Tag Archives: Fluoroscopy

Strong Revenue Recovery of 15% for Fixed Digital Radiography in 2021, Whilst Fluoroscopy Grew by 18% Year-on-Year

Co-written by Graham Cooke

The fixed digital radiography (DR) rooms market experienced strong growth in 2021, with 15% growth in revenue reported, with revenues estimated at $1.2 billion. Likewise, the fluoroscopy X-ray market returned to growth after a year of retraction in demand in 2020, with 18% year-on-year growth in 2021, with an estimated market size of $509 million. These figures, taken from Signify Research’s General Radiography and Fluoroscopy – World 2022  report, show a strong recovery from the challenges experienced during the heights of the COVID-19 pandemic.

Demand returns to fixed room radiography in 2021.

Demand for fixed room digital radiography systems returned to growth in 2021, as procurement budgets were made available, having been temporarily diverted to fund mobile X-ray purchases in the early phases of the pandemic. This allowed previously planned projects to resume, and upgrades and replacements to be installed. For developed regions and countries, higher end features to help tackle the backlog are now increasingly sought after, including auto-positioning, cameras to ensure minimal patient movement before imaging and AI based image analysis. Such features improve workflow, increase the throughput of an imaging department, and should help healthcare providers gradually clear some of the backlog created from the pandemic.

Conversely, the digital mobile X-ray market retracted by 18% in revenue terms in 2021, closing at $684 million. However, this decline was not as severe as previously forecast, with some sustained demand remaining. During the pandemic, obvious benefits of mobile imaging were reinforced, including portability for bedside imaging. Growth is expected to return for mobile DR in 2024, as replacement of older mobile systems drives demand.

For mobile radiography, the importance of brand loyalty in purchasing decisions also returned, after temporary focus solely on inventory available during the pandemic. This allowed, smaller, local vendors to win significant share in new markets as they could service demand from local inventory more readily than global brands. Once global vendor inventory returned to a more normal level, purchasers often reverted to previous purchasing habits.

The general radiography market has experienced issues across the supply chain. Many components, including steel and semi-conductors, are in short supply. Coupled with rising costs of transportation and limited availability of shipping, average selling prices are expected to rise by approximately 8% in the short term for general radiography systems, before stabilising and declining again. This is also adding to lead times for projects, with systems taking a lot longer to reach customers.

Fluoroscopy also returned to growth, but demand is expected to become more specialised

Demand for fluoroscopy also returned to growth in 2021, with 18% year-on-year revenue growth to $509 million reported, up from $431 million in 2020.  However, fewer fluoroscopic procedures are now being performed, with other modalities like CT and MRI taking precedence for procedures traditionally conducted on fluoroscopy systems. Upper GI and barium swallow procedures remain the most procedures maintaining clinical demand for fluoroscopy and will remain essential for the long-term health of this modality.

With fewer fluoroscopic exams being performed and increased focus on return of investment in purchasing decisions, multi-purpose systems are now even more desirable, especially in North America and Western Europe.

Fluoroscopy revenues will surpass 2019 pre-COVID levels next year, but growth will be limited after this, as other imaging modalities continue to challenge fluoroscopy. The fluoroscopy market is set to reach $614 million by 2026.

Key trends by region

North America

  • The US continues to be one of the few countries still favouring classical fluoroscopy systems, due to historical training practices, concerns of patient movement threatening image quality and potential litigation. Demand is expected to gradually transition to remote systems, as new generations of radiographers are trained on remote systems; classical is however still expected to be dominant in the next five years.
  • In the general radiography market, demand for high end features is increasing, with tools to aid workflow becoming highly desirable for many imaging centres and hospitals.

Latin America

  • The Latin America market continues to be highly cost sensitive, with options like computed radiography, retrofit and analogue systems remaining popular. For many end users, there is a desire to digitalise, but currently, the price point remains prohibitive. For the digital solutions that are sold, low-end systems with a lower price point are by far the preferred option – over 50% of fixed and mobile solutions revenue came from the low-end in 2021.
  • Fluoroscopy remains a very small market in Latin America, with the high price point proving a significant barrier for entry to this market. Brazil is the largest adopter of fluoroscopy in the region, with most other Latin American countries seeing minimal sales.

Western Europe

  • High-end product continues to dominate the general radiography market in Western Europe, with 68% of revenue for fixed room product coming from High-end in 2021. Floor mounted systems sell more in unit terms in Western Europe, but with a lower ASP, revenue from ceiling mounted solutions accounts for a higher proportion of the market.
  • Most Western Europe markets have limited demand for fluoroscopy, with France being the key exception. Almost 30% of all revenue in Western Europe comes from this country. France is also unique in that many healthcare providers prefer to use dedicated fluoroscopy systems, rather than multi-purpose which is generally utilised in the rest of Western Europe.

Eastern Europe, Middle East and Africa (EEMEA)

  • Parts of EEMEA remain very cost sensitive, with Africa and less developed countries in the Middle East seeing high adoption rates of computed radiography, analogue and retrofit. For many, digital solutions are too costly, especially with the added infrastructure costs to enable PACS and other healthcare IT solutions on top of the imaging systems. Servicing imaging equipment can also be a barrier to adoption, with few engineers available locally to quickly fix broken systems.
  • Fluoroscopy remains very small for most of EEMEA. The areas that have stronger installed bases are in French-speaking north Africa, where demand follows France. In parts of the Middle East, such as in Saudi, some trends follow the US, as some radiographers were trained in the States, and therefore follow classical fluoroscopy installation practices.

Asia Pacific

  • Asia Pacific remains cost sensitive in many parts of the region, with 57% of fixed room revenue coming from the low-end segments. In countries like India, high levels of analogue and computed radiography remain significant. In China, CT imaging is increasingly preferred over high-end digital radiography.
  • Japan remains essential to the long-term growth of the fluoroscopy markets, with 45% of all unit sales in the region coming from this country alone. Elsewhere, demand is minimal with costs proving prohibitive to adoption.

Competitive landscape

A return to a more conventional vendor landscape was evident in 2021, with global brands such as Siemens Healthineers, GE HealthCare and Philips regaining market share temporarily lost during the pandemic when demand outstripped the available supply. With these vendors able to fulfil demand, smaller local vendors dropped share.

In the fixed DR market, Siemens Healthineers strengthened its position, with a gain of 2.5 percentage points.  For Mobile DR, GE reclaimed the top position, as Carestream experienced a difficult year after a very strong 2020.

For the fluoroscopy market, Siemens Healthineers led, with a very strong 2021, gaining further share. Shimadzu follows with strong sales in its domestic market.


The Fixed DR market will continue to recover. Budgets will continue to return for fixed room, and projects previously postponed will be able to restart. Additionally, in some countries like the US, replacement cycles will stimulate further growth towards the end of the forecast. Globally, ceiling suspended fixed room product revenue will grow at a faster pace (5% CAGR 2021-26) than floor mounted (4% CAGR), especially in more developed markets, where the desire for high-end features often found in ceiling-mounted solutions, are increasingly required. Low-end system demand will continue to be driven by cost sensitive markets such as Latin America, Africa, the Middle East and parts of Asia. However, the price of digital solutions will need to significantly reduce to be an attainable option for these regions. Until the price falls sufficiently, analogue, CR and retrofit will continue to play an important role.

Fluoroscopy systems will also see limited growth but will also come under increasing pressure from other modalities like CT and endoscopy. At the end of the forecast, low single digit annual revenue growth is predicted.  In many countries and regions, the demand for fluoroscopy will come predominantly from multi-purpose systems; as fewer procedures are performed on the systems, budget holders will want to minimise downtime by enabling other general radiography imaging.

Canon Medical Acquires Nordisk Røntgen Teknik A/S to Strengthen its High-End Fluoroscopy Portfolio

On the 1st March 2022, Canon Medical Systems Corporation announced an agreement to acquire Nordisk Røntgen Teknik A/S (NRT), a Danish medical equipment manufacturer headquartered in Aarhus. The acquisition has been finalised following completion of approval procedures and will enable Canon Medical to strengthen its portfolio both in multi-purpose fluoroscopy and interventional gastro. As a result of the acquisition, Canon Medical will have access to European-based technology and manufacturing, as well as the opportunity to deploy advanced technology for multipurpose fluoroscopy.

Dedicated stand-alone fluoroscopy rooms to disappear

A major shift is being seen in the fluoroscopy market, with increased uptake of multi-purpose fluoroscopy systems capable of fluoroscopy, general radiography, and some interventional X-ray procedures. This trend is also reflected in fluoroscopy product launches, with the leading vendors focusing on multipurpose R&F systems, such as Fujifilm’s Persona RF PREMIUM and Siemens Healthineers’ LUMINOS Lotus Max, which were both launched at the virtual RSNA show in 2020.

The number of fluoroscopy exams conducted globally is reducing, although at a slower rate than previously seen. The associated benefits of lowered dose and higher image quality offered by MRI, CT and endoscopy, continue to drive down the number of fluoroscopy examinations performed. This reduction in fluoroscopy procedures alongside an increased focus on improving operational efficiency, is causing health providers to re-evaluate the restricted clinical usage and hence lower return on investment from dedicated fluoroscopy systems and is leading to increased consolidation of dedicated fluoroscopy rooms. With healthcare budgets being stretched globally, multi-purpose systems are becoming more popular as they enable higher usage due to the increased diversity of clinical exams that can be performed and from enhanced workflow capabilities. Furthermore, the shift of healthcare into outpatient settings further facilitates uptake of multi-purpose systems. Signify Research predicts that in the coming years, most dedicated fluoroscopy rooms in developed markets will be replaced by multi-purpose systems.

Increased competition for Siemens Healthineers

With Canon Medical acquiring NRT, competition will be heightened for Siemens Healthineers, the only other active market player in interventional gastro imaging. However, the interventional gastro market continues to be niche, with approximately 100 new global installations forecast for 2022.

An increasing number of Asian manufacturers are developing multi-purpose X-ray systems. Multi-purpose systems are portrayed as economical interventional X-ray systems due to the considerably lower cost, in comparison to an interventional suite.

As a result, to remain competitive in the fluoroscopy market, a robust portfolio of multi-purpose systems is mandatory. NRT’s high-end multi-purpose fluoroscopy systems will be complementary to Canon Medical’s existing portfolio and enable it to further strengthen its market position.

Increased scalability for NRT’s high-end multi-purpose fluoroscopy solutions

Despite its innovative and advanced fluoroscopy offerings, NRT lacks both brand recognition and scalability. Canon Medical’s global sales network will enable NRT to penetrate new markets outside of Europe, which has been its target market ahead of the acquisition. With multi-purpose fluoroscopy rooms forecast to have increased uptake primarily in developed markets, such as Western Europe, access to advanced European technology and manufacturing could strengthen Canon Medical’s market presence. The addition of NRT’s high-end fluoroscopy systems to Canon Medical’s portfolio will also open up the opportunity to provide a wider range of products serving different market segments from entry to high-end.

Canon Medical’s portfolio to be upgraded with NRT’s unique technology

Canon Medical plans to apply NRT’s expertise in advanced technology to its existing X-ray solutions. Examples of NRT’s advanced technology include its inMotion technology for automatic positioning of the detector and tube to pre-set parameters for examinations. Additionally, NRT’s Adora is an automatic, motorized digital radiographic imaging solution featuring a unique, rotating ceiling unit with two telescopic arms, one for the X-ray tube and one for the detector allowing exposures to be performed from any angle through a one-touch operation.

Another example is NRT’s Celex, a tilt-C X-ray multi-purpose system designed with wide projection, flexible and enhanced user ergonomics and patient comfort.  The Celex system offers both static and DR imaging capabilities combined with unique positioning flexibility and a detachable table to provide optimal space inside the C-arm for a variety of examinations.

Canon Medical’s domestic market, Japan, is one of the largest markets for fluoroscopy globally, with the main application of fluoroscopy being the stomach barium test, a common part of the health screening process. Japanese fluoroscopy vendors are continuing to increase the clinical applications of their fluoroscopy systems to include endoscopy and colonoscopy. Lung imaging, tomosynthesis and more advanced applications are increasingly being covered in multi-purpose R/F rooms, with the primary application being gastric imaging, orthopaedics and pain management. Therefore, for Canon Medical to remain competitive amongst its Japanese peers in its domestic market, an upgrade of its existing portfolio to include NRT’s advanced technology could help bolster its market position.

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

More Information

To find out more:

E: enquiries@signifyresearch.net,

T: +44 (0) 1234 436 150