ACC Leadership 2016 Exclusive Q&A with Dr

Siemens' David Pacitti: Imaging, cardio care's future p. 96

Your Industry Source for Health Care and Equipment Coverage March 2016

ACC Leadership 2016 Exclusive Q&A with Dr. Kim Williams American College of Cardiology President p. 44

DOTmed 100 Issue

In this issue CARDIOLOGY • A spotlight on innovations p. 48

SPECIAL PROCEDURES • Cardiac catheterization labs have experienced a shift, moving away from a focus on coronary interventions and to less invasive structural heart procedures p. 52

C-ARMS • Is the era of flat-panel detectors and 3-D technology upon us? p. 66 Score!!! A new Dunlee tube for my GE CT system!

Introducing the Dunlee P40 for the GE Optima CT660* CT system – a smart choice for shrinking budgets. The newest addition to our portfolio of replacement CT tubes, the P40, is not only identical in fit, form, and function to the original tube, it carries the same exact warranty. Like all products we bring to market, it’s designed to perform better and last longer, yet costs considerably less than the original.

For predictable costs to help manage your monthly budget, ask us about covering your Optima CT660 CT scanner under our exclusive Glassware Solutions and NEW Glassware Solutions + programs.

Take advantage of advanced engineering, extensive training, expert technical advice, and ongoing support programs from Dunlee and AllParts Medical, your ultimate partners for tubes and parts.

Learn more about the Dunlee P40, as well as our other products and services, at 800.238.3780 or visit www.dunlee.com

Discover the Dunlee difference.

Dunlee and AllParts Medical are Philips companies. *Products listed may be trademarked by the referenced OEM.

BUILT TO LAST! The MCS-6074 GE Performix® Replacement Tube now with a 12 month full replacement warranty!

Visit us at ECR Expo X2, Stand C315

Varian Imaging Components is continuously investing in new technology and engineering to improve our product portfolio. We are dedicated to bringing our customers the highest quality products with great reliability.

The MCS-6074 CT tube is compatible with GE LightSpeed, Discovery, and BrightSpeed series CT scanners.

To learn more, visit our website at www.varian.com/mcs-6074 VARIAN IMAGING COMPONENTS tel: 843.767.3005 or 800.468.3729 e-mail: [email protected]

The GE Performix trademark is owned by General Electric Company.

March 2016

THIS MONTH’S EXCLUSIVE Q&As 34 52 Cindy Steckel, Prebys Cardiovascular Institute 40 David Mason, Health Connect Partners 44 Dr. Kim Williams, American College of Cardiology 74 Gustavo Perez-Fernandez of GE, and Lisa Reid of Siemens Healthcare

FEATURES 48 Cardiology A spotlight on innovations. 66 52 Special Procedure/Cath Angio Cardiac catheterization labs have seen a shift, moving away from a primary focus on coronary interventions and toward less invasive structural heart procedures. 60 Injectors Injection issues and developments for CT and MRI injector systems. 66 C-arms Is the era of flat-panel detectors and 3-D technology upon us? 78 DOTmed100

Visit DOTmed.com/news for breaking news daily, to comment on stories in this issue, to participate in surveys and more.

HealthCareBusiness news I march 2016 3

PUBLISHER DOTmed.com, Inc. 32 PRESIDENT Philip F. Jacobus CHIEF TECHNOLOGY OFFICER Matt Ulman EXECUTIVE EDITOR Robert Garment EDITORIAL DIRECTOR Glenn J. Kalinoski

EDITORIAL CONTRIBUTING EDITOR Sean Ruck 212-742-1200 Ext. 218 [email protected] 34 40 ONLINE EDITOR Gus Iversen STAFF WRITER Lauren Dubinsky CONTRIBUTING WRITERS Lisa Chamoff Don Dennison COLUMNS Michael Friebe David Handler David Pacitti 6 Letter from the Editor Jill Rathbun Nancy Rowe Bipin Thomas 7 Top Online Stories DESIGN DESIGN DIRECTOR Stephanie Biddle 8 Letter from the Online Editor DESIGN CONSULTANT Oscar Polanco SALES SALES DIRECTOR David Blumenthal 8 DOTmed Online News 212-742-1200 Ext. 224 [email protected] KEY ACCOUNT Susan Minotillo 31 Upcoming Events MANAGERS 212-742-1200 ext. 261 [email protected] Connie Goon 32 Hospital Spotlight 212-742-1200 Ext. 289 [email protected] ACCOUNT MANAGERS Colm Ford 35 Cost Containment Corner 212-742-1200 Ext. 241 [email protected] How Telehealth Can Improve Your Bottom Line Troy Gladstone 212-742-1200 Ext. 246 [email protected] 36 IT Matters Tamir Katsap Image Access Strategies for the Consolidated Enterprise 212-742-1200 Ext. 227 [email protected]

New Products Showcase Press Releases 38 If you have news regarding your company submit it to: [email protected] Article and Story Consideration 47 View from the Hill If you have an article or feature story you would like Ultrasound's Role in New Sepsis Management the editor of HealthCare Business News to consider publishing, submit it to: [email protected] Quality Measure for Hospital Reporting Letters to the Editor Submit letters to the editor to: [email protected] Subscriptions 59 Technology Advisor For all subscription inquiries please email Why Digital Health Initiatives Fail [email protected] or visit dotmed.com/magazine Auctions If you want information about auctioning equipment on DOTmed.com, please call: 212-742-1200 Ext. 296, 91 This Month in Medical History or email us at [email protected] Skinner on his Best Behavior HealthCare Business News is published by DOTmed.com, Inc., 29 Broadway, Suite 2500, New York, NY 10006 Copyright 2015 DOTmed.com, Inc. All rights reserved. 96 The Future of Health Care Imaging: Cardio Care's Future

DOTmedSM provides the HealthCare Business NewsSM to its registered users free of charge. DOTmedSM makes no warranty, representation or guarantee as to the accuracy or timeliness of its content. DOTmedSM may suspend or cancel this service at any time and for any reason without liability or obligation to any party. All trade names, trademarks and trade dress contained herein belong to their respective owners and are used herein with the intent to represent the goods and services of their respective owners. If you think your trade name, trademark or trade dress is not properly represented, please contact DOTmed.com, Inc. Letter from the Editor

Test your political health care IQ Among all the costs and provide a new credit to those fac- candidates — can you match the quotes unprecedented ing high health expenses.” with the candidates? turbulence of this Ben Carson C) “My view is simple: health care is a right, presidential sea- Hillary Clinton not a privilege. Over 29 million Americans re- son, the debate Ted Cruz main uninsured and millions more are under- over health care Marco Rubio insured. That is unacceptable. The time has insurance, “Obam- Bernie Sanders come for a Medicare-for-all universal health acare” and the va- Donald Trump care system that provides every American lidity of a single-payer system (a.k.a. with affordable, quality care.” “universal health care”) has been pretty Get the answers instantly online much eclipsed by all the bluster. D) “I would end Obamacare and replace it Find out who said what right now. But remember this: one of the remaining with something terrific, for far less money Go to www.dotmed.com/iq candidates for president will actually become for the country and for the people.” and get the answers! the president in a few short months. E) “Obamacare is fatally flawed because it The “long-story-short” takeaway from So test your political health care IQ and is poorly constructed and relies on the out- this exercise is that: If a Democrat wins the see if you can match the statements below dated philosophy that the government can White House, if you like the current state of to the candidate who made them: solve our problems through more spending, affairs in health care policy, you can expect A) “I will repeal Obamacare and propose com- more taxes and more bureaucrats.” it to be maintained, and possibly get more mon sense reform that makes health care per- of the same. If a Republican wins the White F) “I will repeal and replace Obamacare with sonal, portable and affordable. I will expand House, look for contentious times ahead Health Empowerment Accounts (HEAs) that competition in the marketplace, empower and plenty of whacking and hacking at the give people — not government bureaucrats consumers and disempower the government.” Affordable Care Act. — control of their health care. With HEAs, B) “As president, I’ll defend the Affordable Americans will have lower premiums, in- Stay tuned…. Care Act, build on its successes, and go even creased health care options and access to Robert Garment further to reduce costs. My plan will crack high-deductible catastrophic insurance.” Executive Editor down on drug companies charging exces- Each quotation belongs to one of these [email protected] sive prices, slow the growth of out-of-pocket

editorial advisory board Abass Alavi, MD, professor of Michael Friebe, PhD an affiliate Katie Regan, clinical publishing radiology and director of research professor at the Technical University manager, MD Buyline education in the Perelman School Munich in Germany Bipin Thomas, chairman, ICURO of Medicine at the University of Heidi Horn, vice president of SSM Pennsylvania School of Medicine Wayne Webster, principal, Health Care’s Clinical Engineering Proactics Consulting Leonard Arzt, executive director, Service (CES) department National Association for Proton Sharon A. VanWicklin, MSN, RN, Jason Launders, medical physicist, Therapy CNOR/CRNFA, CPSN, PLNC, ECRI Institute perioperative nursing specialist, Norman E. Bolus, MSPH, MPH, Jill Rathbun, president, Galileo Association of periOperative CNMT, editor-in-chief, JNMT, Consulting Group Inc. Registered Nurses (AORN) director, assistant professor Nuclear Medicine Technology Program Clinical Barbara G. Rebold, RN, MS, CPHQ Marty Zimmerman, president and & Diagnostic Sciences Department, director, Operations, chief executive officer of UAB School of Health Profession ECRI Institute PSO LFC Capital, Inc.

6 HealthCareBusiness news I march 2016 www.dotmed.com HealthCareBusiness Daily News Online Top trending headlines As we went to print: Welcome to Our News • Toshiba to sell non-imaging health care business in addition to Medical Center Systems division dotmed.com/news/story/29000 • Against the odds, Princeton Baptist cardiologist saves patient's life daily news online dotmed.com/news/story/29066 M Proton therapy is best for the most When health care industry news common pediatric brain tumor: study breaks, you’ll read about it first at: dotmed.com/news/story/28967 dotmed.com/news • MR-compatible cardiac device implants Visit daily and signup for our add significant value to patient care convenient weekly news digest. dotmed.com/news/story/28968 M With Avicenna, IBM Watson Health interprets radiology images dotmed.com/news/story/29020 • A day at ECRI Institute's medical in print device testing laboratory dotmed.com/news/story/29082 • Are low-dose radiation concerns Get a free subscription and based on bad science? Loyola research sign up for the digital version team thinks so of HealthCareBusiness News. dotmed.com/news/story/29012 • Rose Radiology settles false claims allegations for nearly $9 million dotmed.com/news/story/28910 M 7 Tesla MR shows promise in first-of- its-kind cardiac study dotmed.com/news/story/29065 • PET/CT beats CT and bone scans for detecting metastatic prostate cancer: study Subscribe to our Magazine and dotmed.com/news/story/28922 weekly Online News digest now. • Philips and Validic aim to combine fitness data with the HER dotmed.com/news/story/29045 • ASTRO adds its support to Obama's cancer moonshot proposal dotmed.com/news/story/29115 • Stryker to buy Sage for $2.8 billion dotmed.com/news/story/28947

Siemens' David Pacitti: Imaging, cardio care's future p. 96 • Optical Coherence Tomography scan-

Your Industry Source for Health Care and Equipment Coverage March 2016 ner a boon to basal-cell diagnosis ACC Leadership 2016 dotmed.com/news/story/29056 Exclusive Q&A with Dr. Kim Williams American College of Cardiology President p. 44 • GE partners with UAE to improve

DOTmed 100 Issue In this issue country's radiology resources CARDIOLOGY • A spotlight on innovations p. 48

SPECIAL PROCEDURES • Cardiac catheterization labs have experienced a shift, moving away from a focus on coronary interventions and to less invasive structural heart procedures p. 52 dotmed.com/news/story/28893 C-ARMS • Is the era of ﬂ at-panel detectors and 3-D technology upon us? p. 66 M Editor’s Choice Visit HCB Daily News online for breaking stories every day

HealthCareBusiness news I march 2016 7 Letter from the Online Editor Behind every smart device…

Last week over dinner, some friends and What I’m trying to say is that I don’t subscribe to the line of think- I wound up on the topic of self-driving cars. ing that says radiologists are becoming obsolete. I think that, gradu- As you may have heard, Google — and other ally, smart systems will allow radiologists to manage their time more companies — have made significant strides optimally. toward making them a day-to-day reality. They will spend more time interfacing with referring physi- We agreed that most people would prob- cians and patients, explaining procedures, monitoring dose, ably be reluctant to buy a self-driving car that discussing treatment options and personalizing care. Meanwhile, didn’t also have a manual mode ... just in case they will also be the licensed drivers behind the smart systems the computer went haywire or was missing a bit of data pertaining getting patients to their diagnoses on the fastest and most reli- to a rural road, for instance. able routes available. More than ever, health care professionals are finding themselves Here in New York City it’s a lot like how we catch up on our at a crossroads where they must either put their faith in computer emails, the news and the books we’re reading all while the train learning or risk being left in the dust. takes us to work every day. We simply accomplish more in transit When I think of the work IBM is doing with Merge to “teach” than people who have to watch the road. That being said, if you’re Watson how to interpret X-rays, I am reminded of how amazed I halfway to your station and the train just stops running, it’s up to you was when Google unveiled its “search by image” function. Since to use your head and find a way to finish the commute. computers “see” in pixels, their potential for detecting outliers or inconsistencies is seemingly infinite, so health care is a perfect fit. Gus Iversen But what if the computer goes haywire? What if the algorithm Online Editor somehow fails? In most industries it creates a headache or a PR disaster. [email protected] In health care, as with automobiles, it can be a matter of life and death. Twitter: @dotmedcom

The Toshiba Medical Systems bidding war is taking shape with U.S. private equity firms in the running Posted online January 29, 2016 by Gus Iversen

Toshiba shook the health care industry and Bain Capital have also reportedly thrown in excess of $3 billion, according to the Re- when it announced it would pursue the their hats in the mix, although some have uters report. sale of a majority share in its medical speculated that the sale will likely go to a Jap- With the exception of Canon, whose ex- equipment business. Thanks primarily to anese company — allowing the country to ecutive vice president and chief financial of- an anonymous Reuters source, some of the retain the economic benefits of the business. ficer, Toshizo Tanaka, told reporters that the fog has lifted around who we can expect the Companies that were previously cited as company "was raising its hand" for Toshiba serious contenders to be. contenders include Hitachi, Samsung and Medical, the other potential bidders have Some of the most likely purchasing can- GE Healthcare — but it would appear that not been publicly forthcoming about their didates include familiar health care entities they are no longer likely suitors. intentions. like Fujifilm, Konica Minolta, Canon and The Japan Times reported that Toshiba Toshiba is hoping to close the deal by the Sony. In some cases those companies have expects to gain some ¥500 billion (over $4 end of March and raise cash to help improve teamed up with financial partners to place billion) if it sells 80 percent of Toshiba Medi- its financial standing as it undergoes restruc- their bids. cal Systems, according to sources. turing, and aims to recover from accounting The news agency reported that a first While the size of the stake purchased will scandals involving exaggerating profits over round of bidding was expected to close on reportedly be determined in a second round six years. Jan. 29, with a second round pending. of bidding, the sale of Japan's largest health Share this story: dotmed.com/news/28884 The U.S. private equity firms KKR & Co. care business is expected to carry a price tag

8 HealthCareBusiness news I march 2016 www.dotmed.com [ [ HealthCareBusiness Daily News Online > dotmed.com/news St. Louis-based Centene's missing hard drives contained data on 950,000 customers Posted online January 28, 2016 by Thomas Dworetzky

Centene is half-dozen hard drives short abundance of caution and in transparency, monitoring. of full customer security. The St. Louis- we are disclosing an ongoing search for the "The stakes are high because Centene centered managed health care provider has hard drives. The drives were a part of a data handles sensitive health information relating revealed that the drives are "missing" and project using laboratory results to improve to its members. It is, therefore, highly likely held personal information on close to a mil- the health outcomes of our members." that they will have to make a report to U.S. lion patients who had lab work done be- Centene stated that an internal search regulatory authorities and will be fined for any tween 2009 and 2015. for the drives "was ongoing." It noted that data loss," Alison Rea, a lawyer at Kemp Little, The information included names, ad- the hard drives do not include any financial told the BBC. She did commend the organiza- dresses and Social Security numbers, accord- or payment information. tion for being "upfront" about the loss. ing to St. Louis station KMOV-TV. "Consistent with our policies around "If the data has been lost within the or- The drives were unaccounted for in an communication and transparency, we are ganization, the potential damage suffered inventory of IT assets. "Centene takes the beginning the process of notifying all affect- by Centene's members will be minimal. privacy and security of our members' infor- ed individuals and all appropriate regulatory However, if the data has been taken offsite mation seriously," said Michael F. Neidorff, agencies as we continue to search and inves- and is now in the public domain, the dam- president and CEO of Centene, in a state- tigate," said Neidorff. ages claims Centene faces could be much ment. "While we don't believe this informa- Notification to affected individuals will higher," she said. tion has been used inappropriately, out of an include an offer of free credit and health care Share this story: dotmed.com/news/28851 No butts: Ex-smokers need Fiction meets focused greater access to lung CT ultrasound in author screening for cancer John Grisham's new novel

Posted online January 27, 2016 by Gus Iversen Posted online January 27, 2016 by Lauren Dubinsky

CMS announced that it would reimburse annual low-dose Known primarily for his best-selling legal thrillers, John Grish- CT (LDCT) lung cancer screening for cigarette smokers and am's latest novel explores the impact focused ultrasound had former smokers at high risk of developing the disease. Now, on a fictional patient with a malignant brain tumor. evidence out of the Mayo Clinic suggests the criteria, as it currently The adoption and development of focused ultrasound has been stands, may be too exclusive. slow, but "The Tumor" may play a part in speeding things up. CMS is currently only reimbursing annual LDCT lung cancer “The development and adoption of any new medical technol- screening for individuals between 55 and 77 years of age who are ogy, particularly a therapeutic technology, is a process that can either still smoking or have only kicked the habit within the past 15 often take decades,” Neal Kassell, founder and chairman of the years and still retain a smoking history of at least 30-pack-years (or Focused Ultrasound Foundation, told HCB News. a 30-year pack-a-day average). Kassell feels that the book is a perfect vehicle for increasing Establishing an accurate model for screening those at high risk awareness. He also mentioned that increasing awareness goes of developing the disease was no small matter. Having screening hand-in-hand with an increase in funding to support focused ultra- criteria means faster detection and, consequently, big savings in sound research and other activities. terms of both lives and money, for the second-most common can- "The Tumor" is about a 35-year-old father named Paul who was cer in the U.S. diagnosed with a malignant brain tumor. Even though he received New research, published in the Journal of Thoracic Oncology, invasive brain surgery, radiation and chemotherapy, he passed away suggests that the predictive model approved last year needs some nine months after his diagnosis. tweaking in order to be more effective. Specifically, screening The book then takes the reader to an alternate future in which Paul should be made available to former smokers who quit smoking is diagnosed with the malignant brain tumor in 2025, but receives more than 15 years ago. focused ultrasound treatment. The focused beams of ultrasound en- Share this story: dotmed.com/news/28847 ergy ablate Paul’s tumor and he is able to get back to his everyday life. Share this story: dotmed.com/news/28833 10 HealthCareBusiness news I march 2016 www.dotmed.com HEALTHCARE SOLUTIONS

PARTNERING FOR SUCCESS From a single system to a complete medical center….

CONCEPT AND CONSULTATION PLANNING AND DESIGN CONSTRUCTION AND PROJECT MANAGEMENT EQUIPMENT MANAGEMENT AND SERVICE SUPPORT FINANCIAL PLANNING

Visit us at ECR 2016 VIENNA March 2-6 We do it better ! Stand 538, Hall X1

Sales and Service Support in 40 Countries Worldwide!www.elsmed-healthcare.com TailorElsmed Made Healthcare Solutions Solutions, with 20 HamagshimimOne Source St., for Kiryat everything. Matalon, Petach Tikva 49250, Israel T +972-3-558-4839 F+972-3-558-9858 E [email protected] HealthCareBusiness Daily News Online > dotmed.com/news MR study reveals how obese kids become wired to eat Posted online January 27, 2016 by John W. Mitchell

A just-published study in Heliyon sug- “We found that as weight increased dense foods, it is putting children at risk." gests that diet and exercise may not be among children, the connectivity between MR scans were conducted on children enough to help obese kids achieve and the inhibition-associated brain area and the of varying weights on which questionnaires maintain healthy body weights — it reward-associated area decreased,” said about eating habits were also tabulated. may require a change in brain function. Niswender. “Additionally, the connectivity be- Niswender said the MR results statistically “Treatment of obesity in adults is exceed- tween the impulsivity-associated area and the quantified the strength of the functional con- ingly difficult, therefore prevention strate- reward-associated area increased, as weight nections between the brain regions of interest. gies might be useful,” Dr. Kevin Niswender, increased. This led to an imbalance favoring According to Niswender, the study sup- M.D., Ph.D., associate professor and senior impulsivity over control in heavier children.” ports the importance of early identification study author at Vanderbilt University Medical According to the study, childhood obesity of children at risk for obesity, as well as the Center, told HCB News. “Prevention would in the U.S. has nearly doubled in the past 30 need to develop novel methods to treat and need to start in childhood and we sought to years. Among adolescents it has tripled. In prevent the condition. He said the practice identify children who might be at risk.” 2010, a third of kids were considered obese of “mindfulness,” a brain function recali- He explained that there are three specific or overweight. brating strategy, might be one such option. regions of the brain that are modulators for “Adults, and especially children, He described mindfulness as a means to eating habits. These regions are associated are primed toward eating more," said maintain moment-by-moment awareness with impulsivity, reward-motivated behavior Niswender. "This is great from an evolution- of thoughts, feelings, bodily sensations and and response inhibition, all of which affect ary perspective, but in today's world, full of surrounding environment. overeating. readily available, highly advertised, energy- Share this story: dotmed.com/news/28442

MR plus ultrasound to Researchers link high improve breast cancer deductibles to low utilization biopsies and diagnoses of imaging exams

Posted online January 26, 2016 by Thomas Dworetzky Posted online January 19, 2016 by Lauren Dubinsky

Researchers at the University of Twente in the Netherlands Patients who have high-deductible insurance plans had low- are working on a futuristic biopsy robot — merging the best er rates of medical imaging use, according to new research of MR and ultrasound — that may someday make diagnos- that was published in the journal Medical Care. Insurance ing breast cancer and muscle diseases both more accurate plans with an annual deductible of at least $1,200 for individuals and less expensive. and $2,400 for families were considered high. The European research project is known as MR and Ultrasound “Similar to what many previous studies had found, a reduction Robotic Assisted Biopsy, or MURAB. Its aim is to overcome the in health care utilization follows when patient cost sharing in- problems with present screening modalities for breast cancer, which creases,” Sarah Zheng of the Boston University Questrom School of result in 10 to 20 percent of patients receiving false negatives, UT Business, wrote to HCB News in an e-mail. “We found in particular researcher Foad Sojoodi Farimani, said in a statement. that decisions to have any imaging, made by the physician-patient Key to the robotic approach is ensuring that the best possible pair, were sensitive to cost-sharing.” tissue sample is obtained. "If a mammography shows a suspicious Zheng and her fellow researchers used an insurance database image then we need to take a small piece of tissue for lab examina- that includes data on over 21 million adults from 2010. They com- tion. But it’s difficult to determine precisely where the biopsy should pared use rates and costs of X-ray, CT, MR and other imaging tests be carried out. As a result we overlook too many patients who do for patients with and without high-deductible insurance plans. indeed have a problem. That’s an issue we hope to solve," he stated. The researchers found that about eight percent of the patients The MURAB project began in earnest when it got a Horizon 2020 had high-deductible plans. After accounting for age, sex, geo- grant of $4.6 million. Horizon 2020 is a European commission, begun graphic location and health status, they uncovered that those indi- in 2014, designed to place grants totaling $87 million through 2020. viduals used 7.5 percent fewer imaging studies than in other plans. Share this story: dotmed.com/news/28829 Share this story: dotmed.com/news/28675

12 HealthCareBusiness news I march 2016 www.dotmed.com Zetta Medical Ad 4/c Bleed 8.375 x 11 Trim 8.125 x 10.75 Safe Area 7.625 x 10.25

Zetta Medical is the most technically advanced ISO ***BECOME XR-29 Compliant with our Z-Dose29 Today!!!

Service, Parts, Equipment, Support & Remote Diagnostics CT, MRI & PET/CT

Zetta Medical Technologies • 800-991-1021 • www.ZettaMed.com HealthCareBusiness Daily News Online > dotmed.com/news Intensive care telemedicine use is on the rise Posted online January 21, 2016 by John W. Mitchell

Researchers at UC Davis Health System Tele-ICU is essentially two-way video and currently only one in five ICUs have such criti- concluded in a just-published issue of data exchange. The study found that remote cal care physicians available on a 24/7 basis. the journal Critical Care Medicine that tele-ICU monitoring is especially effective in The study highlights the high cost of criti- telemedicine in the ICU (tele-ICU) is life- hospitals that do not have a large number cal care. The researchers found the installation saving and often cost-effective. of specialist physicians on staff to manage price tag for tele-ICU was between $70,000 and “Thirteen percent of the non-federal ICUs critically ill patients on site. Such specialists, $92,000 per bed, with annual costs after the first are currently using the technology and the which include intensivists and internal medi- year between $34,000 and $53,000. However, number is on the rise. It is very expensive tech- cine physicians, act as a “second set of eyes” Yoo said widely accepted medical modeling has nology that some studies have shown to im- to help hospital-based doctors and nurses de- determined that if the cost of a critical interven- prove clinical outcomes,” Byung-Kwang Yoo, termine if a patient’s condition is worsening. tion was below $100,000 to extend one year UC Davis associate professor of public health “This technology could be a poten- of life for a single patient, the intervention was sciences and lead author of the article, told tial solution that could help improve care, deemed to reduce the costs of care. HCB News. “Our primary question was: Is tele- save lives and save money,” Yoo explained. The study was conducted by applying math- ICU worth the costs when applying the stan- “There is a relative shortage of critical care ematical modeling to costs and benefits on data dard cost-effectiveness criteria used widely for physicians and few tend to work in rural and gathered from multiple tele-ICU studies. other technologies and therapies?" underserved communities.” He added that Share this story: dotmed.com/news/28756

Fujifilm announces FDA and CE University of Toledo and Mark clearance for SonoSite Athenahealth partner on Edge II portable ultrasound hospital EHR

Posted online January 25, 2016 by Gus Iversen Posted online January 25, 2016 by Gus Iversen

Fujifilm announced the regulatory clearance of its new por- Athenahealth has announced a significant expansion of its table ultrasound system, SonoSite Edge II, for commercial partnership with the University of Toledo Medical Center distribution in the U.S. and Europe. (UTMC). The institutions will now work together to adapt the The system is designed to meet the needs of practitioners per- cloud-based electronic health record (EHR) system AthenaClinicals forming emergency medicine and critical care applications, for for the hospital setting — marking a departure from the doctor's whom a fast and accurate diagnosis can be crucial. offices where the system is typically deployed. "Since SonoSite introduced the first portable ultrasound system Up to this point, AthenaClinicals was being used at hospitals in 1999, it has continued to build solutions that anticipate the with 50 beds or fewer, whereas UTMC has 250 beds, according to bedside provider's needs," said Dr. Diku Mandavia, chief medical The Wall Street Journal. officer and senior vice president, Fujifilm SonoSite Inc., and Fujifilm The company extended its acute care services in early 2015 Medical Systems U.S.A., Inc. when it acquired RazorInsights and webOMR, which afforded it ac- "The Edge II ultrasound system stays true to the SonoSite legacy cess to technology that could enable comprehensive, cloud-based of durability, reliability and ease of use," he continued. "However, service within AthenaNet for hospitals of all sizes and complexities. we also incorporated enhancements to accelerate the time to im- Together, the two organizations will identify areas for opera- age acquisition, enabling clinicians to make more confident deci- tional improvement, and then design and build service capabilities sions and focus on what matters most, the patient." to support those workflows. With a patent-pending technology called DirectClear to improve According to the Journal, UTMC and Athenahealth established the quality of the images obtained, a wide-angle display for capturing a deal whereby the two will share the cash flow generated over 33 percent more viewing angles and a protective casing to make the time. "Working with Athenahealth to develop AthenaClinicals for system more durable — Fujifilm calls the SonoSite Edge II the rugged, hospitals and health systems is an excellent opportunity to position reliable and responsive ultrasound solution for point-of-care. our providers already using AthenaNet to impact transitions of care Share this story: dotmed.com/news/28812 across UTMC's ecosystem," said David Morlock, UTMC CEO. Share this story: dotmed.com/news/28809

14 HealthCareBusiness news I march 2016 www.dotmed.com

HealthCareBusiness Daily News Online > dotmed.com/news New fMRI research from MIT, Harvard may help reveal susceptibility to depression in children Posted online January 25, 2016 by Gail Kalinoski

Using functional magnetic resonance to statistics from the National Institute of tistics show those children are three times imaging (fMRI) on two groups of chil- Mental Health. That same year, about 15.7 more likely to eventually become depressed, dren ages 8 to 14, researchers at the million American adults also had at least one often by age 15. The researchers studied 27 Massachusetts Institute of Technology major episode. high-risk children ages 8 to 14 and com- (MIT) and Harvard Medical School have The study found distinctive brain differ- pared them to 16 children with no family found such brain scans may be able to ences in children considered high risk be- history of depression. determine whether young people are cause of depression in their families. Previ- In the at-risk children, they found similar at risk of developing depression when ous research using imaging scans had found patterns to those in adults with depression they are older. The researchers hope the two brain regions — the subgenual anterior leading them to believe the differences are information in their study could lead to tools cingulate cortex and the amygdala — often there before depression occurs and may that could be used for early detection, inter- showed abnormal activity in depressed pa- contribute to it. vention and treatment. tients. But it wasn’t clear if the differences More research will be done to track those The study, published in the journal Bio- were caused by the depression, or if the de- at-risk children in the study to see whether logical Psychiatry, is important because an pressive episode changed the brain. early treatment might prevent later depres- estimated 2.8 million adolescents aged 12 Researchers used brain scans of children sion, or how some could avoid depression to 17 in the United States had at least one who were not diagnosed as depressed, but without treatment. major depressive episode in 2014, according had a parent with depression because sta- Share this story: dotmed.com/news/28795 QUiPP app helps clinicians A fifth treatment room better identify women at risk coming to UF Health Proton of a premature birth Therapy Institute

Posted online January 20, 2016 by Lauren Dubinsky Posted online January 15, 2016 by Gus Iversen

Researchers at King's College London have developed an With almost a decade of treatments under its belt, the Uni- app called QUiPP that helps clinicians better identify women versity of Florida Health Proton Therapy Institute (UFHPTI) at risk of giving birth prematurely. will be undertaking a $39 million expansion to increase the The researchers conducted two studies — the first focused on number of cancer patients and indications it can treat. women considered high risk mostly because of a previous early While the installed technology will be upgraded, the centerpiece birth, despite not showing any symptoms, and the second study of the renovations will be the addition of a single-room compact focused on the chances of premature birth in women who had treatment system, which is expected to increase patient capacity symptoms of early labor. by 25 percent. For the first study, researchers gathered data from 1,249 women Currently, the 98,000-square-foot facility treats approximately at high risk who attended preterm surveillance clinics. The esti- 100 patients per day using four treatment rooms — three equipped mated chance of delivery before 30, 34 or 37 weeks' gestations, with rotating gantries and one fixed-beam room — all powered by and within two or four weeks of testing for fetal fibronectin, was one cyclotron. Over the duration of a year that adds up to roughly calculated for each patient and evaluated as a predictive test for the 750 to 800 completed treatment courses. actual occurrence of each event. When the project is completed, UFHPTI will have one of the For the second study, the researchers collected data from 382 most versatile proton therapy systems in the world, according to high-risk women, and a model was developed on the first 190 Stuart L. Klein, MHA, executive director of the institute. "Each de- women and confirmed on the other 192. In both studies, the app livery technique — double scattering, uniform scanning and pencil was shown to perform well as a predictive tool and was much more beam scanning — will enable physicians to use the optimal treat- accurate than when each of the risk factors are used alone. ment delivery customized for each patient," he said. The app can be downloaded for free in the Apple store. The project is expected to take roughly three years. Share this story: dotmed.com/news/28705 Share this story: dotmed.com/news/28674

16 HealthCareBusiness news I march 2016 www.dotmed.com

HealthCareBusiness Daily News Online > dotmed.com/news Akili scores $30 million for video game-based treatment platform for cognitive disorders Posted online January 22, 2016 by Lauren Dubinsky

Akili Interactive Labs Inc., a digital medi- Akili develops mobile software-based meets all of the requirements for rigorous cine company, announced today that it treatments and monitors that resemble clinical studies. The system is currently under has raised $30.5 million in new equity video games. Most notably, the company is testing in a number of clinical studies. investments to fuel further develop- developing a gaming therapy called Project: The company intends to use the $30.5 ment of innovative products that may EVO, which is intended to help patients with million to further develop the product and change the way we approach the treat- ADHD, autism, depression and traumatic help establish the commercial infrastructure ment of cognitive disorders. brain injury. necessary to gain FDA approval and formally "We're seeing the emergence of an en- The science behind the platform was launch the product. tirely new category of non-pharmacological developed at the University of California, A recent pilot study that investigated therapies, and Akili is leading the charge,” San Francisco (UCSF) by Dr. Adam Gazzaley, the effect that Project: EVO has on children John Spinale, former SVP of Social Games at founding director of the UCSF Neuroscience with ADHD found that it improves atten- Disney and partner at JAZZ Venture Partners, Imaging Center and Akili’s chief science advi- tion, inhibition and working memory. Based said in a statement. His company, along with sor. His research has led to a new software- on that data and the results of an earlier Canepa Advanced Healthcare and PureTech based method to measure and improve an randomized, controlled study conducted by Health, were among the primary investors. important part of executive function called Gazzaley, Akili will start a large, randomized, “We love their ability to target some of interference processing. controlled pivotal study to further confirm the most underserved patient populations The developers deployed those mechan- the efficacy and safety of the platform. and disrupt massive markets at the same ics in a consumer videogame engine that Share this story: dotmed.com/news/28792 time," said Spinale. can run on mobile phones and tablets and Veteran shot with own gun in So far, ACA has not reduced MR suite in Indianapolis full time employment: study

Posted online January 6, 2016 by Thomas Dworetzky Posted online January 5, 2016 by John W. Mitchell

If you're running an MR suite, here's something you might The adjusted probability of employees working part time add to your patient admission arsenal: check for concealed before and after the Affordable Care Act (ACA) was enacted weapons before letting someone enter. did not show significant change, according to new research. As more people feel it necessary to exercise their Second Amend- “Although we cannot rule out some changes in certain popula- ment right to carry arms, a new gun risk has just popped up: In tions, such as older workers and those with lower educational attain- Indianapolis a veteran allegedly walked into an MR room packing ment, the evidence shows that there are no large effects detectable a .45 pistol and it got sucked against the magnet and went off, ac- at the aggregate level, using a fairly large dataset,” Dr. Asako Moriya, cording to initial reports. Ph.D., economist and lead study author at the Agency for Healthcare Fortunately his wound was not life-threatening, but it might Research and Quality (AHRQ), told HCB News. The study data came have been, according to a report in the Indianopolis Star. from the Current Population Survey (CPS) for the years 2005-2015. The incident took place at Richard L. Roudebush Veterans Affairs She said the study specifically considered if there was any increase Medical Center, which has since walked back the initial statement by in the number of people working 25-29 hours a week, or less than an unnamed hospital spokesman that an MR machine was involved, 25 hours week, from 2013 through the first half of 2015. stating only that the firing happened "in a procedure room." “We expected an increase in these hour ranges if employers Regardless, with more guns than ever being carried, it is possibly had reduced employee work hours below the 30-hour threshold to time to revisit standard operating procedures surrounding these avoid the employer mandate,” Moriya said. “Also, we expected an powerfully magnetic machines. While this latest incident is appar- increase in working fewer hours if workers had voluntarily reduced ently the first in which someone was shot, it is not the first time a their work hours so they become eligible for expanded Medicaid or weapon has gone off in proximity to MR. Marketplace subsidies.” Share this story: dotmed.com/news/28496 Share this story: dotmed.com/news/28458

18 HealthCareBusiness news I march 2016 www.dotmed.com Illinois Neurological CT scans being used increasingly for adult Institute unveils patients with non-serious injuries: study state's second Posted online January 21, 2016 by Gus Iversen intraoperative MR A new study suggests that too many fornia hospitals. Posted online January 28, 2016 physicians are ordering CT scans when The patients were seen — and discharged by Thomas Dworetzky they may not be warranted. — from EDs after minor falls or low impact Using data provided by the California vehicle accidents. Of them, 3.51 percent un- A seizure in 2009 was the first sign that Office of Statewide Health Planning and derwent at least one CT scan in 2005 versus Cody Krulac had brain cancer. He had two Development, researchers from the Univer- 7.17 percent in 2013, indicating that despite surgeries to remove his tumor, but it came sity of California San Francisco (UCSF) and value-based care initiatives, utilization is in- back for a third time. Krulac got the bad Stanford looked at the treatments provided creasing instead of decreasing. news two days before Christmas 2015. to more than 8 million patients at 348 Cali- Share this story: dotmed.com/news/28724 “I’m 27 and I’m a man,” Krulac told the Peoria Journal Star. “Did I cry? Yes, I did. You can cry about anything you want, but it doesn’t change the outcome. I’m not happy I have to do it at all, but I’m glad it’s me and not my Not on our watch! brother or my dad.” His luck, however, changed — his doctor was at an institution that was about to become just the second Illinois site to utilize intraoperative magnetic resonance imaging (iMRI). Now the brave young man is back home on his family farm, with the lesion removed and a new lease on life. Krulac was the first patient to benefit from the newly installed technology at OSF Saint Francis Medical Center in Peoria, Ill. It let his surgeons scan during his delicate brain surgery — a frontotemporal supratentorial craniotomy for tumor resection. INI Brain Tumor Center Director Dr. Andrew Tsung, who spearheaded the 20-member operating team, expressed delight with the re- AUE enjoys one of sults of the inaugural seven-hour operation. “It vindicates our ability to come together as the lowest DOA rates in the industry!! a team and complete an enormously complex 1.5 % for the last 12 months! task from conception to implementation — and furthermore on the first patient, without When looking for quality systems, parts, service, and repairs, a single technical complication,” he noted in at better than OEM pricing, look no further than… a statement. The use of imaging during procedures is a growing market in the U.S., according to a recent North American intraoperative imaging market report. Share this story: dotmed.com/news/28861 The #1 source for all your Ultrasound needs! www.auetulsa.com • Tel. 1-866-620-2831

HealthCareBusiness news I march 2016 19 HealthCareBusiness Daily News Online > dotmed.com/news UK's Blood Bikers deliver medical supplies wherever 'a bike can go' throughout Wales Posted online January 22, 2016 by Thomas Dworetzky

A series of recently released short films anything from medicine to breast milk. “Ba- a boost in positive publicity led to a surge of is highlighting the good work of the sically,” NABB chairman John Stepney told volunteers, now about 1,500. "Blood Bikers" of Wales, volunteers The Guardian, “anything you can get on the "It's an idea that is catching on," Stepney who use their two-wheel expertise to back of a bike.” told the publication. race blood and medical supplies around A recent "Point of Light" Award from And why not? It's good for the bikers the country, according to ITV. the U.K. prime minister has just raised the involved, said one, to show the public that The efforts of the charity Nationwide As- organization's profile significantly. And the they are “not just a group of mad, hairy bik- sociation of Blood Bikes (NABB) mean that short films have generated interest from as ers looking for an adrenaline rush.” patients in desperate need of a diagnosis far away as Canada and Australia from bik- In fact, nothing could be further from the can have their samples rushed to the lab, ers eager to take this idea on the road — in truth. Consider blood biker David Wilbra- or those in need of blood can get lifesav- their local communities. ham. He is honorary canon of Christ Church, ing transfusions. In fact, in 2013 the orga- The volunteer effort started in the UK in Oxford, and has ridden the roads on his vol- nization handled 35,000 urgent hospital the 1960s. Back then bikers' image was more unteer medical missions for nearly a decade. requests. Hell's Angels than angelic. A group started He is also a full-time police chaplain. “When In addition to saving lives, the NABB also to "do something for the community that I heard about the blood bikes I thought, yes! saves the cash-strapped National Health Ser- would give [bikers] a more upbeat image," I could do this,” he told the Guardian. vice (NHS) considerable money. They shuttle Stepney told National Geographic. In 2008 Share this story: dotmed.com/news/28788 Will Toshiba Medical Systems NYU researchers develop be purchased by Fujifilm? paste to prevent scarring

Posted online January 5, 2016 by Thomas Dworetzky from radiation therapy Posted online January 5, 2016 by Lauren Dubinsky The accounting-scandal-plagued giant is now rumored to be readying to sell all or part of its Toshiba Medical Systems unit, Researchers at NYU Langone’s Laura and Isaac Perlmutter with Fujifilm Holdings a likely contender. Cancer Center have developed a paste that prevents fibrosis Toshiba wholly owns Toshiba Medical, and sources told the — a type of scarring caused by radiation therapy. A study in- Yomiuri Shimbun that it is planning to sell 50 percent or more of its vestigating the paste was published in the Journal of the Federation shares to raise money. Such a sale to an overseas company, how- of American Societies for Experimental Biology. ever, might be tough to get through the government as it would For the study, the researchers mimicked radiation dermatitis by lower the competitiveness of Japanese firms, so it is likely that the exposing mice’s skin to a single dose of 40 Grays, which is a similar buyer would be a Japanese firm. amount of radiation that cancer patients receive over the course of For Fujifilm, the purchase would generate little overlap between five weeks. Some of the mice were normal and others were geneti- existing product lines, as the company's health care offerings consist cally engineered to not have a protein receptor called adenosine A2A. primarily of X-ray systems, pharmaceuticals and endoscopy equip- After a month, the normal mice that received the placebo had ment. Sources report that Toshiba has already discussed its selling a two-fold increase in the amount of collagen, skin thickness and plans with Fujifilm. fibrosis. The mice treated with the paste had only 10 percent more Toshiba, at the very end of 2015, reported that it estimated a skin-thickening collagen and the mice genetically engineered to not net loss in the year ending in March to hit a record $4.5 billion. possess the A2A receptor had no skin reaction. This includes a $1.2 billion restructuring cost brought about by its If the paste comes into clinical practice, clinicians treating early- accounting scandal, The New York Times reported in December. stage cancers with radiation could eventually prescribe an A2A Toshiba admitted in July that it had overstated profits by over 150 inhibitor paste to prevent fibrosis. Women who are treated with billion yen during a seven-year period. radiation for early breast cancer are one example of the types of Share this story: dotmed.com/news/28464 patients it could benefit. Share this story: dotmed.com/news/28461

20 HealthCareBusiness news I march 2016 www.dotmed.com Global helium market expected to continue growing through 2020 with a 7 percent annual growth rate Posted online January 26, 2016 by Lauren Dubinsky

The amount of helium consumed from 2020. The market for nuclear MR is expect- Russia, which each have plans to increase health care applications in 2015 was just ed to grow at an even higher CAGR, which helium production in the near future. over two billion square cubic feet — and a the researchers credit to a greater demand Russia aims to become the world's larg- new report from Technavio suggests that from the health care, federal research and est helium producer through its East Siberian number is going to inflate. The analysis fore- biotech sectors. Gas Program, which is planning on tapping casts growth at a compound annual growth “A continuous demand for supercon- the large gas reserves in Irkutsk and Yakutia. rate (CAGR) of 7 percent through 2020. ductivity in the areas of medical research, From 2011 to 2013, the global helium Helium is predominantly used in MR transport, energy transmission and storage market was in the midst of a severe short- systems, nuclear MR systems and nuclear is leading to a demand for MRI systems,” age, but now it's into its second year of over- reactors as a coolant — and the business Ardhendu Ghosh, an industrial gas expert supply, according to Gasworld Magazine, a is predominantly in the U.S. At exceedingly and Technavio analyst, said in a statement. trade publication dedicated to the industrial low temperatures, helium becomes a liquid The global helium market is dominated gas business. and facilitates the superconductivity that MR by just a few companies because of the very However, research analysts at Technavio imaging depends on. limited production of helium and the large believe that the delayed development of natu- In 2014, the MR market was worth $5 price volatility and persistent shortages. ral gas fields and tensions in the Middle East billion and, like the helium market, is an- The U.S. is the largest producer and will lead to supply concerns and price volatility. ticipated to grow at a CAGR of 7 percent by supplier of helium, followed by Qatar and Share this story: dotmed.com/news/28813

produCt spotliGHt: C-Arm sYstem leVel refurBisHment

Features... Complete meChaniCal refurbishment equipment solutions Component replaCements, and repairs CosmetiC restoration inCluding fully redefined... painted to oem Colors Cost-effeCtive glassware replaCements Universal Digital Resources helps customers effectively manage their medical equipment image intensifier, X-ray tube, touCh sCreen monitors throughout the technology lifecycle. From refurbished imaging equipment, including testing, Calibration, system validation surgical C-arm models, to digital panel upgrades and cost-effective service maintenance Benefits... agreements – we have you covered. enhanCed image Quality minimized X-ray dose Visit Us Online utilizing replaCed glassware Components udrConVersion.Com avoid the high Cost of buying ‘new’ Call to Learn More maintain lower ongoing support Costs 1.855.782.0179 serviCe / maintenanCe also available

UDR-Ad-DotMed-4.825x7-v2.indd 1 3/24/14 10:57 AM

HealthCareBusiness news I march 2016 21 HealthCareBusiness Daily News Online > dotmed.com/news Philips Lifeline GoSafe is now available in Canada Posted online January 21, 2016 by Lauren Dubinsky

Many seniors are active later in life, but Canadian seniors will continue to demand.” tion of demands.” that can come with consequences like The government of Canada reported in GoAlert’s built-in autoalert fall detection a higher chance of falls. To provide more 2014 that 80 percent of seniors participate in technology automatically alerts a 24-hour safety for seniors, Royal Philips has announced at least one social activity per month, 36 per- emergency call response center for help if the availability in Canada of its mobile medical cent perform volunteer work and 13 percent it detects a fall. Seniors can also trigger the alert service, Philips Lifeline GoSafe. are in the workforce. In Canada, falls are the alert if they have a health emergency or just “The health care industry needs to focus main cause of injuries that lead to hospital- want some added reassurance. on senior care now, to try and alleviate the ization among those 65 years and older, and The Canadian population is now made up growing and inevitable pressure on the sys- about 20 to 30 percent of seniors in Canada of more seniors than children and it’s expect- tem, while keeping in mind both cost and have at least one fall per year. ed that by 2021 there will be almost 7 million meeting today's needs of the aging popula- “Seniors are looking to extend their free- people over 65 years old, which will be 19 tion,” David Doyle, director for Philips Lifeline dom and independence, live at home longer, percent of the total population, and that will Canada, told HCB News. “Leveraging smart and stay connected to the world in a mean- rise to 25 percent by 2041, according to a technology is just one of the ways that the ingful way,” said Doyle. “These changing Certified General Accountants Association of industry can meaningfully approach the chal- interests impact the health care industry, and Canada Aging Population report from 2005. lenges ahead and deliver the care and support how we respond to an ever-changing evolu- Share this story: dotmed.com/news/28739 FDA issues draft Siemens Healthcare gets cybersecurity guidelines FDA nod for 1.5 T MAGNETOM for medical devices Amira MR system

Posted online January 19, 2016 by Gail Kalinoski Posted online January 21, 2016 by Lauren Dubinsky

Calling cybersecurity threats to medical devices a growing Siemens Healthcare announced that its MAGNETOM Amira concern, the FDA has issued draft guidance for manufactur- 1.5 Tesla MR system has received FDA clearance. The system ers to monitor, identify and address cybersecurity vulner- has many of the same features found in Siemens' flagship MR abilities in medical devices throughout their life cycles. systems, but it has lower operating costs. The FDA noted that it is essential that manufacturers incorpo- This system is the first to include Siemens' new Eco-Power rate controls in the design phases, but also consider improvements technology, which puts the system into standby mode and allows during maintenance of devices. for power savings of up to 30 percent. It works by monitoring and “All medical devices that use software and are connected to controlling the magnet-cooling helium. hospital and health care organizations’ networks have vulnerabili- The Eco-Power technology is used in conjunction with other ties — some we can proactively prevent against, while others re- features such as the Zero Helium Boil-Off technology in order to quire vigilant monitoring and timely remediation,” said Dr. Suzanne prevent helium evaporation. Schwartz, associate director for science and strategic partnerships. The system also includes protocols that have the potential to short- “Today’s draft guidance will build on the FDA’s existing efforts to en many of the exams. Its DotGo software simplifies protocol manage- safeguard patients from cyber threats by recommending medical ment and helps the clinician determine the correct operating sequence device manufacturers continue to monitor and address cybersecu- for each scan, which increases exam consistency and reproducibility. rity issues while their product is on the market.” The MAGNETOM Amira is equipped with the Syngo MR E11 Schwartz, also the acting director of emergency preparedness/ software architecture. Facilities that use the system with its 60 cen- operations and medical countermeasures in the FDA’s Center for De- timeter patient bore and other Siemens systems are able to switch vices and Radiological Health, made her comments in an FDA news easily between scanners. release. The agency said the draft guidance is part of ongoing efforts The facilities are also able to share many of the coils between to ensure the safety and effectiveness of medical devices at all stages all of the current 1.5T MR systems because of Siemens' exclusive of their life cycle because of the evolving nature of cyber threats. Tim 4G technology. Share this story: dotmed.com/news/28702 Share this story: dotmed.com/news/28747

22 HealthCareBusiness news I march 2016 www.dotmed.com Here are 10 Joint $5 million deal to produce Ebola vaccine

Commission Posted online January 20, 2016 by Thomas Dworetzky citations imaging At Davos the vaccine alliance Gavi The deadly virus that claimed over staff should watch announced that it's signed a $5 mil- 11,000 lives, infecting over 28,000, in its out for in 2016 lion deal with Merck to stockpile latest West African outbreak is very difficult 300,000 doses of anti-Ebola vaccine to contain once it strikes. "The suffering Posted online January 12, 2016 by May for emergencies and addi- caused by the Ebola crisis was a wake-up by Gus Iversen tional clinical trials. In addition, the call to many in the global health commu- pharmaceutical giant will apply to license nity,” Gavi CEO Dr. Seth Berkley said in a its rVSV∆G-ZEBOV-GP live attenuated statement. Judith Atkins, president/CEO of McK- Ebola Zaire vaccine. Share this story: dotmed.com/news/28742 enna Consulting, gave HCB News many examples in her presentation of recent non-compliances that are either becoming more common or are likely to increase in hospital imaging department Joint Com- mission surveys. These included: • C-arm and other portable devices being held to operating room standards. • Disinfectant protocols that do not allow that table to dry in time to be fully effective before placing another patient on the table. • Imaging equipment protocols not offering the same standard of care throughout the hospital, such as hospital-owned physician practices or between the cardiology and imaging departments. • Patient tubes being placed on the patient’s stomach (contamination) during transport to the imaging department. • Imaging techs conducting airway reviews that do not have this function identified in their job description or have documented training. • Evidence of proper history and physicals conducted by radiologists, and generation of immediate post procedure reports. • Building engineering safety violations lack- ing proper long-term corrective plans and funding. • Properly documented protocols to prove that patients are not being over-radiated. • Properly using the two-identifier system (and matching with the order). • Matching imaging physician protocols with protocols in the medical staff bylaws. Share this story: dotmed.com/news/28586

HealthCareBusiness news I march 2016 23 HealthCareBusiness Daily News Online > dotmed.com/news Johnson & Johnson to cut roughly 3,000 medical device jobs, saving between $800 million and $1 billion Posted online January 21, 2016 by Gail Kalinoski

Johnson & Johnson is cutting about be impacted by the actions, according to a and other surgical products. But the market 3,000 jobs from its medical devices busi- company statement. A Johnson & Johnson has slowed due to consolidation of hospital nesses in an effort to save between spokesman told Reuters there are no imme- systems where surgeons face more pressure $800 million and $1 billion and restruc- diate plans to eliminate specific products and to control prices and have less autonomy. ture the divisions to “better serve the did not say what regions might see job losses. The company has left the stents business needs of customers and patients in to- The company estimates the cuts will and has also been focusing on high-growth day’s evolving health care marketplace.” affect approximately 4 to 6 percent of the categories like surgical robotics for the Unit- The New Brunswick, N.J.-based health medical devices segment’s global workforce ed States, Japanese and Chinese markets, care giant said the savings will give the com- over the next two years. In media interviews the Journal reports. pany “added flexibility and resources to fund and company statements, Johnson & John- The global medical devices market is now investments in new growth opportunities son portrayed the restructuring as a way to about $320 billion, but growing only about and innovative solutions for customers and re-prioritize its resources and focus on new 4 percent now compared to the double-digit patients.” or improving products. increase of the early 2000s. J&J’s medical- The cuts will affect Johnson & Johnson’s The Wall Street Journal noted that the device sales were even lower than that av- orthopedics, surgery and cardiovascular busi- medical devices business had been the com- erage, marking only 1 percent in the third nesses. Its consumer medical devices busi- pany’s largest segment, fueled by sales of ar- quarter of 2015, according to the WSJ. nesses, vision care and diabetes care will not tery-opening stents, knee replacement parts Share this story: dotmed.com/news/28725 Conavi Medical scores FDA More of the same from approval for catheter-based USPSTF regarding breast Foresight ICE ultrasound cancer screening

system for heart visualization Posted online January 15, 2016 by Gail Kalinoski Posted online January 15, 2016 by Lauren Dubinsky The U.S. Preventative Services Task Force (USPSTF) has issued its final report on breast screening for women, saying Conavi Medical Inc. (formerly called Colibri Technologies Inc.) once again that it recommends women with average risk announced that its Foresight ICE System has received FDA for breast cancer should get mammograms every two years clearance for intraluminal ultrasound visualization of the between the ages of 50 and 75. heart and great vessels. It is the first catheter-based ultrasound The recommendations, similar to an April draft as well as that can provide both 2-D and 3-D images of cardiac anatomy its 2009 report, continue to be controversial with different age around all sides of the catheter, according to the company. ranges suggested by other groups including the American Col- The procedures vary from patient to patient and between the lege of Obstetricians and Gynecologists and the American Can- techniques, devices and clinical workflows that physicians deploy cer Society. around the world. The Foresight ICE System will help physicians ACOG invited more than 30 organizations to discuss the issue and health care systems refine how patients are treated. and try and come to a consensus, according to The Wall Street Currently, 2-D intracardiac echocardiography is used in a large Journal. That group recommends yearly mammograms beginning portion of certain procedures in the U.S. including atrial fibrillation at age 49 while the ACS recently changed its guidelines to every procedures and certain structural heart interventions like closure of year between age 45 and 55 and then every two years. atrial septal defects. Those patients might also undergo CT, MR or The Task Force did acknowledge that mammography screen- TEE before the procedure in order to get a 3-D view of the anatomy. ing every two years can reduce deaths from breast cancer, but still The Foresight ICE System has currently only been introduced suggested women of average risk in their 40s should discuss the in the U.S., but Conavi Medical is looking to gain approval for it in benefits of breast screenings with their doctors. Europe and Japan in the future. Share this story: dotmed.com/news/28635 Share this story: dotmed.com/news/28661

24 HealthCareBusiness news I march 2016 www.dotmed.com Olympus recalling, redesigning duodenoscopes after FDA gives OK to modifications to cut infection risks Posted online January 18, 2016 by Thomas Dworetzky

After widespread cleaning problems patients from bacterial infections associated sickened at least 250 patients worldwide." with duodenoscopes led to superbug with these medical devices,” said Dr. William In 2010 Olympus changed the design of infections, companies, such as Olympus, Maisel, deputy director for science and chief internal channel seals to keep out foreign sub- worked with the FDA to come up with scientist in the FDA’s Center for Devices and Ra- stances. This made it easier to clean between better sterilization protocols. diological Health. “The Olympus TJF-Q180V’s uses — except that it didn't work all the time Now, two days after a U.S. Senate report new design, as well as the new annual inspec- and led to contamination and the outbreaks linked dirty scopes to outbreaks, the firm tion program, are intended to reduce the risk of infection. Other makers of the scopes, Pen- is voluntarily recalling the complex medical of fluid leakage into the elevator channel, tax and Fuji, also made similar modifications. device for a design overhaul, according to which in turn can reduce patient exposure to While the Olympus redesign may be an an FDA release. bacteria and other potential infections.” important response to correcting the flaw Reports in the Los Angeles Times found In fact, there were more infections from in its instrument, for those ravaged by the that the company was aware of possible the use of improperly cleaned devices than consequences of infection, it does little to design problems in mid-2012, but did not previously thought, according to the Senate soften the blow. While they were sickened reveal them to either government officials report. It determined that, "between 2012 and suffered, scope sales rose 19 percent to or U.S. hospitals. and spring 2015, closed-channel duodeno- $1.8 billion for the half-year ending Septem- “We have made it a top priority to improve scopes were linked to at least 25 different in- ber 2015, according to the Times. the safety of duodenoscopes and help protect stances of antibiotic-resistant infections that Share this story: dotmed.com/news/28679

Stretchable film may lead to smartphone-sized cancer detectors for blood samples

Posted online January 14, 2016 by Lauren Dubinsky

Chemical engineers at the University of Michigan have created a thin, stretchable film that — by coiling light waves like a Slinky — may lead to the development of a smartphone- sized cancer detector for rapidly analyzing blood samples. The film works by producing circulatory, polarized light, which may provide early insight into when cancer recurs. Unlike linear polarization, which is common (it's in sunglasses, for one thing), circular polarization is rare in nature and cannot be seen with the naked eye. It coils light into a 3-D helix shape — instead of a linear wave — that can spin clockwise and counterclockwise. Since the film technology is still being developed, a large and expensive machine is required to produce the light. But the researchers believe that the film may be a simpler and less costly approach to generating polarization. The circulatory polarized light can be used to identify biomarkers from the earliest stages of cancer recurrence in a blood sample. Synthetic biological particles are coated with a reflective layer that responds to circulatory polarized light and binds to the sample's biomarkers. Share this story: dotmed.com/news/28660

HealthCareBusiness news I march 2016 25 HealthCareBusiness Daily News Online > dotmed.com/news More than half of primary care physicians make unnecessary referrals: study Posted online January 15, 2016 by Lisa Chamoff

A study, conducted by Sapna Kaul, as- a brand-name drug when an equivalent also more likely to comply with patient resistant professor of health economics in generic was available because the patient quests, according to the study. The University of Texas Medical Branch asked for the brand-name drug specifically?” The study authors speculated that doc- at Galveston department of Preventive They were directed to respond by checking tors who met with pharmaceutical company Medicine and Community Health, in col- “Never, “Rarely,” “Sometimes” or “Often.” representatives weren't as concerned about laboration with researchers from Mas- Nearly 52 percent of primary care physi- managing health care costs and were also sachusetts General Hospital and Harvard cians reported unnecessary specialist refer- “less confident in their knowledge base,” Medical School, was recently published in rals and 39 percent prescribed brand-name making them more likely to seek input from the American Journal of Managed Care. drugs based on patient requests. specialists. Drug company representatives Researchers sent their survey to 2,938 The study found that internal medicine also may push primary care physicians to physicians, with more than 64 percent re- and family physicians were more likely than make referrals to specialists as a marketing sponding. They then analyzed the responses pediatricians to prescribe brand-name drugs tool, the authors wrote. of 840 primary care doctors. The doctors and make unnecessary referrals. Doctors The authors also hypothesized that the were asked, “In the last year, how often have who interacted with drug and medical de- more experienced doctors, and those doc- you given a patient a referral to a special- vice representatives who had more years of tors working in smaller practices, have stron- ist because the patient wanted it when you clinical experience, were in solo or two-phy- ger relationships with their patients and are believed it was not indicated?” and also, “In sician practices and served a lower popula- looking to avoid disagreements. the last year, how often have you prescribed tion of uninsured or Medicaid patients were Share this story: dotmed.com/news/28636

Philips enters into $90 million, 15-year partnership with Marin General Hospital

Posted online January 13, 2016 by Lauren Dubinsky

Royal Philips and Marin General Hospital (MGH) announced a $90 million, 15-year partnership to improve health care in Marin County, California. This is Philips’ third partnership with a hospital in North America in the past six months, but this is its first partnership with an independent community hospital. “Health care today is changing so fast that no one player in the health care ecosystem can innovate fast or effectively enough to achieve the transformation we all need,” Matt Bierbaum, vice president of managed service and enterprise partnerships at Philips, told HCB News. “For Philips, that means that we have to 'co-innovate' with our provider partners in order to create a better health care future.” “We will have a view of where things are going [in the industry] so that we are prepared for the technological shifts that are going to come without having to do rip-and-replace types of activities because of the way this deal is structured,” Mark Zielazinski, chief information and technology integration officer at MGH, told HCB News. Share this story: dotmed.com/news/28630

26 HealthCareBusiness news I march 2016 www.dotmed.com Google Cardboard VR viewer saves life of Minnesota baby with numerous heart defects Posted online January 15, 2016 by Thomas Dworetzky

Four-month-old Teegan Lexcen had possible to plan for the unique challenges of VR. Muniz had used 3-D publishing software been born with defects so severe that her surgery. Sketchfab to turn the images of Teegan’s heart local doctors had told parents Cassidy Then came a miracle — Teegan's fam- and lung into navigable images on his smart- and Chad that the case was inoperable. ily came across a piece about Dr. Redmond phone. “I looked inside and just by tilting my The list of heart defects were daunting: Hy- Burke, who had used cutting-edge technol- head I could see the patient’s heart. I could poplastic left heart (a rare defect in which ogy for surgery, according to Big Think.com. turn it. I could manipulate it. I could see it as if I the left heart is severely underdeveloped); They reached out to him. were standing in the operating room.” hypoplastic aortic arch (blockage of the main What came next was a novel application Burke and his team used donated human conduit of blood from the heart); double of the cheap cardboard device that made it heart tissue to rebuild Teegan's aorta, and outlet right ventricle, mitral atresia, ventricu- possible for doctors to figure out how to re- then connected it to the pulmonary artery. lar septal defect and abnormal pulmonary pair the defects in ways they could not have A shunt was put in from the right ventricle veins draining to coronary sinus. done otherwise. to her sole pulmonary artery. Several more In addition, she had no left lung and no “Dr. Juan-Carlos Muniz, who runs our operations will be needed to continue to left pulmonary artery. The absence of a left MRI program, came to me two weeks before repair the defects. lung caused Teegan’s heart to be displaced surgery and handed me a piece of cardboard Share this story: dotmed.com/news/28592 into her left chest, making it seemingly im- with a smartphone in it,” Burke told Upload-

DNA sequencing company Illumina forms GRAIL to develop cancer detection test

Posted online January 12, 2016 by Gail Kalinoski

Touting it as a “significant development in the war on cancer,” Illumina, Inc., formed a new company – GRAIL – to develop a blood-based screening test that could detect early-stage cancers in asymptomatic individuals. Illumina, based in San Diego and the world’s largest DNA sequencing company, will be the majority owner of GRAIL. Other investors in the company, which has initial funding of more than $100 million, include venture capital firms Arch Venture Partners and Sutter Hill Ventures, Microsoft co-founder Bill Gates and Bezos Expeditions. Powered by Illumina’s sequencing technology, GRAIL will develop a pan-cancer screening test by measuring circulating nucleic acids in the blood. The plan is to get the cost per test to $1,000 or less and make it available through visits to a doctor or testing center, according to MIT Technology Review. Genetic Engineering & Biotechnology News reported that GRAIL plans to spend the first year in research and development and launch large-scale clinical tests in 2017, with the goal of delivering a pan-cancer test by 2019 and possibly tests for more targeted cancers like breast and lung cancer even earlier. Share this story: dotmed.com/news/28588

HealthCareBusiness news I march 2016 27 HealthCareBusiness Daily News Online > dotmed.com/news GE Healthcare to relocate global headquarters from U.K. to downtown Chicago's West Loop Posted online January 13, 2016 by Gus Iversen

In what Illinois Governor Bruce Rauner is tions, as well as the home of its global Life at 500 Monroe St. in a space currently oc- calling "a tremendous win” for his state, Sciences head office. cupied by GE Capital in downtown Chi- GE Healthcare has chosen downtown Before the investment in Amersham, cago's West Loop. Chicago as its new global headquarters. GE Healthcare spent over 50 years operat- For Rahm Emanuel, mayor of Chicago, The company's executive leadership team, ing out of the Milwaukee area. It arrived bringing in a company that employs 51,000 including the CEO and chief financial officer, in Waukesha in 1947, where the booming people worldwide and reported revenue of will be leaving the U.K. over the next few beer industry had given rise to a population $18.3 billion in 2014, this represents a vote months to set up shop in the Windy City. of capable glassblowers, a valuable skill in of confidence in Chicago’s economic future. The announcement came just a couple the X-ray tube manufacturing business. "In relocating, GE Healthcare sees several of days prior to the news that parent con- GE Healthcare's imaging business is fundamental strengths in Chicago — from glomerate, General Electric, will be relocat- still largely based out of Wisconsin and, our talent to our transportation — that will ing from Fairfield, Connecticut, to Boston. with 6,000 employees still in the area, help them build a great future and remain The company is currently based out of some of them may be asking themselves on the industry’s cutting edge," he said. Amersham, U.K., where it has been since what's next. On Jan. 13 it was announced that GE General Electric purchased Amersham plc. All told, fewer than 200 jobs are ex- Healthcare's parent company, General Elec- for $10 billion in 2004. That location will pected to be directly involved in the tran- tric, would be moving to Boston. continue to serve as its base for U.K. opera- sition, but those that are will be working Share this story: dotmed.com/news/28628 Eliminating more imaging from lung cancer therapy

Posted online January 12, 2016 by Lauren Dubinsky

Researchers at the University of Colorado Cancer Center have developed a new method for identifying and sparing healthy lung tissue during lung cancer radiotherapy without the need for additional testing. The National Institutes of Health funded a clinical trial that’s investigating the method and will be completed in three years. “If our study is successful, we hypothesize that this new treatment approach to include functional imaging would reduce radiation-related side effects for patients that have undergone radiation therapy for lung cancer,” Yevgeniy Vinogradskiy, CU Cancer Center investigator and assistant professor in the Department of Radiation Oncology at the CU School of Medicine, told HCB News. In the past, clinicians treated the lungs as a homogenous organ, but now they have realized that only certain areas should be treated and other areas should be spared. The new method combines air movement information from existing 4-D CT data with some equations to calculate lung function in the tissue that surrounds the tumor. Clinicians can then take that information and use advanced radiation delivery techniques to spare the part of the lungs used for breathing — thereby yielding significantly better outcomes. Share this story: dotmed.com/news/28580

28 HealthCareBusiness news I march 2016 www.dotmed.com Reports: Chinese hospital demolished with patients, doctors still inside, followed by fights with workers Posted online January 13, 2016 by Thomas Dworetzky

What do you do when a demolition aged medical equipment and buried the slated for demolition, and asked the hospital crew starts knocking down the room in morgue, and the six bodies in it, but they staff to take the rooms apart on their own, the middle of an X-ray procedure? were injured in scuffles with workers, said according to the BBC. Well, if you're a patient: Run. hospital official Yuan Fang. According to Professor Wang Jingbo at “I was doing an X-ray on a patient when "We wanted to enter but they prevented the China University of Political Science and a big hole was dug in the wall," Liu Chun- us from entering. They beat our deputy sec- Law, the work needed to follow the law, guang, director of the radiology department retary of the Party committee, a driver of the which it allegedly did not. at the Fourth Affiliated Hospital of Zheng- emergency department and a doctor. The An investigation is ongoing and at this zhou University in Henan Province, told The three are injured," said Yuan. point the deputy director of the Huiji district Shanghai Daily. The workers were dressed in military fa- bureau responsible for the hospital reloca- "The patient was frightened by the rum- tigues, according to ABC news in Australia. tion has been sacked, according to CRI. bling noises and ran away, shouting 'earth- The core of the problem, apparently, was According to the radio news service, quake, earthquake.'" a local government that wanted to expand a the local authorities and the hospital have If you are a hospital staffer, you prob- roadway and allegedly had warned the hos- reached a tentative resolution regarding ably try to save valuable equipment from pital of its demolition plans. Government of- compensation. bureaucratic idiocy. Three doctors tried to ficials stated that they had advised the hospi- Share this story: dotmed.com/news/28609 hold back the demolition derby, which dam- tal that the room and morgue were on land Hospira scores CE mark for Nuitiv, needle-free IV Complete Hitachi® MRI Solutions connector, in U.K., France

Posted online January 11, 2016 by Lauren Dubinsky • Altaire® Coldhead Service • Helium Fills Hospira has received the CE mark to commercially distribute • Helium Fills its Nuitiv clear, needle-free intravenous (IV) connector in the • ACR & IAC Calibrations & Shimming U.K. and France. The system is expected to help reduce the risk of catheter-related bloodstream infections. • Flexible Service Plans Every year, central venous catheters can cause about 80,000 CRBSIs in the ICU, and one incident of CRBSI can cost as much as • Image Quality Tune-ups $56,000 to treat, which includes the cost of pharmacy charges, catheter changes, lab tests and an additional day in the ICU, ac- • Coil Repairs cording to the WHO. It is also the most common type of health care-associated infection of the bloodstream. • Installations & System Moves Nuitiv is able to be needle-free because the male luer is connected from a device such as a syringe or IV set, which activates the • Quality, Refurbished OEM Parts valve and enables fluid to flow. Its connector’s clear housing gives clinicians a better view of the patient’s fluid pathway and helps ...And, a reputation you can trust! ensure it’s free of particulate, and it has a smooth septum surface for disinfection. Nuitiv is also currently available in Chile and will be launched commercially in Europe, Latin America, the Middle East and across the Asia-Pacific region in the near future. Share this story: dotmed.com/news/28562 661-373-1977 • 800-930-7958 • viablemed.com

HealthCareBusiness news I march 2016 29 HealthCareBusiness Daily News Online > dotmed.com/news Mounting concern for geriatrician shortage to treat aging U.S. population as it continues to expand Posted online January 29, 2016 by Gail Kalinoski

The number of Americans older than 75 the last specialty internal medicine residents The AGS is pushing for additional fund- will reach about 31 million by 2030, but choose to pursue. The chances of those ranks ing to provide education for future geri- it's not clear where the specialists will increasing significantly by 2030 appear slim. atricians, said Nancy Lundebjerg, CEO of come from to meet their medical needs. Part of the problem is that even though the New York-based AGS. She told U.S. There are about 7,000 practicing in the extra training is required, the average salary News & World Report that the non-profit United States now, and that number is not of a geriatrician compared to an internist is organization is focused on helping current increasing at the rate of the aging popula- about $20,000 lower. In fact, according to a physicians improve skills and knowledge tion. The American Geriatrics Society esti- report in The New York Times it’s one of the needed to care for aging patients. The mates medical schools will have to train at lowest paying medical specialties. The me- group has a program called the Geriatrics- least 6,250 more geriatricians between now dian annual salary of a geriatrician in 2014 for-Specialists Initiative that has worked and 2030 — about 450 more each year than was $220,000 while the typical cardiologist with surgeons on developing guidelines on the current number. made twice that in a year, according to the post-operative delirium and making emer- The problem is geriatricians — physicians Medical Group Management Association. gency departments more receptive to the who receive certification in internal or family Reimbursement rates from Medicare needs of older adults. medicine who have completed additional are also making it difficult to sustain a ge- Share this story: dotmed.com/news/28872 training in the care of older people — rank as riatric practice.

Henry Ford Hospital to begin Researchers propose using 'game-changing' three-pronged attack against robotic brain surgery system lung cancer subset

Posted online January 11, 2016 by Gus Iversen Posted online January 4, 2016 by Gus Iversen

Having signed a purchase agreement with developer Syn- Researchers at Thomas Jefferson University may have discov- aptive Medical, Detroit's Henry Ford Hospital will become ered a new recipe for fighting a subset of treatment-resistant one of the first facilities in the U.S. to utilize a cutting-edge lung cancer. robotic brain surgery technology called BrightMatter. By combining two drugs with radiation, the researchers believe BrightMatter's long metal arm contains a microscope and high- they have made headway against diseases derived from KRAS-relat- powered lighting that provides incredibly detailed vision to surgeons. ed gene mutations. Using images created during pre-planning of the surgery, Bright- "Currently there is a clinical trial underway to evaluate the combi- Matter's sensors also let the doctors know if their instruments are nation of two cancer drugs, trametinib and palbociclib, made by two properly aligned before they move forward in the patient's brain. pharmadeutical companies for patients with solid tumors and mela- Synaptive Medical, the Toronto-based developer of BrightMat- noma," said Dr. Bo Lu, professor of radiation oncology at Thomas ter, received FDA approval to market the system in the U.S. last Jefferson University, in a statement. April. The study, which was conducted on mice, could have major Dr. Steven Kalkanis, chairman of neurosurgery at Henry Ford repercussions on how a minority of lung cancer cases are treated. Hospital, and co-director of the Hermelin Brain Tumor Center, said While roughly 85 percent of lung cancers are non-small cell lung in a statement annual fees to Synaptive for software updates and cancers (NSCLC), sub-types with KRAS gene mutations have been other technology improvements will cost Henry Ford $160,000 per resistant to conventional and targeted therapies. Sub-types with ALK year, according to Crain's Detroit Business, while the BrightMatter and EGFR-mutations, on the other hand, have recently seen more technology itself cost a little over $1 million. treatment progress. The technology is expected to make 20 to 30 previously inoper- Lu and his colleagues looked to an additional mutation within the able cases candidates for treatment, while also providing a superior KRAS subset and discovered that drug resistance was increased when method of care for an additional 100-plus patients. there was a mutation in a protein called p16. In part, the treatment Share this story: dotmed.com/news/28581 formula they derived aims to undo the effect of that mutation. Share this story: dotmed.com/news/28463

30 HealthCareBusiness news I march 2016 www.dotmed.com Upcoming Events

Medical Fair India 2015 Years in existence: 36 Dates: April 1 – 4 Presented by: Messe Dusseldorf GmbH Average attendance: +6,200 Years in existence: 98 Location: Bombay Convention & Exhibition Who should attend: Physicians, nurses and Average attendance: +10,000 Centre, Mumbai, India other health professionals interested in criti- Who should attend: Clinical and research Dates: March 11 – 13 cal care or emergency medicine. professionals in endocrinology, diabetes, Years in existence: 22 metabolism, obstetrics/gynecology, pediatric Average attendance: +8,000 IARS 2016 endocrinology. Who should attend: Surgeons, hospital Presented by: International Anesthesia Re- directors and managers, hospital administra- search Society AORN 2016 tors, biologists, chemists, process engineers, Location: Hilton San Francisco Union Square Presented by: Association of PeriOperative laboratory assistants, doctor’s assistants, San Francisco, Calif. Registered Nurses nurses, manufacturers, distributors, traders, Dates: March 21 – 24 Location: Anaheim Convention Center & visiting academies and universities, visitors Years in existence: 29 Arena, Anaheim, Calif. from government, and international agen- Average attendance: 1,000 Dates: April 3 – 6 cies and associations. Who should attend: Residents, fellows, Years in existence: 62 SRNAs, anesthesiology assistants-in-training, Average attendance: +5,000 ISICEM 2016 medical students. Who should attend: Staff nurses, nurse Presented by: Erasme Hospital Depart- managers, supervisors, coordinators, team ments of Intensive Care and Emergency ENDO 2016 leaders, assistant directors of nursing, educa- Medicine Presented by: Endocrine Society Annual tors, staff development, RN first assistants, Location: Square Brussels Meeting Centre Meeting clinical nurse specialists, student nurses, ma- Brussels, Belgium Location: Boston Exhibition and Conven- terials management, hospital/facility admin- Dates: March 15 – 18 tion Center, Boston, Mass. istrators, nurse practitioners.

HealthCareBusiness news I march 2016 31 Hospital Spotlight: Prebys Cardiovascular Institute

Prebys Cardiovascular Institute Location: San Diego, Calif. Year founded: 2015 Number of beds: 167 Number of employees: 525 Executive: Cindy Steckel, Vice President, Chief Nursing/ Ops Executive

Recent developments: In early March, the institute will mark its first year of saving lives, which included Major League Base- ball Hall of Fame member Rod Carew, who was implanted with a left ventricular assist device after suffering a massive heart attack last fall. This summer, Scripps will open the adja- cent John R. Anderson V Medical Pavilion, which includes four outpatient cardiac catheterization labs and is connected to the institute by several enclosed walkways. A new Barbey Family Emergency and Trauma Center will open on the ground floor 5 of the institute later this year.

32 HealthCareBusiness news I march 2016 www.dotmed.com Noteworthy distinctions: Prebys Cardiovascular Insti- tute is the most advanced heart care center on the West Coast, featuring world-class physicians, groundbreaking 1 research and state-of-the-art technology. The seven-story building features two hybrid operating rooms; four cardiovascular operating rooms that include cardiac robotics capability; antimicrobial surfaces and finishes throughout; decentralized nurse stations; 59 intensive care unit beds; 108 private inpatient rooms bathed in natural light from floor-to-ceiling windows, and each equipped with motorized ceiling lifts for secure patient movement; and a three-tiered wireless infrastructure dedicated to enterprise, medical and consumer use. The institute is the focal point of Scripps’ highly respected cardiovascular programs, which are consistently recognized by U.S. News & World Report as among the best in the country. Scripps also has partnered for more than 30 years with Kaiser Permanente cardiologists to provide care for Kaiser Permanente heart patients in San Diego County. 2 Specialties: cardiology, arrhythmia, heart failure, cardiovascular surgery.

Images of success: 1. Hybrid operating room 2. Decentralized nurse station 3. Intensive care area 4. Cardiac catheterization lab 5. Patient room

HealthCareBusiness news I march 2016 33 Hospital Spotlight Q&A with Cindy Steckel Vice president/chief nursing and operations officer at Scripps Memorial Hospital, La Jolla

By Sean Ruck

HealthCare Business News recently the building, but the whole program around good for the community. The education we spoke with Cindy Steckel to learn more it. The cool part about it is that as the lead, I offer here, the right staffing, even the fact about her background and about the worked with the architect and made sure to that I got to work with the architect on the developments happening on the Scripps get everyone involved. Cardiac nurses, physi- building, that’s a once-in-a-lifetime oppor- Memorial Campus La Jolla. Steckel was cal therapists, staff delivering trays and, of tunity. We have support from Scripps. We particularly excited to talk about the course, physicians, all shared their thoughts also have really cutting-edge research. We new Prebys Cardiovascular Institute. about what the building needed to be. worked on the very first stents, for example. We built it around the people that We have great doctors who really believe HCB News: How did you get involved worked in it and the patients that live in it. If in their hearts that they want to improve pain health care? you come into my office you’ll see an entire tient care. When I work with a doctor here CS: When I started out, for women it shelf filled with evidence-based literature on at La Jolla, I feel like they are in it for the seemed like there weren’t that many options health care design. patient, not just promoting their own name. — be a nurse, a teacher or a nun. In health Our staff members have that attitude as well. care, I found you could teach, take care of HCB News: When you got the feed- We keep up with the latest technology. Even people and be scientific. In nursing, it’s im- back, were there any surprises around the technicians have shared that with me, portant to get your bachelor’s degree. So I what was being requested? that they like working here because they’re went to college and got it. Since then, I’ve CS: I wasn’t surprised by what we were working with people that are really moving had the chance to do great things from work putting in due to all the advance research we health care forward. We also perform the in cardiac, ICU, leadership roles and moving had done. The things we left out were more largest number of procedures for cardiology on to a Ph.D. in nursing from the University surprising. We didn’t design with single-hand- in the area and the highest in California. of San Diego. I’ve been able to build a career ed rooms, for example. That wasn’t important getting to know all the areas in the hospi- to people, the literature wasn’t strong and that HCB News: What’s the biggest chal- tal. Part of that learning also came from the helped us to save money. We looked at booms lenge you face at the institute? building of the new cardiovascular institute. for the room, but then we went on road trips, CS: It’s really the whole health care re- I started in cardiac where I spent three talked to nurses, looked at the systems in use. form movement. The move from taking care or four years and then moved into the ICU. We found they really didn’t get used as much of one patient at a time just while they’re in My first year working was on a medical te- as we’d thought. They also didn’t look great the hospital to working on population health lemetry unit at a facility in Illinois, but I’ve assembled and cost millions. Instead, we have through the continuum. Helping patients spent the rest of my career at Scripps. By ceiling lifts in every room. I was proud of the monitor health at home, and making sure 2006, I had been a senior director for eight staff and doctors when we were in those dis- we have proper support of that. years, having worked in lots of different ar- cussions and they made the cost-effective deci- HCB News: Any other developments eas, from ICU, to OR, to cardiac again, and I sions for the best in patient care. added the role of being the clinical lead for you’d like to talk about? the design of the new center. HCB News: What sets your facility CS: The John R. Anderson V Medical Pa- apart from others in the area? vilion has a floor with four new outpatient HCB News: How did the center plan- CS: We were the first magnet hospital cath labs that connect to the main hospital, ning come along and what did you in the area. We’ve been designated magnet which is starting to bridge the world be- think of the process? three times, so it’s 12 years now. Now other tween outpatient and inpatient. CS: I know it inside and out now. Not just hospitals in town are getting that, which is Share this story:dotmed.com/news/29125

34 HealthCareBusiness news I march 2016 www.dotmed.com Cost Containment Corner Telehealth and the bottom line By Nancy Rowe

The market for telehealth services and tion rates to drive to and from remote towns ICUs in 32 hospitals from 19 U.S. health care equipment is growing exponentially, — as well as incurring travel costs and lodging. systems, and found that implementation of and there’s a reason for that: telehealth With telemedicine, doctors spend their paid teleICU is associated with significantly lower works. Articles published over the past hours providing patient services instead of driv- mortality and shorter lengths of stay in both 20-plus years document that telemedicine ing. This creates obvious efficiencies, includ- the ICU and hospital. and telehealth save lives, improve patient ing reduced wait times for patients and fewer, Partnering with a large health care sys- outcomes and save money. There is a wide but more productive paid physician hours. tem or a telemedicine service provider com- range of business models, each with its own NARBHA estimates travel savings of more than pany is a cost-effective way for hospitals cost-saving opportunities. $200,000 per year, plus 1,200 hours saved (and other entities such as clinics, nursing driving time. Another benefit is the marked homes, correctional facilities and schools) to Reimbursement improvement in physician recruitment and provide needed, on-demand specialists such More than half of U.S. states have enacted retention. With telemedicine, providers can as neurologists, cardiologists or rheumatolo- legislation to ensure private payers reimburse be recruited from anywhere in the world, and gists without having to hire full-time provid- for telemedicine services. The scope of cover- can live and move wherever they want as long ers to provide 24/7 coverage. The Arizona age varies widely, but the number of states as they are properly licensed and credentialed. Telemedicine Program and Southwest Tele- with parity legislation is climbing steadily. Because providers are not expected to live in health Resource Center offer two resources Many of these states also cover telemedicine or commute to a specific place, there is much to help health care decision-makers find tele- through their Medicaid programs. Medicare less turnover, so the costs associated with los- provider partners. One is an online, search- has expanded its covered procedure codes for ing and replacing doctors are greatly reduced. able directory of telemedicine and telehealth live, two-way telemedicine encounters and service providers at http://telemedicine.ari- now reimburses for remote patient monitor- Reducing hospital readmissions zona.edu/servicedirectory. The second is the ing of chronic conditions. With telemedicine Using telehealth technology to remotely Telemedicine & Telehealth Service Provider parity escalating each year, it’s becoming more monitor patients with chronic conditions Showcase, coming again to Phoenix, June likely that tele-providers will be reimbursed has been shown to reduce hospital readmis- 21-22, 2016 (http://ttspsworld.com/). for their services. How is that a cost-saver? In sions and avoid the penalties associated with Insurers and employers are turning to some cases (such as Medicare), an extra “facil- high readmission rates. The Veterans Health telemedicine as well, and are partnering with ity fee” is paid along with the provider reim- Administration, for example, reports that telemedicine service provider companies to bursement. And in most cases, telemedicine its post-cardiac arrest telehealth program offer their customers or employees conve- and telehealth increase efficiency and reduce resulted in a 51 percent reduction in hospital nient health care from kiosks, computers costs, especially with the financial outlay for readmissions for heart failure. or personal devices while saving money by equipment and telecommunications spiraling Avoiding unnecessary expenses avoiding unnecessary and costly trips to the downward. Here are just a few examples. emergency department or urgent care. The Arizona Burn Center is one example of Closed or capitated systems improved care (faster diagnosis and treat- About the author: For health care systems providing services to ment) through telemedicine with the side Nancy Rowe joined specific populations in specific regions on a set benefit of cost savings. In some cases, the the Arizona Tele- annual budget, telemedicine has been a boon. Phoenix-based burn center can determine medicine Program In Arizona, for instance, the state-contracted that patients can be treated locally, instead in 2014 as associate Northern Arizona Regional Behavioral Health of flying them to Phoenix by helicopter, director for out- Authority (NARBHA, now Health Choice In- which costs $10,000 to $20,000. reach. She directed tegrated Care) is responsible for a vast, mostly TeleICU programs are another example, the award-winning rural area, with far-flung towns, that covers often allowing patients who would have telemedicine program at Northern Arizona nearly half the state. NARBHA implemented been transferred to a larger health care Regional Behavioral Health Authority from a telemedicine network in 1996. This network center to stay in their community hospitals 2001 through 2013 and is the past chair of has accommodated more than 166,000 tele- and keep the revenue local. A 2014 study by the American Telemedicine Association’s psychiatry sessions. Prior to using telemedicine, Craig M. Lilly, M.D., et al., published in Chest Business and Finance Special Interest Group. doctors were being paid their hourly consulta- Journal, looked at 118,990 patients from 56 Share this story: dotmed.com/news/28895

HealthCareBusiness news I march 2016 35 IT Matters Image access strategies By Don Dennison

In part one of this usual best source of records. However, some Access from outside the two-part series, I PACS operators may delay when images are enterprise discussed the in- stored to the VNA, so to provide immediate Even with a shared PACS archive or VNA creasingly common access to recently acquired images, a con- across the consolidated enterprise, images consolidated enter- nection from the enterprise viewer server(s) will need to be accessed by authorized users prise environment, to the PACS may be required. outside of the enterprise. Effective methods driven by facility ac- Some enterprise viewers can connect for providing viewing (such as an enterprise quisition and affili- to more than one image data source and viewer in a referring physician or personal ation. I also covered the motivation and ben- may contain logic to determine the system(s) health record portal) and exchanging imag- efits for consolidating the PACS at different from which to retrieve the necessary data. es (for instance, through an image-enabled facilities within the enterprise into a shared, health information exchange or cloud-based What to look for in a system multi-facility PACS for diagnostic users. service) are also an important part of a com- It is important to be able to provide access In the second and final part, I will explore plete plan. the needs and strategies for imaging con- from within the EMR. Therefore, how the sumers. enterprise viewer is launched, embedded Providing direct enterprise in the EMR, and told what study or studies viewer access (outside the EMR) Enterprise viewer in the to present to the user is very important. A Most enterprise viewers provide an optional EMR for imaging consumers method of SSO user authentication that is interface to allow users to log in directly to With Web-based access and single sign-on supported by the EMR is critical to prevent the application and then search for a pa- (SSO), users can review both clinical and imag- users from having to log in to the viewer sep- tient or study before viewing the images. ing records without having to leave the EMR. arately, while meeting security requirements. Some provider organizations limit access to As users shift from needing to log in to The ability to display all image types the enterprise viewer from within the EMR the PACS to look up a patient’s study data, to acquired across departments and facilities and similar portals. This allows the EMR to relying on the enterprise viewer in the EMR, within the enterprise is crucial to prevent the apply data access controls, preventing the resources (such as databases, servers, stor- need to launch multiple specialty viewers user from searching through image records. age and network) on the PACS are freed up, from the EMR. Ensure that all the necessary Often, it also helps increase use of, and sat- providing more power to diagnostic users. navigation, measurement and analysis tools isfaction with, the EMR, if the diagnostic and To provide a complete patient imaging are available. clinical images are made available along with record, the enterprise viewer needs to pro- If imaging consumers are going to access the patient’s clinical data. If direct access is vide access to images acquired at all facilities images from mobile devices, such as tablets, desired, user authentication via lightweight in the enterprise, as well as across different support for this is also important. directory access protocol (LDAP) is often specialties, like radiology and cardiology. If sought, and features related to searching Change management: it can’t, then multiple specialty viewers will and filtering of imaging records also need to getting adoption often need to be provided and integrated be considered. separately into the EMR, resulting in access If the integration within the EMR is effec- About the author: Don Dennison has challenges and frustration by users. tive, the presentation and navigation of the image data is good, and the speed of worked in the medical imaging informatics Connecting the enterprise display is acceptable, users will typically ac- industry for over 14 years. Currently serving viewer to the VNA, PACS or both cept the enterprise viewer without much as a consultant, he is a speaker and panelist Enterprise viewers typically connect to im- effort. As users are dispersed throughout on topics ranging from medical imaging re- age managers, like PACS and VNA, through the enterprise (and beyond), traditional cord interoperability, integration of imaging standard DICOM communication, but a classroom training is typically not practical. data within the EMR, multi-facility integra- more direct data access method may also Online training, such as videos and FAQs, tion and others. He has published articles be available. While PACS often contain di- are normally sufficient. Tracking study ac- and eBooks on patient identity manage- agnostic images for a specific domain, like cess by user type and facility can help iden- ment, VNAs, PACS, and enterprise viewers. radiology or cardiology, VNA typically store tify where further engagement can lead to Share this story: dotmed.com/news/28894 images from all domains, making them the increased adoption.

36 HealthCareBusiness news I march 2016 www.dotmed.com IN THE CLIMB TO VALUE-BASED CARE, ARE YOU TAKING THE STAIRS OR THE ELEVATOR?

At McKesson, we believe that the best path to the future of better health is a streamlined one. And your journey requires innovative solutions with open architecture. McKesson Cardiology™ offers a comprehensive solution designed to help make your transition to value-based care as seamless as possible. With improved reliability, flexibility and scalability, you can help maximize your IT investment, optimize performance and coordinate care across your entire enterprise according to your specific organizational needs. Because when you have the right tools for the job, there’s virtually no limit to how high you can climb. FOCUS AHEAD FOR BETTER HEALTH.

6626 - ACC 2016 Issue vF.indd 1 2/10/16 10:19 AM

SHOWCASE

PRODUCT PRODUCT NEW NEW

To view these products online, visit dotmed.com and enter DM28561 into the search bar. Have a new product? Email your press release to [email protected]. For a chance to be included in the New Products NPS Showcase, include a high resolution shot of the product. NEW PRODUCTS SHOWCASE

Long-Length DR Detector FUJIFILM Medical Systems U.S.A., Inc. recently introduced the all new FDR D-EVO GL DR detector for single exposure long-length digital imaging. The FDR D-EVO GL features a 17” x 49” field of view. The longer length means time saved versus systems requiring stitching. It also reduces the number of exposures. The FDR D-EVO GL complements its single-exposure acquisition with ISS technology and noise reduction circuitry to contribute to producing clear, sharp images.

Medical Review Monitor Dell has introduced the Dell Medical Review 24 Monitor (MR2416), the company’s first monitor purpose-built for the health care environment. The monitor features an anti-reflective edge-to-edge covered glass on the front, and a smooth, fully-sealed design that is IP-32 rated. The monitor is calibrated to the DICOM part 14 standard grayscale. It features 24 inches of diagonal viewing area with 1920 x 1200 resolution Twin Robotic X-ray System (16:10 aspect ratio). While reviewing or sharing images Siemens Healthcare has announced that the FDA has cleared the Mul- with patients, health care professionals can switch the titom Rax (Robotic Advanced X-ray). The world’s first Twin Robotic X-ray monitor’s orientation between landscape and portrait system, the Multitom Rax boasts a unique design that enables, for the first and adjust height, tilt, pivot or swivel the monitor up to time, the acquisition of 3-D natural weight-bearing images. The unique 60 degrees left and right with consistent 178-degree-by-

open design of the Multitom Rax Twin Robotic X-ray system features a 178-degree viewability from almost any angle for easy

height-adjustable patient table and two independent, ceiling-mounted screen sharing. The device has also been designed to meet robotic arms for the X-ray tube head and the flat-panel detector for al- the IEC 60601-1 standard for medicalSHOWCASE design and safety

most unlimited positioning freedom anywhere in the room. Both ro- requirements.

botic arms can be moved into position automatically or manually with servo motor support to make fine adjustments. While one robotic arm PRODUCT

moves the X-ray tube, the other arm carries the 17” x 17” flat panel

detector, which can acquire static, dynamic and real 3-D sequences. NEW NEW

38 HealthCareBusiness news I march 2016 www.dotmed.com NEW PRODUCT SHOWCASE

Smart Device Ultrasound Solution Royal Philips announced that Lumify, a smart device ultrasound solution, is available for purchase by licensed health care providers or organizations in the U.S. Lumify is offered as part of a subscription model. The Philips transducers available as part of the subscription support Lumify’s use in acute and emergency care, internal medicine, musculoskeletal (e.g., orthopedics, sports medicine and podiatry), urgent care and office practice. Philips’ advanced transducer technology, paired with cloud-enabled and tablet technology, helps users make fast, informed diagnoses through a variety of scan types. Lumify’s scanning app allows users to examine the gall bladder, abdomen and lungs, in addition to having OBGYN, vascular, superficial, musculoskeletal and soft tissue functionality.

Telescopic Tube Column X-ray System Canon U.S.A. Inc. and Virtual Imaging, Inc., a Canon U.S.A. company, recently announced the RadPRO1 Mobile 40kW Flex Digital X-ray Sys- tem, an X-ray system that incorporates a new telescopic tube column helping radiographic technologists to maximize their lines of vision for safe transport when moving around a health care facility. The new functionality builds on the current RadPRO Mobile 40kW System. Designed to provide an effective mobile digital radiography solution for hospitals, clinics and universities, the RadPRO Mobile 40kW Flex Digital X-ray System enables improved visibility, as compared to the current 40kW System. Compatible with the Canon CXDI- 70C, 80C, 701C, 801C and 401C wireless digital flat panel detectors, its fast processing times make it easy to capture high-quality diagnostic images for routine diagnosis or challenging trauma, with flexibility in patient positioning and the ability to manage or manipulate images at bedside.

HealthCareBusiness news I march 2016 39

NEW PRODUCT SHOWCASE HCP Q&A with David Mason CEO and Co-Founder of Health Connect Partners

By Sean Ruck

Health Connect Partners celebrates a we have not been involved in those markets DM: High-quality education is critical for decade of creating conferences this as long as pharmacy, so we are still working hospital department managers. In many of year. HealthCare Business News spoke hard to get out and see everyone and build the markets we serve, their accrediting agen- with one of HCP’s founders to get a his- those important relationships. cies still require the majority of their continu- tory lesson and find out what’s on tap ing education hours to be live. We have an for the remainder of 2016 and beyond.

HCB News: HCP has been around for We come from the old school where getting out and meeting people and years now. How well-recognized is the brand today? building relationships is the most important aspect of business. Our plans DM: We started with our first conference are to continue to go to trade shows and build our brand one customer at a in the fall of 2006. We are celebrating our 10th year of business this year. Our first con- time. We also go visit our customers at their hospitals and businesses. ference was our Supply & Pharmacy Confer- ence where we hosted both hospital supply chain executives as well as hospital phar- HCB News: What plans, if any, do you educational advisory board made up of 10 to macy executives. At that time, we only had have to grow that recognition? 12 top health system executives from each two employees in the company, co-founder DM: We come from the old school of the five markets. These executives get to- and president, Nelson Hendry, as well as where getting out and meeting people and gether by teleconference about six months myself. We knew we had an opportunity building relationships is the most important prior to each conference to discuss relevant to put something together that was unique aspect of business. Our plans are to continue topics and help select the best speakers in and would add tremendous value to both to go to trade shows and build our brand the country for those topics/educational ses- hospitals and the vendors that sold to the one customer at a time. We also go visit our sions. By focusing on quality education, we hospitals, but we also knew we did not have customers at their hospitals and businesses. bring terrific value to the hospital attendees the manpower at that time to tackle both We feel that we are the most helpful to the and they continue to come back and sup- of these markets. So, we elected to focus attendees when we know them personally port our conferences. our energy on the pharmacy market. Since and have a relationship with them so that we have been in the pharmacy market for we can communicate about what is needed HCB News: Which conferences are 10 years now, I would say that our brand is to solve problems and help make connec- your most popular and why? well-known in the hospital pharmacy mar- tions in our industry. DM: Our fastest growing market is in- ket in the U.S. We serve four other markets: formation technology combined with our hospital O.R. and surgical; hospital radiology HCB News: With hospitals feeling the Radiology & Imaging Conference. No single and imaging; hospital information technol- budget crunch more and more, do you department in the hospital can function with- ogy; and hospital supply chain. We are fairly feel that has impacted attendance? If so, out technology and these departments in well-recognized in those markets as well, but in what ways? the hospital have a tremendous responsibility

40 HealthCareBusiness news I march 2016 www.dotmed.com

HCP

both in terms of day-to-day technological HCB News: What do you think are your best relationships is where you will find support as well as keeping a vision for the the challenges facing HCP? your best business. future of the organization’s technology infra- DM: Hospital executives are extremely structure. We have recently combined these busy. They are being asked each day to cut HCB News: Does everyone under- two conferences into a concurrent confer- budgets, do more with less and reduce staff. stand the idea of a reverse tradeshow ence format. The two groups share common One of the challenges we face is making sure at this point? activities like keynote speaking, meals and we continue to bring value to the hospital ex- DM: I think a lot of people understand networking events. The educational ses- ecutive so that they will always make time in it, however, we still find people that have sions are separated so that it can be specific their very busy schedules to be out of the of- never attended an event with a reverse expo to each market, and we also separated the fice for three days to attend our events. We before. So we spend a little time educating Reverse Expo sessions so that the suppliers will never lose track of the fact that the hos- them on the concept and providing them attending could attend all eight hours of the pital attendee is the most important aspect of with tips for success. For your readers, the Reverse Expo for both conferences if they sell our conferences. While cutting-edge educa- concept of the reverse expo is simple. We re- into both of these markets, by buying a dual conference registration. We put these two conferences together because we noticed The exhibiting companies are under tremendous pressure to deliver more for that many of the same suppliers were attending both of our conferences separately. As less as the hospitals have less to work with. Their marketing dollars are being each of these conferences started to grow, squeezed each year, so they have to analyze the best use of their investment. some of the companies had to decide which one would be most important to them. In the past, we would host these two confer- tion is very important to the hospital execu- verse the roles from a traditional trade show ences in the same week. The first would run tives — and we will continue to keep that a and the hospital executive sits in a tabletop from Monday through mid-day on Wednes- priority for our conferences — we also know booth while the suppliers get the booth map day and then the next one would start on that hospitals still need to find quality suppli- and walk the show floor, meeting the de- Wednesday and end on Friday. The suppliers ers. Since they are tasked with reductions in so cision makers/buyers. Once the attendees that support the conferences said they just many areas of their business, they must find know the concept, we then teach them how could not be out of the office for a full week, suppliers that can also deliver more for less. to make the most of their time by putting even though they really wanted to attend And they also need a way to find suppliers together five-minute presentations and also both conferences. So, we came up with a that can solve problems. The best way to do teaching the hospital executives to try and clever way of organizing the schedules such that is to meet the suppliers face-to-face and keep the conversations to five minutes, so that we were able to overlay both confer- determine if there is a basis for doing business. that everyone has a chance to speak with ences over the same dates. We have found By building a relationship with these suppliers, everyone else. After a few minutes in the this to provide increased benefit to all attend- the hospitals are in a better position to find reverse expo hall, everyone understands it ees and the model has been very successful. the best partners to help them solve the very and it works very well. complex issues they face each day. At Health Connect Partners, it is our goal HCB News: Is there any plan to ex- to serve the providers through offering high- pand beyond conferences? HCB News: What do you think the quality educational experiences so that the DM: This year, we plan to expand our challenges are facing exhibitors? providers are better educated, and better educational experience beyond the live con- DM: The exhibiting companies (we call prepared to manage their departments after ference setting by hosting educational we- them Suppliers) are under tremendous pres- attending our conferences or educational binars. Again, the focus of our company is sure to deliver more for less as the hospitals events. We hear success story after success on hospital executive education. Our plans have less to work with. Their marketing dollars story about providers that meet suppliers are to take that same focus and continue to are being squeezed each year, so they have to at our conference who help them solve industry-leading educational opportunities analyze the best use of their investment. We problems or save money (or both). The best specific to the hospital department leaders bring them real value by only bringing decision patient care at the best possible price is the in the markets we serve. It is our hope that makers to our events and then providing them goal for all hospitals, and it is our mission to the educational experience can be extended with the opportunity to meet the hospital ex- help both the hospitals and suppliers reach to reach more hospital executives that may ecutives and build relationships with them, all that goal through our hard work and the not have had the opportunity to attend one in a very intimate setting, for three days. One hosting of our events. of our live events. thing we have learned is that where you build Share this story: dotmed.com/news/28998

42 HealthCareBusiness news I march 2016 www.dotmed.com

ACC Q&A with Dr. Kim Williams American College of Cardiology President

By Sean Ruck

With the ACC’s annual conference fast KW: It was a compilation of opportunity, helped me create the nuclear cardiology lab- approaching, HealthCare Business News circumstance and proclivity. I grew into the oratories at U of C. Before he passed away, caught up with ACC President Kim Wil- fairly new field of nuclear cardiology. I hap- he also nominated me for ACC president. liams to learn about his background, the pened to get involved relatively early in ad- latest with the ACC and his thoughts on vocacy because this area was the subject of HCB News: Why should people con- where health care is and where it needs “turf battles” between specialties. But lead- sider joining the ACC? to be. ers in the field were convinced that growth KW: ACC is a very unique organization. of the specialty could help many patients Although it is thought by some to be dedi- HCB News: How did you get involved with heart disease. We needed to ensure ac- cated to improving the practice of cardiol- in health care? cess to nuclear licensure for cardiologists and ogy, the mission of the College is to trans- KW: I grew up on the South Side of Chi- anyone who is properly trained. My work form cardiovascular care and improve heart cago, with poor access to care, not being able to afford primary pediatric care — we had one, but there were access issues in urgent situations. After my second pneumonia ACC is a very unique organization. Although it is thought by some to be as a child and being admitted into a South dedicated to improving the practice of cardiology, the mission of the Side hospital, I was lying there on an ice bed, and I decided right then to become a South College is to transform cardiovascular care and improve heart health. Side of Chicago pediatric physician. But Sometimes, of course, that actually is by improving the practice things turned out a bit different. In medical school, I found learning about the heart was environment of cardiologists, but it is so much more. most interesting and dealing with heart disease was a lot more rewarding. Fortunately, I was still able to realize my goal of delivering in these areas led to leadership positions in health. Sometimes, of course, that actually inner city health care, as most of my career the American Society of Nuclear Cardiology. is by improving the practice environment was at the University of Chicago on Chi- At the same time, my concern for inner city of cardiologists, but it is so much more. cago’s South Side. I focused on cardiology health led to working with the Association Opportunities to influence health policy and did the majority of my training there. I of Black Cardiologists. Both of these organi- have come to ACC due to recognition by had the opportunity to serve the community, zations opened the opportunities for impact- regulators and legislators that we can be while in college, medical school, cardiology ing policy regarding access to care, clinical trusted to develop appropriate use criteria and nuclear medicine training. I served on guidelines and reimbursement. and quality metrics to improve the value- the faculty there for 24 years. During my year as ASNC president, I was proposition of ordering tests and proce- nominated to the board of trustees of the dures. We have a commitment to quality HCB News: How did you get involved ACC by my faculty mentor at the Univer- in a way that provides a roadmap for many with the ACC? sity of Chicago, Morton Arnsdorf. He had other organizations.

44 HealthCareBusiness news I august 2015 HCB News: What are the main initia- cipients — of the changes. Also, if everyone just treatment. We have many examples in tives you’re championing as president? is performing high-quality work, we do not cardiology of treatment successes, such as KW: I have worked primarily on three of want physicians penalized. Because we have decreasing door-to-balloon time for heart our six strategic platforms. We began with training guidelines, treatment guidelines, attacks, beta-blockers and ACE inhibitors for advocacy for payment reform, as the Medi- appropriate use criteria and existing quality heart failure, and so many more. But we re- care sustainable growth initiative was flawed measures, we hope that we can help design ally need to focus more on prevention. We’ve and prescribed yet another cut in payment. If quality payment models that can help other been doing extremely well at mopping up that had gone through, wealthy practices may specialties as well as our own. the floor, but it’s time we turn off the faucet, have survived, but those serving the under- privileged wouldn’t have, and access to care would be impossible for many. We partnered We’ve been doing extremely well at mopping up the floor, but it’s time we with others inside and outside of medicine and we were able to get the law repealed. The turn off the faucet, with medication adherence, improving diet and exercise. new law, MACRA (Medicare Access and CHIP Again, our mission is transforming cardiovascular care and Reauthorization Act of 2015) will focus on the quality of care given, and fee-for-service will improving heart health. This includes prevention. be going away and replaced by quality metrics associated with payment. Second, has been a focus on transforma- The third principle surrounds initiatives with medication adherence, improving diet tion of care from a volume basis to value in population health. I like to say that our and exercise. Again, our mission is transform- that is measurable. We need to have our goal is to put ourselves out of business by ing cardiovascular care and improving heart members to be at the center — not the re- focusing on prevention of cardiac events, not health. This includes prevention.

The only Emergency Medical Kit designed for the Office-Based Medical Practice

STAT KIT ® 750 • Complete set of medications • Designed to help meet accreditation standards • Always up to date*

* Medications are tracked for Banyan also sells expiration and automatically replaced to INDIVIDUAL medications maximize shelf-life and ensure readiness.

888-STAT KIT Life-Saving Equipment, Medications & Training StatKit.com/StatKit750 Since 1970 or contact your dealer 9483 v.1 02/2016

HealthCareBusiness news I march 2016 45 ACC

HCB News: What are the biggest challenges facing your members today? KW: I would say the biggest challenge is the impending dif- We’ve recently taken a very hard look at governance ficulty of implementing the quality metrics outlined above that and how it could be better. We’ve elected to reduce the will come very quickly. While electronic prescribing is going pretty size of the board to about one-third of its current size. well, we have further to go to get electronic health records that are interoperable. Another challenge is making sure that folks aren’t It’s really impressive that these luminaries in suffering from burnout, and are continuing to provide quality cardiology could vote themselves out of office to care that is measurable. If we’re not able to do that we’re concerned, because there are many physicians — some cardiologists streamline process and improve included — that are overwhelmed by the requirements. We need the function of the College. to maximize time spent with the patient and be more efficient with documentation.

HCB News: What items top the wish list for what members integrate physician and non-physician team members. We have want from the ACC? a large and growing number of advanced practice professionals KW: Our members are clear that in addition to education, and affiliated team members within ACC and we embrace team- they are looking for best quality practices, and appreciate practi- based care. cal advice and guidelines. They are also interested in how best to HCB News: Do you anticipate any big changes in the role the ACC plays in coming years? KW: We have been working hard in the area of prevention — it is certainly not new, but more research has made this an important emphasis to meet our societal goals. Lifestyle, diet, exercise, early disease detection and medication adherence initiatives will benefit the nation and even the world as we partner with medical societies in a large number of countries, including those that have formed our 36 international chapters.

HCB News: Are there any other developments you’d like to discuss? KW: It’s probably not widely known much outside of the College membership, staff and leadership circles, but we’ve recently taken a very hard look at governance and how it could be better. We’ve elected to reduce the size of the board to about one-third of its current size. It’s really impressive that these luminaries in cardiology could vote themselves out of office to streamline process and improve the function of the College.

HCB News: Has the ACA impacted your members? KW: It’s still to be determined — what we’re hoping is that the delivery of care to poor people will grow. Fewer uninsured people helps us all. We’re hoping it fosters real change and tangible prevention initiatives. I want cardiology to be number two — heart disease has been the number one killer of Americans since the Spanish flu ended in 1920. It is now the leading cause of death globally and it’s time we fix that. Share this story: dotmed.com/news/28997

46 HealthCareBusiness news I march 2016 www.dotmed.com View from the Hill Ultrasound’s role in new sepsis management quality measure for hospital reporting By Jill Rathbun

Effective Oct. 1, 2015, for any hospital “Integrating of bedside cardiovascular Medicare & Medicaid Services (CMS) re- discharges where the patient was age ultrasound into the protocols that are ad- leased the Fiscal Year (FY) 2016 Hospital- 18 or older with a diagnosis of sepsis, opted by hospitals to enhance the quality Acquired Condition (HAC) Reduction Pro- severe sepsis or septic shock, a new of care provided to these very sick sepsis gram data on Hospital Compare for each quality measure regarding the man- patients is very important. Adding the ac- eligible hospital, including the following agement of that patient will have to countability factor of a quality measure in measures: be reported by hospitals to Medicare. the hospital quality reporting programs will • PSI-90 composite measure score. One of the clinical elements of the care hopefully increase adoption of these clini- • CLABSI, CAUTI and SSI measure scores. that may be performed so that the hospi- cal practices,“ said Diku Mandavia, M.D., • Domain 1 and Domain 2 scores. tal can report this new quality measure is FACEP FRCPC, chief medical officer and se- • Total HAC score. bedside cardiovascular ultrasound. nior vice president, FUJIFILM SonoSite Inc. The Hospital Inpatient Quality Reporting This new management of sepsis, severe CMS also released the list of hospitals (Hospital IQR) Program is administered by sepsis or septic shock measure joins other that are in the worst-performing quar- the Centers for Medicare & Medicaid Ser- existing measures in the Hospital Inpatient tile and subject to the 1 percent payment vices (CMS) and it pays hospitals that suc- Quality Reporting Program that may re- adjustment on the CMS website. Hospi- cessfully report designated quality measures quire the use of ultrasound to help in meet- tal performance data can be found on a higher annual update to their payment ing the measure’s goals. Specifically, the the HAC Reduction Program page of Hos- rates. Hospitals that do not successfully re- hospital measures regarding central-line pital Compare (accessible from the Hos- port quality measures see their annual in- associated bloodstream infections and the pital Linking Quality to Payment section), crease in Medicare payments reduced by 2 PSI-90 — Patient Safety for Selected In- and the list of hospitals subject to the pay- percentage points per year. Effective Oct. 1, dicators Composite, which includes the ment adjustment for the FY 2016 HAC 2015, hospitals will need to submit informa- iatrogenic pneumothorax at the time of Reduction Program can be found under tion on this new Severe Sepsis and Septic venous catheterization measure — should the Related Links section of the CMS Shock Management Bundle Measure (NQF be considered by a hospital when integrat- Hospital-Acquired Conditions Reduction Measure # 0500) to ensure their payments ing protocols for the use of ultrasound in Program Web page. are not reduced in FY 2018. providing high-quality patient care. This data reported by hospitals about To learn more about the hospital qual- About the author: their success in completing the activities ity reporting programs, including a list of Jill Rathbun is in this measure, including the option of all the measures and their specifications, managing partner at using bedside cardiovascular ultrasound as well as information on comparing the Galileo Consulting if hypotension persists and volume status results among hospitals, please visit www. Group in Arlington, and tissue perfusion assessment is needed, qualitynet.org. Virginia. She will will be reported on the publically available be commenting for Hospital Compare website starting Octo- FY 2016 Hospital-Acquired HealthCare Business ber 2017. Individuals will then be able to Condition Reduction Program News on issues of interest to health care see how well the hospitals in their area are results released professionals. performing on these activities. Just before the holidays, the Centers for Share this story: dotmed.com/news/29199

HealthCareBusiness news I march 2016 47 Cardiology: Special Report A spotlight on innovations in cardiology technology

Dr. Andrew Freeman Dr. Anthony Hilliard Dr. David Kandzari Dr. Garima Sharma

By Robert Garment

Dr. Andrew Freeman is an interventional and how bad they are, and evaluate if they diagnoses, and the way we treat our pa- cardiologist at Denver’s National Jewish need to be fixed. All of these things are really tients,” Freeman concludes. Health and a member of the American exciting, and there are lots of different ways That said, Freeman still relies on echocar- College of Cardiology’s (ACC) Patient- to evaluate cardiovascular disease that we diography as the tried-and-true mainstay of Centered Care Committee, and he is never had before.” his practice. “Not only does echocardiogra- clearly excited about the breadth of in- He also says MRI continues to emerge, phy give a measure of pump function and novation occurring within the arena of and 4-D MRI is providing a great deal of in- overall function, but it also gives detailed cardiac technology. sight in blood flow and vortices. “We can ‘vir- information about valvular disease and pul- He notes, “there is not a single key tech- tual tag’ the blood cells and watch them in monary hypertension,” he says. “It used to nology or modality” that is dominating the motion, watch the eddies and vortices form be that you could listen very intently and try discipline, but a whole basket of options. inside the heart. In certain disease states, your best to come up with what’s going on “No single modality can give us all the infor- sometimes those vortices don’t form, or form [in a patient’s heart], but with echocardiog- mation we need. Each modality has a niche, differently, which is a clear telltale that a prob- raphy, you can really see it. I don’t think I or role to play, and they all complement lem exists. One of our researchers is looking could practice cardiology without it.” each other — that’s the virtue of what we at 4-D formation of vortices and hypertension Dr. Anthony Hilliard, an interventional call ‘multimodality imaging’ — it gives us a in the right ventricle, which is really unique.” cardiologist at Loma Linda University Medi- tool box of techniques we can use.” 3-D probes are improving. “In particu- cal Center in California, is particularly en- Freeman sees a great deal of technology lar, the technology of the ceramics inside thusiastic about the possibilities of what emerging, particularly at the coronary artery the probes has improved, so the temporal he calls interventional echocardiography, a level. There’s metabolic imaging using PET/ resolution is better. And the overall soft- technology he relies on in his practice. He CT, and there’s visual Optical Coherence To- ware interpretation of the signal is getting finds interventional echocardiography so mography (OCT) — an imaging technique much better,” Freeman says. He notes, valuable because it provides him with real- that uses light to capture micrometer-res- however, that 3-D is primarily used in spe- time guidance from a colleague performing olution, three-dimensional images. There’s cialized centers doing complicated heart the echocardiogram while he’s working on intravascular ultrasound (IVUS), a method- valve procedures. a structural heart disease case. ology using a specially designed catheter “So there’s a whole range of ways we’re This is how the procedure works: The pa- with a miniaturized ultrasound probe. Then using emerging technology, combined with tient is generally put to sleep, and a probe is there’s FFRCT, or fractional flow reserve CT. newer modalities and techniques, that are placed down into the esophagus. The result Freeman says, “it lets us see coronary lesions significantly improving the way we make is a 3-D echocardiogram, which means that

48 HealthCareBusiness news I march 2016 www.dotmed.com two views can be taken at the same time points to cardiac MRI as a powerful tool for weakened, but still viable, then opening the — and those images can be turned into 3D informing decision-making regarding the re- artery may strengthen the heart contractility images using a computer algorithm. vascularization of coronary arteries for his pa- and improve symptoms. In contrast, if the What that means for Hilliard is he can tients with advanced coronary heart disease. affected heart muscle is complete scar tis- look at his fluoroscopy — a standard way For example, he uses cardiac MRI to determine sue, then a revascularization procedure will of imaging the heart arteries and structure whether there’s living heart tissue downstream not provide benefit and is therefore not in- — and look at the echo in real time to deter- from very diseased coronary arteries. Kandzari dicated,” says Kandzari, who serves as the mine if he put a plug across a defect properly. notes that this is a very common situation in interventional topic coordinator for ACC’s Two of the variables he needs to consider as patients with congestive heart failure. annual meeting. Cardiac MRI can also be he does the procedure include how the plug “Through imaging of the heart muscle used to determine whether bypass surgery sits across the defect and if it’s the right size. downstream from blocked coronary arteries, or percutaneous revascularization with an- “[Interventional echocardiography] is tak- cardiac MRI may be useful to help inform gioplasty and a stent procedure is a better fit ing a technology that we’ve had for a long whether selected patients may benefit from for his patients. There are three major arteries time and turning it into real-time assistance stent revascularization. If the heart function is to the heart, he points out. If a patient has for interventional cardiology,” says Hilliard, who chairs the ACC’s Early Career Council. He also taps interventional echocardiography in situations where a patient has had a traditional heart valve implanted during open heart surgery and later experiences a leak around the valve. The leaks occur when one or two sutures break away and the patient has a leak through the resulting hole, he explains. Hilliard notes that sutures can break, even under the hands of the most skilled surgeon. While historically the remedy would have been another open heart surgery to fix the valve, Hilliard says that with interventional echocardiography, he can determine if the patient’s tissue can withstand the suture. The availability of this technology means that patients can possibly avoid a redo on their open heart surgery, “which is obviously transformative in the practice of medicine,” he says. From an interventional cardiology perspective, Hilliard notes, “currently, the most exciting new development is percutaneous aortic valve replacement (PAVR).” The technique is also known as transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR), and it is the replacement of the aortic valve of the heart through the blood vessels (as opposed to valve replacement by open heart surgery). In the future, Hilliard expects to see additional therapies to treat more valvular heart conditions being perfected.

Cardiac MRI Dr. David Kandzari, an interventional cardiologist at Piedmont Healthcare in Atlanta,

HealthCareBusiness news I march 2016 49 Feature: Cardiology Report

disease in all three arteries, the routine recommendation would be as: masses, congenital abnormalities and infiltrative disorders such as bypass surgery. However, if one or two of the arteries is nonviable, cardiac sarcoid, amyloid and iron overload syndrome. It’s also used for then the risks of bypass surgery may outweigh its benefit. If that’s the evaluating scarring after MI and assessing myocardial recovery and case, he may treat the two viable areas with a less invasive procedure damage, and also evaluating the pericardium. like angioplasty and stenting. Echocardiology: regular testing, first line test for structure and One of the benefits of cardiac MRI is there’s no radiation, says function. Dr. Garima Sharma, a cardiologist at Johns Hopkins Medicine in Baltimore. Still, the experience can be challenging for patients if they Cardiac CT become claustrophobic, since it takes an hour to do the scan. Preg- Sharma is a big supporter of CT scanning in cardiology. “If a patient nant women are advised not to have cardiac MRIs done, and it’s also comes in with coronary disease and has an abnormal EKG, CT scans not a good fit for patients with renal failure, she says. are really great, because they tell you one thing for sure: Is there or is We put this question to Sharma: All things being equal, when do there not heart disease?” says Sharma, a member of the ACC’s Early you recommend an MRI, when do you recommend CT, and when do Career Council. you recommend ultrasound? She replied: According to Sharma, numerous papers have been written about CT: If I want to answer the question of chest pain related to coro- the use of cardiac CT in the last 10 to 15 years — and that means nary artery disease, or when a patient has an inconclusive stress test, there are now very good guidelines for the use of the technology. Of CT is best. A CT scan looks at the absence or presence of significant course, cardiac CT also has its disadvantages, which include the need coronary artery disease. It is also a great test for cardiac masses, to do additional testing to determine why a patient is suffering from especially thrombus in the heart and congenital heart disease and chest pain, she says. postoperative changes. MRI: This sophisticated technology is aimed at evaluating the ac- Transcatheter aortic valve replacement curate function of the heart. It is reserved for specific questions such Freeman is excited about what he describes as “an absolute explo- sion in percutaneous valve therapy.” Transcatheter aortic valve replacement (TAVR) is one such procedure, as is the soon-to-come-out percutaneous mitral valve repair (MVR). Described by the American Heart Association as a minimally invasive surgical procedure, TAVR repairs a heart valve without removing the old, damaged valve by putting a replacement valve in the aortic valve’s place. Mitral stenosis is another condition that sometimes requires the replacement of a valve. Percutaneous valve therapies “have revolutionized the way we treat significant valvular disease,” says Freeman. While he’s not a surgeon, he has referred patients for these procedures and is confident about their efficacy — and is even more confident about their success because many of the devices to perform the procedures are now on their third or beyond generations. He credits TAVR with helping to improve the lives of patients who would have been too frail to survive an open-heart procedure. Before this procedure was available, there would have been few options available to these patients. With the availability of TAVR, “we can actually fix their valve disease. It’s pretty amazing. In fact, it’s awe- inspiring technology because it’s minimally invasive,” says Freeman. While as with any procedure, there’s always a risk of death, heart attack or stroke, he says the risks with percutaneous valve therapy are “acceptably low, especially when compared to open heart surgery.” Freeman notes that the procedures are costly and the long-term data are still pending in terms of their success rate. TAVR is now a lot easier, safer, requiring less recovery time and better available to frail patients, who previously couldn’t have had anything done. Share this story: dotmed.com/news/29200

50 HealthCareBusiness news I march 2016 www.dotmed.com Staff Safety Reinventing the cath lab to protect a physician’s health

By David Handler

Coronary artery disease is the leading exposure to radiation may cause incidents of that 47 percent of the time a portion of the le- cause of death in America. Percutane- cancer, specifically brain tumors. One study of sion is left uncovered by a stent, which leads to ous coronary intervention (PCI), commonly self-reported brain tumors in interventionalists increased repeat procedures. known as angioplasty, is the most common showed that 86 percent of those tumors were treatment, with more than 900,000 proce- left-sided, the side of the head most exposed Building a successful dures performed annually in catheterization to radiation during procedures. robotics program laboratories across the country. Orthopedic injuries: Heavy-leaded per- Adoption of robotic programs continues to Despite improvements in the devices used sonal protective equipment worn for radiation grow. Hospitals are recognizing the value of in cath labs, the actual procedure has remained protection may result in orthopedic injuries. protection for their staff and investing in the largely unchanged for nearly 40 years. While The incidence of spine issues for interventional- safety of their employees. In addition to the standing over the patient, an interventional car- ists practicing over 21 years is 60 percent. value of protecting cath lab teams, precision diologist snakes wires and catheters up from Cataracts: Cataracts are reported as an- and accuracy of stent positioning may reduce either the femoral or radial artery, reaching the other effect of radiation exposure in inter- operating costs in the cath lab. Imprecision in heart to re-open blocked vessels. Often, a stent ventionalists. In the RELID study, 50 percent stent positioning or size selection can result is inserted to keep the artery open. The proce- of interventional cardiologists had posterior in the use of more stents than necessary, rais- dure uses X-ray (fluoroscopy) to visualize the subcapsular lens changes (precursors to cata- ing the cost per procedure. patient’s anatomy, placing the physician within racts, caused by radiation exposure) versus The introduction of any new technology feet of a radiation source for every procedure. less than 10 percent in the control group. requires operator and staff training and may Physicians frequently spend six or more hours As a result, some experienced physicians require changes to the workflow. Success re- daily in procedures, wearing 20 pounds of lead are speaking out about the health conse- quires commitment from everyone involved aprons in an attempt to protect themselves quences to protect the next generation of to maximize the value robotic assistance can from ionizing radiation emitted by fluoroscopy. interventionalists and advocate for improved bring. When launching a robotics program, Angioplasty saves patients’ lives, but there safety measures. One proven safety measure all team members are involved to ensure phy- is a mounting body of evidence highlighting is robotic technology. It allows physicians to sicians, staff and patients receive the benefit the significant occupational hazards physicians perform procedures seated in a radiation- of robotic-assisted PCI. face in the cath lab. Leading hospitals in the shielded interventional cockpit. The physi- Robotics is no longer a technology of the country, including the recent installations at cian uses digital controls to advance guide- future. It is transforming health care, includ- the Mayo Clinic and Massachusetts General wires and catheters. The PRECISE clinical trial ing the practice of interventional cardiology. Hospital, have implemented a vascular robotic showed that robotics reduces radiation expo- When considering options to update cath system to refine the procedure and decrease sure for the primary operator by 95 percent. labs with robotics, hospitals should consider occupational risks for physicians and staff. Let’s both the benefits for patients and the long- look at what hospitals should consider when Benefits to the patient term health and safety of their employees. evaluating robotic technology for the cath lab. Clinical benefits come from the precision in ro- You can obtain references to clinical trials botic technology, which enhances visualization supporting claims herein directly from Corin- Long-term health for of the X-ray images. This helps physicians to dus by contacting the cath lab workers accurately measure anatomy, which may opti- company at info@ Occupational exposure to low-dose ioniz- mize stent selection. Recent studies show visual corindus.com. ing radiation has been shown to have many estimation of lesion length, which is the most About the author: health consequences for interventional cardi- common method, is often inaccurate and can David Handler is the ologists, who receive the highest amounts of result in the unnecessary placement of a second president and CEO radiation of any medical professional. stent. Robotic technology also allows discrete 1 of Corindus Vascular Brain tumors: Over a career, intervention- millimeter movements enabling cardiologists to Robotics. alists receive 1,000 mSv exposure to the head, position stents exactly where the patient needs Share this story: dotmed.com/news/29201 equivalent to 50,000 chest X-rays. Increased them. Without robotics, the STLLR trial showed

HealthCareBusiness news I march 2016 51 Industry Sector Report: Special Procedures

Shimadzu Trinias MiX 2

A new view on the horizon Special procedures: Multimodality imaging continues to gain ground in the hybrid suite, to guide structural heart procedures such as percutaneous What’s new? aortic valve replacements, left atrial append- By Lisa Chamoff age closures (Boston Scientific received FDA approval last year for the Watchman, a left It’s not big news that over the years, special procedure room, HealthCare Busi- atrial appendage closure device delivered via cardiac catheterization labs have seen ness News obtained the details on what catheter) and other image-guided, minimally a shift, moving away from a primary the leading manufacturers consider the invasive procedures. focus on coronary interventions and best features of their cath lab equipment, Robert Dewey, senior director of toward less invasive structural heart and also asked clinicians which features product marketing at Siemens, says that procedures, such as aortic valve replace- come into play when they’re in the cath what the company calls its dynaCT Car- ments and mitral valve repairs. lab trenches. diac feature uses a C-arm to acquire a Along with this change, the imaging “We are being asked to provide surgical- series of images while rotating around systems for these rooms — including X- like results, if not better,” says Dr. Brijesh- the region of interest, resulting in a 3-D ray, fluoroscopy and echocardiography war Maini, regional medical director of rendering of the anatomy, which can — have become more sophisticated, with transcatheter therapies for the Tenet Health- then either be viewed side by side, or manufacturers promoting new features care Corporation. “The only way you’re go- overlaid, with the fluoroscopy image. and software. For the annual focus on this ing to provide this is with superior imaging.” The Siemens PURE platform allows a

52 HealthCareBusiness news I march 2016 www.dotmed.com pre-procedural CT or MR to be fused “With further research, these tools are medicine at the VA Long Beach Healthcare with a fluoroscopy image utilizing two going to replace other imaging modalities, System in California, formerly chief of cardi- reference images acquired greater than which in turn, if successful, would obviate ology there, says he prefers biplane to single- 30 degrees apart. the need for general anesthesia for a lot of plane systems. “So if you’re introducing a valve, you these procedures,” Maini says. “The use of biplane imaging, with a verti- have this pictorial roadmap of where to po- cal tube and a lateral tube, positioned in the sition it,” Dewey says. Single-plane vs. biplane oblique angles, with concordant cranial or Maini has used Siemens’ intracardiac Another shift in the cath lab is from the use caudal angulation, provides double imaging echocardiography probe for procedures of single-plane to biplane angiography sys- for half the cost — half the radiation cost such as transcatheter aortic valve replace- tems, which has two C-arms set at an angle and less contrast use,” Kern says. “We get ment, which he says makes the procedure to one another. Dr. Morton Kern, chief of to view the coronary arteries almost simul- much easier. In the past, when only 2-D imaging with echocardiography was available, the implantation of the valves was much more difficult, he says. “It really makes the procedure a lot easier, because now you’re not fusing those two-dimensional images in your mind and making a three-dimensional map in your brain,” Maini says. “The machine is doing that for you, which I think is a huge change. You can see your equipment, your device, in a three-dimensional plane. In my mind, I think these imaging technologies make for a superior, faster procedure. There’s still a lot of operator variability, but Your Full Service nonetheless, it makes for an easier, simpler Cath/Angio Solutions experience.” Among the other OEMs, Philips has the ® ® ® EchoNavigator, which fuses live transesopha- Specializing in GE Philips and Siemens geal echocardiogram (TEE) and live X-ray, and its HeartNavigator fuses TEE with a pre- maintains over 8,000 cath/angio procedural CT. GE has multi-modality image TRANSTATE Equipment Company fusion software called CardIQ Fusion and parts in a climate controlled and static controlled environment. Toshiba has technology called Smart Fusion. Shimadzu has 3-D packages for vessel vis- TRANSTATE Full Service Solutions provides on-site cath/angio ibility and multiple detector CT features that repairs services at a fraction of the cost of the OEM. Our allow for multiple dimension reconstruction established clients also have the availability of the Transtate and fluoro overlays to a previously acquired Technical Hotline. CT image. More physicians need to be educated about the fusion modalities currently TRANSTATE Equipment Company available, Maini says, and the technology specializes in the sale of does need further improvement, as now refurbished GE, Philips and the current 3-D technology only shows a Siemens cath/angio systems. 22-degree field of view. But, Maini thinks the Siemens fusion technology is the “pre- parts: 704.332.4552 • service: 704.835.0834 cursor to technology that will change and system sales: 800.710.9996 • technical hotline: 704.835.0835 revolutionize how we take care of struc- 1418 Ameron Dr • Charlotte, NC 28206 • www.transtateonline.com tural heart disease.”

HealthCareBusiness news I march 2016 53 Industry Sector Report: Special Procedures

taneously in two projections and that really after it opened they needed another vas- exam, as well as a technology it calls Inno- facilitates wire movement, balloon place- cular lab, Mariano says. Vascular specialists vaSense, which uses a detector to assess ment, stent placement and post-procedural can use the system’s larger 12-inch-by-16- movement of the gantry and select the best assessment.” inch detector without compromising image position for the image receptor relative to Kern says he’s worked in cath labs that quality. the patient. By reducing the distance from still use single-plane systems and sees the “As volumes go up and down in dif- the receptor to the patient, the system op- limitations. ferent specialties, I can make a cardiac lab timizes imaging geometry and helps reduce “In labs that have biplane and don’t use into a vascular lab or a vascular lab into a radiation exposure while capturing the best it, they’re really, I think, sacrificing the ad- neuro lab,” Mariano says. “It allows cath image, says Miranda Rasenberg, global vantage of having that much information at lab administrators to be a little more flexible interventional marketing manager at GE. hand,” Kern says. and take out a room and put in a new room “The InnovaSense is basically automating There is a split in cardiology on the use when volumes change.” something that physicians can forget dur- of biplane versus a single-plane system, says Ronald Tabaksblat, the business leader for image guided therapy systems at Philips. “Typically, physicians who do pediatric 'As volumes go up and down in different specialties, I can make a cardiac procedures definitely prefer biplane,” Ta- baksblat says. “For the rest, it’s a matter lab into a vascular lab or a vascular lab into a neuro lab. It allows cath lab of what you are used to and how you’re administrators to be a little more flexible and take out a room trained.” Toshiba markets what it calls the Infinix and put in a new room when volumes change.' Select Dual Plane, which the company con- siders a separate category. The system has two separate C-arms, one with an 8-inch-by- 8-inch detector for coronary imaging, and Beat goes on for radiation ing procedures,” Rasenberg says. “When the other with a 12x16 detector for periph- dose concerns you look at how they operate the system, eral views, and one X-ray generator. Reducing radiation exposure continues interventional radiologists, interventional “We call this our no compromise solu- to be an important topic, especially in a cardiologists or surgeons forget to or do not tion,” says Bill Newsom, marketing direc- sector that utilizes imaging to the extent spend the time to bring the detector back tor for the X-ray/vascular business unit at that interventional cardiology does. Philips down to as close to the patient as possible. Toshiba. “The doctor who wants to do pe- provides onscreen dosimetry parameters Technically, all physicians understand how ripherals in the room can have the perfect and launched its DoseWise Portal — which dose works and that lowering the detector C-arm and the perfect panel for that, and collects information on radiation exposure would reduce it, but when they get in a cath the doctor who wants to do coronary can to patients and staff, and provides alerts lab and start placing stents and guidewires, have the perfect C-arm and perfect panel.” when the dose is excessive — at RSNA in in the heat of the moment, they are logically Newsom says the Infinix Select Dual 2014 after a marketing partnership with more focused on the procedure and patients Plane is a little more expensive than a single- Radimetrics. and tend less on this type of dose physics. plane system, but less expensive than buying Toshiba also offers its angiography Dose We automated this functionality on our cath two rooms. Tracking System (DTS), which shows a live labs to support physicians to always drive The Gates Vascular Institute, a Buffalo, image of the dose being delivered to a pa- toward lowest dose as reasonably possible.” N.Y., facility that opened in 2012 and of- tient’s skin and provides a color-coded map There is a cost attached to many of these fers stroke, cardiac and vascular care, uses that shows if the dose is in a dangerous area. real-time dose-monitoring features. Kern the Infinix Select Dual Plane system. Lorie It also offers Spot Fluoroscopy, which allows says that while the clinicians at his facility Mariano, senior director of cardiovascular clinicians to look at a specific area live, while pay attention to dose protocols, the Philips services at the institute, says the system of- seeing previous images of the surrounding DoseWise Portal add-on is more expensive fers flexibility for different patient volumes area, and Live Zoom, which digitally magni- than his facility’s budget permits. in five different specialties, especially as car- fies the fluoroscopic image to provide an “Given no limitation on funds, I think diac volumes have gone down across the enlarged view without changing system that would be an absolutely essential piece country. magnification modes. of our performance measures, to have good When the institute was in the planning GE offers Dose Map, which alerts clini- radiation feedback online, in real time,” stages, nine cardiac labs were needed, but cians to cumulative dose levels during an Kern says. “Not so much for the interven-

54 HealthCareBusiness news I march 2016 www.dotmed.com tional guys, but for the electrophysiologists, [as] they can rack up ultrasound systems and technology for measuring fractional flow some real time on the fluoroscope. To prevent patient injury as well as reserve (FFR) and instantaneous wave-free ratio (iFR), and Tabaksblat physician exposure and staff exposure, that would be a good thing. says the two companies plan to work together to create products But you have to make it affordable.” that make for a better experience in the cath lab. The Real Time Smooth Masking (RSM) technology available with For example, cardiologists use FFR to determine whether a patient Shimadzu’s Trinias MiX angiography system helps lower radiation needs a stent — if the measurement is below .8, it’s been proven that dose, says Jarrahlee Holland, a cardiovascular invasive specialist a stent is best for the patient, and if it is above .8, it’s better not to who uses the system at First Coast Heart and Vascular Center, an place a stent. Tabaksblat says that though there is very clear evidence outpatient facility in Jacksonville, Florida. While using digital subtrac- for using FFR to decide on stent placement, the technology is unde- tion angiography (DSA), which takes the bony tissue out of the image rutilized, and many doctors still rely on the angiogram to determine so the blood vessels can be seen more clearly, the RSM technology whether or not to place a stent. Tabaksblat says this is likely because allows for patient movement without decreasing image quality. the FFR measurement is difficult to insert into the cath lab workflow. “Your patient can still move and it won’t ruin your whole shot,” “You have to get another piece of equipment, another wire, and Holland says. “You can move the table and get more anatomy in one do a measurement,” Tabaksblat says. “Sometimes it’s very difficult picture versus stepping down to each body part with a DSA picture.” to figure out whether that measurement actually matches up with The feature also necessitates less contrast and fewer images that a certain lesion you see in the angiogram. So, a significant number need to be taken, leading to lower radiation dose for patients and of doctors find it hard to use, and therefore don’t use it all the time. staff, Holland says. I think the opportunity we now have at Philips, with Volcano being The facility also uses Shimadzu’s roadmap feature, which allows part of our company, is to totally change that experience so that it for an adjustable overlay to an acquired image, showing the road- becomes as easy to use as something like a StentBoost. That’s what map and landmarks. Additionally, the Shimadzu C-arm can rotate at we’re working toward.” 60 degrees per second, which also makes certain procedures shorter Share this story: dotmed.com/news/29202 and less dose heavy. “You would have to do three to four digital subtraction images to get one image that we can get with the Shimadzu, using RSM and rotational angiography,” Holland says.

Other features, plus flexibility Interim Cath Labs Kern and his colleagues also sometimes use StentBoost, software offered by Philips that provides a clearer view of a stent in relation to the wall of the blood vessel. Other vendors offer similar software, ALL-DIGITAL such as Siemens’ CLEARstent Live, StentViz from GE and Shimadzu’s Mobile & Modular Lab Rentals Score Pro Stent View Plus. Subtraction angiography and image freeze come into play before and after placing a stent, to make sure they have the right result, Kern says. Quickly start, expand, or add capacity to your cardiac or peripheral vascular program Positioning of the devices in the lab is also a consideration, as more Available immediately structural heart procedures are moving from hybrid ORs into the cath lab. Years ago, the hypothetical concern was that if something went All digital flat detector fleet wrong, the patient would need to be opened up, Maini says. Since Safe and reliable interim lab solutions fluoroscopy equipment was usually fixed and could not move out of the way, it made for a less sterile field. The current technologies, such as the Artis zeego fluoroscopy unit from Siemens Healthcare, which is what Maini uses, moves completely out of the way, and the cath lab tables move in multiple directions, simulating a table in the OR, he says. Contact us today! 800-456-3369 “If you were going to do an open procedure on that table, it is very possible,” Maini says. “That is a very important feature of any new fluoroscopy equipment that is going to be used for these MODULARDEVICES.COM procedures.” Changes in workflow may be on the horizon. Philips recently acquired Volcano Corporation, which manufactures intravascular

HealthCareBusiness news I march 2016 55 Industry Sector Report: Special Procedures DOTmed Registered Special Procedures Sales & Service Companies For convenient links to these companies, go to www.dotmed.com and enter [DM 29211]. Names in boldface are Premium Listings. Company (domestic) Contact Name City State Certified DM100 Shimadzu Medical Systems Torrance CA Toshiba Tustin CA Hi Tech Int'l Group Moshe Alkalay Deerfield Beach FL • Integrity Medical Systems, Inc. David Denholtz Fort Myers FL • • United Medical Technologies John Pereira Fort Myers FL Omega Medical Imaging Megan Grosz Sanford FL Healthcare Exports Peter Ehrich Miami FL • • Rytex Industries Patrick McBide Largo FL ChicagoMedX Robert Iravani Chicago IL Modular Devices Mark Koers Indianapolis IN • Columbia Imaging Wayne Horseman Columbia MD Block Imaging International, Inc. Kenn Dextrom Lansing MI • Oxford Instruments Healthcare Ann Arbor MI • • Transtate Equipment Co. Dan Wheeler Charlotte NC Global Inventory Management Alison Fortin Dover NH • Nationwide Imaging Services Robert Manetta Manasquan NJ • • Bayshore Medical Equipment, Inc. John Kolleger Ronkonkoma NY • • MAVIG GmbH Susan Sherman Rochester NY RSTI Terry Speth Solon OH • UDR Conversion Tony Smith Macedonia OH Classic Imaging Melany Eckstein Macedonia OH • • Siemens Malvern PA International Medical Equipment and Service, Inc. Trey McIntyre Fort Mill SC • Cardiac Services Susan Boyette Nashville TN MD Buyline Tom Watson Dallas TX TransAmerican Medical Imaging Robert Woodward Lindon UT Philips Bothell WA GE Wauwatosa WI

Company-International Name City Country Certified DM 100 FlexRay Medical Mads Vittrup Aalborg Denmark • Promed Rainer Bornschein Foehren Germany Stavropoulos Stavros & SIA OE Stavros Stavropoulos Athens Greece NeoRad Nicolay Berard Anderson Oslo Norway Mediparts Service SAC Juan Paulo Reyes Castillo San Borja Peru Anatolia International Trading FZE Danish Mukhtar Ras Al Khaimah United Arab Emirates • • Companies are listed alphabetically by state and country.

56 HealthCareBusiness news I march 2016 www.dotmed.com Industry Sector Report: Cath/Angio Special Procedure DOTmed NEW DOTmed asked the leading Cath/Angio manufacturers to submit up to three of their current EQUIPMENT products to be featured in this section. To learn more about these systems and see other GUIDE models not shown, please visit our online Equipment Guide in DOTmed’s Virtual Trade Show, CATH/ANGIO or go to: www.dotmed.com/cath-angio. We also invite you to rate these products online. SPECIAL PROCEDURE

GE Healthcare / Philips Healthcare / Philips Shimadzu / Trinias C12 Discovery IGS 730 OR AlluraClarity FD20 The Trinias C12 and F12 are The Discovery IGS 730 angiography The AlluraClarity with ClarityIQ Shimadzu’s newest angiography system brings both extremely technology FD20 monoplane systems. These innovative ground- high-quality imaging and complete system provides high quality up designs are constructed using workspace freedom to the hybrid imaging for a full range of clinical the SCORE, SMART and SMILE operating room. Its unique mobile procedures at low dose levels. With philosophy that sets Shimadzu platform brings all the power of a its 20 inch flat detector and 2k digital imaging chain the apart. The Trinias C12 and F12 are designed as versatile fixed imaging system to the table, system provides crisp, virtually distortion-free visualization vascular interventional systems, using our newest 12” yet it can be moved aside, so multi-disciplinary teams of small details and objects for complex procedures. mid-size FPD. The SCORE imaging technology brings a can complete procedures comfortably, with unobstructed Our unique Life Image Guidance solutions like, 3D-RA, higher level of intervention making it possible to reduce access to patients. High-end fluoroscopy image 3D Roadmapping, VesselNavigator, EchoNavigator, patient dose and increase fluoroscopic image quality. guidance, advanced applications, 3D image fusion – it StentBoost, XperCT Dual and XperGuide, provide extra The SMART design allows easy operation with quick all comes on a sophisticated gantry that travels on insight for interventional procedures. The EmboGuide response time while the SMILE concept provides a safe predefined paths with laser-guided precision. Now one and XperGuide ablation provides possibilities to explore and comfortable environment for patients and medical room accommodates a wide range of endovascular, interventional procedures in the Oncology domain. staffs alike. cardiac, hybrid and open surgical procedures, free of Available with unique FlexMove ceiling suspension for interference from fixed floor or ceiling system structures. superb flexibility in Hybrid Suite deployments. Shimadzu / Trinias F8 The Trinias F8 is Shimadzu’s newest GE Healthcare / Innova IGS Philips Healthcare / cardiac system. This innovative 520 IC Philips AlluraClarity ground-up design is constructed Innova IGS 520 is a floor-mounted, FD20/15 using the SCORE, SMART and versatile dose-efficient The AlluraClarity FD20/15 SMILE philosophy that sets angiography system that allows biplane systems are equipped Shimadzu apart. The Trinias F8 is you to scale from diagnostic with next generation dynamic designed as a dedicated cardiac/ coronary evaluations and 16 bits flat detectors (20 inch neuro system using our newest 8” FPD. and 15 inch) and provides high interventions to complex structural The SCORE imaging technology brings a higher level quality imaging for a full range of clinical procedures at heart procedures, from device of intervention making it possible to reduce patient dose low dose levels. The FD15 lateral plane is specifically implants and diagnostic EP studies and increase fluoroscopic image quality. The SMART designed for enhanced neuro positioning. Our unique to complex ablations. Its 20 x 20 cm detector, for pure design allows easy operation with quick response Live Image Guidance solutions, like 2D Perfusion, cardiac procedures, will give you 38% more anatomical time while the SMILE concept provides a safe and 3D-RA, 3D Roadmapping, XperCT Dual, XperGuide, coverage than the 17.7 x 17.7 cm (7 x 7 in.) detectors comfortable environment to patients and medical staffs VasoCT and Vascular StentBoost provide extra insight for available on the market. The integration capabilities of alike. the Innova IGS 520 lets you add or remove component interventional procedures parts of your system or applications without difficulty. Shimadzu / This creates maximum upgradability and effective asset Philips Healthcare / Bransist Single Plane VC-17 utilization with optimal efficiency. Philips Allura Xper FD10 The Bransist product series is a The Allura Xper FD10 monoplane multi-modality platform designed GE Healthcare / Discovery IGS system is equipped with a to meet the needs of a dynamic 740 IR generation of compact dynamic imaging environment. The Discovery* IGS 740 makes 3D flat detector which can easily It comes standard with unique imaging available for more than handle complex projections. features such as RSM-DSA (Real- 95% of the population worldwide, Image quality and X-ray dose reduction are further time Smooth Mask), NAVI-DAS C-Arm movements, including patients with a BMI of enhanced by a real-time dedicated image processing Transverse Travel and Dose. up to 40. It has the widest bore of algorithm that provides excellent image quality through Reduction and many additional software features that the major players’ interventional enhanced contrast and sharpness. The Allura Xper FD10 assure the best image quality. angiography systems used system can be customized with a virtually unlimited number All system configurations come with a bariatric capable for imaging in the field of of acquisition programs for digital angiography and digital KS-70 table with a 500 lb. capacity plus 220 lbs. for CPR Interventional Radiology & Oncology procedures. The subtraction angiography. Image resolution is up to 1024 x compression. Also available in a floor mount model. wide bore also makes it possible to image patients in 3D 1024 pixels for interventional X-ray imaging. Our unique in more comfortable or clinically demanding positions like Live Image Guidance solutions, like 3D-RA, with arms down, on their side supported by cushions or EchoNavigator, StentBoost and EP Navigator, provide with ablation needles in place. extra insight for interventional procedures.

APRIL 2016 MAY 2016 Coming Soon… OR ISSUE HEALTHCARE TECH MANAGEMENT ISSUE • Endoscopy • Patient Monitors DOTmed Equipment • Sterilizers • Infusion Pumps • Hospital Beds • Testing Equipment Guides • Defibrillators

HealthCareBusiness news I march 2016 57 Industry Sector Report: Special Procedures

Siemens Healthcare/ Siemens Healthcare / Toshiba / Infinix Elite iArtis one Artis zeego Toshiba’s Infinix™ Elite provides The Artis one angiography The Artis zeego angiography flexibility in system design, system addresses a broad system boasts unique allowing the ability to adapt to range of angiographic positioning capabilities, with a any facility’s needs. Available procedures, from diagnosing flexible socenter that adapts with 8X8, 12X12 or 12X16 and treating coronary artery the table height to the user’s inch detectors, the system’s 5 disease and peripheral size to allow ergonomic Axis C-arm design provides vessel occlusions to performing electrophysiology surgery. The system’s table tracking aligns the C-arm unparalleled access and procedures. With a positioning flexibility similar to movements automatically to the table position. The coverage to optimize safety, comfort and efficiency. ceiling-mounted systems, the Artis one occupies Artis zeego also offers Large Volume syngo DynaCT WorkRite ergonomic enhancements increase speed and just 269 square feet and has multiple axes capable for visualization of the whole abdomen and thorax; precision without sacrificing safety, while the Access of moving independently of one another, enabling portrait syngo DynaCT increases coverage in the Halo’s design allows better patient access for staff and easy system positioning where needed. The Artis z-plane to image the complete thoracic aorta. equipment. one accommodates head-to-toe coverage of patients up to 6 feet, 10 inches without the need for patient Toshiba / Infinix 4DCT Toshiba / Infinix Select repositioning. Toshiba’s new Infinix™ 4DCT The Infinix™ Select from seamlessly integrates IR Toshiba offers the dual Siemens Healthcare / and CT into one solution, functions of cardiac and Artis Q.zen providing patients with vascular imaging, eliminating The Artis Q.zen family faster, safer and more the need for separate of angiography systems accurate interventions. systems. Clinicians no longer combines a new flat emitter Clinicians can focus on quality of care with the ability need to make the choice X-ray tube – enabling smaller, to plan, treat and verify in a single clinical setting. of compromising safety or square focal spots that lead SUREGuidance technology allows for automatic quality, as the system to as much as 70 percent transition between modalities, and clinicians have high features two independent flat panel detectors and improved visibility of small vessels and improved quality CT images during the interventional procedure Toshiba’s full suite of dose optimizing tools. image quality -- with new crystalline silicon detector instead of having to utilize CT images that are hours technology that allows imaging at doses as low as half to weeks old. the standard levels in angiography. The new detector’s increased homogeneity allows for more effective signal amplification, greatly reducing electronic noise even at ultra-low doses.

MAVIG GmbH • Stahlgruberring 5 • 81829 Munich • Germany Ti-Ba Enterprises, Inc. • 25 Hytec Circle • Rochester, NY 14606 • USA

OT54 & Protective Drapes WD261 New Insights and the Elimination of Underpassing Radiation: Body-Contoured, Height-Adjustable, Scattered Radiation Protection for Femoral and Radial Access Encapsulating, Mobile Radiation Shield

For any more Information see: www.mavig.com or Feel Free to Contact us: [email protected]

DotMed_2014.indd 2 13.02.2015 07:31:56 58 HealthCareBusiness news I march 2016 www.dotmed.com Technology Advisor Why digital health initiatives fail

By Bipin Thomas

There is growing consensus that transi- Patients wave a card at the front desk and relevance to leadership. It’s a philosophy that tioning to digital health is fundamental are automatically checked in. Staff perform a all must adopt. It’s not having a better app to achieving a financially sustainable tightly choreographed routine, with advanced than your competitor, it’s to reconsider the health care system in the U.S. Health care data analytics to find further improvements. entire value chain and relationship with con- organizations are scrambling to execute digi- Examination rooms circle a central hub so sumers over their lifetime. If you’re a hospital health strategies from mHealth to data that doctors can confer easily with assistants tal, use technology to bring to life everything analytics. The term “digital health” has been and specialists. A mobile app lets doctors see that care delivery and personalization can be used as a buzzword and meant many things patients’ medical records and refer to clinical in the modern age. to many people. Now it seems foolish to have protocols. The clinic has a pharmacy, so doc- There are numerous examples where a digital strategy. You just need a business tors give patients pills directly and answer any technology is added at the edges. I can use strategy for the digital age. Whether it’s Os- questions. Most administration is centralized a decent app to review my health plan ben- car reinventing the health insurance business, elsewhere, so staff at the clinic devote their efits, out-of-pocket expenses and look up ChenMed changing the care delivery model attention to treatment. Medicare patients at doctors in my network. But that’s it. If I want or Teladoc disrupting telemedicine, what ChenMed spent nearly 40 percent fewer days to find a provider with the highest rating or binds these companies is they brought digital in the hospital than the national average. change wellness programs, it’s a painful series thinking to the very heart of their companies, These companies realize that the mod- of phone calls. Using technology in a deeper and not just bolted it onto the side. ern age is a time of scarce attention and fashion would send me recommendations Oscar is using technology and design to abundant connectivity, where smartphones based on my clinical and claims history. More make health care simple, intuitive and hu- are our primary access point to everything, advanced technology may incentivize pre- man. Sixteen months after going live, Oscar where money is digital, where the interface scription adherence, routine tests and preven- has joined the elite group of startups known layer is where the profit is and where provid- tive care. These are ways to connect the entire as unicorns, or those with billion-dollar valu- ing a slick, best-in-class human experience value chain across the extended enterprise ations. Through user experience, customer will create the most profound business. and boost patient satisfaction significantly. service and innovative care options, Oscar What these companies have all learned You don’t need a head of digital health attempts to expand the role of the health is that new technology is everything, and or a digital department. In fact, you should insurance company to a health services pro- it’s essential for every company and every banish the word "digital" as an entirely re- vider. Among its innovations are an intuitive person to be cognizant of the possibilities dundant word. website — type in symptoms in plain English it provides. You don’t need a digital health strategy. and receive a list of prospective treatment Technology is not oil to lubricate. It’s oxy- You need an inside-out digitally transformed providers — free calls to doctors and more gen to grow ideas and change business. Mod- health care organization. price transparency. ern businesses need to disrupt themselves at About the author: Teladoc is a national network of U.S. the very core, empowered by what new be- Bipin Thomas is a board-certified physicians and pediatricians havior and new technology make possible. renowned global that lets you resolve your routine medical Health care companies need to re-evaluate thought-leader on issues, on-demand 24/7, via phone or on- their roles in catering to 21st century consum- consumer-centric line video consultations. Teladoc doctors can ers. Health insurance companies need to use health care transfor- diagnose many medical problems, recom- technology to become health partners. Banks mation. Thomas is mend treatment and can even prescribe need to become health care payment solu- a board member of medication if necessary. Teladoc is an afford- tion companies. Why didn’t a national health HealthCare Business News and chairman of able alternative to costly urgent care and ER insurance company invent Oscar? Or a leading ICURO, a digital business outcomes manage- visits for non-emergency medical care. geriatrics hospital start ChenMed or a major ment organization, where he is redefining ChenMed is devoted to elderly people health system launch TelaDoc? personalized care delivery by connecting all who may have multiple chronic diseases. Digital transformation is not about a digi- stakeholders in the emerging health care It profits when they are kept well and their tal department. A chief digital officer won’t ecosystem. health care costs are kept low. ChenMed has save your company. It is not the role of any Share this story: dotmed.com/news/29203 vans to take patients to and from its clinics. additional unit to take your company from ir-

HealthCareBusiness news I march 2016 59 Industry Sector Report: Injectors Contrast media injection — we need it, but we don’t like it! Injection issues and future developments for CT and MRI injector systems

By Michael Friebe, Ph.D.

Injectors are used for X-ray procedures ting a liquid into the patient's bloodstream certainly something that needs to be taken (mainly in the cath and angio labs), for at the right point in time with respect to the into consideration when selecting an injector. diagnostic imaging using tomography imaging procedure. Increased complexity For CT injection protocols, timing is es- systems (CT, MRI, hybrid imaging sys- means decreased patient safety and usually sential to achieve the desired contrast. A tems like PET/CT or MR/PET) and for use also comes with increased investment and relatively standard volume is between 75ml in contrast-enhanced ultrasound (CEUS) operational cost. The question is whether and 150ml, depending on patient weight, examinations. The medical need for con- they really need to be that complex. So what iodine-based contrast media using an injec- trast media in the enhancement of the di- is really needed, what is nice to have and tion rate of typically between 3-5ml/s (using agnostic images is not in question, but the what are the features that a standard user a 20-gauge flexible plastic cannula). The in- application of the contrast media into the can do without? jection protocol also needs to be adapted blood stream is not without danger for the The focus of this story is on electrome- to the type of CT scanner used (number of patient, and requires a great deal of experi- chanical CT and MRI injectors and on intra- slices) and is complemented with the injec- ence and training for the operators of the venous or intra-arterial injections, but many tion of saline solution which requires two injector systems. of the issues also apply to the injection sys- working channels as a syringe or bag system. Contrast media injection is generally tems used for X-ray and U.S. applications. A Timing of injection is critical with respect to realized by using power injectors, mainly medium-sized hospital can easily own and the CT imaging and a computer control is electromechanical or hydraulic piston or pe- operate 25 of these injectors with an aver- therefore essential. ristaltic drives, with two different injection age operational time before replacement Typical MRI contrast media injection volumes (syringes, bags or bottles) with the of seven to eight years, and an investment (gadolinium-based, which shortens the T1 first one, saline, having the task of opening from $10,000 (single syringe) to $40,000 relaxation time) is administered as a rapid the vein for the second one that injects the (multiphase, multi-contrast media). intravenous bolus, depending on weight contrast media. This is then followed by a In general these systems are quite reliab- (approximately 0.2ml/kg) at a flow rate of flush from the first, thereby again reducing le, but require at least an annual maintenan- 2ml/s. For a 100kg (220-pound) patient ap- the total contrast media consumption and ce and safety check, and in case of high proximately 20ml of contrast media is used increasing patient safety through reduced utilization, a service every six months. The that is subsequently flushed with 20ml of flow rates. Fast imaging, as in multi-slice de- cost for these service procedures is typically saline solution at the same injection rate. tector CT imaging or high-field MRI, requires between $500 and $1,500. Approximately 30 seconds after that the MRI dual volume injector systems. More of a problem are the consumables imaging protocols start. The peak enhance- There are issues with the consumables that are required for the different injector ment is about 2 minutes after injection and that are required for the injection, includ- systems. Some use syringes with recommen- holds on for several minutes. The standard ing tubing and syringes, the actual injection ded single use that are very often only repla- MRI contrast media injection protocol is rela- pathway, use of the controlling computer ced once a day. However, others use bottles tively simple, and the injector would theo- system, hardware (batteries, magnetic at- or bags that can contain larger amounts of retically only require one or two different traction when used in an MRI suite, servic- contrast media and do not need to be repla- flow rates and simple timers for 90 percent ing, electric safety), variables of the injection ced for every patient. Tubing from the sy- of all applications. (amount of contrast media, timing, injection ringe/bag to the patient obviously needs to Technically the injectors only require a dri- rate), patient safety and the use of varying be replaced with every patient and the total ving unit that is capable of injection at a flow injection protocols. cost per patient can run from $5 to $25, plus rate of 2ml/s (MRI) or 4ml/s (CT); a volume Injector systems are relatively large and the cost of the contrast media. Investment as of 20ml (typical MRI) to 150ml (CT) contrast complex and need some time for patient well as operational cost in combination with media with injection of saline solution befo- setup, all for an apparently easy task of injec- the required individual patient setup time is re and immediately following the contrast

60 HealthCareBusiness news I march 2016 www.dotmed.com media injection. There are some rarely-used nagement of injector service issues and can that could help to provide new or enhanced advanced protocols that require multiphase track historical use of contrast media with contrast particularly for cardiac imaging. injections and varying flow rates, but with the respect to patients, diseases and imaging Contrast media viscosity is temperature above minimum specification a large majority protocols. dependent, as a warmer application tem- of the normal contrast media imaging could The syringes (single or multi-use) and perature decreases the viscosity and flow be accomplished. The currently available injec- their cost — but also patient safety issues resistance. Warming the contrast media tors can do significantly more than is required related to multi-use — are definitely quite before injection is therefore beneficial, and for these standard injection protocols. Easier, an important consideration. Especially in some injectors have such a feature built into less costly and less complex solutions could the U.S., pre-filled syringes are getting more the system. be developed, especially for use in the MRI popular while other vendors are betting on Another hardware aspect is the power suite, where plastics and avoidance of electro- larger volume bottles that reduce the prepa- source and weight of the injector systems. nic systems/components are also solving the ration time and the cost of the consumables. While most CT injectors are directly con- problem of MRI compatibility/safety. Dual flow allows the parallel injection of nected to a power outlet (weight between What is required from a patient safety contrast media and saline solution, and with 5kg and 25kg), MRI injectors (weight 10kg point of view? Consider the following: • Ease of use and low complexity are key elements of patient safety. If there are only a few variables and components, the user training is fast and the error margin low. • “Open” contrast media and saline volumes should not be used to prevent infections, sepsis and contaminations. • Standard (and easy) operating procedures for injection should be in place to avoid extravasation and air emboli. nector Support • Some injector systems on the market offer optional extravasation protection (through Service sensors that measure variances in skin surface or RFID signals). • All procedures should allow for the removal of any air in the tubing by rotating the injector head and slowly pushing liquid into the tubing with an optional air bubble detection sensor. Providing professional, • Injector systems should include sensors and safety measures if an overpressure occurs. timely and superior • Optional sensors for contrast leaks could support and service be helpful. for medical • Some vendors now offer RFID identifiers that prevent using single-use syringes contrast injectors. more than once. • Equipment should allow for the possibility to recall some forensic data such as the amount of contrast media injected with injectorsupport.com what parameters at what time. 888.667.1062 Other features not directly patient safety-related that are optionally offered are RIS/data management systems connections and network integrations that allow for the measurement of workflow efficiency and imaging optimization. This also allows ma-

HealthCareBusiness news I march 2016 61 Industry Sector Report: Injectors

to 35kg) usually have a battery integrated ferromagnetic materials with little to no must haves, should haves, nice to haves and that has a tendency to be empty every once electronic components, not needed as summarized in the chart that in a while when you really need it. Alterna- Dual volume injectors are needed, and accompanies this story. tive solutions are hydraulic-driven systems a large majority of the CT and MRI injection Michael Friebe is a or almost entirely mechanical systems with protocols are standard with respect to flow professor of catheter a small battery backup of injection infor- rate, while the injection volume is weight technologies and im- mation and control of safety features. Es- dependent. Most systems on the market age-guided therapies pecially for use in the MRI suite, electronic can offer a lot more than these standard at Otto-von-Guericke and metallic components are a potential protocols, which also translates into high University in Magde- safety and operational hazard and for ul- cost for investment and operation (service burg, Germany. timate patient safety the device should be costs, consumables). Patient safety should lightweight and manufactured from non- be a key concern, which also determines the Share this story: dotmed.com/news/29204

MUST HAVE SHOULD HAVE NICE TO HAVE NOT NEEDED CT • Dual Volume Injection • Multiphase • Dual-Flow (should • Prevention Injectors • 3ml/s and 5ml/s flow rate Protocols have with majority of multi-use • Contrast Media Volume (CMV) > 150ml • Protocol Storage Cardiac Imaging) for single-use • Saline Volume (SV) > 150ml • Lightweight and • Remote Diagnostics syringes • Data on CMV and SV injection including date easy-to-use system (for remote servicing) and time • Independent • RIS / PACS connection • Air removal and detection Power Source • Extravasation • Closed CMV and SV Detection • Overpressure detection and automatic shutdown • Contrast Media Leak

MRI • Dual Volume Injection • Lightweight and • Multiphase Protocols • Extravasation Injectors • 1ml/s and 2ml/s flow rate easy-to-use system • Protocol Storage Detection • Contrast Media Volume (CMV) > 25ml • Independent • Remote Diagnostics • Contrast Media • Saline Volume (SV) > 50ml Power Source (for remote servicing) Leak Detection • Data on CMV and SV injection including date • RIS / PACS • Prevention and time connection of multi-use • Air removal and detection • Extravasation for single-use • Closed CMV and SV Detection syringes • Overpressure detection and automatic shutdown • Contrast Media Leak • Full MRI compatibility for at least 3 Tesla

Chart provided by Michael Friebe. DOTmed Registered Injectors Sales & Service Companies For convenient links to these companies, go to www.dotmed.com and enter [DM 29212]. Names in boldface are Premium Listings. Company (domestic) Contact Name City State Certified DM100 JDI Solutions Clark Wilkins Fullerton CA • • Florida Service Plus, Inc Chuck Marshall III Apopka FL Injector Support and Service Ryan Clarke Orlando FL Guerbet LLC Bloomington IN Med Exchange International, Inc. Davyn McGuire Agawam MA • • Global Inventory Management Alison Fortin Dover NH • • Bracco Monroe Township NJ Maull Biomedical Training, LLC Stephen Maull Aurora OH Precise Biomedical, Inc. Amy Milavec Parma OH Bayer Healthcare Warrendale PA Ion,llc Carlos Sanchez McAllen TX

Company (International) Name City Country Certified DM100 Mediproma B.V. Rick Meerkerk Nieuw Lekkerland Netherlands • • Companies are listed alphabetically by state and country.

62 HealthCareBusiness news I march 2016 www.dotmed.com Industry Sector Report: Contrast Injectors DOTmed NEW DOTmed asked Contrast Injector manufacturers to submit up to three of their current EQUIPMENT products to be featured in this section. To learn more about these systems and see other GUIDE models not shown, please visit the Equipment Guide in DOTmed’s Virtual Trade Show, or go CONTRAST to www.dotmed.com/injectors. We also invite you to rate these products online. INJECTORS

Bayer HealthCare / Medrad® Bracco / New EmpowerCTA®+ L-F / Optivantage Mark 7 Arterion® Injection The Contrast Injector, The Optivantage™ features System Reengineered a dual-head CT contrast This is the latest in Bayer’s “Mark” series Safety and Control that Improves delivery system with optional of angiographic injectors. The Mark 7 Workflow. Reengineered, setting a new RFID upgrade. Arterion® takes advantage of the latest standard. This uniquely intelligent interface technologies, now with the optional • Digital touch technology increases user’s between contrast media syringe ® ™ Medrad VFlow (variable flow capability) control and everyday efficiencies and power injector is designed to give you more ways to and a single use hand controller, making • User-friendly safety enhancements at effectively support more complex injection protocols. it lighter, maneuverable and easy-to-use. Less time the patient’s side and control room • Easy, touch-screen interface ® positioning and setting up the Arterion System means • Precise, easily accessible features, including remote • Built-in Patency Check™ feature to avoid extravasations more time with the patient. The intuitive user interface control pause, enable immediate action • Keeps pace with increasing CT scanner speeds guides you through proper set-up, and highlights the • Innovative design allows for real-time control of contrast • Powerhead controls to enable programming and information you need to perform injections confidently. management injection management at patient bedside Includes our VirtualCare® Remote Support capability. • Biomed service-friendly, enabling efficient system maintenance ® L-F / Angiomat Illumena Bayer HealthCare / Medrad ™ ™ ® The Angiomat Illumena Spectris Solaris EP MR Bracco / New EmpowerCTA®+ Injection System The Contrast Injector, contrast delivery system sets Features ease-of-use and reliability: Reengineered the standard for efficiency, versatility • Designed for use in all MR Scanner Advance safety features address and ease of use. field strengths up to and including 3.0T the needs of today’s most modern • User-defined functionality • Optimized color touch-screen facilities. • Ability to switch between cardio, • Six user-programmable phases for • Digital touch technology increases angio and CT modes with one touch added flexibility user’s control and everyday • Expands your ability to deliver advanced patient care • Independent Keep Vein Open (KVO) allows more time to efficiencies across an increasingly broad spectrum of patients and focus on the patient • Saline Advance delivered via a pendant switch or key on procedures • Fiber optic technology enables direct, reliable the injector at the patient’s side prior, allows for the use of communication saline to test patency and vein integrity L-F / Optistar™ Elite • Longer battery life with increased capacity • Saline Jump allows for the immediate advancement to The Optistar™ Elite is an MR • Includes our VirtualCare® Remote Support capability saline once opacification has been reached, minimizing contrast delivery system. Paired the contrast a patient receives with Ultraject prefilled syringes, the Bayer HealthCare / Medrad® Optistar Elite injector helps you ® • Precise, easily accessible features, including remote Stellant D Dual Syringe save time preparing for MR contrast CT Injection System with control pause, enable immediate action delivery, to give you more time with Certegra® Workstation Bracco / EmpowerMRContrast your patients. Intelligent, Intuitive, Innovative, Injection System • Can be operated from the powerhead or the control Designed to increase efficiency with: EmpowerMR® is designed to meet console • Snap-on / twist-off syringe design the demands of today’s advanced MR • Color LCD touch screen • Automatic plunger advance and retract procedures: • Safety features including built-in status alerts, a • Automatic filling and priming • A range of features provide peace of Patency Check feature and Timing Bolus™ injection • Storage and recall of up to 250 protocols mind • Battery-free operation • Multi-phase programming • Intuitive, user-friendly interface makes • Integrated saline test inject operation amazingly simple • Programmable pressure limit • IRIS MR injector data management system • Includes our VirtualCare®Remote Support capability

Visit DOTmed's Virtual Trade Show to see all the product listings from all of our New Equipment Guides, find a Service Provider — and more! Click on "Service" from the main navigation bar on our Service home page.

HealthCareBusiness news I march 2016 63 Contrast Media

Gadolinium can accumulate in the brain — but is it harmful?

By Gus Iversen

It has been a turbulent decade for the half-life of 90 to 120 minutes and after 6 or multiple bonds in a ring-like structure, linear once-unblemished reputation of gado- 9 hours most of it is gone, and we assumed agents form single bonds — like two people linium-based contrast agents (GBCAs) that after a day or two there’s no trace left.” holding hands. Therefore, the bonds of linear — and yet even today it isn’t easy to put So what does it mean that this is not ac- agents break more easily. one’s finger on exactly what it is about tually the case? And if we don’t have scien- Among the linear agents, Kanal says the them that has everyone so excited. tific evidence that there is anything medically accumulation seems to happen most with HealthCare Business News spoke with Dr. detrimental about this accumulation, what Omniscan (GE Healthcare), equaled or fol- Emanuel Kanal, a professor of radiology and exactly is everyone so worked up about? And lowed by Magnevist (Bayer), then likely fol- the director of MR services at the University how will this impact the way MR scans are lowed by MultiHance (Bracco). He says other of Pittsburgh Medical Center, and an expert ordered in the future? linear agents such as Optimark (acquired by on the topics of gadolinium and MR safety, Guerbet when it purchased Mallinckrodt’s con- about the developments that have been tak- Not all gadolinium accumulates trast business last year) may also accumulate, ing place. He remembers a time — not too at the same rate but these agents have smaller market shares long ago — when gadolinium was regarded Here’s what we do know, according to Kanal: and sufficient evidence has not been collected as “one of the safest drugs there was.” Gadolinium is a heavy metal from the lantha- yet regarding their accumulation behavior. The trouble started in 2006 when it came to nide series. In certain forms it can have sig- So why not just swap out linear agents light that administration of at least some of the nificant toxicity, and therefore, it is generally for macrocyclic agents? Unfortunately, that FDA-approved GBCAs to patients with acute or understood that we don’t want to have it in solution oversimplifies the problem. Radiolo- chronic renal insufficiency could lead to neph- our bodies if it is not needed there. We also gists must also factor in the relaxivity of an rogenic systemic fibrosis (NSF) — an often pro- know that the two different types of GBCAs agent — which refers to how much must gressive disease with no known cure in which — macrocyclic agents and linear agents — ap- be administered to adequately produce the skin thickening hampers mobility and can limit pear to cause accumulation at different rates. desired visual contrast. bending at the joints, among other symptoms. There are three macrocyclic GBCAs on the “There is no agent, I believe, that is im- Then, in 2013, findings surfaced to sug- market — Dotarem (Guerbet), Gadavist (Bay- mune to having some retention in the body, gest that gadolinium may accumulate in the er) and ProHance (Bracco) — and although it’s just not the way science or math works,“ brains of patients who undergo multiple ex- it’s unclear if accumulation happens equally, says Kanal, “but there are significant differ- aminations with at least some of the FDA-ap- if at all, among this group, the evidence sug- ences in the amount or rate that they accu- proved GBCAs. It’s a phenomenon that Kanal gests that accumulation happens less with mulate in a human after a certain number of calls intracranial gadolinium accumulation. this group, or perhaps at a slower rate, than doses of these agents.” “No one told us it would stay in the with linear agents. As for the clinical significance of gado- body,” says Kanal. “They told us it had a Unlike macrocyclic agents, which form linium accumulation?

64 HealthCareBusiness news I march 2016 www.dotmed.com “As of today we simply do not know,” used for what patients. We’re seeing people tissue gadolinium that simply does not regis- says Kanal. switching again based on the potential or ter in the scan. Through autopsies and biop- theoretical concern of retaining more gad- sies, Kanal says work is being done to try and Impacting utilization patterns olinium in the patient’s bodies with some shed some light on that possibility. Kanal says his work as an emergency neu- agents than with others.” “And we don’t even know what form it roradiology specialist has been drastically As long as there are no good alterna- will be in,” says Kanal. “Is it in the form in impacted by the knowledge that gadolinium tives to gadolinium, however, it remains a which it had initially been injected? Did it can accumulate in the brain. “Every single vital part of the radiologist’s toolkit and Kanal disassociate and then re-form?” day of my professional life I now find myself doesn’t expect that to change any time soon. Further, accumulation in the brain is canceling studies that are requested with only part of this issue. It has been known contrast where I don’t believe or agree that More than meets the eye for over a decade that gadolinium from at contrast is indicated,” he says. The gadolinium that we can visualize is visible least some GBCAs is retained in the bone The number of gadolinium-enhanced because it is interacting with water molecules of patient recipients, and that the amount MR exams being conducted — both na- in the brain, thereby shortening the tissue T1 retained there is greater for at least some of tionally and internationally — is decreasing, and brightening its signal to become bright. the linear agents than from at least some of he says. When it is being administered, it is According to Kanal, “That kind of gadolinium the macrocyclic agents. sometimes being done at a lower dose, and is almost across the board water soluble, but For now, according to Kanal, there are often affects the choice or what type/brand we do know there is also water-insoluble gado- simply more questions than answers. Defin- of agent is to be administered. linium in biopsies and autopsies — which very ing the medical implications of gadolinium “Which agents people are using is also likely would not be visible on an MR image.” accumulation — if indeed there are any — is changing,” says Kanal. “Just like we saw That means all the data that is being col- a work in progress that researchers continue with NSF, there were massive changes with lected from MR images is potentially over- to chip away at every day. utilization patterns and which agents were looking an undetectable quantity of retained Share this story: dotmed.com/news/29205

HealthCareBusiness news I march 2016 65 Industry Sector Report: C-arms

GE Healthcare and Philips Healthcare Siemens Cios Alpha have recently come to market with a pleth- ora of tools for fixed C-arms to assist with those types of procedures. The tools have already been proven to shorten procedure time, reduce the amount of contrast needed and improve sensitivity. But the biggest trend in the market is flat panel detectors (FPDs) and when they will become the standard for mobile C-arms. Im- age intensifiers (IIs) are still the mainstream technology, but industry experts believe that will change in the not-so-distant future.

Flat panel or image intensifier? Ziehm Imaging introduced the first C-arm with a FPD in 2006, and since then many other manufacturers have followed suit. Phil- ips received FDA clearance for its Veradius Unity in November 2014, which is its third generation FPD system, and Siemens Health- care introduced a new FPD mobile C-arm at last year’s Radiological Society of North America (RSNA) meeting. Despite the influx of FPD mobile C-arms, IIs still remain the industry standard. The main reason for that is cost — a standard C-arm with a FPD costs between $280,000 and $300,000, and standard systems with an II cost between $120,000 and $170,000, according to MD Buyline. “It mainly depends on [whether] a facility has the money to budget for a flat panel Mobile C-arms: Is system,” says Jamie Dildy, clinical analyst at MD Buyline. “That would be your bigger the era of flat-panel hospitals and facilities that are using the C- arm all of the time.” Another reason that FPDs have not detectors and 3-D caught on in the marketplace is because the market leader, GE Healthcare, hasn’t introduced a mobile C-arm with the technology technology upon us? yet. GE’s OEC systems are the most popular C-arms on the market, according to MD By Lauren Dubinsky Buyline. The global fluoroscopy and mobile C- The field of interventional radiology is “It’s not that we don’t know this tech- arm market was valued at $1.69 billion in growing predominantly due to the fact that nology well, but because we know it well, 2012 and is projected to be worth $2.08 there are new types of minimally-invasive we recognize that we did not feel it was the billion in 2019, according to a Transpar- procedures emerging. There has been a right technology to put on a mobile C-arm ency Market Research report. The growth transition from open aortic surgery to mini- in its current state,” says Linda Molani, re- is mainly being fueled by a rising demand for mally-invasive surgery as well as a trend to- gional product marketing manager of sur- interventional radiology procedures. ward endovascular cancer care. gery at GE.

66 HealthCareBusiness news I march 2016 www.dotmed.com E 1 C 98 IN 2 S

33 Y EARS Industry Sector Report: C-arms

However, GE is currently working on its than it would be on the large C-arms,” the system, but a 3-D mobile C-arm can cost own FPD technology and will introduce it to says Blaustein. around $500,000, according to MD Buyline. the marketplace at some point in the future. The other 3-D C-arms on the market Many industry experts believe that once GE Coming to you in 3-D are Siemens’ Arcadis Orbic 3D, which was introduces its C-arm with an FPD, the indus- In April, Ziehm received FDA clearance for introduced in November 2011, and Philips try will start to move away from IIs. its Ziehm Vision RFD 3D C-arm, which is the Healthcare’s BV Pulsera, which received FDA Even though FPDs have not gained pop- only 3-D C-arm with an FPD that provides a clearance in September 2006. ularity among the full-size mobile C-arms, 16-centimeter edge length per scan volume, Lisa Reid, director of surgery and urol- they are popular among the mini C-arms according to the company. ogy segments for Siemens, thinks that the used for orthopedic imaging. One reason Its flat panel is 30 centimeters by 30 industry will start to become more interested is that the price of mini C-arms with FPD is centimeters and the system is ideally suit- in 3-D technology in the OR in the near fu- significantly less than the price of full-size ed for orthopedics, traumatology, spinal ture. Since the 3-D C-arms can be used for C-arms with FPD. injury as well as cardio-vascular hybrid ap- 2-D and 3-D imaging, it’s more versatile than OrthoScan and Hologic are two manu- plications. It also includes Ziehm Smart- having a CT scanner in the operating room facturers that offer mini C-arm systems. Scan technique, which provides 180-de- and you can use the 3-D C-arms for a variety OrthoScan has recently been pushing gree image information of any anatomical of different procedures. FPDs heavily in the market and has been structure. “These are the types of technologies successful with it, according to Matthew Along with many other modalities includ- customers want — they want to be mo- Blaustein, founder and CEO of Bluestone ing mobile CTs and O-arms, 3-D C-arms are bile, they want to be flexible, they want Diagnostics. entering the surgical operating room. to be versatile in the OR, and save costs, “I think if a customer has money, they The O-arm costs significantly more than but they need these more advanced-type will buy the flat detector. You see the flat a 3-D C-arm. The O-arm can cost up to $1 technologies like flat panel detector and detector being a much more viable option million, depending on the configuration of 3-D,” says Reid.

SUPPORT THAT SUSTAINS. KNOWHOW THAT SAVES.™ SEARCH GO

CALL TOLL-FREE 1.866.818.9729 TO CONNECT WITH CLASSIC! REQUEST A QUOTE SIGNUP FOR E-ALERTS CONTACT US LIVE CHAT

ABOUT US NEWS REFURBISHED IMAGING SYSTEMS REFURBISHED IMAGING PARTS REPLACEMENT IMAGING PARTS CUSTOMER SERVICE

Imaging is REQUEST A QUOTE REFURB IS THE WORD™

Pricing for new and used medical imaging parts is just seconds away and available upon request for all modalities of radiological and biomedical equipment. Simply submit your request here, call us toll-free or connect immediately via live chat — any of our qualied Classic reps will quickly deliver a reliable quote.

Everything FIRST NAME * LAST NAME *

ALL GE AMX IV/IV+ CORD REELS ON SALE ™ EMAIL * PHONE * We Do! OCCUPATION * COMPANY * ADDRESS *

Street Address ASK ABOUT GE AMX TOTAL REFURBISHMENT We get ImagIng. WhIch means... We gOt yOur back. ALLApt, Suite, Bldg.NEW (optional)

City State / Province / Region A WORLD LEADER IN Classic supplies new, refurbished and used medical Postal / Zip Code Country TOTAL REFURB? MODALITY * MANUFACTURER / MODEL * YEP.

imaging equipment and parts to hospitals and service ! WATCH US REFURBISH A PROTEUS RAD ROOM MANUFACTURER / MODEL / SERIES PREFERENCE

companies across the globe. We back the quality of our REQUEST A QUOTE

replacement imaging parts and refurbished imaging brOWse Our aLLREQUEST ne QUOTE W WebsIte! naVIgatIOn sIgn uP FOr emaIL aLerts!

Sitemap First Last

FOR QUALITYLegal Terms NEW AND USED IMAGING CLASSIC DIAGNOSTIC IMAGING Email equipment with rigorous testing, free technical support 1333 HIGHLAND RD. SUITE F MACEDONIA, OHIO 44056 Company FAX: 330.425.4400 EQUIPMENTPHONE: 866.818.9729 AND IMAGING PARTS SIGN UP and an industry-leading 120-Day Warranty for all in-house refurbished parts. Classic© COPYRIGHT 2014 CLASSIC DIAGNOSTIC IMAGING- | MADEImaging BY MOSSMEDIA .com

DOT MED CERTIFIED DOT MED TOP 100 ISO 9001:2008 CERTIFIED TRAINED IN SIX SIGMA

TOLL-FREE U.S. 866.818.9729 INTERNATIONAL 330.425.4400

CDI-HalfPage-Q12015.indd 1 2/12/15 10:06 AM 68 HealthCareBusiness news I march 2016 www.dotmed.com New on the market ing and allowing for more interventional and Valve ASSIST and PCI ASSIST for in- At last year’s RSNA meeting, Siemens in- procedures versus open surgery,” says Mi- terventional cardiology. GE is also adding troduced three new additions to its Cios randa Rasenberg, global interventional its FlightPlan for liver embolization to the family of C-arms — the Cios Fusion, Cios marketing manager at GE. “You see it pre- portfolio. Connect and the Cios Select. Cios Fusion dominantly growing in those two areas — They help to plan, guide and assess the and Cios Connect are still pending FDA the vascular surgery area and interventional most complicated procedures that inter- clearance, but Cios Select received clear- oncology.” ventionalists and surgeons are performing ance in mid-January. At last year’s RSNA meeting, GE intro- today. GE’s FlightPlan, which has been in “We wanted to update our entire prod- duced its new ASSIST software packages clinical use for four years, has been shown in uct line to suit the current market because for interventional imaging. The packages clinical studies to help clinicians better iden- a lot of our customers are looking to cut include Vessel ASSIST for interventional tify tumor-feeding vessels. costs, but as well, they need good C-arms radiology, EVAR ASSIST for vascular sur- The studies found that it provides for things like backups to their interventional gery, Needle ASSIST for bone interventions up to 97 percent improved sensitivity in labs and hybrid OR labs,” says Reid. The Cios Fusion has an FPD and a field of view about 160 percent larger than C- arms with standard IIs, according to the IMAGING AND PAIN company. This system is ideal for orthopedic surgeons because they are imaging the Position for Success MANAGEMENT TABLES hips and knees and want smaller systems to be able to maneuver them into different positions. Save Money With 5 different motions and two top The Cios Connect has II technology and options to choose from, the table can be covers a broad range of applications in the configured to meet any need or budget. medium market segment. It has low service Products are built to last with an industry costs and it is geared toward facilities that leading warranty and service solution. are more budget-conscious and looking for a C-arm that does a little bit of high-end ap- Robust Design plications, but mostly basic surgery. Rock solid lifting column with the highest weight The Cios Select also has II technology and capacity in the industry. was designed for routine clinical use to pro- The large 18” height range facilitates safe patient vide easier access to surgical imaging. It’s transfers and optimal mainly for outpatient and pain management working heights. clinics that perform basic procedures. Starting in January, Siemens introduced an expanded version of its Cios Alpha. It has the revised version of the Cios software, a large preview image on the touchscreen, and metal correction functions for metal components in the image.

Interventional procedures are growing There is also a great deal of innovation tak- PAIN MANAGEMENT LITHOTRIPSY/UROLOGY UROLOGY ing place among the fixed C-arms that are used in cardiac catheterization labs. Both GE and Philips launched new products last year Schedule a meeting with one of our sales professionals to establish to shorten the procedure times and improve Oakworks as your C-Arm imaging outcomes. table contract supplier. “The devices and the techniques applied Position for Success in interventional radiology are really grow-

HealthCareBusiness news I march 2016 69 Industry Sector Report: C-arms

identifying tumor-feeding vessels. In ad- In studies, it has been shown to re- ray images and MR and CT images of the dition, when using the software, there duce the need for contrast by 70 percent patient’s vascular structures. That gives the was an 11 percent reduction in proce- and has shortened procedure times by clinician 3-D, color-coded images of the dure time, and 82 percent of radiologist 18 percent. vessels, which improves real-time visual readers agreed on the identification of VesselNavigator can be used for all types guidance. liver tumor-feeding vessels. of endovascular procedures, but one of its In April, Philips launched its VesselNavi- main applications is guiding the treatment What’s to come? gator for its interventional X-ray systems of aortic aneurysms. It’s difficult to precisely Siemens’ Reid and Ronald Tabaksblat, including its fixed C-arms. It’s Philips’ latest position the stent when using conventional business leader for image-guided therapy innovation in live 3-D catheter navigation X-ray imaging, which leads to more contrast systems at Philips, believe that 3-D imag- to guide minimally-invasive treatments of being used. ing will become more popular in the OR. patients with vascular diseases. VesselNavigator works by fusing live X- Jason Launders, director of operations at ECRI, agrees that there is a big need for 3-D in the OR. “I believe the possibilities of 3-D and CT- like imaging on a C-arm are underutilized,” says Tabaksblat. “Imagine a trauma patient not needing to be transported first to a CT and subsequently to an interventional A new level of image lab, but being sent directly to a hybrid OR quality you would not specifically tailored for this type of patient? expect from a mobile Wouldn’t that provide major benefits in C-arm. time to treatment and less risk of moving the patient?” GE’s Molani thinks that a bigger shift in the marketplace will be in terms of efficiency. “I think the universal need is going to be efficiency and workflow, so that is where Taking care of your X-ray imaging needs. we will be focusing more of our attention,” she says. “Can I really use a mobile C-arm “How can I gain intraoperative ORs are usually crowded, with an abun- for cardiac applications?” confidence in spinal procedures?” dance of equipment that is necessary, but With our specially developed heart Ziehm Vision RFD 3D helps avoid poses ergonomic and safety concerns for program, powerful generators and revision surgeries. With an edge the hospital administrators, directors, staff flat-panel technology our C-arms length of 16 cm it offers a 3D dataset provide best results in the most to confirm the correct implant and surgeons. GE is focusing on OR integra- demanding procedures. position in just 3 minutes. tion to make sure that all of the elements of the OR, including C-arms, work together seamlessly. Most of the experts interviewed agree that FPD will become the standard for mobile C-arms in the future. Cost is one of the main hurdles standing in the way, but that will no longer be an issue when the price of

Visit us at ECR 2016: Find out more: www.ziehm.com the technology goes down. Hall X2, 312 “Image intensifiers will become increasingly expensive and the flat panels will come down in price. They are coming down in price in other areas, so they will come down here,” says Launders. Share this story: dotmed.com/news/29206

70 HealthCareBusiness news I march 2016 www.dotmed.com When is a refurbished C-arm the right decision? By Lauren Dubinsky

However, according to Denholtz, it should be easy to find a local company to provide labor, and the seller of the C-arm should be will- ing to provide the parts. “I would be afraid to buy a C-arm from a firm that would not offer a warranty,” says Denholtz. Is refurbishing always necessary? Gugel told HCB News that from time to time he has been able to purchase late-model C-arms from an estate or an imaging center that has David Denholtz Leon Gugel had to sell because it could no longer compete. Sometimes, these late- model C-arms are in perfect condition and can be sold without any refurbishing at all. This is the exception to the rule, but it is not unheard of. In many facilities, the choice to purchase a refurbished C-arm is Both Denholtz and Gugel agree that there is a place for refurbished made to either save money, bridge the gap until there is a bud- and used C-arms, and if a facility thinks that it might be appropriate get for a new C-arm or to help with backlog. Purchasing a used for them, as long as they do their homework, it could be a perfect fit. C-arm can save anywhere from 20 percent to 60 percent, depending It is important to note that many OEMs offer refurbished C-arms. upon the features. But purchasing the wrong unit can be a big mistake. GE, Philips, Hologic and Siemens all offer refurbished products. There are over 50 companies that sell used C-arms and more than Share this story: dotmed.com/news/29207 12 that offer refurbished C-arms. HealthCare Business News spoke with two individuals in the business of selling refurbished C-arms and their advice mirrors advice most refurbishers would offer. David Denholtz, CEO of Integrity Medical Systems Inc., and Leon Gugel, president of Metropolis In- ternational LLC, had much to say regarding the topic. Denholtz pointed out that refurbishing is a very elastic term. He has devised a 30-point checklist that every C-arm must pass before he makes it available to sell. There are different levels of “refurbishing,” and if a facility is in the market to buy a refurbished C-arm, understanding the refurbishing process is an important part of deciding which vendor to buy from. Denholtz recommends doing business with a company that has invested in the same tools that your physicist would use to test the accuracy of the output.

Seeing is believing Gugel recommends inspecting the C-arm before you buy. Purchasing a refurbished C-arm can save your facility money. Therefore, according to Gugel, it is worth it to invest the time and the expense to test drive the unit before you buy it. You might decide to buy, you might decide not to buy, and you may see something you would like to see tweaked. You would not buy a used car without driving it, and a refurbished C-arm is not any different.

What about a warranty? Denholtz recommends that you might think twice about buying a C-arm from a firm that does not offer any sort of warranty. Some firms might say, “we do not have anyone local, and so it is hard for us to provide a warranty.”

HealthCareBusiness news I march 2016 71 Industry Sector Report: C-arms

DOTmed Registered C-arm Sales & Service Companies For convenient links to these companies, go to www.dotmed.com and enter [DM 29209]. Names in boldface are Premium Listings. Company (domestic) Contact Name City State Certified DM100 ProMed Solutions Greg Kennebeck Los Alamitos CA Pacific Healthcare Imaging Marc Bryan San Diego CA Primary Medical Imaging Ike Balian Burbank CA Imaging3 Inc. Becky Mullens Burbank CA Toshiba Tustin CA Multi Surgical Solutions Kristopher Derentz Ontario CA • Hi Tech Int'l Group Moshe Alkalay Deerfield Beach FL • United Medical Technologies John Pereira Fort Myers FL Amber Diagnostics Robert Serros Orlando FL • Integrity Medical Systems, Inc. David Denholtz Fort Myers FL • • Health Care Export Peter Ehrlich Miami FL • • Clinical Imaging Systems Ryan Gilday Palm Beach Gardens FL • • Medilab Global Corp. Rodrigo Henao Miami FL • • Rytex Industris Patrick McBride Largo FL • Imaging Resources Larry Sprague Martinez GA ChicagoMedX Robert Iravani Chicago IL Mini C Sales Fred Morgenstern Northbrook IL Hologic Bedford MA Whale Imaging Jeff Normand Waltham MA Eastern Diagnostic Imaging Dan Bond Taunton MA MedExchange Davyn Mcguire Agawam MA • Columbia Imaging Inc. Wayne Horsman Columbia MD American Radiology Resource David Pac Timonium MD • • Block Imaging International, Inc. Chris Sharrock Holt MI • Complete Medical Services Tony Orlando Sterling Heights MI • • Grand River Diagnostics David Spees Rockford MI Global Inventory Management Alison Fortin Dover NH •

72 HealthCareBusiness news I march 2016 www.dotmed.com Company (domestic) Contact Name City State Certified DM100 Nationwide Imaging Services Robert Manetta Manasquan NJ • • Atlantis Worldwide, LLC Jeff Weiss New York NY Bluestone Diagnostics, Inc. Matthew Blaustein Thornwood NY • Metropolis International Leon Gugel Long Island City NY • Surgical Imaging Associates, LLC Gordon Frye Northport NY Bayshore Medical Equipment, Inc. John Kolleger Ronkonkoma NY • • Biodex Medical Systems, Inc. Shirley NY Tandem Medical Equipment Ian Alpert Bohemia NY • • Crown Medical Systems Brian Schumer Brooklyn NY • RSTI Terry Speth Solon OH • UDR Conversion Tony Smith Macedonia OH • Classic Imaging Melany Eckstein Macedonia OH • • CapMed+ Ric Arcadi Solon OH GEMSS North America Gary Kohler Hamburg PA Siemens Malvern PA Shox Surgical Hugo McGillian Glenn Mills PA Carolina Radiology Solutions Tray Collins Cayce SC Remesta Medical Corp. Michael Baumgartner Knoxville TN • MES, Inc. Renee Oberle Denton TX TransAmerican Medical Imaging Robert Woodward Lindon UT Worldwide Medical System Scott Tawzer Huntsville UT Philips Bothell WA GE Wauwatosa WI

Company-International Name City Country Certified DM 100 ANDA Medical David Lapenat Ontario Canada • • FlexRay Medical Mads Vittrup Noerresundby Denmark • • Ziehm Imaging Martin Ringholz Nuremberg Germany Mediproma B.V. Rick Meerkerk Nieuw Lekkerland Netherlands • •

Companies are listed alphabetically by state and country.

HealthCareBusiness news I march 2016 73 Industry Sector Report: C-arms Q&A with Gustavo Perez-Fernandez and Lisa Reid By Lauren Dubinsky

Lisa Reid types of procedures, then they should consider a smaller C-arm. You don’t quite need as much power because you’re not X-raying soft tissue. If they are doing a lot of vascular, gastro- intestinal and urology procedures then they might want a bigger, more powerful type of C-arm. They should make sure that they are getting the right kind of C-arms for the procedures they are performing.

HCB News: What are some ways a Gustavo Perez- hospital can cut costs when purchasing Fernandez a new C-arm? GPF: On one side, it’s ensuring that they When a hospital is looking to purchase GPF: That really depends on the specific have enough versatility in the solutions they a new mobile C-arm, it can be a chal- clinical needs and financial situation of the are looking to purchase to satisfy the specific lenging experience, especially since cut- facility. Once you gather that information, clinical task, but it’s also important to make ting costs and improving outcomes is you can analyze the individual needs and sure the technology accommodates their governing their decisions. Mobile C-arms challenges of the customer, and provide op- case mix. with flat-panel detectors can cost between tions to satisfy what’s needed. By encouraging them to take a close look $280,000 and $300,000, and those with We believe that hospitals should not in- at their broad mix of cases, it’s important to image intensifiers can be between $120,000 vest in technology for the sake of technol- ensure a level of standardization exists that and $170,000, according to MD Buyline. ogy, especially when certain functionality allows the hospital to achieve economies of There are many features to choose from and features are not needed. At GE, our scale on supporting the infrastructure. Ex- and the issue of radiation dose must be kept team is composed of registered radiology amples of that include training for the tech- in mind. The service that comes along with technologists that understand our custom- nologists, the cost of running the operation the system is also something important to ers’ needs and can help them determine the and familiarity with the ergonomics. think about. best solution. The two areas that we think hospitals Many vendors, including GE Healthcare We consider factors like the number of should look at are having solutions that are and Siemens Healthcare, aim to be a com- operating rooms they have to accommo- versatile, but also achieving a level of stan- plete solution for all of a hospital’s needs. date, the volume and diversity of cases and dardization within their fleet. Gustavo Perez-Fernandez, the president budget. Based on all of that information, we LR: Once they have decided what their of surgery at GE, and Lisa Reid, director of build a tailored solution for the hospital. procedure mix is, they should diversify the the surgery and urology segments at Siemens LR: When you look at C-arms, most fleet. We sell image intensifier systems, Healthcare, spoke with HealthCare Business companies have over three different mod- which are a little less expensive and a little News about the questions a hospital should els. While they all pretty much do the same less powerful, all the way up to high-end flat keep in mind when purchasing a new C-arm. things, of course, some perform different panel and vascular systems. procedures better. They should look at how many of the dif- HCB News: When a hospital is pur- One of the things I would think would ferent types of procedures they are doing, chasing a new C-arm, what questions be important is what types of surgery proce- and then purchase different types of sys- must be asked? dures they are doing. If it’s mostly orthopedic tems, so they can utilize them appropriately

74 HealthCareBusiness news I march 2016 www.dotmed.com and then save money by purchasing some LR: I know more hospitals are looking Also, these types of systems can be back- lower-cost C-arms. at doing minimally-invasive vascular proce- ups to hybrid operating rooms or any type If they are evaluating whether they need dures, which have their own set of needs. of fixed fluoroscopy room. This saves money 3-D imaging in the operating room, they If these are the types of procedures they as well, if you’re thinking about whether should consider looking at 3-D C-arms if they are doing, then flat-panel detectors are one you need another angiography lab and how are looking to save money, not necessarily go- of the things they should definitely consider. much you’ll be able to accommodate it. ing with a [mobile] CT. Depending on the pro- It is a little bit more cost, but the flat-panel If they have some overflow of patients cedure mix and how many procedures they detector systems give better image qual- then maybe they can just use a vascular are doing, sometimes a 3-D C-arm might be ity and they have better gray scale, so that flat-panel detector system to accommodate perfectly suitable for what they need. when they are doing vascular procedures, those studies. they can better visualize the catheter and Share this story: dotmed.com/news/29208 HCB News: How is the technology guidewires. that mitigates dose concerns evolving? GPF: We should not be looking at dose alone — it’s really an image quality/dose equation. We believe that the answer is a combination of an optimized image chain and enabling users to achieve the expertise required to make full use of it. The answer is not simply to add more raw power. We truly believe that the right answer is to achieve a balanced image quality/dose equation. We are investing in a number of technologies around next-generation, low-dose flat panel detectors that will provide our customers with the high image quality they have come to expect. Ultimately, it’s not just about technology, but rather having clinically relevant technology in combination with the users’ expertise that will deliver on the promise of better image quality at low dose. LR: I think the companies are moving toward more pulse fluoroscopy instead of continuous fluoroscopy, and that can significantly decrease the dose. They are also offering a lot of features like radiation-free collimation — being able to collimate off the last image that they have acquired — and newer algorithms and filters that can help reduce dose, but maintain image quality.

HCB News: What are the essential C- arm features that a hospital on a budget should spend the extra money on? GPF: I have a broad definition of “features.” There are “product features” that allow the surgeons to be more efficient at their jobs — aspects such as image quality, dose management and system reliability, all of which are critical for a clinician to accomplish that efficiency.

HealthCareBusiness news I march 2016 75 IndustryIndustry Sector Sector Report: Report: Mobile C-arms C-arms & C-arm Tables

DOTmed NEW DOTmed asked mobile C-arm and C-arm Table manufacturers to submit up to three of their EQUIPMENT current products to be featured in this Guide. To learn more about these systems and see GUIDE other models not shown, please visit the Equipment Guide in DOTmed’s Virtual Trade MOBILE C-ARMS Show, or go to: www.dotmed.com/c-arm. We also invite you to rate these products online. & C-ARM TABLE

GE Healthcare / Hologic / Fluoroscan InSight FD OrthoScan Mobile DI OEC Brivo Plus Designed to meet the challenges of Portable Digital Diagnostic Imaging The affordability and mobility of the extremity imaging, the InSight FD Mini & Fluoroscopy OEC Brivo Plus C-arm has the ability to C-Arm allows you to: See more detail • Portable, Light Weight: 35 lb unit transform health care in private practices and from a distance when viewing larger and easily moved between patient rooms rural hospitals simply by increasing access brighter images on our new 24” HD color and clinics to quality mobile imaging. The familiar widescreen display, change positioning • Flat Detector Technology: Capable of interface makes working, maneuvering, to best suit anatomy and optimize patient dose with our still images and fluoro for extremity imaging and connecting easy and productive. It easily brings rotating flat detector, image at up to 38% less dose than • Optimal Positioning: Easy access to shoulders, weight- images into sharp focus using intelligent point-and-shoot the competition – without the need for pulsed fluoroscopy. bearing knee/foot views technology. • Improved Workflow: Secondary imaging source reduces Image Diagnostics, Inc. / patient wait times GE Healthcare / IDI MDS Video Integration System • Connectivity: DICOM, EMR, USB, Wireless OEC Elite + GE Venue 50 tablet The Aspect MDS Video Integration System • Increased Reimbursement: Allows for additional For the first time, surgeons and is a mobile solution for the display and procedures, established CPT codes physicians can access fluoroscopy and image management of C-Arm images and ultrasound in a single workstation, to help other modalities in the OR. Combined with Philips Healthcare/Veradius maximize efficiencies in OR workflow, floor touchscreen table routing, the MDS displays Unity space and costs. This new system combines your C-Arm images on high definition (HD) monitors Veradius Unity has re-defined workflow the power, precision and performance of the mounted on counterbalanced articulating arms that have during surgical imaging by establishing OEC 9900 Elite C-arm with the simple-to-use GE Venue extraordinary range of motion and positioning. exceptional communication between the 40 tablet ultrasound to help see more during surgical physician, operator and C-arm. ClearGuide procedures. MEDTRONIC / Medtronic O-Arm ® and color coding on the C-arm enables easy positioning, The Medtronic O-arm surgical and the ability to store previous positions reduces GEMSS / SPINEL 3G imaging system, a cone-beam CT repositioning time by 42%. Outlining is made simple with This new high-performance mobile device, is designed to provide optimized a tool that allows you to draw on the touchscreen of the surgical C-arm features an expanded 135° 2D and 3D images to meet surgical Mobile Viewing Station using a stylus pen or finger. With orbital rotation, larger 800mm free space, decision-making needs while resolving multiple OR tablet-like simplicity and ample room for patient access, the premium cart with twin elevating 19” LCD workflow challenges. The O-arm system, when used with multi-purpose system also provides a full-range of dose monitors and smart CXView software with ® StealthStation navigation, is an efficient surgical imaging management features and exceptional image quality thanks DSA cine peripheral angiography functions and virtual solution that can potentially save OR time and save extra to the high dynamic range of the Trixell detector. collimation. The 300kHU rotating anode tube supports a peripheral capital equipment costs (e.g. no special table wide exposure range with Boost Mode (up to 20mA) and required). Visit www.oarm.com for more information. Philips Healthcare / Veradius Neo Pulse Mode (up to 30FPS). Back-Up Fluoro and RAID 1 Power: 15 kW Field of view: 26.2 x storage and 2-year warranty. Omega Medical Imaging/ Omega Single Plane CS-60 26.2 cm Highlights: · True multi purpose top-end system GEMSS / SPINEL 12HD The compact design, ease of with flat detector Our flagship C-arm is equipped with use, and proven performance of · Optimized C-arm geometry with 73 cm C depth a 15.3” Dynamic Flat Panel Detector our systems is ideal for any room. · Super thin flat detector frees up valuable space and boasts wider free space (880mm), Single and dual plane systems come · Superb image contrast thanks to high dynamic range of expanded orbital range (-120°/+45°), equipped with flat panel detectors, powerful cardiac digital Trixell detector wider SID (1110mm) and low ISO Center imaging systems, high definition image capture and large · State-of-the-art wireless data communication with RIS/HIS (910mm). GEMSS Smart Angio Package includes 56’ & 60’ displays. Systems come with full DICOM DSA, Roadmap, Re-Mask, Pixel-Shift, Max Peak and Networking standard. All systems are fully customizable, Philips Healthcare / Minimum Opacification, and Bone Landmarking plus Metal with flexible patient table options and hybrid applications. BV Pulsera Detection, IODC, ABC and Virtual Collimation. Back-up Power: 15 kW Fluoro, RAID 1, Premium Cart, third monitor, two-way laser OrthoScan FD Pulse II-Format: 31 / 23 / 17 cm and 2-year warranty. The first and only mini c-arm with Highlights: pulsed fluoroscopy. • An interventional powerhouse GEMSS / KMC 650 • Reduced Dose: Selectable pulses covering the widest range of The latest GEMSS C-arm is versatile, per second depending upon imaging applications, including cardiac interventions compact, and economical with advanced needs • SmartVision – a fully digital imaging chain including functionality featuring expanded 31.5” • Largest Flat Detector: Square-shape CMOS detector powerful image processing functions free space, 27.2” arc depth, 39.3” SID provides greatest field of view; users see more anatomy • High quality images at a low dose, time after time Pulsed and a greater orbital range (-90°/+45°). • Surgical LED Lights: Reduces shadows, illuminating acquisition 30 pulses / sec 2kW/40kHz high frequency monoblock generator and anatomical detail • Rotating anode power next generation software provide excellent high resolution • 150° Orbital Rotation: enables preferred views without imaging, dose management and increased functionality to stressing anatomy promote safety and improved workflows. Coupled with our • Flat-Form Detector: thinnest flat detector housing on the two-year parts warranty that includes glassware, it’s the market clear winner for small budgets.

76 HealthCareBusiness news I march 2016 www.dotmed.com Siemens Healthcare / ARCADIS Ziehm / Vision RFD 3D GLOBAL STAR MEDICAL / Orbic 3D Ziehm Vision RFD 3D* is the only 2000 ECONOMY The ARCADIS Orbic 3D mobile 3D C-arm worldwide with flat-panel This cost effective c-leg style table is C-arm is capable of performing technology that provides a 16 cm edge manufactured in a long tradition of high quality intraoperative 3D imaging in spine, length per scan volume. It combines 2D and durability. Bariatric rated at 650 lbs patient orthopedics and trauma surgery. The and 3D functionality to offer maximum ease-of-use. capacity. 35” fixed height table. Standard 2” thick premium system’s intraoperative imaging – performed in under 30 Available with 30 cm. x 30 cm or 20 cm x 20 cm. flat- foam pad. 5” swivel locking casters with top lock. seconds – allows enhanced surgical precision in the OR. panels, the C-arm offers game-changing 3D imaging The system requires less positioning due to its isocentric and is ideally suited for orthopedics, traumatology and Image Diagnostics, Inc / design and 190-degree orbital movement, leading to time spinal surgery, but also for demanding cardio-vascular 100UCPLUS Urology table and dose savings. hybrid applications. The Aspect 100UCPLUS mobile urological imaging table is the best selling urology table Siemens Healthcare/ on the market, delivering fixed table capacity Cios Alpha C-ARM TABLES in a mobile solution. The Aspect 100UCPlus The Cios Alpha mobile C-arm system provides a large radiolucent imaging area with 30 cm x 30 cm Full View flat-panel Biodex/ Surgical C-Arm Table 840 for easy C-Arm access and greater anatomical coverage. detector has a 25 kW power output The Biodex Surgical C-Arm Table 840 Urological accessories are easily removable so the table and a field of view that is up offers a choice of tabletop styles. The can be quickly configured for multi-purpose C-Arm imaging vto 25 percent larger than conventional C-arms. Designed standard contoured top provides ample or general patient positioning for non-urological procedures. to cover general surgery to the most advanced procedures workspace for anesthesiologists, yet (including vascular and cardiac), the Cios Alpha has a the narrowness required for cervical procedures. The Image Diagnostics, Inc. / Aspect user-friendly touch screen interface, a unique position rectangular top offers additional space for superior ISR G2 Vascular Imaging Table storage feature, and an active cooling system that helps image quality during long-leg runoff studies. Functional The Aspect ISR table for vascular to ensure exceptional image quality during prolonged design provides complete access with reduced and interventional procedures is IDI’s interventions. radiation exposure to clinicians. Select from functional most advanced C-Arm imaging table. accessories. It delivers extended positioning and Siemens Healthcare / imaging capabilities at an affordable price. The ISR has 32” Cios Connect Biodex / 3D Imaging C-Arm of tabletop float for very large anatomical imaging New, lightweight, easy-to-maneuver Table 820 coverage without C-Arm movement. 4-way Manual-Float C-arm weighs only 545 lbs. and The Biodex 3D Imaging C-Arm Table Tabletop, Motorized Elevation, Iso-Roll, Trendelenburg tilt & provides many high-end features of a 820 is designed and equipped for use Reverse Trendelenburg Tilt, choice of tabletops. multifunctional C-arm at a lower cost. with 3D C-Arms for seed implantation, Addresses all main surgical disciplines, including vascular urology, thoracic/vascular and other general C-Arm Oakworks Medical - CFPMB301 with subtraction and pulsed fluoroscopy. Accommodates applications. Functional design provides complete Oakworks Inc. has worked with top larger patients with the free space of a larger C-arm. access with minimal radiation exposure to clinicians. medical professionals to create the Designed to image larger patients, even for spine The 820 is equipped with a lightweight, non-imaging CFPMB301, a three motion table with a 750 procedures, without power concerns. Removable anti- patient transfer extension, a radiolucent extension and lb. weight capacity. This, combined with a scatter grid enables user to provide pediatric treatment a standard OR accessory rail located at the foot end. low 26.5” height creates the combination that facilities need. with low radiation dose. CFPMB301 features powered height, longitudinal travel and Biodex / lateral travel. The CFPMB301 is ideal for pain management Ziehm / Vision Urology C-Arm Table 800 practices, surgical centers and other multi-disciplinary RFD Hybrid Edition The Biodex Urology C-Arm Table 800 medical facilities. This is the first mobile C-arm is an ideal choice for image-guided offering motorization of all 4 axes. The procedures. The narrow Fiberesin™ Oakworks Medical – Lithotripsy/ movements can be accurately steered tabletop is cantilevered to accommodate portable Urology Table – CFLU401 with the Position Control Center, saving or ceiling suspended C-Arms. Radiolucent areas The CFLU401 is the most versatile valuable time during surgery. The 25 kW generator is one are free of cross members, allowing full fluoroscopic table on the market! Convert the table to of the most powerful on the mobile market and delivers visualization and unobstructed C-Arm positioning. a full featured Lithotripsy table in seconds. crystal-clear images. With flat-panel detectors measuring Functional design provides complete access while The radiolucent table top and 6 extensions 20 cm x 20 cm and 30 cm x 30 cm, this C-arm is ideal for minimizing radiation exposure to clinicians. www. are designed to work with most portable lithotripters and complex interventions in cardiology, cardiac and vascular biodex.com/imagingtables C-Arms. surgery. *The Hybrid Edition represents optional hardware The table features a 500 lb. patient weight capacity and and software that creates an option package for the Ziehm GLOBAL STAR MEDICAL / 4 powered motions – height, Trendelenburg, longitudinal Vision RFD. HLT PLATINUM and lateral travel. The Durabuilt PMT 8000 HLT Platinum Ziehm / Vision RFD series table contains three of the most used Stille/The Stille imagiQ2 Ziehm Vision RFD, with its 30 cm x movements, a 50 month warranty, 18” of The Stille imagiQ2 has an ultra- 30 cm flat-panel detector, provides height range (24”-43”), a 650 lbs. patient weight capacity, transparent, carbon fiber top (.4mm Al) a field of view that is up to 2.5 times and standard 2” pads. Available with four standard offering the industry’s lowest attenuation to larger than that of conventional 9” image carbon fiber tabletop configurations and one cost efficient enable reduced dose and improved image intensifiers. Ziehm Vision RFD also delivers a higher composite, as well as custom configurations. quality. The extended float capabilities resolution thanks to its 1.5 k x 1.5 k image matrix. The GLOBAL STAR MEDICAL / and long tabletop allow for full imaging head to toe. The powerful monoblock generator with its unique liquid 8000 HLTES UROLOGY imagiQ2 range of functionality and slim design helps cooling system is specially designed for extended use The urology package is available in reduce C-arm adjustments. True Free Float™ technology, in operating theaters. It is also a perfect fit for vascular many combinations of Height, Lateral, Full imaging capability up to 6’4” (with headrest), Float procedures, interventional radiology and hybrid room Trendelenburg, Extend, and side-to-side capacity 36” lateral, Elevation range 28-43”, Isocentric roll applications. movements. Low profile frontal base design 15º, Trendelenburg 25º, Patient weight capacity up to to prevent C-arm damage. Large selection of accessories 661lbs (with upgrade). available and compatible with most other accessories. Best specifications, 650 lb capacity, and longest warranty in the industry. Shown with optional fluoroscopy extension providing 56” of imaging.

HealthCareBusiness news I march 2016 77 DOTmed 100 DOTmed 100 Equipment Sellers The following list is based on a combination of the number of ratings and average score companies received from individuals who had transactions with them that were conducted through DOTmed during the 2015 calendar year. The order of the list is based on positive feedback, with those receiving the most positive feedback at the top. Those at the bottom of the list didn’t necessarily receive any negative feedback. They may have just received less feedback overall. A red dot in a company’s column indicates that they are also DOTmed Certified. DOTmed’s Company State DOTmed Certified Company Type Townsend Surgical TN ISO CosmeticLasers.com FL • Dealer Terrain Biomedical & Consulting IL • Dealer 5-Star Rating Quest Medical Supply, Inc. FL • Dealer International Medical Equipment Inc MI • Dealer R VENTURES MEDICAL INC GA • Dealer Duraline Systems NY • Dealer System Brings Oxford Instruments Healthcare MI • Manufacturer Physicians Resource Network MA • Dealer Gopher Medical, Inc. MN • Dealer ‘The Cream’ AA Medical Store IL Dealer FB Eye Equipments, Inc. FL • Broker COMPLETE MEDICAL SERVICES MI • Dealer Colossus Medical GA • Dealer to the Top GSMED FL • Dealer Quest Medical Equipment Inc FL • Dealer Image Technology Consulting, LLC TX • Dealer ADVANCED ULTRASOUND ELECTRONICS OK • Dealer The DOTmed 100 embody the best of business Kingsbridge Healthcare CA • Dealer professionalism and are the most highly ranked Hospital Equipment 4 U NC Dealer Medical Best Buy MI • Dealer companies on DOTmed as rated by their peers. Magnetic Resonance Technologies OH • Dealer We are proud to present the Class of 2016. Danan Medical Systems FL • Dealer Pacific Medical LLC CA • Dealer If you’re in the market for any medical Endoscopy Specialists, Inc. FL • Dealer Masterfit Medical TN • Dealer equipment or service, the companies on the NorthWest Supply WA • Dealer following pages should be on your short list Doctors Depot, Inc. FL ISO Block Imaging MI • Dealer of contenders. They have been proven to of- MEDiSURG IN Broker Ganim Medical OH • Dealer fer integrity, responsiveness and dedication to Redstone Healthcare IL • Broker superior customer service. Requests International CA • Dealer Health Care Exports, Inc. FL • Dealer Here you will find leading Equipment Sell- Didage Sales Company, Inc. IN • Dealer ers, International Equipment Sellers and Parts Heartland Ultrasound IN • Dealer Ultra Solutions, LLC CA • Dealer Sellers. The list of Original Equipment Manu- JLS MedEquip FL • Dealer United Medical Suppliers Inc NC • Dealer facturers is composed of publicly traded com- Danan Endoscopy Systems, Co. FL • Dealer panies with multimillion to multibillion-dollar SakoMed CA Dealer COAST TO COAST MEDICAL MA • Dealer yearly sales numbers. Medicka MN Dealer KMA Remarketing PA Dealer The OEM list was built upon last year’s list No Insurance Medical NJ • Dealer with facts and figures updated. With the ex- INCAV FL • Dealer Monet Medical UT • Dealer ception of the OEMs, which we’ve provided Spectrum Surgical Solutions IL • Dealer website addresses for, companies found on Classic Diagnostic Imaging, LLC OH • Dealer Integrity Medical Systems, Inc. FL • Dealer these lists can be contacted through DOTmed. MTM Medical Inc. FL Broker PhiGEM Parts, Inc. NY • Dealer com — with many companies maintaining a Medical Equipment Dynamics, Inc. MA • Dealer DOTmed Virtual Trade Show Booth and Web- Medical Laser Resources LLC MI Broker Optimum Medical Imaging NY • Dealer Store. We hope you find these lists useful and Bay Shore Medical NY • Broker Prime Medical Instruments, Inc. CA • Dealer we welcome your feedback. Certified Endoscopy Products LLC IL • Dealer If you do business with a company on DOT- ZURICH CORPORATION FL • Broker American Radiology Resource MD • Broker med, be sure to rate them using our 5-Star Rat- Medeco ID • Dealer ing System. DOTmed is a community, and by METROMEDICAL IND. INC. CT • Dealer A. Imaging Solutions AL • Dealer offering feedback you help to make it stronger Dobbs Medical Sales, Inc. TX Dealer Capital Medical Resources MI • ISO and better for everyone. W7 Global, LLC. IN • Dealer Tandem Medical Equipment, Inc. NY • Broker Bemes, Inc. NJ • Dealer

78 HealthCareBusiness news I march 2016 www.dotmed.com Company State DOTmed Certified Company Type Elite Medical NY Broker Lex-Tech, Inc. NY • Dealer GLOBAL DSR FL • Dealer DCSP Medical OH • Dealer Sound Medical Equipment NY • Broker SH Medical Corp FL • Dealer Venture Medical ReQuip, Inc. FL • Dealer Pro Scope Systems OH • Dealer Rytel International L.L.C. OH • Dealer Global Med Systems NY • Dealer Laproman Endoserv LLC MI • Dealer ElecoTek, INC IL • Dealer HMB Endoscopy Products FL • Dealer Jet Medical Electronics CA • Dealer Premier Medical CA • Dealer DirectMed Parts MN • Dealer Equipment Sales International LLC CO • Dealer National Ultrasound GA • Dealer Flex endo MI • Dealer Radiology Solutions LLC MI • Dealer Better Imaging Solutions, Inc. AZ Dealer Medilab Global Corp. FL • Dealer Focused Medical Equipment FL • Dealer Nationwide Imaging Services Inc NJ Dealer Selcon Business Solutions LLC FL • Dealer Medical Laser Consultants FL • ISO EndocorpUSA MI • Dealer Integris Equipment NY • Dealer Absolute Medical NY • Dealer Probo Medical IN Dealer DXE MEDICAL TN • ISO State of the Art Medical KY Broker Beta Medical FL Dealer 1 Atlas O.E., LLC FL • ISO Tecnicare Healthcare Co. FL Dealer Outfront Medical, LLC NJ • Dealer Midwest Medical LLC MN • Dealer Med-E-Quip Locators, Inc. MO • Dealer Artec Group Services, LLC FL • Dealer C.A.C. Medical Sales Corp. FL • Dealer A+ Medical Company, Inc. SC • Dealer Vomark Technologies Inc. IL • Dealer SOS Medical Imaging NC • ISO Anamika Medical NY • Dealer Laser Locators FL • Dealer Current Solutions CA • Broker Southwest Medical Resources CA • ISO Auxo Medical VA Dealer Trisonics PA Dealer MRI Depot FL • Dealer Altima Diagnostic Imaging Solutions, LLC TX • ISO Capital Medical Equipment NJ • Broker Global Medical Parts on Line MO • Dealer Supply4GI MN • ISO iSurgical IL • Dealer Choice Medical Systems, Inc. FL • Dealer The Alternative Source Medical IL Dealer Clinical Imaging Systems, Inc. FL Dealer Gale Medical, LLC GA • Dealer RSTI OH • Dealer The Laser Warehouse FL • Dealer Imaging Associates Inc. NC Dealer 0 Cameron Medical LLC NC • Broker Amber Diagnostics FL • Dealer USOC Medical CA ISO Rytex industries inc. FL • ISO MSTxs SC • Dealer Predictable Surgical LLC OH • Dealer

International Company Country DOTmed Certified Company Type AGITO Medical Denmark • Dealer Niranjan Ultrasound India (P) Ltd. India • Dealer Cervius Medical Denmark • Broker PRAISTON Poland • Dealer Everest Medical Solutions (HK) Co., Ltd. Hong Kong • Exporter Medsystems Poland • Dealer Stewart Medical, Inc. Canada • Dealer FAMECO gme France Dealer ITRIS Tradmed Switzerland • Dealer Mediproma B.V. Netherlands • ISO LBN Medical Denmark • Dealer MED & IT Trading Germany Dealer continued on next page 0HealthCareBusiness news I march 2016 79 DOTmed 100 continued from previous page

International Company Country DOTmed Certified Company Type Ginwon Medical Co.,Ltd. South Korea • Dealer Hospital Equipment Services BV Netherlands • Exporter ANDA Medical Canada • Dealer B49 MEDICAL SOLUTIONS United Kingdom Broker Dr MEDICA United Kingdom • Dealer FlexRay Medical Denmark • Dealer ElsMed Ltd & Relaxation Inc Israel • ISO Bazzimed Lebanon • Dealer MEDLIKIM France • Broker Anatolia International Trading FZE United Arab Emirates • Dealer DODODO Medical Equipment Service Co., Ltd. China • ISO Equipment Sellers Logic S.r.l. Italy • Dealer sitwat medical Pakistan • Dealer VET-TRADE France • Dealer (International) INTRASYSS India • Dealer Transducers-International Netherlands • Broker DOTmed 100 is global and the companies list- AHLS GmbH Austria Dealer ed are the top-rated international companies AP Biomedical Engineer Dominican Republic • Dealer BOND JAPAN CO.,LTD. Japan • Exporter on DOTmed.com based on the combined Med Equip Inc Canada • Dealer number of ratings and average score. The MEDSER Medical Services GmbH & Co. KG Germany • ISO Sananova SRL Romania Medical Office order of the list is based on positive feedback, Avensys UK Ltd United Kingdom Exporter with those receiving the most positive Emico medika Lithuania • ISO FOCUS IMAGING SYSTEMS India • Dealer feedback at the top. Hindland Equipment India • ISO Lviv Ukraine Dealer Man Machine Electronics India • Exporter MEDEX South Korea • Exporter MSG GmbH Germany Dealer NEW VISION MEDITEC CO., LIMITED China Manufacturer WELPO GmbH Germany ISO All4laser Portugal Dealer EngineerExchange United Kingdom • ISO M.C. Medical Ltd United Kingdom • Dealer Raynor Shine Ent Canada • Dealer DOTmed Top100 Parts Companies The DOTmed top 100 Parts Companies list is compiled based on a combination of the number of ratings and average score of those ratings from transactions conducted on DOTmed.com during the 2015 calendar year. All companies below are DOTmed Gold Parts Vendors(GPV) and have received at least five positive ratings over the past year. Some companies on the list have thousands of parts listed on DOTmed, some just a few. We’ve included a “specialty” column to help you find what you’re looking for. The order of the list is based on positive feedback, with those receiving the most positive feedback at the top.

Company State Type Specialty Townsend Surgical TN ISO Endoscope, cytoscope, light source Terrain Biomedical & Consulting IL Dealer Biomed, EKG, defib, O/R, sterilizers, monitors Duraline Systems NY Dealer Autoclave tabletop and dry heat sterilizers PRN MA Dealer Operating room Complete Medical Services MI Dealer Bone densitometer, C-arm, X-ray, CT and Cath lab tubes GSMED FL Dealer Ultrasound Hospital Equipment 4 U NC Dealer Hospital bed and stretcher parts Image Technology Consulting, LLC TX Dealer MRI and CT, MKS Amps Block Imaging MI Dealer Imaging/radiology Ultra Solutions, LLC CA Dealer Ultrasound SakoMed CA Dealer Defibrillator, Pulse Oximeter Classic Diagnostic Imaging, LLC OH Dealer C-arm, chest X-ray, mammo units Integrity Medical Systems, Inc. FL Dealer Bone densitometers, MRI and CT scanners Medical Equipment Dynamics, Inc. MA Dealer Anesthesia monitors and machines, OR microscopes PhiGEM Parts, Inc. NY Dealer GE X-ray parts, Philips X-ray and CT parts Masterfit Medical TN Dealer Defibrillator and AED METROMEDICAL IND. INC. CT Dealer Endoscopy

80 HealthCareBusiness news I march 2016 www.dotmed.com Company State Type Specialty W7 Global, LLC. IN Dealer CT, MRI, C-Arm, PET/CT, Nuc, Cath/Angio, Mammo, U/S ADVANCED ULTRASOUND ELECTRONICS OK Dealer Probes, boards, membranes, etc. Medeco ID Dealer Monitors Pro Scope Systems OH Dealer Endoscopy National Ultrasound GA Dealer Ultrasound Better Imaging Solutions, Inc. AZ Dealer Ultrasound systems, probes and parts Focused Medical Equipment FL Dealer Ultrasound Medilab Global Corp. FL Dealer Imaging Absolute Medical NY Dealer Biomed Nationwide Imaging Services Inc NJ Dealer MR, CT, C-arm, cath lab, ultrasound Tecnicare Healthcare Co. FL Dealer GE, Philips and Samsung parts A+ Medical Company, Inc. SC Dealer Rad room, rad/fluoro, rad/tomo Anamika Medical NY Dealer CR Authorized Acquisitions LLC. IL Broker Biomed, Surgical Med-E-Quip Locators, Inc. MO Dealer Pump IV infusion, PCA, controller Southwest Medical Resources CA ISO MRI, CT, X-ray Tubes Trisonics PA Dealer Ultrasound Vomark Technologies Inc. IL Dealer Ultrasound parts and transducers Altima Diagnostic Imaging Solutions, LLC TX ISO Siemens MRI and CT Bemes, Inc. NJ Dealer Ventilator, oxygen monitor, stress tests Global Medical Parts on Line MO Dealer O/R, Biomed, Endoscopy Amber Diagnostics FL Dealer C-arm, MRI scanner, mammo units Clinical Imaging Systems, Inc. FL Dealer CT, X-ray Tubes, Cath/Angio, MRI parts & coils Gale Medical, LLC GA Dealer Ultrasound Imaging Associates Inc. NC Dealer Ultrasound parts, transducers and accessories RSTI OH Dealer Diagnostic imaging parts Rytex industries inc. FL ISO Siemens Imaging/Radiology/X-ray The Laser Warehouse FL Dealer Laser - Co2 and Yag, liposuction units USOC Medical CA ISO Monitors, infusion pumps, transducers, biomed KEI MED PARTS TX Dealer MRI & CT Philips, Picker, Macroni & Siemens MFI Medical CA Dealer Neurology, ENT, OB/GYN, dental, surgery, endoscopy, EMS Sunshine State Medical Equipment LLC FL Dealer Monitors, defibrillators, pulse oximeters, fetal monitors Northwest Ultrasound, Inc. WA Dealer Ultrasound systems, transducers, parts United Medical Instruments CA Dealer Ultrasound DirectMed Parts MN Dealer MRI parts and coils, CT parts Global Medical Imaging NC Dealer Ultrasound, Nuclear Medicine JDI Solutions, Inc. CA ISO MRI and CT, Mobiles Viable Med Services, Inc. CA ISO MRI scanners and coils, PET camera/scanner All Imaging Systems CA Dealer Ultrasound parts and transducers Associated Imaging Services KS ISO Molecular imaging BMX-RAY INC. FL Dealer Siemens X-ray parts C&C Medical Solutions Inc. IN Dealer Ultrasound transducers, shared service, OB/GYN - vascular Express Systems & Parts Network, Inc. OH Dealer CT, MRI and C-arm scanners Grand Medical Equipment, Inc. NJ Dealer Imaging/Radiology J&M Trading, Inc. TN Dealer Imaging/Radiology JM Scientific MN Dealer Clinical laboratory Medimtech LLC CA ISO Ultrasound transducers, shared service, OB/GYN - vascular Nova Technologies, Inc. CO Dealer Ultrasound systems, transducers, parts Rock Bottom Lasers AZ Broker Lasers

HealthCareBusiness news I march 2016 81 DOTmed 100

Top Medical Equipment OEMs The following list was created based on revenue facts and figures. The list provides some key numbers for publicly traded medical equipment manufacturers. Some companies do not have separate income reported for different industry sectors, so the numbers presented may indi- cate one company with a smaller health care division as being more robust than a company with a larger health care sector representation. When possible, the information utilized company health care incomes. The information presented here is based on income as reported through stock ticker feedback.

Company Name Stock Ticker Employees Sales last Sales growth Web Address 12 months last 12 months

General Electric Company GE 305,000 148.94 Billion 4.60% www.ge.com

McKesson Corporation MCK 70,400 179.05 Billion 30.32% www.mckesson.com

Cardinal Health, Inc. CAH 34,500 102.53 Billion 12.57% www.cardinal.com

Hitachi, Ltd. HTHIF 336,670 97.74 Billion 1.70% www.hitachi.com

Siemens AG SIEGY 348,000 75.64 Billion 5.20% www.siemens.com

Panasonic Corporation PCRFF 254,084 77.15 Billion 1.90% www.panasonic.net

Johnson & Johnson JNJ 126,500 74.3 Billion 4.31% www.jnj.com

SONY Corporation SNE 131,700 82.35 Billion 6.00% www.sony.net

Toshiba Corporation TOSBF 198,741 66.55 Billion 2.40% www.toshiba.co.jp

Bayer AG BAYRY 118,888 53.92 Billion 5.20% www.bayer.com

Abbott Laboratories (x) ABT 77,000 20.25 Billion N/A www.abbott.com

Canon Inc. (x) CAJ 191,889 37.27 Billion N/A www.canon.com

3M Company (x) MMM 89,800 31.82 Billion N/A www.3m.com

Koninklijke Philips (x) PHG 105,070 21.39 Billion N/A www.philips.com

FujiFilm Holdings Corporation FUJIY 79,235 21.56 Billion 2.20% www.fujifilmholdings.com

Fresenius AG (x) FSNUF 216,275 23.23 Billion N/A www.fresenius.com

Medtronic Inc. MDT 92,000 20.26 Billion 19.10% www.medtronic.com

Baxter International, Inc. (x) BAX 66,000 N/A N/A www.baxter.com

Henry Schein, Inc. (x) HSIC 17,500 10.37 Billion N/A www.henryschein.com

Owens & Minor, Inc. (x) OMI 5,700 9.4 Billion N/A www.owens-minor.com

Stryker Corporation (x) SYK 26,000 N/A N/A www.stryker.com

Becton, Dickinson and Company BDX 49,517 10.2 Billion 21.90% www.bd.com

Konica Minolta Holdings, Inc. KNCAF 41,605 10.02 Billion 6.30% www.konicaminolta.com

Boston Scientific Corporation (x) BSX 24,000 NA NA www.bostonscientific.com

St. Jude Medical, Inc. (x) STJ 16,000 NA NA www.sjm.com

Zimmer Holdings, Inc. (x) ZMH 9,500 NA NA www.zimmer.com

Terumo Corp. TRUMY 19,934 4.89 Billion 4.70% www.terumo.co.jp

Smith & Nephew plc (x) SNN 11,000 NA NA www.smith-nephew.com

Hospira, Inc. HSP 17,000 4.0 Billion -2.18% www.hospira.com

CareFusion Corporation CFN 16,000 3.8 Billion 8.23% www.carefusion.com

C.R. Bard, Inc. (x) BCR 13,900 NA NA www.crbard.com

Varian Medical Systems, Inc. VAR 7,300 3.1 Billion 1.50% www.varian.com

Agfa-Gevaert NV (x) AGE 11,775 NA NA www.agfa.com

Intuitive Surgical, Inc. ISRG 3,211 2.38 Billion 11.85% www.intuitivesurgical.com

82 HealthCareBusiness news I march 2016 www.dotmed.com Company Name Stock Ticker Employees Sales last Sales growth Web Address 12 months last 12 months

Hologic Inc. HOLX 5,290 2.71 Billion 6.90% www.hologic.com

Edwards Lifesciences Corporation (x) EW 9,100 2.3 Billion 13.55% www.edwards.com

Invacare Corporation (x) IVC 5,400 1.4 Billion -7.10% www.invacare.com

Hill-Rom Holdings, Inc. HRC 10,000 2.0 Billion 17.90% www.hill-rom.com

The Cooper Companies, Inc. COO 10,200 1.8 Billion 4.60% www.coopercos.com

STERIS Corporation STE 7,600 1.9 Billion 14.06% www.steris.com

Mindray Medical International Limited (x) MR 8,300 1.2 Billion 14.66% www.mindray.com

Carl Zeiss Meditec AG AFX 2,888 1.0 Billion 14.39% www.meditec.zeiss.com

Integra Lifesciences Holdings Corp. (x) IART 3,300 836.2 Million N/A www.integralife.com

CONMED Corporation (x) CNMD 3,600 734.5 Million -3.70% www.conmed.com

NuVasive, Inc. (x) NUVA 1,358 685.2 Million 10.47% www.nuvasive.com

Analogic Corporation ALOG 1,679 540.3 Million 4.39% www.analogic.com

Masimo Corporation (x) MASI 3,139 547.2 Million 10.95% www.masimo.com

Volcano Corporation VOLC 1,800 393.7 Million 3.09% www.volcanocorp.com

Omnicell, Inc. (x) OMCL 1,134 440.9 Million 15.85% www.omnicell.com

AngioDynamics, Inc. ANGO 1,300 357.0 Million 0.72% www.angiodynamics.com

ICU Medical, Inc. (x) ICUI 2,269 313.7 Million -1.00% www.icumed.com

Accuray Incorporated ARAY 1,010 379.8 Million 2.81% www.accuray.com

Syneron Medical Ltd. ELOS 659 255.8 Million -0.45% www.syneron.com

Merge Healthcare MRGE 800 231.7 Milllion -6.93% www.merge.com

Exactech, Inc. EXAC 642 248.4 Million 4.76% www.exac.com

Cynosure Inc. (x) CYNO 576 276.8 Million 29.36% www.cynosurelaser.com

Atrion Corporation (x) ATRI 485 132.0 Million 10.86% www.atrioncorp.com

Vascular Solutions, Inc. VASC 568 147.2 Million 16.73% www.vascularsolutions.com

Prism Medical, Ltd. (x) PSDLF 413 60.73 Million -0.27% www.prismmedicalltd.com

Fonar Corporation FONR 465 69.1 Million 0.80% www.fonar.com

IMRIS Inc. (x) IMRS 168 46.0 Million -12.12% www.imris.com

Digirad Corporation (x) DRAD 253 49.4 Million -2.25% www.digirad.com

Vasomedical, Inc. (x) VASO 194 32.9 Million 12.48% www.vasomedical.com iCAD, Inc. (x) ICAD 102 33.1 Million 16.95% www.icadmed.com

Bovie Medical Corporation (x) BVX 136 23.7 Million -14.50% www.boviemedical.com

GenMark Diagnostics, Inc. (x) GNMK 153 27.4 Million 33.88% www.genmarkdx.com

DGT Holdings Corp. DGTC 94 11.4 Million -83.16% www.dgtholdings.com

Vasamed, Inc. VSMD 33 32.9 Million 12.48% www.vasamed.com

Positron Corporation (x) POSC 26 1.6 Million -41.81% www.positron.com

(x) 2014 data reported is the most recent available

Resource Section The following pages contain small advertisements exclusively from DOTmed 100 companies. This section will help you to get acquainted with some of the products and services offered by these top-rated companies. The information presented is ranked by company ratings with the highest ratings being first.

HealthCareBusiness news I march 2016 83 84 HealthCareBusiness news I march 2016 www.dotmed.com DOTmed 100: Special Advertising Section

WE CAN HELP SUPPORT YOUR PIIC CLASSIC Technical Service, Support, Repairs, Parts, Redeployments, Philips Servers, PIIC’s, Clients and Central Stations. On-Site Service Available Around the Clock, Around the World Buy-Sell-Rent-Repair PRN, Inc 218 Shove St Fall River, MA 02724 600 Sweetwater Club Circle, Longwood, FL 32779-2133 508-679-6185 Ph: 800-449-7077 • 407-389-1311 • Fax: 407-389-1691 Email: [email protected] www.prnwebsite.com Dotmed 100 email: [email protected] 7 Years in a Row

HealthCareBusiness news I march 2016 85 PATIENT MONITORING

Toll Free: 866-468-9558

Equipment Sales New & Recertified Vital Signs Monitors, Infusion Pumps, ESUs, IV Pumps, Defibrillators, ECG/EKGs Ventilators, Patient Monitors

Loaner Program Free loaner if your equipment needs repair or service.

Biomed Testing & Repair

Parts & Accessories

mastermedicalequipment.com [email protected]

YOUR TOTAL EQUIPMENT SOLUTION

• NEW EQUIPMENT • PRE-OWNED EQUIPMENT • • APPRAISALS • TRADE-INS AND LIQUIDATIONS • • NOW ACCEPTING DEALER APPLICATIONS • WWW.GANIMMEDICAL.COM 800.522.5909

86 HealthCareBusiness news I march 2016 www.dotmed.com Imaging is Everything We Do!™

We get ImagIng. We gOt yOur back. Classic Diagnostic Imaging supplies new, refurbished and used medical imaging equipment and parts to hospitals and service companies across the globe.

BROWSE OUR NEW CATALOG: CLASSIC-IMAGING.COM

CALL CLASSIC TOLL-FREE! CLASSIC QUALITY: 866.818.9729 + Dot med certified + Dot med top 100 + ISO 9001:2008 + certified

CDI-Ninth-Q12015-2.375x3.125.indd 1 2/11/15 5:46 PM

HealthCareBusiness news I march 2016 87 systems, and discover the ANDA Medical difference.

systemsyss, taenmds d, iasncdo vdeirs cthoev eAr NthDeA A MNeDdAic Male ddiifcfearle dnicffee.rence. ARTHROSCOPY LAPAROSCOPY HYSTEROSCOPY systems, and discover the ANDA Medical difference. CYSTOSCOsPyYstems, and discover the ANDA Medical difference. systems, and discover GthYeN AENCDOAL MOeGdYical difference. UROLOGY VIDEO SYSTEMS

www.shmedical.com PH: 305-406-2222 FX: 305-406-2113

88 HealthCareBusiness news I march 2016 www.dotmed.com Our skilled technicians restore endoscopy equipment to OEM specs.

The Leader in Professional Pre-Owned Imaging Equipment Sales

ExpEriEncE MakEs thE DiffErEncE

MRI • CT • PET/CT • Ultrasound • X-ray/CR • Nuclear Cameras • Mammo • Laser Printers • C-arms www.nationwideimaging.com Sales: 732-262-3115 [email protected]

HealthCareBusiness news I march 2016 89 What is your flavor?

REPAIR SERVICE SALES (855)-888-USOC www.usocmedical.com

90 HealthCareBusiness news I march 2016 www.dotmed.com This Month in Medical History Skinner on his best behavior

Burrhus Frederic Skinner was born in Susquehanna, Pennsyl- where he would spend the rest of his long career. vania, on March 20, 1904. Known by those in the psychology Skinner’s work had its detractors — some compared his work field as the “father of operant conditioning,” Skinner is better- to that of Pavlov, but he took care to clarify that his belief was that known by many Americans as B.F. Skinner. an action and reward, rather than passive input from a subject’s Skinner started his education as a student at Hamilton College. surroundings, was key to ingraining a new learned response. Un- After graduation at 22, he dabbled in writing as a profession, but like Pavlov’s dogs, which salivated upon hearing the bell, Skinner’s when that didn’t work out, he decided to go back to school to study pigeons (and the rats before them) would take an active role in psychology. He enrolled at Harvard, where he earned his doctorate. achieving a reward. It was also at Harvard where he would develop his theory of operant While Skinner saw potential positive applications for this idea conditioning. of positive reinforcement, in par- Picking up behaviorist re- ticular in the field of teaching, he search, a field left with a sig- came under fire by some who nificant hole when John Wat- interpreted his work as propos- son ceased academic research ing the idea that humans, or in 1920, Skinner had mark- any animal for that matter, had edly different ideas about how no free will or conscience that learning occurred and how wasn’t reliant on outside stimuli behaviors were formed. His (even if it was an active interac- concept of operant condition- tion with those stimuli). Skinner ing was based on the idea of wrote About Behaviorism to try action and consequence. to clarify his position. Skinner wasn’t the origi- However, it was a different nator of this idea, as he built book by Skinner that likely dam- some of his theorizing upon aged his authority in the eyes the work carried out two de- of some. His book Walden Two cades prior by Edward Thorn- was a novel that used his theo- dike. Unlike Thorndike, how- ries as the basis for its plot — it ever, Skinner was able to bring presented a utopian world where his ideas to audiences outside citizens were good due to a sys- of academia. tem of punishment and reward. Skinner developed a box, The idea of a non-academic piece now known as the Skinner Box, which allowed him to observe ani- using theorized concepts didn’t sit well with some of his colleagues. mals interacting with their controlled environment. He introduced a Skinner did leave the world of fiction writing, and in particular to- reward system that doled out food for the animals — first for rats ward the end of his life, he wrote autobiographies and continued to and in later experiments, for pigeons. The pigeons learned that by research behavioral psychology. pecking on a disc, they would release food. This form of action and Skinner was diagnosed with leukemia in 1989 and died a year consequence was refined and Skinner wrote about his research in later. Today, while some of his theories don’t enjoy the level of atten- his book The Behavior of Organisms. Skinner theorized that learned tion they did during his lifetime, some have found their niche. For in- behavior needed some type of consequence, or reinforcement, to stance, positive reinforcement is a tool for success in many of today’s solidify that learning. schools. And as medical professionals know, with the introduction Skinner continued to work in the psychology field, teaching at the of the Affordable Care Act, there’s certainly something to be said University of Minnesota for a short time, then chairing the psychol- for a system of positive rewards and negative consequences when it ogy department at Indiana University. After just a few years, however, comes to shaping behavior. he made his return to Harvard as a lecturer, and it was the institution Share this story: dotmed.com/news/29068

HealthCareBusiness news I march 2016 91 networking, hundreds of providers,

unlimited opportunities.

The HCP conference exceeded my expectations. “It would have taken me several months to meet with as many key decision makers as I met in less than 48 hours.“ save theSPRING dates2 016 SPRING SPRING SPRING 2016 HOSPITAL O.R. 2016 HOSPITAL 2016 RADIOLOGY 2016 HOSPITAL AND AND SURGICAL SUPPLY CHAIN AND IMAGING HEALTHCARE I.T. SOR CONFERENCE SSC CONFERENCE SRAD CONFERENCE SIT CONFERENCE

March 14-16March • Miami, 14-16 FL March. Miami, 14-16 FL • Miami, FL April 13-15 April• Atlanta, 13-15 GA . April Atlanta, 13-15 GA • Atlanta, GA

register online @ hlthcp.comFALL and saveF ALL$100 using code DOTMED2016FALL FALL 2016 HOSPITAL O.R. 2016 HOSPITAL 2016 RADIOLOGY 2016 HOSPITAL AND For further informationAND SURGICAL contact Dan Jewell SUPPLY CHAIN AND IMAGING HEALTHCARE I.T. [email protected] FSC 727-816-9700CONFERENCE FRAD CONFERENCE FIT CONFERENCE

September 19-21 • Dallas, TX September 19-21 • Dallas, TX October 19-21 • Chicago, IL October 19-21 • Chicago, IL

2016 DotMed Advert Actual Size.indd 1 12/17/2015 10:18:59 AM marketplace & classifieds networking, MEDICAL SALES & SERVICES hundreds of providers, Sensible Solutions for Popular Refurbished Radiology Marketplace Display Ad Sizes

2 3/8” x 3 1/2” $400 12x Rate $4,000

Call Today 212-366-9100 2 3/8” x 4 7/8” $500 unlimited [email protected] 12x Rate $5,000 opportunities. It comes down to Trust Trust the Quality and Reliability of our EQUIPMENT

The HCP conference exceeded my expectations. “It would have taken me several months to meet with as many key decision makers as I met in less than 48 hours. . ISO 9001 Compliant Affiliated with Viking Rigging & Logistics, Inc "NATIONWIDE “ RIGGING AND LOGISTICS SERVICES COMPANY" . OEM Certified Technicians . Industry Leading Warranty save . 7 Strategic Remotely theSPRING dates2 016 SPRING SPRING SPRING Stocked Locations 2016 HOSPITAL O.R. 2016 HOSPITAL 2016 RADIOLOGY 2016 HOSPITAL AND . 24/7 Technical Support AND SURGICAL SUPPLY CHAIN AND IMAGING HEALTHCARE I.T. SOR CONFERENCE SSC CONFERENCE SRAD CONFERENCE SIT CONFERENCE

March 14-16March • Miami, 14-16 FL March. Miami, 14-16 FL • Miami, FL April 13-15 April• Atlanta, 13-15 GA . April Atlanta, 13-15 GA • Atlanta, GA

register online @ hlthcp.comFALL and saveF ALL$100 using code DOTMED2016FALL FALL 2016 HOSPITAL O.R. 2016 HOSPITAL 2016 RADIOLOGY 2016 HOSPITAL AND For further informationAND SURGICAL contact Dan Jewell SUPPLY CHAIN AND IMAGING HEALTHCARE I.T. 93 [email protected] FSC 727-816-9700CONFERENCE FRAD CONFERENCE FIT CONFERENCE HealthCareBusiness news I march 2016

September 19-21 • Dallas, TX September 19-21 • Dallas, TX October 19-21 • Chicago, IL October 19-21 • Chicago, IL

2016 DotMed Advert Actual Size.indd 1 12/17/2015 10:18:59 AM SCHOTT Introduces Our Next Generation Medical Cables

SCHOTT has developed new medical light guide cables with eco-friendly PURAVIS ® glass optical fibers. These new fibers, for use primarily in endoscopy applications, provide up to 8% more white light, superior longevity, autoclaving stability and low solarization.

For more information go to: www.us.schott.com/lightingimaging +1-508-765-9744

94 HealthCareBusiness news I march 2016 www.dotmed.com COMING IN APRIL COMING IN JUNE COMING IN AUGUST OPERATING ROOM ISSUE MOLECULAR IMAGING ISSUE PARTS & SERVICE ISSUE • Inside Today’s High-Tech OR Suite • Molecular Technologies • Endoscopy; Sterilizers; Hospital Beds Features: Features: • Your Service Mix: In-House, OEM, ISO Features: • Radiopharmaceuticals • Ceiling Mounted Equipment Installations • Infection Control/Concerns • Imaging Informatics • Viewpoints: Negotiating Service Contracts for Hospitals • SNMMI Leadership Q&A • FIME Exhibitor Guide • Focused Ultrasound • SNMMI Exhibitor Guide & Product • SGNA Leadership Q&A Showcase • SIIM Leadership Q&A COMING IN SEPTEMBER • SIIM Exhibitor Guide CT TECHNOLOGY/ COMING IN MAY ONCOLOGY ISSUE HEALTHCARE TECHNOLOGY COMING IN JULY • CT Scanners, Dosing Issues MANAGEMENT ISSUE WOMEN'S HEALTH ISSUE and X-Ray Tubes • Forces Impacting HTM Professionals • Ultrasound Imaging • Radiation Oncology • Patient Monitors, Infusion Pumps, Testing • Mammography • Proton Therapy • Tomography and Breast Imaging Equipment, Defibrillators Features: • Bone Densitometers Features: • Radiation Shielding • Viewpoints: Clinical Engineers Speak Out Features: • ASTRO Leadership Q&A • AAMI Leadership Q&A • Imaging Department Management • ASTRO Exhibitor Guide & • AAMI Exhibitor Guide & Product • AHRA Leadership Q&A Product Showcase Showcase • AHRA Exhibitor Guide and Show Preview

ADVERTISER INDEX ADVERTISER PAGE ADVERTISER PAGE ADVERTISER PAGEPAGE ADVANCED ULTRASOUND ELECTRONICS Hologic, Inc Pacific Medical www.auetulsa.com 19 www.fluoroscan.com 72 www.pacificmedicalsupply.com 9 Altima Diagnostic Imaging Solutions IDN Physician's Resource Network www.altimadis.com 49 www.idnsummit.com Inside back cover www.prnwebsite.com 84 Amber Diagnostics Image Technology Consulting, LLC Stille Surgical www.amberusa.com 26 www.imagetechnology.net 65 www.stille.se 73 Ampronix Injector Support and Service Surgical Imaging Associates, LLC www.ampronix.com 67 www.injectorsupport.com 61 www.surgicalimagingassociates.com 27 ANDA Medical Integrity Medical Systems, Inc. Technical Prospects, LLC. www.andamedical.com 17 www.integritymed.com 31 www.technicalprospects.com 15, 56 Banyan MAVIG GmbH Transtate Equipment Co. www.StatKit.com/StatKit750 45 www.mavig.com 58 www.transtateonline.com 53 Bayer McKesson Corporation Universal Digital Resources www.medradservice.bayer.com Back cover www.mckesson.com 37 www.udrconversion.com 21 Bluestone Diagnostics, Inc. Mespere LifeSciences USOC Medical www.bluestonediagnostics.com 25 www.mespere.com 50 www.usocmedical.com 23 Classic Diagnostic Imaging, LLC Metropolis International Varian Medical Systems www.classic-imaging.com 68 www.metropolismedical.com 75 www.varian.com 2 COMPLETE MEDICAL SERVICES Modular Devices Inc. Viable Med Services, Inc. www.completemedicalservices.com 28 www.modulardevices.com 55 www.viablemed.com 29 Core Sound Imaging Nationwide Imaging Services Inc Whale Imaging www.corestudycast.com 46 www.nationwideimaging.com 4 www.whaleimaging.com 71 Dunlee Oakworks Zetta Medical Technologies LLC www.dunlee.com Inside front cover www.oakworks.com 69 www.zettamed.com 13 Elsmed and Relaxation Inc. Owen Kane Ziehm Imaging www.relaxation-mri.com 11 www.owenkane.com 43 www.ziehm.com 70 HCP Oxford Instruments Healthcare DOTmed 100 www.hlthcp.com 92 www.oxford-instruments.com/healthcare 1 Special Advertiser section 85

HealthCareBusiness news I march 2016 95 The Future of Health Care Imaging: cardio care’s future

By David Pacitti

Roughly half a decade ago, major car- structures reside. Clearly, medical imaging pendage repair will tout this ability to offer diovascular surgeries required noth- is a crucial component of this dynamic new “specialists within a specialty." Where once ing short of opening up the patient’s form of cardiovascular care, which can al- the interventionalist performed a broad ar- chest — an action that invited a host leviate pain and anguish for patients in ad- ray of invasive cardiovascular procedures, a of potential complications. Often, recov- dition to shortening hospital stays. general interventional cardiologist will in- ery time was extremely slow, and morbidi- Looking ahead, we can expect medi- creasingly handle basic angioplasty, while ties ran high. Elderly patients, in particular, cal images to inform cardiovascular sur- another specialist will perform peripheral struggled to heal following aortic valve surgical procedures on a more routine basis, vascular procedures, along with interven- gery. And the road back from even more prompting an unprecedented level of tional radiologists or vascular surgeons. complex repairs of the mitral valve and the synergy between radiologists, echocardi- A recent health episode with my left atrial appendage? Those journeys were ologists and interventional radiologists. 86-year-old father (one that involved major an even longer and more arduous climb. Witnessing this blending of medical pro- surgery, heavy anesthesia and an extended But a brave new world is dawning in fessionals is exciting for someone like me, recovery period) has further underscored cardiovascular repair — one illuminated who has a long history in the cardiovascu- for me the importance of less invasive, im- by information that only medical imaging lar field. But, more significantly, the rise of aging-assisted cardiovascular procedures can provide. The groundbreaking proce- these new image-guided therapies ushers that can help ensure a better quality of dure known as transcatheter aortic valve in a higher quality of care at a time when life — particularly for our nation’s aging replacement (TAVR) is enabling minimally fewer post-operative complications, re- and elderly citizens. This rapidly growing invasive repair of a damaged aortic valve, duced cases of infection, more rapid recov- segment of the U.S. population, which in- with a computed tomography (CT) scan ery times and more positive patient quality cludes most of the baby boomer genera- and real-time X-ray imaging, or fluorosco- scores are all vitally important for hospitals tion, deserves the best health care that we py, offering physicians a vital land map for if they are to survive — and thrive — in the can provide. As president of a company this revolutionary treatment option. Also, changing U.S. health care landscape. with a broad portfolio of high-tech in- a CT scan now helps physicians determine In addition to this increased incorpora- novations that includes medical imaging whether the patient is even a viable candi- tion of imaging in cardiovascular surgical systems, I’m gratified by the unmistakable date for TAVR, which may spare unneces- procedures, we will see a change in the signs I’m seeing that imaging is helping to sary surgery. Similarly, a transesophageal business structure of cardiovascular care create a picture of better cardiovascular echocardiogram (TEE) now guides physi- delivery. Providers will be judged not just health for thousands of Americans. cians in their repair of the mitral valve and on the quality of care they provide, but also David Pacitti is president of Siemens the left atrial appendage by providing high- by the kinds of services they offer. Hospitals Healthcare North America. ly coveted, minimally invasive access to the that can perform more advanced proce- Share this story: dotmed.com/news/29209 left side of the heart, where those delicate dures such as mitral valve and left atrial ap-

Keeping your patients on schedule is vital to your reputation and your bottom line. That’s why Bayer is committed to providing the highest quality repairs and maintenance solutions for your Medrad® Systems. Our services include:

DirectCARE® | Comprehensive on-site services with uptime guarantees PartnerCARE® | Options to support your in-house capabilities SelectCARE® | Customized solutions to fit your budget VirtualCare® | Remote repair and diagnostics APPROVED UPLOADED RADIOLOGY To learn more about Bayer’s line of equipment service, SOLUTIONS. visit radiologysolutions.bayer.com, BAYER.COM APPROVED email [email protected] or call 1-800-633-7237.UPLOADED

APPROVED UPLOADED

Bayer, the Bayer Cross, DirectCARE, PartnerCARE, SelectCARE and VirtualCare are registered trademarks of Bayer. Comprehensive Imaging Solutions ©2015 Bayer HealthCare LLC. All rights reserved. APPROVED 100 Bayer Boulevard, PO Box 915, Whippany, NJ 07981 UPLOADED Printed in the USA February 2015, PP-D-CARE-US-0015

APPROVED UPLOADED

US-SPECIFIC