Growth SPECTulation

Facing the prospect of lackluster growth over the next several years, the single photon emission computed tomography (SPECT) camera market is looking toward the advent of new imaging agents and molecular imaging to ignite interest in the technology and rescue it from the mire of sluggish sales.

The nuclear gamma camera market in recent years has been overshadowed by the swiftly growing PET (positron emission tomography) segment. The numbers tell the story best. Frost & Sullivan estimated the U.S. gamma camera market at $436 million in 2003, representing a growth rate of 8 percent. Nuclear cardiology accounted for approximately 26 percent of total U.S. revenues last year. In 2004, the market research firm's expectation is for very modest growth of 1 or 2 percent.

Looking to the next five years, depending on developments within the gamma camera market, Frost & Sullivan anticipates revenue growth between 3 percent and 7 percent, with domestic revenues in the range of $500 million in 2008.

"That [growth] is contingent upon the assumption that nothing major hits [the market] in the next few years," adds Monali Patel, Frost & Sullivan industry manager for imaging. The market could reach 7 percent with some outside help, such as current works-in-progress imaging agents coming to market by 2008.


WORLDWIDE OPPORTUNITIES

Worldwide gamma camera revenues reached $638 million in 2003, with a growth rate of approximately 6 percent. Frost & Sullivan's latest analysis sees worldwide gamma camera growth paralleling that of the United States in the 3 percent range.

The consensus among vendors and industry analysts is that there are current growth opportunities for gamma cameras in Asia and in China.

"There is tremendous growth in Asia, but, of course, everything grows in Asia right now," says Markus Lusser, vice president of global marketing and sales for gamma cameras and PET in Siemens Medical Solutions Nuclear Medicine Group. "[Asia] is growth market No. 1. China and India are picking up rapidly."

Nuclear cardiology remains a prime mover in the U.S. gamma camera market in terms of procedures. While nuclear cardiology represents approximately one-quarter of U.S. revenues, nuclear cardiology tallied 55 percent of all gamma camera procedures - 17 million to 18 million - in the United States in 2002, according to the most recent available number from Frost & Sullivan.

Nuclear cardiology, however, has leveled off somewhat in recent years, in terms of U.S. revenues, following its advance of the late 1990s and early this decade.

Still, Lusser sees some areas of strength in the U.S. market for more specialized systems, such as cardiac gamma cameras, "which indicate that more private imaging centers and cardiologists are getting interested in nuclear cardiology and are offering these kinds of services on their own premises."


CARDIOLOGY'S RISE

One reason for the ascent of the nuclear cardiology market in the mid- to late 1990s was the introduction of Cardiolite, the myocardial perfusion imaging agent launched by the former DuPont Pharmaceuticals and currently marketed by DuPont's current parent company, Bristol Myers Squibb. The former Amersham - now part of GE Healthcare Bio-Sciences - followed to market with the introduction of MyoView also for myocardial perfusion.

Now, the gamma camera market is keeping watch for additional imaging agents currently in development, which again will help boost sales and provide a bridge between the technology, molecular imaging and other expanded applications.

"Cardiology obviously continues to be the dominant sector within the market, but there is a lot of waiting to see if some of the new agents come to fruition in the next few years that could open the market to oncology," Patel says.

The nuclear cardiology market segment continues to be supported, in part, by physicians who establish cardiology services within their offices. The office-oriented purchases follow a general trend throughout medical imaging where cardiologists, oncologists and general physicians are expanding their imaging services.

The equipment options are single-head cameras, as well as dual-head systems, with fixed 90-degree angle cameras for cardiology imaging. The variable-angle cameras perform both nuclear cardiology studies, as well as general radiology exams, primarily for the hospital market.

"Over the years, we have seen the replacement of the single-head cameras by the variable-angle systems," notes Luke Liem, cardiology product manager in Philips' nuclear medicine division. "Now, we are seeing a strong growth in the fixed 90 market, which is dedicated to the cardiology office space."


IN DEVELOPMENT

Biotechnology company CellPoint LLC currently is developing ethylenedicysteine (EC) drug conjugate technology through a 2001 exclusive worldwide patent and technology license agreement with The University of Texas M.D. Anderson Cancer Center. The EC technology is designed to function as a chemical bridge linking diagnostic radiotracers or therapeutic radionuclides to ligand disease target seekers or FDA-approved drugs.

Technetium-99m-EC-deoxyglucose (Tc-99m ECDG) would produce a metabolic imaging marker that can diagnose hypercellular activity of cancer cells using standard SPECT.

CellPoint in September 2003 began collaborating with Philips Medical Systems and its SkyLight gantry-free gamma camera to share clinical trial costs to develop optimum imaging techniques for improved clinical information and accuracy of diagnoses. The joint goal, the companies say, is to develop a cost-effective molecular imaging technology that would help clinics and hospitals accurately diagnose cancer and pre-screen patients for therapy.

CellPoint's EC Technology would link deoxyglucose (also used in the PET imaging tracer FDG, fluorodeoxyglucose) with the Tc-99m radioisotope. ECDG is said to mimic FDG and has a longer half-life.


INDUSTRY ALLIANCE

Gamma camera manufacturers are working closely with drug development companies to optimize their new drugs for imaging in the clinical environment, so the gamma cameras will be suited with the appropriate features.

"We have opportunities in imaging cell death, cell proliferation, and metabolism," says Jody Garrard, Philips' product manager for variable angle gamma cameras. "There are agents under development for Parkinson's disease and ADHD [attention-deficit hyperactivity disorder], where there has not been a tool to diagnose ADHD, especially in children."

As drug and imaging agent development progresses, so too must the technology of gamma cameras.

"Say, you want to inject a combination of molecular agents to evaluate a specific cancer type and you want information about hypoxia [oxygen content] in this tumor," says Garrard. "If you inject a combination of drugs with different radioisotope tags, then the gamma cameras need to be more sophisticated to separate these various energies."

Garrard expects vendors to develop software to accommodate the confluence of information, as well as the advent of hybrid imaging to combine anatomical information with the physiological data provided by gamma cameras, as in the case of PET and CT.

"I don't know if the market will move as quickly to SPECT-CT devices [as it did PET-CT]," she adds, "but I think we will see more combined devices in nuclear medicine and software tools that will allow for the use of existing gamma cameras and existing anatomic modalities to combine images via software, if they don't have integrated hardware."

Future sales of gamma camera also may depend, in part, on purchases of dedicated PET systems. While the sales of PET units have not yet surpassed gamma cameras, IS2 Medical Systems Inc. President and CEO Steve Horvath opines that it will not "be long before the dollar volume of PET cameras is equal to the dollar volume of traditional gamma cameras sold in the United States."


PRICE LINES

Horvath views gamma cameras as representing a "mature industry," with prices declining in recent years. In the last few years, he estimated that smaller units were in the range of $270,000, but began to slide to $220,000 to $230,000 last year.

"Most of the small footprint cameras, our information says, are selling for about $220,000," Horvath adds. While he didn't offer a specific price, he did say that IS2's Pulse gamma camera is "well below that" amount.

Horvath sees gamma cameras as "still a very buoyant market," with growth potential in overseas markets, such as Asia and China.

"We also are seeing different segments of the industry that have tended to lag [in the past] are starting to take off," he notes. "For example, cardiology in the United Kingdom has not been that strong; they are now embracing it. Brain imaging, which has been much more popular in Europe, is now starting to at least get more serious attention in North America."


PROVING OUTCOMES

As with the other health imaging modalities, new techniques, technologies and applications spur growth.

"It is all driven by technologies and it is driven by outcomes," says Siemens' Lusser. "If you make it easier to operate and tie it to the nuclear medicine and radiology environment, you are able to demonstrate these outcomes and that nuclear medicine has a key function in the hospital environment."

Still, Lusser says some healthcare providers see nuclear medicine "as a step child" to the other medical imaging modality options and "many users can't necessarily read the fuzzy images of nuclear medicine gamma camera."

Once again, growth in the gamma camera market very well could be contingent upon the development of new tracers, imaging devices and features, and visualization techniques. "That's where we see a tremendous renaissance opportunity for nuclear medicine," he adds.

Radiopharmaceuticals and contrast agents themselves are expected to contribute greatly to the overall medical imaging market, with approximately 23 percent of revenues coming from this segment.