This spring Dr. A. Gregory Sorensen, a distinguished neuro-radiologist with professorships at MIT, Harvard and Oxford, took on a whole new role: CEO of Siemens' health care division in North America. After a morning talk to media at the Radiological Society of North America's annual meeting in Chicago last week, DOTmed News had a few moments to discuss with Sorensen everything from a fiscal crisis roiling Europe to 7-T MRI:

DOTmed Business News: I just came back from a trip to Spain to meet my wife's family in Madrid, and the election was going on. And the entire country was convulsed, and the entire continent is, in the whole Eurozone crisis. Siemens, as a European company, how do you see the contractions, austerity measures in Europe affecting the capital medical equipment business over there?

Sorensen: Certainly, there are challenges to our business as the government struggles with its finances. And it's probably easier for a government to say, "I'll defer buying an MRI scanner for a year rather than lay off a bunch of physicians." However, I think this is a short term issue, not a long term issue. So while we're watching those businesses carefully, in fact we still see growth opportunities there, and the population is getting older there just like it is in the United States. And I think the long-term trend is good. So it's the typical challenge of a business - how do you make sure the short [term] doesn't overwhelm you, while still focusing on the long term?

DMBN: Has Siemens [Healthcare] experienced a hit in its European markets because of the crisis?

Sorensen: Certainly we've seen delays in some of our orders because of the challenges there. But overall, I think our business prospects are still quite good.

DMBN: Moving to a different topic, I know you're going to talk a bit about 7-T MRI during your lecture on mechanistic imaging today . I was speaking with someone from Siemens a couple of months ago who said he thought 7-T MRI was where 3-T was maybe 10 years ago, just waiting for that killer clinical indication to push it over the edge. Do you agree?

Sorensen: 7-T was a little bit like the talking dog at first. It wasn't so much what the dog said, it was just the fact that it could even talk. Ten years ago, people didn't realize - I didn't realize at first - how technically challenging doing MRI at 7-Tesla would be. It's actually just a myriad of engineering problems that have to be solved. Well, at Massachusetts General Hospital, when I was there, we installed our first one about 10 years ago, it was a Siemens device. And now a lot of those man-years of engineering have been put in. I think 7-T is poised to actually show us things we couldn't see at lower field strengths.

DMBN: Where do you think its main usefulness lies - neurology? I know they made a brain atlas on 7-T a couple years ago.

Sorensen: I think neuroscience will be the place. And the things that seem to be the most compelling right now from a patient care perspective are around multiple sclerosis, around head trauma, around neuro-oncology. It's a little bit of a chicken and egg problem because right now the 7-Tesla scanners are still not 510(k) cleared for marketing, which means that most insurance companies won't pay for a 7-T for an MRI. They won't even pay as much as they would for a 1.5-Tesla MRI, much less more, so that means that it's hard to ramp up the clinical infrastructure to use it. Once I think we get a breakthrough on one or two of these applications, I think things will change.

DMBN: Is there a moment you can predict that the greater expense of the 7-T MRI will be met by the supremely better clinical results?

Sorensen: I think so. I think that's actually the challenge for 7-T. It has to show it's so much better it's worth the investment. And at least so far, has that happened? I don't think quite yet. However, we're poised to do that in a couple of diseases. When you look at the costs of treating multiple sclerosis, the therapies are very expensive. And so even an expensive imaging test that can guide that treatment would be very valuable and could easily justify a high cost for its utilization. And that's the kind of the scenario where I think you kind of have to explore. It's not just, "Can I see something?" but, "Can I see something that will leverage or change a lot more expenses downstream?"

DMBN: Your background is in neuro-radiology, and you mentioned Amyvid this morning in your (Siemens media breakfast) talk - this is the in-development PET imaging agent that can help doctors find beta-amyloid deposits in living brains. There's a lot of excitement around it, but do you think its success depends in part on early-stage treatments for Alzheimer's becoming more effective? Obviously, it would be great to be better able to understand early on what your disease state is - but because Alzheimer's is basically untreatable at this point, how useful is that knowledge?

Sorensen: The classic criticism is, because we don't have strong disease modifying treatments for Alzheimer's, who really cares about the diagnosis? And while I think there's certainly some truth to that, it's also clear that many patients and their families desperately want to know the status of their disease. And we see this just because it's on the front page of The New York Times. There's tremendous pent-up interest in this disease because of its long-term implications. But I think this question that you're asking, while a good one, will become less important in the future as there are promising therapies in the pipeline, very promising therapies. We haven't seen many of them with a lot of experience yet, but the early data in some of the trials suggest that some patients actually are getting their memory back - I mean it's remarkable, some of the drugs that are in testing. So I think there actually will be a therapy for Alzheimer's disease in the not-too-distant future, and then the amyloid tracers may become even more relevant. They may even be used to monitor some of the therapies, because the treatments may have some risks associated with them. So, for example, if your amyloid load is down maybe that means you don't need to stay on the therapy. I think in a couple of years this will all become much clearer than it is now.

DMBN: The economist Tyler Cowen recently published a book ("The Great Stagnation: How America Ate All The Low-Hanging Fruit of Modern History, Got Sick, and Will (Eventually) Feel Better") arguing, that the world economy is in trouble, in part because innovation has plateaued, as all the low-hanging technological fruit has been picked by scientists over the last 200 to 300 years. Do you see this applying to health care? I know the last truly new modality - the Biograph mMR - which Siemens released earlier this year, is one of the first ones to come out in almost a decade.

Sorensen: Certainly we're very closely watching to see if there's another diagnostic imaging tool that can surpass what the current imaging tools do. I would say I don't really subscribe to the economist's theory for a couple of reasons. If you look at what CT scanners do today versus what they did 10 years ago, it's a completely different thing. I would say the same with routine MRI. The kinds of images we get on a high-end 3-T are just light-years away from what we got on a high-end 1.5-T system 10 years ago, whether it's parallel imaging, or whether it's the contrast agents, or whether it's echo-planar imaging that's now widely available, or fMRI and diffusion, and these are all tools that, 10 years ago, people were just struggling to actually get working routinely, and now they're everywhere. So, of course it looks like we took all the low-hanging fruit. If there was low hanging fruit up, we'd go take it. But I think people are quite inventive, and if you look at the history of innovation even in the last 5 or 10 years, it's quite remarkable. Is there another technology like MRI or CT out there that's going to have such an impact? I don't see one right now. We're certainly watching, looking for it. But I don't see anything like that in the future.

DMBN: How do you feel about magnetic particle imaging?

Sorensen: I don't think MPI is as breakthrough as we'd like it to be. It's interesting, but when you have to put particles into people, that already puts you in a different regime.

DMBN: Can you think off the top of your head what the next really promising modality might be?

Sorensen: Certainly, for more than two decades everyone has been carefully watching optical imaging - infrared in particular -- because it can penetrate the body. There are some clinical trials going on, especially in the breast, for looking at optical imaging. It's got some strengths, it has some real mathematical challenges, and frankly, some commercialization challenges. The intellectual property landscape is quite a mess in optical imaging, and the killer app hasn't really emerged to help consolidate that. And frankly, it doesn't win on spatial resolution, it doesn't win on chemical resolution. It really wins on cost. And that's hard to get excited about, when the cost of other tools keeps going down. The key for any of these innovations is doing something you just can't do in any other way, not just doing it less expensively or somehow in a more friendly way. And that's what we're still looking for.

DMBN: For new technologies, a lot of people think another big hurdle, especially in radiology, will be comparative effectiveness. Do you see this being a really big player in the next couple of years for Medicare reimbursement, or FDA approval, really wanting scientific evidence showing actual clinical benefits on even small advancements in technologies?

Sorensen: The trend is clear, whether or not health care reform on the federal level passes the Supreme Court. The trend in insurance companies is already moving toward value-based reimbursement. Not fully - we're still very much a fee-for-service reimbursement model in the United States. But unmistakably, there's a trend toward value-based reimbursement. How does that affect what we do? In some ways it makes it easier. If you are no longer focused on the dollar you're getting for an X-ray but rather on what the outcome is, then you're free to say, "Well, does this newer X-ray machine help me?" And when it does, you can make that decision instantly. And so, I think that we're not afraid of that process, because we think our tools are valuable.

DMBN: I guess the complexity argument changes - because now the total cost of health care is what you have to gauge.

Sorensen: It is a more complex argument, and it's harder to tease apart that whole value chain. Traditionally that's why we've avoided it - because so many things happen therapeutically between the diagnosis and the outcome. Did they respond to the treatment? Was the treatment administered well? Was it appropriate for that patient, etc.? And we, as imagers, diagnosticians, don't really control that, so it's unfair to penalize or reward us for those successes. But that era is over, unfortunately. We can't really hide behind that anymore. That requires new thinking on our part. We have to think about how to fit into that value chain.