ICE - February 2018

ADVANCING THE IMAGING PROFESSIONAL

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contents

ICE FEATURES DESIGNING THE

IMAGING ROOMS

February 2018

“ Maybe it’s a rad room today and an R&F room tomorrow, and maybe a CT 10 years from now.” –Jesse Peterson

of

Tomorrow

38

Designing the Imaging Rooms of Tomorrow

24 Professional

Medical imaging is no longer a centralized destination, but has become a

Robert “Bob” Hedderman has

clinical service deployed throughout the entirety of a health system and its

worked as a biomedical equip-

facilities. In this issue of ICE we look at how the evolution of diagnostic imag-

ment technician, biomedical

ing has changed the blueprint of health care facilities.

equipment specialist, radiology equipment technician, radiology equipment specialist and is

Department

Eskenazi Health System Imaging Service Team stays current by utilizing a combination of manufacturers’ training, third-party training and in-house training. They also receive internal and external training for IT certifications, such as cyber security, PACs, A+, medical device integration and healthcare information technology.

Page 26

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currently a radiology enterprise engineer. He serves as one of the foremost in-house authorities on PET technology at the University of Pittsburgh Medical Center.

ICEMAGAZINE

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contents

ICE DEPARTMENTS

12

26

February 2018

35

50

news

people

products

insight

12 Imaging News

24 Professional Spotlight

45 Imaging Matters

21 People on the Move

26 Department Spotlight

29 C-arm Product Spotlight

22 Webinar Wednesday

46 Career Advice

30 C-arm Gallery 37 Tools of the Trade

49 Imaging Service 101 50 Daniel Bobinski 52 ICE Photo Contest 54 Index

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For subscription information visit www.imagingigloo.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher.

Reproduction in whole or in part without written permission is prohibited. © 2018

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ADVANCING THE IMAGING PROFESSIONAL

news

IMAGING NEWS A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY GE Healthcare Launches New Breast Health Portfolio Mammograms are a critical tool in detecting breast cancer, yet one in four women avoid the exam because of discomfort and fear and anxiety from the potential result of the exam. The choice to skip a mammogram can delay a breast cancer diagnosis and impact a patient’s long-term prognosis.

GE Healthcare is committed to developing solutions for women that encourage adherence to screening guidelines, improve outcomes for breast cancer screening and give women an opportunity to be active participants in their health care.

That’s why a team of women used their unique insights, coupled with feedback from patients, technologists and radiologists, to design a new mammography system, the Senographe Pristina. The system offers patients the option to use Pristina Dueta, a newly FDA cleared industry-first patient-assisted compression device, which literally puts women in control of their mammograms.

In traditional mammography, the technologist performing the exam compresses the patient’s breast, often causing discomfort. Pristina Dueta allows women to control the application of compression to minimize the perceived pain and discomfort often associated with a mammogram with the help of a technologist. After the breast is properly positioned by the technologist, the patient can use a handheld wireless remote control to adjust the compression based on the patient’s comfort level.

The Senographe Pristina also has the same high image quality and low dose – the lowest dose of all 3D FDA-approved systems – customers and patients have come to expect, and new comfort features that help decrease pain and reduce anxiety associated with the exam. It replaces traditional design with rounded edges and a thinner image detector to create a more pleasant experience for women as well as armrests that position women to relax rather than tense up during the compression and image acquisition process. Senographe Pristina uses Seno Iris, a powerful and highly scalable workstation designed to speed up mammography diagnoses. Its Enhanced V-Preview image option shows 92 percent of all masses so the radiologist can spend

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The Pristina Dueta is a patient-assisted compression device.

less time scrolling through volume to detect suspicious areas. Once a suspicious area is found on Enhanced V-Preview, the Seno Iris navigation tools allow the radiologist to navigate in tomosynthesis volume quickly to the location of the suspicious area. Radiologists can read tomosynthesis cases 29 percent faster using enhanced V-Preview and Seno Iris navigation tools compared to not using these tools.

Radiologists can also now take Senographe Pristina directly to their patients with a novel configuration: a fully-equipped road-ready Senographe Pristina mobile unit.

GE Healthcare also recently introduced SenoBright HD, a next-generation Contrast Enhanced Spectral Mammography (CESM) exam designed to aid health care providers in breast cancer diagnosis by delivering clear images for a confident and fast patient diagnosis and overall improved patient experience.

Senographe Crystal Nova is a new, more affordable performance digital mammography offering that uses the same carbon fiber image detector as the Senographe Pristina.

Health care providers have the option to incorporate the Senographe Pristina, Senographe Crystal Nova and the accessories in a SensorySuite – a room designed to reduce a patient’s anxiety, discomfort and pain during a mammogram by simultaneously stimulating three of a woman’s senses: scent, sight and sound. •

ADVANCING THE IMAGING PROFESSIONAL

news

Biodex Highlights New Surgical C-Arm Tables Biodex Medical Systems Inc. recently highlighted the latest enhancements to its line of surgical C-arm tables, including unique motion capabilities intended to enhance quality in medical imaging.

Available for hands-on demonstrations at RSNA was the Biodex Surgical C-Arm Table 840 – a stable, accessible and vibration-free fluoroscopic table designed to keep a patient at exactly the right position and angle for a cardiovascular procedure. Features such as a stainless steel base, larger radiolucent area, exclusive SmoothGlide movement and more finite controls have been added to the table design to help ensure a clear image.

A standout capability of this table is the isocentric lateral roll motion, a movement that maintains image center during tabletop motion, minimizing image distortion. RSNA attendees were invited to the Biodex booth to view the table in action.

“We were very excited to bring this line of tables to market,” Biodex’s Rich Schubert said. “Our goal is always to improve the imaging process for our customers and their patients. That’s what these new enhancements are all about.” •

Acertara Acoustic Laboratories CEO Chairs MITA Ultrasound Section Acertara Acoustic Laboratories CEO G. Wayne Moore has been elected as the 2018 Chair of the Ultrasound Section for the Medical Imaging & Technology Alliance (MITA/NEMA).

The MITA Ultrasound (UD) Section is charged with overseeing and directing MITA activity specific to ultrasound imaging. The goals of the UD Section are to serve as a forum for sharing, dis-

cussing, and determining action on regulatory and legislative developments of importance to members; act as pointof-contact for external enquiries to MITA regarding ultrasound; contribute ultrasound-specific expertise to MITA; increase patient access to new ultrasound technology and applications; and improve safety for workers and patients around ultrasound equipment.

As the chair, Moore will lead the UD as it participates in the development of new domestic and international regulatory and standards activities related to ultrasound. •

EOS imaging Awarded the Prix Galien in the Medical Device Category EOS imaging has announced that the Galien Foundation has awarded it the Prix Galien in the Medical Device category.

The award was presented to EOS imaging in recognition of its EOS system for 2D/3D low dose imaging and associated EOS apps suite of online 3D surgical planning solutions for spine, hip and knee surgeries.

“We designed the EOS System specifically to address unmet needs in orthopedic imaging – providing high quality, full-body

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2D and 3D images with less radiation exposure, as well as precise and complete patient data. Subsequently, we built on this foundation to offer EOS-based online 3D surgical simulation, planning and control software solutions to help surgeons improve patient outcomes,” EOS imaging CEO Marie Meynadier said. “We are proud to see EOS becoming a standard of care as our installed base continues to grow worldwide, and are honored that the Galien Foundation recognizes its contribution towards patient safety and improved orthopedic care.” •

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news Medical Imaging Equipment Services to Reach $17.3 Billion The global market for medical imaging equipment services is projected to reach $17.3 billion by 2022, driven by the increasing health care burden of infectious and chronic diseases, growing demand for diagnostic procedures and the ensuing expansion of the installed base of imaging equipment across hospitals, private clinics and diagnostic centers across the world.

Medical imaging equipment plays an indispensable role in modern health care practices, contributing significantly to the improvement in overall patient care. Factors such as aging population, increasing incidence of various diseases, rising focus on preventive health care, growing investments in health care infrastructure and rising volume of diagnostic procedures are driving demand

for medical imaging equipment. Medical imaging equipment services refers to a wide array of services including repair and maintenance of medical imaging equipment, which are critical to routine and profitable operations of health care establishments such as hospitals. Imaging equipment services enable reduction in downtime and thereby revenue losses for equipment owners.

The world health care sector operates under challenging conditions, typified by lower reimbursements, growing costs, declining budgets and growing pressure on profits. Cost containment has therefore emerged as a major operational strategy.

The scenario is driving demand for equipment services from ISOs who offer similar services as OEMs at lower costs. The market is also witnessing a trend towards recruiting

and training in-house biomedical and clinical engineers in clinical engineering departments in large hospitals to achieve savings on equipment services and realize higher equipment uptime. The trend is driving demand for various training services. Hardpressed to cut down on expenditure, some hospitals are moving away from full service contracts to alternative packages such as time and material contracts. Other trends prevailing in the market include growing prominence of remote equipment services and sophistication in technologies such as digital radiography in place of conventional X-rays which promise lower downtime and reduced on-site visits and service costs. • For information, visit www.researchandmarkets.com.

Siemens Healthineers Presents New Systems

Siemens Healthineers has presented its new computed tomography (CT) scanner portfolio, which covers all major requirements and customer needs regarding CT imaging. With its innovative workflow technologies, the portfolio’s four new CT scanners help deliver a new level of standardized, high-quality examinations that support clinical users on their way to precision medicine, while potentially improving patient satisfaction.

The two new scanners in the SOMATOM go. platform – SOMATOM go.All and SOMATOM go.Top – expand the mobile workflow into advanced clinical fields such as cardiology and CT-guided intervention. This mobile workflow enables the technologist to remain closer to the patient during exam preparation and the actual scan. With its high-end systems for single- and dual-source imaging – SOMATOM Edge Plus, SOMATOM Drive, and SOMATOM Force – Siemens Healthineers is introducing to the CT market the new, innovative FAST (Fully Assisting Scanner Technologies) Integrated Workflow with the brand-new FAST 3D Camera. Using artificial intelligence and deep learning technology,

the camera automatically facilitates precise, consistent isocentric positioning of patients.

By enabling the potential for fewer rescans, the potential for lower costs may be realized.

“We believe that our new scanner portfolio is the best possible answer to the very different challenges in computed tomography – in particular, to the simultaneous issues of growing patient numbers and declining reimbursement rates,” said André Hartung, head of computed tomography at Siemens Healthineers.

“With our innovative technologies, we can contribute to the success of health care providers by helping them tap the full potential of CT and to offer high-quality examinations while also reducing costs.” •

Hologic Signs Agreement with Clarius Mobile Health Hologic Inc. has signed a development and distribution agreement with Clarius Mobile Health for its wireless, handheld ultrasound scanner. The partnership supports Hologic’s commitment to early detection and will help ensure that women around the globe have access to the most accurate breast health solutions that are rooted in clinical superiority.

“We’re very excited to partner with a company that places the same value on image quality and accuracy as we do here at Hologic,” said Pete Valenti, Hologic’s division president, breast and skeletal health solutions. “The exceptional

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image quality and portability of Clarius’s ultrasound system, coupled with our industry-leading deep learning algorithms, bring us one step closer to ensuring all women have access to the breast care they need and deserve.” •

ADVANCING THE IMAGING PROFESSIONAL

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Hitachi Spotlights New CMUT Probe Throughout the long evolution of medical ultrasound imaging, one key aspect of ultrasound equipment has remained static: piezoelectric crystals or ceramics have always performed the transmission and reception of the ultrasound signal. This changed earlier in the year when Hitachi Healthcare introduced the SML44 linear array at the European Congress of Radiology. Having recently received FDA 510(k) clearance in the USA, the probe was introduced to the American market at the Radiological Society of North America’s 2017 Annual Meeting.

The SML44 is the first fully-featured commercially available ultrasound probe to employ capacitive micro-machined ultrasound transducers (CMUT) to power its imaging.

This innovative design enables an ultra-wide bandwidth of 2-22MHz, allowing a single probe to address multiple clinical needs and to adapt to a wide variety of body habitus.

Clinically viable CMUT probes – sometimes referred to as “silicon probes” because they are fabricated using techniques first developed in the semiconductor industry – have been pursued by the imaging industry for decades says John Waddell, vice president and general manager of ultrasound.

“CMUT technology has tremendous potential,” said Waddell, “but it also posed some significant engineering challenges. This is actually our fourth-generation CMUT probe even though previous versions were not widely commercialized.

The creative solutions our R&D team devised to overcome obstacles that had stumped other organizations put Hitachi in an enviable position as leader in this emerging field.” •

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news

Samsung Unveils Mobile OmniTom CT Samsung Electronics debuted its OmniTom mobile 16-slice computed tomography (CT) scanner at RSNA 2017. OmniTom received 510(k) FDA clearance for the U.S. market on August 18, 2017.

OmniTom features an array of improvements from Samsung’s CereTom CT scanner, including: • Improved workflow: OmniTom is the world’s first mobile imaging device with omni-directional wheels, maximizing mobility and allowing easier and quieter movement in small spaces.

• Superior image quality: 16-slice (0.625 mm per slice) advanced data acquisition system with effective dose optimization.

• Expanded use: Maintains a small footprint ideal for mobile use while increasing the gantry opening to 40 cm for improved coverage of adult head and neck, and full body pediatric scanning.

• Enhanced safety system: OmniTom features an internal drive system, making portability less strenuous, while also offering smart-sensing collision avoidance software to maximize control and patient safety. •

GE Healthcare and NVIDIA Join Forces GE Healthcare and NVIDIA announced they will deepen their 10-year partnership to bring the most sophisticated artificial intelligence (AI) to GE Healthcare’s 500,000 imaging devices globally and accelerate the speed at which health care data can be processed.

The scope of the partnership, detailed at RSNA, includes the announcement of the new NVIDIA-powered Revolution Frontier CT, advancements to the Vivid E95 4D Ultrasound and development of GE Healthcare’s Applied Intelligence analytics platform.

The new CT system in the Revolution Family is two times faster in imaging processing than its predecessor, due to its use of NVIDIA’s AI computing platform. The Revolution Frontier is FDA cleared and expected to deliver better clinical outcomes in liver lesion detection and kidney lesion characterization because of its speed –

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potentially reducing the need for unnecessary follow-ups, benefitting patients with compromised renal function and reducing non-interpretable scans with Gemstone Spectral Imaging Metal Artefact Reduction (GSI MAR).

NVIDIA, which has helped pioneer the spread of AI across a growing range of fields, including self-driving cars, robotics and video analytics, is working with GE Healthcare to spread its application in health care. GPU-accelerated deep learning solutions can be used to design more sophisticated neural networks for health care and medical applications – from real-time medical condition assessment to point-of-care interventions to predictive analytics for clinical decision-making. For patients, the partnership aims to drive lower radiation doses, faster exam times and higher quality medical imaging.

GE Healthcare and NVIDIA also an-

nounced the following at RSNA: • NVIDIA Platform Powers 4D Ultrasound Visualization: The Vivid E95 4D Ultrasound System uses NVIDIA GPUs to provide fast, accurate visualization and quantification while streamlining workflows across the cSound imaging platform. NVIDIA GPUs accelerate reconstruction and visualization of blood flow and improve 2D and 4D imaging for Echo Lab and Interventional deployments.

• New GE Healthcare Applied Intelligence Powered by NVIDIA Technology: Modules of the new analytics platform will use NVIDIA GPUs, the NVIDIA CUDA parallel computing platform and the NVIDIA GPU Cloud container registry to accelerate the creation, deployment and consumption of deep learning algorithms in new health care analytic applications that will be seamlessly integrated into clinical and operational workflows and equipment. •

ADVANCING THE IMAGING PROFESSIONAL

news SPBS Opens New Headquarters Advances in medical technology are revolutionizing health care delivery, creating an increasing demand for SPBS to service and repair the equipment needed to safely diagnose and treat patients. The company’s recent move to the Dallas-Fort Worth Metroplex, one of the epicenters of the medical industry, positions it to meet this demand in Texas and throughout the country.

“Hospital leaders tell us that managing these new technologies is one of their biggest challenges. We shoulder this responsibility by keeping their equipment operating optimally so they can instead focus on what they do best – overseeing the safety and well-being of patients,” SPBS President and CEO Jeff Daugherty said.

Field service offices across the state of Texas and in Oklahoma, New Mexico, Arizona, Colorado, Missouri, New Jersey, New York and Florida, allow the company to offer clients local

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service technicians, which drastically cuts down on response time. SPBS has been using the field service model throughout the Southwest region since its launch nearly 40 years ago.

Local technicians offer customer-centric service that is increasingly important as health care facilities decentralize and consolidate.

“In addition to supplementing labor for hospitals, our technicians go to off-site surgery sites, imaging centers, stand-alone emergency departments, urgent care centers, and physician practices – wherever the equipment is located. That’s why the demand for SPBS’ services continues to increase,” said Danny Mobley, the director of sales and marketing. •

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news

Varian Partners with Penn Medicine Varian is partnering with Penn Medicine to develop and launch a comprehensive proton therapy training and education program. Comprised of both online and in-person training sessions, participants will have the opportunity to learn key clinical concepts firsthand from proton therapy experts at Penn Medicine. The program will cover all aspects of proton therapy, from patient selection and planning through treatment and follow-up.

In-person training and online courses began in January 2018.

The in-person training consists of up to 40 weeks of onsite training at Penn Medicine in Philadelphia. During these training sessions, participants will be able to work directly with the experts in a clinical environment. The immersive program allows for in-clinic observation and live hands-on learning. The online

program will offer over 80 different training models designed and led by proton therapy experts from Penn Medicine. The modules cover all aspects of proton therapy from the basics of proton therapy, to beam commissioning and quality assurance, to extensive review of clinical topics and outcomes.

“We are proud to be partnering with Penn Medicine on this new comprehensive proton therapy training program,” said Dr. Moataz Karmalawy, general manager of Varian’s Particle Therapy division. “Continued education and training is playing an important role in the growing availability of proton therapy. Through this new program we have the ability to expand the knowledge and skills of clinicians and therapists in proton therapy around the world.” •

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1.800.958.9986 www.gmi3.com 18

ICEMAGAZINE | FEBRUARY 2018

ADVANCING THE IMAGING PROFESSIONAL

imtmedical Offers Ventilation in MRI Environment with Bellavista mr Visual diagnostics have been revolutionized by magnetic resonance imaging (MRI). However, some precautions must be observed when performing an MRI scan. This concerns not only patients but also medical devices. With the bellavista mr, imtmedical now also enables unrestricted ventilation in the MRI environment.

The strength of the magnetic fields poses challenges: magnetic metal parts must not be placed too close to the MRI machine, as they will be attracted by the magnet and can result in serious injuries to patients or damage to the scanner itself.

It can also be very difficult to use medical devices near an MRI machine. Many medical devices have magnetic components that are attracted by the MRI or cannot provide fully reliable performance because of the magnetic fields. This can result in difficult situations in particular for ventilated patients who are especially vulnerable because of their dependence on a ventilator.

“On the one hand, it is extremely important to continue the ventilation strategy; on the other hand, complications must be prevented if the ventilator is placed too close to an MRI scanner,” explains Harri Friberg, CEO of imtmedical ag.

The latest ventilator from imtmedical has been specially developed for such situations. With the bellavista mr, it is possible to continue the ventilation process in the MRI environment without restrictions. This is thanks to the use of materials that are not magnetic or only slightly magnetic as well as two further precautions: a trolley with integrated braking function and the MR-Guard that triggers an alarm as soon as the ventilator goes below the necessary minimum distance from the MRI scanner.

Furthermore, a powerful battery ensures that patients can be transported within the hospital with no problem over a period of four hours. So, not only can the bellavista mr be used on every hospital ward, but it can also be safely moved between wards. •

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news

PEOPLE ON THE MOVE

02

03

04

06

By Matt Skoufalos

1.

Radiological Service Training Institute (RSTI) has named Bernie Dixon its director of services. Dixon joined RSTI from Crothall Healthcare, where he spent three years in various positions, most recently as national director of diagnostic imaging. Trained as a BMET in the U.S. Air Force, Dixon began his career as a field engineer with Digital X-Ray Specialists and later spent 16 years as a CT, nuclear medicine and PET team leader with GE Healthcare.

2.

Rick Neufarth has joined the business development team at the InterMed Group of Alachua, Florida. Neufarth has spent 20 years in sales and management, working in radiology, asset management, equipment sales and IDN partnerships for GE Healthcare and Siemens Healthcare.

3.

Cypress Fairbanks Medical Center Hospital in Houston, Texas has named Hannah Gelbs its COO. Gelbs was promoted from associate administrator at West Houston Medical Center; both are part of the HCA Healthcare Gulf Coast Division. She has a master’s degree in health care administration from Trinity University, and is a member of the American College of Healthcare Executives.

4.

EMD Serono of Rockland, Massachusetts has promoted Zhen Su, global head of medical affairs, oncology, to chief medical officer for North America.

5.

Onrad Inc. of Riverside, California has added David Engert as president and CEO. Engert was president and CEO of Nighthawk Radiology Holdings Inc., has been president and CEO of Quality Care Solutions Inc. (QCSI), and has held senior leadership positions in sales and executive management at McKesson, HBOC, Sybase, Xerox and Boeing.

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6.

Syapse of San Francisco, California has added Dr. Aradhana Ghosh as vice president of oncology. A board-certified medical oncologist who has practiced hematology-oncology at Kaiser Permanente, Ghosh was most recently a medical oncologist at IBM Watson Health.

7.

HCA Healthcare Gulf Coast Division of Houston, Texas has named Eric Evans the CEO of Tomball Regional Medical Center, replacing interim CEO Brett Kinman, who will remain COO. Evans was previously the CEO of East Houston Regional Medical Center, and has been with HCA Healthcare for 22 years. He has a master’s degree in health services administration from George Washington University and a bachelor’s degree in business administration from University of Texas.

8.

The American Cancer Society has elected seven new members to its board of directors: Joseph A. Agresta, Jr., president of Benzel-Busch Motor Car Corporation; Bruce N. Barron of Origin Ventures; Edward J. Benz, Jr., president-CEO emeritus of the Dana-Farber Cancer Institute; Nancy L. Birdwell, former executive vice president and CEO of the Scott & White Healthcare Foundation; Jennifer R. Crozier, president of the IBM Foundation and vice president of IBM Corporate Citizenship; Michael T. Marquardt, CEO of Global Kompass Strategies, Inc.; and Gary S. Shedlin, senior managing director and CFO of BlackRock. ICE

Find weekly installments of People on the Move at imagingigloo.com

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news

WEBINAR WEDNESDAY

Free Educational Opportunities Continue in 2018

U

MRi sponsored the last Webinar Wednesday presentation of 2017. The presentation featured James McGee, founder of NuclearCardiologyReports.com and Wayne Webster, principal at Proactics Consulting.

The duo discussed and provided useful information for those conducting nuclear cardiology perfusion examinations and requiring IAC (formerly ICANL) certification.

Attendees learned about the new IAC standard for production of reports as well as the IAC certification process and how poorly implemented reporting can scuttle attempts to achieve certification.

The webinar also discussed the impact on clinical operations and revenue generation during lapses in IAC certification.

They also addressed how an automated preformatted report program can and should be added to the daily reporting of patient test results.

The webinar received positive reviews via post-webinar surveys.

“I enjoyed the webinar format for this subject ... the presenters were extremely knowledgeable about their subject and offered additional information when answering questions,” said A. Bannister, CNMT. “This was a very informative and educational webinar. I realize now where we could use Nuclear Cardiology Reports to become compliant with Medicare. I am excited to share this information with my leadership and staff,” Nuclear Medicine Technologist T. Jordan said.

Another 2017 webinar “Techniques To Validate Medical Device Suppliers Claims in the Medical Device Industry” was sponsored by Summit Imaging and shared important advice on how to maintain quality in an imaging program.

Summit Imaging CEO and CTO Larry Nguyen and Training Manager Kyle Grozelle shared some of the key factors health

care facilities are validating to identify quality medical device suppliers that can support the rapidly changing industry.

The webinar addressed understanding quality management system standards and investigating traceability.

Nguyen and Grozelle also discussed certifications that reinforce quality.

“ These webinars provide a forum for BMETs to keep their skills and knowledge about the clinical engineering field up-to-date. It is great that so many professionals are logged on at one time, attending the courses and sharing questions that I would have never thought of asking.” – Biomed E. Huynh

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ICEMAGAZINE | FEBRUARY 2018

HTM professionals from around the world attended the live webinar session and provided reviews in a post-webinar survey.

“Thank you so much for showing us what to look out for.

With patient safety, so much is at stake that it is essential we take all reasonable measures to ensure the safety and quality of the equipment we use that comes in direct contact with our patients,” HTM Director G. Scarlatis said.

“I thought this webinar was very informative! It definitely helps boost my knowledge about the medical device industry,” said Biomed E. Huynh.

The 2017 Webinar Wednesday series was hugely successful in 2017 with more than 10,000 registrations. Also, apADVANCING THE IMAGING PROFESSIONAL

Intuitive

proximately 4,500 CE certificates were sent out throughout the year.

The Webinar Wednesday series was also praised by attendees after every presentation, including the most recent ones.

“These webinars provide a forum for BMETs to keep their skills and knowledge about the clinical engineering field up-to-date. It is great that so many professionals are logged on at one time, attending the courses and sharing questions that I would have never thought of asking,” Biomed E. Huynh said.

“I always enjoy Webinar Wednesdays as they provide me with information that is helpful at my job,” Senior Biomed S. Gardner said.

“Webinar Wednesdays – the best way to stay current in the biomedical maintenance business,” added B. Black, BMET. “I use the webinars to help me with the newer AAMI regulation to keep my CBET current. I wish I would have known about this program earlier, however. These really do help and I learn things too. A win/win situation in my book,” said M. Tassler, BMET. ICE

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people

By K. Richard Douglas

PROFESSIONAL SPOTLIGHT Corpsman to Imaging Pro: Robert “Bob” Hedderman

S

ince just after the Civil War, the University of Pittsburgh Medical Center (UPMC) Shadyside Hospital has served the people of the tristate area and the residents of Pittsburgh, where it is located. The 520-bed hospital includes nearly 1,000 physicians and has earned Magnet status from the American Nurses Credentialing Center. UPMC is closely affiliated with the University of Pittsburgh.

At UPMC Shadyside, the imaging and equipment maintenance, management and repairs are handled by BioTronics.

BioTronics is UPMC’s clinical engineering department. It is fully owned by UPMC but does some third-party work as well.

A member of leadership, within the HTM ranks at UPMC/BioTronics commends their imaging manager for being so patient-focused.

“Bob is a great example of someone rising through the ranks to reach the highest levels of technology and customer support,” says Joseph “Joe” A. Haduch, MBA, MS, senior director of clinical engineering at UPMC/BioTronics.

Haduck is referring to Robert “Bob” Hedderman, radiology enterprise engineer for BioTronics at the UPMC Shadyside.

“Bob is a graduate of Penn State’s Biomedical Equipment Program and also served in the Naval Reserve,” Haduch adds.

Haduck says that Hedderman has a

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strong patient focus and that he transitioned to CT, and then PET/CT, and is one of the foremost in-house authorities on PET technology.

“In addition, Bob manages our imaging department at Shadyside Hospital, but what separates Bob from everyone else is his unwavering dedication to his craft and the patients he serves. Bob has over 25 years in clinical engineering experience but his most valued skill set is how he supports his customers, his colleagues and the clinicians throughout UPMC,” Haduck says.

“His commitment puts the needs of the patients ahead of his own personal interests. Bob consistently works weekends, after hours, often without prior scheduling, to make sure our patients expectations and needs are met,” Haduck adds.

Navy Benefits Hedderman first found an interest in HTM because of the Navy.

“I became interested in the biomedical field when I visited the Navy recruiter back in 1986,” he says.

“He informed me of a new program the Navy Reserves were offering with a six-year enlistment that would cover 100 percent of the tuition for two-year medical programs at Penn State. Since I was

already interested in electronics, I decided on biomedical equipment technology,” Hedderman remembers.

He ended up attending a branch campus of Penn State and received an associate degree in biomedical engineering technology.

As Haduck pointed out, Hedderman made the jump from biomed to imaging with additional training.

“The hospital that I was working for at the time was expanding its in-house imaging service program to nuclear medicine.

Since I showed interest, my employer sent me to RSTI for the nuclear medicine introduction course, before I attended manufacturer training,” Hedderman says.

“I also continued into radiology with RSTI and Ditech levels 1, 2 and 3 before attending several manufacturer training courses. Since then, I was hired by my current employer UPMC where I serviced the radiology equipment for five years before I was presented [with] the opportunity to service CT and PET,” Hedderman adds.

Since entering the field, Hedderman has worked as a biomedical equipment technician, biomedical equipment specialist, radiology equipment technician, radiology equipment specialist and finally as a radiology enterprise engineer.

Hedderman remembers the transition to imaging as a little intimidating, at first.

ADVANCING THE IMAGING PROFESSIONAL

Favorite part of being an imaging professional?

“Every day presents a different problem.”

GET TO KNOW THE PRO Favorite book: I prefer to read hunting magazines.

Favorite movie: “Band of Brothers” mini series Favorite food: Pizza 5 things on my bench: • • • • •

Robert “Bob” Hedderman Imaging Professional

“The biggest challenge for me as an imaging professional was stepping out of my comfort zone as a biomed and accepting the opportunity for training in nuclear medicine. I was a biomed only a few years and was working with the OEM engineer on a nuclear imaging problem and remember thinking how knowledgeable the FSE was and doubted if I could handle servicing imaging systems. Looking back, accepting that challenge was only a stepping stone and turned out to be the best decision of my career,” he says.

Helping Fellow Troops Hedderman recalls one prior challenge from when he was part of Desert Storm. Fleet Hospital 6, which had been prepositioned in Japan, was activated in December of 1990. It was WWW.IMAGINGIGLOO.COM

assembled near Alwardi, Bahrain. The hospital remained active until the spring of 1991.

“As a reservist, I was activated for the first Gulf War and served as corpsman/biomed for Fleet Hospital 6 in Bahrain. Fleet Hospital 6 was a 500bed Navy field hospital, that was climate controlled with heating and air conditioning, included several operation rooms, an X-ray room, a lab and a dental department,” Hedderman says.

“Our biomed department consisted of eight to 10 technicians and our primary responsibilities consisted of unpacking and testing the new equipment.

Since the war ended so quickly, and we only had a few non-combat related injuries, most the equipment wasn’t used and the hospital was only in service a few months,” he adds.

Coffee Service manuals PC Cellphone Family photos

When not on the job, Hedderman enjoys hunting, fishing and the outdoors. He has been happily married for 26 years to his wife, Pam, and has a 21-year-old son and an 18-year-old daughter.

“Since both of my kids are in college I no longer coach my son’s hockey team or spend weekends watching my daughter play softball. I am able to spend more time doing outdoor activities, such as kayaking with my wife or archery hunting,” he says.

“This may sound crazy to some people, but I’m sure some can relate. Besides spending time with my family, there is nothing more enjoyable to me than sitting in a tree stand on an autumn morning in the middle of nowhere archery hunting,” he adds.

It is the peacefulness of a fall tree stand that provides a break from the important work of this imaging service specialist. ICE ICEMAGAZINE

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people

By K. Richard Douglas

DEPARTMENT SPOTLIGHT Eskenazi Health System Imaging Service Team

I

ndianapolis is famous for more than a 500-mile auto race; it’s the home of Eskenazi Health. The health system dates back to 1855, starting as City Hospital, and treated Civil War solders in its early days. Named after Sidney and Lois Eskenazi, who provided a $40 million gift to build a new hospital, the 315-bed health care facility partners with the Indiana University School of Medicine.

According to the health system’s website, Eskenazi Health was named one of the nation’s 150 best places to work by Becker’s Hospital Review. It is also home to the first adult Level I trauma center in Indiana.

Besides the main campus, the health system includes 13 major offsite clinics. The system’s biomedical engineering department consists of 20 employees, three of which are dedicated to imaging service.

The imaging technicians include Matt Dimino; radiology service technician-IT, Anthony Phoenix; radiology service technician-IT and Greg deJong; imaging/biomedical service technician.

Supported equipment includes two MRIs, three CTs, five fixed X-ray rooms, two fluoro rooms, three nuclear medicine systems, five IR/cath labs, six mobile X-ray systems, 12 C-arms, four mammography rooms and four offsite locations. They also maintain and service all injectors and dental X-ray equipment.

The imaging team stays current by utilizing a combination of manufacturers’ training, third-party training and in-house training.

They also receive internal and external training for IT certifications, such as cyber security, PACs, A+, medical device integration and healthcare information technology.

Matt Royal, CHSP, CHEP-FSM, CHTM, CL26

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SO-M, CHC, CHFM, CBET, director of biomedical engineering says that “all purchasing, planning, and construction is consulted on by the technicians and management.”

“Contract negotiation is supported by supply chain with the terms and conditions requested by the biomedical engineering department. The technicians typically source the parts and labor. Basic user training is provided by the department; however in-depth training is relied on from the manufacturer,” Royal says.

He adds that the imaging service technicians do all the work unless they require the vendor as a supplement; they have mostly manufacturer training but also utilize third-party training as needed. The team is fully trained on Siemens Aera MRI, Siemens Symbia Nuclear Medicine, Philips Brilliance CT, Philips DigitalDiagnost X-ray, Philips Alura FD IR/cath labs and Hologic Dimensions mammography, according to Royal.

Talented Team All three imaging service team members have skills and competencies beyond their daily work duties.

“One of the imaging techs (Matt Dimino) teaches HETM courses as an adjunct professor at IUPUI.” Royal says.

“Matt Dimino brings his students to the hospital for lecture as well as utilizing the shop as a lab environment. Matt’s part-time role as an adjunct professor helps develop the internal education programs at the organization and ensures a strong relationship with the IUPUI HETM program. The students receive real-world classroom experience by attending the classes at the hospital. Students some-

times become future employees through the internship partnership,” Royal adds.

Anthony Phoenix owns his own HTM company.

“Anthony Phoenix started his career as a biomedical technician and continues it part-time as an entrepreneur who provides biomedical services to health care providers not related to Eskenazi Hospital. His business employs several biomedical equipment technicians who provide onsite and depot repair services,” Royal says.

“The newest member, Greg deJong, is in a hybrid biomed/IT role which I think is unique for succession planning,” Royal says.

“Greg deJong took an interest in ultrasound service which was a gateway for him to the imaging modality. This unique role allows for continued mentoring with the more experienced imaging technicians. Greg is gaining experience on general X-ray and is gaining knowledge on CT and MRI,” Royal explains.

He points out that as part of a succession plan, deJong can move up to a full radiology equipment technician in the future.

“Since the market is lacking experienced imaging professionals, the hybrid position ensures the organization doesn’t have a gap in in-house imaging support,” Royal adds.

Leadership Skills The imaging team is recognized for more than its specialization in various imaging modalities. The imaging service technicians are viewed as potential leaders as well. They have also been involved in projects to assure that there are contingencies in case of failure and to protect the hospital’s equipment.

The team participated in the development ADVANCING THE IMAGING PROFESSIONAL

Members of the Eskenazi Health System Imaging Service Team include (from left) Anthony Phoenix, Greg deJong and Matt Dimino.

and installation of electrical protection for radiology equipment and contingency planning for imaging devices that included assurance of hard drive clones for all imaging devices.

“The electrical protection for the imaging equipment project had the technicians working with the electricians on sizing, procurement and installation of surge protection. They also identified additional protection needs for CT and MRI that included an uninterruptable power supply system,” Royal says.

He says that the contingency planning project included the assessment of the imaging equipment inventory and utilization to establish communication and service protocols to ensure back-up plans for equipment failure.

“Other contingency planning was based on ensuring hard drive clones were made for all imaging devices to ensure faster repair times, hard drive failures often require software reloads that may take long periods to install and configure,” Royal says.

The imaging team is participating in ongoing leadership training.

“The hospital supports an internal leadership program for managers and above, however the imaging team has been asked to be a part of this program to continue to develop leadership skills WWW.IMAGINGIGLOO.COM

as well as project management skills,” Royal says.

“They also make project management part of their goals each year. These projects generally include new purchases of technology and optimization of current technology. They are heavily involved in projects that improve the educational processes in the department and serve in as many roles as needed,” he adds.

The hospital opened in December of 2014 and one challenge the team has been pondering is building a replacement calendar for the equipment, most of which has a useful life of seven years.

They are trying to determine whether to upgrade, to extend the life of the imaging equipment, or replace it.

“With the high cost of replacing or upgrading equipment we obviously can’t replace everything at one time. So, the replacement plan is a tiered approach, where currently we are looking at the oldest equipment first,” Royal says.

“For example, we moved existing cath lab and mammography equipment from the old hospital. We are currently involved in the upgrade or replacement of those systems. We also are analyzing utilization of our ultrasound equipment, although it is not end of support, some of the equipment receives excessive wear and tear and failures on some units are

high. We have looked at rotating less utilized equipment or replacing the equipment that receives the excessive wear and tear,” he explains.

Royal says that the imaging service techs are also involved in improving infection prevention and safety through lead garment management. They have partnered with a company that specializes in the cleaning and repairs of lead garments.

“Often, this is managed by the radiology staff, but the technicians manage this for multiple areas that use X-ray such as the operating rooms, cath labs, dental and the trauma areas. The risk and safety department has endorsed the management of the lead garments by the team because of the effectiveness of the current service program on the imaging equipment,” he says.

All the imaging technicians are part of the Indiana Biomedical Society (IBS). Matt Dimino is a past president of the IBS. He also speaks at medical device cybersecurity workshops.

Eskenazi Health’s imaging service team has proven that they are a well-trained and capable team with diverse abilities that empower them to keep equipment maintained and in proper working order. They are proud of their work and their ability to help Eskenazi Health deliver quality health care and positive outcomes to patients from throughout the Indianapolis area. ICE ICEMAGAZINE

27

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s per a report by Persistence Market Research (PMR), the global surgical imaging market is expected to experience moderate growth throughout the forecast period 2017-2026. The market is estimated to increase at a 4.4 percent compound annual growth rate (CAGR). By the end of 2026, the global surgical imaging market is estimated to reach $1.384 billion.

The global surgical imaging market is segmented on the basis of end user, product, technology and application.

Based on the product, the market seg-

to reach close to $900 million in revenue by the end of 2026.

Based on the application, the orthopedic segment is expected to witness strong growth in the global surgical imaging market during the forecast period 2017-2026. By the end of 2026, orthopedic is estimated to reach close to $500 million in revenue.

Geographically, the market is categorized into Europe, Latin America, North America, Japan, the Middle East and Africa (MEA), and Asia Pacific Excluding Japan (APEJ). Among these re-

“C-arms are currently being used in several areas of medicine and their varied applications are only expected to increase over time.” – Mordor Intelligence ment consists of full-size C-arm, mini C-arms and O-arms. Among these, full-size C-arm is expected to witness steady growth during the forecast period 2017-2026. Full-size C-arm is estimated to account for more than half of the revenue share by the end of 2017.

Hospitals are expected to be the largest users in the global surgical imaging market. Hospitals are estimated

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gions, North America is expected to be one of the largest regions in the global surgical imaging market.

In 2015, the global market for C-arms was estimated to be $1.7 billion. It is expected to exceed $2 million by the year 2021, growing at a (CAGR) of 3.2 percent during the forecast period of 2016-2021, according to Mordor Intelligence.

“C-arms are currently being used in several areas of medicine and their varied applications are only expected to increase over time,” Mordor Intelligence reports.

“These factors, coupled with the increasing demand for health care infrastructure in developing and third-world countries, are driving the global C-arms market. On the other hand, the growing use of refurbished devices and the low replacement rates of C-arm systems are hindering market growth. With increasing focus on the portability of C-arms, there is a great market opportunity for companies producing mini C-arms. However, the increasing cost concerns in emerging economies resulting in increasing pricing pressures are presently the greatest challenge to be overcome in order to tap the full potential of this market.”

Research and Markets forecasts the global flouroscopy C-arms market to grow at a CAGR of 4.02 percent during the period 2016-2020.

Persistence Market Research also predicts continued growth for the global C-arm market.

The global fluoroscopy and C-arms market is likely to exhibit a CAGR of 4.5 percent during the forecast period (2016– 2024) with market revenue expected to increase to $4.2 billion by 2024, according to Persistence Market Research. ICE

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products

GE Healthcare OEC Elite CFD GE Healthcare’s OEC Elite CFD is the first premium mobile C-arm offering both a 31cm and 21cm CMOS flat panel detector, which is designed to produce high image quality at a low dose. The OEC Elite CFD produces crisp and clean images, enabling better imaging confidence by allowing surgeons to see greater differentiation between a patient’s anatomy, such as bone, organs and skin and exceptional vessel detail in even the toughest vascular procedures. Beyond high-quality imaging, the streamlined design of the C-arm is intended to provide the surgeon with more control and maneuverability in the OR with a streamlined workstation, an intuitive user interface and an entirely new ergonomically designed C-arm called Ergo C. The new OEC Elite CFD premium C-arm portfolio will provide clinicians with high-quality images during a variety of surgical procedures, including vascular, spinal, orthopedic, urological, general surgery and pain management. •

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ICEMAGAZINE | FEBRUARY 2018

ADVANCING THE IMAGING PROFESSIONAL

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Ziehm Imaging CMOS Portfolio Ziehm Imaging announces its leadership in the CMOS C-arm segment with a complete CMOS portfolio extending from compact mini C-arms to powerful high-end devices. The CMOSline1 systems are aimed at professionals who are not content with the ordinary and who strive for the optimal. These premium C-arms offer an enhanced CMOS imaging chain from generator to detector. Based on the tried-and-true flat-panel detector, the new CMOSline enables superior image quality by showing significantly more detail. •

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CMOSline represents a system configuration that is based on a Ziehm Imaging CMOS flat-panel detector.

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products Hologic Fluoroscan InSight FD Mini C-Arm Imaging System for Extremity Imaging The Fluoroscan InSight FD Mini C-Arm Imaging System for Extremity Imaging with exclusive rotating flat detector technology provides imaging versatility in the procedure or operating room. The enhanced system boasts significant image quality updates designed to improve the user experience, and now offers a high-resolution mode and a low dose rate mode, while offering clinicians the largest image size and highest image resolution available in the industry, in an intuitive 24-inch HD touch screen.iv,v,vi •

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OrthoScan FD Pulse The OrthoScan FD Pulse is the first and only mini C-arm with pulsed fluoroscopy. The advanced OrthoTouch user interface provides seamless operation of system controls via a familiar experience similar to a smartphone or tablet. It features a 24-inch high-resolution diagnostic widescreen monitor providing a 20 percent larger viewing area. It helps with reduced dose by offering selectable pulses per second depending upon imaging needs. It includes a large flat detector that is a square-shape CMOS detector that provides greatest field of view so users see more anatomy. Other features include surgical LED lights, 150-degree orbital rotation and one of the thinnest flat detector housings on the market. •

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products

Siemens Healthineers Cios Fusion The Cios Fusion premium flat-panel detector system from Siemens Healthineers – part of the company’s new, completely redesigned C-arm portfolio – has two detector sizes: 30cm x 30cm and 20cm x 20cm. The system’s flat-panel detector technology offers greater visibility than image intensifier-based systems, ensuring greater anatomical coverage. The Cios Fusion features the same easy-to-use touchscreen interface and software options as the company’s ultra-premium Cios Alpha mobile C-arm, simplifying cross-training efforts. The touchscreen remote can be positioned at the operating table to control the C-arm from within the sterile work area. The Cios Fusion also includes intelligent power management to virtually eliminate overheating, which can cause delays and scheduling backups. •

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ADVANCING THE IMAGING PROFESSIONAL

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Philips Azurion Azurion is Philips’ next generation image-guided therapy platform and the new core of its integrated solutions portfolio. Azurion supports a full range of configurations across a broad spectrum of image-guided therapy procedures. These include configurations for high volume routine procedures and flexible configurations for advanced procedures. Harnessing vital procedural information from various sources, such as imaging systems, interventional devices, navigation tools and patient health records, Azurion provides interventional staff members with the control and information they need to perform procedures efficiently. •

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DESIGNING THE

IMAGING ROOMS

of Tomorrow

By Matt Skoufalos

DESIGNING THE IMAGING ROOMS of Tomorrow

I

n the field of medical imaging, technological improvements in imaging have begat ever closer clinical collaborations. When a CT scanner can provide cranial imagery in eight minutes instead of 30, for example, it becomes a modality suitable for use in trauma and ER units. This relationship between device sophistication and clinical practice in turn makes health systems reconsider how they allocate their capital resources and array their inventories. After a couple decades, the depth and degree of that change starts to show broader implications for the planning, design and construction of health care facilities. The faster the technological advances, the quicker institutions must move to keep pace and, at some point, those mechanical gains outstripped design and construction standards. To prepare for the increasing expansion of medical imaging services into a variety of health care settings in the years to come requires bringing design standards up to code.

are revised on a continuous process and republished every four years to incorporate the best practices in the field as well as to eliminate conflicts between the latest version of the standard and clinical practice. In short, Gilk said, medical imaging was moving too quickly for that process to keep up.

“A small, dedicated group of us went in and tried to do a major rewrite of the design standards for 2014,” he said. “At the end of that process, what we said is, ‘You need to blow this whole thing up and build it back from scratch because of the rapidity of change.’ Imaging had just moved too quickly for too long so that incrementalism wasn’t cutting it anymore.”

Gilk pointed out how FGI design criteria for CT suites, for example, were presented as being universal in earlier iterations of the document; today, the variety of needs among providers in different clinical settings no longer makes this so. In response, the FGI has taken the tack that any device itself would no longer be “the first stop in defining the destination of what that space should be,” Gilk said.

Instead, the new first stop is a classifica- Tobias Gilk tion system built around how that device will be used to diagnose and treat a patient.

“Once you’ve decided the highest level of care in this acuity or intervention classification system, then you say, what are the design criteria for the technology, and how do those design criteria change if we’re talking about a Class I, strictly diagnostic image, versus a Class II, where you are doing heavy sedation and general anesthesia, or image-guided biopsies and other types of interventional procedures?” Gilk said.

“Now we have a different set of support characteristics for that space. It may be emergency power, different HVAC, how cleanable the surfaces and materials

“ Technologically, nobody would

argue the fact that today we are leaps and bounds beyond where we were 20 years ago.”

“Technologically, nobody would argue the fact that today we are leaps and bounds beyond where we were 20 years ago,” said Tobias Gilk, an architect and radiology planning consultant with RAD-Planning of Kansas City, Missouri. “But even if we take all of these factors that are state-of-the-art today, they only get optimized in a space that’s designed to facilitate them and accommodate their use.”

Gilk is a volunteer with the Facilities Guideline Institute’s (FGI) Healthcare Guideline Revision Committee, which develops minimum design requirements for planning, designing and constructing health care facilities. These

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are inside that suite. Class III, with the rise of hybrid OR, are inter-operative imaging suites, and the demands for patient care and patient support grow even more significant in that regard.

“What’s on the horizon, and what will arrive in the 2018 FGI, is a shift from ‘a CT is a CT is a CT no matter where you put it,’ to ‘the first thing we’re going to think about is what we plan to permit to happen in this space,’ ” Gilk said. “That definition will characterize specifically what the design criteria would be for that room.”

Part of the inspiration for that shift in thinking is that radiology departments don’t exist in the same way they once did, Gilk said: medical imaging is no longer a centralized destination, but has become a clinical service deployed throughout the entirety of a health system and its facilities.

The FGI classification system is a response to “the disaggregation of imaging as a service line” amid “greater levels of patient intervention and patient acuity,” both of which are factors that influence facilities planning. So too does the portability of health care and the rise of in-home care along the greater trend line of a diverse patient cohort. As these and other hard-to-project, key variables offer increasing complexity in planning for the future of imaging rooms, Gilk advocates that his clients adopt a “rowboat and canoe” perspective when budgeting.

“Most capital needs assessments are done with a rowboat perspective: you’re facing where you’ve come from and your back is towards where you’re

ADVANCING THE IMAGING PROFESSIONAL

ARTICLE CONTRIBUTORS headed,” he said. “The canoe perspective is: you pick a horizon point ahead of you, and move towards that. When we’re working with clients, we try to get them to bounce back and forth between the rowboat perspective and the canoe perspective. The information about what has worked for you historically is important, but you need to turn that around 180 degrees and see how that’s going to shift, and how do we make decisions today that position us for greater success potential 10 years out.”

Building for additional capacity and throughput of a variety of patients with discrete health care needs may also be one of the best ways for many institutions to vouchsafe their financial survival. Often, a facilities expansion can allow for greater efficiencies as well as greater volumes, and although the capital outlay to do so may be significant, the potential for increased revenue yields an opportunity to outpace the rate of declining revenues.

“As reimbursement rates decline, we long-ago crossed the threshold beyond which you can’t cost-cut your way to profitability,” Gilk said. “The fixed costs associated with these services are what they are. Unless we get robots to do everything that human beings do in medical imaging services, you’re not going to effectively be able to cut costs as fast as reimbursement rates are declining. Facilities need to be looking at broadening the scope of patients and conditions and locations for which their services are useful, and treating everybody more effectively and efficiently.”

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Just as important in designing imaging suites that are built to last for the next decade is looking at ways to take stock of existing spaces, said Eddie Acosta, director of business development for the Colin Construction Company of Auburn, California. Changing out existing infrastructure to accommodate next-generation imaging equipment can require re-evaluating the composition and nature of shielding in the walls of rad and fluoro rooms, considering the operations in the rooms above or below the imaging suites, and just generally having more interdepartmental conversations about the changing needs of the professionals who will rely on the equipment involved.

“Before, you had these silos,” Acosta said. “You had IR doctors working here, cath lab doctors working here, other specialties, and they were all separate.

I see a lot more collaboration within hospitals in all the different departments. A lot of doctors speak together and kind of plan the future of imaging systems for that hospital to make sure you don’t have all these different, separate modalities. That’s what I see in the future: a lot of equipment functioning together, speaking to each other to have better workflow in the hospital.”

John Metellus, MR product manager at Siemens Healthineers North America of Malvern, Pennsylvania, said that the shrinking footprint of imaging equipment like MR units reflects advancements in its mechanical composition as well as in its total cost of ownership.

Reconfiguring magnet cryo-cooling systems to run nitrogen-free and then with less helium helped with weight and servicing of MR equipment while reducing the amount of space needed to store those cryogens. Zero-boil-off magnets can limit helium consumption, collecting its condensate to help extend the time needed between refills, as well as helping limit the fossil fuel usage associated with its production, he said.

All these factors combine to make the technology more adaptable to a variety of environments.

“Now you can place it where it’s needed, having MR supplement other

JOHN METELLUS MR PRODUCT MANAGER AT SIEMENS HEALTHINEERS NORTH AMERICA

JESSE PETERSON DIRECTOR OF SHARED SERVICES AT GE HEALTH SERVICES

EDDIE ACOSTA DIRECTOR OF BUSINESS DEVELOPMENT FOR THE COLIN CONSTRUCTION COMPANY ICEMAGAZINE

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DESIGNING THE IMAGING ROOMS of Tomorrow

“ Maybe it’s a rad room today and an R&F room tomorrow, and maybe a CT 10 years from now.” - Jesse Peterson departments other than just radiology,” Metellus said. “You can bring MR guidance in to support the angio suite; into oncology for radiation treatment.

Interventional MR has benefited from this smaller footprint, lighter magnets, and the flexibility to site it almost anywhere it’s needed.”

Metellus’ colleague, Matthew Dedman, CT marketing director for Siemens Healthineers North America, said that as MR pushes more into operating-room environments, CT is pushing into hybrid interventional radiology suites. Facilitating that physical installation is a rail system that enables the scanner to be brought to the patient table to incorporate radiography data, and then shifted back out, as many times as it’s needed per procedure.

“We’re looking to be more efficient in how we operate the system and how we build it,” Dedman said. “Not as much HVAC is required, not as much space; we realize these are real costs that facilities are incurring, so we’re actively looking for ways to reduce these costs.”

Other ways of saving space in the imaging room include transferring controls to a mobile unit; the Siemens Somatom go CT scanner platform is operated by a technologist via a mobile tablet, and the computers associated with a typical CT are integrated directly into the gantry itself.

“That’s much easier for our customers from a siting standpoint, and also offers much more flexibility,” Dedman said. “We’re seeing customers and facilities installing CT scanners in a rad/fluoro concept where there’s no dedicated control room.”

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Robert Dewey, vice-president of advanced therapies, surgery, and cross-modality solutions at Siemens Healthineers North America said cross-platform integrations of discrete imaging technologies likely will continue to evolve alongside minimally invasive surgical procedures because vendors don’t really have the luxury of saying, “Here’s a system that we’ve developed and its only function is IR.” “It’s not something welcome from the proceduralists, but it makes a lot of sense to introduce versatility,” Dewey said. “The key is to develop the platform in a way to address all of those without compromising any of them. It’s difficult to get away from the fact that you need a complex piece of technology to guide these procedures; the counter to that is to really just ensure that it’s something that is utilized fully.

“It’s all about what kind of information you need,” he said. “Part of what we’re focusing on is trying to identify which are the clinical segments of the hospital sizes that really fit into the sweet spot. It’s a significant consideration from a budgetary perspective, but it makes a lot of sense clinically.”

As manufacturers press on with multidimensional technology platforms, Jesse Peterson, director of shared services at GE Health Services of Chicago, Illinois, said that facilities’ managers should still be designing universal rooms that can offer the flexibility of each of the various imaging specialties provided within. Such considerations affect building in capacity for power, heating, ventilation, and air conditioning, patient access and workflow. Thinking toward the future builds additional flexibility into a space, he said.

“Maybe it’s a rad room today and an R&F room tomorrow, and maybe a CT 10 years from now,” Peterson said. “We see a universal grid for ceiling structures more often than we did in the past; when you get into the OR spaces or the hybrid spaces, you are seeing a lot of non-fixed devices.”

Peterson also foresees the imaging rooms of the future will focus on elements of patient comfort, from the aesthetics of lighting and paint colors to piped-in sound, visuals through digital imaging, “even the way airflow is handled.” The more comfortable patients are, the less anxiety they have around the imaging study, and the faster and easier it’ll go, he said. Putting more of the experience into the hands of the patient is another way to do it.

“In some of our new mammography products, the patient can control the breast compression under the guidance of a technologist,” Peterson said.

“In some of our sensory suite designs, patients walk into the suite and we hand them an iPad. They pick the images, the intensity, the color, the sound, the lighting – putting that control in the patient’s hands.” ICE

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ADVANCING THE IMAGING PROFESSIONAL

insight

IMAGING MATTERS Open Letter about NEMA/MITA 2-201X Requirements for Servicing Medical Imaging Equipment

T

here is something subtly sinister about the NEMA/MITA 2-201X. It is written in seemingly logical and reasonable language to ensure quality imaging is maintained. It has a stated purpose of ensuring imaging quality throughout the country. However, it is an attempt to get people that don’t know anything about medical imaging to create laws that will have a disastrous impact to most hospitals.

There is no reason for this type of legislation to exist. There are already quality controls built into all of the guidelines that CMS has in place. There is no national dilemma that needs to be addressed. There is simply an attempt to manipulate rules and regulations that benefit manufacturers.

One interesting section is 7.4 Service Activities. Requiring worn parts to be replaced for a variety of circumstances. One of these is if it could cause indirect harm to the patient.

There is no definition as to what indirect harm could mean. Do rescheduled studies, emotional stress, or delay of imaging count? If so, what is enough to qualify? What standards are used to determine what might happen? In short, it is an avenue for the manufacturer to have more parts replaced more often for a nice increase in sales. It has nothing to actually do with improving quality.

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In an attempt to prevent anyone but the manufacturer from selling parts, Section 6 is an interesting read. If you are using an Independent Service Organization (ISO) the parts they provide will be considered Non-Qualified. Even though many ISOs may have a higher quality parts due to more stringent quality control practices, being able to label it as “non-qualified” leaves a lot of room for lawyers to get involved and run everyone out of business. You can, in theory, have a qualified part as a non-manufacturer entity.

The way to have validation as a qualified part is under section 4.4 and is vague enough that the manufacturers will tell you how to do that later.

Perhaps it would be more accurate to say, “Manipulate it later to ensure that only manufacturers can have qualified parts.”

This is only a small sampling of the attempt to drive ISOs out of business and drive the cost of maintaining medical imaging equipment up by significant amounts – all to benefit manufacturers. There is nothing in the document that will significantly improve outcomes for patients.

It only creates a higher cost for health care, with arguably reduced quality, as medical systems cost for ownership will increase dramatically.

With reduced reimbursement, that means cuts will have to be made somewhere.

If you care about medical imaging, the cost of health care, and really improving quality of ser-

Written by John Garrett Manager, Clinical Engineering at Catholic Health Initiatives

vice to the patient find out more about NEMA/ MITA 2-201X. Then, find all the ways you can help prevent it from ever being more than a bold grab by the manufacturers for a monopoly on service. ICE John Garrett has 20 years experience in imaging service including general radiation, mammography, CT and nuclear medicine. He has worked for third-party service companies, manufacturers, sales companies and in-house imaging teams.

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insight

CAREER ADVICE Every Leader Must be a Game Changer

S

omeone recently asked me who the major influence in my life was. I immediately responded that the major influence in my life was my Dad. Both of my parents worked hard; however, my Dad was always my hero. My Dad was not only a hard worker, but he always did the right thing. He had a lot of integrity, was loyal, honest and confident in everything he did. He was very inspiring to everyone around him. He was competent in his jobs and people trusted him.

My Dad was always enthusiastic and had a smile on his face, even during the toughest of times. His employees loved him and would do anything he would ask. But the biggest reason was that he made it a partnership with his staff. Additionally, he could see through problems that even higher management could not see, and he would quickly find resolutions to extremely complex issues. He was a game changer – he transformed his department from ordinary to exceptional.

Outstanding leaders can and should be game changers in today’s highly technological, complex and fast-changing environment. A game changer is a leader who takes an organization or department from ordinary to exceptional. The best leaders go above and beyond. They don’t accept the mundane. They understand the value of service above self.

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Game changers understand the importance of relationships and have the unique ability to effect and implement change. They lead their organizational transformation by improving processes and relationships, often taking an idea and innovating the team toward a great achievement. Leaders who are game changers have a passion and commitment to motivate and inspire others. These leaders also have the skills and abilities to articulate the department’s goals and mission, motivating their team to accomplishment in a committed fashion.

Health care and medical imaging service organizations have their own complex challenges for leaders to overcome and manage. Today’s technological and regulatory requirements in the medical imaging departments are evolving quickly, too. This requires leaders to be persistent and committed.

Successful medical imaging leaders are exceptional game changers in their field. By keeping up-to-date with the latest technological advances, they incorporate emerging technology and overcome obstacles and challenges daily with confidence and resilience.

Game changers must be proactive and maintain enthusiasm within their departments. They must be able to motivate their team to readily accept change to remain relevant and maintain a highly productive department.

Written by Cindy Stephens Stephens International Recruiting, Inc.

The game changer focuses on strategic accomplishments and does not accept failure. They have a purpose to serve, inspire and improve efficiencies while maintaining a cohesive work environment for the staff.

Leadership success requires the ability to define their strategy for upcoming change and challenges. Leaders must be committed and passionate to influence their team to accept change. More importantly, they must be able to inspire staff at every level and every generation.

Realizing that the culture today is different, including diverse backgrounds and generational differences, leaders will invest the time to understand and strengthen the core competencies of the team. Leaders will be able to influence each individual and help them through the technological and imaging platform changes within the department.

Leaders succeed in their roles as game changers by facilitating and influencing change. They have the ability to create a unified and competent environment while achieving desired outcomes efficiently and effectively.

ADVANCING THE IMAGING PROFESSIONAL

Technological and cultural changes today have reshaped imaging service department employees. It requires a set of core values and organizational philosophy that guides performance and accomplishments.

This is especially important when leading a department through the challenges of any type of change. Additionally, successful transformation in today’s fast-moving technological environment often requires leaders to maintain committed employees who can contribute their knowledge, leading to highly effective performance.

How that is accomplished is through a game changer, a leader who can inspire and transform the department from ordinary to exceptional. A game changer requires a set of skills and mindset to commit to a relentless process during a challenging implementation period.

Game changers usually have specific characteristics that help them achieve their goals naturally. They: • Build lasting relationships that are

built on trust.

• L ead by example and easily inspire others to follow.

• Keep up-to-date in technology and processes, and are very knowledgeable.

• Are articulate in communicating a clear vision and goals for achieving change.

• Are great motivators adept at influencing others.

• Provide exceptional customer service by creating an efficient, productive and friendly environment.

• Have positive, collaborative and honest personalities.

• Are persistent but patient.

• Publicly recognize excellence in their employees.

Think about one person who may have influenced your life and your leadership abilities. Are you a leader who can transform your imaging service department from ordinary to exceptional? ICE

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ADVANCING THE IMAGING PROFESSIONAL

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IMAGING SERVICE 101 I

t seems as though the business environment for hospital organizations and companies providing imaging services has never been more volatile. Hospitals have been joining together in buying groups for many years as a way to reduce their costs for purchasing supplies and imaging systems. After recent changes to federal laws and CMS regulations around U.S. health care, that trend evolved to mergers and acquisitions of smaller hospitals and clinics into larger health care organizations. “Get big or go home” seems to be the mantra for the CFOs of health care providers.

Imaging service companies and independent service organizations (ISOs) have seen growth and changes since their inception, especially as the OEMs themselves entered the multivendor services market. GE and Philips have made multiple acquisitions of ISOs to develop their MVS businesses. More recently we have seen big corporations such as Aramark, Sodexo and Baird investing in biomedical and imaging services. And in what I see as a testament to capitalism and ingenuity, we continue to see small and new companies providing service on scanners, sometimes as a subcontractor to an OEM or one of the big biomed services companies.

After more than four decades in medical imaging, I can say the one thing that has remained constant in our business is change.

Sometimes the effect on us as an individual is minimal. I spoke with some imaging engineers at a hospital in southern California about five years ago who had worked for four companies over a period of only 10 years; the hospital, Cohr, Masterplan and Aramark! They said their jobs were essentially unchanged.

They even had the same desks in the hospital biomed shop. However, the direct and indirect effects on individual technicians and engineers due to changes in ownership are usually much larger. Mergers and acquisitions can lead to big changes in policies and the working environment, and are typically followed by layoffs. When this happens in your career as an imaging engineer, it may be the first time you realize the importance of your reputation, WWW.IMAGINGIGLOO.COM

sometimes called your personal brand. The more value your “brand” has, the better your opportunities are going to be.

You develop a reputation or personal brand with your customers and coworkers whether you consciously think about it or not.

Initial impressions are important, especially these days when your coworkers and customers may “Google” you the first time they meet you. With the amount of information available online, it is difficult to maintain an image that is not true to one’s self.

Trust and your personal brand are built over time, sometimes over years. The main components of your brand are reliability, technical competency, the quality of your work and your ability to communicate.

Reliability means showing up to work on time and prepared, and consistently doing your best. It also means you are trusted to do what you say.

Fortunately, being technically competent and able to produce consistently good work doesn’t mean you have to be perfect. Admitting and recovering from a mistake can actually build credibility. Things break (or we would not have jobs), and everyone makes mistakes.

I have known and worked with several imaging engineers who are only mediocre technically but have customers that rave about them as their service engineer. Their customers believe they care about keeping their scanner up and trust them. I have also noticed those engineers are good communicators, and often have developed a personal yet pro-

Written by Jim Carr Director of Services and International Operations for AUE

fessional relationship with the customer.

But be aware that one bad mistake on the job or in your personal life can wipe out years of building a reputation. Adverse events that are typically associated with risk to your reputation include ethics, safety, security and quality.

The company you work for has a lot to do with how your customers see you. As a representative of the company, it is your job to follow and apply their business policies. That can be difficult when the news is not what the customer wants to hear. My advice is to make sure the customer is informed of the policies before there is an issue, if at all possible, and to consistently communicate and enforce the policies. When the customer is not happy about it, being empathetic and sincere in acknowledging their dissatisfaction is critical to your ongoing relationship with them.

There may come a time in your career when the company you work for is adversely affecting your reputation. Many ISOs have been started by field engineers who got fed up with “taking hits” for bad parts. And many other ISOs have been started by people that were laid off by companies trimming their costs.

That is when you will truly see the value of the reputation you have built. ICE Jim Carr is Director of Service and International Operations for AUE. He may be contacted via email at JCarr@auetulsa.com.

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insight

10 UNIVERSAL PRINCIPLES Of Workplace Excellence

W

hen people talk about what it means to have an excellent workplace, the discussion could take years. Many researchers have sought to learn what makes a workplace more productive, but not as common are studies for how to make a workplace excellent. The definition of “excellent” is “extremely good; outstanding,” and the definition of “outstanding” is “exceptionally good.” Look up the definition of “good” and it says, “to be desired or approved of.”

Therefore, I tend to define an excellent workplace as a place where people desire to be. For sure, this definition includes productivity because people want to be productive, but there’s so much more. After nearly 30 years of workplace consulting in industries ranging from medical technology to meat packing and from aerospace defense operations to agriculture, I’ve seen what works – and what doesn’t – in hundreds of different work environments.

What follows is what I call my “10 Universal Principles of Workplace Excellence.”

It’s a compilation of principles that if practiced are key ingredients for making any workplace excellent. Without further ado, here they are: Real leaders keep one eye on the landscape, communicate their vision throughout the company, and listen carefully to all feedback.

Leaders are like guides on a river rafting trip. They keep one eye on the conditions they’re heading toward and make decisions about which actions are the best for getting to where they want to go. They may float the river every day, but the river isn’t

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necessarily the same every day. Therefore, real leaders communicate what needs to happen and then listen for feedback that may be vital.

Example: If a leader tells people to “row” but doesn’t listen when they tell him their oars are broken, they’re all going to be in trouble.

Real managers train their teams, focus on goals, and seriously consider all input for how to improve “the system.”

The role of a manager does not involve blue spandex and a red cape. Frankly, despite the common misconception, nobody is really expecting managers to exhibit superhero behavior. Instead, managers need to be vitally aware of their role: Balance resources to accomplish the vision set forth by leadership, and train teams in the knowledge, skills and attitudes necessary for success.

Managers also need to remember that they themselves are not omniscient, and must therefore be open to feedback from all employees on how to improve operations.

People want to work on things that matter to them.

It’s a core tenet of human nature.

Enough said.

The fundamental nature of any workplace is “product” + “process” = “outcome.”

Regardless of industry, sector or profession, every work environment boils down to this very basic equation, and there’s no need to complicate it. Therefore, learn all the facets of the “raw product,” which is whatever information or

2

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Written by Daniel Bobinski Workplace Consultant

tangible items you are given. Then learn the nuances of the “process,” which is what you do with what you are given. Do those two things well, and learn how to adjust when necessary, and the chances of an excellent “outcome” are greatly increased.

Employees are not mind-readers.

They need to be taught the expected “outcome,” and the nuances of both the “raw product” and “processes” needed to achieve that outcome.

Wouldn’t it be easy to attach a cable to the back of each employee’s head and upload everything they need know? Sure, but it’s not reality. We’re told that medical researchers are striving to achieve that capability, but it isn’t here yet. Therefore,

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ADVANCING THE IMAGING PROFESSIONAL

insight

both managers and leaders must place a high priority on training. And, in practice, managers really need to think like trainers.

They may not do any of the actual training, but employees aren’t mind-readers. They need quality training. Leaders need to prioritize it, and managers need to ensure it happens.

The workplace needs to be a supportive, forward-thinking environment.

Supported objects remain standing in a storm, while unsupported objects fall over. Similarly, forward thinking teams seek solutions, while backward thinking teams seek only blame.

Training other team members to understand what you do is central to team environments.

When team members are clueless about what other team members are responsible for, it leads to slower decisions – and sometimes bad ones. Like players on a baseball team, knowing what one can expect from other team members builds speed, confidence and productivity.

Focusing on results is much more effective than focusing on accurate time cards.

The concept of Results Only Work Environments (ROWE) has been around for a few decades now, and there are good reasons for it. In many jobs, the most important factor is getting results in a timely manner, not whether Jason or Jennifer left early.

Public criticism or disrespect toward a co-worker diminishes the value of all employees.

Think of this principle as one drop of food coloring making an entire bowl of water turn a particular color. When people are publicly reprimanded or shown disrespect (either to their face or behind their back), it is like a poison that starts working its way through interpersonal relationships. Just like the food coloring, the poison eventually taints all aspects of the workplace.

Failure happens, but most failure can be prevented by comprehensive and forward-looking cooperation.

In other words, effective planning, organizing and cooperating results in potential obstacles being identified before they manifest. Turf wars and hidden agendas, whether they be fed by egos or insecurities, prevent open communication, and the result is often unpleasant surprises. Failures can be minimized when employees set aside personal agendas and instead think ahead while rallying around an organization’s mission.

The bottom line in all this? Excellent workplaces go beyond mere productivity. They are places where people desire to be because of the environments that exist. Still, if all you’re looking for is productivity, know that it usually improves when the above-listed conditions are present throughout your organization. ICE

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Daniel Bobinski, M.Ed., runs two businesses. One helps teams and individuals learn how to use Emotional Intelligence. The other helps companies improve their training programs. He’s also a best-selling author and a popular speaker at conferences and retreats. Reach him at daniel@eqfactor.net or 208-375-7606.

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Service that Outperforms 330-573-5706 retrievemedicalequipment.com ICEMAGAZINE

53

index

Adel Lawrence Associates, INC. p. 53

Global Medical Imaging p. 18

KEI Medical Imaging Services p. 17

Service that Outperforms

Retrieve Medical Equipment p. 53

MEDICAL

AUE

SYSTEMS TECHNOLOGIES LLC

ADVANCED ULTRASOUND ELECTRONICS

D E F I N I N G TH E S TA N D AR D

Advanced Ultrasound Electronics p. 49

Health Tech Talent Management, INC. p. 44

Medical Systems Technologies p. 51

RSTI/ Radiological Service Training Institute p. 4

Sodexo CTM p. 19

MedWrench p. 55 Ampronix, Inc. p. 7 Injector Support & Service p. 43

Summit Imaging p. 3 MIT/Medical Imaging Technologies p. 36

BC Group International, Inc. p. 36

TECHNICAL

PROSPECTS

Experts in Siemens Medical Imaging

Technical Prospects p. 48

InterMed Group p. 43 DIAGNOSTIC IMAGING & SURGICAL SOLUTIONS

Carolina Medical Parts p. 8

International Medical Equipment & Service

Multi Diagnostic Imaging Solutions p. 2 The Intuitive Biomedical Solution INC. p. 23

p. 15

MW Imaging Corp.

College of Imaging Administrators p. 44

p. 5

International X-Ray Brokers p. 47

SOLUTIONS

Tri-Imaging Solutions p. 6

Cool Pair Plus p. 52 THE JDIS GROUP CT • MRI • PET/CT • MOBILE

JDIS Group p. 28

PM Imaging Management p. 48

Varex Imaging Corporation p. 11

Diagnostic Solutions p. 47

Radon Medical LLC KEI Med Parts p. 53 E.L. Parts p. 48

p. 51

ICEMAGAZINE | FEBRUARY 2018

p. 20

Ray-Pac® Ray-Pac p. 56

54

Webinar Wednesday

X-ray Parts, Inc p. 17 ADVANCING THE IMAGING PROFESSIONAL

the medical product support network “An excellent resource.

It’s my first stop when I have a question or need information. An asset to any technician’s toolbox.”

–Mark Cooper, Legacy Medical Imaging

“MedWrench has proven to be an invaluable resource in servicing medical technology.

–Sam Morgan, Kaleida Health

“MedWrench connects a wide range of biomed engineers, helping them to share knowledge and experiences.”

–Fadi Ali, RSS

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