Why Are Medical Ultrasound Systems So Inexpensive?

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 long, and thin/light enough for someone to use 8 hours a day without getting repetitive strain injuries. Do you know how thin that makes each wire? Try calling a few cable vendors and ask for a small diameter cable with 200+ connectors that will actually conduct a signal without significant crosstalk and let's see where you end up on price.

It also mentions the system being mounted on a cart. This seems like an area where technology can make some serious improvements. Mount your ADC (for which speed, accuracy, power requirements, and channel counts have been steadily improving) within the probe, and stick a high-speed serialization/deserialization chip on the other end of it, and run power and digital data over a much smaller, cheaper cable. That's the direction that industrial I/O is going, at least.

I guess the point of all this is that there are opportunities to make significant changes to the way these devices operate that will make them easier to build. Switch out the ASICs for GPUs, the analog cable for digital, the custom computer for commodity hardware, and so on because these technologies are more capable than they were in the past.

The recent fight between CA, SF and Uber around the "self-driving car" tests is interesting to me personally, because I ride my bike in San Francisco almost every day, and sometimes with my kids. I do believe that self-driving or driver assisted cars will be safer than people alone, but I also want to know that there have been some amount of testing requirements met so that I know my family and I are safe.

So I ask this question, if your premise is that regulations are overly burdensome, and there is evidence to support this, what do we replace it with to get the same or better oversight of industries?

My 2 cents worth on differences between more expensive vs cheaper ultrasounds, how ultrasound has changed over time, etc is: * ultrasounds are getting cheaper and better. Harmonic imaging was probably the biggest advance for me. * because of cheaper, better machines, many more doctors are using ultrasound than before. A real challenge is making sure they are appropriately trained to use ultrasound to get the most useful images, that they appropriately interpret what they see, and recognise their own limitations. The results you get from ultrasound are highly dependent on the training and experience of the operator, more than most other imaging modalities. Although some techniques are easy to learn, many require substantial training and experience. Putting ultrasound in the hands of someone who doesn't know how to interpret the findings is not risk free. * there is a significant increase in image quality and the modalities available with more expensive machines (although this does not seem to be a linear relationship over the range of price; once you get into the top echelon of machines, differences in cost between them doesn't necessarily correlate with their capabilities). * With more challenging assessments, these differences in image quality and modalities can mean the difference between a diagnostic and a non-diagnostic scan, and change management and outcomes for patients. However, there are some techniques (e.g. vascular access) where entry level machines are usually adequate, particularly if you have access to a better machine for challenging cases.

Although I'd love to see the quantum leap in imaging quality that some startups are apparently aiming for, I'm not holding my breath. That doesn't mean I don't see a lot of potential for technology to improve though - some things I expect or hope to see over the next decade or two are:

the application of computer vision and machine learning techniques to assist with the interpretation of scans. This is already happening a bit (e.g. strain imaging, automated 3D ejection fraction) and it's an active area of research. It has the potential to improve reproducibility of assessments. Maybe, just maybe it will get good enough to help mitigate the problem of less experienced operators using ultrasound.

multimodality fusion for interventional procedures - already, you can do a TEE (a kind of heart ultrasound) and fluoroscopy (video version of X-ray) and fuse the two images in real time to guide cardiac interventions. Maybe this will extend into other areas: e.g. guiding vascular access by fusing accelerometer / gyro / magnetic positioning / video camera data with ultrasound

virtual reality or augmented reality applications to accelerate the acquisition of ultrasound skills. There are already simulators but they're expensive; as they become cheaper and more doctors have access I'm hopeful we can improve the learning curve for image acquisition a bit!

I don't believe this is necessarily batshit crazy because hospitals in close proximity will coordinate to manage patient flow. There is also likely disaster coordination but I've not seen that directly.

"Hostile takeovers" by hospital conglomerates (of which are growing bigger these days) would also be very socially upsetting if their entrance causes existing hospitals to shut down. Hospitals are not something you want competitive churn in.

What is batshit crazy is blocking new hospitals while maintaining high patient to staff ratios and having capacity issues (e.g. getting beds to patients).

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 simple (you also have to put the transmit side, and the rx side has to be of good quality) and you can really benefit from extremely high acquisition rates, so depending on what you want to do such a digital link is not trivial + plus you basically duplicate a large part of the machine in each probe if you do that, so I'm not even sure this will be better in every cases...

Also; a new machine can take several years to design and bring on the market.