Smaller units offer improved workflow and productivity for pennies on the dollar compared to their larger cousins
Ultrasound usage in cardiology has been a market historically dominated by larger, cart-based systems, which offered more power and rapid processing and visualization over earlier generations of smaller, more portable units. Over the last few years, however, the cardiac ultrasound market has started to shift, churning out increasingly compact yet powerful machines, with an inexpensive price differential compared to the more traditional systems.
The miniaturization of cardiac ultrasound equipment has evolved from catheter-tipped transducers for transesophageal, intravascular and intracardiac echocardiography to small full-featured ultrasound machines to compact devices no bigger than many laptop computers. The evolution continues, as manufacturers seek more ways to improve the technology of compact echoes, making them more accessible, affordable, portable and powerful, holding the promise to improve productivity and efficiency, as well as maintain a healthy bottom line.
“We have seen a trend toward miniaturization, but with more sophisticated systems that are penetrating the market quickly,” says Ravindra Sharma, analyst with Millennium Research Group (MRG). For example, the cardiac ultrasound market is set to increase at a compound annual growth rate of 5.1 percent from 2008 to 2012, and the overall sales for the total cardiac ultrasound market are expected to be $450 million in the U.S.
“We also think that the procedure volumes for cardiovascular ultrasound are increasing, driven by an aging population and the prevalence of risk factors like obesity and diabetes, as well as an increased awareness in the general population about cardiovascular diseases,” Sharma adds.
As the Baby Boomer generation reaches its golden years—almost 60 million Baby Boomers will be over 65 by 2031—its members also will reach the peak of their cardiovascular care years, and cardiology is looking for ways to deliver better, faster care at a patient’s bedside. Cardiovascular information system (CVIS) investments enable anywhere, anytime access to healthcare data, which is critical to improving productivity and workflow. It’s also critical to invest in devices that enable cardiologists to obtain critical cardiac data faster and more efficiently, ultimately leading to better patient care.
Bells and whistles
Choosing a compact echo system, and choosing among the various enhancements and features, can be challenging and often depends on the clinical needs of the business. The technology continues to improve for compact echo systems. Better transducers improve penetration in difficult-to-image patients and reduce acoustic noise, so clinicians can view structures in finer detail. Adaptive image processing, as well, helps reduce noise and improve clarity and edge definition.
From a laptop, clinicians can now obtain real-time 2D, 3D and 4D imaging, as well as Doppler data during semi-invasive or invasive procedures, including transthoracic and intracardiac echo, transesophogeal echo (TEE), carotid artery and saphenous vein evaluation, dobutamine stress echo, tissue velocity imaging and intima-media thickness measurements.
Taking the lab to the in- & outpatient
The adoption of hand-carried ultrasound units in cardiology was approximately 6 to 8 percent in unit growth sales in 2008, according to MRG. It is expected to increase to 12 to 16 percent in the next few years, driven by economics, mobility and footprint advantages. With at least a 30 or 40 percent price differential from the larger, traditional units, cost can be a factor in determining whether to purchase a compact echo system.
For some like Richard V. Milani, MD, director of noninvasive laboratories at Ochsner Clinic Foundation in New Orleans, cost isn’t the key factor in choosing a compact unit. “The question really is about maneuverability and getting close enough to patients, especially in the ICU setting, which is replete with machines and ventilators. It can be a daunting task to pull off,” Milani says.
Compact portable echoes can be used throughout the day in almost any capacity including transthoracic and transesophageal cardiology applications. In the outpatient lab, the decision to purchase larger or smaller units takes some attention to detail. “If I were to start a business tomorrow, I wouldn’t purchase 20 compact echoes for use in an outpatient lab, because it’s easier to use the larger units in that setting,” Milani says. The key factor is volume.
At the Ochsner Clinic, for example, the compact echo device is used as an extra TEE unit, since the clinic has a high-volume lab performing at least five to 10 TEEs a day. “We have two outpatient suites and we use the compact system as a second unit in one of those suites when volume is down in the inpatient setting,” Milani says. If there is enough business to keep the compact system “running hot” in an inpatient setting, then it makes sense to have them.
In addition to cardiac imaging, the clinic also does vascular imaging, which allows physicians to do a multitude of functions with the one compact device. The true business advantage of these systems comes from time-savings and improvements in workflow and productivity as cardiology imaging volumes ebb and flow. Determining the number of systems to purchase is based on how long it takes to complete a study and the amount of volume per day.
Small, portable systems make sense, as long as the image quality can aid in diagnosis. If poor image quality from a handheld system results in inconclusive data, the possibility of repeat exams means additional time and money. However, manufacturers have been working continuously on improving the drawbacks experienced with the first-generation compact systems.
“The general disadvantage from these portable systems had been that the image quality was not quite the same as the full-service machines,” says Richard A. Grimm, DO, director of the echo lab at the Cleveland Clinic. “The pursuit in the ultrasound industry has been to provide a machine that is the equivalent to the more fully capable equipment in the larger package.”
The Cleveland Clinic is using compact echo systems in both the inpatient and outpatient settings. Portables are universally used for inpatients and the priority locations are the ICU and the hospital wards. “We can do echo at the bedside in wards or at ultrasound labs,” says Grimm.
The compact systems do not replace the full-sized systems, Grimm says. “In our environment these compact machines are part of the equipment that we have available, part of the imaging armamentarium.”
As long as compact systems are near in performance to the more full-service machines for fundamental imaging, it’s a “no-brainer” from a business standpoint, Grimm suggests. “They will be useful and well accepted as long as the image quality and the performance capability support the standards and demands of the facility.”