Status of Medical Imaging Equipment and Detectors 2020

From Technologies to Markets

Market and Technology Report 2020

• Glossary and definition • Market trends 93 • Table of contents o For each modalities: X-ray, endoscopy, ultrasound, molecular imaging, OCT and MRI • Report scope / Report methodology o Market drivers, roadmaps and technical requirements • Companies cited in this report o System market by applications 2015 - 2024 (value and units) • What we got right, what we got wrong o Detector market by applications and technology 2015 - 2024 (value • Executive Summary 11 and units) • Context 49 o Markets shares at the system level by applications o Scope of the report o Historical perspective • Market shares and supply chain 217 o Medical imaging landscape o Mergers and acquisitions o Toward hybridization o Supply chain analysis o New growth drivers : toward high volume applications o Detector manufacturer market share, by technology o Roadmaps by modalities o Focus on the Chinese ecosystem o Impact of the COVID-19 pandemic o Artificial intelligence in medical imaging • Technology trends 241 o Technology description • Market forecasts 76 o Technology evolution o Definitions o Technologies roadmap o CAGR vs market size graph o Manufacturing process, material o Medical imaging market data and forecasts 2015 - 2025 (value and units) at the system level, by modalities • Conclusion 323 o Medical imaging market data and forecasts 2015 - 2025(value and units) at the detector level, by modalities • Yole Group of Companies 325 o Medical imaging market data and forecasts 2015 - 2025(value and units) at the detector level, by technology

Marjorie Villien, PhD As a Technology & Market Analyst, Medical & Industrial Imaging, Marjorie Villien, PhD., is member of the Photonics & Sensing activities group at Yole Développement (Yole). Marjorie contributes regularly to the development of imaging projects with a dedicated collection of market & technology reports as well as custom consulting services in the medical and industrial fields. She regularly meets with leading imaging companies to identify and understand technology issues, analyze market evolution and ensure the smart combination of technical innovation and industrial application. MarjorieVillien graduated from Grenoble INP (France) and holds a PhD. in physics & medical imaging. Email: [email protected]

Jérôme Mouly Jérôme Mouly serves as a Senior Technology & Market Analyst & Business Developer specialized in microtechnologies within the Photonics & Sensing team atYole Développement (Yole). Jérôme actively assists and supports the development of strategic projects, working with leading customers of the company. Since 2000, he has also been engaged in more than 100 marketing and technological analyses for industrial groups, start-ups and institutes in the field of MEMS, BioMEMS, wearables & connected medical devices. Through the group’s numerous activities at Yole, Jérôme covers the whole microelectronics supply chain, including manufacturing processes and device development. Jérôme Mouly has a Master of Physics from the University of Lyon (France). Email: [email protected]

William Watkins, PhD As a Technology & Market Analyst specialized in Imaging/Materials within the Photonic & Sensing Division at Yole Développement (Yole), William L. Watkins, PhD., is involved in the development of technology & market reports as well as the production of custom consulting projects. Prior to Yole, William worked as a research engineer at Sorbonne University (Paris, France) on the use of nanoparticles in the development of novel inks and pigments. William was awarded a PhD in the field of physics from the Paris Institute of Nanosciences (INSP - Sorbonne University, Paris, France). His research thesis focused on the analysis and development of optical gas sensors using nanoparticles. Email:[email protected]

• APS Active Pixel Sensor • FSI Front-Side Illumination • AMLCD Active-Matrix LCD • GI Gastrointestinal • a-Se Amorphous Selenium • IS Image Sensor • a-Si Amorphous Silicon • IVUS Intra Vascular UltraSound • CsI Cesium Iodide Scintillator • LED Light-Emitting Diode • BSI Backside Illumination • MRI Magnetic Resonance Imaging • CAGR Compound Average Growth Rate • NOTES Natural Orifice Transluminal Endoscopic Surgery • CBCT Cone Beam Computed Tomography • OCT Optical Computed Tomography • CCD Charge Coupled Device • OEM Original Equipment Manufacturer • CdTe Cadmium Telluride • PET Positron Emission Tomography • CIS CMOS Image Sensor • pMUT Piezoelectric Micromachined Ultrasound Transducer • CMOS Complementary Metal Oxide Semiconductor • RF Radio frequency • cMUT Capacitive Micromachined Ultrasound Transducer • TDI Time-Delayed Integration • CT Computed Tomography • TFT Thin-Film Transistor • DQE Detective©2017 Quantum | www.yole.fr Efficiency | Solid-state Medical• ImagingSiPM Silicon Photomultiplier • EM Electro-Magnetic • SNR Signal to Noise Ratio • ENT Ear-Nose-Throat • SPAD Single-Photon Avalanche Diode • FO Fiber-optic • SPECT Single-Photon Emission Computed Tomography • FOP Fiber-optic Plate • SPD Single-Photon Detection • FPD Flat-Panel Detector • TSV Through Silicon Via

Abbott, AGFA, AJAT, Ambu, ams, Aohua, AS Anke, Asahi, Avinger, Basler, BOE, Boston Scientific, Broadcom, Butterfly Network, Caeleste, Canon, CapsoVision, CareRay, Carestream, Clarius, Compact Imaging, Detection Technology, DPIX, Dongbu HiTek, Ecoray, Esaote, Exo, Fujifilm, GE Healthcare, Genoray, Gpixel, Hamamatsu, Heidelberg, Hitachi, Hologic, Hyperfine, Innolux, IntroMedic, iRay, ISDI, JAI, Jinshan, Johnson & Johnson, Karl Storz, Kavo Kerr, Ketek, Kolo, Konica Minolta, Kromek, Leica, LG, Medigus, Mediso, Medonica, Medtronic, Mindray, MinFound, Morita, Neusoft, Olympus, OmniVision, ON Semiconductor, Optovue, Pentax, Philips, Photonicare, Planmeca, Pusen Medical, Rayence, Richard Wolf, Rohm, Samsung, Sharp, Shimadzu, Siemens Healthineers, Silterra, SinoVision, Sirona, Silex, SonoScape, SonoStar, Sony, Spectrum, ST Microelectronics, Stephanix, Stryker, TE Connectivity, Teledyne Dalsa, Terumo, Thorlabs, Topcon, Toshiba, TowerJazz, Trixell, TSMC, United Imaging, Varex, Vatech, Verasonics, Vermon, Vieworks, Vinno, Xfab, X-Scan Imaging, Zeiss, Ziehm, Zimmer, and more…

Medical imaging Ultrasound Photodiode transducers arrays Your needs are Ultrasound out of scope of this report? Contact us for a custom study: Flat panel RF coils displays MRI X-RAYS

Preexisting information

Market Volume (in Munits) ASP (in $) Revenue (in $M)

Information Aggregation

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• Our market data for reusable endoscopy and • We could not forecast the COVID-19 capsule endoscopy was correct and we pandemic and therefore the impact it would anticipated the arrival of the videoscope. have on the global medical imaging business and on the global economy. • We did not anticipate the adoption of • We anticipated the arrival of IGZO in the X-ray disposable endoscopes to be so rapid (due to market as well as the technological change from regulations). CCD to CMOS in interventional imaging. • We did not anticipate such a rapid arrival of point of care ultrasound and OCT • We anticipated the arrival of SiPM in the (technological breakthrough). molecular imaging market. • Our market data for SPECT was a little bit high, and we have corrected it.

Our 2017 report did not cover MRI, this one does.

2015 1920 1946 1970 1970 Chip to the tip Portable endoscope ultrasound

X-Ray Ultrasound fiber-optic Photo-counting Siemens 7T CT scanner discovered X-Ray apparatus endoscope MRI CT MRI machine

Intra-oral GE – PET/CT detector Modalities & systems Digital imaging XIX XX XXI Sensor Semiconductor technologies 1980 1990 2005 2018

Analogue SiPM CdTe-based CMOS GE flexible PM tubes X-ray film CCD technologies pMUT MR coils

Micro camera TFT IGZO endoscopy cMUT

X-ray (radiography + MRI Ultrasound Molecular imaging Endoscopy OCT CT scan)

Main • High-density tissue • Soft tissue • Echogenic tissue • Contrast agent with • Video of visible • Low depth soft contrast specific targets tissue tissue • Widely available • Very high contrast • Cheap • Very high contrast in soft tissue • Widely available • Versatile • Cheap • Versatile on high-density • Versatile (multiple • “See through” • Highly sensitive • Widely available • High sensitivity tissue different sequences imaging • “See through” • Fast • OCT-A • “See through” for multiple • 3D available imaging • View in-depth contrasts) imaging • 3D available • Miniaturization • “See through” Advantages • 3D available • Low contrast-to- imaging noise ratio • 3D available • Can be invasive • Expensive • Low depth • Radiation exposure • Radiation exposure (inside a (intravascular) • Not widely available • Very expensive hole/cavity/surgery) • Expensive • Slow

• Not widely available • Issues with sterility Drawbacks

X-ray is well-positioned in the medical imaging landscape as a “see-through” imaging modality that is widely available and offers a very high contrast on high-density tissue. However, other modalities (e.g. MRI) are taking some CT-scan share in the 3D area because MRI is a non-invasive technique that does not require radiation exposure and offers excellent resolution.

Incoming wave Scintillation Sensor Electronics focusing

Gamma ray, x-ray, Scintillation Incoming wave Sensor In this report, visible, etc. focusing Electronics « solid-state » Tube refers to electronic components, devices, and systems based Ultrasound, x-ray on Crystal semiconductor and IC processes.

Solid-state sensors, CIS, MEMS, etc.

Photon counting CMOS flat panels • Spectral imaging • Lower dose • High image quality • Higher speed and resolution

IGZO Performance a-Se • Better cost efficiency • Direct conversion • Lower noise

a-Si flat panels • Lower cost • Higher integration CCD – Image intensifier • Improved quality • Digitalization

Time

Disposable endoscopy widely Disposable spread in terms endoscopy for of applications specific (going for Capsule gastroenterology) endoscopy applications (small diameter and technologies Reusable and difficult to (rigid and flexible videoscopes for decontaminate) endoscopes) Reusable rigid and flexible fiberscopes for endoscopy rigid and flexible endoscopy 1900s 1960s 2000s 2010s Today 2025 2030 Fiberoptic image guides : key enablers for fiberscopes, will gradually disappear

Camera modules : key enablers for videoscopes but will be replaced by disposable products Very small camera modules with high volume production capabilities : key enablers for disposable products

PMT

PMT has had a wide use in Solid-state (SiPM, APD, CZT…) The molecular imaging development Solid state sensors have seen a of solid-state rapid adoption as they add benefits such as MR compatibility sensors, PET especially SiPM, has PET/CT enabled the combination PET/MR of PET with MR.

Initial PET scans were standalone … rapidly, PETs were combined … thanks to solid-state sensors, machines… with CT scanners… PET/MR was made possible.

SPECT Thanks to the development of CZT, SPECT systems are transitioning from PMT to solid-state

pMUT technology – To be commercialized in 2021 – 2022 for cMUT technology medical and consumer unveiled in 2009 for healthcare applications Successive ultrasonography cart technologies Bulk Piezoelectric – based. New generation developed PZT ceramic cMUT unveiled in Next generation 2017 for point of care that now Bulk Piezoelectric – technology for imaging coexist. PZT ceramic ultrasonography Conventional targeting high technology for sensitivity applications ultrasonography

Reasonable ASP OM* There is a market for OCT outside the specialist’s office. Systems can be installed at $10 000 Specialist retail stores or optician’s shops, or even directly eye care in a patient’s home.

$1 000 Retail stores ✓ Better disease monitoring This emerging opticians ✓ Free up ophthalmologists’ waiting lists market is clearly in strong demand. ✓ Better monitoring of drug effectiveness Products must, $100 by pharmaceutical companies however, have Patient homes good cost to However, the product must have a good cost to performance ratio. performance ratio.

USA : As of 1st July 2020, the CPT (0604T) has Tele- registered OCT for home applications. Patient Upload to diagnosis & acquisition the cloud AI

Patient

Patient Patient MRI

Point of care MRI Patient Patient MRIs were a trend a decade ago which The patients go to the machine The machine goes to the patients ultimately failed. However, we now see a new - A single machine - Expensive - Cheap, - Organ specific revival of such - High resolution - Queueing - Quick - Low resolution products. - High performance - Patient comfort - Movable - Low versatility - Versatile - Dedicated room - Comes to patient - Patients need to - Reduces be moved claustrophobia

Hyperfine and Aspect imaging offer POC systems. It was apparently a trend a few years back but now the big players have gone to bigger, not smaller. This does leave a niche market in the order of tens of million $ for small players such as these start-ups.

What are the drivers for the development of multimodality?:

• First the application itself. For instance, the combination of PET and CT scanners allows a complementary acquisition Many Philips GEMINI TF TOF-PET/CT and therefore offers more accurate modalities are diagnostic information. Conavi IVUS/OCT intravascular catheter being • The second is the available technology. combined to PET MRI Indeed, in the case of PET/MR, this was made offer flexibly possible thanks to the development of high diagnostic magnetic field compatible sensors such as OCT Ultrasound tools. SiPM. • The third is the availability of two or more CT complementary technologies. In the case of catheter based intravascular Endoscopy / Intravascular diagnosis, the use of IVUS allowed to image the tissue in depth. Adding OCT for intravascular complements what IVUS can image. In some cases, it is even possible to combine both technologies to take advantage of both worlds. Status of Medical Imaging Equipment and Detectors 2020 | Sample | www.yole.fr | ©2020 19 TOWARD HIGH VOLUMES MARKETS IN MEDICAL IMAGING Semiconductor technologies are key enablers of this market transformation

• Drivers: disinfection, availability, efficiency Key enabler: Disposable products • This means 1 procedure = 1 product : High volume Low cost/high volume market (Endoscopy) production of camera 2 different modules roads to reach high volume markets: Key enabler: disposable products and Point of care • Drivers: availability, affordability point of care devices Low cost/high volume devices. • Today, OCT and ultrasound systems are bulky and production of (Ultrasound and necessitate specialists to handle them. Point of care OCT) systems are targeting non specialists and widespread micromachined ultrasound usability (nurse’s office, optician, home, etc.) transducers (cMUT/pMUT)

Handheld ultrasound to replace stethoscopes ?

The data is expressed as follows: o By volume (units) System o By market value ($M) Equipment/system Market data and forecasts covered in this report The following report e.g.: CT scanner, endoscope, MRI, etc. presents market data and forecasts with the Detector/module/camera X-ray detector = sensor + scintillator (if needed) + ASIC terminology Endoscopy camera module = image sensor + optics + ASIC highlighted in burgundy. e.g.: a-Si flat-panel detector, CMOS intraoral detector, ultrasound transducer, SiPM

Degree integration of Degree Sensor Sensor e.g.: CMOS image sensor, photodiodes

Spatial resolution Molecular Imaging 10 mm $3B X-ray MRI 1 mm Endoscopy $17B $5B $6B 100 µm Ultrasound $6B 10µm OCT $1B 1µm

100nm

No depth 1mm 1cm 10cm 1m Depth

Medical imaging, a global market worth $38B with four main players.

$6M $6.6B 2019 $0.3B CAGR 16% $4.3B CAGR 4% $3M $0.6B $0.2B CAGR 14%

$0.3B $2B CAGR 5% $1.5B CAGR19-25 +7.3% $3.7B $2.3B CAGR 8%

X-ray Molecular Ultrasound Imaging Endoscopy OCT

Status of Medical Imaging Equipment and Detectors 2020 | Sample | www.yole.fr | ©2020 25 Yole Développement X-Ray Detectors for Medical, Artificial Intelligence for Industrial and Security Applications Medical Imaging 2020 2019

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