Commentary: Next phase of radiology will develop with developing world

Within two weeks this month, Berlin will have played host to two major and one very small radiological meeting. The German Roentgen Society has just left Berlin's International Congress Center, and the combined International Society for Magnetic Resonance in Medicine (ISMRM)/European Society for Magnetic Resonance in Medicine and Biology (ESMRMB) is gathering. At the end of this week, the 25th anniversary meeting of the European Magnetic Resonance Forum (EMRF) will take place at Cecilienhof Castle in Potsdam, some 20 km away.

Several thousand participants from all over Germany, Europe, North America, and a very few from Asia will have been to the city. Yet it is Asia that will heavily influence radiology and MRI in the future. Today 95% of all resources for radiology are spent for 30% of the world's population in Europe, the U.S., Canada, Australia, and Japan. In most other parts of the world, there is one radiologist for every five to 10 million people. Many places have little basic equipment, and very few highly sophisticated systems are available.

This will change, however. As much as medical imaging has changed in developed countries over the last 30 years, it will change in other parts of the world within the next 20 years, though differently.

China's population is approximately 1.3 billion, the population of India is 1.1 billion, of Japan 128 million, of the European Union 494 million, of the U.S. 298 million.

Japan has an abundance of medical equipment, which has led to a surge of imaging examinations beyond any medical necessity or diagnostic indications. With 44 devices per one million people, Japan has the highest density of MR systems worldwide. During 2006, officials in the Ministry of Health, Labor, and Welfare introduced new regulations to reduce the total number of MR procedures and raise the quality of imaging services. They were concerned that too many MR machines were used without the supervision of a radiologist.

The situations in India and China are completely different. In India, government hospitals - in the cities as well as in the countryside - have very limited resources and not much specialist staff. The relative density of radiological equipment is low. In China, most hospitals are still government-run, and bureaucracy is a major problem. Although their populations are of a similar size, far more medical equipment is already available in China than in India, both per capita and in absolute numbers.

The difference in China is between big cities and the countryside. Extremely good hospitals can be found in the big cities, while the countryside is poor. Old equipment in rural hospitals - if there is equipment at all - is replaced with new machines only slowly. Availability and level of medical education and training are also slowly increasing in quality, but it will take years to reach a level of knowledge in modern imaging techniques and applications comparable to that in the cities.

In general, large institutions such as university hospitals, teaching hospitals, and provincial hospitals are well equipped with imported imaging systems. It is foreseeable that Chinese production of heavy medical equipment will increase in the near future. But the type of machines will be aimed at a mass market, and its users will not be well trained.

Recently, a Chinese radiologist summarized the situation: "We have 64,000 hospitals in China. We should - at least - have 64,000 CTs and 64,000 MRIs..."

Lack of financial resources and insufficient production will slow the closing of this gap in the near future. Unlike the European, U.S., and Japanese markets, which are oversaturated, it's likely to take 20 years or more to saturate the Chinese medical imaging market. It remains to be seen which companies and what kind of machines will be considered by the end users or those responsible for system acquisition.

I don't believe that all over China thousands of 3T or even 1.5T MR systems will be installed. Good quality, ease of handling, and relatively inexpensive machines will be the goal.

As Toyota became a trailblazer for automobile quality and innovation, some other company from Japan, or even from China or its neighboring countries, may become the trailblazer for a new generation of affordable, reliable imaging equipment that is useful for everyday patient diagnosis.

Prof. Dr. Rinck is a visiting professor at the University of Mons, Belgium. He can be reached at peter.rinck@umh.ac.be.