Scanning Steps Toward A Bright Future

Scanning Steps Toward A Bright Future

In the coming decades, one can anticipate continued progress in areas like hardware, software, artificial intelligence, and particularly in machine-learning applications in cardiac CT, as they are incorporated into clinical routine for image acquisition, image analysis, and prediction of patient outcomes.

The evolution of CT scanners has advanced to the point where the number of slices per rotation no longer is the benchmark for performance. With the advent of high-speed and multi-slice CT scanners, healthcare providers have changed their approach to imaging, diagnosis, and treatment of patients as new ways for clinical applications in areas such as trauma, vascular, pediatric, and cardiac imaging are possible due to the higher speeds at which scanning can be done. CAD software has been pivotal in bringing new applications to CT, for example, making cancer detection possible with CT.

Rapidly growing demand for bedside imaging, home healthcare, and growing use of CT scan to assess the accuracy of post-interventional medical procedures, medical implants, and anatomical confirmation are some of the main factors driving the industry growth.

Increasing prevalence of diseases like cancer, orthopedic, cardiovascular, and dental disorders will also enhance the growth of the CT scanner market. Also, a never-ending increase in the number of medical implants surgeries owing to unhealthy lifestyles, as well as a growing base of geriatric population, is likely to increase demand.

Other drivers of growth include the growing demands from governments for premium healthcare delivery. Significant advances in imaging technologies promise to improve wellness through quicker and more precise detection of medical conditions. A rising fiscal deficit is expected to hinder the growth of the CT scanner market in developed nations.

The multi-slice feature has evolved CT from simply a diagnostic tool into an interventional modality. Though most of the CT scanners are still used as general systems, some are being modified for specific purposes like bone densitometry or cardiovascular studies. The innovation cycle of CT has become indeed very short with new and cutting-edge technology getting introduced in the CT scanner market, with each being more efficient and faster. There is an increasing demand for high-slice CT. The high slice CT scanner is expected to improve the clinical utility considerably, as the introduction of 256-slice scanner, which has a detector width of 10 to 12 cm would help in scanning organs, including the brain, heart, entire joints, and lungs and liver, within a single rotation. It is also expected to have the feature to scan the heart with a single heartbeat.

The CT-imaging radiation dose continues to be an area of concern. Patients and medical associations have raised voices against this. The industry continues to try and reduce exposure while keeping image quality intact.

What’s new in dose reduction?

In recent years, much work has been done to improve upon CT, but there are more innovations on the way that will impact providers, and augment patient care. CT contributes roughly two-thirds of the total population dose in medical imaging, thus attracting major efforts in radiation protection.

In the coming years, photon-counting detectors – an emerging technology focused on radiation dose-efficiency, high spatial resolution, and energy discrimination – will revolutionize CT practice. The technology is still in the research stage, but it is currently being tested at the Mayo Clinic with results that have shown an 80-percent dose reduction. The effort is to push CT doses toward 1 mSv, the Holy Grail for dosing.

In addition, there are other advancements in filters that help remove softer energy radiation from X-ray beams. When it comes to region-of-interest imaging, technology is under development to change the shape of CT beams to target specific organs, limiting the amount of radiation dose patients receive. It can be particularly useful with certain types of scans, such as cardiac CT.

Filters should allow us to limit the exposure of adjacent organs that are not of clinical interest. Breast and lung tissue are two of the most radiosensitive areas in the body, and in a cardiac CT, they are exposed to the same high dose as the cardiac tissue even though their images are not even glanced at.

To maximize dose optimization technologies, the kilovoltage may be lowered, particularly for angiographic exams, and routine dose levels monitored to identify errant practices. Additionally, clinical indication-based CT protocols may be used to individualize radiation dose.

Alongside technological advancements and strategies to optimize existing technologies, there are other things providers can do to control radiation dose. In addition to following appropriateness guidelines for conducting scans, it is also important to remember that radiation dose is not standardized from one facility to another. According to an article published last year in the British Journal of Radiology, average CT doses can range between 4-to-17-fold based on practice preferences and protocols. Being aware of what other facilities do can help control radiation exposure, if patients switch between settings for scans.

Ultimately, radiology, as an industry, has already done a great job at reducing CT dose, and in most cases the clinical benefit of the scan outweighs the risk of radiation exposure. But providers still must remain vigilant to ensure they are controlling the radiation dose to safeguard patient safety while providing optimal care.

Continued CT advancements will encourage departments and practices to give everyone – not just one person – shared responsibility for keeping tabs on doses related to CT and other modalities.

Diagnosing coronavirus, the fight is still on

On December 31, 2019, the World Health Organization (WHO) was alerted to several cases of a respiratory illness of unknown origin emerging from Wuhan City, Hubei Province of China, with clinical presentations resembling those of viral pneumonia and manifesting as fever, cough, and dyspnea. As of January 30, 2020, the WHO has designated this outbreak as a global health emergency. This newly discovered virus has been named the 2019 novel coronavirus (COVID-19). The number of deaths due to COVID-19 in China has already exceeded the SARS outbreak in 2003. Against this backdrop, researchers have found a possible way to predict this virus through CT evidence. Their findings, Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing, led by Xingzhi Xie from Central South University in Hunan province, was published February 12, 2020, in an online version of Radiology. The study showed CT imaging was able to identify coronavirus before some patients tested positive in laboratory tests.

The detection of novel coronavirus has largely been done using reverse transcription polymerase chain reaction (RT-PCR). This laboratory technique combines reverse transcription of RNA into DNA and amplification of specific DNA targets to identify DNA that matches that of the virus. The purpose of the new radiology study was to describe CT imaging features of five patients who initially tested negative for coronavirus in RT-PCR tests, or had weak positive results, but were highly suspected of infection. The study evaluated 167 patients; of these 5 (3 percent) initially had negative RT-PCR, but had positive chest CT with a pattern consistent with viral pneumonia. After positive CT findings, all patients were isolated for presumed 2019-nCoV pneumonia. Repeat swab testing and RT-PCR tests 2019-nCoV infection in all patients. In 7 patients (4 percent), CT was initially negative, while RT-PCR was positive for novel coronavirus. In 155 patients (93 percent), both RT-PCR and CT were concordant for 2019-nCoV infection. Of the 5 patients with negative RT-PCR and positive CT at initial presentation, the median CT involvement score was 4. The highest CT involvement score was 14 while the minimum was 2.

The authors commented that while a swab test is the standard assessment for 2019-nCoV infection diagnosis, current tests are time-consuming due to high demand. In addition, RT-PCR testing for coronavirus may be falsely negative due to laboratory error or insufficient viral material in the specimen.

The study concluded: previous radiographic studies showed that the majority of cases had similar features on CT images, like ground glass opacities (GGO) or mixed GGO and consolidation. 2019-nCoV pneumonia is likely to have a peripheral distribution with bilateral, multifocal lower-lung involvement. In the context of typical clinical presentation and exposure to other individuals with 2019-nCoV, CT features of viral pneumonia may be strongly suspicious for 2019-nCoV infection despite negative RT-PCR results. In these cases, repeat swab testing and patient isolation should be considered.

With coronavirus pushing China’s health system into turmoil, MedTech companies have accelerated their production for CT systems coronavirus scanning in China. Recently, Samsung NeuroLogica announced that it will dedicate significant resources to editing, manufacture, and shipping of its scanners to help mitigate the growing coronavirus crisis in the country. With assistance from its Chinese distributor Chindex, NeuroLogica will mount a humanitarian effort to step up delivery of the BodyTom units, potentially from months to weeks following initial order throughout China to help meet that need.

In addition, China is deploying tech solutions like never before to overcome its worst crisis in years. The ongoing epidemic has once again reiterated how important emerging technologies are in predicting and combating the spread of infectious diseases.

Artificial intelligence (AI) developer Infervision launched a coronavirus AI solution in China this past month that is tailored for front-line use to help clinicians detect and monitor the disease more effectively. The outbreak has put significant pressure on imaging departments, which are now reading over a thousand cases a day. Patients and clinicians typically have to wait a few hours to get the CT results, but Infervision AI is improving the CT diagnosis speed for each case. The surging number of patients needing diagnosis and the strict laboratory requirements for the use of the rRT-PCR detection kit, to confirm the 2019-nCoV diagnosis, pose big challenges to regional and rural hospitals. Infervision’s tools are helping sites with limited medical resources to immediately screen out suspected coronavirus-infected patients for further diagnosis and treatment.

Market trends

The size of the global CT scanner market was worth USD 6.6 billion in 2019 and it is estimated to reach USD 8.2 billion by the end of 2024, at a CAGR of 4.54 percent during 2019–2024, says Market Data Forecast. Constant developments in technology and supportive government policies for healthcare funding are expected to boost the growth of the market. In addition, growing incidence of chronic diseases, need for early diagnosis, and high clinical utility of CT are expected to drive the market. Factors like high installation cost of CT systems and side effects due to radiation exposure hinder the market growth.

Spectral CT has gained a lot of interest in the past few years because of its potential to offer additional information from CT images. This includes the ability to help definitively make a diagnosis in cases of small pulmonary embolisms, determining if shadowing inside a stent is artifact or restenosis, better delineation of aortic stent graft endoleaks, and to better visualize ischemia or infarcts, using enhanced iodine-mapping techniques based on different X-ray energies. Siemens, GE, Philips, and Canon now all offer spectral imaging capabilities on some of their newest scanners.

North America is holding the highest share of the global market with the quick adoption of advanced technology and the introduction of various devices in favor of the patient’s safety. With modern techniques, the devices are allowing the patient to have lower exposure to higher radiations, which promotes fewer side effects and is enhancing the growth of the market in this region. Also, rising per capita income in developed and developing countries is leveraging the growth of the market. Europe is accounted for in having an enormous growth rate, and is also to have better growth opportunities in the coming years. Increasing expenditure on healthcare, and to have effective treatment procedure at any cost, are boosting up the growth rate of the market in this region.

The CT scanners market in the Asia-Pacific (APAC) region is expected to grow at a compound annual growth rate of 15.7 percent from USD 2.1 billion in 2019 to USD 7.7 billion by 2028, according to GlobalData.

India will be by far the fastest-growing country in the region, growing at a CAGR of 26.3 percent between 2019 and 2028, which is more than double the average growth for the next three fastest-growing markets – Taiwan, New Zealand, and Australia, respectively.

While the increase in the incidence of chronic diseases will be the main market driver, the use of image-guided interventions and inclination toward non-invasive disease diagnosis will propel the market over the next 8 years.

In the APAC region, 64-slice CT scanners are the major revenue contributors within the CT systems, with the market growing at a CAGR of 16.5 percent between 2019 and 2028, followed by 256–320 slice CT systems.

The technological advancements in the medical field will have a positive impact on the growth of CT scanner market. The advent of CT systems with higher imaging slices, using a lower dose of radiation, will help physicians make more accurate clinical decisions while increasing patient safety, and will further drive the market forward.

Way forward

Over the last few years, CT imaging has demonstrated continuous progress in hardware, software, and machine-learning applications. For CT hardware, significant advances have been made in scanner gantry rotation speeds, improving temporal resolution, spatial resolution, detector coverage, and, therefore, overall scan times and needed contrast. In the coming decades, one can anticipate continued progress in all these areas, and particularly in machine-learning applications in cardiac CT, as they are incorporated into clinical routine for image acquisition, image analysis, and prediction of patient outcomes. Major players are and will continue to focus on high-quality, commercially viable, accessible, and affordable solutions, which bring large-scale sustainable, socio-economic, and environment-impacting technologies. The challenges and the exciting new opportunities show promise for a bright future.

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