This report originally appeared in the February 2010 issue of DOTmed Business News

Big Challenges

When it comes to getting hi-tech (and highly valuable) machines into a decidedly low-tech area, you tend to hear helpful comments like, "Are you crazy?" Or, "You must be kidding." And the show-stopper, "Do they have modern health care there?" These responses are usually followed by, "Can you make it work?" "How are you going to get paid?" "Will everything make it there in one piece?" And the encouraging, "You must believe in miracles."

MRI in controlled situations is technical and precise. All the teams - sales, de-installation, crating and rigging, pre installation testing, site planning , RF shielding, shipping, warehousing (if applicable), installation, calibration, and general construction - must work together if the machine is going to meet performance expectations.

If that sounds daunting, I probably shouldn't mention the planning for the change in the power grid, customs inspectors that open everything and aren't always knowledgeable or bumpy roads that make it not only difficult to get the MRI to the site in top form, but also make it likely you'll need to utilize the machine yourself to figure out what has been shaken loose from your own body Finish the trials and tribulations by dealing with bankers who are unlikely to give you the money promised unless it's a stipulation in their will and you may start to get a taste of what it's like. But an MRI is a big risk with a big potential payoff.



MRI sales are difficult because the reality is that one mistake, a shim tray miscounted, an emergency light incorrectly installed, a connection to building steel . . . any one of 100 items to check can cause big problems. If you're wrong, then the image quality is compromised. If you don't fix the problem or don't know how to fix the problem, your mistake grows. If you sell an MRI as-is, where-is, without inspection or staging from a warehouse in the United States to a rural South American facility, it's not just a bad idea. In my mind, it's a crime. Even if you have sold the system for $20,000 (about the price of a good new coil), it still doesn't justify providing inferior product or service. "Getting what you pay for" is shouldn't replace "the customer is always right." At the end of the day, you still have to ship it, shield it, and install it correctly, leaving the customer happy - or you will develop a reputation and it won't be a good one.

Big Rewards

Think about it, if it were easy everyone would do it. So here's where you're wondering why you, or anyone in his or her right mind would want to go through these troubles. The answers are much simpler than the steps required to make it happen. Because they need it, you have it and it's good business. It's the next big market - a really, really big market. It's where everything used is going anyway. If you don't sell it, someone else will. The sales are easy too. Actually, reverse that. The sales are too easy. If it were just an X-ray or a CT scanner, or another plug-and-play system it would be a quick sale and you would be sailing into the sunset. Those that do go through the trouble and do things correctly love the challenge. Everyone remembers the hard installations no one else would even bid on because they were next to impossible or in a far away land. Bringing the world's most difficult-to-install machine to Africa, Asia, the Caribbean, Mexico or even a rural part of the United States gives you an inner feeling of accomplishment. You feel good delivering health care to people who need it.




I have been in on plenty of brand new multi-million-dollar cutting edge downtown America installations. They were fun and at times a challenge. But honestly, I prefer a tight, but workable budget in India, where that old used MRI keeps turning out beautiful scan after beautiful scan because you kept all the little things under control. Many of the used magnets being pulled out with medium image quality are finding a new life with even higher image quality when re-installed. Attention to detail, better shielding technique and equipment installers that care about their work make all the difference. In fact, many of these individuals loving the challenge can be found on DOTmed. Some of the really good independents are a bit harder to find as they don't advertise enough and you don't find them at too many shows. But they're worth hunting down. Ask around when you see a great installation or a terrible one and remember the company or individual. Normally, referrals will help bring the good guys to the top and ostracize those not worth doing business with.

Getting What You Pay For (and What You Expect)

So you want to buy a used MRI at an honest price get it installed in your home town of ______ and you don't want to be ripped off . That's a reasonable request with reasonable steps to take. Unfortunately, the steps aren't free.

1. Consult a pre-installation inspection person to make sure an MRI of your choosing will work in your location. Remember, some MRI units are sensitive to different things and some things are sensitive to MRI. Have a backup location in case you first location fails.

2. Estimate your cost now that you have some basic information and then add twenty percent.

3a. Get a good site planner with plenty of experience for the type of MRI you want to install (high field, open, 3T, cryostat, resistive, aluminum, Oxford, humidity sensitive, vibration sensitive, etc.). If he hasn't worked with the MRI you want to buy, find some else. Then draw up the plan and stay with it.

3b. ( The Architect question) Should you hire one? Sometimes you have to one to meet local government permit and building code requirements and they usually charge about 10% of the construction cost. Most do not understand MRI. I normally have to have multiple meetings to make sure everyone is on the same page. Don't ever let an Architect run an MRI job .His job is to draw.

4. Get your loan for your facility and your magnet, including delivery.

5. Start general construction. Every move must be approved by your MRI job site supervisor. If you've done your homework and picked someone with the proper experience, that person knows the job. He makes sure everything is done right and everyone gets paid. Nothing slows him down and he has a backup plan for every problem.

6. Have your chosen MRI inspected by a professional while it is still set up. It's a must to test every coil and record SNR and serial numbers. Verify the testing personally or via video over the web. Ask for different scans T1, T2, diffusion ...of every coil. If you don't like the system, pay the testing person and get your deposit back. If the system needs repairs and you still want to purchase it, it is best to have it repaired before it's moved. Broken promises of later repairs in distant lands are lessons you don't need to learn. If you like the system, have the professional inspector seal the computer cabinets and consul before he leaves. Record all seal numbers and photograph everything at inspection as this is your point of sale.

7. Set up with the company to de-install. Never let the broker, trucker, salesman or handyman next door touch the system. Allow no service of the system and do not let anyone break any seals. It's upsetting to note, but many a good board is replaced with a weak board before the system ships or while it is in the warehouse in storage of a service company. I suggest you change the lock to avoid late-hour entry. I have gone as far as to post security in high-risk areas. Take all software and service documentation and service diagnostic software before you leave. Your contract should include the operating software and diagnostic software as part of the system. Some OEMs have been known to lock software and remove programs before shipping, requiring a new purchase of software to reactivate after re-installation. When purchasing used from an OEM and keeping OEM service there are very few if any software problems. One of my favorite installers always copies the hard drive at purchase and thus has a backup when needed. As a general rule, brokers and de-installers never release information to OEMs , service companies, or the competition as to the location of prospective sales to keep system and sale clean.

8. De-install, pack and ship. Pack in water and moisture resistant packing.

9. Rigging - unless you're in Europe, Japan, the U.S. or a port with some big fork trucks, you'll need a crane. Get a big one. Only use an MRI rigging company. Fly one in if you have to.

10. Trucking in a container? Air ride is the rule. There is no such thing as soft spring ride on a truck in Mexico or Asia or Africa.

11. RFI and EMI Shielding. You need it, so buy it and ship it with your MRI in the container to save some money. Used shielding can work. But of all the test results I have taken, only 25% of used shielding installed in the U.S. meets equipment recommendations. Even year-old shielding in Mexico, India and the States is often already below the manufacturer standards.

12. Install your MRI. It makes sense to have the company that de-installed it to install it, since you've already established their value.

13. Calibration may require a different company, but that's not usually the case. Still, some companies shim and calibrate better and tighter so they are worth the extra money.

14. Applications/ Service contract. This must be a part of all sales. If you don't buy applications or service contracts, you're setting yourself up for disaster.

When it looks good and everything works well, the sales go through the roof. And the reputation follows you, no matter where in the world you find yourself.