Veterinarians use many modes of imaging: X-rays, CT scans, MRI and ultrasound. CT and MRI units are rarely seen outside large specialty practices, but ultrasound technology has become more common, and many clinics use ultrasound machines on a daily basis for diagnosis and other procedures.*
“Ultrasound can provide a lot of information for its cost, and is often more readily available compared to other imaging modalities,” says Dr. Drew Sullivan, Medical Director of the Medical District Veterinary Clinic at Illinois, a small animal clinic in Chicago run by the University of Illinois College of Veterinary Medicine.* “Fluid can be distinguished from soft tissue masses or foreign bodies, which are sometimes difficult to differentiate on X-rays. Using ultrasound and X-rays together form a great diagnostic tool.”
Purchasing an ultrasound system for the first time, or upgrading your existing system, can be a challenge. To make the investment that best fits your clinic’s needs, consider the following questions:
Q: Do I need to purchase a “veterinary” ultrasound system, or a “human” one?
Some manufacturers offer both human and veterinary systems, and they are marketed differently. They are fundamentally the same, but the difference lies in their software and presets.
Human systems are generally better and cost more because they must have FDA compliance. The images are clearer and more clinically correct because they have to hit minimum human parameters. Manufacturers build into their pricing the added expense they incur to avert risk and liability issues common to human machines. With that said, the image quality between “apples to apples” systems is negligible.
Q: Can a human system without “animal” presets meet the ultrasound needs of my clinic?
Very definitely. Human ultrasound systems, when used with the proper transducers (probes), can perform the same functions as a veterinary system, and often have a greater selection of probes to meet your needs.
Human systems do not necessarily have to cost signifi cantly more than veterinary systems. Shop carefully. Many human hospitals upgrade their systems routinely, thus offering “used” systems that are excellent.
Q: What other equipment criteria need to be considered?
Is a cart-based or portable system the best? If you have a mixed practice, you might want to consider a portable system with a battery power option that can go into the “field”. However, are you willing to subject your new system to the rugged demands of in-the-field large animal work? Would a refurbished one be better? Do you need the same capabilities in the field as you need in the clinic? Some portables are as sophisticated as cart-based in-the-office systems. Are you willing to pay for a more comprehensive warranty to cover potential machine damage, if you can get it?
Archive data management must also be considered. Will you be transferring your data to the offi ce computer; archiving data for future use and referral; or sending data elsewhere for evaluation and consultation?
Q: What vendor should I choose when buying an ultrasound system? You can purchase through basically four types of vendors.
- a) Original Equipment Manufacturers (OEMs): These are the companies manufacturing the machines. Big names are GE, Philips, Siemens, Toshiba, Esaote, etc.
Pros and cons: OEMs are the manufacturers, and as such offer the latest new systems with full service warranties. Most have a full service field sales force to maintain your equipment. Those that have licensed dealers in the veterinary market are showing their dedication to serving this industry.
- b) OEM dealers: In some cases, the big OEMs assign licensing rights for distributors to the veterinary market. For example, GE sells through Sound Elkin (now Sound), and Esaote sells through Cuattro.
Pros and cons: OEM dealers in the veterinary market each sell only one brand of equipment. Therefore, both OEMs and OEM dealers will promote and feature only their brand of equipment, and will have an inherent bias.
- c) Veterinary products distributors: Examples you are familiar with, such as Animal Health International, MWI, MidWest, Schein, PennVet, Webster, etc., sell ultrasound equipment as part of their desire to provide full service to their customers.
Pros and cons: Veterinary products distributors generally offer one or two brands to select from. The advantage of buying from them is that you already have a business relationship and a favorite salesperson. The disadvantage is that they are not ultrasound specialists, so their salesforce is not well-versed in the equipment. And, very importantly, veterinary products distributors do not repair ultrasound equipment, but send it to third party vendors.
- d) Third party vendors: These companies specialize in the sale of medical equipment, in many cases not just ultrasound but also x-ray, anesthesia, monitors, etc. Some examples are Advanced Ultrasound Electronics, DRE, Core Imaging, Choice Medical, and others. Search for those specializing in ultrasound.
Pros and cons: Third party vendors are medical equipment specialists. They are knowledgeable about the equipment they sell. They work with many manufacturers, so do not have a specifi c loyalty to any one company, which makes them an asset in specifying the system that best meets your needs. Third party vendors sell new systems that meet your needs, at competitive prices. They also sell “used” systems that have been checked and/or refurbished to meet OEM specs with warranties. Often, the cost of a refurbished system is a fraction of the cost of a new system, which allows you to “upgrade” to a more sophisticated “human” system if so desired, while still staying within your budget. On the minus side, third party vendors do not have the large sales and service support teams the big OEMs have. This means, in some cases, that the system will have to be shipped in, rather than being repaired on site. Also, third part vendors are not able to offer warranties on refurbished systems that are as lengthy as those on new systems.
Question your fellow veterinarians and learn of their experiences with various vendors. Use the internet for comparing companies – DOTmed.com lists medical equipment suppliers. Check out the ones with 5-star ratings and/or DOTmed 100 ratings. These are reviews by customers. Also, go to any regional or national veterinary conference and visit with the exhibitors. If a company is exhibiting, they are serious about serving the veterinary market.
Human ultrasound systems, when used with the proper transducers (probes), can perform the same functions as a veterinary system, and often have a greater selection of probes to meet your needs.
Q: What criteria should you look for in a manufacturer and/or vendor?
- How many years have they been in business?
- What is their reputation in the market, both human and veterinary?
- Do they offer warranties?
- Do they stock replacement parts?
- Do they offer loaner systems?
- Do they offer training on systems new to you?
- Do they do repair work themselves, or farm it out?
- Do they repair “human” systems to manufacturer specs?
- Do they offer field service?
Be sure to continue to work with whichever company you choose for help in training yourself and your technicians, and providing your staff with information to communicate to clients. If this is your fi rst ultrasound, your clients will appreciate written material, or links to web-based information, to learn about the procedure. A written description of how you do an ultrasound would also be good to have on your practice website.
Purchasing an ultrasound system should be considered a business investment, not an expense. Ultrasound services represent a billable charge to your patients’ owners, while improving your diagnostic capabilities.
A BUSINESS INVESTMENT
Depending on the demographics of a clinic’s customer base, and the complexity of the scan, veterinarians charge anywhere from $100 to $400 for an ultrasound procedure.
For the sake of this analysis, let’s say each customer is charged $150. Let’s also assume your practice does two scans a week.
$150 per procedure x 2 procedures per week x 50 weeks per year = $15,000
If you purchase a system for $30,000, the ROI is two years.
Additional initial costs of an ultrasound also need to be considered. Does the system have “add-on” options you will want? Most come with a full one-year warranty. As well, you will be offered the option to purchase longer-term warranties. You must also consider what transducers (probes) you want with the system, depending on the medical needs of your practice. Will your staff need training for the new system? Sales tax can also be a factor.
Once you have selected the system, along with options, warranty, probes, and tax (if any), you should have the final cost.
Next, decide if you want to purchase the system outright, make time payments, or possibly lease the equipment. Solicit the advice of your accountant.
- For an outright purchase, it is pretty much general policy for vendors to sell a system and expect 50% of the total payment at the time of order and 50% at time of delivery.
- Some vendors offer payment plans – for example, 20% down, and monthly payments for 24 or 36 months. Vendors automatically build preventive maintenance agreements into the cost of the system to protect your investment (and theirs).
- Leasing can be done many ways – money down, 24 or 36 months, etc., and you can have the option to buy the equipment at the end of the lease. There are two key things to know about leasing:
- a) The IRS does not consider an operating lease to be a purchase, but rather a tax-deductible overhead expense. Therefore, you can deduct the lease payments from your business income.
- b) Because an operating lease is not considered a long-term debt or liability, it does not appear as debt on your financial statement, thus making you more attractive to traditional lenders when you need them.
- Shop for the best rates, whether through the vendor, your bank, or a recommended finance company.
*Geese, Melissa. “Ultrasound Has Many Uses in Veterinary Care”. Pet Health Columns, vetmed.illinois.edu/petcolumns.