Industry focus: For MRI, signs of caution and hope

by Olga Deshchenko, DOTmed News Reporter | September 25, 2010
Siemens MAGNETOM Aera
1.5T MR Scanner.
This report originally appeared in the September 2010 issue of DOTmed Business News

It’s late July and Dr. Emanuel Kanal has to pause to consider how many MRI units there are at the University of Pittsburgh Medical Center (UPMC), where he is the director of magnetic resonance services and professor of radiology and neuroradiology.

“That’s an interesting question because they’re updating them as we speak,” says Kanal. “The general answer is we have GE and Siemens. We have wide bore and standard bore. We have 1.5 Tesla and we’re installing [additional] 3 Tesla. We have a research 7 Tesla.”
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He estimates there are about 19 different units throughout the facility. UPMC has been using 3T MRIs for mostly research, but now the scanners will move further into the clinical side. Kanal says he expects the 3T systems to be used predominately for neuroradiologic and musculoskeletal scans, the two areas that bolster the status of the 3T over 1.5T.

“[On the 3T] musculoskeletal imaging is just superb, neuroradiologic imaging in many areas of the brain, for example, is just tremendous. For other applications, I may not specifically choose to go the 3T route, we may still go for 1.5T,” says Kanal. “Right now, we needed more machines just because the MR demand is so high that I just can’t keep up with it. As long as it’s not my only machine, I think 3T is an excellent way to help relieve the pressure. The throughput will be faster on the 3T than it will be on the 1.5T for much of the musculoskeletal and neuroradiologic imaging,” he says.

Since the introduction of MRI to UPMC, the demand for the scans has never dipped, says Kanal. As the modality that continues to expand its arsenal of applications without emitting a drop of radiation, it’s no wonder that MRI is the system of choice for many health care professionals and their patients.

But why has the market been on a decline for the last couple of years? And more importantly, is its current status hindering the diagnostic potential the modality holds?

MR reimbursement woes
Ask anyone from an end-user to an OEM about the status of the MRI market and you’ll be presented with a similar story of its decline.

It started with the 2007 reimbursement cuts, brought on by the Deficit Reduction Act (DRA). This was soon followed by shrinking budgets, a consequence of the economic recession. Then came health care reform. Although that lengthy document still harbors a lot of uncertainties for the health care industry, it’s understood it will bring additional cuts to MR reimbursement.

“That’s why we believe the sales have been stagnant and customers are extremely cautious about investing in new equipment,” says Deepak Malhotra, VP of marketing of MRI business for Philips Healthcare.

The new law’s focus on reduction of spending in health care is forcing many facilities to think carefully about prioritizing their funding and the direction of capital investments.

“Do they need to buy the latest and greatest MR technology or do they need to focus on improvements to the facility?” asks Joel Urick, MR product manager for Toshiba America Medical Systems. “Those [decisions] are obviously affecting the MR market, such as we see over fiscal year 2009, the reduction in total sales across all vendors.”

Such choices are further complicated by the looming reimbursement cuts. The changes in the utilization rate and Medicare’s inclusion of data from the American Medical Association’s Practicing Physicians’ Information Survey (PPIS) will slash reimbursements rates by about 30 to 40 percent, says Pam Kassing, senior economic advisor in economics and health policy for the American College of Radiology.

“We would like it to stay constant, but it’s looking [like] it will be decreasing by 2013. It’s a result of a change in the equipment utilization rate to 75 percent, which Congress mandated in the health care reform bill,” says Kassing.

A bright spot?
Although orders were down in 2009, OEMs are seeing some indication of recovery in the first quarter of 2010.

“We’re hoping the trend on orders continues to rise. Right now, it’s the first positive sign we’ve seen in the market,” says Urick.

Other vendors also report a slight increase in sales halfway through this year and believe many customers are now in a better position to consider purchasing a new MR unit.

“I think people have definitely waited long to see where they stand, what their calculations are and at the same time, the hospitals have gotten their acts together and are seeing how much capital funding they have and which project they should focus on,” says Milind Dhamankar, director of marketing for MR for Siemens Healthcare. “It has taken them some time to come to those conclusions and I think now they are moving forward.”

Losing independence
Massachusetts General Hospital has 12 scanners on its clinical side, manufactured by GE Healthcare and Siemens Healthcare. Dr. James Thrall, the radiologist-in-chief at the hospital, says the contributing factors to the decline of MRI have had drastic effects on one particular group of end-users.

“The industry got a little ahead of itself and started selling units to doctors who were self-referring patients. The cutbacks in reimbursement have made the practice much less attractive and virtually eliminated a market segment that I do not believe is going to come back,” Thrall says.

The hard hits taken by imaging in the health care reform law coupled with the economic recession carry consequences for other segments of the market as well.

“There will be a shift back towards hospital-based providers and away from independent diagnostic and testing facilities. Of course right now, hospitals are suffering through the effects of a bad economy and the uncertainty of health care reform,” says Thrall. “In my experience, both uncertainty and economic hard times slow down the replacement cycle for high-cost medical equipment, including imaging equipment. When those two things happen together, it’s devastating for the industry.”

GE Optima MR450w 1.5T

Dr. Peter Rothschild knows what it’s like to maintain a standalone, independent imaging facility in today’s rough economic climate. He is the medical director of High Field & Open MRI, an imaging center he owns with his brother in Louisville, Ky. The center has been in business for almost 15 years, but lately, as with other independent imaging centers throughout the country, it hasn’t been easy.

“I’ve never seen this market where price was such a factor,” says Rothschild. “[Standalone, independent imaging centers] are squeezing every penny out of everything. Now with another 30 percent decrease in reimbursement coming in January, I think the pressure on these centers to keep what they have, make it work and not run out and buy new equipment is tough. It puts the OEMs in a difficult position,” he says.

Rothschild’s imaging center has 1.5T open high field and standard open scanners. He says his practice has built strong relationships with its referring doctors over the years and is an established part of the Louisville community. His facility works closely with patients on figuring out an appropriate payment plan and employs highly subspecialized and experienced radiologists to read MRI images. He says hospitals in his area are very aggressive about their advertising and recruiting referring doctors’ practices.

"I think outpatient, independently owned imaging centers are unfortunately fading away. They really have a place in the health care system because they increase accessibility of patients to be able to have an MRI and I think it’s unfortunate that they’re kind of being pushed out of the marketplace,” says Rothschild. “I think it’s leaving patients with fewer choices.”

Even faced with such grim industry conditions, Rothschild believes there are steps that can be taken to pull through.

“The ones that will survive are the ones that have the lowest debt. You need to slowly grow, if you’re going to grow at all, and basically, you have to keep your old magnets much longer than you ever thought,” he says. “You have to watch every penny that you spend, you have to scan faster, you have to have less personnel and you have to do a lot more with less.”

Along with OEMs, imaging experts maintain hope for the stabilization of the market as the current financial dip runs its course.

“Optimistically, as the economy improves and as the uncertainty about health care reform is also resolved, we should see a very robust uptick in sales,” says Mass. General’s Thrall. “Just like the stock market, we know that’s going to happen, but predicting exactly when it’s going to happen from a time standpoint is speculative,” he says.

Better days for ISOs and refurbishers
When financial constraints persist, providers look for ways to cut costs anywhere they can. In the midst of the financial landscape of the last couple of years, this focus brought many ISOs and refurbishing companies to the forefront.

“Reimbursement is a huge issue in the U.S. In addition, the continuing economic climate is not conducive to new investments and a lot of health care institutions, especially imaging centers, are holding back. They are using their equipment longer or buying, in some cases, cheaper solutions or refurbished equipment,” says Philips’ Malhotra.

Rothschild’s imaging center has a contract with Siemens and also recently switched over to an ISO for service. He made the decision to work with an ISO because of the price difference, the widespread availability of parts on the servicing and resale market, the flexibility of the company and the high quality of the service engineers.

“What we get for an MRI scan is probably a quarter of what it was 10 years ago,” says Rothschild. “But [as for] our service contracts, they really haven’t changed. Maybe hospitals have a lot of money, but imaging centers don’t,” he says.

A new report, “U.S. Markets for Diagnostic Imaging Equipment Servicing 2010,” suggests that ISOs have a bright future in the imaging realm. The Millennium Research Group (MRG), a medical technology marketing intelligence company, conducted the report.

“One of the biggest areas of costs for [radiology departments] is the servicing business, how much they spend on the annual contracts they have,” explains Ravindra Sharma, manager of the imaging and health IT division with MRG. “If you compare an ISO contract to an OEM contract, there can be a price difference of as high as 30 percent between the two. That’s why ISOs are a really attractive proposition in terms of the pricing and the cost, as radiology departments are looking to cut costs. That’s why we feel ISO market share will increase in the next four to five years,” he says.

Engineering & Network Systems, an independent, multi-vendor imaging equipment sales and service organization, saw a 25 percent increase in its servicing business this year.

“We feel that business is positive because people and hospitals are slow to buy new products and quicker to repair what they have. That’s actually good for us,” says Yolanda English, the company’s director of business development.

Dan McGuan, president of Viable Med Services, agrees with English. His company is a solutions and service provider for open MRI systems. He also believes that business will grow in the near future as facilities continue to be fiscally conservative.

Although the servicing business has been steady, it doesn’t mean it hasn’t changed. Michael Palinski, VP of services for DMS Technologies, which services equipment as a part of its offerings, says his company is “operating in the world of the educated consumer.” Instead of opting in for a full service contract, many customers are now willing to take risks and rely on part time servicing or maintenance agreements, he says.

Customers are also taking advantage of cost-effective options that enable them to accommodate their patient volume without necessarily purchasing the latest equipment. DMS Health Technologies, which also provides mobile, interim and fixed-site diagnostic imaging services, can attest this trend.

“We’ve seen a pretty big increase in the amount of opportunities for MR mobile services, so that’s definitely been growing. We have multiple vendors. We have Siemens, GE and Philips in the fleet,” says Steve Richter, the company’s executive VP of sales. “The demand for that has definitely been very solid for the mobile services.”

Business for refurbishers is also growing beyond America’s borders. Block Imaging International, Inc., a pre-owned and refurbished medical equipment sales company, has seen a lot of interest in MRI units abroad. Steve Rentz, the company’s product manager for MRI and nuclear medicine, says it has brought the modality to parts of Eastern Europe, Greece, Italy and South America.

“There’s been some increased demand in Africa, although…it’s a bit tough logistically to get things down there,” Rentz says. “We have an office in Tokyo, so we source a lot of equipment out of Japan and we’re seeing more outlets in the Pacific Rim as well.”

Rentz says open MRIs generate the most interest because they’re easier to install and easier to operate once they are ready for use.

“If you’re operating in a country where power is not that good, you’ll be better off with an open,” he says.

MRG’s Sharma says ISOs can offer a lot of flexibility to their customers, which will enable them to gain more market share in the next few years. He predicts that business will improve due to America’s aging population and the entry of thousands of uninsured Americans into the health care system as a result of health care reform.

“We expect that the market is going to start stabilizing from here on,” says Sharma. “If you look at the longer four to five year picture, we expect that there will be some growth in the market. It won’t be like it was in the 2005 to 2006, but [there will be] at least some low-digit growth,” he says.

3T or not 3T?
While facilities recuperate from the rough economic conditions, OEMs continue to advance MR technology and tout its many applications and improvements. One of the major trends in the industry is the advancement of 3 Tesla field strength scanners.

Although 3T scanners have been around for a decade, their adoption has been slow because of some functional issues and cost barriers, says Roberto Aranibar, a research analyst with Frost & Sullivan, who authored a 2010 report on the U.S. MR and CT markets.

“Just recently, some companies have begun introducing new technologies that address those previous technical pitfalls in 3 Tesla scanning,” says Aranibar. “That has overcome the technical part but prices of 3 Tesla scanners are still considerably higher than those of 1.5 Tesla scanners. I think somewhere in the order of 30 to 40 percent higher,” he says.

Philips Acheiva 3.0T TX

With the technological improvements to the 3T scanner, OEMs say the modality is broadening its horizons.

“3T in the past has been the domain of early adopters, luminary sites, customers who considered themselves advanced and at the cutting edge of technology,” says Philips’ Malhotra. “It has proven to be a better field strength for neuro imaging and musculoskeletal imaging. It’s pretty much the established gold standard for those two types of procedures.”

Although 1.5T still hold the biggest segment of the market, OEMs say the 3T scanners are making headway.

“Especially in the U.S., we saw the 3T segment jump to almost 30 percent of the value of the market in 2009. Only a few years ago, it was not even 20 percent. I think that’s an encouraging sign for that particular technology,” says Malhotra.

More and more customers are buying 3T systems, especially facilities that have more than one MR unit.

“If people have to invest dollars into an MR, they now tend to invest it into high-end 3T, so there is a future and the asset stays longer,” says Siemens’ Dhamankar.

There are advantages and a rationale behind the 3T investment. For example, Mass. General’s selectively uses its 3T scanners for some of the more demanding imaging procedures.

“The 3T systems are substantially more expensive and they are more expensive to install,” says Thrall. “We have tended to target their use for what I would call, high-end applications, certain neuro imaging applications, some high resolution musculoskeletal imaging and more recently, some high-resolution cardiac imaging.”

Kanal believes UPMC’s newly added 3T systems will be very useful for the facility’s patients.

“For certain applications, they will be diagnostically and cost effective,” he says. “The truth is, they’re going to be faster for certain areas of the body, especially areas where I don’t have to deposit a lot of power, like the brain, where I’d be able to get a lot of imaging without having to worry about how much power I’m depositing into the patient. In other areas, that are not motion sensitive for example, I think that it will be a tremendous benefit,” Kanal says.

Despite the slight increase in 3T adoption, 1.5T is still considered the workhorse of the MR industry.

“The 1.5T MR market is still significantly larger than the 3T market,” says Tom Verghese, chief marketing officer of the MR business for GE Healthcare. “At GE Healthcare, we are not great believers that the 1.5T market will disappear any time soon.”

On a global basis, the lower-field strength scanner still holds the largest segment of the MR market share.

“In the developing markets, some countries are moving from open MR systems to 1.5T systems,” says Verghese. “It is unlikely these users will go directly from an open system to a 3T system because the knowledge and the expertise required to operate a 3T system demands a big leap for clinicians and technologists to make. Many health care institutions in these countries don’t have the trained manpower to switch from an open MR system to a 3T system,” he says.

For independent imaging centers like Rothschild’s, the 1.5T is an obvious choice at this point. Very few imaging centers receive neurosurgical referrals and the reimbursement for a 3T scan is no different than the one for a 1.5T, says Rothschild.

“I think trying to make sense financially for 3T imaging centers is a challenge and you also run into the challenge of how many ISOs can repair a 3T magnet. You’re kind of getting trapped on relying on the OEM,” he says.

Block Imaging International’s Rentz says that many end-users in the U.S. are requesting 3T systems, but the company isn’t seeing many of them yet.

DMS Health Technologies’ Palinski says the majority of the company’s servicing is done on 1.5T systems. But when it comes time to servicing 3T systems, expertise is what matters most.

“There are some nuances but as with all service, it boils down to having highly qualified and trained field service engineers, who are familiar with the products they service,” he says.

OEMs provide 3T options
Last year, Siemens Healthcare introduced its Magnetom Skyra 3T scanner, a 70-centimeter bore unit equipped with the company’s Tim (total imaging matrix) and Dot (day optimizing throughput) technology. The combination of the Tim and Dot technologies aim to improve productivity across the entire MRI workflow. Tim offers a redesigned radio-frequency system and new coil technology that has up to 204 coil elements using up to 128 channels. Dot enables providers to personalize scans to specific patient criteria and proposes optimized exam options. The system is pending FDA approval. The OEM’s Magnetom Verio 3T is currently available on U.S. the market.

Toshiba America Medical Systems also announced its 3T scanner last year – the Vantage Titan 3T open bore unit. This system is also awaiting FDA approval in the U.S., but has already been installed in Japan. The unit incorporates Toshiba’s Pianissimo vacuum-sealed gradient technology that significantly reduces exam noise.

GE Healthcare has a SignaHDxt 3.0T system on the market. The scanner uses the same interface as the manufacturer’s sigma 1.5T HDxt scanners, enabling customers to make an easy transition from one field strength to another.

Philips Healthcare released its Achieva 3.0T TX MRI system last year. Philips is the only OEM that offers a system that can be upgraded from a 1.5T to a 3T scanner.

“We developed it for customers who cannot afford a 3T today or only need a 1.5T today, but want to have the option to upgrade to 3T in the future in an economical way,” says Malhotra. “We have been successful with the solution in mature markets where customers are concerned about increasing competitive pressures from 3T or concerned that the market may start migrating to 3T faster,” he says.

The Achieva 3T scanner is enabled with MultiTransmit technology and aims to improve image quality for body applications. MultiTransmit technology addresses some of the challenges of 3T imaging, such as dielectric shading. The scanner is also designed with speed in mind.

“We are seeing up to 40 percent improvement in speed for some of the applications on 3T using Philips exclusive MultiTransmit technology,” says Malhotra.

Hold the contrast
Another trend in the MR industry is the continuous expansion of non-contrast imaging applications.

“We do a fair amount of imaging in all body parts without contrast,” says Mass. General’s Thrall. “In fact, the trend has been a little away from contrast because of concerns about nephrogenic systemic fibrosis, this horrible condition that has been related to giving gadolinium contrast agents to patients who have impaired renal function,” he says.

Nephrogenic systemic fibrosis is a rare disease but the FDA took note of its connection to MR agents in 2007. The agency asked manufacturers to place boxed warnings on product labeling of all gadolinium-based contrast agents used in MRI.

Toshiba’s Urick says many customers are wary of the side effects associated with the use of contrast and are switching their renal protocols.

“It really gives the customers that have our technology an added benefit to allow diagnosis to those patients who otherwise had no modality that they could utilize to evaluate their conditions,” says Urick.

Facilities can also save money not only on contrasts but on the supplies, such as needles and syringes, that are needed to inject the contrast, says Urick.

At High Field & Open MRI, Rothschild says many scans are done without contrast.

“My view on contrast is, it’s very helpful in certain situations but I think it’s overused,” he says. “I think nine out of 10 times a doctor requests contrast, he doesn’t need it.”

Rothschild says the center works closely with its referring doctors to determine if a patient is really in need of a contrast injection for a scan.

Hitachi Medical Systems America is also working on enhancing its non-contrast imaging capabilities, says Shawn Etheridge, the company’s director of MR marketing.

MR spanning the spectrum
Another trend in the MR industry is the expansion of its applications and uses.

“MR is becoming much more than just a specialized diagnostic tool, it’s becoming much, much more valuable in a whole range of uses across the care spectrum,” says Verghese.

Last year, GE Healthcare purchased ONI Medical Systems, Inc., the world’s only provider of high field dedicated extremity MRI scanners. GE Healthcare now has ONI MSK Extreme 1.5T unit, a high field open MR extremity scanner, on the market.

“It’s a very specialized piece of equipment, that is easier to site, more comfortable for the patient and produces quality images similar to whole-body 1.5T systems,” says Verghese. “We’re seeing MR being used for a broader range of applications.”

Last summer, GE Healthcare also received FDA approval of its MR-Touch device, bringing elastography to MR. The diagnostic tool works by identifying variations in tissue stiffness using low-frequency sound waves in unison with MR to measure tissue elasticity.

Meanwhile, Philips Healthcare is marrying ultrasound to MR with its Sonalleve MR-HIFU (high intensity focus ultrasound) solution, a non-invasive method for uterine fibroid ablation without surgery. It combines the power of HIFU with MR. The product is available overseas and Philips plans to introduce it to the U.S. market within the next 18 months.

Improving the user and patient experience
A challenge faced by OEMs and end-users alike is the complexity of the MR system. On the staff side, the technologist or radiologist performing the scan must possess a high level of expertise to operate the unit. In the Apple iPad era, “where everything is touch screen and everything is simple, MR is still not that intuitive,” says GE’s Verghese.

UPMC’s Kanal agrees that there is a demand for MR systems that are easier to operate, but also points out the expectations come at a time when the modality is much more powerful and capable than ever before.

“There are preset protocols, where you just press a button and it will run them. But clearly, the real capability and power of this machine is to customize it to the patient at hand, and that requires knowledge,” says Kanal. “That requires not only understanding the modality, but it also requires being able to operate the machine to provide the diagnostic information from that patient that you’re looking for, so both have to be satisfied,” he says.

For the other user of the MR unit – the patient – several improvements have been made to maximize comfort. The MRI scan is not the friendliest imaging study: patients spend a significant amount of time in a noisy tube, which can be a severely uncomfortable experience for people who are claustrophobic or dislike the noise. One way OEMs are improving the patient experience is by giving them more space.

“Most manufacturers have gone from making their bore sizes from 60 centimeters to 70 centimeters and that’s supposed to be accommodating larger patients better, as well as creating a more open field, addressing the issue of claustrophobia discomfort for patients,” says Frost & Sullivan’s Aranibar.

Toshiba America Medical Systems surpasses that standard with a scanner that has a 71-centimeter aperture, called the Vantage Titan. The 1.5T scanner has been an extremely successful unit, says Urick.

One OEM with a clear focus to improve patient comfort and enable access to MR scans is Hitachi Medical Systems America. The company’s Oasis 1.2T scanner is a boreless imager with a vertical field magnet. At a width of 82 centimeters and with a weight capacity of 660 pounds, Oasis can better accommodate claustrophobic or bariatric individuals. The scanner comes with Radar technology, which helps reduce motion artifacts.

Hitachi’s Etheridge says that the Oasis is generating a lot of interest because providers are “looking to do as many scans as they possibly can, so they want to buy scanners that really adapt to the broadest possible patient demographic.”

The OEM also has the Airis Elite, an open MR scanner with a vertical field permanent magnet and a table width of 80 centimeters.

Philips Healthcare offers the Panorama Open MRI system, a 1.5T scanner that provides a 360-degree panoramic viewing angle and a 160 centimeter-wide patient aperture.

At his imaging facility, Rothschild says his open MRI units help serve a broader population.

At UPMC, Kanal is a big fan of the wide bore scanners. He cites the fact that the greater amount of space helps set patients at ease, making them more willing to stay still and relax.

Finance and longevity
Now more than ever, customers who are drawn to MRI technology are looking for cost-effective solutions. Siemens’ Dhamankar says that many manufacturers are putting a bigger focus on “affordability and sustainability” when it comes to MRI.

A 1.5T scanner is still considered to be the workhorse modality and the key industry players have a wide variety of systems on the market.

In 2009, along with its 3T system, Siemens also introduced the Magnetom Aera 1.5T scanner (it is still pending approval in the U.S.). Philips Healthcare has its 1.5T Achieva system on the market. Hitachi Medical Systems offers the Echelon 1.5T scanner.

With its ultra short bore, Toshiba’s Vantage 1.5 MR unit was rated number one in the “2010 Top 20 Best in KLAS Awards: Medical Equipment” report.

In the middle of last year, GE Healthcare introduced its 1.5T Optima MR450w scanner.

“So far, we’ve taken a significant number of orders and won market share in the U.S. because of the quality of the images and the quality experience,” says Verghese. “At 1.5T, from a wide bore’s perspective, there was never a scanner that really produced quality images. It was traditional, that if you have a wide bore scanner, you compromised image quality.”

Frost & Sullivan’s Aranibar believes that cost effectiveness is the key to the health of the MRI market in the near future.

“[MRI] is pretty much a luxury modality. It’s not really a core modality that’s in every single imaging facility,” he says. “Unless some cost effective technologies are introduced that can really put this within the reach of more facilities, then I think we’re going to continue to see some consolidation in the market over the next five to 10 years,” he says.

However, despite the financial difficulties, MRI is here to stay. From his position at the Mass. General Hospital, Thrall doesn’t see MRI nearing the end of its advancement.

“It’s certainly mature, but the thing that’s so interesting in the history of different imaging methods is that every time we think that something is mature, someone else comes up with a terrific idea and we’re off to the races again,” says Thrall.

He cites CT as an example. In the 1990s, many people thought the modality was done evolving but then came advances in multi-slice CT, rapid imaging and improved detectors, “so that we almost have something that’s unrecognizable from what it looked like 20 years ago,” says Thrall. “I’m willing to predict the same thing will happen with MRI, whether it’s multi-channel technology or new strategies for applying gradients. I can’t predict what exactly it will be, but it’s almost certain to [happen],” he says.

Philips’ Malhotra expects to see MR take on a bigger “part of the clinical pie” in oncology and cardiology in the near future because of the modality’s ability to image soft tissue and its lack of ionizing radiation.

End-users are also looking forward to further advancement in MR. UPMC’s Kanal is excited for pacemakers that will be safe to use with an MR scan. Last year, Medtronic’s Advida DR MRI SureScan pacing system received approval in Europe. Kanal is hopeful the devices will soon receive FDA approval as well.

“That’s going to open up MR access to hundreds of thousands of patients in the U.S. alone who before this were precluded from being exposed to an MR examination,” says Kanal.

Thrall is looking forward to improvements in MR technology that will not only widen the access to MRI but also shorten the length of time it takes to do a scan.

“For the cost of the MR device, it takes a long time to do the procedures. In other words, the length of time you tie-up in the MR device is much longer than the length of time you tie-up in a CT scanner,” says Thrall. “So if we can get into the multi-channel imaging era, even more so that we are today, it will make the cost efficiency of MR imaging better. It will allow us to do more pediatric patients without using anesthesia and it will help tremendously in managing patients with claustrophobia. I really look to faster imaging as a major opportunity and major development challenge for industry,” he says.

Health care reform will continue to re-form MR
Along with further technological advances to drive MR forward, the effects of health care reform will continue to move through the industry. The cost of imaging frequently comes up in discussions about cutting costs in health care.
“It seems like right now imaging has a bull’s eye on its back,” says DMS Health Technologies’ Richter.

Industry experts predict that outpatient imaging centers will continue to experience financial pressure and productivity will become even more important with decreases in reimbursement.

“You’re going to see people having to justify imaging to a greater degree than they’ve ever done before. They’re going to have to answer - why they performed the scan. The easy referral is going to go away,” says GE’s Verghese.

Manufacturers will also have to deal with the pending medical device tax, although the details of its implementation are yet unclear.

“Whenever you have a new tax, you always end up in a sharing situation, where a part of it is passed on the customer. I think it will end up being everybody sharing a portion of the burden: from customers, to manufacturers, to suppliers,” says Philips’ Malhotra.

Burgeoning potential and a look at the future
MR is becoming a bigger player in interventional and intraoperative applications and more OEMs are working on applications for imaging of neurodegenerative diseases, such as Alzheimer’s and dementia.

“I truly believe that we just truly started scratching the surface of what MR is capable of,” says Hitachi’s Etheridge. “Therefore, even though right now we’re kind of in a transition period, I think that because of what MR can bring to the table, the opportunity going forward for MR is actually better than some of the other modalities,” he says.

As budgets stabilize and the clouds around health care reform clear, imaging professionals are looking forward to unlocking the potential capabilities of MRI.

“Quite frankly, the future of MR is not even written,” says UPMC’s Kanal.

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DOTmed certified
Randy Cox, MRI Technical Services, Inc., GA
Ted Turano, X-Stream Medical, Inc., IA
DOTmed certified
Lucas Mason, Imprex International, Inc., IL
James Gallagher, LG Medical Imaging, IL
Carl Berland, Genesis Medical Imaging, IL
Mike Ghazal, Zetta Medical Technologies, LLC, IL
William King, KING Equipment Services, Inc., IL
DOTmed certified
Wes Solmos, Creative Foam Medical Systems, IN
Ronald Moore, R & D Imaging, Inc., IL
Davyn McGuire, Med Exchange International, Inc., MA
DOTmed certified
Anthony Pinardi, ABR, Inc., MD
Jeff Rogers, Medical Imaging Resources, Inc., MI
Kim Bernard, Dimplex Thermal Solutions, MI
Steve Rentz, Block Imaging International, MI
Rick Bonds, Advanced Medical Imaging Services, MI
Clark Wilkins, JDI Solutions, Inc., NC
DOTmed certified
Michael Palinski, DMS Health Technologies, ND
Brian Bruhschwein, Imaging Solutions, Inc., ND
Alison Fortin, Global Inventory Management LLC, NH
DOTmed certified
Robert Manetta, Nationwide Imaging Services, Inc., NJ
DOTmed certified
Thomas Freund, Oxford Instruments, NJ
DOTmed certified
Marc Fessler, Independence Cryogenic Engineering, NJ
Ryan W. Gilday, Clinical Imaging Systems, Inc., NJ
Leon Gugel, Metropolis International, NY
DOTmed certified
John Kollegger, Bay Shore Medical Equipment, LLC, NY
Mona Abboud, Monarch Medical, NY
DOTmed certified
Tim Wright, Virtual Medical Sales, Inc., NY
Jeff Weiss, Atlantis Worldwide, LLC, NY
Deepak Malhotra, Philips Healthcare, OH
William Mansfield, Professional Installations, OH
James Prout, MagnaServ, OH
Tom Hineman, Ohio Valley Medical Systems, LLC, OH
Ray Wtulich, Hitachi Medical Systems America, Inc., OH
Robert Hoffman, Genesis Magnet Services, LLC, PA
Vincent Tecce, National MRI Parts & Service, PA
Medrad, PA
Lauro Leal, Jr., Reamed Ltda, PR
Trey McIntyre, International Medical Equipment and Service, Inc., SC
DOTmed certified
Debbie van der Touw, Radiology OneSource, TN
DOTmed certified
Teresa Quirante, Techno-Aide, Inc., TN
DOTmed certified
Patricia Richardson, Richardson Medical LLC, TN
Lee Kelly, AAN Radiology Systems, Inc., TX
DOTmed certified
Jaime Redmon, Crest Imaging Solutions, Inc., TX
Dustin Hess, National MRI Shielding, TX
Marshall Shannon, Image Technology Consulting, LLC, TX
DOTmed certified
Robert Graham, Polaris Medical Imaging, TX
DOTmed certified
Larry Knight, Altima Diagnostic Imaging Solutions, LLC, TX
DOTmed certified
Tommy Geske, Sunrise Medical Technology, Inc., TX
DOTmed certified
Robert Woodward, TransAmerican Medical Imaging, UT
Paul Zahn, Shared Medical Services, Inc., WI
DOTmed certified
Thomas Verghese, GE Healthcare, WI

Himanschu Gupta, EverX Pty Ltd, Australia
DOTmed certified
Cicero Oliveira, Kuf Electronics, Brazil
David Lapenat, ANDA Medical, Inc., Canada
DOTmed certified
Friedmut Ballek, Medizintechnik, Chile
Roberto Otarola, Otarola Ingenieria, Chile
Bastian Berkel, Tomovation GmbH, Germany
DOTmed certified
Guenter Braun, MediSys Medizintechnik GmbH & Co. KG, Germany
DOTmed certified
Elias Karakatsanis, Mediservice, Greece
George Georgalas, Meditron S.A., Greece
Tajinder Singh Bhatia, MRI Services, India
G. Karthikeyaraja Raja, Doppler Medical Systems, India
Shekhar Chand Jain, Komega Implex, India
Ravikumar Vishwanath, Medirays Corporation, India
Brijesh Suneja, Rad Image Technologies Pvt Ltd, India
Vikas Kaul, SBM Healthcare India Pvt Ltd, India
Mohamad Reza Rasouli Jazi, Parto Afshan Arman, Iran
Bagher Mahdavi, Tech Mediran, Iran
Efzan Robert Malique, VC Resources, Malaysia
Thomas Gibson, TP Global Medical Equipment, Mexico
Predrag Bjletic, Alpha Imaging, Serbia
Chan Ju Park, K-TEC R&A Corporation, South Korea
Abdulatif Shlash, Shlash Medico, Syria
Imad Muati, IMC, Syria
Cem Kagan, Medview, Turkey