New Report Finds Large-Scale Adoption of Digital X-Ray Technology in the U.S., Growth in Procedures

This article is based on information  from Kalorama’s partner publication IMV (, a premier source of information for the radiology industry. 
In the 1980s, CT and MR scanners revolutionized the imaging industry by generating images digitally rather than using analog/film-based technology.  Since then, radiology/imaging departments have progressed to being almost fully digitally based, with the large installed base of general radiography units being the last frontier.  Due to the need for relatively large imaging plates to image large body parts in a single view, such as the chest, the image quality of the digital technology had to be perfected by industry and proven to the radiology community.
For general x-ray, the adoption of digital technology has gone through several transitions.  Initially, the most cost effective way to effect the transition was to use computed radiography (CR) technology, where the x-ray image is acquired digitally onto a phosphor plate that is installed in a cassette similar in size to the film cassette.  Once exposed, the CR cassette is physically taken to a CR reader to capture the x-ray image digitally.  With the development of digital radiography (DR) technology, the digital x-ray images are acquired directly into a computer, thereby speeding up the acquisition and processing time for the x-ray images.
As of 2010, just over one quarter of the fixed general x-ray systems installed in U.S. hospitals had DR technology, while 70% were CR-only systems and 4% were still film-based.  With the passing of the Consolidated Appropriations Act of 2016, x-ray imaging providers received an extra push to continue the transition to DR technology, with penalties for non-compliance starting in 2017/18.   IMV has been monitoring this adoption trend over the last decade, and IMV’s 2019 X-ray/DR/CR Market Outlook Report observes that over 80% of the fixed general x-ray installed base in U.S. hospitals uses DR technology, up from half of the installed base in 2015.


“IMV’s 2019 X-ray/DR/CR Market Outlook Report observes that over 80% of the fixed general x-ray installed base in U.S. hospitals uses DR technology, up from half of the installed base in 2015.”


Going forward, IMV anticipates that over the next three years, about three quarters of the remaining CR-only systems currently installed are being planned for replacement with new DR systems or to be retrofitted using DR detector kits.  Some hospitals, such as Critical Access hospitals are exempt from the CMS payment reduction policies, so they may be slower to transition, but a number of these hospitals are still planning to replace their CR technology with DR to benefit from the increased productivity of DR technology.
General radiography is continuing to play a major role as a “primary care” imaging modality in U.S. hospitals, utilized for inpatients, outpatients, and emergency patients.  The top five x-ray procedure types performed are chest, abdomen/pelvis, extremities, and spine studies, and constitute almost 90% of the procedure volume.  At hospitals, fixed and mobile/portable x-ray systems are located, not only in the main radiology department, but also in other departments on hospital campuses and in outpatient clinics, imaging centers, and urgent care centers managed by radiology in the hospitals’ service areas.  As a result, even though CT, MRI, PET, and Nuclear Medicine (NM) technology have higher visibility as the “high tech” imaging modalities, the number of imaging procedures performed on fixed general x-ray systems and mobile/portable x-ray units by U.S. hospitals and their associated locations far exceeds the combined volume of procedures performed on their CT, MRI, PET, and NM imaging systems.  IMV estimates that U.S. hospitals performed a total of 152.8 million procedures on fixed general x-ray systems in 2018, compared to 114.9 million procedures performed using their CT, MR, PET, and NM systems, thereby comprising 57% of the 5-modality total of 267.7 million imaging procedures performed by U.S. hospitals (not including procedures performed in independent imaging centers and office practices).
The IMV X-Ray Market Outlook, from Kalorama’s partner publisher, can be found at:
Moreover, IMV estimates that 61.4 million procedures were performed using mobile/portable general x-ray units by U.S. hospitals, bringing the total number of general x-ray procedures performed in 2018 to an estimated 214.2 million, which accordingly comprises 65% of the 5-modality total in U.S. hospitals and their associated locations.

Now that general radiography has joined the ranks of the digital modalities, future artificial intelligence (AI) and machine learning applications that harness the power of the digital information will be a key factor in facilitating further clinical and workflow improvements for radiology.  While the adoption of AI applications for clinical decision support using general x-ray data is still in its early stages, radiology administrators see great promise for using such tools to improve image quality output, workflow, and to use as clinical decision support for radiologists.

IMV’s 2019 X-ray/DR/CR Market Outlook Report explores trends in U.S. hospital radiology departments for the adoption rate of CR-to-DR technology, x-ray procedure volume, the installed base of fixed and mobile general x-ray DR vs. CR systems, x-ray replacement cycles, purchase plans for DR retrofits and fixed & mobile x-ray systems, manufacturer installed base share and brand loyalty, and site operations characteristics. Respondent opinions on how key issues are affecting their department priorities and outlook are featured, and the report provides 5-year market forecast scenarios addressing the fixed general x-ray unit market.  X-ray manufacturers covered in this report include Agfa, Canon, Carestream, Del Medical, Fujifilm, GE, Konica Minolta, Philips, Samsung, Shimadzu, and Siemens, who provide fixed, mobile/portable general x-ray systems, and/or DR retrofit kits.
The report is based on survey responses to an online survey conducted by IMV in January 2019 with 340 radiology administrators/managers in U.S. short-term general hospitals.  Their responses have been projected to the IMV-identified universe of over 5,300 hospitals in the United States that have at least one fixed general x-ray system installed.  For information about purchasing IMV’s report, visit the corporate website at or call 703-778-3080 to speak with a representative.


LORNA YOUNG is the Senior Director of  Market Research for IMV.  The IMV X-Ray Market Outlook can be found at: