Analog Continues To Be In Demand

X-ray machines are finding increasing popularity in the Indian market, albeit intense competition is pushing pressure on margins for the DR sellers.

As X-ray film moved to CR, patients and providers saw tremendous benefits from the resulting enhanced image quality and speed of imaging results. After all, the technology eliminated the likelihood for reshooting an image, therefore lessening the exposure to additional ionizing radiation, reducing costs, and streamlining diagnosis. Later, the advent of DR ushered in further improvements to image quality, speed, and dose efficiency.

DR is driving improvements in the cost of healthcare; while digital imaging incurs some expense, the elimination of film delivers significant cost-savings to the hospital in terms of equipment and space to store films. DR has come a long way since its earliest generation. Decades ago, larger hospitals, university teaching sites, and busy clinics were the primary institutions that could afford the technology over analog systems. Then, as more players came into the market, the cost of the systems went down. Over time, the equipment manufacturers and vendors were able to find ways to produce digital radiography components at lower costs and become more efficient in their production of the units.

Despite all of the innovations the DR sector has seen as of late, even more progress is slated for the future. It is expected that industry will continue to see the physical characteristics of the flat panels evolve. One may see different sizes and shapes of DR panels made available to consumers, along with fused or hybrid imaging like market has seen within the modalities of CT, MRI, and PET. Furthermore, one can expect the software to continue to evolve, bringing faster and higher-quality imaging. In other words, the future for DR is bright, indeed.

Indian market
X-ray machines are finding increasing popularity in the Indian market, albeit intense competition is pushing pressure on margins for the DR sellers. All the segments, analog, DR, and CR, saw increasing numbers being procured in 2017. Analog continues to be in demand as procurement increases in Tier-II and III cities, while the Tier-I cities transition to their digital counterparts. Fluoroscopy, part of DR, is finding increased application in the Indian facilities. 3D mammography is also being sought by the discerning customer.

The Indian market in 2017 was 12,140 units, with value estimated as Rs 697.8 crore. While Siemens, Philips, and GE continue to be the dominant brands, Fujifilm and Agfa have a combined share of about 70 percent in the CR market, other players being Konica and Carestream. Many other players are aggressive in the X-ray equipment segment including Allengers, Samsung, Canon (Prognosys), Skanray, BPL, RMS, Erbis and FX Rays.  2017 saw the entry of some new brands including iRAY, China; Cura marketing some Korean brands; Rayence, USA; and CareRay, China.

Technological advances
There are several notable new and emerging technologies. First, the introduction of automatic exposure detection (AED) will have revolutionary effects on the radiographic image capture world. Other advances in digital include new image stitching techniques that combine multiple images into a continuous image, dual energy imaging that can help with specific tissue image enhancement, and tomosynthesis that creates images that can be viewed in three-dimensional decks and reduce superimposition.

Direct readout radiography. The most important advancements in DR regarding patient care include the introduction of true direct readout radiography. By going to CCD, gadox, and most recently cesium, the images are available to be read by the radiologist in 3–5 seconds. This saves the patient and facility a huge amount of time.

Post-processing software. Over the last 10 years, the biggest advancements in patient care would arguably have been the enhancement to post processing software. Today’s acquisition suites have come a long way since their introduction in the early 1990s. Using advanced algorithms, technicians are able to use less radiation to obtain the same image detail and quality. Lowering the doses is one of the most valuable advancement that can be done in radiography.

AED. Digital panels have been around for a while; the newest and most popular technology available today is the AED. Excess dose is a real hot subject that has been virtually eliminated now by panels that react and acquire at blistering speeds. Less than a 5 millisecond response time is very common. The market is now seeing dynamic panels with very fast reaction and reconstruction time so that positioning and techniques can be verified. Even during fluoroscopy studies, these panels can be utilized.

Wireless DR detectors. The introduction of wireless DR detectors has revolutionized X-ray imaging. Some of the latest detectors offer advanced image quality, greater reliability, and faster capture speeds. The ability to register all DRX detectors with all DRX portable and room-based systems delivers exceptional flexibility and redundancy.

Tomosynthesis. The latest innovations in DR include advanced applications such as tomosynthesis where the X-ray tube sweeps across the patient and makes a series of exposures during the pass and the imaging computer compiles a 3D image from the views acquired. Several OEMs are now offering this feature with general radiographic suites, and on remote RF systems. This functionality can provide improved detail visibility, over CT. Currently, tomosynthesis is used in mammography but it would have application in many imaging scenarios. Standing and weight-bearing studies can also be done with tomosynthesis.

Dual energy. Dual-energy imaging is becoming more popular as well. Thanks to advances in image processing, two images can be taken of the same anatomy at different energies. For example, from a chest X-ray, there would be three possible images produced by subtractive software, just the bones, or just the soft tissues and internal organs, and both together.

Way forward
X-ray is often the start of a patient’s care journey and supports critical clinical decisions from prevention through treatment across the care continuum. It affects productivity, workflow, and care team satisfaction. It is more than equipment and more than an image. X-ray is an imperative. There is yet untapped opportunity in DR. No one yet knows where this will take the market, but it is believed that X-ray will find new avenues of clinical usefulness in the future.