Ultrasound vendors entice potential purchasers with latest

Ultrasound operators who experience injuries caused by repetitive movements in the workplace may be the first in line to view Philips' new iU22 system, which is being launched globally at the ECR.

"We believe it's the most significant ultrasound introduction in 20 years, ushering in new levels of ergonomics, architecture, and intelligent controls for the radiologist needing premium ultrasound capabilities," said Jim Brown, senior director of global clinical and technical marketing at Philips Ultrasound.

Given the relative maturity of ultrasound itself - and of many sonographers - complaints about musculoskeletal repetitive strain injury have increased steadily, he said.

"Around 80% of sonographers have experienced job-related pain. We've listened to the market and acted," Brown said. "The flat screen can easily be moved into almost any position, the control panel goes up and down and side-to-side, and up to 40 controls can be optimized with the push of a single button. Voice command allows hands-free operation, which reduces the risk of repetitive stress disorders. It also makes it easier to perform certain procedures that usually need two hands or two people. Once users are used to it, it improves their workflow."

In addition to voice recognition and a flat-screen monitor, the system offers high-frequency scanning in linear and curved array.

"While most conventional ultrasound systems can't acquire more than 10 volumes per second, the iU22's real-time image former provides up to 30 volumes of tissue data per second to create true instantaneous 4D. This facilitates fetal structure imaging, making many examinations much easier and quicker. It can acquire and display live, rather than postprocessing," Brown said. "We envisage this platform being used in particular for obstetrics and abdominal evaluation, as well as breast, gynecological, and musculoskeletal imaging."

The projected list price is between $180,000 and $220,000. Voice command and the advanced 4D transducers are optional extras. Shipments to Europe are expected to begin in the final quarter of 2004.

"At the moment, the system is targeted at high-end users and centers of excellence. Hospitals may have to budget for this machine, but when physicians see its power and capability, they'll want to buy it," he said.

Siemens is exhibiting a complete range of scanners, plus a first showing for the European market of the Acuson CV70, a high-end system for cardiology, and the Acuson Sequoia C512 for cardiology and general imaging. Both were launched in late 2003 and shown at the RSNA meeting.

"The CV70 has been developed for hospitals providing adult and pediatric cardiovascular services and in particular for transesophageal scanning of the heart from behind with no bone obstruction, and intraoperative applications. Its open architecture allows integration of future technologies," said Holger Reim, a Siemens spokesperson.

The Sequoia CV512 system features a new transducer design and is installed with "coherent matched response technology," a new method of picture acquisition. The probe head technology and image reconstruction processes reduce artifacts caused by the acoustical obstruction of bones and fat.

"These new imaging technologies provide physicians with a clear view into the heart. Coherent matched response also has special options for checking blood flow velocity, providing doctors with additional clinical data," Reim said.

For GE, the emphasis at ECR is on clarity and quality.

"Our first aim is to reduce noise and speckles to increase contrast definitions. Our second aim is to provide images that are close in quality to CT and MRI so that results from the three modalities can be compared." said Pierre Radzowski, marketing manager for ultrasound Europe and Middle East.

To this end, GE has developed speckle-reduction imaging (SRI) and cross beam. Both technologies were launched last September and shown at the Medica exhibition in Germany in November.

"Noise, or speckles, makes diagnosis difficult. This SRI feature suppresses the speckles to improve lesion and border definitions," he said. "Shadowing also impacts on diagnosis. Some structures cause shadows and impair view. With cross beam, ultrasound beams are sent in different directions so that shadowing can be avoided."

Some shadowing structures provide clinical information, such as the presence of stones, and it is important that users not lose that information, he said. Doctors can now split the screen into two halves to see images with and without shadow.

Growth in ultrasound, especially in 4D and contrast harmonic imaging, is expected in France, the U.K., Italy, and Central and Eastern Europe over the next few years, according to Hans Siepmann, senior manager of ultrasound products for Toshiba. Contrast harmonic imaging is the focus of the company's ECR exhibit: the latest version of 3D with real-time (dynamic) compound technology (ApliPure). Launched last fall, ApliPure is the next generation of real-time compounding technology using both spatial and frequency compounding to deliver improved clarity and resolution.

The Aplio platform software is intended for high-end ultrasound machines, and is reportedly being used in Europe. It offers a comprehensive contrast imaging package covering all core applications, one of which is Toshiba's latest technique, MicroFlow Imaging.

In conventional contrast harmonic imaging, the number of microbubbles seen can be quite low and the arterial blood flow can be observed for only a few seconds. MicroFlow Imaging combines two techniques: flash-replenishment sequences (FRS) and a maximum intensity hold process just after the FRS scan. This allows the microvasculature to be reconstructed repeatedly in focal liver or renal disease or breast tumors, for example, allowing diagnosis and early detection of possible malignancies.

"Microflow imaging, a component of contrast harmonic imaging, is a new feature that shows the contrast effects in very small vessels, an application hitherto impossible. This method was limited to larger vessels in the liver and kidney. But now it is important to see vascularization of a tumor to diagnose whether it is malignant or benign," Siepmann said. "It is a normal contrast agent and a normal procedure, but this improved technology uses a wide frequency band to receive and process information, and it allows for a very low flow."

Until recently, contrast had been used to improve Doppler signal, but researchers have designed algorithms to detect, amplify, and map signals from microbubbles, providing real-time imaging of the dynamics of blood supply to organs.

"Now doctors can see 20 or 30 images per second for three to five minutes to study blood supply into a liver lesion in arterial, portal, or late phase for functional information," said Valtero Canepa, group marketing director for Bracco.

At the ECR, Bracco is presenting clinical results of studies aimed at detecting liver metastases and characterizing undetermined lesions. It is also unveiling results of studies that differentiated normal from malignant lymph nodes, as well as imaging studies of the prostate, pancreas, and renal masses.

"The use of contrast in ultrasound is creating a new imaging modality. Contrast ultrasound is clearly superior to normal ultrasound and comparable to CT and MR, but ultrasound is cheaper and more portable. The most expensive ultrasound in the U.S. is around EUR200,000, compared to the latest CT machine at EUR1 million," he said.