Radiation Oncology: Innovative, New Technologies and Research Are Turning Heads P

The past reveals CT’s future — Murat Gungor of Siemens — p. 88

Your Industry Source for Health Care and Equipment Coverage October 2015

You will do more with your CT in 2016…

Even with changing reimbursements and dose reduction

rates, CT continues to dominate p. 56

In this issue Exclusive Q&As with: • Suzanne Richards, CEO of Orange County Global Medical Center p. 34 • Dr. Bruce Minsky, ASTRO president p. 40 Industry sector reports: • Radiation Oncology: Innovative, new technologies and research are turning heads p. 44 • Proton Therapy: The treatment goes mainstream p. 76 We Stand Behind Our Products For more than 100 years, we have focused on providing you with the highest quality products

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Contact us today to find out www.westphysics.com/doseaudits how we can help your 1-866-275-WEST (9378) operation lower patient [email protected] doses while still delivering superb image quality! Need to Lower Patient Doses? CONTENTS WEST PHYSICS is Down With That! October 2015

THIS MONTH’S EXCLUSIVE Q&As 44 34 Suzanne Richards, CEO of Orange County Global Medical Center 40 Dr. Bruce Minsky, ASTRO president

INDUSTRY SECTOR REPORTS 44 Radiation Oncology Innovative, new technologies and research are turning heads 56 CT No shortage of challenges in the CT market 70 X-ray Tubes 52 Industry experts offer their thoughts WEST PHYSICS leads the industry in providing a turn-key 76 Patient Dose Reduction Service that is fully compliant with the new Proton Therapy The treatment goes mainstream Joint Commission imaging standards. Our radiation consultants will assess your policies, procedures, scan protocols, hardware, software and training – everything that affects patient dose – and help you to set up and manage a simple and effective patient radiation dose reduction program. FEATURE 52 Radiation Shielding 76 Contact us today to find out www.westphysics.com/doseaudits There is more to proton shielding than meets the eye how we can help your 1-866-275-WEST (9378) Visit DOTmed.com/news for breaking news daily, to comment on stories in this operation lower patient [email protected] issue, to participate in surveys and more. doses while still delivering superb image quality! HealthCareBusiness news I october 2015 3 䔀瘀攀爀礀琀栀椀渀最戀甀琀琀栀攀戀愀戀礀

吀栀攀䜀䔀䌀漀爀漀洀攀琀爀椀挀猀㈀㔀㤀䌀䘀攀琀愀氀䴀漀渀椀琀漀爀

䌀愀戀氀攀猀䤀渀挀氀甀搀攀搀簀㄀㈀䴀漀渀琀栀圀愀爀爀愀渀琀礀簀䤀渀匀琀漀挀欀一漀眀嘀椀攀眀漀甀爀猀攀氀攀挀琀椀漀渀漀昀爀攀昀甀爀戀椀猀栀攀搀昀攀琀愀氀洀漀渀椀琀漀爀猀漀渀氀椀渀攀琀漀搀愀礀⸀

㠀 ⸀㐀㐀㤀⸀㔀㌀㈀㠀圀圀圀⸀倀䄀䌀䤀䘀䤀䌀䴀䔀䐀䤀䌀䄀䰀匀唀倀倀䰀夀⸀䌀伀䴀 ⌀倀䄀䌀䴀䔀䐀䰀䰀䌀 CONFERENCE & EXPO PREVIEW ASTRO 40 PUBLISHER DOTmed.com, Inc. PRESIDENT Philip F. Jacobus CHIEF TECHNOLOGY OFFICER Matt Ulman EXECUTIVE EDITOR Robert Garment EDITORIAL DIRECTOR Glenn J. Kalinoski 32 EDITORIAL CONTRIBUTING EDITOR Sean Ruck 212-742-1200 Ext. 218 [email protected] ONLINE EDITOR Gus Iversen STAFF WRITER Lauren Dubinsky

CONTRIBUTING WRITERS Lisa Chamoff Michael Gray 34 40 Murat Gungor Tina Vatanka Murphy Jill Rathbun Bipin Thomas

DESIGN COLUMNS DESIGN DIRECTOR Stephanie Biddle DESIGN CONSULTANT Oscar Polanco 6 Letter from the Editor SALES 7 Top Online Stories SALES DIRECTOR David Blumenthal 212-742-1200 Ext. 224 [email protected]

8 Letter from the Online Editor KEY ACCOUNT Susan Minotillo MANAGERS 212-742-1200 ext. 261 [email protected] 8 DOTmed Online News Connie Goon 212-742-1200 Ext. 289 31 Upcoming Events [email protected] ACCOUNT MANAGERS Colm Ford 32 Hospital Spotlight 212-742-1200 Ext. 241 [email protected] Orange County Global Medical Center Troy Gladstone 212-742-1200 Ext. 246 35 Cost Containment Corner [email protected] Squeezing costs out of supply chain management Press Releases If you have news regarding your company submit it to: [email protected] 36 IT Matters Article and Story Consideration The significance of developing an enterprise imaging strategy If you have an article or feature story you would like the editor of HealthCare Business News to consider publishing, submit it to: [email protected] 38 New Products Showcase Letters to the Editor Submit letters to the editor to: [email protected] 43 View from the Hill Subscriptions Congress focuses on imaging For all subscription inquiries please email [email protected] or visit dotmed.com/magazine Auctions 51 Diagnostic Directions If you want information about auctioning equipment on Manufacturers are in the information business now DOTmed.com, please call: 212-742-1200 Ext. 296, or email us at [email protected] HealthCare Business News is published by DOTmed.com, Inc., 82 Medical Museum 29 Broadway, Suite 2500, New York, NY 10006 Copyright 2015 DOTmed.com, Inc. All rights reserved. 83 This Month in Medical History The father of emergency medicine, and Lyndon Johnson

88 The Future of Health Care DOTmedSM provides the HealthCare Business NewsSM to its registered The past reveals CT’s future 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 Back in the saddle again…

Let’s flash back to early 2007… Now HealthCare Business News runs like a well-oiled machine, Imagine you’re now in lower Manhattan, up and the people on our news team have made it easy for me to get on the 25th floor in the conference room of back into my management position — this time as executive editor. a leading Internet company (aka DOTmed) We still have Sean Ruck as contributing editor, and the new kid on and a plan is being hatched: “Let’s create the block, Glenn Kalinoski — who joined us a few months ago — is a dynamic new print magazine focused on our editorial director. So we have plenty of managerial firepower to the underserved business end of the health go around. care industry.” “And let’s design it for the top And let me also mention Gus Iversen, our online news editor. He decision-makers in the industry.” “All in favor, say ‘aye.’” does a great job every day of finding and reporting on the top news And thus, our magazine was born. stories coming out of the health care industry. That’s why dotmed. The first issue rolled off the presses in April of that year, and the com/news should be a page you bookmark and visit every day. rest, as they say, is history. We also run the top online news stories from the past 30 days And now history repeats itself — after a fashion. in this magazine every month. In fact, those news highlights are so The original editor-in-chief of our original magazine was yours truly. informative, I call that section, “What You Need To Know.” Because I served ably in that capacity for almost a year and our magazine started if it’s news that the industry’s decision makers can’t do without, we to find its voice and audience. So much so, that we were soon able to make sure it’s available for everyone to read. turn over the reins to a new editor, while I returned to my other duties. So going forward, you will now see me penning the “Letter from Our publication continued to grow and prosper. We beefed up the Editor” each month, and behind the scenes I’ll be making sure the staff, improved the content, and under the long-term editorial that we put out a quality publication that is always worth your time leadership of Sean Ruck, we became an anchor publication in the to read from cover to cover. Now… “Giddyup!” health care industry. About two years ago we adopted the name, “HealthCare Business News” to accurately reflect that what we cover Robert Garment isn’t about DOTmed. It’s about what matters to you, to your career, Executive Editor and to our industry as a whole. [email protected]

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

6 HealthCareBusiness news I october 2015 www.dotmed.com HealthCareBusiness Daily News Online Top online stories (August 16 — September 15) Welcome to Our News • Scientists create portable linac for imaging and cancer treatment Center dotmed.com/news/26702 M Greg Sorensen will step down as CEO of Siemens Healthcare in October online dotmed.com/news/27031 daily news • The hard numbers on radiological When health care industry news interpretation errors dotmed.com/news/26750 breaks, you’ll read about it first at: dotmed.com/news • ACOs are realizing goals of improving care and saving money: CMS Visit daily and sign-up for our dotmed.com/news/26858 convenient weekly news digest. M Unaggressive prostate cancer better left alone, monitored: 20-year study dotmed.com/news/26929 • Natural process can curb beta-amyloid production, scientists discover in print dotmed.com/news/26860 • GE’s new ventilator may save hospital Get a free subscription and $5 million annually sign-up for the digital version dotmed.com/news/26927 of HealthCareBusiness News. • Molecular breast imaging is an accurate and cost-effective supplemental screening tool dotmed.com/news/26747 M PET scans better than MR at detecting more aggressive prostate cancer: study dotmed.com/news/26813 • Through deal with Merge, IBM’s Watson will interpret medical images Subscribe to our Magazine and dotmed.com/news/26732 • Among critically ill, study finds weekly Online News digest now. probiotics useless against ‘superbugs’ dotmed.com/news/26874 • Using MR-guided focused ultrasound to treat Parkinson’s dotmed.com/news/26972 • AmWell announces telehealth partnerships with Capital BlueCross, AllianceHealth Oklahoma

The past reveals CT’s future p. 88 dotmed.com/news/26810 Your Industry Source for Health Care and Equipment Coverage October 2015 • GE first to get FDA nod for low dose

You will do more with your CT in 2016… CT lung cancer screening dotmed.com/news/26746 Even with changing reimbursements and dose reduction

rates, CT continues to dominate p. 56

In this issue Exclusive Q&As with: • Suzanne Richards, CEO of Orange County Global Medical Center p. 34 • Dr. Bruce Minsky, ASTRO president p. 40 Industry sector reports: • Weak doses of radiation prolong life • Radiation Oncology: Innovative, new technologies and research are turning heads p. 44 • Proton Therapy: The treatment goes mainstream p. 76 of fruit flies, say researchers dotmed.com/news/26842 M Editor’s Choice

HealthCareBusiness news I october 2015 7 Letter from the Online Editor The other side of health reform

After several decades as a heavy smoker, on your side may decrease risk of dementia, and another linking my mother woke up one morning and heavy cell phone usage with brain cancer. decided she’d had enough of cigarettes. Now, I am not suggesting we should all stop using cell phones No patches, no cutting down, just cold turkey. and old people should be glued to their sides every night. I’m also That was about ten years ago and she hasn’t not suggesting that we outlaw fast food, or even cigarettes for that touched a smoke ever since. matter. I think there must be a better solution than simply prohibit- To this day it’s one of the most impres- ing things. sive things I’ve ever seen. Of course, she had I guess my point is that when we talk about health reform the known for years that it was a bad habit, but like most people, that conversation is always rooted in the industry, and there is absolutely knowledge alone was not enough to stop her. It took something a lot of work to be done on that end, but what about thinking about extra. What is that something? health reform as a personal responsibility? I can’t think of a better If you take an evolutionary look at the problem, we are in rare terri- way to cut down health care costs than for people to take better tory. For billions of years life has evolved at a rate where instincts could care of themselves. develop to help fill in the gaps in our understanding. With science, the knowledge of mankind outpaces our experiences, and humans Gus Iversen have the burden of knowing things are true that may not “feel” true. Online Editor We sometimes touch on these emerging discoveries in our news. [email protected] For example, in this issue you’ll see a study that concluded sleeping Twitter: @dotmedcom

Electronic health record vendors and hospitals lagging on interoperability: Chilmark report Posted online August 3, 2015, by Lisa Chamoff

Electronic health record (EHR) vendors ing their customers to a competitor, accord- the major EHR vendors, including Allscripts, are falling well short of the goal of in- ing to the report. Epic and Cerner, noting that while they are teroperability and are actually design- Health care organizations also have a working toward interoperability, there’s a ing systems that perpetuate health care monetary interest in keeping data, said Brian long way to go. organization “data silos,” according to Murphy, a Chilmark Research analyst and The report urges EHR vendors to follow a new report from Chilmark Research. the report’s lead author. the lead of mainstream technology compa- It’s something that will have to change in “The fact that it took an act of Con- nies, including Google, Amazon, Microsoft the shift to value-based reimbursement, the gress to put these products in people’s and Salesforce, that take a platform-as-a- report states. hands speaks to the problem,” Murphy service approach. Salesforce, for example, The report, “Moving to Open Platforms: told DMB News. “Patients can go any- provides an easy way for developers to build EHR Vendor Strategies and Assessment,” where. Vendors and hospitals have in inter- and deploy applications on the company’s provides an overview of several of the major est in [data sharing] not happening. They’re cloud infrastructure, leading to the develop- EHR vendors’ limited interoperability capa- doing the bare minimum and they’re doing ment of millions of applications. A similar bilities and looks at how interoperability has what they need to do in order to continue set-up in health care would allow develop- been hampered by limited adoption of appli- to get paid.” ers in hospitals’ internal IT departments and cation programming interfaces, which allow There are also privacy and security con- independent software vendors to make different software programs to exchange cerns, but many of those are unfounded, changes and add value to the software plat- information. Vendors worry that by opening according to Murphy. forms. applications up to developers, they risk los- The report details the work of several of Share this story: dotmed.com/news/26568

8 HealthCareBusiness news I october 2015 www.dotmed.com Legionnaires’ Interpreting the deluge of information outbreak in New central to health reform

York’s South Bronx Posted online August 6, 2015, by Gus Iversen infects 46 people Events like the annual HIMSS meet- For Healthline, meaningful data analysis Posted online August 1, 2015, by Gus Iversen ing are dedicated to raising the bar on is a full time mission. HCB News reached meaningfully interpreting the deluge out to Dean Stephens, the company’s CEO, With 15 more cases of Legionnaires’ of information at our disposal. to talk about the progress taking place — disease being diagnosed in New York’s It’s a lofty goal, but central to health re- and why his company’s new Coding In- South Bronx, the non-contagious bacteria form. The benefits of data interpretation Sight application could be a game-changer has infected at least 46 people. are poised to improve not only the physi- in risk adjustment and patient population Legionnaires’ disease is a type of pneu- cal health of patients, but the economic management. monia that is caused by bacteria (Legionella) health of the facilities that care for them. Share this story: dotmed.com/news/26424 that grow in warm water. The bacteria spread through water vapor inhalation, such as mist from faucets, showers or cooling towers. According to Mary Bassett, NYC Health Commissioner, the current outbreak is most Not on our watch! likely unrelated to contaminated drinking water because the cases are not consolidated into one or two buildings but are somewhat more widely dispersed. For that reason, officials expect that cooling towers are responsible for the outbreak. According to reporting by NBC New York, the city’s mayor, Bill de Blasio, has thus far confirmed the discovery of two contaminated South Bronx cooling towers. “People have to understand that this is a disease that can be treated — and can be treated well if caught early,” de Blasio said. “The excep- tion can be with folks who are already, unfortunately, suffering from health challenges, particularly immune system challenges. But for the vast majority of New Yorkers, if they were even AUE enjoys one of exposed, this can be addressed very well and very quickly so long as they seek medical treatment.” the lowest DOA rates in the industry!! Two patients have died from the illness, a 1.5 % for the last 12 months! man and a woman in their 50s, both of whom also suffered from other lung problems. When looking for quality systems, parts, service, and repairs, According to the New York Health Depart- at better than OEM pricing, look no further than… ment, most of the cases have been reported in the neighborhoods of High Bridge, Morrisania, Hunts Point and Mott Haven. The Health De- partment recommends that anyone living in those areas and experiencing respiratory symptoms, such as fever, cough, chills and muscle The #1 source for all your Ultrasound needs! aches, seek medical attention right away. Share this story: dotmed.com/news/26564 www.auetulsa.com • Tel. 1-866-620-2831

HealthCareBusiness news I october 2015 9 HealthCareBusiness Daily News Online > dotmed.com/news UK Medical Research Council scientists compress MR images, greatly reduce breath holding Posted online August 4, 2015, by Lisa Chamoff

Scientists in the UK have found a way photographs are taken with a digital camera. around $3,000, pales in comparison to the to perform MRI scans quickly on pa- When taking a photograph, the camera col- recurrent hourly cost of MRI scans, which tients who have difficulty holding their lects information from millions of pixels, but can range from $400 to $800 per hour. breath. then compresses that into a smaller JPEG file. The researchers are testing the technol- By reprogramming the scanner to alter the The acquisition method can also accelerate ogy on a wider range of anatomy and con- way the image is acquired, the Medical Re- detailed 3-D imaging of skeletal muscle and ditions, including joint and cardiac imaging, search Council scientists were able to cut the joints, such as the knee and elbow, which can and they are seeking funding to perform amount of time patients with type 2 diabetes take four to six minutes, during which time multi-center clinical trials on more patients, were required to hold their breath during a the patient has to be completely still, Holling- and to make sure that other clinicians can liver scan from 18 seconds to four seconds, sworth said. The scientists have also reduced also use the method. Hollingsworth said the while retaining image quality. The study was the acquisition time of 3-D imaging of skeletal researchers are also looking to integrate the recently published in the journal Radiology. muscle for genetic diseases, particularly in the technology into scanner hardware, so the Dr. Kieren Hollingsworth, a lecturer in leg, from 4 1/2 minutes to 55 seconds. image compression can be done seamlessly. magnetic resonance physics at Newcastle While the amount of computer power Hollingsworth said the technology could University and senior author of the study, needed to reconstruct the images is much work for CT scans, though not in the same compared the method, which mathemati- greater than standard MRI, Hollingsworth way. cally compresses the MRI images, to how said the hardware cost, which could run Share this story: dotmed.com/news/26581 Yes, heavy cell phone usage BC Technical rolls onward increases risk of brain tumors with acquisition of Ohio

Posted online August 1, 2015, by John W. Mitchell Valley Medical Systems Posted online August 5, 2015, by Gus Iversen A group of researchers spanning three countries have determined that low doses of radio-frequency radiation (RFR) can BC Technical announced the acquisition of Ohio Valley Medi- cause “oxidative stress” — an imbalance which inhibits the cal Systems. It is the company’s fourth acquisition of 2015 and will body’s ability to detoxify harmful effects from wireless devices. strengthen its business in MR imaging support. This condition can lead to both neurological disorders and Ohio Valley Medical Systems will bring the organization a par- cancer. ticular expertise in Hitachi open MR systems, which will allow BC “RFR background has increased by a factor of about 5,000 dur- Technical to include Hitachi MR in its nationwide service portfolio. ing the last 20 years due to wireless technologies. The cell phone On behalf of Ohio Valley Medical Systems, Thomas Hineman, is the first device that delivers RFR just to the human brain,” Igor CEO, said, “This will prove to be a valuable asset to our custom- Yakymenko, lead author and a researcher at the Institute of Experi- ers by expanding our service capability to other product lines and mental Pathology, Oncology and Radiobiology of NAS Ukraine in manufacturers. In addition, response time will be improved as we Kyiv, told HCB News. leverage the nationwide service presence of BC Technical’s field Yakymenko and other researchers from the U.S., Finland and engineers and support staff.” Ukraine culled through 100 peer-reviewed studies to arrive at their Earlier this year BC Technical completed acquisitions of Atlas conclusion. Their findings, published in Electromagnetics Biology Medical Technologies, Eclipse Systems and Virtual Medical Sales. and Medicine, suggest a previously unidentified cellular mecha- All of those transactions were completed with the goal of increas- nism that triggers oxidative stress impairments. ing the company’s capabilities as a national — and non-OEM — RFR causes an imbalance between the production of reactive provider of CT, MR, NM, PET and PET/CT parts and service. oxygen species (ROS) and the antioxidant that creates the health HCB News took an in-depth look at the trend toward consoli- issues, they wrote. This can also lead to other disorders aside from dation in the non-OEM parts and service segment in the August cancer, such as headache, fatigue and skin irritation. issue of our magazine. Share this story: dotmed.com/news/26556 Share this story: dotmed.com/news/26603

10 HealthCareBusiness news I october 2015 www.dotmed.com FDA nod for MR Health care reform requires cheaper software that helps treatment, more efficient care diagnose Alzheimer’s, Posted online August 5, 2015, by Lauren Dubinsky concussions Health care reform is all about better Edwards shared his thoughts on how outcomes, cheaper treatment, and fast- efficiency might be improved as well as the Posted online August 5, 2015, er, more efficient care. For Terry Edwards, time frame he believes those changes will by Lauren Dubinsky CEO of PerfectServe, “faster” has been a take place. One of the hurdles he highlight- point of particular interest. HCB News ed was communication, or lack thereof, New MR software that may speed the diag- spoke to him recently about the ways that between health care professionals. nosis of Alzheimer’s disease, epilepsy and health care systems are being slowed down Share this story: dotmed.com/news/26495 depression recently scored FDA approval. — and what can be done to make things Brainreader’s Neuroreader works by detecting more efficient. changes in brain volume in less than five minutes. The software can also be used to spot changes in brain volume as a result of concussions and other traumatic brain injuries. MR brain images are traditionally analyzed visually by a radiologist, but when changes in the brain volume are minor it’s a time-consuming process. Even the best radiologists are not able to determine the exact volume of every structure in the brain without hours of rigorous manual calculations, according to Dr. Barton Branstetter, a neuroradiologist at the University of Pittsburgh Medical Center, Presbyterian. The Neuroreader software can help radiologists detect changes as tiny as hundredths of a millimeter in minutes, and takes the guesswork out of the process. The radiologist uploads the MR image to the Brainreader server and the Neuroreader analyzes it and benchmarks it against an FDA- approved database of healthy brain tissues. It then produces a report on what brain structure volumes are abnormal and to what extent. It can be used to measure 45 different brain structures. One of those structures is the hippocampus, which is measured to determine a patient’s ability to maintain strong cognitive function. Dr. Majid Fotuhi, chairman of NeuroGrow Brain Fitness Center and Johns Hopkins Medi- cine, believes that knowing the volume of a patient’s hippocampus and monitoring it regularly will become the standard. Recent publications have shown the first evidence of functional and sustained improvement in neurodegenerative conditions. As therapeutic programs are developed, the volumes of multiple brain regions will become crucial information. Share this story: dotmed.com/news/26604

HealthCareBusiness news I october 2015 11 HealthCareBusiness Daily News Online > dotmed.com/news Elekta’s headframe-optional Gamma Knife Icon gets FDA approval Posted online August 5, 2015, by Gus Iversen

Picking up where Gamma Knife Perfexion North America, microradiosurgery is an The Icon received CE Mark in June, and left off, the sixth generation of Elekta’s ultra-precise form of treatment which Icon France’s University Hospital La Timone has stereotactic radiosurgical platform has is the only system on the market capable of been the first to install an Icon in its facility. It received 510(k) approval from the FDA. performing. was also the first hospital to install the previ- Like other Gamma Knife systems, the Icon is The Gamma Knife’s headframe has ous generation Gamma Knife, the Perfexion, capable of ultra-precise dose delivery to lesions traditionally been a crucial component to in 2006. Dr. Jean Regis, a neurosurgeon and in the brain. Unlike previous Gamma Knife sys- the highly specific dosimetry and radiation program director for the hospital’s Gamma tems, however, the company says Icon repre- fall-off that makes the system so effective Knife program, said there are two “signifi- sents a push toward frameless radiosurgery. in treating small targets in the brain. The op- cant opportunities” related to frameless im- This frameless option enables Icon to tion of performing certain procedures with- mobilization on the Icon system. treat a wider variety of tumor types and siz- out it will be welcome news for clinicians The first, he said, will be able to enlarge es. It also opens up the option of performing and patients alike. the scope of indications by more readily fractionated or hypofractioned treatments, The Gamma Knife — first developed permitting hypofractionation. More im- retreatment and microradiosurgery — capa- in the ‘60s and since used to treat almost portant, according to Regis, is the ability to bilities traditionally associated with devices 900,000 people with cranial radiosurgery — evaluate shifts in the patient’s position and less concentrated on brain treatments. contains 192 cobalt-60 sources in a circular to adapt the dose proactively to account According to a statement by Bill Yaeger, array that focus gamma radiation precisely for movement. Elekta’s executive vice president, regional onto a target. Share this story: dotmed.com/news/26601

Royal Philips enlists BofA to New test can diagnose hunt for new buys in health dementia in 3 to 5 minutes

care division: report Posted online August 12, 2015, by Lauren Dubinsky Posted online August 11, 2015, by Thomas Dworetzky It usually takes physicians about four or five hours to diagnose dementia, but a neurologist at Florida Atlantic University has Royal Philips may be on the hunt for opportunities to build developed a new test called the Quick Dementia Rating System up its health care division. (QDRS) that a layperson can perform in three to five minutes. Unnamed sources revealed to Bloomberg News that the recently The study that investigated the effectiveness of the test recruited restructured global giant is looking to acquire devices — and has 267 participants with various forms of dementia and 32 healthy turned to Bank of America for assistance in its hunt. controls. The study participants also included their spouses/sig- No specifics have been revealed so far, but the sources did note nificant others, adult children, relatives, friends and paid caregivers that smaller as well as larger firms will be getting considered during who completed the QDRS. what was described as a six-to-12 month window. The QDRS uses an evidence-based methodology to effectively One such possible target, Swedish firm Elekta AB, saw a rise in its differentiate people with and without dementia. If the individual stock valuations on rumors it might be a candidate for acquisition. does have dementia, it determines whether it is very mild, mild, “Elekta would be a really good fit for Philips and the two com- moderate or severe. panies know each other well, as they already have a project in com- QDRS is a 10-item questionnaire with scores that range from zero mon,” Swedbank AB analyst Johan Unnerus told the news agency. to 30 — the higher scores represent greater cognitive impairment. Besides Elekta, other medical device makers, such as Varian The questionnaire asks about the individuals’ memory and recall, Medical Systems Inc., may also be candidates for purchase by Philips. orientation, decision-making and problem-solving abilities, activi- The Philips war chest for health care buys could grow significant- ties outside the home, function at home and hobbies, toileting and ly, especially if it sells or goes public with its lighting division, which personal hygiene, behavior and personality changes, language and insiders revealed is under consideration during the next 12 months. communication abilities, mood and attention and concentration. Share this story: dotmed.com/news/26672 Share this story: dotmed.com/news/26697

12 HealthCareBusiness news I october 2015 www.dotmed.com New Samsung PET scans better than MR at detecting DR system scores more aggressive prostate cancer: study

FDA approval Posted online August 21, 2015, by Lisa Chamoff Posted online August 6, 2015, by Lauren Dubinsky A recent study looked at 13 patients imaging in detecting primary prostate can- with primary prostate cancer who un- cer, the PET picked out the lesions that were derwent PET imaging with F-18 DCFBC the most clinically significant, with a Glea- NeuroLogica, a subsidiary of Samsung PET, using a low-molecular weight son score of 8 and 9, and greater than 1 Electronics Co. Ltd., announced today radiotracer that targets the prostate- milliliter in size. The researchers compared that the Samsung GC85A DR system specific membrane antigen (PSMA). A the two types of scans by looking at 12 seg- received FDA approval. This is the new- dozen of those patients also had a pelvic ments of the prostate and also at dominant est addition to Samsung’s expanding DR prostate MR scan. lesions. portfolio, which includes the mobile digital While MR was more sensitive than PET Share this story: dotmed.com/news/26813 GM60A, the U-arm digital GU60A and the ceiling digital GC80. Its S-Vue technology enhances the sharpness and clarity of the images and includes adjustable contrast presets and an auto shutter that improves consistency. It features wireless S-Detectors and a portable grid that displays the patient’s body structure clearly without increasing radiation dose. The S-Detectors are compatible with all Samsung DR systems, so when a detector is discarded, it can be used with detectors from the other systems. Its S-Align technology displays the detector’s angle to the Tube Head Unit (THU) to improve image quality during exams. The angle can be automatically fitted when the THU and detector are within a specific radius. Its Smart Control feature allows the operator to position the whole system by pressing one of the control panel buttons. The operator can then move a motorized, tilting receptor with a remote control from -20 to 90 degrees for the skull and hands without needing a table. Patients no longer have to stand for long periods of time during consecutive shooting because of the Smart Stitching technology. The stitching method also provides better diagnostic clarity compared to separate images. In January 2013, Samsung Electronics America, which is a subsidiary of Samsung Co. Ltd, acquired NeuroLogica. NeuroLogica is best known for its CT scanners, but it is also a manufacturer of ultrasound, PET, radiation therapy and MR systems. Share this story: dotmed.com/news/26630

HealthCareBusiness news I october 2015 13 HealthCareBusiness Daily News Online > dotmed.com/news As bad press mounts for duodenoscopes, researchers find other scopes unclean Posted online August 5, 2015, by John W. Mitchell

A study published in the most recent is- ation for Professionals in Infection Control and made Aug. 4 on new cleaning protocols sue of the American Journal of Infection Epidemiology (APIC) about the study, viable, for the duodenoscope used in half a mil- Control about incomplete disinfection residual organisms remained on colonoscopes lion advanced gastroenterology proce- of colonoscopes and gastroscopes coin- and gastroscopes after prescribed cleaning dures a year known as ERCP. According to cided with the release of new FDA ster- protocols, although bacterial transmission or the FDA there have been eight outbreaks ilization guidelines for duodenoscopes. subsequent infection was not assessed in this of antibiotic-resistant bacteria linked to This coincidence could possibly create study or other studies looking at gastroscopes the devices at U.S. hospitals since 2013, confusion among patients. or colonoscopes, according to Tosh. some resulting in death. Recent news re- “Our study did not include duodenoscopes The rate of incomplete disinfection after ports about these infections have raised which are used in advanced ERCP procedures prescribed cleaning included: viable organ- general awareness about all medical that made the news earlier this year because isms were detected 92 percent of the time scope device safety. of infections and deaths,” Dr. Pritish Tosh, an on devices after bedside cleaning; 46 percent Commenting on his study of gastro and infectious disease specialist at the Mayo Clinic of the time after manual cleaning: 64 percent endoscopes, Tosh noted several potential told HCB News. “Our study looked at colono- of the time after high-level disinfection; and limitations of the study. Most notably is that scopes and gastroscopes — these do not have nine percent after overnight storage. The it is a single-site study and may not apply the elevator lifting mechanisms of the more study included testing of 15 colonoscopes nationwide. complex duodenoscope,” he said. and endoscopes used in 60 procedures. Share this story: dotmed.com/news/26627 According to a statement from the Associ- The separate FDA announcement was

GE sells Healthcare Financial MR study finds sleep Services to Capital One in position affects mammalian $8.5B mega-deal ‘brain waste’ removal

Posted online August 12, 2015, by Thomas Dworetzky Posted online August 13, 2015, by John W. Mitchell

The health care sector experienced another massive shift It turns out the most popular sleep position for people and with the announcement that General Electric planned to sell animals — lateral, or sleeping on your side — may affect the Capital One a portfolio of health care sector loans worth $8.5 odds for neurological disorders. A research team used dynamic billion. contrast MR studies on rodents to reach this conclusion. The move by financial giant GE is part of its previously announced “The brain is one of the most metabolically active organs, so it pro- aim to return to its industrial core businesses and sell off $100 billion duces a lot of metabolic waste that needs to be recycled or gotten rid of financial assets lodged in its finance arm, GE Capital, by the end of,” Dr. Helene Benveniste, principle investigator, told HCB News. She is of 2015. The deal is anticipated to close by year’s end. professor of anesthesiology and radiology and vice chair for research, de- The loans are to various types of health care companies — from partment of anesthesiology at Stony Brook Medicine. “If these substanc- hospitals to pharmaceutical firms. Capital One will pay a 6 percent es are allowed to accumulate they become misfolded and aggregate.” premium in the deal, which suggests the banking giant intends to That aggregation may contribute to the likelihood of developing keep GE employees and expand, according to MarketWatch. neurological disorders, she explained. The announced sales of various GE financial assets now total The study was conducted over several years by examining anesthe- about $78 billion, putting it on track to hit its goal by year end. This tized rodents sleeping in the lateral (side), supine (back) and prone (face deal, GE anticipated in its statement, “will contribute approximately down) positions. The data revealed that side position did the best job $1.5 billion of capital to the overall target of approximately $35 bil- of flushing brain waste, followed by the back and face down positions. lion of dividends expected to [accrue to] GE under this plan [subject Researchers know that human dementia is often marked by an to regulatory approval].” onset of sleep difficulty. Share this story: dotmed.com/news/26696 Share this story: dotmed.com/news/26718

14 HealthCareBusiness news I october 2015 www.dotmed.com New study finds Only 10 percent of heart failure disparities in patients get referred for rehabilitation pediatric primary Posted online August 24, 2015, by Frieda Wiley care in many states Only one-tenth of all patients with ated more than 105,619 heart failure Posted online August 10, 2015, heart failure are referred to cardiac re- patients between 2004 and 2014, and by Lauren Dubinsky habilitation post hospital discharge — found that only 10.4 percent of patients despite the Centers for Medicaid and eligible for treatment actually received Certain U.S. states have disparities in the Medicare Services having approved re- referrals. Referral rates increased as the accessibility and availability of pediatric habilitation for eligible patients in 2013. study progressed, yet still remained cat- primary care, according to a new study A new study in the Journal of the egorically low. presented at the 2015 Joint Statistical American College of Cardiology evalu- Share this story: dotmed.com/news/26814 Meetings in Seattle. The study defines accessibility as the amount of time it takes for a patient to reach their chosen health care provider, and availability as the opportunity for patients to choose among different health care service providers. The ACA puts more of an emphasis on the affordability of health care, but the researchers stressed that it’s not the only hurdle in the way of improving the population’s health. They wrote that health care services need to be within reason- able travel times and have sensible wait times. The researchers examined the pediatric primary care services in California, Georgia, Louisiana, Minnesota, Mississippi, North Carolina and Ten- nessee. Those states were selected for their vary- ing sizes and demographics and the different ways they are implementing the Medicaid program and the Children’s Health Insurance Program. The study included over 9 million children in about 16,500 census areas, served by a network of more than 20,000 health care provider locations with about 66,000 individual and group providers. They found that the disparities in wait times were not as noteworthy as the disparities in travel times. All of the states except for Minnesota have statistically significant higher median travel time than California for the publicly insured population, and all states were found to have a statistically significant higher median travel time than California for the privately insured population. They also found that both the rural and urban communities need improvements in accessibility for publicly insured patients. The researchers hope that federal and state policy makers will use the findings of the study to implement targeted policies that address these disparities. Share this story: dotmed.com/news/26660 HealthCareBusiness news I october 2015 15 HealthCareBusiness Daily News Online > dotmed.com/news Family doctors see compensation skyrocket 9.2 percent since 2012, reaching $241,273 Posted online August 7, 2015, by John W. Mitchell

The new gatekeepers in America’s HCB News. “The market is going through since last year. health care systems — primary care a transition right now as doctors still have Evenson told HCB News the survey re- doctors — are seeing their pay increase. one toe in the old fee-for-service model, but vealed a drop in productivity measures used Sources agree the hike is due to the Afford- more and more are being paid under the to calculate total physician pay from 39 per- able Care Act (ACA), and its emphasis on new ACA measures.” cent to 25 percent. Instead, compensation keeping people well and out of the hospital. The MGMA and its 50 state affiliates is becoming less tied to how many patients An annual Provider Compensation Re- comprise more than 33,000 administra- a doctor can see in a day, to how well the port just issued by the Medical Group Man- tors and executives in 18,000 health care doctor can manage quality factors to keep agement Association (MGMA) pegged organizations in which 385,000 physicians patients well. the family practice income growth at 3.56 practice. A shortage of all doctors is projected to percent since 2013 to a median level of Primary care doctors are most often fam- worsen over the next 10 years, which will $241,273. ily medicine specialists, but can also include likely drive physicians’ salaries higher. Ac- “The market is becoming very competi- internists and pediatricians. Family doctors cording to the Association of American tive for primary care services as hospitals em- have seen their income grow 9.2 percent Medical Colleges, the shortfalls could run ploy family doctors to meet the value-based since 2012, according to the survey. Phy- as high as 90,000 by 2025 overall, includ- purchasing goals under the ACA as well as sician specialists, such as cardiologists and ing a shortage of up to 31,000 primary care to keep referrals flowing to their special- orthopedic surgeons, saw their compensa- physicians. ists,” Todd Evenson, COO at MGMA, told tion increase at a lower rate of 2.39 percent Share this story: dotmed.com/news/26642

HHS awards $169 million to Joint Commission tool to 266 new health centers limit falls could save hospitals

Posted online August 13, 2015, by Lauren Dubinsky $1 million annually Posted online August 14, 2015, by Lauren Dubinsky Five years ago, two small health clinics in Mississippi and South Boston embarked on a mission to provide high-quality The Joint Commission Center for Transforming Healthcare is health care to residents in their communities regardless of stepping up to help hospitals reduce the number of accidents whether or not they could pay. Since then, that mission has that take place within their halls. Using its Targeted Solutions grown into a national program supporting 9,000 sites across 1,300 Tool (TST), the commission estimates the average 200-bed hospital community-based health centers and serving 23 million people, could reduce the amount of falls from 117 to 45 — generating called the Health Center Program. roughly $1 million in savings annually. Health and Human Services announced that $169 million in TST is an online service that provides a step-by-step process to ACA funding will be allotted to 266 new health center sites in 46 help hospitals measure the total rate of falls in their facility, as well states, the District of Columbia and Puerto Rico. The centers are ex- as the falls that lead to injuries. It also looks at the barriers that may pected to increase access to health care services for over 1.2 million be preventing individual hospitals from lowering their rate of falls patients across the country. and offers solutions to address those barriers. These funds build on the $101 million that was awarded to 164 TST was developed with the assistance of seven collaborating new health center sites in May 2015. hospitals, and five additional hospitals have participated in a pilot In a blog post, HHS Secretary Sylvia Mathews wrote that health study to test the fall prevention methodology. centers are on the front lines of transforming our health care sys- The pilot hospitals reported raised awareness among staff, and tem. “In health centers across the country, providers are working said their patients were empowered to take a more active role in as teams to coordinate their patients’ care. As a result, patients are their own safety. Ultimately, they reduced the rate of falls by 35 put in the center of their own care — empowered, educated and percent, and falls that result in injuries by 62 percent. engaged to take charge of their health,” she wrote. Share this story: dotmed.com/news/26731 Share this story: dotmed.com/news/26719

16 HealthCareBusiness news I october 2015 www.dotmed.com Four in five International brain cancer consortium takes health care aim at better linear accelerator outcomes execs say Posted online September 1, 2015, by John W. Mitchell their facility A just-announced initiative between “The inaugural meetings held recently has been Elekta and physicians at health care were to identify SRS clinical practices at systems in three countries will work to consortia members in the U.S., Canada and compromised by set best practice standards for treating Germany,” Kris Walmsley, corporate com- hackers within brain cancer patients with noninvasive munications manager at Elekta, told HCB stereotactic radiosurgery (SRS) and ste- News. last two years reotactic radiation therapy (SRT) using Share this story: dotmed.com/news/26907 linear accelerators. Posted online August 26, 2015, by Gus Iversen

A new survey sheds sobering light on the uptick in cyber attacks attempted on health facilities and the helpless- ness with which many of these institutions face the growing threat. By polling 223 C-level hospital executives, the 2015 KPMG Healthcare Cyberse- curity Survey determined that 81 percent of them believe their facility has been compromised by some form of cyber attack or another in the past two years. Those attempts — whether taking the form of malware, botnet (in which computers are hijacked to issue spam or attack other systems) or other external hacking efforts — are happening more than once a week according to 25 percent of the executives surveyed. For 13 percent of them, these attempts are happening virtually every day. Unfortunately, only 16 percent of those surveyed said their facility could detect a system compromise in real time. With regard to readiness, larger institutions are typically more prepared than smaller ones. Among executives at health plans, 66 percent said they were prepared, while only 53 percent of providers said they were ready. According to 65 percent of the respondents, malware is the most frequently reported form of attack, followed by botnet with 26 percent. Share this story: dotmed.com/news/26859

HealthCareBusiness news I october 2015 17 HealthCareBusiness Daily News Online > dotmed.com/news Private information for 3.9 million people exposed Posted online August 7, 2015, by Thomas Dworetzky

A pair of lawsuits in a massive Indiana tients in mid-July. It also offered those po- dren to experience identity theft scenarios health care records hacking case is just the tentially impacted credit monitoring services. when they reach adulthood.” latest turmoil for health care providers The data breach hit several health care The first lawsuit was filed by one patient, facing an ongoing onslaught of black-hat providers, including: Concentra; Fort Wayne James Young. The second was filed by Rory thieves targeting the rich lode of EHR data. Neurological Center; Franciscan St. Francis Hill, Nicole Hill and Dawn McLaughlin. Both The suits, filed in federal court, seek class Health in Indianapolis; Gynecology Cen- suits seek class action status for all patients action status over a digital break-in that ex- ter Inc. in Fort Wayne; Rochester Medical whose records where involved in the breach, posed the private information of 3.9 mil- Group; RediMed; Fort Wayne Radiology As- according to the Fort Wayne Journal-Ga- lion people’s data, which was breached at sociation LLC, including Nuvena Vein Center zette. Medical Informatics Engineering, through its and Dexa Diagnostics; Open View MRI LLC; The lawsuits accuse the company of neg- NoMoreClipboard subsidiary, and discovered Breast Diagnostic Center LLC; P.E.T. Imaging ligence, alleging that Medical Informatics in May, according to the firm. Services LLC; and MRI Center-Fort Wayne Engineering did not take sufficient action The compromised information includes Radiology Inc., according to MIE. to block the data breach, didn’t adhere to patients’ names, Social Security numbers, But to one plaintiff attorney, Richard She- industry standards for protecting data, and birth dates and addresses the Journal-Ga- vitz, told ABC’s RTV 6 in Indianapolis, “The also neglected to correctly employ systems zette of Fort Wayne reported. monitoring needs to go on for many, many or security sufficient to provide protections, The company contacted the FBI’s cyber years. The dangers and risk of exposure and according to court documents. unit in May and began reaching out to pa- hacking like this can cause even young chil- Share this story: dotmed.com/news/26644 FDA approves first 3-D Radiological interpretation printed drug errors are underreported

Posted online August 17, 2015, by Lisa Chamoff Posted online August 18, 2015, by John W. Mitchell

3-D printing has been used to make orthopedic implants Medical errors related to incorrect imaging interpretation and surgical guides, and now the technology has entered are a long recognized, but underreported, problem. Now a the pharmaceutical industry. research team at Emory University School of Medicine has quantified While printing medications at home is still a long way off, the these blunders by culling through nearly 1.8 million imaging reports. U.S. Food and Drug Administration recently approved the first 3-D The near misses were most often associated with: mislabeling printed prescription drug, an oral medication called levetirace- or misidentification with the wrong patient (52 percent), and tam that treats seizures in patients with epilepsy. Sold by Aprecia wrong dictation (48 percent). These mislabeling or misidentifica- Pharmaceuticals under the name Spritam, the pill is built by a 3-D tions most often occurred at the technician level, especially when printer in 30 to 40 layers, instead of the traditional molding pro- portable X-ray machines were used (69 percent). cess, said Aprecia spokeswoman Jennifer Zieverink. The portables were also associated with 44 percent of wrong The company calls this proprietary 3-D printing process the dictation events. Some 56 percent of the reports with errors were ZipDose Technology platform, and the idea is to help children and related to inpatients. The median time for discovering these er- older adults who have difficulty swallowing pills. rors was 22 hours. In total, the researchers estimate near-miss “It creates a very porous product that is very loosely bonded, radiology reading errors number approximately one in just under so when you place it on your tongue and take a sip of water, it 27,000 — 67 out of 1.8 million. just disintegrates in your mouth,” Zieverink told HCB News. “It’s The instances of imaging near-misses in medical literature has like swallowing a liquid.” been limited, Dr. Gelareh Sadigh, diagnostic radiology resident The printing method gives the manufacturers the ability to in the Department of Radiology and Imaging Science at Emory offer high dosages — up to 1,000 milligrams — in a single pill, University told, HCB News. Sadigh said that identifying the con- according to the company. tributing factors is the only way to design solutions to reduce The company expects to make the 3-D printed Spritam avail- these mistakes. The Emory study appeared in the August issue of able at the beginning of next year. the American Journal of Roentgenology. Share this story: dotmed.com/news/26733 Share this story: dotmed.com/news/26750

18 HealthCareBusiness news I october 2015 www.dotmed.com Hackers can alter a drug pump’s programming Posted online August 4, 2015, by Thomas Dworetzky

Like something out of Mission Impossible, Hospira has discontinued making and dis- hacker would also have been able to access, hackers can alter a drug pump’s program- tributing the system. explore and possibly take over other parts ming, potentially killing patients by over- At issue is the so-called “Internet of of the no-longer-so-secure hospital’s care dosing them at a distance — from any- things,” according to BlackBerry Chief Secu- network, to which the device was attached. where in the hospital, or even beyond. rity Officer David Kleidermacher and security The public disclosure caused a chain of “Hospira and an independent researcher expert Graham Murphy. In a YouTube video events including the publishing of a cyberse- confirmed that Hospira’s Symbiq Infusion of their presentation at the BlackBerry Security curity safety advisory from the FDA. System could be accessed remotely through Summit 2015, they showed just how simple Hospira reported to the BBC that it had a hospital’s network. This could allow an unit was to hack an infusion pump — using the been investigating the problem with the De- authorized user to control the device and built in Ethernet jack at the back of the pump, partment of Homeland Security and FDA change the dosage the pump delivers, which with the help of the device’s manual, which “for some time,” adding, “we will continue could lead to over- or under-infusion of criti- provided the fixed IP address that let Murphy to investigate any feedback we receive on cal patient therapies,” The FDA stated in its break into it. To make matters worse, Murphy our devices. We will also continue to com- safety alert July 31. was even able to hack into the WiFi on the municate with customers regarding cyber- At present, no adverse events or actual pump, so that he could control it remotely. security, and software and infusion pump unauthorized access to the infusion system Worse yet, having succeeded in break- updates and/or enhancements.” has been reported, according to the agency. ing into the pump, Murphy showed how a Share this story: dotmed.com/news/26582

HealthCareBusiness news I october 2015 19 HealthCareBusiness Daily News Online > dotmed.com/news Is ‘deep learning’ the holy grail of ultrasound innovation with hand-held scanner in development? Posted online August 10, 2015, by Thomas Dworetzky

The major players in a large sector of for time it will be superhuman.” The key to this potentially revolutionary the radiology market could find them- He has raised $100 million so far through tool is big data. Rothberg revealed to Wired selves disrupted — and possibly out of his Butterfly Network venture to create his that it will employ so-called “deep learning,” business — if a revolutionary biotech smartphone-sized scanner that can be held to the artificial intelligence approach behind Siri entrepreneur succeeds in producing the a patient’s chest to produce a clear, 3-D image. and similar iterative learning systems. They ultimate cheap, small, hand-held ultra- If he succeeds, it will do to the scanning get smarter the more they are used by many sound scanner. market what is now happening with the people, as it builds their database and allows Jonathan Rothberg told MIT Technology clinical laboratory market, where millions sophisticated analysis across a huge pool of Review that he is working on a patented de- of dollars are going into entrepreneurial clinical data. vice that will be “as cheap as a stethoscope” projects to make miniature lab tests that are The point of this effort, however, is not to and “make doctors 100 times as effective.” quick, cheap and accurate. put radiologists out of business. “Spending “We want it to work like ‘panorama’ on The device, known as a “capacitive mi- 18 percent of our GDP, or $10,000 per per- an iPhone,” Rothberg told the publication. cro-machined ultrasound transducer,” or a son, per year, on health care is unsustainable “When I have thousands of these images, I CMUT, will appear to be a “window,” look- and out of touch with the needs of the rest think it will become faster than a human in ing at what is inside a person when it is held of the world,” Rothberg stated. saying ‘Does this kid have Down syndrome, up to a part of the body, according to Tech- Share this story: dotmed.com/news/26655 or a cleft lip?’ And when people are pressed nology Review.

Visit us at RSNA Booth #1408 GE Healthcare first to get FDA nod for low dose CT lung cancer screening

Posted online August 17, 2015, by Gus Iversen Medical Chillers GE Healthcare has received FDA clearance for a lung cancer screening option that utilizes low dose CT. The protocol, which GE says is the first to be approved for CT lung screening, takes into account the latest recommendations from a wide range of medical and regulatory organizations to generate an image of the lung — and any existing cancer nodules — with minimal radiation exposure to the patient. • Serving all medical modalities and brands The value of lung cancer screening with low dose CT was real- • Redundant design to offer efficient and reliable ized in the National Lung Screening Trial (NLST) which looked at performance — proven 99% uptime 53,000 patients across 33 facilities — healthy older adults who had • Dedicated medical service team a history of heavy smoking. Half of those patients were screened • Special geographical options available with low dose CT, the other with X-ray. The NLST determined that low dose CT lowered the mortality rate by 20 percent. Seismic certification: California's Office of Statewide Health Planning & Development (OSP-0169-10) GE’s screening protocol is custom-tailored to its different scanner models and may be implemented on any of its 64-slice or greater CT scanners and the majority of the company’s 16-slice systems. It

800.YOU.KOOL will also work in conjunction with GE’s noise reduction technolo- www.koolantkoolers.com gies, ASiRTM, ASiR-VTM and VeoTM. Mention this ad and receive 15% off your quote Share this story: dotmed.com/news/26746

20 HealthCareBusiness news I october 2015 www.dotmed.com Siemens Healthcare receives FDA approval for two new MR postprocessing applications Posted online August 11, 2015, by Lauren Dubinsky

Siemens Healthcare announced FDA server and it is compatible with all Siemens follow tumor response. PET imaging is the approval of its new MR postprocessing MR systems. It can be used on every body traditional way in which tumor response is applications — syngo.MR OncoCare for part ranging from the brain to the liver. assessed, but it involves radiation. oncology and syngo.MR Neuro Dynam- The syngo.MR Neuro Dynamics is an ap- “You are going to be exposed to imaging ics for neurology. plication that provides tools to radiologists that is based on ionizing radiation, but you Oncologists will now be able to use MR to to assess tumors in the brain. It can be used want to minimize it,” said Sheehan. determine a patient’s response to treatment. to evaluate the blood flows of those tumors. MR systems are typically more expensive “OncoCare’s ability to assess therapy To use Onco.Care, the radiologist loads than PET systems, but this software package response complements the other inherent the MR studies, draws a region of interest can be added on to even the less expensive strengths of MR — non ionizing radiation around a tumor and creates histograms us- MR systems. exams, multiple contrasts and multi-planar ing the software, which allow for quanti- The software is also helpful for referring imaging capabilities,” Anne Sheehan, MR tative evaluation of tumor response. They physicians because it displays a color circle product manager for Siemens Medical Solu- are then able to follow the patient across around the region of interest — red signals tions, told HCB News. “It’s a powerful new a plethora of therapies to determine if they an area of concern and green means the tool for radiologists.” have responded. area is not of concern. The histograms are for OncoCare is a standalone software pack- MR images show great anatomical detail, those who want to be involved in the data. age that can be put on a PC or a syngo.via but in the past they haven’t been able to Share this story: dotmed.com/news/26678

Scientists create portable ® biomorph Sit linac for imaging and cancer radiology furniture Stand treatment options Plus Series Tables with dual motorized surfaces Posted online August 17, 2015, by Lisa Chamoff

Housed in a tunnel 17 miles in circumference and as deep as 574 feet underground, the Large Hadron Collider (LHC) is significantly bigger than any hospital, but facilities will soon be able to harness its power — in a much smaller package. Scientists at the European Organization for Nuclear Research (CERN), which built the LHC in collaboration with thousands of sci- Highest adjustment range available 22.1”- 48.6” entists and engineers around the world, have used the same technology to create what they’ve called a miniature linear accelerator, or mini-Linac, designed to be used in hospitals for cancer treatment and to produce radioisotopes for imaging. The mini-Linac is made up of four modules that are each roughly

20 inches long, for a total package of a little more than 6.5 feet. Plus Series Tables Level Series Tables Only one module has been constructed, though the scientists say Improve your Health, Increase your Comfort, that it is enough to validate the concept. To develop the mini-Linac, the scientists had to double the op- and Gain Productivity. Through built-in ergonomics and full adjustability Biomorph improves efficiency erating frequency used for the radiofrequency quadrupole (RFQ), and well-being in reading rooms. And because Biomorph is a component-based a linear accelerator component used in the acceleration of low- solution you can select the exact features that you need. We are a complete source, including tables, seating, lighting and more. Call today for a free quote. velocity ion beams. With the higher frequency, the accelerator can be more compact. Call 888 302 3375 • view full line at BIOMORPH.COM Share this story: dotmed.com/news/26702

HealthCareBusiness news I october 2015 21 HealthCareBusiness Daily News Online > dotmed.com/news Molecular breast imaging is an accurate and cost-effective supplemental screening tool Posted online August 17, 2015, by Lauren Dubinsky

Molecular breast imaging (MBI) as a sec- crease in detection rates and reduces costs The most reliable way to manage breast ondary screening tool for women with by about 15 percent. The MBI technology cancer is through early detection, but stan- dense breasts is more cost-effective used for the study was Gamma Medica’s dard mammography and 3-D tomosynthesis than screening with mammography LumaGEM, which received FDA approval don’t possess the clarity and accuracy to de- alone, according to a new Mayo Clinic in 2011. tect cancer in the early stages. MRI has the study. The industry is searching for ways to During an MBI procedure, a radioactive same sensitivity and improved specificity as improve cancer detection in dense breasts tracer is injected into the patient through MBI, but it costs three times as much. and research like this may hold the answer. a vein in their arm. The cancer cells take up Breast density notification laws have “In the past, the market has struggled to the tracers more than normal cells do, so been enacted in 24 states, which require meet the needs of the 45 percent of women a nuclear medicine camera is then used to physicians to notify women who have with dense breast tissue,” Philip Croxford, scan the breast for areas where the tracer is dense breast tissue. The intention is to in- president and CEO of Gamma Medica Inc., concentrated. form the women so they can decide, along told HCB News. “This study reinforces that Mammography, tomosynthesis and ultra- with their physicians, if they want to get MBI technology is a highly effective tool for sound are anatomical imaging tests, but MBI further testing. secondary breast cancer screening.” is a functional imaging modality. Because of The results of the study were published The study found that supplementing MBI that, it highlights the metabolic activity in the in the American Journal of Roentgenology. with mammography leads to a four-fold in- breast, despite tissue density. Share this story: dotmed.com/news/26747 Children’s hospitals are Global medical imaging ditching CT for other imaging equipment market to exceed modalities amid cancer risk $35 billion by 2019: report

Posted online August 24, 2015, by Lauren Dubinsky Posted online August 20, 2015, by Gus Iversen

Researchers assume that a decline in CT usage is due to in- In 2012, the medical imaging equipment market was worth creasing evidence that the ionizing radiation from CT scans $24.39 billion and in 2019 it will be worth $35.55 billion — is associated with an increased risk of cancer in patients. that’s the takeaway from a new market report from Transpar- Exposing 10,000 children to the ionizing radiation may lead to one ency Market Research (TMR). malignancy, according to previously published research. The researchers credit the market’s success — projected at a Instead, the children’s hospitals are opting to use alternative im- compound annual growth rate (CAGR) of 5.4 percent from 2013 aging that doesn’t involve radiation, including ultrasound and MRI. to 2019 — to the usual suspects in health care, people living longer However, there may still be a need for CT in cases where ultrasound with managed health issues. They cite the prevalence of cardio- and MRI aren’t adequate. vascular disease, as well as brain and lung disorders, among the The study was conducted using the Children’s Hospital Associa- health issues contributing most significantly to the growing imaging tion’s Pediatric Health Information System, which is a comparative market. pediatric database that provides information on clinical and resource Despite that, investments in CT scanners is counted alongside utilization on inpatient, ambulatory surgery emergency department nuclear imaging equipment as two market segments expecting the and observation unit patients at 45 children’s hospitals. most rapid growth, while X-ray devices are expected to continue The researchers evaluated inpatient and observation unit pa- as the main driver of the market. Other modalities included in the tients for 10 specific diagnoses at 33 participating hospitals from report are ultrasound and MR. Jan. 1, 2004, to Dec. 31, 2012. The diagnoses analyzed were sei- TMR cites 12 major companies profiled in the research report, zure, ventricular shunt procedure, craniotomy, concussion, severe but also says that three of those companies make up over half of head trauma, appendectomy, gastroenteritis, abdominal pain, up- the entire market. Regionally speaking, the biggest growth is antici- per respiratory tract infection and ENT conditions. pated in Asia Pacific. Share this story: dotmed.com/news/26826 Share this story: dotmed.com/news/26790

22 HealthCareBusiness news I october 2015 www.dotmed.com FDA approves Boston Scientific’s Innova stent system, which will treat peripheral artery disease Posted online August 20, 2015, by Lauren Dubinsky

Boston Scientific Corporation announced ments for stents, but the Innova stent plat- Dr. Jaafer Golzar, interventional cardiologist that its Innova Vascular Self-Expanding form’s flexibility, radial strength and fracture at Advocate Christ Medical Center and the Stent System received FDA approval. The resistance are specifically designed for that first to use the Innova Stent System in a clini- new system could represent a major break- anatomy. cal procedure following FDA approval, said through in the treatment of peripheral artery The system is composed of a nitinol in a statement. disease (PAD). self-expanding bare metal stent with an The system also serves as the founda- Before a patient develops PAD, their su- advanced delivery system. It’s available in a tion for the new Eluvia Drug-Eluting Vascu- perficial femoral artery (SFA) or proximal range of sizes including diameters from 5 lar Stent that is designed specifically for the popliteal artery (PPA) narrows and becomes millimeters to 8 millimeters and lengths of SFA. However, the Eluvia stent is pending CE blocked. That causes a build-up of plaque 20 millimeters to 200 millimeters. Mark and is not available for sale in the U.S. in one or more of the arteries, usually in The system utilizes something called “The Innova and the Eluvia Stent Systems the legs. “hybrid cell architecture,” which consists of together demonstrate our commitment to About 8 million people in the U.S. have open cells along the stent body and closed improving health outcomes in the treatment PAD, according to the Centers for Disease cells at each end. The stent was designed of a disease affecting more than 200 million Control and Prevention. PAD of the lower ex- this way to ensure accurate and uniform de- people worldwide,” Jeff Mirviss, president of tremities can cause painful ulcers, infections ployment into the artery. peripheral interventions at Boston Scientific, or amputation of the toes or feet. “The Innova delivery system allowed me said in a statement. The SFA and PPA are challenging environ- to place the stent smoothly and accurately,” Share this story: dotmed.com/news/26792 Using fMRI to inform antipsychotic prescriptions

Posted online August 28, 2015, by Gus Iversen

Nearly one-fourth of all adult stays in U.S. community hospitals involve depressive, bipolar, schizophrenia and other mental health disorders or substance use-related disorders, according to the Agency for Healthcare Research and Quality (AHRQ). In addition to the distress suffered by patients with psychiatric disorders, the burden is shared by their loved ones and also by the health care system itself. A new study from the Feinstein Institute for Medical Research has investigators optimistic about the potential for functional MRI (fMRI) to cut some of the uncertainty out of caring for these patients. By looking at connectivity patterns of a brain region called the striatum, which is known to be abnormal in patients suffering from psychotic symptoms, the researchers have shown they can predict a patient’s response to medication through imaging. A total of 91 regions functionally connected with the striatum provided significant prognostic information. In their report, the researchers concluded with further development, their findings have the potential to introduce a prognostic bio- marker with clinical utility and to reduce the overall burden associated with psychotic illnesses. Share this story: dotmed.com/news/26888

HealthCareBusiness news I october 2015 23 HealthCareBusiness Daily News Online > dotmed.com/news Cardiologist will monitor extreme swimmer on 5,500-mile journey across Pacific Ocean Posted online August 18, 2015, by Lauren Dubinsky

Swimmer Ben Lecomte was repeat- “This is a continuation of our work and our Lecomte said in a statement. “It is my duty as edly stung by jellyfish and followed by interest in the effects of extreme conditions on a father to try to do anything and everything I a shark for five days on his 3,395-mile the human body,” Levine said in a statement. can to reduce the liability on the environment swim across the Atlantic Ocean in 1998. Levine has already started the research on that I am going to pass on to my children.” He’s gearing up to face another amazing Lecomte by taking baseline echoes of his heart He intends to swim 5,500 miles from To- feat, but this time it’s a 5,500-mile swim to be used during and after his swim. Levine re- kyo to San Francisco over the course of 180 across the Pacific Ocean. ported that he was able to obtain “some beau- days accompanied by a boat. He spent the Dr. Benjamin Levine of the University of tiful” 2-D and 3-D images of Lecomte’s heart. last two years training and preparing for his Texas Southwestern is going to use a NASA- Lecomte was the first person to swim journey by studying the flow patterns of the tested technology called remote guidance across the Atlantic Ocean and he is now ocean currents. echocardiography to monitor changes in looking to also become the first person to Lecomte is determined to not live a rou- Lecomte’s heart during his swim. The tech- swim across the Pacific Ocean. His goal is to tine life. “You have people who climb moun- nology was previously used for a seven-year bring attention to environmental issues. tains. You have people who sail around the study of 13 astronauts’ hearts, who were “I’ve noticed changes in the water over my world. This is my passion,” he said. living on the International Space Station. lifetime, more plastic, less and less sea life,” Share this story: dotmed.com/news/26757

Just three percent of adult Researchers find three ways patients account for 30 hospitals can achieve higher percent of hospital charges patient satisfaction

Posted online August 12, 2015, by John W. Mitchell Posted online August 11, 2015, by Gus Iversen

A new comprehensive study across the Denver Health inte- Through a partnership with ProPublica, online review giant grated health network yielded findings sure to come as a Yelp has tapped into meaningful health care data to comple- surprise to both clinicians and policy makers alike. ment the reviews and ratings provided by their users. “Most patients who return to the hospital frequently do so for A study out of Johns Hopkins aims to show them exactly how short periods of time. The patients who were hospitalized multiple that can be achieved. By sending questionnaires and letters to medi- times last year tend not to be the same people who will be hospi- cal personnel and CEOs from a nationwide sampling of 53 hospitals, talized frequently this year,” Dr. Tracy Johnson, director of health researchers think they’ve exposed a few best practices for ensuring care reform at Denver Health, told HCB News. happy patients. She is lead author of a just-published study on super-utilizers The researchers first identified 169 hospitals with a “top rank- in the August issue of Health Affairs. ing” or a “most improved” designation based on their scores in the According to Johnson, it’s difficult to devise good health care December 2012 Hospital Consumer Assessment of Healthcare Pro- policy to get super-utilizers into primary care medical homes if viders and Systems survey. Of them, 53 agreed to participate in the misunderstandings persist about the needs of such patients. survey — representing a wide variety of hospital sizes and regions. Population health strategies, like medical homes, are integral to Of the respondents, 77 percent reported that a commitment to the ACA’s health reform objectives. the patient and family was a vital part of their culture and a key reason The study of nearly 5,000 publicly insured and uninsured for their high performance. In terms of operational satisfaction, the adults with a history of repeated hospitalizations from mid-2011 facilities credited quick responsiveness — in fact 83 percent of respon- through mid-2013 found that just 3 percent of patients account dents cited proactive nurse rounds as a contributing factor in that for 30 percent of charges in any given month. But nearly 75 per- success. These hospitals also promoted specific activities like making cent of such patients dropped out of the super-utilizer category eye contact with patients and sitting at patient bedsides instead of after 12 months. standing over them. Share this story: dotmed.com/news/26695 Share this story: dotmed.com/news/26673

24 HealthCareBusiness news I october 2015 www.dotmed.com International researchers use MR to steer cancer-killing viruses toward deep tissue tumors Posted online August 18, 2015, by Gus Iversen

Like a drone being guided remotely tumor site using the attraction between the therapy effectiveness. They also stated that through a dense forest, an international nanoparticles and the MR magnet. the therapy could be useful for both primary team of researchers may have found a The research comes out of the University and secondary tumors, but emphasize that way to deliver cancer killing viruses di- of Sheffield’s Department of Oncology in the there is still plenty that needs to be done. rectly to tumors deep within the body UK and was funded by the Medical Research “We need to do more studies first, but using the magnetic pull of an MR sys- Council. They conducted their trials using hopefully we will be able to start testing tem. This novel, targeted, approach could a 7-Tesla MR — an exceptionally powerful it in patients,” Muthana told BBC News. dramatically increase the efficiency of can- magnet. “We’d need to check that clinical scanners cer treatment while reducing the necessary “The beauty of using the MRI scanner to are strong enough ... and if we can reduce amount of medication. administer the therapy is that you can also the length of time that a patient would need Using mice as their subjects, the research- use it for its original purpose, providing a real- to be in the scanner. The treatment took 30 ers injected immune cells carrying super- time image-guide to ensure the treatment minutes to an hour in mice.” paramagnetic oxide nanoparticles (SPIOs) has gone where it is needed,” said Dr. Munit- MR has enjoyed several decades as a state- and supplied them with an oncolytic virus ta Muthana, lead researcher, in a statement. of-the-art imaging modality, but rarely has it (OV) which infects and kills cancer cells. They Their study, published in Nature Commu- been looked to for therapeutic purposes. then guided the virus non-invasively to the nications, reports an 800 percent increase in Share this story: dotmed.com/news/26761

AmWell announces telehealth partnerships with Capital Complete Hitachi® MRI Solutions BlueCross, AllianceHealth Oklahoma using free app • Altaire® Coldhead Service • Helium Fills Posted online August 5, 2015, by Stephen Hanks • ACR & IAC Calibrations & Shimming According to the American Telemedicine Association, during 2016, almost two million people with urgent care, non-life- • Flexible Service Plans threatening medical issues will likely be consulting with a doctor via a computer, tablet, or smartphone. Many health insurance • Image Quality Tune-ups companies, state health departments, hospitals, and businesses have shown a commitment to realizing the potential of telehealth. • Coil Repairs Apps such as Vytaliz, Doctor on Demand, Teledoc, and AmWell are all emerging to meet this growing demand. • Installations & System Moves According to the company, Amwell connects patients with a doc- • Quality, Refurbished OEM Parts tor in less than two minutes. Patients can also request an appoint- ment with a specific telehealth doctor. The service provides live video ...And, a reputation you can trust! consults with board certified physicians 24 hours a day, who can offer advice, prescribe medications, and suggest follow-up care. In just the past month, Capital BlueCross, the leading health insurance company in central Pennsylvania, and AllianceHealth Oklahoma have partnered with American Well for their mobile and Web technology and will call its service “VirtualHealthNow,” and it can be accessed from a 661-373-1977 • 800-930-7958 • viablemed.com free app downloaded from Google Play or the App Store or on the Web. Share this story: dotmed.com/news/26792

HealthCareBusiness news I october 2015 25 HealthCareBusiness Daily News Online > dotmed.com/news Through deal with Merge, IBM’s Watson will interpret medical images using Health Cloud Posted online August 17, 2015, by Thomas Dworetzky

Someday in the near future, when historical images, electronic health records, least 90 percent of all medical data today. there’s an X-ray or CT scan that needs data from wearable devices and other re- Watson’s enormous computing power interpreting, your hospital may well lated medical data, in a HIPAA-enabled envi- may ultimately help address the challenges echo the sentiment of the first phone ronment,” according to the company. faced by today’s radiologists confronting this call, when Alexander Graham Bell fa- Merge’s technology platforms are in massive onslaught of data — in some hos- mously said, “Mr. Watson — come here use managing images at more than 7,500 pital emergency rooms these image analysts — I want to see you.” U.S. health care sites, as well as most of the are now facing as many as as 100,000 im- That would refer to IBM’s massive Watson world’s leading clinical research institutes ages a day. Health Cloud effort, which has just ponied up and pharmaceutical firms, according to IBM. The Merge deal will help leverage the AI $1 billion to buy Merge, a medical imaging This huge “data buy” is the computing abilities of the Watson Health Cloud, letting management platform with 30 billion medi- giant’s third major health-related acquisition it analyze and cross-reference medical im- cal images in it. The plan is to use these to — and the largest — since launching its Wat- ages against huge numbers of lab results, “teach” Watson to “see,” according to IBM. son Health unit in April. The two prior deals electronic health records, genomic tests, Watson’s advanced image analytics and were for Phytel (population health) and Ex- clinical studies and other health-related data cognitive capabilities can feast on the data, plorys (cloud based health care intelligence). sources, already representing 315 billion which will make it “smarter.” It will be able Medical images are by far the biggest, data points and 90 million unique records, to “surface new insights from a consoli- fastest-growing data sector in health care. according to the firm. dated, patient-centric view of current and IBM researchers say that they account for at Share this story: dotmed.com/news/26732 Hospira announces first use of fMRI reveals adolescents Plum 360 infusion pump may not outgrow ADHD in

Posted online August 27, 2015, by Lauren Dubinsky adulthood after all Posted online August 28, 2015, by Lauren Dubinsky After receiving FDA approval in January, Hospira’s wireless- capable Plum 360 infusion system with Hospira MedNet has un- Researchers at the University of Cambridge and University dergone its first installation at Shannon Medical Center in Texas. of Oulu used functional MRI (fMRI) to examine the brains of The Plum 360 system has a secondary line that connects directly to young adults who had ADHD as adolescents. the PlumSet cassette and enables the pump to be programmed with Some believe that children may outgrow ADHD as their brain devel- two compatible medications that can be delivered at the same time or ops in adulthood, but research suggests that 10 to 15 percent of chil- one after another. The secondary line that travels through channel B dren still have ADHD in adulthood. Most of the research that tracked of the pump, also integrates with the EMR systems through Hospira’s children with ADHD into adulthood used interview-based assessments, IV-EMR interoperability solution. which don’t reveal differences in brain structure and function. The Hospira MedNet includes an expanded drug library to set safety Researchers turned to MR and fMRI to get answers. They evalu- limits for more medications across more clinical care areas. The system ated MR scans showing the brain structure and memory function also has no remote command execution and provides better protection of 49 young adults between the ages of 20 and 24 who were of the communication ports and support for 128-bit SSL encryption of diagnosed with ADHD at age 16, and compared it with MR scans all data that is transmitted to and from Hospital MedNet version 6.1. of a control group of 34 young adults. The Hospira MedNet version 6.1 features a new capability called They found that the group diagnosed with ADHD in adoles- Alarm Forwarding, which forwards the IV device alarm data to EMR cence had reduced brain volume and poorer memory function, and alarm management systems. It can help improve a hospital’s alarm whether or not they still met the diagnostic checklist criteria for management policies by automating pump alarm notifications. ADHD. More specifically, they uncovered that they had reduced The software also enables automated programming of the infusion grey matter in the caudate nucleus, which is a key brain region pump and auto-documentation of the IV data to the EMR. that integrates information across different parts of the brain and Share this story: dotmed.com/news/26876 supports cognitive functions such as memory. Share this story: dotmed.com/news/26891 26 HealthCareBusiness news I october 2015 www.dotmed.com Johns Hopkins: Hospital monopolies threaten competition and raise medical expenses Posted online August 19, 2015, by Lauren Dubinsky

If the trend toward hospital monopolies gery at Johns Hopkins, said in a statement. treatment to more patients, but if a large continues, it may hamper healthy com- Hospital consolidation is currently grow- health system gobbles up smaller hospitals, petition and increase medical expenses, ing at a rapid rate. In 2013 and 2014 there it could have the opposite effect. according to a Johns Hopkins commen- were 193 mergers and in the next five years “If we think that everyone in America tary recently published in JAMA. one-fifth of hospitals in the U.S. are expected deserves high-quality care, then we have to Health care reform is encouraging hos- to seek a merger, according to the authors. ask ourselves whether we’re creating eco- pitals to consolidate, which is creating mas- An analysis published in JAMA in 2013 nomic conditions that threaten it,” Dr. Albert sive health care chains. Hospital monopolies found that of the 306 geographic health Wu, co-author and professor of health policy aren’t subject to the checks and balances of care markets in the U.S., none were consid- and management at Johns Hopkins, said in a competitive marketplace, which could lead ered highly competitive. In addition, almost a statement. to higher deductibles and copays for patients. half of the markets are considered highly The authors are calling for the Federal “It’s really Economics 101, but in the concentrated, with a handful of small hospi- Trade Commission to be more cautious health care field, the implications of ‘too big tals dominated by one large health system. when hospital systems request approval to to fail’ hospital systems could be far more However, the authors mentioned that consolidate and to pay more attention to devastating than similar consolidations in “limited integration” should not be confused geographic regions where proposed merg- other industries because ultimately they with full consolidation. When large medical ers could create a single dominant health threaten access and quality of care,” Dr. Mar- centers collaborate with smaller community system. ty Makary, lead author and professor of sur- hospitals, it can spread best practices and Share this story: dotmed.com/news/26777 Among critically ill, study finds probiotics useless against ‘superbugs’

Posted online August 1, 2015, by Gus Iversen

In a study published in Infection Control & Hospital Epidemi- ology, a team led by Jennie H. Kwon, clinical researcher in the Washington University School of Medicine in St. Louis’ Divi- sion of Infectious Diseases, followed 70 patients admitted to ICUs at Barnes-Jewish Hospital in St. Louis to determine if a probiotic called Lactobacillus rhamnosus GG could hamper superbug colonization. The researchers monitored the intestinal tracks of those patients, having divided them into one group receiving routine care and another receiving routine care plus probiotics. After administering the probiotic twice daily for as many as two weeks, the researchers reported no statistically significant reduction in the frequency of microbe colonization — 10 percent versus 15 percent for the control group. In her statement, Kwon acknowledged and emphasized the limitations of the study: small patient sample size, brief length of patient follow-up, and use of a single type and dose of probiotic. The researchers also did not assess the possible impact of probiotics on preventing the colonization of superbugs in other bodily regions, such as the stomach or upper airway. Share this story: dotmed.com/news/26874 HealthCareBusiness news I october 2015 27 HealthCareBusiness Daily News Online > dotmed.com/news 1 in 25 patients infected during hospitalization Posted online August 5, 2015, by John W. Mitchell

While it’s well known that 1 in 25 pain assessing other health interventions. nologies, such as UV light and hydrogen tients get an infection while in the Umscheid noted that in 2006 when a peroxide spraying mist devices, may further hospital, there is no good evidence of landmark study on central line infections eliminate bacteria that can be left behind by how much dirty rooms contribute to the was released, it was widely believed that conventional cleaning. But even studies on problem. This was the surprising finding of hospital-acquired infections were a normal conventional housekeeping have not offered a study conducted by a research team at the risk of inpatient care. Since then, many hos- much in the way of good data on effective- Hospital of the University of Pennsylvania. pitals have greatly reduced their central line ness of cleaning agents. “This is not a simple problem,” Dr. Craig infection rate to less than one percent by The study found that hard surfaces such Umscheid, an internist and epidemiologist adopting best practices. as tray tables, bed rails, and toilets, frequent- who is assistant professor at the University of “Everyone who works in a hospital ly touched by patients and health care staff, Pennsylvania and a member of the research knows that we have to remove debris that are prime sources for contaminating patho- team, told HCB News. “But it was surprising are sources of infection, such as stool, blood gens. According to Umscheid, one of the to find that there is a lack of good comparative and other liquids,” Umscheid explained. biggest challenges the study indicates is to studies that were patient-centered, that exam- “But that doesn’t mean surfaces are free better understand the extent to which these ined different approaches for cleaning patient of bacteria after a room has been cleaned.” contaminants might cause infections. rooms.” He said that such studies are the norm He said that new “no-touch” cleaning tech- Share this story: dotmed.com/news/26807 Weak doses of radiation In first full year, ACA prolong life of fruit flies, say increased coverage in researchers in Russia underserved areas by 17%

Posted online August 25, 2015, by Gus Iversen Posted online August 18, 2015, by Gus Iversen

Exposing fruit flies to gamma radiation may sound cruel, but Newly released data is shining light on the impact of the Af- new research suggests that in very weak doses — it can actu- fordable Care Act on the rate of insurance among the most ally make them live longer. Scientists at the Moscow Institute medically underserved populations in the U.S. of Physics and Technology in Russia think their findings could By examining nearly 1,300 federally funded health centers in ultimately inform increased human longevity and perhaps over 9,000 underserved locations (both rural and urban), the Geiger someday “prevent aging” altogether. Gibson/RCHN Community Health Foundation Research Collab- Their research challenges the widely held notion that any orative has generated a compelling report card for the first year of amount of radiation is a hazardous amount of radiation, an as- President Barack Obama’s health reform legislation. sumption that has come under fire before due to its linear no- They found that between 2013 and 2014, the percentage of threshold logic. insured low income patients in those areas increased by 2.3 million Their research is based on the premise of hormesis; a biological — or 17 percent. phenomenon whereby a beneficial effect results from exposure to Likewise, the number of uninsured patients declined by 1.2 mil- low doses of an agent that is toxic or lethal when given at higher lion, a 16 percent reduction. doses. Overall, hospitals in these impoverished areas treated 1.1 million Previous studies have shown small doses of poison can benefit more patients during that time frame, a 5 percent hike that is con- yeast cells, peppermint, and roundworm, said the researchers. By sistent with a larger trend toward federally funded health centers — using radiation to activate the “stress genes” and “stress paths” of whose patient populations have almost tripled in the last two decades. fruit flies, they hope to isolate the mechanisms that push an organ- The researchers based their findings on the 2014 Uniform Data ism to excel and survive. System (UDS), which collected patient and health care information While the average fruit fly lives about two months, the low from the nation’s community health centers. dose exposure increased lifespan by about one week, said Svetlana Notably, Medicaid expansion contributed to nearly 80 percent Zhikrivetskaya, lead author, in a statement. of the 2.3 million newly-insured patients being treated at these Share this story: dotmed.com/news/26842 health centers. Share this story: dotmed.com/news/26766

28 HealthCareBusiness news I october 2015 www.dotmed.com ASE leverages Mindray ultrasound to expand echocardiography in remote areas of Vietnam Posted online August 25, 2015, by Lauren Dubinsky

Rheumatic heart disease is widespread It’s important that patients are able to Mindray will supply six M7 portable cardi- in Vietnam, but echocardiography is be seen in rural settings because the fragile ac ultrasound systems to the Vietnam Heart only available at centers in major cit- and younger patients may not be able to Institute to support the training. The ASE ies because of the cost and size of the handle the long journey to the hospital. The Foundation received multiple proposals of equipment. But even in the major cities, patients who have more serious symptoms interest for this program, but they decided physicians have a heavy workload since they will receive follow-up care at the National that Mindray was the best fit. perform their own scans as well as interpret Heart Institute/Bach Mai Hospital. Mindray also agreed to have one system them, unlike the system in the U.S., where One of the program’s core components remain in Vietnam as a gift to the Bach Mai sonographers perform scans for interpreta- will be to teach local clinicians how to use Hospital at the end of the mission so that tion by physicians. laptop size echo platforms for focused car- the training and work can continue after The American Society of Echocardiogra- diac ultrasound testing. The program will the program. phy (ASE) Foundation is in Hanoi, Vietnam, also involve hands-on training at the Viet- The ASE was founded in 1975 and is the along with Mindray’s ultrasound systems to nam National Heart Institute at the Bach largest international organization for car- try to deal with this issue. The foundation Mai Hospital, an educational symposium diac imaging. It comprises over 16,000 phy- worked to teach local clinicians how to prop- for clinicians located in local provinces, sicians, sonographers, nurses and scientists erly acquire cardiovascular images and use training for local health care workers and that provide guidance, expertise and educa- compact echo systems in areas with scarce a village screening program with over 200 tion to its members. resources. patients. Share this story: dotmed.com/news/26827 Mayo Clinic researchers discover molecular ‘code’ for ‘turning off’ cancer cells

Posted online August 27, 2015, by John W. Mitchell

Just as you would flip a switch to turn off a light, a new discovery by Mayo Clinic scientists may point the way to shutting off the growth of cancer cells. “We found that an adhesion protein, the glue that keeps normal cells together, suppresses cell growth through small molecules called miRNAs,” Dr. Antonis Kourtidis told HCB News. “We discovered that this structure is missing in many tumors.” In cultured cell experiments, loss of miRNAs results in abnormal cell growth. But when the miRNAs are restored, abnormal growth was significantly suppressed, according to Kourtidis. Kourtidis and the other researchers think the discovery of this new, unexpected biology “provides the code, the software for turning off cancer,” adding that preliminary results in aggressive breast and bladder cancer cultured cells have been encouraging. The nuts and bolts of the study are significant, as it brings together two so far unrelated research fields — cell-to-cell adhesion and miRNA biology. Kourtidis noted that the role of adhesion proteins in cell behavior has long baffled scientists. But now that this link has been discovered, it uncovers a new strategy for cancer therapy. Share this story: dotmed.com/news/26875 HealthCareBusiness news I october 2015 29 HealthCareBusiness Daily News Online > dotmed.com/news Feeling understaffed and overworked, NJ nurses ‘had tears in their eyes’ as they braced for strike Posted online August 25, 2015, by John W. Mitchell

Nearly 80 percent of nurses at Shore Medi- hospital, which has an average daily census old and noted that it received an “A” rating cal Center in Somers Point, New Jersey, of 140 patients, said since the beginning of from the Leapfrog Group, a national hospital voted to authorize a strike at the facility if the year, 60 registered nurses have left the rating nonprofit. last minute contract talks are unsuccessful staff. She noted that Consumer Reports, in “We have been encouraging the union in resolving their workplace concerns. its just-published rating of hospital-acquired to come to the bargaining table and to en- “None of us want to go out – we just infections, rates Shore as the country’s 18th gage in meaningful bargaining,” Brian Cahill, want to take care of patients,” Dotty Rud- worst hospital for HAIs. director of marketing and public relations at ert, operating room nurse, told HCB News. “This does not make us proud,” said Jen- Shore Medical Center, told HCB News. “Un- “Many nurses had tears in their eyes when kins. “We want to raise our scores. But some fortunately, the union has only participated in the vote was taken,” she added. of the expertise we need to accomplish this two bargaining sessions in the last 45 days.” The nurses, who are represented by the has been outsourced. Combine this with the He added that in the event of a strike, the Shore Nurses Union, part of the New York reduced number of nurses, patient care is hospital is “well prepared” to take care of State Nurses Association (NYSNA), are seek- being compromised,” said Jenkins. patients with a team of professional nurses. ing to improve staffing levels at the hospital In a statement, the hospital confirmed it Both the union and the hospital say they according to Eric Smith, lead program repre- is in negotiations and said it offers competi- have widespread community support for sentative at NYSNA. tive compensation and benefits. It also said their bargaining positions. Suzanne Jenkins, a case manager at the the Consumer Reports data was two years Share this story: dotmed.com/news/26847

ACOs are realizing goals of Natural process can curb improving care and saving beta-amyloid production, money: CMS evaluation scientists discover

Posted online August 26, 2015, by Lauren Dubinsky Posted online August 26, 2015, by Lisa Chamoff

The ultimate goal of health reform is to develop a system Researchers at The Rockefeller University in New York City that delivers better care, more quickly, and at a lower cost. have discovered how the brain naturally decreases the pro- According to CMS’ new 2014 quality and financial performance duction of beta-amyloid, which could lead to a new approach results, Medicare Accountable Care Organizations (ACOs) are on to the treatment of Alzheimer’s disease. the right track to achieving those objectives. In the study, the scientists at The Fisher Center for Alzheimer’s Re- CMS evaluated the performance of ACOs on a broad spectrum search found that a molecule called AICD, another cleavage product of 33 metrics. Among those metrics are how highly patients rated generated together with beta-amyloid, can regulate the gene expres- their physician, how well clinicians communicate, whether they sion of a protein called WAVE1, which is important in the production screened for high blood pressure, tobacco use and cessation and of beta-amyloid. This is a naturally occurring regulatory mechanism to their use of EHRs. prevent the overproduction of beta-amyloid, though the scientists say In their third year, the pioneer ACOs demonstrated improvements Alzheimer’s disease somehow overrides this protective effect. in 28 of the specific categories and had an average improvement The researchers looked at mouse and cellular models of Alzheim- rate of 3.6 percent across all metrics. The Shared Savings Program er’s disease, as well as the brains of human patients with the disease, ACOs improved 27 of the metrics over the course of 2013 and 2014. and found the levels of WAVE1 were unusually low. When the scien- “These results show that accountable care organizations as a group tists further reduced WAVE1 gene expression in the mice, their beta- are on the path toward transforming how care is provided,” Andy amyloid levels decreased and they performed better on memory tests. Slavitt, CMS acting administrator, said in a statement. “Many of these The work was funded by the Fisher Center for Alzheimer’s Re- ACOs are demonstrating that they can deliver a higher level of coordi- search Foundation, which backs a team of more than 50 scientists at nated care that leads to healthier people and smarter spending.” Rockefeller University led by Dr. Paul Greengard, who was awarded Share this story: dotmed.com/news/26858 the Nobel Prize in Physiology or Medicine in 2000. Share this story: dotmed.com/news/26860

30 HealthCareBusiness news I october 2015 www.dotmed.com Upcoming Events

HCP Hospital Materials ASTRO Average attendance: 2,000+ Management Conference Dates: October 18 – 21 Who should attend: Professionals involved Location: Westin Bonaventure Hotel & Location: Henry B. Gonzalez Convention or interested in bariatric medicine and care Suites, Los Angeles Center, San Antonio Dates: October 7 – 9 Years in existence: 57 AAHKS 2014 Annual Meeting Years in existence: 2 Average attendance: 11,000 Presented by: American Association of Anticipated attendance: 125 Who should attend: Radiologists, Hip and Knee Surgeons Who should attend: Hospital materials oncologists, physicians, researchers Location: Sheraton Dallas Hotel managers Dates: November 5 – 8 ACEP 15 Years in Existence: 25 ASDS 2015 Annual Meeting Location: Boston Convention Average attendance: 800 Presented by: American Society for Der- and Exhibition Center Who should attend: Orthopedic surgeons matologic Surgery Years in existence: 47 Location: Hyatt Regency Chicago Dates: October 26 – 29 Medica 2015 Dates: October 15 - 18 Average attendance: +6,000 Location: Düsseldorf Fairgrounds Average attendance: 1,800 Who should attend: Emergency Dusseldorf, Germany Who should attend: Cosmetic, general physicians, EMTs, nurses Dates: November 16 – 19 and reconstructive surgeons, board-certi- Years in Existence: 46 fied dermatologists practicing dermatologic ASMBS 2015 Average attendance: +130,000 surgery, allied health personnel employed Location: Los Angeles Convention Who should attend: GPOs, integrated delivery by a dermatologic surgeon Center networks, HME/DME providers, physician pri- Dates: November 2 – 7 vate practice, medical laboratories, HER/EMS/ Years in Existence: 32 PHR/PACS/RIS, medical services providers

HealthCareBusiness news I october 2015 31 Hospital Spotlight: Orange County Global Medical Center

Orange County Global Medical Center Location: Santa Ana, California 4 Year founded: 1902 Number of beds: 282 Number of employees: 1250 CEO: Suzanne Richards

Noteworthy distinctions: For over 113 years, Orange County Global Medical Center has had a history of caring for the community by delivering innovative and advanced medical care. Today, it provides comprehensive health care for the entire family through its trauma center, burn center, maternal child health program and more. Orange County Global Medical Center is designated by the County of Orange as one of only two Level II Trauma Centers and provides emergency services for more than 20,000 patients per year. The facility is also home to the Orange County Burn Center, which offers compassionate, comprehensive care through innovative burn care treatments, while optimizing functional and cosmetic outcomes.

32 HealthCareBusiness news I october 2015 www.dotmed.com 2

Specialties: • Verified Level II Trauma Center 3 • Orange County Burn Center • Neurological Services • Maternal Child Health • Pediatric Intensive Care/ Level II NICU • Nationally Recognized Stroke Center

Recent developments: Orange County Global Medi- cal Center is a 2015 Healthgrades Award Recipient for Coronary Bypass Surgery and was recently reaccredited as a primary stroke center by the Joint Commission of Accreditation, Healthcare and Certification.

1. Main Entrance 2. Walkway 3. Hospital Sign 4. The Opmi Pentero 900, a half-million dollar HD micro- scope used by surgeons at OCGMC to visualize tissue structures and blood vessels in microsurgical applications.

HealthCareBusiness news I october 2015 33 Hospital Spotlight Q&A with Suzanne Richards CEO of Orange County Global Medical Center

By Sean Ruck

For this month’s hospital spotlight in- able. Now, 18 months later, we’re at 115 to SR: There are a few. Market share is stallment, HealthCare Business News 120 and the numbers continue to improve. one of the big challenges. We’re one of 30 caught up with Suzanne Richards who hospitals in Orange County. We are high- celebrated her first year as CEO of Or- HCBN: Let’s talk about consolidation a managed care, so we have to be on top of ange County Global Medical Center this little more. It’s fairly common across the our contracting with the medical groups, past April. Richards discussed her back- country in today’s health care environ- with the latest health plans. Another chal- ground and provided the latest on what’s ment. How active is OCGMC in this area? lenge is to ensure with all the quickly evolv- going on at OCGMC. SR: We have four hospitals anywhere ing regulations that we stay on top of them from five to 10 miles apart. When I got here, as well. We pride ourselves on our level of HCBN: How did you get involved in to coin a phrase, I knew we had to synergize, compliance and meeting the regulations. health care? not cannibalize. So we determined the key Then there’s the competitiveness to get high- SR: Actually, I decided at a young age that roles for each hospital. For instance, we had ly knowledgeable and motivated staff. We I wanted to be a forensic pathologist — like two of our hospitals doing spine surgery. To- have to be very competitive with benefits, the television character, Quincy. I went to day, if you’re doing lower spine, you’ll go to salaries and work environments. California State University where I received our sister hospital. For more complex upper a Bachelor’s of Science in nursing. Later, I spine, you’ll head over to us. HCBN: Are there any recent develop- received my Master’s in Public Health from We are also expanding our outpatient ments or technology updates you’d like Loma Linda and my MBA from the University capabilities, since health plans don’t want to highlight? of California’s health care executive program. to direct everything to inpatient treatment. SR: Because we handle trauma and neurol- So on the horizon we have a surgery center ogy, we’re taking one of our floors and putting HCBN: How did you come to be CEO opening, along with some urgent care and an acute rehab center in the building. We’re of Orange County Global Medical Center? perinatal clinics. We also have the health also reopening our geropsychiatry ward. SR: I think in part, it was due to the way center for intensive and partial programs for For technology, I think one of the coolest I approach health care challenges. I learned patients, and we’re in talks with the county updates has been beds we purchased that al- that people have developed policies that to do even more outpatient work for patient low you to speak into them and then they will they’ve continued to follow even if there psychiatric care. translate to the language the patient speaks. were better ways to do things. It’s more important to figure out if what you’re doing is HCBN: What attracts staff to Orange HCBN: What do you think will be the actually best for patients. Being a different County Global Medical Center? big changes to health care in the next type of thinker helped me get the CEO role. SR: We are actually one of the most com- decade? The owner of the hospital I was working plex hospitals in the neighborhood. So we SR: The biggest change, I believe, will be for acquired four hospitals in Orange Coun- attract the top students that want to come the increase we’ll see in microsurgeries. That ty that were losing money. I was asked to and work here because what they see here will also lead to more outpatient work, with come over and help. I was able to turn things they won’t see in the average community just the very ill in hospitals. I’d like to think around and I was put at the head of the flag- hospital. We have the trauma and burn units as people get more educated about their ship hospital (OCGMC) in April 2014. When and other high-quality acute care. health, they’ll be healthier. I came on board, we averaged 75 to 80 Share this story: dotmed.com/news/27009 patients in the daily census. For a 282-bed HCBN: What kind of challenges does licensed facility, that just wasn’t financially vi- your facility face?

34 HealthCareBusiness news I october 2015 www.dotmed.com Cost Containment Corner Squeezing costs out of supply chain management

By Tina Vatanka Murphy

As we seek a more value-based health ticipants identified ways in which trading price changes and the overall complexity of care system, one that delivers better partners increase costs for one another and the health care contracting process creates quality care at a more affordable cost, highlighted how they are collaborating to unnecessary work and increases costs on hospitals and health care systems are address those issues. Below are the top cost- both sides of the supply chain. working with their suppliers to take drivers identified. • The shadow supply chain: Various par- costs out of the system, rather than just • Mistrust and lack of communication ticipants pointed to clinician involvement shifting costs from one to another. The (between the right people): Histori- in the supply chain as a driver of ineffi- more historic approach, with providers and cally, there has been a high level of distrust ciency, cost and waste. Clinicians spend suppliers primarily engaged in contentious between providers and suppliers in the time on supply chain tasks that take them discussions over the acquisition price of a health care industry, much of it stemming away from patient care, while often over- product, is no longer the most effective strat- from the traditional focus on product price ordering products because they have little egy. Instead, the more “valuable” conver- versus value delivered. With supplier sales visibility into overall organizational inven- sations between the two parties are those representatives serving as the primary liai- tory levels. For example, a nurse might re- that take a holistic view, examining the total sons with provider organizations, it’s been order products for a facility not knowing delivered cost of a product, including direct difficult to change the nature of that dis- that another facility within the health care and indirect supply chain costs, as well as the cussion to seek out ways to reduce costs system has a surplus of the same items role products play in improving quality care across the supply chain. available for use. and reimbursements. • Freight charges and excess inventory: • Physician preferences: Cost-to-Serve Health care providers and suppliers that Roundtable participants acknowledged around physician preference items, specifi- have collaborated to address the inefficien- that providers frequently place duplicate or- cally implantable devices, was identified as cies and costs associated with procuring and ders for the same items, resulting in higher a significant cost driver. Traditionally, sup- delivering finished goods, known as cost- freight expenses. Furthermore, products plier and provider organizations have been to-serve, have not only made tremendous are sometimes shipped in more expensive at odds in this area, competing for physi- gains in process efficiency, but also achieved ways (overnighted, via air) when a less ex- cian loyalty and compliance as opposed to significant hard dollar savings. By coming pensive method (two to three day) may be collaborating with physicians to determine together, trading partners have identified acceptable. Someone pays for these high the best product at the optimum cost for outdated and inefficient business practices freight charges — either the supplier foots patient care. Complicating matters are the and implemented more effective processes the bill or passes along the costs to the pro- highly manual, disjointed and duplicative that eliminate costs and improve quality for viders. Sometimes, the freight charges are processes surrounding the use of implant- all involved. more expensive than the products them- able devices in the OR, which ultimately selves. Participants also cited the practice drives an additional $5 billion per year Why is the cost-to-serve in of hoarding inventory, noting how many in health care industry costs due to lost, health care so high? clinicians order and store excess inventory wasted or expired products. Because the supply chain crosses organiza- in fear they will run out. In these cases, About the author: tional boundaries, the actions of one party trading partners lose money when excess Tina Vatanka Murphy is impact all of the parties with which it trans- products expire and must be discarded. the senior vice acts business. This can result in unintentional • The complexities of health care con- president, Global but very real costs. tracting: Roundtable participants voiced Product & Corporate We convened a 64-organization round- the complexity of health care contracting Development at GHX. table to discuss why the cost-to-serve in as a major pain point and cost driver. Both health care is so high compared with other providers and suppliers agree that discrep- industries. In those discussions, the par- ant data, disconnected systems, frequent Share this story: dotmed.com/news/26971

HealthCareBusiness news I october 2015 35 IT Matters The significance of developing an enterprise imaging strategy By Michael Gray

Digital imaging, and a much more intelligent information life The greatest argument for all of the and data manage- cycle management scheme. above-suggested replacements is that the ment in general, • The clinical display application suite of each requirements of these functional compo- have come a very individual department PACS with a single, nents of the department PACS have evolved long way. Clinical independent, universal clinical display appli- beyond the individual imaging departments. information that was cation that is compatible with any hardware These PACS functions have been elevated to once captured and platform, operating system and browser, enterprise-level functions and it is far more stored on individual displays both DICOM and non-DICOM data efficient to have a single enterprise solution pieces of paper as reports, chart entries, and objects, and can be interfaced to any EMR. for each of these operations rather than a care summaries are now digital objects and • The relatively simplistic workflow functions number of individual solutions that have to files managed by one or more enterprise of each department PACS with a single be coerced into working together. content management solutions. workflow application that can provide the While this may look like the argument In some health care systems, the patient’s required features and functions to any of the for “deconstructed PACS,” or as I have re- medical images (structured data), diagnos- individual imaging departments, including ferred to it, “PACS 3.0,” I would quickly tic reports, laboratory results, prescription managing complex cross-site credentialing point out that each of the individual sug- details, and care summaries (unstructured issues, creating individual worklists that con- gested replacements can individually or in data), and the multitude of health details sider physician availability (schedule, loca- combination, function with the majority of collected during years of office visits such as tions, etc.), turn-around time, physician RVU the incumbent department PACS. In this age, weight, smoking status, etc. (discrete loading, sub-specialty reading, credentialing, case, the suggested replacements are effec- data), are all accessible to the physicians and critical results reporting, and peer review. tively “upgrades” to the incumbent systems. caregivers through the organization’s EMR. • The image acquisition, study reconcilia- Whether upgrades or replacements, I will The whole collection of the patient’s longitu- tion, and QA/QC functions of each de- submit that now is the time for the organiza- dinal clinical information is displayable with partment PACS with the similar feature tion to develop the enterprise imaging stra- a general-purpose viewer that can handle all set in the more versatile VNA solutions. tegic plan that will specifically describe how of these diverse data objects. This is especially true in multi-site health the organization is going to achieve the level The selection process, as well as the care organizations where new studies and of systems integration required to deliver any characteristics (features and functions) of associated priors have to be pushed over piece of clinical information to the caregiv- the individual imaging and data manage- low bandwidth or high latency networks. ers, at any location, using any platform in ment systems, should be driven by a detailed It is also applicable to organizations that the most cost-effective and efficient manner. enterprise imaging strategic plan. utilize multiple diagnostic display applica- In the second part of this two-part series We only have to look at what has trans- tions, for example radiology, where there (coming in next month’s issue), I will suggest pired over the last four years in the radiology may be a specialized display application an organized approach to developing the PACS market to understand the complex for mammography, nuclear medicine, ul- enterprise imaging strategic plan and the interdependencies between those systems. trasound, and advanced visualization in relevant technical issues that should be on There has been a systematic dismantling addition to the core radiology diagnostic the agenda. of the traditional and ubiquitous radiology viewer. The VNA is better equipped (than Michael J. Gray is a consultant specializing PACS. The following are PACS functions that the individual department PACS) to match in the digital management and distribution could arguably be replaced: the study data headers (tag morphing) to of medical image data, and the founder of • The long-term data management (archiving) the appropriate display application and Gray Consulting. Gray’s areas of expertise functions of each individual department overcome the network issues with the are market analysis, technology analysis, PACS with the vendor-neutral archive (VNA), most appropriate compression syntax. All strategic planning, equipment utilization, a consolidated image data management of this can be accomplished at the point needs assessment, workflow analysis, and system that can also provide data exchange of data acquisition with the edge server vendor analysis/selection. between the organization’s disparate PACS extension of the VNA. Share this story: dotmed.com/news/26790

36 HealthCareBusiness news I october 2015 www.dotmed.com WHAT’S THE BEST PATH TO THE FUTURE OF BETTER HEALTH? YOURS.

The best way to navigate the evolving healthcare landscape is on a clear path. McKesson diagnostic imaging solutions give you the right perspective, allowing you to manage your current challenges while focusing on what will be needed to succeed in the future. Our diagnostic imaging solutions, combined with our quality workflows, enterprise worklist and vendor-agnostic image repository, can help guide you into the new era of care. Scalable to suit your size and complexity, McKesson Radiology brings valuable information where it’s needed, helping make your transition into value-based care as seamless as possible. When the path is clear, you’re ready for the future. FOCUS AHEAD FOR BETTER HEALTH.

6364-McKesson Focus Print Ad-DOTMed_vF.indd 1 9/14/15 10:52 AM

SHOWCASE

PRODUCT PRODUCT NEW NEW

To view these products online, visit dotmed.com and enter DM27010 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

Stent System Boston Scientific Corporation announced that its Innova Vascular Self-Expanding Stent System received FDA approval. The system is composed of a nitinol self-expanding bare metal stent with an advanced delivery system. It’s available in a range of sizes including diameters from 5 mm to 8 mm and lengths of 20 mm to 200 mm. The system utilizes something called “hybrid cell architecture,” which consists of open cells along the stent body and closed cells at each end. The stent was designed this way to ensure accurate and uniform deployment into the artery.

MR Post-processing Applications Siemens Healthcare recently announced FDA approval of its new MR post-processing applications — syngo.MR OncoCare and syngo.MR Neuro Dynamics.

OncoCare is a standalone software package that can be put on a PC or a syngo.via server and it is com-

patible with all Siemens MR systems. It can be used on every body part ranging from the brain to the liver.

The syngo.MR Neuro Dynamics provides tools to assess brain tumors by evaluating blood flows of SHOWCASE

those tumors. To use Onco.Care, the radiologist loads the MR studies, draws a region of interest around a tumor and PRODUCT

creates histograms using the software, which allow for quantitative evaluation of tumor response. They

are then able to follow the patient across a plethora of therapies to determine if they have responded. NEW NEW

38 HealthCareBusiness news I october 2015 www.dotmed.com New VentilatorNEW GE’s newest ventilator, CARESCAPE R860, has automated nutritional assessment software built-in. ThePRODUCT system works by assessing the patients’ caloric needs through a respiratory care module.SHOWCASE The unit also provides lung protection tools that can help clinicians evaluate when patients may be ready to breathe on their own.

DR System NeuroLogica, a subsidiary of Samsung Electronics Co. Ltd., announced that the Samsung GC85A DR system received FDA approval. The system’s S-Vue technology enhances image sharpness and includes adjustable contrast presets and an auto shutter that improves consistency. It features wireless S-Detectors and a portable grid that displays the patient’s body structure clearly without increasing radiation dose. Its Smart Control feature allows the operator to position the whole system, which includes SmartStitch technology, by pressing one of the control panel buttons. The operator can then move a motorized, tilting receptor with a remote control from -20 to 90 degrees for the skull and hands without needing a table.

Wirelessly Streaming Digital Stethoscope Eko Devices, a digital medical device startup, has received the U.S. Food and Drug Administration clearance to launch Eko Core, a next generation digital stethoscope. Eko Core is the only stethoscope on the market to wirelessly stream heart sounds to a HIPAA-compliant smartphone app and the first to integrate heart sounds directly into the patient’s electronic health record. Eko Core is also the only stethoscope available that enables clinicians to switch between analog and digital modes. The Bluetooth-connected mobile app, available on the Apple App Store, allows clinicians to view a heart sound waveform, save heart sounds directly to a patient’s electronic health record and securely collaborate with a cardiologist for a second opinion.

HealthCareBusiness news I october 2015 39

NEW PRODUCT SHOWCASE ASTRO Q&A with Dr. Bruce Minsky ASTRO president

By Sean Ruck

The American Society for Radia- of new methods available for treating pa- hibit display area. And of course, they have tion Oncology’s 57th annual meeting tients. But it’s important that we don’t lose the chance to see colleagues and renew rela- will be held at the Henry B. Gonzalez the key point — that we’re providing good tionships and build new friendships. Convention Center in San Antonio, patient care. We want to drive the idea that And it’s really an opportunity to interact Texas, from Oct. 18 through Oct. 21. good patient care is not competitive. Instead, with radiation oncology professionals that HealthCare Business News spoke with AS- it’s synergistic with good technology. What attendees might not otherwise have the TRO president, Dr. Bruce Minsky, to learn we’re seeing in patient care today is similar chance to meet. The audience travels from more about his background, what to ex- to the revolution we’ve seen in communica- around the world. In fact, of the 11,000 pect at this year’s big event, and this year’s tions. For a long time, phone conversations attendees, about 20 percent are from theme, “technology meets patient care.” were the main method to communicate and Asia, so there are some unique perspec- email was secondary. Now, with email so ad- tives that lend to a healthy discussion. Of HCBN: How did you get involved in vanced, sometimes phone conversations are the abstracts, 1,600 are from the U.S. and ASTRO? overlooked and there are missed opportuni- historically, Japan has had the largest rep- BM: I’ve been a member of ASTRO since ties. So it’s a balance of adopting emerging resentation from Asia. But this year China my residency. Almost every radiation on- technology while making sure that the best surpassed them, with 219 abstracts being cologist is a member. It provides amazing technology is used case-by-case. presented. educational and professional development I think the change has been in part due to opportunities. Prior to my time as president, HCBN: Is there anything else you’d China’s growing economy, even if it has had I had served on a number of committees. like to highlight from this year’s show? some problems recently, and there’s more BM: Yes, in addition to the robust array of a demand for high-quality cancer care. HCBN: What’s the major initiative or of scientific presentations, there’s a practi- So people from China are traveling to get a initiatives you’ve championed during cal hands-on brachytherapy workshop on better understanding and increased knowl- your presidency? prostate cancer. We’re also providing a edge about the technology that lends itself BM: The role of the president is to de- more-integrated program with our phys- to higher-quality care. sign and oversee the national meeting. So ics colleagues in order to drive home the my primary initiative has been to design the importance of the physics field to radiation HCBN: Are there any big develop- theme and appoint committee members oncology. ments for ASTRO that you’d like to that will choose the abstracts and oversee highlight? the scientific presentations. HCBN: In addition to what you’ve BM: We have a number of initiatives in highlighted, what are some other rea- the works. For example, through a part- HCBN: Can you tell us about this sons you believe people should attend? nership with the American Association of year’s theme? BM: In a short four-day period, attend- Physicists in Medicine, we have the RO-ILS BM: I’m excited about this year’s theme. ees get to learn about the latest technology (Radiation Oncology Incident Learning Sys- With highlighting how technology meets in our field. They learn about the results of tem) patient safety initiative that’s specific to patient care, we’re talking about the many clinical trials and have a chance to see some radiation oncology. We also have an accredi- great advances we’ve made and the variety of the new technology highlighted in our ex- tation program called APEx (Accreditation

40 HealthCareBusiness news I october 2015 www.dotmed.com Program for Excellence) that we’re rolling HCBN: What are the biggest chal- both its technological ability to deliver radia- out this year. Through APEx, we’ll be the ac- lenges facing ASTRO today? tion therapy and continue to grow overall in crediting body submitting data and onsite BM: Our biggest challenge is to continue numbers. As our systemic therapy becomes review. We’re also, of course, an active par- to show how our modality adds value to more robust, the use of radiation therapy ticipant in the Choosing Wisely campaign medical care. We strongly believe it does and will continue to grow, so I see a very bright and have continued to build on our work have data that support that, but we must future for those reasons. Despite it being there. The Choosing Wisely campaign is re- continue to get that data in front of the a single modality, if you look at the history ally a campaign for soul-searching for the other specialties and insurance companies over the last few decades, we continue to medical profession and makes professionals to reinforce that idea. increase our effectiveness and the indica- really stop and look at the therapies we’re tions it’s used for. delivering to make sure they’re valuable and HCBN: Have there been any break- necessary. I think it’s a terrific campaign and throughs or is there any ongoing re- HCBN: What abilities will radiation the best of all societies participate. search you’re particularly excited about? oncologists need to be competitive in BM: There are some. I can’t talk about the future? HCBN: What tops the membership’s the results of the abstracts because they’re BM: They’ll need to maintain clinical skills wish list for what they want from the still embargoed, but there are some phase in the technical delivery of therapy and un- association? 2 and phase 3 studies that will be revealed derstand other fields to be able to integrate BM: Members want many things. They at the show that are very exciting in their other treatments. They’ll need to develop want a strong national meeting, scientific ex- results. research abilities and undertake trials to pertise, platforms to present their new find- prove the value of radiation oncology in the ings, educational opportunities and strong HCBN: What do you think the field delivery of care, and I think that’s a skill that’s representation for radiation oncology inter- will look like 10 years from now? just starting to develop more fully. ests on Capitol Hill. BM: I think it will continue to grow in Share this story: dotmed.com/news/26974

HealthCareBusiness news I october 2015 41 ASTRO Exhibitor Preview

Stop by these booths and tell them DOTmed sent you, and pick up your copy of HealthCare Business News at our publication bin. Beekley Medical Booth 241 Mevion Medical Systems Booth 650 Treatment planning accuracy starts with professional products The MEVION S250 Proton Therapy System is designed to preserve all designed by radiation therapists for radiation therapists. Beekley of the treatment benefits of traditional proton systems while remov- Medical’s Radiation Oncology SPOT(R) skin markers help save time ing the obstacles of size, cost, and complexity while changing the and increase accuracy in both CT and conventional simulation. economics and accessibility of proton therapy worldwide. Visit us at PointGuards(R) temporary mark protectors stay in place for up to 4 ASTRO for more information weeks, ensuring day-to-day reproducibility throughout treatment. Oxford Instruments Healthcare Booth 1669 Cold Shot Chillers Booth 142 Oxford Instruments Healthcare specializes in CT & MRI equipment, Cold Shot Chillers manufactures medical chillers for cancer care facili- maintenance, mobile imaging solutions, parts, and biomedical sup- ties and hospitals. Our chillers are configured to provide correct heat port to healthcare practitioners across North America. With a team removal, using proper flow and pressure requirements. We work of skilled professionals, Customer Portal, nationwide service, and ISO directly with Physicists, OEMS, Distributors, Rebuilders, and Resellers. certifications, OI Healthcare continues to deliver world-class service Stop by booth 142 to discuss your next chiller project. and support while providing cost savings.

IBA Booth 1342 Radiology Oncology Systems (R.O.S.) Booth 235 IBA, the market leader in Proton Therapy, offers a comprehensive plat- Radiology Oncology Systems (R.O.S.) is a world-leader in cost-effec- form of solutions that are scalable and easily integrated into any health- tive, pre-owned equipment solutions, providing linear accelerators, care setting. From our compact single-room Proteus One to the custom CT simulators, MRI systems and more. R.O.S. is also a major buyer of tailored Proteus Plus, our systems are fully featured with IMPT, Pencil used equipment, and is the U.S. distributor of CYRPA® patient po- Beam scanning and 3D CBCT. Our collaborative culture enables leading- sitioning laser systems, the world’s first dual-diode, auto-calibrating edge PT solutions today for tomorrow’s most complex challenges. system. R.O.S.’s mission is to expand the reach of quality, affordable equipment throughout the world.

Samsung Booth 3500 NeuroLogica, the healthcare subsidiary of Samsung Electronics America Inc., develops, manufactures, and markets innovative imaging technologies and is committed to delivering fast, easy and accurate diagnostic solutions to healthcare providers. NeuroLogica, the global corporate headquarters and manufacturer of Samsung computed tomography, is also the U.S. headquarters for sales, marketing and distribution of all Samsung digital radiography and ultrasound systems.

Veritas Medical Solutions Booths 3200 and 280 Exhibiting SmartSolutions™ radiation shielding systems for con- structing radiotherapy treatment facilities from proton therapy centers and multi-room linac centers to simple high dose rooms. Highlights include innovative VeriShield™ radiation shielding, shield- edSmartDoor™ entry systems and pre-manufactured modular facilities designed for temporary or permanent installation.

Varian Medical Systems Booths 828, 832 & ES1 Varian will showcase its full range of treatment systems for radiotherapy, radiosurgery, brachytherapy, and proton therapy at ASTRO this year. Software products are a special focus, with demonstration stations showing RapidPlan™ knowledge-based treatment planning, the Velocity™ platform for data-driven clinical decision making, the Qumulate™ quality assurance tool, and InSightive™ analytics for mining clinical data to help drive better care.

42 HealthCareBusiness news I october 2015 www.dotmed.com View from the Hill Congress focuses on imaging By Jill Rathbun

In coming back from the August recess, zations or shared savings demonstrations expressed concerns at the hearing about hos- Congress got to work addressing an require the provider to take on some level pitals buying physician practices to then be- area that has become a hot topic in the of risk, usually in the form of bonuses and ing able to charge the higher facility payment health care community — consolidation. penalties, for the overall cost of the patient’s rates for services under the hospital outpatient Even before the mergers between Anthem/ care. To handle this type of risk, many pro- department payment system. As discussed Cigna and Aetna/Humana were announced, viders have felt the need to increase in size previously in this column, such a practice has there was concern regarding the number of as a way to better coordinate care and save led policy makers to the topic of “site neutral” hospital and hospital systems, and physician money for the health care system. However, payments for certain services, including some practices that had merged or been acquired. just increasing in size with no additional tools imaging services. In fact, it would primarily be Hospital acquisition physician practices have to help with the rendering of more appropri- the least expensive imaging services, such as already prompted studies by the congressio- ate care may not be producing the intend- ultrasound and X-ray, which would be nega- nal advisory body, MedPAC. Their testimony ed cost-savings results. The types of tools tively impacted by these types of site neutral regarding this phenomenon and its poten- needed to do well in a value or risk-based policies. This is because in some instances tial impact on the health care system and payment system is something that imaging these services are “conditionally packaged,” patients has been given to several Congres- service providers know well: appropriate use which means that hospitals do not always get sional committees. criteria and patient safety protocols. the cost of the service on the patient’s claim A series of hearings in the U.S. House of Appropriate Use Criteria that are evi- because the service is not, in that circum- Representatives was kicked off on Sept. 10, dence-based and developed by physician- stance, paid separately. This incomplete data 2015, by the Subcommittee on Regulatory led organizations, such as the American Col- submission means that the overall payment Reform, Commercial and Antitrust Law of lege of Radiology and the American College by Medicare for the hospital outpatient de- the House of Representatives Judiciary Com- of Cardiology, can help clinicians to order partment can go down, as hospital outpatient mittee. This first hearing entitled, “The State the right scan at the right time, and lower payment rates are set based on the charges of Competition in the Health Care Market- the need for additional imaging services or submitted to Medicare by the hospital, if the place: The Patient Protection and Affordable for expensive imaging tests to be ordered, charges do not get reported on the claim. Care Act’s Impact on Competition,” served when an ultrasound or X-ray test is just as, or As mentioned at the start of this article, to set the stage on a variety of topics. These more, appropriate. With Medicare moving this was the first in a series of hearings Con- included the impact of these various types of forward to adopt Appropriate Use Criteria gress will have on the topic this fall. They are mergers on competition, and what the ef- for the ordering and rendering of imaging something that everyone should be aware of fect is on providers and patients; and what, if services reimbursed under Medicare’s fee for as the hearings could lead to policy changes any, new regulations are necessary to ensure service payment system, it seems only natural that could potentially impact imaging ser- choice and value for all in the U.S. health that the Centers for Medicare and Medicaid vices in the future. To see a video of the hear- care system, given these types of mergers. Services (CMS) would encourage its use in all ing and read the testimony of the witnesses, Future hearings will serve to go into more of its risk-based demonstration projects, such please visit http://judiciary.house.gov/index. depth on these discussions. as Accountable Care Organizations, and pro- cfm/hearings?ID=417B9E62-CB8D-4FC7- For imaging services, there were two vide access to these tools to those providers. 905D-40F39B91E5E7. themes at the hearing that are important to Similarly, patient safety protocols where About the author: be aware of as these hearings continue this central venous access or the placement of Jill Rathbun is manag- fall. One is the concept of providers needing a tap or a needle is done under ultrasound ing partner at Galileo to “get bigger,” to be able to take on risk. guidance have been studied and shown to Consulting Group in The second is the issue of site-of-service for prevent several costly complications. Uni- Arlington, Virginia. the provision of imaging services and the form adherence to such protocols would She will be comment- concept of site-neutral payment, which is a save the health care system and the patient ing for HealthCare source of concern. money, but more importantly ensure higher Business News on Regarding the concept of needing to quality patient care. issues of interest to health care professionals. take on risk, most of the alternative payment Another theme in this hearing revolved Share this story: dotmed.com/news/27113 models such as Accountable Care Organi- around competition. Members of Congress

HealthCareBusiness news I october 2015 43 Industry Sector Report: Radiation Oncology

Varian’s TrueBeam at New York Methodist Hospital

Radiation oncology: innovative, new technologies and research are turning heads

By Lauren Dubinsky

New York Methodist Hospital (NYM) in CyberKnife has a robotic gantry that can be More surgeons are now turning to SBRT and Brooklyn recently installed a new ste- moved in any position. But what all the systems SRS to remove the remainder of a tumor. reotactic body radiotherapy (SBRT) sys- have in common is that hospitals are becoming “Radiosurgery is very effective for small tem and the oncology team can now increasingly interested in the technology. tumors, but if you just cut up a majority of target tumors anywhere in a patient’s “Both the numbers of patients and the a large tumor and make the part that is left body from almost every angle. Some sites being treated with stereotactic radio- over small, then radiosurgery can handle patients are even able to undergo the pro- surgery are on the rise,” says Dr. Hani Asha- that effectively,” says Dr. Lijun Ma, a physi- cedure in only a few minutes. malla, chair of the department of radiation cist from the University of California San There are a variety of SBRT and stereotac- oncology at NYM. “We are currently treat- Francisco radiation oncology department. tic radiosurgery (SRS) systems on the market ing lung, spine, brain, and liver tumors with At first, many surgeons were reluctant to with unique offerings. NYM chose Varian’s stereotactic radiosurgery. We anticipate that use SBRT and SRS. There have been ques- TrueBeam Radiotherapy System because it the number of patients seeking this type of tions about whether it can cause cancer and believes it delivers the same high radiation technology will continue to increase, since it if it will make it more difficult to perform dose rate as the other systems, but can be delivers very effective and precise doses in a surgery afterward. used to treat a wider range of indications short period of time.” “Skull-based surgeons are really good at including large-sized cancers and tumors what they do and are very proud of their sur- smaller than 1 centimeter. Growing use of SBRT and SRS gical skills,” says Catherine Gilmore-Law- Elekta’s Gamma Knife was specifically Surgeons attempt to remove an entire tu- less, vice president of clinical intelligence at designed to treat brain tumors and Accuray’s mor with surgery, but it’s a very difficult task Elekta. “Their acceptance of radiosurgery as and oftentimes some of the tumor remains.

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an integral part of their treatment strategy Other technologies on the market can tumors with low rates of recurrence at the has been increasing over the last 20 years.” also account for patient movement. Vision primary cancer site with minimal side effects. A significant volume of data has emerged RT’s AlignRT can be used along with the “There has traditionally been a fear of about the effectiveness of SBRT and SRS, TrueBeam system to customize how much treating larger tumors with SBRT because and more surgeons are being exposed to the patient can move before the radiation it’s really destructive when the high dose of it in their training programs. It is now en- beam stops, in order to avoid affecting treatment is given compared to most radia- trenched in educational programs at the ma- healthy tissue. tion that is given in gentle or smaller doses,” jority of neurosurgery departments. Accuray’s CyberKnife M6 Series features says Dr. Neil Woody, radiation oncologist at The fields of surgery and radiation oncol- its new InCise Multileaf Collimator (MLC) the Cleveland Clinic and one of the authors ogy are starting to merge, and cancer treat- that works by precisely sculpting dose to of the study. ment is becoming a multi-disciplinary team spare healthy tissue, even for targets that The researchers evaluated the outcomes approach, says Ma. He estimates that 70 move during respiration. “By minimizing of 40 patients 18 months after SBRT was percent of the time neurosurgeons are per- dose to the normal and healthy tissue, side used to treat their node-negative, medically forming surgery in the operating room and effects are minimized and patients benefit in inoperable NSCLC tumors that were greater 30 percent of the time they’re performing their quality of life as they go through cancer than 5 centimeters. They found that SBRT SBRT or SRS. treatment,” says Kelly Londy, executive can effectively and safely treat those types vice president and chief commercial officer of tumors. Major workflow improvements of Accuray. There was no evidence of disease at the In the past, when a patient came to the ra- The Icon is also optimized to perform mi- original tumor site in about 91 percent of the diation oncology department with a tumor, croradiosurgery. During microradiosurgery, cases and 32.5 percent of the patients ex- the surgeon would carefully determine the neuroanatomy is very precisely defined perienced distant failure, which is when the how and where to treat them. A dosimetry and the dose is conformed to the target cancer spreads to other parts of the body. team would design a plan to make sure volume with very high selectivity in order to Additionally, 70.5 percent of the patients the right dose was administered and then preserve any normal structures. didn’t experience any side effects. When the quality assurance would be performed af- Microradiosurgery is commonly used by results were compared to published surgical ter the procedure to make sure everything Gamma Knife centers for extremely exacting studies, lung SBRT appeared to have similar was done safely. indications in very critical anatomical loca- rates of local control and distant failure. “Workflow has improved night and day tions such as the brain stem, adjacent to the The median age of the patients was 76 over the years,” says Ma. “The SBRT and SRS optic apparatus, in the cavernous sinus and and most of them had several significant workflow is totally different from traditional for functional disorders like essential tremor. comorbidities. The preferred way of treating radiation oncology workflow — the patient “[These types of cases are] really the tough- NSCLC is with surgery, but this group of pa- comes in and you do it quickly. It’s more like est of the tough. You have to be absolutely tients couldn’t handle an invasive procedure. a surgical workflow.” sure of what you are doing,” says Gilmore- “In our population, these are patients In August, Elekta received 510(k) approv- Lawless. who don’t have that option — their lung al from the FDA for its new Gamma Knife Microsurgery is also used for trigeminal function is too poor and their heart function system, Icon. Ma believes that the Icon is a neuralgia, which is a pain disorder caused is too poor,” says Woody. paradigm shift and is going to change the by a tiny nerve sticking out of the brain stem. Before the emergence of lung SBRT, frail, way large tumors are treated. The dose must be manipulated around the medically-compromised patients with node- Gamma Knife systems traditionally have nerve, which involves very precise sculpting negative inoperable NSCLC were often head frames, which attach to the patient’s capabilities in a tight space. treated with external beam radiation ther- head with four small screws and ensure that apy, which delivers lower doses over more the radiation beams are precisely targeted. New indications for SBRT treatment sessions. However, many of the But the Icon system is frameless and uses a Lung SBRT has become routine for treating patients experienced several side effects and cone-beam CT (CBCT) workflow that allows non-small cell lung cancer tumors (NSCLC), the cancer often recurred. the physicians to check the patient’s position typically less than 3 centimeters in diameter, Since it was a retrospective study that against planning images. because of its high rate of local control and evaluated only a small number of patients During the treatment, patient motion is limited toxicity. But new research shows that for less than two years, more research will be managed with a motion management sys- it can also be used to safely treat inoperable needed to confirm these results. tem that tracks the patient’s head position. NSCLC tumors larger than 5 centimeters. If the patient coughs or moves their head, A new study published in the Interna- Mounting research the system will automatically stop delivering tional Journal of Radiation Oncology Biol- There used to be a notion that radiosurgery radiation. ogy Physics found that SBRT can treat larger could only treat three or fewer tumors in a

46 HealthCareBusiness news I august 2015 patient, but there was no data to support bases that are becoming available in health treated with radiosurgery for benign and that. A study conducted in Japan and pub- care,” says Dr. Brian Kavanagh, president- malignant brain tumors, in order to identify lished in Lancet Oncology last year investi- elect of the ASTRO Fellows Program and quality metrics and determine the best ways gated how many tumors can reasonably be interim chair of the department of radia- to select patients for treatment and get the treated with radiosurgery. tion oncology at the University of Colorado best outcomes. The researchers evaluated patients with School of Medicine. “There are many questions you can think two to four brain metastases and patients Kavanagh and his colleagues are cur- to ask about how something can be done with five to 10 brain metastases who were rently compiling a large-scale registry of better,” says Kavanagh. “The problem is that treated with SRS at 23 facilities in Japan. patients who are undergoing radiosurgery. there are simply not enough resources or They found that there is no difference in re- Over the next two to three years, they are the time available to test every single good sults between the two groups of patients. partnering with the American Association question in a classic, randomized, controlled “That study, along with recently updated of Neurological Surgeons to collect infor- clinical trial.” guidelines and the ASTRO recommenda- mation on over 27,000 patients who were Share this story: dotmed.com/news/27114 tions, is really fueling a change in the way these patients are treated and for the bet- terment of these patients,” says Gilmore- Lawless. “In the past, patients with larger numbers of metastases would either not be treated or have whole brain radiation therapy and would frequently be viewed as futile cases.” The researchers know that it’s not a number issue, but rather the volume of tumors. Insurance companies are even will- ing to reimburse cases when patients have more than three metastases, says Gilmore- Lawless. Another area that many studies are looking into is the combined use of radiosurgery and drugs. The health care industry is trying to figure out which drugs are the most effective, whether there are safety issues with the combined use of drugs and radiosurgery, and what the optimal drug strategy is. “There is an emerging belief that radiosurgery could play a role in activating the immune system potentially synergistically with immunotherapy to achieve better results,” says Gilmore-Lawless. “This is a promising new area of ongoing investigation and no- ULTRASOUND body has the answers here yet.”

Era of big data Health care is beginning to leverage the power of big data. Industry experts believe that analyzing large quantities of data has the potential to improve treatment outcomes and reduce costs. “Radiation oncology, like a lot of other fields in medicine, is just now trying to wrap our collective heads around what to do with Position for Success some of these enormous information data-

HealthCareBusiness news I october 2015 47 IndustryIndustry Sector Sector Report: Report: Radiation Radiation Oncology Oncology

DOTmed DOTmed asked the leading radiation therapy, planning and treatment manufacturers to NEW submit their leading products to be featured in this new equipment guide. To learn more EQUIPMENT about these systems and see other models not shown, please visit the Equipment Guide in GUIDE DOTmed’s Virtual Trade Show, or go to www.dotmed.com/radiation. We also invite you to RADIATION rate these products online. THERAPY

LINEAR ACCELERATORS Varian/VitalBeam™ platform Elekta / Leksell Gamma VitalBeam™ is Varian’s latest Knife Icon Accuray/TomoTherapy H platform for advanced radiotherapy Leksell Gamma Knife® Icon™, Series in a configurable and expandable the sixth generation of the ® The TomoTherapy H™ System design. As an entry point platform Elekta’s Leksell Gamma Knife is versatile and efficient, enabling with advanced capabilities, VitalBeam system, enables physicians to targeted delivery of radiation to a enables access to a fast control treat virtually any target in the wide range of disease types. The system, high resolution imaging, RapidArc technology brain, regardless of type, location or volume. Icon features completely integrated systems and High Intensity Mode, making advanced care possible Adaptive DoseControl™, which combines real-time motion facilitate the entire treatment process, from planning through at a price point within reach. An intelligent control system management and an integrated stereotactic cone beam delivery. A CT scanner-based platform, TomoHelical™ synchronizes and monitors the system’s fully integrated CT imaging workflow to confirm accuracy and ensure the Mode, provides continuous delivery 360 degrees around features enabling efficient accurate delivery of high precision of treatment delivery. With Icon, clinicians can the patient, while TomoDirect™ Mode allows delivery quality treatments. choose either frame-based or frameless head fixation, and from specific angles. For every patient, highly-sculpted single session or multiple session treatments. dose distributions help to spare normal tissue and reduce MR-GUIDED RADIATION THERAPY treatment toxicities. Elekta / Leksell Gamma Knife Perfexion ViewRay / MRIdian System Leksell Gamma Knife® Elekta / Versa HD™ ® The MRIdian system from Perfexion™ is a complete system Versa HD™ is a sophisticated ViewRay® combines the radiation treatment system, for intracranial stereotactic radiation therapy with magnetic radiosurgery. Leksell Gamma representing the convergence of resonance imaging (MRI) in conventional radiotherapy with Knife meets the highest demands one precision medical device, of efficiency and economy. The advanced stereotactic precision. giving clinicians a view of The high-definition Agility™ beam system includes the latest version internal anatomy during treatment. The system tracks of Leksell GammaPlan® treatment shaping and groundbreaking High Dose Rate mode in the tumor, adapts to motion and only delivers radiation Versa HD give clinicians the flexibility to deliver conventional planning system and provides unmatched accuracy with when the target is in range. In addition, each treatment Leksell Coordinate Frame fixation. The programmable therapies to treat a wide range of small and large tumors is recorded, providing clinicians and patients alike throughout the body, while also enabling treatment of highly APS (Automatic Positioning System) ensures fast, with an MRI-video of the therapy sequence. The accurate and smooth treatment procedure. complex cancers that require extreme targeting precision. MRIdian system offers enhanced delivery of radiation prescriptions and individualized patient treatment. Elekta / Infinity Varian / Edge Radiosurgery Suite Elekta Infinity™ integrates the RADIOSURGERY The Edge™ radiosurgery suite is Elekta Synergy image-guided a fully integrated dedicated system workflow in a Comprehensive Accuray/CyberKnife Robotic for performing advanced radiosurgery treatment system that includes Radiosurgery System using new real-time tumor tracking Volumetric Modulated Arc Therapy ® The CyberKnife M6™ technology and motion management (VMAT). VMAT combines superior System is the first and only capabilities. It combines Varian’s dose conformance and treatment speed, enabling clinicians robotic radiosurgery system to world-class technologies in an end- to “shrink wrap” the dose around the tumor by simultaneously automatically track and adjust for to-end solution for planning and performing non-invasive manipulating the gantry position and speed, MLC leaves, tumor motion during treatment, procedures anywhere in the body — wherever radiation is dose rate and collimator angle. Infinity offers a choice enabling clinicians to precisely indicated. between single or multiple arcs — depending on the maximize dose, minimize side treatment site—to optimize the VMAT plan. effects and maximize patient comfort. Using its unique Xcision Medical Systems / robotic range of motion and continuous image guidance, GammaPod Varian / TrueBeam and the CyberKnife System follows the target through out the Xcision Medical Systems’ first TrueBeam STx systems treatment process, delivering individualized treatment product, the GammaPod, has The TrueBeam™ and TrueBeam™ with sub-millimeter precision across a range of tumor been designed around the STx systems for image-guided types within the body. needs of focal, short course, radiotherapy and radiosurgery breast cancer radiotherapy (respectively) were designed American Radiosurgery / such as APBI and SBRT. to target and treat cancer with RGS Vertex360 One of the key design goals of the GammaPod system pinpoint accuracy. TrueBeam American Radiosurgery is to create a practical and comfortable means of prone systems dynamically synchronize produces the RGS Vertex360, treatment. The GammaPod system is not currently imaging, patient positioning, motion which competes with the Gamma available for commercial clinical use, and is only available management, and treatment delivery Knife® in the noninvasive as a research system. and can deliver dose much faster treatment of brain tumors. The than was possible with earlier RGS Vertex360 utilizes concentric, controlled arcs formed generations of technology. A High Intensity Mode facilitates by rotating gamma ray beams that are emitted from thirty RapidArc® radiosurgery. cobalt-60 sources. It utilizes the Explorer 4D treatment planning system with its OsiriX medical image viewing system. Cost effective RGS technology has successfully treated over 6,000 patients.

48 HealthCareBusiness news I october 2015 www.dotmed.com BRACHYTHERAPY Varian / BrachyTherapy Brainlab / Adaptive Hybrid Applicators Surgery -- AHS Elekta / Esteya Varian Medical Systems offers Dedicated to multi-modality Esteya® electronic brachytherapy a comprehensive library of treatment of benign skull base is Elekta’s new patient-friendly brachytherapy applicators tumors, the Adaptive Hybrid solution for treating skin cancer. Esteya relies and accessories designed Surgery Analysis software on a small, high dose rate X-ray source to for image-guided brachytherapy using CT & MR provides automated, real-time feasibility analysis of apply radiation precisely and directly to the imaging modalities. View our catalog at varian.com/ adjuvant radiosurgery. Three different fractionation cancerous site. The portable set-up enables brachytherapy under Product Resources. schemes are calculated and their feasibility information the system to be used in any minimally is presented in an intuitive traffic light display, adding Xoft® Axxent® Electronic shielded treatment room. Esteya can be used Brachytherapy (eBx®) objective criteria to preoperative and intraoperative anywhere in the clinic, has a favorable procedure time and System® decision making processes. By knowing at which offers user-friendly operation. The Xoft System is FDA cleared and CE state of resection adjuvant radiosurgery treatment is marked for use anywhere in the body, safe, neurosurgeons are able to balance surgical risk Elekta / Flexitron including the treatment of early-stage and radiation toxicity, opening up new horizons for The new Flexitron® remote breast cancer, gynecological cancers preservation of function without compromising tumor afterloading platform offers a safe and non-melanoma skin cancer. control. and intuitive brachytherapy workflow. With Utilizing its proprietary miniaturized five simple, yet ingenious features – including Brainlab / BrainMets X-ray source, the Xoft System delivers treatment standardized transfer tube lengths, 0.5 mm The combination of the directly to cancerous areas while sparing healthy source position accuracy and an intuitive revolutionary Automatic Brain tissue. It is isotope-free, requires minimal shielding user interface – the new Flexitron brings a Metastases Planning software and offers significant treatment time, mobility and cost new standard in treatment delivery. With its 40 channels, with the well-established ExacTrac advantages. For more information visit xoftinc.com. it enables implants up to 40 catheters, making it a versatile IGRT system enables a precise and future-proof system for HDR brachytherapy. Xstrahl /Xstrahl 100 and efficient treatment of multiple brain metastases. Superficial and Grenz Ray The new tool rapidly creates consistent treatment plans, Elekta / Landmark minimizing dose to normal tissue, and offering new brachytherapy applicators therapy system delivers outstanding clinical accuracy with treatment possibilities for larger volumes and higher Elekta offers a comprehensive numbers of metastases. portfolio of specialized, patient- excellent cosmetic outcomes and focused brachytherapy applicators for more provides a nonsurgical alternative Elekta / Oncentra Brachy than 15 types of cancer diagnosed in a for treating primary skin lesions, Oncentra® Brachy offers variety of anatomies. For instance, our wide especially in sensitive areas. comprehensive treatment array of applicators for gynecological brachytherapy are Ergonomically designed, the Xstrahl planning software for available for many applications, ranging from intracavitary 100 provides smooth, controlled movements ensuring brachytherapy and helps to interstitial use and designed to deliver increasingly more straightforward, accurate positioning while maximizing to optimize treatment plan conformal doses in gynecologic brachytherapy. maneuverability and patient comfort. accuracy, providing easy Xstrahl / Xstrahl 150 navigation to any plane that Elekta / microSelectron offers the most relevant Digital Designed for permanent information per region of interest. “Template” solutions The predecessor of the Flexitron installation within the radiotherapy for repetitive tasks, such as the new Implant Modeling remote afterloading platform, the suite, the Xstrahl 150 system can tool and the popular Applicator Modeling feature, help microSelectron® automated, digital remote be mounted on a floor or ceiling reduce implant reconstruction time. Powerful inverse afterloading platform is a proven, reliable stand to suit the user. The intuitive planning optimization automates volume-based system for brachytherapy applications. The machine controls have been planning, making the process fast and efficient. microSelectron allows both HDR and PDR ergonomically designed to provide the operator with brachytherapy. smooth, controlled movements at all times allowing Elekta / Monaco the therapist to easily position the unit ensuring patient Monaco® is a treatment Elekta / Real-time Prostate comfort wherever the treatment site. Solutions planning system featuring Elekta’s Real-time Prostate a new workflow and system TREATMENT PLANNING/GUIDANCE/ architecture designed to Solutions offer a real-time workflow MONITORING for HDR and LDR prostate improve processing speed brachytherapy, enabling treatment Brainlab / ExacTrac: and enhance planning in a single session. In this way, ExacTrac® is a clinically productivity. The latest version there is a minimized chance of patient movement and proven IGRT system of Monaco supports the full associated implant shift. Oncentra® Seeds (for LDR) and which uses high-resolution spectrum of radiotherapy Oncentra® Prostate (for HDR) treatment planning guides stereoscopic x-ray images, techniques, including every step of the workflow and ensures optimal dose acquired before or during advanced 3D planning, distribution. treatment delivery or IMRT, VMAT and stereotactic between fields, to instantly planning – all in a single system. Monaco v5.10 Varian / GammaMedplus iX detect and visualize internal provides significant planning and QA enhancements, as Remote Afterloader System structures and their displacement. The system well as improved workflow efficiency. Advancements in Varian offers the GammaMedplus™ provides a proprietary 6D — x/y/z along with angular 3D planning as well as the addition of MRI and forward iX remote afterloader in either a — fusion and robotic alignment in an automated, planning capabilities further reinforces Monaco as a 24 channel or 3 channel system for high- two-minute process. Unlike linac-based systems, robust and flexible treatment planning solution. dose-rate (HDR) & pulsed-dose-rate (PDR) the fundamental architecture of ExacTrac allows for brachytherapy. Key features include: instantaneous imaging of internal structures anytime • Uniquely designed ultra-flexible solid core during beam-on, without moving any detectors or source cable imaging units into position and even at various table • Fixed treatment length safety feature and gantry angles. • Adjustable height • Multiple safety & backup features

HealthCareBusiness news I october 2015 49 Industry Sector Report: Radiation Oncology

Elekta / MOSAIQ Siemens Healthcare / Varian / BrachyVision Elekta’s MOSAIQ® oncology SOMATOM Definition Edge Treatment Planning System information system is a This premium CT scanner BrachyVision™ is a comprehensive OIS that offers precise data on tissue comprehensive brachytherapy centralizes traditional radiation composition, helping the user planning system for HDR\ oncology, particle therapy reduce uncertainties introduced LDR\PDR. It is fully integrated and medical oncology patient during proton therapy treatment with the ARIA® oncology data info a single user interface, accessible by a planning. Using information from information management multidisciplinary team across multiple locations. both low- and high-energy acquisitions, the new syngo system and the Eclipse™ treatment planning system, MOSAIQ provides oncology staff access to the Rho/Z application generates the correct electron density utilizing a combined database and common interface. underlying clinical and administrative data, improving to be used for planning. SOMATOM Definition Edge is BrachyVision incorporates advanced tools for image both clinical care and operational efficiency. MOSAIQ available in standard format or as a Sliding Gantry (CT- acquisition and manipulation. It supports rules-based has been certified for 2014 Meaningful Use. on-rails) option, which brings dual energy capabilities to dose optimization, and 3-D image-based planning as well the RT treatment bunker. as 2-D film based and filmless planning. P-Cure / The P-Cure System Varian / ARIA Oncology Varian / Eclipse Treatment P-Cure’s adaptive proton Information System Planning System therapy solution with integrated The ARIA OIS is a Eclipse is a market-leading diagnostic imaging and robotic positioning on board comprehensive software comprehensive treatment makes proton therapy more precise and effective at solution for managing oncology planning system that simplifies a fraction of the current capital and operational costs. patients’ entire care path — radiation therapy planning for The system is accelerator complementary and may from initial diagnosis through all kinds of treatment, including be potentially used in treatment of virtually all types survivorship. ARIA includes 3-D conformal, IMRT, VMAT, of cancer. The P-Cure system is supporting proton powerful tools for managing clinical, operational, and electron, proton, and brachytherapy. It incorporates treatment protocols for both scanning and scattering financial processes. With ARIA, software tools reside many tools that substantially speed up the process of beam delivery configurations. on a single platform that is fully integrated with treatment planning complex radiotherapy treatments, including planning. Advanced analytics, evidence-based planning protocols and easy-to-use optimization tools. A guidelines, cloud technologies, and connectivity to new RapidPlan® knowledge-based planning tool provides hospital EMRs through standard interfaces are all part of planners with models that facilitate the rapid generation of the Varian software portfolio. high-quality plans.

50 HealthCareBusiness news I october 2015 www.dotmed.com Diagnostic Directions Manufacturers are in the information business now By Bipin Thomas

One characteristic of the era we live in sor? Nike would then be able to see, all day requires bringing together device connectiv- is that nowadays everyone seems to be long, exactly how their customers live their ity, data integration and management, data in the information business. As a matter lives, where they are, what they do, how fast analytics, cloud, and mobility, all in a way that of fact, those companies which understand their heart races and how flushed they were. works seamlessly together and intuitively for the power information can bring will excel. Looking back a couple of decades, it is all the members of one’s business. That’s why But they have to be prepared to completely quite clear that medicine, and health care in some of the medical device product compa- rethink their business model and current general, have made great strides. New drugs nies are now offering a cloud-based platform relationship with the customer. It is impor- have been developed based on new insights that translates information to actionable in- tant to be prepared to invert how you think into how the human body functions. The sights. This platform allows interoperability about information. influence of external factors on one’s well- with a variety of medical devices and disease Many manufacturers, until now, have used being has been documented and acted upon. management pathways. It generates enor- information secondarily: it was used to help in Technological advances allow medical results mous amounts of clinical data which will help the primary process of dealing with their cus- in hours rather than weeks. But the best is yet the health care industry in many ways, some tomers. While useful, helpful, and sometimes to come. More and more data are being gath- of which will come from a personalized base- essential, it was not their core business. But ered for analysis. Even old medical records line for an individual’s health, using aggregat- the times are changing at warp speed. Today, that have been gathering dust can and are ed data from a number of wearable devices at some companies, information is becoming being brought to life, adding more insights or sensors. The information-driven business primary — the core offering of the company. that are being developed by data scientists model is transforming the way medical de- Imagine a company like Nike. Nike is specializing in medicine. New diseases will vices are used for delivering personalized care, well known for its brand power, products be detected and analyzed much faster, and and this business model is getting much more and style, and is thought of as an admirable treatments for both old and new diseases will established with wide adoption of connected company. But it is also extremely interest- come to the market more rapidly. devices in the health care industry. ing in terms of how they are looking at a At the same time, people are obsessing About the author: world that has become digital. Nike+ was about their health. Today they have more ac- Bipin Thomas is a launched years ago as an experiment. This cess to information and are becoming smarter renowned global joint product development between Apple in diagnosing symptoms. People want to be in thought leader on and Nike produced probably the most ad- control of their health. They want to monitor consumer-centric vanced, high-tech set of running shoes in the functioning of their body, trying to prevent health care transfor- their time. These could synchronize an iPod illnesses and improve the quality of their life. mation. Thomas is to play those songs that would match one’s In short: people want to manage their own a board member of jogging pace, and then upload data on the health. Over the past few years, devices that Healthcare Business News and chairman of run to the Nike+ community to share. give people information on their health have ICURO, a consumer-centric digital care out- Nike clearly saw the potential, and went come to market, and there are literally thou- comes research and management organiza- for it. They pulled out all the stops on digital sands of apps that help people stay in control tion, where he is redefining personalized care and pushed on at a lightning pace. Next, they of their health. These devices and apps are delivery by connecting all stakeholders in the introduced the Fuelband, a bracelet that trac- generating mountains of data, ready to be emerging health care ecosystem. Thomas is es one’s daily activity. Granted, it was rather analyzed. Patients, doctors, hospitals, pharma- a former senior executive at Accenture and limited at the start, but consider this: Nike+ ceutical companies, insurance companies and UST Global, where he launched strategic allowed Nike to see what their customers scientists will all find ways of using this data to digital initiatives across the care continuum were doing when they jogged, but this brace- the benefit of science and society. including providers, payers, medical device let would allow Nike to have contact with Today, innovative software is providing manufacturers, pharmaceutical and life sci- their customers all day long. The first version new ways for manufacturing companies to ences, federal and state health agencies. monitors steps, but what if Nike were to add gain a competitive advantage. But harness- Share this story: dotmed.com/news/27115 a heartbeat monitor and a temperature sen- ing that potential from scratch isn’t easy. It

HealthCareBusiness news I october 2015 51 Feature: Radiation Shielding

Dow R. Wilson, President & CEO, Varian Medical Systems (left), and Dr. Arkadi Stolpner, founder, DTC.

Proton shielding, more than meets the eye

By Philip Jacobus

Dr. Arkadi Stolpner founded the In- In fact, Dr. Stolpner and I are business first Gamma Knife. ternational Institute of Biological Sys- partners and I am so very familiar with the This was my first exposure to the shielded tems Diagnostic and Treatment Center, challenges that he has faced in providing ra- therapeutic room shielding. In many ways, named after Dr. Sergei Berezin, in 2003, diation therapy treatment options in Russia. I am self-taught, and by visiting with other with one used Siemens MRI. Today, the He seemed like the perfect person to talk to physicians and experts in the field I learned CEO operates a fleet of 89 MRIs in 62 cit- about shielding. that the treatment room had to be protected ies in Russia and eastern Europe. After no- PJ: When you decided that there was a with about 20 to 25 centimeters of ordinary, ticing that a high percentage of patients need for radiotherapy, what did you know simple concrete. were diagnosed with cancer, expanding into about shielding? I went on to learn that in general, the oncology was a natural evolution for the AS: My very first purchase was an Elekta more powerful the treatment option (higher company. Gamma Knife. Actually, I did not think too energy of the radiation used), the thicker the First it was an Elekta Gamma Knife treat- much about the therapy room construction concrete has to be. ment unit, then an Accuray CyberKnife. shielding because I was more worried about PJ: What are the thickness requirements Next, came a Varian TrueBeam linear accel- the regulations surrounding cobalt. Our gov- for the different delivery systems? erator and currently, Dr. Stolpner is about six ernment is very strict about the use of cobalt AS: Of course, every country is different in months away from completing construction and other radioactive materials and has a lot its regulations for radiation protection. Russia on a two gantry proton beam center in sub- of regulations surrounding it. We had to fol- is different from Europe which is different urban St. Petersburg. low a strict protocol when we installed our from North America, as I know, but here in

52 HealthCareBusiness news I october 2015 www.dotmed.com

Feature: Radiation Shielding

The radiation oncology center being constructed in Russia by DTC; the facility features concrete shielding walls for both proton therapy suites and linac suites.

Russia, the Gamma Knife requires the least their exposure to the radiation (primary, at AS: No, absolutely not. amount of shielding. For instance, for our least) should be minimized. In certain cases In the case of a linear accelerator, only CyberKnife our shielding was two meters a decontamination layer is necessary. It is the the room with the linear accelerator needs of concrete in certain directions whereas for part of the inner wall which can be relatively to be shielded. But in the case of a proton our Varian TrueBeam, it was two and a half easily dismantled and utilized as radioactive center, the room with the cyclotron must be meters of concrete and thickness. As for pro- waste. So care should be taken about the shielded as well. Also, when the beam trav- ton therapy, sometimes the walls are 15 feet materials used in this decontamination layer, els out of the cyclotron and travels down the thick! In other places, the walls for proton because the materials should be minimally beam line it has to turn at least twice. Once therapy can be only 6.5 feet thick but pro- activated by radiation. As for the protons and to get behind the proton gantries and again ton walls are definitely thicker. And of course high energy cyclotrons, special mathematical to get from the beam line into the proton the construction of the treatment rooms and modeling algorithms are used (Monte Carlo gantries. auxiliary environment, the infrastructure, is method) which allow us to create a statisti- In these areas where the turning takes place there is a considerable amount of neutron scatter, and in these areas the concrete walls must be very thick. As I said, about 15 Our government is very strict about the use of cobalt and other radioactive feet. For effective deceleration and further materials and has a lot of regulations surrounding it. shielding from neutrons, additional materials like plastic or boronated polyethylene can be used. Penetration capacity of the neu- planned by a special team of engineers and cally-proven picture of the dose distribution trons is very high, since they are uncharged physicists. There are a lot of rules which have during operation of this equipment. Further, particles, and such additional shielding gives to be taken into account when dealing with if we have a dose distribution, we can calcu- very good results when installed in the direc- radiation protection. When the high-energy late the necessary shielding geometry and tion of high neutron flux. treatment modalities are used, radioactive most effective materials. Along the walls, on both sides of the or ionized particles in the air arise, so special PJ: Is the thickness of the wall the only beam line and around the gantry rooms, requirements for ventilation should be con- difference between the proton site and a concrete walls are required. sidered. Routing of the cables is important, linear accelerator or Gamma Knife site? Also, in the case of a linear accelerator,

54 HealthCareBusiness news I october 2015 www.dotmed.com the walls might be 15 feet high but in the case of the proton gantry It is relatively expensive and not for everybody. But on the other room, the concrete walls must be almost 60 feet high. hand one can gain some time on the construction, which can be im- So between the cyclotron, the beam line, where the beam lines portant. Also I can imagine that conduit construction could be easier turn and the three story tall gantry room, there is a lot more concrete when such modules or bricks are used. involved in a proton system than in a linear accelerator or Gamma Knife. PJ: What about construction time? As you may know, there is a procedure for pouring and curing AS: We have now worked on two Gamma Knife centers and they concrete, and pouring more concrete into walls which are thicker and take about a month to produce. We have installed multiple linear ac- taller requires more time to pour the concrete and to allow it to cure. celerators as well, and generally it takes about two to three months Therefore, it is more expensive in many ways. The large mass of con- to prepare the site for a linear accelerator. However, a proton site can crete also emits a great amount of heat, so thermal cracks can occur take up to a year and even longer. On a proton site, between the in the wall, which degenerates the shielding effectiveness dramati- treatment rooms, the cyclotron, the beam line and the equipment cally. In order to prevent this, the concrete has to be of a high grade room, almost 40 percent of the building is dedicated to equipment. and specially cured, as well as thoroughly vibrated after the pouring. PJ: Do you have any other advice for someone considering a PJ: Is the only issue comparing a proton site to a conventional proton site? linear accelerator the thickness and quantity of concrete? AS: Establishing this proton center has been one of the most AS: Unfortunately, there is more to it than that, Phil. There are difficult projects of my career. I have already spent nine months miles and miles of conduit that must be placed inside the frame of visiting the site every day and I expect to be working, to one degree the concrete before the concrete is poured. This conduit is used for or another, over the next 24 months. However, I believe in proton cables and water and other components used for the proton system. therapy. I feel there is a place for different treatment options and It is considerably more complicated than a simple linear accelerator. there is definitely a place for proton therapy. I am very excited to be Also, this conduit must turn and bend like a snake to help keep involved in this project and I am quite sure that our efforts here will the necessary shielding effectiveness. Multiple bends increase scat- help to save lives in the years to come. tering, which is good for shielding purposes. There should be no Share this story: dotmed.com/news/27116 straight run for the radiation. So, proton walls take much longer, not only because they are wider and higher but because they have a complicated infrastructure inside the walls. PJ: Are there any other factors to consider? AS: Preparation. We have a saying here in Russia that “he who fails to prepare is preparing to fail.” I can tell you that a lot of thought and prep work has to go in to preparing the areas where the concrete will be poured, even before the concrete is poured. This was so much more time consuming for us than when we poured our linear accelerator or Gamma Knife walls. PJ: What about the floors and ceilings? AS: According to our regulations here in Russia, we cannot place any areas occupied by the staff below or above the linear accelerator or the proton system. Also, because of the weight of the system, it normally goes on concrete which is on top of the sub floor which rests on earth. Typically, our floors are 6.5 feet thick and so are our ceilings. In every machine we’ve installed, we installed it with the idea that we might someday have to remove it, and much of our equipment has been installed under a roof hatch. Sometimes even stationary cranes may be installed in the technical area of a treatment room in order to be able to maintain or repair the unit in the future. PJ: What about specialized concrete blocks that are used to stack and build a shield brick by brick? AS: Certainly, this will save time during the construction phase but I am not sure that anyone has already used them for the construction of a real proton therapy site. But yes, this technology is tested and validated for radiation modalities like protons and neutrons, not only high energy photons.

HealthCareBusiness news I october 2015 55 Industry Sector Report: CT

Priscilla Thomas Butler Farquhar

Ella Kazerooni

Andrea Bradley Pua McKee

New achievements, remaining challenges in the CT market

By Lisa Chamoff

Radiologists achieved a long-awaited create protocols to meet the stringent CMS in reimbursing low-dose CT lung screening, victory at the beginning of 2015 when requirements for reimbursement, hospitals says Dr. Andrea McKee, a radiation oncolo- the Centers for Medicare and Medicaid have also been working to make sure CT gist who runs the CT lung cancer screening Services (CMS) announced that it would scanners meet the Medical Imaging & Tech- program at Lahey Hospital & Medical Center reimburse annual low-dose CT lung can- nology Alliance’s (MITA) Smart Dose Stan- in Burlington, Mass. cer screening for longtime smokers be- dard, to avoid Medicare cuts beginning next “It’s really going to dramatically change tween the ages of 55 and 77. year. At the same time, new Joint Commis- the way we manage lung cancer, and we’re But, as with any slice of success in health sion standards that took effect July 1 put all very excited about it,” McKee says. care, there are still a number of challenges even more emphasis on making sure the In order to qualify for CMS reimburse- facing the CT market. radiation dose from CT scans is as low as ment for a scan, patients with no signs or While the organizers of currently up-and- possible. symptoms of lung cancer must be current running and new lung screening programs The CMS made a “landmark decision” smokers or must have quit smoking within

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Siemens’ SOMATOM Scope is available in an RV configuration, which was released in February 2015.

the past 15 years, with a smoking history of at While the requirements for CMS reim- Through its program, started in 2012, La- least 30 pack-years, an average of one pack bursement may seem onerous, they ensure hey has screened more than 3,000 patients, a day for 30 years. Patients must then receive the quality and safety of screening programs, finding early-stage disease in 75 percent of a written order for screening during a visit says Dr. Ella Kazerooni, who chairs the them. The facility also worked with the ACR with a physician, physician assistant, nurse ACR’s Lung Cancer Screening Committee. to develop Lung-RADS. Though the require- practitioner or clinical nurse specialist who re- “I think whenever there are requirements ments are extensive, having a good lung views and discusses the benefits and harms of instead of outright coverage, it’s natural for cancer screening program requires proper screening, including the possibility of a false people to think of them as obstacles,” Kaze- training and the right multi-disciplinary team positive and the exposure to radiation, and rooni says. “But when you think about the to do the scans the right way and to manage provides counseling on smoking cessation. reasons behind them, they make sense.” the findings, McKee says. “We were able to demonstrate to CMS what a community screening program is like once you have these systems in place,” Though the requirements are extensive, having a good lung cancer McKee says. Providers are still waiting for CMS to issue screening program requires proper training and the right multi-disciplinary a Current Procedural Terminology (CPT) code team to do the scans the right way and to manage the findings. for the scans (providers anticipate the code will be issued in November) and are responding in different ways. Lahey, for example, has already been providing the scans free of Providers must also utilize a standard- Since the National Lung Screening Trial charge through its community benefit pro- ized lung nodule identification, classification (NLST), which looked at 53,000 patients gram. The lung cancer screening program at and reporting system, such as the American across 33 facilities, the threshold for a positive NewYork-Presbyterian/Weill Cornell Medical College of Radiology (ACR) Lung Imaging exam has also increased from a 4-millimeter College is holding its bills and waiting for the Reporting and Data System (Lung-RADS), nodule to a 6-millimeter nodule, which has CPT code to be issued before applying for and collect and submit data on each scan to been found to decrease the false positive rate reimbursement. They’re asking patients to a CMS-approved registry. from 27 percent to less than 10 percent. sign a waiver, which states that if CMS does

58 HealthCareBusiness news I october 2015 www.dotmed.com

Industry Sector Report: CT

not reimburse the scan, the patient will be required to pay the fee. comfortable saying to patients, ‘You will definitely get reimbursed,’ Before the CMS decision, all Medicare and Medicaid patients paid for and sending them a bill later.” the scans themselves. Pua says his facility did look into offering free screenings, but struggled to decide how to address the 20 to 30 percent of patients who end up having a positive study. “Who pays for the follow up?” Pua says. “Again, in thinking ‘If, overnight, all eight million showed up to get an about protecting patients down the road, it’s kind of hard to put that burden on people.” annual CT, that would be an increase of 10 percent of CT Uncertainty aside, radiologists agree that lung cancer screening scans done in the U.S. As with anything in health care, programs will have a big impact on the industry. “It’s going to have a tremendous impact on the field of radiology the adoption rate is always hard to predict and it’s because of the number of patients who will be scanned,” McKee always lower than you expect.’ says. It’s also pushed manufacturers to release new products. In August, GE Healthcare received FDA clearance for a lung cancer screening option for low-dose CT. The product, which is available on all of GE’s Dr. Bradley Pua, director of the lung cancer screening program new 64-slice and greater scanners and most of its 16-slice scanners, at NewYork-Presbyterian/Weill Cornell Medical College, says the includes GE’s new low-dose screening reference protocols, which language from CMS states that if facilities meet the requirements are based on patient size and current screening recommendations. of shared decision-making visits and adding information to the ACR Ken Denison, GE’s global marketing director for CT products, lung cancer screening registry, they “may” be reimbursed. is cautiously optimistic about what the CMS decision means for the “We decided that to protect patients in the long run, we needed industry, with a potential for eight million patients with a history of to approach this from a practical mindset,” Pua says. “We weren’t smoking to be scanned. “If, overnight, all eight million showed up to get an annual CT, that would be an increase of 10 percent of CT scans done in the U.S.,” Denison says. “As with anything in health care, the adoption Mobile and Modular CT Lab Rentals rate is always hard to predict and it’s always lower than you expect.” With the requirements in place, programs are challenging to run. Get a Quote Today! “It’s not as easy as putting out a sign saying, ‘Get your CT lung cancer screenings today,’ ” Denison says. “If health care providers get the word out and get their programs in place, we might see an increase of a couple of million scans a year.” Judith Schmalzing, CT installed base product manager at Sie- mens Healthcare, says the company’s new SOMATOM Scope, a diagnostic CT scanner with a footprint that is small enough to fit inside a mobile imaging vehicle that doesn’t require a commercial license to operate, creates the potential for conducting lung cancer screening in remote areas.

Responsive: In-stock ﬂeet of Joint Commission adds CT dose requirements interim labs available Another challenge that has popped up for radiology departments is for quick delivery and setup new Joint Commission requirements for imaging. The requirements Customer Service: dovetail somewhat with XR-29, also known as the MITA Smart Dose Lease includes 24/7 Standard, but they’re much more far-reaching, says Dr. Geoff West, Service Support the chief executive officer of West Physics, a consulting company that Highest Quality: Newest, most works with hospitals on meeting accreditation requirements and up-to-date Imaging Equipment reducing CT dose. Since July 1, the Joint Commission requires facilities to record a patient’s CT radiation dose index and make it available in a retrievable format. This is less stringent than in the first draft of the requirements in 2014, which would have required that the radiation dose be re- facebook.com/ModularDevicesInc @MobileCathLabs corded in a patient’s interpretive report.

60 HealthCareBusiness news I october 2015 www.dotmed.com Some radiologists had concerns about including radiation dose “Some facilities have quite advanced radiation dose programs in a patient’s record and the need to educate them about what it for CT,” West says. “Some have almost nothing. These requirements means, West says. will really bring all of the accredited facilities up to a minimum level “The radiologists that I spoke to, many supported that and many of dose awareness.” radiologists are already dictating or transferring that radiation dose into the patient report, but a portion of the radiology community felt that if they started putting the radiation dose into the patient’s report that the physicians and patients who don’t understand rad dose would be overly concerned,” West says. “I, personally, think ‘ ... A portion of the radiology community felt that if they patients have the right to know their radiation dose, but I don’t think started putting the radiation dose into the patient’s the community is prepared.” The Joint Commission now also requires facilities to adopt pro- report that the physicians and patients who don’t tocols that consider a patient’s age and size, whether there was understand rad dose would be overly concerned.’ contrast given, and to determine the expected radiation dose exposure for each CT exam. They must also review and analyze incidents where the radiation dose exceeded the expected dose outlined in the facility’s protocols. Facilities must also have a medical physicist measure the radiation While the Joint Commission has no specific requirement for dose dose produced by each CT imaging system for adult and pediatric tracking software, as there is for the MITA Smart Dose Standard, brain and abdomen scans, and conduct annual training for technolo- meeting the new Joint Commission requirements will be difficult for gists on radiation dose optimization techniques. facilities with any appreciable patient volume without any kind of Dose protocols have varied considerably by individual facility up dose management software, says Brent Christenson, senior field until now, according to West. marketing manager for Philips, which launched its DoseWise Portal at

HealthCareBusiness news I october 2015 61 Industry Sector Report: CT

last year’s RSNA (the company previously had tor’s offices that perform diagnostic CT scans patient record; CT Dose Check, which alerts a marketing partnership with Radimetrics). in an outpatient setting and don’t use equip- technicians before they start a scan if the “Can someone do Joint Commission ment that meets the Smart Dose Standard estimated dose will be higher than the pa- without buying something?” Christenson will have their Medicare reimbursements rameters the facility has defined; automatic says. “Yes, but you’re going to do a lot of cut by 5 percent in 2016 and 15 percent exposure control, which tailors the radiation work.” by 2017. Compliant equipment must have dose to the specific body regions and parts At this year’s ISCT, Toshiba introduced new software called CT Vitality that allows providers to manage the CT protocols among multiple Toshiba scanners. The main CT manufacturers, including Siemens, GE, Philips and Toshiba, “If you have to manually make protocol changes on each CT scanner, that’s fraught have created portals on their Web sites to allow customers to check the with error,” says Tim Nicholson, senior status of their scanners and obtain certificates of compliance, which the manager of market development for CT at Toshiba America Medical Systems. manufacturers are legally required to provide.

Getting ‘smart’ The new Joint Commission requirements work hand in hand with XR-29, or the MITA four key attributes: A DICOM Radiation being imaged in order to manage the radia- Smart Dose Standard. Dose Structured Report that enables dose tion delivered to obtain the desired level of Under the law, which takes effect at the information to be captured in a standard- diagnostic quality; and pediatric and adult beginning of next year, hospitals and doc- ized electronic format and included in the reference protocols.

62 HealthCareBusiness news I october 2015 www.dotmed.com The main CT manufacturers, including Sie- 2015, stated that “we have determined that Can third-party products mens, GE, Philips and Toshiba, have created 90 percent of our non-end-of-support CT in- help with compliance? portals on their Web sites to allow custom- stalled base either meets or can be upgraded There has been some confusion about ers to check the status of their scanners and to comply with NEMA XR-29 with a free of whether third-party products will allow fa- obtain certificates of compliance, which the charge upgrade.” cilities to meet the standards. Many compa- manufacturers are legally required to provide. Megan Hayes, director of regulatory nies have been advertising add-on solutions for legacy CT equipment that are compliant with the Smart Dose Standard. In May, MITA published a white paper with a guide for ‘We did what we could do within our scope to balance patient safety with evaluating third-party modifications or solutions, suggesting providers, “approach the the quality of a diagnostic image. If we had done nothing, people would be decision to purchase a solution with cau- screaming that we had done nothing.’ tion” and ask the vendor for detailed information on how its product meets the MITA standards. Manufacturers say they know of no third-party solution that meets MITA’s re- While some critics have said that the and standards strategy for MITA, says the quirements. MITA Smart Dose Standard was a way to legislation was in response to media reports “The opportunity is there for somebody facilitate the purchase of new CT scanners, about radiation overdoses in California. to develop a solution that will meet the XR- Schmalzing, of Siemens, says it’s a good op- “We did what we could do within our 29 standards,” says Scott Merriman, in- portunity for a facility to look at its fleet and scope to balance patient safety with the stalled base marketing manager for molecu- see what makes sense to upgrade. The com- quality of a diagnostic image,” Hayes says. lar imaging and CT at GE. “At this time, we pany also doesn’t push its customers to pur- “If we had done nothing, people would be are not aware of a third-party solution that chase a new system if they can upgrade it. If screaming that we had done nothing.” truly meets all of the requirements outlined a facility has a service contract with Siemens, MITA has estimated that a third of the in the standard.” the upgrade is done at no cost. U.S. installed base can’t be upgraded, and Recently, Zetta Medical, which markets a “I think we all agree that we think this would have to replace its scanners in order product called Z-Dose that the company says is going in the right direction,” Schmalzing to comply with XR-29. Patrick Hope, execu- interfaces with CT scanners from the major says. “The legislation itself has patient care tive director of MITA, says the group has still OEMs and provides for all four of the MITA and outcomes in mind.” been looking at the number to see if it has Smart Dose requirements, published an FAQ A Siemens notification dated Sept. 1, changed. on its Web site addressing the points in the

HealthCareBusiness news I october 2015 63 Industry Sector Report: CT

MITA white paper. A facility might consider a product such “When billing people submit the in- Mike Ghaza, president and chief execu- as Z-Dose if it can’t get a free upgrade from formation to CMS, there currently is no tive officer of Zetta Medical, says he has also the OEM because it doesn’t have a service indication of what [machine] the scan was contacted MITA to get more clarification. contract, or if it can’t afford a new CT. performed on,” Butler says. “Most of the “The health care providers who need to billing is done via software. There’s poten- be compliant with XR-29, I don’t think they tially some complex coding involved.” have the capital to spend the serious dol- Christenson, of Philips, says manufactur- ‘When billing people submit the lars that the OEMs are asking for,” Ghaza ers have been in touch with CMS to discuss information to CMS, there currently says. “If they’re going to upgrade partially, compliance with the MITA standards. As part they would pay five times what they would of that process, manufacturers including is no indication of what [machine] pay us.” Philips have also made efforts to better edu- the scan was performed on. Most Hayes, of MITA, says providers who cate their customers on what it truly means still have questions should work with their to be compliant, as many are confused by of the billing is done via software. equipment vendors. the nuances of the standards and what it There’s potentially some complex “Our mantra has always been to work means for their business, Christenson says. with the OEMs,” Hayes says. “That manu- “We’ve worked with CMS to say, ‘This is coding involved.” facturer is going to be best able to determine how a CT is compliant by these standards, if your machine is compliant.” and this is how you can verify whether or There are still unknowns about how XR- not your solutions are certified during audit “To our knowledge, we will install the 29 is going to be implemented by CMS, cycles,’ ” Christenson says. software, give them a certificate and they says Priscilla Butler, senior director and Nicholson, of Toshiba, says manufactur- will submit their codes and scans that they medical physicist for quality and safety with ers assume that the Joint Commission will are in compliance,” Ghaza says. the ACR. also ask to see the certificates during inspec-

64 HealthCareBusiness news I october 2015 www.dotmed.com tions, similar to when they ask to see proof of a scanner’s ACR accreditation. ‘We know it’s been in the press, we know we had it on our Medic Vision, which offers software called SafeCT, which improves image quality from lower-dose CT scans, is seeking FDA ap- Web site, we know MITA has been trying to raise proval for a new product called SafeCT-29. Medic Vision Chief Ex- awareness about it for well over a year, and we still ecutive Officer Eyal Aharon says SafeCT-29 will provide a DICOM Radiation Dose Structured Report and CT Dose Check on scanners keep getting questions about it.’ that are already equipped with automatic exposure control and pediatric and adult reference protocols. Aharon says that according to the CMS proposed rule on XR-29, proper use of medical radiation,” Farquhar says. “Most of the work verification of compliance shall be performed as part of the periodic from this is the education and awareness components, which is CT accreditation. across the entire spectrum of the health care delivery system. That’s “I would assume that the auditors will test if the XR-29 functions more of a time investment. It’s doing the right thing and the safe are properly implemented, regardless of any certification of compli- thing to do in each case.” ance that may be provided by a vendor,” Aharon says. One of the most common questions Toshiba has been receiv- In a Sept. 4, 2015 written response to the CMS proposed rule, ing from customers is “what’s next?” Nicholson says that based MITA urged CMS to require OEMs or third parties to provide vendor on discussions with MITA, a likely next step is to require that dose certificates stating that the CT scanner is fully compliant with XR-29. information is included in the patient’s health record, something that “MITA’s members who are CT manufacturers have committed is currently required in California. to, and have already started providing, XR-29 certifications to the “You can almost predict the future,” Nicholson says. “If you’re owner/operator of the particular CT system,” wrote Peter Weems, being required to do that report [under XR-29] you’re going to be MITA’s director of policy. “Suppliers, hospitals and other rendering required to do something with it.” entities furnishing the imaging services would then provide this Share this story: dotmed.com/news/27143 certification certificate to CMS and/or an accreditation organization upon request.” “MITA recommends that the OEM XR-29 certifications or those of duly qualified and FDA-registered third parties be required as part KEI Med PARTS of the periodic accreditation of suppliers,” Weems continued. “We urge CMS to work with accrediting organizations to incorporate this is Direct requirement into their standards.” Even more than a year after XR-29 was passed, there is general You need it? We send it! confusion overall. from KEI inventory direct to your site “We know it’s been in the press, we know we had it on our Web site, we know MITA has been trying to raise awareness about it for MRI and CT parts well over a year, and we still keep getting questions about it,” Butler says. “XR-29 says for full reimbursement you must perform a scan Philips • Picker • Marconi • Siemens on a CT scanner that has these features. It doesn’t say you must use these features. Manufacturers need to make sure their customers Need Tech Support and Part Installation, too? understand how to use these features and facilities must understand We provide E cient, Expedited Service! what these features can do for them.” Some facilities have been proactive. In Connecticut, where radia- Call (512) 477-1500 tion dose reporting legislation has been considered, Hartford Hospital has been ahead of the game in complying with Joint Commission Any time. Any Day. Save Time. Save Money. and MITA standards. A minority of scanners had to be replaced, says Dr. Thomas Far- quhar, Hartford Hospital’s chief of radiology. “Those were already being used very minimally,” Farquhar says. Med “Most of the modern, heavily-used scanners were either fully compliant or were able to be, with a simple firmware update.” The facility also began sending dose data from its scanners to a central database more than a year ago. www.keimedparts.com “It’s all part of a program where there’s a greater awareness on a

HealthCareBusiness news I october 2015 65 Industry Sector Report: CT DOTmed Registered CT Sales & Service Companies For convenient links to these companies, go to www.dotmed.com and enter [DM 27143]. Names in boldface are Premium Listings. Company Contact Name City State/Nation Certified DM100 Advantage Medical Electronics William Dixon Mobile AL A. Imagign Solutions David Stopak Birmingham AL • • Amedicus Inc Richard Stockton Gold River CA Medical Imaging Resources Ted Huss Colfax CA • DirectMedParts, LLC Bill Erbes San Diego CA • Southwest Medical Resources Donny Mccormack Ontario CA • • JDIS Group Burke Whitney Fullerton CA • • Toshiba America Medical Systems Tim Nicholson Tustin CA ANDA Medical, Inc. David Lapenat Ottawa Canada • • ScanWorks Chris Ash Centennial CO Hartford Hospital Dr. Thomas Farquhar Hartford CT AGITO Medical Anders Fage Jensen Noerresundby Denmark • • Integrity Medical Systems, Inc. David Denholtz Fort Myers FL • • MRISERV Joe Valdez Fort Lauderdale FL United Medical Technologies Corp. John Pereira Fort Myers FL HIQ Solutions Group Juan de la Cruz Martinez Miami FL ElsMed Ltd. & Relaxation, Inc. Ronen Bechor Tampa FL • • Amber Diagnostics Robert Serros Orlando FL • Clinical Imaging Systems Ryan Gilday Parl Beach Gardens FL • • Puma Export Olga De La Paz Hilah FL Medical Imaging Specislits Erick Simon Sarasota FL • MagnaServ Greg Pearson Stuart FL • West Physics Geoff West Atlanta GA LG Medical Technologies James Gallagher East Dundee IL • IMES and Richardson Healthcare LaFox IL Chicago MedX Robert Iravani Chicago IL MobileScan Imaging Geore Webb Kildeer IL Shared Imaging Melissa Lee Streamwood IL Zetta Medical Technologies Mike Ghazal Lake Zurich IL Modular Devices Inc. Mark Koers Indianapolis IN • • W7 Wayne Kramer Henryville IN Medic Vision Imaging Solutions Ltd. Eyal Aharon Tirat Carmel Israel Samsung Healthcare Deborah Chung Danvers MA MedExchange Davyn Mcguire Agawam MA • • Lahey Hospital & Medical Center Dr. Andrea McKee Burlington MA ARTHUR MEDI COMP TRONICS Arthur Singh Indore Madhya Pradesh India American Radiology Resource David Pac Timonium MD • • Complete Medical Services Tony Orlando Sterling Heights MI • •

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GE Healthcare / Neurologica / Neusoft / NeuViz 64 Revolution™ CT BodyTom® The Ingenuity provides the Uncompromised. Revolution BodyTom is a portable, full body, benefits of high-resolution, CT is a breakthrough that delivers 32 slice CT Scanner that boasts low-dose scanning in uncompromised image quality & an impressive 85 cm gantry and an upgradeable family clinical capabilities through the 60 cm. field of view. BodyTom designed to grow as you convergence of coverage, spatial easily interfaces with PACS, grow. Engineered with resolution, temporal resolution & HIS/RIS and surgical navigation a focus on performance and reliability, the Ingenuity is dose performance – all in one. systems. Its unique capabilities provide high-quality CT available with the advanced technologies of iDose4, IMR, It is the CT designed to help you deliver revolutionary images wherever needed including the OR, Trauma iPatient, MRC Ice tube and the NanoPanel detector series. and differentiated capabilities across all of your clinical Bay, ED, ICU, Radiology Department, Radiosurgery Powered by these integrated technologies, the Ingenuity areas. and Interventional Suite. Neurologica is a subsidiary of enables routine imaging with consistently high-image Samsung. quality across a broad range of patients. GE Healthcare / Revolution™ GSI Neurologica / Philips / Ingenuity A better test. Revolution GSI helps CereTom® The Ingenuity provides the make clinical excellence routine, The Neurologia CereTom is an benefits of high-resolution, delivering consistently high- 8 slice CT scanner that provides low-dose scanning in an definition imaging and expanding rapid scan time, flexible settings upgradeable family designed to diagnostic capabilities across and immediate image viewing. grow as you grow. Engineered applications. It enables you to take These features make it an with a focus on performance CT beyond classical anatomical indispensible tool to any clinician and reliability, the Ingenuity is assessment to quantitative tissue setting that has an urgent need available with the advanced technologies of iDose4, characterization and advanced functional imaging. for real-time data on critically IMR, iPatient, MRC Ice tube and the NanoPanel detector The time is now for spectral CT with Revolution GSI. ill patients so rapid diagnosis can be achieved. Neurologica is a subsidiary of Samsung. series. Powered by these integrated technologies, the GE Healthcare / Ingenuity enables routine imaging with consistently high- Revolution™ EVO Neurologica / image quality across a broad range of patients. Expand your services. Revolution inSPira HD® EVO is designed with the purpose inSPira HD is a portable high Philips / iCT of operating in the reality of now, resolution SPECT imaging The iCT is designed for excellence while anticipating the challenges of system. inSPira HD® is capable in cardiovascular imaging. This tomorrow. It’s designed to support of imaging radioisotope proven platform sets you apart the widest variety of patients and energies between 80 and 200 through industry-leading resolution applications, from complex trauma keV for clinical applications (low-contrast), giving you high or cardiac cases, to large patient such as Epilepsy, Parkinson’s, diagnostic confidence, while backlogs in busy emergency NeuroPsych, Alzheimer’s and Stroke. Neurologica is a simultaneously helping address departments that strain workflows and resources. subsidiary of Samsung. your patient’s needs for low-dose. The synergy in state-of-the-art innovations such as IMR (Iterative Model Hitachi / SCENARIA Neusoft / Reconstruction), NanoPanel Elite detectors and iPatient The scalable SCENARIA CT NeuViz 16 workflow platform enable differentiated capabilities platform is available This full-featured CT scanner with simplicity and consistency. Performing advanced in 64- and 128-slice provides the smallest footprint procedures and imaging challenging patients are now models offering premium with the widest detector routine. capabilities and coverage in 16-slice scanning. workhorse performance. The NeuViz16 has reduced Philips / IQon Spectral CT Incorporating advanced scan times, lower dose With Philips IQon Spectral CT you dose reduction and is easy to site. It includes: Dynamic Focal Spot get conventional, anatomical features, greater to reduce artifacts, MIP, MinIP, SSD, AIP, MPR, bone information you traditionally patient access (75cm aperture with Lateral Shift removal, Virtual Entrography and Vessel analysis. A receive from CT, and on-demand Table) and rapid workflow tools (up to 35 image per 50 kW generator and 5.0 MHU tube lowers the cost of spectral results including color second reconstruction), Hitachi provides feature-rich ownership quantification, the ability to configurations and unique support benefits that create characterize structures based on a superior value. Over 30 years of CT development and material content, and monoenergetic image information manufacturing expertise and 12,000+ CT installations all in one scan. Plus, you get these results with no worldwide comes with Hitachi’s next generation CT – upfront decision making. Scan routinely and the spectral SCENARIA. information is right there at your fingertips, without complexity, at low dose to solve challenging clinical questions.

68 HealthCareBusiness news I october 2015 www.dotmed.com Siemens Healthcare / Siemens Healthcare / Toshiba / Aquilion PRIME SOMATOM Scope SOMATOM Force Toshiba’s Aquilion™ PRIME 16-slice CT system delivers Dual-source CT system is a mid-tier CT solution that image quality, dose reduction and possesses two sets of Siemens’ delivers on customers’ clinical workflow enhancement associated most innovative X-ray tubes and and financial needs today, with with Siemens’ SOMATOM family detectors to extend advanced the ability to adapt as those of CT scanners at an accessible imaging to virtually all patients. needs change in the future. The price point. eCockpit technology Due to its low kV imaging, the scalable, patient-focused system extends the scanner’s operational lifetime by minimizing system broadens CT’s application for patients with renal is available with 80 or 160 slice configurations and wear and tear on vital components. Designed for insufficiency. System also enables the user to perform an makes for faster, more comfortable exams for patients private radiology practices, mobile settings, community entire adult chest, abdomen and pelvis study in just one while providing improved diagnoses and workflow for hospitals, critical access hospitals and specialty second, eliminating the need for breath hold. In cardiac clinicians. practices such as orthopedics and urology. Available in imaging, the system can obtain an entire study within a Scope and Scope Power configurations. quarter of a heartbeat at a native temporal resolution of Toshiba / Aquilion Large 66 ms. Bore Siemens Healthcare / Designed to expand the SOMATOM Definition Edge Toshiba / Aquilion ONE dimensions of CT, Aquilion™ Large Relaunched single-source CT Family ™ Bore (LB) combines Toshiba’s system designed to help improve The Aquilion ONE Family award-winning CT technologies patient outcomes in all clinical systems match current clinical needs with the advantages of a large-bore capabilities – from contrast media- with a field-upgradable path for the platform. Aquilion LB provides a true 70cm field-of- efficient TAVR planning to precise future: view acquisition, covering more anatomy with greater therapy response management, • Aquilion ONE 320 – 8 cm, single accuracy than ever before. Aquilion LB was specifically from low-dose therapy control rotation scan at 0.35 second designed to meet oncology challenges and improve to optimized emergency care workflow. Capable of rotation speed allows for optimal speed and efficiency. patient care. Now CT simulation positioning can easily TwinBeam Dual Energy X-ray imaging, enabling • Aquilion ONE 640 – Single 640-slice rotation covers 16 mirror radiation therapy positioning without compromise. simultaneous imaging at two different energy levels for cm, allowing full-organ imaging in a comprehensive CT the first time in single-source CT. System has options for scan. ADMIRE model-based iterative reconstruction to further • Aquilion ONE ViSION – Combines the capabilities of reduce X-ray dose and iMAR iterative algorithm for the Aquilion ONE 640 with higher volume capabilities, metal artifact reduction. delivering matchless functionality.

HealthCareBusiness news I october 2015 69 Industry Sector Report: X-ray Tubes

Developed markets reduce dose, increase sales www.imesimaging.com | www.rellhealthcare.com In established markets like North America and western Europe, it’s less about having access to X-ray systems than it is about having access to high-value systems with better functionality and lower dose to the patient. “For CT, it means that the majority will be 16-slice systems where detector size is a major cost driver,” says Jonaitis. Finding ways to lower the dose not only benefits the patients and technologists — but the glassware itself. “Using dose reduction software enables the X-ray tube to be used in a less harsh way, with the same image quality results,” says Funk. That means longer tube life while decreasing the down- Glass blowing time of the scanner due to tube failures. Provided by Dunlee New hardware and software are becoming available that drive dose levels lower than were once thought possible, says Jona- Three experts share itis. For mammography, photon counting enables micro-dose exposure, but comes at views on X-ray tubes a higher cost. For CT, iterative construction software is starting to take off. Some experts anticipate that anode end in the low-dose era grounded (AEG) X-ray tubes will become more common. AEG tubes (which are single By Gus Iversen ended, or unipolar) allow for considerably higher power than conventional (bipolar) Ever since Wilhelm Röntgen first pho- and surgical suites. All of these changes are tubes, with smaller size and less heat. tographed the bones in his wife’s hand, coinciding with a trend toward digital imag- Another key benefit of AEG tubes is that THE IMES PARTS the X-ray tube (then a Crookes tube) has ing and easier image acquisition and storage. there is less “off focal radiation,” which allows been a critical and fundamental compo- Heather Funk, senior manager of mar- for a harder beam, or less electrons rebound- nent of medical imaging. We depend on keting and business development at Dunlee, PROGRAM ing and striking the target at areas other than DISCOVER A BETTER CHOICE AT radiation for a range of vital imaging exams expects X-ray tubes to experience modest the focal point. Stopping those stray electrons including CT, radiography, fluoroscopy and growth under the current economic circum- • Ready-to-Ship Inventory from generating unnecessary photons means BOOTH #7913 mammography — and to generate that ra- stances. Her company, a division of Philips less heat is generated, less blur from misplaced • Exclusive QA3 Testing diation, we depend on X-ray tubes. Healthcare, has a rich history in tube design, NOVEMBER 29 - DECEMBER 4 radiation in the image, and less non-useful McCORMICK PLACE, CHICAGO Varian Medical Systems is one of the big- research and manufacturing. radiation hitting the patient. • CT Service Training gest manufacturers of X-ray tubes, produc- That growth seems to be something in- CT systems are replaced in the interest of 7913 ing between 22,000 and 25,000 of them dependent of imaging modalities that have • Expert Technical Support meeting new safety protocols, which means every year. Mark Jonaitis, general manager emerged over the last 50 years or so, like MR tube demand overall could go up, says and vice president of its X-ray tubes busi- and ultrasound. Tom Spees, vice president • 24/7 Parts Hotline: 704.739.3597 x3 Spees. To be compliant with MITA’s XR-29 ness, says there is a global X-ray tube mar- of sales at Richardson Electronics Healthcare standards, for example, an estimated one- ket, but the demands are very different from Division, calls these “supplemental support third of the installed outpatient systems will one region to the next. technologies.” need to be replaced. In some regions, breast cancer screening His company is an industry leader in re- Solutions for Toshiba CT and other major brands. Richardson Healthcare Funk points to the customers who are is proud to announce the addition of IMES products to our existing portfolio. is just now becoming available, he says. In placement tubes, a market that is expected compliant with regulations and mindful of Our product family now includes QA3 tested replacement parts, diagnostic others, mobile C-arms are developing capa- to grow as radiography and CT extend their the bottom line, which has become increas- displays and workstations, and wireless DR systems. To complement our suite bilities that may displace high-end cardiac reach into new frontiers. of high quality products, we offer training and 24/7 expert technical support ingly important with health reform. “We to help lower costs for in-house and third-party service providers.

70 HealthCareBusiness news I october 2015 www.dotmed.com www.imesimaging.com | www.rellhealthcare.com

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Solutions for Toshiba CT and other major brands. Richardson Healthcare is proud to announce the addition of IMES products to our existing portfolio. Our product family now includes QA3 tested replacement parts, diagnostic displays and workstations, and wireless DR systems. To complement our suite of high quality products, we offer training and 24/7 expert technical support to help lower costs for in-house and third-party service providers. Industry Sector Report: X-ray Tubes

awareness will have an impact on the overall market and allow more X-ray tube in a CT gantry at the competitive pricing even on the high end of performance.” IMES testing facility in Fort Mill, South Carolina. IMES is a division Hurdles to in-house maintenance of Richardson Healthcare. For providers that service their equipment in-house, X-ray tubes have traditionally been a source of some trouble. The installation process can be very involved. However, for many systems, radiographic and mammography, for instance, that is beginning to change. As Jonaitis puts it, “simplicity is king.” But that’s not necessarily the case with CT, where he says dosing concerns have given way to some highly sophisticated calibration techniques. Spees has a different perspective on in-house servicing. “The major OEMs prefer that other service organizations, including in- house, don’t work on their equipment because maintenance service is a significant amount of their annual revenue, and an even more significant amount of their margin,” he says. For that reason it’s not uncommon for OEMs to artificially create “barriers” to prevent others from doing maintenance, including changing the X-ray tube, he continued. Aside from 24/7 customer service, Funk’s company offers Dunlee Academy, an online tutorial to help guide technicians through the installation process step by step, complete with pictures and videos.

see customers holding onto their current scanners longer which, in turn, will have a positive impact on replacement tube sales into the future,” she says.

More manufacturing in burgeoning markets? As new markets emerge globally for X-ray tubes, those regions face tough decisions about building locally or importing. As Jonaitis points out, many countries do not like to see government funding going overseas and create regulatory barriers that make importation difficult. In some regions, an alternative might be to use government fund-

ing to create a domestic supply, but building X-ray tubes is no small MCS 8064 task. Their production is a sophisticated process that does not lean replacement X-ray tube. heavily on manual labor (or create a flood of jobs). (Photo: Varian) Funk says it is more likely that existing X-ray tube manufacturers will expand either parts or full production capabilities in developing What’s next? countries to be closer to those customers. “Advanced detectors and more sensitive receptors, along with im- Jonaitis points to Brazil, China and Russia as three countries where age processing algorithms allowing the image to be created with that prediction is already proving to be accurate. fewer photons to the receptor, should be encouraged and strived Much of the cost of X-ray tubes is derived from materials and for,” says Spees. overhead, but Spees says the technical barrier is the most significant. Funk says Dunlee concentrates on ways to keep costs down on its High-end CT tube manufacturing comprises competency in mechani- tubes, and the best way they’ve found to achieve this is by producing cal engineering and thermal management of stress and materials. reliable glassware. “By improving our X-ray tube product quality we “At the functional core is high-voltage vacuum technology, where extend the life of our tubes, resulting in lower overall costs.” cleanliness is imperative,” says Spees. Ultimately, providers need to keep their sights on the needs of Instead of getting involved in the manufacturing process, Spees younger patients. As people live longer lives, that exposure to radia- predicts many of the emerging markets will turn to reliable replace- tion has more potential to cause later damage and that danger is no ment tube vendors to keep their systems operational. better illustrated than in younger patients who are still undergoing “In general tubes will cost less as manufacturers are driven to fast cell growth, says Jonaitis. compete in emerging markets,” says Jonaitis. “This level of cost Share this story: dotmed.com/news/27151

72 HealthCareBusiness news I october 2015 www.dotmed.com www.elsmed.com [email protected]

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- Full Warranty Industry Sector Report: X-ray Tubes DOTmed Registered X-ray Tubes Sales & Service Companies For convenient links to these companies, go to www.dotmed.com and enter [DM 27151]. Names in boldface are Premium Listings. Company Contact Name City State/Nation Certified DM100 Advanced Imaging Services, Inc. Sean Wang Lathrop CA R-Tron Medical Melissa Garske Gold River CA Amedicus Rick Stockton Gold River CA Southwest Medical Resources Donny Mccormack Ontario CA • • Kimtron Medical Pete Cawley Oxford CT • Integrity Medical Systems, Inc. David Denholtz Fort Myers FL • • United Medical Technologies Corp. John Pereira Fort Myers FL Oxford Instruments Chloe Foster Deerfield Beach FL Clinical Imaging Systems Ryan Gilday Parl Beach Gardens FL • • Amber Diagnostics Robert Serros Orlando FL • IMES and Richardson Healthcare LaFox IL Dunlee-Division of Philips Healthcare Aurora IL MobileScan Imaging Geore Webb Kildeer IL Imaging Services Melissa Lee Streamwood IL Zetta Medical Technologies Mike Ghaza Lake Zurich IL W7 Wayne Kramer Henryville IN • ARTHUR MEDI COMP TRONICS Arthur Singh INDORE MADHYA PRADESH Block Imaging Parts & Service, Inc. Jason Crawford Holt MI Advanco Medical Systems Joe Zaremba Sedalia MO • SOS Medical Imaging Eric Smith Cornelius NC • • Remedpar Shawn Lease Charlotte NC Grand Medical Sean Chen Cranbury NJ • • Proton Services Gary Provenzano Sayreville NJ • Deccaid Services Inc. Sal Aidone Deer Park NY • ADAM Imaging Parts Josh Glas Bohemia NY • • Varian Medical Systems North Charleston SC STAT Medical X-Ray Tubes Tim Davis Summerville SC Creative X-Ray Solutions Mason Underwood Summerville SC Tri-Imaging Solutions Jen Davis Madison TN Ed Sloan & Associates Ed Sloan Sr. Goodlettsville TN • Aramark Healthcare Technologies Lenny Place College Station TX KEI MED Parts Patrick Bryne Hutto TX • Image Technology Marshal Shannon Desoto TX • • Technical Prospects Jeremy Probst Appleton WI • • ElsMed Ltd & Relaxation Inc Ronen Bechor Petak Tikva • • INGENIERIA CLINICA Carlos Duran Bogota GOT TUBES?

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74 HealthCareBusiness news I october 2015 www.dotmed.com Industry Sector Report: X-ray Tubes

DOTmed DOTmed asked the leading X-ray tube manufacturers to submit up to four of their current NEW products to be featured in this new equipment guide. EQUIPMENT To learn more about these tubes and see other models not shown, please visit the GUIDE Equipment Guide in DOTmed’s Virtural Trade Show, or go to: www.dotmed.com/x-raytube. X-RAY TUBES We also invite you to rate these products online.

COMING SOON! Philips Healthcare / Philips iMRC Dunlee / DA 200 P40 CT • X-ray tube anode: iMRC with Replacement Tube segmented anode The DA 200 P40 is a 6.3 MHU CT • Heat storage, MHU: 30 effective tube designed as a replacement • Heat dissipation rate, kHU/mm: for use in GE Optima CT660* 1,608 2016 1st Quarter System. *Product listed may be • Tube cooling: Direct trademarked by the referenced • Tube focal spots, mm: Editorial Calendar OEM. Large: 1.1 x 1.2 Small: 0.6 x 0.7 • Maximum generator power: 120kW JANUARY/FEBRUARY Dunlee / Reevo 240G CT • Max mA for small focal spot @ fastest rotation: 800 Replacement Tube DOUBLE ISSUE — • Max scan time at max mA, sec: 4 The Reevo 240G™ is a 8.0 HEALTHCARE IT / HIMSS PACS/RIS/HIS MHU CT tube designed as Varian / MCS 6074 a replacement for use in GE Replacement CT Tube EMR/EHR LightSpeed* VCT, LightSpeed* The MCS-6074 GE Performix® IT integration VCT Select, LightSpeed* RT16, Replacement Tube now has a 12 FEATURES LightSpeed* Xtra, LightSpeed* month full replacement warranty. • Cyber Security, Virus Threats Pro 16, and Discovery VCT systems. *All products listed The MCS-6074 CT tube is compatible • ‘Bring-Your-Own-Device’ Roundup may be trademarked by the referenced OEM. with many GE CT scanner models • RTLS/RFID ® ® including: LightSpeed 16 , LightSpeed Ultra , LightSpeed • Medical World Americas Preview Dunlee / DA 200 CT ® ® ® ® Plus , LightSpeed QXi , LightSpeed RT , Discovery LS , • Viewpoints: Health IT Replacement Tube ® ® ® Discovery ST , Discovery STE , Discovery RX and the • RSNA Wrap-up The DA 200 is a 6.3 MHU CT tube BrightSpeed® series. The MCS 6074 calibrates like the • HIMSS Leadership Q&A designed as a replacement for use original, has long life bearings with 0.5 second full scans. in GE LightSpeed* 16, LightSpeed* • HIMSS Exhibitor Guide & Product Ultra, LightSpeed* Plus, LightSpeed* Varian / Cardinal CT Tube Showcase QX/i, LightSpeed* RT, Discovery LS/ The Varian Cardinal CT housing • HIMSS Show Preview ST/STE/RX, Discovery CT600, CT670, is a direct replacement for the • ECR Leadership Q&A HiSpeed* QX/i, HiSpeed CT/i, HiSpeed NX/i Pro, HiSpeed Stargate/CTR-2150 tube used in Philips BONUS DISTRIBUTION: HIMSS; ECR ZX/i, and LightSpeed* QX/i systems. *All products listed Brilliance 6® and 16 CT scanners. may be trademarked by the referenced OEM. The Cardinal has a high heat capacity with excellent image quality and MARCH — C-ARM / Philips Healthcare / Philips throughput allowing for quicker imaging which translates into INTERVENTIONAL ISSUE MRC cost savings to the medical facilities. C-arms extend their reach • X-ray tube anode: MRC with Special Procedure/Cath-Angio & Injectors segmented anode Varian / B-121 Mammography FEATURES • Heat storage, MHU: 26 effective Housing • DOTmed 100 • Heat dissipation rate, kHU/mm: The B-121 is an air cooled • Contrast Agents 1,608 mammography housing that fits a • Cardiology Special Report • Tube cooling: Direct standard three inch X-ray tube insert. • ACC Leadership Q&A • Tube focal spots, mm: It is meant for digital and tomography Large: 1.0 x 1.0 Small: 0.5 x 1.0 applications. The housing has two BONUS DISTRIBUTION: HCP-OR; HCP- • Maximum generator power: 60kW shroud configurations; with and without quiet D/C fans. Materials Management • Max mA for small focal spot @ fastest rotation: 500 The B-121 offers 300 watts of continuous heat dissipation • Max scan time at max mA, sec: 26 with fans, which is approximately 200% greater than APRIL — OPERATING standard mammography housings. Philips Healthcare / Philips ROOM ISSUE MRC Ice Varian / LEO Radiographic Inside today’s high-tech OR Suite • X-ray tube anode: MRC Ice with Housing Endoscopy; Sterilizers; Hospital Beds segmented anode Varian’s new LEO radiographic FEATURES • Heat storage, MHU: 30 effective housing is designed for 3” rotating • Infection Control/Concerns for Hospitals • Heat dissipation rate, kHU/mm: anode inserts. Varian’s innovative • Focused Ultrasound 1,608 technology allows customers to take • NAPT Leadership Q&A and Proton • Tube cooling: Direct full advantage of high heat load, high throughput and quiet Therapy Update • Tube focal spots, mm: operation. The Leo comes in one standard configuration • SGNA Leadership Q&A Large: 1.0 x 1.0 Small: 0.5 x 1.0 which allows for a significant cost reduction and will be able BONUS DISTRIBUTION: SGNA; NAPT; • Maximum generator power: 80kW to compete in the price sensitive radiographic tube market. • Max mA for small focal spot @ fastest rotation: 667 IDN Summit Spring; HCP-IT; HCP- • Max scan time at max mA, sec: 4 Radiology

HealthCareBusiness news I october 2015 75 Industry Sector Report: Proton Therapy

In those days, Rossi says the systems were Dr Carl Rossi in a not advanced enough to treat common can- treatment room cers. Instead, X-ray therapy represented the at Scripps Proton best clinical option for most patients. Therapy Center Today, improved delivery techniques like pencil beam scanning have replaced the old methods, and what were once uniformly behemoth systems with costs exceeding a hundred million dollars, are now a more versatile range of systems, with price tags that are — in some cases — only tens of millions. That evolution has paved the way for companies like IBA and Mevion Medical Systems to offer single room proton solutions (ProteusONE and MevionS250, respectively) to hospitals that could never have provided the treatment a few short years ago. The comparatively compact design means providing care to a lower vol- Proton therapy goes ume of patients at a fraction of the price. Single gantry systems are becoming more typical in the U.S. and industry insiders mainstream credit that to the country’s relatively mature proton therapy market. By Gus Iversen With so many facilities already operat- If you live in the UK, the name Ashya Meanwhile, Ion Beam Applications (IBA) ing, emerging U.S. proton centers do not King probably rings a bell. Last Septem- has also signed three binding term sheets anticipate the clinical demand to necessitate ber, the 5-year-old boy was taken to Prague with Proton Partners International (PPI) to in- multiple rooms. This is not the case in most against the wishes of the UK’s National stall its ProteusONE compact solution in New- countries, however, where a multi-room fa- Health Services (NHS) for proton therapy port, Newcastle, and a third location that has cility — and its superior capacity — is still the treatment on a brain tumor. not been announced. Those single-room more logical investment. When the child disappeared from the systems will meet the lower volume needs In late April, the Ackerman Cancer Cen- Southampton General Hospital where he of private physicians hoping to provide their ter in Jacksonville, Florida, became the first was under care, his parents were suspected patients with state-of-the-art cancer care. privately owned proton therapy center in the of negligence and an international manhunt Ashya King’s story is one of a kind, but world. The center’s MevionS250 was only the ensued. After turning up in Madrid, Ashya’s the rapid investment in proton therapy is second to become operational. Since then parents were briefly imprisoned. As for their hardly unique to the UK. two more units have been installed in the child, he completed his renegade tumor treat- U.S. and another three are in the pipeline. ment in Prague and is reportedly cancer free. A booming install base “After only three months of operation, we That highly publicized bit of drama Proton centers are popping up around the are now running at a rate of 350 patients per brought proton therapy to the front page world — particularly in the U.S. where the year in Jacksonville,” says Joe Jachinowski, and perhaps underscored the absence of a treatment is more accessible than anywhere CEO of Mevion, “That exceeds the treatment vital treatment option to pediatric patients else on the planet. Despite that, there is still rate, to the best of our knowledge, on a per in the UK — a demand currently being ad- a “severe shortage of facilities,” according room basis, of any place in the world today.” dressed on multiple fronts. to Dr. Carl Rossi, medical director of the IBA installed its first ProteusPLUS in In July, Varian Medical Systems an- Scripps Proton Therapy Center in San Diego. 2001, at Massachusetts General Hospital, nounced contracts with the NHS to bring Rossi’s proton therapy career goes back and since built up the largest install base in their multi-room ProBeam proton therapy to 1990, when he was performing treat- the industry. The ProteusPLUS is in use at system to two locations. One at UCLH (Uni- ment at Loma Linda University Medical Cen- 19 locations throughout the world. IBA’s versity College London Hospitals NHS Foun- ter — the first hospital-based proton facil- single-room solution, ProteusONE, features dation Trust) in London, and the other at the ity in the country. Needless to say, a lot has integrated cone beam CT and is treating pa- Christie NHS Foundation Trust in Manchester. changed since then. tients in Shreveport, Louisiana, at the Willis-

76 HealthCareBusiness news I october 2015 www.dotmed.com

Industry Sector Report: Proton Therapy

Knighton Health System. precise numbers are hard to find, but China proton therapy for nearly a decade. “Over 12 months we put almost 20 is home to approximately 22 percent of the But not everyone is convinced that the ben- rooms into clinical use,” says Olivier new cancer cases in the world, and 27 per- efits justify the cost. Amitab Chandra, a pro- Legrain, CEO of IBA, adding that the com- cent of the world’s cancer deaths, according fessor at Harvard University’s Kennedy School pany has sold 36 systems in total. His com- to the World Health Organization. of Government and Harvard Business School, pany reported an increase of order-intake “There is big momentum in China to says the increasing investment in proton ther- of 86 percent from the first half of 2014 in move toward protons, they plan everything apy is financially irresponsible and an indication comparison to the first half of 2015. centrally and it looks like they are on the that real health reform is a long way off. Hitachi is also heavily engaged in the pro- move, so we see a lot of potential there,” Chandra readily acknowledges the im- ton therapy market, with the majority of its says Legrain. IBA is contracting to build a portance of proton therapy for head and systems installed in Japan. The MD Ander- three-room facility in Guangzhou and an- neck tumors (and pediatric patients like son Proton Therapy Center in Texas uses a other in Hebei which, with five treatment Ashya King), but points to the frequent use Hitachi system and the company will also rooms, will likely be one of the largest facili- of proton to treat prostate cancer as an ex- soon have two systems operating for the ties on the planet when it opens next year. ample of reckless spending where the evi- Mayo Clinic, and another at St. Jude Chil- Mevion recently announced the formation dence has yet to illustrate the benefits. dren’s Research Hospital in Memphis. of a joint venture with Chinese investors to set “We are covering a technology that’s Varian, perhaps the major manufacturer up marketing, sales, service, and manufactur- extraordinarily expensive in an immensely with the fewest facilities in operation, has what ing operations in China. It also received an lucrative manner without any evidence that Mitch Latinkic, the company’s vice president equity investment worth up to $200 million to it works,” says Chandra. He says case studies of marketing, calls “the most advanced install help it create greater access to the treatment. have not been conducted to illustrate the base anywhere in the proton therapy field.” Its Jachinowski says there are currently two benefits of treating prostate cancer because, ProBeam is new enough that it was designed proton therapy centers in China. “One is “it would basically turn off the lights” — specifically for pencil beam scanning. treating in Shanghai, but only a low num- meaning the business model would collapse. Like IBA, Varian also offers cone beam ber of patients.” That facility was built by A 20-year study from Johns Hopkins re- CT for treatment imaging, something the Siemens before it stopped building proton cently concluded that for very unaggressive company initially offered on its linear accel- centers, the other is a two-room ProteusP- prostate cancers, the best treatment is to erator, TruBeam. LUS facility located in Zibo. simply monitor the disease. The findings, The multi-room ProBeam is treating pa- “You have the Chinese market and gov- published in the Journal of Clinical Oncology, tients at Scripps Proton Therapy Center in San ernment involvement and participation, revealed that only two out of 1,298 study Diego with Rossi’s team and also at the Rineck- then you start to look at a large population participants actually died of the cancer. er Proton Therapy Center in Munich, Germany. base — their small cities are what we in the Even with the reduction of side effects, According to Latinkic, Varian currently has U.S. consider our largest cities,” says Latin- treating very unaggressive prostate cancer 13 other confirmed contracts in some stage kic, who describes the Chinese market as with proton therapy may do more damage of development. Those include a facility in “erupting” and says Varian is mindful of Chi- than not treating it at all. It would also create Maryland that is expected to start treating pa- na’s demand for greater access to treatment. unnecessary spending. tients by the end of the year, another at the Prostate cancer is extremely common, Emory Proton Therapy Center in Georgia is Proton for prostate: with over 3 million cases diagnosed in the currently under construction, and the recently gold standard or cash cow? U.S. every year, according to the Mayo Clinic. announced New York Proton Center which Researchers have been experimenting with For the cases that do require radiation ther- has just broken ground in upper Manhattan. protons as a form of radiation therapy since apy, protons are either a new gold standard The U.S. will be home to 29 proton thera- the 1950s, so it’s nothing new. The rapid in care or a cash cow — or perhaps both. py centers by 2020, according to a report by growth of proton therapy may be credited For Frank, it’s a complex problem with RNCOS, a business consulting service firm, to the accumulation of evidence and the ma- converging interests. “The emotions run high entitled “U.S. Proton Therapy Market Outlook turing of the technology. from patients that are diagnosed with prostate 2020.” It projects the market will attain reve- “Radiation is a very effective tool to cure cancer who want access to proton therapy and nue of around $1.22 billion by 2020, growing cancer, but we also know radiation has sig- the physicians that are trying to provide it for at a compound annual growth rate (CAGR) of nificant side effects to normal tissue – the them, health care policy makers that are trying 11.4 percent between 2014 and 2020. elimination of unnecessary radiation is criti- to control and reduce costs, insurance compa- As U.S. market saturation increases the cal to patient care,” says Dr. Steven Frank, nies that are trying to increase profitability, and viability of single room proton solutions, medical director at the MD Anderson Pro- hospitals, urologists and radiation oncologists larger capital investments are being seen in ton Therapy Center. He and his colleagues that lack access to proton therapy and may countries with less access to treatment. The in Texas have been treating patients with ‘lose’ their patients financially,” he says.

78 HealthCareBusiness news I october 2015 www.dotmed.com Proton Therapy in your community?

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With *, you bring proton therapy to your local community and enhance your cancer patients’ lives. * is the only single-room IMPT solution integrating Pencil Beam Scanning (PBS) and 3D Cone Beam Computed Tomography (3D CBCT) * is the compact and affordable IMPT* solution from IBA. The most advanced Proton Therapy solution, available for your clinic.

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*Proteus®ONE is the brand name of a configuration of the Proteus 235. Industry Sector Report: Proton Therapy

Rossi, at the Scripps Proton Therapy Center, estimates there are ap- If advocates of proton therapy for prostate cancer are correct, the proximately 3,000 intensity modulated radiation therapy (IMRT) facili- benefits simply need time to illustrate themselves. In the meanwhile, ties in the U.S. versus 18 proton facilities. “If we get to the point where research from the University of Florida Proton Therapy Institute, pub- the cost is similar, there will be a severe lack of resources,” he says. lished in the International Journal of Radiation Oncology Biology “We already know that protons are better,” adds Rossi. “That’s Physics, found that 99 percent of patients treated for prostate cancer been proven six ways to Sunday.” For him, the only mystery remain- were experiencing “excellent” quality of life five years after treatment. ing is how much better. “These proton therapy results compare very favorably with IMRT Chandra characterizes prostate cancer as the main reason results, particularly for intermediate risk-disease, where disease control proton therapy is a big business, and while physicians using the rates of 70 percent to 85 percent are typical,” said Dr. Nancy P. Men- technology may not entirely disagree with him (both Scripps and denhall, lead author and medical director of the UF Proton Therapy MD Anderson treat far more prostate cancer than any other indi- Institute, in a statement accompanying the study’s publication. cation), their goal of radiating as little healthy tissue as possible includes all tumor sites. Demonstrating value to payors “With prostate cancer, protons allow me to treat less of the blad- As with computers and cell phones, the proliferation of proton ther- der, less of the rectum, and a lot less of the small intestine,” says apy is expected to continue reducing its costs. If prostate treatment Rossi, adding that with an aging population, physicians must be is still a point of some controversy, cost benefits for other tumor loca- more cognizant than ever about the risk of delayed injury or side tions are coming increasingly into focus. effects, which can be very costly in their own right. For treating esophageal cancer, new research out of MD Anderson “Proof-of-concept studies are showing that toxicity’s dose effects outlines the economic value of reducing side effects. It found that when have a cost that is not always measured in the amount of reimburse- treating with proton therapy only 20 percent of patients required a feed- ment that comes from delivery. We need to look at the episodic cost ing tube, versus 65 percent with IMRT. The direct cost of using a feeding of care through time-driven activity-based costing methods (TDABC) tube for over a year was estimated to be $31,000 per patient, in 2001. instead of just the reimbursement of treatment,” says Frank. Assuming the cost of those tubes has not changed since then, almost $1.4 million could be saved for every 100 esophageal cancer patients, from feeding tube expenses avoided with proton therapy. For Frank, those kinds of statistics are essential to helping people BARD, RAO + ATHANAS CONSULTING ENGINEERS realize the full potential of superior care. “As the novel approaches

Innovation | Experience | Proven Success and technologies are proven to be safe and effective, competition in advanced technology such as proton therapy will generate a smaller footprint, become less expensive to manufacture and provide greater access to benefit the larger population,” he says. Last year the American Society of Radiation Oncology (ASTRO) issued a model insurance policy to help insurance companies figure out which cancer diagnoses meet evidence-based standards for proton treatment and warrant coverage. For prostate, ASTRO supports insuring patients treated in clinical trials or within prospective registries, so their outcomes can help establish the body of evidence. BR+A is the Global Engineering Leader in the design of Proton While Medicare covers proton therapy for most indications, it has Therapy Facilities. Our success stems from a talented Core Team of Engineers who have been working together on proton projects for the sometimes been a battle with private insurers. “Over the last two past 16 years. Our familiarity with how to deliver these highly complex years, several of the large commercial insurers have stopped covering facilities, combined with an in-depth knowledge of the technical prostate cancer because they feel they can get the same outcome in requirements of the proton operating system, uniquely positions terms of ‘cure’ without having to pay as much,” says Rossi. our firm as Engineering Leaders in the design and delivery of these One example of this was when a patient in Texas with aggressive extremely specialized facilities. prostate cancer, complicated by insulin-dependent Type 2 diabetes, PROTON THERAPY LOCATIONS was refused coverage from Aetna despite doctor’s recommenda- Atlanta, GA Germany Muscat, Oman San Diego, CA Boca Raton, FL Hong Kong, China New York, NY Seattle, WA tions. The ordeal went to court and the insurance company was Boston, MA Houston, TX Oklahoma City, OK Somerset, NJ Cincinnati, OH Irving, TX Oxford, England Syracuse, NY recently made to cover the treatment. Cleveland, OH Jacksonville, FL Philadelphia, PA Warrenville, IL Dallas, TX London, England Doha, Qatar Washington, DC The patient’s lawyer, Robert C. Hilliard, issued a statement after Flint, MI Miami, FL Royal Oak, MI the ruling. “This is not some unknown experimental treatment. It works. And my client should be given the opportunity to have the www.brplusa.com treatment to save his life.” That sentiment, echoed by the parents of BOSTON | NEW YORK | PHILADELPHIA | WASHINGTON, DC | MIAMI | ST. LOUIS | CHICAGO Ashya King, perhaps best explains the rapid growth of proton therapy. Share this story: dotmed.com/news/27117

80 HealthCareBusiness news I october 2015 www.dotmed.com Industry Sector Report: Proton Therapy DOTmed NEW DOTmed asked the leading proton therapy manufacturers to submit their leading products EQUIPMENT to be featured in this new equipment guide. To learn more about these systems and see GUIDE other models not shown, please visit the Equipment Guide in DOTmed’s Virtual Trade Show, PROTON or go to www.dotmed.com/proton. We also invite you to rate these products online. THERAPY

Hitachi / PROBEAT Optivus Proton Therapy / PROTON THERAPY CENTER ™ Conforma 3000 The Hitachi PROBEAT System DESIGN AND CONSTRUCTION is a proven industry leading Designed with more than two Proton Therapy System, first decades of experience, the FDA-cleared Conforma 3000 BR+A Headquarters: in FDA-cleared IMPT Spot Boston, MA Scanning. IGRT choices include offers sixth-generation technology. The Conforma 3000 features an BR+A Consulting Engineers are CT-on-Rails, C-arm CBCT the Global Engineering Leaders in the design of Proton and gantry-mounted CBCT. electronically variable energy synchrotron accelerator, intensity modulated proton Therapy Facilities. Our success stems from a talented Hitachi’s commitment to Proton Therapy continues with Core Team of Engineers who have been working essential innovations, such as real-time target tracking and therapy (IMPT), image guided proton therapy (IGPT), modular architecture and flexible configuration options together on proton projects for the past 16 years. Our gating. Prestigious medical centers have chosen Hitachi familiarity with how to deliver these highly complex ™ with a focus on throughput, reliability and safety. PROBEAT due to high reliability and efficient work- facilities, combined with an in-depth knowledge of the flow supporting features, such as fully automated beam ProTom / Radiance 330® technical requirements of the proton operating system, switching between treatment rooms and beam matching in Scanning proton beam with uniquely positions our firm as Engineering Leaders in multi-room centers. 3mm diameter at 250MeV in the design and delivery of these extremely specialized air at isocenter. 16’ diameter facilities. IBA / Proteus®PLUS synchrotron with advanced Proteus®PLUS is inspired by beam control produces energies Haskell Architects clinical excellence. Its versatility Headquarters: Melbourne, of 70-250MeV for therapy, powers your institution to rise Australia and up to 330MeV for proton imaging. Enables to the challenges of treating From feasibility studies to patient economically viable projects due to lower construction complex cancer conditions. You treatment, Haskell is the only experienced company that costs and lower operating costs; the system requires up can configure its cutting-edge can deliver a complete solution for your proton therapy to 40% less radiation shielding and operates with up to features into a tailored solution facility’s needs. With in-house real estate, architecture 55% greater power efficiency. that meets the specificities of your practice. Clinically, design, engineering, and construction management staff, we integrate our innovative and thoughtful expertise to you will leverage its IMPT and IGPT capabilities while Sumitomo / 230MeV expanding your research potential to advance cancer Proton Therapy System craft the optimal solution for your project. Our proton care. Its optimized workflow will allow you to maximize Sumitomo Heavy Industries, projects include design and construction of Scripps Proton the use of the system to bring proton therapy to the Ltd. provides a 230MeV cyclotron- Therapy Center in San Diego and Maryland Proton largest number of patients possible. With Proteus®PLUS, based proton therapy system. Its Treatment Center in Baltimore.cobalt-60 sources. It you can add proton therapy to your cancer program and gantry has a compact design with utilizes the Explorer 4D treatment planning system with its create a center of excellence in radiation therapy that will 360° rotation. Both broad beam and OsiriX medical image viewing system. Cost effective RGS enhance your cancer patients’ lives. pencil beam are available. Robotic technology has successfully treated over 6,000 patients. bed and imaging system enables Tsoi/Kobus & Associates IBA / Proteus®ONE* precise patient positioning. CT Headquarters: ® Proteus ONE is the compact (in-room CT and/or CBCT) and online PET system are Cambridge, MA intensity-modulated proton optional. Now in its 30th year, Cambridge- therapy (IMPT) solution from based Tsoi/Kobus & Associates is one of the nation’s IBA. It benefits from the latest Varian / ProBeam® leading architecture, planning, and interior design firms technologies developed with Proton Therapy System for science and technology, college and university, health renowned clinical institutions. Varian’s ProBeam® system is care and commercial real estate projects. We are known Proteus®ONE is smaller, more affordable, easier to at the forefront of the industry, for creating environments that advance the discovery install and to operate. It is ultimately easier to finance. having created the world’s first of new knowledge and for award-winning designs that Proteus®ONE makes the most advanced radiation therapy commercially available multi-room combine cutting-edge technology with compassion and modality available to your institution and your patients. pencil beam scanning system that creativity. TK&A has designed seven operational proton With Proteus®ONE, proton therapy is made easy. enables intensity-modulated proton therapy (IMPT) therapy centers, with five more in development. *Proteus®ONE is the brand name of a new configuration for treating complex tumor shapes or tumors wrapped of the Proteus® 235, including the recently FDA-cleared around critical structures like the spinal cord or brain VOA Headquarters: Chicago, IL Compact Gantry, and is ready for marketing stem. Varian’s ProBeam® combines imaging, treatment planning and state-of-the art proton delivery in a fully VOA is a recognized world leader Mevion / MEVION S250 integrated solution. in the design of proton beam Mevion’s flagship product, the therapy centers. Our design philosophy focuses on MEVION S250 Proton Therapy Varian / ProBeam® Compact creating comfortable and effective healing environments System, is designed to preserve Varian’s ProBeam® Compact for the patient while responding to the unique attributes all of the treatment benefits of single-room configuration of each individual client’s vision and specific needs. As traditional proton therapy systems incorporates the complete functionality one of only three firms to design and build an operational while removing the obstacles and features of its “bigger brother.” It proton therapy center in the United States, VOA is of size, cost, and complexity. includes full 360° Dynamic Peak™ uniquely positioned in this highly specialized project type. Realizing this vision, Mevion has forever changed the Scanning, Dynamic Peak Imaging & economics and accessibility of proton therapy worldwide. Workflow, and full system integration all in a smaller footprint. ProBeam Compact – IMPT without compromise.

HealthCareBusiness news I october 2015 81 Medical Museum: Medical Chest

Each month, we visit Dr. Blaufox’s Museum of Historical Medical Artifacts to take a look back at the medical equipment that cleared the way for what patients encounter in doctors’ offices and operating rooms of today. Some equipment may be recognizable, while other featured inventions have since become obsolete or have had their usefulness discredited.

The picture and description appear courtesy of Dr. M. Donald Blaufox, M.D., Ph.D, from his Web site: www.mohma.org.

Category: Medicine Chest Estimated Date: 1850 Manufacturer: D. Stewart

Description: Measuring 9.5” x 10.5” x 7”, this mahogany cabinet opens to reveal drawers and shelves. The poison cabinet in the rear contains four pontiled bottles. Stewart label on the cover has been pasted over original manufacturer’s (possibly English). The four original pontiled bottles are in the main cabinet. Five of 12 bottles are held in the shelves in the doors. Three are original, with handwritten labels that read “C. Winslow, M.D. Pharmacist.” The two drawers contain replacement weights and scales. A letter of Winslow’s life, obtained from his granddaughter, is in the chest. She discovered that I owned the chest when I sent a letter to her granddaughter, who worked at the Maryland Historical Society, inquiring about Dr. Winslow. His son was a doctor as well. According to her note, Caleb Winslow received his M.D. from the University of Pennsylvania in 1849. He graduated Haverford College in 1842, which was previously the Philadelphia College of Pharmacy (thus his designation as pharmacist). He practiced in North Carolina from 1849 to 1870, then he moved to Baltimore. He took over the practice of his deceased brother Dr. John Randolph Winslow. He was blocked from going into surgery by “colleagues” and practiced general medicine and obstetrics. He retired in 1890 and died in Baltimore in June of 1895. He is said to have operated on 100 cases of bladder stone with only one death prior to coming to Baltimore. He also served as an examiner in surgery on the original board of medical examiners of North Carolina. His biography (slightly different from his granddaughter’s version) can be found in Cordell, E.F. The Medical Annals of Maryland 1903.

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82 HealthCareBusiness news I october 2015 www.dotmed.com This Month in Medical History The father of emergency medicine and Lyndon Johnson

When ex-President Lyndon Johnson survived a heart attack He took a position at the Royal Victoria Hospital, where he set in 1972, it was thanks to a portable defibrillator that was up a cardiology unit. At the time, defibrillators only existed within invented by Dr. James Francis Pantridge only a decade or so hospitals, weighed about 150 pounds, and required an electrical earlier. Known as the “father of emergency medicine,” Pantridge power source to work. Pantridge learned that the chances of survival revolutionized heart attack treatment by enabling providers to bring from a heart attack decrease by 10 percent for every minute a victim a critical intervention directly to the patients. spends without treatment. In fact, most victims died before they Pantridge was born in the United Kingdom on Oct. 3, 1916. He reached the hospital. earned his medical degree from Queen’s University, Belfast. His grad- Pantridge decided to develop a portable defibrillator that would uation in 1939 coincided with the bring the life-saving intervention to start of World War II, and Pantridge the heart attack victim. Using a min- soon joined the Royal Army Medical iature piece of technology developed Corps. by NASA, he put together a defibril- He was sent to Singapore Island, lator that only weighed 5 pounds a strategic British outpost in the Far and operated on battery power. To- East. Japan’s attack on his base in Feb- gether with his colleagues, he also ruary of 1942 is considered to be one later added a safety feature to ensure of the worst defeats in British military that non-medical personnel appropri- history. Despite the brutality of the ately used the device. The upgraded battle, Pantridge earned a Military defibrillator only worked when it de- Cross, a medal commending him for tected a ventricular fibrillation. working tirelessly in adverse condi- Pantridge advocated for defibrilla- tions and prioritizing the safety of his tors to be as ubiquitous as fire extin- countrymen over his own. guishers, but it took decades for the Pantridge was taken prisoner device to even become a standard by the Japanese. Since Japan didn’t part of an ambulance in the United honor prisoner of war status, Pan- Kingdom. (It was adopted much fast- tridge, along with 7,000 other British er in other parts of the world.) When captives, was forced into slave labor. He marched nearly 200 miles the first Mobile Intensive Care Unit was finally created in England, it through the jungle and worked long hours on building the Siam- was named the “Pantridge Plan.” Burma Railway. Pantridge received numerous accolades and honors for his inven- Pantridge also spent two months at a notorious death camp. tion. He was appointed a Fellow of the Royal College of Physicians When he was freed, he did not only leave the camp suffering from in 1957 and served as the chairman of the British Cardiac Society. extreme malnutrition, but also with a new interest in cardiology. Although a brilliant clinician and inventor, Pantridge had a personal- While imprisoned, he suffered from a cardiac condition that is almost ity that some people found off-putting and abrasive. One university always fatal — his heart swelled to three times its normal size. But colleague remarked that his “clicked fingers acted as punctuation Pantridge survived and in 1945, returned to Belfast. and the stiff index finger directed the verbal missile.” Upon his return, he found a job as a part-time pathology lecturer, Pantridge battled a long illness before he died on Dec. 26, 2004, but was soon awarded a scholarship to study at the University of at the age of 88. In addition to his academic publications, Pantridge Michigan alongside Dr. Frank Norman Wilson, a world-renowned published an autobiography, which he appropriately titled, An Un- electrocardiology expert. Pantridge learned enough from Wilson to quiet Life. return to Belfast in 1949 as the leading cardiology authority of the Share this story: dotmed.com/news/27118 United Kingdom.

HealthCareBusiness news I october 2015 83

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HealthCareBusiness news I october 2015 85 SCHOTT offers ROHS Compliant Monolithic Faceplates As the demands for digital imaging applications require faster speeds and higher dosage levels, SCHOTT has developed its Large Format Fiber Optic Faceplate as the protective x-ray barrier for CMOS/CCD detectors. With sizes up to 430 x 430mm, SCHOTT’s 47ARH, and new RFG-92A glasses provide excellent x-ray absorption and contrast, while transmitting high resolution images to the detector.

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HealthCareBusiness news I october 2015 87 The Future of Health Care The past reveals CT’s future

By Murat Gungor

For the past decade, innovations in com- early lung cancer detection is creating new many clinical advantages, particularly in ab- puted tomography (CT) favored high- opportunities for CT. By increasing access dominal imaging, where diagnosing liver end technologies. As utilization of CT to CT scanning, a high-risk population of lesions can be difficult. With DE, only one services grew, the medical field demanded individuals could benefit from increased vigi- study is performed, but a wealth of infor- solutions that could answer new questions lance. What stymies many early detection ef- mation can be generated. For example, a with greater image clarity and much less forts, however, is the inability of the medical virtual unenhanced data set (simulating a radiation. For a time, you could seemingly community to persuade reluctant patients non-contrast study) can be acquired, and plot the trajectory of new CT technology on to come in for evaluations. As hospitals and iodine maps can be overlaid onto the image a steadily increasing slope: more slices and health systems consider how to approach to look at the enhancement patterns. Re- more cost. the health and well-being of their popula- sponding to growing interest in DE, Siemens That changed, however, with the Afford- tions going forward, the ability to deliver now makes DE available not only at the high able Care Act in 2009 and the Protecting early detection outside of hospital walls will end of our portfolio but also on many of our Access to Medicare Act of 2014. Providers become increasingly important. Last year, new CT scanners, including 16-slice systems. began looking for ways to bring care closer Siemens introduced a 16-slice CT system — As health care facilities look to their fleets to the patient while replacing outdated CT the SOMATOM Scope — that is so small it of CT scanners, they must expand their focus technology. Demand began to build for CT can be sited on a mobile vehicle the size of a beyond today’s needs to identify solutions in relatively low-volume or routine-imaging common RV. Since this type of vehicle does that will deliver the clinical functionalities settings. Anticipating these changes, Sie- not require a commercial driver’s license, we and ease of access that future patients and mens released not one but two new 16-slice can reduce the complexity of bringing CT physicians will demand. Sometimes, they CT systems in 2014 — a move that may have imaging to a broader population. This type may even find that the best solutions take prompted some CT luminaries to check their of out-of-the-box thinking may become in- their cue from new approaches to previously calendars for reassurances that they weren’t creasingly attractive for health care facilities. introduced innovations. But by expanding living in 2002. But for years, we observed Undoubtedly, another hot trend in CT their focus, they won’t find themselves re- steady market activity at 16 slices, and based has been dual-energy (DE) acquisition. While gretting the purchasing decisions they’ve on these new developments, we also could DE, like the 16-slice scanner, isn’t new — made five years hence. Instead, they’ll ra- anticipate increased interest in 16-slice CT Siemens pioneered the DE concept in 2005 diate a professional confidence that stems scanners that could address concerns involv- with our dual-source CT systems — wider from knowing that they chose the best value ing patient proximity to care. adoption of DE has been historically ham- at the time — with the right capabilities to With broader population health initia- pered by lack of availability (in many cases, ensure years of valuable clinical use. tives, CT imaging is establishing a role in this was limited to high-end scanners only) Murat Gungor is Vice President, CT Business a more diverse array of clinical settings — and issues pertaining to a cumbersome Line, Siemens Healthcare most significantly, the intensified interest in workflow. That’s unfortunate, as DE has Share this story: dotmed.com/news/27119

88 HealthCareBusiness news I october 2015 www.dotmed.com

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

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.

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The GE Performix trademark is owned by General Electric Company.

Built to last - MCS-6074.indd 1 8/11/2015 11:53:25 AM