Of refurbs, upgrades, and 3Ts

It's bargain hunting time in the MR world, and there are plenty to consider. New systems operating at 1.5T can be had for under a million dollars. A million and a half will buy you a new system tricked out with about any application within the reach of that field strength. This is a bargain in itself, considering how much more a new 1.5T can do today than it could five years ago -- for about the same price.

But the best deals may not be the most obvious. Some don't come off the production line but off leases. They are MR scanners that have run a five-or-so-year course of payments, leased systems whose users would rather send them back to their makers than keep them. They're old by contemporary standards. Their software is outdated; their cowlings faded. But they can be had for about a half million dollars and upgraded to state-of-the-art for a total price hundreds of thousands of dollars less than a comparably equipped system straight from the factory.

They are the diamonds in the rough, products made by original equipment manufacturers that will be more than happy to bring them up to snuff. Vendors are banking on upgrades to bolster their otherwise sagging bottom line in MR, one they expect to droop for the rest of this year and into next. Ironically, they are struggling especially at 1.5T despite the fact that this field strength accounts for the majority of unit sales and revenues in MR.

Just as with annual sales, the installed base of MR scanners in the U.S. comprises mostly 1.5T scanners. This status quo is likely to continue for at least the next five years. The reason is simple. These scanners will do what most radiology departments need done, a propensity that has made them the clinical workhorses of this modality for more than two decades. They won't, however, do the most advanced applications. And that brings us to another of the less obvious deals out there: 3T.

The signal-to-noise advantage of this field strength is extraordinary, a fact known for years but not well appreciated in clinical realms because of the skill level needed for these systems to achieve their potential. The latest breed of 3T scanners, however, has rendered this argument moot. Tailored sequences, advanced electronics, and workflow improvements have delivered on vendors' five-year-old promise to make 3T the new clinical benchmark.

Research studies, such as the one done at the University of Toledo Medical Center in Ohio showing 3T's knack for finding breast cancer, underscore the clinical possibilities (3T detected 66/66 malignant lesions; mammography detected 54/66; and sonography detected 57/66). But much more is waiting in the wings.

With so much of the future of healthcare hinging on improving patient outcomes, medical imaging is being pushed beyond diagnostics. In the years ahead, MR will have to help in the management of cancer patients through the staging of their cancers and monitoring of their response to therapeutics. The improved signal-to-noise of 3T offers an enormous advantage in what might be achieved through virtual biopsies performed using MR spectroscopy.

In this context, the best deal in MR today may be the most expensive one, the purchase of a 3T scanner that can keep its owner on track to meeting the difficult clinical challenges that lie ahead. Their $2 million price tags may be tough to swing, but just as old 1.5T systems can be refurbished to state-of-the-art today, 3T systems bought today will be the refurb candidates for tomorrow.