MARKET REPORT - RADIATION PROTECTION SPECIALISTS in partnership with - HPCi Media
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MARKET
REPORT
in partnership with...
RADIATION
PROTECTION
SPECIALISTS
MARKET
REPORT
SPECIAL
REPORT:
CT – THE
FIRST LINE
OF ENQUIRY
This feature explores the evolution of
modern CT scanning systems and how
they will continue to support
healthcare providers moving forward
Sponsored by
Recently Canon
installed the 100th
Aquilion ONE CT
scanner in the UK
May 2021 building better healthcare 2
MARKET
REPORT
At the end of 2019 the Government pledged “CT is also increasingly used for interventional
£200m in new funding to help the NHS replace procedures and advanced examinations such as
ageing diagnostic imaging equipment, including complex biopsies or radiofrequency ablations,
MRI and CT scanners and mammography which can be accurately guided by CT imaging.”
systems.
This followed research from the European A rich history
Coordination Committee of the Radiological, CT was first launched in the UK in October 1971,
Electromedical and Healthcare IT Industry with the first scan taking place at the specialist
(COCIR) which indicated that, at the end of 2018, Atkinson Morley Hospital in south west London.
14% of CT scanners in the UK were 10 years old or The first commercial installation followed at
over, compared to only 1% at the end of 2011. Manchester Royal Infirmary in 1972.
And, three years on, the situation is even more And, by 1980, three million scans had been
critical, especially when you consider that performed across the country..
diagnostic imaging technology that has surpassed Fast forward nearly two decades and between
the 10-year mark is considered obsolete or September 2018 and September 2019, 5.8 million
inadequate for some procedures. scans were undertaken in the UK alone.
This highlights the importance of the
A growing market technology, and its continued adoption across the
Replacement, or at the very least upgrade, of NHS and private health sector.
equipment is therefore becoming essential.
CT imaging is increasingly used in every aspect How it works
of clinical diagnosis – from trauma, oncology CT – or Computed Tomography – is also known as
diagnosis, treatment planning and follow-up, ‘CAT scanning’ (Computerised Axial Tomography)
screening, orthopaedics, interventional, cardiac, and provides a different form of imaging, known
and everything in between. as cross-sectional imaging.
An easily-accessible, relatively-cheap The origin of the word ‘tomography’ comes
examination and diagnostic tool, CT scans are from the Greek word ‘tomos’ meaning ‘slice’ or
frequently one of the first lines of investigation. ‘section’; and ‘graphe’ meaning ‘drawing.’
Russell Lodge, CT business manager at Siemens A CT system produces cross-sectional images
Healthineers, told BBH: “CT scanning provides or ‘slices’ of a patient's anatomy, like the slices in a
visualisation of anatomy, pathology, and function loaf of bread.
and is a fast, simple procedure that can be And these cross-sectional images are used for
performed on an outpatient basis. a variety of diagnostic and therapeutic purposes.
“Imaging such as coronary angiogram When undergoing an examination, a motorised
examinations, renal tract obstruction, and colon table moves the patient through a circular opening
imaging with barium studies are increasingly in the CT imaging system.
transitioning to this modality with the benefit of As the patient passes through the system, a
additional pathology being picked up on CT source of X-rays rotates around the inside of this
examinations. circular opening, with a single rotation taking less
Streamlining workflow
and speeding up
scanning times is a key
focus for manufacturers
such as Philips
May 2021 building better healthcare 3
MARKET
REPORT
USING SMART FINANCE
SOLUTIONS FROM A
SPECIALIST FINANCIER,
HEALTHCARE
INSTITUTIONS CAN
ACCESS CUTTING-EDGE
TECHNOLOGY WITHOUT
PUTTING A STRAIN ON
OPERATING COSTS
GE Healthcare's
Revolution Maxima
system with auto
positioning uses real-time
depth-sensing technology
to generate a 3D model of
the patient’s body (main
image) and a Deep
Learning Image
Reconstruction algorithm
generates TrueFidelity
images (left)
than a second. position (angle) of the source of X-rays.
The X-ray source produces a narrow, fan- Many different snapshots/angles are collected
shaped beam of X-rays used to irradiate a section during one complete rotation and the data is then
of the patient’s body. sent to a computer to reconstruct all of the
The thickness of this fan beam may be as small individual snapshots into a cross-sectional image
as 1mm, or as large as 10mms. – or slice - of the internal organs and tissues for
In typical examinations there are several each complete rotation.
phases; each made up of 10 to 50 rotations of the
X-ray tube around the patient in co-ordination Clinical outcomes
with the table moving through the circular Matthew Trevail, image guided therapy modality
opening. manager for GE Healthcare UK and Ireland, said:
The patient may also receive an injection of a “CT’s clinical use and diagnostic power have
contrast material to facilitate visualisation of rapidly increased in recent years, with the
vascular structure. introduction of volumetric imaging, faster
Detectors on the exit side of the patient record rotation speed, iterative and AI-based image
the X-rays exiting the section of the patient’s body reconstruction, dual energy, and dose-reduction
being irradiated as an X-ray snapshot at one technologies.
May 2021 building better healthcare 4
MARKET
REPORT
Siemens Healthineers
is working with the
NHS to bring CT
diagnostics into
community settings
May 2021 building better healthcare 5
MARKET
REPORT
“And, for nearly 50 years, it has proven to be a “In many ways, the pandemic has proven what we
vital imaging tool used by clinicians to detect already knew – that data, AI, and connectivity are
cancer, heart conditions, and other diseases, large central to helping those on the frontlines to
and small. deliver intelligently-efficient care.
“But, over the past decade, there has been an “GE Healthcare is not only providing new tools
increased focus on providing new digital tools to to help hospital staff keep up with demand
help healthcare providers achieve clinical and without compromising diagnostic precision; but
operational excellence.” we continue listening to, and rapidly responding
Mark Thomas, CT modality manager at Canon to, customer needs using all tools at our disposal –
Medical Systems UK, adds: “Today, CT is a core including AI.”
imaging modality in all hospitals. The evolution of AI and its use within CT
“From CT Pulmonary Angiography (CTPA) in imaging is one of the key improvements seen in
COVID-19 patients, to diagnosing heart or brain recent times.
conditions and guiding tissue biopsies; it is an AI – or Artificial Intelligence – uses machine
essential tool in the medical practitioner’s arsenal. learning to provide more data using low-dose
“It helps to diagnose disease and conditions scans.
earlier, and to improve life expectancy and And it has the potential to vastly advance
outcomes for patients.” medical imaging, particularly CT scanning, by
And Lodge told BBH: “Examinations using CT reducing radiation exposure and improving
are well tolerated by patients as the scan overall image quality.
acquisition speeds are short and the image For example, GE Healthcare’s Deep Learning
reconstruction speeds fast, providing a real-time Image Reconstruction algorithm generates Siemens Financial
image overview.” TrueFidelity CT images, which offer exceptional Services works with
image quality and preferred noise texture. Siemens Healthineers
and other technology
AI drives innovation To do this, it uses a dedicated deep neural
vendors to provide
And the recent COVID-19 pandemic, as Thomas network to generate the images,, which have the
cost-effective financing
states, has really shown the power of CT potential to improve reading confidence in a wide
solutions for a wide
technology. range of clinical applications, such as head, whole variety of medical
Hannah Timbrell, modality sales specialist for body, and cardiovascular, for patients of all ages. equipment, including
CT advanced molecular imaging at Philips, said: The company’s Revolution Maxima system with CT machines
May 2021 building better healthcare 6
MARKET
REPORT
auto positioning uses real-time depth-sensing “Our customers have referenced ‘phenomenal’ A year ago the first CT
technology to generate a 3D model of the patient’s patient dose reductions, up to 90% below the with Advanced
body, or a specific area. National Diagnostic Reference Levels, at the same intelligent Clear-IQ
time as benefitting from extremely-high-quality Engine (AiCE), a deep
Focusing on what’s important clinical images, and all in a rapid timeframe learning reconstruction
AI algorithm, was
Then, using a deep-learning algorithm, Auto suitable for everyday clinical use.
installed into a UK
Positioning pinpoints the centre of the scan range
hospital by Canon
and automatically centres the patient for a What’s next? Medical Systems
completely hands-free positioning experience. “And the low doses have even been achieved when
In one case, a site scanning more than 60 examining people that have traditionally been
patients per day, and as many as 17 per hour, saw a difficult to image, such as severely-ill patients
93% utilisation rate, allowing staff to automate with their arms by their sides, those unable to
most of their scans and freeing up additional time hold their breath, and bariatric patients.”
for technologists to focus more on patient care Siemens Healthineers’ focus has been on
and comfort. improving speed of acquisition; the advancement
Trevail said: “New AI solutions and automated of dose optimisation technology, such as its Tin
applications help expedite processes and Filter system; and a move towards lower
streamline workflows to allow technologists more kilovoltage imaging.
time to focus on what is important: the patient. Lodge explains: “The general rule in CT has
Philips’ Incisive CT System also harnesses the been that lower doses make it harder to
power of AI. reconstruct images of sufficient quality.
“Anything that can help reduce patient dose “But iterative reconstruction technology is
without reducing image quality has become an changing that.
essential part of any scanner, whether this is with “Advanced Modelled Iterative Reconstruction
reconstruction algorithms, auto-positioning, or (ADMIRE) offers powerful dose reduction,
built-in dose modulation,” said Timbrell. excellent image quality, and everyday suitability,
Thomas adds: “Artificial Intelligence will herald with fast reconstruction speeds, using high-speed
greater rewards with CT and its introduction has processing computers, making it practical for
been a game changer for healthcare. routine use.”
“Only a year ago the first CT with Advanced So what’s next in terms of R&D?
intelligent Clear-IQ Engine (AiCE), a deep learning Most manufacturers believe photon counting
reconstruction AI algorithm, was installed into a CT technology (PCCT) will be key.
UK hospital, and many more orders have followed “With photon counting CT, the system can more
since. accurately count the photons produced by the X-
May 2021 building better healthcare 7
MARKET
REPORT
rays to create an even-clearer image and provide scout/surview image – an image that historically THE PANDEMIC HAS
more information to the clinician,” said Trevail. has only been used to plan scans and has not given
PROVEN WHAT WE
“It’s like throwing thousands of darts at a dart quantifiable data,” said Timbrell.
ALREADY KNOW –
board all at once. With traditional CT, we capture “By doing this, they have made productive use of
some of the darts – or photons – but some stray all the radiation given to the patient, obtaining THAT DATA, AI AND
off course or bounce off the board,” he adds. Bone Mineral Density measurements of the spine. CONNECTIVITY ARE
“With photon counting CT and Deep Silicon “This could potentially allow large-scale, CENTRAL TO
detectors, we can capture more of those opportunistic osteoporosis screening, which could HELPING THOSE ON
darts/photons.” assist in early diagnosis against a disease that it is THE FRONTLINE TO
While this technology is still in development and estimated three million people in the UK suffer DELIVER
is not yet cleared or approved for commercial sale, from; but is frequently left undiagnosed until a INTELLIGENTLY-
it is a focus for all leading manufacturers. patient experiences a fracture.”
EFFICIENT CARE
Timbrell told BBH: “Future technological The patient experience is another area coming
advancements of CT will certainly include photon under the spotlight.
counting. Thomas said: “The external design of CT has
“Anything that makes use of all the information stayed in tune with the changing shape of patients
provided by the radiation given to a patient will around the world.
play a part in future technology.” “Table capacity is now at higher weight
Other advancements include solutions to tolerance, adapting to the growing waistlines of UK
mitigate radiological distortion from metal populations, and the central bore hole of scanners
objects, such as orthopaedic plates or medically- has been getting wider over the last 10 years to
implanted coils; and the improved visualisation of accommodate larger patients more comfortably.”
soft tissue structures surrounding these implants. He adds: “Recently we welcomed the
To address this, Canon launched SEMAR – a 100th Aquilion ONE CT scanner order here in the
Single Energy Metal Artifact Reduction UK, from the latest generation, the Aquilion ONE
reconstruction technique – which improves the PRISM Edition.
visualisation of medical images for clinical “This milestone is an opportunity to reflect on
interpretation with no increased patient dose; a how far we have come with the system and convey
timely innovation for the growing number of our excitement of what the future holds.
people with replacement hips or knee joints and “It was just over a decade ago that CT scanning
other medical implants. was defined by the number of ‘slices’, referring to
the number of rows of detectors in the z-axis.
The patient experience “However, the Aquilion ONE burst onto the
And Philips says its Spectral CT scanners are fast stage in 2007, taking everyone by surprise with its
becoming a benchmark for standard scanner new technological CT innovation, and the
requirements in the future. competitive slice wars was eliminated forever.
“Research in Munich has enabled the Spectral “Today, to be CT cutting-edge is about the balance
information on the Philips IQon system to be used of low dose, high speed, and clear image quality.”
to gain DXA-equivalent data from the But it is also about helping clinicians to make
Philips’ Incisive
system harnesses
the power of AI
May 2021 building better healthcare 8
MARKET
REPORT
sense of the images the equipment is capturing ease while the auto-positioning camera sets the Siemens Financial
and, increasingly, modern equipment is helping to patient up in the correct area for the scan. Services has seen an
address the global shortage of radiologists and “Furthermore, our protocol management increase in healthcare
ease growing pressures. capability suggests a suitable protocol to select clients looking for
direct from the gantry side.” finance arrangements
which enable them to
Under pressure So, with NHS and private health trusts charged
invest in the latest CT
The latest Royal College of Radiologists Workforce with replacing outdated equipment, what are the
equipment without a
Report highlighted growing concerns over a 33% main questions they should be asking when massive capital outlay
shortfall in radiologists, set to reach 43% by 2024. looking to procure the very-latest in CT
Yet, at the same time, the volume of CT imaging technology?
examinations across England is increasing. Respondents to an IMV survey in 2020 put their
Thomas says: “In response to workforce priorities for CT in the following order:
pressures, we continue to innovate CT workflow l Improve patient satisfaction
automation to help give some time savings that, l Improve staff satisfaction and morale
over the course of a full day or week, translate into l Satisfy the needs of referring physicians
more patient appointment slots. l Improve CT department workflow and
“And the advancement of AI-driven CT is a productivity
massive time saver to speed up procedures, with l Improve capability to reduce radiation dose
none of the traditional compromises on image This shows that, when looking to replace a CT
quality or dose.” scanner, departments should look at workflow
Trevail adds: “When considering workflow, we efficiencies to cope with an increased volume of
deploy artificial intelligence in the Revolution patients, reliability features to ensure maximum
Maxima, with an auto-positioning camera. ‘up time’, dose-reduction methods, image
“The radiographer can then focus on the reconstruction algorithms for image quality at low
patient, answering questions or putting them at dose, as well as patient and staff safety and
May 2021 building better healthcare 9
MARKET
REPORT
satisfaction features to
increase comfort
and compliance.
A costly
problem
“Philips
Incisive, for
example, is fully
in-room
upgradable, has
a Tube for Life, a
target of zero
unplanned
downtime, and AI at
every step of the
workflow to reduce dose,
improve consistency, and ease
of use,” said Timbrell.
Trevail adds: “From our customers around the cardiac CT and can select the cardiac Philips' IQon system
world we hear that key considerations when subscription. However, if five years from could potentially allow for
specifying a new CT system usually include: How installation the hospital is undertaking neuro large-scale, opportunistic
will my new system assist with workflow? How procedures for the first time, the neurology smart osteoporosis screening
will my system be continuously upgraded to suit subscription may be appropriate.”
my changing clinical demands? And what new
technologies have been incorporated to bring true Financial help
clinical and patient value?” And Siemens Healthineers is working alongside
And Lodge advises radiology leads and the NHS to realise a new vision for the delivery of
procurement managers to take time to review the diagnostics and elective care within community
type of examinations carried out within a settings.
department and the examinations anticipated to Lodge said: “The flexible provision of CT
be performed with newer technology. diagnostic imaging facilities is central to our focus
“For example, if the scanner is to be used in on bringing diagnostics closer to patients, with
trauma imaging, then speed, accuracy, positioning our involvement in initiatives like the Targeted
and coverage should be considered,” he adds. Lung Health Checks programme just one example
“It is also important to consider the need for of our work in facilitating local community
advanced intervention and the intervention aids diagnostic services.
available to guide precise examination. “More recently, the introduction of modular CT
“Should a scanner be carrying out cardiac imaging facilities suitable for siting within hospital
examinations, with the routine use of heart rate grounds has allowed us to support NHS customers
control and potential for scanning a range of heart in their recovery from the COVID-19 pandemic
rates and arrhythmia – native temporal resolution and in meeting the associated rise in demand for
should be evaluated. diagnostic services.”
“And staff training is also key to getting the best But there are also other options.
results from a scanner. Penny Pinnock, sales manager for healthcare
“The introduction of AI-based guided workflows and public sector at Siemens Financial Services,
can be helpful, while online self-learning said: “Acquiring equipment is only part of the cost
platforms, like PEPconnect, can support users, of extending radiography.
alongside clinical applications training.” “Planning, installation, and development of
But, with estimates that, over the next five building infrastructure are all costly elements of
years, it will cost £1.17billion to invest in new and the process of acquisition that, without the right
replacement diagnostic technologies, including financial tools, have the potential to spike a
CT – and the Government pledging just a fraction hospital trust’s operating costs.”
of this – many organisations are looking for novel Because of this, pay-for-outcomes
ways to ensure they can keep up with the demand. arrangements, such as lease agreements which
And manufacturers are addressing this with a deliver fixed monthly payments over the financing
number of options. period; or Managed Service Contract
GE, for example, has launched a Smart arrangements that guarantee an agreed level of
Subscription service which enables users to access equipment uptime, are becoming popular.
the latest upgrades and new features through a Pinnock explains: “Such financing solutions
subscription model. spread the cost of the technology over an agreed
“There are a number of options available financing period, with payments arranged to align
allowing customers to tailor an upgrade model with the expected benefits of the use of the
that suits them,” said Trevail. technology over time, such as improved
“For example, the customer may be undertaking operational efficiency.
May 2021 building better healthcare 10MARKET
REPORT
“By removing the need for a large initial outlay, associated risks. TODAY, TO BE CT
finance arrangements like these can help improve “They are therefore more inclined, and more CUTTING EDGE IS
cash flow and working capital. able, to create customised financing packages that ABOUT THE
“Additionally, they have the potential to fit the specific requirements of each individual BALANCE OF
incorporate other costs, such as installation, as organisation – for instance, by flexing the
LOW DOSE, HIGH
well as introducing the flexibility of future financing period to suit cashflow needs.
affordable technology upgrades, in line with “This contrasts with the standard financing
SPEED, AND
technology developments.” terms usually available from generalist financiers CLEAR IMAGE
who often lack technical expertise or a thorough QUALITY
Reducing pressure on capital understanding of the healthcare sector.”
She adds: “Siemens Financial Services works with She concludes: “As demand for state-of-the-art
Siemens Healthineers, as well as other technology imaging equipment increases, new financial
vendors, to provide cost-effective financing solutions are required for hospitals to keep pace
solutions for a wide variety of medical technology with healthcare innovation.
and equipment, enabling healthcare organisations “The latest scanning equipment provides
to access the solutions they need without having patients with improved healthcare outcomes and
to commit precious capital budgets. can contribute to earlier and more-accurate
“Such tailored financing packages tend to be diagnoses. This, in turn, has the potential to
offered by specialist healthcare financiers that relieve mounting pressure on resources derived
have an indepth understanding of medical from the current health crisis.
technology and its applications and who “Using smart finance solutions from a specialist
understand the profound impact up-to-date financier, healthcare institutions can access
equipment and technology can bring to the daily cutting-edge technology without putting a strain
operation and can expertly evaluate any on operating costs.”
Philips says its Spectral
CT scanners are
becoming increasingly
popular in the UK
May 2021 building better healthcare 11You can also read
