Loosing the dogs of war on CT

In The Guns of August, Pulitzer Prize winner Barbara Tuchman chronicles the staggering miscalculations and misunderstandings that led to World War I. At any of a number of flash points along the way, the conflict could have been stopped, or limited in its spread. It might have been avoided altogether if world leaders had better understood their own priorities, goals, and intentions.

In CT, the stakes are not as high, but the conflict is just as global and just as likely to spread with devastating results. Reputable, dependable, credible vendors are pushing scanners that can't be in customers' hands for a year, or two, or even three. They are comparing vaporware to the existing hardware of their competitors. They are openly criticizing each other.

It's a risky game. Their promises are not distinguishing individual companies so much as raising the level of expectation for the entire industry, fueling an R&D race that no one can afford to lose. To meet the promises now being made, enormous challenges will have to be met. First is developing the electronics needed to get the information off the CT detector. Second is putting the data in a format that can be efficiently and effectively integrated into clinical workflow. Third, and most formidable, is doing the first and second at a reasonable price.

Vendors are painfully aware that demand for multislice scanners tops out at around $1.2 million. While the engineering necessary to meet the promises being made might be possible, setting up a production line to manufacture the devices may not be fiscally sound.

Vendors are aiming way out in front of a moving target that is being propelled by an industry-wide sense of one-upmanship. If they do not hit this target within the time frames they have set for themselves, buyers may lose faith in superpremium CT. This could trigger a recession comparable to the MRI slump of 1993-94, which occurred when market saturation could not be offset by enough technological or clinical advances to generate sufficient demand.

The worst possible scenario is that this high-stakes game in CT infects the rest of the imaging industry. MRI is becoming highly competitive, as vendors seek to create new markets for high-performance open scanners, 3-tesla systems, and products optimized for cardiac or neurological applications. Nuclear medicine is reaching out with hybrid scanners that combine CT with PET or SPECT. Ultrasound is dabbling with real-time 3-D imaging. Radiography is in the midst of a "digital revolution." If vendors in these segments believe the game now being played in CT might give them an edge on the competition, the entire industry could be at risk.