By John R. Fischer

Whether it’s a parking lot or a hospital campus, mobile medical imaging trailers are able to go where they’re needed most. This is especially helpful in rural and remote areas that are miles away from the nearest healthcare facility. Even if a provider is nearby, many lack the finances or demand to justify purchasing or updating medical imaging suites. “Mobile allows hospitals to get the latest technology,” said Larry Sodomire, president of TDC Trailer. “In rural America, providers share the unit. If providers are only using it one day a week, then the cost can be as low as $10,000 per month. Using mobile imaging trailers, they do not have to redo their whole suite for millions of dollars.”

Mobile imaging can also be an asset to urban and suburban hospitals with high patient volumes. As many of these providers partner with smaller facilities and expand outward, the need for these units has only increased, says Chad Smith, division president of Armor Mobile Systems and Medical Coaches. And it is a suitable alternative when constructing new imaging suites, as it can help prevent service disruptions and patient backlogs. “If a provider is looking to put a brick-and-mortar building in, sometimes they can have temporary mobiles that facilitate imaging while that structure is being built,” said Smith. “It's less costly and they can bring a medical trailer in there for four or five years and then move it out when they're finished.”

Mobile units are frequently upgraded with the most advanced scanning technologies, making their equipment in many cases superior to fixed solutions. Setting them up is also easier in comparison to brick-and-mortar buildings, because they are not subject to the same building codes and regulations, which vary from location to location.

As many units travel specific routes throughout the week, providers can schedule when they need them most in advance, allowing them to give patients advanced notice of when imaging services will be available.

Having the right imaging modality
In recent years, demand for imaging modalities in mobile units has shifted. Whereas rural hospitals once mainly relied on X-ray and ultrasound, many are now in need of more advanced applications like MR, CT and PET/CT. Patrick Doyle, chief executive officer of mobile imaging company DMS Health Technologies, chalks this up to people living longer, which has led to new and higher rates of illnesses.

“Unfortunately, in the PET/CT market, you have a number of cancers in our society affecting our population. PET/CT is now being used for prostate cancer and for cardiac and for brain conditions,” he said. “With MR, we have a more active society. Everybody you talk to will say, ‘My shoulder hurts, so they’re giving me an MR.’ A lot of it is population growth and the number of scans needed.”

Demand in the last few years has been especially high for wide-bore MR because of its ability to image bigger and claustrophobic patients. Advanced 64- and 128-slice CTs have also attained popularity due to lung cancer concerns as well as the ongoing COVID-19 pandemic.

Additionally, CT has become a very popular modality on mobile stroke units (MSUs). In 2021, the University of Texas Health Sciences Center at Houston and Memorial Hermann-Texas Medical Center conducted a study showing 9% mortality rates among ischemic stroke patients treated on MSUs, compared to 12% among those on EMS units.

“We're treating stroke victims right at the site versus the hospital, diagnosing them,” said Smith. “We can actually drive the mobile CT right up to the person who has had a stroke and diagnose whether it's a bleed or a clot right away.”

Nuclear modalities like PET/CT and SPECT are gaining traction due to the number of new radiopharmaceuticals being produced to assess different types of cancer and other forms of imaging such as cardiac, according to Taylor Kelly, vice president of Kelly Mobile Services in California. "I've seen a lot more of those lately than I did in the past. As far as whether PET/CT or MR is moving the most across the board, it's pretty even for both."

Nuclear medicine technology is moving from larger footprint PMT (photomultiplier tube)-based technology to solid-state CsI (Cesium Iodide) detectors that are much smaller and relatively lightweight, according to Matthew Hoover, senior manager of business development at Digirad, who says this transition yields a variety of benefits. “You’re able to do as much and possibly more with a smaller piece of equipment and get better results," he said. "New solid-state CsI detector technology also uses less power and emits less BTU (British Thermal Unit), lowering overall operating cost as well as potentially reducing a facility’s carbon footprint.”

Changes in the components for modalities have also led to changes in the design and specifications for trailers, such as the switch from air cooling gradients to water cooling ones. These material changes, along with the faster release of more advanced scanners, have led mobile imaging providers to upgrade their trailers more frequently.

“We're seeing an uptick in manufacturing new trailers. Providers are getting rid of old ones, especially for MR systems,” said Sodomire. “The same thing is happening with CTs and PET/CTs. They're coming to their end of life and providers either have to get a time and material contract on their imaging equipment, which can be very expensive, or providers trade in their equipment or get new equipment and then put in place an annual service contract.”

Additionally, the interiors of tractor-trailers are a far cry from the cold and sterile, clinical environments that these units once occupied. Instead, many mobile trucking companies are creating warm and inviting areas that make the patient feel more comfortable. Some, for instance, have added decor like skylights, wall murals and interior graphics to calm people who step onto the truck. This enables patients to stay still and focus, which in turn makes scanning faster, easier and more accurate. It also can help reduce repeat scans due to movement.

“We’re starting to see some manufacturers building these trailers that are phenomenal,” said Doyle. “It doesn't feel like you're going out in a trailer. It feels like you're going into a suite.”

What providers should be looking for
Sodomire says that before 2008, the industry produced five to six hundred new mobile imaging trailers a year. The Great Recession caused this number to drop significantly along with the number of buyers of new trailers. But in the last few years, the market has been rebounding and the demand is going up for mobile imaging trailers with state-of-the-art imaging technology. As a result, companies like TDC Trailer are building more imaging trailers. “In 2020, in total, only about 100 new trailers were built,” said Sodomire. “That was probably the first year since 2008 that new trailers were even actually built. And then in 2021, I think there were about 120 total trailers built, and I think this year there will probably be 150 new trailers built.”

While the introduction of new trailers with advanced scanners is a promising sign, providers also must pull their weight to ensure that patients receive top-notch care when entering these units. Doyle says the first step is to choose a mobile imaging partner they trust, that understands the specific needs of their local patient population and will abide by established guidelines in their area. “Many factors go into this, including patient care and revenue. You really need someone who is looking to be a true partner. We are still an investment.”

Smith adds that such a mobile manufacturing partner should be experienced and OEM-approved. “You want a company that has 20 plus years of experience manufacturing mobile medical units. If you’re going to go with a certain manufacturer of a mobile medical trailer, you want someone who's been certified to install the specific equipment by the OEM,” he said. “Look at features that make it easier to set up and operate the unit. Talk to customers who are actually using this particular model in the field and learn what their experience has been.”

It is also important that providers communicate regularly with mobile imagers and let them know of any schedule changes ahead of time. "Lately, we're booking trucks weeks in advance. It makes it difficult to book last minute requests from the different mobile imaging providers. We are busy and the number of drivers that specialize in supporting the mobile imaging industry are few. The more time they can give us to get units moved the better," said Kelly.

Leveraging the advantages of mobile imaging services or mobile imaging equipment "takes a dedicated, multilayered healthcare team," according to Hoover. An important step is getting the word out not just to locals but clinical staff about the purpose and capacity of these units. It also will help clinicians document and report progress updates to referring physicians.

"You need the other cardiologists and oncologists to be aware of the services available, as well as what procedures the equipment is capable of performing, along with the how and where those procedures can be performed,” said Hoover. “Because then they can say to the referring physician, 'Hey, I saw your patient for this on a mobile imaging unit or imaged bedside (or some other point of care). Everything turned out great.'”

He suggested providers publish case studies conducted at their facility on mobile imaging scanners or send out an email blast. “It's about giving the referring provider that confidence and establishing that pattern of referrals."