While CT, MR, PET and nuclear medicine technologies hold greater clout as “high tech” imaging modalities, their combined number of procedures pales in comparison to the number performed on fixed general X-ray and mobile/portable X-ray units by U.S. hospitals. This is mainly due to cost, with multiple departments outside of the radiology department more readily able to afford and utilize radiography scanners, compared to other imaging modalities.

For instance, a total of 152.8 million procedures were performed using fixed general X-ray scanners in 2018, compared to 114.9 million with CT, MR, PET and NM. Out of 267.7 million imaging procedures performed by U.S. hospitals, this comprises 57 percent of the top five modality procedures for chest, abdomen/pelvis, extremities, and spine studies, which make up almost 90 percent of procedure volume, according to IMV estimates. The inclusion of 61.4 million exams performed with mobile/portable general X-ray units raises the amount of general X-ray procedures to an estimated 214.2 million, which is 65 percent of the five-modality total.

The addition of this technology to general radiography is expected to open doors for further clinical and workflow improvements through the influence of emerging AI and machine learning applications. While still in their infancy, these tools are predicted to enhance a variety of aspects in imaging, including image quality output, workflow and clinical decision support for radiologists.

Locations that may be slow to follow suit include critical access hospitals, which are exempt from the payment reduction penalties, and children’s hospitals, which have low Medicare populations among patients.

Young, however, says a number of these hospitals are planning to replace CR with DR for increased productivity, and predicts that plans are or will be put in place over the next three years to either replace about three quarters of the remaining CR-only systems with new DR systems, or retrofit them with DR detector kits.

“We have been tracking this trend over the past decade. Certainly the legislative push sped up the process, and the rate of conversion is what industry watchers are interested in,” said Young. “One can say DR is ‘dominating’ the install base, with 80 percent of the total units installed in U.S. hospitals having DR capability, and going forward, very few future orders will be for CR technology.”

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