Medical Solutions - Siemens Healthcare

Medical Solutions 

The Magazine for Healthcare Leadership 

December 2008 

Breast Cancer 

Where are we – and where are we heading? 

Cardiology 

Diagnosis in the Emergency Room

What’s the difference 

between imaging and 

imaging greatness?? 

Ask the Ultimate Power in Imaging. 

Every year Siemens provides a spectrum of new imaging systems that enhance diagnostic precision. With syngo® 

the first unified software interface for all imaging modalities was delivered. Tim® technology revolutionized MRI, 

and Dual Source CT continues to drive new clinical possibilities. Talk to us to experience these innovations and new 

groundbreaking advancements in imaging excellence. 

www.siemens.com/answersforlife +49 69 797 6420 

Answers for life. 

A91CC-9016-A3-1-7600

Editorial 

Advancing Patient Care 

The growing and aging population is one 

of the most significant challenges facing 

healthcare providers. This trend will drive 

an increasing demand for healthcare services, 

particularly for diseases that occur 

later in life and are costly to treat. In 

many situations, healthcare delivery has 

not evolved to the point where individual 

patient’s needs are considered. Our goal 

at Siemens Healthcare is to enable this 

high-quality, patient-centered approach 

by integrating imaging, laboratory diagnostics, 

and healthcare IT, creating seamless 

and significantly improved workflow 

efficiencies. 

Take prostate cancer as an example. 

Typically, if a clinician wants to clarify 

whether symptoms are signs of prostate 

cancer, he or she, in addition to a physical 

exam, would order a blood test to 

measure Prostate-Specific Antigen (PSA). 

A high PSA level is considered to potentially 

be caused by prostate cancer. Different 

PSA markers have to be combined 

and put in relation to each other to identify 

men who might show an elevated 

PSA, but who, in fact, have a low risk that 

this PSA value is a result of prostate 

cancer. Also, measuring PSA at just one 

point in time is not sufficient. 

When the patient’s PSA levels indicate 

possible prostate cancer, a biopsy needs 

to be performed. The traditional method 

involves some measure of patient discomfort, 

and possibly anxiety, as a clinician 

extracts tissue from different locations 

for diagnosis. Ultrasound, however, 

allows for an image-guided biopsy, which 

enables the physician to target suspicious 

areas for extraction, reducing patient 

discomfort, long-term complications, and 

the amount of time needed for the procedure. 

Should the biopsy yield a positive result, 

molecular imaging biomarkers enable 

the localization of metastatic cancer 

cells in the body. And, Siemens REMIND 

clinical decision support software can 

help ’rule out’ other factors that might 

lead to higher PSA results, but not automatically 

to prostate cancer. When this 

solution is applied holistically, up to 50 

percent of such misleading diagnoses 

can be avoided, saving time and money 

and increasing patient comfort and 

confidence. An estimated US$5 billion 

can be saved annually in the U.S. alone by 

applying measures to avoid unnecessary 

procedures and interventions. 1 

With our recent investment in laboratory 

diagnostics, Siemens has become the 

only integrated healthcare company that 

can offer a complete portfolio to better 

1 

Results may vary. Data on file. 

Jim Reid-Anderson, 

Member of the Managing Board of Siemens AG 

and CEO of the Healthcare Sector 

manage prostate cancer, breast cancer 

– as discussed in the cover story of this 

edition of Medical Solutions – and many 

other diseases throughout the continuum 

of care. With our broad portfolio and 

ongoing innovations, we are here to 

support your efforts in advancing patient 

care: enabling earlier, more efficient, 

accurate, and patient-friendly diagnoses 

and treatments. 

Our goal is simple: to help you save lives 

and offer the best possible care to your 

patients. It is at the center of everything 

we do. Siemens Healthcare provides 

answers for healthcare – answers for life. 

Sincerely, 

Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine 3

Content 

Content 

20 

Personalized Medicine: 

Novel Imaging and Diagnostic Technologies 

38 

Cardiac Care: 

New Standards 

Cover Story 

03 Editorial 

10 Breast Cancer 

Back in the 1980s, a bright young student 

completed her PhD dissertation on MRI brain 

diffusion imaging. Little did she know that 

cutting-edge technology would someday 

save her life. As a breast cancer patient, she 

now talks about her personal experience 

and the needs of affected women. In addition, 

Medical Solutions interviewed three 

imaging experts around the world about 

how diverse imaging solutions and advanced, 

integrated technology are providing a new 

level of care for breast cancer patients. 

06 News 

66 Essay Series: Japan 

71 Further Reading 

75 Service 

76 Imprint 

77 Subscription 

4 Medical Solutions · December 2008 · www.siemens.com/healthcare-magazine

Content 

44 

Med Meets IT: 

Project Expert Care 

60 

Training: 

Three Locations, One High Standard 

Features 

20 With a shared vision of preventive 

and personalized medicine, 

Siemens and National Jewish Health 

aim to develop novel imaging 

and diagnostic technologies using 

genomics, proteomics, integrated 

research, and clinical care. 

26 To overcome claustrophobia and 

positioning difficulties, Clínica 

de Diagnóstico por Imagem relies on 

Open Bore magnetic resonance 

imaging. 

30 The ARTISTE integrated radiation 

therapy solution helps Baton 

Rouge General Medical Center’s 

Pennington Cancer Center to rapidly 

and efficiently deliver radiation 

therapy close to home. 

35 Offering better return on investment 

and workflow efficiency, 

Biograph Molecular CT – mCT – 

is the imaging crossover that will 

change the way hospitals think 

about integrated imaging. 

38 A new cardiac care and research 

institute in Western Canada, 

the Mazankowski Alberta Heart 

Institute, is setting new standards of 

care for both pediatric and adult 

patients under one roof. 

44 By implementing a comprehensive 

IT solution across the entire organization, 

MedCentral, a regional 

health system in Ohio, became a 

world-class institution. 

50 Tissue Strain Analytics is an 

emerging ultrasound technology 

with the potential for quicker, 

more accurate diagnoses of tissue 

anomalies in the liver. 

54 Cardiac biomarkers provide rapid 

diagnosis and risk stratification, and 

help to improve the quality of care 

for chest pain patients at South 

Austin Hospital’s Emergency Department. 

60 Within a global training concept, 

Siemens Healthcare offers stateof-the-art 

training for customers 

worldwide in three dedicated 

training centers located around the 

globe. 


News 

CT Scanning in a Flash 

The SOMATOM® Definition Flash computed 

tomography (CT) scanner sets 

new standards in both image acquisition 

speed and radiation dose as the world’s 

fastest CT with the lowest dose ever. 

Like no other scanner, it can image the 

entire thorax in less than one second and 

complete a cardiac scan in one-fourth 

the time of a single heartbeat, with a 

radiation dose of less than one millisievert. 

“Our goal was to build the most 

patient-friendly CT by significantly reducing 

dose through faster speed,” says Sami 

Atiya, PhD, Chief Executive Officer of the 

CT Business Unit of Siemens Healthcare. 

“Lowest radiation dose is important to 

physicians and patients. It’s important 

to us.” 

SOMATOM Definition Flash utilizes Dual 

Source technology that consists of two 

detectors and two X-ray sources. This configuration, 

coupled with a gantry rotation 

time of 0.28 seconds, enables a temporal 

resolution of just 75 milliseconds, makes 

dual energy scanning possible, and allows 

the use of 200 kilowatts. Now, Siemens 

scientists and engineers have discovered 

how to push acquisition speeds to new 

levels. SOMATOM Definition Flash can 

scan at a pitch of above three, while still 

achieving gapless z-sampling, resulting 

in a table speed of more than 40 centimeters 

per second. That is because the 

two detectors create two complementary 

data spirals that, when put together, 

include all the information found in a 

single spiral acquired at a much lower 

table speed. 

Together, these features enable lung 

scans in 0.6 seconds, taking the burden 

of breath-holding off the patients. Fast 

scan speeds also eliminate the additional 

dose penalty of electrocardiographically 

(ECG) gated thoracic studies, so radiologists 

can scan the thorax and ’get the 

heart for free.’ Dedicated cardiac investigations 

can be completed in about 

250 milliseconds. But more importantly: 

It also reduces dose to unprecedented 

levels down to below one millisievert. The 

new features also permit pediatric scans 

more quickly and safely than ever before. 

In addition, a shuttle mode makes it possible 

for trauma patients to be scanned 

to conduct dynamic time-resolved imaging 

over 40 centimeters, the longest 

range available today. 

Besides the reduced radiation exposure 

that directly results from the high table 

speed, SOMATOM Definition Flash offers 

several other dose-conscious features. In 

dual energy scans, a new photon shield 

prefilters high kilovoltage X-rays, both 

improving material separation and substantially 

reducing dose, making it perfect 

for routine clinical use. Adaptive Dose 

Shielding blocks X-rays that will not be 

used in image reconstruction. New organspecific 

dose reduction eliminates direct 

exposure of radiation-sensitive organs, 

such as the breast, thyroid gland, or eye. 

And Siemens is looking to the future, 

developing iterative reconstruction techniques 

that promise to further reduce 

dose. 

Willi Kalender, PhD, Director of the 

Institute of Medical Physics at the University 

of Erlangen-Nuremberg in Erlangen, 

Germany, says, “The new scanner is a 

true revolution. It picks up on the well 

established concept of Dual Source CT 

but improves it in several ways. We never 

before dared to scan with such a low 

dose and such a high speed.” 

www.siemens.com/ 

SOMATOM-Sessions-Flash 


News 

Large Display for Artis zee Family 

Following the release of the Artis zee® 

family for interventional imaging in radiology 

and cardiology in 2007, Siemens 

launched a new, full-color large display 1 

for integration with the new portfolio at 

RSNA 2008. The Artis zee Large Display 

is a 56-inch monitor that allows users to 

replace up to eight single monitors on 

the system. It provides the integration of 

multiple modalities on one screen for 

greater flexibility and enables the user 

to configure the screen during the procedure. 

The operator can choose from 

different screen layouts directly at the 

tableside of the angiography system. 

This enables the operator to adapt the 

configuration to the individual workflow 

steps. Continuing the flexibility and 

versatility of the Artis zee systems, the 

product can be used for interventional 

radiology, interventional cardiology/ 

electrophysiology, and surgery, and is 

particularly valuable for interventional 

imaging in hybrid rooms as it tremendously 

reduces the number of monitors 

in the room. With its high resolution 

(4 x HD), the Large Display shows even 

the finest details. Up to 200 layout combinations 

and the possibility to connect 

at least 16 image sources and show up 

to ten windows simultaneously enhance 

imaging results and workflow in the interventional 

suite. Moreover, the reduction 

of additional displays and the option 

to put other video signals on the Large 

Display – for instance, for monitoring 

other rooms, telemedicine, or endoscopy 

– make it a rewarding investment for the 

future. 

1 

The information about this product is being provided 

for planning purposes. The product requires 510(k) 

review and is not commercially available in the U.S. 

Comprehensive MR Oncology Solutions 

Cycle 1 Cycle 2 



syngo GRACE after every chemotherapy cycle of a patient with 

known breast cancer: The efficiency of therapy can be easily seen by the 

decreasing choline. 

Within the field of oncology, magnetic resonance imaging (MRI) 

has proven to be one of the most effective imaging techniques. 

For asymptomatic and high-risk patients, MRI enables both 

early tumor detection and oncological staging without radiation. 

To support precise surgery planning, therapy monitoring, 

and follow-up, Siemens provides comprehensive MRI oncology 

solutions, going far beyond single applications and software 

features. 

In Women’s Health, the first quantitative MRI breast spectroscopy 

application syngo® GRACE is now also available for the 

3 Tesla systems MAGNETOM® Verio and Trio. By checking relative 

choline concentration during therapy, the efficiency for 

monitoring treatment is more reliable. This may also reduce 

the number of unnecessary breast biopsies for the women 

concerned. 

In the field of Men’s Health, syngo Tissue 4D 1 , the new task 

card for visualization of 3D dynamic measurements, is particularly 

valuable for prostate evaluation. Offering two evaluation 

workflows – standard curve evaluation or a pharmacokinetic 

model – syngo Tissue 4D supports an efficient oncology workflow 

and reliable follow-up studies. 

Completed by syngo TimCT Oncology – the hardware and 

software solution for seamless whole-body imaging using 

Continuous Table move – these new applications and workflow 

tools expand the comprehensive Siemens solution for 

oncology diagnosis and staging. 

1 

This application is pending 510(k) review and is not yet commercially available in the U.S. 


News 

What is your SPECT’S IQ? 

Siemens demonstrated industry leadership once again with 

molecular imaging’s most recent innovation in single photon 

emission computed tomography (SPECT) – IQ·SPECT 1 . This 

new feature in SPECT enables a comprehensive cardiac evaluation 

including perfusion, attenuation correction, and calcium 

scoring in as little as five minutes 2 when traditional cardiac 

SPECT perfusion studies can average 15 to 20 minutes. Available 

for the Symbia® product line, IQ·SPECT allows organspecific 

cardiac evaluations with enhanced image quality. For 

medical facilities, this innovation means being able to accommodate 

more patients in less time and meet a variety of 

patient needs. 

IQ·SPECT’s ‘intelligence’ is achieved through a combination 

of three technologies beginning with SMARTZOOM, a specially 

designed smart collimator that magnifies the heart while 

imaging the rest of the torso under traditional conditions. 

Second, the SMARTZOOM collimator works in a cardio-centric 

orbit to maximize the amount of cardiac information collected 

from the patient. Finally, unique IQ·SPECT reconstruction 

completes the innovation and is seamlessly integrated into 

the current Symbia workflows and automation features, giving 

physicians access to the most flexible and versatile system 

available today. 

Calcium scoring with SPECT·CT, extracted from a quick lowdose 

spiral CT, has also become a critical element in the cardiac 

work-up to evaluate the extent of cardiac disease in patients. 

Adding the 30-second CT to the SPECT study cannot only illustrate 

any ischemia present in the patient, but also can assess 

the buildup of calcium in the coronary arteries. The addition 

of IQ·SPECT to these important SPECT·CT studies may lead to 

new risk stratification algorithms and workups for patients 

with suspected coronary artery disease. 

1 

Works in Progress. The information about the product is preliminary. 

The product is under development and is not commercially available in the U.S., 

and its future availability cannot be assured. 

2 

New Product Feature based on preliminary internal data. Actual performance 

characteristics have not been established. 

Klinikum Chemnitz is one of the first hospitals 

in Germany to link its teleradiology 

service with an electronic health record 

(EHR). The EHR makes demographic and 

administrative data of a telediagnosis 

available. Provided the patient agrees, 

images and results from diagnostics can 

be shared by different facilities. Thanks 

to a special security system, the data are 

only accessible to authorized users who 

Electronic Health Record for Integrated Care 

are involved in the patient’s treatment. 

Siemens equipped the hospital with an 

overall technology system that includes 

Soarian® Integrated Care 1 (Soarian IC) for 

information exchange, as well as radiological 

image communication software. 

Soarian IC improves the flow of information 

across institutions and sectors without 

the need to exchange existing primary 

systems. As a result, the system 

supports the cooperation between the 

individual clinical facilities and simplifies 

the patient treatment. Together with 

14 regional county hospitals as well as 

medical centers and several practicing 

physicians, Klinikum Chemnitz sets 

standards for integrated healthcare in 

Germany. Especially regarding diagnoses 

in the fields of neurosurgery, traumatology, 

angiology, and radiology, the 

hospital supports regional hospitals and 

practices with its medical expert knowledge. 

For example, a patient who has 

been brought into a county hospital after 

an accident can be scanned with a computed 

tomography system. The image 

data is sent electronically to a responsible 

physician in Klinikum Chemnitz, who 

then diagnoses the patient and sends 

back the report. 

1 

The information about this product is preliminary. The 

product is under development and is not commercially 

available in the U.S. or in Canada, and its future availability 

cannot be assured. 


News 

Neonatal Care 

Siemens RAPIDLab® 1245/1265 blood gas analyzers have been 

enhanced to measure total bilirubin on neonatal whole-blood 

samples. The RAPIDLab systems determine the neonatal total 

bilirubin concentration in 60 seconds using multiple wavelength 

spectrophotometry. Bilirubin is the main bile pigment formed 

from the degradation of hemoglobin. An increased level of 

bilirubin in the blood (hyperbilirubinemia) causes jaundice, 

the discoloration of body tissues. Neonatal jaundice is usually 

harmless, a consequence of immature liver function and the 

breakdown of fetal hemoglobin as it is replaced with adult 

hemoglobin. Severe neonatal jaundice may indicate a more 

serious condition, including erythroblastosis fetalis, that is 

most likely caused by blood incompatibilities between baby 

and mother. Extremely high levels of bilirubin in infants may 

cause bilirubin encephalopathy or kernicterus, a form of brain 

damage. 

The Business Partner in MRI 

“You can’t run a radiology practice without an MRI [magnetic 

resonance imaging] system,” says Franz Walter, MD. “Demand 

from referrers and patients for radiation-free imaging is growing 

steadily.” This is why the radiologist invested in a MAGNETOM® 

ESSENZA immediately after taking over the recently outsourced 

radiology practice of the Evangelische Krankenhaus 

in Zweibrücken, Germany. With a low total cost of ownership, 

MAGNETOM ESSENZA is ideal for setting up and expanding MRI 

services. Zhen Jin, MD, agrees. The Director of the MRI Center 

at Hospital 306 in Beijing, China, looks back on 13 years of MRI 

service at her institute – and installed two additional systems 

last year: a 3 Tesla MAGNETOM Trio and a 1.5 Tesla MAGNETOM 

ESSENZA. The decision for the MAGNETOM ESSENZA was a 

natural one for both physicians: “It is the first system that is 

optimized for cost of ownership. Zero helium boil-off and a 50 

percent lower electricity consumption compared to conventional 

systems are just two examples of its affordability,” says 

Walter. “We wanted a robust system for clinical use to allow 

more time for research on the MAGNETOM Trio,” Zhen Jin says 

as she explains the reason for buying two systems within such 

a short timeframe. MAGNETOM ESSENZA offers full diagnostic 

capabilities thanks to Tim® (Total imaging matrix). Tim provides 

flexibility through versatile coil combinations, accuracy 

through high signal strength and spatial resolution, and speed 

resulting from parallel imaging. It offers access to the applications 

needed for both an outpatient practice and a primary care 

hospital. Zhen Jin also appreciates the integrated IsoCenter 

Matrix coil of MAGNETOM ESSENZA. Thus, the region of interest 

is always at the center of the magnetic field, which makes 

coil repositioning and changing obsolete. 

With 28 patients a day, she is also happy with the speed of the 

exams, as is Walter with 22 exams, which include outpatients 

as well as referrals from within the hospital. Walter mentions a 

Parkinson’s patient who was referred for an angio exam. First, 

he was skeptical about being able to achieve diagnostic image 

quality. Thanks to MAGNETOM ESSENZA’s fast sequences, 

movement artifacts were reduced and the images were good 

for diagnosis. “From any perspective, MAGNETOM ESSENZA is 

definitely up to date,” he says. 

At Hospital 306 in Beijing, Dr. Zhen Jin is happy with MAGNETOM 

ESSENZA’s low cost of ownership. 

Dr. Franz Walter of the radiology practice at Evangelische Krankenhaus 

Zweibrücken likes the system’s ease of use. 

www.siemens.com/ESSENZA 


Breast Cancer 

Breast cancer is by far the most common cancer among 

women. The numbers have been increasing worldwide, 

rising rapidly particularly in younger women. 


Breast Cancer 

An Unexpected Encounter 

Back in the 1980s, a bright young graduate 

student completed her PhD dissertation on MRI 

brain diffusion imaging at the Massachusetts 

Institute of Technology. Little did she know that 

cutting-edge technology would someday save 

her life. 

By Diana Smith 

“I was trained as a scientist and have 

always been interested in health and technology,” 

says the scientist, who wishes 

to remain anonymous. “I became very 

interested in MRI [magnetic resonance 

imaging] in my first year of graduate 

school. My doctoral thesis was on MR 

diffusion imaging, and I continued working 

on MRI abroad for my post-doctorate 

research.” 

A passionate scientist, she continued 

work in the field and built an impressive 

global resume. Since 2006, she has been 

doing research collaboration with a leading 

hospital in Asia, performing a clinical 

research study on breast imaging to 

compare breast MRI and breast diffusion 

imaging with conventional techniques 

such as mammography and ultrasound. 

New Imaging Techniques 

In the blink of an eye, a speck on a 

mammogram or an aberrant lump felt in 

the shower can change a woman’s life. 

Breast cancer is by far the most common 

cancer among women. 1 The numbers 

have been increasing worldwide, rising 

1 

http://www.who.int/cancer/detection/breastcancer/en/. 

Last accessed Nov. 4 th , 2008 

rapidly, particularly in younger women. 

According to the American Cancer Society, 

in 2008, 1.3 million cases will be identified, 

and almost 500,000 women will 

die from the disease. In the U.S., breast 

cancer will be diagnosed in one in eight 

women. Though rare, men can also get 

breast cancer. 

New imaging techniques are helping 

doctors diagnose tumors with greater 

precision and less trauma. Mammograms 

can be less effective in women with 

dense tissue which makes the images 

harder to read. Magnetic resonance 

imaging has been shown to find breast 


Breast Cancer 

lesions underwent diffusion imaging 

and dynamic contrast-enhanced MRI 4 

using a 3 Tesla scanner (Siemens 

MAGNETOM® Trio, A Tim® system). 

The clinical research study was performed 

in Asia, where, increasingly 

younger women are being affected by 

breast cancer. Younger women tend 

to have denser (leaner) breast tissue. 

Dense breast tissue can present special 

difficulties for disease detection. In 

mammography, dense breast tissue and 

tumors both appear white. “It’s like finding 

a polar bear in a snowstorm,” says 

the scientist. 

The scientist’s breast cancer was discovered by chance. 

“Women need 

to know what they 

should look for 

in getting the 

best diagnostic 

examination.” 

cancers that mammograms miss in a 

certain group of patients. 2 A study published 

by the Scientific Assembly of the 

Radiological Society of North America 

(RSNA) reported that the detection rate 

for nonpalpable, invasive breast cancers 

increased by 42 percent in women with 

dense breasts when mammography was 

followed by ultrasound. 3 

“Taking the technology to a new level,” 

the scientist explains, “diffusion is looking 

at the water mobility, the movement 

of water molecules in tissue. We thought 

this technique would be very sensitive 

in finding abnormalities in the breast, 

and it’s perfect when you have a group 

of patients who have proven biopsies, 

because then you have histologic comparison. 

We have the exact pathological 

specimen to compare with what we see 

in imaging.” 

In a clinical study in Hong Kong, 31 

female patients with suspected breast 

2 

Efficacy of MRI and Mammography for Breast-Cancer 

Screening in Women with a Familial or Genetic Predisposition. 

N Engl J Med, Vol. 351, No. 5:427-437 

3 

Mammographic Density and the Risk and Detection of 

Breast Cancer. N Engl J Med, Vol. 356, No. 5:227-263 

Accidental Discovery 

A chance discovery changed everything, 

recalls the scientist. “The clinical results 

from the patient study were really good. 

Out of curiosity, I went in the scanner 

for this diffusion technique. No contrast 

injection was needed with diffusion 

imaging. It was quick and easy, and I was 

out of the scanner in five minutes. As 

I came out, I saw the stricken face of the 

radiologist and knew something was 

wrong.” 

Since the diffusion technique was new 

and is not yet routine for breast imaging, 

the radiologist in charge recommended 

a follow-up with a complete examination 

and conventional diagnostic methods. 

These included digital mammography, 

ultrasound, contrast-enhanced MRI 4 , and 

lymph-node mapping. 

Not the Right Destiny 

At only age 45, the researcher was in a 

low-risk group with no family history of 

the disease. Previous mammograms and 

ultrasounds were normal. A nonsmoker, 

she was slim and followed a healthy diet. 

“I was shocked,” she says. “I couldn’t 

believe it. I always thought I have been 

healthy and active.” 

The hours that followed were a roller 

coaster of emotions, particularly since 

she was thousands of miles from home 

and loved ones. “The worst was the 

moment when you are told you have 

4 

Not available in the U.S. 


Breast Cancer 

“It’s so important to create and offer well-planned 

radiology departments coupled with women’s 

health centers to minimize anxiety and suffering 

after someone is diagnosed with breast cancer.” 

cancer,” she explains. “It feels like you 

just got a death sentence.” That evening, 

the radiologist in charge, who is also a 

caring friend, took the scientist to dinner 

and “turned a potentially sad evening 

alone after a shocking diagnosis into one 

that made me think more about friendship, 

people who care, and the life 

ahead.” 

A Personal Decision 

Because of her background in medical 

imaging, the scientist was more informed 

than most about the diagnostic tools 

and treatments used in breast cancer. 

Like American actress Christina Applegate, 

who elected to have a mastectomy in the 

summer of 2008 at age 36 to eliminate 

constant fear and onerous exams every 

few months, the scientist opted for immediate 

surgery. 

“I know of women who had lumpectomies 

followed by radiation and chemotherapy, 

and their cancer reoccurred,” she says. 

“Every woman is different. I made my 

personal decision to have a mastectomy 

to have peace of mind and reduce the 

risks of recurrence to almost zero.” 

Recovery 

“The first couple of weeks were very hard,” 

remembers the scientist. “I’ve never 

had any kind of surgery before, and of 

course, you cannot bathe or even put 

on clothing yourself. You are very dependent 

on someone to help you.” 

She adds, “In a way, I was very lucky that 

it [finding the cancer] happened where 

I knew the clinicians. Though I was very 

far from home when this happened, I was 

in a well-known hospital with state-ofthe-art 

equipment. I found the hospital 

to be well organized with women’s health 

and radiology all under the same roof. 

Everything was very conveniently located 

in the same building and I could get all 

the tests done within the first 48 hours.” 

“I understand many women are less 

fortunate and they are sent to different 

places and have to wait weeks before 

getting all the tests done. The waiting 

can be bewildering. Some hospitals are 

still not prepared to offer a streamlined 

process for people affected with such a 

diagnosis. Sometimes, the hospital may 

not have the right imaging equipment or 

the latest software. It’s easy for a patient 

to be sent to get multiple tests, get lost 

in the medical maze, and spend endless 

hours and days waiting for the results. 

It’s so important to create and offer wellplanned 

radiology departments coupled 

with women’s health centers to minimize 

anxiety and suffering after someone 

is diagnosed with breast cancer.” 

Speaking Out 

Today, the scientist is still consulting 

and she is using her experience to be an 

advocate and speak to others about the 

disease and the imaging modalities used 

to diagnose and treat it. 

“I’ve learned a lot through this process. 

I now teach women about early detection 

and how it helps to save lives. It’s 

also important to know about the possibilities 

in detection and treatment,” she 

emphasizes. 

“Most people know someone who has 

had breast cancer. Most people know of 

mammography and breast ultrasound. 

Some know about breast MRI, but they 

don’t really know enough details, for 

example, whether their hospital has the 

state-of-the-art scanner with the latest 

software or whether it is using a scanner 

that is ten years old, which does not offer 

the best resolution or the same functionalities 

as the newer ones. Women need 

to know what they should look for in 

getting the best diagnostic examination 

and what they should ask their healthcare 

providers. When patients are wellinformed, 

they have the best chance for 

survival and can live a long and healthy 

life.” 

An Enlightened Path 

“I’m back to my previous activities and 

actually feel better than before,” says 

the scientist. “When you go through an 

experience like this, you get to see who 

really cares about you and who loves 

you for who you are. I have a stronger 

appreciation for people who show kindness 

despite work pressure and busy 

schedules. I particularly remember a lateshift 

nurse and her words of kindness 

and encouragement when she came 

to do an IV [infusion] around midnight. 

When you are flat on your back in a 

hospital bed, you have time to think, to 

ponder, and to feel.” 

She concludes, “I have come from this 

experience with a greater appreciation 

for life. I’m grateful for the early detection 

that helped save my life, and I have 

certainly grown from the enlightenment 

and reflections during this unexpected 

journey.” 


Breast Cancer 

A Worldwide Challenge 

Diverse imaging solutions and advanced, integrated technology 

are providing a new level of care for breast cancer patients. 

For a global view, Medical Solutions interviewed three imaging 

experts around the world: 

Gladys Lo, MD, Chief Radiologist, Department of Diagnostic 

and Interventional Radiology, Hong Kong Sanatorium and Hospital, 

Hong Kong, China 

John F. Nelson, MD, Medical Director, Battlefield Imaging, 

Battlefield Auxiliary Breast Center, Ringgold, Georgia, U.S. 

Karsten Ridder, MD, Radiological Group Practice, 

Outpatient Clinic Professor Dr. Uhlenbrock and Partners, 

Diagnostic Breast Center, St. Josefs-Hospital, 

Dortmund-Hoerde, Germany 


Breast Cancer 

Thank you for finding time to talk to 

us across many time zones. All of you 

provide state-of-the-art breast cancer 

care with integrated imaging systems 

from Siemens that optimize clinical, 

operational, and financial workflow. 

Let’s discuss how diagnosis and treatment 

of breast cancer has changed 

since you started in the field. 

NELSON: I have been practicing for 

about 20 years, so I’ve seen quite a few 

changes. Technologically, we’ve obviously 

seen huge strides in screening mammography 

just in the ability to see and pick 

up lesions. In recent years, most of us in 

the U.S. and across the world have probably 

transitioned to digital mammography. 

I think probably everyone on this 

panel would agree the improved screenings 

have saved lives. So, that has really 

changed the way I practice. Secondly, 

of course, the different modalities we 

use to evaluate patients diagnosed with 

suspected breast cancer also have ballooned. 

Ultrasound is no longer something 

that we do occasionally – it’s something 

we do all the time. Additionally, 

advanced techniques like breast MRI 

[magnetic resonance imaging] have 

revolutionized what I do as a diagnostician. 

RIDDER: Changing from analog to digital 

mammography is like the invention of 

rubber for the wheel. It is much faster 

and more precise than before, especially 

when you are looking at workflow. CAD 

[computer-aided diagnosis] is a helpful 

support in managing the workload of a 

screening center such as ours. But this is 

only one advantage. On the other hand, 

digital systems help the radiologist and 

surgeon communicate with the pathologist. 

LO: The incidence of breast cancer in 

Hong Kong has increased to one in 23, 

and digital mammography is fantastic 

because Chinese women have very dense 

breasts. So, advanced digital mammography 

has really helped to look through 

the breast tissue, and also in picking up 

the microcalcifications. 

How can ultrasound or other modalities 

improve the ability to detect cancers? 

LO: Ultrasound has always been popular 

in Hong Kong because of the very dense 

breasts the women have here. We’ve 

always found it to be very useful and 

complimentary to mammography. MRI, of 

course, I think is a breakthrough. Like Dr. 

Ridder, we also have a multidisciplinary 

approach in our hospital. We communicate 

very closely with the breast surgeons, 

pathologists, radiation therapists, and 

oncologists. 

Why is it important to be an early 

adopter of technology? What are the 

benefits to patients? To the hospital? 

RIDDER: Here in Dortmund, where we 

are located, we are a city of 1.5 million. 

We are part of the hospital’s Radiology 

Institute, and we have the pressure 

of the free market. Women are free to 

decide which institute they want to go 

to. Having better technology gives us a 

competitive advantage. The second thing 

is that with the new techniques, it is better 

for the patients. With our advanced 

radiology equipment, we get the most 

sensitivity and specificity we can. 

Mammography is only one small part of 

all the basic things that have to be 

offered along with the other modalities. 

LO: Our hospital is a private hospital and 

actually prides itself in getting the best 

machines. We have a 3 Tesla MRI breast 

unit, and we’ve been doing a special 

sequence called diffusion to look at the 

breast tissue and had some very good 

preliminary results that will be published 

in JCAT [Journal of Computer Assisted 

Tomography] next year and were presented 

in Toronto at the ISMRM [International 

Society for Magnetic Resonance 

in Medicine] this year [2008] in May. 

You had a special case as a result of 

the diffusion study. Can you tell us 

about that? 

LO: One of my patients is a scientist and 

is aware of what we are doing. Previously, 

she had standard mammography, but it 

was not diagnostic because her breasts 

were very dense. So, we decided she 

should have the diffusion examination 

because it doesn’t involve any ionizing 

radiation, there’s no injection, and it’s 

very quick. What happened was that the 

diffusion study unexpectedly turned out 

to be abnormal. So, this was followed 

with a complete contrast-enhanced MRI 

scan, of course, and at the site where 

the diffusion abnormality was seen, there 

was actually a bilobulated rim-enhancing 

mass with type three signal intensity time 

graph, quite diagnostic like a BI-RADS 

[Breast Imaging Reporting and Data 

System] 1 five lesion, and this turned out 

to be DCIS [ductal carcinoma in situ]. 

After the MRI was done, I suggested 

doing an ultrasound as well and we saw 

the lesion again. I also persuaded her to 

do mammography again because I was 

afraid she might have an area of DCIS 

1 

BI-RADS is a quality assurance tool originally designed 

for use with mammography. The system is a collborative 

effort of many health groups but is published and trademarked 

by the American College of Radiology. 


Breast Cancer 

“There are a lot of 

tools out there 

that we can parlay 

into what we are 

currently doing 

to add diagnostic 

capabilities.” 

John F. Nelson, MD, Medical Director, 

Battlefield Imaging, Battlefield Auxiliary Breast 

Center, Ringgold, GA, USA 

that’s only shown with microcalcifications. 

Both the MRI and the ultrasound 

may not show a certain percentage of 

DCIS cases that present with microcalcifications. 

Indeed, her tumor was at eight 

o’clock, but on the mammography at ten 

o’clock, there was a stipulated area that 

had some microcalcifications in it. 

NELSON: Was the diagnostic MRI also 

negative? 

LO: No, it wasn’t. It was an irregularly 

marginated mass, but it had a type one 

graph. So it was indeterminate. It was 

like a BI-RADS four at the ten o’clock 

lesion, which was seen on mammography, 

and a BI-RADS five lesion that was 

not seen on mammography for the eight 

o’clock. 

How are you using other methods 

of molecular medicine such as PET·CT 

[positron emission tomography/ 

computed tomography], SPECT·CT 

[singe photon emission computed 

tomography/computed tomography], 

or biomarkers? 

NELSON: At our institution, we really 

reserve PET·CT for women with suspected 

extensive disease. For most of our 

women with locally advanced disease, we 

evaluate with breast MRI, and I bet that is 

true for the other two physicians. We’ve 

actually experimented at our institution 

with Bruce Porter’s techniques 2 , and what 

we’re doing now is a lot more wholebody 

MRI for staging and the chest and 

abdomen for screening, along with our 

breast MRI. 

RIDDER: PET·CT is also promising in other 

cancers, like ovarian cancer or lymphatic 

cancer. Where we use these PET techniques 

is also for extended breast cancer 

and the staging of treatment. 

How does an integrated diagnostic 

strategy affect your patients and your 

facility’s success? 

LO: Patients who all of a sudden find 

out they have some abnormality want to 

find out the exact extent of the abnormality 

and what it is right away. If you 

send them to all different types of places 

to get it and they have to wait, that’s tremendously 

stressful on the patient. We 

are lucky that we have everything in one 

place, including the hospital. 

NELSON: In fact, that’s really why our 

facility was built. We are actually in a 

breast center, so every modality, including 

breast MRI, is available. We even offer 

Saturday morning service. We’re also in 

a very competitive environment here. 

We are motivated at our center to place 

the patient at the center of the wheel 

and all the spokes go out, but the patient 

shouldn’t have to move. It’s our job to 

provide all the services that go along 

with breast cancer evaluation. 

RIDDER: I think my colleagues will agree, 

everyone is short of time, and so the 

time pressure is extreme. Also, women 

need to get their results in a short time. 

Why did you choose women’s 

health and breast cancer as your field 

of expertise? 

RIDDER: Honestly, I think it’s one of the 

most exciting fields in radiology, with 

all the new techniques that have been 

2 

Refer to, e.g., Beatty, J., Porter, B: Contrast-enhanced 

breast magnetic resonance imaging: the surgical perspective. 

Am J Surg 193; 5:600-605. 

Smith J.P., Hanson J., Dawson J., Porter B., Tickman R.J.: 

emerging technologies in surgical planning for breast 

cancer. Am J Surg 184; 4:377-9. 


Breast Cancer 

developed in the last ten, 20 years, and 

are still being developed. Maybe only 

comparable to cardiac MRI or multislice 

computed tomography. 

NELSON: For me, it was a calling. My 

sister was diagnosed with breast cancer 

back when I was still in medical school. 

She had two kids. I saw how breast cancer 

affects the patients, their loved ones 

and families, and changes the course of 

life for everybody. So when I got to the 

point of choosing my area of specialization, 

it was just natural. 

“We are lucky that 

we have everything 

in one place.” 

Gladys Lo, MD, Chief Radiologist, 

Department of Diagnostic and Interventional 

Radiology, Hong Kong Sanatorium and Hospital, 

Hong Kong, China 

And why did you choose Siemens 

equipment for your work? 

NELSON: Battlefield Imaging was a brandnew 

center built from scratch alongside 

“Having better 

technology 

gives us a 

competitive 

advantage.” 

Karsten Ridder, MD, Radiological 

Group Practice, Outpatient Clinic 

Prof. Dr. Uhlenbrock and Partners, 

Diagnostic Breast Center, 

St. Josefs-Hospital, 

Dortmund-Hoerde, Germany 

the rest of our medical facilities about 

five years ago. We wanted to go completely 

digital at our center – no film. We 

weren’t building space for film. I actually 

flew to Dortmund to look at the digital 

mammography system they had in place 

there. We’ve had a long-standing relationship 

with Siemens, and we have extremely 

good Siemens service. A lot of what 

drove my interest in Siemens was that 

relationship. When I saw the system and 

compared it with the other two systems 

available at the time, I just didn’t feel 

comfortable that either of the others 

could provide me with the image quality 

or the back-up service that I knew would 

be necessary. The same is true for MRI. 

At that time, the Espree [MAGNETOM® 

Espree Open Bore MRI system with Tim® 

technology] was just coming on the 

market. We have a relatively large patient 

population; many of our patients are 

overweight or obese. The Espree just fit 

perfectly with what we were trying to 

provide. It was really the first full-field, 

high-end machine that offered those sort 

of facilities for the patients. Siemens 

really had the technology that worked 

well for us. 

RIDDER: It’s the whole package you get 

from Siemens, not limited to just the 

image quality. For example, we have a 

different machine that is supposed to 

have the same detector as the mammography 

system from Siemens, but there is 

no comparison between the two images. 

I’m also using our MRI for heart examinations 

and work with other Siemens 

systems as well. Thanks to the common 

syngo® user interface, it is easy to switch 

between the modalities. 

LO: Prior to getting our Siemens digital 

mammography unit, we had one from a 

different vendor. We have images from 

patients who come for follow-up. The old 

images are from the other vendor and 

the new images are Siemens, and it’s 

like night and day. The new Siemens unit 

is seeing so much more, and I’m very 

pleased with that. 

NELSON: I would add that the Siemens 

digital unit had several filter combinations, 

some of which use a considerably 

lower dose. Compared to our screen 

film, we were seeing 30 to 40 percent 

lower doses. We have marketed that 

very strongly in our community, and it 

has been very well received. 

Are you excited about any new 

trends or innovative leading-edge 

imaging solutions for the future? 

RIDDER: We have just started with 

ultrasound automated breast volume 


Breast Cancer 

scanning [ABVS] 3 . We haven’t used the 

technology for a very long time, but 

what I can say now is that we are looking 

at a very promising technique that 

holds a huge potential for breast imaging 

in the future. 

NELSON: I would echo that there are 

some other things on the horizon. I think 

all of us are interested to see if breast 

tomosynthesis 4 is really going to take off. 

Certainly, we’ve found elasticity imaging 

in ultrasound very useful. And I’m really 

excited about diffusion imaging on MRI. 

There are a lot of tools out there that 

we can parlay into what we are currently 

doing to add diagnostic capabilities. 

Diana Smith is a freelance writer based in 

Liberty Hill, TX, USA. 

3 


for planning purposes. The product is pending 510(k) 

review, and is not yet commercially available in the U.S. 

4 

Caution: Investigational Device. Limited by U.S. Federal 

Law to investigational use. The information about Digital 

Breast Tomosynthesis is preliminary. This product is 

under development and not commercially available in 

the U.S., and its future availability cannot be assured. 

Further Information 

www.siemens.com/breastcare 


news-breastcare 

Breast Cancer: 

Where are we – and where are we heading? 

Challenge: 

“It was easy, and I was out of the scanner in five minutes,” says the scientist. “As I 

came out, I saw the stricken face of the radiologist and knew something was wrong.” 

Working on MRI diffusion, a promising breakthrough imaging technique for the 

breast, a scientist unexpectedly discovers her own disease. One chance test completely 

changed her life, but that was just the beginning of an arduous emotional 

and physical journey. 

Solution: 

Today, physicians and clinicians are using an arsenal of integrated diagnostics that 

have revolutionized the management of breast cancer. “I think probably everyone 

would agree that improved screenings have saved lives,” says John F. Nelson, MD, 

Medical Director of Battlefield Auxiliary Breast Center in Ringgold, Georgia, U.S. 

“That has really changed the way I practice.” 

Integrated diagnostics have other benefits, including improved workflow and patient 

convenience. Gladys Lo, MD, Chief Radiologist at Hong Kong Sanatorium, emphasizes 

how new approaches to diagnosis and treatment have positive emotional ramifications. 

“For patients who all of the sudden find out they have some abnormality, they 

would like to find out the exact extent of what it is right away. If you send them to 

all different types of places and they have to wait, that’s tremendously stressful on 

them.” 

Result: 

Technologically, huge strides have been made in the imaging field in the last two 

decades. Integrating laboratory diagnostics, advanced imaging, and information 

technologies can improve a patient’s outcome at every stage of care. In addition, 

integrated technology affects workflow. “It is much faster and more precise than 

before,” says Dr. Karsten Ridder of St. Josefs-Hospital, Dortmund, Germany. 

The journey of detecting, coping with, and beating breast cancer resulted in an 

enlightened new perspective for the scientist. Now, this survivor gives real advice, 

not only on early detection and treatment, but also because of her background, 

specifically on what to look for in hospital imaging equipment and how the level of 

technology may make a difference in a person’s life. All scanners are not created 

equally. 

The ACUSON S2000 ABVS 

Automated Breast Volume Scanner 

reduces operator dependence and 

variability. 

Patient with a 2.8-centimeter, 

grade 3, invasive ductal carcinoma 

in the right breast imaged with 

digital mammography (left) and 

breast tomosynthesis. The mediolateral 

oblique (MLO) digital 

mammography view shows dense 

breast tissue with subtle distortion 

in the lower breast. The MLO 

tomosynthesis slice shows a spiculated 

mass in the lower breast. 


MAGNETOM Espree – Pink is a dedicated MR Breast Scanner with a 70-centimeter Open Bore at 1.5T and an ultra-short 125-centimeter 

system length. 

Diverse Imaging Solutions 

In a multipronged, comprehensive approach, Siemens combines 

laboratory diagnostics, advanced imaging, and information 

technologies to help physicians detect, diagnose, and treat 

breast cancer earlier, faster, and with greater precision. New 

technology offers a range of breast care solutions – all designed 

to contribute to successful disease management. 

MAGNETOM Espree – Pink 

Siemens announced the latest innovation in breast MRI, 

MAGNETOM® Espree – Pink, the new dedicated MRI Breast Scanner 

with a 70-centimeter Open Bore at 1.5 Tesla and an ultrashort 

125-centimeter system length. Both the 70-centimeter 

Open Bore scanner and the new breast coil (Sentinelle Vanguard 

for Siemens) offer an enhanced level of patient comfort, especially 

for obese and claustrophobic patients. The system has 

the capability to position the patient feet-first or head-first 

and provides excellent access to perform biopsies. Sentinelle 

Vanguard for Siemens offers excellent image quality and optimized 

biopsy access for higher accuracy in intervention and 

faster examination time. The dedicated workplace includes 

syngo® BreVis 1 for flexible reading and reporting and syngo 

BreVis Biopsy 1 for fast and accurate MR breast biopsy workflow 

with automatic calculation of target coordinates. 

ACUSON S2000 ABVS Automated Breast Volume 

Scanner 

The ACUSON S2000 ABVS Automated Breast Volume Scanner 2 

streamlines workflow and reduces operator dependence and 

variability by quickly and comfortably surveying and acquiring 

full-field sonographic volumes for comprehensive review and 

diagnosis of the breast. ACUSON S2000 ABVS features an 

integrated room suite design that combines the advanced 

ACUSON S2000 ultrasound system and a column stand with 

an arm assembly, which holds a transducer pod specially 

designed for automated ultrasound breast imaging. It supports 

a high patient load with 250 to 400 single images acquired 

in one scan to calculate the volumes, which are sent to a 

dedicated ABVS Workplace for analysis and manipulation. The 

system features the anatomical coronal plane, which is not 

available using conventional ultrasound and includes semiautomated 

reporting features and comprehensive BI-RADS 

report capabilities. 

Breast Tomosynthesis 

The latest technology now under development in full-field 

mammography, breast tomosynthesis 3 , is a 3D imaging technology 

that acquires 2D projection images of a compressed 

breast at multiple angles during a sweep of the X-ray tube. 

Poised to enhance mammography, the new technology will 

take the two-dimensional images and reconstruct them to 

reveal depth – the third dimension of anatomy. Tomosynthesis 

slices have the potential to show tumors that remain invisible 

in individual images. 

1 

This information about this product is preliminary. The product is under development 

and not commercially available in the U.S., and its future availability cannot be ensured. 

2 

The information about this product is being provided for planning purposes. The product 

is pending 510(k) review and is not yet commercially available in the U.S. 

3 

Caution: Investigational Device. Limited by U.S. Federal Law to investigational use. 

The information about Digital Breast Tomosynthesis is preliminary. This product is 

under development and not commercially available in the U.S., and its future availability 

cannot be assured. 


“National Jewish Health and 

Siemens share a common vision 

of bringing laboratory diagnostics 

together with imaging in 

order to give our patients the 

best care possible.” 

Michael Salem, MD, President and CEO, 

National Jewish Health, Denver, CO, USA 

Bringing Personalized Medicine 

into Focus 

For 109 years, National Jewish Health has sought to offer 

patients the best possible care. U.S. News & World Report has 

ranked National Jewish Health the number one respiratory 

hospital in the nation for 11 years straight. It is continuing its 

legacy by launching a personalized medicine initiative, seeking 

to become a nationally recognized clinical thought leader 

among American healthcare providers. 

By Amy K. Erickson 


“Siemens Financial representatives 

were very responsive to our 

questions. They took the time to 

understand National Jewish Health 

and our financing needs.” 

Christine Forkner, CFO, 

National Jewish Health, 

Denver, CO, USA 

In collaboration with Siemens, National 

Jewish Health’s individualized medicine 

strategy is aimed at merging research and 

clinical efforts to improve and develop 

novel imaging and laboratory diagnostic 

technologies. 

Medical Solutions sat down with Michael 

Salem, MD, President and Chief Executive 

Officer of National Jewish Health, and 

Christine Forkner, Chief Financial Officer 

at National Jewish Health, to discuss their 

strategic alliance with Siemens, their 

shared vision for collaborative research, 

improved diagnostic imaging, and financing. 

It is an ambitious endeavor: National 

Jewish Health will integrate Siemens technology 

throughout the facility’s 19-acre 

campus in Denver, Colorado, U.S. – in 

order to offer patients advanced diagnoses 

and treatments. 

Personalized medicine is a new therapeutic 

approach that uses genetic 

and other information about a person 

to tailor the prevention, detection, 

treatment, and monitoring of disease. 

How does partnering with Siemens 

Healthcare bolster your strategic plan 

to advance the field of personalized 

medicine and use those advances to 

better care for your patients? 

SALEM: Personalized and preventive 

medicine is about the right diagnosis and 

treatment for the individual patient. By 

combining our strengths in technology, 

patient care, and research, Siemens and 

National Jewish will advance the idea of 

early detection and prevention. We will 

be able to provide more accurate diagnoses 

that lead to more targeted and 

effective therapies for our patients and 

patients around the world. To do this, 

we set up three pillars of infrastructure: 

the Integrated Bioinformation and Specimen 

Center, the Center for Genetics 

and Therapeutics, and the Institute for 

Advanced Biomedical Imaging 1 . 

Why did National Jewish Health 

select Siemens Healthcare as a clinical 

and Siemens Financial Services, Inc. 

[Siemens Financial] as a financial 

partner? 

SALEM: Siemens is a world-class company 

and our collaboration brings together 

the best of the best in terms of faculty, 

staff, and technology. We share a common 

vision of bringing laboratory diagnostics 

together with imaging in order to 

1 

The Institute for Advanced Biomedical Imaging is a 

registered trademark of National Jewish Health. 


Patient-centered Medicine 

give our patients the best care possible. 

FORKNER: From a financial standpoint, 

when we looked at Siemens Financial, 

we were looking for a broad agreement 

with a broad scope and a wide range of 

criteria. We considered how easy they 

are to work with, their clear and straightforward 

documents, their experience in 

dealing with local authorities, and their 

expertise in tax-exempt lending. We compared 

their offers with several national 

and large regional banks, equipmentlending 

companies, and their competition. 

Siemens Financial came out on top. 

How will National Jewish Health and 

Siemens Healthcare benefit from this 

joint effort? 

Summary 

Challenge: 

• Moving away from a reactive trialand-error 

method of practicing 

medicine to a predictive, personalized 

model 

• Practically implementing better 

diagnostics that lead to more effective 

treatments 

• Obtaining financial assistance to 

fund state-of-the-art technologies 

Solution: 

• Collaborating with healthcare 

institutions to improve and develop 

novel imaging and diagnostic 

technologies 

• Integrating Siemens technologies 

throughout National Jewish Health 

to help diagnose respiratory, cardiac, 

and rheumatologic diseases 

• Merging the institution’s research 

and clinical efforts at the point of 

care for the benefit of the patient 

• Providing easy, affordable financing 

options to healthcare entities 

Result: 

• Improved patient care 

• Development of a practical model of 

proactive personalized healthcare 

• Advancement of molecular medicine 

• Better diagnostic and imaging 

technologies 

SALEM: We think National Jewish is 

very well positioned to help Siemens 

advance its technologies. In our laboratories, 

we have invented and are committed 

to a number of novel diagnostic 

tests – whether they are genetic tests, 

biomarkers, or new predictive tests that 

can track patient progress – and we think 

a partnership with a leader like Siemens 

will allow us to bring these things to 

patients a lot sooner than we otherwise 

would have. Additionally, we have tremendous 

expertise and access to samples 

and patients. With technology from 

Siemens and great minds on both sides, 

we have the opportunity to be very successful. 

Why did you choose Siemens Financial 

to finance the equipment and technology? 

In other words, what differentiates 

Siemens from other lending 

sources? 

SALEM: This is a competitive business and 

we were looking for a business partner 

and a research partner. 

FORKNER: We went with Siemens Financial 

because our market analysis indicated 

that they had the best rate and some of 

the easiest processes. Siemens Financial 

representatives were very responsive 

to our questions. They took the time to 

understand National Jewish Health and 

our financing needs. They had excellent 

forms, which minimized lawyer time and 

expense. Overall, among the companies 

we considered, Siemens Financial came 

in as the number one frontrunner from 

a financial standpoint and in the broader 

relationship. On top of that, they were 

nice people to work with, which is important, 

especially in the most complicated 

financial transactions. I think we came 

together to make an excellent deal. 

How important is it that Siemens 

Financial provide equipment financing 

options to healthcare providers? 

FORKNER: It’s imperative that they do so 

for several reasons. Healthcare financing 

is always complicated. A lot of hospitals 

are experiencing a credit crunch at a time 

when radiology equipment continues to 

advance. You have to be very competitive 

in today’s healthcare world. It is beneficial 

to everyone that Siemens Financial 

not only has the financing, but also the 

expertise to make a lot of different financ- 

Siemens Provides Personalized 

Financing Options 

Siemens Financial Services, Inc. provides innovative financial solutions 

to healthcare providers such as National Jewish Health. With expertise in 

asset-based lending, capital markets, equipment financing, commercial 

trade finance, and vendor financing, each transaction is tailored to fit the 

specific borrowing needs of the client. 

The financing arm for healthcare at Siemens Financial Services has been 

in existence for over 20 years. “We offer a turnkey approach,” says Lynn 

Beckham, Vice President of Tax-Exempt Healthcare Corporate Finance for 

Siemens Financial Services. “The customer not only looks to us for equipment, 

but also for financial assistance, as was the case with National Jewish 

Health.” 

After Siemens identified the best funding avenues for National Jewish 

Health, the US$13 million transaction was completed in about five weeks 

from start to finish. 

“We offer excellent customer service,” says Beckham. “Our rates are very 

attractive and we are always accessible. With this equipment, National 

Jewish Health will be able to expand and do more research, which in the 

end, means helping more people.” 


ing options available – from tax-exempt 

to not tax-exempt, from an operating 

lease to a capital lease, there are a lot of 

options out there. Siemens Financial not 

only makes those available, they also 

make them easy. 

How are current U.S. market conditions 

affecting your ability to fund projects? 

FORKNER: The market has impacted 

budgets across the country and ours is 

no exception. Siemens Financial worked 

wonderfully with us to help get our program 

financed. National Jewish has a 

dedicated donor base and, with relationships 

with industry leaders like Siemens, 

I think National Jewish will weather this 

crunch just fine. 

National Jewish Health’s mission of 

personalized medicine is aligned with 

Siemens strategy of providing cuttingedge 

technology to improve patient 

care. Can you highlight a few examples 

of how this collaborative effort benefits 

patients? 

SALEM: I think the benefit to patients 

will be this transition to more preventive 

care – this notion or idea of early detec- 

Collaboration Strengthens Patient Care 

A cornerstone of National Jewish Health’s mission to 

advance personalized medicine is the integration of 

Siemens technology within the existing medical infrastructure. 

Currently, physicians and clinicians at National Jewish 

Health are supported by a wide range of Siemens in vivo 

diagnostics and information technology, including 

SOMATOM® Definition, SOMATOM Sensation 64, 

MAGNETOM® Avanto, syngo® Imaging and syngo Workflow, 

Biograph TM 40, ARCADIS TM Avantic, and c.cam. Additionally, 

National Jewish Health plans to install several Siemens 

solutions for in vitro diagnostics in the near future. 

The Institute for Advanced Biomedical Imaging, which 

opened its doors in the spring of 2008, houses two Siemens 

computed tomography (CT) systems and one Siemens 

PET·CT (positron emission tomography-CT) system. 

The institute also has an integrated radiology information 

system (RIS) and picture archiving and communication 

system (PACS) that uses the same syngo architecture as 

the imaging modalities, leading to streamlined data 

reconciliation and consistency. Additionally, National 

Jewish Health and Siemens are launching several collaborative 

research projects that seek to improve the diagnostic 

capabilities of several imaging technologies. The overarching 

goal of these projects is to detect disease earlier 

and make more precise diagnoses, leading to improved 

patient care. 

These projects include: 

• Using technology from Siemens to develop techniques 

for detecting very small lung nodules (four to eight 

millimeters in diameter) in individuals at a high risk for 

lung cancer 

• Developing a model of the lung that can be used by 

others to calibrate CT systems in order to produce comparable 

images 

• Developing a Quantitative Imaging Laboratory at 

National Jewish to improve quantitative imaging techniques 

for better integration of radiologic and molecular 

imaging 



tion. How do you practically implement 

the idea of prescribing medications 

more precisely? Patients suffering from 

COPD [Chronic Obstructive Pulmonary 

Disease] offer one example. COPD is 

really a syndrome, a broad group of conditions 

grouped together through a fairly 

crude diagnostic tool – the amount of 

air a person can exhale in one second. 

Advanced imaging is increasingly able to 

distinguish the two main characteristics 

of COPD – lung destruction and airway 

inflammation. As we learn to distinguish 

the varieties of COPD and couple that 

with information gleaned from biomarkers 

and genetics, physicians will have 

improved knowledge about a patient’s 

disease. Physicians will be able to target 

treatments to address specific situations 

within the COPD spectrum, and patients 

will have better outcomes. 

We also expect to improve imaging of 

the right side of the heart, which is less 

advanced than imaging of the left side 

of the heart. It can often be difficult to 

determine whether a patient’s shortness 

of breath – a common complaint among 

our patients – is caused by problems in 

the lung or in the right side of the heart, 

which pumps blood to the lungs. By 

developing improved tools to measure 

right-heart function, we will better understand 

our patients’ needs and address 

them more effectively. 

One of our collaborative research projects 

also seeks to detect potentially cancerous 

lung nodules when they are smaller than 

we can currently detect. Earlier detection 

and removal of cancerous nodules 

could significantly improve survival in 

lung cancer. 

What are the measurable outcomes 

of the partnership between National 

Jewish Health and Siemens? 



SALEM: Research results and patient 

outcomes. As our collaboration produces 

new methods and tools for diagnostic 

imaging and healthcare solutions by 

bringing together imaging and the clinical 

reference labs, we will share that knowledge, 

which may change the way medicine 

is practiced. And, as the broader 

diagnostic imaging and laboratory communities 

adopt those new methods and 

tools, patient outcomes will improve. 

Providing testing using cutting-edge 

diagnostics and targeted therapies is a 

real challenge. We think if we put 

together the best of what the industry 

has to offer and the best of what academia 

and medicine have to offer in this 

environment here at National Jewish 

Health, then we have the potential to 

really help patients. 

Amy K. Erickson is a Chicago-based writer 

specializing in medicine, science, and biotechnology. 



personalized-medicine 


Magnetic Resonance Imaging 

Expects to improve diagnosis for nervous and circulatory systems: Dr. Romeu Côrtes Domingues 

Room to Breathe 

Siemens 70-centimeter Open Bore technology makes magnetic 

resonance imaging less claustrophobic and more comfortable, enabling 

faster and better imaging for delicate cases. 

By Reinaldo José Lopes 



It’s been a long wait. In October 2007, 

Romeu Côrtes Domingues, MD, and his 

colleagues at CDPI (Clínica de Diagnóstico 

por Imagem, a major imaging diagnosis 

facility in Rio de Janeiro, Brazil) visited 

a factory in Erlangen, Germany, and 

were able to have a ’sneak peek‘ view of 

MAGNETOM® Verio, Siemens new 3 Tesla 

(3T) Open Bore magnetic resonance 

imaging (MRI) device. “It was still a top 

secret project back then,” recalls Domingues. 

“We had almost closed a deal with 

another manufacturer, but when we saw 

MAGNETOM Verio, we realized that this 

was a completely different game – it was 

surely going to become the new benchmark 

in the market. We simply had to buy 

it – and that’s what we did last year.” 

Since it was a novel technology, though, 

MAGNETOM Verio still had to wait in 

order to be registered and approved by 

Anvisa (Agência Nacional de Vigilância 

Sanitária), the Brazilian counterpart to 

the FDA. “They took almost six months 

to do it, but thank goodness the device 

is finally about to be installed,” says 

Domingues with palpable relief. 

The team at CDPI now expects to employ 

MAGNETOM Verio to reduce rejection by 

claustrophobic patients and significantly 

improve the diagnosis of a variety of 

conditions, especially those involving the 

nervous and circulatory systems. “We are 

happy and very proud to be the first in 

Brazil, and among the first in the world, 

to have this kind of technology at our 

disposal. Because we focus so much on 

MRI – we have 50 doctors working on 

it, with thousands of exams per month 

– we need the best. And there’s no 

question MAGNETOM Verio is the best 

option.” 

The Brazilian radiologist and his colleagues 

have been familiar with Siemens 

MAGNETOM systems for quite a while and 

have been working with a MAGNETOM 

Symphony and a MAGNETOM Avanto. 

“Siemens became the world leader in the 

market share of MRI devices, thanks also 

to their MAGNETOM Espree’s Open Bore 

concept,” states Domingues. “Still, mag- 

“There’s no question MAGNETOM 

Verio is the best option.” 

Romeu Côrtes Domingues, MD, 

Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil 

netic resonance can be a difficult method 

when you take into account the patients’ 

rejection rate due to claustrophobia or 

lack of comfort. Conventional small bores 

may frighten off about three percent of 

patients – sometimes we even need to 

hold a patient’s hand to calm him or her 

down while the session proceeds,” he 

says. 

Ten Centimeters that Matter 

Open Bore MRI changes that by providing 

ten centimeters of additional breathing 

room for the patients. “It may not seem 

so at first, but ten centimeters matter a 

lot. You’ll never want to be examined in 

a standard-bore device after that,” says 

Domingues. Combined with the Open 

Bore approach, MAGNETOM Verio will 

allow the team at CDPI to handle difficult 

procedures in a much more flexible way 

and, thanks to 3T, to provide them with 

a welcome enhancement in resolution 

and precision, and also with a bigger 

chance of an early diagnosis in a number 

of conditions. 

“Of course, we’re talking about doubling 

the magnetic field. And that means 

doubling the signal-to-noise ratio, too. 

Some lesions that are nearly invisible for 

a 1.5T machine – in a patient with a case 

of epilepsy that’s difficult to control, for 

instance, or breast cancer at the earliest 

stages – are sure to show up with 3T.” 

But at least in most systems, the precision 

of 3T comes at the price of “unfriendly 

60-centimeter bore systems,” as Domingues 

puts it – precisely the ones that 

look the most oppressive to patients. 

“The unique combination of 3T with 

Open Bore in MAGNETOM Verio will help 

us enjoy the best of both worlds,” he says. 

Domingues explains that both claustrophobic 

patients and children, who normally 

have a hard time undergoing MRI, 

stand to benefit from Open Bore technology. 

“Depending on the kind of procedure, 

you can actually let the mother 

caress the child during the exam. Obese 

patients, up to 250 kilograms, can also 

be redirected to it. And there are positioning 

advantages for those with chronic 

pain or limited mobility.” 

Even for patients who do not suffer from 

any disability and feel just fine in a tight 

place, Open Bore technology can make 

a difference, according to the Brazilian 

radiologist. “Let’s say you need to image 

a patient’s wrist. In any conventional 

machine he would have to go in with 

his wrist first, and we all know how unbearable 

it is to keep your arm stretched 

for 15 minutes. If you need to examine 

someone’s knees, lumbar vertebrae or 

abdomen, the patient’s head can stay 

outside the tunnel, as we say. And that’s 

a lot less stressful.” 

Total Imaging 

According to Domingues, another important 

factor for the success of Siemens MRI 

systems is Tim® (Total imaging matrix) 

technology. “This is crucial, because MRI 

procedures have now become so common 

that between 20 and 30 percent 

of our patients arrive here with requests 

to image two or three different areas,” 

he says. With Tim, up to ten coils can be 

used at the same time. That means 

there is no need for the patient to get in 

and out of the system, or to change 

position inside it. At the end of a typical 

working day of 15 hours, the result is 

that about two or three extra patients 


Open Bore systems open up new possibilities: MAGNETOM Espree and MAGNETOM Verio facilitate exams of claustrophobic, obese, 

and immobile patients, or patients in pain. 

Summary 

Challenge: 

• Patients’ rejection to MRI due to 

claustrophobia 

• Difficult or impossible imaging of 

obese patients, patients that are 

immobilized, or people with chronic 

pain 

• Lack of Open Bore MRI systems with 

a 3T magnetic field 

Solution: 

• Investment in MAGNETOM Espree, a 

1.5T, 70-centimeter Open Bore system, 

and its newly released 3T counterpart, 

MAGNETOM Verio 

Result: 

• Improvement in workflow – up to 

60 MRI examinations in a single day 

• More comfort for patients 

• Increased precision in difficult exams 

• Better research capabilities 

have been examined. “We broke our own 

record a couple of months ago, doing 

60 sessions in a single day. One would 

never be able to reach the same amount 

with a different machine,” reports 

Domingues. 

With MAGNETOM Verio, the team at CDPI 

hopes to strike a rewarding balance 

between faster imaging and higher resolution. 

“By doubling the magnetic field, 

going from 1.5T to 3T, you could in theory, 

image a brain tumor in ten minutes, 

instead of spending 20 minutes on it. But 

with 3T, in those cases, we can produce 

a complete study of the relevant brain 

area, including perfusion, spectroscopy, 

and functional data, that enables us to 

classify the tumor as malignant or benign 

with a very high degree of certainty. That 

would take about 15 minutes, but the 

gain in diagnostic quality would more 

than compensate for the additional time 

we spend,” he says. 

Besides, the combination of Tim, 3T, 

and Open Bore technology is also suited 

to dramatically improve the diagnosis 

of numerous conditions, explains Domingues. 

In the case of breast tumors, MRI 

can both bring to light nodules that are 

hard to detect through mammography, 

and guide doctors to obtain biopsies of 

the affected tissue with a high degree 

of precision. He says: “You are able to 

obtain ‘slices’ of breast tissue that are 

0.5 millimeters thin, so absolutely nothing 

eludes us.” 

Thanks to Tim, an interesting trend in 

recent times is the use of MRI to image 

a patient’s body from head to toe. “It 

can be very useful to detect metastasis. 

In patients with diabetes, where there’s 

systemic damage to blood vessels, you 

can inject the contrast in the whole body 

in order to have a global picture. The 

same goes for myositis, a condition 

that affects the whole musculoskeletal 

system,” Domingues says. 

“In angiographies with 3T, you’re able to 

do dynamic studies where the contrast 

is literally seen arriving at the artery and 

coming back through a vein real fast.” 

The same praise goes to neurological 

exams. According to Domingues, smaller 

and more precocious lesions tend to 

appear in better detail and, with the 

help of spectroscopy, it is easier to say 

whether a given abnormality is a tumor, 

an inflammatory lesion, or a stroke. And 



“Once a patient is examined with 

MAGNETOM Verio, he won’t think of being 

imaged in another machine.” 

Romeu Côrtes Domingues, MD, 

Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil 

there is also the possibility of dynamic 

imaging – a knee in movement, for 

example, a kind of exam that is often 

sought by Brazil’s top soccer players. 

Research 

Apart from the benefits for patients, 

Domingues sees MAGNETOM Verio as a 

boost for CDPI’s research capabilities. 

“We’ve been able to forge a strong partnership 

with universities in Brazil and 

abroad. It’s also a strong motivating factor 

for our doctors. It’s always good for 

them to get away from cases of headaches 

and meniscus lesions every now and 

then.” The research output has been so 

great, says Domingues, that his group 

has had 21 papers accepted for presentation 

at the 2008 annual meeting of the 

Radiological Society of North America 

(RSNA) – more than all the Brazilian 

research groups put together in previous 

meetings. A paper by Domingues and his 

colleagues that has just been accepted 

for publication in the American Journal 

of Roentgenology shows how positron 

emission tomography (PET) and MRI can 

be combined to get a clearer picture of 

lesions in the nervous system, abdomen, 

and bones when the data from PET·CT 

(computed tomography) is somewhat 

doubtful. 

Domingues hopes that MAGNETOM Verio 

will keep his team at the top of their 

game and, more importantly, the patients 

will feel like it is the best solution for 

them. “I believe that, once a patient is 

examined with MAGNETOM Verio, he 

won’t think of being imaged in another 

machine. The difference between it 

and any other device is just staggering. 

That’s why we’re sure that this is an 

investment that will pay off. If you do 

the math, you’ll find out that, at the 

end of five years of work, you can buy 

another machine thanks to the time you 

saved with the first one,” he concludes. 

Reinaldo José Lopes is a science and health 

writer at G1, Brazil’s largest news website. 


www.siemens.com/Verio 

www.siemens.com/Espree 

Dynamic Duo 

In the U.S., MAGNETOM Espree and MAGNETOM Verio also 

help to image children, claustrophobic and obese patients, 

and body areas that are difficult to image. The medical team 

at South Jersey Radiology Associates, New Jersey, like its 

colleagues in Rio de Janeiro, are witness to the flexibility 

and precision of both systems. “They enable us to capture 

patients we would not have been able to image with conventional 

MRI,” says William F. Muhr, MD, Director of Body 

Imaging at the private practice. In two of their locations 

east of Philadelphia, they decided to replace conventional 

1.5 Tesla systems with the Siemens Open Bore technology. 

Muhr says MAGNETOM Espree and MAGNETOM Verio help 

to improve workflow at their facilities by easing the positioning 

of patients and diminishing the number of image 

retakes caused by anxiety-related movements. Thanks to 

MAGNETOM Verio’s 3 Tesla field, the New Jersey team also 

obtains high-quality images of difficult body areas. “We get 

really good image quality in abdominal exams for obese 

patients, and also in challenging exams of small structures 

like the wrist,” Muhr remarks. 

For orthopedic exams, MAGNETOM Verio is fast, around 

15 minutes on average, compared to 30 minutes in conventional 

systems, and that is probably a factor in the high 

acceptance rate among patients: For their next exam, around 

90 percent of patients ask to be imaged on MAGNETOM 

Verio again. 


Designed for Adaptive Radiation Therapy, the 

ARTISTE solution enables radiation oncologists 

to create treatment plans that include IGRT, 

conformal radiation therapy, IMRT, high-precision 

radiation therapy, and gated treatments.

Radiation Therapy 

The Future of Oncology: 

The ARTISTE Solution 

At Baton Rouge General Medical Center’s Pennington Cancer Center 

in Louisiana, U.S., the staff shares the belief that cutting-edge cancer 

care should not be limited to patients at larger hospitals and academic 

medical centers. 

By Sameh Fahmy, MS 

Pennington Cancer Center partnered 

with Siemens to rapidly and efficiently 

deliver advanced and routine radiation 

therapy close to home, providing a wider 

range of options for a larger scope of 

patients than ever before. 

“We need to provide state-of-the-art 

cancer care for the people of this state so 

that they don’t need to go elsewhere,” 

says Director of Radiation Oncology Zack 

Smith, RT, MBA. “They should stay here 

– where their families are, where their 

community is, where their jobs are, and 

where they have all of the support mechanisms 

that will make their treatment 

easier.” 

To that end, the 544-bed, communityowned 

hospital became the first in the 

United States to install the Siemens 

ARTISTE integrated radiation therapy 

solution. By combining a range of 

advanced imaging options, rapid image 

acquisition and processing, and precise 

treatment delivery, the system has given 

the Pennington Cancer Center the flexibility 

to treat routine cases as well as 

those that require complicated treatment 

plans, such as Intensity-Modulated Radiation 

Therapy (IMRT), while maintaining 

a quick and efficient workflow. 

Enhanced Flexibility 

Pennington Cancer Center installed 

ARTISTE in February of 2008. Medical 

Director William Russell, MD, explains 

that its flexibility was a key factor in their 

decision. The solution gives Russell and 

his colleagues the ability to create treatment 

plans that include Image-Guided 

Radiation Therapy (IGRT), conformal radiation 

therapy, IMRT, high-precision radiation 

therapy, and also gated treatments. 

“We chose ARTISTE because it gives us 

the full spectrum of treatment options,” 

Russell says. “It allows us to efficiently 

and rapidly deliver routine radiation therapy 

for patients who don’t require overly 

sophisticated plans, while also enabling 

us to deliver more complex treatments 

using the same platform.” 

ARTISTE is engineered specifically for 

Adaptive Radiation Therapy (ART), which 

aims to precisely deliver dose to the target 

while sparing surrounding healthy tissue. 

Russell points out this is particularly 

important because the size and shape 

of tumors change during treatment and 

because tumors can shift in response to 

factors such as weight loss, inflammation 

in nearby tissues, and normal physiological 

functions – for example, lung tumors 

move as the patient breathes, and the 

prostate shifts in response to fullness in 

the bladder and rectum. 

To help ensure that the treatment dose 

is delivered to the target and not healthy 

tissue, this radiation therapy solution 

allows physicians to image the patient 

just prior to treatment, verify that the 

patient position is correct, and adapt to 

any anatomical changes immediately 

before – or in some cases during – treatment. 

ARTISTE also offers the ability to 

incorporate the dose used for pretreatment 

imaging into the treatment plan 

so that clinicians can accurately monitor 

the dose delivered to the patient. 

“Siemens has always been a leader in 

healthcare solutions, so for us, it made the 

most sense to stay with a company that 

had a proven track record in both therapy 


and imaging for a combined modality 

machine,” Russell says. “This system is the 

future of radiation oncology.” 

The ability to choose between multiple 

imaging options is one of the features 

that makes ARTISTE so unique. Russell 

explains that for patients with simple 

treatment plans, ARTISTE offers twodimensional 

OPTIVUE portal imaging 

for low-dose, high-resolution image 

quality. In situations where additional 

imaging information is required, it offers 

its powerful and unique 3D MVision 

Megavoltage Cone Beam Imaging. 

MVision uses the treatment beam to 

provide 3D target imaging with excellent 

soft-tissue resolution. MVision also 

allows clinicians to incorporate dose distributions 

from cone beam imaging into 

patient treatment plans. 

Rapid Workflow, Improved 

Outcomes 

The images ARTISTE produces are of 

exceptionally high quality, while maintaining 

acquisition speed. “The speed with 

which the megavoltage cone beam 

image is acquired and the speed at which 

the software arrives at a solution for adaptive 

targeting is three minutes,” Russell 

explains, “and that’s very fast.” 

The system’s rapid speed increases 

patient comfort by decreasing their time 

on the treatment table and, Russell says, 

can improve outcomes by minimizing 

the likelihood that the patient or the 

target will shift while images are being 

acquired. Smith notes that another 

benefit of MVision is that it is fully integrated 

and therefore requires no addon 

hardware. “When you bolt on accessories, 

you introduce the possibility 

of set-up errors and need extra quality 

assurance steps,” Smith says. “Because 

everything is in line with MVision, what 

you’re seeing is a Beam’s-Eye-View 

[BEV].” 

ARTISTE’s In-Line Technology also 

streamlines workflow and increases 

patient comfort. Therapists are afforded 

clear access to the patient during setup, 

and the risk of collision between the 

linear accelerator and objects in the room, 

such as a patient’s wheelchair, is minimized. 

“But the biggest plus for me is 

that when patients walk into the room, 

they see a sleek system that is not going 

to enclose them with a bunch of imaging 

apparatus coming out of the sides,” Smith 

says. “It’s a very unthreatening environment, 

and that makes the patients very 

relaxed and allows us to take care of 

them quickly.” 

ARTISTE includes the 160 MLC Multileaf 

Collimator to provide highly accurate 

and precise field shaping. Its leaves 

move at four centimeters per second 

to quickly deliver treatment, and its low 

transmission and leakage minimizes dose 

to healthy tissue. It has a small, fivemillimeter 

leaf thickness over the full field 

to improve conformity to the tumor shape. 

Smith says most patients will only need 

a fraction of ARTISTE’s capabilities, but 

for some patients, even a small increase 

in precision can result in significantly improved 

outcomes. He recalls one patient 

who was treated for a spinal metastasis 

in her upper thorax but suffered a recurrence 

several months later. The cancer 

came back in the same region and had 

started to deteriorate a vertebral body, 

causing pain. The spinal column had 

already received a near-maximum radiation 

dose, Smith says, and without the 

new technology, the sole treatment 

option would have been analgesics and 

a treatment that would only have slowed 

the progression temporarily. 

Using MVision cone beam guidance, 

ARTISTE allowed the patient’s physician 

to pursue a more aggressive treatment 

plan with a degree of precision that Smith 

describes as “almost like a surgeon’s 

knife.” He adds, “By the third treatment 

she was pain free, and today she’s still 

pain free. So her outcome was better. 

The physician having that ability to make 

a difference in this patient’s outcome 

just because of ARTISTE tells me that it’s 

the right technology.” 

Another feature that increases treatment 

options for patients is its 550 TxT 

Treatment Table, which accommodates 

patients of up to 550 pounds (250 kilograms). 

Russell says the combination 

of ARTISTE and Siemens SOMATOM® 

Sensation Open large-bore computed 



“ARTISTE is cutting edge now and 

it’ll still be cutting edge next year, 

the year after that, and for years 

to come.” 

Zack Smith, RT, MBA, Director of Radiation Oncology, 

Pennington Cancer Center, 

Baton Rouge General Medical Center, 

Baton Rouge, LA, USA 

tomography (CT) system, which Pennington 

Cancer Center uses for planning, 

gives them the ability to effectively treat 

obese patients, using the same table for 

both imaging and treatment – helping 

avoid shifts in patient positioning. 

Treating Challenging 

Cases in Europe 

“It used to be that when patients weighed 

over 300 pounds [136 kilograms], not 

only could we not treat them well, but 

we couldn’t plan the treatment well,” 

he explains. “Now, with the combination 

of Siemens wide-bore CT scanner and 

In Europe, MAASTRO Clinic in the Netherlands and the German Cancer 

Research Center (DKFZ) in Heidelberg were the first to install ARTISTE. 

Clinicians at both centers say its flexibility has allowed them to confidently 

treat a number of challenging cases. 

ARTISTE was used at DKFZ, for example, to treat an inoperable esophagus 

tumor. “Treatment for this type of tumor demands a very complicated 

radiotherapy approach,” says Professor Peter Huber, MD, Head of the 

Radiation Oncology Clinical Cooperation Unit at DKFZ. “Using the 

ARTISTE 160 MLC Multileaf Collimator, we were able to significantly 

improve the precision of the dose delivery while protecting immediate 

surrounding healthy tissue.” 

MAASTRO Clinic has treated challenging clinical cases such as a metastasized 

tumor in the abdominal region and a patient with two separate 

metastases: one in the head and neck region, and one in the knee cap. 

“ARTISTE’s imaging flexibility and simplified workflow help us to confidently 

treat proliferated tumors in a wide range of areas of the body,” says 

Bas Nijsten, MSc, Medical Physicist in the Maastricht Radiation Oncology 

Department. “The advanced, high-end imaging capabilities of ARTISTE 

allow us to fully integrate all our Image-Guided Radiation Therapy and 

MAASTRO-developed Dose-Guided Radiation Therapy methods in one 

clinical workflow.” 

ARTISTE’s treatment table, we can offer 

high-quality, precise treatments to our 

larger patients.” 

Large patients, as well as patients with 

tumors located off-isocenter, also benefit 

from MVision’s extended field-of-view 

(FOV) option. 

Ease of Operation, Financial 

Rewards 

Patient setup, imaging, verification, and 

treatment delivery are controlled via 

Siemens intuitive syngo® RT Therapist 

workspace. Adaptive Targeting on the 

software quickly and reliably registers 

pretreatment images with the planning 

CT. 

syngo RT Therapist is a component of 

syngo Suite for Oncology 1 , a streamlined, 

scalable workspace solution that provides 

members of the clinical team with 

the tools and data they need to efficiently 

accomplish their tasks. syngo Suite for 

Oncology also includes syngo RT Oncologist, 

syngo RT Physicist, and syngo RT 

Dosimetrist. Smith says that using syngo 

software across the Cancer Center creates 

efficiency by giving clinicians a common 

operating platform from which to work. 

“So even if I don’t operate the CT very 

often, I can go to it and the browsers are 

the same and the buttons are familiar 

and intuitive,” he says. 

Smith says the syngo platform makes it 

easier for new users to operate ARTISTE 

and has simplified its integration into the 

Cancer Center’s entirely paperless environment. 

As a Siemens partner and the 

first ARTISTE site in the United States, 

Pennington Cancer Center hosts clinicians 

from across the nation and shares its 

expertise with centers that are adopting 

the solution. 

Russell and Smith say that as a community-owned 

hospital, Baton Rouge General 

has a duty to be a good financial steward. 

The addition of ARTISTE accomplishes this 

goal, they say, by providing measurable 

financial benefits. Smith says its rapid 

1 

The COHERENCE Suite of Oncology workspaces is 

currently being rebranded to syngo Suite for Oncology. 

The mentioned workspaces are available for purchase 

under the COHERENCE brand name. 



Summary 

Challenge: 

• Maintaining rapid workflow while 

delivering increasingly complex 

radiation therapy treatments 

• Achieving high image quality in 

challenging situations 

• Treating irregular tumors and 

tumors near critical structures 

• Effectively imaging and treating 

obese patients 

Solution: 

• Expanded treatment options with 

the ARTISTE integrated imaging and 

radiation therapy solution 

• Rapid image acquisition and 

Adaptive Targeting help ensure that 

treatment begins within three 

minutes after positioning 

• MVision Megavoltage Cone Beam 

Imaging delivers exceptional 3D 

soft-tissue resolution with extended 

field of view 

• In-room CTVision allows direct 

comparison of daily patient anatomy 

with planning data 

• Fine-leaf resolution of 160 MLC 

allows exceptional large-field 

conformity and minimal dose to 

organs at risk 

• 550TxT Treatment Table accommodates 

patients up to 550 pounds 

(250 kilograms) 

Result: 

• Flexibility helps ensure that all 

patients receive the treatment best 

suited to their needs 

• Precise treatment delivery 

maximizes dose to target while 

minimizing dose to healthy 

tissue, improving patient outcomes 

• Rapid image acquisition and treatment 

delivery enhance workflow 

and allow clinicians to treat more 

patients, increasing financial rewards 

“This system 

is the future 

of radiation 

oncology.” 

William Russell, MD, 

Medical Director, 

Pennington Cancer Center, 

Baton Rouge General Medical 

Center, Baton Rouge, LA, USA 

throughput – even complex treatments 

such as IMRT can be accomplished in 

ten minutes – allows them to treat more 

patients in a day. 

“If you have 35 patients undergoing treatment 

and you shave off 120 seconds 

from each patient, that’s more than an 

hour saved every day,” Smith says. “From 

an administrator’s perspective, that 

means we can treat four or five more 

patients in the same amount of time.” 

He adds that having a single system that 

can accomplish multiple tasks reduces 

staff training costs as well as engineering, 

maintenance, and vault costs. 

Russell points out that the installation 

of a technologically advanced linear 

accelerator is tangible evidence for the 

general public and physicians that 

Pennington Cancer Center is committed 

to excellence. “Physicians know that we 

have the ability to deliver highly sophisticated 

treatment plans with a state-ofthe-art 

Siemens solution,” Russell says, 

“and that has certainly resulted in more 

patient referrals to this facility.” Smith 

says he is confident that ARTISTE will 

retain its value over time because it is a 

platform for which Siemens is continuing 

to develop technology. 

Upgrades currently available include 

diagnostic CT imaging in the treatment 

room with the CTVision solution. 

Smith also anticipates future advances 

such as kVision Kilovoltage Cone Beam 

Imaging 2 , which delivers excellent 3D 

soft-tissue contrast, particularly for 

pelvic and thoracic targeting, and Dose- 

Guided Radiation Therapy (DGRT) 

Solution 2 . “ARTISTE is cutting edge now 

and it’ll still be cutting edge next year, 

the year after that, and for years to 

come,” Smith says. 

2 

kVision Kilovoltage Cone Beam Imaging and 

DGRT Solution are works in progress and are not 

commercially available in the U.S. 

Sameh Fahmy, MS, is an award-winning 

freelance medical and technology journalist 

based in Athens, GA, USA. 


www.siemens.com/ARTISTE 


Molecular Imaging 

Thinking Outside the Box 

Offering better return on investment and 

workflow efficiency, Siemens Healthcare unveils 

Molecular CT – the next evolution in multimodality 

imaging. More than just a hybrid, Biograph mCT 

is the imaging crossover that will drive change in 

the way hospitals think about integrated imaging. 

By Claudette Yasell, MBA 

Siemens Healthcare recently invited 

imaging opinion leaders from around the 

globe to discuss the future of integrated 

imaging and showcase an innovative new 

Siemens solution: Biograph Molecular 

CT – mCT. As the first scanner developed 

specifically for an integrated imaging 

environment, Biograph mCT sheds light 

on how to maximize workflow efficiencies 

while improving diagnostic capabilities 

for better patient care. 

“As the forerunner in integrated imaging 

solutions, Siemens wants to lead the 

evolution of PET·CT [positron emission 

tomography – computed tomography] to 

maximize these innovations in imaging 

and make them available where they will 

have the most impact. What we’ve done 

with Biograph mCT is taken the best 

Siemens has to offer in CT and enabled 

the introduction of ’smart‘ contrast – 

molecular contrast – using the most 

advanced PET technology available,” 

says Bernd Montag, CEO of Siemens 

Healthcare’s Imaging and IT Division. 

While hybrid imaging is not new to 

molecular imaging experts, the availability 

of molecular contrast in radiology 

opens doors to increased cooperation 

and, potentially, new standard protocols 

that provide diagnostic information 

which is unachievable using independent 

imaging modalities. Financially, using 

one all-encompassing scanner can make 

the most of an institution’s imaging equipment 

and strengthen the existing workflows 

between radiology and molecular 

imaging; all of which target the patient 

as the ultimate beneficiary. 

Smaller Footprint, Larger 

Impact 

Biograph mCT was designed to obtain 

functional, anatomical, and molecular 

information from one noninvasive diag- 



Summary 

Challenge: 

• Obtaining functional, anatomical, 

and molecular information in a fast, 

efficient, and economical way 

Solution: 

• Adding advanced PET functionality 

to a premium CT system 

• Placing PET·CT in the radiology 

suite 

• Enabling molecular contrast in 

radiology 

Result: 

• Increased return on investment 

on imaging equipment 

• Maximized workflow efficiencies 

and patient comfort 

• Improved diagnostic capabilities 

for better patient care 

nostic exam. Using Siemens premium 

CT technology, it adapts to virtually any 

patient and any clinical need with higher 

resolution, contrast, and speed. 

Biograph mCT comes together in one 

powerfully small package. It boasts a large 

bore, short tunnel, and small footprint 

for unparalleled patient care and comfort. 

Biograph mCT is offered with up to 

128 slices. With a table that can accommodate 

patients up to 500 pounds 

(227 kilograms), it makes the technology 

available so that many more patients can 

benefit from the valuable information it 

provides. 

In addition to cutting-edge CT technology, 

Biograph mCT maximizes the most 

advanced PET technology available, 

including features such as a 33-percent 

increase in the PET field of view, highdefinition 

imaging technology with increased 

spatial resolution, and time-offlight 

functionality. It offers the ultimate 

in PET image quality and count rates for 

faster, more comprehensive scanning. 

It can complete routine five-minute PET 

scans, which provide maximum patient 

comfort and workflow efficiency. Applications 

in oncology include the ability to 

delineate lesions for diagnosis, staging, 

and restaging of cancer, providing exquisite 

anatomical detail plus a measurement 

of cell metabolism. 

Patient-centric 

The ability to provide a high-quality 

imaging environment for patients that is 

accommodating, comfortable, and reliable 

plays a key role in the success of a 

hospital’s imaging center. The investment 

made in imaging equipment such as this 

will provide physicians the information 

necessary to better diagnose and treat 

patients. 

With this innovation, patient care can 

also be optimized. With the fastest PET 

acquisition times available and ultrafast 

CT scanning, patient movement is 

decreased, leading to better image quality. 

In addition, higher patient comfort 

is achieved due to shorter scan times. 

Biograph mCT also offers low-dose scanning 

1 in both PET and CT; a very important 

feature in imaging, as more concerns 

are raised with respect to radiation 

dose and increased frequency of tests. 

1 

Data on file 

Working Better Together 

This type of imaging innovation and 

integration is taking a front-row seat in 

the eyes of hospital administrators. 

Facilities can boast major cost savings, 

return on investment, and excellence in 

patient care as well as patient and staff 

satisfaction when innovation and integration 

are optimized. The establishment 

of new paradigms such as molecular CT 

for integrated imaging diagnostics using 

state-of-the-art CT and PET technologies 

allows patient data to flow seamlessly 

and swiftly among departments, harmonizing 

departmental cooperation. 

Biograph mCT is the quintessential 

definition of efficiency: one team, one 

room, one machine, and one comfortable 

patient. It offers the potential of diagnosing 

disease earlier and of more effectively 

managing disease at reduced costs. 

“And speaking directly to the bottom 

line,” says Montag, “with Biograph mCT, 

an institution may only need to purchase 

one imager instead of two, representing 

a huge cost savings potential at a time 

when healthcare budgets are tight.” 

Replacing a two scanner purchase with 

just one can lead to savings in space, 

construction costs, operating costs, and 

life-cycle costs. This scanner is also upgradeable 

to higher slice configurations 

and increased molecular capabilities such 

as high-definition PET and time-of-flight 

capabilities, so the investment made 

today stands firm well into the future. 

A smart new solution, Biograph mCT 

offers increased benefits for patients 

and represents an intelligent solution 

for physicians and administrators who 

want to provide the best patient care 

available and get the most out of their 

investment. 

Optimizing the Gold Standard 

The first choice in imaging diagnostics, 

CT provides ultimate imaging capabilities 

in anatomical and functional evaluations. 

Historically, radiologists were first able 

to visualize anatomical structures using 

axial CT, then spiral, multislice, and now 

Dual Source and adaptive CT. They have 

come to rely on the wealth of information 

provided by the growing speed and 

evolving capabilities of dynamic CT. In 

fact, 28 million CT scans were completed 

in the U.S. in 2006 for oncological evaluations, 

making CT the most widely used 

technology to offer insight into diagnosis 

and treatment for cancer. 2 But as the prevalence 

of diseases and conditions such 

as cancer and heart disease increases, 

the question becomes, “How can we 

offer even better diagnostic information 

with CT?” 

Currently, information from CT scans 

can visualize abnormalities such as 

blood clots, cysts, fractures, infections, 

and tumors in internal structures (for 

example, bones, muscles, organs, and 

soft tissue). CT is also used to guide the 

placement of instruments within the 

2 

IMV 2006 CT Market Summary Report 



body, for example, to perform a biopsy. 

The addition of an iodine contrast agent 

also allows organs and structures to be 

seen more visibly. And with the latest CT 

technology, tumor perfusion is also possible. 

Crossing Over to Molecular 

Resolution 

Obtaining even better diagnostic information 

comes not from the ability to 

visualize a tumor or abnormality through 

the use of a contrast agent, but from the 

ability to delineate the metabolic activity 

within the tumor and to determine 

whether or not it is responding to treatment. 

To move oncology forward, CT 

will break out of being a black-and-white 

modality and capture this type of information 

through the use of a molecular 

contrast agent. This concept, using 

molecular contrast with PET and CT, has 

been applied in the molecular imaging 

arena with unprecedented success. “For 

years now, we’ve seen how molecular 

imaging has influenced the diagnosis 

and treatment of cancer. Hybrid molecular 

imaging with PET·CT has made 

significant inroads in everything from 

diagnosis and staging in oncology to 

determining the effectiveness of cancer 

treatments. It has even been used in 

the development of new drugs,” says 

Montag. 

The information offered by cellular 

molecular activity using PET·CT has been 

proven to change the management of 

oncology cases. Using colorectal cancer 

as a prime example, PET·CT changed the 

management of the disease in 66 percent 

of patients, and additionally, new 

disease was found in 43 percent of the 

cases. 3 

Using a radiolabeled tracer, or molecular 

imaging agent, physicians can visualize 

metabolic information in tumors from 

initial diagnosis through the patient’s 

treatment and follow-up care. The most 

common molecular imaging agent, 

fluorodeoxyglucose, or 18F-FDG, is used 

to illustrate metabolic activity within 

cancerous tumors. Unavailable using CT 

alone, information from the molecular 

imaging agent in conjunction with the 

PET scan can also determine if metastases 

are developing as a result of the primary 

cancer. This information can be pivotal 

in the management of disease, as this 

type of metastatic activity may be too 

small to be seen on conventional CT. 

Other imaging agents are currently in 

the process of being developed. These 

agents are being created to capture 

disease-specific information. There are 

also a number of imaging agents being 

developed that can differentiate between 

3 

Scott et al. PET Changes Management and Improves 

Prognostic Stratification in Patients with Recurrent 

Colorectal Cancer: Results of a Multicenter Prospective 

Study. J Nucl Med, 2008; DOI: 

10.2967/jnumed.108.051615 

active and inactive tumor cells within a 

single tumor, to help the radiation planning 

physician determine where to best 

target therapy. 

The correlated PET·CT images provided 

in a multifaceted imaging environment 

offer a level of information not previously 

available. Taking this information and 

applying it in a new arena, asserting that 

every CT can have molecular imaging 

capabilities, clearly addresses the need 

for more effective imaging in oncology 

and makes it more widely available; 

offering personalized and very specific 

information about patients’ disease. So 

many advances are being made in the 

development of imaging agents that 

the most commonly used imager for 

oncology studies – CT – should be better 

equipped to handle them. 

Claudette Yasell holds an MBA from Dominican 

University, River Forest, IL, USA. 


www.siemens.com/mCT 

“What we’ve done with Biograph mCT 

is taken the best Siemens has to offer 

in CT and enabled the introduction of 

‘smart’ contrast – molecular contrast.” 

Bernd Montag, CEO, 

Siemens Healthcare, Imaging & IT Division, 

Erlangen, Germany 


Facility Planning

Facility Planning 

The Mazankowski Alberta Heart Institute’s development centered on patient experience. 

One result: a healing garden at the center of the institute for patients to enjoy a relaxing atmosphere. 

Canadian Innovation with Heart 

With the support of Healthcare Consulting, Siemens is helping a 

new state-of-the-art cardiac care and research institute in Western 

Canada to set new standards of care. Their approach is simple: 

clinical and operational transformation. Their efforts will not only 

transform the medical options available to patients, but also the 

way in which healthcare providers approach patient care. 

By Richard Cairney


“Healthcare Consulting 

took it all down to what’s 

best for the patient.” 

Carol Manson McLeod, Senior Operating Officer, 

Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada 

Summary 

Challenge: 

• Identify performance measures and 

introduce technological and architectural 

improvements to support a 

patient-centered culture in a new 

cardiovascular institute 

Solution: 

• Employ Healthcare Consulting with 

its portfolio of room and functional 

planning, IT & technology 

consulting, process and performance 

optimization, concepts to increase 

patient satisfaction, and patientcentric 

care concepts 

• Examine existing and planned 

cardiology practices as they relate 

to patients and introduce technological, 

structural, and cultural 

changes to the way care is delivered 

Result: 

• Intensive Care Unit constructed 

in a way that provides patient and 

family privacy while reducing the 

risk of spreading infection 

• Integrated bedside terminals that 

allow for easier admitting, physician’s 

access to electronic patient 

records, and patient education 

• Decentralized nursing stations and 

wireless communication devices 

that eliminate stress-inducing overhead 

pages, bringing patients and 

the care team closer together 

• Coaster-sized pagers that allow 

clinic patients a new degree of freedom 

when waiting for treatment 

• A sea change in culture necessary to 

deliver patient-centric care 

The 600,000-square-foot Mazankowski 

Alberta Heart Institute in Edmonton, 

Alberta, Canada, is one of few North 

American heart institutes to handle both 

pediatric and adult patients under one 

roof. It will take on the most challenging 

cases, including transplants and artificial 

hearts, and houses a world-class cardiac 

research center to help speed the benchto-bedside 

process. Other innovations 

include hybrid operating rooms where 

cardiologists and surgeons, armed with 

the latest medical technology, will work 

together to conduct minimally invasive 

procedures, while being prepared to 

change course and conduct a more invasive 

procedure if necessary. 

The publicly funded Heart Institute, 

adjacent to the University of Alberta Hospital, 

the Stollery Children’s Hospital and 

the University of Alberta itself, will reduce 

patient wait times for clinical visits and 

surgical cases visits, meeting new guidelines 

established by the Canadian Cardiovascular 

Society. The former waiting time 

for nonurgent cardiac surgeries was 

about 14.7 weeks, and the new benchmark 

is six to eight weeks; the urgent outpatient 

electrophysiology waiting list of 

120 days is expected to be cut dramatically, 

to 14 days. The new facility offers 

greater capacity – it is estimated that it 

could handle 600 to 700 more surgeries 

annually, up significantly from the 1,140 

it performed during the past year. 

Beyond increasing capacity to its community, 

the Heart Institute represents a 

radically different type of treatment center. 

By bringing diverse disciplines and 

opinions together, the new institute will 

be changing the very culture of cardiac 

care. And while the institute is equipped 

with the very best in medical technology, 

it is also designed to achieve a gold 

standard of care, where patients’ needs 

come first. 

“The most difficult thing is to get people 

to think outside the box,” says Carol 

Manson McLeod, the institute’s Senior 

Operating Officer. Healthcare Consulting, 

she says, has helped manage change and 

inspire a cultural shift. “The Healthcare 

Consultants helped people start thinking 

of ways they can do things differently – 

so the solutions are homegrown.” 

Prior to the institute’s opening in 2009, 

some of the challenges practitioners 

faced were the result of their efforts to 

provide innovative treatment in the 

previous location, which created high 

demands on the existing space. “We had 

been scaling up our capacity to provide 

new services and increase volumes 

in the same space,” says Patient Care 

Manager Terry Hogan. “We added a lot 

of new services and new concepts that 

required new staff. Everyone was vying 

for the same space to do their work.” 

Patient-centered Care 

The leadership team at the Heart Institute 

recognizes that moving into the new 

institute in 2009 involves much more 

than simply new equipment or treating 

patients the same way with more room. 

It means a sea change in the way the 

institute cares for patients. Siemens 

has installed one single-plane and two 



biplane cath labs, as well as a magnetic 

resonance imaging (MRI) system. While 

this technology provides patients with 

the highest diagnostic capability on the 

market today, the Heart Institute engaged 

Healthcare Consulting to work with the 

team. Siemens experienced healthcare 

professionals helped to develop optimized 

workflows, where processes are refined 

and technology levers are planned. In 

addition, the facility was designed to 

create an environment focused on the 

highest quality of safe patient care, efficient 

utilization of valuable resources, 

and a positive experience for cardiac 

patients and the care team. The mutual 

goal was to create a center of excellence 

and an environment where optimized, 

patient-centered processes are in place. 

Nurses, for example, will carry wireless 

phones to eliminate overhead pages. 

This enables patients to contact nurses 

directly. In clinics, coaster-sized pagers 

will be given to patients, allowing them 

to leave the waiting area. “They’ll be able 

to go anywhere they want to without 

worrying about missing their appointment,” 

says Patient Care Manager Donna 

Daniec. Nursing stations, traditionally 

the hub of a treatment unit, have been 

removed. Instead, nurses are situated 

at alcoves adjacent to patient rooms, 

according to Daniec. 

“We’re taking everything we need to care 

for the patient directly to the patient,” 

she says. “When you look at the spectrum 

of inpatient and outpatient care, we were 

making patients travel around to get the 

services they needed.” 

Even information will be brought directly 

to patients via bedside terminals provided 

by Siemens, says Manson McLeod. 

“We’ve talked about being more focused 

on the patient. We want to do the same 

thing if you are a planned or unplanned 

admission. If you’re coming from a clinic 

and need to be admitted, you would normally 

have to go hither and yon to find 

admitting. But with the terminals, we’re 

able to provide bedside registration – 

the patients will actually be admitted at 

the bedside in their room,” she says. “In 

the future, we’ll even be able to have 

access to electronic patient records at 

the bedside terminals.” 

With the greater space and improved workflows, the Heart Institute hopes to handle 

50 percent more cardiac surgeries and thus, reduce wait times for patients. 



“We’re taking 

everything we need 

to care for the 

patient directly to 

the patient.” 

Donna Daniec, Patient Care Manager, 

Mazankowski Alberta Heart Institute, 

Edmonton, Alberta, Canada 

Turned to Siemens to help optimize the University of Alberta’s new cardiac hospital 

(from left): David Johnstone, MD, Clinical Director; Donna Daniec, Patient Care Manager; 

Terry Hogan, Patient Care Manager; Carol Manson McLeod, Senior Operating Officer 

The Heart Institute is working with 

Siemens to develop a system in which 

doctors can call up a patient’s medical 

images on the bedside screen to explain 

diseases and treatment plans. “The bedside 

terminal is a device for us to teach 

our patients – we are uploading teaching 

materials onto the system and at the 

same time, we’re uploading the same 

content on our website so that what they 

see on the screen at bedside is what they 

will be able to see from home, after 

they’ve been discharged,” Manson McLeod 

explains. The terminals will also serve as 

the patient’s television, telephone, and 

allows them to surf the net or communicate 

via email. She acknowledges that 

some patients will be tentative about 

using the technology, but adds that the 

patient-centric outlook at the institute 

will help them become comfortable with 

it. “We are going to make sure that all 

the members of our staff and volunteers 

– from housekeeping to nutrition personnel 

– are able to help patients use 

this technology.” 

Designed for Safety, Comfort, 

and Synergies 

Manson McLeod credits Healthcare Consulting 

with helping ensure that the institute 

adopts a commitment to patient 

care that is embraced by all staff. Advice 

from the Consulting team even resulted 

in a significant architectural change in 

design of the Intensive Care Unit (ICU). 

Initially, part of the ICU was to be built 

in a traditional way, with eight of the 

beds sharing a common space. But with 

new concerns about infectious disease, 



“Having kids under the same roof 

really changes the focus of the institute, 

in that you need to pay attention to 

their unique needs.” 

David Johnstone, MD, Clinical Director, 

Mazankowski Alberta Heart Institute, 

Edmonton, Alberta, Canada 

Siemens suggested a design change. 

“The Healthcare consultants looked at 

our ICU, and even though we were in 

the midst of construction, the organization 

agreed that it was important enough 

to make the changes,” Manson McLeod 

says. “Healthcare Consulting took it all 

down to what’s best for the patient.” 

That’s not surprising, considering that 

the priority on the patient experience was 

at the forefront of many other elements 

in the design of the building, which 

does not resemble a traditional hospital. 

Every patient room, for example, has 

natural light coming either from exterior 

windows or from the institute’s indoor 

Healing Garden – a placid environment 

that has an immediate soothing effect. 

Steps are being taken to improve the 

experience of outpatients, too. “Siemens 

was very influential – they helped us deal 

with some fundamental issues,” adds 

David Johnstone, MD, Clinical Director 

for the institute. Armed with a worldwide 

perspective and experience, Healthcare 

Consulting helped the institute develop 

performance indicators. “They got us 

thinking on that level, and as a result, 

we’ve adopted targets for our services, 

allowing information to drive policy.” 

Johnstone notes that the institute’s location, 

at the heart of Edmonton’s nationally 

respected health and medical research 

Bedside terminals are used for everything from 

patient admission to patient education and 

entertainment, to file replacement during ward 

rounds. 

center, is another of its strengths that 

lends to its distinct nature. Many cardiac 

patients, for example, are also diabetics. 

The Heart Institute has the advantage 

of being affiliated with the Alberta Diabetes 

Institute, a world-leading diabetes 

research center. Similarly, the institute 

and University of Alberta Hospital are 

attached to the Stollery Children’s Hospital. 

“Having kids under the same roof 

really changes the focus of the institute, 

in that you need to pay attention to 

their unique needs and not just replicate 

what is done in the Stollery,” he says. 

Johnstone adds that the focus on patient 

needs is also being applied through new 

services designed to keep patients close 

to their home communities. The Heart 

Institute serves a population scattered 

across a vast geographic area, with some 

patients coming from remote settings. 

“Heart clinics work, but does it make 

sense that patients have to wait months 

for an appointment and need to drive 

several hours to get here?” he asks. “Is it 

fair that they have to park so far from 

the building that they’re having chest 

pain by the time they make it through 

the door?” 

Telehealth sessions solve some problems, 

and Manson McLeod says the institute’s 

staff is brushing up on the principles of 

adult learning in order to eliminate eighthour 

days for patients in presurgery 

assessments and education. “We were 

doing that because it suited us – not 

the patient,” she says. “The Healthcare 

Consultants helped us to change our 

way of thinking. We’re now creating a 

culture where we think of the patient 

first. We are on the cusp of some fundamental 

changes.” 

Medical and technology writer Richard Cairney 

also serves as the Communications Officer 

for the Engineering Faculty at the University of 

Alberta in Edmonton, Alberta, Canada. 



healthcare-consulting 


Nurses have immediate electronic access to each 

patient’s examination and test results. Barcoding helps 

prevent risks for patient safety. 

Med Meets IT at MedCentral 

MedCentral deployed a complete Siemens solution suite across its 

entire enterprise in an effort to increase patient safety and decrease costs 

through operational efficiencies. It ended up with even more, including 

dramatic improvements in workflows, processes, and interdisciplinary care. 

By Kevin Self 

‘Med Meets IT’ is the concept of seamlessly 

blending two independent fields – 

medicine and information technology – 

into a single, fully-integrated, harmonious 

solution that is easily accessible and conveniently 

deployed in a clinical setting, 

resulting in cutting-edge efficiencies and 

patient safeguards that were not even 

possible in healthcare until recently. 

Competition in today’s healthcare markets 

is fierce. As consumers become more 

informed and begin shopping for hospitals, 

health systems are forced to reexamine 

their operations to find new ways 

to introduce efficiencies and position 

themselves as world-class organizations. 

As anyone involved with healthcare 

management knows, this is easier said 

than done. 

Add regional and statewide competitive 

pressures into the mix and it is enough 

to make even the strongest provider turn 

and run quickly in the other direction. 

For this reason, it is all the more impressive 

when – despite mounting obstacles 

– a mid-sized, regional health system 

demonstrates forward-thinking innovation 

to gain competitive advantage. 

Meet MedCentral Health System, a nonprofit 

health system located in Mansfield, 

Ohio, U.S., that services a city population 

of approximately 50,000 and a countywide 

potential patient pool of nearly 

120,000. With 351 beds, 2,600 employees, 

two hospitals, and four other local 

facilities, MedCentral is situated between 

Cleveland and Columbus – larger cities 

home to two of the country’s best cardiac 

treatment centers. So how is MedCentral 


Integrated Healthcare 

able to compete to the point of earning 

a number one state ranking by 

HealthGrades 1 for its cardiac surgery 

program? 

The answer to this question resides in 

a number of system-wide solutions, but 

there is no debate that the organization’s 

IT initiatives are at the heart of its recent 

rise to the top. With its tagline of ‘Expert 

Care, Close to Home,’ MedCentral epitomizes 

the concept of Med Meets IT across 

its entire enterprise. 

Expert Care, Close to Home 

Physicians practicing at MedCentral are 

more confident by the ability to deliver 

accurate information to the right person 

at the right time. Repeat patients are 

delighted they do not need to re-do 

paperwork before admission. Clinician 

recruitment and retention have never 

been higher. All are recent benefits of a 

strategic effort to improve patient safety. 

But this was not always the case. Four 

years ago, MedCentral was essentially in 

the dark ages as far as fully utilizing IT 

to deliver better patient care. The entire 

health system was operating on a manual, 

paper-based system, and the technology 

it had in place offered limited deployment 

and integration capabilities. When its 

financial system was nearing sunset 

at the end of 2004, MedCentral started 

looking for other solutions. The need to 

replace a single system quickly grew from 

a simple upgrade into a much larger 

initiative. 

“We wanted to find a solution that could 

replace our financial system, but also 

expand to encompass all of MedCentral 

Health System’s needs,” says Chief Executive 

Officer James E. Meyer. “We wanted 

to enhance our ability to use IT to improve 

patient care and safety, and provide 

clinicians with better data at the point 

of care.” 

Enter ’Project Expert Care’ – MedCentral’s 

system-wide IT initiative. 

Redefining Expert Care 

If there was a single mantra for those 

involved with Project Expert Care, it was 

’provide clinicians with better data, more 

efficiently, and at the point of care.’ None 

of these goals were achievable with the 

old paper-based systems. 

In 2004, MedCentral was inefficient and 

relied too heavily on manual processes 

that exposed the health system to human 

error and excess costs. And it was not an 

isolated problem. Nearly every department 

was plagued by delayed laboratory 

results, inaccurate data entry, or lost 

images. This environment was not conducive 

to maximizing quality patient care. 

In radiology, MedCentral was still handsigning 

reports, and it was not uncommon 

for physicians to wait as long as 48 hours 

to receive them. In the laboratory, labels 

were printed and manually sorted – waiting 

17 hours for hard-copy test results 

was considered acceptable. The same was 

true for nursing, where the staff was 

spending inordinate amounts of time 

manually extracting data from records to 

accommodate MedCentral’s reporting 

obligations. 

The objectives of Project Expert Care 

were simple: increase patient safety 

through improved workflow and decrease 

costs through greater operational efficiencies. 

The answer was to build an 

enterprise-wide solution suite that would 

embrace the entire spectrum of care. 

A New Nervous System 

After an extensive evaluation of multiple 

healthcare IT vendors, MedCentral selected 

Siemens for two primary reasons: its 

vision for the future and its robust technology 

offering. 

“We bought into Siemens philosophy of 

Med Meets IT because it was extremely 

compatible with where we wanted to 

go in the future,” says Michael Mistretta, 

Vice President of Information Services 

(IS) and Chief Information Officer at 

MedCentral. “MedCentral’s decision to go 

with Siemens has been validated many 

times over. The incorporation of clinical 

and imaging data at the point of care 

has been almost transformational in our 

delivery for patients.” 

In addition to similar overarching philosophies, 

the tactical approach to developing 

a quality, state-of-the-art IT solution 

was the same – taking an enterprise 

approach over best-of-breed. 

The two new partners decided on a comprehensive 

Siemens solution that included 

Soarian® Clinicals and Financials, 

syngo® Suite, a picture archiving and 

1 

Health Grades, Inc. is a U.S. healthcare ratings 

organization, providing ratings and profiles of hospitals, 

nursing homes, and physicians. 

Thanks to Project Expert Care, MedCentral’s cardiac surgery program earned a number one state 

ranking by HealthGrades. 



communication system (PACS) and radiology 

information system (RIS), Patient 

Identification Check, NOVIUS® Lab, Med 

Administration Check (MAK), and Siemens 

Pharmacy. 

“Workflow was the backbone of the 

Siemens philosophy and one of the greatest 

successes of Project Expert Care. 

Siemens helped us to look at our workflows, 

how we were operating, and how 

Soarian would impact those workflows,” 

says Claudette Brown, RN, BSN, and 

Clinical Applications Manager in the IS 

department. 

Brad Peffley, Vice President of Clinical 

Services, agrees. “We used Siemens consulting 

services along with our own staff 

to tear apart our existing processes and 

look at ways we could gain the biggest 

advantage from the new system.” 

Although the initiative elevated the role 

of the IS department, senior management 

made it clear this was more than a technology 

upgrade. Project Expert Care was 

a system-wide initiative that was integral 

to the future of MedCentral. 

“IT itself doesn’t touch a patient or deliver 

care, but it’s the nervous system for 

all the different activities involved with 

patient care,” says Fred Crowgey, Projects 

Director for IT. MedCentral’s nervous system 

– its core for patient care delivery – 

was Soarian Clinicals. 

“Soarian made us nimble and made 

results available in a timely manner,” 

says Michael David Patterson, MD, Vice 

President of Quality and Performance 

Excellence and Chief Medical Officer. 

“Before that, we were reporting lab work 

on a paper. Nurses then used that paper 

chart for documentation. And the same 

was true for medications – we used a 

paper MAR [medication administration 

record]. It is hard to believe we were 

operating like that – and it was only a 

few years ago.” 

Maximizing Efficiencies in 

Patient Care 

As part of Project Expert Care, one of 

the first metrics baselined and monitored 

– as an indication of the efficiencies 

MedCentral hoped to gain from the 

Soarian solution suite – was reducing 

length of stay (LOS). 

In 2003, the average LOS was 5.4 days. 

Today, that number has been reduced to 

4.6 days – the equivalent of having an 

extra 30 to 35 beds annually. Plus, 

MedCentral’s patient volume is 60 percent 

Medicare/Medicaid, which means dealing 

with diagnosis-related group (DRG) 

reimbursement. Under DRGs, the facility 

receives a set dollar amount regardless 

of the amount of time a patient stays in 

the hospital. 

“If we can safely discharge patients – 

safety being our primary objective – each 

day that we can reduce that stay is a 

dollar savings for the organization,” says 

Janene Yeater, Assistant Vice President 

for Accreditation and Utilization Management. 

“Soarian, in part, enables us to 

speed that delivery of care, helping to 

directly improve our bottom line.” 

One of the biggest benefits of Soarian 

Clinicals is rapid access to test results, 

particularly radiology reports and laboratory 

results. 

The turnaround time in radiology improved 

dramatically when MedCentral 

moved from film to Siemens syngo Suite 

for RIS and PACS. Prior to the implementations, 

its average time for a final report 

was 24 hours – although 48 hours was 

not uncommon. Immediately after implementing 

Siemens digital imaging systems 

A Microcosm of Project Expert Care: 

The Emergency Department 

There is little doubt of the impact that Soarian and other 

Siemens solutions have had across the MedCentral enterprise. 

This, in fact, can be realized simply by examining its 

Emergency Department (ED) – an ideal microcosm of the 

benefits and efficiencies realized through MedCentral’s 

greater Project Expert Care initiative. 

The ED is a primary patient entry point where data capture 

is essential, as well as one of the most stressful and fastpaced 

areas within any hospital. Small inefficiencies are 

amplified within the ED and can lead to problems further 

down the continuum of care. As such, it was a focal point 

at MedCentral when implementing its Soarian solutions. 

Here are some of the efficiencies realized: 

• Reduced ED capacity from over 100 percent to around 

85 to 90 percent 

• Reduced triage-to-admission time from almost eight 

hours to 4.5 hours 

• Reduced triage-to-discharge time from more than five 

hours to 3.2 hours 

• Eliminated the pre-implementation practice of boarding 

patients – some intensive care unit patients – in the ED 

MedCentral’s ED also continues to invest in IT solutions, 

the most recent being the Emergency Department Tracking 

Board, which provides ED clinicians the ability to automate 

portions of the admissions process. For example, if 

a patient is admitted in the ED and needs an X-ray, clinicians 

simply enter the appropriate data and Soarian will automatically 

send a notification to radiology. The radiologist, 

in turn, can monitor the ED Tracking Board to assess the 

incoming caseload from the ED – introducing time efficiencies 

and workflow improvements. 

The ED’s end result – representative of the greater Med- 

Central enterprise – is improved patient safety, decreased 

costs, and better overall quality of care for the patient. 


and PACS throughout the Radiology 

Suite, turnaround time was reduced to 

six hours. In recent months – despite the 

retirement of a radiologist and taking 

on volume from MedCentral’s outpatient 

center – turnaround time was further 

reduced to an average of two hours while 

maintaining quality levels. 

“With PACS and our voice recognition software, 

the final validated radiology report 

– not the preliminary report – many times 

beats the patient back to the room from 

the X-ray department,” says Patterson. 

The story is the same for transcriptions. 

Despite moving all transcriptions inhouse 

and adding the volume from another 

facility, Siemens solutions enabled a 

reduction in radiology staff from six fulltime 

equivalents (FTE) to 4.5 FTEs. 

“Without a doubt, the PACS solution of 

syngo Suite has made radiology more 

efficient and drastically improved our 

throughput,” says Peffley. 

According to Patterson, the same trend 

can be found examining the NOVIUS Lab 

implementation, which is a testament 

to the integration planning of the deployment. 

MedCentral’s laboratory is comprised 

of many independent systems and 

instruments operating in two different 

facilities, including an ADVIA WorkCell® 

CDX Automation Solution with ADVIA 

Centaur® Immunoassay Systems, ADVIA® 

1800 Chemistry Systems, and ADVIA 

CentraLink® Networking Solution. With 

these Siemens solutions in place, “Laboratory 

results are completed within an 

hour or two. Before the implementation, 

it was 24 hours before a physician could 

even look at that result.” 

The reduction in turnaround time enabled 

the lab to increase its labor efficiency 

as well. The number of lab procedures 

completed prior to the implementation 

was 9,975 per FTE. After the implementation, 

this metric jumped to 10,791 per 

FTE – almost a ten percent increase in 

productivity. In addition, all data is automatically 

verified before it is forwarded 

to Soarian Clinicals, helping to assure 

consistency and increased quality in the 

results review process, further enhancing 

patient safety. 

“One person can now do the work of 

two under the old system,” says Debra 

Real-time information on their handhelds helps ensure phlebotomists know about test changes – 

and provide the correct sample at the correct time. 

Ruckman, Phlebotomy Supervisor. In 

the end, these efficiencies in the lab add 

up to better and more timely care for 

the patient. 

“Our physicians now have greater expectations 

for lab results and availability. 

The effect is a completely different interaction 

with the lab,” says Terry Weston, 

MD, Vice President of Physician Services. 

“The conversation is not ‘where’s the 

report and when will I get it,’ but rather 

physicians are free to ask deeper questions 

and explore other possibilities.” 

Enterprise Cost Reductions 

The solutions now in place at MedCentral 

enable direct (i.e. reduced material costs) 

and indirect (i.e. time efficiencies) cost 

savings across the enterprise. The radiology 

department offers textbook examples 

of both. 

By transitioning from a film-based system 

to PACS, MedCentral has eliminated the 

cost of film almost completely. Within 

the first month of implementation it was 

95 percent filmless. This translates to 

an annual savings of about US$450,000. 

What is more, that number does not 

include the additional savings of chemicals, 

canceled maintenance contracts, 

and other ancillary costs associated with 

film. 

MedCentral has also realized indirect 

cost savings in radiology, including 

the elimination of transcription services, 

as well as the intangible benefits of 

Siemens RIS/PACS integration. 

“The integration of RIS and PACS saves 

us from doing many mundane tasks,” 

says Philip Calendine, MD, Chair of the 

Department of Radiology. “When we 

select a patient name from our worklist, 

all the demographics and patient information 

is automatically transferred. 

There is no manual data entry. When 

you’re reading 200 to 250 studies every 

day, saving an extra 20 seconds per 

study translates to hours over the course 

of a week.” 

Automating Patient Safety 

Patient safety was the underlying reason 

for Project Expert Care, and no two solutions 

implemented at MedCentral are 

more directly associated with patient safety 

than the Siemens barcoding solutions: 

Patient Identification Check and MAK. 

“Prior to go-live with Patient Identification 

Check, I would do three or four disciplines 

a month with people misdrawing 

a patient,” says Project Expert Care 

Director Crowgey, also formerly the Lab 

Director. “For the first year after implementation, 

in every place that Patient 

Identification Check was used, I didn’t 

do a single discipline.” 

In fact, since the implementation of 

Patient Identification Check in March 

2006, there has not been a single 

patient identification error. This is due, 



Summary 

Challenge: 

• Inefficient and time-consuming 

paper reporting system 

• Inadequate paper-based documentation 

• Increased risk for patient 

safety due to human error in 

manual processes 

• Medication errors that 

threatened patient safety 

• Excess turnaround times for 

lab and radiology reports 

• High costs associated with filmbased 

imaging technology 

• Extensive back-logs in the 

Emergency Department 

Solution: 

• Siemens Soarian Clinicals 

workflow management technology 

enables best-practice 

implementations and continuing 

process improvements 

• NOVIUS Lab streamlines and 

standardizes laboratory processes, 

reducing turnaround 

times 

• An ADVIA automation system, 

along with ADVIA chemistry 

and immunoassay systems, 

and the ADVIA CentraLink data 

management system automates 

the laboratory 

• Patient Identification Check 

automates patient safety 

through point-of-care barcoding 

technology – helping 

ensure the five rights of 

patient safety 

• Med Administration Check 

(MAK) automates medication 

administration through pointof-care 

barcoding technology 

– helping ensure the five 

rights of medication administration 

• syngo Suite improves communication 

through the use of 

complete imaging management 

workflow, increasing efficiency 

and access to digital information 

in large part, to the quick adoption of 

the technology by phlebotomists. 

“We had a strict policy for labeling tubes 

among the phlebotomists – basically 

three strikes in a year and you’re out,” 

says Crowgey. “They quickly recognized 

that using technology would preserve 

their jobs, as well as help reduce the 

potential to make an error.” 

Patient safety is also reinforced by using 

mobile devices, according to Karen 

Phalor, ASCP, an IT analyst and medical 

technologist at MedCentral. “By simply 

using their handhelds, phlebotomists 

can be fed real-time data when there are 

changes or tests added – this enables 

the correct sample at the correct time.” 

If Patient Identification Check is the safety 

net for patient identification – satisfying 

the five rights of patient safety – then 

Med Administration Check (MAK) is the 

equivalent for medication – satisfying 

the five rights of medication administration. 

Patient Identification Check coordinates 

the efforts of the lab with that of 

the phlebotomists. MAK coordinates the 

efforts of the pharmacy with that of the 

nurses. 

The data generated shortly after go-live 

with the integrated Siemens Pharmacy 

and MAK solution speaks volumes to the 

layer of safety the technology provides. 

“The first week that we launched the 

solution, we caught 383 medication errors 

– the wrong patient about to receive the 

wrong medication, or about to receive it 

at the wrong time, or at the wrong dose,” 

says Patterson. “That was a humbling 

experience. I can’t imagine a healthcare 

system even considering a future without 

something like Pharmacy MAK in place.” 

Core and Quality Measures 

MedCentral has seen a dramatic turnaround 

in its ability to share information 

because of Soarian. “Our core measures 

have improved so much that we’ve not 

only hit our goals, but we’re also talking 

about raising the bar,” says Patterson. 

“You can pick any core measure and I can 

directly relate how Soarian assisted with 

that quality-of-care improvement.” 

When MedCentral first started capturing 

core measurement data: 

• Acute myocardial infarction (AMI) was 

in the 50 th percentile. Today, MedCentral 

is at 93 percent 

• Pneumonia was in the mid-30 th percentile. 

Currently, is it at 90 percent 

• Congestive heart failure was one 

of MedCentral’s lowest baseline scores. 

Currently, it is at 94 percent 

“We’re on the upper level of our stretch 

goal for congestive heart failure and 

looking to extend that beyond the national 

average,” says Michael Schwartz, 

Executive Director of Cardiovascular 

Medicine, and adds that the functionality 

and flexibility of Soarian Cardiology – 

Siemens cardiovascular information solution 

– and syngo Dynamics – Siemens 

cardiology PACS – have also helped 

recruit and retain the best cardiologists. 

The department is a source of pride for 

MedCentral. In 2007, 2008, and now 

also for 2009, HealthGrades named its 

cardiac surgery program the best in Ohio 

– awarding it a Number One ranking. 

In an effort to enhance reporting functionality 

to the already robust Soarian 

offering, MedCentral recently launched 

Soarian Quality Measures, which will 

streamline the quality improvement process 

by automating chart abstraction and 

help expedite the submission of quality 

measures – as defined by the Centers for 

Medicare and Medicaid Services and The 

Joint Commission. 

Interdisciplinary Care 

The ability for various departments and 

disciplines to work together and easily 

share information was a priority from 

the beginning – the primary reason for 

taking an enterprise approach to Project 

Expert Care. “When we examined the 

Soarian solution from an integration perspective 

– bringing together pharmacy, 

lab, radiology, et cetera – it was our top 

pick,” says Phalor. 

Clinicians at MedCentral credit two features 

of the Soarian implementation for 

enabling this interaction: the functional 

screen and online access. 

The functional screen is part of the nursing 

admission assessment that identifies 

criteria points from each discipline. 

Nurses mark each criteria point exhibited 


y a new admission. Soarian processes 

the completed functional screen and 

automatically prompts a consult referral 

to the relevant discipline. 

“The functional screen has been significant 

in improving our patient care, but 

it also helps decrease our length of stay,” 

says Joann Plaster, Vice President of 

Nursing and Social Work Services. “The 

sooner you can get all the necessary disciplines 

involved in the care, the faster 

that patient gets better.” 

In the first month of operation with 

Soarian’s rules and workflow technology 

– the system on which the functional 

screen is based – MedCentral saw a 

double-digit percentage increase in the 

number of consults delivered to the 

various disciplines. 

“This functionality also goes a long way 

with Joint Commission and other compliance 

reporting,” says Yeater. “This process 

is now automated and patient care 

is done consistently and in a standardized 

fashion, which directly impacts accreditation.” 

Access to information has been, perhaps, 

the single greatest benefit of the Soarian 

solution. “There’s a lot of data available 

that we didn’t have before,” says Peffley. 

“Whether it’s patient statistical information, 

departmental statistical information, 

or financial information and budget 

reports, I can get it myself and it’s available 

almost immediately.” 

The result is better communication 

between departments, particularly with 

the nursing and the medical staff. “Nurses 

have access to results immediately and 

electronically. The physicians – even from 

home – also have online access,” says 

Weston. “This is a vast improvement and 

makes a nurse’s reporting capability exponentially 

stronger and faster.” Expressing 

similar sentiments, Crowgey adds: 

“Online access to the right information 

at the right time improves patient care 

and supports faster clinical decisionmaking. 

It is just good quality patient 

care.” 

A Foundation for the Future 

MedCentral, with its suite of Siemens 

solutions in place, is only beginning its 

Turnaround time for radiology reports has decreased from 24 hours to two hours with the 

implementation of PACS and voice recognition. 

Project Expert Care initiative. The health 

system already has plans to expand the 

use of existing technology to remote 

facilities and has a list of new technologies 

that are in some stage of planning. 

These include Computerized Physician 

Order Entry (CPOE), further utilization 

of its Emergency Department Tracking 

Board, Siemens critical care application, 

Soarian Plans of Care, Decision Support 

with embedded analytics, Soarian 

Cardiology and AXIOM® Sensis, Soarian 

Quality Measures, radio frequency identification 

(RFID) capabilities, and Soarian 

Health Information Management (HIM). 

“The goal is to have our entire enterprise 

on one Soarian system,” says Patterson. 

“Siemens will beat every other vendor 

and win the race to a complete enterprise 

solution. This is the secret to our great 

partnership. MedCentral will help Siemens 

to achieve that goal, because we want 

to be the first health system to implement 

the solution.” 

Kevin Self is a writer for Launch International, 

a company specializing in strategic marketing 

and sales enablement for technology companies. 


www.siemens.com/syngo 

www.siemens.com/Soarian 

• The PACS, part of syngo Suite, 

helps provide security as well 

as remote and easy access to 

archived digital images across 

various disciplines 

• The RIS, part of syngo Suite, 

enhances imaging communications 

to and from the radiology 

department and integrates 

seamlessly with the PACS 

• Soarian Cardiology and syngo 

Dynamics aid in moving from 

modality-focused to patientcentered 

care 

Result: 

• Workflow efficiencies resulting 

in reduced length of stays 

• Increased patient safety by 

automating processes and 

minimizing human error 

• Increased laboratory efficiency, 

decreased laboratory turnaround 

time, improved laboratory 

efficiency, and increased 

laboratory capacity 

• Significant improvements in 

core measures 

• Reduced costs through greater 

productivity and elimination 

of materials and outsourced 

services 

• Increased interdisciplinary 

communication 

• Enhanced accessibility to 

information 


Ultrasound 


Ultrasound 

Tissue Strain Analytics – 

A Breakthrough for Ultrasound 

Liver Examinations 

A new era is dawning for quicker, more accurate 

diagnoses of pathologies in the liver, thanks to 

a research partnership between The University 

College London Hospital and Siemens Healthcare. 

By Nils Lindstrand 

A member of the Siemens Healthcare 

Ultrasound Research Advisory Board, 

Professor William Lees, MD, of the University 

College London Hospital (UCLH), 

UK, started researching the clinical potential 

of ultrasound Acoustic Radiation Force 

Impulse (ARFI) imaging about one year 

ago. He soon realized that this technology 

might be a way to increase the clinical 

diagnostic information that results from 

conventional sonographic examinations. 

“Tissue Strain Analytics 1 adds an independent 

parameter to our existing morphological 

diagnostic process. No single 

parameter is going to enable us to characterize 

tissue with any degree of accuracy, 

but the more parameters we have, 

the more confident our diagnosis can be,” 

says Lees of the emerging application. 

Virtual Touch Tissue Imaging 1 , the first 

commercially available implementation 

of ARFI, uses an acoustic ’push pulse’ to 

interrogate the mechanical strain prop- 

1 

This product is not commercially available in the U.S. 


A member of the Siemens Healthcare Ultrasound Research Advisory Board, Professor Dr. Lees examines the capabilities 

of Virtual Touch Tissue Imaging and Quantification in liver fibrosis. 

Summary 

Challenge: 

• Obtain qualitative visual or quantitative 

value measurements of the 

mechanical stiffness properties of 

tissue 

Solution: 

• Tissue Strain Imaging allows 

visualization of differences in the 

stiffness of tissues and pathologies 

that may otherwise appear very 

similar using conventional ultrasound 

imaging 

• Tissue Strain Imaging has the 

potential for immediate results 

• Tissue Strain Imaging is userindependent 

Result: 

• Virtual Touch applications, together 

with conventional sonographic 

scans, may enable physicians to 

avoid unnecessary biopsies 

• Grey scale image presents a map of 

regions and localized areas which 

shows relative stiffness in the tissue 

• Numeric value provides a good 

understanding of the general condition 

of the tissue 

erties or stiffness of tissue, a method 

similar to a physical palpation exam. Virtual 

Touch images provide complementary 

information to the standard B-mode 

image by supplying insights into changes 

in tissue stiffness, which are often associated 

with pathology. 

A Virtual Touch image is formed by applying 

a push pulse, which results in the 

relative displacement of tissue elements. 

The degree of displacement will vary 

with the specific stiffness properties. For 

example, soft tissue will experience 

greater displacement than very stiff tissue, 

which may displace a very small amount 

or not at all. Conventional ultrasound 

beams track the displacement of tissue. 

This information is compared to the 

baseline image, resulting in a qualitative 

elastogram, which visually represents 

the variation in stiffness within a region 

of interest. 

Today, this technology is only available 

by Siemens with the ACUSON S2000 

ultrasound system. “Virtual Touch Tissue 

Imaging is an important evolution of the 

ultrasound scanning technologies,” says 

Lees. “The technology works, it is reliable 

and robust. Virtual Touch Tissue Imaging 

has a minimal impact on the tissue, yet 

it has the ability to extract an impressive 

amount of vital information out of a 

single procedure.” 

Breakthrough for Liver 

Examinations 

Another application of ARFI technology is 

the measurement of shear-wave velocity. 

This is implemented by Virtual Touch 

Tissue Quantification 1 . Shear waves, 

which travel at greater speeds in stiff 

tissue compared with soft tissue, are 

generated, and travel perpendicular to 

the push pulse. While they do not interact 

directly with the transducer, their 

movement may be tracked by detecting 

tissue displacement perpendicular to 

the transmitted, conventional ultrasound 

beam. 

“It is like hitting a board on the upside 

and feeling the effect at the ends,” says 

Lees, “only with an extremely high accuracy 

in the measurement.” Virtual Touch 

Tissue Quantification may prove to be a 

major breakthrough in identifying early 

stages of liver diseases causing cirrhosis. 

In early studies, the application proved 

extremely sensitive in diagnosing fibrosis 

and distinguishing it from normal liver 

and cirrhosis. Conventional ultrasound, 

on the other hand, cannot detect fibrotic 

changes prior to cirrhosis. “We will need 

more data to determine whether this new 

technology is also capable of tracking 

progression of fibrosis or responses to 

treatment, but I am very optimistic that 

it will have this capability,” says Lees. 

The robustness of Virtual Touch applications 

is an important advantage of this 

method. “We have been examining 

obese patients during the clinical studies 

already completed, and Virtual Touch 

Imaging showed very good accuracy,” 

says Lees. 

1 

This product is not commercially available in the U.S. 


Ultrasound 

Lees stresses the advantage of Virtual 

Touch applications as a user-independent 

method. “Both with traditional physical 

palpations and preceding ultrasound 

technologies, it is easier than you would 

imagine for a physician to press harder 

to get the result he or she was expecting 

before the examination. With Virtual 

Touch applications, however, it is just 

pushing a button. You get the same 

accuracy every time, regardless of the 

operator, time, or expectations.” 

A Way to Avoid Unnecessary 

Biopsies 

Virtual Touch applications may offer a 

way to reduce unnecessary biopsies 

and other invasive procedures otherwise 

needed to give an accurate diagnosis 

through easy evaluation of pathology. 

“These kinds of anomalies may be difficult 

to separate from malign tissue with 

other kinds of scanning technologies,” 

says Lees. “This is typical of how Virtual 

Touch Imaging is helping us: We can avoid 

many biopsies and other uncomfortable 

and unnecessary examinations.” 

Using this technology together with 

conventional sonographic scans and 

traditional biochemical examination, 

physicians may also be able to give a 

more reliable answer whether a pathology 

is malignant or benign. 

“I believe Virtual Touch applications will 

be an integral part of scanning procedures 

in the near future,” says Lees. “Our clinical 

tests up until now have shown a very 

high accuracy in separating malignant, 

benign, and healthy tissue. The method 

is quick and user-independent, and is 

totally unnoticeable for the patient.” 

More Validation Needed 

“My present experience today is built on 

more than 200 cases,” says Lees, “and it 

indicates that Virtual Touch applications 

can detect fibrosis in an otherwise 

normal-appearing liver.” Now this needs 

to be validated against liver biopsy and 

biochemical testing for chronic liver 

disease. Experience shows that up to a 

thousand validated cases may be needed 

to be able to define its role. Lees is convinced 

that Virtual Touch applications 

offer improved patient care on an individual 

basis. Physicians will be able to tell 

patients that they have nothing to worry 

about, or to proceed faster to additional 

examinations and treatment if this 

proves necessary. “The benefit of Virtual 

Touch applications is that we can be 

more convinced of doing the right things 

and giving correct information to the 

patient.” 

Lees and the UCLH are now organizing 

clinical tests for Virtual Touch applications, 

collaborating with a number of 

other clinics and hospitals in Great Britain. 

They will start as soon as the last details 

in the methodology are established and 

agreed upon. “We should be able to conduct 

these clinical tests within a couple 

of months,” says Lees. “We have already 

submitted an abstract to the European 

Congress of Radiology 2009 on Virtual 

Touch applications, and I think it will be 

sufficiently validated for wider clinical 

application towards the end of 2009.” 

The interest for Virtual Touch applications 

has so far largely been confined to 

the liver. It may, however, prove to be 

a valuable tool also in examinations of 

other organs, for example, the kidneys 

and thyroid and maybe the lung. It will 

probably not work as well in rapidly 

moving structures such as the heart and 

vascular system. “Apart from this, we 

will need to establish a much larger database 

of Virtual Touch Tissue Quantification 

measurements in other diseases 

of organs,” says Lees. “I think it will be 

another year or two before we fully 

understand the potential of this technology.” 

Nils Lindstrand is a freelance business and 

technology writer based in Stockholm, Sweden. 


www.siemens.com/strain 

Tissue Strain Analytics 

at a Glance 

Tissue Strain Analytics is a new ultrasound application that enables visual 

or numerical measurements of the mechanical stiffness of tissue. This 

new dimension of information, which is not available using conventional 

sonographic imaging, represents the most significant advancement in 

ultrasound technology since the advent of Doppler imaging. Tissue Strain 

Analytics features three applications: 

• Virtual Touch Tissue Imaging allows clinicians to create a relative 

stiffness map (elastogram) for any region of interest. 

• Virtual Touch Tissue Quantification is the first and only application 

to provide a numerical value of shear-wave speed related to tissue 

stiffness at a precise anatomical location. 

• eSie Touch elasticity imaging, available on both the ACUSON 

Antares and ACUSON S2000 systems, enables high-resolution 

elastography using both superficial and endocavity transducers. 


In a busy hospital emergency department such as 

that of St. David’s South Austin Hospital, a part of 

St. David’s HealthCare in Austin, Texas, U.S., it is a race 

against time to diagnose acute coronary syndrome. 

Shearing unprecedented time off the diagnostic process 

contributes to faster, more appropriate therapy, 

better asset utilization and lower costs. Most importantly 

– it saves lives. 

By Diana Smith 

Rush Hour 

’Time is muscle‘ is a common adage 

among cardiologists, referring to the critical 

moments after a myocardial infarction 

(MI), or heart attack, when even minutes 

without intervention can translate into 

muscle damage. However, not all patients 

present to emergency departments with 

obvious MI symptoms. For these patients, 

the need to rapidly determine if a heart 

attack has occurred, obviously, is critical. 

Yet evaluation can be a clinical challenge 

when blood must be sent to a busy central 

hospital laboratory where even 

immediate tests can take an hour or 

more. 

“Time is very much a factor in acute 

coronary syndrome [ACS],” says Steve 

Berkowitz, MD, Chief Medical Officer of 

St. David’s South Austin Hospital, a member 

of the St. David’s HealthCare system 

in central Texas. “When that coronary 

artery is blocked, the heart doesn’t 

receive blood flow to itself and it will fail 

as a pump in a course that would have 

dire consequences to the patient. The 

bottom line: Mortality improves when 

we can intervene faster, so that is our 

fundamental goal.” 

In an effort to speed up this critical time 

between diagnosis and treatment, administrators 

at the 252-bed facility turned 


to Siemens Healthcare Diagnostics for 

cutting-edge technology that has transformed 

the way the Emergency Department 

delivers care for patients who arrive 

with atypical heart attack symptoms. 

The Stratus® CS Acute Care Diagnostic 

System with high-sensitivity assay capability 

has dramatically improved the time 

it takes to arrive at a diagnosis for patients 

with atypical symptoms, according to 

Berkowitz. 

Increased Demand 

In Austin, the fourth-largest city in Texas, 

roughly the size of San Francisco, the 

St. David’s Emergency Department is one 

of the busiest in town, seeing more than 

60,000 patients each year. Located south 

of the Colorado River in the self-proclaimed 

’Live Music Capital of the World,’ 

the hospital is a certified Chest Pain 

Center accredited by the Society for Chest 

Pain Centers. 

Built in 1982, St. David’s South Austin 

Hospital completed a US$50 million 

expansion project in 2004. Today, its 42- 

bed Emergency Department is divided 

into three areas of care: cardiac, examination, 

and fast track. “On average, we 

see 160 to 180 patients and admit 30 

to 40 in a 24-hour period,” says Renee 

Buhman, RN, the Emergency Department’s 

educator. 

Buhman credits specially trained staff 

and advanced technology for much of the 

hospital’s success in dealing with cardiac 

cases. “With a high volume of patients in 

general, there is always the potential for 

a higher number of acute care patients 

like those presenting with chest pain or 

other cardiac complaints. When we can 

determine whether the patient does or 

does not have an acute cardiac event, 

the appropriate diagnosis can be made. 

Siemens point-of-care cardiac technology 

gets us this information fast.” 

The Role of Cardiac Marker 

Testing 

“In an emergency setting, speed is critical 

for patients who have electrocardiographic 

signs of a heart attack, referred 

to as ST-elevation myocardial infarction, 

or STEMI. These patients require immediate 

attention,” Berkowitz says. “They 

are very sick people, and we take them 

directly to the catherization lab for inva- 


Cardiac Emergency Care 

Summary 

Challenge: 

• Reduce amount of time for cardiac 

biomarker test results for quicker 

diagnosis of patients with atypical 

MI symptoms 

• Improve management of chest 

pain patients in the emergency 

department 

• Implement protocol that results 

in proven efficiency to allow better 

reimbursement under pay-forperformance 

system 

Solution: 

• Initiate point-of-care biomarker 

testing using the Stratus CS Acute 

Care Diagnostic System from 

Siemens Healthcare Diagnostics 

right in the ED 

• Establish a protocol for the use of 

the systems that allows for best 

patient care and clinical workflow 

• Educate physicians, nurses, and 

laboratory personnel about the 

benefits of point-of-care testing 

Result 1 : 

• Dramatic time savings on test 

results (troponin and other cardiac 

biomarker test results available in 

only 14 to 17 minutes) 

• Earlier diagnoses lead to earlier 

intervention (70 percent reduction 

in time from ’door to PCI‘) 

• 56 percent reduction in admissions 

for low-risk chest pain patients 

• Faster turnover of ED beds, reduction 

of unnecessary procedures, 

lowered length of stay, and fewer 

readmissions of cardiac patients 

• Better patient care 

• Organized, efficient use of clinicians’ 

time and hospital’s resources 

• Improved reimbursement 

1 


“With reduced 

time to decision, 

we are able to 

initiate therapies 

much more 

quickly.” 

Steve Berkowitz, MD, 

Chief Medical Officer, 

South Austin Hospital, 

St. David’s HealthCare, Austin, TX, USA 

sive treatment as quickly as possible. It’s 

almost like Monopoly – do not pass Go; 

do not collect 200 Dollars; go right to the 

cath lab.” 

According to the Chief Medical Officer, 

the situation becomes trickier when 

people do not have ’typical‘ symptoms – 

severe, crushing chest pain “like an 

elephant standing on your chest,” pain 

radiating down the arm, severe shortness 

of breath, nausea, vomiting, and 

sweating. “As many as half of patients 

don’t have the typical textbook symptoms,” 

he reports. “And time is just as 

critical for those people as it is for those 

who have an established heart attack on 

the electrocardiogram.” 

In these non-STEMI (NSTEMI) cases, standard 

protocols call for cardiac biochemical 

marker testing, which requires that 

blood be drawn and evaluated for 

chemical indicators that show whether 

a heart attack has occurred. These typically 

include a troponin test, which may 

be ordered along with other cardiac biomarkers, 

such as CK-MB, which in high 

concentrations indicates long-term damage 

of the heart muscle, or myoglobin. 

“Elevated troponin is a good indicator of 

heart attack, because when heart cells 

die, they release troponin into the bloodstream,” 

explains Berkowitz. 

Quickened Response 

“In the past, it was necessary to send 

blood specimens to the lab for testing,” 

adds Buhman. “We would get results 

back in 30 to 45 minutes minimum.” 

Now, St. David’s South Austin Hospital 

has turned that number upside down, 

typically getting results in only 14 to 17 

minutes. 

The reason? Three years ago, the hospital 

implemented four Stratus CS Acute 

Care Diagnostic Systems from Siemens 

right in the Emergency Department to 

run the blood assay tests, saving precious 

time for patients. With its high sensitivity 2 

troponin test method, proximity at the 

point of emergency patient care, and 

quick test turnaround times, the Stratus 

CS systems’ protocol translated into 

meaningful results for patients. Cardiac 

biochemical marker results are delivered 

in mere minutes, not the standard onehour 

’vein to brain‘ timeframe recommended 

by many international medical 

organizations. 

“With reduced time to decision, we 

are able to initiate therapies much more 

quickly. Those extra minutes of time 

can be the difference of life or death for 

a patient with heart disease,” says 

Berkowitz. 

Further, getting results faster provides 

some relief on an emotional level, 

explains Buhman. Chest pain patients 

frequently are anxious, she says. “If we 

find their cardiac biomarkers are indicating 

an acute cardiac condition, we 

can let the patient know quickly and 

2 

Defined by the ESC/ACC/AHA/WHF committee as an 

imprecision level of ≤10 percent at the 99th percentile 

of normal. 



Integrated Technology: 

Helping Transform U.S. Healthcare 

Today, hospitals in the U.S. are facing immense pressure to 

provide more efficient and higher quality healthcare 

while reducing costs. Increasingly, reimbursement is linked 

directly to a hospital’s clinical performance. 

Sandra Sieck, RN, President of Sieck Healthcare Consulting 

in Mobile, Alabama, a top expert on healthcare business 

reform, has worked with more than 2,000 hospitals across 

the country to optimize clinical and financial outcomes. 

According to Sieck, though U.S. per capita spending on 

healthcare substantially outpaces European countries, the 

U.S. fails to achieve better health outcomes, and has been 

shown in multiple studies to be last on dimensions of 

access, patient safety, efficiency, and equity. 

Patients and payers alike are demanding fundamental, 

widespread change. Advanced integrated technology is 

helping lead the way. 

American versus European Models 

Per capita spending in the U.S. is higher than in Europe, 

largely because of differences in disease prevalence. The 

U.S. takes a more aggressive approach to detecting and 

treating patients, yet data shows that Americans are in 

poorer health, with higher rates of serious chronic illnesses. 

Reimbursement Challenges 

The U.S. multipayer system also presents financial challenges, 

explains Sieck. “With its multiple rules, forms, and 

procedures, it costs an estimated 20 to 30 percent of the 

total healthcare expenditure, in contrast to only ten percent 

in Canada and some European countries,” she says. 

“Today, in the U.S., we’re seeing increasing expenditures 

and expanding federal benefits to cover a growing beneficiary 

population, Baby Boomers and Baby Loomers [babies 

born in the 70s]. As a self-funded government payer, CMS 

[Centers for Medicare and Medicaid Services], the federal 

agency that operates the Medicare program, has only two 

choices: raise taxes to cover waste or eliminate waste, such 

as excessive treatment times, unnecessary resource utilization, 

and unnecessary hospitalizations.” 

As a result, CMS is seeking widespread transformation of 

the U.S. healthcare system and is using reimbursement as 

a major impetus for change. In 2007, the Secretary of Health 

and Human Services delivered a report to Congress suggesting 

ways to transform Medicare from a passive payer 

to an active purchaser of high-quality, efficient healthcare. 

That plan includes value-based purchasing, which links 

payment more directly to the quality of care and rewards 

providers who supply it. 

The Future of U.S. Healthcare 

Value-based purchasing demands that identified patient 

populations receive specific medical and clinical tests and 

treatment in accordance with professionally recognized 

standards of healthcare to assure full CMS market basket 

reimbursement. Hospitals must have: 

• Better asset or resource utilization – omit waste 

• Optimized decision times – fast, accurate test results 

that facilitate timely treatment decisions 

• Shorter lengths of stay – reduce stays, but not being 

so lean that hospitals face compliance issues or negative 

patient outcomes 

• Fewer admissions for unnecessary chest pain rule-out 

There is no easy answer for improved clinical and financial 

success, but advanced, integrated technology is a key 

component to providing more efficient and higher-quality 

healthcare. Combination testing using advanced technology, 

such as the integration of laboratory, IT, and imaging, 

help ensure better data for treatment decisions and improves 

cost-effectiveness through improved clinical workflow. 

Patients and hospitals alike benefit from better 

quality and maximized efficiency; hospitals can increase 

reimbursement. 

begin treatment. When biomarkers and 

the ECG are negative, we can let those 

patients know their condition does not 

show an acute cardiac condition at that 

time. We decrease patient anxiety by 

letting them know if they have an acute 

cardiac event going on or not. Information 

gives patients back the control they 

feel has been lost.” 

St. David’s South Austin Hospital and a 

second hospital in the St. David’s system 

are the only facilities in Austin using the 

Stratus CS systems to deliver rapid results 

for the diagnosis of a cardiac event in 

NSTEMI patients. From 2003 to 2007, the 

number of NSTEMI patients in the Emergency 

Department increased by 68 percent. 

Yet, the hospital has seen a 70 percent 

reduction in time from ’door to PCI‘ 

(time the patient came through the door 

to percutaneous coronary intervention). 

Additionally, the hospital has realized a 

56 percent reduction in admissions for 

low-risk chest pain patients. 

Besides improving the speed of appropriate 

patient therapy, Berkowitz and 

Buhman credit the state-of-the-art tech- 



“We decrease patient anxiety 

by letting them know if they have 

an acute cardiac event going on 

or not.” 

Renee Buhman, RN, Educator, Emergency Department, 

South Austin Hospital, St. David’s HealthCare, Austin, TX, USA 

nology for helping increase numerous 

efficiencies in the hospital. These include, 

for example, faster turnover of Emergency 

Department beds, reduction of unnecessary 

procedures, appropriate use of telemetry 

beds, lowered length of stay, and 

fewer readmissions of cardiac patients. 3 

Additionally, the hospital has seen reimbursement 

improvements, according 

to Buhman. “There is a better chance of 

appropriate reimbursement when evidence 

supporting the physician diagnosis 

and assigned treatment is in black and 

white. The elevation in cardiac markers 

provides just that in ACS/chest pain 

patients.” 

3 


Synchronized Effort 

“The protocol would have never worked 

without the buy-in of our chief pathologist, 

laboratory department, and emergency 

nurses,” says Berkowitz. “With 

CLIA [Clinical Laboratory Improvements 

Amendments] licensing at stake, there 

were concerns from the lab, which 

wanted to be sure the tests were performed 

and analyzed correctly.” He continues, 

“Intuitively, we wanted to get 

the test done as fast as we could, which 

meant the ED nurses, not laboratory 

personnel, would be responsible for performing 

the tests. When the nurses saw 

how the timeliness would improve patient 

care, they committed to learning how 

to perform the tests.” Now, about 60 

nurses are trained to use the analyzer, 

which translates into direct time savings 

and faster intervention. 

The Stratus CS Acute Care Diagnostic 

System is uniquely designed for use in 

an acute care setting. Small in size, the 

analyzer can be configured as both a 

bench-top or stand-alone workstation, 

with its own lightweight cart, refrigerator, 

and uninterrupted power supply. This is 

what St. David’s South Austin Hospital 

uses. 

“We had the choice of going with a competitor’s 

handheld device or the Siemens 

Stratus CS,” says Berkowitz. “We chose 

the Stratus CS system based on its speed 

and high sensitivity testing, but also 

because of the track record of Siemens 

and the confidence we have in the company. 

The analyzers are the same ones 

the lab has always been using, so they 

knew the instrument and were comfortable 

with it. Overall, we have been very 

pleased with the system, plus the training 

and support by Siemens and their 

Clinical Quality Initiatives team has been 

exceptional,” he says. 

In any busy emergency department, there 

are moments when time is critical. When 

cardiac patients arrive, the pressure is on 

and the clock is ticking. For this central 

Texas hospital, expedited high-sensitivity 4 

troponin testing in the Emergency Department 

with Siemens Stratus CS Acute Care 

Diagnostic Systems has led to unprecedented 

results – improving efficiency, 

buying valuable time, and making a difference 

to patients. 

Diana Smith is a freelance writer based in 

Liberty Hill, TX, USA. 

4 

Defined by the ESC/ACC/AHA/WHF committee as an 

imprecision level of ≤10 percent at the 99th percentile 

of normal. 


www.siemens.com/diagnostics 



At South Austin Hospital, cardiac biomarkers like troponin are analyzed with four Stratus CS Acute Care Diagnostic Systems 

directly at the point of care in the Emergency Department. 


Training and Maintenance 

Only a few steps separate the classrooms from the imaging systems. 

State-of-the-art 

Training 

With UPTIME Services, Siemens Healthcare offers 

joint trainings for both customers and Siemens 

Service Engineers worldwide, providing a variety 

of technical and application courses to keep 

everyone’s expertise on the cutting edge. 

By Justus Krüger 

Gil Palcone was a little disappointed at 

first. Siemens Philippines – computed 

tomography (CT) supplier of The Medical 

City Hospital in Manila – was not going 

to send him to Erlangen, Germany for 

his training course, as it did two months 

before, but to the new Siemens Training 

Center in Shanghai. 

“I did have doubts whether the courses 

in Shanghai would be as good as in Germany,” 

says the 43-year-old biomedical 

engineer. His doubts, however, disappeared 

as soon as he arrived in Shanghai. 

“I am 100 percent satisfied with the 

classes here,” Palcone happily declares – 

and is already hoping for an update of his 

skills in a specific SOMATOM® Definition 

AS+ training. 

The Siemens Training Center in the 

Chinese metropolis is part of Siemens 

Healthcare’s global training concept. 

The training, part of Siemens UPTIME 

Services, helps customers worldwide 

maintain their expertise on the cutting 

edge of medical and clinical technology, 

and develop it even further – regardless 

whether they take place in Germany, the 

U.S., or China. 

Global Training Concept 

“Our global training concept helps 

provide the same high standards in all 

training facilities,” says Thomas Weller, 

General Manager for Customer Services 

at Siemens Shanghai Medical Equipment. 


Each Siemens Training Center is 

equipped with a variety of the company’s 

systems for hands-on maintenance and 

repair training. 

The courses help Siemens customers 

deepen their understanding of extremely 

sophisticated, state-of-the-art medical 

equipment such as the company’s magnetic 

resonance imaging (MRI) and CT 

scanners, or radiography, fluorography, 

and angiography systems. That in turn 

empowers them to optimize workflows, 

avoid and detect operational errors, and 

fully utilize their equipment’s potential. 

This improves examination results and 

increases patient care and satisfaction. 

For the healthcare providers, optimizing 

workflows also means higher system 

availability and a marked reduction in 

terms of costs. 

These are significant issues for the whole 

spectrum of Siemens Healthcare customers. 

Equipment such as CT scanners 

is in such high demand, especially in 

large hospitals, that patients often have 

to endure a long wait. With an inhouse 

engineer educated in one of Siemens 

Training Centers smoothing out potential 

failures within the framework of a 

Shared Services agreement, the systems 

can be utilized more efficiently, saving 

time for both operators and patients. 

Theory and Practice 

“That is an important factor,” says Weller, 

“especially when it comes to systems 

such as CT scanners, which are often in 

use non-stop from eight in the morning 

to ten in the evening.” Indeed, far from 

merely providing the latest theoretical 



The Siemens Training and Development Center in Cary (left) opened in 1992. In 2006, Siemens built a new Training Center in Erlangen. 

Worldwide Training 

A leader in medical technology, Siemens Healthcare has 

implemented a global training process in order to offer 

state-of-the-art training for Siemens Customer Service 

Engineers (CSEs) and customers worldwide. Three Training 

Centers have been set up in: Erlangen in southern 

Germany; Cary in North Carolina, U.S.; and Shanghai in 

China. 

All Training Centers are equipped with the latest Siemens 

systems and the most current software. 

The Training and Development Center in Cary opened in 

1992, featuring a 70,000-square-foot training facility with 

fully functional computed tomography (CT), magnetic 

resonance imaging, and X-ray systems and 35 classrooms. 

In 2006, the Erlangen Training Center opened after 

Siemens Healthcare invested approximately €20 million in 

the building and close to €40 million in its equipment. More 

than 50 imaging systems, which include 15 systems in 

angiography, two SOMATOM® Definition, several Biograph 

and MAGNETOM® systems, as well as syngo® Suite are 

available to participants. 

The center in Shanghai is the most recent addition. As part 

of Siemens Medical Park Shanghai, it is equipped with 

state-of-the-art technology, which includes three types of 

CT scanners: SOMATOM Spirit, Emotion, and Sensation, 

two digital radiography and fluoroscopy systems (AXIOM® 

Aristos and Iconos), as well as several multimodality 

workstations to conduct syngo software and Oncology 

network and workstation training. “Many clinics would be 

happy to have the newest systems and the most current 

software installed as we do,” says Volker Froede, who is 

responsible for Siemens Healthcare’s Training Centers. 

However, participants can also train on older systems and 

even on ones that are no longer sold. 

Each Training Center is highly independent yet also interconnected 

with its two sister centers. If a customer or 

CSE requires training not offered in Shanghai, Siemens 

provides a possibility for him or her to join a class in either 

Erlangen or Cary, wherever the needed training is offered. 

Siemens has designed most training courses for both 

customers and Siemens personnel in order to provide 

the same high level of education to internal staff and 

customers. A strong emphasis is placed on certification. 

All Siemens participants must take a test and receive a 

certificate after having passed it. Many application training 

courses also offer the CME (Continuing Medical Education) 

credits that medical doctors require. 

In addition to classroom training, Siemens offers, for 

example, virtual training, web-based classes and onsite 

training. More than 14,000 participants worldwide attend 

about 1,400 training sessions at the Siemens Training 

Centers every year. In addition, about 16,000 people make 

use of e-learning, thereby making a difference to millions 

of medical professionals, patients, and their families all 

around the world. 

training, the Training Centers also offer 

practical application, which is truly indispensable 

to provide first-class medical 

service. The training divides participants 

into four levels, depending on their 

knowledge level: Basic, Advanced, Expert, 

and Refreshment. The target groups for 

trainings include physicians, radiology 

technologists and radiographers, as well 

as engineers and hospital IT administrators. 

Siemens not only offers its customers 

the chance to continuously enhance 

their skills, but is also sending their own 

service engineers back to school: The 

main participants, other than customers 



of Siemens Healthcare, are Siemens 

Customer Service Engineers (CSEs). 

Combining the courses for customers 

and Siemens staff, UPTIME Services provides 

a great opportunity to exchange 

valuable experience. 

As providing good quality training is a 

top priority of Siemens, the number of 

participants per course does not exceed 

twelve. This allows an intensive exchange 

between trainers and participants. It also 

helps provide everybody with plenty of 

opportunity to work with the systems 

and to get hands-on experience with the 

equipment. 

For Palcone, this is one of the big benefits 

of the training concept. “We don’t 

only study theory; we apply it to the 

systems – every day,” he says. “That way 

you can really absorb the knowledge.” 

Driven by an innovative concept, the 

courses offer an interactive training 

method that is more like a workshop or 

a seminar than a lecture. Trainers keep 

checking whether everybody is following; 

participants ask back; the discussions 

are lively. That way, the trainers have a 

clear picture of how far each student 

has progressed at any one time and how 

much catching up there is to do. Also, 

it is simply more fun and contributes to 

a good learning atmosphere. 

High-Quality Training 

All three training centers offer the same 

quality of training, and that is, in part, 

due to the same level of skills and knowledge 

demanded from the trainers. No 

matter if they work in Shanghai, Cary, or 

Erlangen, the requirements are high, not 

only in technical knowledge, but also 

in the ability to teach and transmit that 

knowledge. 

All prospective trainers first take courses 

along with Siemens customers in one 

of the three Training Centers before they 

start teaching individual modules. After 

that, they will receive ’Train the Trainer’ 

education and finally can start to teach 

whole courses under the supervision of 

an experienced instructor. Upon receiving 

a certification and having several months 

of experience, supervisors will observe 

their teaching in the classes again. “That 

way, we can make sure that we really 

get the quality we want,” Weller says. 

This, however, is not the end of quality 

control. “We ask participants – via a 

questionnaire or online – how valuable 

the training was for them,” says Volker 

Froede, who is responsible for the global 

Siemens International 

Medical Park Shanghai 

Probably no other Chinese city, or even Asian metropolis, has risen 

higher in excitement than Shanghai. More than merely capitalizing on 

its romantic past, Shanghai is a vibrant city that promises plenty for 

the future. 

In this forward-looking metropolis, Siemens has invested more than 

€30 million to set up a new landmark facility. In May 2007, Siemens 

Healthcare China’s headquarters and Siemens Shanghai Medical Equipment 

moved together to the Shanghai International Medical Zone 

(SIMZ) as a pioneer in this new development area. SIMZ is an ambitious 

project of the Shanghai municipal government covering 11.5 square 

kilometers in Shanghai’s southeastern Nanhui district. The new zone, 

set to be completed in 2015, is projected to be an international center 

of medical care, education, training and research and development (R&D). 

The move thus also marked the successful integration of Siemens 

Healthcare China’s R&D, manufacturing, service, sales, and marketing 

resources with more than 1,000 Siemens Healthcare employees, working 

closely together under one roof. Together with Siemens Healthcare’s 

first comprehensive medical equipment show center in Asia and Siemens 

Healthcare’s Service Center for Asia, the new facility represents a strong 

center of gravity for Siemens Healthcare’s activities in China and Asia. 


Small courses allow an intensive exchange between trainers and participants, and help provide everybody with plenty of opportunity to work with the 

training strategy. “A high percentage of 

the questions have to come back with 

either ‘excellent’ or ‘good’, otherwise we 

have to initiate changes to the training.” 

To help provide a truly global and standardized 

training approach, trainers 

“I am 100 percent satisfied 

with the classes here.” 

rotate worldwide. An instructor from 

Shanghai can be asked to teach in the 

U.S. and Germany, while a U.S. trainer 

is just as fit to teach in Erlangen or in 

Shanghai as in Cary. All courses are held 

in English, as the centers not only serve 

Gil Palcone, Biomedical Engineer, The Medical City Hospital, Manila, Philippines 

The Medical City Hospital in Manila, Philippines, a private, tertiary care hospital, serves 

some 40,000 inpatients and 380,000 outpatients a year. 

their respective home markets. The center 

in Shanghai, for instance, is attracting 

interest not only from China but serves 

the entire Asia-Pacific region. In a typical 

week, Manish Pathak, a trainer and 

Senior Manager at Siemens Healthcare, 

will be teaching a class of ten students 

who may come from six countries within 

different corners of Asia-Pacific, from 

Russia to Japan or from China to Australia. 

Growing Fast 

China was a logical choice as the location 

for the third Siemens Training Center. 

“China is a fast growing healthcare market, 

and on its way to be the largest 

market in Asia,” says Weller. “That means 

there is a high demand for technical 

experts and knowledge [in China]. The 

close interaction of R&D [research and 

development], manufacturing, and customer 

service makes a lot of sense. It 

achieves a host of synergy,” explains 

Weller. 

It is, in fact, the synergy that develops 

between education and service that 

further helps to better diagnose and correct 

any issues that may arise. 

A basic course in CT, for instance, enables 

operators to benefit from Siemens 

service support even more than usual. 

While today, based on the service agreement, 

many system malfunctions can 

be solved remotely via Siemens Remote 

Service (SRS), some system malfunctions 

require onsite support by a trained 


systems and get hands-on experience with the equipment. 

engineer, for example, with regard to 

the exchange of a spare part. If inhouse 

engineers at the customer’s site have 

been trained by Siemens in certain issues 

within the scope of a Shared Services 

agreement, a good understanding of the 

system allows them to talk the technical 

language of the Siemens expert, identify 

and explain the issue via telephone, and 

initiate relevant tests. 

“That really enables the customer to 

have a meaningful discussion with the 

expert in the Siemens Service Center. 

If this is not the case, the Service Center 

would usually send a Siemens Customer 

Service Engineer to the hospital,” says 

Pathak. In contrast, when an inhouse 

engineer or operator has a good knowledge 

of the system, he or she can leapfrog 

several time-consuming steps in 

the procedure. In case a problem can be 

identified inhouse or with the help of 

the Service Center, Siemens can immediately 

send an engineer along with the 

required spare part. “If you have a good 

preliminary diagnosis, you can save a lot 

of time,” Pathak adds. 

Training and Siemens Remote 

Service 

The combination of training can truly 

increase efficiency. SRS links the equipment 

at the health service provider 

with a Siemens Service Center, enabling 

experts to recognize sources of error in 

many cases even before the customer 

becomes aware of them. For instance, if 

the temperature in a CT scanner’s cooling 

system leaves a range of tolerance, 

the scanner will automatically report to 

the Service Center. Then, a Siemens 

engineer can proactively contact the 

institution where the system is located 

and either solve the issue remotely or 

dispatch a Customer Service Engineer to 

go to the customer’s site. If the inhouse 

engineer in the hospital or clinic has a 

good grasp of the system, he can count 

on his knowledge to work together efficiently 

with the Siemens expert. “I think 

the combination of remote service and 

training is really ideal,” Weller says. 

Palcone agrees. “We have an excellent 

working relationship with Siemens,” says 

the engineer from Manila. Last month, 

Palcone says, there were difficulties with 

the hospital’s MRI system. Thanks to his 

experience, his course, and Siemens 

Remote Service, the problem got fixed 

within 15 minutes. “Good for Siemens,” 

Palcone laughs. “But even better for us. 

This is really a win-win situation.” 

Justus Krüger is correspondent for the Berliner 

Zeitung in Beijing, China. 



medical_training_center 


uptime-services 

Summary 

Challenge: 

• Utilize the full potential of medical 

equipment 

• Keep expertise on the cutting edge 

• Optimize workflows 

Solution: 

• Global training process to offer 

state-of-the-art training 

• Three main Training Centers in 

Erlangen, Germany; Cary, U.S.; and 

Shanghai, China 

• Variety of technical and application 

trainings 

• Innovative training concept combining 

theoretical and practical training 

• CME (Continuing Medical Education) 

credits for various courses 

• Constant quality controls to meet 

high standards of excellence 

• Training Centers equipped with the 

latest Siemens systems and software 

• Highly qualified trainers 

Result: 

• Competitive edge thanks to higher 

efficiency 

• Higher system availability because 

of workflow and maintenance 

improvements 

• Improved examination results 

through utilizing all existing functionalities 

• Faster, more secure diagnoses 

• Increased patient satisfaction 


Essay Series: Healthcare Systems – Japan 

The Japanese Healthcare System 

By Seiritsu Ogura 

Professor of Economics at Hosei University in Tokyo, Japan, and Editor of the Japanese Journal of Health Economics and Policy 

Japanese healthcare is in a crisis. Unlike 

past crises, this one is a very quiet one, as 

it is coming from disappearing essential 

services. On weekends, we find emergency 

rooms (ER) of any major hospitals 

practically deserted, as patients are 

turned down before – and after – their 

arrivals. The hospitals don’t have enough 

staff to operate the ERs, and, even if they 

did, they couldn’t afford to take care of 

the patient volume. In rural communities, 

local governments are closing their public 

hospitals in large numbers due to lack 

of funds. We have serious shortages of 

physicians, nurses, emergency facilities, 

pediatric hospitals, obstetric facilities, etc. 

We have observed a series of bad decisions 

by the Ministry of Health, Labor and 

Welfare (MHLW) during the past decade 

that should have contributed to this crisis, 

but they are more results than causes. 

We have a shortage of funds because we 

have not infused enough money into our 

health insurance system to care for the 

growing population of the elderly. In the 

past few years, no one wanted to talk 

about tax increases for fear of losing the 

next election. The government has been 

piling up a huge national debt for almost 

two decades, which has reached almost 

twice the size of the GDP. The implicit debt 

in our public pension program is almost 

the same size too. The Ministry of Finance 

wants to restore primary balance by year 

2011 and wants the MHLW to keep the 

lid on healthcare expenditures, allowing 

only a ¥1.1 trillion increase in the costs 

of all social security programs during the 

five-year period prior to 2011. 

In response to these pressures, MHLW 

produced a reform package in 2006 con- 



“The root cause of our present 

crisis is the shortage of funds.” 

sisting of medical insurance programs 

for people over 75, and a new reinsurance 

scheme for people from 65 to 74. 

They put them into effect in April 2008, 

but so far, they have turned out to be 

extremely unpopular. In what follows, I 

will explain the outlines of this financial 

reform package and the reasons why it 

has met with strong public opposition. 

For historical reasons, the Japanese public 

health insurance system consists of 

two basic types of insurance programs: 

employees’ programs and municipal programs. 

The two types of programs have 

very different comparative health risks 

and financial bases. In short, employee 

programs have smaller healthcare needs 

and a larger revenue base, while municipal 

programs have much larger healthcare 

needs and a smaller revenue base. 

In spite of these gaps, up to the 1970s, 

the government was able to provide sufficient 

subsidies for the municipal programs 

to keep them running. As retired 

workers started to concentrate in the 

municipal programs, however, these gaps 

started to widen even further. By the 

early 1980s, the government, facing its 

own huge deficits, could no longer keep 

up with paying subsidies to meet the 

bulging demands of the municipal programs. 

In 1982, the government introduced 

reinsurance of the healthcare costs of 

those at age 70 or older in our health 

insurance. In the scheme, the government 

contributed half of the costs, and 

asked all the programs to pay for the 

other half, according to a formula using 

several factors, including the number of 

individuals in their programs. Over the 

Seiritsu Ogura 

Professor of Economics, Hosei University, Tokyo, Japan, 

and Editor of the Japanese Journal of Health Economics and Policy 

years, the contribution formulas have 

been modified several times, and in the 

meantime, the minimum age for reinsurance 

has been moved up to age 75. 

Finally, starting in April 2008, the government 

renamed the reinsurance scheme 

as ’medical insurance programs for the 

old-old,’ reorganized it into regional insurance 

programs, and started to collect 

ten percent of the costs mostly through 

their own poll taxes. Furthermore, it has 

come up with its own benefit package, 

adopting comprehensive payment for 

most outpatient care, instead of the 

former fee-for-service system. 

This scheme has generated an enormous 

public outcry. Some have even compared 

the insurance to a legendary ‘granny 

dumping mountain,’ blaming the government 

for attempting to deny anyone 

above the age of 75 their normal healthcare 

services. As soon as the details of 

this package became public, most physicians 

expressed their strong opposition 

to its comprehensive payment scheme, 

claiming that it will prevent them from 

performing necessary procedures, using 

necessary drugs, and ordering necessary 

tests. Furthermore, because of the regressive 

poll taxes, this old-old insurance has 

been very unpopular, particularly among 

the poor. It may very well cost the present 

ruling parties the next election. 

In the past, there was another reinsurance 

program involving those under the 

age 75, in which employee programs 

reimbursed municipal programs for the 

cost of those who had switched from 

employee pensions. Starting in April 2008, 

the government replaced this program 

with a comprehensive reinsurance of 

healthcare costs of all the individuals 

between the ages of 65 and 74. Their 

healthcare costs are paid by all insurance 

programs in proportion to the shares in 

insured individuals between birth and 

age 74. The government makes no independent 

contribution to this scheme, 

but it provides subsidies to municipal 

programs for half of their contributions 

and to small companies’ programs for 17 

percent of their contributions. 

This new scheme has met another strong 

protest, this time from large companies. 

Let me explain why. Suppose we have 

someone who had his 65th birthday on 

the 31st of December last year. Let us 

also suppose that he used to spend one 

unit of healthcare a year until his 65th 

birthday, but now he spends four units a 

year. We want to find out how the extra 

three units will be paid in our new re- 



Facts & Figures 

An Aging Population: Japan has the highest life expectancy, the lowest infant mortality, and the most aged 

population in the world today. It will age even further in the first half of this century. By the year 2055, life 

expectancy for men is expected to reach 83.7 years, compared with 79.2 years in 2007, while women’s life 

expectancy is expected to reach 90.3 years, compared with 86 years in 2007. Reflecting the improved longevity 

and low fertility, the percentage of the population at age 65 or older increased dramatically, from 4.9 percent 

in 1955 to 20.1 percent in 2005. It is expected to reach 40.5 percent in 2055. 1 

Medical Care System: Japan has a national health insurance system. The insurance covers the entire population 

either through employee programs, municipal programs, or special programs. All programs offer the same 

benefits. Employers pay 50 percent of the insurance premium. Patients currently contribute either 10 percent 

(age 70 or older) or 30 percent (all others and affluent elderly) to the cost of inpatient or outpatient care, or 

prescription drugs. Children also have a 20 percent co-payment, but many municipalities and cities are now 

bearing some or all of these costs to attract and keep citizens. For people between age 70 and 74, the co-payment 

rate was scheduled to move up to 20 percent, but the move is temporarily suspended. There is a maximum 

subsidy of ¥350,000 (about US$3,200) to the cost of delivery for childbirth. Routine checks during pregnancy 

are not covered by health insurance. 

Within the Organization for Economic Co-operation and Development (OECD) countries, Japan ranks slightly 

below the average in terms of health spending per capita, but the contribution of its public sector to health 

spending is – at 83 percent – well above the OECD average of 73 percent. Japan has fewer physicians per capita, 

about two thirds of the OECD average, which is at least partly due to government policies fixing limits on the 

number of new entrants to medical schools. Japan has the highest number of hospital beds, more than twice 

the OECD average, and the highest number of magnetic resonance scanners, about four times the OECD level. 

Long-term Care System: Public long-term care insurance was introduced in the year 2000 to provide various 

home care and institutional care services for the elderly. Insurance premiums are collected in two ways: namely, 

through a surcharge to health insurance taxes for individuals between age 40 and 64, and through community 

poll taxes for residents age 65 or older. The co-payment for benefits is set at ten percent of the costs. The total 

cost of the benefits has already doubled since the start of the system and reached ¥5,571 billion in 2006. 2 Half 

of the costs are paid by general tax revenues. 

Morbidity and Mortality: Circulatory system diseases are the most prevalent major diseases among the elderly, 

affecting 30.1 percent of this population segment. They accounted for ¥5,379 billion, or 21.5 percent of the 

medical expenditures, in 2005. Cancer was the leading cause of death, accounting for 30.1 percent of all deaths, 

followed by heart disease for 16 percent, and by cerebrovascular diseases for 12.3 percent. 3 

Lifestyle Risk Factors: Smoking is by far the most important single health risk factor in Japan. Smoking among 

Japanese men is, with 39.9 percent, still the fourth-highest among developed countries, whereas cigarette 

prices are at one of the lowest levels. An average pack cost ¥304.6 in 2007. 4 There are few smoke-free public 

areas. 5 Recently, the government has been emphasizing obesity as a major health risk. Although only 3.9 percent 

of all Japanese in 2005 were obese (compared to 34.3 percent in the U.S. in 2006), it has launched a compulsory 

national program to check for metabolic syndromes for employees at age 40 or older. 

1 

2008 Annual Report on the Aging Society, Cabinet Office, Government of Japan 

2 

www.mhlw.go.jp. Last accessed Sept. 16 th , 2008 

3 

www.mhlw.go.jp. Last accessed Sept. 16 th , 2008 

4 

www.mof.go.jp. Last accessed Sept. 16 th , 2008 

5 

www.who.org. Last accessed Sept. 16 th , 2008 


Women: 85.99 years (2007) 

Men: 79.19 years (2007) 

Dentists 

Number per 1,000 Resident Population 

0.761 (2006) 

Hospital Beds 


8.2 (2006) 

Physicians 


2.1 (2006) 

Nurses 


9.3 (2006) 

Life Expectancy at Birth 

Population in Thousands:127,678 (March 2008) 

Total Expenditure on Healthcare as Percentage of GDP: 8.2% (2005) 

Share of the Age Group 65+ of the Health Expenditure: 35% (2005) 

Contribution of the Public Sector to Health Funding: 82.7% (2005) 

Total Expenditure on Healthcare 

per Capita (adjusted for 

purchasing power parity): 

US$2,474 (2005)


“We have a shortage of funds 

because we have not infused 

enough money into our 

health insurance system to care 

for the growing population of 

the elderly.” 

Seiritsu Ogura 

Professor of Economics, Hosei University, Tokyo, Japan, 

and Editor of the Japanese Journal of Health Economics and Policy 

insurance scheme. First we must consider 

co-payment, then this reinsurance, and 

lastly, government subsidies. By a simple 

back-of-the-envelope calculation, we 

find out that co-payment pays only three 

percent, government pays 25 percent, 

premiums of employee programs pay 

52 percent, and premiums of municipal 

programs pay less than 20 percent. In 

2005, the insurance premiums paid 49 

percent, and the government paid 36 

percent, of national healthcare costs. The 

new reinsurance package will increase 

the marginal share of premiums to 72 

percent and reduce the marginal share 

of the government to 25 percent. The 

government is simply shifting its burden 

to employee programs. 

Employees are already paying almost the 

same amount as their own healthcare 

costs in their payments for the elderly. As 

the elderly population increases, so will 

the employees’ payments. This process 

will eventually stop when a sufficient 

number of those in employee programs 

get angry. I would hate to see more 

rounds of cuts in our healthcare services 

and their tragic consequences. Besides, 

we should worry about the deadweight 

losses from such very high payroll tax 

rates: They will reduce employment and 

the companies’ profit. Payroll taxes may 

be far better than poll taxes, but they are 

not as equitable as consumption taxes 

to finance the healthcare of the growing 

elderly population. After the next election, 

I hope politicians will summon enough 

courage to raise the consumption tax 

rate to solve our current crisis in healthcare. 

Another interesting implication of this 

reform package is its impact on weaker 

company-specific employees programs. 

We still have more than 1,200 companyspecific 

programs, many of which may 

decide to dissolve and join the new 

regional programs for employees of small 

companies, rather than paying higher 

tax rates. In the long run, we may come 

closer to having more integrated health 

insurance programs, at least among the 

employees’ programs. 

The opinions expressed in this article do not 

necessarily reflect those of Siemens Healthcare. 

Seiritsu Ogura is a Professor of Economics 

at Hosei University in Tokyo, 

Japan. He is also the Editor of the Japanese 

Journal of Health Economics and 

Policy, the official journal of the Japan 

Health Economic Association, and a 

member of its Board of Directors. He is 

a graduate of the Department of Law, Tokyo University, 

and earned a PhD in Economics from the University of 

Pennsylvania. He was a Chief Economist at the Japan Center 

for Economic Research, one of the leading think-tanks in 

Japan, before he joined Hosei University. Since the 1990s, 

he has been working in the field of aging issues and public 

health in Japan, including population projections, public 

pension reforms, public health insurance reforms, and, most 

recently, long-term care insurance reforms and tobacco 

control issues. He has co-edited two books, Aging Issues in 

the United States and Japan (2001) and Labor Markets and 

Firm Benefit Policies in Japan and the United States (2003), 

both published by the University of Chicago Press. 


Further Reading 


Siemens offers a variety of customer magazines and information 

channels. ’Further Reading’ introduces a selection of articles 

and topics featured there that may be of interest to you. To learn 

more, follow the link below each article. To subscribe to any of 

the magazines, see page 77. 

Artis zeego delivers precise images during the intervention and can easily be stowed away when not needed. 

Artis zeego Supports Hybrid Rooms 

The combination of a C-arm with robotic 

technology is the formula for Artis zeego®, 

the latest high-end angiography system 

from Siemens. Artis zeego provides the 

physician with almost unlimited freedom 

of movement. The system’s flat detector 

rotates around the patient at such high 

velocity and precision that cross-sectional 

soft tissue images are created, acquiring 

more anatomical details than ever before 

possible with an angiography system and 

thus, increasing diagnostic certainty. 

Artis zeego allows the physician to adapt 

the working height to his or her individual 

needs, reducing fatigue and back pain 

during long procedures. If the system is 

not used, it can be conveniently parked 

out of the way, which is particularly 

useful in hybrid operating rooms (OR), 

which combine radiology, cardiology, 

and surgery. The Interventional Center 

at the Rikshospitalet in Oslo, Norway, 

was the first facility to implement Artis 

zeego in such a room. “When we plan an 

operation in the limited space of an OR, 

the increased flexibility with Artis zeego 

means that we don’t have to restrict ourselves 

to avoid problems with the C-arm,” 

says Per Kristian Hol, MD, Manager of 

Radiological Research. 

“Instead, we can make the plan with a 

full focus on the patient and the best 

procedure for the operation at hand.” 

Increasingly advanced and complicated 

interventions performed in the hybrid 

room require the full support of a C-arm, 

especially for changes during the procedure 

or immediate control. As Hol confirms, 

“When expertise and technology 

are scattered, you always are at risk of 

losing precious time if something needs 

to be adjusted. Artis zeego decreases 

that risk.” That is, Artis zeego enhances 

patient outcomes as it enables imaging 

and treatment with greater speed, efficiency, 

and precision. 

www.siemens.com/AXIOM- 

Innovations-zeego 



Paradigm Shift 

in Echocardiography 

T2 FLAIR DWI 

67-year-old male patient 

with dysphasia and right-side 

hemiparesis 

The acquisition of nonstitched, real-time, fullvolume 

3D images of the heart in one single heart 

cycle with the new ACUSON SC2000 volume ultrasound 

system marks a breakthrough in echocardiography. 

Called ’Echo in a Heartbeat,’ the technology 

represents a paradigm shift in ultrasound imaging, 

55 years after the world’s first cardiac ultrasound 

recording using Siemens technology in 1953. With 

a high-volume acquisition rate – in one second, 

every second – acquisition time is dramatically 

reduced, improving workflow in the echocardiography 

suite. 

The advanced architecture of the ACUSON SC2000 

system delivers vastly more information than today’s 

conventional systems and is strengthened by 

Siemens patented Coherent Volume Formation 

technology. Coupled with the system’s high-volume 

acquisition rate, Coherent Volume Formation moves 

away from serial line-by-line acquisition towards 

simultaneous, multiple beams, delivering excellent 

image resolution. 

Customizable, programmable, and protocol-driven 

workflow sequences deliver repeatability for better 

outcomes: greater efficiency, accuracy, consistency, 

and care – from data acquisition to diagnosis. 

Whitepapers on the advanced system technology 

and architecture have been published and can be 

downloaded from the website listed below. 

The ACUSON SC2000 volume imaging ultrasound system 

represents revolutionary innovation for echocardiography. 

www.siemens.com/echoinaheartbeat 

SWI ASL cePWI 

Arterial Spin Labeled Perfusion MRI 

In the neurology world, perfusion refers to the delivery of oxygen 

and nutrients to tissues by means of blood flow, and is one of the 

most fundamental physiological parameters. Disorders of perfusion 

also account for most of the leading causes of medical disability 

and mortality. Perfusion measurements serve as biomarkers for a 

broad range of physiological and pathophysiological functions and 

are of direct diagnostic value in vascular disorders. In the field of 

magnetic resonance imaging (MRI), perfusion imaging measures 

the rate at which blood is delivered to tissue. There are several 

methods for the measurement of classical tissue perfusion. One 

such method is arterial spin labeling (ASL). 

ASL MRI is a noninvasive method to assess cerebral perfusion. 

This technique uses magnetically labelled blood as an endogenous 

contrast agent. With ASL MR imaging, the protons of 

arterial water are magnetically labeled in the feeding vasculature 

of the brain. The labeled arterial protons flow through the vascular 

tree and exchange water with the unlabeled brain tissue. A 

perfusion-weighted image can be generated by the subtraction 

of an image in which inflowing arterial spins have been labeled 

from an image in which spin labeling has not been performed. 

Clinical applications include cerebrovascular disease, degenerative 

disease, brain tumor evalutation, BOLD fMRI, and intervention 

planning. 

In clinical neuroscience, while the application of ASL perfusion 

MRI to the diagnosis and management of acute stroke is both 

obvious and feasible, the clinical utility of ASL is likely to be much 

broader since only a minority of acute stroke patients undergo 

MRI. ASL perfusion MRI could greatly enhance the evaluation of 

both Transient Ischemic Attack (TIA) and chronic cerebrovascular 

disease by quantifying regional cerebral blood flow (CBF) in 

specific vascular territories where interventions may be planned, 

or by allowing the effects of pharmacological therapies on CBF 

to be evaluated. Several approaches now also exist for selective 

arterial labeling, allowing the perfusion distribution of specific 

arteries to be assessed independently. More detailed information 

about the applications of ASL are highlighted in the latest neurology 

edition of the Siemens MR magazine MAGNETOM Flash and 

can be viewed using the link below. 


MAGNETOM-Flash-ASL 



A New Vision of Healthcare 

Siemens plans to achieve the next generation in optimized care through integrating clinical laboratory diagnostics, medical imaging, 

and information technology. 

In its fall 2008 issue, the Siemens research 

and innovation magazine Pictures of 

the Future dedicated a whole section on 

the early detection of diseases and how 

Siemens plans to achieve the next generation 

in optimized care through integrating 

clinical laboratory diagnostics, 

medical imaging, and information technology. 

The articles, complemented with 

statistics and background information, 

literally paint a picture of the future – 

and of the technologies in the Siemens 

Healthcare development pipeline that 

may help make it come true. 

From Molecules to Man 

This article describes how, from genes 

and proteins to cells, tissues, and our 

entire organism, scientists are in the process 

of piecing together a systems view 

of how we work. As they do so, they are 

linking the results of laboratory tests to 

diagnostic images, injecting the resulting 

knowledge into advanced decisionsupport 

systems, and devising strategies 

for early detection and targeted treatments. 

The Future of Medical Imaging 

At the center of this article are infraredbased 

systems that pinpoint abnormal 

tissues and cells, blood tests that detect 

traces of cancer proteins, research that 

is zeroing in on imaging the first signs of 

Alzheimer’s, and strategies for accelerat- 

ing the process of discovering new drugs. 

An interview with John V. Frangioni, MD, 

PhD, Associate Professor of Medicine and 

of Radiology at the Beth Israel Deaconess 

Medical Center and Harvard Medical 

School in Boston, Massachusetts, U.S., 

focuses on solving clinical problems 

through the application of advanced 

engineering and chemistry. Another 

Harvard expert, Mukesh G. Harisinghani, 

MD, Director of the Clinical Discovery 

Program at the Center for Molecular 

Imaging Research and Director of Body 

MRI, Massachusetts General Hospital, 

and Associate Professor of Radiology at 

Harvard Medical School, explains how 

magnetic nanoparticles can help in 

detecting lymph node metastases. 

The Battle Against Breast 

Cancer 

This story features major advances in 

imaging technologies that are now making 

possible more precise examinations 

that place less stress on patients, like 

digital mammography (brought to the 

patient with the help of mobile units), 

computed-aided detection, breast tomosynthesis 

1 , automated breast volume 

scanning 2 and eSie Touch elasticity imaging 

with ultrasound, and magnetic 

resonance imaging techniques for the 

breast. Also focusing on breast cancer is 

an article about how researchers are 

closing in on a diagnostic test that will 

be able to predict whether a patient 

with breast cancer can be successfully 

treated without chemotherapy. Automated 

analysis of tumor-specific genes 

is the key to a new world of individuallytailored 

treatment. 

Answers in the Blood 

Accurately diagnosing illnesses such as 

cancer can be an extremely complex and 

protracted process. Yet, there are now 

many tests that provide a fast and accurate 

identification of diseases in the lab 

– often using just a few drops of blood. 

This article explains how some of them 

work. 

A second article from the world of laboratory 

diagnostics focuses on efficiency: 

In order to accelerate workflows in the 

clinical laboratory, Siemens has developed 

an automated laboratory system 

that runs a large variety of tests in one 

analyzer. It can analyze up to 200 samples 

and perform up to 1,500 diagnostic 

tests per hour. 

1 

Caution: Investigational Device. Limited by U.S. Federal 

Law to investigational use. The information about Digital 

Breast Tomosynthesis is preliminary. This product is 

under development and not commercially available in 

the U.S., and its future availability cannot be assured. 

2 


for planning purposes. The product is pending 510(k) 

review, and is not yet commercially available in the U.S. 

www.siemens.com/PoF 



How to Reduce Dose 

Outstanding developments in the field of 

computed tomography (CT) within the last 

ten years – for instance Dual Source CT 

(DSCT) or dual energy – have increasingly 

made it a standard examination method 

for many indications. Thus, the question 

of radiation dose becomes more and 

more important. 

The German Heart Center in Munich, 

in cooperation with the American Mayo 

Clinics in Rochester and Jacksonville, 

and the Friedrich-Alexander University 

in Erlangen-Nuremberg, Germany, conducted 

the ‘International Prospective 

Multicenter Study on Radiation Dose 

Estimates of Cardiac CT Angiography in 

Daily Practice (PROTECTION-I).’ The study 

compared five CT units from four different 

manufacturers. It included 1,965 

cardiac CT scans that were carried out in 

a total of 50 clinics and heart centers. The 

results show clear differences in radiation 

doses depending both upon the CT 

system manufacturer and the behavior 

of the operator. Radiation can be significantly 

reduced by more consistently 

using already existing technologies for 

dose reduction in CT systems, for example, 

the 100 kilovolt scan protocol or the 

step-and-shoot mode. 

According to the study, the SOMATOM® 

Sensation 64 performed best. Close behind 

was the DSCT SOMATOM Definition. 

Thomas Flohr, PhD, head developer of 

the SOMATOM Definition Dual Source 

at Siemens Healthcare in Forchheim, 

Germany, believes that “The DSCT would 

have performed even better if it had 

already been equipped with the current, 

improved version of the step-and-shoot 

technology during the study.” Despite 

this, in identical clinical situations in the 

study, the average radiation dose of the 

DSCT SOMATOM Definition was more 

than ten millisievert below that of the 

competing scanners ranked in fourth and 

fifth place. Clearly, Siemens has developed 

a radiation-saving system and 

49-year-old patient with a high-grade lesion 

in the right coronary artery revealed by a quick, 

1.8 mSv, low-dose cardiac examination with 

the SOMATOM Definition with Adaptive Cardio 

Sequence. 

additionally provides very good systems 

training so that operators can take 

advantage of the total radiation reduction 

potential of the device. 


SOMATOM-Sessions-Dose 

Diagnostic Center Frankfurt: Innovation and Expertise at the Highest Levels 

By Wiebke Kathmann, PhD 

A visually impressive new building, 

modern work processes, extremely upto-date 

equipment, and outstanding 

cooperation between the Departments 

of Radiology and Cardiology are the 

cornerstones of success at the new Diagnostic 

Center of the University Hospital 

in Frankfurt am Main. 

The architecture is intriguing: clean lines, 

spaciousness, and a waiting area that 

looks like a VIP lounge. Heading up the 

Diagnostic Center and adding to its appeal 

by creating an aura of tranquility are the 

Director of the Diagnostic and Interventional 

Radiology Department, Professor 

Thomas Vogl, MD, and cardiologist and 

Director of the Medical Clinic III, Professor 

Andreas Zeiher, MD. Patients feel well 

cared for – also, of course, due to the fact 

that both Vogl and Zeiher are renowned 

experts in their fields and offer innovative 

interventions. Vogl’s international forte 

is computed tomography-(CT) and magnetic 

resonance imaging-(MRI) guided 

intervention mainly of liver and lung 

tumors and metastasis. People from all 

over the world consult him for transpulmonal 

percutaneous chemoembolization, 

a method used for localized chemotherapy 

of lung tumors, or for laser-induced 

interstitial thermotherapy (LITT). Zeiher’s 

specialty, among others, is regenerative 

medicine, for example, stem cell therapy, 

specialized catheter interventions, and 

measurement of intracardiac flow in diastolic 

dysfunction. 

The appropriate environment for these 

manifold capacities was established with 

the new Diagnostic Center. In order to 

cope with the changes in the German 

healthcare system, an update of facilities 

and concentration of resources was 

necessary, as the center’s Commercial 

Director Dr. Hans-Joachim Conrad, 

stresses. Now, all functional aspects – 

from the helicopter landing place on top 

of the building, to the Departments of 

Radiology and Cardiology in the middle, 

to the shock room in the basement – are 

located in one building. “We were able to 

tighten our processes and increase efficiency 

– among other things – through 

the bundling of the latest imaging systems 

in one building,” says Conrad. The 

center is equipped with state-of-the-art 

equipment from Siemens: three MRI systems, 

eight angiography systems, three 

CT scanners, and one urology system 

support expertise in Frankfurt, providing 

patients with innovative care. 


news-frankfurt 


Service 

Feedback 

Dear Reader, 

The Editorial Team of Medical Solutions 

was honored with distinguished awards 

from respected corporate publishing and 

communications organizations. 

At the Best of Corporate Publishing 

Congress in Munich, Germany, Medical 

Solutions received two exceptional 

awards, placing it among the top corporate 

magazines in Europe. It won a Silver 

Award in the area of ‘B2B – Industry, 

Technology, Energy, and Pharmaceuticals,’ 

where Medical Solutions was the 

only healthcare magazine honored. It 

also obtained a second Silver Award in 

the category of ‘International Communication,’ 

a new category that included 

over 180 entries. The jury was comprised 

of more than 100 renowned experts from 

journalism, design, marketing, corporate 

communication, print, and direct marketing. 

With more than 600 entries, 

the contest is the largest of its kind in 

Europe. 

At the 14th Annual Communicator 

Awards, a U.S.-based international awards 

Feedback to the editor should 

be addressed to: 

by mail: Siemens AG, 

Healthcare Sector 

CC CB1 

Doris Pischitz 

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Germany 

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Please include postal address, email address, 

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program that honors creative excellence 

for communications professionals, 

the magazine received an Award of 

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Magazines.’ Entries were scored on a 

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We are very proud of these achievements 

and thank our interview partners and 

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and support. We hope you appreciate 

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forward to hearing from you soon! 

Sincerely, 

Doris Pischitz, Chief Editor 

Trade Fairs & Congresses 

Title Location Short Description Date Contact 

MR 2009 Garmisch-, 13th International MRI Jan. 20 – 24, 2009 www.mr2009.org 

Partenkirchen, Symposium 

Germany 

Arab Health Dubai, United International Healthcare Jan. 26 – 29, 2009 www.arabhealthonline.com 

2009 Arab Emirates Exhibition and Congress 

Molecular Philadelphia, Integration of Imaging and Feb. 10 – 12, 2009 www.molecular-summit.com 

Summit PA, USA Diagnostics 

ECR 2009 Vienna, Austria Annual Meeting of the European Mar. 6 – 10, 2009 www.ecr.org 

Society of Radiology 

EAU Annual Stockholm, Sweden 24th Scientific Congress of the Mar. 17 – 21, 2009 www.eaustockholm2009.org 

Congress 

European Society of Urology 

ACC 2009 Orlando, FL, USA Annual Scientific Session of the Mar. 29 – 31, 2009 www.acc.org 

American College of Cardiology 

HIMSS 2009 Chicago, IL, USA Annual Conference and Exhibition Apr. 4 – 8, 2009 www.himssconference.org 

of the Healthcare Information 

and Management Systems Society 

75th JT DGK Mannheim, Germany Annual Conference of the Apr. 16 – 18, 2009 www.ft2008.dgk.org 

German Society for Cardiology 

conhIT Berlin, Germany Information Technology Apr. 21 – 23, 2009 www.conhit.de 

in Healthcare 


Imprint 

© 2008 by Siemens AG, Berlin and Munich, 

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MAGNETOM Flash 

Everything from the world 

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presents case reports, 

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SOMATOM Sessions 


of computed tomography. 

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applications, and visions, 

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researchers, and medical 

technical personnel. 

Perspectives 


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