Good afternoon, everyone. We're just going to give it a moment for our participants to join for today's webinar. Just going to wait about another 10 seconds. Good afternoon, everyone. Welcome to today's webinar that is supported from Cardinal Health. We're going to discuss today the advantages to optimizing your nuclear cardiology spec lab. My name is Jamie Warren. I am part of the MedAxium team, and I am joined by two excellent speakers and also my peer Anna. Our speakers today are Anne Marie, who is the system vice president of Heart and Vascular Institute at Norton Healthcare, and Tony, who is the director of noninvasive cardiology at Baptist Health Lexington. Just a few housekeeping items. You'll notice at the bottom of your screen that you do have the option to click on chat. This is where you will see the link to be able to download today's presentation. But if you'd like to ask a question, please head over and click on that green button there to send your questions for the Q&A, and that will at any time during the presentation, we will join these questions once we get to the end. For today, ourselves and our speakers have no disclosures. And we're going to start to hand this over to Anne Marie to describe her program. Good afternoon, everyone, and thank you for joining. Again, my name is Anne Marie Hollis-Dreips, and I am the system vice president for Norton Heart and Vascular Institute. We are a full-service cardiac healthcare system with seven full-service locations, and we have multiple ambulatory sites throughout the state of Kentucky and also southern Indiana. Currently, we're offering traditional SPECT and PET-CT. Our SPECT is available at all of our locations, and our PET-CT is available at our ambulatory sites as well as one of our hospitals, which is located in downtown Louisville. Currently, we do not have access to SPECT-CT for cardiac imaging. Again, we perform traditional, including rest stress SPECT for cardiac, MUGAs, SPECT-CT for amyloid and sarcoid, PET-CT for stress perfusion, myocardial blood flow for viability when requested. We also do FDG for viability, breast perfusion FDG for inflammation assessment for cardiomyopathy. Now we have a multitude of different types of cameras. We have a mixture of vendors, again, so we are not vendor-specific, but all of them are able to perform these studies at any given time. Again, we have our multiple outpatient locations where we are performing our rest stress. And then in the hospitals, we have our PET-CT, and then we also have the one outpatient diagnostic center. So, as we continue to evaluate and we look at the structure of nuclear medicine, again, looking at cardiac CTA with FFR, people, it is always said that nuclear medicine was going to be going away with these implementations of cardiac MRI and cardiac CTA with FFR and heart plaque analysis. We have not found that to necessarily be the truth here at Norton HealthCare. Again, we have a very robust cardiac program, and we do recognize that there are patients who are specific who are not able to have cardiac MRI due to implants or cardiac CTA with FFR due to incision sites based on having CABG open-heart surgery and the artifact that that causes over the sternal and shrouding over the heart. So, again, I am a nuclear medicine technologist for 30 years, so I am always a proponent that we have heard that nuclear medicine will go away at some point, and I have always been the proponent that there is always going to be an aspect of nuclear medicine cardiology that is going to be needed for our patients. Now, as we look at our structure and we look at capital, and we all know that capital is at a premium, and we also know that space constraints are also a premium. So looking at as we are replacing equipment, what is our strategic plan of replacement? And so we are looking at SPECT-CT. There are SPECT-CTs that are a smaller footprint than the current models that we have for nuclear medicine, and how would we utilize SPECT-CT as an option as part of that replacement strategy? We work very, very closely with our radiology department here at Norton HealthCare, and we have a very collegial relationship. So when we started our CTA program, that relationship really blossomed that we feel that we are at the point that replacing equipment with SPECT-CT would offer us that relationship of being able to have cardiologists reading the SPECT nuclear portion, and then having our radiologists also be able to read that CT portion for a nice overlay infusion to get results for our patients. Again, as we continue to look at the population of our patients here, looking at body habitus, looking at other modalities, and what can we find as far as incidentals, which has been coming up a lot, looking at our replacement strategy for SPECT-CT is something that we continue to find value in. As we move through the process and looking first at our outpatient location, we can replace two of our nuclear medicine traditional cameras with one SPECT-CT. That will allow us to do the same amount of patients, if not more patients, on a daily basis based on protocols and based on efficiencies that a SPECT-CT would allow us. As, again, we look at capacity, we look at convenience for our providers and for our patients, as we look at footprint, because we're not getting a new footprint, how do we take all of this into consideration as we start to look at our aging equipment and how we're going to replace them? We do have an amazing physician champion who also is invested in looking at the types of modalities, looking at what we need based on our patient population, looking at, again, how do we advance, which we are doing amyloid and sarcoid, and how do we bring that together where that we are looking at cost efficiencies and how do we get the biggest bang for our buck on precious capital dollars that is going to allow us to expand our program and is also going to create, again, better efficiencies and create capacity as well. These are some of the things that when we are putting together our business proposal and looking at our performa of having capital dollars available of how are we spending those wisely. So those are some of the things, again, that we are looking at as we are considering moving forward in this current process. Now, when we've reached out to other health care systems who have replaced equipment with the SPECT-CT, that has offered us some insight as well on the types of procedures that we're able to do, again, the efficiency of how many cases that you can do per day, and we found that other health care systems that we have reached out to has had great success in replacing those traditional SPECT with SPECT-CT, also being very cognizant that our PET-CT is not only used for cardiac, but it's also used for oncology. We have an extremely large cancer institute here at Norton Health Care. So getting those time slots on a PET-CT has also been, I would say, somewhat of a negotiation of as oncology slots have increased and we are asking and putting in demand on having increased PET-CT, again, having another option of are we able to get the same answers for our providers to create that medical treatment program for their patients with a SPECT-CT that they would be able to get on a PET-CT as well. Sometimes the answer is yes, we can. Sometimes the answer is no, but for those types of acuities and diagnoses and treatment plans that our physicians are looking for, anything that is a yes, that a PET-CT or a SPECT-CT is viable to get them their answers. We then look at, again, in that business performa, saying based on our capacity constraints on the PET-CT, because it is not dedicated to cardiology, here is another viable option that we can, again, create capacity without compromising quality, because that is first and foremost. You don't want to compromise quality when you're scanning patients to get them answers and diagnoses that we are then able to build our business proposal on replacing traditional nuclear medicine cameras with a SPECT-CT. We are all very, very much aware that anything that is being done in a shared service where other service lines, whether it be oncology or orthopedics or trying to get into a traditional hospital setting, to be able to get time slots for patients for cardiac studies is at a premium. How are you creative with what you have control over that is dedicated in your space and being able to, with those capital dollars, being able to replace that equipment in a way that, again, will be able to increase that capacity and, again, a creative way to get those answers for your providers and not being totally dependent and reliant on those other modalities that are, again, expected to be shared with other service lines as well. So, we have found, and we do have a business plan in PERFORMA that is going through the capital phasing approval to, again, start at our downtown facility where our aged-out nuclear medicine cameras in 2025 will be replaced with a SPECT-CT. We also have on the outpatient side where two of our nuclear traditional SPECT cameras in one of our outpatient clinics will be able to be replaced with one SPECT-CT. Again, not only keeping the capacity that we currently have, but actually increasing that capacity, particularly on the outpatient side because that is under the full purview of the Institute and we are able to control those time slots. So, I would have you think, again, as you're looking at these replacements, key drivers. You need to have a physician champion. A physician champion is an absolute must. Do not, from an administrative level, make decisions in a vacuum. You need to have that administrative and that MD champion to be able to move these processes forward and to be able to explain in your business plan, coupled with your capital PERFORMA, what makes the best sense for your service line or your location, whether it be in a hospital, which can be inpatient, outpatient, or whether it be strictly in an outpatient setting. Now, with that, I will let you know, our outpatient settings are hospital departments. So, they are an extension of the hospital. They are not freestanding. So, again, it is that conversation with the hospital, as well, for what makes the most sense of where you are going to put these machines. Our ultimate goal in our five-year plan, because we do a strategic capital plan and strategic heart and vascular service line plan for two and five years, is within five years, as we do our capital expenditures, to replace all of our traditional SPECT cameras with SPECT CT. We, again, have a growing population, particularly here in the state of Kentucky, where, again, not only having what we're calling the silver tsunami of baby boomers that are going to be increasing and needing medical care, but in the state of Kentucky, again, high smoking rate, a lot of sedentary patients, a lot of cardiac disease. I am from the state of Michigan, and I would laugh and say the Midwestern diet is real because we put gravy on everything. I have also learned that the Kentucky diet is real because we fry everything here. So, we are not at a lack of patients who are going to need our services from all health care systems within the state of Kentucky. So, how are we looking at our population, looking at our projected growth in medical needs within cardiology, and creating that capacity in unique ways, knowing that we are not going to necessarily get more bricks and mortar space, but how do you utilize the space and the equipment that you have in order to creatively create that capacity, knowing what is coming? So, those are some things from our standpoint here at Norton HealthCare that we have been looking at, that we are putting together, how we are making these decisions in partnership with our hospital, with our medical group colleagues, and having that physician champion that is really driving the decisions that are being made as well. Thank you, Ann Marie. Tony, we're going to turn it over to you. Talk about your program in Lexington. Sure. Again, I'm the Director of Noninvasive Cardiology, and what that means is I have under me cardiac ultrasound, echocardiography, vascular ultrasound, all stress testing, including nuclear cardiology and cardiac rehab. We're a nine-hospital system, and Baptist Health Lexington itself offers noninvasive services in six different locations, three of them which offer some type of nuclear stress testing. Here at the main campus where the hospital is, we have SPECT-CT and PET-CT, and then at our newest outpatient facility, Baptist Health Hamburg, we have a SPECT-CT camera, and our third nuclear location is a quite aged camera, and it's our only SPECT-only machine. We also offer CTA at two of our campuses, and CTA with FFR, which is just exploding in volume, and it was interesting because I had a conversation with one of my cardiologists recently and told him that I feel like he was single-handedly trying to kill my nuclear volume, and he made a point of stating that the advantage is that CTA is only for certain patient types, like once they have known disease, they don't need a CTA anymore. They're the ones that are going to continue to get our SPECT camera, so as Anne-Marie said, there is still going to be plenty of work for each of these modalities in the foreseeable future. There's always talk that one modality or another is going to replace one, and it just doesn't happen. We have a need for all these so we can continue to take care of our patients. In our PET-CT world, we are just getting ready, well, PET and SPECT, just getting ready to start amyloid testing and sarcoidosis testing, so those are going to be new to us, and our latest facility, which is where I've had the most experience with selecting and purchasing a nuclear camera, because my background is in cardiac ultrasound, although I've been involved in like a breadth of non-invasive cardiology services for the last 15 years. My first, well, one of my first real chances at going through the options and selecting a SPECT camera was at our new facility. Just to tag on a couple of things that Anne-Marie said, or one, that anytime you want to make a change, whether it's in equipment or vendors or whatever, a physician champion is definitely necessary, because if you don't have a physician driving it, that's not going to be a good thing. Because if you don't have a physician driving it, then it's just your department saying, we have this need. Administration is going to listen a lot better if you have a physician champion along with your business partners for presenting your case. And I think that's all I have for my initial introduction. Thank you both. That was very informative and lots of useful information. Thank you. So really quick, my name is Anna Mercurio. I am one of Jamie's colleagues, and I'm excited to be here. I had the pleasure of meeting with both Anne-Marie and Tony, trying to understand the decision-making process. And then as a previous administrator of a large cardiovascular practice, it's always interesting, right? Like, you know, I'm a cardiologist, I'm a cardiologist, and I'm cardiovascular practice. It's always interesting, right? Like where the conversation starts and how the decisions are made and who gets involved. So this is incredibly useful, a great learning process for all of us. So with that, I'd love to know what the pain points in driving to your decision was for each of you. I would say location, location, location. Because once you start looking at replacing equipment and replacing it with something that is new to the healthcare system, everybody wants to be the first to have it. So again, you know, looking at how did we have the inpatient side, how are we looking at the outpatient side? Our downtown campus is in downtown Louisville. It is probably within two miles, you can go across the bridge into Indiana. We have three hospitals that are in Southern Indiana. Two of them are very, very close in proximity. One, you could probably stand on the top of our downtown hospital and look across the river and see our Indiana hospital. But as I've learned coming here is the Ohio River might as well be 500 miles across because people don't necessarily like to cross the river. But what we also looked at is how do you make that decision of a destination? And so that downtown campus, which is the first camera that we are going to replace, is going to be a destination that is not only going to serve that regional area of downtown Louisville, but on Monday, November 11th, we are also opening our Norton West Louisville hospital. So that will also be able to be a nice feeder from that hospital to downtown. And then when you look at our hospital across the river in Southern Indiana, again, it's literally five miles, but patients will be able to in Southern Indiana also have the opportunity to be able to have their care still within Norton Healthcare and to be able to have this kind of technology. So that again, when we looked at what is the biggest bang for the buck, somebody has to be first, somebody is going to be unhappy they weren't first, but we have the plan of who's second, third, fourth, fifth, moving on through. From a hospital standpoint, that is how we particularly chose to replace that first camera at our downtown campus. Looking then what is our outpatient? Again, our outpatient centers are extremely robust. So how do you again, between the hospital side and the medical group side of saying who's first, I would like to have this technology saying, okay, if we're looking at this hospital as the first one, let's look at our outpatient center, which is very, very robust. We do have the aging of equipment that again, went into the timing of this as well and making the decision and having in a hospital setting and then having that outpatient setting going next. So those were some of the things that we looked at, age of equipment, location, patient demographics, into going ahead and making that decision of location and who was to go first. So some of the other things about pain points are if we're talking about replacement versus new, because both are completely different selling points. As the machines get, like one of my cameras will be nearing end of life within another couple of years. And you have space, when you're talking about replacement or new, you have space limitations, depending on where you are in a building, you may have weight limitations. And then if you're going to replace the camera, does the volume at that location justify the money spent to create it, to add a new camera into that location, or do you need to move or rethink about what to do with that spot? And I think replacement is generally easier because you have volume, you have historic volume. Whereas if you're going to try to add a new camera in a brand new location, well you've got to, then you're into volume projecting. And if you're moving into an area that somebody's already had, you already have competition there, it's a little tougher to justify, especially nuclear cameras aren't cheap. And then when you add the construction for it and, you know, your lead lining and your hot labs, and there's a lot more around a nuclear camera that you need rather than just opening an echo lab where you just need a room. The justification of the space, justification of all the construction, everything that comes involved with a nuclear camera adds to your dollar signs. So you have to put a lot more effort into the projected volumes, whereas on the replacement you've got historic volumes. And then you have to determine, as I was listening to Anne-Marie, I'm thinking, you know, one of our other issues is, do you put your business plan first or do you select your equipment first? And the answer, so it's a chicken or the egg kind of thing, and the answer is both. Because you can't put a machine into every location because the machines can be heavy. And some of them have a bit greater space needs than others. So you've got to have an idea of what machine you're going to put into that location, plus you have to, if you're justifying dollars, which is what it boils down to, you've got to have quotes built into your pricing. So I think one of our pain points, one of the initial ones, is determining what equipment is going to best suit the needs of where you're going, and not just for the near future, for the long future. Is it going to be like, in my case, all my machines are dedicated cardiac. So if you're building a new facility or adding a new camera to a new place, is it going to be dedicated cardiac? If so, are you going to have the volume for that? And are you going to go with SPECT or SPECT-CT, or one of the newer machines that are CCT that have great imaging, but then potentially BMI issues? Interesting. Well, that was great and very insightful, although with all the new weight meds, the BMI may not be as big of an issue in the future, but I'm glad you brought up the dollar. Sorry, Jamie. I know we jumped for it, but I have a quick question about the chick and the egg. So did you guys budget first and then look into what the plan was, or did you guys look into it and then budget? Which came first? We quite honestly looked at it at the same time. So we were doing things in parallel to say, what is the equipment that is on the market? What is the equipment that would meet our needs? What, again, as we look at the space, again, our West Louisville hospital that is opening is not going to have nuclear medicine at it, specifically looking at what Tony said with having a hot lab, nuclear regulatory commission regulations, those types of things, knowing the proximity of that hospital to our downtown location, it was a conscious decision not to put any kind of nuclear medicine, cardiac, or even general nuclear medicine into that location because of that proximity. So where do you save your dollars where you can to then reinvest in other projects? So we tried to do things in parallel to say, okay, if we're looking at putting this business plan proposal, what does that mean? What are we going to have to have as far as space? We have an issue at some of our hospitals with infrastructure in, do you have enough electric power, even to power these types of new machines because of the age of the hospital? But also saying, okay, if we're moving forward, where are we at with where we can put things? What are our barriers? What are our opportunities? But we also need to know, what is this going to cost us? Because you can replace a nuclear camera with a new camera if you're at a high volume facility, or we've even in our outpatient facility, we replaced a nuclear camera with a refurbished camera just knowing based on our volume, we can spend this, it's the exact same camera, it's refurbished. This is going to meet our needs based on volume compared to, yes, we truly need to spend the money over here on a brand new piece of equipment because of the churn and burn. So we really went parallel of what is going to be our barriers and is this even worth looking at further, but we also need to know what is this going to cost us in equipment and then everything else that's going to be tied into it. So we really tried to do a parallel approach. Yes, I agree with that. It's interesting. Listen, again, listen, Anne-Marie, because as a system level, she has a lot more breadth that she has to worry about. So she has to be a lot more strategic about what she looks at. And my focus is a lot more singular. It's our hospital, our department, our growth, we have a singular focus. And I've had a system role and I appreciate the breadth that she needs to look at. But back to the chicken versus the egg question, and my short answer to that is nothing is done in a silo. You have to look at everything at once. So you need a gathering of experts. There's probably a better term for it. So you need a team looking at the equipment, figuring out what the equipment is going to be best for the area, for what you're replacing, for the area you're moving into, what will fit the space, what will fit the budget, what will perform the procedures that you're going to want performed. But at the same time, like I would be working with my system, my local and my system business partners and starting a business plan, an overall plan. And at some point, they all have to mesh together into a single business plan, but I would have to work multiple avenues at once to get to where we need to be. Yeah, thank you. It's incredibly complicated. So I appreciate the insight from both of you guys from the different perspective. But at the end of the day, it's still the decision making process. That's great. So jumping into the next question, what was the aha moment that's come out of both of your programs in this process? I think, again, our aha moment is understanding if you're replacing a piece of equipment, what do you need in order for that equipment to fit in space that you currently have? Because again, you're not getting new space. Our aha moment, again, was things that you don't necessarily think about as far as electrical grids and is it able to support this new equipment out and what are the specs and requirements for this equipment to be hooked up with something that when we looked at our various facilities, because they are various aged buildings, that you can't just, again, think, well, this is a plug and play. You take one out, you put one in. There's HVAC considerations. There's sometimes construction dollars that you wouldn't have expected that suddenly you have to consider. So I think those are some of the things where you can't be myopic and, well, I already have a nuclear camera in here, so we're just going to unplug it, deinstall, install this, plug it in, hook it up to your network, and we're good to go. So I think always be mindful when you're putting together those business proposals that you have that information because you can't go back to the well twice. If you have a business proposal and everything that you think is included is in it and it gets approved and then suddenly you have these aha moments of construction or HVAC or other things, it's really difficult to go back and try to explain that and try to get that additional funding. Again, are there other considerations? And I did see in the Q&A a question about CON. Yes, Kentucky is a CON state. So you have to take into consideration, you know, what is your plan B if for some reason the CON for equipment that you're looking at putting in isn't approved? So those, again, no regulations of your state, which is different for us. We have to be cognizant, yes, Kentucky is a CON state. Are hospitals in Indiana? No, they don't have that requirement. Indiana does not have a CON. So again, when you think strategically in location, where does it make sense and what are these things outside of just that myopic thinking of, well, I have a room with a piece of equipment, I'm going to take the equipment out, I'm going to put this equipment in and then not looking at every single thing that is involved. So I have two aha moments that have happened to me at two different facilities in growing the nuclear program. And one is at my last facility, we were staged to put a camera. We were, our system had purchased in what it was actually an old post office and was turning it into a health complex, a health park, so to speak. And we had pre-selected the nuclear camera that was going to go into the space. And within a couple of months before installation, because you plan these for a long time, we found out that the camera was going to be too heavy for the space. So and our structural engineers or whoever the people are that do that, they were like, oops, you guys have a problem. And we looked at other cameras and other options, and we actually determined it was less expensive to strengthen that floor and build up that floor so it could hold the camera in it than to relocate the camera or change the camera. But that was just a, I was fairly new at that place, and it was one of those pieces of due diligence that somehow it missed, there was a gap there. Another one, it was for the opening of a new, our new facility that a year and a half earlier. And again, this was before I started here, which doesn't mean to blame anybody, but it's when you're building a new place, you start like these take years to get open and built. And it's a full medical complex, or a huge outpatient facility with a freestanding ED. And we were staged, we knew what equipment we were going to put in. And then we found out that one of our vendors actually had a new machine that they were going to release before we opened. And Anne-Marie had talked about the time for study and during her intro. This machine, this camera, it's a spec CT, can do the imaging for nuclear stress in a third the time. So now instead of 15 to 20 minutes on a camera, our patients are five to seven minutes on a camera. And I was like, wait a minute, why am I buying this one if I can get this one? So I think the aha moment is there is even once you select your vendor, make sure you stay in touch with them. So if they have a later and greater coming out, you may or may not want to switch to it because some people don't like to buy, you know, the latest and greatest equipment in year one, because like the first year of a car, the first year of a camera, the first year of an ultrasound machine can have complications. But in this case, we jumped at the opportunity to get the latest and greatest for this and have not regretted. So that aha moment is just to make sure you stay in touch, even though you've selected it, because once you have all your plans put together, your business plan submitted, depending on the timelines and the acceptance period, it could be months to a year or so before final approval happens, especially when you're talking a huge budget. So stay in touch with your vendors to make sure you are, if you're spending a big purchase, you're repurchasing and getting the most bang for your buck. We can go to the next slide, please. So earlier in the discussion, we talked about stakeholders and especially with making sure you have an involved medical director, but I'll ask our panel, was there anybody that was surprising to you that you would recommend having at the table when you have these discussions for a replacement or a new purchase of a spec camera? I would say have your clinical engineers, your biomed, again, that was part of our aha moment is when you look at the infrastructure of the room or what is needed for the room for the new pieces of equipment and the specs and the connections and any kind of construction. I would say, you know, having a project manager assigned to you early so that you have people who are looking at the room space as you're looking at the actual equipment and how it will be utilized, I think is, again, really important. Again, we have our radiology partners. So again, anytime you're looking at bringing something on that will involve others outside of your department that you would be reaching out to for any kind of overreads and things like that, not springing it on them saying, oh, we've replaced this equipment, we're now doing spec CTs, so you're now going to see more volume and we're asking you to do these overreads and they may or may not have the capacity of radiologists to be able to do that. So really think through the entire process from start to finish, whether it be regarding the room and the actual replacement or building of the room to be able to house the equipment that is being chosen, but then again, on the back end, once the patient has actually had their testing done, who is involved in that as well and making sure that they understand what may be coming down to them and that they have the capacity or what will it take for them to be able to be in this partnership to get these studies read. There are a wealth of stakeholders you need to plan for this. Admin, finance, I couldn't put a business plan together without my financial directors because I'm clinical. Biomed, engineering, environmental services, if I'm just replacing a machine, I don't need as many people, but if it's a machine in a new facility, it just adds to the number of people. I don't know if the right word is surprise, but two of my key stakeholders, one is going to be my staff. I don't have a nuclear background and my running joke is I know enough about nuclear to be annoying, but my nuclear department, between six nuclear techs, we have 140 years of experience. There is a wealth of knowledge that I will never acquire. When I'm talking equipment, when I'm talking process, when I'm talking space, when I'm talking the path they have to walk between getting from the control room to the camera room, to the hot lab, to your nuclear sub weight room, to the stress room. The path you have to walk and just to make sure your processes are built into your business plan, not actually into the business plan, but you've got to have your process people engaged so that those of us that are not involved in the day-to-day operations don't sit back and pretend like we know how the department works. We need to engage the staff that are doing the work and say, if we design it this way, does this work for you? The other stakeholder that we've used at this facility is patients. We have gathered a group of patients and sat them down and said, this is what we're talking about doing for new construction. This is what we're talking about doing in this location. What are your thoughts? Well, some people hate the location. Some people love the location. Some people think across the street is better. You ask a dozen patients their opinions and you're going to get some crazy opinions, but what you're also going to get is community buy-in for your project because they're going to talk to whoever else they met. Now, all of a sudden, they realize they matter. My two surprise stakeholders are going to be the team that does the work of the business and the patients that might be affected by the decisions we make. Well, as we start to wrap up for this webinar, we're very curious to see the lessons learned that you would share with other administrators who are getting ready to undergo this journey of replacing or purchasing a new spec camera. Any lessons, nuggets that you would provide to them? I would say, again, data, data, data, financial data, population data, location data, and choosing where these cameras are going to go. I think that's important. Don't have a preconceived notion as the administrator of what you think needs to happen or where things need to go. Be open and guide and facilitate the conversation, but really listen to your key stakeholders and come to that decision as a group. So, ditto on the data, but also another stakeholder, I guess I should have mentioned, is our vendor. Once we select the vendors, whether it's, since we're talking about nuclear, whether it's the equipment vendor or the isotope vendor, you want a good partner. And it's interesting because I have, through most of my career, I've been what I call vendor neutral. And just really in the last couple years, I have started working with certain vendors whose service, because customer service, like if you have equipment problems, because we're all going to have equipment problems at some point or software glitches or whatever, you want to be, you want your equipment to be taken care of. You want to be, you want great, you want excellent customer service from whatever vendor you're working with. And just in the last couple years, I have seen a huge difference in the level of service that different vendors will provide. And vendor A may have a slightly more expensive machine, but you know vendor A, once the machine's in place, is going to be for you, there for you at the drop of a hat or realistically within a day or same day to come and get you repaired and get you operational. And service down the road is just as important as the equipment you pick and the vendor you select because getting operational is one thing. Staying operational so that you can then take care of the patients you want to take care of, because as Emory said at the beginning, that's our main goal, is to take care of the patients. But second, you need to get revenue out of that camera so you can continue to make, take care of your patients. So you've got to stay operational and you want to find vendors that are going to be excellent long-term partners to work with your facility. So I think that's my biggest lesson learned, is to make sure I pay attention to the history of the vendors that we're selecting or trying to work with. Well thank you both, that was great. And Tony, I do appreciate you mentioning the often overlooked stakeholders, the patients, and then most importantly, the staff. I like your point about the 170 years of experience. We often don't take advantage of those resources that are most important. So overall though, that was great. Again, this is not my world, but I appreciate having learned from listening to both of you guys, the perspective and the depth that you guys bring. It's incredibly, it actually just reminds me how complicated all of our jobs are, right? And how, why it's so important that we all work well together, and are transparent about what's happening, because there's just so many variables in every aspect of our work, that it's just, you know, critical, the working well together, right? And being transparent. But thank you both, this has been great. I appreciate both of you guys. We're hopeful that if anybody has any questions, they can reach out to us and we can give your contact information to our members, if any of them have any questions. Sure. We'd be grateful for that also. Thank you. Thank you. And this presentation is being recorded and will be available for replay. So when you're looking to purchase your spec camera, and you need some experts to be able to provide some additional information, this will be a great resource for you. Enjoy the rest of your week, everyone. Thank you. Thank you.

nuclear cardiology

SPECT labs

equipment replacement

strategic planning

SPECT-CT

data-driven decision-making

vendor relationships

patient-centric strategies