Dr. Edward Grant, an internationally recognized authority in medical imaging, having authored over 120 peer reviewed articles is one of the most respected imaging professionals in medicine. His recent research has focused on the non-invasive diagnosis of vascular disease using Doppler ultrasound.  He has also been active in the clinical investigation of ultrasound contrast agents and PACS, or computed radiography.  Dr. Grant has authored four books and numerous book chapters.  He reviews for all major Radiology and ultrasound journals and several clinical journals as well.  He is on the editorial board of both major Radiology journals.  He has been an examiner for the Radiology board examination for the past 10 years.  Dr. Grant has lectured on various aspects of ultrasound at numerous national and international venues and continues to be a sought after speaker.  Dr. Grant has been active in improving the quality of ultrasound nationally through the development of accreditation programs and has worked with all national accrediting organizations.

Dr. Grant sat down with Brava Medical and in a candid interview gave his thoughts on the current state of the medical imaging industry.

Brava:  When your facility purchases an imaging system, what are your expectations from the company as far as continued support?

Dr. Grant:  “We demand good service. The service organization really needs to be on top of things.  It’s costing you a lot of money when the scanner is down, so you’re going to need service that is real turnaround and is going to be there quickly. Also, to provide the kind of training you need.  You need follow-up on that and a lot of people don’t do that!  You also need to have vendors that you can trust. In other words, that once the deal has been made, that the company will live up to the promises that were made in terms of support, and helping you out with the newest technology upgrades for your units.  It makes it very difficult for me to not feel burned when I have promises that were not kept. Integrity is paramount.”

Brava:  In your opinion, what are the most significant medical imaging advancements of the last decade?

Dr. Grant:   “MR has probably made the most difference in day-to-day imaging. PET is spectacular technology and I love marrying it up with CT.  PACS is fantastic, but if I had to objectively think about the thing that’s made the most impact in the last twenty years or so, I would say MR.  I would find it really hard to imagine that there will be new technology beyond the existing things that we have in the near future.  Maybe in the future, people will come out with new forms of imaging that we don’t know about right now, but, I think, what you’ll probably see is the refinement of the imaging technologies that we have.  Ultrasound, specifically, has not seen the kind of leaps in the last five years that we saw ten years ago. It’s kind of a fairly stable technology in my opinion.  I think what we need are new novel tracers in PET to really be able to get into other areas in image with PET the way we really should be. It’s the tracers that are going to make that explode if it continues to incrementally increase.”

Brava:  So from a manufacturer’s point of view, it would behoove them to continue to invest in all these imaging modalities?”

Dr.Grant:  “Yes. There’s no choice.  MR is the one they have invested the most in because it has the least explored possibilities of all of them. We spend a lot of time talking to the vendors at the SRU about 3D. The wet blanket there was the inability to display 3D. Vendors tell me how great 3D is, and it is. But unfortunately, as an imager, with high volume coming through to survive, I need to have the interface between the 3D and PACS. Until the ultrasound companies and the PACS companies can get together and make it easy to do those 3D displays, it’s simply too much trouble for me to deal with. The ultrasound companies need to get their information out on the PACS workstation so the radiologist can use it readily. I think MR, on the other hand, is something that there’s still a lot of exploration to be done. The other one is, of course, fusion technology. The PET CT is probably, much to my surprise, state of the art at this point. I think doing PET without CT is falling by the wayside. I guess people have been talking about PET MR, which is not out yet. So I mean, it’s sort of taking the technologies that you have and putting them together. Going to the next step, where somebody is going to come out with some new imaging technique, the way MR and PET were ten or twenty years ago, is probably going to be pretty slow because the government is hitting us so hard in every direction. It’s hard to imagine that the companies are going to have that kind money available.”

Brava:  Are we at our peak, or do you see technology continuing to grow? 

Dr. Grant:  “Unfortunately, from the standpoint of a chairman, which means I’ve really become a glorified psychiatrist and accountant, my life is the bottom line. The threatened, or already in effect, cuts that we’ve seen under the current administration has a real chilling effect on new development. If you look at the sales of major equipment, they are way down compared to what they were before DRA. DRA and imaging has been like a wet blanket. So, I guess, my own rather unfortunate look at this is that, in many ways, we have stuff that’s still available and that we’re the perfect hit when it comes to reimbursements.  If the radiologists are closing imaging centers and are really tightening their belts, the first thing that translates into is a lack of purchasing power for new equipment. What we are going to see is that a lot of  the outpatient imaging centers that have gone wild in the last ten years will really slow down. It’s already slowed down as far as I can tell. So unfortunately, that translates into the companies much less willing to invest in R&D because they do not have income coming in.

Brava: “For someone in your position, are you expecting manufacturers to help out with reimbursements? In other words, to go to the government, stand by their products, and just advise for reimbursement purposes?   To present the position that reimbursements are needed for a study to help the end user to help the patient?”

Dr. Grant:  “They have been doing that. They have been all over Capitol Hill lobbying. Let’s face it, between GE, Siemens, and Philips, that’s a pretty powerful lobby and it’s gone absolutely nowhere. I mean DRA was concocted in the middle of the night with no sensibilities behind it. There were huge cuts and my accountant tells me people on the Westside are closing imaging centers right and left. When the huge cuts are out there done by a Congress that did it in the middle of the night, no one can be a more powerful lobby than the three major imaging vendors that we have and they’ve obviously have gotten nowhere. Let’s face it, the prevailing wind is that doctors make too much money, let’s hit them, and that’s the way people feel about it.  That’s a nice, easy thing to do and now they’re talking about a ten percent decrease in Medicare reimbursements. That’s been stopped at the last minute over the last couple of years, but its back on the books again. Given the current situation, I think the golden era is pretty far behind us, of reimbursements anyway.  I think there’s still going to have to be investment in R&D; otherwise, the companies are not going to remain competitive.”

Brava:  “What’s the most challenging aspect of running your business?”

Dr. Grant:  “Well again, being in an academic environment, it’s very different than you would experience if you were strictly private practice. Regardless of whether you are in academics or private practice, at this point, you have to provide good service to the clinicians and you have to provide a pleasant atmosphere to the patients.  So all of those kinds of service things are at the bottom whether you’re on either side.  At this point, at least in my practice, you don’t sit in an ivory tower in academics anymore. You have to be out there making the money. For us, a couple of issues that have been the most troubling in the last year have been reimbursements as I have mentioned before.  I can’t tell you how many sleepless nights I had thinking about how I was going to make up for the loss of income based on DRA. How am I going to pay people? How am I going to keep them? Part two for me, and this is universal in radiology, is the shortage of radiologists. Where are you going to find that next person? Also, recruiting is very difficult. It’s hard in private practice and probably worse in academics because salaries are typically lower. I worry about who’s going to pay the bills at the end of the month. We have no school support and are only able to survive on what we make in reimbursements. Many other schools have an easier time, but for us, it’s strictly what we make. We’ve, luckily, have had a spectacular year and I don’t know why. I think it’s because on the one side the reimbursements have dropped, but we’ve managed to get our volume up enough to make up for it. So we’ve actually done well. It’s ironic that we’ve actually done as well as we have in the last six months, and the number of nights I couldn’t sleep thinking about how am I going to pay people given the cuts that I’m facing with DRA.”

Brava:  “Is there anything that you would like to say to the healthcare community, as far as the company executive, representative or the clinician, of what you, as a professor in this institution, would like to see from them?

Dr. Grant:  “What I would like to say to the manufacturers, from my standpoint, is live up to your deals. It’s very frustrating when you’re getting nickel and dimed to death or you’re flat out lied to. Unfortunately, I know that happens to everybody. I realize the pressure that people have on the opposite side of the fence, but it just makes my life, and probably the vendors’ lives, really miserable when things were promised and then not followed-up.  We need to stay sensitive to each other’s needs.”