The X factor – the diagnostic X-ray market

Early diagnosis of disease is the foundation for increasing survival rates. Diagnostic X-ray is the most widely used technique for achieving early detection and clinical assessment of adult and paediatric patients, making it a cornerstone of sickness control.

Previously, slow economic growth has hindered the growth of the diagnostic X-ray market. However, with the increasing prevalence of diseases, an aging population and the demand for better healthcare, even in remote areas, there has been an increased need for this essential component of radiology. GlobalData estimates that the global diagnostic X-ray imaging market, worth $2.4 billion in 2012, will reach almost $4.0 billion by 2020, increasing at a compound annual growth rate (CAGR) of 6.7% during the forecast period. The key drivers for increased revenue in the global diagnostic X-ray imaging market are:

• rising prevalence of diseases diagnosed with X-ray systems and an increasing aging population
• increased demand for cost-effective and quality healthcare
• implementation of picture archiving and communication systems/radiology information systems (PACS/RIS) worldwide
• increased patient awareness regarding excessive radiation exposure associated with computed tomography (CT) imaging
• implementation of digital tomosynthesis (DT) to reduce costs and exposure to ionising radiation compared with advanced imaging technologies
• monitoring applications of diagnostic X-ray imaging
• digital mobile radiography systems
• steady reimbursement and other government funding.

Meanwhile, the key barriers in the global diagnostic X-ray imaging market are:

• a growing gap between the supply of and demand for radiologists
• advanced imaging modalities, which inhibit the growth of X-ray imaging
• lack of enthusiasm surrounding X-ray imaging and shrinking radiology training
• decreased monetary incentive to use X-ray imaging over other more expensive modalities
• increasing prevalence of lifestyle-related diseases
• reduced hospital budgets
• trends in hospital consolidation
• the impact of the medical device excise tax.

The X-ray imaging market is a moderately growing field with a CAGR of 6.9% globally. It is a mature sector of the diagnostic imaging market, and its growth is primarily attributable to the emerging economies.

China doubles up

China will continue to provide immense opportunities for increasing sales within the global market as revenue rises from $527.9 million in 2012 at a CAGR of 9.6% to hit the billion-dollar mark in 2020. According to GlobalData's estimates, the Chinese market accounted for 22.2% of the global revenue in diagnostic X-ray imaging in 2012; this share is estimated to increase to 27.6% by 2020, seeing maximum growth.

Growth in sales in China will be attributable to the transition from analogue X-ray systems to digital X-ray systems in the country, as well as to increased sales of systems, as the nation implements healthcare reform and strives to improve healthcare access across the country, from urban to rural regions.

With increasing household incomes and a demand for better-quality healthcare, China will also see a rise in the use of X-ray imaging procedures, as the technique is deemed a basic, cost-effective and user-friendly tool of radiology. This is supplemented by the fact that the country has the largest patient population in the world, and diagnostic imaging procedures are a fundamental part of healthcare practice.

Future outlook

The global economic slowdown has only partially affected the diagnostic imaging market, as these systems are less capital-intensive than other modalities. However, since the market has matured, its growth in markets such as the US and the European Union (EU) has been limited by saturation.

#The market growth for X-ray imaging in the US and EU is heavily dependent on the replacement of existing systems because, as is the case in most of the developed countries, the capacity for new installations is restricted. As the US and EU economies recover, it can be expected that the equipment will be replaced. However, key opinion leaders (KOLs) interviewed by GlobalData (see 'What do physicians think?', opposite) indicated that not all equipment is replaced at the end of the average product lifecycle, which harms sales in the US and EU.

The rising prevalence of disease, and an aging and increasing global population will encourage increased use of diagnostic X-ray imaging. In addition, cost-containment measures implemented by healthcare authorities will favour diagnostic X-rays over the other, more expensive techniques, such as magnetic resonance imaging (MRI) and CT.

What do physicians think?

In terms of technological development, it is generally agreed among KOLs that diagnostic X-ray imaging has reached a plateau, and no major breakthroughs in the field have been made for a long time. However, enthusiasm was expressed for mobile digital radiography. "There is quite a lot of development going on in mobile units, and that will change quite drastically, I think, into the next decade," opined one interviewee for this article. The KOLs also believed that their comparatively inexpensive nature will ensure that X-ray imaging procedures will continue to be performed at all levels of hospitals and clinics and was, in that context, an irreplaceable diagnostic tool.

The KOLs also indicated that the lack of enthusiasm surrounding X-ray imaging - as opposed to more advanced techniques, such as MRI and CT - was unfavourable, and might negatively affect the use of this method in the future.

The editor-in-chief of a radiological journal said that the lack of manuscripts from conventional radiography currently being submitted was due to a lack of interest in the discipline. "Nobody's doing a research paper on X-ray imaging," he said. "Everyone likes alluring modalities like the CTs and MRIs, but from a technical perspective, the hardest thing to read is an X-ray."

KOLs highlighted that the use of X-ray imaging had seen a marked decline since the advent of more advanced imaging modalities, and predicted that this trend would continue. "A plain X-ray is just a two-dimensional structure," said one. "We are all 3D; plain X-ray just gives you a flat image. CT scans let you look at inside of the body, as opposed to just a flat situation. We have cut back [the use of plain X-rays] at least by two thirds and do CTs instead and then, if anyone wants to look at clavicles, we reconstruct the clavicles."