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Cranfield, UK, 14th June 2024 –
Signify Research’s latest General Radiography and Fluoroscopy market report, reported a minor revenue decline of -0.9% for digital radiography systems in 2023, with a return to growth of 6.5% forecast in 2024.
Healthcare facilities faced strong economic pressures globally in 2023, resulting in a shift in product preference from high-end digital radiography (DR) units to low- and mid-range systems. Inflationary pressures also led to subdued spending across many mature markets in 2023. Radiography system revenues were further hampered by the market decline in China, due to the anti-corruption investigations, which has resulted in postponed system purchases to 2024. The fulfilment of pent-up demand in China, in addition to increased demand for digitalisation in emerging markets and large DR tenders in Turkey and Italy, will contribute to a projected global revenue growth of 5.3% for digital radiography systems in 2024.
AI Unlocks New Use-cases for Radiography Equipment
Since the 2023 edition of Signify Research’s report, significant AI developments have occurred in the X-ray market. Examples include the commencement of AI-assisted lung cancer screening in Taiwan with Lunit’s CXR INSIGHT and the commercialisation of new radiography bone densitometry solutions from Ibex Innovations and 16 Bit in EMEA and North America, respectively. These AI developments facilitate new use cases for general radiography equipment and hold the potential to replace CT and DEXA for lung cancer or osteoporosis screening or pre-screening. Positive results from ongoing studies of X-ray in these applications could drive rapid proliferation of X-ray equipment. This is particularly true for implementing X-ray as a mobile, low-budget alternative to CT scans for lung cancer screening in low-income countries and rural populations.
Trials have also begun for the application of KA Imaging’s single-exposure dual-energy technology in Taiwan’s lung cancer screening programme, which enables the differentiation of soft and hard tissue. KA Imaging also entered a partnership with UMG/DEL Medical to bring two dual-energy capable mobile DR systems to market in the USA and Canada. Currently, the technology comes with a high-price premium, which limits its adoption. However, it is gaining momentum, highlighted by Neusoft’s recent announcement of the development of the NeuVision 560M and 580M mobile DR systems with spectral functionalities.
North America
Despite market saturation, demand for DR equipment is further driven by the construction of new outpatient facilities, which often opt for floor-mounted systems due to their cost-effectiveness, convenient installation, and sizing. Additionally, a replacement year running from 2025 to 2027 will drive the purchase of fixed DR systems in the US. This is due to a change in reimbursement in 2016, which drove a market shift from analogue to digital solutions. Systems installed at that time are now approaching end-of-life and will require replacement.
The market for table-side fluoroscopy solutions in the US also continues to outsell remote configurations but the latter is gradually outgrowing classic solutions as younger radiologists enter the workforce. However, remote fluoroscopy remains the incumbent solution in Canada except for in paediatric applications.
Latin America
Chinese vendors are continuing to expand their market share in Latin America, especially for retrofit kits, where they employ aggressive pricing strategies outside of public procurement frameworks which can exclude them. This is further accelerating the decline of computed radiography equipment.
Asian competition represents a challenge for local manufacturers. However, public tenders and high importation fees in markets like Brazil both favour domestic manufacturers. These vendors are also strongly positioned to succeed in the market for mobile and fixed DR systems in the coming years as the region digitalises and transitions away from analogue technology.
Western Europe
Growth for general radiography systems in Western Europe in 2023 was driven by new tenders assisted by NextGenerationEU funding. This is continuing to drive growth in 2024 with initiatives announced in countries such as Spain and Italy. The Italian CONSIP tender includes:
- €39.7m in funding for up to 280 ceiling-suspended DR systems with tomosynthesis
- €80.7 in funding for up to 425 remote fluoroscopy systems
Local manufacturers such as DMS-Imaging, GMM and Stephanix provide strong price competition for imported brands. However Asian vendors like Wandong Medical have persevered and increased their presence in public procurement frameworks in countries such as the UK and Italy by undercutting prices further.
Eastern Europe, the Middle East and Africa
NextGenerationEU driven spending is most prevalent in Eastern Europe, particularly Poland where it was “unfrozen” in 2023, resulting in significant growth in DR systems. Conversely, EU funding remains withheld from Hungary due to political discourse between the two. If differences are resolved, funding will become a potential growth vector for the near-term, driving the purchase of new DR equipment, as seen with other Eastern European recipients of NextGenerationEU funding in recent years.
The Middle East and Africa also contributed to strong growth in 2023 and is projected to continue in 2024. The Ministries of Health in Oman and Saudi Arabia have both released tenders and Public Private Partnerships, while the Turkish Ministry of Health procured 50 ceiling-suspended DR systems from Chinese DR vendor Lanmage in 2023.
Asia Pacific
Demand for radiography and fluoroscopy systems was subdued in 2023 because of the end of the Japanese subsidiary budget, and the postponement of system purchases in China due to the anti-corruption campaign. This has primed the APAC region for the fastest revenue growth in general radiography equipment over the 5-year forecast. However, domestic competition remains a barrier for imported brands in these markets.
Asian competition
Asian manufacturers made significant strides in 2023 in public procurement in Turkey, Italy and the UK. Beijing Wandong participated in the Italian CONSIP tender via an Italian distributor and is also now a listed vendor for supplying the NHS with digital radiography equipment alongside vendors like DRGEM, Mindray and Perlove.
The negative downturn in the Chinese general radiography and fluoroscopy markets also presented little difficulty for vendors like United Imaging and Beijing Wandong, who both continued to grow their global revenue market shares in 2023 for general radiography equipment. Fujifilm also maintained its market position at number three in 2023 for global general radiography equipment in terms of revenues. This was due to its strong offering of multimodal solutions since acquiring Hitachi Medical Systems in 2021. Fujifilm also announced the release of three new radiography systems and a fluoroscopy system at RSNA 2023 for the US market, highlighting its eagerness to further penetrate the US.
Indian vendors like Allengers, BPL and Trivitron also benefit from several domestic initiatives, which streamline production and minimise costs, partly through shared facilities in medical device parks. Paired with technology deals in Korea to source cheap FPDs, Indian vendors are expected to increase their presence both domestically and internationally in the mid-term.
Future market outlook
As inflation eases, the demand for high-end DR systems is expected to increase and digitalisation in emerging markets will drive demand in the low-end and mid-range value segments for DR solutions. For fluoroscopy systems, demand is flat in mature markets due to stagnant procedure volumes. Meanwhile, high costs and inflationary pressures have led emerging markets to prioritise spending elsewhere in the near term.
Due to restricted budgets in emerging markets, many providers continued to purchase analogue solutions and retrofit kits. However, demand has peaked resulting in a projected year-on-year decline through to 2028 in terms of total revenue. Individual markets such as Africa and India will see positive revenue growth through to 2028 for retrofit solutions while computed radiography revenues are projected to decline through to 2028 across all markets. Overall, digital radiography systems are responsible for most future growth in the general radiography and fluoroscopy market.
In the long-term, the X-ray market is projected to consolidate as price pressure and homogenisation of product offerings increase between X-ray vendors without multimodal capabilities, as seen with DMS-Imaging’s acquisition of Solutions for Tomorrow.
Related Research
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About The Author
Max Street – Having graduated from the University of Bristol with a BSc in Pharmacology, Max joined the Medical Imaging team at Signify Research in 2023, focusing on the X-ray market.
About the Medical Imaging Team
Signify Research’s Medical Imaging team formulates expert market intelligence for some of the leading Ultrasound, CT, MRI, and X-ray vendors. Combining primary data collection and in-depth discussions with industry stakeholders, our thorough research approach yields credible quantitative and qualitative analysis, helping our customers make critical business decisions with confidence. Furthermore, our commitment to seeking a plurality of perspectives across the markets we cover guarantees that our insights remain independent and balanced.
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