCT CATEGORY Bionation Imaging delivers almost all types of medical equipment such as CT scanners, MRI scanners, mobile CT scanners etc.

Some of them are discussed below: CT Scanners: A computerised tomography (CT) scanner is a special kind of X-ray machine. Instead of sending out a single X-ray through your body as with ordinary X-rays, several beams are sent simultaneously from different angles. This allows more detailed images from within the body to be constructed, and these images are DECEMBER 2012

IRIA 2013 SPECIAL

then interpreted by a doctor. There are five CT scanners which are ● SIEMENS CT SENSATION 4 ( 4 Slice) ● SIEMENS SENSATION 16 ● SIEMENS SOMATOM VOLUME ZOOM (4 SLICE) ● SIEMENS SOMATOM PLUS 4 Hi Speed Spiral. ● SIEMENS SOMATOM AR.STAR Spiral.

MRI: Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI), or magnetic resonance tomography (MRT) is a medical imaging technique used in radiology to visualise internal structures of the body in detail. The MRI offered by Bionation Imaging DECEMBER 2012

are as follows ● REFURBISHED SIEMENS MAGNETOM C-0.35T ● HITACHI AIRIS-II OPEN MRI ● REFURBISHED SIEMENS MAG ● NETOM SYMPHONY 1.5T M a m m o g r a p h y : Mammography is the process of using low-energy Xrays to examine the human breast and is used as a diagnostic and a screening tool. It is basically used to detect breast cancer. The product of mammography machines available with the company are ● SIEMENS MAMMOMAT 3000 NOVA ● GENERAL ELECTRIC 700T/800T ● GE DMR Plus Mammography system

SETTING TRENDS The company claims that it started a new trend in the market of the radiology equipment. Initially the routine trend was to book the equipment (CT scanner, MRI scanner etc.) from the vendor and wait at least three to more months for the machine as the vender would import and provide the equipment to the buyer. However Bionation Imaging started purchasing machines on their own and keeping them in stock, which made the availability of the machine easy and quick, thereby saving time ensuring easy accessibility.

The company’s branches are at Delhi, Kolkata, Hyderabad, Patna, Allahabad, Kathmandu (Nepal). ■ IN IMAGING 57

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MEDIXVIEW: AN ILLUMINATING SOLUTION FROM BEEJAY REALM Beejay Realm’s Medixview, an X-Ray film viewer/illuminator, comes with several good features like high brightness, uniform light, low heat emission, long lamp life and others

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eejay Realm is a medical equipment company based at Mohali (India). It ventured into the field of radiology in the year 2003 by manufacturing an innovative, slim, sleek and sophisticated doctor-patient friendly Xray film viewer/illuminator (with US FDA approval) under the brandname 'Medixview’. It was marketed as ‘The most innovative, ultra slim medical X-Ray illuminator having high and uniform brightness - A Beauty with Purpose, Effectiveness and Efficiency.’

Medixview reportedly offers numerous benefits over the conventional X-ray view boxes.

Medixview emits and produces a blue-type, highly bright, uniform light more suitable for reading XRay and CT scan and MRI films.

These features of Medixview are expected to help the doctor in making a very accurate and precise reading of X-Ray, CT scans and MRI films. Medixview is flicker free, thereby reducing eye-fatigue even if watched for a longer time. It also emits a very low level of heat, thus reducing the need to clean and replace the lamp frequently.

Medixview presently has two models, both are LED light sources.

The first model is G series, LED and is back lit with thickness of 35 mm, high brightness >11000 lux. The 58 IN IMAGING

Medixview emits and produces a blue-type, highly bright, uniform light more suitable for reading X-Ray and CT scan and MRI films.

These features of Medixview are expected to help the doctor in making a very accurate and precise reading of X-Ray, CT scans and MRI films second model is J-series, LED electronic model, back lit, it has the facility of operation of each individual section, having a choice of normal and film sensor operation, this model is 45 mm thick with a brightness >12000 lux, both the models have a very long lamp life. The LED used in Medixview lasts for 100,000 hours without needing replacement. Besides these technical benefits, Medixview is expected to add elegance and class

to a consultation room.

Medixview also has high end models with very high brightness and area selection. Both G-Series and J-Series models are available in one film to four films i.e. 14X17, 28X17, 42X17 and 56X17 inches viewing area. The other models available are Thinxview and Dentxview for dental and other purposes.

Beejay claims that Medixview has more than five lakh installations in prominent hospitals of India and overseas. Some of its prestigious clients in India include Apollo Hospitals, Hinduja Hospital, Artimis Health Science, Ram Manohar Lohia, Asian Heart Institute, Ramchandra Hospital, PGI Chandigarh, Nanavati, JIMPER, Fortis Hospital, Shara Hospital, Crosslay, Yashoda, K.G hospital, Breach Candy, Sanjay Gandhi, Salby Hospital, Spine Centre, to name a few. It has also been installed in France, Yemen, Sharjah and the US. MedixView is a being touted as a must-have for all ultra-modern, hitech hospitals/clinics/diagnostic centres/medical colleges and institutes because Medixview is the only FDA approved X-ray illuminator in India, besides having CE approval and ISO 9001: 2008 certification. ■ DECEMBER 2012

IRIA 2013 SPECIAL

TERARECON’S SUCCESS SAGA TeraRecon, an advanced visualisation solutions provider for medical imaging, had a successful year and achieved few important landmarks

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eraRecon, a large and dedicated provider of advanced visualisation solutions for medical imaging, received “2012-New Product Innovation Award in Medical Imaging Informatics” from the respected independent research firm Frost & Sullivan. This award represents the seventh time that TeraRecon, Inc. has been recognised with a ‘Best Practices’ award from Frost & Sullivan, and the third time since 2010, following the ‘European Company of the Year’ Award in the category of Medical Imaging, Advanced Visualization Applications, and the North American Growth Leadership of the Year Award. Frost & Sullivan recog-

Pranav Shah Sales Manager—India TeraRecon Inc nised the importance of combining a strong clinical value proposition

with a viable and financially sound proposal in terms of departmentwide and enterprise-wide information technology, and TeraRecon’s success in achieving this balance.

The importance of quantitative imaging and the company’s commitment to this field was also highlighted: “TeraRecon's leadership in quantitative imaging offers providers the opportunity to enhance their clinical decision-support capabilities by being able to more efficiently document, store, and mine image-based analytics.”

In November, TeraRecon made a news release announcing that more than 9,000 iNtuition licenses being deployed globally. iNtuition the flag-

Testimonials for TeraRecon’s iNtuition – Enterprise Advanced Visualization We have TeraRecon’s iNtuition server-client solution installed since early 2011 and I must say it is by far one of the most advanced and user friendly imaging software available today. TeraRecon’s unique server-client solution allows multiple radiologists to work on 3D imaging software from individual PC. We have purchased five concurrent users licenses so that at any given point five radiologists are able to work simultaneously and it really eases out our huge workload. System is robust with seldom breakdown. The clinical applications are very user friendly, built with lot of automation allowing complex tasks to be performed in seconds. Post processing for CT angiography is superior than other modality workstations.

I personally recommend TeraRecon workstations and I am very happy working on it.

Dr Anagha Joshi Professor –Dept of Radiology LTMG Hospital, Mumbai We are very happy to have TeraRecon's Enterprise Advanced Visualization which came together with Agfa DECEMBER 2012

PACS. TeraRecon's iNtuition platform seamlessly integrates with Agfa's PACS allowing radiologists to launch TeraRecon's advanced 3D application right from their work list. The main challenge for any IT administrator is to streamline the entire radiology workflow so as to avoid any time delays and TeraRecon's solution does exactly the same.

TeraRecon application launches immediately allowing radiologists to perform complex 3D tasks in seconds.

The other most important advantage of TeraRecon is their unique server-client technology which allows multiple concurrent users to work on 3D applications. At our institute we would have atleast 3-4 users working simultaneously on TeraRecon's application. The server hardware requirement is considerably low and with just a 2U rack server they are able to support multiple users. The solution is also scalable so as to add more user licenses without any major hardware upgrade. In summary, I believe TeraRecon's solution are very robust and powerful to support Enterprise Advanced Visualization needs.

Vishal G Parte PACS Administrator PD Hinduja Hospital, Mumbai IN IMAGING 59

IRIA 2013 SPECIAL ship product from TeraRecon is an enterprise advanced visualisation solution. Based on revolutionary concept of server-client technology, the solution allows volumetric review of CT and MR studies to be reviewed and post processed, economically throughout the healthcare enterprise.

Using this technology a radiologist can view and process 3D images of CT, MRI and PET from any standard PC in the hospital network. The company claims that it truly gives every physician an access to clinical and decision making tools for CT and MRI images from anywhere, which was never possible before. It provides a scalable, real-time and centrally shared rendering resource that enabled an unlimited number of con-

In November, TeraRecon announced that more than 9,000 iNtuition licenses are being deployed globally current thin client PC users.

At RSNA, TeraRecon showcased its suite of iNtuition Vendor Neutral applications. TeraRecon’s advanced visualisation solution has been Vendor Neutral since very beginning and this has been an important decisive factor while considering

Enterprise advanced 3D solution. The company informs that it has been seeing increasing interest from various institutes to deploy Vendor Neutral Advanced Visualization solution so that they don’t really fall into a trap of working with companies with proprietary software.

New innovations displayed at RSNA includes: iNtuition: Enterprise-class professional advanced visualization with suite of clinical module iEMV: Zero-footprint, browser based distribution of images iNtuition SHARE: CD-free image sharing iNtuition CLOUD: All iNtuition features via an in-house or hosted Private Cloud. ■

PHANTOM HEALTHCARE: SETTING NEW STANDARDS Phantom Healthcare, a firm that deals in refurbished machinery, especially refurbished 1.5T MRIs, claims that it brings quality and affordability in the medical equipment markets of Tier II/Tier III cities of India

I

n India, refurbished medical equipment/device market is under dramatic transformation and would see significant sharp up move in coming years. Primarily driven by technological innovation, globalisation and increasing acceptance, refurbished products offer an exciting affordable price range that provides 40 per cent to 60 per cent off on the original price of the equipment. This low pricing factor, enhanced access to replacement parts and repair technology are contributing to widespread adop-

60 IN IMAGING

DECEMBER 2012

Brijesh Suneja Director, Phantom Healthcare

tion of refurbished medical devices by healthcare institutions.

Sensing the opportunity, "Phantom Healthcare" got established in the year 2008 and has grown in multiples in the last five years. They have carved an eminent position for themselves in the complex technology of MRI machines over the years and are slowly becoming a leader in the refurbished radiology machines industry, especially MRI scanners.

They are a reputed trader, supplier, exporter and importer of a wide

IRIA 2013 SPECIAL range of MRI scanner systems, CT scan systems and related parts and accessories. Engineered from grade A liquid helium, the products have high demand in the market for being reliable and functionally efficient.

As per the Director of the company, Brijesh Suneja, the professionals of the company have dedicatedly offered the customers products that comply not only with regulatory quality standards but also come well within the clients’ budgets. He says that Phantom Healthcare has emerged as a consistent performer and has successfully installed more than 40 super-conductive 1.5T MRIs across the country and in Nepal within a span of only five years. He informs that trained engineers of the company have always risen to most challenging requirements of the customers and that’s the reason why the company is enjoying the support of 40+ satisfied clients which in turn stands testimony of their quality service standards.

Their engineers restore used MRI equipment through repairing, reworking, updating and replacing of worn parts with original parts to ensure a condition of safety and effectiveness comparable to when new, claims the Director. They ensure that processes are consistent with product specifications and service procedures defined by the original manufacturer of the equipment. These actions ensure that the machines perform with the same quality standards as their new counterparts.

As per the Director, buying refurbished medical equipment does not necessarily mean sacrificing on quality. In fact, the biggest differences between new and refurbished medical equipment is the price, but there is a good amount of work involved in finding a good deal.

Now, more and more customers are DECEMBER 2012

using refurbished equipment just like new equipment and often include two year warranty, differed payment facility, user training sessions etc.

In this journey, Phantom Healthcare have become strategic partners with M/s EverX Pty Ltd. Australia which was established in year 1992, with a vision of establishing a complete international medical equipment company with all kind of MRIs and CT sale, service and spare parts support.

For the equipment funding issues, Phantom Healthcare has the support of leading financial institutions like Reliance Capital, HDFC etc. for resolving the funding needs of their clients, informs the company head.

SERVICES PROVIDED The organisation deals in GE’s MRI and CT scan machines, and supplies all models and gives service and parts for the same. The organisation is involved in different roles

in the market, from an importer and supplier to distributor, exporter, service provider and trader.

QUALITY ASSURANCE As a quality conscious organisation, their sole aim is to provide the products that are at par with global standards, claims the Director. The company’s in-house swanky facility hosts ultramodern testing machinery and tools and is supervised by a team of quality auditors. They work round the clock, checking the products on the basis of regulatory parameters before they are sent to the clients. Moreover, they follow a well defined quality assurance policy in maintaining high upkeep standards. All the units are maintained as per the standards aid by the government and are subjected to mandatory audits at regular intervals. Also, a strict traceability is maintained right from the procurement of raw material to the packaging of finished goods. ■ IN IMAGING 61

IRIA 2013 SPECIAL

AERO DR - DIGITAL WIRELESS RADIOGRAPHY SYSTEM High Image Quality and Lower Doses SCINTILLATOR DIRECTCONTACT TECHNOLOGY

We succeeded in creating a new technology whereby a CsI scintillator is made to contact directly over a TFT*1 sensor panel without any protective layer in between them. This technology has made it possible to guide the light emitted fromthe scintillator to the photodiode without causing the light to be dispersed at the interface with the TFT sensor.

High Image Quality and Lower Doses

even at a low dose. It is considered therefore that the AeroDR is effective to reduce the amount of radiation exposure. At the same time, we achieved the wider dynamic range of DR comparable to CR. This means that in radiography of shoulder joints, for example, the AeroDR permits describing the skin line accurately even when the radiographic conditions change alongthe way.

INTEGRATED CONTROL STATION CS-7

Easy Workflow and Reliability UNIVERSAL SOLUTION FOR THE EXISTING X-RAY ROOM The AeroDR detector is the same CS-7 can control not only the AeroDR detectors but also X-ray generators and Konica Minolta existing CR family. No need to operate the Xray console to adjust X-ray exposure conditions.*5

as an ISO 4090 compliant film cassette in size so that it will fit any existing wall-stand or table bucky tray

QUICK PREVIEW AND SMART GUI

SHARED FPD SOLUTION

The optimal combination of the AeroDR detector using a KonicaMinolta CsI scintillator combined with the newly developed lownoise readout ICs delivers a high detective quantum efficiency (DQE) 62 IN IMAGING

AeroDR can be used anywhere with“ the Shared FPD Solution”. As soon as AeroDR is registered to any Xray room, AeroDR will be ready to use in the X-ray room immediately.

After exposure, a preview image immediately appears on the display of the new CS-7 console in less than two DECEMBER 2012

IRIA 2013 SPECIAL seconds. The CS-7 has a user-friendly graphic interface adding new and powerful proprietary functions. GUI design can be modified to customer preferences flexibly, succeeding the conventional console design.

POWER-SAVING TECHNOLOGY Patient safety is of primary importance, therefore the lithium ion capacitor, the world newest technology, was adopted as a battery technology which has many advantages despite of

strength of the cassette.

RELIABLE, RAPIDLY RECHARGEABLE AND LONG-LIFE BATTERY

The lithium ion capacitor, which charges quickly in a battery charger or through a tethered connection, has a long charge and discharge cycle life that does not need to be replaced during the expected life cycle of the detector. If the capacitor gets exhausted in emergency, Aero DR gets over 10 images by the capacitor being recharged for only three minutes.

Light-weight & Durable WORLD’S LIGHTEST WEIGHT WIRELESS FPD The AeroDR Detector is the light-

demanding a lower power consuming panel design, which has been overcome by employing low power ICs and a power-saving control.

NEW BATTERY TECHNOLOGY ACHIEVES LIGHT-WEIGHT YET RIGID BODY The lithium ion capacitor has a charge and discharge cycle life that is tremendously longer than a lithium ion battery and does not markedly decrease in capacity even after it has continuously been used for many years. Therefore, it is possible to be built in to AeroDR and also friendly to the environment. In this case, the structure of the cassette case has become so simple that it is possible to significantly reduce the weight of the cassette and increase the mechanical DECEMBER 2012

est FPD in the world weighing as little as 2.9 kg (6.3 lbs) and supports wireless networking which transmits captured images to the console.

Technologists can easily perform non bucky exams such as table top or cross table projections.

DURABLE MONOCOQUE STRUCTURED CASSETTE We adopted the "Monocoque case" to ensure trouble-free operation even under substantial shock or load.

Since the battery is incorporated in

the cassette (it need not be replaced), it is unnecessary to provide the case with a notch for battery replacement which reduces the rigidity of the case.

Because of this, the cassette case that is appreciably light in weight has sufficient rigidity. Thanks in part to the buffer effect of the built-in battery, the load bearing performance of the cassette is the same as that of our CR cassette.

SEALED AND PROTECTED SCINTILLATOR In order to prevent the CsI crystal from being deformed by local concentration of external force, a doubleglass structure in which the CsI scintillator glass plate and the TF T panel glass plate are overlapped and sealed together is adopted for AeroDR. The double-glass structure not only enhances the load-bearing perform-

ance but also prevents the scintillator edge from being deformed by a mechanical shock (e.g., fall or striking of the cassette) and the TFT sensor panel glass plate from being broken. â– Contact: Tel: 022-61916969 Email : sales@mi.konicaminolta.in IN IMAGING 63

IRIA 2013 SPECIAL

'WE ARE CURRENTLY WITNESSING MORE GROWTH IN TIER II MARKETS' Suhas Pokale, Vice President — Medical Division, FUJIFILM India gives an insight about the growing radiology markets in Tier II and Tier III cities, Fuji's range of CR and DR imaging products for India and his company's plans for the upcoming IRIA 2013 The modern CR and DR imaging systems are revolutionising radiology practice worldwide.

According to you, how will its growing acceptability transform Indian radiology practice?

CR and DR imaging systems are certainly well accepted by radiologists, physicians and also by patients. In fact, these systems have brought in great deal of convenience, speed and accuracy for basic X-ray imaging. Though Indian radiology practice is looking forward to new, state-of-the-art, imaging modalities such as MRI, CT and PET, there are very large numbers of basic X-ray procedures done every day. The diagnosis of these in the shortest time without having to repeat has been facilitated by these modalities. Further, these images can now be stored in digital format on computer and also can be sent to referring physician or surgeon instantly.

How has the year 2012 been for FUJIFILM in India? Also tell us 64 IN IMAGING

how has Fuji's FDR range of products performed in the Indian market?

FUJIFILM in India has experienced further growth of CR systems sales. This growth has been more in Tier II and Tier III towns. Since the launch of FDR, we have installed

We are showcasing the complete range of FDR DEVO panels which help to convert existing X- ray system to FUJI DR system.

Our SYNAPSE PACS solutions with latest version along with the new SYNAPSE 3D is also being displayed

over 50 systems in India. Year 2012 has been a major contributor in DR installations growth. Many of our customers who have switched from CR to DR, are very excited to have the product with better quality and also high speed.

What are you showcasing at the forthcoming IRIA 2013 in Indore?

How promising is this event for Fuji India?

We are showcasing the complete range of FDR DEVO panels which help to convert existing X-ray system to FUJI DR system. Our new wireless DR panel of small size can be used in spot film devices. Our SYNAPSE PACS solutions with latest version along with the new SYNAPSE 3D is also being displayed. We are also displaying our new CR system and imager products. Ultrasound equipment from Sonosite (FUJIFILM Company) also will displayed.

Do you see good potential in Tier II markets for your business DECEMBER 2012

IRIA 2013 SPECIAL growth? Which imaging products will have demand in such market sin particular?

We are currently witnessing more growth in Tier II markets. Our CR systems in particular are in more demand in these markets. As these Tier II markets print images, most of the CR systems are sold with imagers.

Tell us about the growing acceptability and convenience of ITisation in post image processing.

How has your PACS productSynapse benefitted radiologists in

their day to day practice?

Though most of the radiology images are printed on films, we are observing large hospitals, and especially new ones, are considering PACS solutions in order to become paperless and filmless. Many hospitals are adopting new IT solutions for better workflow. SYNAPSE PACS has provided many radiologist tools for fast and accurate diagnosis and also convenience to report the images remotely across the globe.

SYNAPSE 3D gives excellent tools of on the fly reconstruction of the images from the basic image data

received through various modalities.

On which other imaging modalities will Fuji focus in near future ?

CR, DR, mobile digital solutions, mammography and PACS are modalities we continue to focus.

Does Fuji have any future plans for strategic alliance or acquisitions in near future?

Healthcare is one of the key businesses for FUJIFILM Corporation. We continue to develop new products with the core technology that we have. ■

FDR FLEX - FUJIFILM TRUE PORTABLE DR MOBILE KIT It is portable, wireless and has Irradiation Side Sampling (ISS)

T

he FDR Go flex portable kit transforms a wide range of mobile X-ray units into wireless DR systems. This FDR Go flex kit is extremely compact and can be transported quickly and easily.

Speed, increased efficiency and high quality images in various

DECEMBER 2012

scenes with the FDR GO flex portable kit.

Customised to your needs - The compact, wireless FDR Go flex portable kit can be laid out exactly to the users’ specific requirements.

The Utility Box is designed to fit into the cassette box of various portable machines.

Excellent portability - The FDR Go flex portable kit can be used with a diverse array of units in hospitals, clinics or other medical institutions, with no modification of the mobile analogue X-ray units required.

As the kit can also be carried outside the hospital, it facilitates a variety of medical needs including patient home care.

Stress-free operation Preview images are displayed only two seconds after an exposure is made, meaning images can be checked quickly thus improving efficiency. ■ IN IMAGING 65

IRIA 2013 SPECIAL

FUJI'S D-EVO FOR FASTER EASIER AND LIGHTER IMAGING D-Evo is designed to suit everyone’s need in X-ray imaging

F

DR D-Evo is the lightest flat panel detector with patented Irradiation Side Sampling) ISS technology provides sharp, high contrast images with larger latitude.

66 IN IMAGING

Fuji's wireless panels have world’s new technology known as “SmartSwitch” that allows automatic X-ray detection hence, FDR D-Evo doesn't require physical connection between the X-ray generator and DR power supply unit.

On the top of everything D-Evo has “ISS technology” that permits a higher resolution image and reduced doses. It sees the TFT sensor placed in front of the scintillation layer instead of its traditional position behind it.

At three kg, this 14” x 17" flat panel detector (FPD) is the lightest weight FPD in its category and its thin size presents an easy retrofit to existing analog rooms, making DEVO ideal for all types of diagnostic environments and general radiographic purposes. The D-EVO offers a fast and easy solution to

any facility wanting to improve workflow and take advantage of what being digital has to offer.

IMPRESSIVE SPEED! Astounding one second image preview and a nine second cycle time helps a busy environment improve productivity and offer a faster patient turnaround!

It is very easy to use with the ability to off-centre anywhere on the detector allows fast and easy positioning for trauma, paediatric and challenging radiographs.

Impressive image quality is also Fujifilm's 14 X 17" FPD feature.

IDEAL FOR STRETCHER AND WHEELCHAIR IMAGING AS WELL AS CROSS TABLE LATERALS Detachable cord allows for flexible positioning and streamlined workflow, ultra-fast image transmission, with consistent, stable power and network connectivity for uptime you can count on.

Following are the D-Evo series available with us: ● G 35 – Wired/Wireless (GOS 35 X 43 cm) ● G 43- Wired/Wireless (GOS 43 X 43 cm) ● C 35 – Wired/Wireless (CsI 35 X 43 cm) ● C 24 – Wireless (CsI 24 X 30 cm) FDR D-EVO G35i/s was awarded “Good Design Award* 2011” for its usability and design.

DECEMBER 2012

IRIA 2013 SPECIAL

The simple design providing a sense of cleanliness enables it to be used over many years.

With the reliable battery or connector cable and the secure-feeling grip, the cassette is now easier to operate, enabling assured X-ray exposures to be performed.

The unique square shaped cassette, with no need to switch the orientation, greatly enhances the workflow efficiency for the technologist.

D-Evo G35 is powered with dual usage — wireless and wired mode, enhanced image processing, quick preview and the world's first “SmartSwitch” technology.

D-EVO PLUS C35i/s is a novel detector which offers optimum image quality at very low dose.

D-EVO plus C24i - A perfect fit for orthopaedic to neonatal exams If the focus is in reducing dose, the benefits of CsI with ISS technology that are available in D-EVO c24i is significant.

The 24×30cm FDR D-EVO plus is uniquely designed to achieve higher DQE performance characteristics to consistently produce excellent detail with lower noise at very low doses.

Dynamic visualisation adds to the DECEMBER 2012

value of D-EVO C24i. To take full advantage of DR's dynamic range capabilities, Fujifilm has created a new full spectrum optimisation with dynamic-range control processing.

This processing fully utilises all of the exposure data captured and optimises its image recognition output.

It is small and lightweight, which makes it a perfect fit for orthopaedic to neonatal exams.

ROBUST DESIGN This cassette is designed to be tough, offering a uniformly distributed load capacity of up to 310 kg.

On any point of the cassette, the load can be up to 160 kg. Such robustness enables even a heavy part of the body to be placed on the cassette for examination.

ENERGY-SAVING MODE A special energy saving feature allows up to 7.5 hours of use from a fully charged battery. More than any other wireless flat panel detector available today. The battery type is the same as the standard full size FDR D-EVO models and is very easy to change.

D-EVO G43 i/s (Large Sized Flat Panel Detector)

The world's first 43 × 43 cm DR cassette offers ehanced operability.

This square shaped cassette, which does not require horizontal/vertical switching, greatly streamlines the examination workflow.

It frees users from bothersome procedures during an examination, realising a comfortable workflow.

COMPATIBLE WITH EXISTING EXPOSURE STAND Since this DR cassette is designed as thin as a regular CR cassette fitting the existing stand/table, it enables the DR systems to be introduced at reduced cost.

DYNAMIC VISUALISATION Constantly endeavouring to provide the highest image quality, Fujifilm offers a proprietary technology to produce the optimal image for each examination. With the enhanced visibility achieved by this technology, information in greater detail can be obtained from images.

Speedy display of images greatly shortens examination time and the world's first “SmartSwitch” technology allows automatic X-ray detection. ■ IN IMAGING 67

IRIA 2013 SPECIAL

MAGNIFICENT SOLUTIONS FROM MAPLE Maple Digital Technology International offers very cost effective PACS and DICOM solutions to its users

M

aple Digital Technology International is a pioneer in providing Indian customers with efficient, reliable and, robust end-to-end solutions using Apple’s pioneering technology. They assure that they provide impeccable service and attention to customers.

After enjoying success in the consumer and professional film and video industry, Maple ventured into the medical vertical more than three years ago. Since then, it has successfully deployed Osrix-based solutions in over 60 hospitals and diagnostic centres across India.

Osirix is an image processing software dedicated to DICOM images (.dcm/.DCM extension) produced by imaging equipment such as MRI, CT, PET, PET-CT, and confocal microscopy (LSM and BioRAD-PIC format). It can also read many other file formats like TIFF, JPEG, PDF, AVI, MPEG and Quicktime. It is fully compliant with the DICOM standards for image communication and image file formats. Osirix is able to receive images transferred by DICOM communication protocol from any PACS or imaging modality like STORE SCP-Service Class Provider, STORE SCU – Service Class User and Query/Retrieve.

Osirix has been specifically designed for navigation and visualisation of multimodality and multidimensional images such as 2D Viewer, 3D Viewer, 4D Viewer and 3D Series with temporal dimension.

MAPLE also offers "QDRAS" - an 68 IN IMAGING

eco-system meant for: ● Creating database ● Viewing DICOM images ● Editing

● ●

Tagging Fast retrievable archival solution

low-cost

DECEMBER 2012

IRIA 2013 SPECIAL QDRAS FOR COLLABORATION Quick Database Remote Access System (qDRAS) is a complete intraoffice communication tool created by Maple to facilitate seamless information sharing in every possible way.

You can share data in real time with others, even if they are in a different continent. SPIDER can be used effectively by medical professionals for teleradiology, remote consultancy or multi-location centre connectivity.

They claim that their solution is perfect for doctors/medical professionals on the move as they can view complete information with DICOM images on portable devices like iPads, iPhones, androids etc from anywhere and at any time.

They also claim that their skilled technicians understand criticalities of the medical industry and are always available to provide support and solutions catering to unique requirements of each facility and personnel.

CURRENT FEATURES OF THE PROGRAM ● Dicom and non Dicom file support on multi platforms ● 3D MPR, MIP, Curve MPR ● All types of tools for Viewer and 3D ● Virtual endoscopy ● Dicom servers preference for Query, Retrieve and Send ● Web Server: - Administer users from the Web ● Web Server: - Internet and Intranet ● Ultrafast performance ● Intuitive interactive user interface ● Exclusive innovative technique for 3D/4D/5D navigation ● Distributed under open source licensing - LGPL ● Open platform for development of processing tools ● The most widely used DICOM DECEMBER 2012

● ●

viewer in the world More than 50,000 users Centre-to-Centre connectivity

TELERADIOLOGY Teleradiology has improved patient care by allowing radiologists to advise and treat without being near the patient’s location. This is possible by transmitting the patient’s images from one location to another.

Using qDRAS, Maple’s teleradiology solution enables teleradiology without any additonal tool. It helps medical professionals to collaborate with other professionals by easily sharing images or work from outside their clinic or hospital, or advise a patient remotely. All this happens over a secure network to eliminate chances of unauthorised access.

RADIOLOGY WORKSTATIONS Maple claims that its workstation is built with the best-of-the-breed hardware and software components.

Osirix on the powerful Mac Pros brings best of both worlds together to bring the users an efficient, reliable and easy-to-use solution.

PACS Maple provides the users with an easy way to store, quickly retrieve and access images acquired with

multiple modalities through its picture archiving and communication system (PACS) solution. Osirix is a robust and extensible PACS server that provides unique features like Web-based administration, unlimited number of clients and fully compatible with the DICOM protocol.

WEB SERVER Web server is a multipurpose webbased viewer with a highly modular architecture. It has been designed to meet several expectations of clinical information systems and their future evolution regarding medical imaging: providing a web-based access to radiological images, as well as offering multimedia capabilities.

Web server can be easily interfaced to any PACS supporting WADO via a web portal or as an XDS-I consumer in an IHE (Integrating the Healthcare Enterprise) environment.

Web server can be accessed on intranet and internet. ■ For customised PAN-India PACS & DICOM Solutions Contact 250, Powai Plaza, Opposite Pizza Hut, Hiranandani Gardens, Powai, Mumbai – 400 076.

Branch Office : Saldhana Providence, Balmatta Road, Mangalore - 575 001 Tel: +91 90047 45674 / +91 77383 69799 Email: osirix@mapledti.com IN IMAGING 69

IRIA 2013 SPECIAL

PRINTER PERFECT Medion Healthcare now brings you a world class colour printing solution from DNP, Japan, introducing fotolusio range of printer model DS 80. DNP has revolutionised dye sublimation printing with DS 80 printers

D

S 80 printers are compact, desktop, high-speed, highquality printers, which can be connected to any imaging modality. The first thing to consider when thinking about DS 80 printers is its outstanding print quality, which helps to offer excellent prints. DS 80 offers unparalleled reliability and ergonomic design for easy access and front loading of media. The front access panel makes maintenance easier and less time-consuming.

DS80 printers use an exclusive internal print method that safeguards the paper from exposure to dust and other contaminants. The printers feature a cartridge-based ribbon supply that makes loading fast and easy. DS Series printers are competitively priced, high-resolution printers that produce rich print quality that display full colour details and smooth gradation. The lamination layer on the media provides resistance to fading, fingerprints, water, ozone and dust. The best part of owing DS 80 is that it is a complete dry process printer. Unlike other printing solutions it does not use any kind of ink or cartridges that require frequent replacement and does not offer consistent print quality. DS80 printers offer the same reliability print quality for years together since it requires very low

70 IN IMAGING

maintenance and needs no replacement of ink cartridges.

DS 80 printers offer seamless connectivity in a network to all the imaging modalities. It gives the flexibility to format prints directly from the available modality workstation with

just a print command. It is so simple that within less than a minute the print is ready to be delivered.

Especially for ultrasound applications, DS 80 is ideal as it offers direct connectivity to an ultrasound system using USB. So, as a standalone printer, it can be just connected to your ultrasound system. â– Contact: Medion Healthcare 302/303 Pratik Ind. Estate, B-wing, Next to Fortis Hospital, Link Road, Mulund (W), Mumbai 80.

Tel : +91-22-25667093 Fax : +91-22-25667096 Email: sales@medion.co.in, jimit@medion.co.in DECEMBER 2012

IRIA 2013 SPECIAL THE LEADING SOLUTION FOR ONCOLOGY FOLLOW-UP APPLICATIONS It is used to follow the course of a patient's cancer by comparing the latest examination to prior results.

This follow-up involves key steps managed by the software that considerably simplifies the radiologist's work FIRST RATE PARTNERS The best specialised cancer teams contributed to the development of this module: - Curie Institute (Paris, France) - Pitié-Salpêtrière (AP-HP - Paris Public Hospitals Authority) (Paris, France) - Hôpital Européen Georges Pompidou (AP-HP - Paris Public Hospitals Authority)(Paris, France) - Civil Hospices of Lyon (HCL)(Lyons, France) - Montpellier University Hospital (Montpellier France) ■

T

he unique solution for multimodality oncology follow-up Myrian® XL-Onco is the culmination of eight years of development of the Myrian platform. Dedicated to oncology follow-up, it manages the sequencing of tasks essential for the management of the cancer patients with elevated efficiency and in strict complaince with the international RECIST rules, consensually established by European, Canadian and American authorities.

The Cheson protocol whose parameters can be set by the user are also available.

Myrian XL-Onco was developed and validated jointly with leading French experts and makes Intrasense a world leader in oncology follow-up software applied to medical imaging.

It is intended for routine clinical practices of hospital treating cancer patiens as well as pharmaceutical companies and CROs in the framework of phase I, II and III clinical trials to evaluate anit-cancer therapies.

ORIGINAL TECHNOLOGIES Automated retrieval of prior exams, dedicated clinical workflow obeying RECIST rules, automatic 3D registrations of examinations in elastic mode, automated production of reports and graphs.

DECEMBER 2012

Contact: Jigish B Modi Tel: 2506 5664, 98670 01110, email: modimedicare@gmail.com Skype: modi.medicare IN IMAGING 71

IRIA 2013 SPECIAL

MEDICO IMAGING: CARVING A NICHE Medico Imaging provides equipment that offer optimum performance consistently

M

edico Imaging System, is an organisation that supplies, exports, imports and provides services for a wide range of electronic equipment across the globe. It came to light in the year 1993. It claims that its products i.e. magnetic resonance imaging, ultrasound, mammography, CT scanner (new), ultrasound, mammography, mobile Carms, computed radiography etc are procured from the consistent manufacturers.

The company assures that it recognises the specifications and needs of the customers and provides service to them accordingly. The products are extensively used in miscellaneous applications in different area and are highly esteemed for

their features like resistance to corrosion, efficiency, optimum performance, excellent service, reliability, easy installation, optimum safety, energy saving and durability. The organisation is involved in different roles in the market like importer, supplier distributor, exporter, service provider and trader.

PRODUCTS OFFERED Company offers different products, some of them are listed below: MRI equipment includes: ● Siemens Magnetom Trio 3T MR MRI Scanner ● GE 2010 MR750 3T Ult MRI Scanner ● Harmony Master Class MRI Scanner

CT scanners offered are : Siemens Sensation 16 Slice CT Scanner ● Philips MX8000 CT Scanner ● Somatom Sensation 4 CT Scanner ● 2005 Sensation 16 CT Scanner PET CT scanners available are: ● GE Discovery LS PET/CT System ● Siemens True Point 16 Slice PET/CT Medical equipment offered are ● MRI Siemens Magnetom Symphony ● GE Lightspeed 16 Slice CT Scanner ● CT Scanner Somatom Sensation 64 Cardiac MRI systems available are: ● Philips 3.0T Achieva MRI System Medico deals only in Siemens, Toshiba and GE equipment. ■

●

Advertise in

Business Avenues PLEASE CONTACT:

■ Mumbai: Kunal Gaurav 09821089213 ■ Delhi: Ambuj Kumar 09999070900 ■ Chennai: Raghu Pillai 09886293667 ■ Bangalore: Khaja Ali 09741100008 ■ Hyderabad: E Mujahid 09849039936 ■ Kolkata: Ajanta/Prasenjit Basu 09831182580/09830130965 ■ Ahmedabad: Tushar Kanchan 09821459592 DECEMBER 2012

IN IMAGING 73

RADIOLOGY SOFTWARE LIVER TRANSPLANT & SURGERY PLANNING

Advanced Liver Volumetry - A Complete Solution  Liver Transplant Planning  Liver Surgery Planning  Liver Volumetry  Tumor Volume Estimation and Vessel Analysis  Right Lobe and Left Lobe Evaluation  Liver Segmental Analysis Couinaud 8-Segments Volumes  Liver Hepatic Drainage Analysis Congestion Volumes  Pre TACE / Post TACE Evaluation of Lesion Volumes  Pre RFA / Post RFA Evaluation of Lesion Volumes  Radio-Embolization Evaluation  LAI Liver Attenuation Index  Liver Hemochromatosis Evaluation  THAD and THID Volumes measurements

Liver Volumetry

Hepatic Drainage Territories

Couinaud Segments

Radio-Embolization Planning

MYRIAN® FAMILY OF MODULAR WORKSTATIONS: BASE PLATFORMS SPECIALITY CLINICAL MODULES o PRO (Basic CR/DR Workstation) XT- CARDIAC CT XT-CARDIAC MRI o ADVANCED (Double oblique MPR / XP-LUNG XP-LUNGNODULE MIP, CPR, etc.)

XT-BRAIN CT PERFUSION XT-BRAIN MRI o EXPERT (3D Workstation) XP-COLON XP-COLONCAD o EXPERT VL (3D With Volumetry) XP-ORTHO XT- DENTAL o XL-REGISTRATION (Elastic Registration) XL-2D/3D STITCHING XP-FUSION o XL-4D NAVIGATOR XP-LIVER XP-CT CTA sub XL-ONCOLOGY (RECIST 1.0, Modified RECIST 1.1, CHESON) For more details, please contact : JIGISH B MODI PH: 2506 5664, 98670 01110, email: modimedicare@gmail.com Skype: modi.medicare 4/102, DEEP SUNIL, GARODIANAGAR, GHATKOPAR(E),MUMBAI 400077.

www.guerbet.co.in

Improving your disease management through innovative contrast agents

Guerbet is the only pharmaceutical group fully dedicated to medical imaging. It has the most comprehensive range of X-ray and MRI contrast media available worldwide. These products assist medical professionals (radiologists, cardiologists, oncologists, etc.) in better diagnosing and treating their patients (cardiovascular, cancer, inflammatory and neurodegenerative diseases).

To develop new products and assure its future growth every year, Guerbet devotes significant resources to research and development with 200 R&D employees and 10% of sales.

Guerbet is fully at your service with a developed network all over Asia and Oceania.

Our brands ®

HEXABRIX

®

Sodium and meglumine ioxaglate

TELEBRIX

®

Sodium and meglumine ioxitalamate

DOTAREM

®

Gadoteric Acid

LIPIODOL

®

Ethyl esters of iodized fatty acids of poppy seed oil

Sales in 2009: 335 M€ worldwide 31.15 M€ for Asia and Oceania (+21%) 20 subsidiaries and 60 agents worldwide 70% of sales are international Asia Pacific: 4 subsidiaries, 2 liaison offices, 16 agents and 1 distribution center

GAP11005

XENETIX

Iobitridol

Guerbet India Liaison Office

422, Level 4, Augusta Point Sector 53, Golf Course Road, Gurgaon - 12002, Haryana Tel: +91 98108 04757 / +91 12443 54194 Fax: +91 12443 54001