For this roundtable article on ultrasound, TechNation reached out to industry leaders for input and insights regarding what to look for when purchasing an ultrasound system, the latest advancements in the modality, cybersecurity concerns and more.
Participating in the roundtable are The Intermed Group Imaging Service Engineer-Ultrasound Jacqueline Browning, MW Imaging Senior Field Engineer Tom Hanak, Summit Imaging CEO Lawrence Nguyen, Ampronix Director of Business Development and Marketing Michael Thomas and Innovatus Imaging Vice President of Ultrasound Center of Excellence Matt Tomory.
Q: What should health care facilities look for when purchasing an ultrasound system?
Browning: Health care facilities should look for a system that fits their specific needs. Whether that need is identifying what system is compatible with a workflow the customer is implementing or a budget constraint. Having a variety of vendors to choose from is a plus.
Hanak: When searching for an ultrasound system the facility should first look at what type of application they will be using the system for. The most typical applications include OB, cardiac and vascular. Each OEM specializes in different applications, though some have closed the gap between the other OEMs. The second should be the availability of parts and probes in the third-party market. You want to make sure you’re not tied down to just going direct to the OEM for a part or a probe outside the standard warranty they are providing to you when you buy the system.
Nguyen: Healthcare technology managers are actively looking for ways to reduce the total cost of ownership of ultrasound systems while providing quality patient care. A popular strategy is to assess the ability to bring the service in-house once the warranty expires on the systems. It is critical to assess the support available from OEMs and independent service providers to enable HTMs to support the systems that can significantly reduce costs and maintain quality.
Thomas: First and foremost, they need to determine if a console or portable version would best suit their requirements. Next, start researching options such as 3D/4D probes and software that would be the optimal choice within their budget. Due to ease of use and cost savings, we are starting to see an increased shift toward the use of portable ultrasounds.
Tomory: Just because a facility is loyal to or heavy with one OEM, it’s not the reason to purchase from that OEM. Facilities, more importantly individual departments, need to be sure that the OEM and the system model meets the specific needs of the imaging specialty. OEMs do typically lean to one or more specialties. Also, research post-purchase support options. Ensure that the OEM will guarantee that the system is at the current software and hardware level when it rolls off of warranty or contract.
Q: What are some of the latest advancements in ultrasound technology?
Browning: One of the exciting latest technologies emerging are chip-based transducers. Chip-based transducers use silicon chips to convert voltage to resonance. It’s still in its infancy stage and produces lower image quality. The lower quality images would be most viable in point of care, health clinics and physicians’ offices. A feature that is very promising is that it is an early-stage technology to combat chronic illness by using sound waves to destroy diseased tissue.
Hanak: The industry is starting to see everything go toward a more wireless approach. Whether it’s the systems or probes, it’s becoming the standard now. After completing the exam the sonographer has the ability to speed up the diagnosis for the patient. Ultrasound systems are also becoming smaller and ergonomically designed to increase the workflow without compromising image quality. Advancements in software also continue to include higher levels of AI that can speed up the time that it takes to complete a study and reproduce consistent image quality with even the newest sonographer.
Nguyen: One of the latest advancements in ultrasound technology is the ability of new ultrasound transducers to capture higher resolution images, enabling technicians to perform a wider variety of studies. This is great for the health care system and patients as ultrasound studies are non-invasive, relatively quick and a lower cost than other imaging modalities.
Thomas: We are noticing the release of wireless Wi-Fi ultrasound probes. This is an incredible advancement as there are no actual wires being connected to the probes or tablets, which can be very helpful depending on your area of focus, such as veterinary clinics. Also, 4D ultrasound scans still seem to be an industry leader, especially for Millennials, as they want to utilize the latest technology.
Tomory: Single-crystal technology, CMUT technology and wireless-probe technology have been emerging lately, but none seem to be growing at the pace of 3D volumetric imaging. Although 3D Matrix array probes have been available for about 10 years, the technology is maturing and gaining a larger install base. Probe designs, which traditionally contained less than 100 acoustic elements, now contain thousands. We can expect a greater number of probe models and systems from a greater number of OEMs supporting this complex imaging modality.
Q: How do you think these advancements will affect troubleshooting and serviceability?
Browning: Chip-based transducers would make serviceability more cost effective. There is no risk of accidental damage to the array. The current FDA guidelines for transducer repair facilities is driving up repair prices due to the added time needed in testing and validating a transducer.
Hanak: Servicing the newest ultrasound systems can be costly but not compared to the cost with the OEM. The availability of parts may be limited to third-party suppliers. Also, having well-trained and qualified engineers who know the newest platforms and the system architecture is essential when troubleshooting.
Nguyen: These advancements will likely not impact troubleshooting or serviceability as the same principles of testing image quality and failure modes are largely unchanged.
Thomas: Some ultrasound manufacturers are now creating apps that can be downloaded on any handheld device, which would then become the software for the ultrasound system. This would reduce the need for units being serviced utilizing the app interface as manufacturers can send an update to the device to address common issues. Before this, most units would need to be sent into a service center for further diagnosis.
Tomory: One of the biggest challenges with supporting diagnostic ultrasound these days is related to software. The hardware itself is fairly stable. Being able to distinguish between a hardware failure, probe failure and/or software (or even a user-related) issue can be challenging. It’s important to have a strong foundation with ultrasound technology and a robust support network. It’s also recommended to image the hard drive on all critical systems and create frequent backups anytime a change is made to the configuration. Be ready for a failure and minimize opportunities for software corruption using all available technologies.
Q: With AI becoming a popular topic in medical imaging, how does this affect troubleshooting and serviceability of ultrasound systems?
Browning: AI focuses on working with and amplifying end user knowledge. An effect on serviceability and troubleshooting will be continuing to keep a spotlight on optimal system performance keeping a high focus on image optimization. Image quality checks is a key part of scheduled maintenance. This is important due to the diverse pool of end users relying on reproducible imaging in AI.
Hanak: Troubleshooting can be somewhat challenging if you are not sure how the AI software works with the system. You would need a trained engineer who understand the terminology and can accurately identify the specific problem.
Nguyen: AI is a popular topic in medical imaging, however, it has yet to gain traction in service of ultrasound systems rolling into 2020. The shift in workflow derived from AI will occur when cloud platforms become more sophisticated and integrated into workflows of HTMs.
Thomas: Since this is a newer technology, biomeds and service centers will need to work closely with manufacturers to diagnose possible new issues that might arise. The best way we have found is by being in direct communication with our customers at least weekly. This allows us to see how each system is being implemented within their facility and receive valuable feedback when an issue does arise so we can further troubleshoot.
Tomory: Simply put, AI is just complex software. Like all computers and software, garbage in-garbage out. Service engineers need to have good, solid troubleshooting skills and insure optimal image quality prior to addressing any complaints or trouble calls related to AI. In ultrasound, it all starts with a healthy probe, performing as expected. There is going to be increased need to ensure the use of a repair provider that can demonstrate that probes perform as the OEM intended.
Q: With technology advancing so quickly, do you think that it’s possible for a single service provider to address systems and probes?
Browning: At Intermed, we make it a priority to partner with our customer in identifying system and probe issues. Technology is advancing quickly, and the needs of the customer are changing dynamically. Listening to the customer and regularly scheduled maintenance makes this possible.
Hanak: Yes, it is possible. Keeping up with the latest technology and advances is challenging but we take pride in our continuing education process here at MW Imaging.
Nguyen: Absolutely. It is key for HTMs to identify organizations to partner with that have the ability to support systems and probes. This ensures HTMs are receiving the best quality of support possible when troubleshooting problems that could arise from either the system or the probe.
Thomas: There are many variables to consider when servicing and repairing ultrasound machines. One is the availability of parts as some manufacturers limit the number of service centers they will sell parts to. Another variable would be downtime. Some facilities are not able to have any downtime and would require a loaner to be sent to them prior to sending in their unit for evaluation.
Tomory: It’s my belief that systems and probes are best supported individually. Probes are a field of study within themselves. Although some do, there are only a few OEMs that actually manufacture their own probes. Typically, they are outsourced to specialized companies, one being Innovatus Imaging that operates an FDA-registered probe manufacturing facility. Systems are also their own specialty. Combining the number of potential hardware and software configurations available on a single platform, the number is staggering. Although a one-stop shop sounds convenient, the best results may be obtained by using providers who specialize in one or the other.
Q: What are important things to consider regarding cybersecurity when it comes to ultrasound systems?
Browning: Health care organizations need to develop and maintain a strong security culture with ongoing cybersecurity training and innovation. They need to seek ways to stay ahead of a possible cyber attack. It’s important to assist our customer in identifying any upgrades or patches for their systems that are available through the system’s ultrasound manufacturer. The InterMed Group has cyber specialized teams who perform medical device profiling (MDP) for cybersecurity.
Hanak: Making sure your ultrasound system software is up to date is always crucial with regard to cybersecurity. OEMs will always release a newer version of software that includes patches to fix the bugs or any other issues related to the software. Does your facility have an old or outdated system that the OEM no longer supports? If so, we recommend updating the system to ensure the safety of data on your system. The OEMs have taken steps to ensure that their current line of ultrasound systems tackle cybersecurity issues by adding features such as whitelisting to their software, and encrypting the patient information on the hard drive.
Nguyen: The same basic principles of security apply to ultrasound systems as any other connected device in a health care facility. Strong network security will help reduce risks of attacks.
Thomas: Having your system up to date is vital in extending the life of your unit. Manufactures at times will release patches to address bugs within the software, and having your unit updated will prevent unforeseen errors. Additionally, having a network firewall is another layer of protection if the ultrasound is going to be connected to a network.
Tomory: Be prepared. Be sure that, while systems are under warranty or OEM-contract, that the OEM is performing regular software updates. Post-warranty/contract insist on the same level of service. While software upgrades come with a cost, software updates are typically free. Create an image of the hard drive and perform a backup anytime the software is updated, upgraded or user-configurations are modified. It’s also critical that the original software not be modified in any way (virus protection, widgets, etc.).
Q: What else do you think TechNation readers need to know about purchasing and servicing an ultrasound system?
Browning: When it comes to communicating with a service provider or vendor about purchasing and servicing an ultrasound system, make sure they are listening until you feel understood. Every customer has a unique situation and it’s not one size fits all.
Hanak: When purchasing a new ultrasound system for your facility we recommend getting the CES/HTM and IT departments involved in the decision as well. Try and work into the purchase agreement some type of training so that the specified department(s) can perform preventative maintenance and assist when the system goes down. We also always recommend negotiating a copy of software with the system. Improper shutdowns can and will corrupt the software or can cause damage to the system hard drives.
Nguyen: There is a major shift underway of taking ultrasound equipment service in-house. It is a proven strategy to reduce service costs, increase scanning efficiency and enable health care facilities to meet tight budgets. Identifying organizations that can support them at the time of purchasing a system allows optionality for HTMs to decide which service option is best at any given point in time. All HTMs have plans and timelines and we all know things don’t always go as planned. Maintaining optionality allows HTMs to modify how they operate at their discretion to best serve their patients.
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 five-plus years, so it is essential to try and purchase a system with all of the features dependent on what the facility can afford. If they are not able to buy a new system, consider purchasing a refurbished system which, in most cases, still will come with a comparable warranty as a new system would. In regards to choosing a service provider, make sure to ask if the provider has serviced or repaired your specific ultrasound/probe before as this will help reduce future complications that might arise.
Tomory: Insert clinical engineering into the purchasing process for any capital equipment purchase. Do your homework ahead of time and learn what support options are available post-warranty and insure that the OEM provides the necessary tools to support the system post-warranty (service manuals, service training, access codes, software updates, etc.). Everything is negotiable up-front. Be sure to research non-OEM support options and choose one with an ISO 13485:2016 certified quality management system.
