Experts share why the workhorse modality may be the wave of the future

By Elaine Sanchez Wilson

Affordability, portability, emerging applications, and advances in image quality are some of the factors fueling adoption of ultrasound, according to the panel of industry experts that 24×7 consulted for January’s roundtable discussion. A recent market report from Research and Markets attributes the modality’s growth to an aging population, rising prevalence of chronic disease, and increasing healthcare costs, and analysis from Markets and Markets projects the market to reach $6.86 billion by 2020 (compared to its current $5.25 billion worth).

Roundtable participants included: Dave Dallaire, vice president of sales and marketing at Acertara, Longmont, Colo; Rick Lytle, CEO of Alpha Source Inc., Milwaukee; John Steffen, technical services coordinator at Trisonics, Harrisburg, Pa; Tobin Taylor-Bhatia, senior director of ultrasound customer services at Philips, Amsterdam, the Netherlands; and Joan Toth, senior product marketing manager at Konica Minolta Healthcare Americas Inc., Wayne, N.J. Don’t miss out.

24×7: The ultrasound market is expected to grow steadily in the next decade. What are some factors fueling this growth?

Dave Dallaire: Several years ago, technology advancements resulting in improved image quality pushed ultrasound closer to the determinism of care. In the past, ultrasound was a precursor to MR, x-ray, and/or CT. Now, it is possible for an ultrasound to produce an image of the quality that a care provider would previously have gravitated to a CT to obtain in developing their patient management plan. Coupled with ultrasound portability, the industry is identifying new markets and stages within the continuum of care to leverage the technology advancements of ultrasound.

Within the past couple years, the Acertara R&D team has helped develop several ultrasound devices for such applications as identifying potential strokes before they occur, treatment of epilepsy, and easing the painful effects of bone cancer. Ultrasound has even recently been used to bring a patient out of a coma!

Rick Lytle: Factors such as the aging population and an increase in chronic disease are driving the growth of non-invasive ultrasound equipment. And even although capital budgets are increasingly difficult to access, the flat or declining use of other modalities in favor of ultrasound for its safety and efficiency are helping hospitals, networks, and clinics to upgrade equipment as their patient population demands.

John Steffen: Advancement in technology resulting in improved image quality and diagnostics capabilities, coupled with the fact that ultrasound is a less invasive/cost-effective form of imaging, is helping to spur this growth. Improved quality of portable systems and the increased use in point of care (POC) is also expanding sales. Ultrasound is also very inexpensive compared to other imaging modalities, as far as purchase and servicing costs, making it more widely utilized.

Tobin Taylor-Bhatia: Ultrasound’s capability has improved with technology advancements, which create higher-quality images and are more intuitive to users, and this has driven ultrasound’s adoption by new users like nurses, midwives, and general practitioners and new uses like hospital/ambulance, hepatology, emergency medicine, and critical care. Additionally, ultrasound is an affordable and safe imaging technology and its (relatively) small size and portability make it compatible in a variety of care environments.

Joan Toth: The evolution of ultrasound is driven by economic factors, along with physician and imaging company dedication to improving patient care. No longer is ultrasound centered in the hospital radiology department and strictly performed by sonographers.

Since ultrasound functionality is not limited to ‘big box’ systems, POC physicians are able to use intuitive, mobile ultrasound systems, with the same functionality, at the bedside. This has dramatically broadened the market space to include ultrasound use in the emergency medicine environment, critical-care units, anesthesiology, and to physicians who perform musculoskeletal procedures..

24×7: How has the ultrasound market evolved in recent years? How has your company responded to the market’s current demands?

Toth: Ultrasound has evolved as a cost-effective imaging modality that improves patient outcomes. With the improvement in image resolution and system features, as the size, weight, and cost decreases, ultrasound is more readily available to medical specialists who do not currently use ultrasound imaging as part of their routine practice.

Konica Minolta Healthcare, for instance, meets the ever-changing needs of the POC market by providing ultrasound solutions that provide better decisions, sooner, through superior image quality, ease of use, and advanced functionality.

Lytle: An increasing amount of ultrasound equipment is in the market, with a wide range of new and end-of-service life machines. Alpha Source has responded by increasing our nationwide field service network to be accessible, efficient, and responsive. We know how important equipment uptime is to our healthcare provider customers in both rural and urban markets, and have created a service network that can meet the demands for onsite service, technical support, and parts replacement.

We also have unparalleled access to OEM partners, such as GE [Healthcare], for technical, engineering, and clinical support as well as access to hard-to-find replacement parts. In addition to our national field service, Alpha Source now offers small depot repair for mobile ultrasound equipment.

Steffen: The industry is ever-evolving, with an increased number of models entering the marketplace along with more targeted uses. Increased computing power and improved applications has reduced study times and improved workflow, enhancing efficiency.

Trisonics has responded to these demands by staying current and proficient in all newer model repair needs to better support our customers. We are also enhancing our inventory of refurbished equipment, parts, and probes of these in-demand systems to have more offerings at a significant cost savings.

Taylor-Bhatia: Philips has led the way in developing solutions to address today and tomorrow’s biggest healthcare challenges in a number of ways. One example is HeartModel, an anatomically intelligent ultrasound application that automatically detects, segments, and quantifies the left ventricle and left atrium volumes and ejection fraction, from the same Live 3D volume. HeartModel brings advanced automated quantification, 3D views, and robust reproducibility—plus time-savings of up to 82%—to everyday echocardiography.

Toth: With the expanded use of ultrasound, integration of the imaging modality into the physicians’ practice and patient care is paramount. Since the majority of ultrasound growth will come from new POC users, education and training will play an important role in practice integration and the subsequent improvement in patient care.

Training for healthcare providers performing and interpreting ultrasound exams begins in medical school and other provider curriculums. Konica Minolta Healthcare takes this initial training one step further, however, by offering a post-sale educational continuum.

Dallaire: From a technology standpoint, consolidation and resulting profit pressures on these larger organizations has fueled an innovation engine from smaller companies and start-ups. Where previously larger OEMs introduced the next “big thing,” we expect many of the technological advancements to originate within these smaller organizations going forward. Much of this is due to the collective excitement that’s typically found within a smaller organization for developing something new. POC ultrasound using smartphones and tablets are an example of technology introduction driven by the startup/small company sector.

24×7: What are some the biggest challenges currently affecting the ultrasound sector? How is the industry working to address these issues?

Steffen: Currently one of the biggest challenges affecting the ultrasound sector is the uncertainty with [U.S.] FDA regulations regarding servicing/repair of the equipment by non-OEM companies. Being able to provide effective service costs and parts availability to customers is a growing concern.

The industry is working with organizations, such as the International Association of Medical Equipment Remarketers and Servicers, to help provide FDA workshops and legislative lobbying to address the issues.

Taylor-Bhatia: As healthcare systems are consolidating, many of our customers manage large fleets of medical equipment. Cost pressures demand increased efficiency throughout the healthcare system; tools that help biomeds and healthcare systems better manage their fleets, reduce system downtime, and measure the efficiency are in high demand.

Lytle: Choosing service partners for contracts or biomed department overflow can be confusing and difficult, because there is no single standard of service criteria. With a service partner like Alpha Source, however, hospitals and clinics can be assured that we are OEM-trained, operate under stringent quality processes, and meet all FDA guidelines for quality.

Dallaire: The ultrasound market is not so much burdened with challenges at this time, but blessed with opportunity. It seems that new clinical uses for ultrasound are being created every day, many of which will potentially extend and improve the quality of our lives.

24×7: What emerging ultrasound applications are you most excited about? 

Taylor-Bhatia: I’m really excited about new our OmniSphere solution. Our customers tell us that they would like to be able to better manage their ultrasound business, and [want] more control over servicing their equipment by utilizing their biomed teams.

Based on these insights, Philips created OmniSphere, an ecosystem of business and service applications that connects users to their ultrasound systems and data, helping them to increase business efficiency and address operational challenges faced in today’s dynamic healthcare environment.

Dallaire: We are most excited about emerging applications that blend diagnosis with treatment, such as stroke therapy, biomarkers, and highly focused ultrasound.

Steffen: There are a few exciting advancements, such as strain for chemo patients, allowing the reading physician to analyze over time how chemo treatments have or have not affected the overall endocardial function (ejection fraction).

Elastography—the sending of pulse waves through a soft tissue to measure the amount of tissue displacement—allows for the assessment of overall relative tissue stiffness. This technology creates a data set that is easily reproduced from user to user. Having a solid data set that is easily reproducible is what makes this technology so useful for identifying cancerous cells.

Toth: Ultrasound-based telehealth is another exciting application. Support of a healthcare provider in a rural or low socioeconomic area by an ultrasound expert during a scan is invaluable hands-on training. During remote consultations, the end users can receive training on image optimization, as well as using the transducer, and receive a second opinion on difficult cases. Remote ultrasound expertise via telehealth opens endless possibilties of providing world-class care and saving lives in challenging environments.

24×7: What else should biomedical engineers—those likely tasked with repairing ultrasound equipment—know about these devices?

Lytle: Like many areas in healthcare, biomedical departments are challenged to do more with fewer resources and declining budgets. Staying ahead of recommended preventative maintenance (PM) schedules is one important way to ensure quality. Ultrasound images can degrade over time and a consistent PM schedule can help eliminate the risk of missed diagnosis from image degradation. The only way to assure ultrasound image clarity is to evaluate the entire image chain using a standard, repeatable, known image that can be compared for consistency.

Steffen: With the advancements seen on the newer ultrasound systems, [HTM professionals] should be aware that [these scanners] are heavily software-driven and many issues arise from corruption of that software. These newer pieces of equipment have a higher dependency on a computer operating system and typically see less component-based repair issues compared to their older counterparts.

Toth: POC compact ultrasound systems are predominantly purchased with five years of a manufacturer’s warranty. In order to optimize ultrasound integration in a practice, Konica Minolta, for instance, partners with ultrasound end users to provide service and support via Remote Assist. From the office, healthcare providers receive remote consultation, troubleshooting expertise, image optimization advice, follow-up applications support, and gain educational training…and the physician and staff never have to leave the facility.

Dallaire: Ultrasound technology is becoming increasingly complex, and the better biomedical engineers understand how ultrasound works, the better they’ll make decisions about how to service this equipment. This is where a focus on continuous education is key—with not only knowing how to provide field service, but also understanding the advancing design components that are considered when developing an ultrasound that produces a safe and efficacious image.

Additionally, hospitals need to better equip HTM professionals with test equipment that allow them to ensure the proper operation of the probes and ultrasound systems.

Taylor-Bhatia: Part of Phillips’ OmniSphere offering is called Remote Technical Connect, which delivers secure access to ultrasound systems, [thus] helping biomeds and IT teams increase productivity and uptime. Enabling biomeds to provide first-response remotely and be more prepared if they must travel to service equipment can save labor hours and associated costs—not only freeing them up to service other needs, but also increasing equipment uptime. This is a priority for the company, and biomeds can expect to see more innovations from Philips in the coming years.