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Selecting X-ray Equipment and Lowering the Cost of Ownership: An Interview with the Experts

By Kathryn Gray, McKesson Medical-Surgical
February 1, 2016

There's a lot to consider when selecting X-ray imaging equipment. What kind of X-ray is best for your practice? What's best for the patient? What should you know before you buy? How will new regulations impact reimbursement?

I sat down with a couple of experts to get the answers to some questions asked by our customers.

My first conversation was with Richard Spaedt, vice president at Medical Imaging Innovations. Richard is a leader in the field and was able to shed some light on key areas.

What you should know about computed radiography (CR), digital radiography (DR) and film

"CR and DR are the two main ways to make digital X-ray. Each has their pros and cons, but the market is clearly moving toward DR for a variety of reasons," said Richard.

According to the Conference of Radiation Control, Computed Radiography, or CR, records radiographic images to a phosphor plate. This process is similar to the workflow associated with film and chemistry, but instead of going to the darkroom to develop the film, the image is recorded on a CR cassette. This cassette is scanned and converted to a digital format so it can be saved and displayed on a computer. The cassette can be cleaned and reused. CR is faster than the film process and can be less expensive than DR.1

"Film takes longer to develop the image than both CR and DR and has an on-going consumable expense of the film and processing. It also exposes the patient to more radiation," Richard added, "but, if you are doing small volumes and looking for the least expensive outlay up front, this may be worth considering. Just be careful to factor in the long-term costs of the consumables and watch regulations that may require connectivity and legal requirements for backup."

Richard also noted, "In most cases if you did an ROI on a lease payment for CR with mini-Picture Archiving and Communications Systems (PACS), you'd end up having lower long-term costs as the consumable costs with film and chemistry will continue long after the lease payment if over."

The US National Library of Medicine states that Digital Radiography, or DR, is a direct digital capture of an image, instead of a capture and convert process like CR. DR provides better image quality and the ability to capture multiple images quickly. It also exposes the patient to the lowest dose of radiation.2

Richard commented, "Industry wide, DR pricing has come down significantly in recent years, and a 17x17 DR detector is now only marginally more expensive than complete CR units. DR provides a better long-term value - savings in time and maintenance. DR upgrades, as well as CR reader installations, can be performed same-day on X-ray units."        

Here's a snapshot from Medical Imaging Innovations on the features of CR vs. DR.    

  CR DR
    Equipment Size (footprint) X X
    Faster   X
    No Removable parts   X
    Lower Patient Exposure   X
    Higher Quality Image   X
    Lower Purchase Price X  
 

Richard explained, "Although CR is faster than film, CR is slower than DR - minutes compared to seconds. With CR, the workflow only changes minimally from traditional analog film and chemistry: it takes time to remove the cassette, read it, clear it, and replace it. With a limited number of cassettes, this impedes patient care, as there are many exams where you could have more images needed than cassettes on hand. There is also no validation of the image quality with CR until after it has been processed."

Pros and cons of different x-ray equipment

"Each type of X-ray system can be configured with either DR or CR. Once you've decided on the format, select the type of equipment based on your daily volumes, size of the room and type of X-ray imaging typically performed (i.e.: chest, extremity, etc.)," Richard explained.

Richard went on to describe four types of systems:

  • Floor-mounted tube - This is the most common type. It comes with a variety of options and includes a table and a chest stand. With these rooms you are constantly moving the panels and will need to consider drop coverage and replacement cost-- usually not included by the warranty.
  • Overhead tube - This is usually found in hospitals or busy clinics where they have high volume and durability is important. This equipment is more expensive and extensive to install. It also takes up 40-50% more space to install.
  • Straight-arm and U-arm - This equipment is popular with Urgent Care centers. It takes up less space - typical room size of 9x10 - the detector (panel) is permanently mounted to the system so it can't be dropped and it can be set up quickly. From a technologist stand point, they love this room because it's fast and easy. There's no reason to move anything, you just position and shoot.
  • Portable - This equipment is best suited for low volume or startup sites with limited space. It works on standard 110V power and there's no lead shielding required in the walls. Portable X-ray systems can be operational with little to no construction costs, bringing a new practice to market quickly.

Here's a quick view from Medical Imaging Innovations on types of equipment.   

  Floor Mount Tube Overhead Tube Straight-Arm
and U-Arm
Portable
    Smaller Space     X X
    Large Volume   X X  
    Easy to Use     X X
    Variety of X-ray
    Performed
X X X  
    Lower Price X   X X

Rules and regulations for x-ray systems

If you currently have equipment or are buying new, you should be aware of proposed legislation. The 21st Century Cures Act3, Sec 4003, encourages the move to digital X-ray technology and away from film. Starting in 2017, this provision would reduce payments by 20% for imaging services that use film. It also imposes in 2023 a phased-in 7% reduction for facilities using CR X-ray systems. This legislation passed the House in July 2015 and is now before the Senate.

Richard outlined some basic room requirements to get set up:

  • Usually a minimum space of 9'x9' or 9'x10'
  • Power source, varies by equipment selection
  • Lead shield in the room walls
  • Check applicable state laws and requirements

Before you buy anything, make sure you check X-ray licensing and requirements in your state. You may need a license to run the equipment or a technologist may be required.

Top questions to ask when getting an x-ray cost quote

Matt DiCerbo, equipment category manager for McKesson Medical-Surgical, provided some details on quotes. Matt has a wealth of knowledge based on his years of working with a variety of equipment manufacturers.

"There's a lot more to consider than just the cost of the equipment," said Matt. "You should consider the total 5-year cost of ownership and shop around because prices vary."

In addition to X-ray equipment price, Matt outlined these questions as important to understanding the value of your equipment purchase:

  1. What is the length of the warranty?
  2. What does the warranty cover?
  3. Does it include drop rider protection?
  4. What's the cost of replacement parts?
  5. How quickly can parts be replaced?
  6. What kind of maintenance is expected?
  7. What is the cost for maintenance?
  8. What is the generator size?
  9. How many bits does the system have (image quality indicator)?
  10. Does it come with a PACS system?

Richard described Picture Archiving and Communications System (PACS) as a medical imaging technology which provides economical storage and convenient access to images from multiple modalities (source machine types). According to Richard, electronic images and reports are transmitted digitally via PACS. He commented that this eliminates the need to manually file, retrieve, or transport film jackets. Richard also explained that traditional on-site, web-based systems are being replaced by cloud agent software and cloud storage to protect against technological obsolescence and off-site data protection.

"If you're considering remanufactured or refurbished equipment," Matt comments, "this is available but be sure you are comparing the cost, warranty, maintenance record and age of the system."

It's important to you, and your patients, to select the right X-ray equipment. Remember to compare equipment types and their specific functionality, understand any potential regulatory factors, and ask the questions that can help you gauge the true value of your purchase.


Sources:

1. Conference of Radiation Control crpd.org, A Brief Overview of Computed Radiography, http://www.crcpd.org/Pubs/QAC/Oct08QAC.pdf

2. US National Library of Medicine, Digital Radiography, A Comparison With Modern Conventional Imaging, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563775/

3. Congress.gov - https://www.congress.gov/bill/114th-congress/house-bill/6/text

4. American College of Radiology - http://www.acr.org/Quality-Safety/Radiology-Safety

5. Medical Imaging and Technology Alliance - http://www.medicalimaging.org/about-mita/medical-imaging-primer/#x-ray

2016 McKesson Medical-Surgical, Inc.

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