Tag Archives: Bhvita Jani

Signify Premium Insight: MRI and Meeting the Need for Better Imaging

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Research Manager
Bhvita Jani

As highlighted in the recent Premium Insights detailing Signify Research’s expectations for RSNA 2022, there is significant focus and expectation surrounding the advanced imaging modalities, and in particular MRI. Such a focus was borne out in Signify Research’s MRI Equipment – World – 2022 report, which highlighted the potential for MR imaging in the coming years.

There are several reasons for this potential, explains Research Manager for Medical Imaging Bhvita Jani, a turnaround, she explains, that is particularly remarkable given the market’s tribulations during the worst of the Covid-19 pandemic.

The Signify View

“As happened in several advanced imaging technology markets, the MRI market was very negatively impacted by Covid 19. After all, MRI wasn’t only irrelevant for Covid-19 detection, but systems also have a very high price point, a difficulty at a time when providers were stretched.

“As such, there were a lot of orders and sales that were delayed. The exact impact varied from region to region, but overall, we did see a significant drop from $4.7bn in 2019 to $4.4bn in 2020.”

This decline was most apparent in North America and Asia Pacific, where revenue fell  by 10.4% and 9.8% respectively as providers channelled resource to Covid diagnosis and care, delaying many of the elective procedures for which MRI is most commonly used.

This dip was short-lived, however. “In 2021 there was a strong rebound of MRI sales revenue as order backlogs were starting to be fulfilled again, while additional time-sensitive health funding allowed providers to invest resource in modernising imaging equipment. This was particularly true for MRI as providers began to deal with the backlog of elective procedures,” continues Jani.

“Starting with that performance in 2021, the market is continuing to grow in the range of four to seven percent on a year-by-year basis over the forecast period.”

Market Movement

There are several reasons for these strong growth prospects. In many emerging markets there is predominantly new demand for MRI systems as a greater number of providers look to expand access to MR imaging, leveraging additional COVID funding to support investment.

There are also some significant trends in more mature markets. Among them is the rapid pace of technological development. Over recent years there have been innovations such as portable weight-bearing MRI, helium-free MRI and ultra-high field MRI, supporting both entry into emerging markets but also new applications in mature markets.

“Even though some demand is stemming from expansion into new settings, workhorse 1.5 Tesla and particularly 3 Tesla systems are expected to also provide a significant growth driver. New image acquisition technology (exemplified in Siemens Healthineers’ latest 3T MRI launch ahead of RSNA) really showcases that attention on high-end MRI is not dwindling – if anything, as emerging markets get hit by global recessionary impacts the mid and high-end markets will be the main positive drivers of growth mid-term.”

Furthermore, the integration of MRI into clinical workflows as well as broader system efficiency are also a key focus.

“Faster scan times, utilising AI for image reconstruction and reducing the time spent on protocolling are also key for competitive differentiation. AI is one of the tools that vendors are turning to, enabling them to automate a greater portion of the operational workflow, including patient positioning, scheduling and scanner servicing, and fleet management and remote diagnostic tools.

“There has also been innovation with a more clinical focus. With some providers, for example, focusing on how MRI can be better used in certain applications such as neurology, cardiology, orthopaedics and general surgery.”

Such innovations, and such focus on how providers can get value from solutions will help vendors to continue to make sales, giving hospitals a reason to refresh or replace their product ranges, while also helping providers deal with some of the challenges that they are presently facing.

Size Matters

Along with the healthcare-specific challenges that providers and vendors have been forced to tackle in the wake of the coronavirus pandemic, vendors must also deal with growing economic uncertainty, and the change it presages. Amidst this change, some lesser-known vendors that serve specific niches or specific market segments may hope that they can benefit from changing conditions. This looks unlikely however, with around 95 percent of the global MRI market accounted for by just six vendors, and 85 percent of the market accounted for by just three vendors.

“Any change to this picture looks unlikely,” states Jani. “It’s the major players; Siemens Healthineers, GE HealthCare and Philips which are set to continue to do well in coming years thanks to their robust and broad product portfolio which caters for all ends of the MRI spectrum. It is not just factors around MRI modality portfolios that matter though – as providers look to de-risk future investments and better manage imaging assets, wrap around ‘solutions’ such as fleet management, services, analytics, and professional services, of MRI are all important factors in procurement for customers, for which the market leaders have a strong reputation.

“They also have strength globally, which sets them apart from the relatively smaller entrants, Canon Medical, Fujifilm and United Imaging, which are still very reliant on their domestic markets. Despite this, Canon Medical has strengthened its position and sales capacity in its overseas markets, including the United States.

“Furthermore, I expect that with the current economic pressures that are being faced by providers, there will be some opportunities for vendors such as United Imaging to expand beyond their domestic markets, and make some headway in more mature markets. This is especially likely in more price-sensitive markets, as market leaders ‘bake-in’ inflation-proof pricing schemes in the short and mid-term.”

“This opportunity is limited though,” continues Jani, “The established leaders have worked to establish longer-term contracts and managed service agreements, as well as brand loyalty. These make it harder for newer entrants to displace them. Additionally, there is also a lot of pent-up demand, notable in the market leaders’ reported record order books, which will continue to strengthen the market leaders’ market positions.”

Improving Imaging

Despite these competitive differences, there is no reason to think the complexion of the market is likely to change significantly over the forecast period. Instead, provided vendors have the portfolio to match providers’ requirements, sound growth can be expected. This fundamentally is a result of increased demand for better clinical precision and diagnostic outcomes.

The vendors that thrive over the coming years will be those that are best able to meet this  demand for advanced imaging capabilities across their ranges, while navigating inflationary pressures, supply chain disruptions and potentially capped R&D budgets. There will, no doubt, be some interest in niche products for very specific use cases, but broadly, it is the vendors that are already in the most dominant positions that are best placed to keep innovating. Demand, despite some of the economic headwinds facing global markets, looks very robust. Good news for major healthcare technology vendors that rely heavily on the MRI segments as a leading sector for growth and profit margin.”

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Signify Premium Insight: What Providers Want – Keeping Demand for CT Systems High

This Insight is part of your subscription to Signify Premium Insights – Medical ImagingThis content is only available to individuals with an active account for this paid-for service and is the copyright of Signify Research. Content cannot be shared or distributed to non-subscribers or other third parties without express written consent from Signify ResearchTo view other recent Premium Insights that are part of the service please click here.

Research Manager, Bhvita Jani

As with many medical imaging modality markets, the story of CT is closely entwined with the all-encompassing story of the Covid-19 pandemic and its spread around the world. This story is detailed in Signify Research’s CT Equipment – World – 2022. But, as the report’s author, Research Manager Bhvita Jani explains, the effects of the pandemic are nuanced and will affect the market for years to come, while other clinical trends and technological innovations are also set to have a significant impact.

The Signify View

In China, the first country to be affected by Covid-19, CT quickly became the preferred modality for the diagnosis and assessment of the infection. As a result, demand for the modality quickly increased.

“However,” explains Jani, “given this significant increase in demand in China, there was some expectation that there would be a similar increase in demand across the rest of the World. What actually happened was that while some countries, particularly in Western Europe adopted CT as the main diagnostic modality, most other countries used mobile DR as the first diagnostic imaging tool, and only used CT to monitor critical cases.

“Even with some increased demand in the US, and Asia Pacific, for example, and emergency funding made available to pay for equipment purchases, in many cases in developed countries, hospitals had spare capacity with the systems which were already installed. So, unlike in China where CT systems were already operating at full capacity, these countries didn’t need large numbers of extra systems to meet the increase in demand.”

Even without some of the anticipated demand for CT systems coming to fruition in 2020, it still represented a significant jump from 2019, reaching $5.1bn globally in 2020, up from $4.1bn in 2019. Despite this rapid increase in 2020, however, further growth is still anticipated over the report’s forecast period until 2026.

High vs Low

“There are still moderate growth prospects from 2021 to 2026,” Jani continues, “With a 3.7% CAGR for the period.”

“What we’ve found is that, as a result of CT’s use in Covid care, there were more sales of the lower end of vendors’ portfolios, the 17-63 slice systems, in 2020. That product segment had one of the largest increases in 2020. In 2021, this dynamic shifted, and most growth came from hospitals modernising their fleet of CT systems, in order to better deal with the backlog of procedures delayed amidst the disruption caused by Covid in 2020.

“There is still demand for the lower tier products, but this is mainly in developing markets which are aiming to expand access to advanced imaging. However, in developed markets, demand is highest for mid-to-high end offerings, as hospitals face huge waiting lists and want access to the latest available clinical capabilities.”

The impetus to upgrade to more modern systems is therefore currently high. Many providers are looking to take advantage of CT imaging and the technological developments in the CT space over recent years. Reductions in dose, reduction of scan times, improved image quality and better efficiency all have made CT more attractive across a range of clinical settings including neurology, musculoskeletal imaging, cardiology and orthopaedics.

“This is particularly true on the software side,” notes Jani. “CT is an advanced imaging technique, which means that scan times and the time it takes for post processing images can be high. That means there is a lot of opportunity for innovation to make significant improvements. So, in developed markets in particular, providers are willing to upgrade to access the better operational features which allow higher patient throughput, more accurate patient positioning, bespoke software applications for dedicated clinical use cases and other features that can help improve a hospital’s operational workflow.”

The Next Technologies

Vendors are also making technological leaps on the hardware side, with two of the most significant innovations being dual energy or spectral CT and photon counting CT. The commercial impacts of these technologies varies throughout the forecast period, with the impact of photon counting CT in particular likely to be slight.

Though dual energy devices do not provide as greater image quality and definitive tissue characterisation as PCCT devices, they are more affordable and accessible, and so will have a continuing impact in the CT market over the short- and mid-term in developed economies, and a growing role in developing and emerging economies over the longer-term. Commercialisation of photon counting CT is not expected to accelerate for around five years with widespread use expected to take even longer, at around five to seven years. However, there is expected to be continued investment and uptake at leading university hospitals, which will continue to demonstrate the clinical benefits of the technology. The price, however, at around 50 percent more than other top-end scanners, will remain a barrier for the immediate future.

This is less of a hurdle for dual energy CT which is already deployed in China, and tends to be more affordable than photon counting CT, but longer term, photon counting CT, at least according to its acolytes, is expected to become ubiquitous.

“It’s a technology that offers better image quality [compared to conventional CT], decreased noise, better spatial resolution, lower radiation dosing and better tissue determination, so when it comes to diagnosis and treatment planning, its impact could be dramatic,” Jani explains.

“But, until there are more entrants to the market which will help to bring down the price, these impacts are still some way away. Other entrants are beginning to emerge though, Siemens Healthineers received FDA approval for a photon counting CT system in late 2021, while Samsung Neurologica was the second vendor to receive approval in March 2022 for its mobile photon counting CT system. Other vendors such as GE HealthCare, Philips and Canon are also developing products. These are in the testing and evaluation phase are still not commercially available, but should lead to a decline in prices when they enter the space commercially.”

There are other factors that will also improve the affordability of such systems over time.

“Photon counting CT requires considerably more computing power to process the vast amounts of data generated. The cost of this processing power will inevitably fall in the coming years.”

The Way to Work

One of the other technologies driving CT sales growth is artificial intelligence. Much of the excitement surrounding AI focuses on image analysis, but for CT, the technology can also offer significant advantages across an imaging workflow.

“In CT, AI is typically being used in edge applications,” comments Jani, “there is a focus on the operational aspects of CT imaging such as dose reduction, patient positioning, image acquisition and image reconstruction.

“What this means is that in developed healthcare settings, high-end hospitals are increasingly starting to purchase premium CT systems with embedded AI as they are able to benefit from the increased patient throughput that these systems offer.

“This continued focus on reducing scan time, increasing operational facilities, increasing the return on investment, and all these tasks that AI is being used for, is giving providers a reason to upgrade before systems were originally meant to be ready for replacement.

“The CT image analysis market, on the other hand, is primarily being driven by start-ups and scale-ups, alongside modality vendors. This is being driven by several high-value clinical applications, such as coronary artery disease, cardiac assessment, stroke assessments, chronic lung assessment and vertebral compression fractures, while in the mid-term lung cancer, traumatic brain injury, bone density and liver disease are also set to be key clinical use cases driving the market forward.”

Providing for Providers

Although supply to the market is very consolidated, with almost 93 percent of the market accounted for by just six vendors, the current pace of innovation means that CT sales are forecast to grow over the coming years. Short-term challenges such as the logistical headaches and component shortages affecting most areas of medical imaging will cause costs to rise for users, but these aren’t expected to dampen demand.

Instead, new features, new capabilities, and new opportunities afforded to providers will keep demand high.

“There is currently a lot of focus on usability, with consideration given to noise reduction, reliability, enhanced image quality, ease of operation, faster throughput, and more efficient image acquisition all taking a central role.

“Futuristic technologies such as photon counting CT will maintain this momentum in the years ahead, while a diverse portfolio, serving both the performance as well as the high-end market will help current sales.

“In the end, what this comes down to,” concludes Jani, “is putting providers’ needs first.”

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Strong Revenue Recovery of 15% for Fixed Digital Radiography in 2021, Whilst Fluoroscopy Grew by 18% Year-on-Year

Co-written by Graham Cooke

The fixed digital radiography (DR) rooms market experienced strong growth in 2021, with 15% growth in revenue reported, with revenues estimated at $1.2 billion. Likewise, the fluoroscopy X-ray market returned to growth after a year of retraction in demand in 2020, with 18% year-on-year growth in 2021, with an estimated market size of $509 million. These figures, taken from Signify Research’s General Radiography and Fluoroscopy – World 2022  report, show a strong recovery from the challenges experienced during the heights of the COVID-19 pandemic.

Demand returns to fixed room radiography in 2021.

Demand for fixed room digital radiography systems returned to growth in 2021, as procurement budgets were made available, having been temporarily diverted to fund mobile X-ray purchases in the early phases of the pandemic. This allowed previously planned projects to resume, and upgrades and replacements to be installed. For developed regions and countries, higher end features to help tackle the backlog are now increasingly sought after, including auto-positioning, cameras to ensure minimal patient movement before imaging and AI based image analysis. Such features improve workflow, increase the throughput of an imaging department, and should help healthcare providers gradually clear some of the backlog created from the pandemic.

Conversely, the digital mobile X-ray market retracted by 18% in revenue terms in 2021, closing at $684 million. However, this decline was not as severe as previously forecast, with some sustained demand remaining. During the pandemic, obvious benefits of mobile imaging were reinforced, including portability for bedside imaging. Growth is expected to return for mobile DR in 2024, as replacement of older mobile systems drives demand.

For mobile radiography, the importance of brand loyalty in purchasing decisions also returned, after temporary focus solely on inventory available during the pandemic. This allowed, smaller, local vendors to win significant share in new markets as they could service demand from local inventory more readily than global brands. Once global vendor inventory returned to a more normal level, purchasers often reverted to previous purchasing habits.

The general radiography market has experienced issues across the supply chain. Many components, including steel and semi-conductors, are in short supply. Coupled with rising costs of transportation and limited availability of shipping, average selling prices are expected to rise by approximately 8% in the short term for general radiography systems, before stabilising and declining again. This is also adding to lead times for projects, with systems taking a lot longer to reach customers.

Fluoroscopy also returned to growth, but demand is expected to become more specialised

Demand for fluoroscopy also returned to growth in 2021, with 18% year-on-year revenue growth to $509 million reported, up from $431 million in 2020.  However, fewer fluoroscopic procedures are now being performed, with other modalities like CT and MRI taking precedence for procedures traditionally conducted on fluoroscopy systems. Upper GI and barium swallow procedures remain the most procedures maintaining clinical demand for fluoroscopy and will remain essential for the long-term health of this modality.

With fewer fluoroscopic exams being performed and increased focus on return of investment in purchasing decisions, multi-purpose systems are now even more desirable, especially in North America and Western Europe.

Fluoroscopy revenues will surpass 2019 pre-COVID levels next year, but growth will be limited after this, as other imaging modalities continue to challenge fluoroscopy. The fluoroscopy market is set to reach $614 million by 2026.

Key trends by region

North America

  • The US continues to be one of the few countries still favouring classical fluoroscopy systems, due to historical training practices, concerns of patient movement threatening image quality and potential litigation. Demand is expected to gradually transition to remote systems, as new generations of radiographers are trained on remote systems; classical is however still expected to be dominant in the next five years.
  • In the general radiography market, demand for high end features is increasing, with tools to aid workflow becoming highly desirable for many imaging centres and hospitals.

Latin America

  • The Latin America market continues to be highly cost sensitive, with options like computed radiography, retrofit and analogue systems remaining popular. For many end users, there is a desire to digitalise, but currently, the price point remains prohibitive. For the digital solutions that are sold, low-end systems with a lower price point are by far the preferred option – over 50% of fixed and mobile solutions revenue came from the low-end in 2021.
  • Fluoroscopy remains a very small market in Latin America, with the high price point proving a significant barrier for entry to this market. Brazil is the largest adopter of fluoroscopy in the region, with most other Latin American countries seeing minimal sales.

Western Europe

  • High-end product continues to dominate the general radiography market in Western Europe, with 68% of revenue for fixed room product coming from High-end in 2021. Floor mounted systems sell more in unit terms in Western Europe, but with a lower ASP, revenue from ceiling mounted solutions accounts for a higher proportion of the market.
  • Most Western Europe markets have limited demand for fluoroscopy, with France being the key exception. Almost 30% of all revenue in Western Europe comes from this country. France is also unique in that many healthcare providers prefer to use dedicated fluoroscopy systems, rather than multi-purpose which is generally utilised in the rest of Western Europe.

Eastern Europe, Middle East and Africa (EEMEA)

  • Parts of EEMEA remain very cost sensitive, with Africa and less developed countries in the Middle East seeing high adoption rates of computed radiography, analogue and retrofit. For many, digital solutions are too costly, especially with the added infrastructure costs to enable PACS and other healthcare IT solutions on top of the imaging systems. Servicing imaging equipment can also be a barrier to adoption, with few engineers available locally to quickly fix broken systems.
  • Fluoroscopy remains very small for most of EEMEA. The areas that have stronger installed bases are in French-speaking north Africa, where demand follows France. In parts of the Middle East, such as in Saudi, some trends follow the US, as some radiographers were trained in the States, and therefore follow classical fluoroscopy installation practices.

Asia Pacific

  • Asia Pacific remains cost sensitive in many parts of the region, with 57% of fixed room revenue coming from the low-end segments. In countries like India, high levels of analogue and computed radiography remain significant. In China, CT imaging is increasingly preferred over high-end digital radiography.
  • Japan remains essential to the long-term growth of the fluoroscopy markets, with 45% of all unit sales in the region coming from this country alone. Elsewhere, demand is minimal with costs proving prohibitive to adoption.

Competitive landscape

A return to a more conventional vendor landscape was evident in 2021, with global brands such as Siemens Healthineers, GE HealthCare and Philips regaining market share temporarily lost during the pandemic when demand outstripped the available supply. With these vendors able to fulfil demand, smaller local vendors dropped share.

In the fixed DR market, Siemens Healthineers strengthened its position, with a gain of 2.5 percentage points.  For Mobile DR, GE reclaimed the top position, as Carestream experienced a difficult year after a very strong 2020.

For the fluoroscopy market, Siemens Healthineers led, with a very strong 2021, gaining further share. Shimadzu follows with strong sales in its domestic market.


The Fixed DR market will continue to recover. Budgets will continue to return for fixed room, and projects previously postponed will be able to restart. Additionally, in some countries like the US, replacement cycles will stimulate further growth towards the end of the forecast. Globally, ceiling suspended fixed room product revenue will grow at a faster pace (5% CAGR 2021-26) than floor mounted (4% CAGR), especially in more developed markets, where the desire for high-end features often found in ceiling-mounted solutions, are increasingly required. Low-end system demand will continue to be driven by cost sensitive markets such as Latin America, Africa, the Middle East and parts of Asia. However, the price of digital solutions will need to significantly reduce to be an attainable option for these regions. Until the price falls sufficiently, analogue, CR and retrofit will continue to play an important role.

Fluoroscopy systems will also see limited growth but will also come under increasing pressure from other modalities like CT and endoscopy. At the end of the forecast, low single digit annual revenue growth is predicted.  In many countries and regions, the demand for fluoroscopy will come predominantly from multi-purpose systems; as fewer procedures are performed on the systems, budget holders will want to minimise downtime by enabling other general radiography imaging.

Signify Premium Insight: Strong Growth and Increased Competition – The Key Trends in the Interventional and Surgical X-ray Markets

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Research Manager Bhvita Jani

Signify Research has recently released its Interventional & Surgical X-ray – World Market Analysis which details the nuance of the market in the face of turbulence brought by the global Covid pandemic, and its subsequent recovery. The interventional and surgical markets were growing reasonably strongly in 2019 before the pandemic, consistently posting growth of mid-single digits. But, these were some of the markets most affected by the pandemic, with restrictions brought in to combat the virus leading to the cancellation of 30%-40% of elective procedures in some countries during the height of the pandemic.

Such a significant fall in procedures led to anticipation of a similar market decline, however, as the report’s author, Research Manager Bhvita Jani, points out, this wasn’t necessarily the case.

The Signify View

“On the Interventional side, the decline wasn’t as drastic as anticipated,” she explains. “There was softening but the drop, given the situation, was moderate with a high-single-digit to low-double-digit declines.

“On top of this we also saw the market bounce back quickly in 2021, so 2022 so far has been very much like a typical pre-covid year. The markets are stable and within the normal range.”

There have been several drivers of this return to normality. “It was in part a recovery after the pandemic, with a return to elective procedures and the fulfilling of pent-up demand, but, what is actually driving a lot of the growth is demographic factors.

“There is an ageing population, obesity is on the rise and the subsequent incidence of related diseases and conditions, such as cardiovascular disease and stroke among other things. All this means that procedures are becoming more complex and hospitals require more complex equipment to carry out these procedures.

“One of the biggest growth segments in interventional imaging is neurology, for example. Lots of developed countries are placing increased importance in dedicated stroke pathways and increasing the number of stroke centres accordingly.”

Perfecting Products

Such factors are not only driving the market forward, they are also shaping the product trends within the market. The increased demand for complex neurology procedures, oncology procedures and cardiovascular procedures means that hospitals are increasingly prioritising advanced multidisciplinary equipment. As such sophisticated biplane systems, for example, are proving increasingly popular in developed markets.

There are also other considerations for vendors looking to capitalise on the growth in the interventional radiology market. Increasingly providers are looking beyond simple transactions for a piece of hardware, and instead are looking to purchase complete patient care pathway solutions.

“So now, when stroke interventional neurology systems are sold, providers want the entire stroke treatment pathway, including the IT environment that can streamline the process,” Jani adds. “So, we expect more of those type of solutions to become available.”

Another factor contributing to market growth is the changes in settings in which interventional systems are used.

“In certain developed markets, one of the biggest growth factors is office-based labs. This growth stems from such labs being more profitable to the interventional radiologist or cardiologist, as it is a lower cost setting, which results in higher reimbursement.

“So, from a business perspective, these settings represent a higher return on investment. These settings are driving new demand, which is growing the market, compared to inpatient settings, where demand for equipment is almost entirely on a replacement basis.”

Global Changes

As well as meeting the distinct requirements of different customer groups, vendors are also having to react to the changing needs of different geographic markets.

“Vendors in India and China are among those disrupting the market, as they are driving down prices and continuing to increase the affordability and access to interventional technology,” Jani notes.

“In some markets, including China and India, governments are actively pushing more local vendors. This prioritisation of local companies and the incentives that are in place, could begin to threaten some of the international players’ share in those markets.”

For these international vendors, this challenge from lower-priced competitors could also exacerbate pressures closer to home stemming from changing purchasing practices.

“Hospitals are increasingly becoming part of bigger hospital chains. This means that the buying power now sits with group purchasing organisations, and that means there is more competition for these deals and more consolidation. Another more direct impact of this is that, with these bulk deals, the average selling price of systems is going down.”

Carry on Regardless

While such trends will have an impact, and there may be some pricing pressures in the market, according to Jani it remains an attractive area for vendors to serve.

“Despite these changes, providers are still keen to invest in very high-end equipment,” she explains.

“I’d say that compared to other areas of X-ray, decisions about interventional equipment are less driven by price. There is still a significant focus given to a system’s specifications, how the equipment can directly impact clinical outcomes, and the preference of the end user.

“This means, that in developed markets, it is a very hard market to disrupt, with hospitals and clinicians unlikely to want to go through the hassle of shifting from one brand’s equipment to another. Providers tend to replace the equipment from one vendor with equipment from the same brand, so it is very difficult for one brand to steal share from another.”

New technologies could, however, make such shifts more likely, with innovations within AI, for example, which focus on features such as radiation dose management or treatment planning potentially giving providers more of a reason to switch to another vendor’s products.

Future Preparation

As well as focusing on these new technologies, there are also other priorities that vendors in the interventional and surgical X-ray markets should concentrate on to best capitalise on market trends.

“While the high end is very important, if vendors want to maintain a market presence in some of the highest growth markets like China and India, they need to have a performance offering as well. This will allow them to continue to compete against the lower-cost system offerings from those countries.

“Another opportunity for vendors is to focus on more sustainable solutions,” Jani continues. “So, for example vendors offering providers software updates when they are launched by the vendor instead of providers being stuck with the software that was current when they purchased the system.

“This goes hand in hand with the increase in smart subscriptions that we are also seeing in the market, which makes the solutions more stable and improves their longevity, giving the vendors that offer these subscriptions an advantage.”

Strength in Surgical

Many of these trends seen in the interventional imaging market are mirrored in the surgical market, although there are some differences. For instance, one of the major trends in that market is the shift from image intensifier-based systems to systems that use flat panel detectors (FPD). There is also an increasing shift to 3D imaging, a transition that began gathering pace after 3D mobile C-arms were released by the likes of Ziehm Imaging, Siemens Healthineers and GE Healthcare. This has changed the complexion of the market somewhat. Before these releases most growth was expected in Europe, in countries like Germany, for example, but with the release of 3D systems, China is increasingly looking like a big driver of growth. This is particularly important given the levels of competition in the 2D C-arm market.

“Competition is much higher in the 2D mobile C-arm market,” Jani explains. “We are seeing a lot more domestic manufacturers in China and India which are offering systems at a lower price and making it more difficult for multinational companies to grow in those markets. However, there are some opportunities in developing markets, with 2D C-arms providing access to basic imaging in rural areas.

“In developed markets, mobile C-arms are also being used for overspill procedures and as backup to the fixed C-arm, although typically the purchase of an interventional system is prioritised over a mobile system.”

Possibilities and Market Potential

Despite these nuances the interventional and surgical X-ray markets both represent strong growth markets, with a great deal of potential in both developed and developing markets.

“There are going to be disruptive new entrants to the market,” Jani continues, “that is really going to cause a shake up.”

“The affordability of systems is going to increase, which means there is going to a much faster roll out with domestic vendors in India and China particularly accelerating growth in the market.

“Growth will also come from hybrid operating rooms, which are a fast-growing segment. That growth is set to continue in the coming years in both developed and emerging markets, just because of the multi-disciplinary clinical usage and the return on investment.”

“However, the US and China will remain the key growth drivers,” Jani concludes. “There is simply more demand for interventional and surgical X-ray systems due to the increased numbers of procedures that are being carried out, and an increased focus on interventions.

“This, ultimately, is the key driver of growth going forward.”

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Signify Premium Insight: Trends and Takeaways from RSNA 2021 – Medical Imaging Modalities

This Insight is part of your subscription to Signify Premium Insights – Medical ImagingThis content is only available to individuals with an active account for this paid-for service and is the copyright of Signify Research. Content cannot be shared or distributed to non-subscribers or other third parties without express written consent from Signify ResearchTo view other recent Premium Insights that are part of the service please click here.

There have been some major announcements throughout the year that may have somewhat robbed RSNA of its thunder. From Philips launching its latest flagship spectral CT scanner in May, to Siemens revealing its photon-counting CT system, and a new whole-body, low-field MRI system over the past months. Other factors could also have put a dampener on the radiology conference. As has been widely reported attendance at the event was far lower than it was in previous years, while a few high-profile vendors also were unable to attend due to coronavirus restrictions in their countries and companies.

However, despite all this, the vendors, radiologists and providers in attendance were generally very positive about the conference. This was perhaps in part the result of meeting in person again for the first time in two years, but also no doubt down to the solutions being shown to providers.

Tools for a Job

One of the themes that united these different products from different vendors was their focus on straightforward, practical utility. Vendors did, of course, show off their latest feature-rich flagship systems, but they were also keen to promote the mid-tier ‘workhorses’ of their ranges. This is in large part due to the situation providers find themselves in. With large backlogs of patients, which had elective procedures and examinations postponed because of Covid restrictions, providers are looking for cost effective and efficient systems across the modalities, which will allow them to address this backlog most effectively. In most cases vendors were looking to meet this need with existent products, often with new features and software applications, rather than showing new products specifically catering for this product tier.

A corollary of this pattern saw vendors exhibiting products that had feature sets which enabled providers to attend to patients more efficiently and increase patient footfall. This was particularly true in MRI and CT, which have higher scan times, as opposed to X-ray and ultrasound. Imaging vendors were increasingly drawing attention to tools such as embedded cameras to enable technicians to more easily assess a patient’s position before the image is taken and ensure that the scanner will be able to capture the required image.

These hardware developments were also tied to software improvements, with technologies such as smart protocolling being demonstrated at the conference. These technologies offer numerous benefits. They will improve the broader departmental efficiency by improving the number of ‘right-first-time’ scans, and therefore saving radiology departments from having to conduct rescans and reducing the preparation time needed for scans. They will also help make the process of scanning individual patients more efficient and minimise a system’s set-up time. Another benefit is that it makes the systems easier to use, allowing providers to maximise the utility they can gain from the systems, despite potential limitations caused by shortages of technicians or inexperienced technicians.

Although there were fewer product announcements for ultrasound, the technologies on show and vendor positioning were also primarily focussed on workflow efficiency. That said, there was also a strong focus on the ever-improving imaging capabilities of ultrasound as an alternative to advanced modalities in certain applications, with continued focus on contrast-enhanced ultrasound imaging, elastography and micro-vascularization assessment. Other key trends were the increased focus on liver imaging, with Siemens Healthineers and Philips launching new liver analysis capabilities, and the increasing infiltration of AI-based features, not only for clinical decision support but also to assist the user during image capture through probe placement guidance, organ detection and automated labelling.

Technician Tailored

Modality vendors at RSNA 2021 were also looking to aid users through hardware improvements. Some technicians suffer from ailments or injuries caused or worsened by their repetitive use of imaging equipment. To this end, vendors have also been focusing on both the ergonomics and useability of systems to address the technician’s as well as the provider’s and patient’s requirements.

Another manifestation of this drive for efficiency materialised in launches of on-scanner AI solutions which helped improve the acquisition of medical images from the advanced modalities. These deep learning-based image reconstruction techniques can dramatically cut the time it takes to acquire MR images. This  reduces both the effective cost of utilising the modality and the time required, diminishing some of the barriers stopping MRI being more broadly used in clinical practice. The higher scanning efficiency also improves the patient experience and enables providers to scan more patients per day. Similar tools for CT imaging also offer the added benefit of reducing the radiation dose patients are exposed to, whilst improving imaging quality, an increasingly important consideration given the growing interest in CT-based screening programmes in some countries.

Among the broader themes in terms of modalities at RSNA was the fact that innovation and developments are increasingly focused around 3D imaging. There are multiple reasons for this, but in essence, these modalities have greater clinical potential, and with the greater level of precision imaging they provide, enable radiologists to make better diagnoses. This is being illustrated with investment being promoted in these modalities. In China, for example CT is forecast to grow significantly over the coming years, with the Chinese government actively prioritising the modality. This prioritisation means that in some markets CT looks set to increasingly take market share away from high-end radiography systems as the cost of CT becomes more affordable.

This will also be facilitated in part by developments such as those seen at RSNA. The major barriers stalling the adoption of MRI and CT are the investment required both in terms of upfront cost and the time investment required to capture and read the images. Advances in software to expedite image capture and analysis will help diminish these barriers, and enable providers to consider MR and CT systems, where they wouldn’t have previously. For vendors, this also represents opportunity. The maturity of the X-ray market in developed countries means that most sales will be on a replacement basis. CT and MRI on the other hand are markets in which growth for new installations is still possible, through systems which are less expensive and resource intensive to purchase, and therefore enable providers to choose the modalities for the first time. This trend is being catered for further by the likes of Siemens and Hyperfine, for example, who are both marketing smaller and lighter systems, that require less extensive infrastructure for them to be installed within smaller hospitals, clinical departments (e.g., orthopaedic, emergency and intensive care) and outpatient centres.

Efficiency Above All

Ultimately, the factor that united the majority of the developments at RSNA was efficiency and allowing providers to do more with less. Whether that meant less expenditure, less infrastructure, less time or less expertise, most of the new developments at the show opened up increased possibilities for providers. In many instances, instead of demonstrating new high-end clinical tools, vendors were showing providers how they could address the incoming backlog of scans within their budget and time limitations.

This, at times, happened in unexpected places. In many instances, the use of AI in medical imaging was expected to aid image analysis. While this is a developing trend and such tools look set to have a dramatic impact in the future, at present AI has had the most success on the scanner rather than in the reading room. One of the reasons for this is that in many instances, it is easier to demonstrate a return on investment for AI based on scanners compared to image analysis systems. Vendors can demonstrate that AI-enhanced systems can reduce scan times, which directly translates to the ability to conduct more scans for providers. On-scanner workflow tools, such as positioning support, intelligent protocolling and automatic image accept and reject meanwhile can offer a clear route to the necessity of fewer rescans, again clearly enabling radiology departments to operate more efficiently.

Problem Solvers

More broadly RSNA 2021 will have been a successful show for most vendors. While there were less attendees, and some initial consternation at the reduced footfall, in the end, the consensus was that it had actually enabled vendors to have more focused conversations. There were fewer conversations to be had, but those that vendors did have with providers would have been with qualified buyers and focused around solving providers’ specific problems of the moment. These problems would have, in many cases, revolved around dealing with the enormous backlog of patients, and attending to them effectively and efficiently. This focus would have allowed vendors to directly address this problem. Vendors’ displays at RSNA showed that they weren’t resting on their laurels, and have been continuously innovating, with, once again, a great deal of focus on the clinical workflow and efficiency that providers need at present.

This year’s conference will have no doubt benefited from the ‘buzz’ that a return to Chicago will have caused, and with providers’ purchasing disrupted over the last two years and an unprecedented volume of patients to be seen in the coming months and years, RSNA 2021 was always going to represent a golden opportunity for vendors. By giving providers what they need, both in terms of the hardware itself and its integration into the workflow, this opportunity has been seized.


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