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  1. 1. Simplicity is a clear view of patient care and how our customers use technology
  2. 2. Philips: sense and simplicity At Philips Medical Systems Canada, good service and support do not end when the decision to choose Philips is made. The relationship Philips seeks with its clients stretches beneficially for both, far beyond the traditional bounds of vendor and customer. “It’s a philosophy we’ve consciously embraced over the past few years, at all levels of Philips,” says Vice President John Cieslowski. “We concern ourselves from day one – not just with providing a hospital or clinic or other healthcare facility client with state of the art equipment, but also with how that equipment is supported. That philosophy is based on the awareness that hospital needs are constantly changing and so, too, is technology. Consequently, the relationship we strive to have with our clients is a very flexible one.” Philips has been fostering adaptable relationships that have customers responding in growing numbers, vaulting Philips towards the Number One position in the Canadian medical systems marketplace. “We’ve enjoyed that success, I think, partly because being partner oriented and flexible builds trust. And that has benefits both to us and to the hospital,” says Cieslowski. “If you trust someone, then that tends to lead to a long-term relationship. So for us, having comfortable, lengthy connections with clients helps Philips attract better quality employees who are not worried that a short, up and down, market cycle is going to result in loss of employment. They can spend the time it takes to properly look after the changing needs of our customers.” Philips provides its support not just to a customer’s operational and technical people, but also to management – from the chief financial officer and the head of human resources, to the CEO and the board of directors. “We are prepared to help clients at all levels modernize their medical systems,” says Cieslowski. – John Cieslowski, Vice President, Philips Medical Systems Canada John Cieslowski, Vice President, Philips Medical Systems Canada
  3. 3. Thin-client computing for the PACS user improves performance Computed tomography (CT) imaging at The Credit Valley Hospital, near Toronto, has emerged from a systems upgrade in the caring hands of Philips Medical Systems Canada. Like many a discharged patient, it’s in thinner, but far better condition. “Credit Valley has two Philips Brilliance CTs – one a 16-slice and the other a 64-slice – but now we have linked both to what’s known as a thin-client portal server,” explains Philips CT product specialist Michael Regan. “That server holds all of the CT clinical software applications that used to be loaded on every workstation, in effect leaving the workstations as ‘thin’ clients of the server.” That means the much more powerful server is now doing all the ‘heavy lifting’ of processing the CT images. This greatly facilitates clinician access to the images from any computer, laptop, tablet, or other remote device they can connect to the hospital information system. From just about anywhere, including home, they can go online via the internet and open up the portal, which functions as a gateway to those images – and all the other features they could find before only by sitting at the workstations. “Because the portal server is doing the bulk of the work, it also means that the visualization or appearance of clear CT images on those remote thin clients happens much faster,” says Regan. “And that solves the problem of older, remote-access systems. They were quite slow at reconstructing the images.” Radiologist Dr. Stephen Florence, the medical director of CT in Credit Valley’s diagnostic imaging department, likes all that new accessibility and speed. “We’re the Philips beta test site for this portal concept. We’ve been using it now for more than a year and it is working very well,” says Dr. Florence. “The biggest advantage is that the portal has the Philips comprehensive cardiac package on it, so now we can look at the heart without having to go way down the hall and maybe line up to use the workstation. I can access all the cardiac package’s features right from my desktop. And as we add more and more packages to the system, like virtual colonoscopy, for example, that will become even more of an advantage.” A helping hand Dr. Matt Downey, medical director of diagnostic imaging for Quinte Health Care, in Belleville, Ont., says that more than three years of solid after-sales support by Philips has enabled the four-hospital regional institution to both streamline its workflow and greatly expand the use of CT in Eastern Ontario. “Philips has been extremely helpful – first with the CT equipment installation itself and then with the use of our CT applications. And in the process they have also kept us on the leading-edge of CT technology.” Dr. Downey cites the approach Philips took when it helped Quinte Health Care install a second Brilliance CT at its Trenton site to complement the 64-slice Brilliance machine in Belleville. “When we negotiated our original deal three years ago, it was to be a basic 6-slice CT. What we received from Philips for Trenton was a 16-slice CT that’s far more sophisticated and functional than other machines that were leading-edge when we conducted our orginal due diligence for these CT purchases.” Simplicity is results where and when you need them because with Brilliance, better patient care is everywhere Dr. Matt Downey, Rita Downhill, Techs Shannon Rodgers and Cathy Tomaso. Dr. Stephen Florence, Medical Director CT, Credit Valley Hospital. Philips Brilliance CT
  4. 4. Count on Philips for top-level technology, along with planning and installation services When choosing ultrasound machines, Canada’s largest partnership of radiologists went with Philips. Medical Imaging Consultants (MIC) consists of approximately 70 radiologists and is Canada’s largest private radiology partnership. MIC owns and operates five major clinics that provide “imaging excellence” in a full range of modalities to patients and physicians in the Edmonton area. In ultrasound alone, MIC performs approximately 100,000 exams annually. So when MIC makes an ultrasound purchasing decision it will likely get the attention of others in the radiological community. “A few years ago, after a comprehensive review of ultrasound technology available in the marketplace, we purchased 16 general ultrasound (iU22) and 5 cardiac ultrasound (iE33) machines, certainly one of the largest ultrasound sales Philips has made,” says Ivan Olsen, CEO of MIC. “Since then, our radiologists have indicated they are very happy with the performance of the Philips machines. We certainly have the confidence to deal with Philips for additional equipment when the need arises.” What’s keeping Philips popular with MIC, however, is not just its ultrasound technology but its whole approach to doing business. “Over the course of the first six months of 2007, MIC converted its enterprise to digital imaging technology, so we could eliminate film and put all our imaging on PACS. Philips was one of the vendors who played a very significant role in making that happen,” says Olsen. “We bought our fluoroscopy and other digital equipment from Philips, and they were also very much on the ball when it came to planning the installation of the equipment and meeting deadlines. “To their credit, their sales people don’t abandon you as soon as the sale is secured,” adds Olsen. “If something needs fixing throughout the product’s life cycle, they don’t argue; they just step right in and get it done. When your organization is investing millions of dollars in imaging equipment, those are the kind of people you want to do business with.” Simplicity is confidence you're getting complete and accurate diagnostic for every patient every time Dr. Trevor Horwitz, Radiologist, Medical Imaging Consultants. Leading-edge 3D echocardiology Transesophageal echocardiography, or TEE for short, a method of examining the heart with ultrasound, became a lot more attractive in June, when Philips announced its new Live 3D TEE probe. “This new development has the potential to give us a quantum leap in information – and then become the standard of cardiac care,” says Dr. Harry Rakowski, a senior cardiologist at the Toronto General Hospital, and the development director of the Peter Munk Imaging Centre. “With this technique, the TEE probe is put in the esophagus (the swallowing tube) of a sleeping patient in the operating room, and that allows you to get high resolution pictures of the heart because you do not have intervening chest and lungs in the way,” explains Dr. Rakowski. “Until now, those pictures were only two-dimensional. But the new probe will give you live, three-dimensional images in spectacular detail – to the point, for example, of being able to see where the small sutures are in an implanted mechanical heart valve.” Philips iU22 Ultrasound System
  5. 5. 3D imaging results in faster, safer procedures Three-dimensional imaging is helping radiologists expand the range of procedures they do – resulting in quicker treatment and better outcomes. “Our older patients, in particular, are benefiting because by using the new 3D applications we have on our imaging equipment, we are finding new ways to do more complicated treatment procedures and to do them faster,” says Dr. Ferguson, divisional head of vascular & interventional radiology at Atlantic Health Sciences Corp., based in Saint John, N.B. The imaging tools Dr. Ferguson and his Atlantic Health colleagues have at hand include the Philips Allura FD20, an advanced x-ray machine that comes with “three-dimensional rotational angiography,” or 3D-RA for short. This 3D-RA capability improves significantly on the two-dimensional, or 2D imaging, that has traditionally guided angiographic interventions. In vessel-reinforcing stenting procedures for instance, 3D gives clinicians a much more complete picture of what life-threatening embolisms or blockages in the vessels look like and where they are. So interventions can be mapped out and planned more accurately – with the result that interventionalists can usually go in, remove the threat, insert the stent, and get out far sooner, all with less risk to the patient. “What we can say for sure is that technologies like 3D-RA are allowing us to expand the boundaries of patients that we can treat – especially older patients who have complex morbidities and histories,” says Dr. Ferguson. “It’s a known fact that the longer a procedure takes, the higher the risk is of complications setting in. The 3D technology helps us make procedures faster and safer with the usual result of a shorter hospital stay. So in that sense we are definitely improving outcomes.” Simplicity is treating more patients with superior interventional imaging and live 3D guidance Expanding the medical envelope Precise, 3D imaging is enabling physicians to perform new and innovative procedures. An example includes a minimally invasive bone- cementing procedure known as kyphoplasty. Kyphoplasty is used when someone has suffered bone deterioration of the vertebrae – often through osteoporosis or bone cancer. To remedy the condition, the physician, guided by the 3D-RA images, navigates a needle into the centre of the collapsed vertebrae and then inflates a small balloon, which pries the collapsed bones open like it would a clamshell. The space is then filled with cement. “What’s crucial during the procedure is to accurately assess the position of that cement and prevent it from touching the spinal cord, as this can cause pain, altered sensation, or even very rarely, paralysis,” explains Dr. Ferguson. “What the 3D-RA allows is a three-dimensional, real-time digital re-construction during the procedure, so we can see from every angle exactly where that cement is going–and not going.” Interventional Staff, Saint John Regional Hospital.
  6. 6. Flexibility makes a world of difference in General X-ray You’re more likely to make a team if you can play more than one position. That’s an old sports adage that’s quickly gaining currency with diagnostic imaging decision makers too. Indeed, selectors at Markham Stouffville Hospital, just northeast of Toronto, put the new Philips MultiDiagnost (MD) Eleva flat detector x-ray machine on the hospital roster, very much because it is a flexible player. “The MD Eleva is called MultiDiagnost for good reason,” says Michael Rice, Philips’ general x-ray sales specialist. “The reality in Canada is that what customers are called to do in their R&F rooms (radiology and fluoroscopy) is really changing. The number of gastric examinations is diminishing, while the spectrum of other procedures is widening. That flexibility is really the forté of this equipment.” That’s not to say that Markham-Stouffville made a snap judgment. “We did our due diligence process Simplicity is improved efficiency and produ Philips MD Eleva
  7. 7. involving our whole team in making the decision and picking Philips,” says Andrea MacKenzie, Markham Stouffville’s manager of diagnostic imaging.” Much like a professional baseball team might size up its new players, MacKenzie says her team applied four major criteria to decide which x-ray player would win the nod: “Vendor characteristics, financial and contractual, service and support, and finally, product strength, were the four factors we considered.” The ‘we’ making the call for Markham-Stouffville included not just hospital management, but also the hospital’s radiologists, x-ray technologists, information technology staff, radiological information specialists, and PACS operators. “We had input from everybody and from every perspective, and that’s how we came to choose Philips,” says MacKenzie. One perspective that counted most in Philips’ favour was Eleva’s digital capability. “One of the major competitive advantages Philips had was that with the Eleva, we could send fluoroscopy images digitally and directly to our PACS system for distribution,” says Lynne Campkin, director of diagnostic and respiratory services at Markham Stouffville. “The Philips Eleva, is a multipurpose room with a flat detector and we could reduce the amount of radiation that’s needed, without compromising the image quality.” For its part, Philips sent its own installation team onto a field of play that was bounded by tight deadlines. “Our project management team pulled out all the stops in order to meet their time lines,” says Rice. We have a project manager who can call all the necessary Philips resources to the table: the staff who co-ordinate the delivery of the equipment, the engineers who do the installation, and then come our application people who do the training on the site. So what we’re really providing is a quarterback for the team.” With an attitude that’s as flexible as the Philips equipment. “Philips has the resources and the customer focus to meet the commitments they make,” says MacKenzie. “They bent over backwards to help us with a very difficult situation that we ourselves had created. We weren’t just installing the MD Eleva, we were doing multiple installations and renovations to the hospital at the same time. So Philips worked hard with us to co-ordinate all that effort and our facilities folks loved to work with them as a result.” And not just during the week. “The one weekend in particular that I recall most, the Philips installation people worked almost 24 hours on the last night, right around the clock in order to meet our deadline,” says Campkin. There are no more versatile and dedicated team players than that. When the going gets hot, the cool keep going It was a hotly contested request for proposal. But in the end, Philips’ powerful mobile fluoroscopy system, the BV Pulsera and its rotating anode technology with the power to see through virtually any patient, won the nod. “We chose Philips, number one because of the image quality,” says Bill Brodie, technical director of diagnostic imaging at Halton Healthcare Services based in Oakville, Ontario. “But number two was definitely the ease of operating it and learning how to use it. Our technologists found it simple and easily understood. Also, it has a small footprint, so it fits with our ergonomics.” “It uses a very low level of radiation,” explains Brodie. Equally important, Brodie says the Pulsera’s capabilities are a good fit with the surgical procedures often done at Halton, which require careful guidance, including hip and other joint replacements, cardiac pacemakers, and “PICC” lines (peripherally inserted central catheters) that deliver chemotherapy or other drugs to specific organs. On the integration front, the Pulsera was readily connected to the PACS. “Pulsera meets the DICOM communication standard, and its images are digital, so that integrating it and building our PACS became that much easier.” All those benefits have pleased not only Brodie and his radiology colleagues, but other departments, too. “It’s been really well accepted by the surgeons. They are very happy with the quality of the imaging, the maneuverability, and the field of vision they see in the operating room,” says Brodie. “I even had an orthopaedic surgeon stop me in the hall to compliment me. And that doesn’t happen every day.” Bill Brodie with Technologist Lisa Sharp. Dr. Michael Steirman, Penny Kaminski, and Andrea Larman-MacKenzie. ctivity through digital workflow solutions
  8. 8. Simplicity is making hospitals feel less like hospitals Patient visits brighten with Ambient Experience Soldiers’ Memorial Hospital in Orillia, Ont., is shining a new light on the Philips Ambient Experience. In June, the hospital opened its new MRI suite, the first in the country to fully embrace the Ambient Experience – with patient-calming interior design, ambient lighting, and patient selected images and soothing scenes. The new MRI suite at Soldiers’ has added another dimension to its patients’ visits. The hospital’s Ambient Experience MRI suite, which sits adjacent to the new six-storey patient care tower, lets in sunshine from above through a suite-encompassing skylight. But it is inside the examining room where the patient experience changes the most. As never before, patients can control the environment of the examination room – by selecting its lighting from a range of soothing pastels, picking music to accompany calming seascapes, mountain vistas, and other scenes or even cartoon animation, all projected on the walls and ceiling. “Thanks to this suite, we’ve become a state of the art diagnostic centre,” says Gini Stringer, board chair of Soldiers’ Memorial Hospital Foundation and cancer survivor, who has experienced firsthand the diagnostic capabilities of Soldiers’ MRI. The promise of working in such an advanced environment is what Maida Jeraj, MRI charge technologist and overseer of the Ambient suite, admits attracted her to Soldiers’. “In 25 years I’ve seen a lot of MRI centres and by far this is the prettiest one.” “With its muted tones and lighting, patients tell me it doesn’t feel clinical. Also this new scanner and how it will be linked in with our radiological information and PACS systems, makes for a happy staff too. So it is a real privilege to work here.” “We chose Philips first of all because of the excellence of their equipment, but the Ambient Experience aspect of it was also very important because it fit right in with our aim to be patient focused in everything we do,” says David LaFleche, the director of diagnostic imaging. Calming for kids As comforting as the Ambient Experience can be for adults, fidgety or fearful children can be quite a different matter. “The children we examine are either those who we need to put under general anesthetic in order to keep them still enough to capture clear images, or those we sedate, or those who are perhaps older and can lie still at least for a short period of time,” explains Dr. Paul Babyn, radiologist-in- chief at The Hospital for Sick Children (SickKids) in Toronto. So, with two out of three patient categories needing drugs before examination, Dr. Babyn and SickKids, naturally, were interested in an alternative approach. “We realized that a more welcoming and interesting environment could distract them and make children less concerned. We found the MR Ambient Experience met all our needs.” Consequently, SickKids is the second Canadian site, along with Soldiers’ Memorial Hospital in Orillia, to go Ambient. Already converted is SickKids’ 1.5 Tesla MR suite. Soon to join it will be the new 3 Tesla suite expected to be operational later this year. Dr. Paul Babyn, Radiologist-in-Chief at The Hospital for Sick Children. Children, like Kenny McIssac of Orillia, feel more relaxed in the Ambient Experience environment. Ambient Experience projection
  9. 9. North Bay General’s iSite PACS provides anytime, anywhere viewing Unlike the waves that sometimes churn the waters of nearby Lake Nipissing, wavelet-based iSite PACS technology from Philips has swept through North Bay General Hospital (NBGH) without rocking the boat. “We’ve been live with iSite for over a year now and overall it has been a very smooth transition,” says Brenda Monahan, the PACS/RIS co-ordinator at NBGH. “Our physicians, in particular, have really embraced the technology. They now have instant access to all the images they want at their fingertips – in their offices, in the clinics they work in, and just about anywhere else in the hospital.” Quick access to the PACS (Picture Archiving and Communications System) results from an ingenious method of distributing the images. Instead of trying to move whole or even compressed, network-choking images around, the iSite system breaks images down into small, mathematically encoded wavelets. These are re-assembled for quick viewing at the other end, even on regular PC desktops and laptops, with no loss of data. “We’ve seen improvements, as a result, not only in the workflow of our diagnostic imaging department and our radiologists, but also outside the hospital, as we are a district referral centre,” says Monahan, a former nuclear medicine technologist. “It was really quite surprising how fast the benefits started to roll in from iSite.” But those quick returns are the result of some earlier painstaking help from Philips. “When we became the vendor of choice through North Bay’s RFP (request for proposal) process, we spent a lot of time working on their technical needs, but also working with the community and within the hospital to help them gain acceptance for their PACS,” says Stephen Mayer, account manager for healthcare informatics at Philips. Simplicity is providing enterprise-wide clinical information to optimize patient care Xcelera, for extra efficiency in cardiology The Philips portfolio of Xcelera, Cardiology Image Management System, is now bringing new cardiac department efficiencies to more than 1,500 installations worldwide. Among them, the Xcelera Cardiology PACS system installed at St. Michael’s Hospital, in Toronto, has been enabling its users for the past three years to quickly create, review, and distribute echo, cardiac, and soon vascular ultrasound reports – all from a single workstation. “It is easy to see why Xcelera is so popular,” says cardiologist Dr. Stuart Hutchison, St. Michael’s director of the echocardiography and vascular ultrasound labs. “We were able to generate reports before using a digital network, but it was time consuming. Xcelera is considerably more efficient, and its connectivity with the hospital’s IT system is truly seamless.” Summing up his relationship with Philips, Dr. Hutchison simply says: “It’s excellent; never had a bad day.” Brenda Monahan, PACS/RIS Co-ordinator at NBGH. Philips Healthcare Informatics
  10. 10. Clear images, exact locations, using SPECT/CT “Nuclear” medicine is no longer “Unclear” medicine, as nuclear medicine’s detractors used to wryly observe. Not for an estimated 2,600 patients a year in Edmonton’s Capital Health region, at least. Since early this year, radiologists at Capital Health’s Royal Alexandra Hospital have been spotting tumours – and other hard- to-see abnormalities – with greater precision than ever before. They’re doing it through the remarkably keen eyes of a Philips nuclear medicine machine, the first of its kind in Canada. It combines a special SPECT (single photon emission computed tomography) gamma ray camera with an adapted 16-slice CT scanner. The gamma camera visualizes the workings of an organ or an area of tissues, while the CT scanner pinpoints their location in the patient’s body. Together, the technologies provide for better diagnosis and swifter, more appropriate treatment. “Anybody who has seen this technology is overwhelmed by how clear the images are and how cool it is to use,” says radiologist Dr. Michael Hoskinson, clinical specialty coordinator for nuclear medicine at Capital Health. “You can hold a little hot dot over something on the image, and show surgeons and other physicians exactly where that thyroid tumour is, and they say oooh, we had no idea it was there.” “SPECT images do a fine job of showing how that organ and abnormality is functioning, their resolution isn’t very high,” explains Hoskinson. “But when you apply high-resolution CT to those images, you in effect correct them. You still get to see the SPECT functionality, but now you see very clearly what you’re looking at and where it is.” Simplicity is the shortest distance to diagnosis Light at the end of the tunnel Not quite so clear is what the future holds for Capital Health’s SPECT/CT – and that’s a good thing, says Dr. Bill Anderson, the region’s clinical director of diagnostic imaging. “The future possibilities are endless,” says Dr. Anderson, pointing out that the Philips SPECT/CT machine, as one of just a few in the world, will also go to work for the Molecular Imaging Institute, a joint initiative between Capital Health and the University of Alberta, where plans call for it to help researchers “...further advance diagnostic imaging, improving diagnosis and patient care for years to come.” But it will remain rooted in the daily realities of clinical care. “The SPECT/CT is doing regular clinical work right now, and pretty much every day we are finding areas where it shows new benefits,” says Anderson. “One of them is how patients react. Because they can come in with little preparation, be examined quickly, and usually don’t have to come back in to be examined with another modality, it seems almost magical to them. It’s as if what they’ve seen on Star Trek has arrived.” Patient Danny Steeves and Karen Allred, SPECT/CT Supervisor. Philips SPECT/CT
  11. 11. Improved breast cancer diagnosis, using MR There’s one simple fact about breast cancer that gives us more hope at the moment than any other. “The only means today of reducing breast cancer mortality is an early diagnosis,” says breast surgeon Dr. Jocelyne Hébert, unequivocally. Dr. Hébert is a member of a Philips-equipped, multi-talented clinical team devoted to breast cancer patients at a remarkable clinic in Moncton, New Brunswick. In what could well be a model for similar sized hospitals across the country, the Multidisciplinary Breast Clinic, based at the 320-bed Georges-L. Dumont Regional Hospital, not only involves Hébert and two surgical colleagues full time, but also calls on medical oncologists, radiation oncologists, pathologists, radiologists, nurse navigators, and family physicians. All are dedicated to early detection, thorough diagnosis, and swift, effective treatment of the breast cancer scourge. The Breast Clinic has managed to reduce wait-times of up to six months for a final diagnosis by more than 75 percent. Once patients are in the clinic doors, there’s no time wasted either. “A patient at our clinic usually has a complete workup done within two weeks,” says Dr. Marcel Caissie, the hospital and Breast Clinic’s chief radiologist. “By then there’s a diagnosis established. The patients have seen the surgeon and they are ready for treatment, if needed.” Since the clinic started doing Breast MRI and Breast MRI biopsies in 2004, over 1,000 patients have had MRI scans or biopsies. And the demand is growing very rapidly – spurred by good results, improving technology, and most recently by a study in the New England Journal of Medicine that shows MRI scans can spot tumours that conventional mammograms and Ultrasound miss. “With the upgraded Philips MRI equipment and diagnosis system, we acquire images with thinner cross-sectional views faster, and this improves both temporal and spatial resolution,” explains Dr. Caissie. The upshot is that the Breast Clinic is catching more cancers. And most amazingly, of all cancers found, the number of Stage 1 tumours detected has risen from spotting them in 43% of examinations done in 2000-2002 to 53% in 2006-2007. This means patients have a much better outcome and chance of survival. Simplicity is SmartExam: one click to plan, scan and process your MR exam Dr. Jocelyne Hébert and Dr. Marcel Caissie. MR tools improve workflow Joseph Brant Memorial Hospital in Burlington may not be huge, but it has a big reputation for imaging excellence. “The hospital has become a reference site for us,” says Philips account manager Marcel Trentelman. “We bring people to Joseph Brant so they can see how well imaging workflow can be managed.” For MRI department boss, charge technologist Wayne Wilson, what impressed right from the outset were the Achieva MR’s reliability and user friendliness. “We have absolutely minimal downtime, and we don’t have to spend months and months getting someone up to speed on a cryptic interface,” says Wilson. “I believe the Philips interface is one of the most intuitive.” But it is the Achieva’s recipe- card-like SmartExam protocols that truly inspire him. They automate steps for imaging specific parts of the body. “This product really does as advertised. When you use the SmartBrain card, for instance, it doesn’t matter what position the patient’s head is in, the system automatically detects the anatomy and compensates for the angles. The cards standardize the work and yet are very simple to use.” Wayne Wilson, Charge Technologist at Joseph Brant Memorial Hospital. Achieva 1.5T
  12. 12. The future is bright… Interested? Would you like to see your healthcare facility featured in future publications? Please submit your customer stories to us. We would be glad to hear from you. Philips Medical Systems is part of Royal Philips Electronics © 2007 Philips Electronics Ltd. All rights reserved. Philips Medical Systems Nederland B.V. and its affiliates reserve the right to make changes in specifications and/or to discontinue any product at any time without notice or obligation and will not be liable for any consequences resulting from the use of this publication. Printed in Canada August 2007. On the web Via email By mail Philips Medical Systems Canada Division of Philips Electronics Ltd. 281 Hillmount Road Markham ON L6C 2S3 Canada By phone Canada Tel: 1 877 744 5633 ext. 2046