How to purchase an MR machine –
In ten easy lessons
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.
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Every company will say that it has the best equipment available in the world, and that all other companies have outdated equipment that will not perform properly.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’).
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 (your hospital or the taxpayer) or the next customer (also your hospital or 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%.
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 appeared 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 with whom you have negotiated the contract will have left the company by this time. The company itself will have merged with another company, which considers the contract signed with you null and void.
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.
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.
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.
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’).
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).
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.
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.