The procedure was recently brought under scrutiny after a study suggested that patient relief after treatment was similar to placebo.

"I've talked to people who have had it done and they swear by it," says Fabian. "The physicians also do, but that study just came out and it's very controversial."


Ongoing transition to flat detectors

On the technology front, there has been major transition from analog systems to flat detectors, and even wireless technologies.

The average cath angio lab has a life cycle of about seven to 10 years. The first adopters of digital technology acquired that technology in the early 2000s. As the replacement cycle arrives, many project a jumpstart of new lab sales.

"This industry has changed significantly over the last few years and more and more of the technology is going toward digital - in the used systems, as well," says Dan Wheeler, president of Transtate, a North Carolina-based company specializing in refurbished cath angio systems. "We are generating fluouro to image coronaries and other vascular features and the move to digital has allowed for better image quality, better analysis, better database storage and communication across technologies. The only downside is that digital detectors are more costly to maintain."

"Most of the market reports are looking positive on lab replacements," says Moccia. "There is a lot of image-intensifier based technology out there, and all of those labs are going to be looking at upgrading."

Integrated ultrasound and electromagnetic tracking

Ultrasound is not an absolute given in the cath angio lab, but this modality can provide unique information about vasculature without the radiation dose required in other procedures. Manufacturers have taken note of this and are beginning to offer integrated ultrasound systems.

"It is less common to have an ultrasound in an angio suite," says Fabian. "Physicians will wheel in a normal ultrasound to do procedures, but having an integrated ultrasound really allows them more flexibility and access around the patient without having to tie up a big chunk of real estate."

Others are more adamant about ultrasound's place in the cath angio lab, says Dewey. "Ultrasound is very important because it doesn't involve any ionizing radiation, and what we often see is the use of ultrasound in conjunction with electrophysiology."

Electromagnetic tracking systems are also getting more attention. These have the capacity to track procedures using a range of instruments, and these technologies have the know- how to work with all the modalities used in this space, including ultrasound.

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