Buying an MRI: A tragedy in two acts

Many facilities planning for a new MRI unit share the same strikingly similar story. This is because they all share two things in common: the MRI sales representative and the MRI technical representative. This story is common to all MRI vendors and systems.

Act 1 starts with the sales representative (typically young, attractive, and full of charm) and the promise of a quick and painless installation and wraps up with the sales agreement. Act 2, however, introduces the antagonist, the vendor's technical representative (hopefully a person with a few gray hairs) who has the duty of pointing out all of the obstacles that will challenge the preliminary design, budget, and timeline of the project.

Like formulaic plotlines that are recycled year after year, there are undoubtedly hundreds of similar iterations of the following story that can be told by hospitals and imaging centers across the U.S.

Act 1 begins with the sales rep meeting with the client. The narrative between the client and the sales rep often goes something like this:

Client: We've heard that this MRI system can be difficult to site. Will that be an issue here?

Sales rep: Oh, you'd be surprised. We can site magnets in locations today we couldn't even consider five or 10 years ago. New magnet systems are so much easier to site than the systems you may have heard horror stories about, and our system is so much easier to site than Brand X.

Client: So, we should be in good shape with our installation?

Sales rep: Oh, you'll be in great shape! I mean, every siting project has its own unique issues, but we do hundreds of these every year and there shouldn't be anything more than a few little bumps in the road for this project.

And unless the facility has brought on an architect or equipment planner with specific expertise in MRI suite planning at this early stage, the facility is likely to continue viewing the project through rose-colored glasses, losing valuable days and weeks that could be better spent resolving conflicts and addressing the "bumps in the road" before they become costly delays or changes.

But too often, that doesn't happen, which sets the stage beautifully for ...

Act 2: The realization.

Act 2 opens with the technical rep trying desperately to maintain their poker face while the client's blood pressure climbs. The technical rep dreads the prospect of telling the client about the expensive obstacles to the installation that present themselves.

Perhaps it's the CT scanner next door, the angiography suite upstairs, or the gamma camera below -- each of which may be impaired or incapacitated by the magnetic fringe fields from the proposed MRI system. Particularly if these systems were previously installed and especially if they've come from a different vendor, the sales rep likely had no knowledge (nor bothered to seek out the information) about the potential conflicts.

And what if, instead of a gamma camera, a parking level or a nearby elevator is below the MRI suite? Each can be the source of thousands of pounds of steel disrupting the magnetic field as it moves through them. Then one of the little "bumps" foretold by the sales rep may turn out to be $50,000 to $100,000 in project cost overruns for unanticipated steel shielding.

And because MRI systems are very heavy, structural engineers love to design a building's structural support to provide beams right below the 10-ton gantry. But when those beams underneath the magnet are steel, the distortions they present to the magnetic field may require significant modification of the room structure. No building owner likes to see newly installed chunks of the building torn out, particularly when he or she knows that each day of delaying a full patient schedule for the magnet is $10,000 to $15,000 in revenue that will never be recaptured.

The dialogue in Act 2 often goes something like this:

Client: The sales rep told us that there wouldn't be these sorts of problems.

Technical rep: Did you talk with him/her specifically about this issue?

Client: Well, no. But we did ask about siting difficulties, and they assured us that this was an easy system to site.

Technical rep: When all of the siting criteria have been met, it usually is easy to site this system. Who selected this particular location for the MRI?

Client: We thought it would be best to have it here. After all we showed it to the sales rep.

Technical rep: And who evaluated this area against the siting requirements for this magnet?

Client: You mean, that isn't done by the sales rep?!

Technical rep: Those first layouts are simply illustrative, to show you that the system can fit within your facility. We don't do the full technical evaluation until you sign the purchase order and approve the layout.

Client: What will it take to make it work?

At this point the sound effects crew cues the cash register -- cha-ching!

And since the facility is already on the hook for a $1 million-plus magnet and the costs of project delays, established budgets are blown to smithereens, and designers, contractors, and vendors are sent scurrying to try and undo the damage as quickly as possible.

The simplest moral of this drama is buyer beware. But caution without knowledge is not constructive. The more important message from this story is for facilities to understand the limits of their knowledge and the potential costs of those limits. When dealing with multimillion-dollar modalities, hundreds of thousands of dollars in construction, and $10,000-a-day revenue streams, the costs of ignorance can wind up being quite steep.

Facilities are then left with two ways of avoiding a starring role in this recurring story. The first is to develop a degree of expertise within your own staff to enable an informed review of both internal decisions and vendor promises relative to your new MRI suite construction. The second is to make sure that an architect or equipment consultant with the appropriate technical knowledge and skills is onboard for your project early enough to catch these problems before they result in significant costs or delays.

For those clients that want to hold off signing a vendor purchase agreement until the last minute, we recommend that they engage the services of an independent third party to prepare a site evaluation. These evaluations should minimally include a review of modality and infrastructure conflicts. The evaluations, if needed, can also include vibration, electromagnetic interference (EMI), and acoustic studies.

While this recurring story may make for good theater, nobody wants an MRI installation to turn into a tragedy of blown budget and busted schedule. It is only through proper planning of your MRI project that these expensive complications can be effectively avoided.

By Tobias Gilk
AuntMinnie.com contributing writer
September 25, 2006

Reprinted from www.mri-planning.com by permission of the authors. If you would like more information on any aspect of MR facility design or safety, please contact Robert Junk or Tobias Gilk at Jünk Architects.

Related Reading

MRI safety in Canada, September 1, 2006

Magnet room finishes: Protect MRI safety and efficiency when building, August 14, 2006

What TV's 'House' teaches us about MRI and safety, August 1, 2006

Magnet room equipment and furnishings: The ultimate caveat emptor, July 19, 2006

Selecting a site for your next MRI suite: It pays to plan ahead, July 12, 2006

Radiology is dead -- long live imaging! June 23, 2006

Copyright © 2006 Jünk Architects, PC

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