Diagnostic Ultrasound

Bill to close Stark bill loophole won't affect ultrasound

A bill introduced in congress that is created to close a loophole in which Physicians can self-refer diagnostic imaging services does not cover ultrasound, X-Ray, nor fluoroscopy studies. This is a big deal with the recent boom of physician-based ultrasound in which many physicians are bringing ultrasound units into their offices for a wide variety of imaging needs. A link to the story from AuntMinnie.com follows:

 

Quoted from http://www.auntminnie.com/index.asp?Sec=sup&Sub=imc&Pag=dis&ItemId=86437&wf=3193&d=1:

Legislation has been introduced into the U.S. House of Representatives that would close a loophole in federal law that enables physicians to self-refer patients for imaging studies as long as the exams are performed in their own offices.

The so-called Stark law in-office loophole has long vexed radiology advocates who see it as a way for nonradiologist physicians to skirt the law's provisions banning physicians from referring patients to entities in which they have a financial interest. Imaging proponents believe physician self-referral is driving higher imaging utilization and, thus, higher healthcare costs.

But the Stark law loophole would be closed under legislation introduced by Rep. Jackie Speier (D-CA), whose Integrity in Medicare Advanced Diagnostic Imaging Act of 2009 (HR 2962) would amend Title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the Stark laws.

The laws would ban in-office self-referral of modalities such as MRI, CT, and PET, but would not cover x-ray, ultrasound, and fluoroscopy studies. It would also not cover imaging services performed for the purposes of radiation therapy treatment planning or in conjunction with an interventional radiology procedure. In addition, it would not cover nuclear medicine exams apart from PET.

The bill currently has no co-sponsors. It has been referred to both the House Energy and Commerce Committee and the House Ways and Means Committee.

Ultrasound,imaging,Stark law,diagnostic ultrasound,in-office ultrasound,physician ultrasound

4D ultrasound with the Acuson Antares

4D,ultrasound,Acuson,acuson Antares,siemens ultrasound,4D ultrasound,shared service ultrasound,ob/gyn ultrasound,value ultrasound,ultrasound reviews,ultrasound ratings,ultrasound rating,ultrasound machine,ultrasounds

Acuson Antares 4D

The Acuson Antares ultrasound surprised us with its 4D capabilities and confirms that manufacturers are finally able to compete with GE's excellent line of Voluson 4D ultrasound machines. In fact, the Acuson Antares provides a more versatile machine than what you'd get out of a Voluson, and provides excellent image quality while doing so. We still like the Voluson a lot for its 4D, but this is an excellent consideration when looking for something that will fit your budget and provide much of the same 4D functionality that will be appropriate for most uses of 4D ultrasound. The bonus is that it has a very good cardiac package as well.

The Acuson (Siemens) Antares 4D imaging is also very similar to what is found on the new Acuson X300 ultrasound. We have a video coming in the next few weeks that will take a look at the X300 and give you an idea of what it looks like and what it can do (although we did not get a chance to do 4D with it).

You can view our Acuson Antares 4D ultrasound machine video here. It will also be posted to YouTube in the near future and we'll post the video here when it's all done. Please don't hesitate to write me if you have any questions or if you'd like more information on the Antares or any other ultrasound machine. We know what we're doing.

Thanks,

Brian

Video: Acuson X150 ultrasound

x150,acuson ultrasound,siemens ultrasound,acuson x150,inexpensive ultrasound,new ultrasound,ob/gyn ultrasound,anesthesia,endocrinology,podiatry,emergency,general ultrasound,breast ultrasound,gps medical,gpsmed,ultrasound review,ultrasound reviews,ultrasound video

Our latest quick video of ultrasound equipment is here. We reviewed the Acuson X150 and the video will give you a good idea of how it functions, what it looks like and an idea of how easy it is to use. Correction: Apparently, there's not a bi-plane transducer at this time, for that you'd still need the G20. By the time you read this, however, it's possible the probe is available. Call me at 866-347-7633 if you have questions.

In a nutshell, it's no secret that ultrasound has come a long way and it's often hard to tell the difference between some of these. The Acuson X150 has a very easy user-interface and is rock-solid. It follows in Acuson's tradition with a commiment to the long-lasting platform that addresses techs and physicians needs. I spoke with the engineers and apps people at Siemens and they're relieved/excited to have a new, solid product line that can, once again, sell itself.

Quoted from http://www.gpsmed.com/acuson_X150.html:

Acuson X150 Ultrasound Machine

We took a look at the Acuson X150 and the above video is a quick synopsis of its ease of use and outstanding quality. It's a mid-range system at a low-range price. With solid color Doppler, harmonic imaging, easy-to-use interface, and overall excellent image quality, this is EXCELLENT for small-mid size offices performing OB/GYN, Endocrinology, musculoskeletal, anesthesia, vascular, venous, abdominal, breast and many other applications. It's perfect for physician use and is easy to learn and use.

 

GE adds 19th product to "Logiq" series ultrasounds

GE Ultrasound,Logiq ultrasound,GE Healthcare,ultrasound system,diagnostic ultrasound,new ultrasound

Sunday, GE announced that it's adding another system to its already-full line of Logiq series ultrasounds. It now has 19 different "Logiq" series ultrasounds listed on its website. It's like GE is trying to cannibalize itself by confusing the heck out of its reps and customers. Here's the story from DotMed:

Quoted from http://www.dotmed.com/news/story/8991:

DOTmed.com - GE Healthcare Launches New Voluson E6 and LOGIQ PS Ultrasound

CHICAGO, IL -- Today, GE Healthcare (NYSE: GE) launches two new ultrasound systems for the women's health market, the Voluson® E6 and LOGIQ® P3. Both systems are being showcased May 4-6, at the 57th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG), in Chicago at GE Healthcare's booth #1315.

The article goes on to quote Karl-Heinz Lumpi, GM of GE's women's health and specialty ultrasound. He says "The LOGIQ P3 is an economical, compact console ultrasound system offering surprising performance that can help clinicians deliver advanced imaging to OB/GYN practices." I thought that's what they said about the Loigq 3, P5, P6, Logiq 5 and Logiq 5 Pro. Sure, there will be differences, but what customer wants to hear about 19 different products available to them (not including the 6 different Voluson products that are sold to similar markets). I can't imagine this is a fun sales call.

Ultrasound imaging now possible with a smartphone

Portable ultrasound,HCU,Hand carried ultrasound,Acuson P10,Smartphone ultrasound

This came out today from St. Louis' Washington University's website. While the screen is too small to actually get any reimbursement (ala Acuson P10 ultrasound), it would provide some helpful stuff for Emergency Rooms, EMTs, and scanning in rural locations or third-world countries. This technology goes to show how far we've come with the miniaturization of ultrasound in the past few years. Does this replace the console? Absolutely not. Someday you'll have the functionality and image quality of the full console, but the ergonomics are unfriendly and would be a nightmare for techs. We still recommend the full console units for anyone doing more than a few scans per day.

 

Quoted from http://news-info.wustl.edu/tips/page/normal/13928.html:

Ultrasound imaging now possible with a smartphone

Imaging device fits in the palm of a hand



By Tony Fitzpatrick

Computer engineers at Washington University in St. Louis are bringing the minimalist approach to medical care and computing by coupling USB-based ultrasound probe technology with a smartphone, enabling a compact, mobile computational platform and a medical imaging device that fits in the palm of a hand.

William D. Richard, Ph.D., WUSTL associate professor of computer science and engineering, and David Zar, research associate in computer science and engineering, have made commercial USB ultrasound probes compatible with Microsoft Windows mobile-based smartphones, thanks to a $100,000 grant Microsoft awarded the two in 2008. In order to make commercial USB ultrasound probes work with smartphones, the researchers had to optimize every aspect of probe design and operation, from power consumption and data transfer rate to image formation algorithms. As a result, it is now possible to build smartphone-compatible USB ultrasound probes for imaging the kidney, liver, bladder and eyes, endocavity probes for prostate and uterine screenings and biopsies, and vascular probes for imaging veins and arteries for starting IVs and central lines. Both medicine and global computer use will never be the same.

Excellent DICOM, structured reporting solution for OB/GYN, Vascular, Cardiac

DICOM,Ultrasound,Structured Reporting,Accellera,Heartlab,Modality Worklist,Medstreaming

One of the largest concerns my customers face in the ultrasound industry today is the issue of structured reporting and DICOM with their newer or older ultrasound machine. I've seen some neat solutions and have recommended some in the past, but when it came down to really solving all my customers' needs, compromises were made in nearly every situation and I felt I'd been misled a bit. So, I stopped recommending these solutions.

A while ago a friend introduced me to Wael Elseaiidy, a legend in the small world of ultrasound programmers... he created the DICOM solutions for Philips and ATL systems: HDI 5000, IU22 and IE33 ultrasounds. I basically told my friend I was REALLY not interested in hearing about it, but he pushed on and said he'd been recommending this solution to his customers for quite some time, and he had never fallen short or needed to create a compromise. I was intrigued.

My friend was right, this product is different. I met Wael and as it turns out, he didn't duck questions or say "we're working on that." His product is called MEDStreaming, and if you've looked into this market at all, you've probably run across this company. If your research left you with questions about MEDStreaming, I can tell you they're the real thing. I've met them, I've seen the product, and I'm impressed.

Wael and I talked about the new EMR standards, and the fact that video tapes will soon no longer be accepted, and my customers were at a bit of a loss... the other solutions were junk or too expensive. Mr. Elseaiidy outlined the following for me in the meeting about his product's capabilities:

• Vascular, OB/GYN, cardiac structured reporting
• Report generation
• Modality Worklist support with Web-based scheduling
• DICOM data management
• Image Management and connectivity solutions
• Microsoft Office Interoperability
• Automated ICAVL/ICEAL/AIUM Accreditation
• Structured Reporting Based Reporting publishing and data mining
• Structured Reporting Based Data tracking and trending
• Streaming with sound
• CPT/ICD-9 Database
• Side-by-Side exam comparison
• HL7 interfaces
• Wireless HIS/RIS that is HIPPA and IHE compliant

But the key for me and many of my customers is whether it supports their older ultrasounds in a single or mixed environment. It does, but many older systems do not have Structured Reporting, so it's obviously not fully compatible. As of now, it fully supports anything from ATL/Philips from the HDI 5000, SONOS 5500 and newer, Acuson Sequoia, GE Logiq 7 and Logiq 9, newer Siemens systems, SonoSite, and Zonare ultrasound systems. For other systems, drop me a note and I can find out or put you in touch with the folks at MEDStreaming.

I like MEDStreaming as a DICOM, office management solution essentially because it's a relatively simple solution without a manufacturer's intentions in mind. It plays well with all ultrasound systems and it has solutions for your older, non-digital ultrasound systems. Most manufacturer's solutions provide limited capabilities for other manufacturers and it's quite annoying... plus, once you add other functionality the prices get ridiculous.

Other 3rd party solutions cost more than your ultrasounds, and are simply not realistic for smaller offices and hospitals. (And I know I'm going to get hammered with comments from the manufacturers for posting this.)

Since I'm a price/performance guy, this is at the top of my list. Email me if you have questions.

 

Video: Terason t3000 a first look

Ultrasound,Terason ultrasound,acuson p50,hand carried ultrasound,portable ultrasound,GE Ultrasound,laptop ultrasound,anesthesia ultrasound,rheumatoloty ultrasound,vascular,phlebology,vein ultrasound

Here's a quick video I made of the Terason t3000 so you all can see it as well. By no means is this a comprehensive video of its features. I may do that at a future date, but with all the questions I've received, I felt it was important to show just how easy this machine is to use.... it also shows the sliding console and the fact that the "box" is removed from the probe cable. This is my first time posting a video to the site, so I'm testing it here. Let me know if you have troubles viewing it.

Automatic Fetal Biometry?

Obstetric Ultrasound

I don't know how it works and I've never seen it, but Siemens has introduced "Auto OB" software that automatically generates fetal biometry measurements in an ultrasound study. The article from Aunt Minnie Below shows that a University of Hawaii study study shows it to be a successful piece of software. Any readers out there have experience with this? Sounds interesting, but I wonder... if you already have the image, how much time does it save and can it really save from Carpal Tunnel? Regardless, the technology sounds fascinating and I'd love to see it.

-Brian

Quoted from http://www.auntminnie.com/index.asp?Sec=sup&Sub=ult&Pag=dis&ItemId=80479&wf=2414&d=1:

Radiology, Ultrasound Community

"Automation of full ultrasound measurement has great potential for improving productivity and patient throughput, enhancing accuracy and consistency of measurements, and reducing the risk of repetitive stress injury," said Dr. Ivica Zalud of the University of Hawaii in Honolulu. He presented the research findings during a scientific session at the San Diego show.

Automatic measurements can reduce keystrokes and potentially reduce repetitive stress injuries, Zalud said. In addition, they have the potential to improve everyday workflow to increase patient throughput and productivity, and also decrease interobserver variability.

The study team sought to compare the performance of Auto OB software (Siemens Medical Solutions, Malvern, PA) and sonographers in measuring biparietal diameter, head circumference, abdominal circumference, and femur length. They performed two sets of experiments involving five experienced sonographers with at least five years of experience; the first set was designed to assess the performance of the automated approach relative to the expert users in 250 images for each user.

The researchers set a target performance for the automated system for an average error rate of less than 3% in 80% of the cases. In the second set, the researchers sought to compare the automated system with a ground truth generated by five expert users using a set of 10 images per anatomy.

Musculoskeletal Ultrasound could save billions over MRI

msk ultrasound,ultrasound,musculoskeletal ultrasound

The United States could save $736 million annually by using ultrasound instead of MRI for MSK (musculoskeletal) imaging according to a new study in the Journal of the American College of Radiology. The following article is excerpted (the full story is online at Aunt Minnie.com. The study shows that while growth in ultrasound for musculoskeltal imaging has been slower than CT and MRI, it shows that we need to take a closer look at MSK and ultrasound.

The article reports some of the failures in ultrasound, such as lower revenue numbers, and more training needed. However, as the study goes through 2005, the last 3 years of innovation in ultrasound are not included, namely the high resolution portable machines, which offer an advantage over large, expensive machines.

Quoted from http://www.auntminnie.com/index.asp?sec=sup&sub=ort&pag=dis&itemid=80282&wf=2410:

Radiology, News, Education, Service

Study: Picking US over MRI for MSK imaging could save billions

By Brian Casey
AuntMinnie.com staff writer
March 6, 2008

The U.S. could save up to $736 million annually -- and billions over the course of the next 15 years -- if physicians used ultrasound rather than MRI for musculoskeletal imaging when clinically indicated.

That's according to a new study published in the Journal of the American College of Radiology by a multicenter group that includes imaging utilization watchdogs Dr. David C. Levin and Dr. Vijay Rao of Thomas Jefferson University in Philadelphia (JACR, March 2008, Vol. 5:3, pp. 182-188). The lead author on the study was Laurence Parker, Ph.D., also of Thomas Jefferson.

MRI has become the standard of care for imaging a wide range of musculoskeletal disorders, the researchers noted. That preference has been reflected in growth rates for MRI in musculoskeletal imaging: MRI use increased 354% from 1996 to 2005, from 708 studies per 100,000 Medicare beneficiaries to 3,210 studies per 100,000 beneficiaries in 2005.

At the same time, however, growth rates for ultrasound musculoskeletal imaging have been far lower, with the modality usage growing 157.1% over the study period. This is despite the fact that that ultrasound is far cheaper than MRI, with a cost difference of $336 per exam in 2005, according to the researchers. See chart below for a list of growth rates by modality in musculoskeletal imaging.

MSK imaging growth rate, 1996-2005 (per 100,000 Medicare beneficiaries) Modality 1996 2005 Growth CT 138 589 326.5% MRI 708 3,210 353.5% US 147 379 157.1% X-ray 44,153 52,586 19.1% Total 45,146 56,765 25.7%

 

Despite ultrasound's lower growth rate, clinical studies have indicated that for many musculoskeletal applications, ultrasound may offer diagnostic accuracy comparable to that of MRI, according to the researchers. The modality even has certain advantages over MRI, such as the ability to perform dynamic studies.

The researchers sought to examine how much money could be saved if ultrasound were substituted for MRI for a range of musculoskeletal imaging applications in which clinical evidence indicates that ultrasound is at least comparable to MRI. They examined data from the U.S. Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary Master Files (PSPSMF) from 1996 to 2005, as well as data from its own radiology information systems (RIS).

The study included five components:

 

1. Computing musculoskeletal imaging use by modality from 1996 to 2005
2. Predicting future use rates from 2006 to 2020
3. Estimating the cost of MSK imaging by modality
4. Estimating the proportion of MSK MRI procedures for which MSK ultrasound could be substituted
5. Computing the cost savings that would result

To assess the percentage of cases in which MRI exams could have been replaced by ultrasound, the group relied on cases extracted from its RIS over a one-year period, due to the detail of clinical information available in these cases relative to those in the Medicare database. These cases were then analyzed by a panel of three academic attending radiologists, who "examined the body part/diagnosis combinations and made retrospective judgments of what prospectively would have been the best test to answer each clinical question," based on their experience and knowledge of evidence-based imaging literature.

Substitution rates were calculated, both for primary diagnosis and all diagnoses in the report. They found that 45.4% of primary diagnoses and 30.6% of primary and secondary diagnoses could have been made by ultrasound.

The group then calculated cost savings to the U.S. healthcare system by decreasing the MRI utilization rate by the number of substituted cases, and increasing the ultrasound utilization rate. The numbers were extrapolated by multiplying the use rate per 100,000 Medicare beneficiaries by U.S. Census Bureau population estimates for future years.

In calculating average cost factors for each modality, the researchers came up with the following numbers for 2005:

* CT: $276.72
* MRI: $424.73
* US: $88.26
* X-ray: $29.8

A few days with the Terason t3000: Sexy, Cool, and WOW

Acuson P50,Terason t3000,Vivid i,Vivid e,HCU,portable ultrasound,hand carried ultrasound,ultrasound

 

 

There's a great line in the movie Philadelphia in which Denzel Washington says "Explain it to me like I'm a 6-year old". It's been going through my head since Saturday.

I spent some time in the office this weekend, and my inquisitive 8-year old daughter wanted to see what an ultrasound could do (besides 4D babies). I was going over an ATL HDI 5000, Voluson 730, and wanted to spend time with the Terason t3000 I'd received just a few days prior. I told her I'd show her the inside of her body if she was interested.

She was.

After spending time on the other two units, we came to the Terason.

"Is that your computer?" She says. (I bought a MacBook Pro last year.)

"No, but close. It's an ultrasound." I replied.

"You mean like those big things?" she referred to the HDI 5000 and Voluson 730.

"Yeah, but this one is better," I said as I pressed the side keys to release the ultrasound console in a hydraulic-like fashion.

"A-A-A-AWESOME!" She said.

Hearing her reaction, I stood up straighter, smiled broadly, and was really proud... well, for all the wrong reasons. You see, daddy's work just got a lot cooler and, well, it felt great for daddy's ego. Five minutes prior, we spent time watching her carotid artery and jugular... listening to the vein and artery and watching the blood flow through them in all their red and blue glory. Sure, this was cool to her and very educational... but the James Bond ultrasound was a quadruple-"a" "Awesome". Brushed aluminum and things that slide from nowhere are, apparently, much cooler than anatomy. WhatEver!

So it was time to push it a little. I wanted to see if she could figure out this Terason... I figured that if she can figure it out, it's unlikely that a physician new to ultrasound will struggle.

I asked her to turn on color Doppler. Her finger hovered above the "C" on the console, then she looked at me, not scared, but unsure. I told her to go with her instinct. She pushed C and up came a color box. Unafraid. This is important folks.

She smiled. A REALLY big smile. I was proud for the right reasons this time.

I looked at my wife and said "I wish I had a video camera, but I doubt anyone would believe this is her first time using this." Of course, while I'd like to think my daughter is the most brilliant kid on Earth (duh, she totally is).... the point is that the Terason is NOT THAT HARD. I realized that Terason got this right. Yeah, I'm a nerd for being excited, but when trying to sell something to a person who's never used an ultrasound before, EASE OF USE is nearly as important as Image Quality. Frustration leads to bad studies and inefficiency. That's not good when you're driving a needle into someone's body.

So I told my daughter that I wanted to hear her carotid, and she'd need to turn on Pulsed Wave Doppler. She looks down for two seconds and tentatively presses PW.

The sound comes.

Her smile got bigger.

Excited and intrigued, I walked over to the Voluson i we have in-stock, and saw the softkey buttons in different locations; what I once thought was cool (Voluson i) became frustrating and overcooked ... its user interface is just like the Logiq i and Vivid i. I walked back to the Terason: It's elegant. Not perfect, but elegant and functional. Nice.

We stepped over to a Vivid 7. I looked down and didn't want to crush my daughter's now-lifted ego. I didn't need to ask her. I turned it on and before I could say anything, she said "I don't think I can do this one, daddy." Maybe its size was intimidating, I don't know. I imaged her heart on the short axis and told her: "This is what your heart would like if I cut you in a half with a light saber."

OK, so I lose the "dad of the year award," but it was really funny at the time.

So what's the point here?

Techs enjoy consoles. I enjoy the console, and the Terason console is really great for a compact HCU (hand carried ultrasound). But today's market is growing rapidly in the Physician area and I think they'll be like my daughter: Totally comfortable with the Terason because it feels friendly and is friendly. Techs will be the ones who might be a little more tentative at first, while Physicians will likely be relieved. The console serves both sides well. This unit is simply an extension of the PC (When you boot the system, you get a Windows XP desktop, and you can run it completely from the keyboard if you choose). The console is very functional with fewer softkeys than the GE. It's labeled well and acts like any other PC application (because it is a PC application). However, just as if you're coming from any cart-based system: remember that there's only 12-inches to work with, not 24. Things need to be compressed. Get a console if you want a console. If you need portable, you're remiss if you don't call Terason.

Clearly, SonoSite understands this as well, they've taken most of the buttons OFF their machines that are going to physicians. GE adds more. Philips doesn't have anything.

Terason one-ups the latestby using the common, most user-friendly (and coolest) PC on the market: The MacBook Pro.

In the coming week I hope to get a video out on this system and post it for you. I'm also going to do an update on the Portable Ultrasound Market. SonoSite's new products, the t3000 release (Siemens licensed version that will be the Acuson P50), and some rumblings about Zonare have begun to tilt this market in new directions (FINALLY!).

As always, contact me with questions.
-Brian

 

Ultrasound and wrist pain

Auntminnie.com has a good article on the emergence of ultrasound as a screening tool in wrist pain, yet another example of the rapidly expanding musculoskeletal market and the use of ultrasound by a physician as a diagnostic and screening tool.

Quoted from http://www.auntminnie.com/index.asp?Sec=sup&Sub=ort&Pag=dis&ItemId=79894:

Ultrasound shows promise as a screening tool for wrist pain

By Shalmali Pal
AuntMinnie.com staff writer
February 5, 2008

More than 2.2 million people in the U.S. turned up at their doctor's office with complaints of wrist pain in 2005, according to the American Academy of Orthopaedic Surgeons (AAOS). These cases made up 72% of all wrist-related physician visits that year -- and the pain was not related to any specific injury or trauma.

So how many of these wrist issues stemmed from modern-life activities that the human hand is being forced to adapt to, such as typing, mousing, and text messaging?

More than just a handful, based on the anecdotal experience of Dr. Mihra Taljanovic, the head of the musculoskeletal imaging section in the department of radiology at the University of Arizona Health Sciences Center in Tucson. She told AuntMinnnie.com that she has noticed a recent uptick in the number of patients referred to her from private practices for the evaluation of specific wrist and hand-related pathologies

GE Dominates Alphanumeric War; confuses customers, salesforce

GE ultrasound,ultrasound news,new ultrasound

OK GE Ultrasound, it's time to put away your alphanumeric Dungeons and Dragons dice and get some actual humans to name your products.

In December, the FDA approved a product called the GE BT08 Ultrasound system. I thought this was a misprint and ignored it, but I later found FDA the document, located at the FDA site here. And there it was to my surprise: it appears that GE is renaming, or repackaging the GE Logiq 7 to be sold as the "BT08" ultrasound system. No big deal? Read on. This isn't about this one product, and I surely hope that the BT08 Ultrasound System is simply a placeholder name for something else, like Logiq 7 SuperAwesome Edition.

For those who don't know, the "BT0" moniker is reserved for GE's software levels. For example, if you want to buy a piece of GE ultrasound equipment, you would be given options of "BT0" levels of the ultrasound, like Voluson BT04 Pro or Logiq 9 BT07. The "BT" stands for BreakThrough, and the "02" stands for the (approximate) year it was released. The idea was that every year GE would have another "BreakThrough" on every product and, clearly, new customers would beg GE's sales reps to install GE's latest ultrasound ... and as a free bonus: Existing customers would throw money at their sales reps until the latest "BT0" was installed on their system.

Well, as it turns out, people don't upgrade that often when upgrades are either a) Lame, or b) So overpriced that you chose that BMW 3-series instead. But nonetheless it's a neat idea that keeps the stockholders happy and engineers on their toes (and quite annoyed).

But that's not my point.

So what's the big deal about using a name that's already established and represents something completely different? For starters, it worked fine with Windows when it went to Windows 95. Microsoft had missed so many deadlines that the '95 was a promise to its customers that the product would finally be released sometime in 1995. It was the software level and a "promise", not to mention that everyone who could read a newspaper knew what this was. Well, on GE's side, GE ultrasound is not Microsoft, does not have the media hype, and its ultrasound products have a much smaller market and more competitors than just Apple and NeXT. Yet, GE has more than 20 ultrasound products with "BT0" as part of its official name, many of which will have a "BT08" sometime this year, such as the currently available Logiq e BT08 and LogiqBook XP BT08 ultrasound systems.

I know that it seems silly for me to opine on such an issue, but let me illustrate GE's current market so you can understand why GE's tactics are annoying, confusing, and a bit ridiculous. Granted, I don't think GE is trying to confuse or outwit anyone. This is not about just the BT0 name, it's about all their names and how they continue to muddy their own waters.

But first, a disclaimer: This does NOT mean that GE's products suck. They don't. In fact, GE has some of the best products on the market, as I've reviewed here and on my website there are a couple products that are simply the best available. But GE's marketing and overall focus show that the inmates are running the asylum. When does Omar Ishrak, president and CEO of GE Clinical Systems, stand up and scream that ENOUGH IS ENOUGH?!!?

Currently there are no fewer than 22 ultrasound systems available from GE. That's a lot, but maybe it's possible that someone can justify this. But ask any GE ultrasound salesperson, or any GE ultrasound manager for that matter, to truly differentiate these systems from one another... then have them tell it to a customer, who will undoubtedly look at them and say something impolite.

Don't believe me? Let's look at GE's products... All of these systems are currently available from GE in their non-cardiology packages and within about $25,000 in price range:

Logiq A5, Logiq P5, Logiq S6, Logiq 3 Pro, Logiq 3 Expert, Logiq 5 Pro, Logiq 5 Expert, Voluson 730 Pro

All of these are largely for the same overall market, and more are to be released this year. But only certain salespeople are allowed to sell certain types, which is why they have so many different product lines... politics, baby.

So why do I care? Great question. I'm just annoyed by the whole thing and it gets under my skin. If you read this far, it apparently gets under your skin, too. But maybe I'm the only one who thinks this way and customers like being overwhelmed. If it sells ultrasounds, then I guess it simply doesn't matter.

Comments? Email me. I've had some great emails from readers, so thanks to all of you for the tips, compliments and comments. For those who don't know, I keep the emails private so long as you don't post them as a comment.

Terason t3000: Believe the hype, it's the new killer app

I'm in Dallas today on a business trip and met with the western region Director of Sales for Terason, Jerry Michel. He brought the t3000 so I could finally see this unit "in action" so I could get an idea of just how good the images are on this unit.

What I found is that hands down, for price/performance, this unit is an absolute winner. It's small, lightweight, and essentially defies current ideas and standards of how ultrasound works (hardware vs. software processing). This is a powerful machine with excellent image quality.

Color, Doppler, and 2D imaging were really impressive, it held great frame rates when in triplex (Color, Doppler, 2D), and provided excellent waveforms for a vascular study. In the picture I have here (clearly I need to look at these photos after I take them!), you can see a breast image. Next time I'll get more images and post them here. I spent more time playing with the unit than taking pictures.

Since the last post, I've received 6 phone calls and emails from people in this unit. It seems the biggest hesitation people have is that it's not a GE unit or one from a "major" manufacturer. Well, to that I say phooey. If this were a unit from a major manufacturer, it would cost at least $10,000 more and they'd give it a name that some marketing company received a healthy sum for creating, like Acuson P50 or something. This would beat out any direct competitor in a side-by-side, they'd kill it in price, and you'll get a 2-year warranty instead of just one. For example, the current Logiq e, which isn't as good, will cost you at least $5k more... and $7k more for the 2-year warranty.

Oh, and because this is a "true" laptop, you have full access to the Windows and Macintosh OSX operating systems... which means you can store, edit, post-process all images as well as use it as a laptop computer. Yes, this means you can print to any printer on your network, share images over the network, use the word processor and web browser, watch a DVD, etc. Try that with any other "laptop" unit (in which you'd need a special service dongel to get to the operating system... and even if you had access to the dongel, you would likely void your warranty when you tried to install anything due to potential software conflicts). This is a big deal, by the way, because installing anything besides the "approved" dvd-writers, printers, etc., on other systems is a tremendous hassle and often requires a service representative to perform the installation for you, and this would not be a free visit.

To be fair, however, in certain markets this unit isn't quite ready. I would recommend it for nearly all mobile, breast, musculoskeletal, phlebology, vascular, internal radiology, anesthesia, surgery, abdominal, or urology markets. It has a solid reporting package for these markets (which is severely lacking in comparable products). You can do OB/GYN, but you'll want a separate reporting package (I'm going to try it with Ashva's iMagic when I get a chance). I haven't seen the cardiac package, but I think having Siemens pick this up as the upgrade to the Cypress is all that needs to be said (the Terason t3000 will also be sold later this quarter as the Acuson P50). The cardiovascular version of the Terason t3000 (or Acuson P50) will be more expensive (adding CW Doppler and cardiac packages isn't cheap) and will go head-to-head with the Vivid i. For this I think GE has a worthy competitor, and Siemens is betting on it. In addition, you simply cannot ignore the value of a 2-year warranty (Siemens is rumored to only offer 1-year, so you'll want to get the Terason). Obviously Terason knows it has a killer app in the t3000.

Questions? Email me or leave a comment here for everyone else to see.

Terason,SonoSite,Logiq e,portable ultrasound,laptop ultrasound,hcu ultrasound,phebology ultrasound,breast ultrasound,vascular ultrasound,anesthesia ultrasound,nerve block ultrasound,mobile ultrasound

RSNA Summary 2007, Finally! MindRay, Ashva, Terason t3000

RSNA,Terason,MindRay,Ultrasonix,Siemens,Ashva iMagic,ultrasound,radiology,SonoSite,anesthesiology,emergency,physician ultrasound

RSNA in 2007 was quite interesting for ultrasound. We've seen so many changes in the last two years, and for the first time we're seeing a few newcomers take a real stand in this market... particularly for the emerging markets.

Acuson P50 and Terason t3000

If James Bond were going to have an ultrasound, this would be it. This portable ultrasound runs on a MacBook Pro and simply looks cool. It has a slide-out interface (trackball, buttons, etc), brushed-steel look, and incredible graphics. Oh, and the image appears to be quite nice, too. I haven't actually demo'd one of these, but I've been talking to the Terason folks since RSNA and hope to see one in action soon.

Siemens marketing machine did a nice job pushing this product, but under the hood it's a Terason t3000 unit (as reported earleir) and I'm sure we'll see much more about it. But if you're really interested in the product, give me a call and I'll put you in touch with the right people at Terason. It's the same unit, different packaging (oh, and the Terason is available NOW, while the P50 is not yet released). I've found the Terason people to be nice, down-to-Earth and clearly not holier-than-thou as you would find with many of the major manufacturers. Plus, they back this product by a 2-year warranty and it's priced competitively to the GE Logiq e and SonoSite M-Turbo. Keep an eye out for these guys. They've been quiet for a long time, and I don't expect that to last long. Get in now while the pricing is good. Send me an email with your location if you're interested or if you have any questions. Email me here.

 

Affordable DICOM and Reporting for Ultrasound

In the past, I've also talked about a company called Ashva Technologies that has a good DICOM and reporting package. I saw the full demo again at RSNA, but Mohan Mysore, the CEO, spent more time on really taking me through the product. It was more than I expected and an excellent solution for the smaller offices looking for a DICOM solution or something to capture images and provide a REAL reporting package.

I must say I've been really frustrated with the terrible reporting packages from all the portable ultrasound units out there. GE's LogiqBook XP "Report Writer" has long been a joke, SonoSite doesn't even pretend to have decent reporting, and the Acuson Cypress reporting leaves a lot to be desired (unless you enjoy RSIs and frustrating notations). I'm going to go through some installations of the product here and I'll report on my thoughts as I spend time with the product.

 

Mindray taking the industry by storm

The Chinese manufacturer Mindray generated a good bit of buzz at RSNA as well. The company has done a nice job placing itself squarely in the Low Price, Good Product market. It's a niche that nobody really has filled well. Medison tried it, then decided to keep their prices high.

I've done some applications training on the Mindray products and some clinical work. Every time I've walked away from these products, I have said one thing: that it's a really good product for the price. You will not get the super-premium bells and whistles from these products like you'd see from the major manufacturers... ie: You ain't gonna get a Lexus for the price of a Ford. What you do get, however, is a solid imaging machine with good functionality that is reliable. These work really well in the market I serve for those who are looking for a good functional ultrasound at a low price. Your choice now is older refurbished or new Mindray. The big manufacturers should take notice. These guys are going to be all over the place in the next year also.

Terason t3000 receives Frost & Sullivan Innovation Award

Terason,t3000,MacBook Pro Ultrasound,hcu ultrasound,portable ultrasound,hand carried ultrasound,Teratech,SonoSite

Quoted from http://www.frost.com/prod/servlet/press-release.pag?docid=115977843:

Frost & Sullivan Lauds Terason for Innovative Ultrasound Systems

Based on its recent analysis of the portable ultrasound systems market, Frost & Sullivan recognizes Terason – a division of Teratech Corporation– with the 2007 North American Frost & Sullivan Award for Technology Innovation in recognition of its development of two innovative ultrasound systems, the Terason t3000™ and the t3000 Echo™.

"The significance of these system lies in its best-in-class image quality and function that are comparable to the high-end cart-based ultrasound systems but only at a fraction of the price," says Frost & Sullivan Research Analyst Sangeetha Prabakar. "They are the world's only ultrasound systems powered by an off the shelf commercial PC."

The systems consist of two key components – a system-on-chip engine and a MacBook PC. An array of transducers easily connected to the systems allows clinicians to perform any ultrasound exam at the point of patient care anywhere.

DOTmed.com - Ultrasound Experts Issue Guidelines for FAST Exam

Emergency Ultrasound,FAST Exam,AUIM,ultrasound

Quoted from http://www.dotmed.com/news/story/5213:

DOTmed.com - Ultrasound Experts Issue Guidelines for FAST Exam

LAUREL, MD - The American Institute of Ultrasound in Medicine (AIUM) and the American College of Emergency Physicians (ACEP) will publish jointly the Guideline for the Performance of the FAST (Focused Assessment with Sonography in Trauma) Examination.



The FAST examination is a proven and useful procedure for the evaluation of the injured patient immediately during resuscitation to detect large abnormal fluid collections or other collections that need immediate treatment. Prior to its use, more invasive procedures, including surgery, were required to evaluate trauma patients.



With the growing use of the FAST examination to evaluate trauma patients in hospital emergency rooms, pre-hospital situations, military locations, and disaster areas, the AIUM and ACEP joined forces to create guidelines to provide assistance to emergency medical practitioners and to promote high-quality ultrasound examinations.



Created with expert input from both traditional and emergency physician ultrasound experts, the FAST guideline includes indications for performing the examination, qualifications and responsibilities of the performing physician, specifications for individual examinations, documentation requirements, equipment specifications, quality control, and safety standards.



The FAST examination is now taught to more than 95% of emergency medicine residents and included in Advanced Trauma Life Support, a training program for doctors in the management of acute trauma cases. The FAST examination is widely accepted as the standard of care for the initial assessment and treatment in trauma centers.

Is the Terason t3000 better now that it has an Acuson P50 label?

Acuson P50,Macintosh Ultrasound,MacBook Pro Ultrasound,Terason t3000

Terason t3000? Seen it! Only this time it's called the Acuson P50.

The Terason t3000 next to the Acuson P50 (right)

Walking the floor at RSNA, I stumbled across a company I'd seen in the past, but not paid a whole lot of attention to. The company is called Terason, and about 6 months ago, it released (albeit quietly) the MacBook Pro-based Terason t3000 ultrasound system.

So at RSNA, after being quite impressed by Acuson's new product, I later found the Acuson P50 on display at another vendor's booth... only this time it was called a Terason t3000. Come to find out, this product has been around for a bit of time and Siemens has taken it and branded it as its own product.

Back in August I saw an FDA approval that, at the time, didn't make any sense to me. It was from Siemens and it announced the Acuson P50, which it states "The Acuson P50 (TM) Ultrasound System is identical to the Teratech 2000 and previous Teratech models as identified in the predicate device section" ... with the exception of some new probes. As it turns out, this Siemens/Acuson is a re-branded Terason product (a darn nice product at that).

Shocked? Me too, I guess. They've pretty much dropped the ball on this market, failing to build on the Cypress, and now they have a nice product to offer. Lately, industry insiders are all disappointed (worldwide) with Siemens' slow reaction to the ultrasound market. The general feeling is that ultrasound is just a throw-in for their CT and MR products to sweeten a deal... which must be why Siemens fell asleep at the wheel when it comes to innovation and are boasting this MacBook Pro system as its own, excellent innovation. And it's important to note how they're back to branding their ultrasound products as "ACUSON", not Siemens, after they all-but-tried-to-kill the Acuson brand and make it their own. Oops.

But back to the real story here: you shouldn't think that this Acuson P50 is a lesser product, even if you've never heard of Terason (from whom you can buy this same product with different probes). This Terason unit is quite impressive and fully shared service t3000 (Siemens advertises the P50 as a C/V unit only). The Terason folks are good people and they made a product good enough for one of the Big Three to name it their own. Not bad.

I spent some time with the Terason folks at their RSNA booth and they're good people... friendly, knowledgeable and extremely enthusiastic about their systems. They don't advertise the re-branding and, come to think of it, they didn't say much about it when I talked about the P50 and t3000. They're excited about their product and were really enthusiastic about showing the benefits of the Macintosh operating system underneath... something the Siemens reps were not prepared to do (they didn't even know that it was actually running Windows XP and that you had to get out of it to see a Mac interface.... so I think the sales reps were quite surprised as well).

All in all, both products are quite cool. The Terason comes with a 2-year warranty and has the shared services capabilities. If you're interested in this unit, you can drop me an email and I'll put you in touch with one of the sales reps there.

Siemens rolls out ultrasound-equipped MacBook Pro - Engadget

MacBook Pro,Parallels Macintosh Windows,compact ultrasound,Siemens,Terason t3000,terason ultrasound,Acuson p50,siemens p50

For my first RSNA report, the Siemens Acuson P50 compact ultrasound unit is what I thought was one of the coolest, most innovative products I've seen in some time. It's a beautiful unit, and I thought Siemens was waking up to the call, but as you'll see in my next report (coming this week), this excellent unit isn't a result of great engineering from Siemens. There's another small company out there that did the fantastic innovation, and Siemens found a way to market it a whole lot better.

If you're looking, don't look past this unit, it's very cool. And based on my conversations with Siemens personell at the RSNA show, they're still figuring it out. That's because if you really want to know about this P50, the Siemens booth is the wrong booth to see this wonderful little laptop unit. There's another place selling it, too. They created it, but their booth is smaller and their marketing budget and expertise don't have the Siemens label. But the other place has a shared-services unit with slightly different transducers.

As a final note, seeing Engadget pick up this story was pretty cool. It's a MacBook Pro, which is what I recently moved to for my business (highly recommended!), but it's running Windows on the Boot Camp application, which runs native Windows on a Macintosh. Nice, but if you want to run Windows on your Mac, check out Parallels... I can run our custom business app and Outlook 2007 on top of my Mac apps. Way cool. But that's a whole separate issue. If you're here in Chicago at RSNA, stop by the Siemens booth and see this thing, it's incredible. SonoSite beware.

Quoted from http://www.engadget.com/2007/11/26/siemens-rolls-out-ultrasound-equiped-macbook-pro/:

Siemens rolls out ultrasound-equipped MacBook Pro - Engadget

Siemens rolls out ultrasound-equipped MacBook Pro

Posted Nov 26th 2007 11:39AM by Donald Melanson
Filed under: Laptops

We've seen MacBooks re-purposed for various uses in the past, but never quite like Siemens new "P50" laptop, which takes a standard issue (if slightly outdated) MacBook Pro and outfits it with some ultrasound equipment to accomodate doctors that just can't be tied down. Apparently designed specifically for cardiology and vascular applications, this one boasts an "array of transducers," along with an integrated stress echo function and a range of cardiology application packages which, Siemens says, "considerably simplifies and accelerates the workflow in echocardiography and vascular diagnosis." Mac fans may not want to boast too much about this one, however, as it seems that Siemens has opted to use Windows as a basis for the platform.

RSNA next week

Hello all,

Next week I'll be at the RSNA conference in Chicago through Tuesday. If you can't make it and have any questions for the vendors or would like my opinion on any new or old products, send me an email and I'll try and help out. I have a few meetings and will be looking very closely at Ultrasonix, as I haven't had a good look at its equipment yet and I've heard great things about their product. I'll also check out ZONARE and new products from the big three at GE, Siemens, and Philips.

I will also spend some time with the DICOM software maker ASHVA and checking out its iMagic DICOM software. This looks like a pretty solid product for those who are looking for a simple DICOM solution that includes solid reporting features. Drop me a note at my gmail address if you would like my thoughts or any information.

-Brian

 

ultrasound,new ultrasound,diagnostic ultrasound

ZONARE Ranked Top Hand Carried Ultrasound Vendor

A new report from KLAS has ranked the ZONARE ultrasound as the top ultrasound in a few categories. A few of these categories are quite surprising, as well. ZONARE is ranking top in quality, and second in reliability and durability (presumably to SonoSite). It's surprising that such a young company would rank highly in these three categories against companies such as Biosound, GE, and SonoSite. So this is good news for the company, which seems to be a mostly silent player outside of the corporate "large contract" world (they won a large contract out west).

This is one of the companies I'm most interested in seeing at RSNA. It appears ZONARE has a wonderful concept, and other folks in the industry whom I've asked said that the image quality is comparable to some very high-end systems. The person with whom I spoke (not a ZONARE employee) said it went head-to-head with the iU-22, Logiq 9 and Sequoia and held its own very well... some stating that it's comparable to these systems in 2-D imaging. That's quite impressive for a compact system.

However, the system apparently can't compete in color or other areas, but I'm sure they'll be on their way with that soon. I heard from another that its reporting package is the best among compact ultrasounds.

I plan on visiting their booth next week at RSNA and I'll give it a more full report at that time, along with observations on other systems, including the P50 from Siemens (the apparent replacement to the Cypress). Questions?

Anything you'd like me to check out at RSNA? Drop me an email.

Don't forget to check out our specials at the GPS Medical website as well. We're currently running specials on the SonoSite Titan and the Acuson Cypress.

compact ultrasound,Zonare,laptop ultrasound,hcu

Quoted from http://www.devicespace.com/news_story.aspx?StoryID=77421&full=1:

ZONARE Medical Systems, Inc. Ranked Top Hand Carried Ultrasound Vendor in 2007 - News, Search Jobs, Events

ZONARE Medical Systems, Inc. Ranked Top Hand Carried Ultrasound Vendor in 2007

11/14/2007

MOUNTAIN VIEW, Calif., Nov. 14 /PRNewswire/ -- ZONARE Medical Systems, a developer of premium ultrasound systems, today announced it has been ranked as the top hand carried ultrasound (HCU) vendor in the inaugural KLAS HCU study. The company was ranked first in image quality, ergonomics and throughput, according to the survey, and second in reliability and durability.

"We are extremely pleased to receive this top HCU honor based on such a highly respected, independent survey," said Donald Southard, president and CEO for ZONARE. "To be rated as first in KLAS reflects on our commitment to meeting customer needs through innovation, excellent service and unique technology. Along with the significant growth of ZONARE since our first shipment in 2005, this recognition helps reconfirm the expanding acceptance of our proprietary Zone Sonography(TM) technology and Convertible Ultrasound(TM) platform."