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P A R T S Finding your way to the best suppliers

Financially Sick Hospital SyndromeWhy so many are on the critical list

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Your industry source for health care and equipment coverage. www.DOTmed.com

OCTOBER 2010

Inside: Reports on Anesthesia, Leasing and Finance in Medicine

POLISHING UPRADIATION’S IMAGEWhat’s being done to improve safety

DRANDMEDICALToll free: 866.469.0501 | Fax: 405.491.2586 | [email protected] | www.drandmedical.com

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industry sector reports

24

contents

24 Radiotherapy’s Big Move Emerging technology set to guide the sector’s success

38 Medical Equipment Parts Providers Small components lead to big business for professionals

57 Leasing and Finance In a tough economy, to whom do health care providers turn?

61 Anesthesia A new system is emerging to manage this critical procedure

32 Radiation Safety New concerns have cropped up, but are they valid?

66 Hospital Bankruptcies Bankruptcy isn’t always the final chapter

features

October 2010

66

61

24

departments

in every issue

contentsDOTmed.com, Inc.

Philip F. Jacobus

Sean Ruck212-742-1200 Ext. [email protected]

Brendon Nafziger

Heather MayerOlga Deshchenko

David FisherKeith LoriaAstrid Fiano

Stephanie Biddle

Bradley Rose

David Blumenthal212-742-1200 Ext. [email protected]

Don Hurtikant212-742-1200 Ext. [email protected]

Susan Minotillo212-742-1200 ext. [email protected]

Sean Collins212-742-1200 Ext. [email protected]

Daniel Gaspar212-742-1200 Ext. [email protected]

Dustin Sewnauth212-742-1200 Ext. [email protected]

Rigo Smith212-742-1200 Ext. [email protected]

8 Feedback

8 Upcoming Events Calendar

10 In Case You Missed It . . .

20 New Product Showcase

23 In the Next Issue

69 Law & Order

72 Old Into Gold

74 Marketplace & Classifieds

80 Blue Book Price Guide

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Copyright 2010 DOTmed.com, Inc. All rights reserved.

6 Letter from the Editor – We want to hear from you!

18 Health Care Chronicles – The financial impact of radiation therapy

22 Shows & Conferences – ASTRO 2010 gets this month’s spotlight

23 Money Health – Diagnostic service organizations give account departments a break

70 Medical Museum – An ancestor of the equipment found in one of this month’s ISRs

71 This Month in Medical History – The Father of Tropical Medicine

DOTmedSM provides the DOTmed Business NewsSM to its registered users free of charge. DOTmedSM makes no warranty, representation or guarantee as to the accuracy or timeliness of its content. DOTmedSM October suspend or cancel this service at any time and for any reason without liability or obligation to any party. All trade names, trademarks and trade dress contained herein belong to their respective owners and are used herein with the intent to represent the goods and services of their respective owners. If you think your trade name, trademark or trade dress is not properly represented, please contact DOTmed.com, Inc.

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Finance, fine-tuning and feedbackWelcome to your October issue of DOTmed Business News. As the year winds down and companies map their plans for the future, budgets are on everyone’s to-do list. Ap-propriately, this issue’s theme is “finance.” You’ll find our Leasing and Finance ISR on page 57. As might be expected, the market is closely scrutinizing every transaction.

We offer a look at the ongoing bankruptcy crisis hitting hospitals on page 66. Given that health care is considered more of a required than an elective expense, it’s a troubling sign of the times that some hospitals are going under. Yet, there are some success stories to be had and some insight shared from those who have been to the brink and have managed to turn things around.

If you’re a regular reader of the magazine, you may have noticed a change in the format. The abbreviated news pieces formerly found under “Hospital and Health,” “What’s New” and “People and Companies” now all fall under the umbrella of “In case you missed it . . . “ And if you DID miss it, there is of course an easy solution — all of those news blurbs can be read in their entirety as they’re reported by visiting www.dot-med.com. You can also sign up for our weekly e-news that’s delivered every Thursday directly to your inbox. You can be sure there will be plenty of news worth tuning into in the coming months as companies prepare their major releases in time for RSNA, so now is a great time to get acquainted with our online news coverage if you’re not already familiar with it.

Finally, as we at DOTmed News and DOTmed.com begin to wind down the year and prepare for 2011, we want to hear from you, our reader. Tell us what interests you. We have received some feedback and requests, but we’re always looking to improve. What type of stories would you like to see covered going forward? What columns do you always turn to? What information can we provide to make your job easier or more profitable? As much as it’s our publication, it’s your magazine too and we want you to get the most out of it.

To share your comments and feedback, you can contact the writers directly through the e-mail addresses at the end of each article. You can also contact me via e-mail at [email protected]

Until next issue!Sean Ruck

Editor-in-ChiefDOTmed Business News

By email to: [email protected]

By mail to: The Editor, DOTmed Business News

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letter from the editor

MEDRAD, and Multi Vendor Service (MVS) are federally registered trademarks, and Performance. For Life. Is a trademark of MEDRAD, INC. USA. Copyright 2008 MEDRAD, INC. All Rights Reserved.

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feedback

Events for October 2010

Oncology World Congress 2010Oct 15 – Oct 17San Francisco, Calif.

AdvaMed 2010Oct 18 – Oct 20Washington, DC

AHRA Fall ConferenceOct 19 – Oct 21Savannah, Ga.

California Association for Medical Laboratory Technology (CAMLT)Oct 22 – Oct 25Anaheim, Calif.

Medical Group Management Association (MGMA) 2010 Annual ConferenceOct 24 – Oct 27New Orleans, La.

Dubai Congress on Anti-Aging and Aesthetic MedicineOct 26 – Oct 27Dubai

CMEFOct 28China

ASTRO Annual MeetingOct 31 – Nov 4San Diego, Calif.

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Classroom materialsThe first few times I was given a copy of DOTmed Business News I wondered why I received it, but then one day I sat down and leafed through the pages just to see what it was all about. Even though it seems as though the articles are more radiology- or nursing-related, I now find myself looking for one particular article each month.

You see, not only have I been in laboratory medicine for 32 years, but I now teach medical laboratory technician stu-dents at a community career college. I have more than one time used the article “This Month in Medical History” in my classes. Now, each month when the new edition arrives, I take a break, look for the article and read the story. Thanks for all the little tidbits of history you share with the rest of us. I truly enjoy reading the stories!

Thank you,Susan M. Windsor, MBA/MHA, MT(ASCP)

Laboratory Director Georgetown Community Hospital

Georgetown, Kentucky

Legislative lockdownI am Brazilian, and my country is an excellent market for used medical devices, but the Brazilian government has an extremely restrictive legislation. The legislation protects the major manu-facturers and prevents traders from working. [Editor’s note: See 5 forbidden used medical device markets DM 14089]

Please write an article encouraging the U.S. government to negotiate with Brazil focusing on a greater flexibility in the legislation. It would be a win for all of us.

Kind Regards,Jose Siqueira

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Researchers use artificial corneas to restore sightResearchers in Canada and Sweden have restored sight in half a dozen pa-tients using biosynthetic corneas. The artificial corneas, made of synthetic col-lagen and recruited host cells, could help alleviate a human donor shortage and the need for immunosuppressant drugs after transplant, the researchers said.

• Online: dotmed.com/dm14003

Bloodless blood tests now realityThe FDA-cleared spot-check device looks like a pulse oximeter using a pain-less finger probe. But in addition to SpO2 (oxygen saturation), pulse rate, and per-fusion index, the new, palm-sized unit reads out hemoglobin levels in less than one minute.


North Shore-LIJ, Village-Care to open permanent urgent care centerNorth Shore-Long Island Jewish Health System and VillageCare will work to-gether to open an urgent care center in lower Manhattan. If approved by the state, the urgent care center will open early this fall, just eight blocks from the former St. Vincent’s Hospital.


Report: Molecular imaging device market to hit $6.6B by 2014A 5.8 percent yearly increase in the mo-lecular imaging device market is expect-ed to increase to $6.6 billion worldwide by 2014, according to a market research report from Kalorama Information.


Report: EHR adoption rates lowAlthough the Centers for Medicare and Medicaid Services incentive program for electronic health records is set to begin next year, new research from the Harvard School of Public Health shows many of the nation’s hospitals are not ready.


NC hospitals save $2.8M on supply chain costsSeven North Carolina hospitals that formed the purchasing coalition South-ern Atlantic Health Care Alliance saved $2.8 million over the past two years by aggregating their purchasing volume, the group reported in late August.


HHS names first EHR certification bodiesOn Aug. 30, the U.S. Department of Health and Human Services named a software testing lab and a health infor-mation technology nonprofit as the first EHR “certified bodies.”


Former Spectranetics execs indicted for illegally importing devicesThree former Spectranetics executives—George John Schulte, Obinna Adhigije, Trung Pham and BAC representative Hernan Ricaurte have been named in a federal indictment in Colorado. The indictment has 12 counts relating to ille-gally importing medical devices without FDA approval, providing the devices to physicians to use for patients, and pro-moting the products for procedures with-out FDA approval.


DOTmedbusiness news I october 201010

Visit http://www.dotmed.com/news/

and register to receive our weekly e-news. Get the latest news

worth knowing directly to your inbox every Thursday.

in case you missed it...Every month DOTmed News covers hundreds of stories including: medical breakthroughs, studies, equipment, procedures, legisla-tion and more online at www.dotmed.com the following pages offer just a glimpse of some of the stories covered in the past 30 days. To read any of these stories in their entirety, visit the website, click on a search window and type in the letters DM and the proceeding number.

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Pediatrician indicted on 655 counts of prescription fraudA federal jury indicted a Children’s Hos-pital doctor in Colorado on 655 counts of prescription fraud last month. The indictment is based on allegations that Dr. Louis C. Hampers, a specialist in pe-diatric emergency medicine, operated a scheme to obtain tens of thousands of pain and sleeping pills using fake names and unsuspecting patients.


Indian radiologists say anti-sex-selective abortion measures compromise privacyRadiologists in India oppose a state government’s scheme to put devices in ultrasound scanners to make sure they aren’t helping mothers get rid of unwant-ed girls, according to a recent report by the Hindustan Times.


Indiana reports fewer medical errors in health care facilitiesThese events include reported stage 3 or 4 pressure ulcers. According to the annual report, 94 medical error events were reported in 2009, compared with 105 in 2008 and 2007. The current re-port is the fourth from the department.


Cancer detection? There’s an app for thatCell phones could help doctors detect deadly cancers, thanks to a joint effort between the Mazumdar Shaw Cancer Center (MSCC) of the Narayana Hru-dayalaya Hospital in India and Sana, a research group at Harvard/MIT.


Cockroach brains might hold key to new antibioticsScientists at the Society for General Mi-crobiology’s fall meeting at the University of Nottingham in the UK said they have found nine molecules in the brains of cockroaches and locusts that are lethal to 90 percent of methicillin-resistant Staph-ylococcus aureus infections and E. coli.


Report: Medical malprac-tice costs $55BMedical malpractice costs reach $55 billion every year, or 2.4 percent of an-nual health care spending, according to a new Health Affairs report. While high, it fell short of previous estimates, the re-searchers said.


New lobby pushes for ‘Medical Innovation Czar’Venture capitalists and the life science companies they fund have teamed up to launch a new lobby to clear away regu-latory hurdles for medical products.


New York releases third annual report on hospital-acquired infectionsSurgical site infections are dropping in New York State, according to a new report.


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RadNet buys N.J. imaging centers for $17.2 million and stockImaging center chain RadNet Inc. recently inked a deal to buy five New Jersey imaging centers from Progressive Health LLC and own half of a sixth center.


Lone Star state takes aim at ‘pill mills’The Texas Medical Board has begun registration for pain man-agement clinics, instituting requirements from a Texas law that became effective the beginning of September. A pain manage-ment clinic in the state can no longer operate without a certifi-cate from the board.


No childhood cancer risk found from prenatal CT A study found no link between exposure to CT scans and other radiological imaging tests in the womb and increased risk of childhood cancers, but researchers warn they can’t rule out a connection.


FDA calls for new warnings on MRI contrast agentsThe U.S. Food and Drug Administration is slapping new warn-

ings on gadolinium-based contrast agents and cautioning that three brands are associated with a greater risk of nephrogenic systemic fibrosis.


5 forbidden used medical device marketsFrom Syria to Thailand, countries where you can’t sell your used medical equipment. A DOTmed News exclusive report.


Petten reactor is back onlineAs of Sept. 9, the High Flux reactor in Petten, Netherlands is running again at full nominal power after being offline for months of repairs.


CDC: MRI and CT scan use skyrockets in the EROver the last decade, the use of medical imaging in the emer-gency room has skyrocketed, with MRI and CT scans for chest pain nearly tripling and for abdominal pain nearly doubling, ac-cording to a Centers for Disease Control and Prevention report released last month. But is it a good thing?



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FDA increases user fees by 8.5 percent The U.S. Food and Drug Administration announced an 8.5 percent increase in user fees for medical device companies looking to apply for 510(k) or premarket approval starting Oct. 1.


Is your child’s brain devel-oping normally? MRI might have the answerMRI scans of children and teens might be able to help doctors determine if their

brains are developing normally, poten-tially helping physicians catch develop-ment problems before symptoms show up, according to researchers.


U.S. health spending projected to reach $4.6 trillion by 2019Spending is projected to grow at an av-erage annual rate of 6.3 percent over the next 10 years, according to a new analysis by economists at the Centers for Medicare and Medicaid Services.


MedAssets to buy Broadlane for $850MOn Aug. 14 MedAssets Supply Chain Systems, based in Georgia, announced it will purchase Texas-based Broadlane Group for approximately $850 million.


Proton therapy center scheduled for construction in ManhattanA proposed Manhattan proton therapy center, the New York Proton Center, is scheduled to begin construction on the West side next February, so long as the state gives the go ahead once regula-tory approvals are met, according to me-dia reports.


GE’s patient room of the future – todayGE Healthcare said last month it re-ceived approval to launch its Smart Pa-tient Room pilot, a solution designed to provide real-time monitoring of safety protocols.


Study: Radiotherapy linked to chronic diseaseHigh doses of radiotherapy delivered to the abdomen ups risk for diabetes, ac-cording to a study reaffirming the results of a 2009 analysis of childhood cancer survivors.


Census Bureau: Health insurance coverage decreased by 1. 5 million in 2009For the first time in decades, the num-ber of people with health insurance has dropped, according to the U.S. Census Bureau.


Hospital services costs rise 6.3 percentPrices for hospital and related services for consumers rose 6.3 percent since last year, according to the latest unad-justed figures from the Bureau of Labor Statistics.



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They say if you build a better mousetrap, the world will beat a path to your door website.

Medical imaging manufac-turers are in the business of saving lives.

This philosophy is at the core of our mission –

ensuring that the woman with the lump in her breast will be able to get back to work and the father with the pre-cancerous polyp will live to see his daughter get married.

The Medical Imaging & Technology Alliance (MITA) is the leader in medical im-aging and radiation therapy technologies that allow this to happen. We develop products that have revolutionized health care delivery in America by helping patients avoid or limit more invasive procedures, and return to their families, lives and work more quickly.

As part of our mission, MITA is acutely aware of the growing concern for patient exposure to radiation from medical imaging procedures. That’s why MITA and its more than 50 member companies are proactive in developing and advocating for solutions that will reduce exposure to radiation dose while continually improving technology to aid phy-sicians in turning patients into survivors.

This forward-looking thinking is criti-cally important because the stakes are high. Peer-reviewed research confirms that these medical technologies save lives and drastically improve health outcomes, making these ad-vanced technologies fundamental to standards of care. And the proof is in the numbers.

Increased regular mammography screenings resulted in a 24 percent decrease in the death rate from breast cancer between 1990 and 2004. According to the American Cancer Society, if detected early, the five-year survival rate for breast cancer now exceeds 95 percent. Increased utilization of advanced medical imaging, such as CT and MRI, between 1991 and 2004 improved life expectancy by 0.62 to 0.71 years. And for all cancers, physicians have reported that PET scanning allowed them to avoid additional tests or procedures 77 percent of the time.

Furthermore, radiation therapy offers highly personalized, noninvasive and cost-effective care for up to 60 percent of all di-agnosed cancer patients in the United States.

That translates to approximately 650,000 Americans each year who are able to fight their cancer.

But beyond the life-saving impact of medical imaging, researchers have also found that it saves money in the long-run.

For example, a 2005 study published in Radiology, states every $1 spent on inpa-tient imaging correlates to approximately $3 in total savings, and according to research-ers at Harvard Medical School, every $385 spent on imaging decreases a patient’s hos-pital stay by one day, saving approximately $3,000 per patient.

Other disease-specific studies, such as the one published in the 2007 issue of the Journal of the American College of Cardiol-ogy looking att multi-slice coronary CT for evaluating acute chest pain, found that in-creased imaging could save up to $1.2 billion annually in the treatment of stroke patients. Additionally, according to a study published in the New England Journal of Medicine, CT scans have been found to significantly reduce the negative appendectomy rate and the number of unnecessary hospital admis-sions, saving $447 per patient since 1998.

We are proud of the industry’s accom-plishments. But MITA recognizes the need to build on these successes and continuously seek innovations in our products that maxi-mize effectiveness while minimizing risk to the patient.

In fact, industry innovations to medi-cal imaging technologies over the past 20 years have reduced radiation doses for many procedures by up to 75 percent, while con-tinually improving the ability of these tech-nologies to aid physicians in diagnosing and treating disease.

Additionally, underlying the equipment innovations – which are reflective of broader changes in CT, X-ray and other radiation-emitting imaging technologies across the industry—is the industry’s support and com-mitment to the “as low as reasonably achiev-able” or ALARA principle.

The medical imaging community is committed to working both internally and with physicians, other providers, govern-

mental agencies and patients to ensure ap-propriate safety assurances are met, or ex-ceeded; training requirements are met, or exceeded; and reporting of adverse events is done in a transparent and timely manner.

Specifically, MITA endorses: • Expanding and integrating appropriateness

criteria into physician decision making.• Creating a national dosage registry to en-

sure longitudinal tracking of dose levels for patients across America.

• Adopting a standardized method of storing of diagnostic imaging and radiation ther-apy information within electronic health records.

• Exploring the expansion of mandatory ac-creditation for advanced imaging facilities.

• Establishing minimum standards for train-ing and education for hospital and imag-ing facility personnel who perform medi-cal imaging exams and deliver radiation therapy treatments.

• Developing enhanced operational safety procedures and checklists to reduce medi-cal errors.

• Expanding and standardizing the reporting of medical errors associated with medical radiation across stakeholders in a manner that is transparent for patients, families and physicians.

• Working with stakeholders to develop radia-tion dose reference values to provide a data point to compare the dose level of a specific procedure. MITA commits to working with other stakeholders to develop the most ap-propriate way to incorporate this informa-tion into manufacturers’ technology.

These important principles guide our in-novation and thinking to ensure patients receive the best care possible. Patient lives rest in our hands, and therefore safety and effectiveness are at the core of our mission. We continue to be at the leading-edge of research and technol-ogy advancements, looking for ways to build on our successes and improve outcomes.


Health Care ChroniclesMaking health care work smarterBy David FisherExecutive Director, Medical Imaging & Technology Alliance

DOTmedbusiness news I october 201018 www.dotmed.com

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InfraReDx Receives FDA Clearance for LipiScan IVUS Coronary Imaging SystemThe system is the first cardiac catheter to combine intravascular ultrasound (IVUS) and near-infrared (NIR) spectroscopy to help cardiologists identify and characterize the plaques that complicate stenting and are associated with acute coronary events. The NIR spectroscopy identifies the chemical content of the plaques; the IVUS pro-vides an image of plaque structure and stent features. The company expects to con-duct a broad commercial launch of the system within the U.S. by year-end 2010, and anticipates regulatory approval and launch in Europe during 2011.

Carefully designed to meet the workflow demands of today?s busy interventional catheterization labs, the LipiScan IVUS system is able to generate and display the combined chemogram/IVUS analysis immediately upon completion of the single cath-eter pullback. The LipiScan IVUS system provides physicians with an unparalleled “one-stop” visual determination of critical coronary features that will assist in care of coronary patients, including identification of lipid-core plaques, degree of stenosis, ref-erence vessel diameter, plaque burden and stent expansion and apposition.


SonoSite Receives FDA Clearance For LumenVu Catheter Guidance SystemThe LumenVu Catheter Guidance Sys-tem is designed to aid in the placement of peripherally inserted central cath-eters (PICC), the proprietary LumenVu System combines near-infrared tech-nology with a revolutionary fiber optic stylet, which replaces a traditional guide wire, to allow visualization and real-time tracking of a catheter tip as it advances through a vein.


Philips introduces new, sterile, one-piece oral/enteral syringes The new line of oral/enteral syringes (1 ml, 3 ml, 5 ml, 10 ml, 20 ml, 30 ml and 60 ml sizes) includes highly visible text on the barrel that reads “ORAL/ENTERAL ONLY” and an oral only tip that distinguishes it from medication syringes. It will not attach to a standard luer lock connector. Because stan-dard 1 ml syringes are commonly used to administer medica-tion in the hospital setting, PChMV’s 1 ml oral/enteral syringe is a highly noticeable orange color. In addition, the one-piece design eliminates tip separation during filling, and an airtight, brightly colored cap does not allow air or water in, or breast milk to leak out, during prep, storage and warming.

PChMV oral/enteral syringes are compatible with the most commonly used hospital syringe pumps. Other signifi-cant features include individual product packaging that allows the clinician to see the syringe type and size before opening the package and a clear oral/enteral syringe barrel that allows clinicians to easily monitor feeding and check for residuals.


By Barbara Kram Welch Allyn Unveils Cure for Vital Sign Documentation Errors at the Point of CareThe Connex VSM (CVSM) is a full-color, touch screen device that acts as three devices in one-providing comprehensive patient documentation on a single display. This documentation includes automatic measurements such as heart rate, blood pressure, temperature and pulse oximetry; manual parameters such as respiration, height, weight and pain level; and modifiers such as body position, O2 therapy details and others. The CVSM also gives the clinician the ability to control alarms, patient data and monitoring in a customized manner for each patient, and they can docu-ment this data right on the device-eliminating the need to locate a PC and transcribe it later.

The CVSM also enables two-way wireless communication from the bedside. It associates ID numbers to names to help clinicians properly identify patients and allows them to customize which ID fields are required and how they’re displayed, including simultaneous display of multiple forms of ID. The wireless technology is built right into the system allowing the monitor to act as a true mobile device, and it works with current wireless networks to deliver up-to-date patient demographics.


Ascension Orthopedics Receives FDA Approval for TITAN Modular Total Shoulder SystemThe TITAN Modular Total Shoulder System offers a bone-preserving option for patients needing to-tal or hemi shoulder arthroplasty. The modularity of the system allows the surgeon to independently select distal stems and proximal bodies that best match the patient’s anatomy and bone quality. The system is fully interchangeable - allowing all primary and fracture bodies to be used with either press-fit or cemented stems. There are 26 humeral head sizing options available, which are based on published anthropomorphic data of over 300 human humeri to provide anatomic fit. The system also offers multiple glenoid options for patients needing total shoulder replacement.


Viking Systems Receives FDA 510(k) Clearance for its Next Generation 3DHD Visualization SystemViking’s Next Generation 3DHD system provides surgeons from a broad base of surgical specialties with the ability to perform complex minimally invasive sur-gery with a revolutionary vision system that restores their natural depth percep-tion previously sacrificed with 2D sys-tems. Viking Systems’ 3DHD system is planned to offer surgeons the choice of two different proprietary 3D optical sys-tems. The company also plans to offer a 2DHD camera for use with the system for surgeons that may prefer this modal-ity for less complex cases. Jed Kennedy elaborated, “The 3DHD system will offer hospital administrators a flexible solu-tion, intended to provide a vision system solution for the visualization needs of minimally invasive surgeons.”


FDA Clears Medivance’s Arctic Sun 5000 for Fastest, Easiest Therapeutic Temperature ManagementThe Arctic Sun 5000 is Medivance’s next-generation, non-invasive, therapeutic temperature management device. The new patient cooling device has received FDA 510 (k) clearance and offers the fastest initiation of treatment, simplest pro-gramming capabilities and easiest access to treatment data on the market.


DOTmedbusiness news I october 2010 21

As this year’s American Society for Radiation Oncology conference and expo comes during a time of particularly acute

economic hardship and uncertainty about the health care law, attendees of the 52nd annual meeting will hear speak-ers and attend education sessions focus-ing on “gathering evidence and provid-ing value.”

“As health care reform gathers pace, we are going to have to prove what we do is of value to our patients or stop doing it,” says Dr. Anthony Ziet-man, president of ASTRO and professor of radiation oncology at Harvard Medi-cal School.

The theme is timely, as it’s look-ing at how professionals are practicing radiation oncology in 2010, explains Zietman.

“We’re looking at ways radiation oncology can be responsible,” he tells DOTmed News. “We’re looking at ar-eas where we over utilize treatment, areas we over-scan, over-treat, over-

investigate, over diagnose. In a strange kind of way, the economy has almost forced us to really self-reflect.”

ASTRO meeting organizers expect-ed 12,000 people in attendance, a larger audience than in past years, says Ziet-man. He believes the bump in attendance can be attributed, in part, to an optimistic belief that the recession is ending. Loca-tion is also a factor, with people want-ing to visit San Diego to enjoy pleasant weather before winter sets in.

The organization also reports a record-breaking number of research abstracts submitted to this year’s show

and conference. Zietman says attendees should be

sure to catch the two highlighted key-note speakers: Sir Michael Rawlins and Dr. James Thrall.

Rawlins, chief of the National Institute for Clinical Effectiveness (NICE) in the United Kingdom, will educate his audience about the contro-versial British experience in using a panel of experts to weigh comparative effectiveness data to strictly determine what new therapies justify use in the National Health Service.

Zietman says it’s possible that some day, some form of NICE will emerge in the United States.

“It probably won’t be as strong as the one in Britain,” he points out. “If NICE says no, that drug or technology simply won’t be used in Britain.”

Thrall, chair of the American Col-lege of Radiology Board of Chancel-lors, will discuss the lessons radiation oncologists can learn from their diag-nostic radiology colleagues regarding issues of over utilization and radiation safety.

“The keynote speakers are a must-see,” says Zietman. “They speak to medicine in general, about responsibil-ity in medicine.”

This year’s conference will be held from Oct. 31 to Nov. 4 at the San Diego Convention Center. • Online: dotmed.com/dm13987

shows & conferencesASTRO 2010


Bills. For people everywhere, it’s almost a curse word. For hos-pital accounting departments dealing with bills is a daunting task, especially with new rules

and regulations continually cropping up. It’s easy to understand how hospitals and private practices can become overwhelmed with in-voices for all of their services, but using a diagnostic service organization can help pro-viders cut costs and whittle down paperwork. DSOs are becoming more popular as health care facilities look to cut costs but maintain quality care for their patients.

According to a recent report published by Choice Health Care Partners, a national physician practice advisory group, DSOs will continue to increase their U.S. market share over the next few years.

“Rather than being an option, practices are forced, given what’s going on [in the econ-omy and with reimbursement rates], to look at numbers and seek options to stay afloat,” says Avi Soffer, CEO of University Nuclear and Di-agnostics, a DSO for nuclear cardiac imaging. “DSOs, which were optional, are becoming a go-to solution to combat the issues.”

A DSO basically takes over a facility and assumes the responsibilities and costs of operations, condensing all the necessary tasks into just one invoice for the hospital to deal with. The key to saving money, ex-plains Soffer, is consolidating the labor.

UND was able to save one Georgia-based client nearly $300,000 annually, or 37 percent. The DSO took over services that include per-sonnel, isotopes, log maintenance, license up-dates, equipment calibrations, radiation safety officer services, equipment logs and calibra-tion, patient scheduling, pre- and post-test pa-tient education and ICANL certification

Cardiology practices are frequently turning to DSOs, says Soffer, largely be-cause of poor reimbursements for tests, like nuclear stress testing, and expensive lab costs. He points out that cardiology labs, which rely heavily on nuclear testing, need help from a cost-saving DSO.

While the market for DSOs is growing, there aren’t necessarily more organizations out there. The CHCP report suggests consolidation

in the industry as bigger DSO groups acquire complementary organizations that will help them offer complete services to their clients. For example, a DSO specializing in nuclear testing may bring on nuclear camera service companies for comprehensive services.

“As a DSO, a good organization can take on many, many practices on a national basis,” says Soffer.

Hospitals stand to gain the most by turning to a DSO, Soffer says. He points out that they can save millions by turning to a third party for help. While practices can face the same challenges as hospitals, they can make decisions quicker, without the burden of hospital boards.

The client perspectiveThe chief of cardiology at Jackson North Hospital in Florida and brother of Avi Soffer, Dr. Ariel Soffer, turned to a DSO — UND — to strengthen his nuclear cardiology lab.

“[The nuclear lab] happens to be the number one revenue source but also the number one cost outside of HR,” says Ariel.

He points out that before the days of poor reimbursement payments, a strong nuclear lab would do well and didn’t really look at the costs.

“Now that reimbursement has dramati-cally been reduced, costs become a big is-sue,” he says. “There are a lot of moving parts within [a nuclear lab].”

By hiring a DSO to take care of the in-ner workings of his lab, Ariel says costs are down and patient satisfaction is up.

“We found that by ‘insourcing,’ we can control major costs and focus on getting more patients…seen and put into the lab as opposed to worrying about the subtleties of the cost structure,” he says.

While the number one perk of using a DSO in a nuclear lab is the cost savings, says Ariel, the runner-up is the “ease of use.” The DSO companies take care of everything, from technicians to service.

“The [DSO] is motivated to be effi-cient,” he explains, otherwise it would lose the account.

“It is just a beautiful thing,” Ariel says.


Coming in November:The RSNA Issue

Industry Sector Reports:

Mobile Service ProvidersWith imaging centers hitting a rough patch in the road, these providers may offer a lifeline to hospitals.

Radiographic/Rad Fluoro Will the future be rad?

MRI Coil Repair More players are on the field, but is it a game-changer?

Dialysis CMS promises big changes in store. Find out what to expect.

Features:RSNA PreviewThe launch pad for next year’s big products – we offer a sneak peak of things to come.

Ergonomic Design in EquipmentSit back, relax and get the lowdown on the latest.

Medical Device Approval Industry experts discuss the 510(k) process and the impact it may have.

When bills are making hospital accountants sickBy Heather Mayer

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The success of radiation therapy for the more than half a million patients who receive the treatment annually is governed by the ability to destroy the tumor while sparing normal tissue around it. In re-cent years, advances in intensity modulated radia-

tion therapy (IMRT) and image guided radiation therapy (IGRT) have proven radiotherapy to be an indispensable, noninvasive option for cancer treatment.

But, earlier this year, safety concerns fueled by media cover-age of overexposure accidents placed the industry in the national spotlight. Today, OEMs, end-users and regulators are collaborat-ing on enhancing the safety of the treatment process, while re-search and innovation continue to drive the industry forward.

Market status The global radiotherapy market experienced double-digit growth during the last few years, with the U.S. holding a 50 percent share of the market, according to a 2010 report by Koncept Analytics, an India research firm. In the U.S., a high rate of cancer incidence paired with rapid acceptance of new treatment methods and reimbursement rates have driven the industry, according to the report.

However, 2009 proved to be a tough year for sales. But the downturn in the economy might not be bad news for all in the sector – ISOs experienced an uptick in business.

“We certainly have seen an increase in service because people are keeping their machines longer. We’ve actually had to hire new people to meet the demand,” says Steve Schwarz, CEO of Acceletronics, the world’s largest employee-owned in-

dependent radiation oncol-ogy equipment service

organization. OEMs say the

U.S. market is looking up this year and there’s a lot of potential abroad, where many patients re-main underserved.

“Despite the fact that radiation therapy is widely utilized in North America and in

Western Europe, as a noninvasive

treatment that is so effective, it could be

serving a lot more patients as one of the steps toward man-aging their disease,” says Kar-la Donohoe, senior marketing director with Varian Medical Systems. “That is particularly the case in markets like India, China and a number of areas

in Latin America, where there are many fewer radiotherapy treatment centers per capita than we see in North America and Western Europe.”

Although Asia is a lucrative market for radiotherapy, ex-panding treatment to the region is a challenging task.

“The number of linear accelerators per population is very, very low in that part of the world,” says Timothy Prosser, direc-tor, oncology business line management, with Elekta. “China doesn’t have a problem with money [but with staffing] its cancer centers. It’s the only thing restraining the market right now.”

With the opportunities overseas and millions of people expected to enter the U.S. health care system, innovations in imaging capabilities, respiratory motion management tools and specialized radiotherapy devices are enhancing the effi-cacy of radiotherapy.

Image guidance Image guidance capability on radiotherapy devices is one of the most prominent trends in the industry. The potential to im-age the site immediately prior to treatment using linear ac-celerators has come a long way from electronic portal imaging devices for simple plane radiographic images to cone beam CT and supplementary imaging devices, appendages mounted on the device’s gantry.

John Marquez, president of Therapy Remarketing Group, a reseller of previously owned radiation therapy equipment, says the demand for such systems is high.


“Systems with image guidance capabilities are our big-gest request we get right now,” he says. “At minimum, what we’re seeing is that people want systems that are upgradeable. If they currently don’t have image guidance on them, they want something that’s going to be compatible with the mini-mum requirements to upgrade the unit.”

DOTmed News learned that two companies working in a strategic alliance, Acceletronics and an oncology and diagnostic imaging equipment sales firm, Radiology Oncology Systems, are introducing a new imaging device at this year’s American Society for Therapeutic Radiology and Oncology annual meeting.

“We are going to be announcing the release of the first ever FDA approved KV imaging device that can be integrated with any brand of a linear accelerator,” says John Vano, president of ROS. “What this is going to do is allow those hospitals to upgrade older linear accelerator systems to KV imaging technology with-out the need to replace or upgrade them with OEM options.”

The RAD II KV Imager, manufactured by Holland-based TheraView, enables clinicians to identify interfractional organ movement for the targeting and treatment of tumors. It can be configured for Varian, Siemens or Elekta linacs with or with-out beam stoppers.

Acceletronics’ Schwarz says the new imaging device will help clinicians meet the goals of “safety, accuracy and repro-ducibility” in radiotherapy.

Respiratory motion management Technological advancements in respiratory motion manage-ment are enabling clinicians to focus on sites that have previ-ously been hard to treat with radiotherapy. Tumors in areas such as the liver and lungs tend to shift because of breathing, making it difficult to precisely locate their position.

“We see lung cancer as a huge opportunity for treating more patients and actually saving more lives. There is a fairly low cure rate right now with lung cancer,” says Varian’s Donohoe. “There is also a strong differentiation between ‘operable’ and ‘inoperable’ patients and how they are typically treated. A lot of recent scien-tific research into the impact of radiosurgery and radiotherapy on lung cancer patients has been extremely promising.”

In April, Varian introduced TrueBeam, its latest system designed for all forms of external beam radiotherapy, includ-ing IGRT, IMRT, stereotactic body radiotherapy, radiosurgery and RapidArc radiotherapy.

TrueBeam comes standard with Gated RapidArc technolo-gy, a feature that monitors patient breathing and compensates for movement. The technology works by “gating” the beam, or turn-ing it on and off, in response to tumor motion. Varian’s Donohoe says the technology ensures a higher level of dose conformity.

Elekta introduced its innovation for respiratory motion management earlier this year. Designed to reduce treatment margins, the XVI Symmetry product is enabled by 4D guidance and eliminates the need for external markers. The feature works by capturing images of the patient’s breathing phase and then calculating 4D imaging data. The information is used to visual-ize the tumor position in each phase of the respiratory cycle and acquire an average position for the tumor for each treatment.

OEMs say they plan to advance motion management tech-nologies and are excited about the developments in the realm of lung stereotactic surgery.

“We actually have a chance in radiation therapy to be the primary treatment modality for lung lesions over surgery,” says Elekta’s Prosser. “If they’re small enough and caught ear-ly enough, it might be a noninvasive alternative to surgery.”

Linear accelerators continue to expand their capabilities and offer flexibility in the treatment of all tumor sites. In ad-dition, several specialized radiotherapy devices – such as the Gamma Knife, the CyberKnife and TomoTherapy are making headway through research and technological advancements.

Gamma Knife A few years ago, the Gamma Knife Center at the Upstate Uni-versity Hospital in Syracuse, N.Y., was gearing up to upgrade the Cobalt-generated gamma radiation sources on its Gamma Knife unit. The scheduled replacement coincided with Elekta’s intro-duction of the new Leksell Gamma Knife Perfexion, a stereotac-tic radiosurgery system, which the facility decided to purchase.

Dr. Walter Hall, professor of neurosurgery with the hospi-tal, says the Gamma Knife Perfexion is superior to the previ-ous system because of its ability to treat lesions in the cervical spine and an automatic targeting system. If the treatment field is delivered using multiple spheres of radiation, the clinician doesn’t have to readjust the system for each sphere.

“It will automatically move from one sphere of treatment to

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another. It significantly shortens the duration for the treatment in terms of how long patients are actually in the machine,” says Hall.

A Gamma Knife system uses multiple radiation beams that converge in three dimensions and focus on the tumor. Industry experts say the major advantage of this device is its ability to localize the target. In a treatment using the Gamma Knife, a head frame is secured on the patient by a neurosurgeon and the patient undergoes an imaging scan to visualize the tumor. The head frame then stays on during the treatment process.

Hall says he prefers the Gamma Knife Perfexion system because of its accuracy and speed of treatment.

“It’s a single-shot treatment and you’re getting a patient to-tally treated within three hours from start to finish. Many lesions that I would normally operate on could all be treated with the Gamma Knife,” he says. “There’s no hospitalization, there’s no length of stay, it’s less expensive than conventional surgery and the patient outcomes are just as good as with surgery for some lesions. I think the patient satisfaction level is astronomical.”

For Elekta’s neuroscience business, 2009 was a record year. The company’s factory is currently building its hundredth unit, wrote Per Nylund, senior marketing director, business line management, Leksell Gamma Knife, in remarks e-mailed to DOTmed News.

“Approximately 60,000 procedures are carried out every year and more than a half million treatments have been con-ducted to date,” said Nylund.

Within the last year, Elekta introduced two innovations to enhance its system. WarpSpeed is a new tool for treatment plan-ning with the Perfexion system. It provides clinicians with real-time dose planning, enabling them to formulate better treatment plans faster, said Nylund. WarpSpeed allows for the optimiza-tion of dose distribution through modification and addition or removal of isocenters in any image with instant feedback.

Another innovation is the Extend system for the Perfex-ion unit, a program for fractionated treatments. The feature extends the capabilities of the Gamma Knife to treatment of large tumors or lesions close to critical structures located in

the brain, skull base and other regions of the head and neck. Ongoing research and the collaboration between the OEM

and leading facilities promises to continue expanding the clinical reach of the Gamma Knife. The National Institutes of Health is currently sponsoring a U.S. study that’s investigating the use of radiosurgery for the treatment of epilepsy.

“Researchers are looking at patients who have seizures related to mesial temporal sclerosis, and they’re hoping that if they give enough radiation to that portion of the temporal lobe that has the sclerosis, they’ll prevent epilepsy,” says Hall.

The focus on research was evident at this year’s International Leksell Gamma Knife Society meeting held in May. A record 332 posters and oral presentations were submitted for the meeting, the most ever in the society’s 21-year history, said Nylund.

“A continuous growth of tumor radiosurgery fueled by Per-fexion’s ability to treat multiple lesions and multiple fractions is expected,” he said. “Another growing field is in functional neurosurgery, which also includes the use of Gamma Knife ra-diosurgery for Parkinson’s disease and trigeminal neuralgia.”

CyberKnifeAccuray’s CyberKnife is another specialty radiation delivery device. Unlike the Gamma Knife, it’s a frameless robotic radio-surgery system that is not limited to intracranial sites and can treat tumors throughout the body. The CyberKnife uses a com-pact linear accelerator on the end of a robot arm that delivers the treatment, explains Dr. Omar Dawood, VP of clinical develop-ment with Accuray. The mobility of the robotic arm enables the delivery of radiation from a wide variety of angles, thus provid-ing precise sculpting of the dose delivery to the target.

“We have treated just about 90,000 tumors now with the CyberKnife all over the body,” says Dawood. “A little more than half, about 55 percent of all the patients treated are ex-tracranial right now.”

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The system enables clinicians to reduce wide treatment margins in the planning to compensate for the moving target.

More recently, the company released the XSight Lung System, which works with the Synchrony system. Originally, Synchrony used implanted markers in the tumor but XSight Lung allows the system to lock onto the tumor itself.

“It does that by essentially using an algorithm that enhances the images that are taken during treatment,” says Da-wood. “It’s revolutionary because now you’re actually tracking.”

Like the lung, the liver is another organ that moves frequently and there-fore requires correction for respiratory motion. Within a month, Accuray an-ticipates the launch of two multi-center, international studies looking at the treat-ment of liver sites.

The treatment of prostate tumors is another exciting area of development. For years, prostate has been treated with long courses of radiation with small fraction doses, explains Dawood. Re-

searchers are now examining the bene-fits of delivering high doses of radiation in shorter periods of time to the prostate and evaluating the method’s efficacy of reducing some of the treatment side ef-fects, such as erectile dysfunction.

In a 2009 study published in Tech-nology in Cancer Research and Treat-ment, researchers looked at the use of the CyberKnife as an emerging treat-ment approach for localized prostate cancer. They treated 112 patients with the system and found that more than 82 percent of men maintained sexual func-tion two years after treatment.

Research on this CyberKnife capabil-ity is continuing at two multi-center clini-cal studies. A study looking at the homog-enous dose distribution is taking place in 23 centers nationwide. Another study is examining the production of dose distri-butions comparable to those created by high dose rate brachytherapy treatment. HDR brachytherapy has excellent out-comes but also has its set of drawbacks: it’s catheter-based and invasive.

“A huge portion of the community believes in HDR brachytherapy, but doesn’t believe in its invasiveness for patients or the difficulty in performing it because it’s not easy to put in those catheters reproducibly,” says Dawood.

The 10-center study will examine the efficacy of this treatment using the CyberKnife and without catheters. Ab-stracts from both studies will be a part of the poster presentations at the AS-TRO annual meeting later this month.

TomoTherapyThe TomoTherapy Hi-Art treatment sys-tem is an IMRT device known for its com-plete integration of the treatment process.

“TomoTherapy delivers radiation using a slit beam in a helical fashion, much like a CT unit gathers imaging information,” says Dr. Jay Burmeister chief of physics with the Karmanos Cancer Center in Detroit, Mich. “It also images the patient using the treatment beam. It’s really an integrated imaging and treatment platform.”

TomoTherapy uses software for treatment planning, quality assurance, patient set-up and treatment delivery, storing all patient and plan information in one place.

“We have a centralized secure da-tabase, a single point of storage and unmatched computing power, which en-ables rapid creation of very sophisticated treatment plans,” says Dr. Fred Rober-ston, the company’s president and CEO. “Our system has a built-in machine and patient specific quality assurance.”

Robertson says customers are using the system for applications of stereotac-tic radiosurgery, stereotactic radiation therapy and stereotactic body radiation therapy. TomoTherapy has a patented binary multi-leaf collimator, ensuring dose conformity and homogeneity.

“There’s a lot of evidence in the medi-cal literature that this design reduces toxici-ty and side effects and enables radiotherapy with a radiobiologic advantage, which we believe ultimately translates to improved quality of life for our patients and for can-cer survivors,” says Robertson.

With TomoTherapy, patients can be imaged daily, enabling clinicians to offer adaptive therapy, says Robertson. Clinicians can make adjustments based


on changes in the anatomy and have a more comprehensive picture of the dose the tumor already received.

TomoTherapy is also advantageous for hypofractionation, or delivering short courses of high dose radiation, a growing industry trend.

“Daily 3-D image guidance is criti-cally important with hypofractionated dosing because when you’re using larg-er fractions, they have to be delivered correctly and with extreme precision,” says Robertson. “Many physicians would agree that hypofractionated ra-diation therapy is really only possible with very high-quality 3-D volumetric image guided capabilities.”

Advances in image guidance tech-nology for radiotherapy are moving the industry towards personalized patient care and have “really opened up the possibility of being able to personalize the prescription to most effectively treat each patient’s tumor,” says Robertson.

Enhancing the process The complexity of the radiotherapy equipment and the overall treatment process is a challenge end-users and OEMs face today.

“If you go to a typical console of a radiotherapy device these days, it can be overwhelming just walking up and seeing numerous monitors and all of the bells and whistles you see there,” says Karmanos’ Burmeister. “It’s difficult for our thera-pists who operate these machines to pay

attention to the patient and to everything that’s going on with the machine. These machines are doing very complicated things in terms of imaging and delivery with respect to what they used to do.”

OEMs are responding to the chal-lenges faced by clinicians with features that help simplify and organize the intri-cate information.

Elekta offers Synergistiq, a clinical workflow management tool. It integrates the patient’s electronic medical record, imaging data and the control of the linear accelerator in a unified user interface.

With the help of customer input, Varian’s new TrueBeam system was

redesigned from the ground up to offer clinicians an integrated interface and an adjustable level of automation control.

“From a control system perspective, we’ve got a design where absolutely ev-ery element of this machine is complete-ly integrated and synchronized, facilitat-ing automation and a streamlined clinical flow,” says Varian’s Donohoe. “This lev-el of tight integration offers us a platform not just for today’s clinical techniques but also for future innovations.”• Online: dotmed.com/dm14269

Olga Deshchenko can be reached by e-mail at [email protected].

DOTmed Registered Linear Accelerator Equipment Sales & Service CompaniesFor convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 14269]Names in boldface are Premium Listings.

Name Company - Domestic City State Certified DM100 Jose Rodriguez OncoAmerica Cancer Care Centers Huntsville AL John Vano Radiation Oncology Systems La Jolla CA John Marquez Therapy Remarketing Group Long Beach CA • Varian Medical Systems Varian Medical Systems Palo Alto CA Omar Dawood Accuray, Inc. Sunnyvale CA Simon Bhangal LinaTech Sunnyvale CA Stewart Farber Farber Medical Solutions, LLC Bridgeport CT Robert Maziuk VJ Technologies, Inc. East Haven CT Rich Ellis Technical Options of Georgia Marietta GA Timothy Prosser Elekta Norcross GA Nader Alfaqeeh Orbit Medical Technologies, Inc. Harvey IL • Chaz Beadling American X Ray Equipment Sales & Service Cumberland MD Jay Burmeister Karmanos Cancer Center - Wayne State University Detroit MI Kenneth Wolff RS&A, Inc. Rural Hall NC •Marilyn Jaccard Diagnostic Imaging Sales Highlands NJ • Tony Richardson Oncology Services International Montebello NY Larry Day Acceletronics, Inc. Exton PA Bill LeCompte Systemic Energy, LP Lubbock TX Robert Dyer Dyer Technical Service (DTS) The Woodlands TXFrederick Robertson TomoTherapy, Inc. Madison WI

Name Company – International City Country Certified DM100Javier Espinos Ingenieros en Radioterapia Tlalnepantla Mexico


hen the medical physics community discovered that some patients were getting radiation overdoses during CT exams, they got together at the Radiological Society of North America 2009 meeting to figure out how to address the problem. The discussion among CT physicists resulted in a broader meeting that took place the following spring, where all the parties involved in CT exams agreed on a set of opti-mum protocols.

With CT overexposure incidents still fresh on their minds, professionals began hearing of patients being seriously hurt or

even fatally injured by radiotherapy treatments. Anyone in-volved in the planning or delivery of radiation or manufacturing of radiotherapy devices can cite at least one incident described in “Radiation Boom,” a New York Times series that examined the use of radiation and challenged the safety of its delivery.

“I thought, ‘It’s happening all over again,’” says Dr. Wil-liam Hendee, professor of radiology, radiation oncology, bio-physics and community and public health at the Medical College of Wisconsin. “Our attention was already riveted on overdosing in CT and then similar issues arose in radiation therapy.”

By Olga Deshchenko

The RADIotHERAPy

INDuStRyzeroes

in on safety

W


Upon reading the first article in the Times, Hendee made phone calls to a group of industry leaders, including the presi-dent of the American Association of Physicists in Medicine. They decided to bring together radiotherapy stakeholders – medical physicists, radiation oncologists, administrators, manufacturers, dosimetrists and regulators – to come up with recommendations and an action plan. In late June, approxi-mately 400 people attended the “Safety in Radiation Therapy – A Call to Action” meeting, held in Miami, Fla.

“We spent about a day and a half at this meeting thinking of ways that we can make patients safer in radiation therapy. We needed to look at the whole process of radiation therapy and recognize that it’s complex,” says Hendee.

Since concerns over safety made headlines earlier this year, a wave of action to prevent further accidents and restore confidence in the cancer treatment option swept through the industry. Manufacturers, regulators and the clinical commu-nity found themselves on the same page, reexamining their roles in patient safety throughout the treatment process.

For clinicians, it means streamlining protocols and com-munication processes. For regulators, it comes in a form of more rigorous investigations of new radiotherapy devices. For the OEMs, it’s centered on innovations hinged on clinical evi-dence and simplification of the systems that have turned thou-sands of cancer patients into survivors.

The tech boom Radiation therapy came along in the early part of the 20th cen-tury and along with surgery and chemotherapy, it stands as “one of the pillars” of cancer treatment today, says Dr. Antho-ny Zietman, president of the American Society for Therapeutic Radiology and Oncology.

“If you actually look at cancer patients, about 60 percent of them at some stage in the course of their cancer [treatment] will receive some radiation,” says Zietman.

Nearly two decades ago, radiation oncologists relied on conventional linear accelerators to eliminate tumors and had a clear understanding of the role the sophisticated devices played in delivering the treatment.

“Then there was a massive explosion of technology, a huge proliferation of new treatment planning systems and radiation delivery machines,” says Zietman. “Before you knew it, tech-nology had almost outstripped our ability to handle it all.”

The more intricate devices have enabled oncologists to target cancer cells with greater precision and spare the sur-rounding healthy tissue, but it has also necessitated a shift to a more computerized and automated process.

“We can do a better job of treating patients today and preventing after effects or side effects of radiation than we’ve ever been able to do in the past because of all of the sophisti-cated technology,” says Hendee. “But the problem is, it sort of takes the treatment out of the hands of the therapist and puts it in the ‘hands’ of the computer.”

Many facilities have multiple radiation delivery systems in their oncology departments, which makes it difficult to fig-ure out how, and even if, the machines work in sync. Often-times, such uncertainty invites mistakes.

“There may be software errors buried deep within the system that we’re unaware of,” says Zietman. “It took a few very serious radiation events, which were exposed by The New York Times - quite appropriately - to really focus everyone’s minds on this.”

The intricate modalities are operated by a number of profes-sionals who are involved in the process of planning and deliv-ering the treatment: physicians, medical physicists, therapists, dosimetrists and in some cases, nurses or administrative staff. Not only do several people need to be aware of all the treatment information but they must also understand it. The steps that make up the treatment are multifaceted – and everything from the configuration of the radiation beam in regard to the tumor to the tracking of the patient’s respiratory motion makes the infor-mation relay among the radiotherapy team more delicate.

“It’s a complex interchange of information and a handoff of information between these individuals,” says Hendee.

Given the intricacy of the technology and human interac-tion involved in the process, it’s no surprise that attendees of the meeting, hosted by AAPM and ASTRO, discussed strate-gies to improve communication processes in the interests of safety.

Recommendations for the staffIn his presentation at the meeting, Hendee told attendees that the radiotherapy treatment process must be fault-tolerant. Those involved in the planning and delivery must understand


their responsibilities, learn from mis-takes and engage in corrective actions. Although radiotherapy devices are high-ly computerized, human involvement is a part of the treatment process.

“We have to be able to recognize when errors occur and mistakes are made and correct the treatment by cor-recting those errors without letting them progress until a patient is adversely af-fected,” says Hendee. “We’ve had a lot of discussions with manufacturers about this. What we want is an early warning system built into the machine, so that if something is done that doesn’t seem right or it doesn’t match with what might be considered a standardized protocol for that particular type of patient and tumor, the machine will give an early warning.”

Although there is no set date for when the early warning systems will ap-pear on radiotherapy equipment, it’s clear that OEMs favor this proposal. The ra-diotherapy community isn’t running into any opposition to this new feature, “but it requires changes in some pretty sophisti-cated protocols,” explains Hendee.

Another way to ensure safety dur-ing treatment is to focus the clinical team’s attention on the patient. At least two people should be at the console of the device for a checks and balances process, which might be a challenge in the current environment, says Hendee.

“Like a lot of businesses, many hospitals are undergoing rather restric-tive budgetary limitations, but the worst thing you can do would be to limit the number of employees to such a degree that you put patients at risk,” he ex-plains. “We have to emphasize to hospi-tal administrators that the staffing levels must be appropriate, and to do that, we need to do some updating of our own information about staffing levels.”

About two years ago, AAPM came out with recommendations of staffing levels for different types of radiation therapy devices.

“But these systems have become much more complex, the accompanying technology has become much more com-plex and we haven’t updated those staff-ing levels. One of the first things we need is to reevaluate the recommended staff-ing levels and then encourage hospitals to pay attention to them,” says Hendee.

Manufacturers join forces Manufacturers that also attended the meeting acted quickly to address the safety concerns.

“I think the manufacturers heard loud and clear that we’re not supposed to innovate just for the fun of it,” says Timothy Prosser, director of the oncolo-gy business line management for Elekta.

OEMs acknowledge some of the criticism aimed at the complexity of the technology and are working with clinical and other industry partners to simplify the operation of their devices, says Prosser.

In June, the Medical Imaging and Technology Alliance and the Advanced Medical Technology Association an-nounced the Radiation Therapy Check Initiative, an industry-wide effort to develop and implement additional pa-tient protection features on radiotherapy equipment.

“All of MITA’s companies are very interested in ensuring the safety of their products and including new features to further enhance the safety of the prod-ucts,” says David Fisher, the organiza-tion’s executive director. “MITA and the CT manufacturers developed the CT Dose Check Initiative and released that in March and we felt that it was natural to do a similar initiative for radiation therapy.”

The voluntary initiative aims to pro-vide additional checkpoints to radiothera-py teams before the delivery of treatment. It includes a quality assurance verification feature, an enhanced beam modification check, which ensures the correct place-ment of beam modifying accessories when applicable, and a visual patient po-sitioning confirmation to confirm that the patient is properly positioned.

“The manufacturers have commit-ted to including these features [into their products] within 24 months,” Fisher says.

OEMs say maintaining strong rela-tionships with clinical partners is at the core of the advancements that have been leading the radiotherapy industry.

Varian Medical Systems is an OEM that invests significant resources into its comprehensive training programs and continuous technical support. The com-pany offers a “blended learning” ap-proach, which includes classroom train-ing, on-site clinical support and remote learning options.

“Varian operates education cen-ters in the U.S., China, Switzerland and India,” says Karla Donohoe, the com-pany’s senior marketing director. “Our training, education and help desk teams include more than 210 clinically expe-rienced personnel who speak more than 15 languages to facilitate the transfer of knowledge for safe and effective use of our systems. All of this will continue and will be updated to reflect any safety ini-tiatives undertaken by the professional organizations and the clinical users.”

Regulatory movesThe U.S. Food and Drug Administration also took note of radiotherapy safety concerns. In April, the agency sent let-ters to approximately 93 manufacturers to explain the measures it plans to take to improve the safety of radiotherapy devices and their use.

“The FDA is taking these steps to reduce the number of underdoses, overdoses and misaligned exposures from therapeutic radiation,” wrote Dick Thompson, an FDA spokesman, in an e-mail to DOTmed News. “These de-vices include linear accelerators, proton therapy systems, radiation therapy treat-ment planning systems and radiation therapy simulators.”

The FDA analyzed medical device reports and found that errors could be diminished if additional safeguards are incorporated. In the letter, the agency wrote that it received 1,182 MDRs asso-ciated with the use of radiation therapy devices between the winters of 1999 and 2010. Out of those MDRs, linear ac-celerators accounted for 74 percent of the adverse effects reports. Computer software issues, misuse of devices and incorrect display were some of the most commonly reported problems.

In the letter, the FDA also an-nounced that it would no longer allow new radiotherapy devices to undergo a streamlined approval process using third-party reviewers.

“Ultimately, what that means is that new innovations will take longer to get to market,” says MITA’s Fisher. “FDA has a large load and as a result, the third-party review process often makes the process quicker for manufacturers and patients.”


The agency also held a public meeting in June and called for input on the steps that OEMs could take to help reduce the number of errors. Industry experts anticipate the agency taking additional action in the near future.

Reporting errors Amidst discussions about radiation safety, the idea of a stan-dardized, national system for reporting errors is generating a lot of buzz. Current error reporting requirements vary from state to state, says ASTRO’s Zietman. Some states, like Massachusetts, have rigid mechanisms in place, in which state officials moni-tor and investigate patterned errors throughout health facilities. However, at least a dozen states have more lax policies. For instance, facilities in California aren’t required to report errors that involve linear accelerators to state health authorities.

“We need a national reporting system for medical errors, and even near misses. It happens in many states but it needs to happen nationally,” says Zietman.

OEMs agree with end-users on the need for a national re-porting system. Device companies are required to report errors through MAUDE (Manufacturer and User Facility Device Ex-perience), an FDA-maintained database of adverse effects.

“Manufacturers are mandated to report issues and respond to those issues within 24 hours. Hospitals, however, are not obligated to do that,” says Elekta’s Prosser. “We would like to see hospitals under the same requirement.”

However, the concept of a national error reporting mecha-nism, whether voluntary or mandatory, could get tricky when it comes to potential legal action.

“How do you keep malpractice plaintiff attorneys from having access to that information and using it as a way to de-velop malpractice suits?” asks Hendee. “That’s a great inhibi-tion of reporting, so it needs to be worked through.”

Hendee says the industry should also place a bigger empha-sis on failure mode and effects analysis and root cause analysis.

“We need to know why those mistakes are made and how we can keep them from being made again,” he says.

Talk of accreditation The idea of accreditation for facilities that provide radiation therapy treatment is also floating around the industry. Some professionals suggest that accreditation should be tied to reim-bursement and others look to the Radiological Physics Center as a potential accreditation body.

Housed at the M.D. Anderson Cancer Center in Houston, Texas, RPC designates centers as qualified participants in the Na-tional Cancer Institute cooperative clinical trials by evaluating a facility’s ability to safely and effectively deliver radiation.

“I think some of us believe, definitely myself included, that a facility should be credentialed in order to deliver these types of very complex treatments, regardless of whether they are put-ting patients on clinical trials,” says Dr. Jay Burmeister, chief of physics for Karmanos Cancer Center in Detroit, Mich. “I’m not sure how we go about that, if insurance agencies should require facilities to participate in a RPC test before they reimburse for this, but I think it would definitely be advantageous for us to require facilities to be credentialed before they deliver this tech-

nology to patients. The amount of time put into participating in these tests is relatively small with respect to the amount of time that you spend commissioning this technology.”

About 30 percent of facilities across the U.S. are failing one of RPC’s intensity-modulated radiation therapy tests. The number may be misleading, explains Burmeister, because the test is administered largely at prominent institutions.

“Many facilities that don’t participate in clinical trials don’t feel the need seek out external validation tests,” he says. “It is possible that the pass rate for those facilities could be even lower than the 70 percent pass rate that we see for all facilities that are currently taking these tests.”

Cues from the airline industryIn discussions about patient safety, experts often draw parallels between radiation therapy and the airline industry. Both realms depend on the balance of human skill and technology, a relation-ship that has grown more complex over the years.

“Decades ago, the cockpit was much simpler and many more things were done manually, and maybe you had a better feel for what was happening,” says Burmeister. “In this day and age of the autopilot, so many things are done with computers, and in some cases, even without your active participation, that it becomes difficult to keep up with everything that’s going on.”

Checklists or mandatory pauses in the process are safety precautions radiation therapists plan to borrow from pilots. The

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idea of using checklists in medicine was made popular by Dr. Atul Gawande’s book the “Checklist Manifesto,” which promotes the concept of using checklists in the operating room to prevent mistakes. Gawande also advocates empowering all individuals to call a timeout when they feel something is off, a practice that’s gaining ground in radiotherapy.

“That’s becoming pretty widely ac-cepted,” says Hendee. “Everyone on the team has the ability to call a timeout and no one can override that.”

As with other safety enhancing ini-tiatives, OEMs are on board and invest-ing in evaluating the efficacy of the pro-posed solution. Varian Medical Systems is working as a part of a Clinical Council on Patient Safety to investigate the validity of checklists and timeouts in radiotherapy.

“What we see as our role is to do what we can in our software to support the documentation of such checklists and potentially to automate some of these enforced pauses,” says Varian’s Donohoe. “We fully support the efforts

that are being discussed with respect to reporting, standardization and accredi-tation of the users of the technology.”

Next steps Several recommendations were discussed at the AAPM and ASTRO safety meet-ing but how will they reach radiotherapy teams in treatment centers worldwide?

“This is all on my shoulders,” says Hendee. “I have agreed to draft the white paper that comes out of this meet-ing with these recommendations.”

The paper will then be published in the scientific journals Radiation Oncol-ogy and Medical Physics. Hendee says his presentation at the safety meeting will serve as the basis for the paper. He also plans to recommend that AAPM setup a group of experienced medical physicists to work with vendors on ear-ly warning systems.

The organization also looks for-ward to working with the regulatory body on enhancing patient safety.

“The FDA is under a lot of pres-sure from Congress because when con-gressmen read the New York Times, they start beating up on the FDA,” says Hendee. “We’d like to partner with the FDA, in whatever the FDA chooses to do, to represent the best interests of the patients and the best interests of the pro-fessionals and so it’s not just a response to congressional pressure.”

Organizations like ASTRO and MITA are also adamant about ensuring that patients are safe while receiving the most cutting-edge treatments.

“Innovations in radiation therapy have made the devices and the treatment pathways more safe and effective,” says MITA’s Fisher. “We are happy to con-tinue working with the FDA to demon-strate that.”

In the midst of conversations about safety, additional features and protocols are sure to ripple through the industry in the coming months.

“I see a really strong commitment from the clinical, the regulatory and the manufacturing side to get this right,” says Elekta’s Prosser. • Online: dotmed.com/dm14221

Olga Deshchenko can be reached by e-mail at [email protected]

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PARtINg ways

Small components lead to big business for professionals focusing on specifics By Keith Loria

DMS Topline Medical engineer in a CT system for the breakdown of diagnostic imaging parts.


On a Friday afternoon a ra-diologist was seeing the last of the day’s patients through their scheduled CT exams. Suddenly, the

console screen lit up with an error and the system stopped scanning. The X-ray tube failed and with the weekend near and the next week’s long list of sched-uled patients casting a grim shadow of costly uncertainty, the doctor contem-plated how stressful the following week will be. He considered his options.

There are sourcing companies that could find the part, dealers with the in-ventory in stock, brokers without the part in stock, but able to get it, indepen-dent service providers, large suppliers with significant warehouses and origi-nal equipment manufacturers.

The radiologist picked up the phone. Chad Book, regional sales executive for C & G Technologies, took the call.

“There was definitely a sense of urgency in the doctor’s voice when he called, and we knew he was in a jam,” Book says. “Working with hospitals and clinics like this on a daily basis, we see this sort of thing all the time, and we know what to do.”

Book involved the parts team, and they found the tube in stock, while he worked with the doctor on price. With-in an hour of receiving the green light from the doctor, the tube was loaded into packed up and on route to the site. The new tube was installed and the ma-chine was back up for scanning before the weekend was over.

This is all in a day’s work for any reputable parts company, which has to be ready to help quickly and efficiently, as well as offer reliable and reasonably priced parts.

Since the current economic climate has caused hospitals and imaging cen-ters to hold on to their systems longer, their older systems are more likely to break down and need parts, so parts sales have been expanding rapidly.

OptionsPeruse the auctions on DOTmed.com and you’ll see that the medical parts in-dustry is a multi-million dollar business, with numerous brokers, dealers and specialized companies offering parts for

just about every piece of equipment and modality.

Some parts dealers concentrate all their interests on one particular modality or even one OEM brand of equipment.

C&G specializes in CT parts for GE and Toshiba systems.

“Way back in the beginning, our company made the decision that instead of trying to do everything and not ex-cel at anything, to instead stick with a certain product and be the best at it,” Wayne Kramer vice president of global parts operations says. “There are a lot of

people out there that list out everything — all parts, all modalities, but what happens is they aren’t really familiar with any one piece of equipment in an extreme level of detail. They can’t give 81 things an extreme level of detail.”

JDI Solutions, Inc. concentrates 99 percent of its parts business on Siemens MRI while Platinum Medical Parts LLC focuses on GE MRI parts.

ReMedPar is the largest third-party inventory of parts, with more than 75,000 parts ready to ship from its 100,000 square-foot facility.

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Not to rest on its laurels, ReMed-Par will soon be introducing and im-plementing several new programs that should make the search for parts even easier for customers.

“Our most notable program is iTubeNow, which provides a critical component in the roadmap to parts and service independence,” says Mark Suf-fridge, senior vice president for ReMed-Par. “We have discovered that providing the high-quality replacement tube is not enough. Our customers need training and onsite assistance to install the tube. They also need this support immediate-ly, as down time is critical.”

With iTubeNow, the tube, onsite installation support and onsite training are all available in a 24-hour period. The onsite training provides the abili-ties and confidence needed to complete the journey to service independence, Suffridge says.

Going straight to the sourceOEMs are also often reliable sources for quality parts and that branch of the business is gaining more attention from companies realizing the market is con-tinuing to grow.

When GE Healthcare purchased Ambassador Medical in 2002, it did so with the design to grow its inventory of quality refurbished ultrasound systems and parts, though it supports more than just GE products.

While it may seem practical to buy replacement parts from the original OEM, it can be a challenge when trying to track down parts for a discontinued or retired line. OEMs typically invest re-sources in the current market items be-ing offered and therefore don’t always have what’s needed for older equip-ment. Additionally, third-party suppli-ers stocking up on parts from machines purchased specifically to “part out” can be very competitive with pricing.

“This is a lower cost way of main-taining equipment,” says Michael Helms, president of Troff Medical Ser-vices, which has more than 20,000 parts in inventory in its 17,000 square-foot warehouse “With the current economy, everyone is feeling the crunch, even the large hospitals, and everyone is in

a cost-effective frame of mind to trim the fat a little bit. We can help people maintain their equipment at a far more reasonable price.” Suppliers and solutionsFor almost a decade, PartsSource has been a multi-manufacturer, multi-mo-dality, alternative parts supplier sup-porting both imaging and biomed parts requests for hospital equipment.

With an expanding demand on parts and services, other solutions have begun to emerge offering a wider range of choices for companies looking for

that needed piece of the equipment puzzle. DOTmed Certified Parts Vendor was unveiled last year to put parts buy-ers in direct contact with parts stocking vendors.

(Disclosure: DOTmed Certified Parts Vendor is a service of DOTmed.com the parent company of DOTmed Business News).

OverseasEven though the domestic market has been increasing each year, the interna-tional market has been garnering a lot of interest from everyone in the sector.

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“An international parts business is good for many reasons,” says Rob-ert Graham, sales director for Polaris Medical Imaging. “It helps you to ex-pand your reach, as well as customers, to get more parts sold and out the door. You also gain resources that you may be able to use to help you in future busi-ness. It also aids in the marketability of your company.”

Joshua Glas, parts director for ADAM Imaging Parts Inc., has been seeing big increases in his overseas parts market.

“It’s gotten more challenging for them since the dollar has started to ap-preciate a little bit, but it’s still very good,” he says. “I have been fortunate to build strong international relation-ships and I have seen growth every-where—Kenya, Australia, Asia, all over the world.”

Since many of these countries are using older equipment, it gives a parts company the chance to unload some product that is probably never going to be sold domestically.

“There’s not much value in those parts here, so I give them fantastic pric-ing and it’s good for them and a little gravy for me,” Glas says. “Some of these parts can be 20 years old so it’s really a win-win.”

Helms says that Troff Medical reg-ularly ships its wares to anywhere from six to eight countries, but has dealt with more than 25 different countries over the years.

George Fraza, general manager for DMS Topline Medical, says his compa-ny has also been expanding a great deal overseas and has shipped a considerable amount of biomedical parts to Central and South America and some to India. He has made sure to stay on top of cur-rent trends to see where else his busi-ness can grow.

“With the market in India and Rus-sia exploding, we see those as two ex-cellent markets to get into, especially with the boom in hospitals in both,” Fraza says. “There’s a company in India expected to build 3,600 beds worth of hospitals so there is a tremendous op-portunity to expand in the international domain.”

Overseas customers must have a

high degree of trust in the parts provid-er, which makes the relationship aspect more significant. Customer loyalty in the international market is forged quick-ly when the parts provider demonstrates reliability.

“We have developed significant relationships with independent service companies throughout the world who rely on us for spare parts,” says Jason Crawford, president of Block Imaging International. “There are many chal-lenges to this business, and it requires a higher degree of trust than you might expect. A parts company must have a

clear understanding of import/export requirements and documentation. The provider must also be able to work with much longer exchange cycles since it will take two or three times longer to get exchange parts back.”

Deals are also not always governed by U.S. laws, so if someone doesn’t up-hold his end of the bargain, a company could lose out. But for most, it’s worth the risk.

“The overseas parts market is vi-able, but it comes with greater risks and challenges,” says Kramer. “Getting exchange parts takes longer and often

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ends up not happening at all, so any companies evaluating in-ternational business should be ready for a whole new array of challenges in logistics, finances and time required.”

A few years ago, the trend was for equipment and service providers to enter the parts business. Because of their techni-cal background, the independent service organizations know how to handle, test, store and ship parts and they often main-tain a significant inventory. An emerging trend becomes part of a problemOne trend industry experts are starting to note in the parts sec-tor is the selling of entire subsystems rather than just a particu-lar component.

“In my unique position where I have close contact with the customers and I also have close contact with the brokers and friends who run parts companies, what I am seeing are people who have typically been [with] a service company move into parts,” says Larry Knight, operations partner of Altima Diag-

nostic Imaging Solutions, LLC. “When they get a taste of the revenue-selling a whole cabinet instead of selling a single part out of the cabinet it leaves them in a position where they are not motivated the next time to assist the end-user to getting the problem resolved with the minimum number of parts.”

Although it’s not a practice they actively take part in, Robert Graham, sales director for Polaris Medical Imaging, does understand why some take this approach.

“Selling entire subsystems is sort of a case-by-case ba-sis. If engineers aren’t really sure what is wrong with a part of the system, they will throw parts at it to help get the cus-tomer up and running,” he says. “It is better to part subsystems out for monetary reasons, but sometimes it isn’t feasible and doesn’t make sense. We generally do not sell entire subsys-tems if we can help it as it is expensive in shipping and com-plicated to install.”

In an effort to try to make things as easy as possible for the customer, Glas sometimes does something like this to help

Some parts dealers concentrate all their interests on one particular modality or even one OEM brand of equipment.

Block Imaging engineer pulls board from stock for customer order


with troubleshooting a problem.“If they don’t know the exact prob-

lem, we often extend slightly more le-nient return terms in a hero kit situation, referring to a handful of parts where the customer is not sure exactly which one would solve the problem, so they swap the parts until they have a working solu-tion,” he says. “Other times, the customer may want a few parts from the assembly and it may be cost-prohibitive and as a solution a package deal may be presented to offer them some additional value. This business is so unique and exciting I don’t think there are any hard-and-fast rules

that must be applied to for every single transaction. There are often times you will encounter a situation that you have not yet before seen and you must think on your feet to offer value and effective solutions for the customer that you may not have considered before.”

ChallengesClark Wilkins, owner of JDI Solutions Inc., which has more than 3,000 parts for Siemens products in its warehouse, sees two big problems parts companies are facing in today’s environment.

“On one level, there is ever-increas-ing pressure from parts redistributors who constantly beat us down on price but are not passing the savings on to their clients. This combines with a lot of other companies that do not do rigorous QA so their overhead is much lower,” he says. “Level two, the price of the newer equipment remains too expensive to ac-quire the units for parts. We’re still see-ing 10-year-old scanners commanding upward of $200,000 wholesale, which makes it hard to justify scrapping one out for parts.”

Parts come from a variety of out-lets. Everyone knows about the usual means: parting out whole systems and opportunistic purchasing, but while these are important, the real test for any company is ensuring that these parts are in good condition throughout the entire process with stringent steps to ensure quality from acquisition to inventory.

“Resourcing is something we take seriously. We are very aggressive in finding those high quality resources from the OEMs or from hospital groups, and pay very close attention to it all,” Fraza says.

Many of the companies purchase complete systems for parts and then do their due diligence to ensure that they are all working.

“We bring those systems in-house and stage each system to verify each and every part is to OEM specification prior to tearing the system down for parts,” says Gregg Pearson, president of Mag-naServ Inc., which has a complete line of GE MRI and CT parts stocked in six regional locations across the country. “Our in-house repair operation verifies each and every part repaired is operat-

One trend industry experts are starting to note in the parts sector is the selling of entire subsystems rather than just a particular component.


ing to OEM specification prior to add-ing the part to our stocking locations.”

If the company doesn’t have a part in stock, Pearson says it will strip the part from one of its staged systems or second source the part from various vendors.

Medical Purchasing Resource LLC. offers parts for different aesthetic laser systems and obtains most of its in-ventory directly from manufacturers or direct suppliers.

“We do have some laser systems available in-stock as part systems when all other sources are exhausted,” said the company’s president, George Beach.

Finding a DealOne need only look at the listings on DOTmed.com to see that the parts indus-try is inundated with suppliers and deal-ers, but that doesn’t mean all are equal.

“One of the things that has hurt the reputation of the parts industry is what I would call ‘ease of entry into the busi-ness.’ Anybody with a computer and a phone can be in the parts business,” Suffridge says. “What people need to know is where you are getting those parts from. You could be purchasing that part from a parts junkyard and not a company and facility like ours. At ReMedPar, it took us 25 years and tens of millions of dollars of investment in our infrastructure and business to de-velop this high level of quality.”

With so many options, one might think that simply finding the lowest price is the way to go, but parts com-panies warn that this often causes major problems.

“Customers should understand that putting the price of the part as the fore-most parameter is very risky,” Wilkins says. “If you want a tested part, you need to realize that testing process has a cost component which has to be recovered.”

Kramer tells customers, you can’t judge a book by its cover.

“There are many statements that exist in the industry about what compa-nies provide, so it’s always best to do your homework,” he says. “Dig deep to understand how your provider ensures quality, stock consistency, warranties and technical support.”

Graham offers that parts compa-nies pricing far below others often don’t know what they are doing and could soon find themselves out of business. Experience and knowledge are just as important as price in many cases.

“There are several key points to a growing parts business. Knowing what you are doing is, in my opinion, the most important point. I see hundreds of prices being quoted that are way below market value. All this does is destroy the market and cut your own profits,” he says. “You [also] have to send the right parts. A lot of parts are very similar with

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Even though the domestic market has been increasing each year, the international market has been garnering a lot of interest from everyone in the sector.


almost identical part numbers. Knowing which parts belong to which system is essential for getting the customer run-ning again.”

Most major parts companies now offer 24/7/365 on-call support, a skilled customer service staff, in-house parts identification, high-end in-house repairs capabilities, installation service and a global reach.

“Another key and often unperfected means for ensuring stock is maintaining an effective cycle, that is, the ability to recover defective parts and restore them to full functionality,” Kramer says. “Our

company is fully wrapped around this process with no compromise to qual-ity, which gives us the upper hand for keeping critical parts available. When it’s time for a part to ship out, a dedi-cated team of shipping specialists give our parts the ‘white-glove’ treatment in packaging and courier service selection to ensure that parts arrive both on-time and undamaged.”

Even with the significant savings they offer customers, parts suppliers face tough competition in a crowded market. That’s why respect for the cus-tomer is of the utmost importance. To

further show its commitment to its cus-tomers, recently ReMedPar gained ISO 9001 certification.

“Only a company committed to real quality and customer service would invest the time, money and human re-sources in obtaining this certification,” Suffridge says. “Too often, parts sup-pliers take shortcuts to quality.”

It’s more important than ever to do your due diligence on the source of the part. Unfortunately, the same eco-nomic stressors that cause hospitals to keep machines longer have also led to unscrupulous practices by some parts brokers.

“When it comes to survival, it re-ally comes down to offering quality,” Helms says. “We spend a lot of time field testing these units before they are removed. We buy from hospitals that we know, brokers that we know. We know how the stuff was used and only buy good quality equipment. We go through a lot to ensure everyone is happy with the transaction and happy with the parts.

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


SIEMENSParts Repair Depot727-530-0301When you think of Siemens medical parts made in Germany, remember German Electronics in the U.S.A.

German Electronics1 2 0 0 S t a r k e y R o a d # 2 0 5 , L a r g o , F L 3 3 7 7 1

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

Company City State SpecialtiesDietz Healthcare, Inc. Chandler AZ Ultrasound transducersCalscan Medical Ent., Inc. Anaheim CA Siemens, Philips and Picker Marconi MRI/CTCBE Medical, Inc. Anaheim CA Med Resources Imaging Baldwin Park CA Advanced Endoscopy Devices, Inc. Canoga Park CA Beach Medical Costa Mesa CA Southwest Medical Resources Norco CA MRI, CT, PET and PET/CTNationwide Medical Equipment Services, LLC. Ontario CA GE, Philips, Picker Marconi and Toshiba CT and GE, Siemens, Philips MRI KPI Ultrasound Riverside CA UltrasoundSound Imaging Inc. San Diego CA GE MRI and MRI accessories - video monitoring and stereoIMEB, Inc. San Marcos CA Tenacore Santa Ana CA SpO2, ECG/EKG cables, fetal transducers, monitors, infusion pumps, O2 blenders, wall suction regulators Viable Med Services, Inc. Santa Clarita CA Hitachi and Toshiba MRI, Hitachi and Toshiba CT, Siemens PETWholesale Aesthetics, LLC Santa Rosa CA MBI-USA Templeton CA Medimtech LLC Tracy CA Ultrasound probes, ATL, Philips, HP, GE, Siemens, Acuson and Toshiba. Ultrasound monitors, PCB’s, trackball, printers, VCRs SCSI drives, recording mediaNova Technologies, Inc. Julesburg CO Diagnostic ultrasound, ultrasound accessories Medical Systems Technologies Longmont CO Soma Technology, Inc Bloomfield CT Biomedical equipment , C-arm, Portable X-rayEclipse Systems Inc. Durham CT Covenant Imaging Group Boca Raton FL Siemens MRI, accessoriesPlatinum Medical Imaging Deerfield Beach FL GE, Siemens and Philips MRI, coldheads, GE, Siemens, Philips and Toshiba CT, CT and X-ray tubes, Siemens and GE PET/CTIntegrity Medical Systems, Inc. Fort Myers FL Bone densitometer, mammography, C-Arms, X-ray, CT, MRI, nuclear medicine, laser cameras, ultrasoundThe Laser Warehouse Ft. Lauderdale FL Primus Xray Ft. Myers FL TheLaserOutlet.com Jupiter FL Laser handpieces and accessoriesLogix Medical Miami FL Amber Diagnostics Orlando FL CT, MRI, C-arm, X-ray, radiographic, bone densitometer, ultrasound, nuclear camera, mammography, R/F Room, Rad/Tomo,

cath labs, cath/angioNational X-Ray Corporation Palmetto FL C-Arm, Philips cath lab, X-ray tubes, image intensifiers, Kodak POC CRCBC Inc. Pompano Beach FL Biomedical equipment , C-Arm, portable X-rayChoice Medical Systems Inc St. Petersburg FL Diagnostic ultrasoundMagnaServ, Inc. Stuart FL Medcorp Tampa FL Boards, User interfaces, BEP’s, peripherals, Siemens UltrasoundAllied Health Equip Decatur GA Sterilizers, autoclaves, instrument washersMRI Technical Services, Inc. Marietta GA Technical Options of Georgia Marietta GA Duplicate, TOG is Technical Options of Georgia

DOTmedCertified Parts Vendor


We’ll follow-up with the end users that they received it and everything is to their liking. We try to make them happy.”

Keeping TrackWith more than 20,000 parts in Adam Medical’s 14,000 square-foot warehouse, a key component to being successful, according to Glas, is having the technology to keep track of everything.

“The database has definitely evolved with the business,” Glas says. “Basically, it was a glorified Excel sheet when we started, but it has grown into a reporting tool where I can get requests and find parts based on the model, modality, system name — all with a touch of a button. I can also track returns and sales and sales metrics.”

Today, getting a part from a third-party source can be as simple as a click of the mouse, which is why you must keep up with technology. Many customers would rather find their needed part on their computers or cell phones.

That fact hasn’t been ignored. Block Imaging Internation-al makes it simple for customers, as they can request a part by phone, e-mail or through its website.

“If a customer needs a circuit board for a Sensation 16, upon receipt of the customer’s purchase order, we will pull the verified and tested board and professionally pack it for same-day shipping,” says Crawford. “A member of our sales team will verify the part number and provide pricing based on sub-stantial discounts off the OEM price.”• Online: dotmed.com/dm14220

Keith Loria can be reached by e-mail at [email protected]


Company City State SpecialtiesTOG Marietta GA LINAC parts, Linear AcceleratorImaging Resources Martinez GA Gale Medical, LLC Savannah GA Ultrasound MEDX, Inc. Arlington Heights IL Nuclear MedicineUnisyn Medical Technologies Golden CO Siemens, Philips, Picker Marconi, GE and Toshiba MRI and CT, Ultrasound Transducers & PartsZetta Medical Technologies, LLC Lake Zurich IL GE, Siemens, Philips MRI. Coldheads. GE, Siemens, Philips, Toshiba CT. X-Ray Tubes. Siemens, GE PET/CT.Advanced Insurance Partners, Inc. Wheaton IL Axess Ultrasound, LLC Indianapolis IN Ultrasound C&G Technologies, Inc Jeffersonville IN GE and Toshiba CT, GE PET/CTC&C Medical Solutions Inc. Noblesville IN All OEM imaging ultrasoundMarquis Medical Denham Springs LA PET, PET/CT, CTPhysicians Resource Network Fall River MA PAD vascular testing equipment, O/R, BiomedicalMedical Equipment Dynamics, Inc. New Bedford MA O/R capital equipment, patient monitors, modules, roll stands, wall mounts, defibrillator, endoscopy cameras, light sources,

surgical microscope, infusion pump and surgical table accessories, ultrasound probesCertified Tech Aberdeen MD Scintillation Technologies Baltimore MD Clinical Resources Inc Cockeysville MD Metro Scopes College Park MD Berrien X-Ray Berrien Springs MI Block Imaging International, Inc. Lansing MI Acurad Technical Services, LLC Minneapolis MN Bemes, Inc. Fenton MO Respiratory, ventilators, SensorMedics PFTMed-E-Quip Locators, Inc. Maryland Heights MO Infusion and syringe pumps, Kendall SCD PumpsBio Basics Global Park Hills MO Electric beds, patient monitoring, defibrilators, endoscopy camera processor, IV pumpsAdvanco Medical Systems Sedalia MO American Biomedical Consultants, Inc. Smithville MO Minxrad Springfield MO Bennett X-Ray Generator Parts, Portable X-Ray Parts, Orex reader repairs, VIDAR repair serviceCrawford Diversified Services, Inc. St. Louis MO Mediquip Parts Plus, Inc. St. Louis MO Steris &Getinge Sterilizers & WashersUniversal Medical Resources,Inc. Washington MO ADAC/Philips, Siemens, GE nuclear medicineHealthCare Imaging, LLC Asheville NC ImagingJDI Solutions, Inc. Brevard NC Siemens MRIDiversified Dental Service Charlotte NC First Source Inc. Charlotte NC Medical Equipment Expense Solutions Greensboro NC Troff Medical Services Hendersonville NC Imaging equipmentTranstate Equipment Co. Raleigh NC Cath/Angio Special ProcedureRS&A, Inc. Rural Hall NC Linear Accelerators, Simulators, Klystrons, Magnetrons, Thyratrons, RF Drivers, RF DriversAbsolute Imaging Solutions Stokesdale NC ADAC, Philips, Nuclear MedicineAlexander Medical Imaging Taylorsville NC Carolina Medical Parts Winston Salem NC Philips and Picker Marconi MRI, CoilsDMS Topline Medical Fargo ND Superior Radiographic Systems Fargo ND PhilipsEichenauer Heating Elements Newport NH Flanged immersion heatersOxford Instruments Carteret NJ MRI magnet,cold head, compressor


Company City State SpecialtiesCintech Inc. Lanoka Harbor NJ Independence Cryogenic Engineering Little Egg Harbor NJ MedPro, Inc. Marlton NJ UltrasoundPan Am Imaging South Plainfield NJ GE MRIISIS Medical Solutions, LLC Tabernacle NJ SouthWest Imaging, Inc. Las Vegas NV OMED of Nevada LLC Reno NV Anesthesia, endoscopy, defibrillators, patient monitors, ultrasound, imagingPIGroup, Inc. Bacon Hill NY RJP International Inc. Baldwin NY Fetal transducers and monitors, patient monitors, HP defibrillators, Baxter infusion pumpsSpecialty Bulb Co Inc Bohemia NY ADAM Imaging Parts, Inc. Brooklyn NY Diagnostic imaging, X-ray and CTLongevity Parts Brooklyn NY Multi vendor parts for all modalitiesLong Island Ophthalmic Service Center Moriches NY OphthalmologyAdvantage Medical Systems Nyack NY Bed controls and pendants for homecare and hospital bedsAbsolute Medical Equipment Wesley Hills NY EKG, ultrasound, patient monitoring, defibrillator, bone density, anesthesia, mammography, cardiology, lab, fetal monitor,

X-ray tube, CT and MRI coilDuraline Systems West Nyack NY Express Systems & Parts Network, Inc Aurora OH Bone densitometer, mammography, C-Arm, X-ray, CT, MRI, nuclear medicine, laser camera, ultrasoundNorth Coast Medical Equipment, Inc. Berea OH KLC Services, Inc. Hilliard OH Classic Diagnostic Imaging Macedonia OH JMED Imaging, Inc. Bixby OK G E Advantx RFX 8835SFD LPX-GeneratorAdvanced Ultrasound Electronics Tulsa OK Ultrasound Probes, boards, membranes, etc.Med Part Source Carlisle PA All modalities of ultrasound parts/probes. X-Ray tubes/parts, MRI and CT parts.Medical Technic, LLC Philadelphia PA Mammo, ultrasound, CT, MRIGrand Medical Equipment, Inc. Souderton PA Biomedix Medical Toughkenamon PA Infusion pumpsInternational Medical Equipment and Service, Inc. Fort Mill SC Toshiba CT & MRI, Major OEM MRI & CTMARS Medical Lexington SC A+ Medical Company, Inc. Rock Hill SC Major OEM Rad, R/F, mammo, cath lab, C-Arm, bone density, nuclear medicine, CTRadiology OneSource Franklin TN ImagingTenvision Gallatin TN All OEM ultrasoundJ&M Trading, Inc. Goodlettsville TN All modalities from all OEMsReMedPar Goodlettsville TN CT, MRI, mammography, portable X-ray, X-ray, cath lab, C-Arm, ultrasoundTownsend Surgical Maryville TN Tracelogix Corp. Memphis TN Operating Room, BiomedicalAllParts Medical Nashville TN Cath/angio, CT, R&F, rad, C-Arm, mammo, portables, MRINCI Austin TX All OEM gamma cameraMedSurg Equipment, LLC. Beaumont TX Medical gas connections, patient monitor cables, patient monitors, cell signal boostersAAN Radiology Systems, Inc. Canyon Lake TX Nuclear systems engineeringElite Biomedical Carrollton TX Physical Therapy, Rehabilitation, Fitness & Exercise, Defibrillator, MonitoringMedical Purchasing Resource, LLC Dallas TX Image Technology Consulting, LLC DeSoto TX Philips, Picker, Siemens, Hitachi MRI Aesthetic Head Pros Elgin TX Polaris Medical Imaging Houston TX MRI, CT, MRI Coils, X-ray Tubes, Amplifiers, Power Supplies

Imaging PartsDMS Topline Medical o�ers a wide-range of used and reconditioned diagnostic imaging replacement parts from Philips, Siemens and GE. Parts are sourced daily and are available for:

We also have a deep inventory of biomedical equipment parts.

Backed by over thirty-�ve years in the imaging business, our team has the expertise and experience to ensure our customers get the right solutions on time at the best price possible.

Visit ToplineMedical.com for more information or contact us today.

Your source for used and refurbished

MRICTPET/CT

X-RayVascularUltrasound


Company City State SpecialtiesAltima Diagnostic Imaging Solutions, LLC Plano TX Laser Scientific Round Rock TX GentleLase, GentleYAG, V-Beam, GentleLase PlusFOBI Tomball TX Sunrise Medical Technology, Inc. Waxahachie TX Siemens, Philips and Picker Marconi CT and MRITransamerican Medical Imaging Lindon UT Philips, Picker, and OEC ImagingVIP Medical, Inc. Alexandria VA Respiratory critical care ventilatorMid-Atlantic Telerad Sterling VA IV Technologies, Inc. Upperville VA OEM IV pump replacementMedical Equipment Services of VA LLC Virginia Beach VA Northwest Ultrasound, Inc. Kirkland WA LuxarCare, LLC Woodinville WA Technical Prospects LLC Appleton WI Siemens and Philips CT, injector, Siemens X-rayShared Medical Services, Inc. Cottage Grove WI MRI, CT, PETAlpha Source Inc. Milwaukee WI Batteries, Xenon and Replacement Lamps, Fiber Optic Cables, Diagnostic Instruments, Medical Oxygen Sensors, Power

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

SERVING THE CUSTOMER IS THEFOCUS OF EVERYTHING WE DO

When REPAIRING or REMANUFACTURING we have the PARTS and EQUIPMENT to help you.

Specializing in Sterilizers, Washers, OR Tables, OR Lights, Solution Warmers, Scrub Sinks and other related equipment.

When you need something as simple as a part number or are in need of technical support with emergency equipment failures, give us a call, we have what it takes to keep everyone on your team happy.

9300 Watson Industrial Park, St. Louis, MO 63126

[email protected]

www.mqpp.com

What makes DOTmed Certified Parts Vendors unique?DOTmed Certified Parts Vendor are required to agree to DOTmed’s code of ethics and to fill out a public profile that clearly displays their industry experience and areas of expertise. In this way, potential customers will be able to find the right fit for their parts needs. The following is a small sample of the more than 120 DOTmed CPV vendors.

The complete list of companies can be found at: www.dotmed.com/features/certified-parts

ADAM Imaging Parts, Inc.714 Atkins Ave.Brooklyn, NY 11208Phone: 347-985-1679Fax: 718-228-6559Email: [email protected]: www.adamimagingparts.com

Years in Business: 11Warehouse Size: 14,000 Sq. FtRevenue % from Parts: 35%Number of Parts Stocked: 20,000Specialties: Diagnostic imaging, X-ray and CT


DOTmed 5-Star Rating:

(107 Ratings)

Image Technology Consulting, LLC1400 Meadowlark LaneLancaster, Texas 75146Phone: 972-223-3008 Fax: 972-223-0586Email: [email protected]: www.imagetechnology.net

Years in Business: 14Warehouse Size: 80,000 Sq. FtRevenue % from Parts: 60%Number of Parts Stocked: 100,000Specialties: Philips, Picker, Siemens, Hitachi MRI



(99 Ratings)

Integrity Medical Systems, Inc.2312 Bruner Lane Fort Myers, FL 33912Phone: 239-454-9555 Fax: 239-454-9599Email: [email protected]: www.integritymed.com

Years in Business: 22Warehouse Size: 16,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 20,000Specialties: Bone densitometer, mammography, C-Arms, X-ray, CT, MRI, nuclear medicine, laser cameras, ultrasound



(89 Ratings)

iServiceQuality MRI service – the cool choice

MRI

For further information contact us directly:Tel: +1 732.850.9323 Email: [email protected] www.oxford-instruments.com/mri

Unbeatable international field service for magnets, cold heads and helium compressors – expertise you can trustChoose Oxford Instruments – our 50 years experience with magnets means you get the very best service and technical support available. Make the cool choice!

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For further information contact us directly:Tel: +1 732.850.9323 Email: [email protected]

Unbeatable international field service for magnets, cold heads and helium compressors – expertise you can trustChoose Oxford Instruments – our 50 years experience with magnets means you get the very best service and technical support available. Make the cool choice!

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C&G Technologies, Inc.6209 Gheens Mill Road Jeffersonville, IN 47130Phone: 812-280-0048 Fax: 812-280-8820Email: [email protected]: www.cgtscan.com

Years in Business: 20Warehouse Size: 44,000 Sq. FtRevenue % from Parts: 40%Number of Parts Stocked: 20,000Specialties: GE and Toshiba CT, GE PET/CT



(77 Ratings)

PRN218 Shove Street, Suite 101 WestFall River, MA 02724Phone: 508-679-6185Fax: 508-677-9614Email: [email protected]: www.prnwebsite.com

Years in Business: 27Warehouse Size: 12,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 5,000Specialties: PAD vascular testing equipment, O/R, Biomedical



(76 Ratings)

Viable Med Services, Inc.16660 Minter Court Santa Clarita, CA 91387Phone: 800-930-7958 Fax: 818-474-7515Email: [email protected]: www.viablemed.com

Years in Business: 5Warehouse Size: 3,500 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 1,000Specialties: Hitachi and Toshiba MRI, Hitachi and Toshiba CT, Siemens PET



(62 Ratings)

Technical Prospects LLC1000 South County Road CBAppleton, WI 54914Phone: 877-604-6583 Fax: 920-757-6591 Email: [email protected]: www.technicalprospects.com

Years in Business: 13Warehouse Size: 60,000 Sq. FtRevenue % from Parts: 95%Number of Parts Stocked: 20,000Specialties: Siemens and Philips CT, injector, Siemens X-ray



(58 Ratings)

Amber Diagnostics2180 Premier RowOrlando, FL 32809Phone: 888-561-7900 Fax: 407-856-5456Email: [email protected]: www.amberusa.com

Years in Business: 19Warehouse Size: 25,000 Sq. FtRevenue % from Parts: 40%Number of Parts Stocked: 50,000Specialties: CT, MRI, C-arm, X-ray, radiographic, bone densitometer, ultrasound, nuclear camera, mammography, R/F Room, Rad/Tomo, cath labs, cath/angio



(39 Ratings)

AllParts Medical400 Brick Church Park Drive Nashville, TN 37207Phone: 866-507-4793Fax: 615-690-5055Email: [email protected]: www.allpartsmedical.com

Years in Business: 4Warehouse Size: 80,000 Sq. FtRevenue % from Parts: 80%Number of Parts Stocked: 14,531Specialties: Cath/angio, CT, R&F, rad, C-Arm, mammo, portables, MRI



(29 Ratings)

ReMedPar101 Old Stone Bridge Goodlettsville, TN 37072Phone: 800-624-3994 Fax: 615-859-4165Email: [email protected]: www.remedpar.com

Years in Business: 23Warehouse Size: 140,000 Sq. FtRevenue % from Parts: 90%Number of Parts Stocked: 38,000Specialties: CT, MRI, mammography, portable X-ray, X-ray, cath lab, C-Arm, ultrasound



(27 Ratings)

Nationwide Medical Equipment Services, LLC638 Mantoloking RoadBrick, NJ 08723Phone: 732-262-3115Fax: 732-262-3105Email: [email protected]: www.nationwideimaging.com

Years in Business: 16Warehouse Size: 40,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 1,000,000Specialties: GE, Philips, Picker Marconi and Toshiba CT and GE, Siemens, Philips MRI



(23 Ratings)

J&M Trading, Inc.409 Space Park North Goodlettsville, TN 37072Phone: 866-568-7234Fax: (615) 851-1842Email: [email protected]: www.jandmtrading.com

Years in Business: 19Warehouse Size: 35,000 Sq. FtRevenue % from Parts: 80%Number of Parts Stocked: 9,500Specialties: All modalities from all OEMs



(38 Ratings)


C&G Technologies, Inc.6209 Gheens Mill Road Jeffersonville, IN 47130Phone: 812-280-0048 Fax: 812-280-8820Email: [email protected]: www.cgtscan.com

Years in Business: 20Warehouse Size: 44,000 Sq. FtRevenue % from Parts: 40%Number of Parts Stocked: 20,000Specialties: GE and Toshiba CT, GE PET/CT



(77 Ratings)

PRN218 Shove Street, Suite 101 WestFall River, MA 02724Phone: 508-679-6185Fax: 508-677-9614Email: [email protected]: www.prnwebsite.com

Years in Business: 27Warehouse Size: 12,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 5,000Specialties: PAD vascular testing equipment, O/R, Biomedical



(76 Ratings)

Viable Med Services, Inc.16660 Minter Court Santa Clarita, CA 91387Phone: 800-930-7958 Fax: 818-474-7515Email: [email protected]: www.viablemed.com

Years in Business: 5Warehouse Size: 3,500 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 1,000Specialties: Hitachi and Toshiba MRI, Hitachi and Toshiba CT, Siemens PET



(62 Ratings)

Technical Prospects LLC1000 South County Road CBAppleton, WI 54914Phone: 877-604-6583 Fax: 920-757-6591 Email: [email protected]: www.technicalprospects.com

Years in Business: 13Warehouse Size: 60,000 Sq. FtRevenue % from Parts: 95%Number of Parts Stocked: 20,000Specialties: Siemens and Philips CT, injector, Siemens X-ray



(58 Ratings)

Amber Diagnostics2180 Premier RowOrlando, FL 32809Phone: 888-561-7900 Fax: 407-856-5456Email: [email protected]: www.amberusa.com

Years in Business: 19Warehouse Size: 25,000 Sq. FtRevenue % from Parts: 40%Number of Parts Stocked: 50,000Specialties: CT, MRI, C-arm, X-ray, radiographic, bone densitometer, ultrasound, nuclear camera, mammography, R/F Room, Rad/Tomo, cath labs, cath/angio



(39 Ratings)

AllParts Medical400 Brick Church Park Drive Nashville, TN 37207Phone: 866-507-4793Fax: 615-690-5055Email: [email protected]: www.allpartsmedical.com

Years in Business: 4Warehouse Size: 80,000 Sq. FtRevenue % from Parts: 80%Number of Parts Stocked: 14,531Specialties: Cath/angio, CT, R&F, rad, C-Arm, mammo, portables, MRI



(29 Ratings)

ReMedPar101 Old Stone Bridge Goodlettsville, TN 37072Phone: 800-624-3994 Fax: 615-859-4165Email: [email protected]: www.remedpar.com

Years in Business: 23Warehouse Size: 140,000 Sq. FtRevenue % from Parts: 90%Number of Parts Stocked: 38,000Specialties: CT, MRI, mammography, portable X-ray, X-ray, cath lab, C-Arm, ultrasound



(27 Ratings)

Nationwide Medical Equipment Services, LLC638 Mantoloking RoadBrick, NJ 08723Phone: 732-262-3115Fax: 732-262-3105Email: [email protected]: www.nationwideimaging.com

Years in Business: 16Warehouse Size: 40,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 1,000,000Specialties: GE, Philips, Picker Marconi and Toshiba CT and GE, Siemens, Philips MRI



(23 Ratings)

J&M Trading, Inc.409 Space Park North Goodlettsville, TN 37072Phone: 866-568-7234Fax: (615) 851-1842Email: [email protected]: www.jandmtrading.com

Years in Business: 19Warehouse Size: 35,000 Sq. FtRevenue % from Parts: 80%Number of Parts Stocked: 9,500Specialties: All modalities from all OEMs



(38 Ratings)

TheLaserOutlet.com1829 Park Lane South #08 Jupiter, FL 33458Phone: 561-747-3616Fax: 561-747-3626 Email: [email protected] Website: www.thelaseroutlet.com

Years in Business: 8Warehouse Size: 10,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 2,000Specialties: Laser handpieces and accessories



(22 Ratings)

The Laser Warehouse1740 East Commerical FT. Lauderdale, FL 33334Phone: 954-254-4612Fax: 954-766-4064 Email: [email protected]: www.thelaserwarehouse.com

Years in Business: 8Warehouse Size: 7,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 5,000Specialties: Cosmetic & aesthetic lasers



(18 Ratings)

International Medical Equipment and Service, Inc.8190 Regent Parkway Fort Mill, SC 29715Phone: 704-739-3597Fax: 704-259-4008Email: [email protected]: www.imesimaging.com

Years in Business: 8Warehouse Size: 24,000 Sq. FtRevenue % from Parts: 75%Number of Parts Stocked: 5,000Specialties: Toshiba CT & MRI, Major OEM MRI & CT



(17 Ratings)

OMED of Nevada LLC800 Stillwell Rd. # 80Reno, NV 89512Phone: 775-857-3008Fax: 775-857-3009 Email: [email protected]: www.omednevada.com

Years in Business: 16Warehouse Size: 24,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 1,000Specialties: Anesthesia, endoscopy, de�brillators, patient monitors, ultrasound, imaging



(17 Ratings)

Tenacore Holdings, Inc.1525 E. Edinger Ave Santa Ana, CA 92705Phone: 800-297-2241 Fax: (714) 549-7835Email: [email protected]: www.tenacore.com

Years in Business: 10Warehouse Size: 18,000 Sq. FtRevenue % from Parts: 40%Number of Parts Stocked: 150,000Specialties: SpO2, ECG/EKG cables, fetal transducers, monitors, infusion pumps, O2 blenders, wall suction regulators



(17 Ratings)

Oxford Instruments600 Milik St. Carteret, NJ 07008Phone: 732-850-9353Fax: 732-802-0401Email: [email protected]: www.oxinst.com/mri

Years in Business: 51Warehouse Size: 20,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 200Specialties: MRI magnet,cold head, compressor



(14 Ratings)

VIP Medical, Inc.8647 Richmond Highway Suite 623 Alexandria, VA 22309Phone: 888-931-9996 Fax: 866-762-6313 Email: [email protected] Website: www.vipmedinc.com

Years in Business: 11Warehouse Size: 22,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 5,000Specialties: Respiratory critical care ventilator



(13 Ratings)

Block Imaging Parts & Service, Inc.5411 Enterprise DriveLansing, MI 48911Phone: 877-621-2887Fax: 517-668-8899Email: [email protected]: www.parts.blockimaging.com

Years in Business: 14Warehouse Size: 23,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 10,000Specialties: All Modalities, All Manufacturers of Radiology Parts



(11 Ratings)

Sound Imaging, Inc.8390 Miramar Pl Suite ASan Diego, CA 92121Phone: 866-530-7850Fax: 858-368-8556Email: [email protected]: www.soundimaging.com

Years in Business: 13Warehouse Size: 20,000 Sq. FtRevenue % from Parts: 60%Number of Parts Stocked: 50,000Specialties: GE MRI and MRI accessories - video monitoring and stereo



(7 Ratings)


Southwest Medical Resources1290 Elm StreetOntario, CA 91761Phone: 877-873-7967Fax: 951-735-3373Email: [email protected]: www.swmedicalresources.com

Years in Business: 8Warehouse Size: 65,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 250,000Specialties: MRI, CT, PET and PET/CT



(6 Ratings)

Troff Medical Services51 Jackson Loop Rd.Flatrock, NC 28731Phone: 828-697-1086Fax: 828-698-4391Email: [email protected]: www.troffmedical.com

Years in Business: 19Warehouse Size: 18,000 Sq. FtRevenue % from Parts: 80%Number of Parts Stocked: 25,000Specialties: Imaging equipment



(6 Ratings)

Mediquip Parts Plus, Inc.9300 Watson Industrial Park St. Louis, MO 63126Phone: 314-968-7585Fax: 314-968-7945 Email: [email protected]: www.mqpp.com

Years in Business: 11Warehouse Size: 15,000 Sq. FtRevenue % from Parts: 80%Number of Parts Stocked: 25,000Specialties: Steris &Getinge Sterilizers & Washers



(4 Ratings)

Axess Ultrasound, LLC8148 Woodland Dr. Indianapolis, IN 46278Phone: 317-275-5577Fax: 317-275-5570Email: [email protected]: www.axessultrasound.com

Years in Business: 6Warehouse Size: 19,000 Sq. FtRevenue % from Parts: 40%Number of Parts Stocked: 10,000Specialties: Ultrasound



(3 Ratings)

TOG2130 Northwest Pkwy Suite AMarietta, GA 30067Phone: 800-755-9640 Fax: 770-319-1560Email: [email protected]: www.technicaloptions.com

Years in Business: 18Warehouse Size: 6,000 Sq. FtRevenue % from Parts: 100%Number of Parts Stocked: 67,000Specialties: Linear Accelerators (most brands), Magnetrons, Thyratrons



(2 Ratings)

Medcorp5735 Benjamin Center DriveTampa, FL 33634Phone: 813-630-5900Fax: 813-630-5999 Email: [email protected] Website: www.medcorpllc.com

Years in Business: 11Warehouse Size: 15,000 Sq. FtRevenue % from Parts: 40%Number of Parts Stocked: 15,000Specialties: Boards, User interfaces, BEP’s, peripherals, Siemens Ultrasound



(2 Ratings)

Absolute Imaging Solutions8205 B&G CourtStokesdale, NC 27357Phone: 336-643-2000 Fax: 336-643-2555Email: gmans�[email protected]: www.ais-nuclear.com

Years in Business: 9Warehouse Size: 10,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 10,000Specialties: ADAC, Philips, Nuclear Medicine



(1 Rating)

Transamerican Medical Imaging965 West 325 NorthLindon, UT 84042Phone: 800-865-8195Fax: 801-796-7363Email: [email protected]: www.transamericanmedical.com

Years in Business: 16Warehouse Size: 35,000 Sq. FtRevenue % from Parts: 60%Number of Parts Stocked: 15,000Specialties: Philips, Picker, and OEC Imaging


DOTmed 5-Star Rating:(Not rated yet)

Minxrad1920 E. Meadowmere Ste. 8-BSpring�eld, MO 65804Phone: 417-597-4702 Email: [email protected]: www.minxrad.com

Years in Business: 3Warehouse Size: 2,500 Sq. FtRevenue % from Parts: 60%Number of Parts Stocked: 300Specialties: Bennett X-Ray Generator Parts, Portable X-Ray Parts, Orex reader repairs, VIDAR repair service



(2 Ratings)

SouthWestMEDICAL RESOURCES




When defense giant Northrop Grumman decided to leave Los Angeles and was shopping around for

a new headquarters, it did something that made finance types take pause: the company outright bought its shiny new 14-story office in Falls Church, Va., in-stead of leasing it as it was expected to do. All of this was done under the shad-ow of impending leasing reform. “Will more follow Northrop’s lead and buy vs. lease?” asked a Washington Tech-nology headline.

Whatever the answer, change is coming to the capital equipment leasing market. From the regulatory reforms that prompted Northrop to buy, to the selective easing of credit and the new strategies of captive lenders, it’s an in-dustry in flux.

And in the words of one analyst, “Bankers get really nervous when things are in flux.”

Mixed message on new leasing rules Leasing reforms aren’t finalized, but many expect the effect on real estate

to be dramatic, to say the least. CoStar Group Inc., a commercial real estate in-telligence company, noted in a September article that reforms will have “a profound and mostly negative impact on commer-cial tenants and landlords.”

But will they impact the medical capital equipment industry? Accord-ing to most expert predictions: yes and no. No, for smaller imaging centers more concerned about cash flow than debt ratios, but possibly yes for bigger health systems trying to adhere to their debt covenants or look sexier for invest-ments and loans.

The Near-Future of LEASINg By Brendon Nafziger

Regulatory reforms, capital crunches and captives’ new game plan. Here’s a brief peak at the near-future of capital equipment leasing.

Southwest Medical Resources1290 Elm StreetOntario, CA 91761Phone: 877-873-7967Fax: 951-735-3373Email: [email protected]: www.swmedicalresources.com

Years in Business: 8Warehouse Size: 65,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 250,000Specialties: MRI, CT, PET and PET/CT



(6 Ratings)

Troff Medical Services51 Jackson Loop Rd.Flatrock, NC 28731Phone: 828-697-1086Fax: 828-698-4391Email: [email protected]: www.troffmedical.com

Years in Business: 19Warehouse Size: 18,000 Sq. FtRevenue % from Parts: 80%Number of Parts Stocked: 25,000Specialties: Imaging equipment



(6 Ratings)

Mediquip Parts Plus, Inc.9300 Watson Industrial Park St. Louis, MO 63126Phone: 314-968-7585Fax: 314-968-7945 Email: [email protected]: www.mqpp.com

Years in Business: 11Warehouse Size: 15,000 Sq. FtRevenue % from Parts: 80%Number of Parts Stocked: 25,000Specialties: Steris &Getinge Sterilizers & Washers



(4 Ratings)

Axess Ultrasound, LLC8148 Woodland Dr. Indianapolis, IN 46278Phone: 317-275-5577Fax: 317-275-5570Email: [email protected]: www.axessultrasound.com

Years in Business: 6Warehouse Size: 19,000 Sq. FtRevenue % from Parts: 40%Number of Parts Stocked: 10,000Specialties: Ultrasound



(3 Ratings)

TOG2130 Northwest Pkwy Suite AMarietta, GA 30067Phone: 800-755-9640 Fax: 770-319-1560Email: [email protected]: www.technicaloptions.com

Years in Business: 18Warehouse Size: 6,000 Sq. FtRevenue % from Parts: 100%Number of Parts Stocked: 67,000Specialties: Linear Accelerators (most brands), Magnetrons, Thyratrons



(2 Ratings)

Medcorp5735 Benjamin Center DriveTampa, FL 33634Phone: 813-630-5900Fax: 813-630-5999 Email: [email protected] Website: www.medcorpllc.com

Years in Business: 11Warehouse Size: 15,000 Sq. FtRevenue % from Parts: 40%Number of Parts Stocked: 15,000Specialties: Boards, User interfaces, BEP’s, peripherals, Siemens Ultrasound



(2 Ratings)

Absolute Imaging Solutions8205 B&G CourtStokesdale, NC 27357Phone: 336-643-2000 Fax: 336-643-2555Email: gmans�[email protected]: www.ais-nuclear.com

Years in Business: 9Warehouse Size: 10,000 Sq. FtRevenue % from Parts: 20%Number of Parts Stocked: 10,000Specialties: ADAC, Philips, Nuclear Medicine



(1 Rating)

Transamerican Medical Imaging965 West 325 NorthLindon, UT 84042Phone: 800-865-8195Fax: 801-796-7363Email: [email protected]: www.transamericanmedical.com

Years in Business: 16Warehouse Size: 35,000 Sq. FtRevenue % from Parts: 60%Number of Parts Stocked: 15,000Specialties: Philips, Picker, and OEC Imaging


DOTmed 5-Star Rating:(Not rated yet)

Minxrad1920 E. Meadowmere Ste. 8-BSpring�eld, MO 65804Phone: 417-597-4702 Email: [email protected]: www.minxrad.com

Years in Business: 3Warehouse Size: 2,500 Sq. FtRevenue % from Parts: 60%Number of Parts Stocked: 300Specialties: Bennett X-Ray Generator Parts, Portable X-Ray Parts, Orex reader repairs, VIDAR repair service



(2 Ratings)

SouthWestMEDICAL RESOURCES



In new rules proposed in September by the Financial Accounting Standards Board, operating leases will be treated more like financial leases. That is, the cost of the lease will be considered a debt, and the value of the right to use the item in the lease an asset, and added to the balance sheets. The new rules are up for public comment until mid-Decem-ber, following the release of a so-called exposure draft, but they’re expected to take effect as early as 2013.

“What used to happen is, you did not have to claim the liability for that lease on your financial statement if you were the lessee, and you also didn’t count the value of the asset,” an analyst told DOTmed News.

The reason for the reform? Better transparency. According to the World Leasing Yearbook 2010, cited by the International Accounting Standards Board, which developed the new rules with FASB, worldwide leasing activity is more than $640 billion a year, much of it not currently shown on lessees’ bal-

ance sheets.“If a firm is allowed to lease a sig-

nificant portion of its assets and keep it off its financial statements, a perusal of the statements will give a very mis-leading view of the company’s financial strength,” according to New York Uni-versity’s Stern School of Business.

Dan Deighan, founder and CEO of Deighan Financial Advisors and a fre-quent talk-show guest on CNBC about the industry, said the purpose of the changes is to tackle “non-accounting cre-ativity,” such as what plagued Lehman Brothers and other banking houses.

“I don’t think the basic changes were meant to really affect companies in the health care business – they were really designed to affect companies in the finance business,” he said.

Nonetheless, there is still plenty of conversation and speculation about how this will affect doctors’ offices, imaging centers and hospitals that lease big-ticket equipment, like MRI and CT scanners. Opinions are mixed, mainly

because the regulation isn’t finalized. Deighan thinks, by and large, it will

be a non-issue.“I don’t think that that is going to

affect leases and leasing companies and people that want to lease equipment. I think it’s going to wash itself out,” he said.

“What it should do on the balance sheet is balance out,” he added. “It’s just that if you were going to be an inves-tor in an MRI center or larger practice you’re now going to see both entries on the balance sheet, whereas in the past, you didn’t see it.”

But not everyone thinks its impact will be so soft. Michael Terry, president of Premier Asset Finance Group Inc., said it would fall heaviest on those most sensitive to their balance sheets, which could be bigger hospitals and hospitals systems that have covenants with their banks and bond-holders. These cov-enants require the organizations to stick to certain debt ratios, which the new rules could make harder.

“A lot of clients are extremely sen-sitive to what this change will do to their debt covenants if they have to re-classify their leases,” Terry observed.

But all are agreed that the traditional attractions of leasing – no up-front cash and manageable monthly payments, with the lessor taking on the risks of ownership – will remain drivers.

“A smaller practice or group prac-tice is looking more at technology and cash flow,” Terry said. And in a recent article, leasing expert Shawn Halliday, author of “A Guide to Equipment Leas-ing” and “The Handbook of Equipment Leasing,” said a survey of CFOs showed that more than 60 percent “would not al-ter their lease financing strategies based on these new rules.”

Still, increased regulations mean increased risks. And increased risks could mean increased costs. “Some lessors also will have to reassess their pricing strategies and performance met-rics,” Halliday noted.

Or as Deighan predicted, “No mat-ter how you slice it, the cost to lease is going to go up.”

Lenders are already “very closely scrutinized by regulators on the re-serve side,” Deighan said. “As a lender,

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you’ve already tightened how much you will lend based on a percentage of assets and how much you will charge. With more questions going on in the leasing market, you’re going to say either, ‘You know, I’m going to step away from doing leasing deals until I know what’s going to happen,’ or ‘We’re going to charge more to cover our anticipated expenses.’”

As for true impact, for now, “It’s hard to tell,” he admit-ted. “There’s a lot of lobbying going on behind the scenes for exemptions and loopholes and different ways to account for things.”

Capital frees up, but banks become coy The capital equipment leasing industry has been through a rough two-year patch. The 2010 annual survey by the Equip-ment Leasing & Finance Association, a capital equipment lenders lobby, is characterized by descriptions like “stunning,” “unprecedented” and “never before.” New business volume dropped a record 30 percent, compared to the 2 percent decline from the year before, according to the survey. Net income de-clined 54 percent, and revenues dropped around 14 percent. ROE was in single digits, for the first time in more than a de-cade. For the health care sector specifically, much of the drop in business is due to reimbursement cuts and tightened access to capital, experts said.

Independent organizations and the smallest companies, with less than $50 million in business value, were hardest hit, according to the ELFA survey. Captives fared the best, al-though they too lost 46 percent of new business volume.

Still, credit has become more available from its 2008 na-dir, according to experts DOTmed News spoke with. Although hard figures are difficult to come by, analysts said they’ve no-ticed a general easing – with more cash available. Meanwhile, banks and other lending institutions have become more wary about lending credit. There’s good reason for their caution — according to reports, delinquencies and full-year losses are at record levels, with full-year losses almost 2 percent of all full-year average receivables.

Companies that seem to be most affected in their ability to get credit are imaging centers, surgical centers and small

physician practices. Group practices, big hospitals and endow-ments tend to be more attractive to lenders.

But the lack of lending comes also from consumer reluc-tance. Some banks have noted a reduced demand for loans. And a recent survey of capital equipment leasing found fewer transactions, in number and monetary volume, partly because of “hesitation by businesses to invest in equipment.”

Because the demand for capital purchases is down, Terry said many of his clients have excess cash on their balance sheets. “They’re using that excess cash, I think smartly, to pay down other obligations they have outstanding,” he said.

New strategies for captives But these trends mean it might be easier to get loans from cap-tives. Because captives want to move products manufactured by their sister companies, they’re often more eager to lend in a downmarket. According to ELFA, captives approved more than two-thirds of submitted credit applications last year, com-pared with banks, which approved only half.

“I would say there’s more receptivity to closer collabora-tion between equipment finance parts of a captive house to try to drive business,” John Sandstrom, senior vice president and general manager, health care, of Siemens Financial Ser-vices, told DOTmed News. “It’s different when the markets are good, and now that’s driving a closer cooperation.”

Of course, it’s a two-edged sword, and captives also have

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the fiercest struggle with delinquencies, according to ELFA, “with their current assets representing only 93.2 percent of their total portfolio at risk.”

Still, in Sandstrom’s view, captives are finding out it pays to be creative – attracting customers by not just financing equipment, but also offering financial help for whatever cus-tomers might need in order to make use of the equipment, such as construction and real estate.

“If you have a hospital with limited flexibility raising cap-ital, we want to bring in a broader set [of resources],” Sand-strom said.

For example, if a health system wanted to build a new medical office building, Siemens could help finance both the real estate and the equipment leasing. Or if a hospital wanted to move equipment from a mobile trailer in-house, the captive could help cover construction as well as equipment costs, “to finance that as one big project,” Sandstrom said.

With this, Sandstrom said captives aren’t in competition with banks, and that one trend that’s growing is for customers to seek out several financial partners.

“The bank has its things it can do, we can come in and complement that and be a second source of capital,” he said.

“People are seeing even in well-banked situations, that due to the financial crisis, it’s good to maintain multiple sourc-es of capital rather than a single player,” Sandstrom added. “You can’t put all your eggs in one basket.” • Online: dotmed.com/dm14262

Brendon Nafziger can be reached by e-mail at [email protected]

DOTmed Registered Leasing and Finance in Medicine Sales & Service CompaniesFor convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 14262]Names in boldface are Premium Listings.

Name Company - Domestic City State Certified DM100 Andrew Majesty Summit Commercial Finance Scottsdale AZCharles Sconyers, Jr. CLS, Inc. Hot Springs ARCrystal Riley Lease With Crystal Valencia CADex Dean Coastal Leasing, Inc. Ft. Lauderdale FLJohn Mc Mahon Quality Medical South Largo FLDaniel P. Deighan Deighan Financial Advisors, Inc. Melbourne FLCliff Peeke Olympia US Funding Solutions, LLC Parkland FLSteve Fix Leasesource, Inc. Atlanta GAJohn Barry U.S. Bank Equipment Finance Chicago ILMax Frodge Ambassador Financial, Inc. Carmel IN •Philips Healthcare Philips Healthcare Andover MADavid Waldron Traction Business Development LLC Fallston MDGary Saulter Chase Industries Grand Rapids MIJim Buckingham Alpha Equipment Leasing Minneapolis MNJohn Lohrman MTR Health Columbus OHCris Warner Earthwood Holladay UTJC Norton Firmco Medical, Inc. Murray UTJim Gibbons Edison Capital Leasing Spanish Fork UT

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ANEStHESIA gets a wake-up callA new system is emerging to manage this critical procedure

By Keith Loria


GE Aisys Carestation


Anesthesia experts believe that anesthesia today is nearly 50 times safer than it was back in the 1980s. Various studies support this belief, de-tailing advancements in monitoring equipment, anesthesia machines and injection devices. Re-

gardless of the equipment updates, one constant still emerges to present serious challenges — the inconsistency of the hu-man reaction to anesthesia.

The fact that people of the same age, weight and health can have significantly different reactions to anesthesia keeps research and development teams busy. And while advance-ments in production of more effective anesthetic drugs, strict-er standards and guidelines for anesthesia practice and patient safety; and increased education requirements are all ongoing, the big topic currently getting the most attention is what’s hap-pening with the implementation of Anesthesia Information Management Systems in clinics and hospitals.

“There are a number of areas in anesthesia delivery that are being highlighted and those would include the ability to moni-tor and determine levels of anesthesia appropriately. In the U.S., a lot of talk has to do with the communication of the data out of the system to centralized recordkeeping,” says Bruce Dam-mann, director of global strategic marketing for anesthesia de-livery and ventilation for Spacelabs Healthcare. “The govern-ment has put a big emphasis on going electronic and a lot of hospitals have started down that path, but anesthesia seems to be the last bastion of paper records.”

AIMS will be critical in making the transition and are in-tended to create a robust medical record. They can also help the anesthesia care provider monitor and track a patient’s vi-tals during surgery along with other perioperative data as the bedside components of the system are interfaced directly with anesthesia machines and patient monitors.

“The problem is, that even as systems become much more electronic and automated, a large percentage of the customer base seem more interested in maintaining the standard way of delivering anesthesia with numeric controls and the look and feel they have grown up with and known throughout their careers,” Dammann says.

In this case, sticking to tradition can cause problems. Missed revenue opportunities can occur when handwritten records are illegible or when records are incomplete and phar-maceutical and supply charges can be missed if a case unex-pectedly becomes complex.

AIMS for improvement“AIMS can be a stand-alone solution or integrated as a module into a broader perioperative clinical information management system,” says Donald Goldberg, Merge Healthcare’s national AIMS product manager. “It is an electronic anesthesia medi-cal record that maintains integrated communication with other hospital and provider systems throughout the perioperative period, such as clinical information systems used by nurses, clinical data repositories used by hospitals and professional fee billing systems in place for the group.”

Even though AIMS systems have been available for more than two decades, the notion of implementing an automated

anesthesia record has just recently become widespread within the practice of anesthesiology.

“AIMS systems are valuable for gathering, analyzing and developing key metrics for improving clinical practices,” Goldberg states. “Quality improvement, compliance and ac-creditation processes can be automated and performed in real-time, rather than using slow and costly retrospective audits of paper charts.”

A recent study published in the journal Anesthesia and Anal-gesia reports an increase in installation of AIMS in U.S. academic anesthesia departments over the past few years. Industry experts further estimate the adoption of AIMS in the United States is cur-rently at about 10 percent and rising, with 15-25 percent growth expected over the next few years.

“Every hospital should examine anesthesia as much as ev-ery other department to eliminate bad processes that start with paper records, missing info, bad memories and bad handwrit-ing in charts,” says Dr. Carlos Nunez, chief physician execu-tive for Picis Inc. “Physicians are embracing this technology and the integrated technology is ready.”

Still, for the majority of hospitals, especially small and mid-sized organizations, paper-based charting is the norm for anesthesia operations.

According to Goldberg, a convergence of recent changes in the healthcare landscape is driving an increased interest in AIMS and adoption of these solutions.

An endorsement by the Anesthesia Patient Safety Founda-tion lends more weight to a solution for use of anesthesia infor-mation management systems as a means of optimizing medica-tion management and data collection. Another popular solution can be found in the 2006 development of the Physician Quality Reporting Initiative by the Centers for Medicare and Medicaid

Merge Healthcare’s Anesthesia Information Management System


Services and its ongoing evolution of the program and increas-ing traction among providers.

“CMS has recently enacted changes to reward hospitals with increased reimbursement for higher quality and to penal-ize organizations through lower reimbursement for poor qual-ity,” Goldberg says.

At Fairfax Hospital in Virginia, more than 50,000 sur-geries are performed each year. Without an AIMS system in place, this creates 50,000 separate paper records. That leads to some big questions: How do you mine the paper record to ensure compliances with these practices? How do you mine a paper record for resource consumption?

“Automated systems create a more valid and true rendering of what’s going on with a patient, and help us record data more infallibly and accurately than we do via paper. We can spend less time charting and more time focused on the patient,” says Goldberg. “The key is to deliver an application that’s pleas-ing to the anesthesiologist and does not distract from care. The interface must be easy to learn and cannot be tedious to use, otherwise doctors will default to paper.”

Anesthesiologist Jeffrey S. Plagenhoff has extensive ex-perience using an AIMS at Southeastern Alabama Medical Center, where the system has been in place for five years.

“It offers a tremendous amount and in the big picture, there is no logical defense for why we should fight to stay with paper and pen,” Plagenhoff says. “We are being tasked to take quality of care and cost of care to new levels. To think that you can reduce cost and improve quality of care without more data and better data analysis and easier reporting is a ludicrous po-sition to defend. You have to have computerized records.”

Plagenhoff says enhanced compliance will lead to a bevy of benefits, including enhanced efficiency analysis, which in turn, leads to a reduction of errors.

“The AIMS must take up as little space as possible in the crowded OR, must ensure transfer of anesthesia-related informa-tion from pre-op to OR to PACU, and must support connectiv-ity for increasingly ‘mobile’ anesthesiologists—across multiple ORs at a single hospital, across hospital systems, in ambulatory surgery centers, and at physician offices,” Goldberg says.

“When evaluating an AIMS, organizations should focus on interoperability and ensure an easy method for creating inbound interfaces to the AIMS, especially with other PCIMS and the EMR. Use of off-the-shelf hardware will be increasingly impor-tant because this will offer cost advantages over solutions that use only proprietary hardware platforms,” he says.

“Unlike most paper-based charting, the AIMS chart is comprehensive and incorporates nomenclature recognized by the coding community,” Goldberg says. “Additionally, an AIMS can provide real-time support to anesthesiologists by prompting specificity for disease-states and co-morbidities, significantly impacting accuracy of DRG coding and, subse-quently, reimbursement.”

It’s no surprise that the most successful AIMS solutions are those allowing the electronic anesthesia record to operate seamlessly with the other hospital information systems, with the interoperability beginning in the operating room and ex-tends in as far as the outpatient areas.

Other trendsDeborah Pienkowski, director of marketing at GE Healthcare, reports that in addition to the EMR solutions, there has been a warmer reception for digital offerings in the anesthesia market.

“GE has the first fully digital anesthesia delivery solution in the U.S.—although there are others internationally—and we are seeing a high acceptance of that product now,” she says. “President Obama is driving his EMR initiatives and as hos-pitals transition to new products, they are definitely interested in digital solutions.”

The company’s Aisys Carestation has the ventilator, va-porizer, and gas mixer all digitally controlled and measured and has sophisticated communication protocols enabling digi-tal data communication between all core subsystems.

“We also have a product called Mobile Viewer the physi-cians can use to actually view the display of a patient monitor by phone or at their computer,” Pienkowski says. “By having that available, they can be alerted to alarms and they can have the information at their fingertips, which helps in this digital age.”

Healthcare Performance Strategies is a consulting com-pany delivering anesthesia and OR solutions to hospitals, aligning incentives and improving bottom-line results in the operating room.

The company’s Dr. Robert Stiefel, an anesthesiologist by training, admits that health care reform has thrown a little bit of an element of fear of the unknown into the world of anesthesia.


“The [existing] platform and the mechanisms by which anesthesia groups contract for services is a little bit uncertain going forward,” he says. “When there is uncertainty, it causes ap-prehension.”

Stiefel says that recently, talk cen-ters on how anesthesia systems can be-come more integrated and believes in-centives will play a key role.

“The world of anesthesia has evolved in an interesting way in the last decade as the compensation has increased dramatically. If you look at studies from a variety of industries, peo-ple respond to incentives and physicians are no different,” he says. “In order to achieve a given outcome, you need to make sure that all integrated physicians are shopping toward the same goals and get rewarded.”

Training on these digital solutions has been a hot topic in the industry. As hospitals transition from traditional nu-meric delivery systems to digital solu-tions, it’s critical that they invest the time

to have personnel train appropriately be-fore they’re live in the operating room.

The great debateIn 2001, CMS enacted a rule allowing states to determine which profession-als could administer anesthesia and the level of supervision required. This rul-ing started a heated debate among those in the field as to whether certified reg-istered nurse anesthetists need supervi-sion when performing their jobs.

When it comes to the actual ad-ministration of anesthesia and monitor-ing of the patient, there is no difference between a nurse anesthetist and an an-esthesiologist. Both use the same tech-niques, the same equipment, the same drugs, adhere to the same standards of care, and put the patient’s comfort and safety before all else.

Still, there are differences of opin-ions over the amount of supervision nurse anesthetists should have as they do their job.

“As we move into uncharted waters

churned by health reform and other fac-tors, there are far more pressing issues than whether one group of qualified health care professionals should hold sway over another group of qualified health care professionals simply on the basis of degrees or credentials,” says Paul Santoro, president of the American Association of Nurse Anesthetists. “In anesthesia, recent research by highly re-spected companies published in leading journals clearly shows that nurse anes-thetists working collaboratively with non-anesthesiologist physicians are safe, cost-effective and a big part of the answer to the nation’s ongoing issues concerning access to health care.”

Three recently published studies at-test to the fact that nurse anesthetists are determined to be part of the solution to today’s overwhelmed health care sys-tem. In April, RAND published a study on the anesthesia workforce that shows the AANA is doing its part to ensure that a sufficient supply of qualified anesthesia professionals are entering the workforce

TWS239

TWS231

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C E R T I F I E

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DOTmed Registered Anesthesia Equipment Sales & Service CompaniesFor convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 14234]Names in boldface are Premium Listings.

Name Company - Domestic City State Certified DM100 Troy Lair The Compliance Doctor, LLC Los Angeles CA • Scott Patneaude Ace Medical Equipment, Inc. Clearwater FL • Robert Stiefel Healthcare Performance Strategies Ft. Lauderdale FL Juan Cortes Sensor Medics Corp. Homestead FL • •Aaron Frye Doctors Depot, Inc. Jupiter FL •Gamal Shanbaky Gamma Medical Equipment, Inc. Miami FL Rodrigo Henao Medilab International Corp. Miami FL Ken Kirby Aneserv Medical, Inc. Dawsonville GA • •Jose Santana ‘R Ventures Medical, Inc. Woodstock GA Stojan Bozinovski Keeboshop Chicago IL Chris Barnett Medical Equipment Services, Inc. Fulton IL • Mike Solot Kingsbridge Healthcare Lake Forest IL • •Justin Jeffries DRE, Inc. Louisville KY Brad Rumph Heartland Medical Louisville KY Ana Ortega General Biomedical Service, Inc. Kenner LA Robert Gaw, Jr. Physicians Resource Network Fall River MA •Matt Murphy North Star Medical St. Louis MO Neil Little DMS Topline Medical Fargo ND Paul Ewald Eagle Biomedical Services Pennsauken NJ • David Ogren OMED of Nevada LLC Reno NV •Sharon Pelusio Medical Arts Support Corporation Brockport NY Angel Berrios Medic Dental Bronx NY Marc Todd Longevity, LLC Brooklyn NY • •Julie Gutterman Pulse Consultants Mason OH Ray Phillips Drand Medical, LLC Oklahoma City OK James Vollbracht Strategic Surgical Solutions, LLC Hales Corners WI •

Name Company – International City Country Certified DM100David Lapenat ANDA Medical, Inc. Ottawa Canada • •

each year. In the May/June issue of the Journal of Nursing Eco-nomics, a study by The Lewin Group showed nurse anesthetists working solo are the most cost-effective anesthesia model. And in the August issue of Health Affairs, the nation’s leading health policy journal, a study by RTI International confirmed that nurse anesthetists provide safe, high-quality anesthesia care.

The researchers from RTI also found no significant dif-ferences when they compared patient outcomes across three scenarios, including nurse anesthetists working without su-pervision; anesthesiologists working alone; or both providers working together.

Dr. Navin Singh is a board-certified plastic surgeon in pri-vate practice and an assistant professor of plastic surgery in the Johns Hopkins University School of Medicine.

“In the state of Maryland, CRNA nurses can practice inde-pendently and we have used CRNA nurse anesthetists at Hop-kins for 15 years without any issues,” he says. “For more com-plicated patients we perform those surgeries in the hospital with MD anesthesiologists.”

Dr. Mark Perloe, clinical assistant professor in obstetrics and gynecology at the Medical College of Georgia, has a nurse anesthetist in his office and understands their importance.

“We have an anesthetist and an anesthesiologist who is the supervising physician and when [the anesthetist] is working, we have standard protocol where they are immediately super-vising her,” he says. “If you are doing general anesthesia, the

anesthesiologist gives the blessing, but really it’s the anesthe-tist who does the case.”

“By the very nature of their role in patient care and admin-istering anesthesia, certified registered nurse anesthetists work in collaboration with physicians, such as surgeons, obstetri-cians and emergency room doctors. In fact, the same is true for physician anesthesiologists when administering anesthesia for patients receiving surgical, obstetrical or trauma care,” says Santoro. “In either case, nurse anesthetists or anesthesiologists are the anesthesia experts and the surgeons are the experts in their specialty. Nurse anesthetists don’t need a physician ‘by their side’ when administering anesthesia any more than an anesthesiologist does, because the physician does not tell the anesthesia professional what drugs to administer, how to ad-minister them or how to monitor the patient.”

The singular difference, however, is that nurse anesthetists have a nursing background and anesthesiologists have a medi-cal background.

“Obviously both have tremendous value, but as Gallup polls have shown time and again, nurses are one of the most trusted pro-fessions,” Santoro says. “This is because of their uniquely human-istic approach to patient care, a quality that the nation’s 42,000 nurse anesthetists bring to the table 32 million times each year.”• Online: dotmed.com/dm14234

Keith Loria can be reached by e-mail at [email protected]


Battle of the bills

Tales of success

and closure By Heather Mayer

As a favor to a friend, John Baran, a retired Pricewater-houseCoopers partner, sat in on an Auburn Memorial Hospital board meeting to take a look at its financial situ-ation. What he saw wasn’t pretty.

“I saw the place was underwater,” Baran recalls. “I went to the first meeting and said to my friend, ‘Jeez, this place is bankrupt, it just hasn’t filed yet.’”

Baran accepted the position of CFO for the Auburn, N.Y.-based hospital in January 2007 after the interim CFO departed. Having been born at Auburn Memorial, Baran has a special place in his heart for the hospital and wanted to bring it to life again. And even though Baran knew the only way out was to seek Chapter 11 protection, or file for Chapter 11 bankruptcy, he was confident that Cayuga County’s only hospital would not close.

“We knew going in, that our strongest asset was the fact that we were the only hospital in town,” says Baran. “If there were two hospitals, we never would have survived.”

The hospital’s largest liability was about $20 million owed to pension plans, which was considered the biggest burden, and about $4 million owed to trade vendors.

“When you’re starting to run out of cash, you fill up your Visa card and max that out, which is what the hospital did, select vendors and push them out — the ones that squeal the loudest get paid first,” explains Baran. “With the pension plans, no one notices [something is wrong] until the year is over.”

In April 2007, the hospital filed for bankruptcy, ironically the first step in pulling itself up by its bootstraps.

How did we get here? Of course, the main reason a hospital files for bankruptcy protection is because it ran out of money. But why do hospitals face such financial distress? The driv-ing factor behind Auburn Memorial’s struggles is not uncommon: physicians left the facility for a number of reasons and were not replaced. Without physi-cians, a hospital can’t treat patients, and cash flow slows or even ceases.

For the hospital, there was a steady decline in admission in the late 1990s and early 2000s as physicians retired and were not replaced. In some cases, physicians were frustrated with management and left, Baran says.

“At the end of the day, the hospital’s customer is the physician,” says Ba-ran. “Physicians admit patients, but you have to have physicians there to treat [patients] in the first place. If you start to lose customers, all of a sudden, ex-penses exceed revenue. It’s a compounding problem.”

In 2006, new management took over the floundering hospital, and ultimately, the decision was made to file and seek help from the government agency, Pen-sion Benefit Guaranty Corporation (PBGC). The agency is designed to protect employees’ and retirees’ pension programs. In the process of moving pensions to


PBGC, only three out of 1,500 Auburn Memorial’s employees or retirees took a pension cut. The three were highly com-pensated physicians, says Baran.

Those who are familiar with hos-pital bankruptcy realize that the key to keeping the money flowing is physi-cians. In fact, one of the warning signs that a hospital is in financial distress is having a poor relationship with its phy-sicians, says Richard Gundling, vice president of Healthcare Financial Man-agement Association (HFMA).

The light at the end of the tunnelBaran realizes that his hospital’s situation was not typical, especially for upstate New York, which has a bad reputation for bankruptcies and closures, he says.

“Bankruptcy usually means to [up-state New York residents], the company is closing,” says Baran. “The fear in ev-eryone’s mind is, ‘Bankruptcy, I’m go-ing to lose my job.’ That’s the pervasive thought.”

Baran’s most important message to employees, he says, was that no one would close the county’s only hospital. The closest hospital would be 30 miles away in Syracuse.

“I remember saying this [when I met with employees]: ‘Yes, we are filing for Chapter 11, but we are not closing. No, you will not lose pension benefits. You will not lose your job.’”

In July 2008 the hospital reached an agreement with creditors, and the court officially discharged the hospital by November of that year. Generally, it takes a hospital 12 to 18 months to emerge from bankruptcy, says Baran.

While the unsecured vendors — about 500 — lost money, it was in their best interest to continue doing business with the now-thriving health care facil-ity, says Baran.

The hospital lost some of its market to the hospital in Syracuse, not due to the bankruptcy, but to the lack of phy-

sicians. This market, including elective surgeries and baby deliveries, has now gone back to the facility, says Baran.

Auburn Memorial is out of the woods except for $1 million it owes to PBGC, which it expects to pay off next year.

“Four years later and we’re still in business, and business is better than ever,” says Baran.

While the situation Baran encoun-tered was rare for the area, it’s not un-common for a hospital to emerge from bankruptcy.

Hospitals that file for Chapter 11 protection give themselves a chance to reemerge, explains Adam Rogoff, a partner in the corporate restructuring group for the Kramer Levin firm in New York. But those that file for Chapter 7 protection pass the company over to

individual management and liquidate, closing its doors.

Facing financial stressIn New Jersey, the recession certain-ly hasn’t helped already-floundering hospitals, says Kerry McKean-Kelly, spokeswoman for the New Jersey Hos-pital Association.

In fact, six hospitals have filed for bankruptcy protection since 2007, which is an unprecedented number, McKean-Kelly says.

“That’s definitely considered a rash number of filings,” she says.

But it wasn’t solely the recession that pushed these hospitals over the edge.

“In reality, the financial pressures on New Jersey hospitals preceded the recession,” McKean-Kelly says. “Re-imbursement pressures on the state con-tributed not only to bankruptcy filings but also hospital closings.”

Of the six hospitals that filed, two emerged: St. Mary’s Hospital and Bay-onne Medical Center.

McKean-Kelly points out hospi-tals can run into financial problems if they accept a lot of patients covered by Medicare, Medicaid or New Jersey’s

Charity Care. “All three of those major government

programs pay hospitals less than it costs to take care of patients,” she says, explaining that Medicare pays New Jersey hospitals 89 cents on the dollar per patient; Med-icaid pays just 68 cents on the dollar per patient; and Charity Care ranges from 15 cents to 96 cents per patient.

“The big issue is what we would call the patient mix,” she says.

In other words, hospitals taking more government-covered patients earn less than hospitals taking more privately insured patients.

New York hit hardNeighboring New York also felt the pain as two major New York City-based hospi-tals succumbed to financial stress earlier this year. St. Vincent’s Hospital in Man-hatten, closed its doors in April after filing for bankruptcy, carrying a debt of $700 million, and Harlem’s North General Hospital filed for bankruptcy and subse-quently closed its doors in June, $200 mil-lion in debt.

Efforts to save St. Vincent’s from closure fell short. The facility was split up, with Beth Israel Medical Center tak-ing on the hospital’s cancer center; Le-nox Hill running the urgent care center; and Mount Sinai Medical Center acquir-ing the HIV/AIDS center.

“In the crucial seconds of a health emergency getting to a hospital in time can literally save a life,” said City Council Speaker Christine Quinn in a statement last February. “Redirecting patients to a hospital miles away is sim-ply not an appropriate response, and we won’t allow our community, especially our senior community, to be left without an emergency care medical center right here, on the west side of Manhattan.”

In April, days before St. Vincent’s closed its doors, Quinn addressed the situation again.

“Only a full-service hospital can fully replace St. Vincent’s Catholic Medical Center,” she said. “However, no hospital has come forward with a proposal to buy St. Vincent’s and [its] massive debt.”

Over the summer, St. Vincent’s was granted court approval to sell its cancer center, hospice and its long-term home

Through online auctions, McLendon was able to reach a wider range of potential buyers, including international buyers.


health business and certified home health agency.

While the West Village was still reel-ing from losing its only neighborhood hospital, the Harlem community was dev-astated when its North General Hospital shut down and its clinics were handed over to the Institute for Family Health.

“We are extremely saddened and disappointed with the … closure of North General Hospital,” the hospital’s union SEIU 1199 said in a statement. “On the heels of St. Vincent’s Hospital, the closure of yet another acute care fa-cility two months later is the regrettable result of continued and repeated cuts to health care funding.”

As a result of the North General clo-sure, a battle between two unions has en-sued. SEIU 1199 employees have been ousted from their positions unless they saddled up with IFH’s union, OPEIU Lo-cal 153, sending former North General employees to the picket lines.

“The patients identify with us because we’re the people they have seen through-out the years,” says former employee Mullin Davis, as she pickets against the new management. “The impact of this hospital closing is, ‘Where am I going to get care? What’s there for me?’”

The American Hospital Associa-tion recognizes the negative effects a bankrupt and closing hospital have on a community.

“Hospitals are the cornerstone of any community, and when a hospital is faced with financial difficulties, it impacts everyone,” said Matthew Fen-wick, AHA’s associate director of me-dia relations, in an e-mail to DOTmed News. “Given the recent economic downturn, many hospitals have faced tough financial decisions about how to keep their doors open to the community. At the worst, those in need can be de-nied vital services, and at a minimum, face a disruption to their case.”

The Greater New York Hospital Association declined to comment for this article.

Making back the moneyWhether a hospital merely files for bank-ruptcy or eventually closes its doors, there is the issue of paying back credi-tors, lenders and vendors. But if a hospi-

tal closes its doors, it will choose to sell off assets to pay back its debt. When hos-pitals are racing against the clock, auc-tions are a common option to sell assets and make back a nice chunk of change.

DOTmed.com, the parent company of DOTmed Business News, offers on-line auction services. Rick McDaniel, auction manager for the company, says even if hospitals need to liquidate their assets immediately, auctions are a good way to get more money.

“It’s a factor of time and exposure,” he says. “Based on that, we can get the most value [for the assets] because we’re not liquidators. We auction the equip-ment in partnership with the hospital, instead of buying low to sell high.”

While it’s hard to guess how much a certain piece of equipment will sell for in an auction — the market is always changing — an auction is a hospital’s best chance at making a dent in debt owed, says McDaniel.

Hospitals have two types of auctions to choose from when selling their assets: live (onsite auctions) or online auctions.

Hospitals may turn to a live auc-tion instead of an online auction if they are short on time. In some cases, a live auction can liquidate assets in anywhere from two to eight days, while an online auction may last several weeks.

Centurion Service Group, a com-pany that manages both online and live auctions, recognizes that live auctions create immediacy.

“A frenzy usually feeds to higher prices, and you can look at the competi-tion in the eye, and that’s where the ego steps in — you’re not going to let this person win, and the price goes up from there,” says Erik Tivin, Centurion’s CEO.

Online auctions, says McDaniel, also create bidding frenzies. Another factor unique to online auctions is the exposure products receive. Online, the audience is limitless.

Lee McLendon, formerly the CEO of Bossier Specialty Hospital, is now in charge of the liquidation of the facility after the decision was made in Septem-ber 2009 to liquidate assets rather than declare bankruptcy.

Through a DOTmed auction, McLendon was able to reach a wider range of potential buyers, including in-

ternational buyers. “I had assets to sell that had a

cost basis of $4.5 million,” he recalls. “That’s a whole lot of stuff. It took a whole lot of transactions. Without open-ing to a broader market [through auc-tions], there’s no way I would have sold all that stuff.”

Economic stressWhile the economy is starting to show signs of recovery, hospitals “continue to be adversely impacted by the linger-ing effects of the economic recession,” based on a hospital survey published earlier this year.

The survey revealed that patients delay or forgo care — 70 percent of hos-pitals reported fewer patient visits and elective procedures. Making the situa-tion worse, almost nine in 10 hospitals reported an increase in care for which the hospital received no payment at all.

In order for hospitals to stay afloat, they have made significant changes, in-cluding cutting administrative costs, re-ducing staff and curtailing services. The survey found that 89 percent of hospi-tals reported they had not added staff or increased staff hours. Ninety-eight percent reported not restoring services or programs previously cut due to the economic downturn.

In 2009, Bankruptcy Creditors’ Ser-vice, Inc. recorded seven hospital bank-ruptcy filings, including three New York hospitals. The company, which publishes the Troubled Company Reporter, a daily newsletter that tracks large companies and their credit quality, reported that nine hospitals have filed for bankruptcy so far in 2010. The report noted that St. Vincent Catholic Medical Centers has liabilities worth more than $1 billion.

And even while cutting costs, there has been a jump in hospital bankruptcy filings, says Rogoff, and those filings are expected to increase.

“There is a greater demand [for] health care services,” he says. “But there is less revenue coming in.”

“At the end of the day, a hospital is still a business,” Rogoff says. • Online: dotmed.com/dm14239

Heather Mayer can be reached by e-mail at [email protected]


State: Fake nursing school closes, agrees to pay restitution to students California Attorney General Edmund G. Brown Jr. has an-nounced that the operator of a nursing school the AG called a “sham” has settled with the state for a half-million dollars. Brown said the school allegedly pretended to offer an accredited nursing program, and deceived the graduates of the school into believing they were qualified to become registered nurses.

Brown said at least 300 students paid $20,000 each for en-rollment and classes at RN Learning Center, which claimed to offer a fast-track program for earning a B.S. degree in nursing in less than two years. “By creating the illusion it was training fu-ture registered nurses,” Brown said in a press release, “the school destroyed the aspirations of hundreds of students who also lost thousands of dollars in wasted tuition. The school will shut its doors today and pay back its former students as fully as it can.”

Brown’s office negotiated the settlement on behalf of the Board of Registered Nursing. The board is currently contact-ing state medical facilities to warn about unaccredited schools. RN Learning Centers’ owner and operator, Junelou Chalico Enterina, agreed to close the business and pay victims restitu-tion of $500,000. Under the agreement, Enterina is prohibited from ever opening a nursing school in California. The settle-ment concludes a board investigation that began in early 2007 which found RN Learning Center had never applied for ac-creditation; at that time, the board ordered the school to close. • Online: dotmed.com/dm14277

Federal: FTC and state officials target medical discount plans The Federal Trade Commission is teaming up with state at-torneys general and insurance commissioners to target outfits attempting to trick uninsured, unemployed and uninsurable consumers into buying discount plansThe FTC announced that the agency and law officials in 24 states have filed a total of 54 lawsuits and regulatory actions to stop the practices.

The FTC charged three companies with deceptively mar-keting medical discount plans. One case involves Consumer Health Benefits Association, which the FTC claims had tele-marketers giving consumers false claims, including: that they worked closely with major medical insurers; that the discount plan was widely accepted by health care practitioners and fa-cilities; and that the plan would save consumers up to 85 per-

cent on medical expenses. After paying the enrollment fees, consumers then allegedly found that providers did not accept the plan and that the “discounted” price was in some cases higher than the price without the medical discount plan.

“With so many Americans struggling to deal with the costs of health care, these medical discount benefit plans sound ap-pealing because they masquerade as health insurance,” said David Vladeck, Director of the FTC’s Bureau of Consumer Protection, in a press release. “But they are not insurance. They don’t offer the benefits of health insurance, and victims don’t know they’ve been ripped off until after they’ve tried to use the service and paid their bill.” The complaints are not a finding or ruling that the defendants have actually violated the law.• Online: dotmed.com/dm14278

State: California legislature passes adverse event legislationThe California Assembly has passed AB 542, which requires the state Department of Health Care Services to create a work-ing group of experts to make recommendations regarding prevention of hospital-acquired conditions. Provisions of the Affordable Care Act will prohibit federal Medicaid from reim-bursing states for such medical adverse events.

The technical working group would evaluate options for implementing nonpayment policies and practices for hospi-tal acquired conditions for the state Medi-Cal program, and provide the best options to various state officials. The bill would require the medical director and the director of nursing of a hospital to annually report adverse events and hospital-acquired conditions to its governing board, including a com-parison to comparable institutions if the data is available. The working group would include representatives from various ar-eas including consumer advocates, California physicians, hos-pital representatives, and representatives of health insurers.

According to the legislative findings of the bill, patients and purchasers of health care services should not be billed or expected to pay for reasonably preventable hospital-acquired conditions. In addition, patients who have been harmed by a hospital-acquired condition must receive any medically neces-sary follow-up care to treat the complications due to the hospi-tal-acquired condition, and that medically necessary follow-up care and services should be reimbursed.• Online: dotmed.com/dm14280

Law & orderBy Astrid Fiano, Esq.

Each month DOTmed takes a look back at the medical equipment that cleared the way for what patients encounter in the doctor offices and operating rooms of today. Some equipment may be recognizable, while other inventions featured here have since become obsolete or have had their usefulness discredited.

Category: Anesthesia

Estimated Date: 1900

Name: Anesthesia set

Manufacturer: Down Bros

Description: 9”x 5”x 8.5” leatherette case. Contains 2 bottles,one 7” hand marked in drams, and fitted into case the second in a canvas case very similar but only 5”. The mask is made of a celluloid like material, 6”x 3.5’x 3.5” with ivory like fittings. Each piece has nickel plated metal attachments, bottles have hooks for hanging. Also in the case is a pump and rubber tubing.


Horace Wells was instrumental in advocating the use of anesthesia. However, the procedure he championed ultimately contributed to his untimely death nearly two centuries ago. Find out what happened to him by reading the December 2008 edition of This Month in Medical History. Just type DM7623 into any search window on www.dotmed.com.

If you have a medical instrument you’d like to donate to the Museum of Historical Medical Artifacts, or you’d like to find out more about the organization, please send an e-mail to [email protected] and your message will be forwarded.


Museum of Historical Medical Artifacts by M. DONALD BLAUFOX, M.D., PH.D. is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.


Parasitologist Patrick Manson was born in Scotland on Oct. 3, 1844, the second of an eventual nine chil-dren. His initial foray into a profession wasn’t a hint at what he would later become or achieve. Manson was apprenticed to an ironmaster’s firm in Aberdeen,

Scotland at the age of 15. But poor health forced him to abandon that pursuit and he instead focused his energies on medicine. He proved to be adept and passed his final exams by 20, even though he was required to be 21 to receive his medical degree.

From this promising start in the field, he only increased his stature with a discovery that has led to millions of lives saved over the past century.

Shortly after receiving his degree, he departed the British Isles to spend more than two decades in China, studying nu-merous diseases.

Manson began his overseas exploits in Taiwan and after more than a decade, found himself pursuing medicine among the populace of Xiamen, China. The Scot provided what medical services he could to the wary citizens, slowly earning their trust. Eventually, he established enough report that he was able to perform a badly needed surgery on a young man burdened with an elephantoid tumor. The success-ful surgery encouraged many more locals to seek his expert at-tention. These medical administrations ultimately amounted, according to Manson’s own records, to more than one ton of diseased tissue being removed from patients.

By 1875, determined to learn as much as possible about elephantiasis, Manson returned to England. He was likely dis-mayed when he learned that there were no answers to be found amongst the English medical community. Still, he persevered in his efforts and came across a promising lead in an unex-pected locale — the British Museum. It was there he came across the recounting of findings by Timothy Lewis of the Army Medical Service. While practicing in Calcutta, India, Lewis discovered the presence of a microscopic worm living in the blood and urine of patients with chyluria.

Manson calculated the amount of worm embryos in an infected person’s system at a given time and concluded that the embryos could not all mature into worms in the same host

without overpopulating the infected system and killing their host and themselves. Based on the deduction, he searched for a solution that would pass embryos from one host to another.

His solution was found in a bloodsucker rightfully more feared than the literary creation of Bram Stoker . . . the mos-quito.

Manson had a ready volunteer in his servant Huito. Hutio had filariasis and by studying mosquitoes gorged on his blood, Manson was able to confirm his suspicions.

“I shall not easily forget the first mosquito I dissected. I tore off its abdomen and succeeded in expressing the blood the stomach contained,” Manson stated in his journals. “Placing

this under the microscope, I was gratified to find that, so far from killing the filaria, the digestive juices of the mosquito seemed to have stimulated it to fresh activity.”

For being so close to the target, Man-son ultimately fell just short with part of his deduction. He believed the mosqui-toes transferred the disease from victim to victim by laying eggs and contaminating drinking water. It would be a few years before Thomas Bancroft would posit the

theory that the infection was transmitted directly by the insects when they fed on blood.

Still, Manson had made a major impact and had many other discoveries to his credit. He would go on to discover the lung fluke and a number of skin diseases, and his theories and research would contribute significantly to the discovery of the mosquito’s role in malaria.

He published the highly regarded Tropical Diseases: A Manual of the Diseases of Warm Climates, founded the world’s first school of tropical medicine in England and helped found the Royal Society of Tropical Medicine in 1907, serving as its first president. He received a knighthood in 1903 and con-tinued his travels and lecturing for years after his retirement, giving his last address at the School of Tropical Medicine in London, just two weeks before his death at the age of 77. It would be no exaggeration to credit Manson’s research with savings thousands of lives since his momentous discoveries and to rightfully name him the Father of Tropical Medicine.• Online: dotmed.com/dm14290

this Month in Medical History

Van Helsing’s nemesis wasn’t so impressive

72

Timing’s everythingA hospital group in the Midwest familiar with DOTmed auctions, having used the services many times in the past, had a time-sensitive project centering on some capital assets.

It had just three weeks to remove two radiology rooms in two different clinics. Both rooms had to be removed in one day to avoid interruption to patient flow.

The rooms were Continental rooms, manufactured in 1996. One of the rooms had a 2002 tube. The hospital group was field-ing offers in the $2,000-$2,500 price range. Potential buyers, aware of the time constraint the group faced, assumed it would take a lower offer to hit the deadline.

Considering the age of the rooms and with the deadline loom-ing, the group was ready to take the highest offer just to recoup what it could and get everything prepared for the installation of the new rooms awaiting construction. In the past, with such a brief timeline, the group would let vendors come in and deinstall the rooms at no cost, but make little or no money on the equipment.

In this case, the group contacted DOTmed and the auction team immediately began to contact potential buyers around the globe. Each room sold for $4,000 and the winning bidders worked with the group to get the rooms deinstalled within the set time. Deinstallation itself took one day, keeping the patient flow moving.


The sweet smell of success . . . againJackson Memorial has been using DOTmed’s full-service on-line auction platform since August of 2008.

Since then, its auctions have generated over $192,000 in sales of idle equipment that likely would have sold for one-third less or in some cases, even outright scrapped.

The most recent success story involved Olympus BF-P30 and BF-P40 bronchoscopes.

In June, online auction specialist Mark Colavecchio visited with Jackson Memorial to inventory and take photos of more items to add to its Virtual Auction House.

The bronchoscopes were part of the inventory photo-graphed, but they were placed in separate auctions.

Shortly after the bronchoscopes were listed, an interested party e-mailed inquiring about the Olympus BF-P30. While speaking with him, Colavecchio discovered the potential buyer was actually looking for more scopes. Colavecchio e-mailed with links to the other scope auctions from Jackson Memorial. The buyer was interested in both scopes, so Colavecchio spoke with his contact at Jackson Memorial and both scopes were moved into a combined auction, ultimately selling for $5,700.

Jackson Memorial has enjoyed the success and ease of DOTmed’s full-service auctions and looks forward to continued success.


old into golddOTmed Premium Auction Success StoriesOld into Gold is provided by the DOTmed Auction Team. These stories represent just a few of the successful transactions DOTmed users experience every month.

Advertise in DOTmed’s 2011 Buyer’s GuideThe Industry Standard!

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Featuring Our Find-It-Fast Categorical Company Index

Cardiology Cosmetic Defibrillator Endoscopy Exam Room Homecare/Rehab Imaging Laboratory Monitors/ICU/CCU Neonatal Neurology Ophthalmology Physical Therapy Pumps Radiation Therapy Respiratory Sterile Processing Surgical Veterinary

2011 BUYER’S

GUIDE

Your Complete Resource for Medical Equipment Sales & Service

Reserve Ad Space for Your Company Today!Issue Date: February 2011 Closing Date: December 15th, 2010

866-999-DOTmed (3686) x “Ads” (237)212-742-1200 x “Ads” (237)[email protected]

…To Your Phone And Call Us Today!

Owen Kane Holdings, Inc.29 Broadway, New York, NY [email protected]: 212-558-6600F: 212-558-6615

Get top dollar for your Siemens MRI or CT


A Full Service Logistics & Transportation Company

www.solutionservices.us732.657.7777

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The most reliable, national Molecular Imaging service network

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BC Technical, Inc., the largest non-OEM Molecular Imaging Solution Provider, is not affiliated with or endorsed by Philips, ADAC, GE, or Siemens.

BCT080_dotmed_HfPg_Ad_Service.FNL2.indd 1 5/11/10 4:06 PM


Uncompromised reliability, quality and value.

1.888.BCTECH1 (1.888.228.3241) www.bctechnical.com

Visit us at SNM / Booth #1301

BC Technical, Inc., the largest non-OEM Molecular Imaging Solution Provider, is not affiliated with or endorsed by Philips, ADAC, GE, or Siemens.

BCT080_dotmed_HfPg_Ad_Service.FNL2.indd 1 5/11/10 4:06 PM


Whatever your imaging needs,wehave the perfect solution.Medical Imaging:●Product &Parts Sales●EquipmentMaintenance●Equipment Repairs &Service●Consultations

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MEDICAL SALES & SERVICES

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• Established 1919• Can help from ground up• No job too small or too big• Interstate & international crating & shipping• Not just an everyday rigger - WE CARE and we show it• Family owned and operated• Available for carribean travel

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Your #1 Source for WholesaleUltrasound Equipment

EQUIPMENT FOR SALE

Autoclave Tabletop:

872305 - MIDMARK m11 ritter Autoclave Tabletop $4,100 Brand new M11 autoclave, excellent unit new in unopened box. Fernando Campos, Trust med, 7863662624

Beds Electric:

877053 - CPI XH1 Beds ElectricProduction name: Electrical hospital bed. Lily Chen, Tianjin Xuhua Medical Equipment Factory, 22 83717985

Bedside Monitor:

888920 - PHILIPS MP 50 Intellevue Bedside Monitor $4,495 16 monitors includes central station, all soft-ware, cables etc, display. Steve Brennan, Med Equip Resale

Blood Gas Analyzer:

888937 - RADIOMETER ABL 555 Blood Gas Analyzer $1,250 Instrument is in working condition. Muthurajan Muthumalai, M.P.Diagnostics

CT Scanner:

889427 - PHILIPS Mx8000 Quad CT Scanner $49,000 I am looking a stable supplier for pre-owned Philips CT “Mx8000 Quad”. ChangBo Kim, Menfis Korea Co., LTD

Cold Laser:

889321 - ERCHONIA Base Station Cold Laser $17,500 Quality Repossessed Medical/Graphic Equipment ACTUAL PICTURES IN OUR LISTINGS. Daniel Delpriora, Nationwide Electronics Repossession Program, Inc.

Dental General:

888973 - SMARTCABINETS Orthodontic Equipment Dental General $1,498 Providence Pedodontic Bench. Joe Travaglini, BuyDentalEquipment.com

Dry Camera:

889087 - AGFA 5302 Dry Camera $5,400 Very good condition, well maintained always. Michael Mcmann, I/O Computer Service Inc.

ECG unit:

664254 - HEWLETT PACKARD HP 43200MC ECG / EKG ECG unit $149 OVER (175) NEW/SURPLUS UNITS IN STOCK!! HEWLETT PACKARD HP 43200MC ELECTRO CAR. BRIAN WARD, OZARK PRODUCTS, 405-627-8853

New and Refurbished Equipment Sales

• Anesthesia Machines • Beds & Stretchers• C-Arms • Defibrillators• Disposables • EKGs • Exam Tables• Infusion & Syringe Pumps• Lab Equipment• Medical Facility Furniture • Pain Management Tables• Patient Monitors• Stress Test Systems • Surgical Lights & Tables• Ultrasounds • Ventilators• And many other items

PULSEConsultants

513-646-3064

[email protected]

For more information on any of theselistings, visit www.dotmed.com andenter the Listing # in any search box.You can post a free classified ad on

DOTmed.com.Just visit our website and register.

To run a classified inDOTmed Business News

call 212-742-1200Ext “Ads” (237)

Search Equipment[ ? ] 456102


EQUIPMENT FOR SALE

PROTONSERVICES INCORPORATED

776 Jernee Mill Road, Suite 120Sayreville, NJ 08872

1 800 793-0190 Fax 732 238-1225www.prosvcs.com [email protected]

customers for choosing Proton

We install, sell and service all types of whole body diagnostic imaging scanners in New Jersey, New York, Connecticut, Florida, and Eastern Pennsylvania.

We now directly repair and asset manage the following modalities:

MRICT

X-RayR&F

Bone DensitometryMammography

Ultrasound(we cover most manufacturers, please call for details)

We also service:Chillers, Cameras, Processors,

and MRI Coils

We correct chronic and intermittant imaginghardware problems, software problems,

application problems, and assist with ACR Accreditations.

EQUIPMENT FOR SALE

Endoscope:

889335 - OLYMPUS PCF-160AL Endoscope $7,500 I have three of these left. Cam Keating, Mobile Instrument Service & Repair

Exam Room Diagnostics:

888940 - WELCH ALLYN Tycos Wall Mounted Exam Room Diagnostics $110 The safe and convenient way to take accurate blood pressure readings. Euyeal Zeleke, Medical Express Trading, LLC

Hematology Analyzer:

889049 - COULTER T890 Hematology Analyzer $1,950 The Coulter T890 is an automated hematol-ogy analyzer with the following parameters: WBC, LYMPH%, LYMPH #, RBC, Hgb, Hct and Plt. Marra Austrie, Inter Bio-Lab, Inc.

889056 - ABBOTT LABS CD-3200 Hematology Analyzer $3,900 this is a working system that comes with flat screen, monitor, keyboard, cables and tubing. Mark Levine, Labworld

Laser - Alexandrite:

833017 - CANDELA GentleLase Laser - AlexandriteCall for specs, pricing, and delivery. Dan Herbert, Laser Concepts-Cosmetic Laser World, 866-930-4313

Laser - Diode:

889243 - SYNERON E-Laser Laser - Diode $12,500 This is a 2006 Syneron E-Laser in perfect working order. Mike Moreno, MedPro, Inc.

Laser - IPL:

861522 - GLOBAL BEAUTY Q1600 Laser - IPLIPL Q1600 button screen Double treatment heads(SR,HR) Advantage 1. Ria Liu, Guangzhou Qunhao Electronic Technology Development Co., Ltd., 020-62838260

MRI Scanner:

889279 - HITACHI 262PN MRI Scanner $1,000 Always need Copley Controls Gradient Power Amps model 262PN for Hitachi Airis systems. Greg Bress, Hanneman Interenational

Magnet:

888932 - HITACHI AIRIS II Magnet $165,000 installed and calibrated with 90 days warranty available right away. Raymond Gonzalez, Medical Hi-Tech, Inc.

Nuclear Gamma Camera:

888938 - GE OPTIMA Nuclear Gamma Camera $35,000 GE optima, in great condition. Israel Silva, American Imaging Solutions

O/R Camera:

889177 - STRYKER 988 O/R Camera $1,700 Stryker Endoscopic Camera Set, Model 988. Angelos Panagopoulos, Pantur. Inc.

St. Petersburg, FL

Ontario, CA

Brick, NJ

The Leader in Professional Pre-Owned Imaging Equipment

Sales and Service

We now offer Coast to Coast:• Full Service Contracts• Time and Material• Preventative Maintenance

www.nationwideimaging.com

Sales: 732-262-3115 [email protected]

Service: [email protected]

Reasonable Price, Quick or Good,

Pick any two

Toshiba

Nationwide OEM Trained Engineers

The Viable Alternative to OEM Service

HitachiSiemens

• Service• Parts

• Installations• Sales

www.viablemed.com800-930-7958 • 661-373-1977

Call Us Today!


Orthopedic - General:

889442 - ZIMMER Cast Saw+ Vacuum Orthopedic - General $300 Zimmer Cast Saw Model 8909-01 serial 5629 + Zimmer Cast Vacuum. Paul Millthorpe, Millmedlabequip

Oxygen Monitor:

889418 - MSA MiniOX 3000 Oxygen Monitor $399 MSA MiniOX 3000 Oxygen Monitor. Bruce Watkins, Med Flight Auctions

PACS/RIS:

845153 - EESI Pocket PACS Archive #4200 PACS/RIS $4,910 Compact Web-Enabled Pocket-PACS Archive. Tony Evans, Essential Enterprise Solutions, Inc, 7279383374

888997 - EESI Disc Publisher #5100 PACS/RIS $7,995 Medical Disc Publisher, enables medical professionals to create a complete and por-table medical record. Tony Evans, Essential Enterprise Solutions, Inc, 7279383374

Pump IV Infusion:

889409 - BAXTER Colleague Pump IV Infusion $345 Size: 10” X 7. Izabella Shniperson, Lises

Rhinolaryngoscope:

889163 - VISION SCIENCES ENT-3000 Rhinolaryngoscope $3,500 LOOKS BRAND NEW!!! Scope has 0 broken fibers, all OEM tubes, comes with case, . Jaclyn Maglasang, EndoscopyMD

Scale:

889387 - HEALTH-O-METER 599KL Scale $265 Digital Scale Model #599KL Waist Height Capacity: 600 lb / 272 kg Resolution: 0. Steven Cohen, Medical Equipment Exchange

Scope Accessories:

889512 - STORZ 26330040 New, Reusable Sterilizable silicon tubing set Scope Accessories $999 New, Reusable Sterilizable silicon tubing set with pressure dome/transducer for use with Endomat for Hysteroscopy. M. Ashfaq, Endosource Inc.

Spirometer:

889422 - SPIROMETRICS Flomate III Spirometer $1,250 Priced without printer (printer available as option). Kenneth Sanders, Mediscan

Sterilizer:

889030 - MIDMARK M7 SPEED CLAVE Sterilizer $1,195 REFURBISHED M7 AUTOCLAVE. Dave Hill, Portland Surgical Sales LLC

Stretcher:

889524 - UNKNOWN BL-600 XLE Stretcher $7,500 This is a mobile treatment table, equipped with four swivel rollers and locking mecha-nism. Phyllis Barber, MSI Equipment

Sutures:

889350 - ETHICON Asst~ Misc. Boxes Sutures $125 This is for a group of misc. Terry Koehler, MedExtras

Tympanometer:

889141 - WELCH ALLYN 71170 MicroTymp 2 Tympanometer $1,500 Pre-owned, New - outside packaging may be open or missing. Lori Weidow, KMA Remarketing

Ultrasound Transducer Ultrasound:

873449 - PHILIPS D2cwc Ultrasound Transducer UltrasoundPhilips D2cwc Continuous Wave Transducer CW Ultrasound Probe. Yolanda Diaz, Star As-set Recovery, 352-795-0098

Urology Suite:

817821 - LIEBEL-FLARSHEIM HYDRAVI-SION PLUS DR Urology Suite $27,975 PRE-OWNED Hydra Vision Plus DR Urological Imaging System Liebel-Flarsheim MDL#. BRIAN WARD, OZARK PRODUCTS, 405-627-8853

Vet. Ultrasound Ultrasound:

889404 - GE Dataline Vet. Ultrasound Ultrasound $1,350 In stock a General Electric Dataline Ultrasound in good working condition. Juan Sandoval, Monterrey Medical Equipment

Video Endoscopy:

888899 - PENTAX EC-3801L Video Endoscopy $1,600 PENTAX EC-3801L Video Colonoscope Flex-ible Endoscope This is a Pentax EC-3801L Video Colonoscope. Paul Preston, DMI.Med

Wheelchair:

889238 - DRIVE MEDICAL ** NEW ** Deluxe Fly-Weight Aluminum Transport Chair with Removable Casters Wheelchair $170 . Reuven Kohn, All Time Medical

X-Ray Service Tools:

889257 - CPI AEC Set-up Kit X-Ray Service Tools $650 Complete AEC set-up kit including carrying case. Art Gaines, ARTEC IMAGING

Light Source:

815493 - GE Light Source Part #CXE300/BF300w ceramic xenon light source. Lu-Ann Buckholz, Specialty Bulb Co Inc, 631-589-3393

O/R Exam light:

707834 - AMSCO O/R Exam light Part #P129362-228MEDICAL/SCIENTIFIC BULBS CALL LUANN AT SPECIALTY BULB CO, BOHEMIA, NY HALOGEN-XENON-O. LuAnn Buckholz, Specialty Bulb Co Inc, 631-589-3393

EQUIPMENT FOR SALE

PARTS FOR SALE

Pan A

m

Im

agin

gPan Am Imaging

For All Your GE MRI Equipment Parts Needs

908-769-7070www.panamimaging.com

Brand new and used/pre-owned MRI parts, with 6 months minimum warranty

Replacement parts for diagnostic medical imaging equipment.

Used/pre-owned and refurbished parts, with

We maintain a large inventory of parts,

warehouse in New Jersey.

We can provide the parts you need at very competitive prices.


EMPLOYMENT OPPORTUNITIES

888149 – CT Service Engineer Position Available, South CarolinaGreat opportunity with a solid and growing company. At least 10 years of Toshiba experience required. Please contact us for more details. Trey McIntyre International Medical Equipment and Service, Inc. Phone: +1 704-739-3597 x4000

875543 – Pharmacy Position Available, FloridaClinical Pharmacist job in Florida. Seeking clinical Pharmacists to join one of the best places to work in Florida. Please refer to job# JK1419Nx Phil Armfield, Staffpointe, 888-333-4585

864371 – Sales Salesperson Position Available, Minnesota, USASalary: Base plus commission GMI, Inc is currently looking for people that are self-mo-tivated and interested in a sales career. Must have laboratory sales experience or have worked in a laboratory. Send a resume and a cover letter detailing why you should be hired. Richard Powell Global Medical Instrumenta-tion Inc Phone: +1 763-712-8717 x6823

872616 – Anesthesiology Position Available, New York, USA Salary: 127,500- 140K Great career opportunity for a CRNA in Brooklyn, New York. Join one of the largest anesthesiology groups in New York. Salary of 127,500- 140K, dependent on experi-ence. Includes full benefits package. Flexible shifts. Some weekends and holidays. No set schedule. Either a 24 and a 12 hr or three 12 hr. Please reference Job# JS8286

817429 – Radiology Service Engineer Position Available, USAField Service Technician with five (5) years experience for TX, LA, AR, OK. Strong electronics, computer and digital background needed. Experienced in repair, modifications and preventative maintenance of Imaging and Diagnostic equipment. Job requires some travel with expenses paid and vehicle provided.

536242 – MRI Technologist Position Avail-able, USA Salary: based on experience MRI tech to start in Vermont, Virginia, Missouri, Tex-as, Illinois. Must be ARRT, current state license (any state) CPR, etc. Siemens Avanto, GE HDx, Philips Intera , 2 yrs min. experience M-F 8-5 One year contract with optional one year.

ADVERTISER INDEX

Association of Medical Service Providers

Our mission is to provide superior products and services to our customers through a network of local Independent Service Organizations. We provide AMSP members the support of one of the largest and most technically competent national service organizations in the country.

FSE Employment Opportunities

Looking to employ MRI, CT and X-ray field service engineers. Benefits include:

region of the country

Please upload your resume on the AMSP web site

www.amsp.net

Absolute Imaging Solutions, LLC 43 www.ais-nuclear.comADAM Imaging Parts 42 www.adamimagingparts.comAFC, Industries Inc. 26 www.afcindustries.com Altima Diagnostic Imaging Solutions 12 www.altimadis.comAmber Diagnostics 50 www.amberusa.comAmpronix Imaging Technology 2 www.ampronix.com ANDA Medical 11 www.andamedical.comAtlantis Worldwide, LLC 4 www.atlantisworldwide.comBay Shore Medical, LLC 36 www.bayshore-medical.comBlock Imaging Parts & Service, Inc. 46 http://parts.blockimaging.comC&G Technologies 22, 40 www.cgtscan.com Complete Medical Services 59 www.completemedicalservices.comDMS Health Technologies 51 www.toplinemedical.com Drand Medical 1 www.drandmedical.com Dunlee, Inc. Inside Front Cover www.dunlee.comEarthwood Commercial Lending 60 www.earthwoodlending.com

Engineering & Network Systems, Inc. 58 www.ens-imaging.comFirst Call Parts 48 www.firstcallparts.com GECO 49 www.gecousa.com Hitachi Medical Systems 9 www.hitachimed.com Image Technology Consulting, LLC Inside Back Cover www.imagetechnology.netIntegrity Medical Systems, Inc. 35, 45 www.integritymed.comInternational Medical Equipment & Service 41 www.imesimaging.comJohnson Thermal Systems 25 www.johnsonthermal.com Life Systems, Inc. 31 www.lifesystemsinc.comMedcorp, LLC 16 www.medcorpllc.comMedEquip Biomedical 13 www.medequipbiomedical.comMedical Hi-Tech, Inc. 10 www.medicalhitech.comMedical Imaging Resources, Inc. 14 www.medimagingsales.comMediquip Parts Plus, Inc. 52 www.mqpp.comMEDRAD, Inc. 7 www.medrad.com/mvsMetropolis International 30 www.metropolismedical.com

Nationwide Imaging Services, Inc. 15 www.nationwideimaging.comOncology Services International 29 www.thinkosi.comOwen Kane Holdings, Inc. 73 www.owenkane.comOxford Instruments 53 www.oxford-instruments.com/proservePulse Consultants 63 www.pulseconsultants.com Radiology Oncology Systems 27 www.oncologysystems.com ReMedPar 47 www.remedpar.comTechnical Prospects, LLC 39 www.technicalprospects.com Tenacore Holdings, Inc. 64 www.tenacore.com Therapy Remarketing Group 28 www.therapyrg.comTOG 44 www.technicaloptions.com TransAmerican Medical Imaging 37 www.transamericanmedical.com Unfors Instruments, Inc. 8 www.unfors.comVarian Medical Systems, Inc. Back Cover www.varian.com/interayViable Med Services, Inc. 33 www.viablemed.netSPECIAL Certified Parts Vendor AD Section 53-56

ADVERTISER ADVERTISER ADVERTISERPAGE PAGE PAGE


IMAGING

PLANAR Computer Monitor PACS Worksta-tion This auction is for a PACS workstation. It includes: three Planar Dome E3 Monitors – two portrait one landscape. One ACER monitor model AL1914 HP Xw6300 Workstation HP Compaq dx2000 MT and two keyboards. Lanier VoiceWrite Telephone w/ Dictaphone. Auction #15110 – sold for an imaging center in Texas, $15,000.

INVIVO MRI Accessories 3150M, 3155A This auction is for an INVIVO 3150m Physiologic Gas Monitoring System with INVIVO 3155A Monitor. System is complete with all accessories and in perfect working condition. Auction #15589 – sold for a hospital in Ariz. $5,000.

PHILIPS Cath Lab Integris H5000C This auction is for two identical Philips Integris H5000C’s with MRC X-Ray tube and Clinical View station Software package. Both were installed in 2000. This low use integrated imaging system for the heart comes from a prestigious hospital in Florida. This preferred single plane cardio system comes with a ceiling suspended C-arm stand and digital imaging segment. System includes: SyncroNet System Architecture SyncraTouch, SycraPulse, SyncraView. G-arm stand with motorized park AD-5 table OMCP Generator 9” II/XTV MRC tube Roadmap 1 Cinical viewstand software package Standard line rate video output Pan Handle PDU Cables Table mounted radiation shield Cabinet boxes The Integris H5000C is based on SyncraNet System Architecture with distributed intelligence in each of four discrete segments, all of which are linked by a fiber optic LAN. Geometry Segment - motorized, ceiling suspended G-arm - agioDIAGNOST-5, floor mounted patient support - SyncraTouch table side Geometry and imaging Module - Automatic Col-limator - Automated Wedge Filter - Accessories including pan handle Includes an MRC-GS X-ray tube Fluoroscopy: - three programmable modes of digitally processed fluoro - twelve programs for cine acquisition MRC-GS 05/08 X-RAY TUBE - SpectraBeam pre-filter - SyncraPulse Pulsed progressive fluoro - 2.4 MHU anode heat storage capacity - 900 KHU/min heat dissipation Storage capacity of 36,000 images. Auction #15885 – sold for a hospital in Fla. $40,000.

TOSHIBA Nuclear Gamma Camera GCA 7200A Dual Head This auction is for a Toshiba GCA 7200A Double-headed Nuclear Gamma Camera. DOM 1996 Unit was used both for cardiac and full body. Model# GCA 7200A SNBB6622123 Gamma Camera Stand M# NGSD-720B Col-limator Exchange Cart M# NGEC700A Export Kit M# NZEX-723B Rail M# NARS700A Currently installed and in working condition. Presently used on patients. This equipment must be removed by April 1, 2010. Please be ready to make removal arrangements if you are the Suc-cessful Bidder. Unit was under Toshiba service agreement until Sept. 2009 The DiCOM box CA is included Software level is 5.0E – at least, may

have been upgraded. The unit is located on the 1st floor and a loading dock is available. Route to dock is through hallways. Cosmetic rating level is 8 Model of computer is AS44085 Hot lab is not included. Auction #16337 – sold for a hospital in Texas $1,000.

PHILIPS X-Ray Tube MRC 600 This auction is for a MRC 600 Philips X-ray Tube. Compatible with Brilliance 16, 40, 64 Power and Gemini 16 Power. This unit was purchased from live on-site auction. Current owner was told this Tube was in good working condition at time of removal. Stor-age Box Dimensions: 27W x 26D x 35H Weight 282 pounds. Auction #16752 – sold for a dealer in Penn. $8,000.

ATL Shared Service 3000 This auction is for a 1998 ATL 3000 Shared Services Ultrasound. This unit can perform: *OBS *Cardiac and Gen-eral Software *Color Doppler This Ultrasound comes with 6 Transducers: *Curved array C 4-2 *Curved array C9-5 ICT *Phased array P3-2 *Linear Array L7-4 *Linear Array L10-5 Broadband *CW Doppler D10CW 10.0 MHZ All transducers come with original packaging. This unit has been used for 5 years and is in excellent condition. Accessories: VHS recorder. Manuals are available. Auction #11914 – sold for an ISO in Quebec, $6,900.

PICKER Nuclear Gamma Camera AXIS This auction is for a PICKER Axis Nuclear Gamma Camera. This unit was manufactured brand new: September 1999 -Double-headed camera -This system performs both cardiac and whole body scans -This camera is in daily clinical use. This unit is comes with a Digital detector and collima-tor Model of computer: Odyssey FX The camera is under full manufacture service contract. Please inquire for service records. This unit is being sold because facility has recently updated to new technology. Auction #16325 – sold for a hospital in Iowa, $5,000.

MONITORS

COROMETRICS Fetal Monitor 170 This auction is for a Corometrics 170 Series Fetal Monitor. Auction #9598 – sold for a hospital in Tenn. $1,050.

LABORATORY

ABX Hematology Analyzer Micros 60 This auction is for an ABX Micros 60 hematology analyzer. ABX Micros 60 is a fully automated hematology analyzer from ABX Diagnostics (renamed as Horiba ABX). Horiba ABX Micros 60 is a powerful tool best suited for use in any physician’s office lab, hospitals, and small clinics. Auction #10966 – sold for a hospital in Texas, $2,500.

PHYSICAL THERAPY

ZIMMER Muscle Stimulator Sona 5 Ultrasonic Diathermy + Galva 5-M Muscle Stimulation Device This auction is for a Sona 5 Ultrasonic Diathermy + Galva 5-M Muscle Stimulation De-vice. Manufactured by Zimmer MedizinSysteme This unit is brand new in a box. * Sona 5 Micro-Processor controlled ultrasonic diathermy device two Treatment Heads (0.8 MHz and 3MHz) User Manual * Galva 5-M Muscle Stimulation device 1 Main Cable 1 Patient Cable Hygienic Single-Use Electrodes, small Hygienic Single-Use Electrodes, large 2 Pair Electrode Cables 1 User Manual * System Cart Features/Specifications: * Digital, quartz-controlled Time Display * Cou-pling Display * Bar Graph. Auction #16742 – sold for an ISO in Texas, $1,200.

PUMPS

BAXTER Pump IV Infusion Colleague 3 CX This auction is for ONE (1) Baxter Colleague CX Infu-sion Pump There are nine (9) available. Auction #16257 – sold for a hospital in NY, $17,775.

SURGICAL

STRYKER O/R Light Visum Surgical Light This auction is for a pair of Stryker Visum Surgical Lights 682 000 106. Please note that one set has two lights. Your bid amount is for one set. If you are bidding on more than one set, you will have to multiply the amount you bid by the num-ber of sets you wish to bid on. Auction #16758 – sold for a hospital in Texas, $1,000.

OPTHAMALOGY

BAUSCH & LOMB Topographer Orbscan II This auction is for an Orbscan II Topographer that is in very good condition. It was purchased new in 1999. This optical mapping or corneal topogra-phy system mapping system is a diagnostic tool that shows the overall architecture of the cornea including surface power, thickness, front and back shape. Auction #10651 – sold for a group in Calif., $12,000.

OTHER

CINCINNATI Hypothermia Unit Hemotherm 400MR This auction is for a Cincinnati Hemo-therm 400MR. Serial Number: 013-11770M. Auction #15391 – sold for a hospital in Calif., $2,000.

blue book price guideRecent equipment and parts auctions on DOTmed with actual sale prices.

DOTmed AuctionsWant to auction equipment

on dotmed.com? Contact an auction specialist.

212.742.1200, ext. 296 or [email protected].

PHILIPS PARTS. PICKER PARTS. SIEMENS PARTS. HITACHI PARTS.

| |

**Philips, Siemens, Hitachi, and Picker are all registered trademarks

|

USA Contact Information Varian Interay 1-800-INTERAY TEL 843.767.3005 FAX 843.760.0079 E-mail [email protected]

Europe Contact Information Varian X-ray Products Germany TEL 49-2154-924-980 FAX 49-2154-924-994 [email protected]

Replace your Senographe 500T, 600T, 700T, 800T,DMR, or DMR+ with a Varian!

Replacing your GE Mammography Tube?

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M-152: replaces the GE D4142M & D4172M. Rhodium/Moly track. Designed to calibrate on DMR and DMR+ systems.

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Contact Varian Interay or your favorite dealer for all your GE mammography replacement tube needs today!

10_2010

Documents

health care providers

new york

whats new

editor of dotmed business

big business

new product showcase23

anesthesiaa new system

issue of dotmed business