Dream Job: Applications Engineer, Digital Medical Solutions

Marty Pesce, Applications Engineer, CarestreamAfter receiving his X-ray certification, Marty Pesce worked in a hospital for 10+ years as a chief technologist and was cross-trained in different modalities. He became an applications consultant in 2000 and transitioned to Carestream in 2007. When an opportunity arose to be an applications engineer, Marty moved his office base from Philadelphia to Rochester, NY, and shifted his focus from U.S. to Worldwide Operations.

Q: What made you decide to become a Radiologic Technologist?

To answer with a short response: my mom. When I was in college, I changed my major a lot. I went from art, to art history and then to physics and was still unsure about my decision. One summer I was home from college and my mom, an ER nurse at the local hospital, got me a job doing CAT scans. My hometown was in rural Pennsylvania so at that time the CAT scan would come in on a truck to the hospital. Pennsylvania was one of five states that had no requirements for licensure. I did this job for 6 months until the law changed which required technologists working for a private company to be registered, though technologists in the hospital still did not need to be.  So, I went to get my X-ray Certification at Bradford Hospital School of Radiologic Technology. I had to go to school to keep my job rather than go to school to get a job.   After my first year, I also worked a Baylor position as a technologist on the weekends at another hospital so I worked 16 hours a day, 7 days a week.

Q: What is your favorite part about your job?

A: Getting to travel all over the world to work with customers. I have been to 17 countries across Europe, Asia, and Central America. I haven’t gotten to see South America or Africa yet. My favorite trip has to be to Salt Lake City, Utah for the 2002 Winter Olympic Games. I arrived two weeks before the games to train the staff in the Olympic Village and had the opportunity to see the opening ceremonies, and different events.  As a former college athlete, it was a thrill to be so close to the games, the participants, and dignitaries that came through the facility.  It was a once in a lifetime experience.

Applications Engineer Marty Pesce using the Carestream DRX-Evolution.

Applications Engineer Marty Pesce using the Carestream DRX-Evolution.

Q: Outside of work, how have you been involved in the profession?

A: I’ve been involved in State & National X-ray societies. I served two terms on the Board of Directors for the Pennsylvania Society of Radiologic Technologists (PSRT). I recently attended the American Society of Radiologic Technologists (ASRT) House of Delegates meeting in Florida as the PA Delegate. On behalf of the ASRT, I lobbied for the CARE (Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy) Bill which sought to protect patients by way of better education. In April I did a presentation to the Pennsylvania State Society about the history of radiology and how the things we did 100 years ago still influence what we do today. I dedicated the presentation to John (“Jack”) Cullinan.  Jack was a former PSRT president, an author, and my predecessor.  He was known as “Mr. X-ray” and made a big impact on the field of radiology as well as me personally. Jack passed away about a year and a half ago but his book still remains on my desk and I refer to it often.

Q: Tell us some stories relating to the history of X-ray imaging

A: When X-ray technology was new, people feared that X-rays could see through their clothing. As a result, there were companies that manufactured and sold lead lined underwear. An Assemblyman in New Jersey went so far as to enter legislation to make X-ray opera glasses illegal. The funny thing is that concerns over privacy haven’t changed. Just last year the TSA pulled out backscatter scanners from airports because they were too intrusive.

Another story, that pre-dates X-ray regulation, is a documented case about a man from Rochester, NY, that made his own X-ray machine.  His wife was experiencing hip problems so he wrote to a prominent doctor in NYC. After 10 hours of trying to take a good X-ray image, he finally got one and sent that image to the doctor along with an inquiry on how to treat his wife’s burns.

Q: What last question…I heard that you like to dance?

A: Well, only when I am demoing products. One year at RSNA, before I did a product demo with our portable X-ray unit, our CEO said, “Marty, make this thing dance!” It took off from there and I made a full routine!

Enterprise Dose Management Is Radiology’s Opportunity to Lead

AHRA2014Radiology administrators looking to raise the visibility and value of their department should seize the opportunity to lead an enterprise dose initiative.

In a session at last week’s AHRA annual meeting titled, “An Executive Guide to Implementing a Successful Enterprise Dose Solution,” Chris Tomlinson, MBA, director of radiology at the Children’s Hospital of Philadelphia, urged administrators to not be myopic. By extending beyond the radiology department to a truly enterprise program that brings together other service lines like cardiology, oral surgery and oncology, dose becomes aggregate across the care continuum.

To successfully lead an enterprise dose program, Tomlinson shared best practices for radiology administrators:

  1. Ensure radiation safety committee is diverse: Include representation from IT, legal, the C-suite, and a medical physicist. Tomlinson noted a C-Suite stakeholder can help inform the larger health system of changing regulations and program status.  The medical physicist, he shared, has an opportunity to demonstrate their expertise and can often be the unsung hero of the committee.
  2. Understand all clinical workflows involved: An enterprise program must optimize all provider workflows. This cannot be done by radiology dictating protocols, procedures and policies to others. All workflows must be understood and documented in detail for an enterprise program to succeed.
  3. Foster more physician to physician communication: In alignment with ACR’s Imaging 3.0 initiative, radiologists can be leaders in a dose program by outreaching to referring physicians to discuss the necessity of tests, the technology available to lower dose and regulatory guidelines.

Dose was clearly a hot topic at AHRA with Tomlinson’s session being one of several.  You can find more dose management guidance, specifically a slide share from Shawn McKenzie of Ascendian Healthcare Consulting’s “Radiation Dose Safety: Defining and Implementing an Enterprise Dose Management Program” presentation on DiagnosticImaging.com.

Erica CarnevaleErica Carnevale is the social and content marketing manager for Carestream. She attended AHRA 2014 in Washington, D.C. from August 10-13 and reported back from the Carestream booth.


FDA Regulations Benefit the Medical Profession and Improve Patient Care

The U.S. Food and Drug Administration (FDA) branch named the “Center for Devices and Radiologic Health” regulates manufacturers, distributors and importers of medical devices.  Carestream Health follows FDA regulations and guidance relating to the design, manufacture, distribution, servicing and maintenance of its products. In addition, many of Carestream’s products are subject to FDA review for safety and effectiveness prior to receiving permission to market those products in the United States.

FDA  “Center for Devices and Radiologic Health”

The FDA’s “Center for Devices and Radiologic Health” branch regulates manufacturers, distributors and importers of medical devices.

Premarket submissions to the FDA include:

  • Various administrative documents.
  • Evidence that the product performs in a safe and effective manner.
  • In most cases, clinical evidence of the product’s performance must be gathered, analyzed and submitted to demonstrate safety and effectiveness of the device to the FDA reviewer.
  • Evidence that the product was designed and validated for proper performance against its specifications.
  • User documentation to ensure that users of the product are provided with adequate instructions for operating the device.
  • Depending on the level of regulatory control for a particular product, inspection of the manufacturing operation by the FDA may also be required prior to gaining approval to market a device.

Compliance with FDA regulation and guidance is a benefit to our customers and ultimately to the patients whose medical care is aided by the use of our products. Carestream has established and maintains a quality system for the medical devices it manufactures. This quality system consists of procedures and guidelines that are in accordance with the requirements put in place by the FDA. Some requirements apply generally to all devices and some are specific to the types of devices we produce (i.e. radiation emitting devices). The purpose of these requirements is to ensure that every stage of product design, manufacture, distribution, installation and servicing is structured and completed in compliance with processes proven to result in high-quality, safe and effective products.

FDA requirements are not limited to the design, production and sale of the medical device to the customer. As a manufacturer of medical devices, Carestream also maintains established procedures for installing and servicing its products at customer sites. These procedures must be documented, validated and controlled to ensure that the products are properly serviced and maintained.

Procedures are in place to ensure that any complaints or issues reported to us about our products are properly addressed and corrected in a timely manner. Any issues that could impact safety or effectiveness of the device are documented and considered in the ongoing analysis and mitigation of any risks associated with the device.

Carestream is dedicated to ensuring customer satisfaction and improving patient care.  Embracing FDA regulations is one way we continue to provide the medical profession with innovative, well-designed, high-quality products that benefit healthcare providers and the patients they serve.

Do Carestream medical imaging systems aid in the delivery of care at your facility? Are you satisfied with Carestream’s level of service and support? 

Carolyn L. Wagner Regulatory Affairs Manager, X-ray Solutions, CarestreamCarolyn L. Wagner is the Regulatory Affairs Manager for the X-ray Solutions business at Carestream.

Uncompromised Quality: Bone Suppression and Chest X-Ray Images

No one would claim that any part of a radiologist’s job is easy, but there are some aspects of their work that pose greater challenges than others. The interpretation of chest X-rays, the most common way to screen and diagnose lung diseases, is one of those tasks that can often frustrate a radiologist.

The average radiologist has probably viewed thousands of chest X-rays over the course of a career, and is well acquainted with the challenges they pose.  A traditional 2-D image of the chest will include all of the different bones surrounding the patient’s chest cavity, often obscuring the lungs. There are ways to see around the bones, but these systems often require the use of large imagining equipment that make it difficult to get an image of an immobile patient.

Carestream Bone Suppression Software

The bone suppression software can potentially improve the detection of both lung nodules and pneumothorax.

The recent FDA-approved Carestream Bone Suppression Software, now gives radiologists a better solution for chest X-rays—a clear image of the lungs without the expense of difficulties of a full 3-D image. Employing machine learning and pattern recognition technologies, the software accurately detects a patient’s ribs and clavicle structure and suppress these structures on the X-ray image, giving the radiologist an unobstructed view of the lung tissue. By focusing on the ribs and clavicle—the two most distracting bone structures—the software provides a high-quality, clear image that stays as close as possible to the quality of the original image. Five board certified radiologists put the bone suppression software to the test.  They were asked to interpret a series of chest x-rays with and without the bone suppression software, and to rate any change they may have noticed. In studies measuring both lung nodule detection and pneumothorax detection the radiologists recorded a statistically significant increase in detection sensitivity, with no significant increase in false positives when using Carestream’s bone suppression software.

On average, the radiologists who participated in the study reported being 58% more confident in their ability to accurately diagnose patients when presented with the images generated by Carestream’s software.

In addition to the advantages of image interpretation, the bone suppression software works in tandem with traditional 2-D x-rays.  Therefore, there is no need to subject a patient to any additional radiation.   Further, thanks to the portability of 2-D x-ray systems, such as Carestream’s DRX-Revolution, ICU patients no longer need to be physically brought to imaging equipment in order to get a reliable chest x-ray; a reliable chest x-ray can be taken right in the patient’s room.  Radiologists should not be forced to compromise between image quality and practicality when it comes to the health of their patients. Applications such as the bone suppression software are designed to help alleviate the need for compromise by providing a high-quality, low-dose image in a manner that is efficient and practical for both radiologists and patients.

Additional details about Carestream’s bone suppression software can also be found in the white paper, Bone Suppression for Chest Radiographic Images.

Zhimin Huo, Carestream

Zhimin Huo, Ph.D., is a lead scientist at Carestream. She participated in and co-authored the study, Bone Suppression Technique for Chest RadiographsShe also presented a paper at RSNA on this topic, as well as the paper, Computer-Aided Detection of Malpositioned Endotracheal Tubes in Portable Chest Radiographs for ICU Patients.

Improving Image Access and Transfer with Online Applications

The efficiency and effectiveness of viewing and sharing diagnostic images are vital when you handle the imaging process for 24,000 exams on annual basis, with 18,000 of those also including reporting.

Our facility, Cobalt Health, has had the hardware and software in place to properly handle the massive volume of images we collect throughout a given year, but new needs have arrived where what we had was no longer enough. These needs stemmed from two major issues:

  1. Referrers may not have had access to our PACS: This resulted in a staggered, inefficient process in providing them with access to needed images and reports.
  2. Images were transferred via CD/DVD: This resulted in issues related to information governance (privacy), losing image quality in transfer to CD/DVD, and high costs related to purchasing CDs, postage, etc.
Vue Motion

Cobalt Health received positive feedback from referrers who used Vue Motion to access medical images.

We solved both of these issues through the implementation of Vue Motion and MyVue. With the Vue Motion image viewer, we needed to address the issue of providing referrers with easy and access to images and exam results. The solution needed to be intuitive to view images from anywhere, at any time. We targeted MSKCAT (MusculoSKeletal Clinical Assessment and Treatment) referrers and received feedback that the image viewer was easy to use, provided access to previous imaging exams and reports, was easy to navigate, and was seen as a clear preference over using CDs.

With MyVue, the patient portal, we saw a positive result from patients who used it. From the 31 patients who responded back to us about its use, 85% said that the portal worked well. The use of the portal was able to streamline the image access and sharing processes, and thanks to its security, provided a vast improvement in information governance.

By providing this type of ubiquitous image access via web browsers—be it on desktop PCs, or on mobile devices such as an iPad—we were able to remove our worries about referrers not being able to see the images, while the patient access eliminated the need to use CD or DVDs.

What are your thoughts on improving image access and transfer capabilities? Have you been moving toward online/mobile applications instead of hard copy or CD/DVD? If so, what success and issues have you experienced?


Peter Sharpe, CEO, Cobalt HealthRoisin Dobbin-Stacey, Cobalt HealthPeter Sharpe (left) is the CEO of Cobalt Health, and Roisin Dobbin-Stacey (right) is the PET/CT operation manager and PACS manager at Cobalt Health. Together, they presented on their use of Vue Motion and MyVue at UKRC 2014.


AHRA 2014 Keynote Highlights: Lessons for Your Radiology Department from a Fighter Pilot

Radiology’s “top guns” are being tested and success in the changing healthcare environment is dependent on your commitment to yourself, the mission and your team.  This was the message from AHRA 2014 keynote speaker Lieutenant Colonel Rob “Waldo” Waldman, a decorated fighter pilot and the author of the New York Times and Wall Street Journal bestseller, Never Fly Solo.

Think the experience of radiology administrators and fighter pilots are worlds apart? Not so, says Waldman.  The fear he felt on his 65 combat missions – sometimes dodging missiles – is the same stress radiology directors feel as they are tasked to deliver excellence in patient care while facing obstacles like declining reimbursement, dose regulations, the ICD-10 roll out, patient satisfaction improvements and staffing challenges.

AHRA 2014 Day 1 Keynote Speaker Lieutenant Colonel Rob “Waldo” Waldman.

AHRA 2014 Day 1 Keynote Speaker Lieutenant Colonel Rob “Waldo” Waldman. [Photo credit to, Layne Mitchell: https://twitter.com/Lmitchxray]

The training fighter pilots receive to be mission-ready can be applied by radiology department leadership to adapt to change and push performance to the next level.

Waldman urged AHRA attendees to:

  • Convert fear into focus – Commit. Commit. Commit. Place trust in yourself and your team. Identify your target and never fly solo. You can’t overcome obstacles without your wingman – be confident in their skills and training, establish clear objectives, roles and responsibilities, ensure you have the technology you need to succeed and develop contingency plans to ensure you don’t lose focus.
  • Lift Others – Your department team needs to know they can depend on you. You must think outside your cockpit. Foster trust through communication and connection that makes it clear you will not let them fail and will get them to the target. Always “Check 6” or look behind to ensure your wingmen are still with you.  Look for opportunities to recognize the unsung heroes in your service line – like those who ensure your mission critical equipment is maintained.
  • Recalibrate your attitude – Your wingmen are watching and see if you are pulling back.  Be confident that your mission is achievable.  Be willing to take risks and set a team culture for success.

Waldman’s motto “Push it Up” –  a reminder to overcome your fear and fight the urge to pull back on the throttle in tough times – gave AHRA attendees an inspired rallying cry for their hospital and departmental missions.

Radiology administrators, how do you plan to “Push It Up” in your department?


Erica CarnevaleErica Carnevale is the social and content marketing manager for Carestream. She is currently attending AHRA 2014 and reporting back to us from the Carestream booth, #212, in Washington D.C., August 10-13.


Infographic: Traumatic Brain Injuries (TBI) are a Major Public Health Problem

We have written before about the importance of sports medicine, and how it doesn’t apply only to athletes but to recreational enthusiasts too. One of the areas we highlighted was traumatic brain injuries (TBIs), and they occurring more often, among athletes across the spectrum–from professional to youth.

The infographic below highlights how serious TBIs have become in our society. In addition to show how they affect athletes, young and old, there is also information on symptoms to watch for, as well as what could happen if TBIs are left untreated.

With the Centers for Disease Control and Prevention (CDC) estimating that at least 1.7 million TBI every year, it shows that this is an issue that cannot be pushed aside. You can click the infographic below to view it in a larger format.

Infographic - TBI Are a Major Public Health Concern

Implementing Effective Ways to Reduce and Track Radiation Dose for X-ray Exams

DRX-Revolution Mobile X-ray Unit

El Camino uses two DRX-Revolutions as part of its conversion to DR technology.

El Camino Hospital has made dramatic decreases in patient dose in recent years. We use Bayer Radimetrics dose management software to track dose for all CT exams and we are now starting to collect dose for our room and portable X-ray exams and for fluoroscopy and interventional radiography procedures. We are especially proud of our accomplishments in the area of portable imaging, where we have made a significant reduction in dose.

We have lowered dose by replacing CR with DR technology—and by implementing software that enhances visualization and reduces the need for repeat exams.

We installed three new wireless DR portable systems that are used for imaging of critical care patients in our neonatal ICU, ER and OR as well as bedside exams for our main Mountain View campus. We have two Carestream DRX-Revolution portables and have retrofitted two existing mobile imaging systems with DR detectors to perform ER, OR and bedside exams at our Los Gatos campus.

Since critical care patients require more images than other patients, they benefit most from dose reduction as well as the enhanced image quality we are now able to provide to our physicians. We use grids for 90 percent of adult exams and our new imaging software lines up the grid with the tube head. This makes it much easier for technologists to achieve an excellent quality image and reduces the need for repeat exams. The grid improves details in the chest and abdomen as well as thicker body parts and provides better diagnostic data for physicians.

We now use a cesium iodide DR detector that fits into the incubator tray to image fragile neonatal ICU patients. This enables us to produce excellent quality images at a very low dose. Our imaging software includes pediatric settings that help technologists use the correct technique for each patient.

Both adult and pediatric critical care patients benefit from imaging software that helps enhance visualization of pneumothorax as well as tubes and lines by producing an image that is optimized to display the chest and tubes/lines from the original image. This also eliminates repeat exams and reduces dose.

Patient care is also improved by the higher power generators offered by modern portable X-ray systems. These generators enable us to image heavy or obese patients at a lower dose and provide better quality images at a lower dose for all our patients.

Have you converted all your X-ray imaging systems from CR to DR? As part of this transition, are you retrofitting existing systems, purchasing new DR systems or both?

Howard Sanford, El Camino Hospital


Howard Sanford, R (MR), is the imaging operations manager at El Camino Hospital.

Guess The X-Ray- August’s Image Challenge

Happy August everyone! Time for a new image challenge.

Last month’s flashlight image was pretty easy, and we think that this month’s image will be a little tougher. The image for August is below. Please enter your guesses in the comments below or on our Facebook page. The challenge will run until August 31, or until the first person enters the right answer. Good luck!

As always, Carestream employees and their agencies are prohibited from entering.


August Image Challenge

Patient Care Over There: A Talk About Global Radiology Practices

GlobeTodd Minnigh is a familiar face in the AHRA community. As a frequent conference attendee and speaker, he has presented on a variety of topics because he has seen and experienced a great deal throughout his career. In a new role within Carestream, Minnigh’s responsibilities have allowed him to travel the world to get a closer look at how other countries are practicing medical imaging and addressing important trends such as dose reduction and process efficiency.

He took the time to answer a few questions related to the presentation he will be giving at AHRA 2014, “Patient Care, Over There: What We Can Learn from Radiology Practices Around the Globe.” The presentation will be taking place on Monday, Aug. 11, from 4:00-5:00 p.m. and Wednesday, Aug. 13, from 10:00-11:00 a.m.

When it comes to patient care, is there a difference in defining patient satisfaction among countries? Are they looking at different factors? 

Minnigh: The biggest difference is probably not what satisfies the patient, but how it is measured.  In the U.S., under the ACA, we use the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. It looks at things like responsiveness of the staff and the quietness of the hospital. In many industries, Net Promoter Score (NPS) is considered a best practice. It measures the likelihood that customers will recommend you or refer others to you.  In the end, folks will move their efforts toward improving whatever they measure.

What are the biggest challenges facing productivity and workflow issues today? 

Minnigh: The most common challenge is having sufficient budget for expertise and technology. This is true everywhere, more in some locations than others. The technology and processes exist today to make almost any place more productive. The trick is to know exactly what you need, how to implement it and how to pay for it.

What are some of the differences in technology adoption you have seen from around the world?

Minnigh: There are many. The most interesting for folks from the new world may be that many countries overseas have PACS, but still print all their images to film. In some cases this is for archive, referring physicians and/or because the patient expects a copy.

What are some approaches to radiation dose management that you have seen around the world but are not as prominent in the U.S.?

Minnigh: In Germany, radiation dose is very carefully managed. This is one reason portables are limited in the emergency department. Scatter reaches other patients even though they may be ‘far away’ by our way of thinking. Also every machine has a DAP, or Dose Area Product Meter, right on the collimator to determine the amount of radiation the machine produced. Carefully tracking this is a common practice in Europe and is becoming much more common here now too.

What’s the most important lesson AHRA members can take away from the practices you’ve seen around the world?

Minnigh: The most important lesson is to think outside the box.  There are other ways to do things, other priorities to consider.  We get very focused on what we do and doing it better, we often don’t consider if it could be done in an entirely different way or if it really needs to be done at all.

Todd Minnigh, VP, CarestreamTodd Minnigh is the vice president of worldwide sales  and marketing development at Carestream. His talk at AHRA 2014,  “Patient Care, Over There: What We Can Learn from Radiology Practices Around the Globe.” will be taking place on Monday, Aug. 11, from 4:00-5:00 p.m. and Wednesday, Aug. 13, from 10:00-11:00 a.m.