"We can design any solution depending on a department's needs," said Joe Adams, Philips senior marketing manager for radiography, radiography/fluoroscopy, and surgery.

Attesting to the evolving nature of radiography is the recent introduction of self-propelled systems bearing DR sensors. Film-based units have been visualizing bedridden patients for decades. But a few years ago, vendors began promoting DR versions. Last year, about 100 were sold in the U.S. Industry pundits predict many more are on the way.

The incursion of DR into this segment of radiography has undercut the appeal of CR, which previously was necessary if facilities wanted to make digital images from this segment of radiography. But CR is not likely to vanish. The technology remains appealing to facilities with tight budgets, an economic reality that is affecting demand for DR.

Anne Ji, marketing supervisor for Canon Medical Systems, has observed an industry-wide settling in demand for new DR units. This trend has helped Canon, which supplies flat-panel detectors to DR manufacturers but also sells detectors to companies that upgrade analog systems to digital. The U.S. arm of the Japanese company had a banner year in 2007, thanks largely to hospitals that chose to upgrade installed analog systems rather than buy new DR units, Ji said.

"We anticipated this," she said. "We were pushing upgrades, pushing the fact that [hospitals] didn't have to buy new systems."

Cost concerns have contributed to the continued popularity of conventional analog systems, but so has the uneven adoption of PACS, according to Dave Widmann, general manager for the radiography and R/F business at GE Healthcare.

"Without the infrastructure of PACS, they are not as quick to convert to full digital," Widmann said.

The variety of healthcare providers and institutions in the U.S. ensures that film will have a place in radiography for the foreseeable future, as will both CR and DR. Changing market conditions may shift the balance in favor of one or the other for a while, but none is likely to face extinction any time soon.