David A. Siker, MD

As competition among imaging centers intensifies, providers seek technology that gives them an edge. David A. Siker, MD, managing partner of Siker Medical Imaging and Intervention, Portland, Ore, found just such an advantage in the form of 3T. “The best way to compete is to offer the best imaging studies possible, and that’s precisely what a 3T magnet delivers,” Siker says.

It was the desire to produce studies of the highest quality that led Siker, in 2005, to acquire a Siemens Trio with Total imaging matrix (Tim), making Siker Medical Imaging and Intervention first in the United States among freestanding centers to install the 3T system for clinical (as opposed to research) applications.

Siker reports that this purchase will do much to ensure the viability of his enterprise, which launched only a short time ago (in May 2005) and will not complete passage through its period of most pronounced business risk for at least another year.

RECIPE FOR SUCCESS

The Trio with Tim system is Siker Medical Imaging and Intervention’s main modality (a C-arm is used in conjunction with it, and the center will soon add a 64-detector CT scanner). Five neurosurgeons are part of the venture, but Siker is the sole physician physically based at the center. Three crosstown subspecialty radiologists provide backup reads via a T1 line. Siker’s work environment, however, is unlike those of his associates. The center, set near Portland’s historic Pearl district, occupies a century-old, 372-m2, factory-style building that once housed a production bakery. “I did not like any of the conventional medical office spaces that the real estate agents kept showing me,” Siker explains, noting that those offerings lacked authenticity, a characteristic that many Portlanders cherish.

Siker renovated the former bakery (with its rectangular concrete slab foundation that proved ideal to support an MRI unit), but left intact many of the cavernous building’s endearing features (such as the overhead exposed ductwork and long rows of windows) while adding some stylish touches of his own (such as aged pine flooring). “It has a different ambiance. Patients think that it is really cool, and that contributes to putting them at ease when they come in, so they feel more comfortable during imaging studies and procedures,” Siker says. “The MRI room itself was especially built with the claustrophobic patient in mind. It is unusually large; it has windows, wooden floors, and potted plants. It is a very nonthreatening space.”

Siker settled on the Siemens Trio after a careful evaluation of available technology. “It was clearly a genuine workhorse of a system, the best of any that I had seen,” he says. “As a neurointerventional radiologist who performs high-end specialized procedures of the neck and head, I have always been one to push the technology envelope in the clinical setting. This venture is no different. The business plan that I developed spelled out that we would be equipped with state-of-the-art MRI because I wanted the absolute best imaging possible. That made Siemens’ new 3T magnet the obvious—and easy—choice for me.”

COVERAGE AND THROUGHPUT

Siker’s due-diligence efforts took him to several sites where Trio was installed, but without Tim. At one of those, he noticed, alongside the Trio system, another relatively new Siemens MRI product, the Avanto (a 1.5T magnet). This particular unit was outfitted with Tim technology. Siker observed Tim in action and thought it remarkable. “I was very impressed by the image production speed and coverage—quite superb,” he says. Siker had reservations about buying Trio without Tim because, despite the stellar quality of Trio’s images, he was less than fully satisfied with regard to coverage. He indicated, though, that he would buy Trio immediately if Tim could be packaged with it. Siemens responded with the news that it was soon to release a version of Tim expressly for Trio. “The addition of Tim to Trio amounted to a huge transformation of the magnet’s capabilities, in my estimation,” Siker says. “It provided much greater coverage, for one thing. For another, it provided much greater throughput. You can place a patient in the system and scan the brain and thoracic, cervical, and lumbar spine without having to reposition once.”

Trio with Tim contributes directly to superior clinical quality at Siker Medical Imaging and Intervention, but it contributes indirectly as well. “3T requires a bit more fine-tuning than lower-powered units, and that calls for technologists who really know their MRI physics,” Siker says, adding that the necessity of having those highly skilled technologists on staff serves to enhance clinical quality further in the broadest sense, not solely with regard to MRI operation.

Siker’s Trio with Tim is interfaced with the center’s picture archiving and communications system (PACS) and radiology information system (RIS). Siker avoided the high cost of buying information technology by creating a robust RIS of his own from inexpensive, off-the-shelf software (although it should be noted that, prior to becoming a radiologist, Siker was an electrical engineer whose job involved software design). Then, he bought a plain-vanilla web-based PACS at a cost of merely $60,000, a fraction of what he could have spent otherwise.

“For a small, start-up imaging center like ours, where every dollar counts, this approach was invaluable,” he says. “Because our informatics outlays were so small, we had a lot more money available to invest in the very finest MRI system possible. That was important because Trio with Tim is key to our business strategy and to giving us the ability to be a strong competitor.”

Rich Smith is a contributing writer for Decisions in Axis Imaging News.