Bending the Cost Curve

Ultrasound is more accessible than ever; the utility of ultrasound extends across the entire continuum of care and has become fundamental to providing cost-effective care for patients around the world. The past decade has witnessed significant developments in ultrasound technologies, ranging from regular upgradations in portable devices and wireless transducers to 3-D/4-D ultrasound imaging, and artificial intelligence. Researchers and scientists are endeavoring on developing technologies that simplify diagnostic procedures, improve efficiency of clinicians, and enhance image quality. These research and development activities focus on improving overall quality of patient care. In addition, manufacturers are placing emphasis on implementing automation in premium-tier systems, portable devices, and point-of-care (POC) solutions. The prime focus of vendors is on offering cost-effective devices, in the backdrop of growing innovation and competition in the global industry.

Technology Trends
Ultrasound has seen increasing concerns regarding overexposure to radiation by conventional systems, including computed tomography (CT). The trend of using smart fusion technologies, i.e., acquiring images using a combination of ultrasound and MRI, for interventional and therapeutic applications is also gaining momentum. Technological advancements are shaping the ultrasonic device industry.

Anatomically Intelligent Ultrasound. Clinicians face issues in reproduction of images in echocardiography, as results vary based on the sonographer’s experience and techniques used. This issue was addressed with the introduction of artificial intelligence software, Anatomically Intelligent Ultrasound (AIUS). The software collects image volume data with the help of 3-D echo and an optimal version of diagnostic views is created. Quantification measurements are computed from the 3-D dataset and clinicians can carry out assessment of diseases and explore treatment options with highly reproducible images. AIUS also helps in saving time by obtaining dimensions three to six times faster as compared to manual methods. Advances in artificial intelligence technology help clinicians in workflow enhancement.

POC Ultrasound Solutions. Ultrasound has become ubiquitous in point-of-care (POC) solutions to determine and diagnose vascular and cardiac issues. Innovation in ultrasound devices has given rise to handheld, portable devices that are cost effective and save time for patients as well as clinicians.

There continues to be controversy surrounding the use of small hand-held or pocket-sized ultrasound systems. Opponents of hand-held ultrasound (HHU) systems are concerned that its supporters are trying to replace the stethoscope, which is traditionally used during a physical exam. Proponents of the hand-held systems stress the importance of using HHU in conjunction with the stethoscope and physical exam.

Aside from the cost difference between an HHU system, there are many pros and cons to be considered when adopting this technology.

HHU can offer rapid assessment in emergent and critical care situations for shock, chest wall trauma, and various other emergent issues. Supporters state that early diagnosis equates to quicker treatment and consequently a decrease in mortality rates. By using a noninvasive ultrasound device instead of chest X-rays, it is possible to limit the patient’s exposure to radiation, as well as decrease the overall cost associated with assessing the patient in the emergency department.

The limited amount of user training was mentioned as a concern by those opposed to using HHU systems. Another concern was the lack of direct reimbursement for the use of HHU. These systems lack continuous wave Doppler capabilities, and not all systems allow for storage of images. Therefore, they do not meet the billing criteria for a limited echocardiogram study.

Proponents referenced various studies that have been conducted involving the use of HHU and noted these systems reduced time to diagnosis, reduced costs involved, and provided reliable assessments. These results add to an ever-growing body of evidence that HHU systems are a clinical tool that can improve the quality of healthcare delivered when combined with a physical exam.

3-D/4-D Ultrasound Technologies. Availability of better visualization owing to advancements in 3-D and 4-D ultrasound technologies helped gynecologists to determine congenital birth defects. The images offered by 3-D/4-D ultrasound aid in detecting defects better as compared to images delivered by 2-D ultrasound systems. So, congenital birth defects such as spina bifida, cleft palate, and others are easy to detect and conduct diagnostic procedures. Different tools are available in 3-D technologies, such as multi-planar display, which helps in rendering orthogonal views for fetal brain and cavities. In addition, it also helps gynecologists to view a baby’s face, hands, and other features through surface rendering and determine genetic syndromes. Maximum intensity projection is another tool that assists clinicians to view structures of bone, including skull or vertebra, more distinctively, whereas thick slice scanning helps them to visualize toes, fingers, and anomalies like cleft palate better. 3-D inversion mode is helpful in examining fluid-filled structures, including brain ventricles or fetal stomach.

Benefits of 3-D and 4-D ultrasound technologies, such as practical, easy-to-use, safe, and shorter exam time give ultrasound a new life and increased relevance in medical imaging.

Following the emergence of technologies and inclination of manufacturers toward innovation, the ultrasound equipment will improve quality of patient care, enhance productivity of clinicians, and transform medical imaging.

Way Forward
Industry insiders foresee continued advancements in ultrasound toward cost-effective solutions that do not compromise high-quality imaging. In future, ultrasound will become even more automated, mobile, definitive, and intuitive for users, making it an indispensable everyday tool for patient diagnosis and care.