Rise of Indocyanine Green Imaging in the Near Infrared Imaging Market,Clinical Perspective

The integration of near infrared (NIR) imaging into clinical practice has significantly enhanced diagnostic accuracy and surgical precision across various medical fields. At the heart of this transformation is Indocyanine Green (ICG), a fluorescent dye that, when activated by NIR light, provides real-time, high-contrast imaging of vascular structures, lymphatics, and tissue perfusion.

From oncological surgery to cardiovascular diagnostics and hepatobiliary imaging, ICG-based NIR imaging is rapidly becoming a gold standard in modern medicine. Its ability to facilitate minimally invasive procedures while offering detailed anatomical visualization has revolutionized surgical workflows, improved patient outcomes, and opened new avenues for intraoperative navigation.

The global near infrared imaging market size is anticipated to rise from US$ 1,338.6 Mn in 2025 to US$ 2,571.1 Mn by 2032. It is projected to witness a CAGR of 9.8% from 2025 to 2032. With its ability to visualize tissues, blood flow, and tumors in real-time, near infrared imaging is transforming minimally invasive surgery, oncology, and ophthalmology.

This article explores the clinical rise of indocyanine green imaging within the NIR imaging market—its applications, adoption drivers, clinical value, and the transformative role it plays in medical diagnostics and surgical intervention.

Indocyanine Green (ICG) is a water-soluble, tricarbocyanine dye that fluoresces in the NIR spectrum—typically peaking at 800 nm when excited by light in the 750–810 nm range. After intravenous injection, ICG binds to plasma proteins and is rapidly cleared by the liver, making it ideal for dynamic vascular and tissue imaging.

Coupled with specialized cameras and sensors, NIR imaging systems visualize the fluorescent signal emitted by ICG, enabling clinicians to observe physiological functions in real time. This allows for unparalleled precision in localizing tumors, identifying sentinel lymph nodes, assessing tissue perfusion, and ensuring complete tumor resections.

The clinical utility of ICG-guided NIR imaging spans multiple medical disciplines:

In oncologic surgeries, ICG is used for:

• Sentinel lymph node mapping in breast cancer, melanoma, and gynecological cancers.

• Tumor margin visualization in colorectal and liver cancer surgeries.

• Lymphatic drainage assessment to guide precise excision while sparing healthy tissues.

Studies have demonstrated that ICG can detect sentinel lymph nodes with accuracy comparable—or superior—to conventional blue dyes and radiotracers, without exposure to ionizing radiation.

ICG-NIR imaging allows for:

• Coronary artery bypass graft (CABG) patency assessments.

• Myocardial perfusion imaging to detect ischemic regions.

• Identification of vascular anomalies in real time during complex surgeries.

The technology improves graft success rates and reduces intraoperative uncertainty by providing surgeons with visual confirmation of blood flow.

In neurosurgical applications, ICG is used to:

• Visualize cerebral vessels during aneurysm clipping or AVM resections.

• Monitor brain perfusion in traumatic brain injury or stroke cases.

• Guide tumor resections by differentiating vascularized vs. non-vascularized tissue.

ICG angiography is a valuable tool in improving the safety of delicate neurosurgical interventions.

In liver and biliary procedures, ICG helps:

• Identify bile ducts, reducing the risk of bile duct injury.

• Assess liver segments for resections or transplantation.

• Differentiate between benign and malignant liver tumors.

In liver transplantation, ICG fluorescence confirms proper perfusion of the graft and helps assess anastomosis success.

ICG-NIR imaging evaluates:

• Flap perfusion to prevent ischemia and necrosis.

• Skin viability before and after reconstructive procedures.

• Lymphatic drainage in patients undergoing lymphedema surgery.

This helps ensure better aesthetic outcomes and reduces complications.

The clinical community is increasingly turning to ICG-based NIR imaging for several compelling reasons:

1. Real-time visualization: ICG imaging provides immediate feedback, aiding intraoperative decision-making.

2. High safety profile: ICG has a low incidence of allergic reactions and is well-tolerated by most patients.

3. Radiation-free: Unlike traditional imaging techniques, ICG does not expose patients or staff to ionizing radiation.

4. Enhanced surgical outcomes: Surgeons report fewer complications, improved tumor clearance, and better flap viability.

5. Wider anatomical range: The deep tissue penetration of NIR light offers a clear view of subsurface structures, expanding procedural capabilities.

These advantages contribute to shorter operative times, reduced postoperative complications, and improved patient satisfaction.

The global demand for ICG-based NIR imaging is surging due to several interconnected factors:

• Rising cancer incidence: Especially breast, gastrointestinal, and hepatobiliary cancers where surgical resection and lymph node evaluation are critical.

• Increasing adoption of minimally invasive surgeries: Surgeons require advanced imaging for enhanced intraoperative guidance.

• Favorable reimbursement scenarios: In developed countries, coverage for fluorescence-guided surgery is improving.

• Technological innovation: Compact, hybrid imaging systems compatible with existing surgical tools are making integration easier.

Moreover, the growing focus on precision medicine is pushing hospitals and clinics to adopt ICG imaging to meet higher standards of surgical care.

The clinical landscape is supported by a variety of NIR imaging systems designed for ICG fluorescence visualization:

• Stryker SPY Elite and SPY-PHI Systems
  Used in plastic, gastrointestinal, and cardiovascular surgeries for real-time tissue perfusion assessment.

• Novadaq PINPOINT Endoscopic System
  Offers laparoscopic NIR imaging for minimally invasive procedures.

• Olympus VISERA ELITE II
  Integrates fluorescence imaging with high-definition endoscopy for better surgical navigation.

• Fluobeam by Fluoptics
  A portable device popular in reconstructive surgery and oncology.

These tools continue to evolve, offering better resolution, intuitive software interfaces, and seamless integration with surgical robots and navigation platforms.

Despite its benefits, ICG-NIR imaging faces some adoption hurdles:

• Cost of equipment: High upfront investments may deter smaller hospitals or clinics.

• Training requirements: Successful use requires specialized training in interpreting fluorescence signals.

• Limited dye approval: ICG is approved in many countries but with restrictions in use cases or off-label applications.

• Short imaging window: Due to its fast clearance rate, precise timing is critical for optimal imaging.

Addressing these challenges will require collaboration among healthcare providers, device manufacturers, and regulatory bodies.

The future of ICG-based NIR imaging looks incredibly promising. Key developments on the horizon include:

• Targeted fluorescent agents: Engineered ICG derivatives with specific tumor or organ affinity for precision diagnostics.

• AI-assisted image interpretation: Machine learning algorithms that quantify fluorescence intensity and provide automated feedback during surgery.

• Wearable and portable NIR systems: Enabling use in outpatient clinics, emergency settings, and telemedicine scenarios.

• Integration with surgical robots: Enhancing capabilities of robotic platforms like the da Vinci system for delicate procedures.

As regulatory bodies approve new dyes and indications, and training programs become more widespread, ICG imaging is set to become standard practice across surgical and diagnostic pathways.

The rise of Indocyanine Green imaging in the near infrared imaging market marks a paradigm shift in clinical diagnostics and intraoperative guidance. With its high safety profile, real-time visualization capabilities, and versatility across specialties, ICG has firmly established itself as a vital tool in modern healthcare.

For surgeons, radiologists, and researchers, ICG-NIR imaging offers not just clearer visualization—but better outcomes, fewer complications, and more informed clinical decisions. As technology continues to advance and adoption widens globally, the role of ICG in precision diagnostics and surgical excellence is only expected to grow.