Medical Imaging in 2023

Happy New Year, and welcome to the first Imaging Wire of 2023. For those of you getting started on your annual gameplans, here are some potential imaging trends that you might want to consider.

Provider Strain – Many providers limped into 2023 with shaky finances, workforce shortages, and burnout problems, and now they have to navigate an economic downturn. That means they might only be open to “must have” initiatives/technologies that address that list of challenges.

Startup Strain – A market full of strained healthcare providers is generally bad news for medtech startups, especially considering that many of those startups are still in search of their next funding round (from a smaller / more selective group of VCs) or are trying to make their previous rounds last longer than they initially planned.

Paying Down Imaging IT Debt – Southwest’s holiday shutdown prompted many radiology leaders to reevaluate which of their long-delayed tech updates should be now viewed as “must haves” in 2023. These leaders will have a lot to choose from, given how many imaging IT infrastructures are patched together and how many tech initiatives were delayed by COVID.

The Year of AI (again) – There’s a lot of activity in imaging AI and perhaps even more attention, qualifying the AI segment for a wide range of 2023 predictions:

  • AI tools will continue to become more comprehensive
  • Pharma companies will play a growing role in AI funding and strategies
  • AI research will shift towards evaluating commercial tools
  • New chatGPT-inspired reporting/communications use cases will emerge
  • The AI consolidation wave will peak
  • AI adoption will expand among mid-sized hospitals and practices
  • Administrative/operational AI solutions will have another big year
  • The list of reimbursable AI solutions will continue to expand

Diversified Diagnostics – 2022 brought more imaging informatics players into digital pathology, welcomed ambitious new theranostics efforts, and saw a surge of intriguing multi-omics/olgy studies. Those trends should intensify in 2023, as traditionally separate diagnostic areas slowly converge with imaging technologies and teams.

Non-Imaging Biomarkers – Speaking of which, 2023 will bring more progress towards the development and adoption of imaging-related (or imaging-alternative) biomarker tests, including three brand new biomarker techniques that we covered below in today’s newsletter.

More Home Imaging – Medical imaging will continue its shift beyond hospital walls, as home and outpatient care boom, and mobile and DIY imaging technologies evolve.

Medical Imaging in 2022

For our final issue of 2022 we’re reflecting on some of the year’s biggest radiology storylines, including some trends that might have a major impact in 2023 and beyond.

“Post-COVID” – Radiology teams thankfully scanned and assessed far fewer COVID patients in 2022, but the pandemic was still partially responsible for most of the trends included in this recap.

Imaging Labor Crunch – Many organizations still didn’t have enough radiologists and technologists to keep up with their imaging volumes this year, driving up labor costs and making efficiency even more important.

Hospital Margin Crunch – There’s a very good chance that the hospitals you work for or sell to had a tough financial year in 2022, placing greater importance on initiatives/technologies that earn or save them money (and address their labor challenges).

AI Evolution – If a radiology outsider read a random Imaging Wire issue they might think that radiologists already use AI every day. We know that isn’t true, but imaging AI’s 2022 progress suggests that we’re slowly heading in that direction.

New Mega Practice Paradigm – After years of massive national expansions, recent unfavorable shifts in surprise billing reimbursements, radiologist staffing (costs & shortages), and the lending environment seemed to have caused large PE-backed radiology groups to pivot their 2022 strategies from practice growth to practice optimization.

The Patient Engagement Push – Radiology patient engagement gained momentum in 2022, as imaging teams and vendors worked to make imaging more accessible and understandable, more patient-centric imaging startups emerged, and radiology departments continued to get better at follow-up management.

The AI Shakeup – Everyone who has been predicting AI consolidation took a victory lap in 2022, which brought at least two strategic pivots (MaxQ AI & Kheiron) and the acquisitions of Aidence and Quantib (by RadNet), Nines (by Sirona), Arterys (by Tempus), MedoAI (by Exo), and Predible (by nference). This trend should continue in 2023, as VCs remain selective and larger AI players extend their lead over their smaller competitors.

Imaging Leaves the Hospital – Between the surge of hospital-at-home initiatives and payors’ efforts to move imaging exams to outpatient settings, imaging’s shift beyond hospital walls continued throughout 2022 and doesn’t seem to be slowing as we head into 2023.

Canon’s Meaningful RSNA Innovations

After taking a virtual approach to RSNA last year, Canon Medical Systems made its presence felt at RSNA 2022, unveiling an interactive “digital patient journey” booth that featured an interesting mix of new products and business model innovations. 

SP MRIs – Canon unveiled SP-suffix configurations of its Vantage Orian and Galan MRIs (1.5T & 3T), adding new features intended to enhance MRI team efficiency (tablet UX interface, intelligent Ceiling Camera), while making a number of its image quality and productivity-focused solutions standard (AiCE DLR, Fast 3D acceleration, ForeSee View automation).

Mobile XR – The new Mobirex i9 brings a rare update to Canon’s U.S. mobile X-ray lineup, launching with an emphasis on its small size, mobile/flexible design, and its use of Canon’s next-gen CXDI-Elite wireless detectors.

Mobile MI – In a different type of mobile expansion, Canon launched a mobile version of its Cartesion Prime Digital PET/CT, which seems to be a good fit for mobile coaches given its Air Cooled technology and small footprint (fits in 3.15×7.1 meters).

Future Proof Packages – Canon rolled out its interesting new Non-Obsolescence Program, which allows CT and MRI customers to purchase an up-front package that gives them access to all future hardware, software, and service options as they become available. The program covers five years of upgrades, and is priced well below what users would pay if they ordered each item individually.

Glassbeam Clinsights – Canon’s Inclusive Analytics Suite added Glassbeam Clinsights Utilization Analytics, which analyzes DICOM and HL7 data to help Canon service customers understand imaging utilization and productivity levels across their fleets (multi-modalities and vendors).

GE Focuses on Efficiency at RSNA 2022

GE Healthcare had yet another busy RSNA, highlighted by several major launches, and its continued focus on helping imaging teams work more efficiently.

MRI Efficiency – GE’s biggest RSNA launches were in its MRI lineup, and those new launches placed a direct target on workflow, resource, and cost efficiency.

  • GE launched its SIGNA Experience MRI platform, which positions the new SIGNA One user interface as a “cornerstone” for managing a range of GE MRI technologies (AI, DLIR, technologist workflow solutions, AIR Coils), and simplifying MRI operations.
  • GE also unveiled its forthcoming SIGNA Victor MRI (1.5T, 60cm), which will feature the new SIGNA Experience platform, and consumes significantly less power and helium (-10% & -70%).

Future-Forward CT – While GE Healthcare’s CT booth was highlighted by the modular/scalable Revolution Apex platform that launched at RSNA 2021, this year’s event brought news that GE’s latest photon counting CT prototype is beginning clinical evaluations at the University of Wisconsin–Madison (its first U.S. evaluations).

Partnership Plays – GE also announced a pair of partnerships that expand its capabilities beyond the scanners and solutions that it’s known for.

  • GE Healthcare unveiled its OmnifyXR Interventional Suite augmented reality solution, which it co-developed with MediView to support IR visualization and remote collaboration.
  • GE also entered the contrast media injector segment, signing an agreement with ulrich medical that will allow GE to sell the GE-branded CT Motion multi-dose syringeless CT contrast injector in the US.

Much More – GE Healthcare has been busy throughout 2022, so although the other products in its booth were still quite new, they’ve already been detailed in recent Imaging Wire issues. That includes the Definium 656 HD X-ray system, Omni Legend PET/CT, LOGIQ Fortis ultrasound, and the PACS-based intelligent workload management solution.

The Imaging Wire’s RSNA 2022 Reflections

RSNA 2022 is officially a wrap. We hope you had a blast if you made it, and had a great week if you stayed home. We also hope you enjoy our recap of radiology’s most important event in at least three years.

Crowds & Conversations – RSNA’s attendance and overall energy continued to trend upward, as most of the 31k people on-site were super engaged and truly excited to be there. Although attendance was still well below RSNA 2019 (~49k on-site), it was a big jump from last year (~23k on-site), and infinitely better than 2020’s virtual RSNA.

Much Rad Love – If you had “I’m not a radiologist but…” on your RSNA bingo card you’d be in a good spot, because the exhibit hall was full of non-rads talking about how to help radiology teams be more effective and more satisfied.

Focus on Productivity – Perhaps due to all that vendor empathy, just about every new product (hardware and software) focused on eliminating steps / clicks / interruptions, improving workflow integration, alleviating burnout and labor challenges, and better matching diagnostic processes.

Getting Cloudy – There’s no debate that imaging’s shift to the cloud was one of RSNA’s top trends, as informatics vendors continued to strengthen their cloud capabilities and expand their list of cloud-based customers (especially if you include hybrid). There were, however, plenty of debates about who’s cloud tech is truly native and who’s aren’t.

AI’s Two Sides – It seems like many folks are still in AI’s “trough of disillusionment,” as conversations often drifted towards problems with AI’s performance, use cases, funding climate, and provider ROI. However, AI adoption has never been wider, AI products have never worked better, and there are plenty of AI trends to be excited about…

  • AI is becoming less narrow
  • AI workflow integration keeps getting better
  • More radiologists are interested in AI
  • There’s solid traction with operational and efficiency AI
  • We’re not talking about AI replacing radiologists (as much)

Modality Progress – Although there were only a handful of completely new scanners at RSNA, the major OEMs showed continued advancements in MR (image quality, low-helium, low-field, reconstruction, coils) and CT (spectral, photon-counting, upgradability), while nearly all scanners took big strides in operator efficiency.

The Takeaway

Radiology faces plenty of challenges, but it’s populated by some of the smartest people in medicine/medtech who are working hard to solve those challenges. Hats off to the RSNA team for getting all the smart people together every year to push those solutions forward.

The Medical Imaging Economy

With economic warning signs flashing brighter by the day, and hospitals continuing to struggle, it’s hard not to be concerned about medical imaging’s economic situation. However, the major imaging companies’ latest round of earnings suggest that there might be more reasons to remain confident. 

  • Agfa – Agfa’s two imaging divisions had very different Q3s, as HealthCare IT posted solid revenue and earnings growth (+25.7% to $64M; +63.4% to $4.1M EBIT), and Radiology Solutions saw modest revenue growth and a big earnings decline (+1.5% to $121M; -69.3% to $2.9M EBIT).
  • Canon – Canon Medical Systems continued its upswing, posting solid revenue (+9% to $908.5M) and operating profit (+7.5% to $46M) growth amid rising orders and strong post-COVID demand.
  • Fujifilm – Fujifilm’s Healthcare unit posted yet another positive quarter, as imaging drove big increases to revenue (+17.1% to $1.7B) and operating income (+24.4% to $236M). 
  • GE HealthCare – GE HealthCare posted its third straight quarter of revenue growth (+10% to $4.6B), while inflation led to slightly lower profit ($700M).
  • Hologic – The semiconductor shortage caused Hologic’s breast imaging revenue to fall yet again (-20.2% to $212M), while the company’s overall net income plummeted (-63.9% to $118.7M).
  • Konica Minolta – Konica Minolta’s Healthcare revenue increased for the second straight quarter (+14% to $254M), although the division continued to operate at a loss (-$18M).  
  • Philips – Philips’ Diagnosis & Treatment division’s comparable sales fell for the third straight quarter (-2% to $2.37B) due to component shortages, while division profit also declined (Adjusted EBITA -31.6% to $216M).
  • RadNet – RadNet posted another quarter of rising revenues (+5.2% to $350M), although the labor shortage and related payroll inflation cut into its profitability (Adjusted EBITDA -16.1% to $45.8M).
  • Siemens Healthineers – Siemens’ imaging business remained the company’s (and industry’s) top performer, as strong MRI and CT sales drove yet another quarter of revenue growth (+8.1% to $3.35B) and solid margins (Adjusted EBIT +22.4% to $776M).

Although several companies noted economic and inflation headwinds, nearly every earnings report forecasted positive Q4s and 2023s, as supply chain challenges subside and the post-COVID demand surge continues. 

The Takeaway

There are plenty of reasons to be concerned about the economy. However, most companies still reported solid healthcare/imaging financials, and most factors that hurt Q3 performances are likely to improve throughout 2023. Plus, healthcare is historically insulated from economic downturns. 

That doesn’t mean that the next year (or two) will be easy, but it does suggest that medical imaging could fare better than many sectors of the overall economy.

Imaging in H1 2022

The first half of 2022 is now a wrap, and it was another big one within medical imaging. Here are some of the top storylines from the last 6 months and some things to keep in mind as we head into 2022’s second half:

  • Imaging Goes Home – Healthcare’s major shift into patient homes seemed to be bringing imaging along with it in H1, leading to new vendor-side efforts focused on at-home ultrasound (e.g. Caption’s home echo program, GE’s Pulsenmore investment), more providers expanding their mobile imaging capabilities, and new research efforts focused on patient-performed exams and mobile imaging operations
  • AI Shakeup – Everyone who has been predicting AI consolidation got to take a victory lap in H1, which brought at least two strategic pivots (MaxQ AI & Kheiron) and the acquisitions of Aidence and Quantib (by RadNet) and Nines (by Sirona). This kind of consolidation is normal for an emerging segment, but it wouldn’t be surprising if the difficult funding climate leads to above-normal consolidation in H2.
  • Photon Counting Reality – The momentum from Siemens’ photon counting CT launch in late 2021 carried into this year, leading to a series of studies suggesting that PCCT might be as good as anticipated, the launch of Samsung NeuroLogica’s own head/neck PCCT system, and increased photon counting R&D and marketing efforts from the other major CT OEMs.
  • The Patient Engagement Push – The first half seemed to bring a surge in patient engagement activity, including new investments from the major image sharing vendors, increased pressure from radiology leaders to finally achieve universal image sharing, and new efforts to make radiology reports more accessible and understandable.
  • The Platform Pathway – The trend towards AI platforms heated up in H1, as new vendors launched or expanded their AI platforms, the major PACS players increased their AI integration efforts, and startups and radiology teams increasingly embraced AI platforms as a solution to their narrow AI challenges.

Imaging in 2022

Happy New Year, and welcome to the first Imaging Wire of 2022. For those of you working on your annual gameplans, here are some major imaging themes to keep in mind.

COVID Wave Watch – Nothing will have more influence on imaging in 2022 than how / when the COVID pandemic subsides, and how many more waves and variants emerge until we get there.

Efficiency Focus – It’s abundantly clear that imaging must become more efficient, making workflow improvements arguably the top priority for radiology teams and the folks who sell to them.

AI Matures – Imaging AI should mature at an even faster pace this year, bringing greater clinical adoption (and expectations), better workflow integration, improved use cases and business models, and the emergence of clear AI leaders. We’ll also likely see an initial wave of consolidation due to acquisitions and/or VC-prompted shutdowns.

More M&A – Imaging’s extremely active M&A climate should continue into 2022. Based on recent trends, this year’s M&A hotspots are likely to include PE-backed rad practice and imaging center acquisitions, enterprise imaging vendors adding to their tech and “ology” stacks, and more modality and solution expansions from the major OEMs.

Advanced Imaging Advancements – 2022 is shaping up to be a milestone year for MR and CT technology. On the MRI side, recent breakthroughs in magnet strength, helium requirements, portability, and image enhancement (among others) should lead to big changes in how / where MRI can be used. On the CT side, we’ll see OEMs increase their focus on achieving photon-counting CT leadership, even if most of that focus will be from their R&D and future product marketing teams in 2022.

The Patient Engagement Push – Digital patient engagement continues to gain momentum across healthcare, placing pressure on radiology teams to keep up. In 2022, that might mean getting better at radiology’s current patient engagement methods (e.g. image sharing, patient-friendly reporting, follow-up management), although patients’ expectations will likely evolve at an even faster pace.

Imaging Leaves the Hospital – A lot more imaging exams could be performed outside hospital walls in 2022, as payors continue to incentivize outpatient imaging (and image-related procedures) and at-home care continues its massive growth. 

While it’s hard to say which, if any, of these trends will be the top story of the next 12 months, it seems likely that we’re heading into another year with more big news than can fit into a seven-bullet roundup. Wishing you the best in 2022, Imaging Wire readers!

Imaging In 2021

Congrats on wrapping up a truly wild year for radiology and medical imaging, everyone. Here are some of the top storylines from the last 12 months that might explain why it felt more like 18 months.

Mid-COVID – This time last year radiology teams and vendors were preparing for a post-COVID future, but that obviously wasn’t what happened in 2021. Instead, they battled their way through a second pandemic year and accelerated some major imaging-related trends that might extend well into the future (cloud IT, portable imaging, remote reading, backlogs, burnout, tele/home care, and more).

Big Acquisitions – It might not seem like it, but 2021 included an unusually high number of industry-changing acquisitions. These acquisitions turned two imaging leaders into parts of much bigger non-imaging companies (Nuance & Microsoft; Change & UnitedHealthcare), transformed Intelerad into a top-tier PACS player (Ambra, Insignia, HeartIT, LUMEDX), created a pair of new public companies through SPAC mergers (Butterfly & Hyperfine), brought the first big AI acquisition (Zebra-Med & Nanox), gave Canon its own photon-counting detectors (Redlen), and added surgical ultrasound to GE’s portfolio (BK Medical). Of course, there were plenty of practice and imaging center acquisitions too.

AI Maturation – AI is still super young, but there were plenty of signs that it’s growing up fast. 2021 saw imaging AI make its way into far more clinical workflows and curriculums, created a wider divide between the AI leaders and the 2nd/3rd-tier players, and drove a lot more AI vendor consolidation than it might appear. 

Burnout – Burnout remained a dominant theme again this year, making workflow efficiency the top focus area for most radiology team leaders, product developers, and marketers. 

Developing World Imaging – The developing world’s lack of medical imaging is definitely not new, but it seems like imaging players started paying more attention to the half of the world that still doesn’t have enough imaging access. We saw a sustained focus on low/middle income countries from Hyperfine/Butterfly/Nanox/, new developing world strategies from Siemens and Fujifilm, and a major tuberculosis CXR AI endorsement from the World Health Organization.

Population Health Pivot – 2021 also brought a major increase in population health AI activity, including commercial launches from Nanox AI and Cleerly, an increased research focus from academia, and UCSF deploying an automated CAC scoring system for all chest CTs.

Canon’s Big Virtual RSNA

Canon Medical was among the first companies to decide to virtually exhibit at RSNA 2021, but the OEM still had quite a presence, prominently placing Canon signage throughout the convention center and announcing a range of new products and technologies. 

Vantage Fortian – Canon expanded its open bore MRI lineup, launching the Vantage Fortian 1.5T system. The FDA-cleared MRI debuts with a range of productivity enhancements, including new patient monitoring and positioning tools and planning tools for liver, prostate, and whole spine imaging. The Vantage Fortian also adopts Canon’s prioritized AiCE deep learning image reconstruction technology.

MRI Solution Expansion – The Vantage Fortian’s new automation tools will soon expand to Canon’s Vantage Orian 1.5T MR and later go into the Vantage Galan 3T system (pending regulatory approval). Canon will also make Resoundant Inc.’s advanced Magnetic Resonance Elastography (MRE) technology available with its latest MRIs.

Premium Ultrasound Overhaul – Canon Medical introduced the Aplio i-series / Prism Edition, completely redesigning its premium ultrasound family. The Aplio i-series / Prism Edition ultrasounds launch with a new interface and ergonomics, higher processing power, added image enhancement applications (microvascular, ultra wide view), and new AI-based workflow automations.

Aquilion ONE / PRISM CT Enhancements – Canon continued to enhance its Aquilion ONE / PRISM Edition CT scanner, adding its new Precise IQ Engine (PIQE, a new DLIR solution for cardiac CT image enhancement) and SilverBeam X-ray filter (reduces lung cancer CT radiation dosage close to CXRs). These FDA-pending enhancements come one year after the Aquilion ONE / PRISM Edition added Deep Learning Spectral CT scanning (allowing one-beat cardiac scans).

Hi-Def Interventional Detector – Canon also launched a new 12×16 Hi-Def detector for its range of Alphenix interventional systems (Sky +, 4D CT with Sky +, Biplane, and Core+), joining its existing 12×12 detector. The hybrid detector has the highest resolution on the market (76 micron resolution, up to 6.6 lp/mm), while achieving 2-times greater spatial resolution than conventional flat panels.

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-- The Imaging Wire team