By Camille Allred

Technology advancements in angiography have been limited over the past two years as the full impact of the COVID-19 pandemic on hospital budgets becomes increasingly apparent. Budgets in March 2020 were diverted to acquire necessary personal protective equipment instead of purchasing new or replacement equipment. Delays in replacing equipment and installing new labs have rebounded over the past 12 months, though still not to pre-pandemic levels. We are beginning to see hospitals plan for new installations, with interest in angiography being focused primarily on upgrades, updates, and the replacement of equipment when it is no longer functional.

Hospitals appear to be considering longer extensions of existing service agreements or are interested in shared-services agreements, where in-house biomedical engineers are the first-line service specialists. While shared-services agreements theoretically benefit cost savings, they create a requirement to maintain a department of qualified engineers to work on specific equipment. Many of these agreements require specialized training of these employees at an additional cost outside the agreement. End-of-service agreements carry their own challenges. Once the unit is deemed past end of service, parts acquisition is not guaranteed.

Office-based labs remain a strong competitor to hospital-based labs. These outpatient facilities have flourished during the pandemic as the Centers for Medicare and Medicaid Services, along with commercial payers, become increasingly invested in limiting costs. These payers prefer outpatient-based facilities because reimbursement rates are significantly lower than hospital-based imaging. Physicians have found additional benefits to practicing outside the hospital setting, experiencing fewer restrictions, more control of their schedules, and greater autonomy in their practices. Most major equipment manufacturers offer economical options to accommodate this growing market.

Over the past 12 months, there was a noticeable increase in quote volume among biplane solutions. This may be attributable to advances in interventional oncology and neurologic procedures. These imaging and interventional areas benefit from the ability to simultaneously image two planes with one dose of contrast. Philips currently holds the most interest for the biplane market segment with its Azurion 7 biplane solution with various detector options. These systems represent a total of 9% of all angiography quotes seen over the past 12 months, and 46% of all biplane quotes. Some 65% of these configurations were specific to neurologic imaging. As additional hospitals pursue certification as stroke centers of excellence from The Joint Commission, we may continue to see increasing interest in biplane systems. Hospitals with smaller equipment budgets may struggle to validate the higher purchase and service costs of this equipment and may not be well equipped to recruit staff and physicians capable of performing these procedures, which are typically highly specialized.

Ceiling-mounted, single-plane solutions remain the most popular angiography solution considered, with Philips holding a total of 57% of all quote activity in the past 12 months, followed by Siemens Artis Q series. Canon and Shimadzu offer solutions in this market segment but have seen limited interest, with only 4% of quotes each. GE does not offer a ceiling-mounted solution.

Floor-mounted systems are typically lower priced than their ceiling-mounted counterparts yet still retain the ability to perform most of the same procedures. These units have seen improved head-to-toe imaging capabilities over previous iterations and can be used effectively in peripheral applications. However, these systems take up more floor space, and can be moved only so far out of the procedural area when you include the mounting base. GE exclusively offers floor-mounted systems and has 48% of quotes in this market segment. Siemens, Philips, and Shimadzu also offer floor-mounted systems.

Hybrid OR suites continue to be a stable market segment. While Siemens and Canon both offer hybrid suites, we primarily see interest in Canon’s 4D CT solution, with 13% of the quotes in this segment. Siemens Artis pheno and Artis zee multipurpose solutions have seen steady interest over the past 12 months, with a total of 81% of the quote volume between the two systems. GE and Philips solutions for these areas are upgraded versions of their systems housed in floor- and ceiling-mounted market segments.

Angiography markets are likely to grow as applications in minimally invasive solutions continue to become available. The needs of departments and existing procedure-specific programs should be clearly defined before researching and selecting equipment for these applications. It is advisable to consider future procedural programs and whether the selected equipment is designed for or can be upgraded to the specific procedures under consideration. Additional software packages are available for each of these units to tailor usage to anatomically specific procedures. It is possible to apply several of these packages in tandem for units to have multiple functions within one space.

About the author: Camille Allred is a clinical advisor in cardiac and interventional imaging at symplr.