Ultrasound systems have always been an important diagnostic imaging tool. These systems are becoming more popular for various reasons including advanced functionality and the lower cost options available compared to other imaging modalities.
TechNation reached out to ultrasound professionals to find out the latest regarding ultrasound systems including new technology, budget concerns and factors impacting the market. The panel of experts includes Tri-Imaging Solutions Director of Sales (West) Shawn W. Bryant, MW Imaging National Sales Manager Andrew Geidel, Philips Healthcare Director of Technical Development Multi-Vendor Services Richard Gerler, Trisonics Inc. President Stuart Latimer, Global Medical Imaging (GMI) Point-of-Care Sales Manager Tom Siffringer, Conquest Imaging Executive Vice President of Sales and Marketing Matt Tomory, and Exclusive Medical Solutions Customer Service Engineer Carlos Vargas.
Q: What are the newest technologies and/or the latest advances in regards to ultrasound systems?
Bryant: One of the latest advances in ultrasound is the mobility of the systems. The industry is trending toward smaller portable devices, as well as wireless transducers. With that being said, there has been a huge advancement in transducer technology with the addition of the matrix probes. The matrix transducers are creating incredible images helping clinicians across the board. These are typically used in the cardiology environment.
Siffringer: Siemens recently introduced the world’s first system with wireless transducers, the Acuson Freestyle. Siemens also launched the Acuson P500, the first laptop-style point-of-care ultrasound system to incorporate technologies typically found on console systems. The P500 includes disruptive technologies such as “Auto Flash Artifact Suppression,” which features the most sensitive, artifact-free color imaging available today.
Geidel: Image quality has improved exponentially in recent times with the addition of “high-definition,” also known as “high-resolution,” monitors and LCD displays, probes, and software. Progressive “p” resolution has been proven to be the faster, clearer picture, and less prone to blurring therefor allowing radiologists/cardiologists to achieve a much more defined diagnosis. Also, “compact” is the new kid on the block. Systems are being redesigned to be streamlined, lighter, less components, user-friendly, and most of all, have much greater mobility.
Gerler: The trends we are seeing are improved automation, smaller sized equipment and connected systems that are turning system data into actionable insights. For advanced applications, users achieve more diagnostic confidence and improved reproducibility with automation tools such as Anatomically Intelligent Ultrasound (AIUS). Such tools reduce the manual steps required for advanced quantification, and reduce variability in results. The smaller form factor in equipment size is increasing the use and availability of ultrasound. For example, transducers can now be plugged directly into a smartphone or tablet making it easier to perform ultrasound exams outside a traditional exam room. Lastly, ultrasound systems continue to advance with remote diagnostic capabilities that enable not only OEMs, but also in-house teams, to more rapidly identify the source of performance issues which results in faster service resolution and system uptime.
Latimer: One of the biggest advancements we have seen over the last few years is in the size and mobility of the systems. Companies have brought ultrasound technology into handheld devices that can easily fit inside a pocket. The portability and image quality opens up many new market opportunities.
Tomory: There has been major technological advancements in breast ultrasound imaging recently which addresses the challenge with imaging dense breast tissue. Mammography can miss up to a third of cancers in dense breast tissue and almost 50 percent of women have heterogeneously or extremely radiographically dense breast tissue. GE has released the Invenia ABUS (Automatic Breast Ultrasound) system, Philips has added the AWBUS (Automatic Whole Breast Ultrasound) technology to their iU22 and Epiq systems and Siemens has the ABVS (Automated Breast Volume Scanner) option on the S2000 platform. Also, the trend continues for downsizing systems and higher levels of software functions which reduces hardware in the newest systems.
Vargas: Ultrasounds are headed in the direction of substituting radioactive imaging in certain situations. Image processing along with advances in volumetric imaging has significantly improved image quality in ultrasounds allowing for clear, detailed images. Advances in circuitry and processing power have allowed ultrasounds to become smaller and more powerful. Modern technology has also allowed for further advances such as wireless transducers and Contrast Enhanced Ultrasound (CEUS).
Q: How are these advances impacting the market?
Bryant: There have been a number of new ultrasound companies manufacturing a low-cost system, which is trending toward a commoditization of the product. This has the potential to impact the market. Which is why we are seeing companies like GE, Philips, etc. providing systems with advanced technology such as the matrix probe.
Siffringer: For decades, clinicians have asked for wireless transducers – their development would immediately solve a chronic problem, maintaining a sterile field. Without cables to get in the way, wireless transducers give the user more flexibility. The ability to completely submerge its transducers and batteries makes cleaning more effective as well.
Geidel: More hospital off-sites, clinics, and private practices are able to afford these newer, compact, less expensive platforms than ever before. Being able to offer a patient a one-stop event rather than traveling to an imaging center and waiting for the imaging test results and having to make multiple appointments, creates a patient peace-of-mind scenario.
Gerler: Driven by the market’s need to provide quality care at more affordable prices, these on-going advances in image quality and new levels of portability are challenging clinical departments to re-examine when they need to use their more sophisticated imaging equipment vs. an ultrasound system. Improved automation and ease of use reduce the amount of time it takes to perform an ultrasound exam and, in turn, increases patient throughput. This allows departments to increase efficiency and potentially reduce costs for each exam performed. The new smartphone app-based ultrasound concept brings with it new business models and expansion opportunities into the market. For example, Philips Lumify is a low-cost subscription model where no capital purchase is required by the customer. This model reduces barriers to entry into ultrasound, and allows health care providers to try the technology without substantial initial investment.
Latimer: This has impacted the market by decreasing the cost of the systems so that more facilities and specialties can utilize the systems. We now see the smaller devices used in places such as the ER, point-of-care facilities, etc. This also enables providers in other parts of the world, who did not have access to ultrasound, a way to provide the service to their patients
Tomory: Approximately 12 percent of women will develop breast cancer in their lifetimes so this emerging technology will continue to expand the women’s health care market for the foreseeable future. With the technology integration/downsizing, we will see more depot repair options offered by OEMs and ISOs as opposed to servicing in the field.
Vargas: As a whole, the market is seeing a steady growth in ultrasound sales. New technologies allow for smaller, more powerful systems. Point-of-care ultrasound will show an impressive growth in the market.
Q: What impact is point-of-care (POC) imaging having on the ultrasound market?
Bryant: With POC becoming more and more popular, it is allowing clinicians to give general scanning capabilities in their offices. In my opinion this is why the smaller, less expensive ultrasound units are becoming more and more popular. However, the reimbursement side of the POC is a little more complex due to having a trained clinician performing the scans to qualify for reimbursement. There are OEMs specifically focused on the POC market, especially in the MSK (Musculoskeletal) specialty, which is having a hard time getting market penetration into the POC; with orthopedic physicians not fully bought in.
Siffringer: Systems certainly aren’t getting any larger – we increasingly find that space limitations affect equipment decisions. As hardware gets smaller, faster and more powerful, POC imaging is becoming the standard, not the exception. The growth of POC ultrasound, puts a premium diagnostic tool more easily and efficiently in the hands of clinicians, enhancing patient care and outcomes.
Geidel: POC is redefining patient care. With the ever redesigning of ultrasound systems to a compact design and greater mobility, we are creating a more comfortable and less painstaking event for the patient. POC imaging is the new stethoscope in the doctor’s toolbag.
Gerler: There are entirely new user models being created for ultrasound systems, and new market opportunities emerging in historically non-traditional locations. POC is bringing ultrasound technology to users who are not traditionally trained in ultrasound scanning. In recent years we have seen a lot of growth in ultrasound used in regional anesthesia, emergency medicine, and sports medicine applications. In the future, I think we will see growth in ultrasound use by primary care providers and first responders.
Latimer: Point-of-care imaging has impacted the market by increasing the amount of units used and the ability for providers to uncover conditions earlier and easier than ever before. Now, facilities are able to quickly look at the carotid artery or the thyroid right in their office at the time of service.
Tomory: POC imaging has been and will continue to expand with the decrease in size and cost as well as increase in resolution of today’s systems. With ultrasound being an inexpensive and non-invasive modality coupled with expanding applications, there is no end in sight with regards to POC imaging.
Vargas: With portable systems becoming much smaller, this will allow consumers to purchase “Laptop” ultrasounds at an affordable price without reducing quality. Although the majority of the market is mostly larger ultrasounds, portable ultrasounds are becoming more practical and popular. In the past four years these systems have had a significant increase in growth.
Q: How can a facility with a limited budget meet the ultrasound needs of today?
Bryant: One option is to purchase a refurbished unit versus new. I worked with several customers who had not set aside adequate capital money to upgrade their ultrasound units that had become semi-antiquated. We were able to locate systems with exceptional scanning ability that were only a couple of years old. The second option would be to lease an ultrasound machine. The initial low buy-in and monthly payments help with their budgetary restraints. It is very easy to create a metric for the customer to show reimbursements based on patient flow, easily identifying how soon the ultrasound unit will pay for itself.
Siffringer: Facilities do not have to depend on the OEMs anymore. There are plenty of great organizations that provide new and refurbished equipment at considerable savings versus the OEMs. These same companies also provide cost-effective service contract and support options. In-house support is also a great way for facilities to manage budgets and ISOs provide training and technical support to make the transition easier.
Geidel: There are several items of importance that need to be considered when embarking out into the ultrasound market. First and foremost, know your budget and your needs. Consider consulting with an applications person or sonographer in advance so that you can achieve the most out of your investment. Additionally, consider the applications/options and probes that you will be using along with mobility and ease of use. And, lastly, consider how you want to pay for your investment. Leasing is always a viable option keeping in mind how you want to manage your ROI.
Gerler: Ultrasound continues to be an appealing imaging modality due to its relative low cost and non-ionizing qualities. Most ultrasound manufacturers offer used or refurbished equipment which can be an ideal solution for purchasers with a limited budget. Coming from the manufacturer, this equipment can be higher quality than used equipment purchased from a third-party, and typically comes with updated software and a manufacturer-backed warranty.
Latimer: Facilities with limited budgets can meet their customers’ needs much more easily today because the systems are more affordable and user friendly. Places you never would have seen using ultrasound 10 years ago are now offering the service. This is proving to be an invaluable resource to patients because they are able to receive the service at the time of care rather than waiting days to schedule with another center.
Tomory: Let’s face it, budgets are tight everywhere, reimbursements are at an all-time low and providers are always looking to save where they can. Purchasing reconditioned equipment as opposed to new, utilizing ISOs for parts, probes, training, service and migrating service in-house are all ways to reduce costs while not compromising patient care.
Vargas: With portable systems now becoming more popular, facilities can target specific needs at an affordable price without risking quality. Facilities shouldn’t have to feel that name brands like Philips and GE are their only options. Many other OEMs offer ultrasounds for a limited budget with comparable quality.
Q: What do TechNation readers need to know regarding the latest in ultrasound probes and transducers?
Bryant: The OEM website is a great resource for new and upcoming technology. Another great resource is the sonographer, they have vast knowledge and are usually current on new technology. As previously mentioned, the newer matrix probes have really exceeded scanning expectations. A case in point are the 3D Transesophageal TE probes that are giving cardiologists a higher level of diagnosis in the treatment of heart conditions.
Siffringer: In the good old days, transducers were single frequency and required multiple transducers to perform different types of scans. Those days are long gone, with the advent of broadband technology. a transducer can now cover a range of up to 13 different frequencies in the general market and up to 30 in specialized markets.
Geidel: Probe/transducer technology is an ever changing situation. There are vast advances in 3D/4D probes creating a whole world of improvement in image quality and diagnosis. High-definition 2D probes and cardiac matrix probes are the new norm in today’s diagnostic imaging centers and hospitals creating unprecedented viewing, greater ease of proper diagnosis, and shorter scan times for patients
Gerler: As technology continues to advance probes and transducers are becoming more complex, and repair of these probes can requires advanced skills. To ensure optimal performance and not compromise diagnostic integrity, it is recommended that in-house service teams partner with an organization that has the skills and abilities to repair and/or recommend replacement of probes
not working properly.
Latimer: Probes and transducers are also seeing advancement such as single crystal and mtechnology which is enhancing the image quality and the ability to see much more intricate detail within the scan. These new probes are providing superior images over those seen years ago.
Tomory: The latest ultrasound transducers are extremely advanced compared to several years ago. Single crystal, matrix arrays, sophisticated construction utilizing different matching layers and lens shapes and materials all contribute to higher probe repair and replacement costs. Now more than ever, it is critical to ensure probe care and handling analysis and instructions are a part of every provider’s maintenance plans.
Vargas: Transducers are looking toward the future. Some transducers are capable of multiple modes allowing customers to purchase one probe and be sufficient. Some probes are looking into the future and are even becoming wireless.
Q: What are the most important things to look for when considering an independent service organization (ISO) for ultrasound systems?
Bryant: I would encourage the customer to analyze their needs and match those needs with the services offered by the ISO. Most of the ISOs have a niche when it comes to a specific OEM. MD Expos are another great way to talk with your peers and see who they are utilizing. There are several ISOs that offer training and service support in addition to parts support.
Siffringer: There are a number of great organizations to work with. At the top of the list should be reliability and breadth of work. When you are in a hard down situation, can you trust that company to resolve the issue quickly and correctly? What other services does the company provide, such as technical support, parts, training and probe repair? Having a partner who can provide you with a wide array of quality services can make life much easier than having multiple providers for one modality.
Geidel: Reputation, integrity, honesty are first to come to mind. Call around, inquire, and get referrals and recommendations. Don’t be afraid to ask for training documentation. Look at length of time in business and check with your local BBB.
Gerler: As a leading multi-vendor service provider, we see a lot of variability in the quality of service being delivered by independent service providers. We feel that when qualifying any service provider, find out what sort of qualifications they have in place. Are they ISO certified? Do they subscribe to and have a documented process to maintain their equipment to the recommended OEM guidelines? How, when and where have their service engineers been properly trained? What kind of technical and clinical application support do they provide? What is the infrastructure to support primary and secondary level support? And, one of the biggest areas to be concerned with are where replacement parts are coming from and are they delivered with a solid warranty. A replacement part that is not compatible with current software levels, or is dead on arrival only extends downtime of the equipment. Asking these questions can ensure that your service strategy helps you obtain your business goals.
Latimer: Some of the most important things to look for in an ISO are experience and expertise. You want to make sure the company you choose knows how to work and support all the different ultrasound manufactures, as well as be able to provide references to show quality and reliability. Another important factor is to inquire about the company’s commitment to a quality management system.
Tomory: Independent service organizations are being looked at very carefully these days so it is critical to ensure your vendors have a comprehensive quality management system in place. There are no standards currently but International Organization for Standardization (ISO) certification is a good place to start. Also, longevity in the business, the service and support structure to back up the sale and reputation are all indicators of how smoothly a sale and after sale will proceed.
Vargas: Quality should be the main thing to look for when considering a service provider. You want to look for competitive pricing from a quality source for your parts. Experience is also important, especially when dealing with service and tech support. A service provider should always be trustworthy and reliable.
Q: What else do TechNation readers need to know about ultrasound systems?
Bryant: The ultrasound industry is very dynamic and with the advancement in computing power I feel the image quality and mobility parameters will continue to advance at a fairly high rate.
Geidel: You have quite a number of options when it comes to ultrasound. I sometimes scratch my head when I see all the spin offs and startups in the ultrasound industry and on the same token, how quickly they disappear. Look for entities that encompass what’s on the horizon, new technologies and advancement, as well as supporting the existing and end-of-life platforms. As I profess to tell all my new/potential customers, “just give us a chance, give us a test drive, kick the tires, and let us show you how we bring new life to ultrasound!”
Siffringer: The ultrasound market changes just as quickly as the personal computer market. It seems as soon as one manufacturer develops a new offering and gets it to market, another company has developed something to make it obsolete. LCD monitors, SSD hard drives, RF touch screens, faster CPUs, high-capacity memory and matrix array transducer technology are just a few of the great advancements over the last 15 years.
Gerler: Ultrasound systems are safe, fast and easy to use. Coupled with enhanced image quality and reduced acquisition costs ultrasound is an appealing, flexible and mobile technology to improve diagnostic capabilities.
Latimer: It is important to keep in mind that as technology moves forward, the ultrasound systems of today are moving further away from a hardware focus to be more software intense. This is important, not only to the serviceability of the machines, but also because it offers the customer many more options.
Tomory: Ultrasound systems are getting more complicated and integrated and the modality will grow for the foreseeable future. This modality can be supported in-house bringing about better service delivery and lower operating costs when providers partner with the right organizations.
Vargas: The future is promising. Huge advancements are allowing ultrasounds to do more than ever before. A future where imaging is portable and has minimal to no radiation is key for patients and their safety. Advances in technology are allowing for clinics to purchase these machines within their budget limits. Also, physicians are able to perform procedures with extreme accuracy due to quality imaging.
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