PET/CT BUYER’S GUIDE for purchasing used & refurbished PET/CT systems PET/CT Buyer's Guide Copyright © 2015 Table of Contents For Starters ....................................................................... Page 1 Which PET/CT Do I Need? ................................................... Page 2 How Do I Know I’m Getting a Good System? ....................... Page 6 How Much Will the System Cost? ....................................... Page 7 Next Steps ..................................................................... Page 14 For Starters... For Starters... Like shopping for a lot of other medical imaging products, the PET/CT market confronts nearly everyone who enters it with a reality that is both a blessing and a curse: options. With different makes, different models, and myriad software capabilities to consider, it’s easier than ever to get what you need, and at a good value. On the other hand, narrowing the field down to find the system that will be the best fit for your needs (and your budget) can be a daunting task. That’s where this guide comes in. To help you make that perfect pick, this guide will answer the three biggest questions customers ask as they begin shopping for a PET/CT scanner: • Which PET/CT do I need? • How do I know I’m getting a good system? • How much will the system cost? If you’re ready to get started, we are too. Read on to prepare yourself to make a great PET/CT selection for your facility! For a complete listing of Block’s available systems and services please visit 1 www.blockimaging.com Which PET/CT Do I Need? Which PET/CT Do I Need? The first step to answering this question is to ask another question: “How do I intend to use this system?” PET/CTs are used for a variety of studies, from cardiac, to neurology, to oncology. There are some PET/CTs that do all of these things exceptionally well, but paying for capabilities that are outside the scope of your individual practice can needlessly inflate your equipment budget. Once you know what you are going to do, you can begin to assess your options accurately. The most significant considerations are slice count, cooling system, software options, whether you intend the system to be mobile or fixed, and, of course, budget. Slice count: How many slices you need is based on a couple of considerations: What kind of studies you plan to do and market conditions in your area. What Kind of Studies Do You Plan to Do? Oncology studies can be performed on any PET/CT system. Cardiac studies are best performed at higher slice counts and, in some areas, are only reimbursed if using a 64-slice system. If you are primarily interested in doing gated cardiac studies (MPI), a 4-slice GE system is sufficient and, perhaps, ideal. What Are the Market Conditions in Your Area? If competition among practices is high in your area, it may be important to learn which slice counts are available to patients in other local facilities. You might need to be more competitive to draw referrals from local physicians. In terms of calculating reimbursement revenue by patient volume (access radiology reimbursement calculator here), it’s important to understand this tip: Unlike a CT scanner, a higher slice count on a PET/CT generally has no effect on scanning times and throughput. This is because, regardless of the slice count of the CT portion of a PET/CT, the PET portion is always slower. The overall scan time is a result of that speed, not the CT’s. It’s also worth noting that PET scanner speed is comparable across all manufacturers. PET/CTs are available from the “Big 3” manufacturers in the following slice counts: • 2 (Siemens) • 4 (GE) • 6 (Philips/Siemens) • 8 (GE) • 16 (GE/Philips/ Siemens) • 64 (GE/Philips/Siemens) For a complete listing of Block’s available systems and services please visit 2 www.blockimaging.com Which PET/CT Do I Need? (continued) Cooling System Another factor to consider when searching for the right PET/CT scanner is the method of cooling. With the sheer quantity of electrical components operating inside a PET/CT’s gantry, heat builds up quickly. To compensate for this build-up and prevent equipment faults from overheating, there are two main methods of heat dissipation: air cooling and water cooling. Air Cooling Air-cooled systems rely on open ventilation through the external covers of the gantry via fans. Some advantages of this cooling type include: • No concerns over water quality • A lower amount of preventative maintenance • No need to purchase/maintain an external chiller unit • Smaller footprint, fewer cabinets Water Cooling Water-cooled systems rely on external chillers plumbed to a nearby water source. Some advantages of this cooling type include: • Fewer concerns involving inconsistent humidity or ambient temperature • Do not require additional HVAC accommodations for the room itself • Quieter, more comfortable scanning room • Cleaner gantry (fans tend to pull in dust, hair, etc.) Software Options The PET/CT software options that are currently available are too numerous to detail in one place. In addition, many options that perform the same function are called by different names depending on which OEM produced them. For brevity’s sake, we’ll talk about the most commonly sought-after options. Time of Flight This option takes advantage of very fast detectors and electronics that can measure the tiny (nanoseconds) time difference between the detection of each annihilation photon along the line-of-response between opposite detectors. It allows radiation dose reduction and faster scan times. Philips pioneered this product commercially in 2006. For a complete listing of Block’s available systems and services please visit 3 www.blockimaging.com Which PET/CT Do I Need? (continued) Calcium Scoring This option scans heart arteries to find calcium deposits and diagnose heart attack risk. Calcium scoring is available on nearly all PET/CT systems under a variety of proprietary names. Cardiac Gating Cardiac gating correlates images of the heart with certain phases in the heartbeat. It’s ideal for myocardial perfusion studies. This feature is available on most systems from the factory. If the system you are considering does not currently have cardiac gating, it still may be able to be added. Another aspect to consider is the software that you will use to acquire or process your cardiac gated studies. Popular cardiac gating software suites are Emory, Cedars, CVIT and 4DM. If you are already locked into a specific software program, be sure to check that it supports the scanner you are buying. Respiratory Gating Using reflective foam blocks and a calibrated camera, the PET/CT system can compensate for normal breathing movement during a scan. This feature is an add-on. All systems support it. The most popular systems are made by Varian. Mobile PET/CT Installations Some of you may be considering the purchase of a PET/CT scanner for installation in a mobile trailer. This fact will make a significant difference in narrowing down the field of machines you have to choose from. “Mobile-Friendly” Features Here are some features that make a PET/CT better suited to mobile installation: • Air-cooled gantries (since they don’t require a chiller) • Smaller footprint designs • 16 slices or below (as faster scanning means more vibration) “Mobile-Friendly” Models The following are models commonly installed in mobile settings: • GE Discovery ST • GE Discovery STE • Siemens Biograph Duo • Siemens Biograph 6 For a complete listing of Block’s available systems and services please visit 4 www.blockimaging.com Which PET/CT Do I Need? (continued) “Big 3” Offerings in PET/CT Check out the chart below for the most common/popular PET/CT model offerings from the “big 3” manufacturers- GE, Siemens, and Philips. As you shop for the perfect system for your facility, these are the models you are most likely to encounter on the secondary market: PET/CT MAJOR MODEL OPTIONS GE siemens philips Discovery LS4 Biograph Duo Gemini Dual Discovery LS8 Biograph 6 Gemini Power 16 Discovery LS16 Biograph 16 Gemini GXL 6 Discovery ST4 Biograph 40 Gemini GXL 16 Discovery ST8 Biograph 64 Gemini TF 16 Discovery ST16 Gemini TF 64 Discovery STE4 Discovery STE8 Discovery STE16 For a complete listing of Block’s available systems and services please visit 5 www.blockimaging.com How Do I Know I’m Getting a Good System? How Do I Know I’m Getting a Good System? This is a frequent question from people who have never before considered purchasing a used PET/CT. There are a lot of ways to confirm a system's quality. We recommend the following. Start thinking about these early on to allow time for any changes to be made! Process Homework When Considering a Pre-Owned PET/CT Inspection Be sure to have the PET/CT inspected before you pay. Either inspect it yourself (with your tech?) or hire an engineer to inspect on your behalf. This will likely cost you $2,500 - $4,000, but is well worth it. This will let you get to know your prospective system’s current and recent performance, its overall condition, and the environment it's been operated in. Records Any records you can get will be useful. Error logs, service reports, quality control checks, accreditation certificates- each of these documents will help paint a picture of how well a PET/CT has performed and how well it’s been maintained. Refurbishment We’ll be frank with you: refurbishment simply isn’t done as much for a PET/CT as it is for other modalities. Given the typical workload and usage environment of these systems, it’s unusual for them to see the harsher wear and tear of trauma or OR imaging equipment.