Focus for new imaging products shifts as productivity takes medical spotlight

Radiology may lose autonomy as hospitals restructure

Medical imaging technology will take fewer quantum leaps as cost-control screws are tightened with the growth of capitated health care. Vendors will find ways to expand their lines, however, if they focus on the productivity requirements of their customers, the service providers. Productivity concerns now set the terms for the evolution of health-care technology, said Richard M. Levy, executive vice president of Varian Associates and head of Varian Health Care Systems.

Hospitals will better integrate medical imaging with their therapeutic services in the future, he said. The autonomy of radiologists will likely decline as providers adjust their internal systems to boost efficiency and improve outcomes.

"Imaging will be performed in order to improve productivity of the treatment, rather than to diagnose in a beautiful way what the disease is and where it is," Levy told SCAN. "The specialties are now starting to drive aspects of imaging."

Digital medical imaging networks within a hospital will also change as imaging is integrated with therapy, he said. Picture archiving and communications systems tended to form islands within the hospital, developed from the point-of-view of radiology. Chances are no department will be an island in a reformed U.S. health-care system.

"PACS is radiologists talking to radiologists. It hasn't been driven by treatment people," Levy said.

Palo Alto, CA-based Varian, a leading supplier of linear accelerators for radiation oncology, introduced a computer-based information system last year for expediting radiation therapy procedures. Dubbed Varis, the oncology network offers a single common database linked to all phases of the therapy process, including simulation, treatment planning, treatment and related hospital information system functions, he said.

Varis follows the cancer patient using a single computer architecture and operating system from the time that a patient enters the hospital to years later in retrospective studies, he said. Imaging is included in the Varis network. Varian collaborates with Picker International in the use of spiral CT three-dimensional volumetric imaging for therapy simulation (SCAN 12/16/92). More opportunities to bring imaging into the network will arise in the future, Levy said.

"There are other imaging modalities than CT -- for instance, providing chemical information from nuclear medicine and MR. It might be three to five years before this (Varis) is a seamless, automated and totally integrated system," he said. "This is an architecture that will make it easy, not just to bring in images, but to make images part of the whole process, controlled by the radiotherapist."

Changes in hospital turf are underway. Picker now sells CT systems directly to oncologists, something unheard of five years ago when all CT scanners resided in diagnostic radiology, Levy said. Cardiologists are buying special procedure rooms with imaging. Ob/gyn specialists are buying ultrasound scanners.

However, radiologists will continue to be a factor within hospital systems due to their diagnostic skills, he said.

"The radiologist's expertise will always be necessary, but there will be a culture where they are serving the radiation oncologist rather than just operating a department as a center of excellence in its own right," Levy said.

Medical growth remains a focus. Varian continues to view health care as a field for corporate growth, Levy said. The technology conglomerate shifted focus over a year ago from slow-growth areas, such as defense contracting, to health care (SCAN 11/4/92 and 3/24/93).

Health-care growth opportunities will arise, however, not as much in major new system development as increasing the services and ancillary products surrounding Varian's accelerator and x-ray tube lines, he said.

"When capitation comes in and fee-per-service goes out, it is going to be very tough to justify new technologies," Levy said. "Our volume of linear accelerator sales may not go up very fast, but the volume of (related) products, training and service will go up a lot. With (the onset of) health-care reform, with hospitals closing and with centralization of facilities, it is going to be more difficult to sell basic new pieces of equipment."

Varian took a large step in expanding its Salt Lake City based independent x-ray tube supply business (formerly Eimac) last fall with the acquisition of a major tube reloader, International X-ray Tube (Interay) of North Charleston, SC (SCAN 9/8/93).

"There had been two intermediaries between Varian and its (tube) customers: the reloaders and the third-party service companies. We brought the reloader in house," Levy said. "This will bring us one step closer to the market. Interay is a marketing organization. Salt Lake is a factory that was not totally responsive to the needs of third-party service."

Varian is not likely to step further into the scanner service market by becoming an independent service organization itself, he said. The firm also supplies x-ray and CT tubes directly to medical imaging OEMs. As cost concerns increase, however, ISOs are likely to build business.

"There will be a trend to third-party service organizations. The acquisition of Interay is a direct strategic move to position ourselves for that," Levy said."Maybe someday the big hospital chains will have their own in-house service and will not depend on third parties. Then we can deal directly with them."

Varian is placing a load station in the Salt Lake City facility. This station will report to South Carolina where worldwide responsibility for ISO sales is centered, he said.