India’s healthcare story has always been one of contrasts. Metro hospitals run 3T MRIs and multi-slice CT scanners that match the best in the world. Step outside these cities, and the picture changes sharply. “A new 3.0T MRI system costs Rs 15-25 crore; a 128- slice CT scanner, Rs 8-15 crore. For most regional healthcare providers, these price points are simply unrealistic”, says Brijesh Suneja, Director, Phantom Healthcare.
This gap is not just a number on a balance sheet. It decides whether a patient in a small town gets diagnosed on time or has to travel hundreds of kilometres for a scan. As the industry looks for answers, refurbished radiology equipment has emerged as one of the most debated solutions. Can preowned, restored imaging systems genuinely close India’s diagnostic divide, without compromising on safety or trust?
The scale of the gap
The numbers tell a stark story. “India has roughly 2 to 3.5 MRI machines per million people, depending on the data source. But even that number is misleading, because majority of these machines are concentrated in metros and Tier I cities. In a typical Tier II or Tier III district, you are fortunate to find even one functional MRI unit”, explains Dr Arunkumar Govindarajan, Executive Director and Radiologist, Aarthi Scans and Labs.
Dr Pranav Mahadeokar, Consultant Radiologist and HOD, Ruby Hall Clinic, calls this a structural delay with real clinical consequences, “Rural and semi-urban populations frequently face structural delays, often traveling hundreds of kilometers just to access basic cross-sectional imaging. This geographic barrier directly impacts clinical outcomes in time-critical domains like stroke, trauma triage, and oncology staging.”
Dr Kamlesh Kumar, Associate Consultant-MD, Radiodiagnosis, Regency Hospital, Gorakhpur, sees this delay play out at the patient level every day. “In certain medical conditions like stroke, trauma, cancer, cardiac related emergencies and complex infections, delay in imaging can delay medical diagnosis, treatment related decisions and referrals, directly impacting patient related outcomes”. For him, refurbished equipment is a way to bring “quicker clinical decisions, reduce burden of travel, lower out of pocket expenses and better continuity of medical treatment” to smaller cities.
According to Dr Prem Kumar Ganesan, Senior Director and HOD, Radiology and Imaging, BLK Max Hospital, refurbished units act “as a bridge, allowing smaller healthcare centers to acquire Tier I-grade diagnostic capabilities such as 1.5T MRIs or 16- to-64-slice CT scanners at a fraction of the cost.”
The economic case
The cost advantage is the single biggest reason refurbished imaging is gaining ground. Abhishek Mudafale, Investment Principal, Somerset Indus Capital Partners, breaks it down clearly: “Refurbished equipment can significantly bridge this gap by reducing upfront equipment costs by 30 per cent to 70 per cent, making advanced diagnostics commercially viable for smaller healthcare providers. In many cases, facilities upgrading through refurbished systems also report operational cost efficiencies of up to 50 per cent to 80 per cent.”
Suneja mentions that the economic case for refurbished versus new equipment is quite compelling. “A new equipment investment typically involves a capital cost of Rs 8–25 crores, depending on the system type, along with Rs 1–3 crores for installation and infrastructure.”
“Annual maintenance and support amount to 8–12 per cent of the capital cost, the lead time to operation is 12–18 months, the working lifespan is around 8–10 years before technological obsolescence, and the total cost of ownership over 10 years ranges between Rs 12–35 crores.”
He explains, “In comparison, refurbished equipment requires a capital investment of Rs 3.5–12 crores, representing a 40–60 per cent discount. Installation and infrastructure costs are generally lower at Rs 0.5–1.5 crores, while annual maintenance and support account for 6–10 per cent of the capital cost, provided OEMgrade parts and service are available. The lead time to operation is significantly shorter at 6–10 weeks, the working lifespan is typically 5–7 years with proper lifecycle management, and the total cost of ownership over seven years ranges between Rs 5–15 crores.” Talking about the economic advantage, Suneja mentions, “Refurbished systems reduce upfront capital burden by 50–60 per cent, accelerate revenue generation through faster deployment, and lower annual operational costs. For a diagnostic centre with limited capital, refurbished equipment allows immediate service expansion rather than multiyear fundraising delays.”
Dr Mahadeokar adds that “By significantly lowering the entry barriers for standalone diagnostic centers and district-level multi-specialty hospitals, high-end modalities become financially viable in markets characterised by lower per capita healthcare spending.”
Dr Indiresh Desai, Lead Consultant-Radiology, SPARSH Hospital, RR Nagar, Bangalore, agrees the model works best when hospitals treat it as more than a bargain buy: “The correct approach in the same is to evaluate refurbished equipment as a very long term clinical investment, not merely as a very low cost alternative.”
Dr Govindarajan describes an interesting pattern many hospitals now follow. “A new hospital or diagnostic centre installs a refurbished MRI to become operational without overleveraging its balance sheet. Once the business stabilises, usually within three to four years, they upgrade to a new OEM system that offers stronger service coverage and long-term parts availability. This is actually a rational capital allocation strategy, not a compromise.”
Keeping quality and safety front and centre
Cost savings mean little if patients cannot trust the results. Every expert agrees that quality assurance is non-negotiable. “Independent acceptance test ing before clinical use is equally important. Involving qualified professionals, including medical physicists where required, helps validate image quality, equipment performance and radiation safety compliance”, says Mudafale.
Suneja highlights that refurbished equipment can deliver clinical performance equivalent to new systems, provided the refurbishment process is rigorous and transparent.
He explains, “A responsible refurbishment pathway includes source verification, with equipment sourced from reputable OEM facilities, verified lease-return programs, or certified trade-in channels—never from unknown secondary markets or salvage operations. It also includes a comprehensive technical audit comprising full system diagnostics (hardware, electronics, calibration), component-level testing and performance validation, imaging quality assessment against OEM baseline specifications, and verification that no structural damage, recalls, or safety issues exist. This is followed by a certified refurbishment process involving replacement of worn components (bearings, cooling systems, electronics), full alignment and calibration by certified biomedical engineers, replacement of consumables and safety-critical parts, and clean-room assembly standards to prevent contamination.”
“Quality assurance and documentation include comprehensive test reports with before/after performance metrics, full traceability of all components replaced, certification against international standards (IEC 60601, FDA equivalency where applicable), and documented maintenance history. Clinical validation involves pilot imaging studies on known phantoms to verify diagnostic accuracy, comparison against reference systems to ensure image quality, and documentation of clinical performance metrics. When these steps are executed with discipline, refurbished systems can match new equipment performance—often with superior reliability because every component has been individually tested and validated, whereas new systems rely on statistical quality control.”
Dr Gaurav Malhotra, Director-Radiology, Sri Balaji Action Medical Institute, Delhi, believes documentation is what builds confidence, “Every refurbished system should also come with clear documentation of its past usage, process of refurbishment, parts which are replaced, calibration status, radiation safety related checks, performance of image validation and schedule of preventive maintenance.”
Not everyone is equally certain, and that honesty matters too. “There is no foolproof way to guarantee the long-term reliability of refurbished imaging systems,” says Dr Shehzia Lakhani, Consultant, Radiology Department, Saifee Hospital. “Hospitals can minimise risk by purchasing equipment from reputable vendors, verifying service histories where available, ensuring proper installation and calibration, and opting for comprehensive maintenance support. However, despite these precautions, some degree of unpredictability remains unavoidable.”
Maintenance and lifecycle: The real test
Buying the machine is the easy part. Keeping it running is where the real challenges begin. “The biggest challenge with refurbished systems is not acquisition; it is ensuring longterm uptime, service continuity and predictable lifecycle performance. As original equipment manufacturers prioritise newer product lines, sourcing replacement parts for older systems can become more difficult, time-consuming and expensive”, says Mudafale. Dr Ganesan echoes this concern from a service-network angle, “The refurbished imaging market in India is growing, but it remains fragmented. There are too many small vendors operating without the scale required to provide consistent, reliable service over the long term.”
Dr Lakhani stresses, “Since refurbished systems often come with little or no manufacturer warranty, investing in them involves a certain level of risk. In India, post-sales service can sometimes be challenging even for brand-new equipment.” Dr Mahadeokar adds that in remote locations, “The mobilisation time for a qualified engineer can lengthen repair windows,” making strong maintenance contracts essential from day one.
Regulation: Closing the gaps
On regulation, experts broadly agree that India’s framework is a good foundation but needs sharper definition for refurbished equipment specifically. “India has an established regulatory framework for medical devices, led by the Central Drugs Standard Control Organization and the Atomic Energy Regulatory Board,” notes Mudafale.
“However, the current framework does not fully differentiate between refurbished and secondary-market equipment. This creates gaps in standardisation and oversight.”
Dr Mahadeokar offers the most detailed picture of the compliance journey, from CDSCO import licensing to the Ministry of Environment’s NoObjection Certificate requirements, which call for “a certified minimum residual life of 7 years, direct factory refurbishment by the OEM, a 1-year warranty paired with a 3-year CMC, guaranteed spare parts availability, and strict Extended Producer Responsibility e-waste registration.”
Dr Govindarajan flags a specific blind spot: MRI. “Because MRI operates on non-ionising radiation, it falls outside AERB’s primary jurisdiction. India currently has no dedicated regulatory body governing MRI safety standards.” Dr. Malhotra sums up what the industry wants to see next: “clear certification, periodic audits, accountability of vendors, and complete adherence to radiation safety norms.”
The road ahead: Sustainability and scale
Looking to the next five years, the outlook is largely optimistic. Mudafale believes refurbished imaging will move “from being a budget alternative to a mainstream enabler of healthcare expansion.” Sustainability is emerging as an unexpected strength of the refurbished model.
“Beyond economics, refurbished equipment aligns with broader sustainability commitments. Medical device manufacturing is resource-intensive; the electronics, rare metals, and manufacturing energy embedded in a system represent significant embodied carbon. When a system is refurbished and used for another 5-7 years instead of being discarded, that embodied impact is amortised across a longer service life—reducing per-year carbon footprint by 40-50 per cent.
Suneja also adds, “Refurbished radiology equipment is not a temporary workaround for India’s imaging access gap. It is a strategic infrastructure solution that can systematically improve diagnostic accessibility, reduce healthcare disparities, and support sustainable growth.”
Dr Govindarajan sees consolidation as the next big shift: “Three or four well capitalised refurbished equipment companies with national service infrastructure, trained engineering teams, and credible annual maintenance commitments would fundamentally change the reliability profile of this segment.”
And Dr Lakhani, though more cautious throughout, ends on a hopeful note: “If managed responsibly, refurbished imaging equipment can contribute meaningfully to both healthcare sustainability and equitable access to diagnostics, ensuring that more patients receive timely and accurate medical care.”
The consensus across metros, Tier II cities and boardrooms is clear: refurbished radiology equipment is not a shortcut, but it can be a serious strategy. As Dr Malhotra puts it, the goal is a system where “affordability and safety move together.”
If India gets the quality checks, service networks and regulations right, refurbished imaging could well become one of the country’s most practical tools for taking advanced diagnostics beyond the metros.
kalyani.sharma@expressindia.com
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