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  4. > Vital Signs - What’s New in Medical Imaging Advanced Visualization?

Ongoing technology and clinical advances in every imaging modality continue to bring advanced visualization (AV) and clinical applications to centerstage. AV is not just a core step in the interpretation workflow of each of these modalities, but essentially the set of solutions that allows to realize the promises of the advances on the equipment side. That is, the applications that allow to “make sense” of upgraded imaging capabilities, by using innovative ways to interrogate improved image depth and visualize enhanced image quality. This article highlights the recent advances in technical features and deployment models for AV solutions, and provides an update on recent dynamics in the competitive landscape.

What’s New in Advanced Visualization?

If the exhibit floor of the 2013 Annual Meeting of the Radiological Society of North America (RSNA)
had one standout modality this year, it was, without question, the advances with premium Computed
Tomography (CT). Technological and clinical advances in Magnetic Resonance (MR) and molecular
imaging were less impressive but were no less significant. Naturally, these developments in every
advanced imaging modality are turning eyes to advanced visualization (AV) and clinical applications. AV
is not just a core step in the interpretation workflow of each of these modalities. More than that, it is
the set of solutions that will allow the realization of the promises of these imaging advances – the ones
that will “make sense” of these upgraded imaging capabilities by using innovative ways to interrogate
their improved image depth and visualize their enhanced image quality.

Evolving Customer Demands Arising from a Maturing Market

It is a fact that the value proposition of any new premium imaging system being launched in
the marketplace is largely shaped by the set of existing clinical applications it helps improve
and the new clinical applications it gives rise to. Increasingly, in the past few years, the market
success of new premium scanners has also hinged on the availability of wide-set clinical
applications modules and image analytics tools (quantification, computer-assisted diagnosis,
image fusion, etc.).

Furthermore, market demand is on the rise for having this entire solution set accessible
as a multi-modality, multi-tenant, and multi-site solution integrated with multiple PACS and
third-party vendor applications, and that can be deployed in varying “flavors” in and beyond
the primary reading room. Soon enough, the market will demand a true multi-department
solution as well, to also include, for example, all cardiovascular and oncology applications.

Continued Advances with Multi-Specialty Clinical Applications

CT continues to attract the larger share of research and development efforts in the AV industry, with MR
in a strong second place, followed by positron emission tomography (PET/CT) and nuclear medicine, mainly represented by single-photon emission computed tomography (SPECT). Mirroring the technology and market advances of hybrid imaging systems, notably PET/CT and PET/MR, multi-modality image fusion is on the rise as well. Innovations with evermore powerful clinical application “knots and bolts” are appearing in every clinical area where these modalities are evolving, such as radiology, cardiology, image-guided surgery, neurology, nuclear medicine, orthopedics and oncology.

Consolidation around Five Key Industry Vendors

The industry dynamics prevailing in the US three to five years ago pointed toward the possibility of further industry fragmentation. Many relatively new contenders were then actively working to break into the market; vendors with a strong market presence in Japan, such as AZE and Ziosoft, and vendors with innovative thin-client solutions, such as Visage Imaging and Calgary Scientific, to name a few players within these then-emerging competitive tiers.

This industry fragmentation, however, did not take place in the US. On the contrary, the competitive landscape for the US advanced visualization market has since continued to consolidate around five major players. GE Healthcare, Siemens Healthcare, Philips Healthcare, Vital Images (now “Vital, a Toshiba Medical Systems Group Company”), and TeraRecon have all continued to gain ground in the US market while upgrading their several-hundred customer bases to their new-generation platforms.

Intensifying Competitive Dynamics Raising Entry Barriers

Today, the Japan-based vendors have not achieved the wide impact in the US that their strength in the Japanese market suggested they might have as they were entering the US market a few years ago. Ziosoft, which became Qi Imaging in 2011 but retained the name Ziosoft in Japan, as well as AZE have both had difficulty repeating their ongoing success in their domestic market in the US.

However, it is important to note Japan’s significance in the global advanced visualization market, as the country boasts the highest utilization rates of advanced imaging and number of advanced imaging equipment per capita. These varying levels of global market success are due to very different advanced visualization workflows in each region. Imaging providers in Japan, and even more so in Europe, rely much more on radiologists themselves to perform the post-processing manipulations using sophisticated and often cumbersome image analytics tools. Contrastingly, in the US, much of this work is done by technologists, often as part of 3D labs, before pushing the reconstructions and renderings to PACS for radiologist interpretation and then billed separately.

Similarly, the other contenders, including Visage and Calgary, have been much more IT-focused in recent years. They have developed and are now bringing to the market their new universal viewers, which include 3D/4D capabilities and are designed for enterprise-wide deployment. As such, they have been moving away, to some extent, from their former clinical focus as they used to leverage more of their limited resources to develop cutting-edge 3D/4D clinical applications.

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Vital Signs - What’s New in Medical Imaging Advanced Visualization?

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