Polishing Up: Radiation'S Image

Inside: Reports on Anesthesia, Leasing and Finance in Medicine
OCTOBER 2010
SM
Your industry source for health care and equipment coverage. www.DOTmed.com
POLISHING UP
RADIATION’S IMAGE
What’s being done to improve safety
■PARTS
Finding your way to the best suppliers
■ Financially Sick Hospital Syndrome

Why so many are on the critical list
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contents October 2010
features
32 Radiation Safety
New concerns have cropped up, but are
66 they valid?
66 H
ospital
Bankruptcies
Bankruptcy isn’t always the final chapter
industry sector reports 24
24 Radiotherapy’s Big Move

24
Emerging technology set to guide the
sector’s success
38 Medical Equipment
Parts Providers
Small components lead to big business for
professionals 61
57 Leasing and Finance
In a tough economy, to whom do health care
providers turn?
61 Anesthesia
A new system is emerging to manage this
critical procedure
contents
PUBLISHER DOTmed.com, Inc.
PRESIDENT Philip F. Jacobus
editorial
EDITOR-IN-CHIEF Sean Ruck

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STAFF WRITERS Heather Mayer

Olga Deshchenko
6 Letter from the Editor – We want to hear
from you! CONTRIBUTING WRITERS David Fisher
Keith Loria
Astrid Fiano
18 Health Care Chronicles – The financial impact
design
of radiation therapy
DESIGN DIRECTOR Stephanie Biddle
22 Shows & Conferences – ASTRO 2010 gets this SENIOR DESIGNER Bradley Rose
month’s spotlight
sales
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70 Medical Museum – An ancestor of the NATIONAL ACCOUNT Don Hurtikant

MANAGER 212-742-1200 Ext. 275
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KEY ACCOUNT Susan Minotillo

71 This Month in Medical History – The Father MANAGER 212-742-1200 ext. 261
of Tropical Medicine sminotillo@dotmed.com
ACCOUNT EXECUTIVES Sean Collins

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in every issue
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8 Feedback Dustin Sewnauth
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8 Upcoming Events Calendar dsewnauth@dotmed.com
10 In Case You Missed It . . . Rigo Smith
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20 New Product Showcase rsmith@dotmed.com
23 In the Next Issue
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letter from the editor
Finance, fine-tuning and feedback
Welcome to your October issue of DOTmed Business News. As the year winds down
and companies map their plans for the future, budgets are on everyone’s to-do list. Ap-
propriately, this issue’s theme is “finance.” You’ll find our Leasing and Finance ISR on
page 57. As might be expected, the market is closely scrutinizing every transaction.
We offer a look at the ongoing bankruptcy crisis hitting hospitals on page 66.
Given that health care is considered more of a required than an elective expense, it’s
a troubling sign of the times that some hospitals are going under. Yet, there are some
success stories to be had and some insight shared from those who have been to the
brink and have managed to turn things around.
If you’re a regular reader of the magazine, you may have noticed a change in
the format. The abbreviated news pieces formerly found under “Hospital and Health,”
“What’s New” and “People and Companies” now all fall under the umbrella of “In case
you missed it . . . “ And if you DID miss it, there is of course an easy solution — all of
those news blurbs can be read in their entirety as they’re reported by visiting www.dot-
med.com. You can also sign up for our weekly e-news that’s delivered every Thursday
directly to your inbox. You can be sure there will be plenty of news worth tuning into
in the coming months as companies prepare their major releases in time for RSNA,
so now is a great time to get acquainted with our online news coverage if you’re not
already familiar with it.
Finally, as we at DOTmed News and DOTmed.com begin to wind down the year
and prepare for 2011, we want to hear from you, our reader. Tell us what interests you.
We have received some feedback and requests, but we’re always looking to improve.
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get the most out of it.
To share your comments and feedback, you can contact the writers directly
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Until next issue!

Sean Ruck
Editor-in-Chief
DOTmed Business News
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I am Brazilian, and my country is an excellent market for used
medical devices, but the Brazilian government has an extremely
restrictive legislation. The legislation protects the major manu-
Classroom materials facturers and prevents traders from working. [Editor’s note: See
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in case you missed it...
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Every month DOTmed News covers hundreds of stories including:
http://www.dotmed.com/news/
and register to receive our weekly medical breakthroughs, studies, equipment, procedures, legisla-
e-news. Get the latest news tion and more online at www.dotmed.com the following pages offer
worth knowing directly just a glimpse of some of the stories covered in the past 30 days. To
to your inbox every Thursday. read any of these stories in their entirety, visit the website, click on a
search window and type in the letters DM and the proceeding number.
Researchers use artificial North Shore-LIJ, Village- Report: EHR adoption

corneas to restore sight Care to open permanent rates low
Researchers in Canada and Sweden urgent care center Although the Centers for Medicare and
have restored sight in half a dozen pa- North Shore-Long Island Jewish Health Medicaid Services incentive program for
tients using biosynthetic corneas. The System and VillageCare will work to- electronic health records is set to begin
artificial corneas, made of synthetic col- gether to open an urgent care center next year, new research from the Harvard
lagen and recruited host cells, could help in lower Manhattan. If approved by the School of Public Health shows many of
alleviate a human donor shortage and state, the urgent care center will open the nation’s hospitals are not ready.
the need for immunosuppressant drugs
after transplant, the researchers said.
early this fall, just eight blocks from the
former St. Vincent’s Hospital. • Online: dotmed.com/dm14044
• Online: dotmed.com/dm14003 • Online: dotmed.com/dm14028 NC hospitals save $2.8M
on supply chain costs
Bloodless blood tests now Report: Molecular imaging Seven North Carolina hospitals that
reality device market to hit $6.6B formed the purchasing coalition South-
The FDA-cleared spot-check device ern Atlantic Health Care Alliance saved
looks like a pulse oximeter using a pain- by 2014 $2.8 million over the past two years by
less finger probe. But in addition to SpO2 A 5.8 percent yearly increase in the mo- aggregating their purchasing volume,
(oxygen saturation), pulse rate, and per- lecular imaging device market is expect- the group reported in late August.
fusion index, the new, palm-sized unit ed to increase to $6.6 billion worldwide
reads out hemoglobin levels in less than by 2014, according to a market research
report from Kalorama Information.
• Online: dotmed.com/dm14058
one minute.
HHS names first EHR
• Online: dotmed.com/dm13955 • Online: dotmed.com/dm14004 certification bodies
On Aug. 30, the U.S. Department of
Health and Human Services named a
software testing lab and a health infor-
mation technology nonprofit as the first
EHR “certified bodies.”
Former Spectranetics
execs indicted for illegally
importing devices
Three former Spectranetics executives—
George John Schulte, Obinna Adhigije,
Trung Pham and BAC representative
Hernan Ricaurte have been named in
a federal indictment in Colorado. The
indictment has 12 counts relating to ille-
gally importing medical devices without
FDA approval, providing the devices to
physicians to use for patients, and pro-
moting the products for procedures with-
out FDA approval.
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Pediatrician indicted on Indian radiologists say Indiana reports fewer
655 counts of prescription anti-sex-selective medical errors in health
fraud abortion measures care facilities
A federal jury indicted a Children’s Hos- compromise privacy These events include reported stage 3
pital doctor in Colorado on 655 counts Radiologists in India oppose a state or 4 pressure ulcers. According to the
of prescription fraud last month. The government’s scheme to put devices in annual report, 94 medical error events
indictment is based on allegations that ultrasound scanners to make sure they were reported in 2009, compared with
Dr. Louis C. Hampers, a specialist in pe- aren’t helping mothers get rid of unwant- 105 in 2008 and 2007. The current re-
diatric emergency medicine, operated a ed girls, according to a recent report by port is the fourth from the department.
scheme to obtain tens of thousands of
pain and sleeping pills using fake names
the Hindustan Times.
and unsuspecting patients. • Online: dotmed.com/dm14126
Cancer detection? There’s
• Online: dotmed.com/dm14164 an app for that
Cell phones could help doctors detect
deadly cancers, thanks to a joint effort
between the Mazumdar Shaw Cancer
Center (MSCC) of the Narayana Hru-
dayalaya Hospital in India and Sana, a
research group at Harvard/MIT.
CT/MR Cockroach brains might
hold key to new antibiotics
Diagnostic
Scientists at the Society for General Mi-
crobiology’s fall meeting at the University
of Nottingham in the UK said they have
Imaging
found nine molecules in the brains of
cockroaches and locusts that are lethal to
90 percent of methicillin-resistant Staph-
Specialists
ylococcus aureus infections and E. coli.
Report: Medical malprac-

tice costs $55B
Medical malpractice costs reach $55
billion every year, or 2.4 percent of an-
SIEMENS | TOSHIBA | PHILIPS | GE nual health care spending, according to
a new Health Affairs report. While high,
Protecting Your Imaging Interests from Day One it fell short of previous estimates, the re-
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r Time and Materials (T&M) companies they fund have teamed up to
r Custom Limited Liability Contracts launch a new lobby to clear away regu-
r Onsite Technical Support latory hurdles for medical products.
r Remote Technical Support
New York releases third
annual report on hospital-
acquired infections
Surgical site infections are dropping
in New York State, according to a new
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RadNet buys N.J. imaging centers for ings on gadolinium-based contrast agents and cautioning that
three brands are associated with a greater risk of nephrogenic
$17.2 million and stock systemic fibrosis.
Imaging center chain RadNet Inc. recently inked a deal to buy
five New Jersey imaging centers from Progressive Health LLC
and own half of a sixth center.
5 forbidden used medical device markets
• Online: dotmed.com/dm14161 From Syria to Thailand, countries where you can’t sell your used
medical equipment. A DOTmed News exclusive report.
Lone Star state takes aim at ‘pill mills’
The Texas Medical Board has begun registration for pain man-
agement clinics, instituting requirements from a Texas law that
became effective the beginning of September. A pain manage- Petten reactor is back online
ment clinic in the state can no longer operate without a certifi- As of Sept. 9, the High Flux reactor in Petten, Netherlands
cate from the board. is running again at full nominal power after being offline for
months of repairs.
No childhood cancer risk found from • Online: dotmed.com/dm14176
prenatal CT CDC: MRI and CT scan use skyrockets in
A study found no link between exposure to CT scans and other the ER
radiological imaging tests in the womb and increased risk of Over the last decade, the use of medical imaging in the emer-
childhood cancers, but researchers warn they can’t rule out a gency room has skyrocketed, with MRI and CT scans for chest
connection. pain nearly tripling and for abdominal pain nearly doubling, ac-
cording to a Centers for Disease Control and Prevention report
• Online: dotmed.com/dm14163 released last month. But is it a good thing?
FDA calls for new warnings on MRI
contrast agents
The U.S. Food and Drug Administration is slapping new warn-

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FDA increases user fees by brains are developing normally, poten- MedAssets to buy
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The U.S. Food and Drug Administration On Aug. 14 MedAssets Supply Chain
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Study: Radiotherapy linked
Siemens to chronic disease
Acuson High doses of radiotherapy delivered to
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Health Care
Chronicles
Making health care work
smarter
By David Fisher
Executive Director, Medical Imaging &
Technology Alliance
M
edical imaging manufac- That translates to approximately 650,000 mental agencies and patients to ensure ap-
turers are in the business Americans each year who are able to fight propriate safety assurances are met, or ex-
of saving lives. their cancer. ceeded; training requirements are met, or
This philosophy is at But beyond the life-saving impact of exceeded; and reporting of adverse events is
the core of our mission – medical imaging, researchers have also done in a transparent and timely manner.
ensuring that the woman with the lump in found that it saves money in the long-run.
her breast will be able to get back to work For example, a 2005 study published Specifically, MITA endorses:
and the father with the pre-cancerous polyp in Radiology, states every $1 spent on inpa- • Expanding and integrating appropriateness
will live to see his daughter get married. tient imaging correlates to approximately $3 criteria into physician decision making.
The Medical Imaging & Technology in total savings, and according to research- • Creating a national dosage registry to en-
Alliance (MITA) is the leader in medical im- ers at Harvard Medical School, every $385 sure longitudinal tracking of dose levels
aging and radiation therapy technologies that spent on imaging decreases a patient’s hos- for patients across America.
allow this to happen. We develop products pital stay by one day, saving approximately • Adopting a standardized method of storing
that have revolutionized health care delivery $3,000 per patient. of diagnostic imaging and radiation ther-
in America by helping patients avoid or limit Other disease-specific studies, such as apy information within electronic health
more invasive procedures, and return to their the one published in the 2007 issue of the records.
families, lives and work more quickly. Journal of the American College of Cardiol- • Exploring the expansion of mandatory ac-
As part of our mission, MITA is acutely ogy looking att multi-slice coronary CT for creditation for advanced imaging facilities.
aware of the growing concern for patient evaluating acute chest pain, found that in- • Establishing minimum standards for train-
exposure to radiation from medical imaging creased imaging could save up to $1.2 billion ing and education for hospital and imag-
procedures. That’s why MITA and its more annually in the treatment of stroke patients. ing facility personnel who perform medi-
than 50 member companies are proactive in Additionally, according to a study published cal imaging exams and deliver radiation
developing and advocating for solutions that in the New England Journal of Medicine, therapy treatments.
will reduce exposure to radiation dose while CT scans have been found to significantly • Developing enhanced operational safety
continually improving technology to aid phy- reduce the negative appendectomy rate and procedures and checklists to reduce medi-
sicians in turning patients into survivors. the number of unnecessary hospital admis- cal errors.
This forward-looking thinking is criti- sions, saving $447 per patient since 1998. • Expanding and standardizing the reporting
cally important because the stakes are high. We are proud of the industry’s accom- of medical errors associated with medical
Peer-reviewed research confirms that these plishments. But MITA recognizes the need radiation across stakeholders in a manner
medical technologies save lives and drastically to build on these successes and continuously that is transparent for patients, families and
improve health outcomes, making these ad- seek innovations in our products that maxi- physicians.
vanced technologies fundamental to standards mize effectiveness while minimizing risk to • Working with stakeholders to develop radia-
of care. And the proof is in the numbers. the patient. tion dose reference values to provide a data
Increased regular mammography In fact, industry innovations to medi- point to compare the dose level of a specific
screenings resulted in a 24 percent decrease cal imaging technologies over the past 20 procedure. MITA commits to working with
in the death rate from breast cancer between years have reduced radiation doses for many other stakeholders to develop the most ap-
1990 and 2004. According to the American procedures by up to 75 percent, while con- propriate way to incorporate this informa-
Cancer Society, if detected early, the five- tinually improving the ability of these tech- tion into manufacturers’ technology.
year survival rate for breast cancer now nologies to aid physicians in diagnosing and
exceeds 95 percent. Increased utilization of treating disease. These important principles guide our in-
advanced medical imaging, such as CT and Additionally, underlying the equipment novation and thinking to ensure patients receive
MRI, between 1991 and 2004 improved life innovations – which are reflective of broader the best care possible. Patient lives rest in our
expectancy by 0.62 to 0.71 years. And for all changes in CT, X-ray and other radiation- hands, and therefore safety and effectiveness
cancers, physicians have reported that PET emitting imaging technologies across the are at the core of our mission. We continue to
scanning allowed them to avoid additional industry—is the industry’s support and com- be at the leading-edge of research and technol-
tests or procedures 77 percent of the time. mitment to the “as low as reasonably achiev- ogy advancements, looking for ways to build
Furthermore, radiation therapy offers able” or ALARA principle. on our successes and improve outcomes.
highly personalized, noninvasive and cost-
effective care for up to 60 percent of all di-
The medical imaging community is
committed to working both internally and
agnosed cancer patients in the United States. with physicians, other providers, govern-

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Send your press
SHOWCASE
release to
pr@dotmed.com.
Philips introduces new, sterile, one-piece

oral/enteral syringes
The new line of oral/enteral syringes (1 ml, 3 ml, 5 ml, 10 ml,
20 ml, 30 ml and 60 ml sizes) includes highly visible text on
the barrel that reads “ORAL/ENTERAL ONLY” and an oral
only tip that distinguishes it from medication syringes. It will
not attach to a standard luer lock connector. Because stan-
dard 1 ml syringes are commonly used to administer medica-
tion in the hospital setting, PChMV’s 1 ml oral/enteral syringe
is a highly noticeable orange color. In addition, the one-piece
design eliminates tip separation during filling, and an airtight,
brightly colored cap does not allow air or water in, or breast
milk to leak out, during prep, storage and warming.
PChMV oral/enteral syringes are compatible with the
most commonly used hospital syringe pumps. Other signifi-
cant features include individual product packaging that allows
the clinician to see the syringe type and size before opening
the package and a clear oral/enteral syringe barrel that allows
clinicians to easily monitor feeding and check for residuals.
InfraReDx Receives FDA Clearance for

LipiScan IVUS Coronary Imaging System
SonoSite Receives FDA The system is the first cardiac catheter to combine intravascular ultrasound (IVUS)
and near-infrared (NIR) spectroscopy to help cardiologists identify and characterize
Clearance For LumenVu the plaques that complicate stenting and are associated with acute coronary events.
Catheter Guidance System The NIR spectroscopy identifies the chemical content of the plaques; the IVUS pro-
The LumenVu Catheter Guidance Sys- vides an image of plaque structure and stent features. The company expects to con-
tem is designed to aid in the placement duct a broad commercial launch of the system within the U.S. by year-end 2010, and
of peripherally inserted central cath- anticipates regulatory approval and launch in Europe during 2011.
eters (PICC), the proprietary LumenVu Carefully designed to meet the workflow demands of today?s busy interventional
System combines near-infrared tech- catheterization labs, the LipiScan IVUS system is able to generate and display the
nology with a revolutionary fiber optic combined chemogram/IVUS analysis immediately upon completion of the single cath-
stylet, which replaces a traditional guide eter pullback. The LipiScan IVUS system provides physicians with an unparalleled
wire, to allow visualization and real-time “one-stop” visual determination of critical coronary features that will assist in care of
tracking of a catheter tip as it advances coronary patients, including identification of lipid-core plaques, degree of stenosis, ref-
through a vein. erence vessel diameter, plaque burden and stent expansion and apposition.
• Online: dotmed.com/dm14250 • Online: dotmed.com/dm14252
20 DOTmedbusiness news I october 2010
By Barbara Kram Welch Allyn Unveils Cure for Vital Sign Documentation Errors at the
Point of Care
The Connex VSM (CVSM) is a full-color, touch screen device that acts as three devices in one-
providing comprehensive patient documentation on a single display. This documentation includes
automatic measurements such as heart rate, blood pressure, temperature and pulse oximetry;
manual parameters such as respiration, height, weight and pain level; and modifiers such as body
position, O2 therapy details and others. The CVSM also gives the clinician the ability to control
alarms, patient data and monitoring in a customized manner for each patient, and they can docu-
ment this data right on the device-eliminating the need to locate a PC and transcribe it later.
The CVSM also enables two-way wireless communication from the bedside. It associates ID
numbers to names to help clinicians properly identify patients and allows them to customize which
ID fields are required and how they’re displayed, including simultaneous display of multiple forms of
ID. The wireless technology is built right into the system allowing the monitor to act as a true mobile
device, and it works with current wireless networks to deliver up-to-date patient demographics.
Ascension Orthopedics Receives FDA Approval for TITAN Modular
Total Shoulder System
The TITAN Modular Total Shoulder System offers a bone-preserving option for patients needing to-
tal or hemi shoulder arthroplasty. The modularity of the system allows the surgeon to independently
select distal stems and proximal bodies that best match the patient’s anatomy and bone quality.
The system is fully interchangeable - allowing all primary and fracture bodies to be used with either
press-fit or cemented stems. There are 26 humeral head sizing options available, which are based
on published anthropomorphic data of over 300 human humeri to provide anatomic fit. The system
also offers multiple glenoid options for patients needing total shoulder replacement.
FDA Clears Medivance’s Arctic Sun 5000 for Fastest,
Easiest Therapeutic Temperature Management
The Arctic Sun 5000 is Medivance’s next-generation, non-invasive, therapeutic
temperature management device. The new patient cooling device has received
FDA 510 (k) clearance and offers the fastest initiation of treatment, simplest pro-
gramming capabilities and easiest access to treatment data on the market.
Viking Systems Receives
FDA 510(k) Clearance for
its Next Generation 3DHD
Visualization System
Viking’s Next Generation 3DHD system
provides surgeons from a broad base
of surgical specialties with the ability to
perform complex minimally invasive sur-
gery with a revolutionary vision system
that restores their natural depth percep-
tion previously sacrificed with 2D sys-
tems. Viking Systems’ 3DHD system is
planned to offer surgeons the choice of
two different proprietary 3D optical sys-
tems. The company also plans to offer a
2DHD camera for use with the system
for surgeons that may prefer this modal-
ity for less complex cases. Jed Kennedy
elaborated, “The 3DHD system will offer
hospital administrators a flexible solu-
tion, intended to provide a vision system
solution for the visualization needs of
minimally invasive surgeons.”
DOTmedbusiness news I october 2010 21
shows & conferences
ASTRO 2010
A
s this year’s American
Society for Radiation
Oncology conference
and expo comes during a
time of particularly acute
economic hardship and uncertainty
about the health care law, attendees of
the 52nd annual meeting will hear speak-
ers and attend education sessions focus-
ing on “gathering evidence and provid-
ing value.”
“As health care reform gathers
pace, we are going to have to prove investigate, over diagnose. In a strange and conference.
what we do is of value to our patients kind of way, the economy has almost Zietman says attendees should be
or stop doing it,” says Dr. Anthony Ziet- forced us to really self-reflect.” sure to catch the two highlighted key-
man, president of ASTRO and professor ASTRO meeting organizers expect- note speakers: Sir Michael Rawlins and
of radiation oncology at Harvard Medi- ed 12,000 people in attendance, a larger Dr. James Thrall.
cal School. audience than in past years, says Ziet- Rawlins, chief of the National
The theme is timely, as it’s look- man. He believes the bump in attendance Institute for Clinical Effectiveness
ing at how professionals are practicing can be attributed, in part, to an optimistic (NICE) in the United Kingdom, will
radiation oncology in 2010, explains belief that the recession is ending. Loca- educate his audience about the contro-
Zietman. tion is also a factor, with people want- versial British experience in using a
“We’re looking at ways radiation ing to visit San Diego to enjoy pleasant panel of experts to weigh comparative
oncology can be responsible,” he tells weather before winter sets in. effectiveness data to strictly determine
DOTmed News. “We’re looking at ar- The organization also reports a what new therapies justify use in the
eas where we over utilize treatment, record-breaking number of research National Health Service.
areas we over-scan, over-treat, over- abstracts submitted to this year’s show Zietman says it’s possible that some
day, some form of NICE will emerge in
the United States.
“It probably won’t be as strong as
the one in Britain,” he points out. “If
NICE says no, that drug or technology
simply won’t be used in Britain.”
Thrall, chair of the American Col-
lege of Radiology Board of Chancel-
lors, will discuss the lessons radiation
oncologists can learn from their diag-
nostic radiology colleagues regarding
issues of over utilization and radiation
safety.
“The keynote speakers are a must-
see,” says Zietman. “They speak to
medicine in general, about responsibil-
ity in medicine.”
This year’s conference will be held
from Oct. 31 to Nov. 4 at the San Diego
Convention Center.

money Coming
health
in November:
The RSNA Issue
When bills are making hospital accountants sick
By Heather Mayer
B
ills. For people everywhere, it’s in the industry as bigger DSO groups acquire
almost a curse word. For hos- complementary organizations that will help
pital accounting departments them offer complete services to their clients.
dealing with bills is a daunting For example, a DSO specializing in nuclear
task, especially with new rules testing may bring on nuclear camera service
and regulations continually cropping up. It’s companies for comprehensive services. Industry Sector Reports:
easy to understand how hospitals and private “As a DSO, a good organization can
practices can become overwhelmed with in- take on many, many practices on a national Mobile Service
voices for all of their services, but using a basis,” says Soffer.
diagnostic service organization can help pro- Hospitals stand to gain the most by Providers
viders cut costs and whittle down paperwork. turning to a DSO, Soffer says. He points out With imaging centers hitting a
DSOs are becoming more popular as health that they can save millions by turning to a rough patch in the road, these
care facilities look to cut costs but maintain third party for help. While practices can face providers may offer a lifeline to
quality care for their patients. the same challenges as hospitals, they can
According to a recent report published make decisions quicker, without the burden
hospitals.
by Choice Health Care Partners, a national of hospital boards.
physician practice advisory group, DSOs Radiographic/Rad
will continue to increase their U.S. market The client perspective Fluoro
share over the next few years. The chief of cardiology at Jackson North
“Rather than being an option, practices
Will the future be rad?
Hospital in Florida and brother of Avi Soffer,
are forced, given what’s going on [in the econ- Dr. Ariel Soffer, turned to a DSO — UND
omy and with reimbursement rates], to look at — to strengthen his nuclear cardiology lab. MRI Coil Repair
numbers and seek options to stay afloat,” says “[The nuclear lab] happens to be the More players are on the field,
Avi Soffer, CEO of University Nuclear and Di- number one revenue source but also the but is it a game-changer?
agnostics, a DSO for nuclear cardiac imaging. number one cost outside of HR,” says Ariel.
“DSOs, which were optional, are becoming a
go-to solution to combat the issues.”
He points out that before the days of
poor reimbursement payments, a strong
Dialysis
A DSO basically takes over a facility nuclear lab would do well and didn’t really CMS promises big changes in
and assumes the responsibilities and costs look at the costs. store. Find out what to expect.
of operations, condensing all the necessary “Now that reimbursement has dramati-
tasks into just one invoice for the hospital cally been reduced, costs become a big is- Features:
to deal with. The key to saving money, ex- sue,” he says. “There are a lot of moving
plains Soffer, is consolidating the labor. parts within [a nuclear lab].” RSNA Preview
UND was able to save one Georgia-based By hiring a DSO to take care of the in- The launch pad for next year’s big
client nearly $300,000 annually, or 37 percent. ner workings of his lab, Ariel says costs are products – we offer a sneak peak
The DSO took over services that include per- down and patient satisfaction is up.
sonnel, isotopes, log maintenance, license up- “We found that by ‘insourcing,’ we
of things to come.
dates, equipment calibrations, radiation safety can control major costs and focus on getting
officer services, equipment logs and calibra- more patients…seen and put into the lab as Ergonomic Design
tion, patient scheduling, pre- and post-test pa-
tient education and ICANL certification
opposed to worrying about the subtleties of in Equipment
the cost structure,” he says.
Cardiology practices are frequently While the number one perk of using a
Sit back, relax and get the lowdown
turning to DSOs, says Soffer, largely be- DSO in a nuclear lab is the cost savings, says on the latest.
cause of poor reimbursements for tests, like Ariel, the runner-up is the “ease of use.” The
nuclear stress testing, and expensive lab DSO companies take care of everything, Medical Device
costs. He points out that cardiology labs,
which rely heavily on nuclear testing, need
from technicians to service.
“The [DSO] is motivated to be effi-
Approval
help from a cost-saving DSO. cient,” he explains, otherwise it would lose Industry experts discuss the
While the market for DSOs is growing, the account. 510(k) process and the impact it
there aren’t necessarily more organizations out “It is just a beautiful thing,” Ariel says. may have.
there. The CHCP report suggests consolidation

Radiotherapy’s
Big Move
Varian TrueBeam
STx system
Emerging technology
set to guide the
sector’s success.
By Olga Deshchenko

T
he success of radiation therapy for the more than in Latin America, where there are many fewer radiotherapy
half a million patients who receive the treatment treatment centers per capita than we see in North America and
annually is governed by the ability to destroy the Western Europe.”
tumor while sparing normal tissue around it. In re- Although Asia is a lucrative market for radiotherapy, ex-
cent years, advances in intensity modulated radia- panding treatment to the region is a challenging task.
tion therapy (IMRT) and image guided radiation therapy (IGRT) “The number of linear accelerators per population is very,
have proven radiotherapy to be an indispensable, noninvasive very low in that part of the world,” says Timothy Prosser, direc-
option for cancer treatment. tor, oncology business line management, with Elekta. “China
But, earlier this year, safety concerns fueled by media cover- doesn’t have a problem with money [but with staffing] its cancer
age of overexposure accidents placed the industry in the national centers. It’s the only thing restraining the market right now.”
spotlight. Today, OEMs, end-users and regulators are collaborat- With the opportunities overseas and millions of people
ing on enhancing the safety of the treatment process, while re- expected to enter the U.S. health care system, innovations in
search and innovation continue to drive the industry forward. imaging capabilities, respiratory motion management tools
and specialized radiotherapy devices are enhancing the effi-
Market status cacy of radiotherapy.
The global radiotherapy market experienced double-digit
growth during the last few years, with the U.S. holding a 50 Image guidance
percent share of the market, according to a 2010 report by Image guidance capability on radiotherapy devices is one of
Koncept Analytics, an India research firm. In the U.S., a high the most prominent trends in the industry. The potential to im-
rate of cancer incidence paired with rapid acceptance of new age the site immediately prior to treatment using linear ac-
treatment methods and reimbursement rates have driven the celerators has come a long way from electronic portal imaging
industry, according to the report. devices for simple plane radiographic images to cone beam
However, 2009 proved to be a tough year for sales. But CT and supplementary imaging devices, appendages mounted
the downturn in the economy might not be bad news for all in on the device’s gantry.
the sector – ISOs experienced an uptick in business. John Marquez, president of Therapy Remarketing Group,
“We certainly have seen an increase in service because a reseller of previously owned radiation therapy equipment,
people are keeping their machines longer. We’ve actually had says the demand for such systems is high.
to hire new people to meet the demand,” says Steve Schwarz,
CEO of Acceletronics, the world’s largest employee-owned in-
dependent radiation oncol-
ogy equipment service
organization.
OEMs say the
U.S. market is
looking up this
year and there’s
a lot of potential
abroad, where Medical Cooling Solutions
many patients re-
Current chiller provider for:
main underserved. GE OptimaTM MR450w Systems
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fact that radiation
tCity Water Bypass Panel Included
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as a noninvasive tHigh Ambient Package Option (up to 140F)
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tEnvironmentally-Friendly Refrigerants
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serving a lot more patients as tEnergy Saving Components
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“Systems with image guidance capabilities are our big- Respiratory motion management
gest request we get right now,” he says. “At minimum, what Technological advancements in respiratory motion manage-
we’re seeing is that people want systems that are upgradeable. ment are enabling clinicians to focus on sites that have previ-
If they currently don’t have image guidance on them, they ously been hard to treat with radiotherapy. Tumors in areas
want something that’s going to be compatible with the mini- such as the liver and lungs tend to shift because of breathing,
mum requirements to upgrade the unit.” making it difficult to precisely locate their position.
DOTmed News learned that two companies working in a “We see lung cancer as a huge opportunity for treating more
strategic alliance, Acceletronics and an oncology and diagnostic patients and actually saving more lives. There is a fairly low cure
imaging equipment sales firm, Radiology Oncology Systems, are rate right now with lung cancer,” says Varian’s Donohoe. “There
introducing a new imaging device at this year’s American Society is also a strong differentiation between ‘operable’ and ‘inoperable’
for Therapeutic Radiology and Oncology annual meeting. patients and how they are typically treated. A lot of recent scien-
“We are going to be announcing the release of the first ever tific research into the impact of radiosurgery and radiotherapy on
FDA approved KV imaging device that can be integrated with lung cancer patients has been extremely promising.”
any brand of a linear accelerator,” says John Vano, president of In April, Varian introduced TrueBeam, its latest system
ROS. “What this is going to do is allow those hospitals to upgrade designed for all forms of external beam radiotherapy, includ-
older linear accelerator systems to KV imaging technology with- ing IGRT, IMRT, stereotactic body radiotherapy, radiosurgery
out the need to replace or upgrade them with OEM options.” and RapidArc radiotherapy.
The RAD II KV Imager, manufactured by Holland-based TrueBeam comes standard with Gated RapidArc technolo-
TheraView, enables clinicians to identify interfractional organ gy, a feature that monitors patient breathing and compensates for
movement for the targeting and treatment of tumors. It can be movement. The technology works by “gating” the beam, or turn-
configured for Varian, Siemens or Elekta linacs with or with- ing it on and off, in response to tumor motion. Varian’s Donohoe
out beam stoppers. says the technology ensures a higher level of dose conformity.
Acceletronics’ Schwarz says the new imaging device will Elekta introduced its innovation for respiratory motion
help clinicians meet the goals of “safety, accuracy and repro- management earlier this year. Designed to reduce treatment
ducibility” in radiotherapy. margins, the XVI Symmetry product is enabled by 4D guidance
and eliminates the need for external markers. The feature works
by capturing images of the patient’s breathing phase and then
calculating 4D imaging data. The information is used to visual-
ERGONOMIC
ize the tumor position in each phase of the respiratory cycle and
acquire an average position for the tumor for each treatment.
OEMs say they plan to advance motion management tech-
nologies and are excited about the developments in the realm
WORKSTATIONS
of lung stereotactic surgery.

“We actually have a chance in radiation therapy to be the
◀ The Whitestone™
Radiology Dream Station primary treatment modality for lung lesions over surgery,”
Electronic adjustment of: says Elekta’s Prosser. “If they’re small enough and caught ear-
■ Work surface height & tilt ly enough, it might be a noninvasive alternative to surgery.”
■ Monitor height & focal Linear accelerators continue to expand their capabilities
length
and offer flexibility in the treatment of all tumor sites. In ad-
dition, several specialized radiotherapy devices – such as the
Gamma Knife, the CyberKnife and TomoTherapy are making
headway through research and technological advancements.
◀ Ergo Tier Cart™
Electronic adjustment of: Gamma Knife
■ Work surface height
■ Monitor height & focal A few years ago, the Gamma Knife Center at the Upstate Uni-
length versity Hospital in Syracuse, N.Y., was gearing up to upgrade the
Cobalt-generated gamma radiation sources on its Gamma Knife
unit. The scheduled replacement coincided with Elekta’s intro-
duction of the new Leksell Gamma Knife Perfexion, a stereotac-
tic radiosurgery system, which the facility decided to purchase.
◀ Dual Tier Cart™ Dr. Walter Hall, professor of neurosurgery with the hospi-
Independent electronic THAT
tal, says the Gamma Knife Perfexion is superior to the previ-
adjustment of:
ADAPT TO ous system because of its ability to treat lesions in the cervical
■ Both tiers height
YOU! spine and an automatic targeting system. If the treatment field
is delivered using multiple spheres of radiation, the clinician
800.663.3412 www.afcindustries.com doesn’t have to readjust the system for each sphere.
“It will automatically move from one sphere of treatment to

□ – The red border is the bleed
(bleed size is 8.375” x 11”)
□ – The blue border is the trim

(trim size is 8.125” x 10.75”)
□ – The green border is the safety area

(safety area is 7.625” x 10.25”)
another. It significantly shortens the duration for the treatment in the brain, skull base and other regions of the head and neck.
terms of how long patients are actually in the machine,” says Hall. Ongoing research and the collaboration between the OEM
A Gamma Knife system uses multiple radiation beams that and leading facilities promises to continue expanding the
converge in three dimensions and focus on the tumor. Industry clinical reach of the Gamma Knife. The National Institutes of
experts say the major advantage of this device is its ability to Health is currently sponsoring a U.S. study that’s investigating
localize the target. In a treatment using the Gamma Knife, a the use of radiosurgery for the treatment of epilepsy.
head frame is secured on the patient by a neurosurgeon and the “Researchers are looking at patients who have seizures
patient undergoes an imaging scan to visualize the tumor. The related to mesial temporal sclerosis, and they’re hoping that if
head frame then stays on during the treatment process. they give enough radiation to that portion of the temporal lobe
Hall says he prefers the Gamma Knife Perfexion system that has the sclerosis, they’ll prevent epilepsy,” says Hall.
because of its accuracy and speed of treatment. The focus on research was evident at this year’s International
“It’s a single-shot treatment and you’re getting a patient to- Leksell Gamma Knife Society meeting held in May. A record 332
tally treated within three hours from start to finish. Many lesions posters and oral presentations were submitted for the meeting, the
that I would normally operate on could all be treated with the most ever in the society’s 21-year history, said Nylund.
Gamma Knife,” he says. “There’s no hospitalization, there’s no “A continuous growth of tumor radiosurgery fueled by Per-
length of stay, it’s less expensive than conventional surgery and fexion’s ability to treat multiple lesions and multiple fractions
the patient outcomes are just as good as with surgery for some is expected,” he said. “Another growing field is in functional
lesions. I think the patient satisfaction level is astronomical.” neurosurgery, which also includes the use of Gamma Knife ra-
For Elekta’s neuroscience business, 2009 was a record diosurgery for Parkinson’s disease and trigeminal neuralgia.”
year. The company’s factory is currently building its hundredth
unit, wrote Per Nylund, senior marketing director, business CyberKnife
line management, Leksell Gamma Knife, in remarks e-mailed Accuray’s CyberKnife is another specialty radiation delivery
to DOTmed News. device. Unlike the Gamma Knife, it’s a frameless robotic radio-
“Approximately 60,000 procedures are carried out every surgery system that is not limited to intracranial sites and can
year and more than a half million treatments have been con- treat tumors throughout the body. The CyberKnife uses a com-
ducted to date,” said Nylund. pact linear accelerator on the end of a robot arm that delivers the
Within the last year, Elekta introduced two innovations to treatment, explains Dr. Omar Dawood, VP of clinical develop-
enhance its system. WarpSpeed is a new tool for treatment plan- ment with Accuray. The mobility of the robotic arm enables the
ning with the Perfexion system. It provides clinicians with real- delivery of radiation from a wide variety of angles, thus provid-
time dose planning, enabling them to formulate better treatment ing precise sculpting of the dose delivery to the target.
plans faster, said Nylund. WarpSpeed allows for the optimiza- “We have treated just about 90,000 tumors now with the
tion of dose distribution through modification and addition or CyberKnife all over the body,” says Dawood. “A little more
removal of isocenters in any image with instant feedback. than half, about 55 percent of all the patients treated are ex-
Another innovation is the Extend system for the Perfex- tracranial right now.”
ion unit, a program for fractionated treatments. The feature Accuray pioneered the first technology to continuously
extends the capabilities of the Gamma Knife to treatment of synchronize beam delivery to the motion of the tumor when
large tumors or lesions close to critical structures located in it introduced the Synchrony Respiratory Tracking System.
The right choice for your previously owned equipment needs.

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The big difference
between new and refurbished
radiation equipment?
Price.
30-50% savings vs. OEM In fact, that’s about the only difference you’ll find. Refurbished equipment
from Oncology Services International is rigorously tested to ensure reliability
and functionality to match that of new equipment. And we have more in
67,000 stocked parts stock than any other supplier in the world – so you get the solution you
need, when you need it. It’s one of the many ways that we’re different – and
24/7 nationwide service when you take a closer look, it’s pretty easy to see.
and support
98% customer satisfaction
%&#&/)-!*%+)%+!&%#0 ##&,#-),!+&%+##& 0

0+ !%"&*!&$
In an April 2008 Quality Survey of Contract Service Customers, 98% of respondents agreed Oncology Services International met or exceeded service uptime expectations on their equipment.
The system enables clinicians to reduce searchers are now examining the bene- “A huge portion of the community
wide treatment margins in the planning fits of delivering high doses of radiation believes in HDR brachytherapy, but
to compensate for the moving target. in shorter periods of time to the prostate doesn’t believe in its invasiveness for
More recently, the company released and evaluating the method’s efficacy of patients or the difficulty in performing
the XSight Lung System, which works reducing some of the treatment side ef- it because it’s not easy to put in those
with the Synchrony system. Originally, fects, such as erectile dysfunction. catheters reproducibly,” says Dawood.
Synchrony used implanted markers in In a 2009 study published in Tech- The 10-center study will examine
the tumor but XSight Lung allows the nology in Cancer Research and Treat- the efficacy of this treatment using the
system to lock onto the tumor itself. ment, researchers looked at the use of CyberKnife and without catheters. Ab-
“It does that by essentially using an the CyberKnife as an emerging treat- stracts from both studies will be a part
algorithm that enhances the images that ment approach for localized prostate of the poster presentations at the AS-
are taken during treatment,” says Da- cancer. They treated 112 patients with TRO annual meeting later this month.
wood. “It’s revolutionary because now the system and found that more than 82
you’re actually tracking.” percent of men maintained sexual func- TomoTherapy
Like the lung, the liver is another tion two years after treatment. The TomoTherapy Hi-Art treatment sys-
organ that moves frequently and there- Research on this CyberKnife capabil- tem is an IMRT device known for its com-
fore requires correction for respiratory ity is continuing at two multi-center clini- plete integration of the treatment process.
motion. Within a month, Accuray an- cal studies. A study looking at the homog- “TomoTherapy delivers radiation
ticipates the launch of two multi-center, enous dose distribution is taking place in using a slit beam in a helical fashion,
international studies looking at the treat- 23 centers nationwide. Another study is much like a CT unit gathers imaging
ment of liver sites. examining the production of dose distri- information,” says Dr. Jay Burmeister
The treatment of prostate tumors is butions comparable to those created by chief of physics with the Karmanos
another exciting area of development. high dose rate brachytherapy treatment. Cancer Center in Detroit, Mich. “It also
For years, prostate has been treated with HDR brachytherapy has excellent out- images the patient using the treatment
long courses of radiation with small comes but also has its set of drawbacks: beam. It’s really an integrated imaging
fraction doses, explains Dawood. Re- it’s catheter-based and invasive. and treatment platform.”
TomoTherapy uses software for
treatment planning, quality assurance,
patient set-up and treatment delivery,
storing all patient and plan information
in one place.
“We have a centralized secure da-
tabase, a single point of storage and
unmatched computing power, which en-
ables rapid creation of very sophisticated
treatment plans,” says Dr. Fred Rober-
ston, the company’s president and CEO.
“Our system has a built-in machine and
patient specific quality assurance.”
Robertson says customers are using
the system for applications of stereotac-
tic radiosurgery, stereotactic radiation
therapy and stereotactic body radiation
therapy. TomoTherapy has a patented
binary multi-leaf collimator, ensuring
dose conformity and homogeneity.
“There’s a lot of evidence in the medi-
cal literature that this design reduces toxici-
ty and side effects and enables radiotherapy
with a radiobiologic advantage, which we
believe ultimately translates to improved
quality of life for our patients and for can-
cer survivors,” says Robertson.
With TomoTherapy, patients can
be imaged daily, enabling clinicians to
offer adaptive therapy, says Robertson.
Clinicians can make adjustments based

DOTmed Registered Linear Accelerator Equipment Sales & Service Companies
For convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 14269]
Names in boldface are Premium Listings.
Name Company - Domestic City State Certified DM100
Jose Rodriguez OncoAmerica Cancer Care Centers Huntsville AL
John Vano Radiation Oncology Systems La Jolla CA
John Marquez
Varian Medical Systems
Therapy Remarketing Group
Varian Medical Systems
Long Beach
Palo Alto
CA
CA

•
Omar Dawood Accuray, Inc. Sunnyvale CA
Simon Bhangal LinaTech Sunnyvale CA
Stewart Farber Farber Medical Solutions, LLC Bridgeport CT
Robert Maziuk VJ Technologies, Inc. East Haven CT
Rich Ellis Technical Options of Georgia Marietta GA
Timothy Prosser Elekta Norcross GA
Nader Alfaqeeh
Chaz Beadling
Orbit Medical Technologies, Inc.
American X Ray Equipment Sales & Service
Harvey
Cumberland
IL
MD

•
Jay Burmeister Karmanos Cancer Center - Wayne State University Detroit MI
Kenneth Wolff RS&A, Inc. Rural Hall NC
•
Marilyn Jaccard
Tony Richardson
Diagnostic Imaging Sales
Oncology Services International
Highlands
Montebello
NJ
NY

•
Larry Day Acceletronics, Inc. Exton PA
Bill LeCompte Systemic Energy, LP Lubbock TX
Robert Dyer Dyer Technical Service (DTS) The Woodlands TX
Frederick Robertson TomoTherapy, Inc. Madison WI
Name Company – International City Country Certified DM100

Javier Espinos Ingenieros en Radioterapia Tlalnepantla Mexico
on changes in the anatomy and have a attention to the patient and to everything redesigned from the ground up to offer
more comprehensive picture of the dose that’s going on with the machine. These clinicians an integrated interface and an
the tumor already received. machines are doing very complicated adjustable level of automation control.
TomoTherapy is also advantageous things in terms of imaging and delivery “From a control system perspective,
for hypofractionation, or delivering with respect to what they used to do.” we’ve got a design where absolutely ev-
short courses of high dose radiation, a OEMs are responding to the chal- ery element of this machine is complete-
growing industry trend. lenges faced by clinicians with features ly integrated and synchronized, facilitat-
“Daily 3-D image guidance is criti- that help simplify and organize the intri- ing automation and a streamlined clinical
cally important with hypofractionated cate information. flow,” says Varian’s Donohoe. “This lev-
dosing because when you’re using larg- Elekta offers Synergistiq, a clinical el of tight integration offers us a platform
er fractions, they have to be delivered workflow management tool. It integrates not just for today’s clinical techniques
correctly and with extreme precision,” the patient’s electronic medical record, but also for future innovations.”
says Robertson. “Many physicians
would agree that hypofractionated ra-
imaging data and the control of the linear
accelerator in a unified user interface.
diation therapy is really only possible With the help of customer input, Olga Deshchenko can be reached by
with very high-quality 3-D volumetric Varian’s new TrueBeam system was e-mail at olga@dotmed.com.
image guided capabilities.”
Advances in image guidance tech-
nology for radiotherapy are moving the
industry towards personalized patient
care and have “really opened up the
possibility of being able to personalize
the prescription to most effectively treat
each patient’s tumor,” says Robertson.

Enhancing the process
The complexity of the radiotherapy
equipment and the overall treatment
process is a challenge end-users and
OEMs face today.
“If you go to a typical console of a
radiotherapy device these days, it can be
overwhelming just walking up and seeing
numerous monitors and all of the bells and
whistles you see there,” says Karmanos’
Burmeister. “It’s difficult for our thera-
pists who operate these machines to pay

The
Radiotherapy
Industry
zeroes
in on safety
W hen the medical physics community

discovered that some patients were getting radiation overdoses
during CT exams, they got together at the Radiological Society
of North America 2009 meeting to figure out how to address
the problem. The discussion among CT physicists resulted in
a broader meeting that took place the following spring, where
By Olga Deshchenko
even fatally injured by radiotherapy treatments. Anyone in-

volved in the planning or delivery of radiation or manufacturing
of radiotherapy devices can cite at least one incident described
in “Radiation Boom,” a New York Times series that examined
the use of radiation and challenged the safety of its delivery.
“I thought, ‘It’s happening all over again,’” says Dr. Wil-
all the parties involved in CT exams agreed on a set of opti- liam Hendee, professor of radiology, radiation oncology, bio-
mum protocols. physics and community and public health at the Medical College
With CT overexposure incidents still fresh on their minds, of Wisconsin. “Our attention was already riveted on overdosing
professionals began hearing of patients being seriously hurt or in CT and then similar issues arose in radiation therapy.”

Upon reading the first article in the Times, Hendee made “There may be software errors buried deep within the system
phone calls to a group of industry leaders, including the presi- that we’re unaware of,” says Zietman. “It took a few very serious
dent of the American Association of Physicists in Medicine. radiation events, which were exposed by The New York Times -
They decided to bring together radiotherapy stakeholders quite appropriately - to really focus everyone’s minds on this.”
– medical physicists, radiation oncologists, administrators, The intricate modalities are operated by a number of profes-
manufacturers, dosimetrists and regulators – to come up with sionals who are involved in the process of planning and deliv-
recommendations and an action plan. In late June, approxi- ering the treatment: physicians, medical physicists, therapists,
mately 400 people attended the “Safety in Radiation Therapy dosimetrists and in some cases, nurses or administrative staff.
– A Call to Action” meeting, held in Miami, Fla. Not only do several people need to be aware of all the treatment
“We spent about a day and a half at this meeting thinking information but they must also understand it. The steps that
of ways that we can make patients safer in radiation therapy. make up the treatment are multifaceted – and everything from
We needed to look at the whole process of radiation therapy the configuration of the radiation beam in regard to the tumor to
and recognize that it’s complex,” says Hendee. the tracking of the patient’s respiratory motion makes the infor-
Since concerns over safety made headlines earlier this mation relay among the radiotherapy team more delicate.
year, a wave of action to prevent further accidents and restore “It’s a complex interchange of information and a handoff of
confidence in the cancer treatment option swept through the information between these individuals,” says Hendee.
industry. Manufacturers, regulators and the clinical commu- Given the intricacy of the technology and human interac-
nity found themselves on the same page, reexamining their tion involved in the process, it’s no surprise that attendees of
roles in patient safety throughout the treatment process. the meeting, hosted by AAPM and ASTRO, discussed strate-
For clinicians, it means streamlining protocols and com- gies to improve communication processes in the interests of
munication processes. For regulators, it comes in a form of safety.
more rigorous investigations of new radiotherapy devices. For
the OEMs, it’s centered on innovations hinged on clinical evi- Recommendations for the staff
dence and simplification of the systems that have turned thou- In his presentation at the meeting, Hendee told attendees that
sands of cancer patients into survivors. the radiotherapy treatment process must be fault-tolerant.
Those involved in the planning and delivery must understand
The tech boom
Radiation therapy came along in the early part of the 20th cen-
tury and along with surgery and chemotherapy, it stands as
“one of the pillars” of cancer treatment today, says Dr. Antho-
ny Zietman, president of the American Society for Therapeutic
Radiology and Oncology.
“If you actually look at cancer patients, about 60 percent
of them at some stage in the course of their cancer [treatment]
will receive some radiation,” says Zietman.
Nearly two decades ago, radiation oncologists relied on
conventional linear accelerators to eliminate tumors and had
a clear understanding of the role the sophisticated devices
played in delivering the treatment.
“Then there was a massive explosion of technology, a huge
proliferation of new treatment planning systems and radiation
delivery machines,” says Zietman. “Before you knew it, tech-
nology had almost outstripped our ability to handle it all.”
The more intricate devices have enabled oncologists to
target cancer cells with greater precision and spare the sur-
rounding healthy tissue, but it has also necessitated a shift to a
more computerized and automated process.
“We can do a better job of treating patients today and
preventing after effects or side effects of radiation than we’ve
ever been able to do in the past because of all of the sophisti-
cated technology,” says Hendee. “But the problem is, it sort of
takes the treatment out of the hands of the therapist and puts it
in the ‘hands’ of the computer.”
Many facilities have multiple radiation delivery systems
in their oncology departments, which makes it difficult to fig-
ure out how, and even if, the machines work in sync. Often-
times, such uncertainty invites mistakes.

their responsibilities, learn from mis- Manufacturers join forces “Varian operates education cen-
takes and engage in corrective actions. Manufacturers that also attended the ters in the U.S., China, Switzerland and
Although radiotherapy devices are high- meeting acted quickly to address the India,” says Karla Donohoe, the com-
ly computerized, human involvement is safety concerns. pany’s senior marketing director. “Our
a part of the treatment process. “I think the manufacturers heard training, education and help desk teams
“We have to be able to recognize loud and clear that we’re not supposed include more than 210 clinically expe-
when errors occur and mistakes are to innovate just for the fun of it,” says rienced personnel who speak more than
made and correct the treatment by cor- Timothy Prosser, director of the oncolo- 15 languages to facilitate the transfer of
recting those errors without letting them gy business line management for Elekta. knowledge for safe and effective use of
progress until a patient is adversely af- OEMs acknowledge some of the our systems. All of this will continue and
fected,” says Hendee. “We’ve had a lot criticism aimed at the complexity of the will be updated to reflect any safety ini-
of discussions with manufacturers about technology and are working with clinical tiatives undertaken by the professional
this. What we want is an early warning and other industry partners to simplify the organizations and the clinical users.”
system built into the machine, so that operation of their devices, says Prosser.
if something is done that doesn’t seem In June, the Medical Imaging and Regulatory moves
right or it doesn’t match with what might Technology Alliance and the Advanced The U.S. Food and Drug Administration
be considered a standardized protocol for Medical Technology Association an- also took note of radiotherapy safety
that particular type of patient and tumor, nounced the Radiation Therapy Check concerns. In April, the agency sent let-
the machine will give an early warning.” Initiative, an industry-wide effort to ters to approximately 93 manufacturers
Although there is no set date for develop and implement additional pa- to explain the measures it plans to take
when the early warning systems will ap- tient protection features on radiotherapy to improve the safety of radiotherapy
pear on radiotherapy equipment, it’s clear equipment. devices and their use.
that OEMs favor this proposal. The ra- “All of MITA’s companies are very “The FDA is taking these steps
diotherapy community isn’t running into interested in ensuring the safety of their to reduce the number of underdoses,
any opposition to this new feature, “but it products and including new features to overdoses and misaligned exposures
requires changes in some pretty sophisti- further enhance the safety of the prod- from therapeutic radiation,” wrote Dick
cated protocols,” explains Hendee. ucts,” says David Fisher, the organiza- Thompson, an FDA spokesman, in an
Another way to ensure safety dur- tion’s executive director. “MITA and e-mail to DOTmed News. “These de-
ing treatment is to focus the clinical the CT manufacturers developed the CT vices include linear accelerators, proton
team’s attention on the patient. At least Dose Check Initiative and released that in therapy systems, radiation therapy treat-
two people should be at the console of March and we felt that it was natural to do ment planning systems and radiation
the device for a checks and balances a similar initiative for radiation therapy.” therapy simulators.”
process, which might be a challenge in The voluntary initiative aims to pro- The FDA analyzed medical device
the current environment, says Hendee. vide additional checkpoints to radiothera- reports and found that errors could be
“Like a lot of businesses, many py teams before the delivery of treatment. diminished if additional safeguards are
hospitals are undergoing rather restric- It includes a quality assurance verification incorporated. In the letter, the agency
tive budgetary limitations, but the worst feature, an enhanced beam modification wrote that it received 1,182 MDRs asso-
thing you can do would be to limit the check, which ensures the correct place- ciated with the use of radiation therapy
number of employees to such a degree ment of beam modifying accessories devices between the winters of 1999 and
that you put patients at risk,” he ex- when applicable, and a visual patient po- 2010. Out of those MDRs, linear ac-
plains. “We have to emphasize to hospi- sitioning confirmation to confirm that the celerators accounted for 74 percent of
tal administrators that the staffing levels patient is properly positioned. the adverse effects reports. Computer
must be appropriate, and to do that, we “The manufacturers have commit- software issues, misuse of devices and
need to do some updating of our own ted to including these features [into their incorrect display were some of the most
information about staffing levels.” products] within 24 months,” Fisher says. commonly reported problems.
About two years ago, AAPM came OEMs say maintaining strong rela- In the letter, the FDA also an-
out with recommendations of staffing tionships with clinical partners is at the nounced that it would no longer allow
levels for different types of radiation core of the advancements that have been new radiotherapy devices to undergo
therapy devices. leading the radiotherapy industry. a streamlined approval process using
“But these systems have become Varian Medical Systems is an OEM third-party reviewers.
much more complex, the accompanying that invests significant resources into its “Ultimately, what that means is that
technology has become much more com- comprehensive training programs and new innovations will take longer to get
plex and we haven’t updated those staff- continuous technical support. The com- to market,” says MITA’s Fisher. “FDA
ing levels. One of the first things we need pany offers a “blended learning” ap- has a large load and as a result, the
is to reevaluate the recommended staff- proach, which includes classroom train- third-party review process often makes
ing levels and then encourage hospitals ing, on-site clinical support and remote the process quicker for manufacturers
to pay attention to them,” says Hendee. learning options. and patients.”

The agency also held a public meeting in June and called nology to patients. The amount of time put into participating in
for input on the steps that OEMs could take to help reduce the these tests is relatively small with respect to the amount of time
number of errors. Industry experts anticipate the agency taking that you spend commissioning this technology.”
additional action in the near future. About 30 percent of facilities across the U.S. are failing
one of RPC’s intensity-modulated radiation therapy tests. The
Reporting errors number may be misleading, explains Burmeister, because the
Amidst discussions about radiation safety, the idea of a stan- test is administered largely at prominent institutions.
dardized, national system for reporting errors is generating a lot “Many facilities that don’t participate in clinical trials don’t
of buzz. Current error reporting requirements vary from state to feel the need seek out external validation tests,” he says. “It is
state, says ASTRO’s Zietman. Some states, like Massachusetts, possible that the pass rate for those facilities could be even lower
have rigid mechanisms in place, in which state officials moni- than the 70 percent pass rate that we see for all facilities that are
tor and investigate patterned errors throughout health facilities. currently taking these tests.”
However, at least a dozen states have more lax policies. For
instance, facilities in California aren’t required to report errors Cues from the airline industry
that involve linear accelerators to state health authorities. In discussions about patient safety, experts often draw parallels
“We need a national reporting system for medical errors, between radiation therapy and the airline industry. Both realms
and even near misses. It happens in many states but it needs to depend on the balance of human skill and technology, a relation-
happen nationally,” says Zietman. ship that has grown more complex over the years.
OEMs agree with end-users on the need for a national re- “Decades ago, the cockpit was much simpler and many
porting system. Device companies are required to report errors more things were done manually, and maybe you had a better
through MAUDE (Manufacturer and User Facility Device Ex- feel for what was happening,” says Burmeister. “In this day and
perience), an FDA-maintained database of adverse effects. age of the autopilot, so many things are done with computers,
“Manufacturers are mandated to report issues and respond and in some cases, even without your active participation, that it
to those issues within 24 hours. Hospitals, however, are not becomes difficult to keep up with everything that’s going on.”
obligated to do that,” says Elekta’s Prosser. “We would like to Checklists or mandatory pauses in the process are safety
see hospitals under the same requirement.” precautions radiation therapists plan to borrow from pilots. The
However, the concept of a national error reporting mecha-
nism, whether voluntary or mandatory, could get tricky when
it comes to potential legal action.
“How do you keep malpractice plaintiff attorneys from
having access to that information and using it as a way to de- REALITY CHECKS
velop malpractice suits?” asks Hendee. “That’s a great inhibi-
tion of reporting, so it needs to be worked through.”
WRITTEN HERE.
Hendee says the industry should also place a bigger empha-
sis on failure mode and effects analysis and root cause analysis.
“We need to know why those mistakes are made and how
we can keep them from being made again,” he says.
Talk of accreditation
The idea of accreditation for facilities that provide radiation
therapy treatment is also floating around the industry. Some .3*t$5t6-53"406/%t$"3.4t."..0(3"1):
professionals suggest that accreditation should be tied to reim- /6$-&"341&$5t#0/&%&/4*50.&5&34t1&51&5$5
1"$4t&.33*4t$3%3t%*(*5"-93":40-65*0/4
bursement and others look to the Radiological Physics Center
as a potential accreditation body.
Housed at the M.D. Anderson Cancer Center in Houston,
Texas, RPC designates centers as qualified participants in the Na-
tional Cancer Institute cooperative clinical trials by evaluating a
facility’s ability to safely and effectively deliver radiation.
“I think some of us believe, definitely myself included, that
a facility should be credentialed in order to deliver these types tZFBSTPG3&"-*5:$PNNPO4FOTF&26"-4TBWJOHNPOFZ
of very complex treatments, regardless of whether they are put-
t4UBS3FQVUBUJPO2VBMJUZ&26"-4(VBSBOUFFE3FTVMUT
ting patients on clinical trials,” says Dr. Jay Burmeister, chief of
t#PUI/&83FGVSCJTIFEFRVJQNFOU&26"-4BGGPSEBCMFTPMVUJPOT
physics for Karmanos Cancer Center in Detroit, Mich. “I’m not
sure how we go about that, if insurance agencies should require
facilities to participate in a RPC test before they reimburse for 800-722-3646
this, but I think it would definitely be advantageous for us to www.integritymed.com
require facilities to be credentialed before they deliver this tech-

idea of using checklists in medicine was As with other safety enhancing ini- that are being discussed with respect to
made popular by Dr. Atul Gawande’s tiatives, OEMs are on board and invest- reporting, standardization and accredi-
book the “Checklist Manifesto,” which ing in evaluating the efficacy of the pro- tation of the users of the technology.”
promotes the concept of using checklists posed solution. Varian Medical Systems is
in the operating room to prevent mistakes. working as a part of a Clinical Council on Next steps
Gawande also advocates empowering all Patient Safety to investigate the validity of Several recommendations were discussed
individuals to call a timeout when they checklists and timeouts in radiotherapy. at the AAPM and ASTRO safety meet-
feel something is off, a practice that’s “What we see as our role is to do ing but how will they reach radiotherapy
gaining ground in radiotherapy. what we can in our software to support teams in treatment centers worldwide?
“That’s becoming pretty widely ac- the documentation of such checklists “This is all on my shoulders,” says
cepted,” says Hendee. “Everyone on the and potentially to automate some of Hendee. “I have agreed to draft the
team has the ability to call a timeout and these enforced pauses,” says Varian’s white paper that comes out of this meet-
no one can override that.” Donohoe. “We fully support the efforts ing with these recommendations.”
The paper will then be published in
the scientific journals Radiation Oncol-
ogy and Medical Physics. Hendee says
his presentation at the safety meeting
will serve as the basis for the paper. He
also plans to recommend that AAPM
setup a group of experienced medical
physicists to work with vendors on ear-
ly warning systems.
The organization also looks for-
What’s The Right Price For This Imaging Equipment? ward to working with the regulatory
body on enhancing patient safety.
“The FDA is under a lot of pres-
sure from Congress because when con-
gressmen read the New York Times,
they start beating up on the FDA,” says
Hendee. “We’d like to partner with the
FDA, in whatever the FDA chooses to
do, to represent the best interests of the
patients and the best interests of the pro-
fessionals and so it’s not just a response
Call Your Bay Shore Specialist – And Know For Sure. to congressional pressure.”
Organizations like ASTRO and
MITA are also adamant about ensuring
JOHN KOLLEGGER: MRI Sales JACK COLON: CT Sales (GE & Elscint) that patients are safe while receiving the
(800) 471- 1189 EXT. 120 (800) 471- 1189 EXT. 320 most cutting-edge treatments.
LISA MURPHY: PET/Nuclear Medicine Sales STAN ISAACSON: CT Sales “Innovations in radiation therapy
(Except Adac, Siemens, Digirad)
(800) 471- 1189 EXT. 110
(Siemens, Marconi, Picker, Toshiba, etc)
(800) 471- 1189 EXT. 260
have made the devices and the treatment
pathways more safe and effective,” says
GARY MIDGEN: PET/Nuclear Medicine Sales SUSAN BOZINOS: Ultrasound Sales,
(Nuc Med: Adac, Siemens, Digirad, Laser Cameras, Processors MITA’s Fisher. “We are happy to con-
Bone Densitometers, Treadmills) (800) 471- 1189 EXT. 360 tinue working with the FDA to demon-
(800) 471- 1189 EXT. 160
YOLANDA PENA: South America Sales strate that.”
DON TIEDEMANN: MRI Sales
(800) 471- 1189 EXT. 250
(800) 471- 1189 EXT. 300 In the midst of conversations about
INDU CHAUHAN: Europe/Asia Sales safety, additional features and protocols
PHIL EBEL: X-Ray Sales: C-Arms, Rad & R/F, (800) 471- 1189 EXT. 140
Mammo, Cath & Angio Labs, CR, Portable X-Rays are sure to ripple through the industry in
(800) 471- 1189 EXT. 310 JOSEPH ZELAYA: Central America Sales the coming months.
(800) 471-1189 EXT. 390
“I see a really strong commitment
from the clinical, the regulatory and the
We are the largest buyers & sellers of manufacturing side to get this right,”
Pre-Owned Imaging Equipment in the U.S. says Elekta’s Prosser.
1-800-471-1189
Olga Deshchenko can be reached by
www.bayshore-medical.com
e-mail at olga@dotmed.com

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Parting
ways
DMS Topline
Medical engineer
in a CT system for
the breakdown of
diagnostic imaging
parts.
Small components lead to big business for professionals

focusing on specifics By Keith Loria

O
n a Friday afternoon a ra- just about every piece of equipment and people out there that list out everything
diologist was seeing the modality. — all parts, all modalities, but what
last of the day’s patients Some parts dealers concentrate all happens is they aren’t really familiar
through their scheduled their interests on one particular modality with any one piece of equipment in an
CT exams. Suddenly, the or even one OEM brand of equipment. extreme level of detail. They can’t give
console screen lit up with an error and C&G specializes in CT parts for 81 things an extreme level of detail.”
the system stopped scanning. The X-ray GE and Toshiba systems. JDI Solutions, Inc. concentrates 99
tube failed and with the weekend near “Way back in the beginning, our percent of its parts business on Siemens
and the next week’s long list of sched- company made the decision that instead MRI while Platinum Medical Parts LLC
uled patients casting a grim shadow of of trying to do everything and not ex- focuses on GE MRI parts.
costly uncertainty, the doctor contem- cel at anything, to instead stick with a ReMedPar is the largest third-
plated how stressful the following week certain product and be the best at it,” party inventory of parts, with more
will be. He considered his options. Wayne Kramer vice president of global than 75,000 parts ready to ship from its
There are sourcing companies that parts operations says. “There are a lot of 100,000 square-foot facility.
could find the part, dealers with the in-
ventory in stock, brokers without the
part in stock, but able to get it, indepen-
dent service providers, large suppliers
with significant warehouses and origi-
nal equipment manufacturers.
It's As Easy As....
The radiologist picked up the phone.
Chad Book, regional sales executive for
C & G Technologies, took the call.
“There was definitely a sense of
urgency in the doctor’s voice when he
called, and we knew he was in a jam,”
Book says. “Working with hospitals and
clinics like this on a daily basis, we see
this sort of thing all the time, and we
know what to do.”
Book involved the parts team, and
DIZZY?
they found the tube in stock, while he
worked with the doctor on price. With-
in an hour of receiving the green light
from the doctor, the tube was loaded
into packed up and on route to the site.
The new tube was installed and the ma-
chine was back up for scanning before
the weekend was over.
This is all in a day’s work for any
reputable parts company, which has to
be ready to help quickly and efficiently,
as well as offer reliable and reasonably
priced parts.
Since the current economic climate
has caused hospitals and imaging cen-
ters to hold on to their systems longer,
their older systems are more likely to
break down and need parts, so parts
sales have been expanding rapidly. Tested Pre-Owned Siemens Parts & Tubes
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and you’ll see that the medical parts in-
dustry is a multi-million dollar business, www.TechnicalProspects.com
with numerous brokers, dealers and 1.877.604.6583
specialized companies offering parts for

Not to rest on its laurels, ReMed- a cost-effective frame of mind to trim that needed piece of the equipment
Par will soon be introducing and im- the fat a little bit. We can help people puzzle. DOTmed Certified Parts Vendor
plementing several new programs that maintain their equipment at a far more was unveiled last year to put parts buy-
should make the search for parts even reasonable price.” ers in direct contact with parts stocking
easier for customers. vendors.
“Our most notable program is Suppliers and solutions (Disclosure: DOTmed Certified
iTubeNow, which provides a critical For almost a decade, PartsSource has Parts Vendor is a service of DOTmed.
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fridge, senior vice president for ReMed- porting both imaging and biomed parts
Par. “We have discovered that providing requests for hospital equipment. Overseas
the high-quality replacement tube is not With an expanding demand on Even though the domestic market has
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and onsite assistance to install the tube. begun to emerge offering a wider range tional market has been garnering a lot of
They also need this support immediate- of choices for companies looking for interest from everyone in the sector.
ly, as down time is critical.”
With iTubeNow, the tube, onsite
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are all available in a 24-hour period.
The onsite training provides the abili-
ties and confidence needed to complete
the journey to service independence,
Suffridge says.
Going straight to the

source
OEMs are also often reliable sources
for quality parts and that branch of the
business is gaining more attention from
companies realizing the market is con-
tinuing to grow.
When GE Healthcare purchased
Ambassador Medical in 2002, it did so
with the design to grow its inventory of
quality refurbished ultrasound systems
and parts, though it supports more than WE’RE HERE TO SUPPORT ALL YOUR
just GE products.
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ing offered and therefore don’t always &7 7RVKLED
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ers stocking up on parts from machines &DWK/DE 3LFNHU
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vices, which has more than 20,000 parts 704.739.3597
in inventory in its 17,000 square-foot info@IMESimaging.com
warehouse “With the current economy, www.IMESimaging.com
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“An international parts business high degree of trust in the parts provid- clear understanding of import/export
is good for many reasons,” says Rob- er, which makes the relationship aspect requirements and documentation. The
ert Graham, sales director for Polaris more significant. Customer loyalty in provider must also be able to work with
Medical Imaging. “It helps you to ex- the international market is forged quick- much longer exchange cycles since it
pand your reach, as well as customers, ly when the parts provider demonstrates will take two or three times longer to
to get more parts sold and out the door. reliability. get exchange parts back.”
You also gain resources that you may be “We have developed significant Deals are also not always governed
able to use to help you in future busi- relationships with independent service by U.S. laws, so if someone doesn’t up-
ness. It also aids in the marketability of companies throughout the world who hold his end of the bargain, a company
your company.” rely on us for spare parts,” says Jason could lose out. But for most, it’s worth
Joshua Glas, parts director for Crawford, president of Block Imaging the risk.
ADAM Imaging Parts Inc., has been International. “There are many chal- “The overseas parts market is vi-
seeing big increases in his overseas lenges to this business, and it requires able, but it comes with greater risks
parts market. a higher degree of trust than you might and challenges,” says Kramer. “Getting
“It’s gotten more challenging for expect. A parts company must have a exchange parts takes longer and often
them since the dollar has started to ap-
preciate a little bit, but it’s still very
good,” he says. “I have been fortunate
to build strong international relation-
ships and I have seen growth every-
where—Kenya, Australia, Asia, all over
the world.”
Since many of these countries are
using older equipment, it gives a parts
company the chance to unload some
product that is probably never going to
be sold domestically.
“There’s not much value in those
parts here, so I give them fantastic pric-
ing and it’s good for them and a little
gravy for me,” Glas says. “Some of
these parts can be 20 years old so it’s
really a win-win.”
Helms says that Troff Medical reg-
ularly ships its wares to anywhere from
six to eight countries, but has dealt with
more than 25 different countries over
the years.
George Fraza, general manager for
DMS Topline Medical, says his compa-
ny has also been expanding a great deal
overseas and has shipped a considerable
amount of biomedical parts to Central
and South America and some to India.
He has made sure to stay on top of cur-
rent trends to see where else his busi-
ness can grow.
“With the market in India and Rus-
sia exploding, we see those as two ex-
cellent markets to get into, especially
with the boom in hospitals in both,”
Fraza says. “There’s a company in India
expected to build 3,600 beds worth of
hospitals so there is a tremendous op-
portunity to expand in the international
domain.”
Overseas customers must have a

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When it comes to the question of finding the linear accelerator

part you need — we’ve got thousands of answers.
THE RIGHT PART, AT THE RIGHT TIME, AT THE RIGHT PRICE

Trust TOG for parts, and you simply can’t go wrong. We have the largest
independent inventory of OEM linear accelerator replacement parts in the
United States – with tens of thousands in stock at any given time. Plus, our
team of experts has the knowledge to help translate that inventory into
decreased downtime and lower costs for you and your practice. Selection,
quality, value and service – if you’re looking for a company you can count on,
we have every part covered.
/"ÊUÊÊÓ£ÎäÊ ÀÌÜiÃÌÊ*>ÀÜ>Þ]Ê-ÕÌiÊ]Ê>ÀiÌÌ>]ÊÊÎääÈÇÊÊUÊÊ£ÊnääÊÇxxÊÈ{äÊÊUÊÊÜÜÜ°ÌiVV>«ÌÃ°V
nostic Imaging Solutions, LLC. “When they get a taste of the
revenue-selling a whole cabinet instead of selling a single part
out of the cabinet it leaves them in a position where they are
not motivated the next time to assist the end-user to getting the
problem resolved with the minimum number of parts.”
Although it’s not a practice they actively take part in,
Robert Graham, sales director for Polaris Medical Imaging,
does understand why some take this approach.
Some parts dealers concentrate

all their interests on one particular
modality or even one OEM brand
of equipment.
“Selling entire subsystems is sort of a case-by-case ba-
sis. If engineers aren’t really sure what is wrong with a part
of the system, they will throw parts at it to help get the cus-
tomer up and running,” he says. “It is better to part subsystems
out for monetary reasons, but sometimes it isn’t feasible and
doesn’t make sense. We generally do not sell entire subsys-
tems if we can help it as it is expensive in shipping and com-
plicated to install.”
Block Imaging engineer
pulls board from stock for In an effort to try to make things as easy as possible for
customer order the customer, Glas sometimes does something like this to help
ends up not happening at all, so any companies evaluating in-

ternational business should be ready for a whole new array of
challenges in logistics, finances and time required.”
A few years ago, the trend was for equipment and service
providers to enter the parts business. Because of their techni-
cal background, the independent service organizations know
how to handle, test, store and ship parts and they often main-
tain a significant inventory.
An emerging trend becomes part of a

problem
One trend industry experts are starting to note in the parts sec-
tor is the selling of entire subsystems rather than just a particu-
lar component.
“In my unique position where I have close contact with the
customers and I also have close contact with the brokers and
friends who run parts companies, what I am seeing are people
who have typically been [with] a service company move into
parts,” says Larry Knight, operations partner of Altima Diag-

with troubleshooting a problem.
“If they don’t know the exact prob- One trend industry experts are starting to
lem, we often extend slightly more le-
nient return terms in a hero kit situation, note in the parts sector is the selling of entire
referring to a handful of parts where the
customer is not sure exactly which one
subsystems rather than just a particular
would solve the problem, so they swap component.
the parts until they have a working solu-
tion,” he says. “Other times, the customer that must be applied to for every single Challenges
may want a few parts from the assembly transaction. There are often times you Clark Wilkins, owner of JDI Solutions
and it may be cost-prohibitive and as a will encounter a situation that you have Inc., which has more than 3,000 parts
solution a package deal may be presented not yet before seen and you must think for Siemens products in its warehouse,
to offer them some additional value. This on your feet to offer value and effective sees two big problems parts companies
business is so unique and exciting I don’t solutions for the customer that you may are facing in today’s environment.
think there are any hard-and-fast rules not have considered before.” “On one level, there is ever-increas-
ing pressure from parts redistributors
who constantly beat us down on price
but are not passing the savings on to
their clients. This combines with a lot of
other companies that do not do rigorous
QA so their overhead is much lower,” he
says. “Level two, the price of the newer
equipment remains too expensive to ac-
quire the units for parts. We’re still see-
ing 10-year-old scanners commanding
upward of $200,000 wholesale, which
makes it hard to justify scrapping one
out for parts.”
Parts come from a variety of out-
lets. Everyone knows about the usual
means: parting out whole systems and
opportunistic purchasing, but while
these are important, the real test for any
company is ensuring that these parts are
in good condition throughout the entire
process with stringent steps to ensure
quality from acquisition to inventory.
“Resourcing is something we take
seriously. We are very aggressive in
finding those high quality resources
from the OEMs or from hospital groups,
and pay very close attention to it all,”
Fraza says.
Many of the companies purchase
complete systems for parts and then do
their due diligence to ensure that they
are all working.
“We bring those systems in-house
and stage each system to verify each and
every part is to OEM specification prior
to tearing the system down for parts,”
says Gregg Pearson, president of Mag-
naServ Inc., which has a complete line
of GE MRI and CT parts stocked in six
regional locations across the country.
“Our in-house repair operation verifies
each and every part repaired is operat-

ing to OEM specification prior to add- “Customers should understand that Graham offers that parts compa-
ing the part to our stocking locations.” putting the price of the part as the fore- nies pricing far below others often don’t
If the company doesn’t have a part most parameter is very risky,” Wilkins know what they are doing and could
in stock, Pearson says it will strip the says. “If you want a tested part, you need soon find themselves out of business.
part from one of its staged systems or to realize that testing process has a cost Experience and knowledge are just as
second source the part from various component which has to be recovered.” important as price in many cases.
vendors. Kramer tells customers, you can’t “There are several key points to a
judge a book by its cover. growing parts business. Knowing what
“There are many statements that you are doing is, in my opinion, the
Even though the exist in the industry about what compa- most important point. I see hundreds of
domestic market has nies provide, so it’s always best to do prices being quoted that are way below
your homework,” he says. “Dig deep to market value. All this does is destroy
been increasing each understand how your provider ensures the market and cut your own profits,” he
quality, stock consistency, warranties says. “You [also] have to send the right
year, the international and technical support.” parts. A lot of parts are very similar with
market has been
garnering a lot of
interest from everyone
in the sector.
Medical Purchasing Resource Introducing

LLC. offers parts for different aesthetic
laser systems and obtains most of its in-
iTubeNow
ventory directly from manufacturers or
direct suppliers. TM
“We do have some laser systems
available in-stock as part systems when
all other sources are exhausted,” said the
company’s president, George Beach.
CT Tubes Installed
Finding a Deal
One need only look at the listings on Anytime, Anywhere
DOTmed.com to see that the parts indus-
try is inundated with suppliers and deal-
ers, but that doesn’t mean all are equal.
“One of the things that has hurt the Ɣ Certified Technicians
reputation of the parts industry is what Ɣ Delivered and Installed 24/7 anywhere in the US
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a phone can be in the parts business,”
Ɣ Ask how you can receive a FREE ReMedPar Training
Suffridge says. “What people need to
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know is where you are getting those
parts from. You could be purchasing Ɣ For tube replacement on:
that part from a parts junkyard and not GE Lightspeed*, GE Brightspeed* and GE VCT*
a company and facility like ours. At
ReMedPar, it took us 25 years and tens
of millions of dollars of investment in
our infrastructure and business to de-
velop this high level of quality.”
With so many options, one might
think that simply finding the lowest
price is the way to go, but parts com-
24-Hour Hotline: 1-800-624-3994
panies warn that this often causes major
problems. *All products listed may be trademarked by the referenced OEM

almost identical part numbers. Knowing company is fully wrapped around this further show its commitment to its cus-
which parts belong to which system is process with no compromise to qual- tomers, recently ReMedPar gained ISO
essential for getting the customer run- ity, which gives us the upper hand for 9001 certification.
ning again.” keeping critical parts available. When “Only a company committed to
Most major parts companies now it’s time for a part to ship out, a dedi- real quality and customer service would
offer 24/7/365 on-call support, a skilled cated team of shipping specialists give invest the time, money and human re-
customer service staff, in-house parts our parts the ‘white-glove’ treatment in sources in obtaining this certification,”
identification, high-end in-house repairs packaging and courier service selection Suffridge says. “Too often, parts sup-
capabilities, installation service and a to ensure that parts arrive both on-time pliers take shortcuts to quality.”
global reach. and undamaged.” It’s more important than ever to
“Another key and often unperfected Even with the significant savings do your due diligence on the source of
means for ensuring stock is maintaining they offer customers, parts suppliers the part. Unfortunately, the same eco-
an effective cycle, that is, the ability to face tough competition in a crowded nomic stressors that cause hospitals to
recover defective parts and restore them market. That’s why respect for the cus- keep machines longer have also led to
to full functionality,” Kramer says. “Our tomer is of the utmost importance. To unscrupulous practices by some parts
brokers.
“When it comes to survival, it re-
ally comes down to offering quality,”
Helms says. “We spend a lot of time
field testing these units before they are
removed. We buy from hospitals that we
know, brokers that we know. We know
how the stuff was used and only buy
good quality equipment. We go through
a lot to ensure everyone is happy with
the transaction and happy with the parts.
Reconditioned and fully tested

high-voltage tanks for various GE
CT scanner systems as available
at C&G Technologies.

DOTmed Registered Parts Sales & Service Companies DOTmed
For convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 14220] Certified
Names in boldface are Premium Listings. Names highlighted in green are DOTmed Certified Parts Vendors. Parts Vendor
Company City State Specialties

Dietz Healthcare, Inc. Chandler AZ Ultrasound transducers
Calscan Medical Ent., Inc. Anaheim CA Siemens, Philips and Picker Marconi MRI/CT
CBE Medical, Inc. Anaheim CA
Med Resources Imaging Baldwin Park CA
Advanced Endoscopy Devices, Inc. Canoga Park CA
Beach Medical Costa Mesa CA
Southwest Medical Resources Norco CA MRI, CT, PET and PET/CT
Nationwide Medical Equipment Services, LLC. Ontario CA GE, Philips, Picker Marconi and Toshiba CT and GE, Siemens, Philips MRI
KPI Ultrasound Riverside CA Ultrasound
Sound Imaging Inc. San Diego CA GE MRI and MRI accessories - video monitoring and stereo
IMEB, Inc. San Marcos CA
Tenacore Santa Ana CA SpO2, ECG/EKG cables, fetal transducers, monitors, infusion pumps, O2 blenders, wall suction regulators
Viable Med Services, Inc. Santa Clarita CA Hitachi and Toshiba MRI, Hitachi and Toshiba CT, Siemens PET
Wholesale Aesthetics, LLC Santa Rosa CA
MBI-USA Templeton CA
Medimtech LLC Tracy CA Ultrasound probes, ATL, Philips, HP, GE, Siemens, Acuson and Toshiba. Ultrasound monitors, PCB’s, trackball, printers,
VCRs SCSI drives, recording media
Nova Technologies, Inc. Julesburg CO Diagnostic ultrasound, ultrasound accessories
Medical Systems Technologies Longmont CO
Soma Technology, Inc Bloomfield CT Biomedical equipment , C-arm, Portable X-ray
Eclipse Systems Inc. Durham CT
Covenant Imaging Group Boca Raton FL Siemens MRI, accessories
Platinum Medical Imaging Deerfield Beach FL GE, Siemens and Philips MRI, coldheads, GE, Siemens, Philips and Toshiba CT, CT and X-ray tubes, Siemens and GE PET/CT
Integrity Medical Systems, Inc. Fort Myers FL Bone densitometer, mammography, C-Arms, X-ray, CT, MRI, nuclear medicine, laser cameras, ultrasound
The Laser Warehouse Ft. Lauderdale FL
Primus Xray Ft. Myers FL
TheLaserOutlet.com Jupiter FL Laser handpieces and accessories
Logix Medical Miami FL
Amber Diagnostics Orlando FL CT, MRI, C-arm, X-ray, radiographic, bone densitometer, ultrasound, nuclear camera, mammography, R/F Room, Rad/Tomo,
cath labs, cath/angio
National X-Ray Corporation Palmetto FL C-Arm, Philips cath lab, X-ray tubes, image intensifiers, Kodak POC CR
CBC Inc. Pompano Beach FL Biomedical equipment , C-Arm, portable X-ray
Choice Medical Systems Inc St. Petersburg FL Diagnostic ultrasound
MagnaServ, Inc. Stuart FL
Medcorp Tampa FL Boards, User interfaces, BEP’s, peripherals, Siemens Ultrasound
Allied Health Equip Decatur GA Sterilizers, autoclaves, instrument washers
MRI Technical Services, Inc. Marietta GA
Technical Options of Georgia Marietta GA Duplicate, TOG is Technical Options of Georgia
SIEMENS
Parts Repair Depot
727-530-0301
When you think of Siemens medical parts made in Germany,
remember German Electronics in the U.S.A.
German Electronics
1200 Starkey Road #205, Largo, FL 33771
5FMr'BY
TBMFT!HFDPVTBDPNrXXXHFDPVTBDPN

TOG Marietta GA LINAC parts, Linear Accelerator
Imaging Resources Martinez GA
Gale Medical, LLC Savannah GA Ultrasound
MEDX, Inc. Arlington Heights IL Nuclear Medicine
Unisyn Medical Technologies Golden CO Siemens, Philips, Picker Marconi, GE and Toshiba MRI and CT, Ultrasound Transducers & Parts
Zetta Medical Technologies, LLC Lake Zurich IL GE, Siemens, Philips MRI. Coldheads. GE, Siemens, Philips, Toshiba CT. X-Ray Tubes. Siemens, GE PET/CT.
Advanced Insurance Partners, Inc. Wheaton IL
Axess Ultrasound, LLC Indianapolis IN Ultrasound
C&G Technologies, Inc Jeffersonville IN GE and Toshiba CT, GE PET/CT
C&C Medical Solutions Inc. Noblesville IN All OEM imaging ultrasound
Marquis Medical Denham Springs LA PET, PET/CT, CT
Physicians Resource Network Fall River MA PAD vascular testing equipment, O/R, Biomedical
Medical Equipment Dynamics, Inc. New Bedford MA O/R capital equipment, patient monitors, modules, roll stands, wall mounts, defibrillator, endoscopy cameras, light sources,
surgical microscope, infusion pump and surgical table accessories, ultrasound probes
Certified Tech Aberdeen MD
Scintillation Technologies Baltimore MD
Clinical Resources Inc Cockeysville MD
Metro Scopes College Park MD
Berrien X-Ray Berrien Springs MI
Block Imaging International, Inc. Lansing MI
Acurad Technical Services, LLC Minneapolis MN
Bemes, Inc. Fenton MO Respiratory, ventilators, SensorMedics PFT
Med-E-Quip Locators, Inc. Maryland Heights MO Infusion and syringe pumps, Kendall SCD Pumps
Bio Basics Global Park Hills MO Electric beds, patient monitoring, defibrilators, endoscopy camera processor, IV pumps
Advanco Medical Systems Sedalia MO
American Biomedical Consultants, Inc. Smithville MO
Minxrad Springfield MO Bennett X-Ray Generator Parts, Portable X-Ray Parts, Orex reader repairs, VIDAR repair service
Crawford Diversified Services, Inc. St. Louis MO
Mediquip Parts Plus, Inc. St. Louis MO Steris &Getinge Sterilizers & Washers
Universal Medical Resources,Inc. Washington MO ADAC/Philips, Siemens, GE nuclear medicine
HealthCare Imaging, LLC Asheville NC Imaging
JDI Solutions, Inc. Brevard NC Siemens MRI
Diversified Dental Service Charlotte NC
First Source Inc. Charlotte NC
Medical Equipment Expense Solutions Greensboro NC
Troff Medical Services Hendersonville NC Imaging equipment
Transtate Equipment Co. Raleigh NC Cath/Angio Special Procedure
RS&A, Inc. Rural Hall NC Linear Accelerators, Simulators, Klystrons, Magnetrons, Thyratrons, RF Drivers, RF Drivers
Absolute Imaging Solutions Stokesdale NC ADAC, Philips, Nuclear Medicine
Alexander Medical Imaging Taylorsville NC
Carolina Medical Parts Winston Salem NC Philips and Picker Marconi MRI, Coils
DMS Topline Medical Fargo ND
Superior Radiographic Systems Fargo ND Philips
Eichenauer Heating Elements Newport NH Flanged immersion heaters
Oxford Instruments Carteret NJ MRI magnet,cold head, compressor
We’ll follow-up with the end users that they received it and
everything is to their liking. We try to make them happy.”
Keeping Track
With more than 20,000 parts in Adam Medical’s 14,000 square-
foot warehouse, a key component to being successful, according
to Glas, is having the technology to keep track of everything.
“The database has definitely evolved with the business,”
Glas says. “Basically, it was a glorified Excel sheet when we
started, but it has grown into a reporting tool where I can get
requests and find parts based on the model, modality, system
name — all with a touch of a button. I can also track returns
and sales and sales metrics.”
Today, getting a part from a third-party source can be as
simple as a click of the mouse, which is why you must keep
up with technology. Many customers would rather find their
needed part on their computers or cell phones.
That fact hasn’t been ignored. Block Imaging Internation-
al makes it simple for customers, as they can request a part by
phone, e-mail or through its website.
“If a customer needs a circuit board for a Sensation 16,
upon receipt of the customer’s purchase order, we will pull the
verified and tested board and professionally pack it for same-
day shipping,” says Crawford. “A member of our sales team
will verify the part number and provide pricing based on sub-
stantial discounts off the OEM price.”
Keith Loria can be reached by e-mail at kloria@dotmed.com

Cintech Inc. Lanoka Harbor NJ
Independence Cryogenic Engineering Little Egg Harbor NJ
MedPro, Inc. Marlton NJ Ultrasound
Pan Am Imaging South Plainfield NJ GE MRI
ISIS Medical Solutions, LLC Tabernacle NJ
SouthWest Imaging, Inc. Las Vegas NV
OMED of Nevada LLC Reno NV Anesthesia, endoscopy, defibrillators, patient monitors, ultrasound, imaging
PIGroup, Inc. Bacon Hill NY
RJP International Inc. Baldwin NY Fetal transducers and monitors, patient monitors, HP defibrillators, Baxter infusion pumps
Specialty Bulb Co Inc Bohemia NY
ADAM Imaging Parts, Inc. Brooklyn NY Diagnostic imaging, X-ray and CT
Longevity Parts Brooklyn NY Multi vendor parts for all modalities
Long Island Ophthalmic Service Center Moriches NY Ophthalmology
Advantage Medical Systems Nyack NY Bed controls and pendants for homecare and hospital beds
Absolute Medical Equipment Wesley Hills NY EKG, ultrasound, patient monitoring, defibrillator, bone density, anesthesia, mammography, cardiology, lab, fetal monitor,
X-ray tube, CT and MRI coil
Duraline Systems West Nyack NY
Express Systems & Parts Network, Inc Aurora OH Bone densitometer, mammography, C-Arm, X-ray, CT, MRI, nuclear medicine, laser camera, ultrasound
North Coast Medical Equipment, Inc. Berea OH
KLC Services, Inc. Hilliard OH
Classic Diagnostic Imaging Macedonia OH
JMED Imaging, Inc. Bixby OK G E Advantx RFX 8835SFD LPX-Generator
Advanced Ultrasound Electronics Tulsa OK Ultrasound Probes, boards, membranes, etc.
Med Part Source Carlisle PA All modalities of ultrasound parts/probes. X-Ray tubes/parts, MRI and CT parts.
Medical Technic, LLC Philadelphia PA Mammo, ultrasound, CT, MRI
Grand Medical Equipment, Inc. Souderton PA
Biomedix Medical Toughkenamon PA Infusion pumps
International Medical Equipment and Service, Inc. Fort Mill SC Toshiba CT & MRI, Major OEM MRI & CT
MARS Medical Lexington SC
A+ Medical Company, Inc. Rock Hill SC Major OEM Rad, R/F, mammo, cath lab, C-Arm, bone density, nuclear medicine, CT
Radiology OneSource Franklin TN Imaging
Tenvision Gallatin TN All OEM ultrasound
J&M Trading, Inc. Goodlettsville TN All modalities from all OEMs
ReMedPar Goodlettsville TN CT, MRI, mammography, portable X-ray, X-ray, cath lab, C-Arm, ultrasound
Townsend Surgical Maryville TN
Tracelogix Corp. Memphis TN Operating Room, Biomedical
AllParts Medical Nashville TN Cath/angio, CT, R&F, rad, C-Arm, mammo, portables, MRI
NCI Austin TX All OEM gamma camera
MedSurg Equipment, LLC. Beaumont TX Medical gas connections, patient monitor cables, patient monitors, cell signal boosters
AAN Radiology Systems, Inc. Canyon Lake TX Nuclear systems engineering
Elite Biomedical Carrollton TX Physical Therapy, Rehabilitation, Fitness & Exercise, Defibrillator, Monitoring
Medical Purchasing Resource, LLC Dallas TX
Image Technology Consulting, LLC DeSoto TX Philips, Picker, Siemens, Hitachi MRI
Aesthetic Head Pros Elgin TX
Polaris Medical Imaging Houston TX MRI, CT, MRI Coils, X-ray Tubes, Amplifiers, Power Supplies
7JTJUPVSXFCTUPSF
Your source for used and refurbished PO%05NFEDPN
Imaging Parts DMS Topline Medical offers a wide-range of used and reconditioned diagnostic
imaging replacement parts from Philips, Siemens and GE. Parts are sourced
daily and are available for:
t MRI t X-Ray
t CT t Vascular
t PET/CT t Ultrasound
We also have a deep inventory of biomedical equipment parts.
Backed by over thirty-five years in the imaging business, our team has the
expertise and experience to ensure our customers get the right solutions on
time at the best price possible.
Visit ToplineMedical.com for more

information or contact us today.
tXXX5PQMJOF.FEJDBMDPN
JNBHJOHBOECJPNFEJDBMQBSUTtEFöCSJMMBUPSTt&,(tNPOJUPSTtDFOUSBMTUBUJPOTtUFMFNFUSZtNPEVMFTtVMUSBTPVOE

Altima Diagnostic Imaging Solutions, LLC Plano TX
Laser Scientific Round Rock TX GentleLase, GentleYAG, V-Beam, GentleLase Plus
FOBI Tomball TX
Sunrise Medical Technology, Inc. Waxahachie TX Siemens, Philips and Picker Marconi CT and MRI
Transamerican Medical Imaging Lindon UT Philips, Picker, and OEC Imaging
VIP Medical, Inc. Alexandria VA Respiratory critical care ventilator
Mid-Atlantic Telerad Sterling VA
IV Technologies, Inc. Upperville VA OEM IV pump replacement
Medical Equipment Services of VA LLC Virginia Beach
VA
Northwest Ultrasound, Inc. Kirkland WA
LuxarCare, LLC Woodinville WA
Technical Prospects LLC Appleton WI Siemens and Philips CT, injector, Siemens X-ray
Shared Medical Services, Inc. Cottage Grove
WI MRI, CT, PET
Alpha Source Inc. Milwaukee WI Batteries, Xenon and Replacement Lamps, Fiber Optic Cables, Diagnostic Instruments, Medical Oxygen Sensors, Power
Protection, Monitoring Accessories
Resonant Diagnostics LLC. Milwaukee WI MRI Coils

Company – International City Country Specialties
Macor Insumos Hospitalarios Buenos Aires Argentina
EverX Pty Ltd Sydney Australia
TMA Medical Foschbach Austria
Respiratory Care Plus Pictou Canada
Canadian Medical Products Scarborough Canada
Beijing Beauty Blue S&T Development Center Beijing China
Sunray Medical Apparatus Co., Ltd Guangzhou China
Collection Power Sources Co., Ltd. Shenzhen China
Lifepulse Co., Limited Shenzhen China
Shenzhen Wata Sound Industrial Co., Ltd. Shenzhen China
Link FRANCE Strasbourg France X-ray, MRI, CT, all modalities of ultrasound
Ackermann Medical Systems GmbH Dahn Germany Toshiba CT
Medtec GmbH Germany Fuerth Germany All manufacturers of CT and MRI
Medicopex GmbH Oberasbach Germany
LifeTEC Medical Systems San Fernando Guatemala
Falcon Biotech Pvt Ltd. Chandigarh India
Ultrasoundindia Kozhikode India Ultrasound Boards, user interfaces, BEPs, peripherals
Omax Technologies Solapur India
Wave Visions Vadodara India
GDTRE Milan Italy Ultrasound parts, Ultrasound Device
Hospital Equipment Services BV Kampen Netherlands
JA Trading Co Lahore Pakistan
Sid Med Dot Co. Lahore Pakistan
Deans Medical Equipment Peshawar Pakistan
Medinet Korea Co. Ltd. Bucheon South Korea
Dr. Medicom Ltd Co. Taichung Taiwan
Tarena Dushanbe Tajikistan
PCRS Medical Imaging Services St. Helens United Kingdom
When REPAIRING or REMANUFACTURING

we have the PARTS and EQUIPMENT to
help you.
Specializing in Sterilizers, Washers, OR Tables,

OR Lights, Solution Warmers, Scrub Sinks and
SERVING THE CUSTOMER IS THE other related equipment.
FOCUS OF EVERYTHING WE DO When you need something as simple as a part
number or are in need of technical support with
emergency equipment failures, give us a call,
we have what it takes to keep everyone on your
team happy.
9300 Watson Industrial Park, St. Louis, MO 63126

1IPOFt'BY
dave@mqpp.com
www.mqpp.com

What makes DOTmed Certified Parts Vendors unique?
DOTmed Certified Parts Vendor are required to agree to DOTmed’s code of ethics and to fill out a public profile that
DOTmed clearly displays their industry experience and areas of expertise. In this way, potential customers will be able to
Certified find the right fit for their parts needs. The following is a small sample of the more than 120 DOTmed CPV vendors.
Parts Vendor The complete list of companies can be found at: www.dotmed.com/features/certified-parts
DOTmed DOTmed 5-Star Rating: DOTmed DOTmed 5-Star Rating: DOTmed DOTmed 5-Star Rating:
Certified Certified Certified
Parts Vendor Parts Vendor Parts Vendor
(107 Ratings) (99 Ratings) (89 Ratings)
ADAM Imaging Parts, Inc. Image Technology Consulting, LLC Integrity Medical Systems, Inc.
714 Atkins Ave. 1400 Meadowlark Lane 2312 Bruner Lane
Brooklyn, NY 11208 Lancaster, Texas 75146 Fort Myers, FL 33912
Phone: 347-985-1679 Phone: 972-223-3008 Phone: 239-454-9555
Fax: 718-228-6559 Fax: 972-223-0586 Fax: 239-454-9599
Email: info@adamimagingparts.com Email: marshall@imagetechnology.net Email: info@integritymed.com
Website: www.adamimagingparts.com Website: www.imagetechnology.net Website: www.integritymed.com
Years in Business: 11 Years in Business: 14 Years in Business: 22

Warehouse Size: 14,000 Sq. Ft Warehouse Size: 80,000 Sq. Ft Warehouse Size: 16,000 Sq. Ft
Revenue % from Parts: 35% Revenue % from Parts: 60% Revenue % from Parts: 20%
Number of Parts Stocked: 20,000 Number of Parts Stocked: 100,000 Number of Parts Stocked: 20,000
Specialties: Diagnostic imaging, X-ray and CT Specialties: Philips, Picker, Siemens, Hitachi MRI Specialties: Bone densitometer, mammography,
C-Arms, X-ray, CT, MRI, nuclear medicine, laser
cameras, ultrasound
iService
iService
Quality MRI service – the cool choice
MRI
MRI
Quality MRI service – the cool choice
Unbeatable international
field service for magnets, cold
heads and helium compressors
– expertise you can trust
Choose Oxford Instruments – our 50 years
experience with magnets means you get
the very best service and technical support
available. Make the cool choice!
Unbeatable international field service for magnets, cold

heads and helium compressors – expertise you can trust
Choose Oxford Instruments – our 50 years experience with magnets means you get the very
best service and technical support available. Make the cool choice!
For further information contact us directly: For further information contact us directly:
Tel: +1 732.850.9323
Tel: +1 732.850.9323 Email: mriservice@oxinst.com
Email: mriservice@oxinst.com www.oxford-instruments.com/mri
www.oxford-instruments.com/mri

C&G Technologies, Inc. PRN Viable Med Services, Inc.

6209 Gheens Mill Road 218 Shove Street, Suite 101 West 16660 Minter Court
Jeffersonville, IN 47130 Fall River, MA 02724 Santa Clarita, CA 91387
Fax: 812-280-8820 Fax: 508-677-9614 Fax: 818-474-7515
Email: parts@cgtscan.com Email: bob@prnwebsite.com Email: mricentral@yahoo.com
Website: www.cgtscan.com Website: www.prnwebsite.com Website: www.viablemed.com

Specialties: GE and Toshiba CT, GE PET/CT Specialties: PAD vascular testing equipment, O/R, Specialties: Hitachi and Toshiba MRI, Hitachi and
Biomedical Toshiba CT, Siemens PET
Technical Prospects LLC Amber Diagnostics J&M Trading, Inc.

1000 South County Road CB 2180 Premier Row 409 Space Park North
Appleton, WI 54914 Orlando, FL 32809 Goodlettsville, TN 37072
Fax: 920-757-6591 Fax: 407-856-5456 Fax: (615) 851-1842
Email: parts@technicalprospects.com Email: info@amberusa.com Email: smartmedparts@gmail.com
Website: www.technicalprospects.com Website: www.amberusa.com Website: www.jandmtrading.com

Specialties: Siemens and Philips CT, injector, Specialties: CT, MRI, C-arm, X-ray, radiographic, Specialties: All modalities from all OEMs
Siemens X-ray bone densitometer, ultrasound, nuclear camera,
mammography, R/F Room, Rad/Tomo, cath labs,
cath/angio
AllParts Medical ReMedPar Nationwide Medical Equipment

400 Brick Church Park Drive 101 Old Stone Bridge Services, LLC
Nashville, TN 37207 Goodlettsville, TN 37072 638 Mantoloking Road
Phone: 866-507-4793 Phone: 800-624-3994 Brick, NJ 08723
Fax: 615-690-5055 Fax: 615-859-4165 Phone: 732-262-3115
Email: sales@allpartsmedical.com Email: rmpsales@remedpar.com Fax: 732-262-3105
Website: www.allpartsmedical.com Website: www.remedpar.com Email: info@nationwideimaging.com
Website: www.nationwideimaging.com
Years in Business: 4 Years in Business: 23
Warehouse Size: 80,000 Sq. Ft Warehouse Size: 140,000 Sq. Ft Years in Business: 16
Revenue % from Parts: 80% Revenue % from Parts: 90% Warehouse Size: 40,000 Sq. Ft
Number of Parts Stocked: 14,531 Number of Parts Stocked: 38,000 Revenue % from Parts: 20%
Specialties: Cath/angio, CT, R&F, rad, C-Arm, Specialties: CT, MRI, mammography, portable Number of Parts Stocked: 1,000,000
mammo, portables, MRI X-ray, X-ray, cath lab, C-Arm, ultrasound Specialties: GE, Philips, Picker Marconi and
Toshiba CT and GE, Siemens, Philips MRI

TheLaserOutlet.com The Laser Warehouse International Medical Equipment

1829 Park Lane South #08 1740 East Commerical and Service, Inc.
Jupiter, FL 33458 FT. Lauderdale, FL 33334 8190 Regent Parkway
Phone: 561-747-3616 Phone: 954-254-4612 Fort Mill, SC 29715
Fax: 561-747-3626 Fax: 954-766-4064 Phone: 704-739-3597
Email: sales@thelaseroutlet.com Email: sales@thelaserwarehouse.com Fax: 704-259-4008
Website: www.thelaseroutlet.com Website: www.thelaserwarehouse.com Email: info@imesimaging.com
Website: www.imesimaging.com
Years in Business: 8 Years in Business: 8
Warehouse Size: 10,000 Sq. Ft Warehouse Size: 7,000 Sq. Ft Years in Business: 8
Revenue % from Parts: 20% Revenue % from Parts: 20% Warehouse Size: 24,000 Sq. Ft
Number of Parts Stocked: 2,000 Number of Parts Stocked: 5,000 Revenue % from Parts: 75%
Specialties: Laser handpieces and accessories Specialties: Cosmetic & aesthetic lasers Number of Parts Stocked: 5,000
Specialties: Toshiba CT & MRI, Major OEM
MRI & CT
OMED of Nevada LLC Tenacore Holdings, Inc. Oxford Instruments

800 Stillwell Rd. # 80 1525 E. Edinger Ave 600 Milik St.
Reno, NV 89512 Santa Ana, CA 92705 Carteret, NJ 07008
Fax: 775-857-3009 Fax: (714) 549-7835 Fax: 732-802-0401
Email: sales@omednevada.com Email: info@tenacore.com Email: thomas.freund@oxinst.com
Website: www.omednevada.com Website: www.tenacore.com Website: www.oxinst.com/mri

Number of Parts Stocked: 1,000 Number of Parts Stocked: 150,000 Number of Parts Stocked: 200
Specialties: Anesthesia, endoscopy, defibrillators, Specialties: SpO2, ECG/EKG cables, fetal Specialties: MRI magnet,cold head, compressor
patient monitors, ultrasound, imaging transducers, monitors, infusion pumps, O2
blenders, wall suction regulators
VIP Medical, Inc. Block Imaging Parts & Service, Inc. Sound Imaging, Inc.
8647 Richmond Highway Suite 623 5411 Enterprise Drive 8390 Miramar Pl Suite A
Alexandria, VA 22309 Lansing, MI 48911 San Diego, CA 92121
Fax: 866-762-6313 Fax: 517-668-8899 Fax: 858-368-8556
Email: wlm@vipmedinc.com Email: parts@blockimaging.com Email: tanner@soundimaging.com
Website: www.vipmedinc.com Website: www.parts.blockimaging.com Website: www.soundimaging.com

Specialties: Respiratory critical care ventilator Specialties: All Modalities, All Manufacturers of Specialties: GE MRI and MRI accessories - video
Radiology Parts monitoring and stereo

SouthWest
MEDICAL RESOURCES
Southwest Medical Resources Troff Medical Services Mediquip Parts Plus, Inc.
1290 Elm Street 51 Jackson Loop Rd. 9300 Watson Industrial Park
Ontario, CA 91761 Flatrock, NC 28731 St. Louis, MO 63126
Fax: 951-735-3373 Fax: 828-698-4391 Fax: 314-968-7945
Email: info@swmedicalresources.com Email: patrick.helms@troffmedical.com Email: dave@mqpp.com
Website: www.swmedicalresources.com Website: www.troffmedical.com Website: www.mqpp.com

Specialties: MRI, CT, PET and PET/CT Specialties: Imaging equipment Specialties: Steris &Getinge Sterilizers & Washers
Axess Ultrasound, LLC TOG Minxrad

8148 Woodland Dr. 2130 Northwest Pkwy Suite A 1920 E. Meadowmere Ste. 8-B
Indianapolis, IN 46278 Marietta, GA 30067 Springfield, MO 65804
Fax: 317-275-5570 Fax: 770-319-1560 Email: bob@minxrad.com
Email: claudia.haaning@axessultrasound.com Email: sales@technicaloptions.com Website: www.minxrad.com
Website: www.axessultrasound.com Website: www.technicaloptions.com
Years in Business: 3
Years in Business: 6 Years in Business: 18 Warehouse Size: 2,500 Sq. Ft
Warehouse Size: 19,000 Sq. Ft Warehouse Size: 6,000 Sq. Ft Revenue % from Parts: 60%
Revenue % from Parts: 40% Revenue % from Parts: 100% Number of Parts Stocked: 300
Number of Parts Stocked: 10,000 Number of Parts Stocked: 67,000 Specialties: Bennett X-Ray Generator Parts,
Specialties: Ultrasound Specialties: Linear Accelerators (most brands), Portable X-Ray Parts, Orex reader repairs, VIDAR
Magnetrons, Thyratrons repair service
T R A N S AME R IC A N
Medical Imaging
Certified Certified Certified (Not rated yet)
(2 Ratings) (1 Rating)
Medcorp Absolute Imaging Solutions Transamerican Medical Imaging

5735 Benjamin Center Drive 8205 B&G Court 965 West 325 North
Tampa, FL 33634 Stokesdale, NC 27357 Lindon, UT 84042
Fax: 813-630-5999 Fax: 336-643-2555 Fax: 801-796-7363
Email: info@medcorpllc.com Email: gmansfield@ais-nuclear.com Email: eberhardt@transamericanmedical.com
Website: www.medcorpllc.com Website: www.ais-nuclear.com Website: www.transamericanmedical.com

Specialties: Boards, User interfaces, BEP’s, Specialties: ADAC, Philips, Nuclear Medicine Specialties: Philips, Picker, and OEC Imaging
peripherals, Siemens Ultrasound

The Near-Future of Leasing
By Brendon Nafziger
Regulatory reforms, capital crunches and captives’ new game plan. Here’s a brief peak at the near-future of capital equipment leasing.
W
hen defense giant Whatever the answer, change is to be dramatic, to say the least. CoStar
Northrop Grumman coming to the capital equipment leasing Group Inc., a commercial real estate in-
decided to leave Los market. From the regulatory reforms telligence company, noted in a September
Angeles and was that prompted Northrop to buy, to the article that reforms will have “a profound
shopping around for selective easing of credit and the new and mostly negative impact on commer-
a new headquarters, it did something strategies of captive lenders, it’s an in- cial tenants and landlords.”
that made finance types take pause: the dustry in flux. But will they impact the medical
company outright bought its shiny new And in the words of one analyst, capital equipment industry? Accord-
14-story office in Falls Church, Va., in- “Bankers get really nervous when things ing to most expert predictions: yes and
stead of leasing it as it was expected to are in flux.” no. No, for smaller imaging centers
do. All of this was done under the shad- more concerned about cash flow than
ow of impending leasing reform. “Will Mixed message on new debt ratios, but possibly yes for bigger
more follow Northrop’s lead and buy leasing rules health systems trying to adhere to their
vs. lease?” asked a Washington Tech- Leasing reforms aren’t finalized, but debt covenants or look sexier for invest-
nology headline. many expect the effect on real estate ments and loans.

In new rules proposed in September ance sheets. because the regulation isn’t finalized.
by the Financial Accounting Standards “If a firm is allowed to lease a sig- Deighan thinks, by and large, it will
Board, operating leases will be treated nificant portion of its assets and keep be a non-issue.
more like financial leases. That is, the it off its financial statements, a perusal “I don’t think that that is going to
cost of the lease will be considered a of the statements will give a very mis- affect leases and leasing companies and
debt, and the value of the right to use the leading view of the company’s financial people that want to lease equipment. I
item in the lease an asset, and added to strength,” according to New York Uni- think it’s going to wash itself out,” he
the balance sheets. The new rules are up versity’s Stern School of Business. said.
for public comment until mid-Decem- Dan Deighan, founder and CEO of “What it should do on the balance
ber, following the release of a so-called Deighan Financial Advisors and a fre- sheet is balance out,” he added. “It’s just
exposure draft, but they’re expected to quent talk-show guest on CNBC about that if you were going to be an inves-
take effect as early as 2013. the industry, said the purpose of the tor in an MRI center or larger practice
“What used to happen is, you did changes is to tackle “non-accounting cre- you’re now going to see both entries on
not have to claim the liability for that ativity,” such as what plagued Lehman the balance sheet, whereas in the past,
lease on your financial statement if you Brothers and other banking houses. you didn’t see it.”
were the lessee, and you also didn’t “I don’t think the basic changes But not everyone thinks its impact
count the value of the asset,” an analyst were meant to really affect companies will be so soft. Michael Terry, president
told DOTmed News. in the health care business – they were of Premier Asset Finance Group Inc.,
The reason for the reform? Better really designed to affect companies in said it would fall heaviest on those most
transparency. According to the World the finance business,” he said. sensitive to their balance sheets, which
Leasing Yearbook 2010, cited by the Nonetheless, there is still plenty could be bigger hospitals and hospitals
International Accounting Standards of conversation and speculation about systems that have covenants with their
Board, which developed the new rules how this will affect doctors’ offices, banks and bond-holders. These cov-
with FASB, worldwide leasing activity imaging centers and hospitals that lease enants require the organizations to stick
is more than $640 billion a year, much big-ticket equipment, like MRI and CT to certain debt ratios, which the new
of it not currently shown on lessees’ bal- scanners. Opinions are mixed, mainly rules could make harder.
“A lot of clients are extremely sen-
sitive to what this change will do to
their debt covenants if they have to re-
classify their leases,” Terry observed.
Pa^grhnk^]hpg''' But all are agreed that the traditional
O]lmjfqgmgf& attractions of leasing – no up-front cash

and manageable monthly payments,
with the lessor taking on the risks of
ownership – will remain drivers.
“A smaller practice or group prac-
tice is looking more at technology and
cash flow,” Terry said. And in a recent
article, leasing expert Shawn Halliday,
author of “A Guide to Equipment Leas-
ing” and “The Handbook of Equipment
Leasing,” said a survey of CFOs showed
that more than 60 percent “would not al-
ter their lease financing strategies based
on these new rules.”
Still, increased regulations mean
ENS services your X-Ray, CT
and MRI equipment. Our
increased risks. And increased risks
worldwide turnkey imaging could mean increased costs. “Some
solutions also includes buying, lessors also will have to reassess their
selling and relocating your pricing strategies and performance met-
retired equipment. Seasoned engineers are available for
rics,” Halliday noted.
magnet cooldowns, ramping, shimming and coldhead
service. Whether it’s sales or service, ENS imaging
Or as Deighan predicted, “No mat-
experts are here to serve you. ter how you slice it, the cost to lease is
going to go up.”
Lenders are already “very closely
1-954-435-0933 scrutinized by regulators on the re-
ENS-IMAGING.com serve side,” Deighan said. “As a lender,

physician practices. Group practices, big hospitals and endow-
Dan Deighan,
ments tend to be more attractive to lenders.
Founder and
President of But the lack of lending comes also from consumer reluc-
Deighan Financial tance. Some banks have noted a reduced demand for loans.
Advisors, Inc. And a recent survey of capital equipment leasing found fewer
transactions, in number and monetary volume, partly because
of “hesitation by businesses to invest in equipment.”
Because the demand for capital purchases is down, Terry
said many of his clients have excess cash on their balance
sheets. “They’re using that excess cash, I think smartly, to pay
down other obligations they have outstanding,” he said.
New strategies for captives

But these trends mean it might be easier to get loans from cap-
tives. Because captives want to move products manufactured
by their sister companies, they’re often more eager to lend in
a downmarket. According to ELFA, captives approved more
you’ve already tightened how much you will lend based on than two-thirds of submitted credit applications last year, com-
a percentage of assets and how much you will charge. With pared with banks, which approved only half.
more questions going on in the leasing market, you’re going “I would say there’s more receptivity to closer collabora-
to say either, ‘You know, I’m going to step away from doing tion between equipment finance parts of a captive house to
leasing deals until I know what’s going to happen,’ or ‘We’re try to drive business,” John Sandstrom, senior vice president
going to charge more to cover our anticipated expenses.’” and general manager, health care, of Siemens Financial Ser-
As for true impact, for now, “It’s hard to tell,” he admit- vices, told DOTmed News. “It’s different when the markets
ted. “There’s a lot of lobbying going on behind the scenes for are good, and now that’s driving a closer cooperation.”
exemptions and loopholes and different ways to account for Of course, it’s a two-edged sword, and captives also have
things.”
Capital frees up, but banks become coy TOLL FREE 888-304-7859
The capital equipment leasing industry has been through a
rs
Deale d!
rough two-year patch. The 2010 annual survey by the Equip-
ment Leasing & Finance Association, a capital equipment a n te
W
lenders lobby, is characterized by descriptions like “stunning,”
“unprecedented” and “never before.” New business volume
dropped a record 30 percent, compared to the 2 percent decline
from the year before, according to the survey. Net income de-
clined 54 percent, and revenues dropped around 14 percent.
ROE was in single digits, for the first time in more than a de-
cade. For the health care sector specifically, much of the drop
in business is due to reimbursement cuts and tightened access
to capital, experts said.
Independent organizations and the smallest companies,
with less than $50 million in business value, were hardest
hit, according to the ELFA survey. Captives fared the best, al-
though they too lost 46 percent of new business volume.
Still, credit has become more available from its 2008 na-
dir, according to experts DOTmed News spoke with. Although
hard figures are difficult to come by, analysts said they’ve no-
ticed a general easing – with more cash available. Meanwhile,
banks and other lending institutions have become more wary
about lending credit. There’s good reason for their caution —
according to reports, delinquencies and full-year losses are at
record levels, with full-year losses almost 2 percent of all full-
year average receivables.
Companies that seem to be most affected in their ability
to get credit are imaging centers, surgical centers and small

DOTmed Registered Leasing and Finance in Medicine Sales & Service Companies

Andrew Majesty Summit Commercial Finance Scottsdale AZ
Charles Sconyers, Jr. CLS, Inc. Hot Springs AR
Crystal Riley Lease With Crystal Valencia CA
Dex Dean Coastal Leasing, Inc. Ft. Lauderdale FL
John Mc Mahon Quality Medical South Largo FL
Daniel P. Deighan Deighan Financial Advisors, Inc. Melbourne FL
Cliff Peeke Olympia US Funding Solutions, LLC Parkland FL
Steve Fix Leasesource, Inc. Atlanta GA
John Barry U.S. Bank Equipment Finance Chicago IL
Max Frodge Ambassador Financial, Inc. Carmel IN •
Philips Healthcare Philips Healthcare Andover MA
David Waldron Traction Business Development LLC Fallston MD
Gary Saulter Chase Industries Grand Rapids MI
Jim Buckingham Alpha Equipment Leasing Minneapolis MN
John Lohrman MTR Health Columbus OH
Cris Warner Earthwood Holladay UT
JC Norton Firmco Medical, Inc. Murray UT
Jim Gibbons Edison Capital Leasing Spanish Fork UT
the fiercest struggle with delinquencies, according to ELFA,

“with their current assets representing only 93.2 percent of
their total portfolio at risk.”
Still, in Sandstrom’s view, captives are finding out it pays
Financing you to be creative – attracting customers by not just financing
equipment, but also offering financial help for whatever cus-
can count on. tomers might need in order to make use of the equipment, such
as construction and real estate.
“If you have a hospital with limited flexibility raising cap-
ital, we want to bring in a broader set [of resources],” Sand-
strom said.
For example, if a health system wanted to build a new
medical office building, Siemens could help finance both the
real estate and the equipment leasing. Or if a hospital wanted
to move equipment from a mobile trailer in-house, the captive
SPECIALIZING IN MEDICAL EQUIPMENT FINANCING could help cover construction as well as equipment costs, “to
Low Monthly Payments
finance that as one big project,” Sandstrom said.
Preserve Existing Lines of Credit With this, Sandstrom said captives aren’t in competition
Tax Deduction on Payments with banks, and that one trend that’s growing is for customers
Start-Ups May Qualify
A, B, C, and D Credits OK
to seek out several financial partners.
Options to purchase “The bank has its things it can do, we can come in and
Quick Approval complement that and be a second source of capital,” he said.
You select the Vendor and Equipment
“People are seeing even in well-banked situations, that
If You’ve Been Turned Down for Bank or due to the financial crisis, it’s good to maintain multiple sourc-
Vendor Financing, Give Us a Call. es of capital rather than a single player,” Sandstrom added.
“You can’t put all your eggs in one basket.”
Brendon Nafziger can be reached by e-mail at

801.274.3980 | earthwoodlending.com | cris@earthwoodlending.com
bnafziger@dotmed.com

Anesthesia
gets a wake-up call
A new system is emerging to manage
this critical procedure
By Keith Loria
GE Aisys Carestation

A
nesthesia experts believe that anesthesia today
is nearly 50 times safer than it was back in the
1980s. Various studies support this belief, de-
tailing advancements in monitoring equipment,
anesthesia machines and injection devices. Re-
gardless of the equipment updates, one constant still emerges
to present serious challenges — the inconsistency of the hu-
man reaction to anesthesia.
The fact that people of the same age, weight and health
can have significantly different reactions to anesthesia keeps
research and development teams busy. And while advance-
ments in production of more effective anesthetic drugs, strict-
er standards and guidelines for anesthesia practice and patient
safety; and increased education requirements are all ongoing,
the big topic currently getting the most attention is what’s hap-
pening with the implementation of Anesthesia Information
Management Systems in clinics and hospitals.
“There are a number of areas in anesthesia delivery that are
being highlighted and those would include the ability to moni-
tor and determine levels of anesthesia appropriately. In the U.S.,
a lot of talk has to do with the communication of the data out Merge Healthcare’s
of the system to centralized recordkeeping,” says Bruce Dam- Anesthesia Information
mann, director of global strategic marketing for anesthesia de- Management System
livery and ventilation for Spacelabs Healthcare. “The govern-
ment has put a big emphasis on going electronic and a lot of
hospitals have started down that path, but anesthesia seems to anesthesia record has just recently become widespread within
be the last bastion of paper records.” the practice of anesthesiology.
AIMS will be critical in making the transition and are in- “AIMS systems are valuable for gathering, analyzing
tended to create a robust medical record. They can also help and developing key metrics for improving clinical practices,”
the anesthesia care provider monitor and track a patient’s vi- Goldberg states. “Quality improvement, compliance and ac-
tals during surgery along with other perioperative data as the creditation processes can be automated and performed in real-
bedside components of the system are interfaced directly with time, rather than using slow and costly retrospective audits of
anesthesia machines and patient monitors. paper charts.”
“The problem is, that even as systems become much more A recent study published in the journal Anesthesia and Anal-
electronic and automated, a large percentage of the customer gesia reports an increase in installation of AIMS in U.S. academic
base seem more interested in maintaining the standard way anesthesia departments over the past few years. Industry experts
of delivering anesthesia with numeric controls and the look further estimate the adoption of AIMS in the United States is cur-
and feel they have grown up with and known throughout their rently at about 10 percent and rising, with 15-25 percent growth
careers,” Dammann says. expected over the next few years.
In this case, sticking to tradition can cause problems. “Every hospital should examine anesthesia as much as ev-
Missed revenue opportunities can occur when handwritten ery other department to eliminate bad processes that start with
records are illegible or when records are incomplete and phar- paper records, missing info, bad memories and bad handwrit-
maceutical and supply charges can be missed if a case unex- ing in charts,” says Dr. Carlos Nunez, chief physician execu-
pectedly becomes complex. tive for Picis Inc. “Physicians are embracing this technology
and the integrated technology is ready.”
AIMS for improvement Still, for the majority of hospitals, especially small and
“AIMS can be a stand-alone solution or integrated as a module mid-sized organizations, paper-based charting is the norm for
into a broader perioperative clinical information management anesthesia operations.
system,” says Donald Goldberg, Merge Healthcare’s national According to Goldberg, a convergence of recent changes in
AIMS product manager. “It is an electronic anesthesia medi- the healthcare landscape is driving an increased interest in AIMS
cal record that maintains integrated communication with other and adoption of these solutions.
hospital and provider systems throughout the perioperative An endorsement by the Anesthesia Patient Safety Founda-
period, such as clinical information systems used by nurses, tion lends more weight to a solution for use of anesthesia infor-
clinical data repositories used by hospitals and professional mation management systems as a means of optimizing medica-
fee billing systems in place for the group.” tion management and data collection. Another popular solution
Even though AIMS systems have been available for more can be found in the 2006 development of the Physician Quality
than two decades, the notion of implementing an automated Reporting Initiative by the Centers for Medicare and Medicaid

Services and its ongoing evolution of the program and increas- Other trends
ing traction among providers. Deborah Pienkowski, director of marketing at GE Healthcare,
“CMS has recently enacted changes to reward hospitals reports that in addition to the EMR solutions, there has been a
with increased reimbursement for higher quality and to penal- warmer reception for digital offerings in the anesthesia market.
ize organizations through lower reimbursement for poor qual- “GE has the first fully digital anesthesia delivery solution
ity,” Goldberg says. in the U.S.—although there are others internationally—and we
At Fairfax Hospital in Virginia, more than 50,000 sur- are seeing a high acceptance of that product now,” she says.
geries are performed each year. Without an AIMS system in “President Obama is driving his EMR initiatives and as hos-
place, this creates 50,000 separate paper records. That leads pitals transition to new products, they are definitely interested
to some big questions: How do you mine the paper record to in digital solutions.”
ensure compliances with these practices? How do you mine a The company’s Aisys Carestation has the ventilator, va-
paper record for resource consumption? porizer, and gas mixer all digitally controlled and measured
“Automated systems create a more valid and true rendering and has sophisticated communication protocols enabling digi-
of what’s going on with a patient, and help us record data more tal data communication between all core subsystems.
infallibly and accurately than we do via paper. We can spend “We also have a product called Mobile Viewer the physi-
less time charting and more time focused on the patient,” says cians can use to actually view the display of a patient monitor by
Goldberg. “The key is to deliver an application that’s pleas- phone or at their computer,” Pienkowski says. “By having that
ing to the anesthesiologist and does not distract from care. The available, they can be alerted to alarms and they can have the
interface must be easy to learn and cannot be tedious to use, information at their fingertips, which helps in this digital age.”
otherwise doctors will default to paper.” Healthcare Performance Strategies is a consulting com-
Anesthesiologist Jeffrey S. Plagenhoff has extensive ex- pany delivering anesthesia and OR solutions to hospitals,
perience using an AIMS at Southeastern Alabama Medical aligning incentives and improving bottom-line results in the
Center, where the system has been in place for five years. operating room.
“It offers a tremendous amount and in the big picture, The company’s Dr. Robert Stiefel, an anesthesiologist by
there is no logical defense for why we should fight to stay with training, admits that health care reform has thrown a little bit of
paper and pen,” Plagenhoff says. “We are being tasked to take an element of fear of the unknown into the world of anesthesia.
quality of care and cost of care to new levels. To think that you
can reduce cost and improve quality of care without more data
and better data analysis and easier reporting is a ludicrous po-
sition to defend. You have to have computerized records.”
Plagenhoff says enhanced compliance will lead to a bevy
of benefits, including enhanced efficiency analysis, which in
turn, leads to a reduction of errors.
“The AIMS must take up as little space as possible in the
crowded OR, must ensure transfer of anesthesia-related informa-
tion from pre-op to OR to PACU, and must support connectiv-
ity for increasingly ‘mobile’ anesthesiologists—across multiple
ORs at a single hospital, across hospital systems, in ambulatory
surgery centers, and at physician offices,” Goldberg says.
“When evaluating an AIMS, organizations should focus on
interoperability and ensure an easy method for creating inbound
interfaces to the AIMS, especially with other PCIMS and the
EMR. Use of off-the-shelf hardware will be increasingly impor-
tant because this will offer cost advantages over solutions that
use only proprietary hardware platforms,” he says.
“Unlike most paper-based charting, the AIMS chart is
comprehensive and incorporates nomenclature recognized
by the coding community,” Goldberg says. “Additionally, an
AIMS can provide real-time support to anesthesiologists by
prompting specificity for disease-states and co-morbidities,
significantly impacting accuracy of DRG coding and, subse-
quently, reimbursement.”
It’s no surprise that the most successful AIMS solutions
are those allowing the electronic anesthesia record to operate
seamlessly with the other hospital information systems, with
the interoperability beginning in the operating room and ex-
tends in as far as the outpatient areas.

“The [existing] platform and to have personnel train appropriately be- churned by health reform and other fac-
the mechanisms by which anesthesia fore they’re live in the operating room. tors, there are far more pressing issues
groups contract for services is a little than whether one group of qualified
bit uncertain going forward,” he says. The great debate health care professionals should hold
“When there is uncertainty, it causes ap- In 2001, CMS enacted a rule allowing sway over another group of qualified
prehension.” states to determine which profession- health care professionals simply on the
Stiefel says that recently, talk cen- als could administer anesthesia and the basis of degrees or credentials,” says
ters on how anesthesia systems can be- level of supervision required. This rul- Paul Santoro, president of the American
come more integrated and believes in- ing started a heated debate among those Association of Nurse Anesthetists. “In
centives will play a key role. in the field as to whether certified reg- anesthesia, recent research by highly re-
“The world of anesthesia has istered nurse anesthetists need supervi- spected companies published in leading
evolved in an interesting way in the sion when performing their jobs. journals clearly shows that nurse anes-
last decade as the compensation has When it comes to the actual ad- thetists working collaboratively with
increased dramatically. If you look at ministration of anesthesia and monitor- non-anesthesiologist physicians are
studies from a variety of industries, peo- ing of the patient, there is no difference safe, cost-effective and a big part of the
ple respond to incentives and physicians between a nurse anesthetist and an an- answer to the nation’s ongoing issues
are no different,” he says. “In order to esthesiologist. Both use the same tech- concerning access to health care.”
achieve a given outcome, you need to niques, the same equipment, the same Three recently published studies at-
make sure that all integrated physicians drugs, adhere to the same standards of test to the fact that nurse anesthetists are
are shopping toward the same goals and care, and put the patient’s comfort and determined to be part of the solution to
get rewarded.” safety before all else. today’s overwhelmed health care sys-
Training on these digital solutions Still, there are differences of opin- tem. In April, RAND published a study
has been a hot topic in the industry. As ions over the amount of supervision on the anesthesia workforce that shows
hospitals transition from traditional nu- nurse anesthetists should have as they the AANA is doing its part to ensure that
meric delivery systems to digital solu- do their job. a sufficient supply of qualified anesthesia
tions, it’s critical that they invest the time “As we move into uncharted waters professionals are entering the workforce
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DOTmed Registered Anesthesia Equipment Sales & Service Companies

Troy Lair The Compliance Doctor, LLC Los Angeles CA •
Scott Patneaude
Robert Stiefel
Ace Medical Equipment, Inc.
Healthcare Performance Strategies
Clearwater
Ft. Lauderdale
FL
FL
•
Juan Cortes Sensor Medics Corp. Homestead FL • •
Aaron Frye
Gamal Shanbaky
Doctors Depot, Inc.
Gamma Medical Equipment, Inc.
Jupiter
Miami
FL
FL
•
Rodrigo Henao Medilab International Corp. Miami FL
Ken Kirby
Jose Santana
Aneserv Medical, Inc.
‘R Ventures Medical, Inc.
Dawsonville
Woodstock
GA
GA
• •
Stojan Bozinovski Keeboshop Chicago IL
Chris Barnett Medical Equipment Services, Inc. Fulton IL •
Mike Solot
Justin Jeffries
Kingsbridge Healthcare
DRE, Inc.
Lake Forest
Louisville
IL
KY
• •
Brad Rumph Heartland Medical Louisville KY
Ana Ortega General Biomedical Service, Inc. Kenner LA
Robert Gaw, Jr.
Matt Murphy
Physicians Resource Network
North Star Medical
Fall River
St. Louis
MA
MO
•
Neil Little DMS Topline Medical Fargo ND
Paul Ewald Eagle Biomedical Services Pennsauken NJ •
David Ogren
Sharon Pelusio
OMED of Nevada LLC
Medical Arts Support Corporation
Reno
Brockport
NV
NY
•
Angel Berrios Medic Dental Bronx NY
Marc Todd
Julie Gutterman
Longevity, LLC
Pulse Consultants
Brooklyn
Mason
NY
OH
• •
Ray Phillips Drand Medical, LLC Oklahoma City OK
James Vollbracht Strategic Surgical Solutions, LLC Hales Corners WI •
Name Company – International City Country Certified DM100
David Lapenat ANDA Medical, Inc. Ottawa Canada • •
each year. In the May/June issue of the Journal of Nursing Eco- anesthesiologist gives the blessing, but really it’s the anesthe-
nomics, a study by The Lewin Group showed nurse anesthetists tist who does the case.”
working solo are the most cost-effective anesthesia model. And “By the very nature of their role in patient care and admin-
in the August issue of Health Affairs, the nation’s leading health istering anesthesia, certified registered nurse anesthetists work
policy journal, a study by RTI International confirmed that nurse in collaboration with physicians, such as surgeons, obstetri-
anesthetists provide safe, high-quality anesthesia care. cians and emergency room doctors. In fact, the same is true
The researchers from RTI also found no significant dif- for physician anesthesiologists when administering anesthesia
ferences when they compared patient outcomes across three for patients receiving surgical, obstetrical or trauma care,” says
scenarios, including nurse anesthetists working without su- Santoro. “In either case, nurse anesthetists or anesthesiologists
pervision; anesthesiologists working alone; or both providers are the anesthesia experts and the surgeons are the experts in
working together. their specialty. Nurse anesthetists don’t need a physician ‘by
Dr. Navin Singh is a board-certified plastic surgeon in pri- their side’ when administering anesthesia any more than an
vate practice and an assistant professor of plastic surgery in the anesthesiologist does, because the physician does not tell the
Johns Hopkins University School of Medicine. anesthesia professional what drugs to administer, how to ad-
“In the state of Maryland, CRNA nurses can practice inde- minister them or how to monitor the patient.”
pendently and we have used CRNA nurse anesthetists at Hop- The singular difference, however, is that nurse anesthetists
kins for 15 years without any issues,” he says. “For more com- have a nursing background and anesthesiologists have a medi-
plicated patients we perform those surgeries in the hospital with cal background.
MD anesthesiologists.” “Obviously both have tremendous value, but as Gallup polls
Dr. Mark Perloe, clinical assistant professor in obstetrics have shown time and again, nurses are one of the most trusted pro-
and gynecology at the Medical College of Georgia, has a nurse fessions,” Santoro says. “This is because of their uniquely human-
anesthetist in his office and understands their importance. istic approach to patient care, a quality that the nation’s 42,000
“We have an anesthetist and an anesthesiologist who is the nurse anesthetists bring to the table 32 million times each year.”
supervising physician and when [the anesthetist] is working,
we have standard protocol where they are immediately super-
vising her,” he says. “If you are doing general anesthesia, the Keith Loria can be reached by e-mail at kloria@dotmed.com

A
s a favor to a friend, John Baran, a retired Pricewater-
houseCoopers partner, sat in on an Auburn Memorial
Hospital board meeting to take a look at its financial situ-
ation. What he saw wasn’t pretty.
“I saw the place was underwater,” Baran recalls. “I
went to the first meeting and said to my friend, ‘Jeez, this
place is bankrupt, it just hasn’t filed yet.’”
Baran accepted the position of CFO for the Auburn, N.Y.-based hospital
in January 2007 after the interim CFO departed. Having been born at Auburn
Memorial, Baran has a special place in his heart for the hospital and wanted to
bring it to life again. And even though Baran knew the only way out was to seek
Chapter 11 protection, or file for Chapter 11 bankruptcy, he was confident that
Cayuga County’s only hospital would not close.
“We knew going in, that our strongest asset was the fact that we were
the only hospital in town,” says Baran. “If there were two hospitals, we never
would have survived.”
The hospital’s largest liability was about $20 million owed to pension
plans, which was considered the biggest burden, and about $4 million owed to
trade vendors.
“When you’re starting to run out of cash, you fill up your Visa card and max
that out, which is what the hospital did, select vendors and push them out — the
ones that squeal the loudest get paid first,” explains Baran. “With the pension plans,
Battle
no one notices [something is wrong] until the year is over.”
In April 2007, the hospital filed for bankruptcy, ironically the first step in
pulling itself up by its bootstraps.
of the
How did we get here?
Of course, the main reason a hospital files for bankruptcy protection is because
it ran out of money. But why do hospitals face such financial distress? The driv-
bills
ing factor behind Auburn Memorial’s struggles is not uncommon: physicians
left the facility for a number of reasons and were not replaced. Without physi-
cians, a hospital can’t treat patients, and cash flow slows or even ceases.
For the hospital, there was a steady decline in admission in the late 1990s
and early 2000s as physicians retired and were not replaced. In some cases,
physicians were frustrated with management and left, Baran says.
“At the end of the day, the hospital’s customer is the physician,” says Ba-
Tales of ran. “Physicians admit patients, but you have to have physicians there to treat
[patients] in the first place. If you start to lose customers, all of a sudden, ex-
success penses exceed revenue. It’s a compounding problem.”
In 2006, new management took over the floundering hospital, and ultimately,
and closure the decision was made to file and seek help from the government agency, Pen-
sion Benefit Guaranty Corporation (PBGC). The agency is designed to protect
employees’ and retirees’ pension programs. In the process of moving pensions to
By Heather Mayer

PBGC, only three out of 1,500 Auburn sicians. This market, including elective Charity Care.
Memorial’s employees or retirees took a surgeries and baby deliveries, has now “All three of those major government
pension cut. The three were highly com- gone back to the facility, says Baran. programs pay hospitals less than it costs to
pensated physicians, says Baran. Auburn Memorial is out of the woods take care of patients,” she says, explaining
Those who are familiar with hos- except for $1 million it owes to PBGC, that Medicare pays New Jersey hospitals
pital bankruptcy realize that the key to which it expects to pay off next year. 89 cents on the dollar per patient; Med-
keeping the money flowing is physi- “Four years later and we’re still icaid pays just 68 cents on the dollar per
cians. In fact, one of the warning signs in business, and business is better than patient; and Charity Care ranges from 15
that a hospital is in financial distress is ever,” says Baran. cents to 96 cents per patient.
having a poor relationship with its phy- While the situation Baran encoun- “The big issue is what we would
sicians, says Richard Gundling, vice tered was rare for the area, it’s not un- call the patient mix,” she says.
president of Healthcare Financial Man- common for a hospital to emerge from In other words, hospitals taking
agement Association (HFMA). bankruptcy. more government-covered patients earn
Hospitals that file for Chapter 11 less than hospitals taking more privately
The light at the end of the protection give themselves a chance insured patients.
tunnel to reemerge, explains Adam Rogoff, a
Baran realizes that his hospital’s situation partner in the corporate restructuring New York hit hard
was not typical, especially for upstate group for the Kramer Levin firm in New Neighboring New York also felt the pain
New York, which has a bad reputation York. But those that file for Chapter 7 as two major New York City-based hospi-
for bankruptcies and closures, he says. protection pass the company over to tals succumbed to financial stress earlier
this year. St. Vincent’s Hospital in Man-
hatten, closed its doors in April after filing
Through online auctions, McLendon was for bankruptcy, carrying a debt of $700
able to reach a wider range of potential million, and Harlem’s North General
Hospital filed for bankruptcy and subse-
buyers, including international buyers. quently closed its doors in June, $200 mil-
lion in debt.
“Bankruptcy usually means to [up- individual management and liquidate, Efforts to save St. Vincent’s from
state New York residents], the company closing its doors. closure fell short. The facility was split
is closing,” says Baran. “The fear in ev- up, with Beth Israel Medical Center tak-
eryone’s mind is, ‘Bankruptcy, I’m go- Facing financial stress ing on the hospital’s cancer center; Le-
ing to lose my job.’ That’s the pervasive In New Jersey, the recession certain- nox Hill running the urgent care center;
thought.” ly hasn’t helped already-floundering and Mount Sinai Medical Center acquir-
Baran’s most important message hospitals, says Kerry McKean-Kelly, ing the HIV/AIDS center.
to employees, he says, was that no one spokeswoman for the New Jersey Hos- “In the crucial seconds of a health
would close the county’s only hospital. pital Association. emergency getting to a hospital in time
The closest hospital would be 30 miles In fact, six hospitals have filed can literally save a life,” said City
away in Syracuse. for bankruptcy protection since 2007, Council Speaker Christine Quinn in a
“I remember saying this [when I which is an unprecedented number, statement last February. “Redirecting
met with employees]: ‘Yes, we are filing McKean-Kelly says. patients to a hospital miles away is sim-
for Chapter 11, but we are not closing. “That’s definitely considered a rash ply not an appropriate response, and we
No, you will not lose pension benefits. number of filings,” she says. won’t allow our community, especially
You will not lose your job.’” But it wasn’t solely the recession that our senior community, to be left without
In July 2008 the hospital reached pushed these hospitals over the edge. an emergency care medical center right
an agreement with creditors, and the “In reality, the financial pressures here, on the west side of Manhattan.”
court officially discharged the hospital on New Jersey hospitals preceded the In April, days before St. Vincent’s
by November of that year. Generally, recession,” McKean-Kelly says. “Re- closed its doors, Quinn addressed the
it takes a hospital 12 to 18 months to imbursement pressures on the state con- situation again.
emerge from bankruptcy, says Baran. tributed not only to bankruptcy filings “Only a full-service hospital can
While the unsecured vendors — but also hospital closings.” fully replace St. Vincent’s Catholic
about 500 — lost money, it was in their Of the six hospitals that filed, two Medical Center,” she said. “However,
best interest to continue doing business emerged: St. Mary’s Hospital and Bay- no hospital has come forward with a
with the now-thriving health care facil- onne Medical Center. proposal to buy St. Vincent’s and [its]
ity, says Baran. McKean-Kelly points out hospi- massive debt.”
The hospital lost some of its market tals can run into financial problems if Over the summer, St. Vincent’s was
to the hospital in Syracuse, not due to they accept a lot of patients covered by granted court approval to sell its cancer
the bankruptcy, but to the lack of phy- Medicare, Medicaid or New Jersey’s center, hospice and its long-term home

health business and certified home tal closes its doors, it will choose to sell ternational buyers.
health agency. off assets to pay back its debt. When hos- “I had assets to sell that had a
While the West Village was still reel- pitals are racing against the clock, auc- cost basis of $4.5 million,” he recalls.
ing from losing its only neighborhood tions are a common option to sell assets “That’s a whole lot of stuff. It took a
hospital, the Harlem community was dev- and make back a nice chunk of change. whole lot of transactions. Without open-
astated when its North General Hospital DOTmed.com, the parent company ing to a broader market [through auc-
shut down and its clinics were handed of DOTmed Business News, offers on- tions], there’s no way I would have sold
over to the Institute for Family Health. line auction services. Rick McDaniel, all that stuff.”
“We are extremely saddened and auction manager for the company, says
disappointed with the … closure of even if hospitals need to liquidate their Economic stress
North General Hospital,” the hospital’s assets immediately, auctions are a good While the economy is starting to show
union SEIU 1199 said in a statement. way to get more money. signs of recovery, hospitals “continue
“On the heels of St. Vincent’s Hospital, “It’s a factor of time and exposure,” to be adversely impacted by the linger-
the closure of yet another acute care fa- he says. “Based on that, we can get the ing effects of the economic recession,”
cility two months later is the regrettable most value [for the assets] because we’re based on a hospital survey published
result of continued and repeated cuts to not liquidators. We auction the equip- earlier this year.
health care funding.” ment in partnership with the hospital, The survey revealed that patients
As a result of the North General clo- instead of buying low to sell high.” delay or forgo care — 70 percent of hos-
sure, a battle between two unions has en- While it’s hard to guess how much pitals reported fewer patient visits and
sued. SEIU 1199 employees have been a certain piece of equipment will sell for elective procedures. Making the situa-
ousted from their positions unless they in an auction — the market is always tion worse, almost nine in 10 hospitals
saddled up with IFH’s union, OPEIU Lo- changing — an auction is a hospital’s reported an increase in care for which
cal 153, sending former North General best chance at making a dent in debt the hospital received no payment at all.
employees to the picket lines. owed, says McDaniel. In order for hospitals to stay afloat,
“The patients identify with us because Hospitals have two types of auctions they have made significant changes, in-
we’re the people they have seen through- to choose from when selling their assets: cluding cutting administrative costs, re-
out the years,” says former employee live (onsite auctions) or online auctions. ducing staff and curtailing services. The
Mullin Davis, as she pickets against the Hospitals may turn to a live auc- survey found that 89 percent of hospi-
new management. “The impact of this tion instead of an online auction if they tals reported they had not added staff
hospital closing is, ‘Where am I going to are short on time. In some cases, a live or increased staff hours. Ninety-eight
get care? What’s there for me?’” auction can liquidate assets in anywhere percent reported not restoring services
The American Hospital Associa- from two to eight days, while an online or programs previously cut due to the
tion recognizes the negative effects a auction may last several weeks. economic downturn.
bankrupt and closing hospital have on Centurion Service Group, a com- In 2009, Bankruptcy Creditors’ Ser-
a community. pany that manages both online and live vice, Inc. recorded seven hospital bank-
“Hospitals are the cornerstone of auctions, recognizes that live auctions ruptcy filings, including three New York
any community, and when a hospital create immediacy. hospitals. The company, which publishes
is faced with financial difficulties, it “A frenzy usually feeds to higher the Troubled Company Reporter, a daily
impacts everyone,” said Matthew Fen- prices, and you can look at the competi- newsletter that tracks large companies
wick, AHA’s associate director of me- tion in the eye, and that’s where the ego and their credit quality, reported that nine
dia relations, in an e-mail to DOTmed steps in — you’re not going to let this hospitals have filed for bankruptcy so far
News. “Given the recent economic person win, and the price goes up from in 2010. The report noted that St. Vincent
downturn, many hospitals have faced there,” says Erik Tivin, Centurion’s CEO. Catholic Medical Centers has liabilities
tough financial decisions about how to Online auctions, says McDaniel, worth more than $1 billion.
keep their doors open to the community. also create bidding frenzies. Another And even while cutting costs, there
At the worst, those in need can be de- factor unique to online auctions is the has been a jump in hospital bankruptcy
nied vital services, and at a minimum, exposure products receive. Online, the filings, says Rogoff, and those filings
face a disruption to their case.” audience is limitless. are expected to increase.
The Greater New York Hospital Lee McLendon, formerly the CEO “There is a greater demand [for]
Association declined to comment for of Bossier Specialty Hospital, is now in health care services,” he says. “But
this article. charge of the liquidation of the facility there is less revenue coming in.”
after the decision was made in Septem- “At the end of the day, a hospital is
Making back the money ber 2009 to liquidate assets rather than still a business,” Rogoff says.
Whether a hospital merely files for bank-
ruptcy or eventually closes its doors,
declare bankruptcy.
Through a DOTmed auction,
there is the issue of paying back credi- McLendon was able to reach a wider Heather Mayer can be reached by
tors, lenders and vendors. But if a hospi- range of potential buyers, including in- e-mail at hmayer@dotmed.com

Law
& Order
By Astrid Fiano, Esq.
State: Fake nursing school closes, agrees cent on medical expenses. After paying the enrollment fees,
to pay restitution to students consumers then allegedly found that providers did not accept
California Attorney General Edmund G. Brown Jr. has an- the plan and that the “discounted” price was in some cases
nounced that the operator of a nursing school the AG called higher than the price without the medical discount plan.
a “sham” has settled with the state for a half-million dollars. “With so many Americans struggling to deal with the costs
Brown said the school allegedly pretended to offer an accredited of health care, these medical discount benefit plans sound ap-
nursing program, and deceived the graduates of the school into pealing because they masquerade as health insurance,” said
believing they were qualified to become registered nurses. David Vladeck, Director of the FTC’s Bureau of Consumer
Brown said at least 300 students paid $20,000 each for en- Protection, in a press release. “But they are not insurance. They
rollment and classes at RN Learning Center, which claimed to don’t offer the benefits of health insurance, and victims don’t
offer a fast-track program for earning a B.S. degree in nursing in know they’ve been ripped off until after they’ve tried to use the
less than two years. “By creating the illusion it was training fu- service and paid their bill.” The complaints are not a finding or
ture registered nurses,” Brown said in a press release, “the school ruling that the defendants have actually violated the law.
destroyed the aspirations of hundreds of students who also lost • Online: dotmed.com/dm14278
thousands of dollars in wasted tuition. The school will shut its
doors today and pay back its former students as fully as it can.” State: California legislature passes
Brown’s office negotiated the settlement on behalf of the adverse event legislation
Board of Registered Nursing. The board is currently contact- The California Assembly has passed AB 542, which requires
ing state medical facilities to warn about unaccredited schools. the state Department of Health Care Services to create a work-
RN Learning Centers’ owner and operator, Junelou Chalico ing group of experts to make recommendations regarding
Enterina, agreed to close the business and pay victims restitu- prevention of hospital-acquired conditions. Provisions of the
tion of $500,000. Under the agreement, Enterina is prohibited Affordable Care Act will prohibit federal Medicaid from reim-
from ever opening a nursing school in California. The settle- bursing states for such medical adverse events.
ment concludes a board investigation that began in early 2007 The technical working group would evaluate options for
which found RN Learning Center had never applied for ac- implementing nonpayment policies and practices for hospi-
creditation; at that time, the board ordered the school to close. tal acquired conditions for the state Medi-Cal program, and
• Online: dotmed.com/dm14277 provide the best options to various state officials. The bill
would require the medical director and the director of nursing
Federal: FTC and state officials target of a hospital to annually report adverse events and hospital-
medical discount plans acquired conditions to its governing board, including a com-
The Federal Trade Commission is teaming up with state at- parison to comparable institutions if the data is available. The
torneys general and insurance commissioners to target outfits working group would include representatives from various ar-
attempting to trick uninsured, unemployed and uninsurable eas including consumer advocates, California physicians, hos-
consumers into buying discount plansThe FTC announced that pital representatives, and representatives of health insurers.
the agency and law officials in 24 states have filed a total of 54 According to the legislative findings of the bill, patients
lawsuits and regulatory actions to stop the practices. and purchasers of health care services should not be billed or
The FTC charged three companies with deceptively mar- expected to pay for reasonably preventable hospital-acquired
keting medical discount plans. One case involves Consumer conditions. In addition, patients who have been harmed by a
Health Benefits Association, which the FTC claims had tele- hospital-acquired condition must receive any medically neces-
marketers giving consumers false claims, including: that they sary follow-up care to treat the complications due to the hospi-
worked closely with major medical insurers; that the discount tal-acquired condition, and that medically necessary follow-up
plan was widely accepted by health care practitioners and fa- care and services should be reimbursed.
cilities; and that the plan would save consumers up to 85 per- • Online: dotmed.com/dm14280

Each month DOTmed takes a look back at the medical equipment that cleared
the way for what patients encounter in the doctor offices and operating rooms
of today. Some equipment may be recognizable, while other inventions featured
here have since become obsolete or have had their usefulness discredited.
Category: Anesthesia
Estimated Date: 1900
Name: Anesthesia set
Manufacturer: Down Bros
Description: 9”x 5”x 8.5” leatherette case. Contains 2 bottles,one 7” hand marked in drams, and fitted into case the
second in a canvas case very similar but only 5”. The mask is made of a celluloid like material, 6”x 3.5’x 3.5” with ivory
like fittings. Each piece has nickel plated metal attachments, bottles have hooks for hanging. Also in the case is a pump
and rubber tubing.
Horace Wells was instrumental in advocating the use of anesthesia. However, the procedure he championed ultimately
contributed to his untimely death nearly two centuries ago. Find out what happened to him by reading the December
2008 edition of This Month in Medical History. Just type DM7623 into any search window on www.dotmed.com.
If you have a medical instrument you’d like to donate to the Museum of Historical Medical Artifacts, or you’d like to find
out more about the organization, please send an e-mail to sruck@dotmed.com and your message will be forwarded.
Museum of Historical Medical Artifacts by M. DONALD BLAUFOX, M.D., PH.D. is licensed under a Creative Commons Attribution-Noncommercial-
No Derivative Works 3.0 United States License.

This Month
in Medical History
Van Helsing’s nemesis wasn’t so impressive
P
arasitologist Patrick Manson was born in Scotland without overpopulating the infected system and killing their
on Oct. 3, 1844, the second of an eventual nine chil- host and themselves. Based on the deduction, he searched for
dren. His initial foray into a profession wasn’t a hint a solution that would pass embryos from one host to another.
at what he would later become or achieve. Manson His solution was found in a bloodsucker rightfully more
was apprenticed to an ironmaster’s firm in Aberdeen, feared than the literary creation of Bram Stoker . . . the mos-
Scotland at the age of 15. But poor health forced him to abandon quito.
that pursuit and he instead focused his energies on medicine. He Manson had a ready volunteer in his servant Huito. Hutio
proved to be adept and passed his final exams by 20, even though had filariasis and by studying mosquitoes gorged on his blood,
he was required to be 21 to receive his medical degree. Manson was able to confirm his suspicions.
From this promising start in the field, he only increased “I shall not easily forget the first mosquito I dissected. I
his stature with a discovery that has led to millions of lives tore off its abdomen and succeeded in expressing the blood the
saved over the past century. stomach contained,” Manson stated in his journals. “Placing
Shortly after receiving his degree, he this under the microscope, I was gratified
departed the British Isles to spend more to find that, so far from killing the filaria,
than two decades in China, studying nu- the digestive juices of the mosquito seemed
merous diseases. to have stimulated it to fresh activity.”
Manson began his overseas exploits For being so close to the target, Man-
in Taiwan and after more than a decade, son ultimately fell just short with part of
found himself pursuing medicine among his deduction. He believed the mosqui-
the populace of Xiamen, China. The Scot toes transferred the disease from victim to
provided what medical services he could victim by laying eggs and contaminating
to the wary citizens, slowly earning their drinking water. It would be a few years
trust. Eventually, he established enough before Thomas Bancroft would posit the
report that he was able to perform a badly needed surgery on a theory that the infection was transmitted directly by the insects
young man burdened with an elephantoid tumor. The success- when they fed on blood.
ful surgery encouraged many more locals to seek his expert at- Still, Manson had made a major impact and had many
tention. These medical administrations ultimately amounted, other discoveries to his credit. He would go on to discover the
according to Manson’s own records, to more than one ton of lung fluke and a number of skin diseases, and his theories and
diseased tissue being removed from patients. research would contribute significantly to the discovery of the
By 1875, determined to learn as much as possible about mosquito’s role in malaria.
elephantiasis, Manson returned to England. He was likely dis- He published the highly regarded Tropical Diseases: A
mayed when he learned that there were no answers to be found Manual of the Diseases of Warm Climates, founded the world’s
amongst the English medical community. Still, he persevered first school of tropical medicine in England and helped found
in his efforts and came across a promising lead in an unex- the Royal Society of Tropical Medicine in 1907, serving as
pected locale — the British Museum. It was there he came its first president. He received a knighthood in 1903 and con-
across the recounting of findings by Timothy Lewis of the tinued his travels and lecturing for years after his retirement,
Army Medical Service. While practicing in Calcutta, India, giving his last address at the School of Tropical Medicine in
Lewis discovered the presence of a microscopic worm living London, just two weeks before his death at the age of 77. It
in the blood and urine of patients with chyluria. would be no exaggeration to credit Manson’s research with
Manson calculated the amount of worm embryos in an savings thousands of lives since his momentous discoveries
infected person’s system at a given time and concluded that and to rightfully name him the Father of Tropical Medicine.
the embryos could not all mature into worms in the same host • Online: dotmed.com/dm14290

old into gold
DOTmed Premium Auction Success Stories
Old into Gold is provided by the DOTmed Auction Team. These stories represent
just a few of the successful transactions DOTmed users experience every month.
Timing’s everything The sweet smell of success . . . again

A hospital group in the Midwest familiar with DOTmed auctions, Jackson Memorial has been using DOTmed’s full-service on-
having used the services many times in the past, had a timeline auction platform since August of 2008.
sensitive project centering on some capital assets. Since then, its auctions have generated over $192,000 in
It had just three weeks to remove two radiology rooms in sales of idle equipment that likely would have sold for one-third
two different clinics. Both rooms had to be removed in one day less or in some cases, even outright scrapped.
to avoid interruption to patient flow. The most recent success story involved Olympus BF-P30
The rooms were Continental rooms, manufactured in 1996. and BF-P40 bronchoscopes.
One of the rooms had a 2002 tube. The hospital group was field- In June, online auction specialist Mark Colavecchio visited
ing offers in the $2,000-$2,500 price range. Potential buyers, with Jackson Memorial to inventory and take photos of more
aware of the time constraint the group faced, assumed it would items to add to its Virtual Auction House.
take a lower offer to hit the deadline. The bronchoscopes were part of the inventory photo-
Considering the age of the rooms and with the deadline loom- graphed, but they were placed in separate auctions.
ing, the group was ready to take the highest offer just to recoup Shortly after the bronchoscopes were listed, an interested
what it could and get everything prepared for the installation of the party e-mailed inquiring about the Olympus BF-P30. While
new rooms awaiting construction. In the past, with such a brief speaking with him, Colavecchio discovered the potential buyer
timeline, the group would let vendors come in and deinstall the was actually looking for more scopes. Colavecchio e-mailed
rooms at no cost, but make little or no money on the equipment. with links to the other scope auctions from Jackson Memorial.
In this case, the group contacted DOTmed and the auction The buyer was interested in both scopes, so Colavecchio spoke
team immediately began to contact potential buyers around with his contact at Jackson Memorial and both scopes were
the globe. Each room sold for $4,000 and the winning bidders moved into a combined auction, ultimately selling for $5,700.
worked with the group to get the rooms deinstalled within the Jackson Memorial has enjoyed the success and ease of
set time. Deinstallation itself took one day, keeping the patient DOTmed’s full-service auctions and looks forward to continued
flow moving. success.
• Online: dotmed.com/dm14285 • Online: dotmed.com/dm14286
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EQUIPMENT FOR SALE
Autoclave Tabletop: CT Scanner: ECG unit:
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For more information on any of these
Lily Chen, Tianjin Xuhua Medical Equipment Quality Repossessed Medical/Graphic listings, visit www.dotmed.com and
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888920 - PHILIPS MP 50 Intellevue Bedside Dental General:
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To run a classified in
Blood Gas Analyzer: DOTmed Business News
888937 - RADIOMETER ABL 555 Blood Gas
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Ext “Ads” (237)
Muthumalai, M.P.Diagnostics Michael Mcmann, I/O Computer Service Inc.

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Hematology Analyzer: Laser - IPL: Nuclear Gamma Camera:
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Mark Levine, Labworld

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EQUIPMENT FOR SALE
Pump IV Infusion: Ultrasound Transducer Ultrasound:
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Size: 10” X 7. Izabella Shniperson, Lises
Transducer Ultrasound
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MRI Equipment
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m
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nA
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Capacity: 600 lb / 272 kg Resolution: 0. 889404 - GE Dataline Vet. Ultrasound
Steven Cohen, Medical Equipment Exchange Ultrasound $1,350
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Endomat for Hysteroscopy. M. Ashfaq, PENTAX EC-3801L Video Colonoscope Flex-
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Pan Am Imaging Spirometer:
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option). Kenneth Sanders, Mediscan Removable Casters Wheelchair $170
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Orthopedic - General: Sterilizer:
X-Ray Service Tools:
889442 - ZIMMER Cast Saw+ Vacuum 889030 - MIDMARK M7 SPEED CLAVE
Orthopedic - General $300 Sterilizer $1,195 889257 - CPI AEC Set-up Kit X-Ray Service
Zimmer Cast Saw Model 8909-01 serial 5629 REFURBISHED M7 AUTOCLAVE. Dave Hill, Tools $650
+ Zimmer Cast Vacuum. Paul Millthorpe, Portland Surgical Sales LLC Complete AEC set-up kit including carrying
Millmedlabequip case. Art Gaines, ARTEC IMAGING
Stretcher:
Oxygen Monitor: PARTS FOR SALE
889524 - UNKNOWN BL-600 XLE Stretcher
889418 - MSA MiniOX 3000 Oxygen Monitor $7,500
$399 This is a mobile treatment table, equipped Light Source:
MSA MiniOX 3000 Oxygen Monitor. Bruce with four swivel rollers and locking mecha-
Watkins, Med Flight Auctions nism. Phyllis Barber, MSI Equipment 815493 - GE Light Source Part #CXE300/BF
300w ceramic xenon light source. Lu-
PACS/RIS: Sutures: Ann Buckholz, Specialty Bulb Co Inc,
631-589-3393
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2 Tympanometer $1,500 Specialty Bulb Co Inc, 631-589-3393
Medical Disc Publisher, enables medical
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professionals to create a complete and por-
be open or missing. Lori Weidow, KMA
table medical record. Tony Evans, Essential
Remarketing
Enterprise Solutions, Inc, 7279383374

EMPLOYMENT OPPORTUNITIES
888149 – CT Service Engineer Position 872616 – Anesthesiology Position

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ADVERTISER PAGE ADVERTISER PAGE ADVERTISER PAGE
Absolute Imaging Solutions, LLC 43 Engineering & Network Systems, Inc. 58 Nationwide Imaging Services, Inc. 15
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ADAM Imaging Parts 42 First Call Parts 48 Oncology Services International 29
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AFC, Industries Inc. 26 GECO 49 Owen Kane Holdings, Inc. 73
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Altima Diagnostic Imaging Solutions 12 Hitachi Medical Systems 9 Oxford Instruments 53
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Amber Diagnostics 50 Image Technology Consulting, LLC Inside Back Cover Pulse Consultants 63
www.amberusa.com www.imagetechnology.net www.pulseconsultants.com
Ampronix Imaging Technology 2 Integrity Medical Systems, Inc. 35, 45 Radiology Oncology Systems 27
www.ampronix.com www.integritymed.com www.oncologysystems.com
ANDA Medical 11 International Medical Equipment & Service 41 ReMedPar 47
www.andamedical.com www.imesimaging.com www.remedpar.com
Atlantis Worldwide, LLC 4 Johnson Thermal Systems 25 Technical Prospects, LLC 39
www.atlantisworldwide.com www.johnsonthermal.com www.technicalprospects.com
Bay Shore Medical, LLC 36 Life Systems, Inc. 31 Tenacore Holdings, Inc. 64
www.bayshore-medical.com www.lifesystemsinc.com www.tenacore.com
Block Imaging Parts & Service, Inc. 46 Medcorp, LLC 16 Therapy Remarketing Group 28
http://parts.blockimaging.com www.medcorpllc.com www.therapyrg.com
C&G Technologies 22, 40 MedEquip Biomedical 13 TOG 44
www.cgtscan.com www.medequipbiomedical.com www.technicaloptions.com
Complete Medical Services 59 Medical Hi-Tech, Inc. 10 TransAmerican Medical Imaging 37
www.completemedicalservices.com www.medicalhitech.com www.transamericanmedical.com
DMS Health Technologies 51 Medical Imaging Resources, Inc. 14 Unfors Instruments, Inc. 8
www.toplinemedical.com www.medimagingsales.com www.unfors.com
Drand Medical 1 Mediquip Parts Plus, Inc. 52 Varian Medical Systems, Inc. Back Cover
www.drandmedical.com www.mqpp.com www.varian.com/interay
Dunlee, Inc. Inside Front Cover MEDRAD, Inc. 7 Viable Med Services, Inc. 33
www.dunlee.com www.medrad.com/mvs www.viablemed.net
Earthwood Commercial Lending 60 Metropolis International 30 SPECIAL Certified
www.earthwoodlending.com www.metropolismedical.com Parts Vendor AD Section 53-56

blue book price guide
Recent equipment and parts auctions on DOTmed with actual sale prices.
IMAGING have been upgraded. The unit is located on the PHYSICAL THERAPY
PLANAR Computer Monitor PACS Worksta- 1st floor and a loading dock is available. Route ZIMMER Muscle Stimulator Sona 5 Ultrasonic
tion This auction is for a PACS workstation. It to dock is through hallways. Cosmetic rating Diathermy + Galva 5-M Muscle Stimulation
includes: three Planar Dome E3 Monitors – two level is 8 Model of computer is AS44085 Hot Device This auction is for a Sona 5 Ultrasonic
portrait one landscape. One ACER monitor lab is not included. Auction #16337 – sold for a Diathermy + Galva 5-M Muscle Stimulation De-
model AL1914 HP Xw6300 Workstation HP hospital in Texas $1,000. vice. Manufactured by Zimmer MedizinSysteme
Compaq dx2000 MT and two keyboards. Lanier This unit is brand new in a box. * Sona 5 Micro-
VoiceWrite Telephone w/ Dictaphone. Auction PHILIPS X-Ray Tube MRC 600 This auction is Processor controlled ultrasonic diathermy device
#15110 – sold for an imaging center in Texas, for a MRC 600 Philips X-ray Tube. Compatible two Treatment Heads (0.8 MHz and 3MHz) User
$15,000. with Brilliance 16, 40, 64 Power and Gemini 16 Manual * Galva 5-M Muscle Stimulation device 1
Power. This unit was purchased from live on-site Main Cable 1 Patient Cable Hygienic Single-
INVIVO MRI Accessories 3150M, 3155A This auction. Current owner was told this Tube was in Use Electrodes, small Hygienic Single-Use
auction is for an INVIVO 3150m Physiologic Gas good working condition at time of removal. Stor- Electrodes, large 2 Pair Electrode Cables 1 User
Monitoring System with INVIVO 3155A Monitor. age Box Dimensions: 27W x 26D x 35H Weight Manual * System Cart Features/Specifications:
System is complete with all accessories and in 282 pounds. Auction #16752 – sold for a dealer * Digital, quartz-controlled Time Display * Cou-
perfect working condition. Auction #15589 – sold in Penn. $8,000. pling Display * Bar Graph. Auction #16742 – sold
for a hospital in Ariz. $5,000. for an ISO in Texas, $1,200.
ATL Shared Service 3000 This auction is for a
PHILIPS Cath Lab Integris H5000C This auction 1998 ATL 3000 Shared Services Ultrasound. PUMPS
is for two identical Philips Integris H5000C’s This unit can perform: *OBS *Cardiac and Gen-
eral Software *Color Doppler This Ultrasound BAXTER Pump IV Infusion Colleague 3 CX This
with MRC X-Ray tube and Clinical View station auction is for ONE (1) Baxter Colleague CX Infu-
Software package. Both were installed in 2000. comes with 6 Transducers: *Curved array C
4-2 *Curved array C9-5 ICT *Phased array sion Pump There are nine (9) available. Auction
This low use integrated imaging system for the #16257 – sold for a hospital in NY, $17,775.
heart comes from a prestigious hospital in Florida. P3-2 *Linear Array L7-4 *Linear Array L10-5
This preferred single plane cardio system comes Broadband *CW Doppler D10CW 10.0 MHZ
All transducers come with original packaging. SURGICAL
with a ceiling suspended C-arm stand and digital
imaging segment. System includes: SyncroNet This unit has been used for 5 years and is in STRYKER O/R Light Visum Surgical Light This
System Architecture SyncraTouch, SycraPulse, excellent condition. Accessories: VHS recorder. auction is for a pair of Stryker Visum Surgical
SyncraView. G-arm stand with motorized park Manuals are available. Auction #11914 – sold for Lights 682 000 106. Please note that one set
AD-5 table OMCP Generator 9” II/XTV MRC an ISO in Quebec, $6,900. has two lights. Your bid amount is for one set. If
tube Roadmap 1 Cinical viewstand software you are bidding on more than one set, you will
package Standard line rate video output Pan PICKER Nuclear Gamma Camera AXIS This have to multiply the amount you bid by the num-
Handle PDU Cables Table mounted radiation auction is for a PICKER Axis Nuclear Gamma ber of sets you wish to bid on. Auction #16758
shield Cabinet boxes The Integris H5000C is Camera. This unit was manufactured brand new: – sold for a hospital in Texas, $1,000.
based on SyncraNet System Architecture with September 1999 -Double-headed camera -This
distributed intelligence in each of four discrete system performs both cardiac and whole body OPTHAMALOGY
segments, all of which are linked by a fiber optic scans -This camera is in daily clinical use. This
BAUSCH & LOMB Topographer Orbscan II This
LAN. Geometry Segment - motorized, ceiling unit is comes with a Digital detector and collima-
auction is for an Orbscan II Topographer that is
suspended G-arm - agioDIAGNOST-5, floor tor Model of computer: Odyssey FX The camera
in very good condition. It was purchased new in
mounted patient support - SyncraTouch table side is under full manufacture service contract.
1999. This optical mapping or corneal topogra-
Geometry and imaging Module - Automatic Col- Please inquire for service records. This unit is
phy system mapping system is a diagnostic tool
limator - Automated Wedge Filter - Accessories being sold because facility has recently updated
that shows the overall architecture of the cornea
including pan handle Includes an MRC-GS X-ray to new technology. Auction #16325 – sold for a
including surface power, thickness, front and
tube Fluoroscopy: - three programmable modes hospital in Iowa, $5,000.
back shape. Auction #10651 – sold for a group
of digitally processed fluoro - twelve programs in Calif., $12,000.
for cine acquisition MRC-GS 05/08 X-RAY TUBE MONITORS
- SpectraBeam pre-filter - SyncraPulse Pulsed OTHER
progressive fluoro - 2.4 MHU anode heat storage COROMETRICS Fetal Monitor 170 This auction CINCINNATI Hypothermia Unit Hemotherm
capacity - 900 KHU/min heat dissipation Storage is for a Corometrics 170 Series Fetal Monitor. 400MR This auction is for a Cincinnati Hemo-
capacity of 36,000 images. Auction #15885 – sold Auction #9598 – sold for a hospital in Tenn. therm 400MR. Serial Number: 013-11770M.
for a hospital in Fla. $40,000. $1,050. Auction #15391 – sold for a hospital in Calif.,
$2,000.
TOSHIBA Nuclear Gamma Camera GCA 7200A LABORATORY
Dual Head This auction is for a Toshiba GCA
7200A Double-headed Nuclear Gamma Camera.
ABX Hematology Analyzer Micros 60 This
DOM 1996 Unit was used both for cardiac and
full body. Model# GCA 7200A SNBB6622123
Gamma Camera Stand M# NGSD-720B Col-
auction is for an ABX Micros 60 hematology
analyzer. ABX Micros 60 is a fully automated DOTmed Auctions
hematology analyzer from ABX Diagnostics
limator Exchange Cart M# NGEC700A Export Kit
(renamed as Horiba ABX). Horiba ABX Micros Want to auction equipment
M# NZEX-723B Rail M# NARS700A Currently
60 is a powerful tool best suited for use in any
installed and in working condition. Presently
physician’s office lab, hospitals, and small
on dotmed.com?
used on patients. This equipment must be
removed by April 1, 2010. Please be ready to
clinics. Auction #10966 – sold for a hospital in Contact an auction specialist.
Texas, $2,500.
make removal arrangements if you are the Suc-
cessful Bidder. Unit was under Toshiba service
212.742.1200, ext. 296
agreement until Sept. 2009 The DiCOM box CA or sales@dotmed.com.
is included Software level is 5.0E – at least, may

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Inside: Reports on Anesthesia, Leasing and Finance in Medicine

■ Financially Sick Hospital Syndrome

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industry sector reports 24

24 Radiotherapy’s Big Move

PRESIDENT Philip F. Jacobus

EDITOR-IN-CHIEF Sean Ruck

departments ASSISTANT EDITOR Brendon Nafziger

STAFF WRITERS Heather Mayer

70 Medical Museum – An ancestor of the NATIONAL ACCOUNT Don Hurtikant

KEY ACCOUNT Susan Minotillo

ACCOUNT EXECUTIVES Sean Collins

Letters to the Editor

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