Medical solutions Nov - 11 *SIEMENS*

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  • 1. Medical Solutions The Magazine for Healthcare Leadership November 2011Built to Last, Designed to HealLord Norman Foster Has a Vision For Today’s Hospitals
  • 2. Will Jimmy be able to afford goodmedical care when he is my age? The world needs better and more affordable healthcare. That’s why we’ve developed better technologies and more efficient IT solutions. With life expectancy on the increase, healthcare is becoming more expensive. We offer innovative solutions to improve the quality of care and streamline hospital processes before, during and after treatment. From imaging and lab systems that help provide more accurate diagnosis to managing hospitals more efficiently, we can save money that can be put to better use – saving lives. siemens.com/answersA91CC-9084-A1-7600
  • 3. EditorialAdvancing Human Health Hermann Requardt, Member of the Managing Board of Siemens AGHealth is the most important factor for technology with ongoing application sup- and CEO of the Healthcare Sectoreach one of us to live a happy and ful- port; planning a healthcare facility withfilling life. Without our health, we lose a single long-term contract for supply,the freedom to fulfill our potential – and installation, testing, training, and com-our dreams. Thus, human health needs missioning also saves time and money.to be protected and sustained just like Results of such a partnership are mini-natural resources such as clean water, mum equipment downtimes, extended processes, but also at patient communi-fresh air, and the biodiversity our planet service hours, and enhanced clinical and cation or building infrastructure. And,provides – both by society and its indi- patient outcomes. when it comes to the immediate patientviduals. Read in this issue how Siemens as a environment, studies1 suggest that hos-At Siemens, we play a unique role, sup- general contractor helped create a state- pital buildings themselves have substan-porting healthcare professionals to do of-the-art molecular imaging facility in tial effects on patients’ well-being. Learntheir job the best they can by providing Abu Dhabi (page 12) and how, through more in our interview with British starmedical technologies that help deliver a a managed equipment service contract, architect Lord Norman Foster on page 28.better quality of healthcare and enable we supplied the equipment for two brand- Foster shares with us a common goal: toever-improving degrees of individual care new hospitals in the Spanish region of support healthcare professionals acrossthrough advanced imaging, diagnostics, Murcia (page 18). the globe in their personal mission totherapy, and healthcare IT solutions. We Another innovation beyond medicine is help more people enjoy a longer life, athereby help ensure the next generation our Green+ Check, where we support better quality of life, and a happier life.of breakthroughs becomes a reality. healthcare providers in their efforts to With this in mind, I wish you a happyOur commitment to advancing human deliver high-quality, efficient, and environ- reading.health, however, goes beyond merely mentally-friendly care. St. Georg Medicaldelivering the latest diagnostic and treat- Center in Leipzig and University Medical Sincerely,ment technology to our customers. We Center Hamburg-Eppendorf, Germany,support their success through close were the first facilities to have theircollaboration and mutual partnerships. efforts evaluated with this check (pageHealthcare providers benefit from such 24). Just as our health is connected withbusiness alliances in many ways. To prevention and medical treatment, it isbuild and maintain a complete hospital also dependent on a healthy environ-together with Siemens not only improves ment. The Green+ Check takes this into 1 Bryan Lawson: Healing architecture. Arts & Health,its performance by combining the latest account by looking not only at clinical Vol. 2, Iss. 2, 2010, p. 95 – 108. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 3
  • 4. Content 38 44 Content Laboratory Testing: Alcohol Abuse Urology: UpgradeCover Story 03 Editorial 10 Facility Planning To build and maintain a complete hospital together with Siemens not only improves 06 News its performance by combining the latest technology with ongoing application sup- port; planning a healthcare facility with a 90 Essay Series: single long-term contract for supply, instal- lation, testing, training, and commissioning Healthcare Systems – also saves time and money. Results of such South Africa a partnership are minimum equipment downtimes, extended service hours, and enhanced clinical and patient outcomes. 96 Further Reading 102 Imprint 103 Subscription4 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 5. Content46 78Medical Tourism: Magnetic Resonance Imaging:A Global View Remaining Competitive Features32 At the Basque Center on Cognition, 50 At the Siemens Breast Care Day, 68 Riverside Health System boosts Brain and Language in San Sebastian, radiologists and medical students efficiency using Siemens Soarian Spain, research scientists gather were given further insight into breast Clinicals. The 904-bed hospital sys- data on the inner workings of the cancer awareness and extended tem was among the first in the U.S. brain. their knowledge of the latest 3D to meet stringent benchmarks for imaging modalities for breast cancer the meaningful use of electronic38 Regina Reppin and Jos P. M. detection. health records. Wielders are helping physicians diagnose chronic alcohol abuse using a specific blood test and analysis 56 Billions of euros in the world’s 74 A hybrid operating room and a systems that deliver reliable, fast healthcare systems are tied cardiovascular imaging and informa- results. up in frozen capital – inefficiently tion management solution made deployed capital or untapped their debut at St. Joseph Hospital. liquidity potential.44 With Siemens’ EndoExpand Upgrade, Paoli Hospital improved 78 Two hospitals in Germany and the its endo-urologic system without a 62 Saving time and improving U.S. chose the latest Siemens MRI major capital expense. quality with Siemens integrated technology to remain competitive in solutions, syngo.via and syngo.plaza, their markets. is a focus of clinicians at the MR,46 Medical tourism, the truly global Nuclear Medicine and PET/CT Center branch of healthcare, is changing, in Bremen Mitte. 84 While its accuracy, speed, and aided by lower international airfares image clarity impressed from the and the Internet. very beginning, physicians also 66 The FAST functionalities simplify appreciate the ACUSON SC2000 and accelerate CT workflows, as system’s ease of use and positive demonstrated by the first months effect on workflows. of clinical operation at institutes in the UK and the U.S. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 5
  • 6. News Book Your Application Courses Now! As a system or application user, it is vitally important to keep pace with advances in technology and to extend skills in the use of technical medical equipment. Siemens designed a com- prehensive selection of applications courses to provide pro- fessional skills and hands-on experience that customers need for the effective use of modern medical systems and user programs. Covering the complete spectrum from beginners toSiemens Healthcare annouces its “International CT Image the expert level, Siemens’ courses are taught by experiencedContest 2011.” specialists. In a newly published training booklet, customers will find aCan You Beat This? complete listing of courses for the second half of 2011. From angiography to ultrasound, the courses give users system,After Siemens’ first computed tomography (CT) image con- application, and technology training that combine theoreticaltest in 2010, institutions and clinics from around the globe principles with practical exercises in a one-day to five-dayare taking the opportunity to submit their best clinical course format.images for 2011. Such images, taken with the lowest pos- The global training concept offers participants learning oppor-sible radiation dose on Siemens CTs, will then be reviewed tunities on the latest systems at state-of-the-art training cen-by a jury of internationally renowned professors. The aim ters in Germany, the U.S., and China. Participants can attendof the contest is to show that the highest diagnostic image hands-on courses with colleagues covering the maintenancequality can be achieved at minimum radiation dose levels and operation of medical systems and applications, withoutand help to make the public aware of the responsibility the distractions of their daily clinical routine. Clinical workshops,that manufacturers and radiologists have with regards to on-site trainings, fellowship programs, or e-Learning course-diagnostic radiation through best practice sharing. ware optimally supplement the instructor-led courses.Siemens users who use a CT from the SOMATOM® Definition All classes are available for online booking via the link below.family, a SOMATOM Emotion, SOMATOM Sensation, or This Website also provides the opportunity to order the train-SOMATOM Spirit will be able to present clinical images – ing booklet.which have been reprocessed with syngo® CT Workplace,syngo MultiModality Workplace, or syngo.via – in sevencategories: Cardiology, Angiography, Dual Energy, Pediatrics,Trauma, Neurology, and areas of their clinical routine, whichincludes thorax, abdomen, and pelvis.In 2010, the International CT Image Contest from Siemenswas an extraordinary success having received approximately300 clinical images from more than 30 countries. Therewas even a fan community on Facebook with more than1,600 active members who frequently discussed the sub-mitted images. In addition, all Internet users could votefor their favorite picture in a public vote. The Internet pagedevoted to the contest received 17,000 hits within sixmonths.Entries can be submitted until September 18th, 2011.Siemens will announce the winners at the next conferenceof the Radiological Society of North America (RSNA 2011)in Chicago. www.siemens.com/image-contest www.siemens.com/healthcare-training-center www.facebook.com/imagecontest6 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 7. News Reaching New Heights in Mobile X-ray Imaging Mobilett Mira provides a 180-degree rotating swivel arm at an industry-leading arm range. The new Mobilett Mira1 from Siemens opens doors to new dose due to the highly sensitive caesium iodide scintillator perspectives of mobility and imaging freedom for mobile X-ray material (CsI) and the high-end WLAN detector. systems. With its wireless detector and the 180-degree rotat- Mobilett Mira has recently undergone its first clinical use test ing swivel arm (90 degrees in two directions) at an industry- and the feedback was very positive. Physicians especially leading arm range, the system offers new heights of flexibility enjoyed the image quality, which was compared to the image that lets clinicians examine their patients from every necessary quality of high-end stationary lung X-ray systems. Clinicians angle – even patients with limited mobility. The system features can also count on Siemens as a reliable, proactive partner in an integrated cable design for easy handling and cleanability. terms of Mobilett Mira’s uptime. Siemens Remote Services (SRS) Clinicians can feel confident with their diagnosis since the helps ensure uninterrupted system availability with regular system boasts an image resolution of more than seven million anti-virus software updates and remote system diagnosis. pixels. Motion blurring is prevented with the high output power Wireless freedom, outstanding flexibility, and investment of up to 35 kilowatts (kW) or 450 milliampere (mA), resulting security offered by Siemens all make this system uniquely new in sharp, clear images. Patients can experience lower radiation – reaching further than ever before in mobile X-ray imaging.1 This product does not yet have a certificate of conformity. This product is not www.siemens.com/mira commercially available in the U.S. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 7
  • 8. NewsThe Dimension EXL 200 Integrated Chemistry System gives smaller laboratories access to fast, sensitive immunoassay testing on a trustedand proven integrated platform.Advanced technology for smaller-sized clinical laboratoriesSiemens Healthcare Diagnostics recently on an integrated platform, historically dent the new Dimension EXL 200 systemadded the Dimension® EXL™ 200 Inte- available only to higher-volume laborato- will meet customers’ needs. Currently,grated Chemistry System to the Dimen- ries,” said Dave Hickey, CEO, Chemistry/ both Dimension EXL systems allow cus-sion family of analyzers. For the smaller- Immunoassay, Automation and Diagnos- tomers to run a broad menu of tests.sized clinical laboratory, this new system tics IT Business Unit, Siemens Healthcare Available panels include: cardiac, thyroidfeatures the revolutionary LOCI® advanced Diagnostics. The Dimension EXL 200 disorder, therapeutic drug monitoring,chemiluminescence technology, allow- system will also connect to the Siemens drugs-of-abuse testing, protein testing,ing smaller laboratories access to fast, VersaCell™ System, a compact automa- fertility, and routine and specialty chem-sensitive immunoassay testing on a tion system offering advanced sample istry testing.trusted and proven integrated platform. management and sorting capabilities.The test menu includes over 90 percent The VersaCell System allows smaller cus-of the critical methods typically ordered tomers to maximize the number of testsby physicians, and includes a cardiac STAT run on one workcell and improves themenu with high-sensitivity Troponin I efficiency of their operations.results in 10 minutes. Based on the success of more than 900 www.siemens.com/“It’s exciting to offer our low-volume cus- global placements of the Dimension EXL dimension-exl200tomers the same advanced technology with LM system used, Siemens is confi-8 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 9. News“Turn your city pink!”We at Siemens want to raise breast cancer The new campaign is a step toward inform-awareness with our new global campaign ing the public about the disease and the“Turn your city pink! Raise awareness for importance of early detection. In Octoberbreast cancer.” Why? Breast cancer is one 2010, Siemens completed the “Pink Ribbonof the world’s most threatening diseases around the World” campaign, whereand early diagnosis is key for its effective participants helped to raise breast cancertreatment. Siemens wants to help spread awareness in a one-month online cam-the awareness for breast cancer with the paign. Additionally, the German marketnew international campaign, which started research institute Gesellschaft für Konsum-in October 2011 and runs for one year. forschung (GfK) conducted an interna-The campaign aims to get people all over tional survey to determine the needs ofthe world engaged and encourages them women and medical practitioners.to be creative and turn their city pink. The study pointed out that many women because they do not regard it as neces-Pink is the international color of breast think of breast cancer as a key topic, but sary. Ultimately, the goal is to supportcancer awareness. Participants can upload do not receive screenings due to an over- experts and healthcare professionalspictures or videos of their actions to the all lack of awareness. Numerous doctors everywhere to perform to their best abilitycampaign Website and share them with stated that women avoid screening as and focus on detecting breast cancer asfriends, creating even more awareness. they fear that something will be found or early as possible.Siemens will reward every entry with adonation to charity and the most popular 1 iPad is a trademark of Apple Inc., registered in the www.siemens.com/pinkentry wins a pink City iPad1 every month. U.S. and other countries A Fully Automated Process for Nucleic Acid Isolation There are an estimated 400 million FFPE-preserved samples in tissue banks world- wide, underscoring the value of their use for analyzing DNA and genetic associations related to diseases such as cancer and autism.1 To encourage the procedure of pro- cessing FFPE samples, a new Siemens Tissue Preparation Solution2 provides a more efficient and reproducible process for the isolation of high-quality nucleic acids from FFPE tissue samples. Using magnetic particle-based isolation and proprietary iron oxide bead technology, the Siemens method enhances the quality of the extracted nucleic acids that results in more reliable and robust test results. And with the Siemens fully automated tissue extraction process, the hazards associated with handling organic solvents are minimized while the turnaround time is improved. Laboratory staff can walk away from the system and perform other tasks. By improving the speed with which labs can extract nucleic acids, they will be better equipped to manage increasingly large test volumes. The timeliness and quality of the extracted nucleic acids will help to provide physicians and their patients with more reliable informa- tion. Toumy Guettouche, PhD, School of Medicine, Oncogenomics Core Facility, University1 Source: Genetic Engineering and Biotechnology of Miami, states: “The Siemens Tissue Preparation Solution for FFPE has the potential News May 15, 2008 (Vol. 28, No. 10).2 Under development. Not available for sale. to significantly increase the utilization of FFPEs for downstream applications because of the ease-of-use of the instrument as well as the outstanding performance of the chemistry used. It is remarkably easy to use and the different steps of FFPE extrac- www.siemens.com/molecular tion have been automated elegantly which sets it apart from other FFPE extraction systems.” Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 9
  • 10. “Medical functionality is, or rather should be, holistic in its approach. Mental health is as important as, and indeed inseparable from, physical health. The one can affect the other adversely or positively.” Lord Norman Foster, British star architect Overview:12 United Arab Emirates: Reimagining Patient-Centric Imaging18 Murcia: Becoming a Benchmark Hospital24 Germany: Caring for Health and for the Future28 Lord Norman Foster: The Healing Power of Architecture
  • 11. Facility Planning The entrance area of the Tawam Molecular Imaging CentrePatient-CentricMolecular ImagingTawam Molecular Imaging Centre in Al Ain,United Arab Emirates, was designed, developed, andequipped by Siemens with advanced imaging anddiagnostic equipment to help Mubadala Healthcarebring a new level of care to the Gulf region.By Ward Pincus Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 13
  • 12. Ambitious architecture, buildingtechnology, high-end imaging, anddiagnostic equipment: With Siemensas a partner, TMIC sets a new bench-mark for healthcare in the Gulf region. “Iconic,” “soothing” – this is how mon practice of overseas travel for the Mubadala Healthcare, the owner of the diagnosis and treatment of cancer, car-“Siemens is the Tawam Molecular Imaging Centre (TMIC) describes this new, world-class diagnos- diovascular, and neurological diseases. “There is urgency in addressing this only vendor that tic facility located in Al Ain in the United Arab Emirates (UAE). gap,“ explains Bashar Al Ramahi, Senior Manager Business Development at Abu we have given TMIC elicits such descriptions because it Dhabi-based Mubadala Healthcare and combines advanced diagnostic imaging Project Manager for the center, which a full turnkey pro- and workflow technology from Siemens opened in October 2010. Calling positron with elegant arabesque architecture, emission tomography/computed tomog- ject to, and they graciously appointed waiting areas, five- raphy (PET·CT) technology the ’gold stan- have delivered.” star service, and friendly environment, delivering “patient-centric” care on par dard’ for cancer detection and cardiovas- cular and neurological disease diagnosis, with what is available in leading health- Al Ramahi says that “better detection canBashar Al Ramahi, Senior Manager care centers around the world. contribute to improved treatment” ofBusiness Development, Mubadala Healthcare, Clinical care is provided in partnership these diseases.Abu Dhabi, and Project Manager for Tawam with Johns Hopkins Medicine International TMIC also helps Abu Dhabi government-Molecular Imaging Centre – creating a total offering from TMIC owned Mubadala Healthcare pursue its that helps fill a gap in the local health- stated goals of developing a thriving local care market that impacted local disease healthcare industry and reducing the detection and contributed to the com- need for citizens and expatriate residents14 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 13. to travel overseas for world-class medi- from patients and from their families.” tributing to patient care and clinicalcal treatment. As Al Ramahi puts it, TMIC conveys “a hos- outcomes is the region’s first particle pital as well as hospitality.” It is located accelerator, a Siemens Eclipse™ HPPatient Centric Means Patient adjacent to Tawam Hospital, a regionally Cyclotron, which produces radioisotopeComfort renowned oncology center, to support the biomarkers used in PET examinations.With the arabesque latticework covering hospital’s existing work and capabilities. With this set of complementary tech-the exterior of the glass-walled building, TMIC selected the diagnostic imaging nologies, says Al Ramahi, TMIC isthe interior is both infused with natural and workflow systems from Siemens – “one of the few facilities in the regionlight and shaded from the powerful sun including a Biograph® mCT (PET·CT), equipped with a cyclotron and one ofin this desert oasis city. A long entrance- a MAGNETOM® Skyra 3 Tesla open-bore the few facilities in the UAE equipped toway, with the same latticework overhead magnetic resonance imaging (MRI) do, for instance, full cardiac scanningand soothing aqua-green lighting on system, and syngo® Imaging software. with N-13 ammonium.“either side, evokes anything but a medical This equipment serves the twin goals of It was essential to Mubadala Healthcare’sfacility. patient comfort and diagnostic excellence vision for a world-class facility that TMIC“And that’s just what Mubadala Healthcare towards a shorter, more comfortable was self-sufficient in biomarkers. This iswanted, since those coming to the facility imaging experience for patients, and important because it allows for moreare ill, whether with cancer or cardiovas- exceptional image quality and detail for optimal use of the Biograph mCT, ensurescular or neurological disease,“ Al Ramahi treating clinicians. that patients get imaging done when-says. As a result, “They are already under TMIC provides an edge to treatment ever their treatment requires and nota lot of stress, and so we are trying as planning and diagnosis by housing dependent on the availability of interna-much as possible to take this stress away both a PET·CT and an MRI. Further con- tionally sourced biomarkers, and gives Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 15
  • 14. Facility Planning“When you do nuclear imaging, you don’twant patients to be too anxious and nervous,”Al Ramahi notes. Colorful lighting helpspatients to be at ease during their examinations.patients another level of safety, since tion and diagnosis of cancer as well as examination time and a more spaciousgenerated isotopes have a minimal half- cardiovascular and neurological diseases, and more comfortable examinationlife. because it allows physicians to view environment, as well as excellent clinical metabolic activity and the exact location performance due to high-quality images.Technology Blends Speed and of abnormal lesions within an integrated With TMIC operating as a stand-alonePrecision 3D image, providing fast, accurate, and facility with many referring physiciansAl Ramahi says Siemens was selected for effective detection and tracking of dis- located elsewhere in Al Ain or the UAE,the TMIC project for a variety of reasons, ease. it was vital that the Information and Com-among them, “because the PET·CT scan- A PET·CT scan can be completed in five munications Technology (ICT) solution,ner [Biograph mCT] is the fastest in the minutes, while Al Ramahi says that most also provided by Siemens, offer powerfulmarket … nearly twice as fast as others1, standard scans conducted by the facility analysis and sharing functionality. Thisand because it helps to make the experi- last only 20 to 25 minutes, compared to included syngo.via2, an advanced client-ence of the patients much better.” This 45 minutes with other machines in other server visualization software platformspeed, combined with calming lighting, facilities in the UAE. designed to let clinicians more quicklyserene image projections onto the ceil- Because the facility is so unique, it serves and more easily process, read, and shareings, and various music options all help patients with all kinds of needs, includ- images. This software “has so manyto keep patients as calm as possible. ing children and patients undergoing different job functionalities – 3D image“When you do nuclear imaging, you don’t treatment that requires multiple scans. calculations, cardiac software, neuro-want patients to be too anxious and Complementing the Biograph mCT is logical software and analysis, while allnervous,” Al Ramahi notes, since anxious the MAGNETOM Skyra 3 Tesla MRI, which images are archived and easily accessi-patients are more likely to move, thereby has twice the field strength of conven- ble,” Al Ramahi says. The solution alsoaffecting results. tional MRI units, thereby producing includes a radiology information systemThe Biograph mCT plays an important considerably higher resolution scans in and a picture archiving and communica-role in addressing Mubadala Healthcare shorter timeframes. The result is again tions system (PACS). This means that alland Al Ramahi’s focus on the early detec- greater patient comfort through reduced physicians, no matter where they are, can16 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 15. Facility Planninghave access to patient images. At TMIC, Summaryreferring physicians can use a SiemensWeb application to access these images.3 Challenge: • Develop a world-class molecularSiemens: A Partner and Project imaging center in Al Ain that providesConsultant patient-centric care and advancedSiemens’ involvement in TMIC extends diagnostic imaging on par with what’sfar beyond the equipment. From the available at the world’s top hospitalsfeasibility study validating the business • Bring technology, architecture, andcase to ongoing equipment service and design together to provide a patientmaintenance, Siemens has provided experience that is as comfortable andconsulting and other services across the relaxed as possiblewhole lifecycle of the TMIC project. As • Give clinicians access to faster, morethe turnkey manager, Siemens consulted accurate, and higher-resolutionto Mubadala Healthcare on the architec- imaging technologies than generallytural design, construction, workflow sys- available in the Gulf regiontems, technology, and, of course, equip- • Provide a flexible ICT system thatment. It is the first such turnkey project gives TMIC and referring physiciansof its kind for Siemens in the Gulf region direct access to patient imagesand the first such project for Mubadala • Deliver a comprehensive consultingHealthcare. and project management package that“Siemens is the only vendor that we have “We managed makes project realization easy for thegiven a full turnkey project to, and they owner to managehave delivered. We are very pleased with to finish athe equipment and their services,” Al Solution:Ramahi says, adding that having Siemens project that • A beautiful, iconic buildinglead on the project made it easier forMubadala Healthcare as the owner, in should have • State-of-the-art Biograph mCT PET·CT • MAGNETOM Skyra Open Bore MRIaddition to helping speed completion.“We managed to finish a project that taken 18 to 24 system • syngo Imaging and syngo.via softwareshould have taken 18 to 24 months in months in just • Onsite Eclipse HP Cyclotronjust 14 months.” • Turnkey project management – fromMubadala Healthcare is looking to trans- 14 months.” supply of imaging equipment to con-form the character of care in the UAE sulting on building design, technology,and the wider Gulf region. With Siemens Bashar Al Ramahi, Senior Manager and workflowsconsulting across all aspects of its build- Business Development,ing design, workflow software, IT systems, and Project Manager for Tawam Result:and equipment solutions, TMIC has Molecular Imaging Centre • Patients no longer need to travel Mubadala Healthcare, Abu Dhabi,made a bold statement that healthcare abroad to receive advanced molecularin this part of the world can match the imaging services in a comfortable,best available anywhere. non-clinical setting • Patients enjoy a faster, more com-Ward Pincus, who has lived in Dubai for ten fortable, and more relaxed scanningyears, writes on health, energy, green technolo- experiencegies, banking, and finance for publications inNorth America, Europe, and the Middle East. • Physicians can make more confidentHe is a former correspondent for the Associated diagnoses from the high qualityPress in the UAE. images that can be accessed from any 1 Based on competitive literature available at time of location publication. Data on file. 2 syngo.via can be used as a standalone device or together • Optimized equipment use thanks to with a variety of syngo.via-based software options, which a reliable supply of biomarkers onsite are medical devices in their own rights. The described • As the first facility of its kind in the Further Information features are syngo.via-based software options which are medical devices on their own right. Gulf region, TMIC was completed four 3 The syngo.via Web applications are not for diagnostic months ahead of schedule www.siemens.com/ use. For mobile based applications, country specific turnkey-solutions laws may apply. Please refer to these laws before using for diagnostic reading/viewing. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 17
  • 16. Becoming aBenchmark HospitalAs part of a €132 million contract, Siemens Healthcare issupplying two new hospitals in the Spanish region of Murcia withstate-of-the-art medical equipment for the next 15 years. Thiswill enable the state-run hospitals not only to have financial andplanning security during the current economic crisis, but alsoto be competitive and qualify as regional benchmark hospitals.By Manuel Meyer18 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 17. In the Murcia region, 1.5 million residents will be served. Santa Lucía University Hospital in Cartagena is one of ten hospitals to fulfill this need.There is hardly any other area in Spain has built a better reputation with the sider the wait times for appointmentswhere people are as satisfied with their public than any other. with specialists or non-emergencyhealthcare system as in the southern The residents of Murcia have a number operations at public hospitals to be tooregion of Murcia. In the government’s of reasons to be satisfied with their long. The overwhelming majority ofmost recent healthcare survey, taken in healthcare system: While the average wait respondents also indicated that it should2010, two out of three residents of the time for an appointment with a special- take significantly less time to receiveMediterranean coastal region not only ist in Spain is 53 days, Murcians wait an test results. That is an opinion thatrated the public health system as good, average of just 29 days to be seen by might change soon; at least, that is whatthey also gave healthcare staff the top a specialist. They also wait only 51 days Manuel Ángel Moreno Valero, Generalmarks among all public servant groups. on average for surgical interventions, Director at the new Santa Lucía UniversitySince the spectacular response of doc- while residents of other regions in Spain Hospital in Cartagena, hopes.tors, paramedics, and hospital staff to have to remain patients for about ten The region of Murcia has ten government-the powerful earthquake that struck the days longer. operated hospitals to serve its 1.5 millionregion in mid-May of this year, injuring Nonetheless, the healthcare survey also residents. The population of the coastalhundreds, this group of professionals showed that half of Murcians still con- region around the city of Cartagena, a Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 19
  • 18. Facility Planning popular tourist destination, has grown The increased number of beds, emer- disproportionately in recent years. In gency rooms, and operating rooms will order to help ensure medical care to this help to solve wait lists: “The situation growing population, the existing Santa will definitely improve now that the two María del Rosell Hospital, located in the new hospitals are open,” says Moreno. city center, reached a mutual agreement He adds that having more beds and more with the nearby naval hospital to man- treatment rooms is not the only reason age some patients out of the region’s wait times and diagnoses are expected 300,000 residents. to improve. Another major reason is that both hospitals feature the latest in medi- Public-Private Partnership cal technology from Siemens. With the opening of the university hos- As part of a public-private partnership, pital in Cartagena and Los Arcos del Mar Siemens Healthcare has equipped the Menor University Hospital, the neigh- two hospitals with more than 100 imag- boring town of San Javier, the two major ing systems, such as computed tomogra- coastal areas of Murcia welcomed two phy (CT) scanners, ultrasound units, and new government-run hospitals at the mammography systems, under a contract beginning of this year, providing nearly placed by the Murcian health ministry. 1,000 beds. “This means our healthcare Siemens also set up the entire hospital needs are adequately covered for the information and communications system next 25 years,” explains María Ángeles and all of the laboratory systems at both Palacios Sánchez, Minister of Health for facilities. The €132 million contract the Region of Murcia. includes not only the initial process of “The contract with Siemens allows us to remain competitive, thanks to the first-rate technological innova- tion guarantee we have received.” Manuel Ángel Moreno Valero, General Director, Santa Lucía University Hospital, Cartagena, Spain20 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 19. As part of a public-private partnership, Siemens Healthcare has equipped two new hospitals in the coastal areasproviding the hospitals with the latest Princess Letizia at the end of February, of Murcia with more than 100 imagingmedical technology, service, mainte- could even become a benchmark facility systems and set up the entire hospital information and communications systemnance, and financing, but it also offers for all of Spain. Thanks to the public- as well as all of the laboratory systems.an innovation guarantee. Under the con- private partnership with Siemens, thetract, for a period of 15 years, Siemens hospital has the only Artis zeego® multi-will ensure that both hospitals can always axis robotic technology system on thework with up-to-date medical technology. Iberian Peninsula. With the Ysio digitalSiemens will replace the systems with radiography system and magnetic reso-the latest models in each product series nance systems such as MAGNETOM®at specified time intervals of five, eight, Espree, Avanto, and Essenza, both hospi-and ten years. tals work across the board with advanced“In times like these, in an ongoing eco- technology in the fields of clinical imag-nomic crisis that affects public budgets ing, laboratory diagnostics, and informa-as well, the contract with Siemens not tion technology.only offers our government-operated In preanalytical and clinical laboratoryhospital top profitability and security in analysis as well, Santa Lucía Universityterms of financing and planning for the Hospital should become a benchmark hos-future, but also allows us to remain com- pital at the regional and even nationalpetitive, thanks to the first-rate techno- levels in the future, thanks to its ADVIA®logical innovation guarantee we have LabCell® and ADVIA WorkCell® Auto-received,” Moreno explains. But the mation Solutions. The automated trackadvantages of working with Siemens go system, one of the largest of its kind ineven further, he says: “Always being at Spain, is connected to ten analyzers,the forefront of technology enables us transporting up to 3,000 blood and urineto offer treatment methods and medical samples each day. “This will allow usinterventions that, in turn, shorten the to considerably shorten the time frompostoperative process. That means that initially taking the sample to forwardingnot only do we free up beds again more the test results to the treating physician,”quickly, but we physicians are also able Moreno predicts. He does point out,to treat completely different diseases though, that at this point, with the hos-right here in the region,” he affirms. pital slowly building its activities, it is not yet possible to say how the new tech-A Giant Leap in Quality nologies and IT systems from Siemensthrough Siemens Technology will enhance productivity, reduce costs,In the field of interventional radiology or accelerate working processes.and cardiology, the university hospital, “Aside from that, in addition to its tech-which was officially opened by Spain’s nical equipment, a hospital can only Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 21
  • 20. “Aside from financing and price, 70 percent of our decision was based on technological quality, and in that area, Siemens simply had the best offer.” María Ángeles Palacios Sánchez, Minister of Health for the Region of Murcia, Spain. be as good as its medical staff,” Moreno says, commenting that having the bestSummary medical technology available does not help very much if a facility does not alsoChallenge: have excellent staff that uses that equip-• Equip two government-operated hospitals with state-of-the-art ment correctly. This problem did not medical technology during an economic crisis that is causing budget materialize in this case, however. On the fluctuations in the public healthcare sector, as in other areas contrary: “Precisely because we now have• Enhance the quality of the state-funded healthcare sector while the most advanced medical technology achieving the best possible cost-benefit ratio in the region, our hospital has become attractive for many of the best special-Solution: ists from Murcia and the rest of Spain,”• Siemens Healthcare implements its Managed Equipment Services Moreno says, evidently pleased that he (MES) model, assuming responsibility for providing the initial range is now able to count on some of the best of state-of-the-art medical technology and IT systems, financing, specialists in their fields. Those special- service, maintenance, and a 15-year innovation guarantee for the ists include people like José Contreras, systems a radiologist and the head of the new molecular imaging department. He valuesResult: the ongoing support and continuing• Financing and planning certainty for government healthcare sector education and training he now receives• Guaranteed innovation, updates, and replacements for the future at the hospital from Siemens employees.• Quality enhancement and an increased range of treatment and In addition to trainers who help physi- intervention methods through state-of-the-art medical technology cians and nursing staff learn how to• Status elevated to regional and national benchmark hospital operate the systems, a team of six to22 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 21. Facility PlanningManaged Equipment ServicesWhen the Spanish central government in Madrid transferred are highly interesting, which is why they can make offers that,responsibility for healthcare policy to the regional governments in turn, mean tremendous financial savings for the govern-in 2002, Murcia began to invest more in healthcare than any ment agencies awarding the contracts, says Sánchez, explain-other of the country’s autonomous regions. Over the past nine ing the decision in favor of the first business model of its kindyears, the region has increased its annual healthcare budget in Spain.by nearly 200 percent, to its current total of €2 billion. Starting in May 2009, the health ministry conducted a seven-Nonetheless, building two new hospitals and equipping them month series of negotiations, sitting down with various com-with state-of-the-art medical equipment at the same time was panies in direct competition, until Siemens Healthcare wasstill a huge financial and logistical challenge for the regional finally chosen. “Aside from financing and price, 70 percent ofhealth ministry. “That was why we looked for a private inves- our decision was based on technological quality, and in thattor to handle the equipment, service, and financing,” explains area, Siemens simply had the best offer,” says Sánchez.María Ángeles Palacios Sánchez, Minister of Health for the Another market in Europe where Siemens Healthcare hadRegion of Murcia. previously worked with the Managed Equipment ServicesThe arrangement marks the first time in Spain that a single tech- (MES) business model is the UK, which like Spain, has a health-nology partner is responsible for original equipment, service care system that is predominantly financed by the state andand maintenance, updates and replacements, and financing of providers increasingly have to rely on commitments frommedical equipment and information technology at a govern- private companies.ment-operated hospital. This is a completely new business model The Murcian Health Minister expects this business model towithin the Spanish healthcare sector. Sánchez hopes it will yield not only technological innovation, but also – and espe-enable the region “to improve the quality of government-pro- cially – financial certainty for planning purposes, even duringvided healthcare in Murcia at the best possible cost-benefit an era when the Spanish economic crisis is expected to lead toratio.” For technology companies in the healthcare sector, these budget fluctuations in the public healthcare sector, as in othermajor contracts for order volumes of €100 million and more areas.eight Siemens experts is assigned to work area of about 115,000 square-meters, is Crespo adds, Siemens Healthcare itselfwith the two hospitals on an ongoing about twice the size of the other facility. has naturally gained a great deal ofbasis to service, maintain, and monitor In just seven months, Siemens installed valuable experience in implementingthe medical equipment. 18,500 medical systems at the two hos- projects of this size and in emerging pitals, including 100 imaging systems. from direct “competitive dialogue”A Long-Term Technology Regional Health Minister Sánchez is with other providers – a new concept inPartner thrilled at the company’s performance: Spain – as the winner.For Siemens Healthcare Spain, it was “Siemens did this very well and in recorda tremendous challenge to equip two time, much faster than we expected Manuel Meyer is a correspondent for thestate-of-the-art hospitals of this size with beforehand.” For Siemens Healthcare Austria Presse Agentur in Spain and Portugal.medical equipment and IT systems at Spain, the public-private partnership withthe same time and train the staff. Los the Murcian health ministry was highlyArcos del Mar Menor University Hospital important. “We are able to present our-in San Javier has a bed capacity of 329 selves on the market as a long-term tech-and occupies about 61,000 square-meters nology partner, the first to tackle a pro- Further Informationof space. The state-run Santa Lucía Hos- ject on this scale in Spain,” explains José www.siemens.com/pital in Cartagena is even larger, and, Antonio Crespo, the person responsible healthcare-turnkeywith 656 hospital beds and total usable for the contract at Siemens. In turn, Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 23
  • 22. Facility PlanningCaring for Health and for the FutureTwo leading hospitals in Leipzig and Hamburg, Germany, have success-fully completed a new sustainability evaluation developed by Siemens:the Green+ Check. The results acknowledge achievements in sustainabilityand pinpoint the scope for further improvement.By Philipp Grätzel von GrätzFor somebody managing a group of com- alone, which boasts more than 1,000 piqued. The Green+ Check is a thoroughpanies with more than 3,000 employees beds and handles 45,500 inhouse and analysis of a hospital’s sustainability.and an annual turnover of €220 million, 140,000 ambulatory patients per year. Unlike other sustainability checks, it doesProfessor Karsten Güldner, PhD, is sur- The group is also a social enterprise with not focus exclusively on steps taken toprisingly down-to-earth. Looking out the numerous day-care and rehabilitation protect the environment, it also takes intowindow of his office at St. Georg Medical facilities and its own clinic dedicated account the efficiency of processes andCenter in Leipzig, the Managing Director exclusively to treating patients with drug quality of medical care. “It was this broadof Klinikum St. Georg gGmbH and Direc- addictions. Having spent his professional approach that interested me,” Güldnertor of St. Georg Medical Center talks life in this environment, Güldner has says. “As a public hospital, we tend to haveabout trees rather than figures. “I com- developed a very broad concept of corpo- a long-term perspective on everythingmissioned a study of an expert on forest rate responsibility, which the hospital we do. An evaluation of our work onlyecosystems some years ago. And it turned lives up to. “As a hospital, we have medi- makes sense when we look at quality ofout that there are quite a few very rare cal, social, and philosophical roots,” he care, efficiency, and the environmenttrees in our parkways out there,” he emphasizes. “This means that we are all at once.”muses. more than a healthcare repair shop. It is An agreement was reached in the sum-Güldner is proud of his place of work. our job to offer the best possible quality mer of 2010, and St. Georg subsequentlyThe hospital will celebrate its 800th anni- of care, of course. But, we also have a became the first hospital to complete theversary next year. The pavilion ensemble responsibility for the future and for our Siemens Green+ Check. Güldner: “It wasin Leipzig-Eutritzsch was built nearly a environment.” certainly a lot of work for both of us. Butcentury ago. “It is not always easy, but we it is always worth allowing someone fromwant to and we will preserve this heri- Thorough Analysis of Sustain- the outside to take a look at what youtage,” says Güldner. ability Efforts are doing.” Güldner and his staff wereThe St. Georg Group has more to offer When Güldner first heard about the new confident that St. Georg would pass thethan the large St. Georg Medical Center Siemens Green+ Check, his interest was check with flying colors: “We had already worked on both energy efficiency and our IT infrastructure, and we knew that these were assets we had to show off.” “ As a hospital, we are For example, St. Georg Medical Center was among the first hospitals in Germany more than a healthcare to negotiate energy contracting as early repair shop. We also have as the late 1990s. And with the imple- mentation of Siemens i.s.h.med® hospi- a responsibility for the tal information system underway in all of future and for our environ- the group’s facilities, the efficiency of clini- cal processes was also being addressed. ment.” The result was a Green+ score of 57, which is well above the 33 point average across all areas. “It did not actually Professor Karsten Güldner, PhD, Managing Director, Klinikum St. Georg gGmbH, surprise us. We expected to be above Director, St. Georg Medical Center, Leipzig, Germany average. The result acknowledges what we have achieved. And the subsequent24 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 23. Inside the foyerof the UniversityMedical CenterHamburg-Eppendorf
  • 24. Entrance of the Klinikum St. Georg Leipzig’s site in Eutritzsch (left). The shuttle buses of UKE do not produce emission;they are powered by hydrogen.analysis produced some interesting sug- rather complex structure of St. Georg is even bigger. UKE is neither a buildinggestions that are certainly worth think- Group.” nor an ensemble of buildings. It is aning about.” Güldner is especially happy urban district in its own right. With morethat the check gives credit to the social Leipzig Outcome: Negotiations than 8,000 employees, it provides careresponsibility demonstrated by St. Georg with Energy Suppliers for 330,000 inhouse and ambulatoryGroup and the degree of its integration One palpable outcome of the check is patients per year. Its annual turnover hasinto many parts of society. “The check that, in collaboration with Siemens, St. increased from €468 million in 2005 toalso revealed that we have developed a Georg Group is now planning to enter €720 million in 2010.reasonably effective controlling mecha- into negotiations with municipal energy Professor Jörg F. Debatin, MD, Medicalnism. This is not self-evident, given the suppliers in an effort to improve the Director and CEO of UKE, has overseen energy balance even further. “We are several years of transition. In order to also thinking of ways to consolidate our keep pace with an increasingly competi- care processes geographically, but we tive healthcare system, the city of Ham-Summary definitely want to preserve the pavilion burg decided to invest in UKE. The result ensemble. It was, in fact, very interesting was a new hospital building in the middleChallenge: to see that, although we have to live with of all the traditional structures. It opened• Evaluate a hospital’s sustain- this pavilion infrastructure, our energy in 2009. The new hospital considerably ability performance balance was actually quite good.” helped to streamline care processes at• Take into account environ- St. Georg Medical Center in Leipzig is UKE. “But we wanted to keep the other mental aspects, efficiency of a very sizeable hospital. But further 300 buildings as well. So we decided to go processes, and quality of care kilometers to the northwest, University beyond the actual hospital business and Medical Center Hamburg-Eppendorf (UKE) establish a kind of healthcare city thatSolution:• Complete Siemens’ Green+ CheckResult:• Get a comprehensive over- “The Green+ Check made view on what a hospital has reached in terms of sustain- important suggestions ability about how to get ahead with• Pinpoint individual strengths and weaknesses our sustainability agenda.”• Learn about measures to further improve environmental Professor Jörg F. Debatin, MD, protection, process efficiency, Medical Director and CEO of University Medical Center and quality of care in order Hamburg-Eppendorf, Germany to score higher on the sustain- ability scale26 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 25. The right medication at hand: Klinikum St. Georg in Leipzig (left). UKE’s unit dose system saves up to 1.5 tons of packaging waste annually.accommodates healthcare-related part- to 1.5 tons of packaging waste annually discussed at UKE as a result of the Green+ners of all kinds,” says Debatin. by ordering bulk-packaged medication Check. One involves the introduction ofSustainability has been high on the UKE instead of blister-packaged pills. a Green Building Monitor. It presents theagenda for several years already. “Some As far as environmental issues are con- success of the energy-saving projects,say that this is merely marketing, but cerned, UKE employees are encouraged informs about current energy and mediafor us it is really a lot more. As a medical to use bikes rather than cars to come to consumptions, and motivates the employ-service provider, we inevitably have to work, and there is even a voucher system ees to save energy. Another idea is tothink about issues like durability. And so for bike repairs. UKE provides a hydrogen- equip the central energy control stationit was a straightforward question to ask powered bus service for patients, visitors, with a highly efficient combined heat,how we as a hospital could contribute to and employees to get around the vast cooling, and power (CHCP) plant. Thisa healthier environment and to a more campus. A sophisticated hospital catering way, current heat and cooling can besustainable use of ever-scarcer resources. service is another success story in terms produced efficiently and in a resource-It is clear, though, that quality of care of sustainability: by offering patients a saving way.remains our top priority.” choice of 20 different meals, UKE has “The final decisions have not yet beenAs far as Debatin is concerned, it only managed to increase patient satisfaction made. But, these are important sugges-makes sense to talk about sustainability considerably. At the same time, the tions that help us in our discussionsin a hospital context if environmental amount of waste has fallen and costs have about how to get ahead with our sus-protection, the efficiency of processes, remained constant because patients are tainability agenda,” says Debatin. Andand quality of care are treated as a triad. ordering fewer meals than expected. getting ahead is what UKE is striving toAnd, as with his colleague Güldner in do. After all, Hamburg is the EuropeanLeipzig, it was the fact this triad was Hamburg Outcome: Improve- Green Capital 2011. With all its sustain-appreciated by Siemens that attracted him ment in Energy Management ability efforts, UKE is undoubtedly con-to the Green+ Check. UKE achieved an “We knew that we were already perform- tributing to the green credentials of 21stextraordinarily high Green+ of 72, reflect- ing well in these areas,” says Debatin. century Hamburg.ing the hospital’s various steps to increase “What interested us more was to identifyefficiency and improve environmental areas where we can further improve. Philipp Grätzel von Grätz is a medical doctor turned freelance writer and book author basedprotection. For example, the hospital-wide And, we discovered plenty of room for in Berlin, Germany. His focus is on biomedicine,implementation of Siemens Soarian® improvement in the field of energy medical technology, health IT, and health policy.information system in combination with management. One issue we are nowwireless access and digital ward rounds addressing is, for example, whether ithas improved the quality of care and at was really ideal to house our data centerthe same time resulted in a largely paper- in a tower building with maximum sunfree environment. UKE features two exposure.” One idea that emerged fromunit dose dispensing systems for the the Green+ Check was to analyze whetherautomated supply of medication to the an old overhead bunker with thick wallspatients, thereby increasing medication could be used instead in order to reduce Further Informationsafety, clinical quality, and efficiency. the energy required for cooling. www.siemens.com/At the same time, the system saves the Several other projects in the field of greenplushospitalshospital – and the environment – up energy management are currently being Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 27
  • 26. Facility Planning28 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 27. Facility PlanningThe Healing Power ofArchitecture British star architect Lord Norman Foster, in an interview with Medical Solutions, discusses the healing power of architecture, hospital design, and the artistic tightrope act between function- ality and the feel-good factor for patients. By Manuel MeyerThe times in which hospitals focused What does a ”perfect” hospital need Mental health is as important andmerely on medical functionality are to look like? indeed inseparable from physical health.past. It is also no longer a secret that the FOSTER: Almost all hospitals are cold and The one can affect the other adverselyarchitecture of hospitals influences the unfriendly, and yes, of course, hospital or positively.healing process of patients in both psy- staff need functional space. Your questionchological and physical respects. Colors, suggests that you cannot have one with- In a previous interview you saidlight, room layout: modern medicine out the other. I reject that supposition that, for you, architecture begins withtoday exploits all possibilities in order to totally. Unless a hospital meets both the people, and that it’s essentially ahelp patients. And, as a result, hospital material and spiritual needs, that is, help- response to needs – both material andoperators increasingly concern them- ing the patient feel at ease, then it’s not spiritual. Is this especially the case forselves with the creative and therapeutic truly functional. hospital architecture?impact of design and architecture. FOSTER: Yes. Remember that a hospital Talking about functionality. In the past, is like any other building in that it doesn’tLord Foster, most people say that hospital construction has focused exist without customers. If, in a competi-hospital buildings in general are cold particularly on medical functionality. tive world, one hospital treats the patientand unfriendly. On the other hand, FOSTER: Medical functionality is, or in a more civilized manner than another,hospital staff need functional space. rather should be, holistic in its approach. then it’s more likely to survive in the long Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 29
  • 28. “The main challenge is to address the special needs of all the different parties who together comprise the work- ings of a hospital – the patients, doctors, consultants, nurses, and administrators.” Lord Norman Foster, British architectA guiding principle of Foster’s architectural work:Doing more with less.term. The difference isn’t one of cost – choose one, it would be Buckminster general hospital, a children’s clinic,it’s about quality of design. The better Fuller. He was a great visionary – far or a special clinic?environment isn’t necessarily more ahead of his time – and one of the first FOSTER: Yes. ”One size does not fit all.”expensive – it’s about how wisely you people to recognize the importance There are common principles, such asspend the precious resources of time of conserving resources and building opening the building to views and natu-and money. sustainably. His credo of ”doing more ral light, or the creation of a calming with less” has been a guiding principle environment, but each type of healthcareWhat characterizes good architecture? throughout our work. You can see Bucky facility has a unique set of challengesFOSTER: There’s a very old checklist, in the Autonomous House project we according to its size and the people thatwhich goes back to Vitruvius – ”com- did together. His influence is more subtle will use it. We would work very closelymodity, firmness, and delight.” I think in the towers for Swiss Re in London and with specialist medical staff, patients,that still holds true, with the addition Hearst in New York, with their triangu- and users to design a building that ful-of ”sustainable.” lated structures exposed on the exterior. fills their exact requirements yet has the flexibility to anticipate future changesWhat inspires your work in general? Last year, you built a groundbreaking and technological developments.FOSTER: Inspiration can come from many hospital in the English town of Bath.sources – the views, the light, the land- It was the first time that you designed When designing a hospital you havescape, the historic context, the world of a hospital. What were the main chal- to know about the workflow and thenature and even machines and aircraft – lenges there and what features are needs of hospital staff as well asbut architecture is primarily generated important for you when designing a those of patients. How do you collabo-by people’s needs. It means listening, hospital? rate with hospital administrators andasking the right questions and taking FOSTER: The main challenge is to address staff when designing such a facility?nothing for granted – starting with a clean the special needs of all the different FOSTER: All complex projects demandsheet of paper and an open mind. Some- parties who together comprise the work- the integration of what at times mighttimes that process of questioning and ings of a hospital – the patients, doctors, seem to be conflicting demands. Thechallenging leads to new solutions, which consultants, nurses, and administrators; designers have to be good listeners andI’ve characterizsed as “reinvention“. depending on the scale of the hospital be prepared to research in depth. The this list might be extended to teachers, creation of teams with specialist disci-Who are your personal guiding researchers, and students. Fulfilling the plines is also central to the process, andfigures in architecture and why? Can needs of one party should never com- their needs must also be addressed. Inwe see them in your buildings? promise those of the others. this approach, industry has much to offer.FOSTER: There have been many anony-mous architects, as well as known names Would you design differently, On the other hand, Circle hospital inand, of course, teachers. But if I were to depending on whether an object is a Bath looks like a five-star hotel and30 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 29. Facility Planning rural landscape, the fundamental needs of patients for care, reassurance, dignity, Lord Norman Foster and comfort are universal. Do you think that the quality of Norman Foster was born in Manchester, UK, in 1935. After graduating building and facility design might be from Manchester University School of Architecture and City Planning a crucial factor for the cure and in 1961, he earned a Master’s Degree in Architecture at Yale University, recovery of patients? CT, U.S.. He is the founder and chairman of Foster + Partners, a world- FOSTER: Clinical studies have proved this wide enterprise with project offices in more than 20 countries. Since is the case. Recovery rates from surgery, its inception, it has received over 500 awards and citations for excel- for example, have been shown to improve lence and has won more than 86 international and national competi- when the patients have improved views tions. Recent work includes the largest single building on the planet, and better surroundings. Beijing Airport, and spectacular buildings like Millau Viaduct in France, the Swiss Re tower and the Great Court at the British Museum in London What do you need to consider or the Hearst Headquarter tower in New York. In 1990, he was granted regarding materials in the design of a Knighthood in the Queen’s Birthday Honors, and in 1999 was hon- hospitals? ored with a Life Peerage, becoming Lord Foster of Thames Bank. He FOSTER: Materials that have not neces- was awarded the Praemium Imperiale Award for Architecture in 2002. sarily consumed huge quantities of In 2009, he became the 29th laureate of the prestigious Prince of energy in their processing or production. Asturias award for Arts. After redesigning the Reichstag, Germany’s Materials that will age well over time parliament, one of Lord Foster’s most recognizable works, he received and won’t require expensive mainte- the Knight Commander’s Cross of the Order of Merit of the Federal nance during their life span. Materials Republic of Germany in 2010. In the same year, he became the 21st that are tactile to sight, sound, and touch, Pritzker Architecture Prize Laureate. that give comfort and do not offend. As in all decisions, it’s about getting the balance right. You had a severe illness, cancer. How have the disease and your hospital stay influenced your view on hospital architecture? FOSTER: Even if I hadn’t had two life- threatening illnesses, I would have still given these answers from my experienceit’s definitively not the cheapest hos- Are there any differences in hospital as an architect. However, speaking aspital building in the world. What would construction and trends between dif- a patient ”on the receiving end,” I canyou do differently designing hospitals ferent countries and cultures? assure you that my views are backed andin poorer countries with a lower bud- FOSTER: Yes, hospitals are important validated through personal experience.get? public buildings and, as such, I believe On this question, I can only add that theFOSTER: Try to get the basics right and that architects have a crucial role to play best facilities in the world are only asto do more with less. In those areas where in their design. However, as in all walks good as the individuals who operatethe environmental conditions are less of life, preconceptions need to be chal- them. In an ideal world, we need both todemanding, using shade and natural lenged from time to time. If anything, be of the highest standard.ventilation can still modify the climate it was an advantage that we had neverand provide comfortable conditions. With designed a hospital before CircleBath –fewer resources, the priorities have to we were able to apply the expertise andbe more carefully defined. Where funds authority gained through our work inare limited, the potential for savings by civic, commercial, cultural, and residen-repetition and standardization through a tial buildings to look at the buildingwider program of projects assumes more type afresh. Thinking globally and actingimportance. locally as an approach is as valid in the healthcare sector as in any other. AndIs there an architectural category while a building in a hot, urban climate Manuel Meyer is a correspondent for thesuch as ”hospital construction” at all? may look very different to one in a colder, Austria Press Agency in Spain and Portugal. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 31
  • 30. NeuroscienceThe Developmentof Language,in Living ColorAt the Basque Center on Cognition, Brain andLanguage in San Sebastian, Spain, researchscientists are using high-end medical imagingdevices from Siemens that gather data on theinner workings of the brain to explore the humanmechanisms related to the learning, under-standing, and production of language.By Peter Sergio AllegrettiThings that seem the simplest can often at the Basque Center on Cognition,be the most complex. Take for example Brain and Language (BCBL) in Spain. Thethe basic transmission of information. As Center is situated in San Sebastian, anyou read this article, you are most likely elegant coastal city and an ideal place toable to understand each of the individual study the bilingual brain. San Sebastianwords as well as the meaning that the is located at the heart of the Basquecollection of words together are intended Country where inhabitants speak bothto convey. Yet as you do that, what is Spanish and Basque, two languages thathappening now in your brain and your are completely unrelated, yet are usedbody is an extraordinarily complex and side by side in daily life.precisely choreographed series of neuro- The BCBL’s key aim is to unravel thelogical and physical events. mysteries and explore the mechanisms inNow, imagine you were reading this in the brain related to the learning, under-another language – perhaps a second standing, and production of language. Inlanguage you had spoken since birth or essence, scientists are working to under-one you acquired later. Would you under- stand what happens on a neuro-cognitivestand it in the same way? More specifi- level when we speak, listen, and learn,cally, would your brain process the words and to understand how the brain takesand turn them into “understanding” in on a second or third language.the same way? “It’s like an enormous jigsaw,” says BCBLFinding answers to these questions is a Scientific Director Manuel Carreiras. “Wekey focus of the work being carried out are trying to understand how it all fits Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 33
  • 31. Neuroscience Wernicke’s area Auditory cortex Broca’s area Motor cortexThis graphic highlights the areas ofthe brain used when speaking in yournative language. But what would thegraphic look like when learning a newlanguage?together. The truth is, nobody really Here, the center gets its answers with the then refining and reframing them wellknows how language works or how we help of advanced medical devices that are essential to getting good answers.”communicate.” Carreiras is a man with gather data on the inner workings of the As the members of his team show mea mission and a passion: a passion for brain. The BCBL employs a wide array around the testing rooms in the center,language, for understanding and knowl- of technology, including high-end func- I learn that many interesting questionsedge, coupled with keen curiosity. He tional magnetic resonance imaging (fMRI) are being asked, such as: How do babiesand his staff of 60 are working to under- equipment from Siemens as well as learn language? How do they begin tostand more pieces of the great commu- electroencephalogram (EEG) and mag- “understand?” What happens in the brainnications jigsaw. But how can one peer netoencephalogram (MEG) equipment. of a person who has a reading impair-inside the brain deeply enough to under- Carreiras points out that the equipment ment? What parts of the brain dedicatedstand what is happening on a neurologi- is the lifeblood of the center, as long as to language are altered when someonecal level? What parts of the gray matter one knows what to ask of it. “It’s all about suffers a stroke? How does the brain“light up” when communicating and posing the right questions,” he says. “Con- interpret speech as opposed to sign lan-understanding? structing the tests and challenges and guage? And, key to the center’s main34 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 32. Neurosciencemission, how differently does the brain a language test gets underway, I watchfunction when two or three languages the results being recorded and displayedare present? on a bank of computer screens. It isIn order to get good answers, these ques- extraordinary to see images of such clar-tions have to be broken down into a series ity and to watch different parts of theof smaller tests and questions, which will brain “light up” as challenges are posed toserve as the basis of study. Teams of vol- the volunteers. In this case, the womanunteers are recruited to undergo periodic in the MR system is given a series of wordstesting to allow the center to collect a that are totally or partially contradictorybody of data. together with some that are not.As I watch one volunteer slide into the Researchers want to know more aboutSiemens MAGNETOM® Trio™, a Tim which parts of the brain are activated(total imaging matrix) system, 3 Tesla when things make sense and which partsfMRI unit, I am taken around to see how are activated when it is confused.video information is fed onto a small The enormous benefit of actually beingscreen above the volunteer and how able to see this neuro-cognitive activityaudio is piped into the headphones. As means researchers can make what they “It’s all about posing “With Siemens’ 3 Tesla the right questions.” system, we get to look deep inside the brain Manuel Carreiras, Scientific Director, Basque Center on Cognition, Brain and Language, San Sebastian, Spain instead of just at the surface.” Pedro Paz Alonso, Research Scientist, Basque Center on Cognition, Brain and Language, San Sebastian, Spain Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 35
  • 33. call “neuro-correlates” or matches between brain activity and behavioral activity. The benefit of using the MAGNETOM system is that it is excellent at producing 3D spatial results – images that can be seen and interpreted visually. “The MAGNETOM with 3 Tesla has great spatial resolution,” says BCBL Research Scientist Pedro Paz Alonso. “Compared to other neuroscientific imaging techni- ques, with this system we get to look not only into the gray matter in the brain sur- face, but also to white matter anatomi- cal pathways inside the brain. Naturally, this gives us quite useful information. We also use EEG and MEG equipment that offers better temporal resolution.”BCBL uses a MAGNETOM Trio on a study participant to measure her Coupled together, researchers have anneuro-cognitive activity. extraordinary amount of data available to them. The process of putting it all together can take months.fMRI Technology: A New Way of Looking at Language stroke sufferers. The ability to see the locally affected areas ofSiemens fMRI technology makes it possible for researchers to the damaged brain and to track the hemispheric functioningget extraordinary pictures of brain activity with excellent 3D post-stroke means that doctors can give a more accuratespatial resolution. Identifying language and speech disorders diagnosis and better treatment.is now more advanced thanks to fMRI, which means treatment In all its uses, fMRI technology gives startlingly accurateplans are more efficient and suitable to patients. images and information, which are already leading to greatBut fMRI is also being used in life-saving clinical applications. advances in medical practice and research, saving costsOne of the most common uses is to carry out pre-surgical map- for hospitals and, most importantly, may significantly improveping of a brain with a tumor. Before an operation and within patient outcomes.a matter of minutes, an fMRI scan can give doctors critical dataand clear pictures about the location of the tumor and pinpointfunctional areas of the brain with great accuracy, so that thesurgeon can precisely remove all malignant tumoral tissue with-out damaging critical functional areas, such as those responsiblefor speech. This gives the surgeon crucial information about howbest to operate. With a magnetic field of 3 Tesla, MAGNETOM®Trio™, a Tim system, has twice the power of the standard scan-ner, which means greater speed, accuracy, and image clarityin fMRI studies.What is extraordinary about fMRI technology is that researcherscan peer deep into the in vivo brain while it is functioning,without any invasiveness. That is what makes this “currentlythe most exciting technology for the functional mapping of thebrain,” according to Siemens MR Neurology Global SegmentManager Ignacio Vallines. “The benefits for patients, surgeons,and researchers alike are enormous.” Siemens fMRI technology (here with the use of a MAGNETOM Trio 3 Tesla system) enables researchers to better understand human brainVallines also highlights the important work being done with activities, not only for language research, but also for stroke patients.36 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 34. NeurosciencePure research aside, it is satisfying tocome to conclusions from time to time.One of those conclusions focuses onmemory storage and retrieval – how best Goals of the Basque Centerto learn and remember things. The BCBL on Cognition, Brain and Languageresearch team found that retrieving infor- (BCBL)mation is key to remembering it. In otherwords, the process of learning somethingonce and then trying to retrieve it, then • To develop research and innovation in Cognitiverepeating the process again, appears to Neuroscience with special emphasis on language pro-be more effective than repeated learn- cessing and bilingualisming without retrieval. By using fMRI, the • To promote scientific research and national and inter-scientists have been able to get a vision national scientific relations within the area of Cognitiveof what is happening inside the brain Neuroscience and to transfer the results of this researchduring storage and retrieval and “see” to the wider socio-economic communitythis process of learning. • To promote the transfer and dissemination of knowledgeThere are clinical applications for their about cognitive neuroscience, language, and bilingualismresearch as well, ranging from being able both within and beyond the Basque country by organizingto observe what is happening in the brain courses, seminars, national and international conferences,with serious speech disorders to under- and other appropriate means of general communicationstanding what happens to stroke victims • To participate in undergraduate and postgraduatewhen language ability is impaired. In education and training programs and encourage thethe first case, the BCBL medical scanners incorporation of young researchers to this areaand other devices are used to compare • To facilitate the training and ongoing development ofwhat happens in the brain of someone the BCBL personnel and to promote their collaborationwith normal speaking abilities and com- across different lines of researchpare it to those whose speech is impaired. • To forge collaborative links and common interest areasIn stroke sufferers, they look at how some with public and private institutions, centers, and industries,of the functions of the damaged part are with the aim of providing research, training, and techno-taken over by other areas of the brain. logical and consultancy services to use the work developedBCBL Director Carreiras says this quality in BCBL to the fullest economic and social advantageof research would not be possible with-out the modern medical imaging andmeasuring equipment, yet they are stilla long way from reaching their ultimategoal of understanding the process oflanguage and communication. “Althoughwe have more pieces of the puzzle, wedon’t have enough pieces to know howto fit them together.” It is a jigsaw thatis far from being completed. Yet step bystep, every day, they are moving a littlebit closer.Peter Allegretti has reported for NBC in Europeand the USA, and has produced news and cur-rent affairs stories from more than 30 countriesfor the BBC, World Monitor, and Frontline News.He is also a qualified therapist and coach witha keen interest in health issues. He is based inBarcelona. The Basque Center on Cognition, Brain and Language (BCBL) Further Information in San Sebastian, Spain www.siemens.com/mr Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 37
  • 35. Laboratory Testing: Alcohol Abuse38 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 36. Laboratory Testing: Alcohol AbuseA Simple, Reliable Blood TestHelps Detect Chronic Alcohol AbuseRegina Reppin, PhD, University Clinic in Magdeburg, Germany,and Jos P. M. Wielders, PhD, Meander Medical Center in Amersfoort,Netherlands, are helping physicians diagnose chronic alcohol abuseusing a specific blood test and analysis systems that deliver reliable,fast results.By Matthias ManychThe first thing that suffers from chronic incidence of illness and premature deathalcohol abuse is the abuser’s own health. resulting from alcohol problems is theBut the consequences can also be devas- highest in the world.2tating to families, often destroying social Regina Reppin works at the Institute forrelationships. The harmful health effects Clinical Chemistry and Pathobiochemistryof excessive alcohol consumption have at the University Clinic in Magdeburg, abecome a constant strain on society. In city of about 230,000 in Germany. Reppinthe United States, there are nearly 14 estimates that ten percent of patients inmillion alcoholics or people who abuse the region have a drinking problem. Thatalcohol. In 1998, the financial losses due estimate is echoed by Jos P. M. Wielders,to alcohol-related illnesses, premature PhD, who works at the Meander Medicaldeaths, and crimes were estimated at Center in Amersfoort, the second largest185 million U.S. dollars.1 According to city in the Dutch province of Utrecht,information provided by the World Health with a population of about 150,000. TheOrganization (WHO), the situation is Meander Medical Center is among the 20even more severe in Europe, where the most prestigious hospitals in the country, Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 39
  • 37. Laboratory Testing: Alcohol Abuse “Three-quarters of the tests we perform are for legal issues, particularly regranting of driver’s licenses that have been suspended for alcohol abuse.” Jos P. M. Wielders, PhD, Department of Clinical Chemistry, Meander Medical Center, Amersfoort, Netherlands serving about 300,000 people in the area. ask patients about their alcohol use. Wielders puts the percentage of alcohol- The risk, however, that respondents will ics in the regional population and at the underestimate their alcohol problems – hospital at the same figure: ten percent. deliberately or unconsciously – is high. Wielders, head of general and special Anyone who drinks more than 60 grams chemistries at the facility’s Department of alcohol daily, equivalent to one bottle of Clinical Chemistry, reports that alcohol of wine or one-and-one-half liters of abuse has different effects within hospi- beer (about three 16-ounce cans or four tals’ various clinical departments: “When 12-ounce cans), is at high risk. “A person we talk about risk, for some types of with this kind of behavior, though, will trauma surgery, alcohol is reported to vehemently deny it if someone says to be involved in up to 70 percent of the him, ’watch out, you’re on your way to cases.” Up to 25 percent of internal med- becoming an alcoholic,’” says Reppin. icine cases are attributable to alcohol problems, along with up to 30 percent Clear Biomarker, Reliable Test in psychiatry, Wielders says. However, medical laboratories have to While a general practitioner, who knows offer doctors and psychiatrists reliableBecause the samples are bar-coded, his patients well, can estimate whether test methods that confirm alcohol abusedifferent patient tubes with different his or her patient is at risk with a few without any doubt. The carbohydrate-plasma protein requests can be standard questions, there are published deficient transferrin (CDT) is the mostmeasured simultaneously. questionnaires (like AUDIT) available to specific marker to detect high alcohol40 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 38. Laboratory Testing: Alcohol Abuseconsumption, and the Siemens N Latex sample tubes and reagents are bar-coded,CDT Kit is a very specific assay to mea- different plasma proteins can be analyzedsure CDT3. In the late 1980s, Swedish simultaneously. A broad plasma proteinresearchers discovered that high alcohol test menu of more than 60 tests is avail-consumption induces characteristic able for determinations from serum,changes in the common serum protein plasma, urine, and cerebrospinal fluids.transferrin, giving rise to molecular formsthat are significant indicators for alcohol Proven in Internal Routines,abuse, commonly known as CDT. Acknowledged ExternallyReppin heads a working group that The lab in Magdeburg performs aboutfocuses on proteins and molecular biology 2,000 CDT analyses each year, requestedmethods, and she is especially pleasedat this discovery. Now, lab professionalsare not dependent on indicators thateither take months for alcohol abusedetection or that are influenced by non-alcohol related causes. “The rare diseasesthat also raise CDT levels are easier toisolate,” reports clinical chemist Reppin.CDT concentrations in the blood repre-sent the average intake of two to threeweeks, and it takes about two weeks ofabstinence to return to a basic level again,says Wielders. One night of excessivedrinking is not enough to send CDT valuesinto the critical range.Based on these research findings, thenephelometric N Latex CDT testingmethod was developed. Wielders wasinvolved in evaluating the N Latex CDTKit at an early stage of development.The mechanism underlying the test is anantigen-antibody reaction. The reagentused in the test contains monoclonal anti-bodies and CDT-like antigens on Latexparticles. “If CDT was not present in the “We run CDT for the uni-sample, the antibody would agglutinateonly with the CDT-like antigen. CDT from versity clinic’s emergencythe sample inhibits this agglutination.Even without drinking, some CDT is room, psychiatry, andalways present, so results will never be gastroenterology depart-zero,” explains Wielders. This reactioncan be measured with the BN™ II or BN ments. CDT is fullyProSpec® System quickly and accurately.This method determines, with high automated on the BN systemspecificity, whether a test subject haselevated levels of CDT in his or her blood, and samples do not requirebut that is not its only virtue. It is alsoeasy to use and robust. The only immuno- pretreatment.”assay CDT method on the market, samplesdo not have to be pretreated to undergo Regina Reppin, PhD, Institute for Clinical Chemistry and Pathobiochemistry,N Latex CDT testing, and with the BN University Clinic, Magdeburg, Germanysystem all measurements and analysesare automated. After just 18 minutes, itdelivers the first results. Because the Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 41
  • 39. Laboratory Testing: Alcohol Abuse Organ Imaging Options for Damage Associated with Alcohol Alcohol affects the entire body. The immunological they are widespread. The imaging repertoire for these and metabolic changes caused by chronic alcohol abuse includes ultrasound, MRI, and CT. Ultrasound is usually can trigger both acute and chronic diseases. Hardly applied first in detecting dilated bile ducts and to con- a single organ in the body is immune to the ill effects firm diagnosis of fatty liver. Conventional ultrasound, of alcohol abuse. From head to foot, the entire body however, cannot detect fibrotic changes until cirrhosis is at risk. Alcohol adversely affects the mucous mem- is already present. branes, for instance, starting in the mouth and passing Major progress in this regard is offered by Strain through the throat and esophagus before affecting Imaging, a simple ultrasound application that enables the entire digestive tract. If the inflammation caused a real-time assessment of the stiffness or elasticity of by constant, risky consumption of alcohol lasts for many the tissue. Siemens’ unique Virtual TouchTM Tissue years, cell damage can result in precancerous condi- Imaging and Quantification* technology, which dem- tions and potentially in malignant tumors. In addition onstrates and measures the stiffness of tissue, helps to lab findings and clinical examinations, imaging pro- physicians better assess the need for biopsy. Another cesses should help detect these developments early emerging application in the field of elasticity imaging on or locate manifestations of these effects and deter- is MRI elastography. mine their extent. The nervous system can be directly damaged by toxic In the gastrointestinal tract, pathological changes are acetaldehyde, which is a product of alcohol metabolism, often detected via endoscopy. If further examination with consequences including disruptions in eye move- is advisable, tissue samples are taken during this pro- ment, unsteady gait, and disorientation. The diminu- cess. Depending on the suspected diagnosis, but also tion of brain mass that commences in alcoholics can according to the medical center’s specialization, scin- lead to, for example, dementia, which can be visualized tigraphy, magnetic resonance imaging (MRI), and com- using CT and MRI. The good news: If a patient abstains, puted tomography (CT) imaging methods are also used. the body can balance out the loss of nerve cells. Alcohol-related liver diseases such as fatty liver, alco- holic hepatitis, and cirrhosis are as widely known as * Not available in the U.S.by the university clinic’s emergency room Reppin is a fan of the nephelometric ing with the N Latex CDT Kit, it hasand by its psychiatry and gastroenterology measurement with the BN systems and passed all of the external performancedepartments. In the case of emergency the use of monoclonal antibodies, say- tests conducted.room patients who are unresponsive due ing, “Everything I can measure here with Within the department where Wieldersto factors such as delirium or a traffic a monoclonal antibody, I measure with- works, 4,000 to 5,000 N Latex CDT testsaccident, the speed of the N Latex CDT out disruptive factors.” The less a person are performed each year. Tests orderedmethod pays off. In gastroenterology needs to intervene in the test, the more by general practitioners who need thepatients, the aim is often to use CDT to precise its results are. This test’s very high results in order to confront patients aboutdifferentiate between alcohol-induced reliability is also not affected by varia- their alcohol problems are the minority.and non-alcohol-induced liver diseases. tions in the samples. As the expert in Three-quarters of the tests are performedIn these cases, the tests are often accom- Magdeburg explains, lab tests conducted for legal issues, particularly when it comespanied by imaging procedures such as in Germany undergo not only internal to withdrawal and regranting of driver’ssonography, which detect factors such as quality control, but also external reviews. licenses that have been suspended forchanges in the liver caused by cirrhosis To this end, the German INSTAND Society alcohol abuse. In the Netherlands, psy-indicating alcohol abuse. With CDT tests, for Promotion of Quality Assurance in chiatrists commissioned by the govern-alcohol abuse can be ruled out and the Medical Laboratories regularly conducts ment’s Driving Test Organization arebasic cause of the liver disease can be interlaboratory tests. In the four years responsible for the medical judgement oftreated in the early stages. since the lab in Magdeburg began work- the clients’ driving ability. The depend-42 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 40. Laboratory Testing: Alcohol Abuse able CDT immunoassay test is a valuable and acknowledged part of the highly regulated procedures of withdrawal and regranting. “The psychiatrists say that the CDT test is the most valuable contri- bution in the whole report. They hesitate very much to say someone is drinking with a normal lab test, and especially with a normal CDT result. Meanwhile, the CDT test is the cornerstone of the psy- chiatrists’ report about chronic alcohol abuse and an essential part of the offi- cial guideline on the subject,” Wielders reports with some satisfaction. After all, he has been championing the evaluation of this test, along with standardization of reliable test procedures for legal pur- poses for many years. Among his other activities, Wielders is the Chairman of the CDT Committee of the Dutch Society of Clinical Chemistry and a member of the International Fed- Samples do not have to be pretreated to undergo N Latex CDT testing, and with the eration of Clinical Chemistry and Labora- BN ProSpec System all measurements and analyses are automated. tory Medicine (IFCC) working group on CDT standardization. His department is named as a reference lab for the IFCC. This IFCC working group has made a major contribution to ensuring that HPLC is acknowledged as a reference method at the international level. CDT testing with the N Latex CDT Kit and the BN sys- Summary tems has a relative specificity of 97 per- cent compared to the HPLC reference Challenge: method.3 For Reppin and Wielders, the • Health risks, social and economic strain caused by chronic alcohol abuse CDT test has become an essential method • Forensic and clinical decisions require clear-cut test results in diagnosing chronic alcohol abuse. • Biomarkers and test methods must work dependably and robustly • Test method must improve workflow Matthias Manych, a biologist, is a freelance scientific journalist, editor, and author specializ- Solution: ing in medicine. His work appears primarily in specialized journals, but also in newspapers. • CDT: highly specific biomarker to detect chronic alcohol abuse • N Latex CDT with monoclonal antibodies: clear reactions • Reliable measurements via nephelometry1 National Institute on Alcohol Abuse and Alcoholism • BN II and BN ProSpec Systems offer automated workflows (NIAAA), Strategic Plan 2001–2005.2 http://www.euro.who.int/en/what-we-do/health-topics/ • BN systems: fast results for a broad menu of plasma proteins disease-prevention/alcohol-use/facts-and-figures. • N Latex CDT and BN systems in combination deliver accurate results3 Delanghe, J. et al; Development and Multicenter Eva- with no sample prep luation of the N Latex CDT Direct Immunonephelometric Assay for Serum Carbohydrate-Deficient Transferrin, Clinical Chemistry, 53:6 1115–1121 (2007). Result: • CDT: the most reliable biomarker for chronic alcohol abuse3 • N Latex CDT Kit achieves nearly 97 percent relative specificity to the HPLC reference method3 Further Information • Improved workflow throughout the testing process • Automated method with bar-code detection for various sample materials www.siemens.com/cdt • Robust, validated test results in 18 minutes • High sample throughput of up to 130 tests/hour with the BN II System Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 43
  • 41. Paoli Hospital in Chester County, PA, U.S., chose to upgrade its UROSKOP Access – with all the benefits of a new system.More Options at Lower CostsImagine the possibility to enhance urology image quality, improve systemmaneuverability, and better manage patient information – all withoutpurchasing a new imaging system. Paoli Hospital did just that with Siemens’EndoExpand Upgrade. The 214-bed hospital located in a Philadelphiasuburb in Chester County, PA, U.S., improved its endo-urologic system with-out a major capital expense.For the last seven years, Paoli Hospital seven-year-old system was somewhat that would enable the UROSKOP Accesshas used Siemens UROSKOP® Access – an outdated. Paoli Hospital staff contacted to function like a brand-new system andendourologic system that allows clini- Siemens to explore how the system could as a result, maximize the hospital’s returncians to view the entire urinary tract and be upgraded. “Siemens understood our on its investment. The changes includedperform urological diagnoses and endo- situation and really worked with us to new monitors, new sign-on and filmurological procedures with unrestricted identify ways to improve our existing sys- transfer capabilities, and new hand andpatient access from all sides of the table. tem in order to stay on budget and to foot controls. The old monitors wereHowever, the hospital considered if it provide the best possible patient care,” replaced to accommodate the latest high-should replace its endo-urologic system. says Holmes. definition imaging, which was available Working hand-in-hand with Paoli’s in all of Paoli’s new OR suites.Staying on Budget urology, surgery, and biomedical teams, In fact, UROSKOP Access has been able“The move to our new operating room Siemens focused on what changes were to virtually grow with Paoli Hospital’s OR(OR) suite would have been a good time practical, affordable, and potentially most as camera technology changed over theto purchase a whole new urodiagnostic beneficial for the hospital’s patients and past seven years. The suite, for example,system,” says Norma Holmes, BSN, Urol- staff. “Siemens shared our concerns for started with a single chip camera, up-ogy Coordinator at Paoli Hospital. “How- our patients’ well-being as well as for our graded to a three-chip camera, and isever, we had to be smart about how much current and future financial well-being,” now using high-definition endoscopicwe were spending while making sure we says Holmes. cameras.were diagnosing and treating our patients With the upgrade, the OR staff andwith the best technology available.” A Smart Move patients can benefit from these state-The hospital’s staff was very happy with Together with hospital staff, Siemens of-the-art endoscopic cameras withoutits existing UROSKOP Access, but the identified several affordable upgrades purchasing a brand new system.44 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 42. UrologyBy installing new monitors that work in Summarytandem with the high-end endoscopiccameras, the staff noticed significant Challenge:image improvement. “The imaging quality • Equip a new operating room suiteof the new monitors, displaying both the for endourologic and urodiagnosticendoscopic and the X-ray images, is far proceduressuperior to our previous video monitors,” • High-end technology at lowestsays Holmes. “And the warm-up time is possible costs and with lowestsignificantly reduced, which helps our possible training effortsstaff save time.” The new monitors are Norma Holmes, BSN,also more compact and easier to move Urology Coordinator at Paoli Hospital, Solution:thanks to a new hand bar. Chester County, PA, U.S. • Advance the existing UROSKOPIn addition, several changes were made Access system with EndoExpandto improve staff comfort, satisfaction, upgradeand efficiency. The new sign-on and film • Integrate new accessories instead oftransfer capabilities, for example, are fiting from the changes, Holmes thinks purchasing an entirely new systemmuch more user-friendly, enabling staff more than ever that the upgrade was the • Little training efforts since staffto easily add additional studies to a right choice. “Upgrading our existing already worked with the existingpatient’s prior study. And, with the new UROSKOP Access with the EndoExpand systemhand controls and foot pedals, surgeons upgrade was considerably more reason-can maneuver the X-ray head more easily able than replacing the entire system. Result:and quicker. “With these improvements, I would recommend this option to any • Profit from latest high-definitionwe’ve received many of the benefits of facility with the original UROSKOP Access endoscopic imaging system at aa new table system at a fracti on of the and seeking to provide state-of-the-art fraction of the costcost,” says Holmes. technology without large cash expendi- • Maximize the hospital’s return on tures,” she says. “Siemens’ commitment investmentTruly Understanding Best to doing what was truly in our best inter- • Keep up the best possible patientInterests est has made a lasting impression on us.” careThe entire upgrade took just one week,“which was remarkable considering thisincluded the physical move to a new Further Informationlocation and the system upgrades,” saysHolmes. With the upgrades now in place www.siemens.com/uroskopand the hospital staff and patients bene-A Higher Level of Patient CareUROSKOP® Access, the high-performance ■ Radiographic examinations The Upgrade Packagesystem for endourology and urodiagnos- ■ Endourological interventions The EndoExpand upgrade package con-tics, supports a high level of patient care ■ Percutaneous interventions tains the FLUOROSPOT Compact imagingin urology. Siemens is the only vendor in ■ Laparoscopy system including DICOM* and CARE**the market that offers an image intensi- ■ Urodynamics licenses as well as Fluoroloop and Harmo-fier-based X-ray system with free patient ■ Ultrasound examinations nization. It also holds a counterbalancedaccess from all four sides. This helps to articulating swivel arm with two 19-inchease the workflow as patient reposition- Its open interface allows the attachment TFT monitors, two hand-held controls, anding is not necessary, and the anesthetist of endoscopic modules and ultrasound a multifunctional footswitch. The includeddoes not have to change their working systems, so customers can easily integrate DVI Interface allows for connecting withposition. A top-notch system for virtually existing equipment. The two 19-inch TFT high-definition endoscopic devices.all urological applications – whether monitors and the articulating swivel armdiagnostic or therapeutic – UROSKOP allow for viewing endoscopy and ultra-Access enhances a hospital’s clinical sound live images side-by-side with X-rayportfolio for: or fluoroscopy.
  • 43. Medical TourismThe Medical TravelerWhat started in the tuberculosis clinics of the Swiss Alps has growninto a market with many players: medical tourism. But, aided bylower international airfares and the Internet, this truly global branchof healthcare is changing. Medical Solutions explores today’s maintrends and also looks at the benefits and pitfalls of medical tourismfrom the patient’s perspective.By Haig SimonianLeaf through the back pages of many or just escaping the infernal summer to Switzerland. “The broad spectrumEuropean airline magazines, and chances heat. of orthopedics and oncology, and allare, you will see alluring advertisements complex procedures, such as heart andfor doctors and hospitals. Most will be for Swiss Beginnings brain surgery is what they’re after,” sayscosmetic surgery and minor interventions. Switzerland has gained a similar status, Wiesinger.But, depending on the country, among with many patients also from the Middlethe nose jobs and weight loss treatments East. A reputation for quality and reli- The Changing Picture ofwill be pitches for far more complex pro- ability, high-class private hospitals, and Medical Tourismcedures. the possibility of combining medical treat- The U.S. has been the other big magnet.Welcome to the world of medical tour- ment with other attractions prolong a Prestige hospitals, high-tech medicine,ism. Jetting around the globe to find medical tradition that started with the and quality care have won institutions,the best, or the cheapest, treatment has tuberculosis clinics of the Alps – arguably such as the Mayo Clinic, internationalbecome big business. Firm data do not the first significant incidence of medical fame. Often, that status has been bur-exist. The World Health Organization, tourism. nished by visits from foreign heads ofthe most obvious source, collates no “Switzerland has traditionally been a med- state or billionaires – usually from theinformation on cross-border treatment ical tourism market,” says Ole Wiesinger, developing world – seeking cutting-edgeflows, other than for organ transplants. Chief Executive of the Hirslanden group, treatment and technology only inade-But the Geneva-based multinational body Switzerland’s biggest private hospital quately available at home, if at all.concedes medical tourism is becoming chain, with 14 hospitals concentrated in But the picture of medical tourism isincreasingly important. German speaking regions. “Arab visitors changing. Countries that once sentThe idea of traveling for medical care have tended to gravitate towards Geneva, patients abroad have developed theiris nothing new. For decades, doctors German speakers towards Zurich. We’ve own centers of excellence and are nowand surgeons in London’s Harley Street been fortunate, in that domestic demand reaching out themselves. While manyboosted their earnings by welcoming rich has kept us pretty busy. But we intended traditional locations remain busy, com-foreigners, often from the Arab world. In to step up our efforts towards the medi- petition is rising.many cases, non-urgent care is combined cal tourism market now.” India is the best example. In recent years,with other reasons for visiting London, As might be expected, complex proce- Indian specialists, many trained or expe-such as education, culture, shopping – dures are what draw most foreign patients rienced at top foreign universities and Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 47
  • 44. Medical Tourismhospitals, have returned home to open Gilberto Galletta, International Relations the U.S. Local experts promote the coun-clinics. While catering primarily to an Manager of Hospital Israelita Albert Ein- try as offering quality care for prices asincreasingly affluent domestic middle stein, one of Brazil’s biggest and most little as one-quarter of the comparableclass, such centers are also targeting prestigious. Presenting itself as offering, levels in the U.S.foreigners – offering quality treatment “the most advanced healthcare in Latin Jordan’s regional dominance has beenfor a fraction of the price at home. Cul- America,” the high-rise, high-tech hospi- challenged as the United Arab Emiratestural concerns have been tempered by tal in São Paulo offers complex treat- in particular has muscled into the market.the widespread knowledge of English. ments, including liver and bone marrow As far back as 2002, Dubai launchedTake Medanta. The self-styled “Medicity” transplants. Most foreigners come for Dubai Healthcare City (DHCC), partly tois one of India’s biggest multi-speciality cardiology, oncology, orthopedics, and create a medical cluster not only forcenters. Founded by Naresh Trehan, MD, neurosurgery. locals and resident expatriates, but alsoan eminent cardiac surgeon, and located The Hospital Israelita Albert Einstein is medical tourists from around the Gulf.near New Delhi, the huge site combines not alone. A small, if growing, band of top Although not as successful as originallydoctors, scientists, and researchers to Brazilian clinics is targeting foreigners. hoped – vacancy rates for clinic officefoster a multidisciplinary atmosphere in While most are based in the commercial space remain high – this free zone haswhich scientific breakthroughs can be hub of São Paulo, others are in Recife two hospitals, more than 90 outpatienttranslated swiftly into everyday medical in the northeast and Porto Alegre in the medical centers, clinics, and diagnosticpractice. south. laboratories, alongside more than 2,000Spread across 43 acres, the site has A significant proportion of Hospital licensed professionals.1,250 beds, 350 for critical care, with 45 Israelita Albert Einstein’s patients come Abu Dhabi is also investing in healthcare infrastructure, with facilities such as the Imperial College London Diabetes Centre“We can offer the same looking not only to serve local needs, but to attract regional patients, too. And, on quality and technology at the cusp of Europe and the Middle East, Turkey has been trying to develop the very competitive prices.” medical tourism business. Lower Airfares and the InternetGilberto Galletta, International Relations Manager,Hospital Israelita Albert Einstein, São Paulo, Brazil So prevalent has medical tourism become that specialist promoters, with their own Internet sites, have sprung up. The Medical Tourism Association (MTA) is a U.S.-based body propagating treatment abroad. The MTA brings together foreign hospitals and specialists with U.S. middle- men, organizes regular conferences, and produces specialist publications.operating theaters dealing with more from neighboring Argentina, Uruguay, As with “mainstream” tourism, the medi-than 20 specialties. Medanta also boasts and Bolivia – patients who might once cal variety has been helped greatly bya research center and medical and nurs- have travelled to the U.S., but are now two developments. Lower internationaling schools. While the clientele is partly happy with the allure of high-tech medi- airfares have turned flying long distancesdomestic, the organization also targets cine closer to home, explains Galletta. for care from a potentially major disin-patients from abroad – notably those from Interestingly, the hospital’s roster includes centive into a relatively minor cost factor.developed countries seeking comparable patients from Angola, drawn by the com- The second, and even more elemental,quality healthcare at much lower prices. mon language of Portuguese, cultural change has been the Internet. Not onlyAbout 15 percent of Medanta’s patients similarities, and a lack of domestic alter- has the web vastly accelerated globaliza-are deemed to be “medical tourists.” natives, as well as U.S. citizens coming tion, it has also given patients far moreSimilar, if not always as spectacular, primarily on cost grounds. liberty in selecting and creating their owndevelopments are under way in South In the Arab world, Jordan has tradition- healthcare solutions.America and the Gulf – both areas where ally been the leading medical tourism Clearly, patients’ ability to pick and choosemedical tourism was once entirely out- destination. The country, which initially is determined by their illness as muchbound. catered to patients from the Middle East, as their affluence. Someone who has“We can offer the same quality and tech- has widened its scope through global just suffered a debilitating stroke will benology at very competitive prices,” says marketing, and is now looking as far as headed straight for the nearest neuro-48 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 45. Medical Tourismsurgical center, rather than the airport, of the cases covered, and with the U.S. Summarygiven that such a sudden illness leaves the prime destination, even for patientsno time to trawl the Web, let alone the from developed Western Europe. Obtain- Medical tourism – the trend for patientsability or inclination to do so. ing superior care was the second reason, to seek treatment abroad – is gainingBut for non-acute and elective cases, accounting for 32 percent. Here, not sur- popularity. While occasionally sponsoredchoice can be highly relevant. Few non- prisingly, most patients came from devel- by private sector health insurers, or evenexperts are likely to make decisions alone oping countries, with cardiology the main governments, the main impetus has come– opening the way to a new business for speciality sought. Speed was the third from individuals or professional inter-medical tourism intermediaries. reason, with patients traveling for proce- mediaries, using cheaper airfares and theAs yet, there is little research into why dures that would have involved signifi- rise of the Internet to create “tailor-made”patients shun care options at home for cant waits at home. Orthopedics, general treatment options. Hard data remainsforeign solutions. Very occasionally, the surgery, and cardiology were the main scant, but the evidence suggests electiveopportunity can spring from a domestic specialities in such cases. procedures, notably bone and heartstate or private sector health insurance As a motive, cost was in fourth place, surgery, are most in demand. But cancerprovider. When, some years ago, UK accounting for just nine percent of cases. and even brain surgery are also prevalent.waiting lists for non-urgent hip or knee “An aortic valve replacement cost more The evidence further suggests patientsreplacement surgery reached politically than US$100,000 in the United States, travel primarily to seek out the best tech-unacceptable levels, local health author- for instance, but about US$38,000 at nology, quality, or care, with cost play-ities sent patients to continental Europe. a provider in Latin America and only ing only a subsidiary role. But spirallingBeneficiaries included one specialist US$12,000 at a provider in Asia,” noted prices in developed countries suggestcenter in eastern Germany, which, in its the authors. U.S. patients comprised 99 traveling to save money will expand.heyday, had been the orthopedic Mecca percent of the money-motivated medicalfor East Germany’s top athletes. After the travellers, with orthopedics accountingcollapse of communism, the same insti- for 30 percent of all cases and generaltution jumped on the medical tourism surgery for 16 percent. Medical travel onbandwagon. cost grounds “has the greatest potential from friends. Such “soft” benefits may beUsually, however, the decision will be for growth,” the report concluded. These entirely absent for those undertakingthe patient’s own. In a 2008 study, are all interesting facts for providers, but medical treatment far from home.McKinsey, the international consulting they should also be aware that medical Complications, let alone malpracticegroup, examined the reasons for medical tourists will probably also bear in mind issues, are another consideration. Ideally,travel. The survey1 estimated the market the risks before jumping onto the next jet. an operation will go well. But complica-at the time remained relatively modest, Culture and language are the most tions can arise and stays may have toat 60,000 to 85,000 inpatients a year – obvious disincentives. Not everybody feels be prolonged. Follow-up care is anotherthough that figure may have grown since; comfortable abroad, let alone when issue. And, if something goes wrong,unfortunately, the study remains one of undertaking sensitive – and potentially patients need assurances they have someits kind to date. life-threatening – medical procedures. redress. Many such constraints can beThe research analyzed patients’ – and Language skills may have improved, but overcome through a health insurer withhospitals’ – motives, looking at more than fluency, let alone cultural sensitivities, adequate experience of foreign hospitals20 medical travel destinations, examin- cannot be taken for granted. Dubai, for or via an acknowledged and reputableing primary data on the number, type, example, does not attempt to compete intermediary.and origin of so-called “medical travel- on price with, say, much cheaper Asianlers” and interviewing health providers, centers like India or Thailand. Instead, Haig Simonian is Switzerland correspondent of the Financial Times.patients, and intermediaries around the it plays on quality of care and relativeworld. familiarity. Circumstances for family and friends areTechnology as Main Motive further factors. Most patients may wantRather than saving money, seeking the to be accompanied by a relative. Others 1 Tilman Ehrbeck, Ceani Guevara, and Paul D. Mango,best technologies was the main motive may take comfort – and feel their recov- Mapping the Market for Medical Travel, McKinseyfor travelling – accounting for 40 percent ery will be accelerated – by regular visits Quarterly, May 2008 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 49
  • 46. Breast CancerAll About Breast Cancer The Siemens Breast Care Day was one of the highlights of this year’s European Congress of Radiology (ECR). Radiologists and medical students from around the world were given further insight into breast cancer awareness and extended their knowledge of the latest 3D-imaging modalities for breast cancer detection. Medical Solutions asked health journalist Wiebke Kathmann to report back. By Wiebke Kathmann, PhDToday, the chances of surviving breast seeking information and what are theircancer are higher than ever. This is good needs? What are their personal expe-news for women faced with the diagno- riences with mammography? A timelysis – a fate that strikes more than one in international survey, conducted by theten women worldwide. Today’s therapiesare especially effective when the cancer renowned German market research insti- tute Gesellschaft für Konsumforschung “Breast canceris detected early. “It should be detectedbefore it is palpable,” as Michael Golatta, (GfK) on behalf of Siemens Healthcare, helped to provide answers to these should begynecologist at the University of Heidel- questions. detected beforeberg, Germany, pointed out during thepanel session. “At that stage, chances are Siemens’ Breast Cancer it is palpable.”a lot higher that the cancer can be healed Awareness Surveyand less treatment is necessary. The treat- The Breast Cancer Awareness Survey Michael Golatta, MD, Gynecologist,ment is not only more effective but also indicated that almost all of the women University of Heidelberg, Germanyless expensive.” Breast cancer awareness surveyed – on average 82 percent – con-and early detection are therefore major sider breast cancer screening to be veryfactors in combating this health threat. important. It also indicated that thereWhen this is not the case, approximately is some confusion about the differenceone in 80 women dies from the disease. between preventative programs, whichBut how well informed are women in are meant to raise awareness, and screen-general around the globe? Where are they ing programs that cover the costs. Even Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 51
  • 47. Student PerspectivesThe ECR 2011 and Siemens Breast Care Day attracted many So it would be wonderful to get more information into thismedical students from around the world. In the course of group.” Her idea to improve awareness: Combine breast carea Siemens-organized student workshop, we talked to them awareness with sexual education once the teenagers haveabout their knowledge about breast cancer, screening, and gone through the bodily changes and have made friendsdiscussed ways of improving awareness. with their bodies. Let them know it is as important as using a condom.Dana Feldman from Israel, just doing a mini-internship inradiology and about to finish medical school: “With a grand- Mathias Nielsen from Denmark, student in the sixth semestermother who died of breast cancer and a mother just moving and a radiotherapist in training: “Breast cancer awareness isinto the age-group to start the screening, I am very aware of high in Denmark. And there is screening for women past 50.the topic. Overall, I believe there is high breast cancer aware- As many of them live in the country and have trouble getting toness in my country. Nevertheless, I see women with unbeliev- the hospital, a screening bus goes to the smaller communities.ably advanced cancers in the thoracic clinic. They hold on and A radiologist interprets the X-ray mammography results on-site. decide to deal with it later – In suspicious cases, the women when the son is done with the go to the hospital to get a coro- army or some other private nal image, plus palpation and matter. It is not about cost, as ultrasound. the cost is completely covered The cost is covered. I would like by the government. It is more to add that awareness is a good a psychological thing. It is like thing but it also creates fear – a veil that needs to be broken 20-year-olds with pain in the through if you do not want breast come in for screening these women to die. Most of and are unnecessarily exposed them belong to religious groups to radiation. They need to be in- and attend check-ups less formed that a breast can hurt, regularly. that this is normal. I coach mythough the women considered them- aged 25 to 65, answered 24 structured breast cancer screening after self-exami-selves to be well informed, almost half questions in the form of a 15-minute nation or if they belong to a risk group.did not know whether there is an official online interview. Another important motivator is cancer inscreening program in their country. In the past, someone they know that hasIndia, 74 percent of the women stated Improving Knowledge been affected with cancer, or a recom-that they knew of a screening program, When women were asked to rate their mendation by a doctor. Most womeneven though there actually is no current own overall knowledge, about 40 percent from the survey answered that they didofficial program. “This says a lot about rated it as good or very good. 19 percent not have any concerns about the screen-the level of awareness of breast cancer stated they had no or deficient knowl- ing procedure itself, which might preventand breast cancer screening,” commented edge of the subject. This shows that there them from attending, and rated theirNorbert Gaus, Head of the Clinical Product is room for improvement. The same holds personal experience with breast cancerDivision at Siemens Healthcare, Erlangen, true for active participation in breast screening as neutral or positive. Overall,Germany, at the opening press confer- cancer screening. Overall, about half of the fear of radiation was lower thanence. “And it speaks to the need for more the women go once per year, with the expected. As to the components of thecountry-specific information.” percentages being highest in Brazil (73 screening exam, most women namedThe survey was conducted with 500 percent) and lowest in Russia (31 per- X-ray mammography in combinationwomen each from eight countries – cent). 67 percent of the Swedish women with palpation breast examination andAustria, Brazil, China, Germany, India, said they participate every other year. the discussion of the results with theRussia, Sweden, and the U.S. All women, Most women were motivated to attend a doctor. Ultrasound and magnetic reso-52 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 48. Breast Cancer Summary Challenge: • Detect breast cancer before it is palpablegirlfriend in self-examination. And I am telling my mother, to get the best therapy results and reducewho just turned 50, she should go for a screening.” mortality as well as costs • Identify the status quo of breast cancerAlexander Sachs from Germany, studying medicine in Vienna awareness and the information needs ofin the fifth year: “I think there is high awareness, and it is get- women around the worldting better. But I believe the information should be availableearlier in life. Let me give you an example: I work in the Museum Solution:of National History of Vienna where I give guided tours for school • Educate and inform women and makeclasses. I confront them with the preparations of breast cancer diagnostic tools more effectiveand ask them why they think women had these vast forms of • 3D imaging can improve sensitivity beyondbreast cancer 100 years ago. Out of 20, typically two or three X-ray mammography, especially in womensay they did not have examinations. Then, I tell them they should with dense breast parenchymago to palpation examinations every year, do self-examinations, and participate in the screenings Result: after age 50.” His idea to improve • The Siemens Breast Cancer Awareness awareness: Use events like a breast Study revealed a need for more country- cancer marathon to spread infor- specific information on breast cancer mation. If people are confronted and screening programs with it on their way to work due • In countries with formal screening to a road being blocked, they hear programs, breast cancer awareness and about the initiative and can search screening participation rates are higher the Internet for the name after- • In suspect lesions, X-ray mammography wards to find out more, hopefully could be complemented by tomosynthesis, about a certified program. Celebri- 3D ultrasound, or MR mammography in ties talking about their illness could order to improve sensitivity and reduce also help increase awareness. recall, spot compression, and biopsy ratesnance imaging (MRI) are also known by the survey results, Siemens now plans to So, is it time to move on? This issue wasmost women as diagnostic tools used in prepare a breast cancer awareness cam- discussed in a symposium on 3D tech-breast cancer screening. paign to raise the visibility of this topic nologies. globally. This is part of Siemens’ engage- The shift from film-based images to digi-Trustworthy Information ment to provide support for women from tal imaging opened up the opportunityThe majority of women in the survey rely early detection and screening, diagnosis to move from 2D to 3D, namely tomo-on their gynecologist as the main and and therapy, to aftercare. synthesis1. Other 3D technologies holdingmost trustworthy source of information. promise for the future are automatedFamily doctors ranked second. In Austria Breast Care Goes 3D 3D ultrasound (Automated Breast Volumeand Germany, more than four out of five X-ray mammography, the method best Scanning) and breast MR imaging. “Evenwomen see their gynecologist for breast known by women in the survey, is the though these new technologies havehealth matters; whereas in the U.S. and accepted standard for breast imaging, much to offer, X-ray mammography willIndia, the family doctor plays a more especially for breast screening. It is fast, continue to be the firstline imaging toolimportant role. In the U.S., India, and relatively inexpensive compared to other in breast cancer screening,” predictedChina, family members or friends are also techniques, accurate, and detects masses the symposium’s chairman Professorrated as a reliable information source. and microcalcifications; although, 15 toSurprisingly, modern media and the Inter- 30 percent of cancers are missed due to 1 Investigational technology not currently commerciallynet play only a minor role as they are dense breast tissue, small attenuation available in the U.S., Canada and China. Limited by U.S.not considered trustworthy. Based on differences, or tumor growth patterns. Federal Law to investigational use. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 53
  • 49. “With 3D ultrasound, more benign and malignant lesions can be detected.” Matthieu Rutten, MD, Department of Radiology, Jeroen Bosch Hospital, ’s-Hertogenbosch, The NetherlandsIndia Needs More Pink Ribbon CampaignsBy Swati PrasadIn the course of the Breast Cancer developed countries. Gynecologists attri- is a palpable lump or even later – whenSurvey, an online study conducted for bute this to various factors, including malignant cells spread to other parts ofSiemens Healthcare, Gesellschaft für marriage at an early age, early and mul- the body. Sometimes, even after detect-Konsumforschung (GfK) HealthCare tiple childbirths, and breastfeeding of all ing an abnormality, women do not visitpolled 500 women in India. Since broad- children for a long period of time. Most a doctor due to reasons that range fromband penetration in India is only around Indian families (especially in rural areas) shyness to inadequate diagnostic facili-one percent, this survey could cover encourage breastfeeding. Government ties (especially in rural areas), to financialonly English-speaking women, based in programs also reiterate its importance. constraints or factors like indifferenceurban India. The results indicated a However, urban women are fast moving toward the health of women in a patriar-growing awareness of the risks of breast away from this, leading to higher inci- chal society.cancer – an overwhelming 81 percent dence of breast cancer in metropolitan Even though a few large cities in Indiaof the women surveyed thought breast areas. offer medical care for breast cancercancer screening was very important. Awareness about breast cancer is on the patients, the treatment cost can be pro-However, while Indian women feel they rise, but few women voluntarily go for a hibitive. In fact, the vast majority ofare well-informed about breast cancer, routine breast screening. Only educated, breast cancer patients undergo inade-they also indicate concerns that limit working women, primarily based in the quate and inappropriate treatment duetheir willingness to go to a breast cancer metropolitan areas, are known to go for to a lack of high-quality infrastructurescreening center; whether it be doubts a routine screening – mostly when it is and financial constraints.about the effectiveness, fear of compli- part of their health insurance package. India needs regional screening centerscations, or fear of the results. The survey India does not have a national or regional and parallel cancer registration programs.clearly pointed out that Indian women breast cancer screening program. Several Though breast self-examination is theneed to be educated much more about government and private hospitals (such most cost-effective, it needs to be per-breast cancer. as Apollo, Fortis, All India Institute of formed in the right manner. Therefore,Breast cancer is the most common cancer Medical Sciences, and Carestream Health vigorous, nationwide awareness programsamong women in urban India. In rural India) hold awareness programs. But are the need of the hour. Pink ribbonareas, it is the second most common can- again, these are limited to large cities. campaigns need to penetrate every regioncer after cervical cancer. But India is a X-ray mammography is available in a in the country.country of stark disparities – while some large number of public and private hos-women in urban areas get world-class pitals in several towns and cities. How-medical treatment, their peers in villages ever, doctors do not advocate it for mass Swati Prasad is a freelance business journalistget none. screening, since at US$15 to US$38, it is based in Delhi. She reports from India for several publications overseas and has workedToday, one in 22 women in India is likely not considered cost-effective. as a correspondent and editor for the Economicto get breast cancer during her lifetime. Most Indian breast cancer patients self- Times, Business Standard, the Indian Express,The incidence is far lower than in some detect their disease at a stage when there and Business Today.
  • 50. Breast CancerNot one seat left in the symposium that brought radiologists up-to-date on latest 3D imaging modalities.Detlev Uhlenbrock, MD, a radiologist early detection of invasive ductal car- ultrasound and X-ray mammography.from Dortmund, Germany. “In suspect cinomas and depicts irregular borders All studies found a high number of onlylesions, mammography might be com- more clearly. Spot compressions could MRI-detected cancers. It is the onlyplemented by tomosynthesis, 3D ultra- be replaced by tomosynthesis.” He is method that describes tumor-specificsound, or MRI in the future.” Especially convinced that with tomosynthesis, signs like angiogenesis and has a highin women with dense breast tissue, 3D physicians can get more information negative predictive value.” Kaiser votesultrasound looks promising due to the with less radiation. for MRI as an integral part of the work-low sensitivity of X-ray mammography As far as Professor Werner Kaiser, MD, a up: “If your life is threatened, use yourin these patients. “Sensitivity is down radiologist at the Institute of Diagnostic most effective weapon.”to 30 to 48 percent,” stated Matthieu and Interventional Radiology at theRutten, MD, PhD, a radiologist at Jeroen Friedrich-Schiller-University of Jena, Medical writer Wiebke Kathmann is a frequent contributor to Medical Solutions. She holds aBosch Hospital, ’s-Hertogenbosch, the Germany, is concerned, the new standard Master’s degree in biology and a PhD in theo-Netherlands. “This is worse than flipping in breast cancer screening might soon retical medicine, and has worked as an editora coin. With 3D ultrasound, more benign be MRI – not just in high-risk women but for many years before becoming a freelancer in 1999. She is based in Munich, Germany.and malignant lesions can be detected.” increasingly in those at average risk. “InSimilarly, tomosynthesis can improve spite of earlier publications concludingthe detection of lesions in dense breasts that MRI only increases cost and the num-as well as the characterization of focal ber of biopsies and does not lower thelesions. As for Professor Jörg Barkhausen, rate of reoperations, we now agree thatMD, from the University of Lübeck, Ger- with MR mammography, in one out of Further Informationmany, digital breast tomosynthesis may four cases, we get additional, vitally rel- www.siemens.com/become the imaging modality of first evant information on the cancer,” said ecr-breastcaredaychoice for select patients. “It allows for Kaiser. “The sensitivity exceeds that of Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 55
  • 51. 27% Europe 49% AmericasUnfreezing Capital: What HealthcareOrganizations Need to Know The world’s healthcare systems are experiencing various forms of financial pressure. Billions of euros are tied up in frozen capital – inefficiently deployed capital or untapped liquidity potential. Such frozen capital is caused by buying equipment, rather than using alternative forms of financing to acquire it. By Valeriya Masyuta56 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 52. Planned Spendings on Healthcare Infrastructure Around €15 trillion will be needed to fund developments in the global public services infrastructure to 2030. Of that, around €2.5 trillion will be needed for healthcare provision. 21% Asia-Pacific 3% Africa, Middle East, Commonwealth of Independent States (CIS)According to the latest study by Siemens the globe. The 2011 study is the latest in but also the “rental“ or leasing ofFinancial Services (SFS), healthcare orga- that series following a wide publication depreciating assets with decreasingnizations across the world are not making of the findings of its predecessors. This value, such as vehicles and technology.the most efficient use of available financ- is at a time when healthcare systems are Technology tends to advance in suddening tools to acquire vital medical technol- either under severe spending pressures, leaps and in some examples can be obso-ogy. SFS analyzed levels of frozen capital as in Western Europe and the U.S., or when lete within 12 to 18 months. Healthcarein various equipment categories across health systems are undergoing rapid devel- organizations that own previous-generationGermany, France, the UK, Spain, the U.S., opment, for example in China. equipment, which they have to write-offChina, Poland, Turkey, India, and Russia. Within business environments, econo- over, for example, ten years, will find it dif-The analysis took place from October 2010 mists have, for many years, advocated ficult to attract patients in a health systemto January 2011. In 2006, SFS began its ownership of appreciating assets, with that fosters competition – a key trend instudy series of healthcare financing across real-estate being the classic example; the overall reform of global healthcare. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 57
  • 53. “The healthcare system deficit forecast for France is €10.3bn ($14.6bn) for 2011. Supported by the Law of Social Security Financing (LFSS), the public healthcare budget targets savings of €2.4bn ($3.4bn) for 2011.” Thierry Fautré, Président, Siemens Financial Services, Saint-Denis, France “In Germany, healthcare spending is currently carrying a deficit predicted to be around €9bn ($12.8bn) in 2011. The deficit in the German statutory health insurance system is being cut through a combined initiative to raise the compulsory health insurance premia and reduce spending through lower procedure costs.” Kai-Otto Landwehr, CEO, Siemens Finance & Leasing GmbH, Munich, Germany “Capital spending in the UK is to fall by 17 percent between 2010/11 and 2014/15, with £1bn (€1.1bn/$1.6bn) reallocated to social care, and over £20bn (€22.7bn/$32.5bn) of efficiency savings to be achieved.” David Martin, General Manager, Siemens Financial Services Ltd, Stoke Poges, UK Financing methods that enable a health Healthcare equipment categories, such institution to upgrade to a superior technol- as endoscopy, dialysis, transfusion, anes- ogy at certain points are therefore gaining thetics, respiration, and ophthalmic, are popularity. For these methods to be effec- equally susceptible to financially inefficient tive and offer good value, financiers need acquisition that results in large volumes to understand technology development of frozen capital. In fact, these equipment paths and also have the channels through categories represent up to twice as much which to remarket the older equipment at frozen capital as that incurred by diagnos- a reliable and predictable residual value. tic imaging equipment.58 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 54. “There will be very significant investments in the infrastructural development in the Chinese healthcare system – for instance the state has committed RMB 850bn (€91.9bn/$131bn) to phase 1 (2009–2012).” Yang Gang, General Manager, Siemens Financing and Leasing Ltd., Beijing, China “2010 saw the overall Polish health budget cut by some PLN1.5bn (€382.9bn /$546.8bn), even though the reim- bursement budget received a PLN590m (€150m/$215m) injection. While the country’s densities of diagnostic imaging equipment are above the Eastern European norm, they are still well below those in more mature Western economies.” Christian Foltyn, CEO, Siemens Finance Sp. z o.o., Warsaw, Poland “In Spain, health spending as a proportion of GDP has risen dramatically precisely because national income has fallen. Budget pressures are encouraging the exploration of alternative funding formulae, such as public-private partnerships.” Ramón Roncero, Sales Manager Medical Sector, Siemens Renting S.A., Tres Cantos, SpainHowever, the key area for healthcare equip- expensive and invasive exploratory proce-ment investment is diagnostic imaging; dures.from magnetic resonance imaging (MRI), Yet, the acquisition of up-to-date diagnos-computed tomography (CT), to X-ray and tic imaging equipment remains financiallypositron emission tomography (PET) tech- inefficient. In 2010, in the U.S. alone, therenologies. Rapid and accurate diagnosis of was €10.4bn ($14.8bn) of frozen capitalvarious conditions not only enable better related to the acquisition of diagnostichealth outcomes, but also introduce major imaging equipment. In Europe’s top econ-efficiencies and cost savings by avoiding omies, the figure is €5.2bn ($7.4bn), rang- Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 59
  • 55. FinanceRequired Increase in Investments for Healthcare €2,520bnEstimated total globalinvestment requirementsfor healthcare are predictedto be around €2,520bnover the next 20 years.Current investments fallfar short of these require- 2030ments. €252bn 2006 ing from €2.0bn ($2.8bn) in Germany, of under-investment. Therefore, the lack through €916m ($1.3bn) in France, €732m of appropriate technology may have a ($1.0m) in the UK, to €524m ($748m) in direct impact on patient care standards. Spain. In the United States, the Affordable Care Act of 2010 has created considerable pres- U.S., Europe, China – Country sure to reduce procedural costs as insur- Profiles ance companies are forced to accept peo- Healthcare organizations are less able to ple with pre-existing conditions and health have a growing proportion of their annual insurance premiums are more heavily capital budgets tied up in equipment. regulated. In order to help measure and In some countries, such as the UK where control healthcare consumption, leasing strong pressure was enforced by the gov- arrangements are proving critical to under- ernment to stay within the budget, selected standing true cost-per-procedure. Tech- institutions were only able to meet those nology upgrades in radiology are buoyant, requirements by reducing their capital suggesting that this area provides a par- budgets and effectively putting a partial ticularly compelling spend-to-save business freeze on new technology and equipment case. acquisition. This is now spreading to other Asset finance in Europe’s major econo- European countries and the U.S. In this kind mies’ healthcare systems lags behind the of situation, not only is capital spending U.S., with utilization rates well below the under pressure, it is actually being sup- 30 percent of equipment investments pressed, leading to diagnostic and treat- that is typical for the U.S. Financing tech- ment inefficiency through a negative spiral niques such as leasing and renting pro-60 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 56. Financevide European healthcare systems with This inefficiently deployed or “frozen“great potential to improve financial capital can be replaced with an asset-efficiency, transparently aligning costs financing plan that: Exchange rates used in thewith “per procedure“ reimbursements or • simply charges a fixed equipment article (rate date: 05/13/2011)charges. lease/rental and maintenance costIn China’s rapidly developing healthcare against revenue budgets EUR to USD = 1.42system, which is putting forward substan- • reduces longer-term outlay because GBP to EUR = 1.13tial investment, around €1.8bn ($2.5bn) the financier retained title and could GBP to USD = 0.61of frozen capital was associated with diag- dispose of the technology on the CNY to EUR = 0.10nostic imaging equipment acquisition secondary market CNY to USD = 0.15in 2010. While China has no squeeze on • introduces the possibility of the PLN to EUR = 0.25access to capital, the country’s healthcare healthcare organization to upgrade its PLN to USD = 0.36infrastructure development targets are technology aligned with technologyenormous. developments without having to write-Healthcare professionals are determined off the full asset valuethat the rapidly expanding healthcare Summarysystem will be sustainable in the long There is proof that access to the latestrun. Therefore, as the development of medical technology is crucial to improv- Challenge:a universally accessible healthcare sys- ing diagnostic accuracy and treatment • Healthcare systems are either undertem gains pace, equipment vendors are throughput, which in turn helps to avoid severe spending pressures, as inincreasingly offering integrated financ- unnecessary interventions while reducing Western Europe and the U.S., oring to enable a clearer alignment of the cost of healthcare provision. Acquir- undergoing rapid development,costs with health outcomes and establish ing such up-to-date equipment through for example in Chinaa competitive position. asset finance plans provides healthcare • Billions of euro are tied up in frozenAccess to up-to-date technology is vital to finance professionals with a transparent capital – inefficiently deployed capitalboth improve patient outcomes and reduce means to calculate cost-per-procedure or untapped liquidity potentialthe costs per diagnosis, treatment, or and, armed with this knowledge, helps • Healthcare systems are under pressureprocedure. What is then the true scale of ensure that those costs are well under- to use the most effective methods toinvestment in necessary technological and stood and managed. finance up-to-date equipmentinfrastructural development that is required To free frozen capital can therefore helpto create a sustainable, high-efficiency to make necessary investments in new Solution:global healthcare environment over the medical equipment sooner. That enables Replace this inefficiently deployed ornext 20 years? faster and more accurate diagnosis, “frozen“ capital with an asset-financingAccording to projections from SFS, around better treatments of patients, and, as a plan that€15.000bn ($21.419bn) will be needed result, fewer doctor visits. All that leads • charges a fixed equipment lease/rentalto fund developments for the global public to lower healthcare costs, a higher health and maintenance cost against revenueservices infrastructure until 2030. Of that standard, and higher labor productivity budgetssum, around €2.500bn ($3.570bn) will – that benefits the entire society. • reduces longer-term outlay becausebe needed for healthcare provision. These the financier retained title and couldspending projections put into context Valeriya Masyuta, MA, is an editor at dispose of the technology on thehow much public services, in particular Siemens. secondary markethealthcare, are under pressure to use the • introduces the possibility of themost effective methods to finance such healthcare organization to upgrade itsdevelopments. technology aligned with technology developments without having to writeGreat Potential to Improve off the full asset valueFinancial EfficiencyCritical to acquiring healthcare technology Result:and equipment is having better access • Acquiring up-to-date equipmentto flexible capital, improved access to through asset finance plans providestreatment in the U.S., and the expansion healthcare finance professionals withtargets in China. However, a large pro- a transparent means to calculate cost-portion of capital is currently still “frozen“ Further Information per-procedure and, armed with thisin healthcare systems across the globe, www.siemens.com/finance knowledge, to help ensure that thoseand cannot be efficiently leveraged. costs are well understood and managed Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 61
  • 57. More Options, More FreedomClinicians at the MR, Nuclear Medicine, and PET/CT Center inBremen Mitte, Germany, focus on saving time and improving qualitywith Siemens’ integrated solutions, syngo.via and syngo.plaza, andcan view their images on mobile devices.By Andreas Pietsch62 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 58. Advanced Visualization “The most important thing is to lighten the radiologist’s load if you want to increase the efficiency of the practice.” Markus Lentschig, MD, MR, Nuclear Medicine and PET/CT Center Bremen Mitte, Bremen, Germany Espree, MAGNETOM Avanto, MAGNETOM Every radiology office needs a stable PACS Verio) and a 6-slice Biograph® TruePoint™ that can provide images quickly, which PET·CT. They will also receive a new gives the radiologist timely diagnostic MAGNETOM Skyra MRI scanner and a tools and intelligent support in order to Biograph mMR soon. cut down on time-consuming routine The practice sees approximately 20,000 tasks. Additionally, the office also needs patients every year – an enormous vol- highly efficient diagnostic software. ume for radiology technicians and radi- “The combination of syngo.plaza and ologists, which increases the need for syngo.via offers both – and with a largely time-saving support. Every minute spent identical user interface,” says Lentschig. finding and preparing images is a minute As someone who uses both programs, taken away from making a diagnosis Lentschig prefers to perform diagnoses and keeping the radiologists from doing with syngo.via. Other radiologists work their real work. with syngo.plaza and rely on the diag- nostic software for special cases. With A New Level of Imaging IT either clinical workflow, the systems are Always intrigued by the latest technolo- flexible, offering pre-set customizable gies, Lentschig implemented syngo®.via1, tabs and integration with RIS. the advanced imaging software, as a A head examination, for example, shows Siemens development partner in early how the integrated solutions provide 2009. Since then, he has contributed his efficiency and quality. The exam proce- ideas to further optimize the system. The dure varies depending on whether the solution processes images from different patient is complaining of pain or receiv- modalities, such as magnetic resonance ing follow-up care for a tumor or a stroke. imaging (MRI), computed tomography Images that are brought up in syngo.viaThe constant influx of images and data (CT), and positron emission tomography- are preprocessed, removing any detailsfrom patient exams challenges clinicians computed tomography (PET·CT). Addi- that are irrelevant for the current diag-to streamline their workflow in order to tionally, it connects to radiology informa- nosis. The radiologist does not need tofinish their daily workload. “As a result, tion systems (RIS) and picture archiving process confusing or irrelevant imagesthe most important thing is to lighten the and communication systems (PACS) from in order to take indication-specific mea-radiologist’s load if you want to increase leading vendors, including Siemens’ surements and study the images. Thethe efficiency of the practice,” says Mar- newest PACS solution, syngo.plaza. This principle behind this workflow involveskus Lentschig, MD. close interaction led Lentschig to install highlighting the important informationLentschig runs the MR, Nuclear Medicine, syngo.plaza, a year-and-half later, which and eliminating things that are secondary.and PET/CT Center in Bremen Mitte on the combines 2D, 3D, and 4D images on one This saves time and frees the radiologistBremen Mitte Clinic campus in Germany workplace and offers a new dimension from tedious routine work.with two other radiologists. Lentschig and for reviewing images. Additionally, the screen layout forhis colleagues cover the entire examina- What benefits does Lentschig experience syngo.via and syngo.plaza can be custom-tion spectrum in a radiology practice. The using syngo.via and syngo.plaza together ized according to the doctor’s personalsite is home to three magnetic resonance in his clinical workflow? His answer is preferences and the examination require-imgaging (MRI) systems (MAGNETOM® short and sweet: “Efficiency and quality.” ments. For most of the examinations, Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 63
  • 59. Advanced Visualization “xxxxxs the only vendor that we have given a full turnkey project to, and they have delivered.” xxxxxxxxxxhi Business Development, Mubadala Healthcare, Abu Dhabi, and project man- ager for Tawam Molecular Imaging Centresyngo.via WebReport allows the referring doctor to view the patient’s images on the screen before the CD is sent over from the radiology practice,which improves coordination between the medical offices and increases loyalty with the referring doctor.Lentschig has created predefined layouts the greatest possible diagnostic quality, second opinion. “The time that my col-that his colleagues in the practice can you need as many images as possible – leagues and I used to spend searching canadopt or reconfigure according to their but the flood of images is overwhelming now be spent on diagnosis.”preferences. For head exams, the stroke for radiologists. Intelligent selection and This is aided by another application thatlayout opens automatically since strokes sorting mechanisms that help focus on is also available in both imaging IT solu-are the most common reason for an exam the most important frames can only be tions: the 3D reference point. With thisof the head. If another kind of head beneficial. function, the radiologist can quickly nav-exam is required, the radiologist changes One key feature that helps is offered igate to the same coordinates of a patientto the corresponding predefined layout. by both syngo.via and syngo.plaza: the in different series and views of series.If needed, both solutions offer function- Findings Navigator. During each work-alities to display all of the previous and flow step, findings can be added auto- Integration of PACS andnew examination results side by side. matically or manually to a list so that they Advanced Imaging Software“A decade-and-half ago, a stomach can be called up again with a simple Historically, advanced imaging softwareexam gave us 150 images. Today, a nor- mouse click. “When I show my findings to and PACS were two separate systems,mal exam produces 2,000, sometimes a colleague, I don’t need to scroll through often located in two different locations.even twice that many. There’s no way the entire series,” says Lentschig, prais- This means the clinician often had to walkI can look at them each individually,” ing the user-friendly feature that makes to two separate workstations in order tosays Lentschig, pointing out a constantly it easier to efficiently share the images make his or her diagnosis. syngo.via andgrowing dilemma for radiologists. For internally, especially when obtaining a syngo.plaza come very close to creating64 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 60. Advanced Visualization“The time that Web browser, when in combination with a diagnostic-grade screen. General my colleagues images for non-diagnostic purposes can also be viewed using the corresponding and I used to application designed for Apple® mobile devices. Connection is possible any- spend searching where3 within the reach of the hospital Summary network through a secure VPN. can now be With syngo.via WebReport4, physicians Challenge: • Streamline workflow for spent on the have secure and immediate access to reports and images – anywhere3. The clinicians to reduce their daily workload diagnosis.” application can be launched with a Web • Pinpoint relevant data in the browser or, if using an Apple mobile overflow of images available device, by using a corresponding applica-Markus Lentschig, MD, to clinicians tion for non-diagnostic purposes. ThanksMR, Nuclear Medicine, and PET/CT Center • Freedom to work from otherBremen Mitte, Bremen, Germany to the thin-client architecture, minimal locations administration is needed – savings costs while also protecting an investment that Solution: is aligned with patients’ needs. • Integrate diagnostic softwarea uniform user interface with identical “It gives me more personal freedom and picture archiving com-functions, as Lentschig confirms: “Any- because I can communicate with the munications system (PACS)one who is familiar with syngo.via can practice from home or even look at the • Intelligent selection mecha-use syngo.plaza, too.” images on my iPad while I’m on the road,” nisms that help focus on the “The combination of syngo.via and says Lentschig. “Especially when it comes most important framessyngo.plaza makes this system one-of-a- to iPad use, Siemens demonstrates that • View diagnostic reports andkind,” says Lentschig, emphasizing the this company is driving technical prog- images via a secure Internetvalue of his diagnostic software and PACS ress with its innovations, while simulta- connection on a remote com-solution. “Every integration improvement neously keeping up with current trends.” puter or a mobile deviceputs the existing solution further andfurther ahead of the competition.” New Andreas Pietsch is a freelance business writer based in Coburg, Germany, specializing in clini- Result:technical abilities inspire further desires cal IT, healthcare, and logistics. • syngo.via and syngo.plazaand possibilities. A current example of together help create efficiencythis can be seen with the web applica- and improve qualitytions and availability on mobile devices, 1 syngo.via can be used as a standalone device or together • syngo.via WebViewer andwhich many radiologists have embraced with a variety of syngo.via-based software options, which syngo.via WebReport offerwith open arms. are medical devices in their own rights. 2 The application is not for diagnostic viewing/reading on clinicians remote accessMobile Imaging mobile devices. Please refer to your sales representative whether the product is available for your country. Diag-In addition to syngo.via and syngo.plaza, nostic reading of images with a web browser requires a medical grade monitor.Lentschig has the option to view diag- For iPhone and iPad, country-specific laws may apply.nostic reports and images via a secure Please refer to these laws before using for diagnosticInternet connection on a remote com- reading/viewing. For Japan: Applications on iPhone/iPad/iPod are not aputer or a mobile device. This allows the medical device in Japan. Use at your own risk. They arereferring doctor to view the patient’s not intended to be used for diagnosis.images on the screen before the CD is 3 Prerequisites include: wireless connection to clinical network, meeting recommended minimum hardwaresent over from the radiology practice, requirements, and adherence to local data securitywhich improves coordination between regulations. 4 The application is not for diagnostic use. Please refer tothe medical offices and increases loyalty your sales representative whether the product is avail-with the referring doctor. The simplified able for your country.communication also supports exchanges For iPhone and iPad, country-specific laws may apply. Further Information Please refer to these laws before using for diagnosticbetween radiologists when they need to reading/viewing. www.siemens.com/syngo.viaget a second opinion. For Japan: Applications on iPhone/iPad/iPod are not a www.siemens.com/syngo.plazasyngo.via WebViewer2 offers physicians medical device in Japan. Use at your own risk. They are www.siemens.com/ not intended to be used for diagnosis.the ability to access, view, and read iPhone/iPad/iPod are trademarks of Apple Inc., registered syngo.via-weboptionsimages in interactive 2D and 3D with a in the U.S. and other countries. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 65
  • 61. Workflow in CTAn Asset for Staff and PatientsThe new technology platform FAST CARE has been available for the SingleSource CT system SOMATOM Definition AS since spring 2011. The FASTfunctionalities simplify and accelerate CT workflows, as demonstrated bythe first months of clinical operation at institutes in the UK and the U.S.The results have yielded increased satisfaction from staff as well as patients.By Ingrid Horn, PhDHospitals are currently fighting a fierce rately with the click of a button. Accord- entire examination. As the images appearbattle against staff shortages and the ing to Olivia Egan, FAST Adjust enables in real-time, the surgeon accompanyingpressure to perform. This applies partic- technicians to efficiently prepare the the technologist can decide whether toularly to computed tomography (CT), system for scan processes. operate much more quickly than withoutwhich relies on technical specialists. The Joe Larson, Imaging Manager at the FAST Spine.technology platform FAST CARE, available Tacoma General and Mary Bridge Chil- Accelerating the diagnostic process,since spring 2011, unites the optimiza- dren’s Hospitals in Washington, U.S., has FAST Spine eases the time pressure placedtion of radiation dose with its new CARE reached a similar conclusion. After work- on technologists scanning traumafunctionalities while increasing the sim- ing with the software for several months, patients, resulting in a less stressful col-plicity and reliability of CT operations for he feels that FAST CARE has helped laboration with the attending physician.staff with FAST. to improve his technicians efficiency to After just three weeks, no one was will- levels that may have taken longer. ing to work without FAST Spine. Addi-The Major Software Benefits In Tacoma, the technology platform was tionally, according to Larson, consistentlyFor the team headed by Olivia Egan, CT used with a scanner in the emergency good image quality is delivered. As aSuperintendent Radiographer at the and trauma departments, which is impor- result, fewer repetitions are required,Chelsea and Westminster Hospital (CWH) tant since CT examinations are becom- patient radiation exposure is reduced,in London, UK, the software includes two ing more routine procedure for trauma and the diagnostic process is accelerated.major benefits: FAST helps make techni- patients. In acute emergency situations, This also increases economic viability,cians more efficient, while simple com- physicians and CT technologists and since hospitals are often unable topatibility with the various CARE functions radiologists are under enormous pressure obtain reimbursement for repeat imagingleads to high levels of safety when reduc- to deliver a quick and reliable diagnose. – a benefit that is passed down to theing radiation dose. Yet, spinal scans have proven extremely patient. Who would want to pay extraThe CWH has 460 beds and includes time-consuming until now. Technologists for poor imaging?medical, surgical, womens & childrens, normally have to mark each vertebra Maurya Radvilas believes that the qual-and HIV care amongst others, in addition individually and determine its precise ity of patient care is another importantto providing a bariatric service and an position manually to generate an effec- aspect. She holds the position of Directoremergency department. Despite almost tive image, a process which can easily of Imaging in Tacoma’s MultiCare350 CT examinations that are performed take 30 minutes or more. In contrast, the program. The hospital trust, one of theweekly in the imaging department, using FAST Spine program automatically marks largest private healthcare providers intwo scanners which are operated by the vertebrae within a predetermined Washington with more than 450 beds,teams of rotating staff, the FAST Adjust scan area of the spine and independently aims to use this program to consolidatefunction has proven particularly benefi- calculates the position of vertebrae and and improve its care standards. Radvilascial. Here, scan parameters like scan time, discs for anatomically correct imaging. is unequivocal in her appraisal of FASTpitch, and tube current can be set accu- The time saved positively impacts the CARE. Patients benefit from the reduced66 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 62. Workflow in CT Summary Challenge: • Hospitals have to cope with shortage of staff • Patients demand higher standards of care • Best possible diagnosis with least possible dose Solution: • FAST CARE provides easy, safe CT operations • FAST optimizes workflows for technologists • CARE optimizes radiation dose according to organs scanned and patient needs Result: • The use of FAST CARE benefits patients and staff • FAST Adjust facilitates safe parameter settings • FAST Spine reduces time expenditure in cases of spinal column injuries • Less stressful collaboration between physicians and tech- nologists • Faster, more reliable diagnosis for physicians and patients • Competitive advantage thanks to high care standards and economic viabilityAnatomically correct spine reconstructions are very time-consuming procedures, as everyspinal vertebrae and disc needs to have its own reconstruction layer depending on the individualposition. With FAST Spine, these manual steps can be simplified with just a single click.Image courtesy of University of Erlangen-Nürnbergradiation dose and the relaxed working In turn, this increases patient compliance Ingrid Horn, PhD, studied biology and bio- chemistry. She is an expert in science commu-atmosphere. The less maneuvers tech- with the treatment plan, which has a nications and an experienced writer with annologists have to perform during an positive impact on the recovery process. emphasis on biomedical topics in fields likeexamination, the more time remains for The team in Tacoma has discovered that medical engineering, neuroscience, oncology, and pediatrics.the patient. If the patients are respon- FAST CARE makes a decisive contributionsive, assistants can talk to them and cre- to consistently high standards of care.ate trust. The speed of the examinations Be it doctor or patient – the imaging Further Informationand the trust placed in the efficiency of department can deliver rapid results of www.siemens.com/fastcarethe staff promotes patient satisfaction. the higher quality for all clients. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 67
  • 63. Hospital ITMeaningful Use,Remarkable Outcomes Riverside Health System boosts efficiency using Siemens Soarian Clinicals. The 904-bed hospital system was among the first in the United States to meet stringent benchmarks for the meaningful use of elec- tronic health records. By Sameh Fahmy, MSIn his 35 years at Riverside Health System information technology (IT) structure that Riverside Regional Medical Center andin Newport News, Virginia, U.S., Senior could provide seamless access to patient two additional hospitals in the RiversideVice President and Chief Information information while also coordinating tasks system were among the first in the UnitedOfficer John Stanley has seen the orga- among clinicians. The technology would States to meet stringent benchmarksnization grow to include four acute care help the organization maximize efficiency that qualify them for federal incentiveshospitals, a physical rehabilitation facility, and ensure that patients receive care for the meaningful use of electronicand a 400-member physician group as that is consistent with hospital-defined health records. “It’s the right idea thatwell as several surgical centers, a behav- best practices. To meet those needs and we should be adopting more technologyioral health hospital, convalescent centers, to attract and retain the very best clini- to take care of our patients, so we’reand retirement communities. cians, Riverside chose Siemens Soarian® doing it,” Stanley says. “It’s making a dif-In addition to this tremendous growth, Clinicals health information system for ference in terms of safety; it’s making aStanley also has seen the challenges that its acute care division. Stanley says that difference in terms of quality of care.”come with an aging population, the as a result of its investment, Riversideincreasing prevalence of chronic diseases, has improved the quality of care it deliv- “Listening” to Patientsand a regulatory environment that con- ers and created a safer environment for One of the primary reasons Riversidestantly seems to demand more documen- patients, with a 42 percent reduction Health System chose Soarian Clinicalstation. in methicillin-resistant Staphylococcus was for its workflow technology. StanleyFor Riverside to thrive in today’s complex aureus (MRSA) infections as just one emphasizes that rather than simply cap-healthcare environment, it needed an example of the improved outcomes. turing and collecting patient data, the Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 69
  • 64. Hospital IT “It’s the right idea that we should be adopting more technology to take care of our patients, so we’re doing it. It’s making a difference in terms of safety; it’s mak- ing a difference in terms of quality of care.” John Stanley, Senior Vice President and Chief Information Officer, Riverside Health System, Newport News, Virginia, U.S.workflows and embedded analytics in Soarian user interface, notifications can tions (HAIs) account for an estimatedSoarian Clinicals help Riverside optimize be sent to clinicians via phone, pager, fax, 100,000 deaths at a cost of $5-6 billionits processes. Clinicians benefit from or email. Workflows also warn of miss- US$ annually.1a reduction in manual documentation ing data, such as information on patient With the public reporting of HAIs on thetasks, and patients benefit from a reduc- allergies or the need for weight informa- rise, patients will seek those institutionstion in lost orders and delays caused by tion for medication dosing, and help with the lowest infection rates. Prior toinefficient task handoffs. coordinate post-discharge care earlier to its implementation of Soarian ClinicalsClinical Systems Manager Sherry Maynard avoid delays in the discharge process. and related capabilities, Riverside Regionalexplains that as patient information is Riverside has implemented 40 workflows Medical Center (RRMC) had no effectiveentered into Soarian Clinicals, the solution to date, and clinicians routinely suggest and reliable measurement tool to locate“listens” for relevant data and responds new workflows and collaborate with or track the impact that isolation mea-accordingly. If a patient has lab values that the IT department in their development. sures had upon HAIs within the organi-indicate probable diabetes, for example, “Our primary strategy is to create seam- zation. Without reliable baseline dataSoarian suggests that the patient be less integration, a seamless experience, and accurate reporting, measurement ofgiven a hemoglobin A1c test. If the test for patients and physicians,” Stanley says. successful results from practice changeis not administered within a certain “So working toward that, it becomes clear would be impossible.amount of time, Soarian notifies the that we need a state-of-the-art, com- Today, clinicians can access and analyzecharge nurse. plete electronic health record, and that’s information on HAIs from Soarian Clini-Soarian Clinicals provides role-based work- where Soarian comes in for us.” cals documentation using the solution’slists that are organized by category, such embedded analytics capability. RRMCas notifications, orders approaching expi- Reducing Hospital-Associated developed a personalized data-miningration, and medications to be charted, so Infections tool for retrieving and analyzing infectionthat physicians, nurses, and other clini- According to the Association for Profes- information from selected fields in thecians can efficiently move through their sionals in Infection Control and Epidemi- nursing documentation stored in Soarianworkday. In addition to appearing in the ology (APIC), healthcare-associated infec- Clinicals. This tool, developed at RRMC,70 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 65. Hospital ITwas dubbed NIP-IT, for Nosocomial Infec- patients are on ventilators, ventilator set-tion Prevention through Information tings, and weaning criteria, to virtuallyTechnology. eliminate ventilator-associated pneumo-The rate of MRSA infections at RRMC nia in its intensive care unit.appeared to be on the rise before theimplementation of NIP-IT. From 2008 Supporting Riverside’s Patientthrough the end of 2010, however, River- Safety Initiativesside achieved a 42 percent reduction in Riverside Health System is adding moreMRSA hospital-associated infections. In support to its patient safety initiativesMarch 2010, there were no MRSA hospi- by using Soarian Clinicals for medicationtal-associated infections for the entire reconciliation, computerized physician570-bed facility. order entry (CPOE), and a closed-loopLeveraging the tools and capabilities with- medication use process. By combiningin Soarian Clinicals, RRMC revised its outpatient medication history from aisolation assessment documentation to third-party electronic prescribing net-gather information on specific types ofconditions and precautions, includingpresumptive isolation. Additionally, itenhanced the nursing admission data- “Don’t focus on meeting thebase to target specific isolation-triggeringconditions. As a result, the appropriate meaningful use regulations.clinicians are notified so they can quickly Do the right thing for theidentify patients in isolation, helping toreduce time to isolation and the potential quality of patient care andfor horizontal transmission of infection.In another example of measurable out- safety that you provide.”comes, the use of embedded analytics inSoarian Clinicals has allowed Riverside to John Stanley, Senior Vice President and Chief Information Officer,track data from the Soarian Critical Care Riverside Health System, Newport News, Virginia, U.S.module, such as the number of daysRather than simply capturing and collecting patient data, the workflows and embedded analytics in Soarian Clinicals help Riverside optimizeits processes. Clinicians benefit from a reduction in manual documentation tasks, and patients benefit from a reduction in lost orders and delayscaused by inefficient task handoffs. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 71
  • 66. Hospital IT With Soarian, the clinical team has quick and easy access to pertinent patient data and information. The care team can view longitudinal patient data as well as images from the picture archiving and communications system (PACS). It can be securely accessed by clinicians anywhere, anytime through a secure, Web-based interface. Both Stanley and Maynard admit that some clinicians were initially reluctant to embrace workflows as well as CPOE. By setting appropriate expecta- tions, designating pilot hospitals and specialists for each rollout and then apply- ing lessons learned to the others, how- ever, they were able to demonstrate the benefits of the technologies to even the most skeptical clinicians. “When they saw how the technology could help them take care of their patients, that wasBy setting appropriate expectations, designating pilot hospitals and specialists for each when we were able to turn the corner,”rollout, and then applying lessons learned to the others, Sherry Maynard and John Stanley Maynard says.were able to demonstrate the benefits of the technologies to even the most skeptical In one instance, the use of the Soarianclinicians. rules engine helped a radiology techni- cian identify a potential risk from a com- puted tomography (CT) scan based on an elevated creatinine level, which sug- gested kidney dysfunction and a contra- indication for the contrast dye used for work with home medication information CT. The technician sent an unsolicited“When the clini- already documented in Soarian Clinicals, letter of thanks to the IT department that cians saw how the the solution helps Riverside ensure that patients receive a medication regimen noted that the software prevented her from making a critical error in patient technology could that does not duplicate therapies or include incorrect doses. care. “Please pass this message on to the deserving person,” she wrote. “Thank help them take Another significant patient-safety effort you so much!” involves the use of Soarian Clinicals for care of their CPOE, which can help providers reduce Quality: The Greatest Incentive patients, that was serious medication errors when combined with decision support such as drug allergy Riverside Health System saw the poten- tial of IT to transform healthcare early when we were warnings.2 Riverside used a phased approach to implement CPOE at its hos- and first installed Soarian Clinicals in 2002. Their leadership gave them a head able to turn the pitals, with hospitalists at the flagship start when the federal government of institution, Riverside Regional Medical the United States announced a program corner.” Center, the first to start using CPOE in to encourage the adoption and mean- November 2009. They were followed by ingful use of electronic health records Riverside Tappahannock Hospital and (EHRs).Sherry Maynard,Clinical Systems Manager, Riverside Walter Reed. In later months, Stanley says the most challenging partRiverside Health System, specialists such as cardiologists, ortho- of meeting the program’s benchmarksNewport News, Virginia, U.S. pedists, and interventional radiologists was interpreting the regulations, which followed at all three hospitals. The most are detailed in more than 800 pages and recent acute care hospital added to were followed by thousands of pages of Riverside Health System, Riverside Shore comments and interpretations by vari- Memorial Hos-pital, began its CPOE ous agencies. To ensure that they were implementation in April 2011. meeting the letter of the law as well as72 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 67. Hospital IT Summary Challenge: U.S. Stimulus Funds Support • Maximizing efficiency and helping clinicians manage increasing regula- Electronic Health Records tory documentation requirements • Reducing costly and difficult to treat In addition to providing tax cuts and increasing federal funding for methicillin-resistant Staphylococcus education, research, and infrastructure, the American Recovery and aureus (MRSA) infections Reinvestment Act of 2009 created an incentive program to encourage • Improving patient safety by reducing the adoption and meaningful use of electronic health records, with medication errors the goal of improving the quality and safety of patient care. Through the Centers for Medicare and Medicaid Services EHR Incen- Solution: tive Program, eligible healthcare professionals and hospitals can • Soarian Clinicals workflows help qualify for incentive payments when they adopt certified electronic reduce handoffs and warn of missing health record technology and use it to achieve specified objectives. or incomplete information while Incentive payments for hospitals vary, but begin with a US$2 million embedded analytics track performance base payment. measures To qualify for the payments, hospitals must meet 14 core objectives, • Embedded analytics technology in including the use of computerized physician order entry (CPOE), Soarian Clinicals helped Riverside the maintenance of an active medication and medication allergy list, Regional Medical Center create a solu- and the implementation and tracking of at least one clinical deci- tion that analyzes infection informa- sion support rule. In addition, hospitals must meet at least five of tion and uses answers from nursing 10 additional objectives, such as the implementation of drug formu- documentation to help reduce time lary checks and medication reconciliation. to isolation and the potential for Riverside Regional Health System in Newport News, Virginia, U.S., horizontal transmission of infection was among the first in the United States to successfully attest to • Computerized physician order entry meaningful use. helps providers reduce errors associ- ated with poor legibility while work- flows warn of drug-drug and drug- allergy interactions Result: • Clinicians benefit from a reduction in manual documentation tasks;its intent, Riverside worked closely with Meeting the meaningful use benchmarks patients benefit from a reduction inSiemens through regular calls and fre- was certainly cause for celebration at lost orders and delays caused byquent on-site visits that began immedi- Riverside, but Stanley emphasizes that the inefficient task handoffsately after the incentive program was monetary benefit was not the organi- • MRSA infections decreased by 42announced. Stanley says his organization’s zation’s primary motivation. “Don’t focus percent following implementation oflongstanding partnership with Siemens on meeting the meaningful use regula- an infection control and data miningand its commitment to using state-of- tions,” he advises. “Do the right thing for workflow at Riverside Regional Medi-the-art technology to improve the quality the quality of the patient care and safety cal Centerand safety of patient care made it well that you provide.” • With the help of computerized physi-positioned to meet the benchmarks. “I cian order entry and the bar-code-always felt bullish on our ability to meet Sameh Fahmy, MS, is an award-winning free- lance medical and technology journalist based enabled Med Administration Check™the requirements because we were doing in Athens, Georgia, U.S. solution, providers can reduce seriousthe right thing,” Stanley says. “It was just medication errors at ordering anda question of ‘what does it actually take administrationto pass the test.’” Two representativesfrom Siemens even joined Stanley and 1 Murphy D. et al. “Dispelling the Myths: The True Cost ofhis colleagues in Riverside’s corporate Healthcare Associated Infections,” APIC Briefing 2007.boardroom as he carefully filled out the 2 Wolfstadt J. et al. “The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Ratesonline attestation form and clicked the of Adverse Drug Events: A Systematic Review” J Gen“submit” icon. Intern Med 23(4):451–8. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 73
  • 68. Imaging IT/CardiologyPicture PerfectSouthern California is known for its entertainment and motion pictureindustry. At St. Joseph Hospital, an every bit as compelling hybrid operatingroom and cardiovascular imaging and information management solutionmade their debut. With its dynamic image review of cath-lab andechocardiography imaging studies, as well as ultra-efficient processingand archiving capabilities, Siemens syngo Dynamics plays a lead rolein St. Joseph’s hit.By Diana SmithFounded by the Catholic order of Sisters transplants [the hospital partners with that combines cutting-edge technologyof St. Joseph, St. Joseph Hospital in Southern California transplant centers]. with carefully-conceived and tested work-Orange County, California, U.S., opened We can even do left ventricular support flow, all designed to serve more patients,its doors 81 years ago, right as the Golden if we need to,” she adds. At St. Joseph better and faster. Siemens syngo®Age of Hollywood movies began. In its Hospital, more than 7,000 procedures Dynamics cardiovascular imaging andeight decades of operation, the hospital are performed each year. information management solution playshas been a leader in providing innovative a big role.healthcare, particularly in the areas of Demographics Indicatecardiac and vascular conditions. Cardiology Focus Creating a Connected Environ-“We were the first hospital in the area to The focus on cutting-edge cardiology and mentperform open heart surgery and the first cardiac surgery makes sense, explains With the cardiology program gaininghospital to do angioplasty and coronary Mazeroll. “Southern California is similar increased recognition and referralsstenting,” says Renee Mazeroll, RN, MSN, to Florida in that we have relatively mild from out of the state, a top priority forExecutive Director, Heart and Vascular weather. By 2017, it is estimated that 39 Mazeroll was to create an integrated andCenter and Respiratory Services, St. percent of our state’s population will be efficient cardiology image managementJoseph Hospital. Now the largest hospi- age 65 or older. We will be treating an and reporting environment. Her visiontal in the community with 525 beds, St. older population, so you have to look at included providing physicians with theJoseph’s has continued its commitment disease dynamics. Atrial fibrillation is a right tool to access multiple images andto exemplary care – expanding its cardiac disease of the elderly. Particularly, as you clinical information from different modal-and vascular programs, utilizing the most reach 65 or older, the incidence of heart ities, fully describe procedures, create aadvanced technology, and continually disease increases.” report, and then facilitate immediateraising the bar of clinical innovation and As the population ages, the number distribution to the treating physician forcommunity care. of cardiovascular patients will grow. In his or her patient records and also to the“Currently, we have a structural heart response to the increased demand, St. referring physician in addition to elec-program, congenital heart program, Joseph Hospital has opened a state-of- tronic medical record storage. “Sendingvalve program, and we do aneurysms,” the-art hybrid operating room (OR) and a report immediately to the referringreports Mazeroll. “We do everything but has developed a cardiovascular center physician is important. It really helps with Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 75
  • 69. Imaging IT/Cardiology ing from the physicians. “Most of them “Sending a report asked me what time they should be immediately there,” she says. Today, 100 percent of the physicians are in compliance with to the referring the structured reporting procedures. The syngo Dynamics system came with physician really installation-ready template bundles that were developed in qualified clinical set- helps with tings, but St. Joseph opted to customize connectivity.” their templates. “We pulled key phrases from physician dictation and customized our templates, developing them with our Renee Mazeroll, RN, MSN, Executive Director, physicians,” says Mazeroll. Heart and Vascular Center and Respiratory Services, St. Joseph Hospital, Overcoming Workflow Orange, California, U.S. Challenges According to Mazeroll, workflow wasconnectivity between the hospital and Dynamics. Answering all the items on the biggest challenge regarding thethe referring physicans.” Mazeroll’s wish list, syngo Dynamics new system. “We didn’t know what weMazeroll turned to Siemens for a solution. incorporates image and information thought we did,” she says. “You have toAfter lengthy, detailed work on integra- management and post-processing, as take the time and map out every singletion and workflow, St. Joseph installed well as structured reporting all in one step of your workflow. If you assumesyngo Dynamics, which delivers real-time system. anything, it will cause a problem.”data transfer between Siemens Sensis XP, All physicians and staff underwent exten- With the help of a Siemens-facilitatedan interventional cardiology and electro- sive training on the system. Mazeroll three-day workshop, staff rolled up theirphysiology reporting system, and syngo reports very little dissension about train- sleeves and performed detailed situationalThe Hybrid Operating Room:Innovative Care in an Unconventional SettingSt. Joseph Hospital in Orange County, California, U.S. is one selection and placement of various devices physicians use toof the first facilities in the United States to implement a true treat defects in the heart or aneurysms of major blood vessels.hybrid operating room (OR), which allows cardiologists and The result is that many patients can be treated using minimallysurgeons to transition seamlessly from minimally invasive to invasive procedures instead of open surgeries that would haveopen-chest surgical procedures. Staffed by a specially trained previously been required.team of nurses, radiological technologists, and cardiovascular According to Renee Mazeroll, RN, MSN, Executive Director,technologists, the hybrid OR incorporates groundbreaking St. Joseph Hospital Cardiac and Vascular Services, physiciansthree-dimensional technology. report that they are able to use significantly less contrast andPhysicians and staff access exceptional 3D images, created take fewer images because the quality and clarity is exceptional.using Siemens syngo® DynaCT software, with X-rays taken With its revolutionary imaging system, the St. Joseph Hospital’swith the Artis® zeego robotic C-arm. With a virtually limitless hybrid OR is designed to support adult or pediatric, cardiac orpositioning ratio, the state-of-the art Artis zeego system vascular patients – one of the few hybrid operating rooms inreconstructs high-resolution images of the heart and vascular the United States that has such multiple capabilities. Becausesystem, showing the finest anatomical details in 3D and in real it is set up for all kinds of patients, the hybrid OR has a hightime fluoroscopy. In effect, physicians follow a precise, three- utilization rate, optimizing efficiency and workflow. The roomdimensional anatomical roadmap. is used for all types of vascular and cardiac procedures, includ-Such pinpoint accuracy helps doctors assess and measure the ing percutaneous pulmonary artery valve insertion, plus over-most minute structural defects in the heart and blood vessels. flow from the catheterization labs, and even STEMI (ST-segmentAdditionally, the extreme level of accuracy can simplify the elevation myocardial infarction) patients.
  • 70. Imaging IT/Cardiology Summary Challenge: • Delivering seamless, efficient, and accurate cardiac image management • Improving connectivity among in-house cardiologists and referring physicians • Optimizing clinical workflow through integration of imaging and informa- tion for faster, better, and more cost- effective healthcare • Creating a paperless electronic recordSt. Joseph Hospital is among the first facilities in the U.S. to have a true hybrid OR. Solution:It is equipped with Siemens’ cardiovascular IT solution syngo Dynamics and an Artis zeego • Installation of Siemens syngo Dynamicsmulti-axis angiography system. in St. Joseph hybrid operating room and five catheterization and other pro- cedure rooms • Process meetings to develop the most efficient workflow, preparing for each and every step, and allowing for different scenariosanalyses to make workflow as efficient extra workload for data handling and • Extensive training with physiciansas possible. “It’s like math,” adds Mazeroll. allows staff more time to take care of and staff on system operation“If you’ve ever done algebra, every step patients.”is built on the previous step. Every step Result:has to be correct, or the end value is Technology Enhances Patient • Fully integrated, automatic structuredwrong. Even if one tiny factor is off some- Care reporting, report distribution, imagewhere in the middle of a formula, it will Looking to the future, one of St. Joseph management, and storagethrow it off. It’s the same thing with Hospital’s strategic goals is to offer Perfect • Utilization of personalized reportingworkflow. You must identify every single Care, a concept in which “each patient templates, developed in conjunctionstep along the way. When that is done, will receive the right care, at the right with physiciansthe end product is better and everything time and in the right setting.” Design for • High satisfaction ratings of syngoruns smoother. It has now become a Perfect Care is an initiative that unites Dynamics among medical and technicalpractice here to have these process knowledge and technology to provide staffmeetings.” Perfect Care at the bedside. When fully • Streamlined workflow and increasedStatistics reflect workflow efficiency. implemented, this initiative will help staff efficiency, including excellent room“Ninety percent of procedures we start by providing online tools such as clini- utilization and turnover rates and starton time, and our turnover time is under cal documentation, electronic medical times30 minutes for all cases,” says Mazeroll. records, and bedside medication verifi- • Coordinated patient care“We have very little downtime, and are cation. The goal at St. Joseph is to have • Construction of a solid foundationthe market leaders with our imaging seamless electronic medical records for for future development, includingtechnology.” all patients. That will enable caregivers potential upgradesAdditional features of syngo Dynamics to have immediate access to accuratestreamline the reporting process, accord- patient information in real-time.ing to Mazeroll. Previously, data collection Just like a movie set, the delivery ofwas a challenge. “My staff would have to healthcare is a carefully orchestrated pro-pull the medical records and search for duction. With solutions such as syngoinformation to collect the medical data Dynamics, St. Joseph Hospital is usingthat we have to report to the American technology to provide stellar care now, Further InformationCollege of Cardiology [ACC] and the but also set the stage for the future. www.siemens.com/Society of Thoracic Surgeons [STS]. Now, syngo-Dynamicsthe information is sent instantly, electron- Diana Smith, based near Austin, Texas, U.S., is www.siemens.com/Artis-zeegoically, which eliminates the associated a freelance writer specializing in medical topics. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 77
  • 71. Magnetic Resonance ImagingOptimum Patient Care and a StrongerPosition in the Healthcare MarketSt. Franziskus Hospital in Münster, Germany, fully modernized its radiologydepartment in 2010. The hospital decided in favor of one of the latest gener-ation magnetic resonance imaging (MRI) 1.5 Tesla systems, with innovativeimaging and workflow technologies. Meanwhile across the Atlantic, SouthJersey Radiology Associates in the USA, a private diagnostic imaging center,chose the latest Siemens 3 Tesla MRI technology to remain competitive in itsmarket.By Matthias Manych78 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 72. Discussing the benefits of Siemens’ MRI scanners fromevery angle: Professor Christoph Bremer, MD,technologist Linda Willeke, and CEO Burkhard Nolte(images from left to right)Medical Solutions met in Münster with As a major center for medical care for the eye-care department, which is a centerCEO Burkhard Nolte, Professor Christoph area, we also have the major outpatient for high-end care.Bremer, MD, Head of the Radiology center FranziskusCarré on our hospitalDepartment, and Linda Willeke, a radiol- grounds. In total, both the hospital and And how many patients do you serveogy technologist, for a talk about their the outpatient center cover more than each year at St. Franziskus Hospital?recent experiences. 20 medical specialities. This allows us to NOLTE: We serve about 30,000 patients offer patients a very broad spectrum of on an inpatient basis and about 50,000Mr. Nolte, what type of environment services in both inpatient and outpatient patients on an outpatient basis each year.does St. Franziskus hospital operate care. We have a very strong surgicalin, and what are your areas of focus emphasis, with high-end vascular and How important is radiology to thein patient care? spinal surgery units. Plus, we have a very hospital?NOLTE: Including St. Franziskus Hospital, strong obstetrics and neonatology depart- NOLTE: Thanks to the hospital’s broadthere are six hospitals in Münster. We are ment. Our very broad healthcare spec- healthcare spectrum, we enjoy very com-one of the largest hospitals in the area, trum also includes an established ENT fortable competitive conditions. It wassecond only to the university medical cen- [ear, nose, and throat] clinic, where necessary to bring radiology and nuclearter, and we have a capacity of 562 beds. affiliated physicians practice, and our medicine to a level that is appropriate for Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 79
  • 73. Magnetic Resonance ImagingLinda Willeke helped to develop the MRI track at St. Franziskus Hospital and is impressed how the MAGNETOM Aera system speeds upthe daily routine at the hospital. our specific institution. For the two clini- especially in the area of MRI. We are“The handling of cal areas, we invested ten million euros, learning that we can put patients on the MAGNETOM including digitalization. BREMER: The importance of radiology right track very quickly with this imaging modality, meaning we can reach a diag- Aera is excellent. has changed radically over the past two years, ever since we started here with the nosis quicker and more effectively. With the new new team. We are now trying to develop Professor Bremer, your hospital is and offer the entire spectrum of diagnos- the Siemens International Reference system, we have tics and minimally invasive treatments. Center for MAGNETOM® Aera. How And, we are doing so on a customized many options basis to fit the needs of the primary refer- did you reach that point? BREMER: Right from the outset, I indi- now.” rers. That means oncology is a major area of focus when it comes to diagnos- cated to Siemens that I was interested in looking ahead, even beyond high-end Linda Willeke, Radiology Technologist, tics, but also new treatment methods. clinical care, and learning what other St. Franziskus Hospital, Münster, Germany We also see the importance of radiology developments are out there, which are in our examination figures, which are almost ready for clinical introduction. rising steadily, paricularly with cross-sec- Then, we decided to take on a leading tional imaging techniques – and here, role in clinical care and development with80 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 74. Magnetic Resonance ImagingMAGNETOM Aera. Then again, I also facturers in the past, and with the new Summarythink there is a clear connection to the MAGNETOM Aera system, we have manyfact that we have a very strong team options now. You were just talking about Challenge:here. Ms. Willeke, who helped to develop Dot, which helps make scans even faster. • Staying competitiveMRI in our clinical routine from the start, That also applies to staff members who • Cost-effective technologiesis here as a great example. On the whole, do not yet have a lot of experience with • Shorter MRI scan times, even forwe have very strong expertise in the MRI. It is faster for them to learn, which complex examsfield of MRI. I myself have worked a great also means they can perform scans on • Consistent, excellent image qualitydeal on preclinical research projects in their own earlier. in all situationsthis area. BREMER: Tim 4G improves image quality, • Workflow improvements speed, and flexibility. With it, we have • Reducing fear and addressing individualWhat benefits does the new MRI excellent image quality at high acquisi- patient requirementssystem offer, with its features Tim® 4G, tion speeds. Dot accelerates the workflow, • Reducing complexity and stress ofthe fourth generation of Total imaging but also ensures a basic level of quality an MRI examinationmatrix, and Dot™, the Day optimizing in terms of diagnostics, reducing varia- • Increasing patient comfort in MRIthroughput engine? tion between operators. That means that scanningBREMER: Multi-channel technology lets employees who only have a couple of • Potential for more diagnostics andus scan larger regions of the body flexibly. months of MRI experience can already treatments for more patientsFor another thing, we can perform scans perform a wide range of MRI exams, • Openness to future developmentsmuch faster with the new system, which something that would have been incon- Solution: • Groundbreaking MAGNETOM Aera and MAGNETOM Skyra scanners with patient-friendly design • Flexible multi-channel technology for“At our facility, the length of stay large regions of the body is five and a half days, well below • Tim 4G (fourth-generation Total imaging matrix) and Dot (Day optimiz- average. That’s why we need diag- ing throughput) • Large bore opening, short magnet, nostics to run quickly.” soothing illumination Burkhard Nolte, CEO, St. Franziskus Hospital, Münster, Germany Result: • Reproducible and consistent image quality • Significantly shorter scan times • Flexible and variable strategy selec-has raised throughput significantly. At ceivable before. The Dot technology is tions and Tim 4G coil technologyour facility, it is important to ensure that very helpful in that regard. • Accelerated workflow and reducedwe can work almost on demand. We WILLEKE: Patients who come repeatedly operator variationhave reached the point where we can with an indication are examined in exactly • Higher patient throughput, moregenerally complete a requisition within the same way, which also makes the requisitions from internal and externaltwo days, which I have never seen done images more comparable. referrersbefore. Having such a fast unit helps a • Increased accessibility for obese orlot to accomplish this. What are the direct benefits for fearful patients and other patientsNOLTE: At our facility, the length of stay patients? whose access to MRIs was previouslyis five and a half days, well below aver- WILLEKE: One very important benefit is limitedage. That’s why we need diagnostics to the unit’s wide opening, a 70 centimeter • MRI systems that help combat chal-run quickly. open bore design. Even obese1 patients lenges for institutions of various sizes can easily fit into the unit now. Also when and organizational structuresIn light of your experiences, what kinds it comes to claustrophobia amongof opportunities does MAGNETOM patients, we are able to calm them sooner.Aera offer? The fact that the magnet is shorter meansWILLEKE: Handling is excellent. I have also that the patient’s head is back outside the 1 Tim Dockable Table holds up to 250 kilograms/worked with systems from other manu- tunnel much sooner. And, examination 550 pounds. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 81
  • 75. Magnetic Resonance ImagingAs a Siemens International Reference Center, St. Franziskus Hospital and Siemens are partners in advancing magnetic resonance imagingtechnology – and the patients at St. Franziskus Hospital reap the benefits. times are considerably shorter. That has respond more flexibly to other patholog- definitely become noticeably faster for ical findings during the scan and take patients. additional images right away. BREMER: The shorter scan times are first and foremost a function of the coil tech- For which kinds of scans is the tech- nology suitable? WILLEKE: We initially used Dot for cardi- ac scans, and we are now also running it during brain and knee scans. “We have the ability to truly cover During abdominal scans, we are already using it for the liver. But it’s also moving a variety of different scans with forward; we have plans to incorporate MR angiography soon. the MRI unit at excellent quality.” How many patients do you examine Professor Christoph Bremer, MD, Head of the Department of Radiology, in your department, and what devel- St. Franziskus Hospital, Münster, Germany opments do you expect in the future? BREMER: In 2010 we saw about 55,000 patients, and we expect that number to nology, depending on how many chan- be up this year, to about 60,000. We have nels they can measure at the same time. definitely not yet reached the maximum. We now have a 48 channels system, at When you look at trends in our MRI 1.5 T, and we have become significantly department, you can see that figures faster. The new coil technology lets us are continuing to rise in the long term as82 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 76. Magnetic Resonance Imagingwell. One of the reasons for that is that and patient numbers was actually ratherwe have the ability to truly cover a variety conservative. We expect that we will reachof different scans with the MRI system, a break-even point in the near future.while achieving excellent image quality.That definitely boosts demand within Matthias Manych, a biologist, is a freelance scientific journalist, editor, and author specializ-the hospital, but I also think that little by ing in medicine. His work appears primarily inlittle, we will also be able to convince our specialized journals, but also in newspapers.external referrers that we are supplyinggood quality. There is definitely furtherpotential for growth.Can you estimate the cost effective-ness of your investment? Further InformationNOLTE: We are very optimistic that we www.siemens.com/aerawill reach our goals because we realized www.siemens.com/skyrathat our planning in terms of workflow MAGNETOM Skyra with Tim 4G and Dot On the other side of the world, South Jersey Radiology “We were the first facility with a 1.5 Tesla MRI system Associates, P.A. (SJRA), located in New Jersey, U.S., is a in this area in 1987. MRI is absolutely the key to our diagnostic imaging network with a total of ten locations business, and we want to make sure that we are the and over 40 specialized physicians. Within its region, trendsetter.” Another important building block was which has a population of about one million, SJRA is added to this concept when the MAGNETOM Skyra the leading provider of radiology services. To retain this 3 Tesla system was installed. The radiologists hope leading position, SJRA put MAGNETOM Skyra with Tim® that the new unit will help them reach a new level in 4G (fourth-generation Total imaging matrix) and Dot™ parallel imaging. Muhr already views Tim 4G and the (Day optimizing throughput) technology into operation Dot engines as indispensable. Tim 4G delivers crucial in January 2011. improvements in image quality, acquisition speed, and William F. Muhr, MD, is a diagnostic radiologist and increases options for whole-body imaging. magnetic resonance imaging (MRI) specialist as well as “Certainly one of the things that is more obvious to the CEO of SJRA. Muhr reports that the network faces the technologists in day-to-day scanning are the Dot stiff competition from both hospitals and other out- engines, which really enhance our throughput, but patient imaging facilities. To successfully stay afloat in also quality reproducibility. Dot helps the technolo- this situation, SJRA has always focused on providing gists and radiologists to produce excellent images,” personalized, caring patient service and making ongo- Muhr emphasizes. ing investments in state-of-the-art technologies. “Our Alongside a growing number of elderly patients, the aim is to stay on top of the competition with the best network is also seeing more and more high-risk patients and latest technology, to optimize our imaging results with breast cancer. Especially in chronic diseases, Muhr in readings to get the most accurate specialized inter- considers the reproducibility of results to be critical. pretations, and to offer the customer a patient service With Tim 4G and Dot, it is possible to scan more patients experience which he or she will not get elsewhere,” each day, but the radiologists at South Jersey plan to explains Muhr. MRI has been one of the group’s key continue investing the time they gain in achieving high technologies for more than 20 years now. Muhr reports, patient satisfaction. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 83
  • 77. EchocardiographyThe 3D Revolution inEchocardiographyThe Hospital Clínico San Carlos in Madrid, Spain, installed theACUSON SC2000 ultrasound system in its echocardiography lab shortlyafter Siemens introduced the system to the market two years ago.While its accuracy, speed, and image clarity was impressive from the verybeginning, physicians have also come to appreciate the ACUSON SC2000system’s ease of use and positive effect on workflows, as well as itspotential to integrate future applications.Gregory Morley, PhDFor more than half a century, ultrasound take up valuable time, it also produces enabling never-before-seen detail andtechniques have been used to provide artifacts and other unwanted inaccuracies contrast resolution throughout the entirediagnostic information about the heart. due to stitching because not one heart- field of view. An advancement to theToday, 3D ultrasound imaging has become beat is quite like the other, especially in legendary ACUSON Sequoia™ coherentincreasingly widespread in certain special- patients with cardiac conditions. image formation technology, IN Focusties, such as obstetrics and gynecology, The arrival of the ACUSON SC2000™ Technology enables the user to focus onbut most echocardiographers are still volume imaging ultrasound system has, the entire field of view instead of a singleheavily reliant on 2D datasets – mostly however, taken volume imaging to a focal zone revealing more clinically rele-due to the limitations of the heart being new level. In one heart cycle and without vant information in one single image.a dynamic organ in constant motion. stitching or electrocardiography (ECG) The ACUSON SC2000 system wasTo acquire the huge amounts of data gating, the system acquires the full vol- launched in 2009. The echocardiographyrequired to build up a volumetric image, ume of the heart at a 90-by-90 degree – laboratory at the Hospital Clínico Sanechocardiography devices usually have including volumetric quantification of Carlos, in Madrid, Spain, acquired anto rely on a process where data from color Doppler, as well as the left and right ACUSON SC2000 system soon after itsseveral consecutive heartbeats are con- ventricles. IN Focus Technology acquires first release. The hospital has thereforesecutively added to provide an overall and processes information at an unpre- been witness to the evolution of the sys-3D image. Not only does this process cedented 2.88 Gigabytes per second, tem, from its initial versions to the latest,84 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 78. EchocardiographyMedical Solutions · November 2011 · www.siemens.com/healthcare-magazine 85
  • 79. Echocardiography “We are always looking for a better way of getting more accurate results in order to provide improved information to make our decisions.” Alexandra Gonçalves, MD, Echocardiography Lab, Hospital Clínico San Carlos, Madrid, Spain most advanced and user-friendly versions. to provide improved information to make Applications such as the eSie Measure™ our decisions.” workflow acceleration package have con- siderably improved the acquisition and Mitral Regurgitation: analysis process, and they have enabled A Potential Application for reliable data to be generated semi-auto- 3D Technology matically. It is estimated that a least six million indi- Ever since they had access to the latest viduals in Europe and North America are volume imaging technologies, physicians thought to have some degree of mitral at the hospital in Madrid have been regurgitation1, which represents a sub- asking themselves how they could fully stantial caseload for echocardiography exploit the high-quality 3D imaging pro- laboratories such as the Hospital Clínico vided by the ACUSON SC2000 system in San Carlos. Dr. Gonçalves reckons that clinical practice. As Alexandra Gonçalves, at least 30 percent of the patients who MD, of the echocardiography laboratory pass through the laboratory suffer from at Hospital Clínico San Carlos, puts it, “We are always looking for a better way 1 SWISS MED WKLY 2010; 140 (3–4): 36–43. of getting more accurate results in order Lancet 2009 Apr 18; 373 (9672): 1382-94.86 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 80. Echocardiography some degree of this heart disorder. Gonçalves and her colleagues are work- Summary One common method used by clinicians ing hard to validate these 3D techniques to estimate mitral regurgitation is the by comparing 3D results with other tech- Challenge: measurement of the vena contracta. This niques such as magnetic resonance imag- • Improve the accuracy of cardiac measurement is a 2D method in echo- ing (MRI) and cardiac catheterization. The parameters such as mitral regurgita- cardiography which describes the small- latter two techniques may be considered tion, previously measured using 2D est width of the blood flow jet. The more the gold standard, but they have draw- echocardiography sophisticated and widely used proximal backs in clinical practice; MRI is more time- • Improve certainty in diagnosis and isovelocity surface area (PISA) method, consuming, not as readily available as measurements in patients with abnor- based on 2D datasets, takes into account ultrasound, and is also not indicated for mal cardiac geometry the entire cross section of the jet, but all patients, while cardiac catheterization • Reduce inter-observer variability in makes certain assumptions about the is invasive and uses X-rays. The initial measurements symmetry of flow. Says Gonçalves, “When results are promising. “If we use a tool • Speed up and automate the measure- 3D came along, we realized that 2D tech- that gives us a measurement of the mitral ment protocols niques were not providing an accurate regurgitation severity, we must be sure picture of flow in mitral regurgitation – that we are providing a correct number Solution: PISA is often not symmetric or spherical. when we do the report,” explains Gon- • 3D real-time imaging capabilities of With 3D techniques, the cardiologist has çalves. “This is important because it might the ACUSON SC2000 system to display the opportunity to look at the flow in its determine whether a patient is referred the flow in its actual shape real shape.” There are certain situations for surgery.” in which mitral regurgitation flow is even Result: more difficult to quantify, such as after Towards Greater Objectivity • Faster, more efficient workflows due placement of a mitral clip, where there According to José Luis Zamorano, MD, to shorter exam times may be two independent regurgitation Head of the echocardiography laboratory • Accurate and standardized results jets. These are areas where 2D techniques at the Hospital Clínico San Carlos, • Increased diagnostic confidence are particularly prone to error, but where “Another important factor in favor of the 3D techniques could, in principle, pro- 3D technique is that we have a huge vide solid data. Siemens’ new eSie PISA™ inter-observer variability when using the software provides semi-automatic quan- 2D techniques. They require a number tification of PISA from volume color of subjective judgments that in principle Doppler data to assess valvular disease.2 will not be needed with 3D techniques, and you need to send the patient to some- one who is really an expert. When you have semi-automated measurement sys-2 Availability depending on individual country registration tems, the computer will provide quanti- status. tative information to the physician.” The Vena Contracta Width: Prone to error in manual Assumption: 2D PISA assumes a hemispheric Actual: eSie PISA. Free of geometric assump- measurement and poor reproducibility. Limited flow convergence, which is almost never the tions, calculates PISA on jets in any direction. by color Doppler resolution and system setting. case. Generally results in severe underestima- tion of EROA in most cases. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 87
  • 81. Echocardiography “When you have semi- automated measurement systems, the computer will provide quantitative information to the physician.” José Luis Zamorano, MD, Head, Echocardiography Laboratory, Hospital Clínico San Carlos, Madrid, Spaincomplexity of the 2D calculations also believe that in the end, the echocardiog- trust to give us results automaticallymakes them time-consuming to perform. rapher always plays a crucial role. The without having to make assumptionsIf a system is able to perform the greater way we do the acquisition and measure- about shape.”part of tedious calculations, the cardiol- ments requires training, and the person 3D imaging of mitral regurgitation isogists should be able to spend more performing these tasks has to be an still being validated. The echocardiogra-time on other important tasks. However, expert. We are, however, in a much bet- phers at the Hospital Clínico San Carlosas Gonçalves is keen to point out, “We ter position if we have a system we can are aiming to present some preliminary results at the European Society of Cardi- ology this year. For the most part, they see the benefit of 3D echocardiography in determining left ventricular systolic function and in calculating ejection frac- tion. With the new eSie LVA™ volume LV analysis application, a 3D contour of the left ventricle is automatically drawn and ejection fraction data calculated. “[The system] can provide more accurate assumptions about left ventricular sys- tolic function in asymmetrical ventricles, such as those with aneurysm,” explains Gonçalves. Looking to the Future For the time being, 2D techniques “will continue to have their place in the daily routine, because they allow higher frame rates – which means that they keep up better with the heart’s movements,”The 2D technique requires the sonographer to make a number of subjective concludes Gonçalves. Cardiologists arejudgments. The one-beat-acquisition of the ACUSON SC2000 system helps to reduce examining the potential of 3D imaging,inter-observer variability increasing consistency and improving outcomes. particularly in situations where the num-88 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 82. ACUSON SC2000 UltrasoundSystem – TechnologiesThe ACUSON SC2000™ ultrasound system is the first echo-cardiography system on the market that offers instantaneousreal-time 3D imaging of the heart. With this technology, in asingle heart cycle and without stitching or ECG gating, the fullheart volume can be sampled at a 90-by-90 degree angle and16 centimeters depth at up to 40 volumes per second. Data onvolumetric color flow are acquired and accurate volumes arecalculated for the left and right ventricle.New Paradigm in Image QualityIN Focus technology, one of the latest enhancements to theACUSON SC2000 system, delivers the same detail resolutionacross the entire image – from the near field to up to 16 centi-meters depth – without sacrificing frame rates. An advance-ment to the legendary ACUSON Sequoia™ coherent image for-mation technology, IN Focus Technology enables the user tofocus on the entire field of view instead of a single focal zonerevealing more detailed information in one image. By using The ACUSON SC2000 ultrasound system enablesthe power of 64 parallel receive beams, IN Focus dramatically the acquisition of the complete heart volume in aimproves image quality at all depths to ideally display the car- single heart cycle and without stitching.diac structure, motion, and blood flow information for superiorand efficient diagnostic imaging. knowledge-based eSie LVA (left ventricle analysis) application,Semi-Automated Measurements to Reduce Exam Times which automatically draws the contour of the left ventricle. TheThe ACUSON SC2000 system exclusively features the eSie application then compares the data acquired with results fromMeasure workflow acceleration package. This is the first appli- a database containing thousands of clinical cases, and is ablecation in the industry to provide fully automated measurements to automatically calculate ejection fraction and volume data infor routine echo exams increasing workflow efficiency as well as little as 15 seconds, reducing exam time, increasing consis-as the reproducibility and quality of each exam. Customizable tency, and improving patient care. Moreover, eSie LVA supportsaccording to user or department requirements, eSieScan™ the standard American Heart Association segmentation, allow-workflow protocols dramatically reduce the need for user inter- ing standardization of exam protocols between computedaction and the number of keystrokes during the imaging pro- tomography, magnetic resonance imaging, and molecular imag-cess. Exam workflows are improved on both the user level ing. Unlike traditional 2D PISA, which is truly applicable onlyand in the entire lab. In addition, these protocols increase the for a limited number of valvular pathologies, Siemens’ exclusiveconsistency of results and ensure that exams are complete. eSie PISA™ software can be used on almost all patients withHarnessing 3D Data in Clinical Practice valvular diseases to assess valvular disease. The software com-In order to fully exploit the potential of the real-time 3D data putes the status of PISA and effective regurgitant orifice areagenerated by the ACUSON SC2000 system, Siemens has inte- (EROA), and the simple workflow delivers measurement of thegrated a number of additional technologies. These include the EROA within seconds.bers generated from 2D datasets require Gregory Morley, PhD, is a medical writer and journalist based outside Madrid. In his capacitylaborious calculations and – even more as a medical journalist, he has attended moreadverse – are based on assumptions than 30 international medical congressesthat may not be generally true. In these throughout Europe.cases, 3D imaging is expected to resultin more reliable numbers and time sav-ings. And the ACUSON SC2000 system is Further Informationtestimony to the advances in technology www.siemens.com/that show us that we can have it all: The echoinaheartbeatentire heart. In 3D. And in real-time. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 89
  • 83. Essay Series: Healthcare Systems – South AfricaThe South AfricanHealthcare System: A Goal ofQuality Healthcare for AllBy Olive Shisana, ScD, Chief Executive Officer, Human Sciences Research Council, Cape Town, South AfricaThe South African healthcare system brought by sailors who arrived from India Africa in 1910, the Act established thehas been evolving over the last four cen- with infected clothes to be washed by Department of Health in South Africa andturies1. Prior to the arrival of Dutch colo- local people, the Khoisan. The disease allocated functions for health at national,nialists en route to India via the Cape, the spread and killed one-fourth of the Euro- provincial, and local government levels,local population, i.e., the Khoisan and pean settlers and decimated the Khoisan leaving the latter to provide personal careAfricans, relied on indigenous healthcare. workers. With increased demand for services paid by individuals, instead ofEven today, many continue to use this healthcare due to smallpox, health ser- state resources. Various committees advo-system. Jan van Riebeeck arrived in the vices were restricted to whites. Another cating for state responsibility for health-Cape in 1652, carrying in his three ships smallpox outbreak that occurred in 1751 care were established between 1920 andsick, hungry, and poor Dutch sailors. further decimated the local and the Euro- 1935, arguing that the National PublicThe Dutch East India Company, an orga- pean population. The 1755 smallpox Health Act did not extend to the provisionnization he served as an administrator, epidemic brought by a ship from Ceylon of healthcare for all. In 1941, there wasrequired him to establish a food station (now Sri Lanka) was responsible for racial an effort to establish a national healthand medical care for the crew as well as segregation in healthcare, only providing insurance (NHI) plan for South Africa, ledother settlers. Van Riebeeck, a medical care according to one’s skin color. by J. Collie, who chaired the Committeedoctor turned merchant who brought of Enquiry into the National Health Insur-white settlers to South Africa, converted Influences on Health Policy ance, which aimed to cover all peoplehis house into a hospital to care for the There were many events that contributed of all races, except those in rural areas.sick, using Dutch medically trained sur- to the development of public health in There was resistance from various quar-geon-merchants. This hospital was later all four provinces of South Africa – Cape, ters, including the medical fraternity.used not only by settlers, but also by Orange Free State, Transvaal, and Natal. Eventually, the Department of Health’slocal people. This was the beginning of These included the outbreak of diseases Henry Cluver, inspired by the community-western medicine in South Africa, which such as leprosy, bubonic plague, tuber- based care approaches of Sydney andalso made great efforts to subordinate culosis, and venereal diseases. But the Emily Kark, decided to establish a com-indigenous medicine. biggest event that influenced the estab- munity-based care system that treatedWith trade between the East and Europe lishment of public health in South Africa patients holistically, including a goodvia the Cape growing, diseases came. was the Spanish influenza of 1911–1918, understanding of their culture, provisionOne that played a pivotal role in formal- which led to the passage of the National of health promotion services, and cura-izing medical care in South Africa was Public Health Act in 1919. Coming after tive services. As a result of the pressure,the smallpox epidemic of 1713, which the establishment of the Union of South the state appointed the Gluckman Com- Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 91
  • 84. Essay Series: Healthcare Systems – South Africa“Given South Africa’s in 1994, amalgamating the 14 health ing is comparable to that spent by other departments created by apartheid – ten OECD2 countries such as Ireland, the health systems’ chal- for blacks who lived in Bantustans and United Kingdom, Australia, Norway, and four for population groups comprised of Finland; it is slightly higher than the lenges, it is essential Whites, Coloreds, Indians, and Africans expenditure in Japan and significantly to improve its organi- who lived in urban areas. The balkaniza- higher than the expenditure in Chile and tion of South Africa into these racial and Mexico. zation and financing, ethnic groups had enabled the apartheid The public sector spending on health- which is fundamental government to establish a state-deter- care as a percentage of all healthcare mined policy of allocation of resources expenditures in South Africa was 39.7 per- to solving the ills it (including health resources) to ensure cent in 2008, not a significant increase confronts.” that inequality was maintained. It is from 38.5 percent in 2005. However, against this background that we discuss this is significantly lower than govern- the current challenges faced by South ment spending in other OECD countries, Olive Shisana, ScD, Chief Executive Africa’s health system. which averaged nearly 73 percent. What Officer, Human Sciences Research Council, Cape Town, South Africa is not apparent from these figures is that Healthcare Financing the 59.7 percent public spending is inad- The reform of South Africa’s healthcare equate to provide care to the majority system is challenged by the historically (68 percent) of the population who use state-generated inequalities, inadequate the public health sector and do not havemission to investigate the establishment financing of the public healthcare system, medical aid coverage. The balance ofof a new public health system. Its chair- the existence of a two-tiered healthcare 40 percent comes from private sources,man, Henry Gluckman, was probably also system, human resource gaps, poor including medical aid and out-of-pocketinfluenced by the British reformists, who quality of healthcare, and a high burden expenses, and it provides services forhad major challenges regarding their own of diseases. First, let us look at health- the remaining individuals with medicalhealth system. The recommendation of care financing. aid and those who pay out of their ownhis commission, which would have seen Although South Africa is located in Africa, pockets. The distribution of medical aida much more state-centralized healthcare its health spending differs from its neigh- coverage differs very much by race. Thesystem with integration of curative and boring countries. It allocates more to post-apartheid government is underpreventive services, was excluded from health than other African countries. Much pressure to allocate more resources forthe revised 1946 National Health Act. of South Africa’s health spending is gen- public healthcare and to protect the pub-The apartheid government, which came erated domestically, while in other parts lic from financial risks related to health-into office in 1948, simply entrenched of the African continent, donor aid plays care. Currently, the minority white popu-the racial segregation that had started a critical role in financing healthcare. lation is the major beneficiary of accessin the 18th century and began segment- South Africa’s spending on health is fairlying the population by ethnic group and comparable to industrialized countries,rural/urban divide, allocating resources but it has some outcomes that are worseaccording to different racial groups, a than those of the Organization for Eco- Distribution by Race and Percentmove that was to contribute to disparities nomic and Cooperative Development with Medical Aid Coverage byin health outcomes by race. Africans, (OECD) countries and more comparable to Race, South Africa 2010largely based in rural areas in what was other African countries. This is partiallylater called Bantustans, suffered from due to the above mentioned inequities 90diseases of poverty, such as diarrhea, in resource allocation and poor living 80tuberculosis, and respiratory disorders, conditions inherited from the past, but it 70while the whites suffered from diseases is also due largely to a heavy burden of 60 50of affluence, common in industrialized HIV/AIDS, which is reversing the quality 40countries. of life of the population. 30With the release of Nelson Mandela and On the face of it, the country has enough 20other political prisoners and the unban- resources – R102 billion in 2010 – to 10ning of exiles, the new democratic state spend on healthcare to serve the entire 0was formed, culminating in the historic population of nearly 50 million people. s ds ns s an te1994 elections that brought the African In 2008, the country spent 8.3 percent re ia hi ric As lo W Af Co s/National Congress in power. The post- of its gross domestic product (GDP) on an diapartheid government started introducing health, of which 3.6 percent was public Inmajor changes in the healthcare system sector funding. The 8.3 percent spend- Percent of the population Percent with medical aid92 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 85. 41 Number of Nurses per 10,000 Resident Population (2004) Number of Physicians per 10,000 Resident Population (2004): 8.0 Number of Hospital Beds per 10,000 Resident Population (2005): 28.0 Population in Thousands (2006): 48.282 Total Expenditure on Health as % of GDP (2008): 8.3% Public Expenditure on Health as %Male Life Expectancy of Total Expenditure on Health (2008): 39.7%at Birth (2006) 50 Total Expenditure on Health per Capita (2005): US$ 437.00 53 $$$$ $ Female L Expectancy Fe Fe Life at Birth ( t Bi th (2006) Source: WHO Global Health Observatory Website. http://www.who.int/gho/en/. Last accessed July 22, 2011.
  • 86. Essay Series: Healthcare Systems – South Africa HIV Prevalence by Sex and Age, South Africa 20083 Females Males 45 40 32.7 29.1 35 25.8 HIV prevalence (%) 30 24.8 18.5 19.2 21.1 25 15.7 16.3 20 14.1 10.4 10.2 15 8.4 6.2 7.7 10 6.7 2.5 5.1 3.5 5 3.0 2.0 1.8 0 2–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+ Age group (years)to private medical care, as shown on the income countries such as Brazil and attend to better organization and plan-graph on page 92. Mexico, South Africa’s life expectancy is ning of health service provisions, endingSuch inequity is at the center of debate decreasing, largely due to HIV/AIDS affect- stock-outs of medicines, deploying staffin South Africa, causing many to demand ing the young population (see graph in adequate numbers, and fostering aa change in the way healthcare is finan- above) and high rates of tuberculosis (TB). positive attitude among health workersced. Many are calling for the introduc- The country is home to the largest num- towards patients. The country producestion of national health insurance, which ber of people living with HIV/AIDS at 5.6 well-trained medical doctors and nurseshas been under discussion since 1941. million – 10.9 percent of the population who are often recruited and hired byAt the core of the debate is the existence – and it is also one of the 20 highest TB- OECD countries such as Canada, theof a two-tiered healthcare system with burdened countries in the world. Maternal United Kingdom, Australia, and also Araba strong private sector that serves a mortality is rising largely due to HIV/AIDS. States such as Saudi Arabia and theminority of the population who use pri- Unlike the Mbeki administration, which United Arab Emirates. Doctors are oftenvate hospital services. The private health denied AIDS was a problem, the current recruited to work in urban areas, awaysector provides care that is found in Zuma administration is providing anti- from where the majority of the needyhighly industrialized countries – not only retroviral therapy for pregnant women at population lives. The distribution of doc-for local South Africans, but also for higher CD4 cell counts and has a large tors is also skewed towards high-incomepatients coming from all over the world antiretroviral treatment program to reduce provinces like Gauteng and the Westernwho seek modern state-of-art medicine. premature mortality. The high non-com- Cape, where the doctor-to-populationFunding in the public health sector, on municable disease burden, which fell off ratios approach those in industrializedthe other hand, remains inadequate to the radar screen for some time while the countries. Training of doctors and nursesaddress the generally poor health status focus was on HIV/AIDS, is also contribut- has recently begun to decline in Southof the black population in South Africa ing to high death rates. Ischemic heart Africa at the time when the burden ofand the populations of its neighboring disease, stroke, hypertensive heart dis- diseases is increasing. When doctorscountries who seek healthcare in this ease, and diabetes impose a huge burden migrate to industrialized countries, theycountry, which is better than what is avail- on the population. Premature mortality leave a gap that is filled by foreign doc-able in their own. This inequity in access due to these diseases contributes to a tors, mostly from African countries, andto financial resources and poor social liv- decrease in life expectancy. The recent philanthropic doctors from industrializeding conditions contribute to poor health government’s focus on non-communica- countries willing to provide healthcareoutcomes. ble diseases is welcome. in rural and underserved areas. This But for the country to provide good quality migration, coupled with those doctorsHigh Premature Mortality Rates healthcare coupled with good health preferring to work in the private sectorHigh infant mortality contributes to reduc- outcomes requires an adequate supply and those concentrated in high-incometion in life expectancy at birth. Unlike of well-qualified people in the workforce, areas, contributes to the poor quality ofother OECD countries, as well as middle- starting with good managers who can healthcare. When doctors are overloaded94 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 87. Essay Series: Healthcare Systems – South Africaand overworked, the patients suffer;they wait in long queues. Reduction of WHO Health Indicatorsthe shortage of healthcare providers will Infant mortality rate (per 1,000 live births) both sexes 56.0 (2006)require not only an increase in enroll-ment at medical schools and the open- Neonatal mortality rate (per 1,000 live births) 17 (2004)ing of more nurse training colleges, butalso the introduction of task shifting, Under-5 mortality rate (probability of dying by age 69 (2006)where community health workers are five per 1,000 live births) both sexestrained to provide primary healthcare Maternal mortality ratio (per 100,000 live births) 400 (2005)at home and in communities – a movethat the government is enthusiastically Deaths due to HIV/AIDS (per 100,000 population per year) 675 (2005)embracing. Deaths due to tuberculosis among HIV-negative 84.0 (2006)Seeking Solutions for the people (per 100,000 population)Future Source: WHO Core Health Indicators Website: http://apps.who.int/whosis/database/Given South Africa’s health systems’ core/core_select_process.cfm. Last accessed July 4, 2011.challenges, it is essential to improve itsorganization and financing, which is fun-damental to solving the ills it confronts. has taken a first step with the fiscal year adopted by its members, and it holdsThe direction taken by the African 2011 budget to allocate funding for the the majority, evidenced by the latestNational Congress at its National General implementation of national health insur- landslide victory in the local governmentCouncil meeting, held in September 2010 ance. The country is anxiously awaiting elections. The policy has the support ofin Durban to adopt a new national health the release of the policy document that its allies, the strong Congress of Southinsurance plan, is a correct path to take. outlines the nature of the state proposal Africa Trade Union, and the South AfricanThe policy is envisaged to be based on on national health insurance.There will Communist Party. Implementation ofthe principles of the right to healthcare, be many detractors opposed to the imple- this policy will not be easy, but willsocial solidarity, and universal coverage. mentation of the national health insur- require political determination such asA national health insurance fund that is ance system, behavior that is not unique that seen when Thailand introduced NHI.state funded, publicly administered, and to South Africa. One can only look at South Africa is ready. The time is now.a single payer for health services pro- a recent example in the United States,vided by both the public and private sec- where President Obama continues to betors will go a long way to make health- challenged by vested interest groups 1 The opinions reflected in this article are those of thecare accessible by redistributing health and political opponents. In South Africa, author and do not necessarily reflect those of Siemensworkers to serve people of all races living despite the fact that the majority of Healthcare.in urban or rural areas, young or old, South Africans and the majority of private 1 The history of public health in South Africa is based on an unpublished paper prepared earlier by O. Shisana,male or female. Such a system will use medical schemes holders want national S. Zondi, A. Hadland, S. Mfecane, MA and T:scientific evidence to select prevention, health insurance to be implemented, South African Public Health System and Communicablediagnostic, treatment, and care interven- there are a few who vehemently oppose Diseases, 2003. 2 OECD Health Data 2010. How Does South Africa Comparetions to be implemented, rely on national it, just like the detractors who blocked with OECD Countries: http://www.oecd.org/dataoecd/staffing norms ratios to reduce over- adoption of policy on NHI in 1941 or 20/40/45703998.pdf. Last accessed July 22, 2011.crowding and work overload, and require implementation of the Gluckman Com- 3 Shisana O, Rehle T, Simbayi LC, et al. South African National HIV Prevalence, HIV Incidence, Behaviouralaccreditation of facilities to ensure the mission report. This time, the major and Communications Survey, 2008. Cape Town:availability of quality healthcare. The state difference is that the ANC has a policy Human Sciences Research Council Publishers, 2009. Olive Shisana obtained a Doctor of Science degree from Johns Hopkins School of Hygiene and Public Health (now Bloomberg School of Public Health), served as a group manager at the South African Medical Research Council, and later became the first post-apartheid Director General of Health in the Mandela Administration. She also worked for the World Health Organization as Executive Director for Family and Community Health. She previously served as Professor of Health Systems at the Medical University of Southern Africa, and Executive Director for Social Aspects of HIV/AIDS and Health at the Human Sciences Research Council. Currently, she is Chief Executive Officer of the Human Sciences Research Council, President of the International Social Sciences Council based in Paris, Chair of the Ministerial Advisory Committee on National Health Insurance, and member of the Economic Advisory Panel in South Africa. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 95
  • 88. Further ReadingFurther ReadingSiemens offers a variety of customer magazines and informationchannels. “Further Reading“ introduces a selection of articlesand topics featured that may be of interest to you. To learn more,follow the link below each article. To subscribe to any of themagazines, see page 103.Guarding Your Uptime revenues, as downtimes become sched- ulable. Customers around the world experienced the benefits of the Siemens service offer – including the Hanyang University Guri Hospital (HYUGH) in South Korea. “Tube replacement could be scheduled upfront, so that our active uptime could be fully used to treat patients and without caus- ing any interruptions or delays. We had no problem with patient scheduling on the day of the exchange and the follow- ing days,” says Jeong Gon Choi, CT Unit Manager of the hospital. More about Jeong Gon Choi’s experiences with Siemens’ TubeGuard Service can also be accessed using the link below.Hanyang University Guri Hospital (HYUGH), South Korea, benefits from TubeGuard.The X-ray tube of a computed tomography Biograph® mCT positron emission(CT) scanner is absolutely crucial to its tomography – computed tomographysystem availability and image quality. It is scanner. For Siemens Healthcare’s cus-subject to wear and tear. Its lifetime var- tomers, the Guardian Program includingies widely depending on how it is used. TubeGuard means avoiding downtimesIt is precisely here where the Siemens and unplanned workflow disruptions, Jeong Gon Choi,Guardian Program™ including TubeGuard, as well as scheduling patients and the CT Unit Managercomes into play. This Siemens service required staff accordingly. The advan- at HYUGHprovides certainty in avoiding downtimes tages are obvious: establish a positivefor all CT systems belonging to the hospital reputation through a reliable www.siemens.com/SOMATOM® Definition family (SOMATOM uptime, meaning reliable service deliv- tubeguard-casesDefinition, SOMATOM Definition AS, ery to referring physicians. In the end, www.siemens.com/tubeguardSOMATOM Definition Flash) and the this means satisfied patients and secured96 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 89. Further ReadingA Broad ApproachToward Hybrid RoomsHybrid rooms are already well established department; so does Hohenforst-in the fields of cardiology and cardiac Schmidt with the hospital’s cardiologysurgery, where angiographies and open- department.heart surgery take place on the same And, Raftopoulos thinks even further.table. According to customer feedback, He envisions hybrid rooms used in thehybrid rooms can soon also be used in minimally invasive placement of stabiliz-pulmonary medicine or spinal surgery. ing implants, not just of the spine butLung specialist Wolfgang Hohenforst- also of the head, as well as in neuro-Schmidt, MD, Senior Physician at the modulation technologies for essentialHospital Coburg, Germany, is using the tremor, Parkinson’s, or psychiatric dis-technology of the Artis® zee angiogra- eases. The surgeon is confident: “Thephy system to perform syngo® DynaCT- future of Artis zeego can be very brightguided biopsies. The major benefit of and the potential is much greater than itthis approach is that it is a real-time pro- appears even now.”cedure, acquiring three-dimensionalimages of the lung and performing the www.siemens.com/bronchoscopy under fluoroscopy at the AXIOM-thoraxsurgery www.siemens.com/ Wolfgang Hohenforst-Schmidt, MD,same time, in the same place, and in the explaining the advantages of Artis zeesame position in the diaphragm. This AXIOM-spinesurgery in pulmonary medicine.means the precision is much higher thanwith classic bronchoscopic procedures.Even very small tumours of below 1.5millimeters can now be biopsied quicklyand precisely.Christian Raftopoulos, MD, PhD, Headof the Neurosurgery Department at theUniversity Hospital Saint-Luc in Brussels,Belgium, started using the hybrid roomfor spinal osteosynthesis procedures.According to him, Artis zeego providesexceptional 3D image quality right in theoperating room (OR), allowing for qualitycontrol during the procedure. The sur-geon can thus avoid second surgeries andmedical-legal issues. At the same time,he/she is faster when using 3D imagingbefore and during surgery because ofa better 3D perception of the patient’sspine. In sum, the comprehensive diag-nostic and therapeutic support savestime and costs.Speaking of costs, both pulmonary andsurgery departments did not need toinvest in new systems. Raftopoulos sharesthe existing OR with the cardiac surgery Christian Raftopoulos (on the right) with a colleague during a catheter intervention. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 97
  • 90. Further Reading Henry Woo, MD, working at the Artis zee worksta- tion with integrated CARE features.Taking CARE – With Low DoseInterventional ImagingWith Combined Applications to Reduce is convinced of the benefits of CARE: that incorporates CARE for lower radia-Exposure (CARE), Siemens offers a com- “The Low Dose acquisition program is tion dose. Reporting is also made easierprehensive range of technologies for integrated seamlessly with an easy-to- with the use of CAREreport. Instead ofradiation dose management enabling use interface and can be accessed right having to print a report and scan it intosignificantly reduced dose without com- from the footswitch. CARE makes the the system, the physicians can sendpromising image quality. The Cerebro- task of keeping dose low virtually effort- a direct DICOM® image as part of thevascular and Stroke Center at Stony Brook less.” Henry Woo, MD, Director of the study, which significantly speeds upUniversity Medical Center (SBUMC) in Cerebrovascular and Stroke Center at clinical workflow.New York, U.S., has been using CARE SBUMC, says the CARE features have been “Siemens’ attention to radiation dosesince early 2008 with the installation of important. “With certain modalities, such management is one of the key reasonsits first Artis zee®, making dose reduc- as angiography, you can potentially we use Siemens equipment. The built-intion a seamless aspect in its diagnostic deliver large amounts of radiation with- dose reduction applications as well asand interventional care. The Center now out even realizing it. Having the technol- other safety features, the ability to useboasts two new Artis zee biplane rooms, ogy to manage radiation exposure for tools like syngo DynaCT, and the moreeach equipped with integrated CARE you – especially in emergency situations sophisticated software packages likefeatures to reduce dose for patients as or when you are managing a complex, syngo iPilot and syngo iGuide allow us towell as operators. delicate procedure – automatically puts focus our attention above all on patientThe facility is using Low Dose acquisition a lot of minds at ease.” care,” says Woo.to merge already acquired computed The new biplane rooms at SBUMC aretomography (CT) with angiographic sets also equipped with Low Dose syngo®to easily navigate the catheter and reduce DynaCT, an established application in www.siemens.com/both radiation dose and contrast agents. interventional radiology to acquire real- AXIOM-interventionalMedical radiographer Charles Mazzarese time 3D CT-like, high-quality images,98 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 91. Further Reading Siemens Customer Care: es and Supp Increase Your Lab Efficiency Se r vic or t The most comprehensive portfolio of a multimodal approach to customized analyzers, assays, informatics, and auto- online laboratory education, was devel- Education a ement mation is only the first step toward opti- oped to accomplish these goals. In addi- Customer Care mum laboratory productivity. Within the tion, lab processes will become more pro- nag Siemens Healthcare Diagnostics Customer ductive and more efficient with Siemens Ma Care framework, customers can choose as a partner for workflow management nd w personalized services and support, educa- and consulting throughout the whole ra o fl T in ing rk tional resources, and workflow solutions product lifecycle. Wo to elevate quality within the laboratory Sheryl Wilson, Senior Executive of and throughout the healthcare continu- Laboratory Services at Alegent Health, um. Siemens delivers technical expertise Omaha/Nebraska, U.S., appreciates the when needed – online, onsite, and over service from Siemens: “The challenges the phone – helping to keep labs operat- in the laboratory and in healthcare are of our preferred partners built on the ing at peak efficiency. Educational and to increase the value for the dollars that relationship that we’ve built over the training opportunities keep lab personnel are spent. That means increasing our years of trust, honesty, and integrity.” up-to-date on product information and efficiency, lowering our error rate, mak- key trends in disease state management. ing things more timely, things accurate, www.siemens.com/ The Personalized Education Plan (PEP)1, all of those things that add value to the diagnostics-customercare1 Patent pending services that we provide. Siemens is one What Kind of Future Does Australia Want? Population growth, obesity, and an Australian healthcare system is dealing In addition to treating acute diseases, aging population – these are critical chal- with these challenges. prevention, early detection, and an lenges facing healthcare systems world- The survey results are striking. By 2030, increased use of innovative technologies wide. In the “Picture the Future: Australia almost 75 percent of Australians may be must be incorporated into the system to 2030” study, Siemens, together with more overweight, and the number of people a much greater extent. To prevent costs than 40 partners, investigated how the over the age of 65 will double. Chronic from exploding, the experts responsible diseases, which require long-term treat- for the study recommend educating the ment, are expected to grow, particularly population early about possible health in the areas of diabetes, mental illness, risks. This could help prevent issues from joint disorders, cardiovascular disease, sprouting such as obesity. and cancer. These trends will drive up Although the year 2030 may seem in healthcare costs. distant future for some, the study makes Australia generally provides solid health- clear that preparation must begin now. care to its population. The study showed, however, that the system is directed pri- marily at treating acute diseases. Preven- tion accounts for only two percent of healthcare expenditures. Yet, the develop- www.picturethefuture2030. ments predicted require a more holistic com.au/ approach to healthcare. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 99
  • 92. Further ReadingTube Current and Tube VoltageModulation for Reduced DoseAutomated, real-time modulation of the are presently the first in the medical could be reduced to below 10 milligraytube current with CARE Dose4D is a well- imaging industry to provide a tool, CARE (mGy) using 100 kilovolt (kV), downknown method to Siemens’ computed kV, to automatically adjust the tube volt- from 14.1 mGy with the former standardtomography (CT) customers. With this age considering the individual patient protocol set at 120 kV. This dose reduc-CARE (Combined Applications to Reduce and clinical indication. Simultaneously, tion of around 30 percent came with veryExposure) feature, dose savings of up to CARE Dose4D will adjust the tube current minimum compromise in image quality.68 percent are possible when adjusting in real-time during the examination. With CARE kV, CT users can benefit fromthe tube current to the patient’s size and The combination of CARE kV and CARE the full potential of their system whileshape.1, 2 Siemens’ SOMATOM® scanners Dose4D enables individualized patient patients benefit from significantly reducednow feature an additional innovative tech- care by optimizing scan parameters for dose. For more details, please refer to thenology, CARE kV – the first automated, each clinical need. Science section of SOMATOM Sessions,exam-specific tube voltage setting. The benefits of CARE kV are now proven: also available under the link below.While the dose reduction potential when Siemens monitored CARE kV duringoptimizing the tube voltage is known the first months after its introductionand has been previously shown, it is in and evaluated the results. After having 1 Greess H, et al. Rofo. 2004 Jun;176(6):862-9. 2 Greess H, et al. Eur Radiol. 2004 Jun;14(6):995-9.fact, rarely realized in daily clinical prac- scanned more than 12,000 patients, 3 Siegel MJ, et al. Radiology. 2004 Nov;233(2):515-22.tice.3, 4 The relationship between tube there was a clear shift toward 100 kV 4 McCollough CH, et al. Radiol Clin North Am. 2009current, tube voltage, and image quality and 80 kV scans (see graphic below). Jan;47(1):27-40.in CT is complex and thus, adjusting the With this tool, dose was saved in moretube voltage to each individual patient than two-thirds of those patients sur-and exam is challenging and often too veyed, compared to the initial protocols. www.siemens.com/time-consuming. To overcome these And, the dose reduction itself was sig- somatom-sessions-sciencechallenges Siemens’ SOMATOM scanners nificant. For example, abdomen scansLower dose in 67% of patients with CARE kV5 The evaluation Without CARE kV With CARE kV of applied kV shows a clear 100 kV usage [%] 100 kV usage [%] shift toward lower 90 90 kV values using www.siemens.com/ CARE kV. 80 80 tubeguard-cases Source: Internal 70 70 www.siemens.com/tubeguard data evaluation based on anony- 60 60 mous assessment 50 50 on SRS connected 40 40 scanners. 30 30 20 20 10 10 0 0 70 80 100 120 140 70 80 100 120 140 Tube voltage [kV] Tube voltage [kV] 5 Data on file.100 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 93. Further ReadingThe Expanding Role of ClinicalDiagnostics Through ITA new generation of diagnostics IT toolsis getting results into the hands of clini-cians faster, improving the quality of theresults, and enhancing lab operationalefficiency. As a consequence, clinicaldiagnostics is increasing its value to thehealthcare system even as resourcesdecline. And, labs are becoming moreaware that their very survival will dependon the ability to establish value forphysicians, administrators, patients,and payers.As clinicians rely on lab results forpatient management, expectations oflab performance – for example, turn-around time (TAT) and quality – arerising. Clinicians and lab directors agreethat achieving TAT improvement is a toppriority. As clinicians are pressed to seemore patients, they rely more on labsto get results to them as quickly as pos-sible. But, while TAT is often the oneperformance metric for which cliniciansare likely to demand improvements, labdirectors and clinicians agree that theaccuracy of test results is the priority.Increasingly, clinicians expect counselingfrom labs with the use of tests. Over-loaded with information on new develop-ments in medicine, clinicians need helpnavigating through numerous test human review, guiding operations, and fessionals can now go one step furtherchoices. They look to labs to guide them performing quality control. And, labs in cementing the relationship with theirthrough interpretation of test results are reporting a measurable reduction in customers – the clinicians.with easy-to-understand reports. errors concurrent with improvements Siemens conducted a poll of 600 clinicalClinicians’ demand for more help from in TAT and increases in test volumes by laboratory professionals to learn morelabs in supporting their patient manage- deploying diagnostics IT. about their goals in the lab and how theyment decisions is coming at a time when Day to day, clinical labs are already using see IT as a catalyst to achieve this newlabs are faced with budget crunches and diagnostics IT to optimize operations and vision. To learn more about this studylabor shortages. The use of diagnostics deliver excellent service by providing and the instrumental Siemens IT tools,IT to improve quality and efficiency in timely delivery of actionable information. visit the link below.lab operations continues to evolve and, Diagnostics IT is also allowing labs tothe role of diagnostics IT to improve pro- take an active role in supporting initia-cesses and manage lab data are coming tives coming from their own institutions,together. Diagnostics IT is now critical payers, or government regulations. With www.siemens.com/diagnostics-itto reduce human errors, streamlining Gate Medi-Clinic Siemens’ Artis zeego at the Cape the support of diagnostics IT, lab pro- Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 101
  • 94. Imprint © 2011 by Siemens AG, Berlin and Munich, Neuroscience: MedicalRF.com/Corbis, golden section All Rights Reserved graphics, Luis Diaz Diaz, Siemens Alcohol Abuse: Rudolf Wichert/laif Publisher: Urology: Jacob Silberberg/Panos Siemens AG Medical Tourism: Dieter Braun Healthcare Sector Breast Cancer: David Sailer Henkestrasse 127, 91052 Erlangen, Germany Finance: golden section graphics, private Responsible for Contents: Michael Sigmund Advanced Visualization: Siemens Workflow in CT: Siemens Director of Customer Communications: Silke Schumann Hospital IT: golden section graphics, Dermot Tatlow/Panos Chief Editor: Doris Pischitz Imaging IT/Cardiology: Zack Canepari/Panos, Johannes Kroemer Editorial Team: Tanja Berbalk, Emily Smith Magnetic Resonance Imaging: Frank Schinski/Ostkreuz Production: Norbert Moser Echocardiography: Mariona Villavieja, Siemens Essay Series: Orlando Hoetzel, independent Medien-Design All at: Henkestrasse 127, 91052 Erlangen, Germany Further Reading: Kurt Paulus, Jock Fistick/laif, Siemens, Phone: +49 9131 84-7529, Fax: +49 9131 84-4411 independent Medien-Design email: editor.medicalsolutions.healthcare@siemens.com Note in accordance with § 33 Para.1 of the German Federal Design and Editorial Consulting: Data Protection Law: Dispatch is made using an address independent Medien-Design, Munich, Germany file which is maintained with the aid of an automated data in cooperation with Primafila AG, Zurich, Switzerland processing system. Art Direction: Horst Moser We remind our readers that when printed, X-ray films never disclose all the information content of the original. Artifacts in Layout: Claudia Diem, Mathias Frisch, Julia Hollweck, CT, MR, ultrasound, and DSA images are recognizable by their Irina Pascenko, Luitgard Schüller typical features and are generally distinguishable from existing Editorial Coordination: Christa Krick pathology. As referenced below, healthcare practitioners are Photo Editor: Anja Kellner, Florencia Serrot expected to utilize their own learning, training, and expertise All at: Widenmayerstrasse 16, 80538 Munich, in evaluating images. Germany Partial reproduction in printed form of individual contribu- tions is permitted, provided the customary bibliographical PrePress: Reinhold Weigert, Typographie und mehr ... data, such as author’s name and title of the contribution as Schornbaumstrasse 7, 91052 Erlangen, Germany well as date and pages of Medical Solutions, are named. The editors request that two copies be sent to their attention. Printer: Mediahaus Biering GmbH, The consent of the authors and editors is required for the Freisinger Landstrasse 21, 80939 Munich, Germany complete reprint of an article. Manuscripts submitted without prior agreement as well as suggestions, proposals, and infor- Photo Credits: mation are always welcome; they will be carefully assessed Cover: Martin Godwin and submitted to the editorial conference for attention. Cover Story: Yukio Futagawa, Siddharth Siva/Agentur Medical Solutions on the Internet: Focus/arabianeye, Daniel Duart/Agentur Focus, www.siemens.com/healthcare-magazine Julian Röder/Ostkreuz, Dörthe Hagenguth/Agentur Focus, Panos Pictures/VISUM, Siemens DISCLAIMERS: Practice of Medicine: “The information presented in this magazine is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Healthcare practitioners reading this infor- mation are reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Healthcare to be used for any purpose in that regard.“ Contrast Agents: “The drugs and doses mentioned herein are consistent with the approved labeling for uses and/or indications of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in connection with such use. The Operating Instructions must always be strictly followed when operating your Siemens system. The source for the technical data are the corresponding data sheets.” Trademarks: “All trade- marks mentioned in this document are property of their respective owners.“ Results: “The outcomes achieved by the Siemens customers described herein were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption), there can be no guarantee that others will achieve the same results.”102 Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine
  • 95. SubscriptionSiemens Healthcare PublicationsOur publications offer the latest information and background for every healthcarefield. From the hospital director to the radiological assistant – here, you can quickly findinformation relevant to your needs. Medical Solutions Innovations and trends eNews in healthcare. The Register for the magazine is designed global Siemens especially for members Healthcare News- of hospital manage- letter at ment, administration www.siemens.com/ personnel, and heads healthcare-eNews of medical depart- to receive monthly ments. updates on topics that interest you. AXIOM Innovations MAGNETOM Flash SOMATOM Sessions Imaging Life Everything from the worlds Everything from the world Everything from the world Everything from the world of interventional radiology, of magnetic resonance of computed tomography. of molecular imaging cardiology, fluoroscopy, imaging. The magazine With its innovations, clinical innovations. This bi-annual and radiography. This semi- presents case reports, applications, and visions, magazine presents clinical annual magazine is primar- technology, product news, this semiannual magazine case reports, customer ily designed for physicians, and how-to articles. It is is primarily designed for experiences, and product physicists, researchers, and primarily designed for physicians, physicists, news and is primarily medical technical personnel. physicians, physicists, and researchers, and medical designed for physicians, medical technical personnel. technical personnel. hospital management and researches. For current and past issues and to order the magazines, please visit www.siemens.com/healthcare-magazine. Medical Solutions · November 2011 · www.siemens.com/healthcare-magazine 103
  • 96. Global Siemens Headquarters Global Siemens Healthcare HeadquartersSiemens AG Siemens AGWittelsbacherplatz 2 Healthcare SectorD-80333 Munich Henkestrasse 127Germany D-91052 Erlangen Germany Telephone: +49 9131 84-0 www.siemens.com/healthcarewww.siemens.com/healthcare-magazineOrder No. A91CC-00042-M1-7600 | Printed in Germany |CC 00042 ZS 111130. | ISSN 1614-2535 | © 11.11, Siemens AGOn account of certain regional limitations of Local Contact Informationsales rights and service availability, we cannotguarantee that all products included in this Asia/Pacific:brochure are available through the Siemens Siemens Medical Solutionssales organization worldwide. Availability and Asia Pacific Headquarterspackaging may vary by country and is subject The Siemens Centerto change without prior notice. Some/All of 60 MacPherson Roadthe features and products described herein may Singapore 348615not be available in the United States. Telephone: +65 9622-2026The information in this document contains Canada:general technical descriptions of specifications Siemens Canada Limitedand options as well as standard and optional Healthcare Sectorfeatures which do not always have to be present 1550 Appleby Lanein individual cases. Burlington, ON L7L 6X7 CanadaSiemens reserves the right to modify the design, Telephone + 1 905 315-6868packaging, specifications, and options describedherein without prior notice. Europe/Africa/Middle East: Siemens AG, Healthcare SectorPlease contact your local Siemens sales Henkestr. 127,representative for the most current information. 91052 Erlangen GermanyNote: Any technical data contained in this Telephone: +49 9131 84-0document may vary within defined tolerances.Original images always lose a certain amount Latin America:of detail when reproduced. Siemens S.A., Medical Solutions Avenida de Pte. Julio A. Roca No 516, Piso 7 C1067ABN Buenos Aires Argentina Telephone: +54 11 4340-8400 USA: Siemens Medical Solutions USA, Inc. 51 Valley Stream Parkway Malvern, PA 19355-1406 USA Telephone: +1 888 826-9702