PERSPECTIVE

Perspective on the optics of medical imaging

Brian W. Pogue *
University of Wisconsin–Madison, Department of Medical Physics, Madison, Wisconsin, United States

ABSTRACT. Significance: Medical imaging is very commonly described as synonymous with

radiological imaging, yet optical imaging devices are widely distributed throughout
many medical specialties. This delocalized nature of the technology reduces visibil-
ity and dominance as a cohesive medical technology sector.
Aim: Indicators of impact of medical optical systems were examined and compared
to the radiology technology sector.
Approach: This study included a summary of (i) physician users, (ii) global tech-
nology valuations, and (iii) NIH funding levels. Analysis focused on comparing opti-
cal and radiological technology, comparing costs, funding, and finding differences,
while tabulating strengths, weaknesses, opportunities, and threats to the field of
optical imaging.
Results: The 2023 global technology revenue valuation of biomedical optical tools
is $128 billion USD/year while that of radiological tools is $48 billion USD/year.
A direct comparison of US NIH funding in radiology shows $8.5 billion/year, whereas
optical devices are nearer to $3.6 billion USD/year. R&D investment in applications,
such as endoscopy, laparoscopy, and pulse oximetry, is far below those of radio-
logical tools when normalized by valuation.
Conclusions: The medical optical device industry is highly fragmented but has
become the largest single technology sector in medicine today. When contrasted
to radiology, it appears underfunded for research, where point-of-care tools such as
surgery, endoscopy, laparoscopy, ophthalmology, pulse oximetry, and monitoring
have more potential for development through research investment.
© The Authors. Published by SPIE under a Creative Commons Attribution 4.0 International License.
Distribution or reproduction of this work in whole or in part requires full attribution of the original
publication, including its DOI. [DOI: 10.1117/1.JBO.28.12.121208]

Keywords: optical; radiology; surgery; image; laparoscopy

Paper 23022SSPER received Aug. 8, 2023; revised Sep. 1, 2023; accepted Sep. 12, 2023; published Sep.
30, 2023.

1 Introduction
Medical devices used in patient care have many forms, ranging all the way from multi-million-
dollar imaging systems to guide interventional procedures, to pocket-sized diagnostic systems
that cost a few hundred dollars. The major tools developed for imaging or intervention fall into
two very broad categories, which can be roughly categorized as radiologic systems or optical
systems. This is the central hypothesis examined in this paper that while radiological systems are
well defined and organized around a small set of medical specialties and with a harmonized
departmental representation. In contrast, optical systems are widely distributed and not clearly
appreciated as a singular technology. This latter issue is even though optical devices permeate
throughout nearly all medical specialties and compose an even larger and more highly diverse set
of tools than radiological systems. Arguments could be made to classify technologies in different
ways, but the breakdown of optical and radiological is examined here because these two have the

*Address all correspondence to Brian W. Pogue, bpogue@wisc.edu

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 Pogue: Perspective on the optics of medical imaging

majority presence in both diagnostic and therapeutic procedures and have very different repre-
sentations, use cases, and market drivers. The analysis of how to compare optical systems to
radiological systems is not obvious, but this study examines a few ways to think about comparing
their numbers, value, and utility. An earlier version of this analysis was published in 2018,1 but
this new version is updated with 2022 to 2023 numbers and an augmented analysis based upon
current data.
Within medicine, “medical imaging” is nearly always defined as imaging with traditional
radiological systems, such as x-rays, ultrasound, magnetic resonance imaging, and nuclear
medicine methods. The uses of these imaging systems in radiology departments have shaped
this narrative, defining what medical imaging is. This can be seen by the fact that nearly all
textbooks on the subject and all departments of radiology, medical imaging, medical physics
are exclusively organized around radiological systems, as defined above. This is further
reinforced by the workflow in which most medical practitioners order radiological exams to
be completed by the radiology department and interpreted by radiologists as a service.
Radiology is now the largest revenue generator in most major medical centers, as the scan costs
have stayed low while the need for them has seen dramatic increases. This organization of
radiology as a unique specialty was, and remains, necessary due to the inherent risks of radiation
and the skill set needed for interpretation of the images. There are deviations to this, such as in
ultrasound, which are not inherently dangerous when used within its specified limits, and its use
has spread to many other specialties, including family medicine. But in major medical centers,
radiology is still a comparatively well-defined department with a common set of scanners that
gets utilized as a service for many ambulatory, in-patient, and interventional exams. The com-
panies that service these departments are focused on the departmental structure and purchasing
goals. There is a common language, a collaboration pathway for academics, and specialists,
physicians, academics, and industry professionals all attend the same conferences.
Comparing radiological device use and growth to the penetration and use of optical systems
shows a very different adoption pattern, workflow, development landscape, and descriptive
narrative about the field. Optical systems are highly diversified, and this diverse range of tools
is distributed throughout medicine. Their use goes all the way from family practice through
optometry, ophthalmology, dermatology, urology, surgery, etc., and often they are used in a
continuous or functional manner, such as pulse oximetry. In fact, because optical devices are
so diverse in their specialization and capabilities, there is little commonality between devices
used in different medical specialties. This has led to a situation where it is challenging to find
a global understanding of the magnitude of how much optical devices have impacted medicine.
Again, while radiological devices tend to be highly centralized within a department, optical
systems are scattered throughout medical centers and into family clinics, in a highly delocalized
manner. The market forces for different optical devices are wildly different depending upon the
department and the price point, which can span from a few hundred dollars in family medicine up
to millions of dollars in surgical systems. It appears like there is little commonality of location in
between physicians, academic developers, and industry professionals, where they attend different
conferences and it seems like the disciplines do not have a high frequency of crosstalk between
medical specialties. Thus it is hard to identify the entirety of the optical device world, because of
its success in adoption throughout nearly all of medicine. It is not generally viewed as a single
technology sector, but rather each specialty views optical devices as one of the many tools in its
toolkit.
In this study, an analysis of the penetrance, use, and impact of optical devices was carried
out, using radiological devices as a comparator. The goal was to quantify the field as much as is
possible and to identify areas where visualizing it this way might lead to advances.

2 Medical Specialties and Optical Devices

The United States has nearly 1 million physicians, according to the American Medical
Association,2 and a breakdown of these into specialties based on their numbers is illustrated
in Fig. 1. Those that utilize radiological tools (largely radiation oncology and radiology) make
up about 4% of all physicians. The categorization of these two departments is the clearest, given
their complete reliance on radiological systems. Those that utilize primarily optical tools are

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 Pogue: Perspective on the optics of medical imaging

Fig. 1 Numbers of physicians in the United States (from the American Medical Association in
2021)2 roughly categorized into those that primarily utilize radiological systems on a daily basis,
those primarily using optical systems on a daily basis, those that utilize both, and those that utilize
neither daily.

slightly less clear to classify, but are dominated by those general and family medicine who do not
have radiological licenses in their office but can also including geriatrics, dermatology, gastro-
enterology, pathology, ophthalmology, anesthesiology, and physiology and rehab. Together these
compose ∼35% of all physicians. There is a broad category of specialties that utilize both radio-
logical and optical systems, and it is much more challenging to categorically say, but these
including surgery, critical care, obstetrics and gynecology, cardiology, and pulmonary medicine,
composing an additional 36%. The actual breakdown of utility is challenging to make out, so
these are very broad categories. There are a range of physicians who have a high potential for not
utilizing either of these devices, including internal medicine, psychiatry, hematology and oncol-
ogy, allergy and immunology, and pain medicine, although they likely work with colleagues who
do use both. However, when broken down by these broad approximate categories, likely 66% or
a full 2/3 of all physicians utilize optical systems on a nearly daily basis, making it clearer that
optical technology is the largest single technology utilized by physicians in the country.

Fig. 2 Visual display of a range of many commonly adopted optical technologies used in medicine,
broadly classified as diagnostic (top) and therapeutic (bottom), and roughly organized clockwise
from lower system cost (top left) to higher system cost (bottom left), as noted by red dollar signs.

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 Pogue: Perspective on the optics of medical imaging

Gaining a high-level perspective on optical systems in medicine is challenging, because

there is a disconnect between academic biomedical optical system development and industrial
medical system development. This disconnect is partly due to national funding trends, as will be
discussed below, as well as the fact that large medical device companies substantially internalize
their research programs. Thus the academic research in optical systems tends to be more biased
toward scientific or fundamental developments, such as microscopy systems, whereas the device
industry tends to focus on iterative improvements to highly profitable existing systems, which are
largely macroscopic optics-based. A high-level overview of systems in widespread use can be
found from researching the tools used by the physician specialties listed in Fig. 1. Figure 2
illustrates the range of tools that have been widely adopted and in turn shape what these special-
ties do. This is organized roughly around diagnostic tools on the top and cascading to therapeutic
and therapy guidance tools on the bottom.

3 Global Valuation of Optical Devices

One of the most straightforward ways to achieve a top-level view of the impact of a technology is
to assess its financial valuation, here defined as the market investment in each sector, as assessed
by consulting reports. A survey of consulting reports was completed with at least three published
reports assessed for each technology sector (see Table 1), and the average of these reports was
summarized into a single global market value number for the 2022 to 2023 timeframe. The sum-
mary of these numbers is shown below in Fig. 3, illustrating the market impact of optical devices
and radiological devices, organized into red and gray, respectively. It is interesting to note that the
optical device valuation is 73% as compared to just 27% for radiological systems. The details of
the reports utilized as resources and the total range of numbers are listed in Table 1.

Table 1 Complete listing of total range for global market valuation numbers for each modality from
Fig. 3, with the listing of the market research report origin. Note some reports lack clarity about
the inclusion of disposables or other non-device parts to their valuation, which can lead to high
variation in the range, such as for dermatology.

Technology Valuation range Resources

Ophthalmology $50b to $56b GlobeNewswire

Research and Markets
PR Newswire
Endoscopy $30b to $49b Grand View Research
MarketsandMarkets
PR Newswire
Surgical devices $5b to $17b Research and Markets
Grand View Research
Expert Market Research
Dermatology $6.5b to $23b Grand View Research
MarketsandMarkets
Verified Market Research
Microscopy $7.5b to $12b Grand View Research
MarketsandMarkets
BCC Research
Maximize Market Research
Pulse oximetry $2.5b to $2.9b Grand View Research
MarketsandMarkets
GlobeNewswire
BioSpace
CT $4.0b to $8.1b Grand View Research
Mordor Intelligence
Fortune Business Insights

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Table 1 (Continued).

Technology Valuation range Resources

X-ray $3.8b to $7.0b Research and Markets

Future Market Insights
Mordor Intelligence
MRI $5.3b to $9.0b Grand View Research
Statista
Mordor Intelligence
Ultrasound $8.9b to $10.8b Grand View Research
GlobeNewswire
Mordor Intelligence
Nuclear medicine $9.9b to $11.7b Grand View Research
Precedence Research
Image Technology News
Maximize Market Research
Radiotherapy $5.7b to $8.6b Research and Markets
Precedence Research
Grand View Research
Global Market Insights

These global valuations are based upon industry numbers for total market manufacture and
sales of systems annually. Notably this does not represent the revenue seen at medical centers for
use of the systems, which is different. For example, it is well known that radiology departments
are one of the highest profit-generating medical centers in the United States, and this may be partly
because these are diagnostic procedures that are rapid, with many scans per day per system. The
billing costs for imaging and interpretation of the images is in the range of $20 billion per year,
from about 370 million procedures, with a low reimbursement per exam near $100. This can be
contrasted with an optically guided procedure, such as laparoscopy, of which there are about
15 million/year in the United States, and revenue is near $10,000 per procedure, for a compa-
ratively modest revenue of $150 million/year for laparoscopy. So, while diagnostic imaging has
low reimbursements, they can have higher financial impact on the medical center because of the
larger number of procedures done and the number of scans per day that can be achieved on a single
system. Diagnostic procedures also wind up with diagnoses of health conditions that often will
lead to further treatments, further increasing revenue for that medical center. Interventional
procedures require substantial cleaning and sterilization of devices, which increases the cost per
procedure and may require more systems to be present in a single institution.

4 US Investment in Research on Optical Devices

Another important factor that is involved with device development is the amount of investment in
research and development. It is challenging to assess this from company information, but public
disclosure of funding from the United States National Institutes of Health (NIH) is available.
The NIH RePORTER system3 was queried to count the number of grants and dollars devoted
to funding in key radiology and optical technology areas, and this is displayed in Fig. 4. In the
radiological sectors, this was broken into x-ray CT, MRI, ultrasound, nuclear medicine, and
radiotherapy, for a total of $8.5 billion per year, or 70% of the device-based research found.
In the optical sectors, this was broken down into microscopy, endoscopy, pulse oximetry,
laparoscopy, ophthalmology, and robotic surgery, for a total of $3.6 billion per year, or 30%
of the device-based research found. It is very interesting to reflect upon the mismatch in balance
between the revenue-based valuation of technology from Fig. 3, and this investment in research
found in Fig. 4.

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 Pogue: Perspective on the optics of medical imaging

Fig. 3 Global market valuation of six radiological areas (CT, x-ray, MRI, ultrasound, nuclear
medicine, and radiotherapy) is summarized above totaling $48 billion for 27% of the global device
market. The optical technology areas that were largest are also summarized (ophthalmology,
endoscopy, surgery, dermatology, microscopy, and pulse oximetry) totaling $128 billion/year for
73% market share.

Fig. 4 NIH funding levels for 2023 were surveyed from NIH RePORTER,3 with total dollars of
funding listed, in millions of USD. The levels for some are too small to show in the chart.
Optical tools make up $3.6 billion while radiological tools make up $8.5 billion in funding per year.

If the technologies are analyzed as a factor of R&D investment per revenue valuation, there
are some surprising observations, as shown in Table 2. Several key technologies that are widely
used in scientific study have high funding rates, including MRI, nuclear medicine, and micros-
copy, with above 30% funding per valuation of the technology. This is an amazingly high
funding rate and indicative of the scientific value of their advancement as much as their clinical
utility. Older imaging modalities and those that do not have large scientific discovery value tend
to have lower NIH funding rates, including CT, ultrasound, and radiotherapy. These might also
include static technologies, such as pulse oximetry, despite how widespread and clinically mean-
ingful the technology is for critical care. However, there are some optical technologies that have
surprisingly low investment in R&D given their valuation and these include ophthalmology, and
especially laparoscopy and endoscopy. These latter two areas are highly interventional but also
are used in a point-of-care setting where their use has direct curative intent and cannot be
replaced. It could be argued that further investment in these technologies is warranted. Why
research into these devices does not have larger funding at government agencies like the
NIH is not clear, but this should be a topic of further analysis.

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Table 2 Ratio of NIH funding to total global valuation of the technol-

ogy is shown for the range of radiologic and optical tools where data
matched.

Imaging device Funding ratio (%)

CT 10.1

MRI 48.7

Ultrasound 5.6

Nuclear medicine 30.1

Radiotherapy 8.1

Microscopy 30.6

Pulse oximetry 0.8

Laparoscopy 0.2

Endoscopy 0.2

Ophthalmology 0.8

5 Analysis of Strengths, Weaknesses, Opportunities, and Threats

To augment the data below, a narrative summary of strengths, weaknesses, opportunities, and
threats (SWOT) provides a structured way to summarize the status of the field and help point
toward areas that are ripe for development. The details of these are necessarily slightly subjective,
but the attempt has been made to be objective and provide an overview perspective, without
getting into details of any modality or procedure. A summary of the SWOT details are included
in Table 3, and a narrative description of each point is included below in this section.

5.1 Strengths
The largest technological strength of optical imaging can be clearly referenced to the invention
and enormous advances in CMOS camera sensors in the last 25 years.4 These devices now widely
outnumber the number of humans on the planet and are ubiquitous in everyday life, from cell
phones and computers, to every digital image that we see daily. Because of economy of scale,
very high-end sensors can be just a few dollars in cost and even disposable in their use case. This
in turn has led to an enormous optical device industry throughout all sectors of the economy,
a $2.5 trillion industry composing 3% of the > 85trillion global economy. Biomedical optics is
actually a fairly small sector, here estimated at $128 billion, increased from $91 billion in 2015.5
So biomedical optics is 0.15% of the entire global optics industry, but this means that it leverages
the economy of scale that is 700 times its size. This scale reduces the cost of components
enormously, making components available at a lower cost than if they were just produced for
the smaller market of medicine. Within medicine though, optics forms the largest technology
market in medical imaging, and many of the tools and detectors for optical sensing are still the
core technology used in high-end nuclear medicine scanners, advancing technologies, such as
CMOS arrays and silicon photomultiplier tubes.
Perhaps the most obvious medical strength of optical systems is through their use as the
primary tool for all point-of-care vision, where the physician and the patient are in the same
room.6 The physician’s desire is to diagnose by seeing inside the body, through ear, eye, nose,
throat, rectum, colon, vagina, urethra, or skin during a clinical exam, partly illustrated in Fig. 1.
Optical cameras augment their vision with better tools that fit into the body cavity and deliver
high-fidelity images. However substantial improvement may still be possible, such as the ability
to provide more wavelength bands, higher resolution to the point of microscopy, molecular
sensing, and tissue response imaging. Innovations to be developed and tested in clinical trials
will determine the success of these.

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Table 3 Strengths, weaknesses, opportunities & threats (SWOT) of the technology sector of
medical optical imaging.

Strengths Weaknesses

• Highly efficient economical imaging due to • Largely limited to surface and cavity imaging, vision
invention and advancement of CMOS cameras imaging, or near sub-surface sensing/imaging

• Enormous economy of scale with consumer optical • Tissue imaging deeper than a few mm has never
devices, a $2.8 trillion industry been commercially successful due to limited spatial
resolution

• Large engineering workforce, largest technology • Each application has specialized system, diffusing
sector in medicine the overall view of optical imaging systems

• Primary tool for point-of-care and interventional • Slow introduction of contrast agents
vision

• Optical devices are core to many highly sensitive

radiation detection systems

• Synergy with advances in display technologies

Opportunities Threats

• Continuing explosion of consumer technologies • Dearth of communication between academic and

that advance optical imaging capabilities industrial biomedical optics research directions

• Advanced surgical, laparoscopic, endoscopic • Limited NIH investment in optical tech despite
technologies that augment vision beyond just color being widely adopted in point-of-care exams
imaging

• Microscopic to macroscopic imaging in the same • Funding structures limit the ability to work with
instruments industry on collaborative development

• Scattering makes the signal more sensitive to the • Lack of technical domain experts within the medical
entire tissue volume, beyond vessels center to assist physician groups when deploying
advanced medical optical systems

• Highest potential for molecular sensing of all • Physician work overload minimizing use of
imaging modalities due to numerous optical advanced instruments
molecular probes

• Shifting healthcare toward wellness instead of

healthcare, requiring monitoring technologies

• Screening requires low-cost, low-risk systems

5.2 Weaknesses
The weaknesses of optical imaging limit what is possible today and in the future. The most
obvious limitation is that optical light is highly scattered in tissue, which relegates it to
primarily surface imaging throughout the skin, ears, eyes, or mucosal cavities of the body.
Although not necessarily a weakness, this trait defines where optical imaging provides its
maximum value. It is superior to any other tool for surface imaging. Conversely, it is true
that deep tissue imaging of more than a millimeter or two has never been commercially
successful due to limited spatial resolution. Sensing through tissue such as in pulse oximetry
is very successful but imaging has not been. Although significant advances have occurred in
deep tissue sensing and imaging with approaches like diffuse optical tomography and photo-
acoustic imaging, these have not translated beyond research systems into clinical practice.
In comparison to imaging though, there are many good applications for sensing through
tissue, such as pulse oximetry. But true imaging with spatial resolution has not been com-
mercially adopted in medicine today, and given the timeline of development and substantial
testing, it seems likely to follow in the future as well.
A weakness inherent in optical systems being interventional or direct point-of-care is that
each new application has a specialized system and as shown in Fig. 1, there can be very little

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commonality between systems in different specialties. As such, this extreme diversification

diffuses the broader view of what optical imaging technology is within medicine or medical
imaging. Working in ways to better define these systems is something that professional societies
might work on to better represent the field of biomedical optics.

5.3 Opportunities
Key technological opportunities for optical imaging lie in simply harvesting from the continuing
explosion of consumer technologies that advance optical imaging, which keeps producing more
features, capabilities, with embedded processing and expanded spatial resolution, wavelength
range, dynamic range, low noise, and expanded size scales. The advances in sensors and
packaged systems do not necessarily directly translate to medical use, but the wider advancement
of the field creates a technology sector that can invent tools with lower cost production. This will
allow major advances in areas, such as surgical, laparoscopic, and endoscopic technologies
that augment vision beyond just color imaging. Additionally, incredible opportunities lie in
combining microscopic to macroscopic imaging in the same instruments, allowing point of
care or interventionalists to utilize both these size scales. Optics has always been good at both
magnification scales but rarely has been good at blending the two.
Opportunities remain undeveloped in the areas of molecular sensing in medicine. This
aspect of optics is widely utilized in vitro through millions of microscopy techniques, molecular
pathology, flow cytometry, gene profiling, and clinical chemistry. However, many of these tools
are not used in vivo because of the limits to their medicinal chemistry use, despite being
incredibly important for healthcare. Advancement of surgical trials or diagnostic trials with
well-tolerated molecular contrast agents is an area that is ripe for advancement. An additional
feature of optical sensing through tissue is that while multiple scattering reduces the ability to
image with high resolution, it does increase the sensitivity of tissue, by increasing the pathlength
in tissue by 5 to 6 times,7 enhancing the sensitivity to cells and capillaries. So non-image-based
sensing of molecular and capillary features can be significantly improved with highly scattered
light. This is a factor exploited in pulse oximetry sensing8 but not widely exploited yet for other
applications that have more molecular features.
Future healthcare opportunities lie in the ongoing shifts in the funding and goals of
healthcare toward wellness and health monitoring, instead of acute delivery of healthcare once
problems emerge. The commercial monitoring tools developed for home sensing and daily
monitoring are coming from the consumer electronics industry, in which optical sensing is a
key core technology. The costs of these technologies, and those for screening for healthcare
problems, each require a low-cost, low-risk system, and optical technologies are likely going
to be a core part of this pipeline.

5.4 Threats
One of the largest threats to the advancement of optical technologies in medicine comes from
the fact that academic research and industry research are not at all aligned in goals or even in
any realistic communication with each other. Academic research is funded by government
agencies such as NIH, which advance scientifically intriguing technology, but the optical
device industry tends to be insular, inventing their own technologies within each company
to advance new products. This is partly because the field is so mature, and so there are
thousands of overlapping patents in each field, leading to the development space being
just as much about trade secrets and proprietary software as it is about innovations in
hardware technology. Thus communication and advancement are hindered in this environ-
ment, and the dynamics do not lead to collaborative development. Unlike the radiological
field, where industry, academics, and physicians often attend the same conferences together
(i.e. Radiological Society of North America, and the American Society for Therapeutic
Radiation Oncology) and work on the same devices, the optical device sector and people are
highly diversified into their physician specialty areas. This means that there is little commu-
nication across device specialties, such as dermatology, surgery, cardiology, family medicine,
and oncology. Solving this communication and impedance mismatch problem would
have positive potential for technological advancement across medicine and provide better
guidance. It also may help better align funding deficiencies in certain areas of research.

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 Pogue: Perspective on the optics of medical imaging

The need for this is illustrated by the low funding for surgery, laparoscopy, and endoscopy,
as shown in Table 2, despite their critically important role in medicine today.
A medical threat can be seen also in the comparison between biomedical optics and
radiology. Most radiology and radiation oncology departments have entire subspecialties of
medical physicists within their departments, providing them with technical expertise, repair,
installation, and commissioning of new advanced devices. In comparison, optical devices are
rarely ever deployed with technical guidance beyond the company sales or installation specialist,
and training is either remote or not at all in some cases. Thus as optical technologies become
more advanced, there is increasing potential for misuse or early adopters to fail in the accurate or
informed use of the technology. There is a challenge that advanced highly technical areas may
need to advance a field of optical engineers or physicists as a resource for people across the
medical specialties. This occurs in some of the most research active medical centers now but
is not common throughout most medical centers. Finally, there is some risk that high-end
technology will limit its advance in routine medicine because of the growing overload of work,
documentation, and billing inherent in the system. Physician burnout will inevitably reduce use
of technology, limiting future innovation adoption.

6 Discussion
Part of the rationale for this analysis was the fact that optical technologies are so diverse and
spread across so many medical specialties, such that it is hard to grasp the size and scale of the
technology sector. The contrast of optical with radiological was developed to illustrate how
even a distributed set of unrelated technologies (i.e., CT, MRI, ultrasound, and nuclear medi-
cine) can be homogeneously represented in a single department, radiology. This physical co-
localization and user base homogeneity works to its advantage to highlight the field as a whole
and simplify the ability to integrate company collaborations at a high level, as well as national
funding streams and integration of academic developers. Optical systems are highly divergent,
stratified along specialization lines and along price point goals, with comparatively little
crosstalk in the user base. Companies can translate system innovations across specialization
areas, but this is not often done in constructive collaboration with the users nor academic
developers. Additionally, because of the distributed nature of optical systems, the industry
base is also highly distributed, and the academic base of researchers does not necessarily
match that of industry. Industry has developed its own R&D program for most interventional
systems, and there is a direct market from companies to specialists without involvement of
academics. The lack of visibility is part of the reason optical devices are not seen as a single
technology sector today, and it is compounded by the distributed nature of medical specialties
within separate departments or divisions.
Communication barriers are also a factor that limits the development and realization of
optical imaging as a cohesive technology sector. These barriers are because of this distributed
specialty nature, and the fact that academic developers rarely meet with the users. This can be
contrasted with radiology, where the academic developers and users are commonly located in
the same academic medical center or department allowing direct communication and collabo-
ration on research projects. Also the radiologists are trained on the whole realm of radiological
tools, even if they eventually specialize in one of them, they are trained on the whole sphere of
imaging and therapy approaches in radiology. This can be contrasted with the optical users in
surgery, ophthalmology, dermatology, and pathology, where there is little communication on
common tools. Additionally, fewer optical academic researchers are embedded into these
departments at most centers, as compared to large radiology departments that have robust
academic research programs. Thus optical device development suffers from multiple commu-
nication barriers that limit lateral translations and vertically driven innovations in technology.
This aspect is compounded with the other factors to limit the potential of the field.
The most expensive optical technologies are interventional and exist within medical
specialties that tend to have less research because of their interventional or procedure-based
approach to practice. These include gastroenterology, surgery, and dermatology, for example,
where the funding rate and number of controlled clinical trials is less than medicine or medical
oncology. Still, diagnostic radiology has been able to develop research centers around the country

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 Pogue: Perspective on the optics of medical imaging

that advance the tools of imaging, partly because of their promise, but also partly because of their
visibility and cohesive approach to advancing the field as a unified technology sector. A concrete
example of this cohesion is shown in the fact that NIH National Institute of Biomedical Imaging
and Bioengineering funded P41 centers for Biomedical Imaging, where 10 are focused on MRI
or PET, and only 3 are focused on optical technologies in medicine. This is partly because the
diversity of optical technologies makes it harder to exploit a common platform but also partly
because radiological systems represent singular large investments in technology that work as
research resources that attract users. It is worth speculating that if surgical departments put their
same focus on the commonality of high-fidelity higher-parametric functionality imaging systems
and advancing them as a technology sector that higher investment and advancement could follow.

7 Conclusions
This analysis had the goal of providing quantitative numbers on the market forces of optical
technology and the user base of physicians. It illustrates that optical devices do form the single
largest technology sector and larger than that of radiology, in terms of purchased equipment.
It is important to note that radiology still has a very high profit margin, making it the
largest profit center in most medical centers, but this comes from the higher volumes of exams
per day on a limited set of imaging systems. The optical technologies used in many point-of-
care procedures have significant value and when viewed as a technology sector may be better
positioned to translate ideas or find innovations that advance the tool capabilities. Research in
the space of larger interventional guidance systems, such as laparoscopy and endoscopy, is
significantly underfunded, given their position in medicine and the current NIH record on grants.
Further insight into the scope of biomedical optical systems and ways to synergize across
disciplines and enhance areas of needed development may benefit from this basic study.

Disclosures
The author has no conflicts of interest to disclose, as related to this work.

Acknowledgments
This work is dedicated to the large number of biomedical optics device developers who work to
advance functional imaging and therapy approaches across the spectrum of medical specialties.
The author would like to thank Gwen Weerts, SPIE Journals Manager and Editor in Chief of
Photonics Focus, for a critical review of this paper.

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Brian W. Pogue is Chair of the Department of Medical Physics, University of Wisconsin–

Madison; Fellow of Optica, SPIE, AIMBE, AAPM, and the National Academy of Inventors;
and Editor in Chief of JBO. His scholarship focus is at the intersection of medical physics and
biomedical engineering, such as Cherenkov imaging for visualization of radiation dose in radio-
therapy, and in molecular sensing in cancer. He has >500 peer-reviewed publications, 14 patents
with 29 pending, and >$50 million in NIH support.

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