Dr. Suresh Kuppuswamy, Industry Principal at Frost & Sullivan 

Like the other major events of healthcare in 2020, the Annual Meeting of Radiological Society of North America (RSNA) also had to be held as an online-only event forced by the COVID-19 pandemic. The virtual platform of RSNA was very well designed, and it provided ample opportunities for customers to connect to the right representatives from each company.

The virtual meeting room was a unique tool on the RSNA platform where customers can visit the room just like they would walk into a physical booth without any prior appointments. The company representatives engage with the visitors and transfer the meeting to a private room seamlessly. This feature was quite helpful for those visitors who had not secured prior appointments with the vendors to have discussions and product demonstrations.

The vendors, though, had mixed responses when asked if the virtual meeting were as effective as in-person meetings. While most agreed that there cannot be a substitute for physical meetings, some exhibitors claimed that their live virtual programs had good traffic from the customers and partners. COVID-19 has disrupted the traditional way of conducting trade shows, and it might be precipitating a larger digital transformation of the marketing departments within the vendor companies.

Five large themes can be defined from the RSNA virtual floor this year. 

 were the predominant themes and formed the framework for the other two themes of 

 was another emerging theme and it has a potential for huge growth.

Artificial Intelligence in the Post-Pandemic Era

It is quite clear that artificial intelligence (AI) was the No. 1 theme for RSNA this year. Even with just one-third the usual number of exhibitors in the virtual event, almost all players seemed to be pointing out their artificial intelligence capabilities.

Quite understandably the event was dominated by the larger players, and the usual AI showcase had a far fewer number of companies and startups. The key AI theme this year, then, as Platform plays for AI could be biased from that perspective. Platform-based approaches are not really new to radiology AI. Hints were being dropped at RSNA 2019, but this year the AI platform initiatives were the heart of the AI messaging.

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But, what was also curious was the diverse set of strategies evolving, even within the platform play approaches. For example, GE Healthcare had a direct focus on imaging AI with its Edison platform (with Open AI Orchestrator becoming part of the broader offering of health services), whereas Philips Healthcare focused more on precision diagnosis with AI solutions forming a part of that broader strategy (IntelliSpace AI Workflow Suite, IntelliSpace Precision Medicine). Siemens Healthineers has an even broader approach, where their Digital Marketplace goes beyond imaging to support the broader healthcare community (and a somewhat diluted focus on the radiology AI marketplace type approach). We also saw more players developing and/or refining their approach including Sectra [Amplifier], Fujifilm [REiLI], Canon, among others.

But, to not be biased with the virtual nature of this event, we also looked at what happened through 2020, for imaging AI. Several startups leveraged their capabilities to offer solutions for COVID-19 screening and diagnosis, some even securing emergency authorizations (e.g. CuraCloud). Most offered their solutions for free to hospitals, as well, doing their bit to support our COVID-19 warriors. Interesting enough, some of the mature, established start-ups did quite well during this phase of uncertainty – Aidoc, for example, announced that it had tripled its revenues in the first three quarters of 2020, and private conversations with some other AI vendors gave us the same impression. Indeed, similar to broader digital health trends in healthcare, the adoption of AI in imaging has improved for several use cases in 2020, thanks to the negative effects of this pandemic.

An emerging trend was the interest in imaging AI companies from non-imaging vendors. Qure.ai announced a partnership with AstraZeneca (AZ) during RSNA week. AstraZeneca's interest lies in the early identification of lung cancer cases by undertaking lung imaging in emerging markets, such as Latin America, Africa, the Middle East, and Asia. In addition, Qure.ai's solutions are built to address the specific needs of the imaging departments in those regions. This is likely to improve the uptake of AI in emerging markets since players, such as AZ, are driving a use case that resonates well with the local market conditions. To really enable the uptake in emerging markets, Qure.AI has also addressed other concerns. Their qTrack smartphone app, allows film-based X-rays to be converted to digital images using only the user’s smartphone camera and allows for cloud-based algorithms to assess signs of tuberculosis, as well as serves to record patient data. Innovations such as these, and the qBox solution that we covered 

, are key to ensuring AI reaches the masses even in emerging markets.

Enterprise Imaging- Enabler of Efficiency and Productivity

Implementation of enterprise imaging solutions is a time-consuming process. With most hospitals working on skeletal staff due to COVID-19 and the subsequent financial distress that it brought upon them, implementing enterprise imaging during the pandemic was an impossible task. However, this presented an opportunity for both the vendors and the hospitals to consider innovative deployment models. Providers developed an affinity for cloud-based solutions as it does not require investing as much time and effort by the hospital staff as compared to a traditional on-premise implementation. This year witnessed a flurry of activities in cloud-based imaging with various vendors launching solutions that truly leverage the cloud-computing capabilities to realize tangible benefits in the clinical environment.

Earlier in the year, Change Healthcare launched its cloud-native Enterprise Imaging Network that enables aggregation and sharing of imaging data in a secure environment. Hyland launched its Software-as-a-Service (SaaS) solution for enterprise imaging during the event that is intended to relieve the hospitals of their responsibility for application and hardware maintenance. SaaS also enables hospitals to pay as per the usage with components being added only when the hospital demands. The trend towards SaaS in enterprise imaging augurs well for the hospitals who are currently reeling under severe financial stress, as it does not require huge upfront capital spending. Fujifilm highlighted its Synapse Cloud Services for hosting its Enterprise Imaging portfolio in a cost-effective and scalable environment targeting the teleradiology providers, critical access hospitals, and imaging centers.

For those concerned about the bandwidth and privacy issues that come with the cloud solution, GE Healthcare’s Edison HealthLink might be the right solution. Edison HealthLink is a new edge computing technology that permits clinicians to process the clinical data and act on it even before it reaches the cloud. TrueFidelity image reconstruction, CT Smart subscription, and eight other applications are already available on Edison HealthLink. Hyland introduced edge rendering of its zero footprint NilRead viewer that runs a local instance in low internet bandwidth conditions.

With enormous growth in the number of AI applications in imaging, the responsibility of integrating them into the workflow to ensure that they work seamlessly, has been taken up by the enterprise imaging vendors. The latest offering from Agfa Healthcare, RUBEE for AI is aimed at helping the hospitals in choosing the right AI solution for their needs. RUBEE aims to save the time for providers by offering them a curated set of intelligent applications that can be seamlessly integrated into their workflow in quick time.

Enterprise imaging involves networking multiple elements of imaging from different departments and centers and, as such, poses tremendous challenges in integrating the solutions from various vendors. The expertise of vendors like Altamont Software becomes extremely important with enterprise imaging strategy in perspective. Altamont Passport is a product that incorporates routing, pre-fetch, modality worklist, DICOM SR integration solutions to ensure a smooth workflow at an enterprise level. The Altamont Connectivity Platform provides the users with the necessary tools to integrate any image into their EMR or any enterprise system.

While challenges in enterprise imaging continue to emerge new solutions that address these are also being introduced, indicating the broad-based participation of the imaging industry.

COVID-19 has brought back the focus on efficiency and financial sustainability. With this crisis in the background, enterprise imaging will continue to evolve continuously over the next few years to develop into a unified medical record for all types of images in the enterprise. AI will be the toolkit for many efficiencies and productivity improvement initiatives. The developments in these two key domains will be a major driver for the growth of the imaging industry in the next decade.

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Dr. Suresh Kuppuswamy, Industry Principal at Frost & Sullivan

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