Magnetic resonance imaging is the most versatile diagnostic imaging modality and has the ability to demonstrate a wide range of imaging contrasts in humans with exquisite spatial resolution. It features a highly competitive vendor landscape, majorly due to a rising demand for better device functionality and efficiency. This demand has prompted most players to conduct continuous research and innovation, and introduce new products in the market. With new players entering the segment over the next years, competition is likely to get more intense. The global market has gained revenue valued at USD 6611 million in 2017, which is further expected to increase to USD 9120 million by 2022, an impressive CAGR of 6.6 percent from 2017 to 2022.
Indian market dynamics
The Indian market for MRI equipment seems to be converging toward the 1.5T and 3T systems, with the refurbished and 0.2T-0.5T diminishing in their relevance. The buyers are upgrading themselves to the next category.
In 2017, it is estimated as Rs 1750 crore, with 1.5T continuing to dominate the market.
The imaging centers are increasingly overcoming the previous challenges of image distortion, shadowing with the multi drive RF transmit technology with silent scans. The conventional 3.0T MRI systems acquired the patient data with coils and transmitted them to an electronics room through copper cables. In the digital versions, the signals are digitized in the machine room itself and then transmitted to the electronics room via broadband optical fiber cable technology, thus minimizing signal loss and improving the image quality for better diagnostic confidence. The technologically superior 3T machines overcome tissue heating by automatically customizing and delivering the optimal magnetic waves as per the size and shape of the patient, through its personalized patient management system. They offer clinical benefits across spectrum of medical specialties by using advanced applications in neuro, spine, vascular, abdomen, whole-body, breast, cardiac, musculoskeletal, ortho etc. and have espoused the new horizons in diagnostic capabilities and have the potential to change the course of treatment.
However, since GST implementation, some medical facilities located in Tier-III cities and smaller towns are compromising and foregoing the automated sequencers in-built in the better machines.
In 2018, 18 district hospitals in Uttar Pradesh are set to get MRI units. The Patna high court had also directed the health department to ensure that MRI machines are installed in all government medical colleges and hospitals in the state.
India is currently facing a shortage of trained medical imaging professionals, largely because imaging has become so crucial to dealing with most illnesses. Telemedicine could address some of the imaging shortages. Rural and other hospitals that lack enough radiologists are starting to turn to this technology in the hopes that they can farm out some of their imaging needs to better-staffed hospitals. Many major healthcare systems in India, including Fortis Healthcare, Apollo Hospitals, and Narayana Hrudayalaya, have already invested heavily in telemedicine services to try to meet that demand.
Unique Broadband Systems Ltd (UBS) of Canada and Kaynes Technology of India, have been awarded funding by the Global Innovation and Technology Alliance (GITA) of India and Global Affairs Canada, for the co-development and co-marketing of high power RF amplifiers for low-field MRI applications. The project is expected to be completed by 2019. This joint venture will introduce a breakthrough technology in RF based power amplification of MRI or any image processing devices. It enables portability, less heat dissipation, and easier cooling through normal air coolers for MRI scanners. This in turn will make MRI scanning machines more affordable and will also be suitable for rural applications.
The last few years have seen significant advances in the field of MRI imaging. Recent developments in MRI are focused on addressing the challenges of MRI in a holistic way by delivering first time right imaging with superb patient experience.
MRI-conditional implant scans. Medical implant technology has grown increasingly sophisticated, but an implant traditionally complicates the MRI scanning procedure. Nowadays, however, spinal implants, pacemakers, and other devices are becoming MRI-conditional, which means they do not interfere with the scanning process within certain parameters. Recent MRI’s automated user interface model allows for scanning of patients with implants much more easily and quickly.
Increased magnetic flux. The market has witnessed the transformation of 3T imaging from niche to mainstream. Initially, buyers were not sure if it would be worth the investment. The initial expectation was that 3T would be great for neuroimaging, MR angiography, MR spectroscopy, and advanced fMRI and DTI applications. However, the technology has matured, 3T pulse sequences have been improved, motion correction has been introduced, and the range of applications has started to ramp up.
Reduced scan time. The time of scanning has been dramatically reduced, across various protocols, though focus has been directed mostly toward the highest-volume scans like spinal, brain, and knee. In many cases, the common scan time has been reduced by half or more, with new technology allowing protocols to run simultaneously. Reduced scan time has benefits for patients and providers alike; shorter scans reduce patient anxiety and time in the scanner, as does noise reduction and new coil technology, while making MRI more available to patients. For providers, new systems allow an increase in patient throughput without comprising the quality of diagnoses, not to mention the financial and operational benefits.
Multiparametric MRI. Using mpMRI, multiple types of images can be obtained that tell physicians with high confidence whether the tumor is aggressive or not. These allow investigators to evaluate the chemical composition of the tumor without a biopsy.
MRI linear accelerator. The major technological advance in the field of radiotherapy is the merger of MRI and linear accelerators to create a hybrid machine – MRI Linac. The MRI Linac will push the technology of image guided radiotherapy to a completely new level. There will be no dose associated with MRI Linac pretreatment imaging.
MRI software. In recent years, some of the advances in MRI technology have been on the software side. This advancement enables faster contrast scans, simplified cardiac imaging workflows, and even the ability to perform MR scans. The software also delivers multiple, adjustable contrast images and quantitative data from a single 5–6 minute scan. The software reduces the need for several scans using different protocols, helping to reduce scan times and increases patient throughput.
Parallel imaging. The sensitivity encoding (SENSE) parallel imaging technique enables a reduction in scan times by a factor of two or more. Since its original implementation, continuous improvement of the technique has increased its performance and now the new advances allow greatly increased speed in the routine clinical setting.
Propeller imaging. Another important innovation is development of propeller imaging. Now many vendors have a propeller type of method. The method is based on constructing parts of images at a time, and running the scan so quickly that the second time one runs it they acquire another part of the exam, and third time another part of the exam. So it looks like one is acquiring a single picture – a full picture at one moment in time. And it reduces the amount of time exposure for each part of the image.
Challenges and opportunities
A rising demand for undertaking detailed anatomical studies of body parts has been primarily driving the MRI market. This is mainly because of the ability of good quality MRI machines to efficiently scan body portions, thereby detecting anomalies that need treatment. A widespread utilization of MRI is carried out for detection and diagnosis of neurological conditions, due to lack of a standard alternate machine, consequently boosting the MRI market’s growth. A rising geriatric population has also been responsible for propelling growth in the magnetic resonance market, mainly due to higher chances of chronic diseases to develop in old-aged people. This market is also picking up substantial pace owing to surging applications of MRI-guided radiotherapy for brain tumors and other similar ailments.
However, high costs of the MRI systems, coupled with substantial expense attached while servicing the machines are prime restraints. Low medical reimbursement rates, especially in underdeveloped and developing countries could discourage patients from opting for the MRI detection. Nevertheless, many manufacturers in this market are striving hard to come up with groundbreaking innovations, which can reverse effects of the restraints substantially. MRI modality compatible with cardiac pacemakers is one such innovative approach introduced by a few players in recent times.
Changing Landscape Of Diagnostic Imaging
Dr Mona Bhatia
Director and HOD – Department of Radiodiagnosis and Imaging,
Fortis Escorts Heart Institute
MRI, today has surpassed most diagnostic modalities on account of its high accuracy, spatial, temporal resolution, tissue characterization, and functional capabilities. It is without doubt one of the most sensitive diagnostic tools for medical investigations and has the added advantage of being nonionizing, making it the modality of choice, particularly in chronic disorders, oncological, neurological, cardiac, musculoskeletal, and breast imaging.
Currently North America dominates the global MRI market with almost a 40 percent share. This is accounted by the favorable reimbursement policies and insurance coverage, enabling early diagnosis and follow-up of chronic diseases. However, global demand and scenarios are fast changing with government policies promoting diagnostics, in addition to increased recognition of the essentiality of accurate diagnosis driving appropriate treatment and follow-up. Needless to say, the larger populations and growing awareness and demand in Asia and Africa will soon be the chief drivers of global markets, in particular Asian markets such as India and China. The recent changes in the health policy in India promoting affordable healthcare for all are likely to result in an exponential growth in MRI in the coming decade, taking the demand from limited private hospitals to public healthcare and from larger metropolitan cities to smaller cities country wide.
Technological revolutions in hardware and software are important drivers of any change. In order to meet this high demand, the industry will have to ensure technological advances to generate affordability of MRI equipment. One of the critical pieces besides magnetic strength is the declining availability of helium which impacts cost of MRI. Closed MRI systems have driven the market segments for decades but a turnaround toward open systems may become the need of the hour given the increasing aging population.
Advances in technologies, changing healthcare policies, increased dependence, and trust in diagnostics with elimination of radiation linked risks have placed MRI as the number one choice as a dependable and reliable diagnostic tool among physicians and patients. MRI, with its exponential acceptance and adoption, is today the fastest-growing market in health diagnostics.