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December, 2013

Rs. 100

Interview: Dr Amal Mattu | p14

Past Forward: A recap of 2013 with future in mind

Director, Dept. of Emergency Medicine, School of Medicine, UMD, Baltimore, shares his vision for Emergency Medicine

Vol 2, Issue 12, Pages 44


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COLOR DOPPLER | December, 2013 | Volume 2 | Issue 12

p16 | under the scanner

Past Forward!

Another wonderful year to the fold of the past, gifting many a wonderful machine for a better tomorrow. The clock will never stop ticking and will continue to spin the days from one point to another, creating revolution and reoccurrences. Hence, the past goes forward. We bring you here, a few of the excellent machines that floated in the market this year. They have made their triumphal entry and imprinted their marks on the healthy future of mankind


p14 | wordsworth

‘Imaging does Unimaginable Things in ED’ “The most notable advances in my mind: the increase in use of technology, such as CT scanning, point-of-care testing, and bedside ultrasound,” says Dr Amal Mattu, Professor and Vice Chair, Director, Department of EM, School of Medicine, UMD, Baltimore. Despite the advancements it brought to the ED, the overuse and over-reliance of imaging techniques is an area of concern, he tells Color Doppler in an exclusive interview

p29 | talking point

Seamless Imaging on Cloud Mr Ricky Bedi, CEO, Telerad Tech, shares his insights on how teleradiology works, its future and on the company’s committment in making healthcare accessible to anyone, anytime, anywhere


p32 | eduscan

Mission: Better Point of Care! The recently-held International Workshop on Ultrasound Assessment of Shock organized by FUJIFILM SonoSite in Mumbai educated physicians on the role of point-of-care ultrasound for shock assessment in emergency and critical cases

p35 | eventful

Conference with a Difference From roadshows to conferences, EMCON 2013, the 15th Annual Conference of Society for Emergency Medicine, India, held from November 16-20, weaved novel ways of emanating knowledge to the medical fraternity across the globe ensuring better medical practices for today and tomorrow


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COLOR DOPPLER | December, 2013 Volume 2 | Issue 12 KERENG/2012/41766 editor-in-chief Joby Joseph publisher Niranjan Kumar K R M design editor Gireesh chief coordinator Saraswathy M chief correspondent Jumana Engineer co-ordinating editor Rini Baby Thottil copy writers Ria Lakshman V Purnima Sah senior designer Sohan V K

editor's note Another Year, Many Milestones! 2013 was indeed lucky enough for the medical fraternity with the introduction of many a innovation that paved the way for healthy years ahead. As this year draws to a close, let us have a ‘Past-forward’ of the year. In our execution of many visions, Color Doppler could bring to you 18 cutting-edge technological marvels of 2013 such as GE Healthcare’s Optima CT660 FREEdom Edition, Discovery PET/CT 710 and Somo.v INSIGHT; SOMATOM Definition Edge, ACUSON X700 and ACUSON Freestyle from Siemens; Esaote’s G-scan Brio; Echelon Oval from Trivitron; Xporte from Fujifilm SonoSite, EchoNavigator from Philips; UGEO H60, UGEO PT60 A from Samsung; Aquilion Prime from Toshiba and the list goes on. We are also happy that we could bring you the wisdom of the veterans of the industry to your reading room. Meanwhile, in collaboration with Indian Federation of Ultrasound in Medicine and Biology, we have brought out the IFUMB journal into life again. The years fade away, but never dies the memories of the celebrations. We do remember the days spent with you at different knowledge sharing platforms set across the country and could bring to you the glimpses of the same through Color Doppler, thereby gifting you nostalgic warmth of those celebrations. Bidding adieu to yet another wonderful year. Happy New Year in advance.

designer, new media Amit Sudhans manager-product & HR Kishore Kumar P S assistant manager, IT Swetha G manager, accounts Hariharan V V

Joby Joseph Editor-in-chief Follow me on twitter @editorjoby

assistant, accounts Shahana P

COLOR DOPPLER #2/1775-B, Florican Road, P O Civil Station, Calicut, Kerala - 673020, India Phone : +91 495 2378808/ 09 Email : Vision and opinions expressed in this magazine are not necessarily those of Color Doppler, its publisher and/or editors. Color Doppler does its best to verify the information provided but will not take any responsibility for the business moves taken by any reader on the basis of any article published in this magazine. No part of Color Doppler can be reproduced without the prior written permission of the publisher, Niranjan Kumar K.R.M. The rights to reproduce any information published in this magazine are vested with Color Doppler. The magazine is sold on the condition that the jurisdiction for all disputes will be courts/forums/tribunals at Kozhikode, Kerala. Printed, published and owned by Niranjan Kumar K R M, 3/1614 C, Sridevi Niranjan, Near 6th Rly Gate, Nadakkave Post, Calicut-673011 and Printed at Anaswara offset Private limited, 48/2123-c Perandoor Junction, Elamakkara, Cochin 682026 and Published at 34/1347-A, Florican Road, Malaparamba, Calicut-673009. Editor: Joby Joseph.



news scan New Version of Image Suite Software Launched Carestream, the worldwide provider of dental and medical imaging systems and IT solutions launched the latest version of its Image Suite software. It offers flexible image acquisition, processing and storage platform which is compatible with Carestream’s Wireless DR and CR imaging systems, and an optional mini PACS. With features such as web-based patient scheduling, image review and reporting, and archiving solutions, the software is said to be ideal for emergency care centres in imaging clinics and for a wide range of medical specialties. Heidi McIntosh, Carestream’s Global Marketing Manager for X-ray Solutions sees this as a perfect platform for those who wish to shift from CR to DR, or from film to digital imaging. “Our

software offers the same user interface and workflow for both modalities, which reduces training time and makes the transition easier. Existing Image Suite users can upgrade to DR technology with a minimal investment because they keep

Affordable Mobile X-ray Unveiled GE Healthcare announced the launch of Brivo XR115, a lightweight nextgeneration ultra high frequency mobile X-ray system. This system, which is designed and developed in India, addresses five critical problems faced by radiologists and radiographers. Problems such as the image quality from mobile machines of critical anatomies, discomfort that occurs while shifting the patient from hospital bed to the X-ray room, higher radiation and uncontrolled patient movement that occurs during paediatric imaging, and other potential safety issues are addressed by this new X-ray system. The low-dose machine provides high image quality and possesses lower maintenance cost due to its safe design. “We are attempting to address the severe challenges faced by Indian healthcare providers by building a healthier India through technology innovation. Our customers requested us to make X-ray imaging technology safer, more affordable and accessible. Here we are, with Brivo XR 115 addressing all their requirements and


thus help in building a healthier India,” said Terri Bresenham, President and CEO, GE Healthcare, South Asia. Shireesh Sahai, Director, DGS & Surgery, GE Healthcare, South Asia opined that the machine will bring complete peace of mind to the radiologist, radiographer and patient alike. “Keeping in mind the concerns of radiologists and physicians, our team have created a safer imaging environment by reducing X-ray exposure time, lowering radiation dose and providing exceptional images,” he said.

the same console and software platforms and just add a DR detector and license,” he said. The upgraded software now supports images captured by Carestream’s wireless DR systems using DRX-1 and new small format DRX 2530C (25 x 30 cm) detectors, as well as Carestream’s tethered TDR 3543 detector and TDR 3543C detector. This is in addition to the current support of the DIRECTVIEW Classic CR and the DIRECTVIEW Vita family of CR systems. The software enables viewing imaging studies on mobile tablets such as iPads in selected countries outside US. Other attractive features include secure web-based transmission of imaging studies, DICOM storage for reports and software that allows users to create, edit and view studies. Furthermore, it supports a wide variety of specialty measurement tools.

New Prevention Suite from Esaote Esaote recently showcased its novel Prevention Suite - an exclusive package of ultrasound imaging modalities for both cardiac and vascular examinations at EuroEcho-Imaging conference in Istanbul, Turkey. It features a wide range of assessing tools which help the clinicians examine a patient’s risk of cardiovascular diseases. It enables a quick and reliable examination and has got the potential to detect a disease before symptoms occur. Prevention Suite is considered as a onestop assessment tool for early detection and prevention of cardiovascular disease using ultrasound. It comprises of four technologies such as CFI, XStrain, QIMT and QAS. These technologies help in measuring coronary flow quantification, cardiac deformation indexes, carotid intima-media thickness and arterial stiffness respectively. The vascular measurements are carried out using RF signal analysis which offers greater spatial resolution, thereby providing greater accuracy.


event scan

Comprehensive Echo Doppler Evaluation Techniques: CEDET 2014

message from OC

Kerala Institute of Medical Sciences – Society for Continuing Medical Education and Research (KIMS-SOCOMER), is organizing the 3rd National Conference on ‘Comprehensive Echo Doppler Evaluation Techniques – CEDET-2014’ for Cardiology Trainees, Cardiologists and Practicing Physicians across the country on 11th & 12th January 2014 at KIMS, Trivandrum, Kerala.

For registration and more information Mr M T Manoj Asst. Manager – SOCOMER Kerala Institute of Medical Sciences (KIMS), P.B. No. 1, Anayara P.O. Trivandrum, Kerala, India, Ph: 0471 3041424, Fax: 0471 2446535 Email: Web:

The two day CEDET will feature structured echo-based case discussions providing the delegates with an opportunity to learn basic and advanced Echocardiographic and Doppler Techniques. This will be a unique experience wherein answers to frequently asked questions in clinical Echocardiography will be discussed in-depth. It is proposed to address commonly encountered problems in Valvular Heart Diseases, Acyanotic & Cyanotic Congenital Heart Disease, Ischemic Heart Disease, Cardiomyopathies and Pericardial diseases. In addition, the conference will also feature Echo demonstrations. We will be having a distinguished gathering of eminent national faculties representing different institutions from across the country for this mega event. It is expected that this two day programme will benefit all the Cardiology Fellows, Practicing Cardiologists and all Physicians interested in Echocardiography. Thanking you, Prof G Vijayaraghavan, (Program Director) Prof K Suresh, (Organizing Secretary)

67th Annual Conference of IRIA January 23-26, 2014

Agra: The 67th Annual Conference of Indian Radiological and Imaging Association will be held in Agra, from 23rd to 26th January, 2014. The venue of the congress is Hotel Jaypee Palace and Convention Center, Agra. Scientific discussions will be the most important facet of this conference. The best well-known luminaries in various sub-specialities of Radiology from India and abroad will enlighten the gathering with their dedicated work and vast experience. Apart from the comprehensive scientific program, arrangements will be made to give a glimpse of rich Mughal culture of India . For details, log on to www.iria2014agra. com

Ultrafest 2014 to be Held in Mumbai Color Doppler is the official media partner at CEDET 2014, Ultrafest 2014 and INSOUG 2014


April 18-20, 2014

Mumbai: Ultrafest 2014 will be held at

The Renaissance, Powai, Mumbai from April 18-20, 2014. The focus of the 6th edition of Ultrafest will be on Emergency Ultrasound. Many acclaimed speakers from India and abroad will enlighten the gathering on a wide array of topics such as Emergency Ultrasound Infertility, Gynaecological and Fetal Ultrasound. For details, log on to

INSUOG 2014 to be Held in Mumbai May 2-4, 2014

Mumbai: An advanced course in OBGYN Ultrasound, INSUOG 2014 will be held at Hotel Taj Mahal Palace, Mumbai from May 2-4, 2014. The three-day course will be conducted by the current international and national experts of OBGYN USG. The course will be an add on to radiologists, sonologists, OBGYN specialists and Fetal medicine specialists who are interested in acquiring cutting-edge skills in basic and advanced OBGYN Ultrasound techniques. For details, log on to




event scan

IRIA 2014: Agra Calling When the much-anticipated IRIA 2014 is at the doorsteps, Color Doppler revives the memories of IRIA 2013 held at the incredible Indore and brings to you the glimpses of this year’s edition of the epoch making radiology conference


ncredible memories they were, those of the 66th IRIA Annual Conference held at Daly College, Indore from January 4 to 7, 2013. From the informative scientific sessions to food court- everything seems fresh and rejuvenating, enthralling the minds of those who made it to the event. It’s time to revive the old memories and open doors to welcome the 67th Annual Conference of Indian Radiology & Imaging Association, which is going to be held in Agra from January 23rd to 26th, 2014. The venue of the congress is Hotel Jaypee Palace and Convention Center, a magnificent structural blend of red sand stone and marble that pronounce the pride of majestic glory. Committee No events are a one-man show. Being the largest and most anticipated radiology event, IRIA has a number of hands working together behind the screen. The charioteer this year is an eminent ultrasonologist Dr Bhupendra Ahuja, Dr Ahuja Ultrasound Scan Center, Agra. Alongside the organizing chairman, there are physicians such as Dr Yogendra Kumar as organizing co-chairman, Dr Vinita Nanda and Dr Vanaj Mathur as organizing secretaries to make this event a grand success. The team is further backed by a plenty of others working under State Advisory Board, Executive Committee and Office bearers. A Scientific Fete As in the previous conferences, scientific sessions are the important facet of the 67th Annual Conference of IRIA. Leading luminaries in various subspecialties of radiology across the globe will enlighten the conference with their expertise in respective fields. Around 35 international faculties and 140 national faculties are expected to be a part of this radiological event in India. Scientific exhibitions, oral paper presentations and poster submissions are the major attractions of the event. In addition, there will be meetings


Registration Registration is a must for all. The filled registration forms along with the payment should be mailed to the Conference Secretariat. For cancellation of registration, a written request with original payment receipt should be sent to the secretariat. 25 percent of the amount up to October 31st, and 50 percent of the amount till 31st December will be deducted from the paid registration amount. There will be no acceptance of any kind of requests after January 1st, 2014. All refunds will be made within a month after the conference. The kids who are above 5 years, accompanying the delegates must also be registered as an accompanying person. The PG students are entitled to submit a bonafide certificate from the head of department or the respective institution to get an entry. In case if the payment is made by DD/ Multicity Cheques, do send the registration form along with a demand draft/ multi-city cheque in favor of IRIA 2014 Agra payable at Agra, to the Organizing Chairman at the secretariat address. Delegates can also register online and the registration fee can be paid online through the website: www.

on trade, ICRI Governing Body, IRIA Central Council and IRIA General Body Meeting. The discussions will focus on topics such as Abdominal Ultrasound, Pulmonary, Neuro, Conventional, Vascular Imaging, Pelvic Imaging, Cardiac, Spine, Dental Radiology Dexa and Nerve Imaging, Vertebrae and Spinal Cord, MSK Imaging, Breast Imaging, Pediatric Radiology, MSK Imaging, Oncoradiology, Interventional Radiology, Teleradiology, Computer Radiology, Film Reading, Orbit Imaging, Anomaly Scan, Bowel Imaging, Neck Imaging, Head to Toe Imaging, Organ Transplant and Temporal Bone. The event will also be a platform for the industry players and the real-time users to meet and converse. Various medical imaging companies operating across the globe are expected to be a part of IRIA showcasing their new innovations. About Agra Colors of Agra will serve your palette with vibrant glimpse of rich Mughal culture. Four days of your stay in the land of palaces will give you a window of opportunity to visit not only Taj Mahal, but also the Mughal monuments such as Agra Fort, Itmad-ud-Daulah’s Tomb, Fatehpur Sikri, Akbar’s Tomb and so on. The conference is sure to be a visual treat, as well as a knowledge gaining avenue for all who participate. COLOR DOPPLER | DECEMBER, 2013

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‘Imaging does Unimaginable Things in Emergency Care’ “The most notable advances in my mind: the increase in use of technology, such as CT scanning, point-of-care testing, and bedside ultrasound,” says Dr Amal Mattu, Professor and Vice Chair, Director, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore. Despite the advancements it brought to the ED, the overuse and over-reliance of imaging techniques is an area of concern, he tells Color Doppler

Dr Amal Mattu I think the most important, recent and ongoing advancement in EM is the use and refinement of bedside ultrasound. This has, in many ways revolutionized diagnostic testing in EM and without a doubt is saving lives


Ria Lakshman V l cd news


he Emergency Medicine in India is a conundrum, too baffled and scattered to compare with other medical specialties. With steep increase in accidents and other emergency cases, darkness spread across the lives of many. And, the country still stands helpless to provide time sensitive and responsive Emergency Medical System (EMS) to its citizens. In fact, more than the scarcity of services, it is the lack of co-ordination among them that proves harmful. There are many ambulance services, yet they lack a uniform number. Private ambulances run on fee-for service basis. The terms such as air ambulances are unheard to many. Further, practices such as carrying patients via bullock carts to healthcare centres sustain in rural areas, owing to the death of patients. To worsen, the legal complications prevent the people from helping accident or emergency case victims to reach hospitals. The scenario shows improvement with the efforts of organizations such as Society for Emergency Medicine, India (SEMI). On the occasion of 15th Annual Conference of SEMI, held from 16th to 20th November 2013, Color Doppler

makes an effort to understand the various aspects of the emergency medicine, especially its latest advancements, the researches and the pitfalls. Here Dr Amal Mattu, Professor and Vice Chair, Director, Faculty Development and Emergency, Cardiology Fellowships, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland shares with the physicians, the areas they need to focus on, so that they do not miss a larger picture. Dr Amal Mattu completed his EM residency at Thomas Jefferson University in Philadelphia, following which he undertook a teaching fellowship with focus on emergency cardiology. In the year 1996, Dr Mattu joined as a faculty of EM at the University of Maryland. Beyond numerous teaching awards, he has also won prestigious awards such as Outstanding Speaker of the Year Award from American College of Emergency Physician and the 2006 Program Director of the Year Award from the American Academy of EM. In addition to his teaching profession, Dr Amal Mattu has authored and headed as Chief Editor for a few of the popular textbooks of EM. With his extensive knowledge in the field, Dr Mattu talks COLOR DOPPLER | DECEMBER, 2013

wordsworth to Color Doppler. Excerpts from the interview: What are the striking developments that have set a mark in the field of EM? The most notable advances in my mind: the increase in use of technology, such as CT scanning, point-of-care testing, and bedside ultrasound. With these technological advances the ability to diagnose some dangerous conditions earlier have increased, but the major drawback has come from overuse and over-reliance of that technology, which has resulted in significant increases in the cost of medical care and, in many cases, no improvements in disease morbidity or mortality. As an academician and speaker at CME conferences, how do you evaluate the developments in EM? Are there any areas in EM that are less focused or yet to be focused? I do my best to stay up-to-date with the literature, and I try to focus in particular on research that demonstrates practicechanging results rather than esoterica. Audiences of clinicians tend to respond very favorably to this approach. In my opinion, from an EM standpoint, up-andcoming areas that need greater focus (and are gaining better focus) are emergency geriatric care, patient safety issues, and cost effectiveness. With ample experience in authoring and serving as Chief Editor for several EM textbooks, what do you think are the major pitfalls and challenges that are to be addressed in EM so as to improve the outcomes? I’ve mentioned some of the challenges above already, but I would also add that emergency department overcrowding has become a tremendous challenge in the specialty worldwide. According to World Health Organization, Cardiovascular diseases (CVDs) are the number one cause of death globally. As a physician specialized in Emergency Cardiology, what are the pitfalls the physicians usually come across when it comes to CVDs? From an EM standpoint, the diagnosis


of acute coronary syndromes (acute MI, unstable angina) is a great challenge. Though it is a tremendous killer, we don’t have ideal methods for diagnosis: the history and physical exams are imperfect, the electrocardiogram is imperfect, the lab tests are sometimes misleading, etc. This is a diagnosis that we both underdiagnose and over-diagnose. Can you brief on the recent advancements in the field? There are so many. But, I think the most important, recent and ongoing advancement in EM is the use and refinement of bedside ultrasound. This has, in many ways revolutionized diagnostic testing in EM and without a doubt is saving lives. What are the latest researches that are to be pondered in the area of EM? With regards to emergency cardiology, I think the most important research will continue to focus on the best and most cost effective ways of diagnosing acute coronary syndrome. This is perhaps ‘THE’ greatest clinical challenge of our specialty. With regards to geriatric EM, we are learning more and more that many of the concepts we learned about medicine are not always applicable to geriatric patients. As the average age of all first-world countries is increasing, we all are going to be faced with increasing challenges of trying to care for these patients when they are in the ED. There will be an increased focus on resuscitation issues in geriatric EM in the coming years. You are somebody who incorporates technology into education. Tell us a bit about your EMCast. This is a monthly audio podcast lasting 90 minutes during which a handful of my colleagues and I review recent articles from the EM literature, discuss controversial topics, and share interesting cases. This form of CME (Continuing Medical Education)—beyond the textbook—has become increasingly popular among physicians simply because they lack the time to sit and read. The audio form of CME is very time efficient: people can be learning while driving their car, while exercising, while sitting

on the beach, etc. The EMCast podcast is housed on a very popular EM website called EMedHome (www.emedhome. com). Subscribers to this site have access to the EMCast as well as numerous other sources of CME online, including readings, video lectures, etc. The website is owned by an emergency physician in Boston, Dr Rick Nunez. Developing countries still face a severe lag in Emergency Medical Services. As a citizen from a country that provides the best Emergency Medical services to the public, what are the steps/advices you would recommend to the developing countries for the improvement of the same? Emergency physicians must create specialty organizations that will advocate for them. Gaining the assistance of other countries (eg. the US has many physicians that are dedicated to development of the international EM) will help. Those organizations must advocate for the specialty to the governing bodies in medicine. Physicians should strive to increase academic productivity and publish good quality research in order to gain academic credibility. The physicians must be committed to practicing the most cutting-edge medicine possible and conduct themselves in the most professional manners possible. These few things will go a long way toward increasing the credibility of EM in any country, and once credibility improves, people outside of EM will see and understand the benefits of EM to the public. What is your message for the doctors across the world who practice EM? The work you do is immensely valuable. Thousands of years ago, the first physicians (“healers”) were emergency physicians. They focused on treating acute problems. When you think about it, this specialty has a long and glorious tradition. There is no other specialty that is so focused on saving lives, no other specialty that has an open door to any patient no matter how poor that patient is, no matter how ill that patient is, not matter what time of day it is, and no matter what resources are at hand or are lacking. Be proud of what you do. You are true physicians.


under the scanner

Past Forward! Another wonderful year to the fold of the past, gifting many a wonderful machine for a better tomorrow. The clock will never stop ticking and will continue to spin the days from one point to another, creating revolution and reoccurences. Hence, the past goes forward. We bring you here, a few of the excellent machines that floated in the market this year. They have made their triumphal entry and imprinted their marks on the healthy future of mankind

Computerized Tomography (CT) Optima CT660 FREEdom Edition GE Healthcare’s Optima CT660 FREEdom Edition features GE’s exclusive Motion FREEdom with intelligent coronary motion correction. Designed to help address challenging imaging situations, it offers both high image quality and multiple dose reduction features on one platform. It has high performance imaging with expanded capabilities for use in the emergency room and innovative dose reduction features. With Optima CT660, patients can be scanned in seconds. It also features SnapShot Freeze that significantly reduces coronary motion, transcending the limits of CT rotation speed.



under the scanner SOMATOM Definition Edge Siemens Healthcare’s SOMATOM Definition Edge CT Scanner with Stellar Detector technology helps in improving image sharpness without increasing the radiation dose. It gives doctors visualization structures up to 0.3 mm in size even in routine examinations. In fact, cardiac stents smaller than 3 mm size can be viewed. Making Definition Edge one of the safest scanners for patients, this CT scanner comes with a rotation speed of 0.28 seconds. Now patients nearly do not need to hold their breath during a scan. This advanced software is for heart, liver and brain.

Magnetic Resonance Imaging (MRI) G-Scan Brio Esaote’s G-scan Brio with eXP technology gives physicians a cost-effective tool for performing both traditional and weight-bearing musculoskeletal magnetic resonance imaging (MRI) exams. New eXP technology combines powerful hardware platform with advanced software to decrease imaging time by as much as 40 percent, which is critically important when imaging patients with pain. The system also provides high quality images of the hip, shoulder, arms and legs that rival large, expensive whole body MRI systems. For the first time, clinicians now have an easy-to-operate, fast and accurate weightbearing MRI system highly suited for pathologies where a normal MRI appears negative, but where the patient experiences clinical symptoms.

Echelon Oval Echelon Oval by Trivitron Healthcare in partnership with Hitachi Aloka is the first-of-its-kind of MRI system. Enhanced patient accessibility combined with Hitachi’s Workflow Integrated Technology (WIT), advanced imaging capabilities, and UltraPlus Customer Support, makes Echelon Oval an ideal solution for improved workflow, greater diagnostic confidence and increased


cost-efficiencies. Echelon Oval’s 1.5T magnet features high homogeneity, ultimate stability, and a full 50cm FOV in all directions. Hitachi’s mastery of patient-focused MR imaging is demonstrated in Echelon Oval’s Patient Active Comfort Technology. High gradient performance is key to high performance imaging. It includes a 34/150 capable gradient system.


under the scanner Ultrasound X-Porte X-Porte Ultrasound Kiosk, the next generation point-of-care ultrasound from FUJIFILM SonoSite delivers optimum usability and interoperability through its groundbreaking visual learning guides. The kiosk integrates high-resolution ultrasound imaging synchronously with 3D animations that enable “any user, any time of day” to make the most of the operating the technology. It is designed for optimizing user workflow and varied environments, with adjustable height and gesturedriven touchpad for use in a standing or sitting position. The kiosk’s slender profile lends itself to easy navigation down corridors and alongside patient beds; it has a detachable use option for low-footprint environments. The foundational advancement behind X-Porte is a new imaging technology never before used in ultrasound systems: SonoSite’s proprietary Extreme Definition Imaging (XDI) technology.

ACUSON Freestyle ACUSON Freestyle is world’s first ultrasound system with wireless, cable free transducers. It provides maximum freedom while scanning and brings a whole new level of ease-of-use, improved workflow, and excellent image quality. It is designed to meet the unique needs of point-of-care clinicians during ultrasound-guided procedures or for quick look assessments. The qualities that makes this wireless ultrasound best are: It is easier, more flexible scanning with cable free transducers; simpler, more efficient workflow with system controls integrated into the transducer; improved mobility and control—operate the system up to 3 meters away; excellent image quality; and unique infection control capabilities.



under the scanner UGEO H60 The new UGEO H60 from Samsung presents revolutionary performance along with fundamental medical equipment design principles of simplicity, lightness and versatility that make it easy to operate in compact spaces. Distinctive styling, featuring a 10.1” touch screen and a slim body, reflects Samsung’s devotion to practical and usable ideas. The UGEO H60, which was launched at Medica 2012,

is also equipped with an 18.5” LED monitor that enhances the viewing of high-resolution images provided by a cutting-edge hybrid engine. The enhanced hardware and newly added software of the UGEO H60 produce the clearest and most accurate images. SDMR, the noise reduction filter improves edge enhancement and creates sharper 2D images for optimal diagnostic performance. An advanced Doppler ensures the most accurate diagnosis based on color detection regardless of patient’s physiology.

Aplio 500


Toshiba’s Aplio 500 offers picture-perfect imaging with advanced visualization features, including Fly Thru and Smart Fusion. SmartFusion synchronizes Computed Tomography or Magnetic Resonance with ultrasound, helping to locate hard-to-find lesions and aiding in ultrasound-guided biopsies. Aplio 500 comes standard with advanced workflow tools and ergonomics, including the iStyle+ Productivity Suite.

Philips Healthcare’s EPIQ 7 premium ultrasound system with nSIGHT and Anatomical Intelligence helps clinicians to visualize deeper levels of anatomical detail and contrast resolution on patients. EPIQ 7 is the first-of-its-kind ultrasound architecture that offers a totally new level of clinical confidence with a novel approach to create ultrasound images without compromise. Anatomical Intelligence provides advance organ modeling, image slicing and proven quantification, making exams easier to perform, more reproducible and delivers new levels of clinical information. It offers improved image quality with up to a 76 percent increase in penetration and up to 213 percent increase in temporal resolution. Its SmartExam technology increases automation and reproducibility of results, which decreases exam time by 30-50 percent, keystrokes by as many as 300 per exam, and results in a higher level of consistency among users.



under the scanner Fusion Imaging Multix Fusion Multix Fusion digital radiography system by Siemens Healthcare is designed to help users easily position patients on the system or move digital detector to accommodate patient location. The system provides excellent image contrast with Diamond View Plus on-board post-processing tool and automated image processing parameter provides settings based on organ programs.

MRidium IRadimed’s MRidium infusion pump is a widely-accepted non-magnetic MRI IV pump solution available in the market today and is built from the ground up to deliver accurately and safely in the MRI area. The optional integrated Masimo SET SpO2 has the capability of continuous monitoring the patients from the intensive care unit (ICU), neonatal intensive care unit (NICU), neurology and other areas of the hospital right into the MRI suite. The 3860 System also offers an expanded drug library with Dose Er-

ror Reduction System (DERS), which helps prevent medication entry errors while programming infusions and provides the patient safety features that are quickly becoming the standard in infusion therapy in general patient care areas. The MRidium System offers a modular second channel, which when attached to the 3860 IV Pump, allows for delivery of two medications simultaneously during patient scans. An optional wireless remote control monitor has true plug and play capabilities, requiring no installation.

Discovery PET/CT 710 Discovery PET/CT 710 by GE Healthcare is the first double-digit sensitivity PET/CT scanners, with absolute sensitivity of 10cps/ kBq1. The scanners are available with Q.Suite dose reduction software technologies. Q.Suite is designed to address the clinical challenge of respiratory motion. Both the Discovery PET/CT 610 and 710 offer these technologies, which allow doctors to assess biological changes in a patient across the course of treatment.



under the scanner Interventional Radiology Artis Q and Artis Q.zen Siemens Healthcare’s cutting-edge angiographic systems — the Artis Q and Artis Q.zen incorporates a new flat emitter X-ray tube detector and imaging software to reduce dose significantly while improving the imaging quality. Artis Q provides exceptional performance with the new powerful GIGALIX X-ray tube for high contrast resolution at any angle and any patient size. It offers applications for cardiology, interventional radiology and image-guided surgery. Artis Q.zen combines this innovative X-ray source with a new detector technology designed to support interventional imaging in ultra-low dose ranges as low as half the standard levels. This new X-ray tube is intended to visualize small vessels up to 70 percent better than conventional X-ray tube technology.

Discovery IGS Angiography

EchoNavigator Royal Philips’s EchoNavigator live image-guidance tool (EchoNavigator) is world’s first technology to help interventional cardiologists and cardiac surgeons to perform minimally-invasive structural heart disease repairs by providing an intelligently integrated view of live X-ray and 3D ultrasound images. It enables clinicians to perform

procedures more efficiently by providing intelligently integrated X-ray and 3D ultrasound images into one intuitive and interactive view. EchoNavigator also provides easy-to-use system navigation and better communication between the multidisciplinary team carrying out the procedure. Hence, it saves valuable time and enhances patient care.

GE’s Discovery IGS angiography platform is the first interventional X-ray system designed to capture the advantages of both floorand-ceiling-mounted systems. It offers laser-guided motion technology on a wireless, tether-free, motorized mobile gantry for predictable and precise trajectories, Wide Bore 3-D for ease in 3-D acquisitions and more than 20 advanced applications available. COLOR DOPPLER | DECEMBER, 2013






under the scanner

New Products: A Quick Recap Multix Fusion

This digital radiography system is designed to help users easily position patients on the system or move the digital detector to accommodate patient location

Here goes the new products that we brought to you through the new product scan column during 2013

Zonare zs3

Zonare Medical Systems launched ZS3 premium ultrasound system, a machine that offers superb high frequency imaging in abdomen with enormous penetration.

with excellent image contrast. Multix Fusion is comfortable to maneuver, so you can easily position your patients. It provides excellent image quality, further improved by advanced post-processing tools.

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Sonosite India Pvt Ltd

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Noesis Technologies






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Indiaultrasound Sales N service






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under the scanner Somo.v INSIGHT ABUS

Using the proprietary to automate the ultrasound imaging process, the Somo.v ABUS system was developed by GE Healthcare specifically for the breast cancer screening. The Somo.v Automated Breast Ultrasound (ABUS) Platinum with the patented Reverse Curve Soft Touch Transducer offers extraordinary image performance, enhanced breast coverage and, patient comfort. The system is the highest ranking in Women’s Imaging (Specialty).

Edge Radiosurgery Suite

Anatomage Table

This virtual anatomy table, which was developed by Stanford Medical University and Anatomage Inc in USA offers n unprecedented realistic visualization of 3D anatomy and interactivity.

CT660 FREEdom Edition

Echelon Oval

Echelon Oval, an MRI system developed by Trivitron Healthcare in partnership with Hitachi Aloka enhances patient accessibility and workflow, and possesses advanced imaging capabilities, and UltraPlus Customer Support .

Acuson X700

EDGE Radiosurgery Suite from Varian Medical System is a fully integrated dedicated system for performing advanced radiosurgery using new real-time tumor tracking technology and motion management capabilities. EDGE is designed to facilitate fast, accurate delivery of stereotactic radiosurgery.

This premium system of Siemens’provides exceptional image quality, robust technologies and intelligent workflow solutions at an excellent price/performance ratio. The ultrasound system processes more information, more quickly for the best possible diagnosis. The advanced imaging technologies and transducers enable excellent imaging for diagnostic confidence. The machines are integrated with GE’s exclusive Motion FREEdom with intelligent coronary motion correction, a platform that enables fast, high performance imaging with expanded capabilities for use in emergency room and innovative dose reduction features.

Signos Real Time Ultrasound

Signotics introduced Signos Real Time, a new portable ultrasound machine which is considered the world’s smallest. COLOR DOPPLER | DECEMBER, 2013


under the scanner Artis Q and Artis Q.zen

The Artis Q and Artis Q.zen systems are designed to help manage and minimize radiation based on new x-ray tube and digital detector technology. Artis Q provides exceptional performance with the new powerful GIGALIX X-ray tube for high contrast resolution at any angle and any patient size.

Keystone iModality

This remote image viewing system for mobile devices captures visual light photos, videos, notes of moles, specimens, ulcers, abuse cases and more, which is as simple as snapping a photo using a phone or tablet device.

FCR Prima T2

Aplio 500, Aplio 300 CV Toshiba American Medical Systems, Inc,, introduced new ultrasound systems for cardiovascular disease. The two devices, Aplio 500 and Aplio 300 CV can offer an accurate and efficient diagnose and deliver exceptional image quality.



FCR Prima T2 has been designed for those private practitioners with low volume imaging environments. FujiFilm’s this CR reader is small, fast and light and considered to be one the smallest table top CR Systems available with a capacity to print about 73 images per hour.

MicroDose SI Mammo System This new laser Imaging System supports efficient printing and time-saving film cartridges that can benefit healthcare providers of all sizes with enhanced quality control system for mammography images. It provides high-resolution laser imaging at 508 pixels per inch with Automatic Image Quality Control that calibrates film and imager settings. DRYVIEW Daylight Load Cartridges allow users to load film quickly and easily in normal lighting conditions.


Royal Philips Electronics announced MicroDose SI mammography system, the first full-fledged digital mammography (FFDM) system in the market with the capability to enable future Single-Shot Spectral Imaging applications.

The 1.5T GEM RT Open Head & Neck Suite, combined with GE’s Optima 450w GEM MR Scanner, enables high-resolution, large field of view scanning of the head and neck, displaying outstanding soft tissue visualization of tumors and the surrounding organs.


under the scanner Somatom Definition As Open

Personal Solution which can convert a personal computer to your own personal ultrasound training system.

(ICE) capability in addition.

G-scan Brio

Siemens Healthcare launched Biograph mCT Flow, PET-CT system integrated with FlowMotion that can move patient smoothly through the system’s gantry, while continuously acquiring PET data.

Siemens Healthcare’s new RT Pro Edition of the Somatom Definition AS Open 20/64 large bore CT system, was specially developed for use in radiation therapy and permits more precision in therapy planning and cancer treatment

Biograph mCT Flow


NinePoint NvisionVLE

Esaote’s G-scan Brio is a musculoskeletal MRI system that enables cost-effective, weight-bearing or ‘stand-up’ MRI. This easy to operate, fast and accurate MRI system is highly suited for pathologies where a normal MRI appears negative, but where the patient experiences clinical symptoms.

Covidien’s world’s first cordless ultrasonic dissection system, Sonicision delivers faster dissection and reduces visual obstruction, in addition to unique benefits from the industry’s first cordless design.


CX50 xMatrix

NinePoint Medical Inc. introduced NvisionVLE system, an imaging system for the purpose of esophagus disease detection that will perform the test in 90 seconds.

Sonosim Personal Solution

SonoSim Inc introduced SonoSim


Royal Philips Electronics released CX50 xMatrix, world’s first portable ultrasound with live 3D Transesophageal Echo (TEE) that offers 2D Intracardiac Echo

This low radiation dose X-ray system takes a full-body scan in just 13 seconds. Xmplar-dr, offers a number if technological advances for trauma emergency and forensic pathology centres.


under the scanner Aquilion RXL

Barrx Channel RFA Endoscopic Catheter

This Agfa Healthcare product comes with high quality wireless and tethered detectors, either Cesium Iodide (Csl) or Gadolonium Oxysulphide (GOS), providing a superior image quality and significant patient dose reduction, as well as wireless capability.


This new whole-body multi-slice helical CT system with a 32 mm wide detector from Toshiba delivers low-dose scans for each patient in a wide variety of clinical examinations with unsurpassed workflow.

Elekta Versa HD

This Covidien Catheter is used for treating Barrett’s esophagus and certain gastrointestinal bleeding disorders.

Aquilion Prime

Samsung’s first diagnostic ultrasound device for the point-of-care market that allows doctors to perform medical diagnoses very closer to the patient care site comes with features like NeedleMate and Auto IMT.

And the latest one in this issue Elekta launched advanced linear accelerator system Versa HD that gives clinicians the flexibility to deliver conventional therapies to treat a wide range of tumors throughout the body.

uSmart 3200T

This CT system with cutting-edge technologies claims has the world’s fastest reconstruction speed of up to 60 fps, even with AIDR 3D and sets the smallest footprint in the premium CT market segment.

DX-D Retrofit

This light-weight, power-packet uSmart 3200T Ultrasound system is a fusion of cutting-edge technology with an intuitive interface that defines simplicity.


GE Healthcare’s LOGIQ Forward Series ultrasound systems improves affordability of a high performance ultrasound system by 30 percent while incorporating established high performance capabilities from GE’s flagship ultrasound systems. LOGIQ Forward series - LOGIQ F6 and F8, provides clinicians with a less expensive way to diagnose with confidence by using the advantages of advanced and high-performance ultrasound.


Seamless Imaging on Cloud Mr Ricky Bedi, CEO, Telerad Tech Pvt. Ltd shares his insights on how teleradiology works, its future and on the company’s commitment in making healthcare accessible to anyone, anytime, anywhere Ria Lakshman V l cd news


elerad Tech Private Limited has etched its name as an innovator with its state-of-art technology RADSpa. With this mind-blowing product, the company exemplified its unravelling commitment to healthcare segment, by fastening the pace of treatment, especially in emergency healthcare at an unimaginable ratio. And, the brains behind this innovative product are a group of technology innovators and eminent radiologists. One among them is Mr. Ricky Bedi, Chief Executive Officer, Telerad Tech Private Limited. With 25 years of professional experience, Mr. Bedi has known the pulse of the IT industry for long, and knows the right beat to step up. He started his career as software engineer with Viewlogic Systems in 1988 and grew up to senior staff engineer at Level One Communications by 1996. Mr. Bedi further marked his signature by being the Co-Founder and Vice President of Business Development at Vitalect, Inc, a company that develops web-based custom content solutions to support, administer and track learning needs. After serving Vitalect for six years, Mr. Bedi moved to Cadence Design Systems as Product Engineering Staff in 2003, and later to Magma Design AutoCOLOR DOPPLER | DECEMBER, 2013

mation India Private Limited as a Vice President of Application Engineering group in 2006. With his extensive professional track record in IT industry, Mr. Ricky Bedi joined Telerad Tech in 2009 and made his remarkable imprints not merely at technological level, but also in building a world class team with strong technical foundation and inspiring work culture. Mr. Ricky Bedi, who displays an unwavering dedication to his job talks to Color Doppler on teleradiology, RADSpa and more. Having been a software entrepreneur for a long time, how do you see the future of the teleradiology segment? The whole idea of teleradiology evolved because of the dearth of the radiologists. In order to improve patient care, the diagnosis of any kind of diseases has to be done in a timely manner. For example, in Arunachal Pradesh, there was only one radiologist for the entire state and the patients had to wait for days to get their reports back. Considering this situation, we went there, deployed our technology and services to tackle this crisis. With the help of our teleradiology technology, images can be transferred in an optimal and secure mode to any radiologist, sitting at any part of the world at anytime. Accessibility is on the cloud and

it is secure. The radiologists could see the images, do the diagnosis and can easily resend their reports back in a couple of hours. This, indeed, had a direct impact on the quality of the healthcare. There are a number of complex studies, but specialists are short in number. In India, the number of diagnostic centers is on rise. It has turned now as a service business and radiologists can do only a limited number of studies. A diagnostic center will be having only, say two radiologists, and will be busy throughout the day. They get exhausted at one point and this can affect the diagnosis as well. How do you leverage the whole concept of teleradiology to outsource the volume? It’s not about encroaching someone else’s business. Many radiologists always have a misconception that, with the coming in of teleradiology, their businesses are being carried away. But the fact is that we have many radiologists working with us. They can’t cater to thousands of hospitals. The number of resources has to grow up in order to deliver services to such a large number of hospitals. So, the whole idea of teleradiology is authentic. Every hospital and imaging center has got its own radiologists, but there is also a concept of teleradiology. Practicing teleradiology has an indirect impact on


their revenues as well. By practicing teleradiology, they are not only improving the quality of the care they deliver, but improving their business as well. The reason for the steady growth of teleradiology is because of the quality of care and is not about money making. Only if people realize this truth, they will understand the true potential of teleradiology and will accept it. In India, now people are more aware of digital imaging, and many imaging centers are sprouting up. The whole concept of imaging and the mentality of the people are changing. This is helping the growth of teleradiology and is expanding its services in a more dynamic approach. This was unimaginable a few years ago. Another fear that persists in the mind of the people is security. A lot of technologies are involved in teleradiology, and a lot of security measures are included in the networking protocols in order to secure the data. If security was a questionable aspect, financial institutions such as banks would have never been on the cloud. Today, the biggest industries have their sales data on cloud. Teleradiology is a similar concept and is secure as the financial institutions. Security is in place for a long time. It is all about optimizing the model in a more secure manner. The third challenge that we have seen is the infrastructure, and that is where the government has to step in. We haven’t faced this issue in many countries, but only in developing countries such as India and Africa. The whole concept of teleradiology is based on the cloud. With technology we have optimized teleradiology to even work on a 512 kbps bandwidth. We have optimized it even further, that if a disconnection happens, you can still do your remote reading. When the internet connection is reset, the radiologist can continue reading and reporting. This is more about leveraging the technology in order to address the shortcomings. In this scenario, it is really important for the government to step in, improve the infrastructure and provide sufficient band-


widths. Without these aspects, you will be in trouble. These are the challenges that we are facing in teleradiology. However, things are improving as the trend is changing. Telecommunications providers such as Reliance are coming up with 4G. Developments are unstoppable in this area. Mobile applications are widely increasing. That is why we brought teleradiology in mobile platforms as well. We focused on iPad, because iPad has got FDA approval and this was our first target. If teleradiology is an aspect for consideration, then you will have to talk about accessibility anywhere, anytime. So the technology has to be developed in such a way that it should not make the doctor feel that he is handicapped while he is traveling, as his machine is not with him. You have to make sure that these devices and technologies are user-friendly. We do have a patient portal tied to our Teleradiology platform. We empower the patients through the portal. They can always get a second opinion from any doctor of their like. The whole concept of teleradiology is about leveraging the cloud, leveraging the web-based applications. For example, if you look at our client TRS, their Radiologists are all not sitting at one place. They have satellite offices in different geographical locations. Their radiologists are in US, India, Israel, and at the end of the day diagnosis take only 30-40 minutes. All these factors make teleradiology to stay, and it will grow leaps and bounds in future. As population is on increase and the number of radiologists being considerably low, teleradiology plays a crucial role in today’s diagnosis procedures. If you look at our telemedicine platforms, CISCO has helped us to integrate it into our teleradiology platform. Please elaborate on your collaboration with CISCO. How does it work? CISCO has come with a very innovative video technology. It is been optimized to work on low bandwidths such as 256 kbps to 512 kbps. In remote areas,

there is a lack of doctors. The person has to travel to far off places to get the treatment. This has been one among the reasons for the development of teleradiology. The patient is sitting somewhere and it has to be made sure that the diagnosis and treatment is brought to him as if the patient has come to a doctor for treatment. This was the concept, and we worked with CISCO together to make this happen. We have chosen the deep remote areas. Infrastructure in the remote areas was a challenge. None of the technologies can be implemented without good infrastructure. We have seen tremendous response from our patients. We have specialists staff to do the diagnosis. The whole concept is that the patient can come in if he has an image and upload it. The radiologist will look at the image and send reports. The physicians look at the images and reports sent by the radiologists, and give consultation to the patients, all in real time. We have been successful in achieving this. We initially started it as a CSR activity. In fact, the people, who would really need the doctors, do not have the accessibility to these specialists. That was our first motto and we are here to give it back to the society. We are now planning to go into clinics that do not have the specialists and also expand our services to the corporate segment as well. Our services are not limited to India. We have implemented the system in many parts of Africa where accessibility is very difficult. There are people who fly from different parts of Africa to places such as London for diagnosis and treatment. What was the time taken to develop RADSpa and what were the efforts put behind in developing it? It is all about creating the right platform. It is a combination of innovation and usability. Innovation is immaterial without the usability aspect. Why RADSpa is so successful is because of the tight integration of Telerad Tech R&D with its user base. We believe in users helping us design the system, as opposed to COLOR DOPPLER | DECEMBER, 2013

engineers. In addition to the in house domain consultants we have a large pool of Radiologist user base of RADSpa that gives us continuous feedback on the product. The interaction with the clients and end users is seamless and their feedback is instrumental in making the changes in the software , be it the features or the performance. We have some of the largest teleradiology companies in the world using our system . In India we have TRS which is the pioneer in Teleradiology and the largest teleradiology company in India uses our system. The first version of RADSpa took almost 2 years and since then new versions of the product have been rolled out regularly. The product has been designed for high configurability and scablability. We have also come out with specific products for various market segments such as Veterinary imaging market, Dental imaging, Cardiology etc, and every 3 months we release updates for the product as per the planned release schedule . The roadmap for the product is very clearly laid out for the coming times and as part of the plan we have already rolled out the IPAD /IPHONE versions. So the integration and development is much faster than in any IT company. Right? At the end of the day, we are engineers and not doctors. Getting the user involved in the development process will really help in the development process. Here, the feedback is much faster and this will add to the development process.


Our R&D team sits with the doctors, monitors them and develops solutions accordingly. The innovation is of no use if it is not user friendly. Innovation is an ingredient. It goes hand-in-hand with the usability of the customer and hence the customer feedback is more important. We have heard that RADSpa is going to be implemented in teleradiology solutions in a week’s time. So how far the development process has gone at present? We have already deployed it in the electives and will go live in the ER area from October 1st . The testing is going on. The hospitals are being informed in order to make sure that the disruption is minimal. While implementing RADSpa technology, the investment should be minimal for the client. In addition the support should be top class, as any change from their status quo requires 100 percent commitment/ involvement/support to ensure minimal disruption. Finally, the usability aspect cannot be ignored, it has to be simple. Since everything is on the cloud, the user just has to log in and get started and we support them all through the day with our services. Coming into the technology aspect, user interface is an important factor. What is your take on it and how good do you think the user interface of RADSpa is? As discussed earlier, throughout the development cycle we involve our users. The user interface of RADSpa is simple.

It was developed by the radiologists for the radiologists. It was developed after studying and analyzing the users. We made sure that each and every single option is easily understood by the user. Apart from the user interface, the installation as well as the user experience has to be very simple. Another aspect to be looked at while considering software is downtime, especially when it is a web application. How is your take on this? We have partnered with venders who understand the criticality of downtime, especially in the medical industry. You can never ask a doctor to wait when he is attending an emergency case. We have been very cautious and careful with whom we partner. We made it sure that they support us by solving our problems in time. We also made sure that our disaster recovery is bullet proof. Basically, we have two approaches to disaster recovery; The first approach is we have a couple data centers and if one goes down due to a disaster; it will automatically switch to another. The IP address will not be changed and the end users will not be affected in any way. It is an automatic switch. The second disaster recovery is within the data center. We have virtual servers and if the servers go down, the virtual server is automatically switched over and brings up the servers. The maximum downtime that you will ever see is 5-10 minutes. We make sure that we are engaged with the customers all the time. Even if they have problem which is going beyond a stipulated time, we will help them move at ease with our services.



Mission: Better Point of Care! The recently held International Workshop on Ultrasound Assessment of Shock organized by FUJIFILM SonoSite in Mumbai educated physicians on the role of point-of-care ultrasound for shock assessment in emergency and critical cases

Ria Lakshman V l cd news “When you know better, you do better.” - Maya Angelou


he words of this remarkable renaissance writer, who is one of the greatest voices of contemporary literature is befitting to the International Workshop on Ultrasound Assessment of Shock, organized by FUJIFILM SonoSite at ITC Grand Central in Mumbai on November 12 and 13. The workshop intended to educate physicians on the role of pointof-care ultrasound for shock assessment in emergency and critical cases. Since its invention, ultrasound dramatically changed the way patient care was held. Its role in emergency medicine and critical care is beyond improving workflow and efficiency. In the segment, ultrasounds are geared to address time-

dependent and focused clinical questions. One such area would be the assessment of shock in critical patients. This can be challenging even to the experienced doyens of emergency medicine. The chances of high mortality and morbidity in critical patients sometimes prevent the physicians from taking fast and accurate decisions. FUJIFILM SonoSite, the pioneers in

hand-carried and mountable ultrasound, who knew the pulse of imaging industry for decades addressed this area of emergency medicine. With hands-on experiences and real-time lectures from renowned national and international faculties, the medicos gathered at the workshop acquired a sound knowledge on effective use of ultrasound techniques

We believe that education and training combined with technical talent, critical decision making ability, and Imagination together make point-of-care ultrasound a lifesaving tool and improving care delivery and patient satisfaction in India Pavan Behl

Director and General Manager – India and Middle East, FUJIFILM SonoSite Pvt. Ltd




in shock assessment. “Patients in shock have high mortality rates; therefore, diagnosis and initial care must be accurate and prompt to optimize patient outcomes. India is adopting latest technologies, and point-of-care ultrasound technology has been gradually integrated into Emergency and Critical Care department”, shared Dr Diku Mandavia, Senior Vice-President, Chief Medical Officer, FUJIFILM Sonosite Inc. Dr Sanjeev Bhoi, Associate Professor of Emergency Medicine, Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi feels that this initiative of FUJIFILM SonoSite to give training to physicians on effective use of ultrasound is significant in providing quality patient care. “Point of care ultrasound has transformed the way we manage critically ill patients by augmenting physicians’ clinical skills with visually enhanced condition assessment, patient management and critical decision making. Dissemination of knowledge and skills on effective use of point of care ultrasound in acute care is of paramount importance in providing quality of care when it matters the most”, he said. Pavan Behl, Director and General Manager – India and Middle East, FUJI-


Patients in shock have high mortality rates; therefore, diagnosis and initial care must be accurate and prompt to optimize patient outcomes. India is adopting latest technologies, and point-of-care ultrasound technology has been gradually integrated into ED Dr. Diku Mandavia

Senior Vice-President, Chief Medical Officer, FUJIFILM SonoSite Inc FILM SonoSite Pvt Ltd see this as a step towards fulfilling its mission to provide quality point-of-care ultrasound to the patients in hospital and out of hospital. “We believe that education and training combined with technical talent, critical decision making ability, and Imagination together make point-of-care ultrasound a lifesaving tool and improving care delivery and patient satisfaction in India. For this purpose, we have partnered with leading Indian institutions, associations and medical centers to provide point-ofcare ultrasound training to physicians,

nurses and other clinicians and helping deliver the best possible care to the society. Going forward, we plan to hold many more similar workshops in various cities to provide education and training to physicians wanting to integrate point-of-care ultrasound in their daily practice,” Behl concluded. The workshop has also set a platform for knowing X-Porte, the World’s First Ultrasound Kiosk. The machine, which promises to introduce a new chapter in ultrasound visualization technology, integrates high-resolution ultrasound imaging synchronously with 3D animations that enable ‘any user, any time of day’ to use POC ultrasound. X-Porte is developed by SonoSite in collaboration with Henry Ford Hospital Chair of Surgery, Scott Dulchavsky, who has pioneered medical training tutorials for astronauts. Incorporating features such as XDI Imaging (Extreme Definition Imaging), real-time scan along with learning, and gesture driven interface, X-Porte brings forth an entirely new approach to clinical ultrasound. Its touch screen interface is easily customizable and its build is slender, making its portability and usability easier in any environment. Other machines showcased at the workshop included SonoSite’s flagship ultrasound systems such as M-Turbo, S-Series, NanoMaxx and Edge.





Conference with a Difference From roadshows to conferences, EMCON 2013, the 15th Annual Conference of Society for Emergency Medicine, India, weaved novel ways of emanating knowledge to the medical fraternity across the globe

Purnima Sah l cd news


espite its crucial role as a life-saving technique in a highly populated country like India, the complete potential of Emergency Medicine is yet to be explored by the Indian medical segment. It is still in its infancy. A more coordinated and serious effort can take it to the next level, which is the need of the hour so as to curb the ever-increasing road accident deaths in the country. Simply put, a systemic training on critical lifesaving methods and pre-hospital care can make a lot of difference. EMCON 2013, the 15th Annual Conference of Society of Emergency Medicine, India (SEMI), held in Wayanad, Kerala from November 16-20, was an important initiative towards achieving this goal. The journey of EMCON 2013 started


on November 1st with road shows criss-crossing the state with a mission to spread awareness among general public about the importance of Emergency Medicine and Trauma Care. The road show concluded in the beach at Calicut, the epicenter of the conference a day before the actual event commenced and paved way for academic workshops that contributed hugely towards the betterment of the medical professionals specialized in the segment. The conference also featured a two-day pre-conference workshop on pre-hospital care, in-hospital or inter-hospital emergency medical care and disaster planning on November 16 and 17 in ten different venues in Kozhikode. The workshop covered several topics such as, ‘Evidence Based Medicine’ by Dr Rishya Manikam at Baby Memorial Hospital; workshop on ‘Disaster Management’ at Sargalaya Craft Village, Vadakara by Dr Aneesh Banerjee;

‘Simulation Based Emergency Medicine’ conducted by Dr Gireesh Kumar; ‘Managing Pediatric Emergencies— The Need of the Hour’ by the faculty of SUNY Upstate Medical University, Prof Richard M Cantor; and many more similar sessions which were meant to give a basic ideology on trauma and emergency care. In addition to workshops, there were e- posters presentations, oral presentations, lightning oral presentations, photo contest, resident to resident presentation a competition, rising stars and quiz competitions. There were also scientific sessions on various topics such as the latest-cutting edge technology in emergency medicine and trauma care, latest software and apps and their use to beat the challenges in emergency care, research on emergency medicine, and academic and career opportunities. Dr Gray A Johnson, the Chairman of the Department of Emergency Medicine





Organizing Committee members are lighting the lamp during the inauguration of EMCON 2013

who heads the emergency room at Upstate University Hospital pointed out that the primary need of an education meet such as EMCON was to understand and apprehend the similarities in challenges that every emergency physician face across the globe. “It was a huge success. We have achieved more than we could anticipate. I am very happy to say that it is a mission accomplished for team EMCON,” commented Dr Fabith Moideen V M, the Organizing Secretary sharing his happiness on the success of EMCON with team Color Doppler. Apart from all the pleasant experiences, the incident of 24-hours state-wide hartal on a conference day dampened the euphoria. But, it has failed to beat the spirit of the organizers and delegates alike. Dr Venugopalan P P, the Organizing Chairman shares his bitterness, “ Being a Keralite, I don’t have to think a second before stating this statement that Kerala is not a good place to organize international events of prime importance such as EMCON. It was really a nightmare for us when the hartal was declared just a day before EMCON 2013. Being into emergency medicine, we are used to managing crisis. Adopting our disaster management principles, we could safely transport over 1000 participants to the event venue. Looking at the brighter side of this crisis, the hartal taught us how to tackle sudden uninvited strikes. But, undoubtedly, EMCON 2013 went well beyond our expectations with participation of over a thousand people from across the globe.”


Dr Terrence Mulligan, Assistant Professor, University Of Maryland School Of Medicine, Department of Emergency Care who has been working on Emergency Medicine development projects in over 30 countries feels, “Conferences like EMCON is sturdily important for the growth of emergency medicine as they serve many a purpose.Tthey provide medical education for students and doctors besides giving them exposure to advance topics. They also provide exposure to advance level of developments for the formation of emergency medicine society, formation of national curricula for training, or the formation of national co-indicators that eventually will result in widening the talent pool. Without these conferences the development of emergency medicine will not have happened. Abstracts, scientific lectures, presentations, critical medicine lectures really provide huge enthusiasm. I am really happy

Dr Venugopalan P P with Dr Mahesh Joshi

to attend this event. Emergency medicine in India is on a road to greater growth.” Dr Mahesh Joshi, the Executive CoChairman of the Society of Emergency Medicine in India (SEMI) and also the HOD of Emergency Department in Apollo Health City, Hyderabad talked about the inadequate access to emergency medicine or trauma care departments in most of the parts of the country. He also emphasized on how the situation can be made better with those limited available source. “No country has enough emergency medicine facility. The real talent lies in making the most out of what is available. Making existing things work better is a better solution at low cost rather than trying to create new ones and this requires more trained people in trauma care,” he added. Prof S V Mahadevan is the Associate Professor of Emergency Medicine/ Surgery at Stanford University School of Medicine. He elaborated on how Indian physicians lacked the access of proper

Dr Lingappa S Amernath, Dr Gray A Johnson and Dr Terrence Mulligan

healthcare system. “It’s not that our physicians are not smart enough. They are very smart, but they don’t have the access to appropriate training, adequate information and required technology, and processes that are necessary to provide emergency care. Once you make them available and train them, they can take over,” he opined. Dr Anita Bhavnani, the Vice President of American Academy for Emergency Medicine in India (AAEMI) and also the President of Global Academy of Emergency Medicine (GAEM) talked on the leaps and bounds of Emergency Medicine. Elaborating on the same, she said “In United States, it took 15 years to bring this facility and India is developing so fast that in the past 10 years, it has made a lot of progress in the field of emergency medicine which is really unbelievable. We are in the second phase which is the faculty building. There is a serious need of efficient physicians.




eventful Global Academy of Emergency Medicine is really concentrating on faculty building. We have already started the process.” Dr Pankaj Arora, the President of American Academy for Emergency Medicine in India (AAEMI) explained the importance of Emergency Medicine. “Physicians are very passionate about Emergency medicine physician residency programs. They learn this specialty as it saves lives. The American Academy for Emergency Medicine in India is a unique globalization which originated from the thought that there are lots of people who are not getting proper care at the time of need. That’s the reason behind their coming to India in order to bring a change in their lives.” Dr Lingappa S Amernath, the past president of American Academy of Emergency Medicine in India, Chairman and Medical Director at the Department of Emergency Medicine Faxton-St Luke’s Healthcare and also Clinical Assistant Professor at SUNY Upstate Medical University Department of Emergency Medicine New York City gives his message for EMCON 2013. “The need of the hour

Three stars: Prof S V Mahadevan, Dr Anita Bhavnani and Dr Pankaj Arora talking to Color Doppler team at the EMCON 2013

is emergency care and trauma care and both we lack in most of the parts of our country. So, I would strongly recommend that SEMI has been doing a phenomenal job for the past 15 years..” Emergency physicians, residents, para-

medics, physicians, surgeons, post-graduate students, and people from all walks of medicine were enriched by the event. The event concluded with the screening of a documentary film by Jessica McGaugh, ‘The Golden Hour’.

Show of Life


ouldn’t that be a spectacular view, if you meet a magician on road doing wonders amidst a leisurely walk through beach? It happened during the road show organized by EMCON 2013 on Calicut Beach on November 15. The Road show was a novel way of spreading awareness among the public about Emergency Medicine and Critical Care. Through a street play that mocked a road accident, the show presented the reactions from the public to an accident victim, and encouraged the gathering to present the right way of emergency care. The venture, that truly bridged the gap between the physicians and public, began on 1st November 2013 from Kanakakunnu Palace, Trivandrum, and traversed through 14 districts in Kerala before ceasing its mission in Calicut. The journey boasts of presenting 102 road shows across the state during a short span of 15 days. ‘102’ is the ambulance dial code for emergency services from Angel International Foundation, who was also a supporter for EMCON 2013. The visual sequences present you EMCON 2013 Road Show:






Optimize your PACS Investment Sri Krishna Seshadri

Project Manager, Teleradiology Solutions


ealthcare industry is going through a dramatic change when it comes to IT adoption. Now there is an increasing demand for data integration and transmission not just within hospital but across the different providers and organizations. Being a customer ourselves sometime or other, we can relate to the frustration of carrying and maintaining medical records and medical images for continuity of care to another clinical or hospital setting where sometimes non-availability and non-accessibility of information can lead to serious errors in our medical treatment. Today’s healthcare administrators are faced with multiple challenges when it comes to investment decision, what was once “plenty of problems” has become “problems of plenty”, where every decision is a question of choice. Choice has its own advantages and disadvantages. Most often if not, leads to individual bias or ends up with ‘buyer’s remorse’ that never sees the Return on Investment. Technology investment for hospital/healthcare organization, is not a walk in the park when you are faced with hundreds of choices, economic consideration, matching long and short term goals of the organization, keeping pace with the innovation and most of all its adoption among its users to name a few. This situation is not different for selecting a Picture Archiving and Communication System when most hospitals and standalone radiology centers are now purchasing their next-generation PACS systems. In fact, a recent study found 21% of hospitals based in the United States (U.S.) plan to replace their radiology PACS [1]. A recent report by KLAS


revealed that healthcare organizations no longer rely on a single vendor and are seeking out companies that can provide an enterprise-wide imaging strategy that can store and archive images. Selecting a PACS system Challenge or opportunity? Why do we need to buy/replace an existing RIS/PACS system? Will it help my business grow, amidst my competitors? With evolving technology, should I make short or long term decision? Will my vendor support me for a long haul? Questions like these are the ones which make PACS investment decision harder for the provider organizations amidst a fierce competition and multiple vendors. The search for a PACS system can be overwhelming, considering the factors of economic pressures on administrators & CTO’s, highly complicated workflow and vendor capability, ability to scale, interoperability, frequency, complexity, and cost of upgrades; and the vendor’s approach to training and support. These factors figure in evaluating the overall PACS ownership costs and will have a direct impact on the productivity and efficiency to realize cost savings. Total Cost of Ownership (TCO) This in most cases determines the selection of a particular PACS system for your organization, but as a note of caution, it is not necessary that a costlier PACS system will be the ‘right’ one for your organization. Typically, it is not the cost of buying the PACS rather the ‘cost of ownership’ in totality has to be calculated to arrive at a decision. While selecting a PACS system, the costs component includes cost of archival (smaller practices are opting for cloud while large practices still are not for it), servers, number of display stations (mostly underestimated), type of service contracts, Migration costs (for the existing data), disaster recovery management

and business continuity. Unanticipated costs like Integration with third party software which may have to be done for your workflow, needs attention and inclusion in the selection criteria as many healthcare organizations overlook this aspect. Cost in going through third party licensing and integration fee can become significant during implementation and needs to be considered in arriving at the TCO. For a cost conscious Healthcare Organization, selecting a PACS system that provides options of minimal upfront expenditures and no future server hardware or software upgrade costs would be optimal. This necessarily translates into Fee per fee service delivery model ending the issues like obsolescence, no hidden hardware, software, archive space, or storage costs as recurring expense. Integration to Modalities Medical imaging is ever changing with more addition and cross integration of modalities and the capability of these images to better detect diseases and disease conditions pose a challenge for PACS selection especially while integrating these modalities. Typically medical imaging services include magnetic resonance imaging (MRI), ultrasound imaging, X-ray, Computed tomography (CT), molecular imaging in Nuclear Medicine, which hospitals may have all, partly or to be procured in the future. PACS selection will include vendor capability to seamlessly integrate these modalities and access and report in the same system efficiently. Good integration not only results in an efficient workflow by providing users with immediate access to key information but also makes it easy to manage. Making systems interoperable however, needs to be driven by a strategic rather than a tactical or short-term plan. Storage and Archival In most PACS implementation, storage and archival cost exceeds the initial investment in PACS, which brings this issue


viewpoint to the forefront for a strategic decision and the vendor’s capability y to migrate imaging data to Vendor-Neutral Archive (VNA). VNA is a medical imaging technology wherein images and documents are archived in a standard format so they can be accessed by any system. Exponential growth in VNA study volumes is forecasted to drive strong demand for VNA solutions in the next five years according to a report entitled “Medical Enterprise Data Storage – World – 2013” from IHS (IHS:NYSE), a leading global source of critical information and insight. Asia-Pacific has been identified as a high-growth region, with the annual VNA study volume growth estimated at 83.3 percent[2]. Larger migration to VNA is happening in Radiology and Cardiology. Healthcare organizations selecting PACS should include this feature during their PACS selection. Integrating with EHR’s Today’s PACS must be interoperable with EHRs, image viewers, image archives, and other IT applications. Radiologists often do not have access to a clear order or adequate patient medical history (prescriptions, allergies, previous lab work and tests, etc.) to conduct radiology tests efficiently or to make a proper diagnosis.

Most EHR’s in hospitals are HL7 compliant and PACS should be able integrate for seamless flow of information. This also is an important aspect for data for mining, decision making and measuring productivity of hospital units and overall justifying your PACS investment. Customization Long standing hospitals and independent practices usually would have evolved to a particular workflow to suite the process, practices and other requirements. Capturing in detail and thorough mapping of these workflows is a key factor in selecting the right PACS solution as it also impacts the adoption. During the selection process, this feature should be given a higher weightage as this determines the customization efforts. More adoptable the PACS to your workflow less will be the customization requirement and so will be cost. For larger hospitals the ability of the PACS to work through a combination of on-site PACS and cloud technologies optimize workflow and efficiencies in the most cost-effective way. Conclusion While Cross Industry Innovation (CII), brings about technology innovation in healthcare it also makes the current

technology obsolete making investment decision harder and most cases impossible. Hence every investment decision is carefully analyzed inputs are taken from various stakeholders and CFO, CTO and CIO’s of any organization resort to holistic approach while selecting the available investment options. While the future of PACS will focus on its ability to improve Radiologist productivity, embedded analytics, image enhancement and vendor neutral archiving, today’s daunting task of selecting a PACS system still remains a challenge to the healthcare providers, which needs a strategic and holistic approach to select a solution suited to your practice for now and for the future.

Footnotes [1] - 2011 U.S. PACS Replacement Study. Capsite. Accessed July 17, 2013. [2] - [3] -

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December 2013 Color Doppler  

It is time to bid adieu to 2013! During this one year, the imaging industry saw significant changes, both technology wise as well as market...

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