On the angio side, the interventional radiology market was down slightly last year. However, interesting growth areas include a focus on interventional oncology, Lange said. "We are seeing new procedure codes [for reimbursement] coming out for that equipment."

Innovations such as improved diagnostics, image fusion of MR and CT, the growing use of CTA images, an increasing focus on vascular disease, the development of hybrid OR/interventional suites, and even moving the physical location of the cath lab closer to the ER are all trends that may help grow these equipment markets.


Aftermarket Options and Issues

With the choked capital markets today, some health care providers are turning to independent service organizations, pre-owned equipment, or field upgrades to save costs. New equipment in a fixed site hospital setting will run about one million dollars for either a single-plane cath lab or new angio suite. A refurbished suite costs in the $175,000 to $400,000 range installed with a warranty. Systems as recently manufactured as 2002-2006 are often available. With hospitals facing funding losses in the stock market and increasing pressures to serve the uninsured, used systems may become more attractive.

"Pre-owned systems are a very good way to save money in today's marketplace. Many systems that utilize flat panel technology are now available in the secondary market, so end users can get recent technology at affordable prices," said Bill Adkins, President, National X-Ray Corporation.

"When a facility is not financed, it will opt for a pre-owned unit instead of a new one," said Leon A. Gugel, Metropolis International LLC. He noted the significant technical expertise required of third-party providers but said that special procedures suites can be upgraded in the field by qualified companies.

"In a field refurbishment of installed equipment you go in and change the imaging system, do software upgrades, make sure the systems are working as designed," said Dan Wheeler, President, Transtate Equipment Company. "If there is degradation through usage or non-maintenance, we go in and reawaken the equipment and its capabilities."

The most effective upgrades involve changing out and upgrading the front end of the imaging chain and updating the software on the digital acquisition, with OEM support. These upgrades pertain to PACS/DICOM capabilities and remote import and retrieval of cases in a filmless environment. Some hospitals still hold on to their image intensifiers and upgrade those with a CCD camera and digital package as interim steps before equipping a fully digital room, sources tell DOTmed. (See our January 2009 report on X-ray tubes and image intensifiers, online at www.dotmed.com/magazine/archive.)

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