The Roundtable: Nuclear Medicine

This month, Technation explores current trends affecting purchasing and service in the nuclear medicine equipment market. Expert responders address issues ranging from the popularity of new modalities and handling limited capital budgets, to maintaining older cameras. Responders include Danny Hamm, vice president of sales for InterMed Nuclear Medicine Services; Nik Iwaniw, vice president of marketing and services for Univer- sal Medical Resources and John Shaw, president of Northeast Electronics.

What are the biggest trends right now in the nuclear medicine equipment market?
Danny Hamm: A major trend is the acquisition of cardiologists by hospitals. Most specialists in private practice who own cameras are cardiologists. The majority of cardiology practices are now being bought out by hospitals – half of our cardiology customers are now owned by a hospital. Most of the hospitals are leaving the practices alone to function independently with what they have, but in some cases they remove the cameras and refer patients to the hospitals for nuclear testing.

With the economy the way it is right now, the market is good for reconditioned cameras. Nobody wants to spend money, but if they have to buy a camera, they’re a lot more apt to buy a reconditioned camera, either from us or another reputable company that refurbishes and sells like new. But the market is also affected in the opposite direction. Because hospitals are buying cardiology practices, cardiologists don’t need to buy as much equip- ment, because they can use the more modern one at the hospital when they need to, and keep what they have at the office.

NIK IWANIW: From an equipment perspective, SPECT/CT and PET/CT have captured the attention and focus of the nuclear medicine community and are two imaging modalities that are highly visible in molecular imaging scientific literature and clinical use. These systems, in addition to SPECT systems, have provided important contributions for the diagnosis of cardiovascular disease, cancer and more recently, functional brain imaging.

JOHN SHAW: Our target market for sales as a third party or an independent company really depends on doctor’s offices; they buy nuclear medicine equipment primarily for cardiology. We’ve seen hospitals buying out these offices and the doctor goes to work for the hospital, the hospitals are absorbing that equipment, and often shutting down the imaging portion to bring the busi- ness back to the hospital. It’s not necessarily a good thing for our business, because there’s less demand for refurbished equipment. Most large hospitals will have four or five machines, so when they replace a machine, 99 percent of the time they’ll replace it with a new machine.

In new equipment, there are pretty much only three players left: Siemens, Philips and GE, and a lot of the cameras offered are made in Denmark, so a lot of nuclear medicine equipment made has been made by one company. It seems like the manu- facturers aren’t very invested in nuclear medicine, because it’s not a big revenue generator.

How will the market evolve in the next five years? How will that affect the service of equipment?
HAMM: A lot of it really hinges on what happens with reimbursements. CMS slashed reimbursements for specialists, so it’s really demotivated people from entering into the modality of nuclear medicine. The profit margin is not there for a private practice to go buy a camera and start doing nuclear studies on its own. By the time you pay for a new camera, your tech and service, isotopes, and all the costs associated with accreditation, there isn’t a whole lot of room for profit unless you have a very high volume. So people are keeping their current equipment longer. One thing we’ve had more requests for lately is to update the computer system, or workstation, and keep the current camera, as opposed to going and buying a whole new system. The fastest growing trend in the acquisition of nuclear medicine studies is the half-time imaging, or wide-beam construction. Each of the manufacturers has its own of course, and then there is third-party software, which you can add on pretty much any OEM’s camera. The software reduces the time that it takes to acquire the image, so facilities can get more patients through. It also reduces the dosage necessary to perform the study, so everyone is exposed to less radiation.

IWANIW: Budget constraints brought about by the current economic environment have required hospitals and imaging centers to retain and utilize existing nuclear medicine equipment for a longer period of time. There is little indication this trend will change in the future. As a result, clinical engineers may encounter issues locating good parts and technical provid- ers. Subsequently, effective preventative maintenance pro- grams will become important. In some cases this may warrant increased preventative maintenance frequency.

SHAW: Right now, everybody thinks that PET is going to take over nuclear, and that it’s going to be the way to go. A lot of manufacturers have gone to the hybrids (SPECT/CT or PET/CT) and, in my opinion, that’s the buzzword that everybody wants to hear. I believe there is a political angle to this too, if health care becomes run by the government, we’ll see PET go away because it’s too expensive, and the less-expensive SPECT will become more popular. If not, PET will become the major modality. The price will come down eventually, just like CT did, and people will have two or three PET cameras and one SPECT camera.