With in-depth software control, the new ultrasound systems create a cleaner, crisper picture that often rivals those of CT, and even MR.
Ultrasound remains the most versatile imaging modality with an expansion of clinical applications spreading throughout the care facility. Ultrasound is present in more departments than any other non-disposable technology. Over the past decade, the equipment has seen tremendous innovations and technological improvements in imaging quality, resulting in ultrasound images that often rival those of CT, and even MR. This has made ultrasound a legitimate imaging tool in a variety of new applications. Two excellent examples of this include cardiac studies and breast cancer screenings. As ultrasound images continue to improve, there will be growth as the modality offers a more advanced, noninvasive imaging option that does not utilize radiation.
At the same time, ease of use has also improved significantly and the costs have decreased. Ultrasound has become available at almost every price point and size. There are systems available at the premium level, the introductory level, and even handheld and now tablet size systems. Newer technologies such as gesture-detecting transducers – activated by touch – aim to reduce injury and enhance workflow; and reduction of keystrokes facilitates the speed of an examination, but also reduces the strain on the user.
Auto machine learning and AI are automating routine and tedious tasks, allowing users more time to focus on diagnosis and the patient. Software is becoming a bigger and bigger part of these systems. Years ago, it was not uncommon to have 20 or more circuit boards in a system; some of the latest systems have less than half of that now. With the in-depth software control, the new systems can create a cleaner, crisper picture.
Indian market dynamics
In 2017, Indian ultrasound equipment market is estimated at Rs 1310 crore, an 8 percent increase over Rs 1212 crore clocked in 2016. While the premium, very expensive machines saw a decline in market share, all the other segments including high-end, mid-end, entry level, and portable machines gained market share. The B/W are gradually losing share, and are only procured by small clinics, which do the preliminary test and then if required, refer the patient to a nearby diagnostic center for further investigation.
Customer preference is shifting toward high-end technology and high quality imaging for better clinical diagnosis. The market for intraoperative ultrasound (IOUS) is rapidly growing and these ultrasound machines are preferred for various clinical scenarios like robotic surgeries, oncology, surgical gastro applications etc. Hospitals prefer dedicated IOUS machines that are compatible with common disinfectant methods, for safe use in the operating room. The market for high-end portable ultrasound too is seeing rapid growth because of preferences for high technology machines with superior image quality and easy workflow features like touch screen display monitors and high end probes.
The two largest segments for ultrasound tests conducted in 2017 were OB/GYN and radiology. Radiology was the first area to use ultrasound equipment intensively. Due to the large number of important applications, cardiology has also become a traditional setting for the use of ultrasound devices.
Some customers in 2017 include the Apollo chain of hospitals; AIIMS; PGI, Chandigarh; North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong; Sanjay Gandhi Postgraduate Institute of
Medical Sciences (SGPGI), Lucknow; Tamil Nadu Medical Services Corporation Limited (TNMSC); Govt. of Karnataka; KIMS Hospitals, Hyderabad; Amrita Institute of Medical Sciences, Kochi; Dr Mukund Joshi, Mumbai; and RP Scans, Chennai.
GE maintains its leadership by far. Other leading brands in India continue to be Philips, Mindray, and Samsung. Also aggressive in this segment are Siemens, Trivitron (Aloka and Hitachi), Esaote, Sonosite, Toshiba, BPL, and Sonoscape. Recently, Cura Healthcare has forayed into the business of ultrasound equipment devices.
The past couple of years have seen remarkable technological advancements hit the market. These innovations have not only made scanning easier for the end-users, but have taken image resolutions to the next level. With the advent of touch screens, man and machine interactions have become seamless and efficient. The new gesture control touch panels on some ultrasound systems have taken this touch interface one step further. Machines can now be controlled with gestures. Machine control becomes easier and scanning becomes more enjoyable.
Vendors have also introduced elastography, which improves ultrasound’s specificity by utilizing conventional ultrasound imaging to measure the compressibility and mechanical properties of a lesion. Since cancerous tumors tend to be stiffer than surrounding healthy tissue or cysts, a more compressible lesion on elastography is less likely to be malignant. Elastography can properly identify lesions that appear to be malignant on a biopsy, as well as lesions that are benign. Elastography also can be more accurate in gauging the size of the lesions.
Ultrasound systems have made several advances over the years with many more uses in the hospital setting. Enhancements in traditional ultrasound include contrast imaging, volume imaging, and elastography allowing physicians to image blood perfusion and blood flow, view real-time 3D imaging of structures, and differentiate malignant tumors from benign, among other applications.
Mobile ultrasound probe. It is becoming an increasingly disruptive technology for the entire medical imaging industry. A wired or wireless probe can now display an ultrasound image on most off-the-shelf tablets or even smartphones. Image processing has come a long way allowing for the smaller, more mobile stand-alone probe to challenge its predecessor with the larger systems in most aspects including 3D and 4D imaging. The market has been picking up slowly as more and more skeptical providers are embracing portable systems. The technology has the potential to save the medical industry billions of dollars in healthcare cost as a portable probe is only a fraction of what the large cart-based system costs.
PoC ultrasound. Point-of-care ultrasound (PoCUS), while not exposing the patient to radiation, may facilitate early diagnosis and minimize the need for delay in management of patients with major health issues. There have been continual advances in PoCUS technology. This is helping to reduce hospital and patient expenses by decreasing costs to the health system and the time required for diagnosis and treatment. Because hand-carried POC systems are so much smaller than conventional cart-based systems – and because mountable POC machines have a zero footprint in locations where space is at a premium – PoCUS has also found its way into remote corners of the world where funds, facilities, and space are limited.
Image quality. The quality of image has improved exponentially in recent years with the addition of high definition also known as 4K resolution to monitors and LCD displays. Progressive p resolution has been proven to be faster, provide a clearer picture, and be less prone to blurring therefore allowing radiologists/cardiologists to calculate a much more defined diagnosis. The majority of advances came in miniaturization. A lot of systems became smaller and more compact and come with algorithms that help in image quality as well.
Transducer technology. There is a greater commitment to transducer innovations that allow clinicians to easily assess technically difficult patients, such as young children or individuals who are overweight. For instance, Philips’ PureWavetechnology is specifically designed to allow deep penetration and excellent resolution on all patients, even those who are traditionally harder to image. These portable devices improve the accessibility of ultrasound while streamlining diagnostic processes and improving quality of care for patients. This has led to wider adoption by a variety of providers who may not traditionally have used ultrasound, including nurses, midwives, and emergency medicine and critical care professionals.
AI and automation. The new systems feature capabilities such as precision imaging, differential tissue harmonics, and advanced dynamic flow. The systems are more intelligent than ever before, and that helps users to be more confident. Manufacturers are also introducing elements of artificial intelligence (AI) algorithms into their cardiac ultrasound systems to speed automation. It takes a 3D echo dataset acquisition and automatically analyzes the image to identify the heart’s anatomy, labels it, and then slices the optimal standard views for presentation. Other vendors also have introduced elements of deep learning algorithms to help analyze echocardiograms or perform auto quantifications. Next-generation echo systems will incorporate more AI features to further improve workflow by auto-completing time-consuming tasks and augmenting the sonographer so they can become more efficient and consistently accurate.
The pace of innovation in ultrasound continues to offer tremendous improvements to the benefit of clinicians and patients alike. When properly directed toward outcomes that benefit patients, clinicians, and health systems, ultrasound products and technologies can make a real difference in patient care. By focusing attention on ultrasound advancements, this will make a difference for the clinician and ultimately, the patient. These advancements may be as simple as gaining access to world-class ultrasound at an affordable price, or could be as groundbreaking as providing AI-derived diagnostic guidance based on clinician-curated datasets from ultrasound researchers all over the world. Ultrasound portability allows it to be available to
the masses and deliver outstanding imaging detail and diagnostic capabilities, with a small learning curve and reasonable cost.
In years past, there has always been a trade-off between system size and image quality. When purchasing a small, portable system, the user always had to sacrifice a little image quality for the portability factor. Over the next few years, it is expected that systems will continue to shrink and decrease the trade-off when comparing system size to image quality. In addition, continued advancements in automation and quantification; use of artificial intelligence to make ultrasound a more objective and intelligent solution that is accessible to more and more people; advances in processing capabilities, image and data sharing, and virtual education will play a role in their adoption. As the technology continues to evolve, the numbers show it is changing the game and poised to become the dominant technology in the field of medical imaging, globally across the board.