July 26, 2016 Solid Imaging

Volume 11 | Issue 2

Seeing is believing in both cold war antics and cardiac imaging. Armando Diana sees right through the issues in this article charting the course of cardiac nuclear imaging techniques.

Having upright, solid state multi-headed cameras is the difference Digirad Corporation brings to physicians’ offices, hospitals and imaging centers for cardiac SPECT and general imaging applications.
Digirad is a leading developer and manufacturer of solid-state gamma cameras for nuclear cardiology and general nuclear medicine applications. Solid-state technology is much more reliable than conventional vacuum tube-based technology used in nuclear medicine cameras. The detectors are significantly more rugged and environmentally tolerant than their vacuum-tubebased camera counterparts and have uniform performance over the entire useable field of view.

In 2000, it was the first manufacturer to develop solid-state nuclear imaging systems that Mark Casner, president and chief executive officer, says was the start of an innovative time for the company that continues through today.

The company got its start in 1985 serving the military market (using its nuclear imaging technology to look inside a missile and determine how many warheads it was carrying) and then was forced to adapt to new markets once the Cold War ended. Casner said the company meandered through the mid 1990s with wonderful nuclear technology but had not defined a product that had broad market potential.

Then the Eureka moment came when the solid-state camera technology was applied to cardiology in the new millennium. Nuclear technology looks at the function of the organ and not the anatomy. For example, it looks at blood flow in the heart but does not focus on the structure of the heart.

Since the lightweight cameras stand upright they can fit in a room as small as 7 x 8 feet and be installed on nearly any floor, typically without any site modifications, thereby maximizing space within a practice and reducing costs. The solid state cameras are also portable, which gives physicians flexibility in meeting their patients’ needs – in fact, Digirad’s general nuclear camera, the 2020tc Imager®, can go right to the patient’s bedside and the Cardius dedicated cardiac SPECT mobile cameras can serve multiple sites or practices.

In electronics, solid state circuits are those that do not contain vacuum tubes. Solid-state means that electrons flow through solid semiconductor materials and not through a vacuum. Solid-state components last much longer than their vacuum tube counterparts because of their greater resistance to shock, vibration and mechanical wear.

The publicly traded company had sales close to $71 million in 2006 and Casner says the company is tracking close to $76 million in 2007. It is divided into two different divisions, manufacturing and services. The services portion, which delivers mobile nuclear, ultrasound and vascular clinical services to doctors offices and hospitals, is another of its innovations and represents about 75 percent of the company’s total revenue.

MORE THAN JUST PRODUCTS
In addition to its innovations Digirad, headquartered in Poway, Calif., has also brought back an old tradition with a twist – the house call. Today, Digirad is one of the largest national providers of in-office nuclear cardiology, ultrasound and vascular imaging services to physician practices, hospitals and imaging centers through its Digirad Imaging Solutions® (DIS) division. DIS provides support and imaging service to more than 1,000 practices and performs more than 100,000 clinical procedures per year from 38 service locations throughout the United States.

Delivering office calls since 2001, the DIS clients benefit from the use of Digirad’s exclusive solid-state portable CardiusTM SPECT dedicated nuclear cardiology imagers and state-of-the art ultrasound and vascular imaging products. The products are optimized for office-based use and employ the most advanced imaging technology combined with professional staffing.

Digirad has distinguished its services through stringent quality standards to ensure they deliver high consistency, reliability and safety in the services provided to their clients.

Digirad Imaging Solutions has differentiated itself from other service providers by establishing recognized quality programs and seeking formal quality certifications for its service centers. Casner said clinicians must undergo 200 hours of training to earn their certification. In addition, Casner said physicians cannot be reimbursed for the imaging tests by many third party payors unless they gain the certification which ensures compliance and serves as a safeguard to patients.

Digirad Imaging Solutions has received accreditation for many of its service hubs from the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL), an independent certification organization for nuclear laboratories in the United States that is recognized by the majority of third party providers.

DIS offers three separate services for physicians to choose from that best serves their patient and practice needs. The DigiOneTM service is its flagship solution and is a flexible full or part-time office-based service program for nuclear cardiology or ultrasound imaging. The DigiOne service program provides equipment, staffing, quality control, licensing and radiopharmaceuticals to allow patients to be imaged in the comfort and convenience of the physician’s office without the doctor having to make a capital investment in their existing office space. DigiOne offers a means to leverage the doctor’s time and increase the revenue potential without the financial burden or risk of ownership. The service comes in an annual per day lease arrangement.

The DigiTech solution is a staffing and licensing solution provided to practices that purchase the Digirad nuclear cardiology imaging equipment and provides a means and expertise to get started quickly with seamless integration in the physician’s current operations. The practice will have all the benefits of ownership and can focus attention on running the practice, while Digirad provides the operations staff, expertise and licensing to operate the equipment. DigiTech blends equipment ownership and operation of nuclear cardiology services under an annual service agreement.

DigiRent™ is a rental solution for nuclear cardiology or general nuclear medicine imaging systems designed to fulfill short or long term needs at hospitals, imaging centers or private practices that require additional capacity to meet overflow needs. Digirad offers short-term leases that are available exclusively for hospitals. Here, DigiRent is often used to provide services during renovations or instances of unplanned equipment failures resulting from natural disasters, such as flooding, electrical damage, or fires. DigiTech staffing services may be provided in conjunction with DigiRent services, based on resource availability.

GOING MOBILE
Digirad continued its innovation earlier in 2007 when it created a centers of influence business strategy, which takes the DigiOne program to a new level. Under this model, Digirad partners with a preeminent medical center to introduce its mobile services to primary care physicians within that core market. The primary care physicians benefit because they can provide better, more convenient services to their patients under the auspices and support of the faculty from the Center of Influence. The faculty benefit from the patient referrals from the community and the corresponding professional fees; and the Center benefits from the interventional work that is directed to their hospital within the scope of this outreach program.

Casner said that the centers of influence model provides better patient-care, because it combines the family physician’s patient-specific knowledge with the diagnostic expertise of specialists at leading medical institutions.

The company recently announced the signing of a letter of agreement with The Methodist Hospital (Methodist) in Houston. Under terms of the agreement, the fifth since the inception of Digirad’s centers of influence business strategy, Digirad and Methodist will provide imaging and reading services, respectively, to primary-care physicians in the Houston area who are seeking to expand their practices with in-office imaging.

In May 2007, Digirad announced it completed the acquisition of privately held Ultrascan, Inc., a leading provider of mobile ultrasound and nuclear medicine services primarily in Georgia. Ultrascan provides mobile ultrasound services to more than 100 clients through a 32-unit mobile fleet as well as fixed-site nuclear imaging services at physician offices, clinics and hospitals primarily in Georgia.

Casner said the acquisition “diversifies Digirad’s services and expands our client base and was a first step in our strategy to create long-term growth by leveraging and complementing our nuclear cardiology service capabilities with other mobile imaging services.”

He said the acquisition also adds value to Digirad’s well-established operating platform and creates growth opportunities in both ultrasound and nuclear imaging. Digirad has a mobile fleet of more than 120 nuclear and ultrasound imaging systems that are being used in 22 states, primarily in the eastern, mid-western and southwestern United States.

Digirad’s mobile imaging operations bring state-of-the-art equipment and qualified, trained personnel into physicians’ offices to perform the imaging. The patients’ images are interpreted by the physicians and the results sent electronically to the referring physician.

THE PRODUCTS
Digirad’s products include the CardiusTM XPO series of single, dual, or triple-head cameras with an upright imaging chair designed for nuclear cardiology applications. The three-headed camera design is unique in the industry and all camera products use patented solid-state technology and unique multi-head design for superior performance. The cameras offer advanced features for sharper digital images, faster processing, are compact in size, and are lighter weight for portability. The upright products can handle patients up to 500 pounds, and boast improved patient comfort compared to standard nuclear cameras.

The company also offers the 2020tc Imager that provides general purpose nuclear imaging and cardiology imaging. The 2020tc Imager is a mobile, single-head gamma camera for general purpose imaging procedures. The 2020tc has a small footprint and may also be configured for fixed or mobile use to supplement primary imaging.

Digirad also provides a line of workstations equipped with multiple software options for nuclear image interpretation; sells connectivity between imagers from the same or various manufacturers to physicians who wish to integrate studies from multiple imagers into a single workstation or archive; and provides a line of accessories, including hot lab equipment for using radiopharmaceuticals and various other supplies. Digirad’s installed base of equipment exceeds 450 systems.

From starting in an era in which the nation was told to “trust but verify” and serving the military needs to confirm contents of warheads, to leading the market in innovated cardio imaging techniques, Digirad has continued to stay in front of the market. As Casner said, “We almost own the market.”

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