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X-ray Equipment

X-rays, the cornerstone in diagnostic imaging

With advantages associated with DR systems, like effective dynamic range, better medical evaluation, superior and accurate image capture, and reduced radiation exposure for patients and workers, the use of these systems is on the rise.

The COVID-19 pandemic adversely affected the economy in 2020-21, and presented various challenges to clinical healthcare providers and patients across the globe. However, the pandemic has unleashed new opportunities for digital X-ray manufacturers and healthcare providers. Even though it has not been the predominantly discussed imaging modality during the COVID-19 pandemic last year, X-ray has played a major part in detecting and managing the disease. During 2020-21, manufacturers have seen a rapid sale of mobile DR to hospitals. Prior to COVID-19, the DR segment (inclusive of fixed DR rooms and mobile DR systems) was forecast to increase by 9 percent in the number of unit shipments (base growth). Portable X-ray systems are predicted to see significant growth and expected to make revenue of approximately USD 5.6 million by 2025.

The advantages associated with direct radiography systems, such as effective dynamic range, better medical evalua­tion, superior and accurate image capture, and reduced radiation exposure for patients and workers, are contributing to the growth of this technology segment. This has pushed companies to focus on product development and innovation.

Some recent developments in this market include introduction of AMX Navigate, a portable digital X-ray system by GE healthcare, in September 2021. Similarly, in August 2021, Carestream Health has enhanced its premium X-ray system, the DRX-Evolution Plus. The DRX-Evolution Plus now features a smaller tube-head profile with a larger display, helping radiographers conduct exams with greater visibility. An extended tube-column offers greater flexibility, and can accommodate sites with high ceilings. In June 2021, Fujifilm Medical Systems announced the launch of the Persona RF Premium. It is an innovative radiography and fluoroscopy system designed for hospitals and medical centers of all sizes, providing real-time imaging for skeletal, digestive, urinary, respiratory, reproductive systems, and specific organs including the heart, lungs, and kidneys. In March 2021, Koninklijke Philips received 510(k) clearance from the USFDA for its CombiDiagnost R90, a remote-controlled fluoroscopy system in combination with high-end digital radiography.

A major benefit of DR-based systems over film and CR systems is that images are sent directly to a computer screen from the X-ray imaging plate, thereby eliminating the need to retrieve the image plate for processing images or taking a second X-ray shot. An effective dynamic range, better medical evaluation, superior and accurate image capture, reduced radiation exposure for patients and workers, flexibility in image management, improved patient throughput, superior evaluation of data and images, and lower operational costs are some of the other advantages of DR systems. Due to these advantages, the use of DR systems is on the rise.

The global medical X-ray market size was USD 12.14 billion in 2020. The global impact of COVID-19 has been unprecedented and staggering, with medical X-ray equipment witnessing a negative impact on demand across all regions amid the pandemic. The global market will exhibit a lower growth of 2.8 percent in 2021 than the average year-on-year growth during 2017–2020. The market is projected to grow from USD 12.48 billion in 2021 to USD 16.86 billion in 2028 at a CAGR of 4.4 percent during the 2021–2028 period. The rise in the CAGR is attributable to this market’s demand and growth returning to pre-pandemic levels.

The Indian X-ray equipment market in 2020 is estimated at 13,625 units, a 3.57 percent drop from 14,130 units in 2019. By value, this translates into a 20-percent drop from ₹831 crore in 2019 to ₹664 crore in 2020. This change may be attributed to the increase in contribution of the analog machines, from a 29.5-percent share in 2019 to a 34.6-percent share in 2020 by value, and the average analog prices too having taken a dip in 2020.

Of the 8500 units market in 2020, within the analog segment, Allengers leads the pack, with Skanray a close second. BPL is also visible in this segment. The HF machines have seen an increase in share from 60 percent in 2019 to 70 percent in 2020. While there was no change in prices, the systems when combined with the fluoroscopy configuration, are retailed at a unit price ranging from ₹2 lakh to 17 lakh. These typically have a capacity of 1000 MA. The 600 MA LF systems are marketed by the regional brands scattered all over the country.

Within the DR segment, the mobile systems gained majorly, from an 8.9-percent share in 2019 to 29.4-percent share in 2020, by value. These were at the expense of the more expensive fixed systems that dropped from a 46.3-percent share in 2019 to 28.5-percent share in 2020, by value. The retrofit systems continued to be in the 43-percent share vicinity (constituted 44.8 percent in 2019 and 42 percent in 2020, by value). This explains the decrease in value of the total DR market by 23 percent in 2020, from ₹281 crore to ₹214 crore, in spite of a 7.14-percent increase by quantity, from 1330 units to 1425 units.

X-ray equipment vendors* – Indian market

Analog brands Mobile DR brands Retrofit
DR brands
Imported Indian
Tier I Allengers Samsung Allengers Konica
Tier II Skanray Carestream BPL Carestream,
Fuji & Agfa
Others BPL and regional fragmented brands Agfa Skanray Regional brands
Fixed DR brands CR brands
Agfa, Carestream, Fuji, Philips, Siemens, Samsung, Allengers, Fuji, and Prognosis Fujifilm, Agfa, Carestream, Konica, Siemens, Philips, and GE
*Vendors are placed in different tiers on the basis of their sales contribution to the overall revenues of the Indian x-ray imaging market.
ADI Media Research

Within the mobile systems, the Indian machines constituted 87.7 percent by quantity and 63.49 percent by value. The imported segment is catered to by Samsung, Carestream, and Agfa, and the Indian ones by Allengers, BPL, and Skanray.

The fixed-DR market may be further segmented as imported and indigenous systems, and as ceiling and floor models. The Indian machines dominated with 73.5 percent by units, albeit a 49-percent share by value. Within the imported segment, the ceiling systems, in spite of being priced higher, sold slightly more than the floor models, by quantity, thereby contributing 67.7 percent to the imported DR fixed systems segment, by value. In the imported machines segment, the aggressive brands are Agfa, Carestream, and Fuji; and Allengers dominates the Indian segment.

X-ray will remain a cornerstone in diagnostic imaging, and is an area for radiologists and radiology groups to assess any challenges they are facing for potential solutions and new strategies. The need to address X-ray in the delivery of care is expected to grow, regardless of growth and priorities in other specialty areas of imaging, resulting in a need for high-quality, high-volume radiologists, who are adept at interpretation.

The work approach of radiologists and other imaging personnel is expected to change in the future, given new technology innovations, such as artificial intelligence and natural language processing impacting diagnostic imaging. There is still a road to travel until value propositions and offerings are fully realized in the market.

Given the tight job market in radiology, organizations are striving to attract and keep the best talent in place. An approach to achieve this is to ensure radiologists have both high job satisfaction and high engagement, thereby lowering the possibility of burnout and turnover. Making decisions by involving collaborative feedback from the radiologists can prevent situations where their organization’s desire for economies of scale and skill is at the expense of radiologists and contributes to burnout.

Both the shortage of available radiologists and the use of X-ray are not going away in healthcare.

Radiology groups need to acknowledge the severity of the challenges today, and consider strategies that enable their radiologists to work smarter and not merely work harder. New strategies to enable radiologists to focus on areas of imaging they find more rewarding, such as areas of specializa­tion, to drive productivity and TAT while combating burnout, to address volume, and to have an improved work experience will play an important role in radiology groups being best prepared for today and the future.

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