The Indian market is a unique market, and sets its own rules. The continuity of this segment and a growing one at that is one such example.

The radiography field has been gradually replacing analog methods of detection in favor of digital technology over the past few decades. Long before DR came on the market, its predecessor CR had gradually replaced the old analog method of film-screen cassettes by introducing imaging plates manually inserted into a computerized reader. Although larger hospitals have already started to make the conversion to the latest DR technology, CR systems continue to have relevance in Indian medical facilities, largely because they function reliably and replacing them involves additional expenditure.

In recent years, the CR industry has witnessed rapid advancement of technology, where new designs showcasing sleeker, light-weight equipment have been introduced in the market. The size of CR readers has been getting smaller and smaller, with the latest models, now the size of desktop printers. Additionally, the costs have come down significantly, making them quite affordable for small private practices. As image quality and dose efficiency are excellent, CR remains a solid, reliable technology for its price, and many private practices are not prepared to give it up. The CR technology remains an effective solution for small clinics and orthopedic or general practice offices, as well as chiropractors and veterinary care facilities.

The Indian CR market has been growing at a CAGR of 12-15 percent annually with a major share of business from small- and medium-size hospitals, diagnostic centers, and X-ray clinics. Major vendors that include Carestream, Fujifilm, Konica Minolta and Agfa. iCRco also have some presence.

Various factors that influence the growth of this segment for the coming years in India include large population size, increasing spending capacity of the population, expanding network of the private hospital chains, and growing penetration of private standalone diagnostic centers. Demand for CR is expected to continue to grow, albeit may be confined more to lower-end systems. Consequently, there would be a replacement market, which should start then.

Global Market

cr-systems

In USA, in a bid to drive digitization, in late 2015, the Medical Imaging Modernization Act of 2015 was announced to provide payment incentives to encourage image providers to transition from traditional X-ray imaging to digital radiography. As part of this legislation, it was declared that reimbursement payments would be cut from 2017 for images produced with analog film X-ray equipment by 20 percent. The cut in reimbursement for computed radiography (CR) equipment would be more gradual; from 2018 to 2022 there would be a 7 percent reduction in payments for images produced with CR equipment, increasing to a 10 percent reduction from 2023 onward.

In any case, sales of analog X-ray systems have declined significantly in the U.S. over recent years and this downward trajectory will continue. The impact of this on the CR market is debatable. Growth in the CR market was driven by hospitals seeking affordable solutions to replace their existing analog systems with some level of digital imaging. Although, CR systems cannot match the workflow efficiency of digital radiography and this, combined with the significant declines in average selling prices for digital systems, has resulted in decline of the CR market in the U.S., these systems continue to be used by those who own them, at least for the time being.

In other developed markets, CR equipment is forecast to experience continued decline from 2015 to 2019, caused by stronger uptake of retrofit equipment. In Western Europe, there was a significant shift to retrofit combined with stronger than expected growth in fixed flat panel detector (FPD) systems. This change came about due to a broader range of systems available, from low-end systems ranging from USD 65,000 to premium, high-end systems up to USD 200,000. Systems are now available in a range of price brackets to tailor equipment to end-user budgets, which have been declining over the past few years as a result of strict healthcare spending cuts.

In emerging markets, such as parts of Latin America and Asia-Pacific, the single-plate CR market still has some demand, in cases where retrofit is too expensive. However, the multi-plate CR market has also been significantly hit in emerging areas, where the preference has changed toward retrofit, causing significant decline in multi-plate.

The outlook globally for CR longer term is continued decline with preferences changing toward FPD systems and retrofit. This continued change toward FPD and retrofit is being driven by the continued need to save costs longer term by increasing efficiency and workflow. The continued decline in prices for FPD and retrofit are driving this transition as the benefits and cost become more viable than CR. Without any new technologies currently threatening FPD and retrofit, it is unlikely that they will slow down anytime soon.

The Use Case for CR

CR systems are compact, flexible, cost less than DR, and can be used in tight office and clinic spaces. In addition, some CR systems are used for mammography, streamlining workflow, and eliminating the need to maintain film and chemistry for mammography exams.

Primarily, the variety in size of cassettes and the fact one can change pretty easily is one reason for CR technology to continue. Most DR systems offer only 14×17- or 17×17-inch detectors, but if an imaging center or hospital needs an 8×10-, 11×14-, or 14×14-inch plate, CR may be the better option. One of the pros of CR is its versatility as far as the imaging plate goes. CR offers a lot of different sizes, DR does not.

The newest generation of CR systems offers image quality and productivity advances, and continued improvements in these areas are expected in the future.

CR continues to be a viable alternative to wireless portable DR for many customers, with only an occasional need for higher projection flexibility, low throughput, etc. However, CR is also seen as a transitionary technology now, at least in some markets. Increasing availability of cost-efficient DR will drive CR down but slowly.

Cost Factors

The top reason administrators and facilities consider CR over DR is limited budgets. While the price points of DR systems have dropped, CR systems still cost significantly less. Price will always be a deciding factor and DR will always cost more than CR.

While there is not a lot of buzz in the industry right now, there are some brand-new products being launched to appeal to those who remain loyal to CR.

S. Karthikeyan, National Sales Manager, Fujifilm India Private Limited
Industry Speak
A Market Driven by Necessity

Computerized radiography with a market size of more than 4500 units per annum has been growing at the rate of over 10 percent on a year-on-year basis. This is mainly fuelled by customers in the C and D class cities. The preference is to directly go digital rather than starting with analog first and then moving to digital.

Space constraint at customer sites has pushed forward requirement for compact and space-saving CR systems. Cost of equipment and service support are key factors considered while purchasing CR 
and imager. The reduced price gap between 
non-mammography CR and mammography CR has helped customers go in for a mammography-ready CR rather than upgrading their CR system at a later stage.

Since the output from a CR is digital, the end user has greater flexibility in terms of distributing images. This can be sent over a network for reporting through tele-radiology or can be connected to a local mini-PACS network. A combination of CR and mini-PACS in a hospital has been very useful in terms of transferring images from the X-ray room to the consultant room reducing time taken for patient images to reach the consultant. Hospitals have also been trying to utilize the benefit of using CR in mobile vans/buses in order to cater to the rural population and for health camps. CR systems are getting installed in mobile vans along with ultrasound, X-ray, mammography, and diagnostic equipment. A few corporates have opted for mobile vans as a part of their CSR initiative.

To ensure better convenience and quick diagnosis, there has been an increasing trend of CR system installed at ICUs. With the benefit of being used for a variety of applications, such as general purpose radiography, mammography, and dental, CR sales are poised to grow in the coming years.

S. Karthikeyan
National Sales Manager,
Fujifilm India Private Limited

Chandan Naphade, General Manager-X-ray Solutions, Carestream Health India Private Limited
Industry Speak
CR Imaging - Still the Best Answer for Many Imaging Facilities

Computed radiography (CR) has been a vitally important imaging technology for quite some time - it was introduced in the mid-1980s. Today, while many facilities are transitioning to the benefits of digital radiography (DR), it appears that CR will remain a viable X-ray solution for years to come. There are a multitude of reasons for this.

First, there are many smaller facilities still using analog technology. And while film is a time-proven capture medium that can produce quality diagnostic images, it has its drawbacks as well. It is a slow process, requiring the processing of the film after it is exposed. This in turn necessitates the use and handling of harsh, toxic chemicals. These consumables and the film itself are a constant and ongoing expense. Plus, the film requires significant floor space for storage.

Most of these film-based operations would love to upgrade to digital, but the cost of moving to full DR is often cost-prohibitive. This is where CR imaging comes in - because while it is far more affordable than DR to purchase and use, it still provides many of advantages of DR. CR is a much faster and easier process than the film. It yields higher-quality images without requiring processing chemicals or ongoing purchase of consumables. It also eliminates the need for a darkroom, freeing up valuable floor space.

Moreover, significant advances in CR continue. Some imaging companies are still investing in CR, offering solutions that allow facilities to switch from big, multi-plate systems to smaller, lighter, more economical CR units - in fact, there are now CR readers compact enough to fit on a desktop. There are even CR systems available that can be serviced by the user himself - eliminating the need for many service calls, and saving both time and money.

Perhaps, best of all, there are CR solutions that can be implemented without replacement of a facility's existing X-ray generator, tube, or exam table - protecting the significant investment this equipment represents.

Of course, most smaller facilities will transition to DR imaging when the time is right. Until then, they can still look to CR as a viable and dependable answer to their needs.

Chandan Naphade
General Manager-X-ray Solutions,
Carestream Health India Private Limited


 

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