The annual running cost of a nuclear medicine department in Bangladesh
What the recurring budget has to carry once the equipment is paid for: isotopes and kits, service cover, decaying sealed sources, dosimetry, calibration, UPS batteries and the air conditioning that never switches off.
A capital paper for a gamma camera gets three months of committee scrutiny. The recurring budget behind it often gets a single line called consumables, written by someone who has never run a hot lab. The year the warranty ends is when that becomes visible, and it is a bad year to discover it.
Actual figures depend on the department, so what follows is the list of lines that have to exist and what drives the size of each. A recurring budget with all of these present, even roughly estimated, is more useful than a precise number for two of them.
The lines that dominate
Radiopharmaceuticals and cold kits. Usually the largest non-staff line. Driven by generator size, elution schedule and case-mix, and inflated by wastage. Every unfilled slot on a high-yield day is activity that decayed in the store, so booking discipline is a cost control, not an administrative preference.
The service contract. The second largest, and the one most often dropped in the first year after warranty to make a budget work. That is a false economy: a single unplanned board replacement with no contract, plus the lost sessions while it is shipped, generally exceeds the premium.
Staff. Frequently the largest of all, and frequently accounted for somewhere else in the hospital, which is how a department appears cheaper to run than it is.
The lines people forget
Sealed sources decay. The flood source used for daily uniformity and the check sources used for the dose calibrator have a working life and a replacement cost on a schedule. Budget for it or the QA programme quietly stops.
Personnel dosimetry. Badges have to be supplied, read and reported, for every monitored worker, every period, including the staff who only occasionally enter.
Instrument calibration. The dose calibrator, survey meters and contamination monitors need periodic external calibration. This is a scheduled annual cost, not an event.
UPS batteries. A consumable with a life of a few years that fails silently and is only discovered during the load-shed it was bought for. Put replacement in the plan rather than in the incident report.
Air conditioning. Equipment cooling runs continuously, so it appears in both the maintenance line and the electricity line, and in Bangladeshi summers it is not a small number. Add filter changes and humidity control.
Standby generator fuel. Load-shedding is a running cost for this department specifically, because the equipment cannot simply be switched off and restarted at leisure.
Software licences and storage. Module subscriptions where they apply, operating system and antivirus obligations, and PACS storage that grows every year with SPECT volumes.
Radiation protection consumables. Syringe and vial shields get damaged, gloves, absorbent bench covers, waste bags, contamination swabs and decontamination stock. Individually trivial and collectively the thing that stops the department at nine in the morning.
Waste. Storage space, the records that go with decay-in-storage, and the staff time to maintain them.
Regulatory and training. Authorisation fees, the preparation time before an inspection, refresher radiation protection training, and applications training for new staff. Staff turnover converts training from a capital item into a recurring one.
Building upkeep. Positioning laser realignment, door interlocks, delay tank maintenance where therapy is offered, and the plumbing nobody wants to think about.
What the size of the budget actually depends on
Rather than a figure, use the drivers, because they are what a finance committee can question sensibly.
Studies per week, which sets isotope consumption and the wastage ratio at the same time.
Case-mix. Cardiac and SPECT work consume considerably more activity per patient than thyroid uptake and static planar imaging.
Whether therapy is offered. Radioiodine adds inpatient shielding, drainage, waste holding and a longer records burden.
SPECT/CT against standalone SPECT. A second modality means a second QA programme, a second set of consumables and a wider service scope.
Detector count. Most maintenance and QA costs track the number of heads.
Hours of operation. A department running two sessions a day gets better value from each generator and spends more on everything else.
The two mistakes
The first is budgeting year two from year one. Year one is a warranty year with a full set of new consumables, and it understates the real position badly. Build the steady-state budget from the second full year onwards and treat year one as the outlier it is.
The second is treating QA consumables and calibration as optional when money is short. They are the cheapest lines on the list and they are what stands between the department and an inspection finding, a wrong report, or a fault discovered by a patient rather than by a phantom.