 urphy’s
Law is the most reliable guideline when buying an MR machine: anything that can
go wrong usually does. This is what you have to learn before you start diving
into this adventure.
 
Lesson One
Know
what you want to buy. If you do not know anything about magnetic resonance, you
can go straight to any company. The salesperson will know as much as you –
possibly slightly less – so this is the perfect arrangement. The
chances are that it will not be you who chooses the machine: you will choose what
this company tells you is the right choice. Or, more positively, the better the
education of the salesperson, the easier and more efficient will be the collaboration
between user/buyer and company. Sales
and marketing people hardly ever lie, but they would not dream of telling you
the truth. Their claims for performance should be multiplied by a factor of 0.25. Every
company will say that it has the best equipment available in the world, and that
all other companies have outdated equipment that will not perform properly. Marketing
people use a special lingo; for instance, they use the adjectives ‘ultimate’
and ‘optimum’ instead of ‘just another’. The
‘ultimate MR machine’ translates into ‘just another MR machine’
(it is unlikely that they mean ‘ultimate’, which equals ‘the last
one you need before your death’).
Lesson Two There
is no such thing as a free lunch. A company may invite you, the hospital administrator,
five local politicians, and several others who do not understand anything about
magnetic resonance to travel around the world in a chartered jet. You (the taxpayer)
or the next customer (also the taxpayer) will pay for it. However, even if you
do not accept such invitations, the price does not drop. The
price will only drop the day you sign a contract with company A. One hour before
signing, you will get a telephone call from company B, stating that it will reduce
its price by 50%.
Lesson Three After
buying an MR machine, you will find out that the company has not delivered what
you thought you had purchased. Even
if you have a detailed written contract, certain parts of the hardware or certain
software programs only existed on the drawing board of the company's development
department. They are not part of the delivered equipment because they do not exist.
But you have already paid for them. This is usually called ‘works-in-progress’.
The
identical unit that you have seen at the company’s headquarters or at a showcase
performs differently from the unit that has been delivered to you. At exhibition
booths, you always see ‘typical’ images that look great. No one tells
you that the patient was dead when imaged; thus, there are no motion artifacts.
The
salesperson who have negotiated with will have left the company at this time.
The company itself will have merged with another company, which considers the
contract signed with you null and void.
Lesson Four Never
expect functioning equipment. Wherever computers are involved, things will go
wrong. Think twice when you start planning. There are a lot of fantastic ideas
to solve the problems of the world, medical imaging included. But if no one is
using these ideas (or equipment), there is probably a good reason. By
the way, you should have thought three times.
Lesson Five If
something is wrong with the magnet, the responsible company people will tell you
that all the troubles are caused by Eddy Current. This impertinent guy interferes
and messes up everything. No one understands either where he comes from or where
he can be found. Trying
to operate the equipment will be nearly impossible. Manuals are written in such
a way that even their writers will not be able to operate the machine. Much space
is given to unnecessary details, but there is no description of how to switch
on the computer.
Lesson Six When
the MR machine is delivered, you will find out that within the next two months,
a new version will replace the one you purchased. You have bought one of the last
models of a version which will be discontinued and cannot be upgraded in the future. Guarantees
and warranties do not exist and are voided immediately after the first installment
of your payment. Anything in writing is not worth the paper it is written on.
Similarly,
deadlines only mean that the company acknowledges that the Gregorian calendar
has replaced the Julian calendar some time ago. The dates given are meaningless.
There
is one basic rule, however: everything takes longer than you think.
Lesson Seven Manifold
options exist. Some of them are necessary to run the equipment properly. You have
to buy them at horrendous prices (value-added tax not included). This often happens
with car manufacturers, who sell cars without tires (see ‘Options’). Options
bought at a later stage will be even more expensive (see ‘Options’). Among
these options is the Faraday cage. Without a Faraday cage, all images produced
after 10 a.m. will have a central artifact caused by Radio Vatican, which starts
broadcasting at exactly this time on exactly the frequency you use as the resonance
frequency. Service
and maintenance are not included in the purchasing contract (see ‘Options’).
To avoid unpleasant surprises, you should discuss and include them before signing
the delivery contract. The service people will not be trained to cope with the
problems they have to face, anyway. Downtime
is not what you think it is, but what the company defines. If the machine does
not produce images, it is not necessarily out of order. Some companies even try
to change the ground rules. Instead of paying penalties when the equipment malfunctions,
they try to make the customer pay by installing a control clock. If the MR imager
is used more than eight hours per day and five days per week, additional service
charges apply (see ‘Options’).
Lesson Eight The
multiformat camera / workstation / whatever you have bought to be connected to
your MR system cannot be connected. As
soon as it is connected, no information will ever leave this piece of equipment,
because either its ports do not conform to any standard or there are no ports
at all. Laser cameras do not work. Film developing units eat films. PACS links
send pictures everywhere except to where you want them to be delivered to. DICOM
is not a unified standard of image data transmission but an in-house company format
that is changed on the first day of every month. If
two companies are involved, such as an MR manufacturer and a camera producer,
you, the customer, are lost. If something goes wrong, one company will blame it
on the other one and nothing will happen. If something finally does happen, you
will pay dearly (most likely to both companies).
Lesson Nine Something
will be wrong with your building plans but you will detect it too late. The bigger
the hospital, the more people will be involved in the planning and the bigger
the mistakes will be. For
instance, the sewer system of your patient toilets will be connected straight
to the emergency water evacuating system of your computer room. One day the pipes
will be clogged, but there will be a patient who flushes the toilet anyway.
Lesson Ten Do
not believe what your colleagues in the next town tell you about their machine.
They either hate it because they just went through lessons one to nine, or they
love it because they do not know better. If they have the highest patient throughput
in the country, it is because their machine is directly connected to a cash register. Soon
you will be part of this club: either looking forward with dismay or backward
with anger. | 
June 1992
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