Image-guided Therapy Systems Market Size, Share & Trends Report

Image-guided Therapy Systems Market Size, Share & Trends Analysis Report By Product (Ultrasound, Computed Tomography Scanners), By Application (Cardiac Surgery, Neurosurgery), By End-use, By Region, And Segment Forecasts, 2023 - 2030

  • Report ID: GVR-2-68038-536-6
  • Number of Pages: 102
  • Format: Electronic (PDF)
  • Historical Range: 2018 - 2021
  • Industry: Healthcare

Market Segmentation

  • Image-guided Therapy Systems Product Outlook (Revenue, USD Million, 2018 - 2030)
    • Ultrasound Systems
    • Computed Tomography (CT) Scanners
    • Positron Emission Tomography (PET)
    • Endoscopes
    • Magnetic Resonance Imaging (MRI)
    • X-ray Fluoroscopy
    • Single Photon Emission Computed Tomography (SPECT)
  • Image-guided Therapy Systems Application Outlook (Revenue, USD Million, 2018 - 2030)
    • Cardiac Surgery
    • Neurosurgery
    • Orthopedic Surgery
    • Urology
    • Oncology Surgery
    • Gastroenterology
    • Others
  • Image-guided Therapy Systems End-use Outlook (Revenue, USD Million, 2018 - 2030)
    • Hospitals
    • Specialty Clinics
    • Ambulatory Surgical Centers
    • Research & Academic Institutions
  • Image-guided Therapy Systems Regional Outlook (Revenue, USD Million, 2016-2028)
    • North America
      • North America image-guided therapy systems market, by product
        • Ultrasound Systems
        • Computed tomography (CT) scanners
        • Positron emission tomography (PET)
        • Endoscopes
        • Magnetic resonance imaging (MRI)
        • Xray fluoroscopy
        • Single photon emission computed tomography (SPECT)
      • North America image-guided therapy systems market, by application
        • Cardiac surgery
        • Neurosurgery
        • Orthopedic surgery
        • Urology
        • Oncology surgery
        • Gastroenterology
        • Others
      • North America image-guided therapy systems market, by end use
        • Hospitals
        • Specialty clinics
        • Ambulatory surgical centers
        • Research & academic institutions
      • U.S.
        • U.S. image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • U.S. image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • U.S. image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Canada
        • Canada image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Canada image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Canada image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
    • Europe
      • Europe image-guided therapy systems market, by product
        • Ultrasound Systems
        • Computed tomography (CT) scanners
        • Positron emission tomography (PET)
        • Endoscopes
        • Magnetic resonance imaging (MRI)
        • Xray fluoroscopy
        • Single photon emission computed tomography (SPECT)
      • Europe image-guided therapy systems market, by application
        • Cardiac surgery
        • Neurosurgery
        • Orthopedic surgery
        • Urology
        • Oncology surgery
        • Gastroenterology
        • Others
      • Europe image-guided therapy systems market, by end use
        • Hospitals
        • Specialty clinics
        • Ambulatory surgical centers
        • Research & academic institutions
      • U.K.
        • U.K. image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • U.K. image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • U.K. image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Germany
        • Germany image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Germany image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Germany image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • France
        • France image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • France image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • France image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Italy
        • Italy image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Italy image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Italy image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Spain
        • Spain image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Spain image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Spain image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Sweden
        • Sweden image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Sweden image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Sweden image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Denmark
        • Denmark image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Denmark image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Denmark image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Norway
        • Norway image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Norway image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Norway image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
    • Asia Pacific
      • Asia Pacific image-guided therapy systems market, by product
        • Ultrasound Systems
        • Computed tomography (CT) scanners
        • Positron emission tomography (PET)
        • Endoscopes
        • Magnetic resonance imaging (MRI)
        • Xray fluoroscopy
        • Single photon emission computed tomography (SPECT)
      • Asia Pacific image-guided therapy systems market, by application
        • Cardiac surgery
        • Neurosurgery
        • Orthopedic surgery
        • Urology
        • Oncology surgery
        • Gastroenterology
        • Others
      • Asia Pacific image-guided therapy systems market, by end use
        • Hospitals
        • Specialty clinics
        • Ambulatory surgical centers
        • Research & academic institutions
      • Japan
        • Japan image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Japan image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Japan image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • China
        • China image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • China image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • China image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • India
        • India image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • India image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • India image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • South Korea
        • South Korea image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • South Korea image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • South Korea image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Australia
        • Australia image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Australia image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Australia image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Thailand
        • Thailand image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Thailand image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Thailand image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
    • Latin America
      • Latin America image-guided therapy systems market, by product
        • Ultrasound Systems
        • Computed tomography (CT) scanners
        • Positron emission tomography (PET)
        • Endoscopes
        • Magnetic resonance imaging (MRI)
        • Xray fluoroscopy
        • Single photon emission computed tomography (SPECT)
      • Latin America image-guided therapy systems market, by application
        • Cardiac surgery
        • Neurosurgery
        • Orthopedic surgery
        • Urology
        • Oncology surgery
        • Gastroenterology
        • Others
      • Latin America image-guided therapy systems market, by end use
        • Hospitals
        • Specialty clinics
        • Ambulatory surgical centers
        • Research & academic institutions
      • Brazil
        • Brazil image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Brazil image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Brazil image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Mexico
        • Mexico image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Mexico image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Mexico image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Argentina
        • Argentina image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Argentina image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Argentina image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
    • Middle East & Africa
      • Middle East & Africa image-guided therapy systems market, by product
        • Ultrasound Systems
        • Computed tomography (CT) scanners
        • Positron emission tomography (PET)
        • Endoscopes
        • Magnetic resonance imaging (MRI)
        • Xray fluoroscopy
        • Single photon emission computed tomography (SPECT)
      • Middle East & Africa image-guided therapy systems market, by application
        • Cardiac surgery
        • Neurosurgery
        • Orthopedic surgery
        • Urology
        • Oncology surgery
        • Gastroenterology
        • Others
      • Middle East & Africa image-guided therapy systems market, by end use
        • Hospitals
        • Specialty clinics
        • Ambulatory surgical centers
        • Research & academic institutions
      • South Africa
        • South Africa image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • South Africa image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • South Africa image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Saudi Arabia
        • Saudi Arabia image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Saudi Arabia image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Saudi Arabia image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • UAE
        • UAE image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • UAE image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • UAE image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions
      • Kuwait
        • Kuwait image-guided therapy systems market, by product
          • Ultrasound Systems
          • Computed tomography (CT) scanners
          • Positron emission tomography (PET)
          • Endoscopes
          • Magnetic resonance imaging (MRI)
          • Xray fluoroscopy
          • Single photon emission computed tomography (SPECT)
        • Kuwait image-guided therapy systems market, by application
          • Cardiac surgery
          • Neurosurgery
          • Orthopedic surgery
          • Urology
          • Oncology surgery
          • Gastroenterology
          • Others
        • Kuwait image-guided therapy systems market, by end use
          • Hospitals
          • Specialty clinics
          • Ambulatory surgical centers
          • Research & academic institutions

Image-Guided Therapy Systems Market Dynamics

Drivers: Rise In Geriatric Population And An Increase In The Burden Of Chronic Diseases

The World Health Organization (WHO) reports that the leading causes of death worldwide have transitioned from infectious diseases to chronic conditions, including high cholesterol, hypertension, cancer, and heart diseases. The global cancer burden is projected to rise from approximately 19.3 million cases in 2020 to about 28.4 million by 2040. This shift is likely to drive the demand for advanced technologies such as image-guided surgery systems for interventional procedures. United Nations data suggests that the global proportion of people over 65 years is expected to grow from about 9% in 2019 to 11% by 2050. Similarly, the population of individuals aged over 80 years is predicted to rise from 143 million in 2019 to nearly 426 million by 2050. The growing elderly population, prone to chronic conditions such as diabetes, cardiovascular diseases, arthritis, Alzheimer’s, dementia, orthopedic conditions, and other chronic illnesses with multiple comorbidities, is anticipated to stimulate market growth. However, an increase in the elderly population places a significant strain on a country’s economy, particularly in developed nations, by slowing economic growth and increasing healthcare costs. Developed countries such as the U.S. are shifting from a Fee-for-Services (FFS) model to a value-based care approach. Studies have shown that the implementation of image-guided surgery systems can lead to substantial cost savings. For example, a study published by Philips found that image-guided therapy saved an average of nearly USD 900 per patient per year, indicating favorable conditions for market growth.

Increase In Number Of Initiatives For Cancer Radiotherapy

Efforts to enhance cancer radiotherapy and increased investments in advanced image-guided therapy systems by private entities are contributing to market growth. Cancer, a leading cause of death worldwide, is often treated with radiotherapy. The Institute of Cancer Research, UK, reports that over 120,000 people in the UK receive image-guided radiotherapy annually. The institute, in partnership with Royal Marsden Hospital, is spearheading several radiotherapy initiatives, including the IMPORT HIGH and IMPORT IGRT studies, which test the efficacy of IGRT for breast cancer. Numerous academic institutions are investing heavily in cancer radiotherapy projects to improve treatment effectiveness. For instance, Stanford Medicine’s Department of Radiation Oncology is conducting research to develop advanced cancer imaging, diagnostic, and minimally invasive treatment platforms. Similarly, the Brigham and Women’s Hospital has developed an Image-Guided Therapy Program to advance imaging and therapeutic technologies for minimally invasive surgical and interventional techniques. The presence of organizations dedicated to radiology research, such as The Society and College of Radiographers, The Royal College of Radiologists, and the Institute of Physics and Engineering in Medicine, is expected to further stimulate market growth. In 2018, the National Institutes of Health issued a Funding Opportunity Announcement (FOA) for research activities related to Image-Guided Drug Delivery (IGDD) to aid in the treatment of cancer and other diseases, thereby promoting research in the image-guided therapy market and facilitating market growth.

Restrains: High Price Of Image-Guided Therapy Systems

Image-guided therapy systems come with a hefty price tag, posing a significant financial burden on medical institutions. These institutions must bear substantial costs for acquiring, installing, and training personnel on these systems. Siemens’ image-guided therapy systems, for instance, are priced between USD 0.6 million and USD 2.4 million on average. While these high initial costs can be recouped over a span of 3 to 5 years, the cost of the equipment is further inflated by the average number of procedures performed and the overhead expenses related to procurement, installation, and training. Moreover, the adoption of these advanced systems is hindered by global healthcare reforms aimed at curbing healthcare expenditure and budgetary constraints. The slow economic growth in developed countries and the high cost of installation mean that only a limited number of institutions can regularly update their systems, which could potentially dampen market growth. However, the market dynamics are expected to shift in the future, thanks to efforts by both public and private entities to enhance access to image-guided therapies.

What Does This Report Include?

This section will provide insights into the contents included in this image-guided therapy systems market report and help gain clarity on the structure of the report to assist readers in navigating smoothly.

Image-guided therapy systems market qualitative analysis

  • Industry overview

  • Industry trends

  • Market drivers and restraints

  • Market size

  • Growth prospects

  • Porter’s analysis

  • PESTEL analysis

  • Key market opportunities prioritized

  • Competitive landscape

    • Company overview

    • Financial performance

    • Product benchmarking

    • Latest strategic developments

Image-guided therapy systems market quantitative analysis

  • Market size, estimates, and forecast from 2018 to 2030

  • Market estimates and forecast for product segments up to 2030

  • Regional market size and forecast for product segments up to 2030

  • Market estimates and forecast for application segments up to 2030

  • Regional market size and forecast for application segments up to 2030

  • Company financial performance

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