From beer to scanners: What's brewing in Moldova?

2012 11 20 12 13 10 923 Beer Mug 70

A private imaging clinic that opened three years ago in Moldova on the site of a former beer restaurant is serving as a case study in how a modern diagnostic facility can be built successfully from scratch.

Impressive growth has been achieved at the Centrul de Diagnostic German (CDG), or German Diagnostic Center, in Chisinau, the capital city. The average number of monthly examinations performed has risen sharply from 1,297 in 2009 to 3,095 in 2010, 4,463 in 2011, and 7,419 in 2012, according to CDG's general manager Alexander Gutu.

CDG Performance 2009-2012
The number of examinations performed at the CDG has grown significantly since the facility opened in October 2009. Chart courtesy of Alexander Gutu, Management in Radiology (MIR) congress 2012, Milan.The number of examinations performed at the CDG has grown significantly since the facility opened in October 2009. Chart courtesy of Alexander Gutu, Management in Radiology (MIR) congress 2012, Milan.
The number of examinations performed at the CDG has grown significantly since the facility opened in October 2009. Chart courtesy of Alexander Gutu, Management in Radiology (MIR) congress 2012, Milan.

"Our state-of-the art building was equipped with the newest modalities in 18 months. From scratch, we've become the leader of the market in 36 months," he told delegates at the recent Management in Radiology (MIR) annual scientific meeting in Milan.

Moldova is situated between Romania to the west and Ukraine to the north, south, and east, and it became a parliamentary republic in 1991, following independence from the former Soviet Union. It has a total population of slightly more than 3.6 million, gross national income per capita of 2,555 euros ($3,270 U.S.), and a life expectancy at birth of 65 for men and 73 for women. Total expenditure on health per capita was 266 euros ($341 U.S.) in 2009, and total expenditure on health as a percentage of gross domestic product was 11.9, Gutu explained.

In 2007, the country only had one 0.2-tesla MRI system and eight 16-slice CT scanners, all of which were state-owned. Moldova now has eight MR units, seven of which are privately owned, plus 20 CT scanners, nine of which are in private ownership.

The Berlin-based German Service of Diagnostics GmbH bought the 700 m2 former beer restaurant in Chisinau in spring 2007 at a cost of 1.1 million euros ($1.4 million U.S.). The project team composed of three people without a medical background and the local professor of neurosurgery, Dr. Grigore Zapuhlin. The estimated construction time was 12 months, but the actual duration was 18 months, and the building work cost 1.5 million euros ($2 million U.S.). The main challenges were getting the necessary approvals and authorizations, as well as the lack of quality materials in Moldova and unexpected miscellaneous issues, he said.

The clinic opened in October 2009, and the new three-story building now occupies a 1,900 m2 space. The project participants included Siemens Healthcare (technical requirements, onsite measurements, recommendations), Rostral (local architect), BDT Erlangen (workflow and general advice), CDG (consolidation of efforts and general coordination/management), and consultants from partner centers in Germany.

Only two radiologists in Moldova had the relevant MRI experience, and only around 10 of them had the necessary CT experience. Furthermore, most of these doctors were in their late 50s, so the owners decided to select local doctors aged between 25 and 35 and train them in Frankfurt, Erlangen, and Berlin, Germany, and at the University of Graz, Austria. The number of applicants was 80, of whom 12 were recruited. They mainly had previous ultrasound experience only.

In October 2009, there were 44 staff members, composing of 14 doctors, eight radiographers and nurses, and 22 other staff (reception, call center, accounting, and management). By October 2011, there were 91staff consisting of 32 doctors and 27 medical staff and 32 general staff.

The initial range of equipment included a 1.5-tesla MR unit, a 64-slice CT scanner, two ultrasound machines, a digital x-ray system, and a mammography unit. Two new ultrasound units, an endoscopy system from Olympus, laboratory equipment from Roche and Sysmex, Fibroscan technology, and a Siemens Magnetom Skyra 3-tesla machine were installed between 2010 and 2012.

CDG offers fully integrated digital imaging and archiving capabilities from a RIS/PACS; CT, MRI, ultrasound, and a computed radiography (CR) digitizer are all connected to its internal network. The combined RIS/PACS with CR digitizer for general radiology provides advanced imaging services to healthcare facilities throughout the region, Gutu explained.

The owners wanted an efficient way to link and archive images from its digital modalities as well as electronically manage patient scheduling, dictation, report generation, and other tasks. A key requirement was a fully integrated solution from one supplier versus different products from multiple companies, and they chose Agfa HealthCare's IMPAX 6.3 system and software, along with its 5.6 version RIS and a CR 35-X digitizer with NX workstation and MUSICA2 image enhancement software, according to the vendor. Moreover, a second opinion service is available via a link to the company's sister site in Erlangen.

Overall, the goal has been to make the center a showcase for the latest digital diagnostic technology so it can attract both physicians and patients seeking state-of-the-art medicine. The management team has succeeded by developing a coherent marketing strategy that has included aggressive public promotion using regional advertising, as well as special events for physicians, health ministers, and other care providers, he noted.

Promoting a new brand has been difficult, but building a reputation for reliability, strength, soundness, and truthfulness has helped, according to Gutu. He said the team has used various techniques to promote the facility, especially the Web, TV, radio stations, and printed matter (fliers, posters, etc.).

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