Future of ultrasound rests in correctly defining problems

Siemens star sees operator independence as key

The best technology advances come after finding and clearly defining clinical problems, said Ismayil Guracar, a senior fellow at Siemens Ultrasound. He should know. He's come up with more than a few.

Guracar is listed on 37 patent applications related to ultrasound. Four were submitted in 2002 alone. He was dubbed "The Ultrasound Man" after being selected one of Siemens' 12 Inventors of the Year 2002, an honor that goes beyond medical solutions to include 57,000 people in the company's multidiscipline R&D force.

Guracar was a principal behind the development of convergent color Doppler, Siemens' proprietary method for combining the best of two different color Doppler modes, one for velocity, the other for energy. Energy Doppler is best when looking at slow blood perfusion; velocity excels at measuring blood flow through larger blood vessels.

"Customers told us they liked the higher sensitivity of the energy mode, but they also wanted velocity," he said. "We found a way to deliver both."

Lately, he has focused on optimizing the visualization of contrast agents, developing technology that separates the signals from contrast agents and those from surrounding tissues. The technology, called Automatic Gain Compensation for Ultrasound Agent Imaging, is part of the latest Siemens Sequoia 7.0 system release. It uses statistical analysis to automatically optimize system gain settings, depending on whether contrast media are present.

A 17-year-veteran engineer in ultrasound, Guracar entered the industry with Acuson and now plies his trade for Siemens, a feat accomplished through the magic of M&A. He sees R&D placing an ever-increasing emphasis on ergonomics and ease of use. Engineering a product to achieve a clinical goal at the expense of simplicity is unacceptable.

"It does no good to add something that squeezes out a little bit more performance if it doubles the length of the exam," he said. "No one will use it and no one will appreciate it."

Making sure the system fits properly into workflow is an imperative of modern product design, he said. To do this, Siemens engineers look at routine clinical practices. They transplant prototype ultrasound machines from the lab into clinical environments, watch operators as they scan, then ask for their feedback on how to modify the early-stage product.

Using clinicians as touchstones for product development is breeding smarter solutions aimed at enabling faster and more efficient exams. Automation will help users see what is going on in the patient and determine quickly-and in the background-the optimal system settings for image quality and clinical results.

Connectivity will also be a watchword for the future, Guracar said. Increasingly, ultrasound will be integrated with other modalities.

Miniaturization will continue. But predictions of proliferating handheld units at the expense of cart-based systems are ill-placed, he said. Instead, miniaturization will allow more power to be packed into premium performance units, which will be lighter than their predecessors but still depend on wheels to get around.

Three-D imaging may eventually be part of the mainstream, but it's not there yet. Before that can happen, clinicians need to figure out how to make the best use of the information, he said.

"I get the sense that 3D is a solution looking for the right problem," Guracar said. "There's still a mismatch with what the system can do and what people might want to do with it."

Automation has simplified the operation of other modalities, such as MR and CT, assuring the reproducibility of high-quality studies with push-button certainty. The key to the future in ultrasound, he said, is to move more in this direction, to make systems with the least operator dependence.

"There is a lot of raw performance in ultrasound systems today," he said. "The challenge is in making use of it so everybody benefits."