Download The economic impact of physics research in the UK

The economic impact of physics
research in the UK:
Magnetic Resonance Imaging
(MRI) Scanners
Case Study
A report for STFC
November 2012
Contents
Executive Summary................................................................................... 1
1
The science behind MRI................................................................... 2
1.1
1.2
1.3
1.4
2
Introduction ................................................................................................ 2
The science................................................................................................ 2
STFC’s role in MRI..................................................................................... 4
Conclusion ................................................................................................. 5
Economic impact of MRI .................................................................. 7
2.1
2.2
2.3
2.4
2.5
3
Introduction ................................................................................................ 7
The global market for MRI systems ........................................................... 7
Direct UK impacts ...................................................................................... 8
Multiplier impacts ..................................................................................... 10
Conclusion ............................................................................................... 11
Catalytic impacts of MRI ................................................................ 12
3.1
3.2
3.3
3.4
3.5
4
Introduction .............................................................................................. 12
Impact of MRI scanning for breast cancer ............................................... 12
Impact of MRI on treatment of prolapsed discs ....................................... 13
Impact of MRI on limb salvage surgery.................................................... 14
Conclusion ............................................................................................... 15
Timeline of MRI ............................................................................... 16
Annex
Methodological approach ........................................................ 18
List of figures
Figure 2.1: Global MRI systems market 2010-2016
(real growth in 2010 prices)
8
Figure 2.2: Real direct contribution to UK GDP of MRI
systems 2010 and 2015
10
Figure 2.3: Total real GDP impact 2010
10
Figure 2.4: Total cumulative GDP impact 2011-2015
under different growth assumptions
11
Figure 3.1: Number of MRI scans in UK, 2000-2010
12
List of boxes
Box 1.1: The science behind MRI scanners............................................................. 3
Box 2.1: Companies analysed to estimate the direct
economic impact of MRI systems............................................................................. 9
Box 2.2: Growth Assumptions for UK MRI market
growth 2010-2015..................................................................................................... 9
Economic impact of physics research in the UK: MRI scanners case study
November 2012
Executive Summary
„ The global market for MRI systems is significant in size and is growing quickly. Estimates suggest the
global market was worth about £4.3 billion in 2010 and is expected to grow to around £6.2 billion by 2015,
equivalent to an annual growth of 7.7% a year.
„ The MRI industry is also very important for driving growth in the UK economy. In 2010, the industry’s
direct value-added growth was more than seven times faster than in the UK as a whole, and made a
value-added contribution to UK GDP worth £111 million once the industry’s multiplier impacts are
considered. That activity in turn supported around 2,200 UK jobs.
„ Between 2011 and 2015, the industry and its multiplier impacts are expected to contribute between £587
and £685 million to UK GDP in total.
„ The ‘true’ economic value of the MRI industry to the UK will be significantly higher than the conservative
figures presented above. The estimates are based on the financial performance of just four MRI
component manufacturers and exclude the impact of service companies that utilise MRI equipment,
particularly general healthcare service providers like BUPA, AXA and The General Healthcare Group.
„ It can take many years of fundamental research to translate into economic impact. MRI scanners made
today are the result of more than 70 years of research. However, the applications of MRI were not
foreseen until 30 years after the method for measuring magnetic properties was first developed. This
highlights that on-going fundamental research, plus a readiness to act swiftly upon an application or
commercialisation opportunity when such arises, are essential to ensure a continuing flow of future
scientific and technological breakthroughs.
„ Research carried out by the Science and Technologies Facilities Council (STFC) played a major role in
enabling the development of MRI, most notably through development of superconducting magnet
technology. Without that research today’s high-resolution MRI scanners would not have been possible.
„ MRI scanners are capable of providing information that in some cases cannot be obtained by any other
means and therefore improves the success rates of surgery and saves lives.
„ Various research studies have shown that MRI is more effective at detecting early cases of breast cancer
in younger women than X-ray based mammograms, and is more than twice as effective at detecting
breast cancer in women classified at ‘high genetic risk’, particularly women carrying the BRCA1 gene
mutation.
„ MRI has revolutionised the treatment of prolapsed discs by improving the success rate of spinal surgery,
lowering work absenteeism by 1.6 million days each year thus saving the UK economy £166 million in
loss of output, absence management and healthcare costs.
„ By enabling much more accurate diagnosis and treatment planning for patients with primary bone cancer,
limb amputation is now much less commonplace. Limb salvage is more cost effective than amputation
and therefore generates cost savings to the NHS of £5 million to £10 million each year.
This study was commissioned by STFC and carried out by Oxford Economics. It demonstrates the
economic impact of UK fundamental physics research in the area of Magnetic Resonance Imaging (MRI)
to the UK and global economy. It updates the previous MRI case study contained in the report “The
economic impact of physics research: a case study approach (2009)”, which was carried out by STFC,
EPRSC, IOP and RAS.1
1
The report is available on request from STFC.
1
Economic impact of physics research in the UK: MRI scanners case study
November 2012
1 The science behind MRI
1.1
Introduction
Over the past 25 years, medical imaging techniques have given doctors the ability to see what is
happening inside the human body without having to resort to surgery, saving patients pain, doctors’ time
and the NHS money. Foremost among these techniques is magnetic resonance imaging (MRI), the
product of more than 70 years of research.
The field has attracted several Nobel Prizes2, including the 2003 prize in Physiology or Medicine for the
UK physicist, Sir Peter Mansfield. Using a combination of very strong magnets and radio waves, MRI is
able to produce high-resolution images of the opaque interior of the body.
Though it is capable of imaging almost every part of the body, MRI is most commonly used for examining
the brain, the cardiovascular system, the musculoskeletal system and the abdomen. Whereas X-rays
cannot distinguish the detailed structure of soft tissues and exploratory surgery is often regarded as too
dangerous, MRI is able to create detailed images to assist in the diagnosis of conditions such as cancer,
heart disease, multiple sclerosis and Alzheimer’s disease. Furthermore, unlike CT scans and traditional
X-rays, MRI does not involve giving the patient doses of ionising radiation that may increase the risk of
malignancy, so it is ideal when a patient needs to undergo several examinations in short succession. As
an emergency medical tool, MRI has the ability to detect and diagnose strokes quickly, limiting damage
and allowing immediate treatment, and thus promoting recovery. MRI is also capable of imaging
physiological function such as the motion of the wall of the heart and the perfusion of blood through
organs. As a research tool, functional MRI has allowed doctors to see the inner structures of the brain,
imaging the effects of thought processes and seeing how the brain responds to stimuli and manages
emotion.
MRI is, in many ways, the ideal medical imaging technique. It can identify all kinds of tissue, poses no
proven health risks and has no limit to the number of images that can safely be taken. Normally patients
require no preparation and there is no recovery time. Indeed, the lack of harmful effects on the patient
and the operator make MRI well-suited for ‘interventional radiology’, where the images produced by an
MRI scanner are used to guide minimally invasive procedures. Designed through collaboration between
the University of Nottingham and British medical instruments firm EMI, full-body MRI scanners were first
introduced to hospitals in the late 1980s. MRI is now a standard diagnostic tool in many hospitals,
improving treatment, cutting waiting times and saving lives.
1.2
The science
MRI is able to create detailed images of all parts of the body, including the brain, to assist in the diagnosis
of medical conditions. MRI scanners that are made today are underpinned by a range of physics research
conducted over the past 70 years, including an understanding of magnetic resonance imaging, which is
based on a fundamental understanding of matter, and the development of superconducting magnets.
MRI depends on a fundamental property of matter – that certain atoms have magnetic nuclei that become
aligned in a magnetic field. Sir Peter Mansfield at the University of Nottingham realised that the technique
2
2
http://nobelprize.org/nobel_prizes/medicine/laureates/2003/press.html.
Economic impact of physics research in the UK: MRI scanners case study
November 2012
of Nuclear Magnetic Resonance could be adapted to distinguish the spatial positions of hydrogen atoms
in biological tissue and developed rapid imaging techniques that allow images that distinguish between
healthy and cancerous tissues.
Superconducting magnets are key to MRI since the sensitivity to the signal is proportional to the applied
magnetic field. Superconducting magnets allow the highest fields to be generated, and therefore allow
greater imaging detail and contrast, improving usefulness in early diagnosis and in biomedical research.
Normally conducting magnets cannot generate sufficiently strong magnetic fields to enable clinically
useful images to be produced. Thus, the development of superconducting magnet technology enabled
the fundamental physics of magnetic resonance to find practical application in the field of healthcare.
This clearly illustrates how fundamental research in one area can produce significant benefits elsewhere
that could not have been predicted.
Section 1.3 of this report focuses on the crucial role of STFC's Rutherford Appleton Laboratory (RAL) in
the early development of superconducting magnets.
Box 2.1 summarises the science behind MRI scanners and the UK’s involvement in developing such
systems. A more detailed timeline of the development of MRI scanners is presented in Chapter 5.
Box 1.1: The science behind MRI scanners
Magnetic Resonance Imaging (MRI)
„ Magnetic resonance imaging (MRI) depends on a fundamental property of matter – that certain atoms
have magnetic nuclei that become aligned in a magnetic field. If radio waves of an appropriate frequency
(the resonant frequency) are applied, the nuclei tip slightly out of alignment but then re-emit signature
radio waves when they tip back. The radiofrequency emitted depends not only on the type of atomic
nucleus but also on its chemical environment. This is the basis of the important analytical technique
nuclear magnetic resonance (NMR), which has been used in pharmaceutical and materials research
since the 1960s. MRI uses this very technique but takes it a stage further by creating images for
diagnostic purposes.
„ US physicist Isidor Rabi first observed NMR in the early 1930s – work for which he was awarded a Nobel
Prize in Physics in 1944. Further advances resulted in several more Nobel awards. NMR is particularly
good for picking out hydrogen atoms. In the 1970s, physicist Sir Peter Mansfield of the University of
Nottingham and US chemist Paul Lauterbur, realised that NMR could be adapted to distinguish the
spatial positions of hydrogen atoms in biological tissue, particularly in the water component. Using
complex mathematical methods, a three-dimensional image of a living organ could be constructed by
scanning its water content using a version of NMR with variable-gradient magnetic fields. This
breakthrough won them the Nobel Prize in Physiology or Medicine in 2003. By the 1980s, dedicated
clinical instruments were being developed for this technique, now re-named MRI to highlight the imaging
capability of the technique.
„ In a conventional MRI scanner, the patient lies inside a large, cylindrical magnet. The magnetic fields
used to align the hydrogen nuclei are typically 3 to 6 Tesla. They are generated by superconducting
magnets which were also developed in the UK (somewhat in parallel with MRI) by Oxford Instruments,
the first physics-technology spin-out company from the University of Oxford.
„ MRI can now be configured to distinguish between all types of tissue and thus generate detailed images
of organs. Contrast in selected structures can be enhanced by injecting magnetic contrast agents such
as gadolinium, or by using magnetic resonance-sensitive molecules that combine with specific receptors
in the target tissue.
3
Economic impact of physics research in the UK: MRI scanners case study
November 2012
Superconducting magnets
„ Superconducting magnets are key to MRI since the sensitivity to the signal is proportional to the applied
magnetic field. Superconducting magnets allow the highest fields to be generated, and for many of the
applications discussed below this allows greater imaging detail and contrast, improving usefulness in
early diagnosis and in biomedical research. Normally conducting magnets cannot generate sufficiently
strong magnetic fields to enable clinically useful images to be produced.
„ STFC’s Rutherford Appleton Laboratory (RAL), while carrying out research for particle physics detectors
and accelerators, pioneered many early developments in superconducting magnets.
1.3
STFC’s role in MRI
STFC’s Rutherford Appleton Laboratory (RAL) in Oxfordshire played a crucial role in the early
development of superconducting magnets. Without this research that enabled the production of very
powerful magnets used worldwide for many decades, today’s high-resolution MRI scanners would not
have been possible.
1.3.1
STFC’s role in superconducting magnet technology
STFC’s Rutherford Appleton Laboratory has been a leader in superconducting magnet technology for
some 35 years. The earliest development was directed towards bubble chamber magnets for particle
physics experiments but this was soon replaced by a programme of basic conductor development and
accelerator magnet technology. Particle accelerators require high magnetic fields in order to accelerate
particles to high energies, and therefore the potential to use superconducting magnets in particle
accelerators was studied. The early involvement placed a major emphasis on basic conductor
development. Notable outcomes of this research included:
„ A theoretical understanding of superconductor stability and the requirement to
use thin filaments. A superconducting magnet will only remain superconducting if it is
kept below a certain ‘critical temperature’ which depends on the characteristics of the
material the magnet is made of. It is therefore crucial that no heat is generated in the
magnet; otherwise the magnet will heat up and become normally conducting which is
known as a quench. It was discovered that superconducting magnets and wires are
more stable if they are made of lots of thin strands rather than a single, thicker strand.
The individual strands of wire have to be less than 50 microns thin – about half the
width of a human hair. The first filamentary Niobuim Titanium (NbTi) wire conductors
were developed at RAL in collaboration with IMI Titanium Ltd around 1970. These
became known as ‘Rutherford Cable’ and were some were some of the first practical
magnet wires manufactured and have formed the basis for all superconducting magnet
technology.
„ Superconducting joints. These are crucial to the operation of superconducting
magnets as any joint in the conductor has to have a very low electrical resistance to
avoid localised heating that could cause a quench to occur. These were developed by
STFC in conjunction with Oxford Instruments and The University of Oxford Department
of Biochemistry. This technology has been essential to the development of
superconducting magnets for MRI and other applications.
4
Economic impact of physics research in the UK: MRI scanners case study
November 2012
„ Software for modelling electromagnetic fields. In parallel with the R&D on conductor
technology, the computing group at RAL developed a software package called Vector
Fields to enable the magnetic fields from superconducting magnets to be calculated,
visualised and understood. This is critical to the technique of MRI scanning because the
formation of the image depends on a detailed understanding of spatial variation of the
magnetic field in which the patient is placed. In 1984 the developers of the software
spun out a company called Vector Fields Ltd, which is now part of Cobham plc.3 This
software is used throughout the world for a variety of modelling and design applications,
as well as MRI scanning. These applications include the design of motors and
generators, non-destructive defect detection using electric and magnetic fields, and the
design of consumer devices such as microwave ovens and loudspeakers.
The basic conductor development programme was coupled with an extensive magnet technology
development programme. Through R&D programmes, scientists at STFC’s Rutherford Appleton
Laboratory led the world in the understanding of magnet stability. The first superconducting accelerator
dipole magnet prototypes were fabricated as early as 1972 and the first straight Nb3Sn filamentary
magnet in 1977.
Through the 1990s and up to the present date RAL has been closely involved with the magnet system for
the ATLAS Experiment on the LHC at CERN4. These magnets require superconducting magnet
technology at a huge scale.
The current programme is focussed on superconducting magnet technology for the next generation of
particle accelerators beyond the LHC. STFC is also engaged in R&D into novel accelerator technologies
for healthcare applications which promise to improve cancer therapy for the treatment of radiationresistant and awkwardly sited tumours. The development of these new types of accelerator has been
driven largely by the software development initiated by Vector Fields, which has enabled fields from
complex magnet geometries to be modelled accurately. This illustrates how research in fundamental
physics can lead to technology developments for a range of applications, generating economic and
societal benefits.
1.4
Conclusion
It can take many years of fundamental research to translate into economic impact. MRI scanners made
today are the result of more than 70 years of research. However, the applications of MRI were not
3
Cobham Technical Services, based in Kidlington Oxfordshire, is the leading supplier of electromagnetic
analysis and design software to industry, universities, and research establishments throughout the world.
4
ATLAS is a particle physics experiment at the Large Hadron Collider at the European Organization for
Nuclear Research (CERN), based near Geneva. The ATLAS detector is searching for new discoveries in
the head-on collisions of protons of extraordinarily high energy. ATLAS will enable physicists to learn
about the basic forces that have shaped our Universe since the beginning of time and that will determine
its fate. Among the possible unknowns are the origin of mass, extra dimensions of space, unification of
fundamental forces, and evidence for dark matter candidates in the Universe.
5
Economic impact of physics research in the UK: MRI scanners case study
November 2012
foreseen until 30 years after the method for measuring magnetic properties was first developed and 14
years after the first Nobel Prize was awarded for the first detection of NMR.
Research carried out by STFC played a major role in enabling the development of MRI, most notably
through development of superconducting magnet technology. Without that research today’s highresolution MRI scanners would not have been possible.
6
Economic impact of physics research in the UK: MRI scanners case study
November 2012
2 Economic impact of MRI
2.1
Introduction
The MRI industry is not well defined in standard government industry classifications (SIC) and so data are
not available from official statistical agencies such as the Office for National Statistics. To quantify the
economic impact of the MRI industry we focus on the UK and global market for MRI systems. This market
covers the revenues generated from MRI products and their associated maintenance costs.
To supplement the high level market analysis, we also analyse the company accounts of global
companies with MRI-related operations in the UK. Using this information we are able to build up a picture
of the relationship between company revenues and their value-added contribution to GDP and calculate
both the direct and multiplier impacts of MRI to the UK economy.
2.2
The global market for MRI systems
Various studies have been conducted to estimate the global MRI systems market, but the data sources
and methodology are far from fully comparable. This means any estimate of market size should be
considered within a range of likely values, rather than a simple point estimate.
In our previous MRI case study the US Global Industry Analysts Inc. suggested that the global MRI
market was expected to reach £3.4 billion by 2015. According to more recent estimates by market
forecasters BCC Research, the global market for MRI systems was worth even more, about £4.3 billion in
2010, and is expected to grow to around £6.2 billion by 2015, equivalent to an annual growth of 7.7% a
year6. Expanding applications in the neurologic, cardiac and breast MRI areas is expected to drive the
European market, which is projected to grow from £770 million in 2010 to reach around £1.2 billion by
2015, equivalent to an annual growth of 9.3% a year.
A more conservative estimate of the global MRI market is presented by MarketsandMarkets (M&M), a
US-based global market research company. Their research predicts the global market to grow from £2.5
billion in 2011 to £3.0 billion in 2016, at an average annual growth rate of 4% a year7. Irrespective of the
precise size of the global MRI market, the evidence suggests that the market is both significant in size
and is growing quickly.
5
http://www.medicalnewstoday.com/releases/104947.php
6
http://bccresearch.blogspot.com/2010/09/global-market-for-mri-systems-to-grow.html. Report published
in August 2010. Estimates translated from $US terms to £ by Oxford Economics.
7
www.marketsandmarkets.com/Market-Reports/MRI-advanced-technologies-and-global-market-99.html.
Report published in November 2011. Estimates translated from $US terms to £ by Oxford Economics.
7
Economic impact of physics research in the UK: MRI scanners case study
November 2012
Figure 2.1: Global MRI systems market 2010-2016 (real growth in 2010 prices)
£ billions
7
BCC estimates
45% total growth
7.5% a year
M&M estimates
6
£6.2bn
5
22% total growth
4% a year
4
3
£4.3bn
£3.0bn
2
£2.5bn
1
0
2010
2015
2011
2016
Source : BCC Market Research (2010), MarketsandMarkets research
2.3
Direct UK impacts
The direct contribution of an industry or company to an economy can be measured by its gross valueadded contribution to GDP. This is calculated by adding a company’s earnings before interest, taxes,
depreciation and amortization (EBITDA) to total labour costs (i.e. gross wages paid by the company,
including pension and national insurance contributions).
Using information contained in the financial accounts of four8 key UK-based MRI component
manufacturing companies (See Box 3.1), we estimate that MRI systems made a direct value-added
contribution to UK GDP of around £54 million (in 2010 prices), based on turnover of £142 million9
and employment of around 660. This is equivalent to 16% real GDP growth in 2010, and significantly
faster than the 2.1% GDP growth in the UK economy as a whole.
This direct economic impact does not include the impact of companies that utilise MRI scanning
equipment. The medical diagnostics services market consists of both relatively small diagnostic practices
as well as large, more general healthcare service providers like BUPA, AXA and The General Healthcare
Group. As the market is continually evolving and growing it is very difficult to provide a robust estimate of
the size and scale of the pure MRI-based service market. Accordingly, the estimates presented consider
only MRI component manufacturing and will therefore be a conservative estimate of total economic
impact.
8
Note, the previous published MRI case study provided estimates based on five companies. One of
those companies, Lodestone Patient Care, is now part of Alliance Medical, Europe’s leading independent
provider of medical imaging services. Detailed accounts on the UK-based MRI activities of this company
are not published.
9
The data show that around 25% of sales (i.e.turnover) of these four companies are exported to outside
the UK.
8
Economic impact of physics research in the UK: MRI scanners case study
November 2012
Box 2.1: Companies analysed to estimate the direct economic impact of MRI systems
„ Siemens Magnet Technology Ltd (previously Oxford Magnet Technology)10 is the world’s
leading designer and manufacturer of superconducting magnets for medical applications. Around
95% of the magnets produced at its Oxfordshire facility are exported. More than 30% of the MRI
scanners installed in hospitals worldwide use superconducting magnets manufactured by
Siemens Magnet Technology.
„ Oxford Instruments was set up by Martin Wood in 1959, as a spin-off company from the
Clarendon Physics Laboratory at the University of Oxford. The company was a pioneer in the
development of superconducting magnets; 50 years later it is still a world leader in the
superconductivity business. The Oxford Instruments Group now employs 1,300 employees
worldwide and has a turnover of £212 million.
„ Tesla Engineering Ltd, based in West Sussex, manufactures resistive and superconducting
magnets for particle accelerators of all types, and produces specialized gradient coils for MRI
scanners. Tesla also supplies electromagnets for emerging applications such as fusion research
and the semiconductor industry.
„ GE Medical Systems Oxford Ltd (now part of GE Healthcare UK), manufactures and sells highfield MRI magnet systems from its Oxford base.
In terms of prospects for the UK MRI systems industry, by drawing on the global and European market
projections presented in section 3.211, we estimate that the direct annual value-added contribution to
UK GDP will reach between £59 million and £76 million by 2015 (in 2010 prices), giving a cumulative
contribution to UK GDP of between £287 million and £335 million (in 2010 prices) in the period 20112015.
Box 2.2: Growth Assumptions for UK MRI market growth 2010-2015
Growth Assumptions – In real 2010 prices
„ Low-case growth scenario – 1.7% average growth per year. Based MRI global market growth
rates from M&M 2011-2016.
„ Mid-case growth scenario – 5.4% average growth per year. Based on MRI global market growth
rates from US Global Inc.
„ High-case growth scenario – 6.9% average growth per year. Based on MRI European market
growth rates from US Global Inc.
10
http://www.siemens.co.uk/en/about_us/index/manufacturing/siemens_magnet_technology.htm
11
Nominal growth projections translated into real (2010 price-based) growth projections by Oxford
Economics
9
Economic impact of physics research in the UK: MRI scanners case study
November 2012
Figure 2.2: Real direct contribution to UK GDP of MRI systems 2010 and 2015
Real contribution to
GDP £ millions
£67 million
80
£64 million
70
£57 million
60
£54 million
50
40
30
20
10
0
2010
Source : Oxford Economics
2.4
2015 Low
2015 Mid
2015 High
Multiplier impacts
The indirect multiplier is estimated to be 1.64. This means that for every £1 million of output generated
by UK firms operating in the MRI systems market, a further £0.64 million of output is generated indirectly
along its UK-based supply chain. This value-added output supported 900 people whose jobs depend on
MRI manufacturers’ demand for goods and services.
Estimates based on Oxford Economics’ detailed econometric model of the UK suggest the induced
impact multiplier is around 1.25. This means that for every £1 million of output generated by the UK
MRI systems industry and its supply chain, a further £0.25 million of output is generated in the UK
economy as workers spend their earnings on other goods and services. We estimate that this
consumption spending added £22 million in GDP to the UK economy and supported 600 jobs.
This means that the MRI systems industry’s direct value-added contribution to GDP £54 million results in
an additional GDP contribution of £57 million through the multiplier impact, which in turn supported 1,500
jobs. In total, the industry’s total value-added impact contribution to UK GDP in 2010 was
estimated to be £111 million and the industry supported around 2,200 jobs.
Figure 2.3: Total real GDP impact 2010
Real contribution
to GDP £ millions
120
100
Induced
Total
£111 million
Total
2,160 jobs
£22 million
1,500 jobs
80
60
£35 million
Indirect
40
Direct
£54 million
20
0
2010
Source : Oxford Economics
10
660 jobs
Economic impact of physics research in the UK: MRI scanners case study
November 2012
Looking ahead, the MRI systems industry is expected to generate a cumulative value-added
contribution to UK GDP worth between £587 and £685 million in total (including multiplier
impacts) between 2011 and 2015.
Figure 2.4: Total cumulative GDP impact 2011-2015 under different growth assumptions
Real contribution
to GDP £ millions
800
700
Total
£587 million
Direct
Total
£653 million
Indirect
Induced
Total
£685 million
600
500
400
300
200
100
0
Low
Mid
High
Source : Oxford Economics
2.5
Conclusion
Estimates from various sources show that global market for MRI systems is significant in size and is
growing quickly. The MRI industry is also very important for the UK economy. In 2010, the industry’s
direct value-added growth was more than seven times faster than in the UK as a whole, and made a
value-added contribution to UK GDP worth £111 million once the industry’s multiplier impacts are
considered. That activity in turn supported around 2,200 UK jobs.
Between 2011 and 2015, the industry and its multiplier impacts are expected to contribute between £587
and £685 million to UK GDP in total.
As these estimates consider only MRI component manufacturing and exclude the medical diagnostics
services market, the figures are very likely to be conservative estimates of the total economic impact of
the MRI industry in the UK.
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Economic impact of physics research in the UK: MRI scanners case study
November 2012
3 Catalytic impacts of MRI
3.1
Introduction
MRI technology is an excellent example of how the findings from fundamental physics research can lead
to wider economic benefits to the UK and worldwide. This section presents the benefits of three distinct
applications of MRI technology: detecting early cases of breast cancer in various cohorts of the
population, treatment of prolapsed discs, and limb salvage surgery.
3.2
Impact of MRI scanning for breast cancer
Around 2.5 million MRI scans were performed in the UK in 2010, more than three times the number on a
decade earlier (Figure 3.1)12.
Figure 3.1: Number of MRI scans in UK, 2000-2010
MRI scans
2,500,000
2,000,000
Number of MRI scans in UK
1,500,000
1,000,000
500,000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Source : OECD Health Data database, Oxford Economics
MRI scanners are most commonly used to diagnose cancer patients (about 35% of all scans), patients
with spinal problems (about 30%). It is also used to study the heart and blood vessels, other internal
organs, such as lungs or liver, and bones and joints.13
MRI scans are now often used to help diagnose breast cancer. Research has shown that MRI is more
effective at detecting early cases of breast cancer than X-ray based mammograms14. The research stated
that X-ray based mammograms detected only 56% of early lesions in high-risk women compared to 92%
when MRI scans are used. Although MRI scans are shown to produce higher rates of ‘false positive’
12
Source: OECD Health Data database, Oxford Economics.
13
http://www.iop.org/activity/policy/Publications/file_36788.pdf
14
Kuhl CK et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study.
Lancet 2007; 370:485-492
12
Economic impact of physics research in the UK: MRI scanners case study
November 2012
results than mammograms whereby the scan indicates a breast cancer but internal surgery has shown it
not to be the case, but is argued to be an essential tool for checking younger women who were at a high
genetic risk of cancer15.
The findings of a national study funded by the Medical Research Council16 reinforce the view that MRI is
almost twice as sensitive as X-ray mammography (XRM) in detecting breast cancer in women at high
genetic risk. Past research has highlighted that around 2% of breast cancer cases are due to the recently
discovered breast cancer gene mutations BRCA1 and BRCA2. Women with one of these gene mutations
come from families where there is a strong family risk of breast cancer, and more than half of them will
develop breast cancer by the age of 70.
Annual mammograms are offered to women with these gene mutations to allow early identification and
treatment of tumours. However, as women below the age of 50 often have dense breasts, mammography
is not always very effective at detecting tumours.
The study showed that XRM managed to identify only 40% of the tumours in women at high genetic risk,
whereas MRI pinpointed 77%. It was found that by combining both XRM and MRI screening methods,
94% of tumours would be detected. MRI screening was shown to be particularly effective for women
known to carry the BRCA1 gene mutation, detecting 92% of tumours in women carrying this gene,
whereas XRM only detected 23%.
3.3
Impact of MRI on treatment of prolapsed discs
MRI has revolutionised the treatment of spine related pain syndromes. MRI scans have taken a
considerable amount of guesswork out of spine surgery as they give very accurate anatomical detail that
can be used to plan surgery17.
While approximately one-third of the adult population have lower back pain, of those less than 1 in 20
have a prolapsed disc18. A prolapsed disc can result in compression of the sciatic nerve, causing severe
radiating pain in the back and legs. Although 90% will get better without the need for surgery,
approximately 10% will require surgery19. And of those people having surgery, 80% will experience a
significant improvement in pain20.
Using available information above combined with both reasonable and conservative assumptions as set
out below, the economic impact of MRI on treatment of prolapsed discs can be calculated.
„ Assume 1 in 25 adults who have lower back pain have a prolapsed disc – There are 40
million adults in the UK21, so 533,000 cases of prolapsed discs.
15
Malcolm Kell, British Medical Journal. 341:c5513. www.bmj.com/content/341/bmj.c5513
16
The Lancet, Volume 365, Issue 9473, Pages 1769 - 1778, 21 May 2005
17
www.spine-health.com/treatment/diagnostic-tests/new-mri-scan-technology
18
www.nhs.uk/Conditions/Slipped-disc/Pages/Introduction.aspx
19
www.nhs.uk/Conditions/Slipped-disc/Pages/Introduction.aspx
20
www.nhs.uk/Conditions/Lumbardecompressivesurgery/Pages/Whatisitpage.aspx
21
Adult population defined as males aged 16 to 64 and females aged 16 to 59.
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Economic impact of physics research in the UK: MRI scanners case study
November 2012
„ 1 in 10 need surgery – approximately 53,000 operations each year.
„ Following surgery 80% will experience a significant improvement in pain – Assume
these people return to work within 1 month (i.e. 20 working days)
„ 20% do not experience an improvement – Assume these people have a longer period
of absence and return to work in 6 months (i.e. 120 working days).
„ Total working days lost = 2.1 million – (80% x 53,000 x 20) + 20% x 53,000 x 120)
„ Assume a conservative success rate of 50% for discectomies prior to the advent of MRI
– Anecdotally these have been described as ‘hit and miss’ and involving ‘guesswork’.
„ Total working days lost without MRI = 3.7 million – (50% x 53,000 x 20) + (50% x
53,000 x 120)
Thus, an estimated 1.6 million working days are saved each year due to improved success rates
of spinal surgery, due to the availability of better imaging techniques.
A 2011 report, ‘Health at work – an independent review of sickness absence’ estimated that the UK lost
140 million working days each year due to sickness, at a cost to the economy of £15 billion, or £104 per
day22. This means the total saving to the UK economy of £166 million per year due to the
estimated 1.6 million fewer days lost by the use of MRI in the treatment of prolapsed discs. This
cost saving comprises the loss of production or output and other resource costs associated with sickness
absence including the value of time spent on sickness absence management and healthcare costs. Other
costs to society such as loss of quality of life or well-being (‘human costs’) are not included in the
estimate, and as such is a conservative estimate of impact.
3.4
Impact of MRI on limb salvage surgery
There are around 600 new cases of primary bone cancer each year, primarily affecting teenagers and
young adults23. Depending on the type and extent of the cancer, in many cases surgery is required to
remove the affected bone and tissue. Before the introduction of MRI, in most cases the only option was
amputation. Nowadays, a technique called limb salvage can be used – this has vastly reduced the need
for amputation and many cases this restores the normal look and function of the affected limb.
In a 1997 paper assessing the cost-effectiveness of limb salvage, Grimer et al24 reported that over the
previous 20 years, limb salvage surgery for primary bone tumours had become commonplace. About
85% of patients are now offered limb salvage; the remainder have amputation – beforehand, the ratio
was almost reversed. This trend can be attributed, at least in part, to the introduction of MRI scanning.
Other significant factors include improved surgical techniques and chemotherapy treatments.
MRI scanning has enabled much more accurate diagnosis and treatment planning for cancers of this
type. Precision imaging of soft tissues enables clinicians to see the extent of the abnormality, and
therefore optimise the surgical removal. Without the information provided by MRI scanning, there was a
22
www.dwp.gov.uk/docs/health-at-work.pdf
23
http://cancerhelp.cancerresearchuk.org/type/bone-cancer/about/risks-and-causes-of-bone-cancer
24
Grimer et al (1997). ‘The cost-effectiveness of limb salvage for bone tumours’. J Bone Joint Surg
[Br], 1997; 79-B:558-61
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Economic impact of physics research in the UK: MRI scanners case study
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great risk that limb-salvage surgery would not remove enough of the tumour, resulting in recurrence and,
most likely, death. Therefore the usual course of action was complete amputation, with a devastating and
life-long impact on the patient’s quality of life. Grimer quotes Gordon-Taylor and Wiles, who in 1935
described hindquarter amputation as “the greatest mutilation ever performed on the human frame”.
Writing 60 years later, Grimer considered that little had changed. Today, the majority of those affected by
primary bone cancer who would otherwise have had to undergo amputation, can expect to achieve much
better outcomes both in terms of limb function and disease eradication.
Grimer’s 1997 paper, through an analysis of the cost of the initial operation plus rehabilitation and
‘servicing’, established that limb salvage was more cost-effective than amputation. Furthermore, he
forecast that the cost-effectiveness would increase with time, predicting reduced failure rates (hence
lower costs) for limb salvage cases, and increasing complexity (hence higher costs) of artificial limbs.
This study does not attempt to update the Grimer et al analysis to 2012 prices; it implicitly assumes that
the cost-effectiveness today is the same as in 1997. Due to the condition being rare, the overall
economic impact of MRI on limb salvage would be relatively marginal; estimates based on
available information indicate a saving to the NHS of £5m-10m per year25. The greater consideration
is the impact on youngsters who are able to continue their lives with limbs that, in many cases, look and
function normally. In recent years, limb salvage has been extended more and more to patients severely
affected by chronic degenerative bone and joint diseases, such as rheumatoid arthritis, or those facing
diabetic limb amputation or acute and chronic limb wounds.
3.5
Conclusion
Today’s MRI scanners are able to create detailed images of all parts of the body, including the brain and
the spine, to assist in the diagnosis and treatment of conditions such as cancer, heart disease and
multiple sclerosis. MRI scanners are capable of providing information that in some cases cannot be
obtained by any other means and therefore saves lives.
Various research studies have shown that MRI is more effective at detecting early cases of breast cancer
in younger women than X-ray based mammograms, and is more than twice as effective at detecting
breast cancer in women classified at ‘high genetic risk’, particularly women carrying the BRCA1 gene
mutation.
MRI has revolutionised the treatment of prolapsed discs by improving the success rates of spinal surgery
due to the availability of better imaging techniques, lowering work absenteeism by 1.6 million days each
year thus saving the UK economy £166 million. MRI scanning has also enabled much more accurate
diagnosis and treatment planning for patients with primary bone cancer. Limb salvage is now much more
commonplace than amputation and generates cost savings to the NHS of £5m to £10m each year.
Lives saved and improvements to patients’ quality of life that are facilitated by MRI scanners are
underpinned by a range of physics research conducted over the past 70 years. The following Chapter
provides a timeline of the key milestones over that period starting from the initial fundamental research
through to the application of that research used in today’s MRI scanners.
25
Estimate based on the 20-year cost saving of limb salvage versus amputation of £70,000 from
Grimer et al (1997), adjusted for survival rates of men and women following diagnosis and treatments
of their primary bone cancer sourced from http://cancerhelp.cancerresearchuk.org/type/bonecancer/treatment/statistics-and-outlook-for-bone-cancer
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4 Timeline of MRI
1930
US physicist Isidor Rabi develops a method for measuring the magnetic properties of atoms,
atomic nuclei and molecules.
1944
Isidor Rabi wins the Nobel Prize in Physics for detecting nuclear magnetic resonance (NMR) in
molecular beams.
1945
The first NMR measurements are taken of a solid.
1950
Pulsed NMR is invented.
1952
Felix Bloch and Edward Purcell win the Nobel Prize in Physics for their development of new
methods for NMR experiments in solids.
1959
J R Singer at the University of California, Berkeley, proposes that NMR could be used as a noninvasive tool to measure in vivo blood flow.
1969
Raymond Damadian at Downstate Medical Center in New York shows that the NMR signals from
tumours differ from those of normal tissue.
1970
The first filamentary NbTi wire conductors were developed at RAL in collaboration with IMI
Titanium Ltd.
1971
Paul Lauterbur devises a way to create magnetic resonance images.
1973
Paul Lauterbur produces the first magnetic resonance images.
1973
Sir Peter Mansfield of the University of Nottingham publishes a method to construct images
quickly.
1974
Raymond Damadian receives the first patent in the field of MRI for the concept of NMR for
detecting cancer.
1976
Sir Peter Mansfield produces the first magnetic resonance image of a body part.
1977
The first magnetic resonance image of a human is made by Raymond Damadian.
1980
The first useful image of a patient in a hospital is taken.
1984
Full-body MRI scanners are introduced into hospitals.
1984
Computer scientists at STFC’s RAL developed a software package called Vector Fields to
enable the magnetic fields from superconducting magnets to be calculated, visualised and
understood. This is critical to the technique of MRI scanning because the formation of the image
depends on a detailed understanding of spatial variation of the magnetic field in which the patient
is placed.
1986
Technological advances mean that it takes less than 5 seconds to obtain an image.
1993
Functional MRI is developed, opening up whole new areas in terms of imaging brain function
rather than just structure.
1995
400,000 MRI scans in the UK.
2003
Paul Lauterbur and Sir Peter Mansfield are jointly awarded the Nobel Prize in Physiology or
Medicine for their discoveries concerning MRI.
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2003
1 million MRI scans in the UK.
2010
2.4 million MRI scans in UK.
Today Advances in detector technology, being made through research into fundamental particle and
nuclear physics, are enabling MRI to be combined with other forms of imaging such as SPECT
(Single Photon Emission Computerised Tomography) to make possible diagnostic tools of even
greater sensitivity. This will enable the function of an organ to be imaged at the same time as its
structure, enabling clinicians to gain a more detailed understanding of any abnormality.
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Annex
Methodological approach
The case study approach to demonstrate the economic impact of UK physics research utilized in
this study follows the same approach used in our previous study26.
As before, the economic benefits for the UK economy arising from UK fundamental research in
physics have been disaggregated as follows:
„ Direct benefits from the commercialisation of physics research in the MRI systems
industry, measured in terms of company sales, jobs and value-added contribution to UK
GDP;
„ Multiplier effects that arise from further economic activity associated with additional
supplier and income purchases; and
„ Wider or ‘Catalytic’ benefits that are a result of research that delivered positive benefits to
society as a whole (e.g. a health-enhancing application).
Estimates of the number of jobs supported by the MRI systems industry use companies’ accounts data to
estimate the direct number of jobs, while UK productivity is used to translate the indirect and induced
estimates of GDP into jobs supported by that indirect and induced activity.
The approach provides a valuable snap-shot of impact for a particular year, but also considers how the
cumulative impacts build-up over time and where possible we also present projections of likely future
impact over the next decade. Though the focus of the analysis is on UK-level benefits, it is clear that the
impact of UK-based physics research extends globally and generates significant international benefits.
These benefits are reflected in the global estimates of economic impact presented in this paper.
In demonstrating the impact of UK-based fundamental physics research and technology
development the following key points should be noted:
„ The case study provides lower bound estimates which demonstrate the economic impact of
MRI systems. The ‘true’ economic value both to the UK and globally of MRI systems will be
significantly higher than set out in this report. However, by adopting a lower bound estimate
it is highly unlikely that UK physics research has contributed less than the estimates in this
report.
„ The demonstrated benefits are purely indicative. The outputs of each case study cover only
some of the many applications cited in the underpinning research and provide only an
illustration of the economic contribution of physics research to the UK economy. The ‘true
economic’ value to the UK will be significantly greater than specified in this study.
Note that this is not a cost-benefit analysis but an economic assessment. The study
focused on demonstrating achieved gross economic benefits to the UK based on empirical
evidence and stakeholder consultations, without consideration of the costs of providing that
benefit.
26
For full details of the methodological approach please refer to the report “The economic impact of physics
research: a case study approach”, available from STFC.
18
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