1. Building a Modern Diagnostic Center Chain - Dr Vas Metupalle Clarity Radiology Pte Ltd www.clarityradiology.com

2. Contents Introduction..................................................................3 Location........................................................................4 Layout...........................................................................5, 6, 7, 8 Infrastructure...............................................................9, 10, 11, 12 Equipment....................................................................13, 14, 15 Staffing.........................................................................16 Training........................................................................17 Digital radiology..........................................................18, 19,20 Projections....................................................................21, 22,23 Franchise Model...........................................................24, 25

3. INTRO This presentation aims to detail the components of a central diagnostic center with several satellite imaging centers. Xray, Ultrasound, Mammo, CT , MR Xray, Ultrasound, Mammo, Xray, Ultrasound, Mammo, Xray, Ultrasound, Mammo,

4. Location Central advanced diagnostic center - City - good transport links - Building with adequate floor loading / frontage /space, carpark space - Nearby Hospitals with service lacking - Outpatient specialists in vicinity Sattelite diagnostic centers - Well Populated, self contained neighbourhoods - GP groups in vicinity

5. Layout Components: 1. Advanced Diagnostic center - Waiting area x2 (outer, inner) ‏ - Reception - Admin / Marketing / Accounting Room - Pantry - Meeting / Training Room - Radiologist reporting room - rest room - Changing rooms - Technician Work area - Xray Room - Mammo Room - Ultrasound Room - CT Room - MR Room - CT/MR control room Likely 4000sq feet

6. Possible Advanced center Layout 4000 sq feet

7. Layout Components: 2. Satellite Radiology Center - Waiting area - Reception - Changing rooms - Technician Work area - Xray Room - Mammo Room - Ultrasound Room Likely 1500sq feet

8. Proposed Sattelite center Layout 1250sq ft

9. INFRASTRUCTURE 1) Floor Loading MRI area – 12kN CT area - 5KN Rest - 3 KN Specialists required: - Specialist contractor -Professional Engineer - Radiation safety adviser - MR / CT installation +commissioning engineers

10. 2) Radiation Protection , RF insulation - RF insulation for MR room - 3mm thickness lead rooms for xray, mammo, CT rooms. - Lead doors, lead glass - specialist contractors needed to consult with local contractors

11. 3) Power - Uninterrupted Power Supply vital to preserve medical equipment circuit boards from damage. UPS machines tested for medical equipment eg. Caterpillar , Toshiba UPS. Advanced Center - 200 to 300kVA Satellite Center - 60 to 100kVA - Generator supply important for business to run in developing countries.

12. 4) Network - Internet , ADSL / VSAT broadband 2MB/sec Download , 1MB/sec upload - LAN network, Gigabit ethernet within each center - 1x server , with 4x windows professional PCs satellite center - 2x Server, 9 x Windows XP pro advanced center

13. Equipment New Vendors : GE , Phillips, Toshiba, Siemens , Hitachi Recommendation is to get all equipment form single vendor for good price and servicing agreement. Refurbished Suppliers: 1) Amber Dignostics : http://www.amberusa.com/ , http://www.amberafrica.com (Located in Cameroon) 2) Block Imaging : http://www.blockimaging.com

14. Comparison Pricing Equipment New Refurbished (5 yr old) ‏ 1.5T MRI (closed MR) US$ 1.2mil US$ 300 to 400k Open MRI US$ 600k US $ 250k 16 Slice CT US$ 650k US $ 200k Maintenance 1.5T MRI - US$ 70k / year Open MRI - US $ 25k / year CT 16 slice - US $15k / year

19. PACS/ RIS/ TeleRadiology The TELE-RADIOLOGY Hub model provides entire workflow for an online diagnosis and reporting allowing radiologists to remain in central diagnostic center. MiniPACs at Sattelite Imaging centers MiniPACs at Sattelite Imaging centers Advanced Center

20. Teleradiologist Load Balancing a breeze with teleradiology Teleradiologists for Load balancing

21. Projections for 1xAdvanced Center , and 3xSattelite centers -SAMPLE-

22. Projections have to suit local conditions and prices. -SAMPLE-

23. ROI Calculator for Single Modality -SAMPLE-

25. Franchise Process 1. A Prospect expresses interest 2. Confidential meeting &offfer No yes 3. Sign Letter of intent 4. Survey of premise 5. Proposal No yes 6. Sign agreement 7. Set-Up 8. Training 9. Marketing 10. Opening