The ultrasound market is projected to reach $8.2 billion by 2025 which is an increase from $6.1 billion in 2020, according to a recent MarketsandMarkets report. Ongoing technological advancements in the field of diagnostic and therapeutic ultrasound imaging, availability of medical reimbursements for diagnostic ultrasound procedures in mature markets and the growing applications of emerging ultrasound techniques (such as Doppler ultrasound in vascular imaging and 3D/4D ultrasound in oncology) are driving the growth of ultrasound market.
TechNation contacted several companies and experts within the industry to find out more about these devices. Those who responded shared their insights regarding what to look for when purchasing an ultrasound system and more.
Participants include Philips AllParts Medical’s Joni Charles; Avante Health Solutions Manager of Clinical Applications W. Todd Dennis, BS, RVT, RDCS; Summit Imaging CEO Larry Nguyen; Ampronix Director of Business Development and Marketing Michael Thomas; and Innovatus Imaging Vice President of Sales and Marketing Matt Tomory.
Charles: Top of my list is always image quality. Don’t let the bells and whistles distract you from the actual imaging capabilities of the unit. Second on my list would be versatility – how many different things can I do with this unit? The more things I can use it for, the more cost-effective it becomes. Thirdly, I would look at the serviceability of the unit. How much of the service can I perform in-house as opposed to using the manufacturer or third-party to service.
Dennis: Image quality is always a primary concern. You cannot diagnose what you cannot see. Ease of use and workflow tools are of great importance with the throughput demands being placed on sonographers today.
Nguyen: It is highly recommended when purchasing an ultrasound system to assess the total cost of ownership, this includes the service and maintenance of the equipment. A strategy that many health care facilities employ are internal healthcare technology management departments. This provides the capability to service and maintain the equipment with immediacy and avoid elongated downtime to reduce costs and improve patient access.
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: First and foremost, does the system meet the present and possible future needs of the user(s)? As an ultrasound transducer designer and manufacturer, we develop end user requirement specifications (URS) for new device manufacturing to ensure products are built to meet user needs. The same process should be used for purchasing new ultrasound systems – ensure user needs/functionality are met by the new equipment. Also, field upgrades are typically much more expensive, sometimes prohibitively so, than having the system built with capabilities so what are the current and possible future needs? Almost as important is serviceability or cost of ownership – will the system and probes be serviceable by third parties as well as the OEM? Check with your provider on availability of support in the event you choose to self-support or veer away from the OEM.
Charles: Any features that make the patient data more secure.
Dennis: This depends a great deal on the department purchasing the system. LED monitors are able to be seen well in full light; Shear Wave Elastography for liver, breast, prostate, musculoskeletal and other exams.; on-board batteries for quick movement from room to room; self-diagnostics for transducers; Microvascular Flow Doppler and Contrast Enhanced Ultrasound capability are a few.
Nguyen: Recently the advancements in ultrasound can be found in both crystal density along with new wireless technology. By increasing crystal density systems users are able to image at higher resolutions and also create 3D images without the need for moving parts. Adding wireless and battery technology has enabled new bedside quick-use transducers to be used with systems as simple as a tablet.
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. Additionally, newer ultrasound machines are becoming a lot more quiet when running.
Tomory: Multi-dimensional imaging, matrix array probes and various Dopplers are maturing as technologies and are commonplace today. The newest feature is Artificial Intelligence which can supplement diagnoses, be used for vessel detection or anatomy/pathology recognition. I have read articles where the long-term vision is “ultrasound for everybody” where the system directs, reads and diagnoses exams. As someone in the business for 34 years (and married to a sonographer) I believe this is very far off. Sonography is highly specialized and dependent on the technologist to find and capture subtle pathology or physiological nuances through individually unique acoustic windows. If it is me or a loved one, I will rely on a trained sonographer using contemporary technology.
Charles: A lot of the newer systems with Windows 10-based software are not accessible from a third-party service software service standpoint. These are also the systems that have the better patient security software.
Dennis: New advancements bring additional complexity and potentially more service issues, so a quality service organization is a key to maintaining equipment uptime. Third-party service organizations have been adapting to equipment advancements for years and will continue to do so.
Nguyen: With these new compact high-density transducers, the risk from impact damage and misuse increases, these transducers require a closer eye for care before repairable damage occurs. A great strategy is to be vigilant on issues that might just seem cosmetic, a simple crack on the housing of a transducer can be quickly repaired. If ignored, these minor faults can eventually cause significant damage that would force a costly replacement.
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: When I began on the venerable Acuson 128, there were 80 circuit boards, seven power supplies and miles of wiring within ultrasound systems and the diagnostics were contained in EEPROMS on a scan converter board and accessed through a password tied to your employee number. Today, the vast majority of work is performed with a computer and very complex software. Diagnostics are very sophisticated, can be accessed remotely and typically require the OEM or OEM permission to access. The days of being a hardware engineer are waning and software is increasingly the issue with today’s malfunctions. Access to system software, diagnostics and passwords for installation and repair is key – can you negotiate for this or enter into a cooperative agreement with the OEM? The Right to Repair issue has become more prominent due to COVID-19 and it will be interesting to see how this evolves/resolves for third parties and the clinical engineering community.
Charles: I believe it takes a good network of providers. At APM, we work together with many other ISOs to take care of every end user.
Dennis: Any service provider must maintain proficiency in whatever equipment they are tasked with servicing. While complexity certainly adds challenges, a quality organization can overcome these challenges.
Nguyen: Absolutely yes. In fact, we believe it’s critical for an independent service organization that supports ultrasound equipment to support both the systems and probes. Ultrasound technology requires these two components working together to provide a diagnostic image. Often, image quality anomalies may look identical whether it’s a probe failure or system failure. To provide support to the HTM industry, it is imperative the independent service organizations be able to assist in resolving the ultrasound equipment failure and not operate in a vacuum that is limited to only a section of the ultrasound technology.
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: As systems have gotten more complex so too have transducers so much so that increasingly more health care providers are splitting ultrasound into two categories – one is system support and the other is probes. Many do not realize a transducer is a Class 2 medical device and is just as sophisticated, if not more, than the system itself. The technology between the two is completely different and continues to diverge. Innovatus has a full FDA-registered acoustic lab to not only manufacture finished transducers for several OEMs but to test and validate materials, processes and components acoustically, electrically, mechanically and chemically to ensure a safe and effective repair for devices which perform as the OEM intended.
Charles: It seems to have exploded in the last five years. Because of point-of-care systems, ultrasound is being utilized in many areas of patient care (like therapy and interventional radiology); not just in diagnostic care. And, with the ability to buy a probe and put an app on a phone it can easily continue to flourish. It has allowed providers that would otherwise not be able to access ultrasound, to use it in new and expanding ways.
Dennis: Point-of-care ultrasound (POCUS) is rapidly expanding in multiple directions. You have hand-held ultrasound systems that are gaining popularity as a screening device at the bedside. Systems that are primarily touchscreen are expanding into the acute care settings like the ED and ICU where infection control is a primary concern. Then you have small, extremely portable but very powerful cart-based systems replacing small laptop systems in areas like MSK ultrasound where first-generation users are demanding more capability. POCUS is bringing ultrasound to many specialties that have not used ultrasound in the past. These new users are still learning and quality and accuracy of results is widely varied. POCUS is here to stay and organizations are beginning to put policies in place to regulate the use of ultrasound and monitor the accuracy of results.
Nguyen: AI-driven POCUS ultrasound is an incredible diagnostic tool to use during patient transport for EMTs and for medical staff in the use of bladder scanning and vein finding. This sector of ultrasound is growing as the general use and application is non-invasive and a great imaging tool for obvious failures. However, the resolution performance and applications are limited relative to traditional ultrasound systems.
Thomas: I feel POCUS has come along way. We are seeing portable ultrasounds become smaller and lighter. This will allow for more seamless utilization compared to heavier previous models.
Tomory: Point-of-care ultrasound continues to expand at a rapid rate due to the advanced capabilities, reduction in cost and ease of use. The global POC market is projected to double over the next decade as the modern miracle that is diagnostic ultrasound is used to diagnose disease faster, less invasively and less costly than other imaging modalities. They still have not caught up to console-based systems in terms of image quality and sensitivity but perform well when used as intended.
Charles: Always look at more than one manufacturer’s systems before making a purchase. My minimum would be three different manufacturer demos.
Dennis: Purchase a system that will meet your needs in three to five years, not just today. Image quality is the single most important feature of your system. Refurbished equipment can be a very cost-effective option depending on your needs. A capable service organization is key since a broken ultrasound system makes a great paperweight.
Nguyen: Consider taking ultrasound service in-house to reduce equipment downtime. With HTM on-site, response times to faulty equipment is immediate and enables health care facilities to service the equipment with turnaround times far quicker than any other service model. This increases patient access, minimizes operational interruptions and can significantly reduce total cost of ownership.
Thomas: I would encourage readers to do their due diligence on what options they want in an ultrasound system. Most facilities use the same ultrasound systems for 5-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: As mentioned earlier, this technology continues to advance and system service is more software engineering so when purchasing new equipment, long-term support post warranty is a strong consideration. Can you get access to the software itself? What permissions are needed to load/reload software? Diagnostics? Regarding transducers, as technology advances so too must the technology behind transducer repairs. There is a huge difference between getting probes working again and restoring them to OEM form, fit and function.
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