In this issue of TechNation, we examine ultrasound systems. These diagnostic imaging devices have made several advances over the years with many more uses in the hospital setting. Point-of-care systems make exams possible almost anywhere. We sought the insights of industry professionals to shine more light on ultrasound systems.
Industry professionals participating in this roundtable article on ultrasounds include Said Bolorforosh, Ph.D., President and Head, Siemens Healthineers Medical Solutions Inc., Ultrasound; Andrew Geidel, National Sales Manager, MW Imaging; Leon A. Gugel, President, Metropolis International LLC; James Rickner, Global Training Director, Conquest Imaging; Michael Thomas, Director of Marketing, Ampronix Medical Imaging Technology; and Jeff Volpp, Director of Sales and Marketing, GMI LLC.
Bolorforosh: Health care facilities must have excellent image quality to improve diagnostic confidence, workflow efficiency, system portability, upgrade capabilities and premium service.
Geidel: Compact, ease of operation, and mobility. Systems are being redesigned to be more streamlined, lighter, less components, user-friendly, and most of all, have much greater mobility. The cost of the system must fit into the facility’s budget. Furthermore, you have to consider support for your asset, such as software updates, parts availability, and applications training. All these add up to a more comfortable environment for both the tech and the patient.
Gugel: The basic and most frequent ones are easy supportability, parts, probes and to not be overly expensive.
Rickner: The ultrasound capabilities need to match the types of studies or exams that are conducted at the facility. For example: cardiac exams may require LVO, 2D and 4D strain, full cardiac measurement, etc. where an OB/GYN system must provide easy calculations, common measurements and women’s health specific reports, high-quality 2D image quality with option to do other types of scans such as 4D, elastography or Doppler. If the system will be used for multiple exams, it must have more probes than any single or dual application system: phased array, specialized pediatric, TEE, 4D, linear, while, 2D convex for abdominal scans and endocavitary and 2D convex for women’s health to name a few.
Thomas: All ultrasound systems should include an array of features tailored to the facility’s needs and requirements. At the core level, the ultrasound system should have a high-speed CPU system, high-resolution display monitor, transducer pulse controls, touch screen or keyboard/cursor capabilities, a disk storage device, and a printer. Main features to consider would include a combination of versatility, durability and efficiency.
Volpp: It is very dependent on the department that is using the system. Most importantly, the vendor should be able to help them determine the standard and optional capabilities that their system will need to perform their studies and procedures. Of course, all departments will need to be aware of the system’s ability to connect to their PACS.
Bolorforosh: The most significant changes to hit the ultrasound industry in recent years include increased system computation power, workflow automation and improved quality, reduced system cost and greater system portability, and the rise of networking capabilities. These fundamental changes will influence the future of the ultrasound industry.
Geidel: Image quality has improved exponentially in recent years with the addition of “high definition” also known as “4K resolution” to monitors and LCD displays. Progressive “p” resolution has been proven to be the faster, clearer picture, and less prone to blurring therefor allowing radiologists/cardiologists to calculate a much more defined diagnosis. I recently attended a seminar presented by LG introducing their new 4K resolution medical device monitors and I must say image quality was off the charts, absolutely incredible.
Gugel: The majority of advances came in miniaturization. A lot of systems became smaller and more compact. A lot of portable systems, as well as a few algorithms that help in image quality as well.
Rickner: The most significant of all advances is the mobile ultrasound probe. It is becoming an increasingly disruptive technology for the entire medical imaging industry. A wired or wireless probe can now display an ultrasound image on most off-the-shelf tablets or even smartphones. The latest advances in FPGA and microprocessor technology have allowed the larger ultrasound systems on a rolling cart, to shrink down to mere ones and zeros in the form of software apps. Image processing has come a long way allowing for the smaller, more mobile stand-alone probe to challenge its predecessor with the larger systems in most aspects including 3D and 4D imaging. The market has been picking up slowly as more and more skeptical providers are embracing portable systems. According to The Wall Street Journal, the technology has the potential to save the medical industry billions of dollars in health care cost as a portable probe is only a fraction of what the large cart-based system costs.
Thomas: There really has been a proliferation of advancements over the last few years. Some to highlight would be the creation of hand-held ultrasound devices and the adaptation of 3D and 4D ultrasound system capabilities. Also, image quality has vastly improved due to technology advances in transducer sensitivity. Previously, machines were only able to capture a single image, but now they are able to capture images through multiple planes simultaneously allowing for a more complete picture.
Volpp: Quite a few actually. In the cardiology world, strain rate and volume imaging are being used more frequently to assess cardiac function and provide insight into treatment plans. In the point-of-care world, strain and shearwave elastography are helping clinicians assess musculoskeletal injuries and quantify progress of therapeutic outcomes.
Bolorforosh: As we look ahead, the element of service is the key driver for our customers. All customers look for a partner that can basically back their system – a partner with the latest software as well as certified engineers in the field who are available 24/7 with global service coverage to address any customer issue. Customers also want assurances that systems were designed with great reliability in the first place and that certified replacement parts are readily available. How many years can they keep the system in their clinic with a high level of performance and the ability to upgrade their systems to the latest available technology to protect their investment? Customers should also look for an equipment provider that can tailor their service offerings for different types of customers. Some customers only look for one or two years of coverage; others might look for longer-term coverage. Therefore, having that flexibility of service offerings is crucial. Our remote service and remote support offerings are becoming more and more important, particularly for customers who seek a rapid response from the manufacturer. Being able to perform system diagnostics remotely, provide information to the customer, and get the system up and running again quickly are all key drivers.
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. Be sure to inquire about their “quality assurance” procedures and programs.
Gugel: Someone with a good reputation of course, that is always going to be paramount. Because in a rare case of something going wrong, that vendor will still make it right for the customer. Whether it is a part, a repair or a replacement.
Rickner: If you are buying any medical device today, you must think longevity and total cost of ownership. If the system is well thought of in the industry there were many sold and there are many in the market, then availability of parts, probes, and support will be readily available. You don’t want to pick an unpopular model and risk the manufacturer ending the life of a model prematurely, which will in turn make it difficult to find parts or someone to service it years down the road. If there are many in the market, you might even consider buying used since parts and service will not be an issue. If you require service, you should look for a model that allows you options once the unit is off of warranty – today options are power. Even if you want to stay with the OEM, if you know a model will lock out ISOs from servicing your system because of proprietary passwords, you know you will be locked into getting service from the OEM or their aftermarket service division.
Thomas: Finding a qualified and reputable service provider that offers a quick turn-around time as well as offers a warranty on all repaired parts is essential. It is always better to work with a provider that not only can service a system but also has the capabilities of selling the customer a new or refurbished system if needed. If budgeting is a consideration make sure the provider is priced competitively and some providers will offer free evaluation of the repair if requested by the customer.
Volpp: Without question, providers should know the capabilities of their service companies. Where and how will service be delivered to minimize downtime? Additionally, do they have the technical knowledge to fix the problem on the first visit?
Bolorforosh: Health care facilities want a partnership with an equipment provider that fully understands the dynamics that they operate within – whether they be clinical, operational or financial – and that can address their needs with the right equipment, service offering, and level of consultation. Having a complete understanding of those three primary drivers for each customer enables us to develop a tailored solution. Our customers want a partner who knows what the drivers are and who can translate them into relevant solutions and products.
Geidel: There several items of importance that need to be considered when embarking into the ultrasound market. First and foremost, know your budget and your needs. Consider consulting with an applications person or sonographer in advance so 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.
Gugel: The first thing to look at is the actual vendor. The vendor must have the ability to service and care for the system they are selling. Price and supportability share a spot in this as well. There are more ultrasound manufacturers than any other modality and most are good units, so it does truly come down to the vendor and extreme pricing.
Rickner: Besides quality of image, compatibility with types of exams and reliability, longevity and total cost of ownership must be a part of the decision. There should be many in the market (see answer to previous question). They should not have a larger number of high-failing parts compared to similar systems. Consider buying refurbished only when buying from a trusted service partner who will keep you up and running past the warranty period at a familiar rate.
Thomas: First and foremost, health care facilities should look for a reputable company who has established a long history in providing quality products and has satisfied customers. Facilities should always look for new or refurbished systems with a warranty in place so they are not held responsible for faulty machinery and are prepared if an issue arises. They should also assess their budget for the system, their specific use of the system, which features are most important for their application, and whether or not they are looking for a portable or console system.
Volpp: The first priority should be to make sure the system will have everything necessary to accomplish their clinical goals/needs. This is where a trusted vendor partner is so valuable to accurately assess their needs and couple that with the appropriate system. Once the system is chosen, downstream service availability is often overlooked. Make sure you are working with a vendor that can support all of your needs and minimize your risks.
Bolorforosh: First, they should determine whether the equipment provider they are considering can offer manufacturer-certified parts at the fastest possible speed. Secondly, they should make sure that the equipment provider can readily access information 24/7 pertaining to a specific equipment model so that when the need arises, they can quickly provide the information and parts necessary to get the equipment operating again. Finally, they should consider the fact that we operate in a space that is regulated heavily by the Food and Drug Administration and other health care industry bodies. For this reason, making sure that an equipment provider adheres to strict regulatory requirements for all aspects of our business is also key.
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 into ultrasound!”
Gugel: The amount of power a unit will have in generating frequency signals, meaning the trend the last five years or more has been in portable units, however they lack the power of a full grade hospital unit. As such, this “trend” has an impact on actual patient exams.
Rickner: Frequency: how deep will the waves penetrate. The higher the frequency (10-16MHz), the more superficial imaging, the lower the frequency (1 or 2MHz), the deeper the penetration. Make sure your system is adequate for its intended use.
Thomas: I would encourage the readers to do their due diligence on what options they want in an ultrasound system. Most facilities use the same ultrasound systems for 10-plus years, so it is important to try and purchase a system with all of the features dependent on what the facility can afford. If they are not able to purchase a new system, consider purchasing a refurbished system which in most cases still will come with a comparable warranty as a new system would.
Volpp: Budget is such a difficult task for providers to manage as they are making a decision to purchase or service their equipment. Rarely is the least expensive option the best long term fit. Choosing a system and company that can adequately support all of your needs is extremely important. A budget driven acquisition could cost a fortune to support years after the purchase is complete.
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