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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.

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Signify Premium Insights: The Imaging IT and AI 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.

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.

AI Opportunity

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.

Strategic Direction

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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Signify Premium Insight: What to Expect at RSNA 2022 – Imaging IT and AI

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.

Much change is afoot in the medical imaging IT and AI sectors. Imaging IT vendors are transitioning to broader, integrated cloud-native enterprise imaging solutions, while AI vendors are increasing the sophistication and clinical value and utility of their products. Amidst these broader directions, here are our  key expectations for the show.

Imaging IT and AI Vendors Will Have Lots to Share

While this year’s meeting of the Radiological Society of North America might be somewhat subdued from a modality standpoint, imaging IT and AI vendors will be ready for some significant product launches. Unlike last year when Covid-19 was still rife in many countries, and there were still considerable restrictions on travel across the world, this year’s event should see attendance figures much closer to the pre-pandemic levels of 2019. Such enthusiasm should see vendors willing to make a lager  investment into the show and use it as an opportunity to promote high-profile new products.

Imaging IT vendors will be keen to highlight the progress made in developing fully featured, cloud-native enterprise imaging platforms. In some cases, this will be demonstrating additional capability that has been added to an existent platform, while other vendors may, for the first time, demonstrate how different capability across their portfolios can be integrated into a more complete enterprise imaging solution.

The event is also likely to be busy from an AI perspective, with vendors keen to promote their products’ progression from technology to solution. AI outfits will look to demonstrate new, more sophisticated solutions, which address a greater number of clinical segments and integrate more seamlessly into providers’ workflows.

Efficiency and Optimisation

Between unprecedented backlogs of patients whose procedures were delayed during the Covid-19 pandemic, a shortage of trained personnel in many key roles, and the increasing requirement for more time consuming and resource intensive advanced imaging procedures, providers are looking for ways to do more with less.

Imaging IT vendors at RSNA will be highlighting solutions that offer customers greater oversight of the operation of their medical imaging departments, their staff, and their medical imaging modality fleets. This focus will be reciprocated by providers, many of whom will adopt workflow tools as one of the nearest-term investments to enhance productivity. Such solutions also represent a sensible strategy for providers for the longer term, enabling them to better assess departmental performance, improve planning of patient care, strategize future needs and maximise resource allocation.

This is particularly important as provider networks become more complex, with centralised workflows allowing providers better oversight of increasingly decentralised networks, amidst the increasing utilisation of outpatient facilities and teleradiology service providers. This may also facilitate the expansion of provider networks through increasing acquisitions, and enable more sophisticated tools, which leverage AI, to be deployed. The interoperability offered by these holistic systems will help empower provider networks for increased automation and operational AI.

Platforms, Platforms, Platforms

Despite the greater interest and greater practical utility of AI, the young technology still faces some barriers to greater adoption. One of these barriers is a means to deploy AI into providers’ clinical workflows as providers look to scale their radiology AI offerings. The most visible method of addressing this “last-mile challenge” at RSNA will be through platforms.

Several vendors have already released platforms, including third-party incumbents such as Blackford Analysis and Terarecon, but more recently specialist AI companies, larger medical imaging IT vendors, and even hardware vendors have released platforms that support the use of many different algorithms. While plans from major international imaging vendors and imaging IT vendors have so far had the most momentum, platforms from algorithm developers themselves could also be a prominent feature of RSNA this year.

This excitement surrounding AI platforms is also likely to shape many of the conversations that AI vendors have with one another. In past years, vendors may have been looking to forge standalone partnerships with other AI vendors which offer complementary solutions in a bid to offer providers solutions more clinically valuable than either partner could supply alone. While that may still make sense in some use cases, in other cases some of the more established AI independent software vendors will look to forge partnerships with multiple prospective partnersto facilitate the development of a platform and scale their radiology AI offerings. This is especially true given that vendors are increasingly focused on enhancing their product capabilities natively, rather than leverage third parties, as may have been more prevalent in previous years.

The Consolidation of Data

One of the longer-term strategic directions that is set to shape imaging informatics over the coming years is the consolidation of data.

As imaging IT vendors’ multi-ology enterprise imaging strategies evolve, there is a greater need for enterprise-wide data to be consolidated into a central data management platform or the VNA. Doing so will enable providers to better leverage the breadth of data they have. While data management platforms are not a conceptually new product, vendors are beginning to assess how providers can leverage the centralised platform and explore the potential they offer. As such, there are likely to be few flashy announcements associated with the VNA. Instead, vendors will, behind the scenes, be discussing it with their customers to identify opportunities that could be realised.

This will be particularly true given the wider context affecting providers at present. The lasting impact of the Covid-19 pandemic, along with other economic pressures, such as rising inflation and spiralling energy costs mean that hospital budgets will, in many instances, be getting tighter. In such circumstances providers are going to be increasingly keen to monetize the data they have already. For providers, this could mean utilising their wealth of patient data for clinical trials or drug development, for example, or utilising their imaging data to develop AI in house. For this to be a realistic possibility, vendors need to respond and offer sophisticated platforms that properly structure and curate data in formats that allow for the commercialisation of imaging and non-imaging data, including deidentification of patient information for pre-clinical use.

There has already been progress on this front. GE HealthCare’s partnership with Enlitic, for example, emphasises this curation, while Intelerad’s recent acquisition of Life Image also shows that it is an emerging trend in the imaging IT market. While there may not be any blockbuster announcements, vendors will be keen to highlight the importance and potential of these unified data management platforms to prospects at the show.

AI Beyond Radiology

So far, the primary focus of the majority of medical imaging AI has been radiology. However, as AI is maturing, and many radiology AI solutions are becoming more sophisticated, medical imaging AI’s domain will expand beyond radiology. This will see the technology’s purview increasingly grow into adjacent areas such as population health tools that may be deployed as part of screening programmes or identifying incidental findings as part of routine clinical practice.

Such moves, forming key discussion topics for AI vendors at RSNA, represents AI’s growing maturity, and the evolution of AI algorithms into more sophisticated solutions. Such momentum stems from two distinct sources. Firstly, this evolution represents vendors’ need to continue to develop their products to create ever greater value to radiologists, and in return, drive commercial traction. More interestingly, however, is vendors’ plans to tap into the current wave of Category III CPT codes awarded for quantitative imaging AI solutions, which could be indicative of potential future reimbursement.

Many of these CPT codes announced for 2022 do not focus on the traditional domains of radiology AI such as detection and triage, but instead seemingly promote population health applications. This emphasis will entice vendors to position their solutions to leverage these codes in the hope that over the longer term they are upgraded to qualify for tangible reimbursement. But, such leanings also raise the expectation that more population health-focused codes are expected in the coming years, thereby encouraging vendors to increasingly develop population health solutions, or adapt their current solutions to fulfill a population health remit.

Summary

Medical imaging IT and AI markets are evolving quickly, and the RNSA conference allows vendors to, above all else, highlight their progress in several key areas. Of equal importance, however, is what isn’t on display, but what is said. Many providers will be looking to commit to enterprise imaging solutions, cloud strategies and AI adoption over the coming years, and vendors’ presence and messaging could help to influence their approach. Ultimately, vendors have the chance to explain to these providers how the application of their solutions can solve pertinent problems in radiology and beyond.

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Signify Premium Insight: What to Expect at RSNA 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.

As vendors, providers, radiologists and investors are preparing to travel to the annual meeting of the Radiological Society of North America, these are Signify Premium Insights’ expectations for the key modality trends on display at the show.

Subdued Show for Major Modality Vendors

The 2022 edition of the Annual Meeting of the Radiological Society of North America was supposed to be a bumper event for major international modality vendors. After the implosion caused by Covid-19 in 2020 and the ongoing disruption and travel restrictions leading to a more muted show in 2021, this year, when providers have an urgent need for solutions that can help them deal with the unprecedented backlog of patients awaiting care looked ripe to feature many major launches.

However, there are some signs that this expectation may not be realised. Across the modalities, many vendors chose to release new products at ECR, with the July date providing a good launchpad, enabling the vendor to utilise RSNA to showcase the systems in the US and look to secure sales of the new products. What’s more after several years of disrupted shows where vendors may have had an online-only, or no presence at all, vendors may also be questioning whether major shows are the most cost-effective vehicle to launch new hardware.

This is particularly true at present, when a number of vendors are distracted, or otherwise unable to lavish attention on RSNA. Carestream Health, which often has a particularly strong presence at RSNA, for example went into bankruptcy earlier this year. GE HealthCare, another RSNA stalwart is readying itself to demerge from its parent company in January and so is likely to be focusing on priorities beyond the event, while other vendors such as Philips, are facing tough times amidst a change in leadership and the recently announced layoff of 4,000 employees. Such turbulence at these and other vendors is not conducive to a showstopping conference presence.

Focus on Clinical Workflows

While vendors will look to demonstrate new hardware, this will increasingly be done as vendors highlight their integration into clinical workflows.

Providers are stretched as a backlog of patients whose elective procedures were delayed during the worst of the Covid-19 pandemic are now awaiting treatment. In addition, in many markets there is a lack of fully trained and experienced staff. These challenges are exacerbated by providers’ understandable desire for the improved image quality and clinical precision that comes with advanced modalities such as MRI and CT, but also require longer to complete and are relatively resource intensive.

At RSNA vendors will show providers their workflow tools for dealing with these delays. There may be less actual hardware on the show floor, and instead vendors will offer digital demonstrations of hardware being used as part of clinical workflows, alongside, for example, AI-powered scheduling solutions to maximise the efficiency of the use of hardware and improve patient throughput.

Such tools will allow imaging protocols to be set automatically, saving time in radiology departments, while other solutions which focus on automatic patient positioning and automatic imaging acceptance and rejection will further expedite the process and help minimise the requirement for imaging to be redone at a later date. Further, these workflow tools will also look to increasingly target specific clinical tasks, with common or particularly high value imaging exams, such as stroke imaging, liver analysis or breast imaging, having targeted solutions to enable providers to conduct them more efficiently and effectively.

Vendors Promoting TCO and Sustainability

Not only will such tools allow providers to attend to patients more efficiently, but by allowing them to maximise the use of their hardware, their imaging systems will, in effect offer an improved return on investment.

This return on investment offered by medical imaging modalities will be another focus of RSNA, with vendors looking to show the total cost of ownership of their modalities alongside their features and capabilities. Vendors will, for example, be keen to highlight that lower-tier, performance or workhorse systems will still be able to benefit from the latest developments and features from a software side, enabling providers to take advantage of new workflow and efficiency features without being forced to upgrade to brand new systems.

Providers will look to hold discussions with vendors about smart subscriptions and other elements of managed service deals. Such agreements will ensure that hospitals not only receive the medical imaging systems that they require, but hospitals will have much better foresight over the costs of these systems over their lifespan, being able to better account for advantages offered by software upgrades and additional tools, while limiting the amount of downtime providers will be forced to endure.

Another element of this equation which will currently be a priority for providers is energy efficiency. With stretched budgets and elevated energy costs, a medical imaging system’s energy efficiency will be a consideration for prospective customers, vendors will, therefore be looking highlight any strength, or mitigate any weakness, they have in this regard.

Vendors Will be Focused on Advanced Imaging Systems

Although there is opportunity for differentiation among all product categories, the range of developments in both hardware and software among advanced imaging systems mean that such categories will continue to be the primary focus of vendors.

Medical imaging system manufactures will be keen to highlight how they are incorporating and deploying the latest technical innovations such as photon counting CT, spectral CT, and cold-cathode emission technology, for example. Beyond this, these modalities, which require significant expertise and resource, also offer vendors opportunities to sell workflow and productivity tools.

Another facet of vendors’ focus on advanced modalities is that they will be keen to share clinical studies which demonstrate the benefits of their newest technology. Vendors which are looking to promote and normalise these technologies will utilise real world results to show how new technologies can have a material benefit in a range of specific clinical use cases. Vendors will, in essence, look to highlight how technology can be applied, more so than discussing the technology itself.

Developments in Digitalisation

While there are still opportunities to continue to develop medical imaging hardware, for many modalities, in many tiers, greater differentiation between vendors can be seen through the software that is offered.

There are many avenues that this drive to digitisation can take. One of the clearest on display at RSNA is likely to be in facilitating less experienced users’ adoption of modalities. While some vendors have already invested significant effort into such programmes, with Philips Collaboration Live, for example, helping less experienced sonographers conduct ultrasound exams. Such tools, at present, will be attractive, helping stretched providers conduct examinations more efficiently, while also mitigating the lack of experienced staff, a barrier which can make selling additional systems more difficult.

There are also other reasons why vendors will be particularly keen to push digital tools at RSNA. Particularly in more economically turbulent times, relying solely on continued equipment sales is something of a risk and is likely to limit opportunities. An alternative is to instead capitalise on existing installed bases and derive more recurring revenue from them from the sale of digital tools, whether on the diagnostic side or on more of the administrative side.

There is always considerable excitement surrounding RSNA, and this year, with Covid travel restrictions easing, hospitals facing a slew of new challenges, and greater economic and inflationary uncertainty, is no exception. The specifics on display in Chicago remain to be seen, but, for modality vendors at least, the emphasis across the board will be on helping providers face these challenges, with the application of technology in a clinical setting, the tune to which all vendors will march.

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Signify Premium Insight: Trends and Takeaways from RSNA 2021 – Medical Imaging Modalities

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There have been some major announcements throughout the year that may have somewhat robbed RSNA of its thunder. From Philips launching its latest flagship spectral CT scanner in May, to Siemens revealing its photon-counting CT system, and a new whole-body, low-field MRI system over the past months. Other factors could also have put a dampener on the radiology conference. As has been widely reported attendance at the event was far lower than it was in previous years, while a few high-profile vendors also were unable to attend due to coronavirus restrictions in their countries and companies.

However, despite all this, the vendors, radiologists and providers in attendance were generally very positive about the conference. This was perhaps in part the result of meeting in person again for the first time in two years, but also no doubt down to the solutions being shown to providers.

Tools for a Job

One of the themes that united these different products from different vendors was their focus on straightforward, practical utility. Vendors did, of course, show off their latest feature-rich flagship systems, but they were also keen to promote the mid-tier ‘workhorses’ of their ranges. This is in large part due to the situation providers find themselves in. With large backlogs of patients, which had elective procedures and examinations postponed because of Covid restrictions, providers are looking for cost effective and efficient systems across the modalities, which will allow them to address this backlog most effectively. In most cases vendors were looking to meet this need with existent products, often with new features and software applications, rather than showing new products specifically catering for this product tier.

A corollary of this pattern saw vendors exhibiting products that had feature sets which enabled providers to attend to patients more efficiently and increase patient footfall. This was particularly true in MRI and CT, which have higher scan times, as opposed to X-ray and ultrasound. Imaging vendors were increasingly drawing attention to tools such as embedded cameras to enable technicians to more easily assess a patient’s position before the image is taken and ensure that the scanner will be able to capture the required image.

These hardware developments were also tied to software improvements, with technologies such as smart protocolling being demonstrated at the conference. These technologies offer numerous benefits. They will improve the broader departmental efficiency by improving the number of ‘right-first-time’ scans, and therefore saving radiology departments from having to conduct rescans and reducing the preparation time needed for scans. They will also help make the process of scanning individual patients more efficient and minimise a system’s set-up time. Another benefit is that it makes the systems easier to use, allowing providers to maximise the utility they can gain from the systems, despite potential limitations caused by shortages of technicians or inexperienced technicians.

Although there were fewer product announcements for ultrasound, the technologies on show and vendor positioning were also primarily focussed on workflow efficiency. That said, there was also a strong focus on the ever-improving imaging capabilities of ultrasound as an alternative to advanced modalities in certain applications, with continued focus on contrast-enhanced ultrasound imaging, elastography and micro-vascularization assessment. Other key trends were the increased focus on liver imaging, with Siemens Healthineers and Philips launching new liver analysis capabilities, and the increasing infiltration of AI-based features, not only for clinical decision support but also to assist the user during image capture through probe placement guidance, organ detection and automated labelling.

Technician Tailored

Modality vendors at RSNA 2021 were also looking to aid users through hardware improvements. Some technicians suffer from ailments or injuries caused or worsened by their repetitive use of imaging equipment. To this end, vendors have also been focusing on both the ergonomics and useability of systems to address the technician’s as well as the provider’s and patient’s requirements.

Another manifestation of this drive for efficiency materialised in launches of on-scanner AI solutions which helped improve the acquisition of medical images from the advanced modalities. These deep learning-based image reconstruction techniques can dramatically cut the time it takes to acquire MR images. This  reduces both the effective cost of utilising the modality and the time required, diminishing some of the barriers stopping MRI being more broadly used in clinical practice. The higher scanning efficiency also improves the patient experience and enables providers to scan more patients per day. Similar tools for CT imaging also offer the added benefit of reducing the radiation dose patients are exposed to, whilst improving imaging quality, an increasingly important consideration given the growing interest in CT-based screening programmes in some countries.

Among the broader themes in terms of modalities at RSNA was the fact that innovation and developments are increasingly focused around 3D imaging. There are multiple reasons for this, but in essence, these modalities have greater clinical potential, and with the greater level of precision imaging they provide, enable radiologists to make better diagnoses. This is being illustrated with investment being promoted in these modalities. In China, for example CT is forecast to grow significantly over the coming years, with the Chinese government actively prioritising the modality. This prioritisation means that in some markets CT looks set to increasingly take market share away from high-end radiography systems as the cost of CT becomes more affordable.

This will also be facilitated in part by developments such as those seen at RSNA. The major barriers stalling the adoption of MRI and CT are the investment required both in terms of upfront cost and the time investment required to capture and read the images. Advances in software to expedite image capture and analysis will help diminish these barriers, and enable providers to consider MR and CT systems, where they wouldn’t have previously. For vendors, this also represents opportunity. The maturity of the X-ray market in developed countries means that most sales will be on a replacement basis. CT and MRI on the other hand are markets in which growth for new installations is still possible, through systems which are less expensive and resource intensive to purchase, and therefore enable providers to choose the modalities for the first time. This trend is being catered for further by the likes of Siemens and Hyperfine, for example, who are both marketing smaller and lighter systems, that require less extensive infrastructure for them to be installed within smaller hospitals, clinical departments (e.g., orthopaedic, emergency and intensive care) and outpatient centres.

Efficiency Above All

Ultimately, the factor that united the majority of the developments at RSNA was efficiency and allowing providers to do more with less. Whether that meant less expenditure, less infrastructure, less time or less expertise, most of the new developments at the show opened up increased possibilities for providers. In many instances, instead of demonstrating new high-end clinical tools, vendors were showing providers how they could address the incoming backlog of scans within their budget and time limitations.

This, at times, happened in unexpected places. In many instances, the use of AI in medical imaging was expected to aid image analysis. While this is a developing trend and such tools look set to have a dramatic impact in the future, at present AI has had the most success on the scanner rather than in the reading room. One of the reasons for this is that in many instances, it is easier to demonstrate a return on investment for AI based on scanners compared to image analysis systems. Vendors can demonstrate that AI-enhanced systems can reduce scan times, which directly translates to the ability to conduct more scans for providers. On-scanner workflow tools, such as positioning support, intelligent protocolling and automatic image accept and reject meanwhile can offer a clear route to the necessity of fewer rescans, again clearly enabling radiology departments to operate more efficiently.

Problem Solvers

More broadly RSNA 2021 will have been a successful show for most vendors. While there were less attendees, and some initial consternation at the reduced footfall, in the end, the consensus was that it had actually enabled vendors to have more focused conversations. There were fewer conversations to be had, but those that vendors did have with providers would have been with qualified buyers and focused around solving providers’ specific problems of the moment. These problems would have, in many cases, revolved around dealing with the enormous backlog of patients, and attending to them effectively and efficiently. This focus would have allowed vendors to directly address this problem. Vendors’ displays at RSNA showed that they weren’t resting on their laurels, and have been continuously innovating, with, once again, a great deal of focus on the clinical workflow and efficiency that providers need at present.

This year’s conference will have no doubt benefited from the ‘buzz’ that a return to Chicago will have caused, and with providers’ purchasing disrupted over the last two years and an unprecedented volume of patients to be seen in the coming months and years, RSNA 2021 was always going to represent a golden opportunity for vendors. By giving providers what they need, both in terms of the hardware itself and its integration into the workflow, this opportunity has been seized.

 

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