Experience - John A. Sanders

Overview: I have experience and have demonstrated ability as a manager in a number of different settings - as C-level senior corporate management, as institute or departmental leadership, as research group director, and as private business owner. This experience, combined with my practical nature, strategic vision, and insight into business and technical trends allows me to set directions and establish goals appropriate for an organization. My technical knowledge and innovation allows me to identify optimum and achievable solutions with respect to the time and resources available. One of my established strengths is in being able to make the most of what I have to work with and I can do extraordinary things with ordinary resources. As a manager I can identify and tap into team motivations and can energize and lead diverse groups towards achieving the defined goals. I am particularly good at identifying partnership opportunities that provide mutual benefit to all stakeholders.

I have managed all aspects of departmental operations including: Budgeting and accounting, including funding proposals and negotiations;
Needs surveying/assessment and strategic planning;
Project specification/funding/management/reporting;
Personnel recruiting/hiring/scheduling/training/reviews;
Hardware/software purchasing and leasing, including bidding, evaluation, and purchasing of major capital equipment;
Resource allocation and tracking;
Systems and services documentation;
Cost reviews and benchmarking to comparable organizations.

I possess the important ability to effectively communicate with non-technical people so that core technical concepts/issues can be mutually understood and discussed. I have supervised and trained staff and students from a wide variety of backgrounds, and have worked with administrative and/or technical people at all levels.

I am also co-owner of a consulting and surveying company (JnJ Associates LLC).

Overview: I have benefitted by often being the primary or senior technical resource in a multidisciplinary organization - I have had not just exposure to a large number of technical areas, but I have had to constantly extend myself and become directly proficient in those many different areas. I have developed these skills in a wide variety of environments: Governmental hospital;
University teaching hospitals;
Academic clinical research institutes;
Industrial and National Laboratory research and development facilities;
Large IDN and smaller freestanding hospitals;
Private practice outpatient offices and centers;
Corporate multi-site provider organization.

I have developed an extensive hands-on technical skill set that allows me to efficiently assess practical considerations and directly implement new approaches. This uniquely diverse and in-depth biomedical engineering knowledge base is why I have been so effective in working in interdisciplinary environments, especially with industry collaborators.

My career is consistent with the core concepts of professional-level Biomedical Engineering. I have developed in-depth expertise that spans the engineering and medical worlds so that I can effectively bridge the two and help provide the best available healthcare. I also believe that at my level of training, experience, and strategic insight, I effectively provide the bridge between engineering and business/corporate management worlds as well.

I am an expert in medical imaging and informatics technologies. Medical informatics and health information systems is a diverse field and I am very happy to have approached these areas coming from a radiology and medical imaging background. While it can be debated for the field as a whole, it is my experience that radiology and imaging has been a large driving force for the development of networked medical information systems. Certainly it is true that radiology-related digital imaging, reporting, billing, and visualization makes up a large fraction of the demands on current networks and systems. It is also true that the high cost of radiology services puts an increasing emphasis on further development of these systems for more efficient imaging utilization, results communication, and resource/data management.

Health Information Systems: Very few modern healthcare IT environments are only concerned with single sites and unified single-vendor solutions. I have experience in the more typical environment of multiple inpatient and outpatient sites running heterogeneous product mixes of HIS/RIS/PACS/transcription/billing systems. I am very familiar with the issues and technologies involved with integrating all of these systems across multiple institutional boundaries.

These systems have included: HIS (Meditech, VA Vista)
RIS (VitalWorks/Amicas, recent evaluations of other RIS platforms)
PACS (Fuji Synapse, Sectra PACS, Intelerad IntelePACS, GE Centricity)
Mammography Reporting System (MRS)
Document management (Hyland OnBase, Laserfiche, custom in-house)
Digital transcription and voice recognition systems (recent evaluations of VR products).

Associated technologies have included: Preauthorization, coding, and billing processes, CPT/ICD9 coding
HIPAA privacy and security issues, access control.
DICOM object communications and management.
HL7 messaging and interfacing.
IHE IT and radiology profiles and many of their options, workflow analysis.
Structured reporting, EHRs and EMRs.

Computer Platforms: After several years as a Unix (mostly Sun) person, I migrated to the attractive price/performance of Intel and Windows platforms. For the past eight years I have done my development and system/network administration primarily on Windows platforms but I continue to maintain and operate some Linux systems for duties where that OS is particularly well-suited.

I have extensive experience in workstation design and administration, across the entire spectrum of diagnostic reading stations, graphics/3D visualization stations, software development systems, business application workstations, and corporate clerical desktops. As my management scope has expanded I have gained extensive expertise in backoffice and infrastructure server platforms - primarily windows-based systems.

System Administration: Again there is a great synergy between systems adminstration and my background in software engineering and medical imaging. For example, my work with OpenGL programming and in managing diagnostic reading/visualization workstations has kept me familiar with the latest graphics and display hardware systems. I firmly believe in the advantages of contrast/GSDF calibration, layout standardization, and continuous quality control for clinical image display systems. I have managed the full range of IT systems in complex, demanding, and dynamic environments.

Systems and technologies have included: Windows NT/2000/XP/2003 Server.
AD domain design, site setup and server replication, user accounts and roaming profiles.
DNS and DHCP services.
Security and privacy (HIPAA) risk analyses, policies and GPOs, biometrics, intrusion detection systems.
Email administration - MS Exchange Server.
Database administration - MS SQL Server.
Server administration - including 60+ servers:
Fax, backup, application, virus, email and spam/monitoring, database, web, Windows update, accounting and marketing, document management, AD, DNS, DHCP, FTP, VPN, PACS, MRS, RIS, Billing, call-center management, helpdesk, user file disk servers. Workstations, desktops, and laptops - 400+ from technical workstations to staff desktops, with all peripherals.
Diagnostic reading stations - full production-mode stations running:
4 PACS viewers/worklists plus eFilm, connections to 6 different dictation systems, meditech RIS, 2 specialty viewing applications, 12+ "primary" apps including MS Office, simultaneous compatibility with nearly 200 secondary applications, 15 categories of configurations/settings, full roaming profiles, and mapped drive access to user files. SANs - Dell-EMC, caching and archiving systems.
Helpdesk/IT management systems - ServiceDesk, ITIL service-levels and 24/7 response/escalation protocols.
Server clustering, loadbalancing, and virtualization.
Website administration - MS IIS and Apache, for both internet and intranet users.
Telecommunications systems - Avaya, including: digital, VOIP, centralized call center operations, and voicemail.
Remote computer access - DameWare, MS Remote Desktop, some Citrix.

Software Development: I am a Premium Subscription member of the Microsoft Developer Network (MSDN), which has been useful for keeping current with the latest software technologies and tools. For many years I have undertaken software development in order to implement new/novel methods, to produce tailored/custom tools for particular environments and needs, to bridge gaps between available/commercial software, and to more expediently (and often less expensively) solve problems and achieve technical goals. I have extensive experience in application development and in setting up and managing intranet/internet sites and services.

Programming languages and libraries have included: C#/C++/C (Including: STL, .Net, MFC, ATL, COM/DCOM)
OpenGL, GDI+
Unix/Linux shell scripting
SQL, including ODBC and various other data-access methodologies for query/retrieve/manipulation.
Encryption SDK

Development and application environments have included: MS Visual Studio .Net 2003/2005, 2005 Team Edition for Developers
Crystal Reports and CrystalEnterprise
InstallShield Developer
CVS for concurrent version control
Maya animation environment

Networking: I have a long history of building and managing large multi-institutional, heterogeneous networks. This experience stared in the early days of medical networks when I was the first in town to set up sophisticated city-wide connectivity to link medical centers and support research and clinical image exchange. More recently I have managed a large regional WAN/LAN network that linked 9 major hospitals, 10 primary outpatient centers, 12 secondary outpatient centers - both in parallel and interconnected with multiple IDN/Provider network systems. I have experience with a heterogeneous mix of networking types and services, including medical-grade security and access controls.

I consider networking to consist of more than just transport of data packets - it is really information exchange of clinical records and reports, medical images, and business records and documents. my "vertically integrated" engineering skill set helps me work effectively across all levels, from low-level transport-layer packet routing up to and including the successful communication of information objects.

Technologies have included: Ethernet, ATM, ISDN, Point-to-point/T1s
Routing, switching, and filtering (Cisco IOS)
Firewalls (hardware and software)
Content/load-balancing switches
Fiber and copper wiring

Overview: I have nearly 20 years of research and development experience in medical imaging. While my traditional emphasis has been on the amazingly rich and diverse technology of magnetic resonance imaging (MRI), I also have experience with the entire range of radiology modalities including: CT, mammography (film and digital), ultrasound, bone densitometry (DEXA), SPECT, PET, CR/DR, and EEG/MEG. I have always tried to maximize the use of all available sources of imaging information and have done research and clinical work to utilize synergistic combinations of data from multiple sources and to more efficiently deliver that information to the appropriate physicians.

Medical Imaging Research: My imaging research has progressed through general image and signal processing --> theoretical and experimental work in MRI fundamentals --> image analysis using apriori sequence information --> research and development in a range of MRI and MRS clinical applications --> development of functional imaging with MRI, MEG, and SPECT --> medical imaging utilization and communications (surgical imaging systems and telemedicine) --> multimodality data integration and visualization --> coordinate registration of physical and data spaces --> segmentation, recognition, and graphical modeling. There are no solid breaks between these and my current activities and interests span many of these aspects. While my efforts have traditionally been based in neuroradiology, I have been working for more than six years throughout the entire spectrum of radiology subspecialites. I have recently been doing an extensive amount of work in breast imaging, biopsy, and reporting technology.

I have come to consider data registration issues as a key to a number of important applications in medical imaging. In particular, the ability to spatially register multiple data sets having different spatial coverage, resolution, and geometric fidelity allows for the correction of patient movement artifacts (e.g, for better functional MRI), for better evaluation of localized dynamic changes during contrast uptake, for assembling sufficient imaging features so tissue segmentation analysis can be successful, and for quantitative detection/evaluation of tissue changes over time.

Recent research projects have included: Clinical trials for improving post-stroke functional recovery using a combination of implanted electrodes and physical therapy.
Determining the data resolution requirements for rigid and deformable image registration of the breast.
Optimization of the tradeoffs between spatial and temporal resolution in conjunction with data post-processing techniques in dynamic imaging.
Use of physics-based deformable models for extraction of tissue and lesion structure.
Optimization of imaging protocols for use in image-guided deep brain stimulation (DBS) procedures.
Development of procedures for registering MRI patients and acquiring precisely the same slice locations.
Comparisons between pre-acquisition slice positioning registrations and resolution requirements for post-processing interpolation procedures.
Development of fast acquisition sequences for obtaining sufficient tissue parameters for model-based image synthesis.
Development of structured light laser surface scanning to obtain surface models during neurosurgery.
Volumetric and tissue feature change detection before and after simulated high-altitude exposures.
Multimodal functional brain imaging using fMRI, MEG, and SPECT.
Oral and nasal airway model extraction for inhalant aerosol deposition simulations.
Determination of the accuracy and reproducibility of mutual information and interactive SPECT-MRI registration methods.
Protocol development and data acquisition of appropriate cardiac image data for electromagnetic inverse modeling and simulation.
MRI morphometric changes between normal and schizophrenic children.
Development of labeled training sets for use with supervised satellite imaging algorithms.
Registration and visualization of intraoperative video with graphical tissue models.
Development of software for functional MRI preprocessing and statistical change detection.

MRI Subdisciplines: All aspects of clinical MRI.

MRI techniques have included: Functional MRI (I have personally provided routine FMRI examination services to a city-wide referral base)
Breast imaging (dynamic contrast enhancement, MRI-guided biopsy procedures, and implant leakage detection).
Diffusion/Perfusion dynamic MRI for stroke.
Angiography and quantitative velocity imaging (both PC and TOF)
Brain water content imaging - using serially registered T2, diffusion, and MTC.
Cardiac viability imaging.
Proton brain and prostate spectroscopy.

MRI Systems: Over the years I have done clinical protocol and pulse sequence development using many different MRI systems and vendors. Most of the MRIs that I have been responsible for lately have been GE systems. MRI system purchases or major upgrades on average have occurred at least once per year and I have a great deal of experience in evaluating competing vendor offerings, refining bids and specifications, sorting out siting/installation issues, and doing initial price negotiations.

Throughout my career I have worked on a wide range of MRI platforms: 2000-2006 GE Horizon LX 1.5T and 1.0T (base models through Excite/HD TwinSpeed/EchoSpeed)
2002-2006 Hitachi Altaire 0.7T high-field open
2000-2003 GE Profile 0.2T open
1995-2000 Picker Edge 1.5T
1995-2000 Picker Outlook 0.23T open
1994-1998 GE Signa 5x 1.5T
1992-1994 Toshiba Access 0.064T open
1991-1995 Siemens Magnetom 1.5T
1992-1995 Siemens Impact 0.5T
1987-1990 GE Signa 1.5T
1984-1987 Philips Gyroscan 1.5T

Imaging Modalities and Workstations: In a practice that consisted of over 70 radiologists of all subspecialities providng both inpatient and outpatient imaging services, I was responsible for approximately 140 clinical imaging systems of all types. These included: 22 MRI, 24 CT, 39 US, 32 CR/DR, 6 Nucs, 2 PET, 5 DEXA, and 3 digital MG scanners. The majority of these were directly operated by the group practice and I was responsible for the development and execution of clinical protocols. For all of these scanners I was responsible for the imaging data management and its efficient integration into the diagnostic reporting and billing workflows.

I also served as the medical physicist for the practice and have been responsible for CT and diagnostic nuclear medicine dose assessments, tuning, and minimization. My CT work has been done using 4, 6, 16, and 64-channel multidetector CTs from both Siemens and GE.

Recent vendor workstations have included: GE Advantage Windows
Vital Images Vitrea
Confirma CadStream
Stealth Neurostation
Siemens Wizard
Barco/Voxar 3D

Other Medical Imaging Experience: It is impractical to try and describe all of my imaging expertise - I am confident that it is more than adequate to support anything I try to do.

Areas that often seem to come up include: DICOM - I have extensive knowledge in this area and I have developed a complete software implementation of the standard.
Design and implementation of imaging software - and integrations with commercial packages.
Image/data formats - Extensive experience with data conversions of all types.
Purchasing and Contracting - including specifications, RFPs, and Bids.
Acceptance and quality assurance procedures for medical imaging equipment.
Extensive work with vendor sales, installation, application, and service engineers.

Overview: I have been a primary technical contact for nearly all joint development programs with commercial vendors at our facilities. As appropriate, this work has been undertaken as part of my normal development activities, under contract to accomplish particular goals, and as a separately contracted private consultant to provide outside deliverables.

Projects: Northstar Inc (2003 - present) Participation in a multi-center study of neural stimulation in conjunction with post-stroke rehabilitation. This study incorporates FMRI to monitor functional recovery. Confirma Inc (1998 - present) Development of CadStream processing system for breast MRI. On-going new product beta testing and evaluations. Consulting for proprietary pattern recognition technologies. Picker International (now Philips Medical 1994-1999) I have been the primary technical collaborator for a range of joint product development and evaluation projects. Picker IGS (1995-1999) Development of Picker Viewpoint IGS product. Contribute to hardware design improvements. In particular, the movement from ultrasonic to optical digitizer systems. Validation and testing of ultrasonic and optical digitizing systems. Protocol development - surgical procedures and data visualization/processing. Intraoperative validation in human subjects. FDA Intracranial application clinical trials. FDA Spinal application clinical trials. FDA Orthopaedic application clinical trials. MEG data integration into Viewpoint. CT protocols and data integration for Viewpoint. Contract for preliminary evaluation of animation technology for IGS improvements. Contract to scan cadavers and prepare data for IGS workshop and system marketing. Picker MRS (1996-1997) Development of proton spectroscopy for neurologic applications. Protocol development for acquisition and processing. FDA clinical trials with normal and patient subjects. Picker Nuclear Medicine (1995-1998) SPECT- MRI/CT "fusion" (registration package) product development. Fusion product beta testing and clinical development. We have been an active primary development site for this software. Contributions to PIXIE processing software. DICOM data transfer product beta testing and clinical evaluation. Evaluation of stereo display and spaceball visualization systems for clinical use. Numerous marketing/training presentations and hosting site visits. Picker Image Managment (1995-1996) Beta testing of Vistar segmentation/disarticulation software product. Also evaluated its inclusion into the Viewpoint platform. Early evaluation of prototype OnCall portable/notebook workstation. Picker Outlook MRI (1995-1998) Outlook product introduction. We received the first open-design Outlook system in the USA and I worked to refine clinical protocols and integration. Characterize distortion for MEG and surgical use. Identify data integration problems (e.g., non-square image handling). Early contributions to design of interventional MRI adaptations. Marketing presentations and hosting site visits Picker Edge MRI (1995-1999) FDA clinical trials for "brain attack" diffusion /perfusion product. Protocol development for acquisition and processing. Network and data integration with other Picker and non-Picker modalities. Develop FMRI acquisition protocol with synchronized stimulus presentation. Voxel Inc. (1992-1998) Development of a 3D holographic visualization product for radiology. I was the primary collaborator at their only field/alpha test site for this technology. Extensive development effort to take innovative visualization technology and make into a robust clinical product. Engineering for design and installation of processing workstations, operator interfaces, camera system, and data communications. Contract for data transfer software for non-DICOM CT and MR devices. Develop installation and operator training procedures. Establish referral and clinical request protocols. Clinical trials in support of the FDA 510(k) application. PR/marketing/training presentations. Assisted in the process of submitting CPT code modifications to cover this technology. Research and presentation of results regarding potential new applications. Research to extend utility by integration with graphics workstation using digitizers. Provided testimony in arbitration hearings with camera hardware subcontractor Cypros Inc (1997) MRS of DCA treatment for stroke as part of FDA clinical trials. Protocol development. Acquisition and processing of supporting patient data. Polaroid Medical Imaging Systems (1996) Contract to evaluate dry process film performance and reproducibility. Design and test protocol, data preparation and supervise protocol execution. Toshiba America Medical Inc. (1994-1995) Contract to evaluate blood imaging characteristics at both high and ultra-low fields. Designed and implemented equivalent imaging protocols on 0.064T and 1.5T systems. Prepared, scanned, and analyzed two temporal series of blood and gel phantoms. Stealth Inc. (now a part of Medtronix 1992-1994) Pixsys Inc. (now Image Guided Technologies 1992-1995) Early development of an image guided neurosurgery product. I had the second prototype Stealth Neurostation system and worked to refine hardware design (digitizer, computer, and tool) and surgical protocol. Developed in-house software to control Pixsys camera acquisition, load and manipulate image (and MEG) data, register with surgical patient, and present results to surgeon during surgery. Extensive system characterization and validation testing. Provided information for Pixsys patent application. Comparison with frame-based stereotaxic procedures. Biomagnetic Technologies Inc. (1991-1995) Development and evaluation of a clinical 37-channel biomagnetometer product. Contract for evaluation of network connectivity and data transfer options. Consultant to deliver MRI image data transfer and conversion software. Validation work to evaluate effectiveness of MEG localization. Consultant to evaluate camera control options for printing mapped MEG/MRI data to film. Evaluation of image mapping procedures. Siemens Medical Systems Inc. (1991-1995) Development of MR single-voxel proton spectroscopy package for neurologic applications. FDA international clinical trials for neurologic tumors - one of limited group of sites contributing to Protocol development and supporting patient/control data. Research agreements covering earliest fMRI development, cardiac evaluations. Evaluate several Works-In-Progress (beta) packages. Miscellaneous collaborations representing a significant collaborative effort: Independent consultant (JnJ Associates) for legal cases involving image quality/ performance disputes.
SV Enterprises Inc (1996) SBIR grant proposal for MRI coil product clinical evaluation.
MZA Associates Corp. (1994) SBIR proposal for Preliminary Evaluation of Image Restoration Techniques for Magnetic Resonance Imaging. (military technology transfer).
Conductus Inc. (1995) Joint proposal to Picker to further
design and testing of superconducting MR receive coil technology, and integration with Picker Outlook for human trials.
Sandia National Laboratory LDRD proposal for graphics modeling in spine surgery.
Sandia National Laboratory LDRD proposal for human trials and clinical evaluation of 3D ultrasonic imaging technology.

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