The rise of non-ionizing imaging technologies

A new class of imaging technologies aims to reduce and maybe even eliminate ionizing radiation during endovascular interventions.

Radiation safety has always been a big concern for the vascular surgeon performing various endovascular procedures and the patients themselves. Endovascular procedures are done in multiple settings using different imaging equipment, including mobile C-arms and hybrid rooms. Technologies like Fusion have been widely adopted at large centers to reduce radiation dose to both the operator and the patient during EVAR and FEVAR. However, these efforts don’t seem sufficient as the popularity of endovascular interventions keeps growing year over year and appears to be preferred by patients due to faster recovery times. As a result, many companies are developing imaging modalities using nonionizing radiation to replace or reduce X-ray radiation during endovascular procedures. Two main players in this space are Centerline Biomedical(IOPS, which uses Electromagnetic Fields and sensors) and Phillips FORS (Fiber Optics Real Shape).

To gauge the vascular surgeons’ interest in these technologies and get a sense of when, in their opinion, the use of these technologies will peak, I conducted an unscientific poll on Twitter. The response rate was pretty robust, with 76 answering the poll.

On the question of when nonionizing radiation-based imaging will peak, the responses were interesting. The distribution of poll responses bore an uncanny resemblance to the Diffusion of Innovation model (Everett Rogers back, 1962), showing that there’s nothing new under the sun when understanding how markets respond to innovative products.

It was evident from the comments to this poll that there’s a lot of enthusiasm for this technology. Many would like to see it available as soon as possible.

However, there was concern that it would require device manufacturers’ buy-in to make this technology commercially viable.

Some felt that these technologies, at best, will reduce the amount of radiation but will never rise to the level of completely replacing the C-arm for endovascular procedures.

And then there was the issue of cost. This skepticism expressed by some sounds very familiar to those that studied Geoffrey A. Moore’s “The Chasm Diffusion Model.”

Many innovative technologies fail to “cross the chasm” of skepticism, never reaching mass adoption. The current state of competition between different nonionizing radiation-based imaging technologies resembles video formats (Betamax vs. VHS / DVD vs. Laser Disc) back in the day. Ultimately one of these technologies has to win out by capturing a significant share of the market to cross the chasm and widely adopted by the early and late majority. I do not have a clear favorite as I have not seen either technology in action. However, I believe that whoever has the lowest adoption barriers for surgeons/hospitals and device manufacturers will ultimately win out.

In a short follow-up poll on which technology will win out, physicians were evenly split. Some see both technologies as complementary to each other.