Ideas for Hospitals, Centers, and Practices

Get with the Program!
Philips Makes Strides in Dose Reduction
Marketing Mammography and More

Get with the Program!

With an eye on 2012 Medicare requirements, the Virginia-based American College of Radiology (ACR) began its Breast Magnetic Resonance Imaging Accreditation Program (BMRAP) in May. Designed to help imaging professionals prepare for new rules, the program fills crucial government reimbursement criteria.

Specifically, all CT, PET, nuclear medicine, and MRI (including breast MRI) providers who bill under part B of the Medicare Physician Fee Schedule must eventually be accredited before they can receive the technical component reimbursement. Because of this new requirement, Constance Lehman, MD, PhD, recommends that facilities submit applications to the ACR at least 6 months before the January 1, 2012, rules go into effect?to ensure uninterrupted billings. Until then, accreditation is voluntary.

More than 200 imaging facilities have already expressed interest in participating in the ACR?s new Breast MRI Accreditation Program.

As chair of the ACR Committee on Breast MRI Accreditation, Lehman says the ACR is preparing to meet increased demand by boosting many areas, and relying on several factors such as:

1. expertise and infrastructure to assist large numbers of advanced medical imaging providers to get accredited and protect reimbursements by the January 1, 2012, CMS deadline;

2. more than 20 years of experience accrediting over 20,000 facilities;

3. a dedicated staff of certified radiologic technologists to guide providers; and

4. comprehensive, yet flexible processes where special attention is paid to image quality, in addition to equipment, quality control, quality assurance, safety, and personnel qualifications.

According to Lehman, ACR accreditation is valid for 3 years and costs $2,400 for the first unit, with slightly higher fees for each additional unit. If a facility submits all of the requested information within ACR deadlines, the entire process typically takes 4 to 6 months.

Like other ACR accreditation programs, BMRAP enables facilities to improve and maintain excellence through a peer-review assessment of processes, equipment, and image quality. For facilities that solely offer breast imaging services, the new program also fulfills any applicable accreditation requirements under the Medicare Improvements for Patients and Providers Act of 2008.

?This program will help patients and their providers identify practices that provide high-quality breast MRI,? said Lehman. ?This accreditation program sets quality standards for breast MRI providers and helps them continuously improve patient care by evaluating the qualifications of personnel, equipment performance, effectiveness of quality control measures, and image quality.?

Facilities must submit clinical images and corresponding data for each magnet performing breast MRI examinations at their site. Facilities performing breast MRI must have the capacity to perform mammographic correlation, directed breast ultrasound, and MRI-guided intervention?or create a referral arrangement with a cooperating facility that could provide these services. The cooperating facility must be accredited by the ACR in breast MRI (or, until May 10, 2011, has had an application for breast MRI accreditation accepted by the ACR).

?As the most widely recognized medical imaging accrediting body for more than 20 years, ACR accreditation programs are recognized by patients and payors as the industry gold standard and a sign of an extraordinary commitment to quality care,? added Harvey L. Neiman, CEO of ACR. ?More than 200 facilities have already expressed interest in participating in the ACR Breast MRI Accreditation Program, and soon after May 10 they received instructions on how to get started. We are excited to offer this new breast MRI accreditation program and look forward to working with facilities to help them offer the highest quality patient care.?

For more information regarding the ACR Breast Magnetic Resonance Imaging Accreditation Program (BMRAP), call (800) 227-6440 or e-mail: .

?Greg Thompson

Philips Makes Strides in Dose Reduction

Since it first arrived on the imaging scene in the 1970s, CT brought with it the quest to minimize radiation exposure while maintaining diagnostic image quality.

Jason Plante, director, Global CT Field Marketing for Philips Healthcare, recalls that iterative reconstruction, a dose reduction technique, has sought to provide diagnostic images at low dose levels since as early as the 1980s.

?This technique optimizes the actual amount of delivered dose by comparing estimated patient data from a CT scan with real measured data in an ?iterative? way until desired image quality is achieved,? Plante explained. ?Unfortunately, it has been so computationally intensive that it has never been practical to implement.?

Now, significant strides have been made using iterative reconstruction techniques. After years of hard work from its team of engineers, scientists, and physicists, Philips showcased its iDose technology during the recent Radiological Society of North America meeting in Chicago.

According to Philips, the iDose enables up to 80% less dose while maintaining diagnostic image quality. Plante said the technique takes the raw data output of the CT detector and iteratively creates and compares noise and anatomical statistical models. ?In addition to removing noise, an anatomic model is created to ensure that no anatomy is lost in the reconstruction,? Plante continued. ?The result is diagnostic image quality at lower dose levels than previously achievable.?

Plante offered several reasons why the radiology community should be excited about the iDose, which he points out lowers dose without adversely affecting image quality. ?In fact, one of the advantages of iDose is that it is designed to provide the exact appearance as the original full dose images,? he said. ?So the radiologist doesn?t have to ?get used to? a new type of image quality. iDose can be easily integrated into a radiologist?s daily routine.?

Furthermore, Philips has developed a new console called RapidView IR, designed to offset the computationally intensive nature of the algorithm. Specifically, RapidView IR is said to reconstruct iDose images without compromising speed.

Because the iDose interfaces with Philips? existing dose reduction tools, technologists do not need to worry about altering the exam plan. Plante also highlighted another benefit for managers of health care facilities. ?In competitive local environments, dose reduction tools such as iDose can be key differentiators to drive referrals. Being able to promote significantly lower dose levels than your competitors can be a powerful marketing tool in the community.?

As far as pricing is concerned, the iDose varies geographically but is roughly 15% to 20% of the cost of today?s high-end CT scanners, Plante said. ?This is a novel, new method to reduce patient dose resulting from a significant investment in development resources,? he said. ?The price is reflective of the software development and hardware cost for the new RapidView IR console in addition to improved image quality at lower dose levels and differentiating aspects for the customer, which could drive new referrals.?

Available for sale on all iCT and Brilliance 64-channel models, iDose is slated for commercial delivery in the second half of this year. Plante said Philips hopes to deliver iDose to other scanners in the portfolio; however, the company cannot make any commitments at this time.

In addition to the iDose, at RSNA 2009, Philips showcased several new features for the iCT platform that were introduced in the fall.

Philips displayed its 128-slice, 4 cm configuration of the iCT called Brilliance iCT SP. With the new release, the iCT platform is fully scalable in terms of detector coverage (from 4 to 8 cm), tube power (from 100 to 120 kW), rotation speed (0.3 sec to 0.27 sec), and slices (128 to 256). Also, the company introduced its 100 kV station, which can serve as a dose reduction or contrast enhancement for certain patients and protocols.

Along with new interventional tools, like CT fluoroscopy, continuous CT, and table-side controls, Philips demonstrated a dual energy option, which is described as leveraging the last decade?s work on dual energy and spectral CT. With the option, Philips offers a dual energy technique that enables users to explore the area of spectral imaging through a ?spectral viewer? application developed from the company?s experience with dual energy and spectral (photon counting) CT.

?Elaine Sanchez

Marketing Mammography and More

Looking to build your mammography business but facing tough challenges in your marketplace? That was precisely the case for Regional Medical Imaging (RMI), a radiology practice with five locations in Flint, Mich.

Just a few years ago, RMI noticed a downward trend in the number of patients they were seeing. ?We were faced with a lot of economic pressures,? said Randy Hicks, MD, MBA, cofounder of RMI. ?In addition to a 15% unemployment rate in our area, we were experiencing new competition from an imaging group as well as a group of family physicians.? That?s when RMI decided to bring in the big guns?a professional marketing group.

?If you?re going to compete independently, you have to find a way to tell people about yourself, but doctors aren?t so good at that,? said Hicks. ?We felt it would be wise to use professionals, and it has certainly paid off.?

RMI turned to Marketing Works, a York, Pa-based marketing firm with an expanding roster of health care clients. From the start, the agency was focused on helping RMI with their branding. ?We work hard to coach our clients on how to differentiate themselves,? said Tina Rudisill, president of Marketing Works. ?After all, mammography is mammography, unless you have something unique to add.?

Marketing Works guided RMI in promoting their core strengths. First, they persuaded the practice to create an appealing, spa-like setting that women would find inviting. ?They influenced our interiors and the d?cor; we aimed for a boutique-like atmosphere that?s more personal and less clinical,? said Hicks.

But a pretty setting is not enough, cautions Rudisill. RMI invested in training their people, too. ?The point is to offer a different and positive experience,? said Rudisill. ?Everyone in the office has to be a part of the marketing process. The patient experience can fall apart if the bathroom is messy. In a sense, the janitor is as important as the radiologist.?

With the internal stage set, the next step was to find ways to pull in new patients. The agency created a direct-to-consumer campaign, encouraging women to visit RMI for their mammogram. RMI had noticed that despite recommendations from the American Cancer Society, too many women over 40, as well as younger women at higher risk for breast cancer, were not making annual mammograms part of their health care routines. ?Women tend to put their own care last,? said Rudisill. ?The point of the campaign was to remind women that the whole key to breast cancer management is early detection. Our goal was to drive them to the RMI Web site and, ultimately, to make that appointment for their mammogram.?

Marketing Works came up with a provocative and compelling slogan??Your New Breast Friend.? It positioned RMI as the singular place to go for better breast health. The campaign included print advertisements, billboards in high-traffic areas, radio commercials, and direct mail. Launched in 2008, the ?Your New Breast Friend? campaign earned Marketing Works a Quest Award from the Radiology Business Management Association (RBMA).

More importantly, the campaign got results for RMI. ?It?s received a lot of recognition and brought a lot of attention to our practice,? said Hicks. ?The feedback from female patients has been quite positive and referring physicians have noticed, too. The bottom line is that everyone knows who we are now.?

Moreover, according to Hicks, in 2009 RMI grew its mammography volume by 6.5%. And with other innovative initiatives in the offing, chances are the practice will continue to flourish. For example, Marketing Works purchased a mailing list of women in the Flint area who are about to turn 40. In a unique direct mail campaign, RMI sends personalized birthday cards to each woman recognizing the milestone and encouraging her to come in for a mammogram so that she?ll celebrate many more birthdays in the future.

?The practice had been on the brink; that?s why we were brought in,? said Rudisill. ?Referring doctor numbers had plummeted and competition was mounting. But RMI was willing to take risks and do something different and compelling with their marketing, and we believe those efforts have contributed to their growth.?

Rudisill says the budget for the RMI campaign, including PR, internal signage, outdoor advertising, radio, newspaper, Web, and participation in a women?s expo event, totaled $50,000.

While RMI got what it aimed for?improved mammography volumes?Rudisill says their marketing program can deliver even more. ?Women make most health care decisions for a family, so building the mammography business is also a point of entry for driving business to RMI?s other modalities like MRI and PET/CT,? said Rudisill. ?The idea is to introduce mom to the practice for her mammogram, but have her come back for other family needs.?

?Marianne Matthews