The PET/CT long-axis machine with a unit price of over 100 million yuan. Why can it be "the future trend of the medical industry" | Frontline

At the end of 2024, at the annual meeting of the European Association of Nuclear Medicine, regarded as the wind vane in the global nuclear medicine field, top nuclear medicine scholars from all over the world once had a debate: For tumor patients to be diagnosed, PET/CT scans are indispensable. But for this scanning equipment, is it better to make it "longer" or is it sufficient to be "a bit shorter"?

Returning to the initial "nuclear medicine" concept, this rather mysterious thing in the public's perception has actually been developing in China for several decades. Simply put, it is the application of radionuclide tracer technology in medical diagnosis and treatment to detect tumors, monitor treatment effects, and carry out targeted therapy...

Further subdivided, the field of nuclear medicine mainly consists of two parts: diagnosis and treatment, corresponding to nuclear medical equipment and nuclear drug development, respectively, and the former is the center of this debate. These discussions directly point to the iterative trend of PET/CT equipment.

According to the current classification standard of the Chinese Society of Nuclear Medicine, when the axial field of view (aFOV, generally referring to the scanning range) of the equipment scan from the top of the head to the thigh is between 15cm - 35cm, it is a short-axis PET/CT, and when the typical value of aFOV is > 100cm, it is a long-axis machine; when scanning from the top of the head to the toes, if the typical value of aFOV is ≥ 188cm, it belongs to "total body".

In the past, in the era when short-axis machines were the core application, the PET/CT field has always been a game dominated by overseas giants such as "GPS", but in the development of long-axis machines, Chinese enterprises have taken the lead. After 2019, United Imaging Healthcare has successively released two PET/CT long-axis machines, uEXPLORER and uMI Panorama GS, with axial fields of view of 194cm and 148cm, respectively. It has become one of the few manufacturers in the current market that has a commercialized PET/CT long-axis machine.

However, currently, from the publicly disclosed winning bids of medical institutions, in comparison, the winning bid price of long-axis machine products is 2 - 3 times that of short-axis machine products.

In the case that doctors have "gotten used to" the traditional short-axis machines, is it worth spending so much more money? This is where the experts participating in the debate have different opinions.

Some people mentioned that compared with the traditional short-axis machines, PET/CT long-axis machines "bring many perspective changes that traditional equipment cannot observe", such as multi-tracer studies, long-delay imaging, and new drug development. Translated to the clinic, this means shorter scanning time, less radioactive damage to the patient's medication, and lower drug consumption costs;

Opposing scholars, on the other hand, believe that as a "new thing", the economy and practicality of PET/CT long-axis machines remain to be discussed. For example, is the cost difference, and whether the inspection effect or efficiency can also reach this level? Does a better image really bring changes in clinical diagnosis?

With these questions, we talked to Wang Chao, President of the Molecular Imaging Business Unit of United Imaging Healthcare, and Huo Li, Director of the Nuclear Medicine Department of Peking Union Medical College Hospital. From the perspectives of equipment manufacturers and doctors, how do they view these issues?

Is the Long-Axis Machine Really "the Recognized Trend in the Industry?"

Q: Can you briefly talk about what are the R & D and manufacturing thresholds for making long-axis machines?

Wang Chao: In the current global market, the long-axis equipment that has entered the commercialization stage is mainly the products of United Imaging Healthcare and Siemens. Because from the perspectives of capital investment, team configuration, and intellectual property rights, long-axis equipment requires a very large platform to undertake, so not many manufacturers will come in to do it.

In terms of software algorithms, the amount of data that long-axis equipment needs to process is dozens of times that of the past, and clinical testing has requirements for timeliness. The data must be processed and accurately imaged within the time range allowed by the clinic. The algorithm logic it requires is completely different from the past, so algorithm talents are a new investment.

In terms of hardware, in the aspect of independent research and development of core components, we have also laid out a large number of patent protections. The price of long-axis equipment and short-axis equipment is in a multiple relationship. Because the long-axis is pieced together with detectors, and then the image is presented with an algorithm, a large cost lies in the hardware. For example, the length of a short-axis device is 20cm - 30cm, and the long-axis may be 1m, then the highest cost is equivalent to 5 times that of the former.

For example, the cost of raw material purchase is very high. Because including long-axis PET/CT, the core components of many high-end medical equipment cannot be bought. If you do not master the supply chain, you will pay a greater price. First, others will not sell it to you; second, if you want to make independent innovations, the functions and performances of the components are designed to meet specific clinical needs, and there may not be any in the market.

Q: The main cost lies in the hardware. Then how much room is there to compress the cost after generating economies of scale?

Wang Chao: The scale effect exists.

Q: Some studies believe that the current cost of a long-axis machine is 2 - 3 times that of a short-axis machine, but in clinical applications, the economic benefit of a long-axis machine may not be as good as that of two short-axis machines. How do you view the industry's current concerns about the cost and economy of such products?

Wang Chao: This is the view of some people. I think, in terms of economy, the first thing to look at is a question: Can the long-axis solve the problems that the short-axis cannot solve? Some diseases or diagnoses may be well done with the short-axis, but some are 100% impossible to do with the short-axis. When solving this part of the problem, the "length" has a natural advantage.

For example, the advantage of the long-axis machine in the low-dose aspect determines that it can be used for children's scans and pregnant women's scans, thereby expanding the indications; in addition, it can do some dynamic scans to solve the problem of diseases that cannot be seen in the past static state.

Secondly, in terms of economy, some hospitals in the United States may be able to separate scientific research and clinical practice, but in China, it has not reached such a luxurious level. Many large tumor centers in China are equipped with long-axis machines because they have a fast scanning requirement for patients. A long-axis machine can solve the problem of patient flow that several short-axis machines cannot solve. Existing literature studies have confirmed that when doing stress tests, a long-axis machine can scan more than 100 patients a day. In addition to this, it can also allow doctors to carry out some scientific research work that short-axis equipment cannot do.

Simply from the perspective of health economics, the value of a long-axis is much higher than the investment in two short-axis equipment. This does not even discuss the additional machine room cost, personnel cost, warranty situation, etc. that need to be paid when purchasing the second short-axis machine.

Therefore, simply from the input-output ratio, we believe that the future development direction is that any nuclear medicine department with the ability to equip more than three PET/CTs will consider buying a combination of one long-axis and one to two short-axis. Because the long-axis machine will not lag behind the short-axis machine in work, and at the same time, it can provide more high-end values such as clinical and scientific research, these are bonuses.

However, the configuration of a long-axis machine does depend on the positioning of the hospital. If it is a primary hospital that just meets the threshold of using PET/CT, with a relatively small number of patients and no complete nuclear medicine team configuration, the current use of short-axis machines can also meet the needs.

Q: In your opinion, what might be the future market relationship between the long-axis and short-axis devices?

Wang Chao: Overall, the long-axis and short-axis will coexist for a considerable period of time.

Top medical institutions, such as those at the national medical center level, need long-axis machines, and maybe even more than one long-axis machine; in some regional medical center-level hospitals, maybe only a combination of one long-axis machine + short-axis machine is needed to complement each other and solve the problem of low efficiency of the short-axis machine; for the lower-level medical institutions, maybe one short-axis machine is enough.

We expect that the proportion of long-axis machines will gradually increase, but it may not reach such an aggressive level of 1:1 in the short term.

Q: What is the current global installation situation of long-axis machines?

Wang Chao: Since we made the first long-axis machine in 2019 until now, the long-axis system is a relatively new technology globally. In total, the global installed capacity of all manufacturers is not more than 100. From the perspective of United Imaging Healthcare, we have some top hospital users in Europe and North America, such as the Sant'Orsola Hospital in Italy and the BAMF Cancer Medical Center in the United States, and there are about 20 users in China.

Those that are really in use are actually top hospitals, and after they use it, they have indeed raised many problems. For example, in terms of the convenience for doctors to use it (for some communication and exchanges). They hope that we can provide some scientific research tools because top hospitals still want to do some scientific research work. The clinical efficiency has actually been quite high after polishing, which is many times higher than that of ordinary PET/CT, maybe four or five times higher. Then the demands of each hospital for scientific research are different, and they also hope that we have a good scientific research team to support them in this work.

From the perspective of promotion, I think the next step is to truly complete the transformation from scientific research to clinical practice, further explore more unique advantages of the long-axis, and let more people recognize these advantages, so that this product can be used by more and more people.

Q: Has making long-axis machines become a consensus in the industry, or is it still in a controversial stage?

Wang Chao: We believe that a consensus has been formed, otherwise, there would not be so many manufacturers following up on R & D.

Long-Axis PET/CT Installed Hospitals,

There Are "About 20 or So" in China Currently

Q: How many hospitals in China currently have the ability to configure and use PET/CT long-axis machines?

Huo Li: Currently, there are only about 20 in total, concentrated in Beijing, Shanghai, and Guangzhou.

Wang Chao: We believe that in the future, basically provincial benchmark hospitals can have the ability to build nuclear medicine departments, and correspondingly, there may be 50 - 100 hospitals. The Chinese market may only account for 10% - 15% of the global market, and the overseas market will be larger.

United Imaging Healthcare PET/CT long-axis machine applied in Peking Union Medical College Hospital

Q: In clinical applications, from the perspective of hospitals and doctors, what key indicators and new values of long-axis machines may be more concerned about?

Huo Li: How much distance can be seen in one bed, how long it takes to scan one bed, and how much medication dose is for each patient. These three points determine how many patients can be scanned clinically per day, as well as the total amount of medication required and the daily working hours of the staff.

Wang Chao: Yes, in fact, this is the equipment sensitivity system. Sensitivity is the detection efficiency, that is, the so-called many rays emitted by the lesion, and how high the efficiency of seeing it is. A high efficiency means that in the same time, more information can be obtained, the image is clearer, and a more accurate diagnosis can be made.

Q: Are there any specific scenarios where only the long-axis has the advantage and the short-axis cannot do it?

Huo Li: The most typical one is to see the distribution of the drug in the whole body after the injection. After the scan, the distribution of the drug in all organs is very important for the tracer because in the calculation, it may be necessary to correspond to what it is like from the 0th second to the 1st second after the injection, and what it is like from the 1st second to the 2nd second.

However, because the single scanning coverage of the short-axis machine is small, when scanning the whole body, it cannot be done simultaneously, but only in sections. This is equivalent to what may be seen in each section is the situation after the drug is injected for a period of time, while the long-axis "clicks" and it is all photographed.

In addition, when the short-axis is collected in sections, if the image is collected according to the conventional coverage range (the base of the skull - the upper 1/3 of the thigh), sometimes some lesions may be missed. We have a very typical patient. He had a short-axis PET/CT done in another hospital and was collected according to the conventional range. As a result, the primary lesion above the knee joint was not observed, and the lesion in the lung was considered to be a benign lesion. But when he came to Peking Union Medical College Hospital and was scanned again with a long-axis machine, a lesion with abnormally increased metabolism in the muscle above the knee joint was found, and after the primary lesion was determined, the lesion in the lung was confirmed to be a metastatic lesion.