ICE Magazine March 2022

MARCH 2022 | VOLUME 6 | ISSUE 3

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ADVANCING MAGAZINE

IMAGING PROFESSIONALS

Fostering Diversity, Equity and Inclusion in the Imaging Space PAGE 32

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FEATURES

83

DIRECTOR’S CUT

A radiology systems director shares her thoughts on budgeting for fiscal year 2023.

23

COVER STORY

Diversity in health care is a hot-button issue among health care institutions and professionals.

21

RISING STAR

Erica Biller is a CT protocoling technologist at Valley Health/Winchester Medical Center in Virginia.

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MARCH 2022

18 IMAGING NEWS

Catch up on the latest news from around the diagnostic imaging world.

30 PRODUCT FOCUS

A look at some of the latest ultrasound devices.

48

EMOTIONAL INTELLIGENCE A look at seven must-have soft skills for managers.

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CONTENTS MD Publishing 1015 Tyrone Rd. Ste. 120 Tyrone, GA 30290 Phone: 800-906-3373

SPOTLIGHT

10

In Focus Beverly Rosipko

12

Rising Star Erica Biller

Kristin Leavoy kristin@mdpublishing.com

14

Rad Idea COVID and It’s Impact on Radiology - Part 1

Group Publisher

16

Off the Clock Eric Hooper

Editorial

NEWS

President

John M. Krieg john@mdpublishing.com

Vice President

Megan Strand megan@mdpublishing.com

John Wallace

Art Department

18

Events

PRODUCTS

Karlee Gower Taylor Powers Kameryn Johnson

Kristin Leavoy

Webinars

Jennifer Godwin

29 30

Digital Department Cindy Galindo Kennedy Krieg

Accounting Diane Costea

Editorial Board

Laurie Schachtner Nicole T. Walton-Trujillo Mario Pistilli Jef Williams Christopher Nowak

ICE Magazine (Vol. 6, Issue #3) March 2022 is published by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to ICE Magazine at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290.

For subscription information visit www. theicecommunity.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. © 2022

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Imaging News A Look at What’s Changing in the Imaging Industry

Market Report

Product Focus Ultrasound

INSIGHTS

36 SPONSORED: Avante Health Solutions Back to the Basics of Ultrasound

38

Director’s Cut Considerations of FY 23 Budget Planning

41

PACS/IT Assessment of AI Research Report

44

Rad HR Perpetual Coaching

46

SPONSORED: Banner Health A Head That Fits Many Hats

48

Emotional Intelligence Seven Must Have Soft Skills for Middle Managers

50

Roman Review The Sentence

52 56 58

ICE Break AMSP Member Directory

Index

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PITTSBURGH • TULSA • DENVER

SPOTLIGHT

IN FOCUS BEVERLY ROSIPKO

BY JOHN WALLACE

U

niversity Hospitals Director of Radiology Informatics Beverly Rosipko, RT (R), CIIP, MS, is responsible for the radiology operations team and the image library teams. They are an extension of the informatics team as they provide support to the radiology department. She says she is fortunate to work in radiology.

Beverly Rosipko loves how her job allows her to help people.

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When asked how she came upon her current career Rosipko said, “By sheer luck, in 2003, I was asked if I wanted to be the super user for the Radiology PACS for CMC. The plan was to transition from film to PACS, 100% digital. And 19 years later here we are!” Almost two decades later she still gets excited about going to work.

“I love my job because I get to help make things better for our patients! The patient is the number one driving force for me,” she explained. “I have always enjoyed helping others, sometimes to a fault. In my job, I love the opportunities to help others grow into their potential.

I get to participate in designing solutions to improve efficiencies, lead and enable change, each day is different, and I get to learn something new almost every day!”

Among her many accomplishments, Rosipko has a thoughtful answer when asked about her top achievement.

“Leading the conversion of five hospitals onto the UH Radiology Applications to enable one patient radiology record for the radiologists to provide best care! Leading UH to enterprise image management system, which is comprised of radiology, cardiology, ophthalmolo-

ADVANCING THE IMAGING PROFESSIONAL

gy, camera capture, point of care ultrasound, digital pathology and driving electronic image exchange with more than 25 locations connected,” she said.

Rosipko’s fondness for helping patients is matched by her desire to help coworkers.

She explains her leadership style as “servant leadership.”

“I do not expect my team to do anything I would not do,” Rosipko said.

She has an open-door policy and welcomes conversations so she can get to know her team members on an individual basis.

“I like to be in the know and available to my team – personal or professional,” Rosipko said. “I have helped guide some team members when they came to me with personal health problems or other.”

When asked about individuals who have mentored her along the way she named Dr. Donna Plecha as someone who has helped by being encouraging, supportive and uplifting during difficult situations.

“She saw potential in me that I did not see in myself,” Rosipko said about Plecha. “Jennifer Carpenter has been a mentor over the years, she is a strong leader and she has provided me guidance along the way anytime I needed input in the IT realm. She has taught me inadvertently and intentionally over the years, she

has a lot of experience and knowledge to share from business planning and financials to vendor relations.”

Dr. Jeffrey Sunshine has been a mentor the longest.

“We have worked together for over 15 years indirectly and then directly,” Rosipko said. “He helped me in the radiology informatics realm, contracting, communication, ‘Crawl, walk, run’ motto, proactive approach to system issues – ‘How can we monitor it?’

‘Why is the end user notifying us?’ and too many other things to list.”

Her mentors taught her many things through the years including, “Patients first above all else” and that relationships are key, understanding the end users and their perspective is detrimental, communicate 7 ways 7 times and to know her worth.”

Rosipko is paying it forward by serving as a mentor to Tonisa Bermudez and Danielle Caovan.

“They teach and guide me too and I like to think I have small impact on each of my team members, to help them in their career,” she added.

Away from work, she enjoys spending time with family including her husband of 29 years and her three children, two of which are in the health care field as registered nurses. The youngest is a junior in high school. She said she also enjoys her six grandsons who range in age from 2 to 10 years old. •

BEVERLY ROSIPKO

Director of Radiology Informatics at Univeristy Hospital 1. What is the last book you read? “The 4 Disciplines of Execution” 2. Favorite movie? “Sound of Music” 3. What is something most of your coworkers don’t know about you? I grew up on a 200-acre farm, participated in 4-H and participated in horse shows locally and at the Lorain County Fair.

4. What is one thing you do every morning to start your day? Pray 5. Best advice you ever received? Treat others as you want to be treated 6. Who has had the biggest influence on your life? My mom 7. What would your superpower be? Strength 8. What are your hobbies? Traveling, family time 9. What is your perfect meal? Pizza

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SPOTLIGHT

RISING

STAR ERICA BILLER

E

rica Biller, BS, RT(R)(CT), is a CT protocoling technologist at Valley Health/Winchester Medical Center in Virginia. She stands out among her peers less than a decade into her career. Mary Myers, operations manager, medical imaging at Valley Health System/ Winchester Medical Center, said Biller a valuable asset in the Rising Star nomination. “Erica has been a CT tech for 9 years. As Valley Health has expanded across several hospitals in the community, standardization of imaging policies and protocols became a priority for the organization. Erica’s position was created to help with that transition, and she has taken that task and ran with it! In her new role, she acts as a patient advocate, physician liaison, project specialist and technologist preceptor,” Myers wrote.

Erica Biller

BS, RT(R)(CT)

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ICE learned more about Biller in a recent interview.

Q: WHERE DID YOU GROW UP? A: I grew up in New Market, Virginia, but I now live in Broadway, Virginia, with my husband, Kullen, and our two sweet pups, Sadie and Leo.

ADVANCING THE IMAGING PROFESSIONAL

Q: WHERE DID YOU RECEIVE YOUR IMAGING TRAINING/EDUCATION? A: I started radiology school at 18 years old and graduated from Sentara RMH School of Radiology in 2013.

After finishing radiology school, I trained in CT (my true passion) and achieved that certification while working full-time. Shortly after, I decided to go back to school to finish my bachelor’s degree in leadership and organizational leadership from Eastern Mennonite University (EMU) in Harrisonburg, Virginia. I graduated from EMU in May 2021. I have also won two awards in my career, the Linda Weaver Red Bird Award in 2013 and The Ancillary Services Award in 2015.

Q: HOW DID YOU FIRST DECIDE TO START WORKING IN IMAGING? A: When I started high school, they would have job fairs where local organizations would come in to talk about their fields. My freshman year, a lady named Gwen Hinkle, who would one day be one of my clinical instructors, attended one of these job fairs and we instantly clicked. Every year we kept in touch until I was able to apply to radiology school. All of those years, I had my heart set on radiology!

Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: CT is truly my vocation; I love all the things about it!

I have always wanted to work not just with people, but to help people and truly advocate for them, especially those that can’t advocate for themselves. I also completely nerd out with technology and love to learn new things. Imaging gave me both of those things!

Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: My position is so fun because every day there is something new that I get to tackle. Rather it is imaging quality, precept a new technologist, work with our radiologists on new protocols and policies, educating physicians, or verifying orders for appropriateness. I also love that I get to work with all the CT technologists across our system which is what makes us great; working together as one! Each day comes with new challenges.

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: I love in imaging that we are the frontline of diagnosing that patient and particularly in my role. I work directly with our radiologists to make sure that we are giving that patient the best imaging study that we can.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: While my position was a promotion and a great

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accomplishment in my career, I have to say that completing my bachelor’s degree while working full-time through the COVID pandemic was my greatest accomplishment. There were many frustrating moments for me, but I knew if I could keep going that I would come out stronger than before.

Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS? A: My first goal is to start my master’s degree in fall 2022 in leadership and organizational management as I would like to continue to grow in my health care system. I want to lead positive change within Valley Health and become an advocate for my fellow technologists in an even bigger way. •

FUN FACTS FAVORITE HOBBY: Swimming FAVORITE SHOW TO BINGE WATCH: Grey’s Anatomy, I’ve seen every episode too many times to count FAVORITE FOOD: Mediterranean food! There is a little place called Xenia in Harrisonburg, VA that is my favorite spot to eat BUCKET LIST: I want to own a coffee shop one day. I love all things coffee SOMETHING YOUR COWORKERS DON’T KNOW ABOUT YOU: I am an open book, I am not sure there is anything they don’t know

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SPOTLIGHT

Rad idea

BY SHARON MOHAMMED, RT(R), CT, ARRT

COVID AND ITS IMPACT ON RADIOLOGY - PART 1

R

adiology is an important medical specialty, driven by limitless technological advances. Various imaging modalities are now central to diagnosing and treating various diseases for patients all across the globe. Despite the recent changes in the radiology landscape caused by the COVID-19 pandemic, the demand for imaging services will continue to increase.

Moving forward, radiology leaders must develop new approaches and strategies to define the pathway forward.

ECONOMIC IMPACT During the height of the pandemic, many outpatient centers cancelled elective and non-emergent imaging examinations. At one specific tertiary health care institution, there was an 87% reduction in outpatient imaging and specifically a 93% reduction in mammography because of COVID-19. With significant reductions in imaging volume, radiology departments experienced decreasing revenues, causing full salaries for hospital personnel to be at risk.

Radiology practice leaders were proactive with practice modifications and financial maneuvers. This put them in a position to emerge from this pandemic in the most viable economic position.

Recovery efforts included federal assistance. The Coronavirus Aid, Relief, and Economic Security, or CARES, Act was signed into law on March 27, 2020. Hospitals were targeted to receive $100 billion.

Aside from the many federal provisions and stimulus funding, practice leaders worked to minimize the disruption to staffing.

However, through a combination of reduced working hours, temporary salary cuts, bonus suspensions, furloughs and explicit freezes on new staff, practice leaders were forced to evaluate overhead expenses and devise these strategies on a semi-permanent basis.

LOCATION AND HOURS OF WORK In response to social distancing concerns from the pandemic, there was an increase in the installation of home PACS workstations for radiologists to work remotely. Technological advances of PACS, computing power and the Internet further distanced diagnostic radiologists and placed them at the forefront of telemedicine.

As a result, tension and discord grew within in the department.

Radiology staff members in higher socioeconomic groups such as staff radiologists were able to stay at home, while lower socioeconomic, patient-facing groups like technologists were not able to do so. This disparity in working environment led to emotional and 14

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psychological fears of possibly contracting the virus for hospital personnel who were in direct physical contact with patients.

In response to this, virtual platforms were created to enhance communication between members of the radiology team. Connectivity can be a key element for patient-facing staff to continue to thrive. It can be an antidote for maintaining a department’s culture during this pandemic, no matter what new challenges arise.

Remote work technologies such as Zoom and WebEx can be used as pathways to communication, where departmental unity is a driver. Department leaders made sure to actively touch base in regular small group settings. Conscious interaction and engagement through small gatherings was maintained by all members of the imaging team, promoting equitable interactions among all levels of department stakeholders. For patient facing staff to be able to continue to excel at their jobs and perform to their full potential during an extended and stressful period, methods of open communication must be developed. This is critical because when staff members feel as though they know what is happening, they will have more confidence in their leadership and in themselves.

Communicating clearly with all stakeholders and patient facing staff through robust platforms, imaging leaders outlined guidelines to prevent virus spread through human-to-human contact and through imaging equipment and emphasized that every necessary precaution be taken to keep patients and staff safe and protected. Those guidelines included steps to maintain access to critical supplies and PPE. Strategies to clean and decontaminate patient care areas according to CDC guidelines were created.

Creating policies for the safe ambulatory imaging of patients with COVID-19 became a priority. Social distancing protocols were implemented in waiting rooms, hallways and work areas. Universal masking of patient facing staff was also implemented. The efficiency of every patient encounter was optimized where imaging protocols were shortened when possible, to minimize the amount of time a patient spent in the radiology department. Patient flow through the imaging suite was streamlined to minimize unneeded contact. A visitor restriction was also put into place. Technologists and all patient facing staff were further educated on safe PPE use and proper hand hygiene.

Inter-professional collaboration and effective communication has allowed radiology leaders to succeed. They have ensured the safety of patients and staff. They have preserved staff morale and well-being and have continued to provide patients with the highest level of care during the height of the pandemic. • Share your RAD IDEA via an email to editor@mdpublishing.com.

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SPOTLIGHT

THE

Clock

ERIC HOOPER

BY MATT SKOUFALOS

G

rowing up in Granite City, Illinois, just across the Mississippi River from St. Louis, Eric Hooper enjoyed a childhood full of outdoor activities. From waterskiing to bow hunting to riding minibikes, Hooper developed a taste for action mixed in with the excitement of exploring wild places.

“I’ve gotten to do a lot of really interesting things,” he said.

“That adventure piece had always been there, and I was introduced enough to it as a kid to go and do it on my own [in adulthood].”

At 7, Hooper decided he was going to kayak down the Mississippi River with a friend, starting from its headwaters in northern Minnesota down to the New Orleans delta. When he started planning and shopping for the trip, his friend bailed out as the prospects of making the journey became more real.

Hooper continued on with his plan, however, and, at 18, his father drove him to Minnesota to put the boat in the water.

“I made it to Minneapolis and said, ‘I’m done; come pick me up,” Hooper remembered. “It’s the only thing in my life that I ever quit. But the way I think about it, it’s on pause. I’m going to do that before I die.”

Hooper isn’t just an outdoorsman by avocation; he’s a renaissance man who never met a challenge he couldn’t dissect and rise to meet. At St. Louis University, he’d intended to become a conservation officer, but ended up switching over to the nuclear medicine program, where a job-shadowing program landed him work in the field before he’d even taken a course of study.

“Whenever I did really well in my classes, I would remind my classmates that I wasn’t way smarter than everybody else, but that I had been doing the work for a couple years,” Hooper said.

From 2005-2011, he worked as a nuclear medicine technologist in Missouri, earned a masters in health physics from the 16

ICEMAGAZINE | MARCH 2022

Illinois Institute of Technology, and started his own medical physics consulting business, Olympic Health Physics, after graduating in 2012.

At the same time, Hooper continued his enjoyment of wild places in Missouri, supplementing his hiking, camping and canoeing pursuits with a caving hobby. With some 6,400 caves in the state, Hooper and his friends began mapping caves, descending deeper beneath the earth into limestone and dolomite caverns that had been scoured out by the movement of underground streams. It satisfied his thirst for adventure and exploration, particularly in those instances in which the party discovered virgin cave systems.

“That means you’re the first person on the face of the earth who’s seen this,” Hooper said. “We found one in Perry County that’s over eight miles long, and they’re still mapping it. No one even knew this thing existed.”

“There’s places I know I’ve been that no one has ever been back to,” he said. “From an adventure perspective, that’s cool.

That’s the draw to doing difficult things: pushing your body, solving problems, all of those things wrapped up in one.”

His thirst for adventure – really, for pushing the boundaries of his abilities and intellect – drove Hooper to newer and bolder challenges. About 10 years ago, the family began searching for a new climate in which to make their home.

“I had been to Washington as a kid, and I remember typing in ‘North Cascades National Park’ and ‘Olympic National Park’ and ‘Mount Rainer’ and ‘San Juan islands,’ and clicked on Google Images,” Hooper said. “I called my wife into the room, and said, ‘Click through these different tabs, and look at these images. What if we lived here?’ She said, ‘That place exists?’ ” What sealed their move to the Pacific Northwest was Hooper’s interest in joining the Seattle, Washington branch of The Mountaineers club, the preeminent mountaineering club in the world. After graduating from their climbing courses, Hooper immediately became an instructor, teaching the next generation of climbers, and eventually joining the Tacoma Mountain Rescue.

“I’ve climbed mountains, volcanoes and glaciers in the U.S. ADVANCING THE IMAGING PROFESSIONAL

and Canada,” he said. “My time doing caving and vertical caving really helped.

Now I’m more into back-country skiing.

We’ll go and climb Mount St. Helens with [skins on] our skis, and then ski off the top of the mountain.”

More recent obsessions have included Crossfit, finance and aviation; Hooper aims to learn sailing and certify as a scuba diver next. As if that weren’t enough, he also picked up sea kayaking through British Columbia and Vancouver Island, and enjoyed it enough that he’s building a house (of his own design, of course) on Puget Sound.

Asked from where his diversity of interests stems, Hooper cites a pursuit of mastery married with an engineer’s approach to problem-solving.

“Whenever I was teaching at the Mountaineers, a lot of the people who were drawn to climbing are engineers,” he said. “I’m not an engineer, I’m a physicist; but we like to problem-solve. We like to think through things logically. We like to do hard things.”

“Those are all things that you find

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in climbing,” Hooper said.

“There’s a natural draw to things like that for people who think the way I think. I have a natural curiosity about things and trying to solve for difficult problems. I also have a natural draw to adventure.”

“The whole motivation is constant learning, constant Eric Hooper welcomes challenges like mountain climbing improvement, constant develand mapping caves away from work opment,” he said. “When I look at any problem, I do this risk analysis. These are the barriers, kind of vocabulary doesn’t register to me. these are the challenges; what do I need When I get to that point, I say, ‘How is to do to eliminate the risks? When I reach this possible?’ If I can’t make it possible, an end, let’s go do the next thing. There’s what’s the next goal that’s going to get no area that really doesn’t get explored.” me to the same endpoint?”

When you have a problem-solvNow, as the father to a young child, ing mindset, barriers are meant to be he’s able to hand down that same apshattered, and hard work and dedication proach. Much more simply distilled, the overcome apathy and fatigue. Hooper family credo is this, “We don’t give up,” believes most of what he’s achieved owes he said. as much to self-belief as to commitment Which is why, at some point in the to the ends upon which he’s set his vision. future, there’s a river in Minnesota that’s “I don’t really get to a point and say, still waiting. • ‘This isn’t possible,’ ” Hooper said. “That

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NEWS

Imaging News

A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

CLARIUS INTRODUCES ULTRA-PORTABLE WIRELESS SCANNERS Clarius Mobile Health is first to introduce a third-generation product line of high-performance handheld wireless ultrasound scanners for all medical specialists. Now 30% lighter and smaller, the new pocket-sized scanners are available in the United States with “pricing and new features that will put premium handheld ultrasound into the hands of more doctors,” according to a news release.

“The new Clarius HD3 is now so remarkably small that it’s no bigger than my iPhone,” said Clarius CEO Laurent Pelissier.

“Our world-class R&D team has miniaturized the high-performance of traditional, cart-based ultrasound systems into a new form factor that truly feels like a traditional ultrasound probe. By replacing complex knobs and buttons with artificial intelligence (AI), it automatically optimizes imaging for ease of use.”

The entire Clarius HD3 line of ultra-portable scanners is built with the latest antenna technology for steadfast connectivity operating on both iOS and Android devices. Octal beamforming technology delivers up to eight times faster frame rates and micron-level resolution compared to other handhelds.

“The new Clarius third generation probe is the size of my cellphone, so it easily fits in my pocket. You can take it from office to office, from room to room. You don’t need to have expensive equipment or waste time wheeling heavy carts. The third generation Clarius is amazing. It’s light, it’s small, and it connects seamlessly,” stated David Rosenblum, MD, director of pain medicine at the NY Maimonides Medical Center. “Clarius ultrasound has helped me create a high-volume interventional pain practice in which I’m able to do lots of procedures in a safe manner, in a relatively short period of time.”

A new version of the Clarius Ultrasound application is also being released to the App Store or Google Play store with new AI and imaging tools that further advance image quality, as well as new advanced clinical software packages and features that enable clinicians to personalize their imaging experience. The new Clarius Ultrasound App 9 is now available for download to all new and existing Clarius users.

A new Clarius Membership bundle is now available for clinicians in the United States who want to fast track ultrasound proficiency. Available in the United States only, the new membership provides access to all advanced software, enhanced education options and unlimited exam management in the Clarius Cloud. •

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ADVANCING THE IMAGING PROFESSIONAL

QURE.AI’S BREATHING TUBE PLACEMENT AI TECHNOLOGY RECEIVES FDA CLEARANCE Qure.ai has gained 510(k) clearance from the Food and Drug Administration (FDA) for an artificial intelligence (AI) algorithm called qXR-BT, that will help doctors in assessing breathing tube (BT) placements.

Through chest X-rays, the algorithm assists clinicians for intubated patients in locating the BT placement and automating measurements. This is the first solution of its kind to automate the manual measurement process for endotracheal and tracheostomy tubes.

Qure’s qXT-BT algorithm analyzes the tube position, automates measurement and gives the physician a report on the tube’s positional accuracy in less than a minute. This enables clinicians to rapidly identify if the tube is properly positioned or whether extra attention is required. The algorithm is vendor agnostic and is designed to work on both portable and stationary X-ray machines.

Dr. Mannudeep Kalra, attending thoracic radiologist, Massachusetts General Hospital and professor of radiology, Harvard Medical School, who was involved in a research collaboration evaluating the technology said, “Daily monitoring of tubes is critical for all intubated inpatients, and sometimes an arduous task on the portable exam with either the carina obscured or the tip not visible. An accurate AI solution could be a valuable aid for reporting on these chest X-rays- especially with the measurement.” qXR-BT is expected to become a standard feature of any critical care framework, giving residents and junior clinicians more confidence in reliably measuring breathing tube placement in intubated patients. •

CARESTREAM AWARDED 45 PATENTS IN 2021 Carestream Health was awarded 45 new patents in 2021 for global advances in artificial intelligence (AI), digital radiography (DR) workflow and detectors as well as other health care imaging technology areas. Twenty-three of the patents were awarded by the U.S. Patent and Trademark Office, while an additional 22 patents were received in European and Asian countries.

“Carestream continuously strives to deliver cutting-edge technologies worldwide, and these patents demonstrate our commitment to meet the evolving needs of providers and patients alike,” said Eugene Shkurko, intellectual property counsel at Carestream. “Our research and development teams are always focused on enabling better diagnoses and enriching patient care with critical innovations such as lowering radiation dose without sacrificing our standards in image quality and optimizing provider workflow with AI.” Patents earned by Carestream’s scientists and engineers

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in 2021 include: - New medical image capture technolgies with AI that help remove undesired bony structures from X-ray images to increase image clarity - Technology advances in image capture that automate positioning of the X-ray source according to the exam entered by the radiographer; and a patent for X-ray detectors with stepped edges that fit together so that the combined detectors can be used for long length imaging.

Carestream’s growing product portfolio includes 2D and 3D digital medical imaging technology for general radiology and specialty areas such as pediatrics and fluoroscopic surgical imaging, along with digital laser imagers that output medical images to film. These technologies fit budget, workflow, safety and space requirements of imaging facilities worldwide. •

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NEWS PHILIPS INTEGRATES CLOUD-BASED AI AND 3D MAPPING WITH ZENITION MOBILE C-ARM SYSTEM Royal Philips recently announced that physicians will now have access to advanced new 3D image guidance capabilities through its image-guided therapy mobile C-arm system – Zenition, delivering enhanced clinical accuracy and efficiency, and aiming to improve the outcomes for patients undergoing endovascular treatment. The company has signed a strategic partnership agreement with Cydar, a UKbased provider of cloud-based procedure maps software to plan and guide surgery in real time.

As patient numbers rise and procedures become more complex and time-consuming, patient-specific real-time procedure planning and guidance, optimization of equipment utilization, and usability have become ever more important. To help overcome these challenges, Zenition brings together innovations in image capture and processing, ease-of-use, and versatility, many of which were pioneered on Philips’ highly successful image guided therapy platform Azurion. Like Azurion, the Zenition mobile C-arm system allows hospitals to maximize operating room performance, enhance their clinical capabilities, and provide staff with a seamless user experience. The integration of Cydar EV Maps software into the Zenition platform now adds extended procedure planning and real-time 3D guidance capabilities.

Cydar EV Maps assists in the planning, real-time guidance and post procedure review of endovascular surgery. It brings cloud-based AI and computer vision to mobile surgery, enabling reductions in radiation exposure, fluoroscopy time, and procedure time together with improved ease of use, according to a news release. It enables surgeons to create a detailed patient-specific 3D map of the target vasculature to help plan surgery, and then uses these maps to augment intraoperative live image-guidance, updating the maps in real time to account for deformations during surgery, such as guidewires and instruments deforming the patient’s blood vessels. Cydar EV also facilitates post procedure outcome analysis. The combined result of this integration of procedure planning, guidance and review, according to the news release, is that surgeons can work more accurately and efficiently – enabling an approximate 50% reduction in radiation exposure, a significant reduction in fluoroscopy time and a reduction of procedure times by more than 20%, while helping achieve better outcomes for patients.

Cydar EV Maps is currently in use across the EU, UK and US. It is certified Software-as-a-Medical Device with EU CE mark and U.S. FDA 510(k) clearances. • For more information, visit Philips.com.

HCA HEALTHCARE PLANS 5 NEW HOSPITALS HCA Healthcare Inc. has announced plans to build five new full-service hospitals in Texas to help meet the state’s growing need for health care services. The new hospitals include one new full-service hospital in the Dallas Fort-Worth area, one new full-service hospital in the Houston area, one new full-service hospital in the San Antonio area, in partnership with Methodist Healthcare Ministries, and two new full-service hospitals in the Austin area, in partnership with St. David’s Foundation and Georgetown Health Foundation.

HCA Healthcare currently has 45 hospitals and 632 affiliated sites of care in Texas and serves communities across the state, including Austin, El Paso, the Dallas-Fort Worth

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metroplex, San Antonio, Houston, Corpus Christi and the Rio Grande Valley. The new facilities will complement HCA Healthcare’s already existing presence in several rapidly growing communities across Texas.

“Communities across Texas are undergoing a rapid increase in population, and the addition of these new hospitals will help our existing network meet the increasing need for health care services,” said Sam Hazen, chief executive officer of HCA Healthcare. “We are thrilled to expand our presence in Texas, and we believe it will enhance our care and better serve our patients.” •

ADVANCING THE IMAGING PROFESSIONAL

MEDICALLY HOME ANNOUNCES A $110 MILLION STRATEGIC INVESTMENT Medically Home has announced a new, $110 million round of funding from strategic investors including Baxter International Inc., Global Medical Response (GMR) and Cardinal Health who will each have representation on the company’s board.

Cardinal Health, Mayo Clinic and Kaiser Permanente are providing additional capital on top of their previous investments, demonstrating confidence in the growing expansion of the model nationwide.

The Medically Home model unlocks patients’ homes as safe alternative sites to receive high and lower acuity care across the care continuum in the comfort and convenience of their homes. This capability is designed to increase health system capacity and resiliency, while meeting the needs and wants of patients, who often prefer to be cared for at home or in a homelike setting. More than 7,000 patients have been treated using the Medically Home platform and ecosystem, as delivered by health systems across the country and utilization is expanding rapidly.

The newest and existing strategic investors in Medically Home represent a further coming-together of the necessary ingredients to safely accelerate the scaling of the model.

Baxter – Innovation Engine for Clinical Solutions – Global

medtech leader in innovative therapies for critical conditions.

GMR – National Leader in Mobile Healthcare – With more than 30,000 rapid response frontline clinicians, Global Medical Response provides services in all 50 states covering out of hospital emergency, non-emergency and mobile healthcare.

Cardinal Health – Advanced Logistics – Global leader in logistics and distribution of pharmaceuticals, medical and laboratory products. Mayo Clinic – Global leader in serious or complex medical care Kaiser Permanente – National leading health care provider and not-for-profit health plan The model is expected to increase demand for a next-generation clinical workforce that combines centralized care oversight (guided by physicians and nurses in medical command centers) with field clinicians (nurses, paramedics, and technicians), who work seamlessly as a team. This work force is supported by Medically Home’s national partners that bring all the needed clinical and supportive services, medication, medical equipment, technology and other capabilities that create a safe and effective site of advanced medical care. •

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NEWS TRANSAMERICAN MEDICAL SELLS PARTS DIVISION In a move to focus on its next gen X-ray monitors and wireless switches, TransAmerican Medical Imaging sold its radiology parts and refurbishment business to Bio-Med Engineering Inc. TransAmerican Medical has sold used parts for radiological devices for over 30 years. The sale to Bio-Med Engineering Inc. is a natural step for both businesses.

“Bio-Med Engineering Inc. has been servicing medical equipment in the Intermountain, Utah area since 1990 and having a used parts business is a natural for the growing business. It has a reputation for providing great service and having used parts helps the

business provide customers with more options and services,” according to a news release.

The releases added that TransAmerican will focus on its Bluetooth foot switches, hand switches and LED displays which upgrade the outdated monitors and switches found on older medical equipment, and in other industries. Its expertise is in providing performance-enhancing upgrades which improve productivity and operator safety and convenience. • For more information, visit bio-medenginc.com or transamericanmedical.com.

RSNA IMAGING AI CERTIFICATE PROGRAM LAUNCHES As artificial intelligence (AI) applications are integrated into clinical practice, the Radiological Society of North America (RSNA) has created a comprehensive program for radiologists to learn how to incorporate AI into the radiology workflow.

The RSNA Imaging AI Certificate program is the first-ever, radiology-specific imaging AI program with a case-based curriculum that blends learning with practical application. The six-module program launched January 26.

Developed as a case-based curriculum that blends on-demand learning with practical application, the RSNA Imaging AI Certificate program provides essential education and delivers a pathway for all radiologists – even those who don’t consider themselves tech-savvy – to learn how to efficiently evaluate and use AI to improve everyday practice or accelerate their academic careers.

“This is a one-of-a-kind program designed to introduce you to AI in radiology,” said Matthew B. Morgan, M.D., program director and associate professor and director of informatics and quality improvement in breast imaging at the University of Utah in Salt Lake City. “Short, easy-to-watch videos and relevant, engaging hands-on activities will prepare you to be an active participant rather than a passive observer, as this new technology unfolds in our specialty. You owe it to yourself to get educated on this important topic.”

The interactive design of the RSNA Imaging AI Certificate program will provide radiologists with the opportunity to learn via on-demand videos tailored to their schedules. Modules featuring expert instructors consist of videos designed to help

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course participants implement, monitor and use AI algorithms in clinical practice. Independent hands-on exercises will give participants the opportunity to apply what they have learned.

“The RSNA Imaging AI Certificate program’s unique design allows radiologists to develop this skill set,” said Linda Moy, M.D., program director and professor of radiology at the NYU Grossman School of Medicine in New York City. “The content is focused on the mainstream radiologist who wants to be more involved in implementing AI algorithms in their practice. Overall, this certificate will be helpful for all radiologists, because it will increase their level of comfort and understanding of these AI applications.”

According to Moy, the goal of the program is to offer radiologists an ongoing tool and resource.

“This certification program will allow radiologists to develop realistic expectations of how AI software may change their clinical workflow,” she said. “Radiologists want to gain this knowledge to help with their career development, either in their current or future job roles.”

The RSNA Imaging AI Certificate signifies the ability to understand AI algorithm development and illustrate issues with AI algorithms within clinical practice. As the program progresses, RSNA plans to offer additional certificate levels allowing professionals to continue their education in imaging AI. • For more information, visit RSNA.org/AI-certificate.

ADVANCING THE IMAGING PROFESSIONAL

MTMI-GLOBAL TO TRAIN ALABAMA SAFETY INSPECTORS The Medical Technology Management Institute (MTMI-Global) has partnered with the Alabama Department of Public Health’s (ADPH) Office of Radiation Control to provide education and training to its state inspectors, focused on shielding requirements for common radiology department equipment to help ensure patient and health care worker safety.

“Medical uses of radiation have grown very rapidly over the past two decades and remains the largest source of man-made ionizing radiation exposure that is hazardous to the U.S. population” said Dr. Max Amurao Ph.D., MTMI’s National Medical Physicist Council Member. “Understanding the design and evaluation of shields for radioactive sources, X-ray producing equipment and MRI systems are essential for maintaining a safe imaging environment.”

While non-ionizing radiation from MRI is known to present unique hazards for patients, engineering controls from properly designed and installed safety barriers known as shielding, are among the most effective strategies for protecting individuals from the hazards unique to radiology.

“The training and education provided by MTMI was

invaluable to my team; it was thorough and comprehensive,” said John Swindall, director of X-ray compliance at ADPH. “I would not hesitate to use MTMI for future training and would highly recommend them to other state agencies.”

MTMI provided a three-part training course to state radiology inspectors intended to protect and promote the physical and environmental health of the public as well as health care staff. The program focuses on shielding common radiology modalities including radiography, mammography, fluoroscopy, CT, MRI, nuclear medicine, SPECT/CT, PET/CT and radiopharmaceutical therapy. Inspector training strives to ensure that facilities are preventing unnecessary radiation exposure to the public through effective licensing, registration, policy enforcement and emergency response.

The Alabama Office of Radiation Control staff is responsible for all inspection activities for radiology equipment in the healing arts and the service and safety of these machines.

This same staff also evaluates radiation shielding plans with over 200 plans evaluated annually with periodic inspections to ensure the health and safety of patients and health care workers while utilizing radiology equipment. •

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NEWS PROMAXO ANNOUNCES SALE OF IN-OFFICE MRI Promaxo Inc. has announced the sale of its in-office MRI system to Kasraeian Urology, a division of Florida Physician Specialists. FDA cleared for in-office use, the company’s single-sided MRI system with AI-based imaging empowers practices and hospitals to accurately and seamlessly guide prostate interventions under the Promaxo scanner.

“Our technology enables safe and effective pointof-care diagnostic biopsies and treatment of cancers, overcoming limitations of traditional MRIs, and paving way for our $3 billion addressable market for in-office prostate procedures. We are thrilled to welcome Kasraeian Urology to our growing network of physi-

cian practices and look forward to our partnership to improve upon overall patient cancer care in the office setting,” said Dr. Amit Vohra, founder, and CEO of Promaxo.

Dr. Ali Kasraeian, FACS at Kasraeian Urology said, “Our practice is dedicated to providing the most current and accurate tools and techniques for identifying and treating prostate cancer. The Promaxo system reinforces our practice goals as it not only allows us to refine our biopsies, but also facilitates MR-guided therapies within the comfort of our offices and ambulatory surgery center. We are delighted to be able to offer this new technology and service to our patients.” •

TECHNICAL PROSPECTS ANNOUNCES BIOMED TO IMAGING ACADEMY Technical Prospects has announced the launch of its BioMed to Imaging Academy as a new addition to its existing imaging service training programs: Integrated Training and Custom/Corporate Training. Development of the curriculum comes in response to industry demand for training specifically focused on biomedical technicians (biomeds) who are ready to take the next step into servicing medical imaging equipment.

“In light of the ongoing shortage of qualified imaging engineers and the ever-evolving needs of the medical imaging industry, we knew we needed to develop a program that provides more than what traditional training can offer,” said Sam Darweesh, chairman of engineering and vice president of operations at Technical Prospects.

Unique in its mentor-led approach, this two-year instructional program is designed to build confidence in novice engineers through one-on-one, dedicated training from industry-leading experts. Ongoing guidance is also provided by mentors who are carefully paired with students based on their specific learning needs and personality profiles, ensuring optimal retention of the subject matter and improved on-the-job performance. More importantly, for the next year, students gain readily available support and access to instructors and staff who bring decades of combined experience to the program, having worked on some of the most advanced imaging systems in the world.

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To better accommodate the needs of aspiring imaging engineers from around the country, the BioMed to Imaging Academy combines the flexibility of online virtual classroom instruction – through Technical Prospects’ exclusive Interactive Virtual Training Academy (IVTA) – with the confidence-building benefits of in-person training on state-of-theart equipment at its Appleton, Wisconsin facility. Additional workshops and on-the-job training are scheduled throughout the coming year to round out the curriculum.

“This training program offers advantages in flexibility, confidence, and certainty for students and health care providers alike, in that they can be assured they will get the most from the training and be able to service and maintain their medical imaging systems properly,” said Darweesh.

As with all of Technical Prospects’ training programs, the BioMed to Imaging Academy courses were developed to meet the rigorous guidelines of the Association for the Advancement of Medical Instrumentation (AAMI), which include proper instructor licensing and training, maintaining high-quality presentation skills, upholding an appropriate class format, utilizing a tailored approach and customer focus and more. • For more information, visit TechnicalProspects.com.

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NEWS

WEBINAR EXPLORES EFFECTIVE COMMUNICATION STAFF REPORT

T

he ICE webinar series kicked off 2022 with “How to Have Effective Conversations, Especially When It’s Difficult” presented

by Janel Byrne was approved for 1 ARRT Category A CE credit by AHRA (Ref. LEC11051) and approved for 1 CRA credit.

Byrne, an organizational effectiveness manager, provided a 60-minute webinar focused on how to have effective communication with peers and co-workers, especially when it’s difficult. Health care professionals face difficult conversations every day and handling them poorly impacts quality of life, productivity, success and relationships. The webinar provided simple tools to transform difficult conversations into effective, respectful conversations where honest ideas are exchanged,

positive intent is present, action results from the dialogue and the quality of the relationship grows.

About 60 individuals registered for the webinar. A recording of the webinar is available for on-demand viewing at ICEwebinars.live.

Attendees provided feedback via a post-webinar survey that included the question, “Overall, how satisfied were you with today’s webinar?”

“It was informative,” Director of Diagnostic Imaging D. Lind said.

“Very,” said C. Houck, MRI technologist. • For more information, about the ICE webinar series, including a calendar of upcoming presentations, visit ICEwebinars.live.

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PRODUCTS

Market Report STAFF REPORT

A

recent Reportlinker.com report indicates that the global ultrasound market is projected to reach $9.0 billion by 2026 from $6.7 billion in 2021. The report indicates growth at a compound annual growth rate (CAGR) of 6.3% during the forecast period.

Growth of the market is attributed to the technological advancements, increasing incidences of target diseases, rising patient preference for minimally invasive procedures and growing public and private investments.

Also, funding and grants are driving the growth of the global ultrasound market.

However, stringent government regulations may restrict the growth of this market to a certain extent in the coming years.

On the basis of technology, the ultrasound market is segmented into diagnostic ultrasound and therapeutic ultrasound devices. The therapeutic ultrasound segment is expected to grow at a significant rate over the forecast period.

Therapeutic ultrasound technologies include focused ultrasound and shockwave lithotripsy. The growth of this market is driven mainly by ongoing technological innovations in the field of focused ultrasound as well as the expansion of its application horizons.

On the basis of device display, the ultrasound market is segmented into black and white ultrasound and color ultrasound devices. The color ultrasound devices segment is expected to grow at the highest CAGR during the forecast period owing to the benefits offered by these devices, such as better image quality and higher image resolution.

Also, the growing availability of advanced color ultrasound devices, coupled with the continuous decline in product cost across major countries and expanding WWW.THEICECOMMUNITY.COM

distribution networks of major manufacturers across emerging countries, are expected to support the growth of this market segment during the forecast period.

Based on system portability, the ultrasound market is segmented into trolley/cart-based ultrasound systems, compact/handheld ultrasound systems and point-of-care (PoC) ultrasound systems. In 2020, the trolley/cart-based ultrasound systems segment is expected to account for the largest market share due to the growing adoption of these systems across major markets (as a result of their increasing use in emergency care and acute care settings in hospitals and health care institutions).

On the basis of component, the ultrasound market is segmented into transducers/probes, workstations, and other components. The transducers/probes segment is further divided into curvilinear/convex array probes, liner array probes, phased array probes and other probes.

The transducers/probes segment accounted for the largest share of the ultrasound market in 2020. This can be attributed to technological advancements, the introduction of specially designed products, and the rising adoption of ultrasound technology for the diagnosis of various disease indications.

The Asia Pacific market is estimated to grow at the highest CAGR during the forecast period majorly due to the increasing health care expenditure across the region’s major countries (especially India and China), growing public awareness about the therapeutic potential of ultrasound technologies, continuous decrease in device costs (due to growing localized manufacturing and the presence of global market players), rising prevalence of target diseases and the ongoing trend of device miniaturization.

In 2020, the ultrasound market was dominated by GE Healthcare, Koninklijke Philips N.V., Canon Medical Systems Corporation, Hitachi Ltd. and Siemens Healthineers AG.• ICEMAGAZINE

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PRODUCTS

Product Focus ULTRASOUND

1

GE HEALTHCARE Vscan Air

At a time when clinicians need quick insights at the point of care, Vscan Air is a wireless, pocket-sized ultrasound device that can provide crystal clear image quality, whole-body scanning capabilities and intuitive software in the palm of the clinician’s hand. The Vscan Air offers: • Crystal clear images: for confidence in what clinicians see, where they need it* • Dual-probe enables whole-body scanning: with the flip of the wireless dual probe (for deep and shallow scanning) and a push of a button to capture images • Portability without compromise: power of a high-performance ultrasound machine in a lightweight, wireless, pocket-sized solution • Redefining the patient experience and access to ultrasound technology: involving patients by sharing real-time images as simple as see, snap, send * This device has been verified for limited use outside of professional healthcare facilities. Use is restricted to environmental properties described in the user manual. Please contact your GE Healthcare sales representative for detailed information.

*Disclaimer: Products are listed in no particular order.

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ADVANCING THE IMAGING PROFESSIONAL

2

BUTTERFLY Blueprint

Modern diagnostics hinge upon the ability to rapidly generate meaningful clinical information to drive optimal care decisions. Butterfly Blueprint, the health care system solution, supports clinicians by unlocking actionable insights at the point-of-care and driving efficiency across care settings. Blueprint pairs a handheld, easy-to-use, whole-body probe with intuitive, mobile-first workflow. The solution unlocks powerful new uses for ultrasound across the care-continuum, doing for imaging what the stethoscope did for auscultation. Blueprint is enabled through dedicated client experience teams that deliver solution advisory, implementation services and post-go-live support.

For more information, visit butterflynetwork.com/blueprint.

3

SAMSUNG

V8 Ultrasound System

HOLOGIC

SuperSonic MACH 40 Ultrasound System

NeuroLogica Corp., the U.S. health care subsidiary of Samsung, introduces the V8; a high-end ultrasound system that provides enhanced image quality, usability and convenience for ultrasound professionals. The V8 was recently cleared by the U.S. Food and Drug Administration for commercial use in the USA. The feature-packed device includes two new artificial intelligence (AI) functions. The first is “NerveTrack,” an AI technology that detects the location of nerves during live scanning. The second is “UterineAssist,” which detects tissue changes and assists the user with measurements of the uterus.

The V8 is equipped with many premium technologies such as: • ShadowHDR, designed to suppress shadows and enhance the clarity of displayed grayscale images.

• S-Shearwave Imaging, which provides information about tissue stiffness as a result of disease using ultrasonic transverse elasticity.

• S-Fusion technology, which allows synchronous alignment of medical images of ultrasound with one or more cross-sectional studies such as MRI, which are instantly reconstructed in the corresponding plane.

• MV-Flow, which enhances the visualization of low-flow blood flow states.

4

The SuperSonic MACH 40 ultrasound system is Hologic’s premium ultrasound system for breast and general imagers.

Designed to increase diagnostic confidence and efficiency, the system features exceptional image quality with reduced speckle, regardless of tissue density, and improved lesion conspicuity. Powered by UltraFast Imaging, it boasts image capture capacity up to 20,000 frames per second, enabling innovative imaging modes like ShearWave PLUS elastography, UltraFast Doppler, and 3D Ultrasound Imaging for breast.

Users of the MACH system can enjoy an intuitive, ergonomic experience thanks to the SonicPad Touchpad, which helps to improve workflow by reducing users’ movements and examination time.

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COVER STORY

Fostering Diversity, Equity and Inclusion in the Imaging Space

BY MATT SKOUFALOS

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ADVANCING THE IMAGING PROFESSIONAL

COVER STORY

I

n any institutional space, conversations about diversity, equity and inclusion are inherently necessary and implicitly thorny – especially in medical and technical fields such as diagnostic imaging and intervention.

When they crop up in scientific and technical settings, however it can be easy to overlook their relationship to the quantitative space occupied by that work.

“It’s often been thought that something as technical or specialized as imaging is merely a science, or a profession that exists in the absence of sociology or politics or history,” said Dr. Johnson B. Lightfoote. “And in fact, nothing could be further from the truth.”

Lightfoote, who is medical director of the department of radiology at Pomona Valley Hospital Medical Center in Pomona, California, believes the medical imaging space exists to serve two complementary communities: that of the American people – its patients and service populations – and that of its internal constituents, including radiologists, technologists and administrators, to manufacturers, service providers and paraprofessionals.

Axiomatically, Lightfoote believes that the key to serving the diverse communities of stakeholders in the world of medical imaging is to ensure that their perspectives are represented within it.

Whether those perspectives are measured in terms of culture, ethnicity, gender, ability or access, each​is meaningful to the operation and advancement of the field on the whole.

When the professional labor force in imaging resembles the general population for which it provides care and other services, those issues and concerns that are distinct to its unique segments may more easily be addressed in practice.

When they are not, however, health outcomes can be less than optimal; patients may mistrust the guidance of WWW.THEICECOMMUNITY.COM

their practitioners; or worse, care may not be delivered in places or for populations most sorely needing it.

“We exist to serve the community,” he said. “We don’t exist for our own benefit, and any measure of our success as community servants must be measured against how we serve the community. One way that communities can assure and ensure that they’re getting their equitable treatment, distribution and benefit from technology is by having their own representatives at the table.”

Lightfoote has done a considerable bit of analysis around these questions. In a two-part 2014 paper, “Improving Diversity, Inclusion, and Representation in Radiology and Radiation Oncology,” Lightfoote and his co-authors note that, “Cultural competence is not something into which a physician is born, but rather is a skill set developed through education, travel and work experience.”

“The main thing we seek of diversity is improved and equitable service to the population, and to mitigate health disparities.”

- Dr. Johnson B. Lightfoote By diversifying its workforce, the medical imaging field may address its shortfalls among communities who are underrepresented in medicine (URM), specifically because “physician race and ethnicity are the strongest predictors that a physician will care for more-vulnerable and underserved communities,” they wrote.

“The most reliable and predictable way to provide expanded access for traditionally disadvantaged segments of the U.S. population would be to expand representation of URMs in medicine,”

the paper continued.

“There are interventional radiology (IR) deserts – places that are relatively under-served by angiography suites, or by radiologists who are capable of doing limb salvage IR procedures for vascular disease,” Lightfoote said. “We think Black people tend to go to amputation quicker and earlier because there are IR deserts, so we think we should train more Black interventional radiologists.”

“We know that women living in a lower socioeconomic area, women who are of lower educational attainment and women of color, are less likely to get breast tomosynthesis imaging even if the facility they visit offers it,” he said.

“By having X-ray techs, mammography techs and radiologists who are of their community, they will make sure that doesn’t happen.”

“The main thing we seek of diversity is i​mproved and equitable service to the population, and to mitigate health disparities,” Lightfoote said.

According to their analysis, Lightfoote, et al., conclude that non-white racial and ethnic groups are underrepresented among radiologists by about half. For example, although Black, Hispanic and indigenous Americans represent about 30 percent of the U.S. general population, they accounted for only 15 percent of graduating medical school classes in 2014, Lightfoote said. residencies in radiology – along with radiation oncology, ophthalmology, otolaryngology and orthopedics – suffer from a “specialty gap,” he said; that is, “they have less diversity than a graduating medical school class does.”

“What we feel that means is there’s a whole lot of talent that’s been missed,” Lightfoote said. “In micro and macro ways, people need to be represented, and the communities look to us for guidance on what’s important.”

He attributes part of that disparity to a lack of prior exposure to the field – without a robust radiology residency planning program, medical students are less likely to approach the specialty – coupled with stereotypes about radiology being an overly “technical” specialty.

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COVER STORY

“For some unknown reasons, many people, including career advisors, think that it’s so technical that it’s inappropriate for women or Hispanics or Blacks,” Lightfoote said. “They’re getting bad advice. Further back in the pipeline, it’s well known that African-American women are steered away from STEM fields in the first place. If you’re steered away from chemistry and or physics in high school, you won’t end up in radiology.”

To correct for this shortfall, Lightfoote, who chairs the American College of Radiology (ACR) Commission on Women and Diversity, said the ACR created the Pipeline Initiative for the Enrichment of Radiology (PIER), an internship program that partners rising second-year medical students from underrepresented demographics with established radiologists to improve their chances of earning a radiology residency in the future.

“We’re teaching them the trials and tricks three years early,” Lightfoote said.

“We match them with a preceptor who is a world-class radiologist. We house these ambitious students and transport them to ACR headquarters for a oneday boot camp, and then we fly them to their institution where they spend six weeks with the preceptor, and, under the preceptor’s arm, write and publish a research paper.”

“In the PIER program, they’re getting world-class lectures as second-year medical student​s,” he said. “The general faculty preceptors read like a who’swho of academic radiology; we have radiology luminaries and role models of this level of expertise passing knowledge onto their rising junior partners.

These ACR PIER scholars’ names will be recognized in the journals of academic ​ radiology literature.”

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Dr. Yoshimi Anzai, the director of quality and safety of enterprise imaging at the University of Utah Department of Radiology & Imaging Sciences, and chair of the committee on diversity, equity and inclusion at the Radiological Society of North America (RSNA), said that mentorships may be especially important for underrepresented communities simply so that their members can find someone to whom they relate on an aspirational level. Even at their highest levels, professional organizations seeking to address these issues are best served to follow their guidance, she noted.

“In the past, the leadership of large institutions like RSNA or ACR were all white males. We didn’t really have a role model for minority radiologists or minority students.

- Dr. Yoshimi Anzai “In the past, the leadership of large institutions like RSNA or ACR were all white males,” Anzai said. “We didn’t really have a role model for minority radiologists or minority students. You want to have a role model so that students say, ‘One day, I can be like them.’

You want to imagine what your career trajectory looks like.”

“Organizations have to intentionally put diverse people into their leadership because diversity in thought perspectives comes from people of diverse background. That is the beauty of

diversity and inclusion,” she said.

In addition to ethnic and cultural diversity, gender inclusivity is equally important to address in leadership, which Anzai said must move away from “check-the-box diversity, such as ‘Now we hire a minority woman; diversity is done.’ ” Inclusivity, she argued, is more than simple representation or a head count; it is a culture of organization.

“It is our own behavior,” she said. “It requires the leadership commitment to cultivating diverse perspectives and building inclusive culture.”

Anzai also said she believes in a “multi-dimensional” approach to diversity and inclusivity. Organizational leadership, including C-suites, dean’s offices, departments, individual faculty and staff, must commit the necessary resources and proactive, conscious effort.

“Diversity efforts should not be left to minorities and women,” she said.

“Inclusive culture requires strong allies and recognizing the value of allyship.

That’s mission-critical for any organization to thrive.” “[America has] a long history of sexism, of racism, but we have to continue to remind ourselves of it,” Anzai said.

“Are we prejudiced against marginalized populations? Are we kind to people who have disabilities? Are we providing care and imaging needs for transgender patients?”

“We are now very aware that the health disparities exist, so stop denying it,” she said. “We knew the problems have existed for decades, but we swept them under the rug.

We now must find how to mitigate the negative impact of disparities. A multi-dimensional approach is required from patients, providers, payers and communities. All academic commuADVANCING THE IMAGING PROFESSIONAL

COVER STORY

nities, large and small, have to work together to address the fundamental societal program of health disparities.”

“For as much as diversity in health care is a hot-button issue among health care institutions – particularly as globalization and demographic population growth trends have created a more diverse workforce and a more diverse patient set – the institutional commitment to addressing these shortfalls is often lacking,” said Northern Arizona Healthcare Systems Director Nicole Dhanraj. She believes that the best way to handle it is to provide “a pathway to health care,” from education to scholarships and career opportunities, that doesn’t stop at the front door of any given facility.

“We have to go to the root of it,” she said. “It can’t just be, ‘Nicole shows up at an organization and somebody takes her under their wing to groom her into a position.’ We’re expecting people to come to us, and then we will grow them and provide opportunities. However, organizations need to go back to ensure that we are creating the opportunities; helping create and chart the pathway into health care.”

“Organizations try to support diversity; however, other challenges can exist even among institutions that commit to diversifying their workforces,” Dhanraj said. “Entrenched, unconscious biases about gender roles can yield focused judgments about women of any ethnic or racial background whose choices about their careers, the preconceived notions of their cultural strength as a leader, or their families’ needs are hyper-scrutinized,” she said. Those judgments are particularly pronounced in radiology, she said, because “work-life balance is not there.”

“As a leader, it’s hard,” she said. “PeoWWW.THEICECOMMUNITY.COM

ple say, ‘You’re a woman with young kids and a family; you must have sacrificed a lot to get where you are.’ Who said I have to sacrifice? I have a sound support system and a family. Why can’t I have it all? Do I have to juggle and have something suffer? No. However, the assumption, especially with women, is that we have to choose one or the other.”

“And then you have the unconscious bias of not wanting to put a woman into management because she may take leave to have children,” Dhanraj said.

“As much as I promote women in the industry, it’s still a faint thought there because of how unforgiving organizations are about when somebody goes on FMLA or maternity leave. Most of the time, they don’t put a temp there, and the operation falls on whoever is left.”

But how many people would advocate that it’s OK to be ill, on FLMA, or take time for family? Leaders cannot see any person’s additional responsibilities outside the job as potential barriers to their success in their role.”

Even when seeking mentorship, Dhanraj said competitiveness could emerge among some colleagues who believe that diversity forces choices among underrepresented groups. She described an experience at a previous workplace where, in seeking guidance from a female leader, she was regarded as a potential threat to usurp that woman’s position. Similarly, Dhanraj spoke about contending with “a lack of confidence and trust from male counterparts” that can undermine a woman’s ability to simply fulfill the obligations of her role.

“It’s a lack of confidence in skills; a lack of belief in the strength of women leadership,” Dhanraj said. “I had a colleague tell me, ‘Consider cutting your

hair and wearing glasses so people will take you more seriously.’ In his mind, he’s thinking he’s trying to support me so that people recognize that I have the skill and talent, but it boils down to appearance.”

To eliminate behaviors like this from the workplace, Dhanraj argues that what’s needed more than anything are opportunities to have clear conversations about moments like these and the weight they carry with the people who comprise an organization.

“We need to go back to the basic building blocks to get it right,” she said. “I think the first thing is helping people understand their bias and having these open conversations. I’ve been talking about my experiences in little pockets, but it takes courage to be in a group together and allow that aspect of the population to say, ‘This is how I feel; this is how my seniors or colleagues treat me.’ ” Dhanraj reported that people often come to her saying, “I’m afraid if I say anything about it, I’m going to lose my job.”

“We need to create that open space for anyone in any organization to say, ‘This is my experience in this organization, and this is how I would like it to improve,’ without them having a grudge,” Dhanraj said. “Before we go into diverse perspectives, we need to address toxic perspectives. We do not need to wait for HR to help us with this.

Encourage team members to discuss these issues, not with the intent of getting anyone in trouble, but to educate; to help people know what they do not know; and to understand where we could start with ensuring that we are really embracing diversity.” •

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INSIGHTS SPONSORED CONTENT

BY SCOTT TREFNY

BACK TO THE BASICS OF ULTRASOUND

D

iagnostic ultrasound service and support is an ever-growing specialty, and some service providers find themselves in a position where they are either new to this technology or having trouble keeping pace with the rapid growth of the market. No matter how advanced the electronics developed to deliver the newest technology or the increasing speed of computer processing to compile images and manipulate the data, the basic principles of ultrasound remain the same. Whether you are new to ultrasound or an experienced engineer providing service and support, getting back to the basics is an effective way of providing a high level of expertise and effectively communicate with end-users.

Diagnostic ultrasound is defined as a non-invasive medical imaging method that uses high frequency sound waves to form an image of body tissues. Information obtained from these images can be utilized along with other patient data to arrive at a medical diagnosis. Compared to other modalities such as X-ray, CT and MRI, ultrasound is a lower cost diagnostic tool with a smaller footprint, and is without the limitations or risks of magnetic fields or ionizing radiation, respectively.

Ultrasonic principles and theory rely upon the piezoelectric effect, a method of applying an electrical charge to a crystalline substance causing it to vibrate at a certain frequency, emitting sound waves through the applied substance or tissue. Sound waves encounter tissue of varying sizes and densities and are reflected to the source transducer. This reflected sound is converted by signal interpreting boards and sent to a computer for further conversion into a diagnostic image on a display monitor.

Understanding the physics of ultrasound emission and

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detection helps in the troubleshooting process. The remaining architecture of ultrasound systems typically consists of some type of computer, user-interface and monitor. Systems containing a computer tend to be Windows-based devices and utilize basic functions of the Windows platform to interface peripherals and networking. Keeping this in mind helps to understand how to make troubleshooting decisions and finding the best means to support these systems from an economic standpoint.

Consideration of the limitations of ultrasound will also help in understanding the issues that end-users face and efficiently find solutions that address their needs. Ultrasound is comprised of radio frequencies, which means that the system and the image field are susceptible to external noise.

Although many manufacturers have gone to great lengths to minimize any type of interference, the possibility for this to occur still exists. This interference can cause image degradation and artifact to be displayed. Another limitation of diagnostic ultrasound is that it cannot be used in circumstances where there is a fluid or air-filled sac, or where dense structures like bone or metal are within the scanning area, as these structures absorb or reflect the sound waves without allowing for them to pass through.

In my many conversations with end-users and department managers, getting back to basics is a good starting point when entering the ultrasound field, keeping pace with the technological advancement of ultrasound applications, and can help provide solutions to meet the complex needs of the department. So, if you find yourself in front of a system you are not sure about or having a conversation about an ultrasound problem you might not understand, starting with the basics will help put you on the path of finding a solution. • Scott Trefny, MBA, CBET, is a regional service manager for Avante Health Solutions. For 24/7 Technical Support, call 800-958-9986 or visit avantehs.com/ultrasound.

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37

INSIGHTS

CONSIDERATIONS FOR FY 23 BUDGET PLANNING DIRECTOR’S CUT

BY NICOLE DHANRAJ

F

ebruary to March are usually the months I set aside time to start ramping up for the next fiscal year’s budget planning. However, after COVID-19 disintegrated the last two years of my budget, I still try to determine what tools are available for predictive analysis when it seems like the unknown is now the only known we can confidently predict!

OK, so you can tell that I am concerned about preparing a budget forecast. We thought there would be two waves, then a third came, and honestly I am unsure which wave we were in, but it seems like we are stuck on repeat.

So, as I am tasked to prepare my budget, I ask myself, how do I plan? Sheesh, should I even plan knowing that my labor and supply costs will be disseminated? No matter how much I try to extrapolate data from the last few months to the past two years, one thing I can be sure of is that it won’t be accurate.

The modus operandi for budget planning is to look at past performance and future growth; however, the pandemic crushed this concept in multiple ways, reminding us that past performance is not an accurate indicator of future performance. Well, no, we know this … this is why there are contingency funds and a margin to allow for some variations to your budget. But over the last two years, these safety cushions were blown to smithereens, causing us to bootstrap our operation so tight, wondering which

was strangling us more, the pandemic or our actions.

Well, here again, another budget planning, and boy am I shaking my head and wondering which direction do I go … so here goes my attempt to see a sliver of stability in my budget for FY 23. These are my current considerations.

• Current state and future state of labor: My prediction is that labor shortages of this nature would last another 18 months at a minimum. Travelers will be my method of staffing. I predict we will staff for anywhere between 30-60% of our imaging departments, especially in rural areas with travelers. The lure of the travel rates, the desperation organizations face, the increased patient volumes, labor costs, in my opinion, have not yet peaked. The Great Resignation is not yet over. We have employees who are still watching this traveler phenomenon and preparing to make their move. In addition, organizations had to be creative to retain staff, offering higher pay rates, incentive programs, and bonuses on top of bonuses. Labor goes to the highest bidder is the strategy these days. So, to reduce the further strain of attrition, employees will continue to squeeze organizations to show me the money if the organization desires their services to mitigate the shortages and support the increased volumes.

• PTSD and burnout: Imaging professionals, specifically those in hospitals, have been scarred significantly by the internal chal-

“The Great Resignation is not yet over.”

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ADVANCING THE IMAGING PROFESSIONAL

lenges brought on by COVID. The lack of PPE, the longer hours of wearing PPE to protect from COVID, being apart from their families as they worked with COVID patients, and just the mighty and exhaustive efforts to keep the doors open with all their might, I am afraid there is a long road to recovery. We may never see some colleagues return to the hospital environment, and it may take a while to entice the younger generation to give these places a try due to the horror stories. There is a higher probability of attracting candidates if we are ready to shell out the big bucks for the best work-life balance and best experiences. Depending on our entity, patient population, and geographic location, this benefit package may not be something we can readily offer.

• Financial sustainability: Organizations with smaller operating margins or just consistently sliding deeper into the red will have to tighten their purses more than ever, especially if they do not have the opportunity to merge with a more extensive system. So, for now, imaging departments in these areas may not be able to consider any expansion of services, acquisition of capital equipment or contract services.

Here are my considerations: 1. Consolidation is key. Focus on your core services. You may consider partnering with others to offer additional services that you cannot support.

2. Evaluate your department for equipment redundancy. If you have redundancy such as two CT scanners, five portables, etc., you could probably eke out a few more years from aging equipment relying on the additional backup equipment should something go out of service.

3. Remove costly service agreements (sorry, my OEM colleagues), especially on newer equipment. Consider going to time and materials but of course, review the contract agreement to determine coverage levels to determine what is most cost-effective to your department. However, do not dismiss the

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opportunity to get cost effective service contract deals giving us more than we may have been accustomed. Don’t be afraid to negotiate aggressively. We are all trying to survive.

4. Supply Chain Woes. These challenges will continue into the next fiscal year until these folks catch their breath from the last two years, so expect continued higher shipping costs and supply shortages, which translates to ulcer-producing increased costs which we may or may not be ready to pass onto our consumers. On the bright side, this challenge forces us to be attentive to our wastage and thus extract as much value as possible from our spending.

5. Regulatory compliance. As we initiate or maintain federal or state compliance, we will prioritize where we focus. Therefore, priority will go to areas’ resources that are needed to support compliance. In addition, changes in the industry may cause operational changes. One such example is USP 825, which, as of now, has no final date for implementation, but as I prepare for this change, consideration is considered as it relates to radiopharmaceuticals expenses, delivery charges and wastage until I can predict more accurately.

What are your considerations as you start your budget planning this year? I will focus on core services that will drive the mandatory equipment needed, the core supplies to support the services we will provide, and the ravenous labor costs, to include a more extended term usage of a short-term incentive plan (really, I am genuinely not being sarcastic).

Like the pandemic played ninja across my budget, I will slash many columns on this budget spreadsheet.

My focus will remain on labor, supplies and contracts. See, I no longer have or can control these costs, but though all control is lost, my focus is to be hyper-focused on core elements of the budget and ride this mechanical bull till it fizzles out. • Nicole Dhanraj, Ph.D., SHRM-SCP, PMP, GPHR, CPSS, CRA, R.T(R)(CT)(MR), is a radiology systems director for Northern Arizona Healthcare.

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INSIGHTS

ASSESSMENT OF AI RESEARCH REPORT PACS/IT

BY MARK WATTS

H

enry Ford said, “If I had asked people what they wanted, they would have said faster horses.” This sums up the current understanding of artificial intelligence in imaging, a customer can easily describe a problem they’re having — in this case, wanting to get somewhere faster — but not the best solution.

In your research of solutions, I recommend that you compare the algorithm research reports – Summary, Mechanism, Validation and Performance, Warnings and Error messages.

With over 100 imaging AI products on the market, I thought I would share an algorithm report.

The American College of Radiology (ACR) recently held a webinar on the subject of “Build vs. Buy” AI for imaging that will be the subject for my next article. One of the key points of the discussion was regarding the need to validate the bought algorithm against a patient population and cost, speed of deployment, scale ability, integration concerns and relevance.

I chose this Navicular Fracture Algorithm report for this column because of its thoroughness. To assess the value proposition of these products we must understand its limitations and expected contribution vs. the effort to purchase, install and support.

This example of a summary gives parameters for what, who and how the algorithm was developed.

SUMMARY This model is based on convolutional neural networks and uses conventional radiographs of the hand, wrist and scaphoid to detect scaphoid fractures. It applies two networks consecutively: a segmentation network localizes the scaphoid and passes the relevant region to a detection network for fracture detection. It was developed in 2019-2020 at the Radboud University Medical Center and Jeroen Bosch Hospital in the Netherlands. Only radiographs with an anterior-posterior or a posterior-anterior projection of the hand in a neutral position are supported.

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The Mechanism section allows you to evaluate the repeatability in a health care system.

MECHANISM Input: Data type: anterior-posterior (AP) or posterior-anterior (PA) radiograph (X-ray) of the hand, wrist or scaphoid.

File format: DICOM or MHA file containing the Pixel Spacing Attribute (tag: 0028,0030) or Imager Pixel Spacing Attribute (tag: 0018,1164). The Photometric Interpretation Attribute (tag: 0028,0004) should be “MONOCHROME2” (minimum value is intended to be displayed as black).

Target population: All patients with a sufficiently developed scaphoid bone (at least seven years old, preferably older than 18 years).

Output: Score: scaphoid fracture score between 0 (fracture absent) and 1 (fracture present).

Overlay: Class activation map with a heat map color coding that indicates which regions in the radiograph were influential to the prediction of the model: colder (blue-green) and warmer (yellow-red) colors respectively indicate low and high importance regions. The red canvas represents the selected region provided to the fracture detection network.

Model type: Convolutional neural network.

Training data location and time-period: Picture archiving and communication systems of the Radboud University Medical Center and Jeroen Bosch Hospital in the Netherlands, radiographs acquired between 2003-2020.

The validation section allows one to evaluate the scope and depth of the research.

VALIDATION AND PERFORMANCE Scaphoid segmentation network: Evaluation metrics: Dice similarity coefficient (DSC) and (symmetric) Hausdorff distance (HD).

Ground truth: manually drawn segmentation mask of the scaphoid.

Test set: 208 hand, wrist and scaphoid radiographs from the Radboud University Medical Center and Jeroen Bosch Hospital.

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INSIGHTS Results: The network achieved an average DSC of 97.4% ± 1.4 with an HD of 1.31 mm ± 1.03.

Scaphoid fracture detection network: Evaluation metrics: sensitivity, specificity, positive predictive value (PPV), and area under the receiver operating characteristic curve (AUC). Automated image crops were used for evaluation.

Ground truth: binary scaphoid fracture label (fracture present/absent) obtained using a CT scan following conventional radiographs of the hand, wrist or scaphoid within four weeks.

Test set: 190 hand, wrist and scaphoid radiographs (95 fracture, 95 no fracture) from the Jeroen Bosch Hospital.

Results: the network achieved a sensitivity of 78% (95% CI: 70, 86), specificity of 84% (95% CI: 77, 92), PPV of 83% (95% CI: 77, 90), and AUC of 0.87 (95% CI: 0.81, 0.91).

Uses and directions Benefits: Automated scaphoid fracture diagnosis may diminish the risk of missing a fracture, reduce the costs of additional imaging studies and unnecessary therapy, speed up diagnosis and allow earlier treatment.

Target population and use case: Patients clinically suspected of having a scaphoid fracture typically undergo conventional radiography. The model preprocesses incoming wrist, hand and scaphoid radiographs in the picture archiving and communication system, and may be able to assist residents, radiologists or other physicians by acting either as a first or second reader, or as a triage tool that helps prioritizing worklists.

General use: This model is intended to be used by radiologists for identifying scaphoid fractures on conventional radiographs of the hand, wrist or scaphoid. It is not a diagnostic for scaphoid fractures and is not meant to guide or drive clinical care. It should only be used to complement other pieces of patient information related to scaphoid fractures as well as a physical evaluation to determine the need for scaphoid fracture treatment.

Appropriate decision support: The model predicts whether any scaphoid fractures are present. The radiologist examines the predicted scaphoid fracture score and provided visual evidence along with other clinical information to determine if a scaphoid fracture is present.

Before using this model: Test the model retrospectively on a diagnostic cohort that reflects the target population that the model will be used upon to confirm validity of the model within a local setting.

Safety and efficacy evaluation: An observer study with retrospectively collected data was conducted and illustrated that the model was able to detect scaphoid fractures just as well as

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11 radiologists, achieving a comparable AUC. Future research should investigate to what extent this model could improve the diagnostic performance of radiologists.

The warning section points out known issues and potential liabilities. I would be concerned if this level of transparency was not offered.

WARNINGS Risks: Even if used appropriately, radiologists using this model can misdiagnose scaphoid fractures. Delays in diagnosing a scaphoid fracture put patients at a greater risk of developing a non-union fracture, which may lead to complications such as avascular necrosis, carpal instability, osteoarthritis, and ultimately functional loss. False positive diagnoses lead to unnecessary wrist immobilization, which increases health expenditure and decreases patients’ productivity.

Inappropriate settings: This model was not trained or evaluated on radiographs in which the scaphoid is incompletely depicted, obstructed by casts or implants, excessively damaged or malformed, (partially) resected, underdeveloped (children), or not depicted with an AP or a PA projection. Do not use the model when any of these circumstances apply. Only use radiographs that have been made specifically for fracture diagnosis and depict a hand or wrist in a neutral position (i.e. fingers pointing upwards).

Clinical rationale: The model provides visual evidence for the predicted scaphoid fracture probability. This evidence

ADVANCING THE IMAGING PROFESSIONAL

is only interpretable if the input radiograph is similar to the radiographs used for training the model. Clinical end users are expected to place the model output in context with other clinical information to make final determination of diagnosis.

Inappropriate decision support: This model may not be accurate outside of the target population (primarily adult patients). This model is not a diagnostic and is not designed to guide clinical diagnosis and treatment for scaphoid fractures.

Generalizability: This model was evaluated within the local setting of the Radboud University Medical Center and Jeroen Bosch Hospital. Do not use this model in an external setting without further evaluation.

Discontinue use if: Clinical staff raise concerns about the utility of the model for the indicated use case or large, systematic changes occur at the data level that necessitates re-training of the model.

The Error section is helpful for the technical validation of the products ERROR MESSAGES “Uneven pixel spacing encountered. Image scaling might not be accurate”: The uploaded image has a different pixel spacing in the X and Y direction. The model uses the pixel spacing information to rescale the image in order to normalize the scaphoid size before segmentation. Provided that the pixel spacing information is inaccurate, the scaling operation may result into an unnatural looking image.

“Pixel spacing of (1,1) encountered. Pixel spacing information could be wrong or missing”: The uploaded image most likely does not contain valid pixel spacing information. Accurate pixel

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spacing information is required to normalize the scaphoid size before segmentation.

“Bounding box is relatively small or large. Possible scaphoid segmentation failure”: The height or width of the bounding box derived from the generated scaphoid segmentation mask is outside three standard deviations from the mean height or width of the bounding boxes in the training data. This may indicate a failure of the segmentation network to localize the scaphoid.

“Cannot classify the image due to segmentation failure”: The segmentation network failed to segment any pixels of the scaphoid and no bounding box could be generated. Therefore, there is no region of interest to process by the fracture detection network I hope this tour of an artificial intelligence algorithm report will prepare you to ask for and receive a better and more rewarding solution if you build or buy. We are still at the beginning of this AI in imaging journey. We are in the “early adopter phase” as Dr. Nina Kottler, MD, called it on the recent ACR call.

Henry Ford’s famous quote about the Model T was, “Any customer can have a car painted any color that he wants, so long as it is black.” The Model T only came in black because the production line required compromise so that efficiency and improved quality could be achieved.

My goal is to educate so that you can purchase and not be sold a solution that is limited. • Mark Watts is the enterprise imaging director at Fountain Hills Medical Center.

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INSIGHTS

RAD HR

BY KIHANNA PATTON

PERPETUAL COACHING W

here would Serena Williams, Tiger Woods, LeBron James or the National Debate Tournament champions be without coaches? And, what if they were limited to three-to-six-month coaching contracts? I seriously doubt we’d know any of their names had they not been consistently coached since they were children. So, when we implement coaching in the corporate world, why do we typically wait until a person has reached a certain salary grade level to become inclined to support their continued development through coaching? And why do we limit the amount of coaching they receive? We all know that money is a significant factor, but what else?

I’m sure there are arguments to be made, but I find coaching more effective than formal performance reviews because you get real-time introspection on existing issues and explore strategies to correct course when needed.

I’m a proponent of abolishing performance reviews, and perhaps I’ll dive deeper into that in a future column. My argument here is that “the what level” and “how long” should not be limiting factors in a person’s ability to access coaching.

WHAT COACHING IS AND IS NOT We shower employees with training and then say they should know how to do XYZ because

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we exposed them to it. But where was the follow-through and support to push them to be all-stars? Where was the accountability, and I’m not referring to discipline? I believe that employees at every level deserve to be coached and groomed and not evaluated once a year using recycled and useless feedback and metrics.

I like the International Coaching Federation’s definition of coaching. ICF is a reputable organization that credentials professional coaches. Their distinction between different types of coaching is helpful to frame what coaching is and is not. Coaching often gets confused with being primarily a performance feedback mechanism. In the world of human resources and leadership, we often include it as a step in the disciplinary action process, further conflating what coaching is meant to accomplish in a more formal context. Coaching requires a high level of curiosity, guidance and contracting with the coachee around what they want to address or achieve. Rarely is that the goal in the disciplinary process. I argue that it should be, but many of us know that in reality, it is not. Here are a few helpful defining snippets from the ICF website (https:// coachingfederation.org/faqs) that distinguish coaching from other forms of support: THERAPY VERSUS COACHING Therapy: Healing pain, dysfunction and conflict within individuals or relationships and resolving difficulties arising from the past.

Coaching: Self-initiated change in pursuit

ADVANCING THE IMAGING PROFESSIONAL

of specific, actionable outcomes linked to personal or professional success. Future-focused. Emphases are on action, accountability and follow-through.

CONSULTING VERSUS COACHING Consulting: Consultants are retained for their expertise. The assumption is that they will diagnose problems and prescribe and, sometimes, implement solutions.

Coaching: The assumption is that individuals or teams can generate their own solutions, with the coach supplying supportive, discovery-based approaches and frameworks.

MENTORING VERSUS COACHING Mentoring: Expert who provides wisdom and guidance based on their own experience. May include advising, counseling and coaching.

Coaching: This does not include advising or counseling and focuses instead on individual or group settings and reaching their own objectives.

TRAINING VERSUS COACHING Training: Based on objectives set out by the trainer or instructor. Assumes a linear learning path that coincides with an established curriculum.

Coaching: Objectives are set by the individual or team being coached, with guidance provided by the coach. Less linear without a set curriculum.

SPORTS COACHING VERSUS PROFESSIONAL COACHING Sports Coaching: The athletic coach is often seen as an expert who guides and directs the behavior of individuals or teams based on their greater experience and knowledge.

Professional Coaching: Their experience and knowledge of the individual or team determine the direction. It does not focus on behaviors that are being executed poorly or incorrectly.

Instead, the focus is on identifying opportunities for development based on individual strengths and capabilities.

PERSONAL COACHING EXPERIENCE I currently receive coaching on two levels – individual and group. One is peer coaching, through which anyone in our small group can bring topics into a safe space and work through them with a group of trustworthy and exceptional colleagues. And it’s online, so please do not let anyone make you believe that it’s not possible to build genuine connections with people using video conferencing. They provide a mirror. They embody compassion; they operate with a level of curiosity that inspires each week’s coachee to dig deep. They provide a level of support I didn’t realize I needed, and I hope it’s reciprocal.

We meet weekly to focus on the person with the greatest need. What I’ve found most important and that you can incorporate into your culture right now are these three things based on Jennifer Currence, CPC’s advice: Asking open-ended questions: What assumptions or beliefs are you holding on to that affect how you view and react to this situation? What would it look and feel like to have the WWW.THEICECOMMUNITY.COM

outcome you want?

Being curious without judgment: Asking “and what else?” is an excellent way to dig deeper.

Acknowledge and validate: I see that your body language has changed. What’s coming up for you?

In this small group of peer coaches, we challenge each other to think deeply and critically so that we all walk away feeling fulfilled, whether our issue is resolved at that moment or we felt seen and heard. Disciplinary action-related coaching doesn’t do that. It likely leaves the recipient feeling empty and defeated and negatively impacts engagement.

I also have individual coaching through Desmond Blackburn, IGNITEU Peak Performance Coaching CEO (www. coachdesmond.com). He provides the clarity, purpose and accountability that I need to stay actively engaged and fired up about who I am and what I have to offer this world. Desmond says that “humans simply do better when they have help.”

Per Desmond, “Coaching can help professionals to gain greater clarity so that they can become lighter, stronger and faster. We all have plans along with the talent to follow through on them, but far too often, we get stuck. We are stuck in our past and, at times, overwhelmed at what the future may hold. We all have a story (often negative) that we keep telling ourselves. Sometimes that story is stuck on repeat, and it isn’t easy to make it stop. Getting coached by a certified professional has proven to be an effective strategy in helping people create a new story by divorcing the lies they tell themselves and marrying the truth so that they can be the best version of themselves.” I agree.

With the extraordinary value I’ve received in my own life, coupled with the feedback from those who have had great coaching, I believe in coaching into perpetuity. Granted, it can be expensive unless you get creative as we did by forming our peer coaching group, or you find a coaching student who needs hours toward their credential and is willing to coach you for free. I experienced the latter, and she was pretty good. My point is that people of all levels should receive coaching if they want it.

When it comes to how long a coaching engagement should last, I’m opposed to limits. I like to think of approaching it the way Employee Assistance Programs administer services. Many offer services by the problem rather than being time-bound. I can have eight different issues in one year that require separate support engagements and I won’t be turned away because I didn’t have all of my issues addressed within three to six months.

The last thing I’ll leave you with is that I look forward to the day when professional coaching is accepted as perpetual, open to employees at all levels of an organization, and similar to EAP, leveraged by the issue and not by time-limitation.

That’s my opinion, and I’m sticking to it for now. • Kiahnna D. Patton is senior human resources business partner at Children’s Hospital Los Angeles (CHLA) and a nonprofit founder.

ICEMAGAZINE

45

INSIGHTS SPONSORED CONTENT

A HEAD THAT FITS MANY HATS

BY AMANDA WINTER

AN EDUCATIONAL JOURNEY THROUGH JEWELRY, RADIOLOGY, MARKETING AND MORE

L

ike many of us at 18 years old, I was trying to figure out my life and next steps. I was interested in getting into the medical field, but I didn’t think I was smart enough—typical teenage skepticism.

After high school, I did head to college, but my courses weren’t inspiring me. Something just felt “off.” I was disinterested in that journey, and so I left.

I married my husband, who was in the U.S. Air Force. I took a job in a jewelry store, and I went from retail to inventory control manager.

Yet, the medical field was still calling out to me; I thought training to become an X-ray technologist would be fun. I found a school where I could get my X-ray license and started classes for my Limited Scope X-ray License. To my amazement, I made straight A’s! All of it felt right to me, so my education was fun and enticing.

After graduating within 10 months, my first job was at a family practice, where I worked as a medical assistant, and I was the only X-ray tech in the office. I still use everything I learned during that first experience in the medical field today. I enjoy the science of radiology. Becoming a practical radiology tech changed my life because I was inspired to help my patients, and it all felt like home to me.

I later became a mom, and the medical office I worked for was about an hour’s drive,

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ICEMAGAZINE | MARCH 2022

so I found a job closer to home as a floating tech which meant I would round at different offices in the region. I learned, even more, met so many wonderful people and was introduced to new and innovative technology.

I used my skills as a medical imaging assistant in MRI. I learned about MRI safety and became proficient at obtaining IV access. Not long after, I jumped into my role as an all-modality medical imaging assistant float. I worked in Mammography, CT, PET/ CT, and MRI. I continued to feel inspired and engaged.

Because of my experience working in multiple modalities, I was asked to help create an assessment coordinator department to review MRI and CT appointments before patient arrival. We would verify that we have a correct order, authorization and any necessary lab work to streamline our patients’ experience. The creation of the department was successful and still exists today.

I was alerted that my director of operations needed an assistant, and one was needed for the marketing department. I had no experience in marketing, but I thought, “why not give this adventure a try, too?”

And an adventure it was! In this position, I learned about operations and how it aligns marketing strategy. I taught myself how to create ads for magazines and design t-shirts, banner stands and websites. I learned about print quality, excel spreadsheets and pivot tables. The learning opportunities were endless, and I loved it.

In 2019, Banner Imaging was acquired by

ADVANCING THE IMAGING PROFESSIONAL

Banner Health as a clinical radiology program. During this time, I became very interested in becoming a project manager. Since I could balance and effectively be accountable for several locations, employees and patient care plans, I figured a project manager wouldn’t be too far of a stretch.

As I pursued this subsequent interest, I learned Banner Imaging didn’t have a dedicated project manager.

They do, however, offer a tuition reimbursement program through a partnership with the University of Phoenix, which has a Project Management Certificate program.

Banner offers a tuition reimbursement program to any qualified team member who will commit to working at Banner at least one year after graduation. The application criteria depends on the degree and/or major, your length of service and your performance rating. The appraisal program is built around each team member’s Aspirations, Results and Challenge to Grow (ARC) and considers what career path in which each individual is interested.

I am now in my final class, in the home stretch of completing that program, and I hope that Banner Imaging will use my imaging knowledge and new skill set to create a project manager position!

Along my educational journey, I’ve learned what my

strengths are. We took a “strengths and interests” quiz in one of my classes. My top five-character strengths are: 1.

Perseverance 2. Honesty 3. Creativity 4. Love of learning 5. Leadership I’ve learned that my career path falls in line with each of these strengths, and what I’m doing—and where I am today—feels right; it feels like home.

I read a quote by Josh Shipp, “Perseverance is stubbornness with a purpose.” It’s true; I no longer think I am not smart enough. If I don’t know how to do something, I’ll teach myself how to do it. I’ve grown so much since starting my medical imaging journey. I’m grateful for so many impressionable mentors and an incredible cheerleading team. I would not have gotten here without them.

I’ve discovered that perhaps it’s not about the destination, after all.

Perhaps it’s all about the journey. • Amanda Winter, PTR is an office coordinator with Banner Imaging.

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ICEMAGAZINE

47

INSIGHTS

EMOTIONAL INTELLIGENCE

BY DANIEL BOBINSKI

SEVEN MUST HAVE SOFT SKILLS FOR MIDDLE MANAGERS

N

ot long ago my company did some research on the importance of soft skills in middle managers. We surveyed frontline workers, middle managers, and senior managers at several facilities, each with an average of about 300 employees. Surveys included 21 different soft skills, and participants were asked to rank each one as to its impact on helping middle managers be productive and effective.

Space does not allow for a review of all 21 soft skills, so allow me to review and discuss the top seven.

What was most interesting to me was how people working at different levels within the organizations viewed the skills differently. The list below shows the skills ranked one through seven overall but know that different levels in the organization rated each skill differently. Some higher, some lower.

- Able to make difficult decisions - Good at communicating appreciation of others - Takes initiative - Work management (delegation and follow-through) - Keeps promises - Problem-solving skills - Win-win mindset - Able to make difficult decisions.

Interestingly, making difficult decisions ranked highest among frontline workers and senior managers, but middle managers thought that work management and problem-solving skills were more important.

One might think that problem-solving skills and making difficult decisions would be similar, but a difference exists.

In simple terms, solving a problem could be as simple as identifying a path past an obstacle. When making difficult

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decisions, an uncertainty or perplexity exists, often involving a moral conundrum or having a potentially risky outcome.

To succeed in the skill of making difficult decisions, middle managers should clearly understand the values of the company and be capable of evaluating data objectively.

Making difficult decisions is a balancing act that is learned over time. One must become adept at weighing options and comparing risks and rewards.

Good at communicating appreciation to others. What’s amazing about this skill is it ranks number two for frontline workers, but it ranks in the bottom third for middle managers and it’s halfway down the list for senior managers.

Most definitely, the fact that frontline workers rate this number two tells us they believe managers are more effective and more productive if they are good at communicating appreciation. This makes sense to hear frontline workers say this, since they would be on the receiving side of those complements.

Further research is needed, but the fact that middle managers place so many other skills ahead of this one indicates they are unaware of the power of emotional intelligence.

Research by Daniel Goldman in his book “Emotional Intelligence” tells us that two thirds of the difference between average and top performers in middle management positions his emotional intelligence. Being able to communicate value and worth to individual employees is a key component of EQ. Takes initiative. This skill ranks fairly high across all three positional categories. Frontline workers rated initiative third, while middle managers rated it forth and senior managers rated it fifth. Essentially, initiative means when one sees something needs to be done, one does not wait to be told.

This is a valuable skill for being productive and effective.

Work management (delegation and follow-through).

ADVANCING THE IMAGING PROFESSIONAL

This skill was tied for second place among middle managers (rightfully so, I believe), and it ranks number four among frontline workers.

Delegation is a powerful management skill. A good supervisor can see the bigger picture and break that image into bite-size chunks that can be given to multiple people so that large projects are done in a timely and effective manner. The first step involves dividing a project into pieces that can be assigned to people who have skill sets that match the requirements of the job. Beyond that, delegation involves being able to delegate responsibility, authority and accountability.

Delegating responsibility means giving other people the burden or obligation to complete the work. Giving somebody authority means giving them the power and control to do the work. Lastly, delegating accountability means giving them the obligation to explain and justify the results.

People’s passions are fueled when they can own what they do. If a supervisor fails to transfer any of these three ingredients, personal ownership is minimized.

Follows through with promises. Interestingly, although this was tied for sixth among frontline workers and tied for eighth among middle managers, it was ranked as the second most important skill among senior managers. It would seem that senior managers view this skill as very important.

With that in mind, it would make sense that if a middle manager has his eyes set on becoming part of senior management someday, those making that promotion decision will likely look favorably at how well a middle manager keeps his or her promises.

Problem-solving skills. As previously mentioned, this is tied for second place among middle managers, whereas it’s

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tied for sixth place among frontline workers as well as those in senior management. The fact that all three levels of the workplace view this skill as important for being productive and effective tells us that middle managers must be able to solve problems.

As indicated earlier, different kinds of problems exist, so it will be impossible to identify a one-size-fits-all problem-solving method. That said, one suggestion I have is for people to not think they must have all the answers. Get input from others! One of the most valuable pieces of advice I ever received was that a leader does not need to know all the answers; a leader must know where to find the answers.

Has a win-win mindset. The last skill among the top third needed for middle managers to be effective and productive is having a teamwork focus. Win-win thinking involves balancing courage (the desire to have your perspective heard) and consideration (the desire to hear somebody else’s perspective). This does not come naturally. People often have too much of one or the other. Too much courage and one becomes aggressive; too much consideration and one becomes passive. The way to achieve a win-win mindset is to balance the two with healthy amounts of each. • Daniel Bobinski, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach Daniel on his office phone, (208) 375-7606, or through his website, www.MyWorkplaceExcellence.com.

ICEMAGAZINE

49

INSIGHTS

THE ROMAN REVIEW MANNY ROMAN

THE SENTENCE

D

uring a New Year’s Eve gathering, I mentioned to a friend that I respected and admired what he had accomplished in his life.

He graduated from the Air Force Academy. He became a fighter pilot. He implemented a program that trained fighter pilots to out-fight Soviet MIGs during the Vietnam war. He wrote a couple of books about his service. I mentioned that he had a great sentence. He, of course, asked for an explanation.

Here it is.

Management and relationships guru Daniel Pink speaks of an incident that may have occurred in the 1960s in President John F. Kennedy’s office. Playwright, Congresswoman and Ambassador Clare Booth Luce was concerned that Kennedy was attempting to accomplish too many things and thus losing focus. She said, “A great man is a sentence.” The president asked what that meant.

She explained that great leaders did not attempt to do a big number of things. They tried to do one or two big transcendent things. Any great leader that accomplished a worthwhile cause could be described in one sentence. Lincoln: “He preserved the union and freed the slaves.” FDR: “He lifted us out of a depression and helped us win a war.”

As I thought about this Sentence when I first heard of it, I realized a few things.

First, when we are very young, our sentence can only describe a dream or an aspiration, a vision. (Perhaps of becoming a pilot and serving your country.) It can’t really describe who we are yet because we are not who we will become. It is said that a vision without a task is a daydream. Therefore, to accomplish our vision, we need to have a plan, a course of action and implement it towards that vision. (Perhaps attend the Air Force Academy.) We are now in the process of building our Sentence.

In the middle stages of our life, our Sentence is being modified and sculpted by external and internal forces. Life and work get involved in the modification of the Sentence. If we can maintain our vision and the attendant task we are on track with our Sentence. During this critical phase of our develop-

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ment, we are finely tuning our Sentence. (Perhaps by realizing that pilots need specialized training) We are working under the constraints and objectives of our employment and other life circumstances.

In the later years of our life, our Sentence should be pretty well defined. We may have been able to greatly influence our Sentence. (Perhaps by developing and implementing a way to save pilots’ lives with specialized training.) We may have developed the ability to make choices that lead to our desired Sentence. In this case, we would feel that we had a rich and rewarding life.

Maybe other forces had the greater impact and our Sentence is nothing like we wanted or expected. Our life may prove a disappointment and be a cause of bitterness and anger. The Sentence may be fairly negative.

A third, and more likely option, is that we had a combination of disappointments and triumphs. In this case, we may have some regrets and some joy. I would suspect that most people fall within this category and have a relatively moderate Sentence.

All this assumes that we had a vision to begin with and we attempted to implement actions to arrive at that vision. I suspect that, when young, most of us did not have a clear vision of what we wanted to achieve in life. I don’t mean the vision of becoming “rich and famous.” I am talking about something that includes real achievement; a guiding light for your life.

Does anyone really want their defining Sentence to be, “He made a billion dollars?”

Finally, another conjecture that I have is that your Sentence must be spoken and defined by others, not yourself. You can diligently work towards honing the Sentence. You can have the vision and the tasks to accomplish your goals. However, your Sentence must be given to you by those who appreciate and admire your accomplishment. Multiple sentences are possible.

Here is my Sentence for my friend: He served his country with valor, honor and selfless achievement, saved lives and raised a family that follows his example of honorable service. • Manny Roman, CRES, is association business operations manager at Association of Medical Service Providers.

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CARTOON

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Image of a Denisovan girl deduced from genes that govern face shape

Science Matters

Cave rock a source of early human DNA

Researchers have isolated fragments of DNA from sediment taken from the Siberian cave where the mysterious Denisovan people lived 300,000 years ago.

The Denisovans were ancestors of modern humans and lived at the same time as Neanderthals

1 Denisova Cave, Siberia

ASIA

Baishiya Karst Cave, China

The two known Denisovan sites

Traces of DNA were shed as feces, bone fragments in long-occupied cave

SCIENCE MATTERS 2

Researchers found undisturbed rocks of compressed sediment in cave’s floor

Denisova Cave

3

Tiny DNA samples were drilled in laboratory from the cave rocks

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Millions to billions of copies of the DNA were created by polymerase chain reaction, the “PCR” method used to detect COVID virus

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Some of the DNA amplified by this method was from Neanderthals, Denisovans and modern humans; some was from bears and other ancient mammals

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Source: Diyendo Massilani and Matthias Meyer of Max Planck Institute for Evolutionary Anthropology; Mike Morley of Flinders University (Australia); Maayan Harel (face sculpture) Graphic: Helen Lee McComas, Tribune News Service © 2022 TNS

ICEMAGAZINE

53

Imaging Jobs

NOW AVAILABLE htmjobs.com

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Companies like ours have such a difficult time finding qualified candidates for field service roles that it just made sense to publish our opening with HTMJobs.

– K. White, HR/Compliance Manager

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LOOKING TO FILL A POSITION? Visit htmjobs.com/start-posting/ to post a job.

Companies that post with us:

First Call Parts, Associated Imaging Services, Medical Imaging Solutions, Universal Medical Resources Inc, TRIMEDX, Renovo Solutions, Canon Medical Systems, Cal-Ray and Sodexo, and many more!

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Contact us at htmjobs@mdpublishing.com to learn more about our various posting options and low flat-rate recruiting services!

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Field Service Engineer

X-Ray Service Engineer

Field Service Engineer Nuclear Medicine

Universal Medical Resources, a leader in Nuclear Medicine Sales, Service, and Parts has openings for experienced Field Service Engineers throughout the United States. Field Service Engineers are assigned a territory where they are responsible for maintaining nuclear medicine equipment at customer’s sites. The position requires frequent travel within the territory as well as occasional travel outside the assigned territory.

First Call Parts has been providing customers with quality replacement imaging parts since 2009. We pride ourselves in developing a top-notch reputation in the imaging industry as delivering the best in diagnostic imaging replacement parts. We specialize in the sale of refurbished/tested and used, Philips, Siemens, and GE in the Cath/Angio, R/F, and RAD modalities.

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VIEW FULL DETAILS www.htmjobs.com

VIEW FULL DETAILS www.htmjobs.com

Imaging Field Service Engineer III

Customer Support Engineer II/III - MRI/CT

Field Service/Customer Engineer (VL/MR/CT/UL)

Field service on medical equipment, installation of x-ray equipment, Diagnostic Imaging field service engineer servicing multi-vendor/multi-modality equipment in hospital and other environments.

Focusing on c-arms, Digital R/F, Digital Mobiles, x-ray systems and digital capture both DR and CR modalities. Growth opportunities to include CT, MRI, Ultrasound, and others.

The Customer Support Engineer II installs, inspects, troubleshoots, repairs, calibrates and verifies the performance of medical imaging equipment including, but not limited to: MR and CT systems, general radiographic rooms, portables, mammography, ultrasound, bone density and supporting equipment. This is not an entry level role.

FSE job is for Wichita, KS. Hours of operation are 8:30am to 5:00pm Monday thru Friday (excluding Holidays). The territory you will be responsible for will primarily be Kansas and occasionally a few neighboring states. This job includes many benefits including health insurance, 401k investment plans, company car, PTO, bonus programs and more.

Company vehicle or Car allowance, tools, uniform, relocation assistance, training (on the job, online & classroom technical instruction at our training facility in Irvine, CA), benefits on day one of employment, 401K with matching, collaborative team environment, growth, work life balance, strong company culture of excellence... and so much more!

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VIEW FULL DETAILS www.htmjobs.com

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Imaging Service Engineer 1

Imaging Engineer III

Senior Imaging Service Specialist

The role will focus on customer needs and ensuring all CTM related functions are completed in a quality and timely manner to include medical device preventive and corrective maintenance and other related matters. Ideal candidate will have experience and training in biomedical equipment role/field and the capability to serve a wide variety of customer needs.

If you are wondering what makes TRIMEDX different, it’s that all of our associates share a common purpose of serving clients, patients, communities, and each other with equal measures of care and performance.

The SISS must possess and demonstrate a highly advanced knowledge and ability to use the required test equipment and have the required electronic and mechanical knowledge and skills. The SISS must have the ability to interpret and effectively utilize service manuals, schematics and other applicable service information required to perform and document planned maintenance and repair of the diagnostic imaging equipment and systems.

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VIEW FULL DETAILS www.htmjobs.com

VIEW FULL DETAILS www.htmjobs.com

AMSP

AMSP MEMBER DIRECTORY I M A G I N G Brandywine Imaging, Inc. www.brandywineimaging.com 800-541-0632

KMG www.kingsmedical.com 612-757-6714

Medlink Imaging www.medlinkimaging.com 800-456-7800

Interstate Imaging www.interstateimaging.com 800-421-2402

Maull Biomedical www.maullbiomedical.com 440-724-7511

Preferred Diagnostic Equipment Service, Inc. www.pdiagnostic.net 951-340-0760

Radon Medical Imaging www.radonmedicalimaging.com 800-722-1991

The Association of Medical Service Providers (AMSP) is the premier national association of independent service and products providers to the health care technology industry.

Our large pool of modality specialists provide for lower costs and higher quality services for our customers throughout the U.S. Learn more at www.amsp.net.

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INDEX

ADVERTISER INDEX Association of Medical Service Providers (AMSP) p. 56

KMG p. 23 PM Imaging Management p. 51

Diagnostic Solutions p. 37

Maull Biomedical p.40

Ray-Pac® Ray-Pac p. 60

HTMJobs.com p. 54

ICE Webinars p. 25

Injector Support and Service p. 15

MIT Labs p. 21 Summit Imaging, Inc. p. 59

Medical Imaging Solutions p. 3

Technical Prospects p. 4

MedWrench p.26 TransAmerican Medical p. 17

Innovatus Imaging p. 9

Metropolis International p. 40

International X-Ray p. 37 Multi Medix p. 43 KEI Medical Imaging p. 47

SOLUTIONS

TriImaging Solutions p. 28

Mammo.com p. 2

W7 Global, LLC. p. 51 MW Imaging Corp. p. 5

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