X-ray is getting robbed. There?s no two ways about it.
Left: Siemens’ Iconos R2000
While the modality has performed so well for so many years and has been the staple of any imaging department, new techniques and lower costs make MRI and ultrasound exams a feasible alternative to X-ray.
The rise in market share of those modalities is reflected in the stagnation and decline expected in X-ray. Frost & Sullivan predicts a 3 percent drop in market share in the next five years for X-ray, which would still give the modality a sizeable 28 percent market share. Compound annual growth is forecast at 4 percent.
Some analysts predict the acceptance of digital X-ray (namely flat-panel and CCD-based systems) will bring back some of that market share by offering advanced capabilities for X-ray. However, the early reports are finding a slower-than-expected adoption of digital X-ray, as facilities await some hard evidence on the modality?s performance before spending what they perceive to be huge amounts of money for an uncertain return.
?In most cases, first of all, you need a pretty big capital budget. You?re changing equipment, retrofitting rooms and that?s where the capital expenditures are,? said Martin M. Coyne, president of Eastman Kodak Co.?s (Rochester, N.Y.) Health Imaging division. ?Most customers who have stated that they are going filmless in two to three years are signing up for computed radiography right now, because it is a good interim step.?
At RSNA, Kodak heralded three new DR products and two new CR systems for availability next year.
The new DR models include the Kodak DR 9000 system, a full-room system for general purpose radiology for facilities installing new X-ray rooms or converting to fully digital environments. The Kodak DR 7000 system is an upgrade or retrofit system for an existing X-ray room. The Kodak DR 5000 system is designed for dedicated chest exams.
Both of these units utilize flat panels made by Direct Radiography Corp. (DRC of Newark, Del.), a wholly owned subsidiary of Hologic Inc. (Bedford, Mass.). Kodak will make the tables.
In addition, Kodak is partnering with Analogic Corp. (Peabody, Mass.) to develop and manufacture DR products, including the systems unveiled at RSNA. Analogic also will develop products for Kodak based on new technologies, as well as tested and approved technology and components from other manufacturers, including Analogic subsidiary Anrad
Corp. (Saint-Laurent, Quebec, Canada) and Fischer Imaging Corp. (Denver).
While no definitive list prices have been set for the systems, Michael Moehring, global product line manager of Kodak Health Imaging?s capture segment, said the Kodak DR 9000 likely will list for less than $500,000. The Kodak DR 7000 likely will list for less than $300,000, while the estimated list price for the Kodak DR 5000 is less than $400,000.
Kodak plans to begin shipping by mid-2000.
In CR, Kodak introduced its DICOM-compliant Kodak CR 800 and Kodak CR 900 systems, and the Kodak Remote Operations Panel.
The Kodak CR 800 is a fully contained, single-cassette system with a 29- by 25-inch footprint. Kodak is targeting ICUs, ERs, remote clinics and X-ray rooms for the product. This system permits images to be distributed over DICOM-compliant networks for soft-copy review, printing and archiving.
The Kodak CR 800 is set for release April 1. The list price ranges from $99,000 to $127,900, depending on options.
The Kodak CR 900 system is a multi-cassette unit with the same features as the Kodak CR 800 and offers an autoloader to handle as many as eight cassettes. This system can be used for centralized CR processing installations where automatic cassette loading can streamline workflow.
Release is scheduled for Aug. 1. The list prices of the units are expected to range from $175,000 to $185,000, depending on features.
On the topic of DRC, its parent company, Hologic, will begin to produce entire digital radiography systems in-house rather than relying on outside sources for components.
DRC introduced the first two DR systems built totally in-house ? the Epex and the Radex. Thomas Umbel, DRC?s general manager, said the Epex is a general radiography system, which performs all radiographic procedures with a single detector.
Epex will list for $395,000 and is expected to go into clinical trials in April. Commercial availability is slated for mid-summer 2000.
The Radex DR system is a stripped-down system for outpatient settings. The first clinical installations are expected in the second quarter of 2000. The product will list for $330,000.
Under its Fischer agreement, DRC produces the DR1000, a general digital radiographic system and the DR1000C, a dedicated chest system. At RSNA, DRC officials stated that the introduction of the two new DR systems would not affect the contract with Fischer.
Most notable in Shimadzu Medical Systems Inc.?s (Torrance, Calif.) booth was the company?s work in flat-panel digital fluoroscopy, slated for commercialization within two years. Shimadzu displayed images from a works-in-progress flat-panel fluoroscopy system, which currently images a three-sqaure-inch area. By April, Shimadzu hopes to have images from a 9 inch-by-9-inch panel and produce larger panels from there.
Shimadzu also is working to integrate a control panel for the flat-panel digital chest system from Canon Medical Systems (Irvine, Calif.) with the control panel for a Shimadzu generator to streamline the technologists? duties.
Shimadzu also exhibited an upgrade to its Digitex Alpha X-ray system, which incorporates a CCD camera. The Digitex Alpha Plus was released last month.
GE Medical Systems (GEMS of Waukesha, Wis.) showed a new technology designed to help doctors diagnose blood vessel problems, while reducing contrast injections and X-ray exposure to patients.
The new technology is provided by GEMS? Advantx LCA+ system, which is used to pinpoint the location of blood vessel blockages and guide the placement of the balloon during angioplasty. The technology eliminates the difficulty of searching for the right projection or artery.
GEMS also highlighted its Advantx LCA/LP+, a biplane mixed application system intended to image all anatomical areas from neuro to the distal periphery. The system?s 16-inch image intensifier frontal plane and 12-inch image intensifier lateral plane are designed to provide optimum imaging for peripheral angiographic studies, as well as for neuro interventional procedures.
Like the GE Advantx LCA+, the GE Advantx LCA/LP+ is capable of 3D imaging.
GEMS also is replacing its Prestige I remote R/F system with the Prestige II. The Prestige II comes with a single, integrated and streamlined console, table and compact software controlled electronics. It also offers configuration possibilities with choices for X-ray generator power, X-ray tube, variable or fixed working height and reduced patient?s dose.
Prestige II has a list price of between $300,000 to $400,000, depending on options.
In the digital area, the company is expecting big things from its Revolution QX/i digital X-ray system this year. The company plans to start shipping the QX/i in high volume by mid-year. Currently, GEMS is shipping a couple per week.
GEMS also unveiled its Revolution XR/d filmless X-ray table, which has the GEMS Revolution digital detector replacing conventional X-ray film.
The list price is in the $500,000 range, depending on features, and is expected to hit the market in the third quarter.
Coming to the top of GEMS? X-ray line is its Angio CT system, which combines a single-plane angio unit with a CT scanner. Currently, the system targets the treatment of liver disease. Physicians would take an image of the liver, apply treatment and slide the patient into the CT to check the efficiency of the treatment.
GEMS has shipped a dozen or so Angio CTs to Japan; the unit now is available globally. The list price ranges from $3 million to $4 million. The lofty price tag includes the angio lab ($1 million) with the CT scanner ($1 million), as well as a special combination table, control room and in-room features.
GEMS also unveiled a new alliance with Agfa Corp. (Ridgefield Park, N.J.) to private-label Agfa?s CR products.
The partnership ?positions us to offer medical systems and software customers a full turnkey solution for an acquisition device for their CTs and MRIs to CR, as well as a PACS offering,? said Michael F. Mahoney, GEMS? general manager of sales and marketing for integrated imaging solutions.
GEMS will maintain its other CR product agreement with Fuji Medical Systems USA Inc. (Stamford, Conn.). Mahoney said that GEMS is the second-largest distributor of Fuji CR products.
Toshiba America Medical Systems (TAMS of Tustin, Calif.) is working its way into the digital X-ray picture. TAMS displayed digital X-ray images captured with its works-in-progress flat-panel detector via direct conversion technology. TAMS demonstrated a series of vascular studies using the developing technology.
Toshiba favors the two-layer detector design, which consists of a detection layer that converts X-rays to charge, and a thin-film transistor layer, which resembles a matrix of cells. The flat-panel detector under development at Toshiba would handle both dynamic and static images.
TAMS also introduced improvements to its Efficiency 450D, a multi-purpose X-ray system for R&F, non-vascular interventional and general angiography procedures.
The Efficiency system now features the option to select a 12-inch image intensifier in addition to current 14-inch and 16-inch image intensifiers.
The Efficiency 450D currently is shipping with the EPS-Plus Windows NT-based electronic photo spot technology. With this technology, a spot film device is eliminated, which allows for the digital acquisition of images. This addition can reduce overall exam time by up to 30 percent and reduce costs associated with film processing.
Siemens Medical Systems Inc. (Iselin, N.J.) launched its new Iconos R200 fluoroscopic X-ray system at RSNA. The Iconos R200, with integrated image-optimizing, low-dose components, was developed for universal applications, such as routine fluoroscopic procedures and X-ray exams, as well as specific procedures including myelography, venography and angiography.
The Iconos R200 features parallax correction for angulated projections keeping the object of interest centered in the field-of-view. When tilting upright or selecting tomography, the system automatically holds the centering of the object being imaged for optimized workflow.The system features ergonomic controls and one-hand cassette loading for continuous workflow.
Siemens also debuted the newest addition to its digital flat-panel detector line. Vertix FD is dedicated to chest and skeletal applications and targets hospitals and clinics with high patient throughput.
The FDA-cleared Vertix FD features ceiling-mounted tube support and tiltable detector load, which enable exposures to be acquired without conventional film/screen systems. The X-rays are acquired via a CsI (cesium iodide) scintillator and digitalized in the detector matrix (aSi).
Trixell S.A.S. (Moirans, France) ? the joint venture company of Philips Medical Systems International B.V. (Best, Netherlands), Siemens AG, Medical Engineering Group (Erlangen, Germany) and Thomson-CSF (Meudon de Foret, France) ? will begin volume production of its Pixium 4600 digital X-ray detector in early 2000. Trixell has a new production site in Moirans with a manufacturing capacity of 5,000 units per year. Trixell?s stake in the purchase of the former dpiX (Palo Alto, Calif.) has ensured a long-term supply source for amorphous silicon plates.
RSNA also marked the entrance of a new player in the CR market. PhorMax Corp. (Palo Alto, Calif.) introduced its CRView desktop CR system. The CRView is a cassette-based system and boasts a 60- to 90-second scan time with a built-in eraser. It produces images of 2K by 2.5K resolution.
The list price is in the range of $49,950 for a complete system with QC station, which is approximately half the cost of the most expensive systems currently on the market.
PhorMax has signed an agreement for Agfa to provide phosphor imaging plates configured for the CRView. Gary Cantu, PhorMax?s president and CEO, said the company currently is preparing its 510(k) filing with the FDA.
Fuji Medical Systems USA Inc. (Stamford, Conn.) unveiled a new CR technology at RSNA called the Speed Suite. The CR system uses a high-end X-ray generator and combines CR technology with the use of traditional systems to allow a quicker transition to digital X-ray. The Speed Suite can be configured in a single-room or two-room arrangement and is currently in use at three facilities in the U.S.
Fuji also showed the cassette-less FCR 5501D CR reader with dual-side reading technology. The works-in-progress uses clear base imaging plates and dual optical readers to capture X-ray information and read from both sides simultaneously. Typically, the additional X-ray information is absorbed in black imaging plates.
Fuji also displayed its newly available QA Workstation 771, which functions as a technologist?s console for CR plate readers. The workstation features automatic image processing and display enhancements including the ability to link three 14 x 17 images for ?long leg? and scoliosis studies.
Keeping with the digital theme, Fuji exhibited its FCR 5000R-ID CR reader for reading digital mammograms. The works-in-progress includes specially designed algorithms to enhance breast images and can process up to 115 plates per hour for screening applications. Fuji also has a digital CAD reading workstation to go with the FCR5000R-ID.
As promised, Canon Medical Systems (Irvine, Calif.) introduced its new CXDI-22 retrofit bucky sensor for digital radiography at RSNA.
CXDI-22 consists of the digital imaging unit, a control station and operation unit/preview panel. The panel is 2.9 inches thick, which allows for placement in virtually all existing film cassette holders on the market without altering the table design.
Canon is targeting facilities that require versatility from a retrofit solution. It carries a list price of $225,000 and is scheduled for delivery in January 2000.
Vidar Systems Corp. (Herndon, Va.) uncovered its compact, low-end Sierra film digitizer at RSNA for a list price of less than $10,000. At a mere 15 pounds, the Sierra can be wall-mounted to conserve space and features Vidar?s proprietary High Definition CCD technology. Vidar officials said the Sierra requires no routine maintenance and includes a continuous calibration feature to automatically ensure high-level grayscale reproduction and optimum image quality. 
