SonoSite launches new flagship onto medical seas

The ultrasound market in the U.S. stumbled last year, with the exception of hand-carried systems. Sales of ultrasound units were flat in 2004, but demand for handheld systems grew in the double digits, according to industry sources. The physicians driving those sales included not only radiologists but relative newcomers to the ultrasound fold such as surgeons and emergency room physicians.

This trend continues with the launch of MicroMaxx, SonoSite's third-generation hand-carried product. The ultraportable system, which began shipping this summer, weighs less than 8 pounds and is the size of a laptop computer. But it delivers image resolution and performance comparable to conventional cart-based ultrasound systems weighing over 200 pounds.

"The larger cart-based units have more bells and whistles, but for our purposes, the MicroMaxx has been very acceptable," said Dr. John Lipman, director of the center for minimally invasive services at Windy Hill Hospital in Atlanta, GA, who shares the MicroMaxx with diagnostic radiologists.

"We decided on the MicroMaxx because it satisfies interventional and diagnostic needs. It has the horsepower and the quality of a bigger machine, and it has portability," Lipman said.

The architecture of the new product offers improved core performance in 2D imaging, as well as color flow and spectral Doppler, compared with the company's previous high-end system, said Jeremy Wiggins, SonoSite director of product management. The previous generation system, called Titan, is now being pitched primarily to office-based physicians, particularly ob/gyns.

In developing MicroMaxx, SonoSite applied its proprietary Chip Fusion technology to incorporate multiple ultrasound functions onto individual application-specific integrated circuits. The product's 128-channel beamformer works with four such chips, each about the size of a postage stamp.

These ASICS boost functionality while conserving space and power, allowing MicroMaxx to boot up in less than 10 seconds and to continue operating on battery power for up to four hours. The broadband digital beamformer built into the MicroMaxx supports transducers that deliver expanded performance. The system can store video clips of exams and export them using DICOM to image management systems.

As an option, MicroMaxx offers embedded SonoCalc IMT (intima media thickness) software for early detection and management of cardiovascular disease. The software measures the interior lining of the common carotid artery, allowing detection of subclinical atherosclerosis.

All this power comes at a price. Fully configured, MicroMaxx sells for $65,000, about $25,000 more than Titan. Some of this cost, however, is for peripherals that only a few customers may need, such as a transducer for transesophageal echo. Choosing a basic configuration reduces the price tag to about $45,000, Wiggins said.

Some users, including Dr. Robert Worthington-Kirsch, an interventional radiologist at Image Guided Surgery Associates in Philadelphia, have very specific needs. Each month, Kirsch performs more than 20 arterial embolizations for uterine fibroids and treats a dozen patients for varicose veins. MicroMaxx provides the guidance and mapping he needs to plan and conduct those procedures. The small size and light weight of the unit are critically important.

"Portability is a huge advantage for me," said Kirsch, who elected to buy the system himself rather than use cart-based equipment at Roxborough Memorial Hospital in Philadelphia, where he is on staff.

"In our hospital, the ultrasound department and angiography suite are on different floors," he said. "If I am doing a procedure that needs ultrasound guidance, I just bring my own machine from the office, rather than going through the hassle of bringing a machine down from ultrasound."

MicroMaxx, like its predecessors, is designed for the real world, which may involve being banged into doors or dropped on the floor.

MicroMaxx is so resistant to everyday hazards that the company offers a five-year warranty. The product's solid-state construction and reduced number of components enable the company to offer the added value, Wiggins said.

The company maintains that MicroMaxx can meet the requirements of ultrasound's major established markets: radiology, cardiology, vascular imaging, and ob/gyn. But many early adopters work in surgery, interventional radiology, and emergency medicine.

Such expansion beyond the typical practice of ultrasound was the company's core mission when it was founded seven years ago. The goal was to make its hand-carried units the ultrasound equivalent of the stethoscope, ubiquitous and irreplaceable throughout medicine. The adoption of hand-carried units by primary-care physicians was a key element of this strategy. This strategy failed to take root, however, as cart-based systems were needed to verify and investigate suspicious findings that handheld units revealed.

MicroMaxx overcomes this shortcoming, according to the company. The system, which can be used to render definitive diagnoses, may be particularly helpful for portable exams. The extension of these systems into other niches, such as surgery, may also have an impact on radiology.

Dr. Deanna J. Attai, chair of surgery at Glendale Memorial Hospital and Health Center in Glendale, CA, previously used the SonoSite 180 to guide core breast biopsies of suspicious lesions referred to her by primary-care physicians after an abnormal mammogram. Shortcomings of the early-generation handheld unit led her to refer the more challenging cases to radiologists, but MicroMaxx has brought those cases within her purview.

Maintaining control of the patient is a key consideration, according to Attai, who prefers not to "lose" patients to radiology. Going from the surgeon to the radiologist and back to the surgeon for intervention if the biopsy is positive can be unsettling, she said.

"For the primary doctor and the patient, there is comfort knowing the surgeon is able to look at these images just as well as a radiologist can," she said. "My comfort is increased as well, because I get a much clearer picture of the case."