Unity and Unreal have industrial users, including medical.
You are really asking, “why does medical imaging not have budgets for software?” It faces all the same monetization challenges as all business to business software, that tends to, unfortunately, disfavor operationally cheap and performant solutions.
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Speaking of which, why haven't I heard of anyone using game engines as a platform for medical imaging and UX?
Unity and Unreal have industrial users, including medical.
You are really asking, “why does medical imaging not have budgets for software?” It faces all the same monetization challenges as all business to business software, that tends to, unfortunately, disfavor operationally cheap and performant solutions.