Medical Solutions Dec 08 - Breast Cancer

Medical Solutions
The Magazine for Healthcare Leadership
December 2008
Breast Cancer
Where are we – and where are we heading?
Cardiology
Diagnosis in the Emergency Room
What’s the difference
between imaging and
imaging greatness??
Ask the Ultimate Power in Imaging.

Every year Siemens provides a spectrum of new imaging systems that enhance diagnostic precision. With syngo®
the first unified software interface for all imaging modalities was delivered. Tim® technology revolutionized MRI,
and Dual Source CT continues to drive new clinical possibilities. Talk to us to experience these innovations and new
groundbreaking advancements in imaging excellence.
www.siemens.com/answersforlife +49 69 797 6420
Answers for life.
A91CC-9016-A3-1-7600
Editorial
Advancing Patient Care
The growing and aging population is one involves some measure of patient dis-
of the most significant challenges facing comfort, and possibly anxiety, as a clini-
healthcare providers. This trend will drive cian extracts tissue from different loca-
an increasing demand for healthcare ser- tions for diagnosis. Ultrasound, however,
Jim Reid-Anderson,
vices, particularly for diseases that occur allows for an image-guided biopsy, which Member of the Managing Board of Siemens AG
later in life and are costly to treat. In enables the physician to target suspicious and CEO of the Healthcare Sector
many situations, healthcare delivery has areas for extraction, reducing patient
not evolved to the point where individual discomfort, long-term complications, and
patient’s needs are considered. Our goal the amount of time needed for the proce-
at Siemens Healthcare is to enable this dure.
high-quality, patient-centered approach Should the biopsy yield a positive result,
by integrating imaging, laboratory diag- molecular imaging biomarkers enable
nostics, and healthcare IT, creating seam- the localization of metastatic cancer
less and significantly improved workflow cells in the body. And, Siemens REMIND manage prostate cancer, breast cancer
efficiencies. clinical decision support software can – as discussed in the cover story of this
Take prostate cancer as an example. help ’rule out’ other factors that might edition of Medical Solutions – and many
Typically, if a clinician wants to clarify lead to higher PSA results, but not auto- other diseases throughout the continuum
whether symptoms are signs of prostate matically to prostate cancer. When this of care. With our broad portfolio and
cancer, he or she, in addition to a physi- solution is applied holistically, up to 50 ongoing innovations, we are here to
cal exam, would order a blood test to percent of such misleading diagnoses support your efforts in advancing patient
measure Prostate-Specific Antigen (PSA). can be avoided, saving time and money care: enabling earlier, more efficient,
A high PSA level is considered to poten- and increasing patient comfort and accurate, and patient-friendly diagnoses
tially be caused by prostate cancer. Dif- confidence. An estimated US$5 billion and treatments.
ferent PSA markers have to be combined can be saved annually in the U.S. alone by Our goal is simple: to help you save lives
and put in relation to each other to iden- applying measures to avoid unnecessary and offer the best possible care to your
tify men who might show an elevated procedures and interventions.1 patients. It is at the center of everything
PSA, but who, in fact, have a low risk that With our recent investment in laboratory we do. Siemens Healthcare provides
this PSA value is a result of prostate diagnostics, Siemens has become the answers for healthcare – answers for life.
cancer. Also, measuring PSA at just one only integrated healthcare company that
point in time is not sufficient. can offer a complete portfolio to better Sincerely,
When the patient’s PSA levels indicate
possible prostate cancer, a biopsy needs
to be performed. The traditional method 1
Results may vary. Data on file.
Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 3

Content
20 38
Content Personalized Medicine:
Novel Imaging and Diagnostic Technologies
Cardiac Care:
New Standards
Cover Story 03 Editorial

10 Breast Cancer
Back in the 1980s, a bright young student 06 News
completed her PhD dissertation on MRI brain
diffusion imaging. Little did she know that
cutting-edge technology would someday
save her life. As a breast cancer patient, she
66 Essay Series: Japan
now talks about her personal experience
and the needs of affected women. In addi-
tion, Medical Solutions interviewed three 71 Further Reading
imaging experts around the world about
how diverse imaging solutions and advanced,
integrated technology are providing a new 75 Service
level of care for breast cancer patients.
76 Imprint
77 Subscription
4 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

Content
44 60
Med Meets IT: Training:
Project Expert Care Three Locations, One High Standard
Features
20 With a shared vision of preventive 35 Offering better return on invest- 50 Tissue Strain Analytics is an
and personalized medicine, ment and workflow efficiency, emerging ultrasound technology
Siemens and National Jewish Health Biograph Molecular CT – mCT – with the potential for quicker,
aim to develop novel imaging is the imaging crossover that will more accurate diagnoses of tissue
and diagnostic technologies using change the way hospitals think anomalies in the liver.
genomics, proteomics, integrated about integrated imaging.
research, and clinical care.
54 Cardiac biomarkers provide rapid
38 A new cardiac care and research diagnosis and risk stratification, and
26 To overcome claustrophobia and institute in Western Canada, help to improve the quality of care
positioning difficulties, Clínica the Mazankowski Alberta Heart for chest pain patients at South
de Diagnóstico por Imagem relies on Institute, is setting new standards of Austin Hospital’s Emergency Depart-
Open Bore magnetic resonance care for both pediatric and adult ment.
imaging. patients under one roof.
60 Within a global training concept,

30 The ARTISTE integrated radiation 44 By implementing a comprehensive Siemens Healthcare offers state-
therapy solution helps Baton IT solution across the entire organi- of-the-art training for customers
Rouge General Medical Center’s zation, MedCentral, a regional worldwide in three dedicated
Pennington Cancer Center to rapidly health system in Ohio, became a training centers located around the
and efficiently deliver radiation world-class institution. globe.
therapy close to home.

News
CT Scanning in a Flash
The SOMATOM® Definition Flash com- achieving gapless z-sampling, resulting several other dose-conscious features. In
puted tomography (CT) scanner sets in a table speed of more than 40 centi- dual energy scans, a new photon shield
new standards in both image acquisition meters per second. That is because the prefilters high kilovoltage X-rays, both
speed and radiation dose as the world’s two detectors create two complementary improving material separation and sub-
fastest CT with the lowest dose ever. data spirals that, when put together, stantially reducing dose, making it per-
Like no other scanner, it can image the include all the information found in a fect for routine clinical use. Adaptive Dose
entire thorax in less than one second and single spiral acquired at a much lower Shielding blocks X-rays that will not be
complete a cardiac scan in one-fourth table speed. used in image reconstruction. New organ-
the time of a single heartbeat, with a Together, these features enable lung specific dose reduction eliminates direct
radiation dose of less than one milli- scans in 0.6 seconds, taking the burden exposure of radiation-sensitive organs,
sievert. “Our goal was to build the most of breath-holding off the patients. Fast such as the breast, thyroid gland, or eye.
patient-friendly CT by significantly reduc- scan speeds also eliminate the additional And Siemens is looking to the future,
ing dose through faster speed,” says Sami dose penalty of electrocardiographically developing iterative reconstruction tech-
Atiya, PhD, Chief Executive Officer of the (ECG) gated thoracic studies, so radiolo- niques that promise to further reduce
CT Business Unit of Siemens Healthcare. gists can scan the thorax and ’get the dose.
“Lowest radiation dose is important to heart for free.’ Dedicated cardiac inves- Willi Kalender, PhD, Director of the
physicians and patients. It’s important tigations can be completed in about Institute of Medical Physics at the Univer-
to us.” 250 milliseconds. But more importantly: sity of Erlangen-Nuremberg in Erlangen,
SOMATOM Definition Flash utilizes Dual It also reduces dose to unprecedented Germany, says, “The new scanner is a
Source technology that consists of two levels down to below one millisievert. The true revolution. It picks up on the well
detectors and two X-ray sources. This con- new features also permit pediatric scans established concept of Dual Source CT
figuration, coupled with a gantry rotation more quickly and safely than ever before. but improves it in several ways. We never
time of 0.28 seconds, enables a temporal In addition, a shuttle mode makes it pos- before dared to scan with such a low
resolution of just 75 milliseconds, makes sible for trauma patients to be scanned dose and such a high speed.”
dual energy scanning possible, and allows to conduct dynamic time-resolved imag-
the use of 200 kilowatts. Now, Siemens ing over 40 centimeters, the longest
scientists and engineers have discovered range available today.
how to push acquisition speeds to new Besides the reduced radiation exposure www.siemens.com/
levels. SOMATOM Definition Flash can that directly results from the high table SOMATOM-Sessions-Flash
scan at a pitch of above three, while still speed, SOMATOM Definition Flash offers

News
Large Display for Artis zee Family

Following the release of the Artis zee® steps. Continuing the flexibility and
family for interventional imaging in radi- versatility of the Artis zee systems, the
ology and cardiology in 2007, Siemens product can be used for interventional
launched a new, full-color large display1 radiology, interventional cardiology/
for integration with the new portfolio at electrophysiology, and surgery, and is
RSNA 2008. The Artis zee Large Display particularly valuable for interventional
is a 56-inch monitor that allows users to imaging in hybrid rooms as it tremen-
replace up to eight single monitors on dously reduces the number of monitors
the system. It provides the integration of in the room. With its high resolution
multiple modalities on one screen for (4 x HD), the Large Display shows even to put other video signals on the Large
greater flexibility and enables the user the finest details. Up to 200 layout com- Display – for instance, for monitoring
to configure the screen during the pro- binations and the possibility to connect other rooms, telemedicine, or endoscopy
cedure. The operator can choose from at least 16 image sources and show up – make it a rewarding investment for the
different screen layouts directly at the to ten windows simultaneously enhance future.
tableside of the angiography system. imaging results and workflow in the inter- 1
The information about this product is being provided
This enables the operator to adapt the ventional suite. Moreover, the reduction for planning purposes. The product requires 510(k)
configuration to the individual workflow of additional displays and the option review and is not commercially available in the U.S.
Comprehensive MR Oncology Solutions

Within the field of oncology, magnetic resonance imaging (MRI)
has proven to be one of the most effective imaging techniques.
For asymptomatic and high-risk patients, MRI enables both
early tumor detection and oncological staging without radia-
tion. To support precise surgery planning, therapy monitoring,
and follow-up, Siemens provides comprehensive MRI oncology
solutions, going far beyond single applications and software
Cycle 1 Cycle 2 features.
In Women’s Health, the first quantitative MRI breast spectros-
copy application syngo® GRACE is now also available for the
3 Tesla systems MAGNETOM® Verio and Trio. By checking rela-
tive choline concentration during therapy, the efficiency for
monitoring treatment is more reliable. This may also reduce
the number of unnecessary breast biopsies for the women
concerned.
Cycle 3 Cycle 4 In the field of Men’s Health, syngo Tissue 4D1, the new task
card for visualization of 3D dynamic measurements, is particu-
larly valuable for prostate evaluation. Offering two evaluation
workflows – standard curve evaluation or a pharmacokinetic
model – syngo Tissue 4D supports an efficient oncology work-
flow and reliable follow-up studies.
Completed by syngo TimCT Oncology – the hardware and
software solution for seamless whole-body imaging using
Cycle 5 Cycle 6 Continuous Table move – these new applications and work-
syngo GRACE after every chemotherapy cycle of a patient with
flow tools expand the comprehensive Siemens solution for
known breast cancer: The efficiency of therapy can be easily seen by the oncology diagnosis and staging.
decreasing choline. 1
This application is pending 510(k) review and is not yet commercially available in the U.S.

News
What is your SPECT’S IQ?

Siemens demonstrated industry leadership once again with
molecular imaging’s most recent innovation in single photon
emission computed tomography (SPECT) – IQ·SPECT1. This
new feature in SPECT enables a comprehensive cardiac evalua-
tion including perfusion, attenuation correction, and calcium
scoring in as little as five minutes2 when traditional cardiac
SPECT perfusion studies can average 15 to 20 minutes. Avail-
able for the Symbia® product line, IQ·SPECT allows organ-
specific cardiac evaluations with enhanced image quality. For
medical facilities, this innovation means being able to accom-
modate more patients in less time and meet a variety of
patient needs.
IQ·SPECT’s ‘intelligence’ is achieved through a combination
of three technologies beginning with SMARTZOOM, a specially
designed smart collimator that magnifies the heart while
imaging the rest of the torso under traditional conditions.
Second, the SMARTZOOM collimator works in a cardio-centric
orbit to maximize the amount of cardiac information collected
from the patient. Finally, unique IQ·SPECT reconstruction
completes the innovation and is seamlessly integrated into
the current Symbia workflows and automation features, giving
physicians access to the most flexible and versatile system of IQ·SPECT to these important SPECT·CT studies may lead to
available today. new risk stratification algorithms and workups for patients
Calcium scoring with SPECT·CT, extracted from a quick low- with suspected coronary artery disease.
dose spiral CT, has also become a critical element in the cardiac
work-up to evaluate the extent of cardiac disease in patients. 1
Works in Progress. The information about the product is preliminary.
Adding the 30-second CT to the SPECT study cannot only illus- The product is under development and is not commercially available in the U.S.,
and its future availability cannot be assured.
trate any ischemia present in the patient, but also can assess 2
New Product Feature based on preliminary internal data. Actual performance
the buildup of calcium in the coronary arteries. The addition characteristics have not been established.
Electronic Health Record for Integrated Care

are involved in the patient’s treatment. Germany. Especially regarding diagnoses
Siemens equipped the hospital with an in the fields of neurosurgery, trauma-
overall technology system that includes tology, angiology, and radiology, the
Soarian® Integrated Care1 (Soarian IC) for hospital supports regional hospitals and
information exchange, as well as radio- practices with its medical expert knowl-
logical image communication software. edge. For example, a patient who has
Soarian IC improves the flow of informa- been brought into a county hospital after
Klinikum Chemnitz is one of the first hos- tion across institutions and sectors with- an accident can be scanned with a com-
pitals in Germany to link its teleradiology out the need to exchange existing pri- puted tomography system. The image
service with an electronic health record mary systems. As a result, the system data is sent electronically to a responsible
(EHR). The EHR makes demographic and supports the cooperation between the physician in Klinikum Chemnitz, who
administrative data of a telediagnosis individual clinical facilities and simplifies then diagnoses the patient and sends
available. Provided the patient agrees, the patient treatment. Together with back the report.
images and results from diagnostics can 14 regional county hospitals as well as
be shared by different facilities. Thanks medical centers and several practicing 1
The information about this product is preliminary. The
product is under development and is not commercially
to a special security system, the data are physicians, Klinikum Chemnitz sets available in the U.S. or in Canada, and its future avail-
only accessible to authorized users who standards for integrated healthcare in ability cannot be assured.

News
Neonatal Care the discoloration of body tissues. Neonatal jaundice is usually

harmless, a consequence of immature liver function and the
Siemens RAPIDLab® 1245/1265 blood gas analyzers have been breakdown of fetal hemoglobin as it is replaced with adult
enhanced to measure total bilirubin on neonatal whole-blood hemoglobin. Severe neonatal jaundice may indicate a more
samples. The RAPIDLab systems determine the neonatal total serious condition, including erythroblastosis fetalis, that is
bilirubin concentration in 60 seconds using multiple wavelength most likely caused by blood incompatibilities between baby
spectrophotometry. Bilirubin is the main bile pigment formed and mother. Extremely high levels of bilirubin in infants may
from the degradation of hemoglobin. An increased level of cause bilirubin encephalopathy or kernicterus, a form of brain
bilirubin in the blood (hyperbilirubinemia) causes jaundice, damage.
The Business Partner in MRI

“You can’t run a radiology practice without an MRI [magnetic
resonance imaging] system,” says Franz Walter, MD. “Demand
from referrers and patients for radiation-free imaging is growing
steadily.” This is why the radiologist invested in a MAGNETOM®
ESSENZA immediately after taking over the recently out-
sourced radiology practice of the Evangelische Krankenhaus
in Zweibrücken, Germany. With a low total cost of ownership,
MAGNETOM ESSENZA is ideal for setting up and expanding MRI
services. Zhen Jin, MD, agrees. The Director of the MRI Center
at Hospital 306 in Beijing, China, looks back on 13 years of MRI
service at her institute – and installed two additional systems
last year: a 3 Tesla MAGNETOM Trio and a 1.5 Tesla MAGNETOM
ESSENZA. The decision for the MAGNETOM ESSENZA was a
natural one for both physicians: “It is the first system that is
optimized for cost of ownership. Zero helium boil-off and a 50
percent lower electricity consumption compared to conven-
tional systems are just two examples of its affordability,” says At Hospital 306 in Beijing, Dr. Zhen Jin is happy with MAGNETOM
ESSENZA’s low cost of ownership.
Walter. “We wanted a robust system for clinical use to allow
more time for research on the MAGNETOM Trio,” Zhen Jin says
as she explains the reason for buying two systems within such
a short timeframe. MAGNETOM ESSENZA offers full diagnostic
capabilities thanks to Tim® (Total imaging matrix). Tim pro-
vides flexibility through versatile coil combinations, accuracy
through high signal strength and spatial resolution, and speed
resulting from parallel imaging. It offers access to the applica-
tions needed for both an outpatient practice and a primary care
hospital. Zhen Jin also appreciates the integrated IsoCenter
Matrix coil of MAGNETOM ESSENZA. Thus, the region of inter-
est is always at the center of the magnetic field, which makes
coil repositioning and changing obsolete.
With 28 patients a day, she is also happy with the speed of the
exams, as is Walter with 22 exams, which include outpatients
as well as referrals from within the hospital. Walter mentions a
Parkinson’s patient who was referred for an angio exam. First,
he was skeptical about being able to achieve diagnostic image Dr. Franz Walter of the radiology practice at Evangelische Krankenhaus
Zweibrücken likes the system’s ease of use.
quality. Thanks to MAGNETOM ESSENZA’s fast sequences,
movement artifacts were reduced and the images were good
for diagnosis. “From any perspective, MAGNETOM ESSENZA is www.siemens.com/ESSENZA
definitely up to date,” he says.

Breast Cancer
Breast cancer is by far the most common cancer among

women. The numbers have been increasing worldwide,
rising rapidly particularly in younger women.

Breast Cancer
An Unexpected Encounter
Back in the 1980s, a bright young graduate
student completed her PhD dissertation on MRI
brain diffusion imaging at the Massachusetts
Institute of Technology. Little did she know that
cutting-edge technology would someday save
her life.
By Diana Smith
“I was trained as a scientist and have research study on breast imaging to rapidly, particularly in younger women.
always been interested in health and tech- compare breast MRI and breast diffusion According to the American Cancer Society,
nology,” says the scientist, who wishes imaging with conventional techniques in 2008, 1.3 million cases will be identi-
to remain anonymous. “I became very such as mammography and ultrasound. fied, and almost 500,000 women will
interested in MRI [magnetic resonance die from the disease. In the U.S., breast
imaging] in my first year of graduate New Imaging Techniques cancer will be diagnosed in one in eight
school. My doctoral thesis was on MR In the blink of an eye, a speck on a women. Though rare, men can also get
diffusion imaging, and I continued work- mammogram or an aberrant lump felt in breast cancer.
ing on MRI abroad for my post-doctorate the shower can change a woman’s life. New imaging techniques are helping
research.” Breast cancer is by far the most common doctors diagnose tumors with greater
A passionate scientist, she continued cancer among women.1 The numbers precision and less trauma. Mammograms
work in the field and built an impressive have been increasing worldwide, rising can be less effective in women with
global resume. Since 2006, she has been dense tissue which makes the images
doing research collaboration with a lead- 1
http://www.who.int/cancer/detection/breastcancer/en/.
harder to read. Magnetic resonance
ing hospital in Asia, performing a clinical Last accessed Nov. 4th, 2008 imaging has been shown to find breast

Breast Cancer
lesions underwent diffusion imaging

and dynamic contrast-enhanced MRI4
using a 3 Tesla scanner (Siemens
MAGNETOM® Trio, A Tim® system).
The clinical research study was per-
formed in Asia, where, increasingly
younger women are being affected by
breast cancer. Younger women tend
to have denser (leaner) breast tissue.
Dense breast tissue can present special
difficulties for disease detection. In
mammography, dense breast tissue and
tumors both appear white. “It’s like find-
ing a polar bear in a snowstorm,” says
the scientist.
Accidental Discovery
A chance discovery changed everything,
recalls the scientist. “The clinical results
The scientist’s breast cancer was discovered by chance.
from the patient study were really good.
Out of curiosity, I went in the scanner
for this diffusion technique. No contrast
injection was needed with diffusion
imaging. It was quick and easy, and I was
cancers that mammograms miss in a out of the scanner in five minutes. As
certain group of patients.2 A study pub- I came out, I saw the stricken face of the
lished by the Scientific Assembly of the radiologist and knew something was
Radiological Society of North America wrong.”
(RSNA) reported that the detection rate Since the diffusion technique was new
for nonpalpable, invasive breast cancers and is not yet routine for breast imaging,
increased by 42 percent in women with the radiologist in charge recommended
dense breasts when mammography was a follow-up with a complete examination
followed by ultrasound.3 and conventional diagnostic methods.
“Taking the technology to a new level,” These included digital mammography,
the scientist explains, “diffusion is look- ultrasound, contrast-enhanced MRI4, and
“Women need ing at the water mobility, the movement lymph-node mapping.
to know what they of water molecules in tissue. We thought

this technique would be very sensitive Not the Right Destiny
should look for in finding abnormalities in the breast,
and it’s perfect when you have a group
At only age 45, the researcher was in a
low-risk group with no family history of
in getting the of patients who have proven biopsies, the disease. Previous mammograms and
because then you have histologic com- ultrasounds were normal. A nonsmoker,
best diagnostic parison. We have the exact pathological she was slim and followed a healthy diet.
examination.” specimen to compare with what we see

in imaging.”
“I was shocked,” she says. “I couldn’t
believe it. I always thought I have been
In a clinical study in Hong Kong, 31 healthy and active.”
female patients with suspected breast The hours that followed were a roller
coaster of emotions, particularly since
she was thousands of miles from home
and loved ones. “The worst was the
2
Efficacy of MRI and Mammography for Breast-Cancer moment when you are told you have
Screening in Women with a Familial or Genetic Predis-
position. N Engl J Med, Vol. 351, No. 5:427-437
3
Mammographic Density and the Risk and Detection of
Breast Cancer. N Engl J Med, Vol. 356, No. 5:227-263 4
Not available in the U.S.

Breast Cancer
“It’s so important to create and offer well-planned

radiology departments coupled with women’s
health centers to minimize anxiety and suffering
after someone is diagnosed with breast cancer.”
cancer,” she explains. “It feels like you in a well-known hospital with state-of- mammography and breast ultrasound.
just got a death sentence.” That evening, the-art equipment. I found the hospital Some know about breast MRI, but they
the radiologist in charge, who is also a to be well organized with women’s health don’t really know enough details, for
caring friend, took the scientist to dinner and radiology all under the same roof. example, whether their hospital has the
and “turned a potentially sad evening Everything was very conveniently located state-of-the-art scanner with the latest
alone after a shocking diagnosis into one in the same building and I could get all software or whether it is using a scanner
that made me think more about friend- the tests done within the first 48 hours.” that is ten years old, which does not offer
ship, people who care, and the life “I understand many women are less the best resolution or the same function-
ahead.” fortunate and they are sent to different alities as the newer ones. Women need
places and have to wait weeks before to know what they should look for in
A Personal Decision getting all the tests done. The waiting getting the best diagnostic examination
Because of her background in medical can be bewildering. Some hospitals are and what they should ask their health-
imaging, the scientist was more informed still not prepared to offer a streamlined care providers. When patients are well-
than most about the diagnostic tools process for people affected with such a informed, they have the best chance for
and treatments used in breast cancer. diagnosis. Sometimes, the hospital may survival and can live a long and healthy
Like American actress Christina Applegate, not have the right imaging equipment or life.”
who elected to have a mastectomy in the the latest software. It’s easy for a patient
summer of 2008 at age 36 to eliminate to be sent to get multiple tests, get lost An Enlightened Path
constant fear and onerous exams every in the medical maze, and spend endless “I’m back to my previous activities and
few months, the scientist opted for imme- hours and days waiting for the results. actually feel better than before,” says
diate surgery. It’s so important to create and offer well- the scientist. “When you go through an
“I know of women who had lumpectomies planned radiology departments coupled experience like this, you get to see who
followed by radiation and chemotherapy, with women’s health centers to mini- really cares about you and who loves
and their cancer reoccurred,” she says. mize anxiety and suffering after some- you for who you are. I have a stronger
“Every woman is different. I made my one is diagnosed with breast cancer.” appreciation for people who show kind-
personal decision to have a mastectomy ness despite work pressure and busy
to have peace of mind and reduce the Speaking Out schedules. I particularly remember a late-
risks of recurrence to almost zero.” Today, the scientist is still consulting shift nurse and her words of kindness
and she is using her experience to be an and encouragement when she came
Recovery advocate and speak to others about the to do an IV [infusion] around midnight.
“The first couple of weeks were very hard,” disease and the imaging modalities used When you are flat on your back in a
remembers the scientist. “I’ve never to diagnose and treat it. hospital bed, you have time to think, to
had any kind of surgery before, and of “I’ve learned a lot through this process. ponder, and to feel.”
course, you cannot bathe or even put I now teach women about early detec- She concludes, “I have come from this
on clothing yourself. You are very depen- tion and how it helps to save lives. It’s experience with a greater appreciation
dent on someone to help you.” also important to know about the possi- for life. I’m grateful for the early detec-
She adds, “In a way, I was very lucky that bilities in detection and treatment,” she tion that helped save my life, and I have
it [finding the cancer] happened where emphasizes. certainly grown from the enlightenment
I knew the clinicians. Though I was very “Most people know someone who has and reflections during this unexpected
far from home when this happened, I was had breast cancer. Most people know of journey.”

Breast Cancer
A Worldwide Challenge
Diverse imaging solutions and advanced, integrated technology
are providing a new level of care for breast cancer patients.
For a global view, Medical Solutions interviewed three imaging
experts around the world:
Gladys Lo, MD, Chief Radiologist, Department of Diagnostic

and Interventional Radiology, Hong Kong Sanatorium and Hospital,
Hong Kong, China
John F. Nelson, MD, Medical Director, Battlefield Imaging,

Battlefield Auxiliary Breast Center, Ringgold, Georgia, U.S.
Karsten Ridder, MD, Radiological Group Practice,

Outpatient Clinic Professor Dr. Uhlenbrock and Partners,
Diagnostic Breast Center, St. Josefs-Hospital,
Dortmund-Hoerde, Germany

Breast Cancer
Thank you for finding time to talk to thing we do all the time. Additionally, ter for the patients. With our advanced
us across many time zones. All of you advanced techniques like breast MRI radiology equipment, we get the most
provide state-of-the-art breast cancer [magnetic resonance imaging] have sensitivity and specificity we can.
care with integrated imaging systems revolutionized what I do as a diagnosti- Mammography is only one small part of
from Siemens that optimize clinical, cian. all the basic things that have to be
operational, and financial workflow. RIDDER: Changing from analog to digital offered along with the other modalities.
Let’s discuss how diagnosis and treat- mammography is like the invention of LO: Our hospital is a private hospital and
ment of breast cancer has changed rubber for the wheel. It is much faster actually prides itself in getting the best
since you started in the field. and more precise than before, especially machines. We have a 3 Tesla MRI breast
NELSON: I have been practicing for when you are looking at workflow. CAD unit, and we’ve been doing a special
about 20 years, so I’ve seen quite a few [computer-aided diagnosis] is a helpful sequence called diffusion to look at the
support in managing the workload of a breast tissue and had some very good
screening center such as ours. But this is preliminary results that will be published
only one advantage. On the other hand, in JCAT [Journal of Computer Assisted
digital systems help the radiologist and Tomography] next year and were pre-
surgeon communicate with the pathol- sented in Toronto at the ISMRM [Inter-
ogist. national Society for Magnetic Resonance
LO: The incidence of breast cancer in in Medicine] this year [2008] in May.
Hong Kong has increased to one in 23,
and digital mammography is fantastic You had a special case as a result of
because Chinese women have very dense the diffusion study. Can you tell us
breasts. So, advanced digital mammog- about that?
raphy has really helped to look through LO: One of my patients is a scientist and
the breast tissue, and also in picking up is aware of what we are doing. Previously,
the microcalcifications. she had standard mammography, but it
was not diagnostic because her breasts
How can ultrasound or other modalities were very dense. So, we decided she
improve the ability to detect cancers? should have the diffusion examination
LO: Ultrasound has always been popular because it doesn’t involve any ionizing
in Hong Kong because of the very dense radiation, there’s no injection, and it’s
breasts the women have here. We’ve very quick. What happened was that the
always found it to be very useful and diffusion study unexpectedly turned out
complimentary to mammography. MRI, of to be abnormal. So, this was followed
course, I think is a breakthrough. Like Dr. with a complete contrast-enhanced MRI
Ridder, we also have a multidisciplinary scan, of course, and at the site where
approach in our hospital. We communi- the diffusion abnormality was seen, there
cate very closely with the breast surgeons, was actually a bilobulated rim-enhancing
changes. Technologically, we’ve obviously pathologists, radiation therapists, and mass with type three signal intensity time
seen huge strides in screening mammo- oncologists. graph, quite diagnostic like a BI-RADS
graphy just in the ability to see and pick [Breast Imaging Reporting and Data
up lesions. In recent years, most of us in Why is it important to be an early System]1 five lesion, and this turned out
the U.S. and across the world have prob- adopter of technology? What are the to be DCIS [ductal carcinoma in situ].
ably transitioned to digital mammogra- benefits to patients? To the hospital? After the MRI was done, I suggested
phy. I think probably everyone on this RIDDER: Here in Dortmund, where we doing an ultrasound as well and we saw
panel would agree the improved screen- are located, we are a city of 1.5 million. the lesion again. I also persuaded her to
ings have saved lives. So, that has really We are part of the hospital’s Radiology do mammography again because I was
changed the way I practice. Secondly, Institute, and we have the pressure afraid she might have an area of DCIS
of course, the different modalities we of the free market. Women are free to
use to evaluate patients diagnosed with decide which institute they want to go
suspected breast cancer also have bal- to. Having better technology gives us a 1
BI-RADS is a quality assurance tool originally designed
for use with mammography. The system is a collborative
looned. Ultrasound is no longer some- competitive advantage. The second thing effort of many health groups but is published and trade-
thing that we do occasionally – it’s some- is that with the new techniques, it is bet- marked by the American College of Radiology.

Breast Cancer
true for the other two physicians. We’ve

actually experimented at our institution
“There are a lot of with Bruce Porter’s techniques 2, and what
we’re doing now is a lot more whole-
tools out there body MRI for staging and the chest and
abdomen for screening, along with our
that we can parlay breast MRI.
into what we are RIDDER: PET·CT is also promising in other
cancers, like ovarian cancer or lymphatic
currently doing cancer. Where we use these PET tech-
niques is also for extended breast cancer
to add diagnostic and the staging of treatment.
capabilities.” How does an integrated diagnostic

strategy affect your patients and your
John F. Nelson, MD, Medical Director,
facility’s success?
Battlefield Imaging, Battlefield Auxiliary Breast LO: Patients who all of a sudden find
Center, Ringgold, GA, USA out they have some abnormality want to
find out the exact extent of the abnor-
mality and what it is right away. If you
send them to all different types of places
to get it and they have to wait, that’s tre-
mendously stressful on the patient. We
that’s only shown with microcalcifica- are lucky that we have everything in one
tions. Both the MRI and the ultrasound place, including the hospital.
may not show a certain percentage of NELSON: In fact, that’s really why our
DCIS cases that present with microcalci- facility was built. We are actually in a
fications. Indeed, her tumor was at eight breast center, so every modality, including
o’clock, but on the mammography at ten breast MRI, is available. We even offer
o’clock, there was a stipulated area that Saturday morning service. We’re also in
had some microcalcifications in it. a very competitive environment here.
NELSON: Was the diagnostic MRI also We are motivated at our center to place
negative? the patient at the center of the wheel
LO: No, it wasn’t. It was an irregularly and all the spokes go out, but the patient
marginated mass, but it had a type one shouldn’t have to move. It’s our job to
graph. So it was indeterminate. It was provide all the services that go along
like a BI-RADS four at the ten o’clock with breast cancer evaluation.
lesion, which was seen on mammogra- RIDDER: I think my colleagues will agree,
phy, and a BI-RADS five lesion that was everyone is short of time, and so the
not seen on mammography for the eight time pressure is extreme. Also, women
o’clock. need to get their results in a short time.
How are you using other methods Why did you choose women’s
of molecular medicine such as PET·CT health and breast cancer as your field
[positron emission tomography/ of expertise?
computed tomography], SPECT·CT RIDDER: Honestly, I think it’s one of the
[singe photon emission computed most exciting fields in radiology, with
tomography/computed tomography], all the new techniques that have been
or biomarkers?
NELSON: At our institution, we really 2
Refer to, e.g., Beatty, J., Porter, B: Contrast-enhanced
reserve PET·CT for women with suspected breast magnetic resonance imaging: the surgical per-
extensive disease. For most of our spective. Am J Surg 193; 5:600-605.
Smith J.P., Hanson J., Dawson J., Porter B., Tickman R.J.:
women with locally advanced disease, we emerging technologies in surgical planning for breast
evaluate with breast MRI, and I bet that is cancer. Am J Surg 184; 4:377-9.

Breast Cancer
developed in the last ten, 20 years, and

are still being developed. Maybe only
comparable to cardiac MRI or multislice “We are lucky that
computed tomography.
NELSON: For me, it was a calling. My
we have every-
sister was diagnosed with breast cancer
back when I was still in medical school.
thing in one place.”
She had two kids. I saw how breast can-
cer affects the patients, their loved ones Gladys Lo, MD, Chief Radiologist,
Department of Diagnostic and Interventional
and families, and changes the course of
Radiology, Hong Kong Sanatorium and Hospital,
life for everybody. So when I got to the Hong Kong, China
point of choosing my area of specializa-
tion, it was just natural.
And why did you choose Siemens

equipment for your work?
NELSON: Battlefield Imaging was a brand-
new center built from scratch alongside
the rest of our medical facilities about different machine that is supposed to
five years ago. We wanted to go com- have the same detector as the mammog-
pletely digital at our center – no film. We raphy system from Siemens, but there is
weren’t building space for film. I actually no comparison between the two images.
flew to Dortmund to look at the digital I’m also using our MRI for heart exami-
mammography system they had in place nations and work with other Siemens
there. We’ve had a long-standing relation- systems as well. Thanks to the common
ship with Siemens, and we have extremely syngo® user interface, it is easy to switch
good Siemens service. A lot of what between the modalities.
drove my interest in Siemens was that LO: Prior to getting our Siemens digital
relationship. When I saw the system and mammography unit, we had one from a
compared it with the other two systems different vendor. We have images from
available at the time, I just didn’t feel patients who come for follow-up. The old
comfortable that either of the others images are from the other vendor and
“Having better could provide me with the image quality
or the back-up service that I knew would
the new images are Siemens, and it’s
like night and day. The new Siemens unit
technology be necessary. The same is true for MRI. is seeing so much more, and I’m very
At that time, the Espree [MAGNETOM® pleased with that.
gives us a Espree Open Bore MRI system with Tim® NELSON: I would add that the Siemens
technology] was just coming on the digital unit had several filter combina-
competitive market. We have a relatively large patient tions, some of which use a considerably
advantage.” population; many of our patients are
overweight or obese. The Espree just fit
lower dose. Compared to our screen
film, we were seeing 30 to 40 percent
perfectly with what we were trying to lower doses. We have marketed that
Karsten Ridder, MD, Radiological provide. It was really the first full-field, very strongly in our community, and it
Group Practice, Outpatient Clinic high-end machine that offered those sort has been very well received.
Prof. Dr. Uhlenbrock and Partners,
of facilities for the patients. Siemens
Diagnostic Breast Center,
St. Josefs-Hospital,
really had the technology that worked Are you excited about any new
Dortmund-Hoerde, Germany well for us. trends or innovative leading-edge
RIDDER: It’s the whole package you get imaging solutions for the future?
from Siemens, not limited to just the RIDDER: We have just started with
image quality. For example, we have a ultrasound automated breast volume

Breast Cancer
scanning [ABVS]3. We haven’t used the Certainly, we’ve found elasticity imaging
technology for a very long time, but in ultrasound very useful. And I’m really
what I can say now is that we are look- excited about diffusion imaging on MRI.
ing at a very promising technique that There are a lot of tools out there that
holds a huge potential for breast imag- we can parlay into what we are currently
ing in the future. doing to add diagnostic capabilities.
NELSON: I would echo that there are
some other things on the horizon. I think Diana Smith is a freelance writer based in
all of us are interested to see if breast Liberty Hill, TX, USA.
tomosynthesis4 is really going to take off.
3
for planning purposes. The product is pending 510(k) Further Information
review, and is not yet commercially available in the U.S.
4
Caution: Investigational Device. Limited by U.S. Federal www.siemens.com/breastcare
Law to investigational use. The information about Digital
Breast Tomosynthesis is preliminary. This product is
www.siemens.com/
under development and not commercially available in news-breastcare
the U.S., and its future availability cannot be assured.
Breast Cancer: The ACUSON S2000 ABVS

Where are we – and where are we heading? Automated Breast Volume Scanner
reduces operator dependence and
variability.
Challenge:
“It was easy, and I was out of the scanner in five minutes,” says the scientist. “As I
came out, I saw the stricken face of the radiologist and knew something was wrong.”
Working on MRI diffusion, a promising breakthrough imaging technique for the
breast, a scientist unexpectedly discovers her own disease. One chance test com-
pletely changed her life, but that was just the beginning of an arduous emotional
and physical journey.
Solution:
Today, physicians and clinicians are using an arsenal of integrated diagnostics that
have revolutionized the management of breast cancer. “I think probably everyone
would agree that improved screenings have saved lives,” says John F. Nelson, MD,
Medical Director of Battlefield Auxiliary Breast Center in Ringgold, Georgia, U.S.
Patient with a 2.8-centimeter,
“That has really changed the way I practice.”
grade 3, invasive ductal carcinoma
Integrated diagnostics have other benefits, including improved workflow and patient in the right breast imaged with
convenience. Gladys Lo, MD, Chief Radiologist at Hong Kong Sanatorium, emphasizes digital mammography (left) and
how new approaches to diagnosis and treatment have positive emotional ramifica- breast tomosynthesis. The medio-
tions. “For patients who all of the sudden find out they have some abnormality, they lateral oblique (MLO) digital
mammography view shows dense
would like to find out the exact extent of what it is right away. If you send them to
breast tissue with subtle distortion
all different types of places and they have to wait, that’s tremendously stressful on in the lower breast. The MLO
them.” tomosynthesis slice shows a spicu-
lated mass in the lower breast.
Result:
Technologically, huge strides have been made in the imaging field in the last two
decades. Integrating laboratory diagnostics, advanced imaging, and information
technologies can improve a patient’s outcome at every stage of care. In addition,
integrated technology affects workflow. “It is much faster and more precise than
before,” says Dr. Karsten Ridder of St. Josefs-Hospital, Dortmund, Germany.
The journey of detecting, coping with, and beating breast cancer resulted in an
enlightened new perspective for the scientist. Now, this survivor gives real advice,
not only on early detection and treatment, but also because of her background,
specifically on what to look for in hospital imaging equipment and how the level of
technology may make a difference in a person’s life. All scanners are not created
equally.

MAGNETOM Espree – Pink is a dedicated MR Breast Scanner with a 70-centimeter Open Bore at 1.5T and an ultra-short 125-centimeter
system length.
Diverse Imaging Solutions

In a multipronged, comprehensive approach, Siemens com- diagnosis of the breast. ACUSON S2000 ABVS features an
bines laboratory diagnostics, advanced imaging, and information integrated room suite design that combines the advanced
technologies to help physicians detect, diagnose, and treat ACUSON S2000 ultrasound system and a column stand with
breast cancer earlier, faster, and with greater precision. New an arm assembly, which holds a transducer pod specially
technology offers a range of breast care solutions – all designed designed for automated ultrasound breast imaging. It supports
to contribute to successful disease management. a high patient load with 250 to 400 single images acquired
in one scan to calculate the volumes, which are sent to a
MAGNETOM Espree – Pink dedicated ABVS Workplace for analysis and manipulation. The
Siemens announced the latest innovation in breast MRI, system features the anatomical coronal plane, which is not
MAGNETOM® Espree – Pink, the new dedicated MRI Breast Scan- available using conventional ultrasound and includes semi-
ner with a 70-centimeter Open Bore at 1.5 Tesla and an ultra- automated reporting features and comprehensive BI-RADS
short 125-centimeter system length. Both the 70-centimeter report capabilities.
Open Bore scanner and the new breast coil (Sentinelle Vanguard
for Siemens) offer an enhanced level of patient comfort, espe- Breast Tomosynthesis
cially for obese and claustrophobic patients. The system has The latest technology now under development in full-field
the capability to position the patient feet-first or head-first mammography, breast tomosynthesis 3, is a 3D imaging tech-
and provides excellent access to perform biopsies. Sentinelle nology that acquires 2D projection images of a compressed
Vanguard for Siemens offers excellent image quality and opti- breast at multiple angles during a sweep of the X-ray tube.
mized biopsy access for higher accuracy in intervention and Poised to enhance mammography, the new technology will
faster examination time. The dedicated workplace includes take the two-dimensional images and reconstruct them to
syngo® BreVis1 for flexible reading and reporting and syngo reveal depth – the third dimension of anatomy. Tomosynthesis
BreVis Biopsy1 for fast and accurate MR breast biopsy workflow slices have the potential to show tumors that remain invisible
with automatic calculation of target coordinates. in individual images.
ACUSON S2000 ABVS Automated Breast Volume 1

This information about this product is preliminary. The product is under development
Scanner and not commercially available in the U.S., and its future availability cannot be ensured.
2
The information about this product is being provided for planning purposes. The product
The ACUSON S2000™ ABVS Automated Breast Volume Scanner 2 is pending 510(k) review and is not yet commercially available in the U.S.
streamlines workflow and reduces operator dependence and 3
Caution: Investigational Device. Limited by U.S. Federal Law to investigational use.
The information about Digital Breast Tomosynthesis is preliminary. This product is
variability by quickly and comfortably surveying and acquiring under development and not commercially available in the U.S., and its future avail-
full-field sonographic volumes for comprehensive review and ability cannot be assured.

“National Jewish Health and
Siemens share a common vision
of bringing laboratory diagnos-
tics together with imaging in
order to give our patients the
best care possible.”
Michael Salem, MD, President and CEO,

National Jewish Health, Denver, CO, USA
Bringing Personalized Medicine

into Focus
For 109 years, National Jewish Health has sought to offer
patients the best possible care. U.S. News & World Report has
ranked National Jewish Health the number one respiratory
hospital in the nation for 11 years straight. It is continuing its
legacy by launching a personalized medicine initiative, seeking
to become a nationally recognized clinical thought leader
among American healthcare providers.
By Amy K. Erickson

“Siemens Financial representatives
were very responsive to our
questions. They took the time to
understand National Jewish Health
and our financing needs.”
Christine Forkner, CFO,

National Jewish Health,
Denver, CO, USA
In collaboration with Siemens, National Personalized medicine is a new thera- patients around the world. To do this,
Jewish Health’s individualized medicine peutic approach that uses genetic we set up three pillars of infrastructure:
strategy is aimed at merging research and and other information about a person the Integrated Bioinformation and Speci-
clinical efforts to improve and develop to tailor the prevention, detection, men Center, the Center for Genetics
novel imaging and laboratory diagnostic treatment, and monitoring of disease. and Therapeutics, and the Institute for
technologies. How does partnering with Siemens Advanced Biomedical Imaging1.
Medical Solutions sat down with Michael Healthcare bolster your strategic plan
Salem, MD, President and Chief Executive to advance the field of personalized Why did National Jewish Health
Officer of National Jewish Health, and medicine and use those advances to select Siemens Healthcare as a clinical
Christine Forkner, Chief Financial Officer better care for your patients? and Siemens Financial Services, Inc.
at National Jewish Health, to discuss their SALEM: Personalized and preventive [Siemens Financial] as a financial
strategic alliance with Siemens, their medicine is about the right diagnosis and partner?
shared vision for collaborative research, treatment for the individual patient. By SALEM: Siemens is a world-class company
improved diagnostic imaging, and financ- combining our strengths in technology, and our collaboration brings together
ing. It is an ambitious endeavor: National patient care, and research, Siemens and the best of the best in terms of faculty,
Jewish Health will integrate Siemens tech- National Jewish will advance the idea of staff, and technology. We share a com-
nology throughout the facility’s 19-acre early detection and prevention. We will mon vision of bringing laboratory diag-
campus in Denver, Colorado, U.S. – in be able to provide more accurate diagnostics together with imaging in order to
order to offer patients advanced diagno- noses that lead to more targeted and 1
The Institute for Advanced Biomedical Imaging is a
ses and treatments. effective therapies for our patients and registered trademark of National Jewish Health.

Patient-centered Medicine
give our patients the best care possible. SALEM: We think National Jewish is the easiest processes. Siemens Financial
FORKNER: From a financial standpoint, very well positioned to help Siemens representatives were very responsive
when we looked at Siemens Financial, advance its technologies. In our labora- to our questions. They took the time to
we were looking for a broad agreement tories, we have invented and are com- understand National Jewish Health and
with a broad scope and a wide range of mitted to a number of novel diagnostic our financing needs. They had excellent
criteria. We considered how easy they tests – whether they are genetic tests, forms, which minimized lawyer time and
are to work with, their clear and straight- biomarkers, or new predictive tests that expense. Overall, among the companies
forward documents, their experience in can track patient progress – and we think we considered, Siemens Financial came
dealing with local authorities, and their a partnership with a leader like Siemens in as the number one frontrunner from
expertise in tax-exempt lending. We com- will allow us to bring these things to a financial standpoint and in the broader
pared their offers with several national patients a lot sooner than we otherwise relationship. On top of that, they were
and large regional banks, equipment- would have. Additionally, we have tre- nice people to work with, which is impor-
lending companies, and their competition. mendous expertise and access to sam- tant, especially in the most complicated
Siemens Financial came out on top. ples and patients. With technology from financial transactions. I think we came
Siemens and great minds on both sides, together to make an excellent deal.
How will National Jewish Health and we have the opportunity to be very suc-
Siemens Healthcare benefit from this cessful. How important is it that Siemens
joint effort? Financial provide equipment financing
Why did you choose Siemens Financial options to healthcare providers?
to finance the equipment and tech- FORKNER: It’s imperative that they do so
Summary nology? In other words, what differen- for several reasons. Healthcare financing
tiates Siemens from other lending is always complicated. A lot of hospitals
Challenge: sources? are experiencing a credit crunch at a time
• Moving away from a reactive trial- SALEM: This is a competitive business and when radiology equipment continues to
and-error method of practicing we were looking for a business partner advance. You have to be very competi-
medicine to a predictive, personal- and a research partner. tive in today’s healthcare world. It is bene-
ized model FORKNER: We went with Siemens Finan- ficial to everyone that Siemens Financial
• Practically implementing better cial because our market analysis indicated not only has the financing, but also the
diagnostics that lead to more effec- that they had the best rate and some of expertise to make a lot of different financ-
tive treatments
• Obtaining financial assistance to
fund state-of-the-art technologies
Solution:
Siemens Provides Personalized
• Collaborating with healthcare Financing Options
institutions to improve and develop
novel imaging and diagnostic Siemens Financial Services, Inc. provides innovative financial solutions
technologies to healthcare providers such as National Jewish Health. With expertise in
• Integrating Siemens technologies asset-based lending, capital markets, equipment financing, commercial
throughout National Jewish Health trade finance, and vendor financing, each transaction is tailored to fit the
to help diagnose respiratory, cardiac, specific borrowing needs of the client.
and rheumatologic diseases The financing arm for healthcare at Siemens Financial Services has been
• Merging the institution’s research in existence for over 20 years. “We offer a turnkey approach,” says Lynn
and clinical efforts at the point of Beckham, Vice President of Tax-Exempt Healthcare Corporate Finance for
care for the benefit of the patient Siemens Financial Services. “The customer not only looks to us for equip-
• Providing easy, affordable financing ment, but also for financial assistance, as was the case with National Jewish
options to healthcare entities Health.”
After Siemens identified the best funding avenues for National Jewish
Result: Health, the US$13 million transaction was completed in about five weeks
• Improved patient care from start to finish.
• Development of a practical model of “We offer excellent customer service,” says Beckham. “Our rates are very
proactive personalized healthcare attractive and we are always accessible. With this equipment, National
• Advancement of molecular medicine Jewish Health will be able to expand and do more research, which in the
• Better diagnostic and imaging end, means helping more people.”
technologies

ing options available – from tax-exempt
to not tax-exempt, from an operating
lease to a capital lease, there are a lot of
options out there. Siemens Financial not
only makes those available, they also
make them easy.
How are current U.S. market conditions

affecting your ability to fund projects?
FORKNER: The market has impacted
budgets across the country and ours is
no exception. Siemens Financial worked
wonderfully with us to help get our pro-
gram financed. National Jewish has a
dedicated donor base and, with relation-
ships with industry leaders like Siemens,
I think National Jewish will weather this
crunch just fine.
National Jewish Health’s mission of

personalized medicine is aligned with
Siemens strategy of providing cutting-
edge technology to improve patient
care. Can you highlight a few examples
of how this collaborative effort bene-
fits patients?
SALEM: I think the benefit to patients
will be this transition to more preventive
care – this notion or idea of early detec-
Collaboration Strengthens Patient Care

A cornerstone of National Jewish Health’s mission to reconciliation and consistency. Additionally, National
advance personalized medicine is the integration of Jewish Health and Siemens are launching several collabor-
Siemens technology within the existing medical infrastruc- ative research projects that seek to improve the diagnostic
ture. Currently, physicians and clinicians at National Jewish capabilities of several imaging technologies. The over-
Health are supported by a wide range of Siemens in vivo arching goal of these projects is to detect disease earlier
diagnostics and information technology, including and make more precise diagnoses, leading to improved
SOMATOM® Definition, SOMATOM Sensation 64, patient care.
MAGNETOM® Avanto, syngo® Imaging and syngo Workflow, These projects include:
BiographTM 40, ARCADISTM Avantic, and c.cam. Additionally, • Using technology from Siemens to develop techniques
National Jewish Health plans to install several Siemens for detecting very small lung nodules (four to eight
solutions for in vitro diagnostics in the near future. millimeters in diameter) in individuals at a high risk for
The Institute for Advanced Biomedical Imaging, which lung cancer
opened its doors in the spring of 2008, houses two Siemens • Developing a model of the lung that can be used by
computed tomography (CT) systems and one Siemens others to calibrate CT systems in order to produce com-
PET·CT (positron emission tomography-CT) system. parable images
The institute also has an integrated radiology information • Developing a Quantitative Imaging Laboratory at
system (RIS) and picture archiving and communication National Jewish to improve quantitative imaging tech-
system (PACS) that uses the same syngo architecture as niques for better integration of radiologic and molecular
the imaging modalities, leading to streamlined data imaging

tion. How do you practically implement ers and genetics, physicians will have developing improved tools to measure
the idea of prescribing medications improved knowledge about a patient’s right-heart function, we will better under-
more precisely? Patients suffering from disease. Physicians will be able to target stand our patients’ needs and address
COPD [Chronic Obstructive Pulmonary treatments to address specific situations them more effectively.
Disease] offer one example. COPD is within the COPD spectrum, and patients One of our collaborative research projects
really a syndrome, a broad group of con- will have better outcomes. also seeks to detect potentially cancerous
ditions grouped together through a fairly We also expect to improve imaging of lung nodules when they are smaller than
crude diagnostic tool – the amount of the right side of the heart, which is less we can currently detect. Earlier detec-
air a person can exhale in one second. advanced than imaging of the left side tion and removal of cancerous nodules
Advanced imaging is increasingly able to of the heart. It can often be difficult to could significantly improve survival in
distinguish the two main characteristics determine whether a patient’s shortness lung cancer.
of COPD – lung destruction and airway of breath – a common complaint among
inflammation. As we learn to distinguish our patients – is caused by problems in What are the measurable outcomes
the varieties of COPD and couple that the lung or in the right side of the heart, of the partnership between National
with information gleaned from biomark- which pumps blood to the lungs. By Jewish Health and Siemens?

SALEM: Research results and patient has to offer and the best of what aca-
outcomes. As our collaboration produces demia and medicine have to offer in this
new methods and tools for diagnostic environment here at National Jewish
imaging and healthcare solutions by Health, then we have the potential to
bringing together imaging and the clinical really help patients.
reference labs, we will share that knowl-
edge, which may change the way medi- Amy K. Erickson is a Chicago-based writer
specializing in medicine, science, and biotech-
cine is practiced. And, as the broader
nology.
diagnostic imaging and laboratory com-
munities adopt those new methods and
tools, patient outcomes will improve.
Providing testing using cutting-edge Further Information
diagnostics and targeted therapies is a www.siemens.com/
real challenge. We think if we put personalized-medicine
together the best of what the industry

Magnetic Resonance Imaging
Expects to improve diagnosis for nervous and circulatory systems: Dr. Romeu Côrtes Domingues
Room to Breathe
Siemens 70-centimeter Open Bore technology makes magnetic
resonance imaging less claustrophobic and more comfortable, enabling
faster and better imaging for delicate cases.
By Reinaldo José Lopes

It’s been a long wait. In October 2007,

Romeu Côrtes Domingues, MD, and his
“There’s no question MAGNETOM
colleagues at CDPI (Clínica de Diagnóstico
por Imagem, a major imaging diagnosis
Verio is the best option.”
facility in Rio de Janeiro, Brazil) visited
a factory in Erlangen, Germany, and Romeu Côrtes Domingues, MD,
were able to have a ’sneak peek‘ view of Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil
MAGNETOM® Verio, Siemens new 3 Tesla

(3T) Open Bore magnetic resonance
imaging (MRI) device. “It was still a top netic resonance can be a difficult method Domingues explains that both claustro-
secret project back then,” recalls Domin- when you take into account the patients’ phobic patients and children, who nor-
gues. “We had almost closed a deal with rejection rate due to claustrophobia or mally have a hard time undergoing MRI,
another manufacturer, but when we saw lack of comfort. Conventional small bores stand to benefit from Open Bore tech-
MAGNETOM Verio, we realized that this may frighten off about three percent of nology. “Depending on the kind of pro-
was a completely different game – it was patients – sometimes we even need to cedure, you can actually let the mother
surely going to become the new bench- hold a patient’s hand to calm him or her caress the child during the exam. Obese
mark in the market. We simply had to buy down while the session proceeds,” he patients, up to 250 kilograms, can also
it – and that’s what we did last year.” says. be redirected to it. And there are posi-
Since it was a novel technology, though, tioning advantages for those with chronic
MAGNETOM Verio still had to wait in Ten Centimeters that Matter pain or limited mobility.”
order to be registered and approved by Open Bore MRI changes that by providing Even for patients who do not suffer from
Anvisa (Agência Nacional de Vigilância ten centimeters of additional breathing any disability and feel just fine in a tight
Sanitária), the Brazilian counterpart to room for the patients. “It may not seem place, Open Bore technology can make
the FDA. “They took almost six months so at first, but ten centimeters matter a a difference, according to the Brazilian
to do it, but thank goodness the device lot. You’ll never want to be examined in radiologist. “Let’s say you need to image
is finally about to be installed,” says a standard-bore device after that,” says a patient’s wrist. In any conventional
Domingues with palpable relief. Domingues. Combined with the Open machine he would have to go in with
The team at CDPI now expects to employ Bore approach, MAGNETOM Verio will his wrist first, and we all know how un-
MAGNETOM Verio to reduce rejection by allow the team at CDPI to handle difficult bearable it is to keep your arm stretched
claustrophobic patients and significantly procedures in a much more flexible way for 15 minutes. If you need to examine
improve the diagnosis of a variety of and, thanks to 3T, to provide them with someone’s knees, lumbar vertebrae or
conditions, especially those involving the a welcome enhancement in resolution abdomen, the patient’s head can stay
nervous and circulatory systems. “We are and precision, and also with a bigger outside the tunnel, as we say. And that’s
happy and very proud to be the first in chance of an early diagnosis in a number a lot less stressful.”
Brazil, and among the first in the world, of conditions.
to have this kind of technology at our “Of course, we’re talking about doubling Total Imaging
disposal. Because we focus so much on the magnetic field. And that means According to Domingues, another impor-
MRI – we have 50 doctors working on doubling the signal-to-noise ratio, too. tant factor for the success of Siemens MRI
it, with thousands of exams per month Some lesions that are nearly invisible for systems is Tim® (Total imaging matrix)
– we need the best. And there’s no a 1.5T machine – in a patient with a case technology. “This is crucial, because MRI
question MAGNETOM Verio is the best of epilepsy that’s difficult to control, for procedures have now become so com-
option.” instance, or breast cancer at the earliest mon that between 20 and 30 percent
The Brazilian radiologist and his colleag- stages – are sure to show up with 3T.” of our patients arrive here with requests
ues have been familiar with Siemens But at least in most systems, the precision to image two or three different areas,”
MAGNETOM systems for quite a while and of 3T comes at the price of “unfriendly he says. With Tim, up to ten coils can be
have been working with a MAGNETOM 60-centimeter bore systems,” as Domin- used at the same time. That means
Symphony and a MAGNETOM Avanto. gues puts it – precisely the ones that there is no need for the patient to get in
“Siemens became the world leader in the look the most oppressive to patients. and out of the system, or to change
market share of MRI devices, thanks also “The unique combination of 3T with position inside it. At the end of a typical
to their MAGNETOM Espree’s Open Bore Open Bore in MAGNETOM Verio will help working day of 15 hours, the result is
concept,” states Domingues. “Still, mag- us enjoy the best of both worlds,” he says. that about two or three extra patients

Open Bore systems open up new possibilities: MAGNETOM Espree and MAGNETOM Verio facilitate exams of claustrophobic, obese,
and immobile patients, or patients in pain.
Summary have been examined. “We broke our own hard to detect through mammography,
record a couple of months ago, doing and guide doctors to obtain biopsies of
Challenge: 60 sessions in a single day. One would the affected tissue with a high degree
• Patients’ rejection to MRI due to never be able to reach the same amount of precision. He says: “You are able to
claustrophobia with a different machine,” reports obtain ‘slices’ of breast tissue that are
• Difficult or impossible imaging of Domingues. 0.5 millimeters thin, so absolutely nothing
obese patients, patients that are With MAGNETOM Verio, the team at CDPI eludes us.”
immobilized, or people with chronic hopes to strike a rewarding balance Thanks to Tim, an interesting trend in
pain between faster imaging and higher reso- recent times is the use of MRI to image
• Lack of Open Bore MRI systems with lution. “By doubling the magnetic field, a patient’s body from head to toe. “It
a 3T magnetic field going from 1.5T to 3T, you could in the- can be very useful to detect metastasis.
ory, image a brain tumor in ten minutes, In patients with diabetes, where there’s
Solution: instead of spending 20 minutes on it. But systemic damage to blood vessels, you
• Investment in MAGNETOM Espree, a with 3T, in those cases, we can produce can inject the contrast in the whole body
1.5T, 70-centimeter Open Bore system, a complete study of the relevant brain in order to have a global picture. The
and its newly released 3T counterpart, area, including perfusion, spectroscopy, same goes for myositis, a condition
MAGNETOM Verio and functional data, that enables us to that affects the whole musculoskeletal
classify the tumor as malignant or benign system,” Domingues says.
Result: with a very high degree of certainty. That “In angiographies with 3T, you’re able to
• Improvement in workflow – up to would take about 15 minutes, but the do dynamic studies where the contrast
60 MRI examinations in a single day gain in diagnostic quality would more is literally seen arriving at the artery and
• More comfort for patients than compensate for the additional time coming back through a vein real fast.”
• Increased precision in difficult exams we spend,” he says. The same praise goes to neurological
• Better research capabilities Besides, the combination of Tim, 3T, exams. According to Domingues, smaller
and Open Bore technology is also suited and more precocious lesions tend to
to dramatically improve the diagnosis appear in better detail and, with the
of numerous conditions, explains Domin- help of spectroscopy, it is easier to say
gues. In the case of breast tumors, MRI whether a given abnormality is a tumor,
can both bring to light nodules that are an inflammatory lesion, or a stroke. And

“Once a patient is examined with

MAGNETOM Verio, he won’t think of being
imaged in another machine.”
Romeu Côrtes Domingues, MD,
Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil
there is also the possibility of dynamic (RSNA) – more than all the Brazilian and any other device is just staggering.
imaging – a knee in movement, for research groups put together in previous That’s why we’re sure that this is an
example, a kind of exam that is often meetings. A paper by Domingues and his investment that will pay off. If you do
sought by Brazil’s top soccer players. colleagues that has just been accepted the math, you’ll find out that, at the
for publication in the American Journal end of five years of work, you can buy
Research of Roentgenology shows how positron another machine thanks to the time you
Apart from the benefits for patients, emission tomography (PET) and MRI can saved with the first one,” he concludes.
Domingues sees MAGNETOM Verio as a be combined to get a clearer picture of
boost for CDPI’s research capabilities. lesions in the nervous system, abdomen, Reinaldo José Lopes is a science and health
writer at G1, Brazil’s largest news website.
“We’ve been able to forge a strong part- and bones when the data from PET·CT
nership with universities in Brazil and (computed tomography) is somewhat
abroad. It’s also a strong motivating fac- doubtful.
tor for our doctors. It’s always good for Domingues hopes that MAGNETOM Verio
them to get away from cases of headaches will keep his team at the top of their
and meniscus lesions every now and game and, more importantly, the patients
then.” The research output has been so will feel like it is the best solution for
great, says Domingues, that his group them. “I believe that, once a patient is
Further Information
has had 21 papers accepted for presen- examined with MAGNETOM Verio, he www.siemens.com/Verio
tation at the 2008 annual meeting of the won’t think of being imaged in another www.siemens.com/Espree
Radiological Society of North America machine. The difference between it
Dynamic Duo
In the U.S., MAGNETOM Espree and MAGNETOM Verio also tioning of patients and diminishing the number of image
help to image children, claustrophobic and obese patients, retakes caused by anxiety-related movements. Thanks to
and body areas that are difficult to image. The medical team MAGNETOM Verio’s 3 Tesla field, the New Jersey team also
at South Jersey Radiology Associates, New Jersey, like its obtains high-quality images of difficult body areas. “We get
colleagues in Rio de Janeiro, are witness to the flexibility really good image quality in abdominal exams for obese
and precision of both systems. “They enable us to capture patients, and also in challenging exams of small structures
patients we would not have been able to image with con- like the wrist,” Muhr remarks.
ventional MRI,” says William F. Muhr, MD, Director of Body For orthopedic exams, MAGNETOM Verio is fast, around
Imaging at the private practice. In two of their locations 15 minutes on average, compared to 30 minutes in conven-
east of Philadelphia, they decided to replace conventional tional systems, and that is probably a factor in the high
1.5 Tesla systems with the Siemens Open Bore technology. acceptance rate among patients: For their next exam, around
Muhr says MAGNETOM Espree and MAGNETOM Verio help 90 percent of patients ask to be imaged on MAGNETOM
to improve workflow at their facilities by easing the posi- Verio again.

Designed for Adaptive Radiation Therapy, the
ARTISTE solution enables radiation oncologists
to create treatment plans that include IGRT,
conformal radiation therapy, IMRT, high-precision
radiation therapy, and gated treatments.
Radiation Therapy
The Future of Oncology:

The ARTISTE Solution
At Baton Rouge General Medical Center’s Pennington Cancer Center
in Louisiana, U.S., the staff shares the belief that cutting-edge cancer
care should not be limited to patients at larger hospitals and academic
medical centers.
By Sameh Fahmy, MS
Pennington Cancer Center partnered plans, such as Intensity-Modulated Radi- Russell points out this is particularly
with Siemens to rapidly and efficiently ation Therapy (IMRT), while maintaining important because the size and shape
deliver advanced and routine radiation a quick and efficient workflow. of tumors change during treatment and
therapy close to home, providing a wider because tumors can shift in response to
range of options for a larger scope of Enhanced Flexibility factors such as weight loss, inflammation
patients than ever before. Pennington Cancer Center installed in nearby tissues, and normal physiologi-
“We need to provide state-of-the-art ARTISTE in February of 2008. Medical cal functions – for example, lung tumors
cancer care for the people of this state so Director William Russell, MD, explains move as the patient breathes, and the
that they don’t need to go elsewhere,” that its flexibility was a key factor in their prostate shifts in response to fullness in
says Director of Radiation Oncology Zack decision. The solution gives Russell and the bladder and rectum.
Smith, RT, MBA. “They should stay here his colleagues the ability to create treat- To help ensure that the treatment dose
– where their families are, where their ment plans that include Image-Guided is delivered to the target and not healthy
community is, where their jobs are, and Radiation Therapy (IGRT), conformal radi- tissue, this radiation therapy solution
where they have all of the support mech- ation therapy, IMRT, high-precision radi- allows physicians to image the patient
anisms that will make their treatment ation therapy, and also gated treatments. just prior to treatment, verify that the
easier.” “We chose ARTISTE because it gives us patient position is correct, and adapt to
To that end, the 544-bed, community- the full spectrum of treatment options,” any anatomical changes immediately
owned hospital became the first in the Russell says. “It allows us to efficiently before – or in some cases during – treat-
United States to install the Siemens and rapidly deliver routine radiation ther- ment. ARTISTE also offers the ability to
ARTISTE™ integrated radiation therapy apy for patients who don’t require overly incorporate the dose used for pretreat-
solution. By combining a range of sophisticated plans, while also enabling ment imaging into the treatment plan
advanced imaging options, rapid image us to deliver more complex treatments so that clinicians can accurately monitor
acquisition and processing, and precise using the same platform.” the dose delivered to the patient.
treatment delivery, the system has given ARTISTE is engineered specifically for “Siemens has always been a leader in
the Pennington Cancer Center the flexi- Adaptive Radiation Therapy (ART), which healthcare solutions, so for us, it made the
bility to treat routine cases as well as aims to precisely deliver dose to the target most sense to stay with a company that
those that require complicated treatment while sparing surrounding healthy tissue. had a proven track record in both therapy

and imaging for a combined modality target will shift while images are being Smith says most patients will only need
machine,” Russell says. “This system is the acquired. Smith notes that another a fraction of ARTISTE’s capabilities, but
future of radiation oncology.” benefit of MVision is that it is fully inte- for some patients, even a small increase
The ability to choose between multiple grated and therefore requires no add- in precision can result in significantly im-
imaging options is one of the features on hardware. “When you bolt on acces- proved outcomes. He recalls one patient
that makes ARTISTE so unique. Russell sories, you introduce the possibility who was treated for a spinal metastasis
explains that for patients with simple of set-up errors and need extra quality in her upper thorax but suffered a recur-
treatment plans, ARTISTE offers two- assurance steps,” Smith says. “Because rence several months later. The cancer
dimensional OPTIVUE™ portal imaging everything is in line with MVision, what came back in the same region and had
for low-dose, high-resolution image you’re seeing is a Beam’s-Eye-View started to deteriorate a vertebral body,
quality. In situations where additional [BEV].” causing pain. The spinal column had
imaging information is required, it offers ARTISTE’s In-Line™ Technology also already received a near-maximum radia-
its powerful and unique 3D MVision™ streamlines workflow and increases tion dose, Smith says, and without the
Megavoltage Cone Beam Imaging. patient comfort. Therapists are afforded new technology, the sole treatment
MVision uses the treatment beam to clear access to the patient during setup, option would have been analgesics and
provide 3D target imaging with excellent and the risk of collision between the a treatment that would only have slowed
soft-tissue resolution. MVision also linear accelerator and objects in the room, the progression temporarily.
allows clinicians to incorporate dose dis- such as a patient’s wheelchair, is mini- Using MVision cone beam guidance,
tributions from cone beam imaging into mized. “But the biggest plus for me is ARTISTE allowed the patient’s physician
patient treatment plans. that when patients walk into the room, to pursue a more aggressive treatment
they see a sleek system that is not going plan with a degree of precision that Smith
Rapid Workflow, Improved to enclose them with a bunch of imaging describes as “almost like a surgeon’s
Outcomes apparatus coming out of the sides,” Smith knife.” He adds, “By the third treatment
The images ARTISTE produces are of says. “It’s a very unthreatening environ- she was pain free, and today she’s still
exceptionally high quality, while main- ment, and that makes the patients very pain free. So her outcome was better.
taining acquisition speed. “The speed with relaxed and allows us to take care of The physician having that ability to make
which the megavoltage cone beam them quickly.” a difference in this patient’s outcome
image is acquired and the speed at which ARTISTE includes the 160™ MLC Multi- just because of ARTISTE tells me that it’s
the software arrives at a solution for adap- leaf Collimator to provide highly accu- the right technology.”
tive targeting is three minutes,” Russell rate and precise field shaping. Its leaves Another feature that increases treatment
explains, “and that’s very fast.” move at four centimeters per second options for patients is its 550 TxT™
The system’s rapid speed increases to quickly deliver treatment, and its low Treatment Table, which accommodates
patient comfort by decreasing their time transmission and leakage minimizes dose patients of up to 550 pounds (250 kilo-
on the treatment table and, Russell says, to healthy tissue. It has a small, five- grams). Russell says the combination
can improve outcomes by minimizing millimeter leaf thickness over the full field of ARTISTE and Siemens SOMATOM®
the likelihood that the patient or the to improve conformity to the tumor shape. Sensation Open large-bore computed

Radiation Therapy
ARTISTE’s treatment table, we can offer

“ARTISTE is cutting edge now and high-quality, precise treatments to our
larger patients.”
it’ll still be cutting edge next year, Large patients, as well as patients with
tumors located off-isocenter, also bene-
the year after that, and for years fit from MVision’s extended field-of-view
to come.” (FOV) option.
Ease of Operation, Financial

Zack Smith, RT, MBA, Director of Radiation Oncology, Rewards
Pennington Cancer Center, Patient setup, imaging, verification, and
Baton Rouge General Medical Center,
treatment delivery are controlled via
Baton Rouge, LA, USA
Siemens intuitive syngo® RT Therapist
workspace. Adaptive Targeting™ on the
software quickly and reliably registers
pretreatment images with the planning
CT.
syngo RT Therapist is a component of
tomography (CT) system, which Penning- “It used to be that when patients weighed syngo Suite for Oncology1, a streamlined,
ton Cancer Center uses for planning, over 300 pounds [136 kilograms], not scalable workspace solution that pro-
gives them the ability to effectively treat only could we not treat them well, but vides members of the clinical team with
obese patients, using the same table for we couldn’t plan the treatment well,” the tools and data they need to efficiently
both imaging and treatment – helping he explains. “Now, with the combination accomplish their tasks. syngo Suite for
avoid shifts in patient positioning. of Siemens wide-bore CT scanner and Oncology also includes syngo RT Oncol-
ogist, syngo RT Physicist, and syngo RT
Dosimetrist. Smith says that using syngo
software across the Cancer Center creates
efficiency by giving clinicians a common
Treating Challenging operating platform from which to work.
“So even if I don’t operate the CT very
Cases in Europe often, I can go to it and the browsers are
the same and the buttons are familiar
In Europe, MAASTRO Clinic in the Netherlands and the German Cancer and intuitive,” he says.
Research Center (DKFZ) in Heidelberg were the first to install ARTISTE. Smith says the syngo platform makes it
Clinicians at both centers say its flexibility has allowed them to confi- easier for new users to operate ARTISTE
dently treat a number of challenging cases. and has simplified its integration into the
ARTISTE was used at DKFZ, for example, to treat an inoperable esophagus Cancer Center’s entirely paperless environ-
tumor. “Treatment for this type of tumor demands a very complicated ment. As a Siemens partner and the
radiotherapy approach,” says Professor Peter Huber, MD, Head of the first ARTISTE site in the United States,
Radiation Oncology Clinical Cooperation Unit at DKFZ. “Using the Pennington Cancer Center hosts clinicians
ARTISTE 160 MLC Multileaf Collimator, we were able to significantly from across the nation and shares its
improve the precision of the dose delivery while protecting immediate expertise with centers that are adopting
surrounding healthy tissue.” the solution.
MAASTRO Clinic has treated challenging clinical cases such as a metas- Russell and Smith say that as a communi-
tasized tumor in the abdominal region and a patient with two separate ty-owned hospital, Baton Rouge General
metastases: one in the head and neck region, and one in the knee cap. has a duty to be a good financial steward.
“ARTISTE’s imaging flexibility and simplified workflow help us to confi- The addition of ARTISTE accomplishes this
dently treat proliferated tumors in a wide range of areas of the body,” says goal, they say, by providing measurable
Bas Nijsten, MSc, Medical Physicist in the Maastricht Radiation Oncology financial benefits. Smith says its rapid
Department. “The advanced, high-end imaging capabilities of ARTISTE
allow us to fully integrate all our Image-Guided Radiation Therapy and
MAASTRO-developed Dose-Guided Radiation Therapy methods in one 1
The COHERENCE Suite of Oncology workspaces is
currently being rebranded to syngo Suite for Oncology.
clinical workflow.” The mentioned workspaces are available for purchase
under the COHERENCE brand name.

Radiation Therapy
“This system
is the future
Summary of radiation
Challenge:
oncology.”
• Maintaining rapid workflow while
delivering increasingly complex William Russell, MD,
Medical Director,
radiation therapy treatments
Pennington Cancer Center,
• Achieving high image quality in Baton Rouge General Medical
challenging situations Center, Baton Rouge, LA, USA
• Treating irregular tumors and
tumors near critical structures
• Effectively imaging and treating
obese patients
Solution:
• Expanded treatment options with
the ARTISTE integrated imaging and
radiation therapy solution
• Rapid image acquisition and
Adaptive Targeting help ensure that
treatment begins within three
minutes after positioning throughput – even complex treatments platform for which Siemens is continu-
• MVision Megavoltage Cone Beam such as IMRT can be accomplished in ing to develop technology.
Imaging delivers exceptional 3D ten minutes – allows them to treat more Upgrades currently available include
soft-tissue resolution with extended patients in a day. diagnostic CT imaging in the treatment
field of view “If you have 35 patients undergoing treat- room with the CTVision™ solution.
• In-room CTVision allows direct ment and you shave off 120 seconds Smith also anticipates future advances
comparison of daily patient anatomy from each patient, that’s more than an such as kVision™ Kilovoltage Cone Beam
with planning data hour saved every day,” Smith says. “From Imaging2, which delivers excellent 3D
• Fine-leaf resolution of 160 MLC an administrator’s perspective, that soft-tissue contrast, particularly for
allows exceptional large-field means we can treat four or five more pelvic and thoracic targeting, and Dose-
conformity and minimal dose to patients in the same amount of time.” Guided Radiation Therapy (DGRT)™
organs at risk He adds that having a single system that Solution2. “ARTISTE is cutting edge now
• 550TxT Treatment Table accommo- can accomplish multiple tasks reduces and it’ll still be cutting edge next year,
dates patients up to 550 pounds staff training costs as well as engineering, the year after that, and for years to
(250 kilograms) maintenance, and vault costs. come,” Smith says.
Russell points out that the installation 2
kVision Kilovoltage Cone Beam Imaging and
Result: of a technologically advanced linear DGRT Solution are works in progress and are not
• Flexibility helps ensure that all accelerator is tangible evidence for the commercially available in the U.S.
patients receive the treatment best general public and physicians that
suited to their needs Pennington Cancer Center is committed Sameh Fahmy, MS, is an award-winning
• Precise treatment delivery to excellence. “Physicians know that we freelance medical and technology journalist
based in Athens, GA, USA.
maximizes dose to target while have the ability to deliver highly sophis-
minimizing dose to healthy ticated treatment plans with a state-of-
tissue, improving patient outcomes the-art Siemens solution,” Russell says,
• Rapid image acquisition and treat- “and that has certainly resulted in more Further Information
ment delivery enhance workflow patient referrals to this facility.” Smith
and allow clinicians to treat more says he is confident that ARTISTE will www.siemens.com/ARTISTE
patients, increasing financial rewards retain its value over time because it is a

Molecular Imaging
Thinking Outside the Box

maximize these innovations in imaging
Offering better return on investment and and make them available where they will
workflow efficiency, Siemens Healthcare unveils have the most impact. What we’ve done
with Biograph mCT is taken the best
Molecular CT – the next evolution in multimodality Siemens has to offer in CT and enabled
imaging. More than just a hybrid, Biograph mCT the introduction of ’smart‘ contrast –
molecular contrast – using the most
is the imaging crossover that will drive change in advanced PET technology available,”
the way hospitals think about integrated imaging. says Bernd Montag, CEO of Siemens
Healthcare’s Imaging and IT Division.
By Claudette Yasell, MBA While hybrid imaging is not new to
molecular imaging experts, the availabil-
ity of molecular contrast in radiology
opens doors to increased cooperation
and, potentially, new standard protocols
Siemens Healthcare recently invited that provide diagnostic information
imaging opinion leaders from around the which is unachievable using independent
globe to discuss the future of integrated imaging modalities. Financially, using
imaging and showcase an innovative new one all-encompassing scanner can make
Siemens solution: Biograph Molecular the most of an institution’s imaging equip-
CT – mCT. As the first scanner developed ment and strengthen the existing work-
specifically for an integrated imaging flows between radiology and molecular
environment, Biograph mCT sheds light imaging; all of which target the patient
on how to maximize workflow efficiencies as the ultimate beneficiary.
while improving diagnostic capabilities
for better patient care. Smaller Footprint, Larger
“As the forerunner in integrated imaging Impact
solutions, Siemens wants to lead the Biograph mCT was designed to obtain
evolution of PET·CT [positron emission functional, anatomical, and molecular
tomography – computed tomography] to information from one noninvasive diag-

Molecular Imaging
in PET image quality and count rates for nosing disease earlier and of more effec-
faster, more comprehensive scanning. tively managing disease at reduced costs.
It can complete routine five-minute PET “And speaking directly to the bottom
Summary scans, which provide maximum patient line,” says Montag, “with Biograph mCT,
comfort and workflow efficiency. Appli- an institution may only need to purchase
Challenge: cations in oncology include the ability to one imager instead of two, representing
• Obtaining functional, anatomical, delineate lesions for diagnosis, staging, a huge cost savings potential at a time
and molecular information in a fast, and restaging of cancer, providing exqui- when healthcare budgets are tight.”
efficient, and economical way site anatomical detail plus a measure- Replacing a two scanner purchase with
ment of cell metabolism. just one can lead to savings in space,
Solution: construction costs, operating costs, and
• Adding advanced PET functionality Patient-centric life-cycle costs. This scanner is also up-
to a premium CT system The ability to provide a high-quality gradeable to higher slice configurations
• Placing PET·CT in the radiology imaging environment for patients that is and increased molecular capabilities such
suite accommodating, comfortable, and reli- as high-definition PET and time-of-flight
• Enabling molecular contrast in able plays a key role in the success of a capabilities, so the investment made
radiology hospital’s imaging center. The investment today stands firm well into the future.
made in imaging equipment such as this A smart new solution, Biograph mCT
Result: will provide physicians the information offers increased benefits for patients
• Increased return on investment necessary to better diagnose and treat and represents an intelligent solution
on imaging equipment patients. for physicians and administrators who
• Maximized workflow efficiencies With this innovation, patient care can want to provide the best patient care
and patient comfort also be optimized. With the fastest PET available and get the most out of their
• Improved diagnostic capabilities acquisition times available and ultra- investment.
for better patient care fast CT scanning, patient movement is
decreased, leading to better image qual- Optimizing the Gold Standard
ity. In addition, higher patient comfort The first choice in imaging diagnostics,
is achieved due to shorter scan times. CT provides ultimate imaging capabilities
Biograph mCT also offers low-dose scan- in anatomical and functional evaluations.
ning1 in both PET and CT; a very impor- Historically, radiologists were first able
tant feature in imaging, as more con- to visualize anatomical structures using
cerns are raised with respect to radiation axial CT, then spiral, multislice, and now
nostic exam. Using Siemens premium dose and increased frequency of tests. Dual Source and adaptive CT. They have
CT technology, it adapts to virtually any come to rely on the wealth of informa-
patient and any clinical need with higher Working Better Together tion provided by the growing speed and
resolution, contrast, and speed. This type of imaging innovation and evolving capabilities of dynamic CT. In
Biograph mCT comes together in one integration is taking a front-row seat in fact, 28 million CT scans were completed
powerfully small package. It boasts a large the eyes of hospital administrators. in the U.S. in 2006 for oncological evalu-
bore, short tunnel, and small footprint Facilities can boast major cost savings, ations, making CT the most widely used
for unparalleled patient care and com- return on investment, and excellence in technology to offer insight into diagnosis
fort. Biograph mCT is offered with up to patient care as well as patient and staff and treatment for cancer.2 But as the pre-
128 slices. With a table that can accom- satisfaction when innovation and inte- valence of diseases and conditions such
modate patients up to 500 pounds gration are optimized. The establishment as cancer and heart disease increases,
(227 kilograms), it makes the technology of new paradigms such as molecular CT the question becomes, “How can we
available so that many more patients can for integrated imaging diagnostics using offer even better diagnostic information
benefit from the valuable information it state-of-the-art CT and PET technologies with CT?”
provides. allows patient data to flow seamlessly Currently, information from CT scans
In addition to cutting-edge CT technolo- and swiftly among departments, harmo- can visualize abnormalities such as
gy, Biograph mCT maximizes the most nizing departmental cooperation. blood clots, cysts, fractures, infections,
advanced PET technology available, Biograph mCT is the quintessential and tumors in internal structures (for
including features such as a 33-percent definition of efficiency: one team, one example, bones, muscles, organs, and
increase in the PET field of view, high- room, one machine, and one comfortable soft tissue). CT is also used to guide the
definition imaging technology with inpatient. It offers the potential of diag- placement of instruments within the
creased spatial resolution, and time-of-
flight functionality. It offers the ultimate 1
Data on file 2
IMV 2006 CT Market Summary Report

Molecular Imaging
body, for example, to perform a biopsy. proven to change the management of active and inactive tumor cells within a
The addition of an iodine contrast agent oncology cases. Using colorectal cancer single tumor, to help the radiation plan-
also allows organs and structures to be as a prime example, PET·CT changed the ning physician determine where to best
seen more visibly. And with the latest CT management of the disease in 66 per- target therapy.
technology, tumor perfusion is also pos- cent of patients, and additionally, new The correlated PET·CT images provided
sible. disease was found in 43 percent of the in a multifaceted imaging environment
cases.3 offer a level of information not previously
Crossing Over to Molecular Using a radiolabeled tracer, or molecular available. Taking this information and
Resolution imaging agent, physicians can visualize applying it in a new arena, asserting that
Obtaining even better diagnostic infor- metabolic information in tumors from every CT can have molecular imaging
mation comes not from the ability to initial diagnosis through the patient’s capabilities, clearly addresses the need
visualize a tumor or abnormality through treatment and follow-up care. The most for more effective imaging in oncology
the use of a contrast agent, but from the common molecular imaging agent, and makes it more widely available;
ability to delineate the metabolic activity fluorodeoxyglucose, or 18F-FDG, is used offering personalized and very specific
within the tumor and to determine to illustrate metabolic activity within information about patients’ disease. So
whether or not it is responding to treat- cancerous tumors. Unavailable using CT many advances are being made in the
ment. To move oncology forward, CT alone, information from the molecular development of imaging agents that
will break out of being a black-and-white imaging agent in conjunction with the the most commonly used imager for
modality and capture this type of infor- PET scan can also determine if metastases oncology studies – CT – should be better
mation through the use of a molecular are developing as a result of the primary equipped to handle them.
contrast agent. This concept, using cancer. This information can be pivotal
molecular contrast with PET and CT, has in the management of disease, as this Claudette Yasell holds an MBA from Dominican
University, River Forest, IL, USA.
been applied in the molecular imaging type of metastatic activity may be too
arena with unprecedented success. “For small to be seen on conventional CT.
years now, we’ve seen how molecular Other imaging agents are currently in
imaging has influenced the diagnosis the process of being developed. These
and treatment of cancer. Hybrid mole- agents are being created to capture Further Information
cular imaging with PET·CT has made disease-specific information. There are
significant inroads in everything from also a number of imaging agents being www.siemens.com/mCT
diagnosis and staging in oncology to developed that can differentiate between
determining the effectiveness of cancer
treatments. It has even been used in
the development of new drugs,” says 3
Scott et al. PET Changes Management and Improves
Montag. Prognostic Stratification in Patients with Recurrent
Colorectal Cancer: Results of a Multicenter Prospective
The information offered by cellular Study. J Nucl Med, 2008; DOI:
molecular activity using PET·CT has been 10.2967/jnumed.108.051615
“What we’ve done with Biograph mCT

is taken the best Siemens has to offer
in CT and enabled the introduction of
‘smart’ contrast – molecular contrast.”
Bernd Montag, CEO,
Siemens Healthcare, Imaging & IT Division,
Erlangen, Germany

Facility Planning
Facility Planning
The Mazankowski Alberta Heart Institute’s development centered on patient experience.

One result: a healing garden at the center of the institute for patients to enjoy a relaxing atmosphere.
Canadian Innovation with Heart

With the support of Healthcare Consulting, Siemens is helping a
new state-of-the-art cardiac care and research institute in Western
Canada to set new standards of care. Their approach is simple:
clinical and operational transformation. Their efforts will not only
transform the medical options available to patients, but also the
way in which healthcare providers approach patient care.
By Richard Cairney
Facility Planning
“Healthcare Consulting
took it all down to what’s
best for the patient.”
Carol Manson McLeod, Senior Operating Officer,
Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
Summary
Challenge:
• Identify performance measures and The 600,000-square-foot Mazankowski opinions together, the new institute will
introduce technological and archi- Alberta Heart Institute in Edmonton, be changing the very culture of cardiac
tectural improvements to support a Alberta, Canada, is one of few North care. And while the institute is equipped
patient-centered culture in a new American heart institutes to handle both with the very best in medical technology,
cardiovascular institute pediatric and adult patients under one it is also designed to achieve a gold
roof. It will take on the most challenging standard of care, where patients’ needs
Solution: cases, including transplants and artificial come first.
• Employ Healthcare Consulting with hearts, and houses a world-class cardiac “The most difficult thing is to get people
its portfolio of room and func- research center to help speed the bench- to think outside the box,” says Carol
tional planning, IT & technology to-bedside process. Other innovations Manson McLeod, the institute’s Senior
consulting, process and performance include hybrid operating rooms where Operating Officer. Healthcare Consulting,
optimization, concepts to increase cardiologists and surgeons, armed with she says, has helped manage change and
patient satisfaction, and patient- the latest medical technology, will work inspire a cultural shift. “The Healthcare
centric care concepts together to conduct minimally invasive Consultants helped people start thinking
• Examine existing and planned procedures, while being prepared to of ways they can do things differently –
cardiology practices as they relate change course and conduct a more inva- so the solutions are homegrown.”
to patients and introduce techno- sive procedure if necessary. Prior to the institute’s opening in 2009,
logical, structural, and cultural The publicly funded Heart Institute, some of the challenges practitioners
changes to the way care is delivered adjacent to the University of Alberta Hos- faced were the result of their efforts to
pital, the Stollery Children’s Hospital and provide innovative treatment in the
Result: the University of Alberta itself, will reduce previous location, which created high
• Intensive Care Unit constructed patient wait times for clinical visits and demands on the existing space. “We had
in a way that provides patient and surgical cases visits, meeting new guide- been scaling up our capacity to provide
family privacy while reducing the lines established by the Canadian Cardio- new services and increase volumes
risk of spreading infection vascular Society. The former waiting time in the same space,” says Patient Care
• Integrated bedside terminals that for nonurgent cardiac surgeries was Manager Terry Hogan. “We added a lot
allow for easier admitting, physi- about 14.7 weeks, and the new bench- of new services and new concepts that
cian’s access to electronic patient mark is six to eight weeks; the urgent out- required new staff. Everyone was vying
records, and patient education patient electrophysiology waiting list of for the same space to do their work.”
• Decentralized nursing stations and 120 days is expected to be cut dramati-
wireless communication devices cally, to 14 days. The new facility offers Patient-centered Care
that eliminate stress-inducing over- greater capacity – it is estimated that it The leadership team at the Heart Insti-
head pages, bringing patients and could handle 600 to 700 more surgeries tute recognizes that moving into the new
the care team closer together annually, up significantly from the 1,140 institute in 2009 involves much more
• Coaster-sized pagers that allow it performed during the past year. than simply new equipment or treating
clinic patients a new degree of free- Beyond increasing capacity to its com- patients the same way with more room.
dom when waiting for treatment munity, the Heart Institute represents a It means a sea change in the way the
• A sea change in culture necessary to radically different type of treatment cen- institute cares for patients. Siemens
deliver patient-centric care ter. By bringing diverse disciplines and has installed one single-plane and two

Facility Planning
biplane cath labs, as well as a magnetic

resonance imaging (MRI) system. While
this technology provides patients with
the highest diagnostic capability on the
market today, the Heart Institute engaged
Healthcare Consulting to work with the
team. Siemens experienced healthcare
professionals helped to develop optimized
workflows, where processes are refined
and technology levers are planned. In
addition, the facility was designed to
create an environment focused on the
highest quality of safe patient care, effi-
cient utilization of valuable resources,
and a positive experience for cardiac
patients and the care team. The mutual
goal was to create a center of excellence
and an environment where optimized,
patient-centered processes are in place.
Nurses, for example, will carry wireless
phones to eliminate overhead pages.
This enables patients to contact nurses
directly. In clinics, coaster-sized pagers
will be given to patients, allowing them
to leave the waiting area. “They’ll be able
to go anywhere they want to without
worrying about missing their appoint-
ment,” says Patient Care Manager Donna
Daniec. Nursing stations, traditionally
the hub of a treatment unit, have been
removed. Instead, nurses are situated
at alcoves adjacent to patient rooms,
according to Daniec.
“We’re taking everything we need to care
for the patient directly to the patient,”
she says. “When you look at the spectrum
of inpatient and outpatient care, we were
making patients travel around to get the
services they needed.”
Even information will be brought directly
to patients via bedside terminals pro-
vided by Siemens, says Manson McLeod.
“We’ve talked about being more focused
on the patient. We want to do the same
thing if you are a planned or unplanned
admission. If you’re coming from a clinic
and need to be admitted, you would nor-
mally have to go hither and yon to find
admitting. But with the terminals, we’re
able to provide bedside registration –
the patients will actually be admitted at
the bedside in their room,” she says. “In
the future, we’ll even be able to have
access to electronic patient records at With the greater space and improved workflows, the Heart Institute hopes to handle
the bedside terminals.” 50 percent more cardiac surgeries and thus, reduce wait times for patients.

Facility Planning
“We’re taking
everything we need
to care for the
patient directly to
the patient.”
Donna Daniec, Patient Care Manager,
Mazankowski Alberta Heart Institute,
Edmonton, Alberta, Canada
ing materials onto the system and at the

same time, we’re uploading the same
content on our website so that what they
see on the screen at bedside is what they
will be able to see from home, after
they’ve been discharged,” Manson McLeod
explains. The terminals will also serve as
the patient’s television, telephone, and
allows them to surf the net or communi-
cate via email. She acknowledges that
some patients will be tentative about
using the technology, but adds that the
patient-centric outlook at the institute
will help them become comfortable with
it. “We are going to make sure that all
the members of our staff and volunteers
– from housekeeping to nutrition per-
sonnel – are able to help patients use
Turned to Siemens to help optimize the University of Alberta’s new cardiac hospital this technology.”
(from left): David Johnstone, MD, Clinical Director; Donna Daniec, Patient Care Manager;
Terry Hogan, Patient Care Manager; Carol Manson McLeod, Senior Operating Officer Designed for Safety, Comfort,
and Synergies
Manson McLeod credits Healthcare Con-
sulting with helping ensure that the insti-
tute adopts a commitment to patient
care that is embraced by all staff. Advice
The Heart Institute is working with from the Consulting team even resulted
Siemens to develop a system in which in a significant architectural change in
doctors can call up a patient’s medical design of the Intensive Care Unit (ICU).
images on the bedside screen to explain Initially, part of the ICU was to be built
diseases and treatment plans. “The bed- in a traditional way, with eight of the
side terminal is a device for us to teach beds sharing a common space. But with
our patients – we are uploading teach- new concerns about infectious disease,

Facility Planning
“Having kids under the same roof

really changes the focus of the institute,
in that you need to pay attention to
their unique needs.”
David Johnstone, MD, Clinical Director,
Mazankowski Alberta Heart Institute,
Edmonton, Alberta, Canada
Siemens suggested a design change. center, is another of its strengths that

“The Healthcare consultants looked at lends to its distinct nature. Many cardiac
our ICU, and even though we were in patients, for example, are also diabetics.
the midst of construction, the organiza- The Heart Institute has the advantage
tion agreed that it was important enough of being affiliated with the Alberta Dia-
to make the changes,” Manson McLeod betes Institute, a world-leading diabetes
says. “Healthcare Consulting took it all research center. Similarly, the institute Bedside terminals are used for everything from
patient admission to patient education and
down to what’s best for the patient.” and University of Alberta Hospital are entertainment, to file replacement during ward
That’s not surprising, considering that attached to the Stollery Children’s Hospi- rounds.
the priority on the patient experience was tal. “Having kids under the same roof
at the forefront of many other elements really changes the focus of the institute,
in the design of the building, which in that you need to pay attention to
does not resemble a traditional hospital. their unique needs and not just replicate hour days for patients in presurgery
Every patient room, for example, has what is done in the Stollery,” he says. assessments and education. “We were
natural light coming either from exterior Johnstone adds that the focus on patient doing that because it suited us – not
windows or from the institute’s indoor needs is also being applied through new the patient,” she says. “The Healthcare
Healing Garden – a placid environment services designed to keep patients close Consultants helped us to change our
that has an immediate soothing effect. to their home communities. The Heart way of thinking. We’re now creating a
Steps are being taken to improve the Institute serves a population scattered culture where we think of the patient
experience of outpatients, too. “Siemens across a vast geographic area, with some first. We are on the cusp of some funda-
was very influential – they helped us deal patients coming from remote settings. mental changes.”
with some fundamental issues,” adds “Heart clinics work, but does it make
David Johnstone, MD, Clinical Director sense that patients have to wait months Medical and technology writer Richard Cairney
also serves as the Communications Officer
for the institute. Armed with a worldwide for an appointment and need to drive
for the Engineering Faculty at the University of
perspective and experience, Healthcare several hours to get here?” he asks. “Is it Alberta in Edmonton, Alberta, Canada.
Consulting helped the institute develop fair that they have to park so far from
performance indicators. “They got us the building that they’re having chest
thinking on that level, and as a result, pain by the time they make it through
we’ve adopted targets for our services, the door?”
Further Information
allowing information to drive policy.” Telehealth sessions solve some problems,
Johnstone notes that the institute’s loca- and Manson McLeod says the institute’s www.siemens.com/
tion, at the heart of Edmonton’s nation- staff is brushing up on the principles of healthcare-consulting
ally respected health and medical research adult learning in order to eliminate eight-

Nurses have immediate electronic access to each
patient’s examination and test results. Barcoding helps
prevent risks for patient safety.
Med Meets IT at MedCentral

MedCentral deployed a complete Siemens solution suite across its
entire enterprise in an effort to increase patient safety and decrease costs
through operational efficiencies. It ended up with even more, including
dramatic improvements in workflows, processes, and interdisciplinary care.
By Kevin Self
‘Med Meets IT’ is the concept of seamlessly examine their operations to find new ways demonstrates forward-thinking innova-
blending two independent fields – to introduce efficiencies and position tion to gain competitive advantage.
medicine and information technology – themselves as world-class organizations. Meet MedCentral Health System, a non-
into a single, fully-integrated, harmonious As anyone involved with healthcare profit health system located in Mansfield,
solution that is easily accessible and con- management knows, this is easier said Ohio, U.S., that services a city population
veniently deployed in a clinical setting, than done. of approximately 50,000 and a county-
resulting in cutting-edge efficiencies and Add regional and statewide competitive wide potential patient pool of nearly
patient safeguards that were not even pressures into the mix and it is enough 120,000. With 351 beds, 2,600 employ-
possible in healthcare until recently. to make even the strongest provider turn ees, two hospitals, and four other local
Competition in today’s healthcare markets and run quickly in the other direction. facilities, MedCentral is situated between
is fierce. As consumers become more For this reason, it is all the more impres- Cleveland and Columbus – larger cities
informed and begin shopping for hospi- sive when – despite mounting obstacles home to two of the country’s best cardiac
tals, health systems are forced to re- – a mid-sized, regional health system treatment centers. So how is MedCentral

Integrated Healthcare
able to compete to the point of ear- ’provide clinicians with better data, more enterprise-wide solution suite that would
ning a number one state ranking by efficiently, and at the point of care.’ None embrace the entire spectrum of care.
HealthGrades1 for its cardiac surgery of these goals were achievable with the
program? old paper-based systems. A New Nervous System
The answer to this question resides in In 2004, MedCentral was inefficient and After an extensive evaluation of multiple
a number of system-wide solutions, but relied too heavily on manual processes healthcare IT vendors, MedCentral select-
there is no debate that the organization’s that exposed the health system to human ed Siemens for two primary reasons: its
IT initiatives are at the heart of its recent error and excess costs. And it was not an vision for the future and its robust tech-
rise to the top. With its tagline of ‘Expert isolated problem. Nearly every depart- nology offering.
Care, Close to Home,’ MedCentral epito- ment was plagued by delayed laboratory “We bought into Siemens philosophy of
mizes the concept of Med Meets IT across results, inaccurate data entry, or lost Med Meets IT because it was extremely
its entire enterprise. images. This environment was not con- compatible with where we wanted to
ducive to maximizing quality patient care. go in the future,” says Michael Mistretta,
Expert Care, Close to Home In radiology, MedCentral was still hand- Vice President of Information Services
Physicians practicing at MedCentral are signing reports, and it was not uncommon (IS) and Chief Information Officer at
more confident by the ability to deliver for physicians to wait as long as 48 hours MedCentral. “MedCentral’s decision to go
accurate information to the right person to receive them. In the laboratory, labels with Siemens has been validated many
at the right time. Repeat patients are were printed and manually sorted – wait- times over. The incorporation of clinical
delighted they do not need to re-do ing 17 hours for hard-copy test results and imaging data at the point of care
paperwork before admission. Clinician was considered acceptable. The same was has been almost transformational in our
recruitment and retention have never true for nursing, where the staff was delivery for patients.”
been higher. All are recent benefits of a spending inordinate amounts of time In addition to similar overarching philos-
strategic effort to improve patient safety. manually extracting data from records to ophies, the tactical approach to develop-
But this was not always the case. Four accommodate MedCentral’s reporting ing a quality, state-of-the-art IT solution
years ago, MedCentral was essentially in obligations. was the same – taking an enterprise
the dark ages as far as fully utilizing IT The objectives of Project Expert Care approach over best-of-breed.
to deliver better patient care. The entire were simple: increase patient safety The two new partners decided on a com-
health system was operating on a manual, through improved workflow and decrease prehensive Siemens solution that in-
paper-based system, and the technology costs through greater operational effi- cluded Soarian® Clinicals and Financials,
it had in place offered limited deployment ciencies. The answer was to build an syngo® Suite, a picture archiving and
and integration capabilities. When its
financial system was nearing sunset
at the end of 2004, MedCentral started
looking for other solutions. The need to
replace a single system quickly grew from
a simple upgrade into a much larger
initiative.
“We wanted to find a solution that could
replace our financial system, but also
expand to encompass all of MedCentral
Health System’s needs,” says Chief Exec-
utive Officer James E. Meyer. “We wanted
to enhance our ability to use IT to im-
prove patient care and safety, and provide
clinicians with better data at the point
of care.”
Enter ’Project Expert Care’ – MedCentral’s
system-wide IT initiative.
Redefining Expert Care

If there was a single mantra for those
involved with Project Expert Care, it was
1
Health Grades, Inc. is a U.S. healthcare ratings
organization, providing ratings and profiles of hospitals, Thanks to Project Expert Care, MedCentral’s cardiac surgery program earned a number one state
nursing homes, and physicians. ranking by HealthGrades.

communication system (PACS) and radi- patient care,” says Fred Crowgey, Projects extra 30 to 35 beds annually. Plus,
ology information system (RIS), Patient Director for IT. MedCentral’s nervous sys- MedCentral’s patient volume is 60 percent
Identification Check, NOVIUS® Lab, Med tem – its core for patient care delivery – Medicare/Medicaid, which means deal-
Administration Check (MAK), and Siemens was Soarian Clinicals. ing with diagnosis-related group (DRG)
Pharmacy. “Soarian made us nimble and made reimbursement. Under DRGs, the facility
“Workflow was the backbone of the results available in a timely manner,” receives a set dollar amount regardless
Siemens philosophy and one of the great- says Michael David Patterson, MD, Vice of the amount of time a patient stays in
est successes of Project Expert Care. President of Quality and Performance the hospital.
Siemens helped us to look at our work- Excellence and Chief Medical Officer. “If we can safely discharge patients –
flows, how we were operating, and how “Before that, we were reporting lab work safety being our primary objective – each
Soarian would impact those workflows,” on a paper. Nurses then used that paper day that we can reduce that stay is a
says Claudette Brown, RN, BSN, and chart for documentation. And the same dollar savings for the organization,” says
Clinical Applications Manager in the IS was true for medications – we used a Janene Yeater, Assistant Vice President
department. paper MAR [medication administration for Accreditation and Utilization Manage-
Brad Peffley, Vice President of Clinical record]. It is hard to believe we were ment. “Soarian, in part, enables us to
Services, agrees. “We used Siemens con- operating like that – and it was only a speed that delivery of care, helping to
sulting services along with our own staff few years ago.” directly improve our bottom line.”
to tear apart our existing processes and One of the biggest benefits of Soarian
look at ways we could gain the biggest Maximizing Efficiencies in Clinicals is rapid access to test results,
advantage from the new system.” Patient Care particularly radiology reports and labo-
Although the initiative elevated the role As part of Project Expert Care, one of ratory results.
of the IS department, senior management the first metrics baselined and moni- The turnaround time in radiology im-
made it clear this was more than a tech- tored – as an indication of the efficiencies proved dramatically when MedCentral
nology upgrade. Project Expert Care was MedCentral hoped to gain from the moved from film to Siemens syngo Suite
a system-wide initiative that was integral Soarian solution suite – was reducing for RIS and PACS. Prior to the implemen-
to the future of MedCentral. length of stay (LOS). tations, its average time for a final report
“IT itself doesn’t touch a patient or deliver In 2003, the average LOS was 5.4 days. was 24 hours – although 48 hours was
care, but it’s the nervous system for Today, that number has been reduced to not uncommon. Immediately after imple-
all the different activities involved with 4.6 days – the equivalent of having an menting Siemens digital imaging systems
A Microcosm of Project Expert Care:

The Emergency Department
There is little doubt of the impact that Soarian and other • Reduced triage-to-discharge time from more than five
Siemens solutions have had across the MedCentral enter- hours to 3.2 hours
prise. This, in fact, can be realized simply by examining its • Eliminated the pre-implementation practice of boarding
Emergency Department (ED) – an ideal microcosm of the patients – some intensive care unit patients – in the ED
benefits and efficiencies realized through MedCentral’s MedCentral’s ED also continues to invest in IT solutions,
greater Project Expert Care initiative. the most recent being the Emergency Department Tracking
The ED is a primary patient entry point where data capture Board, which provides ED clinicians the ability to auto-
is essential, as well as one of the most stressful and fast- mate portions of the admissions process. For example, if
paced areas within any hospital. Small inefficiencies are a patient is admitted in the ED and needs an X-ray, clinicians
amplified within the ED and can lead to problems further simply enter the appropriate data and Soarian will auto-
down the continuum of care. As such, it was a focal point matically send a notification to radiology. The radiologist,
at MedCentral when implementing its Soarian solutions. in turn, can monitor the ED Tracking Board to assess the
Here are some of the efficiencies realized: incoming caseload from the ED – introducing time effi-
• Reduced ED capacity from over 100 percent to around ciencies and workflow improvements.
85 to 90 percent The ED’s end result – representative of the greater Med-
• Reduced triage-to-admission time from almost eight Central enterprise – is improved patient safety, decreased
hours to 4.5 hours costs, and better overall quality of care for the patient.

and PACS throughout the Radiology
Suite, turnaround time was reduced to
six hours. In recent months – despite the
retirement of a radiologist and taking
on volume from MedCentral’s outpatient
center – turnaround time was further
reduced to an average of two hours while
maintaining quality levels.
“With PACS and our voice recognition soft-
ware, the final validated radiology report
– not the preliminary report – many times
beats the patient back to the room from
the X-ray department,” says Patterson.
The story is the same for transcriptions.
Despite moving all transcriptions inhouse
and adding the volume from another
facility, Siemens solutions enabled a Real-time information on their handhelds helps ensure phlebotomists know about test changes –
reduction in radiology staff from six full- and provide the correct sample at the correct time.
time equivalents (FTE) to 4.5 FTEs.
“Without a doubt, the PACS solution of
syngo Suite has made radiology more Ruckman, Phlebotomy Supervisor. In as well as the intangible benefits of
efficient and drastically improved our the end, these efficiencies in the lab add Siemens RIS/PACS integration.
throughput,” says Peffley. up to better and more timely care for “The integration of RIS and PACS saves
According to Patterson, the same trend the patient. us from doing many mundane tasks,”
can be found examining the NOVIUS Lab “Our physicians now have greater expec- says Philip Calendine, MD, Chair of the
implementation, which is a testament tations for lab results and availability. Department of Radiology. “When we
to the integration planning of the deploy- The effect is a completely different inter- select a patient name from our worklist,
ment. MedCentral’s laboratory is com- action with the lab,” says Terry Weston, all the demographics and patient infor-
prised of many independent systems and MD, Vice President of Physician Services. mation is automatically transferred.
instruments operating in two different “The conversation is not ‘where’s the There is no manual data entry. When
facilities, including an ADVIA WorkCell® report and when will I get it,’ but rather you’re reading 200 to 250 studies every
CDX Automation Solution with ADVIA physicians are free to ask deeper ques- day, saving an extra 20 seconds per
Centaur® Immunoassay Systems, ADVIA® tions and explore other possibilities.” study translates to hours over the course
1800 Chemistry Systems, and ADVIA of a week.”
CentraLink® Networking Solution. With Enterprise Cost Reductions
these Siemens solutions in place, “Labo- The solutions now in place at MedCentral Automating Patient Safety
ratory results are completed within an enable direct (i.e. reduced material costs) Patient safety was the underlying reason
hour or two. Before the implementation, and indirect (i.e. time efficiencies) cost for Project Expert Care, and no two solu-
it was 24 hours before a physician could savings across the enterprise. The radiol- tions implemented at MedCentral are
even look at that result.” ogy department offers textbook examples more directly associated with patient safe-
The reduction in turnaround time enabled of both. ty than the Siemens barcoding solutions:
the lab to increase its labor efficiency By transitioning from a film-based system Patient Identification Check and MAK.
as well. The number of lab procedures to PACS, MedCentral has eliminated the “Prior to go-live with Patient Identification
completed prior to the implementation cost of film almost completely. Within Check, I would do three or four disci-
was 9,975 per FTE. After the implemen- the first month of implementation it was plines a month with people misdrawing
tation, this metric jumped to 10,791 per 95 percent filmless. This translates to a patient,” says Project Expert Care
FTE – almost a ten percent increase in an annual savings of about US$450,000. Director Crowgey, also formerly the Lab
productivity. In addition, all data is auto- What is more, that number does not Director. “For the first year after imple-
matically verified before it is forwarded include the additional savings of chemi- mentation, in every place that Patient
to Soarian Clinicals, helping to assure cals, canceled maintenance contracts, Identification Check was used, I didn’t
consistency and increased quality in the and other ancillary costs associated with do a single discipline.”
results review process, further enhanc- film. In fact, since the implementation of
ing patient safety. MedCentral has also realized indirect Patient Identification Check in March
“One person can now do the work of cost savings in radiology, including 2006, there has not been a single
two under the old system,” says Debra the elimination of transcription services, patient identification error. This is due,

Summary
in large part, to the quick adoption of • Acute myocardial infarction (AMI) was
Challenge: the technology by phlebotomists. in the 50th percentile. Today, MedCentral
• Inefficient and time-consuming “We had a strict policy for labeling tubes is at 93 percent
paper reporting system among the phlebotomists – basically • Pneumonia was in the mid-30th percen-
• Inadequate paper-based docu- three strikes in a year and you’re out,” tile. Currently, is it at 90 percent
mentation says Crowgey. “They quickly recognized • Congestive heart failure was one
• Increased risk for patient that using technology would preserve of MedCentral’s lowest baseline scores.
safety due to human error in their jobs, as well as help reduce the Currently, it is at 94 percent
manual processes potential to make an error.” “We’re on the upper level of our stretch
• Medication errors that Patient safety is also reinforced by using goal for congestive heart failure and
threatened patient safety mobile devices, according to Karen looking to extend that beyond the nation-
• Excess turnaround times for Phalor, ASCP, an IT analyst and medical al average,” says Michael Schwartz,
lab and radiology reports technologist at MedCentral. “By simply Executive Director of Cardiovascular
• High costs associated with film- using their handhelds, phlebotomists Medicine, and adds that the functional-
based imaging technology can be fed real-time data when there are ity and flexibility of Soarian Cardiology –
• Extensive back-logs in the changes or tests added – this enables Siemens cardiovascular information so-
Emergency Department the correct sample at the correct time.” lution – and syngo Dynamics – Siemens
If Patient Identification Check is the safety cardiology PACS – have also helped
Solution: net for patient identification – satisfying recruit and retain the best cardiologists.
• Siemens Soarian Clinicals the five rights of patient safety – then The department is a source of pride for
workflow management tech- Med Administration Check (MAK) is the MedCentral. In 2007, 2008, and now
nology enables best-practice equivalent for medication – satisfying also for 2009, HealthGrades named its
implementations and continu- the five rights of medication administra- cardiac surgery program the best in Ohio
ing process improvements tion. Patient Identification Check coordi- – awarding it a Number One ranking.
• NOVIUS Lab streamlines and nates the efforts of the lab with that of In an effort to enhance reporting func-
standardizes laboratory pro- the phlebotomists. MAK coordinates the tionality to the already robust Soarian
cesses, reducing turnaround efforts of the pharmacy with that of the offering, MedCentral recently launched
times nurses. Soarian Quality Measures, which will
• An ADVIA automation system, The data generated shortly after go-live streamline the quality improvement pro-
along with ADVIA chemistry with the integrated Siemens Pharmacy cess by automating chart abstraction and
and immunoassay systems, and MAK solution speaks volumes to the help expedite the submission of quality
and the ADVIA CentraLink data layer of safety the technology provides. measures – as defined by the Centers for
management system auto- “The first week that we launched the Medicare and Medicaid Services and The
mates the laboratory solution, we caught 383 medication errors Joint Commission.
• Patient Identification Check – the wrong patient about to receive the
automates patient safety wrong medication, or about to receive it Interdisciplinary Care
through point-of-care bar- at the wrong time, or at the wrong dose,” The ability for various departments and
coding technology – helping says Patterson. “That was a humbling disciplines to work together and easily
ensure the five rights of experience. I can’t imagine a healthcare share information was a priority from
patient safety system even considering a future without the beginning – the primary reason for
• Med Administration Check something like Pharmacy MAK in place.” taking an enterprise approach to Project
(MAK) automates medication Expert Care. “When we examined the
administration through point- Core and Quality Measures Soarian solution from an integration per-
of-care barcoding technology MedCentral has seen a dramatic turn- spective – bringing together pharmacy,
– helping ensure the five around in its ability to share information lab, radiology, et cetera – it was our top
rights of medication adminis- because of Soarian. “Our core measures pick,” says Phalor.
tration have improved so much that we’ve not Clinicians at MedCentral credit two fea-
• syngo Suite improves commu- only hit our goals, but we’re also talking tures of the Soarian implementation for
nication through the use of about raising the bar,” says Patterson. enabling this interaction: the functional
complete imaging management “You can pick any core measure and I can screen and online access.
workflow, increasing efficiency directly relate how Soarian assisted with The functional screen is part of the nurs-
and access to digital informa- that quality-of-care improvement.” ing admission assessment that identifies
tion When MedCentral first started capturing criteria points from each discipline.
core measurement data: Nurses mark each criteria point exhibited

by a new admission. Soarian processes
the completed functional screen and
automatically prompts a consult referral
to the relevant discipline.
“The functional screen has been signifi-
cant in improving our patient care, but
it also helps decrease our length of stay,”
says Joann Plaster, Vice President of
Nursing and Social Work Services. “The
sooner you can get all the necessary dis-
ciplines involved in the care, the faster
that patient gets better.”
In the first month of operation with
Soarian’s rules and workflow technology
– the system on which the functional
screen is based – MedCentral saw a Turnaround time for radiology reports has decreased from 24 hours to two hours with the
double-digit percentage increase in the implementation of PACS and voice recognition.
number of consults delivered to the
various disciplines. • The PACS, part of syngo Suite,
“This functionality also goes a long way Project Expert Care initiative. The health helps provide security as well
with Joint Commission and other com- system already has plans to expand the as remote and easy access to
pliance reporting,” says Yeater. “This pro- use of existing technology to remote archived digital images across
cess is now automated and patient care facilities and has a list of new technolo- various disciplines
is done consistently and in a standardized gies that are in some stage of planning. • The RIS, part of syngo Suite,
fashion, which directly impacts accredi- These include Computerized Physician enhances imaging communi-
tation.” Order Entry (CPOE), further utilization cations to and from the radiol-
Access to information has been, perhaps, of its Emergency Department Tracking ogy department and integrates
the single greatest benefit of the Soarian Board, Siemens critical care application, seamlessly with the PACS
solution. “There’s a lot of data available Soarian Plans of Care, Decision Support • Soarian Cardiology and syngo
that we didn’t have before,” says Peffley. with embedded analytics, Soarian Dynamics aid in moving from
“Whether it’s patient statistical informa- Cardiology and AXIOM® Sensis, Soarian modality-focused to patient-
tion, departmental statistical information, Quality Measures, radio frequency iden- centered care
or financial information and budget tification (RFID) capabilities, and Soarian
reports, I can get it myself and it’s avail- Health Information Management (HIM). Result:
able almost immediately.” “The goal is to have our entire enterprise • Workflow efficiencies resulting
The result is better communication on one Soarian system,” says Patterson. in reduced length of stays
between departments, particularly with “Siemens will beat every other vendor • Increased patient safety by
the nursing and the medical staff. “Nurses and win the race to a complete enterprise automating processes and
have access to results immediately and solution. This is the secret to our great minimizing human error
electronically. The physicians – even from partnership. MedCentral will help Siemens • Increased laboratory efficiency,
home – also have online access,” says to achieve that goal, because we want decreased laboratory turn-
Weston. “This is a vast improvement and to be the first health system to implement around time, improved labora-
makes a nurse’s reporting capability ex- the solution.” tory efficiency, and increased
ponentially stronger and faster.” Express- laboratory capacity
ing similar sentiments, Crowgey adds: Kevin Self is a writer for Launch International, • Significant improvements in
“Online access to the right information a company specializing in strategic marketing core measures
and sales enablement for technology companies.
at the right time improves patient care • Reduced costs through greater
and supports faster clinical decision- productivity and elimination
making. It is just good quality patient of materials and outsourced
care.” services
Further Information • Increased interdisciplinary
A Foundation for the Future www.siemens.com/syngo communication
MedCentral, with its suite of Siemens www.siemens.com/Soarian • Enhanced accessibility to
solutions in place, is only beginning its information

Ultrasound

Ultrasound
Tissue Strain Analytics –

A Breakthrough for Ultrasound
Liver Examinations
A new era is dawning for quicker, more accurate
diagnoses of pathologies in the liver, thanks to
a research partnership between The University
College London Hospital and Siemens Healthcare.
By Nils Lindstrand
A member of the Siemens Healthcare logical diagnostic process. No single

Ultrasound Research Advisory Board, parameter is going to enable us to char-
Professor William Lees, MD, of the Uni- acterize tissue with any degree of accu-
versity College London Hospital (UCLH), racy, but the more parameters we have,
UK, started researching the clinical poten- the more confident our diagnosis can be,”
tial of ultrasound Acoustic Radiation Force says Lees of the emerging application.
Impulse (ARFI) imaging about one year Virtual Touch™ Tissue Imaging1, the first
ago. He soon realized that this technology commercially available implementation
might be a way to increase the clinical of ARFI, uses an acoustic ’push pulse’ to
diagnostic information that results from interrogate the mechanical strain prop-
conventional sonographic examinations.
“Tissue Strain Analytics1 adds an indepen-
dent parameter to our existing morpho- 1
This product is not commercially available in the U.S.

A member of the Siemens Healthcare Ultrasound Research Advisory Board, Professor Dr. Lees examines the capabilities
of Virtual Touch Tissue Imaging and Quantification in liver fibrosis.
Summary erties or stiffness of tissue, a method This is implemented by Virtual Touch

similar to a physical palpation exam. Vir- Tissue Quantification1. Shear waves,
Challenge: tual Touch images provide complemen- which travel at greater speeds in stiff
• Obtain qualitative visual or quan- tary information to the standard B-mode tissue compared with soft tissue, are
titative value measurements of the image by supplying insights into changes generated, and travel perpendicular to
mechanical stiffness properties of in tissue stiffness, which are often asso- the push pulse. While they do not inter-
tissue ciated with pathology. act directly with the transducer, their
A Virtual Touch image is formed by apply- movement may be tracked by detecting
Solution: ing a push pulse, which results in the tissue displacement perpendicular to
• Tissue Strain Imaging allows relative displacement of tissue elements. the transmitted, conventional ultrasound
visualization of differences in the The degree of displacement will vary beam.
stiffness of tissues and pathologies with the specific stiffness properties. For “It is like hitting a board on the upside
that may otherwise appear very example, soft tissue will experience and feeling the effect at the ends,” says
similar using conventional ultra- greater displacement than very stiff tissue, Lees, “only with an extremely high accu-
sound imaging which may displace a very small amount racy in the measurement.” Virtual Touch
• Tissue Strain Imaging has the or not at all. Conventional ultrasound Tissue Quantification may prove to be a
potential for immediate results beams track the displacement of tissue. major breakthrough in identifying early
• Tissue Strain Imaging is user- This information is compared to the stages of liver diseases causing cirrhosis.
independent baseline image, resulting in a qualitative In early studies, the application proved
elastogram, which visually represents extremely sensitive in diagnosing fibrosis
Result: the variation in stiffness within a region and distinguishing it from normal liver
• Virtual Touch applications, together of interest. and cirrhosis. Conventional ultrasound,
with conventional sonographic Today, this technology is only available on the other hand, cannot detect fibrotic
scans, may enable physicians to by Siemens with the ACUSON S2000™ changes prior to cirrhosis. “We will need
avoid unnecessary biopsies ultrasound system. “Virtual Touch Tissue more data to determine whether this new
• Grey scale image presents a map of Imaging is an important evolution of the technology is also capable of tracking
regions and localized areas which ultrasound scanning technologies,” says progression of fibrosis or responses to
shows relative stiffness in the tissue Lees. “The technology works, it is reliable treatment, but I am very optimistic that
• Numeric value provides a good and robust. Virtual Touch Tissue Imaging it will have this capability,” says Lees.
understanding of the general con- has a minimal impact on the tissue, yet The robustness of Virtual Touch applica-
dition of the tissue it has the ability to extract an impressive tions is an important advantage of this
amount of vital information out of a method. “We have been examining
single procedure.” obese patients during the clinical studies
already completed, and Virtual Touch
Breakthrough for Liver Imaging showed very good accuracy,”
Examinations says Lees.
Another application of ARFI technology is
the measurement of shear-wave velocity. 1
This product is not commercially available in the U.S.

Ultrasound
Lees stresses the advantage of Virtual to be able to define its role. Lees is con- The interest for Virtual Touch applica-
Touch applications as a user-independent vinced that Virtual Touch applications tions has so far largely been confined to
method. “Both with traditional physical offer improved patient care on an individ- the liver. It may, however, prove to be
palpations and preceding ultrasound ual basis. Physicians will be able to tell a valuable tool also in examinations of
technologies, it is easier than you would patients that they have nothing to worry other organs, for example, the kidneys
imagine for a physician to press harder about, or to proceed faster to additional and thyroid and maybe the lung. It will
to get the result he or she was expecting examinations and treatment if this probably not work as well in rapidly
before the examination. With Virtual proves necessary. “The benefit of Virtual moving structures such as the heart and
Touch applications, however, it is just Touch applications is that we can be vascular system. “Apart from this, we
pushing a button. You get the same more convinced of doing the right things will need to establish a much larger da-
accuracy every time, regardless of the and giving correct information to the tabase of Virtual Touch Tissue Quantifi-
operator, time, or expectations.” patient.” cation measurements in other diseases
Lees and the UCLH are now organizing of organs,” says Lees. “I think it will be
A Way to Avoid Unnecessary clinical tests for Virtual Touch applica- another year or two before we fully
Biopsies tions, collaborating with a number of understand the potential of this technol-
Virtual Touch applications may offer a other clinics and hospitals in Great Britain. ogy.”
way to reduce unnecessary biopsies They will start as soon as the last details
and other invasive procedures otherwise in the methodology are established and Nils Lindstrand is a freelance business and
needed to give an accurate diagnosis agreed upon. “We should be able to con- technology writer based in Stockholm, Sweden.
through easy evaluation of pathology. duct these clinical tests within a couple
“These kinds of anomalies may be diffi- of months,” says Lees. “We have already
cult to separate from malign tissue with submitted an abstract to the European
other kinds of scanning technologies,” Congress of Radiology 2009 on Virtual Further Information
says Lees. “This is typical of how Virtual Touch applications, and I think it will be
www.siemens.com/strain
Touch Imaging is helping us: We can avoid sufficiently validated for wider clinical
many biopsies and other uncomfortable application towards the end of 2009.”
and unnecessary examinations.”
Using this technology together with
conventional sonographic scans and
traditional biochemical examination,
physicians may also be able to give a
more reliable answer whether a pathology
is malignant or benign.
“I believe Virtual Touch applications will
Tissue Strain Analytics
be an integral part of scanning procedures
in the near future,” says Lees. “Our clini- at a Glance
cal tests up until now have shown a very Tissue Strain Analytics is a new ultrasound application that enables visual
high accuracy in separating malignant, or numerical measurements of the mechanical stiffness of tissue. This
benign, and healthy tissue. The method new dimension of information, which is not available using conventional
is quick and user-independent, and is sonographic imaging, represents the most significant advancement in
totally unnoticeable for the patient.” ultrasound technology since the advent of Doppler imaging. Tissue Strain
Analytics features three applications:
More Validation Needed • Virtual Touch Tissue Imaging allows clinicians to create a relative
“My present experience today is built on stiffness map (elastogram) for any region of interest.
more than 200 cases,” says Lees, “and it • Virtual Touch Tissue Quantification is the first and only application
indicates that Virtual Touch applications to provide a numerical value of shear-wave speed related to tissue
can detect fibrosis in an otherwise stiffness at a precise anatomical location.
normal-appearing liver.” Now this needs • eSie Touch™ elasticity imaging, available on both the ACUSON
to be validated against liver biopsy and Antares™ and ACUSON S2000 systems, enables high-resolution
biochemical testing for chronic liver elastography using both superficial and endocavity transducers.
disease. Experience shows that up to a
thousand validated cases may be needed

In a busy hospital emergency department such as
that of St. David’s South Austin Hospital, a part of
St. David’s HealthCare in Austin, Texas, U.S., it is a race
against time to diagnose acute coronary syndrome.
Shearing unprecedented time off the diagnostic pro-
cess contributes to faster, more appropriate therapy,
better asset utilization and lower costs. Most impor-
tantly – it saves lives.
By Diana Smith
Rush Hour
tral hospital laboratory where even
immediate tests can take an hour or
more.
“Time is very much a factor in acute
coronary syndrome [ACS],” says Steve
Berkowitz, MD, Chief Medical Officer of
St. David’s South Austin Hospital, a mem-
’Time is muscle‘ is a common adage ber of the St. David’s HealthCare system
among cardiologists, referring to the criti- in central Texas. “When that coronary
cal moments after a myocardial infarction artery is blocked, the heart doesn’t
(MI), or heart attack, when even minutes receive blood flow to itself and it will fail
without intervention can translate into as a pump in a course that would have
muscle damage. However, not all patients dire consequences to the patient. The
present to emergency departments with bottom line: Mortality improves when
obvious MI symptoms. For these patients, we can intervene faster, so that is our
the need to rapidly determine if a heart fundamental goal.”
attack has occurred, obviously, is critical. In an effort to speed up this critical time
Yet evaluation can be a clinical challenge between diagnosis and treatment, admin-
when blood must be sent to a busy cen- istrators at the 252-bed facility turned

to Siemens Healthcare Diagnostics for claimed ’Live Music Capital of the World,’ a higher number of acute care patients
cutting-edge technology that has trans- the hospital is a certified Chest Pain like those presenting with chest pain or
formed the way the Emergency Depart- Center accredited by the Society for Chest other cardiac complaints. When we can
ment delivers care for patients who arrive Pain Centers. determine whether the patient does or
with atypical heart attack symptoms. Built in 1982, St. David’s South Austin does not have an acute cardiac event,
The Stratus® CS Acute Care™ Diagnostic Hospital completed a US$50 million the appropriate diagnosis can be made.
System with high-sensitivity assay capa- expansion project in 2004. Today, its 42- Siemens point-of-care cardiac technology
bility has dramatically improved the time bed Emergency Department is divided gets us this information fast.”
it takes to arrive at a diagnosis for patients into three areas of care: cardiac, exami-
with atypical symptoms, according to nation, and fast track. “On average, we The Role of Cardiac Marker
Berkowitz. see 160 to 180 patients and admit 30 Testing
to 40 in a 24-hour period,” says Renee “In an emergency setting, speed is criti-
Increased Demand Buhman, RN, the Emergency Depart- cal for patients who have electrocardio-
In Austin, the fourth-largest city in Texas, ment’s educator. graphic signs of a heart attack, referred
roughly the size of San Francisco, the Buhman credits specially trained staff to as ST-elevation myocardial infarction,
St. David’s Emergency Department is one and advanced technology for much of the or STEMI. These patients require imme-
of the busiest in town, seeing more than hospital’s success in dealing with cardiac diate attention,” Berkowitz says. “They
60,000 patients each year. Located south cases. “With a high volume of patients in are very sick people, and we take them
of the Colorado River in the self-pro- general, there is always the potential for directly to the catherization lab for inva-

Cardiac Emergency Care
cal marker testing, which requires that

blood be drawn and evaluated for
chemical indicators that show whether
a heart attack has occurred. These typi-
cally include a troponin test, which may
be ordered along with other cardiac bio-
markers, such as CK-MB, which in high
Summary concentrations indicates long-term dam-
age of the heart muscle, or myoglobin.
Challenge: “Elevated troponin is a good indicator of
• Reduce amount of time for cardiac heart attack, because when heart cells
biomarker test results for quicker die, they release troponin into the blood-
diagnosis of patients with atypical stream,” explains Berkowitz.
MI symptoms
• Improve management of chest Quickened Response
pain patients in the emergency “In the past, it was necessary to send
department blood specimens to the lab for testing,”
• Implement protocol that results “With reduced adds Buhman. “We would get results
in proven efficiency to allow better back in 30 to 45 minutes minimum.”
reimbursement under pay-for- time to decision, Now, St. David’s South Austin Hospital
performance system
we are able to has turned that number upside down,
typically getting results in only 14 to 17
Solution: initiate thera- minutes.
The reason? Three years ago, the hospi-
• Initiate point-of-care biomarker
testing using the Stratus CS Acute pies much more tal implemented four Stratus CS Acute
Care Diagnostic System from Care Diagnostic Systems from Siemens
Siemens Healthcare Diagnostics quickly.” right in the Emergency Department to
right in the ED run the blood assay tests, saving precious
• Establish a protocol for the use of time for patients. With its high sensitivity2
Steve Berkowitz, MD,
the systems that allows for best Chief Medical Officer, troponin test method, proximity at the
patient care and clinical workflow South Austin Hospital, point of emergency patient care, and
• Educate physicians, nurses, and St. David’s HealthCare, Austin, TX, USA quick test turnaround times, the Stratus
laboratory personnel about the CS systems’ protocol translated into
benefits of point-of-care testing meaningful results for patients. Cardiac
biochemical marker results are delivered
Result1: in mere minutes, not the standard one-
• Dramatic time savings on test sive treatment as quickly as possible. It’s hour ’vein to brain‘ timeframe recom-
results (troponin and other cardiac almost like Monopoly – do not pass Go; mended by many international medical
biomarker test results available in do not collect 200 Dollars; go right to the organizations.
only 14 to 17 minutes) cath lab.” “With reduced time to decision, we
• Earlier diagnoses lead to earlier According to the Chief Medical Officer, are able to initiate therapies much more
intervention (70 percent reduction the situation becomes trickier when quickly. Those extra minutes of time
in time from ’door to PCI‘) people do not have ’typical‘ symptoms – can be the difference of life or death for
• 56 percent reduction in admissions severe, crushing chest pain “like an a patient with heart disease,” says
for low-risk chest pain patients elephant standing on your chest,” pain Berkowitz.
• Faster turnover of ED beds, reduc- radiating down the arm, severe short- Further, getting results faster provides
tion of unnecessary procedures, ness of breath, nausea, vomiting, and some relief on an emotional level,
lowered length of stay, and fewer sweating. “As many as half of patients explains Buhman. Chest pain patients
readmissions of cardiac patients don’t have the typical textbook symp- frequently are anxious, she says. “If we
• Better patient care toms,” he reports. “And time is just as find their cardiac biomarkers are indi-
• Organized, efficient use of clini- critical for those people as it is for those cating an acute cardiac condition, we
cians’ time and hospital’s resources who have an established heart attack on can let the patient know quickly and
• Improved reimbursement the electrocardiogram.” 2
Defined by the ESC/ACC/AHA/WHF committee as an
In these non-STEMI (NSTEMI) cases, stan- imprecision level of ≤10 percent at the 99th percentile
1
Results may vary. Data on file. dard protocols call for cardiac biochemi- of normal.

Integrated Technology:
Helping Transform U.S. Healthcare
Today, hospitals in the U.S. are facing immense pressure to choices: raise taxes to cover waste or eliminate waste, such
provide more efficient and higher quality healthcare as excessive treatment times, unnecessary resource utili-
while reducing costs. Increasingly, reimbursement is linked zation, and unnecessary hospitalizations.”
directly to a hospital’s clinical performance. As a result, CMS is seeking widespread transformation of
Sandra Sieck, RN, President of Sieck Healthcare Consulting the U.S. healthcare system and is using reimbursement as
in Mobile, Alabama, a top expert on healthcare business a major impetus for change. In 2007, the Secretary of Health
reform, has worked with more than 2,000 hospitals across and Human Services delivered a report to Congress sug-
the country to optimize clinical and financial outcomes. gesting ways to transform Medicare from a passive payer
According to Sieck, though U.S. per capita spending on to an active purchaser of high-quality, efficient healthcare.
healthcare substantially outpaces European countries, the That plan includes value-based purchasing, which links
U.S. fails to achieve better health outcomes, and has been payment more directly to the quality of care and rewards
shown in multiple studies to be last on dimensions of providers who supply it.
access, patient safety, efficiency, and equity.
Patients and payers alike are demanding fundamental, The Future of U.S. Healthcare
widespread change. Advanced integrated technology is Value-based purchasing demands that identified patient
helping lead the way. populations receive specific medical and clinical tests and
treatment in accordance with professionally recognized
American versus European Models standards of healthcare to assure full CMS market basket
Per capita spending in the U.S. is higher than in Europe, reimbursement. Hospitals must have:
largely because of differences in disease prevalence. The • Better asset or resource utilization – omit waste
U.S. takes a more aggressive approach to detecting and • Optimized decision times – fast, accurate test results
treating patients, yet data shows that Americans are in that facilitate timely treatment decisions
poorer health, with higher rates of serious chronic illnesses. • Shorter lengths of stay – reduce stays, but not being
so lean that hospitals face compliance issues or negative
Reimbursement Challenges patient outcomes
The U.S. multipayer system also presents financial chal- • Fewer admissions for unnecessary chest pain rule-out
lenges, explains Sieck. “With its multiple rules, forms, and There is no easy answer for improved clinical and financial
procedures, it costs an estimated 20 to 30 percent of the success, but advanced, integrated technology is a key
total healthcare expenditure, in contrast to only ten percent component to providing more efficient and higher-quality
in Canada and some European countries,” she says. healthcare. Combination testing using advanced technol-
“Today, in the U.S., we’re seeing increasing expenditures ogy, such as the integration of laboratory, IT, and imaging,
and expanding federal benefits to cover a growing benefi- help ensure better data for treatment decisions and im-
ciary population, Baby Boomers and Baby Loomers [babies proves cost-effectiveness through improved clinical work-
born in the 70s]. As a self-funded government payer, CMS flow. Patients and hospitals alike benefit from better
[Centers for Medicare and Medicaid Services], the federal quality and maximized efficiency; hospitals can increase
agency that operates the Medicare program, has only two reimbursement.
begin treatment. When biomarkers and St. David’s South Austin Hospital and a cent reduction in time from ’door to PCI‘
the ECG are negative, we can let those second hospital in the St. David’s system (time the patient came through the door
patients know their condition does not are the only facilities in Austin using the to percutaneous coronary intervention).
show an acute cardiac condition at that Stratus CS systems to deliver rapid results Additionally, the hospital has realized a
time. We decrease patient anxiety by for the diagnosis of a cardiac event in 56 percent reduction in admissions for
letting them know if they have an acute NSTEMI patients. From 2003 to 2007, the low-risk chest pain patients.
cardiac event going on or not. Informa- number of NSTEMI patients in the Emer- Besides improving the speed of appro-
tion gives patients back the control they gency Department increased by 68 per- priate patient therapy, Berkowitz and
feel has been lost.” cent. Yet, the hospital has seen a 70 per- Buhman credit the state-of-the-art tech-

“We decrease patient anxiety

by letting them know if they have
an acute cardiac event going on
or not.”
Renee Buhman, RN, Educator, Emergency Department,
South Austin Hospital, St. David’s HealthCare, Austin, TX, USA
nology for helping increase numerous tinues, “Intuitively, we wanted to get knew the instrument and were comfort-
efficiencies in the hospital. These include, the test done as fast as we could, which able with it. Overall, we have been very
for example, faster turnover of Emergency meant the ED nurses, not laboratory pleased with the system, plus the train-
Department beds, reduction of unneces- personnel, would be responsible for per- ing and support by Siemens and their
sary procedures, appropriate use of tele- forming the tests. When the nurses saw Clinical Quality Initiatives team has been
metry beds, lowered length of stay, and how the timeliness would improve patient exceptional,” he says.
fewer readmissions of cardiac patients.3 care, they committed to learning how In any busy emergency department, there
Additionally, the hospital has seen reim- to perform the tests.” Now, about 60 are moments when time is critical. When
bursement improvements, according nurses are trained to use the analyzer, cardiac patients arrive, the pressure is on
to Buhman. “There is a better chance of which translates into direct time savings and the clock is ticking. For this central
appropriate reimbursement when evi- and faster intervention. Texas hospital, expedited high-sensitivity4
dence supporting the physician diagnosis The Stratus CS Acute Care Diagnostic troponin testing in the Emergency Depart-
and assigned treatment is in black and System is uniquely designed for use in ment with Siemens Stratus CS Acute Care
white. The elevation in cardiac markers an acute care setting. Small in size, the Diagnostic Systems has led to unprece-
provides just that in ACS/chest pain analyzer can be configured as both a dented results – improving efficiency,
patients.” bench-top or stand-alone workstation, buying valuable time, and making a dif-
with its own lightweight cart, refrigerator, ference to patients.
Synchronized Effort and uninterrupted power supply. This is
“The protocol would have never worked what St. David’s South Austin Hospital Diana Smith is a freelance writer based in
Liberty Hill, TX, USA.
without the buy-in of our chief patholo- uses.
gist, laboratory department, and emer- “We had the choice of going with a com- 4
Defined by the ESC/ACC/AHA/WHF committee as an
gency nurses,” says Berkowitz. “With petitor’s handheld device or the Siemens imprecision level of ≤10 percent at the 99th percentile
of normal.
CLIA [Clinical Laboratory Improvements Stratus CS,” says Berkowitz. “We chose
Amendments] licensing at stake, there the Stratus CS system based on its speed
were concerns from the lab, which and high sensitivity testing, but also
wanted to be sure the tests were per- because of the track record of Siemens Further Information
formed and analyzed correctly.” He con- and the confidence we have in the com-
www.siemens.com/diagnostics
pany. The analyzers are the same ones
3
Results may vary. Data on file. the lab has always been using, so they

At South Austin Hospital, cardiac biomarkers like troponin are analyzed with four Stratus CS Acute Care Diagnostic Systems
directly at the point of care in the Emergency Department.

Training and Maintenance
Only a few steps separate the classrooms from the imaging systems.
State-of-the-art
Training
With UPTIME Services, Siemens Healthcare offers
joint trainings for both customers and Siemens
Service Engineers worldwide, providing a variety
of technical and application courses to keep
everyone’s expertise on the cutting edge.
By Justus Krüger
Gil Palcone was a little disappointed at peared as soon as he arrived in Shanghai. edge of medical and clinical technology,
first. Siemens Philippines – computed “I am 100 percent satisfied with the and develop it even further – regardless
tomography (CT) supplier of The Medical classes here,” Palcone happily declares – whether they take place in Germany, the
City Hospital in Manila – was not going and is already hoping for an update of his U.S., or China.
to send him to Erlangen, Germany for skills in a specific SOMATOM® Definition
his training course, as it did two months AS+ training. Global Training Concept
before, but to the new Siemens Training The Siemens Training Center in the “Our global training concept helps
Center in Shanghai. Chinese metropolis is part of Siemens provide the same high standards in all
“I did have doubts whether the courses Healthcare’s global training concept. training facilities,” says Thomas Weller,
in Shanghai would be as good as in Ger- The training, part of Siemens UPTIME General Manager for Customer Services
many,” says the 43-year-old biomedical Services, helps customers worldwide at Siemens Shanghai Medical Equip-
engineer. His doubts, however, disap- maintain their expertise on the cutting ment.

Each Siemens Training Center is
equipped with a variety of the company’s
systems for hands-on maintenance and
repair training.
The courses help Siemens customers For the healthcare providers, optimizing tial failures within the framework of a
deepen their understanding of extremely workflows also means higher system Shared Services agreement, the systems
sophisticated, state-of-the-art medical availability and a marked reduction in can be utilized more efficiently, saving
equipment such as the company’s mag- terms of costs. time for both operators and patients.
netic resonance imaging (MRI) and CT These are significant issues for the whole
scanners, or radiography, fluorography, spectrum of Siemens Healthcare cus- Theory and Practice
and angiography systems. That in turn tomers. Equipment such as CT scanners “That is an important factor,” says Weller,
empowers them to optimize workflows, is in such high demand, especially in “especially when it comes to systems
avoid and detect operational errors, and large hospitals, that patients often have such as CT scanners, which are often in
fully utilize their equipment’s potential. to endure a long wait. With an inhouse use non-stop from eight in the morning
This improves examination results and engineer educated in one of Siemens to ten in the evening.” Indeed, far from
increases patient care and satisfaction. Training Centers smoothing out poten- merely providing the latest theoretical

The Siemens Training and Development Center in Cary (left) opened in 1992. In 2006, Siemens built a new Training Center in Erlangen.
Worldwide Training
A leader in medical technology, Siemens Healthcare has network and workstation training. “Many clinics would be
implemented a global training process in order to offer happy to have the newest systems and the most current
state-of-the-art training for Siemens Customer Service software installed as we do,” says Volker Froede, who is
Engineers (CSEs) and customers worldwide. Three Training responsible for Siemens Healthcare’s Training Centers.
Centers have been set up in: Erlangen in southern However, participants can also train on older systems and
Germany; Cary in North Carolina, U.S.; and Shanghai in even on ones that are no longer sold.
China. Each Training Center is highly independent yet also inter-
All Training Centers are equipped with the latest Siemens connected with its two sister centers. If a customer or
systems and the most current software. CSE requires training not offered in Shanghai, Siemens
The Training and Development Center in Cary opened in provides a possibility for him or her to join a class in either
1992, featuring a 70,000-square-foot training facility with Erlangen or Cary, wherever the needed training is offered.
fully functional computed tomography (CT), magnetic Siemens has designed most training courses for both
resonance imaging, and X-ray systems and 35 classrooms. customers and Siemens personnel in order to provide
In 2006, the Erlangen Training Center opened after the same high level of education to internal staff and
Siemens Healthcare invested approximately €20 million in customers. A strong emphasis is placed on certification.
the building and close to €40 million in its equipment. More All Siemens participants must take a test and receive a
than 50 imaging systems, which include 15 systems in certificate after having passed it. Many application train-
angiography, two SOMATOM® Definition, several Biograph™ ing courses also offer the CME (Continuing Medical Edu-
and MAGNETOM® systems, as well as syngo® Suite are cation) credits that medical doctors require.
available to participants. In addition to classroom training, Siemens offers, for
The center in Shanghai is the most recent addition. As part example, virtual training, web-based classes and onsite
of Siemens Medical Park Shanghai, it is equipped with training. More than 14,000 participants worldwide attend
state-of-the-art technology, which includes three types of about 1,400 training sessions at the Siemens Training
CT scanners: SOMATOM Spirit, Emotion, and Sensation, Centers every year. In addition, about 16,000 people make
two digital radiography and fluoroscopy systems (AXIOM® use of e-learning, thereby making a difference to millions
Aristos and Iconos), as well as several multimodality of medical professionals, patients, and their families all
workstations to conduct syngo software and Oncology around the world.
training, the Training Centers also offer knowledge level: Basic, Advanced, Expert, tors. Siemens not only offers its custom-
practical application, which is truly indis- and Refreshment. The target groups for ers the chance to continuously enhance
pensable to provide first-class medical trainings include physicians, radiology their skills, but is also sending their own
service. The training divides participants technologists and radiographers, as well service engineers back to school: The
into four levels, depending on their as engineers and hospital IT administra- main participants, other than customers

of Siemens Healthcare, are Siemens get the quality we want,” Weller says.
Customer Service Engineers (CSEs). This, however, is not the end of quality
Combining the courses for customers control. “We ask participants – via a
and Siemens staff, UPTIME Services pro- questionnaire or online – how valuable
vides a great opportunity to exchange the training was for them,” says Volker
valuable experience. Froede, who is responsible for the global
As providing good quality training is a
top priority of Siemens, the number of
participants per course does not exceed
twelve. This allows an intensive exchange
between trainers and participants. It also
helps provide everybody with plenty of
opportunity to work with the systems
and to get hands-on experience with the
equipment.
For Palcone, this is one of the big bene-
fits of the training concept. “We don’t
only study theory; we apply it to the
systems – every day,” he says. “That way
you can really absorb the knowledge.”
Driven by an innovative concept, the
courses offer an interactive training
method that is more like a workshop or
a seminar than a lecture. Trainers keep
checking whether everybody is follow-
ing; participants ask back; the discussions
are lively. That way, the trainers have a
clear picture of how far each student
has progressed at any one time and how
much catching up there is to do. Also, Siemens International
it is simply more fun and contributes to
a good learning atmosphere. Medical Park Shanghai
High-Quality Training Probably no other Chinese city, or even Asian metropolis, has risen
All three training centers offer the same higher in excitement than Shanghai. More than merely capitalizing on
quality of training, and that is, in part, its romantic past, Shanghai is a vibrant city that promises plenty for
due to the same level of skills and knowl- the future.
edge demanded from the trainers. No In this forward-looking metropolis, Siemens has invested more than
matter if they work in Shanghai, Cary, or €30 million to set up a new landmark facility. In May 2007, Siemens
Erlangen, the requirements are high, not Healthcare China’s headquarters and Siemens Shanghai Medical Equip-
only in technical knowledge, but also ment moved together to the Shanghai International Medical Zone
in the ability to teach and transmit that (SIMZ) as a pioneer in this new development area. SIMZ is an ambitious
knowledge. project of the Shanghai municipal government covering 11.5 square
All prospective trainers first take courses kilometers in Shanghai’s southeastern Nanhui district. The new zone,
along with Siemens customers in one set to be completed in 2015, is projected to be an international center
of the three Training Centers before they of medical care, education, training and research and development (R&D).
start teaching individual modules. After The move thus also marked the successful integration of Siemens
that, they will receive ’Train the Trainer’ Healthcare China’s R&D, manufacturing, service, sales, and marketing
education and finally can start to teach resources with more than 1,000 Siemens Healthcare employees, work-
whole courses under the supervision of ing closely together under one roof. Together with Siemens Healthcare’s
an experienced instructor. Upon receiving first comprehensive medical equipment show center in Asia and Siemens
a certification and having several months Healthcare’s Service Center for Asia, the new facility represents a strong
of experience, supervisors will observe center of gravity for Siemens Healthcare’s activities in China and Asia.
their teaching in the classes again. “That
way, we can make sure that we really

Small courses allow an intensive exchange between trainers and participants, and help provide everybody with plenty of opportunity to work with the
training strategy. “A high percentage of rotate worldwide. An instructor from their respective home markets. The center
the questions have to come back with Shanghai can be asked to teach in the in Shanghai, for instance, is attracting
either ‘excellent’ or ‘good’, otherwise we U.S. and Germany, while a U.S. trainer interest not only from China but serves
have to initiate changes to the training.” is just as fit to teach in Erlangen or in the entire Asia-Pacific region. In a typical
To help provide a truly global and stan- Shanghai as in Cary. All courses are held week, Manish Pathak, a trainer and
dardized training approach, trainers in English, as the centers not only serve Senior Manager at Siemens Healthcare,
will be teaching a class of ten students
who may come from six countries within
different corners of Asia-Pacific, from
Russia to Japan or from China to Austra-
“I am 100 percent satisfied lia.
Growing Fast
with the classes here.” China was a logical choice as the location
for the third Siemens Training Center.
Gil Palcone, Biomedical Engineer, The Medical City Hospital, Manila, Philippines “China is a fast growing healthcare mar-
ket, and on its way to be the largest
market in Asia,” says Weller. “That means
there is a high demand for technical
experts and knowledge [in China]. The
close interaction of R&D [research and
development], manufacturing, and cus-
tomer service makes a lot of sense. It
achieves a host of synergy,” explains
Weller.
It is, in fact, the synergy that develops
between education and service that
further helps to better diagnose and cor-
rect any issues that may arise.
A basic course in CT, for instance, en-
ables operators to benefit from Siemens
service support even more than usual.
While today, based on the service agree-
ment, many system malfunctions can
be solved remotely via Siemens Remote
The Medical City Hospital in Manila, Philippines, a private, tertiary care hospital, serves Service (SRS), some system malfunctions
some 40,000 inpatients and 380,000 outpatients a year. require onsite support by a trained

systems and get hands-on experience with the equipment.
engineer, for example, with regard to the temperature in a CT scanner’s cool- Summary
the exchange of a spare part. If inhouse ing system leaves a range of tolerance,
engineers at the customer’s site have the scanner will automatically report to Challenge:
been trained by Siemens in certain issues the Service Center. Then, a Siemens • Utilize the full potential of medical
within the scope of a Shared Services engineer can proactively contact the equipment
agreement, a good understanding of the institution where the system is located • Keep expertise on the cutting edge
system allows them to talk the technical and either solve the issue remotely or • Optimize workflows
language of the Siemens expert, identify dispatch a Customer Service Engineer to
and explain the issue via telephone, and go to the customer’s site. If the inhouse Solution:
initiate relevant tests. engineer in the hospital or clinic has a • Global training process to offer
“That really enables the customer to good grasp of the system, he can count state-of-the-art training
have a meaningful discussion with the on his knowledge to work together effi- • Three main Training Centers in
expert in the Siemens Service Center. ciently with the Siemens expert. “I think Erlangen, Germany; Cary, U.S.; and
If this is not the case, the Service Center the combination of remote service and Shanghai, China
would usually send a Siemens Customer training is really ideal,” Weller says. • Variety of technical and application
Service Engineer to the hospital,” says Palcone agrees. “We have an excellent trainings
Pathak. In contrast, when an inhouse working relationship with Siemens,” says • Innovative training concept combin-
engineer or operator has a good knowl- the engineer from Manila. Last month, ing theoretical and practical training
edge of the system, he or she can leap- Palcone says, there were difficulties with • CME (Continuing Medical Education)
frog several time-consuming steps in the hospital’s MRI system. Thanks to his credits for various courses
the procedure. In case a problem can be experience, his course, and Siemens • Constant quality controls to meet
identified inhouse or with the help of Remote Service, the problem got fixed high standards of excellence
the Service Center, Siemens can immedi- within 15 minutes. “Good for Siemens,” • Training Centers equipped with the
ately send an engineer along with the Palcone laughs. “But even better for us. latest Siemens systems and software
required spare part. “If you have a good This is really a win-win situation.” • Highly qualified trainers
preliminary diagnosis, you can save a lot
of time,” Pathak adds. Justus Krüger is correspondent for the Berliner Result:
Zeitung in Beijing, China.
• Competitive edge thanks to higher
Training and Siemens Remote efficiency
Service • Higher system availability because
The combination of training can truly of workflow and maintenance
increase efficiency. SRS links the equip- Further Information improvements
ment at the health service provider www.siemens.com/ • Improved examination results
with a Siemens Service Center, enabling medical_training_center through utilizing all existing func-
experts to recognize sources of error in www.siemens.com/ tionalities
many cases even before the customer uptime-services • Faster, more secure diagnoses
becomes aware of them. For instance, if • Increased patient satisfaction

Essay Series: Healthcare Systems – Japan
The Japanese Healthcare System

By Seiritsu Ogura
Professor of Economics at Hosei University in Tokyo, Japan, and Editor of the Japanese Journal of Health Economics and Policy
Japanese healthcare is in a crisis. Unlike

past crises, this one is a very quiet one, as
it is coming from disappearing essential
services. On weekends, we find emer-
gency rooms (ER) of any major hospitals
practically deserted, as patients are
turned down before – and after – their
arrivals. The hospitals don’t have enough
staff to operate the ERs, and, even if they
did, they couldn’t afford to take care of
the patient volume. In rural communities,
local governments are closing their pub-
lic hospitals in large numbers due to lack
of funds. We have serious shortages of
physicians, nurses, emergency facilities,
pediatric hospitals, obstetric facilities, etc.
We have observed a series of bad deci-
sions by the Ministry of Health, Labor and
Welfare (MHLW) during the past decade
that should have contributed to this crisis,
but they are more results than causes.
We have a shortage of funds because we
have not infused enough money into our
health insurance system to care for the
growing population of the elderly. In the
past few years, no one wanted to talk
about tax increases for fear of losing the
next election. The government has been
piling up a huge national debt for almost
two decades, which has reached almost
twice the size of the GDP. The implicit debt
in our public pension program is almost
the same size too. The Ministry of Finance
wants to restore primary balance by year
2011 and wants the MHLW to keep the
lid on healthcare expenditures, allowing
only a ¥1.1 trillion increase in the costs
of all social security programs during the
five-year period prior to 2011.
In response to these pressures, MHLW
produced a reform package in 2006 con-

“The root cause of our present

crisis is the shortage of funds.”
sisting of medical insurance programs Seiritsu Ogura
Professor of Economics, Hosei University, Tokyo, Japan,
for people over 75, and a new reinsur-
and Editor of the Japanese Journal of Health Economics and Policy
ance scheme for people from 65 to 74.
They put them into effect in April 2008,
but so far, they have turned out to be
extremely unpopular. In what follows, I
will explain the outlines of this financial
reform package and the reasons why it
has met with strong public opposition.
For historical reasons, the Japanese pub-
lic health insurance system consists of years, the contribution formulas have the poor. It may very well cost the present
two basic types of insurance programs: been modified several times, and in the ruling parties the next election.
employees’ programs and municipal pro- meantime, the minimum age for re- In the past, there was another reinsur-
grams. The two types of programs have insurance has been moved up to age 75. ance program involving those under the
very different comparative health risks Finally, starting in April 2008, the govern- age 75, in which employee programs
and financial bases. In short, employee ment renamed the reinsurance scheme reimbursed municipal programs for the
programs have smaller healthcare needs as ’medical insurance programs for the cost of those who had switched from
and a larger revenue base, while munici- old-old,’ reorganized it into regional in- employee pensions. Starting in April 2008,
pal programs have much larger health- surance programs, and started to collect the government replaced this program
care needs and a smaller revenue base. ten percent of the costs mostly through with a comprehensive reinsurance of
In spite of these gaps, up to the 1970s, their own poll taxes. Furthermore, it has healthcare costs of all the individuals
the government was able to provide suf- come up with its own benefit package, between the ages of 65 and 74. Their
ficient subsidies for the municipal pro- adopting comprehensive payment for healthcare costs are paid by all insurance
grams to keep them running. As retired most outpatient care, instead of the programs in proportion to the shares in
workers started to concentrate in the former fee-for-service system. insured individuals between birth and
municipal programs, however, these gaps This scheme has generated an enormous age 74. The government makes no inde-
started to widen even further. By the public outcry. Some have even compared pendent contribution to this scheme,
early 1980s, the government, facing its the insurance to a legendary ‘granny but it provides subsidies to municipal
own huge deficits, could no longer keep dumping mountain,’ blaming the govern- programs for half of their contributions
up with paying subsidies to meet the ment for attempting to deny anyone and to small companies’ programs for 17
bulging demands of the municipal pro- above the age of 75 their normal health- percent of their contributions.
grams. care services. As soon as the details of This new scheme has met another strong
In 1982, the government introduced this package became public, most physi- protest, this time from large companies.
reinsurance of the healthcare costs of cians expressed their strong opposition Let me explain why. Suppose we have
those at age 70 or older in our health to its comprehensive payment scheme, someone who had his 65th birthday on
insurance. In the scheme, the govern- claiming that it will prevent them from the 31st of December last year. Let us
ment contributed half of the costs, and performing necessary procedures, using also suppose that he used to spend one
asked all the programs to pay for the necessary drugs, and ordering necessary unit of healthcare a year until his 65th
other half, according to a formula using tests. Furthermore, because of the regres- birthday, but now he spends four units a
several factors, including the number of sive poll taxes, this old-old insurance has year. We want to find out how the extra
individuals in their programs. Over the been very unpopular, particularly among three units will be paid in our new re-

Facts & Figures

An Aging Population: Japan has the highest life expectancy, the lowest infant mortality, and the most aged
population in the world today. It will age even further in the first half of this century. By the year 2055, life
expectancy for men is expected to reach 83.7 years, compared with 79.2 years in 2007, while women’s life
expectancy is expected to reach 90.3 years, compared with 86 years in 2007. Reflecting the improved longevity
and low fertility, the percentage of the population at age 65 or older increased dramatically, from 4.9 percent
in 1955 to 20.1 percent in 2005. It is expected to reach 40.5 percent in 2055.1
Medical Care System: Japan has a national health insurance system. The insurance covers the entire popula-
tion either through employee programs, municipal programs, or special programs. All programs offer the same
benefits. Employers pay 50 percent of the insurance premium. Patients currently contribute either 10 percent
(age 70 or older) or 30 percent (all others and affluent elderly) to the cost of inpatient or outpatient care, or
prescription drugs. Children also have a 20 percent co-payment, but many municipalities and cities are now
bearing some or all of these costs to attract and keep citizens. For people between age 70 and 74, the co-pay-
ment rate was scheduled to move up to 20 percent, but the move is temporarily suspended. There is a maxi-
mum subsidy of ¥350,000 (about US$3,200) to the cost of delivery for childbirth. Routine checks during preg-
nancy are not covered by health insurance.
Within the Organization for Economic Co-operation and Development (OECD) countries, Japan ranks slightly
below the average in terms of health spending per capita, but the contribution of its public sector to health
spending is – at 83 percent – well above the OECD average of 73 percent. Japan has fewer physicians per capita,
about two thirds of the OECD average, which is at least partly due to government policies fixing limits on the
number of new entrants to medical schools. Japan has the highest number of hospital beds, more than twice
the OECD average, and the highest number of magnetic resonance scanners, about four times the OECD level.
Long-term Care System: Public long-term care insurance was introduced in the year 2000 to provide various
home care and institutional care services for the elderly. Insurance premiums are collected in two ways: namely,
through a surcharge to health insurance taxes for individuals between age 40 and 64, and through community
poll taxes for residents age 65 or older. The co-payment for benefits is set at ten percent of the costs. The total
cost of the benefits has already doubled since the start of the system and reached ¥5,571 billion in 2006.2 Half
of the costs are paid by general tax revenues.
Morbidity and Mortality: Circulatory system diseases are the most prevalent major diseases among the elderly,
affecting 30.1 percent of this population segment. They accounted for ¥5,379 billion, or 21.5 percent of the
medical expenditures, in 2005. Cancer was the leading cause of death, accounting for 30.1 percent of all deaths,
followed by heart disease for 16 percent, and by cerebrovascular diseases for 12.3 percent.3
Lifestyle Risk Factors: Smoking is by far the most important single health risk factor in Japan. Smoking among
Japanese men is, with 39.9 percent, still the fourth-highest among developed countries, whereas cigarette
prices are at one of the lowest levels. An average pack cost ¥304.6 in 2007.4 There are few smoke-free public
areas.5 Recently, the government has been emphasizing obesity as a major health risk. Although only 3.9 per-
cent of all Japanese in 2005 were obese (compared to 34.3 percent in the U.S. in 2006), it has launched a com-
pulsory national program to check for metabolic syndromes for employees at age 40 or older.
1
2008 Annual Report on the Aging Society, Cabinet Office, Government of Japan
2
www.mhlw.go.jp. Last accessed Sept. 16th, 2008
3
www.mhlw.go.jp. Last accessed Sept. 16th, 2008
4
www.mof.go.jp. Last accessed Sept. 16th, 2008
5
www.who.org. Last accessed Sept. 16th, 2008

Women: 85.99 years (2007)
Men: 79.19 years (2007)
Dentists Hospital Beds

Number per 1,000 Resident Population Number per 1,000 Resident Population
0.761 (2006) 8.2 (2006)
Physicians Nurses
Number per 1,000 Resident Population Number per 1,000 Resident Population
2.1 (2006) 9.3 (2006)
Life Expectancy at Birth
Population in Thousands:127,678 (March 2008)
Total Expenditure on Healthcare as Percentage of GDP: 8.2% (2005)
Share of the Age Group 65+ of the Health Expenditure: 35% (2005)
Total Expenditure on Healthcare

per Capita (adjusted for
purchasing power parity):
Contribution of the Public Sector to Health Funding: 82.7% (2005) US$2,474 (2005)
“We have a shortage of funds costs in their payments for the elderly. As
the elderly population increases, so will
because we have not infused the employees’ payments. This process
will eventually stop when a sufficient
enough money into our number of those in employee programs
get angry. I would hate to see more
health insurance system to care rounds of cuts in our healthcare services
for the growing population of and their tragic consequences. Besides,

we should worry about the deadweight
the elderly.” losses from such very high payroll tax
rates: They will reduce employment and
the companies’ profit. Payroll taxes may
Seiritsu Ogura be far better than poll taxes, but they are
Professor of Economics, Hosei University, Tokyo, Japan,
not as equitable as consumption taxes
and Editor of the Japanese Journal of Health Economics and Policy
to finance the healthcare of the growing
elderly population. After the next election,
insurance scheme. First we must consider I hope politicians will summon enough
co-payment, then this reinsurance, and courage to raise the consumption tax
lastly, government subsidies. By a simple rate to solve our current crisis in health-
back-of-the-envelope calculation, we care.
find out that co-payment pays only three Another interesting implication of this
percent, government pays 25 percent, reform package is its impact on weaker
premiums of employee programs pay company-specific employees programs.
52 percent, and premiums of municipal We still have more than 1,200 company-
programs pay less than 20 percent. In specific programs, many of which may
2005, the insurance premiums paid 49 decide to dissolve and join the new
percent, and the government paid 36 regional programs for employees of small
percent, of national healthcare costs. The companies, rather than paying higher
new reinsurance package will increase tax rates. In the long run, we may come
the marginal share of premiums to 72 closer to having more integrated health
percent and reduce the marginal share insurance programs, at least among the
of the government to 25 percent. The employees’ programs.
government is simply shifting its burden
to employee programs.
Employees are already paying almost the The opinions expressed in this article do not
same amount as their own healthcare necessarily reflect those of Siemens Healthcare.
Seiritsu Ogura is a Professor of Eco- ter for Economic Research, one of the leading think-tanks in
nomics at Hosei University in Tokyo, Japan, before he joined Hosei University. Since the 1990s,
Japan. He is also the Editor of the Japa- he has been working in the field of aging issues and public
nese Journal of Health Economics and health in Japan, including population projections, public
Policy, the official journal of the Japan pension reforms, public health insurance reforms, and, most
Health Economic Association, and a recently, long-term care insurance reforms and tobacco
member of its Board of Directors. He is control issues. He has co-edited two books, Aging Issues in
a graduate of the Department of Law, Tokyo University, the United States and Japan (2001) and Labor Markets and
and earned a PhD in Economics from the University of Firm Benefit Policies in Japan and the United States (2003),
Pennsylvania. He was a Chief Economist at the Japan Cen- both published by the University of Chicago Press.

Further Reading
Further Reading
Siemens offers a variety of customer magazines and information
channels. ’Further Reading’ introduces a selection of articles
and topics featured there that may be of interest to you. To learn
more, follow the link below each article. To subscribe to any of
the magazines, see page 77.
Artis zeego delivers precise images during the intervention and can easily be stowed away when not needed.
Artis zeego Supports Hybrid Rooms

The combination of a C-arm with robotic out of the way, which is particularly interventions performed in the hybrid
technology is the formula for Artis zeego®, useful in hybrid operating rooms (OR), room require the full support of a C-arm,
the latest high-end angiography system which combine radiology, cardiology, especially for changes during the proce-
from Siemens. Artis zeego provides the and surgery. The Interventional Center dure or immediate control. As Hol con-
physician with almost unlimited freedom at the Rikshospitalet in Oslo, Norway, firms, “When expertise and technology
of movement. The system’s flat detector was the first facility to implement Artis are scattered, you always are at risk of
rotates around the patient at such high zeego in such a room. “When we plan an losing precious time if something needs
velocity and precision that cross-sectional operation in the limited space of an OR, to be adjusted. Artis zeego decreases
soft tissue images are created, acquiring the increased flexibility with Artis zeego that risk.” That is, Artis zeego enhances
more anatomical details than ever before means that we don’t have to restrict our- patient outcomes as it enables imaging
possible with an angiography system and selves to avoid problems with the C-arm,” and treatment with greater speed, effi-
thus, increasing diagnostic certainty. says Per Kristian Hol, MD, Manager of ciency, and precision.
Artis zeego allows the physician to adapt Radiological Research.
the working height to his or her individual “Instead, we can make the plan with a
needs, reducing fatigue and back pain full focus on the patient and the best
www.siemens.com/AXIOM-
during long procedures. If the system is procedure for the operation at hand.”
Innovations-zeego
not used, it can be conveniently parked Increasingly advanced and complicated

Further Reading
T2 FLAIR DWI
67-year-old male patient
Paradigm Shift with dysphasia and right-side
hemiparesis
in Echocardiography
The acquisition of nonstitched, real-time, full- SWI ASL cePWI
volume 3D images of the heart in one single heart
cycle with the new ACUSON SC2000™ volume ultra-
sound system marks a breakthrough in echocardiog-
raphy. Called ’Echo in a Heartbeat,’ the technology
represents a paradigm shift in ultrasound imaging,
55 years after the world’s first cardiac ultrasound Arterial Spin Labeled Perfusion MRI
recording using Siemens technology in 1953. With
In the neurology world, perfusion refers to the delivery of oxygen
a high-volume acquisition rate – in one second,
and nutrients to tissues by means of blood flow, and is one of the
every second – acquisition time is dramatically
most fundamental physiological parameters. Disorders of perfusion
reduced, improving workflow in the echocardiogra-
also account for most of the leading causes of medical disability
phy suite.
and mortality. Perfusion measurements serve as biomarkers for a
The advanced architecture of the ACUSON SC2000
broad range of physiological and pathophysiological functions and
system delivers vastly more information than today’s
are of direct diagnostic value in vascular disorders. In the field of
conventional systems and is strengthened by
magnetic resonance imaging (MRI), perfusion imaging measures
Siemens patented Coherent Volume Formation™
the rate at which blood is delivered to tissue. There are several
technology. Coupled with the system’s high-volume
methods for the measurement of classical tissue perfusion. One
acquisition rate, Coherent Volume Formation moves
such method is arterial spin labeling (ASL).
away from serial line-by-line acquisition towards
ASL MRI is a noninvasive method to assess cerebral perfusion.
simultaneous, multiple beams, delivering excellent
This technique uses magnetically labelled blood as an endo-
image resolution.
genous contrast agent. With ASL MR imaging, the protons of
Customizable, programmable, and protocol-driven
arterial water are magnetically labeled in the feeding vasculature
workflow sequences deliver repeatability for better
of the brain. The labeled arterial protons flow through the vascu-
outcomes: greater efficiency, accuracy, consistency,
lar tree and exchange water with the unlabeled brain tissue. A
and care – from data acquisition to diagnosis.
perfusion-weighted image can be generated by the subtraction
Whitepapers on the advanced system technology
of an image in which inflowing arterial spins have been labeled
and architecture have been published and can be
from an image in which spin labeling has not been performed.
downloaded from the website listed below.
Clinical applications include cerebrovascular disease, degenera-
tive disease, brain tumor evalutation, BOLD fMRI, and intervention
planning.
In clinical neuroscience, while the application of ASL perfusion
MRI to the diagnosis and management of acute stroke is both
obvious and feasible, the clinical utility of ASL is likely to be much
broader since only a minority of acute stroke patients undergo
MRI. ASL perfusion MRI could greatly enhance the evaluation of
both Transient Ischemic Attack (TIA) and chronic cerebrovascular
disease by quantifying regional cerebral blood flow (CBF) in
specific vascular territories where interventions may be planned,
or by allowing the effects of pharmacological therapies on CBF
to be evaluated. Several approaches now also exist for selective
arterial labeling, allowing the perfusion distribution of specific
arteries to be assessed independently. More detailed information
about the applications of ASL are highlighted in the latest neurol-
The ACUSON SC2000 volume imaging ultrasound system ogy edition of the Siemens MR magazine MAGNETOM Flash and
represents revolutionary innovation for echocardiography. can be viewed using the link below.
www.siemens.com/
www.siemens.com/echoinaheartbeat
MAGNETOM-Flash-ASL

Further Reading
A New Vision of Healthcare
Siemens plans to achieve the next generation in optimized care through integrating clinical laboratory diagnostics, medical imaging,
and information technology.
In its fall 2008 issue, the Siemens research ing the process of discovering new drugs. be able to predict whether a patient
and innovation magazine Pictures of An interview with John V. Frangioni, MD, with breast cancer can be successfully
the Future dedicated a whole section on PhD, Associate Professor of Medicine and treated without chemotherapy. Auto-
the early detection of diseases and how of Radiology at the Beth Israel Deaconess mated analysis of tumor-specific genes
Siemens plans to achieve the next gen- Medical Center and Harvard Medical is the key to a new world of individually-
eration in optimized care through inte- School in Boston, Massachusetts, U.S., tailored treatment.
grating clinical laboratory diagnostics, focuses on solving clinical problems
medical imaging, and information tech- through the application of advanced Answers in the Blood
nology. The articles, complemented with engineering and chemistry. Another Accurately diagnosing illnesses such as
statistics and background information, Harvard expert, Mukesh G. Harisinghani, cancer can be an extremely complex and
literally paint a picture of the future – MD, Director of the Clinical Discovery protracted process. Yet, there are now
and of the technologies in the Siemens Program at the Center for Molecular many tests that provide a fast and accu-
Healthcare development pipeline that Imaging Research and Director of Body rate identification of diseases in the lab
may help make it come true. MRI, Massachusetts General Hospital, – often using just a few drops of blood.
and Associate Professor of Radiology at This article explains how some of them
From Molecules to Man Harvard Medical School, explains how work.
This article describes how, from genes magnetic nanoparticles can help in A second article from the world of labo-
and proteins to cells, tissues, and our detecting lymph node metastases. ratory diagnostics focuses on efficiency:
entire organism, scientists are in the pro- In order to accelerate workflows in the
cess of piecing together a systems view The Battle Against Breast clinical laboratory, Siemens has devel-
of how we work. As they do so, they are Cancer oped an automated laboratory system
linking the results of laboratory tests to This story features major advances in that runs a large variety of tests in one
diagnostic images, injecting the result- imaging technologies that are now mak- analyzer. It can analyze up to 200 sam-
ing knowledge into advanced decision- ing possible more precise examinations ples and perform up to 1,500 diagnostic
support systems, and devising strategies that place less stress on patients, like tests per hour.
for early detection and targeted treat- digital mammography (brought to the
ments. patient with the help of mobile units), 1
Caution: Investigational Device. Limited by U.S. Federal
Law to investigational use. The information about Dig-
computed-aided detection, breast tomo- ital Breast Tomosynthesis is preliminary. This product is
The Future of Medical Imaging synthesis1, automated breast volume under development and not commercially available in
At the center of this article are infrared- scanning2 and eSie Touch elasticity imag- the U.S., and its future availability cannot be assured.
2
based systems that pinpoint abnormal ing with ultrasound, and magnetic for planning purposes. The product is pending 510(k)
tissues and cells, blood tests that detect resonance imaging techniques for the review, and is not yet commercially available in the U.S.
traces of cancer proteins, research that breast. Also focusing on breast cancer is
is zeroing in on imaging the first signs of an article about how researchers are www.siemens.com/PoF
Alzheimer’s, and strategies for accelerat- closing in on a diagnostic test that will

Further Reading
How to Reduce Dose

Outstanding developments in the field of of the operator. Radiation can be sig-
computed tomography (CT) within the last nificantly reduced by more consistently
ten years – for instance Dual Source CT using already existing technologies for
(DSCT) or dual energy – have increasingly dose reduction in CT systems, for exam-
made it a standard examination method ple, the 100 kilovolt scan protocol or the
for many indications. Thus, the question step-and-shoot mode.
of radiation dose becomes more and According to the study, the SOMATOM®
more important. Sensation 64 performed best. Close be-
The German Heart Center in Munich, hind was the DSCT SOMATOM Definition.
in cooperation with the American Mayo Thomas Flohr, PhD, head developer of 49-year-old patient with a high-grade lesion
Clinics in Rochester and Jacksonville, the SOMATOM Definition Dual Source in the right coronary artery revealed by a quick,
and the Friedrich-Alexander University at Siemens Healthcare in Forchheim, 1.8 mSv, low-dose cardiac examination with
in Erlangen-Nuremberg, Germany, con- Germany, believes that “The DSCT would the SOMATOM Definition with Adaptive Cardio
Sequence.
ducted the ‘International Prospective have performed even better if it had
Multicenter Study on Radiation Dose already been equipped with the current,
Estimates of Cardiac CT Angiography in improved version of the step-and-shoot additionally provides very good systems
Daily Practice (PROTECTION-I).’ The study technology during the study.” Despite training so that operators can take
compared five CT units from four differ- this, in identical clinical situations in the advantage of the total radiation reduc-
ent manufacturers. It included 1,965 study, the average radiation dose of the tion potential of the device.
cardiac CT scans that were carried out in DSCT SOMATOM Definition was more
a total of 50 clinics and heart centers. The than ten millisievert below that of the
results show clear differences in radia- competing scanners ranked in fourth and www.siemens.com/
tion doses depending both upon the CT fifth place. Clearly, Siemens has devel- SOMATOM-Sessions-Dose
system manufacturer and the behavior oped a radiation-saving system and
Diagnostic Center Frankfurt: Innovation and Expertise at the Highest Levels

By Wiebke Kathmann, PhD
A visually impressive new building, is computed tomography-(CT) and mag- stresses. Now, all functional aspects –
modern work processes, extremely up- netic resonance imaging-(MRI) guided from the helicopter landing place on top
to-date equipment, and outstanding intervention mainly of liver and lung of the building, to the Departments of
cooperation between the Departments tumors and metastasis. People from all Radiology and Cardiology in the middle,
of Radiology and Cardiology are the over the world consult him for transpul- to the shock room in the basement – are
cornerstones of success at the new Diag- monal percutaneous chemoembolization, located in one building. “We were able to
nostic Center of the University Hospital a method used for localized chemother- tighten our processes and increase effi-
in Frankfurt am Main. apy of lung tumors, or for laser-induced ciency – among other things – through
The architecture is intriguing: clean lines, interstitial thermotherapy (LITT). Zeiher’s the bundling of the latest imaging sys-
spaciousness, and a waiting area that specialty, among others, is regenerative tems in one building,” says Conrad. The
looks like a VIP lounge. Heading up the medicine, for example, stem cell therapy, center is equipped with state-of-the-art
Diagnostic Center and adding to its appeal specialized catheter interventions, and equipment from Siemens: three MRI sys-
by creating an aura of tranquility are the measurement of intracardiac flow in dia- tems, eight angiography systems, three
Director of the Diagnostic and Interven- stolic dysfunction. CT scanners, and one urology system
tional Radiology Department, Professor The appropriate environment for these support expertise in Frankfurt, providing
Thomas Vogl, MD, and cardiologist and manifold capacities was established with patients with innovative care.
Director of the Medical Clinic III, Professor the new Diagnostic Center. In order to
Andreas Zeiher, MD. Patients feel well cope with the changes in the German
cared for – also, of course, due to the fact healthcare system, an update of facilities
that both Vogl and Zeiher are renowned and concentration of resources was
www.siemens.com/
experts in their fields and offer innovative necessary, as the center’s Commercial
news-frankfurt
interventions. Vogl’s international forte Director Dr. Hans-Joachim Conrad,

Service
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the contest is the largest of its kind in Excellence in the area of ‘Corporate
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Dear Reader, At the 14th Annual Communicator ten-point scale by judges from the Inter-
Awards, a U.S.-based international awards national Academy of the Visual Arts, in
The Editorial Team of Medical Solutions
was honored with distinguished awards which Excellence Winners receive a 9.0
from respected corporate publishing and or above.
communications organizations. Feedback to the editor should We are very proud of these achievements
At the Best of Corporate Publishing be addressed to: and thank our interview partners and
Congress in Munich, Germany, Medical by mail: Siemens AG, contributors for their continuous input
Solutions received two exceptional Healthcare Sector and support. We hope you appreciate
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Award in the area of ‘B2B – Industry,
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Medical Solutions

The Magazine for Healthcare Leadership

Ask the Ultimate Power in Imaging.

Answers for life.

Advancing Patient Care

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 3

Cover Story 03 Editorial

4 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

60 Within a global training concept,

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 5

6 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

Large Display for Artis zee Family

Comprehensive MR Oncology Solutions

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 7

What is your SPECT’S IQ?

Electronic Health Record for Integrated Care

8 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

Neonatal Care the discoloration of body tissues. Neonatal jaundice is usually

The Business Partner in MRI

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 9

Breast cancer is by far the most common cancer among

10 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 11

lesions underwent diffusion imaging

to know what they of water molecules in tissue. We thought

examination.” specimen to compare with what we see

12 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

“It’s so important to create and offer well-planned

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 13

Gladys Lo, MD, Chief Radiologist, Department of Diagnostic

John F. Nelson, MD, Medical Director, Battleﬁeld Imaging,

Karsten Ridder, MD, Radiological Group Practice,

14 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 15

true for the other two physicians. We’ve

capabilities.” How does an integrated diagnostic

16 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

developed in the last ten, 20 years, and

And why did you choose Siemens

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 17

Breast Cancer: The ACUSON S2000 ABVS

18 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

Diverse Imaging Solutions

ACUSON S2000 ABVS Automated Breast Volume 1

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 19

Michael Salem, MD, President and CEO,

Bringing Personalized Medicine

20 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

Christine Forkner, CFO,

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 21

22 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

How are current U.S. market conditions

National Jewish Health’s mission of

Collaboration Strengthens Patient Care

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 23

24 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 25

26 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

It’s been a long wait. In October 2007,

MAGNETOM® Verio, Siemens new 3 Tesla

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 27

28 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

“Once a patient is examined with