X-ray film sales can sustain strong investment in R&D

The digital healthcare revolution may be ongoing, but the industry that built its business on film is not ready to abandon wet processing technologies. Opportunities for growth in medical x-ray film merit continuing R&D investment, according to leading providers of analog and digital imaging solutions.

Kodak has launched three new medical x-ray films in the past 12 months, and another is in the pipeline. Agfa and Ferrania have also introduced new products to a market that is holding its own in the face of digitalization.

"It is important to remember that 70% of imaging procedures worldwide are still performed with film, so plenty of opportunity still exists in the marketplace," said Eileen Heizyk, worldwide marketing manager for film capture and output systems in Kodak's Health Imaging Group.

Specific opportunities may warrant development of specialty film products. Concerns about radiation led Kodak to develop a new general-purpose film that the company says can reduce x-ray dose to patients by up to 50% while maintaining excellent image quality. The new high-speed film, Kodak Hyper Speed G Medical Film, was demonstrated as a work-in-progress by Kodak's Health Imaging Group at the American Healthcare Radiology Administrators meeting in August.

The product promises to reduce not only radiation exposure to patients but the impact of patient motion as well. Salvaging films that might otherwise be lost due to motion will reduce the need for retakes and further decrease patient exposure to radiation. Trials are under way in the U.S. and several European countries to document the product's benefits.

"We continue to invest in developing radiographic film systems that set new standards for image quality and for other important performance characteristics, including patient dosage. In studies we conducted at healthcare facilities in several countries, reduced radiation dose was ranked as one of the top three objectives," said Betsy Guffey, product line manager of film systems for Kodak's Health Imaging Group.

Much of the opportunity for new films is found in emerging healthcare markets such as those in Asia Pacific (excluding Japan), Latin America, some East European countries, and Africa. Agfa's new x-ray film, announced in August, is targeted specifically at hospitals and clinics in those markets, which constitute a huge block of customers, said Jan Leeuws, global marketing manager for Agfa's film and print products.

"Just because we as a company are bringing digital solutions to our customers, it doesn't mean that we are not focusing on the thousands of customers who still rely on analog," he said. "They will move to digital imaging at their own pace. In some countries that may be in five years; in others it could be 10, 15, or even 20 years."

Healthcare expenditures in these regions are still low. As they grow, film consumption grows with them. Radiography facilities in these areas generally rely on less expensive locally sourced film-processing chemicals, which may vary in strength and quality. Agfa's CP-GU was designed to offer better image quality and consistency in radiography even when films are processed in weaker chemistries or less favorable conditions. Use of new technologies in emulsion preparation enables Agfa to offer the x-ray film at an economical price, Leeuws said.

"In these emerging markets, a lot of the local chemistries are not performing well with our high-end film, which requires a lot of hardening during processing," he said. "Customers using this new film will achieve the more robust image quality that they require."

CP-GU x-ray film offers control over image contrast. Users can alter processing temperature to attain higher or lower gradients, thus tailoring their imaging contrast. Quality will be suitable for most general x-ray applications, although orthopedic studies with a large density range and high contrast would be better performed with a high-end film, Leeuws said.

These films have a place geographically as well as clinically. Agfa's customers in North America, Western Europe, and Japan, where existing films are working well, will not be offered CP-GU film. Evidence of Agfa's latest advance in wet processing technology will not be found at the 2004 RSNA meeting, either.

"At RSNA we would like to show the future to our customers, and the future is definitely digital," Leeuws said.

Alan Budge, U.K. and Europe general marketing manager for Ferrania LifeImaging, agrees that digital solutions are the key to future profits. He estimates that more than 90% of Ferrania LifeImaging's sales over the next five years will come from the hardware, software, peripherals, and service contracts associated with digital acquisition.

But Ferrania is not ready to close the door on wet processing products. Its R&D in the film sector continues, due to an anticipated demand for film and paper products for a number of years, not to mention awareness that competitors are doing the same.

The company's latest product in this stable is the LifeRay XDA Plus ultra-thin laminar grain (UTLG) film, a green-sensitive orthochromatic film for the medium-speed contrast market. Shown at the 2003 RSNA meeting and now available worldwide, LifeRay XDA Plus UTLG consistently delivers quality in the face of inconsistent processing conditions, according to the company. It also claims that the film uses lower levels of chemicals in processing, reducing the environmental impact of x-ray imaging.

"We are continuously looking to ensure that our range of products keeps ahead of competitors' solutions where possible, and we do expect further film-based products to be launched in the next 12 months," Budge said. "This will include conventional solutions and films for our range of dry imagers. But there is no doubt that the level of film usage is lower than it was, and the chances of any quantum leap improvements are less likely for the future."

Growth opportunities for conventional films are more likely found outside developed nations. But even in the U.K., where significant government funding and a centralized PACS procurement process is boosting the switch from analog to digital imaging in healthcare, Ferrania sees opportunities to expand its business in conventional solutions.

Breast imaging is an area where demand for film is still growing in Western healthcare markets. Kodak responded to this trend by launching its Min-R EV (enhanced visualization) mammography film, showcased at the last RSNA meeting. The mammography film, used with Kodak's EV screens, offers higher contrast, sharper detail, and wider exposure latitude, according to the company.

"Min-R EV represents something of a breakthrough in terms of image quality," Heizyk said. "New products like Min-R EV give us a decided advantage in this category."

Kodak has also introduced two films for the general radiography market in the past 12 months: Kodak MXG, a green-sensitive midcontrast film, and X-OMAT BT, a T-grain film for customers who use blue light-emitting screens. The launch of Hyper Speed G, another general radiography film that offers low-dose imaging, is expected in the coming months.

"This advanced product reduces radiation dose for patients by up to 50%, while maintaining high levels of image quality," Heizyk said. "In the past, a decrease in radiation usually involved a sacrifice in image quality."