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Ultasound System
Ultasound System
Ultasound System
Purpose
General-purpose ultrasonic scanning systems provide two-dimensional (2-D) images of most soft tissues
without subjecting patients to ionizing radiation. They are typically used in the hospital’s radiology department
to complement other imaging modalities and in other hospital departments and private physician offices
primarily for abdominal and OB/GYN scanning. Some systems include additional transducers to facilitate more
specialized diagnostic procedures, such as cardiac, vascular, endovaginal, endorectal, or small-parts (e.g., thyroid,
breast, scrotum, prostate) scanning.
Principles of operation
Ultrasound refers to sound waves emitted at frequencies above the range of human hearing. For diagnostic
imaging, frequencies ranging from 2 to 15 megahertz (MHz) are typically used. Ultrasound waves are mechanical
(acoustic) vibrations that require a medium for transmission; because they exhibit the normal wave properties of
reflection, refraction, and diffraction, they can be predictably aimed, focused, and reflected.
A typical ultrasonic scanning system consists of a beamformer, a central processing unit, a user interface (e.g.,
keyboard, control panel, trackball), several probes
(transducers or scanheads), one or more video displays, some
type of recording device, and a power system. UMDNS Information
This Product Comparison covers the following device
To perform ultrasonic imaging, a probe is either placed on terms and product codes as listed in ECRI Institute’s
the skin (after an acoustic coupling gel is applied) or inserted Universal Medical Device Nomenclature System™
(UMDNS™):
into a body cavity. Ultrasonic probes contain one or more Scanning Systems, Ultrasonic, Abdominal [16-241]
elements made of piezoelectric materials (materials that Scanning Systems, Ultrasonic, General-Purpose [15-976]
Scanning Systems, Ultrasonic, Obstetric/Gynecologic [15-657]
convert electrical energy into acoustic energy and vice versa). Scanning Systems, Ultrasonic, Small-Parts [18-052]
When the ultrasonic energy emitted from the probe is Scanning Systems, Ultrasonic, Vascular [15-957]
reflected from the tissue, the transducer receives some of
5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA Tel +1 (610) 825-6000 Fax +1 (610) 834-1275 Web www.ecri.org E-mail hpcs@ecri.org
Scanning Systems, Ultrasonic, General-Purpose
Figure 1. Views of a variety of transducers: (1) flat linear, (2) curvilinear, (3) phased, and (4) mechanically-steered annular
these reflections (echoes) and reconverts them into electrical signals. These signals are processed and converted
into an image (sonogram). Lower sound frequencies provide decreased resolution but greater tissue penetration,
while higher frequencies improve resolution when deep penetration is not necessary (e.g., in pediatric or small-
parts studies).
Multifrequency (broadband) transducers have larger frequency ranges than traditional transducers. Larger
bandwidths allow the user to more easily select transducer resolution and tissue penetration in different imaging
procedures. Many suppliers offer multifrequency probes that allow switching among two or more frequencies—
for example, among 2.5, 3.5, and 5 MHz.
Various modes are available for displaying the returning echoes. B-mode (brightness-modulated mode) is the
scanning system’s basic imaging mode. B-mode produces a real-time, 2-D image that represents a cross-sectional
slice of the area under study. The image is created as the transducer sweeps the pulsed ultrasound beam through
the image plane either mechanically or electronically. The image is updated multiple times to produce a moving
image, and the sweep (or frame) rate determines how often the image updating occurs. M-mode (motion mode)
uses a fixed-position pulsed beam to produce a moving display of a single scan line over an interval of time. Used
almost exclusively in cardiac applications, M-mode produces a graphical display of a moving structure (e.g., the
cardiac valve over several heartbeats). Simultaneous display of M- and B-modes is particularly useful when
examining dynamic structures, such as the heart.
Transducers most commonly generate two differently shaped patterns: rectangular (linear) images and wedge-
shaped (sector) images. Linear images are produced by flat, linear array transducers, which contain a series of
piezoelectric elements arranged in a single line with available array
lengths of 4 to 15 cm. The elements are pulsed sequentially in groups,
advancing from one end of the array to the other while the system
switches between transmit and receive modes. This produces a number
of parallel acoustic beams across the length of the array during a single
sweep to image a rectangular region directly in front of the elements.
(Figure 1 illustrates the basic types of transducers and the ultrasonic
wave patterns they generate.) As with other real-time scanners, each
linear sweep updates the display with a new cross-sectional image.
Various methods are used to improve image resolution, such as special
transmit and receive phase-delay techniques that significantly improve
beam focusing and image quality. Because the entire length of the array
is placed on the patient's skin, a large field of view displays structures
close to the transducer. Therefore, a flat linear array (often called just
"linear array") system is ideal for obstetric examinations in which the
placenta or fetal skull might be positioned close to the transducer.
Because of their less sophisticated electronic circuitry, scanners utilizing
only linear array transducers are generally less expensive than many
other real-time ultrasonic scanning devices, but they do have some
disadvantages. For instance, maintaining complete skin contact with the
large surface of the array is sometimes difficult.
Two basic transducer configurations are currently used for sector
scanning: mechanical and nonmechanical (electronic). Mechanical-
sector transducers contain one or more piezoelectric elements in a
sealed fluid path. A motor-driven system moves the element rapidly
through an arc that establishes the sector, while the transducer switches
between transmit mode and receive mode. Although mechanical
transducers commonly use a single element, some use an annular array:
multiple concentric, ring-shaped elements that produce a cylindrical,
more uniform, and better-focused beam in both the horizontal and vertical planes. This 2-D focusing reduces slice
thickness for improved image clarity. Activating the elements at different delays allows the beam produced by
these arrays to be focused at several different depths.
Electronic-sector scanning uses array transducers, which consist of a series of linear piezoelectric elements. A
curvilinear-array (convex array) probe operates similarly to the flat linear probe, but its convex shape allows a
larger field of view than a flat linear array transducer with the same contact area so that images of deep structures
can be more easily obtained.
Electronically steered scanning uses phased-array transducers, which consist of a series of individual
piezoelectric elements operating as a unit. Phased arrays are the same as linear arrays except that they have
smaller contact areas and electronic timing circuits that allow them to fire groups of elements in a variety of
sequences. This permits each burst of ultrasonic energy to leave the transducer at a slightly different angle.
Transmitting and receiving ultrasonic energy through different angles within the scan plane forms a sector image.
Phased-array transducers are generally smaller and easier to handle than most other transducers. However, they
require more sophisticated electronic timing systems. Although they provide a limited field of view for nearby
structures, their smaller scanning surfaces (often as small as 6 mm) permit imaging of structures in tight areas or
behind obstructions (e.g., areas between or behind ribs).
Electronic transducers provide a greater number of imaging capabilities, such as simultaneous 2-D and
Doppler imaging. And, because they have no moving parts, they also appear to be more reliable. But, in the
typical linear element configuration, with rows of elements arranged horizontally, electronic focusing is possible
only in the 2-D (horizontal) scan plane; therefore, there is no focusing action along the transducer’s vertical plane
to reduce slice thickness.
Multidimensional arrays have the normal row of elements arranged horizontally, but they also have a few (five
to seven) vertical rows of elements. These vertical rows allow the arrays to be focused in the vertical (slice
thickness) plane as well, creating a tighter focal area. However, the vertical focus cannot always be adjusted, nor
can the beams be steered vertically. Nevertheless, these arrays (often referred to as 1.5-dimensional arrays)
provide somewhat better vertical resolution than standard linear arrays.
In both mechanical and electronic systems, each sweep produces a new cross-sectional image (frame) that is
used to update the display. Generally, high frame rates are useful for imaging rapidly moving structures, while
lower frame rates provide improved image quality by increasing the density of the acoustic lines that make up
the image. Depending on the system, frame rates can be fixed, selected by the operator, or varied automatically
based on the field of view chosen by the operator. Some scanning systems permit the user to change the field of
view by varying the sector angle.
A scan converter system displays the image on a high-resolution video monitor. During scanning, the
converter assigns discrete shades of gray (grayscale) to the returning echo amplitude levels; the number of shades
depends on how many bits of information can be stored for each point of image memory. Some scanners offer
user-selectable preprocessing and postprocessing features that permit the operator to optimize the image quality
by altering the texture and grayscale emphasis within the image. The scan converter also permits freeze-frame,
which captures a single real-time frame for display and analysis.
Some scanning systems are capable of performing real-time three-dimensional (3-D) ultrasound, which
involves volume-per-second acquisition and display for volume measurements, improved image presentation,
and volume-of-interest studies. 3-D images can be produced by direct online 3-D acquisition, with a transducer
scanning a volume instead of a slice of the tissue. Another method is the reconstruction of previously acquired 2-
D cross-sections or tomograms in an offline procedure. An advantage of 3-D ultrasound is that it can simulate
intraoperative visualization. 3-D ultrasound images may be clinically useful for cardiac, blood-flow, ophthalmic,
brain, prostate, renal, and fetal imaging, as well as for surgical planning.
On some systems, the operator can magnify (zoom) the display for further examination and can also store
images on hard disks or magneto-optical disks or transfer them via networks for storage on picture archiving and
communication systems (PACS). (For more information, see the Product Comparison titled Picture Archiving and
Communication Systems (PACS), Radiology.)
Many ultrasonic scanning system suppliers incorporate the National Electrical Manufacturers Association
Digital Imaging and Communications in Medicine (DICOM 3.0) Standard on their scanning systems. The purpose
of this standard is to allow digital images produced by any medical device to be stored and transferred through
PACS or other means, regardless of the device supplier.
The maximum display depth of a system indicates the depth for which space is provided on the display, rather
than the actual penetration by the ultrasound energy, which is based on many factors, including transducer and
signal-processing characteristics. The display depth, the size or field of view of the displayed image, and the
image focus are usually operator selectable.
Scanned structures can be measured using digital calipers—cursors electronically superimposed over the
scanned cross-sectional image that calculate the size of the scanned structure. The caliper system can also be used
to plot and measure the area, circumference, or volume of a structure. In obstetric applications, gestational-age
programs use digital caliper measurements to calculate the age of the fetus.
A data-entry keyboard permits information such as patient name, date, and type of study to be entered and
displayed along with the scanned image. In some systems, an alphanumeric keyboard interacts with a computer
to permit manipulation of the displayed image or system operating parameters.
Doppler imaging
Many scanners now include Doppler capability to determine the
direction and speed of blood flow. Most scanners include spectral
Doppler, either continuous-wave (CW) or pulsed-wave (PW). CW
Doppler, the simplest spectral Doppler mode, is commonly used for
blood-flow analysis in which vessel-depth information is not
important; it receives information from all the moving reflectors in the
path of the beam. CW Doppler is able to provide accurate
measurements of blood velocity through the sample area. PW Doppler
is used when depth selectivity is required, but it cannot be used for
higher velocities because of the problem of frequency aliasing; when
the pulse-repetition frequency (PRF) is too low to adequately sample
the Doppler frequency shift, aliasing causes high-velocity blood flow in
one direction to be displayed as flow in the opposite direction. To
resolve the problem of aliasing, the PRF can be increased or a lower-
frequency transducer can be used. Some scanners allow the use of a
high pulse-repetition frequency (HPRF) Doppler mode—a function
that corrects for aliasing by increasing the PRF for a sample volume
depth. PW Doppler allows the operator to select the area of interest for
flow analysis using cursors superimposed on the 2-D image. PW
depth-selective information is obtained by acoustic pulses emitted from
the transducer, allowing the precise location of the target area, as well
as the flow, to be determined.
Spectral Doppler includes a spectrum analyzer to display frequency shifts plotted against time, with grayscale
intensity varying with the received signal’s strength or amplitude. The spectrum analyzer may also employ fast
Fourier transform (FFT), a high-rate sampling method that analyzes the Doppler-shift signals and performs
complex calculations on them. FFT analyzers typically produce peak and mean displays. The peak display
provides a linear-time waveform that represents the maximum instantaneous velocity present. The mean display
provides a linear-time waveform that represents the statistical mean velocity of all velocities present.
Commercially available spectrum analyzers incorporate various permutations of these displays, but the basic
peak and mean should be adequate for most clinical applications.
Some units provide a simultaneous display of real-time and 2-D imaging and Doppler. Other units freeze the
2-D image when Doppler is engaged; if the transducer or patient moves, however, it can be difficult to determine
the precise anatomic location of the blood flow being measured. Thus, some units update the 2-D image at
adjustable intervals, although the Doppler shuts off during the 2-D update. True simultaneous (duplex) scanners
allow the 2-D image to remain in real time (although at a lower frame rate) while the Doppler beam provides flow
information.
Doppler color flow mapping (CFM) simultaneously assesses the direction and relative velocity of blood flow at
multiple points along multiple beam paths. The result is an image of the hemodynamics of vessels. As
conventional 2-D real-time techniques display the anatomic features in black and white, color superimposed on
this image visually depicts the direction and average velocity of blood flow. CFM complements and enhances the
diagnostic value of conventional 2-D real-time images, as well as provides more information about and enables
better quantification of the direction and velocity of blood-flow abnormalities.
Like color television, CFM uses combinations of primary colors. In cardiac and other vascular studies, red and
blue hues are commonly used. White shades are often added to the colored background to indicate higher flows,
such as those caused by stenotic valves or narrowed vessels. In addition to blood-flow direction, mean flow rate
and degree of variance can also be depicted by CFM.
Many scanning systems are capable of power Doppler imaging, which can be used as an adjunct to CFM.
Power Doppler displays the integrated power of the reflected signal in the conventional color-flow Doppler
technique. It increases the flow sensitivity of color Doppler imaging and provides good results even at angles
perpendicular to the direction of flow, which cannot be visualized at all with standard Doppler. This technology
can produce images of structures not normally seen sonographically. However, power Doppler provides no
quantitative data, such as flow rate or direction.
Some systems offer a triplex mode, which simultaneously acquires and displays 2-D grayscale, spectral
Doppler, and color-flow data. The triplex mode is used in the quantification of blood flow and flow anomalies in
small vessels to improve placement of the Doppler sample volume.
Harmonic imaging
Harmonic imaging (HI) is a sonographic technique designed to provide images of higher quality than those
provided by conventional techniques. Harmonics are frequencies that occur at multiples of the fundamental or
transmitted sonographic frequency. In HI sonography, ultrasound is transmitted at one frequency and received at
twice that frequency. This technology was initially used in conjunction with contrast echocardiography to
enhance myocardial contrast visualization. The principle of the technique is based on the fact that microbubbles
resonate when they come in contact with ultrasonic frequencies. The oscillation of the microbubbles triggers
“backscatter,” which is usually at a higher frequency than the original ultrasound frequency. Since signals
emanating from microbubbles are much more likely to contain harmonics than signals returning from tissue,
most of the higher frequency sensed is due to echo contrast. The returning high-frequency signal can be isolated
from the fundamental signal by use of a filter or addition of inverted fundamental pulses. This allows the image
to be produced by the high-frequency signal alone. Generating 2-D images from harmonic frequencies improves
image quality by improving resolution and reducing artifacts in the harmonic signal so that the signal-to-noise
ratio is improved. Recently, studies have found that the use of HI without contrast agents also results in enhanced
echocardial visualization (Caidahl et al. 1998). This has allowed the development of tissue harmonic imaging
(THI), which is possible because harmonic energy is generated as ultrasound passes through tissue. THI is now
commercially available from several companies.
Reported problems
Ultrasound diagnostic imaging appears to be risk-free when used properly. However, its accuracy depends on
the skill of the operator, who must continuously and carefully adjust transducer direction and instrument
controls to avoid artifacts in ultrasound images, which can significantly degrade image quality and possibly lead
to an incomplete or incorrect diagnosis. In addition to routine quality assurance procedures, the scanner must be
maintained properly in accordance with its manufacturer’s technical support service.
Ultrasound transducers should be handled carefully to avoid damage. A quality control program should
include frequent testing of transducers and system performance with standard ultrasound phantoms to evaluate
lateral and axial resolution, distance accuracy, sensitivity, uniformity, and hard-copy appearance.
Electromechanical problems, such as cracks in piezoelectric elements, can alter beam width and/or spatial pulse
length, thereby affecting lateral and axial resolution.
Errors in distance measurements can cause incorrect calculations. An error margin of 2% or less measured over
10 cm is considered acceptable for most ultrasound systems. The appearance of the hard-copy image should be
the same as that of the image on the monitor. Most manufacturers can supply a test pattern on software to
evaluate the performance of the recording device.
Purchase considerations
ECRI Institute recommendations
Included in the accompanying comparison chart are ECRI Institute’s recommendations for minimum
performance requirements for general-purpose ultrasound scanners; recommended specifications have been
categorized into three groups based on specific clinical applications. General-purpose scanners are routinely used
for imaging abdominal organs. Diagnoses of disease, cysts, and tumors can be made from the anatomic formation
(e.g., size, texture, location) provided by ultrasound scans. Basic Doppler capabilities enhance evaluations of
abdominal organs, allowing further diagnosis by providing information on blood flow.
General-purpose scanners with OB/GYN capabilities are used to investigate a variety of gynecologic
abnormalities, including infertility; to detect the presence and condition of a fetus; to investigate the blood supply
to the fetus; and to monitor fetal growth throughout pregnancy. Ultrasonography is also useful in guiding
amniocentesis and other invasive procedures. Obstetric analysis packages provide valuable information,
including gestational age, fetal weight, and fetal growth calculation, and some are also capable of report
generation. Endocavity transducers are available for use with gynecologic imaging. Comprehensive OB/GYN
studies require a full-featured system, which is used in a hospital’s radiology department, OB/GYN department,
or imaging center or in OB/GYN offices in which comprehensive obstetric ultrasound examinations are
performed.
Some general-purpose scanners can be equipped with specialized high-frequency small-parts probes for use in
thyroid, breast, scrotum, neonatal brain, and musculoskeletal evaluation. Endocavity transducers are available on
some general-purpose scanners for prostate screening. General-purpose abdomen and small-parts studies require
a full-featured system, which is typically used in a hospital’s radiology department or imaging center.
General-purpose scanners with vascular capabilities provide flow profiles of vessels throughout the body,
enabling clinicians to diagnose arterial and venous abnormalities and their causes. Doppler further extends
vascular techniques by providing flow detection in vessels, such as those found in organs and tumors and in
extremities. Spectral Doppler analysis packages can perform calculations automatically. A comprehensive
vascular study requires a full-featured system, which is used in a hospital’s radiology department, cardiology
department, or noninvasive vascular lab or in a vascular surgeon’s office. Examinations include comprehensive
extracranial and peripheral vascular studies.
Other considerations
When purchasing an ultrasonic scanning system, facilities need to consider six basic issues: functions and
features, cost, ease of use, upgradeability, image storage, and customer support. Some suppliers now provide
remote diagnostics whereby scanning system functions can be monitored at a remote location through a modem.
Ultrasound accreditation
Within the last several years, the American College of Radiology, the American Institute of Ultrasound in
Medicine, the Intersocietal Commission for the Accreditation of Vascular Laboratories, and the Intersocietal
Commission for the Accreditation of Echocardiography Laboratories introduced accreditation programs for
hospital- and office-based ultrasound practices. These voluntary accreditation programs were created to ensure
the quality of ultrasonic imaging because significant variations in image quality have been found among hospitals
and offices. In the United States, healthcare payers and managed care providers can insist on ultrasound
accreditation as a condition for being a referral site or for reimbursement.
Cost containment
Since ultrasound systems entail ongoing maintenance and operational costs, the initial acquisition cost does
not accurately reflect the total cost of ownership. In today’s competitive ultrasound market there are, in general,
few significant technical differences between high-end ultrasound scanners manufactured by the market leaders.
Therefore, a purchase decision should be based on issues such as life-cycle cost (LCC), local service support,
discount rates and non-price-related benefits offered by the supplier, and standardization with existing
equipment in the department or hospital (i.e., purchasing all ultrasound scanners from one supplier).
An LCC analysis can be used to compare high-cost alternatives and/or to determine the positive or negative
economic value of a single alternative. For example, hospitals can use LCC analysis techniques to examine the
cost-effectiveness of leasing or renting equipment versus purchasing the equipment outright. Because it examines
the cash-flow impact of initial acquisition costs and operating costs over a period of time, LCC analysis is most
useful for comparing alternatives with different cash flows and for revealing the total costs of equipment
ownership. One LCC technique—present value (PV) analysis—is especially useful because it accounts for
inflation and for the time value of money (i.e., money received today is worth more than money received at a
later date). Conducting a PV/LCC analysis often demonstrates that the cost of ownership includes more than just
the initial acquisition cost and that a small increase in initial acquisition cost may produce significant savings in
long-term operating costs. The PV is calculated using the annual cash outflow, the dollar discount factor (the cost
of capital), and the lifetime of the equipment (in years) in a mathematical equation.
The following represents a sample seven-year PV/LCC analysis for a general-purpose ultrasound system.
PV = ($620,970)
Other costs not included in the above analysis that should be considered for budgetary planning include those
associated with the following:
Software upgrades not covered under warranty or by the service contract
Fulfillment of accreditation program requirements
Optional specialty probes
Optional image-archiving or data-analysis system
Other disposables and accessories, such as biopsy needles, phantoms, probe covers, contrast agents,
cleaning solutions, and procedure trays
Utilities
Contributions to overhead
As illustrated by the above sample PV/LCC analysis, the initial acquisition cost is only a fraction of the total
cost of operation over seven years. Therefore, before making a purchase decision based solely on the acquisition
cost of an ultrasound system, buyers should consider operating costs over the lifetime of the equipment.
For further information on PV/LCC analysis, customized analyses, and purchase decision support, readers
should contact ECRI Institute’s SELECTplus™ Group.
Hospitals can purchase service contracts or service on a time-and-materials basis from the supplier. Service
may also be available from a third-party organization. The decision to purchase a service contract should be
carefully considered. Because ultrasound systems tend to be highly reliable (many suppliers have a 99% to 100%
uptime guarantee), the financial risk associated with not purchasing a service contract may be minimal. However,
the decision to purchase a service contract can be justified for several reasons. Most suppliers provide routine
software updates, which enhance the scanner’s performance, at no charge to service contract customers.
Furthermore, software updates are often cumulative; that is, previous software revisions may be required in
order to install and operate a new performance feature. Purchasing a service contract also ensures that preventive
maintenance will be performed at regular intervals, thereby eliminating the possibility of unexpected
maintenance costs. Also, many suppliers do not extend system performance and uptime guarantees beyond the
length of the warranty unless the system is covered by a service contract. Because transducers and hard-copy
imaging devices are the components of the system most prone to failure or damage, they should be included in
the service contract.
ECRI Institute recommends that, to maximize bargaining leverage, hospitals negotiate pricing for service
contracts before the system is purchased. As a guideline, full-service contracts typically cost approximately 6% to
8% of the ultrasound system’s purchase price. Additional service contract discounts may be negotiable for
multiple-year agreements or for service contracts that are bundled with contracts on other scanners in the
department or hospital. Buyers should also negotiate for a nonobsolescence clause stating that the supplier agrees
not to introduce a replacement system within one or two years and that if a replacement system is introduced
during this time period, 100% of the purchase price can be applied to the purchase of the new system.
In addition, given the current highly competitive market for ultrasound systems, hospitals should negotiate for
a significant discount—many suppliers discount new, fully configured systems from 15% to 25%. The actual
discount received will depend on the hospital’s negotiating skills, the system configuration and model to be
purchased, previous experience with the supplier, and the extent of concessions granted by the supplier, such as
extended warranties, fixed prices for annual service contracts, and guaranteed on-site service response. Buyers
should make sure that applications training is included in the purchase price of the system. Some suppliers do
offer more extensive on-site or off-site training programs for an additional cost.
ECRI Institute recommends that buyers consider the number and types of ultrasound studies performed at
their institution before deciding on a specific system configuration. Also, if multiple scanners are necessary to
handle the patient volume, hospitals should determine the types of scanners and capabilities required in order to
avoid paying for unnecessary analysis packages and scanning features. For instance, a hospital may want to
purchase three scanners: one dedicated to OB/GYN, one to general radiology, and one to cardiac scanning. In this
case, purchasing all three scanners from one supplier could result in a significant discount. Standardization of
equipment can make staff training easier, simplify servicing and parts acquisition, and provide greater bargaining
leverage when negotiating the purchase of new equipment and/or service contract costs.
Given their relatively low capital cost compared to other imaging equipment, ultrasonic scanners are typically
purchased outright; however, leasing more expensive, high-performance systems is becoming more common. In
general, renting is not a cost-effective alternative.
Stage of development
General-purpose ultrasonic scanners have been commercially available for many years. Most have a modular
design that can be easily upgraded to include specialized functions, such as cardiac scanning and/or spectral
Doppler and CFM, permitting users to keep pace with the rapidly changing technology of ultrasonic imaging.
Given its low cost relative to other imaging technologies (approximately $20,000 to $300,000, depending on
system configuration), its noninvasiveness, the absence of ionizing radiation, and recent improvements in image
quality, ultrasound is now a preferred medical imaging technique.
Current trends are directed toward the use of digital processors to provide image enhancement, improved
resolution, analysis of tissue characteristics, and new transducer scanning techniques. This introduction follows
the larger trend toward the development of all-digital radiology departments. Applications have now expanded
to include intraoperative ultrasound (the use of ultrasonic imaging to aid in surgery), harmonic imaging,
ultrasonic breast imaging, intravascular ultrasound (the use of a miniature high-frequency transducer in a
catheter inserted into the blood vessels), ultrasonic delivery of therapeutic agents, ultrasound tissue
characterization, and ultrasonic contrast agents.
Another ultrasound technology that is quickly gaining acceptance is breast sonography for detecting cancer
and directing aspirations, wire localizations, and core biopsies. Ultrasound reflects the acoustic characteristics of
breast tissue and is well established as an ancillary technique for evaluating breast lesions. Because it is
nonionizing, ultrasound is particularly advantageous for evaluation of palpable masses in young, pregnant, or
lactating women. Ultrasound examination can overcome much of the decreased sensitivity of mammography in
patients with radiographically dense breasts that can make it difficult to distinguish cancer tissues from normal
glandular tissue. It can differentiate cysts from solid masses seen on mammograms or found on palpation.
Because taut compression is not required, it can be useful in evaluating a painful, inflamed breast to determine if
a focal, drainable abscess is the problem. It can also be helpful when no mammographic abnormality is seen in a
clinically suspicious area of the breast. However, ultrasound cannot detect all solid masses, nor can it consistently
show microcalcifications. Overall, sonography of the breast is an extremely useful examination, particularly as an
adjunct to mammography and physical examination.
In addition to examination of the breast, sonography is also being used to guide procedures such as
percutaneous cyst aspiration, hook-wire localization, fine-needle aspiration, and large-needle core biopsy of the
breast. For these procedures to be performed safely, the shaft and tip of the needle must be well visualized to
allow for accurate needle placement. Transducer-mounted needle guides, needles designed with central
apertures, and complex electronic guidance systems have been developed to facilitate accurate needle placement
and assist in these procedures. Electronic beam steering is also in development for use in sonographically guided
needle interventions. This technique can considerably enhance the visibility of needles used in interventional
procedures, thus increasing the safety and allowing more rapid performance of the procedures.
The use of contrast agents has recently been very successful. A number of different contrast agents are now
commercially available, and others are being developed and tested as this technology continues to develop and
improve. Software packages that compensate for artifacts, such as those caused by microbubbles in ultrasound
contrast agents, are also available.
Some suppliers can now provide remote diagnostics that monitor device performance from remote locations to
diagnose problems before they become apparent to the user.
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Kanal KM, Kofler JM, Groth DS. Comparison of selected ultrasound performance tests with varying overall
receiver gain and dynamic range, using conventional and magnified field of view. Med Phys 1998
May;25(5):642-7.
Needleman L. Review of a new ultrasound contrast agent—EchoGen-emulsion. Appl Radiol 1997 Oct;(Suppl):8-12.
Nyborg WL. Scientifically based safety criteria for ultrasonography. J Ultrasound Med 1992 Aug;11(8):425-32.
Patterson SL, Monga M, Silva JB, et al. Microbiologic assessment of the transabdominal ultrasound transducer
head. Southern Med J 1996 May;89(5):503-4.
Supplier information
ALOKA
Aloka Co Ltd [139280]
6-22-1 Mure Mitaka-shi
Tokyo 181-8622
Japan
Phone: 81 (4) 22456465 Fax: 81 (4) 22454058
Internet: http://www.aloka.co.jp
E-mail: int-sle2@am.aloka.co.jp
B-K MEDICAL
B-K Medical A/S (Denmark) Sub Analogic Corp [170319]
Mileparken 34
Herlev DK-2730
Denmark
Phone: 45 44528100 Fax: 45 44528199
Internet: http://www.bkmed.com
E-mail: info@bkmed.dk
ESAOTE
Esaote China Ltd An Esaote Group Co [371773]
135 Bonham Strand Trade Centre
Hong Kong
People's Republic of China
Phone: 852 25458386 Fax: 852 25433068
Internet: http://www.esaote.com
E-mail: esaote@esaotechina.com
Internet: http://www.esaote.com
E-mail: esaote.spain@bcn.servicom.es
FUKUDA DENSHI
TeraRecon Inc [371002]
2955 Campus Dr Suite 325
San Mateo, CA 94403
Phone: (650) 372-1100, (877) 354-1100 Fax: (650) 372-1101
Internet: http://www.terarecon.com
E-mail: info@terarecon.com
GE HEALTHCARE
GE Healthcare Asia (Japan) [300443]
4-7-127 Asahigaoka Hino-shi
Tokyo 191-8503
Japan
Phone: 81 (3) 425826820 Fax: 81 (3) 425826830
Internet: http://www.gehealthcare.com.jp
E-mail: hisao.matsuka@gemsa.med.ge.com
HITACHI
Hitachi Medical Corp of America [107620]
50 Prospect Ave
Tarrytown, NY 10591-4598
Phone: (914) 332-5800, (800) 332-2080 Fax: (914) 332-5555
Internet: http://www.hitachiultrasound.com
E-mail: info@hitachiultrasouncd.com
KONTRON MEDICAL
Kontron Medical AG A Charterhouse Co [441506]
Reinacherstrasse 131 Postfach
Baele CH-4002
Switzerland
Phone: 41 (61) 3362222 Fax: 41 (61) 3362200
Internet: http://www.kontronmedical.com
E-mail: infos@kontronmedical.ch
MEDISON
Medison America Inc [155965]
11075 Knott Ave Suite C
Cypress, CA 90630
MINDRAY
Mindray Medical International Ltd [291060]
Mindray Building Keji 12th Road South High-Tech Industrial Park Nanshan
Shenzhen 518057
People's Republic of China
Phone: 86 (755) 26582888 Fax: 86 (755) 26582680
Internet: http://www.mindray.com
E-mail: intl-market@mindray.com
PHILIPS MEDICAL
Philips Medical Systems Asia [188101]
30/Fl Hopewell Centre 17 Kennedy Road
Wanchai
People's Republic of China
Phone: 852 28215888 Fax: 852 25276727
Internet: http://www.medical.philips.com
E-mail: medical@philips.com
SHANTOU INSTITUTE
Shantou Institute of Ultrasonic Instruments [298131]
77 Jinsha Road
Shantou 515041
People's Republic of China
Phone: 86 (754) 8250150 Fax: 86 (754) 8251499
Internet: http://www.siui.com
E-mail: siui@siui.com
SHIMADZU
Shimadzu (Asia Pacific) PTE Ltd [172209]
16 Science Park Drive #01-02 The Pasteur Singapore Science Park
Singapore 118227
Republic of Singapore
Phone: 65 7786280 Fax: 65 7792935
Internet: http://www1.shimadzu.com/products/medical/index.html
E-mail: sales@shimadzu.com.sg
SIEMENS
Siemens AG Siemens Health Services [401832]
Hartmannstrasse 16
Erlangen D-91052
Germany
Phone: 49 (9131) 840 Fax: 49 (9131) 842379
Internet: http://www.siemensmedical.com
E-mail: info@siemens.com
TOSHIBA
Toshiba America Medical Systems Inc [101894]
2441 Michelle Dr
Tustin, CA 92780
Phone: (714) 730-5000, (800) 621-1968 Fax: (714) 734-0362
Internet: http://www.medical.toshiba.com
E-mail: info@tams.com
Note: The data in the charts derive from suppliers’ specifications and have not been verified through
independent testing by ECRI Institute or any other agency. Because test methods vary, different products’
specifications are not always comparable. Moreover, products and specifications are subject to frequent changes.
ECRI Institute is not responsible for the quality or validity of the information presented or for any adverse
consequences of acting on such information.
When reading the charts, keep in mind that, unless otherwise noted, the list price does not reflect supplier
discounts. And although we try to indicate which features and characteristics are standard and which are not,
some may be optional, at additional cost.
For those models whose prices were supplied to us in currencies other than U.S. dollars, we have also listed the
conversion to U.S. dollars to facilitate comparison among models. However, keep in mind that exchange rates change
often.
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