Medical Imaging Markets
Volume I: Radiography
Published by Kalorama Information, publishing division of MarketResearch.com
Executive Summary
1.1X-RAY OVERVIEW
X-rays are a form of electromagnetic radiation. Their extremely short wavelength—only about 1/10,000 that of visible light or even less—gives them the ability to penetrate materials that absorb or reflect ordinary light. Like a light bulb, an xray tube is a simple device that generates a specific electromagnetic radiation. Each tube is composed of a negatively charged cathode and a positively charged anode. The cathode contains a filament. Voltage, or current, is applied to the filament. This generates a stream of electrons that hurtle the short distance into the metal anode at nearly the speed of light. The collision produces x-rays.
The x-ray has evolved into one of the most important devices ever invented to help physicians detect disease or other illnesses. The use of the x-ray, accompanied by various contrast media taken orally or by injection, makes it possible to detect changes in tissue even before clinical symptoms may arise. For example, a dentist uses an x-ray to find cavities in teeth or abscesses at the roots of teeth. The brain specialist uses this diagnostic tool to find tumors or abscesses in the brain or spinal cord. A nose and throat specialist uses x-ray to locate trouble in the sinuses. The earliest signs of tuberculosis or silicosis in the lungs may be seen in x-ray pictures. The gastroenterologist may apply xrays to locate ulcers or tumors in the stomach and duodenum, or in other portions of the intestines.
Traditional radiography involves the use of film to capture x-ray images. The exposed film is chemically processed to create a visible image that physicians use to diagnose a patient's condition. Making diagnoses based on the images from x-ray film has been the standard for medical imaging because of the x-ray’s functional utility and perceived high image quality.
1.2 TRANSITION TO DIGITAL X-RAY
To produce a conventional radiograph, a film cassette is placed behind the anatomy to be imaged. A generator, which produces x-rays, is positioned opposite the film cassette. The transmitted x-rays pass through soft tissue, such as skin and muscle, and are absorbed by harder substances, such as bone. These x-rays then form a latent image upon the film. After the film has been exposed, it passes through a series of chemicals and then dries. But now, digital radiography has evolved to overcome the limitations of conventional x-ray film. The digital systems replace the conventional film cassette with an electronic receptor that directly converts the x-rays to digital images.
The explosion in computer memory and processing power has allowed digital medical imaging tools to take a significant market share—about 30%—from film. This has led to a decline for conventional film from its primary role in the x-ray market. Digital systems make it possible to produce x-rays in seconds. These images, which also are sharper than the images of conventional film, can be transmitted almost instantaneously to a computer screen. They also can be sent across town or to a researcher on the other side of the world. This telemedicine capability offers potential savings for cost-minded hospitals, which have created large archives and staffs to store and carry around film images. Essentially, digital x-rays can be stored less expensively on a hard drive or a chip and transmitted electronically or to a PACS (picture archiving and communications system).
Digital technology found application in medical x-rays in the 1980s when A/D converters and computers were adapted to conventional fluoroscopic image intensifier- TV systems. Digital imaging has lead to an improvement and renaissance in the traditional x-ray modality. Digital x-ray images are sharper and cleaner than film-based x-rays images are. Many fluoroscopic x-ray procedures have benefited greatly from the use of digital technology. In a digital fluoroscope, a photoemitter is connected to an image-intensifying system, which creates a video signal that is digitized, stored and processed. A monitor is driven by a digital display controller and converts the processed information into displayed brightness. Angiographic procedures that are used to examine the blood vessels in the brain, kidneys, arms and legs, and the blood vessels of the heart have benefited as well. Radiologists are able to view the results of fluoroscopic examinations of the upper GI in real time using digital acquisition.
The evolution to digital has begun. Over the next few years, many conventional medical x-ray systems will be upgraded to digital technology. In addition to digital fluoroscopic systems, the majority of film cassette-film screen systems will be replaced by digital x-ray detectors.
It is possible to generate digital x-rays in a number of ways, as indicated in Exhibit 1.
Exhibit 1
Methods of Digital X-ray Generation
• Digitize a conventional film-based image.
• Use a photostimulable phosphor screen to store x-ray photons and a laser scanner to convert them into an image.
• Use the indirect capture technique—x-ray energy is converted into light and then detected by a photodiode or other optoelectronic device.
• Use the direct capture technique—a charge is generated directly by the absorption of x-rays using photoconductors.
1.3 KEY APPLICATIONS
The market for medical x-ray technologies can be divided into sectors according to application, such as chest x-rays and mammography. Some companies have developed different systems for each application or focused their business on a specific modality.
1.3.1 Chest X-rays
Chest x-rays are the most commonly performed diagnostic x-ray examination. A chest x-ray can help determine if there exist problems in the organs and structures in the chest. However, a chest x-ray can sometimes be difficult even for experts to interpret and may not provide all the information needed to determine the cause of a problem. If a chest x-ray is abnormal, more specific x-rays or other tests such as a CT scan, an ultrasound or an MRI scan may be needed.
Yet, the chest x-ray is the most commonly performed radiographic exam. Approximately 45% of all radiographic exams are chest x-rays. More than 150 million chest x-rays are performed yearly in the United States at a cost of more than $11 billion. Any technique that increases the speed of the procedures would be advantageous. This is where digital x-ray imaging can play a major role, as it can eliminate the time-consuming step of conventional film processing. In addition, digital x-ray technology can eliminate the need for the chemicals used for developing the film, which are potentially hazardous and require special storage conditions. As the images created by digital systems surpass those produced by film in terms of quality, and because digital imaging vastly improves the efficiency of storage and transmission of image data, the advantages of converting to digital x-ray technology are obvious.
1.3.2 Mammography
A mammogram is an x-ray-based image of the breast. Physicians use a mammogram to locate tumors and cysts. This diagnostic tool helps determine the difference between noncancerous and cancerous disease. According to the National Center for Health Statistics, in 2003 there were more than 17 million physician office visits during which mammograms were ordered or provided (National Ambulatory Medical Care Survey: 2003 Summary, Table 17). The number of hospital outpatient department visits during which mammograms were ordered or provided totaled approximately 1.5 million (National Hospital Ambulatory Medical Care Survey: 2002 Outpatient Department Summary, Table 15). The percent of women 40 years of age and older who had a mammogram from 2001 to 2003 totaled 70% (Health, United States, 2005, Table 86.)
The breast is difficult to image. High resolution is required to detect potential tumors, but the extent of exposure to x-rays must be kept as low as possible to prevent possible side effects through regular screening. Approximately 600,000 cases of breast cancer are diagnosed annually in the developed world. Most have a mammography that confirms the diagnosis. A breast biopsy also is performed. This procedure is usually performed under x-ray guidance.
Mammography does well to save lives by detecting breast cancer at an early stage through screening. There also are economics involved. It is estimated that the cost of treating early-stage breast cancer is approximately $11,000 per patient, while a late-stage treatment costs nearly $140,000. Moreover, digital mammography devices are able to use much lower doses of x-ray, which gives them an advantage over traditional film-based modalities. In addition, the use of computer-aided detection (CAD) software aids in pinpointing tissue densities that might be cancerous. Many digital x-ray product manufacturers have decided to focus their efforts on the mammography market.
1.3.3 Cardiovascular Procedures
Radiography has also found extensive use in the cardiovascular area. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Atherosclerotic coronary artery disease, myocardial infarction, congestive heart failure and cardiac arrhythmias represent the most common cause of hospitalization in all developed countries. The westernization of lifestyle and nutrition in many developing countries has lead to increases in the prevalence of CVD. Research on CVD has determined that many factors play important roles in determining susceptibility to many of the major diseases of the cardiovascular system including nutrition, genetics, environmental triggers, hypertension and atherosclerosis.
CVD is indicated by the appearance of atheromatous plaques in coronary arteries, which block the blood supply to the heart muscle. Although important risk factors have been identified, such as smoking, a high blood cholesterol level, diabetes, and a family history of heart disease, more remains unknown than is known about the formation of atheromatous plaques. The traditional electrocardiogram provides an accurate assessment of disease once preliminary clinical symptoms appear. However, the manufacturers of imaging systems, such as computed tomography (CT), ultrasound, magnetic resonance (MR) imaging and positron emission tomography (PET) continue to develop techniques that can point out plaque build up and heart function irregularities well before patients show clinical symptoms.
The use of x-ray techniques for imaging moving blood is a challenge to system manufacturers. The heart and blood vessels are in constant motion, and the image in many applications involves motion, rather than a static image. There have been problems with creating technologies that can fulfill these requirements in sufficient detail and resolution. But, digital technology products have evolved that image at sufficient speed to meet required specifications, though the memory required to store such images is extremely high. More than 70% of angiography laboratories in the United States have made the transition to filmless imaging.
1.4 MARKET SUMMARY
The market for medical x-ray imaging systems, undoubtedly, has been propelled with the advent of digital technology. There will always be a need for x-rays to detect breast cancer and for diagnosing internal injuries, ranging from the breakage of bones to the tearing of tissues and the buildup of plaque in coronary arteries. But digital technology enables x-ray modalities to detect problem sites more rapidly and with greater accuracy. These capabilities are helping fuel hospitals’ transition from film-based systems to filmless environments. Digital modalities will not completely eliminate the need for film-based systems, notably in developing countries. But digital technology is justified in many applications in which the economics justify the use of digital, and where the user can afford to make the transition.
1.4.1 Traditional X-Ray
The world market for traditional film-based x-ray systems is still growing, but only by a few percentage points annually. The market for film-based systems is stronger in the developing countries where digital technology may not yet have made significant inroads. The move toward PACS by hospitals and other large health care institutions is automatically helping to fuel their transition to digital and away from film.
Exhibit 2
Summary: World Market for Medical X-Ray Equipment 2006, 2008, 2010
Source: Kalorama Information
1.4.2 Digital X-Ray
The market for digital x-ray systems should experience significant growth in the next few years in the United States, reaching more than $1.4 billion in 2010. Much of this growth will be fueled by a transition by many to computed radiography (CR)—the technology of making x-ray images with conventional x-ray equipment but in which the images are captured on reusable photostimulable phosphor plates, instead of single-use xray film. These CR systems are less expensive than direct radiography (DR) systems, which convert x-rays into digital data without the use of image capturing plates. These digital data generate an image on a computer screen. Or the digitized image can stored via PCAS.
Exhibit 3
Summary: The U.S. Market for Digital X-Ray Equipment 2006, 2008, 2010
Source: Kalorama Information
1.4.3 Mammography
Mammography system sales will be fueled by the transition to digital technology, as well as by the promotion of annual breast examinations for women. According to the American Cancer Society, breast cancer is the second most common cancer among women, and more than 211,000 new cases of invasive breast cancer occurred among women in the United States in 2005. Breast cancer ranks as the second leading cause of cancer-related deaths among women, causing an estimated 40,000 deaths in 2005.
Exhibit 4
Summary: U.S. Market for Mammography Systems 2006, 2008, 2010
Source: Kalorama Information
1.4.4 Fluoroscopy
Fluoroscopy is an imaging technique commonly used to obtain real-time images of the internal structures of a patient through the use of a fluoroscope. A fluoroscope consists of an x-ray source and fluorescent screen between which a patient is placed. Modern fluoroscopes couple the screen to an x-ray image intensifier and charge coupled device (CCD) video camera that enable the images to be played and recorded on a monitor. The radiologist controls an x-ray beam that is transmitted through the patient.
In fluoroscopy, the radiation is blocked more effectively by dense tissue, such as bone, than by soft flesh, and the result is a dark shadow of bones on the screen, against a light background. Fluoroscopy obtains live x-ray images of a living patient.
Angiography used to diagnose an occluded artery may be performed using fluoroscopy or CT. Fluoroscopy is also used to guide catheters containing contrast media into the spinal cord and other areas; to guide removal of kidney stones; and to plan radiation therapy. These procedures are all facing competition from CT, MRI and ultrasound modalities. This competition is hurting the fluoroscopy market, which will see little growth.
Exhibit 5
Summary: U.S. Market for Fluoroscopy Systems 2006, 2008, 2010
Source: Kalorama Information
1.5 SCOPE AND METHODOLOGY
This report analyzes the current and potential world market for medical x-ray systems. Several modalities that use x-rays to create images, such as fluoroscopy and CT, are included in the report. This report emphasizes the current and future markets for these products. This report generally reviews the nature and direction of research, as well as future markets. It also profiles several companies involved in marketing medical x-ray equipment, including Analogic, Fuji, Kodak, GE Healthcare, Imaging Dynamics and R2 Technology, among others.
Market forecasts are based on an examination of current market conditions and on investigations into the development of new products by key companies. The market data provide multiple year forecasts for all product segments covered in the report. The information presented in this report is the result of data gathered from company product literature and other corporate brochures and documents, as well as information found in the scientific and trade press. In addition, interviews were conducted with company executives, clinicians and researchers.
