Whether we’re talking about what to have for dinner or the tools we use every day to get our jobs done, there is a balance between want and need, cost and budget, value and ROI. For the interventional practitioner, striking this balance in their cath lab equipment choice can be a delicate decision that will affect their facility on a number of levels for years to come. As interventional technology advances, this choice is coming down increasingly to the matter of analog cath lab vs. digital cath lab.
Below are some hardware points prospective cath lab buyers should bear in mind when addressing this choice:
The Image Intensifier (II):
Analog systems are the only kind that have these. They’re a pretty expensive part and, unfortunately, they all eventually lose image gain and the quality suffers. On the upside, IIs are readily available on the second-hand market both "certified used" and "refurbished". A digital detector system, on the other hand, has no II. Instead these units are equipped with flat-panel digital detectors (DD) that exhibit very limited degradation and over a much longer period of use.
Part and parcel of having an II is the need to collimate down when viewing anatomy in a higher magnification. While finer details become visible, the field of vision is reduced further and further with each subsequent magnification, whereas magnification on a digital system is possible without any reduction of scale.
Both II and DD labs can support subtraction features. However, DD systems show a strong advantage in dealing with motion subtraction during cardiac procedures.
And, yes; as you might have suspected, DD cath systems also have much higher image resolution than their analog predecessors. Resolution will vary from model to model, but by and large, DDs far surpass IIs in this area.
Resolution is, of course, also impacted by post-processing, accuracy, and monitoring etc. Though analog technology is older, quality control in these areas can still enable II images to be relatively clear and reliable.
So, why settle for analog?
By now, you’re probably figuring that this article is an all-out plug for digital over analog. If all you’re looking at is image quality, that’s absolutely true. Analog just can’t compete. But, for so many hospitals and clinics around the world, system quality is far from the only angle they must consider. Below you’ll find a few areas where analog might make more sense.
The Image Intensifier (II):
Remember earlier, when I mentioned how expensive it is to replace an II? Well, what I didn’t mention is that it is even MORE expensive to replace a DD; somewhere in the neighborhood of two to three times more. While DDs don’t degrade in image gain as much, if something else goes wrong, the price tag will be much higher than on the analog II. Part of this is due to the scarcity of digital detectors on the second-hand market. The purchase of a DD is almost guaranteed to be from the OEM.
Like any product, the newer ones always cost more. When purchasing a cath lab service contract to protect your equipment investment, you can expect to pay around 50-60% more for coverage on a DD system.
As facilities make the transition from analog to digital, more and more recently de-installed analog systems are being purchased by parts vendors. This will continue to help drive down the cost of those aforementioned expensive IIs as well as most other parts.
The long and the short
Obviously, there are going to be as many want/need and financial scenarios out there as there are hospitals and clinics. And, aside from the hardware options, there's also software, procedures, workflow, and integrations to consider. Needs in these areas will vary almost too much to comment on and will often come down to preferences and individual specialties.
In spite of this range of situations, we can offer these comments relative to hardware costs:
On the higher budgetary end, we suggest a digital detector cath lab for optimum image quality. However, bear in mind that a chunk of your budget should also be reserved to take care of those larger parts and service costs.
For facilities under tighter monetary constraints, a better solution may be the purchase of a late-model used analog system. While the image won’t be able to approach the clarity of a digital system, analog technology has been used for years and is still viable and reliable for interventional use.
The long and the short of it is; digital cath labs offer great hardware perks. If you can swing it, you won’t be disappointed. If you can’t, an analog cath lab can still hold you over until the economic winds push you into better financial straits.