Roundtable: Ultrasound Systems

TechNation invited several companies to share their expert insights regarding ultrasound systems with readers in this roundtable article. Participants include Avante Health Solutions Repair Operations Manager Chris Parker, Probo Medical Director of Training and Field Service Hobie Sears and Innovatus Imaging Vice President of Sales and Marketing Matt Tomory.

Q: What are some must-have features facilities should consider when purchasing an ultrasound system? 

PARKER: Some common features facilities should look for are: application software that is easy to navigate; user interface that is organized and has a simple layout; ease of maintenance and serviceability; and standard options such as networking.

SEARS: This will depend on your facility, but one of the most noted must-have features in recent years is that the ultrasound sound system is built on Windows 10. There is more availability on units on Windows 10 than a few short years ago, so that does make it a bit easier. Wireless networking is another feature that has become common place, when getting a new unit be sure to verify it is coming with wireless networking. One last thing that everyone should consider are the cybersecurity suites being built into many systems available today, not something that you use when scanning, but certainly a powerful feature of many units.

TOMORY: The ultrasound system technology curve has somewhat flattened over recent years so there are many systems that produce image quality far exceeding what was available 5 years ago. Workflow and efficiency enhancements are high on the list – this decreases exam time and increases patient throughput. Ergonomics are also a critical consideration. I have many sonographer friends (and am also married to one) and debilitating repetitive motion injuries to arms, wrists and shoulders are on a dangerous rise. System layout, workflow efficiencies, probe/cable design, system adjustability should all be optimized for sonographer comfort and safety.

Q: What are some of the latest features facilities should consider when purchasing ultrasound devices? 

PARKER: Some new technology features to consider are: 

Artificial Intelligence (AI) since there are tasks on the system that can be automated. In today’s age this technology is becoming commonplace. As new software is released, there will be more options relating to AI in the very near future. 

Shear wave elastography, which is used to measure tissue stiffness. This is commonly used to measure the liver for fibrosis. This option is replacing the FibroScan method, which was very common but less reliable. 

3D/4D technology. There are clinical options, hardware, and applications which have drastically improved the 3D/4D image quality. Original equipment manufacturers (OEMs) are starting to include a separate GPU for image acquisition. This really gives 3D/4D rendering a boost, prevents the PC from being overtasked, and helps provide a clear and precise image without lag.

SEARS: What is key about new features is the actual plan to utilize them, it doesn’t make sense to pay extra money for high-end features unless you intend to use them. So, part of the consideration process should look into the actual usage of those new features. With that said, features in cardiac ultrasound such as strain, heart modeling and AI enhanced measurement packages are certainly in high demand. In the OB market, more advanced 3D/4D tools and more options, tools around 4D imaging are always in demand. Radiology or general imaging departments should be looking toward the updated versions on some technologies, such as contract enhanced ultrasound, updated elastography technology as well as newer measurement tools and AI assisted tools. MicroFlow color imaging is also a feature that deserves a look. Newer features are sometimes necessary or become useful, but sometimes those new features don’t pan out in the ultrasound market, so choose wisely.

TOMORY: Artificial intelligence is more common today for measurements and diagnostics which decreases scan times and may enhance diagnostic outcomes. 3D/4D ultrasound for cardiac exams is common today whereas it was used infrequently only 5-10 years ago. Ultrasound fusion imaging is another breakthrough where the ultrasound image is overlayed or displayed next to an established CT, MRI or PET exam to guide or correlate anatomy.

Q: What are the advantages and challenges of a handheld POCUS system compared to a cart-based ultrasound system? 

PARKER: Advantage: mobility. For example, in an emergency department where time is critical, the sonographer can quickly perform a scan and have the data ready for a physician in a matter of minutes. 

Advantage: affordability.  

Disadvantage: display size. On a cart-based system, the display is in the 22- to 24-inch range with OLED technology. The average size of the display on a POCUS is approximately 15 inches. 

Disadvantage: processing power. When comparing a POCUS system and cart-based system, size is the major factor – not just the physical size but the hardware package size inside the machine. While the technology has come a very long way and image quality is impressive on some, the hardware is still limited due to the size of the package in POCUS systems. In a cart-based system, you have a much larger footprint for larger and more powerful FPGAs and other ICs that you cannot fit into the POCUS system. This affects the image quality and overall processing power of the machine.

SEARS: The obvious advantages of POCUS systems are their ability to be stationed where they are needed in your facility. Today’s POCUS systems have come far from those that started out in this niche market. These systems have better image quality, have more options, and can perform some higher functions, all at a much better price than a full console system. On the disadvantage side, they will just not compete in the long run with the imaging and available tools/higher features on a console system.   

TOMORY: Point-of-care ultrasound systems (POCUS) continue to improve. I recently scanned with a $2,000 unit from a major manufacturer and was amazed at the image quality and features. While the portability and convenience cannot be argued, console-based systems still provide the most features and highest image quality.

Q: With technology advancing so quickly, do you think that it’s possible for a single service provider to address systems and probes? 

PARKER: Yes, it is very common in today’s market. Outside of the OEM, there are now multiple third-party vendors that sell, service and repair systems, probes and parts. Third-party service providers like Avante Health Solutions also offer the opportunity to purchase quality equipment at a fraction of the cost.

SEARS: In the end, even newer units are still ultrasound units at their core. While new advanced features give systems more abilities, generally it doesn’t change the concept of how the ultrasound data is captured, processed and displayed. Service providers that understand ultrasound service have little trouble adapting to the newer technologies and understanding how to repair these units and support the ultrasound transducers.

TOMORY: Just like we go to specialists when we or loved ones have health problems, the advancement in technology is best addressed by specialists; an organization dedicated to one specialty day in and day out. Dedicating all engineering, resources, technology, training and mission is the best way to support your ultrasound systems and transducers.

Q: What else do you think TechNation readers need to know about purchasing and servicing ultrasound devices?  

PARKER: Over the last 10 years, I have seen ultrasound technology change rapidly. The systems are getting far more advanced, and the number of parts is being condensed down for serviceability. From a purchasing standpoint, I think customers should get the right people involved to ensure they are getting the most for their dollar. From an imaging, applications and user ability standpoint, the sonographers should be very involved in the purchase since they will be using the equipment regularly. The healthcare technology management team should also be involved from a serviceability standpoint to ensure they are comfortable handling the maintenance and care in-house.

SEARS: When it comes to any significant purchase, having a solid relationship with those vendors you work with is crucial. This goes for the system purchase and the service provider. Your service provider should also have experience with the product line/manufacturer for your ultrasound unit. One last item is, does your service provider offer training programs for your biomed staff should you decide to train your staff to undertake the ultrasound service in part or completely?

TOMORY: Ultrasound systems are highly optioned and it is always more cost effective to add options with the system sale as opposed to later on. So, consider the needs of the department both now and in the future when placing an order. Long-term support is also a strong consideration – the system will likely be in service 5-7 years or longer, so service support post warranty needs to be considered. Clinical engineering should always be involved so questions around training, service keys and manuals, parts, etc. are addressed.