To the Point
By Keith Loria
Radiology Today
Vol. 25 No. 2 P. 16

Portable X-ray is making a difference at the point of care.

Handheld DR systems are becoming a gamechanger in the industry, as several companies are bringing these systems to market for the first time. The capabilities of many handheld DR devices allow them to be used almost anywhere, such as out of hospital settings, in emergency response vehicles and helicopters, on the sidelines of sporting events, in military settings, in remote living areas, at pop-up clinics, and for disaster response scenarios. The systems offer broader access to care, efficiency, safety, and convenience.

Mobile Screening
Fujifilm’s FDR Xair is currently pending regulatory approval in the United States; however, it is being used in other parts of the world, capturing thousands of images in Europe, Africa, South Asia, and Southeast Asia.

“The system is an ultralight, compact, battery-powered, handheld X-ray combining the latest compact X-ray tube and battery power technologies with Fujifilm’s high-sensitivity image capture and image processing technologies,” says Rob Fabrizio, the director of strategic marketing, diagnostic imaging for Fujifilm Healthcare Americas Corporation. “Easy to carry, handle, and operate, the FDR Xair facilitates X-ray acquisition and diagnoses in various medical settings, serving patients with limited mobility or people living in inaccessible remote geographies, even areas without electricity.”

The system consists of a handheld X-ray device; Fujifilm’s ultralightweight, glass-free detector; and a lightweight convertible tablet laptop.

“The FDR Xair handheld X-ray weighs just seven pounds, is battery powered, and can be carried in a backpack,” Fabrizio says. “The system’s built-in lithium polymer battery lasts up to 100 images in environments where there is no electricity. The width of the product is 30 X 25 X 14 cm, and it has a highly durable LED light source, which is also beneficial for imaging in locations where there is no electricity.”

The FDR Xair can reach remote parts of the world, and the system is currently being used to expedite the process of tuberculosis (TB) diagnosis in areas with limited resources, including in Pakistan’s mountainous regions, India, Vietnam, and other countries. Additionally, the FDR Xair has reached vulnerable coal miners in Pakistan’s remote region of Lakhra in Sindh province.

“In 2021, we announced that the FDR Xair System was added to the Diagnostics Catalog of medical devices as a recommended chest X-ray system for tuberculosis diagnosis,” Fabrizio says. “Through our efforts, we have reached thousands of patients, and many who were diagnosed with TB immediately after the screening, as medical professionals can determine the diagnosis right away.”

The catalog is issued by the Global Drug Facility under the “Stop TB Partnership” in collaboration with the World Health Organization. Through this, Fujifilm supplied the FDR Xair System to public medical institutions, nongovernmental organizations, and nonprofit organizations involved in TB eradication through the Global Drug Facility.

“In addition to the system helping [with] TB screening in emerging countries, the FDR Xair System was used as a chest X-ray device for diagnosing pneumonia amid the COVID-19 pandemic,” Fabrizio says. “The handheld portable X-ray has been donated to countries including Cambodia, as part of the Japanese government’s official development assistance for developing countries in combating COVID-19, and Vietnam, under the Grant Assistance for Grassroots Human Security Projects.”

Point-and-Shoot Capability
OXOS Medical develops ultraportable X-ray solutions that allow providers to easily capture high-quality static and dynamic images with minimal radiation. The company recently created a “radiology department in a box,” which allows radiographic imaging to be performed in settings where traditional X-ray systems are inaccessible or impractical. The system is lightweight and battery operated. It includes an ondevice screen viewfinder, on-device AI algorithms, lower radiation profiles, and point-and-shoot user interfaces.

“In short, we want to make X-ray imaging safer, simpler, and more accessible,” says Evan Ruff, CEO of OXOS Medical. “Beyond portability, we’re enhancing imaging through advanced technology and artificial intelligence. We use AI to streamline device calibration and have innovations in our near-term roadmap to tap AI to finetune imaging alignment and radiation output, reducing reshoots and exposure.”

According to Ruff, the company’s portable X-ray solutions are bringing point-and-shoot to X-ray. For example, in professional sports, they allow team doctors to make real-time decisions about player injuries without using third-party equipment and lengthy delays for imaging. Kevin Kaplan, MD, an orthopedic surgeon and head team physician for the Jacksonville Jaguars, has been using OXOS’ handheld DR device for more than three seasons.

“As the head team physician for the Jaguars, my priority is to ensure the best possible care for the players,” Kaplan says. “The athlete’s history, physical exam, and radiographic evaluation are all crucial in determining whether players are safe to return to play. OXOS allows me to scan the players’ extremities with both static and dynamic techniques, which is far superior to traditional X-rays.”

In Kaplan’s opinion, the image clarity is better than other devices on the market. “Its clarity of picture is better than any device available on the market. Its portability and freedom of motion allows us to take it where care is needed. Its versatility enables me to diagnose players even when I am not on site. Its safety profile, with significantly less radiation, is unmatched – it is much safer than all existing options for the doctors and technicians and for the players too.”

Many other physicians are using it, as well. “For children, whose growing bodies are more sensitive to radiation—and can be tough to get to sit still for an X-ray— the low radiation profile and reduction in reshoots are transformational,” Ruff says. “In remote areas, we empower doctors to serve more patients with improved quality of care that wasn’t possible before. Even in traditional settings like hospitals and orthopedics practices, OXOS ultraportable X-ray devices can reduce the need for patient transport.” OXOS has also worked with VA physicians to improve access to imaging across its facilities.

The company is currently awaiting FDA 510(k) clearance on the latest iteration of its device. “Generally, the device has an output of 80kV, 2.0 mA, with a 9” detector,” Ruff says. “Once approval comes through, we can provide finalized specifications.”

Extreme Environments
MinXray offers the Impact system, a complete portable DR system designed and developed to provide radiographic imaging capabilities in locations or situations where traditional X-ray systems are not available.

“MinXray’s Impact system is portable and powerful and has FDA 510(k) [approval] for whole body imaging,” says Mike Cairnie, MinXray’s director of global sales. “The system is available with AI software and is customizable in packaging depending on the needs of the customer. Due to the interchangeable/rechargeable batteries, it is possible to image hundreds of patients in a single day.”

Currently, MinXray’s Impact system is being used globally for TB screening in extremely remote locations such as northern Nigeria and the South Pacific. MinXray has even taken the Impact system to the Mt Everest Base Camp (elevation 17, 598 feet) to provide imaging services. In the past, those patients would have had to descend the mountain for comparable services. MinXray has also tested the system in zero gravity to prove it can successfully perform in space.

“The Impact system has proven to be extremely capable of providing exceptional service in extremely remote and austere areas of the globe,” Cairnie says. “It is now possible to transport a complete digital radiography system in a backpack for use in remote locations where diagnostic radiography capabilities were not available in the past.”

Added Flexibility
Since handheld DR is extremely lightweight and compact, it introduces groundbreaking portability, bringing imaging to patients’ homes, places where space is limited, and remote areas. In many cases, it brings imaging access directly to patients in places where these services have been either very difficult or impossible to deliver.

Additionally, handheld DR may help patients feel less intimidated about receiving an X-ray, as the device is small and the operator is much closer during exposure. This can help ease the exam and treatment process for many patients, such as pediatric patients, geriatric patients, or patients with anxiety.

“In terms of economics, handheld DR doesn’t require installation, reinforced walls, electrical work, or cabinetry that takes up space,” Fabrizio says. “This can be beneficial for small facilities and facilities that simply do not have space but need to have cutting edge X-ray technology on site to diagnose patients quickly.”

Ruff notes that handheld systems provide enhanced accessibility and convenience for hospitals and doctors, as the systems offer flexibility and don’t require much infrastructure. “This flexibility means care can be delivered where needed without traditional, stationary X-ray equipment constraints,” he says. “Portable imaging also improves efficiency and speed, enabling quick diagnosis and treatment, as the systems can be used right at the point of care. This immediacy can be crucial in emergencies or for quick decision- making in sports medicine.”

Another important aspect for many facilities is that these systems can reduce costs. By using portable imaging, hospitals can reduce the costs of transporting patients to radiology departments. “It reduces the need for large, dedicated radiology suites, which can benefit smaller clinics or resource-limited settings,” Ruff says. “Finally, it can also improve revenue. Whether it’s a professional athlete getting back on the field quicker and avoiding missed minutes or operational and clinical efficiencies in a traditional health care setting, portable imaging that’s safe and accurate helps reduce cost and contributes to the bottom line.”

From a population health standpoint, the systems can improve access to care, particularly in underserved or remote areas where access to radiology services is limited. They can also be a catalyst for health care equity—portable imaging can help bridge the gap in health care delivery, providing high-quality diagnostic tools to populations that might otherwise have limited access to such technologies.

The Future of Handheld DR
Looking to the future of portable DR, the field is at a crucial juncture. Several key innovations are set to redefine its trajectory.

“AI is poised to play a transformative role in diagnostics and the administration of imaging tests,” Ruff says. “By optimizing device calibration, aiding positioning, reducing signal noise, and minimizing radiation exposure, AI will continue to improve both safety and efficacy in medical imaging.”

The trend towards portability reflects a shift in health care needs, bringing imaging capabilities directly to the point of need in diverse settings. This portability, coupled with the growing demand for device modularity, opens new doors in care delivery, particularly in areas such as skilled nursing facilities.

These developments—AI integration, portability, and modularity—are more than just trends; they represent a paradigm shift in medical imaging.

“As health care moves towards value-based models, these advancements in portable digital radiography are crucial for improving care delivery’s final mile, making it more flexible, efficient, and patient-centric,” Fabrizio says. “This is a journey towards truly exceptional care, driven by innovative technology.”

— Keith Loria is a freelance writer based in Oakton, Virginia. He is a frequent contributor to Radiology Today.