One of the top modalities on display at the 107th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), which takes place from November 28-December 2 in Chicago, will be ultrasound devices.

Ahead of RSNA 2021, five individuals with a vested stake in the ultrasound equipment market—Jodi Miller, director, market development of Fujifilm Sonosite; Jeff Cohen, general manager, ultrasound, Philips; Joan Toth, senior product marketing manager, the Americas, Konica Minolta; Ajay Gannerkote, head of ultrasound, Siemens Healthineers; and G. Wayne Moore, BSc, MBA, FASE, CEO of Acertara Acoustic Laboratories and 2021 chair for MITA’s Ultrasound Section and Service Committee—discuss how the COVID-19 pandemic impacted ultrasound operations and what HTM professionals should know before handling these delicate devices.

24×7 Magazine: It’s been an unprecedented time in healthcare, to say the least. In what ways has the COVID-19 pandemic affected the ultrasound equipment sector?

Jodi Miller: Nearly every industry has been touched by the COVID-19 pandemic, but the healthcare market and ultrasound sector experienced one of the most direct impacts. Early on, physicians saw that one of the biggest advances in the management of COVID-19 was portable, bedside ultrasound. Its powerful capabilities, coupled with its portability, proved to be very valuable in evaluating both COVID and non-COVID patients.

Ajay Gannerkote: The COVID-19 pandemic, while devastating, brought to the forefront the capabilities of high-quality ultrasound imaging for clinicians and their patients. For example, lung ultrasound is strongly recommended for acute respiratory failure and can be a useful alternative during the COVID-19 outbreak if CT is not readily available.

Another aspect in which COVID-19 has impacted the ultrasound equipment sector is the increase in bedside ultrasound imaging to help lower infection risks to patients, staff members, and the hospital community. Ultrasound provides a mobile high-quality imaging solution that can be brought to the bedside and is easily disinfected versus the need to wheel a patient through the hospital for other imaging, such as CT. We are seeing a need for premium imaging in a highly portable footprint.

Jeff Cohen: The pandemic accelerated the adoption of point-of-care ultrasound, or POCUS. Ultrasound has proven itself once again as a mobile, low-capital-intensive, versatile imaging modality. We have also seen a significant and prolonged impact on the use of cardiovascular ultrasound due to COVID-related heart disease. If anything, ultrasound will further develop, as it is now in the hands of new users who will help explore its applications.

Joan Toth: The pandemic has solidified ultrasound as a first-choice imaging modality at the point-of-care. Handheld and hand-carried portable units deliver rapid, efficient, and quality care at the patient’s bedside. Ultrasound plays a valuable role aiding in the diagnosis of patients presenting with suspected COVID-19 and in the ongoing management of care in patients confirmed with the virus. After all, molecular test results are not available in a timely manner, chest x-ray is a poor diagnostic test for the virus, and CT is impractical as a diagnostic test for all patients; therefore, lung ultrasound is established for the evaluation of acute respiratory failure and has been used during the pandemic as a vital decision support tool.

G. Wayne Moore: Without a doubt, the No.1 issue related to ultrasound equipment, especially probes, was the massive disruption of the worldwide supply chain. Ultrasound was an essential imaging modality to identify and monitor the progression of COVID-19 symptoms in the lungs of affected patients, impacting both patient management and treatment. There was a huge demand for POCUS ultrasound devices and probes to perform these examinations.

Ultrasound probes are designed and manufactured from major components of the probe, such as the connector, array, and cable that are made in up to six different countries. Shortages in cables and other parts were simply not available as these countries basically shut down during the pandemic. Original equipment manufacturers (OEMs) were forced to locate second-sources for these components—something that positively impacted Acertara’s probe repair business.

24×7: What are some of the hottest trends in the ultrasound equipment sector, and how are they influencing the design and development of such technologies?

Toth: As new users of POCUS continue to expand the market, the imaging modality now plays a ubiquitous role in multiple hospital departments and office settings. With such widespread use, the technology must keep pace with assisting the novice user. And with Konica Minolta’s SonImage HS2 Compact Ultrasound system, for instance, ease of use is addressed by system integrated education, a programmable keyboard, customizable pre-sets, measurement automation, and reproducible scans—powered by one-touch image optimization features.

With these technological advancements, ultrasound is used in a wide range of clinical applications. AI will ultimately have the largest effect on mitigating the ultrasound learning curve and AI-enabled systems will help expand its clinical utility.

Cohen: Integration of ultrasound in more pathways of clinical decision-making. It’s not only about the image alone anymore, but also what data can be distilled out of it. Artificial intelligence (AI) certainly helps there—with guided acquisitions, image quality improvements, and automated measurements.

The utility of ultrasound in combination with other clinical data sources into consolidated clinical views to help healthcare professionals make informed decisions is another trend. Remote connectivity and collaboration also recently became an important trend, accelerated by COVID-19 especially. Finally, the use of ultrasound in guiding interventional procedures continues to grow.

Moore: Incorporating AI into POCUS devices is very hot right now and will continue to be for some time. Using AI in POCUS devices allows them to be used by more frontline clinicians who may not be experts at ultrasound, but really need the diagnostic information provided. AI guides the non-expert healthcare provider through various ultrasound clinical applications.

Gannerkote: The most important influence on the design and development of ultrasound technologies is the customer. In talking and listening to customers, we have a better understanding of their needs, which drives innovation and solutions. Based on conversations with customers, we understand that the ever-increasing incidence of obesity affects the quality of ultrasound study. Therefore, addressing the technical challenges associated with this increasing trend is critical for the ultrasound industry.

Miller: One trend we are seeing is the growing need for data archiving, workflow, and reporting. Consistent POCUS clinical documentation allows providers to archive POCUS images in the PACS and in the patient’s electronic health record, allowing them to share images across the care continuum. Furthermore, POCUS can present administrative challenges for many providers, especially in fast-paced emergency settings inundated with COVID-19 patients, where it can be hard to capture POCUS billing information.

The industry is also seeing the demand of ultrasound guidance for peripheral IV access. Bedside ultrasound equipment allows clinicians to visualize veins they are unable to palpate due to depth or other comorbidities, and essentially guides them to where they should place the IV, thus reducing the number of sticks and complications. Ultrasound-guided peripheral IVs can be pivotal in an acute-care setting and can make significant impacts on patient safety, patient satisfaction, and cost reduction.

Lastly, we are beginning to see emergency medicine and critical-care clinicians incorporate transesophageal ultrasound into their practice for use during cardiac resuscitation. Physicians often encounter technical and physical limitations when using traditional transthoracic echo during the evaluation and resuscitation of critically ill patients. Transesophageal ultrasound, however, can provide the critical information needed to help guide physicians when trying to make life-or-death decisions during resuscitation.

24×7: What are the top dos and don’ts healthcare professionals should keep in mind when purchasing ultrasound devices?

Gannerkote: Of course, there are many factors to consider. Healthcare professionals must assess the imaging and performance requirements within the clinical area as well as aspects beyond the ultrasound system, such as clinical and service support.

For example, Siemens Healthineers Ultrasound has put significant efforts toward our Smart Remote Services (SRS). SRS allows our experts to connect with the medical equipment and user. Our customers are seeing higher than 80% faster incident resolution versus onsite visits, through this real-time remote assistance, diagnosis, and repair. With our eSieLink Remote Applications, our clinical team is even able to optimize settings and provide quick real-time support and training. Remote services, with faster issue resolution and assistance, ultimately leads to improved patient care.

Miller: One category of soft costs associated with POCUS equipment includes training and education. For example, how closely a manufacturer partners with a provider after delivering the imaging equipment makes a significant difference in the total cost of ownership. Users of the equipment need to be trained to develop the necessary expertise in handling the equipment. Other important factors healthcare professionals must consider when purchasing ultrasound systems include the system’s functionality, image clarity, and ease of use.

Toth: The first step in procuring an ultrasound system is to identify the needs of the hospital, clinic, or practice. However, future needs are often not considered. A common mistake is selecting a system that doesn’t grow with the practice. As procedures migrate from acute care to the ambulatory surgery center and office settings and as patient retention is paramount, choosing an ultrasound machine that delivers timely, safe, and cost-efficient patient care is the foundation on which to build an efficient POCUS workflow.

For example, beyond evaluating features and functionality, hospitals and practices should look at ultrasound systems that deliver excellent image quality in hard-to-image anatomies, such as deep joints in the shoulder or hips, and across populations including larger-sized patients. Further, for practices seeking to introduce or expand interventional services, choosing an ultrasound system that facilitates needle visualization and placement will support this growth.

Cohen: Do consider the ultrasound purchase in the context of your overall environment, including your EMR and PACS solutions, as well as your portfolio of imaging and ultrasound equipment. The ability of the device, even a handheld device, to fit into your workflows is often an [important] part of its value. Similarly, many of Philips’ customers with multiple systems find it important that the user experience is similar from system to system, to help reduce staff training time. Finally, the ability of the vendor to support your system over the long-term, with service, education, and ultimately upgrade programs is also important.

Moore: My advice? Involve the HTMs as early as possible in the buying process. Use their subject matter expertise in technical discussions related to post-warranty servicing and lifecycle costs.

24×7: What best practices should HTM professionals adhere to when servicing, maintaining, handling, and repairing ultrasound devices—and ultrasound probes, in particular?

Moore: Work with the ultrasound OEM as a partner, get trained, and only work with third-party vendors who are ISO 13485:2016 certified with a scope that fits your needs.

Miller: It’s critical that healthcare providers partner with a vendor who helps with training and support to ensure their employees are using and caring for the equipment correctly. It’s also necessary that the staff members are following the cleaning protocols and specifications supplied by the vendor. There are many different cleaning solutions on the market, including some that can damage the transducers, making it crucial that the employees are following the manufacturer’s guidelines. Lastly, I recommend that the medical facility works closely with a manufacturer who has best-in-class warranties and service contracts.

Gannerkote: When transducers are revised or changed using methods or materials outside of OEM specifications, there are potential impacts to image quality and subsequent clinical outcomes. For instance, use of materials that are not the original OEM array and lens material for a repair may cause the transducer to not perform to its fullest potential and diagnostic performance.

Aligned with American Institute of Ultrasound in Medicine guidelines, we agree that the quality of an ultrasound image is highly dependent upon the quality of the transducer used to acquire the image. And since the OEM developed the technology, an OEM is the best entity to provide recommendations to maintain an optimal image. Therefore, it is important for a healthcare provider or equipment service provider to work directly with the OEM to ensure that they’re following OEM specifications for care and use of their transducer and system.

Toth: Purchasing equipment from a company with a strong service innovation team is key. For Konica Minolta, customer support is not just about fixing equipment when it breaks. We drive customer satisfaction by supporting customers when their ultrasound systems are working perfectly. For this day-to-day added value support, Konica Minolta provides Blue Moon Life-cycle Solutions, designed to minimize downtime, maximize productivity, and eliminate risk throughout the system lifetime.

Moreover, ultrasound probes are delicate devices that are generally handheld during exams and [touch] the patient. Three primary use and maintenance issues should be considered for most POCUS environments.

  1. Clean probes properly between uses. Make sure manufacturer-approved cleaners and disinfectants are used on the probes as some cleaners can damage some probe materials.
  2. Invest in annual preventive maintenance (PM) visits. As the handheld probes can get bumped and knocked around a bit, make sure that they and the entire system are in calibration and good working order. A properly performed PM by a trained engineer makes sure the units are working as expected.
  3. Be prepared for unforeseen circumstances. Ultrasound probes can be dropped and damaged. This type of damage is not generally covered by warranties and extended warranties, which can lead to significant unanticipated expenses. Manufacturers or distributors often offer accidental damage coverage, usually as part of a comprehensive service offering, that can really ease the financial pain of accidental probe damage. Either budget for accidents or sign up for an appropriate level service contract to address this uncertainty.

24×7: Anything else 24×7 Magazine readers should know about the ultrasounddevice sector?

Cohen: Ultrasound continues to be one of the most powerful and versatile modalities to cost effectively diagnose disease. And there is still a tremendous runway in the development of ultrasound solutions for patients and caregivers.

Gannerkote: We are particularly excited about the possibilities for care with innovative ultrasound technology in settings that may not otherwise have been enabled access to high-quality imaging—and for the exciting potential new technologies such as Siemens’ 4D Volume ICE catheters, which is the first of its kind in the industry, will offer going forward.

Miller: At Fujifilm Sonosite, we like to refer to POCUS as the Swiss army knife of healthcare, given that it is a multifaceted device, and its many benefits cannot be denied. POCUS has emerged as a valuable technology when it comes to the diagnosis and management of critical care patients—which was highlighted most recently during the darkest days of the COVID-19 pandemic. Many providers relied on lung ultrasound to assess respiratory failure in COVID-19 patients. Additionally, multi‐organ POCUS, including lung ultrasound and focused cardiac ultrasound as a clinical adjunct, played a significant role in the triaging, diagnosis, and medical management of COVID‐19 patients.

It’s difficult to find another modality that can assist clinicians in so many different medical specialties. However, before purchasing POCUS equipment, medical facilities and HTM professionals should partner with a manufacturer that is committed to service, support, and product quality to ensure the best possible care is being offered to their surrounding communities.

Moore: Ultrasound is an exciting imaging sector to be in. Its clinical utility is ever-expanding—and the opportunities for qualified service personnel are huge.