Contrast Manufacturers in Imaging AI? Here's Why it's No Joke.

John F. Kalafut PhD

I have heard many times the past couple years someone stating something akin to "what the heck are these contrast companies trying to accomplish or do with an imaging AI strategy? Why would selling contrast make them capable of delivering departmental or enterprise digital stuff?" The recent moves in the market by Bayer and Guerbet in acquiring AI workflow orchestration/hosting platforms has caused this question to be asked by many in the community. Now I agree if the organizations were just manufacturing and selling contrast agents, yes, there should be some healthy skepticism. It's crucial, however, to recognize a key point giving them credos to develop and deliver imaging AI solutions. Bayer, Bracco and Guerbet also develop, sell and maintain powered contrast injection/delivery systems and complimentary or adjacent analytical tools and information systems - Latest Trends in Contrast Media Injectors – PT Medical Technologies. Note that GE Healthcare - also a large manufacturer of contrast agents - has more fully entered the injection system market via a very close relationship with Ulrich. This could be a whole other post, so I will leave it at that.

The ubiquity of their device and software solutions gives them access and visibility into the diagnostic imaging market and buying centers in health systems. Nearly every CT scanner has a contrast injector associated with it (~60-70% of all CT exams involve IV contrast) and every angio/cath lab will have an injection system in it. Also, most MR scanners, and nukemed/PET-CT scanners will have a contrast injector in or near the scan room. These are complex, distributed, electro-mechanical systems that also have matured to include a full suite of capabilities that entail the collection, computation, and transmission of data to and from the scanner, PACS, RIS and other departmental or enterprise systems.

I know for what I speak because the early part of my career was spent developing the informatics architecture and software tooling for MEDRAD/Bayer, including the incorporation of OTS software stacks, interoperability via DICOM, HL7 and web-services (SOAP - back in the day). I had initiated the creation of what is now the DICOM SR SOP class for injection data. Back in 2008-09, our strategy was to bring the delivery systems onto the network and then, by investing in server-side aggregation and deployments, to build out a launchpad for adjacency growth via software apps. One of the reasons for the Radimetrics™ acquisition was to fast-track the need to get “serious” in the imaging IT segment.

Fast-forward 13 years and we have witnessed a software and analytics evolution pattern across each of the major contrast delivery and contrast agent manufacturers -Bayer, Bracco, and Guerbet, and even GE. Each has their brand of contrast injection/delivery systems (Guerbet acquiring the old Liebel-Flarsheim brand), remote service capabilities, their own suite of connected analytic solutions for contrast and radiation analytics + optimization, and scanner and imaging IT interoperability and connectivity solutions. Some also distribute or have distributed software applications (like MergeCAD). They have national scale sales, service and clinical application teams touching nearly every hospital as well. Those service and apps teams are critical for getting any medical innovation into use. They also have strong relationships with departmental admins, biomeds, radiologists and, because of the “smart” capabilities of the systems, connections, and relationships with service-line leaders in radiology, cardiology, and nuclear medicine, and often enterprise IT. These are much different capabilities and relationships from those developed and needed when representing contrast agents.

The number of sales reps for contrast agents has decidedly decreased the last 10+years (and contrast doesn't need a service team). However, those reps have strong relationships with healthcare system purchasing, GPOs and supply chain. They can and will help influence or at least open the right doors at a healthcare delivery organization for other teams in their commercial organization. A commercial team that has relationships with purchasing, GPOs, IT, and service-line teams is valuable and something that pure-play, healthcare IT or software vendors will find difficult to replicate. As an aside, these are crucial relationships for advancing innovation into healthcare operations and something I've seen many IT-focused startups not realize until way too late in their lifecycle.

Realize, too, that there is more economic parity between contrast delivery systems plus analytics tools and imaging AI applications versus a scanner or PACS and an AI application from an ISV. Historically, scanner sales teams don't like to get stuck in long sales cycles/evaluation for software applications that might delay or put at risk a several hundred thousand-to-million-dollar scanner sale. Compare that dynamic to a $30-$50,000 contrast injector and the add-on value of AI applications can be more accretive and interesting to the finances.

Now, it is and can be a far journey from designing and deploying analytic software (like radiation dose management solutions) to clinical applications that will probably be presenting data, visualization, and other information to the radiologist in the reading room. There are also complex IT workflows and architectural skills that the contrast + injector vendors may not readily have access to - talented and experienced deployment engineers, interface builders and solution architects. These are also in-demand resources right now, and securing the right talent can be difficult when PACS vendors even struggle to hire and keep seasoned deployment teams. However, the advantages discussed above, and the imaging IT and scanner manufacturer neutrality make Bayer, Geurbet and Bracco interesting and credible horses in the race to “AI-ify” the diagnostic imaging environment of today and tomorrow. As Herman Oosterwikj pointed on his recent LinkedIn post, it is significant and will be interesting to see how they influence the dynamic and evolving, imaging AI market space.

Asher Orion Group is Activating Medical AI for Improved Outcomes. We help healthcare organizations and private practices identify the most appropriate and useful clinical analytical tools and facilitate measurement of utilization and demonstrate ROI. We help AI Vendors with product processes, management and life cycle planning. We help them define and refine the market needs and scope, customer fit and value proposition. We bring together Enabling Technology companies needed to support both of these client groups. Benefit from our six decades plus of experience. Tap the knowledge we garnered through engagements with GE Healthcare, University of California San Francisco, Partners Healthcare – Mass General Brigham, Boston Children’s Hospital, Oxford University, and more.