High-field scanners stir up market for patient-friendly MR in Europe

Europe has traditionally lagged behind the U.S. in its interest in open MR technology. Now the launch into the European market of two MR systems, each claiming performance comparable to 1.5T but friendlier to patients, may at last buck that trend.

Europe has traditionally lagged behind the U.S. in its interest in open MR technology. Now the launch into the European market of two MR systems, each claiming performance comparable to 1.5T but friendlier to patients, may at last buck that trend.

The high-field newcomers are the 1.5T Magnetom Espree from Siemens Medical Solutions and the Panorama 1.0T from Philips Medical Systems. Both will be showcased at ECR 2005.

Siemens installed its first four Europe-bound Espree systems during the first two months of 2005. Three went to customers in Germany, the other to a university hospital in Switzerland. Meanwhile, Philips has collected orders for the Panorama 1.0T from clients in Spain, Germany, Switzerland, and the Netherlands following the system's debut at the 2004 RSNA meeting. Delivery of the Panorama 1.0T to European customers is scheduled to begin in May.

Both Siemens and Philips are playing up the ability of their latest MR offerings to maximize patient comfort without compromising image quality. This message is particularly important in Europe, which has traditionally had a tightly regulated healthcare market. In the U.S., some consumers' ability to choose where they have their scans has helped drive demand for patient-friendly MR. Patient choice has had far less impact on scanner sales in Europe. So radiologists' preference for higher field systems capable of yielding more detailed images has, to date, held down sales of open MR scanners.

"In Europe, physicians' trust and confidence have been lacking, I would say, in low-field open MR technology," said Jacques Coumans, Philips vice president of global marketing. "The feedback we are now getting with the Panorama 1.0T is: 'I can feel comfortable with this field strength. I don't have the feeling I might have missed something.'"

The U.S. market for open MR has also been aided by the high numbers of obese patients in that country, said Britta Fuenfstueck, head of MR marketing for Siemens. Although obesity levels are increasing in Europe, this is unlikely to be the main driver for open MR sales.

"European open MR sales in the high field are expected to rise due to interventional MRI and patient comfort issues," she said. "Patients are becoming better informed and now want to choose when and where they have their scans. Nonobese patients also want higher levels of comfort during exams."

Designing a high-field MR scanner with an open aspect has been a technical challenge. Siemens and Philips have taken very different routes to achieving this goal.

Philips' 1T scanner slots in at the top of the company's Panorama open MR portfolio, which additionally comprises a 0.23T system and a work-in-progress 0.6T unit intended for the interventional market. The Panorama 1.0T shares the look of conventional open MR systems but incorporates an actively shielded, vertical-field, superconducting magnet (SCAN 10/27/04). Low- to midfield open MR scanners are built around permanent magnets, while cylindrical MR units generate horizontal magnetic fields.

"Physics tells us that if you have a vertical field system, you can create surface coils with better efficiency than you can for horizontal field cylindrical systems. Also, the imaging contrasts are better at 1T than 1.5T," Coumans said. "With the Panorama 1.0T, we are seeing both this increase in contrast and an increase in signal-to-noise ratio."

The Espree, on the other hand, bears a closer resemblance to a CT scanner than to an open MR system. It has been built with a doughnut-shaped 1.5T superconducting magnet and bases its claims to the open market on geometry: its 70-cm inner bore diameter and 125-cm bore length (SCAN 7/30/04). Siemens is positioning the Espree as its third 1.5T scanner, to complement the closed-bore Magnetom Avanto and Magnetom Symphony.

"Our challenge was to build an open-style 1.5T scanner," Fuenfstueck said. "A large proportion of obese patients cannot be scanned on open low-field MR systems with sufficient image quality for diagnosis. Also, referring physicians are used to 1.5T level image quality. Almost 75% of the world MRI market is composed of 1.5T systems."

The Espree may have a "closed" magnet, but patients will have more room than they would in a conventional open MR scanner, she said.

"There are a couple of practical criteria that determine what openness really is," she said. "Headroom, that is the distance from your nose to the magnet when inside the scanner, is 30 cm with the Espree. This distance is considerably smaller in other open MR systems, because you have to get the magnet's pole shoes very close together to get good field homogeneity."

Other open MR suppliers are less confident that ramping up the field strength is the best way to win European sales, whatever the scanner design. Hitachi Medical Systems has decided not to market its own higher field open MR system, the 0.7T Altaire, in Europe, at least for the moment. European clients may choose from Hitachi's range of 0.2T Airis Mate, 0.3T Airis II, and 0.4T Aperto. This latter midfield system is not available in the U.S.

GE Healthcare is marketing its 0.7T Signa OpenSpeed globally, though most open MR sales to Europe, Africa, Russia, and the Middle East are still generated from the 10-year-old 0.2T Profile, said Laura Smith, global MR marketing manager for GE Healthcare's open products. Orders for the 0.35T Ovation are also up in these regions, where the open MR market is growing by 15% to 20% every year.

Harsh economic realities mean that high-field open scanners are unlikely to make significant inroads in Europe, according to Smith. The average reimbursement rate for an MR scan in Germany, for example, is $85 for publicly funded patients and $360 in the private sector. In France, reimbursement is $300. This compares with MR reimbursement rates in the U.S. of at least $600.

"The reimbursement issue tends to push purchasing decisions in one of two directions. Either customers go toward the cylindrical 1.5T and 3T market, which will allow them to scan more patients, or they move toward the mid- to low-field open scanners that require smaller investment," she said.

Siemens is confident, however, that integration of its Total Imaging Matrix (TIM) technology into the Espree will give customers who might previously have bought a cylindrical scanner the speed they require. The company is also hoping that the Espree's small footprint and low vibration sensitivity will remove practical barriers to open MR sales.

"Our MR customers don't want to buy a new system every two years, so they want to know that they are purchasing the very latest technology. The newest innovations are happening at 1.5T, not at 1T or 0.7T," Fuenfstueck said.