Diagnostics & Imaging Week

VIENNA, Austria – More than 18,000 radiologists and exhibitors turned out for last Friday’s opening of the European Congress of Radiology (ECR), which continued to distinguish itself as a showcase for CE-marked products not yet available in the world’s largest radiology market, the United States.

The event also reinforced trends in radiology that are common to both markets, including a much-lamented spread of obesity among patients that is on the rise in Europe.

Miniaturization of scanners for greater mobility and flexibility, the digitization of radiology exams, the combination of multiple scanning modalities for fusion diagnosis and the increasing costs to hospitals for new equipment were industry trends, with a mix of new products as well as manufacturers’ promises for future releases.

Some 5,269 abstracts were submitted for ECR 2008, a 20% increase, and the final program offered 1,800 lectures, with speakers from 40 countries, and 2,000 research presentations, asserting authoritatively the scientific credibility of the event, held each year since 1991 in Vienna.

ECR 2008 was organized by the European Society of Radiology (ESR; Vienna, Austria), which gathers a membership of 30,000 radiologists from 115 countries. Formally organized just last year, ESR distinguishes itself from what ESR President Maximilian Reiser called “old, elite associations accessible only to a few individuals and that are behind the times.”

Massive recruitment banners promoted the new membership fee of €10 ($15), reduced “to show solidarity with colleagues from countries with lower average incomes and allowing as many physicians as possible to join the exchanges,” according to Reiser, who is director for the Institute for Clinical Radiology at the University of Munich-Grosshadern (Munich, Germany).

The exposition drew 270 companies presenting across 265,000 square feet of an exhibition area that spilled over into neighboring office towers for special hands-on sessions for radiologists with new equipment.

Responding to the increase in obesity in Europe, manufacturers promoted XXL products, such as tables supporting weights greater than 300 pounds, and more powerful scanners capable of deeper penetration to image organs of the “technically difficult patient.”

Increased bore size for magnetic resonance imaging scanners were prominently displayed by several manufacturers.

The miniaturization and resulting portability of ultrasound scanners is another response to the technically difficult patient, not only for obesity, but for other physical or mental infirmities.

“There is more of a tendency to bring radiology to the patient rather than the patient to radiology departments,” said Reiser, adding that it is a response to a social responsibility for providing care to the elderly and those with dementia.

Pierre Radzikowski, manager for ultrasound in Europe, the Middle East and Africa for GE Healthcare (Waukesha, Wisconsin), based in Solingen, Germany, said GE can lay claim to starting the trend two years ago with the release of the Vivid I, Logic I and Voluson I products.

“These were the first compact systems capable of delivering the quality of image of bigger systems,” he said.

A 2007 report from Frost & Sullivan (London) reaffirms GE’s claim to leading the market and surprisingly does not place either Siemens (Erlangen, Germany) or Philips (Eindhoven, the Netherlands) on the map.

Siemens set out to correct this deficiency with the launch of the Acuson P10 pocket ultrasound device at the MEDICA trade show.

At ECR 2008, Siemens presented an expansion of the Acuson line with the S2000, promoted as a higher-end platform with more scanning and image processing modalities.

The Acuson line is not yet available for distribution in the US.

“Siemens needs to do something, and quickly,” said one competing product manager. “They lost 4% market share in ultrasound last year.”

At Philips, Jim Walchenbach, global market manager for ultrasound, said miniaturization “clearly is a market trend, a new paradigm, and we will have a unique position in this market, but not yet.”

He added that happily for Philips, “most hospitals still want powerful equipment and portability is not their primary motivator for a purchase.”

A market trend that is absolutely unique to Europe is contrasted-enhanced ultrasound (CE-US), “a very important piece in the market right now, very hot,” according to Radzikowski at GE.

“If we go into a radiology group with an ultrasound product at any hospital in Europe today the first question is ‘How are you performing with contrast agents?’” he said.

Walchenbach of Philips agrees the trend is uniquely European, “but that will not be true in five years.”

He said Bracco Diagnostics (Milan, Italy), maker of the leading contrast agent for liver tumor diagnosis that is the dominant procedure used in Europe is currently seeking approval from the FDA, and “I would expect that to come in the next couple years.”

Walchenbach said government health funds, the dominant payers for healthcare in Europe, are driving the shift to CE-US.

“It’s a question of economics. When you look at the demographics of Europe with its aging population, there is a great pressure on hospitals to find alternatives to the expense of CT and MRI for diagnostic imaging.”

The shift is most mature in Germany, he said, where it is recommended for daily practice, but CE-US has won acceptance throughout European markets, including France, Italy, Spain and the UK, with significant penetration in Scandinavian markets as well.

Ultrasound is a first choice for diagnostic imaging for many diagnosis-related groups (DRGs) due to its lower cost. But using the example of liver scans, ultrasound, even when Doppler is added, has poor sensitivity for characterizing lesions and generates false-negatives at a 50% rate or greater.

The most-used and best-documented procedure combines the Philips IU22 system with Bracco’s SonoVue, microbubbles of sulphur hexafluoride, a transpulmonary echocardiogram contrast agent that improves the display of vacularity of liver and breast lesions during Doppler sonography leading to more specific lesion characterization.

These microbubbles of gas measuring averaging 2.3 microns are lipophilic, with a low soluability in blood and the microbubbles are too large to permeate blood vessels, making them markers for blood circulation.

SonoVue also is exhalated through the lungs and not the liver, posing low risk for patients who have impaired renal function.

A paper from the Imperial College School of Medicine (London) published last year says that several prospective studies show that compared to contrast-enhanced CT and MRI for metastases, in some cases lesions too small to be detected are accurately shown on CE-US, an improvement in sensitivity from 63% to 91%.