Imaging support specialists must develop top-notch people skills, compete with or join the OEMs, and deal with the blending of service engineering and information technology.
Robert Barr, a student at Texas State Technical College, Waco, works on a CT scanner.
Engineers and technicians who maintain and repair imaging equipment don’t work in isolation. Experts say people skills are just as important to job success as the ability to do the technical work on the radiological devices.
“We have informatics meetings every other week,” says Pam Jorgensen, CBET, CRT, imaging supervisor for Harborview Medical Center in Seattle. “It has to be a team approach—the doctors, us, the PACS people, the IT guys, the wire-pulling guy for a bad port or a bad cable. The days of one person taking care of radiology are long gone. We all have the same client, and that’s the patient in the end.”
At Texas State Technical College in Waco, medical imaging instructor Tommy Rutherford says he tells his students repeatedly that they must get along as they go along.
“We teach communication skills,” he says. “You’ve got to have the personal skills—with the radiologists and especially with the nurses.”
Rutherford says a service engineer doing his or her job well can also act as the best salesperson there is from an equipment manufacturer’s perspective.
“A service engineer is just a salesman,” Rutherford says. “If a machine does its job and works well, that hospital is going to buy another one. The equipment is so similar now—you go right down the line and the images are beautiful. What they are after now is uptime on the equipment. If it’s always broken, they’re not going to buy another one. An SE [service engineer] sells equipment—that is one thing we really stress to the students.”
While Rutherford may be right that there is a sales-satisfaction component to the servicing of radiology equipment, that doesn’t stop original equipment manufacturers (OEMs) from bidding for service contracts allowing them to maintain and repair competing manufacturers’ machines. Broad-based service contracts where one OEM takes care of a whole hospital or a group of hospitals, no matter whose equipment the hospitals use, have become a big part of the radiology equipment servicing industry.
“We have a large number of contracts that provide servicing for everything in the hospital that is an imaging asset,” says Michael Swinford, general manager for multivendor and clinical services for GE Healthcare Technologies, based in Jupiter, Fla. “Different hospitals are in different situations—some outsource, some have in-house engineers, and oftentimes we work with and support in-house staff for GE and non-GE equipment.”
At its clinical services center in Jupiter and at its multivendor diagnostic imaging center in Arlington, Tex, GE trains its engineers on non-GE equipment. “We not only train them, we develop different service technologies, different service tools, and different parts repair capabilities,” Swinford says. It isn’t just maintenance that GE Healthcare offers. “It’s also asset optimization, like techniques for improving throughput and asset utilization,” Swinford says.
While GE Healthcare normally has at least one on-site technician to take first call at each of its client hospitals, it backs up these technicians with on-call specialists who can handle any repair or malfunction. “We have a balance of generalists and specialists,” Swinford says. “For contracts that are 3 to 10 years in duration, we train [on-site] specialists. … We make an investment in training for that customer, even to the point of hiring technicians with specific skill sets so we ensure secondary and maybe even tertiary technical backup.” The company, Swinford says, trains more than 500 service engineers yearly on non-GE devices alone and provides ample continuing education. “We did 327,000 hours of training in 2003, and overall have invested over $100 million in training service engineers.”
It isn’t just on-site help that GE Healthcare provides, Swinford says. Because uptime on an imaging modality, particularly a high-end modality like a CT scanner or an MRI machine, is critical to both patient throughput and hospital income, GE is increasing its emphasis on its remote diagnostic capabilities. Equipment and technicians can monitor the software on a modality like a CT scanner or MRI machine and sometimes engineer an electronic fix without being on-site. “Many times, the problem is corrupt files,” Swinford says. “For CT and MRI, we find that 30% to 50% of all problems can be fixed remotely, and even with a service engineer in the hospital it saves time.”
Another advantage of its sheer size in servicing all kinds of equipment, says Swinford, is that GE Healthcare has developed “robust databases” for each type and make of equipment it sees.
“We can look at the service history of a device,” Swinford says, “and because of that, we can see opportunities to maximize the operation of that device.”
From the vantage point of running GE Healthcare’s multivendor enterprise, Swinford sees the big picture; but down in the trenches, the perspective changes. Harborview Medical Center’s Jorgensen certainly knows about that. She supervises a three-person team that oversees service engineering on the hospital’s imaging equipment. Jorgensen is one of the three on her team. She is hoping to add a fourth person soon.
Harborview is the sole level-one trauma center in the Pacific Northwest, Jorgensen says. The hospital is licensed for 345 beds, almost all of them for intensive care. Although it is affiliated with the University of Washington, it is a county hospital located off campus, she adds.
Harborview’s busy time is from 4 pm to 4 am, when most trauma patients arrive, Jorgensen says. For her, that means that mornings are the perfect time to schedule preventive maintenance (PM) checks, when patient demand is lowest.
With the computed radiography (CR)—or digitized x-ray—equipment, PM checks are stepped up. Even though the OEM specs call for yearly PM, at Harborview they are done quarterly. “We do them four times a year because of the wear and tear we get here. That really helps,” Jorgensen says. “With the portable x-ray, we do them every 6 months.”
To ease the usage disruption in radiographic rooms, Jorgensen breaks down PMs between checking and maintaining image quality on the one hand and checking and maintaining the machine’s mechanics on the other. “This breaks up the downtime,” she says. “We schedule the room weeks ahead of time, just as if we were a patient. But if it’s busy, we get bumped.”
The hospital has OEM service contracts for its MRI and its three CTs as well as for its angiography equipment, Jorgensen says. Even so, her team gets the pager buzz on these modalities and then is responsible for contacting the OEM.
“With our service contracts, the OEM has to have somebody available in the Seattle area; that’s written up,” Jorgensen says. “They’ve had to bring people up from Oregon a few times, but we’ve never had to go to a third-party [non-OEM] provider.”
Harborview is so careful not to jeopardize the use of its CTs that it serves as a de facto warehouse for CT tubes.
“If the OEM has another client go out, they pick up a tube from us here. That’s how critical it is for us to have the CTs up and in operation,” Jorgensen says.
Harborview encourages its radiological service engineers to attend seminars and trade shows, take classes, and pursue dual certifications. “We don’t get paid more—it’s kind of self-pride,” Jorgensen says.
One thing Jorgensen and her team don’t do is work on mammography x-ray equipment. “We have one mammography room, but we carry a service contract on that,” she says “They have tighter regulations for breast biopsies. There are more regulations on mammography than for CT or [angiocardiograms].”
Like others, Jorgensen says that the lines between radiology service engineering, information technology (IT), and picture archiving and communication system (PACS) teams are getting increasingly blurred.
“It is getting more difficult to say how to separate IT from radiology,” she says. “We install and manage our own virus software and maintain the firewalls. We have to make sure we can manage our own computer workstations, so I only call IT if the jack is dead or I need an [electronic] address for a new piece of equipment.”
Likewise, Swinford says the networking of imaging devices through a PACS, a radiology information system (RIS), or a hospital information system (HIS) has changed how service engineers work.
“There is a huge merging going on between IT and clinical devices,” Swinford says. “When you’ve got devices sharing images over a network, for example, everything is communicating together, and the ability to isolate and diagnose issues is more and more complex.”
Things like configuring DICOM coding headers between the imaging equipment and the PACS workstations, where the radiologists sit, are left to the PACS team, Jorgensen says. But she says her team does have to know whether it’s a PACS problem or a modality problem that’s causing an image to go bad.
“Usually, it’s easy to see,” she says. “If I can’t transfer my images or the patient is not on my work list, that’s almost always on the PACS side.”
When the PACS first went in, Jorgensen says her team would get blamed if the PACS team took too long to respond to a problem. “The PACS people could be 2 or 3 hours before they’d call back. The radiologists demanded that [the PACS team] go on the same pager system that we have,” she says. “Now the radiologists can call the PACS people directly. Everybody’s got to play really nice in the big sandbox.”
Swinford at GE Healthcare can see the big picture involving hundreds of service engineers. Jorgensen at Harborview sees things hands-on under difficult conditions of continuing trauma. But Rutherford at Texas State Technical College encounters his budding radiology technicians when most have yet to see either trauma or complexity.
The college runs a 2-year program that produces both BMETs and certified medical imaging technicians, or CMITs. Rutherford teaches the rudiments of imaging technology and repair to the 60 to 80 students who choose the radiology equipment repair route.
The college has several C-arm x-rays, two of them digital; about five ultrasound units; a fluoroscopy unit; and six portable x-rays, Rutherford says. It also has a 20-year-old CT scanner and an aged and donated MRI machine that it spent $45,000 to ship across the state and install on campus. Rutherford says the MRI’s electronics and diagnostics are operable, but the machine itself isn’t functional because of the danger of the magnet. If the magnet was going, metal objects could be sucked violently into it, and the liability insurance for such a mishap is too expensive, Rutherford says.
Rutherford says the equipment allows him to teach the basics of all the modalities. The students learn the theory behind each imaging method and can study the actual physical workings of the machine. They learn to handle the machines physically and to do the PMs laid out in OEM manuals. “It’s mostly taking the equipment apart. Cleanliness is the big thing,” Rutherford says. “Equipment is so expensive, and just a dirty filter can bring a system down.”
Rutherford says 95% of his graduates quickly find jobs, either as trainees for OEMs or for third-party independent service providers. “Once they get some experience, the job market is competitive for service engineers. A Cadillac x-ray is worthless if nobody can fix it,” he says.
Rutherford’s imaging repair career began in the military; later, he worked for major hospitals and for a big OEM. “Most imaging equipment is pretty reliable,” he says. “The problems are the intermittent problems—if a component gets hot and stops and then starts working again.”
Rutherford remembers other stresses too. “Cardiac catheterization labs are real stressful,” he says. “You’ve got a person on the table with a catheter in the heart and the machine breaks down—the person could die. I’ve been in situations where I had to help hold wires together so the doctors could finish a procedure.” Rutherford knows his students won’t see those types of emergencies for a while.
Whether those students go on to work as in-house service engineers, like those at Harborview, or as OEM engineers, like those provided by GE Healthcare, they are vital to the patient-treatment process—and to the economic health of the hospitals they serve. Hospitals need their expensive modalities serviced and repaired quickly. And while the radiology service engineer’s job is becoming increasingly complex, it’s also becoming more exciting. Just ask Jorgensen. “There are private hospitals where we could make more money,” she says, “but since we’re a trauma center and continually get new technology, and since we can continually go to new classes, that has kept us here. The technical challenges and being state of the art—it’s a good feeling.” 24×7
George Wiley is a contributing writer for 24×7.