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ADVANCING THE IMAGING PROFESSIONAL

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ICE FEATURES

August 2018

“We need them up, we need a happy customer, and if the customer chooses to have their people be the first responder, we give them the tools, the diagnostics, and the training to be able to do that.

It always equals 100 percent, whether it’s 100 them, zero us, and everything in between.”

32 Cover Story

-Tim Peeler

rofessional P 20 Spotlight

Hybrid versions of equipment maintenance and support blend responsibilities

The military can be a great source

among OEMs, ISOs and in-house teams as the pursuit of cost savings has forged

for kicking off a rewarding career,

relationships among groups once believed to be firmly set in stiff competition. At

whether that means remaining

the root of that shift is a pursuit for value-based operations. A desire for cost sav-

enlisted or eventually taking skills

ings has pushed creativity in the formation and execution of service agreements

to the civilian side. Jim Dlouhy,

into new places.

MBA, RT (R)(VI), radiology administrator in imaging services at W.G. Department

The 10-member imaging team serving the Norton Health Care System is a part of the larger 44-member clinical engineering department servicing approximately 45,000 pieces of equipment. The group supports CT, MRI, linear accelerators, ultrasound, nuclear medicine, imaging, radiology and radiology oncology devices.

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“Bill” Hefner VA Health Care System in Salisbury, North Carolina is a prime example.

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contents

ICE DEPARTMENTS

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August 2018

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38

news

people

products

insight

10 Imaging News

20 Professional Spotlight

37 Imaging Matters

16 People on the Move

22 Department Spotlight

25 Nuclear Medicine Product Spotlight 26 Nuclear Medicine Gallery 30 Tools of the Trade

38 Career Advice 40 Imaging Service 101 42 Daniel Bobinski 46 Index

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ICE Magazine (Vol. 2, Issue #8) August 2018 is published by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to ICE Magazine at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

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IMAGING NEWS A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

AUE Offers Sonostar Wireless Probes Advanced Ultrasound Electronics (AUE) has reached an agreement to represent Sonostar Wireless probes in the U.S. “These probes are excellent for human point-of-care applications, sports medicine, EMS and veterinary markets. Sonostar probes have FDA approval. These probes have excellent color imaging quality and connect via Wi-Fi to iPads or iP-

hones and to Android devices as well. The app is provided at no charge,” according to a news release.

There are a variety of probes available, including 4 convex models, 4 linear models, 2 double headed probes, 2 transvaginal probes and a 4D bladder probe.

The probes come with a two-year replacement warranty and offer a three-

hour battery life before recharging.

Available accessories include a wireless charger, needle guides, “smart glasses,” an I-Pad cart and an i-Pad table stand. • For more information on specifications and features, an Operators Guide, and list of probes and frequencies, visit www.auetulsa.com.

Acertara Acoustic Laboratories Team Receives Patent Acertara Acoustic Laboratories, an independent ISO/IEC 17025:2005 accredited medical ultrasound acoustic measurement, testing, and calibration laboratory, and ISO13485:2003 certified probe repair and new product development facility, announced that its research and development team has been awarded United States patent #9,983,175 related to a device used for testing diagnostic ultrasound probes.

“This patent represents the 43rd patent our R&D team has been awarded related to diagnostic ultrasound system and probe testing devices. Our engineering team first developed the modern ultra-

10

ICEMAGAZINE | AUGUST 2018

sound probe testing paradigm more than 20 years ago when we introduced FirstCall at Sonora Medical Systems,” Acertara President and CEO G. Wayne Moore said.

“It is our passion to continue redesigning the probe testing market by creating disruptive technologies that match the very complex and sophisticated ultrasound probes being used today, including 2D matrix arrays, single crystal arrays and cMUT arrays. Our team is focused on the continuing challenge of taking our test equipment product development legacy to the next level and creating products that ensure the safety and efficacy of ul-

trasound probes and systems for our most important customers – patients.”

“We have already made significant strides in that area by our introduction of the Aureon and ATLAS devices, both of which have patents issued as well as multiple patents pending,” he added.

The research and development team at Acertara Acoustic Laboratories has been awarded more than 40 U.S. and international patents for products ranging from 3D ultrasound devices and complex test devices to devices that deliver super-saturated levels of oxygen to the myocardial tissue of heart attack patients. •

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Allied Mobile X-Ray Selects First Source to Fill Equipment Need for Expansion First Source Inc. announced that Allied Mobile X-Ray and Ultrasound (AMX), a provider of diagnostic imaging services in South Florida, has placed a sizable, multi-unit order for its Vision M lightweight portable imaging system. The equipment is earmarked to fill the company’s equipment need toward its expansion into the Tampa/St. Petersburg area. AMX has been in business for over 30 years and services more than 200 skilled nursing homes. In addition to long-term care and other residential facilities, they provide services to more than 2,500 physicians.

The decision to purchase the Vision M was made by AMX after gaining experience with several Vision M units acquired in the past year.

“The Vision M has proven its durability, maneuverability and the versatility that we expect from a mobile imaging product,” said Eric Amar, president and owner-operator of AMX. “Along with excellent image quality, a major consideration in determining which mobile imaging product we chose, was the Vision M’s innovative feature that it is a fully integrated system.”

The Vision M solution includes the Visaris Avanse image acquisition software complemented with a Varex wireless Cesium detector. The software is integrated with the X-ray tube; this enables the technologist to set exposure factors from the system’s laptop computer rather than the X-ray tube – ultimately increasing productivity. •

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news MR Solutions Offers MRI Upgrade Service Following requests from customers, MR Solutions is offering a service to upgrade old MRI scanners to provide state-of-theart imaging quality. The key technology in an MRI scanner is the spectrometer or “electronic brains” which interprets the signals from the magnet and creates the image. MR Solutions can replace an old spectrometer with the latest generation EVO2+ for advanced levels of functionality and user control with an unlimited number of TX and RX channels.

MR Solutions’ upgrade service includes a wide number of options including the replacement of all the electronic systems, replacement of the gradient coils, boosting the power of the gradient coils, and even up-

grading from a wet, helium magnet to a dry magnet which does not require helium topups. The costs associated with helium topups have increased substantially and reach thousands of dollars on an ongoing basis.

The upgrade service is suitable for any brand of preclinical MRI system up to 11.7T and includes comprehensive development software and an extensive sequence library optimized for multiple applications.

Physicist David Taylor, chairman of MR Solutions explained, “Customers were increasingly asking us if we were able to do anything with their existing equipment. While some providers offer refurbishment we wanted to go further and

offer customers fully upgraded equipment. We have now successfully carried out such upgrades and have decided to offer the service more widely.”

MR Solutions has offices in the UK, North America and Asia as well as a network of agencies across the world. •

Florida Hospital Adds NeuroLogica’s BodyTom Elite

NeuroLogica, a subsidiary of Samsung Electronics Co. Ltd., has announced that Florida Hospital in Orlando, Florida, added the BodyTom Elite, the newly upgraded, portable, 32-slice computed tomography scanner, to its brachytherapy suite.

The BodyTom Elite improves the patient experience, patient safety and workflow efficiency by eliminating the need to transfer patients. The scanner increases the volume the department can take on while decreasing operating room time by 12

ICEMAGAZINE | AUGUST 2018

allowing patient repositioning to occur in the OR. Real-time imaging enhances accuracy when treating cancer patients undergoing brachytherapy treatment.

“Introducing a 32-slice CT scanner has improved our imaging quality and our post-scan reconstruction capabilities, which has helped us deliver our patients higher quality care,” said Dr. Matthew Biagioli, board certified radiation oncologist at Florida Hospital.

“Looking forward, the addition of the

BodyTom Elite will allow us to accommodate a higher volume of patients in our brachytherapy suite.”

The BodyTom Elite incorporates a fresh new visual design, upgraded software including improved noise- and metal-artifact reduction, along with multiple hardware enhancements. The system remains a self-shielded, multi-departmental imaging solution capable of transforming any room in the hospital into an advanced imaging suite. • ADVANCING THE IMAGING PROFESSIONAL

Philips Ingenia Elition MR Solution Receives FDA 510(k) Clearance Royal Philips has received 510(k) clearance from the FDA for its Ingenia Elition 3.0T MR solution and two clinical applications, Philips Compressed SENSE and 3D APT. This integrated suite of innovations enables clinicians to perform exams faster, increase diagnostic confidence and improve the patient experience. The first commercial installation of the Philips Ingenia Elition in the U.S. has recently been completed at Hennepin Healthcare, a comprehensive health care system in Minneapolis.

“Together, the Ingenia Elition and our new clinical applications make producing high-quality images fast and easy, enabling prompt diagnosis and setting the stage for effective treatment,” said Arjen Radder, global business leader for MR at Philips. “We’re receiving a strong positive reaction from our customers as we continue to roll out our all-new Ingenia digital MR portfolio. It’s providing health care organizations like Hennepin Health with innovative solutions that seamlessly connect data, technology and people to drive the highest quality of care.”

“To deliver fast, consistent and accurate diagnoses, our staff need to be supported with technology that gives them the ability to provide the best patient care, in an efficient and cost-effective way,” said Dr. Hennepin Healthcare Radiology Chair Chip Truwit, MD. “Philips’ Ingenia Elition plays a critical role in elevating the standard of care for our patients in imaging and in improving overall operations in our new imaging center.”

The Ingenia Elition is part of Philips’ all-new Ingenia digital MR portfolio, which supports radiology departments to enhance productivity, improving the patient and staff experience, while delivering better value-based care through improved patient outcomes at lower costs. In addition to receiving U.S. FDA approval the Ingenia Elition 3.0T is also available for sale in Europe. •

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news

Riverside Adds Varian Edge Radiosurgery Suite Riverside, a regional pioneer in the use of stereotactic radiation therapy, has added an Edge Radiosurgery Suite to its dedicated radiosurgery center. The new system is designed to perform advanced, non-invasive cancer procedures anywhere in the body – including the brain, spine, head and neck, adrenal gland, lung, liver and pancreas – with extreme precision and low toxicity.

“This new Edge system was specifically designed for performing radiosurgery and will be an excellent enhancement to the cancer care we provide at Riverside,” says Dr. Ron Kersh, a radiation oncologist at Riv-

erside Regional Medical Center.

The Edge, created by Varian Medical Systems, uses new real-time tumor tracking technology and motion management capabilities, improving both safety and comfort for patients by protecting healthy tissue with sub-millimeter-accuracy.

Cancer patients today often have a range of treatment options. Whether a first-time diagnosis, a recurrence or a metastasis (a cancer that has spread from the primary site of diagnosis), Riverside has remained at the forefront of delivering the latest treatment options. That’s just one of

the reasons they partnered with University of Virginia and Chesapeake Regional to open the state’s first and only dedicated radiosurgery center.

With a multi-disciplinary team that includes neurosurgeons, radiation oncologists, a physicist and a team of nurses and support staff, the center has become a model for domestic and international cancer centers providing radiation care.

The center currently treats more than 400 radiosurgery cases every year. •

GE Healthcare Introduces Virtual Reality Training Options With 25 percent of the Healthcare Technology Management (HTM) population expected to retire over the next 10 years, hospitals and health care systems face an increasing challenge to train the next generation of professionals safely, affordably and efficiently. At AAMI 2018, GE Healthcare introduced interactive, customizable training options enabled by Virtual Reality (VR) technology for HTM professionals who service CT and MR equipment.

GE Healthcare trains more than 8,000 HTM professionals each year. This training features “mixed reality” training using wearable devices and web-enabled technology that supports guided instruction for service and repairs. VR technology enables training to be conducted onsite at a provider’s facility.

“We have a few quantifiable outcomes achieved through the VR training technology,” said Amato DeRosa, system director, biomedical engineering, Hartford Healthcare. “The obvious is cost savings by eliminating travel to a GE training facility. Less obvious, but equally important, is the boost to employee engagement and morale. We no longer must ask engineers to travel over the weekend and take time away from their families. We have seen a 14

ICEMAGAZINE | AUGUST 2018

quality of life improvement, too.”

The benefits of VR training also include helping impact a provider’s productivity and offering a safe learning environment.

Students gain experience maintaining and troubleshooting a system at their work site. This allows them to avoid abandoning their station to travel to a training facility, from which they would be unable to provide emergency support. Also, customized, on-site training is unique to each hospital and health system. VR training offers a safe, low-risk learning environ-

ment. It allows for mistake-driven learning where employees can safely make mistakes and learn along the way.

“Training the next generation of HTM professionals is a very hot priority right now, and virtual reality is going to be a big enabler,” said Art Larson, general manager, global services training & documentation, GE Healthcare. “This technology allows for the flexibility and customization health care providers want, making training available when and where it works best for them.” • ADVANCING THE IMAGING PROFESSIONAL

FDA Clears Biograph Vision PET/CT System

The FDA has cleared the Biograph Vision, a new positron emission tomography/computed tomography system from Siemens Healthineers that delivers a new level of precision in PET/CT imaging.

The Biograph Vision features new Optiso Ultra Dynamic Range (UDR) Detector Technology, which is based on silicon photomultipliers (SiPMs) rather than the photomultiplier tubes (PMTs) that have been the industry standard. This new system design enables

Siemens Healthineers to reduce the detector’s lutetium oxyorthosilicate (LSO) crystal elements from 4 x 4 mm to 3.2 x 3.2 mm, resulting in higher spatial resolution. Utilizing these extremely small LSO crystals and covering 100 percent of the area of the scintillator array with SiPMs, the Biograph Vision is designed to deliver industry’s fastest time-of-flight (ToF), with a temporal resolution of just 249 picoseconds, as well as effective sensitivity at 84 cps/ kBq. For these reasons, the Biograph Vision helps to reduce scan time by a factor of 3.9 to improve patient throughput as well as reduce patient radiation exposure and tracer cost.

The Biograph Vision also has a large 78cm bore that offers 24 percent more space than a 70-cm bore. This larger bore can reduce patient anxiety in addition to enabling easier positioning for radiotherapy (RT) devices or bariatric patients. The system fits into any room that houses a PET/ CT scanner from the Biograph mCT family without the need for renovations.

Additionally, the Biograph Vision offers

optional features to improve the quality of patient care. FlowMotion Multiparametric Suite, the industry’s first automated solution for whole-body parametric PET exams, provides not just the standard uptake volume (SUV), but also information regarding metabolic glucose rate and distribution volume.

This information helps clinicians differentiate between non-metabolized and metabolized fluorodeoxyglucose (FDG) in the patient. OncoFreeze and CardioFreeze provide PET/CT images that are virtually free of motion in the same period of time as a regular whole-body scan, helping to improve lesion conspicuity, delineation and quantification compared to images acquired without these features.

“The Biograph Vision represents a major leap in performance beyond any PET/ CT system previously manufactured,” said Jim Williams, PhD, head of Siemens Healthineers Molecular Imaging. “With this system, we extend the boundaries of PET imaging and help our customers explore a new frontier in precision medicine.” •

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PEOPLE ON THE MOVE

By Matt Skoufalos

1

Prestige Medical Imaging of Newburgh, New York has added Ken Vaughan as executive vice president of sales, Michael Colaiacovo as vice president/managing partner for the PMI Ohio Region, and Deborah Buonsignore as account executive/applications specialist. Prior to joining PMI, Vaughan was client director for GE Healthcare, and northeast regional director of corporate sales for Carestream Health.

Colaiacovo started with Picker International as a service engineer, transitioned to Alpha Imaging in 1994, and in 2017, became vice president of sales for FujiFilm Medical’s northeast zone. Buonsignore began as an X-ray technologist for the Mayo Clinic in Scottsdale, Arizona, and worked for Merry X-Ray and GE Healthcare as a product sales specialist.

2

Caliber Imaging & Diagnostics Inc. of Boston, Massachusetts added regional sales manager Lisa Edone. She has worked in senior sales and marketing positions at Restoration Robotics, Syneron/Candela, Merz, Lumenis, Medtronic Neurological and B. Braun Medical Inc.

3

Elizabeth Holmes has relinquished her post as CEO of Theranos Inc. General counsel David Taylor will add her duties to his own; Holmes, the founder of Theranos, will remain as chair of its board.

4

Rani Therapeutics has added Dennis Ausiello to its board of directors. A former chief of medicine at Massachusetts General Hospital from 1996 until 2013, Ausiello directs the Center for Assessment Technology and Continuous Health (CATCH), a joint effort between Massachusetts General Hospital and Massachusetts Institute of Technology (MIT). He also serves on the board of directors of Pfizer Pharmaceuticals, Alnylam, Seres Therapeutics, and is a consultant for Verily.

5

Tyber Medical LLC has promoted Executive Vice President of Operations Gary Thomas to COO and added Wesley Johnson as executive vice president of product development.

6

diploma in digital electronics and computers from Madras Christian College.

7

Joint Commission International (JCI) of Oak Brook, Illinois has shifted its Middle East Region Principal Consultant Francine Westergaard to European region principal consultant in the European Region. Westergaard has more than 30 years of nursing experience as a practitioner, educator, administrator and researcher, and holds master’s degrees in nursing education and business administration. Lynda Mikalauskas will take over as JCI principal consultant in the Middle East and Africa Region. Mikalauskas was former associate director of the JCI European office, former director of nursing at the American Hospital in Istanbul, Turkey, and chief clinical/chief nursing officer at Johns Hopkins Medicine International in Abu Dhabi, United Arab Emirates. Kathryn Leonhardt has been named principal consultant of the JCI Quality and Safety Training program. Leonhardt is a board-certified preventive medicine physician who has been vice president of clinical quality, vice president of patient experience, and patient safety officer at a Wisconsin health system. John Yoon has been named JCI managing director of the Asia-Pacific region. Prior to joining JCI, Yoon was the Philips Healthcare regional director of Southeast Asia and head of Philips Capital at the Asia-Pacific office in Singapore.

8

Castlight Health Inc. has promoted Chief Product Officer Maeve O’Meara to executive vice president of product and customer experience, and added Judith K. Verhave, chairwoman of the National Business Group on Health, to its board of directors.

9

Thomas Pearl has been named vice president of human resources for Organogenesis Inc. Pearl was formerly vice president of human resources for laboratory diagnostics at Siemens AG; previously, he held senior positions at Bayer HealthCare. Pearl has a bachelor’s degree in finance from Siena College.

AMRI has named Prakash Pandian as CIO; he has been CIO of Biogen Corp., was senior director of IT at Millipore Corp. and Merck Millipore, and holds a post-graduate

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ICEMAGAZINE | AUGUST 2018

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PROFESSIONAL SPOTLIGHT Knowing the Right People: Jim Dlouhy, MBA, RT (R)(VI)

T

he military can be a great source for kicking off a rewarding career, whether that means remaining enlisted or eventually taking skills to the civilian side.

Jim Dlouhy, MBA, RT (R)(VI), radiology administrator in imaging services at W.G. “Bill” Hefner VA Health Care System in Salisbury, North Carolina can attest to that fact.

“I first became interested in the imaging field while I was in college. I was contacted by SFC Dutch Vanderpol, a recruiter in the National Guard medical unit, based in Iowa City, who was talking to me about career opportunities,” Dlouhy remembers.

“When he started discussing the imaging field, with the civilian career opportunities, possibilities for deployments and the opportunity to go through a complete program and come out debt-free, he really caught my interest,” he says.

Dlouhy’s initial imaging training was through the military.

“I went through the Army Academy of Health Sciences at Fort Sam Houston in San Antonio, Texas. I first had to go through the Army Basic Training course, and then a general orientation course that they ran at the time before being allowed to move to the Imaging Specialist course,” Dlouhy says.

“The total time to complete all that was 14 months, but the course was accredited on the civilian side also. The army was able to cram all of this in because they had drill sergeants that got you up at 4:30 in the morning, did physical training, marched to breakfast, then 20

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marched everyone to the classroom for classes from 8 a.m. through 4:30 p.m., then a short period for supper and back to the barracks where from 6 p.m. through 10 p.m., it was mandatory study time,” Dlouhy adds.

He says that subject matter was taught in blocks, followed by testing shortly thereafter. He says that if you fell below a certain grade point average, you were transferred out of the program into a secondary MOS, which kept motivation high for most people.

After Dlouhy got out of school, he started as the supervisor of a small department in Belmond, Iowa. He was there for seven years and then took a general imaging position with Mercy Medical Center North Iowa in Mason City, Iowa.

“After a few years as a general imaging technologist, I became one of the vascular interventional technologists, working with a small team of technologists, nurses and radiologists performing a variety of challenging exams for several more years. At the same time, I was the X-ray specialist for Alpha Company, then Headquarters and Headquarters Company of the 109 Medical Battalion, Iowa National Guard in Iowa City, Iowa,” he says.

Dlouhy says that he served in that capacity in Iraq in 2003 and in the 1st Support Battalion with Multinational Force and Observers in the Sinai Peninsula of Egypt in 2008.

“I began working on my Master of Business Administration while in Egypt and completed it a few weeks before deploying to Afghanistan in 2010. While

in Afghanistan I saw a job posted for the administrative position for the imaging service at the Salisbury VA Medical Center in North Carolina, which I applied for.

I was fortunate enough to be selected for that position and I have been the radiology administrator for the Salisbury system since April 2012,” Dlouhy says.

Dlouhy learned his area of specialty on the job.

“My first area of specialty was vascular interventional, which I learned on the job

“T he transition from focusing on individual patients that have a clear beginning and end to their cases to administering a multidisciplinary program in three different cities with double-digit annual growth in procedures and almost tripling our equipment inventory has been an exceptional learning experience for me.” - Jim Dlouhy, MBA, RT (R) (VI), radiology administrator

ADVANCING THE IMAGING PROFESSIONAL

Favorite part of being an imaging professional?

Enabling patients to keep or improve their quality of life.

Jim Dlouhy MBA, RT (R)(VI)

through some very good instruction courtesy of Interventional Supervisor Angela Culliton, and a wonderfully experienced IR technologist, Luann Austin,” he says.

“I also had exceptional teaching from our interventional radiologists, especially Dr. Darius Zawierucha and Dr. Ryan Holthaus. Since taking my current position I’ve been focused on developing skills within the federal system for personnel management, equipment acquisition and program development,” Dlouhy adds.

He says that his biggest challenge is coming from a rural nonprofit environment to a federal VA system that is growing incredibly fast locally and is one of the top two VA systems for unique patients seen in the last year.

“The transition from focusing on individual patients that have a clear beginning and end to their cases to administering a multidisciplinary program in three different cities with double-digit annual growth in procedures and almost tripling our equipment inventory has been an exceptional learning experience for me,” Dlouhy says.

Great Mentors and Family Off the job, Dlouhy enjoys marriage and life on two wheels. He also feels lucky to have been exposed to some great colleagues.

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“I have been married 15 years to an exceptionally supportive and patient woman who consented to be my wife two days before I deployed to Iraq. I also have a son who has been very successfully developing a career in a custom cabinetry firm in north Iowa,” he says.

“My wife and I really enjoy camping in the mountains of North Carolina and riding our motorcycle on the Blue Ridge Parkway,” he adds.

Dlouhy attributes his success to the people who have been his inspiration and whose standards he has emulated.

“I think the most important thing to know is that any success I’ve had has come about because of the people I’ve been privileged to know. I’ve been greatly influenced by a number of people who have very high drive to be exceptional in their quality of work, productivity, ethics, and compassion for their patients,” he says.

“This has been on both the civilian and military side. There are a lot of people I worked with that have motivated me through their examples in their daily activities. I believe having had worked with these people and learned from them has improved me personally and professionally,” Dlouhy adds.

We are sure they feel the same way. ICE

GET TO KNOW THE PRO Favorite book “The Enchiridon” by Epictitus Favorite movie “A Bridge Too Far” Favorite food Mississippi Pulled Pork Hidden talent Professional quality sheetrock installation and finishing What’s on my bench?

• Black coffee, and lots of it • “The Enchiridon” by Epictitus • “The Meditations” by Marcus Aurelius • Microsoft Excel • The VA VistA software package

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people

By K. Richard Douglas

DEPARTMENT SPOTLIGHT Norton Healthcare Imaging Services

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he largest city in Kentucky is Louisville, home to the Louisville Slugger Museum and Factory.

It is also a place to view the craftsmanship of a bygone era at the Conrad-Caldwell House Museum. And, perhaps the city’s most notable landmark is historic Churchill Downs – the home of the fabled Kentucky Derby.

For a large city, health care availability is a necessity and one provider took on that challenge beginning 130 years ago. It was originally the goal of a group of women known as the Home Mission Society of St. Paul’s Episcopal Church that set out to build a hospital in Louisville.

In the intervening years, other hospitals were opened and they eventually all became the Norton Healthcare System.

Today, the health care system serves patients throughout Kentucky and Southern Indiana via five large hospitals, 13 Norton Immediate Care Centers and 190 physician’s practice locations.

All thanks to those women from the Episcopal Church with contributions from the Presbyterian church, the United Methodist Church, the United Church of Christ 22

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For a large city, health care availability is a necessity and one provider took on that challenge beginning 130 years ago. and the Roman Catholic Church to create the Norton system.

Today, hospitals include Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Children’s Hospital, Norton Hospital and Norton Women’s and Children’s Hospital. There is also the Norton Children’s Medical Center.

The 10-member imaging team is a part of the larger 44-member clinical engineering department servicing approximately 45,000 pieces of equipment.

“The imaging team is freestanding in the fact there are two directors, myself

and Neil Feldmeier (biomed) that report to Scott Skinner, our system director of clinical engineering,” says Doug Elmore, director of imaging services.

The group supports CT, MRI, linear accelerators, ultrasound, nuclear medicine, imaging, radiology, radiology oncology devices and none of the devices are on full-service contracts.

Is there any equipment the group does not support?

“Not at this time. Occasionally the organization will purchase a one-off device, in that case training is not prudent or financially sound to train in such cases,” Elmore says.

The imaging team takes care of five hospitals and one medical center with approximately 1,800 beds. They are responsible for multiple pieces of equipment, including CTs, MRIs and RAD rooms. This does include physician practices.

They also provide service to several R/F rooms, cardiac cath labs, special procedure labs, linear accelerators and 65 physician practices, including 32 that are offsite.

Training comes by way of factory training at the OEM. “We found that the OEMs typically don’t ADVANCING THE IMAGING PROFESSIONAL

Norton Healthcare Imaging Services maintains equipment at five large hospitals.

recognize third-party training and will not supply service keys. We have a very robust training budget,” Elmore says.

In addition to imaging service and support, the team is very involved throughout the acquisition stage.

“We are involved in all contract negotiations and source our parts,” Elmore says.

He says that the group has, and will utilize, third-party labor during vacation season or if he has multiple team members out for training.

“My team is fully trained on all modalities with few exceptions. We have a couple of legacy nuclear cameras that we’ll take a first look and utilize OEM or third-party if necessary,” Elmore says.

“In our physician practices, we’ll occasionally leverage a local third-party group if there is a need in the hospitals,” he adds.

Securing the Network The imaging team has been involved in a system-wide networking project with the help of an in-house specialist.

“Currently, we are upgrading our wired and wireless network across the system; all imaging devices are moved WWW.IMAGINGIGLOO.COM

(network configuration) almost simultaneously in each facility. This commands a tremendous amount of coordination,” says Elmore.

“Fortunately, we were able to create a new position approximately two years ago – medical device security specialist – that also acts as a liaison between CE and IT,” he adds.

The imaging team has proven themselves to be proficient at problem solving, along with their IT colleagues, to head off possible trouble.

“The CE imaging team, along with our medical device security specialist and IT security team, routinely partner on security initiatives,” Elmore says.

Away from work, team members contribute to the imaging community, and the larger HTM community, in a number of ways.

“Key team members are AAMI members and multiple persons are CBET certified and three are CHTM certified. Everyone in CE is a member of the Kentucky Association for Medical Instrumentation (KAMI),” Elmore says. This includes the imaging team.

The imaging team has proven themselves to be proficient at problem solving, along with their IT colleagues, to head off possible trouble.

“The CE executive is board-certified as a Fellow of the American College of Healthcare Executives and is a Certified Materials and Resource Professional (CMRP). Conferences attended by various persons annually include AAMI, ACHE, RSNA, Archimedes Medical Device Security and HIMSS,” Elmore adds.

In a city that has helped produce a lot of home runs, the dedicated imaging team at Norton Healthcare is hitting it out of the park every day. ICE ICEMAGAZINE

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PRODUCT SPOTLIGHT Nuclear Medicine to Hit $17 Billion by 2020

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he global nuclear medicines market is expected to reach $17.6 billion by the end of 2020, growing at a compound annual growth rate (CAGR) of around 12.29 percent from 2015 to 2020, according to Mordor Intelligence.

Grand View Research also predicts that the nuclear medicine market is expected to reach $13.8 billion by 2024.

The nuclear medicine/radiopharmaceuticals market is projected to reach $7.27 billion by 2021, according to another report by MarketsandMarkets.

Nuclear medicine uses in radiological imaging include magnetic resonance imaging (MRI), computerized tomography (CT), positron emission tomography (PET) and single proton emission tomography (SPECT).

“The use of nuclear medicines for diagnostic purposes has gained huge popularity all around the world. There has been increased use of SPECT, PET, CT and MRI for diagnosis of cardiac diseases, brain diseases, cancer and many others,” according to Mordor Intelligence.

“Nuclear medicine is being used for

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therapeutic purposes for treatment of Alzheimer’s disease, coronary heart diseases, bone metastasis, cancers and different medical conditions affecting the thyroid gland, and scar tissue removal.

Advancement in diagnostic imaging is bringing in more use of nuclear medicine. Nuclear cardiology has gained great popularity in North America.”

“ Nuclear medicine is being used for therapeutic purposes for treatment of Alzheimer’s disease, coronary heart diseases, bone metastasis, cancers and different medical conditions affecting the thyroid gland, and scar tissue removal. “ The Mordor Intelligence report lists several driving factors for the global nuclear medicines market. In addition, it sheds light on several opportunities

that exist for the market players. Some of the market drivers are the increasing incidence and prevalence of cancer and cardiac ailments, increasing application of SPECT and PET with advancement of technology, growing awareness amongst physicians and public awareness for better health care.

“The segmentation based on the application has been subdivided based on diagnostic and therapeutic application,” according to Mordor Intelligence.

“The diagnostic application includes the application of SPECT and PET in cardiology, neurology, oncology and others. The therapeutic applications include application in oncology, thyroid, endocrinology and various other therapeutic areas.”

The global nuclear medicine market has been geographically segmented into North America, Europe, Asia-Pacific, Middle East and Africa, and Latin America. High technological advancements coupled with a developed economy has North America as the largest market followed by Europe and Asia-Pacific. ICE

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products

GE Healthcare NM/CT 870 CZT NM/CT 870 CZT builds on GE Healthcare’s expertise in cadmium zinc telluride (CZT) digital detectors. With a new CZT design, the system delivers 58 percent increased sensitivity compared to the first-generation, general purpose, digital SPECT/CT. This system can conduct a whole-body planar scan in under four minutes with excellent spatial and ultra-high energy resolutions. Clinicians can achieve improved quantitative accuracy resulting in expanded applications, greater utilization and procedural growth. NM/CT 870 CZT also features SmartConsole workflow enhancements and Q.Volumetrix MI for improved quantitation. •

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ADVANCING THE IMAGING PROFESSIONAL

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MR Solutions Continuous PET Detection System Traditionally PET imaging has been offered with one, two, three or even four rings of detectors with gaps between the rings. MR Solutions’ continuous PET detection avoids any artifacts caused by the gaps. These arrays can be incorporated into the clip-on PET scanners for sequential multimodality imaging with MR Solutions’ MRI or CT scanners. The PET scanner is also available as an insert inside the bore of the cryogen-free MRI scanners for simultaneous PET/MR images. The PET scanners provide a resolution below 1mm and can be used as a standalone scanner. •

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Philips Vereos Digital PET/CT Vereos is a fully digital, clinically proven PET/CT solution supported by rigorous clinical evidence, including more than four years of investigational studies and over 100 published clinical studies. Vereos is a well-established, comprehensive solution to help clinicians improve patient care and manage costs.

Featuring Philips’ proprietary Digital Photon Counting (DPC) technology, Vereos offers improved detectability and characterization of small lesions1. The system provides uncompromised detectability and quantification at half the PET dose2. Vereos also provides lesion detectability in one tenth of the time3. • [1] Nguyen NC, Image Quality and Diagnostic Performance of a Digital PET Prototype in Patients with Oncologic Diseases: Initial Experience and Comparison with Analog PET, J Nucl Med 2015; 56:1378–1385 [2] Knopp,M, Binzel,K, Bardos,P, Knopp,M, Wright,C, Zhang,J, Nagar,V, Hall,N, Maniawski,P, Next Generation Digital PET/CT: A Phase I Intra-Individual Comparison with Current Photomultiplier TOF PET/CT. Radiological Society of North America 2015 Scientific Assembly and Annual Meeting, November 29 - December 4, 2015, Chicago IL. [3] Zhang J., Evaluation of speed of PET acquisition: How fast can we go? - A validation of list mode PET simulation approach with true acquisitions, SNMMI 2017

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ADVANCING THE IMAGING PROFESSIONAL

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Siemens Healthineers Biograph Vision PET/CT System The Biograph Vision features new Optiso Ultra Dynamic Range (UDR) Detector Technology, which is based on silicon photomultipliers (SiPMs) rather than photomultiplier tubes (PMTs). This design enables Siemens Healthineers to reduce the detector’s lutetium oxyorthosilicate (LSO) crystal elements from 4 x 4 mm to 3.2 x 3.2 mm, resulting in higher spatial resolution. Utilizing these extremely small LSO crystals and covering 100 percent of the area of the scintillator array with SiPMs, the Biograph Vision is designed to deliver a fast timeof-flight (ToF), with a temporal resolution of just 249 picoseconds, as well as highly effective sensitivity at 84 cps/kBq. The Biograph Vision helps to reduce scan time by a factor of 3.9 to improve patient throughput as well as reduce patient radiation exposure and tracer cost. It has a large 78-cm bore that offers 24 percent more space than a 70-cm bore. The system fits into any room that houses a PET/CT scanner from the Biograph mCT family without the need for costly renovations. •

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BY MATT SKOUFALOS

HYBRID SERVICE CONTRACTS BLEND IN-HOUSE, ISO AND OEM SKILL SETS

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ADVANCING THE IMAGING PROFESSIONAL

raditionally, health care facilities have faced an either-or circumstance in servicing their medical imaging technologies: find an external solution, whether from the original equipment manufacturer (OEM) or a third-party independent service organization (ISO), or do the work in-house. For OEMs, those service contracts have long been a reliable source of revenue, but as hospital purse strings tightened, ISOs made more headway in the market by offering comparable support at reduced rates.

As both groups have jockeyed for position, some health care institutions sought to control more of those costs by bringing service work in-house. Hybridized versions of support agreements that blend responsibilities among the OEMs, ISOs and inhouse teams have emerged, as the pursuit of cost savings has forged a collegiality of relationships among groups once believed to be firmly set in stiff competition. At the root of that shift is a pursuit of value-based operations that has pushed creativity in the formation and execution of service agreements into new places.

“Clinical engineering is more powerful and more engaged then they have ever been in our history in diagnostic imaging,” said Tim Peeler, vice president of service for Canon Medical Systems USA. “Their goal is to create value through clinical engineering, and that is to drive costs down and maintain quality at the same time.”

Service strategies can vary according to specific modalities and even individual pieces of equipment, all depending upon what produces the greatest value for

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the institution. Inhouse imaging service departments may directly service modalities like ultrasound with less support from equipment manufacturTIM PEELER ers than computed tomography (CT) and magnetic resonance (MR) systems, which tend to draw a higher level of external support.

“It’s IDN-specific as to where their service plans create value,” Peeler said.

“Based on the capabilities of their own engineers, the performance of the system, and the related costs, they make a judgment as to how much value they can create for the modality or the individual system.”

Service contracts have become more of a component of the vendor-customer dialogue at the point of purchase, as opposed to discussing those terms upon the expiration of warranty, with even more of that dialogue occurring in the middle of a

multi-year agreement, Peeler noted. “[Health systems] are trying to create value all the time, at all the points of the life cycle of equipment, moreso than they ever did in the past,” he said. “There are plenty of customers that, once a point-ofpurchase agreement was consummated in a five-year term, it was never touched until it expired five years later.”

Today, however, those discussions are taking place before customers make a decision on what equipment to purchase, when they purchase a warranty, and even modifying existing agreements to drive additional cost savings.

“There’s no point in time at which they’ve given up trying to create value,” Peeler said.

In-house, a lot of that value can be created by training clinical engineering staff to service imaging equipment without relying on third-party or OEM technicians.

But as the service workforce turns over due to retirement and relocation, it can be difficult for organizations to maintain quality. Equipment standardization can

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help, but when there’s inadequate training of staff, or a lack of specialized training on the pieces of equipment in need of service, institutions will work toward an external service agreement.

“If they have the ability to make any contribution, they try to make a contribution,” Peeler said. “If they have no ability to make a JOHN BARBATI contribution, they just try to create the best value in a contract model.”

“What’s untouchable today may be touchable tomorrow,” he said. “If [an institution] can’t contribute at all [to an equipment service plan], they’re trying to at least negotiate the contract down.”

Canon customers’ in-house imaging service staff have access to the same comprehensive training programs, curriculum, documentation and diagnostic tools as do Canon engineers. Peeler described the relationship as a “partnership model” with “no barriers to entry.” Some of that training is included in the purchase, and some is available as a value-add to a GPO purchase.

“We give full access to our customers to get the training they need to collaborate,” he said. “They receive the tools, the training, the documentation, everything they need for partnership solutions. When you have the tools and the training, you have the same capabilities as our own engineers.”

Canon service agreements include preventive maintenance (PM)-only deals, comprehensive agreements, time-and-materials “and everything in between,” Peeler said. Its In Touch Flex solution, which Peeler said was created out of a desire to offer a more flexible service agreement to its customers in a value-driven environment, works to negotiate the differences among full-service, first-pass, partnership and PM-only agreements.

It’s also the kind of plan that wouldn’t likely have been available as recently as five years ago. Then again, the financial challenges that health care facilities are facing today are more exacerbated than those of five years ago, too.

“I believe we’re still the only OEM that doesn’t charge annual licensing fees for diagnostic tools,” Peeler said. “That’s not an area we try to make money on at all. We always felt that a clinical engineer working on our equipment was the same as our own engineer if we provided them the training and the tools and the documentation to be successful.”

“We need them up, we need a happy customer, and if the customer chooses to have their people be the first responder, we give them the tools, the diagnostics, and the training to be able to do that,” he said. “It always equals 100 percent, whether it’s 100 them, zero us, and everything in between.”

As larger health systems try to standardize on a vendor – at least on modality, if not multi-modality agreements – they have more capabilities to train their people, to take advantage of synergies and volume, and to increase savings and value. The more they standardize, and the more volume that they have, the more value they can create.

John Barbati, senior director of service business management at Siemens Healthineers, said that large hospital organizations are taking on more in-house service duties than they have in the past, and are seeking customizable solutions to do just that. Sites that have the facilities and

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wherewithal to staff a full-service, in-house team might still purchase third-party or OEM services for offsite diagnostic imaging centers or ambulatory clinics.

“We need them up, we need a happy customer, and if the customer chooses to have their people be the first responder, we give them the tools, the diagnostics, and the training to be able to do that. It always equals 100 percent, whether it’s 100 them, zero us, and everything in between.”

- Tim Peeler, vice president of service for Canon Medical Systems USA

“It depends on the size of the institution, and it also depends on their philosophy,” Barbati said. “I like to think of this as market segmentation.

We try to work with customers to understand and define what their mission is. If we’re talking about it being an in-house operation, our training program for customer engineers is the same as training for our engineers – in the same classroom alongside our engineers.”

One of the customer agreements that Siemens Healthineers recently introduced is Share 360, which spans the gamut from on-demand support to a comprehensive menu of options for a “second-level relationship.” That relationship integrates Siemens’ expertise into the customer experience via branded, handheld devices with which to access the Siemens call center, order parts and tools, and get service information as needed.

“In that situation, it’s almost like they have a full-service agreement from us, the difference being they rely on us for all of the backbone to be successful,” Barbati said. “They have certain needs all the way to helping them run their operation, and the data-driven activity to help them be more efficient and more effective at what they do.”

Full-service agreements guarantee on-location support and parts delivery, which absolves facilities of the burden of planning for those types of needs; on the other end of the spectrum, Siemens also offers in-house training and application support, which fits what Barbati sees as being more popular in a “DIY” service environment.

“Right now, the market is going that direction more than it was five or seven years ago,” he said. “More and more, customers want to do more of their service themselves. We have moved very rapidly to support them at every possible level.”

One facet of service and support that’s aiding vendors more than ever is the idea of data-driven technologies, Barbati said. Onboard equipment can analyze the probability of parts failures and the likelihood of their occurrence, remotely monitoring technology and modeling service at planned intervals.

“Instead of waiting for a machine to go down, and then figuring out what you’re going to do to fix it, we’ve spent a lot of time developing tools to figure out when and what we have to do to prevent that from occurring,” Barbati said. “We are not just monitoring the system, but we have a set of tools that alert us whenever there’s a potential problem with the system.”

ADVANCING THE IMAGING PROFESSIONAL

That kind of technology also supports remote connections of engineers to diagnostic information, or automated fixes based on pattern recognition, and without having to send a technician or get the customer to intervene. For example, one of its latest services, TubeGuard, can predict when a CT tube is going to fail, allowing facilities to dictate their service windows during off-hours.

“Most of the time by doing preventive maintenance and doing a lot of the monitoring that we do, we’re able to predict and keep those problems from occurring,” Barbati said.

“We’re able to keep those pieces of equipment up almost 100 percent of the time.”

From the perspective of the health system, whether working with OEM or ISO service vendors, there’s always room for negotiating standard-template service contracts, said WENDY J. STIRNKORB Wendy J. Stirnkorb, director of imaging services at Regional West Medical Center in Scottsbluff, Nebraska.

Those kinds of details can include specifics like hours of service, equipment uptime percentages and the length of the initial warranty. It can also include a multi-agency service agreement that supports a variety of vendors, or a mix of vendors and in-house staff that might have been more difficult to compile not long ago.

“We’re all in business to make money while incurring the lowest cost possible,” Stirnkorb said. “That is crucial to financial responsibility. There’s a growing trend to have more of a partnership with our vendors and a less adversarial relationship.”

Stirnkorb’s career has spanned large, matrixed organizations, huge academic research organizations, and smaller, community-health-based organizations. From her perspective, most of the bigger institutions can afford and staff their own in-house service personnel. Sometimes they recruit from OEMs or ISOs, which she said assures “built-in experience, skill and knowledge of the equipment.” Smaller organizations that do not have that luxury most often rely on in-house teams “with mixed results” she said.

Ironically, larger organizations have new-

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er equipment that may require less service, whereas those smaller, regional hospitals might depend on older equipment that needs closer attention and more frequent maintenance. One thing servicers of either need, however, is lots of training.

“You pay for one or the other, whether you’re paying additional salary hours or you pay for them to go to training with someone who has those skills and experience, or paying for an internship where they’re working with someone you trust and respect who already has that skill set,” Stirnkorb said.

Paying for training means dedicating budget to it (as well as to travel and lodging as necessary), and making sure that training is calculated as a piece of the investment in service. Those things can help with employee retention, pass-through of technical knowledge and creating an environment in which in-house staff are valued. Stirnkorb said she works in a facility where training and professional development are valued highly, but that they must always be advocated for and justified to assure fiscal responsibility is being weighed with training needs.

“I’m a big believer of investing in your employees,” Stirnkorb said. “They tend to stick around a little bit longer, and your return on investment is not only with engaged and happy employees, but you have this built-in knowledge base that’s there to support patient needs.”

Wherever the responsibility for the balance of the work lies, all sides involved are interested in maintaining cost controls, keeping equipment running and maintaining operational efficiency. For that reason, Stirnkorb believes nontraditional service agreements will continue to evolve and specialize to meet the individual needs of customers.

“Collaboration with service specialists

who are skilled and experienced in servicing specific equipment is a cost-effective and efficient way to assure regular preventive and corrective maintenance occurs as suggested, extending the useful life of the equipment,” she said. ICE

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insight

IMAGING MATTERS Your Job is Documentation

I

f you have been in medical imaging for more than a few days, you have probably heard someone complain about documentation. It is not uncommon for an imaging specialist to declare that getting the equipment repaired is more important than documenting the work. It is all about patient care after all. That sounds reasonable, but it misses the big picture. Documentation is patient care.

This is the medical field. Documentation is everything in every aspect of medical services. Recording that a bed was cleaned, the amount and time a specific drug was administered, wait times for access to a patient room, and all service performed on medical equipment is equally important for patient care. Documentation is concerned with patient care for all patients, not just the next patient.

Recording the details of the service performed, any vital measurements, and the nature of the service all add to the data base of knowledge for that equipment. It contributes to a larger body of information that can be used to calculate a number of important and useful insights. There are a number of items that this entered (or forgotten) information impacts in a well-run company/hospital.

Properly documented preventive maintenance (PM) and corrective maintenance (CM) allows the calculation of how often a type of equipment fails. This calculation

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can be used in a number of different ways.

It can be calculated for the first three years out of warranty and compared to the fifth year and beyond to see if there is a significant increase in repair costs and downtime. It can be used to calculate the need for more or less equipment. It can assist in calculations for more field service engineers (FSE) to ensure that there is enough staffing to provide adequate service. All of these items translate into better patient care. They also translate into more efficient use of the limited reimbursement dollars that a hospital receives. As those reimbursement dollars decrease or become harder to achieve, the value of documentation of service increases.

Detailed documentation can assist in calculating trends. Do you have significantly more service events at a specific time of day? Do you have more service incidents when a specific operator is using the equipment? Are you seeing problems after the monthly hospital generator test?

For critical units, part failure trends can be used to minimize downtime by scheduling parts replacement prior to normal failure.

These are only a few of the items that allow for an understanding of how to improve unit uptime and increase useful life.

“I don’t have time to complete documentation,” is a common statement made by many a FSE. The truth is, it is simply a paradigm shift. If the documentation is

Written by John Garrett Director of a Clinical Engineering Department in CHI

part of the job, the job isn’t complete until you have performed the documentation.

Simply require the documentation to be completed prior to starting the next job. An FSE would not leave a job to start another without replacing the covers of an imaging system. The documentation should be viewed the same as leaving the covers off of a system. Once the new habit is developed, the payoff in the benefits of data and CMS compliance will be seen. 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 inhouse imaging teams.

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insight

CAREER ADVICE

Written by Cindy Stephens Stephens International Recruiting, Inc.

Strategies for a Competitive Advantage

D

uring the past several years, we have seen an increase in the demand for hiring quality imaging service professionals and a decline in available quality talent for these vital positions.

With many baby boomers retiring, there are not enough qualified individuals to replace these experienced and well-trained imaging service professionals. Add to that competition among hiring organizations and a need to retain the top talent organizations have already invested in.

Retaining your top employees should be a major concern since other competing organizations are going to do whatever they can to hire your best talent for their open positions. We know that employee turnover, if ignored, does not make it disappear. It is too risky to ignore, and the related costs can be expensive via decreased employee morale and customer service. If you do not retain top talent, it may impact the level of experience, skill and reliability needed for excellent customer service. No organization can afford that in today’s very competitive market.

Candidates today have the best opportunities available with many companies attempting to recruit them for similar positions. Many employees won’t hesitate to leave an organization for better opportunities. Many imaging service engineers leave a job due to salary and compensation issues as well as opportunities for growth.

However, many have informed us that other factors for leaving an organization in38

ICEMAGAZINE | AUGUST 2018

clude “windshield time” and the often-extended time away from their families due to the huge service areas they cover. Worklife balance is a huge factor as well as feeling they are a valued member of the organization. Other factors include feeling like their job is going nowhere, lack of opportunity for additional training to improve their skills and lack of growth potential.

Therefore, it is important to have an effective hiring practice and retention policy.

Retaining top employees is important for a successful imaging service department.

Building strong relationships within the organization is key.

A successful retention strategy includes, key factors such as competitive salary and benefits, measurable performance objectives, effective communication processes, training and initiatives to encourage employee commitment.

Employees need to feel they belong and should have a sense of pride and ownership in their responsibilities. Satisfied employees know what is expected and enjoy their work.

Imaging service engineers often enjoy being leaders who can share knowledge and skills with other imaging service staff.

Therefore, it is a good strategy for managers/supervisors to encourage and provide opportunities for sharing this knowledge through in-house training programs, presentations, etc.

Recognition for hard work and successful completion of special projects is important. A simple acknowledgement of ap-

preciation via a hand-written note, verbal appreciation in front of a group or a small gift certificate goes a long way.

Create a healthy work environment. Encourage individuals to join an exercise program, support healthy eating choices and encourage individuals to reach for goals, whether personal or career-oriented.

Provide growth opportunities within the organization so imaging service engineers feel they have a career path. Encourage and recognize leadership, professional development and other training opportunities within the department. Provide funds and opportunities for certification training and accessibility to accomplish the certification. By investing in your team and building on their skills, employees gain a sense of success and accomplishment that they can be proud of.

Part of retention strategies include making the hiring process a high priority and avoiding delays. Top quality candidates are considering all aspects of opportunities to them and they will quickly stop considering any company that does not place an urgency on the hiring process.

In our 30 years in business, we understand what clients go through in their hiring process and know from experience that candidates go with the company who has the most to offer in salary and compensation as well as the quality of the work environment.

More than ever before, salary, compensation and benefits are very important.

Candidates will typically go with the comADVANCING THE IMAGING PROFESSIONAL

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Med pany that has the most to offer. When salary and compensation are close for similar positions, candidates will consider other criteria to see which company is the best fit. An organization’s culture is critical and, in this small industry, reputations are a big consideration, too. After all, most candidates do not want to work for a company with a bad reputation or for companies known for treating their employees poorly or not providing a good work-life balance.

Many companies take their time during the hiring process to ensure they have the “perfect” candidate. Companies don’t want to waste time hiring the wrong person because of the associated costs of hiring individuals. Therefore, human resource professionals and hiring managers want to see all available talent before they have a final offer for a prospective employee. The problem is that the “perfect” candidate may not always exist for that particular area, and often companies lose a great candidate because of delays in the hiring process.

Consider the value of attracting and retaining quality talent, rather than continually replacing staff because competitors have more to offer.

Understanding the reasons for losing top talent is crucial and having an excellent hiring and retention policy in place is critical.

One way to ensure your organization is the employer of “choice” is to offer more to prospective candidates than the competition. ICE

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insight

sponsored by:

AUE

ADVANCED ULTRASOUND ELECTRONICS

DEF IN IN G THE STAN DAR D

IMAGING SERVICE 101

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

AEM Programs Should Be Allowed

M

ost of us were very happy and encouraged by the recent FDA decision to NOT require close regulation of servicing companies, and by the study FDA published that explained the reasoning behind that decision. Last month, I talked about that study and the lessons we should learn from it. Now, I want to bring up what I consider to be a bad decision that was first announced by the Centers for Medicare & Medicaid Services (CMS) in 2011, clarified in a 2013 memo and fully implemented in 2015.

In November of 2015, the State Operations Manual that is used by surveyors (e.g.; auditors such as Joint Commission) was amended to say Alternative Equipment Maintenance (AEM) programs are not allowed on any imaging systems.

Hospitals need to pass audits by the Joint Commission or an alternative surveyor in order to receive Medicare and Medicaid payments. That means they are essentially forced to meet the guidelines laid out by CMS, even though many hospitals have evidence that shows their AEM programs on scanners have improved patient safety and decreased their maintenance costs.

AEM programs are plans that imaging service and clinical engineering departments can develop for a specific type of 40

ICEMAGAZINE | AUGUST 2018

medical device. They specify how often preventive maintenance is scheduled and the procedures that need to be performed during the PMs. AEM plans need to be based on data and risk analysis, and have been used for years by many hospitals in order to reduce their costs and decrease risks to patients on various types of scanners, including ultrasound and MRI systems. When the CMS issued the 2011 memorandum that seemed to say they would not allow AEM for imaging systems, they were surprised when it was met with resistance and anger by many HTM professionals, described at the time as a “large and disappointed response by the CE and biomed community.” The CMS said they were surprised that many administrators and directors were certain that their costs and the risk to patients would actually increase in many cases, if they only do what the manufacturer says to do. CMS put out a questionnaire to gather opinions from the HTM and imaging service community, and AAMI submitted 244 pages regarding the value of evidence-based quality as part of AEM programs in health care facilities. Representatives from CMS met with two large biomedical engineering associations – ASHE and AAMI. Even though they had that input from the HTM and im-

aging service communities, in 2015 they made a decision to not allow AEM for any imaging systems.

I believe that the decision by the CMS is based on an incorrect assumption. The 2013 memo has a statement that says AEM programs are not allowed if “Other Federal or state law … require adherence to manufacturer’s recommendations and/or set specific requirements.” I do not know of any U.S. or state law that requires manufacturers to specify the frequency or methods for maintaining any imaging systems except those that emit X-rays. The FDA law is very clear that the OEMs that produce scanners with ionizing radiation must provide a schedule and procedure(s) for maintenance (ref: 21 CFR Part 1020).

However, the part of FDA law that covers other scanners – including nuclear medicine, MRI and ultrasound systems – is not as specific. Until recently, many user manuals and service manuals actually had different PM schedules. Since the CMS decision in 2015, many manufacturers have revised service and user manuals to specify less frequent PMs. The most ludicrous example I know of is the SonoSite ultrasound systems. The manuals actually say PMs are not needed – ever. Anyone who has worked on ultrasound systems knows that is absurd; several studies have shown ADVANCING THE IMAGING PROFESSIONAL

Still think you can get some mileage out of your “end-of-life” Nuclear Medicine camera?

that about 25 percent of the probes in use today have defects that make them unsafe electrically or unable to produce correct clinical results.

The user manuals for most modalities include a large amount of user maintenance, as well, and those user checks would actually reduce risks to patients and costs in many cases. For example, MRI user manuals tell the user to inspect the coils and look for physical damage. Ultrasound manuals often say that probes should be visually inspected every day. Those parts can often be repaired if the damage is discovered early enough. However, it seems the CMS surveyors are focusing on the imaging service departments, and I have not heard of any auditor looking at the user maintenance schedules and procedures. But in some cases the OEM says the user should do more maintenance than is actually needed, or tests that the scanner tech is not equipped or trained to do.

Many hospitals have had AEM programs for several years on imaging scanners. They have proof that they have reduced costs and risks to patients by following them. The imaging service and HTM professionals responsible for the scanners are in the best position to determine what is best for their hospital. Many have changed their terminology and don’t call the testing they do PMs or AEM, hoping they can keep checking the scanners using the procedures and schedule they have determined are best in their situation without running afoul of the CMS. The requirements for implementing AEM are already documented in the State Operations Manual.

I urge the CMS to reconsider their decision and allow AEM programs for all diagnostic imaging systems, so long as they require the use of data and risk assessments to develop them. ICE

“ The user manuals for most modalities include a large amount of user maintenance, as well, and those user checks would actually reduce risks to patients and costs in many cases.”

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insight

THINKING LIKE THE PERSON IN CHARGE Managing Risks and Rewards

A

ll of us have certain moments etched into our memory. For me, one of those occurred on July 20, 1969, when astronaut Neil Armstrong first set foot on the moon. It truly was “one small step for a man, but a giant leap for mankind.”

In the years since, I’ve often referred to mankind’s desire to engage in space travel as a parallel to our world of work. We seek challenges and rewards, but those rewards are almost always accompanied by risks. It’s been this way throughout all of time. From teams of cavemen hunting mammoth to teams at NASA figuring out ways for people to survive in space, people in charge of organizations drive forward to achieve certain rewards, and they’re always managing risks along the way.

Apple started strictly as a computer company, but they struggled to maintain even a 10 percent market share. In 2007 they risked shifting their business model to producing consumer devices, and now they are one of the most successful companies in the world.

The founders of Whole Foods Market started by borrowing $45,000 and got kicked out of their apartment because they were storing food products there. Then a flood wiped out their store. Undeterred, they rebuilt and looked for ways to expand.

As you probably know, Jeff Bezos bought the brand in 2017 for over $13 billion.

The risk versus reward paradigm is at the core of any entrepreneur. In fact, the definition of an entrepreneur is, “a person who organizes and operates a business or businesses, taking on greater than normal financial risks in order to do so.”

42

ICEMAGAZINE | AUGUST 2018

“ I think one of the best ways people can increase their value to an organization is to think like an entrepreneur. Even if you’re not the person steering the ship, if you’re looking at situations from a leader’s perspective, you’re seeing things that the average employee does not see. You have a deeper understanding of the risks involved, and you look for ways to manage those risks. “ Ultimately, a business venture may fail and the entrepreneur may end up financially depleted. But successful entrepreneurs set goals, take risks and press on in pursuit of rewards.

Granted, not everyone is steering an organization’s ship and taking all the risks.

However, I recently read and reviewed

Written by Daniel Bobinski Workplace Consultant

a new book by Larry Farrell, titled, “The Entrepreneurial Attitude: Lessons from Junior Achievement’s 100 Years of Developing Young Entrepreneurs,” and I have to say, I think one of the best ways people can increase their value to an organization is to think like an entrepreneur. Even if you’re not the person steering the ship, if you’re looking at situations from a leader’s perspective, you’re seeing things that the average employee does not see. You have a deeper understanding of the risks involved, and you look for ways to manage those risks.

This practice sharpens your critical thinking skills, which leads to better decisions, which, like I said, increases your value as an employee.

My neighbor, Chris Stevens, runs a nonprofit organization. But even running a nonprofit, Stevens says he wants people onboard who are “in it to win it.”

“When selecting leaders, you need peoADVANCING THE IMAGING PROFESSIONAL

insight ple who want the organization to succeed. You want people who are willing to fill the gaps where needed, not people who are waiting to be told what to do. I want people who are willing to see what’s needed and make things happen without a lot of guidance,” he says.

In other words, as the leader, Stevens values people who see the big picture and are willing to take initiative, evaluating and managing risk as they go.

With all this, you might be asking, “What should my role be in balancing risk and reward?”

Great question. Glad you asked.

What we’re talking about is called “risk management,” and it normally involves the following general steps: 1: Identify the risk 2: Analyze the risk 3: Rank the risk 4: Respond to the risk 5: Track and review the risk These steps can be called different things depending on who’s teaching them, but the basic process is the same.

That said, before I go over these risk management steps and what you can do with them, let me back up and reinforce some essential groundwork. The starting point for all action is knowing the overarching vision and mission of your company, followed closely by knowing the goals that are in place that will take your company in the direction of that vision and mission. Then, as you start looking at ways those goals can be met, you must also look for things that might get in the way. This is step one, identifying the risks.

From there you can analyze the possible obstacles and determine their potential likelihood as well as the magnitude of impact they might have on your plan. This is analyzing and ranking the risks.

The key from this point is to develop plans and suggest or implement actions that minimize or eliminate the risk. This is step four in the process (responding to the risk), and it’s also akin to the maxim offered by many leaders: “Don’t bring me problems, bring me solutions.” After all, it’s one thing to identify a risk (a potential problem), but you are more valuable to your organization when you can identify a plan to minimize that risk or eliminate it altogether (the solution).

It’s people who think and act this way that appeal to leaders like Chris Stevens. Leaders seek employees who look for ways to overcome obstacles in route to achieving the organization’s goals.

Finally, step five is tracking and reviewing the risk. You can’t just identify risks and then implement plans to minimize them. You really do need to keep an eye on potential risks to make sure they don’t flare up.

Most leaders love employees who think this way. Like I said, you don’t have to be the person steering the ship to be able to think like a person who steers the ship.

Whether you’re strategizing ways to take down a wooly mammoth or dealing with the problems of getting a spacecraft into orbit, as you find ways to minimize risks, you increase the likelihood of receiving rich rewards. ICE 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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index AUE

Ray-Pac®

ADVANCED ULTRASOUND ELECTRONICS

D E F I N I N G TH E S T AN D A R D

Advanced Ultrasound Electronics p. 40

Inrayparts.com p. 17

Ray-Pac p. 48 Medical Imaging Technologies p. 41

InterMed Group p. 31 MedWrench p. 47

RSTI/ Radiological Service Training Institute p. 9

Carolina Medical Parts p. 15

Sodexo CTM p. 13 International X-Ray Brokers p. 36 Diagnostic Solutions

DIAGNOSTIC IMAGING & SURGICAL SOLUTIONS

Multi Diagnostic Imaging & Surgical Solutions p. 2

SOLUTIONS

Tri-Imaging Solutions

p. 45

p. 24

THE JDIS GROUP CT • MRI • PET/CT • MOBILE

JDIS Group p. 4 MW Imaging Corp. p. 5

TTI Travel p. 43

Exclusive Medical Solutions, Inc. p. 31

KEI Med Parts p. 39 Oxford Instruments Healthcare p. 3

Global Medical Imaging p. 39

KEI Medical Imaging Services p. 36

Varex Imaging Corporation p. 6

Webinar Wednesday p. 18

PM Imaging Management p. 44

Injector Support & Service p. 36

X-ray Parts, Inc p. 11

MarShield Radiation Protection Products p. 43

Radon Medical LLC p. 31

46

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