Ultrasound On An Upward Trajectory

Ultrasound On An Upward Trajectory

The expanding use of ultrasound across many medical specialties is ensuring that the market remains on an upward trajectory.

Over the years, the diagnostic imaging capabilities of ultrasound have spread across all clinical applications, from obstetrics and gynecology, orthopedics and cardiology, to emergency medicine, prostate cancer, and breast cancer detection. 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/or health systems, ultrasound products and technologies can make a real difference in patient care. The speed, efficacy, cost-effectiveness and noninvasive nature of ultrasound imaging are some of the key attributes that have given this technology an edge over other imaging modalities. In addition, ultrasound equipment is economical; even the most advanced ultrasound systems cost only about one-fifth of the price for a low-end magnetic resonance imaging (MRI) system.

Technology innovation in the area of diagnostic ultrasound imaging has been quite dynamic. Solutions considered high-end 2 years ago are currently considered mid-range, or even in some cases, considered low-end options. This trend has resulted in a high level of competitiveness in the area of technology among manufacturers of ultrasound equipment, forcing them to constantly add innovative features to their existing products. 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.

Indian market

The Indian ultrasound equipment market in 2018 is estimated at Rs 1361 crore.

GE continued to dominate the market. Philips and Mindray were neck-to-neck at about 14 percent market share each. This year, Mindray gained ground with the launch of its premium Reasona series. It received huge orders from Directorate General of Health Services, Bihar Medical Services, and Gujarat Municipal Corporation, apart from the corporate chain of hospitals. Samsung continued to retain its share. Siemens was also aggressive in this segment in 2018. Sonosite continued to be number one in the portable range of ultrasound equipment. Toshiba, Aloka, Cura, Esaote, and SonoScape were the other prominent players.

Application was primarily in radiology and obstetrics and gynecology, which had a combined share of 77 percent. Cardiovascular ultrasound is also a popular technique with Indian physicians.

The Indian ultrasound market is forecast to grow at a double-digit rate in 2019, buoyed by the government’s efforts to expand healthcare coverage, increasing private sector spending on healthcare and a growing medical tourism industry. Government spending on healthcare has also upped its allotted spending by 22 percent. As India’s population continues to surge the long-term ultrasound market seems promising.

Global market

The global ultrasound market is projected to reach USD 8.4 billion by 2023 from USD 6.3 billion in 2018, at a CAGR of 5.9 percent.

The color ultrasound devices segment is expected to grow at the highest CAGR over the next 5 years owing to the benefits offered by these devices, such as better image quality and higher image resolution. Also, the growing availability of advanced color ultrasound devices, coupled with the continuous decline in product cost across major countries and expanding distribution networks of major manufacturers across emerging countries, are expected to support the growth of this market segment during 2018–2023.

In 2018, the trolley/cart-based ultrasound systems segment is expected to account for the largest market share due to the growing adoption of these systems across major markets (as a result of their increasing use in emergency care and acute care settings in hospitals and healthcare institutions).

In 2018, Europe is expected to account for the largest share of the global ultrasound market. This can be attributed to the large number of ongoing clinical research projects in the field of ultrasound, expansions in the clinical applications of focused ultrasound (and the early commercialization of these devices in Europe), and the significant healthcare expenditure across mature European countries (such as Germany, France, the UK, Italy, and Spain).

The Asia-Pacific market is estimated to grow at the highest CAGR majorly due to the increasing healthcare expenditure across the region’s major countries (especially India and China), growing public awareness about the therapeutic potential of ultrasound technologies, continuous decrease in device costs (due to growing localized manufacturing and the presence of global market players), rising prevalence of target diseases, and the ongoing trend of device miniaturization.

Factors such as the increasing prevalence of target diseases; rising patient preference for minimally invasive procedures; technological advancements; increasing number of diagnostic centers and hospitals; and growing public and private investments, funding, and grants are driving the growth of the global ultrasound market. However, stringent government regulations may restrict the growth of this market to a certain extent in the coming years.

What to look for when purchasing an ultrasound system

When purchasing new equipment, the focus should be on image quality, proper diagnosis, and improved outcomes for patients. First and foremost, does the new system meet or fill a need clinically? Does it improve patient outcomes or fill a gap clinically? What is the maintenance cost going to be? Is the system reliable? Is it a brand-new system on the market? Will there be bugs in a new platform one need to be concerned about? How are software upgrades managed? Is the new platform sustainable (the model upgradable to newer hardware functions as new clinical applications emerge)?

When evaluating ultrasound technology, consider how the equipment will advance, grow or scale as business needs change and evolve. Do they offer living technology? Understanding how living technology is provided versus software patches is key to maintaining state-of-the-art performance. With the equipment warranty and support offerings during the life cycle, a few companies are now offering 5-year warranties that can also cover maintenance items like batteries and transducer damage.

Look for a reputable company that will deliver on what it promises and that also provides outstanding customer service before and after the sale. Facilities should also ensure that the company they work with has a quality management system in place so the buyer can be confident in the quality of the product they purchase. Lastly, it is essential to discuss the total cost of ownership in regards to the ultrasound system so that the buyer understands the long-term financial ramifications revolving around the purchase as well as any service needs after the initial investment.

While pricing is a key factor, value adds such as field service engineers, technical support, training, transducer repair and parts should factor in the decision. ISO 13485 certification ensures that the provider is invested and committed to the highest standards of quality and service.

Will the vendor provide service training? Will they make their training manuals available? How do they handle software upgrades when the service is being performed by in-house or third-party servicers? The basic question around parts is availability. Does the vendor have adequate parts and probe supplies? Can they delivery parts/probes next day? What are their warranty terms and warranty rates?

One of the most important factors facilities should look for is a service provider that has experienced, local engineers. This enables them to respond to needs thoroughly and quickly, which limits machine downtime. Also, consumers should verify that the service company has a quality management system in place to assure that all parts are tested and of the highest quality. Another recommendation would be to check with local references to garner personal feedback and get firsthand accounts of the company in question.

Pros and cons of new and refurbished ultrasound systems

New equipment has the latest and greatest technology and features that comes with a higher price. New equipment rushed to market can lead to software and hardware issues that could result in unwanted downtime. Refurbished equipment offers leading edge technology and features at a much lower cost to acquire. The age of the refurbished equipment can lead to parts availability issues due to end-of-life protocols by the manufacturers.

From a practical standpoint there is little difference today in refurbished or new systems of the same model. New platforms that add substantial new technologies and features are a different story. If facilities want or need new clinical applications that their current system does not have, or want improved imaging, doppler, etc. – and again, their current system cannot be upgraded – then new is the way to go. If one wants to add a system or more to their existing inventory and want to use the same model, then refurbished is a great way to go as one will save cost and get the added capacity they may need.

Technological advancements over the next few years

The industry will continue to see advancements in automation, quantification, and the use of artificial intelligence (AI) to make ultrasound a more objective and intelligent solution that is accessible to more and more people around the globe. Continued advances in processing capabilities, image and data sharing, and virtual education will play a role. Biggest potential is expected to lie in precision health—combining ultrasound information with other markers (e.g. genetic) and processed with the power of AI/big data technologies. These results could lead to substantially refined and individualized screening, diagnostic, and treatment results—ultimately, improved outcomes. Additionally, market will see ultrasound expanding beyond diagnostics and being used in more interventional procedures and even for treatment.

New technologies such as gesture-detecting transducers — activated by touch—aim to reduce injury and enhance workflow. 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. Experts also see a continued expansion of the diagnostic power of ultrasound in terms of applications.

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. The difference is the amount of processing that the backend of these systems [can now do]. With the in-depth software control, the new systems can create a cleaner, crisper picture.

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, experts expect to see systems continue to shrink and decrease the trade off when comparing system size to image quality.

Over the past decade, the quality of images produced by ultrasound equipment vastly improved. 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. In both applications, ultrasound now offers vivid, color images—all taken with no dose of radiation.

Ultrasound continues to gain traction as an alternative to angiograms in cardiology, and believed to see greater use over mammograms in detecting breast cancer. 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. This not only helps limit the amount of radiation patients are exposed to, but also limits imaging technicians’ exposure.

Challenges affecting the ultrasound sector

One of the big challenges in ultrasound is variability: patient variability, system variability, and user variability. Clinicians are challenged with imaging different sized patients with consistency and clarity. Manufacturers continue to innovate their products to grow the clinical efficacy of their systems. As ultrasound systems continue to improve in both image quality and advanced functionalities, their use is expanding into a broader range of clinical applications.

With more and more new ultrasound users, training and education remains primary challenges—particularly in emerging markets. The industry often participates and helps to coordinate ultrasound education in a traditional sense, and augmenting those activities with virtual education will continue to open up ultrasound as a viable technology for clinicians in these markets. Another challenge is related to AI, as the industry needs access to data to train algorithms to ultimately drive better outcomes for patients and clinicians. There is an increased interest in data-sharing agreements, opt-in patient agreements, and traditional research agreements that will help advance the technology while protecting patient data.

In addition, ultrasound procedures are often far more time-consuming than other imaging modalities. For example, while it may take only minutes to capture the required images with a CT scan, an ultrasound could take up to 30 minutes, if not longer. Because of the time ultrasound procedures require, the modality does not provide the return per appointment that other procedures offer. Despite longer procedures, ultrasound is potentially safer than other imaging methods because it does not utilize any form of radiation. It is crucial to educate imaging technicians, doctors, and insurance companies on the impact of over-radiating patients and increase awareness of the long-term side effects of excessive radiation exposure.

Way forward

Ultrasound is used by a myriad of imaging technologists because it is considered practical, safe, fast and easy to utilize. Industry insiders foresee continued advancements in ultrasound toward cost-effective solutions that do not compromise high-quality imaging. Ultrasound will become even more automated, mobile, definitive, and intuitive for users, making it an indispensable everyday tool for patient diagnosis and care.

“Ultrasound in specialty segments like urology, robotic surgery, surgical oncology, surgical castro, neurosurgery surgery, etc are seeing tremendous growth and are being adopted by enterprise and super specialty hospitals at a rapid pace. High end segment is expected to see major growth this year primarily because of the migration of mid-end customers. Mid-end and value segments are expected to grow nominally.Applications like contrast ultrasound, and RAPID (Rapid Assessment Prostate Imaging and Diagnosis) are gaining prominence.”

Brahadeesh M
President – Imaging,
Trivitron Healthcare

Industry Speak
Transforming Point-Of-Care Ultrasound With Technology And Innovation

Fujifilm SonoSite India has been committed to providing innovative and reliable cutting edge compact ultrasound solutions that have been aiming to foster better healthcare across the country. Our product portfolios are a blend of vital customer insight, experience, and clinical expertise that together address and empower the healthcare professionals in elevating patient care benchmarks in India.

The SonoSite Edge II and SII ultrasound system offer an enhanced imaging experience through industry-first transducer innovations like DirectClear and Armored Cable Technology.And, because it is a SonoSite, the Edge II and SII stays true to our design pillars of durability, reliability, and ease of use. Moreover, it comes with an industry leading standard 5-year warranty.

DirectClear: A new generation of SonoSite transducer technology. With DirectClear technology, the company now offers transducers with higher performance that maintains our industry-leading durability. The technology combines several new design features for significant performance improvement. Compared to the previous generation of transducers; tests have shown an increase of up to 30 percent in penetration and resolution with these new additions. DirectClear technology is available on several transducers across the SonoSite point-of-care ultrasound portfolio.

Armored cable technology. In high traffic environments, it is a simple fact that transducer cables will be rolled over, stepped on, twisted, and shut in doors. These everyday occurrences can easily damage an average transducer cable, and lead to reduced image quality. We saw this as a problem: products need to stand up to the environments that they are built for.

So, we developed a system for manufacturing superior, more durable transducer cables. SonoSite’s Armored Cable Technology surrounds transducer wiring with an embedded metal jacket, protecting it from common use/abuse scenarios. SonoSite transducers can resist drop damage, roll-over breakage, and even deterioration from harsh medical cleaners and disinfectants.

Nitin Gupta
Country Manager,
Fujifilm SonoSite – India

Second Opinion
Latest Trends In Equipment Upgrading

The spectrum of uses of ultrasound has grown exponentially off late and so has patient population. Market trends in ultrasound equipment because of advancement in technology have to keep pace with this growth. We have already experienced volume rendering, increased computational technology, contrast enhancement, and enhanced image reconstruction which has improved patient care. Now manufacturers are focusing on expanding ultrasound use in radiology with even better applications which are faster, have high fidelity transmission, and excellent resolution with one touch image optimization to decrease scan time. The machines are getting lighter and are more compact, so take less space. They can easily be wheeled next to patients.

Specific transducers, no longer limited to just 2D imaging, have expanded to cover women imaging, urology, interventional procedures, pediatric patients, cardiology, and the spectrum is ever increasing just as the variation in probe frequency is resulting in more exams more quickly. Portable hand held units packed into smaller devices with long battery backup and wireless probes have eased use in emergency medicine. Elastography earlier used only for liver and available in convex probes, has expanded to include thyroid, prostate, breast, pancreas, cervix, intra-abdominal organs, which means that now linier, intracavitary probes are also carrying this technology.

Contrast ultrasound software is now incorporated in high-end machines for enhanced detection of lesions and this has opened a new door and inspired scientists to explore the potential for functional imaging like PET if the contrast agents and isotopes can be integrated. Internet connectivity with wi-fi incorporation in machines is the latest trend and is a very efficacious and fast way for providing service by remote accessibility. Regular updating is easier and if different devices and modalities are linked using this technology, one can imagine the excellence in reporting! Image transfer using wi-fi is so fast that as soon as the examination is complete, the images are available to doctors, even remotely.

Artificial intelligence (AI) has already made way in almost all fields of medicine including diagnostics because of its better analytics, accuracy, and precision. Soon this technology is going to be applied to ultrasound as well. Marketing trends are expected to see growth in software and hardware manufacturing and then integrating algorithms and developing machines in near future, which can be so advanced that they may enable virtual tissue sampling in malignancy and tumor behavior.

Dr Vivek Sharma
Senior Consultant in Radiology,
Medanta – The Medicity


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