Tag Archives: MRI

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: What Signify Premium Insights Expects in 2023: Medical Imaging Modalities

With the dawning of a new year, the medical imaging modality market takes another step forward. Some of the developments set to occur in 2023 have been a long time coming. Vendors, for instance, have long been innovating and refining medical imaging modalities to improve image quality, one of the fruits of this labour, photon counting CT, is coming of age and will continue to make clinical progress. Other changes are more rapid. Global economic headwinds accelerated rapidly in 2022, catalysing change at vendors and providers alike. Amidst the uncertainty that a new year brings, there are, however, some predictions Signify Research can be confident in making.

Asian Manufacturers will Strive to Capture the US Market

To succeed, vendors must head to where their greatest opportunity abounds. In many cases, for Asian manufacturers, this means making a success of the large and lucrative US market. For many of these Asian vendors the opportunities in their domestic markets are looking limited, in Japan, for example, government spending on healthcare has slowed, while in China, the rate of market growth has eased since its peaks over the past decade, with the country’s slow relaxation of its Covid policy not set to benefit modality vendors for some time yet.

With such challenges at home, vendors must increasingly focus abroad. There are different ways this focus could manifest, with, for example, Canon Medical establishing a new US subsidiary, Samsung developing a new Boston Imaging brand and United Imaging looking to increase its footprint in the region.

Which method is adopted will largely be dependent on individual vendors. Some smaller and midsized vendors may focus on distribution partnerships, ensuring that their products can be sold alongside complementary products from other brands while also benefiting from the distributors’ after sales and support networks. Other, larger Asian vendors such as United Imaging and Canon Medical need scale to be able to compete with the international leaders in medical imaging. Scale allows for greater reinvestment in research and development, as well as stronger negotiation capabilities when sourcing components and raw materials and reducing production overheads through the economies that scale offers. Such benefits will only be realised through a greater company presence in the US, enabling large vendors to tender for and secure larger, hospital and health system wide contracts.

Vendors will Increasingly Prioritise the Indian Market, Perhaps in Vain

China has long been among the key growth markets for medical imaging vendors. However, even before the Covid pandemic, the rate of growth had slowed considerably. Some point to the expansion of healthcare provision in rural China as an ongoing opportunity. This is true, but between protectionist procurement policies and the relatively moderate potential rural China offers compared to the cities given the preference for lower cost systems, growth prospects are still lower than the country has offered in the past.

As such, medical imaging vendors will have to increasingly focus on other emerging markets if they hope to enjoy similar growth prospects, and India is likely to be at the centre of these ambitions. Several vendors are increasingly making inroads into the country, with the likes of GE HealthCare’s partnership with Wipro and Fujifilm’s establishment of screening centres indicating the growing importance the country holds. It’s easy to understand why, as well as a growing population and in particular a rapidly expanding middle class. Politically, India is stable compared to several other opportunities and enjoys more cordial relationships with western countries than can be said for some markets. While there is a growing momentum for domestic manufacturing of medical products, partnerships such as the aforementioned GE – Wipro collaboration meet this requirement, ensuring it is not necessarily a barrier to large international vendors. Essentially, everything is in place for India to enjoy the same sort of significant growth as China has enjoyed over the past decade.

However, this has been the case for several years. What India lacks is the actual execution. Growth in China was so impressive, in part, because of the efficient implementation of healthcare policy. This efficiency is lacking in India, where the filtration through regional governments and local authorities slows the actual implementation of healthcare policy. India represents a compelling opportunity for international vendors, and they are wise to increasingly focus on it. But, simply considering it the ‘new China’ and treating it as such is a foolhardy way to approach the market. In 2023, vendors need to target India in a far more nuanced manner if they are going to realise its advantages.

Demonstration of Dedicated Clinical Solutionss will be a Key Driver of Purchases in 2023

In 2023 vendors will have to increasingly aid providers in meeting the challenges they are facing at present. In some instances, improvements in specifications and additional features will help achieve this, however, vendors will also need to show providers how their modalities will be able to address the clinical problems that providers are facing.

One example where this has already been effective is Siemens Healthineers, which, with its 2020 acquisition of Varian, has been successfully offering providers products tailored to oncology use cases. Given Siemens Healthineers’ success and the growing need for oncology care, the area is going to be an increasing focus for medical imaging vendors. This will likely manifest in, for example, greater molecular imaging capability.

There are also other growing clinical segments that medical imaging vendors will be likely to target. One growing area is liver care with the increasing prevalence of non-alcoholic fatty liver disease and other related conditions. There are growing rates of cardiac and vascular disease, while providers are also facing increases in neurological conditions such as Alzheimer’s. The tighter integration of modalities into workflows for such clinical conditions could encourage providers to make purchases, upgrading their modalities.

Another facet of this, as providers endeavour to diagnose diseases early is the increasing adoption of population cancer screening programmes. While such initiatives are likely to take a considerable time to develop, some smaller vendors such as 4D Medical are developing screening-specific modalities, while providers will be more considerate of screening as they make and execute their procurement plans.

Vendors Will Position Themselves as Experts in Outpatient Imaging

In the US and several other mature markets, outpatient imaging is among medical imaging’s most rapidly growing segments. The segment as a whole is growing, but concurrently, the segment is also becoming more consolidated as acute providers either partner with or, increasingly acquire independent outpatient imaging sites. As this trend continues, the scale of opportunity available to medical imaging vendors increases and as it does, so too will the interest they have in the segment.

One way vendors will look to capitalise is to establish themselves as experts in outpatient imaging. GE HealthCare is among those vendors looking to garner such a reputation. Along with medical device manufacturer Medtronic, GE already boast of dedicated teams with expertise in outpatient servicing, but, along with other vendors looking to take advantage of the outpatient space, will begin to offer dedicated solutions and support for that market in ambulatory care settings and in office-based labs. After all, in these settings, providers don’t need only the medical imaging equipment to conduct scans, but also more fundamental assistance and guidance with operational processes such as billing, reimbursement, and the establishment of the business. Imaging vendors will be keen to deliver these services, the likes of which can often offer higher-margin, and ‘stickier’ business than simple transactional sales.

Tackling this market, which is diffuse and decentralised will not be easy for medical imaging vendors more accustomed to selling into major acute settings, however, in 2023 vendors will make concerted efforts overcome these challenges, and capitalise on the growth opportunities the outpatient segment affords.

Disruptors won’t Disrupt

Recent years have seen a number of ambitious companies make bold plans to launch new, innovative and disruptive products onto an unsuspecting market. These companies have sought, variously, to free medical imaging hardware from the acute locations which have previously housed them, enable amateurs to diagnose conditions as well as professionals and bring medical imaging hardware to medically underserved areas of the world.

These ambitions are all well and good, and in some instances even noble, the reality is that so far results for the vendors trying to make these ambitions a reality have been disappointing. Although these vendors sought to disrupt certain markets they have, for the most part been struggling. Butterfly Network, arguably the most successful of this set of disrupters has made progress in the handheld ultrasound market, establishing itself firmly as one of the segment’s leading vendors, laying claim to a 23% share in 2022.

However, from a commercial standpoint the vendor hasn’t performed as strongly. With a share price of $2.33, less than a 10th of its peak in 2021. What’s more, while Q3 revenues increased YoY to almost $20m, so too has the net loss, which quadrupled from $13.6m to $54.7m. It’s a similar story at other vendors, Nanox, perhaps the vendor with the most grandiose claims, has, as of yet, failed to even produce a marketable product, while being dragged into legal disputes for allegedly making false claims, while shares in Hyperfine, a vendor producing portable MRI systems, fell from $9.9 in December 2021 to less than $0.8 a year later.

These disruptive vendors need 2023 to be a successful year. Providers dealing with current problems may help them gain some ground, but the uncertain economic climate, political unrest in and between key markets, and lingering upset to supply chains following the Covid pandemic means providers will likely have had enough of disruption. Stable, reliable old hands will be held in the highest regard in 2023.

Signify Premium Insight: Re-born in the USA

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. The content is only available to companies that have subscribed to this paid-for service. To view other recent Premium Insights that are part of the service please click here.

Canon has recently announced its intention to redouble its efforts on the medical imaging market in the US, with the launch of Canon Healthcare USA.

With the new subsidiary, Canon aims to accelerate the growth of its medical business in the US, as part of its ongoing ‘Excellent Global Corporation Plan’. The vendor hopes to improve its competitiveness across medical imaging, noting that its CT, MRI and Ultrasound businesses, as well its X-ray component businesses were particular areas of focus.

Under the plans, Canon will establish Canon Healthcare USA at a new location in the Cleveland area and will see the new venture take over a portion of product sales and service from Canon Medical Systems, which until takeover by Canon in 2016, traded as Toshiba Medical. The move will put it in tighter competition with the likes of GE HealthCare, Philips and Siemens Healthineers, but, will the Japanese vendor be able to hold its own?

The Signify View

The United States has long been the world’s most lucrative medical imaging market. As such for any medical imaging vendor harbouring any grand ambitions, it is inevitable that the region must, sooner or later, be targeted. Canon already has a sizable presence in the US, carving out a reasonable market share in several key modalities. In ultrasound, for example, Canon can lay claim to the fourth highest share of the North American market in 2021, with a market share of seven percent. Similarly, in the North American MRI market, Canon can boast of market share of around five percent, while the vendor lays claim to around nine percent market share in CT, once taking the number four spot in both.

However, as a vendor with grand ambitions, Canon is seeking to significantly improve these figures. According to one press release from the vendor, for example, Canon hopes to ultimately capture “the number one share of the global CT market at an early stage”.  With such focus in place, Canon was bound to make a bolder move, and there were several reasons why it chose to make it now.

One of the factors providing impetus for Canon to focus on the US market at present is simply, that it’s where its best growth prospects lie. The vendor has, in the past focused much of its effort at its home market, targeting sales in Japan. This has been rewarded with the vendor capturing a significant market share across modalities in its domestic market. However, government spending in Japan has declined, leading to tougher market conditions in its home market, and a resultant decline in demand. This has been exacerbated by global market conditions and supply chain and logistics challenges. These factors combined mean that Japan does not represent the opportunity it may have done in the past.

Location Selection

There are, of course, other markets where Canon could have focused in order to grow. The US is, after all, perhaps the most fiercely fought market in world. However, there are a many reasons that make other markets less appealing. Europe, for example, is difficult to navigate, with the continent’s fragmentation into numerous individual markets making it complex for a vendor to efficiently tackle. Emerging markets offer considerable growth opportunities but are volatile, and, particularly at a time when the world is facing significant macroeconomic challenges, are a far riskier proposition than may be palatable.

Further to this, and despite the establishment of a new subsidiary, Canon also has some presence in the US. Between Canon Medical’s sites and sales networks that were made available through the Toshiba acquisition, as well as the Ohio base of recent Canon acquisition Quality Electrodynamic Devices, the foothold the Japanese vendor already has in the market, offers an attractive base from which it can grow.

What’s more, having this network, even if slight compared to its chief competitors of GE HealthCare, Philips and Siemens Healthineers, makes Canon a more viable option in the US. While there are some differences in the image quality and capabilities between systems from different vendors, in many cases these are slight, with advantages in technology being, for the most part, temporary. With this being the case, providers must look to other factors, including total cost of ownership, when making their purchasing decisions. As such the after-sales service and support that Canon can offer with its already established network, bolstered by its new subsidiary, will allow it to compete on a more even footing with the other players in the market.

A Tailored Fit

In addition to better serving customers, having this greater presence will also enable it to tailor products, and their marketing to better target American customers. Canon has indicated plans on this front, highlighting that as part of the launch of its new American subsidiary, it will partner with medical institutions to research the utilisation and implementation of its more advanced medical imaging systems. This will not only help introduce Canon’s products to new customers in the in US, and, the vendor will no doubt hope, foster some positive sentiment among the radiology community, but it will also allow Canon to ensure its products can fit seamlessly into American hospital’s imaging workflow.

This could be particularly important for photon-counting CT. At present only Siemens Healthineers and Samsung Neurologica have solutions approved by regulators and commercially available. Canon has been making efforts in photon counting CT, having purchased Redlen Technologies in 2021, in part to secure supply of semiconductor technology necessary in producing photon counting CT detectors, and having prototype installations active in Japan. Canon’s strides in this nascent market, along with a greater focus on the US, could enable it to become one of early market leaders in the young technology. Maintaining its presence over the long term would still be a challenge as the likes of GE and Philips release their own systems but getting to market quicker and establishing an installed base earlier, would at least give it the advantages of incumbency. While Siemens Healthineers and GE’s positions in the broader CT market are far higher than any other vendors, such, a move by Canon could help displace Philips for third, with the Dutch vendor harbouring a market share only slightly higher than that of Canon.

The Scale of the Problem

Ultimately, however, these facets of Canon’s strategy fall into a much greater trend which is particularly pertinent for all Asian vendors. Above all else these vendors need scale. In its latest financial results, Canon forecasts full-year revenues of $3.9bn for FY 2022 in its medical segment. A significant figure but still only around a third of what Siemens made in 2022 in its Imaging segment alone. Canon is a significant global player, but it still lacks scale compared to its market-leading competitors. This lack of scale in healthcare, which is affecting other Asian vendors, including compatriots Fujifilm, Shimadzu and Konica Minolta, as well as other Asian vendors including Samsung, United Imaging and Mindray, makes competing at the top that much harder. With smaller revenues, Canon has less to invest in the research and development that it needs to fight at the top, it has less resource to pour into portfolio expansion and software solutions which will allow it to compete for broader enterprise-wide tenders; it also is less able to maintain the same density of service and maintenance teams, perhaps offering larger vendors an edge as equipment downtime and managed service elements become increasingly important to providers.

These challenges will have to be faced, but, in the near term, increasingly focusing on capitalising on the lucrative US market, and using a new subsidiary to realise the opportunities it offers, provide a sensible first salvo in what is sure to be a lengthy campaign.

About Signify Premium Insights

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. The content is only available to companies that have subscribed to this paid-for service. To view other recent Premium Insights that are part of the service please click here

Signify Premium Insight: The Medical Imaging Modality Trends on Display at RSNA 2022

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. The content is only available to companies that have subscribed to this paid-for service. To view other recent Premium Insights that are part of the service please click here.

There were several reasons why RSNA 2022 could have been a disappointment on the modality front. Many vendors, for instance, had priorities beyond an annual conference, including ongoing component shortages, logistics challenges, and disruption in emerging markets. Beyond that several vendors had more specific distractions, with GE HealthCare preparing to list publicly in January and Philips welcoming a new CEO two of the more high-profile examples.

Providers too could have justifiably been reluctant to expend too much effort on RSNA. While new technology can improve productivity at hospitals, providers are presently facing a litany of challenges, including staff shortages, clinician burnout, a backlog of procedures delayed by Covid-19 countermeasures and precarious budgets thanks to the ongoing economic volatility.

The Signify View

Despite these omens, RSNA proved to be a positive show, with many vendors pleased by attendees’ receptiveness.

This receptiveness stems from vendors’ willingness to address the aforementioned challenges being faced by providers, with many of the solutions on display directly addressing burnout and resource shortages, and improving clinician efficiency. These workflow tools manifest in several different ways, with both new tools, but more frequently an expansion of previously seen developments. Camera-based workflows, for example, were once again on display at the show. While camera-based systems have been available for several years, at RSNA 2022 they were far more prevalent and increasingly sophisticated, with advanced modality systems ensuring correct patient positioning, detecting patient movement which could have rendered an image unusable and ensuring correct alignment, for example.

This focus on workflow was also shared with solutions aiming to improve the efficiency of image acquisition and analysis, with vendors identifying pain points which, though individually minor, could across an entire imaging workflow, or cumulatively over an extended period, offer considerable time savings. Vendors, for example, demonstrated solutions that automatically rotate images across all body parts in order to save radiologists a minimal amount of time on each read, an amount which, over time, can contribute to much-improved efficiency. The same is true of automatic patient recognition to streamline the capturing of images, and automatic accept/reject functionality for image quality control, which helps catch scans that aren’t of diagnostic quality early, minimising the need for rescans and helping to ensure the efficient running of radiology departments.

Physical Digital

This workflow focus was also apparent in ultrasound, with vendors looking to solve the same problems being faced by providers. As with other modalities, digital advancement was crucial in realising these goals, with, for example, remote collaboration and teleultrasound systems helping to mitigate staff shortages by allowing experienced sonographers to support less experienced colleagues and effectively attend to more patients. Not all advancement on display was digital however, with several vendors releasing new ultrasound systems. A number of these systems centred around versatility and shared services that provide utility in a number of scenarios.

While such trends are already significant in some ultrasound markets, such as in China, there is growing interest in such versatility more broadly with providers and the caution they must exercise with regards to their budgets an important consideration that can be aided by the purchasing of systems that can be used in a greater variety of cases.

Despite this trend, however, vendors are still keen to highlight their premium platforms, and some vendors whose product refresh schedules coincided with RSNA 2022, used the conference to show off their latest top-of-the-line wares.

These products will, no doubt have garnered attention, but, as noted in the recent Premium Insight detailing our expectations for the show, attendees’ focus was primarily lavished on the advanced modalities.

Advanced Ambition

The pace of innovation has, over recent years, tended to be quicker in advanced imaging than it has for other modalities. This rapid development and heightened competition means that vendors have more to highlight at conferences and exhibitions, and providers have higher hopes of finding transformative products which can significantly aid them as they face the hurdles in the industry. Some of this focus was on hardware itself, with photon-counting CT, a technology that vendors expect to radically expand the clinical capability of CT imaging when it becomes widely commercially available, one of the central considerations of the leading CT vendors. Although there were not major announcements or new product introductions for photon-counting CT, vendors were keen to discuss their progress with the technology and assure providers of its imaging credentials.

CT and MRI weren’t the only advanced modalities focused on by vendors. There was also a more concerted effort to show molecular imaging systems at RSNA, with several leading vendors highlighting both their latest products as well as how molecular imaging could offer significant benefits in some key clinical workflows, such as prostate cancer detection, myocardial blood flow and urology for example. Vendors were keen to show exactly how molecular imaging could offer sizable clinical improvements compared to other, presently more common workflows.

This focus on clinical utility was not unique to molecular imaging, however, with vendors showing how different modalities were particularly suitable for meeting specific clinical requirements. Once again, this offered vendors the opportunity to emphasise the improvements offered by their latest CT technologies, with vendors highlighting how spectral CT and photon-counting CT could be particularly advantageous in more critical clinical situations.

This promotion went beyond merely showing and demonstrating the products however, with vendors keen to highlight clinical validation studies to providers in a bid to prove their claims and encourage excitement and readiness among providers for the latest products as they become increasingly available commercially.

Software Solutions

As well as their endeavours to demonstrate the clinical value of their latest hardware, vendors were also attempting to engage providers with the software, and particularly AI tools they have been developing and expanding. Unlike in previous years, there wasn’t a litany of high-profile partnerships announced, with vendors instead highlighting incremental progress forward. For example, vendors broadened the clinical use cases that their AI tools could be utilised on, expanding the number of clinical applications built into their workstations. These tools will not revolutionise a hospital’s imaging workflow, but, at a time when efficiency amidst hospital’s limited resource is crucial, the ability of such tools to reduce the time required for acquisition and reconstruction, and minimise mistakes will have been well received by the providers in attendance at RSNA.

There was a similar pattern among ultrasound vendors. While there are some factors that make ultrasound imaging unique, such as the need for solutions to often be implemented in real time, as the scan is being conducted, rather than applied retroactively on the PACS, the focus was, as with other modalities, once again on workflow and tools focused on clinical efficiency rather than improving diagnostic AI.

Once again, vendors’ focus was squarely on the clinical problems providers are being forced to overcome at present. This focus from providers on their current challenges, as well as vendors’ readiness to address them, ensured that RSNA’s annual meeting was purposeful and productive. Attendance may still have been lower than in the years immediately preceding the Coronavirus pandemic, and, even with the attendance of more Asian vendors, there were still some significant companies which were unable to attend, with Chinese vendors a notable absence. But with what are several potentially difficult years ahead for providers, there is a keenness to invest in solutions, and work with vendors, to ensure that radiological needs can be met.

About Signify Premium Insights

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. The content is only available to companies that have subscribed to this paid-for service. To view other recent Premium Insights that are part of the service please click here