2015 PET IMAGING MARKET SUMMARY REPORT. Table of Contents

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1 2015 PET IMAGING MARKET SUMMARY REPORT Table of Contents I. Objectives... I-1 II. Executive Summary... II-1 III. Methodology... III-1 IV. Findings...IV-1 A. PET Scan Volume...IV-1 B. Installed Base of PET/CT and PET Scanners...IV-32 C. Purchase Plans for PET Imaging Equipment and Market Scenarios...IV-54 D. Radiopharmaceutical Utilization and Budgets...IV-70 E. PET Imaging Site Operations Characteristics...IV-90

2 2015 PET IMAGING MARKET SUMMARY REPORT Exhibits A. PET Scan Volume 1. Total Estimated Clinical PET Scans, by Current PET Capability, IV-1 2. Distribution of PET Imaging Sites and PET Scans, All Sites, by Current PET Capability, IV-2 3. Total PET Imaging Sites, by Current PET Capability, by IMV Census Year, 2001 to IV-2 4. Distribution of PET Imaging Sites and PET Scans, by Site Type, IV-3 5. Total Estimated Clinical PET Scans, by Site Type, IV-3 6. Total PET Imaging Sites, by Site Type, by IMV Census Year, 2001 to IV-4 7. Distribution of PET Imaging Sites, by Current PET Capability and Site Type, as of 2015 PET Census Survey...IV-4 8. Distribution of PET Capability of PET Imaging Sites, by Site Type, as of 2015 PET Census Survey...IV-5 9. Percent of Short-Term General Hospitals Performing PET Imaging, by Current PET Capability, as of 2015 PET Census Survey...IV Whether PET Scan Volume Will Increase, Decrease, or Stay the Same Over the Next 12 Months, by Site Type, as of 2015 PET Census Survey...IV Current and Anticipated 2016 PET Scan Volume, by Site Type, as of 2015 PET Census Survey...IV Average Annual Clinical PET Scans per Site, by Current PET Capability and Site Type, IV Average Annual Clinical PET Scans per Site, by Current PET Capability, IV Average Annual Clinical PET Scans per Site, by Site Type, IV Distribution of PET Imaging Sites by PET Scan Volume Ranges, by Current PET Capability, IV Distribution of PET Imaging Sites by PET Scan Volume Ranges, by Site Type, IV Mix of Oncology, Cardiology, and Neurology Clinical Applications for PET/CT and PET Scans, IV Total Estimated PET/CT and PET Scans, by Clinical Application, IV Clinical PET/CT and PET Scan Application Mix, by Site Type, IV Percent of PET Imaging Sites Performing Clinical Application Types, and Mean Annual PET Scans per Site Performing, IV Percent of PET Imaging Sites Performing Oncology Applications, and Mean Annual PET Scans per Site Performing, by Site Type, IV Percent of PET Imaging Sites Performing Cardiology Applications, and Mean Annual PET Scans per Site Performing, by Site Type, IV Percent of PET Imaging Sites Performing Neurology Applications, and Mean Annual PET Scans per Site Performing, by Site Type, IV Estimates of Clinical Applications Mix, by Current PET Capability, IV Estimates of Percent & Number of Sites Performing PET Scans, and Average Scans per Site Performing, by Clinical Application, IV Distribution of PET Imaging Oncology Scans, by Indication Type, IV Distribution of PET Imaging Oncology Scans, by Lung Cancer Indication Type, IV Distribution of PET Imaging Oncology Scans, by Indication Type, IV Total PET Imaging Oncology Scan Volume, by Indication Type, IV PET Oncology Scan Volume for Lung Indications, IV Percent of Sites Performing PET Oncology Scans, and Mean Annual Scans per Site Performing, by Indication Type, IV Estimates of PET Oncology Scans, by Current PET Capability, IV Estimates of Percent/Number of Sites Performing PET Oncology Procedures, and Average PET Scans per Site Performing, by Current PET Capability, IV Types of PET Neurology Scans, by Current PET Capability, IV Types of PET Neurology Scans, by Site Type, IV-21

3 36. Percent of Sites Performing PET Neurology Scans, and Mean Annual PET Scans per Site Performing, by Neurology Study Type, IV Percentage Mix of PET Scans Performed, by Current PET Capability, IV PET Inpatient vs. Outpatient Mix, All Sites, IV PET Inpatient vs. Outpatient Mix, by Site Type, IV Mix of Pediatric vs. Adult PET Scans, IV Mix of Pediatric vs. Adult PET Scans, by Site Type, IV Whether Fixed PET or PET/CT Site Performs Research Scans, by Site Type, as of 2015 Census Survey...IV Percentage of Sites Performing Research vs. Clinical PET Scans on Fixed PET or PET/CT Scanners, by IMV Census Year, IV Whether PET Imaging Site Has a Grant-Funded PET Research Center on Campus, as of 2015 PET Census Survey...IV Whether PET Imaging Site Has a Grant-Funded PET Research Center on Campus, by Site Type, as of 2015 PET Census Survey...IV Percent of Fixed PET/CT Sites Performing Diagnostic CT-Only Scans with No Associated PET Scans, by Site Type, as of 2015 PET Census Survey...IV Percent of Fixed PET/CT Sites Performing Diagnostic CT-Only Scans with No Associated PET Scans, by IMV Census Year, 2003 to IV Average Number of CT-Only and PET Scans per Site, at Sites Performing Diagnostic CT-Only Scans on their Fixed PET/CT Scanners, IV Average Number of CT-Only and PET Scans per Site, at Sites Performing Diagnostic CT-Only Scans on their Fixed PET/CT Scanners, by Site Type, IV Whether Department Currently Performs or Plans to Perform Specialized PET Scans, as of 2015 PET Census Survey...IV Whether Department Currently Performs or Plans to Perform NaF 18 Bone Scans, by Site Type, as of 2015 PET Census Survey...IV Whether Department Currently Performs or Plans to Perform PET Simulation for Radiation Therapy Treatment Planning, by Site Type, as of 2015 PET Census Survey...IV Whether Department Currently Uses or Plans to Use Neuroimaging Agents to Detect Beta-Amyloid Plaque for Alzheimer s Disease, by Site Type, as of 2015 PET Census Survey...IV Whether Department Currently Performs or Plans to Perform PET Myocardial Perfusion Studies, by Site Type, as of 2015 PET Census Survey...IV Whether Department Currently Performs or Plans to Perform Cardiovascular CT Studies with a PET/CT Scanner, by Site Type, as of 2015 PET Census Survey...IV-31 B. Installed Base of PET/CT and PET Scanners 1. Distribution of Fixed PET/CT vs. PET Scanners in Hospital vs. Non-Hospital Sites, as of 2015 PET Census Survey...IV Distribution of Fixed PET/CT and PET Scanners, by IMV Census Year, 2001 to IV Distribution of Fixed PET/CT and PET Scanners, by Hospital vs. Non-Hospital Location, by IMV Census Year, 2001 to IV Distribution of Hospital and Non-Hospital Sites with Fixed PET/CT or PET Scanners, by IMV Census Year, 2001 to IV Site Type Mix of Sites with Mobile vs. Fixed PET/CT & PET Scanners, by Site Type, as of 2015 PET Census Survey...IV Distribution of Mobile vs. Fixed PET/CT and PET Sites, by Site Type, as of 2015 PET Census Survey...IV Mobile vs. Fixed PET/CT or PET: Sites and Units, as of 2015 PET Census Survey...IV Distribution of Fixed PET/CT and PET Scanners, by Site Type, as of 2015 PET Census Survey...IV Distribution of Sites, by Number of Fixed PET/CT or PET Scanners Installed, by Site Type, as of 2015 PET Census Survey...IV Percent Distribution of Fixed PET/CT & PET Installed Base, by Manufacturer, as of 2015 PET Census Survey...IV-36

4 11. Fixed PET/CT & PET Installed Base Share, by Manufacturer, by IMV Census Year, 2003 to IV Unit Distribution of Fixed PET/CT and PET Installed Base, by Manufacturer, by IMV Census Year, 2005/06 to IV Fixed PET/CT & PET Installed Base, by Manufacturer, by Site Type, as of 2015 PET Census Survey...IV Fixed PET/CT & PET Installed Base, by Year of Installation, as of 2015 PET Census Survey...IV Distribution of Fixed PET/CT & PET Installed Base, by Year of Installation, by Site Type, as of 2015 PET Census Survey...IV Fixed PET/CT & PET Installed Base Market Share, by Installation Timeframes, as of 2015 PET Census Survey...IV Percent Distribution of Fixed PET/CT Installed Base, by Manufacturer, as of 2015 PET Census Survey...IV Unit Distribution of Fixed PET/CT Installed Base, by Manufacturer, by IMV Census Year, 2005/06 to IV Fixed PET/CT Installed Base Share, by Manufacturer, by IMV Census Year, 2003 to IV Fixed PET/CT Installed Base Share, by Manufacturer, by Site Type, as of 2015 PET Census Survey...IV Fixed PET/CT Installed Base, by Year of Installation, as of 2015 PET Census Survey...IV Distribution of Fixed PET/CT Installed Base, by Year of Installation, by Site Type, as of 2015 PET Census Survey...IV Percent Distribution of PET/CT Installed Base, by Number of CT Slices, as of 2015 PET Census Survey...IV Distribution of PET/CT Installed Base, by Number of CT Slices, by Site Type, as of 2015 PET Census Survey...IV PET/CT Installed Base Market Share, by Number of CT Slices, as of 2015 PET Census Survey...IV Percent of PET/CT Installations, by Number of CT Slices, by Year of Installation, as of 2015 PET Census Survey...IV Bore Size of Installed PET/CT Scanners, as of 2015 PET Census Survey...IV Distribution of Installed Base of PET/CT Scanners, by Bore Size, by Site Type, as of 2015 PET Census Survey...IV PET/CT Installed Base Market Share, by Bore Size, as of 2015 PET Census Survey...IV Percent of PET/CT Installations, by Bore Size, by Year of Installation, as of 2015 PET Census Survey...IV Percent Distribution of Fixed PET Installed Base, by Manufacturer, as of 2015 PET Census Survey...IV Unit Distribution of Fixed PET Installed Base, by Manufacturer, by IMV Census Year, 2005/06 to IV Distribution of Fixed PET Installed Base, by Year of Installation, by Site Type, as of 2015 PET Census Survey...IV Whether PET/CT Scanner Has Time of Flight Capability, as of 2015 PET Census Survey...IV Whether PET/CT Scanner Has Time of Flight Capability, by Site Type, as of 2015 PET Census Survey...IV Whether PET/CT Scanner Has Point Spread Function, as of 2015 PET Census Survey... IV Whether PET/CT Scanner Has Point Spread Function, by Site Type, as of 2015 PET Census Survey...IV Whether PET/CT Scanner Has Cardiac Gating, as of 2015 PET Census Survey...IV Whether PET/CT Scanner Has Cardiac Gating, by Site Type, as of 2015 PET Census Survey...IV Whether PET/CT Scanner Has Respiratory Gating, as of 2015 PET Census Survey...IV Whether PET/CT Scanner Has Respiratory Gating, by Site Type, as of 2015 PET Census Survey...IV Distribution of Financing Methods for PET/CT & PET Installed Base, by Site Type, as of 2015 PET Census Survey...IV Distribution of Sources for PET/CT & PET Service Support, by Site Type, as of 2015 PET Census Survey...IV-53

5 C. Purchase Plans for PET Imaging Equipment and Market Scenarios 1. PET Site Plans for Purchasing PET Imaging Equipment Over the Next Three Years, as of 2015 PET Census Survey...IV Trend in PET Site Plans for Purchasing PET Imaging Equipment Over the Next Three Years, by IMV Census Year, 2003 to IV PET Site Plans for Purchasing PET Imaging Equipment Over the Next Three Years, by Current PET Capability, as of 2015 PET Census Survey...IV PET Site Plans for Purchasing PET Imaging Equipment Over the Next Three Years, by Site Type, as of 2015 PET Census Survey...IV Planned Purchases of PET/CT vs. PET/MR Scanners, as of 2015 PET Census Survey...IV Planned Purchases of PET/CT vs. PET/MR Scanners, by Site Type, as of 2015 PET Census Survey...IV Planned Purchases for First Buyer, Replacement vs. Additional PET Imaging Units, by Current PET Capability, as of 2015 PET Census Survey...IV Planned Purchases for First Buyer, Replacement vs. Additional PET Imaging Units, by Site Type, as of 2015 PET Census Survey...IV Reclassified: Planned Purchases for First Buyer, Replacement vs. Additional PET Imaging Units, by Current PET Capability, as of 2015 PET Census Survey...IV Trend in Planned Purchases for First Buyer, Replacement vs. Additional PET Imaging Units (Reclassified), by IMV Census Year, 2011 to IV Distribution of Planned PET/CT Purchases, by Number of CT Slices, as of 2015 PET Census Survey...IV Planned Purchases of PET/CT Scanners, by Number of CT Slices, by Current PET Capability, as of 2015 PET Census Survey...IV Planned Purchases of PET/CT Scanners, by Number of CT Slices, by Site Type, as of 2015 PET Census Survey...IV Trend in Planned Purchases of PET/CT Scanners, by Number of CT Slices, by IMV Census Year, 2011 to IV Distribution of Planned PET/CT Purchases, by Bore Size, as of 2015 PET Census Survey...IV Plans for New vs. Refurbished PET Scanners, by Site Type, as of 2015 PET Census Survey...IV Distribution of Intended Financing Methods for Next PET Acquisition, by Site Type, as of 2015 PET Census Survey...IV Percent Distribution of Sites Mentioning Manufacturers Being Considered for Future PET Imaging Unit Purchases, as of 2015 PET Census Survey...IV Percent Distribution of Sites Mentioning Manufacturers Being Considered for Future PET Imaging Unit Purchases, by IMV Census Year, 2008 to IV Brand Loyalty: PET Manufacturers Being Considered by Current PET Imaging Sites, as of 2015 PET Census Survey...IV Distribution of 2015 PET Capital Equipment Budgets, as of 2015 PET Census Survey...IV PET Capital Equipment Budget Trend, by Budget Year, IV Distribution of 2015 PET Capital Equipment Budgets, by Current PET Capability, as of 2015 PET Census Survey...IV Average 2015 PET Capital Equipment Budget per Site Having Budgets >$0, by Current PET Capability, as of 2015 PET Census Survey...IV Distribution of 2015 PET Capital Equipment Budgets, by Site Type, as of 2015 PET Census Survey...IV Distribution of PET Capital Equipment Budgets, as of 2015 PET Census Survey...IV Current PET Replacement Cycle, Based on 2015 PET Census Survey Responses...IV Average Age of PET Imaging Systems Upon Replacement, by IMV Census Year, 2003 to IV Estimated Raw Replacement Unit Demand from PET Installed Base, Based on Current PET Replacement Cycle, IV Scenario I: Raw PET Replacement Demand, Estimated PET Imaging Unit Market Projections, IV-68

6 31. Scenario II: Reduced Purchase Intent for <200 Bed Hospitals, Estimated PET Imaging Unit Market Projections, IV Scenario III: Respondent Plans for Near Term Slip to Latter Years, Estimated PET Imaging Unit Market Projections, IV-69 D. Radiopharmaceutical Utilization and Budgets 1. Total Estimated Clinical PET/CT and PET Scans, by Source of Radiopharmaceuticals, IV Percent of Clinical PET/CT and PET Scans Supplied by Outside Suppliers vs. Cyclotron on Site, IV Radiopharmaceutical Sources for PET/CT and PET Sites, by Current PET Capability, IV Radiopharmaceutical Sources for PET/CT and PET Sites, by Site Type, IV Distribution of Clinical PET/CT and PET Scans, by Source of Radiopharmaceuticals, by Site Type, IV Average Clinical PET/CT and PET Scans per Site, by Source of Radiopharmaceuticals, by Current PET Capability, IV Average Clinical PET/CT and PET Scans per Site, by Source of Radiopharmaceuticals, by Site Type, IV Average Clinical PET/CT and PET Scans per Site, by Source of Radiopharmaceuticals, All Sites, IV Average Clinical PET/CT and PET Scans per Site, by Source of Radiopharmaceuticals, for Fixed PET/CT and PET Sites, IV Distribution of Clinical PET/CT and PET Scans, by Radiopharmaceutical Used, IV Distribution of Clinical PET/CT and PET Scans, by Radiopharmaceutical Used, IV Percent of Sites Using Radiopharmaceuticals and Mean Annual PET Scans per Site Using that Agent, IV Average Clinical PET/CT and PET Scans per Site Using F 18 DG, by Current PET Capability, IV Whether Department Currently Performs PET Myocardial Perfusion Studies, by Current PET Capability, as of 2015 PET Census Survey...IV Whether Department Currently Performs PET Myocardial Perfusion Studies, by Site Type, as of 2015 PET Census Survey...IV Distribution of PET Imaging Sites Performing PET Myocardial Perfusion Studies, and Number of PET Scans Performed, by Current PET Capability, IV Percent of Sites Performing PET Myocardial Perfusion Studies and Mean Annual PET Scans per Site, by Current PET Capability, IV Percent of Sites Performing PET Myocardial Perfusion Studies and Mean Annual PET Scans per Site, by Site Type, IV Distribution of PET Myocardial Perfusion Studies, by Whether Stressed or Not Stressed with a Pharmacological Stress Agent, by Current PET Capability, IV Percent Distribution of PET Pharmacological Stress Agents Used in PET Myocardial Perfusion Studies, IV Percent Distribution of PET Pharmacological Stress Agents Used in PET Myocardial Perfusion Studies, by Site Type, IV Percent of PET Myocardial Perfusion Studies Using PET Radiopharmaceutical Agents, IV Percent of Sites Performing PET Myocardial Perfusion Studies Using RB 82 and Mean Annual PET Scans per Site, by Site Type, IV Percent of Sites Performing PET Myocardial Perfusion Studies Using N 13 Ammonia and Mean Annual PET Scans per Site, by Site Type, IV Average Price per Dose of F 18 DG Used in the Last Full Quarter for PET Scans, by Site Type, as of 2015 PET Census Survey...IV Whether F 18 DG Price per Dose Includes Shipping, as of 2015 PET Census Survey...IV Percent Distribution of Millicuries of F 18 DG Injected per Patient, by Site Type, as of 2015 PET Census Survey...IV-84

7 28. Distribution of 2015 PET Radiopharmaceutical Budgets, for Fixed PET Imaging Sites Using Outside Suppliers...IV PET Radiopharmaceutical Budget Trend for Sites with Fixed PET Imaging Units, IV Distribution of PET Radiopharmaceutical Budgets, by Site Type, IV Average PET Radiopharmaceutical Expenditures per Fixed PET Imaging Site, by Site Type, IV Average PET Radiopharmaceutical Expenditures per Clinical PET Scan at Fixed PET Imaging Sites, by Site Type, IV PET Radiopharmaceutical Expenditures, in PET/CT and PET Sites, by Site Type, IV Distribution of PET Radiopharmaceutical Budgets, as of 2015 PET Census Survey...IV Market Share of PET Radiopharmaceutical Suppliers, Based on PET Radiopharmaceutical Expenditures, IV Market Share Trend of PET Radiopharmaceutical Suppliers, Based on PET Radiopharmaceutical Expenditures for Fixed PET Imaging Sites, IV Market Share of PET Radiopharmaceutical Suppliers, Based on PET Radiopharmaceutical Expenditures, by Site Type, IV Percent of PET Sites Mentioning Radiopharmaceutical Suppliers Used, IV-89 E. PET Imaging Site Operations Characteristics 1. Department Operating PET Imaging Equipment, by Site Type, as of 2015 PET Census Survey...IV Department Operating PET Imaging Equipment, by Current PET Capability, as of 2015 PET Census Survey...IV Year PET/CT or PET Facility Started Performing PET Scans, by Site Type, as of 2015 PET Census Survey...IV Year PET/CT or PET Facility Started Performing PET Scans, by Current PET Capability, as of 2015 PET Census Survey...IV Average PET Scans Performed per Fixed PET Imaging Unit, by Site Type, IV Average PET Scans Performed per Fixed PET Imaging Unit, IV Percent of PET/CT and PET Sites with Staff Types, as of 2015 PET Census Survey...IV Percent of PET/CT and PET Sites with Staff Types, by Current PET Capability, as of 2015 PET Census Survey...IV Percent of PET/CT and PET Sites with Staff Types, by Site Type, as of 2015 PET Census Survey..IV Mean Number of FTE Staff per PET/CT and PET Site Having that Type, as of 2015 PET Census Survey...IV Mean Number of FTE Staff per PET/CT and PET Site Having that Type, by Current PET Capability, as of 2015 PET Census Survey...IV Mean Number of FTE Staff per PET/CT and PET Site Having that Type, by Site Type, as of 2015 PET Census Survey...IV Average Annual PET/CT and PET Scans per Certified Technologist FTE at Fixed PET/CT & PET Sites, IV Distribution of Sites, by Total Physicians in Department Who Read PET/CT and/or PET Scans, by Current PET Capability, as of 2015 PET Census Survey...IV Distribution of Sites, by Total Physicians in Department Who Read PET/CT and/or PET Scans, by Site Type, as of 2015 PET Census Survey...IV Average Annual PET/CT or PET Scans Read per Physician per Site, by Current PET Capability and Site Type, IV Distribution of Sites that Send PET/CT or PET Scans to Off-Site Radiology Service to be Read, by Site Type, as of 2015 PET Census Survey...IV Hours per Week (Monday-Friday) PET Department Open for Scheduled Procedures, by Current PET Capability, as of 2015 PET Census Survey...IV Hours per Weekend PET Department Open for Scheduled Procedures, by Current PET Capability, as of 2015 PET Census Survey...IV Waiting Time for Non-Emergency Outpatient PET Scan, by Current PET Capability, as of 2015 PET Census Survey...IV-100

8 21. Waiting Time for Non-Emergency Outpatient PET Scan, by Site Type, as of 2015 PET Census Survey...IV Waiting Time for Non-Emergency Outpatient PET Scan, at all PET/CT and PET Sites, Fixed and Mobile, by IMV Census Year, 2001 to IV Waiting Time for Non-Emergency Outpatient PET Scan, at Fixed PET/CT and PET Sites, by IMV Census Year, 2001 to IV Ranking of Top Referring Physicians, by Type of Physician, as of 2015 PET Census Survey...IV Whether Facility has a Nuclear Medicine Physicist on Staff, by Site Type, as of 2015 PET Census Survey... IV PET Patient Scans per Thousand Population, by State...IV-103

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