PET/CT Buyer's Guide: Used & Refurbished Systems

PET/CT
BUYER’S GUIDE
for purchasing
used & refurbished
PET/CT systems
PET/CT Buyer's Guide
Copyright © 2015
Table of Contents
For Starters ....................................................................... Page 1
Which PET/CT Do I Need? ................................................... Page 2
How Do I Know I’m Getting a Good System? ....................... Page 6
How Much Will the System Cost? ....................................... Page 7
Next Steps ..................................................................... Page 14
For Starters...
For Starters...
Like shopping for a lot of other medical imaging products, the PET/CT market confronts nearly
everyone who enters it with a reality that is both a blessing and a curse: options.
With different makes, different models, and myriad software capabilities to consider, it’s easier
than ever to get what you need, and at a good value. On the other hand, narrowing the field
down to find the system that will be the best fit for your needs (and your budget) can be a daunting
task. That’s where this guide comes in. To help you make that perfect pick, this guide will answer
the three biggest questions customers ask as they begin shopping for a PET/CT scanner:
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•
•
Which PET/CT do I need?
How do I know I’m getting a good system?
How much will the system cost?
If you’re ready to get started, we are too. Read on to prepare yourself to make a great PET/CT
selection for your facility!
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
1
Which PET/CT Do
I Need?
Which PET/CT Do I Need?
The first step to answering this question is to ask another question: “How do I intend to use this
system?” PET/CTs are used for a variety of studies, from cardiac, to neurology, to oncology. There
are some PET/CTs that do all of these things exceptionally well, but paying for capabilities that
are outside the scope of your individual practice can needlessly inflate your equipment budget.
Once you know what you are going to do, you can begin to assess your options accurately.
The most significant considerations are slice count, cooling system, software options, whether
you intend the system to be mobile or fixed, and, of course, budget.
Slice count:
How many slices you need is based on a couple of considerations: What kind of studies you
plan to do and market conditions in your area.
What Kind of Studies Do You Plan to Do?
Oncology studies can be performed on any PET/CT system. Cardiac studies are best
performed at higher slice counts and, in some areas, are only reimbursed if using a
64-slice system. If you are primarily interested in doing gated cardiac studies (MPI), a
4-slice GE system is sufficient and, perhaps, ideal.
What Are the Market Conditions in Your Area?
If competition among practices is high in your area, it may be important to learn which
slice counts are available to patients in other local facilities. You might need to be more
competitive to draw referrals from local physicians.
In terms of calculating reimbursement revenue by patient volume (access radiology
reimbursement calculator here), it’s important to understand this tip: Unlike a CT
scanner, a higher slice count on a PET/CT generally has no effect on scanning times
and throughput. This is because, regardless of the slice count of the CT portion of
a PET/CT, the PET portion is always slower. The overall scan time is a result of that
speed, not the CT’s. It’s also worth noting that PET scanner speed is comparable across
all manufacturers.
PET/CTs are available from the “Big 3” manufacturers in the following slice counts:
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•
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2 (Siemens)
4 (GE)
6 (Philips/Siemens)
8 (GE)
16 (GE/Philips/ Siemens)
64 (GE/Philips/Siemens)
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
2
Which PET/CT Do I Need?
(continued)
Cooling System
Another factor to consider when searching for the right PET/CT scanner is the method of cooling.
With the sheer quantity of electrical components operating inside a PET/CT’s gantry, heat builds
up quickly. To compensate for this build-up and prevent equipment faults from overheating, there
are two main methods of heat dissipation: air cooling and water cooling.
Air Cooling
Air-cooled systems rely on open ventilation through the external covers of the
gantry via fans. Some advantages of this cooling type include:
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•
•
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No concerns over water quality
A lower amount of preventative maintenance
No need to purchase/maintain an external chiller unit
Smaller footprint, fewer cabinets
Water Cooling
Water-cooled systems rely on external chillers plumbed to a nearby water source.
Some advantages of this cooling type include:
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Fewer concerns involving inconsistent humidity or ambient temperature
Do not require additional HVAC accommodations for the room itself
Quieter, more comfortable scanning room
Cleaner gantry (fans tend to pull in dust, hair, etc.)
Software Options
The PET/CT software options that are currently available are too numerous to detail in one
place. In addition, many options that perform the same function are called by different names
depending on which OEM produced them. For brevity’s sake, we’ll talk about the most commonly
sought-after options.
Time of Flight
This option takes advantage of very fast detectors and electronics that can measure
the tiny (nanoseconds) time difference between the detection of each annihilation
photon along the line-of-response between opposite detectors. It allows radiation dose
reduction and faster scan times. Philips pioneered this product commercially in 2006.
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
3
Which PET/CT Do I Need?
(continued)
Calcium Scoring
This option scans heart arteries to find calcium deposits and diagnose heart attack
risk. Calcium scoring is available on nearly all PET/CT systems under a variety of
proprietary names.
Cardiac Gating
Cardiac gating correlates images of the heart with certain phases in the heartbeat. It’s
ideal for myocardial perfusion studies. This feature is available on most systems from
the factory. If the system you are considering does not currently have cardiac gating,
it still may be able to be added.
Another aspect to consider is the software that you will use to acquire or process your
cardiac gated studies. Popular cardiac gating software suites are Emory, Cedars, CVIT
and 4DM. If you are already locked into a specific software program, be sure to check
that it supports the scanner you are buying.
Respiratory Gating
Using reflective foam blocks and a calibrated camera, the PET/CT system can
compensate for normal breathing movement during a scan. This feature is an add-on.
All systems support it. The most popular systems are made by Varian.
Mobile PET/CT Installations
Some of you may be considering the purchase of a PET/CT scanner for installation in a mobile
trailer. This fact will make a significant difference in narrowing down the field of machines you
have to choose from.
“Mobile-Friendly” Features
Here are some features that make a PET/CT better suited to mobile installation:
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•
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Air-cooled gantries (since they don’t require a chiller)
Smaller footprint designs
16 slices or below (as faster scanning means more vibration)
“Mobile-Friendly” Models
The following are models commonly installed in mobile settings:
•
•
•
•
GE Discovery ST
GE Discovery STE
Siemens Biograph Duo
Siemens Biograph 6
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
4
Which PET/CT Do I Need?
(continued)
“Big 3” Offerings in PET/CT
Check out the chart below for the most common/popular PET/CT model offerings from the “big
3” manufacturers- GE, Siemens, and Philips. As you shop for the perfect system for your facility,
these are the models you are most likely to encounter on the secondary market:
PET/CT MAJOR
MODEL OPTIONS
GE
siemens philips
Discovery LS4
Biograph Duo
Discovery LS16
Biograph 16
Discovery LS8
Discovery ST4
Discovery ST8
Discovery ST16
Disc
Discovery STE4
Biograph 6
Biograph 40
Biograph 64
Gemini Dual
Gemini Power 16
Gemini GXL 6
Gemini GXL 16
Gemini TF 16
Gemini TF 64
Discovery STE8
Discovery STE16
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
5
How Do I Know
I’m Getting a
Good System?
How Do I Know I’m Getting a Good
System?
This is a frequent question from people who have never before considered purchasing a used
PET/CT. There are a lot of ways to confirm a system's quality. We recommend the following.
Start thinking about these early on to allow time for any changes to be made!
Process Homework When Considering a Pre-Owned PET/CT
Inspection
Be sure to have the PET/CT inspected before you pay. Either inspect it yourself (with
your tech?) or hire an engineer to inspect on your behalf. This will likely cost you
$2,500 - $4,000, but is well worth it. This will let you get to know your prospective
system’s current and recent performance, its overall condition, and the environment it's
been operated in.
Records
Any records you can get will be useful. Error logs, service reports, quality control
checks, accreditation certificates- each of these documents will help paint a picture of
how well a PET/CT has performed and how well it’s been maintained.
Refurbishment
We’ll be frank with you: refurbishment simply isn’t done as much for a PET/CT as it
is for other modalities. Given the typical workload and usage environment of these
systems, it’s unusual for them to see the harsher wear and tear of trauma or OR imaging
equipment. If regular maintenance has been performed on the system, refurbishment
on the scale seen among other equipment types is frequently unnecessary.
Accreditation
It’s important to consider whether or not the system you’re looking at will be eligible
for accreditation but, ultimately, this is not something your vendor can answer for you.
Accreditation occurs once a system is installed and operational and is done by a 3rdparty accreditation company. Receiving accreditation involves checking the quality
of the scan, the equipment, the room it’s installed in, and even a facility as a whole.
Because dealers do not offer accreditation services, the buyer is responsible for making
sure their facility is compliant to receive accreditation and, thereby, the applicable
reimbursements. Learn more about medical imaging accreditation FAQs here.
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
6
How Much Will
the System Cost?
How Much Will the System Cost?
This is the question that many customers think of first. We’ve saved it for last because we believe
the overall value of an equipment purchase is every bit as important, if not more important, than
the up-front price. If you go for the cheapest option up front, you can end up paying even more
on the back end of your PET/CT scanner project to get your system where you really needed it
in the first place.
That being said, we’re going to share the relative price ranges in the current market for systems
as well as options and accessories that will be a part of your overall project cost. AND, to make
sure this project is considered from all angles, we’ll talk about a few costs that probably won’t
come from your PET/CT vendor but will still be essential to a quality finish.
The PET/CT System
The pricing of an individual PET/CT will vary from system to system as well as from vendor to
vendor, but the chart below lists some current industry averages for a used system, delivered and
installed, without a 1-year service agreement:
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
7
How Much Will the System Cost?
(continued)
PET/CT Accessories
Injectors
An injector will generally cost between $5,000 and $20,000 dollars depending on
its age and whether it is a single or a dual-head unit.
PET Infusion Systems
After the radioisotope dose has been mixed for the patient it can be administered with
a syringe or, to reduce exposure for techs, with an infusion system. A good example
is the Medrad Intego for 18F-FDG. These systems are about the size of an end table
and automate the patient infusion process. At present, the cost of an infusion system
averages between $90,000 and $100,000.
Hot Lab
Building your hot lab will require a number of components: dosimeters, lead bricks, a
calibrator, an L block- maybe even some structural shielding, depending on the design
of the room your lab will occupy and the requirements of the state you’re operating
in. Your hot lab requirements will need to be assessed on an individual basis, but the
median range for building a new hot lab area is $25,000 - $35,000.
NOTE: If you are doing primarily cardiac studies, you can skip the hot lab requirement
and go with a solution like a rubidium (Rb82) generator. Pricing on these can be
difficult to nail down without an individual consultation.
ECG Trigger Monitors
These will be necessary if your site intends do cardiac gated studies. Some systems
will come with them, and others will not. Be sure to ask your vendor about them. Their
average price ranges between $5,000 and $10,000, depending on make and model.
Workstations
There are a variety of workstations that can be added to PET/CT scanners for reading
and manipulating images. Workstations can also be added to enable a system with
software options that aren’t standard features. Some common workstations include
GE’s AWW, Siemens’ Leonardo, Wizard, and Navigator, and Philips’ Extended
Brilliance Workstation.
Workstation pricing varies based on the age of the workstation, the software options
that are loaded on it, and whether or not the workstation is available on the used
market. A 10 year-old, used workstation for a single or dual-slice machine can cost as
little as $2,000. On the other hand, a 3 or 4 year-old workstation set up for a 64-slice
PET/CT can cost $15,000 to $30,000 on the used market or $80,000 to $120,000
purchased new.
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
8
How Much Will the System Cost?
(continued)
Radiation Therapy Lasers
These oncology accessories average around $8,000 to $45,000 depending on the
number needed and whether or not the lasers are fixed or movable.
Treatment Planning Workstations
This workstation is specifically related to planning cancer treatments. Treatment planning
workstation prices vary greatly depending on the level of the software packages that
are purchased along with them. They start around $10,000 and can cost upwards of
$100,000 with the latest applications.
Mobile Trailers
If you intend to use your PET/CT scanner in a mobile setting, you’ll need to budget for
the price of the trailer itself as well. The price range on these is very broad. A trailer and
installation can range from $75,000 for a used trailer to $400,000 for a new trailer.
In addition, you will need to purchase a “hardening kit”. The hardening kit is a rigid
plate that is used to anchor the system to the floor of the trailer and increase its
resistance to the shaking and bumping that comes with travel. As simple as they may
seem, these kits usually run $10,000 - $20,000 and are next to impossible to find on
the secondary market.
Contractor Fees
Unfortunately, this part of your project will involve far too many variables for a single
guide to tackle. Preparing your facility for the installation of a PET/CT may require you
to work with a variety of specialists including (but not limited to): building contractors,
electricians, plumbers, HVAC technicians, architects, and physicists. Many of these
people will each represent a different company with a different pricing structure, some
of which will vary yet again by region. With this many possibilities, we can’t rule
anything out, but we can offer a few items to help set your expectations and point out
some valuable caveats:
• Once you’ve settled on which PET/CT system you intend to purchase, forward a
drawing of your space from an architect to your installer as soon as possible. Their
site planner will propose a room layout from this drawing.
• Check your state requirements for warning lights and door switches or interlocks.
The specification and installation of these items will require interaction among
your architect, installer, electrician, and builder. These requirements and their
connection to your PET/CT are a common source of delays if not investigated in
advance of the project. Find out more about your state’s unique radiology health
laws here.
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
10
How Much Will the System Cost?
(continued)
• Involve HVAC contractors early in the project to help avoid delays. A drafty scan
room can be just as much of an HVAC problem as an overheated room. A proper
scan room temperature makes things comfortable for both the PET/CT and your
patients (hospital gowns aren’t particularly well-insulated).
• Several drafts of the room layout will probably pass back and forth. When
a final layout is agreed upon, be sure to schedule a preliminary visit from the
installing engineer. One visit is often enough, but this could be the first of two or
three, depending on the extent of the room modifications.
• If you have purchased a water-cooled PET/CT, you will need access to water
lines for your chiller. Your plumbing and HVAC contractors will collaborate on this
installation.
• Most PET/CT scanners will need 480V, 3-phase power. Pricing will depend upon
your electrician, but this can be one of the more costly components of a scan room
remodeling.
• Consider dimmable lighting for the scan room. The softer settings help reduce
glare that impairs the PET/CT tech’s view of the room and are a comfort factor
for patients. The brighter settings are ideal for cleaning and system maintenance.
• Your scanning room will need to be lined with leaded drywall to shield the
surrounding areas from radiation. This can be installed by your building contractor
like regular drywall, but the material costs will be significantly higher. The cost
per sheet is determined by the thickness of the lead lining, and because thickness
requirements are dictated by local authorities, lining prices will vary from region
to region.
• The control room will need a leaded window for viewing patients and a leaded
access door. Once again, your building contractor can install these materials.
Pricing on both will vary by the thickness of the glass/ lead and whether or not
your state requires door switches or interlocks.
• You’ll need to communicate with your IT specialists to ensure that the proper
networking connections are available in the scan room for the engineer to connect
the system to the facility PACS network.
• After installation, you’ll need a state-certified radiation physicist to come out and
approve your system. Don’t schedule your physicist’s visit too far in advance. A
project with this many moving parts can easily be subject to a delay or two.
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
11
How Much Will the System Cost?
(continued)
Applications Training
Applications training, or apps training as it is commonly shortened, is a comprehensive program
that walks PET/CT techs through all aspects of a system, from basics like turning the unit on
and off to quality assurance tests and patient positioning for all study types. In most cases,
an applications trainer will customize the protocols for the particular studies your facility will
perform most often.
Apps training is a must for users that are new to the PET/CT modality and it is not cheap. A day
or two is recommended for the machine to have its protocols set up and for any workflow issues
to be settled. Prices can vary anywhere from $1,500 - $5,000 dollars per day, not including
travel expenses for the trainer. On the other hand, apps trainers are often accredited and can
provide techs with the value-added benefit of continuing education credits for the days that they
are in training.
If your techs have a high level of familiarity with systems similar to your incoming purchase, it
may not be necessary to provide all of them with full apps training. However, if a PET/CT is
being moved from one type of facility to a drastically different one (say, from a pediatric site to
a hospital’s oncology wing), an apps trainer will be needed to build the new protocols. Talk to
your installer about providing an “in-service” or system demonstration of use in either case. This
is sometimes referred to as “buttonology” or “knobology” and is essentially a basic tech tutorial.
Whether you need “buttonology” or a full three days with an apps trainer, it is imperative to
communicate with your PET/CT tech staff and get a clear understanding of what they do and
do not know.
Service
Even at the prices you can find on the used market, a PET/CT scanner represents a sizeable
investment both monetarily and in terms of providing excellent patient care. We recommend
accompanying that investment with some type of warranty or service plan. Even if your site wants
to take all the risk for parts and labor to maintain the system through your own in-house clinical
engineers, it may still be worth asking about parts warranties or parts availability commitments
from your vendor, even for only a limited number of months. Equipment downtime affects patient
throughput, staff scheduling, and reimbursements, not to mention the anxiety level of your entire
imaging department!
The features of a PET/CT scanner service contract will vary from vendor to vendor and so will
pricing. Hopefully though, the homework you did on your vendor included a look into some of
their service options.
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
12
How Much Will the System Cost?
(continued)
The third-party service market offers a variety of creative packages, whether you have an inhouse biomed team or are looking for full risk management. Tube coverage, 24/7 coverage,
parts AND labor, and chiller inclusions are just a few of the variables to consider in selecting a
service agreement and provider.
By way of example, the following are average annual prices for PET/CT coverage on popular
models under Block Imaging’s Full Service agreement. Please note that many service providers
will offer discounts for multi-year contracts:
PET/CT service Coverage
Average annual prices under Block Imaging’s Full Service agreement
AVERAGE aNNUAL
SERVICE COST
SIEMENS BIOGRAPH 16
ge DVCT 64
phILIPS 64
gE LS4
PHILIPS GXL 16
GE DISCOVERY 16
$136,000
$136,000
$148,000
$117,000
$143,000
$126,000
A Final Word on Cost
Once the details of a PET/CT project are broken out, a simple response to the cost question
emerges: Prices vary too much for a one-size-fits-all answer. The best way to begin is by selecting
a vendor who takes the time to understand all of your specific goals for the PET/CT project.
Your patient volume, ideal timeline, technologist’s experience, room size, budget, physician’s
demands, and competitor’s equipment are all factors that a vendor must understand in presenting
the best equipment and service.
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
13
Next Steps...
Next Steps...
Keep reading about PET/CT in these additional articles:
How Much Does a PET/CT Scanner Cost? 2015 Update
GE Discovery PET/CT Scanners Compared
Four Things to Know BEFORE You Choose a Mobile PET/CT
Siemens Biograph Duo PET/CT Review
See which pet/ct is best for you
For a complete listing of Block’s available systems and services please visit
www.blockimaging.com
14