Key drivers of the X-ray equipment market include advances in digital technology, superior image quality, speed and improved flexibility, an aging population, and rising expectations for quality of care.

X-ray imaging is the fastest and easiest way for a physician to view and assess broken bone, cracked skull, spinal trauma, cancer, developmental disorders, and dental condition. With the advent of digital systems, there has been a paradigm shift in the way images are captured, processed, and finally presented. The innovations and advancement of radiography has greatly improved the diagnosis and treatment of medical conditions and has led to safer and more reliable manufacturing techniques.

Market dynamics

The X-ray equipment market continues to be dominated by analog radiography equipment. In 2009, there was an estimated sale of 5000 units, valued at Rs.195 crore. This is a 15 percent growth over 2008. This does not include the Rs. 50 crore computed radiography equipment, which when attached to the analog X-ray machine, acts like a digitizer, creating an illusion of a digitized image. This also excludes X-ray imaging applications for cardiovascular/vascular surgery and surgical C-arms.

The four brands, GE Healthcare, Siemens, Allengers Medical Systems, and Philips Healthcare, command 70 percent of the market in unit terms and 80-85 percent in valued terms.

2009 may be termed as a watershed year with the acceptance of the digital radiography equipment. With sales of 30 units, estimated at approximately Rs. 30 crore, this segment is expected to double over the next couple of years.

Although DR equipment are retailed at a unit price range of Rs. 72 lakh to Rs. 1.45 crore, the faster turn-around of patients, higher image quality, and single system being sufficient for 80–100 patients per day, justifies the procurement.

GE Healthcare and Siemens are the major players providing this advanced technology with Philips Healthcare also having some presence.

Vendors

The major players in the X-ray equipment and film processors market include Allengers Medical System Limited, Carestream Health, GE Healthcare, Jindal Photo (exclusive distributor of FujiFilm), Philips Healthcare (Alpha X-ray and Meditronics), and Siemens Ltd. Other players in this market include AGFA Healthcare India Pvt. Ltd., Chayagraphics, Cura Medical Equipment Pvt. Ltd., Erbis (Toshiba Medical Systems), Ess Ess Medicos Pvt. Ltd., Gabri International, Picks Medical Systems Ltd., Shimadzu, Sun Narula Group, and Trivitron.

Allengers offers a range of high frequency, line frequency, and digital X-ray equipment. It also offers Venus, high frequency mammography system and Allengers Life and Allengers Pride series of cardiovascular X-ray systems (fixed/ mobile) with flat panel.

Carestream Health offers image information products, services, applications, and integrated systems. It offers Kodak point-of-care CR 120, 140, and 360. It also offers wireless cassette-sized DR detector-DRX 1 with excellent image quality, improved productivity, and high flexibility.

Cura offers GE DMR mammography system and DReam ERA digital radiography equipment.

GE Healthcare has recently introduced SenoBright contrast enhanced spectral mammography (CESM) technology that reduces ambiguity in mammography results, enabling physicians to detect and diagnose cancer with more confidence - even in the densest part of the breast tissue. SenoBright uses X-rays at multiple energies to create two separate exposures. These resulting images specifically illuminate and highlight areas where there is angiogenesis, growth of small blood vessels potentially related to the presence of cancer.

GE Healthcare has also launched Tejas XR 6000 - next generation convertible X-ray equipment. The new Tejas XR 6000 will be manufactured at GE Healthcare's plant in Bangalore. It can be upgraded to a true digital X-ray at a fraction of the cost of digital X-rays available in the market.

GE Healthcare's Innova range of flat panel detector provides high detective quantum efficiency. Innova's dose-efficient technology is regulated by AutoEx, a GE-exclusive control system that adapts on the fly - automatically and continuously - to keep image quality and patient dose at optimum levels.

Jindal Photo Ltd. is the exclusive distributor of Fujifilm and offers X-ray films and medical X-ray systems.

Philips offers a wide range of conventional, mobile, fluoroscopy, R/F, C-arm, dental, and remote controlled radiography systems. The integral breast workspace by Philips comprises a set of solutions to review multi-modality breast images at one work spot to help drive quality and efficiency. It includes the MammoDiagnost VU, multi-modality breast applications, and DynaCAD Enterprise for advanced data analysis.

The MammoDiagnost DR is Philips' digital solution for mammography and is designed for efficient high-volume screening. Unlike general systems, it is specifically designed to handle the high volumes of data occurring in mammography and switching between examinations takes less than a second.

SNG (Sun Narula Group) offers Himalayan LCD X-ray viewing systems. Some of its reputed clients include Sir Ganga Ram Hospital, New Delhi; Medanta-The Medicity, Gurgaon; Goverment of Delhi; Fortis Healthcare, Delhi; and Escorts Heart Institute, Delhi.

Trivitron offers Pride series of high frequency X-ray equipment. It also offers C-arm image intensifiers.

Growth drivers

The benefits of computed radiography systems to radiography departments have significantly spurred the uptake of these systems. Moreover, ageing population and increasing volumes of radiographic procedures have placed greater demand to streamline the workflow. Compared to analog systems, digital radiography solutions simplify the processing of radiographs, and as a result, demand for these systems has continued to rise, supporting climbing market revenues.

As facilities seek to enhance throughput and reduce patient exposure to X-ray radiation, demand for digital solutions has grown in the market. Economic growth is also allowing the government to increase spending on healthcare, thereby driving demand for new diagnostic X-ray equipment.

Key drivers of the X-ray equipment market include advances in digital technology, superior image quality, speed and improved flexibility, an aging population, and rising expectations for quality of care. The X-ray market continues to experience a sustained demand, due to the increased usage of evidence-based medicine and requirement of X-rays to diagnose internal injuries and to detect breast cancer. The use of digital X-rays allows finding problem sites quickly and with great level of accuracy. These factors are pushing many hospitals to make a transition from analog X-rays to DR equipment.

Technological trends

Digital radiography equipment is poised to grow further because the radiation dose used is much less as compared to the dosage used for analog systems. Improvement in image processing software, optical collecting systems, and laser scanners combine to boost the sensitivity of modern digital systems.

CR cassettes use PSP plates in place of film and screens. These plates are coated with europium-activated barium fluoro-halide. The halide used may be bromide, iodide, or a combination of both. CR systems are equipped with the ability to adjust level of brightness in images which gives radiologists the ability to view structures that cannot be easily detected on radiographic film. With film, the contrast is determined by the composition of the film, the radiographic technique, and the chemical processing. The main advantage of computed radiography is noted in it being portable and mobile, where the CR characteristics reduce the number of repeated examinations required due to inaccurate technique, adjustment, or exposure. CR also provides the ability to provide rapid electronic image distribution.

The DR technology uses a direct process to convert X-ray energy to digital signal. The image is directly captured on the flat plate and the image is then viewed in the computer. This technology uses amorphous selenium (a-Se) or an amorphous silicon (a-Si) flat plate placed in between the object to be diagnosed just as the process carried out for film-based systems. It offers key value propositions of 2-3 times higher throughput as compared to CR, superior image quality, and low radiation dose.

While analog X-ray equipment takes around 8-10 minutes per patient, DR equipment only takes 2 seconds to 1 minute per patient. Radiation dosage in DR systems is far lower as compared to analog equipment. Some of the large hospitals like AIIMS, Delhi; PGI, Chandigarh; CMC, Vellore; and various government medical colleges have taken an initiative to provide this highly advanced technology to its patients.

DR is witnessing rapid innovations in hardware as well as its software applications. A few of the exciting applications are tomosynthesis, dual-energy imaging, tissue equalization, and automatic image stitching.

Interventional procedures have become a bona fide subspecialty with its own technologists, nurses, and specially trained radiologists. Interventional radiologists function as radiologists diagnostically and as surgeons therapeutically.

Cancer is a growing concern worldwide with millions of new cancer cases diagnosed each year. Radiation therapy is the leading non-surgical technique, utilized in the treatment of cancer patients. An ageing population, increasing life expectancies, and rising incidence of cancer continue to enhance demand for radiation therapy. Further, technological advancements are driving the development of sophisticated screening methods that facilitate early cancer detection.

Digital mammography is considered a relevant means of breast cancer screening, delivering proven clinical outcomes. It enables to detect a whole new type of diagnostic information. Standard mammography only sees the structure of breast tissue. With this advanced technology, doctors can also locate the proliferation of small blood vessels, potentially associated with cancerous tumor growth. In addition, it shows potential for measuring the extension of the lesion to help to plan surgery and treatment. Patients receive an intravenous injection of standard iodine contrast agent, and after two minutes undergo a five-minute digital mammography examination. Images are acquired in familiar mammography views so that they can be quickly and easily correlated with standard results, facilitating interpretation by other specialists like surgeons or oncologists.

Advanced solutions integrate mammography, ultrasound, and MRI studies on a single work spot for review and reporting. It provides radiologists a complete picture by enabling the review of all breast exams in conjunction with each other. It also helps to streamline workflow by providing single-click comparisons with automated multi-modality presentation of patient history.

The cardiac X-ray equipment market's demand graph has seen a steep hike since the introduction of digital flat panels. These systems have provided cardiology departments with a reason to replace legacy systems as well as invest in more sophisticated technologies. Digital flat panel systems considerably lower image noise, offer edge enhancement, sharpen contrast harmonization, optimize workflow, and improve patient throughput.

The introduction of three-dimensional rotational angiography (3D RA) and flat panel detector technology has further contributed to diagnostic accuracy, faster procedures, and improved patient care.

Reduction of hazardous effects of X-rays on the human body is one of the major challenges for X-ray imaging equipment manufacturers, who are looking forward to launch new equipment with advanced capabilities. In addition, high funding requirements are acting as a barrier for smaller market participants.

Dramatic changes are expected in radiology in the coming years, including widespread use of digital technologies. Radiology departments may apply analog and DR systems to various applications, depending on the requirement of the departments. Over the long term, DR is likely to evolve as stand-alone system for chest imaging and digital X-ray tables. Along with this, analog with CR systems may continue to be in use for mobile X-ray applications as customers seek avenues to create the-all-digital department. The ability to digitize a film image and transmit the data to remote sites will continue to aid the CR and DR technologies to further evolve.