Neurnradiologu
Neuroradiology 11, 183-184 (1976)
© by Springer-Verlag 1976
The Economy of the EMI-Scanner H. H. Jacobsen, M. Kragsholm and Chr. Holm Department of RadiologyRigshospitalet, Copenhagen, Denmark
Summary. It is shown - taking in consideration the local circumstances - that the EMI scanning of the brain is less expensive than pneumoencephalography percutaneus carotid angiography or cerebral four vessel angiography.
Key words: EMI scanner, Medical economics.
The EMI scanner and other later manufactured computerized tomographs are very expensive. However, within certain but wide limits, this equipment provides diagnosis of an accuracy which is superior to that of the neuroradiological methods of pneumoencephalography, ventriculography, carotid and vertebral angiography. Futhermore, computerized tomography causes no complications or discomfort to the patient. Rigshospitalet bought an EMI scanner in August 1974. At present, March 1976, we have made 1800 examinations and we can truely say that we completely share the excitement with this radiological invention, which has been expressed by others. During the past year we have reached the conclusion that every X-ray department serving a neurosurgical department should have such equipment. Whether this is true for other X-ray departments, we do not know, but we do know, that some routine is necessary in order to achieve proper interpretations of the tomograms. We have been very interested in comparing the costs of a scan with each of the following examinations: pneumoencephalography, percutaneous carotid arteriography, the so-called four-vessel examination and brain scanning with radioactive isotopes. As far as the latter method is concerned, its diagnostic accuracy is far from that of the EMI scanner. This investigation is based on local conditions and the current salaries of the medical personnel.
A more detailed explanation of the many items in the table is necessary: Purchase price is stated in round figures as the installation expenses, for which it is impossible to give exact figures, are included. Depreciation for conventional X-ray equipment is 10% per year. Compared to this the gamma camera and the EMI scanl~er are in rapid development, i. e. the technical obsolescence requires a higher depreciation estimated at 15% per year. The return is calculated on the basis of amounts invested in the equipment at any time (purchase price minus yearly depreciations). The interest represents a yearly average interest, and is calculated as follows, using the EMI scanner figures: Purchase price + scrap value
D. kr. 2225000 D. kr. 222500 D. kr. 2447500
The average interest is then: 146850
2 447 500
x 12% =
2
The rate of interest used is 12%. It is unknown whether this rate is higher or lower than the actual interest level during the lifetime of the equipment, but the size of rate used is of minor importance, since the table should give the cost per examination for the EMI scanner compared to the costs per examination when using conventional methods. Salaries are given as average salaries for the various groups of personnel in effect in June 1975. For certain examinations we give fractions, indicating the man-hours involved in one of the examinations in question as, for instance, a nurse or a technician. Some might find the total number of persons involved for an encephalography higher than necessary but, as men-
H. H, Jacobsen et al.: The Economy of the EMI Scanner
184
Table 1 EMI scan
Purchase sum of apparatus
Encephalography
2225000
Depreciation 15%
1100000
Examinations per working day Examinations per year (220 days) Cost per examination, fixed Bed-days at 1000 Utensils per examination Cost per examination, total
4 vessel
angiography
Radioisotope scan
1300000
1300000
1000000
333750
150000
10%
Interest 12% Personnel salaries Medical doctors at 113 000 Radiographers at 68400 Photographers at 67 200 Hospital porters at 60000 Technicians at 80000 Engineers at 120000 Laboratory workers 68400 Maintenance and repair
Percutaneous carotid angiography
146850 '/2 2
56500 136800
~/~
40000
1 2 1 1
110000 72600
130000 85800
113000 1 136800 2'/4 67200 1 60000
113000 153900 67200
130000 85800 1 23/4 1
66000
113000 188100 67200
'/2
56500
% 1 89000
27500
32500
32500
6000 68400 5000
802900
587100
582400
616600
351900
6 1320
4 880
4 880 608.26 25.-
667.16 2000.115.-
633.26
2782.16
2
tioned earlier, the figures refer to the actual conditions in our department, when we use a Mimer III equipment for this examination which normally includes tomography. Maintenance and repair are based on the experience of the engineer. Bed-days. The hospital cost of having one patient staying in the ward is roughly D. kr. 1000/day. EMI scan and radioisotope scan do not require a day for the patient, but angiography requires at least one day and encephalography two days or more. Examinations per working day do not express the average daily work-load, but the number of examinations that can be carried out within a normal working day i. e, from 0800 to 1530 h when the department is working at full personnel capacity. The EMI scanner is very rarely used during the acute ward, because of the rather short working day stipulated by the radiation rules and the labour agreement, and because of the shortage of personnel outside the normal working hrs.
1
2 440 661.82 1000.115.-
1
1776.82
6 1320 1401.36 1000.570.-
266.59
2971.36
346.59
80. m
The table should be comprehensible when we add that utensils cover negligible items as contrast media, saline, syringes, hypodermic needles, drains, film and paper. Other wards with other working methods will report different figures, but the tendency seems clear, and we find that the following proportional figures can be set up with approximation:
E M I scanning Pneumoencephalography Percutaneous carotid angiography Four-vessel angiography Radioisotope scan Received: April 9, 1976 Dr. H. H. Jacobsen
Neuroradiologisk Afdeling Blegdamsvej 9 Rigshospitalet DK-2100 Copenhagen, Denmark
1 4114 23/4 4~!2 1/2