This month, the ICE Magazine roundtable discussion is focused on X-ray machine technology, management, and innovation.
Diagnostic imaging professionals participating in this roundtable discussion are:
- Angela Bosh, Director of Imaging and Cardiopulmonary Services, AdventHealth
- Chris Beasley, Imaging Director, MU Health Care
- Robert Hinton, Technical Director/Radiology Imaging Equipment Specialist, and Zachary Carr, Diagnostic Imaging Quality Lead Tech, The Ohio State University Wexner Medical Center
- Jill Jones, Associate Director of Medical Imaging, Banner Imaging
- Josh Miller, Manager of Technology, Manager, Technical Operations and Service Engineers, Corewell Health
Q: WHAT IS THE TYPICAL LIFESPAN OF AN X-RAY MACHINE IN YOUR FACILITY, AND HOW DO YOU DETERMINE WHEN IT’S TIME TO REPLACE IT?
Bosh: Within radiology, each imaging modality has a different useful life. Although manufactures provide end-of-life (EOL) timelines for equipment, often parts and repairs extend years beyond that EOL timeline. EOL for equipment and equipment downtime frequency can be a key driver in prioritizing the replacement of equipment when it may be the only unit at your facility. Specific modalities within radiology require more frequent upgrades, updates or replacements to meet market demands. However, there are several other factors to consider when determining when to replace equipment including:
- Downtime frequency
- Useful life
- Depreciation/book value
- Technology requirements for new service lines
- Upgrades/updates available for current system
- Lead time of equipment once ordered
- Construction timelines for updated code requirements
- Market needs and growth
- Efficiency in scan/exam time
- Security issues with current operating system of medical equipment
- Mobile or alternate location to provide services during construction
Beasley: Lifespans vary. In general, 10-15 years.
Hinton: The average lifespan of X-ray equipment across our facility is currently approximately 8.5 years. However, we have plans to replace older systems within the next 1-2 years, which will impact this figure. Over the past year, we have already replaced four systems as part of our ongoing modernization efforts. When evaluating equipment for replacement, we consider several key factors, including age, service history, maintenance costs, potential IT risks, and overall impact on operations.
Jones: The lifespan of the X-ray machines in our facilities are 15-20 years old. They are placed on an aging list to be replaced once they become end of life for parts or upgrades.
Miller: We assign a 10-year useful life to all fixed X-ray assets. The average age of our fixed X-ray install base at Corewell West is 8 years. We evaluate equipment replacement based on the following elements: equipment risk, reliability, service support, life cycle stage, maintenance cost, patient safety, overall product quality, technology status and clinical staff productivity.
Q: WHAT FACTORS INFLUENCE YOUR DECISION TO REPLACE OR UPGRADE AN X-RAY MACHINE (E.G., COST, REGULATORY COMPLIANCE, TECHNOLOGICAL ADVANCEMENTS)?
Bosh: When equipment needs refreshed, it is my goal to upgrade equipment whenever possible to reduce overall cost and downtime. However, the exception to performing an upgrade versus full replacement is when there are limitations in feature/functionality.
Beasley: Replacements are often determined by a blend of several considerations. For example, utilization, downtime percentage, technology obsolesce, equipment age, end of service life status, and cost.
Hinton: The decision to replace or upgrade an X-ray machine is influenced by factors such as regulatory compliance, technological advancements, cost considerations, performance, and integration with existing systems (PACS and EHR). Ensuring compliance with evolving industry standards and leveraging new technology for improved imaging quality and efficiency are key drivers. Financial feasibility, service availability, and patient throughput also play crucial roles in the decision-making process. In recent years, a more evidence-based approach has been adopted, referencing data from organizations like ECRI and the American Hospital Association, consulting with vendors and clinical engineering teams, and considering end-of-life and end-of-support notifications. This strategic approach ensures that imaging infrastructure remains reliable, efficient, and aligned with industry best practices while optimizing patient care and operational sustainability.
Jones: Cost, Regulatory compliance, technological advancements and user friendliness are all factors that we consider when replacing X-ray equipment. Construction costs for floor mounted versus ceiling mounted units are a consideration as well.
Q: WHAT EMERGING X-RAY TECHNOLOGIES OR AI ARE YOU EXCITED ABOUT?
Bosh: I am very excited about the AI advances that provide enhanced imaging capabilities, advanced throughput and improved quality. I am also interested in the expansion of virtual capabilities that provide shared staffing models in certain modalities.
Beasley: We’ll continue to see the reading assistive technology to help streamline the radiologist’s workflow. This will include both diagnostic aids as well as reading prioritization assistance.
Hinton: There are several things. I guess we could break it down into a few categories: supporting technologies, system features, and benchmarking.
- Supporting technology would be things that support data analytics. If a department expects to keep track of things like repeat/reject rates, exposure trends, or technologist performance, they are going to need a robust system that can provide that information easily. EMRs can only do so much in terms of quality metrics, we’re going to need better software to manage these metrics. A lot of the large vendors have caught on and are building their platforms now. I look forward to seeing what they come up with.
- System features: Automation and safety features will probably have the largest impact on future X-ray systems. Things like barcode scanning patient wrist bands to bring up the patient on the modality screen. I’ve seen at least one company that can use facial recognition to ensure the correct patient is performed. A lot of large vendors are putting efforts into integrating automation features in their systems. Power driven tubes that line up with the correct detector, auto-selection of protocols based on order, etc. Detector technology will keep moving forward as well. Vendors are going to keep making their detectors lighter, more durable, better batteries with improved resolution and higher detector quantum efficiency so we can use less radiation to achieve the same image quality.
- Benchmarking: There are some projects from the American College of Radiology and the American Association of Physicists in Medicine to create benchmarks for exposure. This has been needed for a few years now, and I’m excited to see what they come up with. This will go a long way to help reduce overall patient dose for radiography.
Jones: Emerging AI technologies that excite me are the use of AI to assist radiologists with interpreting images. Using AI to analyze images and data to identify abnormalities and patterns will be very useful. Using VR for training can create immersive learning for technologists as they learn new equipment and procedures.
Miller: Advancements in solid state digital detectors. Specifically, the reliability and lower radiation dose.
Q: WHAT IS YOUR FACILITY’S APPROACH TO PREVENTIVE MAINTENANCE FOR X-RAY MACHINES? (DO YOU USE IN-HOUSE SERVICE ENGINEERS, THIRD-PARTY OR OEM?)
Bosh: At our facility, we have partnered with one company to support equipment via a third-party for a majority of our imaging equipment.
Beasley: All three can be a viable approach.
Hinton: Our facility employs a comprehensive preventive maintenance strategy for X-ray machines to ensure optimal performance, regulatory compliance, and patient safety. We utilize a combination of in-house service engineers and third-party service providers, depending on the specific needs of each system. Our clinical engineering team plays a central role in managing service contracts for all imaging equipment, ensuring that maintenance agreements align with operational and budgetary requirements. They also establish and oversee a planned routine maintenance and preventive maintenance schedule to proactively address potential issues, minimize downtime, and extend equipment lifespan. While our in-house team handles routine inspections and minor repairs, we collaborate with OEM service providers and authorized third-party vendors for specialized servicing, software updates, and complex repairs. This structured approach guarantees continuous system reliability, regulatory compliance, and the highest standard of patient care.
Jones: My facility has in-house service engineers that we work with for the preventative maintenance on the equipment. They do often send it out to third-party vendors based on service contracts or the makes and models of the equipment.
Miller: Corewell West uses a combination of in-house service engineers, OEM and third party. Our approach to service is influenced by the education/training level of our in-house engineering team, service contract costs, replacement part costs, end of service life status, etc. Our goal is to utilize the in-house engineering team over service contracts when possible. We have a robust team that is well trained and brings a lot of experience. We are continually investing in the professional development of the team to ensure that we can maintain and repair the equipment in a timely manner. If we do not have the ability to maintain an X-ray system in house, we typically look first to the OEM to provide service. Third-party service providers are typically evaluated for equipment that is deemed end of service life by the OEM.
Q: HOW DO YOU HANDLE UNEXPECTED MACHINE DOWNTIME TO MINIMIZE DISRUPTION TO PATIENT CARE?
Bosh: Unexpected downtimes are a challenge for every leader especially in cases where you may only have one machine for that modality. To minimize the impact to patient care, we work closely with our service team to expedite the repair or issue that is causing the downtime. If extended downtimes occur due to delays in the repair, we work with our sister facilities to ensure patients are treated timely through a robust transfer process.
Beasley: Different units have different organizational and operation impacts. In critical places such as CT in the ED, the redundancy of a second unit is important. Redundancy is a tactic that should be considered, however in some circumstances capital constraints makes this untenable. When unable to create redundancy, plans should be made in advance to determine alternate workflows. Other considerations to be considered would be to redirect off site, rescheduling, or choosing an alternate modality.
Hinton: We are actively working to analyze and refine our approach in this area. To minimize disruption to patient care during unexpected X-ray machine downtime, our facility has a structured contingency plan in place. Our clinical engineering team prioritizes rapid diagnostics and triaging, leveraging in-house expertise to quickly address minor issues. Given our focus on equipment standardization across our large institution, we primarily utilize Siemens imaging systems. For more complex failures, we engage vendor-specific service providers or authorized third-party vendors under pre-established service contracts to expedite repairs. Additionally, we maintain redundancy within our imaging fleet by designating backup units or reallocating patient cases to alternative imaging modalities when feasible. In high-volume areas, we implement proactive scheduling adjustments and closely coordinate with clinical teams to minimize patient impact. Regular preventive maintenance and system monitoring further help mitigate the risk of unexpected failures, ensuring consistent, reliable imaging services.
Jones: Most of our facilities only have one X-ray room per outpatient site. When we have the unexpected downtime, having the communication available to staff scheduling patients helps to get the patient scheduled at another close facility or for another day at our facility. Our service engineers work diligently to try to prevent an extended period of downtime.
Miller: From the radiology engineering standpoint, we always take first look to see if we can immediately troubleshoot and repair the asset to minimize downtime. If not, we engage the service supplier. The engineering team communicates with the clinical team/leadership team in downtime situations. This includes text, email, phone and in person conversations. Updates include equipment issues that were found, part delivery/arrival updates and overall updates on when the equipment will be returned to clinical use.
Q: WHAT ADVICE WOULD YOU GIVE TO RADIOLOGY DIRECTORS LOOKING TO OPTIMIZE THEIR X-RAY DEPARTMENTS?
Bosh: Why reinvent the wheel? Reach out to your vendors for the most up-to-date information. Also, reach out to peers to validate what the vendors suggest as value-ads when replacement equipment. Assess the financial impact of not having the technology and evaluate your market trends to remain competitive within your market.
Beasley: There are a lot of moving parts in any department. It’s difficult for any singular leader to know all the nuances of a given situation. So, learn to get into the details of your operations with your front line team members. They can help you understand where you do and do not have operational capacity. When capacity is exhausted, learn to work with administrators to make the case for expanding resources, such as equipment and staffing.
Hinton: I know imaging systems are expensive, and there is probably a desire to spend the least amount of money possible. Look for the best value, not the cheapest option. Some options are worth the cost like automation, and expert training on the equipment. The physics of X-ray exams hasn’t changed much, but the systems are getting more sophisticated. It’s worth it to spend the money to properly train your technologists to fully utilize these modern systems. Make sure your rooms are big enough! Small cramped X-ray rooms will limit your ability to adopt better systems and optimize throughput. Spend the money on supporting software that can help you analyze things like repeat rates and exposure trends. I have a feeling these are going to be reporting requirements in the future.
Jones: Outpatient imaging department X-ray volumes have increased in the past few years. Accurate staffing ensures that patients are in and out of the facility in a timely manner. If it is an option, having two technologists working together or a technologist with an assistant, as this helps to keep the workflow moving smoothly and timely.
Miller: Maximize your assets. The patient demand has changed as many patients expect second shift and weekend options. Pausing on capital and using your equipment 12-16 hours per day 7 days a week extends that request versus adding another incremental piece of equipment.
This month’s article was sponsored by X-ray America. For more information on this company, visit x-rayamerica.com.
