Innovations in Medical Imaging: Technological advances, growth opportunities and future market outlook

• Publication date: August 2009

Introduction Medical imaging technologies are widely used in clinical diagnosis to guide therapeutic and surgical intervention and to monitor disease progression, recurrence and treatment response and to improve surgical navigation. A plethora of imaging modalities are available to the medical community to provide anatomical and functional information. Extensive research indicates that the application of medical imaging may lead to ...

Introduction

Medical imaging technologies are widely used in clinical diagnosis to guide therapeutic and surgical intervention and to monitor disease progression, recurrence and treatment response and to improve surgical navigation. A plethora of imaging modalities are available to the medical community to provide anatomical and functional information. Extensive research indicates that the application of medical imaging may lead to significant reduction in healthcare costs by increasing the speed of diagnosis, avoiding the need for expensive treatments and surgical procedures and reducing mortality rate through early screening programs

During the last few years there have been a number of dramatic changes within the medical imaging as companies face tough economic and the initiation and implementation of new legislation. The emerging markets provide strategic opportunities for sustainable growth as patient demographics change, economies grow and healthcare coverage expands to increase the purchasing power of the individual.

Meanwhile reimbursement and regulation remain the two major stumbling blocks in the development of innovative medical imaging agents, which are currently subjected to “drug-like” criteria and rigorous standard operating procedures. However a better reward system that pays for getting the best patient results will ensure the right technologies are applied to get the right answer and outcome.

Use this report to

• Highlights some of the key technologies which healthcare companies are developing to maximize the using of medical imaging in the detection, diagnosis and treatment of diseases

• Analyses the recent technological breakthroughs that have impacted the medical imaging field and how this expand the use of imaging now and in the future.

• Discusses the potential of new technologies to improve the quality of imaging and how it may be applied in the diagnosis of a variety of diseases

• Identifies the most novel technologies that may revolutionize medical imaging, including the use of molecular imaging and virtual surgery

• Provides recent examples of new imaging agents, equipment and software programs and companies competing in each space.

• Analyzes the leading healthcare companies, their business strategies, market positioning and product portfolios and discuss geographical and technological trends now and in the future of medical imaging.

• Summarizes the challenges and opportunities that face the healthcare industry with a focus on the implementation of new technologies and the additional challenges associated with their use



Key findings from this report

• Diagnostic screening using imaging technologies can lead to the early detection of disease to minimize the use of invasive procedures, enhance the use of targeted therapies and palliative care, and improve patient management.

• New technologies that replace the need for X-rays and radioactivity are under development such as magnetic particle imaging (MPI) could revolutionize the way medical imaging modalities are used in the future for diagnosis, treatment and maintenance therapy.

• Advances in medical imaging software, molecular imaging and new imaging agents will expand the use of medical imaging in a broad range of disease and medical settings to ensure patients receive the right technology to get the right treatment.

• In the field of cardiology medical imaging has rapidly progressed e.g. detect heart attacks and measure plaque build in coronary arteries. Cancer will become the next frontier for medical imaging, where early detection can save lives. Whilst in the future the CNS arena e.g. Alzheimer’s disease and depression, will represent key challenges for future diagnostics.

• In addition to technological challenges face by healthcare companies the industry faces three external challenges global economics, reimbursement and regulation which will impact the future growth and innovation of the sector and determine the role medical imaging will play in the future of diagnostics.

Medical Imaging Industry in the United States

TABLE OF CONTENTS
Innovations in medical imaging
Executive Summary 10
Introduction 10
Current issues in medical imaging & recent breakthroughs 11
Challenges, opportunities & regulations 11
Market, trends & future directions 12
Chapter 1 Introduction 16
What does medical imaging encompass? 17
Anatomical & functional imaging 20
Why is medical imaging of value to the pharmaceutical industry? 21
Applications of medical imaging in drug R&D 23
Leading imaging modalities 26
X-Ray 27
Computed tomography 28
Magnetic resonance imaging 30
Functional MRI 31
Optical near-infrared fluorescence imaging 32
Ultrasound 34
Nuclear medicine 35
Positron Emission Tomography 35
Single Photon Emission Computed Tomography 38
Other imaging modalities 40
Video imaging 40
Comparison of imaging modalities: in vivo & ex vivo applications 41
Advantages & disadvantages of imaging modalities 42
Therapeutic applications 43
Cancer 44
Breast cancer 45
Colorectal cancer 46
Cardiovascular disease 46
Coronary artery disease 46
Stroke 47
Other cardiovascular conditions 47
Gastrointestinal conditions 48
Orthopedics & osteoporosis 48
CNS and thoracic trauma 48
Therapeutic conclusions 48
Chapter 2 Current issues in medical imaging & recent breakthroughs 52
Pre-processing & post-processing issues 53
Artifacts 54
Noise 58
Noise & artifact reduction 58
Raw data acquisition & image reconstruction 58
Image enhancement & portioning 59
Conclusions on imaging issues 60
Breakthroughs in medical imaging 60
Novel imaging agents 62
CT imaging agents 62
MRI imaging agents 63
Ultrasound imaging agents 64
PET & SPECT imaging agents 65
Imaging agent conclusions 67
Novel scintillator & detectors 68
Multimodality imaging devices 69
SPECT-CT & PET-CT hybrids 69
Spectral CT 72
High field MRI 73
Conclusions on imaging breakthroughs 75
Chapter 3 Challenges, opportunities & regulations 78
Geographical challenges & opportunities 80
US market growth & legislative impact 80
International markets and changing dynamics 82
Urbanization and rise of the emerging markets 85
Patient demographics: therapeutic dynamics 87
Technical Challenges & Opportunities 89
Molecular imaging 90
Molecular imaging probes 92
Regulatory support 93
Molecular imaging consortia 93
Imaging task forces 94
Targeted and multifunctional imaging agents 96
Nanotechnology 96
Nano-enabled delivery 97
Nano imaging materials 97
Targeted contrast agents 98
Multifunctional imaging agents 98
Novel imaging modalities 99
Magnetic Particle Imaging 99
PET-MRI 102
Real-time whole animal imaging 103
Multi-spectral opto-acoustic tomography 106
Computer assisted imaging & virtual surgery 107
Virtual surgery 108
Breakthrough conclusions 109
Reimbursement & regulations 109
Overall conclusions 111
Chapter 4 Market trends & future directions 114
The medical imaging market 115
Leading manufacturers of medical imaging equipment 116
Leading healthcare companies 119
GE Healthcare, New York, US 119
Hitachi Medical Corporation, Tokyo, Japan 119
Philips Medical Systems, Amsterdam, The Netherlands 120
Siemens Medical Solutions, Berlin & Munich, Germany 120
Toshiba Medical Systems Corporation, Tokyo, Japan 121
M&A activity 122
Recent market trends 125
Global trends in medical imaging 125
Technological trends in imaging equipment 126
Imaging agents & nanotechnology 126
Image-guided radiation therapy and patient selection 127
Future directions 128
Molecular imaging & diagnostics 128
Medical imaging informatics and networking 129
Medical imaging and virtual reality 130
Summary & overall conclusions 131
Chapter 5 Appendices 134
Primary research methodology 134
Companies involved in medical imaging 135
Glossary 136
Acknowledgements 141
Index 142
Bibliography & Endnotes 143

List of Figures
Figure 1.1: Medical imaging uses a spectrum of wavelengths 17
Figure 1.2: Medical imaging technologies 19
Figure 1.3: Imaging techniques and their uses 22
Figure 1.4: Medical imaging in the drug discovery & development process 24
Figure 1.5: X-ray of a skull a) anterior-posterior and b) lateral view 27
Figure 1.6: Computed tomography of the head a) coronal section and b) sagittal section 28
Figure 1.7: X-ray imagers 29
Figure 1.8: Evolution of CT imaging 30
Figure 1.9: Magnetic resonance imaging of the head 31
Figure 1.10: Functional magnetic resonance imaging of the brain 32
Figure 1.11: Multispectral imaging of the arm (700-900 nm range) 33
Figure 1.12: Ultrasound image of a baby in-utero 34
Figure 1.13: Principles of PET imaging 36
Figure 1.14: Fused PET/CT image of anatomy and function 37
Figure 1.15: SPECT detection 39
Figure 1.16: video imaging 40
Figure 1.17: Therapeutic application of medical imaging 44
Figure 1.18: Therapeutic applications of medical imaging 49
Figure 2.19: Medical imaging workflow 54
Figure 2.20: CT imaging artifacts 55
Figure 2.21: US imaging artifacts 56
Figure 2.22: US imaging artifacts 57
Figure 2.23: Recent technological breakthroughs in medical imaging 61
Figure 2.24: New scintillator materials 68
Figure 2.25: Opportunities in PET & SPECT for better energy resolution 69
Figure 2.26: Advances collimators focus and maximize SPECT-CT 70
Figure 2.27: Schematic of Spectral CT technology 73
Figure 2.28: Diffusion MRI - CNS 75
Figure 3.29: Historical and future outlook of MR/CT revenues in the US (1997-2011) 81
Figure 3.30: Global Population (2008) 86
Figure 3.31: Population over 60: world and developed regions (1950-2050) 87
Figure 3.32: Projected global deaths for selected conditions (2005-2030) 88
Figure 3.33: Application of molecular imaging 91
Figure 3.34: Delivery platforms for contrast agent 96
Figure 3.35: Multifunctional agents 99
Figure 3.36: Schematic of MPI technology 100
Figure 3.37: IVIS Kinetic images in small animal models 106
Figure 3.38: Real-time whole body optical imaging of Zebrafish 107

List of Tables
Table 1.1: Examples of image-related biomarkers with application in a variety of disease areas 26
Table 1.2: Common PET positron-emitting tracer isotopes 35
Table 1.3: Common SPECT radionuclides 38
Table 1.4: Ex vivo imaging modalities 41
Table 1.5: In vivo imaging modalities 42
Table 1.6: Advantages & disadvantages of imaging modalities 43
Table 3.7: Impact of American Recovery & Reinvestment Act (ARRA) on healthcare & medical imaging 82
Table 3.8: Recent impact of investment & regulation on international healthcare & medical imaging markets 84
Table 3.9: Typical effective radiation doses for medical imaging procedures 102
Table 3.10: Leading manufacturers of small animal imaging equipment and probes 104
Table 4.11: The medical imaging market – market leaders 115
Table 4.12: Leading manufacturers of medical imaging equipment 117
Table 4.3: Leading manufacturers of medical imaging equipment (cont) 118
Table 4.4: Recent M&A activity in the medical imaging field 123
Table 4.5: Recent M&A activity in the medical imaging field (continued) 124
Table 5.16: The medical imaging market – leading companies in the US 135