It’s only a matter of time before any hospital or clinic is faced with the daunting task of swapping out capital imaging equipment weighing several tons.

These operations can require breaking massive holes in the walls, and if they’re not done right, the space made to transport equipment can leave lots of room for other things too – like costly mistakes.

“Sometimes the choreography involved can be wild,” Brian Leiser, ACHE, zone vice president, BC Technical Inc. told HealthCare Business News. A former Marine who started in the business as an engineer 18 years ago, his company both direct contracts and performs work for OEMs. "Some folks think it's just another piece of equipment, and they'll figure it out, but it’s always a complex process.”

As a case in point, Leiser described an install/deinstall project that stands out in his mind as a prime example of the usual challenges, with a few zingers lumped in for good measure.

“[The client] had to spend money or they were going to lose it by the end of the fiscal year,” he said. “So, they had to buy and install the equipment very quickly." Where Leiser normally recommends a lead time of 90 days, this job would be compressed into six weeks.

The clinic, which was operated by a physician in rented hospital space, was replacing a PET-only system with a PET/CT on the fifth floor.

“The new equipment coming in was much larger,” Leiser explained. “So, how can we get this in? The elevators wouldn’t work. The only way we could do it was to cut a hole in the side of the building and crane the equipment up and push it through in pieces.”

All this required review and approval from the state, the owner of the building and engineers. Roads had to be blocked to get the crane on site, hospital parking lots had to be closed and, as with most installs, a local construction crew was needed to get the room ready.

If all that wasn’t complicated enough, an initial meeting with the hospital engineer revealed that the floor would not support the incoming PET/CT, so a very heavy steel plate had to be fabricated off-site, craned into the building and bolted onto the structure to disburse the weight across two floor beams.

“Now the power is different, the HVAC is different, flooring and walls are different. Plus we have to fix the 10 by 20-foot hole in the side of the building five floors up. And all this is happening at once. On top of this, in an area that doesn't get much rain, it started raining on us,” Leiser recalled with a laugh.

In the end, to BC Technical’s credit, the job was successfully completed on the expedited schedule.

Working as an ambassador to the OEM
There are few, if any, medical equipment installation jobs more costly or involved than that of a proton therapy cyclotron. When the Emory Proton Therapy Center in Atlanta was preparing to take on this multimillion-dollar endeavor, the city considered it a major investment. Both the governor and the mayor were among the dignitaries on hand to watch the two-hour installation process.

The job was conducted by Remetronix, a leading installation company that primarily partners with equipment manufacturers. "The OEMs are governed by a lot of regulatory responsibility, and that's how we operate too," said Russ Knowles, company CEO and owner.

Over his 26 years with the company, Knowles says he has been involved in about 40,000 jobs. While OEMs have high standards for contractors such as his company, he said his workload is very predictable and most projects only require three weeks of notice.

According to Knowles, the Atlanta proton job, like most of their projects, went off without a hitch.

He credits his success record, in part, to a detailed 40-point project management tool. He also relies on interpersonal skills and aptitude testing to screen potential new-hires for vital customer service skills. In addition, Remetronix spends about half a million dollars a year on safety, training and other certifications to meet 20 OEM standards.

“This business is a lot more than turning a wrench,” he explained. “In the Atlanta projects, my staff was onsite for up to seven months, sometimes working 10 hours a day. The crew needs to have good customer service skills, to know what to say and what not to say. They are acting as an ambassador for the OEM.”

For Cam Thomson, project manager with Oxford Instruments, quality installs and deinstalls boil down to a few key factors: open and clear communications, assigning specific tasks and responsibilities, schedule enough time and insist on excellent preplanning.

Like Remetronix, Oxford utilizes a robust project management software to make sure they meet these goals for their customers.

“Many jobs stall because of poor preplanning and inability to be able to respond to challenges that arise, and lack of resources. Site egress issues, not knowing the policy and procedures of the facility you are working in, can add to delay,” said Thomson.

Communicating with the onsite construction crew
One of the most common holdups in an install/deinstall job is when unforeseen delays with the onsite construction team take place. Often times, these days can be attributed to a lack of familiarity with the technical aspects of imaging equipment, such as power requirements.
“We run into ... the construction folks telling the customer that the site will be ready, and when we go to do the inspection prior to delivery, the site is nowhere close to being done. We run into (this) all the time,” said Bob Iravani, owner of Chicago Medical Exchange Inc. which sells new and refurbished medical equipment.

In order to help mitigate these speed bumps, Iravani and his team make it a point to monitor the work of the construction crew. As part of that, they carefully check hallway and ceiling heights to make sure that no damage is done in the moving of the system, and think about the timetable required to get the installed system into operation after it is in place.

On one occasion when Chicago Medical Exchange was removing a CT scanner from the third story of a facility, Iravani’s crew was not able to get the crane close enough onto an adjoining underground parking garage. There was concern that the crane might collapse the structure.

“We had to get a crane that was four times more than the weight required because we had about 100 feet of reach. This was an additional cost because we couldn’t use the simple rig,” said Iravani. “So I watch out for parking garages – and underground walkways.”

Some projects are obviously less complicated than others, like an X-ray room versus a CT or MR system. Generally, Iravani recommends at least two to four weeks of advanced planning from a client, but he said his company will show up whenever they are needed.

“The more time we have to plan for it, the better it is more likely to go,” he said. “The secret is to plan, plan, plan – and plan some more to prevent surprises.”

Insights from the OEM
For equipment manufacturers aiming to get their system installed at a provider’s facility, picking the right company to partner with makes all the difference.

“Consider all factors before accepting a bid for existing equipment from a broker. There are [many] companies in this business with varied degrees of experience and technical skills,” said Edward Thieman, vice president of business operations for Virtual Imaging Inc., a Canon Company. “Depending on their experience, the success of the project can certainly be impacted in terms of timeline, safety risks and viability for partial or whole reselling.”

In planning an install, potential downtime and the entire cost of equipment ownership are factors that he thinks should be included when crunching the numbers. For instance, if one company can complete an installation in a week, how much revenue will a facility save over another company that takes four weeks?

Thieman stressed the importance of cybersecurity considerations and properly disposing of any equipment hard drives that may contain sensitive patient information. He recommends that that the biomed and IT managers be involved in any deinstallation project.

For equipment coming into the facility, ensuring interconnectivity with existing systems should be one of the first objectives.

“Companies that are good at this (interconnectivity) will advise you as soon as you ask,” said Thieman. “It shouldn’t take a week … to get an answer. This means they do not have a standard program in place.” Looking back over the roughly 1,500 imaging equipment installs in his career, Thieman recalls a particularly precarious project involving an MR magnet and some less-than-ideal geographical circumstances. At this job site, the crane operator had to build a 200-foot-long platform across an eight-foot-wide entry point into the side of a building.

“This was very uncomfortable because one wrong move and the magnet would have toppled onto a hill with about a 45-degree slope that ended at the bottom of a river,” he said. “The planning took three pre-visits with riggers to come up with the optimal solution.”

Thanks to careful planning and an expert team, the project was successfully completed.

The independent service value proposition
One of the best things a facility can do prior to contacting anyone about a potential install/deinstall project is conduct a cursory inspection of the space. Chad Jones, CEO at Buckeye Medical Solutions, an Ohio-based company that specializes in install/deinstall projects, reports that three out of five times they discover issues that weren’t considered when initially planning the project.

The advantage of an independent operation is being able to provide more competitive pricing than some of the larger companies and OEMs. According to Jones, one healthcare company was quoted $68,000 for a project he was able to complete for $27,000.

“That same company has stopped using OEMs and has had us do 17 projects for them,” he said. “In my 20-plus years of doing this type of work, I've been to all the OEM's for training and certifications.”

Brandon Transfer & Storage, a Florida-based moving company with a specialty in medical equipment, takes pride in delivering what their healthcare clients are asking for, even when the circumstances are less than ideal.

"We've taken an MR magnet out on one day's notice,” said Steve Lewis, an owner of Brandon, who has 50 years of experience in the family business. “We worked around emergency rooms with ambulances coming and going with cranes. We're pretty accommodating about what needs to be done.”

Lewis, who estimates the company does one or two install/deinstalls per month, doesn’t advocate for a one-day turnaround. He thinks it’s better to space things out so that you don’t have all the contractors on the site at one time but allow each one to do their job well.

Unfortunately, all the time and space in the world is irrelevant when a provider fails to connect the dots on issues preventing the relocation of a particular system, which was the case on a recent East Coast assignment for Buckeye Medical.

“A few months back, we had a customer reach out to us for a deinstall of a PET/CT to relocate it to their new facility without a prior site inspection,” recalled Jones. “We dispatched our team to the site, and upon arrival the first thing we discovered was that the current owner had the original freight elevator removed and two passenger elevators put in its place.”

In other words, the way the system came in was no longer available to be the way it went out. To further complicate things, using a crane to remove the system through the fourth story window was prohibited by city codes and an ordinance intended to keep the major street below from becoming congested.

Ultimately, the customer had to make the tough decision to cut down the new machine so it could be moved in the existing passenger elevator.

Jones said the best thing a provider can do to make sure they are prepared for an install/deinstall project is pick up the phone and have a free conversation with the company they plan to enlist for the work. “Another very important factor is if you are planning an install/deinstall, please have us come inspect the job prior to the job starting,” he added.