TechNation recently invited several companies to participate in this roundtable article on diagnostic imaging devices. Participating in the article are Agiliti Vice President of Clinical Engineering Chris DeHart, MW Imaging Senior Service Director Tom Hanak, Probo Medical Director of Training and Field Service Hobie Sears and Innovatus Imaging Vice President of Sales and Marketing Matt Tomory.
Q: What are the basics that every biomed should know when it comes to imaging devices?
DeHart: There are a few things every biomed should know about imaging devices. First, they should have a foundational understanding of basic radiation theory and X-ray. Second, biomeds should take part in radiation safety training prior to working on any device that emits radiation. They should also have training on the specific devices they service and the proper tools and test equipment to use. Lastly, biomeds should have a desire to service and work closely with customers. Hospitals rely heavily on these devices and back-up equipment isn’t always available. Having effective communication skills with a high sense of urgency is important to keep the customer informed on service activity.
Hanak: When it comes to ultrasound devices, there are three things that are core. HTM professionals servicing their fleet of ultrasound systems should have a basic knowledge of ultrasound principals and theory, a general knowledge of transducer care and handling, and they should have basic training on the particular platform they are servicing. Every ultrasound system and OEM are different in one way or another. When the engineer has basic system training, this increases their confidence and provides for a better evaluation of the system overall.
Sears: There are several things to understand when moving into the imaging realm of service. These include the urgency of service, the greater the spotlight will be on you as the engineer and the amount of communication that you will need to provide to the various shareholders in the imaging department will be greater. Often biomeds are referred to as generalists, moving into imaging will also change that perspective … you are likely to become a specialist, or at least an engineer with specialist’s qualities. You must be prepared for these new challenges, which will include technical training, of course, it should also include soft skills training to fill in any gaps you may have in your communication/people skills. The technical stuff is generally easier for engineers and getting those soft skills refined takes as much, if not more, work and practice.
Tomory: The basic functionality of the device or how to operate the device. When I first started with GE Ultrasound in 1999, I was not trained on an echo system called the Vivid 5. When I arrived, I could not immediately find the very obscure on/off switch which unfortunately was quickly noticed by the sonographer. At Innovatus Imaging, I teach an ultrasound applications/knobology class for service engineers which encompasses basic operation, imaging modes, terminology and functionality tailored for service engineers. Preventative maintenance would be the next step in the process followed by technical training to diagnose and repair the device.
Q: What are some approaches/strategies health care facilities can use to maintain and repair their fleet of imaging devices?
DeHart: Hospitals have a lot going on, and it can be challenging to keep an aging fleet of imaging equipment running. Many times, this equipment is at end of service life with the OEMs, which makes accessing or sourcing parts a lot more difficult. Eventually, all devices will become unserviceable by the limitation of parts, and this is where customers must pay attention to the service frequency and equipment downtime to help make informed decisions on servicing their imaging equipment – or purchasing new modalities. Tracking equipment downtime is one of the most important strategies health care facilities can use because of the impact it has on patient care. If customers are unable to provide services for a patient and the patient goes out of network, the hospital loses out on revenue for that patient.
Hanak: Empower your engineering team by providing system training and making sure there is a good support system in place. Utilizing quality focused companies (ISO 13485:2016 certified) that offer services such as free technical support further enables your team to access knowledge related to troubleshooting difficult issues. While patient safety is the most important aspect of any imaging device, uptime is also critical to keeping everyone happy. These independent service organizations have the ability to send hero kits and parts for the systems, as well as provide loaner probes during repair. It is essential to have a great support system that can walk the engineer through the process of diagnosing the issue all the way through to the final function verification of the system.
Sears: Generally speaking, invest in your greatest asset: your imaging engineering staff! Make sure the imaging engineering staff is well-trained and efficiently deployed. With staffing shortages these days, you need to be sure that your imaging engineers have the training and support they need. As well, if you have a staff that will be reduced due to retirement, you need to have a plan in place to capture that knowledge. (I’ve seen many folks retire with knowledge that could have been captured, yes it would have cost a bit more, but it would have been worth it.) With a trained staff you can create partnerships with companies you trust regarding parts and other necessary components, training, backup labor, etc. to keep your imaging equipment running efficiently.
Tomory: This is more of a timeline: Before the purchase order is sent for the device, service training, manuals, diagnostic keys, etcetera must be negotiated so the facility may service after the warranty period. Research should also be done into the availability of parts and devices such as probes and coils – in the case of ultrasound and MRI – to ensure the ability to support post-warranty. Prior to warranty expiration, audit companies you can rely on for support including taking on-site or virtual tours, check for ISO 13485 certification, history of supporting the HTM community, scalability and reputation to ensure seamless transition to in-house service.
Q: What are some important service items to discuss with the OEM when purchasing new devices?
DeHart: For imaging equipment, it’s important that the features and functionality of the device fully meet the clinical care needs of the organization – which should be discussed thoroughly during the purchasing process. Service costs continue to increase, so if you can negotiate a longer warranty period upfront, this will help to reduce the service cost over time. You can also look to negotiate service contracts prior to the sale as vendors may offer discounted service contracts at this point in time. Another service item you discuss is clinical training and support for the life of the device. With the current high rate of turnover in many front-line roles, having a plan for the ongoing training needs of new staff is really important.
Hanak: The initial warranty of the product should be addressed. Determining what is included in that warranty; what is the response time on service, what is the lead time on parts and probes, will access be provided so I can perform my own routine maintenance? You also want to address system training for your engineering team. When the OEM warranty has expired, have they provided your team system training so you can continue to service your equipment? You may want to discuss post-warranty services as well; know what the cost breakdown is for labor and parts, and how they handle repair and replacements for transducers.
Sears: The discussion should include all the service items. Part of the buying process should be a comprehensive list of all the needs a hospital-based imaging engineer will require to provide service on the device after the warranty. This is, of course, easier to say than achieve. But it should include the delivery of real service manuals, training options and the ability to access OEM service-level tools on the unit. Will you get all these things? Maybe or maybe not, but you certainly won’t get them if you don’t ask.
Tomory: As mentioned earlier, negotiate for training (comprehensive – not first look), access to diagnostics (full and detailed – not just pass/fail), service manuals (not basic but comparable to if not same as issued to OEM service engineers). Also discuss opportunities and conditions/barriers to upgrades in the event hardware or software improvements are made which may be bug fixes (unintended features ) or system enhancements/additional functionality.
Q: What type of training can in-house biomeds complete to better service imaging devices?
DeHart: First and foremost, biomeds should complete device-specific training for the equipment they need to support. After they complete formal training, there are a number of more informal tasks biomeds can do to build their knowledge, experience and comfort level with imaging equipment. They can help with “first look” service requests, like making sure equipment is plugged in and cords aren’t kinked, checking on environmental factors and making sure the room temperature (humidity) is at the appropriate level. These are simple tasks biomeds can do to help familiarize themselves with the equipment when they are first starting out. First look service requests can also include very light troubleshooting without disassembling the equipment, which is where engineers can get in trouble if they have limited experience. Another good place to start is with routine preventive maintenance because they can follow the step-by-step instructions.
Hanak: Basic knowledge of ultrasound principles and theory, a general knowledge of transducer care and handling, and basic training on the particular platform they are servicing are recommended. There are a multitude of training courses available. For those with zero ultrasound training I would recommend basic ultrasound theory to start then escalating to system specific training. System specific training is usually hands-on troubleshooting and repair for each model and will include system architecture and theory. There are other classes such as transducer handling and care, and networking and connectivity classes that can be taken as well.
Sears: A biomed moving into any imaging modality should start with the basics. That doesn’t mean they can’t shadow/work with an experienced engineer, but that kind of OJT is not a replacement for foundational training. It is best to have both: a solid foundation in training, and the ability to be mentored by an experienced engineer. Once the foundation is strong, other training can be added on top with higher results. At Probo Medical we teach a basic ultrasound course just prior to any system course making it convenient to do both in one trip.
Tomory: Technical training from the OEM or independent service organizations is critical but do not neglect the soft skills of the operational training I mentioned earlier. Without understanding how to operate the device, you may become a good engineer but not a great one. Also, do not neglect your communication skills. These are important in all aspects of life of course but technologists are under tremendous stress when imaging devices malfunction – repairing the technologist is as important as repairing the device. This will also be of great importance when this does not go according to plan which frequently occurs.
Q: How can independent service organizations assist with the maintenance and repair of imaging devices?
DeHart: Independent service organizations (ISOs) can serve as a neutral third-party to support hospitals with developing service strategies that prioritize turnaround times while reducing costs. This can include onsite repair services and parts sourcing – or utilizing remote diagnostic and monitoring capabilities to see device status and even provide proactive service scheduling. ISOs can access and recertify imaging parts to ensure hospitals have the right part at the right time in the most cost-effective means possible. Lastly, ISOs can serve as a valuable partner when it comes to evaluating new technologies – providing an unbiased perspective during the capital planning process.
Hanak: Independent service organizations can assist with maintenance and repair of ultrasound imaging devices by offering multiple services such as probe repair, free technical support, on-site repair, sales of parts probes and system. These services allow the clinical engineering/HTM departments and the biomedical engineers the confidence to effectively support the ultrasound departments they service. MW Imaging offers all these services and we take pride in being an ISO 13485: 2016 certified company dedicated to providing the highest quality products and services to our customers. MW Imaging Corp. has deep tenure in ultrasound service and parts. Having been in business for 30-plus years our depth of knowledge exceeds the industry norm.
Sears: ISOs are uniquely set to help facilities work on imaging devices, because we understand their needs better. Obviously, we are not the manufacturer and have many of the same hurdles in front of us as hospital facilities. We figured out how to be successful in spite of those hurdles and can therefore impart those ideas. ISOs, such as Probo Medical, are also very customer-centric and have a high sense of urgency. We have numerous ultrasound modality experts that work at the field level servicing our customers. So be it parts, training, service, equipment or consulting we are more likely to have the same mindset as a hospital facility, than an OEM.
Tomory: ISOs are critical to the health of the U.S. health care system by providing cost savings, training, technical support, device repairs and replacement parts to supplement the OEMs. Health care providers must research potential partners (notice I did not say vendors) who will collaborate with them to provide fast, safe and effective service on imaging devices which ensure quality patient care as well as throughput and clinical satisfaction.
Q: What else do you think TechNation readers need to know about diagnostic imaging equipment?
DeHart: Technology is advancing faster than it ever has before. The most important aspect about medical device purchasing and service is to have a multi-year plan. Planning for the future will help hospitals to care for their patients appropriately and will help to keep their organization viable in the health care space.
Hanak: When servicing ultrasound equipment it is always a good idea to make a current backup of the system settings, and labeling the backup with the current software version, date and the system IP address. This should be done any time there are changes made to the system setting for any reason. Yes, it seems simple but it could really help you out when your system has an issue.
Sears: As a company Probo Medical is suited to help with the ultrasound imaging modality from the basics of training (basic and full system courses) to technical support as needed, helping you advance your career in imaging. When necessary Probo can provide parts, expertise and even onsite supplemental help, as you need it, to keep your imaging gear running at its greatest potential.
Tomory: Diagnostic imaging equipment is specialized, complex and mission critical for patient care and diagnoses, health care provider revenue and there are many layers of hospital staff which rely on the safe, effective operation of that equipment. This is why radiology is its own department and imaging support is usually separate from biomedical support. The staff has unique needs so speed/uptime, first time fixes, longevity of repairs and minimal disruption are essential.
