A Glance at Latest Advances in Ultrasound

The ultrasound market is largely driven by innovations in underlying technologies and more sophisticated software algorithms, which allow manufacturers to offer smaller, more powerful, and complex systems.

Ultrasound is currently the most cost-effective, noninvasive diagnostic radiological modality, devoid of the harmful effects of radiation. Over the last few years, ultrasound systems have witnessed a blizzard of developments in their underlying technology. This has catalyzed a significant change in the patterns of ultrasound usage vis-a-vis other, older imaging modalities, especially in terms of concerns about the latter – for example, radiation risk in X-rays and computer tomography (CT), and cost for both CT and magnetic resonance imaging (MRI).

One significant development has been the commercialization of handheld miniaturized devices that offer advanced computational power. This trend has been adopted by more diagnostic ultrasound manufacturers with the introduction of portable, hand-carried systems. Facilitating the growth of handheld units has been the evolution of wireless probes, which allow care givers to carry ultrasound into any part of a hospital, physician’s office, or elsewhere. Owing to such innovations, ultrasound has the ability to quickly image internal organs without being hampered by cables or moving bulky machines around in a patient’s room. This capability of ultrasound can improve not just the point-of-care (PoC) at hospitals, but also the public’s access to medical imaging. Vendors additionally are working to improve compact ultrasound systems for use in tight premium spaces within hospitals, such as in the OR.

The ultrasound market is largely driven by innovations in underlying technologies and more sophisticated software algorithms, which allow manufacturers to offer smaller, more powerful, and complex systems. Key developments include acceleration in processing speed and enhancement in the quality of diagnostic images – coupled with advances in contrast-enhanced imaging and precision in the timing of image capture. This has been accompanied by a sharp reduction in noise-to-signal ratios in the final data to optimize spatial, contrast, and temporal resolution, including rotatable views for better visualization. The Indian market is thus predicted to grow at a double-digit rate in 2018, buoyed by the government’s efforts to expand healthcare coverage, increasing private sector spending on healthcare, and a growing medical tourism industry. With the country’s population predicted to surpass that of China’s around 2024, the longer-term prospects for the Indian ultrasound market are also encouraging.

Technological Advances
New technologies are improving the competitiveness of ultrasound. Speckle reduction, volumetric imaging, and elastography make it possible to reduce artifacts, improve the contrast of an image, reduce image noise, and better gauge tissue stiffness to detect subtle hard-to-spot abnormalities. These technologies increase ultrasound’s accuracy, repeatability, and efficiency, and help keep the modality competitive with other cross-sectional imaging modalities. Enhancements to ultrasound also include contrast-enhanced imaging.

PoC ultrasound. Ultrasound images today are available with far-higher resolutions than in the early 2000s, when most physicians were used to pictures being fuzzy. Superior image quality along with ease-of-use lower cost ultrasound units has driven ultrasound to the point-of-care (PoC) setting – both for diagnostic and interventional procedures. PoC ultrasound has the potential to save billions of dollars on an annual basis across health systems. It has the capacity to revolutionize patient care and improve procedural efficacy, decrease complications, and limit pain and suffering.

Developments in transducers, beam formation. Ultrasound has also made quantum leaps in factors such as transducer sensitivity and beam formation. For example, line-by-line imaging in beam formers has been replaced in some systems by large zone acquisitions, allowing users to view examinations in grayscale and color Doppler. Meanwhile, retrospective imaging makes it possible to process raw data multiple times, while retention of channel domain data allows for patient-specific imaging. Because of all the above, clinicians are able to use ultrasound to image blood perfusion and blood flow in vessels with diameters of 2 mm and less, with small vessel beds displayed via Doppler flow false-color 3D or grayscale reconstructions.

Mobility and ergonomics. Ergonomics and mobility are being addressed by vendors in order to differentiate their systems and grow user volumes. New-generation ultrasound systems stand out in terms of design. Most are noiseless to permit sonographers to minimize distraction and focus on the exam, with settings customized and organized depending on clinical preferences. Some have slanted bodies to prevent users hitting their knees or feet on the machine, with keyboards that can be raised or lowered depending on user height, probes that are shaped to the human palm, and rotatable LCD monitors for sharing the display with colleagues. Other innovations include the possibility of use in both sitting and standing positions, with memory features to accommodate different users. Some recent ultrasound machines have tablet-sized touchscreen-based interfaces, which significantly reduces the reach and steps in order to start and complete an exam. This enables faster workflow. Touchscreens allow users to tap in order to start functions, pinch and drag to zoom in and out, and swipe to expand the image.

Miniaturization. There is an increase in the use of ultrasound as an alternative to CT and MRI in many PoC settings. One of the reasons for the trend is mobility as well as increasing miniaturization. Smaller ultrasound machines provide solutions to concerns about cables or wheeling bulky machines around patient rooms, and address tight space demands in key hospital settings such as the operating room. Compact models can be transported by being wheeled or atop a cart.

3D/4D imaging. While 2-D continues to be widely used in clinical applications, recent technological advances such as matrix transducers have been enabling factors and triggered interest in 3D and 4D ultrasound. 3D/4D ultrasound has a more rapid acquisition rate of datasets and subsequent improved image visualization. Leading imaging vendors already offer 4D imaging products – across all modalities, PET/CT, MRI, and ultrasound. However, 4D ultrasound is capturing a great deal of interest in applications where ultrasound has already made a case for itself, due to cost, mobility, or radiation concerns.

AI. Some vendors have launched artificial intelligence (AI) systems to enhance speed and automatically take image volume data from 3D echo to recreate optimized diagnostic views. In cardiac echo in particular, the result offers major potential by permitting reproducibility of imaging. Nevertheless, such cutting-edge technologies are still in their infancy. Only time and user experience will determine their eventual success.

The Future
With rapid technological advancement, the newer matrix array transducers are smaller than the previous generations allowing a small footprint access over areas of narrow window availability. Wireless transducers are now available for use in select cases. Devices compatible with tablets are being developed. The trend is only expected to grow in the future. The challenge will no longer be to develop smaller, more affordable ultrasound technology. Instead, it will be processing, transferring, and storing the massive amounts of data that the ubiquitous equipment produces. Limitations will arise in terms of the number of radiologists and other doctors who can decipher meaningful information from this vast data. However, in the future this will also drive toward more automation in diagnosis and standardization of analysis. The possibilities are vast, but, more importantly, the impact that innovations can have on improving the quality of life and saving human lives is significant.