VIENNA, Austria — Along with the world première of Viamo, a portable ultrasound unit, at the European Congress of Radiology here earlier this week, Toshiba (Tokyo) presented an estimate of the worldwide market for such devices, placing current sales at €500 million ($632 million).

An informal survey by Medical Device Daily of executives from the leading medical imaging companies during ECR 2009 confirmed that number, as well as Toshiba's estimate that this market has grown aggressively at a rate of 20% for each of the past few years.

The market for all ultrasound equipment is estimated to be $4.7 billion annually and headed for $6.2 over the next five years.

While portable ultrasound accounts for 10% of these sales, it is expected to undermine sales of cart-based and fixed-installation units as it continues to expand.

GE Healthcare (Waukesha, Wisconsin) started the trend to portable ultrasound in 2005 with the introduction of the Vivid i, a laptop model ultrasound for the cardiovascular cath lab as well as urgent care, emergency rooms, critical care, and operating rooms.

Successfully tapping an unmet need in medical practice that was originally proven by the original category creator, SonoSite (Bothell, Washington), sales of the Vivid i tore away market share from competitors, catapulting GE by 2006 to the lead position for ultrasound worldwide.

GE enjoyed the first-to-market advantages until 2007, when Siemens (Erlangen, Germany) introduced the Acuson P-10, a pocket-sized model that pushed the portability challenge just as Blackberries took away many everyday tasks from the laptop computer.

With a flip-up monitor and thumb controls, the P-10 is widely referred to as a next-generation stethoscope bringing basic ultrasound further out of the hospital and successfully creating a personal data assistant feel for cardiologists, as well as ob/gyns.

Philips Medical Systems (Andover, Massachusetts) was the laggard in this fast-developing market, but finally arrived in late 2008 with a high-end model, the Compact Extreme 50 (CX-50).

The CX-50 is loaded with a digital broadband beam former gives Doppler performance and Philips migrated premium ultrasound imaging capabilities from its fixed systems into the new portable, such as PureWave and XRES.

Toshiba attacks the high end

Jos Ruis, vice president of Toshiba Medical System Europe (Zoetermeer, the Netherlands), told MDD the Viamo is entering at the high-end of the market priced at €50,000 ($63,000).

Toshiba has an installed base of 200,000 ultrasound scanners worldwide and Ruis says sales to existing customers are not just a strategy but a runaway success.

"People are buying it on the spot," he said, adding they hesitate about the trade-off in image quality with competitors portables but are acting immediately after seeing the capabilities of Viamo.

While Ruis would not give a number for pre-market sales, an executive from Toshiba who declined to be named, said "I am hoping to see the kind of pre-orders that they have had in Europe when I get back to Japan."

He said Japan would be the next market roll out for Viamo, "sooner than the annual May radiology event there."

As for the United States, he said, "we are still thinking about it."

Ruis said Toshiba's strength will be in Western Europe where there is a large and active replacement market.

"Eastern Europe, on the other hand, is an expanding market for new products, and one of our core markets, though the user case is different with customers are trying to catch up with capabilities," he said.

The Russian government has launched a number of programs for ultrasound acquisition over the past few years, he said, adding that the day before the market launch Toshiba demonstrated Viamo for two Russian delegations at ECR 2009, including one group from Gazprom.

An East-West divide

Michael Rapp, vice president for ultrasound marketing at Siemens Medical USA (Mountain View, California), asks, "Will a high-end portable do well in these market conditions?"

He notes that the Viamo is priced at €50,000, "and that does not include the transducers and probes that need to be added."

Rapp agrees with other executives there is vast opportunity in Europe east and north of Vienna, but adds that while there are a lot of new systems purchased, the Eastern European market "is primarily driven by price sensitivity, not features."

"My guess is that a machine in the middle range is going to sell better in the East than it does in Western Europe," he said.

Robert Körbler, Philips' managing director for healthcare in Austria, said he has been selling medical imaging equipment for 17 years in Eastern Europe, starting in Hungary with Hewlett-Packard, a business that now is Philips Healthcare.

He sees that market for ultrasound now reaching maturity and may start to follow a pattern that has characterized sales in recent years in the mature markets of Western Europe.

"There has been a significant shift in the ultrasound market in Western Europe where the middle market disappeared and customers are polarized either to the low or high end systems," Körbler said.

He defined the low end as instrument starting around €14,000 and the high end with systems that can run as much as €150,000.

"In this shift, some customers have gone for portables, but this growth has not come at the expense of the existing products," he said.

The hot application has been cardiac cath labs, where space is at a premium.

"Here the portables have done very well, there continues to be a very big demand with the key driver right now being integration with other imaging systems being used for guidance and assessment," Körbler said.

As for the coming competition among the market leaders, he said estimates for growth this year in medical imaging generally range from plus 0.5% to minus 2%.

"Taking market share in this environment would be a very aggressive ambition as everyone is going to defend their share aggressively," he said.

Staggered rollout for Philips CX-50

Radjen Ganpat, sales development manager for ultrasound with Philips Healthcare EMEA (Böblingen, Germany), said the CX-50 was introduced in September at the European Society of Cardiology meeting in Munich, Germany, because the new high-end portable was targeted as at the lucrative cardiovascular market as a first application.

He acknowledged that the price point starts at €50,000.

CX-50 was not shown at the world's largest radiology event, the annual Radiological Society of North America (Oak Brook, Illinois) extravaganza in Chicago, three months later because the general radiology model was not yet ready.

That was being introduced to radiologists in Vienna at ECR 2009.

Ganpat said Philips has begun to ship its cardio model, but the general radiology model will not be delivered commercially until Q309.

"CX-50 is our first portable model, and I can assure you that we are working on a lower-end product, though I can not give you a timeframe," he said.

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