TechNation reached out to healthcare technology management gurus and original equipment manufacturers to find out the latest regarding X-ray and tips for maintaining these important devices.
Participating in this Roundtable on X-ray are RSTI Training CEO Todd Boyland, Siemens Healthineers Vice President of Service Business Management Matthew McCallum, Konica Minolta Healthcare Americas Inc. Director of Marketing, Digital Radiography Guillermo Sander, Biomed Security DBA/ProHealth Care’s David Yaeger.
Q: What are some of the newest features in X-ray that facilities should consider when buying new?
Boyland: Some of the newest features in X-ray that facilities are considering when purchasing equipment revolve around patient dose reduction and technically advanced features that aid in diagnosis speed and accuracy. Some examples of technically advanced features include tomosynthesis, 3D reconstruction, workflow automation and Computer Aided Detection (CAD) integration. When people consider CAD, digital mammography comes to mind, but other modalities (digital radiography chest X-Rays) in addition to digital mammography are seeing the benefits of CAD. Data metrics is likely to be an important consideration soon as Artificial Intelligence (AI) implementation continues to expand.
McCallum: When purchasing X-ray systems, facilities should consider features that ensure a foolproof system. The system design should allow future innovations and options to be added easily. Also, consider any features or algorithms that assist with reducing patient dose while maximizing image impression. Finally, consider artificial intelligence (AI), which can be utilized not just for clinical diagnosis but also to improve automated workflow and perform system self-diagnosis.
Sander: At Konica Minolta Healthcare, our newest innovation in X-ray is Dynamic Digital Radiography (DDR), an enhanced X-ray technology that enables clinicians to analyze and quantify the dynamic interaction of anatomical structures with physiological changes over time to enhance diagnostic capability and efficacy. Clinical studies have shown that DDR may be a clinically relevant option to assess COPD and allow for earlier discovery and a better understanding of dyspnea. Future studies will examine the use of DDR for assessing joints and joint movement. AeroRemote Insights is a system monitoring service that providers and organizations can utilize to manage their X-ray assets and help improve department productivity. Buyers should also consider the total cost of ownership, including what is covered in maintenance/service contracts, how a manufacturer addresses software obsolescence (since many systems can have a 15-20 lifespan) and if there is an upgrade path for new technology (e.g., new detector technology).
Yaeger: Radiology departments continue to evaluate systems for image quality with reduced dose. Adding remote monitoring availability of systems to help troubleshoot system failures can be a valuable tool for biomed technicians. Predicting failures is a future possibility with remote monitoring of systems.
Q: How can facilities overcome budget constraints when it comes to acquiring X-ray devices?
Boyland: Many facilities are working to stretch the lifecycle of imaging equipment to help reduce costs. Ensuring parts availability and support for legacy devices needs to be weighed against the cost of replacement or upgrade. There are many providers that will sell and install DR FPD upgrades onto systems that weren’t originally designed to accept newer FPDs. This can be a cost-savings that allows health care providers to keep up with technological demands. While DR FPD upgrades can be a major improvement over current technology, facilities need to be aware of who is responsible for various components related to the upgrade. For example, if an OEM or service provider is responsible for servicing a radiography system, who is responsible when there is a failure and determining if that failure is a result of an FPD upgrade provided by another vendor.
McCallum: To optimize system maintenance, facilities with experienced in-house biomed departments can reduce service costs by looking for OEMs with shared service contract options that include tech support, access to system maintenance, and troubleshooting information, as well as software diagnostic license keys and discounts or price caps on certified spare parts. Another cost-saving measure: detector pooling and deductibles, which can provide greater budget flexibility over the system’s life. Providers with limited or nonexistent medical imaging biomed capabilities should holistically examine their entire X-ray fleet to determine cost-saving opportunities where there is redundancy or with respect to systems with lower productivity requirements. With this approach, you can prioritize higher coverage levels on your more critical equipment to protect patient exam volumes.
Sander: Seeking the lowest price is usually not the best long-term option after considering the time and cost for maintenance and repairs. Leasing or pay-per-use capital agreements can help facilities invest in new technology without a large outlay of funds upfront. Both approaches can also change the investment from a capital to an operating expense, which can help alleviate purchasing constraints.
Yaeger: Create a plan that identifies the potential life of this equipment. Determine, or develop, an organizational life cycle management program that identifies the expected length of time each piece of equipment should be replaced. Also take into consideration the utilization of your equipment. As an example, if you have determined that the lifecycle is 8 years and your utilization is at 40%, consider extending the lifecycle past the 8 years. If your utilization is at 90% consider replacing that unit earlier than the 8 years. Understand that replacing all units in one year may not be fiscally possible for your organization and involve the provider with this plan.
Q: What should one look for in an X-ray/radiology service provider?
Boyland: Engineer certification is a hot-topic item for most health care providers today. Facilities want to be assured that the engineers who are servicing their equipment are doing so in a safe, cost-effective manner that helps to minimize equipment downtime and maximize patient throughput. Flexibility is another key attribute when considering imaging service providers. Service providers today need to have the technical capabilities and required tools to work on a large array of systems from many OEMs.
McCallum: For a true provider/vendor partnership, look for a vendor that offers comprehensive, personalized service offerings that align with your department’s critical patient care objectives – for example, providers with 24/7 or extended care access command service coverage outside the typical 8 a.m. to 5 p.m., Monday to Friday workdays. Find a service partner that performs routine maintenance or non-urgent service on days and times that don’t compromise critical patient care. When you can determine when your service provider has access to the system, you operate at maximum productivity, accommodate higher patient volumes and ultimately achieve higher revenue. Additionally, providers should look for robust training solutions that enable and empower clinical staff to provide a higher level of patient care and prevent employee burnout. Solutions like on-demand applications support, ongoing clinical education and soft skill development training ensure that technologists, staff and managers receive up-to-date support when, where and how they need it.
Sander: Look beyond the acquisition price and consider the cost and coverage of the service agreements. If the supplier does not offer solutions to help manage your systems, such as dashboards that capture utilization, exam volume, image reject reasons, exposure levels for exams and critical events such as dropped panels, you will have to invest additional resources over the life of the system. Also, find out what type of upgrade path is available for a system and whether new technologies or features can be added over time. Again, consider that a typical X-ray system can last up to two decades, so it is important to acquire a solution that allows your organization to change and adapt to advancements in technology – both hardware and software.
Yaeger: There should be a strong local service team willing to partner with the in-house team. The provider should be well established in the industry, responsive to the needs of your organization, whether you have an in-house biomed department, third-party repairs or you contract with the manufacturer themselves. They should provide a clear escalation process for unresolved service events. Knowledge from the provider that they understand security needs of your organization and are willing to keep their equipment up to par with OS and application versions and security patches.
Q: What steps can be taken to facilitate future upgrades?
Boyland: Ensuring compatibility with the current/desired facility workflow is something that needs to be considered for future upgrades. This can ensure future upgrades integrate seamlessly with the goals of the department. Having IT and PACS involvement is important to ensure systems comply with their expectations regarding security and interoperability.
McCallum: Software upgrades drive advancements in today’s imaging equipment, sustaining the life of an X-ray system and avoiding more frequent and costly full-system upgrades. Factory upgrades for X-ray systems are typically available 3 to 10 years after purchase, while minor software updates may be available for the system’s entire life. Budget at least one upgrade into the total cost of ownership calculation. By planning for this at the point of sale, you’ll obtain access to new features down the line and potentially extend the system’s useful life by several years.
Sander: Don’t just look at what you are doing now, but rather what role radiology or X-ray will play in your practice or hospital department in the future. Hospitals are becoming more networked and interconnected, so pay particular attention to this. Also, look for systems and platforms that are designed to grow and evolve with your practice.
Yaeger: When purchasing equipment, identify in the SOW or SLA the upgrade timetable established by the provider and any associated costs. Negotiate the costs into the purchase price as to eliminate costly upgrades throughout the lifecycle of the equipment.
Q: What advice would you give a biomed involved in the purchasing of a facility’s X-ray devices?
Boyland: Develop an understanding of biomed and in-house engineer access to servicing newly installed systems. OEMs work hard to create a sense that they are the only one who can service their imaging equipment. The reality is that OEMs have a responsibility to provide access and documentation necessary for the in-house engineers (and third-party engineers) to ensure safe compliance following in-house service of imaging systems. The in-house and third-party engineers also have a responsibility that the imaging system performs to OEM criteria following service by the in-house or third-party engineer.
McCallum: Understand what you need from the OEM to service and maintain new equipment. Will you only require an on-demand level of support for your entire department – or will you need technical training to deliver a higher level of expertise? Or will you need something in between? Do you have preventative maintenance and a parts strategy in place to maintain compliance? Do you understand all the risks of opting for time and materials?
Sander: Really pay attention to maintenance costs. Consider the tools provided to manage the equipment as well as the type and quality of service solutions the vendor provides to monitor and manage your systems; for example, the ability to gather reject and usage data for all systems in the network without having someone manually download the data. Talk to your supplier to find out how they can help you plan for the future to help you do more.
Yaeger: Prior to purchase, request a listing of any special tools and test equipment (including service software) with part numbers and pricing. Request training costs with any required prerequisite classes. Purchasing – have detailed discussion with your provider surrounding the security capabilities of their equipment. Obtain a Manufacturer Disclosure Statement for Medical Device Security (MDS2) form from them that shows their capabilities to secure their product. Collaborate with your security team in reviewing the document for strengths and weaknesses. Does it support the latest networking capabilities? Can you change admin passwords from their defaults? Can you install antivirus protection software, etc.?
Q: What else do you think TechNation readers need to know about purchasing and servicing X-ray equipment?
Boyland: That OEMs have a responsibility to provide access and documentation necessary for the in-house engineers (and third-party engineers) to ensure safe compliance following in-house service of imaging systems. The in-house and third-party engineers also have a responsibility that the imaging system performs to OEM criteria following service by the in-house or third-party engineer.
McCallum: At the point of sale, an OEM may offer a haggle-free, best-offer service contract that simplifies and expedites deliverables required by most customers – including basic tube, battery and detector coverage – and protects parts that will most likely fail in the early years of ownership. Lock in prices early to avoid increases.
Sander: X-ray is no longer just about the image capture, you also need to consider the image processing. Think of a camera for photography: would you want to buy an old digital camera that has lower resolution compared to today’s digital camera? Think about digital radiography in the same way: 10 years ago DR technology was expensive, but today the price has gone down, the quality has greatly improved and there are advancements in image processing that you’ll likely want to utilize either today or in the near future. Also, consider the ability of the manufacturer to service and help you manage the asset. With film X-ray, many sites had two systems in case something went down or broke. This may not be the case with DR, so inquire how your vendor can provide not just preventative maintenance, but prescriptive maintenance and help self-predict when maintenance is needed.
Yaeger: Ensure you have received all documentation for service and support of your equipment and accessories prior to acceptance. Have a clear communication path for service and support requests from your vendor. Review the service history with department staff and leadership prior to the end of warranty. Follow up with the vendor to resolve any outstanding warranty services issues.
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