“Medicine in the future has to be predictive, personalized, and very precise to the individual, and it has to be pre-emptive…Imaging will play a key role in meeting a number of core scientific challenges in the future, the most important of which is understanding complex biological systems. In its most profound sense, imaging is the science of extracting spatially and temporally resolved information at all physical scales... Innovation in imaging is heavily dependent on interdisciplinary interactions, requiring great mastery of physics, computer sciences, image formation, and biology. Research trends include detection of subclinical disease, image "understanding" and quantitation (such as CAD and neuroscience), in vivo cellular and molecular imaging, and image-guided interventions.”
Dr. Elias Zerhouni,
Director, National Institutes of Health, February, 2006
INTRODUCTION
Over the next two decades innovations in Diagnostic Imaging will drive change in the healthcare industry towards ‘Personalized Medicine.’ This change will result in a multi beneficial situation for patients and practitioners alike.
20/20 HealthCare Partners (20/20HCP) has assembled a group of experts with a comprehensive range of backgrounds who have developed a strategy for developing and commercializing technologies that accelerate the implementation of a wide range of Personalized Medicine approaches. We are continually assessing both innovative technologies and the healthcare market to determine innovations that will achieve our vision. Our team’s approach relies on identifying diagnostic technologies that will most successfully effect change Healthcare Industry. By establishing a structure and strategic partnerships for the early identification of opportunities, expediting development through nimble management and short product development cycles we are able to bring products to market quickly as possible.
THE CURRENT IMAGING MARKET
Evolving from the early X-rays by Roentgen over a century ago, to imaging of organs by computerized tomography (CT) and magnetic resonance imaging (MRI) both of which are over two decades old, diagnostic imaging is a part of modern medicine that has, like so many crucial technologies, entered the Digital era. Medical imaging is used for diagnosis in the leading causes of death; namely, heart attacks, strokes, and cancer. What was once called the Radiology Department is now often called the Diagnostic Imaging department because there exists a wealth of new technologies available far more capable than old fashioned x-rays.
A trauma victim's internal injuries are imaged with a CT scanner in the Emergency Department. Breast cancer, a leading cause of death in women, is detected with mammography and ultrasound. According to a Freedonia Group study (Freedonia Group Inc), the medical imaging equipment market in the US will register gains of 7.6 percent per year through 2008 to $9.5 billion, faster than projected growth in national health expenditures.
Growth will be stimulated by an increasing incidence of patient procedures involving diagnostic imaging, partly the result of an aging population and more importantly reflecting significant advances in noninvasive imaging technology.
Current Diagnostic Imaging equipment technologies are quickly reaching the practical/inherent limits of improving image resolution, requiring new multidisciplinary approaches. Today, a physician who wants to see better quality and higher resolution utilizing current equipment requires higher radiation and stronger and longer scan times, an obvious detriment to the individual patient, the patients in the waiting room and inevitably the doctor. Additionally, increasing the inputs (scan time, radiation et al) does not necessarily mean better results or higher throughputs; for example, MRI over 3-4T is not recommended for human use, a 64 slice CT already presents data overload (300-500 slices/study) and a 50 micron DR Mammography scan file is 40 MB leading to a massive file of 300 MB per patient. The Radiologist is now faced with increasingly larger and more complex image datasets to review in order to arrive at a diagnosis.
By 2005 we had already been aware of DI & Contrast Media Industry’s evolution
. In 2004 GEHC bought Amarshem and became the only full line supplier of DI/CM. In 2005 we were witnessing the market preparing for DI/CM Consolidation: Firstly, the German Pharma Schering AG unable to obtain full value as a combined Pharma & CM entity, divested its Nuclear Medicine CM line and then sold itself to another all Pharma company. Our prediction is that in the near future the old Schering AG CM line will be bought by Siemens or Philips. Secondly, Tyco decided to break itself up to three independently traded entities where the largest entity is its healthcare business constituted
in part of Tyco old CM acquisition - Mallinckrodt. Our assumption is that Philips or Siemens will be target buyers for Mallinckrodt. Thirdly, Bracco divested itself of Esaote to become a CM pure play. We believe that a target buyer for Bracco will be Philips or Toshiba. Fourthly, Smaller CM Manufacturers (e.g. EZEM, EPIX
Pharmaceutical, Advanced Magnetics, IMRAX) all suffer from a very unfriendly FDA receptivity in approving new CM products thus, helping the CM manufacturers above to maintain high margins and positive attraction by the big DI manufacturers.
“I think the future is going to be in algorithms and software issues. There are going to be better tools to determine a vulnerable or stable plaque, how to determine better degrees
of stenosis, and how to take stents out of the equation.”
Peter Fail, MD,
Director, Cardiac Catheterization Laboratories and Interventional Research for the Cardiovascular Institute of the South (CIS).
In our view, by 2010 improved vision will be accomplished through Better Imaging Techniques:
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Organ Specific Photon Recovery / Photon Amplification; Dynamic vs. Spatial resolution; Algorithmic ways to improved resolution & reduced exposure
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Smart Computer Aided Diagnostic (CAD) algorithms to allow easier adaptation, better workflow, better productivity and increase utilization of the ever more complex data sets presented to the interpreting Physician.
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Improved and Organ Specific Contrast Media to allow ‘Higher Glow’ at lower exposure, Molecular Imaging for earlier diagnostics and Hyperpolarized MRI.
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New DI Modalities: Optical Imaging for assessing the integrity of blood vessels and red blood cell motion, Wet EM biopsy for immediate, cellular level Dx.
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Introduction of Predictive tools/algorithms for better Dx/Tx; enter Px
By the year 2010 SiemensHC and PhilipsHC will own a full CM line.
The selling Strategy of Multinational DI will follow the Gillette ‘Razorblade’ Model:
Boxes are ‘given’ away for a long term CM Contract. Using this model will intensify competition and will lower AAGR. We believe that GEHC will be ahead of the game and will own cooperative deals with all major Pharma/BioTech with Minor ownership in one. Smaller CM manufacturers will probably consolidate.
By 2020 we foresee that the market will be patient oriented and imaging/diagnostic tools will be directed towards a specific patient characteristics. A unique PX will results in a targeted diagnostic (Dx), and therefore leading to a targeted Therapeutic (Tx).
The vision is to give the doctor better tools to find disease in a shorter time while eliminating the human factor in the process (patient/doctor negative impact). For example:
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Molecular Imaging - functional targeted imaging for Dx specific patient / disease.
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Imaging Techniques, Algorithms, Sequences, MI for immediate verification of Tx effectiveness.
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Patient Specific/Lesion Specific, Targeted Tx - Silver Bullet - Micro bubble - Tx U/S, Tx MI, Smart PDT
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‘Predictive’ WorkStation at doctors disposal to prescribe for the specific Patient Px, best Dx - drug and Tx regimen
In the year 2020 GEHC, SiemensHC, PhilipsHC will all own BioTech, Tx & Personalized medicine to complete the cycle Dx/Tx/Px.
SUMMARY
20/20 HealthCare Partners believes that there are different opportunities between today and the year 2020; these are based on the notion that boxes are no longer the limiting factor.
The opportunities lie in developing new clinical procedures on existing boxes, extracting more information from the diagnostic data by HW and SW, optimizing data flow and work flow for the patient, physician and the overall simplification of the Health Care Delivery System.
Between today and the year 2020 we strive for earlier detection of disease hence, more treatment options and better outcomes, more reliable individualized disease characterization, improved utilization of tests, equipment, and physician’s time all resulting in lower overall costs.
