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Radiology Technology and
Technologists
“The physicians determine nearly all of a
hospital’s costs through their individual
utilization patterns. This is the physician
trump card in the endgame with hospitals.
Enlightened hospitals know this;
enlightened physicians know how to play
it.”
Bleeding Edge: the business of
healthcare in the new century, 1998
Radiology Imaging Modalities
Diagnostic and Interventional Angiography
Ultrasound
X-ray and Fluoroscopy
CT
MRI
Nuclear Medicine, including PET
Mammography
Diagnostic and Interventional
Angiography
X-ray (Special Procedures) Systems that are designed to provide
applications for both diagnostic and interventional
(Angiographic) applications.
Single Plane Angiography Lab ($1,500,000)
Dedicated special procedure (Angiographic) systems that are
configured with one imaging positioner. These systems
provide complete head-to-toe coverage; No Hearts (Cardiac
Cath).
Bi-Plane Angiography Lab ($2,300,000)
Dedicated special procedure (Angiography) systems that are
configured with two imaging positioners. These are typically
dedicated neuro vascular (Angiography) suites that can also be
configured for peripheral coverage.
Ultrasound (General, OB, Vascular, Urology, Surgery)
Premium Level ($200,000 - $300,000)
Premium ultrasound systems have the highest performance characteristics
available. Typically such systems are used in high volume, research
facilities. Premium systems may be cost prohibitive for some facilities.
High Level ($150,000)
The High level is for performance and applications required by the high
volume, sophisticated facility.
Mid Level ($100,000)
This segment includes price sensitive characteristics for the imaging center,
clinic or can function as a secondary or dedicated unit in the hospital.
Low Level ($40,000 - $50,000)
This segment has a lower cost and limited applications. Typically the low
system is found in the clinic or office market. Niche market, mobile systems
may be found here.
Point-of-Care ($20,000 - $50,000)
This tier includes hand-carried, highly portable, high-performance systems
used primarily at point-of-care.
X-ray and Fluoroscopy
Full Field Digital Radiographic System ($650,000)
High end Radiographic Units ($100,000 - $150,000)
Radiography systems typically recommended for hospitals and clinics with a
need for a heavy duty system and a medium volume of patients.
Low end Radiographic Units ($60,000 - $80,000)
Radiography systems upgradeable to a digital system. These units are
typically used in large hospitals with high throughput.
Mid range Radiographic Units ($80,000 - $120,000)
Radiography system using digital technology. These units are typically used
in large hospitals with high throughput.
Radiography systems typically recommended to <100 bed hospitals and
clinics.
Mobile Radiographic Units ($45,000 - $55,000)
X-ray and Fluoroscopy
Conventional R/F Systems ($300,000 - $500,000)
Conventional R/F systems include a fluoroscopy unit mounted over the
patient table. Staff are required at the table to operate the fluoroscopy
function.
Digital Spot R/F Systems
Non-Digital Spot film R/F Systems
A digital fluoroscopy system is often purchased with an R/F unit and is
a computerized method of image storage and playback from a variety
of X-ray based systems.
A spot film device is used to take hard copy radiographs during the
fluoroscopy procedure. These radiographic images can be taken using
regular radiographic cassettes or a spot film camera.
Remote R/F Systems ($600,000 - $650,000)
Remote control R/F systems feature a fluoroscopy assembly below the
patient table by which fluoroscopy is operated from a remote console.
Computed Tomography (CT)
Multi-Slice CT Scanners
Premium Helical CT Scanners ($895,000)
Multi-slice CT scanners have 2 or more rows of detectors for spiral imaging
acquisitions. It is designed for high volume imaging facilities and/or
specialized imaging applications.
Dual-Slice ($900,000 - $950,000)
Dual Slice CT scanners have the Capability to provide 2-Slices per 360degree X-ray Tube Rotation.
Quad-Slice ($1,300,000 -$1,500,000)
Quad-Slice CT scanners have the Capability to provide 4-Slices per 360degree X-ray Tube Rotation.
Eight- Slice ($1,900,000)
Eight-Slice CT scanners have the Capability to provide 8-Slices per 360degree X-ray Tube Rotation.
Premium Helical Single-Slice CT scanners have a single row of detectors for
spiral imaging acquisitions. The systems are configured with advanced
imaging capabilities for high volume caseloads.
Cardiac CT ($1,000,000 - $1,600,000)
Premium Helical Single-Slice and Multi-Slice CT scanners that are configured
with advanced imaging capabilities for Cardiac Scoring (Coronary Artery
Disease).
Computed Tomography (CT)
Mid-Range Helical CT Scanner ($715,000 - $870,000)
Entry Level Helical CT Scanner ($385,000 - $465,000)
Axial CT scanners have a single row of detectors for imaging acquisitions.
Designed for low volume or low budget facilities, the scanner is incapable of
spiral or helical acquisitions.
Oncology Specific CT Scanners ($570,000 - $1,000,000)
Entry Level Helical CT scanners have a single row of detectors for spiral
imaging acquisitions. It is designed for low volume caseload or facilities
with a limited budget.
Axial Single Slice CT Scanners (?)
Mid-range Helical Single-Slice CT scanners have a single row of detectors
for spiral imaging acquisitions and are configured for moderate volume
caseloads.
Oncology specific CT scanners are base CT systems configured with
Visualization and/or Dosimetric software and workstations (Virtual
Simulation package for RTP). The base CT system is determined by the
anticipated volume of the facility.
Specialty CT Scanners (?)
Specialty CT scanners are niche market systems utilizing CT technology for
specific applications. These systems include mobile (moves within the
facility) CT configurations.
Magnetic Resonance Imager (MRI)
3.0T High Field Strength ($2,500,000)
1.5T High Field Strength ($2,500,000)
Short bore, mid-field magnetic strength typically designed for moderate to
high volume clinical settings or those requiring advanced imaging options.
Open Mid-Field Strength ($2,000,000)
Short bore, high magnetic field strength typically designed for high volume
of cardiac applications or those requiring advanced imaging options.
1.0T Mid-Field Strength ($2,200,000)
Short bore, high magnetic field strength typically designed for high volume
clinical settings or those requiring advanced imaging options.
1.5T Cardiac MRI ($3,000,000)
High magnetic field strength typically designed for research and large
facilities for advanced imaging applications such as functional imaging and
spectroscopy.
Open designed mid-field strength superconductive MRI systems utilized for
whole body applications.
.5T Low-Field Strength ($1,300,000)
Short bore, low field magnetic strength designed for whole body imaging
for low volume clinical settings.
Magnetic Resonance Imager (MRI)
Intraoperative MRI ($2,500,000)
Open Designed Low Field Strength ($900,000 - $1,300,000)
Intraoperative MRI offering capabilities for surgical planning in the
operating room.
Open designed low field strength (generally permanent magnets) designed
for whole body imaging for outpatient clinics or backup to high-end magnet.
Other MR Systems
This includes low field MRI systems such as dedicated breast and dedicated
orthopedic MR systems.
Nuclear Medicine
Single-Head Gamma Camera ($290,000 - $480,000)
Single-head imaging detector gamma camera that provides
applications for whole body and SPECT imaging.
Single-Head Circular Detector
Single-head gamma camera with circular imaging detector
that provides applications for whole body and SPECT
imaging.
Single-Head Rectangular Detector
Single-head gamma camera with rectangular imaging
detector that provides applications for whole body and
SPECT imaging.
Single-Head Square Detector
Single-head gamma camera with square imaging detector
that provides applications for whole body and SPECT
imaging.
Nuclear Medicine
Dual-Head Gamma Camera (Dual-head imaging detector gamma camera that
provides applications for whole body and SPECT imaging.) ($440,000 - $1,200,000)
90-Degree Fixed
180-Degree Fixed Gamma Camera
Variable angle, dual-head imaging detector gamma camera that provides applications for whole body
and SPECT imaging. Configured with coincidence imaging and attenuation correction packages.
Variable Angle w/ CT & AC
Variable angle, dual-head imaging detector gamma camera that provides applications for whole body
and SPECT imaging. Configuration includes coincidence imaging package.
Coincidence w/Attenuation Correction
Variable angle, dual-head imaging detector gamma camera that provides applications for whole body
and SPECT imaging. Configuration includes attenuation correction.
Variable Angle w/Coincidence Detection
Variable angle, dual-head imaging detector gamma camera that provides applications for whole body
and SPECT imaging.
Variable Angle w/Attenuation Correction
180-degree fixed dual-head imaging detector gamma camera that provides applications for whole
body and SPECT imaging.
Variable Angle Gamma Camera
90-degree fixed dual-head imaging detector gamma camera that provides applications for whole body
and SPECT imaging.
Variable angle, dual-head imaging detector gamma camera that provides applications for whole body
SPECT & Computed Tomography (CT) imaging. Configured with CT and attenuation correction
packages.
Variable Angle w/ CT, CoDe & AC
Variable angle, dual-head imaging detector gamma camera that provides applications for whole body
SPECT/PET/CT imaging & Computed Tomography (CT). Configured with CT, Coincidence Detection &
attenuation correction packages.
Nuclear Medicine
Triple-Head Gamma Camera ($600,000 - $1,200,000)
Triple-head imaging detector gamma camera that provides applications for
whole body, cardiac and brain imaging.
General Purpose Triple-Head Gamma Camera
Triple Head w/Attenuation Correction
Triple-head imaging detector gamma camera with the attenuation
correction option that provides applications for whole body,
cardiac and brain imaging.
Triple-Head w/Coincidence Detection
Triple-head imaging detector gamma camera that provides SPECT
applications for whole body, cardiac and brain imaging.
Triple-head imaging detector gamma camera that provides
applications for whole body and SPECT imaging. Configuration
includes coincidence imaging package.
Coincidence & Attenuation Correction
Triple-head imaging detector gamma camera that provides
applications for whole body and SPECT imaging. Configured with
coincidence imaging and attenuation correction packages.
Nuclear Medicine
Other (Specialty) Gamma Camera
Gamma cameras that include mobile cameras for bedside exams and
dedicated cardiac cameras.
Dedicated Cardiac
Nuclear medicine gamma cameras that are dedicated cardiac
systems.
Mobile Camera
Nuclear medicine gamma cameras that are designed to perform
the exam at bedside (mobile environment).
Nuclear Medicine (PET)
Low End ($1,000,000 - $1,400,000)
Mid End ($1,500,000 - $2,100,000)
High End PET scanner utilized for both research and clinical
applications.
PET / CT Scanners ($3,400,000 - $4,300,000)
Mid Range PET scanner utilized for research and clinical
applications.
High End ($2,200,000 - $3,600,000)
Low End or Entry Level PET scanner utilized for clinical
applications.
Combination of PET and CT scanners that provides two exams:
CT for anatomy and PET for physiological imaging.
Cyclotron ($1,100,000 - $2,000,000)
Used for Production of Positron-Emitting Elements, or
Radioisotopes (oxygen, carbon, nitrogen, fluorine, etc.).
Mammography
Full Field Digital Mammography Unit ($500,000)
Diagnostic Mammography System
Full field digital mammography to provide full field breast imaging.
This technology is most appropriate for large teaching facilities.
A diagnostic mammography unit is a radiographic device that is
designed to perform X-rays of the breast. A fully diagnostic
mammography system must include the capacity to perform biopsy
and magnification studies.
Digital Capable ($95,000)
A diagnostic mammography unit that has been retrofitted
for easy upgrade to full field digital when it becomes
available.
Conventional Diagnostic Units ($95,000)
A diagnostic unit that can perform magnification views and
can be fitted with an add-on device that attaches to the
system. These units are capable of diagnostic exams but
are not retrofitted for full field digital when it becomes
available.
Screening Mammography System ($71,000)
Screening units are basic systems that do not feature magnification
or biopsy capabilities and are typically placed in outpatient imaging
centers, mobile coaches or in hospitals as a second mammography
“Retail is for suckers”
Kramer
How is a purchase price
determined?
List price minus
Discounts associated with being part of a Global Purchasing
Organization (GPO)
Volume discounts for buying multiple units or a basket of
goodies
Discounts for being a “research site”
Discounts for being a “show site”
Old fashioned Negotiation
How much does this stuff cost to
operate?
Contribution Margin
Total collected dollars minus
Variable cost per Procedure
Technologists
Consumables (Film, Contrast, Supplies)
Total Fixed Costs
Equipment Depreciation or Lease (5 Years)
Service/Maintenance/Contract
Let’s try to buy an MRI
scanner!!
Income (Collected Dollars)
Average Reimbursement per procedure ($650)
Projected number of procedures/year (4200)
350/month
16/day
2/hour
Total Collected Dollars over 5 years
$650 x 4200 x 5 = $13,650,000 (!!)
Let’s try to buy an MRI
scanner!!
Expenses
Fixed Costs
Purchase Price = $2,000,000
Service Contract = $120,000 x 4 years = $480,000
Variable Costs
Technologist: $50/procedure
$50 x 4200 x 5 = $1,050,000
Consumables: $40/procedure
$40 x 4200 x 5 = $840,000
Let’s try to buy an MRI
scanner!!
5-Year Contribution Margin
$13.65M (Income) - $2.0M (Cost of Equipment) - $480K (Service
Contract) - $1.05M (Technologists) - $840K (Consumables) =
$9,280,000 (!!!)
Let’s try to buy a
Mammography Unit
Income (Collected Dollars)
Average Reimbursement per procedure ($60)
Projected number of procedures/year (3600)
300 per month
14-15/day
1.75/hour
Total Collected Dollars over 5 years
$60 x 3600 x 5 = $1,080,000
Let’s try to buy a
Mammography Unit!!
Expenses
Fixed Costs
Purchase Price = $80,000
Service Contract = $4500 x 4 years = $18,000
Variable Costs
Technologist: $30/procedure
$30 x 3600 x 5 = $540,000
Consumables: $16/procedure
$16 x 3600 x 5 = $288,000
Let’s try to buy a
Mammography Unit!!
5-Year Contribution Margin
$1.08M (Income) - $80K (Cost of Equipment) - $18K
(Service Contract) - $540K (Technologists)- $288K
(Consumables) =
$154,000
Contribution Margin Comparison
MRI: $9,280,000
Mammography: $154,000
Real Analysis
Start Up
YEAR 1
MRI INCOME
Gross Billings
Estimated Contractual Adjustments
Estimated Collections
TOTAL MRI INCOME
EXPENSES
Technologist Salaries
$50/exam
Supplies (film, contrast, etc)
$40/exam
Repairs/Maintenance
Data/Computer
Admin (FDA, MQSA, ACR, tech credentials, etc)
Depreciation/Amortization
MRI 1.5 Tesla purchase price $
2,000,000
TOTAL EXPENSES $
Contribution Margin
Modality
MRI
Average Charge
Average Reimbursement
1,500
650
YEAR 3
YEAR 4
YEAR 5
$
$
$
$
6,300,000
(2,709,000)
3,591,000
3,591,000
$
$
$
$
6,615,000
(2,844,450)
3,770,550
3,770,550
$
$
$
$
6,945,750
(2,986,673)
3,959,078
3,959,078
$
$
$
$
7,293,038
(3,136,006)
4,157,031
4,157,031
$
$
$
$
7,657,689
(3,292,806)
4,364,883
4,364,883
$
$
$
$
$
$
210,000
168,000
10,000
5,000
400,000
$
$
$
$
$
$
229,320
185,220
120,000
10,500
5,000
400,000
$
$
$
$
$
$
240,786
194,481
120,000
11,025
5,000
400,000
$
$
$
$
$
$
252,825
204,205
120,000
11,576
5,000
400,000
$
$
$
$
$
$
265,467
214,415
120,000
12,155
5,000
400,000
$
793,000 $
950,040 $
971,292 $
993,607 $
1,017,037
$
2,798,000 $
2,820,510 $
2,987,786 $
3,163,425 $
3,347,846
Exam Volume
4200
$
$
YEAR 2
Exam Volume
4410
Exam Volume
4631
Exam Volume
4862
Exam Volume
5105
Radiology Imaging Modalities
(Contribution Margins)
Diagnostic and Interventional Angiography ($1.5M)
Ultrasound ($380K)
X-ray and Fluoroscopy (-$1.0M)
CT ($3.6M)
MRI ($4.7M)
Nuclear Medicine, including PET ($1.1M)
Mammography (-$200K)
TOTAL: $10.08M
Speaking Hospital
Administratorese
Contribution Margin
Incremental Revenue
Bond Rating
Cost per Adjusted Discharge (Cost per Case)
FTE Reductions
Clinical Need?
What about the
technologists?
Hypothesis #1
The availability of qualified technologists in radiology
is at a crisis stage and will continue to have a
significant impact on health system’s ability to deliver
imaging services
Hypothesis # 2
“The wisdom of the
world can be found
in the lyrics of
country music
songs”
“Since my phone still
ain’t ringin’ I’ll assume it
still ain’t you”
Sobering Statistics
Since 1994, the number of first-time candidates
taking the RT exam has declined by 32%
Since 1995, the number of radiography programs has
declined by 14% (677 to 584)
75% of radiology managers report they are
understaffed in budgeted positions
Radiology Management, May/June 2001
Sobering Statistics (cont.)
Percent of
Registrants
Birth Decade of ARRT Registered
Technologists
35%
30%
25%
20%
15%
10%
5%
0%
33%
32%
16%
15%
4%
1930's
1940's
1950's
1960's
Decade of Birth
1970's
“The last thing I needed
the first thing this
morning, was to have
you walk out on me”
Annual Turnover Rates
General Radiology - 20%
CT - 23%
MRI - 24%
Nuclear Medicine - 33%
Ultrasound - 32%
Angiography - 28%
Radiology Management, May/June 2001
“If you’ve got the
money, honey, I’ve got
the time”
Web Designer
PC Support
Hardware Analyst
Hardware Technician
Technical Trainer
System Administrator
Vascular/Interventional
MRI
CT
Mammography
Ultrasound
Nuclear Medicine
Radiography
Average Wages by Job Class (Radiology vs. Computer Technology)
$70,000
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
$-
What can you get for $400
per month?
4-year, $16,000 car loan @ 7% per year
Full- time daycare for a 6-year old
12 rounds of golf at Utah public courses
$184,816 if invested @ 6% over 20 years
“I got a call from the
folks over at Bell just to
let me know my next
phone call I could walk
outside and yell”
“After losing money on
operations in 1999, the notfor-profit sector managed to
eke out a 0.6% operating
margin in 2000…”
Modern Healthcare, 64-2001
Hypothetical Example
350 bed teaching hospital
2500 clinical employees
$300M annual net patient revenues
0.6% operating margin = $1.8M profit
Cost of raising each employee wage by one dollar per
hour = $5.2M
“Workin' in the fields
Till you get your back burned
Workin' 'neath the wheel
Till you get your facts learned
Baby I got my facts
Learned real good right now”
Technologist
Productivity/Workload
Exams per technologist FTE
3500
1992 AHRA
1995 AHRA
2000 AHRA
3000
2500
2000
1500
1000
500
0
DIAGNOSTIC
RADIOLOGY
(INCLUDES
MAMMOGRAPHY)
CT
ULTRASOUND
MRI
NUC MED
INTERVENTIONAL
“Runnin’ over the cat
again only makes it
flatter, it don’t make it
more dead ”
ACR Resolution #52
Be It Resolved, that to address the medical workforce
shortage that includes radiologists, radiation oncologists,
imaging technologists, radiation therapists and medical
physicists, the American College of Radiology and
representatives from the major radiological societies
form a task force to explore ways to increase the
medical workforce.
What is being done?
Media Campaign
Recruitment Video
Work Force survey
Research
Scholarships
Non Radiologists Sub Task Force
on Human Resources
The development and dissemination of a recruitment
videotape to Junior High schools, High schools and
Public Television stations.
Non Radiologists Sub Task Force
on Human Resources
The ASRT is developing a research project to find ways
of improving productivity and job satisfaction.
Non Radiologists Sub Task Force
on Human Resources
The ASRT Education and Research Foundation has
begun to develop minority scholarships to interest a
significant population in the radiologic sciences as a
career path.
Non Radiologists Sub Task
Force on Human Resources
Other areas to be Investigated…
Increasing the number of schools
Increasing funding for existing schools
Exploring the development of Technologist’s Assistants
and Radiologists PA’s
Development of web page on the ACR and RSNA web site
describing careers for imaging technologists, radiation
therapists, and medical physicists.
Improving job satisfaction and job opportunities
Increasing the number of students
“Little things I should
have said and done, I
just never took the time”
Non-monetary retention tools
that radiologists can implement
Very public reward and recognition programs
Scholarships in exchange for years of service
One-time “big splash” events (paegentry!!)
Cover the cost of professional memberships,
subscriptions, etc.
Conclusions
Radiology equipment is really expensive
If managed well, owning and operating radiology
equipment can be very profitable
The price paid for equipment varies wildly and can be
irrational
Radiology is critical to the financial health of hospitals
Conclusions
Rad Tech staffing crisis exists!!
Crisis impacts diagnostic radiology most (lowest wage
area)
Techs are working harder than they were 5 years ago
ACR is exploring several options to solve the staffing
problem
Special Thanks to:
Dwight Yoakam
Willie Nelson
Bruce Springsteen
Charles Williams, MD