An evolution in the continuum of care
Before patients can be treated, they must first be diagnosed. Medical diagnostic products play a very significant role in making the invisible visible. This enables healthcare professionals to expand and improve their abilities to detect and define the extent of disease, for better treatment and quality of life.

Medical imaging has evolved beyond recognition since the first use of X-rays to visualise bones in the living body over a century ago. Today, the ability to scan the entire body in a matter of seconds and identify disease-induced abnormalities with pinpoint accuracy is taken for granted. Medical imaging is now firmly established as an integral part of modern healthcare, clearly demonstrated by the fact that in 2001 over 700 million medical imaging procedures were performed worldwide. Of these, approximately 110 million scans were ‘enhanced’ or made possible with medical diagnostic products, generating revenues of around £2.7 billion. The relevance of imaging to the practice of modern medicine will continue to increase in future years, driven by a number of factors.

One of the most significant growth factors is the rapid ageing of the global population and the subsequent rise in prevalence of many age-related diseases such as cardiovascular disease, cancer and neurological disease (Alzheimer’s, stroke and depression). Imaging is particularly well suited to assist in the diagnosis and management of such diseases and indeed, statistics show that people over the age of 45 require three to four times as many investigations as those under 45. Age-related diseases are among the most common in the industrialised nations and represent the highest cost burden to the healthcare system. Accordingly, there is tremendous social and political pressure to develop earlier and more reliable diagnostic tests to assist in the treatment and prevention of these diseases.

Patients are also becoming better informed about their medical condition and its management through access to the internet. Accordingly, physicians will have to incorporate each patient into the clinical decision making process which increasingly involves the selection of appropriate imaging techniques.

Global medical diagnostic market
Amersham Health, Bracco, BMS/DuPont, Tyco/ Mallinckrodt and Schering, together with their respective licensees, are the major players, accounting for more than 90 per cent of the global market.¹

There are four main medical imaging modalities – X-ray (including computed tomography, CT), magnetic resonance imaging (MRI), radiopharmaceutical imaging, and ultrasound. Radiopharmaceutical imaging always requires a diagnostic product, while the other three modalities may or may not use a diagnostic product, depending on the procedure. Each modality is rapidly evolving to meet the growing demands of modern healthcare requirements. Overall, the emphasis in technology advancement is to improve the speed, efficiency and functionality of instrumentation, lower its cost and hence increase accessibility. Improving the speed will allow for increased numbers of procedures per unit, keeping pace with the rising demand.

X-ray medical diagnostic market
X-ray has become the modality of choice in the radiology clinic as it can be used to image virtually every part of the body. It is also used for diagnosing cancer, heart disease, circulatory disease, respiratory disease, as a surgical aid and to follow the effects of treatment, and the market is growing by around five per cent a year. Of the more than 600 million X-rays generated annually, approximately 70 million procedures are performed with a medical diagnostic product, generating sales of over £1.2 billion.

Of the procedures performed, coronary angiography in particular is forecast to continue to play a major role in the management of cardiac patients. The number of coronary angiograms is expected to grow globally but with the emphasis shifting from diagnostic to interventional procedures (PTCA and stent placement) which generally require higher volumes of medical diagnostic products.

Of all the X-ray imaging methods, CT has had the most impact on the medical diagnostics market due to the large installed base of over 38,000 instruments, the rapid development of the scanner technology, and the non-invasive nature of the procedure. Approximately 40 per cent of the CT scans currently involve the use of medical diagnostic products (iodinated contrast media). During the last two years, innovations in X-ray detector technology have provided the capability to perform sub-second imaging of millimetre thin slices (multi-slice CT). This advance has opened up a host of new applications, many of which require administration of large volumes of contrast media, such as blood vessel imaging, blood clot imaging, large field imaging, and the ability to separately image the different vascular phases of contrast media.

Other advances in equipment and device technology include:

• compound modality instruments combining CT and radiopharmaceutical imaging units
• digitalised images providing greater sensitivity and clarity
• multi-detectors allowing for more complex exams
• digital plate detectors that will enable true 3-D volume scanning.

MRI medical diagnostic market
MRI has become the imaging method of choice for many applications and is routinely used in imaging the central nervous system, particularly for detecting cancers in the brain. More recently, MRI has found use in imaging the blood vessels and depicting brain regions affected by stroke. Although there are some similarities to the images obtained using CT, MRI is complementary to CT in many respects. While CT excels at demonstrating bony regions in great detail, MRI can reveal differences in soft tissue. For these reasons both MRI and CT have experienced concurrent growth in usage.

More than 35 million MRI scans were performed in 2001. Roughly 25 per cent of these require the use of a medical diagnostic product, generating sales of over £300 million. Every category of contrast-enhanced MRI has experienced growth and this is expected to continue. New clinical indications may arise from diagnostic products in development for imaging vascular and air spaces, or targeting specific tissues such as lymph nodes and blood clots.The ability to identify high-risk patients in the foreseeable future, along with the need for accurate anatomical and functional information, will drive the market for these new products.

Improvements in magnet technology, pulse sequencing and software are being developed which will improve image clarity and speed while at the same time providing improved patient comfort and easier scanning. The continued innovation in instrumentation, coupled with new medical diagnostic products, position MRI for further growth during the next few decades.

The Market report contines on the next page »

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