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Why Are Medical Ultrasound Systems So Inexpensive?

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Re: Why Are Medical Ultrasound Systems So Inexpensive?

#61

Post by LiesNStartupPR »

legulere wrote: post #10

> If you can really build an effective ultrasound system that people want to buy for significantly less than the currently available price when you've no expertise in the field, then why hasn't someone else with vast experience in the field gone and done exactly that? If you just made a new effective ultrasound system that passes the FDA, why would you sell it for a lower price when you also can make more money?

Because there are multiple competitors in the field, and you are a new entry. In order to be accepted as an unknown in a quality and results conscious market, you either have to be way better, way cheaper, or some combination of those.

If you are an established player, then you can sell for slightly less and get market share from your competitor. But in a competitive market, he is also smart and makes the system cheaper, then undercuts you, and on it goes until price reaches equilibrium at a much lower price point.

If you are in a monopoly position, then you can extract a premium profit until either the govt stops you with anti-trust, or a competitor appears who wants some of that profit. If you listen to everyone on this thread, ultrasound systems are easy to make so jump right in!

Ultrasound is an incredibly competitive market with multiple large players, each of whom has high quality technical teams and they compete for market share.

Re: Why Are Medical Ultrasound Systems So Inexpensive?

#62

Post by LiesNStartupPR »

graeham wrote: post #26

This is a great post, thanks for writing and sharing. I'm a biomedical engineer and found both posts interesting. There are really exciting things happening right now where the murky area between expensive, slow medtech and fast-moving, lower cost consumer products are being explored. There have been some specatular implosions of approaches straying to far towards the consumer tech-startup approach. Like most things,…

Original post author here, thanks for your comments.

There is a robust second hand market for ultrasound systems and probes, just google for those companies or search on eBay.

There are also research platforms out there for imaging from various universities, some of which are open source. They aren't nearly as good as the commercial codes, but a few grad students can't compete against teams of full time professionals working for decades. Commercial codes are unlikely to be open sourced. Many are tied to the architecture of the systems, and most are reused in later systems and so are still useful decades later. It's highly unlikely that any company would open source them, it's just not how they operate.

As for explosions of technology and advances - yes, I do expect more advanced electronics and signal processing to have a large impact on ultrasound in the coming years, but it is more complex than most in this thread give credit for, and will take time to appear.

Re: Why Are Medical Ultrasound Systems So Inexpensive?

#63

Post by LiesNStartupPR »

agumonkey wrote: post #40
graeham wrote: post #26

This is a great post, thanks for writing and sharing. I'm a biomedical engineer and found both posts interesting. There are really exciting things happening right now where the murky area between expensive, slow medtech and fast-moving, lower cost consumer products are being explored. There have been some specatular implosions of approaches straying to far towards the consumer tech-startup approach. Like most things,…

I trust the current post on the physics and EE side of things. That said I'm also very curious about the computer graphics side nowadays. It seems to me that historically, most of the complexity was handled through sophisticated mathematical abstractions at the material level, making the research very costly. How much post processing can be done to infer more information from less costly inputs (I'm thinking ideas li…

Quick answer - yes, GPUs are now reaching the point that they are becoming useful, but also imaging techniques such as superresolution methods, ultra fast imaging, and others, demand even more computation. I expect to see advancements in the next few years because of this, and at some point (maybe 10+ years from now), that GPU power will exceed the demand from ultrasound and even the highest end systems can use them for all needs. This is not lost on the community and they are working on exactly that kind of research.

Re: Why Are Medical Ultrasound Systems So Inexpensive?

#64

Post by LiesNStartupPR »

guitarbill wrote: post #7
franciscop wrote: post #2

This kind of description can be made of any hardware piece. We came from a whole room, slow computer to an iPhone that can make billions of operations per second. I see the previous post as complaining about this not happening on the industry. Of course making an iPhone (or a OnePlus phone if you want to get into low-scale) is not easy, but the technology has advanced and standardized enough to be considered "cheap"…

I came here to make exactly the same argument. Or cars, if we pick something that also needs certifying (from a purely manufacturing perspective). I get that most people would rather have a car, so more cars get made, so they're cheaper. (Athough roughly comparable, and there's different models. To me, it seems a car is more complicated than an ultra-sound system). The author of the original article made a good point…

I do appreciate being called a "condescending asshat", I might get a t-shirt with that on it, thanks.

I though my credentials were one paragraph instead of many, but maybe I need to count again.

As for lording it over you with qualifications - I just needed to make it clear that I actually do have a huge amount of experience in this area, otherwise instead of being a "condescending asshat" people would be asking who the hell do I think I am commentating on this.

I make no apology for knowing what I'm talking about, there's too many articles written by people with no idea about the topic.

And don't take it personally, I've something of a reputation in ultrasound for being blunt.

Re: Why Are Medical Ultrasound Systems So Inexpensive?

#65

Post by LiesNStartupPR »

JPLeRouzic wrote: post #5
franciscop wrote: post #2

This kind of description can be made of any hardware piece. We came from a whole room, slow computer to an iPhone that can make billions of operations per second. I see the previous post as complaining about this not happening on the industry. Of course making an iPhone (or a OnePlus phone if you want to get into low-scale) is not easy, but the technology has advanced and standardized enough to be considered "cheap"…

* Several IC makers are selling integrated devices (TI, Analog, Maxim), for example at TI: LM96530 (Beamformer), LM96511 (VGA/LNA) and LM96570 (TR Switch). Those are eight channels ICs, they cost $200 together. There are ICs for 16 or even 64 channels. * Another claim is the need for a huge number of piezos, this probably a view from a remote past: With adequate coding and enough channels to enable beamforming, there…

The basics of imaging require a certain number of elements. The acoustic window must be a certain size for the application, the elements must be smaller than a wavelength to avoid grating lobes (0.5 wavelength for perfect phased arrays in that regard). Divide one into the other, and you get a number of elements that's usually between 100 and 200.

On what basis do you make your statement that this is too many elements? IMO implies opinion, do you have any facts or physics to back up your statement?

Laws of physics do not change with time.

Re: Why Are Medical Ultrasound Systems So Inexpensive?

#66

Post by LiesNStartupPR »

temac wrote: post #49
ChicagoBoy11 wrote: post #30

The fallacy this author makes in his response is unfortunately very symptomatic of our society's poor grasp of fundamental economic principles. Worth noting that despite failing to see some of the larger forces at work that the previous post mentioned the author nevertheless acts condescendingly towards that other post, which is also very similar to how society-at-large operates. The one factor the author completely…

The author mostly said that: this kind of equipment is intrinsically quite expensive, because lots of various tech are intrinsically high-end. Now there is also the question of regulation. From my experience, the major part of the cost of a system does NOT come from there, even if regulation does not have a trivial cost. The major part of the cost comes from the BOM, from R&D, and from sales. And this is a sector whe…

Pretty good summary of what I said, thanks.

Re: Why Are Medical Ultrasound Systems So Inexpensive?

#67

Post by LiesNStartupPR »

dfox wrote: post #25

The transducer is one thing, also the electronics are highly non-trivial, to the extent that it is in my opinion the most complex of the big three medical imaging techniques used. With CT you have some large mechanical thing, pretty much straightforward X-ray source and image sensor, slight issue with interconnect between the stationary and rotating part (that only has to carry power and digital data) and bunch of so…

And all for ~1/10th of the cost of a CT or MR system.

Re: Why Are Medical Ultrasound Systems So Inexpensive?

#68

Post by LiesNStartupPR »

temac wrote: post #39
LeifCarrotson wrote: post #31

Earlier quoted context omitted.

I have used a similar machine. It was purchased used for about $3,000 for a pregnancy resource center. And as a Test & Measurement EE experienced with some high-density analog cables, I was extremely impressed with the quality of the cable in that device. But reading your post and this one: > ... and then it's got to connect to the cables off to the system - all 100 to 200 wires down a cable that's a couple meters lo…

That advice is so good that people are already working on it... even in the past! Believe it or not, there is no plot for using outdated technology and keeping the prices high. This is a quite competitive market, and engineers working in the field are not stupid. There are already some machines using GPUs for the signal processing. I think there might also be some machines with ADC in the probe, although this is not…

Exactly, thanks for putting this so succinctly.

Re: Why Are Medical Ultrasound Systems So Inexpensive?

#69

Post by hwillis »

LiesNStartupPR wrote: post #60
hwillis wrote: post #56

Earlier quoted context omitted.

Is he correct, though? Even a high quality ultrasound probe is only a few thousand dollars. At best, I don't like this post because it just plays up the difficulty of the engineering without any context. Yes, making an ultrasound is hard and complex, but its not as hard and complex as making a car, which is how much they cost. He just presents the engineering like we should be able to intuitively relate that to cost.…

A 2 cent PZT buzzer is ridiculously far from an ultrasound probe, engineering wise, and your units are off by about three orders of magnitude. And soldering depoles PZT. A transducer does not cost as much as a car (well, not a well made car), but a system does. That's the cart plus a number of transducers. Yes, I only covered the transducer in that post, but as I noted, the systems and software deserve their own Pt I…

What units? Thickness mode resonant frequency? The cost? injection molding precision? The 100 micron thing? I have a PZT buzzer on my desk that I measured the thickness resonance, which is 5 cents in units of 10k. Injection molding accuracy is around a thou, but the precision and surface finish is impeccable. I also have on my desk parts with 0402 resistors- 500 microns wide, 350 microns tall. I soldered them by hand without magnification. 38 AWG wire is 100 microns wide. 100 microns is wide enough to drive a truck through.

Soldering with silver-lead depoles PZT. Bismuth solder does not and regardless repoling PZT is trivial- a couple hundred volts at most, and temperatures below the melting point of plastics.

The transducer is the only part of the system that should concievably be expensive, though. Doctors don't use special, medical-company made laptops- they use thinkpads or dell or whatever. The cart is unnecessary! It shouldn't be where the cost is coming from. The cart should add a few thousand dollars. The electronics have no business costing tens of thousands of dollars. The R&D, the software, and the transducers are the only plausible money sinks. If making a monitor is expensive, the companies should buy a cheap laptop and write an application to run on it.

I do really enjoy your posts but I am firmly in the camp that the price of ultrasound machines is an order of magnitude too high. I also think it needs to come down ASAP and that the future of cancer treatment really depends on regular ultrasound screenings and machine learning.

Edit: also, to back up my statements about the electronics: https://news.ycombinator.com/item?id=13245998

Re: Why Are Medical Ultrasound Systems So Inexpensive?

#70

Post by JPLeRouzic »

LiesNStartupPR wrote: post #65
JPLeRouzic wrote: post #5

Earlier quoted context omitted.

* Several IC makers are selling integrated devices (TI, Analog, Maxim), for example at TI: LM96530 (Beamformer), LM96511 (VGA/LNA) and LM96570 (TR Switch). Those are eight channels ICs, they cost $200 together. There are ICs for 16 or even 64 channels. * Another claim is the need for a huge number of piezos, this probably a view from a remote past: With adequate coding and enough channels to enable beamforming, there…

The basics of imaging require a certain number of elements. The acoustic window must be a certain size for the application, the elements must be smaller than a wavelength to avoid grating lobes (0.5 wavelength for perfect phased arrays in that regard). Divide one into the other, and you get a number of elements that's usually between 100 and 200. On what basis do you make your statement that this is too many elements…

>> do you have any facts or physics to back up your statement?

I do not think that beamforming needs more than a few emitting sources neither a Nobel prize. Check no further than your Wi-Fi router's antennas.

The technology you are describing is entirely different and older, as in your description there is no beamforming.

In the technology you describe, there is a requirement for two emitters/receivers to be separated by less than a wavelength, however this strong requirement does not exist for beamforming.

What makes beamforming useful is modulating and coding the beam. Another thing important is the SNR, as it is the addition of the waves that creates "beams".

When I checked Google patents I found beamforming patents in ultrasound imaging since 1986, and super-resolution (pionnered in astronomy and microscopy) in ultrasound imaging since 2005 (US 20050160817).

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