You say you want a digital revolution?

Phasing out the use of radiographic film proves harder than pioneers in digital radiography expected

BY GREG FREIHERR

<< Greg Freiherr

We now know that the adoption of digital radiography will not come in an electrifying flash. Sites will transition from film to digital technology far more methodically. Some will use computed radiography to gain familiarity with the idea. Others will replace only the oldest film-based equipment with electronic detectors. A few sites will do both and possibly also retrofit a few film-based systems with electronic detectors.

A complete change to electronic systems will occur but probably not for a decade or two. This mantra of slow and steady progress is a far cry from the roaring '90s, when the RSNA meeting featured such excesses as cab drivers wearing caps hyping DR, banners atop booths announcing the arrival of full-field digital mammography, and center-stage demos of digital radiographs being put into PACS.

Expectations have come back to earth, as supply problems plagued Sterling's flat panel, and the FDA defeated Trex Medical's digital mammography application. But these were not the reasons the revolution failed to arrive: It was doomed from the start.

We like to think our world is driven by technology, but technology is often more like a chessboard pawn than the queen. Works in progress may be paraded to show off the prowess of a company, creating demand for a product yet to be launched. Or they may be intended to stall the market, putting customers on hold for a year or two so they won't buy from a competitor. Or works in progress may be shown to deflect OEM interest in a competitor's components. Digital x-ray has been used for all these purposes.

A case in point was the technomarketing balloon that took flight during the 1995 RSNA meeting. Showcased in front of the Du Pont Medical booth, the prototype of this revolution resembled a heating pad with a computer cable in place of the electrical cord. What captured crowds at hourly demonstrations was the possibility that direct radiography, as Du Pont called it, might be fitted into some 200,000 x-ray tables, wall buckys, and portable x-ray units around the world. The pad—this self-scanning electronic array—was inserted in place of the usual film cassette. It was billed as the next step in the transition to all-digital radiology.

The Sterling Group, which would be known as Sterling Diagnostic after acquiring Du Pont's medical business, would fast-track system development. Sterling would sell DR products under its own label, while supplying digital detectors to major vendors that had been caught napping.

By touting the coming revolution, Sterling strategists hoped to push vendors into this kind of supply agreement, which would give their competitors incentive to form supply agreements for DR, by raising demand for digital radiography and stalling orders for conventional ones.

Rather than cutting the supply agreements, however, the major vendors responded with their own initiatives, to stall the market and hold their radiography customers. In early 1997, Siemens and Philips announced the formation of Trixell, a joint venture with Thomson Tubes Electroniques. The French company would develop and build flat-panel digital detectors. Later that year, GE staged an event in Santa Clara, CA, at the flat-panel production facility of its partner EG&G Amorphous Silicon (now owned by Perkin Elmer).

The message was clear. The top three x-ray vendors would soon be making their own proprietary digital x-ray equipment. They were spending hundreds of millions of dollars on R&D. And by the way, their detectors were better than detectors made by their competitors.

Sterling was making claims about its detector ahead of its launch. GE, Siemens, and Philips did the same. But the ploy gave credibility to Sterling's claims that an x-ray revolution was in the cards. Expectations leaped when the FDA cleared detectors made by Sterling and Swissray.

By the end of 1999, it was painfully apparent that the revolution just was not going to happen. Few vendors had anything new to say.

As this year's RSNA meeting approaches, the market will no doubt be treated again to rosy predictions. Perhaps they will be right.