By Kathy F. Mahdoubi
This report originally appeared in the April 2009 issue of DOTmed Business News

Everything moves in reverse at Newtech Recycling's computer and electronics recycling facility in Somerset, NJ. Technicians operate in much the same way as you might see in a manufacturing video played backwards. Each piece of equipment is processed and broken down: first the casing and the circuit boards, the plastics and metal components and the wires, until there is nothing left except the individual components used to manufacture them.

Jim Entwistle is President of Newtech Recycling, Inc. He encounters defunct diagnostic X-ray equipment regularly, and it's his business to know exactly what to do with it. For the most part, there is no guesswork.

"It comes in and we take it apart," says Entwistle. "I am truly the end-of-life person in this process. I'm the end of the line."

A push toward environmental health and regulation has increased recycling across the country and much of the world, but the business of recycling is also encouraged by financial opportunity. The green movement in the medical equipment industry is much the same as any other industry that recycles. A technologically advanced piece of equipment like a CT or PET scanner or MRI has a relatively long lifespan and can be bought and sold a number of times before being considered officially obsolete and retired from the regular medical field, but the usefulness does not end there. Some medical technologies can be used for other applications, in veterinarian medicine, for instance, or converted for use in industrial applications. If equipment doesn't find a new career in one of those fields, several imaging technologies, including X-ray, CT, MRI and PET can be processed by specialized recycling companies and broken down into individual commodities - plastics, steel, aluminum and copper, etc. - to be resold in those markets.

"All of these materials will go back in as feed stock for new manufacturing," says Entwistle. "They go to refineries in the United States and also overseas, but it's all broken down."

Even nuclear medicine technologies, such as linear accelerators, which use depleted uranium shielding, and gamma knives, which house radioactive materials, can be rendered perfectly safe and can be recycled after being properly processed by a licensed and trained professional for the removal of environmentally sensitive materials.

Entwistle may occasionally recycle X-ray equipment, but other types of equipment like CT, MR and gamma knives are outside his league, he says. Enter Martin Campbell, president of Campbell Technological Resources, Inc., and Tommy Geske, president of Sunrise Medical Technology, Inc. These gentlemen are versed in the "scrapping out" of most of these and other types of medical equipment.

"When we bring the equipment in we obviously take a look at it and make sure that there are no surprises," says Campbell. "CT and X-ray will have oil-fill transformers and those will have to be segregated and handled with great care. MRI magnets are typically very heavy -- 6,000 to 30,000 lbs, so those require special equipment for handling."

Each piece of equipment has its own decommissioning and recycling protocol. With MRI, this protocol is split even further depending upon the type of magnet used.

"There are two different kinds of MRI magnets," explains Campbell. "Cryogenic magnets can be ramped down. You can use the resistance and the power supply to pull some energy out of the magnet and allow the magnet to ramp down. If you have a permanent magnet, you must ship the magnet in a container that protects the environment from the magnetic field."

Most MR machines have a "quench" circuit, which automatically shuts down the magnetic field, says Geske. This is a good thing, because of the cost and labor issues involved in ramping down a magnet. Once a magnet is quenched there is ordinarily no remaining magnetism, although some kinds of steel have been known to retain some of the magnetic property. Proper inspection of the equipment ensures that it is safe to recycle.

MRI magnets themselves are a virtual metal quarry waiting to be mined, but the present economy has depressed commodity prices to such a degree that it is not nearly as profitable to scrap equipment as it was just twelve months ago.

"A year ago we did very well scrapping MRI and CT, but there's not a whole lot of activity going on with salvage right now," says Geske. "We have seven magnets in the warehouse that we'd love to scrap out."

Instead of breaking down a piece of medical equipment into their respective commodities, folks like Geske are obliged to "sit on it" until prices are more palatable.

"For example, six to seven months ago aluminum sold for a little over a dollar a lb. Today's it's down to above 15 cents a lb," he says. "Copper hit an all-time high of $4.15 and now it's down to $1.12."

Campbell continues to recycle equipment and seems to be handling plummeting commodity prices with due patience. If the equipment is delivered to their facility, the elimination of transport cost keeps scrapping profitable. When one market suffers, others may thrive. The resale of medical equipment for veterinarian applications appears to be a robust market. With no insurance reimbursement issues, selling to veterinary practices can be far more attractive than dealing with medical practices that may be hindered by payer agendas.

"Veterinarian medicine represents an alternative for a business person to get involved with because it's a cash business." explains Geske.

Other applications for resold medical equipment come care of the industrial sector, Geske says. CT technology is often used in non-destructive industrial applications, such as testing the structural integrity of vessels and pipelines, and more specifically for testing industrial welds. Another option for used medical equipment is international exportation - yet another cash market.

"Perfectly functional equipment is oftentimes exported to parts of the world where new models just aren't affordable, like parts of Russia and South America," says Geske. Other regions, like Africa, are underserved and in more desperate need of important diagnostic equipment. In this case "you might have two or three CT scanners in a country of 15 million, and no MRI technology."

But governmental and environmental-group regulations regarding the export of used medical equipment are growing steadily more stringent, especially on the receiving end. For instance, several countries throughout the world have implemented embargoes against importing used medical equipment. Brazil has such an embargo, and China does as well. This is partly due to the careless and predatory resale of nonfunctional equipment.

"That's why China closed its doors to the US for used equipment," says Geske. "It wasn't rebuilt or refurbished and ended up being junk and never worked."

Uninformed owners of large, complex medical technologies are often in "a quandary" as to what to do with their equipment, but that is not as much of an issue in nuclear medicine. Hebert Marquez is president of Radiation Oncology Services, Inc, a CA-based company providing worldwide installation, parts, service and removal of radiation therapy equipment. Marquez says that some machines, like linear accelerators, do not contain radioactive material, but do produce radiation that may irradiate the machine's depleted uranium shielding, thereby requiring special handling.

"Everything can be recycled except for the DU - the depleted uranium needs to be disposed of properly," says Marquez.

Philotechnics, Ltd. operates out of Tennessee and is one of the relatively few companies licensed to contain and remove radioactive materials from decommissioned nuclear medicine equipment. This process is regulated in part by the Nuclear Regulatory Commission (NRC).

"Depending upon what state you live in, the Nuclear Regulatory Commission has authorized individual states to administer their own rules," says Andy Armbrust, president of Philotechnics. "This is called the agreement state process."

The NRC and state regulatory agencies license and inspect equipment involved in nuclear medicine, such as those that require or produce radioactive sources. Examples of these include blood irradiators that use cesium-137 sources, and cyclotrons, which are used in proton therapy and can produce a variety of proton-emitting radionuclide tracers for use with PET scanners. Another example is gamma knife technology, which pinpoints and destroys cancerous tissues by administering a high dose of radiation using cobalt-60 sources. In order to be recycled these and other types of equipment need to be demanufactured and the radioactive sources removed for the half-life, or period of decay, of the respective radionuclide, says David McIntyre, public affairs officer for the NRC. X-ray and CT technology is not regulated, because while they may conduct radiation, they do not contain any radioactive materials themselves.

No matter what the equipment is, there is probably a method for recycling some, if not most of it. The salvage and commodities market may not be as profitable as it has been in the recent past, but recycling medical equipment is still typically a better option than outright disposal for the environment and your bottom-line.