It's hard to believe diagnostic imaging equipment sales can stay depressed for long with the crowds that thronged the world's largest medical meeting in Chicago last week.
Attendance at the Radiological Society of North America's annual meeting reached 58,118 early last week and was expected to pass 60,000 before it was over last Friday.
But though the masses came to eye the latest computed tomography and magnetic resonance scanners and angiography systems on display, buying seems to be another matter.
"You can just feel the cost containment," said Daniel Hricko, vice president at Jannx Medical Systems, a consulting firm that advises hospitals on equipment purchases. Only a few years ago executives from most of his client hospitals would have attended the show, Hricko said. Now, only a few bother. And they typically stay a day instead of a week, as they used to.
Even when those hospitals and health systems come, Hricko said, they are "very selective buyers," forced by shrinking capital budgets to look more carefully before they sign on the dotted line.
Hospital consolidations, cost pressures from managed-care payers and an oversupply of some big-ticket imaging systems in many regions are continuing to crimp buying.
There's plenty of aging equipment that needs replacing, vendors said, perhaps even pent-up demand for some systems such as old-fashioned X-ray machines, as many purchasers have remained on the sidelines. However, equipment replacement has all but eclipsed service expansion as the driving force behind buying.
Despite some recent improvement, "it's still a flat or a slowly rising marketplace," said John Ariatti, vice president for sales at Toshiba America Medical Systems.
As a result, refinements to existing equipment-especially those that promise to reduce operating costs-are the order of the day. Toshiba, for instance, announced a triggering option for its high-end CT scanners that would cut use of contrast media by 25%.
But potential customers remain tough to convince.
"Although I see a lot of improvements in technology, it's the same ideas as last year," said Alan Love, a veteran hospital administrator who last month became telemedicine director at the Texas Center for Applied Technology at Texas A&M University, College Station. But the lack of must-have breakthroughs did not disappoint him. Coming to the RSNA meeting this year wasn't about buying now, Love explained, but instead evaluating what may be available for purchase down the road.
Despite the dearth of true technology breakthroughs, manufacturers hold out hope that new uses for old gadgets will spur sales. Picker International, for instance, showed a nuclear medicine camera that can image malignant tumors as they consume radioactively labeled sugar, a method previously possible only by using positron emission tomography scanners costing millions of dollars more.
By substituting the new technique for multiple CT scans done today, Kenneth Bartholomew, M.D., who bought one of the Picker systems, expects to save at least $500 for each of more than 100 patients scanned per month at the Medical Center of Bowling Green (Ky.), where he practices.
Combining imaging more directly with treatment also promises to shave costs and strengthen the case for new equipment purchases. For example, almost every major equipment vendor showed how CT and MR scanners could be outfitted to guide therapeutic intervention with heated probes, catheters or surgical instruments. "Diagnosis and therapy will be compressed in time until they happen simultaneously," predicted Thomas J. Miller, group vice president at Siemens Medical Systems.
In perhaps the boldest example of the trend, Ferenc A. Jolesz, a physician at Brigham and Women's Hospital, Boston, illustrated the advantages of neurosurgery directed by real-time MR imaging during a brain tumor operation performed in Boston and viewed simultaneously via satellite at an RSNA scientific session. The novel, split-magnet design of an MR system from General Electric Medical Systems gives surgeons access to patients while acquiring images that simultaneously show the operations' progress.
That combination of real-time, tissue-sensitive imaging with surgery lets doctors "go into very risky areas" because they can see exactly where their instruments are, Jolesz said. And surgeons can also be sure they have completely removed tumors before ending the operations, he said.
But clinical sex-appeal is not what it used to be. Payers are demanding proof that benefits outweigh equipment costs. So physicians are thinking harder before they ask for the latest equipment-even in such promising fields as image-guided surgery.
"I think there will be more opportunities with interventional MR," said William Thompson, M.D., radiology chairman at the University of Minnesota who also coordinated the scientific program at RSNA this year. Impressed by the potential of Jolesz' demonstration of MR-guided surgery, Thompson was less sanguine about justifying its expense. "That magnet cost $3 million. It's too damn expensive," he said.