How huge is the MRI market globally (in absolute terms)? By how much is it growing? What are the growth drivers?
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Dr Richard Hausmann
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We estimate that the market globally is about $5 billion in equipment. Overall it is a growing market. Globally we see CAGR of 4-5 per cent per year. Growth is very inhomogenous,whereas the developed markets like Europe, US and Japan are pretty much flat and slowly growing, the big growth regions are China, India and Brazil. Emerging countries are growing at 10-15 per cent. While new applications drive growth in developed countries, in emerging countries it is coverage. In countries such as Germany, Europe, Japan and US, most of the new scanner sales are replacements of existing equipment, whereas in emerging countries, it is additional scanners.
The imaging market is still dominated by ultrasound, X ray etc which make up more than 50 per cent of the share of the market while MRI occupies close to 12 per cent of the market. Why?
The use of MRI is growing globally due to its sensitivity and therefore unique properties as a diagnostic tool. However, it does lag behind other imaging technologies, especially in countries like India. The MR market typically grows about 1.5-2 times the GDP growth in India. Secondarily, as the adoption of the ultrasound and CT equipment increases, we will continue to see increased adoption of 1.5T systems in tier II and III towns. There is a lack of knowledge of MRI in certain markets that inhibits its usage and it also has a higher total cost of ownership. We are constantly innovating and looking for new techniques to lower total cost of ownership to increase access to MRI as well as train new users of MRI.
What is the MRI penetration in India vis-a-vis markets such as US and Europe. Also throw some light on the systems in use.
In the US market, there are about 25 MRs for every one million persons and in Europe, the figure stands at 15 MRs. In India, we have over 1500 MR systems in the market and averaging at about 1.2 MRs per million people. There is a tremendous opportunity for MR growth in India. We continue to invest and innovate in lowering the total cost of ownership of MRIs. We see the market adoption of 3T MRIs increasing. On the other hand, the worldwide market for 7T systems has decreased over the last few years because of the costs associated with 7T installs. Both preowned and refurbished Gold Seal MRIs as well as entry level 1.5T systems will continue to grow in rural and community practices every year for the next decade.
How much is cost and pricing a challenge?
We are differentiating and have different models for different market segments. We clearly see a value market segment which is looking for more robust entry level scanners which can fulfill most of the tasks needed at a much lower price point. We are serving that market as much as the need for high end scanners which are more expensive. In between, there is a huge market for performance scanners, used as day to day scanners by hospitals and clinical practitioners. We have a range of MRIs from $ 6000 to $ 6 billion.
How is the shortage of liquid helium supposed to affect the business? How do you plan to overcome this challenge?
There is currently a shortage of helium but we have recently seen some relief. Helium supply is a strategic priority that we plan for in our business. We anticipated the recent shortage earlier this year and are constantly working to make sure it doesn’t affect our ability to deliver MRI systems to our customers. For example, we’re building a new 5,000-sq ft helium liquefaction facility (50 new jobs; $17 million investment) in Florence, South Carolina. We left no stone unturned as it’s an absolute priority for us to continue to ship our systems around the world so that doctors can treat their patients.
Tell us about the sales of Brivo MR355 Inspire launched this year for emerging markets?
We introduced Brivo MR355 and Optima MR360 1.5T systems in the year 2009 and it had been a great success in India and other emerging economies. We have already sold 1000 systems in this product line. Both of these systems are green MRIs with broadband technology. In India, 70-75 per cent of the market is 1.5T MR technologies and 25-30 per cent of the market is 3.0T MR technology. We see increased adoption of 1.5T systems in tier II and III towns and 3.0T systems in tier I towns.
How are you dealing with reimbursement cuts in the US due to changing healthcare reforms?
We are constantly looking for ways to improve productivity for customers so they can optimise their throughput at the same quality. For example, our new software platform, DV24.0, improves productivity by up to 30 per cent compared to previous versions. All of our customers with our DV platform, including those in the US, will receive this software upgrade, which will help them improve productivity and therefore lessen the blow of reimbursement cuts.
How do you see the market for paediatric imaging in India?
The neonatal MRI concept is in the research and development phase, there is nothing in product yet. However, we see an MRI that is compatible with the neonate environment especially useful in hospitals having more than 25 beds in neonatal ICUs. Again, this technology is just a concept at this point but it’s an opportunity we see where MRI could help diagnosis of these fragile patients.
Tell us about MAVRIC and how do you see foresee a market for the product in India? How many installations by now?
MAVRIC SL is for MR imaging of patients with MR conditional metal implants. In India alone, there are more than 100,000 new knee and hip and joint replacements being done routinely; this will continue to increase as major orthopaedic centres start utilising more and more joint replacement surgeries. We strongly believe that these patients need to be continuously monitored post joint replacements using a non-invasive and non-ionising imaging such as MAVRIC SL. The feature is very useful in imaging soft tissue and bone loss around metallic implants. We have already launched this in India in October 2013 and we expect to have five installs by end of the year in major academic institutions.
Tell us also about Ideal IQ and why did you find it relevant in the Indian context. Have you organised any awareness drives on the same? How many installations in India till now?
In India, one in five adults are considered obese and one in three children are considered obese as well. There are several states like Punjab, Kerala, Delhi, Gujarat where obesity is a major reason for various diseases. With IDEAL IQ, you can get non-invasive FAT and IRON quantification in the liver in less than a 16-second exam. We have organised awareness campaigns through specific CME events across India and have more than 10 installations in India.