OBJECTIVES: Innovation in Medical Imaging Equipment (MIE) increases rapidly with benefits on quality, safety of diagnostic procedures and health outcomes, but the austerity measures adopted by healthcare systems have led to aging of the Installed Base (IB). The study aims to propose some actions for the MIE renewal policy in Italy. METHODS: The study has been conducted by: 1) a review of national and international literature on the state of art of MIE, 2) a survey of financial solutions available for renewal or maintenance and procurement policies, 3) a review of health policies adopted for managing and improving innovation. RESULTS: Guidelines states that no more than 10% of the age profile should be > 10 years old. In Italy the 26% of angiography, 21% of CT scanners, 31% of MRI and 19% of PET have > 10 years, being inadequate for diagnosis and representing the targets for replacement. Trend of aging is worsening with a decrease of equipment density. Obsolescence and low technological turnover have impact on accuracy, safety (i.e. CT radiation dose), quality of image, upgrade, with high risk of failure, breakdown, leading to high management costs, increasing waiting list and delaying diagnosis. The scarce resource available have led the Local Health Authorities to use financial solutions for renewal or maintenance as rental, service, pay-per-use and Public-Private Partnerships. Moreover, some Countries have implemented inpatient payment system with adjustments for new technology innovations. CONCLUSIONS: A renewal policy of MIE have to be based on HTA approach. Allocative appropriateness should be taken into consideration for investments and disinvestments, avoiding the replacement of under-used technologies and by considering the healthcare organizations (i.e. inpatient and outpatients services, hub and spoke model, technological complexity). Adoption of specific financial solutions and tariffs with reimbursement depending on ageing of MIE could promote the renewal of IB.