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> MRIs are extremely scarce tools of last resort and treat them like we treat blood tests.

How would this work?

I can do a blood test and send it to the lab to be processed in ~5 minutes from the moment I meet the patient. Consumable costs are about $2.

I can also do an MR scan. It took a fair bit of training and the scanner and scan room cost about US$2 million. Service contracts on the scanner, scan room, chillers and required staffing utterly dwarf the cost of the scanner over its lifetime.

The scan takes 20-75 minutes. Then the images get sent for reporting. Unlike a blood test, reporting isn’t automated. Even if it was, how could availability of MR ever be similar to a blood test?

[cyberax]

> I can do a blood test and send it to the lab to be processed in ~5 minutes from the moment I meet the patient. Consumable costs are about $2.

This depends on a blood test. Bacteria cultures or PCR tests still take more time.

A mid-range scanner costs $500k, the room itself indeed might cost more. Just as real estate. Scanners are just not scarce anymore, there are even sites that sell used ones: https://prizmedimaging.com/collections/mri-equipment (I now want one in my backyard...)

You can lease a new top-level device at around $30k per month: https://www.meridianleasing.com/equipment/medical/mri-machin...

So you're looking at maybe $1k a day that you need to pay towards the device cost. The consumables (helium) are pretty negligible.

A full-body scan is about 1 hour. But for a follow-up you will need to focus only on a few areas, reducing that to maybe 20 minutes. So one device can feasibly do 10 primary scans a day and 20-30 follow-ups. So the cost of the device itself becomes on the order of $100 per imaging session.

This is literally in the "blood test" expenses range.

> Unlike a blood test, reporting isn’t automated.

Radiology readings is one thing where AI is already making inroads. And radiologists can be located anywhere, it's a perfectly remotable job.

> Even if it was, how could availability of MR ever be similar to a blood test?

Yeah, indeed. How can we imagine that people will have computers on their _desks_ when even a small IBM takes half a building?

Mass production happened. And this time it has taken the industry completely by surprise.

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I manage an MR service. Not a large one, but it keeps me busy.

>A mid-range scanner costs $500k, the room itself indeed might cost more. Just as real estate.

The room is about $250k to get it fitted out and the Faraday cage built.

> Scanners are just not scarce anymore, there are even sites that sell used ones: https://prizmedimaging.com/collections/mri-equipment (I now want one in my backyard...) You can lease a new top-level device at around $30k per month: https://www.meridianleasing.com/equipment/medical/mri-machin...

The Skyra is end of life and the ones I know of are getting pulled out. Too old. The generation after it is getting on too. The new generation will appear next year. Likely ‘dry’ magnets - low helium usage. The Siemens 1.5T has already had this upgrade.

> So you're looking at maybe $1k a day that you need to pay towards the device cost. The consumables (helium) are pretty negligible.

A service contract is expensive and also required. I’d expect them to be up to about US$75-100k a year. Coils are US$10-20k each and a scanner has about 10 different ones. We blow about one a month across our scanners and get them replaced. Various things break, and it comes in waves. In recent months: the body coil blew (this is a big deal, $150k?), gradient amp, amp cables, helium expansion vessel, vacuum pump, bore screen, knee coil, another knee coil. The service contract covers all the repairs.

>A full-body scan is about 1 hour. You can do them in 30-45mins, improving the business case.

But for a follow-up you will need to focus only on a few areas, reducing that to maybe 20 minutes.

Doing a real scan of a body site is vastly better, and is about 20 mins per region.

> So one device can feasibly do 10 primary scans a day and 20-30 follow-ups. So the cost of the device itself becomes on the order of $100 per imaging session. This is literally in the "blood test" expenses range.

We get around that number out of our scanners doing real scans and our costs are a lot more than that.

I don’t see staffing mentioned? A good tech will improve throughout, and you need more than one. A good operation will have several per scanner. They reduce the ever present danger and keep the operation running smoothly. I’m biased, I’m a tech.

Another thing missing - liability. I work in a country that isn’t quite as full of lawsuits as the US. Whole body scans are a glorious way of collecting liability. Poor quality images of everything in ‘well’ patients. As a rule in imaging, ask a good question get a good answer. When you’re searching the whole patient for something’s it’s easy to miss something.

> How can we imagine that people will have computers on their _desks_ when even a small IBM takes half a building? Mass production happened. And this time it has taken the industry completely by surprise.

The radiologist needs to be onsite. We give drugs. They inject things, they biopsy, they are doing stuff.

Yes, lots of stuff can be done remotely and AI assisted. Assuming they can all be replaced assumes a role that the radiologist had a long time ago, or maybe never had.

There are a lot of efficiencies that can be made, and radiology needs all the help it can get, but it isn’t a ludicrously inefficient or stuck in the past.

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> I don’t see staffing mentioned? A good tech will improve throughout, and you need more than one. A good operation will have several per scanner. They reduce the ever present danger and keep the operation running smoothly. I’m biased, I’m a tech.

That's why I put the cost of the scan at $1k, to make room for a profit margin and the staffing cost (which will be more than equipment).

Liability is an issue, but not an insurmountable one. If you get poor-quality images, you can just retake them. So biasing radiologists towards that can be a workable solution. There is also a lawsuit in the US going on against one of the full-body scan companies that missed a cancer, so we'll see how it turns out.

> The radiologist needs to be onsite. We give drugs. They inject things, they biopsy, they are doing stuff.

For clinical MRI. Not the diagnostic screening ones, they are done without any contrast.

> There are a lot of efficiencies that can be made, and radiology needs all the help it can get, but it isn’t a ludicrously inefficient or stuck in the past.

Radiology is fine, the AI will help them to do quick screening and point out possible pathologies.