Risk-Gated Capital Allocation for Radiological Equipment Replacement Under Safety and Budget Uncertainty

Abstract

Capital allocation for radiological equipment replacement is not a simple age-ranking problem. Hospitals must decide when continued operation is no longer admissible, which otherwise admissible systems have the strongest replacement case under uncertain technical evidence, and which replacement portfolio should be funded when capital, commissioning capacity, and service continuity are constrained. Existing medical-equipment models commonly aggregate age, reliability, safety, obsolescence, clinical importance, and cost into compensatory scores, whereas radiological renewal guidance emphasizes lifecycle planning, quality assurance, and technological obsolescence. This integrative conceptual review develops Risk-Gated Replacement Allocation (RGRA) for Computed Tomography (CT), fluoroscopy, radiography, and radiotherapy equipment. RGRA separates three decisions that should not be collapsed. First, a non-compensatory radiation-safety and mandatory-compliance gate excludes inadmissible retain-or-defer choices. Second, robust replacement-priority intervals quantify decision stability across plausible criterion-weight and evidence uncertainty. Third, a budget-constrained portfolio model selects replacements by avoided expected lifecycle loss while respecting service-continuity and implementation constraints. An Expected Value of Information (EVI) rule targets additional testing or vendor evidence only when it can change a borderline decision. The synthesis yields seven formal decision rules, six falsifiable propositions, and a prospective validation design. The framework contributes an auditable management architecture in which safety defines feasibility, uncertainty determines confidence, and optimization determines the funded replacement portfolio.