Despite the excitement surrounding new ultrasound clinical applications, in 2018 healthcare providers continued to predominantly purchase traditional equipment. Traditional equipment (which includes cardiology, OB/GYN, and radiology) accounted for more than 70% of global ultrasound unit shipments in 2018 and traditional revenues totaled $4.9 billion of the $7.0 billion ultrasound market. Traditional ultrasound revenues grew 6.6% year-over-year (YoY), a faster rate than the revenues of non-traditional (which includes breast, gastroenterology, internal medicine, interventional cardiology and radiology, surgical, urology, vascular, veterinary, and other), point-of-care (POC) (which includes anesthesiology, critical care, emergency medicine, and musculoskeletal), and primary care applications. Although traditional ultrasound is forecast to maintain its stronghold of the ultrasound market during the next five years, non-traditional, POC, and primary care present large opportunities for ultrasound manufacturers.
Radiology on its own accounted for more than one-third of all ultrasound unit shipments in 2018 and was the preferred equipment in all markets because of its ability to be used by various hospital departments in a shared services model. Healthcare providers faced major budget constraints, rising incidence of chronic illness, and emphasized return on investment in purchasing decisions. These factors drove high demand for radiology systems since they were affordable and could be used by several departments in a hospital.
Rising incidence of chronic illness also drove growth for cardiology ultrasound since heart disease was one of the global leading causes of death in 2018. In regions where heart disease rates were very high, like the mature markets of North America, Western Europe, Asia Pacific, healthcare providers purchased 3D/4D cardiology equipment to use in interventional procedures. Cardiology is an area of emphasis for innovation from medical imaging manufacturers and technology companies. For example, Philips Healthcare launched the EPIQ CVx—a premium cardiology-dedicated ultrasound system—in 2018 and has developed an artificial intelligence (AI) software, coined Anatomical Intelligence, to improve cardiac examinations. DiA Imaging Analysis has also made a major impact on the cardiology market with its LVivo Toolbox, a set of AI-powered applications that aid in cardiology examination interpretation. DiA has partnered with several ultrasound vendors Neusoft, GE Healthcare, Esaote, Konica Minolta, Terason, and Edan to incorporate DiA’s AI into ultrasound portfolios.
In 2018, OB/GYN ultrasound unit shipments increased by over 10% YoY, making it the fastest growing traditional ultrasound application. High birthrates in emerging markets drove increased demand for OB/GYN systems. One of the largest OB/GYN markets was in mainland China where relaxed child-limiting policies have led to a rise in birthrates. Conversely, OB/GYN revenues declined in countries with low birthrates, like Japan and South Korea. In other mature markets, an emphasis on improving women’s healthcare drove OB/GYN growth in North American and Western European markets as governments and healthcare providers aimed to improve access to quality care.
Non-traditional ultrasound applications continue to grow. Mature markets have embraced non-traditional ultrasound imaging, but this equipment is less popular in emerging markets where budgets are limited and primarily tied to purchasing essential traditional equipment. In 2018, many emerging and mature markets faced extreme budget constraints which resulted in only 1.5% YoY unit growth for non-traditional systems compared to the total market’s 5.6% YoY unit growth. Historically, traditional applications have been prioritized ahead of non-traditional applications, but a few non-traditional applications are becoming essential for healthcare providers. Ultrasound-guided minimally invasive surgeries (MIS) have increased because these operations improve patient outcomes and save costs for healthcare providers. By reducing the incision size, MIS decreases patients’ post-operative pain and recovery time and increases surgical success rates and the hospitals’ patient throughput, compared to open surgery. Interventional and surgical applications will drive revenue growth for non-traditional ultrasound from 2018 through 2023 as ultrasound-guided MIS is used in place of more conventionally open surgeries.
Breast ultrasound was one of the fastest growing non-traditional applications in 2018 and will be an exciting market over the next few years. GE Healthcare maintained strength in the market segment with their newly launched Invenia ABUS 2.0 breast ultrasound system and collaborated with Koios and Qview to incorporate AI for breast screenings. Meanwhile, Hologic—the global leader in breast imaging—seeks to stake its claim in the breast ultrasound market with its recent partnership with Clarius and acquisition of SuperSonic Imagine. New technology, such as shear-wave elastography and contrast enhanced ultrasound, improve tissue characterization and are driving revenue growth for breast, gastroenterology, and internal medicine ultrasound. Non-traditional ultrasound has high growth potential but must first overcome lack of training and reimbursement to reach its full potential.
Despite only accounting for a small portion of the total ultrasound market, POC and primary care ultrasound are rapidly growing market segments, with unit shipments growing 7.9% and 14.2% YoY, respectively, in 2018. POC ultrasound has become a widely-accepted tool to introduce diagnostic imaging to unconventional settings and the governments of Brazil, mainland China, India, Japan, South Korea, etc. identified primary care as an area of improvement for their healthcare systems and provided funding for ultrasound systems. Handheld ultrasound and AI make quick diagnostic assessments more efficient, which is a major priority of POC. While efficiency and patient access are common drivers for POC ultrasound, each of the four POC market segments grew in 2018 because of various factors. Anesthesiology was the fastest growing POC segment, primarily because of the increased use of nerve blocks as an alternative to opioids for pain management; the emergency medicine and critical care segments benefitted from many residencies requiring doctors to be trained in ultrasound; and musculoskeletal ultrasound unit shipments were in high demand in mature markets with aging populations that are seeking joint replacement surgeries.
Non-traditional, POC, and primary care ultrasound have great potential to change how and where ultrasound is administered and are prime markets for manufacturers to launch new and state-of-the-art ultrasound products. Nonetheless, traditional applications have proven to be a staple of ultrasound. To best navigate the ultrasound market, the largest and most-established manufacturers should look to offer diverse portfolios, while smaller competitors are better suited to target and innovate specific segments of the market.