In today's healthcare environment, reducing costs and improving
efficiencywhile adding value to patient care is on the radar screen
of virtually allhealthcare organizations. While many new and
emerging technologies promise todeliver on these justifiable goals,
radiology departments and those chargedwith making purchasing
decisions need hard data to prove the long-term value ofthe
technology. Such is the case with dry laser imaging technology.
Introducedin 1994, dry laser imagers have become the most rapidly
adopted laser imagingsystems in history. They accounted for more
than half of all laser imagerspurchased in the U.S. in 1997. For
facilities still considering the switch fromwet laser imagers to
dry laser imagers, a comparative cost analysis can providethe data
needed to make informed decisions about such an investment, as well
asa concrete demonstration of the long-term efficacy of the
The medical imaging community has often been more successful in
dealing withthe short-term aspects of cost, and less cognitive of
the long-term effects. Atthe same time, experience has indicated
that a large segment of the life-cyclecost for a given system is
attributed to operational and support activities(e.g., up to 75% of
the total cost), both measured over a long-term timeperiod.1 Based
on this scenario, Stone Family Enterprises, Inc.-Medical
ImagingConsultants developed a program that would provide a
comparative cost analysisof wet laser imaging systems vs the
KodakTM (formerly Imation) DryViewTM LaserImaging System at 25
hospitals throughout the United States. The study foundthat
facilities switching from their wet laser imagers to dry laser
imagingsystems would average a 16 percent savings in film
The study was designed to analyze the capital and operating
costs of the wetlaser imaging system and the dry laser imager at
each site. Aggregate data wasthen assembled. Capital costs included
the cost of planning and purchasing thewet or dry laser imaging
systems and the necessary support equipment, buildingcomponent
costs, and opportunity costs (opportunity costs can be expressed
asthe incremental marginal loss from money that is not invested in
a betterpaying proposal).2 Operating costs included the cost of the
film, consumables,maintenance, service, safety, and utilities. In
both cases, capital andoperating costs included all of the complex
combinations of resources, such aspersonnel, equipment, and film.
In short, the life-cycle cost analysis quantified the total
investment for allnecessary activities spread across the system's
life cycle-planning, selectionof equipment, site preparation, cost
of the system, operational use, sustainingsupport, and the
projected costs to operate the system.3 The life-cycle for thestudy
covers a 5-year span. Study design The study was designed to
address anumber of questions: Do dry laser imagers require fewer or
more personnel tooperate it? If more personnel are required, how
long will this affect the costof the system? Will existing
personnel need to be extensively retrained and, ifso, at what cost?
Does dry technology decrease or eliminate certain steps inthe laser
imaging process? Are the capital equipment costs for a dry
systemmore or less than for a wet system? Does the finished film
cost more or lesswith a wet system than with a dry system?
Background information for these surveys was provided by a
radiology departmentrepresentative at each of the survey sites. In
our study, equipment costs andthe cost of the dry laser film was
provided by the Kodak account representativefor each respective
site. Verification of water, wastewater, and electricityrates were
verified by the researchers. In instances where support
equipmentdocumentation was unavailable, information was gleaned
from industry catalogs.All of this information was then plugged
into an algorithm to determinefinished film costs for wet laser
imaging systems and dry laser imaging systemsat the same
The numbers below are a compilation of results from the
- Average wet system cost/site totals-5-year life-cycle:
- Average DryView system cost/site totals-5-year life-cycle:
- Average savings per site with DryView system-25 sites:
- Average wet laser imaging system finished film (per film)
- Average DryView finished film (per film) costs: $2.73
The survey addressed the concerns an institution might have when
determiningwhether or not to invest in dry laser imaging
technology. It took a close lookat labor savings and costs; the
impact of the technology on patient care(reduced examination
times); and the effect of the technology on the efficiencyof
radiologists and attending physicians. It is true that the bottom
line wouldnot be affected in most cases by labor savings in the
areas served by theradiologists or attending physicians. However,
where time savings wererealized, the whole enterprise (the
hospital) benefited-not just the medicalimaging department. Cost
reduction opportunities take on different forms witheach medical
imaging application. The following list represents some of theareas
where dry laser imaging systems provide potential savings:
Potential cost savings with dry laser imaging
Cutting purchase costs:
1. Reduces the number of types of supplies in stock.
2. Reduces the number of purchase orders necessary to sustain a
Cutting process costs:
1. Reduces the number of steps needed to arrive at a finished
2. Reduces the cost of one or more steps in the imaging process.
3. Automates operations.
4. Reduces materials consumption.
5. Reduces a significant source of image variability (QC).
6. Faster patient throughput due to the ease of siting dry laser
imagingsystems. Positioning of an image processing system no longer
is dictated byease of access to water, floor drains, and venting
systems. Because of the timesaved each day in technologist labor,
patient films are available sooner to theradiologist.
7. Staff training is not required to deal with EPA and OSHA
regulations forhandling chemical spills (i.e., spent fixer), or
hazardous materials (HazMats).
8. Saves time on film processor crossover cleaning and saves an
average of 10minutes per day in performing processor linearity
Cutting equipment downtime:
1. Eliminates daily crossover cleaning.
2. Linearity checks are no longer needed for a wet laser imager.
3. No wet laser imager preventive maintenance needed from one to
two times permonth.
4. Eliminates laser imaging system downtime due to clogged drains
caused byalgae buildup.
Cutting administrative overhead:
1. Labor can be shifted to other areas of need in the department
due to processsimplification.
2. Tighter QA/QC controls can be maintained due to the elimination
of manysteps (in labor, inventory, and in service cost to the
equipment) in theoperation.
Reducing liability costs:
1. No contact dermatitis problems associated with handling
developer and fixer.
2. No respiratory discomfort due to fumes given off by the
chemicals used inwet processing systems.
3. No concerns with the EPA or OSHA associated with the disposal of
4. Lower risk to the institution from flooding caused by clogged
5. Lack of liability concerns with the improper disposal of fixer
that containssilver. (Liability does not stop for the hospital when
it turns the chemistryover to an industrial reclaimer service.)
Soft savings realized:
1. Reduces patient room/recovery room charges due to placement of a
2. Reduces waiting time for radiologists and referrals due to laser
1. Hanan M: Consultative budgeting: How to get the funds you
need fromtight-fisted management, p 115. New York, American
2. Blanchard B: System engineering management: New dimensions in
engineering,pp 1-3. New York, John Wiley and Sons, Inc., 1991.
Questions to ask when investing in new technology
When you are buying into a new technology, you need to ask the
- How valid is this new technology?
- Will we as an institution have to hire more radiologists,
technologists,managers, or service engineers as the result of
purchasing this new technology?
- What are the building requirements, i.e., the need to add new
space or therenovation needs to existing space?
- Will we have to add additional support equipment to make the
- Is this new technology cost-effective?
- Does this technology fit in with the institution's short- and
- Will this new technology improve the quality of patient