Let’s face it, everyone wants to jump right to the question of how much todays’ Digital Radiography (DR) systems cost. And most people want the answer quickly. Well here it is: somewhere between $25K and $50K. But that’s a big spread. So let’s re-focus the question where it should be: what are the things about a DR configuration that add cost to the system, and which of these things actually add value (vs. just perceived value):
- X-ray Scintillator Material
- Panel Manufacturer
- Image Processing
- Warranty and Support
For the sake of this article, we are going to assume that you have narrowed your DR search down to the state-of-the-art indirect DR panels that use a combination of scintillator and TFT array to produce its images. This filters out all the CCD, CR, and direct DR configurations, since they have gradually fallen out of favor in today’s veterinary DR marketplace (for more information on the differences between these types of DR technology, read the DR Comparison article here.
X-rays Scintillator Material
The two main scintillators used these days are gadolinium oxysulfide, and cesium iodide (commonly referred to as Gadox and Cesium, respectively). The primary benefit of Cesium is high sensitivity to the x-ray signal, allowing lower exposure factors to produce an image. This is why Cesium is heavily used in human radiology (especially pediatrics), where the principal concern is to minimize the radiation dose delivered to the patient. The sacrifice to this high sensitivity is an increase susceptibility to noise. With less dose (lower number of x-rays) comes higher uncertainty of the recorded signal (therefore higher noise, lower signal-to-noise ratio, SNR). With Gadox, the sensitivity is slightly decreased (less than 10%), but with the additional radiation dose to get the same signal, there is less noise in the signal, resulting in a slightly higher signal-to-noise ratio.
Cesium panels are more costly than Gadox, (around $5,000), all options being equal. This is due to higher production costs (see next section) and higher demand in the human market.
In general, the phrase “you get what you pay for” holds in the veterinary DR market, and most of this cost comes in the reliability of the panels, both in their ability to consistently produce quality images as well as in their longevity in the clinic. The most reputable panel manufacturers in the world (both human and veterinary) are Varex, Canon, Samsung, Toshiba, Fuji, GE, Siemens, Philips, and AGFA, with a whole slew of second–tier panel manufacturers (mostly southern-Asian) entering the market space.
Especially when Cesium is concerned, there is a much higher manufacturer-dependence on this quality. Gadox is typically mixed in powder form with a liquid epoxy to a uniform concentration and “poured” into thin sheets where it hardens to form a layer with precise thickness. This is a relatively easy process that has simpler quality controls and lower variation from batch-to-batch and manufacturer-to-manufacturer. Cesium on the other hand is “sprayed” onto a substrate at a given concentration, then “baked” in an oven causing crystals to form and grow upwards and in parallel. The cool part is that these crystals serve as “light tubes” that increase the efficiency and resolution of the scintillator light leading to the higher sensitivity we spoke of earlier. The issue is that the quality of the end-product depends greatly on the concentration of the initial deposition, the time-temperature profile of the baking process, and the angle of crystal growth (if they grow even slightly diagonally, their efficiency significantly decreases). Only the manufacturers with years of experience growing Cesium have developed a consistency and quality you need.
Assuming a “good” quality DR panel, whichever manufacturer is used, these hardware differences produce only minor variation in panel sensitivity. All of this is very much secondary to the most important step in the acquisition process: Image Processing. The minor pixel-level differences only yield the raw image data, which is virtually useless diagnostically. The importance of image processing is not only in the ability to create a sharp, diagnostic image. Virtually any commercially available software can do this. More important, though, is the ability to produce this image quality consistently across a wide range of patients, anatomies, and positions. Again, any image processing software worth its weight CAN produce a nice image of a cat’s skull as well as one of a Rottweiler’s hip. The ones that demand a premium price tag are the ones that don’t require any individual tuning of the parameters to achieve this consistency. A “hands free” image processing suite that is used on daily basis in thousands of human and veterinary DR panels every day for the last decade; now that’s worth the price of admission.
Software and Workflow
Needless to say, the vast majority of the DR market is the human medical sector, and so the majority of software/user interface development is geared towards that application. Some DR manufacturers have not properly adapted their units to the needs of veterinary clinics, either due to lack of resources or expertise. This leads to more cumbersome workflows that take time away from your patients. Beyond expanding your caseload, your DR system should make it easy to send X-rays to radiologists and other specialists either from the Cloud or directly from the DR unit.
If you’re going to a conference, you should be able to pull up the X-ray images on your tablet, iPad, smartphone, or computer station. Even more importantly you need the ability to share the images with clients in the exam room so they have a visual representation of their pet’s health, and the tremendous value of the digital radiographic procedure. Numerous complicated toolbars and sub-windows just get in the way of the take-home message: that you were able to quickly and accurately make a radiologic assessment of their pet’s health. While software may seem like a frivolous thing to spend money on, an investment in DR system with a quality interface saves money in the long run.
Warranty and Support
Your DR system is an investment, any way you slice it. And the truth is, you’re going to spend the money, whether upfront or over the long term in the form of extended service. Even more truth is that the amount you spend after the purchase can be even more impactful on the total cost of ownership. This is why this is probably the most important section of this article. You need to make sure you are working with a DR partner that has a long history of quality service in the veterinary market and with its vendors. The worst thing you can do is leave yourself vulnerable to ala carte support or worse, an un-supportable device (because the manufacturer no longer produces parts for the system). Extended warranty/service packages are often a salesman’s least favorite talking point, because they just want to get the deal done, but this is an enormously important part of your buying decision.
To over-simplify: for ~$25K you can buy a DR system from a company that just recently started working with a second-tier panel manufacturer, with re-purposed human software, image processing software that requires tuning for each image, and offers inexpensive extended service. Good luck.
Or you can invest $50K for a DR system from a company that has decades-long relationships with industry-leading panel manufacturers using robust, hands-free image processing in an intuitive software platform designed specifically for veterinary applications, equipped with extended service packages that will put you at ease for years to come.