MRI installations require the coordination of many specialists. Here, the front end of the magnet was blown off, causing obliteration of the magnet and equipment rooms.

It doesn't matter who you work for—a large institution or a small imaging center—sometime, somewhere along the way, you are going to find yourself involved with a substandard imaging installation. It even happens in original equipment manufacturer (OEM) projects, as any project manager working for a major equipment vendor will tell you over a drink. You might be wondering, how is it that a facility can spend so much money on equipment, planning, oversight, etc, and still have an installation disaster? The following guidelines and tips will provide insight into how things can and do go wrong and will better prepare you for your next MRI project.

Profit Principles

One cause of project disasters is the failure to engage experienced people to plan the project correctly. This is not so common for new equipment installations because large vendors have a dedicated planning staff and project managers, but problems can still arise if the vendor personnel are overloaded.

A complex imaging project like an MRI installation requires the coordination of many specialists in various construction and engineering fields, but someone has to be involved who understands how the entire project comes together. Sometimes the mistaken impression exists that the architect is going to provide oversight—which is fundamentally an untenable assumption. The architect understands all aspects of construction, but is almost always completely unaware of the technical nuances of the machine.

Take this example. One particular model of open MRI requires a minimum of 27 feet of separation between the isocenter of the magnet and any high-voltage transformers, air handlers, automobiles, and other possible sources of magnetic interference. It is an important but rather technical specification issue that an architect would have no way of knowing unless he or she has competent technical support.

In this example, these specifications were not considered, and the MRI was built with a large step up transformer on a concrete pad just outside the scan room. The room was built out and finished. The engineers came in to shim the magnet—the process of improving the homogeneity (think consistency) of the magnetic field—only to find it could not be shimmed. The transformer was 17 feet from the isocenter of the magnet and caused distortions in the magnetic field that could not be corrected until it was relocated, along with the entire 480V service to the building.

Another example was the system where the electronics shared a common space with the magnet. This was technically feasible because of the design of the system. The problem was that no one paid attention to the minimum separation distance between the electronics and the magnet. After shimming the magnet, the system was turned on for the first time and the shim was immediately destroyed—again, by electromagnetic interference from transformers in the cabinet. The result was a costly relocation of the electronics and a complete reshimming of the magnet.

Disinterested Parties

Another cause of expensive disasters is the involvement of vendors who simply do not care or are not cognizant of the quality needs inherent in imaging projects. Their careless work is often hard to spot or correct as it happens, unless you retain oversight personnel who have extensive prior experience in these types of projects. There is a big difference between a general contractor who has built a lot of buildings and a general contractor who has built a lot of MRI suites. If you do not have either a general contractor or a project manager with specific experience in this area, you are probably going to end up with a significant problem.

An example of this is a project where the magnet was placed close to an exterior wall of a building. The other side of the wall was an uncontrolled location, so it was theoretically possible that someone could enter the magnetic field exclusion zone where pacemakers can be disabled.

The solution for this construction problem was to install magnetic shielding—1-inch-thick steel plates—on the wall to contain the field. The problem was that the people retained to install this shielding were unusually disinterested. They sank anchor bolts into hollow cinder blocks to bolt the plates. In some cases, they did not even bother to anchor the plates, but instead propped them up against the wall!

There was not a project manager in this case, and the general contractor had zero past experience with magnets. This problem was discovered at installation. It was the facility's good luck that the wall where this shielding was placed was not finished. If the plates had been covered over with studs and Sheetrock, the underlying problem might have only been discovered when the plates came flying through the wall and into the magnet. Fortunately, the problem was discovered and corrected before it resulted in a disaster.

Incompetent/Unethical Vendors

The most common source of substandard installations is the vendors that either do not know what they are doing or that engage in unethical practices. The best way to know if a vendor has the qualifications to do the installation of your imaging equipment is to ask for references and actually check them. Or, talk to colleagues in the business who have already done MRI projects and find out who they used. If you can find a colleague who has done an imaging center project or two and used the same vendor twice, your search should be over.

Be careful about placing primary concern on the bid costs. If you make your decision based solely on the price, you are certain to end up getting what you paid for—and it probably will not be what you wanted. Completing imaging projects properly requires a lot of expensive tooling and personnel. Installation vendors that have no practical experience may offer a bid substantially lower than their competitors, but they often make fundamental errors—the primary reason for many failed installations. Problems can range from sloppy installations to burned cables. The root cause of these problems seems to be a combination of general lack of knowledge of the subtle nuances of the installation and overworked—and often underpaid—installers.

An example of such a project involved a rigging company that the dealer hired to remove an MRI scanner that was to be reinstalled in an imaging center a few states away. The riggers had plenty of time to do their work, but a complication arose when the specialists retained to de-energize the superconducting magnet were delayed 3 days on another project. The riggers did not understand that the majority of the disassembly could, in fact, take place safely before the specialist's arrival and delayed the start of their work as well. When the magnet was finally de-energized, the riggers panicked at the thought of having less than 24 hours to de-install the system and used a rather unorthodox method of cable removal—they cut dozens of cables at the cabinet and penetration panel rather than disconnecting them! The replacement of the cable set took weeks, cost well into five figures, and was absolutely avoidable.

The more insidious problem arises when the vendor's primary concern is to get the maximum profit. In this instance, a vendor will generally take one of two paths: One way is to use substandard employees and techniques, which is the number one cause of failed installations. The other is to "manufacture" problems that require costly solutions and then bill for these additional services.

For example, a vendor gave its client a quote for an additional $45,000 in services to correct "defects" in the magnet. It turned out that the original installer had improperly installed shimming magnets, and then claimed the need to install unnecessary parts. While this example is probably a mix of both incompetence and unethical behavior, one thing is certain: This client faced a $45,000 rework charge and an installation disaster.

Avoiding Nightmares

It is probably not possible to eliminate all problems during the course of such complicated projects, but here are a few tips on how to minimize your risks:

• Fly first class. It is not necessary to purchase your equipment from the OEM to get OEM-level service, but be prepared to pay more. Get experienced planners, contractors, and a vendor with well-trained personnel. Independent service companies that use experienced engineers and approved tools have much higher operating costs than the small companies that low-bid projects to get any work they can— figuring they will find a way to get it done. That way is usually completing a fraction of the work and then leaving you to find another vendor to correct the mistakes.
• Stay involved. Check on references. Ask questions. Visit the project as often as possible and look around carefully. Make sure the vendor knows you are watching and monitoring the job. If you don’t have sufficient background to understand what you are seeing, engage a local service engineer to inspect it from time to time. An experienced eye can often assess the project in minutes because the person knows what to check. For the cost of a lunch, you might be able to avoid a very expensive rework situation.
• Establish a clear chain of responsibility. When organizing your project, get turnkey quotes so that your vendors take full responsibility for the operation and the quality of their part of the project. When purchasing the equipment, get a contract stipulating that the vendor is responsible for every aspect, from de-installation to operational start-up. Insist on fixed cost caps (not-to-exceed amounts) to avoid unscrupulous add-ons. And above all else, have someone involved in oversight who has done one of these projects before. There is no project management training that is more costly than learning on the job.
• Use the same vendor for both sides. If you are relocating equipment or purchasing pre-owned equipment, there are a number of things you can do to protect your interests, but perhaps the most important one is to use the same service vendor for removal and reinstallation. If two different firms perform these services, problems with the installation will often lead to finger-pointing between the de-installers and installers. If you have a single vendor responsible for both sides—especially a vendor who has replacement parts responsibility—you can be sure the vendor is very interested in a smooth, on-time project and not likely to try to take advantage of you.

A Successful Outcome

Read more about MRI safety in the June 2006 issue of 24x7.

There are problems in every imaging equipment project. It is a complicated job with several parties involved and many nuances, which can delay the work and incur costly rework. The only way to guard against mishaps is to budget realistically, use experienced people with proven reputations, be willing to pay for their services accordingly, demand accountability and risk sharing, and pay attention. If something does not seem quite right to you, do not ignore it. Find an impartial observer to take a look. Vigilant planning and these practical tips will ensure a successful MRI project.

Clark Wilkins is founder of JDI Solutions Inc, The People To Call When You Want It Done Right; www.jdis.com. For more information, contact