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Roundtable: Ultrasound

Ultrasound devices are important tools when it comes to delivering quality healthcare. TechNation reached out to experts in the field to find out more about ultrasound devices and probes.

Tue Jul 01 2014By TechNation Magazine

Roundtable: Ultrasound
 
 
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Ultrasound devices are important tools when it comes to delivering quality healthcare. TechNation reached out to experts in the field to find out more about ultrasound devices and probes.

Members of the TechNation panel for this roundtable discussion are Robert Broschart, director of technical services for Axess Ultrasound LLC; G. Wayne Moore, FASE, president and CEO of Acertara Acoustic Laboratories; Hobie Sears, senior sales service manager at Trisonics Inc.; James “Jim” Carr, director of service and international operations at Advanced Ultrasound Electronics; Lawrence Nguyen, CEO of Summit Imaging; Matt Tomory, vice president of sales, marketing and training for Conquest Imaging; and Drew Brown, Director of Operations at GMI. Here is what we found out.

Q What are the latest advances or significant changes in ultrasound probes in the past few years?

 

roundtable 11 Roundtable: Ultrasound

Matt Tomory Vice President of Sales, Marketing and Training for Conquest Imaging

Broschart: The greatest change has been in the use of single crystal technology. This has increased the bandwidth and number of active “elements” that can be used. A dramatic increase in image quality has resulted from this technology.

Moore: In terms of array materials recent advances made using single crystal arrays, 2D matrix arrays, and the progress being made with cMUT and pMUT technologies are all at the forefront. In terms of electronic advances in ultrasound probes, it would be that more ASICs and other integrated circuit technologies are migrating into the design of the acoustic stack and away from the front-end of the ultrasound system. Additionally, new commercially available wireless probe technology obviates the need for a cabled connection between the probe and the ultrasound unit, a major component of probe cost.

Sears: The OEMs all have their own names and new concepts in transducer development over these last few years. The real take-away from this is that transducer design is at the forefront of ultrasound development. It will continue beyond single crystal and matrix technology possibly pushing into CMUT or other yet to be developed technologies. What is important is strategic planning to deal with the higher cost of these transducers and technology as it relates to the cost of ownership.

Carr: The biggest advance in transducer design has been the so-called single crystal probes that are “grown” with thousands of individual elements and are capable of producing volumetric 4D (real-time 3D) images in multiple planes. The essentially perfect homogeneity of the piezoelectric elements can be used to create a significantly better 2D image, as well. These are replacing the mechanical 4D probes that could be seen as a new advance, but are really a rebirth of the old “wobbler” probe technology used before electronic phased array probes were viable.

Nguyen: The latest and most exciting advancement in ultrasound transducer technology is the added capability of live 3-D imaging during Transesophageal Echocardiogram (TEE) studies. These new TEE transducers utilize complex matrix arrays to obtain significantly more data than standard phased arrays. This allows clinicians to scan and view the human heart with live 3D image data to quickly provide more comprehensive data to better diagnose patients.

Tomory: Probe technology has evolved in several areas recently. Manufacturers have developed a process to grow transducer crystals that are homogenous at the atomic level. These probes allow for greater frequency bandwidth and improve image quality. Another development is the wireless transducer by Siemens. These probes are the beginning of what I see to be remote ultrasound scanning where the scan takes place at one location and is processed at another. The other development is the maturing of the matrix array transducers. These probes have thousands of elements and are used for 2D, 3D and 4D imaging. The advantage of these with 3D/4D imaging is they are solid state with no motors, oils and are smaller and lighter than ever.

Brown: The significant increase in the use of multiplexing and sparse array technology.

Q How will recent ultrasound probe advances impact the ultrasound market in the future? How will they impact the maintenance of probes and ultrasound devices?

 

roundtable 2 Roundtable: Ultrasound

Robert Broschart Director of Technical Services for Axess Ultrasound LLC

Broschart: The probe technology has allowed ultrasound to move into markets previously thought impossible for ultrasound – oncology, podiatry, MSK, etc. More patients can now be scanned effectively with ultrasound thus increasing patient care. In terms of probe maintenance, with the new technology, it has become paramount that proper and accurate testing be performed. If we cannot test these new probes, then we cannot hope to properly repair them.

Moore: Ultrasound continues to narrow the gap in clinical imaging performance with both CT and standard MRI for several clinical applications and that should keep the ultrasound market growing at a faster pace than the other “heavy-metal” modalities. Lastly, ultrasound is more easily and economically deployed into more clinical environments and is more versatile in both applications and configurability. Probes are becoming more complex and more expensive, so the number of companies with the technological sophistication to test and repair them will trim down.

Sears: Ultrasound is likely to continue to grow into new areas of imaging with new transducer developments. This may create niche fields with specialized transducer development. It will be up to each facility to decide if those new studies and niche fields are right for them. Specialty transducers are going to be more expensive to maintain and may require specific training, these cost should be part of the discussion for the facility. It is clear that the new developments in transducer technology will require new tools and test devices for major repairs. Some of these devices have become recently available; others will need to be developed. However, the best strategy for maintenance is one of education on care and handling of transducers. Experienced ultrasound service engineers are the best ambassadors to get that discussion going in departments that use ultrasound.

Carr: The matrix array or single crystal designs have provided capability to do faster and earlier diagnosis of many anomalies, and the research on ways to use this exciting technology is still in the infant stages. However, these complex probes are exacerbating an already large problem in the industry; the ability to test a transducer and system to assure the clinical efficacy of the diagnostic results. A white paper published over 10 years ago revealed that just two dead elements or channels next to each other caused the Doppler measurement and results to be incorrect. There is no test equipment or diagnostics available today that can detect just two dead elements on even a 128-element probe, let alone one that might have 9,600 elements! The manufacturers have taken out or restricted access to any diagnostics that might help us determine if the probe and system are working properly. I believe that regulation may be necessary to protect patients if companies can’t provide tools capable of testing these highly complex systems in order to have confidence in the clinical results.

Nguyen: Multi-dimensional technology enables clinical technicians to accelerate the image capture and improve the diagnosis by utilizing comprehensive 4-dimensional data that reduce anomalies. Live 3D TEE transducer failures become significantly more difficult to service because the damage from electrical shorts become more catastrophic due to its higher power and smaller form factor. A quality transducer service provider will be able to yield higher repair success rates from these complex devices which will help lower the total cost of ownership of the device. The alternative is a replacement at a much higher cost. Hospital administrators will want to ensure they are working with a reputable and well-trained team of ultrasound support technicians who can repair beyond the component level. This will provide the highest probability of repair success and lower the total cost of support by up to 97 percent relative to OEM replacements.

Tomory: These new technologies add to the diagnostic quality of ultrasound systems but also the cost initially. Independent organizations are developing repair capabilities for these new generation probes but usually are a few steps behind so the cost of maintenance will be higher than conventional probes. Once a technology has been out for a year or so, the market does catch up and the cost is usually driven down by increased supply.

Brown: Image quality continues to improve, but it is also driving up the cost of maintenance. Many of the new multiplexing and sparse array technologies are designed so that they cannot be repaired completely and they also have a shorter average life span than more traditional transducers.

Read the full article on the Juy 2014 issue of TechNation

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