By Matt Skoufalos
In working to deliver technology that facilitates the optimal patient experience, medical imaging equipment manufacturers continuously contemplate how those improvements are driven from the perspectives of the technologists and physicians who care for those patients. Health care systems that have pushed deeper into delivering a high-quality patient experience may also see that investment making a positive impact on their productivity and bottom-line metrics.
Abby Weldon, senior director of women’s health at Siemens Healthineers North America, spoke about the significance of improving the patient experience in women’s health by connecting patients with a broader array of health care services. The imaging procedure with which many women routinely interact is mammography, which can become an entry point into other services offered by a given health care system if the experience is positive.
“The main difference is, in the United States, women can choose where they’re going,” she said. “Choosing where you’re going is important because it’s estimated that women make 80 percent of the health care decisions in the U.S., including for their family and friends.”
As medical imaging facilities are rated on the quality of the patient experience they provide – with reimbursement sometimes being tied to that experience – a mammogram can open up a downward revenue stream, not only for follow-up care, but also for family health care in general.
“A lot of facilities market their services based on the technology they offer,” Weldon said. “That’s how we can compete: better technology, greater patient comfort and boutique services. Plus, the federal breast density inform law takes effect in September, and that’s something facilities can use as a patient communication tool. It’s hard to get women to come for callbacks; it might add to their experience if they know they have dense breasts and could use some diagnostic follow-up right away.”
Moreover, because a mammogram is an annual screening, performing the procedure competently and delivering a high-quality patient experience can ensure follow-up visits. On the flip side, a poor experience squashes the potential for repeat business. As Weldon points out, some industry estimates put the number of women who don’t return for a subsequent mammogram at nearly 50 percent.
“Why don’t they return? A lot of it is a fear of a positive result,” she said. “We’ve definitely taken a lot into account when designing the mammography systems.”
Despite mammography technology being reserved explicitly for women, Weldon points out that, historically, breast imaging systems have not been designed by women, nor necessarily even with significant input from the technologists who operate the devices. If the professionals who spend the most time with the mammography system enjoy a better experience, they’ll be better positioned to make the patient experience pleasant as well.
“Most women have a lot of anxiety and a lot of fear when it comes to the breast compression itself,” Weldon said. “We really do design this to be a more personalized experience to help encourage women to have a more pleasant experience than they were expecting.”
“If you can get it right the first time, you’re going to have to deal with fewer callbacks, retakes and having to get the patient back in,” she said. “That’s very much a part of the patient experience that does contribute to productivity gains.”
Siemens Healthineers MAMMOMAT B.brilliant is built to support patient comfort as well as technologists’ ease of access. It features paddles designed to allow for easier access in patient positioning, and with curvatures that mirror the physiology of the breast to mitigate discomfort. Likewise, the face shield on the device allows the patient to lean into the unit, both stabilizing the patient and gaining access to more posterior breast tissue during the study. Its intelligent personalized compression system is designed to optimize breast compression on an individual basis for each patient, with the aim of delivering a consistent image over time, and without compressing the tissue more than is necessary to capture a high-quality image. MAMMOMAT B.brilliant even includes adjustable mood lighting that’s intended to help reduce anxiety and soothe a patient’s nerves.
For technologists, the system display puts patient information and workflow steps at eye level, where they can be easily observed. Its ComfortMove function allows the tube unit to move independently from the image detector, which supports both improved patient positioning and greater mobility for technologists around them.
Beyond the updated mammography technology itself, Weldon said Siemens Healthineers is working to enable a more personalized screening experience for women by facilitating better follow-up and more comprehensive evaluation at the time of the study itself. All women over 40 are urged to get annual mammograms, but they should also have access to other, supplemental tools, like ultrasound, contrast mammography or breast MRI at the time of their screening or beforehand.
“What we’re looking at is how can we utilize risk management tools, or incorporate AI into screening before the patient leaves,” Weldon said. “In general, coming up with a more individualized, personalized screening benefits the patient.”
Katie Grant, vice-president of the magnetic resonance business at Siemens Healthineers North America, discussed how its new MRI technologies focus on the patient experience by making exams more comfortable, efficient and “even enjoyable.”
The manufacturer is addressing patient comfort in a variety of sensory contexts. Mood lighting and themed skins for the MR scanner can help change the scanning environment visually, while “in-bore infotainment” offers music, news or other distraction. A variety of contoured coils similar to weighted blankets helps maintain patients in position more comfortably. Patients can even download mobile applications with educational resources about the procedures they’re about to undergo, explanations of the scan experience, audio samples of scanner sounds and virtual walk-throughs of the imaging environment.
“We’ve focused on enhancing the patient experience with lighting and entertainment,” Grant said. “Now patients can watch a video or listen to music during their MRI exams. We’ve also worked to make the machines quieter, since the noise can be unpleasant, and improve the coil design for ideal comfort.”
Beyond sensory improvements, Siemens Healthineers is also working to reduce the total cost of ownership of their MRI systems through technological advancements. These include the MAGNETOM Flow, a work-in-progress 1.5T MRI scanner that only utilizes 0.7 liters of helium, thereby reducing consumable materials costs.
Another functional improvement is the 80-cm open bore on the MAGNETOM Free.Max MRI scanner. This feature helps claustrophobic patients feel more comfortable and accommodates obese patients who were previously unable to undergo MRI studies because of their size.
However, probably the most significant improvements in both patient experience and financial bottom-line comes from the use of artificial intelligence (AI), which has the potential to significantly reduce exam times. Deep learning processes could enable practitioners to cut exam times in half, Grant said.
“Doctors often estimate exam times to be 45 minutes to an hour. We’ve reduced these times to 15 to 30 minutes,” Grant said. “Quicker exams enhance the patient experience by minimizing the time spent in the scanner and the anxiety of waiting for results.”
Grant estimates that reducing exam times could increase revenues by 20 to 50 percent through increased throughput and greater staff efficiency with the technology. Patient experience metrics can improve even further when that improved throughput results in shorter wait times and table times.
“Given the significant capital expense of MRI systems, we are very focused on finding ways to reduce these costs,” she said.
Erdogan Cesmeli, Ph.D., chief strategy, marketing and commercial officer for molecular imaging and computed tomography at GE HealthCare, described how a patient-centric approach to product development from vendors also supports health care providers’ financial positions. By considering the imaging study in three phases – pre-scan, study and follow-up – GE HealthCare is taking a holistic approach to the management of diagnostic imaging work from the perspectives of referring physicians, technologists and specialists in radiology and oncology. The idea, Cesmeli said, is for imaging analysis to be performed more intuitively, more affordably and with faster results.
Advanced functionality networks enable AI-powered patient positioning algorithms that identify anatomical landmarks to best determine patient orientation for a given study. These generate body contours, show where to center the patient within the scanner and generate reproducible results if subsequent studies are required.
“Some scanners, staff have to kind of guess where the anatomy is, and do some landmark detection and scout scan range scanning to position the area of interest,” Cesmeli said. “With automatic patient positioning based on the angles, the operator can see and position the patient better than otherwise.”
Eliminating bottlenecks at the bedside is one benefit of the AI-powered technology strategy; another is helping create more intuitive, automated workflows; GE HealthCare describes this technology as “Effortless Workflow.” In environments that may have been affected by staffing issues like turnover or retention, a lack of vocational experience, or availability, automated workflows can help drive better patient outcomes overall, not least of all by cutting appointment times down.
“From the patient point of view, it’s a better experience because staff does not have to do a lot of work,” Cesmeli said. “They have more time to focus on the patient, to get them physically and psychologically ready for the exam itself, and then be able to send the results off.”
“This is good not only for the staffing, of course, but good for the administration, the quality is more standardized, and in the end, the referring physician is happy with the results, and the patient is happy with the results coming faster,” he said. “We feel we are contributing to the topline of the hospital, and not needing to do extended hours of work, which helps the bottom line.”
Other technological advancements enable imaging studies that may not have been possible just a few years earlier. Increasing bore and gantry sizes helps accommodate a greater variety of patient body types for cardiac study, but improvements to those processes can further increase patient comfort. In the past, patients would be asked to hold their breath in order to generate the highest-quality possible images during cardiac CT. To facilitate this, some patients were administered beta blockers to help regulate their heart rates. Solutions that are currently in development at GE HealthCare would provide ultra-wide imaging coverage around the whole of the heart, thereby enabling alternatives for beta blockers, as well as the use of electrocardiograms during studies.
“We were talking about five-beat cardiac; now we are talking about one-beat cardiac, without any ECG gating, or dose, or auxiliary pharmaceuticals,” Cesmeli said. “Now they only hold their breath for a second or two versus 10 seconds.”
Other imaging innovations on the horizon based on photon-counting may enable reduced patient radiation doses, while helping expand the potential functionality of imaging modalities to pediatric or sensitive tissue areas where CT may not otherwise be necessarily practicable.
“Photon-counting systems have the potential to do a better job and better delineation of the region of interest,” Cesmeli said. “We aim to extract more and more insights in terms of the tissue characterization, which I think is going to be revolutionary, like virtual MR exams done on CT. We’ve also made great progress evolving existing systems and workflows, so that from the time of the acquisition, images are automatically reconstructed. The radiologist still needs to read and confirm so that there is no mistake, but it has the potential to cut hours of work down to minutes so they can think more about the nature of the patient combined with the current scan results.”
“By automating A to Z, we are enabling doctors to make conclusions more confidently than they have before,” he said. “There’s still the human element and education that needs to take place, and referring physicians learning about those capabilities. That comes to partnership with the societies of physicians really making sure that this is known and that there’s no ineffective referrals.”
Ultimately, Cesmeli said, innovations come from market research and its medical advisory board as well as its own internal evaluations and re-evaluations of workflow processes based on conversations with health care professionals at every stage of the study.
“Now we are going much more granular, working through our customers, working with our customers, to really understand their challenges beyond scanners; to understand the referring physicians, and making the designs of the machines to supplement care,” he said.
