Fusion Imaging in Nuclear Medicine is the Growing Trend

Latest trend gaining momentum in the market is developing hybrid imaging systems, propelled by the recent introduction of PET/MRI hybrid systems.

From the evolution of revolutionary technologies for diagnostic testing to the innovative products introduced to treat identified diseases, the medical discipline has shown tremendous progress in the last two decades. In this ecosystem, medical imaging has emerged as a constantly evolving, high-stakes component, thanks to the top healthcare and technology brands launching innovative, highly accessible products with advanced functionalities. Particularly, nuclear imaging has gained immense preferential appeal in recent times.

Nuclear medicine imaging, a noninvasive procedure used to diagnose and treat various disorders associated, is one of the safest imaging modalities in diagnostic testing today. Advancement in diagnostic imaging is bringing in more use of nuclear medicine. In the past few years, there have been remarkable innovations in nuclear imaging technologies to enhance image quality and reduce emission–transmission mismatch artifacts.

The latest trend gaining momentum in the market is the growing focus on developing hybrid imaging systems in which SPECT and PET combined with X-ray CT are currently widely used, with PET/MRI hybrid systems having also been recently introduced. PET/MRI systems are the emerging hybrid imaging devices, which are likely driving the market growth. These scanners combine the anatomical imaging and functional imaging data, bringing MRI’s excellent soft tissue characterization and imaging without ionizing radiation.

Indian Market Dynamics
The Indian nuclear medicine equipment market is estimated at Rs. 290 crore. GE dominates the segment and considers only gamma cameras/SPECT to be alignified strictly as nuclear medicine, where it has an 83 percent market share. Siemens is the other strong contender. We have conservatively included PET scanners, which may also be used for molecular imaging and cyclotrons also in this segment.

PET scanners have seen a major increase in demand from 10 units in 2015 to 36 in 2016, albeit the average unit prices have seen a decline. Cyclotrons continue to be procured as very discerning buys. This year two RF-based cyclotrons were procured, one in Bengaluru and the other in New Delhi.

Global Market Dynamics
The nuclear medicine and radiopharmaceuticals market is projected to reach USD 7.27 billion by 2021 from USD 4.67 billion in 2016, growing at a CAGR of 9.3 percent. SPECT gamma cameras used in nuclear medicine represent the largest share of the market for new and used equipment in this field, followed distantly by new PET/CT and SPECT/CT systems.

North America is the most lucrative region for players owing to robust healthcare infrastructure and high adoptability of new technology. Europe serves the second-most demand as a regional market for nuclear medicine; however, Asia-Pacific is expected to extend the demand at the most prominent rate. This rising demand is primarily from the emerging economies of India, China, Australia, and Japan, wherein increased investment on healthcare has escalated in the recent times. Moreover, due to the presence of vast population, neurological and cardiovascular diseases as well as cancer cases are growing, which will further increment the demand in the Asia-Pacific nuclear medicine market.

Technological Advancements
The clinical utility of SPECT, SPECT/CT, PET/CT, and general nuclear medicine remains a viable mainstay in assisting physicians and healthcare facilities with the care of their patients. Technical advances for nuclear medicine systems remain relatively the same. PET/MR is being investigated for clinical utility but is an expensive modality. Also, fusion imaging with SPECT/MR is being investigated. The adoption of SPECT/CT for clinical reasons and its replacement in the install base is a major recent development. Another SPECT/CT advance is quantification and the adoption of quantification for oncology and the growing application of radionuclide therapy.

The market is also seeing new SPECT/CT visualization techniques such as for bone imaging. One final SPECT/CT advance is the introduction of solid-state technologies, but they are principally for research purposes and have fairly narrow applications at present, for example, organ imaging and specific tracers.

On the PET side, there are new acquisition techniques that include continuous bed motion, which enables personalized acquisition and allows routine incorporation of respiratory motion correction. Another PET advance is the increasing adoption of large-bore PET, approaching 80 cm. These large-bore systems are being used for radiation therapy planning, which is becoming an increasing application for PET.

A primary advance for nuclear medicine lies with the development and implementation of radiopharmaceuticals that not only target specific diseases for diagnosis but also impact treatment of diseases, particularly cancer.

Nuclear myocardial perfusion imaging (MPI) with PET and SPECT has been the gold standard for noninvasive detection of coronary ischemia and infarcts. However, the high radiation doses patients receive are making some providers think twice before referring their patients for nuclear MPI. Newer dose-lowering technologies have helped reduce radiation dose by more than 50 percent for cardiac computed tomography angiography (CTA) scans, making it much more attractive as a diagnostic imaging modality. New CT technology – including perfusion imaging with advanced visualization software and CT-fractional flow reserve (FFR) imaging – may lead to increased use of CT. When 64-slice CT scanners were first introduced a decade ago, CTA dose was 20–30 mSv, but new reconstruction software, more sensitive detectors, and other technologies have reduced this below 10 mSv. With the newest scanners and software, it is now possible to perform CTA with about 1 mSv of dose. This new dose profile has made CTA much more attractive, and nuclear imaging now finds itself in the position as the high radiation dose technology being called into question.

Outlook
Nuclear imaging has manifested and improved in the recent years and this trend is expected to continue in the future. The development of new radioisotope tracers will take nuclear medicine beyond the standard FDG (fluorodeoxyglucose), which will enable greater specificity to target individual tumors or disease processes. As nuclear medicine becomes more efficient and is able to offer greater information, doctors will continue to turn to this modality for the answers they need. With the ability to quantify tumors, for example, doctors are able to better understand where the patient needs to be in the treatment process. No other modality can really do this like nuclear medicine. Technological advances will continue to extend the uses for this imaging modality.