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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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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 ResearchTo view other recent Premium Insights that are part of the service please click here

Signify Premium Insight: Trends and Takeaways from RSNA 2021 – Imaging IT and AI

This Insight is part of your subscription to Signify Premium Insights – Medical ImagingThis 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 ResearchTo view other recent Premium Insights that are part of the service please click here.

Co-written by Steve Holloway, Amy Thompson and Dr. Sanjay Parekh

For the first time in two years, radiologists, vendors and providers all gathered in the halls of Chicago’s McCormick place as RSNA 2021 got underway. While attendance was down at the show compared to previous years, and some vendors were notably absent because of continuing Covid policies and restrictions, many key decision makers were still present. For some vendors, this thinning out of the crowd enabled focus only on the best prospects, with most reporting time at the show as more beneficial than had been expected.

More With Less

As well as enabling vendors to utilise the show more efficiently, the subject of doing more with less will also have been a central facet of many conversations. Providers have, after all, endured a very turbulent period over the past two years, with the coronavirus pandemic exacerbating existent trends that have seen radiologists forced to deal with greater numbers of increasingly complex medical images.

Providers are looking to their imaging IT vendors for assistance in tackling this challenge, and vendors, as demonstrated by many solutions at RSNA are acquiescing. Chief among the imaging IT vendors’ contributions were operational workflow and analytics tools. In the current environment, providers are less concerned about grand product announcements and instead, they are hoping for tools and refinements that allow them to achieve more, without a commensurate increase in spending. Notably, this need was highlighted at the show with vendors increasingly promoting tangible improvements in operational outcomes.

RSNA also saw these operational concerns addressed with tools beyond that of improvements to imaging IT solutions, with vendors looking deeper into their quivers for answers. One such direction sees tools to help with patient engagement, such as patient self-scheduling, with vendors reporting how their tools reduced patient no-shows. Other tools, including patient portals and the previously discussed radiology video report functionality from Visage, also focused on improving patient engagement in their care. This improved engagement, it is hoped, will allow providers, to better manage their resources and maximise their care provision.

An adjacent problem is a shortage of technicians and radiologists compared to the volume of patients. As well as providing software tools that can help, RSNA saw vendors such as Siemens Healthineers touting their radiology scanning and remote image acquisition support as extensions of their radiology IT packages, while yet more still are set to follow with partnerships. While these changes are more subtle to detect versus the “louder” product releases, it is evident that healthcare IT platform vendors have a renewed focus not only on technology deployment with customers, but also on supporting customers from a service-line perspective. This was especially evident from imaging IT vendors with broader modality business, who see upside in combining a range of software and service options (fleet management, operational workflow, professional services) to secure long-term customer partnerships.

Strength in Numbers

Partnerships was another of the event’s themes particularly evident in the AI exhibitor section. Partnerships are already a well-established method for vendors to improve their capability and add products from other vendors in areas where they do not have the resource or expertise. Some partnerships were announced before the show but saw the fruits demonstrated for the first time, while in other instances RSNA 2021 would have seen future partners make their introductions and take their first steps to collaboration.

There are examples of AI developers partnering with larger imaging IT vendors, such as those held by Cortechs.ai, Behold.ai and Riverain with IBM Watson Health, as Big Blue emphasised in its launching of its AI Orchestrator platform. More commonly however, the partnerships on display at RSNA saw two or more AI vendors come together to combine their capabilities and give themselves a broader offering that could more successfully compete, such as Viz.ai partnering with Avicenna.ai. Market leaders are starting to emerge, and conditions are becoming more challenging for smaller vendors, which could increasingly find capital investment hard to find, and revenues more difficult to secure. Under these circumstances, a meeting at RSNA which results in two vendors being able to take advantage of each other’s AI solutions to offer providers broader tools and better clinical value will help both vendors retain relevancy in increasingly crowded markets.

Algorithms Delivered

Beyond the tools themselves, some vendors also used RSNA as an opportunity to highlight the steps they were taking in solving the last mile challenges of selection, purchase, integration and deployment of algorithms within providers’ clinical workflows. As detailed in a recent Premium Insight, IBM Watson Health’s AI Orchestrator was one such innovation. This new AI orchestration platform is vendor agnostic, and should allow providers, regardless of their chosen PACS or broader imaging IT supplier, to easily deploy, integrate and take advantage of AI solutions. IBM’s solution takes a disparate approach however as it is not integrated into the vendor’s AI marketplace, and therefore not helping providers in the potentially onerous task of selecting and purchasing AI tools.

IBM was far from the only vendor touting the benefits of its platform at RSNA, with vendors such as Blackford Analysis, which was one of the earlier vendors to take up the marketplace plus platform approach, and Aidoc, which has more recently offered an AI platform, albeit with its own flavour, at the event.

Such platforms are not yet universal, however. Some larger vendors are taking different approaches, with Siemens Healthineers and Agfa HealthCare, for instance, taking a more integrated approach. There are other vendors still, some of which were perhaps expected to show more at this year’s RSNA, which have still not launched similar solutions. This will not be a hindrance in the immediate term, with many providers happy to wait for their replacement cycle before sourcing new systems. There are also legitimate reasons why they have not launched such systems, with the process of ensuring all integrated algorithms are clinically robust, particularly resource-intensive. However, these absences will only become more glaring over time, and could quickly become a significant differentiator

For AI developers themselves, being on a platform is not necessarily a lucrative proposition, with many inclusions unlikely to be making significant revenue. However, to be on a growing platform as the recognised solution for a given clinical application comes with a certain degree of cachet and puts them in a position to capitalise later. Particularly when the time comes that VC funds press for returns on their investments, and it becomes increasingly tenuous to be a small AI developer. Ultimately, the race is on for many AI image analysis developers to prove their standing as top in their category and demonstrate customer uptake at scale and differentiation within the category. This is no mean feat in an increasingly crowded market, so many view platform partnerships as a means to get to customer scale faster. One could already argue based on RSNA this year that the leaders in each vertical are starting to emerge and that market consolidation and a thinning of the field is on the near horizon.

Covering All Bases

RSNA also saw some progress on some of imaging IT’s more typical themes, including the adoption of cloud. Although in many cases,  ‘cloud capable’ and ‘cloud native’ as marketing terms took more of a backseat comparatively to last year’s RSNA.

Although cloud remained present in vendor conversation, vendors centred messaging more on operational outcomes and enterprise imaging, with less hype around the technology, the actual underlying strategy and implementation has taken steps forward, with providers having a clearer idea of their aims and a better understanding of how cloud can help. Providers and vendors are, for example, having increasingly productive conversations about the conversion to cloud. Some of these focus on providers’ reasons for adopting a cloud strategy, whether it is to take advantage of more flexible business models such as SaaS-based models and the options that brings. Other details are more pragmatic, aligning renewal cycles for both Imaging IT and data-centre hardware contracts, and determining whether full public cloud or hybrid cloud architectures would suit a provider’s business and budget more effectively.

There were, however, also clear differences in how much of a priority the subject was for different vendors, with some such as Philips focusing on other parts of its portfolio, while those with cloud as a more central component of their offering such as Visage and Sectra, unsurprisingly, far more enthusiastic about its use. Fundamentally, few vendors are able to truly leverage cloud technology natively across their complete portfolios, such is the R&D investment and re-architecting required. Those that are further ahead in the process are pushing cloud more as a differentiator to customers; those slower to transition will instead downplay the importance of cloud-native near-term.

Overall, it was clear the importance of cloud is growing in customers’ minds. For a growing proportion of the market, it is now just around the corner and so theoretical conversations on cloud deployment are transitioning to more detailed discussions on execution. This includes factors like cybersecurity and operational and maintenance costs as well as looking for guarantees on comparable system performance. For others, cloud remains a longer-term aim, with nearer-term focus on operational workflow more prominent. However, evidence at the show clearly shows that cloud is becoming more important in provider considerations and highlights that its time will come sooner rather than later for imaging IT.

Good to be Back

RSNA 2021 was an exciting event. This may have, in large part, been down to the general positive feeling of meeting in person after so long, particularly under conditions that are just stringent enough to ensure only serious, engaged professionals attend, allowing vendors to have fewer, but more focused conversations.

The technologies and products being touted by the vendors weren’t revolutionary. Many vendors had used the “lull” offered by COVID-19 to optimise and refine their product portfolios as opposed to breaking substantial new ground. Nowhere was this more evident than in imaging IT, where enterprise radiology integration appeared to have finally matured, with most of the top 20 vendors now providing an integrated radiology offering.

There were some interesting new approaches, and illustrations of the growth of key technologies within the imaging IT and AI markets also; the closer incorporation of AI vendors into the wider conference rather than tucked away in the basement was particularly symbolic. Against this backdrop there were also some more intriguing topics. Digital pathology, for example, is one area that garnered sizable interest, with both regulation changes in the US and the pandemic shining a light on the analogue nature of pathology, encouraging interest in the field. Further visions, often the progenitors of longer-term strategies, were also being discussed, with topics such as AI-based triage for pathology being incorporated into radiology workflow tools, making an appearance.

Closer to the present, however, RSNA was a show centred around an industry that is performing strongly in a period of relative quiet. As the conference took place, before the Omicron variant rose to prominence, the worst of the pandemic appeared to be over, and vendors appeared on a strong footing (see Signify Research’s recent financials roundup). Looking ahead there are several broader technological trends set to increasingly make an impact, with AI, more mature enterprise imaging and cloud capability all growing in strength. Vendors, alongside providers, are laying the groundwork for these technologies and solving pressing issues that will open future opportunities. RSNA 2021, therefore was important. It was an event that helped culminate the past and hasten the arrival of medical imaging IT’s future.


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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 ResearchTo view other recent Premium Insights that are part of the service please click here

Signify Premium Insight: Vendor Financials Roundup – The Health of the Imaging Sector Q3 2021

This Insight is part of your subscription to Signify Premium Insights – Medical ImagingThis 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 ResearchTo view other recent Premium Insights that are part of the service please click here.

The third quarter of 2021 has been impacted less by the coronavirus pandemic than any of the previous six. This is evidenced in the financial results of the major medical imaging companies which shows that vendors are, by and large, progressing steadily along the recovery curve and in many instances showing growth for the trailing 12 months in the upper single digits and beyond.

One of the vendors that did, at first glance, appear to struggle, was GE Healthcare, which posted year on year growth for the quarter of -5%. However, this negative growth figure was, in part at least, a result of a tough comparable quarter, with last year’s $300m ventilator order for its Life Care Solutions business proving hard to match. This fall, however, was at least partially offset by increased volume in Imaging and Ultrasound. Despite this, the figure still stands in sharp contrast to those of its closest competitors, Siemens Healthineers and Philips, which posted growth figures of 12.7% and 10% in their respective Imaging and Diagnosis and Treatment businesses.

Of more concern than a tough comparable quarter in 2020 are the supply chain issues that GE pinned most of the blame for the negative growth on. GE was not alone in suffering from such problems, with players in industries as diverse as carmaking and meat production all being affected. The vendor did highlight that it was working to minimise the disruption, citing the example of its CT team in Japan that has worked to reduce production lead time by 40% from when parts are received compared to a year ago, but these initiatives have so far been unable to offset the challenges being faced. Canon was another vendor that highlighted this problem. Although the Japanese firm posted a year-on-year improvement just shy of ten percent, the vendor noted that the figure was still below its expectations.

Medical imaging vendors have, for the most part, performed strongly over Q3 2021. N.b. While Fujifilm Healthcare did enjoy organic growth and saw a ‘surge’ in revenue, the acquisition of Hitachi Ltd.’s diagnostic imaging-related business also contributed to its dramatic quarter-on-quarter growth.

Order from Chaos

GE Healthcare’s decline does look set to be short-lived, however, with it, and several other vendors highlighting remarkably robust order books. GE reported year-on-year order growth of 21% globally. Philips boasted comparable order growth of 15% in its Diagnosis & Treatment business in the third quarter, Siemens Healthineers highlighted that it had booked more than Eur20bn of order intake in its FY2021, Canon’s medical segment mentioned that it was building up its order book for the coming year, while Agfa described its order book as ‘healthy’.

The strength of these vendors’ order books is a result of several factors. The aforementioned supply chain issues are among them, with providers being forced to place orders for purchases that cannot be made right away. There are also other more pervasive trends having an impact.

One of the key reasons is the continuing Covid support packages from many governments. In countries with publicly-funded healthcare systems, providers are still benefitting from additional funding that has been allocated over the last 18 months. These providers have already spent heavily on equipment such as ventilators and patient monitors that was urgently needed during the worst of the pandemic, now their focus has turned to the enormous backlog of patients waiting for postponed elective procedures. To address this backlog many providers are investing heavily in imaging equipment, seeking to take advantage of both additional systems, as well as the efficiency improvements that newer equipment can offer.

This glut of orders is also present in privately-funded markets, although here providers are spending to take advantage of the backlog, which represents a significant revenue opportunity, much needed for many following the difficulties of the past 18 months.

Maintain the Chain

This increase in demand was noted by many different vendors. Fujifilm mentioned the demand of its ultra-lightweight mobile digital x-ray systems and ultrasound devices, both Philips and Siemens called out the popularity of their CT systems, Agfa mentioned the demand for its healthcare IT solutions and Konica Minolta highlighted the success of digital radiography and diagnostic ultrasound, among others. This, almost universal demand for medical imaging devices is obviously good news for medical imaging vendors, although there are also some risks.

Supply chain issues could continue to blight performances, and if one vendor is particularly struggling to supply equipment, then orders could leak away to competitors, similar to providers’ prioritisation of availability above all else in the digital radiography market during the height of the pandemic (a trend discussed in more detail here). Essentially, supply chain management and logistics is, in many ways, set to be the most crucial factor over the coming 12 months.

There are other clouds on the horizon too. While many governments have prioritised investment in new medical imaging systems, few seem able to address the shortage of radiologists. Longer-term this shortage could increasingly bite, with the purchasing of additional systems coming to an end when there is a lack of radiologists, technicians and other imaging professionals to use them. This shortage means that over time vendors will have to focus on other factors peripheral to the imaging systems themselves in order to boost their revenues. Improving efficiency and workflow, offering AI capability that will assist in some of the less complex and time-consuming tasks, and increasingly offering services as part of deals, are factors that could make a significant difference in coming years, given that the rapid rise in equipment demand can only last so long.

The worst of the pandemic’s volatility appears to be over, with vendors squarely into recovery.

Major Market Focus

One feature of this quarter’s results was that much of the commentary and discussion was centred around developed markets, with little attention directed elsewhere. Emerging markets often provide palpable growth when there is a lack of opportunity in more established markets. At present, however, many healthcare providers in emerging markets are particularly stretched financially. This combined with the more volatile nature of these markets, and the simple fact that vendors’ largest markets are enjoying unrivalled demand, means that the focus is elsewhere.

One market that is growing is China, but this has been more beneficial for some vendors than others. The two Chinese vendors tracked for this Premium Insight, Beijing Wandong and Shenzen Mindray both enjoyed year-on-year growth in the quarter above 20%. According to the latter this was a result of predominantly domestic growth, stemming from China’s ‘unprecedented’ medical investment in the wake of the coronavirus pandemic and a large expansion of public hospitals. Given China’s strategy of favouring local vendors, domestic companies have been the main beneficiaries of this investment. However other international vendors also performed strongly in the country, with Philips, for example acknowledging revenue delays, but touting mid-single digit order growth for the quarter. The vendor also said it expected prospects to improve further as regulatory guidelines in the country ‘become clearer’.

Time to Eat

Despite this nuance, when all is said and done, it has been a lucrative quarter to be a medical imaging vendor. While there have been weaker spots, AGFA noted a ‘softer’ quarter, for example, and Sectra saw revenues dip compared to the previous quarter as it experienced its usual quarter-to quarter variability, but these are minor hiccoughs in what is currently a booming market. The challenge for vendors will be how they can continue to capitalise on this very strong demand and ensure that nothing prevents them turning this demand into revenue. This will mean ruthless supply chain management and ensuring that there are no hurdles in producing and delivering medical imaging systems.

Vendors will be keen to make the most of this demand, which appears robust enough to support strong performances for the coming quarters. However, in servicing this demand they should maintain an eye on the future. The time will come when government spending boosts end, hospitals are left with more restricted budgets, providers have purchased all the medical imaging equipment their staff is able to utilise, and vendors will have to find more creative ways to grow.

Until then, the famine of the pandemic’s peak is past. Now is the time to feast.


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 ResearchTo view other recent Premium Insights that are part of the service please click here