U.K. cancer screening initiative will replace old imaging equipment

The British government has embarked on a major initiative that will involve extended cancer screening services and an injection of new funding to replace old equipment and install new systems.

More than $435 million will be invested by 2004 in new National Health Service equipment to purchase 50 MR systems and 200 CT scanners (150 of which will replace old units). Of this total, some $211 million was allocated earlier this year to modernize cancer equipment. The bulk of this sum will be used to purchase the CT scanners.

“By 2004 all CT scanners in the NHS will be less than 10 years old,” said Health Secretary Alan Milburn.

According to the Department of Health, early indications are that multislice CT scanners will make up “a significant proportion” of the scanners purchased.

“By 2010 our five-year cancer survival rates will compare with the best in Europe,” the government said in a statement outlining extensive reform plans for the NHS.

More tests mean more personnel needed

The National Breast Screening Program—currently offered to women aged 50 to 64—is being extended to include women up to age 70. The use of two-view mammography is expected to result in a 40% improvement in detection rates. The addition of 400,000 women to the current 1.2 million already screened each year will require a 40% increase in skilled staff.

To meet this need in a country where there is a shortage of radiologists (fewer than 1500), a pilot program creating a new grade of “assistant practitioner” is beginning this month. These assistants will take the mammograms under the supervision of a qualified radiographer, thus freeing up more time for radiographers.

Additionally, the NHS will upgrade its cervical cancer screening program and introduce a new national screening program for colorectal cancer.

There is no central inventory of U.K. imaging equipment, although various attempts have been made by independent sources to assess the age and number of installed systems. A survey by AXrEM, the U.K. industry association of x-ray equipment manufacturers, shows that more than 75% of MR systems are less than five years old, while more than 10% of CT scanners are over 10 years old. X-ray equipment is even older, with almost 60% of radiography equipment older than 10 years—the realistic lifespan of equipment before it should be replaced, according to NHS guidelines.

In the time since this equipment was bought, advances have been made not only in reducing the radiation dose, but also in improving image quality and decreasing maintenance costs, AXrEM’s director, George Fraser, told the Royal College of Radiologists in December 1999.

“So it can be not only false economy but unnecessarily risky to keep old x-ray equipment in use,” he said.

The latest survey of installed electromedical equipment in Europe by the Coordination Committee of the Radiological and Electromedical Industries (COCIR) indicates that the age profile of U.K. equipment is worse than that of its neighbors for certain modalities. Based on data from the end of 1998, the industry survey found that 12% of the 387 CT scanners in the U.K. were older than 10 years, compared with an average of 9% for the other eight European countries included. Some 7% of 235 MR systems in the U.K. were older than 10 years, compared with 4% for the total. Of the 765 mammography units in the U.K., 72% were installed before 1993 (62% for all countries).

National lottery providing part of equipment funds

The planned purchase of 50 MRI scanners, which will increase cancer detection and improve staging through an additional 190,000 procedures annually, comes on top of a purchasing program already under way—using money from the national lottery.

The New Opportunities Fund (NOF), which distributes national lottery money to good causes, is providing $218 million to the national cancer program, of which $135 million is being used to buy 33 MRI systems (21 new scanners, 12 replacements), breast screening equipment (including 229 additional and replacement x-ray machines and 47 ultrasound scanners), and 56 linear accelerators for hospitals in England.

(Because different equipment purchasing and management systems operate in the four U.K. countries, health authorities in Scotland, Wales, and Northern Ireland are coordinating their own applications for equipment. The NOF expects to make the grants available to those countries early next year.)

The first MRI systems purchased under the NOF allocation have already been installed. The majority of them are 1.5-tesla machines.

“There is still a long way to go; investment needs to continue for quite a few years,” said Janet De Wilde of MagNET, which evaluates MRI systems as part of an independent program supported by the U.K.’s Medical Devices Agency.

The NOF program contributed to a lull in the $36 million MRI market. When the availability of funding was announced in September 1999, many hospitals that were looking to purchase new systems suspended order placements in anticipation of receiving a grant, according to John Atwill, U.K. sales and marketing manager for Philips Medical Systems. As a result, the current 6% average annual growth rate of MRI sales could slow in 2000 but see an upturn in 2001, with 10% growth projected for next year or 2002.

New technology development, improved affordability (a 1.5-tesla system costs between $1.02 million and $1.31 million), and increased usage are driving market growth, according to Atwill. Not only are physicians and clinicians making more referrals for MR examinations as they gain familiarity with the modality, but consumers are also demanding scans.

Private sector purchases have also helped to boost the market. At the end of 1998, 20% of the 235 installed MR systems were in the private sector, according to data from COCIR. Atwill believes, however, that the trend toward private funding partnerships or leasing arrangements, whereby management services take the risk on capital investment, will slow as system prices come down.