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.
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 14Ã—17- or 17Ã—17-inch detectors, but if an imaging center or hospital needs an 8Ã—10-, 11Ã—14-, or 14Ã—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.
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.