PLEXAR IMAGING: A STARTUP DETERMINED TO SOLVE THE CT DOSE VARIABILITY PROBLEM by SHISHIR RAJ ADHIKARI Submitted in partial fulfillment of the requirements For the Degree of Master of Science Department oF Physics CASE WESTERN RESERVE UNIVERSITY August 2013 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We Hereby approve tHe tHesis/dissertation oF Shishir R Adhikari candidate For the Master oF Science degree*. (signed) Edward M. Caner (cHair oF the committee) Bruce E. Terry Steven Izen Edward M. Caner (date) 06/25/2013 *We also certiFy that written approval has been obtained For any proprietary material contained therein. Dedicated to my Family. Table of Contents LIST OF FIGURES .................................................................................................................................... 4 LIST OF TABLES ...................................................................................................................................... 6 ABSTRACT ................................................................................................................................................ 7 PLEXAR IMAGING .................................................................................................................................. 8 NEED .......................................................................................................................................................... 8 DOSE VARIABILITY .................................................................................................................................................... 9 LACK OF STANDARDS OR COMMON METRICS ................................................................................................... 13 DEMAND FROM CT TECHNOLOGISTS .................................................................................................................. 14 CANCER .................................................................................................................................................................... 16 INTRODUCTION TO CT ....................................................................................................................... 18 CT IMAGES .............................................................................................................................................. 21 ATTENUATION COEFFICIENT AND HOUNSFIELD UNIT ........................................................... 23 IMAGE QUALITY (IQ) .......................................................................................................................... 24 IMAGE NOISE ......................................................................................................................................... 25 TUBE CURRENT ....................................................................................................................................................... 26 SCAN (ROTATION) TIME ....................................................................................................................................... 26 SLICE THICKNESS ................................................................................................................................................... 27 PEAK KILOVOLTAGE (KVP) .................................................................................................................................. 27 RECONSTRUCTION ALGORITHM ........................................................................................................................... 28 PLEXAR’S TECHNOLOGY .................................................................................................................... 29 SCANNER CHARACTERIZATION ............................................................................................................................ 30 1 GREEN LINE GENERATION .................................................................................................................................... 34 PROTOCOL RECOMMENDATION ........................................................................................................................... 37 MARKET .................................................................................................................................................. 38 NORTH AMERICAN MARKET SHARE FOR CT SCANNERS BY COMPANY ....................................................... 40 MARKET SIZE .......................................................................................................................................................... 42 COMPETITION/ALTERNATIVES ...................................................................................................... 43 GUIDANCE SYSTEM ................................................................................................................................................. 44 DUKE UNIVERSITY’S RESEARCH .......................................................................................................................... 45 DOSE REDUCTION STRATEGIES ........................................................................................................................... 46 Fixed Tube Current (Technique Chart) .................................................................................................... 46 Tube Current (mA) Modulation ................................................................................................................... 47 Angular (x,y) mA Modulation ....................................................................................................................... 48 Longitudinal (z) mA Modulation ................................................................................................................ 49 Angular and Longitudinal (x,y,z) mA Modulation .............................................................................. 50 Automatic Exposure Control (AEC) ........................................................................................................... 51 Iterative Reconstruction (IR) ....................................................................................................................... 52 BUSINESS MODEL ................................................................................................................................ 57 TRIAL PERIOD ......................................................................................................................................................... 57 Freemium .............................................................................................................................................................. 57 CONVERGECT .......................................................................................................................................................... 60 Customer Solution Profit Model (CSP) ..................................................................................................... 60 Pay per Scan Model ........................................................................................................................................... 61 DOSE REDUCTION QUANTIFIER (DRQ) ............................................................................................................. 61 CT OEMs ................................................................................................................................................................. 61 2 FDA ........................................................................................................................................................................... 61 SWOT ANALYSIS ................................................................................................................................... 62 STRENGTHS ............................................................................................................................................................. 62 WEAKNESSES .......................................................................................................................................................... 64 OPPORTUNITIES ...................................................................................................................................................... 64 THREATS .................................................................................................................................................................. 65 SO STRATEGIES ...................................................................................................................................................... 66 WO STRATEGIES .................................................................................................................................................... 66 ST STRATEGIES ....................................................................................................................................................... 67 WT STRATEGIES ..................................................................................................................................................... 67 FIVE FORCES ANALYSIS ..................................................................................................................... 69 THREATS OF NEW ENTRANTS ............................................................................................................................. 69 THREAT OF SUBSTITUTES ....................................................................................................................................