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Radiology Information Systems

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Issue 5 2016

Publisher FRI Media (Pty) Ltd for ProMed Computer Services Editorial Quinton Mbokazi Lee Raath-Brownie

Contents Technology news for the Informed Radiologist

Design Marc Raath Proofing Lee Raath-Brownie Vicki Jacob Distribution Quinton Mbokazi Contributors Carine Kilian Clive Daniell Rudi Craps Branden Greenwood Enquiries to: quinton@promed.co.za The views expressed in this publication are those of the authors and not necessarily those of the editors or publishers. Furthermore, advertising material contained in this magazine does not carry the magazine’s endorsement or guarantee of the product claims for the products made by the manufacturers. While every care has been taken to ensure accuracy of content, no responsibility can be taken for any errors and/or omissions. The content of this publication may not be reproduced in part or full without the consent of the copyright owner. ProMed Computer Services Tel: 08610 PROMED or 011 966 0600 Offices: Johannesburg (HO), Port Elizabeth, Bloemfontein and Durban www.promed.co.za

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2 Cover profile The need to manage big data - By Carine Kilian 4 Upgrading information technology hardware What you need to know when upgrading or purchasing IT hardware - By Rudi Craps 6 Centricity Clinical Archive solution Hospital-wide access to patient documents helps to drive efficiency with Centricity™ Clinical Archive (CCA) solution 0 Artificial intelligence 1 Artificial intelligence may aid in Alzheimer’s diagnosis 2 Technology 1 Mobile access to radiology images and the need for DICOM key object - By Clive Daniell 4 Cloud computing 1 The pros and cons of cloud computing - By Branden Greenwood 8 Buying a medical display 1 What to look for when buying a medical display? 2 Lifestyle and gadgets 2 Samsung’s next generation smartphones at the core of its connected Galaxy experience 4 Industry news 2 Local and global news Keeping abreast of electronic health records GE invests R500 million to innovate in Africa for Africa NHI costs to skyrocket SA Medical Aid Customer Satisfaction Index changes Radiologists sue minister International Day of Radiology: 8 November 2016 2 Upcoming Events 3 Radiology related events from across the globe

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cover profile

The need to manage big data By Carine Kilian

“It is a sad thing nowadays that there is so little useless information” Oscar Wilde in 1894.

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ata on its own has become a source of value as the world continuously experiences a shift in economic power. Big data is rapidly becoming a driving force for economic development is poorer countries. This is exciting and more staggering is the vast number of facts and untold nuggets of information that could baffle the most ardent followers of the internet. Every day the world creates 2,5 quintillions of data. That’s 25 with 17 zeros for those

who struggle with reading numbers. This is everything from sophisticated medical data to Facebook photos and Twitter gossip. It is estimated that 90 percent of the world’s data has been created in the last two years alone, with 90 percent in digital format. The amount of data created daily is sufficient to fill 10 million Blu-ray disks, enough to cover the Eifel Tower in Paris. Data being stored today is growing four times faster than the world economy and influencing most of healthcare provision today. The internet population is estimated to be growing at 14 percent per year. In 2013 the number of people having access to the internet reached three billion. This is equal to the world population in 1960. Experts indicate that 40 zettabytes of data will be in existence in the year 2020. In 2012, the World Wide Web only contained about 500 billion gigabytes of data. This is equal to only one half a zettabyte. The facts are quite staggering and one can only imagine Oscar Wilde’s reaction today. Big data has made a massive difference on the healthcare practitioner’s ability to provide quality and affordable healthcare. 70 percent of people in the USA and UK now tract their health measurements through applications either via smartphone or tablet technology. This is providing a massive opportunity for healthcare practitioners and their patients to collaborate in the future in managing their health as a team.

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Most medical practitioners today would have to quit practicing if they did not have access to sophisticated computerised information systems. These programs have dramatically improved the paper, filling and ‘it’s in a box somewhere’ record keeping systems. Data management, however, is complex and can be more problematic than a simple cardboard storing system. Many systems may take long to master and need constant updating and tutoring. Nothing can be more frustrating than lousy support, incomplete training and irregular updates. The chaos caused by a system crash can have dire consequences for both patient and healthcare practitioners. Despite these challenges, the use and management of data has become indispensable today. Although a physician’s primary role will remain an expert in the art of medicine, the use of data will continue to assist in the decision making process, dynamically contributing in query and analysis, accumulation of scientific knowledge and observations based on state-of-the art recommendations. The future of healthcare is going to depend on the more effective use of information and data. Clinical IT must be able to meet these demands to improve, empower and provide healthcare assistance. RadiologyIT Issue 5 2016


Positioning radilogy practices as technology leaders

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Upgrading information technology hardware

What you need to know when upgrading or purchasing IT hardware By Rudi Craps

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aking savvy business decisions in the current, often unpredictable economy that is South Africa, it is difficult to know what the best way forward is when deciding to purchase or upgrade information technology (IT) hardware. Often we are faced with the choice between branded equipment and a potentially hefty price tag and unbranded, often seemingly cost-effective equipment. Any business, small or enterprise may consider the unbranded equipment as a more viable option due to the initial capital outlay as being more affordable. However, the unforeseen expense of supporting this equipment in the years to come may cause the business to incur further unforeseen expenses and may even cause permanent loss of data or extended periods of downtime. These expenses take the form of hours of downtime for maintenance and troubleshooting when problems occur, as well as adding additional items such as more storage or compute resources that a growing business will eventually require. The decision to install branded equipment, even though the additional

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cost may be substantial, allows for cost- and time-effective maintenance and IT support as well as scalable upgrade options when it is required. It also provides additional behind-thescenes features that allow for several maintenance features to be performed proactively as well as features that notify the vendor’s helpdesk of a failure before it affects the environment. Another benefit of having a reputable system is that parts are readily and widely available and can be sourced in minimal time. Technicians are also more likely to have experience with the system flaws that may arise and even when downtime is required to troubleshoot errors, it can generally be minimised thus fewer hours

taken away from business time, which costs any size business valuable time. What does the industry think about innovative features and designs, as opposed to price and also support and reliability? There is a yearly survey done by IT pros (www.itbrandpulse.com) examining many different areas in IT in, which the industry collectively votes on each brand in each category in private cloud environments, public cloud environments as well as hybrid cloud environments. Some of these require equipment to be acquired and others where only the software is considered as cloud relieves the need for any additional hardware purchases to be made and functions on a company hosting the equipment in the cloud. RadiologyIT Issue 5 2016


Upgrading Information Technology Hardware In the survey of 2015 a few of the highlights are as follows: VMware overwhelmingly made it fivein-a-row with its 2015 victory in every leader category of server virtualisation (market, price, performance, reliability, service and support and innovation). Microsoft and Oracle placed second and third, accordingly, for market leader. Another double category winner, Dell, was the favourite as market leader for industry standard servers, as well as micro servers. For industry standard servers, this marks the third year in a row that Dell was chosen market leader (in front of HP and Cisco, respectively), though the remaining leader titles were evenly split: Dell for price, service and support awards, HP for performance, reliability and innovation. This year’s micro server survey results showed Dell regaining the market leader title it lost in 2013, with IT pros also giving Dell the entire category honours (price, performance, reliability, service and support and innovation). HP, the reigning two-time title holder, finished second and Supermicro rounded out the top three. Intel Xeon once again swept enterprise server LOM (two straight years) and picked up its fourth consecutive win for enterprise server processors. Intel Xeon was selected as the market, price, performance, reliability, service and support and innovation leader for LOM, with Broadcom coming in second across the board, followed by Emulex and QLogic in a thirdplace market leader tie. In the largest vote margin in the January surveys, Intel, with its Xeon-family offering, received market, price, performance, reliability, service and support and innovation awards for server processors. The Intel Atom processor commanded the runner-up market leader space, followed by AMD.

were IBM and NetApp, in that order. For deduplication backup target appliances, EMC swept all of the leader titles (market, price, performance, reliability, service and support and innovation). HP came in the second market position, with Dell and IBM tied for third. EMC Isilon pulled out another across-the-board victory in scale-out file storage systems (market, price, performance, reliability, service and support and innovation) leaving NetApp’s Clustered Data Ontap 8.x as number two and HP’s StoreAll Storage as number three market leader finishers. Looking at the surveys performed and the results it shows, we can clearly see that there is constant competition between different vendors for innovation that drives IT and is the reason system features, reliability and support ranging from hardware and software utilising the hardware and both are advancing every day. Looking at the results worldwide then using information gathered from around the world, we can safely assume the following: Operating systems running on branded hardware (VMware, Microsoft, Citrix, etc) have very specific requirements and often limitations that are usually stated in their hardware compatibility lists (HCL), which is taken into consideration when releasing new machines as well as customised software to conform to the standards required and set by the software vendors. Drivers for the hardware are kept up to date with firmware releases that can be performed during maintenance windows ensuring that bugs are fixed and will never occur on the environments they are installed at.

Deployment is simplified as there are many fewer surprises with installations of new or replacement equipment due to very clearly tested deployment guidelines etc. Unbranded hardware lack in these areas and could cause many headaches such as delayed project rollouts, unforeseen issues on a new system either immediately or after an installation is complete, unsupported configurations on operating systems not documented due to no standards existing. Another consideration when looking at these surveys is that we can also look at it from outside of IT and consider it to be marketing jargon, not worth the effort. ProMed has done many installs before at sites all around South Africa and when these deployments take place a few things can be mentioned: Storage is the heart of a system and if one wishes to reduce cost of an overall solution this is the last place to cut costs. Even in the event of all servers failing in an environment, as long as the data is safe the business can generally recover normal operation quickly. Utilising some features provided by software vendors such as VMware and Microsoft Hyper-V, systems can be automatically recovered very quickly and often without much/any disruption to business operation and reduces risk to a business and the clients of the business. Looking at the international response to the topic it seems then that more companies are considering risk versus cost benefit and not many are even considering cheaper alternatives due to loss in revenue during outages at unforeseen times.

In another survey done on storage specifically the following was found: EMC proved to be the most dominant vendor in the annual storage surveys by picking up three market leader titles: fibre channel disk arrays (sixth year in a row) and in two newly-added categories, deduplication backup target appliances and scale-out file storage systems. For fibre channel disk arrays, the results were a repeat of last year: EMC as market, performance, reliability, service and support and innovation leader. Price went to Dell. Market leader runners-up Issue 5 2016 RadiologyIT

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Centricity Clinical Archive solution

Hospital-wide access to patient

documents helps to drive efficiency with Centricity™ Clinical Archive (CCA) solution

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niversity Hospital Antwerp (UZA) based in Belgium is a university centre providing tertiary care, academic training and international scientific research. Approximately 600 000 patients visit its 38 departments every year, which all benefit from organisation-wide access to medical imaging and scanned documents using the Centricity Clinical Archive (CCA) solution from GE Healthcare. UZA employs approximately 2 800 people including 400 doctors and 1 400 nurses. CCA provides vital support to over 1 350 professionals at the hospital in the roles of clinicians, administrators and accounting staff. At UZA, Centricity Clinical Archive (CCA) is deployed as a Level 3 Vendor-Neutral Archive (VNA) to store images and documents with full XDS standard support. XDS stands for cross-enterprise document sharing and is an integration profile for document-based information sharing defined by Integrated Healthcare Enterprise. Clinicians and other staff regularly access the information in CCA via the Universal Viewer ZFP (Zero Footprint) from virtually anywhere and at any time, helping to improve departmental efficiency and access to data.

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Organisational challenges in summary • 38 highly-specialised departments spread throughout the hospital • Large amounts of patient data held in a variety of formats and locations, including paper Goal • Implement a solution to improve access to data throughout the enterprise Actions • Select Centricity Clinical Archive to power departmental efficiency and productivity • Migrate proprietary scanned documents archive to a standards based XDS document repository Results • Clinicians benefit from a time saving of circa 30 percent, helping them to see more patients and to increase the time they can spend with each patient • Accounting staff find patient data they need within two minutes, enabling rapid reimbursement RadiologyIT Issue 5 2016


Centricity Clinical Archive solution • •

Improved IT workflow with enhanced upload and technical applications thanks to innovative VNA Cross-departmental collaboration achieved having moved from silos of data to a single, unified source

Benefits for clinicians: Increasing productivity Clinical efficiency has been on the rise since the implementation of Centricity Clinical Archive solution at University Hospital Antwerp. Workflow efficiency improvements have been experienced by clinical staff that is rapidly able to access patient reports, images and other data through the Universal Viewer, Zero-footprint (ZFP). GE Healthcare’s Centricity Clinical Archive enables care providers at UZA to access a longitudinal patient record of clinical information from across the hospital, helping prevent unnecessary patient transfer, duplicated tests or scans and loss of information. “Using the Universal Viewer ZFP, we can easily locate data from within or outside the hospital, improving workflow. That could include reports needed for consultations or results from examinations such as ultrasound of the kidneys or urinary tract. This enables effective care decisions to be made as rapidly as possible, without the need to refer to a specific, secluded workstation,” states Prof Dr K Van Hoeck, head of clinic in the paediatric department, UZA. Improvement in clinical workflow with rapid access to patient data “Previous systems prevented us from working as rapidly as we would have liked. With Centricity Clinical Archive, we have seen a significant improvement and can work about 30 percent more efficiently, giving us time to see more patients. Productivity has improved in the department with CCA thanks to the time savings made but also due to the complexity and quality of data available. The benefit is experienced by doctors, social nurses, physiotherapists, speech therapists and other care providers,” said Dr Sandra Kenis, senior neurology staff, UZA. Benefits for clinicians: Cross-departmental connectivity With 38 departments producing an average of 3 500 patient documents a day, collaboration and cross-departmental connectivity are key to enabling clinicians and care providers at UZA with access to the relevant information. Centricity Clinical Archive consolidates clinical documents and images from multiple departments into a single reliable system. Universal

Viewer Zero Footprint interfaces with the electronic patient record to provide a single point of access to patient data. Connecting care across UZA “The ability to view documents and images throughout the hospital is critical as we frequently share information with other departments. I work closely with paediatric urologists and when deciding whether to operate or not, it’s vital they have fast access to reliable data such as scans of ultrasound images. Whether I’m in my own department, with a paediatric urologist or working from home, I have the reassurance that CCA is there when I or my colleagues need it,” states Prof Dr K Van Hoeck. Rapid access to the patient history With CCA, University Hospital Antwerp (UZA) has rapid access to a history of patient documents. Data can be shared between departments but clinicians also benefit from enhanced access to information from sites outside the hospital as paper reports are scanned and accessible via CCA. The clinical information viewer within Centricity Clinical Archive is IHE XDS compatible and offers a web-based zero footprint client, offering a highly intuitive matrix view of the patient’s history, along with thumbnails for fast and easy access.

Key metrics at UZA • Number of patients in the XDS archive: 1 219 271 • Most documents for a single patient: 2 673 • Average amount of documents per patient: 341 • Documents scanned per day and registered into the XDS archive: 5 000 • DICOM Archive: 1 382 816 studies • Non-DICOM Archive (XDS): 4 161 337 documents • New documents per day: 3 500 on average • Documents migrated to XDS before go live: 3,5 million • Universal Viewer ZFP is opened on average: 260 times per day

“Cross-departmental collaboration is key as we often need to work closely with other departments such as radiology, paediatrics and a number of specialist sub-departments within paediatrics. Multiple departments and clinicians can access the required patient information via CCA, with only a simple phone call needed if we want to discuss with colleagues in detail,” added Dr Sandra Kenis, senior neurology staff, UZA. Benefits for administrators: Enhancing workflow Centricity Picture Archiving and Communication System (PACS) with Universal Viewer, ZFP, tightly connected with University Hospital Antwerp’s information system (HIS:C2M), provides administrative personnel access to patient records in a digital format, consolidated in a single viewer. The timeline and filtering functionalities enable relevant diagnostic data to rapidly be accessed by accounting and administrative staff, enabling it to be smoothly incorporated into accounting processes. Administrative and accounting workflow is streamlined and all information is processed within two minutes.

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RadiologyIT Issue 5 2016


centricity clinical archive solution “We must correctly register a patient’s stay at the hospital. CCA enables us to fill any gaps in information enabling departmental records to be kept up to date and the correct billing for services rendered. When we open a patient file, it is extremely simple to access the data we need. Previously, we would have to spend large amounts of time searching for information, while data can now be accessed from a single source. Typically, I can locate all information needed within two minutes, and the quality of that data is also improved thanks to its enhanced visibility,” states Mariska Sel, medical secretary, accounting, UZA. “CCA gives us access to relevant patient information to help ensure we get the appropriate reimbursement for cath lab work. The technology is a lot faster and clearer than previous systems. We can put documents side by side so they are easy to cross-reference, plus we can easily find information by date and type using the timeline and filtering features. Previously, we had to search and scroll to find data, slowing down the reimbursement process, while now it just takes a few clicks,” added Vicky Somers, medical secretary, cardiology, UZA Benefits for IT departments: A single data source “Previously, patient reports and other documents went into different systems, depending on whether they were scanned via our central ‘scanning street’ or within the department itself. This resulted in silos of data, with clinicians or administrators often unable to locate data that had been created in another department. Now, those files are all registered into the XDS Registry of CCA, meaning they can be viewed through CCA and its Universal Viewer – reducing any gaps in data records and allowing everything to be viewed from a single terminal. Looking to the future, UZA will import movies from endoscopy, pictures from dermatology and ophthalmology, digital slides from pathology and much more,” states Katleen Smedts, project leader, IT department, UZA. Streamlining IT processes UZA digitises all paper-based patient records via an internal ‘scanning street’ facility. The information is then equipped with XDS metadata before being sent to Centricity Clinical Archive. This process makes the patient record available digitally in CCA and viewable with Universal Viewer ZFP. Centricity Clinical Archive supports IT administrators by offering a choice of virtual server deployment to save data centre space, enabling disaster recovery by connecting to cloud storage, and enhancing reliability with standardised configurations. “Beforehand, only our scanning facility was connected to a digital medical archive viewer. With CCA, a large number of medical devices are connected, with images and documents all accessible from a single source. The average patient has around 350 documents, so it is important the relevant data is easy to access. The IT department has also benefitted, as now we only need to integrate and maintain a single viewer as compared to three before,” added Katleen Smedts.

comprehensive patient information, not just imaging but multi-ology data at the point of care. A growing number of -ologies is introducing increasingly complex storage and management requirements from different technology vendors, formats and standards. The concept of siloed data runs counter to the general expectations of ‘integrated anywhere, anytime’ data access. There is a growing urgency to manage clinical images and other documents at the enterprise level and make meaningful connections between the disparate data sources and the clinicians who require access to them. The IT department at UZA and at other leading medical centres are increasingly seeking solutions that offer a unified approach combining both flexibility and a high degree of control for the internal IT team. This complexity makes it difficult to provide access to the right images and documents at the right time throughout different stages of patient care. This is why forward-thinking hospitals such as University Hospital Antwerp have chosen to migrate from multiple proprietary departmental repositories to a single vendor-neutral archive, enabling the rapid, organisation-wide sharing of data. Centricity Clinical Archive solution: the journey to a vendor neutral archive A VNA is a crucial platform for consolidating and sharing imaging and other clinical data efficiently. When selecting a VNA, it is important the solution is looked at holistically, keeping in mind enterprise-wide consolidation and sharing of imaging (DICOM) as well as other clinical document formats (non-DICOM).

Benefitting from a vendor-neutral archive (VNA) As diagnostic capabilities and availability of medical imaging continue to advance, healthcare IT executives face the daunting task of managing vast amounts of data created by the modalities and devices in their facilities across the network. At UZA, care providers continue to require more Issue 5 2016 RadiologyIT

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Artificial Intelligence (AI)

AI may aid in Alzheimer’s diagnosis

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esearchers in The Netherlands have coupled machine learning methods with a special MRI technique that measures the perfusion or tissue absorption rate, of blood throughout the brain to detect early forms of dementia, such as mild cognitive impairment (MCI), according to a new study published online in the journal Radiology. MRI can help with the diagnosis of Alzheimer’s disease,” said principal investigator Alle Meije Wink, PhD, from the VU University Medical Centre in Amsterdam. “However, the early diagnosis of Alzheimer’s disease is problematic.” Scientists have long known that Alzheimer’s disease is a gradual process and that the brain undergoes functional changes before the structural changes associated with the disease show up on imaging results. Physicians have no definitive way of identifying who has early dementia or which cases of mild cognitive impairment will progress to Alzheimer’s disease. “With standard diagnostic MRI, we can see advanced Alzheimer’s disease, such as atrophy of the hippocampus,” Dr Meije Wink said. “But at that point, the brain tissue is gone and there’s no way to restore it. It would be helpful to detect and diagnose the disease before it’s too late.” For the new study, the researchers applied machine learning methods to special type of MRI called arterial spin labelling (ASL) imaging. ASL MRI is used to create images called perfusion maps, which show how much blood is delivered to various regions of the brain. The automated machine learning program is taught to recognise patterns in these maps to distinguish among patients with varying levels of cognitive impairment and predict the stage of

An efficient VNA comes with built-in flexibility and adoption of industry standards such as DICOM, HL-7 and IHE-XDS, along with IT standards such as HTTPS, web services and XML. It should also offer security features for authentication, encryption, auditing and logging to protect data and documents within the system. University Hospital Antwerp required this type of flexibility and security in order to connect a variety of devices, meet evolving departmental needs and help ensure information was accessible from anywhere and at any time. “The ability to access both DICOM images and non-DICOM information with XDS support places us as a pioneer in

Alzheimer’s disease in new (unseen) cases. The study included 260 of 311 participants from the Alzheimer Centre of the VU University Medical Centre dementia cohort who underwent ASL MRI between October 2010 and November 2012. The study group included 100 patients diagnosed with probable Alzheimer’s disease, 60 patients with mild cognitive impairment (MCI) and 100 patients with subjective cognitive decline (SCD) and 26 healthy controls. SCD and MCI are considered to be early stages of the dementia process and are diagnosed based on the severity of cognitive symptoms, including memory loss and thought- and decisionmaking problems. The automated system was able to distinguish effectively among participants with Alzheimer’s disease, MCI and SCD. Using classifiers based on the automated machine learning training, the researchers were then able to predict the Alzheimer’s diagnosis or progression of single patients with a high degree of accuracy, ranging from 82% to 90%. “ASL is a promising alternative functional biomarker for the early diagnosis of Alzheimer’s disease,” Dr Meije Wink said. He added that the application of automated machine learning methods would be useful as a potential screening tool. “ASL MRI can identify brain changes that appear early in disease process, when there’s a window of opportunity for intervention,” Dr Meije Wink said. “If the disease process from SCD to MCI to Alzheimer’s disease could be intercepted or slowed, this technique could play a role in screening.” Source: Radiological Society of North America

the adoption of this technology in Belgium. We hope other hospitals will follow suit and use the technology to improve efficiency, ease of use and quality of care. Our key advice to anyone going through a similar implementation is to prioritise meta data; good quality meta data will ensure your VNA and its filtering functionalities can operate as efficiently as possible,” concludes Katleen Smedts. “As a university hospital, it is important we make the best use of technology to remain innovative. With GE Healthcare’s VNA, Centricity Clinical Archive solution, in place, we have taken solid steps in preparing ourselves for the future. It integrates with everything we need,” said Katleen Smedts, About GE Healthcare GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter - great people and technologies taking on tough challenges. From medical imaging, software and IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients. For more information about GE Healthcare, visit our website at www.gehealthcare.com.

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RadiologyIT Issue 5 2016


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technology

Mobile access to radiology images and the need for DICOM key objects By Clive Daniell on call or doing a ward round and just want to see the report and some reference images, a mobile device is perfect for such scenarios but scrolling through hundreds of images may be frustrating and time consuming. If the clinicians wanted to review the study in more detail, they may prefer to do this in the comfort of their consulting rooms and on a larger monitor.

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ne of the driving factors influencing many practices in South Africa to upgrade or refresh their picture archiving and communication system (PACS) solutions, is the requirement to have mobile access to the radiology images. This demand comes from the radiologists themselves and the clinician who refer to them. Accessing radiology images on a mobile device is not new technology and many vendors have mobile apps or web viewers to provide the functionality. For me the question is not about the technology but more about what other considerations a practice should take when deploying such a solution. In this article, I would like to explore the need to create digital imaging and communications in medicine (DICOM) key objects, especially in large cross sectional imaging studies. So, my question is, “Do the advancements in mobile technology and accessing radiology images, increase the need for radiologist to save DICOM key objects while reporting?” For some of you this may seem like a dumb question, because flagging significate ‘key’ images that are

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referenced in the diagnostic report, is common practice and part of your everyday workflow but for others, I’m not so sure this practice is that common. This may be due to a number of reasons. • The PACS application and how easy it is to flag the images, is it intuitive or does it require multiple mouse clicks? • A general lack of understanding of DICOM and DICOM key objects and the benefits they bring to referring clinicians. • Adding additional steps to the reporting workflow may be perceived to impact on report turnaround times. • The general perception that clinicians want to view all the images in a study. So, why would mobile technology increase the need to flag significate images in large cross sectional studies? Well, here are a few factors worth considering. The first is how clinicians may use the device and under which circumstances. Beyond showing their patients how fancy they are, I believe the true benefit of mobile technology allows clinicians to quickly reference patient images. They may be

Secondly, we need to consider mobile data costs. Depending on the connectivity in the hospital, many clinicians will access images on a mobile device by using 3G mobile networks. In South Africa data is not cheap. I’m not so sure clinicians will be happy to use all their data on scrolling through 100s of images trying to find the relevant ones, while if the radiologist has flagged key images, the access would be so much easier and cheaper. Thirdly, with the introduction of RESTful services to the DICOM standard, called DICOMweb™, the future way we access images will change and the audience wanting access to images will also change. Mobile devices will be at the forefront of using these services already evident with the development of patient portals, mobile apps and other web based applications. The use of webbased technology is changing PACS as we know it. By radiologists flagging key images, other users and applications can gain quick access to these images without having to download the whole study. This has far reaching benefits across the imaging enterprise. Flagging key images is a workflow function performed by radiologists during reporting, with the intention of making it easier to access significate images in a study. Mobile technology lends itself to consuming this type of DICOM object. So yes, creating DICOM key objects is an important function worth considering in the radiologists workflow and even more so when mobile access to image is deployed as part of the solution. RadiologyIT Issue 5 2016


Business continuity within minutes

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Cloud computing

The pros and cons of cloud computing By Branden Greenwood

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loud computing has become the thing everyone loves to talk about but not many people really understand. It can be a complex topic that sometimes can even confuse the technically minded. Therefore,

for the average person who needs to make business decisions about the future information technology (IT) needs of their business, ‘the cloud’ becomes more like a minefield. To start unpack this IT trend, we first have to understand what it is. The simple answer is basically any IT service you put up on the internet as opposed to being on premises. This is normally divided into cloud applications such as say Gmail or any sort of service, which hosts medical imaging for you on a per use basis. The other form is the more technical, namely hosted data centre, in which case you move the big costly server room in your office to a hosting provider or completely outsource the entire data centre to someone else. Lastly, there is the lesser known hybrid

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cloud solution where you have part of your application or data centre at your premises and the rest hosted off at a third party or hosting data centre. Now, this all sounds great and most people have heard the sales pitches like, “you can save money by sharing costs with others”, “leave the maintenance headaches behind you”, “free application upgrades” and so on and so on. However, few sales people point out the very real dangers and pitfalls associated with cloud solutions. First and most important of all of them is security. You are basically entrusting your imaging, medical records and financial information to someone else, be it a local entity you have contact with or a large multinational IT concern and how sure are you that they are keeping RadiologyIT Issue 5 2016


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Cloud computing of our data. Many sales people come to us with a great solution and they seem to check all the boxes and meet all our requirements but almost always fail to mention that our data is going to be kept in some far flung data centre in some far off country. In some cases, they promise a local server but then go and do backups to overseas locations. For those of us in the healthcare industry this is the single biggest problem we face when moving to the cloud.

your data safe? Some local providers even buy servers and services from overseas providers and don’t inform you. Therefore, your precious data may be at risk from everything from a determined hacker to a bored system admin. Fortunately enough there are companies out there who take this type of thing very seriously and containerise your data in such a way they themselves can’t see it on their servers and they deploy state-ofthe-art protection in the form of firewalls and intrusion prevention systems. The real issue here is most people never stop to think of these dangers and see only the fact that you are passing the IT maintenance headaches to someone else. As consumers we have to insist on full details of how the provider is going to protect our data not only on the server in their data centre but also getting it to their data centre. Often we also forget that our data can be stolen in transmission and we never ask about things like encrypted connections and isolated networks. Which brings to mind the other big issue with cloud services for us in South Africa ie connectivity. For most of the Western world, internet connection is seen as a basic right with some campaigning for it to be added to the basic human rights in their countries along with water and sanitation. Sadly, for those of us in Africa, internet connectivity, whilst having improved in leaps and bounds in recent times, is still a luxury rather than a right. There are many areas where internet connectivity works but

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at poor speed and poor service quality and places where it simply doesn’t exist at all. Consider then that cloud solutions simply don’t exist when your line goes down and the impact on your business is extremely damaging. Imagine not being able to function for a week or more thanks to telephone cable theft or a lightning strike. Fortunately enough, we South Africans are an innovative bunch and there are many providers who offer hybrid cloud solutions and multiline backup solutions for existing data links. Sadly, more often than not as consumers we don’t see the big picture and see these things as expensive add-ons that can easily be discarded a nice to have but not necessary. We need to rather approach these solutions not from the point of view of the solutions providers in the USA, UK and Europe but rather with a solution tailored to our unique needs here in South Africa. The last and most worrying issue with cloud solutions today is the location

There are strict rules in place regarding the keeping of patient records not to mention the moral responsibility attached to being the guardians of a person’s most private medical records. We have to be very careful and uncompromising to ensure that every part of the provider’s infrastructure is at all times kept within the borders of our country and within the control of our laws and regulations. Sadly, this in reality rules out most of the current major cloud providers, however, there are many providers who do provide services exclusive to South Africa. Despite what many may say or think, there are large companies who are willing to invest in our country and house large data centres such as the IBM cloud data centre being prosed in Johannesburg and the more we support them, the more it encourages others to follow. At the end of the day, as daunting as all these issues may be, it is simply a case of not going out and buying cloud for clouds sake. The benefits undoubtedly far outweigh the pitfalls but we need to question those offering solutions and carefully research our decisions when choosing to move to the cloud. We need to learn to hold back if there are any doubts and not chase after the next big thing in this day and age of flashy new gadgets, app stores and the ‘must have now’ culture. We need to find and partner with providers who are honest and transparent and meet all our needs as well as address all the problems and we need to focus on providers who offer real innovation to the healthcare industry. RadiologyIT Issue 5 2016


Vacancies SALES EXECUTIVE GP & CT Have at least 3 years Sales Consultant experience in the pharmaceutical or medical environment. Radiology preferential; Possess excellent written and oral communications and presentations skills; Possess excellent customer facing and relationship building ability; Be a self-starter, deadline and results orientated; Understanding of IT software and hardware; Demonstrate product and marketplace knowledge, understanding both infrastructure and workflow, of Radiology IT solutions, or similar complex environments; Demonstrate commercial acumen and understanding of business finance; Have proven ability to: Prepare quotes and sales materials; Present technical solutions to customers at all levels;

TECHNICIAN WC/JHB/ SNR/JNR Have at least 3 years’ experience in a technical IT support environment; MCTS/MCITP qualification desirable; A+ and N+ required; LAN and WAN experience; Demonstrate an in-depth understanding of IT systems; Demonstrate a basic understanding of Virtual environments; Possess excellent interpersonal and communication skills ; Be able to troubleshoot and resolve both technical issues; Be prepared to travel for implementation and support work; Be able to work independently to achieve results with minimal supervision; Be willing and able to learn the latest RIS / PACS workflow technology at an application and technical level in a condensed period of time.

PACS ADMINISTRATOR JHB/BFN Have at least 3 year’s experience in a technical IT support environment; Demonstrate an in-depth understanding of complex IT systems; Possess excellent interpersonal and communication skills; Be able to troubleshoot and resolve both technical and workflow issues; Be prepared to travel regularly for implementation and support work; Be able to work independently to achieve results with minimal supervision; Be willing and able to learn the latest RIS / PACS workflow technology at an application and technical level in a condensed period of time. Provide front line support for key customers on all software application; Resolve workflow and technical issues independently, where possible, or work with others to ensure their resolution; Develop and maintain your own skill set and knowledge base to ensure that you are able to be the subject matter expert that the customer can rely on; Be a positive representative in all dealings with the customer, taking ownership of any issue raised and ensuring each issue is addressed to the satisfaction of the customer; Provide effective communications, both written and verbal, between company and the customer by means of regular meetings, feedback reporting, escalation of unattended issues and follow-ups; Interface between head office support functions and the customer to ensure consistently high levels of customer satisfaction; Other ad-hoc duties as requested; Ensuring general housekeeping and sound administration of area of responsibility; Always projecting a positive company image in interactions with customers and colleagues; Time management.

Should you feel you are suitably qualified, please e-mail your C.V. confidentially to beverley.thuynsma@gmail.com


Buying a medical display

What to look for when buying a medical display? 10 golden rules to remember

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hen considering a new medical display system, accuracy, efficiency and compliance are likely to be the most decisive criteria. And with good reason. After all, dependable image representations are of vital importance in

the healthcare imaging arena. But, how can you recognise products that rank high on all these criteria? Below, we have listed 10 golden rules to consider when investing in medical display equipment.

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Image stabilisation sensors are a must

Over the years, display manufacturers have developed a number of technologies to stabilise the luminance of their medical monitors. When considering a medical display solution, it’s important to understand that fundamental differences exist in sensor technology. Understanding these differences will ensure you maximize your investment. Backlight sensors Backlight sensor technology is the most commonly used stabilisation method in the industry. As the name suggests, this technology measures and controls the intensity of a display’s backlight, near the lamps, at the back of the display. Displays equipped with backlight sensors will produce stable backlight luminance over time but do not perform intervention-free calibration, quantitative quality assurance (QA) checks nor maintain a complete record of the display’s compliance. Front of screen sensors Contrary to backlight sensors, front of screen sensors perform their measurements at the front of the display, ie where the images and subsequent diagnoses take place. This approach has numerous (inherent) advantages but here again, it’s important to do your homework, since not all front of screen sensors are high-precision luminance photometers able to perform precise quantitative measurements:

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• Fixed or mechanical sensors Some manufacturers equip their monitors with fixed or mechanical sensors, which only monitor the white point of a display. This type of sensor is not National Institute of Standards and Technology (NIST) traceable. It is therefore important to read all technical information supplied by manufacturers to understand calibration recommendations because an external photometer is often required. • Fixed high-precision luminance photometers The most accurate measurements are achieved with fixed high-precision front of screen luminance photometers. These provide accurate and traceable measurements of the complete DICOM curve twice per second and over the full lifetime of the display. Due to their position, front of screen luminance photometers account for changes in the complete optical stack, where the images are being viewed and not just the backlight. The Coronis display line from Barco uses an 18-bit precision photometer called ‘I-Guard’. This patented I-Guard sensor is traceable based on the National Institute of Standards and Technology (NIST) standard. During the manufacturing process in a controlled environment, the ‘I-Guard’ sensor is calibrated to the centre of the screen along the entire DICOM GSDF curve.

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DICOM states that highprecision front of screen photometers must be used to perform quality assurance

DICOM Part 14, published by the National Electrical Manufacturers Association (NEMA) and the American College RadiologyIT Issue 5 2016


Buying a medical display of Radiology (ACR), provides strict guidelines for how grayscale display function calibration and quality assurance tests should be performed on displays used in diagnostic imaging applications. •

DICOM Part 14 states… “The photometer may be of the type that attaches directly to the display face (with a suction cup) or of the type that is held away from the display face. If of the latter type, the photometer should be well baffled to exclude extraneous light sources, including light from the background area of the test pattern.”

A NIST traceable photometer, such as the I-Guard sensor from Barco, is permanently attached to the display face and is internally baffled to exclude extraneous light sources. Displays that use backlight sensors to stabilize luminance, on the other hand, cannot prove compliance with the DICOM Part 14 standard without the use of an external photometer (puck). •

DICOM Part 14 states…”setting the DDL for the measurement field to a sequence of different values, starting with 0 and increasing at each step until the maximum DDL is reached.”

Backlight sensors can only quantitatively measure the intensity of the backlights from the rear of the display. To fully comply with DICOM Part 14, displays that use backlight sensors require periodic manual interventions, using an external photometer. Alternative systems, such as the I-Guard photometer and MediCal QAWeb software from Barco, precisely measure the entire digital driving level (DDL) range per DICOM Part 14.

• DICOM Part 14 states…”using a photometer to measure and record the luminance of the measurement field at each command value.” Again, displays that use backlight sensors to stabilise their luminance cannot prove compliance with the DICOM Part 14 standard without the use of an external photometer. By contrast, the I-Guard and MediCal QAWeb software from Barco maintain a complete front of- screen QA database without any human intervention.

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Uniformity correction helps to increase the accuracy of medical image reading

LCD monitors represent a significant technological innovation compared to their CRT-based predecessors. However, all LCD panels suffer from inherent uniformity imperfections, which cause arbitrary patterns called noise or mura. Studies show that a 40% luminance variation can be measured between individual pixels.

These unwanted non-uniformities may have a negative influence on the accuracy and efficiency of reading medical images and of subsequent medical diagnosis, as they make it difficult to discriminate subtle image features. More specifically, they increase the risk of possible ‘false negatives’ (clinically relevant features that remain undetected) and possible ‘false positives’ (non-uniformity interpreted as being part of the medical image). Dedicated solutions, like Barco’s Uniform Luminance Technology (ULT), address these non-uniformities by characterising the non-uniformity (spatial noise pattern) of the display. Appropriate correction values for every display pixel and all video levels are calculated and applied. ULT does not alter the content of the medical image. It simply removes distracting noise in the display, resulting in improved diagnostic quality and possibly higher accuracy in clinical results.

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Don’t overlook the benefits of centralised quality assurance

Be sure to consider an allinclusive online and remote service for calibration and QA on medical display systems. These systems can incorporate automated DICOM calibration, quality assurance, display asset management, problem solving and comprehensive reporting. As such, it assists facilities in preparing for joint commission audits and ensures radiologists effortless and continuous diagnostic confidence without interrupting their busy workflow. Issue 5 2016 RadiologyIT

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Buying a medical display

6

Protect your valuable LCD by means of a high-quality protective glass

In many hospitals, medical displays are classified as ‘capital equipment’. When not equipped with a protective front glass, however, they are vulnerable to damage from intensive use, cleaning products, fingerprints, dust, etc. Physical damage of the LCD is typically also not covered by the standard warranty conditions. It is therefore advisable to thoroughly read the warranty terms and conditions before making your display selection. Due to the wide array of environmental factors that can damage an LCD screen, Barco installs high-quality protective covers on its Nio and Coronis display systems. The benefits are clear: improved durability, easy cleaning, protection against inadvertent damage and reduced eye fatigue. Moreover, Barco’s protective covers use a proprietary coating which reduces reflection to <0.5% and significantly improves visible contrast.

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‘Characterise’ your displays to compensate for component degradation

Two methods exist in the industry for maintaining DICOM compliance between calibration measurements. Some medical displays are ‘characterised’ during the manufacturing process, thereby creating a factory default look up table (LUT). Think about this as resetting the display back to its original settings. This default LUT is designed to provide ‘factory reset’ setting. However, it doesn’t account for the degradation of all display components in the optical stack, like the polarizer and diffuser, which occur as the display ages. To compensate for these changes, some medical display systems dynamically ‘characterise’ a look up table, which is modified each time the display is recalibrated by means of a photometer. This method is used by Barco, since it has found that component aging significantly affects the DICOM conformance of the display. The use of a dynamic LUT gives users a more accurate view of a display’s current performance.

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Eco-friendliness and diagnostic precision are not mutually exclusive

Everywhere on the planet people are rapidly embracing ‘green’ technology. With the introduction of the Coronis Fusion 6MP DL, Barco has proven that this eco-awareness doesn’t need to preclude ultimate diagnostic performance. The Coronis Fusion 6MP DL system complies with restriction of hazardous substances (RoHS) and waste electrical and electronic equipment (WEEE) regulations and it consumes 27% less power than the average dual-head 3MP colour display system, while at the same time ensuring supreme diagnostic precision.

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Choose a display that perfectly matches your application needs

Medical displays come in all sizes and resolutions. When buying a new solution, it’s essential to select a display that is well-adapted to your specific application and reading environment. But it shouldn’t stop there. When considering new screens, it is also wise to anticipate future trends, such as the rapid shift towards multimodality colour imaging.

Barco’s wide product portfolio enables healthcare professionals to always find a ‘fit-for-purpose’ solution for their specific needs or preferences. Besides traditional dual-head monitor systems, customers can opt for the latest ‘fusion’ display systems, which make it possible to use a 30-inch screen as two seamless dual heads or one large single-head display. In addition, Barco is a pioneer and specialist in multi-modality displays system, allowing you to simultaneous read colour, grayscale and fused modalities on a single multi-purpose monitor.

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All warranty conditions are ‘not the same’

When considering your next medical display purchase, be diligent in reviewing the elements of the factory warranty. Ask for documentation of warranty claims. Reading through the warranty terms and conditions can provide better insight into what the factory warranty actually covers and what performance level is guaranteed. Barco’s warranty clearly states that the display systems, including the graphics controller, are warranted for a period of five years. Barco has been a solid and trusted provider of medical imaging technology for over twenty years, and its products and service have been valued by customers all over the globe.

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Purchase a complete product solution from one vendor

A complete imaging solution includes displays, a high-performance graphics controller and dedicated software for quality assurance. Some display companies rely on third parties for components like graphics controllers and software. This raises the potential for complications and incompatibilities within display systems. Barco, however, focuses on providing a complete product solution that has gone through rigorous validation testing with all major workstation manufacturers and PACS companies. This approach ensures you that all components are designed to function smoothly as a system and it gives you a single point of contact for support. RadiologyIT Issue 5 2016


Lifestyle and Gadgets

Samsung’s next generation smartphones at the core of its connected Galaxy experience

Galaxy S7 Edge Gold

Galaxy S7 Black Onyx

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amsung Electronics Co Ltd’s latest additions to the Galaxy family of products, the Samsung Galaxy S7 and Galaxy S7 edge was created for today’s consumer lifestyle, leading the industry with a more refined design, advanced camera, streamlined software functionality and unparalleled connectivity to a galaxy of products and services. “We believe in a world that is brighter, sharper, more convenient and fun. We strive to deliver on that vision with the Galaxy S7 and Galaxy S7 edge by marrying elegant look with functionality and providing a seamless mobile experience,” said Craige Fleischer, director of integrated mobility at Samsung Electronics South Africa. “We are committed to empowering our consumers with groundbreaking technological solutions, in order to enhance the user experience of our products.” Advanced camera: High quality images no matter the time of day or location The Galaxy S7 range introduces the first dual pixel camera on a smartphone, delivering brighter and sharper images, even in low light. Thanks to the revolutionary dual pixel technology, the lens has a wider aperture and larger

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pixel, the camera has a faster shutter speed and a more accurate autofocus even in low-light conditions. Motion panorama, a new camera mode, brings movement to traditional panoramic photos, giving the user a completely visually appealing understanding. Refined design and function The 5,1-inch Galaxy S7 and 5,5-inch Galaxy S7 edge are constructed with 3D glass and metal, all in a sleek design with durability and ergonomic curves for a comfortable grip. From work to play, the device’s new always-on display, gives consumers a simplified, zero touch capability where they don’t need to worry about missing a call or important notification.

consumption and minimise notifications. Additionally, users can record their gaming practice or share their screen to challenge others. Paired with Galaxy S7 and Galaxy S7 edge, Vulkan API gives users the ability to play highperformance graphic games with lower battery consumption.

Without compromising design, the devices both have increased utility with IP68 water and dust resistance. Edge UX, the advanced edge available on Galaxy S7 edge, provides convenience and increased efficiency by creating easy shortcuts to users’ most loved functions such as email, selfie mode, panorama mode or third party applications.

Whether it’s the seamless connection between Galaxy S7 and Galaxy S7 edge and the new Gear S2 Classic to monitor fitness, or connecting with Gear VR to “travel” the world – Samsung redefines what’s possible for the use of mobile solutions.

Enhanced performance: from charging to gaming Galaxy S7 and Galaxy S7 edge delivers fast wired and wireless charging technology. Additionally, the hybrid SIM card tray allows users to insert a microSD card for up to 200GB of extra storage and in some select regions, the tray can be used with a dual SIM card. Samsung made significant hardware and software updates to optimise gaming performance on Galaxy S7 and Galaxy S7 edge. The powerful processer and bigger battery capacity ensure longer playing time, and the internal cooling system keeps the device from overheating. Game Launcher, a new add-on for gamers, allows users to manage battery

The Galaxy experience Samsung continues to challenge the limits of hardware, software and services to create devices that are designed to improve how consumers connect, share, organise and get more out of life. The company is redefining what is possible, past the restrictions of today’s technology, by introducing a constellation of seamless mobile experiences.

Beyond the phone, Galaxy S7 and Galaxy S7 edge users can also get the best mobile payment service with Samsung Pay; it’s secure, easy-to-use and accepted almost anywhere. Protected by Samsung KNOX, fingerprint scanning and advanced tokenisation, Samsung Pay works with near field communication (NFC), magnetic secure transmission (MST) and barcode technology, making mobile payments available to more merchants and consumers than ever before. “At Samsung, we are relentless in our pursuit for excellence and our philosophy is to make meaningful designs that capture attention and inspire our customers. The beautiful story behind the innovation of our mobile products is centred on putting the customer first and that’s keeping us ahead of the pack,” concluded Fleischer. RadiologyIT Issue 5 2016


Industry News Local

New index shows SA healthcare rated one of lowest by patients

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n the first Future Health Index (FHI) released by Philips it shows that cost is a significant barrier to healthcare in South Africa, much more so than any other market surveyed. The FHI explores how countries around the world are positioned to meet longterm global health challenges through the integration of health systems and the adoption of connected care technologies. The FHI focuses on three factors to help countries become better poised to meet current and future healthcare challenges. These are access to healthcare, integration of the current health system and the adoption of connected health technology and systems. South Africa received an overall score of 56,7 out of a possible 100, highlighting the need for a concerted effort to increase access to healthcare, according to the report. SA’s rating is based on low access to healthcare resources but a high adoption of connected care technology. The cost of healthcare came out as one of the top barriers to coordinating healthcare further in South Africa.

named as current challenges that impact healthcare access in South Africa. The need for integration became apparent in the research as 77% of patients reported having to repeatedly provide the same information to multiple doctors. “The Future Health Index has uncovered a number of significant areas where our healthcare system

must transform if we are going to succeed in delivering long-term valuebased care,” said Ntutule Tshenye CEO of Philips South and Southern Africa. “It is encouraging to see South Africa starting from a reasonably strong position in its readiness to adopt connected digital technologies that will ultimately drive transformation.” Source Fin24

South Africa’s healthcare system is one of the lowest-rated by its patients among the 13 countries surveyed. South Africa ranked 8th out of 13 countries. “The results of the survey highlight the need for a more concerted effort to increase access to healthcare, and conversely indicate a stable performance on healthcare integration, and above average performance on connected care technology adoption,” the index found. Improving access to healthcare services was indicated by health care providers (HCPs) and patients as something the SA government should prioritise to improve public health. Additionally, both patients and HCPs think the SA government should build and improve hospitals and other healthcare facilities. Limited resources, a lack of staff and education were Issue 5 2016 RadiologyIT

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industry news local

GE invests R500 million to innovate in Africa for Africa

The new state-of-the-art GE Africa Innovation Centre in Johannesburg

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E, one of the world’s biggest digital industrial companies, officially opened its R500 million 2 700m2 facility, the GE Africa Innovation Centre in Johannesburg, South Africa, on 13 June 2016. The centre, a first for GE in Africa, is another big investment for GE, affirming that Africa and South Africa

Jay Ireland, President and CEO of GE Africa immersed in a GE Africa Virtual Reality Experience

continue to be a good investment destination for big businesses and that solutions to Africa’s challenges, should come from Africa. The centre is the 10th GE Innovation Centre globally and the first Innovation Centre for GE in Africa. It is the first GREEN and LEED certified GE building in Sub-Saharan Africa and

The centre was launched on 13 June 2016

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will be GE’s centre of excellence (COE) for innovation in Africa. As part of GE’s continued commitment to support SMEs the building was 90%+ built, designed and executed by local businesses. It will be the home to GE’s innovation across Africa within its key business sectors such as aviation, energy, healthcare, oil and gas, power and transportation and will serve as the new headquarters for GE Healthcare. John Flannery, President and CEO of GE Healthcare globally, attended the opening event. Speaking at the official opening ceremony, Jay Ireland President and CEO for GE Africa said, “Innovation is shaping how we see the world and how we participate in its development today and into the future. GE is committed to driving innovation in Africa for Africa through supporting skills and SME development. The GE Africa Innovation Centre is one platform through which we are using our resources to empower ourselves and our stakeholders to positively contribute towards the sustainable development of Africa. RadiologyIT Issue 5 2016


Industry News Local

CT scanner at the GE Africa Innovation Centre

We are looking to impact and enhance the career aspirations of over 100 engineers from previously disadvantaged backgrounds. These are young people who will come through the centre and share their innovative solutions whilst learning from some of the best GE minds in their respective fields. They will work across GE’s product portfolio and deliver simplified world-class products to GE customers.” The cutting edge facility boasts an Experience and Exploration Centre, coffee shop and catering facilities, agile workspaces, Learning and Development Centre, Innovation Ideation and Collaboration Centre, as well as a GE Prototyping Laboratory and sustainable Healthcare Customer Experience Centre.

GE Africa Healthcare Experience

visitors will be treated to a glimpse of an interconnected and efficient hospital catering for both primary care settings and premium facilities. Further, the centre’s eight new permanent work stations will also provide customers with hands-on clinical education and applications training. At the centre’s announcement in 2014, Minister for Small Business Development, Minister Lindiwe Zulu said, “As the Ministry for Small Business Development, we are confident that working together, we will be able to unlock economic opportunities and thus achieve inclusive economic growth and sustainable employment, particularly for women, youth and people with disabilities. Together, we must ensure

that small entrepreneurs have abundant opportunities to grow and develop their enterprises in an environment that nurtures the development of these enterprises and enhances their job creation potential.” The centre will enable skills and SME development in Africa and serve as the basecamp for the Londvolota Enterprise Development Trust which launched in 2015 with a commitment to accelerating supplier development in South Africa and the equipping of SMEs to participate in the GE value chain. The ultimate goal of the centre is excellence and collaboration for GE, its customers and stakeholders across Africa.

Speaking at the opening, the Gauteng MEC for Health, Qedani Mahlangu said, “The Gauteng Department of Health is always working tirelessly with all the relevant stakeholders and this initiative will play a significant role in reducing the infant and maternal mortality rate in the province”. The Healthcare Experience Centre is designed to mimic different care areas in a hospital environment and includes focused spaces to help familiarise customers with care area technologies in the operating theatre and intensive care unit, cardiology, oncology, maternal and infant care and general radiology and after sales service. Featuring virtual and augmented reality displays and a range of installed equipment, Issue 5 2016 RadiologyIT

GE Africa Innovation Centre’s reception features a three-storey mural by Peter Mabeo

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industry news local

NHI costs to skyrocket Econex estimates the funding shortfall at approximately R200 billion. This is because SA’s economic growth has been assumed at a more optimistic rate than the reality. The economy showed a 1,2% contraction in the first quarter of 2016 and future growth has been forecasted around 1% or 2%, at best.

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The International Monetary Fund (IMF) has cut South Africa’s economic growth outlook for this year from 1,3% to 0,7%, and growth projection for next year was revised down to 1,8% from 2,1%. “The funding shortfall in 2025, assuming a growth rate of 2% per annum would equal more than a third of tax revenue generated from personal income tax, 75% of corporate income tax and 51 percent of VAT,” Econex points out.

The White Paper estimates the cost of healthcare under the NHI by 2025 at R256 billion, however, several commentators warned that these estimates were done with an optimistic assumption of 3.5 percent annual economic growth.

In total, the funding shortfall under this scenario is projected to be 13% of total tax revenue generated in the 2015/16 fiscal year.

he estimated cost assumptions for the implementation of the National Health Insurance (NHI) for South Africa in the White Paper published last December have been called into question by research and public interest bodies.

Several companies, associations and institutions submitted their comments on the NHI in May and June questioning the lack of clarity on funding. Economics consultancy, Econex, says its calculations indicate that the total amount required to fund the NHI in 2025 is almost as large as the estimated revenue collected from individuals in the 2015/16 fiscal year. The Free Market Foundation has done some “back of the matchbook calculations” and estimated the NHI to cost R367,4 billion when fully implemented. Econex says a 16% increase in NHI costs will bring the final cost to R357 billion by 2025. Shortfall The White Paper estimates NHI expenditure of R185 billion in the 2020/21 fiscal year and R255 billion in 2025/26. According to the White Paper, the shortfall in 2025 will be R108 billion based on 2010 prices.

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The Free Market Foundation says in its submission it is seriously doubtful whether South Africa is in a position to afford an ambitious proposal such as the NHI. “We are of the view that the introduction of an NHI will place an unnecessary and intolerable burden not only on South Africa’s people but also the South African government - a burden that will be felt for many generations to come if it is introduced.” Government has indicated that the NHI will be funded by tax revenue and mandatory NHI contributions. The Free Market Foundation says government should concentrate its efforts and scarce taxpayer resources on those who cannot afford health care. Government could act as financier for those who truly cannot afford it and let people decide for themselves where to spend their money, it says. “It is not necessary to finance the healthcare

needs of the entire population. Doing so is not a particularly good use of scarce taxpayer resources,” the foundation concludes. Lack of compliance Public interest law centre Section 27 refers to an assessment of the Office of Health Standards Compliance which indicated that on average health facilities across the country achieved 46 percent compliance to standards. “This suggests that most health facilities are unlikely to be of a standard to support an NHI,” it says in a submission published in June. “The White Paper touches on issues of human resources, infrastructure, funding of NHI and a health information system, but insufficient detail is provided to enable an assessment of the prospects of success of interventions and insufficient progress has been made thus far.” The law centre says the administration process and issues of management and governance remain “extremely opaque”. The roles of provinces, districts and municipalities have been obscured. The current timeframes do not give the Department of Health enough time to ensure that implementation of the NHI is successful. “The setting of unrealistic timeframes creates unrealistic expectations from health service users and from those implementing the policy. There is little doubt that it will not be possible to fully implement NHI by 2025. There is no reason, therefore, for the department to set itself up for failure,” says Section 27. Costly Keith Engel, CEO of the South African Institute of Tax Professionals (SAIT), says there is no doubt that the NHI will be expensive in both the short and long-run. “Most countries have underestimated the cost. The question is where will the funds come from in a South Africa? Treasury has indicated that a VAT increase is a strong candidate.” RadiologyIT Issue 5 2016


Industry News Local

SA Medical Aid Customer Satisfaction Index changes

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sample of 2105 private medical aid policyholders in South Africa gave the health insurance industry a satisfaction score of 74,2 out of 100 in the latest South African Customer Satisfaction Index (SAcsi), which is virtually unchanged since the last measure in 2015. In his report, Prof Adrè Schreuder, CEO of Consulta and founder of SAcsi, states that the industry is seeing a change in the leading brand for the first time in three years, with Liberty moving from a below par performance in 2014 to being named as industry leader this year. The six companies included in the Medical Aids survey were Bonitas, Discovery Health, Liberty Health, Medihelp, GEMS and Momentum Health based on their market share. Liberty made remarkable progress and scored an industry-leading 76,9 out of 100. Momentum Health, Bonitas and Discovery Health scored on par with industry at 75,6, 75,2 and 74,1 out of 100 respectively. Medihelp and GEMS scored below par at 70,7 and 67,5 respectively. In the case of GEMS the seven point decline in its score since 2014 is really concerning. The overall satisfaction score is in line with other insurance products released in the past two months, which indicated slightly higher satisfaction with short term and life insurance brands in South Africa. “SAcsi looked at satisfaction with

Engel says government may have to increase taxes just to cover already committed expenditure. In early 2016, many talked of a VAT hike to cover current operating costs. He questions the wisdom of “multiple layers of tax increases”. The Helen Suzman Foundation says the “hard fact” of the matter is that the financial basis for the envisaged plan will not exist until South Africa grows at a rate faster than that projected by the IMF for any year up to 2021. Issue 5 2016 RadiologyIT

the three types of medical plans: comprehensive, network schemes and hospital plans. This showed that customers on comprehensive plans were more satisfied (76,1) than those on hospital plans (72,2) or network options (70,3). Customers who have experienced rejected claims report dramatically lower overall satisfaction levels of 63,3,” said Prof Schreuder. The overall perceived values are low. Private healthcare in South Africa is becoming a grudge purchase, so these companies should be looking to actively improve the perceived value scores. It is particularly evident that the economy and customer perception of a lack of value had an effect as the industry’s perceived value score declined by 1.3 index points since 2014. Only two brands showed increased value in the year-on-year comparison – Liberty and Momentum Health. Given the fact that customer expectations remain high it is concerning that all of the brands fail to meet expectations in terms of reliability as they report that things go wrong more often than expected. This may be due to the fact that as a relatively expensive product, customers have high expectations of medical aids. GEMS customers reported the lowest perceived quality scores. Momentum, Bonitas and Discovery Health scored on par with the industry average and Liberty is leading the market.

The low growth rates will mean that government will be forced to postpone aspects of its program, disrupting the phasing of the program proposed in the White Paper. The White Paper also propose major restructuring of publicly provided health care. This reorganisation will impose costs, not only in terms of funding, but also of management attention and health professional skill development. The Suzman foundation says the Medium Term Expenditure Framework

Prof Adrè Schreuder ”It is clear that South African medical aids are working to reduce the number of complaints and improve how they are handled, as evidenced by significantly fewer complaints. “Medical aids are a high touch industry, meaning that there is a lot of interaction with the brands. Liberty has reported less than half the number of complaints since last year, reducing this from 23% of customers to 10.4% of customers. In addition, they improved how complaints are handled. Momentum has the highest score in the industry when it comes to handling complaints satisfactorily.” Consulta holds a licence with the American Customer Satisfaction Index (ACSI) and forms part of a growing number of ACSIlicensed partner countries worldwide, which allows South Africa to compare customer satisfaction in various industries with this global community. This shows that South African healthcare insurers obtained significantly higher overall scores than the US, while GEMS is performing at the lower end of the scale, the other South African healthcare provider.

should define the context of everything that is done in the public provision of health care. Greater attention has to be paid to costing units of provision, cost effectiveness studies and costbenefit analysis. This is the only way to develop better service with the limited resources available, the foundation says. Source: IOL

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industry news local

Radiologists sue minister they are not required to pay for these services upfront. The fund is supposed to reimburse medical providers including radiologists‚ who provide diagnostic services using imaging technology such as X-rays and ultrasound. The Radiological Society’s executive director‚ Richard Tuft‚ painted a somewhat different picture to that described by Mafata‚ saying the fund’s capacity to process and adjudicate claims had worsened since it introduced Umehluko. “Due to the systemic failures of the fund‚ and a failure by its officers to effectively fulfil their statutory duties‚ there exists a backlog of thousands of claims worth millions of rand. Many of these claims have not even been processed despite being lodged years ago‚ while many of those that have been approved have simply not been paid timeously or at all‚” he said.

T

he Radiological Society of South Africa and 19 individual radiology practices have taken legal action against the labour minister over the Compensation Fund’s alleged failure to process and pay out R121,5-million in claims for services they provided to injured workers. The case potentially has implications for the medical profession at large‚ as the applicants are not only asking the High Court in Pretoria to order the Compensation Fund to pay approved claims within 14 days but also to take steps to ensure that unprocessed claims are dealt with in a manner that improves its systems. The Compensation Fund was established under the Compensation for Occupational Injuries and Diseases Act to provide compensation to people who are injured at work. However‚ it has long been a source of frustration for both workers and medical service providers as claims get lost or delayed‚ sometimes for years.

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Last June‚ things got so bad that the biggest company handling claims on behalf of medical practitioners‚ CompSol‚ temporarily suspended its services. At the time‚ the South African Medical Association (SAMA) said many doctors were refusing to attend to ‘injured-on-duty’ cases because they had no confidence they would be reimbursed by the fund.

Tuft said the average debtors’ days for claims from the Compensation Fund was 350 days‚ compared to an average 12 days for claims from medical schemes. “Despite previous and repeated engagement with the fund’s administrators our approaches to resolve the backlog have been to no avail‚ leaving litigation as the last resort,” he said.

On Monday‚ 4 April 2016, compensation commissioner Vuyo Mafata conceded the fund had a history of unpaid claims but said it had improved its turnaround time, now averaging just 60 days, by automating its processes with an electronic claims system called Umehluko.

Mafata said the fund had tried to engage with the Radiological Society once it became aware of its plans to litigate last November‚ but to no avail. The Department of Labour would oppose the matter‚ but remained open to trying to resolve the matter out of court‚ he said.

The fund was solvent‚ with R52-billion in its coffers‚ and had paid claims totalling R6-billion so far this year‚ he said‚ adding, “We don’t want to not pay anyone.”

Claims could be outstanding either because there was documentation missing or because employers had failed to register the claim‚ as required by law‚ Mafata said.

Since many injured workers cannot afford the medical costs associated with their diagnosis and treatment‚

The fund had set up a team to try to help SAMA’s doctors resolve their outstanding claims‚ he concluded. RadiologyIT Issue 5 2016


Industry News international

Pay for women equals men in academic radiology, JAMA

A

survey of two dozen US public medical schools found that female radiologists were paid essentially the same amount as their male counterparts, the only medical specialty to achieve gender pay equity, according to a new article published 11 July in the Journal of the American Medical Association (JAMA). Female radiologists had an unadjusted average annual salary of $289 797, a difference of less than 1% compared with the average annual salary of $290 660 for men. After adjustments, female academic radiologists actually made more than men, with an adjusted average annual salary of $285 127, compared with an adjusted average annual salary of $282 749 for male academic radiologists. Radiology was the only major medical specialty in which the average adjusted annual salary for women exceeded that of men, according to the study team led by Dr Anupam Jena, PhD, of Harvard Medical School in Boston (JAMA, 11 July 2016). The researchers performed their analysis by extracting salary information published online from 24 public university medical schools in 12 US states, comprising a total of 10 241 academic physicians. They adjusted the salary data based on age, years of experience, faculty rank, scientific authorship and other factors. Overall, female physicians made 20% less than their male counterparts, with a mean annual salary before adjustment of $206 641, compared with $257 957 for male physicians, a difference of $51 315. The difference narrowed but still persisted after adjustment, with female physicians making a mean salary of $227 783, compared with $247 661 for men, a difference of 8% or $19 878. The salary differences persisted across faculty rank at the US medical schools surveyed, with female full professors having salaries comparable to male associate professors and female

Issue 5 2016 RadiologyIT

Salary differences by gender at academic institutions (adjusted) Specialty

Men

Women

Difference

Overall

$247,661

$227,783

8%

Radiology

$282,749

$285,127

-0.8%

Orthopaedic surgery

$368,070

$327,117

11%

Surgery

$312,411

$280,030

10%

Cardiology

$263,690

$229,940

13%

Paediatrics

$220,009

$195,457

11%

Internal medicine

$207,497

$191,338

8%

Family medicine

$191,879

$185,635

3%

associate professors reporting salaries similar to male assistant professors. Radiology may be a rare success story in terms of achieving gender equity in physician salary, according to the study. Not only did women radiologists have higher adjusted salaries than men, but a 2014 study by Jena et al found that radiology had the smallest difference in academic rank between gender in all specialties.

â&#x20AC;&#x153;Radiology had among the smallest sex differences in full professorship of all specialties, which suggests the potential importance of evaluating specific specialties to understand the practices associated with improved male-female equity in academic medicine,â&#x20AC;? Jena and colleagues wrote. Source: AuntMinnie.com

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industry news International

Managing the radiation dose while communicating the risk patients and their families with the impression that this issue is a deeply concerning one,” McCollough said.

D

espite evidence that low doses of ionising radiation associated with imaging are not dangerous, the medical community is frequently faced with the challenge of communicating the risk and managing the dose.

community that exist to manage dose levels in CT. It also suggests approaches for presenting radiation risk and benefit information that support the ‘as low as reasonably achievable’ (ALARA) principle and acknowledge the overall low or non-existent risk of CT.

In an opinion piece titled, “The Role of the Medical Physicist in Managing Radiation Dose and Communicating Risk in CT,” Dr Cynthia H McCollough, Professor of Medical Physics and Biomedical Engineering and Director of CT Clinical Innovation Centre, Department of Radiology, Mayo Clinic, Rochester, Minnesota in the US, discusses the discrepancy between the public’s perception of radiation risk and the actual risk from low doses of ionising radiation. The article, published in the June 2016 issue of the American Journal of Roentgenology, reviews resources from the medical physics

“When asked by a patient or a patient’s family about the risk of radiation, it is incumbent on each of us to remember the tenet of justification first and foremost,” McCollough said. “If the examination is needed, the benefit will outweigh any small or potentially nonexistent risk. The next responsibility is to image the patient with care by adjusting the delivered dose to the patient size and to the diagnostic task.”

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The correct approach to the discussion of radiation dose and communicating the risk is one that includes the five elements that neither brush aside the potential for risk nor propagate the alarmist message that CT is dangerous. These elements, contained in the American Association of Physicists in Medicine’s Position Statement on Radiation Risks from Medical Imaging Procedures1, are: 1. Support the radiation safety tenet of justification ie medical imaging procedures should be appropriate 2. Commit to patient safety in medical imaging by acknowledging the need to keep doses as low as reasonably achievable while also maintaining the diagnostic benefit of the examination or procedure 3. Acknowledge that the risks of medical imaging are small and may, in fact, be non-existent 4. Emphasise that the discussion of risk needs to be accompanied by discussion of medical benefit 5. Express concern about the reporting of predicted cancers as though they are fact and, in particular, to express concern that some patients are not receiving appropriate medical care because of their fears of radiation exaggerated by speculative reports. Source: American Roentgen Ray Society

“There have been too many polarizing articles on the topic of radiation dose in CT. These articles serve only to perpetuate the discussion, leaving RadiologyIT Issue 5 2016


Industry News international

International Day of Radiology: 8 November 2016

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he fifth annual International Day of Radiology (IDoR) will be celebrated on 8 November 2016 and will focus on breast imaging. Celebrate the thousands of lives saved by the many contributions of breast imagers. IDoR joint sponsors, the American College of Radiology, the Radiological Society of North America and the European Society of Radiology, will host international activities to mark the event, together with more than 100 medical societies in 57 countries. 8 November 2016, marks the 121st anniversary of the 1895 discovery of the X-ray by German physicist Wilhelm Röntgen. Join us as we recognise radiology’s role in diagnosing and treating breast cancer. Ways to Celebrate the Year of Breast Imaging: • Participate in International Day of Radiology (IDoR) activities • Sponsor a community event to demonstrate the importance of annual breast cancer screening starting at age 40 • Hold a workshop, lecture, webinar, open house or tweet chat for medical professionals or consumers • Post, share, like and retweet information from social media accounts (use #IDoR2016) • Include IDoR information on your website • Publish articles in your newsletter • Recognise the accomplishments of your professional team • Draft a news release or op-ed and send to local media • Request an official proclamation by a local governing body Do you plan on celebrating IDoR 2016? Share your ideas and photos using the hashtag #IDoR2016. Issue 5 2016 RadiologyIT

INTERNATIONAL DAY OF RADIOLOGY NOVEMBER 8, 2016

BREAST IMAGING SUPPORTED BY EUSOBI, SBI, EUROSAFE IMAGING AND IMAGE WISELY

AN INITIATIVE OF THE ESR, ACR AND RSNA

WWW.IDOR2016.COM

Since 1985

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Upcoming events

Upcoming Events 2016 22 to 27 August 2016 24th Zurich Course on Diagnostic and Interventional Neuroradiology Switzerland Based on the success of combining diagnostic and interventional neuroradiology in the past courses, the 24th Zurich Course will be held at the Department of Neuroradiology of the University Hospital of Zurich. Since its inception in 1992, the primary educational goal of the Zurich Course has been to link neuroradiology with fundamental neuroanatomy, neurobiology and clinical manifestations of neurologic disease. Formal lectures, interactive case discussions, video- and hands-on workshops are the educational format. This year, the diagnostic part of the course will cover selected topics on fundamental and advanced clinical neuroimaging of the brain, including neuroanatomy, neuro-oncology, neuro-immunology, neuro-vascular disease with emphasis on haemorrhagic and ischemic stroke and neuroradiology of the skull base. Venue: University Hospital of Zurich, Switzerland For more info visit: http://www.cinr-zurich.ch

3 October 2016 to 5 October 2016 The 16th International Cancer Imaging Society Meeting and Annual Teaching Course Glasgow The 16th annual meeting will offer an exciting array of educational material from cutting edge research to a review of basic concepts in cancer imaging. With a faculty of international experts in oncologic imaging, the meeting promises to offer insightful content in didactic lectures, hands-on workshops and informal presentations with audience participation. The 2016 meeting will highlight the changing role of imaging as it relates to advances in cancer diagnosis (such as genomics) and predicting and monitoring response of targeted therapies. Venue: University of Strathclyde, Glasgow For more info visit: icimagingsociety.org.uk

5 October 2016 to 7 October 2016 The 16th Mediterranean African Society of Ultrasound Conference (MASU) 2016 Alexandria, Egypt The Egyptian Society of Radiology and Nuclear Medicine is hosting the MASU in Alexandria, Egypt. MASU is a non-profit scientific association that seeks to promote the development of medical and biological ultrasound in Africa and Mediterranean countries. As multinational and multidisciplinary association,

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MASU is interested in all medical and biological applications of ultrasound and promotes research activities with experts coming from different countries. MASU organises an international scientific congress every two years and international post-graduate courses in African and Middle East countries. MASU is also planning to grant fellowships to young fellows in order to make them fully acquainted with the most advanced applications of ultrasound in the fields of diagnosis, treatment and research activities. For more info visit: www.masu2016.org/

24 October 2016 to 24 October 2016 ICIS interactive Masterclass in Imaging of Prostate Cancer Learning Tree, Stockholm Masterclass in Imaging of Prostate Cancer is a one-day teaching course in the highly commended ICIS interactive series, which will review PI-RADS interpretative guidelines for multi-parametric prostate MRI for disease detection. The roles for multi-parametric prostate MRI in the management of low to high risk prostate cancer will be highlighted. This event is RCR accredited. For more info visit: www.icimagingsociety.org.uk

3 to 6 November 2016 2nd RSSA/SASPI Paediatric Imaging Congress Spier Estate, Stellenbosch, South Africa The International Faculty of five renowned Paediatric Radiologists consists of Professor Kassa Darge, Body Imaging, University of Pennsylvania, Philadelphia, USA; Professor Edward Lee, Thoracic Imaging, Harvard University, USA; Professor Beverley Newman, Cardiac Imaging, Stanford University, California, USA; Professor Kimberly Applegate, Image Gently and Body Imaging, Emory University, Atlanta, USA and Professor Savvas Andronikou, Thoracic Imaging, University of Bristol, UK, supported by South African Paediatric Radiologists, coordinated by Dr Jaishree Naidoo, President of the African Society of Paediatric Imaging and Head of Division of Paediatric Radiology, Charlotte Maxeke Johannesburg Academic Hospital. The programme covers four categories namely abdominal, thoracic, cardiac imaging and radiation protection in children. The chosen topics will give insight and guidelines into the management of both common and challenging conditions encountered in the paediatric patient. A special masterclass dedicated to all aspects of Emergency Paediatric Radiology will be held on Thursday, 3 November and will require a separate registration. There will also be an interactive case-based interpretation sessions in the afternoons led by the international faculty and lectures on new horizons in paediatric abdominal, cardiac and thoracic imaging. For more info visit: www.rssasaspi2016.co.za/ RadiologyIT Issue 5 2016


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