Recently M.I.T. Vice President Sarah Lee participated in TechNation magazine’s annual Roundtable on Computed Tomography.
TechNation contacted several experts and asked about purchasing and maintaining equipment. We also asked about the latest advancements. The panel members are Matthew Dedman, Director of Strategic Accounts for CT at Siemens Healthineers; Sarah Lee, Vice President, MIT; Josh Raines, Vice President Technical Services, Tri-Imaging and Ed Sloan Sr., President and CEO, Ed Sloan and Associates.
Q: What are some of the biggest challenges of purchasing and maintaining CT equipment?
Dedman: A big challenge today is that our customers are acquiring a CT scanner now with the expectation that we are not going to change out that piece of equipment for maybe 8 to 10 years or even longer; in the past, they bought a CT scanner with a 5- to 7-year replacement cycle. The challenge is finding a solution with the flexibility to allow for future upgrades that expand critical services. A big challenge on the service side is that CT is becoming the frontline gold standard imaging modality for many hospitals – a critical modality to the point that if their CT scanner is down, they may have to put their hospital on diversion and no longer accept imaging patients. So, obviously, uptime is even more important. In short, finding a key solution that is flexible, adaptable, and upgradeable to meet future demands and critical needs as well as a CT service provider that can proactively monitor and maintain CT equipment to avoid downtime is crucial.
Lee: From our standpoint, as the service company, the biggest challenge would be being able to find the system with everything on it that the customer wants. It is always doable, it just takes some time. The only challenge with maintaining equipment is finding parts for the older equipment hospitals still have.
Raines: Some of the biggest challenges are tube availability and parts for newer systems. Another challenge is finding qualified service engineers to work on the newer equipment.
Sloan: The most glaring challenge is the cost associated with buying and maintaining new equipment. Many of our customers overcome this hurdle by purchasing quality preowned systems. Selecting the appropriate technology to suit the current and future procedural demands of the department. In reality, not everyone needs a 512-slice CT or a 32 channel MRI.
Q: What are some of the latest advancements in CT equipment that facilities should consider when purchasing new?
Dedman: CT scanners, like many other technologies, are becoming more efficient than ever. As a result, manufacturers such as Siemens Healthineers are introducing CT platforms with smaller X-ray generators, lower power requirements, lower cooling requirements, and a smaller footprint. All of this translates into lower operational expenses for the hospital, so Siemens Healthineers has invested in efficiency technology to allow these lower power requirements and lower cooling requirements to reduce that operational expense for our customers. This is being done without compromising the critical care. Many new technologies in the industry are related to efficient operation of a CT scanner, to ensure that the scanner operates within ideal parameters to extend the life of the equipment and specifically the life of its X-ray tube. Technologies exist – particularly from the biomed aspect – that are important advances to consider in CT, knowing that biomeds will be maintaining this asset up to 8 and 10 years or longer, and how critical CT has become to hospital operations. These efficiency features all help ensure lower downtime for that equipment.
Lee: If they are buying refurbished equipment, specifically GE, the console is what they need to look for. The extreme console is faster and does not go down like the older consoles.
Raines: One of the latest advancements is the improved image quality of scans available with a lower dose than what was needed with previous systems.
Sloan: Buyers should be sure they will use the technology. Sometimes getting it loaded with all the bells and whistles is great, but always look into how needed it is for your operation. What needs to be a priority is enhancing patient care and streamlining productivity.
Q: What are the most important things to look for in a CT equipment and/or service provider?
Dedman: I see three big things. One is the remote servicing and remote acting service monitoring capabilities of the equipment vendor and equipment service provider. The reactive break-fix model in CT is not enough anymore since that modality has become critical to several hospital service lines, particularly the emergency department. CT scans are the gold standard of ED imaging. CT’s demands are so much higher, and as a result, remote servicing and proactive monitoring are very important. Additionally, the efficiency element of new CT scanners is designed to extend the life of the CT gantry as well as that X-ray tube – this is a very important element. And lastly, the scanner’s future upgradeability is important, showing that it has an 8-to-10-years-and-beyond roadmap to be able to expand critical capabilities and meet that hospital’s changing demands – whether that involves offering new service lines or increasing the capacity to handle new patient volumes.
Lee: You need to look for a company that is reputable and actually refurbishes the equipment not just paints it. For service you need to look for a company that knows what they are doing and one that is not a one-man show that will have enough personnel to get to you right away. They do not have to have a 100 engineers, a few is fine as long as they have enough for the customers they have. Everything does not break at once, one engineer per 10 CT contracts is plenty.
Raines: It is always important to check references and to speak with their current customers to find out what types of experiences they have had with the company. My top criteria include finding a company with the specific expertise needed for a facility’s equipment, parts support and pricing as well as the company’s reputation.
Sloan: Dependability, flexibility, availability and reputation. Develop a relationship with your equipment and/or service provider. Being able to trust them is a must. Always consider parts availability, you don’t want to get a system that you can’t find parts to service. Make sure your service provider completes PMs in a timely manner because this will increase the life and reliability of your equipment.
Q: How can purchasers ensure that they will receive the necessary literature and training tools when they purchase CT equipment?
Dedman: This is a very customer-specific answer. It really depends on the service relationship that they have with the OEM. If it is a full OEM service, there probably is not much need for training materials at all. But we all know there are varying levels beyond full OEM service, including shared service all the way to complete in-house biomed servicing. So, the question is very customer specific and depends on their master service agreement. I would advise working with your OEM to ensure that those necessary elements are included in a master service agreement.
Lee: They need to put it in the stipulation up front before purchasing the equipment and make sure they see it in the contract.
Raines: It is important to get a written agreement that states that the necessary literature and training tools will be provided.
Sloan: When purchasing, you should always ensure that equipment contracts include a demonstration of the mechanical operations of systems. Having a system staged so you can inspect it and verify that it meets OEM specifications is always something to look for. It’s cliché, but you wouldn’t buy a Ferrari without giving it a test drive first, would you? Being able to see the systems running and analyze it’s quality is a big part of purchasing a system. Used equipment sellers do not typically include clinical procedure training in a system purchase, so make sure you discuss your options with the provider if that is needed for your site.
Q: How will the market for CT equipment evolve in the next five years?
Dedman: We are seeing several new CT market trends. One is a pronounced shift toward the “front lines of health care.” Increasingly, you see CTs being placed directly in the emergency department as opposed to the radiology department. We now see CTs installed in freestanding emergency departments that actually accept ambulance patients, and they need CT systems to retain that designation. We are also seeing new, unique mobile imaging configurations utilizing CT: CTs within an actual ambulance to perform remote imaging for suspected stroke patients. So, I see a shift of CT toward the front lines of health care, with an increased focus on uptime and reliability of CT equipment.
Lee: Like always, you will see higher slice equipment come in and the older stuff will start to phase out because parts will become hard to find. Also, the government will probably make new laws that might make this happen quicker.
Raines: I think we will see continued movement toward CTs that can provide improved images with lower dose. There has been a lot of advancement in this area, but I predict that it is going to get even better.
Sloan: As the current population ages, and we see a push to reform health care, the market will demand an increase in technology while decreasing the cost associated with the imaging procedures. I’m seeing more non-minimally invasive procedures, complex diagnosis of patients, and a deeper integration of the clinical information regarding the overall care of the patients. Overall, a smaller margin between price and performance.
Q: What else do biomeds need to know about CT equipment?
Dedman: I can’t stress enough CT’s growing importance in health care today. Roughly 50 percent of patients who present at an emergency department receive some type of imaging, and most of that imaging is CT. And the fact that CT is the gold standard of imaging for many areas in the hospital highlights the importance of maintaining that equipment and ensuring that it operates at its optimal performance level, because it really is a critical component of the care pathway. Biomeds need to recognize the importance of data derived from a CT scanner in relation to a patient’s care in today’s health care environment. It’s an indispensable, critical element of efficient, effective patient triage within the hospital.
Lee: If they are servicing themselves they need to buy parts from a trustworthy company to eliminate down
time. If they don’t service CT, don’t be afraid to use third party for service, you can find really good companies and it will save the hospital money.
Raines: Biomeds need to know that they will benefit from strong software skills. They should also consider attending training from a service provider and/or seek education at trade shows like the MD Expo. Tri-Imaging Technical Training is a unique and intuitive training program that will prepare a service engineer to efficiently and effectively troubleshoot diagnostic imaging systems. The 2017 training calendar will soon be available on the Tri-Imaging website.
Sloan: We are in a “fix it NOW” industry. Something that needs to be understood is that it’s not an 8 to 5 thing. With trauma centers, no one is going to want to take the risk of leaving a system down for any prolonged period of time. Biomeds need to be able to asses the problem, have an accurate parts supply, and have a trusted technical support provider at all times.
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