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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.
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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.
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.
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).
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