TechNation reached out to several companies and industry experts in search of the latest information regarding ultrasound systems and devices. The following individuals agreed to share their insights with our readers in the healthcare technology management (HTM) field.
Participating in the 2022 roundtable article on ultrasound are Probo Medical Vice President of Marketing Brian Gill, MW Imaging President Robert Grzeskowiak, Avante Health Solutions Ultrasound Specialist James Hawse, Summit Imaging CEO and CTO Larry Nguyen and Innovatus Imaging Vice President of Sales and Marketing Matt Tomory.
Gill: The best way to start is to define your needs, then determine a budget/price range. There are many versatile machines at good prices, but some are much better than others at certain specialties. By prioritizing your needs, the salesperson can offer systems that will provide the best solution. I always like the idea of price versus performance. This is especially the case for warranties. If warranties are a priority, you’ll probably want to look at new equipment that can offer one- to five-year warranties included with the purchase. But if image quality or top-name manufacturer is a priority, you may trade an extended warranty for better overall performance. A good salesperson should be able to provide a few choices that include new/refurbished options with varying performance levels and warranty.
Grzeskowiak: Look for system applications (cardiac, vascular, abdomen, OB/GYN), meets the needs of the end user, access to service tools, system manuals, system service and applications training.
Hawse: A trusted resource that will engage with thought-provoking questions to best understand all facets of their imaging needs; ultimately providing the best and most reliable imaging device that meets the facility’s needs of today and allows for expansion into the future. In addition, it is extremely important to understand the resources that the vendor has invested that will be available post sale.
Nguyen: Health care facilities should assess the resources available to an ultrasound system and its transducers to maximize equipment uptime. These resources would include partnerships with independent service organizations that support in-house clinical engineering teams to work together and service the equipment quickly. Other resources to consider are if the transducers with the system are repairable to reduce the overall cost of ownership.
Tomory: Ultrasound systems have dramatically evolved, and the technology has matured to the point where there are many good systems in all market segments which will serve health care providers and patients well. First, the systems must be evaluated for features needed now and potentially in the future. Options are much less expensive at the point of purchase. Second, what is the long-term cost of ownership? Will the manufacturer offer training, service keys, etc.? And, are aftermarket parts and probe repairs available? This is why involving the HTM department in the decision is absolutely critical.
Gill: From a service perspective, machines with Windows 10 (or Windows 10 IoT) have become a strong consideration for some, and a must for others. This is not because of advanced performance, however. This is a security measure. Windows 7 stopped providing security updates in 2019, which is scary for IT professionals. So, they demand Windows 10, but unfortunately Windows 10 is installed mostly in newer ultrasound systems that are more expensive. Also unfortunate: the only way you can upgrade the system is if the manufacturer can supply it. This is a rare case. The second new key feature: from a broad clinical perspective, I’d say single-crystal probes have been the biggest image-quality breakthrough in recent years. Yes, there have been some really great technologies for niche markets, but single-crystal probes are available to a much larger audience.
Grzeskowiak: Original equipment manufacturers have gone to great lengths to lock out system diagnostics from biomeds and third-party service companies. Large hospital organizations have the buying power to demand access to system diagnostics, service manuals, training and software.
Hawse: Artificial intelligence (AI) technology is advancing quickly and providing great tools for enhancing exam efficiency and accuracy. Shearwave technology and expanding beyond the liver in areas like MSK, thyroid, prostate and bowel. Ultrasound fusion is the combination of other imaging modalities (MRI, CT, PET) with real time ultrasound influencing diagnosis, monitoring and therapy. Microvascular flow allows for the visualization of lower velocities and small diameter blood vessel flow. The development of higher frequency transducers for exams requiring higher resolution and superficial imaging.
Nguyen: A very common feature health care facilities are looking for in ultrasound equipment is matrix imaging capabilities. This feature enables physicians to more quickly assess and diagnose patients. This new, powerful imaging capability increases the accuracy and throughput of physicians.
Tomory: Several manufacturers have introduced artificial intelligence (AI) features which may improve diagnostic confidence, increase the speed of patient throughput and reduce administration time. Cybersecurity is a frequent topic when discussing AI as well as the modality in general and several OEMs have specific products to secure the system data and the system itself.
Gill: Windows 10 will help ease security measures a great deal. We’re seeing more hospitals demand Windows 10 in their facilities, and it has become an issue lately with the lack of ultrasounds available. Cost is a prohibiting factor, but there are GE and Philips machines available in the new and refurbished markets. While security attacks on ultrasounds are extremely rare and seemingly unproductive … it’s a potential risk and IT departments don’t like risk.
Grzeskowiak: System diagnostics and technical service literature enhance biomeds/third-party service organizations repair capabilities. MW Imaging has the capability of enhancing the service abilities of biomeds/ISO field engineers by providing 24/7 tech support, same or next day part delivery, hero kits and over 100 years of technical expertise.
Hawse: New tools and software on ultrasound systems require continued training and education. Facilities need the right resources that have made the investments in a cohesive program from their customer service, tech support, field service, parts/probes, probe repair and training. This allows for an efficient, consistent message that provides the quickest resolution.
Nguyen: These advancements will nominally affect troubleshooting of image quality. Matrix transducers, commonly exhibit CW noise in scenarios where other standard transducers would not. Strong partnerships with transducer repair facilities to help identify these issues will help quickly diagnose problems and quick service of the equipment.
Tomory: Over the years, ultrasound systems have become much more software and less hardware based. When I entered this industry, I was trained on the Acuson 128 which had approximately 80 circuit boards, seemingly miles of wire and software was on EEPROMS. Troubleshooting these systems required electronics and hardware knowledge. Today, software and IT knowledge are important as well as access to the system’s software, hard drive and diagnostics. As always, I strongly recommend service engineers/HTM professionals back up the system’s drive in the event of a crash or corruption.
Gill: Absolutely. Some companies specialize in one or the other, but a few larger companies address the needs. We provide both and have facilities around the U.S. that specialize in certain tasks. We have two probe repair facilities, one dedicated to TEE, a nationwide service team and a large parts department.
Grzeskowiak: Yes, however research and design time is required to learn about new system/probe architecture, troubleshooting, circuit board, probe and system repair procedures. Purchasing systems, parts and probes to meet future customer demand is also a requirement.
Hawse: Yes, but it requires the combination of vision, investment and communication to create/obtain the tools required. A true partnership between vendor and facility allows for a deep understanding of the facility’s ever changing inventory and needs. As a result, the appropriate investments can be made to stay in line with the technology advancements and provide the resources required.
Nguyen: We think it’s critical that an ultrasound service provider provides both system and probe service. The ultrasound system and its probes are one ecosystem of technology, and failures that manifest in imaging can be either the system or the probe. From a troubleshooting perspective, it’s imperative to isolate the problem to the system or the probe. In instances where a clinical engineer has a problem and needs assistance to identify if it’s a system or probe issue, an organization that provides both will be the most effective partner.
Tomory: The cost of ownership of ultrasound systems’ balance has also shifted over the years. Today, with hardware being minimal and probes being much more complex and expensive, the bulk of the cost of ownership for ultrasound is probe related. Probes are evolving faster than the systems and health care providers need a reliable source who maintains a technology edge for probe repair. When it comes to comprehensive probe repair instead of just exchanges, a repair organization needs a solid internal supply chain to repair all the various components of a transducer from the lens to the connector and everything in between – especially in today’s uncertain times.
Gill: Keep the system clean and give it appropriate power. High heat is an enemy of the system. We walk into facilities that have systems with no ventilation around the ultrasound and/or is plugged into an overloaded power. This is bad, bad, bad. When your system overheats and/or it’s starved of power, your system will eventually have an expensive problem. Get dedicated power if you can and give the machine room to breathe. Clean the filters twice a year and vacuum out any dust that’s on the panels.
Grzeskowiak: Six-month system and probe preventive maintenance is recommended. MW Imaging can provide on-site service, 24/7 tech support, next day delivery of parts, hero kits, full and preventive maintenance service contracts, in house probe evaluation, repair and loaner capabilities.
Hawse: Like any device, treating it well with routine maintenance will add years to the life. Complete annual PMs, frequent cleaning of filters, practice good high- and low-level disinfection on the system and probes with approved methods. Have approved probe care and handling training for relative departments/end users, inspect probes frequently and identify problems early to remedy before they become bigger issues. Any service needs should be handled by a trained professional utilizing approved parts that have been thoroughly tested.
Nguyen: A common strategy for health care facilities is to utilize transducer repair services to avoid costly replacements. To give perspective, a basic repair of a transducer can cost as little as 5% of the replacement price. This method guarantees the attempt to save on transducer life cycle cost at virtually no risk to health care facilities.
Tomory: For an ultrasound system I would suggest proper shutdowns are important – follow the OEM process or you will corrupt software and damage hard drives. Regarding probes, I strongly recommend damage mitigation training for anyone who handles probes in any department. TEE probes are especially important which is why we recently launched our comprehensive SafeTEE programs and tools for TEE probes. Much of the damage we see daily is either preventable or able to be mitigated.
Gill: If you don’t think your salesperson knows what they’re doing, get a different salesperson or shop elsewhere. Do not buy from brokers who can’t give you support. Make sure they have real facilities and real technicians on-staff. If they’re outsourcing, you’ll likely run into problems when you need parts, replacement probes, service or applications support. You’ll need those people, it’s inevitable, and time is money. In making such a large investment, you should be able to have someone readily available. They should have replacement probes and parts, as well as technical support, to reduce your downtime to a minimum.
Grzeskowiak: The ability to repair systems quickly will enhance cash flow, reduce patient overflow and improved customer satisfaction. MW Imaging’s technical team can provide the necessary products and services to assure a quick turnaround time.
Hawse: Have a clear understanding of your needs and prioritize all aspects of your project, like technology/options required, identify imaging needs of today and tomorrow, budget, training needs, service needs, etc. Align yourself with the vendor that spends the time to learn about your project and offers a solution based on your priorities. Warranty and service are extremely important, make sure and have a good understanding of what resources are available to you post sale. Have the vendor walk you through a service call and how that is handled and prioritized. There is big difference in a model that outsources all resources and one that is integrated with in-house customer service, tech support, field service, parts, probes, probe repair and clinical support. Lastly, if you are able, do a site visit with the vendor and learn first-hand of its resources.
Nguyen: The cost of repairing faulty equipment is much lower than the alternative cost of replacement and is a fruitful savings opportunity with virtually no risk. Opting to repair first rather than immediately replace the technology can maximize its useful life and save health care facilities as much as 95 percent relative to the cost of original equipment manufacturer replacements.
Tomory: Most of the readers of TechNation are HTM professionals and understand the long-term costs and service limitations associated with new capital equipment. I would recommend HTM be involved in purchasing decisions so devices can be evaluated for long terms costs and service as well as features for patient care.
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