Demand for PET/CT exceeds vendors' initial expectations

GE takes early sales lead by courting radiologists

The history of fusion imaging has been anything but encouraging. Since the early 1990s, sporadic attempts by entrepreneurs to sell software that combined anatomic and functional data sets have failed, leading some industry pundits to question whether the market was ready last year for high-priced hybrid scanners combining PET and CT. It now appears that the gamble taken by Siemens Medical Solutions and GE Medical Systems to launch these products is beginning to pay off, and there may be plenty of demand left over for newcomer ADAC/Philips.

Marvin Burns, industry analyst and president of Bio-Tech Systems, a market research firm in Las Vegas, reports that of the 267 PET systems booked in 2001, 21% were combined PET/CT systems, making up 35% of PET's total sales of $437 million. By 2008, Bio-Tech predicts that 34% of the PET units sold will be combined PET/CT systems (235 out of a total of 700 units), making up 41% of PET's total sales volume ($494 million out of a total $1197 million).

These PET/CT systems combine a multislice CT scanner and high-performance PET system on the same axis, which gives users the benefits of high-quality, fast CT augmented with PET to improve diagnostic sensitivity and accuracy. The units, which are near the high end of the price spectrum at around $2.7 million, appeal primarily to radiologists anxious to gain a foothold in this field while retaining control of expensive diagnostic equipment, Burns said.

GE has been particularly successful at going after the radiology community, he said. The company generated about 50 orders for its combined PET/CT systems domestically and 10 more outside the U.S. between the commercial launch of its Discovery LS in the second half of 2001 and the end of the year.

GE has confirmed that sales of Discovery LS, which combines the LightSpeed multislice CT scanner with the Advance NXi PET system, have been brisk. The company reported that more than 50 units were installed globally last year and more than 80 additional orders have been received.

"Demand has exceeded expectations, but not capacity," said GE spokesperson Patrick Jarvis.

In early March, GE Medical Systems opened a 215,000-square-foot, $30 million PET/CT technology center at the company's corporate campus in Waukesha, WI (SCAN 3/20/02).

Siemens, which introduced biograph at the end of 2000, has gotten off to a slower start. The company sold only about a half dozen of the PET/CT systems in 2001, according to Burns. He said orders for biograph have been picking up, however, and Siemens confirmed this. As of April 1, the company had sold "close to 50 units," according to Barbara Franciose, president of the Siemens nuclear medicine group.

"We anticipate a significant increase in the next six months as the PET/CT market continues to grow," she said.

ADAC/Philips may soon enter the frey. The company has developed a PET/CT scanner called Gemini, which combines its new Allegro PET system with Philips' Mx 8000 multislice scanner. ADAC has begun taking orders for Gemini and plans to begin routine shipments later this year (SCAN 4/3/02).

GE jumped into the lead largely by leveraging its strength in the CT market in North America and by linking positron imaging with premium multislice CT, Burns said.

"GE surmised correctly that many of its CT users would be receptive to adopting image fusion, combining the virtues of PET with high-performance CT imaging," he said. "This is quite a departure from selling nuclear medicine equipment, where the focus has traditionally been on the nuclear medicine physician."

To a specialist in nuclear medicine, the rationale for combining PET and CT is to allow better interpretation of the PET image, thereby improving diagnostic accuracy. GE turned this around, Burns said, focusing instead on the opportunity to use PET to improve the diagnostic accuracy of CT. To that end, GE has promoted its combined PET/CT system as a fast CT augmented by PET, which provides a sophisticated contrast medium that offers valuable functional detail in color.

Initially, the Siemens marketing approach for biograph was different, Burns said. The company focused on nuclear medicine departments rather than the radiology centers pursued by GE. This was an outgrowth of the development scheme underlying biograph, which emphasized positron imaging. Specifically, Siemens combined its top-of-the-line HR PET system with a Somatom Emotion CT scanner rather than its flagship quad- or 16-slice Sensation platform. The HR system is sold primarily to research institutions prepared to invest the $2 million required to obtain the highest resolution PET images. The Somatom Emotion is a high-performance but less than premium-grade CT scanner.

"Therefore, Siemens initially visualized the biograph as a sophisticated research instrument, rather than a mainstream clinical PET system," Burns said. "Although Siemens recently recognized the merits of bringing the biograph more into the clinical mainstream, it is still behind GE in this segment, even though Siemens had an earlier start."

GE's marketing approach emphasizes that the CT scanner can be used at maximum capacity (15 to 20 procedures a day), with PET scans interspersed depending on patient volume. Since the CT scan can be functionally completed in about 60 seconds in the combined mode, there is no burden from a timing standpoint, Burns said. In addition, PET scans can be scheduled during the day, when contrast agent FDG is easily available, with full utilization of the CT in the evenings and on weekends, when FDG is less available.

"This has economic appeal and helps justify the high initial investment," he said.

Siemens apparently is beginning to adopt a similar market strategy, although its approach hinges on geography. In Europe, the company continues to focus on nuclear medicine departments. In the U.S., however, radiology is taking an increasingly high profile.

"In the U.S., we are seeing that the CT portion of PET/CT is driving many decisions," said John Thomas, marketing manager for nuclear medicine and PET. "So we have decided to expand marketing into the radiology side while continuing to market strongly into nuclear medicine, which is one of our strongholds."

Positioning PET as a means for enhancing the CT image makes sense when radiologists are the target market. Doing so provides a framework in which radiologists can work. FDG studies, for example, show metabolically active and inflammatory tissue, which is useful when correlating functional information with the anatomical observations obtained with CT.

GE strategists might not have been so successful if they had tried to sell an integrated CT scanner and gamma camera, Burns said. In conventional nuclear medicine, every technetium agent has different pharmacokinetic properties and clearance rates and different affinities for various types of tissue. This necessitates different protocols for each type of study and specialized software for each application. In addition, most conventional nuclear images have few anatomical reference points and are presented in a format unfamiliar to most radiologists. This is different from PET, he said.

"PET images clearly show anatomical outlines, with higher brightness in metabolically active areas," he said. "This allows easier anatomical registration with CT images in a format that is readily understandable to the radiologist."