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.

Winners Announced for 2021 Imaging Wire Awards

The Imaging Wire is thrilled to announce the winners of the 2021 Imaging Wire Awards, honoring this year’s most outstanding contributors to radiology.

The following Imaging Wire Award winners were nominated by their peers and selected by a panel of judges for their efforts to evolve radiology and improve the lives of clinicians and patients:

COVID Hero: Lt Col Giovanni Lorenz, DO; Deputy Radiology Product Line Leader, San Antonio Military Health System (SAMHS)

Lt Col Dr. Giovanni Lorenz distinguished himself and the San Antonio Military Health System during the COVID pandemic, developing new remote diagnostic programs that improved SAMHS’ cardiac imaging operations, while also leading several National military COVID-19 working groups.

Diagnostic Humanitarian: Arlene Richardson, MD; Radiology Department Chair, Jackson Park Hospital

Dr. Richardson serves as Radiology Chair for Jackson Park Hospital and Medical Center, where she upholds equitable care for the hospital’s traditionally underserved patient population, and is deeply involved in RAD-AID International, where she currently serves as Director of RAD-AID Tanzania.

AI Activator: Greg Zaharchuk, MD, PhD; Professor of Radiology, Stanford University, Founder of Subtle Medical

In addition to his clinical and academic achievements at Stanford, the image enhancement solutions that Dr. Zaharchuk developed with Subtle Medical have significantly improved hospitals and imaging centers’ productivity and their patients’ experiences. 

Insights to Action: Richard Duszak, MD; Professor and Vice Chair of Radiology, Emory University

Dr. Duszak founded the Neiman Health Policy Institute and currently leads radiology health policy and practice efforts at both Emory University and the JACR, where he and colleagues have expanded awareness of imaging overuse and volume growth.

Burnout Fighter: Chris Mattern, MD; Practice President, Greensboro Radiology

Dr. Mattern created and leads many of Radiology Partners’ mental health and burnout prevention programs, combining education, mentorship, and communication to improve the organization’s cultural wellness.

Cornerstone: Elad Walach; CEO, Aidoc Medical

Elad Walach and his teams have developed seven FDA-cleared AI products and brought AI into clinical use across 600 global sites, improving medical imaging efficiencies and quality of care.

Tech Trailblazer: Sheela Agarwal, MBA, MD; Chief Medical Information Officer, Nuance Communications

Through her work with the ACR Data Science Institute and Nuance Communications, Dr. Agarwal has championed radiology professionals’ role in bringing AI into clinical care, while providing much needed tools and frameworks to support AI adoption.

The 2021 Imaging Wire Award judges include: Bill Algee of Columbus Regional Hospital, Dr. Jared D. Christensen of Duke University Health, Dr. Keith J. Dreyer of Mass General Brigham, Dr. Allan Hoffman of Commonwealth Radiology Associates, Dr. Saurabh Jha of Penn Medicine, Dr. Ryan K. Lee of Einstein Healthcare Network, Dr. Marla B.K. Sammer of Texas Children’s Hospital, and Dr. Irena Tocino of Yale New Haven Hospital.

Congratulations to this year’s Imaging Wire Award winners and nominees, who’s efforts to elevate radiology is truly inspiring. Also, thanks to this year’s amazing judges and everyone who nominated these very deserving imaging professionals!

RSNA 2021 Reflections

The first in-person RSNA since COVID is officially a wrap. Hope you had a blast if you made it to Chicago and a productive week if you stayed home. We also hope you enjoy The Imaging Wire’s big takeaways from what might have been both the most special and most subdued RSNA ever.

Crowds & Conversations – We were already expecting 50% lower attendance than RSNA 2019, but the exhibit hall and cab lines looked more like 70% below 2019’s crowds (even less on Sunday & Wednesday). That said, most of the stronger companies had steady booth traffic and nearly every exhibitor emphasized that the attendees who did show up were ready to have high-quality conversations.

Focus on Productivity – Just about every product message at RSNA focused on productivity and efficiency, often with greater emphasis than clinical effectiveness. The modality-based efficiency enhancements seemed to be the most impactful, which is good news for technologist bandwidth and patient throughput, but might be bad news for rad burnout unless informatics/AI efficiency can catch up (it doesn’t seem like that happened this year).

Modality Milestones – The major OEMs did a good job making modalities cool again, debuting milestone innovations across both their MR (low-helium, low-field, reconstruction, coils) and CT (photon-counting, spectral, upgradability) lineups. We also saw the latest scanners take big strides in operator efficiency and patient experience. There weren’t many breakthroughs with X-ray or ultrasound, and most point-of-care ultrasound OEMs stayed home (rads aren’t their market anyway), but attendees seemed okay with that.

AI Showcase – The RSNA AI Showcase had solid traffic and high energy (especially on Mon & Tues), helped by continued AI buzz and the fact that RSNA finally let AI vendors out of the basement. The AI Showcase highlighted many of the trends we’ve been seeing all year, including larger vendors transitioning to AI platform strategies, an increased focus on workflow integration and care coordination, and a greater emphasis on radiologist efficiency. There were also far fewer brand-new AI tools than previous years, as many vendors focused on improving their current products and/or expanding their portfolio via partnerships. 

PACS Cloud Focus – PACS vendors continued to place a major emphasis on their respective cloud advantages, and there was a widespread consensus that cloud is on every imaging IT roadmap. The PACS vendors seemed to talk less about multi-ology enterprise imaging than previous years, and expanding EI beyond radiology/cardiology still seemed pretty futuristic for most players. It was also quite clear that most of the PACS players’ AI marketplaces/platforms haven’t been as prioritized as earlier announcements might have suggested.

Best RSNA Since… 2019 – We’ve heard some folks saying this was the “best RSNA ever” because it was easy to get around and it was great to see everyone, but those seem more like pandemic silver linings than “best ever” qualifications. Still, the imaging industry made the most of RSNA 2021, and everyone seemed truly happy to be together again after two long years of working from home. As long as COVID cooperates, we should be set up for an excellent RSNA 2022.

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-- The Imaging Wire team