COVID-19 resulted in patients holding off most procedures related to oncology, cardiology, neurology and general radiology. Also, elective procedures in hospitals and diagnostic centres came to a halt. Moreover, restructuring of procurement budgets had to be done to address COVID-19 related requirements first. This caused disruptions in trade, supply chain, and manufacturing globally.
The radiology industry was especially hit hard as this resulted in a delay of procurements of other capital-intensive equipment such as imaging modalities. Manufacturing of ultrasound, CT (computerized tomography) and mobile X-ray systems, as well as other imaging systems were also stalled or delayed.
In an interview with Omnia Health Magazine, Srikanth Kompalli, Program Manager, Healthcare & Life Sciences Practice, Frost & Sullivan, said that CT, X-ray (digital and portable), and ultrasound (point-of-care) modalities were at the forefront for effective, and early diagnosis of COVID-19 across the globe, as well as in the GCC countries.
He said: “Regarding the business impact within the radiology modalities, nearly 40-45 per cent of the market was affected at unit shipments scale, and for the GCC this had a greater proportion tied towards import of equipment’s (as almost all imaging equipment are 100 per cent imported). Further, in H1 2020, due to supply chain disruptions globally, the business had to be managed with current capacity, and the immediate ordering had to be based on stock availability with manufacturers/distributors within the GCC region.”
In terms of business metrics, Kompalli highlighted, the imaging market was the hardest hit market due to the pandemic, and the business loss was close to almost 45 per cent in the GCC region. Apart from immediate procurements of mobile X-ray, portable ultrasound systems (laptop / hand-carried), cart-based ultrasound, and CT, the other modality procurements were affected until Q3/start of Q4 of 2020.
End-users such as hospitals and diagnostic centres saw elective procedures being put on hold and strict lockdown measures allowed treatment of mostly COVID-19 affected patients. In the GCC, hospitals and healthcare providers witnessed approximately 50-65 per cent footfall loss in radiology departments in 2020.
Current state of global medical imaging informatics market
While developed countries digitalised their imaging workflows long ago, emerging countries started adopting digital technologies after a long gap. Growth saturation in developed markets and the rapid adoption in developing markets, especially in Asia Pacific (APAC) and Middle East, will drive the traditional radiology IT market consisting of RIS and Radiology PACS.
According to Kompalli, currently, the global informatics market is valued at US$8-US$8.5 billion coupled with a healthy CAGR of close to 5-6 per cent range in the next five years.
“Hospitals and health systems across the globe are financially stressed due to relatively lower growth of reimbursements as compared to the operating costs,” he emphasised. “Industry consolidation benefits the unification of operating systems and resources, leading to improvement in margins. However, mergers in the hospital industry give rise to multiple imaging systems that are rarely interoperable, driving the need for a strategy like Enterprise Imaging to achieve efficiency and economies of scale.”
Today, the notion of patient care has undergone substantial change as it transitions from physician-centric to patient-centric, driving the change in systems to gather, collate, and retrieve longitudinal clinical data, including medical images. Informatics solutions such as PACS, VNA, universal viewer, image exchange help achieve higher standards of care.
Furthermore, COVID-19 has pushed imaging departments to operate at skeletal strengths and work remotely to a large extent. Radiology, being a non-patient facing discipline, was one of the prime areas where remote work was possible through setting up a teleradiology workflow from hospitals to radiologists’ home-cum-offices. Though this initially seemed like a temporary shift to teleradiology, the pandemic’s persistence in large parts of the world has created a critical mass for the trend to remain permanent.
“Radiomics, radiogenomics, and related areas are emerging as strong sub-segments within the precision imaging discipline. With radiology and radiologists keen to play a larger and more active role in patient care, radiology is expected to transform from just an imaging interpretation area to one that creates the patient’s entire phenotypic feature,” he added.
Impact of AI
During the early days of the pandemic, Teleradiology & Artificial Intelligence (AI) technology solutions were poised to support and act as adjacent front-line on the back of COVID-19 induced imaging volume decline and stay throughput for effective diagnosis measures. According to Kompalli, this trend will continue and take centre stage. “As testing volumes surge across the globe, this solution will help clear the backlog and save radiologists from a burnout-like situation,” he added.
AI in imaging augments workflow optimisations such as faster image analysis and manual image analysis automation that will augment the radiologist shortages in many countries, including the GCC region. This in turn consents strategy measures from hospitals and OEM’s in procuring advanced imaging solutions in the future, which best aids in analytical solutions for improved and quicker diagnosis.
Additionally, embracing AI applications with clinical decision support functionalities is expected to reduce inefficiencies caused by radiology staff shortage and system inadequacies by up to 10-15 per cent per year.
Kompalli concluded: “With undue financial pressure on providers, a healthcare stimulus package will be the key element in procuring equipment that addresses productivity, efficiency, and Total Cost Ownership. Thereby next-gen equipment’s embedding workflow automation, image-sharing, and analytical solutions will boost the workflow by 20-30 per cent, aiding in serving more procedural volumes.”
Key role in diagnosing COVID-19
To a certain extent, at initial stages, ultrasound has helped in early detection of COVID-19, said Kompalli. He explained that point-of-care ultrasound (POCUS) depicted B-lines, pleural line irregularities, and variable consolidations. Lung ultrasound findings, however, significantly decreased ICU discharge, suggesting persistent but slow resolution of some COVID-19 lung lesions. Although POCUS identified deep venous thrombosis in less than 20 per cent of patients at the bedside, nearly one-fourth of all patients were found to have computed tomography–proven pulmonary embolism.
References available on request
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