RSNA 2008: Mining the Landscape, Assessing the Exhibits

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In assessing the imaging technologies on display at RSNA, an observer provides tools for making critical decisions regarding your capital budget for 2009

Despite reports that capital equipment budgets are frozen at some hospitals, buyers were out in force at the 2008 meeting of the RSNA in Chicago. Nonetheless, professional attendance did not reach last year’s level, and exhibit square footage purchased and vendor attendance also were down, reportedly.

Clearly, the global economic crisis is having an impact, and both vendors and health care providers are feeling pressure on the capital side. Our financial analysts believe that from a capital-purchase standpoint, vendors will feel the greatest effect in the middle of 2009. For providers with technology decisions to make, it is more important than ever to make every dollar count, and we predict that there are still some great market opportunities.

Providers also need to maximize the equipment that they currently own; 64-slice (and beyond) CT is a great example. Scanners capable of doing cardiac imaging are located on every corner in most cities, but we have yet to see a market where one provider has risen to the top as the cardiac imaging provider of excellence. The technology is there, but in almost all areas, the cardiac imaging program for which it was purchased has not developed. The market is wide open, with no new technology purchase necessary.

One positive consequence of these changes is that hospitals, imaging centers, and now vendors are placing a renewed focus on efficiency. Surveying the offerings on the show floor makes the priorities of every vendor clear: increasing the efficiency of all departments across modalities and decreasing scheduling blocks to increase revenue from one unit dramatically. With digital mammography, for instance, halving the scanning block can more than double revenue.

Top Five Trends

We identified five top trends on the show floor. First, focus on superpremium technologies was diminished. We didn’t see a big-splash technology, making this one of the more sedate RSNAs in recent history. The other side of this is that we’ve seen many vendors focusing on developing budget lines: a 1.5T MRI scanner for less than $1 million and a workhorse 16-slice CT scanner costing less than $500,000. The four major manufacturers have all introduced budget CT and MRI units.

Second, the focus on women’s imaging continued. This is seen not only with digital mammography and the excitement around tomosynthesis, but in a huge array of offerings in the second-line imaging space for treatment planning and diagnosis. Subject to the economy, mammography volumes may decline, but vendors perceive providers as likely to purchase.

Third, interest continues to grow in breast tomosynthesis. We predict that it is the one truly disruptive technology that will be introduced in the next few years. Fourth, further advances in ultrasound generated considerable excitement, as vendors continue to add functionality. Increased attention to radiation dose in 2008 has also refocused interest on ultrasound.

Fifth, we are starting to see the additional development of niche offerings, with new market entrants such as specialty, head-only PET/CT scanners and new dedicated breast MRI offerings. There is real interest in developing market-specific platforms for specific patient populations, although, as capital dollars become scarce, these niche scanners are increasingly difficult to justify over a workhorse platform.

CT

During the past 12 to 18 months, 64-slice CT has become the technology of choice for hospitals interested in purchasing a workhorse CT scanner. While a 64-slice CT scanner is not required to perform the vast majority of studies, prices have fallen so precipitously that 64-slice CT can now be purchased for less than $1 million (without the cardiac package). It is a justifiable purchase today if there is a possibility that coronary-artery imaging will ever be performed during the life of that scanner.

Is 64-slice CT good enough for coronary-artery imaging? Evidence demonstrates that 64-slice CT is the standard of care for coronary CT angiography (CCTA) for most patients, but one serious concern is radiation dose. Dose-reduction protocols exist, but if they are not used, 64-slice CCTA is associated with a hefty radiation dose. Dose-reduction packages are very important for sites planning to offer CCTA in a programmatic way.

Nonetheless, 16-slice CT remains