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Upgrading keeps MR systems state-of-the-art

Business News
Prof. Wentz, Klaus-UlrichKilchberg, Rodiag Diagnostic CentersSwitzerland

Upgrading keeps MR systems state-of-the-art

Five of Rodiag's nine Philips MRI systems - housed in nine institutes spread over the German-speaking part of Switzerland - are at least eight years old. However, frequent upgrades have continuously brought them to up to date, making their performance virtually indistinguishable from brand new systems. The independent radiology group's newer systems operate under the same life cycle regime, which sets an optimal balance between upgrades and new systems.
In a highly competitive environment, Rodiag excels by offering the most advanced techniques available, regardless of the system's age, according to Klaus Wentz, M.D., Rodiag's head of research and development.
Prof. Klaus Wentz Rodiag Diagnostic Center, Kilchberg
Prof. Klaus Wentz
Rodiag Diagnostic Center, Kilchberg

Rodiag Diagnostic Center's nine sites operate virtually new scanners via continual upgrades

The imperative to operate the most sophisticated, up-to-date MRI scanners available is particularly intense in northern Switzerland, a region that as far back as 1994 was a saturated and established market, with an MR density of approximately 20 systems per one million inhabitants. After steadily ramping up its operations from 1988 to 1995, providing services and equipment to select hospitals in northern Switzerland, Rodiag jumped into this highly competitive market in earnest, expanding - from 1995 to 2000 - to nine sites with 1.5T Philips scanners. Amazingly, Rodiag still operates six of the MRI systems that were part of this major five-year expansion - two of which had their tenth birthdays in 2005. Upgraded with Release 11 software and hardware, these two systems function at a level that is identical to Achieva systems emerging from the factory today.

Maintaining equilibrium

Rodiag thrives in its market by maintaining a balance between upgrading its Philips systems - keeping them up-to-date and competitive - and investing in new scanners when (Swiss) depreciation schedules dictate. According to Dr. Wentz, depreciation can be delayed substantially by continually improving MR assets.
"You gain time by always operating the best equipment," he says. "And you're always a good competitor in the market if you keep your machines upgraded. 'Forklift upgrades' - simply buying new systems from time to time - is not as smart as continuous upgrades, we think, if the upgrade price is significantly below depreciation value."
A critical factor when deciding whether to upgrade or buy a new scanner, according to Dr. Wentz, is the investment cost of an outright purchase. Rodiag officials have calculated that the average one-month downtime involved in relocating an "old" system and siting a new one is worth over 7% of a new system's value, mainly due to lost referrals.
"Make no mistake, a new system is a great investment - but in a highly competitive environment you need to assess whether the short-term downtime will result in excessive loss of business and referrals," he says. "We estimate that if we are out of business for a month transitioning between an old and new systems, we are losing 200 patients at $350 [USD] per patient, for a total lost revenue of $70,000."
The benefit of upgrading
Like the woman in the first illustration, without "intervention" an MR system will continue to age - losing vitality and robustness over the years.
But if measures are taken to suspend the aging process - continuous upgrades in the case of an MR system - then usefulness and vitality can be prolonged, see second graph.

A continuous stream of excellence in imaging

Philips has supported Rodiag's upgrade investment strategy by offering a continuous stream of powerful upgrades for the entire Philips MR platform over the years. These include upgrades to the latest technical and clinical performance level for Release 4 through Release 6 (1994-1998, initial Gyroscan NT), Release 7 through Release 11 (2000-2004 initial Intera), and Release 1 (2005 Achieva). Rodiag took advantage of the Philips upgrade path for all its MR systems as new releases became available. Today each of the nine Rodiag MR scanners operates at Release 11 or Release 1.
All of the Philips upgrades brought major new techniques to Rodiag's MR systems, keeping them at the cutting edge. "One of the major upgrades that was noticed immediately by clinicians sending patients to us was Release 5's diffusion-weighted imaging in 1997," Dr. Wentz recalls. "It had a significant impact on brain imaging - especially stroke management - in clinics and private practices. In just eighteen months, all Rodiag centers were performing DWI."
Subsequent upgrades were similarly impressive - with Release 6 bringing dramatically improved image quality and MobiTrak peripheral MR angiography, and Release 8 introducing SENSE parallel imaging to Rodiag and the MR world. Release 9 introduced THRIVE for amazingly crisp abdominal studies, and 2004's Release 11 featured the Achieva platform with the multi-channel FreeWave architecture and ExamCards - Internet downloadable, exchangeable protocols.
"Philips ExamCards are a big help in managing the sites' day-to-day MR practices," Dr. Wentz says. "ExamCards make studies faster and protocols can be tailored to the preferences of individual users in our 12-radiologist group, in which radiologists often rotate between sites. This was a major step for me and will evolve into utilization management products that will help users operate their equipment with optimal efficiency. If they do that right it will be unbeatable."
MR Investments without Upgrades         Click image to enlargeMR Investments with Upgrades         Click image to enlarge
MR Investments without Upgrades
MR Investments with Upgrades
        Click image to enlarge
        Click image to enlarge


 Lower investment, better performance through the years

 Because MR is still a rapidly developing technique, the requirements for MR

 system performance are constantly increasing, as represented by the vertical

 axis in these graphs.


 Without upgrades (left graph), an MR system remains at the level at which it

 was acquired. Over the years, this increasingly widens the gap between

 state-of-the-art and its status at purchase. Operating a below state-of-the-art

 system could damage a site's reputation and result in lost referrals. To

 compensate, system replacement becomes necessary every five years,

 but the technical gap is still too large, particularly in year 4 and 5 after

 initial purchase.


 By upgrading the system every year (right graph), Rodiag can maintain a 

 minimal performance gap and prolong the life cycle to over 10 years. These

 graphs illustrate that over a 10-year period, upgrading requires lower total

 investment and provides better performance through the years.

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Apr 24, 2006

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Achieva 1.5T, Intera 1.5T
Release 1, Release 1 (FreeWave), Release 10, Release 11, Release 12, Release 2, Release 2 (FreeWave), Release 7, Release 8, Release 9
Explorer / Nova Dual, Gradient, gradients, Master / Nova, Omni / Stellar, Power / Pulsar
Body, Brain, Breast, Carotid, Cervical spine, Hip, Kidneys, Knee, Liver, Lumbar spine, Musculoskeletal, Neck, Neuro, Peripheral MRA, Shoulder, Small bowel, Thoracic spine, upgrades, Vascular, Wrist

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