"We tell people to buy a full service contract and buy tubes only when you need them," Kramer advised. "We try not to raise the cost of the contract to cover the cost of X-ray tubes."

Another approach is to share the liability for the tube with the service company. It will likely be cost-prohibitive for the healthcare provider to assume all risk, although it may work for equipment you plan to replace when the X-ray tube expires. Many providers enter into a shared risk arrangement with an ISO. This is far less costly per month than assuming all risk and it means that you'll pick up the agreed risk percentage for the replacement cost of the tube when needed.


"In all candor, the market right now will not support full service contracts with glassware [X-ray tube coverage], so enter into an agreement with an inducement for the servicer to respond quickly," suggested Geske, referring to negotiable guaranteed response times for service.

When the time comes to replace the tube, you'll need to choose new or used. For instance, C&G Technologies, Inc. completely refurbishes tubes using a specialized process that they say extends the life of the part. "That takes a major cost item and gives the customer a level of comfort. It takes one of the dice rolls out of the equation," Kramer said.

Understandably, the tube-makers recommend new glass, which comes with a warranty. "The value proposition that Dunlee brings is we are an OEM, so we can deliver OEM quality but not at the OEM prices," said Thomas T. Spees, Director of U.S. Sales for Dunlee, a division of Philips Healthcare. Their low prices allow ISOs to sell tubes for about 20% less than the OEM.

Another leading tube-maker is Varian Interay, Charleston, SC. "In many cases and many models of CT scanner, we have actually extended the life of the CT scanners for our customers by offering value-priced CT tubes," said David Hurlock, International Marketing Manager.

Many service arrangements are available to meet the bottom line of hospitals and imaging centers as the CT market adjusts to challenging forces. Ultimately, despite reimbursement cuts, the innovation and capability of computed tomography--plus the killer app of colonography--may overcome all economic obstacles so that CT continues to lead medical imaging into the future.

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DOTmed Registered CT Sales and Service Companies
Names in boldface are Premium Listings.

Domestic
John Stringer, Best Medical International, AL
William Dixon, Performance X-Ray, AL
Bill Stephens, DBRS Medical System, CA
Rick Stockton, Atlas Medical Technologies, CA
DOTmed Certified
Greg Bare, Radiation Oncology Systems, CA
Kurt Bringolf, Eclipse Medical Imaging, CA
DOTmed Certified
Chris Ash, Scanworks, CO
David Denholtz, Integrity Medical Systems, Inc., FL
DOTmed Certified/100
Dennis Giuzio, Mobile Radiology, Inc., FL
Paul Aagaard, 5 Star Imaging, Inc., FL
Robert Serros, Amber Diagnostics, FL
Ed Ruth, Managed Medical Imaging, FL
Bernie Bartoszek, MagnaServ, Inc., FL
John Pereira, United Medical Technologies, Inc., FL
David Tortorich, International Radiographic, GA
Rex Fortenberryd, R & F Imaging Systems, Inc., GA
Robin West, Premier Imaging/Medical Systems, GA
Mike Mercer, Barrington Medical Imaging, IL
John Pemberton, Barrington Medical Imaging, LLC, IL
Martin Zimmerman, LFC Capital, IL
Ron Ragan, Genesis Medical Imaging, IL
DOTmed 100
Mike Ghazal, Zetta Medical Technologies, LLC, IL
Charles Gauthier, Imaging Services, IL
William King, Performance X-Ray, AL
Ronald Moore, R & D Imaging, Inc., IN
Greg Kramer, C&G Technologies, Inc., IN
DOTmed Certified/100
Kevin Fix, Ultimate Medical Services, Inc., LA
Davyn McGuire, Med Exchange International, Inc., MA
DOTmed Certified
Jeff Rogers, Medical Imaging Resources, Inc., MI
DOTmed 100
Bruce Hull, Network Imaging Systems, NC
DOTmed Certified
Billy Paniaha, Right Coast Medical Imaging, NC
Christi Kukes, DMS Health Group, ND
Robert Manetta, Nationwide Imaging Services, Inc., NJ
DOTmed Certified/100
Gary Provenzano, Proton Services, Inc., NJ
DOTmed Certified
Joseph Jenkins, International Imaging Ltd., NV
Sal Aidone, Deccaid Services, Inc., NY
DOTmed Certified
Leon Gugel, Metropolis International, NY
DOTmed Certified/100
John Kollegger, Bay Shore Medical, LLC, NY
DOTmed 100
Tim Wright, Virtual Medical Sales, Inc., NY
Tim Austin, Austin's X-Ray Service, OH
Trey McIntyre, International Medical Equipment and Service, Inc., SC
DOTmed Certified
David Hurlock, Varian Medical Systems, Inc. - Interay, SC
Ward Huddleston, Med Image Systems, Inc., TN
Ronald O'Leary, Medical Digital Imaging of Texas, TX
Michael Webster, Legacy Medical Imaging, TX
DOTmed 100
Lynn Williams, Advanced Imaging Management, TX
Tommy Geske, Sunrise Medical Technology, Inc., TX
DOTmed Certified/100
Carl Hoffman, Blue Ridge Medical Imaging, VA

International
Himanshu Gupta, EverX Pty Ltd, Australia
DOTmed Certified/100
Artemio Santacruz, Ara Electric SRL, Central
Marcelo Dominguez, Sistemas Medicos, Chaco
Carlos Duran, Ingenieria Clinica, Columbia
Abdelrahim Khalil, Besisc, Egypt
Aydogan Polat, MEDSER Medical Services, Germany
DOTmed 100
Florian Dickopp, Medicopex GmbH, Germany
DOTmed Certified/100
Vinod Dua, C-Max Healthcare, Haryana
Rami Marom, ElsMed Ltd & Relaxation, Inc., Israel
DOTmed Certified/100
Joseph Dar, Z.L.Printek, Israel
SewaSingh Dhimaan, Dynamic Bio - Medical systems, New Delhi

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