Tapping the Inner Voice - Express Healthcare

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INSIGHT INTO THE BUSINESS OF HEALTHCARE

February 2007

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Buyers Guide

Tapping the Inner Voice

Jayata Sharma takes you through what ultrasound is all about, and the future of ultrasound.

In physics the term 'ultrasound' applies to all acoustic energy with a frequency above human hearing (20,000 hertz or 20 kilohertz). The choice of frequency is a trade-off between the image spatial resolution and the penetration depth into the patient, with lower frequencies giving less resolution and greater imaging depth.

Ultrasound is a medical imaging technique, which has now been used for many years worldwide. There are many reasons for a doctor to suggest an ultrasound. Like when the perhaps is pregnant, and the obstetrician wants to have an ultrasound to check on the developing foetes or determine the due date. Or maybe a patient is having problems with blood circulation in a limb or the heart, and hence the doctor will ask for a doppler ultrasound to look at the blood flow.

Different uses of Ultrasound

Medical ultrasound is usually used in cardiology, endocrinology, gastroenterology, gynaecology, obstetrics, ophthalmology, urology, musculoskeletaltendons (muscles nerves), vascular (arteries and veins), intravascular ultrasound (e.g. ultrasound guided fluid aspiration, fine needle aspiration, guided injections), interventional, and contrast-enhanced ultrasound. The main advantage of ultrasound is that certain structures can be observed without using radiation. Ultrasound can also be done much faster than X-rays or other radiographic techniques.

All of the above give a two-dimensional image of a three dimensional object like the foetus or a human organ. Two other recent ultrasounds currently in use are 3D ultrasound imaging and doppler ultrasound.

3D imaging allows you to get a better look at the organ being examined and is best used for early detection of cancerous and benign tumors by examining the prostate gland for early detection of tumors, looking for masses in the colon and rectum, and detecting breast lesions for possible biopsies. It is also used for visualising a foetus to assess its development, especially for observing abnormal development of the face and limbs. And for visualising blood flow in various organs or a foetus.

Doppler ultrasound is based upon the doppler effect. When the object reflecting the ultrasound waves is moving, it changes the frequency of the echoes, creating a higher frequency if it is moving toward the probe and a lower frequency if it is moving away from the probe. How much the frequency is changed depends upon how fast the object is moving. Doppler ultrasound measures the change in frequency of the echoes to calculate how fast an object is moving. Doppler ultrasound has been used mostly to measure the rate of blood flow through the heart and major arteries.

"Now, with the latest machines we get better resolution as a result of tissue harmonics. The ultrasound machines now can cover larger areas in one sweep," says Dr Yojana Nalawade, Consultant Sonologist with Mumbai's SL Raheja Hospital.

How an Ultrasound works

Producing a sound wave: In medical ultrasound, a sound wave is produced by creating short, strong pulses of sound from a phased array of piezoelectric transducers (usually a type of ceramic). The electrical wiring and transducers are encased in a probe. The electrical pulses vibrate the ceramic to create a series of sound pulses from each. The frequencies present in this sound wave can be anywhere between two and 13 MHz. The goal is to produce a single focused arc-shaped sound wave from the sum of all the individual pulses emitted by the transducer.

To make sure the sound is transmitted efficiently into the body (a form of impedance matching), the transducer face has a rubber coating. In addition, a water-based gel is placed between the probe and the patient's skin.

The sound wave is partially reflected from the interface between different tissues and returns to the transducer. This returns an echo. Sound that is scattered by very small structures also produces echoes.

Receiving the Echoes: The return of the sound wave to the transducer results in the same process that it took to send the sound wave, just in reverse. The return sound wave vibrates the transducer's elements and turns that vibration into electrical pulses that are sent from the probe to ultrasound scanner where they are processed and transformed into a digital image.

Forming the image: The ultrasound scanner determines three things from each received echo: the direction of the echo, how strong the echo was, and how long it took the echo to be received from when the sound was transmitted. Once the ultrasound scanner determines these three things, it can locate which pixel in the image to light up and to what intensity. Transforming the received signal into a digital image can be best explained by using a blank spreadsheet as an analogy. The transducer elements receiving the impulse determine the 'column' in the spreadsheet (A, B, C, etc.). The time that it took to receive the echo determines the 'row' (1, 2, 3, etc.), and the strength of the echo determines the brightness that the cell should change to (white for a strong echo, black for a weak echo, and varying shades of grey for everything in between).

The market now

According to industry experts, the market for ultrasound machines is growing at 20-25 per cent annually. "As the technology is advancing, the machines are advancing, and hence the diagnostic sector is advancing too," says Dr VK Singh, Consultant Radiologist with Apollo Hospital, Gorakhpur.

Currently, the different types of ultrasound machines available in the market are static scanner (B&W), real-time scanners, colour dopplers and 3D-4D ultrasound machines. The demand for ultrasound machines has increased mainly because it has now become handy and it can go bedside. The market for B&W scanners is the highest in India, with a market share of around 60 per cent. This is mainly because of better resolution of these machines. "Also, as newer technologies keep coming in the urban areas, the older ones keep shifting in the rural areas and hence the number does not decrease," says Dr RK Sodani, who runs the Sodani Diagnostic Clinic at Indore.

After B&W, there is around 30-35 per cent market of colour doppler followed by a mere five per cent marker share of the 3D-4D machines.

According to industry experts, the market for ultrasound machines is on a rise as more and more specialities are using the machines. Even the radiologists and cardiologists are now using different ultrasound machines designed for their speciality. Now it has become a trend to keep one static and one portable ultrasound machine at diagnostic centres and in hospitals. "In fact, the demand for portable machines has increased in the last couple of years, as they have become lighter," says Dr Nalawade, who also owns the Nutan Mammography and Sonography Centre - Sophie at Mumbai. Earlier, the portable machines weighed 10-12 kgs, but now they weigh only 4-5 kgs.

"The demand is growing for more advanced machines now," adds Dr Sodani.

The cost of ultrasound machines ranges from Rs 5 lakh for a B&W machine to Rs 50 lakh for a high-end one. The market players in this section are GE-USA, Seimens, Philips, L&T and many more.

Dangers of ultrasound imaging

The safety of ultrasonography has been studied extensively. All medical procedures have beneficial consequences with risk for detrimental consequences. Ultrasound does have bio-effects. Usually, these are in some proportion to the amount of energy put into in the tissue, and high-intensity ultrasound can have the following effects:

Cavitation: Very high negative acoustic pressures can cause temporary microscopic vacuum pockets. When these collapse, they produce very high local temperatures that can cause damage to the immediate region.

Heat generation: Local tissue absorbs the ultrasound energy and increases their temperatures. Long-duration elevated temperatures above 41 C can damage tissue.

Bubble formation: Dissolved gases come out of the solution due to local heat increase.

Concern of Doctors

The doctors using ultrasound machines are concerned about mainly the downtime being very high. "Whenever any part of the machine fails, we are asked to simply replace it, and not repair the same," says Dr Nalawade. The technology is so high-end that nobody wants to touch the machine to repair. Most of the parts are imported and to purchase those parts again proves to be quite costly. Doctors are also complaining that the after-sales services by the sellers is very poor. Medicos are worried that it takes a long time for sellers to get back to them regarding any problem in the machine. Also, sellers do not have adequate PCB's in stock, and doctors cry foul as their AMC mentions low downtime, but how low, nobody knows. Traditionally, an ultrasound machine should only be used by a trained radiologist, or a through medical professional. "However, now-a-days, any lay person is capable of acquiring a ultrasound machine. There must some restriction on the use of machines by non-medicos, as the diagnosis hereby given will not be proper," says Dr Singh. He also mentioned that the introduction of PC-PNDT Act has brought some impositions on the use of ultrasound machines, but fake certificates are always available, and hence the problem still persists.

The Future of Ultrasound

As with other computer technology, ultrasound machines will most likely get faster and have more memory for storing data. Transducer probes may get smaller, and more insertable probes will be developed to get better images of internal organs. Most likely, 3D ultrasound will be more highly developed and become more popular.

"The entire ultrasound machine will probably get smaller, like a laptop, perhaps even hand-held for use in the field (e.g. paramedics, battlefield triage)," avers Dr Nalawade. One exciting new area of research is the development of ultrasound imaging combined with heads-up/virtual reality-type displays that will allow a doctor to see inside you as he/she is performing a minimally invasive or non-invasive procedure such as amniocentesis or biopsy.

Larsen & Toubro Limited

Mindray

Esaote India
NS Limited

Meditronics

Resolution Enhancement Software

Drastically eliminates speckle noise artifact from the fundamental signal. The system further enhances the raw images by incorporating contrast & edge enhancement in real time. This combination generates the finest images with utmost clarity.

Spatial Compound Imaging

Uses technology of scanning individual pixels from various directions and gives much more information. This suppresses the noise from the useful echoes in real time and produces very high resolution images without affecting the frame rate.

Tissue Harmonic Imaging

Offers exceptionally high resolution images generated with pure harmonic frequencies and suppresses noise from fundamental signal without compromising penetration. This helps in comfortably diagnosing the difficult to scan patients.

Pulse Wave Doppler

Sequina delivers excellent doppler sensitivity even in extreme low flow areas, without affecting grey scale resolution. The wide range of PRFs supported by angle correction keys helps in evaluating variety of blood flows easily.

Colour Doppler and Power Doppler

Sequina offers superb colour pick up in both high as well as extreme low flow states. equina's directional power doppler also retains the directional information that is not captured inconventional systems.

Simultaneous B and C mode

Sequina offers facility to view simultaneous live greyscale and colour mode. This gives flexibility to the operator for easier comparison and better presentation of organs and vessels.

Freehand 3-Dimension Imaging (optional)

The Advanced 3D option in Sequina, constructs realistic 3D images quickly and easily. The system gives flexibility of generating volume rendering images with minimum operations.

Panoramic Imaging (optional)

Generates images with extended field of view by digitally stitching series of images and giving complete information of large parts in a single scan. This enables operators to evaluate widespread pathologies with ease.

Trapezoidal Imaging

Images are constructed using the beam steering method. The system architecture is designed so that trapezoidal images can be generated easily. This has benefit of changing the image direction without changing the probe position.

Extended Field of View

The system offers the facility to widen the scanning area without moving the transducer. The system can generate the virtual convex images while using the linear transducer. This is useful while scanning large organs like liver or full term foetus.

Real time Spectral Analysis

Sequina's unique RTSA function gives flexibility to analyse the spectal doppler in real time. The Real time spectral analysis continuously updates all the doppler indices that simplifies the operations and increases the productivity.

Beam Steering Beam steering function changes the firing sequence of ultrasound beam and constructs images which are steered in either direction. This helps in acquiring good B-mode resolution as well as better colour pickup.

Larsen & Toubro Limited

Medical Equipment & Systems
Gate No. 7, Annexe Building,
Saki Vihar Road, Powai,
Mumbai 400 072, INDIA.
Tel.: 022-55053204,
Fax: 022-55051276
E-mail: ebg-med@LNTEBG.com

Advanced Imaging Technology

Powerful Multi-beam Parallel Imaging (MBP) increases temporal resolution and real-time frame rate, while collecting useful information to re-build high quality images.

Fine Tissue Optimization (FTO) eliminates noise, improves signal-to-noise ratio and emphasizes boundary imaging.

Extended Phase Harmonic (EPH)* results in enhanced harmonic signal and restrained original wave, increasing resolution and accuracy in identifying subtle pathological changes.

Transmitting Spectrum Focusing (TSF) greatly decreases side lobe while improving spatial and temporal resolution.

Innovative Transmitting

Apodization (ITA) minimizes artifact through specific apodized transmission,reducing near-field clutter and enhancing precise sound beam for more predictable results.

Accurate Vessel Imaging (AVI) automatically distinguishes subtle tissue Doppler signal from blood cell to form high resolution images.

Professional Clinical Application

Color, Power, DirPower, CW*, PW, HPRF, Color M mode*

Harmonic imaging, trapezoid imaging, intraoperative ultrasound,ultrasound guided biopsy, real-time dual display, dual ECG trigger imaging*, ECG module AVI/DICOM/CIN format cine,M/PW cine save,cine save editable,multi-image review Intelligent Work Flow

iStation: intelligent patient information management platform

iTouch: one button for automatic image optimization

Operation Navigation: guide for an effort-saving and reasonable exam

Unique DVD-video recorder*, CD-RW, USB ports, DICOM, VCR-video recorder

Offline Analysis System

Auto Image Review: automatic browser Ergonomical key board layout and user-define buttons System ibernation

Mindray Headquarters

Address: Mindray Building, Keji 12th Road South, High-tech Industrial Park, Nanshan, Shenzhen 518057,
P. R. China.

Tel: +86 (755) 26582888, 26582492
Fax: +86 (755) 26582500, 26582501, 26582680
E-mail: intl-market@mindray.com

For MyLab30CV

System : Portable Premium Performance Cardio-Vascular Color Doppler System .

Type of beamformer (Analog or digital): Latest generation fully Digital beam former

Display type (LCD / CRT): 15" TFT with 170º viewing angle with high contrast

Platform (General / cardiovascular / radiovascular): Cardio-Vascular Color Doppler System upgradable to radiovascular

Probes available:Broad Band Probes- Cardiac Phased array Sector for Adult, Pediatrics & Neonatology/ Convex Array / Linear Array /200deg Endocavity / CW probes

Special Probe: Intra-operative / Laparoscopic /Adult & Paed. Multiplan TEE probe

Frequency Range: 1 to 6MHz

Special Advanced Modes

Tissue harmonic imaging: Available , 3 - Levels in all transducers
Compound imaging: NA
Panoramic imaging: Available - VPAN(option)
Trapezoidal imaging: NA
3D
Available (option)
4D
Available (option)
DICOM compatibility: Available. DICOM Storage, Media, Printer, Worklist, Storage Commitment, MPPS (DICOM License required) (option)
CnTI (Contrast Tuned Imaging): Available (option) Dedicated to Ultrasound Contrast Media)
X- Strain and Strain Rate: Available ( The Latest 2D based strain rate)-option
TVM (Tissue Velocity Mapping or TDI):
Available (option)
Stress Echo: Available (option)
Compass M-Mode:
Available - Anatomic M-Mode with dual line

Capability (option)

Speckle noise reduction algorithm: Yes Available

No. of active transducer ports: 2 Electronic Probes, 1 pencil probe

Measurement and calculation: Available for all applications mentioned here

Media Storage: CD, DVD, USB Storage Devices (HD, Memory Pen), Remote Archive connected to Lan/Wan Network, VTR, DICOM Storage SCU

Peripherals: B/W and RGB Video Printer, Super VHS VTR, PC Printer (USB, WIFI, Bluetooth), Dicom Printer

Applications : Abdominal, Advanced Biopsy Imaging, Advanced Musculoskeletal, Advanced Prostate Imaging, Cardio, Cerebrovascular, Gynaecology, Intraoperative Imaging, Neonatal, Neonatal Cardiology, Obstetrics and Fetal Heart, Paediatric Cardiology, Paediatric General Imaging, Peripheral Vascular, Superficial/Small Parts, Transcranial Doppler, Urology, Vascular

Price:Depends on the configuration. Pls check with the nearest office.

After sales service support: 24hrs Services and our offices are situated in all major cities and our representatives are available in all smaller towns also. We shall rectify the problems of our machines with in Maximum of 24 hrs from the time we receive the call.

Esaote India NS Limited

B-604/704, Xford Tower, Gurukul
Ahmedabad - 380052
Tel: 91-079-27433140, 30124999
Fax: 91-079-27490245
Email: esaote@icenet.co.in
Website: www.esaoteindia.com

For MyLab50

System: Whole Body Color Doppler System with Extreme Flexibility.

Type of beamformer (Analog or digital): Latest generation fully Digital beam former

Display type (LCD / CRT):
17" fully flat high resolution strain free monitor with tilt possibility

Platform (General / cardiova: cular / radiovascular)- Whole Body Color Doppler System

Probes available: Broadband Transducers - Convex / Linear / Phased array sector/ 200 deg Wide angle Endocavity

Special Probes: Intra-operative / Laparoscopic / Special Biopsy Probe / Adult & Paed multi-plane TEE probe

Frequency Range: 1 to 16MHz

Special Advanced Modes

Tissue harmonic imaging:
Available 3 - Levels in all transducers
Compound imaging: NA
Panoramic imaging Available - VPAN (option)
Trapezoidal imaging: NA
3D
Available (option)
4D
Available (option)
DICOM compatibility: Available. DICOM Storage, Media, Printer, Worklist, Storage Commitment, MPPS (DICOM License required)(option)
CnTI (Contrast Tuned Imaging):
Available (option) Dedicated to Ultrasound Contrast Media)
X-Strain and Strain Rate Available (The Latest 2D based strain rate)-option
TVM (Tissue Velocity Mapping:
Available (Tissue Doppler & Tissue Mapping)-option
Stress Echo:
Available - can work together with strain rate (option)
Compass M-Mode Available Anatomic M-Mode with dual line

Capability (option)

Speckle noise reduction algorithm: Yes Available

No. of active transducer ports:3 Electronic Probes,1 pencil probe

Measurement and calculation: Complete Calculation packages for all the applications Packages

Media Storage: CD, DVD, USB Storage Devices (HD, Memory Pen), Remote Archive connected to Lan/Wan Network, VTR, DICOM Storage SCU

Peripherals: B/W and RGB Video Printer, Super VHS VTR, PC Printer (USB, WIFI, Bluetooth), Dicom Printer

Applications: - Abdominal, Advanced Biopsy Imaging, Advanced Musculoskeletal, Advanced Prostate Imaging, Cardio, Cerebrovascular, Gynaecology, Intraoperative Imaging, Neonatal, Neonatal Cardiology, Obstetrics and Fetal Heart, Paediatric Cardiology, Paediatric General Imaging, Peripheral Vascular, Superficial/Small Parts, Transcranial Doppler, Urology, Vascular

Price: Depends on Configuration. Pls check with the nearest office.

Esaote India NS Limited

B-604/704, Xford Tower, Gurukul
Ahmedabad - 380052
Tel: 91-079-27433140, 30124999
Fax: 91-079-27490245
Email: esaote@icenet.co.in
Website: www.esaoteindia.com

Sonoscape SSI-1000™

A leading-edge Full Digital Portable System.

15" LCD high resolution display
Multi parameter Compound Imaging
Tissue Harmonic Imaging
Natural Frequency Digital Scan Converter (NFDSC)
Progressive Real-time Aperture Change (PRAC)
Progressive Real-time Apodization (PRA)
Adaptive Tissue Flash Rejection (ATFR)
Tissue Correlated Smart Frequency Selection (TCSFS)
Quad frequency, high density transducers
Color Flow Mapping, Color Doppler Energy Mapping,
Spectra Doppler Imaging, etc
Linear, convex and phased array probes from 1.5 to 15MHz.
USB 2.0 image storage
ECG INPUT
DlCOM
3D

Extended Clinical
Applications

Abdominal, Obstetrics, Gynecology, Urology, Pediatrics, Neonatal Head, Vascular, Small Parts, Transcranial and Adult Cardiac, etc.

MEDITRONICS

Corporate Office : 101, Shiv Industrial Estate, K.B.B. Marg, Chinchpokli (E), Mumbai - 400 012
Tel. : +91-22-2371 9143/2377 1739
Fax: +91-22-2379 1272
Email : sales@meditronicsasia.com

jayata.sharma@expressindia.com

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