Handheld ultrasound evolves to offer cart-based imaging

Customer feedback, usability studies guide design

SonoSite has taken an evolutionary step forward in handheld ultrasound, building on modular technology to produce a system that offers high-resolution imaging yet maintains ease of use and portability.

The Titan, which was commercially launched in early April (SCAN 4/16/30), can be configured to support exams for virtually any branch of medicine or application, according to the company. These include the major segments such as cardiology, radiology, ob/gyn, and vascular, as well as applications specific to the emergency room, ICU, CCU, or outpatient clinic.

This flexibility translates into price points over a very wide range-between $25,000 and $75,000. Early sales have been toward the high end of this range, as other SonoSite products fill lower cost niches. But Titan could easily serve as a jack-of-all-needs, according to Dan Walton, SonoSite vice president and general manager.

"It is not going to do all the things big systems do," he said. "And we don't want it to. It is meant to fill the need in imaging for a durable, reliable, high-end imaging system in a portable package."

With Titan's official debut in early April, Walton and colleagues have been touring major medical centers throughout the U.S. and Europe, demonstrating it to physicians, many of whom are already familiar with SonoSite's products. The company has sold 11,000 handheld systems since 1999. This installed base could provide a huge source of revenue for the company, if a substantial segment decides to upgrade to Titan.

"It's too soon to tell how many customers will want to upgrade to Titan, but I think it will be pretty substantial," Walton said.

Titan promises to do for diagnostic ultrasound what laptops and docking stations have done for personal computing. Titan can be used in its integrated docking station or as a mobile point-of-care solution using the Mobile Docking System, a kind of minidock that fits into Titan's carrying case. The minidock allows individual images and video sequences to be downloaded into a PC, for example, or information system. As networking technology evolves, SonoSite can change the mobile and cart-based docks accordingly, rather than reengineer the Titan itself.

The integrated docking station is built into a lightweight, highly maneuverable cart. The station provides connectors with which the user can link to broad-based information technologies such as HIS or PACS. It also includes three transducer ports. Users can switch with a single keystroke to any of six transducers plugged into these ports. The cart features ergonomic designs, including a table that can be raised or lowered to match the patient's bed.

Titan compares favorably with much bulkier cart-based systems, offering color power Doppler, pulsed-wave Doppler, tissue harmonic imaging, M-mode, and DICOM compatibility. Its modular design allows the flexibility to add components and software applications to fit specific needs or to upgrade the system as new technologies become available. By September, Titan customers will have the option to configure the cart and docking station with a large-size monitor. The connectors are already in place. (Radiologists can hook into display monitors in an interventional suite, for example.) Only the mounting bracket on the cart remains to be added.

Clinical upgrades, such as the enhanced vascular upgrade due by the end of this year, might be added. These include interchangeable hardware components specific to the Titan platform or an industry standard flashcard, which today can support between 64 MB and 1 GB of data.

"The hospital staff plugs the flashcard in, hits a key, the data are uploaded, and the upgraded system is ready to go," Walton said.

Durability has become a hallmark of SonoSite products. System designers have built Titan to withstand impact resulting from a three-foot fall to a hard surface, a specification that arose from the company's interest in selling the product to the military for battlefield use.

Titan has been a long time in the making. Its design is the result of feedback from customers and more than a dozen usability studies. Customer consensus called for improved space utilization, adaptability to practice workflow patterns, and cost-effective upgradability. It's taken four years to meet all three requests.

"Technology had to catch up to our concepts in order for us to deliver this product," Walton said.

Titan's success will depend on remaining true to the corporate maxim of providing users with high-quality imaging in a portable package. Titan is the most powerful device in SonoSite's product line, offering a larger display than other handheld portables and better resolution through algorithms that automatically optimize image quality. But Titan is also the heaviest of the SonoSite brood.

The company's specialty products, the iLook 15 and 25, weigh about three pounds. The mainstay SonoSite 180 Plus and Sonoheart Elite (a cardiac-optimized version of the 180 Plus) weigh about 5.7 pounds. Titan weighs in at about 7.5, which is still well below what company executives believe is the limit for a truly portable ultrasound system.

"Anything over 10 pounds is too heavy," Walton said. "It's like laptop computers."

Weight is minimized through the extensive use of software to control system functions and by leveraging proprietary ASIC (application-specific integrated circuit) technology. Much of the high-powered computing is performed by just three ASIC chips built into a single circuit board. This miniaturization enables mobile usage, connectivity, and the flexible acquisition of new capabilities.

The ASICs provide a speed advantage, as well. Titan boots its non-Windows operating system to ready status in less than 10 seconds. A fast boot means a lot, especially as the product is hauled from one bedside to another.

"Doctors don't want to wait two minutes to boot up," Walton said. "They want to turn on the machine, put the probe on the patient, and get an image."

With Titan, he said, that's exactly what they get.