• Biplane Systems: Philips 41%, Siemens 34%, Canon 14%, GE 10%

*Note: GE Healthcare does not offer a single-plane ceiling-mounted solution. However, GE offers a unique design with their IGS 7 series. It is a floor-based system that can move around the patient table via laser guidance.

Replace versus “upgrade”
The last few years have seen several vendors offering an “upgrade” path to existing customers. While the offer is presented as an upgrade, it is more something referred to as a “forklift upgrade”. In principle, the offer may be designed to use the structural base of the imaging system (gantry) and replace all internal components, mechanical, electrical, imaging chain and software. In some cases, the vendor opts to simply pull out the old system and replace it with a new system, thus, the “forklift” terminology. About 26% of Philips quotes we have seen in the past 12 months represented as a “Catalyst Upgrade”. Siemens presents their upgrade solution as an EVOLVE promotion. Both are effectively a new system, being presented as an upgrade. Often, there is not much, if any, difference in these upgrade offers versus a new system with an offer to take the older system back and provide a trade-in credit.

High-interest clinical applications

Radiation dose reduction & management
All active vendors have very strong and focused solutions to provide optimal imaging with the least amount of radiation necessary. They have standard software to monitor and alert staff when radiation exposure is high or above normal operational limits. The variables that determine radiation exposure are highly complex, involving patient size (body mass), imaging techniques/settings, length of procedure, and procedure and/or physician protocols and preferences. While many vendors claim superiority in dose management and dose reduction, the variables outside of the system design ultimately impact the dose. This aspect of this technology requires all aspects to be closely monitored and followed by the manufacturer and their design, by the radiology operators and by the interventional physician and their use of the system.

• Hybrid IXR/Surgical Labs – Mostly cardiac-based, this is specifically designed for the growing therapeutic area for minimally invasive structural heart, which includes catheter-based versus open-surgical based treatment for cardiac valve disease. The option to forego surgery to address heart valve disease continues to grow and gain FDA approval for an increasing patient population. Clinical studies continue to compare cost, long-term outcomes, recovery times and patient preference. However, many organizations have opted for specialized configurations to allow this procedure. This specialized area has moved toward a more traditional interventional design versus the original hybrid surgical/interventional design.

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