These days, there?s a big demand for small ultrasound systems. While manufacturers have enhanced their portable units with new features for new uses, compact systems still have some limitations.

In radiology departments across America, you may soon see a sign that reads, “Ultrasound no longer resides here.” Indeed, ultrasound has become a mobile modality. You’ll find it in the emergency department (ED), the operating room, and the intensive care unit. If ultrasound is omnipresent, it’s in large part due to today’s high-quality portable units.

New developments in ultrasound technology, including hand-carried units (HCU), are revolutionizing the sonography field. And while the units get smaller and more mobile, the image quality and versatility is constantly improving. The second HCU report issued by Klein Biomedical Consultants (KBC), the industry’s leading analyst, indicates global revenues for HCU systems grew by 42% in 2007 to $565 million. The recently published “US Market for Hand Carried/Handheld Ultrasound Systems: Challenges & Opportunities—2007 Report” shows GE Healthcare became the undisputed leader in worldwide HCU revenues, growing 50% to $250 million for the year. Along with GE, Klein projects the market leaders in 2010 will be SonoSite and Zonare Medical Systems, which grew 22% and 60%, respectively, during 2007.

Klein characterizes HCU systems as those that weigh less than 11 pounds. The United States continued to be the largest single market for HCU units at $239 million, Klein reported, and demand continues to grow.

“The HCU market should remain dynamic over the next 5 years as clinicians face increasing demand for portable ultrasound exams,” Klein said. “We believe the growth rate for HCU will be approximately 20% in the US and 15% internationally over this time period with an average of 17% worldwide. This should make the HCU market the driving segment for increasing global ultrasound revenues overall.”

Growing Demand for Skilled Sonographers

By Marianne Matthews

For hospitals and imaging centers, choosing the right ultrasound equipment is just one challenge. Attracting skilled sonographers is another. In its 2008 Radiology Compensation Review survey, health care recruiting firm RadSciences Group said that while its health care clients found it easier to recruit radiography, CT, MRI, and nuclear medicine technologists in 2007 compared to previous years, sonographers were not as easy to come by.

The survey showed higher demand for sonographers, vascular sonographers, and cardiac sonographers. The company said the number of job searches by RadSciences Group for these positions increased from 47.9% of overall searches in 2006 to 58.5% in 2007.

Moreover, health care organizations are still willing to compete for the best candidates by offering perks. While bonuses and relocation packages have remained steady with radiography and other specialties, the survey noted a slight increase in “sign-on bonuses,” specifically in ultrasound.

While some employers are offering incentives to attract sonographers, the flip side of the story is that they are also demanding solid experience. The recruiting firm found that many health care facilities it has worked with would not consider applicants with less than 1 to 2 years of practical, hands-on experience. In many cases they also require candidates to be proficient in both general ultrasound and vascular studies, according to RadSciences Group.

Marianne Matthews is editor of Medical Imaging. For more information, contact .

HCU system sales are by far the fastest-growing market segment in ultrasound. Klein notes that 10 new HCU products were shipped in the US market during the year, including the first pocket-sized device from Siemens. The five largest HCU markets in the United States were cardiology, emergency medicine, radiology, anesthesiology, and OB/GYN, according to the report.

Benefits and Limitations

Ultrasound is finding new uses, and today’s providers have a plethora of compact products to choose from. While units vary in size, versatility, and quality of image, the consensus is that mobile units are easy to use, function well in multiple settings, and are cost-effective. Even so, portable ultrasound has its limitations.

Arthur Fleischer, MD, professor of radiology and director of diagnostic sonography at Vanderbilt University, uses a ZONARE unit, a laptop-sized device that can be detached from the larger cart. “We need to bring the device to the patient,” Fleischer said. “Sick patients often can’t be moved. The mobile units give us much more flexibility.” Fleischer adds that the smaller units are improving in versatility and image quality. “Processing time is a little slower due to memory requirements, and accessibility to PACS is also limited, but we’re satisfied with the overall performance,” Fleischer said.

ZONARE’s z.one system is characterized as a convertible system since it can be separated from the cart and used as a hand-carried device, much like a laptop computer. Weighing in at 5.5 pounds, the versatile system is being used by radiologists, interventional radiologists, vascular labs, and EDs. The system features new transducer technology that expands imaging capabilities and applications, whether used with the z.one’s cart-based configuration or the portable compact unit. Users can choose from nine transducers. The P4-1c, for example, is designed to address transcranial and abdominal vascular imaging. It has a small footprint, (14 x 21 mm), which is ideal for acoustic access to these types of exams. In addition, the P4-1c has a combination of nine multiple frequencies within 2D and M-Mode, Tissue Harmonics, Color/Power Doppler, and PW Doppler. The user can easily choose the optimal frequency for their patient while scanning and can penetrate up to 30 cm. The P4-1c transducer is lightweight and ergonomically designed, resulting in easier imaging access and increased operator comfort.

Portable ultrasound units are playing a critical role in emergency medicine. Siemens’ ACUSON P10, for example, was designed for use in complementary initial diagnostic care and triage, specifically in the fields of cardiology, emergency care, and obstetrics. The pocket-sized unit weighs just 1.6 pounds. It includes a unique feature known as Focused Assessment with Sonography for Trauma (FAST) for emergency situations. The FAST application detects fluid that can determine cardiac activity and pericardial effusion.

This pocket-sized unit weighs 1.6 pounds and was designed for initial diagnostic care and triage.

Eyal Herzog, MD, director of the Cardiac Care Unit at St Luke’s Roosevelt Hospital Center in New York City, uses the ACUSON P10. “There are limitations to the unit’s capabilities, including 2D imaging, but we’re happy with the results so far,” Herzog said. “It can’t detect color flow, so it is not effective detecting a leaking valve. But it has many advantages in emergency situations, especially with a critical cardiac patient.” Herzog adds that any physician can be trained to use the device.

Traditional Uses and Emerging Applications

While GE Healthcare offers a line of five compact ultrasound systems, the company’s “e” products focus on expanding ultrasound’s reach to new clinical areas. The LOGIQ e is geared toward emerging uses for ultrasound, such as assisting physicians in visualization of patient anatomy for interventional and surgical procedures, including regional anesthesia, as well as real-time patient evaluations in emergency settings and sports medicine.

“Ultrasound has set the standard in assisting regional anesthesia,” said Jeffrey Swenson, MD, professor and director of anesthesia for the orthopedic center at the University of Utah. “Because of its detailed visualization of anatomical structures, especially of the facial planes and nerve bundles, the LOGIQ e offers superior capability for ultrasound-guided nerve blocks.”

Industry experts predict the growth rate for hand-carried ultrasound units to be approximately 20% in the United States over the next 5 years.

LOGIQ e was built for emergency care as well. According to the company, the compact system is designed with dedicated software specifically for unique clinical needs and automatic image optimization with one-button operation. The report package can automatically send clinical images to a network folder where a PDF can be picked up by the patient’s electronic medical record, a key need in emergency medicine.

The LOGIQ line is based on GE’s raw data approach to ultrasound imaging. Rather than storing ultrasound images as video pixels, the data is stored as digitized ultrasound waveforms. The result, according to the manufacturer, is high ultrasound fidelity. Moreover, the data can be captured in three dimensions in near real time. Clinicians can view, reprocess, reslice, and review images long after the patient has left.

Ultrasound has long been used for obstetrics and gynecology. But manufacturers are bringing more improvements and enhancements to this traditional area of care. GE launched enhancements to its Voluson E8 at the American Institute of Ultrasound in Medicine (AIUM) Annual Meeting in March. The system is helping physicians assess the anatomy, an initial step in assisted reproductive medicine. Specifically, the Voluson E8 works with GE’s new software, SonoAVC, to automatically measure and calculate the number and volume of ovarian follicles. The company also offers a compact line of Voluson with units weighing as little as 11 pounds and enabled by 3D and 4D technologies.

The future looks promising for manufacturers of hand-carried ultrasound units. No longer the domain of the radiology department, expect to find portable ultrasound throughout the health care enterprise, especially wherever space is at a premium.

James Markland is a contributing writer for Medical Imaging. For more information, contact .