en en fi en en en en en fr en en en en en en en en en en en en en en en en en en en en en he en en en en en en en en en en en ro it en eu en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en en it en en en en en en en en en en en
Often, the true value of medical technology can be found in the experts who provide service, training, and support for the complex technologies they install. These technologies are helping physicians care for their patients, but they require a clear understanding of how to utilize them in clinical practice.
As Device Applications Specialists (DAS) at Bracco Diagnostics, Dina Pfenning, RT(R)(MR), DAS, Territory Manager, and Mark Brandalise, RT(R)(CT), Senior Device Applications Specialist, know their roles are critical to the effective delivery of care, particularly in the CT suite. Pfenning and Brandalise are part of a 10-person DAS team that provides injector installation and application training for Bracco’s SmartInject Solutions. These consist of interconnected IT technologies that include automated contrast injection systems to help radiologists and technologists manage patient safety, keep up-to-date records, manage compliance, and track real-time CT contrast protocol performance.
Pfenning started her career as a radiologic technologist in hospitals and outpatient imaging centers before joining Bracco Diagnostics 20 years ago, spending the past seven as a DAS. Brandalise was a registered radiologic technologist focused on CT and X-ray before joining Bracco. Today, their team installs up to 500 injectors every year in facilities across the United States. Installations range from just one injector in a remote facility to more than 100 in a large integrated delivery network (IDN).
Technology for Technologists, by Technologists
Bracco’s SmartInject Solutions center on the NEXO® Contrast Management System, a networking technology that tracks contrast delivery and manages CT imaging protocols for performance outcomes. It includes the EmpowerCTA®+ Injector System, which optimizes imaging capabilities, streamlines workflow, and enhances patient care.1,2 Meanwhile, Bracco’s EmpowerMR® Injector System provides a comprehensive approach to supporting technologists and radiologists to ensure safety and image quality in magnetic resonance imaging.2  These SmartInject systems can be adapted for technologists in any facility, from small hospitals to large IDNs that scan hundreds of patients a day.
“Their time isn’t wasted doing multiple things,” said Brandalise. “The injector's doing a lot of it automatically for them. I believe it increases their patient workflow, which ultimately keeps every technologist very happy. They're not bogged down with delays waiting for an injector to do something.”
Pfenning explained that many injector features are developed with input from CT technologists. “We try to put everything at the technologist’s fingertips so it's easy for them to use. Most controls are available both in the CT suite and by the patient's side,” she said.  For example, the flow rate can be adjusted on the fly without interrupting the injection. Injectors also feature a Saline Jump, which enables the technologist to reduce amount of contrast delivered to the patient while simultaneously optimizing enhancement.2
“That’s a win-win situation for everybody. When techs become comfortable with the saline jump feature, you can see their faces light up because they recognize that they are improving patient care by delivering a reduced amount of contrast , yet images are still optimal. And they're giving a nice saline flush after the contrast injection which hydrates the patient,” she said.
Brandalise says another technologist-inspired feature is the Saline Advance, which flushes a patient's IV line and vein to check for patency before contrast injection. “That way the vein actually helps acclimate to the desired flow rates, which should reduce the potential for extravasations3,” he explained.
The Pendant Switch allows technologists to easily start and stop injections at the table, by the patient’s side. “That gives the technologist full control of the injector,” said Brandalise.  And it can be used in conjunction with the Saline Advance to deliver a pre-flush on the IV. “This will tell the technologist the PSI that particular IV is taking, and then they can make a judgment if it will withstand the actual injection during the contrast injection,” he said.
Bracco smart injectors include protocol management on the Remote-Control workstation of the system, with 100 protocols that can be organized by body type or location for quick selection.
“A simple press of a button pulls up that protocol, which allows the technologist to run that specific protocol, or they can manipulate that protocol to accommodate whatever might be going on at the IV site. If they feel they need a slower rate, they could drop the flow rate or the contrast volume if they're doing a weight-based program,” explained Brandalise.
With patient safety in mind, there are several ways to stop the injection: In the CT suite, with the Pendant Switch, which will stop the injection as long as the switch is in the technologist’s hand; or by pressing the pause button on the display of the injector head. If the injector is tilted down and an injection in progress, techs can simply spin the injector head upwards to engage the tilt lock feature and automatically stop the injection.
In the technologists’ work room, touching the Remote Control monitor anywhere will pause the injection when necessary. The technologist can easily restart it when they’re ready. “I call it touch with purpose,” said Pfenning. “It's not a hard stop. It's a pause, so that you can check in to be sure the patient's doing okay. And then you can restart the injector at any point in time without losing an injection that has already started.”
In follow-up conversations with their customers, Pfenning and Brandalise often receive rave reviews for the system. “We hear that our injector keeps the workflow going due to the way that it functions. I also hear that people like our injector because they feel it's a clean injector – there’s not a lot of contrast leakage or egress into the system, which could cause a malfunction. I honestly believe that, with the speed and the cleanliness, customers are incredibly happy with that injector system,” said Brandalise.
A Smooth Installation Process
Bracco’s entire DAS team has a background in health care, which gives them unique insight into the technologist’s workday. “Everybody's an RT, so we all share that same background and have that same passion for the job,” said Brandalise.
Once a customer is ready to implement a Bracco injector install, a DAS like Brandalise or Pfenning schedules a call to discuss logistics and goes through a series of checklists to prepare for the installation. Items include how many electrical outlets are available and what consumables need to be ordered. The DAS team also meets with the lead technologist and/or manager on site to develop an installation and applications training plan.
“Ultimately, we don't want to interrupt the customer’s daily workflow. When we arrive on site, we hope to provide support by preparing and planning so that everything is ready to go pre-installation,” said Brandalise.
At installation, the DASs work with the staff to ensure plans are being properly implemented and running smoothly. “Communication is the key to a very smooth transition into the installation and the application process,” said Brandalise.
Success Through Applications Training
After installation, the DAS team helps the customer program existing protocols on the new injectors and trains the technologists on injector functionality. Bracco offers individual and group training in a hands-on setting.
The goal is to educate technologists according to how the customer prefers to train their imaging staff. “We want the customer to be happy. As a DAS, we come in early and we work late to accommodate the customer and give the proper training so they're comfortable they can use the equipment with full confidence,” said Brandalise.
Once the onsite injector application training is complete, technologists are invited to participate in an online competency post-test that delivers Category A ARRT credits. For the EmpowerMR® system, Bracco offers 7.75 ARRT Category A CE credits. EmpowerCTA® Injector System injector training includes 8 ARRT Category A CE credits.
Bracco also partners with Applied Radiology to offer an online injector competency training program  that supports a facility’s annual competency JCAHO requirements for equipment reviews and for new employees.
A Commitment to Customer Satisfaction
Each Bracco’s Device Application Specialist is committed to achieving the highest level of customer satisfaction and provides continued support after an injector installation and application training.
“We see projects through from the very beginning to the very end,” Pfenning explained. “We do what it takes to get the job done. We see success when our customer is extremely satisfied with the product and service that we provide. “
Pfenning continues, “One of the greatest compliments I've ever received as a DAS was when I was given a hug after the installation and apps training and was told that they really enjoyed the applications process because it was thorough, informative and genuine.”
Brandalise added, “It’s nice when people say we made their install and apps training a seamless transition for them.  Plus, once we leave their imaging departments, we continue to support them. They can call or email us, and we will get them the answer they need. We are there for them any time, any hour. That’s the commitment a DAS will make to any of our customers.”
Bracco Smart Solutions customers not only enjoy injector installation and applications training that is delivered by  a professionalism DAS with expertise and knowledge, but a sense of humor and a respectful appreciation of the business relationship that Bracco enjoys with each account, is also evident.