This report originally appeared in the July 2010 issue of DOTmed Business News

Connie Stahl, a radiologic technologist for Seymore, Ind.-based Schneck Medical Center, still remembers clearly when the department transitioned its portable X-ray equipment from analog to digital (DR) less than 18 months ago.

"Our images became instant and we no longer had to take the time to process our films," Stahl says. "If there's a trauma case or if a physician needs to see the image right away so they can continue their care, they can view the image in the ICU or the emergency room. It was such an improvement."

The switch over to DR technology is still the biggest driver in the portable X-ray industry, but the changeover will still take a bit more time before it's complete.

Schneck Medical Center currently utilizes GE Healthcare's top-of-the-line DR system, the Definium AMX 700, a portable flat panel detector that allows processed images to be sent within seconds to an integrated monitor for review.

"This is what we all want when we go to do exams. If it's in use, we will wait," Stahl says. "We don't even like to take out our old portables anymore. This one drives so smooth, the interfacing works well and it is very user friendly."

Refurbishers also acknowledge the value of this GE Healthcare unit. Steve Walsh, president of Eastern Diagnostic Imaging, an imaging equipment refurbishing company, says the manufacturer is ahead in the industry.

"GE continues to maintain its market share in the portable business," says Walsh. "AMX portable is still the industry standard."

Along with GE, other OEMs are cranking out new equipment and advancements for the portable units, as the extinction timetable for analog units appears closer every day. Industry estimates have the digital units comprising as much as 80 percent of the industry with computed radiology (CR) only maintaining about 20 percent.

The only thing keeping everyone from having one is the price. Walsh says the adoption of DR technology is lagging because of a well-known concern: lack of capital.

"[The industry] is under the same constraints that all areas of medicine are under, the financial restraints of the economy," says Walsh. "It affects the hospitals just like everybody else. They can only spend what they actually take in," he says.

Although portable X-rays aren't at the top of a hospital's wish list, the consensus among industry professionals is that sooner, rather than later, they will be everywhere.

Siemens offers two different portable X-ray systems in the U.S., the Mobilett XP Hybrid, which uses analog film cassettes, and the Mobilett XP Digital, a DR system with advanced flat panel detection technology and a portable workstation for rapid image acquisition, processing and archiving.

"The industry is transitioning from analog to digital and everyone wants to get rid of film because of chemicals and you have to walk around with the cassettes more. When you work digitally, you can speed up the process of getting images read and make the diagnoses quicker," says Herbert Westin, Siemens' senior director of surgery and urology. "Our portable digital system is very small and compact, and because the weight is very low, you don't need to use special elevators and it's easy to move."

That's important, Westin says, because the portable X-ray systems can be used in an emergency situation, such as a hurricane, earthquake or flood, where people can't get to hospitals.

"When Hurricane Katrina happened, there was a need for emergency care, and many of the hospitals didn't have power, so you could bring in portable solutions for X-rays, such as the Mobilett XP Digital, which you could use with a generator to charge the batteries," he says. "You also don't have any issues with cables, so when it comes to positioning or cleaning, they won't get in the way."

Bill Lammers, director of radiology for Citizens Memorial Hospital in Bolivar, Mo., has spent the last year using Siemens' Mobilett XP digital.

"It's the best portable ever," Lammers says. "You go over and take your image and within 12 seconds you have your image in front of you. If you are doing trauma, you don't leave the room. I cannot tell you how much time it saves. Is it more expensive? Sure, but it's definitely worth it."

His one complaint? "I wish it had the same swivel tube stand as GE's AMX. But I would rather have this with the DR, than to not have it; we will never go back."

If one was to manufacture a patchwork portable X-ray unit that would be ideal, Ralph Frizzle, president of Largo, Fla.-based German Electronics, believes he knows the makeup of that perfect system.

"Develop a portable that is light, can roll easily on carpet, withstand banging into the elevator walls, does not use batteries, has a small tube head, flexible control arm, folds up for storage, and uses an infrared remote control console," he says. "These features exist individually in different makes and models but not all in any one model."

Changing with the times

Philips Healthcare currently offers the Practix Convenio battery powered portable X-ray system from the Practix family, which also includes the Practix 400, 300 and 160 models. Each system is compact and can take X-rays into some very small places. The Practix Convenio is cable-free and can run for several hours on a single battery.

Philips is in the midst of transforming its portable X-ray offerings from analog to digital, and expects to continue being one of the major players in the sector for years to come.

"We definitely have an evaluation going now from the analog to the DR world with our products. When we see the market move, we respond to the market needs and with movement going at a much faster pace, we are positioning ourselves to be in the DR portable environment," says Rich Fabian, vice president of X-ray North America for Philips. "Our first goal is to have something in the next trade show at the end of the year. If actions and desires come together, we will have something to talk about by then."

Greg Neukirch, national vice president of sales for general X-ray at Philips believes that the portable market is very healthy right now.

"It's one worthwhile investing in and providing resources to," he says. "The trend has been going on for a while. The flat plate detector is really the key piece. The quality, the speed, the efficiency, going in from that to a wireless component, to get the data back quicker to the radiologist."

Although he wouldn't reveal what their new products would look like, Neukirch did say that the company is investigating the benefits of wireless DR as opposed to other DR units and that Philips is very sensitive to the issue of cable versus non-cable and wireless capabilities.




According to Frank Serrao, marketing manager at Shimadzu Medical Systems, USA, wireless and detachable DR flat panels are attracting the main buzz in the radiology community today.

"Detachable DR panels are panels, which are tethered either to a mobile or a fixed unit, but can be disconnected and switched on the fly," he says. "For example, a full size 14" x 17" panel can be swapped out with a smaller pediatric DR panel without turning off the equipment and rebooting the system."

With wireless panels, data communication is either transmitted from the panel to the base (distance limited) wirelessly, or after images are taken, the panel is plugged into a base for both recharging and data dumping before its next use.

Shimadzu is currently focusing on higher power mobile units to allow for DR imaging to both geriatric and pediatric patients, in which breathing could be erratic.

"[Top priorities are] the integration of the new detachable and wireless DR panels, as well as end-user feature-friendly operations to make the systems as simple to operate in today's stressful imaging department environments," Serrao says. "We also continue to develop products and processes to help in the 'greening' of our world."

As of June, Rochester, N.Y.-based Carestream Health, Inc. has brought the mobile DRX-retrofit kit to the market, which lets health care providers upgrade selected mobile X-ray systems to wireless digital radiography machines.

"Customers are clamoring for this kit because it enables them to quickly and affordably convert CR-based portable X-ray systems to wireless DR. There's no more lugging CR cassettes to the processor and back to patients," says Eileen Heizyk, Carestream's worldwide marketing manager of digital capture solutions. "It allows them to move into digital radiography without having to make an entirely new purchase. It's a very economical way to upgrade to digital radiography."

This wireless DR system can help increase on-site productivity and deliver immediate access to images for improved patient care, particularly for critically ill patients in emergency rooms, operating rooms and the intensive care unit.

"There is a great deal of interest from the bigger hospitals that have more mobile units, but we have had an interest from smaller sites too, who really want to extend the life of the system they have," Heizyk says. "They will be in trauma centers, big ICUs, emergency rooms; there are no tethers or cords or wires, so it's in a better position to be in a sterile environment."

Currently, the kits are compatible with GE's AMX-4 and AMX-4 Plus, and Siemens' Mobilett Plus, Mobilett XP and Mobilett XP Hybrid.

"It works with GE and Siemens, which represents a large market share," Heizyk says. "Not only does it make imaging in the mobile environment easier, it allows you to use a detector in a room if you have the DRX system. It's really maximizing how much you can use it."

Money matters

Of course, when a health care facility is considering making the switch, it needs to factor in that it is moving from a system that is below $50,000 to one that will run greater than $200,000.

"Usually when customers work out the financials for digital, they make sense, at least at high-volume facilities," says Fabian. "When you consider the image quality and efficiency benefits...there is a desire and need for it. When you move your department to digital, you are married to it."

Although money does seem to be freeing up this year for many hospitals, after an 18-month capital freeze by many, some in the industry are concerned that it might not help the sector too much.




"One challenge is simply our customer prioritization of capital spending and where they are prioritizing," says Philips' Neukirch. "Funds may not be in the X-ray realm and that's a general concern we have."

Looking ahead

Another big reason why the switch to digital is important, according to Siemens' Westin, is that with President Obama's health care plan and the push for an integrated electronic records system, the images collected from the X-rays can be included.

In the next year or two, more OEMs will be introducing wireless capabilities for their portable units, but because they are still in their infancy right now, many experts feel that health care facilities should wait before purchasing them.




"The tethered receptor is still the way to go," said Sal Aidone, vice president of Deer Park, N.Y.-based Deccaid Services Inc., a diagnostic imaging sales and service company. "The wireless, because of the tremendous amount of data, has to be stored locally then uploaded through a connection. There's no real improvement in speed."

The wireless systems also need to have on-board power supplies, making the unit heavier and much more susceptible to damage if dropped.




The portable X-ray industry as a whole looks strong for the foreseeable future as the entire medical imaging sector has a lot going on.

"The medical imaging market is a unique sector that will never cease to grow, to develop and to constantly challenge both the manufactures as well as the users-physicians and technicians alike-to use the latest and greatest technologies in assisting mankind in its quest to stay healthy," Serrao says.

Keith Loria can be reached by e-mail at kloria@dotmed.com.

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DOTmed Registered Portable X-ray Equipment Sales & Service Companies
Names in boldface are Premium Listings.

Domestic
Dave Beam, Beam X-Ray, CA
Jaime Ramirez, Healthcare Imaging, Inc., CA
Veronica Alvarez, Vercarmed, CO
Fujifilm Medical Systems USA, Inc., CT
David Denholtz, Integrity Medical Systems, Inc., FL
DOTmed certified
DM100
Ralph Frizzle, GECO, FL
Keri Cox, Amber Diagnostics, FL
Larry Sprague, UMS, GA
DOTmed certified
Mike Bisch, Kentucky Special FX, KY
Davyn McGuire, Med Exchange International, Inc., MA
DOTmed certified
Philips Healthcare, MA
Chris Sharrock, Block Imaging International, Inc., MI
Steven Tunis, Unlimited X-Ray, MI
Joe Zaremba, Advanco Medical Systems, MO
Bob Burbury, Minxrad, MO
DOTmed certified
Ron Shaw, Triangle X-Ray Company, NC
Shanna Flanagan, DMS Health Technologies, ND
Neil Little, DMS Topline Medical, ND
Joseph Jenkins, International Imaging Ltd., NV
Marc Todd, Longevity, LLC, NY
DOTmed certified
DM100
Sal Aidone, Deccaid Services Inc., NY
DOTmed certified
Abdelrahim Khalil, Besisc, NY
Leon Gugel, Metropolis International, NY
DOTmed certified
Eileen Heizyk, Carestream Health, Inc., NY
Tim Austin, Austin's X-Ray Service, OH
Mary D. Lampley, J&M Trading, Inc., TN
DOTmed certified
DM100
Julie Poole, ReMedPar, TN
DM100
Courtney Lane, Innovative X-Ray Services, LLC, TX
Joseph A. Nelsen, JOJ-XRS, TX
DOTmed certified
Richard Fabian, Philips Healthcare, WA
Vito Ciparis, Mobile-CR LLC, WI

International
Hassan Karaki, M P I, Lebanon

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