Hospitals in the market to buy a new CT scanner should avoid the trap of getting fancier technology than they need, and they should be aggressive with vendors in calculating uptime in service contracts, tech planning experts with ECRI Institute advised during a recent event on CT equipment purchasing.

"We understand you have your one chance every seven years to get a CT scanner, so you want to buy the latest and greatest systems available today," Robert Maliff, director of ECRI's applied solutions group, said during the institute's webinar, held Wednesday. "But clinically do you truly need that?""

In the online talk, "Cost vs. Reality - What CT scanner should I choose?" the health care technology non-profit also revealed that 128-slice scanners were the type of CT equipment its hospital clients were most interested in.

Know what you need

CT scanners are a big investment for most hospitals. Average prices range from $400,000 for a 16-slice scanner on the low end to $1.6 million for one of the hundred-plus slice premium systems, according to Jason Launders, a medical physicist and senior project officer for medical devices with ECRI. Generally, buyers hope their scanner lasts seven to 10 years, he said.

"A lot of people probably overbuy technology, but we also know there are a lot of considerations" down the road, Launders said. "It's important to get the decision right."

[Go here to find out how to watch an archived version of the webinar.]

Still, when purchasing, it's best not to get too bogged down in slice counts. Since 1998, when multi-slice scanners became commercially available, providers would talk a lot about how many slices or "channels" the device had, he said. But it's not the be-all, end-all, as coverage area of the detector is also a clinically important number. Also, with the top-of-the-line premium systems, such as Philips' iCT, Siemens' Definition Flash or Edge, or Toshiba's Aquilion One or Premium, other advanced applications are often the main driver of value.

"Over the last three or four years, slices have become less important," he said.

128-slice on top

Of the current models, 64-slice scanners are the "workhorse" in modern radiology, and come with a "medium" price tag and total ownership costs, Launders said. They're often also upgradeable, a key consideration for many buyers, to 128-slice, which allows for better 3-D modeling and artifact reduction, and is "definitely a popular place to be at the moment," he said.

In fact, among ECRI's clients, 128-slice is often at the top of their wish-lists. According to internal research by the institute, by the third quarter of this year, interest peaked around 128-slice scanners, while interest in 64-slice ones dropped to third place, behind premium equipment, which saw a boost at the end of last year with the release of new technology. Sixteen-slice scanners, basic and relatively cheap systems that are usually not upgradeable, saw a slight jump this past quarter, even though interest is still well below its more powerful cousins.

These trends were reflected by the voting preferences of webinar participants. When asked in a poll, more than one-third said they would be most interested in buying a 64-slice system, another one-third wanted 128-slice, with premium and 16-slice rounding out the bottom.

Good service

The scanner's specifications and cost are only part of the equation. There's also the not-so-small matter of the service contract.

When buying the equipment, most hospitals opt for a multi-year contract at point-of-sale, Maliff said. Typically, these contracts last 12-60 months post-warranty.

Service isn't cheap. On average, expect to pay between 6.3 and 9.5 percent of the total acquisition costs each year, he said. This means bills average well above $100,000 annually.

Among several points to keep in mind, two issues stand out: travel minimums and uptime guarantees. Travel minimums are, in effect, the minimum charge a vendor hits you with for sending out a field service engineer. If your travel minimums are four hours, that means even if an engineer fixes your machine within 15 minutes, you'll still be billed for four full hours. Urban and suburban providers might have some wiggle room here in negotiating better terms for their minimums, but not everyone is so lucky. "You might not have leverage for that if you're in a rural area of an exurb of a major city," Maliff said

For uptime guarantees, vendors like to calculate uptime over the course of a year, Maliff said. That's good for them, as it gives them leeway, but it's probably in the best interest of the hospital to have uptime calculated monthly or quarterly, he said.

"Be aggressive here," he suggested.

Other costs

There are also other costs to keep in mind when siting the equipment. The X-ray tube in the scanner generates an immense amount of heat, and if there isn't a water-cooling system in place you'll have to increase the air-conditioning to the room, Launders said - in some cases, you'll have to double it. "(It's a) major consideration for siting a new machine," he observed.

Also, many new CT scanners are finding homes outside the radiology departments: some end up in radiation oncology for treatment planning, surgical suites for intraoperative CT imaging, and the emergency room for trauma cases. But this requires serious calculations on expected utilization rates.

"You certainly do not want to install a $1 million device where it's going to be used twice a day," Maliff said.

ECRI Institute's webinar, "Cost vs. Reality - What CT scanner should I choose?" also covers new radiation dose control techniques you should watch for, emerging CT technology, and more on the cost and utility of different CT scanner specifications. The webinar is available for viewing in full (for a fee) here.