Diagnostic Imaging Market Developments, Fall 2015

Diagnostic Imaging Market Developments, Fall 2015, updated 11/11/15, 11:03 PM

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Diagnostic Imaging Market Developments
Fall 2015
Diagnostic Imaging Market Picking Up. The global diagnostic imaging devices market was valued at USD 26,477.1
million in 2014 and is expected to grow at a CAGR of 5.2% from 2014 to 2020, to reach an estimated value of USD
35,793.4 million in 2020.(Source: Persistence Market Research). The global diagnostic imaging market is growing at a
moderate rate due to increasing prevalence of chronic diseases and injuries, and the growing aging population. More
accurate Improved diagnostics – facilitating earlier discovery of disease and wellness – technology advances are also
fueling growth, despite cost containment measures promoted by government and private payors
3D Imaging Market a Key Accelerator. The North American 3D imaging market is expected to grow from $4.9b to $16.6b
at a CAGR of 27.5% due its more comprehensive visibility and incisive diagnostics. New partnerships spurring the 3D
imaging market include Konica Minolta with STEAMTrax, and Panasonic with Leica Camera AG. Various 3D imaging
providers such as Konica Minolta, Google, Inc., Lockheed Martin, Able Software, Panasonic, Agilent Technologies, GE
Healthcare, Philips Healthcare, and TomTec Imaging solutions are offering advanced 3D imaging solutions, technologies,
and devices pertaining to the needs of both diverse verticals.
Diagnostic Imaging Proven to Save Costs. Researchers at Harvard Medical School have determined that the length of a
patient’s hospital stay is reduced by one day for every $385 spent on medical imaging equipment. Such investments could
lead to savings of about $3,000 per patient. Hospitals are using IT systems not only to archive patient files but also to
optimize processes, supply systems, and communications.
Molecular Imaging: The Key to Earlier Detection of Diseases. Diagnostic imaging is often not used until the
consequences of an illness have to be addressed. Molecular imaging is developing methods that will make it possible to
detect illnesses at an earlier stage and employ more specific diagnostic techniques. For example, today’s systems can
already detect certain tumors and deposits in blood vessels at a very early stage.
New Imaging Techniques Replacing Exploratory Surgery. PET/CT integrated units can image biological functions,
like blood flow, glucose metabolism and metabolic changes associated with cancer much earlier than you could see tumors
or other physical changes in the organ. By fusing PET and CT one can see both the metabolic information of PET and the
anatomic detail of CT at once.
2
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Diagnostic Imaging Trends
New MRA Stroke Diagnostic Technologies Build Upon Traditional Modalities. VasSol, Inc. developed a non-invasive MRI-
based stroke diagnostic system that quantifies stroke risk by objectively measuring a patient’s blood flow to, from and in the
brain and neck. The system is called a NOVA® scan or QMRA® (Quantitative MRA). NOVA's efficacy was confirmed by
VERiTAS, a six-year, blinded, 72-patient prospective study conducted at five major medical institutions and the results were
accepted by the Journal of the Americcan Medical Association, Neurology.
New Imaging Technologies Determine Chemical Composition. Researchers have demonstrated a new type of imaging
system that reveals the chemical composition of living tissue for medical diagnostics and cellular studies. Knowing the chemical
content of tissue is needed for early detection of disease, and the system also can be used to study molecular dynamics in living
cells as they are occurring. The new technique works by "coding" individual photons from a pulsing laser with a megahertz radio
frequency and then collecting those photons with a detector after they have interacted with tissue.
New 3D Mammography. Digital breast tomosynthesis (DBT) has been a frequent topic in trade publications for a few years.
Many states have passed dense breast tissue notification laws, which will spur DBT’s growth. In Jan 2015, the Centers for
Medicare & Medicaid Services (CMS) established two new add-on codes that extend additional payment when DBT is
performed along with 2D digital mammography.
Increasing Importance Data Analytics. Collecting more penetrating data is becoming critical in providing information not only
about diagnostics but also about equipment and resource usage and patient compliance, among other matters. For instance,
McKesson QICS™ for Throughput Management, automates and tracks various exam workflows. It pinpoints areas where
departments may be inefficient or a particular employee is struggling so that interventions, such as extra training, can be taken.
Images Need to Support Transitions to More E-visits and Telehealth Use. The accessibility of images is becoming more
important as e-visits and telehealth continue to grow. One report estimates there are more than 75 million e-visits in the U.S. and
Canada. Healthcare providers who are distant from their patients will need to be able to view images and access patient data
remotely. Ideally, relevant clinical data from the patient’s EHR will be integrated with medical images and test results, giving tele-
providers the information they need when treating remote patients.
3
Diagnostic Imaging Trends (cont.)
_______________________________________________________
Multimedia Enhanced Radiology Rreporting (MERR). A study from Emory University and the Harvey L. Neiman Health
Policy Institute found that 80% of respondents said MERRs “improved understanding of radiology findings by correlating
images to text reports.” The study also found that the multimedia reports provided easier access to images while monitoring
progression of a condition, and saved time understanding findings without supporting images. While improving the radiology
report, the multimedia-enhanced version also provides more financial value to radiologists. A recent study showed that 80%
of respondents indicated an increased likelihood of preferentially referring patients to facilities that offer MERR, and 79%
indicated an increased likelihood of recommending peers use facilities offering MERR.
Wider adoption of cloud technologies. Radiology, along with the rest of the healthcare sector, is moving to the cloud, and
it is happening fast. According to an article in Applied Radiology, the global cloud computing marketing in healthcare was
valued at $1.8 billion in 2011, and is expected to grow at 21% at compounded annual growth rate (CAGR) of 21% to $6.8
billion by 2018. While initial upfront costs can vary between the intensity of building an organization’s own private cloud, or
the ease and flexibility of using public cloud architecture, the process efficiency, financial predictability of paying for only
what the organization needs, and long-term cost savings are making the cloud a worthwhile investment.
Centralization of clinical data. Collaboration is a must for health facilities. Department silos are being broken down,
enhancing personnel collaboration and the centralization of clinical data. Vendor neutral archives (VNAs) are evolving
beyond being a repository for radiology. The evolution is allowing the capability to store and exchange clinical content in
DICOM and/or non-DICOM formats. This goes beyond the traditional capabilities offered by a VNA by embedding intelligent
lifecycle management and meta-data management to optimize the efficiency of multiple archives.
Mobile Devices and Telemedicine on the Rise. The global telemedicine market in 2016 is predicted to be $27 billion, with
virtual health services accounting for nearly 60% of the total. It is expected that by 2018, two-thirds of interactions with
healthcare organizations will be conducted via mobile devices. Mobile applications are now compressing radiology images
taken in the hospital or a physician’s office to a secure network and allow the transfer to portable wireless devices.
4
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Diagnostic Imaging Trends (cont.)
Interventional Oncology. A large and growing IR subset is interventional oncology. It directly
targets cancer tumors using advanced image-guided technology. With minimized
complication, morbidity and cost of procedure, image guided ablation has emerged to be the
primate treatment modality for cancer. RadioFrequency (RF) and cryoablation devices are
often used to treat kidney, liver and lung cancer while cryoablation devices can be used to
treat prostate cancer.
PAD Interventions. Another major IR application address peripheral artery disease (PAD).
Stenting, angioplasty and mechanical atherectomy are available interventional treatments. it is
estimated that more than 12 million American suffer from PAD.
Stroke Care Advancements. Interventional radiologists are at the forefront of advancing
stroke care. The use of a new cerebral protection device, coined Mo. Ma, during carotid artery
stenting effectively captures particles released during the stenting procedure that prevent
debris from travelling to the brain where it can cause a stroke.
New Interventional Applications. Other treatment options for IR include (a) stenting blocked
mesenteric arteries to prevent injury and even death from a condition known as mesenteric
ischmia which causes severe pain and leads to excessive weight loss, and (b) freezing
damaged nerves, a procedure known as cryonerolysis, to treat more than 15 million Americans
that suffer from chromic nerve pain.
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Trends in Interventional Radiology
6
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Diagnostic Imaging -- Industry Stats
Source: Global Data
Diagnostic Imaging -- Industry Stats
7
Compound Annual Growth Rates
CAGR '04-'11
CAGR '11-'18
CAGR '04-'18
MRI Systems
-0.4%
7.4%
3.4%
Ultrasound Systems
2.5%
5.1%
3.8%
Computed Tomography Systems
-6.8%
5.0%
-1.1%
Nuclear Imaging Equipment
-3.5%
5.0%
0.7%
X-ray Systems
3.5%
3.2%
3.3%
Mammography Equipment
-7.0%
1.3%
-3.0%
Angio Suites
2.2%
0.1%
1.2%
Contrast Media Injectors
4.0%
3.8%
3.9%
C-Arms
3.7%
2.8%
3.3%
Bone Densitometers
-2.4%
4.6%
1.0%
Total
-1.3%
4.8%
1.7%
Source: Global Data
_______________________________________________________
Selected Diagnostic Imaging M&A
8
Date
Trans Value
($millions)
Acquiror
Target
Target
Sales
($millions)
Target
EBITDA
($millions)
Sales
Multiple
EBITDA
Multiple
04-Nov-15
$3,300.0
Excelsior Union Limited
Mindray Medical International Limited
$1,300.0
$230.5
2.5x
14.3x
05-Aug-15
$1,000.0
International Business Machines
Corporation
Merge Healthcare Incorporated
$227.6
$39.5
4.4x
25.3x
02-Aug-15
-
BC Technical, Inc.
Ohio Valley Medical Systems
-
-
-
-
16-Jul-15
-
Richardson Electronics, Ltd
International Medical Equipment and
Service, Inc
-
$122.5
-
-
22-Jun-15
$93.0
Medtronic plc
CardioInsight Technologies Inc.
-
-
-
-
23-Mar-15
-
M.H. Carnegie & Co.
Simplify Medical, Inc.
-
-
-
-
14-Jan-15
$8.9
Amarantus BioScience Holdings,
Inc.
DioGenix, Inc.
-
-
-
-
19-Nov-14
-
Intertek Group plc
ScanBi Diagnostics
-
-
-
-
04-Sep-14
$21.0
Veracyte, Inc.
Allegro Diagnostics, Inc.
-
-
-
-
29-Jul-14
-
Bruker Corporation
Vutara, Inc.
$2.0
-
-
-
28-Jul-14
$70.0
Medtronic, Inc.
Visualase, Inc.
-
-
-
-
30-Jun-14
$375.0
Stryker Corporation
Small Bone Innovations, Inc. (Sbi)
$48.0
-
7.8x
-
07-May-14
-
Orthotic Holdings Inc. (OHI)
Orthera, Inc.
-
-
-
-
21-Apr-14
-
Decision Diagnostics Corp.
Shasta Technologies LLC
-
-
-
-
14-Mar-14
$20.0
Sorin Group S.p.A.
Oscor Inc.
-
-
-
-
18-Feb-14
$93.5
GSI Group Inc.
JADAK Technologies Inc.
-
-
-
-
14-Jan-14
-
CytoCore, Inc.
MEDITE GmbH
$9.5
-
-
-
14-Jan-14
-
Grupo Biotoscana SL
United Medical Ltda
-
-
-
-
31-Dec-13
$120.0
Stryker Corporation
Patient Safety Technologies, Inc
$20.0
$3.1
6.0x
38.7x
31-Oct-13
$114.9
AMETEK Inc.
Creaform Inc.
$49.7
-
2.3x
-
13-Sep-13
-
Bruker Corporation
Prairie Technologies, Inc.
$11.0
-
-
-
26-Apr-13
$26.0
Emergent BioSolutions Inc.
Bracco Diagnostics Inc.
-
-
-
-
25-Mar-13
-
Psilos Group Managers, LLC
Gamma Medica, Inc.
-
-
-
-
07-Mar-13
$34.4
Fonar Corporation
Health Diagnostics Management, LLC
(HDM)
-
-
-
-
28-Jan-13
-
Samsung Electronics America, Inc. NeuroLogica
-
-
-
-
_______________________________________________________
Common IR Procedures
Angiography
Arteriovenous Malformations
Balloon Angioplasty
Biliary Drainage and Stenting
Central Venous Access
Chemoembolization
Embolization
Gastrostomy Tube
Hemodialysis Access
Infection and Abscess Drainage
Needle Biopsy
9
Radiofrequency Ablation
Stent
Stent Graft
Thrombolysis
Urinary Tract Obstruction
Uterine Artery Embolization
Uterine Fibroid Embolization
Varicocele Embolization
Vena Cava Filter
Vertebroplasty
_______________________________________________________
Accuray
Agilent
Aktina Medical
Analogic Corporation
Annidis Corp.
Bayer
Bracco Group
Carestream Health
Cerner Corporation
Cook
Esaote
Fuju Medical Systems
GE Healthcare
Hitachi Medical Systems
10
Selected Industry Players
_______________________________________________________
IBM
Hologic, Inc
Konica Medical
McKesson
Medtronic
Medrad
Mitsubishi Imaging
Philips Healthcare
Siemens Healthcare
Sonosite
Toshiba Medical Systems
Varian Medical Systems
Ziehm
Zonare
The Walden Group …
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T h e W a l d e n G r o u p


2012 Strategic Healthcare M&A Report – The Annual Issue

At a glance …

 The State of the MedTech Sector

 Valuation and Performance Metrics of Leading Healthcare Companies

 Notable Deals in Q4 2012 -- Summaries

 Top Deals of 2012 > $100m in Transaction Value

 Analysis of more than 85 M&A Transactions announced or closed in Q4 2012




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The Strategic Healthcare M&A Report analyzes important merger, acquisition and strategic transactions taking place in the healthcare industry. A complimentary copy of the
Report can be obtained by subscribing at www.waldenmed.com. Please feel free to e-mail suggestions for future content to the address listed above.

With 20 years of experience and a lengthy track record, The Walden Group is a strategic healthcare investment banking and consulting firm, specializing in fitted mergers and
acquisitions for medical device, diagnostics, healthcare IT, healthcare services and niche pharmaceutical firms.

© 2013 The Walden Group®, Inc. No part of this report may be reproduced without written permission of The Walden Group, Inc. All rights reserved.

Widely Regarded Healthcare Industry Experts
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Research Capabilities
Through years of handling middle market transactions, WG has
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and active business development activities.
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and managing transactions that involve large prospect populations.
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acquisitions in the U.S.
Hundreds of companies contact us for M&A and market perspectives.
17
_______________________________________________________
18
Representative M&A Deals


























V. Mueller ENDOlap™
______________________________________________________
Selected Transactions
The sale of Endo Optiks, LLC, a developer of minimally invasive ophthalmic endoscopic systems, to
Beaver Visitec International, Inc., a global leader of world renowned brands for ophthalmic and specialty
microsurgical procedures and a unit of Roundtable Healthcare Partners.
The acquisition of MicroSurgical Technology, Inc., a manufacturer of specialized ophthalmic surgical
devices, by Halma p.l.c, a provider of health optic products, sensor technologies, instruments for eye
surgery and diagnostic monitoring devices.
The sale of Katena Products, Inc., a leading manufacturer of ophthalmic surgical instruments,to The
Cortec Group a private equity firm.
The acquisition of Arxa5 Corporation d/b/a IOP Ophthalmics, a provider of amniotic membranes and
other technologies for ophthalmic surgery, by Katena Products, Inc., a leading manufacturer of ophthalmic
surgical instruments. After a market review, The Walden Group initiated this transaction on behalf of Katena
and The Cortec Group, its financial sponsor.
The sale of Life Systems, Inc., a leading endoscopic repair and maintenance company, by STERIS
Corporation, provider of infection prevention, contamination control, and surgical support products and
services. After identifying LSI has a strategic fit on Steris’ behalf, at the request of LSI and consent of
Steris, The Walden Group represented LSI and arranged for the transaction.
The acquisition of Brennen Medical, a maker of advanced wound and burn products based on porcine
xeongraft and oat beta glucan technologies, to Molnlycke Health Care, a Sweden-based maker of
advanced woundcare and surgical products. Representing Molnycke, The Walden Group performed a
strategic acquisition search, identified Brennen as a key synergistic fit and arranged for the transaction.
19
_______________________________________________________
20
Selected Transactions (continued)
The sale of Total Repair Express, national provider of surgical instrument repair services and instrument
tracking information systems, to Steris Corporation, provider of infection prevention, contamination
control, and surgical support products and services.
The sale of Bell-Horn Orthopedic Products, a supplier of orthopedic softgoods primarily to independent
pharmacies, to DJO Incorporated, a leading producer of orthopedic devices and products for rehabilitation,
pain management and physical therapy.
The $75 million purchase by Moog Inc. (NYSE), a manufacturer of precision control components serving
military, commercial aircraft, aerospace, industrial and medical equipment sectors, of Curlin Medical LLC,
a maker of "smart" ambulatory infusion pumps for pain management and other applications. The Walden
Group was retained by Moog, conducted an acquisition search, identified Curlin as a strategic fit, and
originated the transaction.
The sale of Jarit Surgical Instruments, a major manufacturer of general surgical instruments sold into
hospitals and clinics primarily through large group purchasing organizations, to Integra LifeSciences
Holdings Corporation, a public company focused on neurosurgery, tissue regeneration products, and
surgical instrument lines.
The sale of Taut, Inc., a leading manufacturer of bladeless laparoscopic access ports and other minimally
invasive products, to Teleflex Incorporated (NYSE:TFX), a large diversified manufacturer with significant
medical operations.
The divestiture of the MAYFIELD® Cranial Stabilization and Positioning Systems and the BUDDE®
Halo Retractor System by Schaerer Mayfield USA, Inc. (formerly Ohio Medical Instrument Company)
to Integra LifeSciences Holdings Corporation (Nasdaq: IART).
The sale of Seattle Systems, Inc., a leading manufacturer of orthotics, prosthetics, orthopedic and pain
management products, to an affiliate of The Trulife Group Limited (Ireland), a manufacturer of
orthopedic, breast care, pressure care, prosthetic and consumer products.
_______________________________________________________
Among our Testimonials…
Barnes & Thornburg LLP (Law Firm)
"I was telling Todd yesterday that you were one of the most professional, sharp and enjoyable Investment Bankers with whom I've
had the pleasure of working in my 30 years of doing this, and I've worked with tons of IBs over the years. You are a real pro with
whom I look forward to the opportunity to work again!“ David Millard, Partner
Endo Optiks
“Thank you so much for your expert guidance and involvement in all facets of the recent sale of our ophthalmic, micro-endoscopy
business. We felt you melded so seamlessly with us that you were part of our company. Your rare skill set, combining extensive
corporate law knowledge with decades of investment banking experience, was invaluable.
It took several years for ophthalmic surgeons to become comfortable utilizing our proprietary, triple-function endoscopy rather than
an operating microscope for diagnostics and treatment. The endoscopic cyclophotocoagulation (ECP) procedure we pioneered
was initially confused with more invasive procedures. We were so impressed with your understanding of these dynamics in
presenting our company to prospective acquirers based on the science and safety/efficacy data, which demonstrated superior
patient outcomes compared to other surgical techniques.
We especially want to thank you for your detailed negotiating skills, resulting in a doubling of the purchase price from the initial
proposal and providing several options for increased consideration from future performance. Your "all in" approach, diligence,
professionalism, and persistence were evident in every phase of the negotiating and sale process.” Steve Kohn, CEO and Co-
Founder, Endo Optiks, Inc.
Halma p.l.c. (HLMA.L:LSE)
"Thanks so much for your expert advisory work in regard to the MST transaction. Being an acquisitive company, Halma has a
certain style and process of reviewing, valuing, negotiating, performing due diligence and closing a deal. I was very pleased with
how you provided important contributions in all phases, most notably helping both us and the sellers come together on difficult
issues. I considered you at all times an integral part of our team, promoting our best interests. This was especially on display as
you helped tailor our approach to the unique needs of this transaction. I look forward to working with you and your team on the
next acquisition.“ Adam Meyers, Chief Executive Officer, Health Optics Division
21
_______________________________________________________
Among our Testimonials…
Current Solutions LLC
"Three years ago, I was on the opposite side of the table from Walden in negotiating the purchase of a Walden listed
business. I was so impressed with the honesty, integrity and effectiveness in which you represented your client and treated
us as the acquiring company, it made perfect since to ask you to represent our company for a potential sale. I was also
very impressed with Walden's deep healthcare clinical knowledge and extensive industry network. You took pains to
prepare us individually and as an organization so that the transaction material and all dealings were as professional as the
manner in which we run our business. All dealings reflected quality and translated into an excellent valuation.” Glynn
Bloomquist, President
Bell-Horn Orthopedics
“Thank you so much for your invaluable assistance in divesting Bell-Horn to DJO Global. As you advised, it was so
important to spend the time in advance to organize the company, our financial reporting, our organization and our
operations, so that the presentation of our company was Blue-chip, professional and effective. The Walden Group helped
create credibility every inch of the way. All this effort and your firm's interactions with other parties leveled the playing field
and created the conditions for win-win negotiations on very attractive valuation and deal terms. There were so many details
and subtleties that you kept us on top of. And, when our lawyers became involved, we appreciated your teamwork
approach and pivotal contributions in negotiating the definitive agreements." Todd Katz, President
Sanbor Corporation (China)
"Now that the dust has settled, I just wanted to thank you for your fortitude and resilience in getting our deal done … at last.
I now know how hard it is to complete a corporate sale, especially one in China. When the world was falling apart in 2008,
a former suitor could not complete our deal and we were all burned out, you picked up the pieces and helped us start
afresh with new energy. The Walden Group pinpointed new acquirers needing a high-end China-based engineering and
technical production company and then navigated the maze one more time to a happy conclusion. There were so many
"deal wires to connect" and you helped put everything together. Even at the end when special pass-through tax allocation
expertise was required by both sides, you brought in just the right talent to solve the problem.“ Wayne Meng, President
22
_______________________________________________________
Principals
James A. Walden - Prominent healthcare investment banking professional for more than 25 years.
Previously, CEO and Chairman of the Board of Phillips Appel & Walden Inc., a major Wall Street firm.
Richard S. Cohen - Arranged more than 75 merger and acquisition transactions. Co-Chair of the 7th Annual
Healthcare M & A Conference. Formerly, a corporate and securities lawyer at Wachtell, Lipton, Rosen & Katz;
a senior officer of The Trump Group (a prominent Leveraged Buyout Firm); a director of public companies;
and President of a privately owned manufacturer.
Merle Symes - Former President and CEO of the U.S. division of Ulrich Medical, a German maker of spine,
radiology and other surgical products where he grew the company 60% in three years. Prior to that he served
in senior positions at Bausch & Lomb and Monsanto. Mr. Symes is an expert in technology management, new
product development, market positioning, merger integration and turnarounds Wharton MBA and B.S. in
Chemical Engineering.
Steven Steiber, Ph.D. - Healthcare market research executive formerly with major companies including GfK
Healthcare, Opinion Research International and the Gallup Organization. Mr. Steiber has more than 25 years
experience designing market intelligence programs for leading pharmaceutical and medical device
manufacturers, analyzing the data derived, formulating strategic plans and helping to execute those plans.
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