Digital x-ray market still waiting to catch a wave

Despite predictions of huge market potential and assumptions that radiology departments were ripe for new filmless technologies, the promise of digital x-ray has been little more than that since the first products were introduced in the mid 1990s. Some 20 companies currently claim to be developing digital x-ray systems, but only a few actually offer commercial products, and only a handful of customers have bought them.

In fact, after four years of hype, the lack of response by the medical community has been deafening. Fewer than 100 DR systems have been sold worldwide, and only about half of these have gone to sites in the U.S.

Several vendors insist that the DR business is turning up, however. Both Swissray and GE Medical Systems report rising DR sales, although many are to overseas customers. In the last four years, Swissray has taken orders for 65 digital units; of these, 32 will be delivered this spring to sites in Romania (SCAN 10/27/99). GE claims to have sold 23 Revolution XQ/i digital chest systems last year, with about half of these going to U.S. sites (SCAN 10/27/99).

Meanwhile, the number of companies offering digital x-ray systems continues to expand. Kodak just introduced its first DR systems, engineered in conjunction with Analogic (SCAN 12/15/99). For the time being, Analogic is supplying detectors manufactured by Hologic, which has installed more than a dozen of its own digital systems. Analogic is confident, however, it will have a cost-effective DR technology of its own on the market in the near future (SCAN 2/16/2000).

In addition, industry sources indicate that Siemens and Philips may be in production with their radiographic systems by mid-2001 (SCAN 1/12/00).

Even though sales appear to be picking up, however, the numbers are surprisingly low for this late in the game. Estimates by digital x-ray pioneers over the last four years pegged the number of radiographic units installed in the U.S. at about 75,000, including general purpose and dedicated chest systems. Surveys of the installed base, bolstered by anecdotal information, indicated the average age of equipment was from 10 to 15 years. Owners needed a reason to replace them, vendors said. It was suggested that digital imaging would provide that reason and spark a groundswell of demand.

PACS adoption criticalBut today the same companies that created these expectations are tempering them. Industry consensus recognizes that the adoption of PACS is the critical element that must be in place before the medical community embraces digital radiography—not the other way around. And the PACS industry has been going anything but gangbusters.

“Sites that currently have PACS are really looking for this technology, so they can bring x-ray into the PACS and get rid of the rest of their film,” said Kevin Hobert, global manager of digital x-ray at GE Medical Systems in Milwaukee. “Sites that don’t have PACS are still looking at this (digital x-ray) technology, but I think the markets are really going hand in hand.”

While the entire installed base of radiographic equipment might eventually go digital, the predicted tsunami of demand will be more of a ripple. New radiographic equipment is adopted cautiously. Many first-time customers will likely replace one of their several radiographic rooms with a digital system, while the rest will be pulled into the digital age through their use of computed radiography.

“When you try to develop a department-wide digital x-ray solution, you need to factor in operational issues, such as the percentage of portable studies being done and how many rooms are going to be supported,” said Clay Larsen, vice president of marketing and network development at Fuji Medical Systems USA in Stamford, CT. “You need to consider in this strategy whether and how rooms will be consolidated.”

Early adopters will absorb the first few hundred radiographic tables and dedicated chest units. But then demand will likely slack off as these sites publish papers on their experiences with digital radiography. Productivity will be a major consideration.

“We have to prove that productivity will go up with these systems,” said Jeff Levett, product marketing manager for Siemens X-ray. “We have to prove that (digital radiography) is cost-effective technology, rather than the smoke and mirrors that people have seen up until now.”

Conventional thinking challengedAs momentum builds in the clinical mainstream, a strange twist on an old pattern may appear. In the past, dedicated chest systems were de-emphasized, as cost concerns and changes in the practice of medicine drove down the volume of chest exams. Fears of tuberculosis abated, and chest screening for lung cancer was found to be less than optimally effective. From the 1970s to the present, wall buckys were hung in the vast majority of radiography and fluoroscopy rooms and general radiography rooms to reduce or eliminate the need for dedicated chest systems.

But as film-based radiographic systems are swapped for digital ones, the need for digital chest systems may return. Table-mounted digital detectors will not be able to do chest exams and computer-aided detection systems built into dedicated digital chest products may increase the efficacy of screening for lung cancer and other pulmonary diseases.

Consequently, the growth in digital chest unit sales may depend on the development of technology that expands the clinical utility of the equipment, as well as the acquisition of new radiographic tables. How digital x-ray equipment will evolve is the great unknown.

Already, historical designs are being challenged. Swissray, for example, has developed a floor-mounted digital system called ddRCombi that can pivot from an upright position for chest exams to a horizontal one for table-based procedures, thereby using a single detector for both types of studies (SCAN 12/15/99).

“In a managed-care environment, tying up real estate (for a general purpose and a dedicated chest system) may be too expensive,” said Ueli Laupper, CEO of Swissray America in New York City. “The multifunctional aspect (of ddRCombi) will allow rooms to be consolidated.”

Given the range of factors that can affect the adoption of digital radiography, it is difficult to make sales predictions. Industry moguls, however, believe that sales of general purpose digital radiographic systems will ramp up in the next three years, reaching as many as 500 unit sales to U.S. customers in 2003. Sales of digital dedicated chest systems are also expected to rise, but those numbers will be lower. No more than about 100 such systems will likely be selling annually in the U.S. by 2003.

Even so, such numbers would still represent an important milestone for digital radiography.