Healthcare technology management is the unsung hero of health care in the United States and around the world. These men and women keep medical devices in working order to a standard that ensures patient safety. Test equipment is a huge part of their job whether it be a repair or preventative maintenance. Test equipment for diagnostic imaging devices is just one category of important tools HTM professionals use to safeguard patients. TechNation reached out to a panel of experts to find out what to look for in imaging test equipment.
The panel of experts includes Fluke Biomedical/RaySafe Product Sales Specialist Ed Brand, Tri-Imaging Solutions Vice President of Operations John Drew, Lynda Hammond from ATS Laboratories, Radcal Corp. President and CEO Curt Harkless and RTI Inc. Northeast Account Manager and Product Specialist John Larrier.
Q: What are the most important things to look for when purchasing test equipment for diagnostic imaging equipment?
Brand: When purchasing test equipment, ease-of-use is most important. It’s tempting to get distracted by a test device’s bells and whistles, but it’s difficult to obtain accurate results and increase productivity if you have to constantly re-learn how to use the device every time you need to test a piece of medical equipment.
Drew: Most important is to determine what your need is. Then, look at equipment that will meet that need. Second, future expansion. There are many bells and whistles that can be added to the basic setup. You may not need them now, but you may want to add them later as you take on more modalities, etc.
Hammond: Have a clear understanding of the ultrasound imaging system parameters you intend to evaluate. In particular, a key selection factor is the frequency range of the transducers to be tested and the type (linear, convex, endocavity and TEE).
Ed BrandProduct Sales Specialist, Fluke Biomedical/RaySafe
Harkless: Since your test equipment represents a major investment that is critical to your business for a long time to come, one should look for a partner who is proven, stable, reliable and established. Consider the life cycle of the relationship including service, repair and calibration considerations that are critical to operating and maintaining test equipment over the long run. As diagnostic imaging continues to grow and evolve, the requirements of your test equipment may grow and will likely evolve as well. One should select test equipment from a line that is modular, interchangeable and extensible to meet changing needs.
Larrier: The most important things to look for are that the equipment meets the needs of the user, it’s ease of use, and the level of support and service provided. The user needs to consider what they need to accomplish with the equipment and will the purchase allow them to do so. Once they have considered that, they should consider how will using the equipment fit into their workflow and are they willing or able to adjust their workflow to use new equipment. The smartest physicist or biomed needs questions answered and quick access to support and service is key in deciding what equipment to purchase.
Q: What are some of the fundamental test equipment capabilities HTM professionals need to be able to test and maintain imaging equipment?
Brand: Test equipment needs to be able to accurately measure all pertinent parameters on each modality. PC connectivity is important, especially when used to generate reports. But in situations when time is of the essence, it is extremely useful to be able to view all measured parameters as well as waveforms without needing to connect the test equipment to a laptop or tablet.
Drew: Generally speaking for maintenance just basic capabilities such as measuring kV, mA, dose, dose rate and using a multi-meter are sufficient. If performing more complex troubleshooting then using an O’scope may be necessary.
Hammond: Phantoms provide a means to monitor the performance of an ultrasound imaging system on a routine basis. The phantom provides test structures that evaluate an imaging system’s dead zone, vertical and horizontal measurement calibrations, focal zone, sensitivity, functional resolution, axial-lateral resolution, gray scale, displayed dynamic range and image uniformity. In addition, Doppler flow phantoms used in combination with digital pumping and controller system provide a means to evaluate the velocity, sensitivity, penetration and direction of flow.
John DrewVice President of Operations, Tri-Imaging Solutions
Harkless: In X-ray imaging, the name of the game is getting good imagery with minimal dose which is why ensuring that the system is operating correctly is so important. In assessing the behavior of the system, the following are standard measurement quantities: dose, dose rate, kV, mA, filtration, pulse number and pulse duration. The ability to view and analyze waveforms of these quantities provides a much deeper understanding of the operation of the X-ray system, especially for the new dynamic mode switching systems. Specialized measurements such as beam width in CT systems can also be important and streamlined accessories and techniques exist to perform these measurements.
Larrier: A critical capability for test equipment is that it can measure low doses accurately and do so in a reproducible manner. Equipment needs to be able to produce multi-parameter information in one shot so that a test engineer can work efficiently. The equipment also needs to be paired with a robust software system to provide useful and accurate analysis of the information.
Q: What are some of the latest features or capabilities departments should look for when purchasing test equipment for medical imaging devices?
Brand: Departments should look for test equipment that is designed to be adaptable to ever-changing measurement needs. For example, manufacturers of mammography machines are constantly introducing new target/filter combinations. New test equipment should be able to measure all commercially available machines as well as be adaptable to new ones that will soon become commercially available.
Hammond: The ATS Model 570 Endoscopic-Multipurpose phantom has the ability to accommodate linear, convex, endocavity and TEE probes without exposing the transducer to potential damage from bending of the cables.
Harkless: With the advent of low-cost computer tablets, measurement systems providing two-line text displays are being displaced by those that integrate large, easy to read displays. These displays run sophisticated applications that automatically record and display all measurement details including time and date stamp, detailed measurement data, waveforms, serial numbers of equipment used and calibration date. All of this information can be immediately saved in standard formats for later review or archiving. Since these displays are essentially tablet computers, all of the connectivity features such as Internet communication, e-mailing of reports, and remote printing of results are now accessible to the user.
Larrier: New test equipment should be able to provide data in a wireless communication mode. Low-dose sensitivity is essential in testing today’s mammography and dental equipment effectively and accurately every time. Additionally, detector design and layout as well as the ability to upgrade hardware and expand calibrations and beam qualities so the equipment can be used in the ever-changing landscape of medical imaging devices is a must.
Q: How can health care facilities make sure they are purchasing quality testing equipment for their medical imaging devices?
John LarrierNortheast Account Manager and Product Specialist, RTI Inc.
Brand: Pay attention to what the OEMs’ service engineers are using. Ask them what they like and dislike about their test equipment. If you’re able, also ask your medical physicist the same questions. Most importantly, get a demonstration, or, better yet, ask for an extended evaluation.
Drew: There are a few common manufacturers out there that most of us use. Their equipment is all good and pretty much does the same measurements with some variation (they may argue this point). I recommend asking around to find out what your colleagues are using. Demo it for some time to get familiar with it before making your choice.
Hammond: Seek opinions from colleagues in the field. Review the warranty policy. Call the manufacturer – Are they able to answer your questions and concerns?
Harkless: Experience, stability and commitment to the X-ray system quality assurance mission result in quality instruments. For instance, Radcal has been committed to the industry, designing and manufacturing instruments in the U.S. for over 40 years. Many of the company’s original products, the 1015, remain in productive use to this day. That said, the industry continues to grow and evolve so innovation in the area of sensors, touchscreen displays, wireless communications, and analysis software is also critical.
Larrier: Health care facilities should actively engage the vendor in proving the quality of their equipment. An onsite demo of the equipment should be arranged and, if necessary, further independent testing by a qualified staff person should be conducted to verify the quality of the equipment. A facility should also inquire about quality with other users of the equipment. A check with OEMs might also be helpful to find out what their field service personnel use. Finally, facilities should make sure that the equipment is certified by an approved standards organization.
Q: Is it important to have a testing device with a waveform display? Why or why not?
Lynda HammondATS Laboratories
Brand: Yes! Absolutely! Waveforms give context to the numbers and they can help you diagnose tube or generator issues.
Drew: Yes, waveforms can be very helpful for troubleshooting. When performing PMs I recommend saving all the test data to a laptop. It will allow you to compare to other PMs, make reporting easier and use as a tool for troubleshooting now or in the future.
Harkless: The ability to view the waveform provides a depth of understanding with regard to the operating state of the imaging system unmatched by point measurements. New innovations provide ever improving imaging capabilities with reduced effective radiation dose. These improvements come with added complexity that requires waveform display and analysis to effectively assess. Waveform analysis can seem daunting, but with the right equipment and software this analysis can be achieved with ease (and without the need for special equipment or scopes as in the past).
Larrier: Yes. A numeric read-out provides the quick results of a test or measurement. However, the waveform can show the “how” and perhaps “why” that result (the digital read-out) was given. The waveform provides the user an extra layer of information, especially if there is a question about the outcome of the test, by giving the user the option to inspect the measurement in greater detail.
Q: What else do you think TechNation readers need to know about purchasing test equipment?
Brand: As with most anything, you get what you pay for. If you do your homework and consider the payback you’ll realize in the form of increased productivity, you’ll be happy with your investment. Also, purchase test equipment that is “future proof.” This will help you prolong your equipment’s useable life as technology advances.
Curt HarklessPresident and CEO, Radcal Corporation
Drew: You will find many pieces of test equipment will fit your need. I feel that finding one that has ease of use, expandability, meets your size requirements, etc. takes a little time. Don’t be afraid to ask for a demo and then work with it in your operating space for some time to determine if it really works for you. It is an expensive decision and will be with you for years to come.
Hammond: If you don’t understand anything about the equipment you are purchasing continue to ask questions and seek information until you are comfortable.
Harkless: Time is money when performing quality assurance on high usage systems. It is worth thinking through the QA process in its entirety including setup, measurement, analysis, reporting and archiving of the results. Look for systems that provide hands-off automatic ranging, direct data readout, and avoid the need for applying manual corrections. Systems that provide the ability to generate forms tailored for a user’s individual needs that are completed automatically in the course of a measurement can dramatically reduce the timeline and effort associated with the measurement process. Forms in standard applications such as Excel facilitate archiving and subsequent retrieval in the future.
Larrier: Price, of course, is a major consideration. However, all of the considerations noted above – accuracy, dependability, dataflow – should be considered first. If the equipment meets the needs of the facility’s staff, then price should be the final consideration. The work being done is important enough that the facility should ensure that it is getting the best equipment.
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