Time for a Change? Evaluating CT Scanner Buying and Maintenance Decisions
By Beth W. Orenstein
Radiology Today
Vol. 19 No. 8 P. 16

A CT scanner can cost anywhere from $100,000 to $3 million, depending on whether it's new or refurbished and its level of technological sophistication. It's never simple to determine whether and when a new scanner is needed or which one to buy.

CT scanners also have to be maintained to meet quality standards and be accredited. In this article, we ask three radiology administrators and a customer service representative from Philips for some guidance on the ins and outs of buying and maintaining CT scanners.

Is it time for a new one? Heidi A. Hordyk, MBA, MSHA, RT(R), CNMT, CRA, director of radiology at Murray-Calloway County Hospital in Western Kentucky, says your department may have a 16-slice scanner that is working fairly well and not having a lot of downtime, but the technology is not meeting the needs of your patient population. "That's where we are," she says. "We have a 16-slice and a 64-slice scanner, and 16-slice is older technology, so we are only using it for backup." Hordyk recently began the process of replacing it.

According to Asset Management in Radiology, a 2009 publication of the AHRA, CT scanners should ideally be replaced every eight years. In practice, it's about that long or less, according to the book, which is part of the AHRA development series.

If it's time to buy, start with three to five vendors. "That's a good practice businesswise," says Ernesto A. Cerdena, PhD, CRA, RT(R), CV, CT, FAHRA, FACHE, corporate director of radiology services at AtlantiCare, a member of Geisinger, in Southern New Jersey. "Ask for requests for proposals from many vendors, including your established vendors and potential vendors. Consider industry leaders and up-and-coming vendors," he says.

Hordyk says that every vendor has pros and cons. "It's a matter of choosing which fits your needs best," she says.

Have Clear Goals
When you're evaluating proposals, make sure you're comparing apples to apples," Cerdena says. "One vendor's lower bid might not include product capabilities, service, and warranties that another vendor's higher bid covers." Also, include key organizational stakeholders in writing proposals, ranging from frontline staff to physicians to key leaders. Include those in other departments, disciplines, and areas such as information technology, quality, facilities, procurement, and others, Cerdena advises.

Know your requirements, Hordyk and Cerdena agree. It's important to have clear goals and needs for the CT scanner. For example, will it be general purpose or special purpose? General-purpose CT scanners are used for routine imaging of all anatomic regions and can accommodate all types of patients. If it's to be your workhorse, it needs to have minimal downtime and be rather stable.

If you're looking for a CT scanner for specific applications, however, such as
pediatric radiology or cardiac imaging, vendors need to demonstrate not only the scanners that they have available but also the resources they provide for those specific applications. "We do a lot of bariatric patients," says Rick Perez, RT, CRA, FAHRA, administrative director of New York University Winthrop Hospital in Mineola, New York. "So we need to make sure we have a heavier table weight and can scan patients up to 400 pounds."

Seek Input
Seek input from all who will use the scanner. You should put together a team that includes radiologists, technologists, medical physicists, and administrators, and they should all be involved in the process of selecting a CT scanner, the administrators agree; the more involved the stakeholders are, the less likely issues or surprises will arise when the new scanner is installed.

Consider all logistical and operational issues. Do you have space big enough to install the CT you want in the right orientation? That's a consideration that can easily get overlooked, Cerdena says. "The vendor will tell you it will fit if you put a monitor or camera so that the operator can see the patient from the control area, but that might not be effective or efficient. It's different seeing the patient directly during scanning vs looking at the patient via camera from the control area. The vendor should meet your needs, rather than presenting a one-size-fits all solution," Cerdena says. "Ask all questions up front, including the 'what-if' scenarios. Make decisions based on what the vendor can give you now rather than what it might be doing or would be willing to change."

What floor is the scanner going on, and how heavy is it? Those are questions that need to be answered, too, Perez says. "A sixth floor of an office building wasn't designed for that kind of weight." Also, he says, you need to be sure you have an ample power source not only for the scanner but also for the chillers that keep its tubes cool.

Once you've selected your scanner, you need to think about maintenance and warranties. Entering into a maintenance contract is a major decision, just as selecting a scanner is, says Jim Salmons, senior director of health systems customer services for Philips. "It requires time and multiple conversations before finalizing." Any line item in your contract is subject to negotiation, he says. "The key to making this process work for both parties is to find a partner that can not only provide the experience-based guidance to help you focus your negotiating efforts in the right direction but also customize a service program to your individual needs."

Maintenance should not be a purely financial decision, Salmons says. "Simply choosing the lowest bid during a request-for-proposal process is rarely the right decision," he says. "Patient care is the ultimate goal for us all, and the ability to diagnose and treat patients hinges on having equipment that both works and works as well as it's supposed to. A good maintenance provider will be able to deliver the level of service you require in order to maintain the level of care patients deserve."

Consider Your Service Contract
Hordyk says you can usually get a better deal on a service contract if you buy it at the same time as the scanner. Most scanners have warranties that cover the first two or possibly three years, but the period after the original warranty runs out is a cause for concern, she says.

Also, a warranty from the original equipment manufacturer (OEM) may cost more than one from a third-party vendor. That, Hordyk says, is when you have to consider the age of your scanner. If it's brand new equipment, the OEM has the resources and experts who are trained on it, she says. If it's four or five years out, other companies may have had time to get their experts trained on it. "The further out it is, the more known the piece of equipment is, and the gap of knowledge isn't as great," Hordyk says.

Can you do your own maintenance? Yes, Salmons says. However, he cautions, keep in mind that it may affect the warranty. "You need to check with your specific OEM's warranty stipulations. If you are going to do your own maintenance, you will still need a capable partner to support you with parts, training, and technical support. Having an option for backup service resources is advisable as well."

Hordyk recommends thinking about where your facility is located and where your service contractor is in relation to you. How long will it take for those who service your scanner to get to your site if necessary? Are they nearby or a flight away?

"You can specify in your service contract how quickly the vendor will respond and whether you will require 'round-the-clock, on-call, onsite response," Cerdena says. "If you're down for two hours out of 24, that's two hours you're not operating." You can specify that you want same-day parts. The contract should cover any impact on charges. "It should also hold the vendor responsible for costs to your company that result from downtime or other vendor-related issues that impact your patients or organization," he says.

Your warranty and service needs may change over time, Salmons says. "Your chosen service provider should be able to provide you with enough flexibility to adjust your service plan entitlements to meet your changing needs," he explains.

"You can operate without a service contract," Hordyk says. "But you're hedging your bets whether you will need it or not and, if it's for something major, you may be talking a six-figure replacement."

Make sure your service contract includes preventive maintenance, Salmons advises. "That's the cornerstone of any good service contract," he says. "You must always ensure your chosen service provider has the ability to meet all the OEM specifications for preventive maintenance to reduce the potential for issues before they even begin."

Perez agrees that preventive maintenance is critical. "Some you need to do once a month, some quarterly," he says. "But it is important for maintaining not only your equipment but also your accreditation. And for you to receive payment for your studies, you have to have accreditation."

Most service contracts have a means to end built in. So, if you're unhappy with the service, you can get out of it. However, Salmons says, "You need to take into consideration the amount of effort and time that moving from one provider to another will entail, particularly if it's in the middle of a contract term when you may not have adequate time to plan for a transition. That makes selecting the right service provider up front all the more important."

If you are considering a contract that exceeds your budget, take a look at your service needs and make sure the service levels match your actual needs, Salmons says. "You may not want to pay for service that is not necessary," he adds. "Health tech maintenance should not be taken lightly. Ultimately, a patient's well-being may be at stake. Additionally, you may need to determine if you have the right mix of equipment. If not, you may need some assistance managing your capital asset mix."

Ask Around
The radiology administrators also recommend connecting with peers when making decisions about buying and maintaining scanners. "One of the benefits of being a member of AHRA is we have an online forum to compare issues or ask questions," says Cerdena, a past president. "It is a great venue for sharing best practices and addressing problems, concerns, and issues."

Go beyond the vendors' sales pitches, and marketing material claims, Cerdena says. "Every vendor is going to say, 'We have top service.'" Take the time to verify their claims on legitimate rating sites, he says. Various companies publish vendor service rankings. Vendors may say they have 98% or 99% uptime. However, he notes, "Get everything in writing in the contract. Hold the vendor accountable to what is in the contract from day one. Addressing issues as they arise will enhance your relationship and ensure the vendor is meeting—or exceeding—your organizations' needs."

Beth W. Orenstein, of Northampton, Pennsylvania, is a freelance writer and regular contributor to Radiology Today.