Clinicians are rarely content to carry on using the same medical equipment year after year. Even where services are relatively well equipped, this year’s technology usually offers more than last’s. Clinical aspirations and patient expectations, driven by pressure to replace or upgrade existing equipment to improve patient treatment, safety and service efficiency, create a demand for equipment funding that is hard to satisfy. There are always limits on the amount of money an organisation can invest in its medical equipment, yet limits are not always a bad thing. They direct an organisation to look at what it really needs and encourage it to get the most out of what it already has. Many healthcare organisations are not good at doing this: for example, a surprising number of clinical and capital developments are initiated without considering the full consequences on future equipment needs and spending [1].