Tag Archives: X-ray

Signify Premium Insight: Is the Future of Ultra-Portable X-ray in OXOS’ Hands?

Earlier this month medical imaging startup OXOS secured $23m in Series A funding, bringing its total funding to $45m.

The vendor, which was co-founded by an orthopaedic surgeon in 2016, is focused on the development of a handheld dynamic digital radiography system for use in orthopaedic surgery, an industry first. The funding round will help the vendor to expedite product development, as well as enable the vendor to increase the availability of its Micro C handheld device in markets across the world.

The potential for handheld X-ray in the coming years is significant, but so too are the challenges, the question is, how well equipped is Oxos to meet them?

Signify Premium Insight: Walmart Health’s Growth Shows Store is Serious About Retail Therapy

Earlier this month Walmart announced plans to double the number of health centre locations it offers in the US in 2024. The move will see 45 new Walmart Health centres opened in 2023 and 2024, adding to the 32 that have already been established since 2019.

Alongside primary care, dental care and Walmart telehealth among other services, Walmart Health also offers X-ray imaging services to patients. As such the retailer could play a significant role in the growing trend towards the consumerisation of healthcare and the increasing prevalence of outpatient imaging.

With this rapid expansion, retailers including Walmart could become attractive targets for vendors, but, how best can they capitalise?

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

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

Asian Manufacturers will Strive to Capture the US Market

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

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

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

Vendors will Increasingly Prioritise the Indian Market, Perhaps in Vain

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

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

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

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

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

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

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

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

Vendors Will Position Themselves as Experts in Outpatient Imaging

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

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

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

Disruptors won’t Disrupt

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

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

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

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

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

Signify Premium Insight: 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.

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