Industry experts sound off about the latest innovations in ultrasound
Suffice it to say that the global ultrasound sector is on the rise. Below, five ultrasound industry experts—Bob Thompson, president, ultrasound, Siemens Healthineers; Jeremy Probst, president and CEO of Technical Prospects; Neal Sandy, chief marketing and commercial officer, GE Healthcare Clinical Care Solutions; David Nye, senior territory manager at Trisonics Inc; and Amanda DePalma, head of global marketing for ultrasound at Philips—sit down with 24×7 Magazine to discuss what’s propelling demand for ultrasound and what HTM professionals should consider when maintaining and repairing these sought-after systems.
24×7 Magazine: A recent MarketWatch report projects the global ultrasound market to exceed $7.2 billion by 2022. What are some key factors contributing to this growth?
Jeremy Probst: Ultrasound offers an effective imaging option that is extremely cost effective to own and operate within healthcare facilities. The equipment itself also has a significantly smaller footprint than other imaging modalities, which makes this an ideal option for small clinics and private practices.
In addition, ultrasound is noninvasive and uses no radiation. As we continue to learn more about the long-term effects of radiation exposure, I expect to see more and more emphasis on imaging procedures that limit or eliminate the amount of radiation patients are exposed to. These factors, combined with the improved quality of images produced, have dramatically expanded ultrasound’s diagnostic capabilities and have allowed it to grow within the market.
Amanda DePalma: There are numerous factors contributing to ultrasound’s growth. Key factors are that ultrasound is an affordable, accessible, and safe technology that can reach a diverse patient population and improve millions of lives around the globe.
Neal Sandy: Projected growth in the ultrasound market through 2022 will be fueled by several factors, including an expansion of usage in emerging markets, expansion of new users in areas such as acute care and primary care (including handheld ultrasound), advancements in artificial intelligence to improve diagnostic accuracy and efficiency, and increased attention to therapy guidance and ultrasound as a therapy.
David Nye: Ultrasound continues to grow for multiple reasons. Not only are the types of studies increasing, but so also are the departments using ultrasound systems. Years ago, ultrasound was only used in departments like radiology, echocardiography, and Ob-Gyn. [Now,] it continues to grow in such areas as point of care, orthopedics, and many others.
Bob Thompson: In addition to solid growth in emerging and developing markets such as India, China, and Latin America, we are also experiencing the move toward more value-based care. Ultrasound is a major factor in this offering, providing cost-effective, easily accessible imaging, which helps to improve clinical outcomes in more cases. Ultrasound is already the most widely used imaging technology—and its range of clinical applications, disease pathways, and patient populations it can address is expanding.
Moreover, as we drive to more precise medicine, physicians need more imaging information—an area where ultrasound is experiencing growth. From improvements in image quality, greater use of artificial intelligence, and greater acceptance of advanced features like fusion imaging, contrast-enhanced ultrasound and shear wave elastography are all contributing to the expansion of the clinical use of ultrasound.
24×7: What are some of the biggest innovations currently affecting the ultrasound market and what technological advancements do you expect to see in the next few years?
DePalma: We will continue to see advancements in automation, quantification, and the use of artificial intelligence to make ultrasound a more objective and intelligent solution that is accessible to more and more people around the globe. Additionally, we’ll see ultrasound expanding beyond diagnostics and being used in more interventional procedures and even for treatment. For example, at Philips, we just introduced EPIQ CVxi, our third-generation integrated ultrasound-angiography cath lab solution for real-time, workflow-optimized image guidance and advanced quantification for structural heart procedures.
Sandy: As with several industries, artificial intelligence is already beginning to transform the ultrasound market. In addition, continued advances in processing capabilities, image and data sharing, and virtual education will play a role. We expect the biggest potential to lie in precision health—combining ultrasound information with other markers (e.g. genetic) and processed with the power of AI/big data technologies. These results could lead to substantially refined and individualized screening, diagnostic, and treatment results—ultimately, improved outcomes.
Thompson: According to the World Health Organization, 1.9 billion people globally are reported as overweight, with 650 million people classified as obese. Imaging challenging patients requires new levels of performance and new innovations. We need to enable clinicians to image deeper without losing image quality. Siemens Healthineers worked with clinicians and the ultrasound community to address these challenges [with our] ACUSON Sequoia ultrasound system and DAX transducer, which allow physicians and users to image at depths up to 40 cm without losing image quality, versus most conventional system depth.
Also, let’s not underestimate workflow, ease of use, and the reduction of ergonomic injuries for operators. New technologies such as gesture-detecting transducers— activated by touch—aim to reduce injury and enhance workflow. Reduction of keystrokes facilitates the speed of an examination, but also reduces the strain on the user. Auto machine learning and AI are automating routine and tedious tasks, allowing users more time to focus on diagnosis and the patient. We also see a continued expansion of the diagnostic power of ultrasound in terms of applications.
Nye: Software is becoming a bigger and bigger part of these systems. Years ago, it was not uncommon to have 20 or more circuit boards in a system; some of the latest systems have less than half of that now. The difference is the amount of processing that the backend of these systems [can now do]. With the in-depth software control, the new systems can create a cleaner, crisper picture.
In years’ past, there has always been a trade-off between system size and image quality. When purchasing a small, portable system, the user always had to sacrifice a little image quality for the portability factor. Over the next few years, I expect to see systems continue to shrink and decrease the trade off when comparing system size to image quality.
Probst: Over the past decade, we’ve seen the quality of images produced by ultrasound equipment vastly improve. This has made ultrasound a legitimate imaging tool in a variety of new applications. Two excellent examples of this include cardiac studies and breast cancer screenings. In both applications, ultrasound now offers vivid, color images—all taken with no dose of radiation.
Ultrasound continues to gain traction as an alternative to angiograms in cardiology, and I believe we will see greater use over mammograms in detecting breast cancer. As ultrasound images continue to improve, there will be growth as the modality offers a more advanced, noninvasive imaging option that doesn’t utilize radiation. This not only helps limit the amount of radiation patients are exposed to, but also limits imaging technicians’ exposure.
24×7: In your expert opinions, what are some of the biggest challenges currently affecting the ultrasound sector? How is the industry working to overcome them?
Nye: We are seeing an increasing shift moving ultrasound maintenance and repair to in-house HTM professionals. The challenge for these in-house engineers is managing the increased workload and increasing their knowledge base to effectively keep the ultrasound systems up and running. Different parts of the industry deal with it differently. We try to create relationships with the in-house engineers and provide training, support, and onsite assistance, if needed.
Probst: Ultrasound procedures are often far more time-consuming than other imaging modalities. For example, while it may take only minutes to capture the required images with a CT scan, an ultrasound could take up to 30 minutes, if not longer. Because of the time ultrasound procedures require, the modality doesn’t provide the return per appointment that other procedures offer.
Despite longer procedures, ultrasound is potentially safer than other imaging methods because it does not utilize any form of radiation. It is crucial that we continue to educate imaging technicians, doctors, and insurance companies on the impact of over-radiating patients and increase awareness of the long-term side effects of excessive radiation exposure.
DePalma: With more and more new ultrasound users, training and education are critical challenges for our customers. This challenge requires that we both innovate to make ultrasound more intuitive and easier to use, as well as develop novel ways to provide training and education for a diverse customer base.
Sandy: Education remains a primary challenge—particularly in emerging markets. The industry often participates and helps to coordinate ultrasound education in a traditional sense, and augmenting those activities with virtual education will continue to open up ultrasound as a viable technology for clinicians in these markets. Another challenge is related to AI, as the industry needs access to data to train algorithms to ultimately drive better outcomes for patients and clinicians. There is an increased interest in data-sharing agreements, opt-in patient agreements, and traditional research agreements that will help advance the technology while protecting patient data.
Thompson: One of the big challenges in ultrasound is variability: patient variability, system variability, and user variability. Clinicians are challenged with imaging different sized patients with consistency and clarity. Manufacturers continue to innovate their products to grow the clinical efficacy of their systems. As ultrasound systems continue to improve in both image quality and advanced functionalities, their use is expanding into a broader range of clinical applications.
Coupled with AI, users can benefit from automation and improved diagnostic accuracy and more personalized treatment planning. The healthcare sector needs to provide more effective outcomes at a lower cost—and ultrasound can help here, beyond just imaging.
24×7: What special considerations must HTM professionals have in the maintenance and repair of ultrasound systems?
Thompson: There are two key considerations for system maintenance and repair, which go beyond the classical break/fix: services and connectivity as a basis for it. Both elements should be viewed in terms of total cost of ownership (TCO)—which goes beyond just the system investment. TCO includes a view of the entire lifecycle and can address reliability, stability, and security; ongoing education; as well as other new services like remote support.
Connectivity provides opportunities for users to leverage the full potential of their ultrasound systems based on smart remote services (SRS)—for instance, convenient access to software and important security updates when needed, in order to stay operational. When talking about service, direct suppliers understand long-term usage of their systems and can support users and systems beyond implementing a needed repair. Direct suppliers are proactively able to offer the right elements for a sustainable lifecycle of the system, maximizing investment.
Probst: Above all else, medical imaging engineers and technicians should always follow the original equipment manufacturer’s recommended preventative maintenance schedule. This not only keeps equipment operating properly, it also protects any warranty policies the equipment holds. That being said, technicians should pay special attention to ultrasound probes, their cords and grounding wires, and monitor for wear and tear between maintenance.
Because of the frequency of use, these parts are the most likely to become damaged or worn down and should be replaced immediately. Clinics and hospitals should also identify a reliable imaging parts supplier that is able to provide ultrasound parts on time and within budget.
Sandy: [The first consideration is] trained and skilled resources: Skilled and highly trained resources enable quick resolution of maintenance events, including hardware and software issues, as well as clinical applications issues. And OEMs have a direct connection to engineering resources that developed the equipment. [Other considerations include:]
- Ensuring patient safety: When working on medical devices, there is risk involved if equipment is not properly maintained or repaired correctly. OEMs must comply with regulatory guidelines that ensure the proper validation of engineering and manufacturing processes, training of field and biomed engineers, parts and probes.
- Productivity: In today’s fast-paced healthcare environments, speed of efficient maintenance and repair translates in many ways to improved patient care. Service organizations must be responsive as it relates to service events, ensuring quick remote technical support, the deployment of field resources, and parts procurement. Beyond patient care, hospital costs are directly impacted by the speed in which providers react to service events.
- Digital capabilities: Digital capabilities of service providers are becoming more vital every day to enable improved engagement with healthcare providers and drive faster response times to both service and request and information that may be required for accreditation or regulatory audits.
- Cybersecurity: Ransomware has become front and center in the healthcare industry. And ultrasound service providers are impacted by this area because of the sheer size of the install base. [Therefore,] it’s vital to have a provider that can ensure the efficient deployment of corrective patches and know the vulnerabilities of their equipment.
Nye: My favorite advice is to ask the sonographer questions—and listen to [his or her] answers. Most sonographers I’ve met are truly experts. They might not know how to explain the problem—but if you ask the right questions, [sonographers] do an excellent job of answering in detail.
24×7: Do you have any more expert advice you want to impart on 24×7 Magazine readers regarding the ultrasound sector?
Sandy: The pace of innovation in ultrasound continues to offer tremendous improvements to the benefit of clinicians and patients alike. When properly directed toward outcomes that benefit patients, clinicians and/or health systems, ultrasound products and technologies can make a real difference in patient care.
By focusing our attention on ultrasound advancements, this will make a difference for the clinician and ultimately, the patient. These advancements may be as simple as gaining access to world-class ultrasound at an affordable price, or could be as groundbreaking as providing AI-derived diagnostic guidance based on clinician-curated datasets from ultrasound researchers all over the world.
Probst: I believe ultrasound is an underused modality that offers noninvasive imaging and the added patient and provider benefit of no radiation. Because of this, I challenge providers to ask themselves, “Can we do this exam without radiation?” As ultrasound imaging continues to advance, more opportunities for use will emerge and providers can reduce the amount of unnecessary radiation patients are exposed to.
Nye: Ultrasound is a great field to be in. With [the field] ever-changing, it always keeps you on your toes and continues to force you to learn about new technology.
Thompson: Ultrasound remains the most versatile imaging modality with an expansion of clinical applications spreading throughout the care facility. Ultrasound is present in more departments than any other non-disposable technology—and this can present challenges for servicing and maintaining a fleet of systems, as well as understanding utilization rates. Adopting tools like predictive analytics may leverage hospital investments and lend to overall system sustainability. [Further,] I have spent my whole professional career in ultrasound, and it still inspires and excites me every day to see the impact that ultrasound is having on patients.