Philips Practix Convenio

DOTmed Industry Sector Report: Portable X-ray

August 13, 2009
by Joan Trombetti, Writer
This report originally appeared in the July 2009 issue of DOTmed Business News

Portable X-ray equipment travels anywhere and everywhere in and outside of hospitals, clinics, veterinary offices, coroner and dental offices, nursing homes and even on battlefields. The units range from handheld to slightly larger, yet still easy to carry, box-like units that can be transported in the back of a van and even to stand alone units that are wheeled from one place to another in a hospital.

Digital Imaging is the latest and greatest in portable X-ray equipment

Probably the most exciting advancement in portable X-ray technology is the transition to DR (digital radiography). However, the transition has been slowed by the weakened economy. In terms of spending on equipment, portable X-rays aren't usually a top priority. Many facilities want to convert, but are making due with their current systems during the economic downturn - keeping them on-board with proper maintenance, or refurbishing when necessary.

The consensus from companies dealing with new and refurbished portable X-ray equipment is that DR technology is superior to conventional film-based systems or CR (computed radiology). The DR systems are much faster and present what many feel to be clearer images than the older methods.

A GE AMX 4 partially
disassembled for service
at Managed Medical Imaging



Leon Gugel, President of Metropolis International, LCC, sees cost as a major factor prohibiting many health care facilities from transitioning into DR portable X-ray imaging. "In terms of technology, GE and some small independent companies have come up with digital portables that are great," says Gugel. "But their cost is still too high for almost everyone, except for the largest health care institutions." A new portable digital X-ray machine can cost over $200K.

Sal Aidone, Vice President of Deccaid Services, Inc., Deer Park, NY agrees with Gugel. "I believe the portable X-ray industry is stable, because bedside X-rays will always be needed." He says that the possible increase in sales for the future will someday be in digital portables. There is a positive side. "The DR panel can keep a portable in constant use, especially if the hospital has a WiFi system, where the images can be sent from anywhere in the hospital," Aidone says. This eliminates the need for a technician to return to develop the X-ray, or manually transport it from one location to another. Aidone believes that if digital portable X-ray prices fall - there will certainly be a boom for the industry as many facilities are likely waiting to jump onto the digital bandwagon.

Siemens offers two different portable X-ray systems in the U.S., the Mobilett XP Hybrid, which uses analog filmcassettes, 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 company used to offer a CR system, says Senior Director of Surgery and Urology Herbert Westin, but many of their customers already had CR equipment and wanted to either stay with film or upgrade to digital. Westin says that although portable X-ray sales are down for the company, there is room for growth, as only about 10-15% of the total market for portable X-ray has gone digital, from large hospitals down to smaller clinics.

Virtual Imaging's RadPRO
40kW High Frequency Digital
Mobile X-Ray System



Others believe facilities will save money in the long run by converting to digital. According to Ed Ruth, Account Manager for Managed Medical Imaging, LLC, some of his clients who have converted report increases of about 20% to 30% in meeting the imaging needs of their patients. And, he says that his clients are very happy with the image quality they receive. "I certainly don't hear many negatives about DR," says Ruth. "About the only negative other than cost that we've encountered is some technicians find it hard to move the heavy plate. But they love how the instant images give them the ability to reposition patients and retake images as needed."

Another supporter of DR technology is Kelly Phipps, Service Sales Specialist, Core Medical Imaging. "Portable X-ray is a stable, yet changing industry," says Phipps. The big change is the conversion to portable DR. Phipps says that portable DR enables significant increases in FTE efficiency and enhanced patient care, including a lower radiation dose, which seems to be on everyone's mind in the medical community - especially when it comes to treating children.

Phipps believes that the economy is having an impact on the health care industry's conversion to portable DR, but "in reality, there are multiple factors affecting this conversion." He believes that the first factor is the ability of the facility to understand the significant improvements to both its bottom line and patient care, which can be realized by converting to true portable DR. "Once this is understood, it is up to the institution to rank the urgency of converting to portable DR. All too often, managers don't understand how significant the improvement is for both short and long term objectives, because if they did, they would make every effort to place the portable DR/upgrades at the top of their list."

Wayde Keeling, President of Lone Star X-Ray Services, describes the portable X-ray market as stable because all health care facilities need one. He believes, "customers need to realize that the older portables are being classified by the OEM as obsolete and they need to upgrade to spend their money wisely." Keeling says DR plates and displays are expensive but, "although the price is quite high, many customers opt to keep their CR plates for mobile exams for now and are planning to someday covert to the DR plate." Keeling offers preventive maintenance and battery replacements most commonly and deals with GE equipment most frequently.

A Shimadzu Evolution/ CXDI-50C
at Evergreen Healthcare's
NICU provides the physician
with 2 critical views
in under 4 minutes.
(Image courtesy of Core
Medical Imaging)



"Portable X-ray, in my opinion is on the rise because of DR technology," says David Voegtlin, President of Diagnostic Excellence. DR technology allows mobile acquisition of images without moving the patient from their room or the OR with little difference in image quality from those on stationary systems. The use of DR in conjunction with portable X-ray dramatically cuts the time that it takes to obtain images and have them available for review by a radiologist or specialist. "DR technology provides improvement in patient care and a reduction in the time spent by radiology technologists in performing these procedures," says Voegtlin.

Portable X-rays - most used and most abused

Phipps says portables are the workhorses in any imaging department. Yet, they don't get the respect other equipment receives. The challenge is to try and train radiology technologists to respect the fundamental changes inherent with the new high-end DR portables like those equipped with Canon CXDI-50 and CXDI-60 detectors, as well as WiFi to send images to PACS via the facilities wireless network, for example. Phipps says that common service to portable X-ray equipment includes preventative maintenance and mechanical repairs, which are a result of their "challenging work environment."

Matt Horne, President of Imaging Tech Co, Ltd, sees the portable X-ray industry as a stable market as far as the number of units in service. "The market is stable because hospitals are buying new and refurbished portables at about the same pace as in previous years and portables are an essential piece of equipment for any radiology department's day-to-day operations," says Horne. "Due to the mobile nature of the machines, service problems vary widely from mechanical to electronic to a combination of both. There is nothing that would be considered a common problem when it comes to portable X-ray machines." His biggest challenge is finding facilities that do not have in-house service providers. When it comes to DR portable X-ray equipment, Horne believes the technology needs to improve and the cost needs to come down to make digital a viable improvement on a portable. "I feel digital technology on a portable is overkill and asking for expensive trouble," says Horne. "A portable experiences very rough treatment in its daily use and to put a system costing in excess of $100K is a poor use of resources, because for the same price, a facility could put a CR reader on every single floor." Typically a CR system runs about $30K to $75K, depending on the vendor.

Kenneth Saltrick, President of Engineering Services, Twinsburg, OH sees the used equipment and parts market required to refurbish portable X-ray machines definitely on the rise and sees quality versus cost as the biggest challenge. Saltrick limits his services to the repair of Interconnect cables for the 9400/9600/9800/9900 C-arms for GE. "The machines are selling strong and due to the workmanship, none have come back to us once we work on the cables," says Saltrick. "Most of our sales are to distributors, or third party parts supply networks. We have a hospital following that we deal with directly."

Weighing just 5.5 pounds, the
Aribex NOMAD Pro Handheld
X-ray can go anywhere, in
or out of the office.



President of JCF Engineering, Inc., Stephanie Espinola agrees and says that the service costs of maintaining portables are a challenge because "they are subject to extensive abuse by technicians and smaller problems are not always reported." She finds her company is constantly replacing cable and hand switches, addressing mechanical failures and attempting to undo harm done by technicians/supervisors attempting to repair equipment themselves using the wrong hardware and repair techniques. JFC has even designed a Van Lift that they sell to local mobile imaging companies in order to try to prevent damage to portable X-ray machines in transit. It is mounted on six shipboard machinery mounts to prevent damage to the electronics. The ram slides out to unload, flips up and the X-ray machine is winched down to the ground. "The most common damage to an X-ray machine is caused by winching the machine up too far, breaking off the yellow 'stops,'" says Espinola. "Amazingly, we have problems with technicians breaking this piece of equipment as well."

For those who have not converted because of the economy, regular preventive maintenance is all the more important. When a machine is wheeled to a neonatal intensive care unit or to the Emergency Room it has to work. By nature alone, portable X-rays are tough and withstand the rigors of usage in the day-to-day health care facility worlds. "Portable units like the AMX-4 are workhorse systems that can last for a long time if maintained correctly," says Carlos Cooper, Regional Manager for Managed Medical Imaging. He says that the most common cause of downtime with an AMX-4 is related to the charging system. "When technicians do not correctly charge a unit, they are slowly causing damage to the parts related to the charging system," says Cooper. Battery life shortens and charging circuits go bad. When the system is not properly charged, calibration settings can become inaccurate in the RAM memory causing inaccurate output of Kvp/Ma (Mas) settings, which results in poor image quality. Regular preventive maintenance can ensure that these problems are addressed before they grow.

Popular because they really can go anywhere

If a patient can't get to an X-ray machine, the portable X-ray machine can get to the patient, making it a very popular piece of medical equipment in settings in and outside of hospitals.

Portable X-ray machines are used on battlefields, in rural communities where health care facilities are few and far between, nursing homes, prisons and morgues.

Philips Healthcare offers the Practix Convenio battery powered portable X-ray system from the Practix family. These machines are compact and can take X-rays into very small places. The Practix Convenio is cable-free and can run for several hours on a single battery. Scott Burkhart, Vice-President, General X-ray and Surgery, Philips Healthcare says, "With computed radiography technology, staff and patients get all the benefits of a digital workflow." Burkhart says that Philips is working with various health care facilities to determine ways to install completely wireless DR portable X-ray systems. "It's a lot of research dealing with evolving technology," says Burkhart. "But we'll get it done."

Bob Burbury, Digital X-ray Engineer at Central X-ray, sells and services portables and installs CR systems in cars and vans. "Many people use the term 'portable' for all X-ray systems that have wheels that move around room to room. Large mobile X-ray machines used in hospitals are not easy to carry into nursing homes, morgues, prisons, etc. My business focuses on small lightweight portables like MinXray, Sterne and SourceRay, etc." Burbury says that these units can be driven around in the back of cars or vans and this market uses digital imaging equipment (mostly CR) to scan and process images. "Portable providers in my area are converting to digital from film technology, thus reducing read time, travel times and miles driven," says Burbury. He says that the learning curve varies from user to user from working and viewing images on laptop computers to actually learning how to work from inside the vehicle, to scanning, viewing and sending images wirelessly. Burbury believes that as the wireless imaging market continues to advance, the portable X-ray market will find many more applications.

Handheld Portables

Aribex, Inc. of Orem, UT offers the NOMAD line of handheld X-ray systems. These systems are used in dental and veterinary offices and for forensic identification. "Handheld X-rays can easily serve multiple operatories as well as out-of-office situations," says Steve Dawson, Marketing Manager of Aribex. They are also used in dental surgical suites, which rarely have conventional X-ray equipment. Dawson says that cordless, battery-powered, handheld X-ray devices have not only revolutionized the dental office, but have proven to be of incredible value in access-to-care situations. Because of their lightweight and ease of transport, they can go places wallmounted X-rays obviously could never go to help patients who were previously denied access to care. Dawson says that one of the biggest challenges his company has faced has been "the pioneering effort of introducing the new category of handheld X-ray with federal and state regulatory agencies." But with the latest research supporting the safety of their product, the enthusiasm of X-ray professionals who have purchased more than 3500 units and the clearance for handheld X-ray use in 41 states, the NOMAD has now been established in the industry.

All in all, it is an exciting time in the portable X-ray world. Will the need for speed send the CR portables packing to be replaced by DR systems? It looks like the answer may still be up in the air, but it seems like CR portables will be around for a while.



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

Domestic
Stephanie Espinola, JCF Engineering, Inc., CO
David Denholtz, Integrity Medical Systems, Inc., FL
DOTmed Certified/100
Jorge Fernandez, ABC Med, Inc., FL
Robert Serros, Jr., Amber Diagnostics, FL
Ed Ruth, Managed Medical Imaging, FL
Maggie O'Mahoney, Mobile X-Ray Solutions, GA
DOTmed Certified
Matt Horne, Imaging Technologies Co., Ltd., IL
Asif Bhinder, tekyard, MN
Brian Kinn, Twin Ports Imaging, Inc., MN
Joe Zaremba, Advanco Medical Systems, MO
Robert Burbury, Central X-Ray Corp., MO
DOTmed Certified
Christi Kukes, DMS Health Technologies, ND
Robert Manetta, Nationwide Imaging Services, Inc., NJ
DOTmed Certified/100
Sal Aidone, Deccaid Services, Inc., NY
DOTmed Certified
Leon Gugel, Metropolis International, NY
DOTmed Certified/100
Moshe Alkalay, Hi Tech International Group, Inc., NY
DOTmed Certified
John Kollegger, Bay Shore Medical, LLC, NY
DOTmed 100
John Patti, NCD Medical Corporation, OH
Kenneth Saltrick, Engineering Services, OH
DOTmed Certified
Mike Baxter, One Call Medical Imaging LLC, PA
David Wingo, Radiology Equipment Partners, TN
Wayde Keeling, Lone Star X-Ray Services, TX
David Voegtlin, Diagnostic Excellence, TX
Joseph Nelsen, JOJ-XRS, TX
DOTmed Certified
Max Kras, CED /PORTABLE X-RAY DEPOT, TX
Steve Dawson, Aribex, Inc., UT
Kelly Phipps, Core Medical Imaging, WA

International
David Lapenat, ANDA Medical, Inc., Canada
DOTmed Certified/100
Ahmed Fawzy, East Connection Ltd., Egypt