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Although empirically quantifying the success of a conference is a difficult thing to do, last week’s meeting of the Radiological Society of North America (RSNA) certainly ticks a lot of boxes. While there are some useful metrics that can be employed – attendance at the show, for example, was 31,000, a dramatic improvement on last year’s 19,000 – more significantly, however, are the less objective measures. This is where RSNA 2022, for AI and imaging IT vendors at least, really shone. There was an energy and enthusiasm about the show, with exhibitors and attendees alike keen to engage in meaningful discussions about the latest products and their place in a provider’s radiology departments.
Was this buzz however a true reflection of the innovation on display in Chicago? Or was it just a symptom of an annual meeting returning to normality after several years of disruption?
The Signify View
While it is true that there will always be a strong contingent of radiologists and clinicians who attend to keep abreast of the latest developments in radiology, there was a real sense of purpose to many of the conversations, with vendors both keen to show off a fair catalogue of new products, as well as highlight some of the subtler, more strategic elements they were engaging in, such as partnerships and collaborations. There were some gaps at the show, with a lack of Chinese vendors a particularly noticeable absence due to domestic Covid restrictions still being enforced.
This was particularly true in AI, with several developers exhibiting at the show for the first time. These growing ranks were something of an incongruity given the inevitability of consolidation in the medical imaging AI market, however there are several factors that explain this abundance. There were some vendors, which, freed from the Covid travel restrictions of recent years, or better established in their domestic markets, were keen to show their products in the US. There were also other, younger, vendors present. While the nature of investment is shifting towards later stage investment at more established vendors, there is still a lot of capital being poured into young AI start-ups, especially those based across Asia. Visibility is important if these vendors stand a chance of converting funding into revenues over time, so even with consolidation looming, they need to be working to make inroads.
Another factor going against these newer vendors at RSNA is that radiologists are becoming more discerning. There is a plethora of tools that offer accurate image analysis for certain exam types. Vendors joining this cohort face an uphill battle as market leaders are emerging, offering a broader range of capabilities beyond detection, adding additional tools that incorporate AI into clinical pathways beyond image analysis, or diversifying their product portfolio by targeting a broader range of use cases, for example.
A corollary to this, which was in evidence at RSNA, is that vendors are also realising that the overall financial opportunity from image analysis is ultimately limited; there will, after all, only ever be a certain amount that can be paid to read a medical image. As such, some of the more established vendors are now endeavouring to deliver products that offer value along a broader aspect of the care pathway. Further, products that key into the far more significant opportunity of addressing providers’ operational challenges will, in turn, enable these vendors to tap into healthcare providers’ large operational budgets rather than smaller departmental software or research budgets. Several large healthcare technology vendors have already shifted their focus in this direction, often working on the incorporation of AI into the modality fleet rather than image analysis itself.
This broader focus wasn’t the sole preserve of AI vendors. There is always excitement around a market’s, significant, longer-term technical directions, such as imaging IT’s expansion into other ‘ologies’ as enterprise imaging solutions become ever more complete, and cloud capability, for example. On this front, the increased presence of AWS and Azure, along with the arrival of Google highlighted the continuing interest providers have in cloud, as well as the opportunity medical imaging offers for cloud vendors.
Despite this increased presence at the show, many announcements weren’t headline grabbing developments that came out of the blue. Instead, RSNA witnessed predominantly incremental changes, with vendors diligently continuing to work on re-architecting their solutions in order to capitalise on the potential of cloud. So far, viewers and data management have been among the greatest beneficiaries of this focus, although hinting at the market’s most-likely future direction, hybrid, rather than fully cloud-hosted deployments, have so far gained the most traction.
Vendors are also myopically focused on the difficulties providers are facing at any given moment. At present that means offering solutions that can help vendors with their operational challenges.
Between staff shortages and burnout, enormous backlogs of patients waiting for elective interventions that were delayed by Covid, rising energy prices and wider economic issues, there are lots of difficulties providers are currently facing. These issues were being widely addressed. For vendors who offer modalities as well as IT tools, there was considerable focus on fleet optimisation, ensuring that providers can efficiently utilise their medical imaging hardware and get the highest quality images from it in the least amount of time.
Playing to Strengths
Those imaging IT vendors which don’t also offer modalities however, had to instead play to their own strengths. At RSNA, this, in many instances manifested in vendors highlighting advancements in workload balancing, tools that intelligently assign radiology cases to the most appropriate radiologist at the most appropriate time and incorporates metrics such as Relative Value Units (RVUs). An operational workflow strategy alone will not play a role in disrupting the competitive landscape; it merely means vendors are meeting a different set of needs for a provider, which address alternative pain points.
One of the ways vendors are attempting to address these pain points is by focusing on their unification strategies and continuing to consolidate capability from across vendor portfolios into the singular imaging IT platform. One example of this at present is the increasing incorporation of advanced visualisation (AV) within the PACS. This development of the diagnostic portion of enterprise imaging will not happen overnight, largely thanks to AV’s legacy as a modality-linked standalone workstation. However, as seen at RSNA, vendors are increasingly focusing on the integration across their entire ecosystems. The same is also happening with AI-based image analysis and AV. A development increasingly expected of vendors as providers look to streamline the diagnostic user experience and improve the efficiency of radiologists.
Similar expectations are also growing for the interoperability of medical imaging data. While such connectivity is still limited, the convergence of enterprise data has begun with relevant EMR data becoming progressively available within the diagnostic viewer, the overarching drive towards structured, standardised and curated data remains in its infancy. The power of such data however, can translate into benefits beyond informatics, in scenarios such as analytics, AI development and real world data applications. Informatics data will increasingly be a valuable resource across provider networks and beyond.
Partners and Provision
Another trend on display at the show evidenced by all vendors developing AI solution, is the question of how to support radiologists and other clinicians in adopting them. AI orchestration platforms are an increasingly common way of bridging this gap and are now being offered by all manner of vendors from the incumbent platform specialists, AI independent software vendors (ISVs) themselves, mid- and large imaging IT vendors, and even some modality vendors. However, for the AI ISVs and platform specialists, they still rely upon a final integration point into the PACS, which ultimately, creates an additional layer in the workflow that PACS vendors with native AI platforms can overcome.
Without being able to partner with an imaging IT vendor, independent AI platform vendors will have to target individual providers directly, which will severely hamper their ability to scale rapidly. This aversion isn’t universal, and there are some vendors that realise the importance of the working more closely with PACS vendors, and some of those exhibiting at RSNA highlighted partnerships which involved providing their orchestration platforms to the imaging IT vendors.
There is progress in other ways too. Large imaging IT vendors themselves are making inroads, more thoroughly incorporating orchestration platforms into their digital strategies, in order to effectively connect ever more components across their entire digital ecosystems.
Another development is in imaging IT vendors becoming increasingly discerning in their choice of platform partners. Informatics vendors offering platforms have, for the most part been happy to partner with a vast array of medical imaging AI vendors, on the grounds that it was better for their customers to enjoy a larger breadth of capability. In many cases, though, these wider platforms failed to gain significant traction. At RSNA there were several moves towards altogether fewer, but more carefully chosen platform partners. This isn’t to say that looser integrations, enabling the hosting of the broader range but, based on RSNA there is likely much greater selectivity for actual collaborative partners. Further, some vendors remained committed to developing AI tools natively to retain greater control on the workflow, and only turning to partner vendors for niche use cases.
Ultimately, however, as is so often the case at RSNA, the greatest significance stems not solely from what was on show, but from the further reaching trends that the announcements and demonstrations indicate. Most significantly for imaging IT and AI vendors, was the greater awareness of contemporary challenges facing healthcare providers. The tough economic climate means providers are even more stretched, but, by the same token they are receptive to digital solutions that may seek to alleviate this. More sophisticated AI solutions, workflow tools which allow greater oversight of medical imaging departments, and more considered deployment and utilisation of tools. Perhaps not the most headline-grabbing year for RSNA, but an event set to have a sizable impact, nonetheless.
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