Short track speed skater J.R. Celski did plenty of hard work to become one of the best comeback stories of the 2010 Winter Games, recovering after his thigh was sliced by the blade of his own skate just five months before the competition and going on to win two bronze medals in Vancouver.

Although it didn’t get much attention from the mainstream media, ultrasound played a big role in tracking Celski’s recovery and allowed him to start training for the games earlier than expected, says Dr. Bill Moreau, managing director of sports medicine for the U.S. Olympic Committee, who served as medical director for Team USA at the recent Sochi Games. In fact, the use of ultrasound imaging to diagnose musculoskeletal injuries and track treatment is increasingly becoming the gold standard for U.S. Olympic athletes, surpassing MRI, so it’s no surprise that the musculoskeletal market remains the fastest growing area for ultrasound.

Moreau explains that ultrasound is the best way to distinguish between tendonitis and tendinosis, looking for vascular changes in the tendon and leading to the correct diagnosis. It’s also especially useful for follow- up and assessing whether someone is healing — a noninvasive, low-cost test that is good for both professional athletes and regular folks.

“It takes a lot of the guesswork out of return to play decision making,” Moreau says. “Ultrasound has been around for a long time. Now we can see there’s a much greater focus on it, especially in musculoskeletal medicine.”

It’s been said for years now that ultrasound is in the midst of a revival, with continued efforts to limit radiation exposure and lower health care costs. A recent study by 15 U.S. medical centers showed that although use of CT scans has risen for diagnosing kidney stones, CT is no better than ultrasound, which is less expensive and reduces patients’ exposure to radiation.

In reality, the U.S. market is growing, but the rate has slowed a bit from the double-digit growth seen in 2011. Last year, overall U.S. sales were up nearly 3 percent, according to a report published in April by Klein Biomedical Consultants. There is still a lot of movement in the point of care sector, including the musculoskeletal area, which grew 26 percent in 2013, according to the report.

The Klein report predicts the U.S. ultrasound market will grow to $1.88 billion by 2018, representing an annual rate of growth of 5.8 percent, while the firm Transparency Market Research predicts that the global ultrasound market will grow steadily over the next several years, at an estimated compound annual growth rate of nearly 5 percent.

“The trend line isn’t probably as steep as we would have predicted,” says Brian Murphy, vice president of ultrasound marketing and sales for Esaote.

Health care providers are still working under the volume-based approach and can be less willing to invest in ultrasound, Murphy says.

“There are a lot of transitions going on,” Murphy says. “Physician practices are being purchased by hospitals, people are still adapting to the Affordable Care Act. When that happens, I do believe ultrasound is a perfect storm.”

Point-of-care diagnostics is expected to be a main driver in the marketplace. Manufacturers continue to come out with advances, looking to expand the use of ultrasound in emergency care. There have also been new, FDA-approved products for fusion imaging used in prostate cancer biopsy as well as liver and other abdominal interventions, and also a new product on the market from GE Healthcare for automated breast ultrasound.

Harvey Klein, the president of New York City-based Klein Biomedical, notes that even the fast-growing musculoskeletal market will likely reach its plateau.

“It can’t be growing 20 to 30 percent in a couple of years,” Klein says. “At some point in time there’s going to be saturation.”

Ultrasound for emergency care
Samsung, which entered the ultrasound market in 2010 with the acquisition of Medison, is hoping to expand in the fast-growing point of care segment. Doug Ryan, group vice president for health and medical equipment at Samsung’s enterprise business division, says the company has begun to work in the emergency medicine space, and has been doing a lot of work in emergency medical services, where X-ray and CT are the key imaging modalities.

The company is working with some major medical groups to test the Samsung PT60A, a highly portable and lightweight tablet-based technology for use in triage.

“It’s really going to be a high impact trial for EMS using portable ultrasound to triage patients,” Ryan says.

Importance of workflow automation
Workflow automation is important to health care organizations, notes KLAS Research in its May ultrasound report, which surveyed 178 providers to find out which ultrasound vendors and technologies are delivering the best value and time savings. This year, GE Healthcare led the pack with its Logiq E9, saving an average of seven minutes per scan, the most time across all scan types. Providers praised the Scan Assistant software and the ergonomic features such as ability to easily raise and lower the monitor.

Patricia Venters, chief marketing officer for ultrasound at GE Healthcare, says Scan Assistant was developed with experienced and new stenographers. It’s an “intelligent” program that mimics users’ scanning sequences and helps reduce keystrokes.

Philips, which was virtually tied with GE in the KLAS report for its iU22 ultrasound, has products with various degrees of automation of steps, which enables clinicians to get more predictability.

“The benefit of that is you get high-quality outputs more consistently,” Says Sean Gallimore, vice president of global ultrasound marketing for Philips. “It reduces the amount of steps and the amount of time to do exams. It also ends repeat exams.”

Philips also redid its entire beam-forming capability in the transducer for its EPIQ ultrasound system, which launched last year and is used in cardiovascular imaging. The company used “massive parallel processing for precision beam forming,” Gallimore says.

“Typically what the compromise is, either you have to give up frame rate or penetration to get image quality,” Gallimore says. EPIQ provides “more consistent image quality throughout the field of study.”

In fact, Klein partially attributes a decline in the cardiology sector to the late introduction of the Philips EPIQ system, which he considers to be the next wave of premium systems. The expectation of the launch stalled the market and shipments of the system were too late in the year to have a positive impact on the growth of the cardiology market.

Siemens’ ultra-premium ACUSON S3000 ultrasound system also received very good reviews based on data in the most recent KLAS report, with providers raving about image quality from the system’s higher-frequency, curved-array transducer. The S3000 system, along with the rest of the ACUSON S family of ultrasound systems, recently received further enhancements with the new HELX Evolution release, which debuted last December.

“The initial customer feedback regarding the ACUSON S3000 has been remarkable,” says Jeffrey Bundy, CEO of the Siemens ultrasound business unit. “And now, with the improvements delivered by the HELX Evolution release in terms of image quality, operational efficiency and workflow, we feel that the ACUSON S3000 system is well positioned to become a huge leader in the ultrasound arena.”

Smarter biopsy
Dr. Jeffrey Lumerman, a urologist who practices in Garden City, N.Y., has been using the UroNav fusion biopsy developed by Invivo, a subsidiary of Philips Medical Systems. Generally, ultrasound-guided biopsy is done after a prostate-specific antigen (PSA) blood test comes back positive. The new technology fuses MRI and ultrasound images to provide a more comprehensive picture of the prostate and uses a technology similar to GPS navigation, allowing doctors to better target the biopsy. The MRI shows areas where doctors are more likely to find significant cancers.

“You can biopsy the prostate in a way where you’re targeting the areas where you’re more likely to find something significant,” Lumerman says. “We’re detecting the prostate cancer more readily. This is a substitute for doing these random incidental biopsies.”

Lumerman and his group have done more than 50 biopsies using the technology since the beginning of the year and almost all the doctors in his group are routinely using it.

“This is the future,” Lumerman says. “The advantage of this is once you find this cancer, you know in three dimensions exactly where it is. You can target treatment. Now that you know where it is, you may be able to treat just that area. And all the side effects may go away because you’re only treating this area.”

In May, Esaote received FDA clearance to market and sell its Virtual Navigator ultrasound fusion imaging software. The software fuses real-time ultrasound images with MR, CT or PET.

Tomo Hasegawa, head of the ultrasound division for Toshiba, says the company is seeing a lot of activity in ultrasound purchasing specifically for biopsy. The company offers Smart Fusion, which syncs previously acquired CT and MR images with live ultrasound side by side, on its premier ultrasound system, the Aplio 500.

“Even though Medicare is backing off on codes for ultrasound-guided procedures, it’s still a growth area,” says Hasegawa, who mostly sees the technology used for liver biopsy.

Elastography — used to measure tissue stiffness to help physicians distinguish stiffer tissue indicative of malignant tumors from softer, healthy surrounding tissues — is another emerging ultrasound technology.

“You’ll find some people who actually swear by it and others who won’t touch it,” says Esaote’s Murphy. “It’s likely that elastography could replace prostate biopsy.”

Ultrasound also continues to make its way into breast imaging. Last year, GE Healthcare introduced the Invenia Automated Breast Ultrasound System, used to detect cancer in women with dense breasts, and is the only manufacturer with an ultrasound system that is FDA approved for breast cancer screening. The Invenia ABUS features new automated compression tools for enhanced workflow and ergonomics and reverse curve transducer that lets providers get images in less time, compared to previous versions of the technology, according to the company.

Microvascular flow
What Hasegawa and those at Toshiba are really excited about is a technology that provides the capability of imaging microvascular flow with superior detail and definition. The company provided a preview of the technology at last year’s RSNA, and they plan to bring it to the marketplace by early July. Such visualization can only be done through MR or CT with contrast agents.

“Just the possibility that you can get the same kind of resolution with ultrasound without the contrast is something we’re really, really excited about,” Hasegawa says. “Early investigators have validated that excitement.”

Meanwhile, in the cardiology sector, there’s been a lot of attention surrounding quantifying wall motion, or motion of heart muscle, and Hasegawa says that the company is working with some of the leading cancer centers to research the effects of chemotherapy on the heart. Oncologists have long recognized that too much chemotherapy can lead to heart failure, which is asymptomatic.

“Having this system give you a number that is associated with how well the heart is contracting has been shown to be a very good leading indicator,” Hasegawa says. “It’s so practical and so compelling that I think some of these more advance cancer centers are starting to bring it in.”

More MSK advancement?
Last year, Siemens began shipping its ACUSON Freestyle system, an ultrasound system that features wireless transducers. Siemens is the first company to introduce a system with cable-free transducers, and while it has many uses in interventional radiology, as well as critical care, cath lab, or emergency care, it is particularly useful in the musculoskeletal market, Bundy says.

Moreau has been working with a colleague, Dr. Dustin Nabhan, on some areas of exploration for ultrasound. While traditionally the primary application is for imaging soft tissue, they recently published a case study in which they used ultrasound to examine the osteochondral surface. They are also exploring ultrasound for the differential diagnosis of hip and groin pain.

“We hope the things that we do will help the people on Main Street,” Moreau says. Moreau says that in the future he sees technology that will fuse ultrasound images with X-ray.

“The opportunity to couple images to multiply the effect of the information that you’re trying to obtain, I think that that’s right around the corner,” Moreau says.

Click here to check out the DOTmed Virtual Trade Show for Ultrasound.

DOTmed Registered HCBN July 2014 - Ultrasound Companies

Names in boldface are Premium Listings.
Domestic
Bill Ward, Freedom Imaging, CA
Ted Huss, Medical Imaging Resources, CA
DOTmed Certified
Moshe Alkalay, Hi Tech Int'l Group, FL
DOTmed Certified
Robert Guyton, Manifest Medical, FL
DOTmed Certified
Lamar Gale, Gale Medical, LLC, GA
DOTmed Certified
DOTmed 100
Heather Sudduth, Ultrasound Imaging Technology, Inc, GA
DOTmed Certified
John Gladstein, Medical Device Depot, MD
DOTmed Certified
John Bailey, BMX Medical, Inc., MN
Michael Zanish, Pro Select Services, MN
David Blumenthal, DOTmed.com, Inc., NY
Darlene Benavidez, Better Imaging Solutions, Inc., AZ
DOTmed Certified
Mohamed El Baz, RC Medical, Inc., CA
DOTmed Certified
Duc Dang, 2D Imaging, Inc., CA
Robert Harris, Imaging Associates, Inc., NC
DOTmed Certified
Jonathan Ames, KPI Ultrasound, CA
DOTmed Certified
DOTmed 100
Grant Norris, Associated Imaging Services, KS
DOTmed Certified
DOTmed 100
Tony Orlando, Complete Medical Services, MI
DOTmed Certified
DOTmed 100
Robert Manetta, Nationwide Imaging Services, NJ
DOTmed Certified
DOTmed 100
George Hrtshchuk, Advanced Ultrasound Electronics, OK
DOTmed Certified
DOTmed 100
Lynne Gillooly, Lillooly Ultrasound, NC
Gary Mansfield, Absolute Imaging Solutions, NC
Brian Kosar, Providian Medical Equipment LLC, OH
Josh Sutton, Focused Medical Equipment, FL
Mike Sweeney, National Ultrasound, GA
Chris Wright, Axess Ultrasound, IN
Mike Feinstein, Samsung, NJ
Rachel Miller, Toshiba America Medical Systems, CA
Christopher McHan, Neusoft Medical Systems USA, Inc., TX
Judy Barton, Supersonic Imagine, WA
Charlie Jahnke, MedPro Imaging, Inc., WI
DOTmed Certified
April Lebo, Trisonics, PA
Patrick Hardy, Sentinel Imaging, PA
DOTmed Certified
DOTmed 100
Elmer J. Rudd, CO
DOTmed Certified
DOTmed 100
David Denholtz, Integrity Medical Systems, Inc., FL
DOTmed Certified
DOTmed 100
John Pereira, United Medical Technologies, FL
DOTmed Certified
DOTmed 100
Oswaldo Gui, Let Medical, FL
DOTmed Certified
Derrell McCrary, Choice Medical Systems, FL
DOTmed Certified
DOTmed 100
Mark Asmer, MedCorp, FL
DOTmed Certified
DOTmed 100
Volodymyr Markevych, Vomark Techologies, IL
DOTmed Certified
DOTmed 100
Beau White,, Advanced Imaging Healthcare, IN
DOTmed Certified
Robert Serros, Amber Diagnostics, FL
DOTmed 100

International
Lakshmi Narayana, Man Machine Electronics, India
DOTmed Certified
DOTmed 100
JALAL ABUELSAUD, DARALFIHA FOR MEDICAL EQUIPMENT, Saudi Arabia
David Perez, PEKMEDICAL, Mexico
Sebastian Tautscher, Lysis - Individual Healthcare Solutions OG, Austria
DOTmed Certified
DOTmed 100
Guenther Perhofer, Mides, Austria
DOTmed Certified
David Lapenat, ANDA Medical, Canada
DOTmed Certified
DOTmed 100
Welshen Gao, DODODO Medical Equipment, China
DOTmed Certified
DOTmed 100
Mads Vittrup, AGITO Medical, Denmark
DOTmed Certified
DOTmed 100
D.R. Reddy, Intrasyss, India
DOTmed Certified
DOTmed 100
Niranjan Kumar, India Ultrasound, India
DOTmed Certified
DOTmed 100
Karen LaSaga, CCE Medical Equipment, Canada
DOTmed Certified