I do a fair amount of consulting with veterinarians buying digital radiography systems. By the time they get to me, they are usually pretty confused because they cannot sort out the truth from the nonsense in the information they get from the digital radiography vendors.

Somehow the vendors get veterinarians focused on minutiae such as pixels, lines per millimeter, and fill factor. Most veterinarians get so focused on these little issues that they forget to focus on the big issues. It seems to me that many veterinarians rank their PACS and digital radiography purchasing decisions as follows:

1. Price
2. What type of system they are getting (CR vs. DR)
3. Number of Pixels
4. Number of lines per inch
5. Price

And that is pretty much where it ends. From my vantage point, this is a complete and utter disaster. I hear many complaints from veterinarians that are unhappy with their purchases. This is probably a combination of unrealistic expectations and because their decision buying process was out of whack. Personally, I would rank my purchasing decision as follows:

1. Image quality: You probably noticed that image quality didn’t even make most veterinarians list above. I find this completely bizarre. Would you buy a refrigerator that didn’t keep your food cold? Probably not, yet many veterinarians buy products that will give them crummy (sometimes nondiagnostic) images.
   • Always compare digital images to digital images.
   • Only evaluate images obtained at a veterinary practice –NOT IMAGES SHOWN TO YOU BY A VENDOR.
   • If the image quality is not there – look elsewhere.
     
   • 
     
2. Service and vendor reputation: You are trusting your vendor to sell you a system that will suit your needs. You will rely on your vendor for future service. You are relying on your vendor to pretty much organize a big chunk of your computer system. Why go with a vendor with a questionable track record? We have already seen some smaller digital radiography vendors go out of business and leave their customers in the dust.
   • Be sure to understand what the service contract says?
   • When will the vendor be onsite after you call?
   • How long does the vendor have to reply to a call?
   • What is included in the service contract?
     
   • 
     
3. Type of system you are purchasing: I see so many veterinarians willing to trade image quality to get some new fangled technology that will give them an instantaneous image. This is wrong. For most small practices, there is nothing wrong with CR. I would prefer to see a practice spend less money and get a full featured, DICOM compliant CR system than a cut rate DR system with no support and a crummy image.
   
   
4. Ease of use: You will have to interact with this machine every day.
   • Is it easy for you and your technicians to use?
   • Can non-computer literate staff members use this machine?
     
     
5. DICOM compatibility: Assuming that a vendor makes it past the first four cuts, now we can dig deeper.
   • Does the vendor have a DICOM conformance statement?
   • Can you send images to any radiologist?
   • How does your vendor store images?
   • What will happen if you need to migrate your data in the future?
   • Can you send images to an offsite backup service if the images are not stored as a DICOM file?
   • Do they provide DICOM query/retrieve functionality?
   • Can you autoroute images?
     
     
6. Integration with the hospital network: Although there are only a few practice management software vendors that integrate with digital radiography systems at this point, this will become important in the future. Integration with practice management is a bonus if it is available.
   
   
7. Price: In my opinion, you should not shop for price. Do your best to decide on a few companies and then look at the price. I am sure that I will be criticized for ranking price at the bottom but you really get what you pay for with digital radiography. If you can’t afford the system you really want, maybe you should consider sticking with film (remember-there is nothing wrong with film) or waiting for the price to come down. I would encourage you not to buy a cut rate system with no features just to get your foot in the door.
   
   
8. Now the little things: You can probably leave these off but vendors seem to make a big deal out of them. If you like, you can investigate things like pixel numbers, molecular makeup of the detector, fill factor, light dispersion factor, etc.

Remember: There is no single system that will fit every situation and every budget. Do your research and hire a consultant if the vendors try to confuse you.