Industry experts sound off about what’s new in the ultrasound sector

Suffice it to say that the global ultrasound sector is on the rise. Below, six ultrasound industry experts—Bob Thompson, president, ultrasound, Siemens Healthineers; Jeremy Probst, president and CEO of Technical Prospects; Neal Sandy, chief marketing and commercial officer, GE Healthcare Clinical Care Solutions; David Nye, senior territory manager at Trisonics Inc; Dan Skyba, director, Ultrasound Business Unit, Canon Medical Systems USA, Inc.; and Amanda DePalma, head of global marketing for ultrasound at Philips—sit down with Axis Imaging News to discuss what’s driving demand for ultrasound and what technological advancements are propelling the sector forward.

AXIS Imaging News: A recent MarketWatch report projects the global ultrasound market to exceed $7.2 billion by 2022. What are some key factors contributing to this growth?

Dan Skyba: A couple of things have converged in the ultrasound market, which are bolstering its growth. First, we’ve seen tremendous innovations and technological improvements in imaging quality. Ultrasound systems are on the market for every clinical use, at every price point, and all now deliver high-quality imaging.  Over the past 20 to 25 years, there has been a dramatic improvement in image quality, resulting in ultrasound images that often rival those of CT, and even MR. At the same time, ease of use has also improved significantly and the costs have decreased.

Ultrasound has become available at almost every price point and size. There are systems available at the premium level, the introductory level, and even handheld and now tablet size systems. The improvements in image quality, coupled with the improved ease of use and decreased costs, have created a tremendous opportunity to bring ultrasound to a broader global marketplace.

Jeremy Probst: Ultrasound offers an effective imaging option that is extremely cost effective to own and operate within healthcare facilities. The equipment itself also has a significantly smaller footprint than other imaging modalities, which makes this an ideal option for small clinics and private practices.

In addition, ultrasound is noninvasive and uses no radiation. As we continue to learn more about the long-term effects of radiation exposure, I expect to see more and more emphasis on imaging procedures that limit or eliminate the amount of radiation patients are exposed to. These factors, combined with the improved quality of images produced, have dramatically expanded ultrasound’s diagnostic capabilities and have allowed it to grow within the market.

Amanda DePalma: There are numerous factors contributing to ultrasound’s growth. Key factors are that ultrasound is an affordable, accessible, and safe technology that can reach a diverse patient population and improve millions of lives around the globe.

Neal Sandy: Projected growth in the ultrasound market through 2022 will be fueled by several factors, including an expansion of usage in emerging markets, expansion of new users in areas such as acute care and primary care (including handheld ultrasound), advancements in artificial intelligence to improve diagnostic accuracy and efficiency, and increased attention to therapy guidance and ultrasound as a therapy.

David Nye: Ultrasound continues to grow for multiple reasons. Not only are the types of studies increasing, but so also are the departments using ultrasound systems. Years ago, ultrasound was only used in departments like radiology, echocardiography, and Ob-Gyn. [Now,] it continues to grow in such areas as point of care, orthopedics, and many others.

Bob Thompson: In addition to solid growth in emerging and developing markets such as India, China, and Latin America, we are also experiencing the move toward more value-based care. Ultrasound is a major factor in this offering, providing cost-effective, easily accessible imaging, which helps to improve clinical outcomes in more cases. Ultrasound is already the most widely used imaging technology—and its range of clinical applications, disease pathways, and patient populations it can address is expanding.

Moreover, as we drive to more precise medicine, physicians need more imaging information—an area where ultrasound is experiencing growth. From improvements in image quality, greater use of artificial intelligence, and greater acceptance of advanced features like fusion imaging, contrast-enhanced ultrasound and shear wave elastography are all contributing to the expansion of the clinical use of ultrasound.

AXIS Imaging News: What are some of the biggest innovations currently affecting the ultrasound market and what technological advancements do you expect to see in the next few years?

DePalma: We will continue to see advancements in automation, quantification, and the use of artificial intelligence to make ultrasound a more objective and intelligent solution that is accessible to more and more people around the globe. Additionally, we’ll see ultrasound expanding beyond diagnostics and being used in more interventional procedures and even for treatment. For example, at Philips, we just introduced EPIQ CVxi, our third-generation integrated ultrasound-angiography cath lab solution for real-time, workflow-optimized image guidance and advanced quantification for structural heart procedures.

Sandy: As with several industries, artificial intelligence is already beginning to transform the ultrasound market. In addition, continued advances in processing capabilities, image and data sharing, and virtual education will play a role. We expect the biggest potential to lie in precision health—combining ultrasound information with other markers (e.g. genetic) and processed with the power of AI/big data technologies. These results could lead to substantially refined and individualized screening, diagnostic, and treatment results—ultimately, improved outcomes.

Thompson: According to the World Health Organization, 1.9 billion people globally are reported as overweight, with 650 million people classified as obese. Imaging challenging patients requires new levels of performance and new innovations. We need to enable clinicians to image deeper without losing image quality. Siemens Healthineers worked with clinicians and the ultrasound community to address these challenges [with our] ACUSON Sequoia ultrasound system and DAX transducer, which allow physicians and users to image at depths up to 40 cm without losing image quality, versus most conventional system depth.

Also, let’s not underestimate workflow, ease of use, and the reduction of ergonomic injuries for operators. New technologies such as gesture-detecting transducers— activated by touch—aim to reduce injury and enhance workflow. Reduction of keystrokes facilitates the speed of an examination, but also reduces the strain on the user. Auto machine learning and AI are automating routine and tedious tasks, allowing users more time to focus on diagnosis and the patient. We also see a continued expansion of the diagnostic power of ultrasound in terms of applications.

Nye: Software is becoming a bigger and bigger part of these systems. Years ago, it was not uncommon to have 20 or more circuit boards in a system; some of the latest systems have less than half of that now. The difference is the amount of processing that the backend of these systems [can now do]. With the in-depth software control, the new systems can create a cleaner, crisper picture.

In years’ past, there has always been a trade-off between system size and image quality. When purchasing a small, portable system, the user always had to sacrifice a little image quality for the portability factor. Over the next few years, I expect to see systems continue to shrink and decrease the trade off when comparing system size to image quality.

Skyba: We’re seeing the biggest innovations happen around imaging of the liver. As the obesity epidemic grows globally, NASH, NAFLD and other diseases of the liver are on the rise. Ultrasound is a great tool to help distinguish between different disease states in the liver and can help clinicians determine the best treatment plan. New liver analysis tools—based on Shear Wave technologies and contrast—have been a game changer for measuring tissue characteristics in the liver. Ultrasound tools that quantify liver tissue viscosity, attenuation, and perfusion patterns are available and all contribute important diagnostic information.

At Canon Medical, we offer a robust Liver Analysis Package on our Aplio i-series platform, which is designed to gives clinicians the tools they need to address every stage of liver disease. As these epidemic problems continue to grow, having a cost effective, noninvasive way to screen, diagnose, and monitor the progression of liver disease in a relatively easy and low cost manner—through ultrasound—is a huge technological and diagnostic advancement. I expect to see the adoption of these tools continue to grow in the next few years.

Probst: Over the past decade, we’ve seen the quality of images produced by ultrasound equipment vastly improve. This has made ultrasound a legitimate imaging tool in a variety of new applications. Two excellent examples of this include cardiac studies and breast cancer screenings. In both applications, ultrasound now offers vivid, color images—all taken with no dose of radiation.

Ultrasound continues to gain traction as an alternative to angiograms in cardiology, and I believe we will see greater use over mammograms in detecting breast cancer. As ultrasound images continue to improve, there will be growth as the modality offers a more advanced, noninvasive imaging option that doesn’t utilize radiation. This not only helps limit the amount of radiation patients are exposed to, but also limits imaging technicians’ exposure.

AXIS Imaging News: In your expert opinions, what are some of the biggest challenges currently affecting the ultrasound sector? How is the industry working to overcome them?

Probst: Ultrasound procedures are often far more time-consuming than other imaging modalities. For example, while it may take only minutes to capture the required images with a CT scan, an ultrasound could take up to 30 minutes, if not longer. Because of the time ultrasound procedures require, the modality doesn’t provide the return per appointment that other procedures offer.

Despite longer procedures, ultrasound is potentially safer than other imaging methods because it does not utilize any form of radiation. It is crucial that we continue to educate imaging technicians, doctors, and insurance companies on the impact of over-radiating patients and increase awareness of the long-term side effects of excessive radiation exposure.

DePalma: With more and more new ultrasound users, training and education are critical challenges for our customers. This challenge requires that we both innovate to make ultrasound more intuitive and easier to use, as well as develop novel ways to provide training and education for a diverse customer base.

Sandy: Education remains a primary challenge—particularly in emerging markets. The industry often participates and helps to coordinate ultrasound education in a traditional sense, and augmenting those activities with virtual education will continue to open up ultrasound as a viable technology for clinicians in these markets. Another challenge is related to AI, as the industry needs access to data to train algorithms to ultimately drive better outcomes for patients and clinicians. There is an increased interest in data-sharing agreements, opt-in patient agreements, and traditional research agreements that will help advance the technology while protecting patient data.

Thompson: One of the big challenges in ultrasound is variability: patient variability, system variability, and user variability. Clinicians are challenged with imaging different sized patients with consistency and clarity. Manufacturers continue to innovate their products to grow the clinical efficacy of their systems. As ultrasound systems continue to improve in both image quality and advanced functionalities, their use is expanding into a broader range of clinical applications.

Coupled with AI, users can benefit from automation and improved diagnostic accuracy and more personalized treatment planning. The healthcare sector needs to provide more effective outcomes at a lower cost—and ultrasound can help here, beyond just imaging.

Skyba: I see two big challenges facing the sector: The first is the adoption of ultrasound over other imaging modalities that radiologists have been more accustomed to using. It really takes a mind-shift for radiologists and clinicians to understand that you can get the same quality images from ultrasound that may have historically been sourced from a CT or MR system. You can now get the same quality images quickly, easily, and in a cost-effective way. We’re seeing the shift happen quickly in pediatrics—where radiation prohibits excess use of other ionizing imaging technologies. While the use of ultrasound for emergency medicine and point of care applications has grown rapidly in the past decade, it’s taking a bit more time to see the shift to ultrasound happen in primary general imaging departments.

The second issue facing the sector is reimbursement. The technology has grown very quickly, and tools are changing the landscape, but it can take a long time for institutions to adapt and establish the right reimbursement structure which incentivizes physicians to switch to ultrasound. How the industry can help the sector overcome this is by supporting the ultrasound societies and independent advocacy groups who are promoting and educating clinicians in the broader uses of ultrasound. 

AXIS Imaging News: Do you have any more expert advice you want to impart on AXIS Imaging News readers regarding the ultrasound sector?

Sandy: The pace of innovation in ultrasound continues to offer tremendous improvements to the benefit of clinicians and patients alike. When properly directed toward outcomes that benefit patients, clinicians and/or health systems, ultrasound products and technologies can make a real difference in patient care. By focusing our attention on ultrasound advancements, this will make a difference for the clinician and ultimately, the patient. These advancements may be as simple as gaining access to world-class ultrasound at an affordable price, or could be as groundbreaking as providing AI-derived diagnostic guidance based on clinician-curated datasets from ultrasound researchers all over the world.

Skyba: Overall, ultrasound is an imaging modality that has really “come into its own” in comparison to other imaging technologies. Ultrasound portability allows it to be available to the masses and deliver outstanding imaging detail and diagnostic capabilities, with a small learning curve and reasonable cost. And as the technology continues to evolve, the numbers show it is changing the game and poised to become the dominant technology in the field of medical imaging, globally across the board.

Probst: I believe ultrasound is an underused modality that offers noninvasive imaging and the added patient and provider benefit of no radiation. Because of this, I challenge providers to ask themselves, “Can we do this exam without radiation?” As ultrasound imaging continues to advance, more opportunities for use will emerge and providers can reduce the amount of unnecessary radiation patients are exposed to.

Nye: Ultrasound is a great field to be in. With [the field] ever-changing, it always keeps you on your toes and continues to force you to learn about new technology.

Thompson: Ultrasound remains the most versatile imaging modality with an expansion of clinical applications spreading throughout the care facility. Ultrasound is present in more departments than any other non-disposable technology—and this can present challenges for servicing and maintaining a fleet of systems, as well as understanding utilization rates. Adopting tools like predictive analytics may leverage hospital investments and lend to overall system sustainability. [Further,] I have spent my whole professional career in ultrasound, and it still inspires and excites me every day to see the impact that ultrasound is having on patients.