Tag Archives: ECR

Signify Premium Insight: United Imaging Determining the Right Tool for the Job

Earlier this month, at the European Congress of Radiology in Vienna, United Imaging’s ambitions on the European medical imaging market were made clear with the launch of the uMR Jupiter 5T. The MRI system was the centrepiece of the Chinese vendor’s maiden appearance at the show. The system is the world’s first commercially available whole-body ultra-high field five tesla MRI system, which, United Imaging hopes, will help establish its reputation as a technical leader.

While other vendors have developed systems with more powerful magnetic fields, United’s release continues the vendors’ rapid technological rise. However, is the Chinese vendor focusing on the right priorities?

Signify Premium Insight: Providers Prepared to Back the Right Horse at ECR 2023

The start of this month saw vendors, providers and radiologists alike gather in Vienna to attend the European Society of Radiology’s headline meeting, the European Congress of Radiology (ECR).

After several years of disruption thanks to the global Covid-19 pandemic, which saw events canceled, rescheduled or made 100% virtual, ECR 2023 marked the first time since 2019 that the meeting returned to its established late winter slot. Matching this return to tradition was also a return to form, with an event that, unlike last year’s event when Covid-19 had a greater impact on vendors’ decisions to attend and coincided with many would-be attendees’ summer holidays, saw footfall closer to those seen before the pandemic at 17,000 attendees compared to 23,000 in 2019.

That isn’t to say Covid’s impact has been completely expunged from the show. While ECR itself has largely returned to normal, the pandemic has left providers with difficult challenges which vendors are helping to solve.

Signify Premium Insight: Where AI and IT Belongs in Radiology at ECR 2023

With the European Congress of Radiology (ECR) now squarely behind us, it is time to reflect on last week’s Vienna event.

Last year’s meeting, which took place in July, was somewhat subdued, with a limited presence from many Asian vendors thanks to lingering Covid restrictions, while other would-be attendees from Europe were instead on their summer holidays. As such, this year’s conference had a something of a make-or-break atmosphere, with some vendors ready to re-evaluate their commitment to the show, should the 2023 event also fail to excite. Fortunately for the European Society of Radiology, vendors, for the most part, went home satisfied. While the events’ opening day was a little shy of footfall in some quarters, the overall number of visitors and the presence of some new vendors brought positive energy to the exhibition’s halls.

Signify Premium Insight: Imaging IT and AI: The Key Trends on Display at ECR 2022

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In mid-July, the European Society of Radiology met in Vienna at their annual gathering, the European Congress of Radiology. The show, returning to an in-person format after two years of Covid-enforced cancellations, was also rescheduled switching to summer from its usual late-winter timeslot.

This schedule likely contributed to one of the biggest changes at the show, a reduction in attendees, as radiologists, hospital management and other buyers may have been enjoying vacations or taking advantage of public holidays such as Bastille Day in France. This change was significant and, in some ways, set the tone for a more focused affair than had been enjoyed in previous years.

The Signify View

This fall in attendance was also exacerbated by the show’s layout, which deviated from a traditional format. Major imaging vendors were given more floorspace, but at the expense of being dispersed and in some cases, harder to find. This allowed them to simulate “care pathway experiences”, reflecting the interests of many of the show’s attendees. Interestingly such experiences were only offered by the largest vendors, with mid-size and smaller vendors sticking to more traditional booths, serving neatly as a visual representation of the differences between these two tiers of vendors.

This reduction in turnout was not mirrored by vendors, who, for the most part, were not deterred. This was particularly true among smaller European vendors, including a significant number of AI start-ups taking advantage of the show, which typically have not exhibited at RSNA. These vendors, for whom the expense of exhibiting at RSNA is currently too high and US FDA regulatory barrier daunting, could use the show to interact with Western European radiologists, the same clinicians that could well be among their earliest customers.

Cloud Considerations

The show’s location also was significant. Cloud adoption is one of the ongoing trends in medical imaging IT. The nature of this trend is very different in different regions, with Western Europe and North America especially divergent. This is particularly true when it comes to public cloud. There are some instances of public cloud in certain European countries such as the UK, evidenced by GE HealthCare’s recent deal for its first Amazon Web Services-based deployment of its True Pacs software in Europe, at the Royal Orthopaedic Hospital. However, such deployments are exceptions.

More typically, European cloud deployments centre around private cloud, with the imaging IT vendors themselves providing the cloud capability for providers. There are pockets of public cloud adoption, with the UK’s National Health Service (NHS) fostering a close relationship with Microsoft and pursuing a cloud-first strategy, while Italy also has started along a path to public cloud adoption. More generally though there is distrust of public cloud and a reluctance to, in essence, share patient data with large US-based big tech cloud providers.

This hesitancy was on display at ECR. At RSNA, where catering primarily to the North American market, public cloud is widely promoted. At ECR however, vendors were more muted in their promotion of cloud capability, engaging in conversations with attendees, but none of the major vendors made significant product announcements.

Instead, much of the focus, particularly for the large medical imaging vendors, centred on the best utilisation of hardware, with radiology service line, operational workflow and other tools aimed at improving radiology departmental efficiency. This focus reflects where the surest return on investment is for many customers in the near term.

The show’s location also influenced other facets of the show. The North American EMR market is very established with just a handful of players accounting for most deployments. As such, it makes sense for medical imaging companies to promote tools that consolidate diagnostic imaging into the EMR. In Europe, however, the EMR market is very fragmented, rendering such approaches, as yet, unfeasible. In 2020, for instance,  no vendor had a share of the inpatient EMR market in EMEA of more than 16% (as detailed in Signify Research’s EMR/EHR Market Intelligence Service).  The opposite is also true in other areas. Europe is far more advanced than North America in terms of digital pathology, and customers could be feasibly looking to adopt solutions soon. As such, at present, ECR represents a better opportunity to promote such solutions, than many other events.

Competitive Categories

Unsurprisingly, one of the areas that did have a large presence at the show was AI. Despite this presence however, the level of new and unique products was minimal, with many of the young vendors at the show adding products to already well-established categories such as breast imaging (e.g., b-rayZ) or brain volumetric analysis (e.g., Mediaire). This is, in part, a result of those categories being seen as a safer, more conservative option where there is already known demand, while the AI market remains nascent. This desire to stick to established  toolkits may prove sensible in the near term as vendors are able to ride on the rising tides of those areas, but longer term it seems very risky, with many of these smaller players likely to be displaced or made redundant by other, better-established companies with more sophisticated products that already have sizeable installed bases.

In releasing a single-purpose chest CT tool, for example, a vendor must do something unique to gain traction, otherwise a product risks being overshadowed, not only by the plethora of other point solutions, but increasingly by more advanced comprehensive solutions, which can identify multiple findings at once.

These better-established vendors with more sophisticated products are also facing important decisions of their own. These vendors must continue to evolve and further develop their products to ensure that they remain attractive in what is an increasingly competitive market. In many instances it is the direction of this development that they must focus upon, whether they should choose to expand first into different modalities (multi-modality approach) or if it is better to expand across different pathologies (multi-ology approach).

Where Next?

There are merits to both approaches. Expanding into different modalities could allow a vendor to create ever more sophisticated end-to-end solutions, to cover a patient’s entire care pathway (e.g., lung cancer screening). This may also bring regional opportunities, enabling an AI solution to be used in areas where specific modalities are preferred for certain tasks, for example. However, it could put AI vendors into greater competition with large imaging vendors such as GE HealthCare and Siemens Healthineers, which offer a complete range of modalities, imaging IT systems in-house and develop algorithms for their modalities natively. In such circumstances, the large international medical imaging vendors are likely to have the advantage.

Decisions of a similar significance will have to be made by vendors of all size, and, as consolidation begins to take hold in the market, the consequences are likely to become ever more severe. The evidence of these decisions will be seen at coming trade shows, with RSNA the next opportunity for AI vendors to show, once again, that they are able to offer improvements in and beyond radiology to bring greater value to clinicians. To do so, vendors must continue to progress, either by developing new tools, or enhancing existing tools. However, funding runways for many medical imaging AI are limited, especially for those vendors that have not managed to raise capital investment in the past couple of years, so vendors must take what they can to ensure long-term viability.

The picture is less dramatic for imaging IT vendors. Here the broad direction is known; a shift toward cloud-native muti-ology enterprise imaging solutions. This change is coming, and all vendors have begun working towards such products, but many still need to secure buy-in from providers. This will be a particular focus at RSNA, where several significant launches, which were held back at ECR, are expected, once again propelling the market forwards.

Despite it being quieter than “normal”, ECR was still a positive show, giving vendors a chance to explain their visions to a predominantly European customer base. Now, however, they must look ahead and prepare to help a much larger audience realise those visions in Chicago at the end of the year.

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This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. This 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 Research. To view other recent Premium Insights that are part of the service please click here

Signify Premium Insight: The Key Modality Trends on Display at ECR 2022

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. This 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 Research. To view other recent Premium Insights that are part of the service please click here.

A fortnight ago, the European Society of Radiology met in person at its European Congress of Radiology (ECR) for the first time since before the Coronavirus Pandemic. The congress, rearranged from its regular winter slot at the end of February or start of March to mid-July, had a different feel than usual but the major imaging vendors were still represented, and there were still plenty of exhibitions epitomising and heralding developments in the medical imaging market.

 The Signify View

However, finding these new products was not always easy. The event was more diffuse than it has been in previous years, with some vendors in particular being located away from the show’s main thoroughfares, ensuring that they received the very minimum of passing footfall. This in itself was something of a rare commodity. The event occurred as many in Northern and Western Europe took summer holidays, while the event also conflicted with France’s Bastille Day celebration reducing overall attendance at the event. This, combined with a greater online presence reducing the need for some attendees to visit in person and reluctance among some would-be attendees because of the lingering impact of Covid, meant the event was far quieter than it had been in previous years.

For those that did choose to attend, and were able to find vendors’ booths, there were some interesting products to be found. Many of these were not focused on specific pieces of equipment or promising particular capability, but instead were centred around patient experience, with several vendors choosing to eschew traditional booths in favour of more immersive experiences. These experiences simulated care journeys and specific scenarios enabling attendees to get a feel for how a vendor’s individual systems could work in unison in a clinical setting, rather than just learning of the capabilities of individual pieces.

In some circumstances this focus on patient experience makes sense. In MRI and CT imaging, for example, focusing on patient experience can help hospitals operate more efficiently. Improving patient experience can help scans be conducted more quickly and reduce factors like anxiety or restlessness. These can impact the quality of the image which can result in a rescan, having implications in terms of both time and money. In other modalities, however the focus on experience was frequently also for the benefit of the technician. In X-ray and ultrasound, for example, products focused on reducing strain on the user and increasing productivity and efficiency, as well as improving ease of use, with less touch points or tablet-based interfaces for example. Embedded camera-based workflows and smart protocoling were also notable themes for X-ray equipment.

Technical Talk

Despite this, however, vendors were still keen to promote the technical prowess of some of their solutions. The large international imaging vendors, for example, were keen to show off their top of the range systems, with the likes of Philips and Siemens Healthineers exhibiting their spectral CT and photon-counting systems respectively. Philips also debuted its multi-nuclei MRI system, the MR7700, with a focus on high-quality diffusion imaging and advanced neurology. Broader trends amongst MRI and CT vendors demonstrated improvements in speed of image acquisition, ease of use and enhanced patient experience.

This was also true in ultrasound, albeit with a different emphasis. Whilst there were some new systems on display at ECR this year, the differential in image quality across ultrasound systems from different manufacturers is often small, and regularly not significant enough to determine a purchasing decision. As such, ultrasound vendors must use other factors to differentiate their systems. At ECR this requirement manifest with several vendors promoting software solutions, for liver analysis for example, and new ultrasound probes, seeking to offer their customers an advantage compared with other rival systems.

Another way ultrasound vendors are attempting to differentiate their systems is through the use of advanced imaging software. Increasingly this means ultrasound manufactures are partnering with AI companies to be able to offer additional software capability which enhances and complements their scanners, without having to invest into expensive algorithm development themselves. AI will increasingly play an important role within ultrasound, in both image acquisition and analysis, and leveraging specialist partnerships will allow ultrasound vendors to take advantage of this interest more swiftly.

Beyond AI ultrasound there was also a bigger presence of teleultrasound solutions. Some vendors, such as Philips, have offered teleultrasound capability for some time, enabling users to more easily get second opinions or advice from doctors with more experience or specialist knowledge. At ECR other vendors also started to exhibit such capability, again, offering customers capability which extends beyond that of sheer technical capability.

Competitor Competence

There is a similar impetus in X-ray, although in general X-ray vendors tended to be more discreet, often avoiding explicitly saying which AI companies they were working with, and instead only promoting the capability. In part this could stem from the fact that many X-ray vendors have formed partnerships with the same AI developers in order to be able to offer the same capability as their rivals.

As well as AI, large modality vendors’ exhibits at the event also tended to focus on showing off their end-to-end solutions and the more holistic approach to imaging they are offering. This will allow them to better capitalise on the broader medical imaging deals that providers are increasingly looking to strike with vendors. Under these deals, providers are not just looking to acquire individual pieces of medical imaging hardware, instead they are looking to make broader deals for medical imaging equipment, including tools that help manage particular care pathways and solutions that help hospitals maximise the use of their medical imaging equipment fleets. Vendors at ECR were trying to showcase such holistic approaches, to demonstrate the possible returns on investment from such broad solutions.

Increased focus on precision diagnosis, a reduction in imaging and procedure times, improvements in productivity and AI powered smart workflows were also prominent themes amongst leading imaging vendors. Improvements in examination accuracy by smart assistant technology, which provides feedback at the point of image acquisition, was also demonstrated.

Elsewhere, Ziehm Imaging became one of the first OEMs to openly market IGZO detectors on its mobile C-arm product line at ECR 2022, which may spearhead increased uptake of this technology.

Other broad trends were also evidenced at the event. Canon, for example, revealed its City Hopper mobile CT solution, a truck-based CT system, which, while distinct from other mobile imaging modalities, continues to acknowledge the need for imaging to move out of traditional settings, and key into post-pandemic demand for more mobile and more versatile imaging equipment.

Despite this launch, as well as a full line-up of all of Canon’s component brands, there were only limited numbers of attendees from the vendor’s Japanese headquarters. This absence was also true for other Asian vendors, which lacked representation at the show. For Chinese vendors in particular, this may be a result of continuing travel restrictions resulting from the coronavirus pandemic, with the requisite quarantine periods simply not worth it, particularly given the show’s increasingly online presence.

Summer in the City

This absence is likely also due to the show’s new summer timeslot. RSNA is a far bigger event than ECR, so it is natural that vendors prioritise the American event. In previous years, when ECR took place in winter, vendors were able to follow a US launch with a European launch, enabling European buyers to see equipment for themselves and vendors could hope to secure sales. With the new timeslot, and the lower attendance given vacations and public holidays, vendors may be tempted to hold off making product announcements until RSNA where they can be sure of a larger audience, albeit one that has also been shrinking in recent years.

This will be one of the challenges for both ECR and vendors attending ECR in future. The ESR has committed to summer dates for the next three years. Lower competition for the spotlight could mean the show establishes itself as the ideal location for less well-known vendors to release products, or, alternatively, the show, which is also a hotbed of presentations and discussion, could increasingly reflect European market trends, somewhat diverging from RSNA’s focus.

Regardless of these questions for the future, ECR’s return gave vendors a chance to not only show off their latest and greatest products, but, for the larger vendors, show how they can be used within hospitals to better support imaging departments and help them offer better care. Significant developments are always on the way, and some vendors will have been dismayed by the show’s relative quiet, but, for those customers that did choose to attend, the event will no doubt have proved valuable.

About Signify Premium Insights

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. This 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 Research. To view other recent Premium Insights that are part of the service please click here