MRI Buyer's Guide

Copyright © 2017

Table of Contents

For Starters ........................................................................................... Page 4

Which MRI Scanner Is Best For Me? ............................................. Page 6

How Do I Know I’m Getting a Good System? ........................... Page 12

How Much Will This Cost? .............................................................. Page 14

The Next Step ..................................................................................... Page 19

For Starters
For Starters

Getting started in making the best MRI purchase decision can be overwhelming- so many
options, features, and capabilities. There’s much to learn and most certainly leg work to be
done. Fortunately for your team, you’re on the case!

We put this buyer’s guide together specifically for all you proactive MRI shoppers. Our goal is
to assist with the aforementioned learning and leg work that lie before you; that is to say, we
want to help you answer these three big questions about buying your MRI scanner:

• Which MRI scanner is right for me?

• How can I be sure I’m getting a good system?
• How much will this cost?

Once you know these three things, you’ll be well on your way to making an informed MRI
scanner purchase. If you like the sound of that, get your mouse finger ready and click on
through to the other side!

For a complete listing of Block’s available systems and services please visit 4
www.blockimaging.com
Which MRI Scanner
Is Best For Me?
Which MRI Scanner Is Best For Me?
Magnet Strength
An MRI magnet is an incredibly powerful thing. Here’s some perspective on that statement:
The magnetic field of current clinical MRI magnets ranges from 0.3-3.0 tesla (T). The magnetic
field of the Earth (yes, the ENTIRE planet) is approximately 0.5 gauss. If you’re not up on your
units of magnetic measurement, this means the magnetic fields of our MRIs are anywhere
from 1,660 to 60,000 times stronger than that of the world on which they sit. Choosing which of
these ultra-powerful beauties will work best for your facility is one of the more important factors
in purchasing an MRI.

The strength of an MRI system’s magnetic field is directly proportional to the level of detail in
the images the system produces. Presently, there are magnets available in four main categories:
3.0T, 1.5T, 1.0T, and open/extremity magnets under 1.0T. Because they are suited for a more
specific set of studies, we’ll cover extremity MRI systems in a guide of their own and focus on
full-size scanners in these categories.

3T
Excluding clinical research institutions, a
3T MRI is the highest tesla strength magnet
you’re likely to encounter as you plan your
purchasing options. If you’re doing the types
of studies that involve very minute detail,
3T could be worth considering. Specialties
like sophisticated brain work are where 3T
really shines. Be aware though- the image
detail of 3T comes at the higher end of the
MRI cost spectrum.

1.5T
These are your “bread and butter” MRI systems. A 1.5T MRI is completely sufficient
for the majority of scans that are routinely done today. The 1.5T short bore MRI still
remains the standard and still accounts for the vast majority of MRIs currently in use.
Unless you intend to focus on a specialty like brain imaging, an MRI from this category
can get you the image detail you need for much less. After all, though the price tag
is substantially higher for a 3T than a 1.5T, the current federal reimbursement does
not change.

1.0T
Most 1.0T systems were manufactured prior to 2002 are have become increasingly
rare. They have less efficient magnet designs, lower functionality, and diminished
image quality as well. All of that being said, there are a few specialized areas
(research, small animal veterinary, etc.) that 1.0T systems can support in a most
economical fashion.

For a complete listing of Block’s available systems and services please visit 6
www.blockimaging.com
Which MRI Scanner Is Best For Me? [continued]
Magnets under 1.0T
Most of the magnets in this category are found on open or extremity systems. These
magnets have the lowest strength and, therefore, the lowest image clarity, but are
intended for certain niches that they are ideally suited to fill- namely, imaging limbs
and select scans for obese or claustrophobic patients.

Open vs. Closed

Closed Magnets
This magnet type is the one you’ve most likely seen before- the basic “donut” shape.
As we said earlier, the typical closed-bore MRI has a magnetic strength of 1.0T
through 3.0T with a bore diameter of 60cm. Some manufacturers also offer a 70cm
“widebore” option. Examples of wide-bore systems include the Siemens Espree, the
Philips Ingenia, and the GE 450W. Toshiba offers a 71cm bore in their Titan model.

The image clarity of studies on closed systems is usually greater than that of an open
MRI system, but many patients struggle with feelings of claustrophobia when going
into the bore. The standard bore size is also sometimes problematic for obese
patients.

Open Magnets
These magnets are designed primarily to accommodate larger patients and patients
that struggle with claustrophobia. The system has two flat magnets positioned over-
and-under, parallel to one another. This leaves the bore more open and alleviates the
concerns of tight spaces. The trade-off is, of course, lower magnet strength.

While improving with every era, the clarity in this magnetic range is diminished
compared to that of a closed-bore system. That being said, depending on the
particular studies and image quality expectation, an open MRI can be the perfect
balance of imaging need, capital cost, and patient comfort.

For a complete listing of Block’s available systems and services please visit 7
www.blockimaging.com
Which MRI Scanner Is Best For Me? [continued]
Fixed vs. Mobile
Fixed MRI
Fixed systems are installed at a set location such as a hospital, imaging center, or
research facility. Over 90% of all MRIs purchased will be installed this way.

A fixed MRI system will generally cost less than the same model installed for mobile
use. This is true of both up-front purchase price and ongoing maintenance costs.
There will, however, be significantly more planning and (often) remodeling required
to prepare a room and install a fixed MRI.

The installation of a fixed MRI requires careful orchestration of project managers and
engineers to ensure the system is installed safely and properly. In most cases, the
system is brought in through a wall opening or rigged to a crane and then lowered
into the MRI suite from an opening in the roof. Additionally, if there is already an MRI
in the room, it will have to be properly de-installed before the new system arrives. The
entire site planning process involves everything from construction to room shielding,
and can take a few weeks to a few months.

Mobile MRI
It's become relatively common for imaging facilities to use mobile MRI trailers owned
by equipment dealers, brokers, or service companies on a rental basis. There are a
lot of reasons for renting, but there are at least as many reasons why a facility might
want to take a page out of the dealer playbook and own a mobile MRI system of their
own, including:

•• Gaining a foothold as you prep your permanent space

•• Testing a market
•• Overcoming a lack of space
•• Serving multiple locations
•• Upgradability
•• Speculation
•• Generating rental revenue

There is no one-size-fits-all solution when it comes to outfitting your facility with MRI equipment.
The list of variables at play puts almost every facility in unique circumstances in one way or
another. If, however, the needs at your facility call for flexibility, space savings, or an ace-in-
the-hole cost offset, the mobile MRI option might be the perfect fit.

Request a mobile MRI rental

For a complete listing of Block’s available systems and services please visit 8
www.blockimaging.com
Which MRI Scanner Is Best For Me? [continued]
Helium Boil-Off Rate
MRI scanners generate an enormous amount of heat and require cooling via liquid helium
to operate. Depending on the design of its primary magnet, an MRI scanner will experience
helium consumption (AKA boil-off) at a certain rate. The higher the boil-off rate, the more will
eventually need to be spent to refill the scanner’s cooling system. Many scanners feature
“zero boil-off magnets” that do not consume helium during the course of normal operation.
These systems only require a refill in the event of a more serious service need. Other magnet
designs consume a tiny amount of helium each day (1%-4% per month is typical) and, barring
a breakdown, would require a top-off annually or semi-annually. As you may be able to guess,
scanners with zero boil-off magnets tend to cost more than their gradual boil-off counterparts.

Examples of zero boil-off magnets include the CXK4 LCC, found on many 1.5T GE scanners,
and the OR105 and OR122, used on Siemens Avanto and Espree models. Some common
magnets with gradual boil-off include the OR70, used on the Siemens Symphony, and the
OR76, used on the Toshiba Vantage and Toshiba Titan.

Gradient Packages
The gradient package of an MRI scanner will significantly impact its image quality and should
be top-of-mind as you consider your options. Gradients are 3 smaller magnets within a large
metal coil alongside the primary magnet. These three magnets are responsible for producing
the X, Y, and Z planes and allow the magnetic field to be altered in very precise ways to
capture specific parts of the body (slices). Each OEM names their gradient package something
different (i.e., “Twinspeed”, “XGV”, “Ultra”, “Master”, etc.). They are all names for the same
component type, but not all gradient packages are created equal- so be on the lookout.

Gradients are characterized by two important metrics: amplitude and slew rate. Without
drowning in a sea of complicated physics, the amplitude is a measurement of how rapidly the
magnetic field changes over a given distance. This rate of change is expressed in milliteslas
per meter (mT/m). A gradient slew rate is a representation of the time it takes the system to
get from zero to peak amplitude. This rate is expressed in teslas per meter per second (T/m/s).

Discover More MRI Resources

For a complete listing of Block’s available systems and services please visit 9
www.blockimaging.com
Which MRI Scanner Is Best For Me? [continued]
An example: Siemens Quantum gradients (amplitude 30 mT/m, slew rate 125 T/m/s) will
provide better image clarity and thinner slices than GE SmartSpeed gradients (amplitude
23mT/m, slew rate 50 T/m/s).

The higher the amplitude and slew rate, the higher the cost of the MRI system. Although you’ll
be getting more anatomical slices and clearer images, you’ll have to first determine if the
additional costs can be justified by your patient volume and the type of studies you perform.
Any reputable dealer will be able to consult with you to help you determine what is best for your
practice – just ask!

Coils
Most MRI systems come with a standard set of coils. The coils in this set will cover your needs
for most common scans (hence their inclusion in the standard set). The exact makeup of this
set can vary slightly by manufacturer, but the most common coils include:

• Head
• Neck
• Spine
• Shoulder
• Body
• Knee
• Large and small GP flex

If you would like to expand your scanning capabilities, you can invest in additional coils. We’ll
talk more about that in chapter 3.

For a complete listing of Block’s available systems and services please visit 10
www.blockimaging.com
How Do I Know I’m
Getting a Good System?
How do I know I'm getting a good system?
This is a frequent question from customers who have never before considered purchasing a
used MRI. There are a lot of ways to confirm a system's quality. We recommend the following.
Start thinking about these early on to allow time for any changes to be made!

Inspection
Be sure to have the MRI inspected before you pay. Either inspect it yourself (with
your tech?) or hire an engineer to inspect on your behalf. This will likely cost you
$1,500 - $3,000, but is well worth it. This will let you get to know your prospective
system’s current and recent performance, its overall condition, and the environment
it's been operated in.

Records
Any records you can get will be useful. Error logs, service reports, quality control
checks, accreditation certificates- each of these documents will help paint a picture
of how well an MRI has performed and how well it’s been maintained.

Refurbishment
We’ll be frank with you: refurbishment simply doesn’t mean as much for an MRI as it
does for other modalities. With MRI, the very design of the equipment means there
are very few moving parts and this dramatically reduces the need for “under-the-
hood” restorative work to any of the internal (and expensive) electronics. If regular
maintenance has been performed on the system, refurbishment on the scale seen
among other equipment types is rarely necessary. Because of this, a “refurbished”
MRI has often received little more than light cosmetic restoration.

References
This is a simple request to make of your vendor: 3 references. Current customers,
past customers, business partners- anyone who’s had to put trust in your prospective
vendor. This will tell not only what to expect from the product, but also from the
service and follow-through of the vendor.

Accreditation
It’s important to consider whether or not the system you’re looking at will be eligible
for accreditation but, ultimately, this is not something your vendor can answer for
you.

Accreditation occurs once a magnet is installed and operational and is done by a 3rd-
party accreditation company. Receiving accreditation involves checking the quality
of the magnet scan, the equipment, the room it’s installed in, and even a facility as a
whole. Because dealers do not offer accreditation services, the buyer is responsible
for making sure their facility is compliant to receive accreditation and, thereby, the
applicable reimbursements.

For a complete listing of Block’s available systems and services please visit 12
www.blockimaging.com
How Much
Will This Cost?
How much will this cost?
System
First and foremost on the list of costs associated with an MRI project is, of course, the MRI
machine itself. Pricing for your system will vary across a number of factors (magnet strength,
make, model, vintage, etc.) but at present, used MRI machines average inside the ranges
below. NOTE: the prices in this chart include equipment only.

$150,000 or less $150,000 - $300,000

Hitachi Airis II Siemens Concerto GE 1.5T Excite HD
Hitachi Airis Elite Siemens Magnetom C GE 1.5T Excite HDE
GE Optima 430S Extremity Siemens Symphony GE 1.5T LX Mobile
GE Ovation Siemens 1.5T Symphony 8ch Hitachi Aperto 0.4T Open (not available in US)
GE Profile series Siemens 1.5 TIM Symphony Philips Achieva 8ch
GE 1.5T Excite II Toshiba Vantage AGV Philips Achieva 16ch
GE 1.5 LX Toshiba Vantage XGV Siemens Essenza
Philips Intera Achieva Toshiba Vantage ZGV Siemens 1.5T Symphony Mobile
Philips Intera Toshiba Titan

$250,000 - $400,000 $400,000 +

GE Excite HDi GE 1.5T Optima 450W
GE 3T Excite HDXT GE 3T Discovery MR750
GE 1.5T Excite HDXT Philips 1.5T Ingenia
GE Optima MR360 Philips 3T Ingenia
Philips 1.5T Achieva 32ch Siemens Aera
Siemens 1.5T TIM Avanto Siemens Espree
Siemens TIM Trio 3T Siemens 3T Verio

Want to see customized pricing for your MRI machine project?

Use this handy form to describe your requirements.

For a complete listing of Block’s available systems and services please visit 14
www.blockimaging.com
How much will this cost? [continued]
Coils

As we mentioned earlier, your system will most likely come with a set of commonly used
coils (if it doesn’t, you might want to reconsider your vendor choice). However, there are
more specialized coils or higher-grade coils that can be purchased separately to add to your
capabilities.

16 to 32-Channel Coils
The most expensive coils fall in the 16 to 32-channel category. New MRI coils in
this category cost between $40,000 (ex: wrist coil) and $120,000 (ex: breast biopsy
coil) depending on size and application. Refurbished 16 to 32-channel coils are not
always easy to find on the secondary market, but when they are available, a used
parts vendor can save you an average of 40 or 50% off the price of a new one.

4-Channel Coils
Less expensive coils fall in the 4-channel category. Buying them new will cost
anywhere from $12,000 (ex: wrist coil) to $40,000 (ex: neurovascular coil). Refurbished
4-channel coils are plentiful. These will only cost an average of $6,000 to $12,000.

Service

Note that the figures in this chart represent current averages for MRI systems in fixed locations.
Service pricing for MRIs installed in mobile trailers varies greatly depending on which type of
magnet is installed and how far/how often it will travel. Service numbers for these systems need to
be addressed on a case-by-case basis. Key features within MRI Service include helium (cryogen),
preventative maintenance visits, coils, chiller, parts, labor, travel, and overtime coverages.

For a complete listing of Block’s available systems and services please visit 15
www.blockimaging.com
How much will this cost? [continued]
Accreditation

As we mentioned in our previous discussion of the topic, accreditation is difficult for an

equipment vendor to quantify in any sense. The costs associated with it will vary depending
on two things:

1) Which accreditation company you choose to work with- Each accreditation company
will have its own fee schedule

2) How close your existing facilities are to compliance with their standards- Any number of
modifications may be needed requiring any number of contractors or amount of materials

Because these costs are so difficult to quantify, the best advice we can offer is to be aware of
the possibilities and begin planning for them early on in your project.

Site Prep
This aspect of your MRI project involves too many variables and parties to give any sort of firm
number. Preparing your facility for an MRI installation may require you to work with engineers,
building contractors, electricians, architects, and any number of other specialists depending
on how your existing building is set up. The costs for their services and the materials they’ll
require will need to be determined on a case-by-case basis.

Download the MRI Project Planning Guide

Logistics

This is another area in which costs will vary. Location of your site and even your floor plan
will play a part. There are, however, certain aspects of your MRI logistics that we can mention
rough ballpark pricing for:

Deinstallation
If your site has an existing MRI, clearing the way for
your new purchase will be a part of your cost scenario.
Talented engineers who can properly handle your system
are invaluable. There’s quite a bit more to deinstalling
an MRI than physically disconnecting the components.
Expect to spend around $10,000 for a deinstallation and
allow 2 - 3 days to get it done right.

For a complete listing of Block’s available systems and services please visit 16
www.blockimaging.com
How much will this cost? [continued]
Rigging
After your existing system is disconnected, rigging it
out of the building will be your next concern. Be sure to
use professional riggers who are familiar with medical
equipment. First floor rooms or those adjacent to
exterior walls are the norm, but there are exceptions.
For a “normal” removal, expect to spend approximately
$10,000 - $12,000 to get it safely on the truck. “Non-
standard” removals, will cost more and vary significantly
depending on the exit path at your specific location.

Transportation
Depending on your location and the location of your vendor, expect to pay between
$5,000 and $10,000 for overland domestic transport.

Installation
The installation of your MRI is a complicated project and involves ramping it back up
to field, laying miles of cable, precision tuning, and shimming, all of which requires
expertise and sensitive (and expensive) tools. Expect to spend between $50,000
and $80,000 for a “typical” installation of a 1.5T MRI System.

Helium
If you have a full service agreement covering your MRI, you won’t need to concern
yourself with this question or its answer beyond knowing that the cost of the helium
you are likely to use is built, at least in part, into the price of your service contract.

For those who opt out of a service agreement:

Due to the demand for helium and current
constraints on availability, prices continue to
rise. Because of these constraints, one-time
fills are almost never provided to customers
who do not have signed contracts with
suppliers. In the event you do get stuck with
the bill for a complete cryogen fill, it can cost as
much as $60,000. Fortunately, between the wide
availability of zero-boil-off magnets and quarterly
preventative maintenance visits, the need for
helium refills should be minimal after the first one.

For a complete listing of Block’s available systems and services please visit 17
www.blockimaging.com
The next step
The next step
There you have it: the basics for picking the system you need, finding a reliable vendor to
provide it, and setting preliminary budget expectations for the project. Whether you feel ready
to start combing the market or have more questions, we’re here to help you along the way
to making a great MRI pick. Contact us online or give us a call at 517-668-8800 to begin the
conversation.

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For a complete listing of Block’s available systems and services please visit 19
www.blockimaging.com