Engineering to Meet Patients’ Needs: A Conversation With Stephen Neushul, iCRco CEO

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Stephen NeushulWith reimbursement increasingly linked to patient satisfaction, as well as a growing consumer influence in health-care spending, making a positive patient experience possible is a priority for radiology groups and hospitals. Stephen Neushul, CEO of iCRco, a developer of CR, DR, and mammography systems (as well as complementary software), sat down with to discuss how engineering, workflow, ergonomics, and dose-reduction capabilities intersect to improve the patient experience in imaging’s oldest modality. ImagingBiz: Radiography is the oldest imaging modality and the one that touches the most patients. How do you envision it continuing to evolve? Neushul: Radiographic technology had very primitive beginnings. In the beginning, it took a very long time to expose a film to get a very low-resolution exposure (something like 50 DPI), and you’d burn the patient in the process. Today, our systems can achieve 500 DPI, about 10 line pairs per millimeter, so we’ve already gone from very low image quality to high-resolution radiography. As time goes by, our sensors are going to keep getting better, our machines are going to get more precise, and we’ll see more information within radiographic images. We saw that evolution when we went from film to digital imaging—the digital form is more convenient, and now it’s even better than film at visualizing the data, so the modality is evolving, as we speak. At iCRco, we’re working on a very high-resolution digital-imaging solution for mammography, which is one way I see radiography evolving. In addition, CT is an advanced, digital form of radiography, so I see our new cone-beam CT system taking radiography into the third dimension. It has the potential to exceed the resolution of standard CT at 20% of the dose. ImagingBiz: How can radiographic technology be engineered to meet the needs of patients? Neushul: One of the key issues is ergonomics. We have spent a lot of time assessing our designs, based on how a customer will use our product. Our CR cassettes are thinner and lighter than any other manufacturer’s cassettes. On our new portable line of CR products, we made the cassette thinner so that it could easily fit under patients without moving them. When you think about the design of an imaging solution, you want the smallest footprint with the fastest throughput; particularly with a cassette-based CR solution, you want a very fast cycle time, so you don’t have to wait for a machine. Of course, with flat-panel DR you want the fast cycle as well, but at some point, a faster cycle provides no additional benefit because of other ergonomic factors, such as positioning of the patient. You always have to think about the end user and the process. Our new dual-bay mammography CR system can actually process two images at one time, to match the functionality and the workflow of DR. The unit is small enough to position right next to the patient, so the unit has good ergonomics and functionality. We examine how the technologist interacts with the machine and how the patient interacts with the machine. We’ve redesigned our mammography cassette 10 times to get the plate as close to the chest wall as possible, even though our first design exceeded the requirements for this specification. We keep tweaking our devices to exceed what is required by the standards. The other design feature that we have pushed to new lows is the size of our machines. Our units can go on a cart and roll right up to the patient. In a hospital or clinic, you want to be able to move things easily to where they’re most needed. ImagingBiz: How do reliability and durability come into play in meeting patients’ needs? Neushul: Having a machine that works every day—you don’t have to think about it, it just does its job—is the pinnacle of performance. You want a system that is robust and that doesn’t bend the plates (in the case of CR), so that it works every day and the quality of the images doesn’t degrade over time. With a CR solution, if your plate is being damaged every time you take an image, between the first day and last day you have a quality problem you can’t track—the quality of the image goes down, but you don’t notice it. We have machines that have done 750,000 cycles without degradation; our systems stay consistently good. Of course, all machines can break down once in a while, but if you can guarantee consistent quality over a long time period, that’s the most important thing. We’re going to implement a new service-and-support program for our imaging solutions that includes a yearly diagnostic report as a part of periodic maintenance. With our new Digital Physicist tool kit, we will supply an annual report that gauges the exact health of our digital imaging devices. This ensures that they operate to meet a precise quality standard. It will also provide a guarantee of consistent quality for our customers. Some of our machines are now 10 years old, so they will really benefit from a checkup. ImagingBiz: How do safety features, including dose reduction, come into play? Neushul: We have developed (and continue to develop) software that makes it possible to reduce dose by processing images more efficiently. The highest-dose images are those of the spine, and by using advanced processing techniques, we can reduce the dose you use to match that of a film-speed system. With spine images, because you have to go the whole width of your body, you get a lot of scatter; we can use a really high dose and not get a better image (just more scatter and a poor-quality image). Chest imaging and spine imaging are high-dose imaging, and they are the parts of the body that you are most concerned to protect from high doses. We work on these images a lot; we use technologies such as needle phosphor imaging plates, which can reduce dose by 75% (over standard CR). ImagingBiz: Where is the increased need for these features taking the equipment, in terms of engineering and design? Neushul: In CR and DR, we’re going to high-resolution applications, high-speed and high-throughput applications, multibay designs, and portable designs. Our systems are robust and very small, with very good performance characteristics. Our whole ethos has always been bringing the package size down; we make the systems as small as they can be, and then make them high-resolution systems, with high reliability and high throughput. We’re also focused on modular design, which makes servicing the equipment easier and more affordable. ImagingBiz: In future payment/delivery models, reimbursement will be more closely linked with patient outcomes. As a manufacturer, how do you plan for this future? Neushul: We’re trying to be as cost efficient as we can. Our products have a very low cost of ownership, and our value proposition is very well defined. Our systems are the cornerstone of the imaging chain, and they need to be fast, to offer low dose, to be easy to service and inexpensive, and to offer high quality. As we look forward, that’s what we strive to provide. Everything that we do revolves around patient care and the quality of patient care. Cat Vasko is editor of and associate editor of Radiology Business Journal.