Interventional and surgical X-ray equipment markets plummeted in 2020

January 20, 2021
By Bhvita Jani

The world market for Interventional and Surgical X-ray equipment is forecast to reach almost $3.9 billion by 2024, according to a new report from Signify Research. The world markets for interventional X-ray and surgical X-ray are estimated to have declined by 17.4% and 16.3% respectively in 2020. Growth in this market is predicted to return from 2021 onwards, as the negative impact of the pandemic is expected to subside. Recovery is forecast to be gradual rather than “V shaped”, with the steady return of elective procedures and as healthcare expenditure is restored following the diversion to COVID-related equipment.

Product trends
In the surgical X-ray market, flat panel detector (FPD) 2D mobile C-arms are forecast to have the fastest growth through to 2024, with a CAGR of 3.4%. In 2020, there was a shift toward low-end to mid-range FPD 2D systems as a result of stretched capital expenditure budgets. Demand for image intensifier systems is slowing down, with the key markets now the emerging regions. However, in developed markets, such as the United States, usage of imaging intensifier systems is still high in pain management clinics. 3D mobile C-arms are primarily used for imaging the joints, spinal fusion and fractures, and the market is expected to start seeing signs of recovery from 2021 onwards, following the return of elective spinal procedures to pre-pandemic levels. Regions with the highest adoption of 3D Surgical X-ray imaging include China, Western Europe and the United States.

Within the interventional X-ray market, the interventional cardiology (IC) market was more negatively impacted by COVID-19 than interventional radiology (IR) due to heavier reliance on elective procedures. An increase in the number of structural heart procedures performed, in particular, percutaneous coronary intervention (PCI), continues to be a factor maintaining clinical demand for the IC market. The IR market has experienced a continued expansion of clinical procedures being performed. An increased incidence of peripheral vascular disease is driving demand for general vascular angiography. Despite an estimated 26% drop in the hybrid operating room segment in 2020, fastest growth is predicted for this product category through to 2024.

Key regional trends
• North America: The North American market has been significantly impacted due to postponement of non-critical surgeries, and as budgets for non-diagnostic X-ray equipment were diverted to COVID response. The North American market will be driven by replacements of existing equipment and increasing demand from outpatient clinics and facilities.
• Latin America: Brazil has been one of the worst impacted countries globally by COVID-19, resulting in a severe market retraction for both the interventional and surgical X-ray markets in 2020.
• Western Europe: The Western Europe market is forecast to experience pricing pressures from 2020 onwards, with the economy suffering as a result of high COVID-19 impact. Recovery is expected to be steady and gradual through to 2024 as economies struggle with the impact of the pandemic.
• Eastern Europe, Middle East and Africa: The Saudi Arabia-Russia oil price war and the COVID-19 pandemic have further set back the prospects of a recovery, and the market is forecast to sharply decline in 2020 by 20.1%. Postponement of elective procedures contributed to the huge drop in demand in 2020.
• Asia Pacific: The Chinese market has had one of the quickest recoveries from the COVID-19 pandemic globally, with a forecast contraction of high single digits in 2020 for the surgical X-ray market. Demand for hybrid operating rooms and 3D mobile C-arms is high in China, mainly in high-end hospitals.

COVID-19 impact (clinical impact)
From 2021 onward, there is expected to be pent-up demand for both interventional and surgical X-ray systems. With the postponement of nonessential elective surgeries and medical procedures to conserve medical resources for COVID-19 patients, cardiovascular procedures were severely impacted during 2020. However, the massive financial burden of COVID-19 on healthcare providers is expected to result in reduced capital expenditure budgets for imaging equipment, including Interventional X-ray and Mobile C-arm systems.

While PCI procedures are assumed to be critical in treating acute myocardial infarctions (MI), only a small amount of PCI procedures performed on patients were for these life-threatening conditions. The rest of the PCI procedures are considered as “elective procedures” and were deferred during the pandemic. Globally, hospitals saw a decline in cardiovascular procedures.

The pandemic is having a negative impact across all interventional markets (including IC and IR), due to a combination of reduced vendor sales activity (on-site demonstrations, new product launches, conferences) and plummeting elective procedure volumes during national lockdowns.

Demand for image intensifier mobile C-arms was less impacted than for FPD equivalents in 2020 due to COVID-19, as providers focused on cost-effective equipment due to reduced capital budgets.

Top trends and key takeaways
3D mobile C-arms are forecast to have the highest adoption in China, Western Europe and the United States. The Chinese market accepts the benefits of 3D mobile C-arms from a navigational and clinical perspective. In contrast, the United States market is a challenging market for 3D mobile C-arm system manufacturers to penetrate due to the extensive use of Medtronic’s O-arms in minimally invasive spinal surgery, also offering navigational capabilities.

In India, local X-ray manufacturers were spearheading the uptake of both surgical and interventional X-ray systems pre-COVID. Within the mobile C-arm market, Kiran facilitated the uptake of low-end 2D FPD mobile C-arms from 2019 onwards, offering more affordable FPD solutions than global vendors. As a result, the Indian market is gradually shifting from predominantly image intensifier systems to a higher presence of 2D FPD technology. In a similar manner, Innvolution Imaging is accelerating the uptake of cath labs in rural areas of India, making cardiovascular care more accessible and affordable to the wider part of society.

Augmented reality is expected to be at the forefront of state-of-the-art hybrid operating rooms, in order to aid procedural navigation, reduce operating times, and radiation exposure. Real-time navigation data can be used to enhance patient outcomes using holographic images, as well as having full visibility of the operating room. Within image guided therapy, 3D scan images, segmentations and measurements can be layered on top of the patient directly in the interventional suite for real-time clinical decision support, as well as preoperative planning.

Bhvita Jani
The multidisciplinary use of hybrid operating rooms (HORs) is facilitating uptake through to 2024, as healthcare providers tightly monitor return on investment, and usage statistics to better inform purchasing decisions. Despite the initial higher associated cost compared to dedicated interventional X-ray systems, the increased profitability and the flexible utilization are fueling uptake in developed markets. Usage of HORs is predominantly in cardiac surgery, followed by vascular procedures, facilitating enhanced clinical precision and patient outcomes in more complex cases.

About the author: Bhvita Jani is a senior market analyst at Signify Research.