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by Joan Trombetti and
Robert Garment

This article is from in the November 2007 issue of DOTmed Business News. A list of registered users that provide sales & service can be found at the end.

Radiographic and radiographic/ fluoroscopic equipment, (commonly referred to as Rad and R/F rooms), all begin with an X-ray source to initiate the imaging, and offers the buyer a great number of options. First, there are many different models - from busy little portable Xray machines to heavy-duty Remote R/F rooms - there are many OEMs, the choice between film, computed radiology (CR) or direct radiology (DR), then top that off with whether to buy new, remanufactured, or refurbished, and you have a great deal to consider.

Estimates of the growth rate for Rad and R/F equipment is predicted to be a healthy six percent annually over the next three years.

Digital radiology (DR) vs. computed radiology (CR) vs. film

One of the biggest topics in Rad and R/F room technology is DR and CR, and how long film will hang on. Some people said five years ago film would be gone in five years - and now they're saying it again. Others say film will be around at least for 10 years, and maybe more.

It basically comes down to economics - can a facility afford a brand new DR Rad room, when a film-based system can be had for a faction of the price? But it's not quite that simple. The other part of the equation is the cost saving on film and processing with a CR or DR system. How do you calculate how long will it take for the initial larger investment in digital be recouped? That's usually a function of thru-put. A busy hospital Rad room could reach break-even in two to four years with a DR system; your average doctor's office might never see that benefit.




Then there are a number radiologists who simply prefer film over a computer monitor. Here's a good analogy: everyone loves the no-film cost and instant gratification of their digital camera, but most of us still really enjoy the look and feel of a 4x6 inch print in our hands.

CR - the transitional step from film to total digital imaging

For the uninitiated, CR basically replaces the film in the cassette or bucky with a digital imaging plate. Unlike DR, which instantly sends the image a workstation, the CR plate has to be pulled out and walked over to a reader to acquire the image.

For many facilities, converting a machine to CR is an affordable step before going to DR. The increasing adoption of PACS technology by healthcare facilities has helped make CR become very popular, and is making DR more attractive.

At one time, the DR market consisted mostly of large institutions like teaching hospitals and medical centers. Now DR is more and more frequently found in smaller facilities as well. Ultimately, the unseating of CR by DR seems likely. However, CR's characteristic cassettes will be around for sometime because many still feel that CR is a solid stepping stone to digital technology.

How much does CR capability cost?

According to Mudi Ramesh, director of new business, Huestis Medical, Taunton, MA - a Rad and R/F remanufacturer - the cost to upgrade a film-based system to with a new CR system, "can start around $30,000- $40,000 for the smaller, simpler units used in doctors' officers and community hospitals. For a large hospital-based, multi-suite radiology department, the cost ranges from $100,00 to $150,000."




On the other hand, used CR systems are much more affordable. They have been auctioned on DOTmed.com for between $10,000 to $50,000. Used DR Rad units are just coming on the market, and are being auctioned for prices ranging from $50,000 to $130,000.

Dale Allman, vice president, operations, for Horizon CSA, Troutman, NC - a service-only company that specializes capitated risk programs - says when adding CR capability, "you want the CR brand that will work best with the Rad unit, laser printers and other equipment you have, and service counts, too. Some people will say image-wise, Fuji is better than Agfa is better then Kodak and vice-versa, but it's not that simple; you need to look at all the angles to get the best fit."

Ralph Frizzle, president of GECO, Largo, FL, states that on average "a hospital
can save about 50% on refurbished Rad and R/F equipment. Frizzle believes that "reverse engineering and the right attitude are the ingredients that make a company successful. Factory-trained technicians are part of the mix, too. They can find solutions that improve the bottom-line in radiology equipment maintenance." Frizzle added that GECO only carries Siemens, because, "by focusing on one major manufacturer, we're able to produce the best product."

Getting more "mileage" out of the system

Michael Bamgartner, president, Remesta Medical Corp., Knoxville, TN, echoes the advice of all the ISOs interviewed for this report when it comes to keeping a
system running, "If you want to extend the life of your Rad or R/F equipment and avoid downtime, it's essential to have regular PMs performed by a competent service company. All the dust from linens and bedding in a hospital will clog the fans and filters of the cooling system in no time. I recommend two PMs a year," Bamgartner said. "Anything less and you're asking for trouble."

Buying refurbished or remanufactured equipment - deal or no deal?

Rad and R/F units are one class of imaging equipment that can be successfully
remanufactured, as well as refurbished. The OEMs out-source many of the components they use, and these are available to the ISOs.

While incorporating the same digital imaging technology as new systems, remanufactured Rad and R/F machine. Another factor to consider is that basic radiology has not changed much in the past 10 to 15 years, so a professionally refurbished or remanufactured X-ray system will operate at the same level as a new one if upgraded components are used. Therefore, if a hospital's budget won't accommodate a new machine, or the radiologists like to use plain film, remanufactured or refurbished equipment is an excellent alternative.

Terry Michel, president of Radiology Systems Engineering, Inc., Cherry Valley, CA, mainly sells new equipment because, "once a piece of equipment is refurbished, meaning a major teardown of the equipment, the manufacturer's liability is gone, and the liability falls onto the company that did the refurbishing." Before opening his own company, Michel worked for Siemens, and learned the correct way to refurbish. "You completely disassemble the machine, replace all damaged or questionable parts, and components prone to wear." He feels there are too many companies that just slap some paint on a unit and claim it's been refurbished. "This puts lives at risk and makes the industry look bad," Michel says. He gives DOTmed credit for blacklisting those in the business who are known to deliver unreliable service. "It takes a strong company to blacklist people who are clients - and it speaks volumes for the integrity and
reputation of DOTmed," says Michel.

Maggie O'Mahoney, marketing and sales manager of Mobile X-Ray Solutions, Augusta, GA, specializes in the GE line of AMX machines. She recommends buying from a company that completely rebuilds their equipment. "The rebuilding process should begin with the complete disassembling of each unit, so that it can be rebuilt from the ground up. In addition to replacing components, O'Mahoney says, technicians "should perform a system calibration in full compliance with BRH standards." O'Mahoney follows her own advice and says if you buy from companies like hers, you'll get, "maximum performance, durability and longevity with minimal maintenance."

Sal Aidone, vice president and an owner of Deccaid Services Inc., Deer Park, NY, says radiographic equipment refurbishing entails some safety issues. "Overhead tube stand safety reels and counterpoise assembles must be checked and replaced if worn or out of date, as do tube stand bearings and brakes, patient table locks and bearings." Aidone notes. If the equipment uses an old style generator, auto transformers must be checked for brush wear, tanks checked for insulating,
oil level and oil quality. "Of course, an R/F unit is more complex," adds Aidone. "The imaging system must usually be overhauled, the camera tubes or intensifiers also usually need to be replaced to meet specs." Aidone feels that
the higher mechanical operation of a fluoroscopic unit, spot film assay, tilting table, chain driven table top - need many hours of disassembly and repair.

Brokers offer both refurbished and "as is" equipment

There are also reputable companies that do sell refurbished Rad and R/F equipment, but do little in the way of refurbishing themselves.

For instance, Leon Gugel, president, Metropolis International, Long Island City, NY, whose company buys and sells R/F units from all OEMs, agrees that high quality work is important in refurbishing. "You need to deal with professional
technicians who really know what to do with the different types of equipment." Gugel says that a hospital or outpatient facility can save as much as 30 to 60 percent with either refurbished Rad or R/F equipment.

Richard Fosco, president, Healthware, Inc., Oak Brook, IL, sells primarily GE and Philips, as well as Picker R/F equipment "as is." "These are working units that have been professionally de-installed - usually by the customer or our contractor," says Fosco.

Peter Chen, president of Global Medical Equipment in Harleysville, PA sells all brands of Rad and R/F systems all over the world. Like Fosco, Chen does not refurbish - but he does repaint the equipment.

Ted Huss, president, Medical Imaging Resources, Colfax, CA, says that his company typically buys and resells equipment from a vendor who specializes in refurbishing for the broker market. "We use well known and trusted subcontractors or provide an OEM service contract," reports Huss.

Steve Clark, president, Pacific Imaging Sales and Services, Coquitlam, British Columbia, has a sound policy: "Typically, in refurbishing equipment, I look at safety first. If the equipment is more than 10 years old, it's no good." Clark says mechanical parts that might compromise the structural integrity of the equipment should be replaced, as well as components that can reduce the radiation output of the equipment. Clark believes that smaller outlying hospitals may benefit fiscally from refurbished machines. "Generally, hospital equipment is well used and that is the area in which a large percentage of refurbished equipment is sourced from," says Clark. "Large hospitals, however, shouldn't even consider refurbished equipment. It's a step backwards as the ever-changing digital technologies today have so much more to offer the radiologist/clinician in diagnostic tools."

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DOTmed Registered Radiographic, Radiographic/Fluoroscopic Sales and Service Companies
Names in boldface are Premium Listings.

Domestic
Gus Antus, Ampro International, Ltd, AZ
DOTmed Certified
Jaime Munoz, Jaco Medical Equipment, Inc., CA
DOTmed 100
Ted Huss, Medical Imaging Resources, CA
DOTmed Certified
Terry Michel, Radiology Systems Engineering, Inc., CA
George Gyurtsak, Mediserve, FL
Samuel Sandlin, A.M. X-Ray Service, Inc., FL
DOTmed Certified
Ralph Frizzle, GECO, FL
Jose Reda, General Medical Equipment, FL
Maggie O'Mahoney, Mobile X-Ray Solutions, Inc., GA
DOTmed Certified
Robin West, Premier Imaging/Medical Systems, Inc., GA
Richard Fosco, HealthWare, Inc., IL
DOTmed Certified/100
Alfred M. Brown, Precision Medical Services, Inc., IL
Enrique Aguillon, Self Employed, IL
Mark Ardoin, Omni Imaging Service, LA
Steve Walsh, Eastern Diagnostic Imaging, Inc., MA
Mudi Ramesh, Huestis Medical Corporation, MA
Bob Gaw, PRN, MA
DOTmed Certified
Wayne Horsman, Columbia Imaging, Inc., MD
James Surra, Alpha Med, ME
Glenn R Hammerquist, Berrien Xray, MI
Tom Gohn, International Health Network, MO
Dale Allman, Horizon CSA, NC
William Brooks, Salem Medical Electronics, Inc., NC
Sal Aidone, Deccaid Services, Inc., NY
DOTmed Certified
Leon Gugel, Metropolis International, NY
DOTmed Certified/100
Bill Titus, Ti-Ba Enterprises, Inc., NY
Darrel Kile, Classic Diagnostic Imaging, OH
DOTmed Certified/100
Robert Patsy, Imaging Group, OH
Jim Miller, Miller Medical Imaging, OH
Jim Monro, RSTI Training Center, OH
DOTmed Certified/100
James E. Bowman, Jr., US Medical Resources Corp., OH
Peter Chen, Global Medical Equipment, PA
DOTmed Certified/100
Dan Delpriora, Nationwide Electronics Repossession, SC
David Wingo, Central Imaging, Inc., TN
Mike Jackson, Combined Imaging Associates, TN
Glen Harris, J&M Trading, Inc., TN
Michael Baumgartner, Remesta Medical Corp., TN
Charles McDonough, Premier Imaging, Inc., TX
Pat Thai, AMCI Corporation, TX
Ross Philip, Comemsa, TX
Juan Sandoval, Monterrey Medical Equipment, Inc., TX
Matt Smith, TranzRad, TX
DOTmed Certified/100
Andy Hobbs, Ultra Imaging, Inc., TX
Edward Stone, Jr., Sim Net, Inc., VA
Alan Jennings, Tek Direct X-Ray, LLC, WA
April Showen, Radon Medical Imaging Corp-WV, WV

International
Daniel Pereira, Hospital Planet, Inc., Brazil
Steve Clark, Pacific Imaging Sales and Services, British Columbia
Manuel Casanova, Servicio De Equipos Medicos, Chile
Abdelrahim Khalil, Besisc, Inc., Egypt
Hesham Ali, Medronics, Egypt
Jamal Bazzi, Bazzimed, Lebanon
Siang Seng Wong, Healthtronics, Malaysia
Mauricio Gonzalez, Medixmg, Mexico
Carlos Diaz Escobar, Servicios Y Equipos Medicos, Mexico
Juan Manuel Esquivel Martinez, X-ray Sistemas Medicos, Mexico
Ruud Simons, Medi-Trade, Netherlands
DOTmed Certified/100
Abdul Rauf, Medi-Equip Engg Services Khan Plaza Multan, Pakistan
Faisal Mirza, Sunshine, Pakistan
Luca Adami, IAE Industria Applicazioni Elettroniche, Sweden
Amnat Yodnin, Fine Med co.,LTD, Thailand
Yasar Demirel, Istanbul Medikal Sistemler, Turkey

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