December 2007

Sound with a Sight TECHNOLOGY TRENDS – Ultrasound in Medical Imaging

Sound is not always heard..it is seen as well’ – at least docs would agree !

A cyclic sound pressure with a frequency greater than the upper limit of human hearing (above 20 Kilohertz/20,000 hertz) can be used to image the anatomy of human body and that’s ‘ultrasound’.

Being one of the most widely used diagnostic tools in modern medicine, ultrasound-based electronic devices are increasingly used to harmlessly reveal the inner structure of human body. The technique, widely known as ‘ultrasonography’ provides high quality visualisation of muscles, tendons, and internal organs, their size, structure and any pathological lesions with real time tomographic images. It is also used to visualize a fetus during routine and emergency prenatal care.

The biggest advantage is that the technology is relatively inexpensive and portable, especially when compared with modalities such as magnetic resonance imaging(MRI) and computed tomography (CT). As currently considered in the medical environment, ultrasound poses no known risks to the patient. Ultrasound is generally described as a ‘safe’, as it does not use ionizing radiation, which imposes hazards, such as cancer production and chromosome breakage. However, ultrasound energy has two potential physiological effects – it enhances inflammatory response and it can heat up soft tissue. However, current studies indicate that benefits to patients far outweigh the risks.

Ultrasound finds application in a wide variety of medical diagnostics, and is especially useful for obstetrics. It can be used to date the pregnancy (gestational age); confirm fetal viability; determine location of fetus; check the location of the placenta in relation to the cervix; check for the number of fetuses (multiple pregnancy); check for major physical abnormalities; assess fetal growth (for evidence of IUGR); and check for fetal movement and heartbeat.

Other scans routinely conducted are cardiac, renal, liver and gallbladder (hepatic). Other  applications include musculo-skeletal imaging of muscles, ligaments and tendons, ophthalmic ultrasound (eye) scans and superficial structures such as testicle, thyroid, salivary glands and lymph nodes. Due to the real time nature of ultrasound, it is often used to guide interventional procedures such as fine needle aspiration (FNA) or biopsy of masses for cytology or histology testing in the breast, thyroid, liver, kidney, lymph nodes, muscles and joints. Ultrasound scanners using pulsed wave and colour Doppler are used to visualize arteries and veins.

We believe that the performance, size, durability, ease of use and cost-effectiveness of our products are the prime advantages of our ultrasound devices in medical diagnostics. There are five biggest advantages of our devices:

(I)  Bringing ultrasound to the patient  – Our systems’ mobility eliminates delays, which are associated with the outpatient referral process or moving heavy, cart-based systems across hospital departments to scan patients.

Pavan Behl
Country Manager, SonoSite India

(2) Quicker diagnosis and treatment – By providing ultrasound at the primary point-of-care, our systems can eliminate delays associated with the outpatient referral process or moving heavy, cart-based systems across hospital departments to scan patients. This increased accessibility is changing clinical practice, improving patient care and safety and has the potential to reduce healthcare costs through earlier and more rapid diagnosis of diseases and conditions.

(3)  Reducing Risk and complications The systems allows to see the unseen and, where previously physicians relied on their knowledge of morbid anatomy, now, with real-time ultrasound imaging, they can perform procedures and see inside the body

(4)  Increasing Clinical Productivity The image resolution of the SonoSite systems is so high that physicians rarely need to subject patients to additional exams involving larger systems. Because the results are available much more quickly, it greatly improves the overall patient care.

(5)  Creating the future of ultrasound Hand carried ultrasound is an extension of the physician’s eyes, ears and fingertips. The systems are increasingly being used for procedures where physicians need cost-effective, non-radiating imaging in such diverse applications such as real-time trauma assessment in emergency situations, guiding interventional procedures such as biopsies, nerve blocks and surgery, and in the imaging lab for full diagnostic examinations. It is the future of ultrasound.

A.B.Sivasankar, Director- Imaging Division, Trivitron

What are the advantages of ultrasound devices?
Ultrasound is a non-invasive imaging technique  using high frequency  sound  waves  developed  to visualize  internal organs, their size, structure and the pathology. It is one of the most  widely used  diagnostic tools in modern medicine. It is portable, relatively inexpensive with no risk to the patient  as  well as the operator. Applications  of ultrasound  include cardiology, obstetrics, gynaecology, Vascular, musceloskeletal,  urology, neuro-surgery etc. Ultrasound especially plays a major role in women welfare through prenatal ultrasound examination.

What is Market Opportunity of Ultrasound Devices?

India is one of the fastest  growing market in the world  for ultrasound medical devices. The current market  size of the medical ultrasound  device in India is  approx  3 billion rupees and is growing at an average CAGR of 20% per annum. Presently 90% of the demand  being met through imports. Further, if we look into the healthcare expenditure, 70% is spent for treatment and only 30% for diagnosis. For a better healthcare administration this  ratio should be  inverse  i.e. 70 %  should be for  early diagnosis, which will actually result in reduction in actual treatment cost. Shortly with insurance expected to play a major role in healthcare and  with  increase in the middle income group capacity to pay for better treatment we can witness a significant  demand  for ultrasound.

What is the leading edge  of Trivitron devices?
We market the ultrasound  from the pioneers who were the first to introduce ultrasound to medical diagnostics internationally and  who have  manufactured more than 220,000 units – namely Aloka Japan. Recently Trivitron have signed a JV with Aloka for manufacturing the ultrasound units in India. This fifty year old company has the experience and expertise in developing unique technologies in ultrasound diagnosis and recent ones being ‘e-tracking’ and ‘e-flow’. Aloka’s eTRACKING (Echo Tracking) is a new, more accurate way to uate vessel wall stiffness before the onset of changes such as thickening or plaque formation. eTRACKING allows you to detect atherosclerosis much earlier than commonly used Intima Medial Thickness (IMT). By estimating a patient’s “blood vessel age”, a healthcare provider can advise the patient to alter his or her lifestyle through diet and exercise to prevent atherosclerosis. eTRACKING also supports accurate tracking of treatment at 0.01mm accuracy. eTRACKING also enables FMD, a non-invasive way to assess endothelial function, which is considered the first indicator of atherosclerosis. FMD measures minute vasodilatation with 0.01mm accuracy. Broadband Harmonics also enhances a high-definition blood flow imaging mode used primarily for vascular imaging – Directional eFLOW. This can be used for both low-velocity and high-velocity flow, delivering greater spatial and temporal resolution. Very  Recently Trivitron has launched the first compact, light-weight Windows based Laptop Color Doppler in India. This unit offers high image quality, networking and work flow benefits not previously possible in a small system.

Advances in Ultrasound Technology
Traditionally, ultrasound imaging was possible only in 2D. However, latest technological advances have made 3D and even 4D imaging a reality.

3D ultrasound works similarly to the traditional 2D ultrasound, except that the ultrasound waves are directed from multiple angles. These waves are reflected back and captured and together to provide enough information to construct a 3D image – in much the same way as multi directional cameras are used to create 3D movies.

However, 4D ultrasound system is set to provide a ‘next generation’ integrated solution for medical imaging applications, allowing practitioners to provide faster treatment and improve therapeutic success rates. When rapid succession 3D images are processed real-time, creating a three-dimensional motion video – it gives a 4D ultrasound. This is achieved through 30 frame per second volumetric imaging. 4D uses the same frequency of sound waves as a normal ultrasound, but the sound waves are directed from many more angles, producing a ‘real-time’ video of the anatomy.

An important factor in ultrasound image processing is the beam-former – the part of the system that provides the focusing for the ultrasound beam. Even today’s most advanced state-of- the-art medical ultrasound imaging systems suffer from very poor image resolution. This is due to the very small size of deployed arrays of sensors and the distortion effects by the influence of the human body’s non-linear propagation characteristics. The solution lies in the latest adaptive beamformer that significantly improves image resolution at very low cost and results in better diagnosis. 

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