MR outlook: The road ahead, a glance back

Clinical extensions will be the main thrust of MR vendors in the year ahead. Breast, orthopedic, and cardiac MR will take on added weight. Speed will continue to be an issue as companies attack motion artifacts accompanying scans as one means to extend clinical capability. Efforts will focus on making results more reproducible and less dependent on the skill of operators. Vendors will continue to press 3T as the gold standard of clinical imaging, but their case will be more difficult to make because of reimbursement issues, certainly among outpatient imaging centers. The now inevitable implementation of the Deficit Reduction Act Jan. 1 will see to that by slashing revenues for MR procedures as much as 30%.Outpatient clinics, therefore, may be inclined against the purchase of 3T scanners but might favor those operating at 1.5T, whose price continues to erode and which may, therefore, be viewed as bargains. Vendors might also see some increased demand from hospitals, which could pick up the slack from imaging centers, thanks to the new legislation. Twenty years ago the Reagan administration introduced Diagnosis Related Groups, which spurred the expansion of outpatient imaging. Last year's Congress may have brought the industry 180°, with the tables finally turned in favor of hospitals.

Market snapshot

In 2005, U.S. customers bought $1.35 billion in new MR scanners compared to $1.5 billion the year before. The slippage continued in 2006. By midyear, total new unit sales in the U.S. were about $630 million, slightly under the pace for the previous year. Revenues from 1.5T scanners slipped to about $450 million, down from last year by about 10%. Revenues from 3T, which were about $70 million at the halfway mark, showed worse erosion, about 20% below the previous year's pace.Industry pundits speaking with

DI SCAN

at the RSNA meeting noted that sales overall have rebounded but not enough to overtake 2005 figures. The market for 3T shows particular strength.Most remarkable, however, has been the collapse of the market for open scanners. Sales of these units amounted to less than $30 million at the halfway mark in 2005. If the collapse continues - and industry sources indicate that it is continuing - the total for the year could be just $60 million compared with $155 million in 2005.

RSNA exhibit floor

Highlights included Philips' Achieva XR, the first MR scanner designed to allow site upgrade from 1.5T to 3T. GE demonstrated its future emphasis on interventional MR with examples of breast biopsy, focused ultrasound for fibroids and, potentially, other lesions, and brain surgery - all made possible by a design that allows the interchange of patient tables. Toshiba's coming entry into 3T and its planned assault on 1.5T with high-performance scanners bore testament to the collapse of midfield MR, which had been the company's stronghold in this modality. Siemens built on its Tim (total imaging matrix) technology to create opportunities in several clinical areas, including angiography, thanks in large part to a continuously moving table.Hitachi refused to give up the ghost of opens past, announcing plans for a new high-field open MR. Hologic pressed forward in this area as well, showing the Esaote-supplied clam-shaped Opera extremity scanner. Italian vendor Paramed spotlighted a 0.5T scanner, a clam-shaped system tipped on its side and reminiscent of GE's double-donut configuration. Hoping to catch some lift from the updraft building for breast MR, Aurora Imaging Technology demonstrated its dedicated breast scanner.

Aurora Imaging Technology

focused on spiral imaging specific to the Aurora 1.5T breast scanner, surrounded by claims of a 300% boost in signal-to-noise and consequent improvements in image quality and speed. Rather than acquiring data line by line, as happens in a conventional fat saturation 3D Fourier transformation, spiral RODEO (Rotating Delivery of Excitation Off-resonance) acquires data from the center of the field-of-view outward in a spiral pattern. Current owners will get the upgrade in early 2007. Facilities that order the breast MR system will receive spiral RODEO automatically. The technology, cleared by the FDA almost a year ago, was shown as a work-in-progress at the 2005 RSNA meeting.

Esaote

has come out with a range of open extremity MR scanners, including the C-Scan and Opera (see Hologic). Its most innovative, the G-Scan, visualizes limbs, joints, and spine, tilting the patient to any position from supine to standing, and offers weight-bearing imaging of the spine in the standing position. The compact G-Scan has been shown at RSNA meetings going back to 2004.

Fonar

the company that trademarked itself "The Inventor of MRI" captured the spotlight with a press conference entitled "Aching Back? Sitting Up Straight Could Be the Culprit." The study, conducted with the Upright MRI scanner at The Positional MRI Research Centre at the University of Aberdeen in Scotland, addressed the proper sitting position.

GE Healthcare

launched a new initiative in interventional MR built around a basic design characteristic of the Signa HDx that allows the use of a dockable patient table. These tables can be outfitted with a focused ultrasound transmitter to ablate fibroids and, potentially, other pathologies; a biopsy-capable breast coil integrated into a table (see Sentinelle Medical); or the company's latest, a high-density head-neck-spine array. Swapping one table for another streamlines patient throughput and extends clinical opportunities by allowing patient prep outside the device. Integrating the head-neck-spine array with 3D capabilities improves planning and intraoperative navigation while documenting improved patient outcomes.

Hitachi Medical Systems America

is the premier supplier of open scanners and plans to remain so, even as the popularity of this technology in the U.S. slides. Company executives hope to revitalize interest with the Oasis, a high-field open system, presented as a mockup at the RSNA meeting. The system, which was long on promise but short on details, will operate at a field strength greater than 1T. It will be commercially released at an undisclosed date. In the meantime, the company will bolster revenues by upgrading its installed base of 0.3T Airis systems with improved gradients, radiofrequency transmitters and receivers, and a new computing platform, as well as selling its Echelon 1.5T and Altaire.

Hologic

featured the Esaote-supplied Opera, an MRI scanner that covers all extremities, including hip and shoulder. Intended for orthopedic specialists, the clamshell, 0.2T system uses a display screen for scout images to assist in positioning patients. The unit, which is built low to the floor to allow easier access by patients, is priced in the low $400,000s.

Invivo

offered its Precess MRI patient monitoring system, providing wireless remote display of patient signs. Precess is compatible with systems up to 3T.

Medrad

introduced Certo, a wireless network designed to support patient monitors such as the company's Veris. The network allows equipment to move easily between the MRI suite and the control room. The company also featured its 3T Prostate eCoil, designed for use with GE's Signa HDx 3.0T scanners.

MR Instruments

displayed a transmit-and-receive head coil, the TEM 3000.

ONI Medical Systems

upgraded its 1T MSK Extreme scanner, featuring vSPEC, a spectrometer that leverages software to synchronize pulse initiation and signal cycles to optimize data acquisition for scanning extremities. The spectrometer works with a set of six specialized transmit/receive coils with inside diameters ranging from 80 mm to 180 mm.

Paramed

introduced the MR-Open, a U-shaped, cryogen-free superconducting system for general-purpose applications. The system grew from joint R&D between Paramed and another Italian firm, ASG Superconductors. Paramed also featured its C-shaped 0.22T unit, MRJ, a dedicated extremity scanner.

Philips Medical Systems

featured a 1.5T to 3T upgrade. The Achieva XR, which allows a doubling of field strength without changing magnets, is more cost-effective and efficient than a traditional forklift upgrade, which requires system downtime and could involve facility construction and the installation of additional components. The Achieva 3.0T X-series features a new magnet and gradient, as well as RF advancements, providing enhanced performance and a larger field-of-view. The new 3T system is available in a mobile configuration. An expanded portfolio of RF coils with higher SENSE factors allows faster cardiac MR and faster, higher resolution 4D contrast-enhanced MR angiography. SmartExam, which permits the downloading of optimized MR protocols, was expanded from head and brain imaging (introduced at RSNA 2005) to include knee and spine. This latest capability will be commercially released in 2007.

Resonance Technology

extended its offering in functional MR with the new FuncLAB, which combines 3D graphics and sound with automated data processing, eliminating time-intensive manual data analysis. Functional and anatomical images are sent automatically in DICOM format from the MRI device to the processor, which hooks into the department network.

Sentinelle Medical

commercialized R&D conducted at Sunnybrook and Women's Health Sciences Centre with a new table dedicated to interventional breast MR. The table, featured as part of GE's new interventional initiative, supports bilateral and unilateral imaging and biopsy, and medial and lateral approach. The table is enabled for parallel imaging, features guidance software, and comes equipped with disposable biopsy plates.

Siemens Medical Solutions

split Tim into two classes. Tim T supports TimCT (continuous table), which captures data for peripheral angiography in a single continuous study. Tim T also improves workflow by streamlining ordering, planning, processing, and distribution, particularly through syngo Chorus MR, which integrates the scanner into RIS and PACS. Both configurations, Tim I and Tim T, offer features that include syngo TWIST, which utilizes parallel imaging to perform 4D MR angiography; syngo BLADE for correcting motion artifacts in neurological, orthopedic, and abdominal procedures; syngo GRACE, which enables breast single-voxel spectroscopy; and syngo DTI Tractography, which enables 3D visualization of white matter tracts in the brain for improved neurosurgical planning, based on diffusion tensor imaging.

Toshiba America Medical Systems

set the groundwork for future entry into the 3T market with a 3T work-in-progress, featuring a new short-bore magnet design that delivers high homogeneity. Pianissimo technology, migrated from the company's 1.5T platform, will muffle the increased noise that accompanies 3T. Vantage Atlas 1.5T debuted with a new 128-element system. An integrated coil supports multiple exams without repositioning the patient. A 205-cm range of table movement allows for feet-first imaging. Vantage Atlas Plus 1.5T, which cleared the FDA just prior to the meeting, features an elliptical bore designed to decrease patient anxiety caused by claustrophobia, yet offers an expanded field-of-view - up to 55cm.