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Signify Premium Insight: Blurring Boundaries: CT, X-Ray and KA Imaging

This Insight is part of your subscription to Signify Premium Insights – Medical ImagingThis content is only available to individuals with an active account for this paid-for service and is the copyright of Signify Research. Content cannot be shared or distributed to non-subscribers or other third parties without express written consent from Signify ResearchTo view other recent Premium Insights that are part of the service please click here.

Canadian X-ray detector manufacturer KA Imaging recently announced that it is investing almost $1.5m in the development of what it claims is the world’s first dual-energy mobile X-ray system.

The move marks a shift for the vendor, which has hitherto only produced flat panel detectors for medical applications. As such, the new system will utilise its own Reveal 35C dual-energy X-ray detector. This will enable the system to create three images in a single exposure. As well as a standard X-ray, a soft tissue image without bone, and a bone image without soft tissue are also captured simultaneously.

KA Imaging says the device expands on the diagnostic capability of X-ray, and will be most useful in cases where critical patients cannot be moved to traditional imaging rooms, or in rural or remote communities where access to fixed X-ray systems, CT scanners and MR systems is limited.

The Signify View

The volume of diagnostic medical imaging procedures is, and is set to continue, rising. Signify’s Diagnostic Imaging Procedure Volume Database showed growth in both CT and X-ray imaging, with the growth in CT outstripping that of X-ray, this is true in North America, where X-ray procedure volumes are forecast to grow at just 0.6% CAGR between 2019 and 2025 compared to 2.7% for CT.

This difference in growth masks a burgeoning trend which sees an increasing convergence between high end X-ray imaging and lower end CT. This is evident in both directions, with value-oriented CT systems being chosen over high-end X-ray systems in some cases, while high end X-ray systems are, in some cases, also beginning to bridge the gap in capability to low end CT. KA Imaging’s dual energy mobile system is indicative of this convergence, promising to offer improved image quality compared to traditional digital radiography (DR), at a lower radiation dose than CT, and requiring less technical expertise.

The lower infrastructure requirements of X-ray systems compared to CT systems means that they are, in some respects, more versatile, easier to install and can be deployed across a greater range of clinical settings. This versatility has also been one of the focuses of KA, which for its first foray into device manufacture, decided on a mobile system. This is a sensible decision. One of the developing trends in medical imaging is an increasing shift toward outpatient sites. These sites could benefit from higher image quality than a traditional DR system affords. Such fidelity could allow these centres to improve their diagnostic precision and promote the use of the more sophisticated modality as a differentiator from their local competition. However, the cost, infrastructure, and expertise required to purchase and operate CT could be prohibitive, leaving these centres to instead utilise devices effectively occupying a middle ground such as that promoted by KA.

System Builder

The fact that KA Imaging has sought to make a device at all is also significant. The vendor’s mobile X-ray system is reliant on its previously released Reveal 35C X-ray detector, a category that, for medical applications at least, the vendor is better known. Its decision to release a system, instead of merely relying on the detector itself, raises questions as to the traction the detector has so far received in the market. The vendor’s decision to launch a system could therefore represent a bid by KA Imaging to promote its dual energy technology directly to the providers and physicians that will utilise it, rather than being beholden to large medical imaging vendors who must first select KA’s dual-energy detector for use in their systems, before themselves selling it on to the end users. KA Imaging’s strategy has also been to sell directly to end users, and the decision to create an end-to-end dual energy mobile DR solution was primarily driven by feedback from end users.

This is unlikely to be a long-term strategy for KA Imaging, which will instead use the device to increase awareness of its detector technology and demonstrate its benefits in a clinical setting. This, KA will hope, will be enough to convince the likes of GE Healthcare, Philips and Siemens Healthineers to use KA’s detectors to adopt the technology in their own systems. However, this will mean the dual energy mobile DR system will also be in competition with KA Imaging’s OEM customers. Longer-term, KA Imaging could struggle to compete with larger medical imaging vendors, given their advantages in scale, medical device manufacturing, and established supply networks and sales channels. However, producing a system in the near term, selling to several, well-heeled and influential customers, could help promote the vendor’s dual-energy detector.

The Cost of KA

These first customers, who must be willing to pay the significant premium the dual energy technology demands compared to traditional X-ray systems, could find benefit in some of the advantages in image quality and usability that the system offers compared to X-ray and CT respectively. However, at present the cost is likely to be prohibitive for any broader adoption, given that for providers, it represents a significant investment in what is still a limited niche. KA Imaging has suggested some use cases and are conducting studies to support them, with one paper referenced by the company claiming that the technology helped detect 25% more pneumonia cases than traditional X-ray.

The vendor will be targeting providers who are looking to bring the detector to the point of care, making imaging more comfortable and convenient for patients, as well as more challenging settings like critical care units and paediatric wards. Another possibility is for several departments to share a dual energy mobile detector, reducing each department’s reliance on busy shared CT resource. This could be helpful for time sensitive acute conditions which benefit from earlier particularly given the quicker turnaround times offered by X-ray compared to CT.

However, in some countries, such as China, providers are increasingly skewing towards the purchase of CT instead of high-end X-ray systems. These sites are increasing the proportion of CT scanners they have compared to high-end X-ray systems. This trend is particularly driven by the increased affordability and maturity of CT systems from local manufacturers. There are penalties for such a shift, with lower throughput than X-ray systems, as well as a higher level of expertise required by radiologists and technicians in terms of patient positioning and image interpretation. However, the improved image quality, CT’s versatility and, importantly for providers, the additional reimbursement that CT affords, could render KA Imaging’s target of the premium X-ray an insurmountable challenge.

The Hard Sell

Price is a constant consideration for providers when it comes to purchasing medical imaging equipment. At present, this is major challenge that KA Imaging will face with its dual energy X-ray system. The device does offer advantages compared to other mobile X-ray systems that will be valued by some, and the ability to upgrade existing systems with the dual energy detector will help mitigate the cost of upgrading, but at present, progress for KA Imaging will be hard won. If KA can gain traction with its dual energy detector, and garner interest from large international imaging vendors, the price of acquiring the technology will fall and a successful niche could be established.

However, this boundary between X-ray and CT will increasingly become a bitterly fought space. Digital tomosynthesis solutions, currently being promoted by the likes of Adaptix and Nanox for example, could be used outside of breast imaging, combining some of the advantages of X-ray and CT. Another potentially transformative technology is AI. Workflow tools could be used to improve the efficiency of CT imaging and to aid less experienced technicians, while diagnostic algorithms could be used in reading rooms to supplement the expertise of radiologists.

Whether KA Imaging can make headway in such a changeable space remains to be seen. The device and the detector technology it relies on could help doctors, particularly if its cost can be reduced enough to be a viable alternative for more providers. Unfortunately, given the price differential, without a key application or remarkable use case, its appeal could be lost on providers who have the luxury of choosing between several viable options. KA Imaging’s dual energy system and particularly its dual energy detector has an opportunity, but the vendor must now work to make sure that providers get a chance to experience its potential.

About Signify Premium Insights

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. This content is only available to individuals with an active account for this paid-for service and is the copyright of Signify Research. Content cannot be shared or distributed to non-subscribers or other third parties without express written consent from Signify ResearchTo view other recent Premium Insights that are part of the service please click here