While PET-CT and SPECT-CT scanners are the most important molecular imaging techniques in nuclear medicine, this is not being reflected in actual procurement.

The Facts

  • The SPECT and SPECT-CT markets are larger than the PET, PET-CT, and PETMRI markets as these scanners have been in use longer and are less expensive, and their use has become routine for a wide range of indications. Yet, the industry is looking at SPECT techniques being replaced by PET procedures.
  • Growth is expected from PET, with the major switch in cardiology from SPECT to PET. PET in neurology has also proven to be of high interest. Oncology will remain the primary area of interest for PET imaging with the likely introduction of more than half a dozen new tracers on the market within the next five years.

The current PET-MRI technology is hampered by several shortcomings compared with PET-CT, the most important issues being how to use MR data for PET attenuation correction and the low sensitivity of MRI for small-scale pulmonary pathologies compared with high-resolution CT.

More and more clinicians are looking for ways to quantify images. Being able to compare the change in the size of a tumor before and after treatment allows clinicians to objectively determine the extent of the disease and effectiveness of treatment. As clinicians look to implement more preemptive and definitive treatment programs, they are demanding access to integrated, comprehensive data on the patient's diagnostic history. Over the last decade, PET image reconstruction technology has been designed to provide better image quality, reduced acquisition time, and lower injected dose.

Yet, the market for PET-CT is not really picking up.

Indian Market Dynamics

The Indian nuclear medicine equipment market witnessed a major decline in 2014, with sales of only about 19 systems, valued at Rs.115 crore. The market for PET scanners was estimated at Rs.105 crore, with sales of 13 units. There is better realization for PET scanners, as buyers are upgrading their equipment from 16-slice to the better contrast and spatial resolution offered by 64- and 128-slice systems. While GE, Philips, and Siemens are the three leading vendors marketing PET scanners with an equal market share, GE and Siemens are the major vendors in the SPECT scanners segment.

Global Market

The global nuclear medicine equipment market is expected to reach USD 2.13 billion by 2020 from USD 1.78 billion in 2015, and a CAGR of 3.6 percent. In 2015, the SPECT systems are expected to account for the largest share of nuclear medicine equipment market, by product; in the SPECT segment the hybrid SPECT systems are likely to command the largest share.

Cardiology application segment is expected to account for the largest share of the global nuclear medicine equipment market, by application; the hospital segment is expected to account for the largest share of the global nuclear medicine equipment market, by end user. Increased adoption of nuclear imaging equipment by hospitals around the world is a major factor for the large share of hospitals in the global nuclear medicine equipment market. In 2015, North America is expected to account for the largest share of nuclear medicine equipment market, followed by Europe, Asia-Pacific, and the rest of the world (RoW).

In the coming years, the nuclear medicine equipment market is expected to witness the highest growth rate in the Asia-Pacific region. The high growth in this region can be attributed to increasing research and development investments, expansion of international players and increasing disease burden, and favorable regulatory framework. The players in this market have implemented various strategies to expand their global footprint and increase their market share. The key strategies followed by most of the companies manufacturing nuclear medicine equipment include agreements/partnerships/alliances/collaborations; new product launches; expansions, and others.

Challenges and Opportunities

Over the years, the nuclear medicine equipment market has witnessed various advancements in products and their approvals to meet the needs of patients and the radiologists. These advancements have led to the improved use of many existing nuclear medicine equipment as well as the introduction of some new ones.

Incessant introduction of new and advanced products, increasing preference for SPECT and PET scans, investment in modernization of diagnostic imaging centers, advances in radiotracers, advent of alpha-radio immunotherapy-based targeted cancer treatment, development of new radiotracers, and rising incidence and prevalence of cancer and cardiovascular diseases are the key factors driving the growth of the global nuclear medicine equipment market. Additionally, factors such as increasing prevalence of diseases associated with aging population, strong product pipeline, and growing demand for nuclear medicine procedures in the emerging market are also expected to fuel market growth in the coming years. On the other hand, high cost of nuclear medicine equipment, decreasing reimbursements for radiology, shorter half-life of radiopharmaceuticals, and competition from conventional diagnostic procedures are key factors limiting the growth of this market. In addition to this, hospital budget constraints and increasing adoption of refurbished systems are major challenges faced by industry players in the global nuclear medicine equipment market.

Way Forward

We are currently in a period of tremendous promise and exploration in cardiac imaging as instrumentation and techniques develop rapidly and as modalities are tested in ever-evolving combinations, both as hybrid systems and through software-directed registration. Although CT fused with PET and SPECT now plays a dominant clinical role, it is clear that MR, ultrasound, and even bioluminescence and optical imaging fusion technologies may be used routinely in the next decade. For cardiac diagnosis and treatment, these techniques promise to provide novel approaches that will doubtless be significant adjuncts to contribution from other disciplines, including monitoring of stem cells and nanotechnology- based therapies and enhancement of image-guided procedures.

Indian Market Dynamics is based on market research conducted by Medical Buyer in March 2015.

"Improved gamma camera systems with enhanced solid-state detectors have replaced the conventional sodium iodide-based systems, enabling dedicated cardiac imaging, in particular by reducing the scan time, radiation dose, and improved image resolution. Hybrid systems such as SPECT/CT enable better localization of tracers to discrete anatomical disease sites. PET/CT has revolutionized oncologic imaging by its unique ability of characterizing and quantifying tissue metabolic activity at the cellular and subcellular levels that can help in staging cancers, identifying early recurrence, choosing the most appropriate therapy, and for monitoring treatment response of tumors to chemotherapy and radiotherapy. This has a subsequent impact in delivering individualized cancer therapies. The advent of combined PET/MRI will be an additional impetus for diagnostic applications and optimizing patient care. The major challenge, however, in developing countries such as India would be how to make these modalities cost effective and widely available."

Dr S Sumati
Senior Consultant and in-charge,
Nuclear Medicine and PET-CT Division, Global Health City, Chennai

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