Big future for little ultrasound

Think back to when you were little, really little, and everything was big. Remember reaching up to the sink and wondering how you'd ever wash your hands? It is one of those defining visions that surfaces every now and then in my mind: looking up at this big box with the sink atop it. Then, as time went on, the sink got smaller, and I remember wondering, "How is it doing that?" Ultrasound appears headed on a similar path.

Clinical systems once considered the ultimate in portability now seem gigantic compared to hand-carried models. Probes for 4D imaging that once fit in a tech's hand are being fitted into endoscopes and catheters. Where will ultrasound go? Apparently wherever engineers can wedge it.

This niching of products, however, barely hints at the long-term prospects for miniaturized ultrasound. The global market for diagnostic ultrasound is about $4 billion. Hand-carried units account for only about a tenth of that, but demand is rising.

For the most part, the primary beneficiary has been hand-carried ultrasound pioneer SonoSite of Bothell, WA. Now that the market is getting bigger, however, larger companies are taking more of an interest. Among them is GE Healthcare, which this spring launched ultracompact products for cardiology, radiology, and ob/gyn. The company's marketing campaign riled SonoSite, which took issue with GE's claims to have the "first" such cardiology system.

Such wrangling is common among companies, but the real battle has yet to begin. Current skirmishes are over the market as it exists today - not over what it will become. Over time, as systems get smaller, they will reach a point when the context in which they work takes precedence. The first inklings of this change are already being seen.

Ultrasound scanners can't just be carried into a room and used. They eventually have to be laid down...somewhere. That's why, when these scanners are dedicated to specific clinical settings, they often are put - amazingly - on carts, small ones, admittedly, but carts nonetheless.

The problem is that hand-carried ultrasound units are still seen as stand-alone units. To be truly accepted into clinical practice, they will have to blend in with the other technologies in the OR, ER, ICU, and doctors' offices. This will require a change in perception.

Companies led by SonoSite and GE are working on the premise that, like personal hygiene in a small child's life, ultrasound has value, even though it may be difficult to accomplish. So they have created hand-carried machines to provide information in a variety of settings. But these machines are transitional. If the need for ultrasound under particular conditions is established, the technology will evolve to forms that fit those conditions. It will evolve into something new, integrated into the surroundings - amid the patient monitors and the blood pressure cuff - to become a part of the day-to-day practice of medicine.