Even as DR gains in popularity among acute care and outpatient care facilities alike, traditional CR retains and maintains a solid fan base.
With technological advancements stepping up multiple notches, the past few years witnessed a progressive shift in the radiology market from analog to digital systems, with cost savings, efficiency, productivity, and patient-centrism being pillars of the value-based imaging. Reduced scan times and improved image quality have been the driving factors for the rising popularity of digital radiography (DR) systems.
The adoption of DR over the past two decades has transformed medical imaging's oldest modality, enabling bread-and-butter X-ray images to be acquired quickly and then easily transferred into PACS for distribution, interpretation, and archiving. Before DR arrived, many facilities upgraded their X-ray equipment with CR, which replaced film-screen cassettes with imaging plates that can be carried to a reader for digital output. In India, while many facilities are transitioning to the benefits of DR, it appears that CR will remain a viable X-ray solution for years to come. However, on the global front, there is still a dilemma. Imaging facilities are yet to decide whether to spend the money to upgrade their CR equipment to DR, or swallow a 7 percent to 10 percent reduction in medicare reimbursements for CRs. Many of these facilities are located in rural areas, with less access to the capital needed to buy new equipment.
The benefits of DR are widely recognized by the medical imaging community. 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; also, the film requires significant floor space for storage.
Filmless radiology departments are the way to go and most large hospitals in the corporate sector have adopted the DR systems leading to revenue saving. Better detectors, faster processing, more powerful computers, bigger and sharper displays, and efficient archiving are transforming the way one looks at medical imaging. Higher-grade medical viewing monitors provide excellent image quality. One thing is certain – the future of DR is wide open. Beyond dose issues, most buyers' checklists of needs focus on three points: extremely reliable direct DR solutions, flat-panel detectors providing excellent image quality, and systems with flexible usability. Over the next few years, what they are really looking for is more utilization in leveraging the equipment that they have in place to do more things. So the radiology department has to become more competitive and be able to do more things for doctors.
Indian Market Dynamics
The X-ray equipment market is growing exponentially with an increase in the number of imaging centers. The growth in the analog segment is stagnant, while the digital radiography systems acquire market share due to wider adaptability.
The market players are expanding their product portfolio keeping in mind the price constraints in the adoption of DR systems. The latest generation of X-ray detectors and radiography-cum-fluoroscopy systems are gaining traction. The demand for indigenous systems and refurbished systems is steadily growing. With the Make in India initiative providing the requisite impetus, the indigenous players are keen to match safety features and offer competitive price points.
2016 saw a unique teleradiology public-private partnership. Fujifilm India Private Limited signed a contract with KRSNAA Diagnostics Pvt. Ltd., to install 1000 CRs across India. This enables converting X-ray setups from analog to digital and patients getting immediate reporting through teleradiology, especially in remote areas, where senior doctors are not always present. This installation reduces reporting time and delivers enhanced image quality, aiding in better diagnosis. This is a two-year project and FujiFilm will supply and install 1000 units of FCR Prima and 1200 units of DRYPIX imager. The first phase covers all the districts of Assam, followed by Telengana.
This year was also when demonetization saw a flurry of purchases of machines, followed by a slump, especially in case of smaller setups.
Global Market Dynamics
The global X-ray equipment market is projected to reach USD 11.92 billion by the end of 2021, growing with a CAGR of 5.0 percent from 2016 to 2021, estimates Infinium Global Research. The global X-ray equipment is dominated by CR systems as they are relatively less expensive than DR systems and entail less retraining of medical practitioners. The market for digital X-ray equipment will grow impressively at a CAGR of over
13 percent by 2020.
The demand for digital X-ray equipment is growing at a significant rate since the procedure forms the basis of diagnosis and also the treatment of various medical conditions. Tele-imaging enables healthcare professionals to perform and interpret medical images from remote locations, where technology is hard to reach. The teleimaging technology has undergone significant technological advancements which let the doctor or hospital to share videos and images of ultrasound via the Internet, using an IP camera and remote access software. This technology allows real-time teleradiology expertise in the presence of a junior sonographer or radiologist at the patient center. It helps in reducing inpatient care and will be efficient in handling the shortage of the physician's workforce. Moreover, the introduction of fully automated, versatile, and easy-to-use digital X-ray systems has led to significant expansion of teleradiology and teleimaging in remote areas, which will drive this market's growth over the next 4 years.
The top three emerging trends that Technavio healthcare and life sciences research analysts cite as driving the global digital X-ray equipment market include:
Reduction in reimbursements for film-based X-rays and CR. The market has witnessed a reduction in reimbursements for film-based X-rays and CR, which will fuel the market for digital X-ray systems. This is a clear indication to incentivize the transition from traditional X-ray imaging to digital X-ray systems. With such acts in the market, the vendors are seeking to adopt digital X-ray systems to gain cost advantages. For instance, in May 2016, Agfa HealthCare launched a DR upgrade program, which provides a quick transition from traditional film-based X-ray systems to digital X-ray systems. The company provides hospitals a step-by-step guidance to transition to the DR even in the absence of immediate capital.
New product launches coupled with technological advances. New products featuring advanced technologies will substantially drive the market. The advances in technology of radiographic systems used in routine examinations (chest, neck/spine, and limbs), specialty services (dental and mammography), and emergency services (ICU, neonatal ICU, and hospital wards) have resulted in the development of new radiation sources and technologies by using neutrons and X-rays. The advance from analog to digital X-rays has led to the development of many applications and radiation-based imaging techniques. The introduction of flat panel CR in X-ray equipment has increased their efficiency and imaging quality. Digital imaging has revolutionized the imaging industry by replacing conventional film-based radiography that uses X-rays/neutrons. Images can be stored in electronic format, which can then be enhanced to achieve optimum results. In addition, reducing the radiation dose and using high-sensitivity plates enhances the sharpness and resolution of the images.
The vendors in the market are launching new software that is compatible with the existing digital X-ray equipment. In May 2016, Varian Medical Systems launched a new computer-aided engineering (CAE) software to simplify the process of shielding and radiological protection systems design. Such new product launches enable vendors to generate substantial revenue and thereby boost market growth.
Emergence of portable digital X-ray equipment. One of the upcoming trends gaining traction in the global market is the emergence of portable digital X-ray equipment, which is expected to witness a faster growth during the forthcoming years, at a CAGR of 7.2 percent. The portable X-ray systems circumvent the need for a technician to develop the X-ray, or physically transport it from one location to another. In addition, handheld systems are increasingly used in emerging applications such as veterinary, medical, military, customs screening, and security checks. Further, the portable digital X-ray equipment has huge potential, as the current adoption rate is around 15 percent. This means that there is a potential pool of 85 percent of customers who may switch from portable analog X-ray equipment to portable digital X-ray equipment in the near future.
In terms of geography, North America region remains the major market followed by Europe in the actual period. APAC region will witness strong growth driven by the countries such as India and China.
While developed regions will continue to dominate the market in terms of revenue, emerging nations are expected to respond to the market optimistically due to the developing healthcare infrastructure, leading to increase in hospitals and rising focus on healthcare among the growing middle-class population.
Rising awareness for diagnosis of lifestyle diseases coupled with improved technology in imaging has shifted demand for X-ray equipment market. Market for X-ray equipment is growing steadily due to rise in the lifestyle diseases, which has led to early diagnosis among the population. Also, due to the definite lifecycle of the equipment, growing replacement demand has also been fuelling demand for X-ray equipment.
Adding Edge to Technology
The X-ray equipment market is flooded with the key players bringing in the best-possible digital radiography systems offering cutting-edge digital enhancements. The healthcare providers want to leverage their existing imaging investments yet generate higher-quality images with the potential for lower radiation dose. Some of the newest systems have focused on improving productivity and workflow for more efficient operation and cost control.
Recent studies have revealed that a sheet of graphene can be used to generate surface waves known as plasmons when struck with photons from a laser beam. Plasmons can further release a sharp pulse of radiation that can be tuned to uniform X-ray wavelengths. This radiation is said to be relatively safer, as it can result in lower-dose X-ray systems being built in the future.
A research group at the University of Waterloo patented an innovative technology to create a digital X-ray imager that can be built by a typical flat-panel display manufacture, 25 to 50 percent more sensitive than current digital imagers. The technology can also provide improved visualization of soft tissue and bone comparable to CAT scans by using a single exposure dual-energy X-ray approach, which offers 50 times less radiation to the patient than a traditional CAT scan.
A team led by UCL scientists has successfully developed a new X-ray imaging technology that excels at determining different shapes and types of matter – a capability that conventional X-rays could only match by using prohibitively high doses of radiation. This phase-contrast X-ray imaging technology can be utilized to identify tumors in living tissues.
Industry vendors have been working to provide solutions, and 2016 witnessed the introduction of several new products designed to aid the transition from analog to digital in different ways.
New wireless detectors. The latest generation of wireless DR detectors with automatic beam detection achieves the traditional use case of both CR and film, but with the benefits of much higher throughput and improved dose efficiency. Automatic beam detection capability enables a simple path to digital retrofits, since no integration with the X-ray generator is required. State-of-the-art DR panels are now equipped with a data-processing engine and carry their own calibration files, which allows the images to be corrected on the panel. With the calibration data stored on the panel, the DR cassettes are more portable between the equipment and the rooms. On-panel image corrections decrease the image transmission time and improve the wireless link robustness by reducing the number of images transmitted with each image acquisition.
Dose efficiency. Both GOS (gadolinium oxysulfide) and CsI (cesium iodide)-based DR detectors have higher dose efficiency than CR. With increased dose utilization, DR can produce the same image quality as CR at a lower dose and can produce higher-contrast resolution images than CR using the same dose. The cesium-based detectors feature automatic exposure detection for easy install without connecting to a generator interface cable.
Sharing equipment. Using Bluetooth, the most advanced detectors are designed to connect automatically to equipment that controls the X-ray tube and generator. Installation is accomplished with a wireless access point through which images can be sent for display or storage, image processing software, and a display screen. Auto detect features are staples in new products and can be used to control detectors and other X-ray components at multiple locations in a facility.
X-ray imaging has come a long way with the forefront technologies in the DR systems. Equipped with the finest imaging machinery, these systems offer enhanced sharpness and clarity along with the dose-reduction techniques. Future DR panels will enable advanced applications like tomosynthesis and dual-energy imaging. In the near future, DR upgrades will soon be available for multiple imaging labs utilizing a common server, instead of multiple individual consoles for each room. Ultimately, these advances will greatly improve patient care by maximizing imaging efficiency while minimizing radiation exposure.