2016 saw the mid-segment take a beating, with preference for 16- and 128-slice equipment.

Over the years, prompted by technological advancements, the nuclear medicine equipment market has witnessed the launch of various new products. Incessant introduction of new and advanced products, investment in modernization of diagnostic imaging centers, development of new radiotracers, increasing use of SPECT and PET scan results, alpha radio immunotherapy-based targeted cancer treatment, rising incidence and prevalence of cancer and cardiovascular diseases, strong product pipeline, and growing demand for nuclear medicine procedures in the emerging markets are the key drivers for nuclear medicine devices.

Indian Market Dynamics

The industry is still reeling under the recent increase in import duty on nuclear medicine equipment from the current 5 percent to 7.5 percent to help companies manufacture these products in India itself. This is in tune with the government's Make in India initiative. The step came in end-January 2016, over a month ahead of the Budget 2016-17, tabled in Parliament on February 29. The government also imposed special additional duty of 4 percent on these items by withdrawing exemptions.

mri-equipmentnuclear-medicineThe Indian nuclear medicine equipment market in 2015 was valued at 135 crore, with sales of 10 PET scanners, 21 gamma cameras, and one cyclotron. The buyers for PET scanners included Rajiv Gandhi Cancer Institute & Research Centre, New Delhi; Jaslok Hospital and Research Centre, Mumbai; Lilavati Hospital and Research Centre, Mumbai, and a couple of leading diagnostic centers in Bangalore. A cyclotron was purchased by Dr. Maniar in Mumbai.

There is a change in the buying pattern for PET scanners. Till last year buyers were upgrading their equipment from 16-slice to the better contrast and spatial resolution offered by 64- and 128-slice systems. 2015 saw the mid-segment take a beating, with preference for 16- or 128-slice equipment.

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. The cyclotron was supplied by GE.

The Road Ahead

During the last decade, PET/CT and SPECT/CT have made advances in research and clinical application of fusion imaging. These two modalities are established in the market today, with PET/CT being the standard-of-care in oncology, and SPECT/CT an upcoming hybrid modality currently being used mainly for cardiac scans.

Over the past four years, PET/MRI has been making inroads as well and it could eventually supplant PET/CT as the modality of choice in some areas of oncology, neurology, and cardiology. The excellent soft-tissue contrast of MRI and the multifunctional imaging options it offers, including spectroscopy, functional MRI, and arterial spin labeling, complement the molecular information of PET. Simultaneous PET/MRI also allows doctors to follow tracer distributions over time and combine quantitative molecular PET information with information on cellular densities, flow, and perfusion, including data obtained from advanced MR-based spectroscopy, diffusion, and perfusion studies.

Nuclear-medicineThe development of a fully integrated PET/MRI system is technologically challenging. It requires not only significant modifications of the PET detector to make it compact and insensitive to magnetic fields but also a major redesign of the MRI hardware. Indeed, PET/MRI has the potential to broaden horizons in the emerging field of molecular imaging, because complementary anatomic and biologic information is obtained and synergisms of both modalities can be expected. The novel imaging technology may not enter clinical routine before its impact on diagnostic accuracy has been proven and the effect on therapy management and cost-efficiency has been considered and validated.

The exorbitant cost of hybrid scanners puts them out of the reach of small medical imaging clinics and rural setups, making them affordable only to multispecialty hospitals and larger clinical setups. With companies building most systems through in-house research and looking for a quicker return on investment, increased government funding for product development could reduce the cost of advanced hybrid imaging platforms.

Developing alternative fusion platforms – optical imaging with PET – will also help hybrid imaging solution providers decrease the overall cost of systems. In addition, factors including stringent regulatory guidelines, shorter half-life of radiopharmaceuticals, competition from conventional diagnostic procedures, growing adoption of refurbished diagnostic imaging equipment, and hospital budget cuts act as a challenge for the market.

Dr Parul Mohan,Senior Consultant and In-charge Nuclear Medicine,Mahajan Imaging and Fortis Hospital, New Delhi
Second Opinion
Handheld Gamma Probe

A gamma probe is a handheld device for intraoperative use following interstitial injection of a radionuclide, to locate sentinel lymph nodes by their radioactivity. It is used primarily for sentinel lymph node mapping and parathyroid surgery. Intraoperative sentinel lymph node as well as tumor detection may be improved under some circumstances by the use of beta (negatron or positron), rather than gamma detection, because the very short range of such particulate radiations eliminates the contribution of confounding counts from activity other than in the immediate vicinity of the detector. This has led to the development of intraoperative beta probes. Radiation detectors for intraoperative probes can generally be characterized as either scintillation or ionization detectors. Alternatives to inorganic scintillators are plastic scintillators, whose combined high counting efficiency for beta particles and low counting efficiency for 511-keV annihilation -rays make them well-suited as intraoperative beta probes in general and positron probes in particular. Semiconductors used in ionization-detector probes include cadmium telluride, cadmium zinc telluride, and mercuric iodide. The earliest small field-of-view intraoperative gamma camera systems were hand-held devices having fields of view of only 1.5–2.5 cm in diameter that used conventional thallium-doped sodium iodide or sodium-doped cesium iodide scintillation detectors. Later units used 2-dimensional arrays (mosaics) of scintillation crystals connected to a position-sensitive photomultiplier tube and, more recently, semiconductors such as cadmium telluride or cadmium zinc telluride. More recently, larger field-of-view (up to 55 cm) devices have developed, which are attached to an articulating arm for easy and stable positioning. These systems are nonetheless fully portable and small enough overall to be accommodated in typical surgical suites.

Dr Parul Mohan
Senior Consultant and In-charge Nuclear Medicine
Mahajan Imaging and Fortis Hospital, New Delhi

Indian Market Dynamics is based on market research conducted by Medical Buyer in July 2016.

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