Feature Article

The financial recession and changes in healthcare reimbursement policies are contributing to a changing view of innovation in the medical technology industry. As demand grows for smaller and less costly devices, innovation increasingly is associated with optimisation of existing technologies. This is especially evident in medical imaging, a mature market that won’t see the same rapid growth as some of the newer segments of the device industry. After a period of significant growth and innovation, the focus among manufacturers has shifted from adding features to optimising existing technologies to meet market needs.

A growing market
The global market for medical imaging is valued at about US$19 billion (excluding services, accessories and other add-ons), according to a report from InMedica. The company forecasts a global compound annual growth rate of 4 to 5% over the next five years. In today’s sluggish economy, this is solid growth, but it does not measure up to some of the newer medical device technologies—or even the recent past of the medical imaging industry itself.

Figure 1: This figure, courtesy of InMedica, shows the past and predicted growth of the medical imaging equipment market by modality.

“Medical imaging globally continues to be a growing market,” says Nadim Daher, Medical Imaging Principal Analyst, Frost & Sullivan. In the more mature market, the growth is in single digits. Some pockets of high growth remain in certain markets.”

The recession and cuts in healthcare expenditures, especially in Europe and the United States, have had a direct impact on the market. The computed tomography (CT) and magnetic resonance imaging (MRI) markets have been hit hardest because they are significantly more expensive than other options, such as X-ray and ultrasound.

“The market is readjusting itself, and the uptake of high-end modalities such as MRI and CT has declined in the last couple of years,” says Eramangalath Sujith, Programme Manager, Europe, Israel and Africa Healthcare, Frost & Sullivan. “The economic downturn and limited annual budgets have forced hospitals to go in for low-end slice configurations,” Sujith adds. CT uptake, in particular, has suffered during the last couple of years.

The slow growth is also a result of clinicians thinking twice before ordering a scan for a patient, evaluating both the financial cost (especially of CT and MRI scans) and the risk of radiation (CT and X-ray equipment).
A few years ago, excitement about CT and MRI was so high that doctors would send patients in for a scan without a second thought, says Daher.

Today, reductions in healthcare spendings have resulted in long waiting lines for MRI scans for many patients in Europe, says Sujith. The CT market, however, is recovering from concerns about radiation.

“CT has suffered heavily due to claims of high dosage. It was arguably high enough to induce cancer if done repeatedly. Today many OEMs have introduced effective dose control features and numerous techniques that result in lower dose exposure,” Sujith says.

New systems address affordability and efficiency

The need for affordable equipment in emerging markets, such as China, also has contributed to the focus on developing simpler and more economical equipment.

“Most medical imaging exhibitions today focus on affordable, efficient, work-horse systems that appeal to a wide spectrum of users,” says Stephen Holloway, Market Analyst, Medical Imaging & Healthcare IT Group, InMedica. “The rapid development of healthcare in regions such as China, Brazil and India has driven this trend further, with premium suppliers now implementing products specifically designed for these regions—affordable basic imaging systems with a low price tag.”

While the CT and MRI markets have slowed down, higher growth is predicted in other segments, most notably ultrasound, which already has the largest market share in Europe. Globally, point-of-care ultrasound is forecast to grow at a double-digit rate in 2012, according to a report on medical electronics from InMedica.

“The success of the point-of-care market so far has been due to three key factors: the development of application-specific tools, investment in physician education of use of ultrasound in the point-of-care setting, and proof of ultrasound significantly improving clinical procedures and patient safety,” says Holloway.

Another interesting development is in the X-ray segment, where flat panel screens and wireless equipment are driving growth of mobile X-ray systems.

“In mature markets, much of the fixed room X-ray equipment has already transitioned to digital. As image sharing and healthcare IT integration become increasingly important, the transition to wireless mobile X-ray is the obvious next step,” says Holloway.

Wireless systems improve workflow and can also allow smaller hospitals and imaging centres to shift to flat-panel detectors and digital radiography because the panel is transferable and can be shared between different mobile systems, says Holloway.

Although small, mobile devices typically will drive growth, there are exceptions to the rule. For example, 64-slice and above CT systems will grow faster than the CT market in general.

Combining several image modalities into one system is another trend in medical imaging. This enables patients to undergo different types of scans without being moved and produces images that are easier to compare. For example, companies such as Philips, GE and Siemens have developed PET-MRI hybrids. Combining the two was a challenge because PET equipment contains metal, and metal can interfere with an MRI scan.

CT is also making a comeback in the form of combination systems.

“CT is increasingly playing a vital role in therapeutic intervention the last couple of years with the advent of hybrid devices such as PET/CT, SPECT/CT, CTA (CT angiography), which have CT as the cornerstone,” Sujith says.

Promising future
The rate of growth may have slowed in the medical imaging market, but the market is still growing steadily. Companies are addressing needs such as reducing healthcare costs and increasing efficiency. For clinical settings where mobility is important, devices that enable point-of-care examinations will continue to drive the market. Even though the CT and X-ray equipment markets will see smaller growth, there is still a place for state-of-the-art equipment.

“Each modality is going about its own innovations and it’s all poised for further advancements,” says Daher. “I don’t see any of them having reached their full potential. They all have a bright future ahead of them.”

Camilla Andersson
is Associate Editor of EMDT