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T H E E U R O P E A N H O S P I T A L S P E C I A L I S S U E F O R T H E E U R O P E A N C O N G R E S S O F R A D I O L O G Y

Nowadays, no radiologyconference would becomplete without adiscussion on turf battles.The rapid development

and broad acceptance of cardiac CThas exceeded expectations, andboth radiologists and cardiologistsare incorporating this technologyinto their practices. Educationalcourses on cardiac CT are in highdemand and well attended by bothradiologists and cardiologists. Manyhospitals consider purchasing thelatest generation of multislice CTscanners to remain in the game andretain part of the technical revenuesassociated with cardiovascularimaging.

Radiologists typically harbour anumber of resentments when theysee the increasing number ofcardiologists moving into thecardiovascular CT field. Theygenerally believe that technicalunderstanding and sophisticationshould be the defining attributewhen defining who should control

A battle zone: Coronary CTangiography. As a viable alternative toconventional catheter angiography, thelatest Dual Source 64-slice CTtechnology (Somatom Definition,Siemens) for example, presents robust,non-invasive cardiovascular images

By Stefan G Ruehm MD, AssociateProfessor of Radiology and Directorof Cardiovascular CT at the DavidGeffen School of Medicine,University of California Los Angeles(UCLA, USA)

integrate results with patientmanagement. They feel thatcardiovascular CT – under theircontrol – will help them to bettercontrol their patients and that theyshould be the logical heirs of thismodality.

In addition they often regard CTimaging as a mandatory tool toincrease revenues in a decliningreimbursement environment.However, depending on the

competitive advantage for eitherside. A joint model, based ontrue teamwork, with the idea ofdivision of labour andresponsibilities, could yield amutually successful strategy.Both physicians and patientsmight benefit from aninterdisciplinary approach thatutilises both cardiologists andradiologists to make treatmentdecisions.

Turf wars

imaging technology, and rely on thecomprehensible perception thatcardiologists may lack knowledgeabout CT technique and equipment,radiation physics and safety.Radiologists are often frustrated thatother medical professionalsfrequently do not share thisperspective. Many radiologists viewcardiologists as the group ofphysicians that has already takenfrom them coronary angiography,echocardiography and increasinglyrenal and peripheral arteryinterventions. They perceive thecardiologist’s interest in cardiac CTas just another example ofinfiltrating their turf.

On the other hand, cardiologistsfeel that they have more expertisein invasive coronary angiography,better understanding of cardiacanatomy and pathology and betterunderstanding of the clinicalimplications of normal or abnormalfindings of a cardiac CT study, sothey can find the best way to

political environment of medicalpractice, governmental action hasincreasingly been noticed inregulating who can own andoperate imaging equipment inorder to avoid the practice ofunlimited self-referral.

A detached view of turf issuesallows a less emotionalassessment. Although turf issuesmay be initiated by technologicinnovation, they are basically notabout technology alone, but ratherabout how the technology can beimplemented in an existingbusiness or medical practicemodel. As a general concept,technology by itself has limitedvalue until it finds a place in abusiness model or, in other words,until someone is willing to pay forit. Since the radiology practicemodel relies so heavily ontechnology, both radiologists andcardiologists need to understandthe interaction of a newtechnology with a medical practicemodel, a relationship that is notalways intuitive. CT is an exampleof a new technology that hasrevolutionised radiology. The mainreason for the successfulimplementation of CT was thatradiology could integrate CT intoits business model without majordifficulty. Interestingly, CT wasinitially marketed toneurosurgeons. However, CT failedto find a home in their businessmodel since neurosurgery couldnot incorporate this high-costtechnology, compared withradiology with its generally large-scale imaging operation and widebase of referring physicians.Consequently the successfuladoption of CT enabled theintegration of MR imaging withoutmajor problems.

Cardiologists commonly controla large number of patients withpotentially significant amounts ofyet undiagnosed cardiovasculardisease. CT as a non-invasivemodality can be utilised toexamine these patients.Cardiologists might be tempted toemploy a variety of treatmentstrategies when they find evenasymptomatic disease in variousvascular areas. Whether, due to

potentially unnecessarytherapeutic measures, such anapproach raises overall healthcarecosts, or if early diagnosis andtreatment might prevent diseaseand therefore save costs, remainscontroversial. Since radiologistsusually depend on referrals, theyare less susceptible to self-referralissues. Given that radiologistsgenerally have imaging expertisethat cardiologists lack, e.g. better

knowledge of peripheral vascularanatomy or nonvascular pathologyin the chest, it appears justifiedthat radiologists are required toalso read all CT studies forpotential nonvascular findings.

On the basis of this analysis, itshould be clear that a simpleduplication of a practice model forcardiac CT to be operatedseparately by cardiologists andradiologists offers no real

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Accuvix XQ, made by Korean firm Medison(pioneer of the first commercial real-time 3-DUS scanner) has been upgraded and re-releasedas Accuvix XQ Prestige 07. Since its launch in2003, this equipment has been continuouslyimproved and the firm reports it is nowconsidered a ‘next-generation ultrasounddiagnostic system with future standards’.

Medison adds that, during its debut at ISUOG2006, Accuvix Prestige 07 attracted keen supportamong international visitors due to its SpatialCompound Imaging(SCI), which achieves strikingenhancement of 2-D image quality; 3-DCompound Imaging (3-D CI), which dramaticallyimproves image quality of C-plane – a drawbackof current ultrasound diagnostic systems, andthe 3-D Auto-Contour, which realises fast 3-D,thereby setting new standards for premiumultrasound systems and helping to produce

more precise andconvenient diagnosis.

Accuvix XQPrestige 07 hasvariousadvanced probefunctionalities,such as

129,024channels,Clip CineStore

and easy-to-handle UserInterface.

Traditionally, radiography systems have an X-ray tubeat one end, film-screen cassette or detector at theother, a table between, and perhaps a mountedassembly on a U-arm or chest stand. Visitors to theFrench firm Biospace Med’s stand at RSNA 2006, inChicago, were therefore intrigued to be shown theEOS digital X-ray unit - a radical new digital radiogra-phy design that resembles a department store dress-ing room.

Biospace Med explained that the EOS linear-scan-ning architecture begins with a pair of X-ray tube anddetector assemblies, positioned at 90° right angles,

responding digital planar radiographs anda 3-D bone envelope image.

A 2-D spinal examination can be per-formed within 5–10 seconds; a full bodyscan in under 25 seconds. The manufac-turer also points out that patient irradiationis 5–10 fold below the dose received dur-ing conventional CR or DR examinations.

‘High image dynamics allow the simulta-neous observation of soft and bone tis-sues,’ Biospace Med points out, adding:‘The 3-D bone envelope, calculated using aproprietary technology, can be derivedfrom the two digital radiographs for thespine, knee and hip. It replaces the 3-Dimage obtained from highly irradiating CTmultiplanar digital imaging.’

Developed in collaboration withENSAM/LBM (Laboratoire deBiomécanique de l’Ecole NationaleSupérieure des Arts et Métiers), Paris, andETS/LIO (Laboratoire de recherche enImagerie et Orthopédie de l’Ecole deTechnologie Supérieure), Montréal, theEOS has successfully undergone clinical tri-als at the Hôpital St Vincent de Paul, Parisand Hôpital Erasme (Brussels) within anEU-funded programme.

The EOS will be in sale from mid-2007.

The EOS digital x-ray unitStepinside:theEOS

Accuvix XQPrestige 07

Accuvix XQupgraded

Mercury’s VisageIntegrating clinical applications andpromising new levels for image quality

Visage CS cardiac package

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Mercury Computer Systems, whichdescribes its products as: ‘3-D tothe Core solutions that empowerthe transformation of the medicalimaging workflow, from acquisition,reconstruction, and visualisation, todistribution and management’, willpresent its full Visage range forOEMs at ECR 2007. The companyreports that this presentation aimsto demonstrate the level of imagequality and performance nowneeded to cope with the huge datavolume generated from multi-sliceCT and CT/PET scanners as well asnew clinical applications within thediagnostic process.

Acquisition‘Our next-generation digital MRIreceiver has breakthrough noisereduction technology’, Mercuryreports. ‘The Visage MR is a high-bandwidth, analogue-to-digitalreceiver board with four times theresolution of current-generationMRI receivers, coupled with anextremely high sampling rate; thusit allows shorter scan times andhigher patient throughput. VisageMR incorporates breakthroughphase stabilisation technology thatvirtually eliminates phase error-induced noise in MRI images andMRI-specific noise-reducingtechnology that significantlyimproves signal-to-noise ratios(SNR) in MRI images comparedwith existing offerings in themarketplace.’

ReconstructionAlso on show will be thecompany’s 100X acceleratedSpiral CT reconstruction with theMercury Cell Accelerator Board(CAB), its latest Cell BroadbandEngine (BE) processor-basedproduct. ‘The CAB is designed todeliver an unprecedented 180GFLOPS of performance and anamazing 25 GB/s memorybandwidth in a single PCI ExpressATX form factor card forembedded medical OEMapplications,’ Mercury points out.

Advances in 3-D and 4-DvisualisationThe firm reports that its medical3-D and 4-D visualisation andanalysis includes ‘…blazingly faststudy-loading with 2000-slicedataset start times measured inseconds, real-time high definitionvolume rendering without thedrastic down-sampling andcontour artifacts common toother implementations. Our state-of-the art volume visualisationsolutions deliver breakthroughlevels of image quality andaccelerated rendering – all on

scalable, commercially availablestandard GPU platforms.’

At ECR 2007, the firm willdemonstrate its Visage CS ThinClient/Server, with complete 3-DPACS workflow integration andenhanced 3-D capabilities,including a Cardiac AnalysisOption featuring quantitative andvisual analysis of cardiacdynamics using 4-D multi-slice CTdata to assess functionalparameters as well as coronaryartery analysis. Additionally,Visage CS will feature improvedbone removal and vesselvisualisation tools that greatlyimprove the performance andsimplicity of CT angiographyworkflow.

Mercury also points out that itsVisage PACS, a web-based,scalable, enterprise-grade imagemanagement system, nowfeatures ‘…powerful newfunctions that enable flexiblearrangement of multiple viewers,powerful new options for side-by-side comparison, as well ashanging protocols. Visage PACS isfully integrated with Mercury’s 3-D thin client technology, offeringconsistent and efficient imageand database access throughboth 2-D web viewers and 3-Dthin clients.’

At ECR 2007, Mercury ComputerSystems will be in Expo C,booth # 343

much like a dual-head cardiac gamma cam-era. ‘These assemblies are mounted on verti-cal rails and slide up and down during anexamination, with the patient standing or sit-ting inside the system at a point where the X-ray beams from both assemblies intersect.’

Designed for orthopaedics, the EOS lowirradiation 2-D and 3-D digital X-ray scannercovers the body from head to toe. Withpatient in a standing position, the systemscans two simultaneous, perpendicular planarX-ray views to provide the clinician with cor-

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“Even in today’s increasingly digitisedradiology environment, hard copyimaging remains an invaluable diag-nostic and communication tool formedical professionals. However, upto now the design of radiologyimagers has been largely limited tocentralised, large, all-in-one systemsthat are shared between manydepartments. Not only do these offermore capability than most practition-ers will ever need, they also do notoffer the on-demand, customisedperformance that the modern hospi-tal requires.

Flexible solutionsSony has taken a radically differentapproach to radiology imaging, offer-ing small, even personal, dedicatedimagers that provide maximum qual-ity with incredible space and efficien-cy savings. The latest range of SonyDigital Radiology Imagers isdesigned with the practitioner inmind, to give them the freedom topay only for what they need andmake maximum savings on capitalinvestment, space and running costs.

Able to produce monochrome andcolour paper, as well as blue diagnos-tic film hard copies the range can betailored and matched to specialistapplications.

Workflow efficiencyThe biggest innovation, however, is inefficiency. Sony’s Digital RadiologyImagers offer practitioners next-to-application, mobile printing, whichallows quick access to film and paperhardcopies and saves valuable timeand manpower during the diagnosticprocess. This specialised and modularconcept provides enormous work-flow advantages: rapid diagnosis,improved time management, on-demand printing and tailored outputfor every need.

It is this aspect of the Sony rangethat marks a break with traditionalcentralised imaging workflow. Theaim is to move towards a more flexi-ble and more efficient vision of radio-logical imaging, in which practitionersare not beholden to a large and oftencumbersome central system. Sonybelieves the future lies in small, ver-satile and fast imagers that enhanceradiology facilities’ patient treatmentcapability.

Whether specialised in CT, MRI,CR/DR, nuclear medicine or workingwith PACS, our range offers easy con-nectivity and advanced architecturedesign, to allow users to take fulladvantage of both current and futuremodality trends. Even the format sizecan be varied from 8”x10” up 14”x17”imaging, offering an even wider rangeof option at radiologists’ fingertips.

Maximum performance, mini-mum spaceSony’s Digital Radiology Imagers alsohave the smallest footprint in theirclass, further enabling convenientand time-saving next-to applicationinstallation, in even the smallest envi-ronments. The latest designs can beinstalled vertically or horizontally foreven greater unique space savingcapability.

However, size does not belie theirperformance. Sony has led the devel-opment of dry thermal print technol-ogy for the past 25 years; all its radi-ology imagers feature automaticImage control technology to providehigh contrast, high-density imageswith superb clarity and sharpness. All

Imaging foreveryone andevery facility

Ludger Philippsen,Senior Manager atSony Healthcare,says modular workflowsolutions are ‘the future’

colour paper images are coatedwith a special laminate forenhanced durability and reliability.

Furthermore, with no wet pro-cessing, darkroom or chemicalsinvolved in the processing andusing digital thermal technologyrather than complex and mainte-

nance-intensive laser optical com-ponents, the company’s productsoffer the benefits of small size, lowpower use and minimum mainte-nance.

Dramatic changes are afoot inthe medical imaging market. Watchthis space…”

E C R

Meet our team at ECR 2007

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Tilting MRIandFusion Imaging

Discover

atECR 2007

News . . . . . . . . . . . . . . . . 1-5Intensive care . . . . . . . . 6-9Laboratory . . . . . . . . . . . . 10Futures & research . . . . . 11Urology . . . . . . . . . . . . 12-13Hygiene . . . . . . . . . . . . . . 14IT . . . . . . . . . . . . . . . . . .15-18Global events &medical tourism . . . . . . . 20

contents

T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R KV O L 1 6 I S S U E 1 / 0 7

F E B R U A R Y / M A R C H 2 0 0 7

5, 12, 13 UrologyNew study to be presented atEAU Congress; plusprostate

cancer andcurrentreports

6-9 Intensive careStrong role for anaesthesia inMRI procedures. Draeger’s

ventilatorfor use

with 3-Tesla

New Labour Code causesconfusion and angerThe amended version of the newCzech Labour Code stipulatesthat emergency working hoursand overtime in hospitals andsocial care institutes be altered sothat employees are paid no lessthan they receive for regularworking hours. Many stronglyoppose this change - includingtop Czech EU representativessuch as MEP Cabrnoch (CivilDemocratic Party), who said theCode imposes even more regula-tions than the EU requires. A keyissue, he said, is whether or notbeing ‘on standby’ for work is tobe included in hours worked.

Some hospital directors say it istoo early to assess the Code’simpact on local wages. Physiciansmust be reachable by phone,24/7. However, on standby, theycannot stay in hospital, but mustbe home to receive emergencycalls. Staying in hospital is work!That’s too expensive, ICU man-agers say. ‘We are sending dutyphysicians home, and some willalso be working in shifts, because

it’s cheaper for us.’The reason is clear – they wantto save money by paying doctorsat work only a fraction of whatthey deserve according to the EUnorm and Labour Code. Stayingby the phone is not work!

Many think wages will remainthe same as now and, generally,physicians accepted the changesto their working hours withoutmuch discontent. Any salarychanges will be soon be knownfrom the new work contractsbeing prepared in line with thenew Labour Code. If adverse,effects will be mostly felt inICUs, operating theatres,orthopaedic and plastic surgeryunits.

Right wing politicians blamethis situation on those whopushed the bill through parlia-ment - the Social Democrats andCommunists. Some note thatCommissioner Spidla’s draft EUlabour regulation will clarify thematter and define what work isto be included in working hours.

Rostislav Kuklik reports on the effect of EU rules on Czech healthcare

16-18 IT & telemediSoft - Alive and kickin’.Plus: IT in Italy, and EUe-health news andevents

FREE INSIDE

16-page pull-out

The ECR special supplement

plus

presentations from the

EH Hospital Manager Sym

posium

French fundraisersfund geriatric wardsA nationwide fundraising campaign

aimed at improving the lives of elderly

hospital patients collected €1,750 mil-

lion last year, beating the 2005 total

by more than 17%.Cash raised by the campaign, called

‘Operation + de Vie’, will help to fund

363 projects in geriatric wards

throughout France. These are imple-

mented with the help of the medical

teams concerned and include develop-

ing activities for patients, helping to

relieve their pain and improving recep-

tion facilities for visiting families.Other projects include buying equip-

ment to provide a hairdressing and

beauty salon, supplying special anti-

bedsore mattresses, and buying a pro-

jector and films for long-stay patients.

* European Hospital will feature thepotential value of employing aprofessional fund raising manager toaugment investment funds in hospitals.Read about our special managerssymposium, to be held at the ECR thisMarch. ECR supplement (centre pull out).

Pages 12–13. Also, go to our website:www.european-hospital.comVitamin pills increasemortality Denmark – Vitamins A, E and beta

carotene, taken singly or with other

supplements, ‘significantly increase

mortality’ according to a review study

released by the Cochrane Hepato-

Biliary Group* at Copenhagen

University Hospital. Their study, pub-

lished in the Journal of the American

Medical Association (JAMA), did not

find evidence that vitamin C could

increase longevity, but did find that

selenium tended to reduce the risk of

death.The Copenhagen researchers

analysed 68 previous trials of the five

antioxidant supplements, involving

232,606 participants, and say their

findings contradict those of observa-

tional studies that claim antioxidants

improve health. ‘Considering that 10-

20% of the adult population (80-160

million people) in North America and

Europe may consume the assessed

supplements, the public health conse-

quences may be substantial.’ The team reported that 47 ‘low-bias

risk’ trials, with 180,938 participants,

were ‘best quality’. Based on those

low-bias studies, vitamin supplements

were found to be associated with a 5%

increased risk of mortality. Beta

carotene was associated with a 7%

risk, vitamin A with a 16% risk and vit-

amin E with a 4% risk. No increased

mortality risk with vitamin C or seleni-

um were seen.* The Cochrane is an internationalnetwork of experts who carry outsystematic reviews of scientific evidenceon health interventions.

ECR 1-16RadiologyCurrent aggressive IVFtreatments put patients at risk

Dutch researchers showhealth and cost benefitsin ‘milder’ approach

The Netherlands – In-vitro fertili-sation (IVF) is an overly aggres-sive treatment and needlesslyexposes childless women to sub-stantial risks of complications andserious discomfort, according toresearchers at the UniversityMedical Centre, in Utrecht.

During standard IVF treatment,high drug doses are used to stimu-late the ovaries – but these cause

Replacing one embryo, and freezinganother for use in a second attempt

if necessary, cut the twin rate to onein 200 births compared with one ineight births when two embryoswere replaced at the same time.

Twin births have risen by 66% inBritain from 6,000 a year in 1975to almost 10,000 a year today, dri-

ven by the increase in IVF. One infour IVF pregnancies leads to thebirth of twins compared with onein 80 natural conceptions.

An expert group commissionedby the Human Fertilisation andEmbryology Authority (HFEA) inthe UK recommended last Octoberthat tough controls be introducedto cut the number of patients inwhom two embryos are replaced.

The report is to go out to publicconsultation next month and theHFEA is due to announce its newpolicy in the autumn. A spokesmansaid: “We know that multiple birthsare the single biggest risk for moth-

ers and children.”(The Lancet. 2/3/07. ‘A mildtreatment strategy for in-vitrofertilisation: A randomised non-inferiority trial’).

menopausal symptoms such assweating, flushing, depression andloss of libido for two to threeweeks. From a study comparingmild and standard IVF treatments,which involved 404 patients, theUtrecht team concluded thatlower drug doses are not only aseffective as higher doses, but alsoless unpleasant. Reporting in The Lancet Bart C

J M Fauser and colleagues said:‘Our findings should encouragemore widespread use of mildovarian stimulation and singleembryo transfer in clinical prac-tice. However, adoption of ourmild IVF treatment strategy wouldneed to be supported by coun-selling both patients and health-care providers to redefine IVF suc-cess and explain the risks associat-ed with multiple pregnancies.’

The mild version also provedcheaper at €8,333 per pregnancy,compared with €10,745 for stan-dard treatment. The researchersalso point out that replacing oneembryo in the womb at a time,instead of the usual two embryos,

achieved almost the same live birthrate – 44% – over a year, whilst italso dramatically cut the chances ofproducing twinsAlso writing in The Lancet, IVF

specialist Professor William Ledger,

of the University of Sheffield, com-mented that as success rates in IVFhave risen in recent decades, atten-tion has turned to improving thesafety of the procedure. ‘Somepatients want to complete the pro-cedure as quickly as possible andsee twins as the most desirable out-come,’ he added. ‘While 75% ofIVF treatment in the UK continuesto be paid for by the patients them-selves, many couples will opt fordouble embryo transfer because itis much less costly.’It was pointed out that the stan-

dard treatment could producetwins but using the mild treatmentto produce a single baby wouldmean the patient paying for a fur-ther treatment cycle. Multiple births carry a higher

risk of complications for motherand babies, including an increasedrisk of being born prematurely.

4

I N T E R V I E W

A medical giant that’s packedwith inspiration, enthusiasmand commitment

Toshiba Medical Systems Corporation is a global medical solutions company coveringresearch and development, manufacture, sales and service for medical diagnostic X-raysystems, CT scanners, magnetic resonance imaging (MRI), ultrasound, nuclearmedicine systems, as well as healthcare IT systems and radiation therapy equipment.Daniela Zimmermann, of European Hospital, recently visited Toshiba’s massivemanufacturing factory based in Nasu, an industrial area located 150 km northof Tokyo. Toshiba Corporation is one of Japan’s biggest leading companies -just as Siemens is in Germany. The medical business is one of the corebusinesses of the entire Toshiba organisation; it is a rapidly growing andpromising business segment.At Nasu factory, which is noticeably clean and organised, lots of eager,busy people are engrossed in their work. Innumerable products awaiteddeliveries after system assembly and strict quality control tests.As the No.1 supplier of diagnostic medical systems in Japan, Toshiba

manufactures more equipment than offered in Europe, e.g.clinical laboratory systems and Healthcare IT solutions.

Daniela next travelled toToshiba’s global head office,a high-rise building locatedin the heart of Tokyo (far

right), to interviewMasamichi Katsurada, Presidentand CEO of Toshiba Medical Systems

Corporation worldwide and a formerchairman of the Japan Industries

Association of RadiologicalSystems (JIRA)

the needs of the market, i.e. forthe needs of the medical carefield.

Our philosophy is summarisedin our slogans ‘Made for patients,‘Made for you’ and ‘Made for Life’.Our goal is to contribute tomedical care and to society byproviding clinical value.Does Toshiba offer financing todoctors, clinics, or hospitals?In Japan we have a financingcompany. Also in the US, our ownfinancing company is inoperation.

In Europe we offer finance withdifferent models and partnersdepending on countries.

Finance is one solution for ourcustomers. Let’s talk more aboutour business. In Japan, we notonly offer diagnostic imagingsystems, but we’re also in thehospital solutions business,providing excellent after salesservice. The Toshiba Group has alot of experience and know-howin PC business, IT solutionsbusiness and home electronics

and so on. By utilising theseresources, we strongly promotehealthcare IT solutions businessin Japan. Because of differencesin healthcare systems andlanguages, we have alliances withhealthcare IT firms in the US andEurope.Is China a market for your IT?China has huge potential but isalso challenging. Their socialsystem is different from westerncountries. I think we haveopportunities in China; bit by bitwe are developing andestablishing IT software there. Inthe next five to ten years, therewill be many changes in thehealthcare environment and theway they will use technology forscreening and so on, and then ITwill also be important. We arelooking in that direction. What kind of role does theEuropean market play forToshiba?The European market is veryimportant for us, as well as theUS market. We started our

Daniela Zimmermann: Whattrends do you foresee inhealthcare in the next five toten years?Masamichi Katsurada: It is mostimportant to envision our future.Fundamentally, in any country -Japan, the USA, those in Europe –social security expenditure andaging population are mostchallenging. Roughly half of socialsecurity expenditure is forhealthcare. All the developedcountries are struggling with this,trying to improve healthcareefficiency and quality. Humansare the same everywhere, strivingfor better life, better healthcare,resulting in healthcare costincrease.

In short, the recent global trendtowards cost containment forsocial security and medicaltreatment is changing the medicalenvironment. In addition,developed countries mustproperly manage healthcarerelated issues for their agingpopulations, while developingcountries usually focus onestablishing basic medical carefacilities.

To satisfy the wide range ofmedical requirements, we alwaysendeavour to maximise clinicalvalue. We use our advancedtechnologies to provide clinicallyhigh-value-added solutions overthe entire process of medical carefrom preventive medicine andscreening, to diagnosis, totreatment, and to follow-up. Wealso contribute to thecontainment of medical care costand to the improvement inmedical service efficiency, as wellas to the enhancement of thequality and safety of medical careby providing optimal solutions for

business in Europe around 1970.Today there are 27 EU memberstates and, beyond that there are41 countries in Europe, includingRussia, where Toshiba is doingbusiness. We established ToshibaMedical Systems Europe B.V. in1981.

On the basis of a wellestablished customer base inWestern Europe for more than 35years, we are now expanding ourmarket share also in EasternEurope and the CIS, withparticular emphasis on the newEU member states, wheresubstantial growth in GDP andhealthcare investments areexpected. We will contribute tohealthcare in these countries.

Our defined mission in Europeis to contribute to healthcare inEurope, establish, grow andmaintain market leadership andcustomer satisfaction in four mainimaging modalities: Ultrasound,

CT, MRI and X-Ray, which areimportant in the medical imagingfield. We are seeking to achievethis mission through consistentand clear communication oftangible performance benefitsand demonstrated productinnovation leadership incombination with strong andcontinued investments in ourEuropean customer supportinfrastructure.

Through close clinicalcooperation with leadinguniversities and luminary sitesacross Europe, and through manykinds of alliances with Europeanenterprises, we continue todevelop our product capabilitiesto meet and exceed the changingneeds of the European customersand markets. Currently, we areexperiencing a strong focus on‘clinical outcome’ and ‘Life cyclecost & -management’ objectives,which are central elements of

Discovering Toshiba

MasamichiKatsurada

CT (above) and ultrasound research and development at Nasu

5

I N T E R V I E W

quality assurance and costcontainment programs underimplementation in several EUmember states.

In summary, it can be said thatthe size and complexity of theEuropean market, in combinationwith high standards of healthcareand academic expectations,provide Toshiba with ongoingchallenges that requires us toremain at the forefront ofcompetitiveness and thus areessential to the sustainability ofour global success.Let’s discuss molecularimaging. What does Toshibathink about this development? Our business activities arefocused on medical systems, ITsystems, and healthcare solutionsthat contribute to the entireprocess of medical care frompreventive medicine andscreening, to diagnosis, totreatment, and to follow-up. Wefeel that molecular imaging canmake significant contributions ina variety of areas. We plan toemploy molecular imaging toprovide individualised medicalcare by developing newtechnologies in various areassuch as DNA-based diagnostictechniques, in vitro diagnostics,and clinical application softwarefor diagnostic imaging systemsbased on molecular imaging. Weare participating in the nationalprojects and collaborativeresearch programs withuniversities and will continue toinvest our resources in this field.Toshiba is at the very high endof technology with its 256 slicesCT and the 3-Tesla MR. What isyour strategy to implementthose technologies in theglobal market, and what is yourstrategy to combatcompetition?We are using our technologicalleadership to advance globalcollaborative development ofthese new technologies, includingclinical applications, with the goalof providing the highest possibleclinical value.

In the field of CT, we areconducting the ‘CorE64’ globalmulticentre research project incollaboration with nine leadinghealthcare institutions in sevencountries. In this global researchproject, we have been evaluatingthe results of CT coronaryangiography obtained using ourAquilion 64-slice CT system, andcomparing these results withthose obtained by conventionalcoronary angiography usingcardiovascular X-ray systems. Thisresearch is yielding significantresults.

We believe that 256-slice CTwill be a great breakthrough thatwill revolutionise theconventional CT studies. We havestarted the clinical developmentof this new technology incollaboration with clinicalresearchers. The keywords include‘extremely low dose’ and ‘whole-organ perfusion’.

Currently, we are alsoconducting a global collaborativeresearch project in the field ofMRI. Our superior technology hasled to the expansion of our MRIsystem sales. These technologiesinclude high-speed cardiacscanning by parallel imaging,world No.1 silent scantechnology, and outstandingclinical applications such as FreshBlood Imaging (FBI), which candepict blood vessels withoutcontrast medium. As for the 3-TMRI, we have continuouslyperformed its basic research anddevelopment and are consideringthe time of release. Currently weare developing a commercial 3-T

system, which we, as a leadingsupplier of MRI systems, willpromote globally.

We provide leading ultrasoundimaging technologies such asmyocardial strain imaging andMicro Flow Imaging. We have alarge diagnostic X-ray system line-up that covers the full range ofclinical applications. Our recentlyreleased FPD vascular systemwith multi-access C-arm hasquickly gained an excellentreputation worldwide. In additionto medical imaging technologies,we also provide IT services toimprove efficiency in healthcareactivities.

Another of our priorities isresearch and development forfuture healthcare technologies,

such as a surgical robot andComputer Aided Diagnosis (CAD)systems.Why did your MRI enter theGerman market so late?MRI involves significantinvestments and costs, thereforebusiness volume is important. Weneed volume to fully support ourcustomers and provide excellentservice and maintenance. Onlyrecently did all pieces of thepuzzle come together for us,hence the renewed MRI activitiesin the German market. Japanese companies are knownworldwide as being very IT andtechnology oriented. Whatstrategy does Toshiba have toguide clients and enhancecommunication with them?

Although IT and technology areareas in which we are extremelycompetitive, our primary strategyis to build on our technologicalleadership to develop medicalsystems that provide the highestpossible clinical value to ourcustomers in actual medicalpractice building on ourtechnological leadership. Wealways place the greatestimportance on building long-term relationships with ourcustomers. Based on this policy,we have enjoyed closerelationships with our customersin Europe since we first beganoperations there 37 years ago.

In the future, we will continueto invest aggressively in sensor,detector and systems integration

technologies, since these are coretechnologies, in which we haveextensive experience. To maximiseclinical value, we will continue ourresearch and development with afocus on actual clinical practice. InEurope, we also plan to furtherstrengthen our partnerships withmedical institutions by conductingcollaborative research and so on.

In addition, after-sales serviceand customer training programsare essential to ensure that thecustomers can always get themaximum out of their systems.We will strive to further improveour after-sales service and trainingprogrammes, which is veryimportant for achieving thehighest level of customersatisfaction.

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The impact of PACSRADIOLOGISTS DIVERSIFY INTO NEW FIELDSSweden - PACS is pushing radiologists towards increasing specialisation, according to anew study - among the first to examine the impact of PACS on radiologists’ careers –published in the Journal of Digital Imaging (27/12/2006). Dr Kent Fridell, of the clinicalscience, intervention and technology department at the Karolinska Institute, said thestudy is ‘…unique in both timing and scope’ and, he added: ‘The consequences toradiologists of introducing distributed radiology have shown that when analogue filmsare replaced with digital images viewed on a computer, radiologists’ diagnostic practicealso changes.’

In the study, work practice is defined as professional role, diagnostic practice, andtechnology in use. Dr Fridell found that, following the introduction of a PACS,radiologists tend to shift from a position of individual professional expertise to that ofan actor in a network. ‘As the flow of images takes new routes, new relationships arecreated between actors in the network,’ he said. Prior to the advent of PACS, clinicianswould meet with the experts – the radiologists - in clinical meetings, for example. ButPACS has given clinicians access to images and, with this, their ability to read themimproves, which in turn tends to turn the radiologist into a consultant.

Additionally, since digital imaging developed, reading X-rays has become moretechnical. ‘Suddenly, radiologists’ training shifts to greater exposure to technologycourses rather than interpretive diagnostic techniques,’ said Dr Fridell.

Initially, the increase in the technology focus can cause insecurity, as radiologistsworry that their reading skills will become lower. However, the technology also providessuperior ability to illustrate anatomic details using new digital techniques such as 3-Dreconstruction, opening the door to specialisation.

For example, to help the neurosurgeon, the vestibulocochlear nerve could be imagedin full length by the radiologist. ‘In this way, the radiologist has become a new andimportant advisor in discussions with the neurosurgeon,’ Dr Fridell pointed out. Thischange in working practice makes radiology more specialised and creates newsubspecialty opportunities, he added.

Endovascular brachytherapy Endovascular brachytherapy has beensuccessfully modified by scientists atIsotopen Technologie München AG (ITM),solving problems of radiation exposure toRhenium-188. The researchers are nowproducing Rhenium-188 with previouslyunknown high specific activity in a new typeof generator, Isotopen Technologie reports.

The itm Rhenium-188 PTA solves theproblems previously experienced withendovascular brachytherapy in the peripher-al area. As there is a lack of suitable stentsfor the femoropoplitealarea, restenosis followingconventional PTA has beena big problem.

Rhenium-188 with veryhigh specific beta-activity isadministered via a radiationcatheter immediately afterdilatation of the stenosis.The radiation time is indi-vidually determined for thepatient; it is generallybetween seven and tenminutes.

Using the itm Rhenium-188 PTA is simple, fast andsafe, the firm reports. ‘A special applicatorensures that doctors are not exposed to anynoteworthy levels of radiation despite thehigh activity levels used.’

Rhenium-188 beta rays have idealcharacteristics within the vessels andradiation levels drop quickly. Radiationpenetrates to a maximum level of about

Toshiba’s Activion T16Multislice CT system

‘Ready-Set-Go’ – just three steps and scanning begins

The ‘revolutionary’ Activion16 Multislice CTsystem will be launched at the ECR 2007congress Toshiba Medical SystemsCorporation reports. ‘The Activion16 offersfast advanced acquisitions through easyoperation by just three steps: Ready (selectthe scan region) – Set (perform scanplanning) – Go (start scanning),’ Toshibaexplained. ‘The user is guided through eachstep of the scan planning, simplifying theprocess even further. The systems’ designmaximises both operator and patientcomfort, allowing the operator to focus onthe examination and patient, rather than onthe system.’

Due to the incorporated 0.5 mm Quantumdetector (used in all Toshiba 4- to 64-sliceCT systems) with 350-micron isotropicspatial resolution and the industry’s bestlow-contrast resolution of 2 mm @ 0.3%, the system ensures outstanding imagequality in every examination at lowest X-raydose, the report continues.

Extremely low-dose scanning, combinedwith a fast scan protocol and Quantum De-noising software, enables an entire lung of30 cm to be examined in only 10 seconds,resulting in crystal clear, highest resolutionimages, further expanding diagnosticcapabilities. This low-mAs scanning is agreat benefit to patients, specificallychildren*.

The company further adds that its new 3-D volume rendering software ensures 3-Dimage generation is easy. ‘Whereas self-

evident 3-D preset icons ensure easyoperation and quick results, the optionalVessel View package offers additionalfunctionality by generating curved multi-planar reconstructions used for CTAdiagnoses.’

The newly developed subtractionalgorithm SURESubtractionTM effectivelyremoves bone structures, Toshibacontinues. ‘It ensures high-qualitysubtraction of scanned series and gets youthe best out of a contrast injection becausebone or metal can already be removedduring the scan procedure. This optionenables the user to distinguishcalcifications from contrast medium in amore effective way, dramatically increasingthe diagnostic value of the examination.’

*1 This technology is described in a report on“Low-dose imaging of the infant inner ear forwhich Toshiba received a Cum Laude award.Visit Toshiba and view the ActivionMultislice CT System at the ECR: Booth316 (Expo C Hall).

configuration, Isotopen Technologiesays, adding: ‘Only 23% of long andcomplex femoropopliteal stenoses andvascular obliterations still remain opensix months after PTA. With the itmRhenium-PTA, the cumulative rateachieved after two years is around 46%of arteries treated.

New and revolutionaryapplications reportedHeartSpeed with the direct-conversionSafire. Several hundred of these FPDs arenow in use internationally

Flat-panel detectortechnology (FPD)

incorporated into new digital radiographysystems. The technique exploits differentphysical properties of soft-tissue and bonystructures affecting the attenuation of X-rayphotons at different X-ray energies. Duringa single examination a ‘low-energy image’and ‘high-energy image’ of the patient arecaptured. The construction of a pair of‘energy subtraction’ images is obtained as aworking result, says Schimadzu. ‘One majoradvantage of DES is the clear depiction ofcalcification, thereby strongly supportingcharacterisation of pulmonary nodules.’Cone Beam computed tomography CBCT -enables precise tumour treatment.

Cone beam (CBCT) imaging visualisesvascular tree structures in 3-D. Used incancer therapy, it allows the preciselocalisation of tumour zones as well astheir treatment with optimum dosage.CBCT evaluation shows a 200%improvement in resolution when comparedwith current 128 slice CT scanners, whilereducing total patient dosage by 90%,Shimadzu explains. Slot Radiography – This technique isprimarily used to examine scoliosis andlower limbs. Slot radiography enables theacquisition and reconstruction of so called‘long images’, displaying a complete spineor lower limbs. Shimadzu reports that itintroduces this technique with itsmultifunctional remote controlled R/Fsystem. During an examination, a sequenceof 5cm-wide slots is acquired, to avoidimage distortion as a result of the divergingX-ray beam and to reduce scatter anddosage to a patient. After acquisition theindividual slots are digitally reconstructedinto a long image.Shimadzu’s products are on show at the ECRExpo C, booth 328 – or go to www.shimadzu.de

3mm so that only the vascular walls areselectively radiated. The procedure iscarried out on an angiography table andthere is no need to transport the patientto the radiotherapy department, thecompany points out.

A centring unit is not needed in thevessel with the itm Rhenium-188 PTA.The catheter centres itself within thevessel when filled with the isotope, so theradiation dose is also homogenouslydistributed in vessels with irregular

Shimadzu specialises in the production ofadvanced medical imaging systems andequipment, clinical diagnostic systems,including CT, digital subtractionangiography, cardiovascular systems, digitalradiography & fluoroscopy systems,ultrasound and general radiographyequipment. Now it has announced‘breakthrough applications’ in cardiologysystems, general radiology rooms and R/Frooms, that have used Safire, its advanceddirect-conversion 43 x 43 cm (17 inch) flatpanel detector (FDP). ‘This producesdistinct advantages in image quality anddose efficiency when compared withindirect-conversion flat-panel,’ the firmreports. ‘The direct-conversion technologycreates clearer high-resolution images withless signal deterioration and reducednoise.’

For the clinical areas mentioned above,the company has produced newtechnologies such as Tomosynthesis, Dual-Energy Subtraction, Slot Radiography andCone Beam CT. Digital Tomosynthesis - Individualtomographic layers are stacked on top ofeach other and digitally compiled to createa volume reconstruction of the region ofinterest. Up to 90 exposures can beacquired in a single tomographic sweep,greatly reducing examination time. WithSafire, large regions can be examined withsignificantly reduced X-ray dose, the firmpoints out. By incorporating this technologyin a multifunctional R/F system, Shimadzualso enables tomosynthesis with patientsin an upright position – particularly helpfulfor examinations of scoliosis or load-bearing joints (hips, knees).Dual-Energy Subtraction – This recognisespulmonary nodules better, and is often

NEW

The new Wolframapplicator is said tosignificantly reduceradiation exposureduring Rhenium-PTA

The Toshiba ActivionTM 16Multislice CT

3-D CT chest angiography (Toshiba ActivionTM

16 with SureSubtraction)

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GE Healthcare

GE imagination at work

© 2007 General Electric Company GE Medical Systems, a General Electric company, doing business as GE Healthcare.

Re-think. Re-discover.Re-invent. Re-imagine.We have a shared passion. A desire to transform healthcare. By listening to your needs and putting the strengthof the world’s leading scientists, engineers and business people together, anything can happen. The future ofhealthcare can change forever. Predict, diagnose, treat, monitor and inform in ways never thought possible. Helppatients experience what we call early health, which focuses on early prevention rather than late diagnosis. If wecan find disease sooner, we can help people live longer, fuller lives. Together we can re-think, re-discover andre-invent. Healthcare Re-imagined.

To see Radiology Re-imagined, come visit us at the European Congress of Radiology (ECR),Booth 202/Expo B, or visit www.gehealthcare.com/re-imagine

Healthcare consultant Harald PitzPhD is Vice President for Healthcareand Higher Education & Research atSAP AG.

Having studied computer science,with a focus in medicine, at

the Technical University in Darmstadt, Germany, 1993 Dr Pitz received hisPhD at the TechnicalUniversity

of Berlin. Before joiningSAP AG, he was

responsible for various IT related healthcare

projects at theUniversityHospital, Frankfurt.

At the Managers symposiumDr Pitz will discuss:

Consumerism –the impact on health-care business modelsand processes Business models and businessprocesses have radically changed inindustries such as manufacturing andtrading during the last few decades.This change has reduced coststhrough streamlining processes bothwithin enterprises as well assignificantly across enterprises byextending the value chain towardscustomers and suppliers. Costreduction has freed up resources todrive innovation.

Market forces have had a significantrole to drive this radical change. As akey player, consumer behaviour -shopping for the best price on almostevery product or service - has made amajor contribution to this. As allthose changes wouldn’t have beenpossible without strong IT support, IThas become strategic in enterprises,enabling efficiency throughstandardisation, and providingflexibility and adaptability toaccelerate innovation in increasinglycompetitive environments.

Why hasn’t all that happened inhealthcare? In nature, healthcare interms of diagnoses and treatment issomething people need and nothingpeople want. Health insurances arecovering the majority of the cost sono patient really looks at costs orbetter prices. Due to a lack ofincentives, individual stakeholders,such as provider organisations,insurances or pharmaceuticalindustries, have not driven cross-organisational change. Thus, so far,consumerism as a key market forcein many industries has been limitedin healthcare.

However, we expect this to changesignificantly over the next years, andstrong signals already exist in thehealthcare market. Today, provider

10 March atECR 2007

‘Hospital managers frequently view radiology both as a devil and as an angel,’ says ProfessorChristian Herold, President of ECR 2007, in his welcoming address to participants at EuropeanHospital’s 4th Hospital Manager Symposium.

The ‘devil’ view relates to radiology being a sophisticated speciality at the highend of technology-driven medicine, and thus frequently associated with highcosts, he explains, adding: ‘The ‘angel’ perspective is based on the notion thatradiology stimulates improvement in hospital IT service, is also at the forefrontof quality and risk management initiatives, and improves the quality of carethrough largely non-invasive or minimally invasive diagnostic and interventionalprocedures.

‘This now well-established Hospital Manager Symposium will examine theeconomic, organisational and managerial challenges related to radiology in ahospital environment.’ Finally he advises: ‘Come prepared for a lively andinteractive session.’

Certainly European Hospital’s selection of speakers, all experts inmanagement, finance and information technology, promises to bearout the professor’s prediction.

continued on page 8

The 4th HospitalManager Symposium

Experiences, advice anddiscussions for radiologists

and managers

MANAGEMENT • IT • FINANCE

MANAGEMENT

M A N A G E R S Y M P O S I U M

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Business Intelligence is a processthat enables hospitalmanagement to understand andformulate their business strategytogether with the objectives andmeasurements that support it.While the term ‘BusinessIntelligence’ is often confusedwith IT software, it is amanagement process that uses IT.

This presentation will showhow managers can make bestuse of IT investments by followingthe business intelligence process.The aim thereby should be todefine and verbalise the existingbusiness strategy and to attach

A graduate of LeuvenUniversity and specialist invascular imaging, from 1983until last year, consultantradiologist Jan Schillebeeckxwas the Chairman of theImelda Hospital inBonheiden, Belgium. Inaddition, from 1996–1999,he also served as Chairmanof the Belgian ProfessionalSociety of Radiology. His Board Certificationsinclude the KBVR (BelgianSociety of Radiology; RSNA(Radiological Society of NorthAmerica); ECR (EuropeanCollege of Radiology);EuroPACS Society (of which

the right objectives and KeyPerformance Indicators (KPIs) toit. Through data mining ofexistent IT systems, followed bya data validation procedure,management can gain a muchbetter transparency of theiractual business processes, suchas handling of scheduling,waiting times, billing etc

The speech will demonstratehow continuous BusinessIntelligence has helped ImeldaHospital, in Bonheiden, Belgiumto keep its yearly productivityincrease high, along with patientand staff satisfaction. This will be

continued from page 7

he has been a Boardmember); SCAR (Society ofComputer Assisted Radiology),and the ACR (AmericanCollege of Radiology).

Dr Schillebeeckx’s focus at the symposium will be:

Business intelligence in healthcare Turning strategy into action

Rising from the ashes – lessonslearnt from six years ofturnaround process of one of thelargest hospital providers inEurope.

When the Vivantes project waslaunched, by merging 10hospitals and 14 nursing homespreviously run by the regions ofBerlin, nobody knew whetherthat experiment would work.Putting together more than5,000 beds at 10 sites in Berlin– a mixture of ancient buildingsand new architecturalexperiments of the 1980s – wasa challenging idea, with manysceptics. Now, six years later –and after a period close tobankruptcy – Vivantes hasshown that you can haveefficient structures andoperations as a non-privatehospital provider.

Over the last years, Vivantesreduced costs of about 250million euros, while increasingcases treated by a couple of

Dr Jaeger will demonstrate how to ...

Take a new approach to hospitalmanagement Look in the crystal ball and sharerisks with suppliers

percentages. Being one of themost efficient hospitals in Berlin– in one of the most competitivehospital markets – is a goodstarting point for further growth.Centralise administrationprocesses and specialisedmedical services – the outcomerewards the struggleCentralization, standardizationand specialization – all principlesrun against people wanting tokeep everything like it is and hasbeen. But it is worth thestruggle. Seeing new consultantscoming in with a new attitudetowards professionalism andalso quality parameter outcomesrising due to centralizedprovision of specialized care (e.g.first line breast cancer treatmentwith remote adjuvant therapy)highly reward the effort to startthe ignition. Look ahead - yes, there is ascientific way to gaze into acrystal ball Nothing is as sure as the future

– true in medicine. Illness islargely driven by age and lifestyle– as well as geneticpredisposition. Taking the currentonset of in-patient treatment (i.e.,prevalence and incidence) andextrapolating it by taking thedemographic changes intoaccount, clearly gives a preciseglimpse of what we will face inthe future. We did that prognosisfor Berlin and discussed bothoutcome figures and influencingtrends (e.g., new treatmentopportunities) in our medicalboards. Based on fact-driveninformation we have plannedfuture case volumes andstructures as well as the staffnecessary to serve those needs ofthe population.Change your clinicians´perspectives – let them talk tolocal GPs, but in a focused way

Most in-patient cases come viageneral practitioner (GP) referral.So, the GP is mainly thegatekeeper for which hospital tochoose. The influence of patients´choice will increase, but the GP isthe key – at least for the timebeing. We asked our consultantsto talk to the GPs – on a moresystematic and regular basis. Wehelped them to identify whosends more, or less, patients byusing monthly statistics.Furthermore, based ondemographic data, we were ableto prioritise the list of GPs to see– those with high patientpotential and little Vivantesmarket share are top of the list.That sounds easy in theory – butgetting that effort to life is not.Change your perspective – ineveryday business, take thepatient’s viewpoint

Hartwig Jaeger MD PhD, isDirector for CorporateDevelopment of Berlin-basedVivantes - one of Europe’sbiggest hospital groups. Therehe works on businessopportunities for hospitalsbased on internal and externalfactors such as demographicsand technical development.

Dr Jaeger is a medical doctor(for his PhD theses he workedon molecular mechanism ofbiliary cholesterol secretion). Hisgained experience in thebusiness side of healthcareduring his five years as aconsultant with McKinsey.

In 2005 he joined Vivantes,which runs 5,000 hospital bedsat nine hospital sites in Berlin.

These serve around 200,000 in-patients and 300,000 out-patientsannually. Vivantes also runsnursing homes for about 2,000inhabitants and engages inspecialised out-patient clinics.

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organisations, for example, publiclyspeak of competition and gainingmarket share; this would have beenperceived as unethical years ago. Costpressure, caused through ageingpopulation and increasingly expensivetreatments drives process efficiency inall kinds of organisations. However,similar to industries such asmanufacturing and trading, the patientbeing transformed into an informedconsumer will again play a significantrole.

Well-being through prevention,attractive environments, andinformation is something people wantand increasingly expect, as well ashigher cost awareness, as co-payments and payback schemesincrease. This will lead to patientcentric processes, which will reachbeyond hospitals to the collaboratingstakeholders. Collaboration willrequire information sharing, enabledby privacy laws protecting the dataand patients’ rights. In fact, the patientmight become the owner of his/herdata and decide about its distributionand use.

Healthcare organisation willincreasingly adopt measures, such asprocess standardisation, outsourcingetc. to increase efficiency, centrearound patients and collaborate withothers. IT will need to becomestrategic to accomplish this in acompetitive way. Currently the ITindustry is investing in service orientedarchitectures to enable that change.”

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complemented with acomparison of operational datain another hospital (in adifferent country and with adifferent scale). The aim of thiscomparison is to show howhospitals can differ substantiallywhen it comes processes andbusiness ramifications.

The objective of thispresentation is to show howthe business intelligenceprocess will almost certainlyunearth huge gaps betweenthe management’s perceptionsof business processes with thereal picture on the ground. Byunderstanding the real situationbetter, managers can makeintelligent decisions to closethose gaps.”

After an apprenticeship as a butcher, Dr Stephan Feldhaus studiedphilosophy, theology and economics at the universities of Munster,Rome, Zurich, then gained his PhD in theology from Munich’s Ludwig-Maximilians-University. Following this he worked at the university as anassistant in the catholic-theological faculty.

He was head of the scientific editorial department of theBioethics/Ethical Economics magazine in Munich from 1992–98, when healso was a freelance at the Rat von Sachverstaendigen für Umweltfragenin Wiesbaden (a council of experts for environmental matters).

Up to 1998 he also held lecturing positions at Munich, Weihenstephanand Eichstaett universities.

His scientific work regarding ethics focused on economic,

Dr Feldhaus will discuss

Efficiency and ethics in hospitals – a contradiction?environmental and energy technology issues, and has beendocumented in various publications.

In 1999, Dr Feldhaus joined Siemens AG, in Erlangen, where hebecame responsible for the Internal Communications department ofthe Power Generation group. In 2001, he was made head of GroupCommunications and also represented Power Generation in theEconomic Council of Siemens AG.

He was appointed head of Employee Communications and MarketCommunications within the Corporate Communications departmentat Siemens AG’s headquarters in Munich, in 2005. Since October2006 he has headed the Corporate Communications department ofSiemens’ Medical Solutions Group.

Current market research clearlyshows that patients mainly careabout quality – that is not new.But how do they really feelabout hospitals? What is theirmain concern? And what dothey base their first impressionof a hospital on? A qualitativemarket research revealed indetail how patients and theirrelatives feel about hospitals.Not surprisingly, anxiety leadsall emotions and hardly allowsan unbiased perception ofinformation. Getting beyondthat feeling of fear is key –there are many ways todemonstrate that the hospitaltackle that issue seriously.Innovate co-operation – takeyour suppliers on board, andshare risksPPP is a modern buzzword inhospital management – butwhat comes next? Is ‘sale-and-lease-back’ the answer to shortterm investment barriers? Whopays the bill in the long run?Looking at different industrieswhere high volume investmentsare common, what can welearn from them? Clean-roomtechnologies for chipproduction or drug researchlabs and manufacturing sites,these all use an ‘open book’ forfair compensation.

Hospitals could follow this,possibly by starting withmedical product suppliers.Instead of paying for each itemor each service (i.e. usage), wecan see a risk sharing approach,as we have in the DRGcompensation system. We, as ahospital provider, arereimbursed by case, not byevery service or syringe used onthat case. Why don’t we alsohave suppliers who getreimbursed by case? Combinedwith an ‘open book’, i.e. sharinginsights about real coststructures and adding capitalcosts and surpluses, that trust-building partnership could bethe next S on the curve.

M A N A G E R S Y M P O S I U M

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RADBOOKThe Radiology Guide to Technology & Informatics in Europe

2007

� CT � PAGE 18

� MR � PAGE 26

� PACS & RIS � PAGE 70

� Mammography � PAGE 6

� Ultrasound � PAGE 97

Sectra MicroDose Mammography is based on a unique digital photon-counting technology delivering excellent high-contrastimages at the lowest radiation doseon the market.

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INFORMATION TECHNOLOGY

For the past decade, Rainer Braunschweig MD hasbeen Director of diagnostic imaging andinterventional radiology the clinic at the BG-KlinikenBergmanntrost, in Halla/S, Germany. Prior to this hewas Senior Consultant and Assistant Professor first atthe University of Tubingen, then at the University ofMunich.

His specialities include interventional radiology,traumatology, gastroenterology, orthopaedics,digital radiography, CT, MRI, and quality assurance

During the last 10 years IT-technology in hospitals caused ahigh level of interest from boththe clinical and economicalperspective. Work-flow andfinancial benefits are possible. Tointegrate hospitals with, forexample, different levels of theirclinical departments to functionalhealthcare clusters, it will beworthwhile using IT for:● work-flow improvement● ensured archiving (short andlong)● communication andconsultation● patients transport and particularly to develop healthcare much more efficient.Method – We are completedigital for administration (HIS)integrated diagnostics(RIS/PACS) telemedicine (e.g.teleradiology) and for regionaland national healthcare units.

We use a local raid-basedarchive (PACS) including a high-speed network (inclusivewireless LAN), HIS foradministration and billing and acentral digital national archive

(DACS). The central online archiveis EMC-Centera; it is publicnetwork based and also providescommunication with each of theincluded hospitals. Results – Using IT we haveimproved patient care generally.And, working with the samestaffing level, we have increasedthe numbers of patient more thanfive times. As far as the processtime for each patient isconcerned, on average wedecreased from 12.8 days downto 7.8 days.

Using teleradiology we haveincluded over 10 hospitals forconsulting, being on call, patientmovement and specializedhealthcare.Conclusion – As a strategic andmanagement tool, informationtechnology (e.g. HIS/RIS/PACS/DACS) is one of the most efficientapproaches to ensure healthcarequality, as well as workflow andfinancial benefits.

This is true for local hospitalswith complete digital environmentas well as for regional andnationwide hospital groups.

At the symposium, Dr Braunschweig will speak on …

Local and national IT concepts inhospitalsHIS/KIS/RIS/PACS/DACS

aggregate, at a user’s access point,various data comprised of bothDICOM image data and non-DICOM objects (e.g. waveformsfrom electrocardiography; cinefiles, e.g. echocardiograms, etc).

Healthcare is experiencing anexponential growth of digitalinformation, where storage andlong term archiving will createunprecedented economicchallenges. Regulatoryrequirements (e.g. HIPAA in theUSA) impose stringent dataprotection and retention periodsthat exceed the lifetime of storagesystems. However, not all data isevenly concerned by suchconstraints: evidently, orthopaedicand breast cancer screeningimages have very different lifecycleand retention periods. Newarchival systems include intelligentalgorithms to secure and optimisestorage usage, as well as long-termdata preservation features to copewith media obsolescence.

New architectures are needed, tocope with massive amounts ofdata and increasing requirementsfor reliability. Grid-based archivaltechnology is coming tohealthcare. This allows archivalfeatures to be provided to anyapplication on an ‘as-needed’basis. A grid is incrementally builtfrom entry-level hardware andprovides high reliability byconstantly adapting to a changingenvironment.

The first PACS generations areclearly no longer adapted to thesetrends. They have generatedinfrastructures composed of

Georgios Rimikis PhD isresponsible for the strategicdevelopment of enterprisestorage solutions and theirmarketing at Hitachi DataSystems in Germany.

A physics graduate fromthe University of Heidelberg,he received his PhD at theUniversity of Karlsruhe, andbegan his IT career in 1992,as a product manager, thenhead of productmanagement andpurchasing of storagesystems in Europe, forComparex InformationGmbH, Mannheim. Later, asa marketing manager atIBM Germany GmbH, DrRimikis was responsible forco-operations withindependent softwarevendors in Europe, the Middle East, and Africa (EMEA).

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Dr Rimikis will be discussing:

Secure, effective clinical dataarchiving with the HitachiContent Archive Platform Advances in clinical technologies have enabledhealthcare professionals to increase the quality ofhealthcare as well as improve the overall patientexperience. As these technologies are implemented,integration of information technology within theclinical infrastructure is critical to providing acomprehensive solution. That is, a solution that notonly supports clinical workflow, but delivers highlyavailable, uninterrupted access to data and all kindsof applications. The ongoing adoption of new clinicaltechnologies places increased demands on thehealthcare IT infrastructure, underlining the need forreliable, flexible storage solutions that can scale asrequired.

Hitachi Data Systems has defined a new approachto the active archive market, which combinesindustry-leading Hitachi storage with openstandards–based archiving software. The HitachiContent Archive Platform establishes an activearchive environment - a single online repository thatenables protection, search, and retrieval across fixedcontents and other content types.

Fixed content means that an item reflects aparticular real-world event that happened at a pointin time - for example, an X-ray image of a brokenarm, an e-mail message, or a completed digitalvideo. For the item to remain valuable in the future,its content must remain fixed to accurately reflect theoriginal state.

‘ ‘‘information islands’, where notonly the storage is dedicated toeach subsystem but alsoinformation access is restricted.New paradigms of informationmanagement systems are emergingthat support the interconnection ofmultiple medical sources(Modalities, PACS, EPRs) acrossterritories, allow the aggregation ofdata and related indexes for betteraccess, and intelligently managetheir lifecycle.

The presentation at thesymposium will describe projectsthat exemplify those trends and willexplore some of the key functionsprovided by new generationmedical archive systems.

There is a clear trend towardsregionalisation of healthcareinstitutions. In search of betterinvestment models, largenetworks of hospitals anddiagnostic imaging centres areconsolidating their IT networks.Government initiatives, such asthe UK’s NpfIT, the USA’s RHIOs,or Canada’s Infoway, extend thescope of such consolidation tocountries. Large projects, togetherwith the adoption ofheterogeneous PACS in multiplelocations, are bringing newchallenges for enterprise-wideimage and data managementsystems: despite theheterogeneity of source systemsand their geographicaldistribution, users expect thatinformation will flowtransparently through all locationsand data distribution will beanywhere at anytime.

Simultaneously modernmedicine is increasingly asking forfast, easy access to all datarelated to a patient. Specialtypractices (cardiology, oncology,mammography, etc) requireaccess to a global view of apatient’s record to properly assessthe situation. Newly designedsystems must be able to

At the EH symposium, Dr Algayres will discuss:

Key trends in medical archive systems

M A N A G E R S Y M P O S I U M

Bernard Algayres PhD is aBusiness Manager for Europe,Africa and the Middle East, forEastman Kodak’s Health Group.As an engineer, his technicalexpertise in IT includes softwaredevelopment and systemsintegration, and includes afocus on storage and archivalsystems over the last decade.

He was involved with thedesign of the CarestreamVIParchive, Kodak’s leadinghealthcare informationmanagement system, from itsinception. Today this system is

installed in over 200healthcare centresworldwide.

*T. Cupples, J. Cunningham and J. Reynolds, “Impact of Computer Aided Detection in a Regional Screening Mammography Program,” AJR: October 2005; 185:944-950

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11

FINANCESabine Eidmann Dipl Sozworked for, or headed,departments in finance firms(e.g. Deutsche Leasing AG) for25 years - 15 of these as aspecialist in risk management.In May 2005 she became areasales manager at PhilipsMedical Capital GmbH. Oneyear later she became Directorof the Healthcare BusinessUnit at Comprendium Leasing(Germany) GmbH, where shemainly deals with customers inthe clinical sector and medicalpractices specialising instructured business finance.

Sabine Eidmann points outthat Comprendium Leasing,

which has a track record of25 years in Germany forindividual leasing offers,belongs neither to a bank normanufacturer. Its refinancingis conducted through capitalmarkets, an independencethat, she says, enablescreative and new ‘off thebeaten track’ concepts.

At the symposium SabineEidmann will discuss the typeof financing models availableand necessary to boost hospitalprofits and will present:

What leasingcompanies canprovideBoth income and expensesadversely affect profitability forGerman hospitals. Incombination, they reduce thescope of investments, althoughthese are necessary to cut costsand increase revenues. The actualhold up of investments is said toamount to around €50 billion. Inmany hospitals expenses exceedrevenues because treatment costsare far too high due to a lack ofmodern equipment andprocesses. There is a clear trend:On a long-term basis, thegovernment will only provide thepolitical framework in which anincreasingly market-orientedhospital system will develop.

A recent study by RWI/admedshowed that a fifth of all hospitalsface closure within the necessaryreform process. The hospital thatsurvives is the one that usesintelligent strategies for bothinternal and external situations,drawn from modern managementmethods; financing; marketing;cost structuring and revenuegeneration. It is of minorimportance whether the hospitalis public or private, or a charity.

To keep up competitively,sufficient financing for necessaryinvestments will be afundamental requirement forfuture hospitals.

Two major trends are obvious:Hospital financing will changefundamentally, shifting frompublic subsidy financing toclassic credit financing. In thefuture hospital, the decision ofwhether to invest, or not, willhave to be calculated by itsprofessional managers, followingfundamental and objective cost-advantage evaluations. In allaspects of business economics,including the costs of interestand amortisation, whenever aresult is positive investmentshould be seriously considered.

All professionals in a hospitalmust participate in that decisionprocess.

Privately-owned hospitals givean impressive example of howthis should work - theirinvestments are profit-oriented,free from governmental andpolitical regulations, and meetwith remarkable success. Theyoften use leasing as an externalfinancing source for theirinvestments.

Leasing for medical equipmentand IT includes a variety ofcontract models; each should be

evaluated to find the one thatbest fits a hospital’s individualneeds. The classic well-knownmethod of public bidding can betransformed to a catalogue offinancing specifications tailored toa hospital’s needs. In particular,the exchange of medicalequipment at several stages ofthe planned amortisation periodmust be considered – normally atthe end of the assumed period ofusage, but earlier exit scenariosshould also be taken intoaccount. In this field, leasing isadvantageous compared with a

loan, because the VAT in leasingis only applied on the effectivewear and tear.

Modern instruments of leasingresolve the hold up ofinvestments in a combination ofclassic loan financing forbuildings and floating capital andleasing to finance tangiblegoods. An advanced financingstrategy will enable hospitals toshift from traditional institutionsthat present treatments topatients, to modern companiesthat meet the demands of theircustomers.”

M A N A G E R S Y M P O S I U M

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Over the past few years asteady growth in the numberof private diagnostic facilitieshas been seen. Observationreveals few dominant trendsin this process.

Let’s focus first on theorigin of such facilities.Despite the involvement ofsome major multinationalfirms, companies based inthe Polish capital hold thebulk of this market. Large orsmall, these companiesrepresent two differentphilosophies in terms ofoperation: one beinglimitation of costs tomaximise profit; the other isuncompromising quality,even at some cost to profitmargin. In between, there issome balance betweenthese two attitudes, but thatis in the minority. So far the‘ultimate quality’ approachseems to have the upperhand. In some cases theresult is so successful thateven medical universitiesdecide not to purchase theirown equipment but tooutsource diagnostic imagingaltogether.

Refunds for services fromthe National Health Fundremain a burning issue. Atthe moment the NHF isrefunding examination costsfor hospitalised patients and

Over many millennia people havesupported healthcare in manyforms - from the ‘GoodSamaritan’ in the Bible, to theelderly lady who died five yearsago in Birmingham and left $1.3Million to a hospital for CancerResearch.

Healthcare fundraising isnothing new. For hundreds ofyears before the introduction ofthe NHS almost every hospital inthe United Kingdom was builtwith ‘Public Subscription’ orFundraising. Generous individualsgave large and small amounts insupport of their local hospital andits mission in their community.Around the globe there is anincreasing interest in the amountof involvement that philanthropicdonations can have on thebottom line funding of healthcare.

In a world where the cost oftechnology is often outstrippingthe capacity of finance managersto pay the bills, hospitals arelooking at their communities tosupport this vital communityservice. Globally, most hospitalsreceive donations from gratefulpatients and relatives; as a thankyou or a memory. However, thereis a significant need to make thisan organized, professional andintentional activity, rathersomething that is just left tochance that it ‘might’ happen.

Having said that, fundraisingprinciple number one is that itshould be more about peoplethan it is about money and theaim of all this activity should be

Given the dramatic changesin healthcare delivery over thepast half century - whichinclude the dawning of ourelectronic age - healthcarecosts are rising in anexponential manner, all ofwhich challenges healthcaremanagers’ abilities to planand fund new investments.Traditionally this has involvedprivate money and equity.

As funds are not usuallyreadily available, leasingrepresents a good alternativeoption, especially for medicalequipment, because costs canbe spread over years andadvances in technology canalso be followed.

More recently, the publicsector has used theprivate/pubic partnership todevelop large investments,drawing the initial fundingfrom the private sector. Thishas advantages: the cost isspread over years and usually

Healthy fundraising efforts canprompt great corporations as wellas rich and poor people to givemoney for hospital needs.Depending on the target set, suchdonations pay for anything from arestful patients’ garden to an MRIscanner and even new wards andbuildings. ‘In the United Kingdomthe healthcare sector is one of thefastest growing areas forfundraisers and a significantnumber of healthcare facilities areemploying full time fundraisers,’says Peter Fletcher FFIA CFRE *.

Peter Fletcher speaks as anexpert. His working life began inthe motor trade in Australia, buthe soon chose to enter a SalvationArmy Training College to becomea minister, a role in which hegained early experience as afundraiser.

From 1990-92, as ResidentialDirector of the Salvation Army’sRed Shield Appeal, in Victoria, heco-ordinated the AnnualDoorknock appeal, liasing with themedia, undertaking speakingengagements, and much else. Allof this resulted in the raising of anastonishing $3,000,000 in bothyears of his directorship.

In 1992, as ResourcesDevelopment Officer for theUniting Church Synod of Victoria,his tasks included managingfundraising appeals for specialprogrammes for overseas aid.From 1995, in succession heworked as Fundraising Managerfor the Anti–Cancer Foundation,Muscular Dystrophy Associationand the Royal Adelaide Hospital.

During the latter, he instigated anaward-winning Major GiftCampaign. This raised around$5,000,000,000 – ‘one of the bestcampaigns of its type seen inAdelaide,’ Peter himself exclaims.

Today Peter Fletcher is Directorof Philanthropy at the UniversityHospital Birmingham Charities inthe UK.

He is also a frequent speaker atFundraising Conferences inCanada, America, New Zealandand Australia. Now living in theUK, he is a member of theInstitute of Fundraising (UK),Chair of its Midlands Regiondivision, and Chair of its HospitalSpecial Interest Group. Peter isalso a member of the Associationfor Healthcare Philanthropy (USA)and an associate member of theAssociation of FundraisingProfessionals (USA).

Peter was also the foundingProgramme Director of ‘MadisonDown Under’; a four-dayworkshop for Fundraisers basedon the Association for HealthcarePhilanthropy’s Madison Instituteat Wisconsin, USA: ‘Arguably thebest and most intensivefundraising workshop in theSouth East Asia region,’ he pointsout. He also continues to be awelcome participant in otherfundraising training courses andworkshops.

Nikos Maniadakis BSc MSc PhD isGeneral Manager & President ofthe 800-bed University GeneralHospital of Herakleion, in Crete.Including the University of CreteMedical School, and with a €200million annual budget; 2,500employees; buildings covering115,000m2 and serving 400,000patients annually, the hospital isone of the biggest healthcarefacilities in Greece. Dr Maniadakis holds an OxfordUniversity Certificate in AdvancedMethods of Economic ModellingAnalyses [2000], is the author ofmany publications and he lecturesin Greece and Britain. He is amember of the Royal EconomicSociety of England; OperationalResearch Society; ProductivityAnalysis Research Network;International Health Economists’Association; International Societyfor Pharmaceutical OutcomesResearch, and the InternationalSociety of Technology Assessmentin Healthcare.

Jacek BrzezinskyMD PhDis ClinicalResearch Directorat HelimedDiagnosticImaging, basedin Katowice,Poland.to develop a bond between the

organization that needs fundsand the people, often gratefulpatients, who have the ability tosupport. The most importantperson in this exchange is notthe doctor; it is not the financemanager, or even the CEO or thefundraiser, it is the potentialsupporter who has the ability tomake a gift.

Working in a hospitalenvironment is to work in aplace of miracles where everyday people are in some formgetting their lives back and aregrateful to the medics, alliedhealth professionals, healthcarescientists, administration andalso the porters and ancillarystaff. This ‘good will’ can beturned into significant supportfor the organization, but it needsto involve everyone.

Fundraisers are not so muchraising funds for an organizationbut involved in creating a changeof culture, so that anorganization can articulate itsneeds to a public who arereceptive to being asked forsupport. Fundraising is not just afinancial exercise, but anorganizational commitment to‘Change the World’ and givingpeople an opportunity throughtheir gifts to be part of thatchange. * CFRE: Certified FundraisingExecutive. FFIA: Fellow of theFundraising Institute – Australia.** Details: www.institute-of-fundraising.org.uk

co-funded examinations,where primary health carefacilities share the cost of out-patient examinations. In thepast, the role of diagnosticimaging in the efficiency ofthe medical process has beenunderestimated, in somecases to such an extent thatsome diagnostic exams werenot refunded unless referralwas after a hospitaladmission. This was far fromefficient. Nowadays,awareness of the importanceof diagnostic imaging isgrowing, which is reflected bythe increasing number ofscreening studies sponsoredby local authorities. Of coursethere are issues to beresolved. One is theinadequate number ofprocedures limited bycontract, leading to longwaiting lists. Anotherimportant issue is the case ofprocedures performed overthe contract. Private andpublic diagnostic entities arerequired to stay within limitsof the contract. However, onthe other hand they areobliged to perform everyprocedure in life threateningcircumstances. Obviously thisresults in exceeding thenumber of examinations,leading to vigorous disputeswith the NHF, sometimes

ending in court.Fortunately these are not the

only sources of finance fordiagnostic procedures. Over theyears a more or less constantpercentage of patients, on alevel of 10%, haveexaminations financed byprivate insurance companies orwith their own funds. Alsoworth mentioning is the everexpanding involvement ofprivate diagnostic centres in anincreasing number ofpharmaceutical trials.

What about the futureoutlook? It is extremelyoptimistic. More and moreprojects to expand privatediagnostic centres are beingfinanced with European funds.At the moment the number ofsuch beneficiaries is alreadyquite substantial. Also there isgrowing awareness, even at thelowest levels of localauthorities, that early diagnosisresulting from a timelydiagnostic procedure is highlybeneficial and thereforeimportant. We can look forwardwith confidence to the futureand expect a steadily growingmarket share of privatecompanies in the business ofdiagnostic imaging.

private firms are better atdelivering projects on timeand on cost compared withthe pubic sector.

Donations could be a bigsource of income – certainlysome prominent institutionsreceive large amounts ofmoney annually – but this isnot the case for the greatmajority of hospitals.

Overall, different fundingmethods present advantagesand disadvantages, and aremore suitable for certaintypes of projects.

When implementinghealthcare projects, it isimportant to seek otherpoints of view, lookingbeyond the purely financial.For example, in many casesconsidering the cost-benefitof new projects not just inmoney terms, but also interms of the life years gainedfor every euro spent in newinvestments.

Given his expertise, and particularly his responsibility forthis large healthcare facility’s business plan, Dr Maniadakishas much to impart on the pros and cons of

Leasing, private investments, privateequity, PPP and fund raising

At the Symposium, Dr Brzesinsky will describe

Diagnostic imaging and financingprivate diagnostic facilities in Poland

Peter’s theme and advice for our hospitalmanagement visitors will be

Healthcare Fundraising –You will get what you ask for!

M A N A G E R S Y M P O S I U M

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13

Launching its newest Accutronseries injector, Medtron AGproudly reports that the injector’shigh levels of accuracy, efficacy,and safety result from fifteenyears’ experience in development,

To gain approval from US andother global markets, ProvotecGmbH & Co KG, of Espelkamp,Germany, increased the patientload of its Prognost XPE tables.

A bucky table is an inexpensivetool in the X-Ray department,Provotec points out. ‘However, dueto the increasing use of movablestands, especially combined withdigital image receptors, furtherrequirements to the patientpositioning table do arise. Alongwith tabletop movements in XYZdirections, to optimise theadvantages of movable stands,table movement is desirable with apatient in the room.’

The Prognost XPE is a mobilepatient positioning table withmotorized elevating and floating

The world’s first wireless & radio controlled injector with Bluetooth technology

ON SHOW AT ECR 2007the intensive research of theexpert team, their close follow-upof imaging modalities and, finally,their experience in addressingend-user input and needs.

The company’s new AccutronMR, for example, is the onlytotally wireless injector on today’smarket. Its batteries, which runthe shielded motor, need only anovernight charge to provideregular operating power forseveral days. ‘Wireless Bluetoothtechnology was chosen for itshigher compatibility with MR fieldenvironment to allow directcontrol of all injection parametersand operation via the remotecontrol,’ Medtron adds. ‘The sameone page touch-screen controlsthe injection head. Using theexclusive ELS (Easy-Loading-Syringe), even night shift canbenefit from this easy handling.Sticking to the latest MR imaging

suites and protocols, the doublehead Accutron MR brings thewidest scope of injection capacityup to 3-Tesla.’

Reporting on the developmentof its Accutron CT single head,Medtron explains that the aimhas been to optimise theinjection work-flow, costeffectiveness and patient comfort,whilst also presenting users withthe same quality of standardcontrast CT protocols.

Future developmentsExamination times, shortened byIT and Computer AssistedDiagnostics (CAD), require adeeper integration and simplifiedmanagement of contrast mediainjection for the imagingsequence, Medtron points out. Tothis end, along with many largeimaging corporations, thecompany is involved in the

Mobile positioning table takes heavyweights

Time-saving breast biopsy tools

Precision and clarity in details thanksto high resolution

‘The large range of accessoriesincludes adaptations forcustomary vacuum guns.The biopsy unit can be

tailored to various softwaresystems. A co-ordinatesystem will be availableshortly.’

Noras points out that, beingmodular, this system is morecost-effective for newcomers. ‘Thedifferent components (Post&Pillaror grid system, 4-ch coil) can beassembled according to the user’sneeds and the accessories can beadapted to his biopsy system.’The CPC 8-ch phased arraymultipurpose coil – ‘This 2x4chcoil, provided with an adjustableholder, offers high-resolutionimage quality and has beendesigned for parallel imaging. Asit enables a great number ofimaging applications – carotidartery, jawbone, ears, eyes, aswell as movement studies of allarticulations – this device

represents a cost-savingexamination solution. Thedevelopment of customisedholders for the musculoskeletalsystem is also possible. The MR-safe trolley with instrument table,LED light and vacuum pump forfixation mats can also be used tostore the CPC coil and variousinstruments,’ Noras adds. View the Noras range at ECR,Expo A, booth 125.

Prognost XPEtables take

patients up to230 kg

tabletop, which allows variablepatient positioning as well asoptimal use of modern X-raytube/image receptor combinations.

‘Not having a line cable makesthe Prognost XPE - Akkuparticularly comfortable,’ Provotecsays. ‘A rechargeable battery(accu) supplies sufficient energy tomoving patients to the desiredworking heights. While one accusupplies energy to the table,another is loaded in the loadingstation. This is very user-friendly,because the accus can be changedsimply and quickly and without atool. Even if charge signals areoverlooked and the accu is“suddenly” empty, changing ittakes only seconds. The loadedaccu can be removed with one

hand from the loading stationand replaced in the Prognost XPE– Akku, against the empty one.Using a fixed working height, butthe advantage of a mobile tablewith the floating tabletop,Prognost XP is the right choice.Neither line cable nor electricity isnecessary.’

Additionally, all versions can beequipped with a moveable Bucky,or cassette holder under thetabletop.Details: www.provotec.com

CANopen project (already availablefor its double-head CT injector, theInjektron CT 2).

The company predicts its projectswill result in the next generation ofCIA425-approved injectors, whichwill communicate with and be fullycontrolled by imaging software, sothat injection parameters can beautomatically adapted to the imageacquisition sequence.Medtron will demonstrate thenew Accutron range at thisyear’s European Congress ofRadiology.Extension Expo A, # 16.

MR-guided interventional breastprocedures have increaseddramatically over the last fewyears. Noras MRI Products, ofHochberg, Germany, is anestablished specialistmanufacturer of instruments andaccessories for this field. At ECR2007, the company willdemonstrate two systems. The Noras MR breast puncturesystem now has 4-ch phasedarray coil. ‘The wide access –medial, lateral and cranio-caudal– permits punctures in the wholebreast volume without time-consuming patient repositioning,’the company explains, adding:

NEW

NEW

Wirelessdisplayinstallation

Accutron MR

E C R

•••• developes, manufactures and markets X-ray generators, bucky tables, wall stands, buckys and cassette trays for radiology(Bucky-Systems), also Systems with DR-Detectores.

Spare parts are also available for PICKER radiographic systems

PROVOTEC GmbH & Co KG • X-Ray- & High Tension SystemsBrandenburger Ring 2 – 4 • 32339 Espelkamp / GermanyPhone: +49 5772 97 89 00 • Fax: +49 5772 97 89 10 • info@provotec.de

www.provotec.com

‘

I N T E R V I E W

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14

Molecular imagingGE was the first to undertake molecular imagingdevelopment on a large scale. ‘You have to be avery special company to work in this discipline,’Reinaldo Garcia,(right) President and Chief Executive Officer of GE Healthcare International, pointed out, when we asked for an update on his company’s progress in this field

RG: This is not simply anothertechnology; you need acomprehensive understanding ofmany technologies and sciencesto be able to master it. You needto understand not only how theequipment works, but also tounderstand (and have) biologyand chemistry technologies. Manyyears ago, when we realised weneeded this knowledge to pursuethe road to molecular imagingand other things.

continues and the indications arevalidated and approved, theycould be used to identify specificdiseases using our imaging agentin conjunction with a PETmachine. Now, we know whatwe’re doing on the imaging side;we can optimise the equipment,and, because of that, we canoptimise the imaging agent.That’s why we’re now able todevelop this product. Where could this developmentlead?

For PET applications, for example,FDG (fluorodeoxyglucose) iscurrently the generic kind ofisotope that identifies tumours.

and change the outcome for thepatient. If you don’t treat people,most likely they will die. You canin many cases remove the cancereither surgically or by chemotherapy.If the cancer is metastatic andhas already spread to other partsof the body, it is more difficultand in many cases impossible totreat. If it is caught early, you canmanage it and there’s a highprobability of eliminating it. Theearlier you find a tumour, thegreater the chance of treating it.Studies have shown that if youcatch breast cancer at phase one,the patient’s chance of survivalover the next five years is more

than 90%. At phase four it is 20%.It’s similar with colon cancer.

So, by using molecular imagingwith specific tracers and usingPET/CT technology, you canidentify tumours when they arevery small, and this offers a greaterchance of impacting it.

It’s the same with cardiacdisease. In Europe and the UnitedStates, 65 million people haveheart problems but no symptoms.They don’t have a clue that theyare ‘the walking wounded’. If we

CARDIOVASCULAR IMAGING

trying to address disease-specificchallenges. It’s not about makingequipment faster, greater, smaller– it’s about what the big diseasechallenges are and what we needto do to address them. That’swhat defines our work today.You can’t abandon equipmentdevelopment – you havecompetitors.No, but equipment will evolve toadapt to diseases. Ultimately,what are doctors for? To identifydiseases; so if we can meet thechallenge of diseases, doctors willbuy our equipment, notequipment from somebody else.Because of the focus on disease,equipment will evolve; thinkabout the VCT (volume computedtomography). We are trying toresolve a big cardiologychallenge: How can I haveconsistently good images of theheart? To do this, you have toimage the heart over a very shorttime. So we developed a productto image the heart in five beatsand it is a big success. If youpursue the strategy of resolvingdisease, your product will bedeveloped to that end and it willbe much more successful than ifa bunch of engineers simplydeveloped a product.

Among other things, we arefocusing mainly on three areasthat are very important to us:cardiology, oncology andneurodegenerative diseases. MRcan be used for cardiology, alongwith CT, ultrasound, PET, cath labsand even X-rays. All thesetechnologies have been adaptedand focused on one disease.Adapting the technologyaccording to the disease is, Ibelieve, an important strategy. Ifyou concentrate on Early Health,which means seeing earlier anddiagnosing earlier so you cantreat earlier, you should be ableto continue that strategy withexisting systems. Of course, newproducts to tackle these threemajor diseases will also come onto the market.

Among a multitude of commitments,award-winning cardiologist Prof. Ernst Evan der Wall is ESC Vice-President. He isalso a founding member of the AmericanSociety of Nuclear Cardiology (ASNC),Society of Cardiovascular MagneticResonance Imaging (SCMR), edits theInternational Journal of CardiovascularImaging, is an Associate Editor of theJournal of Cardiovascular MagneticResonance Imaging, and Editorial BoardMember of several other publications,including the European Heart Journal,Journal of Nuclear Cardiology, Journal ofHeart Disease, etc.

The US finally did it: radiologists and cardiologists gottogether to draft guidelines for cardiovascular imagingprocedures and define quality standards. However,Europe still awaits a binding consensus to end internalsquabbles in hospitals. Meike Lerner, of EuropeanHospital, discussed this situation with ProfessorErnst E van der Wall MD, (right) Head of theDepartment of Cardiology at Leiden UniversityMedical Centre, in the Netherlands, and VicePresident of the ESC (European Society of Cardiology)

internalise. Therefore, in theNetherlands we are about tocreate a special training in cardio-radiology - or radio-cardiology.This means that, at the end of histraining, a cardiologist will spenda year in radiology and vice versa.

Another step forward is the factthat the professional associations,ESC (European Society ofCardiology) and the ESR(European Society of Radiology),organise joint congresses andseminars. Also, we should notforget nuclear medicine, anotherdiscipline with which we closelyco-operate. That way the ECSguidelines for CT and MR andnuclear radiology came about inco-operation with the otherassociations and are recognisedby them. This sounds very harmonious,so why are there stilldisagreements?The guidelines alone are notsufficient. We need standardprotocols for quality assurancethat also can be applied at locallevel. Moreover, some crucialissues remain to be solved: Whichphysician will scan which patient?How will the reimbursement behandled?

In terms of reimbursement, theDRGs will help, but they are notyet completely formulated andare currently still rather discipline-oriented. To me, a 50:50 split

seems like a just solution. In terms of responsibility, it’s

also difficult to clearly definecompetencies. In my opinion,generating images is, in principle,a radiologist’s task, albeit in closeco-operation with the cardiologist.The interpretation of imagesshould be done jointly. But whoshould have the final say? Thecardiologist knows the physiologyof the heart, knows the patientand considered the scannecessary in the first place. Theradiologist quite justifiably says: ‘Iam more than a photographer.I’ve studied medicine and I’m the

specialist when it comes tointerpreting images.’Consequently, the radiologistshould assess which furtherprocedures might be indicated forthe patient and he or she shouldanalyse the images with thecardiologist. The cardiologist, inturn, should be the one toformulate the diagnosis. This is arather theoretical solution of theproblem which, in every day life,obviously often leads to astalemate.

The definition of proceduresand responsibilities as well asstandard protocols is the goal we

identifies areas showinginflammatory conditions thatcould potentially be cancer. It’sjust like PET. It’s an MR image; itworks like a PET but there is noinjection. It is another way ofthinking about molecular imaging.We are the only ones who can dowhole-body imaging that canperform a PET-like application.

Right now we are working ontracers to identify newdegenerative diseases and cardiacconditions. As the research

But if you want to find outspecifically whether it is benign ormalignant, and what kind oftumour, you have to use a morespecific tracer. That’s where it willlead – to the identification ofspecific kinds of cancer withmuch more certainty andsensitivity. That means you’ll beable to find cancers much earlier,when they are smaller, and alsobe more certain of what thedisease is. And it’s now possibleto significantly regress the disease

can identify them early, theycould receive a simple treatmentto prevent coronary disease or aheart attack. That’s where ourtechnologies are becoming morecritical.Politicians should be alerted tothese cost factors.Yes. If I have a heart conditionand am heading for a heartattack, I could take drugs toeliminate that probability; they’dcost me $1,500 a year. If I don’tknow about my condition, thenhave a heart attack and survive it,treatment would cost more thanten times the $1,500. It is far lesscostly to address the problemsearlier. Keeping things undercontrol and never allowing me tohave a heart attack is just oneexample that shows howsignificantly less expensive this is.Along with molecular imagingequipment, what else might GElaunch in the next five years? We won’t deviate from this pathof Early Health. This is animportant strategy, one that reallydefines the way we invest ourmoney in R&D, the way weoperate and the way wecommunicate. Everything I havebeen talking about has beenabout Early Health. We are really

ultimately want to reach togetherwith radiologists and nuclearmedicine specialists – as well aswith surgeons. There is one thingwe cardiologists must not forget:imaging procedures in cardiologyare here to stay only if we co-operate closely with radiologists.

Despite all disagreements, theintensive discussions were fruitfuland we are making progress. I’mconvinced we will have aEuropean consensus paper by2010. The groundwork has beenlaid in our joint congresses andwith the routine updates of ourguidelines. I am very optimistic.

What is important from amolecular imaging standpoint isthat it improves sensitivity andspecificity. We need tounderstand the behaviour of cellsand molecules, the way they reactto certain stimuli that are createdvia another chemical componentin the body such as an imagingagent, and tracers.EH: Have there been anysignificant advances at GEsince we last spoke on thissubject?It’s an evolution and will continueto evolve. Only a few months ago,for example, we receivedapproval to use DaTSCAN toidentify dementia with LewyBodies.

This is a new use for DaTSCAN.You have to differentiateParkinson’s disease from othertremors, because if you use thesame treatment, you can actuallycause more damage. Itdifferentiates betweenParkinson’s and Essential Tremor.With DaTSCAN you can nowidentify dementia with Lewybodies, as well as Parkinson’sdisease. This is important,because treatment is specific toeach condition.

A great application we have is awhole-body imaging MR that

I N T E R V I E W

ML: The recent consensus paperby American radiologists andcardiologists will make their co-operation much smoother andimprove the quality ofcardiovascular imaging. Arerelevant European professionalassociations also trying toformulate standards so as toend the eternal bickeringbetween cardiologists andradiologists?EvdW: Obviously, we’ve beendiscussing unified and clearlydefined procedures in Europe – foryears. So far, we have not beenable to arrive at a pan-Europeansolution. However, at local levelthere is an increasingrapprochement betweencardiologists and radiologists. Inmy institution there is a constantexchange between ourselves andradiology colleagues. We havedefined internal procedures thatsatisfy both sides and we co-operate closely. Most otherhospitals handle this in a verysimilar way. What we don’t have isan agreement that is valid for allcountries, but at the same timetakes into account therequirements of the individualcountries, and even hospitals.That’s the problem. In principle,cardiologists and radiologists agreethat the best outcome, and bestpossible interpretation of imagesrequire joint efforts and exchange.The disciplines are linked – that’s afact that physicians must

COMMUNICATION BUT NO CONSENSUS

15

Light therapy supportsdiagnostic imaging

‘In our private centre we try tolive a new dimension indiagnostics,’ Dr Alth explained.‘This means we provide acomprehensive range ofequipment of the latestgeneration for digital X-ray, digitalmammography, ultrasound, CT,MRI and radiotherapy. Moreover,we are the first in Europe to offerlight therapy support – which ourpatients embrace enthusiastically.’

Asked how that novel systemworks, he pointed out that many

SLOVAKIARADIOLOGY IN A SMALL

CENTRAL EUROPEAN COUNTRY

Slovakia was part of the Austrian-Hungarian Empire until 1918,when Czechs and Slovaks were brought together to form theCzechoslovak Republic. After World War II, and up to 1948, thecountry was still part of Europe, but then fell behind the ‘IronCurtain’. From 1989 it began ‘knocking on the EU door’ andentry was granted in 2003. Today Slovakia’s population isaround 5.38 million. To serve that number, the country has 340radiologists and 1,100 radiographers. Peter Boruta MD PhD,Professor of Radiology and Head of Radiology at Slovak MedicalUniversity, in Bratislava, and Director of the Imaging Diagnostic

Institute in Trnava, reports.

There are two famous Slovaks in thehistory of world radiology.

The Hungarian-German physicistPhilipp Eduard Anton von Lénárd,(born: 1862, in Austria-Hungary –today Slovakia. Died: 1947 inGermany) won the Nobel Prize forPhysics in 1905 for his research oncathode rays.

Vojtech Alexander, (born 1857 inKezmarok, died 1916 in Budapest)founded radiology in the Kingdom ofHungary, and became one of theworld’s most influential radiologists.Among his many achievements, hedescribed the development oftuberculosis. He owned the first X-rayapparatus in Slovakia. He also wroteSlovak poems.

Behind the Iron Curtain The history of Slovak radiologydeveloped alongside Czech radiologyin the Czechoslovak Republic.Training of Slovak radiologists inspecialised X-ray centres in Pragueand Hradec Kralove, and their closeco-operation, improved the quality ofX-ray centres in Slovakia’s statehospitals. Being in the east ofCzechoslovakia, Slovakia has aslightly lower level due to having lessequipment and personnel. From1953, the government organisedinstitutional post-graduate teachingfor radiologists, radiographers andradiology technicians. Top qualityradiology was centred in threetowns, Bratislava (Slovakia’s capitalcity), Banska Bystrica (centralSlovakia), Kosice (an easternSlovakia metropolis). In 1983, theBiomedical Research institute inBratislava had the first CT scanner inthe country, and two more wereinstalled within two years. The threeradiology centres producedcompletely adequate X-raydiagnoses. Routine X-ray diagnoseswere carried out at different qualitylevels in the state hospitals andexternal departments.

Czech, Slovak, Hungarian and EastGerman radiology societies enjoyedclose co-operation. Few of us hadthe opportunity to visit radiologydepartments and congresses in

E C R

patients feel very uncomfortableduring MRI and CT exams, andsometimes they have specificproblems - such as claustrophobia.‘So we opted for Ambient Lighting,a dynamic lighting concept byPhilips. It’s designed to create asoothing atmosphere in theexamination environment. Lightcreates wellness is the motto ofthis concept. A patient beingmoved through the scanner canlook at a harmonious play ofpastel colours that soothes and

relaxes him, or her, and detractsfrom the actual examination. Thefelt scanning time is shorter, theplay of colours reduces fear andmakes patients feel secure and atease.’

Asked how the lighting isintegrated into a clinicalprocedure, and whether itresembled a pre-programmedlight show in a discotheque, DrAlth said the interaction of thehomogeneous general lightingsystem and the additional wall-

mounted LEDs is controlledmanually, to be able to adapt it toindividual situations. ‘Anotheradvantage is that we cancommunicate with patients withhearing problems via colour codes.In MRI or CT scans you often havecommands such as “hold yourbreath” or “resume breathing”.Now, for example, a green light,can tell the patient to breath again,while a red light tells him to hold abreath. That makes life easier notjust for patients but also the staff.’

At the clinic, wellness seems tobe a leitmotiv – from the receptionthrough the waiting area to thehallways: generous light, pictures,and friendly colours… It’s almostlike in an art gallery, I remarked. DrAlth was pleased. ‘I’m happy thatthis is your spontaneousimpression, because that is exactlywhat we wanted to achieve withour focus on superior service andwhere we consciously want to offeran alternative to the often quitedepressing hospital routine. Andindeed, we opened with a largePrachensky vernissage. Others willfollow.’

On 700 m2 the managementhave installed a state-of-the-artequipment park for imagingdiagnostics and plan to handle upto 500 patients daily. ‘That’s quite atask for the medical staff,’ Isuggested, but Dr Alth was notfazed. ‘We have a team of topspecialists and a board of expertsthat will support us with complexcases,’ he said reassuringly. ‘So, fastand accurate diagnoses areguaranteed.’

western countries. However, fromtime to time we had a chance topresent our results abroad (ICR,ECR, national radiologicalcongresses).

Knocking on the EU door (1989 – 1993)After the political movement,changes in radiology in our countryalso took place. The splitting of theCzechoslovak Republic created aseparate Slovak radiology society,with lots of work on ownmanagement. We had to prepareradiology guidelines for thegovernment. Changes in medicalcare were followed by changes inradiology. Privatisation came as anew phenomenon to our medicalcare. We were under pressure tofind the best way towards effectiveradiology. We had to choose thebest from a lot of data. Formerpersonal contacts helped us toimplement data from many trainingprogrammes organised by EAR andUniversity hospitals (Vienna, Graz,Zurich, Freiburg, Heidelberg andmany others).

Into the EU (from 2003)Improvements in politics andeconomic reforms acceleratedgrowth in the amount of radiologyequipment. There is continuousexchange of old X-ray apparatus bystate-of-the-art apparatus, up to CRand DR. Old-fashioned axial CTscanners have been replaced byMSCT. We have two cardio MSCT,one 64 row and one 2x32 rowdetector CT. Today more than fiftyCT scanners are in use. Among25MRI units, we have nine open heartsystems in private practice. Wehave six interventional X-raycentres.

Many of our X-ray departmentshave problems finding qualifiedradiologists. Lots of qualifiedpersonnel are leaving to find betterpaid jobs in EU countries. It is avery good indicator of our quality,but unfortunately brings us theserious problem of findingadequate substitutes.

In post graduate teaching we canaccept some positive improvementsand we add positive ideas from EU

recommendations to our postgraduate programmes.

Close co-operations with EAR,radiological societies of EU countries,and special teaching programmes(the Star programme organised byEAR, Schering, Siemens, SRS, SMU;the Hands-on Workshop organisedby Heidelberg, EAR, Schering, SZU)are just a few teaching activities.

Attendance of the German-Slovakradiological association was also astep towards close co-operation toexchange data regarding radiologicalimprovements, research, andteaching. To improve radiology, orstandardise radiology in EUcountries, visits by experts and theexchange of residents and studentsis a necessity.

The end result of close co-operation between radiologists atHeidelberg University, the private

Drs Gunther Alth and FriedrichVorbeck at the new centre

NEW FOR EUROPE

Colourful lighting: not onlyenhancing, but able to instruct

patients in the CT scanne

radiology group Linz and theradiology group in Slovakia, is theImaging Diagnostic Institute inTrnava. The first fully equipped X-raydepartment with CR, bodyultrasound, mammography, 64MSCT, with cardio and MRI, hasbeen operating for a year. They useRIS and PACS to be more effectiveand improve results. Top qualifiedpersonnel, state-of-the-art algorithm,and a high level of roomconfiguration, guarantee the highestlevel of radiology examinations andpostgraduate teaching programmesfor radiologists and X-ray technicians.

Slovak radiology has a goodchance of becoming a qualifiedmember of EAR.

One of Europe’s mostmodern radiology anddiagnostics centres openedin Vienna-Donaustadt,Austria, this January. Built upfrom around six millioneuros raised by privateinvestors, and now offeringstate-of-the-art technologyplus medical expertise andpatient-oriented services, thecentre will readily competewith any university hospital. Christian Pruszinsky, ourcorrespondent in Austria,asked Dr Gunther Alth, thecentre’s manager, andDr Friedrich Vorbeck, howthis centre differs fromthe rest

A Cardio CTAquilion 64 from

Toshiba, at theDiagnostic

Imaging Institutein Trnava

From left, at the Vitrea workstation:A Glezlova MD, Prof. P Boruta andP Jánska MD

After Bratislava and Lucenec, thesecond MRI Hands-On Workshop washeld at the Kosice Hospital.The organisers, from left (dark suits):M Requardt, F Giesel MD MBA, H vonTengg-Kobligk MD, R Ringelband MD,with hospital personnel

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