TechNation reached out to several radiography experts seeking their participation in this roundtable article on radiography. The article addresses the latest features in radiography equipment, how to overcome budget challenges and more.
Participating in the article and sharing their insights are MXR Imaging Director Strategic Accounts David Chandre; Tri-Imaging Solutions Siemens Lead Engineer/Instructor Kenneth Hable, MD, BSRT; GE Healthcare Vice President of X-ray for U.S. and Canada Brian Murphy; Carestream Health Worldwide Product Line Manager for Radiology Systems Steve Romocki; and Konica Minolta Healthcare Americas Inc. Director of Marketing for DR Guillermo Sander.
Chandre: It is an exciting time in medical imaging. This ever-changing area of health care never disappoints those interested in new technologies. Within the general imaging equipment category, we see advances in several areas that include the equipment as well as the tools used for image interpretation and distribution. Some of these include dynamic digital imaging, dual energy technology, dose tracking software, advanced auto-stitching, low-dose techniques and feature sets, the use of AI technology aiding in workflow and image interpretation, advances in the use of the FHIR interface platform as well as physician and patient portal access to image and report information.
Hable: Many of the newest and most exciting features entering the field of radiology equipment fall in the categories of machine learning and artificial intelligence (AI). Both are being integrated to improve a wide range of operational features and address all aspects of the system or equipment. This includes many different features of applied technology including the introduction of 3D cameras, enhanced automatic and virtual collimation, and exam workflow integration and management options. On the diagnostic side, AI is also making a significant impact within the field through the addition of deep learning techniques used to compare and aide in the reading of radiographic exams.
Murphy: The introduction of artificial intelligence and the trend of lower radiation dose paired with higher image quality expectations across a fleet represent the new complexity in buying decisions. New features in radiography equipment that can improve clinical outcomes for a facility spans from digitally enhanced image quality, cybersecurity packages, on-device artificial intelligence and software applications that can provide greater insights than what traditional 2D X-rays provided in the past. An example is GE Healthcare’s Critical Care Suite, the industry’s first on-device AI algorithm to prioritize critical chest X-ray review. There is not any one-size-fits-all answer, so it’s essential the vendor works closely with the buying committees to determine precisely what features and outcomes are most important to determine the best investment for their organization.
Romocki: Medical imaging equipment has evolved over the years becoming more flexible and intuitive. Budget constraints, workflow issues and space challenges are now easily overcome with smarter technologies. When buying new equipment, facilities should consider their specific needs. These may include augmenting workflow and productivity or deploying specialty practice applications such as orthopedics, women’s health care, pediatrics and otolaryngology. Choosing intelligent products that incorporate the latest technology such as artificial intelligence, while delivering quantifiable benefits, should be central to any equipment purchase today.
Sander: First you have to be fully digital; not just the detector but the entire system including the software. Also look to how the platform can be upgraded to future technologies, such as new image processing, stitching capabilities and capabilities such as Dynamic Digital Radiology, which enables physicians to observe movement by capturing up to 15 sequential radiographs per second. Look beyond system operation to how the equipment and manufacturer enable proactive service, such as Blue Moon Lifecycle Solutions, to maximize uptime and minimize in-person intervention. Finally, in an era of coronavirus, how efficiently can the system be cleaned between patients to maximize both safety and productivity.
Chandre: This business dynamic is more important than ever before. The need to explore beyond the traditional capital equipment budget paradigm is now an essential component for all health care providers. With our nationwide coverage for sales and service support, we see many approaches to this topic. Some include a restructuring of the budgeting process to encompass a decentralized approach. In this model, capital expenses are mapped to full revenue streams and patient encounters.
Others pertain to the standardization of equipment purchases that leverage buying power and reduce the cost of implementation due to a common and repeatable construction and logistic process. And, of course, the utilization of varied acquisition models ranging from purchase, lease, subscription and more. Additionally, it is not uncommon to notice several similarities in equipment from OEM to OEM. This occurs often in the areas of general imaging and portable units. Many OEMs use similar or the same base structural components while developing their finished products. We recommend you explore the details of the system and its sub-components to confirm that any perceived value-adds reach beyond the OEM’s name. Often, the feature and functional needs you have, can be satisfied by multiple products with widely varied price points.
Hable: Facilities should consider additional consideration during their budgeting plans around these key areas; 1) Identify the potential and expected life cycle of the equipment from the organizational point of view. This includes decisions such as; usage volume, usable life expectancy and future planned replacement schedules. 2) Identify and plan for the proper maintenance processes required to meet the desired equipment life cycle expectations. This means considering moving the routine preventative maintenance (PM) processes in-house as well as serious consideration of shared (first look) or complete in-house support of the equipment through utilization of existing biomedical and clinical engineering departments and staff.
Murphy: We are always happy to work with facilities to find a solution that meets their needs.
Romocki: Radiography devices have become far more flexible than before. Carestream encourages customers to engage in smart planning – understand needs, select solutions that fit radiology workflows, integrate systems and capitalize on the possibilities of digital imaging. Accordingly, facilities will be able to assess their budgets and make the right decisions. For example, upgrading for higher performance by choosing add-on features or using imaging software and detectors that works seamlessly across devices and reduces technologist training, are a few ways to overcome budgetary challenges.
Sander: Consider different system architectures and whether a straight arm or U-arm, often used without a table, can meet your clinical needs. For example, the KDR Advanced U-arm is a highly versatile DR system that can perform exams with or without a table as well as standing, weight-bearing and chair/wheelchair studies. Analytics and business intelligence tools such as AeroRemote Insights can provide the information facilities need to fully utilize imaging assets and plan for the future. Think through the use of the equipment in the next three years and examine the mix of studies you perform today and how that will expand in the future based on referral patterns. Some sites will purchase too many features and others don’t purchase enough, so again it goes back to what you need today and what you project for tomorrow.
Chandre: When selecting a service provider, we believe meaningful differentiators are, but not limited to, the following:
Hable: My recommendation is to consider any provider’s ability to offer a true provider/vendor partnership. This would include their ability to offer comprehensive, personalized service offerings. Examples would be troubleshooting technical support, part supply and support, as well as options for full, on-demand or flex service personnel offerings. Additional considerations should be given to a service provider’s ability to supply the necessary training for your in-house engineering and support staff. System or platform specific training for your imaging, biomedical or clinical engineering staff allows you to utilize existing staff resources for maintenance that reduce system downtime and increase internal customer service.
Murphy: Every hospital is under pressure to optimize the total cost of ownership. Needing to do more with less is the norm and health care providers must use innovative technology to compete. Digital service solutions use technology like preventive, predictive and prescriptive analytics to drive actionable insights. We would encourage radiology departments to look for service providers with extensive experience in health care combined with the ability to use machine data and analytics to provide insights for healthcare technology management improvements, including sustainable cost savings, while enhancing quality and efficiency. These are typically capabilities that are well suited for OEM service providers.
Romocki: Your health care facility is unique. Find a provider that will work with you to leverage your image capture devices for higher image quality, productivity and speed. They should be able to develop a custom mix of tools so that you are paying for things you need and use, as opposed to buying things you might not need right away. Most of all, your service provider should serve as a guide, offering suitable solutions and training with access to a network of technology consultants, field service engineers and technicians. Ideally, relationships with a radiology service provider should grow as your imaging needs grow.
Sander: Definitely look beyond break/fix and reactive maintenance. The business climate today doesn’t allow sites to have a system on standby. Ask about the tools and services available to manage the system when everything is going well. Does the provider or system capture data on productivity, rejects and retakes, usage, type of exams, etc., to proactively optimize use? Is remote monitoring available to help identify an issue before it leads to downtime to help the facility maximize ROI?
Chandre: We recommend working with equipment providers that offer a clear and flexible life cycle support path for the equipment under consideration. This should include the ability to receive upgrades, and service support, from the OEM and qualified third-party providers. An inability to step outside of OEM coverage can limit health care providers in many areas, including equipment upgrades. Consideration should also be given to the ability to receive software upgrades via remote access to the systems. This valuable method is often lost in the larger discussion of HIT security. We encourage our customers to thoroughly review this method and weigh the risk/benefits of this item with their HIT/HTM teams.
Hable: I strongly recommend a clearly defined SOW and/or SLA prior to purchasing decision. Considerations for the SOW/SLA should focus on compatibility with the current and desired facility workflow. This helps ensure future upgrades integrate as seamlessly as possible within the departments existing workflow while meeting the new goals set forth for the new addition. Work with related departments such as HTM/IT staff so features such as security and interoperability can be accounted for in advance. Lastly, consult with your favored third-party service provider to consider after warranty support, part availability and staff training.
Murphy: Technology obsolescence management programs offered by OEM service providers can help ensure your investments remain current over the life cycle of the product. These offerings enable refreshes of your radiology equipment by leveraging computing system hardware and system software upgrade options, along with cybersecurity and O/S vitality solutions. Often OEM service providers can structure these offerings as part of a recurring subscription that can meet your operating budget needs.
Romocki: With careful planning, worthwhile upgrades are within reach. Identify your requirements and consider benefits to technologists, clinicians and patients. Does your site need a software or hardware upgrade? Would an add-on feature bridge the gap? Could a portable imaging system fill a need? These are a few important questions to answer as your facility mulls an upgrade. Depending on the solutions in use, it is possible to scale and extend the life of imaging devices. Work with your radiology service provider to examine solutions available to you.
Sander: First and foremost, ask the questions so you understand what you are buying. Can I add a second detector? Can I add more features? How will the manufacturer continue to invest in the platform? Systems may have a digital detector, but was the software also designed to operate the equipment, control the column and arm movement or provide direct a connection to the generator.
Chandre: We believe the involvement of biomedical personnel is critical for a sound decision when purchasing imaging equipment. They serve as subject matter experts (SME) to the decision team. They aid in the evaluation of the system’s technical parameters, such as, research regarding any known system up-time issues, serviceability, service options, biomed training considerations, PM requirements and connectivity to facility systems as well as adding to discussions pertaining to equipment life cycle and/or total cost of ownership projections.
Hable: Really pay attention to maintenance costs as this is their area to provide significant impact to the bottom-line. Consider OEM warranty costs as well as shared and third-party provided options. Work with a provider to consider all the costs and availability/feasibility of obtaining the necessary training, tools and other special equipment needed to properly support the equipment. Additional considerations should be given to the ability to integrate the support of any new equipment into their existing workflow and volume, what the OEM recommended PM and service intervals are and how the addition of this equipment will fit into their current system to monitor and manage it.
Murphy: Biomed team members should focus on promoting products and services that promote a lower the total cost of ownership. These can include elements of the following service enablers:
Romocki: Thoughtful planning lies at the core of every purchase. Radiography devices perform critical functions, whether at a hospital or an imaging center. Clinicians require high-quality images to make accurate diagnoses for treatment. Enhanced productivity and improved workflow features enable facilities to function at their best while offering optimal patient care with low-dose radiation and shorter wait times. Collaborate with an innovator and make sure that the solution you pick meets your needs today and considers changing needs into the future.
Sander: Biomeds should be an integral part of the decision-making process for new equipment. They should consider how they can help the facility be more productive. Does the system or manufacturer give them the tools to proactively provide maintenance, troubleshoot and solve problems to maintain uptime? If something goes wrong, how quickly can it be addressed and how does the manufacturer support them?
Chandre: The acquisition of medical imaging equipment reaches well beyond its’ final intended purpose of providing highly diagnostic medical images. Its’ purchase impacts many diverse areas and decision points. These include facility services and construction, ease of installation, the technologist’s use of the equipment and the system’s associated workflows, HTM support needs, the efficient flow of information into and out of the system via HIT elements such as RIS/PACS, and the needs of those performing the final interpretation of the patient’s images. The needs of all of these constituents need to be considered when acquiring medical imaging equipment. Having an industry partner experienced, knowledgeable and consultative is critical when purchasing medical imaging equipment of all types.
Hable: OEMs have a responsibility to provide the necessary access and documentation for in-house engineers and third-party service providers to ensure system compliance following the servicing of imaging systems. Request and ensure you’ve received all documentation for service and support of the equipment as well as any necessary accessories or required tools prior to acceptance. Have a clear process for service and support requests with the OEM to address warranty issues as well as with your in-house and/or third-party service provider as the OEM warranty period comes to an end. This will help ensure the necessary levels of support, part availability and training are available to you and your staff for proper support after the warranty period.
Murphy: With more than 2 billion X-ray exams done annually, X-ray is often the hospital’s first impression of a patient. Just like first impressions with people, the first image taken helps set the path going forward. At GE Healthcare, X-ray is reinventing itself to be the most intuitive and technologically powerful imaging tool that helps health care providers deliver great diagnostic confidence. The future of X-ray is providing images that reveal insights and improve outcomes in real time.
Romocki: Digital radiography has made great strides in the last five to 10 years. Radiography equipment takes image acquisition and processing to a higher level, with tools like shareable detectors that are not tied to a single device, for instance. Image capture software can process images with greater sensitivity and intelligent imaging options for better results. Today’s portable systems take many radiology services directly to the patient at the bedside, in the operating room or intensive care unit. As the population ages, the need for sensible, flexible solutions will accelerate. With continuous innovation and a focus on customer needs, radiography equipment will continue to play a significant role in the medical setting.
Sander: It is important to consider the equipment provider. Look at companies that understand service is as important as the system itself. At Konica Minolta, we provide remote monitoring to proactively send parts before the system goes down. Our service solutions troubleshoot issues remotely and we provide a support services portal 24/7. It’s those little extras beyond maintenance and repair that can impact the facility’s bottom line through enhanced productivity and efficiency.
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