Mobile ultrasound devices have been on the rise over the last years. This can hardly come as a surprise. Whether a (para)medic at the scene of an accident, a midwife doing prenatal checkups or deliveries, a veterinarian or a gp... many health care workers might at a certain point feel the need for an on the spot ultrasound, either to counter an emergency or to be able to prevent one. This need for point-of-care-ultrasound (POCUS) is not confined to certain borders. Resource poor countries, where even referral hospitals might lack proper equipment or skilled staff, can come to mind, but the need is also felt by doctors and midwives in remote areas in western countries where the closest hospital may simply be too far away.
Of course mobile ultrasound devices have been available for years in some form or another, but Bring Your Own Device (BYOD) is becoming more and more common practice in healthcare settings. It allows for the integration of personal mobile devices into the daily activities of medical professionals. Ultrasound transducer technology is advancing, becoming smaller in size, more affordable and much more integrated in lightweight portable systems and personal mobile devices. Currently, we are at the point at which a probe and a smartphone or tablet with an app is all it takes to make ultrasound scans. Life-saving imaging technology combined with the possibility to store, share and discuss findings online, and the use of a cloud-based service platform open up a whole new range of opportunities in terms of diagnostics, sharing of information, communicating, giving feedback and providing training at any spot.
Ultrasound as a vehicle for change
Africa is the continent with the lowests number of obstetric ultrasounds performed worldwide. This won’t come as a surprise as the minimum requirement of 4 prenatal checks set by the WHO is often also not met, especially not in rural areas in sub-saharan Africa. There are some other factors that can also play a role here. For instance, the majority of hospitals lack a reliable electricity supply which is essential for the use of conventional ultrasound machines. In some areas there might be cultural or religious resistance against revealing what happens in the womb, contributing to resistance against the use of obstetric ultrasounds. The theoretical and practical training of health professionals performing prenatal scans is often of low quality. Profound experience and knowledge are lacking and there is no real training system. Incorrect use of ultrasound or wrong interpretation of results can lead to unnecessary interventions.
The uncontrolled influx of ultrasound machines (often via donations or NGOs) has led to un unequal spreading and often there is no follow up in training, maintenance or replacement of broken parts, leading to the machines ending up unused somewhere. There is an increased interest of manufacturers in introducing mobile ultrasound devices to sub-saharan Africa. These have the potential to overcome some of the current hurdles, but a critical view is warranted. Mobile devices allow for the performing of ultrasounds in rural areas and a real-life connection with experts on distance may avoid wrong interpretations or decisions, but this doesn’t address the need for a regulation of ultrasound practices and theoretical and practical training. Midwives can play a vital role in rural areas in performing basic obstetric ultrasounds. This can impact clinical decisions and a timely referral in a positive way.
Sounds from Africa
An interesting initiative rolled out in Congo illustrates the potential of mobile ultrasound technology in addressing prenatal health. The “See Your Baby” project (Ona Mtoto Wako) cuts both ways. It makes mobile ultrasound scanning available in the most remote and rural areas and uses it as an incentive to reach woman and convince them to partake in other essential prenatal tests (malaria, HIV, anemia). Detection and treatment can help prevent prenatal and perinatal mortality and morbidity in women who wouldn’t otherwise make it to a clinic (in time). In this way, the ‘wow-factor’ that comes with seeing their unborn baby makes mobile ultrasound technology a vehicle of positive change in prenatal care in the broader sense.
Another initiative bringing ultrasound technology into the hands of primary health care workers in Africa is the Vscan Access Education Program of GE in Nigeria. More than 650 units of the Vscan Access ultrasound diagnostic device will become operational in primary healthcare clinics all over the country. At the same time, 100.000 hours of training in basic obstetric scans will be made available to 1300 midwives and antenatal primary health caregivers. The program will focus on the early detection of potentially life-threatening pregnancy complications, tracking fetal growth and estimating gestational age. In this way, mobile ultrasound technology will become an important tool in risk-detection, making critical decisions on when and where to refer and wirelessly transferring patient data to referral facilities.
Another project was the Mobile Ultrasound Patrol in Morocco, in 2014, by QuelComm Inc. Onsite ultrasounds were performed in three rural villages by local midwives, nurses and GPs. The M-Turbo, a portable ultrasound system of Sonosite (Fujifilm), was used to scan patients and the images were send to Sony Xperia smartphones wirelessly through a dongle. The smartphones had Tricefy cloud software pre-installed which allowed for the images to be stored in the cloud and be safely transferred from the field to specialists in hospital clinics for a second opinion. In this way, numerous high-risk pregnancies were traced and dangerous home births avoided, quickly and at low costs.
Let us now make a short exploration along some mobile ultrasound devices currently on the market. Remember that the devices mentioned here are only some of the options available worldwide in a market that is still rapidly expanding.
Clarius Mobile Ultrasound Scanner
Clarius is a point-and-shoot mobile ultrasound concept manufactured in Canada. Clarius consists of a handheld ultrasound scanner which is wireless and waterproof, powered by rechargeable batteries that allow for 45 minutes of active scanning and can last 7 days when idle. The scanner is fit to withstand challenging environments. The Clarius scanner goes together with the Clarius app that works on iOS as well as on Android devices and provides automated gain and frequency settings and allows for the transfer of images in DICOM (Digital Imaging and Communications in Medicine Standards). The app is connected to the Clarius Cloud which facilitates the process of securing the data (saving, sharing and management of images). Clarius makes use of point-to-point wifi (wifi-direct network) or bluetooth. The Clarius scanner is cleared by the FDA and its most basic version comes at the affordable price of about 8900 $CDN.
Another player in the field of mobile ultrasound devices is Philips, which offers the Lumify package. It consists of a transducer, the Lumify app and access to the Philips HealthSuite digital platform. Lumify can be connected to existing databases and networks, but also makes its data accessible through the digital platform, that allows for saving, analysing and sharing data and collaborating with other health care providers. Philips also offers software updates and online training and support.
The Lumify provides high resolution 2D-images and includes a color Doppler-mode and a built-in barcode reader that uses the device’s camera to read patient barcodes for filing patient information. The Lumify transducer comes in three variants, two of which can be used in obstetrics and gynaecology. They vary in, among other things, bandwidth, field of view and scan depth. To use the Lumify, you need a smart device running on Android (so far, an iOS-version is not available), an internet connection, and email functionality. A USB portal is also needed, since the transducer has to be connected to the device with a cable. Although the Lumify can be bought, Philips focusses on its leasing plan, which makes the package available for $ 199,-/month.
GE has had mobile ultrasound devices on the market for quite some time. This might explain why their collection did grow into what they call the “Vscan Family”. Each of the models - the Vscan Extend, the Vscan and the Vscan with Dual Probe - is a pocket-sized ultrasound device with WIFI (wireless image transfer).
The Vscan Extend is a portable on-the-go pocket device with a touchscreen, that looks and works like a smartphone and allows for fast and simple bedside ultrasound assessment, real-time and with high resolution. You can tap and swipe, connect to the internet, personalize the device, store images, transfer data (wireless DICOM data transfer) and make use of GE Apps, the GE Health Cloud environment or connect to your standard imaging workflow. The device is connected by a wire to a probe (a linear and sector transducer integrated in one probe).
The Vscan is a slightly differently designed handheld pocket-sized ultrasound device. When you open the device it starts up and the interface, which makes use of presets for common applications, can be used with one hand. The device is connected by wire to a probe. The battery can provide 90 minutes of continuous scanning. The Vscan is fit for deep tissue scanning, can be used in obstetrics (for instance for fetal ultrasounds) and gynaecology and has a doppler function. The Vscan works with the dual probe for deep and shallow tissue scanning.
Mobisante: The MobiUS system
Another provider of imaging at the point-of-care is Mobisante. They offer the MobiUS system that comes in different variations.
The MobiUs SP1 is a smartphone device connected by wire to a probe of choice. Images are stored and can be shared via secure Wi-Fi, cellular networks or USB. The battery allows for 60 minutes of continues scanning and with an extended battery this can be stretched to 330 minutes. The MobiUS SP1 is sold at around $ 8000,- which puts it in the same price-range as GE’s Vscan.
The MobiUS TC2 is a medical grade tablet with an antimicrobial coating that can be connected to different sorts of probes. The tablet can make use of WiFi or Gigabit Ethernet and can transfer data via email, USB or Mobisante’s Cloud-Based Image Management service (Ultralinq). The cloud allows for reviewing, reporting, managing, sharing, distributing and archiving images in DICOM. The battery allows for over two hours of continuous scanning.
The MobiUS PE system allows for the use of your own Windows-based device. All it takes is to download the software, plug-in the probe of choice and scan. There are some minimum hardware specifications and a high-speed USB host port and an internet connection are required. Besides that, it works quite the same as the other MobiUS systems.
Fujifilm: Sonosite iViz
With the Sonosite iViz, Fujifilm takes its shot at the mobile ultrasound market with a self designed and built tablet. The iViz can be combined with the P21v transducer (which has a scan depth of 32 cm) to form a mobile ultrasound device that can be used in obstetric care. It is made out of aluminum and was drop-tested to one meter. The transducer is water proof.
The iViz can be operated one-handedly and provides high resolution images. Data may be exported via USB or DICOM, emailed or archived in the Tricefy cloud or sent to the electronic medical record. The iViz has a built in barcode scanner that allows for easy retrieval of patient information. Data transmission and archiving to the cloud are fully encrypted.
The Sonosite iViz may be combined with the free SonoAccess app that provides extensive training and education materials.
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Randy Hamlin, BYOD: Delivering on the promise of connected health. See: https://www.lumify.philips.com/web/news/byod-delivering-on-the-promise-of-connected-health
Austin Walters. Seeing Clearly: Ultrasound = Future of Diagnostic Imaging. March 16, 2015. See: http://www.globalhealth.care/2015/03/seeing-clearly-handheld-ultrasound.html
Carrera, J.M., (2011) Obstetric Ultrasounds in Africa: Is it Necessary to Promote their Appropriate Use? Donald School Journal of Ultrasound in Obstetrics and Gynecology 5(3): 289-296. doi: 10.5005/jp-journals-10009-1205. See: http://www.jaypeejournals.com/ejournals/ShowText.aspx?ID=1148&Type=PAID&TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=99&isPDF=YES
Hannah McNeish, How the Novelty of an Ultrasound Can Help Tackle Maternal Mortality. Sept, 5, 2016, see: https://www.newsdeeply.com/womenandgirls/how-the-novelty-of-an-ultrasound-can-lead-to-life-saving-hiv-treatment/
Project Ona Mtoto Wako, see: http://www.onamtotowako.com/
GE Africa (Lagos). GE Partners with USAID and Ministry of Health to Launch Antenatal Care Program for 2 Million Expectant Nigerian Mothers. March 7, 2006. See: http://allafrica.com/stories/201603071054.html
Pavithra Rao & Dona Joseph. Africa Wired: Portable ultrasound device to tackle child mortality VSCAN GE. Africa Renewal: December 2016 - March 2017. http://www.un.org/africarenewal/magazine/december-2016-march-2017/africa-wired-portable-ultrasound-device-tackle-child-mortality
Mobile Ultrasound Patrol in Morocco, http://www.mobileultrasoundprojects.org/
Clarius Mobile Ultrasound Scanner, see: www.clarius.me
Intro-video Clarius: https://youtu.be/azEI8v5BPRY
Clarius Mobile Health. Clarius Provides Quick Access to Ultrasound for Prenatal Care. Portable, wireless scanner enables ultrasound imaging anywhere. May, 4, 2017. See: http://www.prnewswire.com/news-releases/clarius-provides-quick-access-to-ultrasound-for-prenatal-care-300451406.html
Suzanne Hodsden, Clarius' Pocket-Sized, Wireless Ultrasound Scanner Cleared By FDA. December 16, 2016. See: https://www.meddeviceonline.com/doc/clarius-pocket-sized-wireless-ultrasound-scanner-cleared-by-fda-0001
Lumify Philips, see: https://www.lumify.philips.com
Vscan of GE, see: http://www3.gehealthcare.com/en/products/categories/ultrasound/vscan_family
Mobisante, see: http://www.mobisante.com
Sonosite iViz, see: https://www.sonosite.com/product/sonosite-iviz
Photo 1: BYOD, see: https://www.lumify.philips.com/web/news/byod-delivering-on-the-promise-of-connected-health
Photo 2: CCBY Nuffield Centre, LIHS, University of Leeds, Runner-up: Emma Firth, Tanzania. See: https://flic.kr/p/8v472q
Photo 3: CCBY KissitoIntl, Emergency OB training, Uganda. See: https://flic.kr/p/bu6w3s
Photo 4: GE Sustainability Nigeria
Photo 5: Courtesy of Ona Mtoto Wako
Photo 6: Trice Imaging Inc
Photo 7 - 11: Pictures for product websites.