Vendors adopt strategy of 'swapping gantries' to upgrade CT customers

Forklift upgrades return with advent of 16-slice scanners

When CT vendors introduced quadslice scanners in 1998, they waxed optimistic that these systems might be upgraded by simply swapping out detectors for others capable of more slices. With the commercialization of 16-slice scanners, however, reality has scotched those expectations.

The four vendors of multidetector CTs are swapping mostly whole systems rather than detectors, especially when customers want to go from four to 16 slices. They have many reasons for this strategy. Such forklift upgrades are faster and easier. An old system usually can be hauled out and a new one bolted down in two to three days-about half the time needed to swap a detector. Whole-system replacements come with factory installation and QA of all components. Rather than having just a new detector and some selected hardware and software additions, these customers have an entirely new product.

Some end users choose to keep their old system and buy a new 16-slice scanner. Vendors like them the best, because the company does not have to transport, refurbish, or shop the old system around.

"In our price book, we call this package 'stay in place,'" said Chuck Armstrong, Philips director of diagnostic CT. "In essence, they trade in their old system but then buy it back from us."

All four vendors report that this is one of the most popular choices, bearing testament to the growing demand for CT exams as much as their powers of persuasion.

"We had the volume that would allow us to have two scanners, and we didn't want to have a dramatically different level of service between the two rooms," said Dr. Geoffrey Browne, chief of radiology at Alamance Regional Medical Center in Burlington, NC.

Since acquiring the Siemens Sensation 16, staff at the 160-bed hospital have been directing patients with the more challenging diagnoses to the 16-slice scanner. The system is being used to perform virtual bronchoscopy from data obtained during a chest exam. Complicated orthopedic cases and heart patients are also being sent to the system.

While expanding clinical applications were a big part of their decision to buy the 16-slice scanner, the continuing demand for routine CTs was the main reason for keeping the quadslice system, which also serves as a backup in case the Sensation 16 goes down. Other users have simply elected to trade their old system in for a new one.

"The nice thing about this is the siting," Armstrong said. "You lift the old system off the bolts, drop the new one down, and tighten them up. Then it's just a matter of connecting the cables and turning on the power."

The price charged customers for such a quad- to 16-slice upgrade is about a half-million dollars, according to Armstrong. Prices vary, however, depending on the customer and the age of the installed equipment.

Upgrading customers by bringing in a different machine seems anachronistic. In the early 1990s, customers complained of technological obsolescence in the fast-moving MR marketplace. Vendors responded with upgrades based principally on field upgrades requiring mostly software and only minimal hardware. Back then, CT had stagnated, a condition that was reversed with the introduction of multidetector scanners.

Still stung by criticism of forklift upgrades in MR, vendors said the detectors might be swapped out of installed systems when more powerful detectors became available. They were careful to note at the time, however, that all the mechanics of such upgrades had not been worked out and that system replacement might be more attractive.

Today, as then, none of the vendors volunteer the term "forklift upgrade." They prefer to use the term "gantry swap." But much more than gantries are being replaced, and that is advantageous to the end user, according to Douglas Ryan, CT business unit director for Toshiba America Medical Systems.

"They are getting all new components," he said.

Rotation times may be faster. Aquilion 16, for example, features a faster rotation time than its quadslice predecessor: 400 versus 500 msec. And there may be other niceties, such as a longer couch. One customer who chose to go with a gantry swap noted that replacement systems come with a one-year warranty. If the detector is swapped, only that part is covered.

Vendors work with customers to determine which upgrade path is the best for specific situation, considering the system currently installed, the desired upgrade, customer convenience, warranties, and the need to minimize downtime.

None of the four vendors recommends swapping quad- and 16-slice detectors. The weight and size of the detectors is so different that balancing and recalibration is a nightmare. Customers with a Philips dual-slice scanner, however, might consider upgrading their systems to quadslice detectors. Philips Medical has done some of these, according to Armstrong. But they are the exception.

Upgrading some machines in the future may be different, however. The 10-slice scanners introduced by Siemens and Philips late last year are equipped with detectors capable of producing 16 slices per rotation. They generate only 10 slices because they lack the software and computing capability needed to do 16, according to Berndt Schnakenberg, Siemens vice president of CT worldwide marketing.

No new analog-to-digital converters or electronics need to be added to these scanners. A relatively simple software upgrade and the addition of more computing power do the trick. The cost is about $250,000.

"Upgrading from 10 to 16 means exchanging the computer and software and doing the calibration," Schnakenberg said.

That does not mean that he expects a big demand for upgrades. History argues against it, he said.