Hand-carried ultrasound market finds new legs

Image quality and improved ease of use characterize latest technologies appearing on RSNA exhibit floor

The early dream of a sonographic equivalent to the stethoscope is finally beginning to take shape. The emergency department, operating room, intensive care unit, rural and remote sites, and physician's offices-all are being equipped with lightweight scanning units that may change the practice of medicine. In short, ultrasound is going places. It's getting there later than innovators would have liked but faster than traditionalists believed possible.

In some hospitals, the proportion of hand-carried and portable ultrasound systems has increased dramatically, rising from 1% or 2% to as high as 10% in the last few years, said Lars Shaw, vice president of marketing for Zonare Medical Systems of Mountain View, CA.

The market for ultracompact systems is about $300 million, less than 10% of the nearly $4 billion ultrasound market worldwide, according to Terri Bresenham, vice president and general manager of diagnostic ultrasound and IT for GE Healthcare. But she expects it to grow about 55% this year.

Ultrasound companies that specialize in compact systems are seeing double-digit increases in sales. SonoSite, the first to introduce hand-carried sonographic systems in 1999, posted total worldwide revenues of $39.5 million in the second quarter of 2006 compared with $33.5 million for the second quarter of 2005, an increase of 18%. In the U.S., sales increased by 19% in the second quarter to $20.2 million. Internationally, sales rose by 17% to $19.3 million.

With a product that bridges the gap between hand-carried ultrasound and small cart-based systems, Zonare tripled the number of installations of its z.one convertible systems in the first six months of 2006. GE's growth in global ultrasound sales, which topped $671 million in 2005, a 15% increase over 2004, was due in no small measure to the expansion of the hand-carried sector, according to Bresenham.

The rise of the hand-carried segment centers on two groups of customers, she said. Traditional ultrasound users are turning to compact or hand-carried products because smaller units allow them to visit remote or mobile imaging settings and to navigate in and around the tightest spaces: labor and delivery and intensive care units. New users welcome hand-carried ultrasound in the hospital's interventional suite or operating room to serve as a visualization tool and guide the performance of biopsies or ablations or the placement of central venous lines. Hand-carried systems are also beginning to take root in private physicians' offices.

To respond to the needs of traditional users, GE introduced the i series of high-end compact products, concentrating on image quality and advanced, specialized applications. The Vivid i, which was launched in 2005, incorporates many of the same features of the Vivid console line, including a user interface and reporting tools specifically geared for cardiac imaging.

The 4D handheld Voluson i system, introduced earlier this year, is designed for obstetrics and gynecology imaging inside and outside the hospital. The laptop-sized system can be toted from the physician's office to a rural site to bring high-level imaging directly to the patient or transported to a delivery room to monitor high-risk patients during labor.

"Perinatologists see high-risk patients in their offices and do their monitoring on a full-blown console," Bresenham said. "Instead of having a lower end ultrasound system in the labor and delivery area, they can take in a Voluson i and get volumetric information that is no different from what they had in their office. Because it's portable, the Voluson i is not disruptive to the workflow of labor and delivery."

GE expects to unveil the newest addition to its Logiq line of compact products for the general radiology community at the 2006 RSNA meeting. The Logiq i will give traditional users the image quality of high-end ultrasound systems and the diagnostic information they have wanted, according to Bresenham.

Image quality is what Nelson Patterson, global director of customer marketing for SonoSite, calls table stakes. It is a fundamental aspect of mainstream ultrasound systems and a necessity for users of the technology who lack top skills in image interpretation.

"People are looking for a machine that gives high image quality, so they don't have to go back to school to learn how to use the system," Patterson said.

SonoSite will show at the RSNA meeting the fourth upgrade to its high-performance MicroMaxx hand-carried ultrasound system, designed to optimize image quality by reducing speckle and background noise.

In addition to a steady increase in image quality, companies are addressing the needs of new ultrasound users by focusing on ease of use and durability. These are particularly important for equipment designed for environments where ultrasound seldom treads.

GE's Logiq e, which the company brought to market earlier this year, is intended to help emergency department physicians and surgeons make quick "go or no-go" decisions by streamlining operations and workflow. GE will feature the Logiq e at the RSNA meeting.

How a handheld product is designed affects where it can be used, Patterson said. Protecting the keyboard from fluids allows use of SonoSite hand-carried units in the emergency department, angiography suite, or operating room. Hand-carried products with angled and beveled edges can be used at the point of care without concern about damage from bumps or drops, said Tom Dugan, senior vice president for global marketing and sales at SonoSite.

"Having a wireless capability also dramatically changes the way users think about handheld ultrasound, because they can complete an exam at the bedside, send the image wirelessly, and wait while someone else reads the scan and decides whether another view is needed," he said.

The upgrade being shown by SonoSite at the RSNA meeting enhances its wireless data management option by increasing the rate of data transmission and improving the encryption standard in keeping with the Health Insurance Portability and Accountability Act, Patterson said.

Zonare is addressing the emergency and critical care sector by offering a two-in-one system: a small 160-pound cart-based system that houses a removable 5.5-pound Scan Engine. At less than half the weight of some standard cart-based systems, the z.one SuperCart is maneuverable and easy to position at a patient's bedside, and the Scan Engine can be popped out to complete scanning no matter how tight the space is, according to Shaw.

"We've found that most of our customers didn't want to do 10 studies a day on a tiny little handheld unit that didn't have a big user interface," he said. "That's the reason we made the system convertible. So whenever you have to go to a patient's bedside, you have a 160-pound system that's easy to push around. Then when you need to reach across the patient or across the bed, you just pop out the Scan Engine."

The z.one ultrasound system is operating at more than 300 sites worldwide. It capitalizes on the company's proprietary zone sonography technology, which acquires images in large zones and saves them in software. Without a bulky hardware beamformer, the z.one system is small and light, well below the customary 15-pound limit for handheld ultrasound units.

At the RSNA meeting, Zonare will show an automatic optimization option that allows even novices to quickly obtain sharp ultrasound images, Shaw said. The company will exhibit five new transducers, a new cart that has a standard monitor and full keyboard but is smaller in size, and a wireless-ready Scan Engine.

Boston-based Terason is targeting new ultrasound applications in interventional radiology and other forms of image-guided intervention and surgery as well as conventional pediatric ultrasound and imaging of the breast, vasculature, and heart. The company, which released its first product in 2001, markets a laptop imaging unit that can be converted from a portable to a cart-based system. The Terason t3000 has a custom-designed integrated ultrasound chip and a 256-channel processor.

Medison offers advanced ultrasound capabilities, such as 3D, harmonic and trapezoidal imaging, and color and power Doppler, in a unit the size of a briefcase.

While console ultrasound systems have been steadily shrinking in size, it was the introduction of handheld systems that opened up new clinical avenues for the technology.

"The handheld part of this made everybody aware that you could do imaging at the bedside that you never thought you could," Shaw said. "Now there are physicians and nurses using ultrasound regularly who never thought about using ultrasound before."