The future appears limitless as researchers and medical technology manufacturers continue to strive towards increased image quality, physicians work towards better diagnoses, and patients anticipate speedier, more comfortable, and less costly MRI exams, writes Anshuman Ojha of Elets News Network (ENN)
Magnetic resonance imaging (MRI) technology has gained impetus from the keen interest shown by technology developers and manufacturers who wish to make it more patient friendly. It has become one of the preferred diagnostic imaging methods for imaging the central nervous system, particularly for detecting brain tumors, spine lesions, imaging blood vessels, and stroke affected areas of the brain.
The global magnetic resonance imaging market is a shifting, capital equipment market that is saturated with numerous players developing innovative technologies. Given their impressive safety and efficacy as well as non-invasive nature, MRI systems have seen continued adoption since they were first introduced to the healthcare market. Rapid advances in the field imaging along with the development of MRI safe technologies have greatly expanded the potential of therapeutic applications.
The US market will be driven by physician adoption of new systems, especially high-field devices, as a result of acceptable safety profiles for high-field strength devices and the decreasing cost of equipment. The global MRI systems market will more than double in value from approximately US$ 4.1 billion in 2013 to over US$ 9.2 billion by 2020, representing a Compound Annual Growth Rate (CAGR) of 11.8 percent, according to market research firm Reportstack.
Closed systems with high field strengths dominate the market due to their high clinical significance and higher image resolution. Technological advancements such as the introduction of MRI-compatible pacemakers and digital broadband scanners drive the growth of the MRI market. Aging population in developed countries and increasing cases of chronic diseases in developing economies accelerate the market growth from the demand side.
The use of MRI technology is expected to dilate globally owing to its significance in modern medical diagnosis for diverse biomedical applications. MRI systems for neurology and brain disorders command the current market, while cardiac MRI and breast MR systems are gaining momentum, due to rising cardiac and breast cancer cases globally. With its ability to image anatomically and functionally, MRI has found its way into surgical applications as well as in diffusion and perfusion imaging. It is being combined with other modalities such as PET, SPECT and ultrasound to achieve new heights of image clarity. The overall MRI markets in Japan are expected to experience growth through 2020, including low-field systems, which are declining in many other countries globally. China will experience growth during the forecast period, although low-field systems will grow at a small CAGR of one percent. In India, the low-field strength MRI market segment will decline slightly at a negative CAGR of 0.6 percent through 2020.
In France there is no market for low-field MRI system sales, although the market for mid- and high-field systems is expected to undergo significant growth in the coming years. MRI is one of the fastest growing market segments in the country, and will be valued at over US$ 181 million by 2020. Valued at just US$ 30 million in 2013, the high-field MRI market in UK is one of the smallest in Europe, due to poor reimbursement and slow adoption of advanced systems.
In Brazil, cost and reimbursement remain the top concerns of practicing radiologists who must base diagnostic strategies on cost-effectiveness to a greater degree than their counterparts in US or EU. As a result of this slow market growth, many US and EUbased companies often overlook the Brazilian market, focusing on greener pastures in Europe and US where profitability is easier to achieve and maintain. This leaves radiologists in Brazil with limited options in terms of new technology, which in turn slows progress in the country and ultimately hurts patient outcomes.
The market of diagnostic MRI systems in India will see a growth of 15 percent CAGR over the next five years. The increased potential offered by new diagnostics tools, such as functional MRI, weight-bearing MRI, and diffusion of new clinical applications of this technology among physicians and patients are fueling the growth. Improved clinical outcome for patients has allowed the modality to reach tier-II and tier-III cities, avoiding the patients to travel many miles for an MRI scan.
The Indian MRI systems market is estimated at `1190 crore in 2014. About 356 units of diagnostic MRI systems were sold. On the basis of technology, Indian diagnostic MRI systems market may be segmented as 0.2-0.5 T MRI, 1.5T MRI, 3T MRI, and refurbished MRI.
Though 3T systems have an edge over 1.5T systems in terms of image quality, clinical applications, and certain other aspects of MR imaging, the versatile good system with multiple channels and coils on 1.5T system can equally provide great imaging. Nowadays, more and more manufacturers were flouting higher field MRIs of 3T to upgrade. However, in India it is not financially viable to invest in 3T machines as the cost is double of a 1.5T system. The manufacturers have now wisely developed robust 1.5T systems capable of everything a 3T could do and at a marginally higher cost. Using parallel imaging technology these systems can produce equally good images and also take lesser time as compared to earlier systems.
The future of MR imaging lies in high-field MR systems but equally in low field systems, which are patient friendly and targeted to specific body parts and diseases. Public-Private- Partnership (PPP) may also play a huge role in providing accessibility to patients residing in remote parts of the country. There is a constant increase in the number of hospitals, day centres and private clinics all over India and to cater to this growing need, there will be immense demand for diagnostics in the country.
Major Players The MRI market is dominated by GE Healthcare, Siemens, Philips, Toshiba and Hitachi — all had something new to offer. Here is a look at some of the latest innovations in MRI systems.
At RNSA, GE Healthcare unveiled its new SIGNA Pioneer 3.0 Tesla MRI system that comes with a new imaging technique called MAGiC, which, according to Ioannis Panagiotelis, GE’s global CMO, may reduce imaging times by up to two-thirds.
“Our big thing was the return of SIGNA, which we first introduced in 1983, with four new systems,” Panagiotelis says. “It was always associated with leadership and innovation and this is a vision we want to bring back for MR.”
The scanner features an enhanced version of GE’s SilentScan technology, which originally was only available for neuro scans, but now makes most scans nearly completely silent. Additionally, the SIGNA Pioneer features Total Digital Imaging, which enables improved image quality and increases signal-to-noise ratio by up to 25 percent.
With MAGiC, Panagiotelis explains, one can get six different image contrasts from one composition, taking a total of approximately five minutes, one-third of the time normally required.
“We can actually go back after the scan and change the contrast,” Panagiotelis says. “Let’s say you made a mistake; you can simply move the contrast of the image you got and optimise the contrast. We think there will be a huge interest in MAGiC as it’s a real answer to the needs of the customer today.”
Both the SIGNA Pioneer scanner and the MAGiC technology are pending FDA approval and have not yet received the CE mark.
Two other systems GE will introduce in 2015 are the SIGNA Explorer and SIGNA Creator, the latter an entry-level, value-segment system.
Philips has introduced Ingenia 1.5T S, a new addition to the Ingenia and dStream family specifically designed for medium- to large-scale hospitals that serve large patient volumes with high-performance MR imaging.
It includes mDIXON XD, which provides fat-free imaging and four contrasts in one sequence in virtually all applications and anatomies, including subtractionless MR Angiography, whole body imaging, and even combinations of fat-free and motion-free imaging simultaneously; and O-MAR, a solution for excellent image quality, even for patients with orthopedic metal implants.
“What makes Ingenia 1.5T S unique is that it addresses the root causes in a holistic way, delivering ‘first time right’ imaging for high productivity and a superb patient experience,” says Annemarie Blotwijk, director of MR marketing for Philips Healthcare. “mDIXON XD and O-MAR improve MR speed and robustness to make MR more accessible to patients and new applications. It strengthens Philips’ Premium IQ solution, which aims at delivering more diagnostic information in the available time slot.” Philips has also introduced new quantitative techniques in body and cardiac imaging to make MR a more definitive diagnostic solution, including MR elastography for the assessment of liver fibrosis and T2 or T1 mapping for cardiac disease assessment.
“Today, MR is already crucial and established imaging modality already today, but our customers see a huge potential to increase the impact of MR even more,” Blotwijk says. “The future of MRI is in delivering faster, more definitive diagnosis, shortening the time to diagnosis with more definitive outcomes. This will be achieved by making MR procedures extremely fast and reliable and by making MR more patient friendly. It will also require more quantitative data and provide intelligent data analysis tools to provide definitive answers and enable personalised treatment plans.”
At RSNA, Philips demonstrated the concept study of an MRI coil that is not only fully digital, but also features an integrated power supply. This allows a data-only connection of the coil, significantly speeding up the workflow.
“In the future many MRI developments will be based in the software domain, arising from the coupling of digital data acquisition, reconstruction and post-processing,” Blotwijk says. “We believe that meaningful innovation starts with collaboration, which is why we developed a high-end reconstruction framework with a plug-and-play environment for new and custom reconstruction algorithms that also supports a graphical programming interface for our clinical research partners.”
“Considers MRI a young modality because its potential is so limitless, and the company’s latest products have focused on improving speed and clinical use”, said Stuart Schmeets, Senior Director, MR Marketing, Siemens Healthcare.
“The efficiency of healthcare has evolved, making the diagnosis faster, and some of the buzz in the industry has been, ‘How can we increase speed for MRI?’” Schmeets added. “It is about collecting more information in less time and completing complex diagnoses.”
At RSNA, it unveiled its 1.5T Magnetom Amira MRI system, which was designed to speed up scans to as little as 10 minutes, while saving energy when the scanner is not in use. According to Schmeets, the system allows for 20 percent shorter exam slots, accommodates more patients per day, makes MRI expertise accessible to every technician, reduces the number of rescans with standard procedures, and minimizes complexity and maximizes efficiency for each MRI exam in an institution.
Siemens also introduced its new, FDA-cleared 24-channel version of the Magnetom Skyra, Siemens’ advanced wide-bore 3T MRI system.
“The new configuration of the Skyra joins the previously available 48-channel version and has a lower cost entry point for customers looking to perform advanced clinical applications,” Schmeets says. “We have a tremendous customer feedback programme and that helps drive our R&D and where we are headed.”
Additionally, Siemens has in the pipeline its new, 510(k)-pending SEE it solution for prostate MRI exams, which will enable users to perform noninvasive prostate MRI without an endorectal coil. According to Schmeets, MRI has the highest sensitivity and specificity for assessing prostate cancer as it can rule out the presence of life-threatening cancer with more than 89 percent certainty.
“Powerful coil technology and unique applications help to streamline processes and maximise system utilisation,” Schmeets added.
Siemens continues to make use of its Day Optimising Throughput MRI exam software, which provides intuitive protocol management designed to produce quality exams in less time, with the potential to shorten exam time up to 20 percent.
Toshiba Medical Systems
Toshiba introduced the Vantage Elan MR system, a 1.5T MR system, designed to help providers save time, money, and space. Josh Emperado, Toshiba’s senior manager for MR market development, says the Vantage Elan magnet and couch fit in a footprint of 23 square meters and it offers the lowest total cost of ownership.
“The buzz we hear in the industry is about making the whole exam much more comfortable and patient friendly,” Emperado says. “At the same time, MR technology is complex, and we need to make it easier for the customers. Our new system is quieter, more comfortable, and we’ve streamlined the process so that patients spend the least amount of time possible and customers can perform them easier.”
Among its features are Toshiba’s standard Pianissimo noise-reduction technology that’s designed to help put patients at ease, a single set of coils that does’t need to be readjusted for multiple exam types, and noncontrast imaging techniques allowing for safer exams.
“Toshiba puts customers first with an MR system that delivers productivity, reliability, and high image quality, but can fit into the budgets of small community hospitals,” says Nancy Gillen, vice president marketing and business development at Toshiba America Medical Systems. “We think hospitals of all sizes should be able to offer their patients the very best in imaging to enhance patient care and outcomes.”
Toshiba’s MR series also offers an upgradable solution to its existing Superb Micro-Vascular Imaging technology, which enables the visualisation of micro-vascular flow without the use of contrast.
Hitachi Medical Systems
The mandate around Hitachi’s MRI systems in 2014 dealt with several industry trends that shaped the direction of its newest products.
“MRI continues to move from qualitative to more quantitative assessment—such as techniques to visualise certain biomarkers and then map those over traditional anatomical images,” says Shawn Warthman, MRI marketing director for Hitachi Medical Systems America. “Our new MRI platforms needed to meet diverse market segment needs. Like all imaging modalities, MRI is focused a lot on workflow enhancements, continuing to push exam times closer to 15 minutes from the norm of 30 minutes.”
At RSNA, Hitachi introduced new software designed to improve image quality, workflow and new clinical applications for its customers. These include a new k-space parallel processing scan method, improved fast spin-echo imaging, new fat suppression sequences, improved tuning and prescan set up, noncontrast tissue perfusion, white matter lesion detection, breast spectroscopy, and cardiac wall motion analysis.
Key features in Hithachi’s Echelon Oval 1.5T system include 74-cm oval bore, a 63-cm wide mobile patient table, and workflow-integrated technology with integrated coils and on-gantry monitor.
One of the emerging trends in the global MRI systems market is the intense competition among the vendors. The leading vendors provide an extensive range of advanced instruments globally and the low-key vendors also deliver a wide range of products to suit the needs of their customers.
One of the major drivers in the market is advance in technology, which results in the availability of efficient and inexpensive devices. Advances in technology enhance the quality of the output by improving field strength, which results in a better signal and improved image quality. Technological innovations in the healthcare industry have resulted in the development of customised equipment as per the needs of the patients.
This impressive growth will be driven by continual design developments, cost reductions, reimbursement improvements and the rapid uptake of less expensive MRI systems in emerging markets.
One of the major challenges in the market is the growth of the used and refurbished MRI systems market. Many local vendors are exporting and importing used and refurbished MRI systems. Used and refurbished MRI systems are available at half the price of new ones, and the vendors also provide a warranty period of a couple of years on them.
However, current economic factors remain the greatest threat to new innovation in the next five years, despite numerous advancements in MRI system capability.
Healthcare providers are calling on manufacturers to develop both cheaper and better technology, meaning suppliers’ success will depend on the development of MRI solutions offering improvements in cost, efficiency and workflow, while also enhancing clinical diagnostics.
Despite the need for replacements, hospitals do not always decommission MRI systems at the end of the products’ manufacturer – recommended lifecycles, which negatively affects sales in developed markets as new system purchases are delayed or abandoned.
The Indian MRI market will be fueled by the rapid uptake of less-expensive MRI systems that will allow access to healthcare in more remote areas of these price-sensitive economies. With increase in average income, growing demand for healthcare, and higher standards for care, emerging markets are expected to see a rise in MRI diagnostic procedures, as the technology offers safe and valuable insight into patient conditions and is a powerful, irreplaceable decisionmaking tool for physicians.
In a time of rapidly changing environments due to regulations, financials, competition and technology, medical imaging will be a focal point of successful providers. The difference between successful providers and those that struggle will come down to the people who make up the organization and can utilize the resources and create an organization that is informed and flexible.