capital equipment track - amazon web services equipment track challenges with new equipment...
TRANSCRIPT
1/30/16
©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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CapitalEquipmentTrack
ChallengeswithNewEquipmentAcquisiHon
ProfessorofRadiologyandCardiologyJohnsHopkinsSchoolofMedicineChiefPhysicist–JohnsHopkinsHospitalJointAppointment–JohnsHopkinsSchoolofPublicHealth,BalHmore,MD
MahadevappaMahesh,MS,PhD,FAAPM,FACR,FACMP,FSCCT.
email – [email protected] Phone: 410-955-5115 (O)
Disclosure
BookroyalHesfromLippincoOWilliams&Wilkins
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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LearningObjecHves
• NewequipmentthatisimpacHngclinicalcare• Outlinemethodstoevaluatenewequipment• Analyzetrendsinnewequipmentadvancesandpricing
• DevelopbestpracHcesforprocuringnewequipmentforyourpracHce
CapitalPurchaseProcess
• Requirements–NeedsAssessment• SpecificaHons
– InviHngVendorstosubmitproductsthatmatchesspecificaHons
• SelecHons– ReviewingmodaliHesfromvariousvendors
• PurchaseDecisions– SelecHngmodality&ensureregulatorycompliance
• InstallaHonandAcceptanceTest• ConHnualofQualityAssuranceProcess
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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BestpracHcesforprocuringnewequipment
Needassessment• PopularityversusNecessity
– Ex:DigitalmammographywidelyindemandbypaHentgroupsevenbeforeitwasclinicallyproved
– BreastTomosynthesisaka3DmammographyismorepopularandindemandbypaHentgroups
• HospitalsmaywishtoacquiringlatestmodaliHestobetheflagshipcentertoaOractmorepaHents
Radiography
X-rayImagingSystems
Bi-planeFluoroscopysystem
CTscanner
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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ImagingModaliHesImpacHngClinicalCare
• ComputedTomography– 64MDCTvs320orFLASHCT
• MagneHcResonanceImaging– OpenvsClosedsystems(1.5Tvs3.0T)
• FluoroscopyandRadiography – Flatpaneldetectors
• MobileandWirelessdigitaldetectors• DigitalBreastTomosynthesis• Ultrasound-3DandHandheld
ComputedTomography(CT)
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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16.1 17.2 18.4 19.7 21.6 22.8 25.8
29 33.1
37.9 41.4
44.3 47.2
51
2.2 2.3
2.6 2.9
3.5 3.5
4.8
5.9
6.5
7.5
8.7
9.6
10.4
11
18.3 19.5 21.0
22.6 25.1 26.3
30.6
34.9
39.6
45.4
50.1
53.9
57.6
62.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
0
10
20
30
40
50
60
70
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
To
tal p
roce
du
res
(millio
ns)
No
. o
f p
roce
du
res
(millio
ns)
Out-patient Hospital Total
Annual growth of >10% per year
NumberofCTproceduresinUS
IMVBenchmarkReportsonCT
2007:68.7million2008:73.1million2009:77.5million2010:81.9million2011:85.3million2012:80.6million2013:76.0million
MDCT
CTinMedia2001
2014
RadiaHonBoom,NYHmes
2014
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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CTscanners
• RapiddevelopmentinCTtechnologyisenabling– FasterandbeOerCTimaging– LowerradiaHondose– QuickassessmentinEDhelpstotriagepaHentstoeitheradmittohospitalorsendhome
• TwodisHnctsystems– WidedetectorCTscannersthatcoversenHreorgansinsinglerotaHon
– DualsourceCTscannersenabledualenergyCTscans
Scancoverage-320vs64sliceMDCT
320 slice
64 slice
MaheshM,MDCTPhysics:TheBasics…,2009 JohnsHopkinsonToshiba320CT
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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DualSourceCT:DefiniHonFLASH*
DefiniHon–FLASH2ndDetectorsetsHllsmallerthan1stbutlargerthanDefiniHon
SFOV:1stdetector–50cm,2nddetector–34cm
X-rayTubeA
X-rayTubeB
DetectorB
DetectorA
*Siemens JohnsHopkins–May2009
Cou
rtesy
of G
erm
an H
eart
Cen
ter/
Mun
ich,
Ger
man
y�
Radiographics2011
DualEnergyCT
• PromisingnewdevelopmentinCT
• PotenHaltoimprovelesiondetecHonandcharacterizaHon
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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DualEnergyCTAdvantages• SoughtamerapplicaHon-
possibleduetotechnologicaladvances
• ReducesarHfacts• BeOerdelineaHonof
structures• EffecHveindifferenHaHng
structures–effecHvediagnosis
Disadvantages• Costly• RequiresaddiHonalHme
– ProcessingImages– ReviewingImages
• Notnecessarilysuitableformostsmallertomediumsizehospitals
• Noextrareimbursement
AdvancedvsConvenHonalCTScannerAdvantages• Newdetectortechnologies
enableslowerdosestudies• DualenergyCT,perfusion
studies• IteraHvereconstrucHon• ImproveddosemodulaHon• Structureddosereports
Disadvantages• Costly• Notnecessarilysuitablefor
mostsmallertomediumsizehospitals
• Noextrareimbursement
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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MagneHcResonanceImaging(MRI)
MRIscanners
• ClosedversusOpenMRIscanners• Closedsystems–1.5Tvs3T• OpenMRIsystemstendtobe
– lowermagneHcfieldstrengths(<1T)– Imagequalityisomencompromised– LessinHmidaHngforpaHents– GreatcomfortforpaHentswhoareclaustrophobic
– Workswellextremityimaging
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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MRI:3Tvs1.5TscannerCasefor3Tscanner
• BeOerimagequality• Fasterstudiespossible• PosiHoningforfuture
needs• DifferenHatefrom
compeHtors• AOractleadingspecialists• Costly-exceeds$2M• Reimbursementsaresame
Casefor1.5Tscanner
• ConvenHonalscanner• CosteffecHveformost
rouHnestudies• Lessexpensive-$1-1.5M• Reimbursementsaresame• Fieldtrendingtowards
higherfieldstrengths
1.5T3T
MRSafetyChallenges
• MRsafetyiskey– Greaterwith3Tduetohigherfieldstrength
• Definesfacilitydesign• TrainingofMRusers• FasterscanimplieshigherpaHentthroughput–higherrevenue
AJR:188,June2007
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FacilityDesignConsideraHons
• AssessmentregardinginstallaHonofmodaliHes– Forex:MRscannerlocatedclosetoelevatorrequiresaddiHonalreinforcementtominimizevibraHons
– WeightofPET-CTcandictatethelocaHoninafacility
• RecognizinglocalregulaHonsregardingx-rayfacilitydesignminimizesdelayinconstrucHon– OmenregulaHonsrequiressubmirngleadshieldingplanspriortoconstrucHon
ScaOerRadiaHon-ImpactonFacilityDesign
8%
0.4%
DataforSiemensFLASH140kVand38.4mmbeamexpressedasuGy/mAs
Console
24&
19&
Console
48&
26&
CTRoom1
CTRoom2
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PET-CTScanner–FacilityDesign
PET Gantry
CT Gantry
FluoroscopyImageReceptorsFlatPanelDetectors(FPD)vsImageIntensifiers(II)
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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DigitalMammmographyvsTomosynthesis(3D)Tomosynthesis
TomosynthesisSlice
PlanarMammography
DigitalMammogramCourtesy:HologicInc,Bedford,MA
MedicalCenter–VendorAgreement
Desired• InnovaHon• CosteffecHvetodeliver• PaHentcareathigh-quality• Carewithhighquality• ProducHvity• Removebarriers• AidsinstandardizaHonof
pracHce
Challenges• Confiningtoavendorcan
limitaccesstobestfeatures/modaliHes
• AdvancedmodaliHesareuniquewitheachvendor– ExFluoroscopyorCT
• Agreementtoworktogetheriseasieronpaperthaninreality
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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MedicalCenterwithSingleVendor
Advantages• StandardizaHoneasy• FamiliarityopHmizesuser
training• EquipmentdownHmecan
beminimizedwithon-Hmeserviceagreements
• TrainingusersiseffecHve• CosteffecHvedeals
Disadvantages• LackofcollaboraHon• Chancetoseeother
vendorsproductdecreases• Minimizesexposuretonew
features• Vendor-userrelaHonship
cansourleadingtosubopHmalservice
MedicalCenterwithMulHpleVendors
Advantages• Possibilitytoaccessunique
features• CangetbestmodaliHes
thatfitstheneed• Abletogetnewandcurng
edgefeatures• CompeHHonamong
vendorscanbenefitinobtainingbeOerservice
Disadvantages• Difficulttostandardize
pracHce• Difficulttocutdealsto
reducecost• Requirestrainingon
mulHpleplavorms• Usersmaynotliketoo
manyvariables
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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StandardizaHonvsCustomizaHon
StandardizaHon
• Assistsinuniformcare– Ex:StandardheadCTscans
• MinimizespaHenterrors• Minimizesbillingerrors• OpHmizesusertraining
• Worksbestwithsinglevendor
CustomizaHon
• Benefittoexplorenewideas
• Protocolstosuitspecialimagingneeds
• Exploitsalientfeaturesondifferentvendorplavorms
• WorksbestwithmulHplevendors
CTDoseCheckStandard
• CompliancerequiredforCTscannersoperaHnginoutpaHentcentersandphysiciansofficesandnotnecessarilyinhospitals
• However,salesstaffomenpressurehospitalmanagementtoupgradeCTscannerthatsHllhasmanyyearsofacHvelife
• NeedtoidenHfykeypersonnel(suchasqualifiedmedicalphysicist)whocanprovidecorrectinterpretaHonofimpendingregulaHons
MaheshM.JACR,2016
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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BestpracHcesforprocuringnewequipment
• AssemblingrightteamiskeyEspeciallywithadvancedimagingmodaliHes• ExpertswhoareawareofregulaHons(naHonallyandlocally)pertainingtothesystemsofinterest
• Requirementswithregardtofacilitydesign,assessingaccreditaHonrequirements,etc.RFcoil
MRIPETA
MRI
PET
BMRI
PET
C
Commonbed
RFcoil
RFcoil
RFcoil
Singlebed
PET PET/CT PET/MR
PET-MRI
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©DrM.Mahesh–MS,PhD,FAAPM,FACR,FACMP,FSCCTJohnsHopkins [email protected]
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Conclusions
• IdenHfyingrightteamwithexperHseiskeyforsuccessfulcapitalacquisiHons
• AdvancedmodaliHesrequirescustomizedevaluaHoncomparedtostandardizedassessmentmethod
• MatchingmodaliHestousersneedimprovespaHentcareandcanbecosteffecHve
Contact Info: email – [email protected] Phone: 410-955-5115 (O)