April 2015

Digitisation The Shift in Trend

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Digitisation-Trend-1Radiography is undergoing a major transition toward digital technology based on flat-panel detectors, with affordable offerings such as retrofit kits driving migration away from film in many cash-strapped regions, writes Anshuman Ojha of Elets News Network.

Xray machines and their use in a variety of fields, for glancing through the insides of solid substances, began in the last decade of the 19th century. As the true nature of these rays and the length of their applications was being studied by a number of industries, their first true use begun when physicists started using them for studying the structure of atoms and crystals and medical doctors started using them for diagnosing and treating diseases.

The healthcare segment, an important end-user of x-ray machines and the major revenue generator of the global x-ray systems market led to demands of nearly 575,000 x-ray machines in 2014. This demand is estimated to grow at a moderate CAGR of nearly 5.2 percent in the next 3-4 years and reach 700,000 by 2018.

General radiography is undergoing a major transition toward digital radiography (DR) technology based on flat-panel detectors (FPD), with affordable offerings such as retrofit kits driving migration away from film in many cash-strapped regions. While shipments of FPD and retrofit flatpanel detector DR systems produced an estimated 17 percent of annual general radiography shipments in 2014, that figure is expected to reach 25 percent in 2017.

Indian market

The Indian X-ray machines industry is growing steadily owing to the growing popularity of the digital segment. DR systems are emerging as one of the fastest growing segments as they tend to offer higher resolution due to flat-panel detectors. The DR-based X-ray systems market is likely to see a compound annual growth rate (CAGR) of nine percent in the coming six years. This is, reportedly, the highest CAGR, which can be attributed to high patient throughput rates, low radiation risks, and excellent image quality of HF X-rays.

Currently, the Indian X-ray machines market is dominated by analog models. Even computed radiography (CR) has brought in many changes to its earlier version, in terms of number of plates, method of image reading and producing, erasing older images. Direct DRs have improved the workflow efficiency like never before.

Though costlier acceptance of DR is showing high growth rate especially by government and corporate healthcare providers as they confirm to its better output and return on investment (RoI) justified. The usage of digital models is increasing as people are becoming aware of newer technology and their perceptions are changing.

The mammography market is already dominated by flat-panel detector-based full-field digital mammography systems, led by adoption in mature regions. Purchasing in emerging regions is relatively low, however, with not much demand for breast screening, and few healthcare providers are able to purchase the costly equipment.

The DR-based X-ray systems market is likely to see a compound annual growth rate (CAGR) of nine percent in the coming six years.

Interventional and mobile C-arm systems sales are benefitting from a growing trend toward minimally invasive surgery. Advanced systems with digital technology and advanced navigation software are driving growth in mobile C-arm x-ray, while interventional x-ray is already dominated by digital technology and is being spurred on by new installations of hybrid operating rooms that combine multiple imaging modalities and full surgical equipment in one room. Furthermore, hospitals are becoming more receptive to new procedures like transcatheter aortic valve implantation (TAVI) as an alternative to open-heart surgery. These procedures are performed using high-end mobile C-arm systems with flat-panel detector technology.

Lack of government support for indigenous manufacturing, cost of duties on components, availability of technology (DR, CR systems) at local level, regulatory issues including AERB certification for indigenous manufacturing are some of the challenges faced by both vendors and buyers.

Digitisation-Trend-2

Global market

Driven by continued digitization of x-ray machines and increasing healthcare investments in emerging regions, the global market for x-ray machines is expected to reach US$12 billion by 2017, according to IMS Research.

The global x-ray machines market significantly benefits from the rising pool of geriatric population across the globe. Old-age naturally leads to a number of chronic diseases and many issues related with the health of bones, leading to increased necessity of x-ray scans. The introduction of technologically advanced x-ray machines has also led to increased demand from sophisticated applications.

Economic development in the Asia- Pacific regions, backed by a huge patient base, has increased demand for a variety of x-ray machines from private and government hospitals.

The market is, however, limited by a certain extent due to factors such as implementation of regulations such as Affordable Care Act and Patient Protection Act in certain countries, and low rate of adoption of digital radiography systems in the market.

Past trends of the global x-ray machines market indicate that alongside the factor of technologically advanced products, the factor of image quality is an important buying criterion as it relates directly with the quality of diagnosis. Price is an important factor to be considered in the price sensitive Chinese market of x-ray machines. Furthermore, developing countries from East and West Europe, having recently been through an economic depression, also place high importance upon the price factor of x-ray machines.

The market is also observing a shift in buying pattern – buyers are moving towards mobile x-ray machines from conventional x-ray machines. Increased adoption of picture archiving and communication systems (PACS) in the European and American healthcare industries, as well as government-led reformations in healthcare facilities in developing countries represent the chief positive trends in the market in the current scenario.

The large patient pool and a rapid rise in prevalence of target diseases and the rising volume of globe’s geriatric population are also significantly adding to demands of x-ray machines on a global front.

Technology advancements

Recent advances in imaging technology – like CT scans, MRIs, PET scans, X-ray and other techniques — have had a huge impact on the diagnosis and treatment of disease. Advances in imaging over the last five years have revolutionized almost every aspect of medicine. More detailed imaging is allowing doctors to see things in new ways. Imaging can provide early and more accurate diagnoses. In some cases, it might even lead to better and more successful treatment.

Digitisation-Trend-3Digital imaging
Digital radiology is not a new concept, but in the past decade, it has become cheaper, more common and more flexible. As computers and their networks have evolved, so has digital imaging. Several advancements in digital imaging have helped to reinvent traditional methods, such as the X-ray. For example, wireless and mobile X-ray systems allow health care practitioners to examine a patient at their bedside, when he or she can’t be moved to the radiology room. Remote viewing systems enable practitioners to look at images outside of the imaging center’s picture archive and communication system. It also gives patients access to their images through the Internet.

Magnetic particle

imaging MPI (not to be confused with myocardial perfusion imaging, a radiology method for the heart) is a new medical imaging technology that maps superparamagnetic iron oxide nanoparticles that are injected into the blood stream. The first proof-of-principle study of this method was published in 2005. MPI’s main advantages are that it’s more detailed than traditional imaging techniques, and it does not use any radiation. It produces images quickly, in comparison to other radiation-free techniques such as MRI, which is also more expensive.

These advancements in medical technology are available in health care settings today. Researchers at universities and companies are investigating other emerging technologies that could make their way into the hospital setting in the next few years. The upcoming decade may bring even more interesting advancements. This makes it an exciting time to become a radiology technician and learn to apply some of these and other technologies.

Digitisation-Trend-4CRT vs LCD

Nowadays majority of radiology monitors are LCD and they have many advantages over the older CRT monitors.

The LCD screens are much thinner and lighter than their predecessors, and are more adjustable to fit the workspace. Because the screen is not curved, there is less light reflection and distortion artifacts have been eliminated. These monitors also take up less overall space, which can be a huge benefit in some reading stations, and they are more environmentally friendly. The LCD monitors use less power and monitor disposal is easier because the lights do not contain mercury. Some of the earlier complaints about LCD monitors have been addressed as the technology improved. For example, the refresh rate is now much better than when the monitors were first introduced. And complaints about difficulty viewing angles have diminished.

Outside sources of lighting are needed for LCD monitors as they do not emit light on their own. To accommodate this, backlighting (light behind the screen) is used. Originally, the monitors used cold cathode fluorescent lamps (CCFLs) for the backlighting, with a diffuser that spreads the light across the display. Most displays now use lightemitting diodes (LEDs). Often, LEDs are incorrectly referred to as a type of screen that is different from LCD technology. In reality, the screen type is LCD and the LED is the lighting system. There are many advantages to LED lighting, such as a higher contrast ratio, and improved color accuracy. The LED lighting also adds consistency to the images.

How images are viewed on the screens has changed significantly over the past decade as well. It used to be the norm for radiologists to have to move between workstations if they were comparing images, but now the trend is to double the size (at least) of the screen. The radiologists do not want separate displays, but rather, one big wide screen.

Color versus Grayscale

As with pixel choice, the decision regarding color or monochrome monitors depends largely on the monitor’s use. There is one 5 MP color monitor on the market right now, but, it is expensive. For the most part, 5 MP monitors for mammography are monochrome but it is not as simple as buying a 5 MP monitor and just using it for all applications. A 5 MP grayscale monitor does not give you the flexibility to view some of the computer assisted diagnostics when you are using color to look at things like ultrasounds where you see color representing blood flow. It has been observed that customers are choosing 3 MP color and 5 MP grayscale for mammography.

These advancements in medical technology are available in healthcare settings today. Researchers at universities and companies are investigating other emerging technologies that could make their way into the hospital setting in the next few years. The upcoming decade may bring even more interesting advancements.

Drivers & challenges

  • With growth in the number of hospitals and diagnostic centers, demand for x-ray machines will keep rising
  • Increasing incidence of injuries is an important reason for growth in the x-ray market
  • Increasing prevalence of osteoporosis will boost the growth in the x-ray market
  • Demand for x-ray systems are likely to increase due to the technological advancements
  • Convenience associated with CR and DR will drive the x-ray machines market
  • Emission of harmful radiations cause many people to avoid x-ray scans
  • Low standard of after sales services negatively affects the market especially in smaller cities and towns
  • Digital units are however priced higher than analog ones which have been traditionally present in the market. Due to growing target population, the market offers huge prospects for players to grow and serve the market in a lucrative way
  • The current challenge for most of the private/corporate set-up is how to do away with films cost burden. CD publisher, pen-drive storage systems, and image digitizers are few solutions catching up with these healthcare providers

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