BANGOR – Suppose you had $150 to spend and a list of important things you could spend it on – get a brake job, neuter the cat, join the Y – which one would you choose? How would you decide?

It’s a familiar problem for some of us, but members of the Bangor area business community got a chance to wrestle with higher-stake options Tuesday morning, when Eastern Maine Healthcare Systems offered a behind-the-scenes look at hospital spending choices.

About 35 members of the Bangor Area Chamber of Commerce met at the Spectacular Event Center to participate in a mock capital spending planning session utilizing the same computer program used by the fast-growing regional health system.

All in attendance were issued scorecards, while a panel of 10 volunteers with a hypothetical $5 million to spend prioritized six compelling proposals with a combined price tag of more than $8 million:

. $960,000 for a digital mammography machine. The newest imaging process for detecting breast cancer at an early stage, this “second generation” technology can be used on all women. It allows closer inspection of suspected tumors, uses a lower dose of radiation and uses a filmless process that is suited to computer applications.

. $1.1 million for an intensity modulated radiation therapy upgrade, allowing cancer specialists to pinpoint radiation doses to tumors. IMRT allows a higher, more effective dose of radiation to be administered with fewer side effects.

. $977,000 for a 16-slice computed tomagraphy scanner. Multislice CT technology allows for rapid, detailed examination of all parts of the body. Virtual colonoscopy, noninvasive cardiac testing and precise cancer staging are some uses.

. $1.17 million for a new outpatient cardiac wellness center. The current cardiac rehab center is too small for the volume of patients who need it. This inadequacy causes delayed entry into a vital part of a heart patient’s recovery.

. $3.3 million for a Picture Archiving and Communications System. PACS is in high demand by radiologists and is considered a valuable recruiting tool. The technology allows near-instantaneous access to X-rays and other medical images by computer and allows these images to be transmitted anywhere in the world with the push of a button.

. $627,000 for a robotic surgical system. With this technology, a surgeon seated at a computer screen uses remote controls to manipulate a five-instrument surgical arm. Because the instruments are small and the physician’s hand does not need to enter the surgical field, incisions are much smaller. Infection, pain and other complications are reduced, making patient stays shorter and safer.

The panel listened to a brief presentation on each proposal before scoring it on six points: clinical impact; improvement of the facility; patient-family-physician satisfaction; increased hospital income; enhanced productivity; and increase or retention of patients.

A computer program “crunched” the numbers, yielding a prioritized list of acquisitions. Two proposals didn’t make the first cut at all.

EMHS President and CEO Norm Ledwin, who opened the meeting, said hospitals everywhere are struggling to acquire cutting-edge technologies demanded by patients and physicians, using a shrinking supply of investment dollars.

“It’s all about choices,” said Ledwin.

For the past six years, EMHS has used a computer program developed by Strata Decision Technology of Champagne, Ill., to help guide investments.

Strata CEO Catherine Kleinmuntz spoke at Tuesday’s event, saying hospitals are faced with reduced reimbursements from Medicare and Medicaid programs, increased costs, historic underinvestment in facilities and equipment and other pressures.

Prioritization of investments, using a systematic method such as the one her software provides, is key to hospital survival, she said.

The computerized results of Tuesday’s exercise recommended investment in the new mammography technology, the IMRT, the multislice CT scanner and the improved outpatient cardiac rehab center.

PACS and the robotic surgical arm fell off the list. Some reconsideration found that PACS could be phased in over a three-year period, much to the relief of panelist Lianne Harris.

Harris, president of a physician recruiting service, said the digital imaging technology is essential to attracting quality radiologists. “Every single radiologist I talk to refuses to go someplace that doesn’t have PACS,” she said.

Harris said after the meeting that the experience was a useful opportunity to learn about new technologies and the complex considerations that guide hospital spending. “It’s not enough for patients to receive good care,” she said. “Hospitals need to look at all the angles.”

For those who were sold on the “must-have” benefits of all six proposals, the hospital has good news: They’ve all been approved already and are either up and running or under development.

Community relations director Jill McDonald said EMHS officials soon will consider a new slate of 23 capital projects.