The arrival of flat panel detectors in the late ‘90s undoubtedly sounded the death knell for image intensifiers. But while most experts agree their days are numbered, it may be a while yet before image intensifiers go the way of the dinosaur.

It’s true that over the last 15 years, flat panel detectors have replaced image intensifiers in high-end imaging applications such as cardiology systems. The advantages of the technology are numerous: it’s lighter, captures clearer images and uses lower radiation dose.

Logic dictates that as flat panel detectors continue to approach the price of image intensifiers, they’ll eventually eclipse their market share, but that hasn’t happened just yet. After taking a huge plunge in the mid-2000s, the image intensifier market has remained surprisingly stable. “The image intensifier business continues to chug along,” says David Hurlock, global sales manager at Varian.

“For whatever reason, flat panel detectors don’t seem to be totally adopted,” agrees Tom Spees, director of USA sales at Dunlee, speculating that every hospital still has at least one machine with an image intensifier in it.

Why haven’t flat panels taken over? For one, uncertainty around hospital reimbursements has made hospitals more wary of buying capital equipment. Though all new machines now come equipped with flat panel detectors, not image intensifiers, many hospitals are holding onto their existing equipment.

Numerous surveys suggest that though the economy is starting to pick up, providers still plan to play it safe with equipment spending until they have a better idea of how health reform will impact their bottom line.

Furthermore, depending on the hospital’s volume and size, the cost-benefit ratio may not add up. “Although flat panel detectors have dropped, they still have difficulty competing with the value of image intensifiers for what I would consider to be moderate real-time imaging applications,” says Spees.

Furthermore, there are pockets in the market in which image intensifiers still hold their ground for now. For example, dynamic flat panel detectors, which process moving image sequences in fluoroscopic procedures, have been around since 2002, but have yet to replace image intensifiers.

Because dynamic panels are much more expensive to develop and difficult to manufacture, there are fewer manufacturers offering detectors capable of dynamic imaging. “The prices for dynamic detectors that would replace an image intensifier haven’t decreased like the prices for static flat panel detectors,” says Hurlock.

Nevertheless, dynamic digital detectors will someday replace image intensifiers as OEMs engineer new dynamic imaging upgrade products and imaging providers adjust to the financial implications of health reform and purchase new equipment.

“Unless the economy picks up and they know what to expect from the government, I don’t think a wise hospital will spend money where they don’t have to,” says George Pardue, president of Imaging Affiliates.

Down the tubes
Compared to the latest and greatest offerings in the imaging world today, X-ray tubes are downright ancient. They were originally invented more than 100 years ago by British physicist William Crookes when he discovered that his experimental electrical discharge tube contained cathode rays — what scientists later identified as electron streams.

This, in turn, led to Wilhelm Röntgen’s discovery of X-rays in 1895 when he noticed that invisible rays coming from a Crookes tube wrapped in black photographic paper was making a nearby screen glow. He began to investigate these rays full-time and later won a Nobel Prize in physics for his research.

As X-ray became increasingly useful for medicine, workshops began manufacturing Crookes tubes. The tube’s anode was made of a heavy metal and was tilted at an angle to the cathode, so the X-rays would radiate through the side of the tube.

These cold cathode type X-ray tubes were used until about 1920, when they were replaced by the hot cathode Coolidge tube — what we know now as the modern X-ray tube.

Despite its centenarian status, the market for X-ray tubes continues to be robust, according to experts.

The biggest market for X-ray tubes is CT, which continues to be a preferred diagnostic tool used widely in emergency departments and oncology. Traditional radiographic rooms and X-rays continue to be a steady source of business as well.

“Portable machines and fixed radiographic machines continue, to this day, to make up a huge sector of the market space,” says Spees. “Just the sheer volume of the systems installed indicates there’s still a healthy robust replacement market for those,” he adds.

The global X-ray marketplace will remain stagnant through 2017 for new equipment sales, according to experts. However, sales aren’t necessarily tied to how well the new equipment market is doing.

“X-ray equipment tends to be pretty durable, so it’s not uncommon to have a static X-ray room that is well over 10 years old — after 10 years you’ll need a replacement,” says Spees.

And procedure volume remains strong, according to Varian’s Hurlock, who says it continues to grow by 5 percent a year.

An ode to anode
While anode end grounded X-ray tube technology has been around for over a decade, the widespread adoption of anode grounded tubes adapted for CT machines (manufactured by Varian) is a relatively recent development that promises to improve the modality’s efficiency and power.

Traditional X-ray tubes split the voltage between the cathode and anode to accelerate the electrons needed to create X-rays. With anode end grounded tubes, however, the voltage is directed at the cathode side of the tube only.

This design eliminates the risk of electrical discharge between the anode and the tube housing, meaning that the housing and the anode can be built closer together, helping the tube cool more efficiently and boosting its life expectancy. It delivers twice the continuous watts of power in a smaller, lighter package, resulting in faster, higher-quality CT scans, according to information published on Varian’s website.

“It’s proven to be the superior technology for systems requiring high volume and high throughput imaging,” says Hurlock. And he doesn’t see the tube’s takeover stopping with CT. “Soon, new modalities will come to market that leverage the increased power in a smaller size package that AEG tubes provide,” he adds.

“Overall, the size of the tube is getting smaller and smaller,” says Richard Harris, senior X-ray tube specialist at Oxford Instruments Service. He points out that the technology also has another advantage: by using only one high voltage cable, it does away with the internal wiring responsible for many of the causes of failure in the traditional bipolar X-ray tube.

But it may be a while before these tubes take over completely. “We’ve got so many systems out there that still require bipolar tubes. It might take another 10 years to weed out bipolar products altogether,” says Harris.

If it ain’t broke…
In the near future, the forecast for the X-ray market looks positive. Though there’s always talk of other modalities such as ultrasound or MRI taking over X-ray one day, that doesn’t seem to be the case anytime soon.

“If you’ve got a broken arm or hand, conventional X-ray is all you need — the cost factor of MRI is too much,” says Imaging Affiliate’s Pardue.

Experts agree that the biggest short-term obstacle to purchases of capital equipment and adoption of new technologies remains the uncertainty around the Affordable Care Act. “Ultimately, the technologies that will grow are the most efficient technologies that provide high definition images at a lower incremental cost,” says Varian’s Hurlock.

To check out the X-ray tube New Equipment Guide, click : HERE

DOTmed Registered X-ray Tube and Image Intensifiers - September 2013 Companies

Names in boldface are Premium Listings.
Domestic
Rick Stockton, Atlas Medical Technologies, CA
DOTmed Certified
DOTmed 100
Elie Semaan, Rayon-x Engineering, LLC, CA
DOTmed Certified
Michaelle Serrano, Oxford Instruments Service, LLC, FL
DOTmed 100
Glenn R. Hammerquist, Berrien X-Ray, MI
Eric Smith, SOS Medical Imaging, NC
DOTmed Certified
DOTmed 100
Ben Williams, DEXA Solutions, LLC, WI
Greg Kramer, C&G Technologies, IN
DOTmed Certified
DOTmed 100
Rex Fortenberry, R & F Imaging Systems, GA
John Pereira, United Medical Technologies Corp., FL
DOTmed 100
David Denholtz, Integrity Medical Systems, Inc., FL
DOTmed Certified
DOTmed 100
Robert Serros, Amber Diagnostics, FL
DOTmed 100
Ronen Bechor, Elsmed Ltd. & Relaxation, Inc., FL
DOTmed Certified
DOTmed 100
Josh Glas, ADAM Imaging Parts, NY
DOTmed Certified
DOTmed 100
Tony Smith, Classic Diagnostic Imaging, OH
DOTmed Certified
DOTmed 100
Jeremy Probst, Technical Prospects, WI
DOTmed Certified
DOTmed 100
David Hurlock, Varian Medical Systems, SC
Michael McKinney, Imaging Affiliates, NC
Paul Beard, Block Imaging Parts & Services, Inc., MI
DOTmed 100
Tom Spees, Dunlee, IL
Mike Ghazal, Zetta Medical, IL
Charles Gauthier, Imaging Services, IL
DOTmed Certified

International
Mads Vittrup, AGITO Medical, Denmark
DOTmed 100
Dustin Bradley, Link Medical Syztems Europe, France