There is no such thing as a perfect piece of equipment that suits every radiology department, and acquiring the right tools involves a carefully mapped out process. That is the view of Dr. Annalisa Trianni, a medical physicist from the Hospital Santa Maria della Misericordia in Udine, Italy.
“There is no absolute right machine; it depends on the conditions,” explains Trianni, who will be chairing today’s session on equipment purchasing decisions. “So, purchasing is a process, which requires different stakeholders to be involved – with each providing the knowledge required to make the right choice.”
As a result, she emphasises that the session will be aimed at multiple types of professional – not just radiologists or medical physicists – although they do play a key role. In December 2013, a Euratom directive made radiologists and other clinical professionals responsible for reducing patients’ radiation exposure, and in the case of CT and x-ray units, Trianni argues that purchasing the most suitable equipment is the start of that process.
Drawing up a specification is among the first steps in buying equipment – whether fitting out a standard mammography room or buying a cutting-edge MRI scanner. Andy Rogers, lead interventional medical physics expert (MPE) at Nottingham University Hospitals NHS Trust, will be talking about technical specifications, but emphasises that this title is somewhat misleading.
“What I won’t be talking about is whether, for example, the filtration must be ‘x’ or ‘y’ – that’s too technical,” he explained. “The role of the technical specification is to take a physicist’s understanding of how the equipment works and mould it into a generic statement of requirements needed to help the clinical team.”
Rogers, who is immediate past president of the British Institute of Radiology, argued that it is essential to understand clinical needs before drawing up a technical questionnaire about speed or size requirements. To give an example, his team is currently procuring a paediatric interventional x-ray unit, and he is completely ambivalent about whether it is floor- or ceiling-mounted. Instead, he has specified that the x-ray unit must optimise space in a small room and allow access to the patient.
Moreover, Rogers has not specified specific dose requirements or imaging specifications for the x-ray equipment, other than the usual CE marking and national regulation requirements. Instead, his headline criterion for evaluation is ‘clinical image quality’, followed by ‘dose efficiency’ and ‘usability’. As he explains, if equipment has a poor user interface, patients and clinicians cannot make best use of the features. He also avoids any mention of company-specific features.
The aim of the technical specification, he adds, is to help manufacturers understand the hospital’s needs and to allow the local evaluation team to objectively choose the right equipment for local clinical need. After explaining the types of cases and patients they have, and any future plans, it is the manufacturer’s job to present something that can be judged against this specification, he said.
Once a shortlist of equipment has been drawn up, the hospital management must assemble an evaluation team of up to three people – often a radiologist or cardiologist, a medical physics expert, and a radiographer. These professionals will usually attend a site visit organised by a company to one of its customers. According to Rogers, it makes sense to take the opportunity to ask existing users about the doses they use to help him to judge dose efficiency.
The final step is to rank the vendors and products on a set of criteria weighted to emphasise the most important aspects. He avoids giving scores out of ten, as it is hard to do, and often subjective. Instead, a ranking approach weighted by criteria importance is employed. With companies often seeking feedback after an unsuccessful bid, he prefers to give feedback using relative criteria.
During installation of the new equipment, it is important to collaborate with every stakeholder in the hospital, emphasised Prof. Mustafa Özmen, former deputy general director at Hacettepe University Hospital, Ankara, Turkey.
“During every installation project, you’ve got to improvise, so you need their help,” he noted, explaining that radiologists need to collaborate with stakeholders as varied as the hospital finance department. “And, at the end of the day, when the equipment is installed, what is most important is human experience – whether people are happy – so it is essential to proceed accordingly.”
To get people involved, Özmen often organises talks and requests feedback from the staff involved.
“You cannot ask a physicist to get everyone together – it is the radiologist who is responsible for their equipment,” he said, explaining that after 30 years in the same department, he knows the fabric of the building and existing equipment like the back of his hand. “But the best way to be unsuccessful is to do everything by yourself.”
Please note that for pre-recorded sessions published during the ECR Highlight Weeks, there will be no chairpersons. However, we still wanted to keep Dr. Trianni’s statement for the article as she initially gave it.
Professional Challenges Session
PC 13 Equipment purchasing decisions: a team approach
- Preliminary evaluation of the need and utilisation
Elmar Kotter; Freiburg/DE - Technical specification as the prerequisite for clinical use
Andy Rogers; Nottingham/UK - Site planning and project management
Mustafa N. Özmen; Ankara/TR - Legal and financial aspects of procurement
Andrea Giovagnoni; Ancona/IT - Economic issues
Elisabeth Schouman-Claeys; Paris/FR
FURTHER READING
Parikh K, Arbor A (2017) Capital equipment procurement process at a quaternary academic center: a resident’s perspective. ECR 2017 / C-0545: myESR.org/17545
Do TD, Reichhardt N, Hähnel S et al (2019) General Considerations and Criteria for Procurement of a Dose Management System. EuroSafe Imaging 2019 / ESI-0084: myESR.org/1984
Andersson JS, Granberg C, Ahlström Riklund K (2018) A novel system for quality assurance of radiology equipment. EuroSafe Imaging 2018 / ESI-0064: myESR.org/1864
Denjoy N (2016) Medical Imaging Equipment Replacement in Europe – Essential and Long Overdue. EuroSafe Imaging 2016 / ESI-0044: myESR.org/1644