TechNation reached out to OEMs and Healthcare Technology Management professionals for a look at replacement tubes and bulbs. We asked what health care facilities should look for when purchasing tubes and bulbs. We also asked what to look for when it comes to certain features and warranties.
Varex Imaging Corporation’s David Hurlock, W7 Global President Wayne Kramer, Eric Massey with Crothall Healthcare AdventHealth-West Florida; Christopher Nowak, Senior Director, Information Services, Healthcare Technology Management at UHS; and Paul Porter, Commercial Manager, On Demand, GE Healthcare, shared their insights for this popular monthly article. Cybersecurity will be the topic of the Roundtable article in the next issue of TechNation.
Q: What are the most important things to look for when purchasing replacement tubes and bulbs?
Hurlock: Buyers should look for the best value for their situation, which may not be the lowest price. The seller should have a proven track record of delivering high-quality products and should stand behind its products if there are any issues.
Kramer: Ultimately you’re going for the best mix of value and quality. An X-ray tube should always be backed by a reasonable warranty. Pricing is important, but shouldn’t be the most important factor in making this decision. If you’re buying a preowned tube, you want to obtain a level of comfort with the tube’s usage history and age, combined with whatever testing and refurbishing work has been done since it was last installed. It’s not all black and white. In many cases, I would be more comfortable with a tube that has gone through a solid refurbishment process (including testing on an actual system) with unknown usage counts than I would with a tube that was just removed from an old system but with known counts, especially if those counts are high or the tube is more than a few years old. But more important than anything else is having a level of trust and comfort with your supplier, so that you know if something happens during the warranty period you will be covered.
Massey: We would look at price, warranty and if it is a direct fit to go in without modification.
Nowak: The first thing I look for when purchasing tubes/bulbs is the reputation of the supplier. Does the supplier support the HTM career field (such as purchase exposition space at national or local meetings attended by HTM professionals or conduct education sessions for HTM professionals)? Does the supplier have a quality management system in place for the organization? Does the supplier provide technical support after the sale? Once these requirements are established then I consider fitment, quality and cost – in that order.
Porter: When it comes to reliable system performance, managing maintenance costs means more than minimizing the cost of a replacement part. It means limiting downtime, reducing service calls and ensuring clinical excellence with every image. After ensuring tube performance, image quality excellence, dose efficiency and optimal service life, customers should evaluate warranties, service costs and supplier quality.
Q: What are some options customers should inquire about?
Hurlock: What are my alternatives? Are there compatible replacement X-ray tubes available for my system? For CT tubes: does any company offer a tube service contract that would cap my X-ray tube expense over several years?
Kramer: Make sure to get as much information as you can. When considering X-ray tube options, you should always get details about the date of manufacture, usage count, history, condition and warranty. It’s a good idea to get pictures of the tube being offered, clearly showing the labels and that all is as represented. It’s also typical for X-ray tubes to be priced on an exchange basis, or outright at an additional charge. “Exchange” means that a like defective core tube must be returned to the supplier. Also be sure you understand how much time the supplier will allow for you to ship back the exchange before billing an outright core charge. Typically equipment manufacturers, in the case of brand-new OEM original tubes, have the strictest policies when it comes to exchange returns, as well as the highest core charges.
Massey: This would depend on the modality. For CT tubes, you would want to know if it has liquid bearings. On any tube, you want to see if it is a direct fit to go in without modification.
Nowak: Is there an option for on-site installation assistance? Is counter-to-counter shipment available?
Porter: With product quality, customers should consider tube performance, image quality, dose efficiency, service life, warranties, costs and supplier reputation. With tubes being consumable, customers often prefer the savings and peace of mind associated with some type of contract coverage – including options that proactively monitor the tube. GE Healthcare supports whatever service model best meets the customer’s needs.
Q: Can you discuss the pros and cons of purchasing a new product versus a refurbished product?
Hurlock: A new X-ray tube will have a better warranty, usually for an extended use period, and often with a “full replacement” warranty. All Varex glass diagnostic tubes and many of our CT tubes have a one year/full replacement warranty. Typically, refurbished tubes have a short warranty, often 30-90 days, and the warranty is prorated. If the warranty is 30 days/prorated, and your newly installed-ray tube fails in 29 days, you only get a credit for 3 percent of the purchase price. With refurbished tubes, it’s important to know your supplier, and the quality of their refurbishment process. Choose a supplier who stands behind their product.
Kramer: New tubes tend to be associated with lower risk and higher cost. There can be many options for obtaining brand new tubes, sometimes at very different prices. If you’re spending the money for a new tube, make sure you’re getting an OEM-level warranty, or at least a warranty that suits the price being offered. There are, unfortunately, some dishonest people out there trying to peddle tubes as new that aren’t, so be careful. If an offer seems too good to be true, most of the time it is. You should be able to vet the supplier through industry references and websites.
Massey: The life expectancy of an aftermarket versus an OEM tube.
Nowak: I would consider purchasing a used product only on a system that might be approaching end-of-life or has been budgeted for replacement in the not too distant future. Other than that, I would only buy a new tube unless there is some massive backorder or some other thing beyond control.
Porter: New tubes are often considered the most reliable choice. Refurbished tubes have been proven reliable, as well, but we suggest customers put considerable thought into the refurbisher and their processes. The definitions of refurbished versus remanufactured versus repaired versus tested can be confusing. Supplier quality and reputation should be a consideration in any purchase decision.
Q: What types of warranty and product support should customers be aware of when purchasing tubes and bulbs?
Hurlock: The length of the warranty, and if the warranty is prorated or full replacement. Typically, a full replacement warranty offers the least risk to the customer. Another option for CT scanners is a tube service contract, where a service company contracts to have a good working tube on a system for a period of time, typically 3 years. This gives the lowest risk and gives the provider a known cost of life for that CT tube.
Kramer: Any quality X-ray tube should be supported by a competitive warranty – always. Beware of sellers looking for a quick, cheap sale and not offering a warranty. Even if you’re offered a warranty, it means nothing if the company doesn’t support it. I’ve personally experienced being offered a fantastic warranty for a used tube, only to find the supplier completely unresponsive when a claim was made. Always use a reputable company with a solid track record when buying an X-ray tube. Generally speaking, quality used and refurbished tubes will have warranties of at least 90 days on a prorated basis. New tubes typically come with 12 months and might vary between full replacement and prorated. Some also come with usage limits, such as 100,000 scan seconds for CT. All of this is standard in the industry. Don’t assume that buying a brand-new tube automatically means you’re avoiding the risk of warranty failure. Over the last year we actually experienced a higher rate of warranty failures for new tubes than used/refurbished ones.
Massey: Is the warranty per scan or is it a yearly warranty? Does the warranty include installation? Is it a prorated warranty?
Nowak: For new product, I would expect a warranty that is not less than the OEM warranty if I am buying a third-party product. A non-prorated warranty is preferred.
Porter: Warranties may differ between conventional ball bearing tubes and liquid bearing tubes, with liquid bearing tubes often having a longer warranty. Some tubes, often the value line of products, may also have scan limitations. This may not be an issue if the imaging system is in a low-volume environment. When a tube is covered by a service contract, the coverage terms of the contract will dictate the warranties on tube service, uptime commitments and other aspects of tube support.
Q: Is a non-OEM parts only contract a cost-effective solution to offset risk?
Hurlock: A parts only contract with an independent service company offers a high value alternative if your facility has installation capabilities in house or contracted.
Kramer: Parts offered by aftermarket suppliers are very reliable, every bit as much as parts offered by the OEM. In fact, a common fallacy is that parts coming from the OEM are always new. This is not always the case. OEMs often bring in exchange parts, repair them and offer them right alongside their new parts. In many such cases, you’re just paying a higher OEM price for the same thing. Many aftermarket providers offer parts that have been system tested and are supported by a warranty that is often as good (sometimes better) than the OEM. Non-OEM replacement X-ray tubes, from long-standing, reputable manufacturers, are also a viable solution. They cost far less than an OEM original and usually carry the same level of warranty.
Massey: On CT units it is. Usually you can get them for the cost of a tube replacement. On high use CT units you will replace a tube once a year justifying the cost. On units that don’t have high usage you would be better off going T&M.
Nowak: There are a lot of variables to this question. It depends on the device and its criticality to the operations and workflow. Does my team have the skill set to support the gear? Can I get my team educated and what is the expected learning curve for the device? Non-OEM parts are excellent as long as the vendor is vetted and has a quality management program in place.
Porter: If the definition of risk is focused solely on cost, then a non-OEM parts-only contract might be an effective solution, but customers should understand the integrity of the parts that will be used for repairs on their systems, including if the contract provides for the use of authentic OEM parts for any such repairs. If the contract seller is utilizing parts from unregulated, uncertified suppliers, then material savings may be offset from labor rework, downtime and other potential issues arising from the use of such parts.
Q: What else do you think TechNation readers need to know about purchasing and servicing tubes and bulbs devices?
Hurlock: A quality installation is very important to prolong the life of your X-ray tube. Be sure your X-ray tube installer knows how to properly install and calibrate the X-ray tube on your model system.
Kramer: One of the most important things to remember is that, whether purchasing new or preowned, you have options. Don’t assume that you have to go to the OEM and pay their asking price, even if you want to buy brand new. Check around with companies in the industry to find the most cost-effective, reliable solution that fits your specific needs and budget.
Massey: You need to find a reliable vendor and partner with them. Knowing where your tubes are coming from is very important. These are high-end devices and you don’t want tubes arriving DOA affecting patient care. The companies I have partnerships with test these tubes before they are shipped. I always know I’m getting a quality part.
Nowak: Glassware is a critical part of an imaging system. Always vet and understand who you are partnering with for your glassware. Heck, I do that for any part or service we purchase for our program, not just tubes and bulbs. I would never want to compromise the care to the patient, the safety of the operator or the safety of any visitors at my facilities. I never want to jeopardize the reputation and/or integrity of my employer by purchasing parts and services that are not high quality and competitively priced. Lowest cost might sometimes be the right choice, but as a leader it is incumbent upon me that I validate any and all parts and services, my patients and my employer are counting on me.
Porter: GE Healthcare invests heavily in our customers’ success. For example, Tube Watch is GE Healthcare’s predictive solution that is designed to remotely monitor and predict tube failures before any disruption occurs, allowing remote repairs or scheduled repairs at a more convenient time. It delivers peace of mind by converting potential unplanned downtime to planned events, helping to avoid patient and staff disruptions and associated revenue loss. Tube Watch allows proactive part delivery and service scheduling to minimize the impact of tube failures and quickly restore the scanner.
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