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Ultrasound Equipment

Seeing the unseen

New systems are likely to integrate the novel technology into ultrasound. The increased role of AI and miniaturization of ultrasound will be a game-changer for radiology.

From screening and diagnosis to treatment guidance and assessment, it is impossible to imagine healthcare without medical imaging. What would have been perceived as miraculous a century ago is taken for granted today, with peering into the smallest vessels, watching the brain at work, observing fetal development, and virtually travelling through the digestive system. Physicians can both pinpoint tiny tumors, image the entire body at once, and perform image-guided surgery without major incisions.

Medical imaging professionals who appreciate the power of diagnostic images to guide care decisions and delivery are also aware of where imaging falls short. In image acquisition, there is often a wide gap between those expert operators, who can reliably acquire pristine images, and those who struggle with consistency. In interpretation, radiologists can unlock all sorts of information from an imaging study, yet non-diagnostic studies still occur, and images are not as accessible for non-radiologists. And around the world, many patients lack access to the imaging they need.

Ultrasound has made progress in addressing its traditional weaknesses in operator dependency and image quality, and retains its advantages in affordability, portability, and lack of ionizing radiation.

Ultrasound is historically one of the most operator-dependent medical devices. An experienced, expert technologist can coax remarkably clear images from a transducer, while a less experienced user might be unable to get diagnostic images from the best equipment. But today, advances in artificial intelligence (AI), automation, and live collaboration have countered this traditional challenge, making ultrasound now easier to use than ever.

After an exam, AI can check the quality of the resulting images. This capability gives technologists immediate feedback, helping to promote confidence in their technique, and helping to prevent callbacks.

In addition, AI enables automated measurements for a variety of applications, including abdominal, cardiac, breast, and fetal imaging. For example, 3D imaging combines with new technology to provide user-independent measurements of abdominal aortic aneurysms. Removing potential variability from this important measurement is critical when managing aneurysm progression.

AI also brings new efficiency to all aspects of post-processing, including choosing the best images for diagnosis, color-coding anatomy, and voice-recognition technology. Automation partners with AI to increase consistency regardless of operator, while also reducing repetitive tasks. Technology that automatically optimizes gain and TGC assures that optimal images are achieved in 2D, 3D, or 4D.

Consistent imaging can help physicians assess severity of disease, plan treatment, and compare exams over time. All these advances also can increase staff satisfaction by freeing up staff time for their most challenging clinical assessments, and allowing technologists to focus their expertise and energy on the patient.

In the past, ultrasound’s low-contrast resolution limited its application. While cost and convenience made it a common first modality, often imaging using other modalities was required for diagnostic certainty.

The development of advanced imaging modes, including harmonic imaging, spatial compounding, and tissue aberration correction reduce artifacts and enhance contrast resolution, enabling ultrasound to deliver new insights across anatomies and applications.

Today, ultrasound systems quantify liver fat, aid in detecting breast cancer that mammography may miss in women with dense breasts, deliver photo-realistic views, change the lighting source to backlight anatomical structures, and image blood flow in small vessels to check for cancer or inflammation or to assess perfusion, to name just a few examples.

Advances also enable system operators to support diagnostic certainty by accessing expertise remotely. With recent advances, ultrasound operators can connect with experts quickly and securely from the ultrasound system and receive guidance and support via Windows, Chrome, iOS, or Android devices.

The future promises to further expand applications, driven by new methods that provide exceptional penetration at high frequencies, increasing the number of patients who can be diagnosed with the support of ultrasound imaging; higher temporal resolution and frame rates that are expanding the use of ultrasound in interventions; and 3D imaging that brings value to new care areas. Vascular surgeons can now see an ultrasound image that reflects the anatomy they see in their minds, cementing a place for ultrasound in procedural planning and guidance that may have future applications in other areas.

The Indian ultrasound market, over the next two years is poised to see the high-end segment constitute maximum share. While buyer preferences are moving from premium to high-end models, the mid- and entry-level customers are also either upgrading or replacing their systems in favor of high-end models. And manufacturers, in response, are launching high-end models.

The market in 2021 is estimated at ₹1450 crore, by value. In line with the distinct shift from the mid- and entry-level machines to the more superior models, the market saw a 29.46-percent increase by value over 2020, with a miniscule increase in units procured. And yet, the premium models were side-lined in favor of the high-end ones. The market estimate includes the refurbished machines, a ₹45-crore segment in 2020. Portable machines continued to gain popularity. The black-and-white models are seeing demand shrinking, with buying restricted by selected government facilities or for veterinary use.

Indian ultrasound equipment market
Major vendors* – 2021
Tier I Tier II Tier III Tier IV Others
GE Philips Mindray & Samsung Sonoscape, FUJIFILM Sonosite, BPL, bionet, Trivitron, and Toshiba Konica and Esaote
*Vendors are placed in different tiers on the basis of their sales contribution to the overall revenues of the Indian ultrasound equipment market.
ADI Media Research

By type the cart/trolley-based machines continued to dominate with 81.45-percent share, and the balance 18.55-percent was contributed by the compact machines.

GE continues to dominate this market with a huge lead over Philips, the next in the chain. Mindray and Samsung are neck-to-neck and in 2021 closed the gap with Philips. While Mindray made inroads into referral centers, Samsung’s cardiovascular ultrasound machines did well, and the brand continued with its efforts to shift the users’ perception of being a premium brand. BPL, Sonoscape, Trivitron (Hitachi and SonoRad), bionet and Sonosite are aggressive players. Other brands that have presence include Esaote and Konica, and some Chinese brands. Following the completion of FujiFilm Corporation’s acquisition of Hitachi Ltd.’s diagnostic imaging business, Hitachi has changed its name to FujiFilm Healthcare Americas Corporation, effective July 1, 2021.

The buyers that made a difference and contributed to the huge growth were either the referral centers, with the key opinion leaders (KOLs) being sought for their interpretation skills, or the fresh graduate doctors. To name a few referral center buyers in 2021, Thane Ultra Sound Centre, Thane West, Thane, Mumbai; The-Ria-Clinic, Gamdevi, Mumbai; MediScan Systems, Mylapore, Chennai; and Abhishek Scanning Centre, Begumpet, Hyderabad.

The corporate hospital chains that had stayed away in 2021 are expected to make their procurements in 2022, albeit an 18–20 percent increase in the market is not expected. GE’s acquisition of December 21, 2021, of BK Medical, and how the company’s active imaging technology is accepted by the Indian market will be interesting to watch. Currently, GenWorks markets the company’s products in Tier-II and Tier-III cities while the GE team focuses on Tier-I cities. Also, with the Government e-Marketplace (GeM), the online procurement platform for government bodies, now making it mandatory for sellers to mention the country of origin, while registering all new products, a move seen as an attempt by the government to restrict products made in China, may also have an impact on brand shares.

The global ultrasound equipment market is projected to grow from USD 7.8 billion in 2021 to USD 12.93 billion in 2028 at a CAGR of 7.5 percent in the 2021–2028 period. Due to the increasing adoption of advanced imaging systems in healthcare industry, ultrasound systems continue to be irreplaceable. In view of the rising healthcare costs, affordable and accurate imaging; diagnosis achieved through ultrasound technology will continue to attract patients, and render profits even in conventional medical settings.

Recent advancements in this technology and introduction of innovative equipment, along with the developing healthcare facilities in emerging countries, have influenced market players to develop easily operable devices. Additionally, the growing prevalence of chronic diseases and expansion of applications of these systems are some of the major factors anticipated to propel the growth of the market in coming years.

GE Healthcare, Koninklijke Philips N.V., and Canon Inc. accounted for a dominant share of the global market in 2021. Also, a few major players are utilizing the opportunities generated by the outbreak of Covid-19 pandemic in order to further strengthen their market position.

For instance, in June 2021, Wipro GE Healthcare has enhanced its local capability to manufacture a wide range of Versana products in India. This is a part of the company’s strategy to expand localization and strengthen the supplier ecosystem. The Versana ultrasound range is part of the company’s affordable product portfolio, and are manufactured at its state-of-the-art facility in Kadugodi, Bengaluru.

In August 2020, Koninklijke Philips N.V. launched a new dedicated cardiovascular system called the Affinity CVx at the annual meeting of the European Society of Cardiology (ESC).

Other players, such as Hitachi, Siemens Healthcare, Samsung Medison Co., Ltd., and Esaote are constantly focusing on introducing new systems with advanced technologies in the market.

Doctors urge expanded use of ultrasound contrast agents; patients benefit from broader use of UCAs to enhance diagnostic ultrasound exams. Ultrasound experts urged the healthcare community to work to expand utilization of ultrasound contrast agents (UCAs) in order to offer patients broader access to low-cost, safe, and reliable diagnostic imaging.

UCAs are currently approved for imaging the heart and liver in adult and pediatric patients, and additionally for imaging the urinary tract of pediatric patients. UCAs are versatile imaging agents that also are useful for imaging tumors and organ systems throughout the body, including the kidney, bowel, breast, pancreas, prostate, and carotid arteries. After decades of safe and routine use of UCAs in modern medical centers around the world, it is clear that adult and pediatric patients benefit from broader use of UCAs to enhance diagnostic ultrasound exams. A single intravenous injection of a UCA will show multiple organs throughout the body, and several organs may be involved with the same pathology.

Contrast-enhanced ultrasound (CEUS) is a radiation-free imaging technique that is often equivalent or superior to more expensive imaging tools like MR or CT. CEUS also allows for dynamic and repeat examinations, is highly effective for monitoring a patient’s response to therapy, and unlike MRI and CT, it can be used in patients with kidney failure or allergy to iodinated contrast agents used in CT. CEUS is a dynamic, real time scanning tool that offers a highly reliable method of imaging all soft tissue tumors in the abdomen and pelvis, and allows physicians to identify, characterize, and stage tumors of the liver, kidney, prostate, breast, and other organ systems.

POCUS utility on the rise amidst Covid-19

Hitesh Singh
Sr. Product & Marketing Manager,
FUJIFILM Sonosite India Pvt. Ltd.

Today, we live in an era of rapid technological advancements, and as newer diagnostic imaging modalities have emerged, the traditional physical examination has become less central to the clinical assessment of patients. Point-of-care ultrasound (POCUS) imaging, performed and interpreted by a treating clinician at the bedside, has emerged as a versatile tool that can augment the diagnostic accuracy of the traditional bedside assessment of patients. These devices not just help in reducing costs to the health system but also reduce the time required for diagnosis and decision making. The POCUS systems are much smaller, compact, and can be easily mobilized as compared to the conventional bulky cart-based systems, for quick bedside patient examination, and new mountable touchscreen systems with zero footprint can easily fit in the space-constraint rooms.

Point-of-care ultrasound is like a Swiss Army knife which has been widely embraced by intensivists, E-Med physicians, cardiologists, and anesthesiologists, and nowadays it has additionally permeated an array of other clinical specialties, such as pain management, nephrology, pediatrics, interventional radiology, surgery, and many more.

POCUS is playing a significant role amidst Covid-19 pandemic, especially when it comes to providing physicians with a sterile, quicker, and more effective way to diagnose Covid-19 patients. This technology requires fewer specialists as compared to a traditional imaging techniques, which can lead to less PPE being utilized throughout the hospital.

Nowadays, medical practitioners are well accepting the small and mobile devices that enable them to take instant diagnostic decisions and streamline all other steps in a patient-care process by using bedside ultrasonography. They prefer sanitizable ultrasound equipment in operation theaters and ICU settings for infection control (patient safety) during surgeries and invasive procedures. Dynamic imaging, precision-based clinical visualization, and real-time analysis are some of the other benefits that POCUS offers as a bundle.

Moving ahead, the rising prevalence of chronic diseases, the growing aging population, rise in healthcare expenditure, technology advances, and increasing awareness about portable devices will drive the growth of ultrasound segment. Factors that could impact the growth in the future include regulatory challenges, counterfeit products, and protracted Covid-19 pandemic.

It is clear that CEUS can play a pivotal role in accurately diagnosing cardiovascular disease, and broader approvals for these agents would align with standards of care that are well established throughout the world.

Two-thirds of the world’s population lack access to basic medical imaging technology, causing preventable and sometimes fatal delays in diagnosis and treatment, according to World Health Organization.

For many, access is limited simply because diagnostic imaging systems are often expensive and stationary, and transportation is inconvenient and limited. Patient in a rural location and the subsistence farmer in a developing country have the same challenge – imaging systems are only in large hospitals many miles from their homes. Ultrasound’s greatest contribution in the future may lie in innovation that brings imaging to new locations.

Even within a hospital, it can be difficult to bring very ill patients to the imaging department. During the ongoing Covid pandemic, physicians are using ultrasound imaging for bedside diagnosis to avoid transporting patients to imaging departments.

In fact, wireless transducers make it possible to leave the system itself outside the room, decreasing opportunities for cross-contamination. The use of ultrasound as a bedside imaging modality is likely to continue even when the pandemic is over.

Ultrasound is also appearing more frequently outside the hospital, in doctors’ offices. In the future, as ease of use increases, primary care physicians may reach for a multi-application transducer just as they reach for a blood pressure cuff, and perform a quick imaging study to determine if a patient should be referred to a specialist.

New collaborative tools bridge the gap between operators and expertise so that ultrasound can be used in remote locations and for underserved populations. In some locations, the cost of systems is a barrier to widespread use. Simpler systems, in which access to powerful off-system processing is available through the cloud, may enable healthcare systems and governments to place ultrasound systems in a greater number of locations.

Already today, a transducer paired with a mobile device can convert a smartphone into an ultrasound system, combining two-way audio-visual calls with live ultrasound streaming.

Regardless of how far ultrasonography has progressed, the sector continually faces fresh marvels.

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