Ann: Cyclopharm's USA Technegas Expansion Update, page-31

CTPA is the method of choice for acute PE but there is a clear role for V/Q in post-PE risk stratification and for identifying chronic PE and CTEPH. V/Q spect may be better for diagnosing smaller, more distal PE and you still get lung images so some of the perceived advantages of CTPA are lost with better, modern imaging V/Q techniques. CTPA definitely has a big advantage in access as most EDs have this easily available.

Simply replacing existing V/Q tracer in the US is still a big change for this company and seems inevitable given technegas is widely considered the best available V agent. So reasonable to expect a solid and relatively sustainable increase in revenue. If v/q use does decline over time for acute PE management the company will need to establish a use case for diagnosing small airways disease (asthma, early COPD) as this is a gap in the diagnostic market that is not well done by spirometry etc. That, and identifying response to Rx in these disorders with new small molecule inhaled medications targeting distal airways, could be clinically useful and would support more routine clinic-based use (rather than ED use). In this regard CT doesn't seem to be the functional imaging answer and so maybe V/q could be.