ICE Magazine October 2020 by MD Publishing

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OCTOBER 2020 | VOLUME 4 | ISSUE 10

ADVANCING MAGAZINE

IMAGING PROFESSIONALS

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mammography PAGE 25

Freestanding Tall Ambulatory clinics in post-pandemic America PAGE 28

in focus

kara mayeaux PAGE 12 Address Service Requested MD Publishing 1015 Tyrone Road, Ste. 120, Tyrone, GA 30290

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COVER STORY: FREESTANDING TALL: AMBULATORY CLINICS IN POST-PANDEMIC AMERICA

DIRECTOR'S CUT IN FOCUS

Banner Imaging Senior Director of Operations Kara Mayeaux's desire to serve in the diagnostic imaging field is just one example of how she transforms challenges into positives.

There are some strategies that I am employing to grow when it comes to delegation and they have been yielding great results.

No single factor will have exerted greater pressure on medical imaging in 2020 than the novel coronavirus (COVID-19) pandemic. From March to June, health care facilities across the United States were shuttered to all non-essential procedures by state order, as the country worked, with mixed results, to respond to the rapidly spreading virus.

RISING STAR

Lisa Nagel is very knowledgeable and is an honest, strong leader who builds trust easily.

ICEMAGAZINE | OCTOBER 2020

ADVANCING THE IMAGING PROFESSIONAL

OCTOBER 2020

IMAGING NEWS

Check some of the latest industry news regarding new devices and the latest technology.

RAD HR

25 WWW.THEICECOMMUNITY.COM

Teams need their leader as they continue to navigate their world amidst COVID-19 and their personal and systemic experience of racism in the United States

PRODUCT FOCUS

The global mammography systems market is projected to surpass $3.5 billion by 2025, according to a research report by Global Market Insights Inc.

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MD Publishing 1015 Tyrone Rd. Ste. 120 Tyrone, GA 30290 Phone: 800-906-3373 Fax: 770-632-9090

CONTENTS SPOTLIGHT 10

Rising Star Lisa Nagel, Mercy Health St. Rita’s Women’s Wellness Center

In Focus Kara Mayeaux, CRA, Banner Imaging

John M. Krieg john@mdpublishing.com

Rad Idea Employee Engagement

Vice President

Off the Clock Amy Peronace, Banner Imaging

Editorial

NEWS

Publisher

Kristin Leavoy kristin@mdpublishing.com

John Wallace Erin Register

Art Department

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

Jonathan Riley Karlee Gower Amanda Purser

PRODUCTS

Account Executives

Jayme McKelvey Megan Cabot

Editorial Board

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

Circulation

Lisa Lisle Jennifer Godwin

Market Report Report: Mammography Systems Market to Reach $3.5 Billion

Product Focus Women's Imaging

INSIGHTS 32

Coding/Billing AUC Pivot

Director's Cut Delegate

Banner Imaging Continuum of Care

Cindy Galindo Kennedy Krieg

Department/Operational Issues Changing Our Narrative

Accounting

Rad HR Lean In – Create the Space for Those You Lead to be Human

Digital Department

Diane Costea

42 ICE Magazine (Vol. 4, Issue #10) October 2020 is published by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to ICE Magazine at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www.theicecommunity.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2020

ICEMAGAZINE | OCTOBER 2020

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SPOTLIGHT

RISING BY ERIN REGISTER

STAR

isa Nagel, 36, grew up in the small rural town of Botkins, Ohio, with a population of around 1,154 people. She graduated high school with approximately 52 classmates in 2002 and attended Owens Community College in Perrysburg, Ohio, a suburb of Toledo, Ohio, from 2002-2005. There, Nagel earned an associate degree in applied science with a major in radiography. She graduated first in her class, Summa Cum Laude. Currently, Nagel is a supervisor at Mercy Health St. Rita’s Women’s Wellness Center in Lima, Ohio. Mercy Health Regional Director of Medical Imaging Sandy Michalski nominated Nagel as a Rising Star. “Lisa showed great potential as she walked into a new role at a very busy women’s imaging center and hit the ground running,” Michlalski stated. “She has immense knowledge of regulatory, quality and safety issues, as well as being very organized. She is an honest, strong leader and builds trust easily. Lisa excels with process improvement, and her strength is attention to detail. She manages the operations well but also understands the behaviors necessary to be an excellent leader. I envision a very bright future for Lisa." ICE learned more about this Rising Star in a question-and-answer interview.

Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: I had been accepted to the nursing program at the University of Toledo but changed my mind at the last minute because I received an opportunity to job shadow and learn more about radiology. I was fascinated by the technology and being able to take images that would allow you to see the inside of the human body. This was the perfect profession where I could use science to help people. As I learned 10

ICEMAGAZINE | OCTOBER 2020

LISA NAGEL

more about the field, I became fascinated about mammography. I had the prospect to train in mammography in 2011, and ever since then, it has become a true passion of mine.

Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: I enjoy being a part of such a great team dynamic! Everyone is so patient-care oriented, that has been a true blessing to get to work with all of the team members daily. My supervisor position has also helped me grow as a leader by getting the opportunity to work on the day-to-day operations of the department and staying very involved with processes and workflows as part of the patient care team.

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: The continuous advancements in the imaging field are what interest me the most. Attaining experience deriving from the conversion from film-screen to digital, and now tomosynthesis within mammography, has been truly astonishing. There is always more to learn in the imaging field. The technology is always changing. These new innovations increase quality and enable us with patient care by helping us catch diagnoses earlier.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN THE FIELD THUS FAR? A: My greatest accomplishment was in my previous position as quality imaging specialist, incorporating development and implementation of the tech QA process that we built into our EMR system. We were able to modify some of the tech QA selections within our EMR system so they could be used to fulfill the new MQSA EQUIP regulations when they were implemented. The team was fortunate enough to go to the EPIC headquarters in Wisconsin to present the process we had created, which was a great experience. • ADVANCING THE IMAGING PROFESSIONAL

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SPOTLIGHT

IN FOCUS KARA MAYEAUX

BY JOHN WALLACE

anner Imaging Senior Director of Operations Kara Mayeaux, CRA, is not one to shy away from a challenge. Her desire to serve in the diagnostic imaging field is just one example of how she takes on difficult situations and transforms them into positives. The bonus, and it is a big one in her eyes, is that her chosen profession empowers her to assist others.

Kara Mayeaux commanded an Engineer company in Iraq.

ICEMAGAZINE | OCTOBER 2020

“The medical imaging field piqued my interest because I wanted to do something that was diverse and challenging and would provide me opportunity while allowing me to help people,” Mayeaux, a former flight attendant and Army officer, explains. “I had always wanted to serve people and as I began to research options, I found the medical imaging field which just met all of the things I was looking for and finished school in 2000. It was challenging and diverse (X-ray, interventional work, radiation therapy), provided opportunity (management, leadership) and allowed me to help people.” Along the way, Mayeaux obtained the Certified Radiology Administrator (CRA) designation in 2019. Earning the CRA was a big achievement, but Mayeaux points to two other things as those she is most proud of. “What I am most proud of is my son, Conor. He was, and remains, a blessing and

I’m extremely proud of the young man he’s become. My next greatest accomplishment is my military service, both active duty and in the National Guard,” she says. As a member of the Arizona Army National Guard, Mayeaux was selected to command an Engineer company of approximately 200 traditional Arizona National Guardsmen. The mission of these “citizen-soldiers” was to conduct convoy security missions throughout Iraq. “As a traditional member of the National Guard, I took a two-year break (2005-06) from my medical career to build, train and lead a team of soldiers brought together from across Arizona,” Mayeaux says. “It was a great honor of which I remain extremely proud, humbled and blessed to have had. The team accomplished an extremely difficult and dangerous mission and sacrificed a lot for their country, state and communities. To the point of sacrifice, I’d note that such is not unique to only the deployed soldier. In my case, Conor was only nine years old when I deployed. Over the course of the 18-plus months that I was gone he demonstrated extraordinary strength and courage. He’s a hero who, like so many other family members, sacrificed a lot for his country. I absolutely could not have done it without him.” Mayeaux says that her current job and goals bring a great level of satisfaction. “I love leading people and seeing what great teams can accomplish. In my case, it

ADVANCING THE IMAGING PROFESSIONAL

KARA MAYEAUX, CRA

Senior Director of Operations, Banner Imaging What is the last book you read? Or, what book are you reading currently? “A Stolen Life”

Who is your mentor? My husband, his dedication to faith, family along with his work ethic continue to inspire me.

Favorite movie? “Forrest Gump”

What is one thing you do every morning to start your day? Positive intentions along w/ deep gratitude for what I have.

What is something most of your coworkers don’t know about you? Flight Attendant with private charter..moved me around the country flying private charters, sports team, and movie sets.

Best advice you ever received? Make the day, don’t let the day make you. Don’t carry a grudge, forgiveness is a gift.

is particularly rewarding as the amazing things that our teams accomplish contribute directly to outstanding patient care,” she says. “I also love the challenges my job presents. In April of 2019, we closed the doors on three separate organizations on a Friday afternoon. That Monday, we stood them back up as one organization. While it was certainly amazing to witness the transition, I think even more amazing and gratifying was to have been a part of the transition. The leaders from over 20 locations, along with their 500-plus team members were exceptional and we were taking care of patients on Monday. Looking back, there is not a day that I am not genuinely impressed by the actions and subsequent accomplishments of the team.” As a proven leader, Mayeaux has her own signature approach. “I think I’d best describe my approach to leadership as one of maintaining a positive attitude, leading by example, leading people and managing issues to create a positive, professional environment of mutual trust and shared understanding,” she explains. The Army talks abut influencing as an element of leadership and it being more than just giving orders but inspiring purpose and providing direction through words and personal example, Mayeaux explains. “I try to set achievable standards, provide necessary resources and empower our teams in action to build teams and achieve high-quality results

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Who has had the biggest influence on your life? My Dad! What would your superpower be? Power of learning What are your hobbies? Golfing & gardening What is your perfect meal? Anything seafood, Sashimi, Sushi, oysters

Kara Mayeaux says her son, Conor, is a hero.

Kara Mayeaux served in Iraq for 18 months.

at both the individual team member and organizational level,” she says. “I’m deliberate in developing and investing in those members of the team whom I think are future leaders in the organization. And while there are a variety of ways and techniques and ideas on how to do this, for me it is really just about leading by requiring more from the individual than they think they’re capable of. I’ve been extremely fortunate to have had, and continue to have, leaders who’ve done this for me. I know I’d not be where I am today but for having more required of me than I thought myself capable of.” Her leadership style is also a reflection of those who have helped her along the way. “I’ve been blessed to have had great mentors over the years, all of whom pushed me and challenged me, but most importantly trusted and believed in me,” Mayeaux says. “Dr. Threasa Frouge has provided me my earliest leadership opportunities in medical imaging. She has kept me laser focused on the importance of exceptional pa-

tient care. Jessica Montgomery, always provided guidance on the importance of taking care of your team and never forgetting that you were in their shoes, at one point too. They taught me the importance of hard work and the value in investing in and empowering people. They required more of me than I thought myself capable of, provided me opportunity, allowed me to fail and never gave up on me. Mayeaux’s current leader, Jason Theadore, CEO of Banner Imaging, provides encouragement, and a great example of developing and investing in people. Jason envisions success with every goal he sets for his team. There is no other option for him, and it’s taught me to think the same way: to stay positive and focus on success.” Today, Mayeaux stands on the shoulders of those who helped shape her leadership. Ever mindful of, and focused on, the team. She relishes the opportunity to lead, inspiring and empowering her teams to achieve great things, improve the organization and provide the best patient care possible. •

ICEMAGAZINE

SPOTLIGHT

Rad idea

BY SANDY MICHALSKI, MBA, CRA, RT(R) DIRECTOR-MEDICAL IMAGING

EMPLOYEE ENGAGEMENT

nowing your team well, can aid any leader in terms of engagement. Research shows the foundation of employee engagement starts with knowing what is expected of you when you come to work, followed by having the tools and resources and moves up the scale to include someone caring about them as an individual and feeling valued. While the initial building blocks of engagement regarding tools and resources are tangible; how do you communicate the expectations of one’s role, and where do they find the tools and resources? Humans have varying degrees of understanding communication and different learning styles. Knowing which type of communication is the most effective for your associates helps support your method(s) of sharing important information. One key method to show your associates that you care about them as an individual, is to ask them about personal milestones involving family. For example, a graduating senior or the birth of a grandchild. These acknowledgments show care and concern. One of the most challenging aspects to employee engagement is recognition and feeling valued. Realizing individuals prefer to be recognized in different ways, can lead to higher engagement. A tool that I have used in the past, when assuming a new team is a “Getting to Know YOU” form. It asks simple questions about the person, their family, favorite foods, sports teams and so on. It also touches on how they most like to be recognized, and their preferred method of communication. I’ve always found this a fun exercise, and it is certainly optional. I share my information with the team as well. This makes for interesting conversations and friendly rivalries for different sporting events. This form can be modified to fit the type of team you are 14

ICEMAGAZINE | OCTOBER 2020

leading. It is also a useful tool to augment the typical strength-finding analytics often used when you have other leaders in your reporting structure. If not for this tool, I would have never learned there was a dessert called the “monster cookie.” For this, I will be forever grateful! I hope you enjoy learning as much about your team members as I have enjoyed learning about mine. • SANDY MICHALSKI, MBA, CRA, RT(R), Regional Director of Medical Imaging at Mercy Health. Share your RAD IDEA via an email to editor@mdpublishing.com.

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SPOTLIGHT

Off Clock THE

AMY PERONACE, DIRECTOR OF WOMEN’S IMAGING AT BANNER IMAGING IN PHOENIX, ARIZONA BY MATT SKOUFALOS

“

If you need anything, just ask Amy.”

In Amy Peronace’s household, the punchline of that joke turns on its understatement. By day, the mother of three directs women’s imaging services at Banner Imaging in Phoenix, Arizona, helping make some of the most complicated health conditions people may experience feel routine. In off-hours, Peronace loves traveling, exercise and staying active with outdoor activities. She also embraces an attitude that she describes as “living generously” – of giving back whatever time, resources or energy she has to the people and causes closest to her. “[Being] sensitive, emotional, caring, feeling – I always have been guided toward that,” Peronace said. “What can 16

ICEMAGAZINE | OCTOBER 2020

I do to help?” In the spring of 2015, Peronace decided to help out a stranger in one of the most demanding ways imaginable. She opted to become a surrogate mother. Two of her friends had done the same thing, “and I thought they were crazy,” Peronace said. But when one of her friends delivered a surrogate baby, she had the chance to meet the adoptive family in the waiting room, and her perspective shifted dramatically. “I got to see how amazing it was to create a whole family for someone and change their life,” she said. “It wasn’t anything I ever thought I would do, ever.” Working with an agency, Peronace was matched with a man in Barcelona, Spain, where surrogacy is illegal, and single men are not allowed to adopt children. He traveled to the United States for several doctor’s appoint-

ments, and had lots of contact with Peronace throughout her pregnancy. “We got really close,” Peronace said. “When he came out with his mom, our families all had dinners together. He really got to know my kids and my parents and my brother and sister, and we still connect to this day.” In October 2016, the man and his mother were in the delivery room when Peronace gave birth to a healthy baby boy, and handed him over to his new family. Emotions were high, and yet, afterwards, things quieted down almost immediately. Peronace was given a private room next door, and got to sleep through those next, typically restless nights in relative comfort. The new dad remained in Arizona for several weeks, completing adoption paperwork and letting his son grow strong enough for the transatlantic flight. Yet, as close as everyone became, Peronace said she nonetheless was able to separate ADVANCING THE IMAGING PROFESSIONAL

out the processes of pregnancy and childbirth from the strong connections she’d formed with the family she’d help create. “It’s such a scientific and medical process, from implementation to genetic testing; it’s never done off of emotions or feelings,” Peronace said. “From Day One, it’s so medical and step-bystep. But really connecting with the dad and knowing that this was his [baby], you can really easily separate yourself from [the process].” By the winter of 2018, the baby that Peronace had helped bring into the world was growing into a toddler an ocean away. But back at home, another emergency was brewing; almost overnight, a close family friend was diagnosed with kidney failure. This married father of two had careened from being a healthy, active, athletic person into a dialysis patient three days a week. Peronace accompanied his wife to a few doctor visits to help her develop the technical expertise around how to manage her husband’s care at home. “I went just for support,” she said; “to learn how to hook him up to the dialysis equipment, how to change his lines and do his dressings, and I did that if she was out of town.” “Every single night for eight hours, his bedroom had become a sterile room,” Peronace said. “Trucks came in with hospital-grade equipment. You’d have to mask up, glove up, coming in.”

Eventually, it became clear that her friend needed a kidney transplant. Peronace decided to see if she could be a match. In secret, she underwent an extensive evaluation process. Weeks of comprehensive laboratory panels, medical imaging, psychological counseling, and other diagnostic tests followed, including meetings with a nutritionist, a counselor and a financial analyst before the case finally came before a medical review board. The board said she was as close to a perfect match for the recipient as they’d ever seen. “I did all of that without even telling him because I never wanted to get his hopes up in case something went wrong or, God forbid, I changed my mind,” Peronace said. “It wasn’t until it was approved that I let him know that we were good to have surgery in a month.” The reaction was understandably overwhelming. “I gave him a T-shirt that said ‘Kidney buddies for life’ on it,” Peronace said. “My son was videotaping it. Once it connected, everybody was crying.” Despite the recovery being “one of the hardest things I’ve ever done,” Peronace said she was back to feeling like herself again within two weeks. The transplant was a success, and today, almost a year-and-a-half after the surgery, her kidney is functioning at 70 percent in her friend’s body.

“Now I just go for yearly labs and it’s great,” Peronace said. “He’s got his muscle mass back, his color back; he’s like a whole new person. I don’t even notice [that I’m missing a kidney]; I sometimes don’t even think about it.” Unlike her decision to become a surrogate mother, which Peronace said was fairly clinical, the choice to become a living organ donor was much more emotionally driven. “I get the surrogacy thing is hard for people to comprehend, and that took a lot more thought,” she said. “The kidney thing, even before he said anything, I was like, ‘If this guy ever needs a kidney, he can totally have mine.’ ” Those with whom she shares her story may feel like the differences they make in their own lives don’t measure up to what Peronace has done. She is quick to dismiss such attitudes. Instead, she advocates heavily for individual people living generously however they can manage to do it. “I give myself a hard time because I’ve done these two amazing things,” she said, “but every time somebody’s like, ‘I need volunteer work,’ and I don’t have time, I feel so guilty not volunteering.” “If you have the means to, give back in whatever capacity you can,” Peronace said. “You can be donating time, donating money, helping neighbors. It does so much, not only for the person you’re doing it for, but yourself.” •

Amy Peronace's acts of kindness include donating a kidney and serving as a surrogate mother.

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ICEMAGAZINE

NEWS

Imaging News A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

CANON MEDICAL LAUNCHES SOLTUS 500 MOBILE DIGITAL X-RAY SYSTEM Health care facilities regularly require rapid imaging exams performed in a variety of complex situations, often at the patient’s bedside. With the launch of Canon Medical Systems USA Inc.’s all-new SOLTUS 500 Mobile Digital X-ray, facilities now have access to a system that is equipped with enhancements that can streamline bedside exams to help improve workflow and productivity. The FDA 510(k)-cleared SOLTUS 500 has a compact design with advanced features that promote efficiency and patient safety, without compromising image quality. Features include an enhanced ease-of-use with intuitive tubehead controls, including an 8.4-inch touchscreen display and dual collimator controls for increased access and accuracy. Another feature is an increased detector wireless range and productivity with Canon Medical patented technologies. The Distributed Antenna System optimizes detector wireless range, and the Enhanced Workflow Package supports the exam from start to finish at point of care. It boasts exceptional safety and security features for patient, clinician and facility, including anti-collision technologies, pressure sensitive steering, improved maneuverability and smart ID card log-in for secure accessibility. Also, simplified detector charging and storage capacity allows space and functionality for

ICEMAGAZINE | OCTOBER 2020

detector charging, storage and accommodating accessories such as disinfecting wipes and protective bags. “Today’s hospitals are challenged with productivity demands and it’s imperative that their X-ray systems are able to perform seamlessly where and when they need them,” said Jay Aboujaoude, managing director, X-ray business unit, Canon Medical Systems USA Inc. “The SOLTUS 500 meets that need without compromising on image quality, which is made possible with the unparalleled Canon detector technology that is at the heart of the system.”•

ADVANCING THE IMAGING PROFESSIONAL

GROUPS PLAN MASSIVE OPEN-SOURCE COVID-19 MEDICAL IMAGE DATABASE The nation’s largest medical imaging associations are working together to develop the new Medical Imaging and Data Resource Center (MIDRC), an open-source database with medical images from tens of thousands of coronavirus (COVID-19) patients. The MIDRC will help doctors better understand, diagnose, monitor and treat COVID-19. The National Institute of Biomedical Imaging and Bioengineering (NIBIB) at the National Institutes of Health (NIH) is funding the effort through a contract to Maryellen Giger, Ph.D., of the University of Chicago, which will host the MIDRC. The MIDRC effort is co-led by the three medical imaging associations with Etta Pisano, MD, and Michael Tilkin, MS, from the American College of Radiology (ACR), Curtis Langlotz, MD, Ph.D., and Adam Flanders, MD, representing the Radiological Society of North America (RSNA), and Maryellen Giger, Ph.D., and Paul Kinahan, Ph.D., representing the American Association of Physicists in Medicine (AAPM). “The MIDRC database will provide a critical tool to help the medical imaging community, doctors and scientists better understand COVID-19 and its biological effects on humans. This knowledge, and the technological advancements the registry can enable, will ultimately help providers

save lives,” said Etta Pisano, MD, ACR chief research officer. Medical imaging helps radiologists detect, diagnose and monitor disease. However, many unanswered questions remain about how imaging could be deployed against COVID-19. For example, artificial intelligence (AI) algorithms could help radiologists better prioritize and analyze scans. But thousands of images must be collected and annotated to train these algorithms. The MIDRC will bring together engineers, physicians and scientists to collect and organize the data to answer these crucial questions. Funded under the National Institutes of Health’s special emergency COVID-19 process, the MIDRC will create an open access platform to collect, annotate, store and share COVID-related medical images. The MIDRC will soon leverage existing data collection efforts to upload more than 10,000 COVID-19 thoracic radiographs and CT images, including many from the ACR COVID-19 Imaging Research Registry and the RSNA International COVID-19 Open Radiology Database (RICORD). This will allow researchers worldwide to access a wealth of images and clinical data to answer COVID-19 clinical and logistical questions. •

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ICEMAGAZINE

NEWS

SIEMENS HEALTHINEERS TO ACQUIRE VARIAN Siemens Healthineers AG and Varian Medical Systems Inc. have entered into an agreement, pursuant to which Siemens Healthineers shall acquire all shares of Varian for $177.50 per share in cash. This corresponds to a purchase price of approximately $16.4 billion. Varian’s Board of Directors unanimously approved the agreement and recommends that the Varian shareholders also approve the agreement. The acquisition of Varian is expected to close in the first half of calendar year 2021, with closing being subject to approval by Varian shareholders, receipt of regulatory approvals and satisfaction of other customary closing conditions. “With this combination of two leading companies we make two leaps in one step: A leap in the fight against cancer and a leap in our overall impact on health care. This decisive moment in the history of our companies means more hope and less uncertainty for patients, an even stronger partner for our customers, and for society more effective and efficient medical care. Together with Varian’s outstanding and passionate employees, we will shape the future of health care more than ever before,” said Dr. Bernd Montag, CEO of Siemens Healthineers AG. •

ICEMAGAZINE | OCTOBER 2020

GE HEALTHCARE UNVEILS NEW TECHNOLOGIES At this year’s virtual ISMRM meeting, GE Healthcare showcased new technologies to enable neuro research to better understand Alzheimer’s disease and traumatic brain injury, as well as accelerate clinical translation. The 510(k)-pending SIGNA 7.0T, as well as research devices SIGNA ultra-high performance (UHP) 3.0T and the head-only MAGNUS gradients, represent GE Healthcare’s continued dedication to advancing neurological research and clinical translation with leading institutions around the world. SIGNA 7.0T is designed to overcome the limitations of the majority of today’s clinical MRI systems by leveraging the ultra-high field magnet technology within its core. With approximately five times more power that most clinical systems, SIGNA 7.0T is designed to detect subtle structures that may be significant for clinicians and researchers alike. This new 60-centimeter bore system is designed to be a more powerful tool to image neurodegenerative diseases as well as extremities. SIGNA 7.0T features UltraG gradient technology, GE’s most powerful, wholebody gradient coil, designed to meet the needs of ultra-high field imaging speed and resolution. This system features the familiarity of SIGNAWorks applications platform so clinicians can use the latest state-of-the-art applications such as deep learning-based platform tools like AIR x brain for automated slice positioning and Silent MR imaging. In addition, SIGNA 7.0T will be equipped with Precision RF transmit and receive architecture designed to enable improved image quality and research flexibility. “The integration of the new MR platform into SIGNA 7.0T system has resulted in outstanding image quality,” said Garry Gold, professor of radiology at Stanford University. “Stanford has been working with GE at the 7.0T field strength for over 15 years and we expect this new platform to be transformative for the next generation of scientists, researchers and clinicians.” •

ADVANCING THE IMAGING PROFESSIONAL

RADNET, HOLOGIC ANNOUNCE AI COLLABORATION RadNet Inc. and Hologic Inc. have entered into a definitive collaboration to advance the use of artificial intelligence (AI) in breast health. Hologic will contribute capabilities and insights behind its market-leading hardware and software, and will benefit from access to data produced by RadNet’s fleet of high-resolution mammography systems, the largest in the nation, to train and refine current and future products based on AI, according to a news release emailed to ICE magazine. “RadNet will share data from its extensive network of imaging centers, as well as provide in-depth knowledge of the patient pathway and workflow needs to help make a positive impact across the breast care continuum. The collaboration will enable new joint market opportunities and further efforts to build clinician confidence and develop and integrate new AI technologies,” the release adds. “We believe the future of breast health will rely heavily on the integration of AI tools, such as our 3DQuorum imaging technology, as well as next generation CAD software, that aid in the early detection of breast cancer,” said Pete Valenti, Hologic’s division president, breast and skeletal health solutions. “We are energized by the opportunities this transformative collaboration with RadNet creates for patients and clinicians alike. Access to data is critical in training and refining AI algorithms. With this collaboration, we now have the opportunity to leverage data from the largest fleet of high-resolution mammography systems to develop new tools across the continuum of care, provide workflow efficiencies and improve patient satisfaction and outcomes.” “As part of its collaboration with Hologic, RadNet intends to upgrade its entire fleet of Hologic mammography systems to feature Hologic’s 3DQuorum imaging technology, powered by Genius AI,” the release states. The collaboration will be bolstered by RadNet’s recent acquisition of DeepHealth, which uses machine learning to develop software tools to improve cancer detection and provide clinical decision support. •

PHILIPS ANNOUNCES KODEXEPD ENHANCEMENTS Royal Philips has announced new imaging and workflow enhancements for its novel KODEX-EPD cardiac imaging and mapping system. The system is now being used to treat patients with atrial fibrillation (AF), a common heart rhythm disorder, at 40 sites worldwide with over 1,500 patients treated. The latest release includes improvements in imaging and mapping performance, as well as enhanced features to support cryoablation procedures. Unlike traditional methods to image the heart during AF procedures such as CT and X-ray fluoroscopy, the KODEX-EPD system uses a combination of sensors attached to the body and catheters inside the heart to image the anatomy and properties of the heart, using innovative dielectric sensing technology. As a result, electrophysiologists can create detailed 3D views of the heart of a patient in as little as three minutes and navigate to the target location more easily and efficiently, with the required precision and without using radiation. “The new release of the KODEX-EPD system represents a significant step forward in terms of image quality and workflow efficiency for AF procedures, as we continue to work towards our longer-term goal of providing real-time therapy assessment,” said Marlou Janssen, general manager Philips EPD Solutions. “By partnering with Medtronic and developing unique capabilities for cryoablation, we can give more physicians access to this truly innovative cardiac imaging and mapping system and contribute to delivering efficient workflows with Medtronic’s best-in-class cryoablation therapy.” Advances in the new release include faster, high-resolution imaging, improvements in mapping functionality and point density, as well as new visualization options such as ‘multi-chamber’ view to help understand the relative positions of adjacent chambers and ‘glass view’, which provides physicians with an improved perception of 3D catheter location and orientation within the heart. For cryoablation procedures, the KODEX-EPD system offers enhanced Occlusion assessment functionality with high accuracy and a simplified workflow. The KODEX-EPD cardiac imaging and mapping system is commercially available in the US, Europe and China. • For more information, visit www.philips.com/epd.

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ICEMAGAZINE

NEWS

FDA UPDATES

FDA CLEARS PORTABLE MRI SYSTEM FDA CLEARS AI-BASED MRI INTERPRETATION ASSISTANTS The Food and Drug Administration (FDA) has cleared two additional Siemens Healthineers artificial intelligencebased software assistants in the AI-Rad Companion family. Both new software assistants free radiologists from routine activities during magnetic resonance imaging (MRI) examinations. The AI-Rad Companion Brain MR for Morphometry Analysis automatically segments the brain in MRI images, measures brain volume and marks volume deviations. The AI-Rad Companion Prostate MR for Biopsy Support automatically segments the prostate on MRI images and enables radiologists to mark lesions, facilitating targeted prostate biopsies. “These new AI-Rad Companion applications for MR exams in the brain and prostate regions will help physicians manage their workloads and achieve a patient-focused decision-making process to increase efficiency and improve the quality of care,” said Peter Shen, vice president of innovation and digital business at Siemens Healthineers North America. • For more information, visit siemens-healthineers. us/ai-rad.

ICEMAGAZINE | OCTOBER 2020

Hyperfine Research Inc. has received 510(k) clearance from the FDA for its category-defining portable MRI technology, the Swoop Portable MR imaging device. Hyperfine’s Swoop system is a point-of-care MR imaging device that wheels directly to the patient’s bedside, plugs into a standard electrical wall outlet and is controlled through a wireless tablet, making MR imaging accessible, immediate and seamless. This clearance for the market-ready device covers enhanced imaging and software and expands Hyperfine’s brain imaging indication to include patients aged 0 to 2. Swoop is the company’s latest-generation device, incorporating user feedback and technological enhancements evolving from the original device, which was cleared in February 2020. With this clearance, the Swoop system is now available for purchase, with shipments commencing immediately. Hyperfine’s Swoop system was designed to address the limitations of current imaging technologies and make MRI accessible anytime, anywhere, to any patient. Swoop wheels directly to the patient’s bedside, plugs into a standard electrical wall outlet, and is controlled by a wireless tablet such as an Apple iPad. Images are captured at the patient’s bedside, with results in minutes, enabling critical decision-making capabilities across a variety of clinical settings including neuro intensive care units, emergency departments, pediatrics, ambulatory, outpatient surgery centers and more. The complete Hyperfine system costs less than the annual service contract alone for most current MRI systems, and it consumes 35 times less power than those same systems. Designed as a complementary system to traditional MRIs, new users can be trained on system operation, device navigation and device safety in about 30 minutes, helping clinicians to streamline workflow. •

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FDA CLEARS NEW AUTOMATED TEE PROBE DISINFECTOR CS Medical has announced the successful clearance of a new Class II medical device by the U.S. FDA and Health Canada, TD 200 Automated TEE Probe Disinfector with TD 12 AquaCide high-level disinfectant. “Building off the TD 100 platform, TD 200 with TD 12 AquaCide provides customers with a faster high-level disinfection time and an overall quicker total cycle time of ten minutes,” according to a release from CS Medical. “TD 200 is the first medical device cleared in North America which provides high-level disinfection in just three minutes. The single-use biocide, TD 12 AquaCide comes in granulated form. The TD 12 AquaCide bottle is pierced inside the TD 200, is mixed with water, and heated to create a liquid high-level disinfectant. Simple step-by-step instructions are displayed on the LCD screen for the end-user,” the release adds. “Today’s news shows CS Medical’s continued commitment to providing products and services that effectively reprocess TEE ultrasound probes. TD 12 AquaCide provides new and exciting oppor-

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tunities for CS Medical. With a quicker high-level disinfection claim than TD 5 or TD 8, as well as not requiring deactivation prior to disposal, TD 12 AquaCide will reduce reprocessing time and reduce potential ecosystem damage. TD 200 with TD 12 AquaCide is the combination of years of research, development, and commitment by our entire staff,” said Mark Leath, CS Medical president. “TD 200 with TD 12 AquaCide is another example of our pledge to work with health care professionals and other professional organizations to reduce HAIs and increase awareness for a better and safer health care system. In addition to our employees, I am thankful and appreciative of the cooperation and assistance given to us by the TEE ultrasound probe manufacturers, without whom TD 200 with TD 12 AquaCide would not be the product it is today.” • For more information, visit csmedicalllc.com or call 919-255-9472.

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PRODUCTS

Market Report Report: Mammography Systems Market to Reach $3.5 Billion STAFF REPORT

he global mammography systems market is projected to surpass $3.5 billion by 2025, according to a research report by Global Market Insights Inc. Rising awareness about the early detection of breast cancer coupled with the availability of free breast screening programs will accelerate market growth. Increasing incidence of invasive breast cancer across the globe will stimulate mammography systems industry demand in the upcoming years. Breastcancer.org estimated that about one in eight women will develop an invasive form of breast cancer during their lifetime. Risk factors associated with breast cancer, such as hormone replacement therapy, genetic factors, child-bearing and growing adoption of unhealthy lifestyle habits, will further contribute toward a greater adoption of breast imaging modalities, thereby impacting global market demand over the projected years. Grand View Research reports that the rising health care expenditure, booming health care industry and growing demand for regular monitoring are some of the pivotal factors expected to propel demand for mammography equipment in the coming years. Growing government initiatives to improve clinical interpretation and increase access to mammary gland cancer screening systems is one of the crucial factors expected to drive the demand over the forecast period. In addition to these initiatives, the Health Resources and Services Administration (HRSA) has introduced Federal Consolidated Health Centers Programs to increase the screening procedures in medically underserved areas, Grand View Research reports. Mammography systems are an advanced medical 24

ICEMAGAZINE | OCTOBER 2020

equipment used for early detection and diagnosis of breast cancer. It is a low dose X-ray technique designed to image breast tissue. Mammography is mainly used for patients with symptoms of breast cancer who have no signs of breast cancer. The aim of mammography is early detection of breast cancer, through screening of microcalcifications and characteristic mass/lumps. It is a non-invasive technique that involves exposure of breasts to low dose of ionizing radiations to produce the inside image of the body. According to the Breast Cancer Research Foundation, breast cancer is the leading cause of mortality among women in developing countries. It is the most frequent cancer detected among women across about 140 countries. The history of the mammography systems industry dates back to 1913, when A. Salomon, a surgeon from Berlin conducted a study on 3,000 mastectomies for the study of mammography. Up until 1960, only a few developments were seen in this technique, until R. Leborgne, Ch. Gros and several other European and American radiologists contributed. Between 1980-1990, substantial improvements in screen film technology was witnessed and dedicated mammography units were established. As breast cancer was categorized as public health threat, the Mammography Quality Standards Act of 1992 was imposed to maintain the screening quality. Currently, leading players such as Fujifilm, Hologic, Siemens Healthineers and GE Healthcare are developing mammography systems to enhance cancer detection rates with reduced exposure to radiation. With the launch of first digital breast tomosynthesis system in the U.S. market by Hologic in the year 2011, a new breakthrough was established in the mammography systems industry, that was followed by launches from other market players including GE Healthcare, Siemens Healthineers and Fujifilm. â&#x20AC;˘

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Product Focus

Women's Imaging FUJIFILM

ASPIRE Cristalle with Tomosynthesis and Simulated 2D Fujifilm’s innovative engineering and advanced image processing has created a high sensitivity mammography system for low dose and exceptional image quality. Featuring patented Comfort paddles, Fujifilm’s ASPIRE Cristalle with Digital Breast Tomosynthesis (DBT) is designed to more comfortably adapt to individual breast shape and minimize pinch points. Its recent S-View feature generates an excellent quality synthetic 2D image from the 3D images at almost half the dose of a 3D and dedicated 2D view combined. Today, more than 9,000 global customers trust Fujifilm Digital Mammography Solutions. • For more information, visit: https://www.fujifilmhealthcare.com/womens-health.

*Disclaimer: Products are listed in no particular order.

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PRODUCTS

GE HEALTHCARE Serena Bright

HOLOGIC

Typically lesions identified with contrast-enhanced mammography are sent to MRI for biopsy, but now with Serena Bright, the industry-first contrasted enhanced biopsy-guided solution, breast biopsy procedures can be performed with the same mammography equipment, with the same staff and in the same room as the screening or diagnostic mammogram. Key to this technology’s application is GE Healthcare’s SenoBright HD Contrast Enhanced Spectral Mammography, a diagnostic imaging tool that delivers high sensitivity for more accurate breast cancer diagnosis.1 By highlighting areas of unusual blood flow to help localize lesions that need biopsy, Serena Bright can help improve radiologists’ diagnostic confidence.2 Serena Bright will be commercially available in the United States in October 2020. • 1. C ontrast-Enhanced Mammography: A Systematic Guide to full/10.2214/AJR.17.19265

2. 510(k) Premarket Notification Submission: https://www.accessdata.fda.gov/cdrh_docs/pdf19/K193334.pdf

Clarity HD High-Resolution 3D Imaging Clarity HD High-Resolution 3D Imaging provides the fastest and highest resolution 3D images in the industry. Clarity HD technology’s breakthrough detector and advanced 3D imaging algorithm work together to deliver exceptional 3D images – regardless of breast size or density. The technology is available on the 3Dimensions Mammography System, offering Hologic’s Genius exam, which is proven to detect 20-65 percent more invasive breast cancers than 2D alone. Hologic’s latest innovation, 3DQuorum Imaging Technology, powered by Genius AI, works in tandem with Clarity HD technology to reduce tomosynthesis image volume for radiologists by 66 percent. •

ICEMAGAZINE | OCTOBER 2020

Interpretation and Reporting. AJR https://www.ajronline.org/doi/

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4 SIEMENS HEALTHINEERS MAMMOMAT Revelation Mammography Platform

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The MAMMOMAT Revelation Mammography Platform from Siemens Healthineers is engineered to make the difference in early breast cancer detection, workflow, dose and patient comfort. HD Breast Tomosynthesis offers the widest image acquisition angle available at 50 degrees, resulting in the industry’s highest in-plane resolution for improved separation of overlapping breast tissue, and 3D image-quality, improving diagnostic confidence and aiding in earlier cancer detection. HD Breast Biopsy enables one-click targeting of suspicious areas with a +/- 1mm accuracy. The InSpect integrated specimen imaging tool permits imaging and real-time review of biopsy samples at the technologist workstation to improve biopsy workflow, shorten compression time and reduce patient discomfort. Also, the MAMMOMAT Revelation is the first platform to offer automated breast density measurement during a mammogram for immediate, personalized risk stratification and more personalized care. The system’s new VC20 software includes efficiency improvements, reduced system calibration times, and an accelerated booting time, in addition to accelerated exam times via the 50-degree TomoFlow feature. New biopsy accessories include a spacer plate for easier imaging of smaller-breasted patients. •

ICEMAGAZINE

COVER STO RY

ICEMAGAZINE | OCTOBER 2020

ADVANCING THE IMAGING PROFESSIONAL

AMBULATORY CLINICS IN

POST-PANDEMIC AMERICA BY MATT SKOUFALOS

o single factor will have exerted greater pressure on medical imaging in 2020 than the novel coronavirus (COVID-19) pandemic. From March to June, health care facilities across the United States were shuttered to all non-essential procedures by state order, as the country worked, with mixed results, to respond to the rapidly spreading virus. Losing a quarter’s worth of business left a lasting negative impact on the entirety of the imaging space, but the effects of the pandemic were felt differently by practitioners of different sizes and compositions. The divides among them are likely to grow even more pronounced: smaller entities lacking the resources that allow their larger competitors to weather the disruption may be ripe for acquisition. Murat Gungor, the senior vice president of diagnostic imaging at Siemens Healthineers North America, said market constraints are likely to bring practices on the brink to some difficult choices.

the market has to have the intention of stealing business from someone else.” Under such conditions, “the whole activity in this space has been very much centered on consolidation,” Gungor said. The U.S. diagnostic imaging market comprises some 12,000 total imaging centers, split nearly 50-50 between hospital and non-hospital settings, Gungor said. However, those 6,000 freestanding imaging centers constitute a very fragmented market, with the top five players accounting for just 10 percent of the entire sector, or some 600 locations. Another 3,000 are single-facility entities, “which means they have a name, and one location with maybe a couple of imaging systems, and that’s it,” Gungor said. “The big fish in this bucket are somewhat going after the smaller fish,” he said. “Smaller entities with one or two locations are in a tougher position because they lack the necessary economies of scale.” In the final months of 2020 and beyond, Gungor believes that competitive imbalance could lead to

“ Smaller entities with one or two locations are in a tougher position because they lack the necessary economies of scale.” – Murat Gungor, the senior vice president of diagnostic imaging at Siemens Healthineers North America The $20-billion diagnostic imaging center market only grows at 1 to 1.5 percent annually, “and COVID probably slowed down that,” Gungor said. “It’s hard to see any additive growth,” he said. “Any entrance to

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more single-entity practices fighting for their survival, as private-equity investors smell opportunities to grow their market share. As bigger entities that take this tack, the consolidation trend could intensify throughout the end of the year, he said. “We see this reaction from the

top freestanding customers that we deal with,” he said. “They’re more than ever focusing on mergers and acquisitions, and I think that’s going to continue, which will make them even stronger in terms of size and patients.” “If you have the ability to do it, why wait?” Gungor said. “Most of the smaller settings are under economic pressure, and we think that might continue.” Facilities affiliated with hospital systems will probably have a stronger hand to play, Gungor said; it’s not easy for freestanding centers to scale up to the acquisition of more sophisticated imaging devices. Getting to break-even on a multi-million-dollar equipment investment requires strong study volumes and patient throughput, a difficult task made harder under pandemic conditions. “If you’re more localized, it’s hard,” he said, “especially in a smaller setting. In a very hospital-dominant market, it’s not easy to show presence.” Multistate imaging businesses that were strong going into the pandemic should be able to operate at the scale to be able to manage its impact, as the current environment offers an opportunity to broaden their geographical coverage. “The ones that are more successful are more spread out,” Gungor said. “You might be a 50-location freestanding entity, but if you are geographically diverse, that gives you a good presence in the market space that a hospital-based setting won’t have: your patient mix is different, your industrial relations might be different.” Despite their size advantagICEMAGAZINE

COVER STO RY

es, hospital-based imaging centers don’t necessarily have it easy. Varying reimbursement rates and the pressures of price transparency around site-neutral payments have sharpened competition for patient populations. With insurers driving down their costs by encouraging patients to negotiate rates and shop around, “pressure is high on those entities,” Gungor said. As patients are motivated toward lower-cost options, freestanding imaging centers may hold an advantage over their more well-heeled competitors. Patients tend to prefer hospital-based imaging centers for highend procedures, giving freestanding centers a “more bread-and-butter” clinical caseload, Gungor said. Freestanding imaging centers “are trying their best to change that” perception, but only the largest competitors in the space may be capitalized well enough to acquire new technologies

to an “aggressive asset management model,” replacing those systems that deliver modalities for which there’s pent-up demand. The secondary objective is managing those patients within a COVID-compliant cohorting system. Every facility must adhere to social distancing protocols, pre-screen for symptomatic patients, ramp up sanitization measures and take other appropriate precautions to keep staff and patients healthy. Those patients who’ve deferred or delayed needed imaging studies will show up, Gungor said, but it’s up to imaging centers to boost their confidence in the safety and quality of the experience they receive – if their customers have money to spend on imaging studies. For its part, Gungor said Siemens Healthineers is doing what it can to support the survival of facilities throughout the industry of all shapes and sizes.

“ But if you’re an outpatient imaging business, and you lost money this year on COVID, you’ve got a train coming at you on further reductions that are unavoidable unless Congress raises budget neutrality to pay for them.” – Bob Still, executive director of the Radiology Business Management Association (RBMA) of Fairfax, Virginia

after the impact of the pandemic. “They know this is the way to compete against hospital systems and attract more sophisticated referrals to stay alive,” Gungor said. “They tend to buy used X-rays or C-arms, which can still be competitive; hospital systems definitely go to the newest-innovation devices.” Once the economic conditions perpetuated by the pandemic are resolved, he believes those facilities that endure will very quickly revert

ICEMAGAZINE | OCTOBER 2020

“We are more diversified than any individual account or customer, and we are able to work with all of them, and we have the portfolio to support that,” he said. “Our job is to make sure that they go through this successfully. We’re truly in this together, and we need to make sure that they come out of it healthy.” Bob Still, executive director of the Radiology Business Management Association (RBMA) of Fairfax, Virginia, believes that throughout America,

there’s still a generational demand for medical imaging studies. Although study volumes are still rebounding from a valley dug during the peak of the pandemic, “if you look at the really big picture, there’s a whole bunch of us baby boomers who are going to need imaging over the next 20 years,” Still said. “COVID really took a hit on everybody,” he said; “revenues are going to drop close to 20 percent this year just because of it. “But if you’re an outpatient imaging business, and you lost money this year on COVID, you’ve got a train coming at you on further reductions that are unavoidable unless Congress raises budget neutrality to pay for them,” Still said. With the Centers for Medicare and Medicaid Services (CMS) set to implement proposed changes to the coding structure for office and outpatient evaluation and management (E/M) codes, imaging providers may see an 8-percent decrease in radiology revenues “as a result of the necessary budget neutrality adjustment,” the American College of Radiology (ACR) noted in November 2019. ACR, however, estimates the impact to be slightly higher, at 9 percent, equaling about $452 million annually, or $5.6 billion industry-wide over the next decade. “[CMS] indicated that they understand these concerns,” ACR said, but at the time the rules were developed, the agency said “it was premature to finalize a strategy for mitigating the impacts in this final rule.” That’s setting up the industry for a protracted lobbying stretch to stave off the potential deficit. “Health care professionals who provide patient services that do not fit in the evaluation of management classification will take a hit to allow

ADVANCING THE IMAGING PROFESSIONAL

“ We’re working through, as best we can, a backlog in patients, and trying to get back to patients who would skip that mammography, or low-dose lung scan, or follow-up cancer treatment.” – Kit Crancer, vice president of public policy and executive director for CDI Quality Institute in Minneapolis, Minnesota their colleagues to see their rates increase,” Still said. “Under the Medicare requirement of ‘budget neutrality’ if one group is a ‘winner,’ another group providing patient services is a loser.” “In the outpatient imaging business, I think the equipment managers and others are concerned about this,” he said. “If the pie is smaller, can we wait a year or two years to buy that MRI?” RBMA is in the process of surveying its membership to determine possible negative effects in practices caused by these changes. Still said most of the people affected by it have recognized that it’s a concern, but no solutions have yet presented themselves. Like Gungor, Still believes “all of the patterns we’ve seen in recent years will continue,” i.e., mergers and acquisitions that drive industry consolidation, with private-equity capital greasing the wheels for it, and hospital-based radiologists joining freestanding imaging centers, potentially growing business at both ends. If COVID-19 impacts have prevented facilities from acquiring new technology, “the good news is you can borrow money cheap,” Still said. “That’s a nice way to fund equipment.” He does, however, believe the clinical impact of the pandemic will manifest itself in reduced patient volumes and an uptick in self-payers. People who’ve lost work or income due to illness, caregiving or industry shutdowns may have also lost their health insurance, and could decide to put off diagnostic studies, even over a matter of a few hundred dollars. For

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its part, RBMA has helped its membership navigate state, federal, and local relief opportunities, all of which Still believes has had an impact. Kit Crancer, vice president of public policy and executive director for CDI Quality Institute in Minneapolis, Minnesota, said that at some of its sites across the country, imaging volumes fell by as much as 70 percent during elective procedure bans enacted during the pandemic. “Routine mammography dropped almost entirely,” Crancer said. “Women could not go and get their annual screenings in a number of states, elective procedure prohibitions resulted in the furloughing of staff, and then you see the instability of reopening.” “That, in a nutshell, is what we were dealing with previous to looking at that Medicare fee schedule,” he said. Since the virus has retreated from its peaks in parts of the country hit hardest and earliest by it, CDI has been able to reopen the majority of its freestanding imaging centers and bring back the majority of staff. However, Crancer said, “there’s still that looming fear that there could be another shutdown.” “We’re working through, as best we can, a backlog in patients, and trying to get back to patients who would skip that mammography, or low-dose lung scan, or follow-up cancer treatment,” he said. “And then, having weathered the impacts of this global pandemic, providers who are at the tip of the spear, trying

to diagnose these life-threatening procedures, now face a reduction in reimbursement rates.” The cuts “will certainly result” in Medicare patients suffering a lack of access to imaging services, Crancer said. He fears that already-struggling facilities may close, cutting off access to populations that may not have local options for an affordable imaging study performed. “Critical access facilities and providers in rural America are going to face significantly more challenges for this,” Crancer said. “The timing is absolutely wrong to add to the instability of these institutions, and that’s exactly what’s going to happen if Congress doesn’t act. Our hope is that they will waive the budget-neutrality strictures.” If there’s a bright spot on the horizon, Crancer sees it as the reformation of prior authorization statutes, an advocacy issue across the medical imaging industry. Care delayed or deferred by the pandemic could have a catalytic effect on resolving some of those regulations that create barriers to getting studies performed. “I think policymakers realize that the status quo as it relates to insurance companies to take weeks to get turned around on prior authorization is unacceptable in the face of a growing number of patients who’ve had to delay their care,” he said. “If you’re already anxious, we don’t want you feeling more anxious.” •

ICEMAGAZINE

INSIGHTS

AUC PIVOT T CODING/BILLING BY MELODY W. MULAIK

he testing period for Appropriate Use Criteria (AUC) implementation is almost over – well not quite. While there was no information in the Centers for Medicare and Medicaid Services (CMS) Medicare Physician Fee Schedule (MPFS) Proposed Rule released on August 4, 2020, CMS subsequently updated their website to indicate that the educational and operations testing period for the Appropriate Use Criteria (AUC) consultation requirement has been extended through CY2021. This means that there are no payment consequences associated with the AUC program during CY2020 and CY2021.1 So, with this information now in hand, what should you do? Push off your implementation plan by a year? Continue with your current plan and use the additional time for testing? Or, hold tight to wait to see if CMS will make a dramatic change and either totally change how reporting is done or somehow find a way to eliminate the requirement entirely? The answer to that depends on your type of organization, how much COVID-19 has impacted you financially and your tolerance for risk. There is not one right answer to the above quandary. There are pros and cons to each, but it is important that you weigh your options and make an educated decision that is the right fit for your organization. Hospitals and health care systems need as much time as possible to modify their systems, build interfaces and test all the possible scenarios for orders in all of the affected settings by employed and non-employed ordering providers. What might seem like a straightforward process

ICEMAGAZINE | OCTOBER 2020

can quickly become complicated when you start laying out all the potential ordering scenarios that could occur in the acute care and outpatient settings. One suggestion is to separate the IT implementation from the operational implementation. You can build the required systems infrastructure and ensure that you can appropriately submit claims to a wide variety of payers without requiring a mandatory AUC consultation by your ordering providers. This is a very important distinction when you consider how you define implementation timeframes. There are some outstanding questions that CMS need to address with additional guidance. For example, how will radiologists communicate on the claim that an exam was interpreted at a critical access hospital (CAH) and thus exempt from the consultation requirement? It could be tempting to let the unanswered questions prevent you from taking action on the majority of issues that we do have the answers to at this point. That said, it is OK to put some items on hold, but address the greater issues in the project scope. Don’t be afraid to tackle the challenge of a revised timeline head on. Having open and candid conversations with all of the stakeholders to ensure that there are no surprises at any point in the process is vital to a successful implementation. Don’t apologize for needing time to ensure that all of your required system changes are in place and working correctly. • MELODY W. MULAIK, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc.

REFERENCES 1. h ttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program

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DELEGATE I DIRECTOR’S CUT BY MARIO PISTILLI

have to admit that one of my biggest flaws is effective delegation. It is something I have really been working on in my career and still have a long way to go to become better. One of my core values is to contribute to the growth and development of others. I firmly believe that a leader not only should surround themselves with the best talent, but also grow and develop the people around them. It takes a certain amount of patience to be an effective delegator. I find it easy to fall into the trap of just doing things myself because I perceive that to be easier or faster. One of the most difficult shifts for me to make is the transition from a doer to a leader, which Sostrin (2017) states is among the most difficult transitions for a leader. There are a host of reasons why some people are resistant to delegating. Some people, like me, are perfectionists and are concerned about the end result. There are some that feel that passing on work will diminish their own value to the organization. If you need to suppress the growth of others to protect your own value, then I suggest you reexamine your values. Someone else does not have to lose for

ICEMAGAZINE | OCTOBER 2020

you to win. No matter how self-aware you think that you are, some of these biases may creep in and necessitate some serious self-reflection. The first step in becoming a better delegator is to recognize that you cannot do everything yourself and that you can provide better value to your organization through delegation. There are some strategies that I am employing to grow in this area and that have been yielding some great results and happier team members. • Get to know your team. Make sure you have conversations with your direct reports about the areas in which they would like to grow and develop. What are the things that excite them? What are the areas they are curious about and want to learn more about? What are their strengths so you can play to those also and provide tasks and projects that can give them some wins. I have been very open and intentional with my direct reports in having conversations around what are the things they would find valuable to work on. • Create a delegation map. Once you have spent some time with your direct reports digging into what are their strengths and opportunities, and in what areas they would like to grow make a table or a roadmap so that you can keep these things in mind as opportunities come up. I note down strengths, opportuADVANCING THE IMAGING PROFESSIONAL

nities, areas for growth, projects delegated, future projects to consider. • Be clear on what success looks like. At times, I am not as clear as I could be on exactly what I want the person to do or what a good outcome for me is. I have worked on being clear about that upfront, so the person is clear about what they need to execute. I have found at times when I am unclear, some people are reluctant to ask as they think they should already know. I also encourage, during my check-ins, to talk about success along the way to ensure it is still clear and still makes sense in the context of the project. There are times that priorities might change, or we learn that the problem we thought we had is actually something entirely different so the measure of success may change. • Be clear on what failure looks like. I try to be clear and talk through what would happen if they failed at this. The point is not only to be prepared for any potential fallout, but also to reassure my team that I have WWW.THEICECOMMUNITY.COM

their backs should failure happen. You need to support your team and be there to avoid anything catastrophic from happening, but you should create safety for your team around low-impact failures. Think through with your team about who would be impacted and how, if things do not go as planned. • Be very clear about the why. Make sure that there is agreement on why this delegation is important and why it was important that you chose them. Have the discussion to pull in the things you learned from your delegation map about their strengths and weaknesses. You might say, “I thought this would be a great project for you because I know you want to grow in the physician relationship space.” • Check in frequently through the process. I try to frame this in a way that I do not come across as micro-managing. I don’t focus on progress, but focus more on asking what they are learning about the process. Oftentimes, I will even start

out by saying not to give me a status update on the progress of the project, but a status update on you. How are you feeling about this project? Is there anything you need from me for this? So even though at times I need to work on my patience, the rewards of seeing teammates grow is well worth it. I have grown to gain more satisfaction in the success of others and witnessing the growth of the talent around me. • MARIO PISTILLI, CRA, MBA, FACHE, FAHRA, is administrative director for imaging and imaging research at Children’s Hospital Los Angeles. He is an active member and volunteers time for ACHE and HFMA organizations. He is currently serving on the AHRA national Board of Directors. He can be contacted at mpistiili@chla.usc.edu.

REFERENCES Sostrin, J., To Be a Great Leader, You Have to Learn How to Delegate Well, Harvard Business Review, 10 Oct, 2017.

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CONTINUUM OF CARE E

veryone knows that going for a yearly mammogram can be stressful. That stress is exacerbated when it is for a diagnostic study. Stress builds from the anticipation of when a symptom is detected, to the day of the appointment. Patients often come in anxiety ridden and nervous.

BEST PRACTICES BY AMY PERONACE

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Now, imagine you are walking into a breast center of excellence where the radiologists are fellowship trained in breast imaging and the staff specializes in breast imaging. Imagine that office is also contracted with a medical vendor to train its staff and surgeons on the latest biopsy equipment. It eases a patient’s anxiety to know they will receive face-to-face contact with the radiologist to discuss their results at the time of the appointment. What happens when a biopsy is recommended? Would you look for a facility that can help you navigate through the biopsy procedure, help you coordinate continuing care and take the stress and burden off locating advanced medical care? Many women get their mammogram based on convenience, where their friends and family go or where their doctor sends them. A mammography center selection shouldn’t

be based on just those criteria. A truly integrated breast center excels in what it can do for the patient regarding continuum of care, managing the patient’s results and coordination with labs, specialists and counselors. This is all something we offer at Banner Imaging. We have designated Breast Centers of Excellence, complete with fellowship-trained radiologists, dedicated staff and Breast Cancer Navigators to help guide patients through what could be one of the most stressful times of their lives. We also have a Bard Center of Excellence in which our radiologist does case reviews and trains others on the latest biopsy equipment. Since Banner Imaging is affiliated with Banner Hospitals and Banner MD Anderson, patients should be at ease knowing they have a fully integrated medical community at their fingertips for continuum of care. Along with this, we work very closely with multiple oncologists and surgeons throughout Arizona to deliver the most comprehensive and highest quality of care to our patients. Banner Imaging, along with a multitude of imaging centers and referring physicians, have installed a medical portal called Powershare which allows us to easily share patient images with their orthopedic, surgeon, oncologist, etc. It also lets us send ADVANCING THE IMAGING PROFESSIONAL

Since Banner Imaging is affiliated with Banner Hospitals and Banner MD Anderson, patients should be at ease knowing they have a fully integrated medical community at their fingertips for continuum of care. and retrieve images with other medical centers to ensure complete care for our patients. Our partnership with Banner MD Anderson led to implementing a Breast Cancer Navigator process. Once patients are referred to this program, they have complete access to genetic counseling, nutritionists, counselors, oncologists, surgeons, plastic and reconstructive surgeons, all to help guide them through this process. This process not only helps guide our patients but also helps referring physicians with ease of scheduling as well as getting the best care for their patients.

ON THE HORIZON •R ad Path correlation: The communication and teamwork between a radiologist and their pathologist is critical in biopsy centers. Radiologist must trust and have a good working relationship with the pathologists interpreting the studies for their patients. Our partnering pathologist will begin hosting quarterly meetings with our breast imaging radiologist. This will give them to a chance to connect and discuss interesting cases and rare pathology. This strengthens that relationship and lets them discuss, in depth, outcomes affecting breast and thyroid biopsy patients. •O n Site Cytology interpretation: We are working closely with our pathologist to provide onsite interpretation to our thyroid WWW.THEICECOMMUNITY.COM

biopsy and fine needle aspirations patients. With the use of a special microscope, the slides are sent directly to the pathologist remotely and he can determine if we have adequate sample size as well as diagnose the specimen immediately. This will result in immediate results for our providers and patients. •G enetic Testing: Banner Imaging has partnered with Ambry Genetics and its high-risk program that screens for a patient’s breast cancer assessment risk and family history, identifies high-risk patients, and educates them about genetic testing prior to their imaging appointment with Banner. By identifying high-risk patients, we can refer patients to a network of specialists to ensure they get the proper screening or treatment. A positive patient’s family members can also be tested for free so it’s a great way to save other generations of the family. As we continue to fight the cancer battle for those we love, there is some peace of mind knowing that programs, partnerships, counseling and teams of medical professionals are available and can be easily accessible from the first step toward fighting this battle – at a routine mammogram. • AMY PERONACE is the director of women’s imaging at Banner Imaging in Phoenix, Arizona.

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CHANGING OUR NARRATIVE I DEPARTMENT/ OPERATIONAL ISSUES BY JEF WILLIAMS

have discovered a rhythm to our industry over the past nearly 20 years working in healthcare IT and medical imaging. Despite the disruptive nature of innovative modalities, AI, analytics and advanced imaging applications, there remains a staunch ebb and flow that is quite predictable. I would characterize this pulse as the interplay of vendors, providers and events. Purchasing, innovation and, ultimately, adoption is dependent upon this annual dance. This is not unique to health care nor imaging. You can find these patterns in technology (Oracle Week), fashion (Paris Fashion Week) and consumer electronics (CES). I find it interesting, though, that much of the message that wraps these popular and intensive events has often found its way into the local, daily vernacular of health care environments where real people are doing real work to solve the mundane, yet important problems. People return from these events with some sense of confusion related to true solutions but with a pocketful of terminology. “We need to look at cloud solutions in a deconstructed model that provides an enterprise platform,” says one meeting member. “Oh no, we will be federating with a careful eye to data in motion utilizing a VNA with zero footprint viewer to ensure data

protection,” argues another. Thing is, both may be right, and possibly no disagreement truly exists between them. Vendors have historically adopted a transactional model for sales and engagements. Modalities, and even PACS to a certain degree, were known quantities. I speak often with leaders within the technology solutions and they are fighting hard to build consultative sales teams. I applaud this effort, but it is incumbent upon those of us who are making or influencing decisions to really enforce this type of behavior. We need to drop the terms that everyone knows and start with problem statements and use cases. Only then will we make the kinds of informed and smart decisions that make our technology eco-systems and ultimately our organizations higher performing and better prepare for the ongoing shifts in delivery. I am not pointing fingers here or vilifying vendors for this. They need to find ways to explain these innovative solutions and often are looking for ways to differentiate products and functionality. The downfall here, from what I have experienced, is that burning that into our local lexicon can cause significant issues with design, procurement, development and ultimately deployment. Many times, I have experienced conversations in war rooms and board rooms that are not truly achieving their true value because of the limited vocabulary of those in the room. Just recently I was discussing with a CIO their recent procurement of a solution. I asked what drove that decision

Your long-term goals may require near term solutions.

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ADVANCING THE IMAGING PROFESSIONAL

– his response was, “Because everyone in imaging is telling me we were the only people who don’t have this.” Problem is, this organization already had equivalent functionality required to meet their business model with existing systems. What they really needed were tools around simplifying access and optimizing their workflow. So, how do we get better at asking the right questions and moving away from marketing and vendor narratives in defining our problems and getting better in defining exactly what we are working toward and what we need to get there? Here are a few tips I have learned over the past few years in preparing for strategy, design and selection meetings. • Orient Yourself: Everyone is tempted to “keep up with the Joneses.” Problem is, the Joneses are looking to farm, and you may be looking to manufacture. Architecture must align with business and clinical strategies. Too often those in IT get caught up in wanting the latest and greatest. While that is a lofty goal, health care does not generate enough revenue from IT to let them drive. Just because we can, does not mean we should. Know yourself. Know what you are capable of doing. WWW.THEICECOMMUNITY.COM

Then, be sure you are justified in what you are doing. • Clearly Define Your Problem Statement: Problem statements are tricky. The stakeholders within health care represent differing, and often conflicting, interests. Defining the problem statements begins with defining the stakeholder group that represents the problem statement. There will be a list. And all will be important. But they will not be equally important. Prioritize. • Codify Your Goals and Outcomes: What are you trying to achieve? Break it down by year over a 5-year process. These goals are related to revenue, cost avoidance, architectural simplification, data security, clinical workflow and patient engagement. Codifying these outcomes will help you contextualize the vendor solutions and offering beyond how they may brand or bundle functionality. • Consider Alternatives and Bridge Strategies: Your long-term goals may require near term solutions. You may need to adopt a bridge or interim strategy that allows you to meet your goals in some unique way prior to future enterprise adoption of a single vendor system providing critical steps required

within a department or specialty. • Come with an Agenda: Any meetings with vendors should be driven by your best-informed leaders. Those who have done steps 1-4 above. Certainly, respect those from the vendor side who’ve taken the time to prepare slides or demos, but begin the conversation before you meet. Clearly define what the meeting is about, have a clear agenda of what you want to discuss, and let them know what the outcome of the meeting will be. This will ensure a better experience for everyone, save hours of wasted demos and PowerPoint presentations, and ultimately speed your decision-making and ultimately your better new future. This is a most exciting time to be in our industry. And our success in achieving better health care will require a better-informed buying community, and a vendor community committed to collaborate and consultative sales and support. I am hoping, and diligently working to ensure, we don’t mismanage this great era. • JEF WILLIAMS, MBA, PMP, CIIP, is a managing partner at Paragon Consulting Partners.

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LEAN IN – CREATE THE SPACE FOR THOSE YOU LEAD TO BE HUMAN

A RAD HR BY JANEL BYRNE

t this point there’s little doubt that the year 2020 has fundamentally shifted how each person in the United States (let alone across the world) is living their lives. I don’t hear anyone in my network claiming, “Well, we’ve seen this before and this is the ‘how to’ guide for managing this effectively at home and at work.” And, as I write this, George Floyd was murdered approximately one month ago. For Black and African-American individuals this tragedy – plus the deaths of Breonna Taylor, Ahmaud Arbery and so many more – is NOT a shift in their world. This is their reality every day. To clarify intent up front, I do not intend to use this space to incite a political conversation. Rather, my hope is to inspire leaders to lean into their discomfort and to be more present, visible and engaged with their teams

ICEMAGAZINE | OCTOBER 2020

than ever before. Silence is NOT the answer. Your teams need you as they continue to navigate their world amidst COVID-19 and their personal and systemic experience of racism in the United States. That said, what does action, or leaning in, look like for leaders right now? While leadership is not a one-size-fits all approach, leaders need to be checking in with those they lead. This means explicitly letting those you lead know that you care about them as human beings first, you are here to listen, learn about their experiences and better understand what success looks like for them. To make this more tangible, the examples I will share are in real-time, as I’m learning alongside all of you. An immediate lesson I continue to re-learn is that my intent does not matter; my impact is all that matters. Intent lives in your head and people do not walk away with what you intended for them to hear, rather, they walk away with what they heard, how you made ADVANCING THE IMAGING PROFESSIONAL

them feel, and how you impacted them. In multiple virtual meetings this past month I’ve seen myself and other leaders “step in it.” For example, in a department meeting where employees were invited to share how they were feeling, folks grew emotional and shared a lot of anger. The leader facilitating the conversation felt like he needed to respond to each person’s statement with some kind of solution. In response to an employee stating she feels she’s been treated differently at work because she is a Black woman, he said, “I’m so sorry you feel that way and we do not stand for that here – that’s never our intent, we are against racism!” While (again) well-intentioned intent does not matter here, impact does. For leaders, we already feel pressure to find solutions when our teams bring forward challenges. In this case, these conversations are not about finding an immediate solution, they are about creating and holding a safe space for those we lead to share their authentic, raw experience and pain; and for them to ultimately contribute to, and have a say in, what is done to make things better. With this response, the leader unintentionally disregarded this employee’s experience; her truth. While I’m not in this employee’s head, I fear she may have walked away thinking “He’s not actually here to listen to me; he just needs to defend the organization.” In this case, the leader and I debriefed afterward and I shared this observation with him. He took the feedback graciously and I walked away empowered to bring observations like this to the forefront in the future so we can all continue to grow together. I saw him shift his approach in the very next meeting. Instead of responding to each person’s statement with a solution he said things like, “Thank you for your courage and vulnerability ... is there anything else you’d like to share?” Or sometimes he just said “Thank you” because that’s all that was needed. I was particularly impressed when he stated, “I will never know what that was like for you as I’m not you and never will be. And, as your leader, I know I can do better. What can I start doing, stop doing and/or continue doing for you WWW.THEICECOMMUNITY.COM

right now?” I also know he followed up with his team individually to ask about his impact. “Overall, how was that conversation for you?” “What can I do on a go-forward to ensure you have a safe space to share and contribute so we can all move forward effectively?” For meetings I have been leading, I begin with a check-in. I have noticed that I struggle with how to best open the conversation and then hold the silence, i.e., not try to fill the space with my voice and instead allow my team to process and share in their own time (even if that means we sit in silence for a few minutes). In one meeting I opened by saying, “I would like to hear how everyone is and what you are experiencing right now ... even if it’s just one word that describes where you are

An immediate lesson I continue to re-learn is that my intent does not matter; my impact is all that matters. today. This is a safe space, surrounded by the warmth of your colleagues, for you to be human.” There were minutes of silence that felt like an eternity, and then there were words I’m not used to hearing at work, which included folks swearing, tears, people challenging one-another’s statements and people too concerned to speak up because they don’t want to say the “wrong” thing. I found myself also saying “thank you” and asking for clarification with statements like, “Help me understand, when you say you feel numb, what does that mean to you?” There were also times when I opened the floor to others who were silent and they stated they did not want to share. I was reminded that creating a safe space is about the space for people to share and NOT

share – which is absolutely OK. I made a mental note to follow-up individually to offer a private space to share. In general, you will have folks who would rather discuss items one-on-one versus in a group – and sometimes folks who benefit from both – and for these conversations, it’s vital to ensure individual time exists to process as needed. I also found myself getting responses like, “I’m OK,” followed by silence. This is an invitation to dig a little deeper to truly understand what “OK” means to them and what might be right under the surface. They may say that they still don’t want to share, which should be respected. Or, the additional nudge is all they needed to begin sharing. I came across this image that captures how a slight shift in the questions you ask may create the space for people to open up. Sometimes, “How are you?” is too open-ended or loaded for the person to respond, especially if they are struggling. Shift that to “What’s one thing I can do to support you right now?” or “What are your top three feelings today?” and you give this person a better opportunity to articulate where he/she is at and share what’s most beneficial for them. When it was time to close the meeting I asked, “as we come to a close please know this is not the end of the conversation, just the amount of time we have together today. This conversation, and us checking in with one another, is ongoing. For today, is there anything additional you hope to share so that you can walk away feeling as ‘whole’ as possible?” Now, as we come to the close of this article, a quote that inspires me to lean in and feel whole as a human being and leader is from Maya Angelou, “Do the best you can until you know better. Then when you know better, do better.” As leaders, we are going to keep making mistakes, especially now. What’s critical is holding ourselves accountable to those lessons and walking the talk - those we lead are human beings first and deserve leaders that do better. • JANEL BYRNE, MSW, SHRM-CP, is an organizational effectiveness manager at Children’s Hospital Los Angeles.

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HTMs EXPEDITING EQUIPMENT SERVICE WITH EXPERT THIRD-PARTY TECHNICAL SUPPORT

E BY LARRY NGUYEN

ach year, health care organizations spend millions of dollars on equipment maintenance. Reducing costly outside service technicians’ expenses by streamlining equipment maintenance and repair processes presents an enormous opportunity. This allows health care facilities the ability to reduce expense and increase revenues without sacrificing quality of care. Partnering with a reliable third-party vendor that offers effective technical support can help ensure the longterm reliability of expensive medical equipment. Unfortunately, the recent pandemic has left a draining impact on resources leaving many health care facilities fighting to stay afloat to continue serving patients. Both financial and regulatory constraints have put pressure on hospitals to do more with less and an uncertain future will likely pause new capital equipment purchases. Healthcare technology managers (HTMs) will be under even more pressure to service and maintain hospital equipment. In response to the pandemic, a more efficient and simplified process supplemented by third-party technical support is being widely used among HTMs. Rather than immediately requesting an outsourced

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technician when medical equipment malfunctions, clinical engineers are looking to expert third-party vendors who offer remote dial-in tech support to help them diagnose their equipment. Depending on the results of the remote tech support, HTMs can then determine if a field service technician site visit is required to repair their machines, or if a remote solution can resolve the issue. In addition, we expect that most third-party support vendors will offer 24-hour expert support to HTMs in health care facilities. These experienced professionals can provide clinical engineers with the assistance they need to resolve and perform service repairs. In general, there are three factors that an HTM should analyze to assess a remote technical support team. • Quick and accurate diagnosis is critical in assisting HTMs to service and maintain their medical devices. • High-quality remote technical support offers either A) immediate resolution if no electronic replacement parts are needed, or B) the ability to identify and provide high-quality replacement parts if there is an electronic failure. • The capability to walk an HTM through installation of the replacement parts and validation testing. In today’s health care environment, equipment downtime will have far greater ADVANCING THE IMAGING PROFESSIONAL

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consequences than ever before. This is due to increased utilization needs and lack of resources to increase the quantity of devices. Professional and reliable remote technical support provides HTMs and clinical users quick resolution of equipment failures, thereby maximizing equipment uptime. By providing an accurate diagnosis and quality replacement parts, high equipment uptime is maintained and capital spending can be significantly reduced. This optimal support model will lower costs by preventing unnecessary service on the same device. This process can be streamlined by finding a trusted third-party vendor that consistently provides high-quality repairs and replacement parts. A good indicator of a company’s service quality is the length of its warranty. Companies with longer warranties provide higher quality parts that last longer and indicate the vendor’s confidence in their service and product. A vendor’s reputation in the clinical engineering community is also a great way to determine the quality of its service. When health care facilities take service in-house, one concern they may have when working with third-party repair companies is that mistakes may inadvertently be made during the repair process. When parts are not repaired correctly there can be serious repercussions that could potentially compromise patient safety. To allay these concerns, the FDA published a report that there is “no WWW.THEICECOMMUNITY.COM

objective evidence is not sufficient to conclude whether or not there is a widespread public health concern related to servicing of medical devices, including by third-party servicers.” Even with support of the FDA, it is crucial for clinical engineers to authenticate every refurbished part to allow detection of flaws prior to installation. High-quality replacement parts and support are critical to a successful transition from traditional service agreements to full in-house service. Quality of support to clinical engineering teams is the foundation in building trusted relationships with end users. We recognize the pressures and comparisons to OEM service contracts that clinical engineers encounter and have found that decreasing downtime is even more key to increase equipment availability and utilization to best serve patients. At Summit Imaging, a team of technical support engineers are available 24 hours a day, seven days a week to assist your team with ultrasound equipment failures. Because of our experience and our comprehensive, growing database of diagnostic error codes, our diagnostic time averages less than three minutes per call, with a 97% first-time call accuracy. Summit Imaging’s technical support comes at no additional cost. •

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LARRY NGUYEN is CEO and CTO at Summit Imaging. FOR MORE INFORMATION, visit www.mysummitimaging.com.

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GIVING AI A HOME A PACS/IT BY MARK WATTS

s I gazed down on the blueprints for the new medical center the chief medical officer asked me if I wanted the signage to read Radiology or Medical Imaging? I was being given an opportunity to design a new medical center. As I looked over the design, I thought about the mistakes I had made in the past with new construction. Was I building the hospital of 15 years ago or the hospital of the future? Where would I put the Clinical Artificial Intelligence Center? Historical precedents in radiology and laboratory medicine offer lessons for how to shepherd a new tool into the realm of safe and effective clinical use. Such accomplishments were due, in large part, to the gathering of relevant stakeholders under a single department. This approach ensured that the necessary clinical participants took the controls rather than ceding them to third-party developers. Thus, to secure AI’s place in the annals of successful medical technologies, I would propose the establishment of the first departments of clinical AI. This proposal is deeply rooted in the history of American medicine. On February 22, 1890, the first X-ray photograph was “accidently” generated at the University of Pennsylvania, although unbeknownst to its creators, Dr. Arthur Goodspeed and William Jennings. When the significance of this emerging technology was finally appreciated after the discovery of Roentgen rays, Goodspeed began informally collaborating with surgeons to deploy the technology clinically. This quickly led to the first division, and subsequently,

ICEMAGAZINE | OCTOBER 2020

department, of radiology. Under the auspices of this department, clinicians, researchers, engineers, managers and ethicists worked together on a shared mission to pioneer various technologies and methods that are intrinsic to the way medicine is practiced today. Within academic medicine, algorithms are currently developed in silos by researchers interested in the intersection of health care and machine learning. This has led to a panoply of published models trained on health data, yet only a handful have been prospectively evaluated on patients. In fact, when models have been prospectively evaluated on clinical outcomes, the results have frequently been unimpressive. In contrast, the same multibillion-dollar technology companies that exploit patterns in our digital behavior to sell advertising have now founded entire research programs around health AI. I would argue that the lack of clinical results is the byproduct of a lack of coherence, leadership and vision. The failure to plan for success will lead to suboptimal deployment. If we in health care do not change course, we should expect that AI deployment to progress much the way the EHR revolution did, that is, mainly based on corporate and administrative benefits without requiring any demonstrable improvements in processes or outcomes for our patients or ourselves. As in the development of other areas that required full departmental support, the decision to establish a department of clinical AI has several logistical and policy implications. First, leveraging the premises of AI to improve health care represents challenges in several ways such as implementation issues and applied policies. A chief mandate of department of clinical AI would be to make health centers “AI Ready.” These initiatives should lead to the development of models that will directly ADVANCING THE IMAGING PROFESSIONAL

benefit the health of our patients, pioneer research that advances the field of clinical AI, focus on its integration into clinical workflows and foster educational programs and fellowships to ensure we are training current practitioners as well as the next generation of leaders in this field. In addition to these traditional tripartite roles, AI departments should also play an essential role in the implementation, utilization and enhancement of the infrastructures that underlie AI solutions. Central to this mission will be removing barriers to data access, and the proposed department would therefore assume partnered stewardship of the institution’s data as part of its mandate. While the role of information technology specialists in maintaining a health system’s computational infrastructure should not be subsumed, the department would be responsible for integration, research and production databases that can support its broader mission. By centralizing this role, we would finally overcome the chasms among ideas, development and effective deployment. Second, these new departments will be instrumental as the United States financial and regulatory environments shift to acknowledge and incorporate AI’s potential to improve care. The tasks and benefits involved may require a modified model of reimbursement such as that in place for laboratory tests. But as has been the case for corporate AI (eg, Amazon), demonstrated improveWWW.THEICECOMMUNITY.COM

ments in clinical and financial outcomes could provide financial incentives to support the clinical use of AI and drive the increased deployment of predictive models. Market incentives will no doubt promote the proliferation of companies seeking to sell models to health systems. However, the need for model re-calibration precludes simply buying and deploying third-party models. Clinical AI departments will work to ensure that health systems are poised for safe implementations that are tailored to their specific patient populations, and that the necessary data analytics will be readily available for negotiating with payers. Third, the clinical utilization of AI will require standardization such as the establishment of best practice guidelines regarding workflow integration design, performance assessment and model fairness. Appropriate models should be tested on held-out current data to assess performance and safety, and only then prospectively evaluated first without, and then with, deployment in terms of accuracy and impact on clinical end points. From there, regular re-assessments of model calibration must occur to ensure the relationship between the inputs and the outputs has not changed, and to re-fit the model where it has. This requirement for re-assessment and recalibration in a specific clinical context has become evident when researchers have attempted to apply one site’s data sets

across institutional, system and geographic boundaries: AI applications can be sensitive to small input changes, and this potential fragility must be carefully and expertly monitored. While AI intrinsically manifests some degree of “black box” characteristics, the functionality and reasons for its results should be as transparent and explicable as possible so that clinicians can incorporate these modalities into their workflows. Twenty years now into the 21st century, there is little question that AI will be a defining technology for the foreseeable future. We need visionary clinicians working with expert technical collaborators to establish the organizational structures requisite to translate technological progress into meaningful clinical outcomes. With the innumerable ways in which medicine could be improved, the hype around AI in health care will only be realized when the scattered champions of this movement emerge from their silos and begin formally working as a team under the same roof. Our patients are waiting for us to make use of these advances to improve their care, and every day wasted is a missed opportunity. As I looked at the blueprints for Fountain Hills Medical Center, I wondered who will establish the first department of clinical AI? • MARK WATTS is the enterprise imaging director at Fountain Hills Medical Center.

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HOW AI IS MAKING A LASTING FOOTPRINT ON BREAST IMAGING

W BY SAMIR PARIKH

ith October designattechnology. Over the last decade, the ed as Breast Cancer introduction of Digital Breast TomoAwareness Month, now synthesis (DBT) provided radiologists is an especially pertinent time to with more image slices and data than reflect on the most talked about ever before, allowing clinicians to have a trend in breast canmore holistic view of the cer screening – Arbreast and detect more The process tificial Intelligence invasive cancer – a huge (AI) – and where it’s boon since early detecreduces the headed. When you tion saves lives. number of consider the primary Although this wealth images to review functionality of AI of information has been and thus the in breast imaging, helpful in identifying canand its initial impact cer, the associated large amount of time on enhancing workdata file sizes and abunnecessary for flow and improving dance of images can hinreview, without accuracy in recent der the efficiency of the compromising years, the topic is image reading process. even more relevant This issue spurred the image quality, in light of the backdevelopment of AI techsensitivity or log of cases facing nology that can identify accuracy. many clinicians as clinically relevant regions screening facilities open their doors for mammograms after the COVID-19 lockdown. Image reading, in particular, has benefited greatly from innovations in AI

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of interest and preserve important features during the creation of 6 mm slices from the original high-resolution 3D data. The process reduces the number of images to review and thus the amount of time necessary for review, without comproADVANCING THE IMAGING PROFESSIONAL

mising image quality, sensitivity or accuracy. This example is only one recent advancement of many that demonstrates how AI is positively influencing mammography and where it is likely to go in the future. With AI, time is on our side â&#x20AC;&#x201C; the longer AI applications are in play, the more cases consumed; and therefore, more insights are revealed. There are still many other aspects of breast imaging that could use refinement in efficiency in the long-term, paving the way for AI technology to continue to grow and make a sizeable impact on the delivery of patient care. One aspect is the development of new risk models for patients based on their electronic health records in order to have an efficiently compiled and more personalized screening pathway plan WWW.THEICECOMMUNITY.COM

before they head in for screening. Currently, women who are at high risk of breast cancer can qualify for an MRI scan, and women with dense breasts (who have a slightly elevated risk of breast cancer) can qualify in some states for an additional test, such as ultrasound. The current risk models use simple metrics such as a womanâ&#x20AC;&#x2122;s breast density, but machine learning offers the opportunity for improved risk prediction, by, for example, finding patterns in mammograms that are predictive of breast cancer but are not identified by radiologists today. In fact, beyond imaging, AI may one day similarly have the ability to efficiently determine the best course of treatment after screening and diagnosis. Additionally, to further streamline the screening process and as AI technology quite literally grows

smarter, there exists potential for certain mammograms to be marked almost definitely benign, giving clinicians the confidence to either skip the case entirely or review quickly. This would allow clinicians to move on to the more complex, higher risk cases in their workload. In conclusion, the need for efficiency and quality care in breast imaging endures, solidifying a critical role for AI in mammography that will only continue to develop. By examining the current inefficiencies with breast screening and health care, trend-followers in the breast imaging technology industry can best anticipate the new needs that AI has the exciting potential to meet. â&#x20AC;˘ SAMIR PARIKH is the global vice president of research and development for Hologic Inc.

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EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI

THREE THINGS YOU SHOULD KNOW ABOUT ANGER

ost people have seen anger in the workplace. Since it’s a natural human emotion, we’re bound to see it from time to time. While some people get angry more quickly than others and others never seem to show it at all, there are three things all workers should know: why anger occurs, how to recognize its different forms and what do to with it.

WHY ANGER OCCURS Everyone is born with the emotion of anger. As babies, we can’t talk, so anger is useful for helping us get our needs met. If we’re hungry, we get fussy. If we’re thirsty, we get fussy. If we need a diaper change, we get fussy. Then, when someone notices we’re getting fussy, they consider what might be causing the 48

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fuss and address the issue. Eventually we learn to talk and – hopefully – we’re taught to ask for things to get our needs met. But if you’ve ever seen an elementary-age child throwing a temper tantrum, it’s fair to say the child is still using anger to get his or her needs met. Adults who use anger are doing the same thing. When it all boils down, people have two reasons for why they display anger: • s omething is happening that they don’t want to happen • s omething is not happening that they want to happen If a person has not learned alternative methods for achieving his or her desires, such a person may default to what worked in his or her infant and toddler years – anger. Also, know that some people use anger as an intimidation tool. This ADVANCING THE IMAGING PROFESSIONAL

approach works on people who dislike being around conflict, because such people will do whatever is necessary to avoid the conflict. Thus, a person may use anger to manipulate such people. Anger also works on people who want to be liked. If person A wants to be liked by person B and person B gets angry about something, person A will often move mountains to ensure person B stops being angry. Sadly, if person B knows this, he or she may choose to display anger just to get his or her way. Some people say anger can be a response when someone senses a loss of control, but really, this ties to the two bullet points above. Think about it. If something is happening (or not happening) that you don’t want (or want) to happen, you may display some form of anger to influence (or manipulate) what’s going on. It’s a way of regaining a sense of control in the situation.

TYPES OF ANGER Typically, we think of anger as aggressive, outward behaviors. Someone raises his or her voice or slams a door or hits a wall or desk. Such a person may even throw things or get physical with others. Displays of external anger are easy to recognize. But anger can also be internal. The phrase “beating yourself up emotionally” is actually an inward display of anger. Internal anger can also occur through self-harm, such as cutting, or emotionally isolating oneself from others. A third type is passive-aggressive anger. This includes acts that damage someone else’s property, reputation or psyche through a subtle action that has plausible WWW.THEICECOMMUNITY.COM

deniability. This can include “conveniently forgetting” to do something, shutting someone out of a decision-making process or completing an assignment late or not to an expected level of quality. People often rationalize their reasons for displaying any of these types of anger, but those reasons will always boil down to something not happening that they want to happen, or something happening that they don’t want to happen.

WHAT TO DO WITH ANGER It’s a good idea to find ways to get things done without resorting to anger because anger is truly not healthy for us. According to Chris Aiken, MD, an instructor of clinical psychiatry at Wake Forrest University School of Medicine, “In the two hours after an angry outburst, the chance of having a heart attack doubles.” Studies also show that people who have outbursts of anger are three times more likely to have a stroke within two hours of the outburst. But you can’t just repress anger, either. Aiken also says that repressing anger doubles one’s risk of having coronary disease. Anger is also known to weaken our immune systems. Remember that anger, whether it’s external, internal or passive-aggressive, is simply an attempt to regain a sense of control. A danger also exists if a person holds that mindset for a long period of time, as it can lead to anxiety, stress, substance abuse and even depression. The good thing is we have other choices. Healthy alternatives to anger are almost always available, it’s just that we must learn them.

In my professional background, I know we can’t unlearn things, we can simply learn alternative actions and choose them instead. Therefore, one way to regain a sense of control without using anger is identifying and choosing healthier alternatives for regaining peace and/or confidence. One great method is to realize that when we get angry, there’s almost always something we could have done differently so that whatever happened didn’t happen that way. Many times that action has to do with planning and communication. After all, most co-workers aren’t clairvoyant. Specialists also recommend counting or taking deep breaths or going for a walk, and yes, those types of actions can be helpful. If you have the time to do an activity that gives you a short-term sense of control, it’s probably a good idea to choose it. It will calm you down enough to think through a larger, more difficult situation that leads you to be angry. But, for long-term solutions, I recommend my clients think though what they could do differently in the future to prevent a troublesome, anger-inducing problem from happening again. That type of thinking leads to long-term growth – and decreasing the number of times one gets angry. • DANIEL BOBINSKI, M.Ed. is a bestselling author and a popular trainer on workplace issues. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach him on his office phone, 208-375-7606, or through his website, www.MyWorkplaceExcellence.com.

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