Innovations in Health Care: Ultrasound Imaging

Ultrasound has found acceptance because of its cost advantage and the fact that it does not cause any harmful side effects. Read about some of the applications identified by Frost & Sullivan.

The importance of ultrasound imaging in medical diagnosis can be understood by the diversity of applications to which it caters. Frost & Sullivan identifies at least 15 applications, ranging from the more conventional gynecology and obstetrics, cardiology, anesthesiology and emergency medicine to lesser-known uses for neonatal imaging, urology and nephrology.

There are several reasons why ultrasound imaging is widely preferred:

  • The technique uses acoustic waves, which are safe and cause no discomfort to the patient or long-term side effects; the same cannot be said about molecular and radiological imaging modalities.
  • It produces live images that are well-suited for immediate feedback and guidance during medical procedures.
  • The instrumentation is usually portable. The standard form factor for ultrasound imagers is a cart-based system that can be wheeled to the patient’s bedside.

However, there also are acknowledged limitations of ultrasound:

  •  The image quality is considerably poorer than MRI and CT imaging.
  • Ultrasound scanning is much more labor-intensive and requires more skill than competing modalities, which are largely automated.  
  • The acoustic radiation gets attenuated as it travels through the body, so it is not ideal to image tissues deep in the body.

Several companies’ innovations, though, are addressing these shortcomings.

Elastography: Capturing a Physical Dimension During Imaging

Elastography is a relatively new imaging approach that uses ultrasound imaging to gather information on the elasticity of soft tissues to determine a disease state. Cancerous tissues tend to be harder or less elastic than healthy tissues. The logic is an extension of manual palpation during an exam, in which a physician feels the stiffness of tissues.

Acoustic radiation is directed towards the target tissues; this radiation propagates through the body in the form of shear waves, creating some disturbance in the target tissues. Ultrasound imaging is then used to quantify how fast the shear waves travel through the tissues; speed is used as a proxy for tissue stiffness.

SuperSonic Imagine’s (Aix-en-Provence, France) Aixplorer is the first imaging system that incorporates both ultrasound and shear waves to offer conventional B-scan images, Doppler images capturing blood flow, and real-time quantitative measurement of tissue stiffness. Elastography is particularly used to diagnose liver diseases.

Molecular Ultrasound: Improving Spatial Resolution Using Contrast Agents

One of the ways to improve image quality is to use contrast-enhancing agents to augment spatial resolution. This approach leverages targeted microbubbles to specifically bind to the target, providing additional clarity and enhancing the features of the tissue on cellular and molecular levels. Cancerous tissues overexpress certain biomolecules, which can be targeted: the microbubbles aggregate on the tumor surface to provide contrast during imaging. This approach is known as molecular ultrasonography or molecular ultrasound.

Used as a research tool for several years, molecular ultrasound has recently been integrated into conventional ultrasound systems as part of general imaging. In June 2018, Siemens Healthineers launched its latest ultrasound product, Acuson Sequoia, which features conventional ultrasound imaging, elastography and contrast-enhanced ultrasound imaging. Siemens’ proprietary BioAcoustic technology is believed to increase the longevity of the bubbles and improve diagnostic time and sensitivity.

Pocket Ultrasound: The Stethoscope of the 21st Century

Ultrasound systems are already the most portable scanners, easily finding their way into emergency rooms, ambulatory care and surgical theaters. As a means of further enhancing mobility, manufacturers pay considerable attention to developing a portfolio of ultra-portable devices. Advances have quickly progressed from laptop-connected systems to ultrasound probes that can be connected to a smartphone.

A number of companies, beginning with medical imaging majors Siemens Healthineers, GE Healthcare and Philips Healthcare, have designed easy-to-use transducers that can work on a plug-and-play mode. Philips’ Lumify and GE’s VScan are both handheld probes that can be connected to a tablet or a smartphone. Canadian company Clarius provides even more freedom than the smartphone-connected ultrasound units: its products are all handheld probes, but they need not be wired to a smartphone. Instead, they double as a transducer and a receiver, and beam photos and videos to a computing unit in real time. All of the portable devices have backend programs and an app interface that help the users program and control imaging parameters and save and share files.

Artificial Intelligence: Improving Image Output and Automating Imaging Workflow

One of the limitations identified earlier was that image quality depends on a user’s skill or expertise. Ultrasound is not readily suited for nurses and duty staff, so despite the lower cost, it may not be of value in low-resource settings. This problem can be at least partially addressed by the use of artificial intelligence (AI).

The most prominent among the proponents of AI in ultrasound imaging is Connecticut-based Butterfly Network. The company’s Butterfly iQ is a handheld, smartphone-connected scanner that is intended as a personal scanner for physicians and technicians, Its price is less than $2,000, whereas ultrasound units in the market generally range between $5,000 and $15,000. The system has machine learning algorithms that can actually guide users toward what they are looking for. In fact, since the probe is connected to a wireless network through the smartphone, more experienced staff can remotely help on-site staff guide the probe. Frost & Sullivan believes that Butterfly Network is one of the most exciting young technology companies on the scene now, unveiling attractive designs and leveraging cutting-edge AI technologies. The company is backed by Jonathan Rothberg, a scientist and entrepreneur best known for developing the Next-Gen DNA sequencer that has drastically reduced the cost of genome sequencing. Butterfly iQ has been cleared by the U.S. Food and Drug Administration for as many as 13 clinical applications.

The Road Ahead

Ultrasound has found acceptance because of its cost advantage and the fact that it does not cause any harmful side effects. Recent innovations will increase its profile even more, not least because it will be more affordable and easier to use. The simplicity of its functioning has earned it the moniker “the stethoscope of the 21st century.”

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