When the Los Angeles Lakers come north to play the Sacramento Kings, the Kings fans haul out the cowbells. The cowbells are the Sacramento fans' answer to disparaging remarks made years ago by Lakers coaches who called Sacramento a "cow town." It does have an agricultural element with the great farms of the Sacramento Valley, but Sacramento is no cow town. The city has a population of about 410,000, but the metropolitan area is spread over three counties and totals about 1.8 million. Of this population, an estimated 1.1 million have HMO coverage. This is the market served by Radiological Associates of Sacramento (RAS), which operates 18 stand-alone imaging centers and six radiation oncology centers.

Sacramento is the California state capital, and is home to thousands of state employees, legislators, and those who lobby or serve them. The public employees, with their generous health care benefits, are one reason that Sacramento is referred to as the "managed care capital of the world." RAS covers close to 300,000 lives under capitated contracts.

Other RAS statistics: its technology includes nine MRI, five CT, one PET, five nuclear medicine cameras, 18 mammography units, 20 ultrasound units, nine linear accelerators, and untabulated numbers of plain film and more specialized units. On any given day, according to company promotional literature, RAS puts 325 patients "under beam," and performs 1,800 imaging procedures at its centers, including 300 mammograms and 125 MRIs. It does an additional 1,000 procedures daily at the hospitals it covers.

Sacramento lately has been billing itself as "the digital city," an acknowledgement of the many technology companies like Hewlett-Packard, Intel, and Apple that have opened facilities there. The city has also developed a reputation as a "call center" where the telephone traffic of many major corporations is routed. Sacramento also is home to a growing number of retirees.

According to RAS executive vice president Fred Gaschen, Sacramento is not only a growth market for general radiology but also, because of retirees, for radiation oncology. "The longer people live, the greater the chance they will get cancer," he says. "I think that is what is happening in Sacramento. We've got a growth in the general population and in our aging demographics. Cancer rates are higher in older individuals."

George Wiley is a contributing writer for Decisions in Imaging Economics.