By John W. Mitchell
The demand for MR upkeep does not go away just because the number of scans has been reduced. In fact, the summer months are often when cooling issues are most likely to arise.
With hospital and clinic imaging volumes down by about half during the pandemic and the crush of critically ill COVID-19 inpatients, Dick Branca, director of sales at Cool Pair Plus, and his team were concerned that attention to cooling might not be top-of-mind for some healthcare providers — and could have costly consequences.
“We’ve been getting a lot of calls this month (July) for helium refills,” said Branca. “The slowdown in volumes due to the pandemic creates conditions that are especially problematic for MR cooling. It’s nights or weekends — and during a pandemic — when people aren’t paying attention that helium pressure builds, leaks, or you get oil contamination.”
Cool Pair Plus has not seen any catastrophic quenches this summer, where helium is vented violently and loudly as a fail-safe, but even routine service calls for low or contaminated helium recharges can become very expensive if left unattended. Typical helium corrections may cost between $8-10,000, with more severe cases, such as a quench, running upward of $30,000.
“You can save a lot of money by paying attention,” advised Branca. “While we’re in business to respond to our clients’ emergencies and to keep their MR units in the service of patients and generating needed overhead revenue, you have to remember that the MR is never ‘off’ — operators need to pay attention to cooling at all times.”
The pandemic offers built-in downtime
Even though MR use is down during the pandemic, cooling — or HVAC services — are continuing with business as usual. Chris Wong, vice president of operations with Advanced Cooling Technologies, said that while some clients have opted to delay regular chiller service to minimize the number of nonessential personnel on-site, most are keeping up with maintenance.
“The majority of our clients realize that chillers run twenty-four-seven to keep the MR magnet cool,” said Wong. “If the chiller breaks down, it becomes an emergency.”
Some MR providers, according to Wong, are even taking advantage of the pandemic slowdown as an opportunity to do the more involved service and preventative maintenance that requires taking the scanner offline. Powering down the unit means sacrificing scan revenue and operating income, so when better to do it than when scan volumes are already depleted?
Wong added that a scheduled shutdown can be a lot less cost-prohibitive when it’s completed during regular weekday hours, compared to the higher overhead of service on nights or weekends.
Redundancy is cooling’s best friend
Pandemic aside, every summer offers problems with scorching temperature and thunderstorms threatening MR cooling. Turner Hansel, president of Filtrine Manufacturing Company, advised thinking about cooling redundancy. Failure to do so is a common cause of extended downtime that he sees from clients.
“Make sure that your facility has an emergency cooling backup system in place,” Hansel said. “This ensures that your medical equipment can continue operating if, for some reason, your chiller breaks down. Filtrine suggests using either city water if it's cold enough or building chilled water from your HVAC system.”
In recent years, Hansel also reported that the company is seeing an uptick in need for multi-modality cooling of medical equipment. Medical equipment manufacturers are building multipurpose machines that deliver both diagnostics and treatment. These sophisticated systems require special chillers designed to handle two different cooling requirements.
Proper chiller design is a recurring theme. Tony Trumblee, medical account manager for Glen Dimplex Thermal Solutions, said that reliable chillers with built-in redundancy are the baseline starting point for trouble-free MR operations. He advocates the use of remote monitoring for safeguarding after-hours or during unusual and unforeseen situations, such as the pandemic.
Branca agreed that remote monitoring and chilling are a good paired solution. He recalled one job where the Cool Pair Plus crew was installing a remote monitoring system on a chiller, and as soon as it came online it reported several out of range readings that could have led to greater problems if they hadn’t been detected.
Think about the patient
Adhering to the OEM recommendations for your MR keep-cold needs is probably one of the more obvious recommendations to make sure everything is operating to spec. Above and beyond that, Trumblee suggested tying chillers into a Building Management System (BMS) so that performance can be monitored and alarms can be addressed immediately.
He also suggested that one of the best ways to ensuring the health of an MR unit is by keeping the patient in mind.
“Skimping on the purchase of a chiller can have a large impact on maintaining a consistent schedule for scanning patients,” Trumblee said. “People are hoping for a pleasant experience when scheduling a scan; they certainly don’t want to show up and find out the MR is down because the chiller isn’t functioning.”
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After the initial OEM warranty and service agreements expire, Trumblee advised looking around to find out what companies might be able to fulfill your facility’s maintenance needs thereafter. Dimplex, for example, works to schedule preventive maintenance in the spring and fall so that chillers will be ready for the summer's big heat loads.
Much of the work of companies specializing in HVAC chilling keep legacy equipment up and running as hospitals seek to extend end-of-life for expensive MRs. There have been some technological designs in recent years that improve energy efficiency and longevity.
Digital scroll compressors for improved modulation in handling heat loads is one example, according to Craig Conlon, service manager at Northern Air Systems, which specializes in mobile MRs. He said the configuration is being used more and more in the past five years, although the solution is not as compatible with legacy MR units.
Ultimately, MR operations still mostly come down to preventive maintenance basics.
“We still get a lot of calls in the summer due to a lack of proper preventive maintenance,” said Conlon. "Everything runs fine until it doesn't. We have seen some pullback in service since the start of COVID-19, although that tide seems to have turned at the beginning of July as scan volumes appear to be increasing.”
Not all chillers are created equal
When buying a refurbished MR, pay attention to the chiller unit that comes as part of the deal.
"Often, the old chiller comes with the system,” said Wong. “What customers often do not realize is that the chiller should be thoroughly evaluated before being reinstalled. Refurbishers often are only focused on the MR unit and may not provide the customer an option for a new chiller.”
The same caution applies when a facility is installing a new MR. Cooling cannot be an afterthought. Advanced Cooling Technologies has seen numerous sites where the general contractor installed the chiller without proper airflow clearances.
A poor chiller design can degrade performance and shorten chiller life. The HVAC installer should coordinate with the general contractor early in the project to ensure the physical layout meets the chiller OEM installation requirements.
“We’ve actually seen installs where a chiller was venting hot air into another chiller,” recalled Wong.
When it comes to mobile MRs specifically, cooling can present unique challenges. As Will Rausch, vice president of operations at Northern Air says, it’s “a different animal” altogether. Not only must the units be cooled during patient operations, but while being transported in an 18-wheeler. Mobile chillers have to be “ruggedized” and able to operate from various power sources.
“Our chillers have to be very robust,” explained Northern Air’s Conlon. “They have to operate efficiently from a generator aboard the trailer and efficiently transition to building power. And because the units are on the go, we have to be up for performing required maintenance anywhere.”
In the end, the MR cooling experts appreciate their customers' business. But what they want most is to avoid expensive service calls and downtime for their clients. Wong typified this attitude toward customers.
"Our goal is to make sure there is high MR availability for the patient and high reliability of revenue stream for the facility," he said.