Mr.
C(EO)MOS

What moved you to join Ziehm Imaging back in 1994?

That was more or less a coin­ci­dence after I got my degree. Ziehm Imaging was looking for engi­neers and assigned me to the depart­ment that devel­oped image con­verter mod­ules for x-rays. I enjoyed the work and it excited me from day one. And I enjoyed it back then, it didn't occur to me that I might be leading the com­pany someday.

Twelve years later, you were then appointed CEO. Since then, you are on the road a lot and have all kinds of com­mit­ments. How much can you really still get involved in the actual prod­uct devel­op­ment these days?

That's some­thing that is still very dear to me. The fact that I'm on the road a lot means that I get to see the differ­ent require­ments of the inter­na­tional markets and can give feed­back to our devel­op­ers. But especially when things get tough, and we need to be at a dead end with a prod­uct, I obvi­ously try to help and coordi­nate my ideas. In general, I always try to stay as close as possi­ble to what's going on.

In your long career, is there any product that you're especially proud of?

Yes, there is. In fact there are two of them. The first one is obvi­ously the flat-panel detec­tor tech­nol­ogy, because we were so far ahead of our com­pet­i­tors back then. Even though it's been ten years, it's still an abso­lute high­light for me. And the other one, naturally, is the Ziehm Vision RFD 3D, with its fan­tas­tic image quality. We devel­oped a prod­uct that the entire industry envies us for. We're still the one and only com­pany to offer a mobile 3D device at this level.

Apart from the successful prod­ucts, why have you stayed loyal to Ziehm Imaging for so long?

I like the medical technology industry and the people who work in this very highly specialized world. At the same time, the technology fasci­nates me. A C-arm has so many com­po­nents and parts that all have to work. It feels really great to make appli­ca­tions in the health sector better and safer and help patients in this way.

When you look back at the past 22 years at Ziehm Imaging, how would you describe the com­pany's devel­op­ment?

When I joined Ziehm, the economic situation wasn't very rosy. There were a lot of challenges and the prod­uct was obsolete. Mr. Ziehm, the com­pany founder, was hiring new engineers back then, and I was one of them. But the most difficult phase was back in 2003 after our acqui­si­tion of Instru­men­tar­ium, when we practi­cally became our own direct com­pet­i­tor. That wasn't very com­fort­able for me, it was uncom­fort­able for a lot of employ­ees. But since we became inde­pen­dent in 2004, we have been able to con­tinue our devel­op­ment under Aton. The past ten years have been espe­cially suc­cess­ful for Ziehm Imaging, with con­tin­u­ous expan­sion across the board.

What does the rapid growth mean for Ziehm Imaging?

On the one hand, growth means more satisfied cus­tom­ers. In Germany, we have always been very strong. But we owe our growth in the recent years partic­ul­arly to inter­na­tional markets like those in the US, China or the Middle East. Growth also allows us to secure existing jobs and create new ones. We also want to have a certain impulse in order to keep expand­ing our lead­ing edge in tech­nol­ogy. In other words, if you want to achieve more, you have to sell more. And we're work­ing to meet this goal at all times.

What's in the future for Ziehm Imaging?

Our increased sales of high-end devices will con­sol­i­date our position as a market leader in Central Europe. In this segment, the demand for 3D navigation in mobile imaging is especially great. And of course we plan to expand our international growth by developing and marketing new prod­ucts, by obtain­ing approvals in China, Latin America, and other parts of the world, and by oper­ating our local sales system. But the key factor for our con­tin­ued growth is our broad prod­uct portfolio.

Technical innova­tions are a pre­req­ui­site for growth. What mobile X-ray imaging trends will play impor­tant roles in the future?

There's a lot happen­ing in the area of inter­ven­tional sur­gery, spe­cif­i­cally in vas­cu­lar sur­gery and cardi­ol­ogy. In these areas, C-arms are get­ting closer and closer to achieving the capac­ities of the fixed installed units. We're meeting this demand by offering our mobile Hybrid Edition, which was devel­oped for hybrid oper­a­ting rooms. Top image quality is key here, and we are improving our prod­ucts with new tech­nol­ogies on an ongoing basis. The second big trend involves intra­oper­ative navigation-guided 3D imag­ing. While this topic is well-established in some high-end markets, it hasn't yet arrived every­where in the world. We have started to make inroads, but there's still a lot to do in this area.

Ziehm Imaging's closest com­pet­i­tors are large com­panies. What advan­tages does Ziehm Imaging offer com­pared to its com­pet­i­tors?

We focus exclu­sively on the mobile C-arm. That makes us much more flex­i­ble. For instance, we are able to imple­ment new ideas and demands much more quickly than our big compe­titors. And we're also able to respond to our customers' wishes much more pre­cisely. A good exam­ple of this is the flat-panel detec­tor: At Ziehm Imaging, we have used flat-panel detec­tors for ten years and are already launching the next gener­a­tion on the market. Some of our compet­i­tors have yet to do this. We're a great exam­ple of Germany's suc­cess­ful SME sector. We're small, but specialized, and when it comes to technology, we're cutting-edge.

Ten years of flat-panel technology marks a milestone for Ziehm Imaging and constitutes a paradigm shift for its customers. In your view, what is the advantage of flat-panel detector technology compared to con­ven­tional image inten­si­fiers?

The flat-panel detector enables the C-arm to have a larger opening, which gives the physi­cians more space near the patient and allows them to work with their instru­ments unim­peded. The images are abso­lutely free of distor­tions, and the contrast and image quality are undoubt­edly better than that of the image inten­si­fiers commonly used in the past. On top of that, we are able to design imaging more intel­li­gently, working with lower doses and at the same time, optimizing image quality. All in all, the flat-panel detector is a more modern pack­age that offers more options. Of course, it also costs more than a con­ven­tional image inten­si­fier. In the high-end sector, that isn't really a major factor, but in the low-end sector, con­ven­tional image inten­si­fiers will continue to be the standard for a number of years due to the lower price tag.

In 2006 you were the Vice President of Global R&D. You were probably closely involved in developing the first flat-panel detec­tor at Ziehm Imaging. Can you recall the first discus­sions and conver­sa­tions about this invention?

The develop­ment goes back much further than that. We first started talking about it back in 2000. Back then, we all knew that it was the tech­nol­ogy of the future. As a tech­nol­ogical leader, our declared goal was to break new ground. So we unan­i­mously decided that we not only wanted to develop the flat-panel detec­tor tech­nol­ogy; we had to actually do it.

At the time, Ziehm was ahead of the compet­i­tors. The big rivals took a long time to kick into action. Does this make you proud?

In 2006, we were certainly proud of our achieve­ments. Today, it's an expec­ta­tion that we have set for our­selves and one that we use as a bench­mark for achieve­ments. That's why it's impor­tant to keep setting new accents. The flat-panel detec­tor alone is no longer enough. It's now especially impor­tant to logically integrate it into our sys­tem and to explore what we can achieve with the overall sys­tem. 3D imaging is a good exam­ple of this. With­out the flat-panel detec­tor, we wouldn't be able to move around the oper­a­ting table and wouldn't be able to provide the image quality we have today. So you see, in the end, the flat-panel detec­tors will con­tinue to be a very impor­tant ele­ment, even if it is not the key element.

What is your prognosis? What detec­tor tech­nol­ogies will shape the future?

I see different directions for the future. CMOS will definitely play an impor­tant role. These detec­tors are already on the market and various manu­fac­turers, from the big players in the industry, as well as com­pa­nies in China, Korea and the United States, are address­ing this new tech­nol­ogy. To date, flat-panel detec­tors have used amor­phous sili­con (a-Si), and this tech­nol­ogy will also con­tinue to be refined in the future. Today, the image inten­si­fier is still the pre­vailing prod­uct in our busi­ness, but in the future, more and more com­pa­nies will be putting flat-panel detec­tors on the market.

You just used the term CMOS. For us tech­nol­ogy novices, can you describe how the new CMOS tech­nol­ogy works, for dummies?

A CMOS detec­tor is like any other detec­tor. Its primary func­tion involves pro­vid­ing an image. But what sets CMOS apart is the higher sen­si­tiv­ity that enables smaller pix­els to be dis­played with a lower dose while pro­ducing the same quality. That per­mits us to achieve higher res­o­lu­tion with the same dose. Or con­versely, you need a lower dose to achieve the same res­o­lu­tion. You can com­pare it with the latest smart­phones and the ones a-Si uses today. While it was pos­sible to take adequate quality pic­tures with the older smart­phones, the quality of the pic­tures provided by the new models is expo­nen­tially better.

What do you think are the overall advan­tages of CMOS?

To put it in a nutshell, the clinical advan­tages are definitely offered by the improved image quality, the high res­o­lu­tion and the lower dose.

How long have you already been toying with the idea of this tech­nol­ogy?

For about six or seven years. It took a long time to translate this tech­nol­ogy into an industrial prod­uct. On top of that, we had decided to develop our own Ziehm detector. Now we have finally gotten to where we wanted to go: We have our own CMOS detec­tor that is exactly tailored to our needs.

Were there any critics of CMOS out there, and if so, how do you respond to them?

Of course there were, and there are still some around. I heard criticism or skepticism from various camps. In the end, though, the out­standing per­for­mance of the panel speaks for itself. The industry agrees the CMOS panels let you achieve the same image quality with smaller pix­els and still get a higher res­o­lu­tion. The criticism usually has to do with cost effec­tive­ness. That's why CMOS panels are mostly used in expensive high-end appli­ca­tions. We'll have to see how this devel­op­ment unfolds in the future. Right now, the spot­light is on us.

In addition to the new CMOS detectors, Ziehm Imaging will also con­tinue to use the tried and true detec­tor tech­nol­ogy. What is the advan­tage of the con­ven­tional a-Si detectors?

CMOS is especially cost effec­tive when it is used for smaller formats. While you can also pro­duce larger-scale formats, the larger the format, the more advan­tages offered by an a-Si detector. That's why the two tech­nol­ogies are both in place and both of them will con­tinue to be refined.

So how does the story end? Will the new modern CMOS tech­nol­ogy become the new leader in mobile X-ray imaging?

Yes, it will, but cer­tainly not in all areas or for all devices. It's similar to the auto­mo­tive world. There you also have whole range of models, including com­pact, mid-sized and luxury models. While not every­one will choose to buy a top-class model, those who opt for high-end oper­a­ting room equip­ment will be "driving" with CMOS technology.