Chapter 2: Machine Selection

Dr. Andrea Dreyfuss, Dr. David Martin, and Dr. Dan Summers

One of the biggest obstacles when starting an international ultrasound project is access to machines and access to a platform to store images. With the new age of hand-held devices as well as cloud-based storage options, the accessibility of imaging overseas has increased exponentially. Selecting a machine that is appropriate for the local site is imperative and should be considered well in advance of any travel.


Size matters

The first consideration is what size of machine to use: handheld, portable/ cart-based or a large, immovable machine. In many places, older immovable machines may already exist, having been donated by prior groups or purchased by the local facility. The advantages to these large machines are that they often are equipped with several advanced features not available on smaller, more portable machines. In addition, because they don’t move, an entire room can be dedicated to ultrasound with appropriate equipment (cot, sheets, gel) in the area. However, these large machines have several disadvantages including difficultly in access for sicker patients who cannot be moved, longer transport times, and often, the complexity of the machines themselves.

Portable machines are becoming increasingly popular and are often very practical in limited-resource settings. The advantages of hand-held or cart-based machines are that they can be taken quickly from patient to patient and room to room. Many providers who perform POCUS exams are most familiar with portable machines, and they are often extremely durable, which is another advantage. Disadvantages do exist, however, including finding reliable power-outlets and battery half-life, concerns over theft, and privacy and space for scanning. Because portable and hand-held machines are so popular, the chart below outlines some of the specifics for several models.


And how much will that cost?

The second consideration is, of course, cost. It may, in fact, be the primary consideration and may dictate the types of machines available to buy. Overall, machines are becoming increasingly more affordable, although with limitations in their technical capabilities compared with machines costing in the hundreds of thousands of dollars. In addition, several discounts for international programs exist, some of which are mentioned below.

Some machines offer a rental program, or a rent-to-buy. This is a nice option for a limited budget, but, ultimately, the goal should be for final purchase. When renting a machine, ‘splurging’ for the extra insurance is a good idea as much can happen when traveling with an ultrasound machine. 

There are several loaner programs as well, which allow a group to bring portable ultrasound machines with them for short medical mission-type trips. While this may be advantageous for clinical-based trips or teaching programs, it is not sustainable and care should be taken to have at least one machine to purchase for the site.

Another way to cut costs on a machine is to consider a refurbished machine. Several companies sell older machines that have been repaired and are appropriate for use. Keep in mind, however, that older models may have antiquated parts making them harder to service in the future. Although some groups also bring older machines that are no longer in use at their home institutions, it is important to consider the longevity of these machines- if they are bound to break in six months, it may not be an ideal choice.

Other costs to consider are the ‘extras’ that go with the machine. This may include a printer, a cart, gel holders, or any number of extra features that are needed for the machine. The number and type of transducer is also important, especially as the transducers may be more expensive than the machine itself for some models. 

Saving your images

Finally, once the machine is acquired, the ability to share the images is vital to its utility. If the medical system has a PACS, make sure the machine can upload to that system. If no PACS is available, images may be printed (although this requires ongoing purchase of paper, which is not often feasible) and eliminates the ability to share clips. Several machines now also have cloud-based storage, some of which are free after initial purchase and others with an annual fee. Cloud-based storage has the advantage of being accessed by multiple users anywhere in the world, but the disadvantages of the potential for personal health information to be compromised and also the need for reliable internet and possibly additional costs. (Other aspects of image-transfer are discussed further in Chapter 6.)

Which machine to choose?

Hand held machines*

LumifyButterflySonosite IVIZGE V-scanClarius Wireless
Cost~$7000 per probe or $14000 per
3 probes
+ android tablet
$2000 + $420/year for cloud usage* + ios tablet or phone

*scholarship available
>$10,000 + android tabletStarts at $2,995, cloud storage includedStarts at $6,900
Technologypiezo-electricCMUT-on CMOS silicon chippiezo-electricpiezo-electricpiezo-electric
ProbesLinear, curvilinear and phased array (purchased separately); no transvagThree-in-one single probe (linear, curvilinear, phased array)Linear, curvilinear and phased array (purchased separately)Dual-probe-in-one (curvilinear and linear)Separate linear, curvilinear, micro-convex and transvag (purchased separately)
DopplerColor,
no pulsed-wave
Color, power, pulsed-wave (pro versions only)Color, powerColorColor, pulsed-wave ($1000 extra)
StorageCan be configured for DICOM, PACS, cloud offered via TricefySub-scription-based cloud. If configured for DICOM PACS needs retrieval from cloud first.Can be configured for DICOM PACS, cloud offered via TricefyCan be configured for DICOM PACS, cloud offered via TricefyCloud-based storage via free clarius cloud. Can also be configured for DICOM PACS with retrieval from cloud. 
Additional featuresNo sub-scription, unlimited storage
Websitehttps://www.usa.philips.com/healthcare/sites/lumifyhttps://www.butterflynetwork.com/iqhttps://www.sonosite.com/sites/default/files/2796_MKT02988%20US%20iViz%201.2%20Spec%20Sheet%20v12%20%281%29.pdfhttps://www.vscan.rocks/clinical-specialties/emergency-medicinehttps://clarius.com/emed/
* This table represents only a limited selection of available ultrasound devices

Cart-based machines

Sonosite M-turboZonare
Cost>$20,000*
*SoundCaring grant available (~$16,000 for machine plus three probes)
starts at $2,995
Technologypiezoelectricpiezoelectric
ProbesSeparate linear, curvilinear, phased array and endocavitaryMultiple convex, linear, sector, and endocavitary
DopplerColor, power, pulsed-waveColor, power, pulsed-wave
Storage16gb encrypted, internal flash driveVariable
Additional featuresMultiple models available
Websitehttps://www.sonosite.com/sites/default/files/M-Turbo_brochure_v14.pdfhttps://www.mindraynorthamerica.com/ultrasound-machines/

Useful Links

Take Aways

  1. Machine selection will depend on intended uses and is often limited by cost. 
  2. Select a machine that will be appropriate for the site where it will be used (durable, portable, ease of use, etc).
  3. Several scholarships and grants exist for international projects.

Resources

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