Computed tomography (CT) has emerged as the workhorse of modern medical imaging, with technological advancements like faster scan times, thinner slices, multiplanar reformatting, and 3D rendering revolutionizing the scope of CT. The biggest advances in CT scanners over the past few years have been the introduction of new dose-lowering technologies, easily upgradeable scanners to allow conversion to high-slice systems, and faster gantry speeds to freeze cardiac motion. The breakthrough advancements in CT technologies, along with new product launches from the major market players, each being more efficient and faster, represent major factors driving growth in the market. 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 the key drivers for industry growth.
There has been a significant improvement in the speed with which 3D volume can be imaged, as well as in routine spatial resolution in the slice direction, owing to helical scanning and multidetector row CT. This, coupled with various other technological advances, has resulted in CT imaging speed increasing by more than seven orders of magnitude since it was first introduced in the early 1970s. The increase in speed, combined with improvement in low-contrast detectability and image quality, has resulted in the technique becoming more robust and allowing CT to become mainstream in medical care.
Indian Market Dynamics
The Indian CT scanners market, valued at 900 crore in 2015–2016, saw a 13 percent increase in value terms over 2014–2015. The smaller machines, <16-slice category, continue to gain popularity, and account for 40 percent of the market in value terms. The 16-slice machines, giving value for money, contribute to 25 percent. The discerning customer continues to prefer the 64- and larger-slice machines. The three brands, GE, Philips, and Siemens, dominate the market, albeit the Revolution ACT by GE has gained ground.
The pre-owned, refurbished CT scanners are primarily sold in the <16-slice category, with Siemens being the most popular brand. Some GE systems are also sold. About 30 units were also sold in the 16-slice category, at an average unit price of 1 crore, and a couple of systems in the 16- to 28-slice category, at an average unit price of 2.5 crore. The leading vendors in this category are Cura, Sanrad, Ives Medical, Soma Technology, and some regional freelancers.
The recently announced AERP regulation that systems older than 7 years cannot be refurbished and sold has changed the dynamics of the market. At the outset, freelancers who currently sell about 100 systems annually, will perhaps get marginalized over this year, after which the preowned segment is expected to shrink.
The global medical CT systems market is valued at USD 4.9 billion for 2016, and is projected to flourish about twice as fast as other medical devices, driven by product improvements, growing clinical applications, an aging population with significant diagnostic needs, and rising incidence of chronic disease, estimates Kalorama Information.
Trends Shaping the Global Market
Adoption of high slice-count systems: Amidst the increased focus on cutting healthcare and hospital costs, spending twice as much on 256- or 320-slice CT systems for clinical applications such as cardiac imaging when a 64-slice system is sufficient for a cardiac diagnosis, may appear unnecessary. However, users of 256- or 320-slice systems can vouch for superior image quality and better diagnostic capability in CT angiography.
Software-aided dose reduction: Since CT exams add to a patient's lifetime exposure to ionizing radiation, dosage remains an issue for the increased use for these systems. Currently, CT systems feature various technologies, such as iterative reconstruction software, intraoperativity, and dose-tracking software to reduce the amount of emitted radiation as well as the number of unnecessary scans.
Clinical application in pediatrics: Over the past few years, there has been a decrease in the clinical application of CT in pediatrics. Apart from difficulty in deciding the extent of further reduction in the rates due to limited evidence about the appropriateness of most CT procedures, radiation doses from pediatric CT also vary widely in clinical practice. However, this presents an opportunity to reduce doses through standardized protocols and other processes. By implementing readily available dose-reduction strategies, as well as eliminating unnecessary imaging, it will be possible to significantly reduce future radiation-induced cancers caused by the use of CT in pediatrics.
High-speed systems: The increase in clinical utilization of CT has been driven by improvement in image quality and speed, and robustness and utility of the CT technique. There has been a significant improvement in the speed with which 3D volume can be imaged, as well as in routine spatial resolution in the slice direction, owing to helical scanning and multi-detector row CT. This, coupled with various other technological advances, has resulted in CT imaging speed increasing by more than seven orders of magnitude since it was first introduced in the early 1970s. The increase in speed, combined with improvement in low-contrast detectability and image quality, has resulted in the technique becoming more robust and allowing CT to become mainstream in medical care.
Improved resolution with smart photons: CT systems are limited by crosstalk based on their use of reflectors. In direct conversion photon-counting detectors, each photon creates a number of charge carriers in the semiconductor in proportion to the energy deposited. Charge carriers produced in the semiconductor follow electric field lines to prevent crosstalk, as a result of which, these detectors avoid the geometric inefficiencies in scintillator-photodiode detectors currently used in commercial systems and help achieve better spatial resolution.
Portable CT units: Portable CT is expected to become a standard of care in the next decade as rapid diagnosis and treatment play an increasingly important role in improving the health outcomes for patients and reducing healthcare costs. Portable head CT imaging is particularly gaining importance in aiding diagnosis and treatment of patients with cranial pathology, as bringing the modality to the patient increases imaging speed and safety, which is critical in neurologic emergencies.
With cutting-edge technologies, modern CT systems have the potential not only for evolution – to improve the current CT images by incorporating software-aided dose reduction, but also for a revolution – to enable novel applications with the advent of new technologies such as spectral CT and dual-energy CT.
Rapid progress in detector technology with respect to the quality of sensors and count rate capabilities has paved a way to the next generation of photon-counting CT detectors. The continuous efforts of CT researchers in industry and academia have led to the development of the PCD-CT prototypes, a step closer to the production of commercial PCD-CT systems in future years. The change from energy-integrating detectors to photon-counting detectors will be a revolutionary quantum leap, similar to the jump from single-slice to multislice CT.