Market conditions must be uniquely assessed when determining whether to invest in new technology or services. In this case, the strong reputation of the investigating institution likely created favorable conditions for an investment in EBUS to be successful. The primary flawed assumption in this model was that patients were referred strictly based on the presence of EBUS. No verification for this premise is offered (eg, questionnaire of patient or referring physician), and for this particular institution and catchment area there was no comparable alternative, suggesting perhaps these patients would have come to this institution based on a strong reputation independent of technology available. When deciding if any figure, in this case $2.4 million, is truly meaningful and applicable to other settings, other considerations must be addressed.