16 Jan, 2019
8 Tips to Buy USG Machine
“8 TIPS:
HOW TO BUY AN ULTRASOUND MACHINE
Dr Vishal Kumat
Kumat Diagnostics, Nashik
The purpose of this write up is to make our radiologist colleagues aware about the factors which matter in deciding for or against a particular machine.
Good image quality is fairly subjective. It is also relative to the capabilities of the machine. Frequently, two people looking at the same image will have a different perspective on what is “good.” Those who have used an ultrasound machine before often want the images to be similar to the images of their old machines. New users want images that fits their brain’s perspective of what they think the anatomy should look like. It is up to you to decide, and your opinion may change as you see different machines & talk to their users.
So lets get started.
1) *Budget*
Define your rough budget with +/- 2SD which would be about 2-4 lacs.
Just to illustrate the above point, If you want a fairly decent machine
Price brackets would be as follows
- 15-25 lacs Most baseline machines fall in this criteria
- 25-40 lacs Most mid range come in this bracket
- 40-60 lacs Most premium machines are here
- 60 lacs & beyond are generally bought by Hospital with comprehensive AMC/CMC ie servicing & warranty with extended list of state of the art software & hardware and cutting edge technologies
If your budget is below 15 lacs , most likely you will have to settle for a refurbished machine, which is a different topic all together. However there are few companies which do offer value for money basic ultrasound machines in the price bracket of 10-15 L with comprehensive warranties. Leading the bandwagon is GE & a few others like Sonoscape, Mindray, Esaote, Aloka, Medison. If you are a beginner and short on funds , you can definitely consider these machines.
Let me add a word of caution here, most of these machines are basic in make-up and design and you will require upgradation in the years to come most likely below the 5 year mark, because technology wise a lot of “water would have already flowed under the bridge”. Define your rough budget first , then think of a machine.
Also flexibility in budget can fetch you extra useful and novel features in a steady machine which will definitely help you in the long run.
2) *Sturdiness of the machine*
Track record of a machine does count!\
In my opinion hardware based machine are robust & very unlikely to break down.
3) *Service availability.*
This is a myth that a particular company offers excellent post sales service & a few others are bad at it. Believe me, all of them are the same! Try to shortlist and buy a machine where the local service provider either is readily available or is your good friend Companies will lure you while buying a machine with exhaustive list of facilities & prompt service but when it comes to business you are always left perplexed & scratching your head.
4) *Always see for yourself*
Golden mantra of assessing a particular machine is by a demo!
When you have locked your rough budget. Take a pen & paper out (or an excel sheet) & write down 5-6 companies offering machines in that same range & capabilities & start seeing them thoroughly. Many a time, what you see in the company brochure & in reality is very different.
When you take a demo what should you actually see?
- Liver
- Kidney
- Renal vascularity
- Bowel
- Mesenteric nodes
- Shoulder
- Thyroid
5) Grading a particular machine .
How to rate that a specific machine is good, average, ordinary or excellent?
There are different criteria which people use in general.
A) *Grey scale*
B) *Doppler/color pick & spectrum*
C) *Ease of operability / knobs/ user friendly/ ergonomics
D) *Linear probe*
So what to look for :
- Clarity of image
- Scan
- Bowel
- Mesenteric nodes
- U bladder
- Thyroid
- Shoulder
Penetration without loss and good resolution should be a factor which separates an average looking linear probe from an outstanding one. Most recent machines have excellent linear probes with some of them giving unparalleled resolution. The best way to rate a good linear probe is the ease of locating the appendix & ileo-caecal junction in a well built patient. Believe me this never fails.
E) *Upgradability and compatibility with software*
SUMMARY
So choose wisely & look for the future
Like Amitabh Bachhan says in SARKAR
Nazdik ke fayde see pehle dur ka Nuksaan dekhna chahiye
COMPLETE ARTICLE IS AVAILABLE ON RADBUZZ -- Subscribe by sending your postal address to indianradiologist1@gmail.com
6) *Negotiation*
This part is a bit uncomfortable & a little confusing for many radiologists.
Best thing to do is to try to stick to your budget. Always take compressive range of probes & software as it helps in negotiations.
Be firm but Reasonable as we are not buying consumables products
It is best is to involve a senior or a person who already has that machine or some of your lecturers, Assistant Professor, or senior Radiologist. Their tips & words are very handy. Their final offer to the company is more often than not respected. Also, have a list of costing of different companies that provide similar models with near identical features, and can surely help you negotiate better. Lastly in negotiations, its always better to get more features & software rather than cutting cost and saving a few thousands/lakhs.
7) *Warranty*
Very important facet in today's day & age Always ask for extended warranty in minimum possible cost as it saves you lot of headache in the future.
AMC & CMC terms & conditions should be clear, simple & on paper. Some companies offer attractive holistic warranty (extending upto 5 years for free) while others are less forthcoming.
However it should be noted that generally companies giving extended free warranties either are new entrants trying to gain entry in the market or tend to have higher breakdown rates than those who refrain from giving them.
But individual experiences do differ. My personal view is to buy a machine which has the least breakdown as well as good warranty cover preferably for a minimum of 3 years. One more alternative in case extended warranty is not provided or is costly is insuring that machine.(again entirely different discussion for a later date)
Choose wisely but definitely you should have your backs covered with extended warranty or comprehensive machine break down insurance or a combination of both.
8) *Sharing views of existing users*
This is the most neglected part by our people may be because we are just too lazy
Pick up the phone & better find out about the machine you want to buy directly from the horse's mouth. Cumulative personal experience of a particular machine by different Radiologists could be a vital factor deciding in favor of or against a machine
Many new promising entrant models are less than 5 yr old & their sturdiness/breakdown record can only be sought by asking our fellow colleagues who are already using it.
You may definitely have a change of mind by going through the critical reviews & small problem faced by the Radiologist in a particular machine. So call up people before you lock your machine.
But there is a catch here too.
It may sound like a paradox or sheer oxymoron , but the truth is, never ever buy a machine on mere recommendation of a particular individual,/friend/boss or anyone even if he/she is an authority in their field.Many a times your vision & future utility of a particular machine is totally different from the machine recommended to you. So the gist of it is , “ Suno Sabki , Karo Dilki”
Last but not the least
Many a times you are short on budget by a few lacs??
What do you do in such a case?
Settle for a machine with which you are not happy?
Decrease a few features, softwares & a probe here or there?
The answer is simple given to me by my boss when I was in such a dilemma.
“Spend a little less on furniture , keep your lifestyles little less lavish & spend more on the machine on which you entire diagnosis is dependent upon !!!”
Thanking you for your patient read!!
Dr Vishal Kumat