Ultrasound

Diagnostic

• 

  Representative Device

  Ultrasound covers a broad spectrum of conditions.

  Condition
  Ultrasound can be a helpful diagnostic for many conditions of a mother, fetus, or neonate. These include placenta previa, abruption, incomplete abortion, causes of bleeding, multiple gestations, ectopic pregnancies, and many others. Compact ultrasound units have gained interest for low-resource settings due to their portability and lower price.
  
  Mechanism of Action
  Ultrasound devices transmit sound waves at 2-18 MHz (hundreds of times greater than the limit of human hearing) and create an image based on the reflected waves received by the same handheld transducer. The strength of the reflected wave depends principally on the difference in density between adjacent structures inside the body. The more dissimilar the tissues, the more reflective their boundary will be. Images are typically 2D “slices” but more recent devices present 3D images and animations. Doppler ultrasound can also be used to measure blood flow. Devices require a coupling gel on the surface of the body, and most come with probes of different shapes suited to imaging different anatomy.
  
  Current Use in High-Resource Settings
  Universal coverage is common in many developed countries, although substantial debate persists on the utility of routine screening. A Cochrane review of eight studies randomizing 27,024 women found that routine ultrasound after 24 weeks gestation does not improve outcomes of pregnancy. Selective screening of high risk mothers, on the other hand, is generally agreed to save lives. In all settings, clinical relevance is highly dependent on the operator’s skill and timing of the screening.
  
  Application in Low-Resource Settings
  Ultrasound use is less common in the developing world, but available in urban centers. The use of ultrasound for fetal sexing (leading to selective abortion) is a serious issue in several emerging markets, including India, where fetal sexing by ultrasound is illegal, and punishable with prison time.
   

  Associated technologies in Development

  GE India Mobile Ultrasound, ITW Ultrasound, Mobisante Mobile Ultrasound, UWASH Ultrasound

  REPRESENTATIVE DEVICES

  MAKE

  MODEL

  PRICE*

  TECH

  STATUS

  NOTES

  GE

  Vscan

  $10,000

  2D+Doppler

  Marketed

  Fully featured, small package

  Sonosite

  Nanomaxx

  $5,000

  2D+Doppler

  Marketed

  Largest market share in portable

  Signostics

  Signos

  $4,000

  2D Still

  Marketed

  Still images only, small package

  Healthpower

  WED-3100

  $3,500

  2D+Doppler

  Marketed

  Chinese copy of Sonosite

  * Prices are approximated. Actual pricing can, and will vary by marketplace and market conditions.

• CHARACTERISTICS OF REPRESENTATIVE PRODUCT

  TECHNOLOGY CHARACTERISTICS

  OPERATIONAL PARAMETERS

  POTENTIAL OPPORTUNITIES FOR IMPROVEMENT

  SKILLS

  REQUIRED

  Intended end user

  Training required

  Time required per use

  Sonographer, physician

  Weeks

  Minutes

  Training in the operation and interpretation of ultrasound images remains a hurdle for efficacy. Separation of operators and interpreters could lower this hurdle.

  ENVIRONMENT/ INFRASTRUCTURE

  Power required

  Waste collection

  Complementary technologies required

  Temperature and storage

  Maintenance

  <4 hrs operation/charge

  Batteries

  Coupling gel

  None

  Battery replacement every 1-2 years

  Modern, portable ultrasound units are already efficient, lightweight, durable, and in some cases are water resistant and designed for outdoor use. Theft, however, remains a concern for a portable, high value device.

  COST

  Device Cost (Approx)

  Cost/course (Approx)

  $3,500 –10,000

  <$1

  Cost remains a major barrier to uptake and use.

  OTHER

  Portability

  Regulatory

  Efficacy

  <5 kg

  Highly dependent both on user skill and timing of screening

  Regulatory control of ultrasound for fetal sexing can trigger administrative burden. In India, for example, ultrasound machines are often kept in locked rooms, and a user log must document each mother’s visit.

  Additional devices required for impact: Various, including comprehensive emergency obstetric care