Revenue growth for fixed General Radiography and Fluoroscopy is set to reach 10% and 8% respectively in 2021

Published 09/12/2021

The fixed digital radiography market is expected to grow at 10% year-on-year in 2021, reaching $1.1 billion, whilst the fluoroscopy market will also experience good levels of growth at 8%, closing 2021 at $463.2 million. These figures, taken from Signify Research’s General Radiography & Fluoroscopy – World 2021 report, show an encouraging rebound after a challenging 2020, during the COVID-19 pandemic.

Demand to switch from mobile to fixed radiography in 2021

The general radiography market grew by 12% in 2020, due to the exceptional demand for mobile radiography systems. The world market for mobile radiography systems is estimated to have increased by an impressive 77% year-on-year.

Mobile digital radiography (DR) systems are at the forefront in providing initial screening for pneumonia, a secondary and more progressive stage of COVID-19 in severe cases. Mobile DR systems are also used to track progression of pneumonia due to the capabilities of bedside imaging, enabling their use in emergency rooms, A&E facilities and in the ICU. During the peaks of the pandemic, hospitals and healthcare facilities around the world were desperately attempting to procure mobile radiography systems to supplement existing inventory in the face of supply shortages at most of the leading vendors.

As healthcare facilities rapidly sought out mobile systems, often discarding brand loyalty for whatever systems were available, budgets were diverted away from fixed radiography systems and fluoroscopy systems. The fixed digital radiography (DR) market declined by 14% year-on-year in 2020. In unit terms, 11% fewer fixed DR systems were sold in 2020. As the pandemic begins to subside, and healthcare budgets gradually return, investment in the fixed general radiography market is projected to return to pre-pandemic levels by the end of 2021.

On the contrary, the global market for mobile radiography systems is projected to see a sharp decline of 39% in 2021. With most hospitals and health clinics having recently purchased mobile radiography systems during the pandemic, the inflated installed base will restrict the need for new systems in the coming years. The market is forecast to return to growth in 2023, driven by the replacement of older analogue systems.

Stronger growth forecast in multi-purpose fluoroscopy

The fluoroscopy market experienced a challenging year in 2020. With fluoroscopy budgets diverted to COVID-19 response, alongside fewer fluoroscopy procedures, the market saw a 19% decline in revenue. Clinical demand is shifting away from fluoroscopy to CT and endoscopy, further threatening this market. The main procedures that remain a stronghold for fluoroscopy include barium-swallow scans and upper GI procedures. Stronger growth is forecast for multi-purpose systems which can perform both radiography and fluoroscopy, due to wider clinical usage and associated higher return on investment. After the steep decline in 2020, the fluoroscopy market is expected to gradually recover and surpass 2019 revenue levels by 2024.

Key trends by region

North America

  • Unlike most other world regions, North America and in particular the United States, remains a classical fluoroscopy market, with far lower uptake of remote imaging, due to the associated detachment from the patient and concerns of jeopardising image quality and subsequent litigation.
  • Brand loyalty continues to be strong for general radiography equipment, to prevent retraining and adjustment of workflows.

Latin America

  • Demand for analogue and CR systems remains high in Latin America, with the lower prices being a key deciding factor. In Brazil it is estimated that 85% of general radiography exams are still conducted on analogue systems, a far higher number than many other emerging countries. However, with falling prices of flat panel detectors, digitalisation is expected to gather pace in the coming years.
  • Fluoroscopy remains a small market in Latin America due to the relatively high system prices yet lower utilisation due to the niche clinical applications they address. The shortage of trained radiographers is also holding back the fluoroscopy market.

Western Europe

  • The general radiography market in Western Europe continues to remain focused in the higher end market segment, especially floor-mounted systems.
  • Fluoroscopy continues to be a very small market in most Western European countries, with France being the exception, where the market for remote systems is forecast to increase over the coming years. France is unique in that hospitals use fluoroscopy for patient positioning and to localize where to start imaging, and this modality is therefore used frequently. Additionally, there is a strong replacement market and older systems are typically replaced like-for-like and not with a multi-purpose system. Most other Western European countries have much less uptake of dedicated fluoroscopy equipment.

Eastern Europe, Middle East and Africa

  • Lower-cost analogue solutions continue to sell well in the African general radiography market. In Eastern Europe there remains a focus on floor-mounted digital X-ray solutions, as the lower price point is a key factor in this price-sensitive market.
  • French speaking parts of North Africa still have a strong demand for fluoroscopy systems, following France in this trend. Elsewhere, demand remains lower.

Asia Pacific

  • The fluoroscopy market is largest in China and Japan, with all other Asian countries having very limited uptake, as other modalities are favoured for traditional fluoroscopy procedures.
  • Lower cost floor-mounted systems continue to dominate the general radiography market, especially in China.

Competitive analysis

In 2020, Carestream consolidated its position as mobile DR market leader, followed by GE Healthcare, Siemens Healthineers, Philips and Fujifilm.

Siemens Healthineers and GE Healthcare secured the position of joint market leaders in the fixed DR market, with GE Healthcare gaining significant share in 2020.

Siemens Healthineers was the world market leader for fluoroscopy in 2020, with Shimadzu, Canon Medical and Philips following.

Future outlook

The fixed DR market will rebound in 2021, as budgets and investment will return to fixed radiography rooms. Signify Research forecasts investment will gradually return for high-end DR solutions, such as ceiling suspended and multi detector systems from 2021 onwards. Growth in the low-end fixed DR market is forecast to primarily come from emerging regions, such as Africa, Latin America and Asia, where there is a significant installed base of analogue radiography and computed radiography ready for digitalisation. Growth in the fluoroscopy market will be limited as clinical procedures move from fluoroscopy to CT or endoscopy. As a result of increased focus on cost-efficient solutions and return on investment, most of the demand for fluoroscopy equipment will be captured by multi-purpose systems capable of performing general radiography procedures.

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