In the new age of health care innovation, the ultrasound platform has transitioned from traditional hardware systems comprising mostly technological components to complex software-driven devices powered by PCs. This transition has dramatically changed the way we service ultrasound equipment, train our clinical engineers, and approach our relationships with IT.
Now more than ever, a good capital equipment planning strategy for ultrasound can help prevent costly repairs and extend the life of equipment. It involves preparation, preparedness, and prevention. Let’s take a look at how you start to incorporate best practices in your department in this new technological context.
The first step is understanding what equipment you have in inventory. Many times facilities don’t really understand their ultrasound inventory. It is too often categorized by manufacturer and not by system type, even though one unit may be very different from another made by the same company.
Auditing your inventory should not be limited to counting machines and equipment or gaining basic knowledge about the ultrasound platform. The goal should also be to gain more knowledge. Ultrasound units are no longer just boards that develop images, but high-end computer- and software-based units that communicate across various networks and talk to other devices. We need to be able to deal with that complexity. Basic knowledge of ultrasound today is important, but it only gives you a foundation for ultrasound use and service. System-specific knowledge is necessary to fully service today’s ultrasound units.
Preparedness is not the same as preparation. It is a matter of building awareness versus doing the groundwork. It is about getting ready for the failure that may never occur. Doing the tasks that put you into a state of preparedness takes dedication, because you are not fixing something, you are only getting ready to fix something. Preparedness means understanding how things function and gathering information before you ever have to use it.
This is the area of greatest change in ultrasound service. Preparedness encompasses the tasks that need to be done before the machine has a failure, so that when it does fail you are prepared. So what are the tasks of preparedness? They can vary with different ultrasound units, but they fall into the same basic overall categories, as follows.
Presets. Equipment-specific information often includes options, user presets, networking data, protocol information, and calculation data. In years past, systems were not as customizable as they are today. Not having presets was painful, but they could be recovered with work. But today’s units often have thousands of pages of customizable data; with no preset data, repairs are impossible without contacting the OEM. The OEM can get you back up and running, but you won’t have the preset data. Moreover, it can take days and significant expense just to get the unit functioning. This data is certainly needed after a software load, but is also often loaded back on its own to resolve basic corruption issues, or for the user who accidentally changes or deletes a setting. Having preset disks current and up to date means 10 to 15 minutes to get back up and running rather than days of downtime. This may seem simple (and it is), but at least once a month we get a call from a hospital that does not have the presets saved, and there is nothing we can do to help.
Software. Do you have a plan for reloading software? Have you obtained your units’ software? Getting it in an emergency is not generally an easy task. Software should be ready and available for reloading, if necessary. If the manufacturer does not provide the software, you can create a copy of the unit’s hard drive to serve as a backup. Then, if the system fails, the hard drive can be inserted and you can have the machine up and running in an hour. This can take approximately 1 to 2 hours per machine, but it has a very high success rate. And remember that any time you touch a system’s hard drive, you risk damaging it—so either work with a service provider or make sure you are properly trained.
Network Design. Having a network design for all your ultrasound units is paramount. To map out your network design, go to each machine and identify its IP address, username, application entity title, and port number. Also, find out what devices it sends information to or gets information from. It isn’t important how you document this information, but make sure that the appropriate people have access to the documentation. Typically, either the biomedical engineer or an ultrasound technologist will take the lead role in this effort, or they may work together. The process should take only 15 to 20 minutes per unit. Having the network design available when a machine goes down or loses settings helps keep downtime to a minimum, reduces spending or extra costs on service calls, and also makes for a smoother, less stressful repair.
IT Partnership. A facility’s IT team can be integral to the maintenance of ultrasound equipment. The key to a good working relationship with IT is to have a clear delineation of where the biomed team’s responsibilities end and the IT department’s begins. This will ensure that repairs are easier and less stressful for everyone. For example, suppose you urgently need an IP address to repair a unit. The last thing you want to do is to call a help desk to open a ticket. Having a direct contact in the IT department can result in a solution in a matter of minutes rather than hours.
Prevention. Prevention can mean the difference between a $500 repair and a $28,000 replacement. Moreover, it can help keep your facility in compliance and maintain positive patient outcomes. Effective prevention involves three main areas of focus: preventive maintenance, phantom imaging, and accreditation.
Preventative maintenance (PM). Many of the elements of preparedness described above are involved in a good PM program. PM is an opportunity not only to verify the unit, but also to be sure you know the unit and are prepared for its failure.
Phantom Imaging. This strategy is used as a quality assurance (QA) tool in checking the imaging ability of a transducer and ultrasound unit. There are various types of phantoms (most only check 2D imaging), but they all work in basically the same manner; which one you select will have more to do with durability than imaging. The best phantoms to use are tissue-mimicking types that provide vertical and horizontal pins for measurement and have black-cyst and contrast targets.
As with ultrasound scanning, the effectiveness of phantom imaging depends on the user. If your scanning skills are poor, phantom imaging will not perform well. Although it is a good PM tool, it should not be relied upon for troubleshooting purposes.
Accreditation. In recent years, the accreditation societies have started raising their standards for ultrasound PM and QA. There are three major players in the arena, and they all have their own rules:
The American College of Radiology (ACR) generally applies to radiology, OB/Gyn, breast, and specialty applications and has typically been the toughest standard to meet. If you design your PMs around ACR rules, then you will meet the other accreditations as well. In order to satisfy ACR standards, you must do two PMs per year on all ultrasound equipment. The PMs must include some sort of QA procedure, such as phantom imaging.
The other two organizations, the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) and of Vascular Testing (ICAVL), are owned by the same parent company. They only require one PM per year, and their rules tend to be less stringent than ACR’s. In 2010, ICAEL began requiring the use of phantom imaging, and we anticipate ICAVL will require it soon.
When it comes to accreditation, make sure you are always reviewing each organization’s most recent requirements, which you can generally find online.
The Bottom Line
Modern ultrasound systems incorporate high-end computers and need to be handled accordingly. If our training and knowledge do not reflect the ongoing shift in ultrasound to software-driven technology, we will become very frustrated. What’s worse, our downtime will increase, expenses will rise, and patient safety and data may be put at risk.
Clinical engineers are skilled and talented. However, if they were not trained in computers and computer networking, it is not a skill they can pick up quickly or on their own. Biomeds and engineers need proper training and service tools, which involve basic ultrasound knowledge complemented by formal training in computer and networking technology. Only then can they meet the demands of today’s ultrasound service and repair
Hobie Sears is senior sales service manager at Axess Ultrasound, Indianapolis. In addition to servicing ultrasound units from various manufacturers, he teaches ultrasound system courses at Axess and is co-chair of the company’s council on technical instruction and writing. For more information, contact [email protected]