DOTmed Business News February 2008

FEBRUARY 2008

Market Intelligence on New and Used Equipment & Parts from www.DOTmed.com

CANCER KILLER:Proton

Therapy

21st Century

DR and CRDe-InstallationRiggers and CratersSterilization Sales and Service

PLUS MORE...

nyTher

A DOTmed EXCLUSIVE: Inside Digital X-ray Imaging

FEBRUARY 2008

table ofcontents

23DEPARTMENTS4 Hospital and Health News

8 What’s New

49 People and Companies

50 Old Into Gold

51 Marketplace andClassifieds

52 Blue Book Price Guide

18 CR and DR

23 Riggers and Craters

29 De-Installers

34 Sterilization

38 Monitors

42 Chillers

FEATURES10 Proton Beam Therapy—

An Accelerating Market14 Digital X-ray Imaging:

Technology, Market Changes,and Business Opportunities

DOTmedbusiness news I FEBRUARY 20082

letter fromthe editorPeacock AlleyWe’re especially proud of two stories in this issue, one by Associate EditorBarbara Kram, the other by industry consultant Wayne Webster, founder ofMassachusetts based Proactics Consulting.

In both instances, our writers tackle an issue central to the health andwell being of today’s medical equipment business: how technology is chang-ing the market, creating new business opportunities and, most important, pro-viding new therapies that are turning the tide in the battle to cure killerdiseases.

Signs of the validity of that claim are everywhere.As Webster notes, cur-rent digital X-ray technology is having a significant impact in veterinary anddental medicine.

But the big payday is in human radiography where, Webster says,“change occurs so rapidly that imaging devices considered leading edge threeyears ago are now deemed obsolete.”

In his piece, Webster provides history, insight into changing technology,an examination of the markets and applications and finally, suggests whereopportunities might materialize in the future. In short: invaluable reading.

Barbara Kram, meanwhile, has been following a spate of developmentsin proton therapy for several months, often referring to the subject as an“overnight sensation” that’s been 50 years in the making.

Not surprisingly, technology’s played the crucial role in making it moremainstream. With what’s available now, proton therapy destroys canceroustargets without any damage to surrounding, healthy tissue.

Oncologists and radiologists are mightily impressed with what compa-nies in the proton business call the “smart bombs” accomplishing this feat.

But the entire healthcare community, however, is scared of the cost.Skillfully delving into the economics of proton therapy is what makes Kram’sstory so relevant to this magazine’s readers and users. As already said aboutWebster’s piece: invaluable reading.

Elsewhere at DOTmed.com Inc., our website’s DOTmed Careers sec-tion is worth a long, hard look. It’s filled with news about jobs, continuingmedical education classes, engineer/technician training opportunities, newsrelated to the internal training/development at healthcare facilities, and, ofcourse, training and education information from highly regarded trainingcompanies. With more than 12,000 daily users, DOTmed.com is among thetop rated healthcare job websites.

Colby CoatesEditor-in-Chief

DOTmed Business News

February 2008PublisherPhilip F. JacobusExecutive EditorRobert Garment212-742-1200 Ext. [email protected] Coates212-742-1200 Ext. [email protected] EditorBarbara Kram212-742-1200 Ext. [email protected] Creative EditorBradley Rose212-742-1200 Ext. [email protected] DirectorsStephanie BiddleRudy CardenasReportersJoan [email protected] [email protected] Johns212-742-1200 Ext. [email protected] Hutchins212-742-1200 Ext. [email protected] Manager: Mitch Aguirre212-742-1200 Ext. [email protected] Executive: David Blumenthal212-742-1200 Ext. [email protected] Executive: Mike Galella212-742-1200 Ext. [email protected] Executive: Sandy Jablonski212-742-1200 Ext. [email protected] you want information about auctioningequipment on DOTmed.com, please call:212-742-1200 Ext. 296, or email us [email protected] ReleasesIf you have news regarding your companysubmit it to: [email protected] WritersIf you have an article or feature story youwould like the editors of DOTmed BusinessNews to consider publishing, submit it to:[email protected] to the EditorSubmit letters to the editors to:[email protected]

DOTmed Business News is published byDOTmed.com Inc., 29 Broadway, Suite 2500,

New York, NY 10006

Copyright 2007 DOTmed.com, Inc.

DOTmed provides the DOTmedbusiness News to its registered users free of charge. DOTmedmakes no warranty, representation or guarantee as to the accuracy or timeliness of its content.DOTmed may suspend or cancel this service at any time and for any reason without liability or ob-ligation to any party. All trade names, trademarks and trade dress contained herein belong to theirrespective owners and are used herein with the intent to represent the goods and services of theirrespective owners. If you think your trade name, trademark or trade dress is not properly repre-sented, please contact DOTmed.com, Inc.

DOTmedbusiness news I FEBRUARY 2008 www.dotmed.com

HIMSS08 Stirring Great InterestThe Health Care Information and Management Systems Soci-ety’s annual meeting and conference in Orlando later thismonth (Feb. 24-28) is shaping up as a “must attend” for thosein that business sector.

First off, the topic is hot and getting more so all the time.It’s an area where real cost savings are possible so hospital ad-ministrators are very interested, not to mention legions of so-lution vendors.

The conference boasts a laundry list of important discus-sions and roundtables, best summed up probably by one called,“The Changing Health Care Landscape and theAcute need forInformation Technology.”

Then there’s HIMSSO8’s impressive and suggestive rosterof keynote speakers. Among them: physician and former Sen-ate Majority Leader Bill Frist, AOL founder Steve Case andDr. Eric Schmidt, chairman and CEO of Google. Besides beingat the epicenter of the info tech business, the latter two wouldseem naturally interested in health care’s specialized info techneeds and, perhaps, positioned to provide solutions.

One other intriguing note, HIMSS and Blank Rome LLP

are co-sponsoring the 2nd Annual Health Care Venture Fair,billed as a unique opportunity for growing companies to show-case solutions to investors. What’s that sage advice? Followthe money.● [DM 5355]

GE Earnings Up But Healthcare LagsAlthough General Electric’s recently announced earnings areon the plus side, Chairman and CEO Jeffrey Immelt has beentelling financial analysts that medicare regulations continue tocut growth at its healthcare unit due to changes in how hospi-tals are reimbursed for medical imaging machine scans. GEHealthcare is the world’s biggest maker of MRI, PET, CT andX-ray scanners.● [DM 5356]

Gold nanoparticles show promise intreating cancer.

Thanks to work byShuming Nie, Ph.D.,and his colleagues atthe Emory-GeorgiaTech NanotechnologyCenter for Personal-ized and PredictiveOncology, goldnanoparticles look tobe emerging as power-ful tumor-homing bea-

cons for detecting microscopic tumors or even individualmalignant cells. Until now, the particles have been used mainlyin rheumatoid arthritis research.

Experiments show that the coated gold nanoparticles couldserve as potent imaging agents for studies of cancer cells. Re-searchers injected the targeted nanoparticles into mice withhead and neck carcinomas and obtained results within fivehours. As control experiments, they injected matching micewith the untargeted nanoparticle. The unique optical spectra ofthe nanoparticles were easily detected in both sets of animals,but only the targeted nanoparticles accumulated in tumors.● [DM 5357]

4

You’ll see an ID code such as [DM 1234] at the end of everystory. If you enter that ID code – be sure to enter the “DM” – inany search box on www.dotmed.com, you’ll see the originalstory as it ran in our online News. You’ll find convenient anduseful links in many of those onlinestories. Try it!

� [DM 1234] What does this ID code mean?

hospital & health news

Gold nanoparticlesstick to cancer cellsand make them shine.

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News from North of theBorderTwo newsworthy items from Canada.

Waiting for healthcare servicesthere cost the government, taxpayers andpatients another $15 billion, says the

Canadian Medical Association. Maxi-mum wait time for an MRI, for exampleis 30 days but CMAsays the average pa-tient goes almost 60 days instead. Infact, patients who don’t get a scan withinthat first 30 days often end up waitingmore on the average of 85 days. In theinterim, of course, associated medial ex-penses just continue to mount.

Meanwhile, in a story reported lastmonth in DMBN, the president of theCanadian Nuclear Safety Commission,Linda Keen, has been fired. She wasblamed for provoking an international

medical crisis when she closed, forsafety reasons, the Chalk River nuclearreactor, among the world’s top produc-ers of medical isotopes and the mainsupplier to the US medical community.● [DM 5358]

CMS Takes FurtherSteps to LowerMedicare Out-of-Pocket CostsThe Centers for Medicare &Medicaid Services (CMS)has announced 70 new areasacross the nation that will bepart of the second phase of acompetitive bidding programdesigned to help lowerMedicare beneficiaries’ out-of-pocket costs and im-prove access to certain

high quality durable medicalequipment including pros-thetics and orthotics.Ten geographicareas already par-ticipate in a pro-gram aimed atproviding greaterbeneficiary access tostandard and complexpower wheelchairs,walkers, oxygen suppliesand hospital beds.

The program also is supposed to

help federal officials prevent unscrupu-lous suppliers from participating inMedicare. Once the competitive biddingprogram is implemented nationally, it‘sexpected to save $1 billion annually.

“Competitive bidding means thatMedicare beneficiaries will have accessto these products at substantially lowercosts,” said CMS Acting AdministratorKerry Weems.

The home care medical equipmentindustry, however, has taken the govern-ment to task for some of its policies.Concerns include at o o - s l o w

adoptionof accredita-

tion standards and underestimation ofthe true costs of equipment and serviceprovision.

Additional information on theDMEPOS competitive bidding programis available at the following Web site:http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/.

Information for beneficiaries aboutwhat they can do to protect themselvesfrom fraud and abuse when they needcertain medical devices and services canbe found at http://www.medicare.gov/Publications/Pubs/pdf/11345.pdf .

Information about the program forproviders is available at:http://www.medicare.gov/Supplier/Static/About/DMEPOS.asp● [DM 5325]

6

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AMA Calls on Tobacco toBe Regulated by FDAAMA president Ronald Davis, MD,has hit out at the federal government,suggesting it has earned failing gradesfor its tobacco control legislation andpolicies.

“It’s a cruel irony that tobacco, thenumber one cause of preventable death, isone of the least regulated products,” Davissaid.

AMA says a new report from the AmericanLungAssociation should serve as a reminder that“we need meaningful legislative reforms to givethe FDA strong regulatory authority over to-bacco products.”

While some states have made progress,32 states have received failing grades for tobacco preventionand control funding. By spending more on tobacco prevention

and cessation programs, states have the ability to save lives andstop new smokers before they start.● [DM 5346]

Fujifilm Phases Out U.S. Medical FilmProductionFUJIFILM Medical Systems USA, Inc. will phase out the pro-duction of medical imaging film products at FUJIFILM Manu-facturing USA Inc. in Greenwood, S.C. by April 1, 2008.Over the past decade, the medical imaging industry has beenundergoing a steady transition from the use of medical imagingfilm including double and single emulsion and dry films, to dig-ital image acquisition and softcopy diagnosis via PictureArchiv-ing and Communications Systems (PACS). In fact, Fujifilm isthe world market leader in digital X-ray with more than 52,000CR systems sold, and a leading PACS provider with well morethan 1500 Synapse® PACS installations around the globe.

Although Fujifilm Greenwood has been producing X-rayfilm products, the market shift to PACS systems has led to sig-nificant declines in the overall sales of medical film.As a result,FUJIFILM Corporation has decided to consolidate the produc-tion of all medical film to one facility in Japan.

“While we must adapt our business to the changing land-scape of the medical imaging market, Fujifilm remains unwa-vering in our efforts to meet the existing demands for medicalfilm,” said FUJIFILM Medical Systems USA President andCEO Makoto Kawaguchi. “As is our history with all of ourmedical imaging products, Fujifilm is committed to the qualityand innovation of our extensive medical film lines. The ongo-ing and stable delivery of film to our medical customers willcontinue without interruption,” Kawaguchi said.● [DM 5332]

DRE Medical Equipment Introduces NewMicroscopesDRE Inc., an international medical and surgical equipment sup-plier, has introduced two new microscopes: the DRE Om2100Ophthalmic Microscope and DRE Em1000 ENT Microscope,the first microscopes to be released as part of the expandingline of medical equipment carrying the DRE brand.

what’s new

8




The DRE Em1000 ENT Microscope is a manual, fiber-optic surgical microscope developed for ENT procedures. TheOm2100 Ophthalmic Microscope is ideal for cataract surgeriesand post-op exams.

According to Charlie Vittitow, General Manager of DRE,“The Om2100 and Em1000 are fantastic additions to our prod-uct line because each offers features needed in specific medicalpractices. With the addition of our microscopes, DRE can bet-ter serve our ENT and ophthalmology customers, both of whichare essential to our business.”

TheDREbrand includes an established line of surgical equip-ment products. DRE’s product line includes the Integra AV-SAnesthesia Machine, the Waveline Plus Vital Signs Monitor, andthe Maxx Luxx II Surgical Operating Room Lighting System.● [DM 5336]

BioMed Techs Among “Best Careers”for 2008U.S. News & World Report has identified “biomedical equip-ment technician” among its list of “31 Careers with Bright Fu-tures” in its online guide to “Best Careers for 2008.”

The magazine says, “imagine you’re in a hospital bed,hooked up to a heart monitor and a ventilator. Those machineshad better be working properly. Fortunately, they almost al-ways are. Whom do you thank?Abiomedical equipment tech.”

As with any field, there are plusses and minuses, the arti-cle notes, but clearly the good outweigh the bad. “Next timeyou’re visiting someone in the hospital and hear those lifesav-ing beeps and alarms, think about whether you just want to begrateful to a biomed tech, or become one,” the piece concludes- a strong endorsement for the field.

According to U.S. News & World Report, to select the “31Careers with Bright Futures,” the magazine used both quantita-tive and qualitative criteria. “From the hundreds of careers andvariants in the Bureau of Labor Statistics’ Occupational Out-look Handbook plus other candidate careers, we selected the 31

that offered outstanding opportunities” based on job satisfac-tion, training difficulty, prestige, job market outlook, and pay.● [DM 5347]

Carestream Health Nets Wide Rangeof OrdersCarestream Health, Inc., has signed contracts for its KODAKDIRECTVIEW computed radiography and digital radiographysystems with a number of U.S. healthcare facilities.

Carestream Health recently launched several new digitalimaging systems including the KODAK Point-of-Care CR-ITX560 System, KODAK DIRECTVIEW CR Classic and EliteSystems, and KODAK DIRECTVIEW DR 9500 and DR 3500Systems. The company’s portfolio of computed radiographyand digital radiography products meet the needs of hospitals,trauma units, orthopaedic and specialty clinics, nursing homes,outpatient imaging centers, and other healthcare facilities.

Among the facilities that have placed orders for Care-stream Health’s digital imaging systems:Alpena (MI) RegionalMedical Center; Bethesda (MD) Memorial Hospital; CapeCanaveral (FL) Hospital; Illinois (Peru) Valley CommunityHospital; Kennedy Health (Cherry Hill, NJ); Novant Health-care Systems (Charlotte, NC); Brunswick Hospital, Supply,NC, Renown Health (Reno, Nev.); Tallahassee (FL) MemorialHospital and U.S. Naval Hospital (Camp Lejeune, NC).● [DM 5348]

9

Biomedical equipment technician,one of the “best careers” for 2008


By Barbara Kramroton therapy is anovernight sensation morethan 50 years in the making.

It’s been known fordecades that protons are a

better weapon against cancer than the X-ray photons used in conventional radia-tion therapy. However, the use of protonswas strictly limited until recent advancesin medical imaging allowed doctors tovisualize and target the cancers moreclearly to take advantage of the precisiondelivery of proton radiation.

Now that multi-slice CT scanners,high-powered MRI imaging and PETtechnologies are in widespread use, thepotential for proton therapy efficacy andadoption expands tremendously. Thinkof protons as cancer-killing “smartbombs” that can be put to use only witheffective guidance systems.

“In the early days of proton therapythere was no imaging or very poor imag-ing so you had a very precise weapon andno way of seeing where you were aimingit,” says Bernt Nordin, President, IBAParticle Therapy, Inc., Jacksonville, FL.“Now with better imaging we can definethe tumor shape and volume in three di-mensions and know exactly where totreat, and more importantly, where not totreat to avoid complications.”

What’s more, medical imaging ad-vances help spot cancer in the early stageswhen intervention does the most good.

Why use protons instead of (or incombination with) photons? Conventionalphoton particles irradiate tumors too, butphotons travel right through the tumor,whereas protons can be aimed to remaininside the lesion to deliver their payload.

“Proton therapy allows us to beat thediseases that we couldn’t using conven-tional radiation therapy techniques andequipment,” said Susan Michaud, Co-Di-rector of Radiation Therapy Services,Francis H. Burr Proton Therapy Centerat Massachusetts General Hospital Can-cer Center. “Using conventional treat-ment, you always end up treating normaltissues and organs. With protons we canprovide a true conformal treatment to al-most any area of the body and we can dothat without treating normal tissues thatwill leave the patient with side effects,”she says, noting the particular impor-tance of that to pediatric patients.

“This is something that over thenext couple of decades will be changingthe field dramatically because you nowhave a tool that for the first time puts theradiation where you want it,” explainsJerry Slater, M.D, Director of RadiationOncology at Loma Linda UniversityMedical Center. Slater’s father James M.Slater, M.D. is a pioneer in the field who

broughtthe tech-nique intothe hospitalsetting.

The clinical efficacy and promise ofprotons also portends its businessprospects. While five foundational pro-ton therapy centers are operational in theU.S. today (see sidebar), several moreare in various stages of planning and de-velopment in anticipation of the expand-ing application for the life-saving powerof protons.

An Unlimited MarketProton therapy is the better mousetrap inradiation oncology. To date about 55,000patients have received the treatmentworldwide, according to the NationalAssociation for Proton Therapy, whichpromotes its use. While the predominantapplication has been for prostate cancertreatment, proton therapy’s tissue-savingadvantage is also critical in treating can-cers of the brain, eye, lung, kidney andother sites.

Proton therapy can be used for “anylocalized cancer that radiation is used[for],” Dr. Slater says. “Prostate has beenused a lot just because it’s such a commondisease. There are potentially hundreds ofdifferent cancers that will be using protons

An Accelerating MarketAdvances in medical imaging allow cancer-killing“smart bombs” to unleash their life-saving potential.

P

10


in the future.” The therapy is also used totreat non-malignant conditions.

CIBC estimates that the proton ther-apy market will exceed $2 billion by2010. The demand for cancer treatmentis projected to be great and, in terms ofsupply, the U.S. doesn’t have nearlyenough proton therapy centers.

Let’s do the math:About 1.4 millionAmericans receive a cancer diagnosiseach year and about 800,000 receive ra-diation treatment in some form. A con-servative estimate is that 20 percent ofthose patients or 160,000 would benefit

from proton therapy.A four-room pro-ton therapy center could probablytreat about 1,500 patients yearly.That suggests a patient populationto support more than 100 proton

therapy centers.However, each facility requires

expansive physical plant size — meas-ured in football fields — and significantinvestment, along with a partnership ofclinical and engineering experts tobuild it. A proton therapy center today

can cost in the range of $150 to $250million, and that may be an estimate onthe low side

The original proton therapy centerswere built largely with government dol-lars. The unit at Loma Linda UniversityMedical Center was funded by the insti-tution, the U.S. Department of Energy,and the Adventist Church. Mass Gen-eral’s unit was funded by the institutionand the NIH.

M.D. Anderson’s proton therapycenter is a for-profit model with manyinvestors including Sanders Morris Har-ris (SMH), a Houston-based investmentbank. Hitachi provided the equipment,debt financing and equity investment intheir center. Other investors includelocal police and firefighter pensionfunds, and GE.

The University of Pennsylvania’scenter, under construction, was paid forby the institution. The University ofFlorida used tax-exempt bonds. Financ-ing options vary widely and are tailoredto the project from outright purchase todebt equity financing, leasing, fee-per-use rental, special purpose tax-exemptbonds, and other arrangements.

“Every transaction is different withthe magnitude of the expense varying

widely,” said Jon W. Slater (also James’son), President and CEO, Optivus Pro-ton Therapy Inc., San Bernadino, CA.“The preferred financing for most of theacademic centers and a lot of smallernon-profits is to work with large finan-cial firms to put together a bond financ-ing device to limit the liability exposureof the hospital yet have them maintainfull control of clinical operations.” Op-tivus, the engineering firm that main-tains and upgrades Loma Linda’s center,is working on more than a half-dozenprospects for new proton therapy centersat U.S. sites.

The reality for health care organiza-tions that want to offer proton therapy isthat many years of planning and ap-provals, along with institutional, state andfederal aid, plus private investment, mayall be needed to bring a center to fruition.

But some new ideas are springing upin the private sector. A few innovatorsoffer turnkey solutions so that physiciangroups or hospitals can get into the seg-

ment. One such business model comesfrom ProCure Treatment Centers, Inc.

“A proton project is a very capitalintensive, very complex process. It isgoing to be beyond the wherewithal —the staffing and financial capabilities—of larger doctor groups or communityhospitals,” says ProCure’s CEO HadleyFord. The company, staffed by technicalexperts in this esoteric field and backedby venture capital, builds the centers forits partners including radiation oncologygroups and hospitals. ProCure has twocenters in the works. Partners in theirfirst site in Oklahoma City include tworadiation oncology physician groups,and INTEGRIS Health, the state’slargest non-profit health system. IBA,the leading proton therapy particle accel-erator manufacturer, is providing its cy-clotron for the project. Another ProCuresite is planned in the western Chicagosuburbs at Central DuPage Hospital.

ProCure handles the business end ofgaining investment and running the en-

11

Radiation beam scattersas it encounters tissue.

Proton beam eliminatesscatter effect.


tire project and facility, while partnerphysicians handle the clinical end. “It’sa typical outsource model,” Ford says.“It’s not dissimilar from EDS or IBM in-stalling a large computer system intoyour company. They own it and run itand man the help desks so that you canfocus on what your business does best.We figure hospitals and doctors treat pa-tients best. We build proton centers bestso it’s a good match.”

Nordin says, “When a new technol-ogy comes, it’s usually the large univer-sities that are the early adopters and ittakes time before this comes into com-munity health care settings. ProCure isgoing to accelerate that spread of thebenefits of proton therapy to more pa-tients in more places.

A Few Specialized PlayersOnly a handful of companies providemajor equipment for proton therapy, al-though more OEMs are getting involvedwith some supporting technologies andworks in progress.

The main piece of equipment usedin proton therapy is the sub-atomic par-ticle accelerator, which comes in two de-signs: either a cyclotron or asynchrotron. Both use magnetic fields toaccelerate the particles and focus the

beam, although there are technical dif-ferences in the accelerator path andbeam output. Synchrotrons are installedat Loma Linda and M.D. Anderson.Nearly all other U.S. sites have IBA cy-clotrons including Mass General and theUniversity of Florida; and at the forth-coming locations at the University ofPennsylvania and Hampton University,as well as Oklahoma.

IBA, headquartered in Belgium, of-fers its own scalable approach, workingwith ProCure and other equipment mak-ers including Elekta, a market leader inlinear accelerators, who brings IBA itsknow-how in workflow and informationsystems, patient immobilization, andother techniques and devices. AnotherIBA partner is CMS, experts in treat-ment and dose planning.

“The equipment is turnkey in thesense that we build it, ship, install, but wealso service it so that for the hospital it’sbasically a push-button operation,” saidNordin. “They never have to worry aboutall the complex technology behind thethick wall. They can bring in their pa-tients and treat them as they would inconventional radiation therapy and not re-ally notice much of a difference.”

Varian Medical Systems, PaloAlto,California, is poised to become a major

player. The company acquired ACCELInstruments GmbH, which made cy-clotrons in service in Switzerland andGermany. Varian is known for its treat-ment planning system and patient infor-mation management systems, and for itsinstalled base of 5,000 linear accelera-tors used in photon therapy.

“The technologies are very comple-mentary. Our role isn’t favoring one par-ticular technology or another, our role isas a tool maker, to make all the clinicaltools clinicians need because all cancerpatients aren’t the same,” says LesterBoeh, Vice President of Emerging Tech-nologies at Varian. “We have operationsall over the world that we can leveragein terms of design, manufacturing, pro-ductization, installation, customer sup-port, spare parts distribution, marketing,all that infrastructure already existsaround the world.”

The company’s expertise in clinicalworkflow will prove useful as proton ther-apy continues to move from research en-vironments to mainstream clinicalsettings. “We see a big opportunity tobring all of our skills and expertise in clin-ical workflow to proton therapy as wehave been doing so successful in photontherapy—or radiation therapy—all thesedecades,” Boeh says. Note thatVarian also

12

U.S. Proton Therapy Centers:• James M. Slater, M.D., Proton Treatment

and Research Center at Loma LindaUniversity Medical Center, CA

• Francis H. Burr Proton Therapy Center atMassachusetts General Hospital Cancer Center

• The Proton Therapy Center at M. D. AndersonCancer Center, TX

• Midwest Proton Therapy Institute,Bloomington, IN

• University of Florida Proton Therapy Institute

Proton Therapy Centers Under Construction:• Hampton University (VA)• University of Pennsylvania Medical Center• Northern Illinois University Proton Treatment and

Research Center (DuPage National TechnologyPark in West Chicago)

• INTEGRIS Health, Oklahoma City, OK• Barnes-Jewish Hospital, Washington University

School of Medicine, St. Louis, MO


teams with GE on a position managementsystem as part of GE’s proton package forits CT scanners.

An interesting niche company inproton therapy is Still River Systems,Littleton, MA, which, in partnershipwith MIT, is developing acompact proton therapysystem one-third thesize of current systems.The design is driven bypractical necessityrather than theory.

“We took a differentapproach. Whystart with aphysics ex-pe r imen t?Why not startwith what peopleare doing today in radiationoncology?” says LionelBouchet, Director of Cus-tomer Service and Support forStill River Systems. “Although the parti-cles are small you will always need largesystems to accelerate protons—bigger

than regular linear accelerators [used inphoton therapy]. But cyclotrons (unlikesynchrotrons) can be reduced in size byincreasing the magnetic field.” The first

installation for the companywill be at Barnes JewishHospital in St. Louis, MO,which reported its center

will cost $20 million — sig-nificantly less than oth-

ers—and have apatient capac-

ity of about250 per year.Note thatAccuray has

partnered withStill River Sys-tems to supply arobotic patientp o s i t i o n i n gsystem.

Other OEMsinclude Hitachi’s Power and IndustrialDivision. The company acquiredAccSysTechnology, Inc., a world leader in thecommercial supply of ion linear acceler-

ator systems. TomoTherapy is the otherequipment maker for this specialty, part-nering with Lawrence Livermore Na-tional Laboratory on a prototype for asmaller, lower-cost system than nowavailable. Siemens has works inprogress and is exploring the next gener-ation carbon ion approach to particletherapy.

Rounding out the manufacturers isMitsubishi, which built two synchrotronsystems in Japan.

A Promising FutureANewYork Times article (12/26/07) putproton therapy in the public eye butraised concerns over costs. The fact thatMedicare and aligned insurers pay forthe treatment supports its value, al-though published research is scant sincerandomized clinical trials that withholdproton therapy would be unethical.

Most experts conclude that the tech-nology in the past was limited only bythe imaging equipment used in conjunc-tion with treatment planning.

13

Only a handfulof companiesprovide majorequipment forproton therapy

continued on page 46

DIGITAL

IMAGING

DOTmedbusiness news I FEBRUARY 2008 15

uyers of new and pre-owned medical imaginginstrumentation find it difficult to stay currentwith all of the changes in imaging technology.

Change occurs so rapidly that imaging de-vices that were considered leading edge just

three years ago are now deemed obsolete by the market.So what’s different in the last few years in X-ray tech-

nology advancement and device introduction that has ledto what some call, Technology Useful Life Compression.

Consider market conditions as if you were being im-aged with a 64-slice CT.

In one 10-second breath hold we could: image yourwhole body, achieve sub-mm resolution, collect data with1 mm slices, produce 700-1000 images and image theheartheart in 1-beat

All of this is possible for about $1.5 million.This is quite the change from three years ago when

the market was just beginning to see multi slice CT. And,there’s now much more to digital X-ray than just CT.

But in order to understand where the market isheaded, some history, technology, insight into the forcesdriving the buyer, seller and original equipment manufac-turer (OEM), the markets and applications is all required.

In short, the question that looms: how do DOTmed

readers capitalize on the opportunities associated withthe migration to digital X-ray from analog.

The Digital AdvantageAsk buyers and sellers about the advantage of transition-ing from analog to digital radiography and improved im-aging, faster throughput and elimination of film are alwaysthe “correct” answers.

Oddly though, with all of the institutions around theworld using analog X-ray devices you’d think they’d all betransitioning to digital. But it’s been a gradual progres-sion, one very much driven by cost and performance.

Eliminating film was the biggest catalyst, the trenddating back to the late 1970’s when two Texas specula-tors, the Hunt brothers, accumulated a major position inthe silver market and then conspired to artificially raiseits price. Like so many things there was a down streameffect as silver is a component in film.

Spurred by rising prices, OEMs send users began tolook for ways to eliminate film and go digital. Thus themove to convert to digital X-ray imaging was on and therewas no stopping it.

And with good reason since the first real benefit ingoing digital is the elimination of film. Others include:elimination of film storage rooms, increased productiv-

ity/throughput and improved imaging, though this is appli-cation dependent since clinical images are not necessar-ily better just because they’re digital.

TechnologyThrough the 20th century technological advancementmoved at a digestible pace. There came a point at thebeginning of the 21st century when technology beganmoving faster than the market could adapt. How wouldthis change the way we acquire and think about a newtechnology like digital X-ray?

The advantages or perceived advantages of transi-tioning from analog to digital are well documented. Butlet’s take the buyer’s view as they weigh a move to digi-tal imaging.

In Standard Radiography the primary considerationsare patient volume, image reimbursement and acquisi-tion time or throughput advantages. These are reason-ably common parameters when qualifying any newtechnology or device. In most imaging facilities, what’stop of mind is broadening applications and increasing thenumber of patients imaged. If throughput can also be im-proved, then such facilities can manage the up tick in pa-

tient traffic with the same staffing.The reciprocal is also a consideration. If throughput

improves with the new equipment and the patient volumeis maintained, then department staffing reductions are anoption.

Secondary considerations are many. The necessityfor and the impact of equipment change is more than fi-nancial. Staff has to adjust work routines and learn newoperating systems. This has an immediate impact onproductivity.

In addition, image storage and recall of those imagesis important. Although digital imaging removes the needfor space, cabinets and hardcopy storage, electronic stor-age requires the addition of equipment and software sothat these images can be recalled, manipulated andtransported for viewing. All of this requires different ex-perience and knowledge, not to mention additional outlayof capital for hardware and software.

Analog to Digital PathwayThis transition requires a change in the staff work rou-tine, with many opting to take small steps at the outsetand with a minimal disruption in patient flow.

Computed Radiography (CR) is a way to test the

B

Technology, Market Changes, and Business OpportunitiesBy Wayne Webster


water before diving in. Converting to a digital signal eliminatesthe need for hardcopy storage and the image is now stored dig-itally. Moreover, the department should see improved workflow.

Next after CR is Direct Digital Radiography (DDR orDR). Using an imaging plate made from amorphous silica orselenium and sandwiched with a semiconductor device like acharged couple device (CCD), the DR plate can covert the cap-tured X-ray energy to a charge that is read by the CCD and thenconverted to a digital signal.

The result is that with the replacement of the analog equip-ment there is no requirement for a scanning step as in CR andthe image is available immediately electronically. Again, im-proved patient throughput is the result.

In the digital scheme the image is captured on an imageplate, a receptor. From the receptor the data is transferred elec-tronically to an image management system. From there it’sprocessed in software by an image processor and sent back tothe image management system. Once processed the digitalimage can be stored and retrieved, sent to a patient informa-tion system or moved to a communications network where itcan be viewed at an adjacent monitor or at a reading stationmany miles away.

The processing, transferring and archiving of the digitalX-ray image is a seamless process dependent on software andbandwidth. But like so many advanced technologies the veryswitch to digital for the purpose of eliminating film has caused

the development of a variety of other technologies like PACS.This is an example of technology breeding technology.

Markets & ApplicationsThere are three market segments in which digital X-ray is mak-ing a significant impact.

Veterinary. Vets are using CR and DDR technology. Theywant to eliminate the use of film and the associated storage ofhardcopy files. In general, the veterinarian is focused on cut-ting costs and is usually interested in securing pre-owned dig-ital X-ray equipment. Equipment portability is important.

Dental. Dentists want their patient base to know that theyare employing the latest technology for dental care. Theprospect of eliminating the expense of film and its associatedprocessing is an extra benefit. Dentists believe that with theinstant imaging available with DDR systems they achieve bet-ter throughput and increase productivity.

Human Radiography. By far the largest market of thethree, the radiologist is interested in CR, DDR and volume CT,with the latter still garnering most of the interest.

CR and DDR may still be the workhorses of general radi-ography but CT, originally introduced in 1972, has been rebornwith the advances in multi-detector and volume CT.

The new CT with volume detectors and slice capabilitiesof 40, 64, 256 or higher is center stage. Along with new andinteresting applications comes a high acquisition cost. Thesescanners cost well over $1 million and require expertise to useand technology to deal with the reams of images produced witheach scan.

Although the advanced volume CT is more complex andcan do more than the single slice scanner, the marketplace driv-ers are similar.

Technically inclined radiologists often drive such decisionsso the savvy hospital or imaging center administrator needs to un-derstand the market for any new device as well as how much ca-pability needs to be purchased to attract the available patient base.

Another influential market factor behind new CT multi-slice technology is the promise of new applications. As thoseusing this new imaging technology publish new and innova-tive applications the demand grows. Some say reimbursementis what grows a technology, but without the applications driv-ing the demand for reimbursement, growth in the installed basewould be limited. Although you can make the argument thatonce a new medical device reaches a critical mass resulting inlocal competition, new limited applications and techniques areimplemented to further justify the cost of acquisition.

The View from the Supply SideWhat of the vendors of the multi-slice or volume CT, how havethey responded to this market?

Their goals for the CT were well established: isotropic res-olution (similar resolution in all three planes), increased imag-ing speed (rotate the gantry faster), shorten scan time (increaseapplications and improve throughput) and sub millimeter res-olution (improve lesion detection).

16


In 2003-4 we saw the introduction of the first multi-sliceCT’s. First there were 2 then 4 and 8-slice scanners. By dou-bling numbers of rows, 16-slices was the next expected with32 close behind. But something happened. Instead of the dou-bling effect continuing, there was a technology shift and itjumped from 16 to 40 and then 64. The 256-slice CT was fore-casted on the day that the 64 began to be marketed.

With the introduction of the larger or volume CT detectorcertain attributes of the CT scanner had to be changed to meet theobjectives set by the manufactures for improved performance.

The result of these improvements is quite remarkable.Whole body scans in fewer than 10-seconds. The gantry rotatesevery 0.37 seconds. In 2005, we were excited to learn that thisnew speed allowed for the imaging of the heart in 5-beats. Thefirst reports considered this quite a breakthrough. But, tech-nology was moving faster than we could digest the change. Ina few months it was 3-beats and seemingly overnight it was 1.

Entire body scans are being performed with slice thick-nesses of 1-1.5 mm. Each study is generating 500-1000 im-ages. Remember technology breeding technology? Now thereis a demand for computer assisted detection (CAD) to handleall of the images produced with each study.

Collecting, processing, archiving and transmitting all ofthe data resulting from a study is no small matter. Storage de-vices, network capability and bandwidth are required to moveand store the patient studies. This is another example of tech-nology breeding technology.

Lastly, everyone assumes if the scanning is faster, then the

radiation dose is less than in conventional analog film imag-ing. Unfortunately, this is not the case. In CR and DDR imag-ing, the dose to the patient is similar to film based imaging.

One assumes that volume CT almost demands the deliveryof a lower dose. It’s faster so the dose must be lower. It isn’t.When used for CT angiography, the, the dose rate from a sin-gle X-ray source CT is substantially higher than that receivedby the patient during conventional angiography.

The vendors are working on making alterations to the vol-ume CT scanners to lower the dose. These changes will mostlikely cause an early obsolescence of the equipment already in-stalled.

Digital X-ray’s Market ApplicationsThe applications for digital X-ray can be split into those forvolume CT and those in standard radiography.

For CT scanners with 64-slices or higher, with a single ordual source X-ray source, the preeminent application is CT an-giography (CT-A). The ability to freeze the motion of the heartand image it in 5 beats or less is phenomenal.

Radiologists and cardiologists see this new technology asa real breakthrough. By studying patients with known or sus-pected heart disease, examining their anatomy and simultane-ously performing a calcium scan, the cardiologist gets a fullpicture of the condition of a particular patient’s heart.

Some even predict this application may replace invasive car-diac catheterization. It’smore likely, however, that this technology

17

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The use of film X-rays isbeing phased out and re-placed by digital alterna-tives including high-speed DR and more af-

fordable CR systems. Market forcessuch as the high cost of film, whichcontains raw materials including sil-ver, and concerns over the environ-mental impact of chemicalprocessing, are among many factorspushing health care providers overthe digital divide.

The shift toward electronicmedical records and the growing useof PACS systems are also intensify-ing the urgency to convert imagingstudies to digital formats and sys-tems. An ever-present need to cutcosts, particularly with today’s re-duced reimbursements, makes CRand DR attractive for their increasedpatient throughput and more effi-cient workflow, which digital sys-tems support by removing manysteps for technologists performingthe study, storing, and transferringimages where needed. Of course, ra-diologists and other physicians caneasily obtain remote access to digi-tal files. As though these issuesweren’t enough to convinceproviders to switch from analog filmto digital CR or DR, some newertechnologies also promise to reducepatient exposure to radiation.

There are two ways to “go digi-tal.” Computed Radiography (CR) is asimple — and many believe interimstep—to replace film cassettes withreusable plates that translate the X-rayimage into a digital format. DOTmedindustry experts estimate that the cur-rent market for new CR technologiessupports sales of about 5,000 systemsper year. In the more sophisticatedDigital Radiography (DR) systems,the image is stored directly and auto-matically into a digital file. State-of-the-art DR technology provides thefastest performance and workflowwith the highest quality imaging avail-able while minimizing radiation expo-sure during the exam. About 1,000new DR systems are sold each year.

An IncrementalTransition From Filmto Digital X-rayBy Barbara Kram

CR and DR:

CR 85X multi-plate


As far as the installed based, the vast majority of hospitalshave some form of CR in place. Yet many major hospitals arestill film-dependent. Regarding DR, market watcher IMV esti-mates about one-third of U.S. hospitals have at least one DRsystem in their radiology department.

“We see tremendous growth in DR and have a long way togo for full penetration into the market,” says David Widmann,Global General Manager of Rad/R&F for GE Healthcare. “Theexpansion of our digital line is beginning to reach out into dif-ferent markets and we have a commitment to make those tech-nologies available even in the rural healthcare markets.“

“We expect the market [for DR] to grow. It’s not going to‘hockey-stick’ grow but it’s definitely going to continue grow-ing gradually and smoothly across the marketplace,” predictsKevin Oakley, National Marketing Manager for DR, FujifilmMedical Systems USA. (As of this writing, the company is an-ticipating FDA approval for its Unity SpeedSuite, a single-de-tector, value-oriented DR system.)

Many Players in a Crowded FieldMore than 40 manufacturers offer over 80 products for digitalX-ray acquisition systems, Frost & Sullivan reports. These in-clude the big OEMs, which are DR dynamos such as marketleader GE, Philips, Canon and Carestream Health (formerlyKodak), and Toshiba, along with Fujifilm and Agfa. (Fujifilmwill discontinue U.S. production of medical film April 1, 2008but will continue to supply film to customers.)

Some flagships leading-edge OEM offerings include GE’sDefinium 8000, which among other features provides auto-matic advanced image processing so technologists don’t haveto manually paste multiple images together. (GE doesn’t pro-duce CR systems.)

Carestream’s DirectView DR9500, is a single-detector de-sign that does dual duty with a ceiling mounted U-arm to keepthe bucky and tube aligned while it moves around the patient.Atthe same time, the company remains committed to CRhaving purchased leading manufacturer OREX in 2005.

“There’s no question that we are continuing to in-vest in our computed radiography portfolio,” saysEileen Heizyk, CareStream’s Worldwide MarketingManager for CR. “Some of the higher-end parts of themarket are more saturated and may be moving moreto DR, but there is certainly plenty of growth and op-portunity in the smaller facilities value tier.”

Virtual Imaging, Inc., Deerfield Beach, FL is aCanon authorized distributor that specializes in upgrading fa-cilities from film straight to DR. “We can go into any facilityand upgrade to DR without dismantling the room, and getequipment to OEM specs,” says Kris Kessler, Creative Mar-keting Director. “We skip the CR aspect and go directly to DR.”This is possible because of the versatility of the Canon CXDI-50G Digital Radiography System, which is compact yet largeenough for chest and abdominal X-rays.

Many smaller manufacturers offer a number of niche prod-ucts to meet nearly any budget or application.

One example isAlara, Inc., which makes CR systems. TheirT-Series is a drum-based, compact tabletop CR. “It’s inexpen-sive, rugged, and easy to use. We sell a lot in veterinary and inhuman health care applications, particularly in the podiatry andchiropractic markets,” says Kuldip Ahluwalia, V.P., Sales andMarketing,Alara, Inc., Fremont, CA. “The beautiful thing aboutCR over DR is it’s a stand-alone device. It’s easily upgraded fromyour standard X-ray scanner. There is no workflow differenceand it’s an inexpensive way to move into the digital world.”

Another niche company is Torrance, CA-based iCRco, Inc.,which offers a CR technology that also promises to tamp downthe cost of ownership of digital X-ray while overcoming someinherent CR design challenges. The company’s True Flat ScanPath technology ensures that nothing ever comes in contact withthe active area of the costly phosphor plates, producing 500,000or more artifact-free images for the end-user with no degrada-tion in image quality, according to the company. “True Flat ScanPath is the first thing an end-user should look at when transi-tioning to the digital environment,” suggests President and CEOStephen Neushul. (The company also has a DR offering.)

Independent service providers sell and service systemsmade by the smaller OEMs, an arrangement that can save sig-nificant costs.

Sal Aidone, Vice President, Deccaid Services, Deer Park,NY, sells CR systems made by iCRco, Radlink, and KonicaMinolta, as well as OREX. “Independentcompanies like us and the smaller sup-pliers can drive down costs as long as thecustomers don’t have the mindset thatthey have to buy from the large OEMs.They need to look for quality instead ofjust a name,” Aidone says.

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The DigitalDiagnostfamily is Philips’state-of-the art solu-tion for direct digitalradiography.


The costs for new CR systems depend on the manufacturerand features and range from about $40,000 to $60,000 for asmall system for an imaging center, up to $90,000 to $120,000for large, high-end, multi-slot, hospital-grade CR. DR requiresa more significant investment starting in the six figures. Entry-level DR can go for $200,000.

If all this sounds too expensive, consider some hidden costsof film. “Typically there’s sticker shock when people hear aboutpricing for the new CR systems, but they have not done theirhomework in terms of factoring the cost for producing one sin-gle film, let alone a study of three to four films,” says MichaelLies, President, Medical Advantages, Inc., Pittsburgh, PA. Ad-ditional costs include courier service to doctors off-site and thecost of lost films and repeat studies which digital solutions elim-inate. “If customers do their homework, they are not in shockwhen they hear competitive pricing for CR systems.”

As hospitals and imaging centers upgrade to new CR orDR systems, the used CR systems are put to good use.

“What we are finding is hospitals are expanding the use ofCR. They seem to be shuffling equipment around. They mightput in a DR room but they don’t get rid of their CR, they are mov-ing it to another department or an off-site imaging center,” reportsHeizyk. “There is a lot of competition among hospitals to partic-ipate in the imaging center market and make it easier for their pa-tients. We are finding they are moving CR to imaging centersoffsite or adding another CR unit to an existing department.”

In othercases the usedequipment be-comes avail-able on themarket, providing an-other cost-saving oppor-tunity. Expect to pay around$20,000 to $30,000 for refurbishedsingle-slot CR systems and $35,000 to $40,000 for refur-bished multi-slot CR. Be sure your system includes the com-puter hardware, software, and cassette reader and viewer and isbrought to OEM specifications and supported with a warranty.(Few used DR systems are on the market and supported withwarranties.)

Time to “Go Digital”?There’s a growing consensus that it makes economic sense toconvert from film to a CR systems in most cases. “Film willsoon be a thing of the past with CR the low-cost solution in themarket,” predicts Kessler.

Here are some other suggestions from DOTmed users andindustry experts: You know it’s time to go digital when…”thecosts of film, transportation of files, filing and storage, chemi-cals, duplication, lost films, plus the hassle of not having thefiles at the doctors’ fingertips exceed the cost of the new sys-tem,” says Mark Kladivo, Broker, pcCentral, Urbandale, IA.

“When you consider the direct and indirect costs of film,going filmless just makes sense,” says Scott Wasson, Presidentand CEO, Radiology Services LLC, Evansville, IN. “Practi-cally all CR systems are more reliable than film processors.”

At the same time, the decision must be driven by your par-ticular needs and budget constraints.

“It only makes economic sense to switch from film to CRor DR when the cost of the system is less than the cost of chem-ical processing. It depends on each facility, the volume of im-ages and the reimbursement,” advises Donnie Torok, BusinessManager, Beach Medical Imaging, Indian Harbour Beach, FL.

CR vs. DRWhen should you invest in CR versus DR? Industry insiderspredict that CR will continue to dominate the market for thenext three to seven years but that DR will gain ground there-after. Most hospital radiology departments have some combi-nation of CR and DR, along with their older film systems.Generally, CR systems are more affordable for imaging centersand private practitioners, and even small and community hospi-tals, while larger institutions or groups consider investing in DR.

“When you have 100 films per day then DR will makesense. If less than 100 films per day then CR is a good choice,”suggests Samuel Sandlin, owner of A.M. X-Ray Service,Miami, FL.

“I don’t think CR pricing can go much lower so it’s a stepbetween film and DR. But if you don’t have a real need for superspeed then you really don’t need a DR. It’s just for hospitals thatwant the latest and greatest,” says Aidone. “I would rather have

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Eleva Wireless GXR WirelessDetector (prototype). (Imagecourtesy of Philips Healthcare)


a new CR than one of those older DRs.It would be faster and the technology is

more up to date.”“CR is leading the way into the film-

less future. If a facility has a mid- to high-volume throughput and intends to stay inbusiness more than two or three years,then it is irrational not to go with CR. DR,still being very expensive, has yet to se-cure a major market share,” says JosephJenkins, International Imaging Ltd., Hen-derson, NV. He stresses the difference inpriorities for large and small healthcareproviders. “When you’re spending otherpeople’s money, you can buy DR, butwhen you’re spending your own moneyyou have to be more practical.”

“The larger institutions that are wellfunded tend to buy the leading-edgetechnology whether or not they reallyneed it,” says Cefalo. “For-profit hospi-tals are not as well funded and they re-ally have to scrutinize that decision forCR and DR….It’s still quite difficult tobeat the value of CR.”

Still, DR is the cutting-edge X-Ray

technology, coveted by clinicians ofmany specialties. In fact, access to in-of-fice digital radiography (and MRI) capa-bilities are among U.S. orthopedicspecialists’ greatest unmet needs, ac-cording to IMV. “Digital radiography isa key priority for many orthopedic prac-tices in their efforts to have remote ac-cess to imaging results, to better managelarge volumes of imaging data, and ulti-mately to provide more accurate patientdiagnoses,” concludes Mary C. Patton,Director, Market Research, IMV.

Kessler observes, “With CR theuser must replace their CR cassettesafter so many uses which incurs addi-tional costs. With DR you do not have toworry about replacing equipment as fre-quently. Digital detectors are moredurable and reliable, which extends thelife cycle of any existing equipmentwithout any residual costs.”

However, there is one applicationwhere CR may reign supreme for sometime to come. “I don’t think CR will goaway, it has good applications in

portable X-ray,” Sandlin says. “I’ve seensome sites go portable with DR and itdoesn’t work out as well. It needs to bewireless or everybody runs over thecable. It’s easier to use a cassette whenyou’re on the hospital floor or ER. So Ithink CR will be around a while.”

Carestream just launched its newKODAK Point-of-Care CR-ITX 560System for ICU and portable applica-tions. “We’ve made it easier for the techsbecause they can do the imaging bed-side. You can tell at that point if youneed to take another shot. Or, if it’s acritical care situation, get a quick X-rayview without carrying away cassettes toput through a reader. The reader is rightthere bedside,” Heizyk says.

Fujifilm is another OEM well awareof the portable application for CR. Thecompany partnered with Hitachi to cre-ate the FCR Go digital portable ma-chine. This device also allows thetechnologist to see immediately whetherthe X-ray position was correct while onthe unit floor with the patient. Images go


straight to PACS and the design elimi-nates the need for re-training for tech-nologists since its interfaces areconsistent with prior technologies’.FCR Go is expected to earn FDA ap-proval and become available in the U.S.in mid-2008.

Some of the newest innovationscombine the best of both worlds —CR’s ability to position the detectorfreely and DR’s instant image accessand high resolution. Agfa’s DX-S cas-sette-based X-ray system can be usedfor any number of exams yet offers DR-like workflow—perfect for a traumasetting.

Also on the horizon is a wirelessdigital detector from Philips that inte-grates benefits of both CR and DR. Theunit will synch with the hospital net-work and integrate with PACS at thepush of a button.

Another trend is toward automationof multiple spine images for faster stud-ies with less wear and tear on the tech-

nologist. For instance, Toshiba’s dualdetector RADREX receives instructionsfor body part mapping directly from RISinformation and imports work lists forthe particular patient and study. Thetechnologist doesn’t have to find settingsfor, say, a chest or abdominal X-ray.

These and other innovations meanthat those who have delayed the deci-sion to go digital may leapfrog ahead ofother providers. And by waiting, priceshave come down that put not just CRbut possibly DR within reach.

“From a DR perspective, one of thethings that’s happened in the last five toten years is that a lot of people whowere going to buy new X-ray equip-ment held off those decisions so thatthey could buy other kinds of high-endtechnologies such as MR and multi-de-tector CT,” Oakley says. “What’s hap-pening now is they really can’t waitmuch longer.”● [DM 5372]

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DOTmed Registered DR and CR Sales and Service CompaniesFor convenient links to these companies’DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 5372]Names in boldface are Premium Listings.

Name Company – Domestic City State Certified DM100Ted Huss Medical Imaging Resources Colfax CA ��

Samuel Sandlin A.M. X-Ray Service Miami FL �

Donnie Torok Central FL Med Equip Satellite Beach FLDavid Denholtz Integrity Medical Systems, Inc. Fort Myers FL ��

Kris Kessler Virtual Imaging Inc Deerfield Beach FLMark Kladivo pcCentral Urbandale IAScott Wasson Radiology Services LLC Evansville INJoseph Jenkins International Imaging Ltd. henderson NVTim Austin Austin’s X-Ray Service Swanton OHPeter Chen Global Medical Equipment Harleysville PA ��

Michael Lies Medical Advantages Inc. Pittsburgh PA ��

Paul McCabe Peterson Imaging Inc. King of Prussia PAWill Martinez Trident Imaging Services Santa Fe TXJohn Snyder Cal-Ray, Inc. Oshkosh WI

Name Company – International City State Certified DM100Maciel Passarelli Ramos Construtec Rio Comercio Ltda Rio de Janeiro BrazilWang Zhixuan Hangzhou office of Huaxin Co. Ltd. Hangzhou ChinaAbdelrahim Khalil Besisc Cairo EgyptMike Gergatsoulis Technomedical Thessaloniki GreeceAlejandro Rodriguez Interfase-Medica Chihuahua MexicoMohammad Shuaib Image Vision Lahore PakistanFlorin Anghel AmediT Bucuresti RomaniaTheera Sirinawee Welldone Solution A.Lamlookka Thailand

Watch for the PACS industry sector report in the March issue of DOTmed Business News.

RadPRO 40kw DigitalMobile X-Ray System(Courtesy of VirtualImaging)


Unlike sellers of medical equipment or medicalservice engineers that face the same problemsevery day, riggers and craters moving medicalequipment in and out of hospitals and other facil-ities are faced with an endlessly shifting landscape.

New and challenging problems, it seems, are de riguerwith each project. But working in concert with the de-installer,riggers and craters create innovative approaches to the mostdifficult relocation assignments.

The rigging and crating industry has a market value worthmillions of dollars annually. Though the business can be lucra-tive at times, insurance plays an expensive and key role. Mostcompanies carry a $2 to 6 million dollar umbrella policy, dueto the job’s unique risks and effect on balance sheets. Riggersmust carry general liability, equipment coverage, business auto,trucker and workers’ compensation insurance, among others.

JC Duggan, Brooklyn, NY carries $6 million in liabilityinsurance. John Duggan, vice president of the company saysthe hardest part of handling equipment in a city like New Yorkis the environment that he and his staff contend with.

“Many of our major hoisting jobs require closing streets,”says Duggan. “Last summer, we had to close the eastbound di-rection of 34th Street to hoist a 3T MRI magnet over a 15-storybuilding to rig it in through a rear wall opening.” That’s nosmall undertaking given the Big Apple’s landscape.

Whether moving an MRI, CT scanner, nuclear camera,gamma knife, linear accelerator or an entire laboratory, forevery new job a rigger and crater faces, plans that were origi-nally laid out can change without warning. It’s safe to say ittakes years of rigging to learn the proper techniques, how to

calculate geometry and forces and how to use the proper equip-ment for each piece of medical equipment moved.

Ronald Cortamilia, Director of Logistics at Med Trans Lo-gistics, Port San Lucie, FL, says his company has successfullytransported and rigged medical equipment for some of thelargest OEMs. “We specialize in medical imaging and pharma-ceutical equipment,” says Cortamilia. He said that Med Transhas rigged MRIs that weigh 8000 to 70,000 pounds.

Many riggers, he says, tend to underestimate medicalequipment rigging. “Moving a printing press as opposed to anMRI magnet are two entirely different rigs,” says Cortamilia.“The site conditions for rigging in a hospital versus an openwarehouse pose challenges that can’t be taken lightly.”

What You See is What you GetAn experienced rigger will look at a job and visualize theprocess. Does the machine need to be dismantled? What routein or out of the building looks to be the most efficient? Whatequipment is going to be needed? What must be done to protectthe walls and floors from damage? Is the ceiling too low in cer-tain areas to get the machine in or out? Does the floor have tobe braced from below?

Fran Ambrose, president of F. Ambrose Rigging, Mont-gomeryville, PA, said that the logistics of rigging never end.“From making sure that all the proper permits are in hand, tohaving the right equipment (often times fabricating it) to en-suring the job is done the right way, it’s all in a day’s work. Ifan MRI gets damaged, the aftermath has a snowballing effectthat not only adversely affects the rigging company, but also

23

Moving MedicalEquipment?

By Joan Trombetti

It’s Going Nowhere WithoutRiggers and Craters


the hospital or medical facility involved, and the patients await-ing what could be a lifesaving procedure,” he says.

Ambrose is a master of his trade. His company has been inbusiness for 30 plus years, has a staff of 25, a number of whichare family. Ambrose has organized the handling of 3000+MRIs. “Every situation is different,” he says. “Some riggingand crating jobs need special equipment and accessories, andwe have our own welding and woodworking shop to fabricatethe pieces we need. We can rig, warehouse and transport justabout anything.” Ambrose owns a fleet of state-of-the-artequipment including forklifts with a capacity to hold up to80,000 pounds, air ride trucks and trailers, high capacity liftgates, crane service and aerial platforms for high rise removals.

Like Ambrose, NOR-CAL Rigging & Installations, SanLeandro, CA, is an MRI specialist. Company president, SteveOwen says his company business is about 90 percent MRI. “Wemove about two to three a week,” he says. Like other riggingcompanies, NOR-CAL fees run about $5,000 for a fairly sim-ple move, while more challenging rigging jobs can run as highas $200,000. “We are about to rig a job in Indiana that shouldrun around $100,000 because we need to use a 350 ton crane,”Owen says. One particularly nettlesome job that stands out inOwens’s mind is moving an MRI out of an antique buildingwhere garage floors had to be demolished and a ramp had to beconstructed to get the machine out. “We were dealing with fouror five other unions to make sure the project was carried out to

the finish without a problem.” Although NOR-CAL covers a$3 million dollar insurance policy, with a $2 million dollar um-brella, Owen is proud to say in the 23 years he’s been in busi-ness, “there has never been a problem.”

Professional riggers tend to have a wide variety of tools toget the job done, including cranes and forklifts. Many utilize avariety of industry-specific tools like hydraulic jacks, hydrauliccomealongs, hydraulic pushers, chains and all kinds of ‘nutsand bolts’. They have to have both U.S. and metric tools, sincemany of the machines sold in the U.S. are metric. Designingequipment and accessories to fit the need is also a commonpractice among many reputable rigging companies.

Diamond Rigging, Batavia, IL, technicians, for example,are very much into design. They built the Hitachi Alta ire coldheart cart for long runs or tight doorways, aluminum gantriesfor MRI installations and stainless steel rigging and jackingequipment for Mires. One of the most challenging jobs MaxMayer, company president, has faced was installing an AriesElite over a basement. “My crew and I worked under a scaffold-ing structure, jacked up the 34,500 pound unit 24 inches androlled the magnet onto a steel supported structure independentof the building – all during ‘Taste of Chicago’ traffic,” saidMayer. “We started the job at midnight and finished at 6:00 am.”

For smaller, lighter and less complicated medical equip-ment moves, it is not uncommon for reinstallation companiesto handle their own rigging, but for bigger jobs there is no sub-stitute for experience.

Richard Babyak, president, Transit Solutions, North Brad-dock, PA, says common mistakes include, “not adhering to thefacilities policies and procedures, not making arrangementswith shipping/receiving departments and not making sure theequipment is source free and decontaminated. I feel that mis-takes are made by not having the experience or the ability toprovide the services, being unfamiliar with the equipment andtaking shortcuts,” he says.

24


Meanwhile, Bob Holt, vp-gm, Quickway Rigging & Trans-fer, Minneapolis, MN, says his company works in partnershipwith others to make sure the whole job, runs seamlessly. “Quick-way is involved in the transportation, unloading, uncrating andplacement of MRIs, CTs and many other medical systems, aswell as the relocation of those systems,” says Holt. “The numbersvary, but annually we move approximately 25 to 30 medical sys-tems, with an average cost of $5000 to $30,000. The more diffi-cult the job is, quite obviously, the more expensive.”

Bill White, operations manager, Brandon Transfer & Stor-age, West Palm Beach, FL, says moving an MRI runs anywherefrom $5,000 to over $8,000. “Some weigh 34,000 or morepounds, so the type of crane required usually determines thefee. For complicated jobs when a crane has to reach 60 to 70feet, and a tractor trailer truck has to have the capacity tocounter-weight – the job can run over $18,000,” he said.Gamma knifes are generally thought to be the most expensivemedical machines to move.

Michael Ahng, operations manager, Reed Machinery &Transportation, Aurora, IL, a full service rigging, moving andspecialized transportation company, suggests the biggest mis-take a rigger makes is not using the proper rigging points on apiece of equipment per the manufacturers directions.

Ahng described his most versatile piece of equipment asthe 30/0 Versa-Lift, which has the ability to extend its counterweight and lift 30 tons. It has a compact design allowing it tofit into tight quarters. He says MRIs are difficult to handle be-cause each manufacturer has different rigging specificationsfor each model and many require metric tools and shackles forlifting. “In addition, the imaging rooms can have many obsta-cles that must be overcome for installations and de-installa-tions,” says Ahng.

Delicate Medical EquipmentMany see MRIs as being able to withstand force, but realisti-cally, the machine is extremely delicate and proper care mustbe taken when rigging and crating. According to Aaron Buck-ley, Strategic Analyst for Chick Packaging Group, Inc., Chicago,IL, “the choice of equipment used to rig an MRI should be wellthought out, because an unbalanced center of gravity could cre-ate havoc.” Chick uses a tri-lifter, which helps remove the MRIfrom the delivery truck and a 35,000-pound forklift that enablesworkers to place the machine on MRI skates, which are essen-tial to navigate the machine around corners. Chick PackagingGroup has twelve locations throughout the US.

MEI, LCC, Albany, OR, has combined rigging and cratinginto one function according to Bill McGinty, operations man-ager. “By combining the two functions, MEI has more controland can coordinate all the activities involved in a project andpass along efficiencies and provide quality assurance to theircustomers.” MEI president and CEO, Dan Cappello said thatpricing a project is dependent upon the model of a machine andthe peculiarities of the move path (length, turns, elevation, etc.).“A simple move could be priced as low as $2000, with morecomplex moves running as high as $50,000 or more,” he said.

For the most part, rigging outside of the United States (ex-cept in Western Europe) is handled by trucking companies.

Sometimes, riggers do their own crating, while others work inconcert with professional craters and trucking companies.

For example, O.B. Hill Trucking & Rigging, Natick, MAis a multi-million dollar business offering rigging, millwright-ing services, crane and boomtruck services, flatbed, lowbed,over-dimensional and specialized trailer service, as well as crat-ing, warehouse and storage facilities to much of the Northeast.The company’s Randy Curtis said OB has moved more than165 MRI machines in the last 18 months, including medical in-stallations for companies like GE Medical Systems, Philips,Siemens, Toshiba, Varian and others.

Like rigging, crating demands experienced hands. For ex-ample, crating for an air shipment is different from crating forocean shipments. When you are shipping by air, you don’t wantto over crate, because charges are incurred per pound. Depend-ing on what is being shipped, air shipment tends to handle frag-ile machines with more care than shipping by ocean, whichrequires heavier crating.

Phil Jacobus, president of DOTmed, says, “WhenDOTmed auctions equipment, it sometimes handles shipping.Anytime DOTmed ships internationally, it always recommendsto the ‘successful bidder’ that they ship an entire container –even if the equipment they are shipping doesn’t fill the con-tainer. It is much more likely that your machine will arrivesafely and without damage if it is completely contained.”

25


DOTmedbusiness news I FEBRUARY 2008 www.dotmed.com28

Many times, ships carrying delicate medical machines sailfrom a cold climate to a warm climate or warm climate to acold climate. It is not uncommon for moisture to build up insidethe top of the container that holds the equipment. Craters usedesiccant to absorb the moisture, and some will install theequipment in a vacuum bag, sucking out all the air, protectingthe equipment from moisture buildup. If moisture builds, someequipment is prone to rust during short shipments so when thesystem is turned on, the circuit board can short out.

Bob Cralle, General Manager, Chick Packaging California,Inc feels that vacuum bagging is a necessity when shipping high-value and fragile medical equipment. “The combination of vac-uum bagging in addition to desiccant protects the delicateelectronics contained in many of these machines,” states Cralle’.”

Larry Knight, Director of Operations at Sunrise MedicalTechnology, Inc. (SMTI) says the company handles the de-in-stallation, rigging and shipping of MRIs under power usingtrucks. “When we transport MRIs, we do it in a way that allowsthe cold head to continue to run and less helium is lost,” saysKnight. “We do this for land and sea transport.” SMTI doesnot use vacuum bags when crating. They use expansion bagsbecause Knight believes they are a much more flexible fixturefor crating moderate to heavy small equipment.

Sometimes craters must use special wood, depending onthe country that they are shipping to. Many countries require

wood that has been disinfected, so that it is not prone to insectinfestation while traveling internationally.

Freight Dynamics, Minneapolis, MN, is a $2 million ayear, third party logistics company that provides nationalpackaging and crating for the medical industry. Operation’sSpecialist Mitch Findley said that when picking up medicalequipment that is not packaged for transport, moving techni-cians use pads and straps and lock the equipment into place ina truck. “We bring the equipment back to the facility where itis offloaded and packaged to our specific packaging instruc-tions,” says Findley. “Freight Dynamics is ISPM (Interna-tional Standards for Phytosanitary Measures) 15 Certified andauthorized to build and export wood crates in accordance withthe the International Plant Protection Convention (IPPC).”

International Packing and Crating (IPC) maintains a fullyinsured manufacturing and warehouse facility in Itasca, IL,specializing in wooden packaging for both domestic and in-ternational shippers. Company Senior Vice President, ArtGutierrez says crew chiefs go directly to a site to work withriggers to measure and build the necessary crating needed foreach machine. “If a machine is traveling internationally, wewill use vapor barrier corrosion protection,” he says. “Thisvapor barrier is placed around the machine to protect it. Onceit’s on, we vacuum all the air out and add dessicant before weseal it to make sure no moisture or corrosion occurs.”



Ever take wire cutters to a 440-voltline that was reported to be inpower lock down mode by a hospi-tal’s maintenance staff?

But it wasn’t.The results of that miscue can be, as you

would imagine, shocking, if not potentiallyfatal.

But such are the occasional compromis-ing situations faced by a crew of de-installerswho might be removing an MRI, Linear Ac-celerator, RF, CT or a bi-plane Cath Lab.

De-installing expensive, fragile and some-times massively bulky medical equipment andthen rigging, crating, transporting, re-installingand calibrating it in another location can be avery tough job, almost a heroically unsung onein the medical equipment business. And yet,it’s still one clients take for granted.

Here’s a quick assessment of the basicsinvolved in a de-install, from Michael Pro-feta, president, Magnetic Resonance Tech-nologies, Willoughby, OH, who views all 50states as the region his company serves.

“It has many logistical issues. The equip-ment is large, requiring very special riggingand handling. There are always constructionrequirements to and coordination issues withgeneral contractors, mechanical contractorsfor chillers and HVAC units, electricians, rig-gers, transportation, site personnel. The list isendless.” So the de-install involves all of theabove plus many variations specific to indi-vidual modalities. Bottom line: nothing’s easyin the de-install trade.

Quite simply, the business can be dirty,dusty, and frustrating. Often a crew will finditself navigating troughs of bundled wires andcables in the dank basement of a 100-year-oldhospital at 3 am on a Saturday morning.

Other times, the pathways, door clearancesand corridor routes that once accommodated theinstallation of a Gamma Knife or an R&Fcombo might now pose a huge impediment tothe de-installation of the same machine.

At times, the situation gets dicey, saysJames Young, vp, Acceletronics, Inc., Exton,PA, who recalls a recent de-install of a cardiaccath lab that happened to be in an adjoiningroom to another cardiac cath lab. Access tothe cath lab being removed was, of course,through the first room. Acceletronics and thehospital were on such a tight schedule “thatwe were taking things out while people wereon the table in the first room.”

Harried hospital administrators are always anxious to keep noise and dust pollu-

29

Finding Solutions toTricky Challenges aWay of Life for De-Installers

By Colby Coates

of the Medical EquipmentBusiness?

UnsungHeroes


tion down and not upset the patients. But sometimes, in orderto keep schedules, hold down costs and meet shipping dead-lines, extraordinary steps are called for and it’s up to the savvyde-installer to mastermind the effort.

Who’s Calling the Shots?Sometimes one company, especially those that operate in amulti-state region and usually also sell and service the samemedical equipment they’re de-installing, will handle most, ifnot all, facets of the job from physically extracting the equip-ment from one location and delivering it safely to another.Whether it’s to a facility across town, a ship loading exports ora warehouse where it will be refurbished or sold for parts, thecomplexity of the job rises exponentially.

Other times, however, several different specialist firmsplay key roles as subcontractors in the operation. In such cases,a mix of different crews, bosses and clients, demand intenseand direct communication between all parties. And even if sev-eral specialists are required, the onus should be on the client toestablish one chain of command, giving overall managementsupervision to one person. Otherwise, as happened to the de-in-staller who shall remain nameless, a facility maintenanceworker might forget to cut off the juice.

A perfect example of how specialized de-installs have be-come: only a small number of firms are licensed to remove thecobalt from a linear accelerator (often called putting it in the“pig”). Only then can the de-installer begin the job.

“We prefer to be in charge of everything from the very be-ginning,” says Michael Webster of Legacy Medical Imaging,Fort Worth, TX. “Things go smoother that way.”

That’s a point heartily endorsed by Steven Ford, president,Professional Imaging Services, San Diego, CA, who says, “it’s amistake to have multiple people responsible for one job. Insteada single company should be hired.” “That one point company,” hesays, “then hires any other subcontractors that are needed. Thatway, the lines of communication and responsibility are clear.”

As Glenn Hammerquist of Berrien X-Ray, Berrien Springs,MI, says about what’s necessary to ensure that a de-installation gosmoothly, “communication, communication, communication.”

Many de-installers interviewed for this piece suggest thatclients, be they hospitals, imaging centers or small doctor’s of-fices, will, in what they think is an effort to control costs, try tobring two or three different companies together for one de-in-stall. They think that by parceling out the job, they’ll pay less.Unfortunately, while that perhaps makes intellectual sense, thereality is usually different.

Insurance Always an IssueFrom an insurance perspective, the cost of being a de-installercan be substantial too.

Many de-installers carry insurance well in excess of $5million, with the odds of never having to make any panickycalls to the insurance company increasing in direct proportionto the amount of scrupulously detailed planning that goes into

30


each operation. Insurance coverage also varies sometimes ac-cording to region, size of the job and scope of the de-installer’sresponsibilities. But it’s not uncommon for some policies toreach as high as $10 million.

Darrel Kile, Classic Diagnostic Imaging, Macedonia, OHsays whatever the policy’s face value, it should cover, “theworkers, tools, trucks and any hospital property.”

Frank Boseman, president, Boseman Medical Imaging,Greenwood, SC, recommends a variety of policies including,“commercial general liability, products and completed opera-tions, and general cargo insurance.”

Carrying suitable insurance is also a necessity given thefact that theft of parts occasionally occurs. Nowadays, mostof a system’s loose components will be shrink-wrapped, thepackages signed by the de-installer who then takes photo-graphs. Not a panacea for the sticky fingered but particularlyhelpful in dealing with clients and insurance companies.

It’s All About Small DetailsIt’s somewhat ironic how large a role small details play in de-installation. In a business where the simplest, one day de-in-stall of a CT can cost about $1,000 up to the thousands andthousands required to pay for a cross country odyssey, the avail-ability of OEM dollies, for example, are often the differencebetween keeping a de-install on track or shutting down severalcrews for hours.

“As soon as an OEM stops production on a certain pieceof equipment it stops making the dollies that fit it,” says EdGibbs, North Coast Medical Equipment, Berea, OH. “So inthe aftermarket, we make our own or do whatever it takes.”

And that’s just one of the hundreds of items that must befactored into any de-installation, remembering, of course, thateach and every move is different from the one that preceded it.Nonetheless, tricks of the trade accumulate over time, promptingGibbs, who serves a 13 state area, to suggest that de-installerswith a 25 year track record like his are probably a customer’sbest bet, especially outfits that ramrod the entire process.

The de-install arena is, in fact, rife with horror stories ofoperations gone badly. One company, JDI Solutions, Brevard,NC, even hosts what it calls a “Wall of Shame” on its website,displaying pictures of a number of de-installs gone awry.

Dust is another small albeit villainous detail. Of the 50 plusrespondents to the DOTmed Business News questionnaire aboutde-installation, dust was a virtual unanimous choice, as alwaysbeing an important issue that the de-installer has to contend with.

“The surrounding environment can sometimes be a dis-advantage during installs/de-installs,” says Al Brown, Preci-sion Medical, Kankakee, IL.

“But we find that shrink-wrapping, bubble-wrapping,padding, boxing equipment and components on pallets is al-ways a safe bet.”

“Rooms should be isolated from the rest of the facility byplacing plastic drapes at doorways and adding blanket drapesto buffer noise,” says Larry Knight, Sunrise Medical Technol-ogy, Waxahachie, TX. Wearing protective garb, bunny slip-pers and cleaning up with industrial strength vacuums are alsoall part of the regular routine for most de-installers. Also pop-

When Dan Kujawa first metLeo Parra, they knew they

were destined to worktogether.

Today, their companies have teamed up to offer you:• The finest deinstallation services.• Any type of imaging equipment.• Anywhere in America.Call Dan or Leo and get their 40 years of combinedexperience. Plus, an old-time commitment toquality and honesty that’s hard to find these days.

Unitech Imaging, Inc. Mundi X-Ray, Inc.118 West Maple Road 6315 Balmoral TerraceBirmingham, MI 48009 Clarkston, MI 48346Dan Kujawa, President Leo Parra, President248-258-4860 [email protected] [email protected]

31


ular, dust and grime gathering rubbermats are placed outside the entryway ofthe room where the de-install is happen-ing so as workers go in and out, much ofthe excess detritus is captured.

As the new, more sophisticatedtechnology replaces the old and hospi-tals and clinics continue to upgrade, itseems as if specialization in either par-ticular categories of equipment or brandsfrom one OEM or another is assumingan increasingly important role.

KNJ Tech Service, Monticello, IN,for example, is in line to handle Nation-wide Imaging’s business in a 15 statearea, says company principal James Gant.And Siemens, according to industry scut-tlebutt, was so unhappy with the work ofa couple of less than professional de-in-stallers that it’s authorized five de-in-stallers across the US to handle its work.

The OutlookLooking forward, most de-installers in-terviewed by DMBN are relatively opti-mistic about their respective futures,

though some problems loom.One company executive said that

increased competition from Korean,Chinese and Indian manufacturers hascut into the major OEM’s market shareto the point that aggressive selling is be-coming more prevalent.

Says one exec, “the major OEM’s

are making new equipment more af-fordable by lowering prices and offer-ing a variety of attractive financingdeals. “ In some cases, interest is beingwaived for up to a year and paymentscan be deferred.” ● [DM 5369]

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For any MRI service you need, MRT has it absolutely down cold.Since 1993 we have been providing total solutions for MRI Projects.

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Boomers Help Drive Install, De-Install BusinessRuss Knowles of Remetronix, Port St. Lucie, FL, is averaging well over 2500 in-stalls, de-installs annually, significant growth from the 100 or so projectsRemetronix oversaw when it opened its doors in 1993.

It’s obvious Knowles, who concentrates solely on this niche, eschewingsales and service, knows whereof he speaks.

So what’s driving such growth? “Baby boomers need diagnostic imagining,”he says, noting those boomers’ cardio vascular problems spur such demand. Inaddition, “obesity in this country is at an all time high,” another phenomenonthat’s heightened the need for technology driven healthcare solutions.

As much as the vaunted baby boomer demographic is a huge catalyst forgrowth, another important one is DRA’s effect, which, Knowles says, promptedhospitals and clinics to reconsider buying refurbished or used equipment. Newor used, Knowles points out, “We specifically went after de-installs because forevery new MRI that’s put in, it’s likely an old one has to move out.”


DOTmed Registered Deinstallation Sales and Service CompaniesFor convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 5369]Names in boldface are Premium Listings.

Name City/SateCompany – DomesticSteven Ford San Diego / CA

�� Professional Imaging Services NationwideStephanie Espinola Denver / CO

� � � �JCF Engineering, Inc. Midwest - DenverRuss Knowles Port St. Lucie / FL

�� Remetronix Not indicatedBryan Coombs Ocala / FL

�X-ray Repair & Sales West and North WestTodd Muhlestein Oakley / ID

� �National Deinstall & Refurb Southwest, Northeast, NorthwestJames Gant Monticello / IN

� � � � � � � �KNJ Tech Service Southwest, Northeast, NorthwestRonald Moore Evansville / IN

� �R & D Imaging, Inc. NationwideJames Roller Monticello / IN

� � � � � � � � � � �R-TECH Solutions Inc. Nationwide, Europe, Austrailia.Glenn Hammerquist Berrien Springs / MI �� Berrien Xray MidwestLeonardo Parra Clarkston / MI

� � � � � � � � � � � � �Mundi X-Ray, Inc Midwest for removal, Worldwide for InstallDan Kujawa Birmingham / MI

� � � � � � � � � � � � �Unitech Imaging, Inc. Midwest for removal, Worldwide for InstallTom Gohn St. Louis / MO

�� International Health Network NationwideLeon Gugel Long Island City / NY

�� Metropolis International Nationwide - all 50 states.Pete Schliebner Strongville / OH �� Benchmark Imaging Group NationwideDarrel Kile Macedonia / OH �� Classic Diagnostic Imaging Whole countryMichael Profeta Willoughby / OH ��Magnetic Resonance Technologies Serving the USAEdward Gibbs Berea / OH

�North Coast Medical Equipment, Inc. Not indicatedJim Monro Solon / OH

�� RSTI Training Center NortheastJames Bowman, Jr. Cincinnati / OH

� � � � � � � � � �US Medical Resources Corp Focus is east of Miss., also Nat’l and Int’l.Timothy Paradise South Euclid / OH �� Company not available NationwideSteven Roberts Tulsa / OK

� � �AccuRad Medical Imaging Services SouthwestJames Young Exton / PA

�Acceletronics,Inc.Richard Babyak North Braddock / PA

� � � � � � � � �Transit Solutions Northeast, Southeast, and MidwestFrank Boseman Greenwood / SC �� BMI WorldwideChris Reilly Summerville / SC ��CER Medical NationalMichael Baumgartner Knoxville / TN �� Remesta Medical Corp. SoutheastMarshall Shannon DeSoto / TX ��

�� Image Technology Consulting, LLC South Central USA and NationwideMichael Webster Ft. Worth / TX

�� Legacy Medical Imaging NationwideWayde Keeling Abilene / TX

� � � � � �Lone Star X-Ray Services South Central – Licensed in TX OnlyLarry Knight Waxahachie / TX �� Sunrise Medical Technology, Inc. NationwideRex Lindsey West Jordan / UT �� BC Technical, Inc. NationalCarl Hoffman Salem / VA

�� Blue Ridge Medical Imaging National and InternationalPaul Zahn Cottage Grove / WI

�� Shared Medical Equipment Group, LLC NationalSteve Beno Green Bay / WI

�� Sterilizer Services, Inc. MidwestSam Ames North Fond du Lac / WI �� Systemic Junctures Corp. National and Crate for International shipmentNameCompany – International CountrySergio Leonardo Barral Buenos Aires / Argentina

� � � � � �Wickham S.A. WorldwideNorbert Schulz Vienna / Austria

� � � � � � � � � � �Schulz Consulting Worldwide (Excluding USA)Saeed Hashemi Richmond Hill / Canada

�� NASS MedImage National and InternationalSteve Clark Coquitlam / Canada

�Pacific Imaging Sales and services Not indicatedAbdelrahim Khalil Cairo / Egypt

� � � � � � � �Besisc USA and WorldGeorges Kardous Decines / France

�� Kardous Med Equipment FranceGuenter Braun Mettlach / Germany

�� MediSys Medizintechnik GmbH & Co.KG Central EuropeVinod Dua Panchkula / India

�C-Max Healthcare All North, South, East, West - InternationalDean Kenney cd. Victoria / Mexico

� �Socios en Tecnologia Mexico AnywhereFaisal Mirza Karachi / Pakistan

� � � � � � � � �Sunshine National

Certified

DM100

MRI

CT &

PET

Rad

Room

R/F

Room

C-Arm

Cath

Angio

Ultraso

und

Mam

mo

Bone Den

-sitome

Nuclear

Sim

ulators

Linear

Accelerat

Other

(w/Cysto

& Den

tal)

33


Louis Pasteurpopularized thesterilization ofmedical equip-ment the 1860s.

As a result of sterilizinginfections and using antisep-tic techniques in operatingrooms, patient survival ratessoared. Pasteur was an ardentadvocate, preaching adher-ence to the sterile surgicalpractices also followed byLister in England.

But if he were alive today,Psteur would most likely revelin the magnitude of how far hismethods have evolved into theadvanced capabilities of mod-ern-day sterilization and thestate-of-the art equipment thatgoes along with it.

On a global basis, themedical sterilization systemsand equipment market ispushing north of $2 billion.The US is the largest marketfor medical sterilization sys-tems at about half of that, withEurope and Japan trailing. Oneform, steam sterilization is a $250 mil-lion business while another, EthyleneOxide, is nearer to $300 million.

So why is there increased govern-ment and private pressure on the health-care community to do something aboutthe widespread problem of acquired in-fections (HAIs), which has affected 2.3million hospital and ambulatory patients,causing as many as 99,000 deaths yearly.

If everything’s so sterile, why is theFDA, citing strict standards for productquality control and assurance, legislat-ing medical device producers to upgradeand expand sterilization and disinfectionsystems. The Joint Commission of Med-ical Standards (JCAHO) requires hospi-tals to document performance testing ofall sterilizers found in surgery, centralservice, and other departments. Usually,the departments that have sterilizers areresponsible for verifying proper sterili-zation performance and for keeping arecord of the testing. Each department’sdata must be aggregated and reported.

Common Methods of SterilizationCommon methods of sterilization in-clude physical and chemical methods.Physical utilizes dry heat, steam, radia-tion and plasmas. Radiation relies ongamma radiation, electron beam, X-ray,ultraviolet, microwave and white (broadspectrum) light. Chemical methods in-clude ethylene oxide, propylene oxide,chlorine dioxide, ozone gases and a va-riety of chemicals in liquid and vaporform, such as glutaraldehyde, hydrogenperoxide and peracetic acid.

According to Raef Warzynski, Pres-ident of Eagle Technical Services, Eagle,WI, sterilizing equipment must pass aBowie Dick test to verify that it is able tomaintain a vacuum without any airleaks. “This test is mandatory in thehealth care market and performed daily.”He says that even though a sterilizerpasses a Bowie Dick test, it could stillhave an internal steam leak causing poorvacuum levels, one of man reasons why

qualified technicians must inspect ster-ilizers.

Eagle sells both new and refurbishedsterilizers. Warzynski says reputable ster-ilizer remanufactures clean and test theunit, paint the exterior and frame and in-stall new plumbing, with the cost de-pendent on what is done in the rebuildingprocess. “Some rebuilders install newelectronics, while others reinstall the oldelectronics,” says Warzynski. “This iswhere sale price differs. New controllerstypically cost about $8,000 to $10,000.”Warzynzki believes that the advantagesof buying a new sterilizer are a 15-yearvessel warranty and knowing that youare not buying a plugged or defectivevessel. “I’ve had a lot of success in mar-keting and selling Primus Sterilizers,”says Warzynki.“

Sterilization EquipmentMarket STERIS Corporation, with revenues of$1.2 billion in fiscal 2007, offers a mixof capital products including sterilizers.

34

In The Sterilization Industry

By Joan Trombetti


A provider of infection prevention andsurgical products and services, STERIS’primary focus is on the critical marketsof healthcare, pharmaceutical produc-tion and research.

Stephen Loes, Vice-president of Mar-keting, Sterile Processing, believes thatSTERIS is a leader in the industry be-cause, he says, “We offer the highest lev-els of value and quality in our productsand services and provide the broadestarray of solutions based on what our cus-tomers actually need. This includesSTERIS project design professionals whowork with healthcare organizations to de-velop practical and scalable sterile pro-cessing and surgical suite layouts and planfor optimal efficiency and future growth;instrument tracking capabilities, a full-lineof sterilization and high level disinfectionequipment including steam, ethyleneoxide, low-temperature liquid and vapor-ized hydrogen peroxide systems.”

As for the company’s main products,Rick Gurley, Director of Low-Tempera-ture Reprocessing and Applied InfectionControl for Sterile Processing says, “Inaddition to our well known Amsco® andCentury® steam sterilizers, STERIS hasrecently launched some new sterile pro-cessing and high-level disinfection sys-tems such as the Reliance™ EndoscopeProcessing System; the Amsco® V-PRO™ 1 Low Temperature SterilizationSystem and the VaproSure™ Sterilizer,which uses an EPA registered sterilant tosterilize all the surfaces in ORs, ERs andother enclosed spaces and is. The com-pany says, the only sterilization processdesignated and certified by the Depart-ment of Homeland Security as an anti-ter-rorism technology.”

Another key player in the steriliza-tion equipment market is PRIMUS Ster-ilizer Company, LCC. Since 1990,PRIMUS has been designing a simpleyet versatile and easily serviced line ofsteam sterilizers. With corporate head-quarters located in Omaha, NE, and pro-duction facilities in Omaha, as well asGreat Bend, KA, PRIMUS sterilizers aredesigned and manufactured according toQuality Management System, which iscompliant with ISO 9001:2000 and13485:2003, FDA Good ManufacturingDevices: General Regulation (21 CFR

Part 820) and UL listed through dealers,representative and authorized serviceagents for both domestic and interna-tional markets.

According to Connie L. Mansfield,Manager of Marketing Services,“PRIMUS is the only major US manu-

facturer with their own ASME certifiedpressure-vessel factory. It is our onlybusiness.” The company takes pride inthe unique Pri-Mirror® finish, whichproduces the most sanitary of all ves-sels.” The PRIMUS clinical line includes10 standard 316L stainless steel pressurevessels, from two to 72 cubic feet andcustom sterilizers of virtually any size.

David L. Counley, Vice-President of

Sales and Marketing says, “Quality andintegrity is the core belief of our com-pany since inception 20 years ago. Thequality of our product is paramount en-suring we deliver the most cost efficientsterilizer with simplistic functionalityand ease of operation, thus reducing

‘Total Cost of Ownership’ (TCO). Ourability to provide a complete ‘turn keyapplication’ from design to post serviceand support enables us to consistentlymeet the unique challenges of steam ster-ilization.” And board member, PeterHuff says PRIMUS is one of the rarehealthcare companies that has grown atdouble-digit rates over multiple decadesin good markets as well as bad.

35

Sterilizing equipment must pass a Bowie Dick test to verify that it is able to maintain a vacuum without any air leaks.


L & R Services is a medical equip-ment and repair service company thatsells refurbished tabletop sterilizers.President, Randy Lowers says theamount of refurbishing a sterilizer needsdepends on how the previous ownertook care of the unit. “Some units can berebuilt by replacing common consum-able parts like gaskets and filters, whileothers need rebuilding or replacing sole-noids,” says Lowers, adding “I’ve re-built tabletop sterilizers for $100 up to$2000.” As far as finding service andparts for sterilization units, Lowers saysit’s fairly easy, especially if you havebeen in the field for a while and havenumber of resources to turn to. “As faras parts go,” he says, “it is all up to themanufacture – most sterilizers in thefield today are still honored by the man-ufacturer, though you come across a unitthat is now obsolete and this can causesome problems.”

Chris Miller, President of ZoetekMedical sells both new and refurbishedsterilizers. “Our market seems to demandequal amounts of both new and refur-bished sterilizers,” he says. Zoetek Med-ical services and installs sterilizersalmost every day. Miller said that histechnicians do a complete electricalsafety inspection, as well as replace com-mon failure parts and do detailed clean-ing and calibration of the temperatureand pressure. Finally, a spore test is per-formed and brought back to the Zoetek

lab for testing. Sales support

person, TerraStumbo of Zoeteksaid that a refur-bished unit, de-pending on itscondition, canrange in price from$5,800 (low end) to$12,000 (high end).A new unit runsfrom $14,000 to$18,000. “We esti-mate the cost of arefurbished unit tobe about 50 percentthe cost of a newunit,” says Stumbo. She went on to saywhen Zoetek refurbishes a sterilizer,technicians replace the external tubingand steam traps, then rebuild the safetyvalve. “They replace common parts likefilters and door gaskets, and verify allconnections. If needed, they replace theheater and calibrate the temperature con-trollers,” states Stumbo. “When refur-bishing a steam generator, ourtechnicians clean the inner chamber andreplace the heater if necessary.”

Sterilizer Services, Inc. sells newMidmark, SciCan and Tuttnauer sterili-zation products. Steve Beno, Presidentof Sterilizer Services said that the com-pany sells used autoclaves to other refur-bishing companies and end users. “Our

main line is service, which accounts for95 percent of the business,” says Beno,“Sales is the other five percent.” Benosaid that from a budgetary standpoint,the lifespan of a sterilizer is about 15years. “There are some units that weservice that are 30 years old,” he says.“They run and do their job, but parts thatwere common 15 years ago are nolonger available.”

Beno gets his parts from OEMs(STERIS or Getinge) or other supplierslike RPI or PartsSource. Beno feels thatSTERIS and Getinge control the steril-izer market, but “with STERIS movingmanufacturing out the US, PRIMUSmight move up as a main US producerof autoclaves.” He said that STERISsells remanufactured units and he pro-motes Medequip and Continental be-cause, “our company gets the warrantywork for selling their units.”

Bob Reindel is a Biomedical Techni-cian II at Sodexho, Inc., which is an inte-grated food and facilities managementservice company in the US, Canada andMexico with $7.3 billion annual revenueand 125,000 employees. Reindel said thattheir healthcare environmental services di-vision helps ensure that a facility is consis-tently clean and comfortable for patients.Staate Hayward is an imaging specialistunder the Sodexho,Inc. umbrella. He feelsthat the lifespan of a sterilizer can be 20years plus. He said that Sodexho strictlyservices sterilizers and has seen units thatare old but still able to perform flash ster-ilization modes. Sodexho services hospi-tals and clinics sterilization equipment by

36

VaproSurepatient room


cleaning, checking and replacing what isnecessary and by testing all safety valvesand operational features. “The newermodels have many self-checks built-in viafeedback sensors – pressure, temperature,water flow, etc,” says Hayward.

North American Medical is a usedmedical equipment liquidation company.President Mitchell Guier says, “we buyand sell a wide variety of medical equip-ment. We sell anything from CT scan-ners and MRI’s to autoclaves andstretchers.” He sells used sterilizers anddoes not refurbish any of his equipment.Guier says that before he sells a steril-izer, it has been checked by a hospital’s

biomedical department to make sure itmeets guidelines for certification. Hisunits run anywhere from $4,000 to$8,000 depending on the age and model.

Biomedical Technical Specialtiesoffers per diem consulting, JCAHO sur-vey preparation, cost savings initiatives,inventory certification, complete physi-cal inventory, review quality of inven-tory data and equipment risk assessment,program development, equipment inven-tory review and assessment, mainte-nance inspections, per diem contractmaintenance and equipment repair andsales. President of the company, Jeo-vanni Rivas said that Biomedical Tech-nical Specialties sells mostly refurbishedsterilizers – about 95 percent refurbishedand five percent new. Rivas said that inorder to ensure proper operation, steril-izer equipment should have spore testdone on a daily basis and chambersshould be cleaned at least once a year.He always recommends using distilledwater in tabletop sterilizers.

On a slightly different note, but stillin the sterilization market, SPSmedicalSupply Corp. is the largest sterilizer lab-oratory in North America and a corpo-rate member of numerous healthcareorganizations, including standard settingorganizations like AAMI and CSA.

“With a dedicated staff and over 50sterilizers, SPSmedical provides sterili-zation test results to thousands of cus-tomers each year, and we manufacture a

comprehensive line of sterilization mon-itoring, packaging and record keepingproducts,” says Mariann Pierce, Direc-tor of Sales & Marketing. “SPSmedicalshares a passion for infection preventionas we assist healthcare facilities andmedical device manufacturers meet theirsterility assurance needs.”

SPSmedical has a quality system inplace and complies with the FederalFood and Drug Administration. “Thesystem we are regulated with is compli-ant with QRSs (Quality Systems Regu-lations) as listed in the United StatesCode of Federal Regulations. 21 CFRPart 820. Pierce said that the company’smarket involves all healthcare industrieswhere instruments and devices are re-processed, e.g. hospitals, private officesand clinics as well as dentist’s offices.“There are other companies out therethat are competitors who offer testingservices and those who offer sterility as-surance products,” says Pierce. “How-ever, we are the only company thatoffers both testing services and a full-line of sterility assurance products.”

The Future of SterilizationThe need to improve sterilization meth-ods and machinery has created ongoingresearch in order to produce better andmore complete sterilization perform-ance. Steve Beno thinks the new Ozone

37


DOTmed Registered Sterilization Sales and Service CompaniesFor convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 5373]Names in boldface are Premium Listings.

Name Company – Domestic City State Certified DM100Michelle Booth Booth Medical Equipment Alexander AR ��

Randy Lowers L & R Services Miramar FL ��

Gil King Remarket Medical, Inc Union Point GA ��

Mitchell Guier North American Medical Sweet Springs MO ��

Boyd Campbell Southeastern Biomedical Associates, Inc. Granite Falls NCDavid Ogren OMED of Nevada Reno NVJeovanni Rivas Biomedical Technical Specialties Staten Island NYChris Miller Zoetek Medical Victor NY ��

Bob Mighell World Medical Equipment Marysville WA ��

Raef Warzynski Eagle Technical Services Eagle WIStaate Hayward Sodexho Manitowoc WISteve Beno Sterilizer Services, Inc. Green Bay WI ��

Name Company – International City State Certified DM100Yasser Elsayed Direct Response Cairo Egypt

Primus sterilizer chamber. (Courtesy of Sterilize Services, Inc.)


In the world of medical mysteries,monitors and other portable orfixed diagnostic cardiographysystems serve as hard-workingdetectives, carefully gathering

and analyzing patient data, in real timeand after the fact. Whether a Phillips In-telliVue patient monitor checking vitalsigns, a GE Holter or ECG seeking heartarrhythmias, or a Quinton Stress Moni-tor looking for possible arterial block-age, monitors measure and evaluatecritical body functions, allowing physi-cians to better diagnose and treat every-thing from high blood pressure tocardiac arrest.

Phillips Cardiography Systems andGE Healthcare Diagnostic ECGs aregenerally considered the top two compa-nies for patient monitoring systems.However, their expertise is pricey andJapanese (Nihon Kohden), Chinese(Mindray), and other global companiessuch as Welch Allyn and Schiller arecoming forward with either low-end, orjust lower priced, monitors making it“tough to compete,” according to somemonitor dealers who sell both new andre-furbished equipment.

For Scott Burke, however, GM/GEHealthcare ECG, his company’s “her-itage of research in ECG algorithms,dating back to its purchase of Marquettein 1998,” clearly warrants its NumberOne position, globally, in restingECG/EKG quality.

“Hands down, we are NumberOne,” Burke says, insisting that whileUK-based GE Healthcare is a globalcompany with a “very strong presence”in Asia and the Middle East, poorly-made foreign monitors can sacrificequality for cost.

“You’re not just looking at cost, butthe depth of research,” he adds. “Thereare different classes of equipment that fitcertain price ranges. For GE, we canprovide ECG’s from $9500 to $20,000,depending on the ruggedness of theequipment and the number of specialfeatures. But our resting ECG’s arebased on solid, proprietary and contin-ual research, data, and science.”

Pat Dorsey, global product managerfor GE Healthcare’s Holter Monitor Sys-tem, notes that GE’s legacy of research

goes back even further in this area, to thelater 1970s.

“Not only do we have clinical ex-cellence in how we detect and measurealgorithms,” Dorsey says, but we haveproducts that measure three levels of dis-ease: measuring anthemia, measuring di-minished blood flow, and, since the2006, new Holter software that can givea clinician a look at a patient’s future riskof sudden cardiac death, which we intro-duced at the Heart Rhythm Society. Thisis huge for us.”

According to Dorsey, GE’s globalmarket in Holter monitors represents about15 percent of its total business, ranking it

Number Three of Four in the world, withPhillips Number One, overall.

Medical Electronics Co., Inc(MEDELCO), based in Boynton Beach,FL, sells, rents, and leases pre-ownedequipment such as ECG/EKG machines,patient monitors, pulse oximeters, defib-rillators, ultrasound and more. RonaldTarr, its president for 24 years, has about$400,000 worth of inventory on site atany time. And because of the imbalanceof trade support, he says about 98 per-cent of his sales will be domestic.

“Too many global dealers care onlyabout the cost of the equipment, theydon’t care about the quality or accuracy,”

38

Monitors Area MedicalMarvel

By Jean Grillo


Tarr begins. And many foreign competitors entering the US mar-ket also have unfair cost advantages. “You’ve got Chinese com-panies coming in with no overhead, offering a very low price formonitors,” he adds, “That makes it very tough to compete.”

The cost differential is significant. For example, a GEDASH monitor, offering high-performance and mobile moni-toring that includes an integrated wireless LAN option, sellsanywhere from $5500 and $8000, depending on features. FullECG/EKG monitors can start at $20,000 and up. “Some low-end companies can offer their own monitors for half that,” Tarrnotes. “I’ve had doctors in here asking why should they pay somuch more, and I answer, ‘Do you ever walk into a hospitaland see those low-end names?’ No, you don’t.”

Jeff Corliss, global marketing manager for Philips Cardio-graphy Systems, says pressure exists from Chinese, Japaneseand Korean monitor manufacturers, but more for smaller sitesthan for hospitals settings that mandate cutting edge care.

“The individual drivers for the monitor markets are quitedistinct,” Corliss notes. “You have clinics and doctors’ offices,where much is driven by cost, and you have hospitals where12-lead ECG’s are among the most pervasive, highest volumeprocedures. Hospitals are driven by three concerns: streamlineworkflow, maximize connectivity, and handle real clinical pres-sure. Philips has built our business on the hospital setting andwe offer the best seamless, wireless ECG, stress and Holter in-tegration. We’re the only ones doing 16 lead ECG’s for exam-ple. That is very important when it comes to adult chest painwhere every second counts.”

Corliss points out Philips is supporting the American HeartAssociation’s “Door-to-Balloon” initiative which seeks to cutdown the time it takes when someone walks in with chest painsto when that person receives angioplasty. “We are looking todo it within less than 90 minutes. None of our Asian competi-tors have the kind of seamless/integrated integration required toaccomplish this.”

Quality Costs“Quality costs money,” says Roger Nasiff, president, Nasiff As-sociates. His Brewerton, NY company, although small, is cred-ited with having created the first PC-based CardioCardmonitoring ECG’s, Stress and Holter machines. In 1996, NasiffAssociates built the first PC-based CardioSuite, a PC-basedsystem that monitors all three. Separately, Nasiff sells itsECG’s for $2195, its Stress Monitors for $3395 and its HolterMonitors for $3195, with the Suites going for $6295. Theseprices are very competitive when put up against GE, Phillips,and other big companies.

Low cost doesn’t have to mean low quality, however, asNasiff pointedly explains.

“I would say GE and Phillips are tops in EKGs, GE andQuinton are tops in Stress Monitors, and Phillips still leads inHolters,” Nasiff explains, “ but these guys are huge and willmake and create 1000 of them a month. My company will make50 to 70 Holters a month, but many people who bought them inthe early 1990’s are still using them. Our quality is very high. Idefinitely think we offer the best value for the price.”

Nasiff, with two degrees in biomedical engineering and aPhD in electronic engineering, began in the basement of hishouse, but, today, he says his craftsmanship creates a level ofaccuracy that trumps cost.

“Schiller or Welch Allyn has a nice breadth of products, butwhat they sell isn’t quite as accurate yet. To Nasiff, better diagno-sis is the only “blue sky” parameter worth pursuing, now or inthe future.

“To me, to increase our depth and accuracy in any moni-toring system is, in itself, major blue sky advancement. We allneed to work to make the systems better, more accurate, and toavoid settings that lead to wrong diagnoses,” Nasiff says,adding, “While everyone’s all excited about wireless, Nasiffhasn’t pursued it yet, outside of our own research, because wefeel it’s still not as accurate as what we have out there. Youcan still lose data.”

Refurbishing/Repairing Monitors Companies offering used and refurbished monitors suggest amixed bag in terms of market strength. Owners are split interms of whether sales are weak or strong.

John Newbury, sales and service manager for Medelco, de-scribes a variety of monitor repairs and refurbishing used onpreviously owned monitors.

39


“We clean the entire inside with a blow out from an air gun,”he says. “We then have qualified engineers inspect all the inte-rior electronics. Sometimes we need to replace external cables,and, if the unit needs it, we’ll professionally repaint the outside.”

“I think the market is still strong,” reports Ronald Tarr,president of Medelco Co. in Boynton Beach, Fl. “Smart hospi-tals and clinics are buying the pre-owned equipment for 25 or35 cents on the dollar, and, as I mentioned, technology has notreally changed in the last 10 years.”

Ron Smith, of Lifeline Biomedical in Nashville, TN, agrees.“The market is strong. With the state of reimbursements,

doctors and administrations are looking to upgrade older unitswith newer equipment, but need to be frugal in acquiring same.”

Adds Alan Avitt, sales manager, Display Resources, Inc:“Smaller clinics and doctors’ offices now can utilize equipmentnever before available to them.”

“The market for used is strong as always, especially theparts market insists Mitchell Guier, broker, North AmericanMedical, Sweet Springs, MO. “Manufacturers stop making spe-cific models and BioMed departments are scrambling to serv-ice the 50 monitors they still have in service.”

Randy Lowers, president of L&R Services in Miramar, FL,takes the opposite view.

“Recently, I see the market as weak due to the fact thatmany manufacturers from abroad are starting to sell producthere in the USA at cheaper prices then we are accustomed to.Also, domestic manufacturers are quick to make a product ob-solete after a short selling period. One manufacturer I won’t

name will sell something, support it 100 percent for five years,and then discontinue parts production. This makes selling theirproducts refurbished and/or used harder because the seller can-not support the product for a warranty unless they have an in-ventory of their own.”

Having said that, Lowers acknowledges a 32 percent in-crease in total sales for refurbished or used ECG/EKGs, theonly medical monitors he deals with.

“It all comes down to price,” says Charles Moore, presi-dent of Moore Medical Sales & Service, Cartersville, GA.“Manufacturers are starting to discontinue certain models. Theindustry is pushing for new equipment because they make moremoney. Plus, the Japanese are dropping their prices on newitems, in order to get into the market. Mindray (Chinese) is verycheap but parts are a real problem.”

Poor operator performance also throws a wrench (liter-ally) into how new equipment becomes problematic and inneed of repair.

“Never use a monitor without proper training from a ven-dor,” says Robert Keller, president, Travelmed, Northridge,CA. “Malfunctions can be due to several issues such as testingand training,” he says, adding, “A monitor should be operatorfriendly, as easy to operate to avoid human mistakes from anon-understanding operation.”

“Operators of monitors and EKGs are the biggest problemin the field,” Randy Lowers says. “Ninety percent of my serv-ice calls are due to operator error.” Biggest issue is getting

40



DOTmed Registered Monitors Sales and Service CompaniesFor convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 5374]Names in boldface are Premium Listings.

Name Company – Domestic City State Certified DM100Robert Keller Travemed Northridge CAAaron Frye Doctors Depot, Inc. Jupiter FLRandy Lowers L & R Services Miramar FL ��

Ronald Tarr, CBET Medelco Boynton Beach FLJohn Pritchard II Venture Medical ReQuip, Inc. Tampa FLCharles Moore CMoore Medical Sales & Service Cartersville GAAlan Avitt Display Resources, Inc. Des Moines IAJay Jordan State of the Art Medical Bardstown KYRick Roehl UHS Edina MNAnwar Syed MDIC St. Louis MO ��

Mitchell Guier North American Medical Sweet Springs MO ��

Boyd Campbell Southeastern Biomedical Associates, Inc. Granite Falls NCDavid Ogren OMED of Nevada Reno NVJeovanni Rivas Biomedical Technical Specialties Staten Island NYRoger Nasiff Nasiff Associates, Inc Brewerton NYChris Miller Zoetek Medical Victor NY ��

William Kulp ScottCare Cleveland OHRon Smith Lifeline Biomedical Nashville TNMike Davies ProNet Medical Salt Lake City UT

Name Company – International City State Certified DM100Rabi Avvali Sondos Medical Equipment Dubai U.A.E.


The bottom line about medical chillers is succinct: theyare indispensable equipment that if not in good work-ing order can grind any hospital’s operations to anabrupt stop.

Should one of these sometimes hefty (as much as 90 tons)cooling systems go awry, multimillion dollar hospital equip-ment—- MRIs, CT Scans, X-rays, Operating Room Air Condi-tioners——stops dead in its tracks.

And the dominoes would continue to fall: diagnostic andtherapeutic operations stop, patients’ health is perhaps imper-iled and a hospital, clinic or center sees multiple revenuestreams shut down until repairs are completed.

So when problems unexpectedly beset chillers, most oftenas a result of poor maintenance, the medical institution can gointo what Martin King, president of Legacy Chiller Systems,Placerville, CA, describes as “mission critical” mode.

And the folly of allowing such a situation to occur, saychiller manufacturers and specialists, is that 95 percent of allproblems could be avoided, provided facilities adhere to a reg-ularly scheduled preventive maintenance program.

“It’s so easy to catch the problems before they occur,” saysJerry Hoover, HVAC Service Solutions, Inc., Dallas, PA, achiller specialist serving a wide variety of institutions in theNortheast. Hoover, who strongly advocates quarterly servicecalls, also says that whatever service and maintenance com-pany hired, “make sure they are familiar with the equipment.”

Even with the best maintenance, however, chillers some-times fail, though usually it’s not mechanical failure. Moreoften than not, refrigerants run low, filters get clogged, dust anddirt builds up. But such small factors are not always obvious to

42

Chillers:Indispensable to AnyHospital’s Operations

By Jean Grillo

Special low temp process chiller used for Bio Diesel production down in Gonzales Texas. (Courtesy of Legacy Chiller Systems)


the medical equipment engineer at a facility, so it becomes justanother important reason to call in a professional chiller serv-ice company.

OEMs tend to favor authorized service operations as well.Most back the practice of having factory trained mechanics andtechnicians primarily service one brand and its considerablerange of products

Though some facilities still call the local air conditioning re-pairman on occasion, that’s usually not the whole answer. WhileHVAC technicians certainly can service the chiller, the advantageto a medical chiller specialist is knowledge of various modalitiesand how the chiller fits into their operational system.

Why Chillers Are So ImportantMRIs, CTs and many major medical devices generate heatwhile in operation. With the advent of super conducting MRIsthat rely on liquid helium, and high speed helical CT scannersthat have powerful X-ray tubes, chilled water is the perfect so-lution to dissipate the heat that is produced.

Chillers, meanwhile, with integrated tanks and compres-sors are the workhorse of the fleet and are available in manysizes, from one to 90 tons. Most medical MRI chillers, how-ever, weigh in around two to 10 tons, costing up to $40,000.

Manufacturing a chiller has become a specialized skill, one

that the OEMs have ceded to independent manufacturers. The OEM matches the size of the chiller to the heat of the

head load. If an end user purchases a chiller that is too small inan effort to save money, or a used machine that is overpoweredto the heat load demand, then a chiller can fail more quickly.An underpowered chiller will have to work too hard, and acompressor can burn up. With an overpowered chiller, the com-pressor turns on and off too quickly, and again the compressorcan burn up.

“All the OEMs have special applications for the large-scale image equipment that needs to be kept cool,” King says.His company, in fact, is among the dominant players in manu-facturing MRI chillers, shipping “hundreds annually.”

Filtrine Manufacturing Company, another importantchiller manufacturer, has been in the cooling business since1901. Based in Keene, NH, it’s forged close ties with the majormedical equipment OEMs over the past seven years, says MarkHuston, director of marketing and communications.

“All the major OEM’s work with us because everythingwe do is customized to their design,” Huston says, adding, “andour chillers are backed by a lifetime guarantee.”

And Turner Hansel, a Filtrine vp, points out, “The keyissue when installing an MRI chiller is getting the start-up right.Doctors,” he says, “hate to see scan time interrupted, becauseMRI’s are cash cows.”

43

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Chiller Technology SimpleAlbeit SophisticatedChiller technology has not changed muchover the years nor is it that complicated.Still, chiller technology, and almost moreimportant, chiller repair and refurbishingrequires a host of special skills.

While some medical equipment en-gineers are familiar with the technologyof the chiller and the basic concept, veryfew, if any, will try to repair a brokenchiller. An MRI technician will replaceparts and a cold head, or load liquid he-lium, and a CT engineer will diagnosehigh voltage problems in a CT scanner,but neither has the skill to work on a bro-ken chiller. Sometimes chiller problemsresult from design flaws or while in-stalling the chiller. But the vast percent-age of breakdowns is attributable to poormaintenance.

According to Gary Julian, GJ Main-tenance, Garland, TX, “The biggestcause of chiller death is not cleaning thecondenser coils,” he says. “These arehard to get at within the compressor sys-

tem. It takes some effort to disassembleand get access.”

Julian’s specialty is medical chillermaintenance for display trailers, 18-wheelers hospital and medical centersset up to house MRI and cath labs. Ac-cording to Julian, costs for a correctly re-furbished chillers averaging seven to 10tons is anywhere from a few thousand tomore than $20,000.

Sig Carlson, president and founderof Recovery Systems, acknowledgesthat his company, based in Crystal Lake,IL, “gets a very high percentage of busi-ness for chillers related to GE, Siemensand Philips equipment.”

Chiller manufacturers must workclosely with independent and some-times authorized service personnelaround the world. These service per-sonnel install the machine, perform pre-ventative maintenance, and repair itwhen it breaks.

“The key is that chillers must besized for the right range of outside tem-perature, whether its 40 below or 120,”says Carlson. “What we do at Recov-ery Systems is offer compressors thatcan be integrated to operate separatelyor in sequence.”

44

Are you looking for honestservice as well as quality

pre-owned medicalsystems that actually work?


Carlson estimates smaller chillers,five to 10 tons, for example, costroughly $10,000. Larger ones can runup to $40,000 with refurbished equip-ment “half those costs.”

Chiller Repair and Refur-bishing a Vital Service Among the chiller refurbisher and repaircompanies polled, most agree preventive

maintenance several times a year is key.“I would say a mobile unit should

be looked at every three months,” saysRonnie Taylor of SVSR, Inc, Statesville,NC, “With fixed sights every sixmonths.” Over or under powering achiller means, “the motor windingsoverheat and short. This could causecontractors and controllers to fail also,causing major downtime,” Taylor adds.

Laurence Frayne of Prairie Imag-ing, Hurst, TX suggests that checking“all systems” twice a year is sufficientbut Mitchell Guier, broker for NorthAmerican Medical in Sweet Springs,MO, thinks four times a year is best. “Ithink a service contract should requiremaintenance every few months, withpersonnel actually going up on the roofto make sure the chiller isn’t leaking,”he says.

Sig Carlson agrees about regularlyscheduled maintenance, but says it’svery difficult to find quality repair peo-ple to do the work.

“Schools have eliminated a lot ofthe mechanical trade education theyonce offered high school students.” Carl-son says. “Today, you are really depend-ent on using people who don’t know alot about the product they’re repairing.”

There are simple chillers, generallytwo to 10 tons that represent about 75percent of all medical applications. Butthen there are complex ones, 24 tons ormore, with multiple compressors andseparate chilling units, such as theSiemens 3.1 Tesla MRI. The latter re-

quires only expert attention. An inadequately maintained chiller

can quit after only a few years. A well-maintained one can last “a lifetime.”

“Adding more sensors to (detect)overload helps prolong chiller life,” saysSaeed Hashemi whose company, NASSMedical Image, does all service, repair,application and technical training for GEproducts and is based in Ontario,Canada.

While Legacy’s King feels stronglythat “mission critical” chillers ought tobe purchased new “otherwise you’re notgoing to get the same warranty, you’renot really going to know a machine’spast maintenance record,” others such asHasemi disagree. He says it’s appropri-ate to rebuild a chiller and that it onlymakes economic sense to opt for newone, “when (the current one) is not ca-pable of cooling to the minimum re-quirement.”● [DM 5370]

NOTE: DOTmed.com has been in-volved in auctioning a number ofchillers because frequently when theoriginal equipment manufacturer sellsthe machine, they ask the hospital tobuy the chiller separately. When themachine is sold or traded in, the hos-pital is sometimes left with chiller, andthey have utilized the DOTmed On-line Auctions to sell them.

45

DOTmed Registered Medical Chillers Sales and Service CompaniesFor convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 5370]

Name Company – Domestic City State Certified DM100Martin King Legacy Chiller Systems Placerville CASig Carlson Recovery Systems Crystal Lake ILMitchell Guier North American Medical Sweet Springs MO ●Ronnie Taylor SVSR, Inc. Statesville NCMark Huston Filtrine Manufacturing Company Keene NHMarc Fessler Independence Cryogenic Engineering Little Egg Harbor NJGary Provenzano Proton Services, Inc. Sayreville NJ ●Jerry Hoover HVAC Service Solutions, Inc. Dallas PAGary Julian GJ Maintenance Garland TXLaurence Frayne Prairie Imaging Hurst TX

Name Company – International City State Certified DM100Saeed Hashemi NASS MedImage Richmond Hill CanadaRami Marom ElsMed Ltd & Relaxation Inc Holon Israel ●


“As the imaging improves, we’renow able to focus [protons therapy] bet-ter and better. We’re just still on the veryfrontier of what it is potentially going todo,” Dr. Slater says.

With the imaging problem solvedonly the issue of money stands in theway of more widespread adoption ofproton therapy. New cyclotron designsand creative business models are pro-viding more manageable and affordableoptions that may soon bring protonbeam therapy to the masses, so to speak.

“It is going to be a big change forradiation oncology. I hope that placescan get up and running and that manymore centers open. I really think this isgoing to replace portions of conventionaltherapy in the next ten years,” Michaudpredicted. “As the public becomes moreaware of proton therapy and the demandcontinues to grow, we as health careproviders need to provide this latesttechnology. People count on us for that.”● [DM 5375]

46

continued from page 13 Protons

operators to understand that ECG’swork with electric current, and thatmeasurement can be skewed by bodyjewelry, scars, even interference fromthe operator.

Lowers is so concerned he per-forms workshops in proper ECG opera-tion at a small college nearby. The mostcommon part failure will be the actualpatient cable or leads. “Preventive main-tenance requires that cable or leadsshould be inspected frequently, as staffusing the unit will not be able to iden-tify if the unit is out of calibration un-less it shows patient is dead.

Several refurbishers complainedabout the growing bulk of OEM manu-als, which, some insist, staff ends up notreally reading.

One major OEM, speaking off therecord, admitted that can be the case.

“We continue to try to refine the in-terface so operators can understand ourequipment by using it, even if theyhaven’t read the manual,” this OEM ex-ecutive explains.

With a shelf-life of five to ten years,monitor and heart cardiology equipmenteither are upgraded by the OEMs them-selves (then deemed obsolete) or care-fully re-furbished by 50 or so companiesstateside who correct leakage, updatingdata, and more.

Mitchell Guier sells only used mon-itors.

“Monitor technology has devel-oped by leaps and bounds,” Guier notes.“Manufacturers are now bundling fea-tures. Now, one monitor can performdozens of diagnostic tests, as opposed tojust one or two tests 10 years ago.”

All those features demand specificparts and BioMed departments are“scrambling to service the 50 monitorsthey have in service,” Guier says.

According to Randy Lowers, a re-furbished ECG can sell for $500 to$5000, substantially lower than the lowfour figures new equipment requires.Lowers, also, is among one of the fewrefurbishers dealing exclusively withnon-domestic sales.● [DM 5374]

continued from page 40 Monitors

GECOGECO”Even a Cave Man can save money on Siemens parts at GECO”

SiregraphSireskopMultixSomatomPolyphosSireconMultigraphAngioskop

PolydorosTridorosIontmatExploratorMemoskopUroskopMammomatCoroskop

PandorosOrbixMobilettPolymatThormatVideomedKoordinatVertex

SirecordGarantixOptiluxDigitronSiremobileCompacHeliphosSimomed

Siemens Medical X-Ray and CT Parts in Stock:

Siemens 44cm Image Monitor - Repair and Exchange - ‘New’ SiemensLCD Monitors, X-Ray Tubes - Image Intensifiers - Power Supplies -Circuit Boards, Collimators, Foot Switches, Cassette Trays, Grids,

Ion Chambers, Lamps and much more.

When you think of Siemens Medical X-rayand CT systems made in Germany, think ofGerman Electronics Company in the USA.

We stock and service what we sell.TOLL FREE: 888-428-9729

TECHNICAL SUPPORT: 727-530-0301Fax: 727-530-1440

[email protected] • www.GECOusa.com12530 Enterprise Blvd.• Largo, FL 33773

“Siemens” and all Siemens brand name products are registered trademarks of Siemens Medical Solutions, AG.

Sterilizer by TSO3 could replace ethyl-ene oxide and hydrogen-perioxide unitsin the near future. Raef Warzynski feelsthat Ozone may also be the answer toPrion sterilization and be a low cost al-ternative to Plasma and ETO steriliza-tion. He feels that it still needs to be aproven method but it does have poten-tial. The challenge, however, in devel-oping Prion deactivation technologies isthat there is no appropriate standard fora company to measure the effectivenessof sterilization technique against Prions.Whatever the challenges, the steriliza-tion equipment industry is alive and welland has evolved over the years – drivenby consumer demand and competitionin the marketplace. As medical devicesbecome more intricate, and regulatoryand sterilization standards become moredemanding, sterilizer manufacturers andcompanies are working to develop andmaintain advanced systems and featuresto meet the challenges. ● [DM 5373]

continued from page 37 Sterilization


will identify normal patients and thosewith limited disease who can be managedmedically and with life style changes.Those with serious coronary artery dis-ease will, of necessity, go on to the moreinvasive cardiac catheterization.

In addition to CT-A, which is over-whelmingly the application of choice forvolume CT, there is trauma and vascularimaging too. These last two areas arenot gaining much momentum . probablybecause the cost of the equipment andmarginal improvement in scan resultswill limit demand for volume CT use.

In general radiography CR & DDRwill continue to replace film based analogequipment. The improvement in imagingmay not be evident in standard radiogra-phy with digital but in mammographythere seems to be no question that the tran-sition to digital from analog yields im-provements for the patient and the reader.

Understanding the OpportunityThis is a difficult task, almost a double-edged sword since technology is movingmore rapidly than ever. With each newintroduction, technology breeds technol-ogy. New applications, which are a re-sult of the capability of the newtechnology, seem to be arriving monthly.

Moreover, technology and applica-tions are shortening the life cycle. Onceit was 5-7 years. Now, however, it canbe as short as 24-36 months, whichmeans the entry for a buyer is expensiveand the exit at 36-months even more so.

Five years ago a dealer in pre-owned imaging devices might have paid50¢ on the new equipment dollar for a5-year old device. Now, with the furi-ous pace of new technology introductionby the OEM’s the technology life cycleis much shorter. Now a center interestedin selling or trading in a device for thepurpose of upgrading to the latest andgreatest may find that they are being of-fered 10¢ on the dollar. Frequently theyare unable to recover enough to retire theoutstanding debt.

Summing It All UpAs we consider digital X-ray and themarkets involved, we know that transi-

tioning to digital from analog and elim-inating film means improvements in pro-ductivity, reduced cost with theelimination of film processing and aconstant introduction of new technology.

In human radiography we have vol-ume CT with applications mainly in CT-A. Some project an expansion intovascular and trauma but that’s an openquestion. CR & DDR will continue toimpact and grow general radiographyand mammography.

Technology Breeding Technology.As technology continues to advance, thelife cycle shortens. This decreasesequipment value and results in expen-sive entry and very expensive exit forthe user of the equipment. Technologylife cycles that once were typically 5-7years are now 2-3 years.

We find ourselves in a truly won-derful time in the development of X-rayimaging technology. What’s old is newand now more than ever we are employ-ing more non-invasive techniques to di-agnose disease earlier. ● [DM 5376]

About the AuthorWayne Webster founded Proactics Con-sulting in 2003 for the purpose of pro-viding business planning and strategicacquisition support for diagnostic imag-ing clinics and hospitals seeking new op-portunities in medical diagnosticimaging. Proactics also supports busi-ness development efforts for High-Techelectronics & other businesses requiringstrategic business planning guidance.

Clients include: GE Health Care,Perkin Elmer, Inc., Neusoft Group, Ltd.(China), and The I.R.I.S. In addition hehas supported the business planningprocess for dozens of imaging clinicsand hospitals. Webster also serves as theManaging Director for Diagnostix Plus,Inc. In this capacity he supports the de-velopment and implementation of newbusiness opportunities for the company.In addition, he is the Technical Editorfor IAMERS, a medical device trade as-sociation. Those interested in readingone of Wayne’s articles can visitwww.Proactics.net and request a copyand learn more about the services of-fered by Proactics Consulting.

47

continued from page 17 X-rays


Sometimes shipping/logisticscompanies handle rigging and cratingfor their customers. Rusty Waterhouseis an account executive and logistic ex-pert for American Shipping Company,Grapevine, TX. The Texas basedfreight forwarder suggests that whencrating equipment vacuum/barrier bag-ging be used because it is a small priceto pay for peace of mind and offers ab-solute protection from a moisture ladenenvironment.

Similarly, Image Technology Con-sulting, LCC, Desoto, TX, offers logisti-cal services for rigging, and they alsouse wooden crates to deliver delicatemedical machines. Marshall Shannon,president, says his services costs a bitmore than most, but “we make sure wehave your machine padded, protected,strapped and packaged so that it willshow up on the other side exactly as itleft the original facility.

Ultimately, both riggers and cratersare successful as a result of their experi-ence, which usually translates into get-ting the job done faster, safer andcheaper.

DOTmed RecommendsIf you’re using an independent serviceorganization to dismantle and rig yourequipment, make sure that either theyhave the equipment they need, or thatyou are paying them enough so that theycan afford to rent the equipment theyneed. When it comes to rigging andcrating and shipping valuable medicalmachinery, cutting corners is a no-no. Ifthe firm you are considering does nothave the funds to rent the equipment, ofif they feel that they need to ‘improvise’to save money, chances are problemswill arise.

Despite all the advance planning,it’s likely there will be some problemsduring a complicated project involvingmoving medical equipment but in orderto minimize the risk, always go with areputable company (there are plenty outthere). Check references and stay in-volved with the project. Visit often andalways, always ask questions.● [DM 5369]

continued from page 28 RiggersSIEMENS WANTED!

• MRIs and CT Scanners• Top Dollar Paid — Finder's Fees for Referrals• We will buy these SIEMENS systems now for cash!• Harmony MRIs — Fixed & Mobile• Symphony MRIs — Fixed & Mobile• Impact MRIs — Fixed & Mobile• Empty MRI Trailers• Sensation CTs

We will deinstall anywhere in the U.S.Systems needed over the next 12 months.Top dollar paid.• Finder's fees for referrals.Save this number • Share this number:

Owen Kane Holdings, Inc.Call our SIEMENS Expert At 212-558-6600 Ext. 250

[email protected] Broadway, New York, NY 10006


people & companiesMedical Advantages Inc. Serves DiverseMarketsMedical Advantages Inc. has sold new and pre-owned diagnos-tic imaging systems to imaging centers, doctors’ offices, mobilex-ray companies and hospitals for more than ten years. Theysell a wide range of products nationally and throughout Canada.

“Diversification is our mantra because our valued clients re-quest many types of diagnostic imaging systems,” said PresidentMichael D. Lies, a radiologic technologist. “One week they needa couple of BMD systems, and the next week three dozen ECGsystems, and then the following month eight ultrasound systems.”

The company buys its new and pre-owned medical equip-ment from six or seven suppliers. “We like to do continuedbusiness with the same companies and individuals who haveproven themselves trustworthy. For installation and training werely on specific engineers and service techs depending on themodalities,” Lies said.

“We are seeing trends from analog to digital systems in theimaging centers, doctors’ offices and small hospitals. Becauseof new governmental restrictions for reimbursement - DRA -these trends are slow, but I like to think the changeover will in-crease during this election year,” he said.

“DOTmed has always been helpful to us particularly nowthat we are DOTmed Certified. This Certification provides ourend user clients with a healthy comfort level of assurance.” ● [DM 5340]

Marquis Medical Celebrates First AnniversaryOpportunity knocked for Joseph Sciarra when CTI MolecularImaging of Knoxville, TN was taken over by Siemens in Oc-tober of 2005. CTI, in partnership with Siemens, virtually in-vented the PET scanner, a way to measure radioactivitydistribution within the body to track various disorders such asstroke, Alzheimer’s and epilepsy. Now Siemens owned the en-tire company outright.

Sciarra, a long-time CTI employee and highly-trainedavionics technician, felt the merger created a competitive “void.”

“My partners and I felt there was no choice for customerslooking for PET and PET/CT service providers. Where oncethey had CTI and Siemens, now they just had Siemens,” he ex-plains. Thus Marquis Medical was born.

Based in Denham Springs, Louisiana, Marquis Medical spe-cializes in the maintenance, installation and servicing of SiemensPET and PET/CT scanners. A small company with a staff of four,Marquis rests its reputation on its extensive knowledge of theSiemens product. Indeed, when Washington University Schoolof Medicine in St. Louis, MO, sought to replace its worn-outPET scanner, Marquis won the contract and the task of delicatelyinstalling a significant piece of equipment in a working, highly-complicated research hospital ICU. (See DM 4820)

While only a year old, Marquis Medical now has a widerange of customers, from research facilities such as Washing-ton University, to private practices and other clinical and nu-clear imaging centers. The company services 10 Siemens PETand PET/CT accounts and projects 20 by the end of 2008, ac-cording to the recently DOTmed Certified Sciarra.

As for acquiring new customers, “We had advertised withother sites without impact,” Sciarra recalls. “But DOTmed hasbrought us the most response. It’s been very helpful to us andour business.”● [DM 5192]

Crown Medical International Delivers Quality Medical Imaging EquipmentCrown Medical International, Inc. is the home of reliable di-agnostic equipment at affordable prices. In business since 2001,Crown Medical supplies pre-owned diagnostic imaging equip-ment to hospitals, doctors, laboratories and governmentsthroughout the world.

“Combine extensive experience, a large inventory and aconstantly updated network database,” says President GaryBenitez, “and you can rest assured that Crown Medical Inter-national, Inc. will deliver a quality product that will exceedyour expectations.”

Crown Medical specializes in the most popular models ofCT, MRI and ultrasound and will expedite the process of se-curing and delivering medical imaging equipment worldwide.“We are licensed, bonded and insured, and we deliver all equip-ment properly packaged and ready to be installed,” states Ben-itez.

Crown Medical International, Inc. relies on an experiencedstaff that offers a full range of value added services designed tosimplify and streamline — from acquisition through installa-tion, and maintenance. They determine the services and prod-ucts that best suit individual clinical and budgetaryrequirements. Crown Medical International has a completesuite of services that includes purchasing and selling equip-ment, turnkey projects with in-house financing, consulting,service contracts, de-installation and installation and cratingand transportation services. ● [DM 5200]




DOTmed Works with South Carolina Company to Move Equipment

by Scott HutchinsJohn (Jack) Chesney runs a leasing business in Beaufort, SC,dealing in medical equipment, computers, and vehicles. Sellingthe equipment is not his business, but when people are no longerleasing a particular unit, he calls DOTmed to resell it.

Recently, a friend of his in Charleston was closing herOB/GYN/cosmetic practice and moving to California, and sheentrusted him to handle the sale of her equipment, includinglasers, ultrasounds, chillers, and examination tables. It was veryimportant to them that he sell it and not get robbed. Chesneyhad tried eBay, then learned of DOTmed from a competitor inSavannah, GA. Chesney thought the disclaimers and contractseemed fair. “We could get hurt,” he said, “but we didn’t.”

Of his DOTmed sales contact, David Blumenthal, Chesneysays, “I was very pleasantly surprised to see David did every-thing he promised. He gets back to you; he’s professional, andmakes sure people get what they’re paying for.” Chesney sayshe has had some opportunities to do some deals without Blu-menthal’s help for which he could get more money, but becauseDavid has been square with him, he has opted not to do suchtransactions on his end. “For somebody I can trust, I’ll pay extra.He has even gone back to the buyer and gotten a little bit moremoney. If it’s something you guys do better, I’m not going towaste my time for an extra 10%, because it’s not my business.”

With DOTmed’s assistance, he has made $47,200, includ-ing a QuantelAramis II Laser – Erbium for $14,500, a lot of12Ritter Midmark 104 Exam Tables for $1,200, five ZimmerCyro 5 Chillers for $3,500, a GE Logiq 200 Pro OB/GYN Ul-trasound for $6,500, an Asclepion MeDioStar Laser - Diodefor $16,500 and a STORZ D-Actor 100 EPAT for $5,000.

To further facilitate the purchasing process, Chesney founda crating outfit in Charleston, “So David and I are going to de-liver a quality piece of equipment.” Chesney welcomes thosewho wish to come inspect and test the equipment. While hehimself does not know how to run much of the equipment, heinstead relies on establishing trust with his customers.

“You are experienced and you do what you say you’regoing to do, and it’s a fair price, and I’ve been delighted. It’sbeen perfect.”

What Riches Lie in Sheehan’s ShedJohn Sheehan had some second hand MRI equipment in a stor-age shed from doing some odd job deinstallation work. He ex-pected that it might have some value. Having learned of

DOTmed from someone whom he had worked with, he ordereda DOTmed-Managed Auction. DOTmed set up the picturesand information.

“DOTmed was very helpful with the type of informationto put in and also with setting it up. They had a cookbook for-mula to make sure we had the right information so the poten-tial buyer would know what he was looking at.”

Many of Sheehan’s auctions ran for over a year, but Shee-han followed e-mail and phone contact procedures to revise theauctions and kept them going until it finally paid off. In 2007,he sold an APD model HC-8C4 Cryo Compressor for $2,500,a 2006 Neslab HX-200A Chiller for $2,800, and six PhilipsMRI coils for $2,000, double the starting bid.

Sheehan finds the site a good place to show equipment andis very happy with the service, which he finds easy to use andto navigate through. “I have some other stuff in my garage,old x-ray equipment, to put up in the future.”

old into goldDOTmed Premium Auction Success Stories

Ace Medical Equipment, Inc. Page 35Amber Diagnostics, Inc. Page 16ANDA Medical Page 6Bayshore Medical Page 48Complete Medical Services Page 4Direct Medical Page 47Dunlee Inside Front CvrETS-Lindgren Page 9German Electronics Company Page 46Genesis Medical Imaging, Inc. Page 5Integrity Medical Systems, Inc. Page 20Logical Solution Services, Inc. Page 39Magnetic Resonance Technologies, Inc. Page 33Marquis Medical Page 17Med1Online Inside Back CvrMedequip Engineering Service, Inc. Page 36MedTrans Logistics, Inc. Page 25Metropolis International Page 44MMI Medical, Inc. Page 8Nationwide Imaging Services, Inc. Page 3Oxford Instruments Page 43ReMedPar Page 7REMETRONIX Page 24Still River Systems Page 13Sunrise Medical Technology, Inc. Page 28Techmed Solutions, Inc. Page 30Tenacore Page 40Unitech Imaging, Inc. Page 31Varian Interay Back CoverVenture Equipment Page 41Viable Med Services Page 29Virtual Imaging, Inc. Page 21

DOTmed Business News Advertisers


marketplace & classifiedsThese are some of the more than 27,000 listings on www.DOTmed.com on any given day.

Medical Domain Names For Sale!xray.bz • medical.bzbiomed.bz • hitachimri.nethitachmed.net • radiology.bzmagnet.bz • medimaging.usmedicalimages.us • medicalpros.orgmedicalpros.us • mra.bzContact Andrew Hyde today!www.HYDE.bz • Ph: 770.714.7840

EQUIPMENT FOR SALE

BIOSOUND Megas Portable Cardiac –VascularGeneral Calculations, Phased, linear andconvex array, digital scan converter,wide bandwidth multi-freq. probes.Charlie Jahnke, MedPro Imaging, Inc.877-846-8818DOTmed 100 and DOTmed Certified

For Sale GE Senograph 700T MammoUnit Super-Clean System Just In! ACRthrough 2009, Complete with all Parts andAccessories. Call for excellent pricing.Contact David Denholtz / Integrity MedicalSystems, Inc.Phone: 239-454-9555DOTmed 100 and DOTmed Certified

CTI ECAT EXACT 47 PET Camera/Scanner2001 System in Excellent Condition, Avail.now! Full warranty and installation serviceavailable. Also lease.Joseph Sciarra, Marquis Medical732-677-31596

EQUIPMENT WANTED EMPLOYMENT OPPORTUNITIES

MRI & CT Service Engineer PositionsAvailableLocation: IL, MO, MI, IN, FL, USASalary: Base + BonusField Service engineer with GE/SiemensMRI or CT experience. 5 plus years experi-ence. Join the industries’ leading sales andservice organization. Full benefits includingHealth, dental, Life, 401K. Multpile locationsavailable. Craig Palmquist,

Genesis Medical Imaging 847-961-5802

Radiology Service EngineerLocation: MA, NH, ME, VT, CT, RI, USASalary: $40-$80kField Service Engineer positions available with rapidly growing and progressive full service radiology imaging company.Jason Olenio, Associated X-Ray Imaging800-356-3388

MEDICAL SALES & SERVICES

EQUIPMENT FOR SALE EMPLOYMENT OPPORTUNITIES EMPLOYMENT OPPORTUNITIES

THE HUBSCRUB COMPANYClean and disinfect wheelchairs with HUBSCRUB automation. Fast turnaround time. Done right.877-482-727 *** hubscrub.com

R-Tech Solutions, Inc.Install and Deinstall all imagingequipment. Equipment relocation,crating andtransportation,after hours& weekendservice. 20years experi-ence.(574) 278-7191 www.r-techsolutions.net

Vision Systems www.patternless.com #1 supplier of re-furbished optical & ophthalmic equip-ment, exam lane, pre-test, diagnostic &lab. 866-934-1030DOTmed Certified

Advanced Nuclear ConsultantsTurnkey solutions in nuclear medicine. Sales, Parts & Service. Pre-owned & refurbished gamma cameras from ADAC,Philips, GE, Siemens, Toshiba & more.Rich Armijo, Owner, 2001 Karbach SuiteJ, Houston, TX 77092. 888-668-5633www.ancmedical.comDOTmed Certified

51

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ThinkEmail us at

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blue book price guideRADIOLOGY

PICKER Portable X-Ray Explorer II Manufactured1994 Dunlee Tube PX-1355C Target Angle 12.5Focus .75 125 KVP Sold for hospital. Auction 4240 -$1,500.00

PLANMED portable Mammo Unit Sophie Classic Man-ufactured 2002. Tube Number 629692V Tube TypeM113SP Sold for hospital. Auction 4241 - $4,500.00

SIEMENS Mobilette II Portable Unit 1990 50 - 117KVP Signal: 1.2 Mass - 400 Mass 5 collimator Fieldsize is adjustable .5cm x .5cm to 45cm x 33cm Thisunit is in great working condition. Sold for hospital inNew Jersey. Auction 4271 - $1,500.00

SIEMENS Portable X-Ray Mobilette II 50 - 117 KVPSignal: 1.2 Mass - 400 Mass 5 collimator Field size isadjustable .5cm x .5cm to 45cm x 33cm. Great workingcondition. Sold for hospital. Auction 4272 - $1,300.00

SIEMENS CT Scanner Somatom Plus 4 equipped witha xenon detector. Deinstalled by a hospital, and ingood working condition before deinstallation. Sold forbroker. Auction 4297 - $20,000.00

DYNARAD Portable X-Ray Phantom 2000; Condition:Very Good; Two units are available. Priced per unit.Auction 4425 - $7,000.00

SIEMENS CT Scanner Somatom Volume Zoom DoM:January 2001. The following is the Site ID#: 400-093429. Current tube installed May 2006. Before dein-stallation, this unit was in good working condition.Gantry Slice Count: 706,568. Sold for dealer. Auction4434 - $42,500.00

NUCLEAR

KODAK Dry Camera 8100 Manufactured 2002Imager has 5 connections/Modem/V-2 Key Pad/PS422Host/R232 Host/Spy Out Put, Pacs Link 25 PrintServer w/ PKD Key Pad. Sold for hospital. Auction4257 – $1,500.00

ADAC Nuclear Gamma Camera Epic, manufactured1998. System Includes: Generator/Model Number2152-3000A, Pegasys Work Station, Dual Monitors,Processing Terminal, Adac Power Supply Collimatorcart, Standard table, 4 Columinators. Sold for hospital.Auction 4318 - $6,000.00

ADAC Nuclear Gamma Camera Arc 3000 Pegasys 20:The computer platform for this unit is Sparc 20 and thesoftward application is Pegasys 20. A color monitorcomes with this auction along with a Codonics EP1650printer. Good working condition. LEGP collimator.Analog system. Priced low for fast sale. Sold for brokerin Georgia. Auction 4466 - $500.00

ULTRASOUND

GE OB / GYN Logiq 200 Pro Ultrasound. Includes twoprobes: one 3CB and one 6.5mhz. Sold for broker inSouth Carolina. Auction 4226 - $6,500.00

MRI

HITACHI MRI Scanner MRP 5000 Coils: Knee, Spinewrap (med and large) 6” + 10” circular, head Opticaldisks: Maxell 644 MB MO RW Dryview 8100 lasercamera Sold for imaging center in South Carolina.Auction 4112 - $5,000.00

MARCONI MRI Scanner Eclipse Parts Kit: 61 usedparts from known working systems at the time of dein-stallation; sold on an outright basis; “as is.” Sold fordealer. Auction 4337 - $13,500.00

PHILIPS MRI Scanner Gyroscan .5T Parts Kit: 31used parts from known working systems at the time ofdeinstallation; sold on an outright basis; offered “as is.”Sold for dealer. Auction 4341 – $10,000.00

SCHILLER MRI Accessories MAGLIFE C monitor com-patible with .2T to 3.0T scanners of all manufacturers.Includes Magmove non-magnetic trolley, SchillerMagscreen remote control & display unit placed out-side faraday cage. Sold for dealer in France. Auction4517 - $2,500.00

BONE DENSITOMETERS

GE Bone Densitometer Lunar Prodigy Advanc 2005system. Software level 9.15.010. Used for less than 20procedures per month. Includes: Prodigy Computer,Lunar Direct 17 inch CRT Monitor Prodigy Printer.Price includes GE professionally deinstalling the unit.This is covered by the service contract. This is alsooptional. Sold for Imaging Center in Florida. Auction4431 - $25,500.00

IMAGING ACCESORIES

KODAK Multi-Loader 8700 You are bidding on TWO(2) Kodak Dryview 8700 Laser Imagers with ONE (1)GE Dry Cam 8800 Multi-Input Manager. 8700/ MFG.Date 1998 8700/ MFG. Date 1996 8800/ MFG. Date1998. Sold for hospital. Auction 4232 - $1,000.00 KODAK Film Duplicator Dryview 8300 Table Top LaserImager. Both imagers were never used and in the origi-nal box. Sold for hospital. Auction 4244 - $5,000.00

O/R - SURGICAL

JACE Continuous Passive Motion knee machines(CPM) K100-2, lot of 4. Includes Jace MS9916 KneeCPM Pads. Great shape. Sold for hospital. Auction3716 - $1000.00

OHMEDA Anesthesia Machine 8000, OHIO V5A VEN-TILATOR, OHMEDA 5400 (VOLUME MONITOR),OHMEDA 5100 (OXYGEN MONITOR), GMS AB-SORBER, HALOTHANE (FLOUTEC 4), ISOFLURANE(ISOTEC 4), SPACELABS 90303B MONITOR (ADULT& INFANT NIBP, SAO2, ECG, RECORDER) ,MOD-ULE VER. 3.51.57N (PART #3068-35-205) Sold forbroker in New York. Auction 3845 - $1,600.00

GE/Marquett Bedside Monitor Eagle 4000. Flat ScreenMutiparameter patient monitors with ECG, Temp , IBP ,SPO2 ,NIBP , Defib sync. No patient cables. Sold forhospital. Auction 4245 - $3,600.00 OLYMPUS Gas-troscope GIF-130. Good angulation and the rubbercoating is very good, no kinks or bulges or cuts, slightlyyellowed numbers. Stated good condition by hospital.Sold for broker in Kentucky. Auction 4246 - $1,875.00

OHIO Infant Incubator Care Plus (three units). Sold forhospital. Auction 4265 - $900.00

MARQUETTE Monitor Lot: Eight (8) Eagle 3000 physi-ological monitors with dual invasive pressures, NIBP,and EKG. With EKG,IBP,NIBP,SpO2,Temp, Rec. Builtin printers. Sold for hospital in Wisconsin. Auction 4291– $3,250.00

DELL Computer System MX 8000 Work Station. Soldfor broker. Auction 4440 - $2,500.00

IMED Pump I/V Infusion Gemini P-4 SIX (6) VolumetricInfusion. Sold for hospital. Auction 4526 - $1,000.00 HILL-ROM Beds Electric VersaCare manufactured2004. Comes with a scale, central brakes and steer,chair position, sliding foot extension, air mattress,siderails lockout, and battery backup. Sold for dealer inFlorida. Auction 4559 - $3,200.00

ENDOSCOPY

OLYMPUS Colonoscope CF-10L Has some black dots.One owner from local hospital. Angulation is very goodand smooth, plasticcoating is very good with the ex-ception on one cut near the top that would never be in-serted (not even close and would not detract from use).Includes case. Sold for broker. Auction 4300 -$1,000.00

LASERS

ASCLEPION Laser - Diode MeDioStar model 1511.Manufactured 9/2005. Sold for broker. Auction 4228 -$16,500.00

QUANTEL MEDICAL Laser - Erbium Aramis II Manu-factured in 9/2005 Sold for broker. Auction 4231 –$14,500.00

STORZ Cosmetic General D-Actor 100 EPAT. Greatshape with light usage. Sold for broker. Auction 4263 -$5,000.00

CARDIOLOGY

MEDTRONIC Defibrillators Adult Electrode Medtronic Adult Electrodes Lot Includes: 11996-000041 Adult Qickpace Electrode 13ea exp 7/2009Medtronic 11996-000091 Adult Quick Combo Elec-trodes 17ea 7/2009. Original packaging. Sold for hos-pital in New York. Auction 3715 - $500.00

ZOLL Defibrillators NTP1000 Hard protective caseand all pieces are wrapped in plastic still. All cords,manuals, etc are included. Sold for crater in Utah. Auc-tion 4258 - $375.00

PHYSIO CONTROL Biphasic Automated External De-fibrillators (AED) LifePak 500 in excellent condition.Current with latest AHA CPR/AED guidelines. Pediatricenabled (with pink electrode connector). Unit includesone (1) non-rechargable OEM battery with expirationdate 8/2011, two (2) Quik-Combo Redi-Pak electrodeswith expiration date 10/2008, and carrying case. Soldfor dealer in Wisconsin. Auction 4303 - $350.00

PHYSIO CONTROL Defibrillators Codmaster XL FIVE(5) Available. Priced per unit. Includes Paddles, ECGCables. Sold for manufacturer in New Hampshire. Auc-tion 4437- $600.00

SOMATICS, INC. Electroconvulsive Therapy Unit(ECT) DAKMED INC. MODEL 750. New in the originalbox. Requires 9 volt battery not included. Sold for sur-plus outlet in Ohio. Auction 4501 - $125.00

RESPIRATORY

OHMEDA Gas Management System (GMS), AbsorverAir Shield Ventimeter controller, Halothane Vaporazer,ForaneVaporazer, Ethrane Vaporazer. Sold for ex-porter in Florida. Auction 3930 - $1,850.00

ALPHATEK Film Processor AX 700 LE Used WorkingCondition. Sold for exporter. Auction 3944 - $1250.00

AIR SEP CORPORATION Oxygen Concentrator NEWLIFE ELITE This oxygen unit only has 1,265 hoursrecorded at the last inspection. Sold for dealer in Mis-souri. Auction 4288 - $225.00

TRAILERS

MEDICAL COACHES Empty Trailer 1997 Trailer, 102inches wide 4474 – $23,000.00

Recent equipment and parts auctions on DOTmed with actual for-sale prices.

PRSRT STDU.S. POSTAGE

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PERMIT NO. 1884

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DOTmed Business News February 2008

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