Commissioning in CT. Advance Specialty Training CT Mike Lai DM, DR&NM Tuen Mun Hospital

Transcription

1 Commissioning in CT Advance Specialty Training CT Mike Lai DM, DR&NM Tuen Mun Hospital

2 From the Scratch What type of CT you want? High end ( slices, dual source, dual energy) Work horse ( 64 rows), HA Standard Funding source (CBV, Donation)

3 64 Row Toshiba: Prime 80 row 160 slices; detector sizes: 0.5mm Siemens: AS+ / Edge 64 row 128 slices; detector size: 0.6mm Philips: Ingenuity 64 row 128 slices; detector size: 0.625mm GE: VCT lite / HD row 128 slices; detector size: 0.625mm

4 High End CT Cluster with one or more CT installed Deliverables: 1000 Cardiac cases per year Recommendation from Cardiac unit and COC DR Philips: ict (128 row) Toshiba : Aquilion One Vision Siemens: Dual source CT GE: HD750 Freedom/256 slice CT (FDA not clear)

5 Toshiba Aquilion One Vision 320 row ;640 slices 275ms rotation time Larger radiation exposure due to wider fan beam required

6 Somatom Definition FLASH 70kVP ;140kVp Temporal resolution: 75ms Disadvantages: Heavier gantry Same phase but different angles

7 Philips ict 128 row; 256 slices 3D Nano II detector 1024 matrix imaging Temporal resolution: ms

8 GE Discovery 750HD FREEdom 64row;128 slices Dual energy switching time 0.25ms Temporal resolution: 0.29ms

9 Scanning Speed GE Freedom Siemens Definition FLASH Stellar Philips ict 0.35s 0.28s 0.27s Toshiba Aquilion One Vision Does scanning speed really matter? What about temporal resolution? GE Freedom Siemens Definition FLASH Stellar Philips ict Toshiba Aquilion One Vision 0.29ms by germ stone technique 75ms by two X- ray sources 175ms 175ms

10 Spatial Resolution For heart rate >75bpm, 75ms temporal resolution corresponds to 0.075s x 35mm = 2.62mm

11 Dual Energy At <65BPM there is a single optimal recon phase for all Vessels. >75BPM, recon shifts to systole, there is no single optimal phase Residual motion ~10mm/sec Residual motion ~25-40mm/sec Husman; Radiology: Volume 245: Number 2 November Sun; Clinical Radiology: Volume 66 (2011) 614e620

12 Spatial and Temporal Resolutions Temporal resolution Spatial resolution GE Freedom Siemens FLASH Philips ict Toshiba ms 75ms 135ms 135ms 0.23mm 0.3mm 0.34mm 0.36mm

13 Cardiac Motion Correction Snap Shot Freeze make use of three different phases of cardiac motion to reconstruct the final image Motion Correction Map Detect the deviation of the final image to choose the optimal phase for reconstruction

14 Looking for a New Scanner Site Visit to existing local centers RSNA (Chicago, USA) ECR (Vienna, Austria) On hand experience on the workstations and new technology More interactive time with application specialists Attend local seminar arranged by vendors

15 Major Equipment Procurement > 1 million major equipment Justification for procurement 9 years of service? No spare parts Obsolete technology Downtime report Cluster Chief Executive priority COC endorsement ( Replacement plan)

16 CT Replacement Plan CT reached 9 years Financial Year Hospital (s) 14/15 QEH, RH,QMH,TMH 15/16 UCH,PMH 16/17 KWH,YCH,PMH,PWH x2, POH 17/18 KWH,NDH 18/19 QMH,AHN 19/20 TKO,CMC

17 Major Equipment Procurement Submission of request by Jan each year Capital Block Vote (CBV) ~10M & 15M Equipment, installation MX8100 (Depend on site) Site Preparation Price proposal / quotation from vendors ECRI

18 Equipment Cost Breakdown Main System Site Preparation Cost Ancillary Equipment and accessories Training: local & overseas Trade - in

19 Main System CT scanner systems Gantry Examination couch Operator console +/- review console Image reconstruction unit Transformer Thin client server system Processing software

20 Site Preparation Cost Demolishing works and partition Lead lining False ceiling Floor Wall make up Cabling and Trunking Air-conditioner and Chiller Fire detection system Furniture

21 Ancillary and Accessories Ancillary equipment Vital sign monitor Defibrillator/ vital sign monitor Contrast injector Contrast warmer CCTV Operating spot light Thin client server Network switch

22 Ancillary and Accessories Accessories Mattress Cradle Phantom Humidity monitor Light box Lead Apron Pad slide (Laser printer)

23 Paper Submission Major Equipment Procurement (MEP) Estimated activity Expected utilization Expected workload statistics Manpower Recurrent cost Maintenance cost Consumables

24 Annual Plan for New / Additional Service 3 Digit Forum in May each year Held in HAHO chaired by CE All CCE present their annual plan Shortlist for submission to Bureau

25 Annual Plan Submission New service title Existing situation Service Gap Action Plan Resources required

26 User Checklist Site Selection Location (Main department / A&E) Not near or under the drainage pipe Route for transportation of the equipment Floor loading and ceiling loading are sufficient for equipment installation

27 User Checklist - Environment All fire services provision are checked/installed according to related ordinance FM 200, smoke detector, sprinkler, NOVEC The design and capacity of the air conditioning is checked/installed to meet the requirement for normal equipment operation

28 User Checklist - Environment Provision of water supply and drainage system are checked/installed to meet the equipment requirement The provision of electricity supply is checked/installed to meet the equipment requirement. eg 3-phase power supply, essential power supply /non-essential Provision of medical gas and scavenging system are installed where appropriate

29 User Checklist Radiation Protection Radiation protection requirements are in compliance with the Radiation Ordinance of Hong Kong Pre-meeting with Medical Physics Unit for specific requirement

30 User Checklist IT Cconsultation from the IT Department has been sought on the design and installation of the image network, if applicable (including PACS Advisory Committee for installation of PACS) Provision of trunking/conduit works to suit installation requirement, if applicable

31 User Checklist Others Prior arrangement has been made on service provision during the transition period(when the site is suspended for installation works), if applicable Prior arrangement on disposal of old machine before site installation if applicable Close liaison with ICN, MHO and safety officer to ensure rules and regulations are complied during site preparation

32 User Checklist - Others Storage size of thin client server Reporting framework design Thin client / generic web base client Image transfer / printing protocol Furniture design for scanner, workstations and archive, consumables UPS for scanning console and processing workstations

33 Site Visit EMSD, Supplier, contractor Floor loading Equipment layout plan Electricity supply Essential / separate source / Capacity Air conditioning Chiller water /Additional air conditioner Fire

34 Floor Loading 3 kpa (60LB/sq ft) for commercial building 5 kpa (100LB/sq ft)for government building 1m 2 = 10.75sq ft 1075 LB /m ton /m % usable

35 Machine Loading CT ~ 2.8 ton 1.5T MRI ~ 5 ton 3T MRI ~ 10 ton

36 Power Requirement Toshiba A Philips A GE A Check the Power Supply!! Aged hospital may already reach its limit!!

37 Power Consumption and Heat Dissipation Power Consumption : 80kW-100kW Heat dissipation Scanner room: 6000W Control room :1000W

38 Room Data Sheet

39 Room Data Sheet

40 Space Requirement 6200mm

41 Information from Vendor Specification of the equipment Height and Width Floor loading requirement Room cooling requirement Cooling requirement of the scanner Temperature and humidity? chiller

42 Tender Specification Divided into three main categories Mandatory Desirable Optional At least two vendors should meet all the mandatory conditions

43 Tender Specification A very tactic procedure Study carefully the specification from all potential vendors is essential Vendor selection 70% price and 30% technical Stringent required from head quarter

44 Tender Specification Sample technical specification Tender CT sample.doc Site specific requirement Procurement procedure Building service IT requirement

45 Tender Specification - Monitors Medical grade, resolution, portrait or landscape Resolution Include all trunking and cabling in network Technical substitution

46 Tender Specification - Licenses Permanent / floating No. of concurrent user Basic / Advance processing software

47 Processing Software Basic function image reviewing software 2D, 3D, Volume rendering, segmentation, endoscopic view Perfusion Brain and liver Dental planning Lung nodule measurement Virtual Colonoscopy

48 Processing Software Cardiac Vessel analysis Plaque analysis Cardiac function analysis Volume measurement CTA Auto bone removal Stent planning Orthopedic planning software

49 TAP Tender Assessment Panel Representative from Cluster Representative from HA Procurement Radiologist Senior radiographer Medical physicist Justification on tender clauses

50 Tender Evaluation Price : 70 % Technical : 30% 10 year life cycle cost (9 year comprehensive maintenance) Kick out when fail to meet M clause

51 Price Evaluation The lost price as denominator Price different as numerator Maximum points 70 The difference in points = 70 x fraction Points obtained by 2nd lowest price vendor = 70-differnece in points

52 Price Evaluation Summary A B C XXX Main System 2,408, ,500, ,000, Trade-in Discount -100, , Peripheral + Accessories 2,556, ,700, Site Works 3,000, ,900, Maintenance 2nd 1,640, , , rd 1,640, , , th 1,640, , , th 1,590, , , th 1,590, , , th 1,590, , , th 1,340, , , th 1,340, , , th 865, , , Total Life Cycle Cost 21,104, ,512, ,898, Total Tender Price 7,864, ,500, ,500, Price Score Technical Score YYY Main System 2,408, ,800, ,000, Trade-in Discount -100, , Peripheral + Accessories 2,260, ,200, Site Works 1,100, ,533, Maintenance 2nd 1,612, , , rd 1,612, , , th 1,612, , , th 1,562, , , th 1,562, , , th 1,562, , , th 1,312, , , th 1,312, , , th 850, , , Total Life Cycle Cost 18,668, ,999, ,481, Total Tender Price 5,668, ,800, ,633, Price Score Technical Score Total Score

53 Technical Evaluation Total no. of desirable points is added Highest points as denominator Maximum points = 30 Difference in points = 30 x fraction of the difference

54 Summary Section A (Common) Section B Part I (XXX) Section B Part II (YYY) A B C 2.2 Y N N 2.4 Y Y Y 3.8 N N Y 3.11 N Y Y 3.12 Y Y N 5.3 Y Y N 5.4 Y Y N 6.4 Y Y Y 6.5 N Y N 7.2 N N Y 7.4 Y N N Y N Y Y N Y Y N N Y N Y 9.11 Y N Y 9.27 Y Y Y N Y Y Y N Y N N N 11.1 Y Y Y 11.5 N Y N 11.7 Y Y Y A B C 1.2 Y N Y 1.3 Y N Y 1.6 Y Y Y Y N Y Y N Y Y N Y Y N N 3.8 Y N Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y N Y Y N Y 9.13 Y Y Y Y Y Y Y Y Y A B C 5.2 Y Y N N Y N N Y N N Y Y N Y Y Y Y N Y Y N Y Y N N Y Y N Y Y N Y N

55 Summary A B C Section A Section B XXX Section B YYY Total D for XXX Score for XXX 30% Total D for YYY Score for YYY 30%

56 MTB For major equipment > HK$400M External celebrities as chairman Once a month MTB paper reach HAHO 2 weeks before board meeting Straight forward / required discussion Re-tender

57 Kick Off Meeting Successful tenderer Facility management Procurement EMSD ICN Contractor

58 Layout Plan Draft your floor plan requirement Scanner position Console Injector position Accessory equipment Reporting area

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60 Floor Planning 5 main areas Control Console Central scanner area Nurse preparation area Patent preparation area Reporting area

61 Control Console At least 7 wide Scanning table = 30 Operator area = 24 Passage = 30

62 Control Console Lead Glass 900mm x 1800mm Height from floor ~ 800mm 120kV 3-5mm lead equivalent

63 Scanner Components Scanner Gantry 70cm diameter Couch Transformer X-ray, system Image reconstruction unit for raw data storage and processing Nursing items and accessories

64 Scanner Area Ambient space for longitudinal movement of the couch Allow passage for working personnel Liaise with vendor for cabling requirement

65 Trunking

66 Scanner Area Dummy to simulate the gantry requirement Epoxy layer on the floor to ensure spirit leveling

67 Gantry MDCT involve heavy component which required stringent environment during tube rotation

68 Centrifugal Force Roller Coaster 5G Jet Pilot 8G X-Ray Tube 40G

69 Patient Transportation Area Enough space for transfer of patient in heavy stretcher If possible, allow rotation of stretcher inside the scan room Wall oxygen, suction + anesthetic gas E-trolley Physio-monitor

70 Medical Gases Purity test Performed by HKO, EMSD Long booking period required

71 Injection Room

72 Injector Dual head injector Proprietary injector syringe Generic Dual head injector Direct feeding of contrast bottles Proprietary tubing set

73 Simple Calculation Cost of each proprietary injector syringe = HK$50 Extension tube ~HK$4 Cost of the tubing set Pump host (HK$200)+ extension tube (Hk$24) + Patient tube(hk$10 change for every patient) Break even point ~ 5 patients a day

74 Archive Capacity Data Size of a CT image 512 x 512 x 12bit ~ 0.25M One abdomen examination ~ 300 image 40 elective cases per day x 360 working days = 40 x 300 x 360 = 1 Telabyte per year

75 Archive Capacity Temp Archive for diagnostic 1TB / yr Long term archive for documentation with 1/3 compression ~ less than 0.1TB / yr N.B. Compression of data required license Determine your storage requirement for Long term (PACS) and Short term archive (Local archive)

76 Internal Network Hub for external network Hub for internal network Gigabyte Ethernet Workstation A Control Console Local Archive Workstation B

77 External Network Hub for external network 10/100/Giga Laser Printer PACS network epr Image distribution to WS in other clinical RIS Broker units e.g. navigation, RT

78 Irradiation Apparatus License License application should be done - (P license) & (Operating license) P license should be applied and completed before the arrival of scanner Operating License should be applied and completed before clinical operation Each license takes about 4 week time of application

79 Acceptance Acceptance test Performed by Medical Physics Unit Functional test Performed by Staff from Radiological Department Acceptance test + Functional test Payment

80 X-ray Tube Life of the X-ray tube varies from tube from tube and from different vendor From 300,000 cycles to 1 million cycles Dunlee, Variant, Philips, GE Cost ~ HK$1 million

81 Milestone Plan