TechNation reached out to original equipment manufacturers and third-party service providers to quiz them about ultrasound systems. The result is insightful information regarding a variety of issues, including cybersecurity and parts procurement.
Participating in the roundtable article are Avante Ultrasound Vice President of Purchasing Bryan Carlin, Head of Siemens Healthineers Ultrasound North America Sabine Duffy-Sandstrom, MW Imaging Senior Customer Service Engineer Tom Hanak, Ampronix QC and Service Manager Albert Maldonado, GE Healthcare Clinical Care Solutions Chief Marketing and Commercial Officer Neal Sandy, and Innovatus Vice President Ultrasound Center of Excellence Matt Tomory.
Q: What should health care facilities look for when purchasing an ultrasound system?
Carlin: When purchasing ultrasound equipment health care facilities should always look for reputable companies. For instance, Avante Ultrasound is ISO 13485:2016 in refurbishing ultrasound equipment. We have not only a domestic standard, but an international standard for our equipment. The equipment should be fully QA’d and tested before purchasing, both functionally, as well as cosmetically.
Duffy-Sandstrom: First and foremost, it is important that health care facilities look for a trusted partner that understands their specific challenges and can look at their organization as a whole to provide, in addition to the best possible system to meet their needs, consultation services that offer a complete ultrasound solution. Health care facilities will also want to ensure that their provider is equipped with reliable, certified 24/7 service and support both in the field and through remote connectivity for quick resolutions to avoid any interruptions to patient workflows. In terms of the performance of an ultrasound system, critical capabilities include impeccable image quality to help with accurate diagnosis, portability of the system to meet a broad range of imaging requirements, and a full range of advanced applications that can adapt to all patient sizes and characteristics.
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 directly to the OEM for a part or a probe outside the standard warranty they are providing to you when you buy the system.
Maldonado: They need to determine if a portable or console version will best fit their needs. Once they determine which version, they can begin researching on the budget and the options (software, 3D/4D, probes, etc.) that will best fit their application. We have seen the portable version to be cost effective and popular with customers.
Sandy: It is important to consider several things when purchasing an ultrasound system. Is the system specifically designed for the work I do, and does it provide a high level of diagnostic confidence? Does the company provide both applications and service support? Are the workflow features saving me time? Is the system known to be dependable? Ultrasound systems should be a reflection of the care providers’ daily activity. For example, if the health care facility is an obstetrics clinic, there are ultrasound systems specifically designed for this use case. It is the same in radiology, cardiology and more recently in point-of-care environments like the emergency room and operating theater.
Tomory: There are multiple facets to this question, one being the wants versus the needs of the clinical side of the equation. What capabilities/features are needed to deliver optimum patient care and return on investment versus what is new and cool? On the clinical engineering side, it is critical to understand long-term cost to support the device and transducers. The system may come with a great warranty, but all warranties eventually end. There needs to be a plan in place to support the system whether continuing with the OEM, utilizing third-party service or bringing service in-house. You must negotiate – on the front end – system training, diagnostics access and service documentation to have the option of migrating away from the OEM post warranty.
Q: What are the most important things to look for in an ultrasound system provider in regard to service and parts?
Carlin: Some of the things customers would want to look for is what type of service and parts (if any) does the vendor provide? Will the company provide field service engineers, replacement parts? When purchasing equipment, it is very important to find a vendor that will offer after-sales support. Most of our customers are in hospital, or emergency settings, and it is very important that a system is not “hard down” because the vendor failed to offer service.
Duffy-Sandstrom: All ultrasound system providers will be able to offer certified factory parts for their systems. While parts are essential, the most important factor to consider is access to service engineers that are experts in ultrasound and dedicated solely to this unique modality. The Siemens Healthineers dedicated ultrasound field and remote service engineers are not only experts on our specific systems, but they also have a complete understanding of the customer’s department needs, workflow and clinical applications. Collaboration and shared knowledge between the remote diagnostics team and the dedicated ultrasound onsite service engineers are indispensable when it comes to service for an ultrasound system. It is important that health care facilities look for a trusted partner that is committed to a long-term relationship and offers this level of support throughout the entire life cycle of the system.
Hanak: I would look to negotiate some other types of service when purchasing the system; i.e. training. Knowing how the system works and how it is disassembled is key when the system comes off contract with the OEM. Asking the provider for a list of the service parts and the cost for those parts could also factor in choosing the right provider for the facility. This will give them a better idea of costs associated with the system when the warranty ends.
Maldonado: The turnaround time when the unit is in for service. Some manufacturers have their parts made overseas and may delay the service of the ultrasound. Find out if the manufacturer has loaners or an exchange program.
Sandy: Customers should look for a provider who understands their service demands so the appropriate relationship can be established around responsiveness and parts availability. For customers, working with a certified OEM ensures the quality and efficacy of their parts, along with well-trained service technicians.
Tomory: There are many options for parts, service and probe repair – so how do you choose? Price is always a part of the equation but what about performance, safety and longevity? With regards to ultrasound parts, I consider them somewhat binary – they function, or they do not but with probes, many “repaired” probes will work but do they perform as the OEM intended? Will you or the ultrasound technologist notice an increase or decrease in acoustic power? Loss of sensitivity? Lack of focus? Without sophisticated acoustic instruments, possibly not. Utilizing a provider who has demonstrated a commitment to quality by being ISO 13495:2016 certified is a good start. Ask your provider how they ensure their work restores OEM form, fit and function to ultrasound probes and systems.
Q: What are the most common repairs ultrasound systems require?
Carlin: The most common repairs for ultrasound equipment are due to misuse or neglect. For example, we at Ultra Solutions often see a lot of probes that have what we call “drop out.” This is because of the probe being dropped. We also see a lot of repairs for re-lens on the probe, this is a direct cause of not using the proper cleaning solutions for probes. We highly recommend customers get their machines looked at twice a year for preventative maintenance. This is a routine checkup, if you will, and this often allows our engineers to catch something that may be happening, before a major repair is needed.
Duffy-Sandstrom: Service repairs to ultrasound systems and components depend on many factors including the volume of patient exams, proper care and cleaning of the system and transducers, as well as adhering to the factory-recommended planned maintenance scheduled to proactively address any worn or damaged components before they fail. With that in mind, transducers, being a key imaging component for ultrasound, need to have optimal performance in order to obtain diagnostic and reproducible images. As transducers are hand-held devices, they are more prone to damage caused by human error such as drops and other concussive contact when moving the system. Built-in batteries in portable ultrasound systems are another component that can require replacement more frequently but as with the transducers, this also depends on the usage and volume of portable exams being performed.
Hanak: The most common repairs are typically related to the control panel/user interface. Most often, the sonographer is constantly adjusting the gain controls or the temporary gain controls to optimize the image for each patient. We constantly see ultrasound gel get into these controls. Buttons can break or become missing causing a need to repair or replace.
Maldonado: We seen minimal problems. Mainly with the probes, this is due to the wear and tear the probes are put through. The probe is not a part that sits at rest, it is constantly being moved, pulled and stretched. Also, we have seen the hard drives become full and needing to replace it. Not because the hard drive is defective, but the end user wants to keep the data.
Sandy: Periodically, there are challenges with probes and other hardware like monitors and roller balls on the keyboard. One area that customers should be prepared for these days is software reloads to ensure they are protected against cybersecurity threats.
Tomory: Ultrasound systems have continued to get smaller and have fewer parts with each new release and generation. When I began service in the industry on the Acuson 128 in 1986, the system had over 80 circuit boards, 6 different power supplies and miles of wire. Today there are a few boards, a computer and power supply. The largest cost, and highest number of failures, are the probes. They are delicate and are handled (and mis-handled) constantly. One of the most common issues we see is the use of improper chemicals (or the proper chemicals used improperly) to clean and disinfect transducers. There are many chemicals out there for probes, but the OEM manuals must be checked for compatibility. When using a probe repair provider, are they performing proper chemical testing on their plastics, lenses and even adhesives to ensure the OEM recommended chemicals are compatible for that make and model?
Q: Where do you see ultrasound trends going?
Carlin: Our industry is constantly changing. I believe the refurbish market is trending in the right direction due to improved service and repair capability. The refurbish system offers customers on a budget a chance to receive a beautiful, like new condition system for one third the price of new.
Duffy-Sandstrom: As technology advancements continue to evolve, I think we will see a tremendous increase in the use of Artificial Intelligence-based capabilities that could lead to the expansion of the patient population that can be diagnosed with ultrasound. These increased capabilities could offer a more quantitative image instead of a potentially subjective image which could reduce unwanted variability and increase clinical confidence.
Hanak: Ultrasound trends are going to follow the same trends as PC or laptop computers. Just as they have become smaller and more powerful so will ultrasound systems. You are starting to see more portables and handhelds become available in the market. Wireless ultrasound transducers and systems are becoming more popular, but I always wonder about the image quality with them.
Maldonado: The trend is going to our smartphones. Nowadays our phones are equal or better to a computer. An ultrasound is technically a computer (internally) running Windows or Linux in the background. This will give the end user an easy way to diagnose a patient and the data can be sent via the phone.
Sandy: Artificial intelligence has become more and more prevalent, and the best examples are those that solve a very specific clinical or operational use case. At GE Healthcare, we’ve introduced various AI-powered ultrasound systems to improve the consistency and accuracy of the diagnostic information provided to clinicians and providers. Handheld ultrasound is proving useful in many clinical departments and is becoming incredibly popular amongst clinicians. Primary care facilities are also starting to see the benefits as well.
Tomory: Systems keep getting smaller and more powerful and the portable market continues to grow as ultrasound expands into more areas of health care facilities. Ultrasound probes are getting more sophisticated as matrix arrays and single crystal technology becomes more common. The newest technology, Capacitive Micromachined Ultrasound Transducers (CMUT) like the new, and very cool, Butterfly IQ are starting to enter the market and I expect to see more development of this technology. These transducers use a machined chip instead of a traditional piezo-electric material which makes them more versatile and less expensive to produce.
Q: What are important things to consider regarding cybersecurity when it comes to ultrasound systems?
Carlin: There is always a risk when dealing with customer confidentiality and exporting data, however the majority of ultrasound systems use DICOM which communicates with what’s called a Picture Archiving and Communication System (PACS). This is a medical imaging technology that provides economical storage and convenient access to images from multiple modalities through a secured network. This is very safe and universal option in the imaging world.
Duffy-Sandstrom: Cybersecurity continues to be a growing concern for the health care industry, and keeping patient data safe and secure is a top priority for all health care institutions. An ultrasound system’s security infrastructure should be a main determination in purchasing an ultrasound system. Always ensure that you are partnered with a provider that engineers systems to include fully integrated cybersecurity technology.
Hanak: Making sure your ultrasound system’s 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 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 the cybersecurity issues by adding features such as whitelisting to their software, and encrypting the patient information on the hard drive.
Maldonado: Make sure the ultrasound software is up to date. The manufacturers are updating and making patches for bugs in the software. If the ultrasound is going to be connected to a network, the network’s firewall is another security blanket to avoid any attacks from the outside (Internet).
Sandy: Ultrasound systems are and will continue to be connected. This is a good thing as new software and service enhancements become easier to deploy. Connected systems do pose cybersecurity risk, yet ultrasound providers are rapidly moving to protect clinicians, facilities and patients leveraging the latest cybersecurity technology. Ultrasound customers should review the cybersecurity features on their systems and understand how those capabilities fit in to their overall cybersecurity plan.
Tomory: Like most devices these days in a hospital, ultrasound systems are networked and most run Microsoft Windows. It is critical to ensure you work with the OEM to provide the latest software updates on a regular basis. Software updates usually contain modifications to the ultrasound system software and also patches for Windows with new security features. Unfortunately, there are people in this world who through malice, greed or boredom are constantly trying to get into hospital systems so make sure your ultrasound systems are always up to date.
Q: What else do TechNation readers need to know about purchasing and servicing an ultrasound system?
Carlin: Do your research before purchasing from any company or person. Make sure the company is ISO certified, and can provide quality equipment. Don’t look at just price, look at resale value as well. It’s one thing to buy for price but quality standards and brand names hold value. It’s a safer and smarter purchase for the end user.
Duffy-Sandstrom: Meeting clinical imaging ultrasound needs requires a complete solution from a trusted partner that is interested in a long-term relationship from selection and installation, to training and 24/7 dedicated support. It is also important to understand the value of investing in connectivity solutions with the ability to push online updates and provide service through remote assistance.
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 departments can perform preventative maintenance and assist when the system goes down. We always recommend negotiating a copy of software with the system. Improper shut downs can and will corrupt the software or can cause damage to the system hard drives.
Maldonado: Make sure the manufacturer supports the product over the phone or by email. We have experienced end user calling for support on “how to” issues. Although the user manual might have the answer, some end users learn better if they are taught step-by-step over the phone or email.
Sandy: No matter your price point or expertise level, there is an ultrasound system that will fit your needs. The latest technologies are only making ultrasound easier and more efficient. It’s critical to consider reliability, the company pedigree and your individual needs when selecting an ultrasound system.
Tomory: Ultrasound technology has gotten very good over the years and the modality continues to penetrate additional areas of health care facilities. When you begin procuring parts and probes/probe repair, look beyond the immediate cost and determine the best value for you and your patients. After all, when I need a specialist for a health problem, I do not call around looking for the lowest price – I look for the best for me and mine and you should as well for you and yours.
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