Due to the progressive nature of the X-ray machine market, where there are changes on a quarter by quarter basis, long-term projections may vary significantly from the actual growth. The Indian X-ray market is expected to reach USD 88 million by 2012, growing at a compound annual growth rate (CAGR) of around 10 percent. The Indian market is currently witnessing an increasing demand for high-end X-ray equipment boosted by the introduction of computed radiography (CR) and digital radiography (DR). Demand for digital radiography systems in India is expected to double during the period 2009 to 2012. Multinational companies currently play a key role in India's high-end X-ray equipment market.

The demand for low-end X-ray equipment such as analog radiography is expected to remain stable over the next two to three years. This is because the Indian government will continue investing in healthcare, as several regions lack even basic medical equipment. There is also a growing trend of multinational companies' low-end X-ray machines being replaced by Indian X-ray machines.

Types of X-ray machines

Analog and high frequency (HF). Analog fixed X-ray machines have a decent image quality and are considered to be highly cost-effective compared to the higher priced CRs and DRs. Several tier II cities, smaller and rural facilities primarily opt for these. High frequency (HF) technology for fixed and mobile X-ray machines is preferred in metros, tier I, and tier II cities. This tendency is expected to permeate to smaller cities and towns in the next three to five years.

Fluoroscopy. Even though fluoroscopy usage has gone down, radiologists still prefer to have it as an add-on feature. Limited penetration of endoscopy and colonoscopy still makes fluoroscopy the only choice for a significant number of physicians.

Computed radiography (CR). Entry level or low-end CRs were introduced in the Indian market in 2005, leading to a significant increase in sales of CRs. Upgrades from analog to CR were driven by high patient load or prescribing doctors asking for better image quality. CR offers faster turnaround of patients as compared to analog and has the potential to digitize the entire radiology department. CR has a good penetration in private hospitals due to the peer pressure exerted by competing hospitals.

Digital radiography (DR). Digital radiography equipment having cesium iodide (CSL) detectors with a very high detective quantum efficiency (DQE) have an advantage over CRs or gadolinium oxide detectors with a lower DQE. While the resolution and contrast of DRs are generally considered to be better than those of CRs, there are only specific cases where the difference is significant. For example, IS spine X-ray and images for obese patients would be better in DR. However, DRs are standalone X-ray machines unlike CRs, which can be connected to multiple existing X-ray machines. This, along with the high price of DRs, restrains its sales.

Mammography. Currently, breast cancer is the second most prevalent type of cancer among women in India. According to the National Cancer registry, mammography is still in its infancy as there is no national or state-level population-based breast cancer-screening program in India. Reasons for growth in mammography equipment are availability of low-cost mammography machines in recent years and the increase of surgical, medical, and radiation oncology services in India. As per the Indian Council of Medical Research (ICMR), an estimated 100,000 new cases of breast cancer are diagnosed every year, with a projection of 250,000 cases by 2015. Only a fraction of patients who undergo surgical breast cancer treatment have a contra-lateral mammogram done pre-operatively. A positive trend of mammography equipment installations in private hospitals was reported due to increasing awareness of breast cancer diagnosis in urban population of India.

Challenges facing Indian X-ray industry

The Indian X-ray industry is becoming increasingly competitive due to a rising number of multinational players taking advantage of low entry barriers. Majority of the high-end X-ray machines depend heavily on imports, which are controlled by multinational companies. Also, high customs duty is a challenge.

Outlook

The DR market is poised for significant growth in the next 2-3 years when the price of DRs is expected to fall closer to the current price of CRs. However, CR poses a significant threat to DR growth since it offers flexibility in terms of connecting with multiple X-ray machines at a highly competitive price. Overall, the analog X-ray machine industry in India is expected to maintain steady growth while the high-end X-ray industry growth should be strongly driven by imaging facilities increasingly turning from analog to digital radiography healthcare solutions.