Our Sponsors:Jeffrey Gitomer Sales Seminars – use the code “Anthony” to receive your discount.Sales Gravy University – tell Jeb that Anthony sent you.Resources & Links mentioned in this episodeConnect with Craig on TwitterSales Engine – Craig’s businessCraig Wortman Ebook: How To Communicate With InfluenceDan Pink0985325305 The theme song “Into the Arena” is written and produced by Chris Sernel. You can find it on SoundcloudConnect with AnthonyWebsite: www.TheSalesBlog.comYoutube: www.Youtube.com/IannarinoFacebook: https://www.facebook.com/iannarinoTwitter: https://twitter.com/iannarinoGoogle Plus: https://plus.google.com/+SAnthonyIannarinoLinkedIn: https://www.linkedin.com/in/iannarinoTweets you can use to share this episodeOftentimes we have too much knowledge ~ Sales pro Craig WortmannClick To TweetDiscipline is the cornerstone difference between influencers and those who are notClick To TweetSubscribe toIn the ArenaApple PodcastsGoogle PodcastsAndroidby EmailRSSOr subscribe with your favorite app by using the address below Podcast: Play in new window | Download (57.3MB)Subscribe: Apple Podcasts | Android | Email | Google Podcasts | RSSWhen you think of a professor at a business school, you may instantly think of dry, boring lectures. But that’s the last thing you’ll get when speaking with Craig Wortmann. He’s a very sharp sales professional who trains business people how to use the opportunities that sales provides to care for people in a way that serves their needs best. In that, he has come to see that the power of listening and telling stories are two of the most effective ways to do that. On this episode you’re going to hear how Craig has come to those conclusions and how you can learn to use both more effectively in your sales career.How the power of story can increase your sales success, on this episodeClick To TweetIf you’re going to be successful in sales, you need these three things.Through his experiences as a sales professional and as a professor in a prestigious business school, Craig Wortmann has discovered that there are three primary things that salespeople need to be equipped for success: Knowledge, skill, and discipline. Too often the focus is on the knowledge with too little emphasis on skill and the discipline it takes to implement it effectively. Craig unpacks this powerful observation in this chat with Anthony, revealing how you can apply all three to achieve greater success in your sales career.Most things that lead to success are not that hard, we simply don’t do them.Craig Wortmann doesn’t think that success is really all that difficult to achieve because the things that bring success have been demonstrated over and over. The problem is not typically a lack of knowledge, it’s a lack of action. On this episode Craig chats with Anthony about the ways he challenges his students to implement the things they learn and to do so consistently. He believes (and has seen) that consistency in the little things that bring success have massive repercussions on your outcomes. Find out more on this episode.Many things that bring success are not hard, we just don’t do them ~ Craig WortmannClick To TweetThe pause after a prospect’s response is invaluable.One of the important aspects of a sales professional’s personality is the ability to talk. It’s a good thing, but not always the best thing in every situation. For example, when a question has been asked and the prospect answers, it’s imperative that sales pros learn to pause before breaking the silence. In that pause most of the time the prospect will begin to speak again, revealing even more information about their need that would not have been uncovered otherwise. Craig Wortmann talks about the power of the pause and how you can learn to use it to meet your prospect’s needs more effectively, on this episode.You’ll be more successful in sales as you learn to be more human.When Craig Wortmann says that salespeople need to learn how to be “more human,” he means that we need to think less like a salesperson and more like a feeling, caring human being. The basis of all sales is providing solutions to the very real needs and problems of customers. Compassion and care have to be at the root of that if we are going to build the trust needed in order to provide those solutions effectively and consistently. Craig advises that sales professionals stop thinking about “getting the sale” and start thinking about “caring for the person.” The difference that little shift will make is monumental. Find out more about Craig and his philosophies surrounding sales on this episode.We gain access to more actionable information if we keep our mouths shut ~ Craig WortmannClick To TweetOutline of this great episode Who is Craig Wortmann? Why did Craig start his book with the topic of discipline? The power and significance of a handwritten thank you note, and what actually doing it says about you. The framework of knowledge, skill, and discipline. Why listening is so important and how do you do it effectively. The power of the pause for a sales professional. What Craig means by being human as a salesperson. The 4 significant types of stories and why they fuel your sales career. The best way to connect with Craig.
The Thai Police searched 118 spots across the country in a nationwide raid for illegal immigrants and arrested 99 foreigners on April 26. Among those arrested were nationals from India, Myanmar, Germany and Laos, the Bangkok Post reported.The operation, called X-ray Outlaw Foreigner, marked 118 premises, 74 of which were international schools, Tourist Police Deputy Commissioner Maj. Gen. Surachet Hakpal said, according to the report.More emphasis was laid on international schools because foreigners staying illegally in Thailand most often approached these schools as language teachers, added Hakpal.The most common charge against the arrested foreign nationals is overstaying in Thailand after expiry of their visas. According to Hakpal, most foreigners caught on this charge belong to countries like India, Germany and Myanmar. Another common charge against them is that of illegal entry, with people from India, Myanmar and Laos being the main accused.The areas that were searched included some top tourist hubs like Pattaya city in Chon Buri province, Hat Yai district of Songkhla, and Koh Samui, since foreign criminals are often found posing as tourists, the report added.Some of the foreign nationals held by the police are associated with crimes such as romance scams, credit card forgery and illegal drugs. The police said that these people would be blacklisted.Earlier in April, the police took into custody 66 foreigners after conducting another set of raids as part of the nationwide sweep on illegal immigrants.“Those who’ve overstayed are mostly Indians and Pakistanis, while several Laos and Vietnamese were among those who committed theft and crossed the border illegally,” Maj. Gen. Prasert Ngoenyuang, commander of tourist police had said, as per Khaosod English. While 51 of these foreigners were arrested for entering the country illegally, the 11 other foreign nationals were charged for overstaying their visas. “They will be deported to their homelands and blacklisted so they cannot come back to commit crimes in Thailand again,” Hakpal was quoted as saying in the report.The police have conducted over 3,000 similar raids and arrested as many as 868 people in the past couple of months, Hakpal added.Following a nationwide search conducted on March 14 and 15 this year by tourist, immigration and police agencies, 117 foreigners, including Indians, were detained in Bangkok for allegedly breaking the law.“X-Ray Outlaw Foreigner” is an ongoing police effort that began in February this year in Thailand to crack down on foreign nationals who are involved in activities such as entering the country illegally, working without a permit and testing positive for drugs. Related ItemsbangkokThailand
Editors’ Recommendations How to Shave With a Straight Razor Sprint Through Airport Security With These TSA-Approved Men’s Grooming Kits For the last 20 years, New York-based eShave has been producing high-quality razors, brushes and just about every other shaving essential.They’ve improved on their already popular line of pre-shave oils with new formulas that are paraben-free and enhanced with natural oils.Parabens are preservatives that many companies put in skin care products to extend shelf life and prevent spoilage. There are mixed opinions on the negative effects of parabens, but some studies have connected them to diseases and mild skin rashes. Because of this, skin care enthusiasts have started to shy away from anything with parabens in it and flocked to brands like eShave.These new blends are available in three flavors: White Tea, Verbena Lime, and Orange Sandalwood. Each has a similar base of grapeseed, cottonseed, castor and safflower oils for top-line moisturizing, while avoiding clogged pores over time. EShave has also added vitamins A and E to your mug nice and soft following a shave.Each is lightweight and loaded with individual properties for different faces. The Orange Sandalwood has a special blend of therapeutic botanicals to awaken your tired skin. Verbena Lime uses the natural properties in both elements to stimulate the skin, then soothe it for sensitive faces. Lastly, White Tea is the softest of the bunch, offering calm and subtle relief with potent healing.“The oils prime and protect the skin pre- and during the shave, then absorb quickly to give skin an added layer of protection,” said eShave President/Founder Danielle Malka through a press release.The scents definitely have a tropical aspect to them after a few trials and do provide a nice glide for the razor as it goes over the skin.Each of the oils are $22 and can be purchased here. Portion Control: The Best Meal Prep Containers on the Market The Best CBD Oil and Skincare Creams for Managing Pain 7 Fall Cocktail Recipes to Enjoy With Cooler Weather
The Jamaica Social Investment Fund (JSIF) is providing $3 million in grants for the staging of several summer camps targeting 700 at-risk youth. Managing Director of JSIF, Omar Sweeney, said the partnership complements the strategy of the JCF to deliver summer camps which target high-risk youth and support behaviour modification and positive youth development. The Jamaica Social Investment Fund (JSIF) is providing $3 million in grants for the staging of several summer camps targeting 700 at-risk youth.Under Summer Camp 2017, the JSIF will provide the money for the Jamaica Constabulary Force (JCF) to support five residential summer camps across the 18 communities that fall under its Integrated Community Development Project (ICDP), which is funded through a loan from the World Bank.The camps are being established in partnership with the Ministry of Education, Youth and Information in response to the growing need for targeted social interventions to foster positive youth development.A Memorandum of Understanding (MoU) was signed by the entities during the launch of the programme on July 17 at JSIF’s Oxford Road offices in Kingston.The two-week residential summer camps will be held between July 9 and August 24.Camp facilitators and counsellors will be mobilised from the Community Safety and Security Branch, the Corporate Communications Unit (CCU), Mobile Reserve as well as participating schools.Managing Director of JSIF, Omar Sweeney, said the partnership complements the strategy of the JCF to deliver summer camps which target high-risk youth and support behaviour modification and positive youth development.“This partnership recognises that improved community safety and crime prevention requires that the police act in partnership with the general public and with other Government, private and voluntary sector organisations to deliver collaborative services that will address crime, fear of crime and other safety issues which concern communities,” he said.He noted that this strategy is part of the National Crime Prevention and Community Safety Strategy (NCPCSS), with a focus on high-risk groups, particularly in the 15 to 24 age cohort.Assistant Commissioner of Police, Warren Clarke, read a message from Police Commissioner, George Quallo, who expressed his gratitude for the substantial donation by JSIF.He noted that partnerships of this nature are essential for achieving positive, sustainable changes.“Through a shared vision for youth development, violence prevention and reduction as well as nation building, the JCF and JSIF have been solid partners. Through the years, our two agencies have maintained a collaborative partnership which has seen us working together in volatile areas,” Commissioner Quallo said.Meanwhile, key architect of the summer programme, Deputy Commissioner of Police, Novelette Grant, said the programme is in response to the nexus between youth violence, school and street gangs and the impact on general community violence.“We recognise the level of neglect, abuse, and overall negative life experiences that impact youth in underserved communities and how this, in turn, undermines their efficacy as fully functional, productive citizens. This programme has been life changing for the participants and we are very happy for the continued interest and support,” she said.The partnership is part of JSIF’s wider Summer Camp 2017 initiative which will provide grant funding of $22 million to fund a total of 32 camps across the 18 ICDP communities targeting a total of 5,009 beneficiaries. Story Highlights Under Summer Camp 2017, the JSIF will provide the money for the Jamaica Constabulary Force (JCF) to support five residential summer camps across the 18 communities that fall under its Integrated Community Development Project (ICDP), which is funded through a loan from the World Bank.
Los Angeles: Lautaro Martinez fired a 22-minute hat-trick as Argentina thrashed Mexico 4-0 in a friendly international in San Antonio. Inter Milan striker Martinez scored in the 17th, 22nd and 39th minutes at the Alamodome to give Argentina a deserved win over a lacklustre Mexico team on Tuesday. Paris Saint-Germain midfielder Leandro Paredes scored Argentina’s other goal from the penalty spot after 33 minutes as the South American giants romped into a 4-0 lead at halftime. But it was the 22-year-old Martinez who grabbed the headlines with a clinical exhibition of finishing which took his international goals tally to nine in 13 appearances. Also Read – Puducherry on top after 8-wkt win over ChandigarhMartinez opened the scoring in the 17th minute, picking the ball up deep in Mexican territory before twisting and turning past several defenders and firing low past Guillermo Ochoa. Martinez bagged his second five minutes later, with River Plate’s Exequiel Palacios punishing sloppy play in the Mexican defence to send the Inter Milan striker through on goal to finish for 2-0. A disastrous start for Mexico got worse shortly after the half hour mark when Carlos Salcedo was adjudged to have handled in the area to concede a penalty. Paredes duly stepped up to convert to give Argentina a 3-0 lead. Martinez completed his hat-trick six minutes from half-time, again capitalising on lackadaisical Mexican defending to dart in and shoot past Ochoa. Argentina were without several first choice regulars, with Lionel Messi, Sergio Aguero and Angel Di Maria all missing from their two-game international tour of North America.
A warning for Canadians to check their freezers, some of the Aunt Jemima products inside may have been recalled.Pinnacle Foods Canada Corporation is recalling Frozen Waffles and Frozen French Toast slices from the market over possible Listeria contamination.Anyone who might have consumed one of the products is being urged to contact your doctor.Recalled products can either be thrown out or returned to the store where it was purchased.According to the Canadian Food Inspection Agency, food contaminated with Listeria may not look or smell spoiled but it can make you sick.Symptoms include vomitting, nausea, persistent fever, muscle aches, severe heache and neck stiffness.Pregnant women, the elderly and people with weakened immune systems are also at risk.There have been no reported illnesses or incidents, to date, associated with eating one of the products.Anyone looking for more information is being urged to check out the CFIA website.
BUENOS AIRES, Argentina — Prime Minister Justin Trudeau says he learned of a former Liberal MP’s gambling problem just over a week ago, but his office had no information that an RCMP investigation was connected to the issue.Trudeau says his office was aware the Mounties had been examining Raj Grewal’s connection to the prime minister’s trip to India this year.He said the PMO was also aware of an ethics investigation into Grewal that began in May, after two opposition MPs expressed concerns that Grewal might have been in a conflict of interest related to the India trip.Grewal had invited a construction executive — who was paying him for legal services — to official events with Trudeau during the trip.Grewal took to Facebook on Friday night to say he has repaid his sizable gambling debts and is now reconsidering his hasty decision to quit politics.Trudeau says the RCMP conducts independent investigations.The Canadian Press
Mumbai: Social activist Anna Hazare Sunday welcomed the news that former Supreme Court judge Justice Pinaki Chandra Ghose was being considered for appointment as the chief of country’s first Lokpal, the anti-corruption ombudsman. Justice Ghose, who retired from the Supreme Court in May 2017, is a member of the National Human Rights Commission (NHRC). Speaking to reporters, Hazare said, “I welcome the decision of appointing the country’s first Lokpal. The people’s movement for it, going on for 48 years now, has finally won.” Also Read – Squadrons which participated in Balakot air strike awarded citations on IAF Day Hazare has led several agitations and hunger protests demanding the appointment of Lokpal at the national level and Lokayukta in states. He had sat on a hunger strike in February-March in his native Ralegansidhi in Ahmednagar district over the non-appointment of Lokpal. The Lokpal Act, which envisages establishment of anti-graft body Lokpal at the Centre and Lokayuktas in states to look into cases of corruption against certain categories of public servants, was passed in 2013.
The police media unit said that these officers will be mostly deployed in buses leaving Colombo this week and buses returning to Colombo next week.When carrying out arrests the plain clothed policemen will have to show their identification cards, the police media unit added. (Colombo Gazette) Plain clothed policemen will be deployed in passenger buses during the Sinhala and Tamil New Year to make sure drivers follow the road rules, the police media unit said today.The plain clothed policemen will travel as ordinary passengers and purchase tickets when travelling in the bus. The plain clothed policemen will also take measures to protect passengers who may fall victim to thugs and pick-pockets in the bus. According to the police there have been complaints from passengers that bus operators often violate road rules when driving during the Sinhala and Tamil New Year as there is less traffic and very few traffic policemen on the road.
The injured had been rushed to hospital for treatment. Three people were killed and at least 10 others were injured following an accident near the Kallaru bridge, along the Puttalam – Mannar Road.According to the police, a small lorry had met with the accident killing three people who were in the vehicle.
The head of Calgary-based TransCanada says he’s ready to move ahead with the Keystone X-L pipeline project now that there have been some stumbling blocks removed in the U-S.He says the company has deals with all landowners along the route in Montana and South Dakota, and with 84 per cent in Nebraska.CEO Russ Girling says the company will spend the coming weeks trying to reach deals with the remaining 16 per cent, before the eminent-domain process begins.The Keystone decision now rests in President Barack Obama’s hands, with a Nebraska court clearing an obstacle that has delayed the conclusion of the years-long debate over the oil project.(The Canadian Press) TransCanada ready to move forward after Nebraska court clears Keystone hurdle by News Staff Posted Jan 10, 2015 7:34 am MDT AddThis Sharing ButtonsShare to TwitterTwitterShare to FacebookFacebookShare to RedditRedditShare to 電子郵件Email
#Lithuania’s Supreme Court orders retrial in Real IRA arms case, after Irishman Michael Campbell was acquitted of terrorism charges— BNS Lithuania (@BNSLithuania) June 26, 2014 Campbell’s lawyer Ingrida Botyriene rejected the prosecutor’s arguments, telling the court that “provoked activity cannot be recognised as criminal”.Campbell went on trial in August 2009 after having been arrested in a January 2008 sting in Vilnius, where he met a Lithuanian agent posing as an arms dealer. He denied being a member of the Real IRA.Campbell’s brother Liam was one of four Real IRA leaders found liable by a civil court for a 1998 Omagh bombing that killed 29 people.- Additional reporting by © – AFP 2014Read: Irishman Michael Campbell released after Real IRA arms conviction overturned >Read: Ireland, Britain not helping in Real IRA arms case: Lithuania > AN IRISHMAN WHOSE conviction for trying to smuggle arms from Lithuania to the Real IRA was overturned is to face a retrial.Michael Campbell was originally sentenced to 12 years in prison in 2011 but the conviction was overturned last October when an appeals court cited a lack of evidence.But an expanded seven judge panel of the Lithuanian Supreme Court have now ordered a retrial, saying that it is “necessary to assess all the peculiarities of the case”. Source: BNS Lithuania/Twitter Read judgement here (in Lithuanian)Campbell has long insisted he was framed by British intelligence and the appeals court last October had said that there was no evidence linking him with the Real IRA.In the latest twist in the case, the Supreme Court panel said that the appeals court gave a “contradictory” assessment of intelligence witnesses.“The panel decided to annul the verdict of 2 October, 2013, and refer the case to an appeals court,” judge Gintaras Goda said, reading the verdict.The 41-year-old Campbell, who currently lives in Ireland, did not come to Vilnius for verdict.His lawyers and prosecutor did not appear either, and they could not be immediately reached for a comment.“The court of appeals groundlessly downgraded part of evidence and by giving priority to testimony of the acquitted person,” prosecutor Gedgaudas Norkunas told the court in a hearing last month.
Mar 16th 2017, 8:12 PM By Fora Staff 15 Comments Source: Hassle.comThe company currently provides on-demand cleaning services in nine countries in Asia and Europe, but it only trades as Hassle in Ireland and the UK.Original planThe move by Hassle to expand its marketplace has represented a shift back to the original idea the company was based on.The first iteration of Hassle provided on-demand access to more than 25 different professions, including personal trainers and driving instructors.However, after a year the company’s operations were pared back to exclusively offering cleaning services after the founders noticed that was the main chore households were looking to outsource.The cleaning service started in London and was launched in Dublin in 2014. Since then it has expanded to Cork and has nearly 20,000 users to date.The most recent company records show the Irish Hassle operation lost more than €850,000 between March 2015 and December of that same year.Written by Killian Woods and posted on Fora.ie Short URL CLEANING SERVICE HASSLE has revealed plans to branch out into the provision of extra household services as part of a €10 million investment.The company, which has been dubbed the ‘Hailo for cleaners’, was set up by Kildare native Jules Coleman, who co-founded the business with Alex Depledge and Tim Nimmo in 2012.Two years ago the company was bought by Helpling, a German rival in the on-demand house cleaning space. Following the purchase, Coleman left the company and has since joined investment firm Index Ventures.The latest cash injection of €10 million will be used to expand Hassle’s marketplace in Ireland to include window cleaning, electrical, painting and furniture-assembling services.The rollout of these additional services has come two months after Hassle’s parent company introduced additional household services to its users in Germany.Helpling co-founder Benedikt Franke said the expansion of its on-demand marketplace will help the business become profitable within the next year and develop Hassle into a one-stop-shop for all home-based services.The funding for the expansion was raised by Hassle’s parent company Helpling, with the round led by the Asia Pacific Internet Group.This latest investment round has brought total investment in Helpling, whose main backer is giant German startup incubator Rocket Internet, to €67 million. http://jrnl.ie/3292693 Take me to Fora 16,992 Views Image: Shutterstock/Monkey Business Images Tweet thisShare on FacebookEmail this article Image: Shutterstock/Monkey Business Images Thursday 16 Mar 2017, 8:12 PM An Irish company will make it possible to get someone put together your flat-pack furniture The cleaning app is also branching out into electrical and painting services. Share Tweet Email1
San Diego bike helmet giveaway prepares for Wednesday’s Bike to School Day 00:00 00:00 spaceplay / pause qunload | stop ffullscreenshift + ←→slower / faster ↑↓volume mmute ←→seek . seek to previous 12… 6 seek to 10%, 20% … 60% XColor SettingsAaAaAaAaTextBackgroundOpacity SettingsTextOpaqueSemi-TransparentBackgroundSemi-TransparentOpaqueTransparentFont SettingsSize||TypeSerif MonospaceSerifSans Serif MonospaceSans SerifCasualCursiveSmallCapsResetSave SettingsSAN DIEGO – San Diego police and the San Diego County Bicycle Coalition will give away helmets to student bicyclists who aren’t wearing one in preparation for Wednesday’s Bike to School Day.The event aims to emphasize issues such as cyclist safety and increasing physical activity among children. KUSI’s Elizabeth Alvarez was live at Pacific Beach Elementary School as the giveaway was happening. KUSI Newsroom, Elizabeth Alvarez, KUSI Newsroom, Elizabeth Alvarez May 7, 2018 Posted: May 7, 2018 Categories: Good Morning San Diego, Local San Diego News FacebookTwitter
(WHDH) — Firefighters responded Friday morning to a gym in Worms, Germany, after officials say a lifter got a “very sensitive” body part stuck inside a weight that’s typically placed on a barbell.The Feuerwehr Worms Fire Department posted photos of broken five-pound weight on their Facebook page and said crews were forced to use a vibrations saw and a hydraulic emergency kit to remove the weight from the man’s body part.Officials say crews worked for three-hours before they were able to remove the weight.The fire department shared a message for fellow weight lifters: “Please do not imitate such actions!”It’s not clear what motivated the man to get into such an awkward situation. Copyright 2019 Sunbeam Television Corp. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
SEE BELOW: From Back-End Support to Revenue Partner (sidebar)Magazine production has changed dramatically in the last few years. Tools and standards that have come to the forefront—ad portals, virtual proofing, online insertion orders, PDFs—which weren’t exactly new, still gained significant ground.Today, publishers and printers know there’s no single solution. Digital asset management and metadata are all being used, but what’s old is new again, with old standbys such as “printing to the numbers” and gray component replacement being resurrected to find cheaper, faster ways to create the final print product.The publisher/printer relationship often boils down to one factor: Price. Financial pressures have grown significantly over the last year and it’s unlikely to change in the near future. But publishers may want to look at the bigger picture and assess whether the cost savings they’re seeing are necessarily worth a corresponding drop in service. Color ManagementColor management continues to be one of the industry’s most vital topics, since improvements in color not only improve the finished product, but can yield production efficiencies and savings through reduced waste.City and regional publisher Niche Media works with its printers to calibrate to the profiles of the presses. “Our make-ready’s are faster, we’re up to color instantly and consistently because of the closed loop color on the presses,” says director of manufacturing Shawn Lowe. “You’ll see more publishers partnering with printers as we all fight to keep clients happy and coming back.” His goal is to reproduce a common ad better than his competitor, while being consistent across all of its publications so that an ad in Gotham is identical in quality to an ad in Michigan Avenue, for example.Gray component replacement (GCR) is a technique for replacing gray tones otherwise made from yellow, cyan and magenta separations instead with black ink. Adopted in 1987 by Newsweek, today Time Inc. sees a broader adoption of GCR ink efficiency software with publishers. “The cost savings are substantial and economic forces should speed adoption,” says Guy Gleysteen, senior vice president of production at Time Inc. “Similarly, virtual proofing has been in the marketplace for several years, but it seems likely that wider adoption in 2009 is inevitable as publishers focus on viable cost reduction technologies. Both are widely deployed at Time Inc.”Tighter press controls will also play a larger role. “What is needed now is the ability of presses, especially Web presses, to have tighter color control,” says Connecticut Cottages & Gardens art and production director Matthew Hageman. “It’s the final piece of the puzzle on the way to printing to the numbers. The front end controls are there, the closed-loop color technology is there. The new generation of presses is getting close, so I think it’s only a matter of time.” One of Quebecor World’s primary technical initiatives in 2008 was assisting with the roll-out of G7 qualification to the Web offset process (the printer claims its Dyersburg, Tennessee plant became the first G7 Qualified Web offset facility in North America). Quebecor World partnered with IDEAlliance to extend G7 Qualification, which began as a sheet-fed process, to Web offset technology.Is Virtual Proofing Taking Off Or Behind The Times? Digital workflows enable printers to combine production services once considered distinctly separate, such as pre-press, printing and distribution. Now they’ve been combined to create a seamless manufacturing process to save time and money without sacrificing quality and service. “It starts with offering a digital and proofless prepress workflow, moves to a lean, but flexible printing and bindery operation, and goes out the door through multi-faceted distribution systems to cover all channels,” says Dan Drake, director of print operations at IPC Print Services. “This allows the publisher to keep advertising open longer because they can submit files later and still get the publication in the hands of the reader faster.”While virtual proofing has existed for years, just 61 percent of publishers used it in 2008 (up from 52 percent in 2007), according to Folio:’s 2008 Manufacturing and Production Trends Survey. “While we have offered it for many years, I believe 2009 will be the year everyone takes a hard look at soft proofing,” says Drake. The systems offer more than just proofing capabilities and more stable PDF formats, he says. “It’s just like the evolution of computer-to-plate, it took some time, but now the process can be trusted.” In 2009, Hearst will continue to implement virtual proofing with its printers, conduct further tests for fully compliant PDF/X-4 files, and “continue to raise the awareness among the ad community about the importance of including the ISO 12647-7 Digital Control Strip on their supplied proofs for better print predictability,” says William McGuirl, quality assurance director at Hearst Magazines.One production department, which wishes to remain anonymous, tested the concept that when printing with a printer that has calibrated monitors in the press room, provided the front-end calibration matches that of the printer and the front-end set up converts to a profile that matches the paper stock (instead of converting to generic CMYK), the need for proofs is eliminated. “We ditched virtual proofing over the summer. I realized that as long as my monitors were calibrated, and as long as my front end set-up was the same as the premedia set-up at our printer, virtual proofing was unnecessary,” the source says. “The department only uses scatter proofs for the well, which they don’t ultimately send to the printer. They went on press with a number of hard proofs, but didn’t bring them out until the press was up to color. It was dead on.”Eliminating A Few StepsBlood-Horse Publications has implemented an automatic e-mail notification for when a file is uploaded to an FTP site. “There’s no more watching the site for files. It’s watching for us,” says print operations manager Lisa Coots. Blood-Horse is also using DALiM TWiST, a premedia job processing system, for all of its files. “This allows us to automatically send the files to our printer, Publishers Press, who is also using DALiM,” she says. “As a result, we can view uploaded pages and easily identify pages and forms that aren’t complete.“They can also send a new file as a replacement for a previously sent file, and as a result, “can monitor their system to make sure the new file will get printed,” says Coots. “We‘ve taken advantage of electronic approvals for some print projects. It’s fast, efficient and paperless.”Coots says Blood-Horse is in the process of upgrading the in-house electronic tracking system where “we currently cannot attach digital files to the e-ticket,” which will make the system user-friendly for print and digital, and allow them cross-platforming on some projects. Blood-Horse is investigating an ad system that would allow clients to upload a file, attach it to an insertion order and automatically send it though the DALiM TWiST system. “This will reduce man-hours and make for a more efficient workflow,” she says. Connecticut Cottages & Gardens has seen time-saving benefits from Brown Printing’s Web-based workflow. “Since we need less time to ship and proof, we’ve been able to extend in-house deadlines. This has given our ad sales team more time to sell,” says Hageman. “It also allows last minute changes that previously would have caused 12 hours worth of chaos to be dealt with in less than half the time at a fraction of the stress.”Ad Portals Draw Small PubsWhile ad portals—which allow advertisers to submit advertising materials electronically and allow the publisher to place the materials into the correct workflow—were once the realm of larger publishers, smaller publishers like Connecticut Cottages and Gardens have begun to use them (although ad portals overall showed little growth over the last year, with 22 percent of publishers using them in 2008 versus 21 percent in 2007).“I think ad portals are going to become big business,” says Hageman. “They save so much time and aggravation. We’ve logged more hours than we can count troubleshooting files for people…I think it can even deter smaller advertisers who can’t afford an agency from advertising at all. The idea that an advertiser can drop a file on a Web site, have it preflighted in seconds, and upon approval be placed into the printer’s workflow, is phenomenal.” Niche Media’s success with ad portal SendMyAd makes Lowe think that “ad portals will continue to grow and prosper. Anything that will save time, both in allowing for more ad pages, and in delivery speed to the plant, is important.” However, Lowe says that portals can be a double-edged sword. “You have to keep the books open later, but you still have to make your press date and deliver books on time. There’s little margin for mistakes, so the first shot has to be dead on.” Niche Media started experimenting with ad portals more than three years ago, and believes that they will “continue to grow and consolidate,” says Lowe. “Advertisers are also looking for the speed and additional time to get last minute creative to press.” Niche is also starting to convert to InDesign and Acrobat, particularly “after seeing the industry shift to Adobe, to the point where Quark now has a publishing system that is file agnostic and will take ID files,” says Lowe. “The goal is to first reproduce the supplied creative perfectly, since many advertisers are pushing back on poor reproduction.” Postal and Co-MailingPublishers have been adjusting for mailing rates, as Periodicals, Standard or First Class postage will rise by just about 4 percent in May. But as publishers know, that’s not a given. IPC’s Dan Drake says the Intelligent Mail Barcode—the next generation of USPS barcode technology for sorting and tracking letters and flats—could be as big as co-mailing in terms of cutting costs and boosting efficiencies. “The incorporation of the full-service Intelligent Mail Barcode into magazine distribution systems will be huge,” he adds. “It will be mandatory in 2010, but the U.S. Postal Service is expected to raise rates for magazines that do not incorporate it sooner. If you wait until late fall, you could find yourself scrambling.”Traditional WorkflowOvid Bell emphasizes “lean manufacturing” to cut costs, and is pursuing paper deals with vendors that will have an immediate effect for customers. The printer has installed a new perfect binder, which provides a 143 percent increase in production capacity, and is recasting one of its presses as a cover press, including a sheeter for perfect bind covers. “We’re also working on shorter turn around schedules,” says president John Bell, primarily with monthlies that can maintain production schedules. “In the short-run production arena, there aren’t many.”The industry may see more manufacturing partnerships between publishers in the same market. “Smaller publications may lean on other publishers to help create, print and distribute their magazines and newsletters, due to reduced staff and increased manufacturing costs,” says Coots. “We are all in this together.” Just as publishers are realizing with edit and marketing, there’s only so much that can be cut from the manufacturing process. Lowe says that Niche Media is still “one of the few publishers who run 50/50 splits. Investments in technology are necessary just to stay in the game today.”SIDEBAR:From Back-End Support to Revenue PartnerPublishers today aren’t just looking to printers for print solutions, but also for revenue generating opportunities. Increasingly, that comes in the form of digital solutions such as digital magazines, but also support (or even full providing) of core disciplines such as content develop and advertising administration.Many publishers are looking to printers to help them connect print and online, with services ranging from digital editions to Web development. “One of the most important trends coming out now are e-books, and yet the newsstand and subscription copies are just as important,” says Shawn Lowe, director of manufacturing at Niche Media. “I think you will see a new co-existence between Web and print where print will drive content on the Web and then the Web will take that content and drive consumers deeper to advertisers. E-books are ready instantly, and will draw attention to the magazines that are coming out soon and drive newsstand sales.”“Content Portability” is one of the new paradigms in a digital age. Intellectual property has its maximum value when it can be repurposed into multiple channels, each of which can generate new revenue streams. That prompted Quebecor World to form The Publishing Services Group in June 2008 by merging the company’s magazine, book and directory businesses. “There is a meaningful opportunity to demonstrate to clients how they can expand their offerings cheaply and efficiently by taking advantage of the Publishing Services Group and certain of its new digital tools including its digital asset management solutions, digital editions, ad and edit portals and electronic communication systems,” says Sean Twomey, executive vice president of The Publishing Services Group. “They create new subscription and direct sales opportunities, as well as advertising upsell possibilities. They also allow for a more efficient way of versioning editorial and advertising.” In additional to digital editions, Fry Communications offers online video, which can be packaged with digital editions and online directories. “This offers direct contact with the advertiser,” says vice president of sales Steve Grande, who says that the price is “several hundred dollars per unit.” Fry also offers a Web-based infrastructure for creating online yellow pages directory as well as variable data services which helps clients target personalized messages to their audience. “Our role is to move forward to an information distribution company in print, direct mail and online,” says Grande. “More of the requests we’re getting from publishers are related to the work functions the printer can take over and provide as a service and run the gamut from dealing with digital advertising management and providing help desk support for advertisers to dealing with pagination and book makeup. With our direct mail operation, we’re now talking to certain customers about mailing their invoices for them.”
Scrolls, the upcoming game from Mojang, has a gotten a lot of attention already. This isn’t a surprise because it comes from the red-hot publishers of Minecraft, but unfortunately not all the attention is the good kind. Bethesda, the publisher of the Elder Scrolls series threatened legal action action after Notch (the creator of Minecraft) announced he was making and upcoming game called Scrolls. The battle over the word has yet to go anywhere, though it could have been settled by a game of Quake.This weekend a very early trailer for Scrolls was released. It doesn’t feature any gameplay and the release date is only said to be “eventually” but we can at least get some idea of the art style. There is a brief clip at the end that shows us what the game’s action might be like, but it’s too early to tell.It’s been that Scrolls will combine elements of a collectible card game and a board game, so we have some idea of what to expect. It’s said to be a grid-based game with creature-summoning and a player damage system not unlike that of Magic: The Gathering, according to the unofficial wiki. We also know that there won’t be any chance of confusing this games with the first-person point-of-view hack-and-slashers we seen in the Elder Scrolls series.So far we know that Markus “notch” Persson will have a hand in developing that game and that the story will be written by Jerry “tycho” Holkins, of Penny Arcade fame.via Ars Technica
Thinking about a change of career? Google’s got a heck of a job offer for you. They’ll potentially pay up to $40,000 a year for you to not drive one of their autonomous cars. That’s based on base pay for $20 per hour working full time hours (40 hours a week).There has to be some kind of catch, you say? Of course there is. Google isn’t just planning on throwing money at people to ride around with an AI chauffeur while sucking on slurpees and binge-watching Netflix from the non-driver’s seat.No, you’ll actually have to pay attention. Google’s cars have logged plenty of hours on real roads, but there are still going to be times when the car doesn’t know how to handle a situation — say, sharing a narrow section of road with an oncoming bus. Since there’s no way of knowing when you’ll need to lend a helping hand (or foot), you need to be ever vigilant behind the wheel.You also have to be able to type a minimum of 40 words per minute — presumably because you’ll be expected to submit reports about your rides, not because they want you doing double duty as a Zagat reviewer. It’ll also be extremely helpful if you happen to live in or near Chandler, Arizona, because that’s where Google’s autonomous vehicles will be hitting the streets.A couple other caveats: you must have a bachelor’s degree and a spotless criminal record. Apart from that, if you’re comfortable with a one or two-year contract and think $20 per hour is fair pay for what you will (and won’t) be doing, go apply!It would be pretty sweet to be able to add “driverless car driver” to your resume, even if Google’s official job title is “vehicle safety specialist.”
We can say this much for death: It gives us the chance to (finally) have the last word. And these well-known figures made the most of it with gravestone etchings that are pithy, provocative, and pretty unforgettable.Mel Blanc: That’s All Folks!Mel Blanc’s headstone at the Hollywood Forever Cemetery in Southern California. Photo by Robert A. Estremo CC BY SA 2.5Some epitaphs pretty much write themselves. Blanc, the voice of Bugs Bunny and Porky Pig just lifted the words he ba-dee-ba-dee ba-dee shouted at the end of each Warner Brothers cartoon.Mel Blanc was the original voice of Bugs and would voice the character for nearly five decades.[Hollywood Forever Cemetery, Los Angeles, CA]Bette Davis: She did things the hard way.Bette Davis epitaph. Photo by Wildhartlivie CC BY BY 3.0No kidding. The greatest actress of her generation didn’t just tussle with Whatever Happened to Baby Jane? co-star Joan Crawford.In 1937, not thrilled with the roles she was being offered, Davis sued Warner Brothers to break free of her contract — setting into motion the end of the all-powerful studio system.Studio portrait of Bette Davis (1940).(A delicious bit of irony: Before her death in 1989, Davis chose a burial plot with a nice view of her old stomping ground, the WB Lot.)[Forest Lawn Memorial Park, Hollywood Hills, CA]Martin Luther King, Jr.: Free at least, Free at last, Thank God Almighty I’m Free at Last.Photo by satomiichimura/Flickr CC BY 2.0How very fitting: The inspirational — and immortal — words that the eloquent civil rights leader delivered on the steps of the Lincoln Memorial, in 1963, are etched into his tombstone.King at the Civil Rights March on Washington, D.C.[National Historical Park, Atlanta, GA]Rodney Dangerfield: There goes the neighborhood.Rodney Dangerfield’s tombstone at Pierce Brothers Westwood Memorial Park Cemetery in Los Angeles, California. Photo by Alan Light CC BY 2.0This was the final punchline from the self-deprecating comedienne, whose well-known catchphrase was “I don’t get no respect.”Press photo of Rodney Dangerfield performing on stage in 1972.It was fitting then that shortly after Dangerfield’s death, his widow held an event in which the word Respect was written in the sky, as guests released butterflies into the air.[Westwood Village Memorial Park, Los Angeles, CA]William ShakespeareWilliam Shakespeare’s tomb.Photo by David Jones CC by 2.0Good friend for Jesus sake forbear, To dig the dust enclosed here. Bless be the man that spares these stones, And cursed be he that moves my bones.William ShakespeareThe Bard was no fool. He actually penned this clever couplet to prevent his corpse from being dug up for research purposes — a pretty common (ewww!) activity during the 1600s.[Holy Trinity Church in Stratford, Warwickshire]Jack Lemmon: InJack Lemmon’s grave. Photo by Alan Light CC BY 2.0Succinct and clever — perfect for movies’ Everyman. Lemmon’s pal and frequent co-star, Walter Matthau, is buried nearby.[Westwood Village Memorial Park, Los Angeles, CA]Robert Frost: I had a lover’s quarrel with the world.Photo by Mauro Lanari CC BY SA 3.0The line came from one of the four-time Pulitzer Prize-winning poet’s less-well-known works, “The Lesson for Today.” The proceeding line: “I would have written of me on my stone: I had a lover’s quarrel with the world.” Frost was, you might say, true to his word.[Old Bennington Cemetery, Bennington, VT]Frank Sinatra: The best is yet to come.Frank Sinatra’s Grave in Cathedral City, California, USA.Song lyric and final wish. (Admit it, you thought it’d be “I did it my way,” right?)[Desert Memorial Park, Palm Springs, CA]F. Scott Fitzgerald: So we beat on, boats against the current, borne back ceaselessly into the past.The grave of F. Scott Fitzgerald and Zelda Fitzgerald in St. Mary’s Catholic Cemetery in Rockville, Maryland. The quote is the final line of The Great Gatsby.The legendary closing line of the novelist’s greatest work, The Great Gatsby, would become his epitaph.[Old Saint Mary’s Catholic Church Cemetery, Rockville, MD]Ludolph van Ceulen: 3.14159265358979323846264338327950288Ludolph van CeulenThe German-Dutch mathematician was the first brainiac to calculate the value of Π (or pi) to 35 numbers. He was so stoked by his discovery that he decided to have those very digits etched into his tombstone.[Pieterskerk, Leiden, South Holland, Netherlands]Lucille Ball: You’ve Come HomeLucille Ball from the New York Sunday News.A touching double-entendre: The famous redhead was originally buried in Forest Lawn Memorial Park in Hollywood, but her ashes were moved in 2003 to her New York birthplace (residing in the same plot as her parents, grandparents, and brother).[Lakeview Cemetery, Jamestown, NY]Jesse James: Murdered by a traitor and a coward whose name is not worthy to appear here.Jesse James’ grave. Photo by IslandsEnd CC BY SA 3.0The man of which the gunslinger will not speak: Robert Ford, a member of his posse, who shot the unarmed outlaw in the back of the head, as he was cleaning a dusty picture above his mantel. The words etched into Ford’s tombstone would read: “The man who shot Jesse James.”[Mount Olivet Cemetery, Kearney, MO]Rita Hayworth: To yesterday’s companionship and tomorrow’s reunion.Grave of film actress and dancer Rita Hayworth at Holy Cross Cemetery in Culver City, California. Photo by IllaZilla CC BY SA 3.0Wonder which of her exes (James Hill, Dick Haymes, Prince Aly Khan, Orson Welles, or Edward C. Judson) the oft-married Forties sex symbol was thinking of when she came up with this tender sentiment?[Holy Cross Cemetery, Culver City, CA]Merv Griffin: I will not be right back after this message.Merv Griffin’s grave. Photo by RadioTripPictures CC BY 2.0The final sign-off for this talk show host — who, during his almost-25-year-run, interviewed everyone from Andy Warhol to Rosa Parks.[Westwood Village Memorial Park, Los Angeles, CA]1800s cowboy Clay Allison: He never killed a man that did not need killing.Sounds like a line from a John Ford western, right? Cattle rancher and gunfighter of the Old West, Allison had a rep for rowdiness, surviving several gunfights. Though it may be noted, this buckaroo had a “playful” side: A drunken Allison once rode his horse through town…wearing only a gun belt.[Robert Clay Allison Burial Site, Pecos, TX]Charles Bukowski: Don’t TryCharles Bukowski’s gravestone. Photo by Marika Bortolami CC By 2.0Two words the gritty novelist and poet would offer to aspiring writers about inspiration.Bukowski explained the phrase thusly: “Somebody asked me: ‘What do you do? How do you write, create?’ You don’t, I told them. You don’t try.”Bukowski artwork. Photo by Scottlbaker CC by 3.0“That’s very important: not to try, either for Cadillacs, creation or immortality.You wait, and if nothing happens, you wait some more.”[Green Hills Memorial Park, Rancho Palos Verdes, CA]HG Wells: Goddamn you all: I told you so.Boy, did he ever. Among the spot-on predictions that would see the light of day: television, email, genetic engineering, lasers, and the atomic bomb.The time machine and invisibility? Not so much. (Actually, Wells would be cremated, but he wanted these words to be his epitaph.)[Golders Green Crematorium, London]Read another story from us: “Don’t Try” – The Meaning Behind Charles Bukowski’s Gravestone EpitaphRest in peace? Hopefully. But these well-known figures weren’t about to enter The Great Beyond without having an iconic last word.
News | Medical 3-D Printing | August 08, 2019 RSNA and ACR to Collaborate on Landmark Medical 3D Printing Registry The Radiological Society of North America (RSNA) and the American College of Radiology (ACR) will launch a new medical… read more Video Player is loading.GE Cardiographe cardiac CT scanner at SCCT19Play VideoPlayMuteCurrent Time 0:00/Duration 0:38Loaded: 26.15%Stream Type LIVESeek to live, currently playing liveLIVERemaining Time -0:38 Playback Rate1xChaptersChaptersDescriptionsdescriptions off, selectedCaptionscaptions settings, opens captions settings dialogcaptions off, selectedAudio Trackdefault, selectedFullscreenThis is a modal window.Beginning of dialog window. 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News | PACS | August 08, 2019 NetDirector Launches Cloud-based PDF to DICOM Conversion Service NetDirector, a cloud-based data exchange and integration platform, has diversified their radiology automation options… read more Videos | CT Angiography (CTA) | August 07, 2019 VIDEO: Walk Around of a GE Cardiographe Dedicated Cardiac CT Scanner This is a quick walk around of the GE Healthcare Cardiographe dedicated cardiac CT system on display at the… read more News | PACS | August 09, 2019 Lake Medical Imaging Selects Infinitt for Multi-site RIS/PACS Infinitt North America will be implementing Infinitt RIS (radiology information system)/PACS (picture archiving and… read more News | Artificial Intelligence | August 08, 2019 Half of Hospital Decision Makers Plan to Invest in AI by 2021 August 8, 2019 — A recent study conducted by Olive AI explores how hospital leaders are responding to the imperative read more Siemens Go.Top CT scanner at SCCT19Video Player is loading.Play VideoPlayMuteCurrent Time 0:00/Duration 1:05Loaded: 15.14%Stream Type LIVESeek to live, currently playing liveLIVERemaining Time -1:05 Playback Rate1xChaptersChaptersDescriptionsdescriptions off, selectedCaptionscaptions settings, opens captions settings dialogcaptions off, selectedAudio Trackdefault, selectedFullscreenThis is a modal window.Beginning of dialog window. 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The CT scanner might not come with protocols that are adequate for each hospital situation, so at Phoenix Children’s Hospital they designed their own protocols, said Dianna Bardo, M.D., director of body MR and co-director of the 3D Innovation Lab at Phoenix Children’s. Feature | November 10, 2010 | Heather A. Brown, Ph.D. A Guide to Building a Successful 3-D Program Covering all the bases is key when implementing 3-D Sponsored Content | Case Study | Radiation Dose Management | August 13, 2019 The Challenge of Pediatric Radiation Dose Management Radiation dose management is central to child patient safety. Medical imaging plays an increasing role in the accurate… read more Videos | CT Angiography (CTA) | August 07, 2019 VIDEO: Walk Around of a Siemens Go.Top Dedicated Cardiac Scanner This is a quick walk around of the new Siemens Somatom Go.top cardiovascular edition compact computed tomography (CT) read more Technology | Neuro Imaging | August 07, 2019 Synaptive Medical Launches Modus Plan With Automated Tractography Segmentation Synaptive Medical announced the U.S. launch and availability of Modus Plan featuring BrightMatter AutoSeg. This release… read more Technology | Cybersecurity | August 07, 2019 ScImage Introduces PICOM ModalityGuard for Cybersecurity ScImage Inc. is bridging the gap between security and functionality with the introduction of the PICOM ModalityGuard…. read more The turn of the century has brought disruptive technological changes to the medical industry. 3-D/4-D advanced visualization offered cutting-edge technology that introduced a new dimension of glitz to the radiology department. No hospital purchased a 64-slice computed tomography (CT) scanner without a 3-D workstation included.However, many institutions have learned that a successful 3-D program — one that offers an edge on the competition — requires more than installing 3-D software in the CT department. In fact, many of those very promising 3-D workstations now collect dust in the corner as they sit unused, for many reasons. This article will outline a framework for imaging directors to consider as they utilize the exciting technology of advanced visualization to their department’s benefit.Enterprise is a Must Some radiologists minimize the use of 3-D imaging, because they are trained to examine 2-D images and reconstruct 3-D images in their minds. While studies show that 3-D visualization improves diagnosis, many successful 3-D programs are geared more towards the referring physician than the radiologist.Clinicians greatly appreciate post-processed images that reveal critical findings in an intuitive view. For example, a 3-D rendering can show the proximity of blood vessels to a tumor, a complex fracture or the degree of stenosis for treatment decision-making. Appropriately rendered 3-D images can change a surgeon’s approach to a complicated procedure and can even decrease surgical times and improve patient outcomes. Furthermore, clinicians frequently review 3-D images with patients because they provide an educational tool.Successful 3-D imaging programs serve numerous end-users, including radiologists, cardiologists, orthopedists and more. Radiologists will want access from their reading station; a surgeon may want access from the operating room (OR) and a cardiologist may need to read a case remotely.Delivery of the appropriate images begins with a flexible architecture that can accommodate many levels of use, both inside and outside the institution. A dedicated workstation offers little in the sense of efficiency. Some vendors have tried to retrofit workstations with remote log-in tools, such as Citrix or add-on client/server components. But a true unified client/server system allows designated users to access and manipulate data easily and efficiently as necessary to maintain the patient’s continuum of care.A director planning the implementation of a 3-D program not only has to consider what software they purchase, but also who has access. Scalability is a critical aspect of any enterprise system. Client/server systems are based on a centralized processing server with multiple access points. Either the number of concurrent users or number of slices loaded becomes a limiting factor.Depending on the architecture of the system, hardware might have to be purchased for each concurrent user. Directors investigating enterprise systems should understand the hardware architecture, proprietary nature of the hardware, associated maintenance and licensing costs, and bandwidth constraints for remote access.Lastly, a truly virtual system should offer the ability to share a session so that multiple users can log in simultaneously to view and interact with a case. With Web-sharing capability, which requires no client software to be installed, clinicians can get a quick consult with a radiologist when they can’t physically go to the radiology department. This improved communication and access to radiology allows both physicians to better understand the case and ultimately improves patient outcomes. Other areas of collaboration include tumor boards, acute stroke decision-making and endovascular presurgical planning.Workflow Issue With the appropriate software system in place, multiple levels of interaction will occur, including basic viewing to more advanced usage. The most common model for a 3-D program is to have technologist super-users — either in the computed tomography (CT) department or a centralized 3-D lab — perform initial post-processing. They can save a series of images to the picture archiving and communications system (PACS) and/or save the processed case in the system so any physician can resume workflow to maximize efficiency.History has proven 3-D software alone does not create a successful advanced visualization program. As this cutting-edge technology stormed into imaging departments promising amazing multicolored, dynamic anatomical renderings, users quickly found it takes time to learn how to use the tools and become proficient.Training is a critical step in establishing a program; basic vendor applications training will not be enough. Technologists need to understand the anatomy, pathology and processing tools they are using to generate each image. Without a champion physician who is willing to act as a resource, the techs will be left on their own to create what they think may be useful.Both the physician and the technologist have to be committed to working together, especially in the beginning. Directors should look for services that help align what the physicians need and then teach the technologists how to generate the images.Establishing post-processing protocols is essential for a technologist-driven 3-D program. By having protocols for specific types of cases, technologists know exactly what to produce (maximum-intensity projections [MIPs], curved vessel views and 3-D rotations), and physicians can rely on receiving a consistent set of images every time. Protocols can also be tailored to support referring physicians.A system that can be customized with user-defined protocols will help drive consistency and quality. User-defined palettes can align the most frequently used tools for streamlined workflow. Macros can assemble commonly used sequences of functions into a single button click. A single “one-size-fits-all” interface will not meet the multitude of needs placed on an enterprise system; a flexible interface can be adapted for many different users and study types.Budgeting for 3-D Capital Expenditure Imaging directors immediately begin a return-on-investment (ROI) analysis when they hear the term “capital expense.” The majority of 3-D visualization is for computed tomography angiography (CTA) exams where the post-processing is bundled in the Medicare current procedural terminology (CPT) code. Therefore, directors should consider other factors in their justification for 3-D software. Can the capital expenditure be offset by increased scanner throughput, consolidation of disparate software systems and increased program success? Are other financial models available?- Increased scanner throughput — With 6,000 CT scanners in the United States, nearly every medium- to large-size hospital now has a 64-slice CT scanner offering CTA exams. Referring physicians may develop loyalty to a specific institution if they can depend on state-of-the-art 3-D images that assist them in their patient care (e.g., presurgical planning, post-treatment surveillance, patient education).While 3-D processing for vascular imaging is not reimbursable, departments make money on increased throughput with improving physician loyalty. High quality and efficient delivery of 3-D imaging may influence where clinicians send patients for imaging.The vast majority of advanced visualization performed does not get reimbursed directly, but is instead a required component of the bundled CTA charge. (See section below on 3-D reimbursements.) However, there is a CPT code for nonvascular exams that can earn substantial reimbursement. The CPT code, 76377, reimburses approximately $100 per case above and beyond the reimbursement for the scan.This is most frequently used on orthopedic CT exams. An orthopedic surgeon may greatly appreciate a 3-D reconstruction of a comminuted fracture for presurgical planning. By marketing 3-D services for nonvascular exams, imaging centers may benefit from both increased scan volumes and 3-D reimbursement.- Consolidation of software — Directors of radiology are faced with ongoing maintenance and upgrade costs of numerous software platforms across multiple modalities. These computers are often scattered throughout the department or hospital, creating disparate islands of information, causing bottlenecks in workflow and forcing doctors to move from one computer to another to access a single patient’s data.Directors should take an inventory of their current software products. The price of upgrading to an all-encompassing enterprise-wide software system can be offset by the reduction in annual maintenance costs of the systems it replaces. The ideal software solution should be vendor-neutral, multimodality and application-rich.- Increased program success — Hospitals garner recognition from services such as stroke, trauma and cardiovascular programs. In order for these programs to be successful, the right people have to access the right data at the right time. For example, CT perfusion imaging is required to support level 1 stroke programs. This may be one of the most challenging to implement.The decision-making process on whether to use tissue plasminogen activator (tPA) treatment is often multitiered, requiring more than one physician to access and interpret the data in a matter of minutes. Knowing that every second counts for the stroke patient, these programs must have a defined workflow with easily accessible software to meet the demands of extreme high-speed turnaround.- Purchasing an enterprise solution with no capital — A major barrier to purchasing an enterprise software system is the capital expenditure and recurring software maintenance costs. By exploring leasing, “software as a service” and other payment options, the cost of 3-D software can be transferred to the operational budget where it is more easily justified.In the current economic climate, many institutions have constrained budgets with capital freezes, seemingly eliminating the opportunity to upgrade to an enterprise solution. Software companies have begun circumventing a lack of capital with more flexible budgeting options. Financially-savvy directors should explore all cost models in their preliminary investigation of software vendors.Conclusion Many factors play into the success of a 3-D program. Directors should:- Set goals for 3-D service, such as establishing new programs (e.g., cardiac) or increasing physician loyalty.- Be proactive in selecting their software systems and not simply accept the cost of the workstation when they purchase major equipment.- Take inventory of the existing software systems and evaluate which can be consolidated with an enterprise system.- Designate both technologist and physician champions to establish protocols and workflow that will meet the goals of the 3-D program.- Budget for and establish a training plan for the technologists who will be performing the majority of the post-processing.- Create a marketing plan to promote 3-D services to clinicians.Cracking the Codes for Reimbursement Reimbursement for post-processing is dependent on the type of CT or magnetic resonance (MR) scan involved. Any CT angiography (CTA) or MRA scan requires that image post-processing be performed as described in the Medicare current procedural terminology (CPT) codes (see example 70498 below). For non-CTA/MRA exams, 3-D post-processing may be reimbursed independently from the scan itself (see 76377 below).Proper documentation for reimbursement of 76377 includes: 1. written order for the referring physician for 3-D processing; or 2. radiologist dictates that 3-D was necessary for interpretation of the exam.- 70498 CT Angiography, Neck – CTA, neck, with contrast material(s), including noncontrast images, if performed, and image post-processing.- 76377 3-D Rendering with Post-Process – 3-D rendering with interpretation and reporting of CT, MRI, ultrasound or other tomographic modality, requiring image post-processing on an independent workstation.Heather A. Brown, Ph.D., assistant professor at Jefferson Community and Technical College, Louisville, Ky., has developed the only college-accredited program for volumetric medical imaging. She manages the clinical team at Ziosoft Inc., whose mission is to help customers develop successful tech-based 3-D programs. FacebookTwitterLinkedInPrint分享 News | CT Angiography (CTA) | August 06, 2019 Artificial Intelligence Improves Heart Attack Risk Assessment When used with a common heart scan, machine learning, a type of artificial intelligence (AI), does better than… read more