Digital imaging developments in Europe show move toward PACS - Picture Archiving and Communication System

LUXEMBOURG - Digital image archiving, processing and communication using PACS (Picture Archiving and Communication System) installations are becoming more widely used in Europe. The Impax digital imaging network from Agfa-Gevaert (Mortsel, Belgium) can be combined with CT, MRI, and ultrasound, plus digital radiology, to provide high-quality image acquisition. Impax, like most European archiving systems, uses open standards such as DICOM 3.0 to simplify integration into multi-vendor environments.

To cope with today's ongoing transition from conventional to digital environments, Agfa-Gevaert has developed the Compact Imaging Center, which is a combination of the Curix Compact Plus all-purpose daylight system with the Scopix LR5200 high-resolution laser imager and a darkroom feed option. Using the same processor for both types of imaging work should provide significant savings. In combination with CR, MRI, CT digital signal acquisition, conventional acquisitions like mammography, general Xrays, etc., all can be stored and quickly retrieved. Vepro (Pfungstadt, Germany) also has developed a digital PACS. The Medimage PACS allows digital image archiving, processing and communication with direct connection to all imaging devices. Telecommunication via modem or ISDN makes possible transfer of images internationally.

The Micromedica (Torino, Italy) Scanquick Visual system enables all formats of original X-ray film to be scanned and converted into digital format together with detailed reports. The system accepts film or paper with automatic recognition of media as well as high-speed processing of up to 500 plates per hour. As with the Medimage system, all input images can be transmitted digitally.

Aloka (Tokyo, Japan) has added to its SSD-1700 Dyna-View ultrasound system an optional digital image compression module which is without image degradation. Data output is DICOM-compatible.

Direct-capture digital X-ray systems

A new, flat digital X-ray detector from Trixell (Moirans, France) promises to be a major innovation in medical imaging technology that hopefully will help radiologists to improve clinical care as well as lower costs over the long term. Trixell is a European consortium formed by Philips of the Netherlands, Siemens of Germany and Thomson of France to commercialize the system.

The new technology, planned for commercialization in 1998, will make it possible to digitize standard radiographic procedures such as chest X-rays, which represent the largest part of total scans performed in radiology departments. The detector, which has been developed for both radiography and fluoroscopy applications, is a flat, solid-state device using amorphous silicon technology and digital signal processing. The first device on the market will be a large, high-resolution detector for radiographic applications, and it will be followed by dynamic detectors for fluoroscopy - also operating in radiographic mode.

Sterling Diagnostic Imaging (Newark, Delaware) also has developed a self-scanning digital array using an amorphous selenium-coated, thin-film transistor panel which also is expected to become commercially available in 1998. The Trixell detector is intended for incorporation into complete X-ray systems, whereas the direct radiography system from Sterling Diagnostic will include a system controller to provide the user interface for the entry of patient demographics, selection of image processing software and selection of network output devices. The system creates a high-resolution image in digital format within seconds of exposure and can be viewed almost immediately on a workstation monitor, printed out on film or transmitted via DICOM-based networks.

A digital stereotactic biopsy system based on third generation CCD technology has been developed by Siemens-Elema (Solna, Sweden). The Opdima system, designed for use with the Mammomat 3000 modular mammography system, eliminates film processing. This time-consuming procedure is replaced by rapid digital acquisition and reconstruction, with images displayed in near real-time so that the entire examination and biopsy sampling procedure is considerably shortened. This should increase patient throughput and, importantly, it will reduce patient discomfort significantly. The CCD detector cassette fits into the regular biopsy unit as well as standard object tables.

Depressed market encourages moves

Although the pending merger of Amersham International (Little Chalfont, England) and Nycomed (Oslo, Norway) to create the largest global imaging company may have in part been under discussion between the two companies for several years, as maintained by Bill Castell, CEO at Amersham, the deal doubtlessly has been given additional impetus by changing market conditions.

Contract buying tactics and threats of generic competition are continuing to pressure contrast media manufacturers in the U.S., and increasingly in Europe. Ionic, non-ionic and even MRI contrast media prices have been adversely affected, producing profitability pressures on all players, but especially Nycomed and Bracco (Milan, Italy), for whom contrast agents constitute a major part of revenues. Both companies supply around one-third of the world market for contrast agents, either from their own production or through licensees.

Bracco, which is 50% owned by E. Merck (Darmstadt, Switzerland), managed to hold its contrast media sales unchanged last year at around $730 million, while Nycomed sales revenues in that segment fell by 10% to about $660 million.

Guerbet (Roissy, France), whose sales last year only increased nominally by 1% to about $209 million and whose net profits fell by 33%, also has been heavily affected by competition. With greatly diminished profitability, both Bracco and Guerbet now look to be vulnerable, although both companies are aiming to reduce their reliance on nonionic X-ray contrast agent sales by concentrating on MRI contrast media sales, which grew in Europe in 1996 by dose to 50%, and by pressing ahead with ultrasound contrast agent development.

Table 1
World Imaging Market

                           U.S. $ billion
                         1995           1996

Nuclear Medicine         1.20           1.40         +17%
Contrast Media(*)        4.30           3.70         -15%

                         5.50           5.10

* In 1996:                      88.5%               X-ray
                                11.0%               MRI
                                 0.5%               Ultrasound

Selected Major Suppliers of Imaging Consumables

Company:                 Headquartered in:

Amersham Nycomed         Britain/Norway
Bracco                   Italy
Byk Gulden               Germany
Daiichi                  Japan
Guerbet                  France
Mallinckrodt             United States
Schering                 Germany

Source: The BBI Newsletter

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