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2026.09.28 | TB | MedTech | Photon-Counting CT, MRI & Ultrasound

原标题：Photon-counting CT Scanner, MRI & Ultrasound Technology Market – Canon & Shanghai United Imaging Healthcare – Senior Marketing Executive, CT at Koninklijke Philips NV

#medtech

Third Bridge · 2026-09-28

Client-led • 25 Aug 2026

Companies: 7751 JP, 688271 CN, SIE DE, 600718 CN, GE US

Expert Senior Marketing Executive, CT at Koninklijke Philips NV

Agenda

Questions

[00:04:57] What are the competitive advantages of big medical imaging companies such as GE HealthCare and Siemens Healthineers? Would a hospital administrator choose one of them over Canon, UIH [Shanghai United Imaging Healthcare] or others?

Expert [00:05:14]: I think that the general question of the big three vs other players like Canon, United Imaging, Neusoft and others really comes down to two big questions today in terms of buying customer. The first is the breadth of the portfolio, which is, of course, changing with time. That is whether you have full coverage of the standard imaging modalities, X-ray, CT, MR, but also nuclear medicine and other elements like hospital and patient monitoring, therapy devices, etc. The second comes down to the existence and trust in the channel in various markets, whether that is the sales channel or the service channel for each of the vendors, of course, Canon being very much closer to the big three in that sense than United in all markets globally.

[00:06:11] Why does it matter to have a portfolio of older modalities and whether to buy a CT scanner from one company and an MRI from another?

Expert [00:06:23]: That has occurred in the past. What we see as a trend of the last 10-15 years is that there is consolidation in purchasing and more centralisation of purchasing within hospital systems where there's been a strong preference for standardisation, standardisation for purchasing and procurement contracts, but also standardisation in terms of uptime guarantees in terms of clinical applications, training and the like. There is a push in particularly integrated delivery networks in the US and larger hospital systems worldwide to standardise purchasing when and if possible.

Client [00:07:01]: It's more from the PoV [point of view] of the hospital administrator than the doctors because it simplifies things on the finance side, yes?

Expert [00:07:11]: Yes, it gives them aggregated purchasing and leverage in negotiations, etc.

[00:07:17] Siemens was the only company with photon-counting CT on the market for five years. What advantages did that give Siemens, considering it was the only company offering this?

Expert [00:07:34]: What we've seen is in those five years, they've been able to consistently pull ahead in terms of their market share leadership. Prior to that, it was every year or two that they were tussling with General Electric back and forth for market leadership, one pulling ahead of the other in the cycle of new product introductions and market influences. Since then, you see a consistent pulling ahead that's given them thought leadership, both in the direct sales of photon counting CT, but also thought leadership influencing in deals where photon counting isn't even at play in terms of showing leadership in CT technology. We see that even continuing a bit after the introduction that GE made last year for the announcement of their new product, so they do have a first-mover advantage that will continue for some time until a second and third player get ramped up in the space.

[00:08:33] You previously mentioned you want to buy your kit from the same vendor. Is there only one company you buy photon-counting CT from, which automatically provides an advantage in negotiations for the rest of the portfolio?

Expert [00:08:51]: It can, but what we see is that, of course, photon counting is still very early in its adoption. It has certain advantages vs conventional CT today, but those advantages are only seen in certain areas, and they're not necessarily proven in all areas with clinical evidence. The premium that is placed on photon counting, you see still not being paid for universally and unquestionably when that's in the discussion on the CT side. You also have advantages and disadvantages in other modalities that play when you consider the portfolio at play. It is not as simple as looking solely at the CT within the purchasing decision. You also have to consider cardiovascular labs, ultrasound monitoring devices, etc, if you take that standardisation and view of things.

[00:09:48] You mentioned that many advantages are not yet proven. Is that because studies can be time-consuming? Is it not as transformational as previous innovations?

Expert [00:10:14]: I wouldn't necessarily say it's not as transformational. There is a normal adoption cycle within CT. It usually takes and it's this five-year period where you go from observational studies to actually showing the impact on care. The early studies, of course, in imaging, you see higher resolution pictures, you see that those are potentially easier to interpret. It's something that radiology appreciates, but whether you've actually changed the care pathway for those patients that are imaged on photon counting vs conventional CT, that takes a number of years to trace the care pathway through, if you understand.

If I have a photon-counting CT vs a conventional at the hospital and something is seen on photon counting, perhaps something that wasn't able to be seen before. The question is, has my treatment as a patient changed because of that or not in terms of the overall health care economics, or is it just a better picture? If it's just a better picture, is it worth the price premium for that CT vs having a conventional CT that maybe would have gotten me to the same answer. Now conceivably, we all want to buy in and we say, photon counting has higher resolution. I can see disease earlier. Therefore, I should be able to do something earlier, but that may require downstream changes in the health care pathway that aren't just the CT scanner.

[00:11:40] What does the phrase ‘thought leadership’ mean in practice?

Expert [00:11:48]: I think CT scanners are long-term purchases. The replacement cycle for CT has increased over the last 12 years from an average replacement every seven years to an average replacement every 12 years, so not quite doubling, but significantly longer. Whenever you are purchasing something, you want to make sure that you're purchasing from a vendor that is in command of that space, so that they are going to progress with you and be with you throughout not just that 12 years, but the expected duration of 18-22 years of lifespan for that CT scanner. The other thing is that you want to establish that relationship and know that continued innovation will come on to the platforms you're investing in, in terms of future clinical applications, future workflow advances as upgrades to that product. Setting in mind that you're a company that has that rich pipeline available to you is quite important and quite important to the customer.

[00:12:51] UIH has been growing incredibly quickly. How has it managed to overcome barriers to entry, such as thought leadership and others?

Expert [00:13:08]: I think they've done a very good job of establishing that early. They've shown first movers advantage in some spaces. They were the first with a very robust whole body PET scanner, which is something that while it's a smaller market, it's a bit more niche than CT, certainly claimed the attention and got the attention already even at some of the academic hospitals in the United States. They also had quite a progress in terms of the artificial intelligence spend and the number of software applications that they were able to come with quite quickly if you look at it. Also just by demonstrating that they were able to go from a very small portfolio and almost no market share in roughly 2014 to having a considerable share around the world, but specifically moving up to number two/number one position within the largest market of imaging, which is in China within the decade is certainly impressive.

I think they do demonstrate that thought leadership, the ability to get things done as well as the robustness of not just filling a portfolio, but having a couple of those examples of leadership, whether it's in PET or in AI. They're also moving that way into CT, making some noise with their introduction of the SiriuX platform at I think it was RSNA last year, if not China Med [sic] or CMEF before that. I would say that most of the questions that you tend to hear often public in the market today have less to do with the product and the technology and more of what is the service network, what is the reliability of the system, what's the quality of the system that are things that simply take time to build up evidence for.

[00:15:03] Are there major differences in service provision or machine quality among big companies?

Expert [00:15:12]: Quality-wise, I think there are puts and takes, but everybody operates, I think, more or less in the similar band, if you will. There are always examples here and there. Examples where things haven't worked as well, but given the regulated nature of the industry, those are things that are largely controlled for in terms of the quality of the product. In the service channel, that is something that is highly local. It really depends on the individuals that are hired by those companies, so you can see variability mostly, of course, with UI, with some of the newcomers, Canon no longer being a newcomer in some areas of the portfolio. Of course, in those spaces, you can really see regional variations. It has to do with the longevity and the experience of the individual engineers sometimes that are in those spaces. Of course, the big three plus Canon have been more established, say, in the United States and in Europe for some time, and you're having United and others coming into play where they're building that. It really becomes an individual question as they build the network of engineers that they have around the world.

[00:16:27] Does Canon take different approaches to service provision, or down to regional variations?

Expert [00:16:37]: It's regional. I think the layer on top of that or below that, if you dig one layer down is that there's always the choices that you have, of course, direct vendor service and you have third-party servicers around the world. It really depends on the region that you're in if they're building that from scratch, if they're buying that through a third-party servicer and then the quality of the teams that they're building or buying. It's not something that is endemic to the vendor themselves. It's simply the staffing and the experience that they have either directly or indirectly.

[00:17:14] Are third-party service providers taking a share from big companies, and in which areas?

Expert [00:17:23]: They are. If you look at it, it's roughly inversely proportional to the position in the portfolio. At the lower end of the portfolio, the lesser expensive equipment and imaging, in particular, we see a trend toward higher proportions of third-party servicers. As you get to the middle of the portfolio and up, it starts to transition very heavily toward the vendors. That's a nature of really the complexity of the machines, the newness of the technology, the access to tooling and spare parts as well as the knowledge to fix them, right? There's an advantage that the OEMs have in that sense that they're more familiar with their technology. They have more access early on, but it is an area that is increasingly competitive toward the middle, middle-lower portions of the portfolios.

Client [00:18:10]: Are OEMs required to provide spare parts to third-party service providers?

Expert [00:18:16]: They are not allowed to block access to them. If they're available for purchase, they're made available for purchase as well as the documentation for servicing, there's a minimum required threshold that can be made available to a third-party servicer, to a biomedical hospital upon request.

[00:18:37] Does kit standardisation favour any of the big companies over others? Do some have better relationships with central decision-makers and with individual departments?

Expert [00:18:57]: Yes. I think that's an area where the big three certainly have an advantage if you look across the market, both because of the longevity with which they've had those relationships. Also it comes back to the breadth of the portfolio. The more times you have the chance to engage administrators, to engage procurement staff in the discussion, the more familiar you are to them and the more ability you have a chance to refine those relationships and cement them for the long term.

[00:19:34] I expect growth at the leading edge, where new technologies are, not in developing markets, because the kit is too expensive. What do you think?

Expert [00:19:51]: The growth comes, if you look at dollar or euro growth, certainly it's coming from the mature markets. It's biased toward the portions of the portfolio that have greater value and hence, greater potential price and profitability. You do have some growth in the middle, mid-lower portions of the portfolio in the developing market with older technologies, but that is more unit growth than it is in volume growth than it is value growth. Then you see actually paradoxically right now some contraction, if you will, globally at the very lowest part of the portfolio for the first time coming into play over the last year or so and continuing where there is more of a standardisation toward the middle. In the mature markets, it's a bit of a shift up across modalities right now where you start to see more investments in things like photon counting in CT, you see more investment in helium-free MRI, etc. Again, that comes with additional growth.

[00:21:00] Do some major companies have strengths in particular modalities? Which are they?

Expert [00:21:11]: Yes. You see cycles, so if you look across the companies, it's right now a very innovative time in CT with Photon counting being pursued by from what I can tell, every one of the major vendors as well as some of the startups out of China, where you've got first-mover advantage on the product side with Siemens, but you also have pockets of incredible competence across many of those companies, whether it's GE, Canon, United Imaging, Neusoft all have strengths in those areas from a technology perspective.

When you look at it from a business perspective, of course, that favours some of the more established companies or the longer established companies of Siemens and GE with a bit more marketing muscle behind those things and also Canon closely behind them. If you look at MRI, you have leadership in two of the big three with a third coming along with the helium-free. The major modalities tend to follow a pattern where one vendor is ahead for a bit of time and then the others rapidly catch up. That's how it has been for quite some time. It remains to be seen now with some of the new entrants, how that dynamic changes or if it just adds more players.

[00:22:39] What's your instinct on the new vendors doing changes?

Expert [00:22:46]: I believe that the new vendors will accelerate the pace of innovation, and you'll see more of a five- or six-way race coming to fruition rather than it fundamentally changing the dynamic. It will just accelerate the dynamic when it comes to periods of change. The big test in that will be, does everybody stay in the race, or do you start to see some consolidation? I think it's too early to predict that. There is certainly room for a fifth or sixth player in the market, but it's different than it has been, say, in ultrasound for years where you've been used to having more than three or four players. It will be exciting. It's hard to predict. That's a bit of a crystal ball question.

[00:23:33] Why is ultrasound fragmented? Is it because it’s older technology, cheaper and not dangerous to use?

Expert [00:23:46]: I think it's entrance of more players because it was an easier market to enter. It's a simpler technology. If you look at the scale, especially as things are moving to being handheld and using tablets as the interfaces nowadays with access to inexpensive components outside of the transducer. It really lends itself to having more competition. It's easier to manufacture, easier to transport, easier to service and the intellectual property to get started in large parts of ultrasound wasn't as big of a barrier as it was in the larger modalities. It's a combination of capital and IP as well as the age of the technology in some ways.

[00:24:38] Multiple departments in hospitals use ultrasound. Rheumatologists and cardiologists operate their own ultrasound machines. Is that a path other modalities also take? Why is ultrasound siloed in the radiology department?

Expert [00:25:02]: The reasons are a bit more technical with that. Ultrasound has two things going for it. The first is what we just talked about. It's inexpensive. It's portable. It's easy to move around. The second is something you mentioned earlier, which is that the risk factor for ultrasound is quite low, so there is no ionising radiation. There is no magnetic field or training for safety around that. There is no knowledge on MRI, for instance, it's a very technical, very physics heavy way of acquiring the image where ultrasound is more, let's call it, point and shoot like your camera to a certain degree. Accessibility, lack of risk and portability all come together historically to have facilitated that, and it's really resulted in the proliferation you have, which is that it's in all the departments.

[00:25:54] What are Canon's competence pockets?

Expert [00:26:02]: They've certainly been strong over the past decade or so in CT. They're growing to a certain degree, a bit stronger in MR, but they're not quite as strong. They're very much clearly behind the big three that way. Their advanced visualisation and AI capabilities were greatly enhanced with the acquisition of Vital Images a few years ago, so they've got a pretty strong offering in the health care IT space that way, but they are largely dependent, especially in the US on their CT presence and then secondarily to the nuclear medicine and then with MR coming in third that way.

Client [00:26:47]: What was the name of the acquisition?

Expert [00:26:52]: They acquired Vital Images. I think it's been maybe 10 years now, it's their advanced visualisation space and their AI applications. The product name is Vitrea, if you look that up, I don't know what the business unit term is. I think they're Canon Healthcare Informatics [sic] now is what they call it.

[00:27:25] Are there other big differences in the offering levels in AI data visualisation among the big vendors?

Expert [00:27:35]: That has been an area where actually, I think you can almost make the comment across the board that the big three plus Canon have similar offerings in the space. Of course, there are natural puts and takes, but overall, that's an area that among the OEMs has a bit stagnated over the last few years as there have been just an explosion in the number of start-ups and medium-sized companies in the visualization and AI space. Actually, with access to some of the toolkits and the rise of AI, the barrier to compete in that space has been lowered dramatically from what it was 10 or 15 years ago. I think you're going to see a lot of rethinking of how those applications and how those platforms evolve into the future with really two distinct trends, one that started earlier, which is that in the radiology space, you see radiologists really consolidating their tools and their reading around the PACS and using less third-party applications, less third-party workstations or thin clients nowadays than in the past outside of academic centres that have their own 3D labs that do processing.

[00:29:39] Do vendors have advantages? Do they have access to raw data that big companies are trying to build applications on top of them don’t?

Expert [00:29:53]: You can really think of the space and break it down. There are applications where the OEMs have a natural advantage, but it's also their space. Image formation, turning electrical signals and photons in CT or magnetic sequences in MRI into images themselves, that access, that architecture is something that is uniquely available to the OEMs. It's also the knowledge of the physics of the machine that allow that to happen. It's very difficult to do that from the outside.

The second area that is pretty uniquely available to the OEMs is the on-scanner workflow, so anything that automates patient placement, exam setup, the execution of the exam itself, that is something that is uniquely positioned for the OEMs and is much easier to do, if not impossible to do for the start-ups. Third parties, on the other hand, have the ability to start with DICOM data or the images that come out of the scanner, almost as easily as the OEMs themselves other than owning the contract and the connection to the site and the data pathway. There's nothing physically preventing them from using the same data that way from a diagnostic task or a triaging task that is out there.

[00:31:16] Are there other major regional differences in where the big vendors are strong or weak?

Expert [00:31:28]: A bit. I think out of the big three, there are small differences between the US, western Europe, eastern Europe to a certain extent. Within China, there's a bigger difference in that Canon does not do very well in China for historical and cultural reasons. On the flip side, if you look at the newer vendors, UI is doing very well in China, but only starting to emerge in eastern Europe and some of the other geographies, but if you look at the big three in particular, it's relatively consistent across the west. It's just in the east where things start to change.

Client [00:32:09]: Is Canon dominant in Japan, or is there still a lot of competition?

Expert [00:32:14]: They are, yes. Within Japan, Canon is dominant and then the relative contribution of the others follows the same relative breakdown just below Canon.

[00:32:30] Canon is an outsider to the big three. Has the company tried to break into this market differently than UIH? How exactly was that different?

Expert [00:32:45]: If we can look back, Canon entered the CT market almost exactly 20 years ago in North America. Their approach was actually wholly different than United Imaging when they started, and they've continued that, which is they focused almost entirely, I always have to say that, on the human relationship with the customer. They invested heavily in clinical applications. They invested heavily on training the customer and making sure they had almost unlimited access to being able to understand how to use their systems. Then only after that moved into technology differentiation with some of the very first large coverage systems, the 16cm systems that came to market.

If I compare that with United Imaging in terms of how they've entered, it's largely been technology first. It's been coming up with first the whole body PET in nuclear medicine. It's been coming heavily AI applications first and an overwhelming number of applications at the beginning, along with the promise to customers in many markets of unlimited upgrades and software for life, if you think that. They have taken as the different companies have taken different approaches as they've entered the market as they've scaled up, and they've largely been successful, albeit at different points in time.

[00:34:16] Canon is caught in the middle and isn’t the natural beneficiary of standardisation, unlike the big three companies. UIH outcompeted Canon on price and technology. What do you think?

Expert [00:34:38]: I think that's a good hypothesis because I think what you see with Canon is despite entering, for instance, CT about 20 years ago, they have not risen out of the third or fourth place setting in most markets outside of Japan. They don't look to be fundamentally expanding their portfolio to be a full coverage player, which means they'll be at the disadvantage in standardisation. I think that's a fair assessment.

Client [00:35:08]: Technological mastery falls off a cliff after CT, nuclear medicine and MRI, yes?

Expert [00:35:30]: Yes. I'm not as familiar with those spaces, but I don't see that they have a broader portfolio other than I think they have a small monitoring business and they've got a small ultrasound business also, but it's not nearly as meaningful as others.

[00:35:52] How related are the underlying physics and R&D technologies for the different modalities? Are they unrelated, hence you have to do R&D separately?

Expert [00:36:10]: The amount of overlap in R&D is small relative to the opportunity or to the goal at hand. If you look at it, there is, of course, some synergy between, say, CT and general X-ray because of the need to have an X-ray tube development team, although. You have some basic mechanical and electrical skills that could overlap, but MRI physics and CT physics are fundamentally different. As an example, ultrasound physics are different from both of those, so you would have to have a full outfit or nearly a full outfit for each one