Opinions: is it true that ultrasound machines are unreasonably expensive?

Original author: Graham Jenson, Paul Reynolds
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The first part of the article contains a post from the Medium website , where software developer and blogger Graham Jenson gives his opinion on ultrasound. In the second part, the author of the blog “Lies, Damn Lies, and Startup Advertising” [Lies, Damn Lies, and Startup PR], engineer Paul Reynolds, with extensive experience in developing and creating these devices, argues with this opinion. He wrote a rebuttal post , and then in another post he answered questions raised by his readers.

Why are ultrasound machines so expensive (Graham Jenson)


What technology is more useful, more knowledgeable, more interesting and more expensive than an ultrasound machine? He can look inside living beings without powerful magnets and X-rays, and he, in fact, is made of a speaker and a microphone that displays results on the screen.

Why is there no ultrasound in every biology class in every school so that you can see how the muscles work and the heart beats? Why is ultrasound not at hand for doctors along with a stethoscope and thermometer? Why can’t I buy myself such a device, just to keep track of how my injuries heal? Probably, because devices with a cost of £ 20,000 ($ 30,000) are considered inexpensive .

After I gave $ 200 for a visit to the doctor with my injured leg, and I was examined on an ultrasound machine the size of a closet and looking like a TV from the 50s, I wondered how much money I could buy for myself. Finding a “cheap” device for $ 8,000, I could not connect the cost with the technology, simplicity and usefulness of such a tool.

So I did a little research.

Measuring transducer


The transducer is a ceramic with two pieces of metal on the sides. If you compress the converter, it produces an electric current. If you let current through the contacts, it moves the converter. Ultrasound requires a little more than a dozen transducers operating at megahertz frequency. To achieve the required resolution, you need to collect an array from them. For such purposes, lead zirconate titanate, or PZT , is most often used .

When current is supplied to the converter, it expands, the reverse current causes it to compress, and if you do this periodically, you will get a wave whose length will be about two times its thickness. Since the speed of sound in ceramics is 3200 m / s , and for a wave at 5 MHz, the length will be 0.64 mmtherefore, the thickness of the PZT should be around 0.32 mm. This is pretty small.

The manufacture of transducers with the required accuracy is apparently the reason for the high cost of ultrasound, since strict requirements are imposed on each transducer, and many are required for ultrasound. They are expensive, and since they require 20 pieces, they quickly increase the cost of the device.

The cheapest megahertz DTCs I have found cost $ 12 apiece . So, an ultrasound scan with 20 transducers should cost more than $ 200, and an array of 40x40 DTSs for receiving three-dimensional images should already cost $ 19,200.

To reduce their cost, you can try to make the converter yourself. Can I do it myself? Here are a few resources dedicated to this issue:

Man himself makes converters from barium titanate .
People try to print integrated circuits at home .
• The dissertation on the creation of PZT-films .
A way to make a “low-cost high-density PZT array”.
Description of the manufacture of a flexible DTS array .
An array of 64 elements at 35 MHz for high-resolution images .

One way to produce a DTS array is to useslicing and filling method . Separate converters can be manufactured by lowering the PZT into ethanol and then spraying it onto the metal. After ethanol has evaporated, a thin film of PZT will remain on the metal. But this will require special equipment, and it will probably be easier to find a laboratory or manufacturer with experience to build the array - but this is not so interesting.

Iron and software


A computer that can work with a megahertz converter costs a little today - for example, GPIO-contacts on the Raspberry Pi can do this. Screens are very cheap, and in general you can make a conclusion to your phone or home screen. Also, I do not think that the calculations carried out in the device, or its display can be very expensive.

The software can be expensive, but this is because each ultrasound machine uses its own special proprietary software. If there was a standard hardware platform for which software could be made, with standards and APIs, this would greatly reduce the cost of the devices. There are attempts to create an open ultrasound architecture , but I don’t know how much they entered the masses.

Perhaps most of the cost of the hardware and software of ultrasound stems from the need to obtain medical certificates. Jes from Hacker News wrote :
Some specifications that must be met are ISO 13485, ISO 14971, IEC 60601 3rd edition, IEC 62304, and perhaps a dozen more that I forgot about, such as RoHS, WEE, radiation, etc. If you measure the length of the thigh of the fetus and calculate from it the approximate fetal age of the fetus, you would not want to make a mistake in this.

Creating any medical device can be very expensive, but it can also have other areas of use: education, imaging, sports training, and entertainment. The trick 22 is that in these areas ultrasound will not be used because of the high cost of the devices, and they will not become cheaper until the market for them grows beyond the boundaries of healthcare.

Who does something with the problem of expensive ultrasound


The University of Newcastle is working on an ultrasound scan worth $ 40–50 , and this work has attracted media attention . They reduced the cost of the apparatus by using a single movable transducer to form an image.

Company Butterfly Network Inc is trying to create a device for ultrasound on a single chip, which will cost no more than a stethoscope. They received $ 100 million in investments , and I hope they can create an amazing technology, thanks to which everyone can order an ultrasound. Phillips' Lumify

project is a hand-held ultrasound device that connects to a smartphone / tablet. It looks cool. But while not everyone can buy it . echOpen and its branch

Murgen - open source projects developing an ultrasound machine and development kit. Such projects can really help reduce the cost of ultrasound by giving access to technology to programmers and engineers.

More self-study links:

Basic principle of medical ultrasonic probes
Phased Array Ultrasonics
Pocket Ultrasound
How does medical ultrasound imaging work?
How to use an ultrasound machine
Mobile Ultrasound Device with video
Principles of Ultrasound

Response post, part 1: “Why is ultrasound so inexpensive”, or “It’s always easy for you when someone else does the work” (Paul Reynolds)


Recently, a link to a post with Medium appeared on Hackernews, discussing the high cost of ultrasound machines. I have been working in this industry for over 20 years, and ultrasound is my main area of ​​expertise. Unfortunately, the mentioned post belongs to the category of those written by a specialist in another field. Such specialists often become victims of the illusion that their knowledge in their field extends to others, they do not appreciate the complexity and difficulties of the work of others, and as a result miss many subtle (and not so) moments of an incredibly complex technological field.

The premise in the article sounds like “why does a cheap ultrasound system cost $ 30,000 if I can buy inexpensive parts and it’s very easy to assemble? It’s not difficult, I figured out everything in a couple of hours! ” And although premium ultrasound can cost $ 150,000 (which is a small fraction of the cost of CT and MRI systems), there is a reason why ultrasound is the most common imaging system in the world. Therefore, let me refute the claims of its simplicity and excessive cost.

What knowledge do I have in order to comment on articles in this area? My doctoral dissertation was dedicated to the modeling, development, construction and testing of ultrasound. For 13 years I led a consulting group that produced industrial software for ultrasound, as well as participated in many projects to develop and build ultrasound devices for various fields, including medicine. I’m the Editor’s Assistant in the journal IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control, the leading journal in this area, and I have also chaired the IEEE Ultrasound Technical Program Committee for Transducers for ultrasonic sensors). I worked for the largest suppliers of ultrasound equipment in the world, as well as for small companies. I created and released commercial software and supported it for years. There are not many people who have such experience and are able to appreciate the technical details of hardware and software.

All my thoughts relate to general things, are not tied to a particular company, so I do not disclose any proprietary or proprietary information. For those interested in this, I highly recommend Tom Szabo's book, Diagnostic Ultrasound Imaging: Inside Out , which popularly describes a wide range of questions on this topic.

First, in one paragraph we will refute the argument about the cost of ultrasound using basic economic principles. If you can build an effective ultrasound machine that people want to buy, less expensive than those that are available on the market, and at the same time you have no experience in this area, then why hasn't someone more experienced built such a machine? Why did not one of the large companies bring down prices to capture the market? If there is a cartel conspiracy of companies to support prices, why the government has not yet condemned them (believe the person who worked in the companies - they are paranoid about complying with the rules, do not take kickbacks and try not to do anything that seems illegal). Later I will describe the rules of the Food and Drug Administration (FDA), but for now I’ll say that although [converters] add value to the product,

I was involved in hardware and software development, and although software is also difficult to do, hardware is harder to do. If you make a mistake when developing the equipment, you cannot recompile the program and get a new product in an hour, your alterations and rebuilds take weeks or even months. The equipment sent to the client should work, it cannot be fixed in the field with an update, it cannot be delivered with a user agreement, which states a disclaimer of warranties or declare that it is delivered “as is”. It needs to be supported where it works, sometimes for decades. Software can be developed on a laptop while sitting in a small room, but equipment development tools can be large and expensive, and their maintenance also costs money. When developing software, you have no problems with suppliers changing materials, formulas, prices, or even leaving the business and leaving you without spare parts. To protect yourself from these risks, you need specially trained people who are also worth the money.

Then we move on to the technical part. An ultrasound system consists of three main components: an acoustic transducer (transducer or just a sensor), a system, and software. The sensor is what you hold in your hand, it contacts the patient and transmits / receives ultrasound. For each system, there are several sensor options, each has its own field of application, and therefore the system must be able to support a wide range of such sensors.

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The sensor is connected by cable to a system that has all the necessary electronics, which receives signals, converts them into a picture, gives the doctor the opportunity to change the work settings, etc. The system is running software and displays a picture on the screen, although in our time the boundaries between hardware and software are slightly blurred. In hospitals, such equipment is usually transported by trolley, although more compact (and limited) systems are found.

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Consider the transmitter. Pictures are taken from good presentations ( 1 , 2 ).





The first shows the lenses (the part in contact with the patient). It focuses the ultrasound and attenuates it so as to avoid reverberations at the skin level that could obscure the picture - but without excessive attenuation so as not to lose the signal. It should provide good contact with the patient, should be thick enough to serve as an insulator, and strong enough to be cleaned, disinfected, sometimes dropped, and subjected to other influences for many years. The thickness should be the same over the entire surface, a deviation of several percent of the wavelength will already distort the image. In this case, the ultrasound wavelength is about 100 microns. But it’s easy to do, isn't it?

Then comes the matching layer, which transmits ultrasound from piezoelectrics of high acoustic impedance to the housing with low impedance. Today, there are schemes with several layers, each of which must have a certain thickness, density, stiffness and the amount of signal attenuation. Sometimes they must be conductive, sometimes insulating. They should also be machinable and have a constant thickness, like lenses.

Then comes the piezoelectric active material that converts electricity into vibrations and vice versa. It should also have a certain thickness, not changing on the surface, with an accuracy of microns. The material used matters - cheap options have different thicknesses and they work poorly, and those that strictly follow specifications and work well are expensive. It must not lose piezoelectric properties at operating temperatures and withstand strong electromagnetic fields. Piezoceramics like PZT have been used since time immemorial, but today piezoelectric on a single crystal can be used to create modern image generation modes - it is harder to work with, it is more expensive, but its performance is better. Polyvinylidene fluoride, sprayable materials and cheap PZT, from which the buzzer is made,

Then comes the backdrop, the material that absorbs the right amount of acoustic energy, so that the device receives a short pulse coming from the front of the sensor and used to build the picture, but it does not absorb so much to weaken the signal too much. It usually needs to be made from a dielectric, and its weight should not be a burden for the doctor.

After that, all parts must be fastened together. The bonding line should not be very thick so as not to interfere with the passage of sound, but also not very thin so that all layers are held together tightly. These should be micron-thick bonds, not changing over their entire area. Just right?

Let's deal with the acoustic stack. It can be divided into several elements involved in creating the image. Yes, they require many different ones - in most sensors from 100 to 200 elements. A device with 20 elements, which was mentioned in a previous article, is useless for any serious applications. Moreover, all these layers and piezoelectric elements must be isolated from each other electrically and mechanically, not too thick and not too thin insulation.

Then you need a flexible circuit that transmits signals from and to each element, and it must correspond to these elements with an accuracy of 100 microns (yes, and the size of each element is no more than two human hair), and then the circuit must be connected to the cables leaving the system. All 100-200 wires go through the cable a couple of meters long, and it should be light and thin enough so that the doctor can use it for eight hours a day without straining the muscles. Can you imagine how thin individual wires are? Call the cable sellers and ask them for a small diameter cable with 200 contacts, a conductive signal without interference, and you will know its price.

All this must be placed in a case that is ergonomic enough for the doctor, large enough to accommodate acoustic equipment in it, small enough to not be very heavy, and smooth enough to not harm the patient. And besides everything else, it still should not overheat, so that neither the doctor nor the patient would suffer.

Simply!

Nah yes. And this I described the simplest version. I did not go deep into multilayer sensors, a curved substrate, exotic materials, devices with electronics in the handle, the dimensions of each section necessary for working with acoustics, spectral responses, temperature characteristics, the corresponding electrical impedance, and all the other difficulties that I have to deal with, creating and selling such devices in reality.

And, I also forgot about universality, reliability and cost. These devices must work for years, must be compatible with each other, so that the system can generate pictures with them so that the user does not notice the difference, and should be inexpensive enough so that the user can buy them and the manufacturer would make a profit. Have you ever made a prototype? 2 prototypes? 4? 100? 10,000? And so that they are all the same? Yes, having decided to sell and support products, you find yourself in a different world.

And I also forgot to test the devices for compliance with your internal specifications, the FDA rules and other regulators, so that they would not shock you and burn you, and provide the correct medical data so that you would not be diagnosed incorrectly and prescribed the right treatment.

And that I have not yet reached the system and software. The sensor alone requires the work of people who are knowledgeable in acoustics, imaging, clinical requirements, materials, equipment design, electronics, data processing, security, operating rules, user experience, reliability, testing, doing business, and much more, you won’t list everything . Well, you also need to support employees, office, HR department and admin.

All this requires tremendous knowledge and effort - as if human lives depend on them.

I have a lot of experience in developing and building such things. Could I create a company that would manufacture them and do it well? Yes. Could I make them much cheaper than others? Not.

Putting it all together and getting an incredibly complex electromechanical product, with micron-scale components, long-term requirements for many years, reproducible without the ability to take advantage of economies of scale (millions of devices are out of the question), on the basis of which decisions are made that affect human life. And this is just a sensor. Therefore, in fact, you need to ask, "why are ultrasound machines so inexpensive"?

Response post, part 2: answers to questions on the first post


First, let's go over the technical part of the questions. When I mention the conference in the text, I mean the symposium of the international ultrasound community IEEE UFFC .

1) What if we put more electronics in the sensor and use the GPU to form the beam?


The sensors really move in that direction. After Philips introduced in 2003 the first real two-dimensional array operating by means of a subarray forming an electron beam in the sensor, shifts were noted in this area. It is important to understand that the development of electronics (usually an ASIC, a specialized integrated circuit) used in only one sensor is a huge investment of money, man-hours and time. And you also need to integrate all this into the acoustic stack and make it work smoothly. A large enough team has been developing this kind of product for several years, and although the development of electronics makes this task easier for 2016 than for 2003, it is still a very big task. All large companies already have their own two-dimensional arrays,

In addition, replace the one-dimensional array with a two-dimensional one, and you will immediately get new difficulties in data processing - volumes instead of planes, thousands of individual signals instead of 200. Even more computing power is required, and although the volumes of available power grow over the years, so do the requests. At some point, the available computing capacity will overtake demand economically, but so far this has not happened.

What about regular, one-dimensional arrays? Of course, more electronics can also be crammed into it, but remember that in one system 10-20 types of sensors are supported (cardiac, abdominal, vascular, obstetric, etc.), and it is more logical to create a single system in which there is a common equipment capable of servicing many sensors, or copy the same electronics for each sensor to simplify the system? Economically, it now makes sense to assemble all the common components in the system, but if the electronics become cheaper and better, then the equation will change. Now this option is being considered.

Right hereThere are specifications for the Verasonics open platform, good equipment for those who want to learn, test and develop ultrasonic equipment, although commercial premium systems often have higher specifications. Sampling up to 62.5 MHz, 14 bits, 256 channels - up to 224 Gb / s, or about one Blu-ray disc per second. Thunderbolt 3 supports up to 40 Gbps, so compare and feel the difference. No matter how good modern electronics are, the demands of top ultrasound devices are still higher. This will change over time.

We also note that this system supports a voltage with a signal amplitude of up to 190 V, which means that it is impossible to use chips produced using minimum technological processes. This means a larger electronics and higher cost - and this is unlikely to change in the near future, fundamental physics imposes its limitations (possibly until the advent of new materials). In recent years, improvement has been achieved using piezoelectric on a single crystal , but now nothing of the kind is visible on the horizon.

There is still a heating issue. Electronics is heating up. A few watts in a small hand-held sensor can seriously raise the temperature and burn the patient or doctor. There are strict rules for maximum heating of the sensors, and the quality of work is always limited by these rules - the sensor works worse than it could for safety. If on each channel the electronics produces 50 mW, then 200 channels will give out 10 watts, and that is too much. But if the electronics produces only 5 mW, then in total there will be 1 W, and this will already be more interesting. If one could manage with such a low consumption, then the argument from the plane of practicality would move to the plane of size and economy.

Now about the formation of the beam. For starters, those interested can watch an excellent presentationabout this question. She is from 2005, some questions are already outdated, but the basics have not changed. I will tell the rest that beam formation takes raw data and builds a picture from them. To do this, you need to get a large stream of data (those same 224 Gb / s), conduct a bunch of mathematical operations depending on the image mode, and display the result on the screen. The presentation ends with a development forecast "analog electronics go to the sensor, and digital - to the software." This is exactly what is happening now. GPUs have become powerful enough to take on the work of specialized beam former, and in the coming years their speed is likely to increase. They will not be available soon in hospitals, since current systems have been living for at least a dozen years, but they are already approaching.

From the point of view of electronics, the process is underway, but some peak ultrasound requests show that it has not yet reached, or is only reaching the right condition. At the same time, requests for devices with two-dimensional arrays of converters are growing. After 20 years, the ultrasound ecosystem will change, the cost and speed of the electronics will move the load between the system and the sensor.

2) What about microproduction or 3D printing?


Another wonderful question, and research in this direction has been going on for the past 20 years. The study of the use of microelectromechanical systems (MEMS) in ultrasound has been funded by companies for more than 20 years. For example, in the early 1990s, cMUT (capacitive ultrasonic MEMS transducers) were declared the “next stage” of ultrasound, and today, in 2016, in addition to narrow areas of application, such devices are just starting to enter the market. And this is not due to lack of effort, simply the technology did not work as expected. Many problems have arisen, some of which have been resolved, but now they still cannot compete with piezoelectronics and standard production in terms of price and quality. They still need to be worked on, and if they can be improved, increased reliability and lower cost, they will penetrate into many areas of application.

pMUTs (piezoelectronic ultrasonic MEMS transducers) are also being studied, but there are even more difficulties with them than with cMUTs. Such materials are based on lead, and people hate lead in semiconductor manufacturing. More acceptable materials, zinc oxide and aluminum nitride, do not show such good results, so their use is so far limited to thin-film acoustic resonators (FBAR). There are some promising examples with the addition of scandium to aluminum nitride, which increases productivity, as well as production methods for improved piezoelectric elements, but so far they have a lot of problems.

3D printing? It is very difficult to print the active materials and other specialized components that make up the converter, but they also do this. GE delved into the question more than others, and she, along with other companies, is already making presentations on this topic. So this is still in its infancy, but new production methods are advancing, and they will help improve performance, reliability and prices.

3) I can buy spare parts in the store for $ x, why is the system more expensive than $ x?


Because the assembly of a reliable and proven platform, on the basis of which it will be possible to make medical decisions, requires a lot of effort and man-hours. This is true for any product, and even without observing the conditions of regulators. If you do something substandard, you will sell one copy, and the business will not work, and rumors will spread quickly. In a field filled with competitors, such as ultrasound, you will quickly lose prestige and leave the stage. Each sensor must support several modes of image generation - b-mode, harmonic, Doppler, etc. - and for each of them it takes time to program and approve. Then it will be necessary to support it, satisfy customer requests, pay your employees so that they don’t leave to develop the latest mobile application for social networks, and create a new generation of improved systems. In fact, these are standard costs and problems of any long-term enterprise. And also profit, supporting the company afloat, providing the manufacture of new products and the emergence of advanced technologies.

In fact, innovations are coming, but it’s not as easy as you think, it’s not a microphone or smartphone that can be thrown out in a couple of years.

If you want to study and participate in our industry, then welcome - there is always a place for those who help to improve ultrasound technology. You can send a message to me, because I have great connections, and I can connect you with the right people.

4) You have not made a price list for all components to prove that the price is not too high.


Firstly, such an article would look more like a price list, and I tried to clearly describe what is included in the process of creating such a system, and that it is not as simple as you think. The prices from the Medium article were based on some statements about the simplicity of ultrasound technology, and I wanted to explain why the task of creating such devices is actually complex and multifaceted, requiring various compromises. For a professional, it sounds like “I can build a minicar [a children's racing car without a motor - approx. transl.] for $ 100, and if you put a motor in it, it will turn into a car! Why are car manufacturers fighting for $ 50,000 for cars ?! ”

Secondly, I have to carefully mention the prices and capabilities of the equipment. I worked for different manufacturers of ultrasound equipment, and I need to take care not to spill trade secrets, so I act carefully and make sure that everything I write is public.

And lastly, the market is highly competitive, and the fact that there are no low prices for equipment suggests that there is something to pay for, and that prices are adequate. If you think that the market is not competitive, I don’t know how I can convince you. I will try in the next paragraph.

5) Equipment manufacturers organized cartel conspiracy and keep prices high


Such statements surprise me. I have been working in this field for more than 20 years and have never seen a hint that something like this is present in the field of ultrasound. Everything indicates strong competition. On a market of about $ 6 billion with several large players of international scale (here is a list of the largest players, here is a list of smaller players , here is a study, where 25 companies are mentioned), and is regulated in such a way as to ensure the absence of price conspiracies, cartels, and other non-market manifestations. In ratings, companies are constantly changing their places, each is looking for some kind of legal advantage in technology or value. The medical use of ultrasound is also very heavily regulated, and many countries, especially the United States and European countries, will very hard fall upon a company found to be in non-market behavior.

In each of the companies where I worked, I felt serious pressure in order to improve quality and reliability and at the same time lower prices. If you study today's systems and compare them with old ones, you will notice both serious improvements for top models, the price of which has remained at about the same level, and the appearance of devices at relatively low prices, the capabilities of which are superior to yesterday's systems.

If someone starts a company that produces high-quality ultrasound systems in large quantities at a low price, I guarantee that this company will be bought by one of the major players who incorporates it and takes advantage of the technology. So, if you really believe in a conspiracy and that ultrasound systems are very easy to do, then start your company and take advantage of that easy profit that everyone else misses. Even better - I personally will help you. Seriously, write to me, tell us what we are doing wrong, and I will either hire you, or find you a job in the industry, or organize a joint company to earn millions. And if you are sure that there is a conspiracy, I will give you the contacts of various regulators in different countries who will be happy to review the evidence you have that can be used in court.

Few areas in which companies operate in a market with so much competition unfolding among many large players. This is not an option in which " Intel owns 99% of the server market and competitors do not force it to lower prices, " it is more like an automotive industry in which many competitors compete.

6) Engineers do not understand what they are doing, and pass by the obvious things that could make the product faster, better and cheaper.


Thousands of people work in the industry - engineers, researchers, and support staff. They are smart, educated, experienced and capable. If they wanted, then many of them would be able to easily make all sorts of applications, social networks or whatever else is in fashion, and make more money with less stress. But they do not leave, because they love their work, they do everything to improve the technology, to accelerate and reduce the cost, and also know that their work helps people and changes the world for the better. They cannot miss the obvious improvements in technology or methods; it is not in their nature. Given the high competition in the industry, if managers in a company ordered engineers not to use the available advantages, they would immediately quit and move to another company, or start their own.

There are many professional organizations dedicated exclusively to ultrasound, mainly for medical use. One of them is IEEE UFFC , which I am quite involved in. IEEE is a nonprofit organization dedicated exclusively to technology, it does not support any commercial companies or anyone else's interests. She publishes journals with peer-reviewed articles on the cutting edge of developing transducers, materials, electronics, systems, and imaging. Every year, she organizes conferences where a couple of hundred people discuss and learn about best practices and technologies. This year I saw presentations3D printing of converters, new materials, fast image creation via GPU, microproduction, advanced electronics for sensors. Companies spend mountains of resources on research on these topics, graduate students defend doctoral work on them, and gradually these innovations are included in the final products when the technology matures and becomes cost-effective and reliable.

7) All the cost goes into compliance with the rules, without the FDA, these machines would cost less at times!


This is difficult to refute without citing internal figures from different companies, and I will not do this. I know that the price includes compliance with the rules, but it is not included in the list of the most expensive articles. Compliance with the rules and restrictions requires engineering tests and documentation, but nothing that a good team of engineers interested in manufacturing a safe device would do. And the presence of clear rules, common to all, allows competitors to play on an equal footing.

Yes, you can go to AliBaba and buy a veterinary ultrasound machine there, which was not adjusted to any standards. Good luck in obtaining a high-quality, or at least just useful image, and I also wish you that this device is safe, reliable, and it has some kind of support. And in general, so that he does a small fraction of what is available to top ultrasound systems.

There are reasons why ultrasound is the most popular way to get images in medicine, and it is safe in particular because of the rules and restrictions from the FDA and others.

8) What a dumbass does not know how to make a sensor without sharp edges!


Ultrasound is not like an MRI or CT in the sense that the result depends on the patient and the doctor - all images are different from each other, and to obtain them, experience is required. The acoustic window, in which clinically useful images can be obtained, sometimes requires placing the sensor in a certain place and some pressure, which can be unpleasant for the patient. If he starts to move due to discomfort, it makes it difficult to get a good image. For some sensors, the size is specially reduced so that they can reach hard-to-reach places, but trying to get the maximum acoustic area required to get a good picture can result in not very rounded corners. Of course, they are not so sharp as to cut patients, but they can lead to some discomfort, if they are designed incorrectly. In addition, it is easy to create a cable with 200 wires and minimal interference, and it is difficult to create it flexible, convenient for use by a doctor and inexpensive.

9) Phones are cheap, and they have a lot of all kinds of technologies - why is ultrasonic technology not so cheap?


Several million phones are sold every year, which is about 4 orders of magnitude more than ultrasound systems. On average, phones live from 18 to 24 months, and ultrasound machines last ten or more years. The quality of phones does not depend on people's lives. There are no economies of scale for ultrasound systems. Perhaps this reminds one of a debate about whether a chicken or an egg appeared earlier and that the “ingenious mobile application” has not yet been released, because the ultrasound system is too expensive, but if there is demand, then technology will come. Do you have such an app? As some mentioned, there are rumors that Butterfly Labs are working on just such, but, despite all my connections in the industry, I have not heard anything about what they have been doing for several years. I hope they give something amazing

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