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

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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.”

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

Signify Premium Insight: FDA Approval for Samsung NeuroLogica as Interest in Photon Counting CT Grows

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.

Earlier this month, Samsung Electronics subsidiary NeuroLogica Corp announced that its new OmniTom Elite, with Photon-Counting Detector technology, has received FDA 510(k) approval. The approval means that NeuroLogica is the first vendor to have a 510(k) cleared, single-source mobile photon counting CT system in its stable.

The clearance also marks the next stage in the commercial growth of photon-counting CT, a much-lauded step which has long been considered to represent CT’s next technological milestone. A photon-counting CT detector can directly convert individual X-ray photons into electrical signals, which makes higher resolution and lower dose imaging possible. In receiving FDA approval for its detector, NeuroLogica becomes only the second vendor to be able to offer such a system commercially, after Siemens Healthineers received 510(k) approval for its own system in October 2021.

The Signify View

Many leading medical imaging vendors have had photon-counting CT squarely in their sights for several years. While Siemens Healthineers, with its 2021 clearance, has made the most commercial headway on the systems so far, its competitors are not far behind, with Philips, GE, and Canon among those vendors working on their own systems. There is also good reason for this focus, with the new technology promising higher image quality, better signal to noise ratio, higher resolution and lower dose than current CT technologies. In particular, the technology will help radiologists more clearly distinguish between different tissue types and the composition of different tissues, bringing benefits to a whole raft of use cases, from oncology and stroke care, to cardiovascular and pulmonary care.

However, these benefits are still some way off being realised at providers. Siemens’ commercially available system is still at the very first steps of adoption, with its price representing a significant barrier to purchasing for all but the best-funded research and academic hospitals. This premium price is, in part due to the fact that the new photon counting CT system sits at the top of the vendor’s CT range, positioning that will likely be mirrored by other large vendors when they release their own systems.

Samsung has however adopted a more unusual approach. The vendor has been making headway over the years with imaging modality sales, down in no small part to its aggressive pricing strategy whenever a large tender has been available. Whilst the specifics will be different for photon counting CT, the American subsidiary of the Korean conglomerate is still looking to make the adoption of the new technology a more palatable financial prospect. The vendor has highlighted that its new, FDA-cleared photon counting detector is available, not just as a stand-alone piece of equipment, but also as an optional upgrade to providers which have already recently purchased OmniTom CT scanners. This significantly reduces the cost of acquiring photon counting CT technology, making this technology more widely accessible.

A Gradual Plan

An upgradeable option will not only help bolster sales in the short term but should also help providers plan their transition to mobile photon counting CT. After all, instead of committing today, when the technology is still very young and the number of conducted studies and the volume of testimony about the technology is limited, a vendor can purchase one of Samsung’s non-photon counting systems safe in the knowledge that there is a clear upgrade path in future. As well as helping to ease its customers’ transition to a new technology, NeuroLogica is also using the new technology to help continue to carve out its own niche in mobile CT. This is important. With a handful of vendors dominating the traditional fixed CT market, a market in which it is difficult to gain traction and take market share from established competitors, NeuroLogica’s focus on mobile CT has helped it differentiate itself. As such its continued aim is to convince providers that OmniTom systems are needed in addition to, rather than instead of, other CT systems. Photon-counting technology could be powerful in this regard, helping to mitigate the reduction in image quality that is often the price to pay for having a mobile system.

This strategy isn’t without its own problems, however. One of the most significant barriers is encouraging providers that they need another CT system. While there may be some appetite for a system in a critical care ward, where patients quickly need imaging, and such a process could have a significant impact on patient outcomes, in non-critical care, providers are more likely to focus their budgets on more versatile fixed systems.

Whether NeuroLogica is able to overcome these challenges depends on the value it is able to offer providers with its new photon-counting CT system. In its press release, NeuroLogica mentioned that it is focusing on several use cases including stroke, trauma, intensive care and intra-operation imaging. While some of these seem unlikely targets, others, such as stroke care make sense, with the rapid detection of stroke critical to patient outcomes. Photon-counting CT does have advantages in this regard, with the technology’s improved image quality advantageous in stroke detection. Further, mobile photon-counting CT’s use in stroke detection could also benefit from the increasingly thorough stroke detection and triage AI tools from stroke care software developers such as Viz.ai and RapidAI, with such tools and mobile photon counting CT being mutually beneficial.

Ready and Waiting

More broadly, NeuroLogica’s FDA clearance is, like the research and developments from other vendors, not going to suddenly revolutionise the CT market, but it does highlight the interest and potential of the technology. Vendors will approach photon counting CT in different ways. Some such as Siemens have focused on cadmium telluride detector technology, while others, including GE have focused on using silicon-based detectors, with Mats Danielson, CEO of acquired company Prismatic Sensors insisting that the element’s purity sidesteps some limitations of cadmium-based systems.

In addition to the lack of convergence on technical aspects of photon counting CT technology, there is still ambiguity as to the best clinical applications of the technology, with even NeuroLogica, a vendor which has taken an original approach to the adoption of the technology, acknowledging that research in collaboration with partners will still be necessary in developing the full potential of its photon-counting OmniTom CT scanner.

For NeuroLogica then, the FDA approval does represent a significant milestone. What’s more, becoming only the second vendor to get cleared by the regulator is quite a feather in the firm’s hat, helping establish its credentials as an innovative company, as well as showing its intentions to be a key player in the PCCT market – albeit in its own way. This milestone will not instantly hasten the adoption of the technology, but it will bolster the vendor, letting NeuroLogica’s customers and potential customers know that when it comes to photon counting CT, it is ready when they are.

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