With the long shadow of COVID subsiding, medical imaging companies face a new problem: unprecedented supply chain and shipping complications. It’s the same pandemic shock facing most sectors of the global economy. But the difference is that hospitals, clinics, and physician practices still have patients who need help. They rely on specialists who install and deinstall imaging equipment to meet their mission.

“We have noticed significant concerns related to inflation, the economy, and evaluating buying decisions overall, Dean Yellen, nationwide imaging services project manager, MXR Imaging, told HCBN. “Spending habits are changing, and we have seen an increase in projects that are being placed on hold for a multitude of reasons.”

MXR is seeing project delays of six to eight months, with international shipping stresses part of the slowdown. Also among the complicating factors are resource-related delays with OEM partners and construction holdups among customers. In such times, Yellen stresses, it’s vital to keep customers informed to ensure project completion is as close to schedule as possible.

The good news for radiology installs and deinstalls is that the pandemic logjam is breaking up.

“At many healthcare facilities, budgets originally slated for new equipment purchases were reduced or diverted to support the resources needed to address COVID during the height of the pandemic,” said Brian Calderbank, global director of strategy and marketing, Carestream Health. "Now we are seeing that many are restarting their capital budgeting processes as the COVID emergency lessens in their regions.”

One silver lining from the pandemic is that it heightened the importance of efficient workflow, according to Calderbank. In addition to that, Carestream has also seen a surge in provider IT departments seeking system security updates that had been delayed during the press to care for patients critically ill with COVID.

Hospitals seek more aftermarket systems
As equipment spending increases, many providers are opting for used instead of new systems. Bob Iravani, president, Chicago Medical Exchange, reports that prices for used equipment are at the highest levels he’s seen. For example, he cited used CT equipment costs that are up as much as 40% (Yellen with MXR Imaging cited the same increase in project costs). And even if providers opt for a new system, Iravani added, some OEMs are quoting delivery of 39 weeks due to supply chain slowdowns.

“Every time I talk to a manufacturer, the delivery time is longer and longer,” Iravani said. “And unfortunately, we must pass along higher costs as we’re paying more. There’s also a lot of competition right now for used systems, and some buyers are willing to pay exorbitant prices. Sometimes we have to walk away when the bidding gets too high.”

During the pandemic, repair companies such as DirectMed Parts and Service, LLC, experienced selling hesitation, especially among healthcare practices. Tanner LoRusso, vice president of sales, said the trend drove their internal repair capability rather than sourcing for new parts. Pre-pandemic, the company was purchasing several million dollars of deinstalled equipment per quarter, that number dropped 95% during the pandemic.

“We didn’t have the ability to buy used equipment because hospitals were not replacing their systems. We had to pivot and perform more repairs in-house with fewer harvested parts from used scanners," he said. "We hired more engineers to expand our repair lab capabilities. We had some of our biggest growth during the pandemic years, demand for CT parts in particular.”

Shipping backlogs manifested in another way, according to Iravani with Chicago Medical Exchange: more damaged equipment. Such occurrences delay entire projects as it can take months to resolve an insurance claim.

“I’m hearing about this from other companies, as well,” he explained. "Shipping companies are scrambling to fill vacancies, and some of their hires are inexperienced, especially when it comes to moving large pieces of equipment."

He recalled one instance in which a customer called to tell him the driver was elderly and appeared frail. When Iravani called the shipping company, they assured him the driver could move the palleted equipment. Instead, the driver bent a couple of wheels on the pallet mover, unbalancing and damaging the equipment. Iravani remains extra cautious with shipping companies because he fears the lack of experienced drivers may persist for a few more years.

Meeting unique install challenges
Pandemic-driven complications aside, the usual challenges related to installs and deinstalls persist; customer subcontractors behind on-site prep work and/or egress and entry routes not scouted correctly to ensure that hallways and doors were wide enough. Iravani said that customers had not increased cooling to the specifications needed for new systems in two instances, requiring retrofits after the installation.

One of the more unusual installs in the past year was cited by Robert Anderson, U.S. and Canada implementation manager for Carestream. The company installed an X-ray room aboard the new MV Global Mercy, the world’s largest civilian hospital ship.

“We project-managed part of the installation remotely from the U.S. while the imaging room was being installed on the ship in China,” said Anderson. “Then the ship sailed to Belgium, and we project-managed the rest of the installation remotely from the U.S. while the ship was in port there. The ship will eventually be in Dakar, Senegal to provide medical training in the coming months.”

In another service feat, MXR Imaging had to remove a mobile MR in New York City in space walled off by surrounding expansion over the years. The only way to remove the unit was to devise a double crane swing over existing buildings.

“Two cranes were involved, and the mobile had to be transferred from one crane to the other while hoisted up in the air,” said Yellen.

In addition to CT installs in hospitals and clinics, Canon is active in the veterinary sector. The company recently installed a new large-bore CT scanner at a world-class equestrian center in Florida. The system combines a Canon CT scanner with a unique lifting platform that allows examinations to be performed on standing, non-anesthetized horses.

“Installing this type of system is much different than installing a traditional CT scanner due to the height-adjustable gantry system and platform,” Brian Hutfless, Canon’s vice president for south zone services, told HCBN. "This scanner system allows the gantry to lower below floor level for imaging of horse extremities. The gantry also raises above floor level for head, neck, and body imaging.”

Helium-free MR and AI features gain ground
One area of interest among providers seeking new imaging technology is helium free, or low helium MR systems, according to Adam Senne, national account executive with Simon Hegele.

"This could be a game-changer in the process of easing the installation requirements and concerns about rushing magnets to a site and getting the cold head running to avoid the loss of costly helium,” said Senne. “The continued challenges in the global helium market will likely drive this transition even further in the next few years.”

Senne contrasts this with the height of the pandemic, when customers were keenly focused on basic radiography equipment for faster turn-around of COVID lung images. Now, he sees a trend toward deinstalling used systems to make way for new equipment. These used systems take several paths depending upon age, ranging from refurbishment and reselling, to parts harvesting or outright scrap.

AI applications to improve productivity and reduce dose are also much in demand, according to Calderbank with Carestream. He cited the company's AI platforms for image enhancement, workflow intelligence, and analytics intelligence. He said their customers were especially interested in AI to manage noise cancellation.

Customers are also keen on remote service applications, according to Yellen with MXR, who said video calls have been a daily occurrence between his customers and support staff. “We are now able to instantly see and guide the site through their current issue. This allows us to resolve more than 20% of customer's calls remotely,” he said. "We have also found these interactions to be beneficial even if we are not able to remotely resolve the issue and a field service engineer needs to be dispatched to the site."

Canon also cited a shift to online services to support a host of functions, from staff education and fleet management to cybersecurity support, according to Andrea Hearn, senior manager, life cycle marketing. The company cited its partnership with Glassbeam Clinsights, an AI/machine learning, data analytics platform for predictive customer support. And Canon recently introduced its online Medical Marketplace to expedite parts ordering. Hearn added that Canon supports its part distribution network with 40 distribution depots.

“Post-COVID, we continue to experience an increase in online service usage by our customers," she said. “It’s convenient, and coupled with our vast onsite services; we are keenly focused on the needs of our customers.”

Providers are also seeking such features as dynamic digital imaging, dual-energy technology, dose tracking software, advanced auto-stitching, low-dose techniques, and feature sets that use AI technology to aid workflow and image interpretation.