The 2021 Medical Imaging Report
Insights into the latest trends shaping the medical imaging industry
The 2021 Medical Imaging Report
Insights into the latest trends shaping the medical imaging industry
<span class="leftalign">Part of Informa:</span><span class="rightalign">Report developed in<br>collaboration with:</span>
What's transforming medical imaging today?
COVID-19 resulted in patients holding off most procedures related to oncology, cardiology and neurology. Also, elective procedures came to a halt. Moreover, restructuring of procurement budgets had to be done to address COVID-19 related requirements first. This caused disruptions in trade, supply chain, and manufacturing globally.
The medical imaging industry was especially hit hard as this resulted in a delay in procurements of capital-intensive equipment.
Developed with insights from global research and consulting firm Frost & Sullivan and leading technology research provider Omdia, this report deep dives into the impact of COVID-19 on the medical imaging industry, how AI is disrupting the industry, the latest trends shaping it, and the evolution of the discipline from being a diagnostic modality to playing an active role in patient care.
Which smart technologies are going to create the most impact on the medical imaging industry in the future?
- Artificial Intelligence (AI)
- Big Data
- Augmented Reality (AR)
- 3D medical imaging
- Nuclear imaging
State of the global imaging market
Different imaging modalities and global demand
Technological advancements in diagnostic imaging devices, rising incidences of chronic diseases coupled with the rapidly ageing population and rising awareness for early diagnosis of clinical disorders are the key factors that are expected to boost the diagnostic imaging market growth.
Diagnostic imaging refers to the use of different imaging modalities that capture images of the human body for diagnosis and treatment of diseases and hence plays a vital role in improving overall health.
Omdia defines the different imaging modalities below:
CT equipment is becoming more advanced. Hospitals are transitioning to higher slice solutions, such as 64–128 slice systems, that offer advanced features at a reasonable price.
MRI procedures continue to grow globally. Technological development and increased use of high field strength magnets have expanded the use of MRI to new use cases.
Ultrasound is a versatile modality. There are mature segments, like OB/GYN and cart systems, and POC and handheld segments.
X-ray has several segments that all perform uniquely. For example, the mammography market is well established and cyclical, while C-arm is a newer and faster-growing market.
Molecular imaging is in the very early stages of development. This modality merges various imaging techniques to produce advanced imaging often used to diagnose cancer and other diseases or disorders.
Among the modalities, X-ray sees the highest demand globally (38 per cent), followed by Ultrasound (27 per cent), MRI (16 per cent), CT (16 per cent) & Molecular Imaging (4 per cent).
Furthermore, research done by Omdia found that the biggest market for medical imaging equipment by region in 2019 was Asia & Oceania (40 per cent), followed by North America (29 per cent).
Impact of COVID-19
Short-term and long-term effects
From 2017 to 2019, the medical imaging industry was growing and adding US$2 billion every year, according to Frost &. Sullivan. However, due to the pandemic in 2020, there was a drop of about 15 per cent in revenue.
Most hospitals that have been affected by the pandemic are financially struggling. There is a drop in the gross margins for hospitals which have impacted capital expenditure planning and budgeting. Due to the pandemic, hospital budgets were diverted away from nonessential equipment to increase spending on COVID-19 related equipment.
Procedural volumes reduced significantly, as people started avoiding visiting medical facilities due to the fear of contracting the virus, thereby causing huge losses for hospitals. Government shutdowns also caused severe supply chain disruptions.
Medical imaging equipment roughly occupies about 50 per cent of a hospital’s capital expenditure budget. With the number being so heavy, most hospitals will look at not spending a big chunk of their budgets on medical imaging, which is one of the topmost areas where hospitals look to cut costs.
The current situation is uncertain, with countries like India battling its second wave. How will this impact the consumption or the procurement of medical imaging will depend on the pandemic. Considering all of these factors, Frost & Sullivan has given an aspirational range, an optimistic view, and a conservative range, which is a pessimistic view. The imaging industry’s growth trajectory will most likely be within these two ranges.
The medical imaging industry saw a drop of about 15 per cent in revenue in 2020
Frost & Sullivan
Source: Frost & Sullivan
As per the aspirational scenario, after witnessing a drop in revenues in 2020, the medical imaging industry is likely to achieve 85-90 per cent of 2019 market revenues in 2021.
Until 2022, the medical imaging industry won't reach the highest levels it did in 2019. Post that the market will continue to grow. There could be a minor drop in 2024, which is cyclical in nature, with hospitals sometimes delaying purchasing imaging equipment.
Due to the pandemic, Original Equipment Manufacturers (OEMs) are continuing to revise guidance every quarter based on the previous quarter's performance, therefore making it difficult to predict how the market will grow.
It is important to note that some of the imaging modalities were used for the management of COVID-19 patients. Frost & Sullivan found that digital radiography, CT and point of care ultrasound segments witnessed unprecedented growth (8-15 per cent) in 2020.
A similar trend will be seen in 2021 due to the pandemic persisting in large regions of the globe for a significant amount of time.
These modalities will continue to see positive growth trends. The two modalities that suffered a lot were MRI and mammography. They are expected to gradually return to 75-80 per cent levels of pre-COVID-19 revenues.
Interventional X-ray is expected to reach pre-COVID19 growth, as it is needed to address the pent-up demand for surgeries and procedures. It is a modality that is primarily used in operating rooms and helps in guiding the surgery. Because many elective procedures were delayed or postponed in 2020, the buying of this modality also suffered. But there is only a certain limit to which elective procedures can be postponed. The cases will start to pile up and there will be a greater number of patients who would need urgent care. This will give rise to a demand for interventional X-ray.
Moreover, most hospitals would be looking towards informatics as this will assist the radiology department in cutting costs. Informatics provides the data, analysis, and insights about how well a department is doing and utilising its assets and how productivity can be improved. To track all of this there is an increased need to invest in informatics. The demand for technologies such as enterprise imaging will be highlighted in the post-pandemic period. It is the route for achieving efficiency and will play a key role that will lead to the better performance of the segment.
Hospitals have had to take countermeasures to limit the virus spread, which has impacted the medical device market. These include:
Disinfection of scanning areas and equipment – This has slowed patient volume, as the procedure takes longer.
Modification of the working environment
Accessibility to appropriate personal protective equipment (PPE)
Monitoring of radiographers' health
Suspension of system installations – To stop the spread, nonessential work, including on systems in the early stages of installation, was suspended. This measure is forecast to drive a significant decline in unit shipments.
Furthermore, the COVID-19 outbreak is affecting supply chains and disrupting manufacturing operations around the world. In Western Europe, a primary concern faced by medical suppliers has been the logistical challenges caused by the driver shortage and assurance of the health and safety of the available drivers and their infrastructure.
The pandemic has caused manufacturers to pivot their manufacturing capabilities toward critical care systems to meet the high demand.
According to Omdia, as markets stabilise, much of the pent-up demand from delayed equipment purchases in 2020 will be met in 2021 and 2022. Procedural volumes are expected to rebound as patients return to normal healthcare routines.
Also, governments are expected to increase expenditure to revamp healthcare infrastructures to safeguard against future pandemics.
As markets stabilise, much of the pent-up demand from delayed equipment purchases in 2020 will be met in 2021 and 2022
Some of the challenges that are likely to arise include the fact that healthcare providers will most likely face severe budget constraints owing to the elevated spending to combat the pandemic. Moreover, the resurgence of cases in many nations will hinder the recovery process by forcing healthcare systems to continue to divert resources to address COVID-19 patients. Also, delays in the vaccine approval process and vaccine distribution challenges are set to increase the length of the pandemic.
According to Frost & Sullivan, the postponement of procurement in the pandemic years can lead to higher purchasing in subsequent years leading to a US$45 billion market in 2025. However, the uncertainty of the pandemic re-emerging in sequential waves can create a permanent dent in the sales leading up to US$43.8 billion in annual revenues in the year 2025.
The medical imaging industry is likely to achieve 85-90 per cent of 2019 market revenues in 2021
Frost & Sullivan
Smart technologies are breaking down barriers
The imaging industry is witnessing three major trends, highlights Frost & Sullivan.
Trend 1– Disruptive technologies
The first big trend is disruptive technologies and the disruption it is causing in business models. There is also a change in behaviour in radiology departments.
There is a lot of talk about how Artificial Intelligence (AI) is coming in, how clinicians are adopting it, and how is it going to disrupt clinical work. These are currently at a nascent stage but hold a lot of promise.
Artificial Intelligence (AI)
AI is not going to replace radiologists, but it is going to significantly complement and supplement the radiologist’s capability. In fact, AI has the capability to analyse the image before it goes to the radiologist, allowing them to pick up an image that has been flagged off by AI rather than browsing through thousands of images.
This will help in triaging and reaching out to patients who need urgent care and improves clinical outcomes for the entire hospital. Moreover, This is how a healthcare system based on value-based reimbursement models would work.
Previously, hospital departments would not talk about data. It is only now as vendors have started offering data analytics solutions, hospitals are keenly looking into how data can help increase operational efficiencies within departments.
They are also looking at finding out how and where waste is happening, what can be done to prevent it, and how more can be achieved with fewer resources. In the post-pandemic world, most hospitals are going to work on minimal resources, but are going to expect more outcomes than what was seen before the pandemic.
Therefore, data analytics is going to be a very important value proposition for vendors.
Cloud gained significance during the pandemic as it was quicker to deploy and didn't need in-house resources to prepare. During the pandemic, offices were shut down and staffing resources were laid off, and the cloud became a better model to deploy as it was being done off-site and didn’t consume in-house resources’ time.
Going forward, there will only be higher cloud adoption. Previously, operators were on the fence about the cloud and were looking at hybrid models – storing the most sensitive data in the data centres in-house and only moving the secondary workloads to the cloud.
But the pandemic has shown that it's possible to move the entire primary workload to the cloud. Many vendors have also started talking about the cloud as being a key value proposition of their offerings.
Where can AI make the most impact in imaging?
- By directly incorporating AI in the picture archiving and communication system (PACS)
- Using standalone/independent AI applications
- Integrating AI directly in imaging equipment/scanners
Trend 2 – Innovative business models
Most hospitals are in financial distress due to the pandemic as they have had to delay elective procedures, which are the top profit-making procedures. This has reduced their spending capability and budgets, which will impact medical imaging procurement.
However, the industry has pivoted and have started offering the “Opex” or enterprise business model. In this model, the hospital doesn’t need to buy the equipment from its capital expenditure budgets, so they would pay as they use. This would involve once in a year or a five-year payment plan through fixed monthly or yearly instalments. This would give hospitals clear visibility as to what expenditure is coming their way and how much they have to spend on imaging services. This is a model that will continue to gain traction moving forward.
Trend 3 – Evolution of the discipline
In the past, radiologists were confined to their dark rooms where they would read and interpret images. Today, they have come out of their reading rooms and interact more frequently with the referring physicians and are becoming proactive in reaching out to patients. Increased collaboration is bound to improve clinical outcomes. This behavioural change is happening as part of patient-centric care. Within radiology too, everything is being centred around the patient. Several solutions are available to address this such as enabling patients to access the images and sending images outside a network. AI is increasingly being used in clinical support and helps radiologists in various ways, one being triaging. Today, radiologists are ready to play a key role in patient care and can ensure that the patient gets the right treatment at the right time.
In the past, radiologists were confined to their dark rooms where they would read and interpret images. Today, they have come out of their reading rooms and interact more frequently with the referring physicians and are becoming proactive in reaching out to patients.
Applications of AI
Use cases of AI in medical imaging
While currently quite niche, the areas of applications and use cases of AI in medical imaging are gradually becoming wide-ranging. Most of the work that AI is doing at the moment in medical imaging is around analysing. This means that when images are taken, AI algorithms are being developed that will read a particular image and look for any abnormalities before adding it to the radiologist’s worklist.
Some companies are doing exceptional work in other parts of the imaging workflow such as in the acquisition, assigning and reporting stages.
AI algorithms can look at the images and highlight any findings which deviate from the normal. This will help radiologists go through the images quickly, save their critical time and helps in clinical decision support. Moreover, AI has improved the way reporting is done. For example, a company called Nuance offers noteworthy capabilities in natural language processing for healthcare in general and for radiology in particular.
Source: Frost & Sullivan
So, when a radiologist starts dictating the findings, the company’s solution picks up all the dictation words and fills in the report by picking up the relevant words, so that the radiologist doesn’t have to spend time writing it. This becomes easy for subsequent algorithms to analyse a set of structured reports and then analyse it together to improve quality outcomes. Similarly, viewing and interpreting are other key areas where AI vendors are focused.
Today, AI is helping radiologists by guiding them towards factors that need immediate attention and increases their productivity. Therefore, it will not make their role obsolete but help them do more value-added work, which will increase their contribution towards clinical outcomes and operational efficiency.
Furthermore, AI can play a key role in low-resource settings. For example, in a developing country like India, tuberculosis cases are quite high and there may not be enough resources in the country or the ideal number of radiologists needed to go through all the X-rays required for tuberculosis evaluation. Or for instance, many countries have a mammogram screening programme, where women of a certain age group are asked to compulsorily undergo mammograms once every two or three years. This results in millions of different images. When you screen 100 patients probably three or four would turn out to be positive. In such a situation, the AI algorithm can look at those images first and detect the ones that deserve immediate attention.
In a developing country like India, tuberculosis cases are quite high and there may not be enough resources in the country or the ideal number of radiologists needed to go through all the X-rays required for tuberculosis evaluation
In the past, whenever AI companies would approach hospitals, there were always questions about who is going to pay for this as there were no reimbursement models available. However, in the U.S., the Centers for Medicare & Medicaid Services (CMS) has approved reimbursements for two algorithms. One is for a diabetic retinopathy algorithm.
Many more such algorithms are likely to be approved for use in clinical settings. Also, as part of their business case, AI vendors can’t solely rely on reimbursement models but will need to show how much department time is being saved by the algorithms. This is when hospitals will join the AI adoption.
Improving diagnostic power
The combination of AI in radiology, pathology and genomics can improve diagnostic power but is at a very nascent stage.
The one area where it has got a bright future is oncology. The use case of the convergence of imaging and digital pathology and genomics to happen in oncology will lead to higher accuracy of diagnosis as well as earlier detection. Either of these two means that the health systems will save a lot of money.
Therefore, a hospital needs to identify the disease at the earliest stage and get the right diagnosis the first time. If this has to happen, hospitals have to rely on data from other disciplines.
Data from the other clinical disciplines is going to improve the clinical diagnosis and accuracy of imaging. This is currently termed radiogenomics, which is the combination of the fields of radiology and genomics.
The field of radiogenomics is currently overcoming the translational gaps that separate the pre-clinical and research environments where it is mostly established, such as in cancer research and drug development, from the clinical setting, where it is gradually gaining acceptance as a clinical decision-making tool.
When images are being fed to the AI algorithms, they will have some radiology findings and when these are correlated with the genomic or digital pathology findings, the AI algorithms can do the diagnosis with higher confidence and accuracy.
Case studies of commercially deployed AI solutions
1. Digital Diagnostics (formerly IDx LLC): It is the first autonomous AI algorithm to be approved by the U.S. FDA. This means that the algorithm does not require a doctor to sign off on the diagnosis. The product is IDx-DR for diabetic retinopathy screening in diabetic patients.
2. Companies like RapidAI and Viz.AI have AI solutions that are being used in stroke diagnosis in hospitals, allowing for faster detection and communication to the clinical teams to ensure the fastest possible treatment, since every second in stroke cases counts.
3. When COVID-19 struck, several imaging AI solutions were developed and deployed to help doctors detect COVID-19 from lung imaging, to predicting the severity and prognosis of a positive patient (e.g., need for a ventilator), etc.
4. Lunit INSIGHT MMG is a commercial AI solution for breast cancer detection from mammograms. A study published in JAMA Oncology and Lancet Digital Health compared various commercially available mammography AI solutions with Lunit Insight MMG. Based on 8,805 cases, Lunit’s algorithm showed the best accuracy among other available solutions.
Barriers to AI implementation
Nicholas Cnossen, MD, MPH and Manish Kohli, MD, MPH, MBA from Albright Stonebridge Group (ASG) highlighted that despite the potential of AI to transform healthcare, many pertinent issues are slowing more rapid and widespread adoption.
One of the most pressing issues is how to regulate AI in an accountable, fair, and transparent manner while implementing it for complex and risk-intensive processes.
AI regulation can be approached from an ethical, technical, or legal-regulatory perspective. There are various concerns regarding each of these approaches, and the concerns are often overlapping.
The ideal regulatory framework will likely require a multidisciplinary effort that adequately addresses concerns around data privacy, accuracy, patient safety and medico-legal implications. Within the legal-regulatory sphere, questions arise regarding the appropriate scope of legal policies surrounding AI as well as which entity or entities ought to be responsible for implementing and enforcing said policies.
There are accountability challenges because AI and deep learning algorithms such as neural networks are “black box” systems that defy traditional conceptualization and explanation. Individual errors or large-scale discriminatory patterns may result from AI for which it will be difficult to assign liability in the absence of a fundamental understanding of the underlying mechanisms resulting in error.
Scanning the future of medical imaging
The medical imaging market of the U.S. and EU contribute about 55 to 60 per cent of the global revenues, according to Frost & Sullivan. The remaining come from the Asia Pacific (APAC) and the rest of the world. These two markets can be defined as replacement markets in the sense that their installed base is plateauing, there are no new projects, but a greater number of units here are getting replaced. Whereas in the APAC and the other emerging countries, this trend is in the reverse as there are a greater number of Greenfield projects, which means that the installed base is growing.
Today, OEMs are looking at three to four per cent growth, when it comes to equipment. This shift is pushing them to look at other growth avenues such as moving from equipment selling to solution selling or consultative selling by entering into partnerships. OEMs want to partner with customers in a way that they can come to them with these three things. It is going to be a consultative set-up so whether the hospital has the capability to pay or not, or buy the equipment, they are going to install it and make monthly or annual fixed payments. The manufacturers are going to penetrate deeper into these hospital relationships by offering different value propositions.
This includes services such as training of the staff. For instance, if there is a new MRI with a new feature, and if the technicians are not able to use that feature efficiently then the investment is going to go to waste. So, these companies are going to visit the hospitals and see what can be done to improve the productivity and efficiency on outcomes by training the staff.
The post-pandemic era will see an increased focus on cost-cutting measures in radiology departments. There will be an increase in solutions and equipment’s that improve efficiency. There is also going to be a higher emphasis on the total cost of ownership rather than the cost of acquisition and how much a hospital is going to spend for the next 10 years in maintaining that equipment.
Omnia Health’s Trend Report is a look at the latest trends shaping a key healthcare category informed by data and insights.
- Orthopaedics (June)
- Oncology (September)
- Obs/Gynae (November)
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Imaging & Diagnostics Focus Day:
25 - 26 May
The Arab Health Virtual Focus Days will take place over three weeks, ahead of the in-person event, with dedicated days for the most topical healthcare sectors that are re-shaping the healthcare industry’s landscape.
The Imaging & Diagnostics focus day will include high-level keynotes that will feature talks from the trailblazers and innovative companies in healthcare in each of the sectors.
Total Radiology Conference:
The theme of the Total Radiology Conference this year is “Looking ahead. Embracing innovation”. The conference will look at imaging and diagnostics beyond COVID-19 and see how it has been shaped by the pandemic.
This CME-accredited meeting will present the very latest practices in medical imaging, accurate imaging diagnosis to improve care quality for radiology patients. The event will take place at Dubai World Trade Centre.