PACS landscape shows big changes at this year's RSNA show

Mergers, acquisitions, and partnerships by the big six?Agfa, GE, Kodak, Marconi, Philips, and Siemens?have changed the face of PACS. The landscape is also changing because infusions of cash have reached a few independents, while others struggle to keep alive with limited resources.

Jockeying for market position, domestically and worldwide, continues among the big six even though they still control over 75% of the market. Independents are making inroads in niche markets, yet those that once controlled niche markets and tried to branch out into full PACS have found the road a challenging one.

Other changes affect the PACS landscape. The incorporation of radiology information systems (RIS) into PACS has had a dramatic impact on the way people evaluate PACS vendors, with worklist management and RIS functionality playing a key role. Nearly all the majors have either purchased or developed a defined relationship with a RIS vendor and are strongly pushing the integration of both basic and advanced RIS functionality in PACS.

It will be especially interesting to gauge the impact of major purchases by the majors: the Siemens purchase of SMS, the Philips purchase of ADAC, and other related recent acquisitions. Also worth noting will be the impact Siemens' purchase of Acuson will have on the role that KinetDx will (or will not) play in the SMS PACS product line.

Application service provider (ASP) models will be all over the floor. ASPs will be offered from vendors who aren't even sure what ASPs are; this has become the "gotta have it" offering in the product portfolio, especially by smaller vendors who have neither the financial resources nor the patience to wait for PACS to complete its typical multiyear sales cycle.

This year should be a banner one for digital and computed radiology (DR and CR), with major price drops for both. DR will break the $200 thousand mark for the first time, about half of what has been seen in prior years, with CaresBuilt, Canon, Trixell, and others showing low-cost DR products. CR will break the $100 thousand mark, with several vendors offering CR units in the $70,000 and $80,000 range. It is premature to say what Kodak will do with the Lumisys CR product, but it will be interesting to see how the ACR-2000 product is positioned within the Kodak product line.

Voice technology has finally come of age, and L&H, IBM, and TalkTechnology all have solid product offerings this year. The same can also be said for software innovations, especially from Voxar, whose cost-effective 3-D software has changed the way radiologists look at high-cost dedicated CT and MRI workstations. Flat-panel displays will also be featured, although prices still have a way to go before they will be incorporated in PACS designs on a widespread basis.

Streaming image technology that allows images to be sent to primary-care physicians' offices over the Internet has hit the big time this year, with both Stentor and RealTimeImage scoring major OEM contracts, with IDX and Kodak, respectively.

Money plays an important role in a company's viability, and several vendors are flush with new capital infusions that should allow them to rapidly grow the business. These include eMed Technologies, Emageon, and AMICAS. After having had two initial public offerings pulled due to market conditions, eMed finds the $22 million cash infusion by its investors a particularly bittersweet victory.

PACS pricing remains about the same, but the value for the dollar is much greater this year, as networks finally allow for PACs potential to be fully met. It should be an interesting week in Chicago.